Hot Topic Presentations

Hot Topic presentations are one of the most popular components of SAHM annual meetings. The following 20 minute pre-recorded presentations feature some of today's hottest topics in adolescent health.   


 

#thisisourlane: Leveraging Teachable Moments to Promote Wellness After Firearm Injury

Alison Culyba, MD, PhD, MPH
UPMC Children's Hospital of Pittsburgh, University of Pittsburgh

Description:
Firearm-related injuries now outpace motor vehicle collision as the leading cause of death among U.S. AYA ages 12-24, and far exceed the rates in other high-income countries. According to 2017 YRBSS, 4.8% of U.S. high school students reported carrying a gun in the past year, increasing risk for violent injury. While mass shootings and school shootings often dominate the news, youth of color in marginalized communities bear a disproportionate burden of firearm violence. Recognizing firearm violence and injury as a public health issue offers important opportunities for prevention.

Violently injured youth are at high risk for re-injury and mental health sequelae; 25-40% experience reinjury and 15-75% experience post-traumatic stress symptoms. Hospital-initiated violence intervention programs (HVIPs) provide a novel approach that capitalizes on the post-injury period as a teachable moment to engage youth and families through individualized case management and linkage to community-based resources. Emerging research across the Health Alliance for Violence Intervention network demonstrates that HVIPs can reduce reinjury and promote healing and recovery. 

Grounded in the voices of violently-injured youth and frontline violence intervention specialists, this Hot Topic presentation will provide a brief overview of the epidemiology of firearm violence, highlight the disproportionate burden experienced by young people of color, examine the role of HVIPs in firearm violence prevention, and translate HVIP best-practices into brief trauma-informed strategies all adolescent health professionals (physicians, nurses, social workers, psychologists, advanced practice providers, other health professionals) can use to foster wellbeing following violent injury.

Learning Objectives:

  1. Frame firearm violence as a public health issue firmly in the domain of AYA health
  2. Identity key components of hospital-initiated violence intervention programs (HVIPs)
  3. Describe practical strategies for adolescent health providers engaging with youth to promote healing and recovery following violent injury


 

No Vapor Without Fire: A primer on e-cigarette and vaping associated lung injuries

Nicholas Chadi, MD, MPH
Sainte-Justine University Hospital Centre/University of Montreal

Description:
E-cigarette or vaping associated lung injury (EVALI) is a newly recognized clinical entity that can lead to severe illness and even death. While EVALI can affect individuals of all ages, more than 50% of cases have been reported in youth under the age of 25. Most affected individuals report using vaping products containing tetrahydrocannabinol, the main psychoactive substance found in marijuana. Use of flavored or unflavored vaping products, with or without nicotine, as well as use of vaping products purchased from the black market are also common among affected individuals. Individuals with EVALI present with severe respiratory symptoms such as shortness of breath, cough and chest pain, often accompanied by gastro-intestinal symptoms such as nausea, vomiting, diarrhea and abdominal pain. They can also present with constitutional symptoms such as fever, chills and weight loss. The pathophysiology of EVALI involves an acute and non-specific pattern of lung inflammation, in the absence of a known infectious cause, which is clearly visible on chest imaging studies. Providers can screen for use of e-cigarettes and other vaping products using short validated screening tools. Youth presenting with non-specific respiratory, constitutional and gastro-intestinal symptoms should be asked about use of vaping products in the past 90 days. Management of youth with suspected EVALI includes close inpatient or outpatient monitoring, corticosteroid administration and cessation of e-cigarette or vaping product use. Different strategies such as behavioral counseling, motivational interviewing, cognitive-behavioral therapy and use of nicotine replacement therapy can be helpful in supporting cessation efforts.    

Learning Objectives:

  1. Discuss the epidemiology of e-cigarette or vaping associated lung injury (EVALI) among adolescents and young adults with a focus on demographic and substance use risk factors    
  2. Describe the clinical presentation and pathophysiology of EVALI, including common signs and symptoms, as well as typical imaging and laboratory findings    
  3. Determine how providers with medical, nursing, psychology, social work, and other professional backgrounds can screen for and address EVALI in their own clinical practices using evidence-based strategies.    


