Emergency Department Directors Are Willing to Expand Reproductive Health Services for Adolescents

Study ObjectiveNearly 20 million adolescents receive emergency department (ED) care each year, many of whom have untreated reproductive health issues. ED visits represent an opportunity to provide appropriate care, however, ED physician reproductive health care practices and capabilities in the United States have not been described. We sought to characterize pediatric ED director's individual practice and ED system resources for providing adolescent reproductive health care.Design, Setting, Participants, and InterventionsWe invited pediatric ED division and/or medical directors nationally to participate in an anonymous, online survey.Main Outcome MeasuresOutcomes included ED directors' personal practice regarding providing adolescent patients reproductive health care, and their ED's resources and standard practice regarding screening adolescents for sexually transmitted infections (STIs) and other reproductive health concerns.ResultsOne hundred thirty-five of 442 (30.5%) ED directors responded. Respondents were 73% (90/124) male, with a median of 18 (interquartile range, 13-23) years of experience and 63% (84/134) working in urban EDs. Seventy-one percent (90/130) preferred face-to-face interviews for obtaining a sexual history, but only 59% (77/130) of participants “always ask parents to leave the room for sensitive questions.” Eighty-four percent (106/127) were receptive to pregnancy prevention interventions being initiated in the ED, with 75% (80/106) of those willing to provide an intervention. Only 16% (21/128) indicated their ED has a universal STI screening program, and only 18% (23/126) “always” successfully notify patients of a positive STI test.ConclusionED directors are comfortable providing adolescent reproductive health care, and many individual- and ED-level opportunities exist to provide improved reproductive health care for adolescents in the ED.     

Knowledge and Awareness of Emergency Contraception in Adolescents

Study ObjectiveThe purpose of this study was to (1) describe the awareness of emergency contraception among adolescent females, (2) identify factors that are associated with accurate knowledge of emergency contraception and (3) describe prior use of emergency contraception among adolescent females.DesignCross-sectional study.SettingThe study procedures were carried out at Kapiolani Medical Center's Teen Clinic in Honolulu, Hawaii, which is comprised of an ambulatory university-based resident clinic.ParticipantsEnglish-speaking females who were between the ages of 14 and 19 were invited to participate.InterventionsThis study utilized a self-administered, anonymous survey that contained questions regarding emergency contraception as well as questions on reproductive and sexual health.Main Outcome MeasureThe primary outcome was percentage of adolescent women who were aware of emergency contraceptives.ResultsA total of 100 surveys were distributed and collected. Fifty-six percent of respondents had an awareness of emergency contraception and 69.6% of these adolescents were able to correctly list an emergency contraceptive method. Older teens were more likely to have an awareness of emergency contraception but we did not find any other factors that were associated with accurate knowledge of emergency contraception. Adolescents who had used emergency contraception in the past found it to be acceptable.ConclusionsDespite being at high risk for unintended pregnancy, adolescents in this population had lower rates of emergency contraceptive awareness in than has been reported in adults.     

Italian Adolescents and Emergency Contraception: A Focus Group Study

Study Objective

Using a qualitative method, the purpose of this study was to: (1) obtain information directly from the adolescents on their attitudes and knowledge regarding emergency contraception; and (2) investigate the presence of differences between male and female participants' attitudes and knowledge.

Emergency Department Evaluation of Abdominal Pain in Female Adolescents

Study ObjectiveEvaluation of acute abdominal pain in an adolescent female patient should include consideration of all potential sources of pain, including gynecologic etiologies. The goal of our study was to determine the frequency of evaluation of gynecologic causes of abdominal pain in adolescent girls seen in a pediatric emergency department.Study DesignA retrospective review was performed of girls between 12 and 21 years of age presenting to the emergency department or urgent care centers at a single pediatric institution with the chief complaint of abdominal pain during 2016. Frequency analyses of demographic and clinical characteristics are presented.ResultsA total of 1082 girls presented with a chief complaint of abdominal pain. Menarche was documented in 85% of patients, sexual history in 52% of patients, and assessment of contraception use in 28%. Pregnancy testing was performed in 77%. Sexually transmitted infection (STI) testing was performed in 31%, and in only 73% of patients who reported being sexually active. Imaging was performed in 52%. In the subgroup of patients who reported being sexually active and presented with abdominal pain and vaginal discharge, only 37% had a pelvic examination performed. In multivariable modeling, Black patients were significantly more likely than White patients to have STI testing performed (adjusted risk ratio [aRR] = 1.39; confidence interval [CI] = 1.13-1.70) and to undergo a pelvic examination (aRR = 2.45; CI = 1.34-4.50), and less likely to undergo imaging (aRR = 0.69; CI = 0.59-0.81).ConclusionThe assessment of abdominal pain in adolescent girls should include gynecologic etiologies. Our results raise concerns that there are deficiencies in the evaluation of gynecologic sources of abdominal pain in girls treated at pediatric facilities, and evidence of potential racial disparities.     

