National Survey of Pediatric Sickle Cell Providers on Their Contraceptive Practices for Female Patients

Abstract Introduction: Pregnancies of women with sickle cell disease (SCD) have increased risk of morbidity and mortality, with potential additional complications due to uncertain teratogenicity of hydroxyurea and the newer medications. Unintended pregnancy is common among adolescents and young adults (AYA). We aimed to assess the beliefs, practices and barriers of U.S. pediatric hematology providers related to contraception for female AYA with SCD, as little is known about this topic. Methods: We developed a 25-question, web-based survey guided by the Health Belief Model to assess pediatric SCD providers' contraceptive perspectives and practices. Most questions were adapted from published surveys assessing provider views and practices on contraception for general AYA care or patients with other chronic health conditions. The survey was distributed from December 2020-April 2021 to licensed U.S. prescribers who provided care to female SCD AYAs ages 12-21 years within the prior two years. The anonymous survey was distributed by two methods: (1) a list of 526 pediatric SCD and/or general hematology providers from the HRSA SCD Treatment Demonstration Program Regional Collaborative, cross-referenced for reminder emails to 126 providers using a list from the HRSA Regional Genetics Collaborative (https://www.hrsa.gov); (2) directors from all 74 U.S. ACGME-accredited Pediatric Hematology-Oncology fellowship programs, asking then to forward the survey to their SCD providers. Surveys with >50% completion were analyzed using descriptive statistics and chi square analyses. Results: Of 177 respondents, 160 surveys met inclusion criteria and were analyzed: 73 (45.6%) contacted by emails and 87 (54.4%) contacted via the fellowship directors (Table 1). Respondents recruited via fellowship program directors were more frequently NP/PAs (total of 30 (18.7%)), of younger age (total 103 (64.4%) and had fewer years in practice compared to those contacted directly. The majority of providers reported counseling (76.9%) and/or referring patients for contraception (90.9%), but not prescribing (41.8%). Practices regarding contraception differed by provider characteristics (Table 2). Trainees vs. established providers less frequently reported counseling about contraception (54.1% vs. 84.6%, p<0.001). Overall however, younger vs. older providers (<45 years), did not differ in contraceptive counseling (75.7% vs. 80.7%, p=0.7). Motivators for providing counseling differed by certain demographics (data not shown): female providers more frequently counseled about contraception when patients disclosed being sexually active (87.0% vs 66.7%, p=0.046); NPs/PAs more frequently counseled if standards for counseling were in place (45.5% vs 22.0%, p=0.03); and providers with more years in practice when they had concerns about SCD patients' increased pregnancy risks (43.1% vs 23.9%, p=0.03). Provider practices did not differ by region or size of SCD practice. Providers who believed that hydroxyurea causes increased risk of pregnancy complications more frequently reported prescribing contraception (48.8% vs. 31.7%, p=0.04), but did not differ by counseling or referral practices. Concerns about teratogenic risk of hydroxyurea was not significantly associated with provider practices. The most frequently reported barriers for counseling (>30% respondents) were insufficiencies in time, patient/parent willingness, formal training, knowledge/ability and/or professional guidelines. Concerns about side effects was a barrier to prescribing (34.2%), while lack of access to providers with contraceptive expertise was the most common barrier to patient referral (34.9%). Multivariate analyses are ongoing. Conclusions: To our knowledge, this is the first national report of pediatric hematology providers' beliefs and practices regarding contraception for female AYA with SCD. While providers generally felt responsible for offering counseling and referral but not prescribing, practices varied based on certain provider characteristics, beliefs and perceived barriers. Clinical guidelines, improved provider education and training, and patient/parent decision Figure 1 Figure 1. Disclosures Smith-Whitley: Global Blood Therapeutics: Current Employment. Strouse: Takeda: Consultancy.

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Self-reported gender bias encountered by hematology and oncology fellows.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.11017 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 11017-11017

Author(s):

Nino Balanchivadze ◽

Karla D. Passalacqua ◽

Sally Askar ◽

Philip Kuriakose ◽

Narjust Duma ◽

...

