BACKGROUND:In solid organ transplant patients, non-participation in all aspects of the medical regimen is a prevalent problem associated with adverse consequences particularly in the adolescent and young adult (AYA) age group. This study is the first to evaluate the feasibility, utility and impact of a text messaging (TM) intervention to improve participation in laboratory testing in adolescent liver transplant patients.METHODS:AYA patients, aged 12 to 21 years, were recruited for a prospective pilot trial evaluating a TM intervention delivered over a 1-year period. The intervention involved automated TM reminders with feedback administered according to a prescribed laboratory testing frequency. Participation rate in laboratory testing after the intervention was compared to the year prior. Patient responses and feedback by text and survey were used to assess feasibility, acceptability and use of the intervention.RESULTS:Forty-two patients were recruited and 33 patients remained enrolled for the study duration. Recipients of the TM intervention demonstrated a significant improvement in participation rate in laboratory testing from 58% to 78% (P<.001). This rate was also significantly higher than in non-intervention controls (P=.003). There was a high acceptability, response rate and a significant correlation with reported versus actual completion of laboratory tests by TM.CONCLUSIONS:TM reminders significantly improved participation in laboratory testing in AYA liver transplant patients. The intervention demonstrated feasibility, acceptability, and use with a high proportion of patients who engaged in and perceived a benefit from using this technology.

This study’s purpose was to identify distinct publishing trajectories among 442 participants in three prominent mentored health services research career development programs (Veterans Affairs, National Institutes of Health, and Agency for Healthcare Research & Quality) in the 10 years after award receipt and to examine awardee characteristics associated with different trajectories. Curricula vitae (CVs) of researchers receiving awards between 1991 and 2010 were coded for publications, grants, and awardee characteristics. We found that awardees published at constant or increasing rates despite flat or decreasing rates of first-author publications. Senior-author publications rose concurrently with rates of overall publications. Higher overall publication trajectories were associated with receiving more grants, more citations as measured by the h-index, and more authors per article. Lower trajectory groups were older and had a greater proportion of female awardees. Career development awards supported researchers who generally published successfully, but trajectories varied across individual researchers. Researchers’ collaborative efforts produced an increasing number of articles, whereas first author articles were written at a more consistent rate. Career development awards in health services research supported the careers of researchers who published at a high rate; future research should further examine reasons for variation in publishing among early career researchers.

Background: Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users. Objective: To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life. Methods: We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores. Results: We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m2; 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores. Conclusions: Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors.

To address the critical shortage of physician scientists in the field of adolescent medicine, a conference of academic leaders and representatives from foundations, National Institutes of Health, Maternal and Child Health Bureau, and the American Board of Pediatrics was convened to discuss training in transdisciplinary research, facilitators and barriers of successful career trajectories, models of training, and mentorship. The following eight recommendations were made to improve training and career development: incorporate more teaching and mentoring on adolescent health research in medical schools; explore opportunities and electives to enhance clinical and research training of residents in adolescent health; broaden educational goals for Adolescent Medicine fellowship research training and develop an intensive transdisciplinary research track; redesign the career pathway for the development of faculty physician scientists transitioning from fellowship to faculty positions; expand formal collaborations between Leadership Education in Adolescent Health/other Adolescent Medicine Fellowship Programs and federal, foundation, and institutional programs; develop research forums at national meetings and opportunities for critical feedback and mentoring across programs; educate Institutional Review Boards about special requirements for high quality adolescent health research; and address the trainee and faculty career development issues specific to women and minorities to enhance opportunities for academic success. (C) 2010 Society for Adolescent Medicine. All rights reserved.

