Journal of pediatric and adolescent gynecology最新文献

Purpose: To understand how patient portals can support adolescent sexual and reproductive health (SRH) care needs and to identify factors impacting use of patient portals for adolescent-clinician communication.

Methods: We conducted semi-structured interviews with adolescents, parents/guardians, and primary care providers (PCPs) by video or phone. Interview guides explored experiences with adolescent healthcare-seeking generally and SRH care specifically, as well as perspectives regarding adolescent portal use. Interviews were recorded, transcribed, and deidentified. Interviewer summaries written after each interview noted key themes that informed analysis. The analysis team collaboratively coded transcripts. Codes were synthesized into analytic memos, which were refined to develop results.

Results: We interviewed 31 people from one health system: 10 adolescents 14-17 years old and 10 parents/guardians of adolescents aged 14-17, and 11 primary care providers (PCPs). A motivator of portal use shared by all participants included convenience of use. Clinicians and parents/guardians also viewed portals as a tool to support adolescent independence and improve quality of care. Barriers shared by all participants included lack of adolescent portal uptake and dissatisfaction with functionality. Clinicians and adolescents raised concerns about confidentiality while parents and clinicians raised concerns about safety of care. Supports shared by all participants included encouragement and guidance from trusted adults, while adolescents and clinicians described the reinforcing nature of positive care experiences using the portal.

Discussion: Through the perspectives of adolescents, parents/guardians, and clinicians, we elucidated key factors that may influence adolescent portal use for SRH care needs. We identified critical intervention targets for future research.

Purpose: Following the US Supreme Court's Dobbs vs Jackson Women's Health (Dobbs) decision and subsequent changes to abortion access, increasing emergency contraception (EC) access for adolescents is vital. The first step is understanding providers' knowledge, attitude and practices regarding EC post-Dobbs.

Methods: This cross-sectional internet-based survey was sent to providers within three general pediatric primary care systems from November 2023 to January 2024. Questions addressed EC knowledge, attitudes (perceived barriers and desired support to increase EC prescription) and practices post-Dobbs.

Results: There were 51 participants. Most (81%) providers felt adolescent EC prescription was more important post-Dobbs, but very few (7%) had changed their own prescribing practices. Overall, providers had a mean knowledge score of 71%. Providers closer to training had a higher EC knowledge score (77% vs 68%, p = 0.02), as did providers who were generally willing to provide EC (72% vs 58%, p=0.004). Providers in urban and rural areas were more likely to have prescribed EC than suburban counterparts (54% urban, 40% rural, 16% suburban, p = 0.04). Various barriers were elicited, most commonly relating to lack of awareness and knowledge about EC. Over half of respondents noted they would be more likely to prescribe EC with clinical decision support built into the EMR (69%), an order set in the electronic medical record (57%), and education sessions (55%).

Discussion: This study highlights a strong need to bolster provider EC education in pediatrics and address systems factors that will facilitate easier, more confident EC prescription.

Objectives: To summarize the effects of combined hormonal contraceptives (CHC) on bone health in adolescent girls.

Design: A systematic search was performed using the following databases: Medline, EMBASE, CINAHL and Cochrane Library clinical trials register, from inception to July 2024.

Eligibility: Intervention and cohort studies that assessed the use of CHC on bone health in adolescent girls aged 10-19years old were included.

Data synthesis: Four randomized control trials and eight observational studies (n =2689) were included.

Conclusion: Current evidence indicates that the use of CHC in post-menarchal adolescent girls reduce bone accrual compared to non-users. The negative impact on bone accrual is likely related to the estrogen dose in the CHC preparation, the regimen used and the duration of use.

Prospero registration number: PROSPERO CRD 42024574905 on 31 July 2024.

Study objective: Estrogen replacement therapy (ERT) improves bone and neurocognitive health in adult women with premature ovarian insufficiency (POI). However, the response in adolescents is largely unknown. We aimed to assess the impact of transdermal estrogen replacement therapy (TDE2) in adolescents with POI on these outcomes.

Methods: Nine adolescents with idiopathic POI, naïve to ERT, and 9 controls with regular menses matched for age, race and BMI were recruited between 2018-2023 for a 24-month study. Primary bone health outcomes were changes in lumbar spine BMD Z-score and 3% distal radius trabecular volumetric BMD. Primary neurocognitive outcomes were quality of life (CHQ-87 survey) and memory (ChAMP).

Results: Adolescents with POI experienced significant increases in BMD Z-scores at all DXA skeletal sites (lumbar spine ∆ +0.68, total hip ∆ +0.37, femoral neck ∆ +0.56, total body less head ∆ +0.82, all p<0.05). Control participants exhibited an increase in BMD Z-score at the total body less head (∆ 0.43, p=0.034) with no significant change at other skeletal sites. There were no significant changes from baseline to 24 months in pQCT measures. Total memory index significantly increased in both groups from baseline to 24 months (controls ∆ +17.2, cases ∆ +24.6, p=0.041 and 0.001 respectively), but there was no difference between groups. There were no other significant differences in neurocognitive outcomes among or between groups.

Conclusions: Central BMD increased in adolescents with idiopathic POI in response to TDE2, but peripheral BMD measures were unchanged. The impact on neurocognitive outcomes in these adolescents remains uncertain.

Purpose: This systematic review aims to identify, assess the quality of, and synthesize evidence on nongenetic maternal factors, such as psychological factors, lifestyle, nutrition, and endocrine conditions that may be associated with pubertal timing in male and female offspring.

Methods: The search was conducted in Medline, Embase, PsycInfo and Web of Science. The reference lists of retrieved articles were checked to avoid missing relevant studies. There were no restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa Scale. This review has been registered on PROSPERO (CRD42023394102). A best-evidence approach was applied to qualitatively summarize the findings and draw conclusions on the level of evidence.

Results: The search yielded 4199 studies, of which 73 were included in this systematic review. In both boys and girls, there is strong evidence of a positive association between maternal gestational weight gain and an earlier pubertal timing, while no association was found with maternal substance use, thyroid dysfunction, or gestational hypertension. In addition, there is insufficient evidence of an association with maternal psychological factors, smoking, diet, physical activity, prepregnancy weight/body mass index, diabetes, menstruation-related disorders, and steroid medication use.

Conclusion: This review provides a comprehensive overview of the quality and consistency of existing evidence regarding maternal factors during pregnancy that may be associated with the pubertal timing in their offspring. This review may serve as an orientation for future research initiatives, with a particular focus on exploring these associations among male offspring and in low- and middle-income countries.