Louisiana and Mississippi Family Physicians' Contraception Counseling for Adolescents with a Focus on Intrauterine Contraception

Study ObjectiveThe adolescent pregnancy rate in Louisiana (LA) and Mississippi (MS) is one of the highest in the United States. One approach to decrease that rate is to increase contraceptive use. We sought to characterize LA and MS family physicians' (FPs) contraception counseling for adolescents with a focus on the intrauterine contraceptive device (IUD).Design, Setting, Participants, Interventions, and Main Outcome MeasuresOnline survey of resident and practicing physician members of the LA and MS Academy of FPs.ResultsThree hundred ninety-eight of 1616 invited FPs responded; 244 were included in our analysis. When counseling adolescents about contraception, respondents “frequently discussed” oral contraceptives and condoms 87.5% (210/240) and 83.8% (202/241) of the time, respectively. Newer and more highly effective contraceptives such as the ring, patch, IUD, and implant were “frequently discussed” only 34.6% (82/237)-39.3% (92/234) of the time. In the previous 6 months, 56% (136/243) of respondents ever discussed an IUD with an adolescent. Respondents were more likely to have discussed IUDs if they learned IUD insertion during residency, had on-site access to IUD inserters, believed they were competent and/or comfortable with IUD counseling. In 5 clinical scenarios asking whether the respondent would recommend an IUD to a 17- or a 27-year-old patient (in all scenarios patients were eligible for an IUD), respondents were restrictive overall and significantly fewer would recommend an IUD for the adolescent.ConclusionOur results suggest that there are missed opportunities for full-scope contraception counseling by LA and MS FPs. When these FPs counsel adolescents about contraception they less frequently discuss newer methods and more highly effective methods. Additionally many LA and MS FPs use overly restrictive eligibility criteria when considering IUDs.     

A New Strategy for Trichomonas Testing Female Adolescents in the Emergency Department

Study ObjectiveSensitive trichomonas diagnostic testing has become available, including nucleic acid amplification tests (NAATs) and a rapid antigen test. The study purpose was to determine if adding sensitive trichomonas testing to routine female sexually transmitted infection (STI) evaluations would increase trichomonas identification and treatment.DesignTwo study time periods. Study time 1 (T1) was used for a retrospective review. Study time 2 (T2) was used for a prospective study.SettingEmergency Department.ParticipantsSymptomatic female patients aged 13-20 years (N = 447).InterventionsImplementation of routing trichomonas testing in the Emergency Department during T2.Main Outcome MeasuresTrichomonas diagnosis and treatment rates were compared during T1 and T2.ResultsDuring T1 31 of 234 of eligible patients (13%) were trichomonas-tested. Laboratory-confirmed trichomonas was identified in 3 of 234 (1.3%). During T2, 212 of 213 of eligible patients (99.5%) were trichomonas-tested; 39 of 212 tested trichomonas-positive (18.4%); 29 of 212 tested rapid trichomonas antigen test-positive (13.6%; P < .001), and 33 of 188 tested trichomonas NAAT-positive (15.5%; P < .001). Trichomonas treatment was given to 3 of 3 laboratory-confirmed trichomonas cases during T1 (100%) compared with 37 of 39 during T2 (95%; P = .688). During T1, 14 of 17 women who received trichomonas treatment (82.4%) did not have a laboratory-confirmed trichomonas diagnosis and during T2 13 of 52 women without a laboratory-confirmed trichomonas diagnosis (25%) were treated for trichomonas (P < .001). Rapid trichomonas antigen tests and trichomonas NAATs were concordant in 178 of 188 patients (94.6%).ConclusionIncorporating trichomonas rapid antigen tests and NAATs into routine female adolescent STI testing significantly increased the number of laboratory-confirmed adolescent trichomonas diagnosis and treatment and are useful Emergency Department STI screening tools.     

