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Transgender and gender diverse patients who are assigned female at birth may request menstrual management to alleviate an increased dysphoria due to menses. The objective of this study is to describe the initiation and use over time of menstrual management methods (MMMs) in transgender and gender diverse adolescents. A retrospective chart review was conducted of patients in a multidisciplinary pediatric gender program from March 2015 to December 2020 who were assigned female at birth, identified as transgender or gender diverse, and had achieved menarche. A descriptive statistical analysis was performed. Of 133 patients, 119 (90%) identified as transgender male, 11 (8%) as gender nonbinary, and 3 (2%) as another gender identity. Mean age was 15 (standard deviation 1.6) years. Only 12 (9%) patients had ever been sexually active. During the study period, 48 (36%) used gender-affirming testosterone. At the initial visit, 114 (86%) patients were not using an MMM. Of 80 patients who initiated a new MMM, 3 (4%) chose continuous oral contraceptive pills, 65 (83%) used norethindrone acetate (NETA), and 9 (11%) planned levonorgestrel intrauterine device (IUD) insertion. At 1 year, 56 patients were using NETA and 20 had an IUD in place. This study provides data on MMM choice in transgender and gender diverse adolescents using these methods almost exclusively for menstrual management and not contraception. Although few patients were using an MMM at baseline, most opted to start a method when given the opportunity. The most common methods were NETA or an levonorgestrel IUD. [ABSTRACT FROM AUTHOR]

Purpose: Annual low-dose CT (LDCT) for lung screening in high-risk individuals decreases both lung cancer-specific mortality and all-cause mortality. Community oncology practice networks constituting the National Cancer Institute Community Oncology Research Program (NCORP) conduct clinical trials across the cancer spectrum. The authors report access to and characteristics of LDCT screening for lung cancer in these community oncology practices.Methods: A landscape capacity assessment was conducted in 2017 across the NCORP network. The primary outcome was the proportion of adult oncology practice groups offering LDCT lung screening on site. The secondary outcomes were the proportion of those screening services (1) with radiologist participation in service management and (2) offered at ACR Designated Lung Cancer Screening Centers.Results: Fifty-two percent of components and subcomponents responded to at least some portion of the assessment, representing 217 practice groups. Analyzing the 211 adult oncology practice groups responding to the primary question, 73% offered lung screening services on site. Radiologists participated in managing 69% of these services. Forty-seven percent were offered in ACR Designated Lung Cancer Screening Centers. Minority and underserved practice groups were less likely to offer lung screening; however, this association dissipated when analyses focused on practices within the United States. Safety net and Critical Access Hospital designation increased the likelihood of screening availability.Conclusions: The majority of community oncology practice groups within the NCORP offered lung screening on site, although radiologist participation in service management and ACR Lung Cancer Screening Center designation, markers of service quality, were more variable. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypothesis that children with elevated psychosocial risk would have increased attrition and worse weight outcomes in weight management treatment.Study Design: This was a prospective cohort study of 100 new patients, aged 4-12 years, in a weight management clinic. Parents completed the Psychosocial Assessment Tool. Logistic regression analyses were conducted to calculate the odds of attrition from the clinic and a nonmeaningful change in body mass index (BMI) z-score (ie, <0.1 unit decrease in BMI z-score) over a 6-month period based on psychosocial risk category, adjusting for child demographics and baseline weight