Elizabeth R. Woods

To determine the percentage of female adolescent patients (13-26 years old) who had HIV testing ordered within 90 days of incident sexually transmitted infection (STI) diagnosis during an outpatient clinic visit. This was a retrospective chart review study evaluating 830 visits among 589 female patients 13 to 26 years who had an incident STI diagnosed in outpatient Adolescent Medicine or Pediatric Practices in an urban, nonprofit, academic, free-standing children’s hospital at the main campus and a community site in the Northeast United States. Odds of HIV screening was greater at the community-based adolescent medicine practice (odds ratio [OR] = 3.17; 95% confidence interval [CI]: [1.92, 5.24]) and when seen by an adolescent medicine provider (OR = 1.44; 95% CI: [1.02, 2.03]). Only 33.5% (n = 283) of 844 clinical encounters had HIV screening obtained within 90 days of incident STI diagnosis. Overall, HIV …

Purpose: The objectives of this study were to assess the knowledge of HIV and pre-exposure prophylaxis (PrEP) in transgender adolescents and young adults (AYAs) and to test the acceptability of rapid HIV testing among transgender adolescents in a multidisciplinary gender clinic. Methods: Participants enrolled on the same day as their mental health or medical appointment in a multidisciplinary gender clinic. They completed survey questions regarding HIV and PrEP knowledge and were also offered an optional same-day, rapid, fourth-generation HIV test. Participants who had an HIV test answered additional questions about their testing experience. Results: We enrolled 61 participants; just over half (n=31) were assigned female at birth. Less than a third (n=20, 32.8%) scored 80% or above regarding HIV knowledge. Nearly half of the participants (n=29, 47.5%) were not interested in PrEP. Forty-one percent of …

IntroductionPediatric asthma home visiting programs have improved clinical outcomes, but little is known about how providers perceive these programs. The purpose of this study was to understand how primary care providers and their colleagues in a medical home perceive an asthma home visiting program that is available at no cost to their patients.MethodsAfter several years of running an asthma home visiting program using community health workers (CHW) in 10 pediatric primary care offices in the South Coast of Massachusetts, we surveyed the providers of patients who had enrolled in the program. An anonymous online survey was developed by the program leaders, the program analytics team, and the CHWs for quality improvement purposes. Survey domains included the perceived utility of various aspects of the program, impact on patients, and interaction with CHWs, as well as demographic information …

Objective There are limited studies evaluating anal cytology results or the prevalence of anal human papiloma virus (HPV) in adolescent and young adult (AYA) men who have sex with men (MSM). The purpose of this study was to review anal cytology screening results and determine whether abnormal findings resulted in completion of anoscopy in AYA MSM (13-26 years old). Patients and Methods This was a retrospective study evaluating 84 anal Papanicolaou screening results among 36 AYA MSM patients 13-26 years who had an anal Papanicolaou test completed at an outpatient Adolescent/Young Adult Medicine Practice at Boston Children’s Hospital; an urban, non-profit, academic, free-standing children’s hospital from January 1, 2010, to December 31, 2020. Results The findings of anal Papanicolaou screening included atypical squamous cells of undetermined significance (ASCUS) (37%), negative for squamous intraepithelial lesion (31%), inability to read (21.3%), and low-grade squamous intraepithelial lesion (10.8%). Most patients who had ASCUS results were referred for anoscopy (n=28, 90.3%), and of those referred only 6.5% (n=2) completed an anoscopy (Table 2). Of those with low-grade squamous cell intraepithelial lesion (LGSIL) results, 88.9% (n=8) were referred for anoscopy, and among those who were referred, only 3.3% (n=3) had completed an anoscopy. Conclusion This study showed that there were abnormalities in cytology when anal Papanicolaou test screening was performed in this population, and the completion rates for anoscopy were low.