 

Treatment of Chronic Hepatitis C in Youth: Leveraging a Transition from Risk to Wellness

Scott E. Hadland, MD, MPH, MS
Boston Medical Center / Boston University School of Medicine

Description:
This Hot Topics presentation will highlight the critical role of clinicians of all disciplines in treating hepatitis C virus (HCV). Recent data from the World Health Organization (WHO) highlight the rising global prevalence of HCV, reaching 1 in 43 individuals in some countries. Risk factors—often established during youth—include injection drug use, sexual intercourse, human immunodeficiency virus, and incarceration. In many settings, the incidence of HCV is rising more rapidly among young adults than any other group. Receipt of treatment remains low, and disparities exist by gender, nationality, and race/ethnicity.
 
The presentation will review treatment with direct-acting antivirals (DAAs) for youth ≥12 years, and underscore how treatment can be incorporated into an interdisciplinary care continuum. Medication choice has historically been based on age, genotype, viral load, and fibrosis. However, at the time of writing, several regulatory agencies had approved 8-week treatment with glecaprevir/pibrentasvir for all youth ≥12 regardless of genotype, dramatically simplifying treatment choices. By the time of the Hot Topics presentation, this simplified treatment regimen will likely be recommended by WHO. Even still, clinicians will need to advocate for expansion of these expensive medications into resource-poor settings.
 
Last, the presentation will show how clinicians, by incorporating HCV treatment into routine care, can support a transition from risk to wellness. Since treatment can engage difficult-to-reach populations in health care, the presentation will use youths’ direct quotes to show how their clinicians leveraged this opportunity to offer other medical and mental health services to traditionally underserved youth.

Learning Objectives: 

  1. Provide a brief overview of the global epidemiology of hepatitis C, including risk factors, unmet need for treatment, and disparities by gender, nationality, race and ethnicity
  2. Determine hepatitis C treatment regimens (including newer simplified algorithms, as well as those defined by patient age, hepatitis C genotype, viral load, and fibrosis), and assess the availability of treatment in resource-poor settings
  3. Identify ways that clinicians from medical, nursing, psychology, social work and other backgrounds can address hepatitis C in their practices, and through youths’ quotes, highlight how treatment can leverage the transition from risk to wellness


Ensuring Access to Safe, Legal Abortion for Young People: What Adolescent Health Professionals Need to Know about Self Managed Abortion

Krishna K. Upadhya, MD, MPH
Planned Parenthood Federation of America

Description:
While the prevalence of self managed abortion (SMA) is difficult to measure, research indicates many adolescents and young adults are seeking information about SMA online. This is not surprising given that youth are particularly vulnerable to geographic, legal, political and cultural barriers to abortion care. Even in the absence of barriers some individuals prefer SMA to in-clinic abortion.

Use of mifepristone followed by misoprostol is a safe and effective medication abortion regimen endorsed by the World Health Organization (WHO). In the United States, the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy (REMS) restrictions require mifepristone to be dispensed to patients only in clinics, medical offices and hospitals under the supervision of a certified prescriber. In combination with restrictive state laws, REMS limit the growth of novel and patient-centered approaches to delivery of medication abortion, including telemedicine and pharmacy dispensing. Under an increasingly restrictive abortion access landscape, travel to a clinical site may be especially challenging for youth, and may increase the need and/or desire to end an unwanted pregnancy outside of the healthcare system. Research indicates mifepristone and misoprostol ordered online can be safe and effective, but legally risky. Criminal charges related to young people attempting abortion outside of a health care system, including by obtaining medications by mail, have occurred in the United States. Advocacy by adolescent health professionals and organizations to ensure access to safe, effective abortion care and to eliminate criminal penalties for individuals self managing abortion is important to promoting youth health and wellness.

Learning Objectives:

  1. Discuss the current context and extant research on self managed abortion in the United States 
  2. Describe the World Health Organization recognized regimens for medication abortion, emerging evidence regarding innovative approaches to delivery of medication abortion services, and data on the safety and effectiveness of these approaches
  3. Explain the importance of expanding access to both in-clinic and self-managed medication abortion, and the importance of decriminalizing self-managed abortion, especially for young people


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