Confidence in adolescent contraceptive counseling among residents and fellows training at the University of Texas Southwestern in Dallas, Texas

OBJECTIVES

Evaluate trainees' perceptions of past training and confidence in counseling about five contraceptive methods.

STUDY DESIGN

Trainees completed an online survey in 2020. Logistic regressions evaluated the relationship between participant characteristics and confidence.

RESULTS

Among 227 respondents (63% response rate), pediatric trainees reported the least confidence in counseling across each contraceptive method. Past training and confidence were associated.

CONCLUSIONS

Gaps in training should be addressed to improve confidence in contraceptive counseling among pediatricians in reproductively restricted states.

Factors impacting parental uptake of COVID-19 vaccination for U.S. Children ages 5-17

COVID-19 vaccination of U.S. children lags behind adult vaccination, but remains critical in mitigating the pandemic. Using a subset of a nationally representative survey, this study examined factors contributing to parental uptake of COVID-19 vaccine for children ages 12-17 and 5-11, stratified by parental COVID-19 vaccination status. Among vaccinated parents, uptake was higher for 12-17-year-olds (78.6%) than 5-11-year-olds (50.7%); only two unvaccinated parents vaccinated their children. Child influenza vaccination was predictive of uptake for both age groups, while side effect concerns remained significant only for younger children. Although parents were more likely to involve adolescents in vaccine decision-making than younger children, this was not predictive of vaccine uptake. These results highlight the importance of addressing the unique and shared concerns parents have regarding COVID-19 vaccination for children of varying ages. Future work should further explore adolescent/child perspectives of involvement in COVID-19 vaccination decision-making to support developmentally appropriate involvement.

COVID-19 vaccine uptake and attitudes towards mandates in a nationally representative U.S. sample

Widespread uptake of COVID-19 vaccination is vital to curtailing the pandemic, yet rates remain suboptimal in the U.S. Vaccine mandates have previously been successful, but are controversial. An April 2021 survey of a nationally representative sample (N = 1208) examined vaccine uptake, attitudes, and sociodemographic characteristics. Sixty-seven percent were vaccine acceptors, 14% wait-and-see, and 19% non-acceptors. Compared to wait-and-see and non-acceptors, acceptors were more likely to have a household member over age 65, have received a flu shot, have positive COVID-19 vaccine attitudes, and view COVID-19 vaccination as beneficial. Mandate support was higher among respondents who were vaccine acceptors, had positive views about COVID-19 vaccines, believed in COVID-19 preventive strategies, perceived COVID-19 as severe, were liberal, resided in the Northeast, were non-White, and had incomes < $75,000. Public health campaigns should target attitudes that appear to drive hesitancy and prepare for varying mandate support based on demographics, COVID-19 vaccine attitudes, and the scope of the mandate.

The impact of financial incentives on COVID-19 vaccination intention among a sample of U.S. adults

Financial incentives are one of several strategies that have been explored to enhance COVID-19 vaccine uptake. Although widely discussed, it is unclear how much of an incentive and for which subset of individuals incentives would be effective. This study explored the impact of hypothetical $600 or $1200 incentives on COVID-19 vaccination intention. From a nationally representative panel of U.S. adults, 346 individuals reported hesitance towards COVID-19 vaccination and were then asked about their willingness to accept a vaccine if offered hypothetical incentives. Results indicated 26.89% would get vaccinated if offered $600, and 30.06% if offered $1200. In the multivariable model that included sociodemographic and attitudinal predictors of vaccine uptake, those classified as ‘wait-and-see’ compared to those classified as non-acceptors were more likely to accept COVID-19 vaccines when given financial incentives, and those who believed more strongly in the benefits of COVID-19 vaccines were more likely to accept a vaccine when first offered hypothetical $600 and then $1200 incentives. Individuals unsure if they ever had COVID-19 were significantly less likely to be willing to get the vaccine for $1200 as compared to those who believed they previously had COVID-19. These results suggest that financial incentives can increase intention to receive a COVID-19 vaccine.

Symptoms of colorectal liver metastases: correlation with CT findings

AIM

To correlate CT appearances of colorectal liver metastases (LM) with pattern and severity of symptoms.

MATERIALS AND METHODS

One hundred and twenty patients with treated primary colorectal carcinoma were prospectively assessed by questionnaire for recent symptoms when attending for CT examination. Thorax, abdomen and pelvic CT scans were prospectively assessed for LM and extrahepatic disease (EHD). The number of LM, percentage liver replaced by LM and distribution of LM were recorded.

RESULTS

Patients' ages ranged from 35 to 89 years (median 60) and 74/120 (62%) were male. Four subgroups were compared: group 1 - LM only (n = 30); 2 - EHD only (n = 22); 3 - both LM and EHD (n = 28); 4 - neither LM/EHD (n = 40). Anorexia was significantly worse in gp2 vs gp4 (P = 0.016) and lower abdominal pain (LAP) was significantly worse in gp2 vs gpl (P = 0.019). General pain was the worse symptom in all groups but notstatistically greater in any group. Patients with more than 10 LM had significantly worse anorexia (P = 0.002). general pain (P < 0.001) and LAP (P = 0.001). There was a trend (P > 0.05) towards worse symptoms with either volume of diseased liver or subcapsular LM.