Federal tax credits are an evidenced-based strategy to promote health equity. Our objectives were to describe families’ knowledge and use of tax credits, to analyze the association between receipt of tax credits and asthma health outcomes, and to offer referrals for free tax preparation to families. We hypothesized that tax credit receipt would be associated with improved asthma outcomes. We surveyed the parents of children aged 2–18 years old with high-risk asthma living in low-income neighborhoods about tax credits. We then conducted a retrospective observational study using a convenience sample of 102 parents of children enrolled in the Community Asthma Initiative from March 2017-January 2020. We analyzed the association of report of tax credits with reductions in ED visits, inpatient stays, PCP visits, steroid courses, missed school days, days of inactivity, and missed parental workdays using a paired t-test. We enrolled 102 parents in this study. Nearly one third of the parents (29%) did not report any tax credits. Housing costs (34%) and paying bills and debts (34%) were the most common use of tax credits. Among the 55 with 6-month follow-up information, significant reductions were seen in inpatient stays (0.46, p-value< 0.01), steroid courses (0.73, p-value< 0.01), missed school days (4.19, p-value< 0.01), and days of inactivity (2.81, p-value< 0.01) compared to no significant reductions among non-tax credit recipients. Expansion of tax credits may be an important way for pediatricians to promote health equity in asthma outcomes.

The incidence of anal dysplasia caused by the human papilloma virus (HPV) is increasing in men and can be a precursor to the development of anal cancer (1). Oncogenic HPV types are believed to be the causative agent in up to 90% of anal cancers. In men who have sex with men (MSM) living with the Human Immunodeficiency Virus (HIV), the incidence of anal cancer is even higher (45.9 per 100,000) vs.(5.1 per 100,000) in MSM not living with HIV (2). Additionally studies have shown that the prevalence of having any type of anal HPV type can be as high as 92.6% in MSM living with HIV (3). There are well known screening guidelines for cervical cancer in women starting at age 21. However, screening for anal dysplasia caused by HPV in high risk adolescent/young adult (AYA) population (< 26 years old) such as MSM living with HIV is not standardized or universally recommended even though the risk of anal cancer in this population can be as high as two times the rate of cervical cancer in women (4). Anal cytology has been recommended by several research groups for screening at-risk populations for anal cancer based on the guidelines of cervical screening; however, there are no universal screening guidelines for MSM living with HIV< 35 years of age (5, 6). The purpose of this opinion paper is to review current recommendations for screening for anal dysplasia in AYA MSM living with HIV, with implications for clinical practice and research.

ImportanceThe COVID-19 pandemic has affected youth mental health. Increases in site-specific eating disorder (ED) care have been documented; however, multisite studies demonstrating national trends are lacking.ObjectiveTo compare the number of adolescent/young adult patients seeking inpatient and outpatient ED care before and after onset of the COVID-19 pandemic.Design, Setting, and ParticipantsUsing an observational case series design, changes in volume in inpatient and outpatient ED-related care across 15 member sites (14 geographically diverse hospital-based adolescent medicine programs and 1 nonhospital-based ED program) of the US National Eating Disorder Quality Improvement Collaborative was examined. Sites reported monthly volumes of patients seeking inpatient and outpatient ED care between January 2018 and December 2021. Patient volumes pre- and postpandemic onset were …

PurposeThe COVID-19 pandemic has profoundly impacted the mental health of adolescents/young adults (AYA) globally. Patients with eating disorders (EDs) are no exception, with studies noting worsening ED-related symptomatology (eg, calorie restriction, binging, purging, excessive exercise) during the pandemic. Though anecdotally, ED programs have felt an increase in demand for ED-related care, there is little empiric evidence to date. We aimed to compare ED-related care pre-and post-onset of the pandemic among AYA in inpatient and outpatient settings using a sample of geographically diverse adolescent medicine programs.MethodsThis study examined data from 11 academic adolescent medicine programs throughout the United States as well as data from one private ED program, which was analyzed separately. Data were obtained as part of the National Eating Disorder Quality Improvement …

Background Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. Objective The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). Methods We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. Results The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow …

