September 25, 2020
In This Issue

Research Spotlight:
Health care seeking behaviors of urban Black male adolescents

CPCE in the News:
Chlamydia and gonorrhea have increased among younger women, study finds

CPCE in the News:
COVID-19 News

Upcoming Events

Recent Publications
Health care seeking behaviors of urban Black male adolescents
Preventive health visits decline in the adolescent years, despite American Academy of Pediatrics (AAP) recommendations for annual visits for this age group. Among adolescents, males and racial/ethnic minorities are especially unlikely to receive preventive care, putting them at increased risk for physical and mental health problems and exacerbating disparities in rates of obesity, diabetes, sexually transmitted infection, and other chronic conditions.

A CHOP team led by George Dalembert, MD, MSHP and including Alexander Fiks, MD, MSCE sought to elicit drivers of preventive care seeking from Black male adolescents and their parents. They interviewed 23 Black male adolescents, ages 13 – 18, who had at least a two year lapse in preventive care visits, and 22 parents (20 mothers and two fathers). The team identified four themes reflective of preventive care seeking behavior:

  1. Receiving preventive care is important to knowing the teen is mentally and physically well.
  2. Ensuring that teens receive preventive care is part of the responsibility of a “good” parent.
  3. Males, in general, are disengaged from health care. Mothers are often the drivers of adolescent and family participation in well visits.
  4. Remembering well visits is hard, particularly among life’s many obligations. Reminders are helpful.

Interestingly, there was general agreement among parent and teen participants. Results suggest that visit reminders may be most effective if they are directed at mothers and emphasize the importance of well visits for teen mental and physical health.

“Due to the anxiety caused by COVID-19, the pandemic has had a detrimental effect on preventive care- seeking that would potentially provide resources for coping,” Dr. Dalembert said in a recent CHOP Research Institute Cornerstone blog post. “As adolescents and their caregivers think receiving preventive care is important to knowing teens are mentally and physically well, it’s potentially more helpful than ever to think about the barriers and facilitators of receiving preventive services and design disparities-mitigating interventions that incorporate their insights.”

Further research is needed to test the impact of reminders on receipt of care in this population. 
Chlamydia and gonorrhea have increased among younger women, study finds

CPCE and PolicyLab Core Faculty member Sarah Wood, MD, MSHP commented on a research study conducted outside of CHOP that found increasing rates of chlamydia and gonorrhea among women ages 18-30 in the United States. Dr. Wood took the opportunity to discuss the importance of annual STI testing, as testing can lead to discussions about safe sex practices and general reproductive health. “When we think about STIs, we’re never thinking about just the one individual,” she said in the Philadelphia Inquirer. “We’re thinking about their partner and their partner’s partners. When we catch early infections, we may identify young men who need to come in and get treated as well.” Patients in their late teens and early 20s are especially vulnerable because of the transition from pediatrics to adult care, Dr. Wood added.
COVID-19 News

Centre County, Pennsylvania saw an increase of COVID-19 cases with the return of students to Penn State University. David Rubin, MD, MSCE discussed this trend with Centre Daily Times. “I would not ignore these trends in these areas around University Park and State College because I do think there’s clear, consistent information here in multiple counties that the center of the state has heated up a bit,” he said on September 10. In a September 19 update he suggested there would be a clearer picture of how the county is managing the spread of the disease by around the end of the month.

Meanwhile in the Philadelphia region, there may be a limited window of opportunity for schools to reopen, at least with some capacity, as reported in the Philadelphia Inquirer.

Nationwide, the pandemic has exposed structural racism and underinvestment in public schools, wrote Dr. Rubin, Meredith Matone, DrPH, MHS and Susan Coffin, MD, MPH along with Meira Levinson, PhD of the Harvard University Graduate School of Education for The Washington Post. They advocate for bold investments in COVID-19 testing capacity, school infrastructure to improve ventilation, and access to paid leave and other financial incentives for public school teachers and staff, as well as parents.

See more at our COVID-19 News page.
Upcoming Events

Talking About PTSD: Improving Communication and Care for Refugee Patients
Date: September 29, 2020
Time: 3:00 - 4:00 pm
Join PolicyLab for a discussion with refugee community leaders, refugee health care providers, mental health experts, and medical interpreters who will discuss the challenges of communicating mental health treatment options across language and cultural differences and how new resources can help foster better communication between clinicians, professional medical interpreters and refugee patients. For more information, click here.