This study examined the prevalence, demographic variables and adverse outcomes associated with non-adherence to post-transplant care in adolescent liver transplant recipients. We conducted a retrospective chart review of 111 adolescent patients (age 12-21 yr) greater than six months post-transplantation and defined non-adherence as not taking the immunosuppressive(s) or not attending any clinic visit in 2005. Fifty subjects (45.0%) were non-adherent and 61 (55.0%) were adherent. Twenty percent of the subjects did not attend clinic and 10.9% did not complete laboratory tests. Non-adherence was significantly associated with fewer completed laboratory tests (p < 0.0001), single parent status (p < 0.0186), and older age and greater years post-transplantation by both univariate and multivariate analyses (p < 0.008, p < 0.0141 and p < 0.0012, p < 0.0174, respectively). Non-adherence to medication was significantly associated with a rejection episode in 31 patients (p < 0.0069) but not in the subgroup of seven patients who stopped their immunosuppression completely. Non-adherence to post-transplant care is a prevalent problem in adolescents particularly of an older age and greater years post-transplantation. Rejection was a significant consequence of medication non-adherence except in a subgroup with presumed graft tolerance who discontinued their immunosuppression. These results emphasize the need for strict monitoring of adherence to post-transplant care to improve long-term survival and quality of life in adolescent transplant patients.

OBJECTIVE. Pro–eating disorder Web sites are communities of individuals who engage in disordered eating and use the Internet to discuss their activities. Pro-recovery sites, which are less numerous, express a recovery-oriented perspective. This pilot study investigated the awareness and usage of pro–eating disorder Web sites among adolescents with eating disorders and their parents and explored associations with health and quality of life. PATIENTS AND METHODS. This was a cross-sectional study of 698 families of patients (aged 10–22 years) diagnosed with an eating disorder at Stanford between 1997 and 2004. Anonymous surveys were mailed and offered in clinic. Survey content included questions about disease severity, health outcomes, Web site usage, and parental knowledge of eating disorder Web site usage. RESULTS. Surveys were returned by 182 individuals: 76 patients and 106 parents. Parents frequently (52.8%) were aware of pro–eating disorder sites, but an equal number did not know whether their child visited these sites, and only 27.6% had discussed them with their child. Most (62.5%) parents, however, did not know about pro-recovery sites. Forty-one percent of patients visited pro-recovery sites, 35.5% visited pro–eating disorder sites, 25.0% visited both, and 48.7% visited neither. While visiting pro–eating disorder sites, 96.0% reported learning new weight loss or purging techniques. However, 46.4% of pro-recovery site visitors also learned new techniques. Pro–eating disorder site users did not differ from nonusers in health outcomes but reported spending less time on school or schoolwork and had a longer duration of illness. Users of both pro–eating disorder and pro-recovery sites were hospitalized more than users of neither site. CONCLUSIONS. Pro–eating disorder site usage was prevalent among adolescents with eating disorders, yet parents had little knowledge of this. Although use of these sites was not associated with other health outcomes, usage may have a negative impact on quality of life and result in adolescents’ learning about and adopting disordered eating behaviors.

Background: Non-adherence is reported as a common behavior in adolescent transplant recipients. Yet, the prevalence, morbidity and mortality associated with this behavior is poorly described and understood in the pediatric liver transplant population. Aim: To determine the prevalence and adverse consequences associated with non-adherence to immunosuppressive therapy in the adolescent liver transplant population. Methods: We reviewed the charts of ninety-eight patients from 1987 to 2002 who by December of 2002 had survived at least one year post-transplant and were followed by the Pediatric Liver Transplant Service at any point during their adolescent period (ages of 12-21). Non-adherence was defined as the voluntary admission of non-adherence by the patient or reported non-adherence by a parent or heath care provider. Results: Using the inclusion criteria, a total of 97 patients represented the study sample. 37 subjects (38.1%) were defined as non-adherent and 60 (61.8%) were adherent. Non-adherence was significantly associated with episodes of late acute rejection (P < .025) and with episodes of late acute rejection as an adolescent (<.001). Non-adherence was also significantly associated with re-transplantation and death secondary to chronic rejection (P < .01, P < .025 respectively) using Chi-square analysis. Conclusions: Non-adherence to immunosuppressive therapy is a prevalent problem in the adolescent liver transplant population. The greater incidence of late acute rejection, and death and re-transplantation owing to chronic rejection in non-adherent patients suggests that non-adherence is significantly associated with an increased risk of morbidity and mortality. Further investigation of this issue is necessary to identify risk factors to design the most effective intervention to address this problematic behavior and to increase patient survival and well-being.

