S. Jean Emans

Whose Personal Control? Creating Private, Personally Controlled Health Records for Pediatric and Adolescent Patients

Personally controlled health records (PCHRs) enable patients to store, manage, and share their own health data, and promise unprecedented consumer access to medical information. To deploy a PCHR in the pediatric population requires crafting of access and security policies, tailored to a record that is not only under patient control, but one that may also be accessed by parents, guardians, and third-party entities. Such hybrid control of health information requires careful consideration of both the PCHR vendors access policies, as well as institutional policies regulating data feeds to the PCHR, to ensure that the privacy and confidentiality of each user is preserved. Such policies must ensure compliance with legal mandates to prevent unintended disclosures and must preserve the complex interactions of the patient-provider relationship. Informed by our own operational involvement in the implementation of the Indivo PCHR, we provide a framework for understanding and addressing the challenges posed by child, adolescent, and family access to PCHRs.

Partner condom use among adolescent girls with sexually transmitted diseases

PURPOSE To explore associations of self-reported condom use with sexual risk knowledge and behaviors, perceptions of peer condom use, and communication with sexual partners about condom use among adolescent girls with sexually transmitted diseases (STDs). METHODS Adolescent girls with cervicitis or pelvic inflammatory disease (PID) completed a 62-item self-administered questionnaire on sexual risk knowledge and behaviors, condom use, perceptions of peer condom use, and condom use negotiation with partners. Associations with frequency of condom use and condom use at last sexual intercourse were analyzed. RESULTS A total of 24 girls were enrolled: 13 with cervicitis and 11 with PID; 22 had complete data for analysis. Compared with girls who reported low frequency of condom use, girls who reported condom use all or most of the time were younger (16.7 vs. 19.5 years; p = .008), were less likely to have a prior history of STD (67% vs. 0%; p = .03), and were more likely to think that all or most of their friends use condoms (72% vs. 0%; p = .02). Compared with girls who had not used a condom with last sexual intercourse, girls who had used a condom were younger (16.2 vs. 17.9 years; p = .04), had fewer lifetime partners (2.7 vs. 8.4; p = .03) and had higher mean scores in condom use negotiation (29.1 vs. 24.4; p = .02), and were more likely to think that all or most of their friends used condoms (100% vs. 31%; p = .001). Knowledge about condoms and STD prevention was high (mean 14.3 +/- 2.3 of 16) but was not associated with condom use. CONCLUSIONS STD interventions for partner condom use among high-risk adolescent girls must recognize the decrease in condom use with increasing age and focus on maintaining safer sex behaviors, building condom use negotiation skills, and promoting the perception of condom use by friends.

Gender Differences in Research Grant Applications and Funding Outcomes for Medical School Faculty

PURPOSE To evaluate whether there were differences in acquisition of research grant support between male and female faculty at eight Harvard Medical School-affiliated institutions. METHODS Data were obtained from the participating institutions on all research grant applications submitted by full-time faculty from 2001 through 2003. Data were analyzed by gender and faculty rank of applicant, source of support (federal or nonfederal), funding outcome, amount of funding requested, and amount of funding awarded. RESULTS Data on 6319 grant applications submitted by 2480 faculty applicants were analyzed. Women represented 29% of investigators and submitted 26% of all grant requests. There were significant gender differences in the mean number of submissions per applicant (women 2.3, men 2.7), success rate (women 41%, men 45%), number of years requested (women 3.1, men 3.4), median annual amount requested (women

New insights into the old problem of chronic pelvic pain.

115,325, men

Hormonal Contraception and Thrombotic Risk: A Multidisciplinary Approach

150,000), mean number of years awarded (women 2.9, men 3.2), and median annual amount awarded (women

Predictors of Papanicolaou smear return in a hospital-based adolescent and young adult clinic

98,094, men

Anorexia Nervosa, Athletics, and Amenorrhea

125,000). After controlling for academic rank, grant success rates were not significantly different between women and men, although submission rates by women were significantly lower at the lowest faculty rank. Although there was no difference in the proportion of money awarded to money requested, women were awarded significantly less money than men at the ranks of instructor and associate professor. More men than women applied to the National Institutes of Health, which awarded higher dollar amounts than other funding sources. CONCLUSIONS Gender disparity in grant funding is largely explained by gender disparities in academic rank. Controlling for rank, women and men were equally successful in acquiring grants. However, gender differences in grant application behavior at lower academic ranks also contribute to gender disparity in grant funding for medical science.