Keyword(s):

Gender Equity ◽

Gender Bias ◽

Middle Eastern ◽

Daily Practice ◽

Chi Square ◽

Pediatric Hematology ◽

Cell Counts ◽

Increased Risk ◽

Fellowship Programs ◽

Survey Responses

11017 Background: Gender-related bias and discrimination have been well documented, particularly in male-dominated fields such as surgery, and have been associated with increased risk for physician burnout. In hematology/medical oncology, women make up between 41% and 49% of first-year fellows, but represent less than 40% of the academic hematology/oncology workforce. We aimed to study current hematology/oncology fellow perceptions about gender-related bias and challenges to inform interventions that promote gender equity. Methods: An anonymous 18-question survey was sent online to 165 adult and 75 pediatric hematology/oncology fellowship programs. Two group comparisons to analyze survey responses between genders were performed using chi-square, or Fisher’s test (if cell counts < 5), and Wilcoxon Rank Sum tests. Results: A total of 133 fellows completed the survey, where 88 self-identified as female (66%) and 45 (33.83%) self-identified as male. Most participants were White (52%), followed by Asian (29%), Hispanic (9%), Middle Eastern (5%), and Black (3%). Most respondents (n = 100; 75%) were age 31-40 years. More than half (54%) were enrolled in adult hematology/oncology fellowships, 24% were enrolled in pediatric hematology/oncology fellowship programs, and 88% practiced in University-based programs. Compared to male respondents, female fellows were more likely to report experiencing gender bias (p < 0.001), felt more insecure in their job (p = 0.043), felt second-guessed by colleagues (p < 0.001), and were more likely to believe that they had been unfairly denied a promotion (p = 0.003). In addition, female respondents were more likely to report having been mistaken as a non-physician (p < 0.001) and were more concerned about perceived gender bias. Female respondents reporting gender bias used techniques such as wearing a white coat (p < 0.0001), emphasizing a professional look (p < 0.0001), and ensuring “Doctor” (p < 0.0001) was clearly written on their badge more often than male fellows. When asked about how to combat gender-related challenges, female fellows more often recommended formal lectures and instruction about gender bias for attending physicians and non-physician staff. Suggestions about mitigating gender-related bias included encouraging same-sex mentors and open discussions about existing bias. Conclusions: Female hematology/oncology fellows reported facing gender-related bias and challenges in daily practice and often used specific techniques to face these challenges. Transparency and directed education about gender bias may help mitigate these challenges to create better working environments for fellows.

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Characteristics of US Health Care Providers Who Counsel Adolescents on Sports and Energy Drink Consumption

International Journal of Pediatrics ◽

10.1155/2014/987082 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Nan Xiang ◽

Holly Wethington ◽

Stephen Onufrak ◽

Brook Belay

Keyword(s):

Health Care ◽

Health Care Providers ◽

Vegetable Intake ◽

Group Versus ◽

Energy Drink ◽

Care Providers ◽

Provider Education ◽

Chi Square ◽

Cross Sectional ◽

Provider Characteristics

Objective. To examine the proportion of health care providers who counsel adolescent patients on sports and energy drink (SED) consumption and the association with provider characteristics.Methods. This is a cross-sectional analysis of a survey of providers who see patients ≤17 years old. The proportion providing regular counseling on sports drinks (SDs), energy drinks (EDs), or both was assessed. Chi-square analyses examined differences in counseling based on provider characteristics. Multivariate logistic regression calculated adjusted odds ratios (aOR) for characteristics independently associated with SED counseling.Results. Overall, 34% of health care providers regularly counseled on both SEDs, with 41% regularly counseling on SDs and 55% regularly counseling on EDs. On adjusted modeling regular SED counseling was associated with the female sex (aOR: 1.44 [95% CI: 1.07–1.93]), high fruit/vegetable intake (aOR: 2.05 [95% CI: 1.54–2.73]), family/general practitioners (aOR: 0.58 [95% CI: 0.41–0.82]) and internists (aOR: 0.37 [95% CI: 0.20–0.70]) versus pediatricians, and group versus individual practices (aOR: 0.59 [95% CI: 0.42–0.84]). Modeling for SD- and ED-specific counseling found similar associations with provider characteristics.Conclusion. The prevalence of regular SED counseling is low overall and varies. Provider education on the significance of SED counseling and consumption is important.