We assessed the relationship between outcomes at one year and a variety of possible predictors among a group of adolescents who were hospitalized for medical complications associated with adolescent onset AN. We reviewed the 12 month outcomes of 41 adolescent patients admitted for medical complications associated with AN to our center. Data on initial percent ideal body weight, length of initial hospitalization, and percent ideal body weight at discharge from first admission were collected. Our primary outcome measure was percent ideal body weight obtained 12 months after initial discharge. Using multiple linear regression to predict percent ideal body weight achieved at 12 months postdischarge, we found that only percent of ideal body weight at discharge predicted better outcomes. Response to initial hospitalization in terms of weight gain, rather than admission weight or length of initial hospital stay, predict better outcomes at 12 months. These results suggest the need for further study of predictors of response to intensive hospital treatment in order to improve initial response rates and ultimately to better outcomes postdischarge.

No, this isn’t about cyclophosphamide or steroids, nor even about broken romances, but rather the issue of manuscript rejection. To some, this is insignificant compared with life and death matters heretofore noted, but to others, manuscript rejection is experienced as a major life event. This may be understandable in the world of academia in which appointments and promotions depend heavily on research productivity often measured by the number (if not quality) of publications in peer-reviewed journals. Reactions vary by personality and even gender, in my experience, with men tending to blame the editor and women, themselves. Some respond by immediately sending the unchanged paper to another journal, others address reviewers’ comments in revision while others commit the work to a bottom drawer. While the second seems the most prudent reaction, it is not at all uncommon to see the first and third. In order to better understand the phenomenon, it may be helpful to know why manuscripts are rejected. The most obvious is that the reviewer’s comments and/or editorial review reveal uncorrectable flaws in research design and methodology. Often, however, the reason for rejection has nothing to do with the quality of the manuscript! Remember that editors are constrained by page limitations imposed by the economics of publication of paper journals. They must consider not only the merits of a given paper but also the overall balance of subject matter and the interests of the journal’s readership. As an example, a perfectly fine manuscript may be rejected simply because the subject has been recently addressed or, in the judgement of the reviewers and/or editors, would not be of general interest to the target audience. It is not surprising, therefore, that about three-quarters of submitted manuscripts ultimately get published. The origin of this figure is unclear but is often stated when journal editors get together. It prompted me to investigate the situation with regard to the Journal of Adolescent Health. Accordingly, I obtained the data for the l84 manuscripts rejected in the year 2000 and did a PubMed search in early 2002 to see how many had been published in other journals by that time. I used the name of the corresponding author and identified titles that were identical or sufficiently similar to suggest that they were the same manuscripts. I did not read the actual manuscript to determine if our reviewers’ and/or editorial comments had been addressed or if there had been any revisions made. I found that in the period that had elapsed since JAH rejection, 14 manuscripts (7%) had been published elsewhere. Further investigation showed that, of these, 28% appeared in international journals; 21% in public health journals; 21% in general pediatric journals; 14% in specialty journals (e.g. infectious disease and psychiatry/psychology); and the remainder in a variety of others. There are many caveats to this mini-study. It would surely not pass “peer-review” were it a submitted manuscript! It is likely that the time frame for follow-up is too short and that other manuscripts will be published subsequently. I am committed to continuing to track them and will report on the findings in a year’s time. It is also possible that some were missed probably owing to their publication in journals not captured by PubMed (e.g. some behavioral/social science publications). It is also possible that titles were changed so radically that I did not recognize them, although this is less likely as I did read the abstracts. Despite these limitations, the findings may be helpful in encouraging authors not to personalize manuscript rejection, but rather to consider revision and resubmission to another journal, perhaps one with a different audience or orientation. They also deliver a message to editors to reconsider our terminology. Perhaps a better term for us to use in the letter indicating that a manuscript has not been accepted for publication instead of “reject” would be “decline”! Respectfully submitted,