CONCLUSION

With increasing liver tumour burden there was an increase in symptomatology but extrahepatic abdominal metastatic tumour produced more symptoms than LM alone. Symptoms, particularly pain, therefore are not good predictors of hepatic metastatic disease.

A novel fluorescein-histamine reagent to quantitate histamine receptor expression on leucocytes

The expression of histamine receptors on the surface of rat lymph node cells was studied using a reagent made by directly coupling fluorescein isothiocyanate (FITC) to histamine. This approach contrasts with the use of previous reagents, made by coupling histamine and fluorescein separately to a protein carrier, which bind non-specifically to cells and cause staining unrelated to histamine receptor expression. The new reagent was used, in combination with a panel of monoclonal antibodies, for the dual staining of rat lymph node cells for two-colour flow cytometric analysis to investigate the distribution of histamine receptors on different leucocyte subsets. The majority of cells were stained by the FITC-histamine reagent and these constituted two distinct populations, those with the properties of small lymphocytes and a second population which included macrophages. Inhibition studies with the drugs mepyramine and cimetidine, which are antagonists of H1 and H2 receptors, respectively, showed that most lymphocytes possess H1 receptors while the macrophages have H2 receptors. It seems that macrophages have a higher number of histamine receptors than the majority of lymphocytes, but that they are of lower affinity.

Plasma beta-thromboglobulin in the differential diagnosis of Raynaud's phenomenon

Plasma beta-thromboglobulin (beta TG) levels were measured by radioimmunoassay in 61 patients with systemic sclerosis, 19 with carefully defined primary Raynaud's phenomenon, and 8 with Raynaud's phenomenon in suspected transition to systemic sclerosis. Elevated beta TG was present in 50 (82%) patients with systemic sclerosis but levels could not be correlated with duration or extent of disease nor any particular pattern of visceral involvement. Transitional Raynaud's patients had elevated beta TG in 7 (88%) cases, whereas results in patients with primary Raynaud's phenomenon were comparable to normal controls. beta TG, a sensitive measure of in vivo platelet activation, is useful in the differential diagnosis of Raynaud's phenomenon.

The effects of triiodothyronine, hydrocortisone and insulin on lipid synthesis by cultured fibroblasts preincubated in a serum-free medium

Studies of lipid metabolism in cell cultures are usually carried out after preincubation of cells in media containing lipoprotein-deficient or delipidated serum. The artifacts produced during delipidation prevent the standardization of assays and the study of the role of hormones on lipid metabolism. We studied the effects of triiodothyronine, hydrocortisone, insulin and their combination on cholesterol and fatty acid synthesis in cultured human skin fibroblasts preincubated for 24 h in an artificial medium (medium A) consisting of equal volumes of Dulbecco's modified Eagle's and Ham's F-12 media enriched with transferrin, biotin and calcium pantothenate. In cells preincubated in medium A the incorporation of acetate to cholesterol and the activity of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase were much lower than in cells preincubated in standard medium containing lipoprotein-deficient serum. Addition of the three hormones caused a marked stimulation of the incorporation of acetate to cholesterol (from 3.1 to 17.7 pmol/min per mg protein), an activity similar to that in cells preincubated in lipoprotein-deficient serum plus hormones. The stimulatory effect of the hormones on HMG-CoA reductase activity was smaller, from 11 to 26 pmol/min per mg protein compared to 83 pmol/min per mg protein in cells preincubated in lipoprotein-deficient serum plus hormones. Most of the stimulatory effect was due to insulin. The lack of coordinate response between these two parameters in cells preincubated in artificial medium could not be explained by (a) stimulation of a post-mevalonate step as measured by the incorporation of mevalonate to cholesterol; (b) the in vitro inactivation of HMG-CoA reductase by phosphorylation: incubation of fibroblast microsomes with Escherichia coli alkaline phosphatase resulted in a decrease in HMG-CoA reductase activity, in contrast to an increase in hepatic microsomes; (c) the presence of inhibitors of HMG-CoA reductase in the microsomal extract. In cells preincubated in medium A the incorporation of acetate to fatty acids and the activities of acetyl-CoA carboxylase and fatty acid synthetase were approximately equal to that of cells preincubated in standard medium containing lipoprotein-deficient serum. Hormones added to medium A caused a stimulation of incorporation of acetate to fatty acids (from 5.1 to 19.8 pmol/min per mg protein), the activity of acetyl-CoA carboxylase (from 494 to 820 pmol/min per mg protein) and of fatty acid synthetase (from 300 to 678 pmol/mg protein). These values were significantly higher than those obtained in cells preincubated with lipoprotein-deficient serum with or without hormones.(ABSTRACT TRUNCATED AT 400 WORDS)