category.Results: The majority of patients were male (59%), black (36%) or white (43%), and had severe obesity (55%), and 59% of families were categorized as having moderate or high psychosocial risk. Over the 6-month period, 53% of families were lost to follow-up, and 67% did not have a clinically meaningful decrease in BMI z-score. Compared with children of families with low psychosocial risk, children of families with moderate or high psychosocial risk were 3.1 times (95% CI, 1.3-7.2 times) more likely to be lost to follow-up and 2.9 times (95% CI, 1.1-7.9 times) more likely to have a non-clinically meaningful change in BMI z-score.Conclusions: Children presenting with increased psychosocial risk have higher attrition and poorer weight outcomes, supporting the need for psychosocial screening as a standard component of pediatric weight management treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess the odds of a psychiatric or neurodevelopmental diagnosis among youth with a diagnosis of gender dysphoria compared with matched controls in a large electronic health record dataset from 6 pediatric health systems, PEDSnet. We hypothesized that youth with gender dysphoria would have higher odds of having psychiatric and neurodevelopmental diagnoses than controls.Study Design: All youth with a diagnosis of gender dysphoria (n = 4173 age at last visit 16.2 ± 3.4) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables to controls without gender dysphoria (n = 16 648, age at last visit 16.2 ± 4.8) using multivariable logistic regression. The odds of having psychiatric and neurodevelopmental diagnoses were examined using generalized estimating equations.Results: Youth with gender dysphoria had higher odds of psychiatric (OR 4.0 [95% CI 3.8, 4.3] P < .0001) and neurodevelopmental diagnoses (1.9 [1.7, 2.0], P < .0001). Youth with gender dysphoria were more likely to have a diagnosis across all psychiatric disorder subcategories, with particularly high odds of mood disorder (7.3 [6.8, 7.9], P < .0001) and anxiety (5.5 [5.1, 5.9], P < .0001). Youth with gender dysphoria had a greater odds of autism spectrum disorder (2.6, [2.2, 3.0], P < .0001).Conclusions: Youth with gender dysphoria at large pediatric health systems have greater odds of psychiatric and several neurodevelopmental diagnoses compared with youth without gender dysphoria. Further studies are needed to evaluate changes in mental health over time with access to gender affirming care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the odds of a behavioral health diagnosis among youth with differences of sex development (DSD) or congenital adrenal hyperplasia (CAH) compared with matched controls in the PEDSnet database.Study Design: All youth with a diagnosis of DSD (n = 1216) or CAH (n = 1647) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables (1:4) with controls (n = 4864 and 6588, respectively) using multivariable logistic regression. The likelihood of having behavioral health diagnoses was examined using generalized estimating equations.Results: Youth with DSD had higher odds of a behavioral health diagnosis (OR, 1.7; 95% CI, 1.4-2.1; P < .0001) and neurodevelopmental diagnosis (OR, 1.7; 95% CI, 1.4, 2.0; P < .0001) compared with matched controls. Youth with CAH did not have an increased odds of a behavioral health diagnosis (OR, 1.0; 95% CI, 0.9, 1.1; P = .9) compared with matched controls but did have higher odds of developmental delay (OR, 1.8; 95% CI, 1.4, 2.4; P < .0001).Conclusions: Youth with DSD diagnosis have higher odds of a behavioral health or neurodevelopmental diagnosis compared with matched controls. Youth with CAH have higher odds of developmental delay, highlighting the need for screening in both groups. [ABSTRACT FROM AUTHOR]

Highlights a study which predicted posttraumatic stress symptoms, in parents of children who survided childhood cancers. Details on the current family, individual and posttreatment variables; Information on the treatment events; In-depth look at the parent experience of the diagnosis of cancer in their children; Methodology used to conduct the study; Results of the study.