The medical student presents the new admission on Rounds: “This is a l6-year-old Black male…” Why do you state his race? Does it matter?,“ I interrupt. What follows may be a reasoned discussion of the risk factors for his hypertension of which one is being African-American. Often, however, there is no known association between the patient’s race and the differential diagnosis. Similarly, in research papers, demographic characteristics of the study population are presented and analyses provided which may draw conclusions about associations between them and risk factors. Recent discussions in the scientific literature and at meetings of editorial boards (including that of the Journal of Adolescent Health) have called into question this common practice. Concern has been appropriately expressed about the possible stigmatization of a racial group should risk factors be reported to be more common in that group. Given the United Nations conference on racism taking place as I write this, it is particularly timely that old practices be re-examined in light of new information. Just as in the case of calling into question the ”tradition“ of reporting the patients race in a case presentation, we must ask ourselves what may be the risks as well as benefits of reporting of race in scientific publications. We must be especially cautious not to attribute a finding to race without controlling for socioeconomic status, a frequent confounder. In the field of Adolescent Health, the literature is replete with reports of racial minority groups being at higher risk for delinquency, pregnancy, and sexually transmitted disease to name but a few. Dissemination of such data may result in prejudicial attitudes or practices which are potentially dangerous. On the other hand, we have also learned from race-specific reports published in this Journal that black parents are more likely to more effectively monitor the behavior of their teens, that black teens are less likely to abuse cigarettes and to binge drink and that black teenaged women have better self-image and a lower incidence of eating disorders than white teens. These data paint a very different picture of minority teens that might not otherwise have been known, were the data not analyzed and reported by race. David Satcher, M.D., the Surgeon General of the United Sates this week presented data on the health problems of Blacks and called for attention to their effective remediation. To be able to evaluate the impact of resulting governmental interventions that will result from this, it will be important to be able to monitor disease and risk prevalence by race to track hoped-for improvement. It was only a decade ago that the medical community first realized how little was known about the health problems of women because until l990, research studies often failed to include female subjects. When they had been included, it was rare that data were separately reported by gender. For example, it is only recently that we have learned that heart disease, not breast cancer, is the leading cause of death for women. The special health problems of adolescent females have been long ignored because of our failure to present gender-specific data for this age group except for those related to sexuality (e.g. pregnancy, sexually transmitted diseases, etc.). Before we change the practice of reporting race in research articles, I urge consideration of what may be gained or lost in each instance. We must ask ourselves each time, Why do you report (or not) the race? Does it matter?

Introduction Part I. Life-span Differences in Health Issues for Women: 1. Adolescence 2. Early childhood 3. The perimenopausal years 4. The older years Part II. Special Health Issues for Women: 5. Sexually transmitted diseases 6. Pregnancy and its prevention 7. Mental health 8. Substance abuse 9. Violence 10. Nutrition and exercise Part III. Health Policy Issues for Women: 11. Medical care of women in the United States 12. Women as doctors 13. Choosing the right physician 14. Research in women's health Appendixes References Index.

The purview of pediatrics includes the growth, development, and health of the child and therefore begins in the period before birth when conception is apparent. It continues through childhood and adolescence when the growth and developmental processes are generally completed. The responsibility of pediatrics therefore may begin during pregnancy and usually terminates by 21 years of age.1 Short and concise, yet this Statement developed by the Council on Child Health of the American Academy of Pediatrics (AAP) and published in 1972 had a monumental impact on the health of teenagers, as well as on the practice of pediatrics. An earlier position of the AAP (1938) had defined the upper limits of pediatric practice to extend “well into adolescence.”2 Although some pediatricians at the time were seeing early adolescents, many chose to discontinue care for patients who were approximately 12 years of age. The age cutoff for admission to hospital pediatric services was 14 years. It is noteworthy that in 1969, the Council on Child Health had been charged with updating this position. What transpired in the 3 years that intervened reflects perceptions about the respective practice domains of the other specialties, as well as changing views about the health of adolescents. According to those close to the debates that took place, the Statement went …

Risk factors for the initiation of cigarette smoking were examined in 2 consecutive cohorts of teenagers (N = 1,901). Students in Cohort 1 were followed over 4 years from 9th to 12th grade; those in Cohort 2 were followed over 3 years from 9th to 11th grade. Among girls with no history of smoking at baseline, those with more friends who smoked at baseline (p < .001) and those with higher sociability scores (p < .05) were significantly more likely to have tried smoking over the study interval. Among boys with no history of smoking at baseline, those with more friends who smoked at baseline (p < .05) and those with higher depression symptoms scores (p < .01) were significantly more likely to have tried smoking over the study interval. The data suggest that future research is needed to examine potential gender differences that may have implications for the next generation of smoking-prevention programs.