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Lindsay SF, Woodhams EJ, White KO, Drainoni ML, Johnson NL, Yinusa-Nyahkoon L. Understanding Barriers to Contraception Screening and Referral in Female Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 9:63-71. [PMID: 31634022 DOI: 10.1089/jayao.2019.0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Contraception screening and referral occur infrequently in cancer care for young women of reproductive age. Barriers to contraception screening and referral in this setting have not been thoroughly identified. Objectives: We sought to understand oncology clinicians' current practices and perceptions of barriers to screening and referring young women for adequate contraception during cancer treatment. Methods: We conducted individual semi-structured interviews with 19 oncology clinicians whom we recruited from an urban, northeast medical center. Participants included physicians, advanced practice clinicians, and nurses in surgical and medical oncology. The interview guide addressed core components of the Promoting Action on Research Implementation in Health Services framework, and subsequent directed content analysis identified themes indicative of barriers to contraception screening and referral. Findings: Participants varied significantly in their current contraception screening practices; many conflated early pregnancy diagnosis or pregnancy avoidance counseling with contraception, whereas others described inaccurate contraceptive recommendations for specific clinical scenarios. Participants also lacked clarity of roles and responsibilities within the oncologic care team for contraception and assumed that another team member had addressed contraception. Participants perceived themselves to lack adequate education about contraception, which precluded contraception discussions. Conclusion: We recommend cancer centers consider these possible barriers to contraception screening and referral by promoting development of institutional guidelines to standardize contraception screening and referral, clarifying roles and responsibilities for contraception discussions within the care team, and expanding oncology clinician education on contraception. National professional organizations should work to expand guidelines to inform and support this process in clinical practice.
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Affiliation(s)
- Sarah F Lindsay
- Department of Obstetrics and Gynecology, Hartford Healthcare Medical Group, Hartford, Connecticut.,Department of Obstetrics and Gynecology, UConn Health, Farmington, CT
| | - Elisabeth J Woodhams
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | - Katharine O White
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | - Mari-Lynn Drainoni
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Natrina L Johnson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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52
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Close AG, Ghuman A, Friehling E, Hamm M, Frederick NN, Miller E, Kazmerski TM. Experiences with Menses and Menstrual Suppression of Young Women with a History of Cancer. J Adolesc Young Adult Oncol 2019; 9:23-29. [PMID: 31592736 DOI: 10.1089/jayao.2019.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Adolescent and young adult (AYA) women undergoing multiagent chemotherapy are at risk for heavy menstrual bleeding (HMB). There is a paucity of data on the experiences with menses of AYA women with cancer, their risk for HMB, and how they perceive menstrual suppression. Objective: This study aimed to (1) describe the attitudes and experiences of AYA women with a history of cancer regarding their menses and menstrual suppression and to (2) investigate facilitators and barriers to improve this aspect of oncologic care. Design/Methods: AYA women with a history of cancer completed individual semistructured interviews regarding their experiences, attitudes, and preferences around menstrual health. Two independent reviewers conducted a thematic analysis of transcribed interviews to elicit major themes. Results: We interviewed 20 young women with a history of cancer (mean age 19.9 years) who were treated with chemotherapy within the past 5 years. Themes included the following: (1) negative feelings and worry about menstrual bleeding; (2) positive attitudes toward menstrual suppression; (3) misconceptions about menstrual health; and (4) desire for tailored discussions about menstrual suppression. Conclusions: AYA women with a cancer history elucidate clear opinions regarding menstruation during chemotherapy, and many hold misconceptions regarding menses and menstrual suppression. Enhanced patient-provider communication and patient educational resources around menstrual health and menstrual suppression are needed to improve comprehensive oncologic care during chemotherapy.
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Affiliation(s)
- Allison G Close
- Division of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amita Ghuman
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erika Friehling
- Division of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Megan Hamm
- Director of Qualitative, Evaluation, and Stakeholder Engagement Research Services, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natasha N Frederick
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania
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53
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Fertility preservation in patients with hematologic malignancies and recipients of hematopoietic cell transplants. Blood 2019; 134:746-760. [PMID: 31292116 DOI: 10.1182/blood.2018846790] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/30/2019] [Indexed: 02/07/2023] Open
Abstract
Patients with hematologic malignancies and those undergoing hematopoietic cell transplantation (HCT) face a complex set of challenges when considering options for fertility preservation (FP). There are no standard options for prepubertal children, and women with hematologic malignancies may not be eligible for standard FP options. Fortunately, initial therapies for most blood cancers are not highly gonadotoxic, affording an important opportunity for postremission counseling and referrals to fertility specialists. These patients face a high risk of relapse, and many will be referred for autologous or allogeneic HCT, which carries an extremely high risk of infertility. The expanding indications for HCT to include benign hematologic disorders as well as autoimmune diseases mandate that all hematologists are familiar with these risks. Oncofertility researchers are continually pushing the boundaries of what may be possible for our patients; in the meantime, communication and shared decision-making between hematologists and patients, as well as program-building, education, and outreach are essential to ensure that these patients, many of whom will be cured, maintain all of their options for a fulfilling life after intensive therapy.