Objectives: To identify parents' preferences for goals and structure of intervention programs to support the psychosocial needs of families impacted by congenital heart disease (CHD).Study Design: Information about parent priorities for psychosocial programs was obtained in this mixed-methods study conducted at a pediatric hospital in the Mid-Atlantic region of the US. Participants were parents (N = 34; 20 mothers, 14 fathers) of children with CHD between the ages of 1 and 3 years who had cardiac surgery at less than 6 months of age. Qualitative data were excerpts from semistructured interviews. Quantitative data were participant choices regarding their ideal psychosocial program resulting from a card sort.Results: Parents reported that psychosocial interventions should support partnership in their child's care, promote self-care, facilitate communication with providers, prepare parents for challenges after hospitalization, provide education about child neurodevelopment, and help parents engage social support. Parents reported needing formalized support across care, brief intervention models, in-person individualized or small group support, and involvement of multidisciplinary providers and peer mentors in the delivery of interventions.Conclusions: Parents of children with CHD need psychosocial interventions that empower them to act as primary caregivers and effective advocates for their child. Individualized, formalized, and multidisciplinary approaches to psychosocial care are necessary to best accommodate the dynamic stressors related to parenting a child with CHD and may mitigate the impact of parent mental health problems on child outcomes. [ABSTRACT FROM AUTHOR]

To describe the demographic characteristics and psychological symptoms of gender-diverse patients and to compare symptoms between prepubertal and pubertal subgroups This was a retrospective chart review of all gender-diverse patients seen by at least 1 provider at the Nemours Gender Wellness Program from March 2015 to December 2020. The extracted data included demographic and psychosocial characteristics at baseline and 1-year follow-up visits. Pubertal status was determined by Tanner staging by a pediatric endocrinologist or gynecologist. Descriptive statistics were used to compare these variables between prepubertal and pubertal subgroups. Our sample included 177 individuals at baseline and 96 subjects at the 1-year follow-up visit. Most patients were White (83.0%), non-Hispanic (92.0%), transgender male (72.9%), and pubertal (90.4%). Compared with prepubertal patients, at the baseline visit, pubertal patients had significantly higher rates of current (68.1% vs 17.6%, P <.001) and lifetime (80.0% vs 23.5%, P <.001) depressive symptoms, current anxiety symptoms (70.0% vs 41.2%, P =.01), lifetime suicide attempts (12.5% vs 0%, P <.001), and a formal diagnosis of an eating disorder (5.0% vs 0%, P <.001). Symptoms did not change significantly over time from baseline to the 1-year follow-up visit. We found elevated rates of psychological symptoms and diagnoses in gender-diverse youth, with higher rates in pubertal compared with prepubertal patients. By elucidating how the psychosocial characteristics of gender-diverse children and adolescents differ based on pubertal status, these data can be used to improve current outreach and treatment strategies for transgender pediatric patients. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse adults have higher rates of cervical and other anogenital cancers than their cisgender peers. Vaccination against human papilloma virus (HPV) is known to prevent >90% of cervical and other genital cancers, as well as many oropharyngeal cancers, and thus may be an important tool in childhood and adolescence to prevent cancer in adulthood. The objective of this study was to assess the rates of HPV vaccination in gender diverse youth and reasons for not initiating HPV vaccination. This is a retrospective chart review of all patients at least 11 years old who were seen in a multidisciplinary pediatric gender program from March 2015 to December 2020. Data were abstracted on patient demographics, HPV vaccine initiation, and reasons for not initiating vaccination. Frequency counts and percentages were used to describe the total patient population and subgroups based on sex assigned at birth. Outcomes were compared between subgroups using chi-square tests. This study was approved by our institution's Institutional Review Board. Of the 163 patients ages ≥11, 133 (82%) had initiated HPV vaccination. Demographic characteristics of those who had and had not received the HPV vaccine series are listed in Table 1. Patients who initiated the vaccines were significantly older than those who had not (15.1 vs. 13.7 years, P <.001). Although a higher proportion of patients who were assigned male at birth had started the vaccine series than those assigned female at birth (88% vs. 80%), there was no significant difference between these groups. Reasons given for not receiving the HPV vaccines included parental concerns about both short- and long-term side effects, planning to wait until their child was older, and being opposed to vaccines in general or the HPV vaccine specifically. While the majority of our gender diverse patients had initiated the HPV vaccine series and our rate was actually slightly higher than the national average, it was lower than for other age-concordant vaccines. This was especially pronounced for younger patients, despite the early recommended age of vaccination. As transgender and gender diverse patients have higher adult rates of HPV-related cancers, increased uptake of HPV vaccination during childhood and adolescence could have a significant impact in this population. Further research is needed to determine how to improve vaccination uptake in gender diverse youth, especially at earlier ages. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1378479-1-ANY.docx [ABSTRACT FROM AUTHOR]