Underrepresented in Medicine (UIM) in Academic Pediatrics
Date: September 29, 2020
Time: 4:00 pm
Featuring Gabrina Dixon, Associate Professor of Pediatrics, Children's National Hospital, The George Washington University. Brought to you by the Academic Pediatrics Association (APA)'s Qualitative Research Special Interest Group. Hear Dr. Dixon discuss her qualitative research exploring why medical students and faculty who are underrepresented in medicine (UIM) enter the field of academic pediatrics. This event aims to discuss the following two articles with a focus on the key findings, qualitative methods, and next steps to explore further. And, you can ask the author your questions!
Register for the Zoom meeting here.

Cancer and COVID-19: Update from Penn's Abramson Cancer Center
Date: September 30, 2020
Time: 6:00 - 8:45 pm
This activity is designed to focus on the major areas in which the COVID-19 pandemic has impacted how cancer care is delivered and experienced by patients. Participate in this live webcast and join the discussion on this fast moving subject while gaining up-to-date, practical information with immediate clinical and operational application. Anthony S. Fauci, MD, Director NIAID and Founding Member of the White House Coronavirus Task Force, will deliver a keynote address. Learn more and register here.

12th Annual Fighting Asthma Disparities Summit
Date: October 1, 2020
Time: 8:15 am - 1:30 pm
The Virtual 12th Annual Fighting Asthma Disparities Summit will build on existing knowledge and experience with a deeper discussion on health inequities in childhood asthma. Experts will share lessons learned from implementing a patient-centered approach to asthma management in diverse populations. Register here.

CPCE/PolicyLab Seminar: Scientific Writing: Breaking Down the Workflow into Manageable Steps
Date: October 2, 2020
Time: 12:00 - 1:00 pm
Presented by Chris Feudtner, MD, PhD, MPH. Join via BlueJeans.

American Academy of Pediatrics Virtual National Conference & Exhibition
Dates: October 2-5, 2020
The 2020 AAP Virtual National Conference program includes over 150 on-demand sessions and more than 35 live sessions taught by world-class faculty. Learn more and register here. See the list of CHOP presenters here.

International Workshop on Microbiome in HIV Pathogenesis, Prevention, and Treatment 2020
Dates: October 7-8, 2020
The virtual edition will provide an immersive experience to all participants through an interactive platform for real-time Q&A sessions and roundtables to fuel inspiring discussions that will move the microbiome and HIV interaction field forward. Learn more and register here.

Fels Public Policy in Practice Speaker Series featuring Dr. Rachel Levine
Date: October 8, 2020
Time: 6:00 - 7:00 pm
Please join the University of Pennsylvania's Fels Institute of Government for a virtual conversation with Dr. Rachel Levine, Secretary of the PA Department of Health. Learn more and register here.

CHOP Global Health Virtual Conference
Dates: October 9-10, 2020
The 2020 12th Annual CHOP Global Health Conference will explore how politics, governance, and leadership affect global child health. In low-, middle-, and high-income countries around the world, these key factors influence health systems in powerful ways, and affect healthcare delivery. This meeting will bring policy, political science and global child health experts together to share approaches for working with and within various political systems to positively impact child health. The meeting will also challenge and equip attendees to become advocates for child health within their own systems at the local, national, and international levels. Learn more and register here.

How Epidemics Show Us Who We Are: From HIV/AIDS to COVID-19
Date: October 14, 2020
Time: 4:30 - 6:00 pm
Join the Drexel University Dornsife School of Public Health for the virtual Jonathan Mann Health and Human Rights Memorial Lecture 2020 featuring Mary T. Bassett, MD, MPH, who has dedicated her career to advancing health equity. Learn more and register here.

Diagnostic Error in Medicine 13th Annual International Conference (SIDM2020)
Dates: October 19-21, 2020
Join researchers, educators, clinicians and patients to learn about the latest work to drive diagnostic quality and safety. Virtual education events will include keynotes, breakout sessions, oral abstracts, and poster sessions. Learn more and register here.

IDWeek 2020
Dates: October 21-25, 2020
Given the evolving global pandemic, IDWeek organizers have made the unanimous decision to convert the meeting to a 100% virtual event. Receive the latest updates on COVID-19 and other infectious diseases through an exciting and content-rich virtual program. Learn more about the virtual program or register now. Anthony S. Fauci, MD, FIDSA will deliver the opening presentation during the Chasing the Sun event on Oct. 21 at 10 a.m. ET.
Recent Publications

Population-specific reference data are required to interpret growth measurements in children. Sitting height and leg length measurements are indicators of proportionality and can be used to evaluate children with disordered growth. Sogol Mostoufi-Moab, MD, MSCE and her research team developed separate sitting height and leg length reference charts for Non-Hispanic Black, Non-Hispanic White, and Mexican-American children in the United States.