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54
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Frederick NN, Revette A, Michaud A, Bober SL. A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients. Pediatr Blood Cancer 2019; 66:e27673. [PMID: 30767372 DOI: 10.1002/pbc.27673] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adolescent and young adult patients with cancer (AYAs) identify sexual and reproductive health (SRH) as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to explore AYA perceptions and experiences of SRH communication with oncology clinicians. METHODS Twenty-three AYA patients and survivors ages 15-25 years from a large academic oncology center participated in semistructured qualitative interviews investigating their experiences discussing SRH issues, including specific topics discussed, conversation barriers and facilitators, suggestions for clinicians on how to improve conversations, and education and resource needs. Interviews were audio recorded, transcribed, and coded using a thematic analysis approach. RESULTS Interviews with AYAs revealed two primary themes-a need for oncology clinicians to discuss SRH and critical gaps in current SRH communication practices. AYAs reported a need for improved SRH communication for the purposes of general education, addressing specific SRH issues experienced, and understanding the long-term impact of cancer and treatment on SRH. The current communication gaps are exacerbated by patient discomfort initiating conversations and the presence of family members. AYAs shared six key recommendations for clinicians on how to improve SRH communication. CONCLUSIONS AYAs identify a role for oncology clinicians in discussing SRH as a primary aspect of comprehensive health care during cancer treatment and in survivorship; however, multiple gaps and barriers interfere with such discussions. Future efforts must focus on clinician education and training in SRH as well as education and intervention opportunities for AYAs to optimize the care provided.
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Affiliation(s)
- Natasha N Frederick
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Anna Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alexis Michaud
- Perini Family Survivors Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sharon L Bober
- Perini Family Survivors Center, Dana-Farber Cancer Institute, Boston, Massachusetts
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55
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Bober SL, Michaud AL, Recklitis CJ. Finding sexual health aids after cancer: are cancer centers supporting survivors' needs? J Cancer Surviv 2019; 13:224-230. [PMID: 30815783 DOI: 10.1007/s11764-019-00744-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Sexual dysfunction is one of the most prevalent and distressing treatment-related side effects for both male and female cancer survivors. Survivorship care guidelines recommend therapeutic sexual aids to help improve sexual problems. However, little is known about the availability of sexual aids and resources at cancer centers. METHODS Twenty-five comprehensive cancer centers affiliated with both the National Cancer Institute and the National Comprehensive Care Network were surveyed using the "mystery shopper" method to determine whether various types of sexual aids were available at the centers. Staffs from cancer center staff retail stores and patient boutiques were queried in separate telephone calls regarding the availability of these aids for and women. RESULTS Of the 25 centers contacted, 23 (92%) responded about aids for men, and 22 (88%) responded about aids for women. Eighty-seven percent of the centers reported having no sexual aids available for men, and 72% of centers reported having no aids available for women. The most common advice given to mystery shoppers was a suggestion to use the internet. Only one center had numerous aids/resources for both men and women. CONCLUSIONS The large majority of cancer centers reported having no sexual aids or other sexual health resources available for men or women. IMPLICATIONS FOR CANCER SURVIVORS Results underscore the widespread lack of resources to promote sexual health rehabilitation at major cancer centers, both for male and female survivors.
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Affiliation(s)
- Sharon L Bober
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
| | - Alexis L Michaud
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
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56
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Takae S, Lee JR, Mahajan N, Wiweko B, Sukcharoen N, Novero V, Anazodo AC, Gook D, Tzeng CR, Doo AK, Li W, Le CTM, Di W, Chian RC, Kim SH, Suzuki N. Fertility Preservation for Child and Adolescent Cancer Patients in Asian Countries. Front Endocrinol (Lausanne) 2019; 10:655. [PMID: 31681163 PMCID: PMC6804405 DOI: 10.3389/fendo.2019.00655] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/09/2019] [Indexed: 12/31/2022] Open
Abstract
Background: At present, fertility is one of the main concerns of young cancer patients. Following this trend, "fertility preservation (FP)" has been established and has become a new field of reproductive medicine. However, FP for child and adolescent (C-A) cancer patients is still developing, even in advanced countries. The aim of the present study was to assess the barriers to FP for C-A patients by investigating the current status of FP for C-A patients in Asian countries, which just have started FP activities. Method: A questionnaire survey of founding members of the Asian Society for Fertility Preservation (ASFP) was conducted in November 2018. Main findings: Of the 14 countries, 11 country representatives replied to this survey. FP for C-A patients is still developing in Asian countries, even in Australia, Japan, and Korea, which have organizations or academic societies specialized for FP. In all countries that replied to the present survey, the patients can receive embryo cryopreservation (EC), oocyte cryopreservation (OC), and sperm cryopreservation (SC) as FP. Compared with ovarian tissue cryopreservation (OTC), testicular tissue cryopreservation (TTC) is an uncommon FP treatment because of its still extremely experimental status (7 of 11 countries provide it). Most Asian countries can provide FP for C-A patients in terms of medical technology, but most have factors inhibiting to promote FP for C-A patients, due to lack of sufficient experience and an established system promoting FP for C-A patients. "Don't know how to provide FP treatment for C-A" is a major barrier. Also, low recognition in society and among medical staff is still a particularly major issue. There is also a problem with cooperative frameworks with pediatric departments. To achieve high-quality FP for C-A patients, a multidisciplinary approach is vital, but, according to the present study, few paramedical staff can participate in FP for C-A patients in Asia. Only Australia and Korea provide FP information by video and specific resources. Conclusion: The present study demonstrated the developing status of FP for C-A patients in Asian countries. More intensive consideration and discussion are needed to provide FP in Asian societies based on the local cultural and religious needs of patients.