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ANALISIS PERILAKU HYGIENE MENSTRUASI MELALUI HEALTH BELIEF MODEL (HBM) PADA SISWI SMP DI JAKARTA UTARA

National Nursing Conference ◽

10.34305/nnc.v1i1.122 ◽

2020 ◽

Vol 1 (1) ◽

pp. 16

Author(s):

Luqman Effendi ◽

Nurul Khotimah

Keyword(s):

Health Belief Model ◽

Health Belief ◽

Personal Hygiene ◽

Perceived Threat ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Pruritus Vulvae ◽

Perceived Benefit ◽

Belief Model

Keluhan pada organ reproduksi yang sering terjadi adalah Pruritus vulvae yaitu ditandai dengan adanya sensasi gatal parah dari alat kelamin perempuan. Pruritus vulvae disebabkan oleh jamur, bakteri dan virus yang muncul 44% karena buruknya Personal Hygiene dan Hygiene Menstruasi. Penelitian Tahun 2015 di 4 wilayah di Indonesia yaitu di Nusa Tenggara Timur (NTT), Jawa Timur, Papua, dan Sulawesi Selatan terkait kebersihan saat menstruasi menemukan 67% remaja di kota dan 41% remaja di desa masih adanya perilaku negatif. Tujuan penelitian untuk mengetahui beberapa faktor yang berhubungan dengan perilaku hygiene menstruasi melalui Health Belief Model (HBM). Penelitian ini adalah penelitian kuantitatif dengan menggunakan pendekatan cross sectional dengan sampel sebanyak 101 siswi SMPN 244 di Jakarta Utara, dianalisis secara univariat dan bivariat menggunakan chi square. Perilaku Hygiene Menstruasi baik baru dilakukan 55,4% responden. Perilaku Hygiene Menstruasi berhubungan secara signifikan dengan pengetahuan (OR=5,1), perceived threat (OR=3,9) dan perceived benefit (OR=3,3) dengan P Value < 0.005. Health Belief Model (HBM) bisa dipertimbangkan sebagai suatu pendekatan dalam upaya memperbaiki perilaku hygiene menstruasi pada remaja. Peningkatan pengetahuan direkomendasikan dengan menekankan pada ancaman penyakit yang berkaitan dengan perilaku hygiene menstruasi dan manfaat-manfaat yang langsung dirasakan oleh remaja berkenaan dengan perilaku higiene menstruasi.

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Coverage and Timing of Influenza Vaccination Among Privately Insured Pregnant Women in the United States, 2010-2018

Public Health Reports ◽

10.1177/00333549211026779 ◽

2021 ◽

pp. 003335492110267

Author(s):

Kai Hong ◽

Megan C. Lindley ◽

Fangjun Zhou

Keyword(s):

Influenza Vaccination ◽

Pregnant Women ◽

Vaccination Coverage ◽

Influenza Season ◽

The United States ◽

Metropolitan Statistical Area ◽

Provider Education ◽

Vaccination Uptake ◽

Increased Risk ◽

Privately Insured

Objective Pregnant women are at increased risk of serious complications from influenza and are recommended to receive an influenza vaccination during pregnancy. The objective of this study was to assess trends, timing patterns, and associated factors of influenza vaccination among pregnant women. Methods We used 2010-2018 MarketScan data on 1 286 749 pregnant women aged 15-49 who were privately insured to examine trends and timing patterns of influenza vaccination coverage. We examined descriptive statistics and identified factors associated with vaccination uptake by using multivariate log-binomial and Cox proportional hazard models. Results In-plan influenza vaccination coverage before delivery increased from 22.0% during the 2010-2011 influenza season to 33.2% during the 2017-2018 influenza season. About two-thirds of vaccinated women received the vaccine in September or October during each influenza season. For women who delivered in September through May, influenza vaccination coverage increased rapidly at the beginning of influenza season and flattened after October. For women who delivered in June through August, influenza vaccination coverage increased gradually until February and flattened thereafter. Most vaccinated women who delivered before January received the vaccine in the third trimester. Increased likelihood of being vaccinated was associated with age 31-40, living in a metropolitan statistical area, living outside the South, enrollment in a consumer-driven or high-deductible health plan, being spouses or dependents of policy holders, and delivery in November through January. Conclusions Despite increases during the past several years, vaccination uptake is still suboptimal, particularly after October. Health care provider education on timing of vaccination and recommendations throughout influenza seasons are needed to improve influenza vaccination coverage among pregnant women.

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Relationship of Hydroxychloroquine and Ophthalmic Complications in Patients with Type 2 Diabetes in Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158154 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8154

Author(s):

Hung-Chih Chen ◽

Hung-Yu Lin ◽

Michael Chia-Yen Chou ◽

Yu-Hsun Wang ◽

Pui-Ying Leong ◽

...