Sage Myers, MD, MSCE is among the authors of a study linking episodes of diabetic ketoacidosis and cognitive problems. The study leveraged the Pediatric Emergency Care Applied Research Network (PECARN). The study enrolled 758 children, 6–18 years old, who presented with DKA in a randomized multisite clinical trial evaluating intravenous fluid protocols for DKA treatment. A total of 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2–6 months after the DKA episode. A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.

Multisystem inflammatory syndrome in children (MIS-C) is an illness that resembles Kawasaki Disease (KD) or toxic shock, reported in children with a recent history of COVID-19 infection. Joseph W. Rossano, MD, MS and his colleagues ran a retrospective study to analyze echocardiographic manifestations in MIS-C. In their cohort of MIS-C patients, left ventricular systolic and diastolic function were worse than in classic KD. These functional parameters correlated with biomarkers of myocardial injury. However, coronary arteries were typically spared. The strongest predictors of myocardial injury were global longitudinal strain, right ventricular strain, and left atrial strain. During subacute period, there was good recovery of systolic function, but diastolic dysfunction persisted.

Hansel Otero, MD and colleagues wrote a commentary on the how the economic and social effects of the COVID-19 pandemic have shifted how radiologists work and teach. The upheaval that defined the first half of 2020 has created a new landscape, however, one in which long-standing barriers and silos have crumbled. With this new vista comes an historic opportunity, they argue, to restructure pediatric radiology educational efforts to be more efficient, effective, cooperative and inclusive, both domestically and globally.

Infants in the neonatal intensive care unit (NICU) are particularly susceptible to healthcare-associated infections (HAIs). NICUs in low- and middle income countries face additional challenges to HAI prevention. Researchers including Susan Coffin, MD, MPH conducted semi-structured interviews with NICU staff during a prospective cohort study to better understand the role of the implementation context surrounding infection prevention interventions in low- and middle income countries. By eliciting healthcare worker perceptions about the context surrounding an infection prevention intervention, their study identified key organizational and societal factors to inform implementation strategies to achieve sustained improvement.

Youth with systemic lupus erythematosus (SLE) experience high rates of psychiatric comorbidities, which may affect medication adherence. Joyce Chang, MD, MSCE and colleagues examined the association between psychiatric disorders and hydroxychloroquine adherence and determined whether psychiatric treatment modifies this association. Their results showed that the impact of psychiatric disorders on medication adherence differed by whether youth had received psychiatric treatment. Improving recognition and treatment of psychiatric conditions may increase adherence in youth with SLE.

Juvenile spondyloarthritis (JSpA) represents a group of inflammatory arthritides with several distinctive features (enthesitis, involvement of spine and sacroiliac joint, HLA-B27 association and development of uveitis). There are limited data on the course of uveitis in children with JSpA. Pamela Weiss, MD, MSCE, Timothy Brandon, MPH, and their team ran a cross sectional/retrospective study to estimate the prevalence of uveitis and to look at the presence of HLA-B27 in relation to uveitis occurrence and ocular symptoms in a cohort of JSpA patients. About one-tenth of patients developed uveitis, the majority of which was symptomatic. Fewer than half of the patients with uveitis were HLA-B27 positive. HLA-B27 status was not statistically associated with either the development of uveitis or symptomaticity of uveitis.

Researchers including Hansel Otero, MD sought to determine the feasibility of using contrast-enhanced ultrasound (CEUS) evaluation to determine thoracic duct (TD) outlet patency. Nine patients referred for lymphatic imaging and intervention underwent percutaneous intranodal ultrasound contrast injection and conventional lymphangiography (CL). Eight of 9 patients had a patent TD by CEUS and CL. One patient did not have a patent TD. There was 100% agreement between CEUS and CL. These results suggest that CEUS is an imaging modality that might be as accurate as CL in determining TD patency.

Although COVID-19 is a mild infection in most children, a small proportion develop severe or critical illness. Data evaluating agents with potential antiviral activity continue to expand, such that updated guidance is needed regarding use of these agents in children. Kathleen Chiotos, MD, MSCE, Kevin Downes, MD and colleagues convened a panel of pediatric infectious disease physicians and pharmacists to develop a set of guidance statements based on best available evidence and expert opinion. Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For children with severe or critical disease, this guidance offers an approach for decision-making regarding use of remdesivir.

About CPCE

We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.

CPCE E-News is edited by Holly Burnside. Please feel free to contact us with questions or feedback.