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Affiliation(s)
- Seido Takae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Seido Takae
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, South Korea
| | | | - Budi Wiweko
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
| | - Nares Sukcharoen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bankok, Thailand
| | - Virgilio Novero
- St. Luke's Medical Center, Quezon City, Philippines
- Section of Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Philippines Manila, Manila, Philippines
| | - Antoinette Catherine Anazodo
- Kids Cancer Centre and Sydney Youth Cancer Service, Sydney Children's Hospital, Randwick, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia
| | - Debra Gook
- Melbourne IVF, Melbourne, VIC, Australia
| | - Chii-Ruey Tzeng
- Division of Infertility, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | | | - Wen Li
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | | | - Wen Di
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ri-Cheng Chian
- Center for Reproductive Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
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57
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Anazodo A, Ataman-Millhouse L, Jayasinghe Y, Woodruff TK. Oncofertility-An emerging discipline rather than a special consideration. Pediatr Blood Cancer 2018; 65:e27297. [PMID: 29972282 PMCID: PMC6150802 DOI: 10.1002/pbc.27297] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
Originally absent from the oncologist's consult, then placed in a 'quality of life' rubric, oncofertility should now be an essential part of a comprehensive cancer treatment plan in patients of reproductive age, including adolescents and young adults (AYAs). Oncofertility encompasses the endocrine health of the patient, as well as fertility management options. Thus, pubertal transitions in males and females, bone health, and menstrual health are all part of this discipline, enabling practitioners to work in interdisciplinary teams to solve problems in reproductive health. This review provides a summary of the essential considerations required for the assessement of reproductive risk and choice of fertility preservation options as well as considerations for developing oncofertility services for AYAs.
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Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
- School of Women’s and Children’s Hospital, University of New South Wales, Sydney
| | - Lauren Ataman-Millhouse
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology University of Melbourne Royal Women’s Hospital, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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58
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Ferrante AC, Gerhardt CA, Yeager ND, Rausch JR, Lehmann V, O'Brien S, Quinn GP, Nahata L. Interest in Learning About Fertility Status Among Male Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2018; 8:61-66. [PMID: 30260730 DOI: 10.1089/jayao.2018.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE As many as two-thirds of male childhood cancer survivors are at risk for fertility impairment as a consequence of treatment. Despite this, survivorship guidelines lack concrete recommendations as to when fertility status conversations should happen between patients and providers and what should be discussed. Thus, conversations may be inconsistent, or do not occur at all in survivorship. To inform recommendations for fertility-related conversations in survivorship, this pilot study aimed to better understand background (e.g., age, diagnosis and treatment intensity) and psychosocial factors (i.e., perceived barriers and perceived susceptibility) associated with survivor interest in learning about fertility status. METHODS Male survivors (N = 45) 15-25 years of age were recruited within 1-8 years of completing treatment. Survivors completed questionnaires based on the Health Belief Model (HBM) to assess perception of infertility risk and attitudes toward testing. RESULTS Most survivors (n = 31; 69%) reported they were informed of their risk for infertility by a healthcare provider before treatment, but only 31% (n = 14) of the sample banked sperm. Nearly two-thirds of survivors (n = 29; 64%) were interested in learning more about their fertility post-treatment. This interest was significantly correlated with greater perceived susceptibility to infertility by survivors, but it was not associated with other psychosocial or background factors. CONCLUSION Informing survivors of their personal infertility risk may increase interest in pursuing testing. Offering opportunities for fertility testing and family planning alternatives may mitigate potential psychological distress and unplanned pregnancy. While additional research is needed, future survivorship guidelines should encourage regular communication about fertility status and offer fertility testing for male survivors.
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Affiliation(s)
- Amanda C Ferrante
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Cynthia A Gerhardt
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Nicholas D Yeager
- 2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,3 Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Rausch
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Vicky Lehmann
- 4 Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sarah O'Brien
- 2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,3 Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio.,5 Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gwendolyn P Quinn
- 6 Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Leena Nahata
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,7 Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
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