Objective To provide a 10-year follow-up of asthma cost-savings for patients served by the Community Asthma Initiative (CAI) group compared to a coarsely cost-matched comparison group from similar neighborhoods (comparison group). Methods CAI provided home visits and case management services for patients identified through emergency department (ED) visits and hospitalizations. Asthma costs for the two groups were extracted from the hospital administrative database for ED visits and hospitalizations for one year before and 10 years of follow-up. To eliminate cost differences at intake, a coarse cost-matching was implemented by randomly selecting comparison patients with similar costs to CAI patients (N= 208 pairs). The difference in cost-reduction between CAI and comparison patients was used to compute the adjusted Return on Investment (aROI). Results There were no significant differences between …

OBJECTIVE Aminoglycosides are frequently used for empiric and definitive treatment of cystic fibrosis (CF) pulmonary exacerbations. Various methods have been described for aminoglycoside therapeutic drug monitoring. The objective of this study is to evaluate the effect of patient-specific pharmacokinetic calculations for aminoglycosides used to treat CF pulmonary exacerbations. METHODS Ambidirectional cohort study of patients admitted to a children's hospital from June 1, 2018, through February 28, 2019, and June 1, 2019, through February 8, 2021. The primary outcome was the occurrence of dosing changes after analysis of initial serum concentrations in either group. Secondary outcomes included occurrence of nephrotoxicity, duration of antibiotics, and length of stay. RESULTS Twenty-four patients (75%) in the intervention group versus zero in the …

Objective We examined asthma control in children hospitalized for status asthmaticus 7–10 days after discharge with or without an additional prescription for systemic corticosteroids.Methods This was a prospective observational study of patients aged 5–17 years with a documented history of asthma or β-agonist responsive wheezing admitted to the hospital for an acute asthma exacerbation. We compared patients who had any systemic corticosteroid prescribed at discharge with those who were not prescribed systemic corticosteroids at discharge. The primary outcomes were asthma control after discharge, as defined by the Asthma Control Test (ACT), and missed school days, which we modeled with multivariable linear and Poisson regression, respectively.Results A total of 56 patients were included in the study, 29 (52%) received dexamethasone inpatient and then were discharged without additional …

BackgroundFamily support has been shown to be important for adolescents and young adults (AYA) in eating disorder (ED) treatment. Many families were impacted by the pandemic, potentially altering their ability to support individuals in ED treatment. This study examined the association of COVID-19 related familial economic change with self-reported mental health (MH) and ED concerns in AYA seeking treatment for ED.MethodsAYA patients with EDs aged 10–27 years enrolled in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) completed an additional COVID-19-specific survey (n = 89) that assessed their perception of the effects of the pandemic on their lives and their ED. Participants self-reported on familial economic disruptions, measured through a composite score of four markers: (1) family member’s work hours cut, (2) family member was required to stop …

PurposeThe COVID-19 pandemic has had a profound impact on adolescent health and well-being, particularly for adolescents already experiencing mental health difficulties. With increased feelings of isolation and stress due to COVID-19, adolescent patients with eating disorders (ED) are faced with an even greater challenge with respect to recovery. This study examines the relationship between ED/mental health (MH) symptoms and patient-reported motivation to recover from an ED in the time of COVID-19.MethodsPatients were recruited through the Registry of Eating disorders and their Co-morbidities OVER time in Youth (RECOVERY) study at Boston Children’s Hospital. RECOVERY is an innovative, longitudinal web-based registry of patients ages 10-27 seeking ED-related care; our study aims to understand patients’ experience with an ED. RECOVERY patients were sent an additional survey in July 2020 …

Eating disorders (EDs) such as anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder are associated with restricted diets and abnormal compensatory behaviors, frequently leading to malnutrition and oral and gastrointestinal manifestations. Dental and oral complications are generally caused by malnutrition, micro-nutrient deficiency, and chronic acid exposure; hence, treatment of the ED and frequent dental examinations are essential to reduce morbidity. Gastrointestinal manifestations are multifactorial in origin, and may be caused by disordered behaviors, malnutrition, anxiety, and/or may be a function of the ED itself. This article reviews the most common oral and gastrointestinal manifestations of EDs and describes emergent complications such as acute gastric dilation and superior mesenteric artery syndrome. It is important for providers to recognize complications associated with EDs …