Keyword(s):

Type 2 Diabetes ◽

Conditional Logistic Regression ◽

Categorical Variables ◽

Control Group ◽

Case Group ◽

Research Database ◽

Continuous Variables ◽

Chi Square ◽

Increased Risk

The purpose of this study is to evaluate the relationship between hydroxychloroquine (HCQ) and diabetic retinopathy (DR) via the national health insurance research database (NHIRD) of Taiwan. All patients with newly diagnosed type 2 diabetes (n = 47,353) in the NHIRD (2000–2012) were enrolled in the study. The case group consists of participants with diabetic ophthalmic complications; 1:1 matching by age (±1 year old), sex, and diagnosis year of diabetes was used to provide an index date for the control group that corresponded to the case group (n = 5550). Chi-square test for categorical variables and Student’s t-test for continuous variables were used. Conditional logistic regression was performed to estimate the adjusted odds ratio (aOR) of DR. The total number of HCQ user was 99 patients (1.8%) in the case group and 93 patients (1.7%) in the control group. Patients with hypertension (aOR = 1.21, 95% CI = 1.11–1.31) and hyperlipidemia (aOR = 1.65, 95% CI = 1.52–1.79) significantly increased the risk of diabetic ophthalmic complications (p < 0.001). Conversely, the use of HCQ and the presence of rheumatoid diseases did not show any significance in increased risk of DR. HCQ prescription can improve systemic glycemic profile, but it does not decrease the risk of diabetic ophthalmic complications.

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The ANGPTL8 rs2278426 (C/T) Polymorphism Is Associated with Prediabetes and Type 2 Diabetes in a Han Chinese Population in Hebei Province

International Journal of Endocrinology ◽

10.1155/2020/1621239 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Guangsen Hou ◽

Yong Tang ◽

Luping Ren ◽

Yunpeng Guan ◽

Xiaoyu Hou ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chinese Population ◽

Han Chinese ◽

Hebei Province ◽

Control Group ◽

Chi Square ◽

Han Chinese Population ◽

Increased Risk ◽

Bonferroni Test

Background. Our aim was to investigate the association between the genetics of the angiopoietin protein-like 8 (ANGPTL8) rs2278426 (C/T) polymorphism with prediabetes (pre-DM) and type 2 diabetes (T2DM) in a Han Chinese population in Hebei Province, China. Methods. We enrolled 1,460 participants into this case-control study: healthy controls, n = 524; pre-DM, n = 460; and T2DM: n = 460. Ligase assays on blood samples from all participants were used to identify polymorphisms. Differences in genotype and allele distributions were compared by the chi-square test and one-way analysis of variance, and a post hoc pairwise analysis was performed using the Bonferroni test. The logistic regression technique was adjusted for age, sex, and body mass index. Results. The frequency of the TT (10.9%) genotype was significantly higher in pre-DM patients than in controls (odds ratio [OR] = 1.696, 95% confidence interval [CI] = 1.026–2.802, P = 0.039 ). In the T2DM group, the CT (48%) and TT (15%) genotypes were significantly higher compared with those in the control group (CT : OR = 1.384, 95% CI = 1.013–1.890, P = 0.041 ; TT : OR = 2.530, 95% CI = 1.476–4.334, P = 0.001 ). The frequency of the T allele was significantly higher in the pre-DM (32.8%) and T2DM (39%) groups compared with the control group (26.9%) and was significantly associated with an increased risk of pre-DM (OR = 1.253, 95% CI = 1.017–1.544, P = 0.034 ) and T2DM (OR = 1.518, 95% CI = 1.214–1.897, P = 0.001 ). Furthermore, insulin levels in the pre-DM and T2DM groups were significantly decreased in those with the TT genotype compared with the CC and CT genotypes. Conclusion. ANGPTL8 rs2278426 may be involved in the mechanism of insulin secretion and could lead to an increased risk of pre-DM and T2DM.

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Sickle Cell Trait and Renal Function in Hispanics in the United States: the Northern Manhattan Study

Ethnicity & Disease ◽

10.18865/ed.27.1.11 ◽

2017 ◽

Vol 27 (1) ◽

pp. 11 ◽

Cited By ~ 7

Author(s):

Nicole D. Dueker ◽

David Della-Morte ◽

Tatjana Rundek ◽

Ralph L. Sacco ◽

Susan H. Blanton

Keyword(s):