To describe menstrual history, associated dysphoria, and desire for menstrual management in transgender male and gender diverse adolescents who were assigned female at birth Retrospective chart review Tertiary care children's hospital All patients seen in a multidisciplinary pediatric gender program from March 2015 through December 2020 who were assigned female at birth, identified as transgender male or gender nonbinary, and had achieved menarche None Patient demographics, menstrual history, interest in and prior experiences with menstrual management, parental support, and concerns about menstrual management Of the 129 included patients, 116 (90%) identified as transgender male and 13 (10%) as gender nonbinary, with an average age of 15 (SD 1.6) years. Almost all (93%) patients reported menstrual-related dysphoria. Most (88%) were interested in menstrual suppression. The most common reasons for desiring suppression were achievement of amenorrhea (97%) and improvement of menstrual-related dysphoria (63%). Most gender diverse patients assigned female at birth reported dysphoria associated with menses and desired menstrual suppression. This information can encourage physicians to raise this topic and offer menstrual management for gender diverse patients who experience distress related to menses, especially for those who are not ready for or do not desire gender-affirming hormonal treatment. Future research is needed to better understand patients' experiences with menses and to determine the optimal menstrual management methods. This could be an important intervention to improve outcomes for this vulnerable population. [ABSTRACT FROM AUTHOR]

Gender diverse individuals are those whose sex assigned at birth does not correspond with their gender identity. Gender dysphoria, or the distress associated with the incongruence between an individual's gender identity and sex assigned at birth, is associated with adverse psychosocial and health outcomes. We hypothesize that puberty intensifies this distress, in effect exacerbating mental health symptoms and increasing healthcare utilization across all services. Our study seeks to investigate the influence that puberty has on mental health symptoms and service utilization for a cohort of gender diverse youth at a multidisciplinary care clinic. This is a retrospective chart review of all gender diverse patients seen at the Nemours Gender Wellness Program from 2015-2020. Abstracted data include demographics, pubertal status, symptoms of depression, anxiety and gender dysphoria, body image concerns, self-harm related thoughts and behaviors, and clinic service utilization. Comparisons were made according to pubertal status defined as the onset of secondary sex characteristics. Descriptive statistical analysis was performed using frequency counts, percentages, means and standard deviations. Categorical variables were compared using chi-square and Fisher exact tests. 199 patients were included. Most were White (83%) and non-Hispanic (91%). Participant ages ranged from 5-18 years, with a median of 15 years. 136 (68%) individuals identified as transgender male, 35 (18%) as transgender female, 17 (9%) as non-binary, and 11 (6%) as another gender. Among all participants, 75% reported depressive symptoms, 74% reported anxiety symptoms, and 96% reported gender dysphoria. Prepubertal individuals were less likely than pubertal patients to report symptoms of depression (40% vs. 90%, p< 0.01) and gender dysphoria (94% vs. 99%, p=0.05). There were no differences in anxiety symptoms, body image concerns, suicidal ideation, suicide attempts, or self-harm by pubertal status. The Gynecology service was utilized by pubertal patients more than prepubertal patients (73% vs. 24%, p< 0.001). There were no significant differences in Psychology, Psychiatry, or Endocrinology utilization based on pubertal status. We found high rates of psychological symptoms in gender diverse youth, especially in pubertal patients. However, except for Gynecology, service utilization was not correlated with pubertal status. Understanding how psychological symptoms change around the time of puberty in this population may help families, providers, and policymakers improve on current outreach and treatment strategies for gender diverse youth. [ABSTRACT FROM AUTHOR]

