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Objective. Human Papillomavirus (HPV) is the most common sexually transmitted infection and the leading cause of cervical and oropharyngeal cancers. Vaccination can prevent over 90% of HPV-attributed cancers among those aged 9-26. Rural populations are less likely to receive the complete HPV protocol than urban; rates have further declined post-COVID. The aim of this scoping review is to evaluate multilevel (patient/young person, parent/caregiver, physician/team, healthcare organization, community, and policy) influences on HPV vaccine hesitancy in rural communities. Study Design and Analysis. An informationist conducted a systematic search of published empirical studies between 20102021 across 7 databases, resulting in 915 publications. Using pre-specified criteria, the team reviewed 33 full texts. With a standard codebook, two reviewers independently coded the studies; discrepancies were resolved by a third reviewer. A mixed methods analysis was conducted to integrate quantitative and qualitative data. Setting. Rural US communities. Population Studied. Empirical studies of rural HPV vaccination hesitancy. Instrument. Standard codebook. Outcome Measures. By the frequency cited, HPV vaccine prevalence, awareness, knowledge, attitudes/beliefs toward HPV vaccine hesitancy. Results. The modal publication year was 2020 (N=7 studies). Primary care provider recommendation strongly influenced parents' decisions to vaccinate their children. Prescriptive provider communication approaches were less common but more influential than consultative. Multilevel interventions, although rarely applied, were effective in reducing HPV vaccine hesitancy. Adolescents themselves were the most common foci of change. Barriers to rural HPV uptake included; limited vaccine awareness, few primary care sites, the stigma of STI's, and strict religious values. Most studies were observational (85% of studies); interventions included; educational materials or training (75%), media (12.5%), and a free HPV vaccine (12.5%). Conclusions. Tailored interventions to rural parents/caregivers, particularly of marginalized youth (e.g., LGBT+) could increase awareness and knowledge about the vaccine. Provider training increases HPV vaccine recommendations; programs should also be targeted to rural school nurses and dental care providers. Linking primary care practices and public health dissemination strategies on college campuses, secondary schools, and community sites, are key., Presenters Sherri Sheinfeld Gorin, PhD, FSBM, Angela Kuznia, MD, MPH, Meghann Lewis, Cornelius Jamison, MD, MS, MSPH, Rebecca [...]

Adolescent idiopathic scoliosis affects 1% to 3% of U.S. adolescents. It is defined by a lateral curvature of the spine (Cobb angle) of at least 10 degrees in the absence of underlying congenital or neuromuscular abnormalities. Adolescent idiopathic scoliosis may be detected via the forward bend test and should be confirmed with scoliometer measurement. Mild scoliosis is usually asymptomatic; it may contribute to musculoskeletal back pain, but there is no evidence that it causes disability or functional impairment. Patients with severe scoliosis (Cobb angle of 40 degrees or more) may have physical pain, cosmetic deformity, psychosocial distress, or, rarely, pulmonary disorders. Several studies have shown modest benefit from bracing and scoliosis-specific physical therapy to limit progression in mild to moderate scoliosis, but there were no effects on quality of life. Because no high-quality studies have proven that surgery is superior to bracing or observation, it should be reserved for severe cases. There is little evidence that treatments improve patient-oriented outcomes. The U.S. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents 10 to 18 years of age. [ABSTRACT FROM AUTHOR]

High blood pressure in children and adolescents is a growing health problem that is often overlooked. Children should be screened for elevated blood pressure annually beginning at three years of age or at every visit if risk factors are present. In children younger than 13 years, elevated blood pressure is defined as blood pressure in the 90th percentile or higher for age, height, and sex, and hypertension is defined as blood pressure in the 95th percentile or higher. In adolescents 13 years and older, elevated blood pressure is defined as blood pressure of 120 to 129 mm Hg systolic and less than 80 mm Hg diastolic, and hypertension is defined as blood pressure of 130/80 mm Hg or higher. Ambulatory blood pressure monitoring should be performed to confirm hypertension in children and adolescents. Primary hypertension is now the most common cause of hypertension in children and adolescents. A history and physical examination and targeted screening tests should be done to evaluate for underlying medical disorders, and children and adolescents with hypertension should be screened for comorbid cardiovascular diseases, including diabetes mellitus and hyperlipidemia. Hypertension in children is initially treated with lifestyle changes such as weight loss if overweight or obese, a healthy diet, and regular exercise. Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications and should be evaluated for cardiovascular damage with echocardiography. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics are effective, safe, and well-tolerated in children. [ABSTRACT FROM AUTHOR]

More than 20,000 US women are diagnosed with ovarian cancer each year. The average lifetime risk is 1.3%, but risk increases with BRCA1 or BRCA2 gene mutations (40% and 18% risk, respectively, by age 70 years) or hereditary nonpolyposis colorectal cancer syndrome (12% lifetime risk). Other risk factors include smoking, possibly past clomiphene use, and more years of ovulation. Symptoms are nonspecific. Abdominal pain is most common; others include pelvic pain, bloating, and early satiety. When ovarian cancer is suspected, evaluation should begin with transvaginal ultrasonography with Doppler studies. Cancer antigen 125 testing can be obtained, but levels are not elevated in all patients. Other biomarkers (eg, OVA1) and scoring systems can be used to help determine if cancer is present. When diagnosed early (stage I), the 5-year survival rate is 90% for epithelial ovarian cancer. However, most patients with epithelial ovarian cancer are diagnosed in stage III or later, with a 5-year survival rate of 17% to 39%. Treatment involves total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without chemotherapy. Fertility-preserving options can be considered in some early-stage cancers, followed by more definitive surgical procedures. There is no evidence that routine screening is beneficial and it is associated with significant harms from unnecessary procedures. Women with genetic syndromes that increase risk should be considered for prophylactic bilateral salpingo-oophorectomy., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)