United States ◽

Chronic Kidney Disease ◽

African Americans ◽

Kidney Disease ◽

Sickle Cell ◽

Sickle Cell Trait ◽

The United States ◽

Genetic Mutation ◽

Single Mutation ◽

Increased Risk

Sickle cell anemia (SCA) is a common hematological disorder among individuals of African descent in the United States; the disorder results in the production of abnormal hemoglobin. It is caused by homozygosity for a genetic mutation in HBB; rs334. While the presence of a single mutation (sickle cell trait, SCT) has long been considered a benign trait, recent research suggests that SCT is associated with renal dysfunction, including a decrease in estimated glomerular filtration rate (eGFR) and increased risk of chronic kidney disease (CKD) in African Americans. It is currently unknown whether similar associations are observed in Hispanics. Therefore, our study aimed to determine if SCT is associated with mean eGFR and CKD in a sample of 340 Dominican Hispanics from the Northern Manhattan Study. Using regression analyses, we tested rs334 for association with eGFR and CKD, adjusting for age and sex. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation and CKD was defined as eGFR < 60 mL/min/1.73 m2. Within our sample, there were 16 individuals with SCT (SCT carriers). We found that SCT carriers had a mean eGFR that was 12.12 mL/min/1.73m2 lower than non-carriers (P=.002). Additionally, SCT carriers had 2.72 times higher odds of CKD compared with non-carriers (P=.09). Taken together, these novel results show that Hispanics with SCT, as found among African Americans with SCT, may also be at increased risk for kidney disease.Ethn Dis. 2017; 27(1):11-14; doi:10.18865/ed.27.1.11.

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Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Journal of Clinical Medicine ◽

10.3390/jcm10040643 ◽

2021 ◽

Vol 10 (4) ◽

pp. 643

Author(s):

Veronica Giorgione ◽

Corey Briffa ◽

Carolina Di Fabrizio ◽

Rohan Bhate ◽

Asma Khalil

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Chi Square ◽

Increased Risk ◽

Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

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Is There an Increased Risk of Haemophilus influenzae Septicemia in Children with Sickle Cell Anemia?

PEDIATRICS ◽

10.1542/peds.71.6.927 ◽

1983 ◽

Vol 71 (6) ◽

pp. 927-931

Author(s):

Darleen Powars ◽

Gary Overturf ◽

Ernest Turner

Keyword(s):

Haemophilus Influenzae ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Clinical Course ◽

Febrile Child ◽

Low Grade ◽

Upper Respiratory Tract ◽

Pneumococcal Infections ◽

Increased Risk ◽

Upper Respiratory

The risk of Haemophilus influenzae septicemia/meningitis to children who have sickle cell anemia (SS) has been determined to be greater than that seen among normal infants. Of ten bacteriologically proven cases, eight episodes of infection were observed among 234 children with sickle cell anemia (645 person-years), who were less than 5 years of age. There was one case per 69 infants with sickle cell anemia who were less than 18 months old and one case per 36 children with sickle cell anemia between 19 and 59 months of age. Unexpectedly, two infections occurred among 224 children (824 person-years), aged 5 to 9 years; both died. Contrary to the rapid clinical course of pneumococcal infections in children with sickle cell anemia H influenzae septicemia was regularly heralded by a greater than 24-hour prodrome of upper respiratory tract infection, low-grade fever, and otitis media. Three (30%) preventable deaths occurred. Antibiotic therapy for the febrile child with sickle cell anemia must be predicated on the known 400-fold increased risk of pneumococcal septicemia in those less than 5 years old and the fourfold risk of H influenzae septicemia in those less than 9 years of age.

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Lead Neuropathy and Sickle Cell Disease

PEDIATRICS ◽

10.1542/peds.54.4.438 ◽

1974 ◽

Vol 54 (4) ◽

pp. 438-441

Author(s):

Gerald Erenberg ◽

Steven S. Rinsler ◽

Bernard G. Fish

Keyword(s):

Case Report ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Lead Poisoning ◽

Cell Disease ◽

Hemoglobin S ◽

Increased Risk ◽

Rare Manifestation ◽

Poisoning In Children

Four cases of lead neuropathy in children with hemoglobin S-S or S-C disease are reported. Neuropathy is a rare manifestation of lead poisoning in children, and only ten other cases have been well documented in the pediatric literature. The last previous case report of lead neuropathy was also in a child with hemoglobin S-S disease. The neuropathy seen in the children with sickle cell disease was clinically similar to that seen in the previously reported cases in nonsicklers, but differed in both groups from that usually seen in adult cases. It is, therefore, postulated that children with sickle cell disease have an increased risk of developing neuropathy with exposure to lead. The exact mechanism for this association remains unknown, but in children with sickle cell disease presenting with symptoms or signs of peripheral weakness, the possibility of lead poisoning must be considered.

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