Academic Women Faculty: Are They Finding the Mentoring They Need?

Between July, 1974 and February, 1979, 109 adolescent girls, ranging in age from 10 1/2 to 19 yr. with unexplained chronic pelvic pain, underwent diagnostic laparoscopy. Endometriosis was the most common finding occurring in 49 patients (45%), followed by postoperative adhesions in 17 patients (16%) and congenital abnormalities of the uterus in 10 patients (9%). Other important causes were chronic pelvic inflammatory disease with peritubal and periovarian adhesions in 9%, chronic hemoperitoneum in 5%, functional ovarian cysts in 5%, and uterine serositis in 2%. No pathology could be seen in 10 patients (9%). Analysis of the presenting symptoms and physical findings revealed in most instances that the presence of significant pelvic pathology as a cause of the chronic pelvic pain was predictable and had been previously misdiagnosed. Intraoperative and postoperative management of the major problems encountered stress the importance of conservative surgery and the need for long-term follow-up.

Performance of Massachusetts HMOs in providing Pap smear and sexually transmitted disease screening to adolescent females.

Heightened publicity about hormonal contraception and thrombosis risk and the publication of new guidelines by the World Health Organization in 2009 and the Centers for Disease Control and Prevention in 2010 addressing this complex issue have led to multidisciplinary discussions on the special issues of adolescents cared for at our pediatric hospital. In this review of the literature and new guidelines, we have outlined our approach to the complex patients referred to our center. The relative risk of thrombosis on combined oral contraception is three- to fivefold, whereas the absolute risk for a healthy adolescent on this therapy is only 0.05% per year. This thrombotic risk is affected by estrogen dose, type of progestin, mechanism of delivery, and length of therapy. Oral progestin-only contraceptives and transdermal estradiol used for hormone replacement carry minimal or no thrombotic risk. Transdermal, vaginal, or intrauterine contraceptives and injectable progestins need further study. A personal history of thrombosis, persistent or inherited thrombophilia, and numerous lifestyle choices also influence thrombotic risk. In this summary of one hospitals approach to hormone therapies and thrombosis risk, we review relative-risk data and discuss the application of absolute risk to individual patient counseling. We outline our approach to challenging patients with a history of thrombosis, known thrombophilia, current anticoagulation, or family history of thrombosis or thrombophilia. Our multidisciplinary group has found that knowledge of the guidelines and individualized management plans have been particularly useful for informing discussions about hormonal and nonhormonal options across varied indications.

The relationships of calculated percent body fat, sports participation, age, and place of residence on menstrual patterns in healthy adolescent girls at an independent new England high school

OBJECTIVE Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits. METHODS Participants in this longitudinal cohort study were sexually active young women 12–24 years of age presenting to a hospital-based adolescent clinic. Participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. Logistic regression modeling was used to determine variables independently associated with return. RESULTS: The outcome measure, return, was available for 439 of 490 participants (90%). Mean participant age (± standard deviation) was 18.3 (± 2.2) years, 49% were black, 23% were Hispanic, and 51% had Medicaid health insurance. Variables independently associated with return included belief that the Papanicolaou smear will not be painful (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.08, 2.83), belief that return for follow-up will prevent cervical cancer (OR 1.83, 95% CI 1.12, 3.07), likelihood that the doctor will be honest (OR 4.07, 95% CI 1.37, 17.5), and low self-reported impulsivity (OR 1.66, 95% CI 1.06, 2.63). Family history of cervical cancer was associated with decreased likelihood of return (OR 0.28, 95% CI 0.08, 0.78). CONCLUSION Specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits. These findings may guide the design of interventions to increase compliance with recommendations for Papanicolaou smear return.