Emergency Department Evaluation of Abnormal Uterine Bleeding in US Children's Hospitals

Study ObjectiveTo assess initial evaluation patterns of patients presenting to the Emergency Department (ED) with abnormal uterine bleeding (AUB) including differences by raceDesignRetrospective multicenter cohort study from October 2015 through September 2020SettingForty-seven children's hospitals submitting data to the Pediatric Health Information SystemParticipantsFemale patients aged 8-21 with an ED encounter with AUB as the primary diagnosis codeInterventions and Main Outcome MeasuresProportion of visits with at least 1 laboratory assessment for the evaluation of anemia, iron deficiency, and/or hemostatic disordersResultsWe identified 17,759 unique patients with AUB seen in the ED who met inclusion criteria. Median age was 16.3 years (IQR, 14.1-17.8 years). Most encounters (n = 11,576, 65.2%) included evaluation for anemia, but only 6.8% (n = 1,215) included assessment for iron deficiency and 26.2% (n = 4,654) for hemostatic disorders. Black patients accounted for 34.7% (n = 6,155) of AUB encounters yet constituted only 25% of all ED encounters (n = 198,192). Black patients with AUB were less likely to undergo bleeding disorder evaluation (OR = 0.76; 95% CI, 0.69-0.83) but more likely to receive evaluation for sexually transmitted infections (OR = 1.63; 95% CI, 1.48-1.80) compared with White patients, despite controlling for age and concomitant pain.ConclusionsIn a national cohort of adolescents presenting to the ED with AUB, evaluations for anemia and hemostatic disorders were infrequently performed, and racial differences existed regarding initial assessment. Further studies are needed to understand the factors underlying racial differences in hematologic testing and the impact of this disparity on health outcomes for females with AUB.     

Long-acting Reversible Contraception for Adolescents and Young Adults: Patient and Provider Perspectives

Study ObjectiveTo describe and explore provider- and patient-level perspectives regarding long-acting reversible contraception (LARC) for teens and young adults (ages 16-24).MethodsData collection occurred between June and December 2011. We first conducted telephone interviews with administrative directors at 20 publicly funded facilities that provide family planning services. At 6 of these sites, we conducted a total of 6 focus group discussions (FGDs) with facility staff and 48 in-depth interviews (IDIs) with facility clients ages 16-24.ResultsStaff in the FGDs did not generally equate being a teen with ineligibility for IUDs. In contrast to staff, one-quarter of the young women did perceive young age as rendering them ineligible. Clients and staff agreed that the “forgettable” nature of the methods and their duration were some of LARC's most significant advantages. They also agreed that fear of pain associated with both insertion and removal and negative side effects were disadvantages. Some aspects of IUDs and implants were perceived as advantages by some clients but disadvantages by others. Common challenges to providing LARC-specific services to younger patients included extra time required to counsel young patients about LARC methods, outdated clinic policies requiring multiple visits to obtain IUDs, and a perceived higher removal rate among young women. The most commonly cited strategy for addressing many of these challenges was securing supplementary funding to support the provision of these services to young patients.ConclusionIncorporating young women's perspectives on LARC methods into publicly funded family planning facilities' efforts to provide these methods to a younger population may increase their use among young women.     

吉妮宫内节育器用于紧急避孕的临床观察

目的观察吉妮宫内节育器(GyneFix IUD)用于紧急避孕的临床效果.方法选择1998年7月至2000年8月来我院距第一次无保护性交大于72 h、但在120 h以内的就诊者126例.在严密消毒下由专人放置吉妮节育器,术后口服环丙沙星片3日,随访至下次月经来潮.按Dixon方法计算妊娠概率.结果126例受试者预期妊娠数为11.957,实际妊娠数为0,避孕有效率为100%,无一例感染发生.随访1个月,无一例环脱落,续用率为92.86%.结论只要严格掌握适应症,术后常规应用抗生素预防感染,吉妮IUD用于紧急避孕是高效安全的,而且尤其适用于要求长期避孕者.