• The Psychosocial Assessment Tool-Hematopoietic Cell Transplantation (PAT-HCT) is a measure of family psychosocial risk for families of a child undergoing HCT. • The PAT-HCT demonstrates strong reliability and validity with moderate to strong correlations with the validation measures. • The majority of families fall into the universal level of risk. A greater proportion of families scored at the targeted and clinical levels of risk than in previous studies. • Overall, parents were appreciative that they were asked about the patient's and family's well-being. • Parents were provided with feedback about their risk scores on the PAT-HCT and found this process helpful. Family psychosocial risk screening is an important initial step in delivering evidence-based care in hematopoietic stem cell transplantation (HCT). Establishing an evidence-based screening approach that is acceptable, reliable, and valid is an essential step in psychosocial care delivery. This is a 3-institution multimethod study. In part 1, caregivers of children about to undergo HCT (n = 140) completed the Psychosocial Assessment Tool–Hematopoietic Cell Transplantation (PAT-HCT), a brief parent report screener adapted for HCT, and validating questionnaires. Families received feedback on their risks identified on the PAT-HCT. In part 2, 12 caregivers completed a semistructured interview about their perceptions of the PAT and the feedback process. The reliability and validity of the PAT-HCT total and subscale scores were tested using Kuder-Richardson-20 (KR-20) and Pearson correlations. Thematic content analysis was used to analyze the qualitative interview data. Internal consistency for the total score (KR-20 =.88) and the Child Problems, Sibling Problems, Family Problems, and Stress Reactions subscales were strong (KR-20 >.70). Family Structure, Social Support, and Family Beliefs subscales were adequate (KR-20 =.55 to.63). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Feedback was provided to 97.14% of the families who completed the PAT-HCT, and the mean rating of acceptability was >4.00 (on a 5-point scale). The qualitative data indicate that families appreciate the effort to provide screening and feedback. The PAT-HCT is a psychometrically sound screener for use in HCT. Feedback can be given to families. Both the screener and the feedback process are acceptable to caregivers. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Central nervous system (CNS) malignancies and/or their treatment in pediatric cancer survivors are known to be associated with deficits in neuropsychological functions. We report findings from a nation-wide study of childhood cancer survivors to investigate intelligence and attention/concentration from a multi-dimensional perspective in a diverse sample from this population. Main methods: Four hundred forty-four pediatric cancer survivors between 6 and 17years of age, who had suffered CNS involvement associated with their malignancy, were evaluated. All patients completed a measure of general intelligence. Attention was measured by a continuous performance test (CPT) and by parental report using a standardized psychological inventory. Key findings: Social economic status (SES) was a significant predictor of intellectual functioning and scores on independent measures of attention. After controlling for SES, cranial radiation therapy (CRT) was strongly predictive of impairments in intellectual functioning. Patients who had completed a transplant procedure did not have significant impairments in intellectual functioning when compared to other participants. CPT performance was most clearly influenced by a younger age at diagnosis and the presence of a supratentorial brain tumor. Reaction time was lower in patients who had received CRT. Gender did not correlate with CPT performance, but caregiver reports of deficits in attentional functioning were more prevalent in girls compared to boys. Significance: These findings are important given the large, representative sample and multi-dimensional assessment of attentional functioning. The presence of a very strong SES effect on all dependent variables must be addressed in studies of this nature. [Copyright &y& Elsevier]

Abstract: Objective: To examine the implications of use of differential thresholds for studying medical Posttraumatic Stress Disorder (PTSD). Methods: Self-report data from 6,542 young adult survivors of childhood cancer and 374 of their siblings were used to create clearly differentially defined groups to compare prevalence, correlations and predictors of posttraumatic stress. Results: Prevalence of posttraumatic stress in survivors compared to siblings differed by definition used, ranging from an odds ratio of 4.21 (95% CI 2.11–8.38) when posttraumatic stress was defined as meeting full symptoms plus functional impairment to 1.42 (95% CI 0.79–2.56) for partial symptoms with functional impairment. Re-experiencing symptoms did not substantially contribute to the ability to identify functional impairment and emotional distress. Although most of the variables associated with posttraumatic stress symptoms and impairment were consistent across definitions of PTSD, marital status and employment demonstrated nonproportional relationships. Conclusions: Choice of the definition used in studying posttraumatic stress after serious illness alters not only epidemiological findings, but also associations with correlates and predictors. This is important in the current debate about the criteria for PTSD in the upcoming DSMV. Further study is needed to determine if these findings are applicable to people exposed to other types of traumatic events. [Copyright &y& Elsevier]