BACKGROUND:The Community Asthma Initiative (CAI) was included in the New England Asthma Innovations Collaborative, which received a Centers for Medicare and Medicaid Services (CMS) Innovation grant. Under this grant, CAI transitioned from a mixed community health worker and nurse model to a nurse-supervised community health worker model. CMS limited enrollment to patients with Medicaid and encouraged 3 home visits per family.METHODS:A total of 389 patients enrolled under the CMS grant at Boston Children’s Hospital from 2013 to 2015 (CMS group) were compared with 733 CAI patients with Medicaid enrolled from 2005 to 2012 (comparison group). Changes in 5 asthma-related measures (emergency department visits, hospitalizations, physical activity limitations, missed school days, and parent and/or guardian missed workdays) were compared between baseline and 6 and 12 months …

BackgroundThe Coronavirus (COVID-19) pandemic dramatically transformed daily life for adolescents and young adults, altering social and physical environments. Previous research has shown such shifts in daily life to be especially challenging for people living with eating disorders (ED). However, the extent of this environmental change on ED symptoms and mental health (MH) has been relatively unexplored in patients with EDs. This study examines the implications of the COVID-19 pandemic on ED and MH symptoms and motivation for ED recovery in adolescents/young adults.MethodsParticipants were enrollees in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) who responded to an additional survey (n= 89) in July 2020 to assess the impact of the COVID-19 pandemic. Participants reported concerns of their ED worsening due to living in a “triggering environment” due to the pandemic as well as COVID-related changes in intrusive ED thoughts, depression, anxiety, isolation, and motivation to recover. Logistic regression models, adjusted for age and ED diagnosis, examined the association of triggering environment with MH and ED symptoms.ResultsThe majority of respondents reported concern for “triggering environment”(63%), as well as increased ED thoughts (74%) and feelings of anxiety (77%), depression (73%), and isolation (80%) in response to the COVID-19 pandemic. Nearly one-third reported decrease in motivation to recover (29%). After adjusting for age and ED diagnosis, participants who reported triggering environment had nearly 18 times the odds of decreased motivation to …

Background The Coronavirus (COVID-19) pandemic dramatically transformed daily life for adolescents and young adults, altering social and physical environments. Previous research has shown such shifts in daily life to be especially challenging for people living with eating disorders (ED). However, the extent of this environmental change on ED symptoms and mental health (MH) has been relatively unexplored in patients with EDs. This study examines how young people with EDs feel the COVID-19 pandemic has affected their living environments as well as their ED and MH symptoms and motivation for ED recovery. Methods Participants were enrollees in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) who responded to an additional survey (n = 89) in July 2020 to assess their perceptions of the impact of …

PurposeThe COVID-19 pandemic has led to the development and worsening of eating disorder (ED) symptoms in adolescents and young adults. In order to examine COVID-19-related trends in ED care-seeking at our institution.MethodsWe used interrupted time series regression to examine pre- and postpandemic monthly summary data of the following: (1) ED-related inpatient admissions for medical stabilization; (2) ED-related hospital bed-days; (3) completed outpatient ED assessments; and (4) ED outpatient care-related inquiries at a children’s hospital in Boston, MA.ResultsInpatient admissions, hospital bed-days, and outpatient care-related inquiries increased on average over time postpandemic compared to stable volume over time prepandemic (p < .01). Outpatient assessments decreased precipitously initially following COVID-19-related limitations, and rose quickly back to baseline.ConclusionThese …

PurposeRestrictive eating disorders (EDs) are often comorbid with other mental health conditions such as anxiety and depression. However, their relationship with degree of malnutrition remains unclear. We set out to assess how malnutrition is associated with anxiety and depression in adolescents/young adults (AYAs) with EDs.MethodsA sample of 145 AYAs (ages 10-24 years) with EDs were recruited from a large children’s hospital in the northeastern US for the RECOVERY study, a longitudinal web-based registry of AYAs with EDs. Patients with restrictive EDs [anorexia nervosa (AN), other specified feeding and eating disorder (OSFED), and avoidant/restrictive food intake disorder (ARFID)] were included. Those with bulimia nervosa, binge eating disorder, or disordered behaviors without restriction were excluded. Patients whose baseline surveys took place during the COVID-19 pandemic were excluded due to …