Publications by authors named "Andrea E Bonny"

49 Publications

Rapid refeeding does not worsen anxiety in adolescents with anorexia nervosa: a pilot study.

Eat Disord 2021 Jun 29:1-15. Epub 2021 Jun 29.

The Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.

The study aimed to describe the progression of state anxiety in adolescents with anorexia nervosa (AN) hospitalized on a high calorie refeeding (HCR) protocol. Participants, 12-21 years, admitted for malnutrition due to AN were placed on a HCR protocol in which calories were advanced by 300 kcal/day. The State-Trait Anxiety Inventory for Children (STAIC) was given to participants within 24 hours of hospitalization and the state anxiety component of the STAIC was administered daily immediately before and after breakfast until discharge. Of 22 patients enrolled, 86% were female, mean age was 14.9 ± 2.0 years, and 95% had AN-restrictive type. The median state and trait anxiety scores at time of admission were 37.0 (28-55) and 35.5 (23-51), respectively. There was no significant difference in median pre-meal state anxiety from hospital day 1 to 6 (34.0(26-55) vs. 38.5(25-55), -value = 0.079) or in median post-meal state anxiety from hospital day 1 to 6 (35.5(29-56) vs. 37(24-56), -value = 0.484). Similarly, we found minimal correlation between change in caloric intake and change in pre-meal S-anxiety (Spearman correlation coefficient = -0.032) or post-meal S-anxiety (Spearman correlation = 0.032). While this was a small sample observing anxiety over one week, we found no evidence that state anxiety increased with advancing calories, providing additional support for the use of more rapid refeeding protocols.
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http://dx.doi.org/10.1080/10640266.2021.1939920DOI Listing
June 2021

Protecting Adolescents During a Sexually Transmitted Infection Testing Shortage: An Additional Challenge During a Global Pandemic.

JAMA Pediatr 2021 Jul;175(7):667-668

Division of Adolescent Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Columbus.

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http://dx.doi.org/10.1001/jamapediatrics.2021.0287DOI Listing
July 2021

Expedited Partner Therapy in Adolescent Females: A Study of Acceptance and the Impact on Reinfection Rates.

Sex Transm Dis 2021 Apr 1. Epub 2021 Apr 1.

University Health Services, University of Wisconsin-Madison Nationwide Children's Hospital The Ohio State University College of Medicine Columbus Health Department Center for Biostatistics at The Ohio State University Biostatistics Resource at Nationwide Children's Hospital The Research Institute at Nationwide Children's Hospital.

Background: Given the high risk of sexually transmitted infections (STI) in adolescents and young adults (AYA), this study evaluated expedited partner therapy (EPT) acceptance and STI reinfection rates in AYA females before and after availability of EPT.

Methods: The pre-EPT cohort was a 3-year (11/2012-11/2015) retrospective chart review of AYA females positive for Chlamydia trachomatis (CT) and/or Trichomonas vaginalis (TV) prior to introduction of EPT. An EPT protocol for CT and TV infections was implemented following legalization in Ohio in 2016. The post-EPT cohort was a prospective review of patients positive for CT and TV for 2 years (5/2016-5/2018) after EPT introduction. We evaluated EPT acceptance and compared reinfection rates (positive test 1-6 months after initial infection) in the pre-EPT versus post-EPT cohorts and by EPT acceptance.

Results: Among patients offered EPT, 28% (67/237) with CT and 25% (24/97) with TV accepted EPT. There were no significant differences in the reinfection rates for CT or TV in the pre- versus post-EPT cohorts (CT: 24% (57/240) vs. 20% (38/192), p=0.42; TV: 23% (22/97) versus 14% (12/87), p=0.11). Although lower, reinfections rates were not significantly different among patients who accepted versus did not accept EPT (CT: 13% (6/48) vs. 21% (23/110), p=0.50 and TV: 6% (1/18) vs. 18% (9/49), p=0.69).

Conclusions: Despite the implementation of an EPT protocol, STI reinfection rates among AYA females remained high, and many declined EPT. Further research is needed to identify barriers to the provision and acceptance of EPT and ways to address these factors.
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http://dx.doi.org/10.1097/OLQ.0000000000001436DOI Listing
April 2021

Disparities in HIV Education and Testing Between Metropolitan and Nonmetropolitan Adolescents and Young Adults in the U.S.

J Adolesc Health 2021 04 5;68(4):819-822. Epub 2020 Dec 5.

Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.

Purpose: To examine receipt of formal sexual health education on Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and receipt of HIV testing in adolescents and young adults (AYAs) residing in nonmetropolitan versus metropolitan areas.

Methods: A secondary data analysis of the 2015-2017 National Survey of Family Growth of AYAs ages 15-24 years (N = 3,114). Logistic regression models predicted associations between nonmetropolitan versus metropolitan status and outcomes of interest (formal sexual health education on HIV/AIDS and HIV testing).

Results: Most AYAs (85.3%) reported receiving formal sexual health education on HIV/AIDS, while less than half (46.9%) indicated receiving HIV testing. Residing in a nonmetropolitan area was associated with a lower odds of reporting formal sexual health education on HIV/AIDS (OR = .47, CI = [.29, .77]) but not with HIV testing (OR = 1.33, CI = [.89, 2.01]).

Conclusions: AYAs living in nonmetropolitan areas are less likely to receive formal sexual health education on HIV/AIDS.
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http://dx.doi.org/10.1016/j.jadohealth.2020.11.009DOI Listing
April 2021

Administration of Exogenous Hormones and the Implications for Cigarette Smoking-Related Behaviors.

Curr Psychiatry Rep 2020 10 22;22(12):70. Epub 2020 Oct 22.

Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, 43215, USA.

Purpose Of Review: Preclinical evidence indicates progesterone and estrogen influence drug-taking behaviors, including nicotine/tobacco. However, clinical research on this relationship is less clear. This lack of clarity may be due to measuring naturally occurring endogenous hormones to examine this relationship, which introduces substantial error. Therefore, the goal of this review is to examine the link between the delivery of exogenous hormones and cigarette smoking-related behavior.

Recent Findings: Exogenous progesterone may have favorable effects on cognition, symptomatology, consumption, and smoking cessation. Hormonal replacement therapy does not have a clear relationship with smoking-related behaviors. Oral contraceptive use may have adverse effects on stress response, nicotine metabolism, and symptomatology. Additional research is needed to explore how the administration of exogenous hormones may (a) strengthen research methodology on this topic, (b) enhance our understanding of the role of progesterone/estrogen on smoking-related behaviors, and (c) improve smoking cessation outcomes.
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http://dx.doi.org/10.1007/s11920-020-01197-6DOI Listing
October 2020

Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward?

JMIR Pediatr Parent 2020 Oct 9;3(2):e23463. Epub 2020 Oct 9.

Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, United States.

Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19-related consequences and offer clues to improving AYA OUD treatment in the long term.
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http://dx.doi.org/10.2196/23463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584981PMC
October 2020

Immunity to Hepatitis B is Undetectable in the Majority of Adolescents and Young Adults Seeking Outpatient Medication Treatment for Opioid Use Disorder.

J Addict Med 2020 12;14(6):e359-e361

Department of Biobehavioral Health, The Pennsylvania State University, PA (SWS); Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH (SWS, ERM, SCM, AEB); Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH (ERM, SCM, AEB); Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (AEB).

Objective: To assess prevalence and predictors of hepatitis B immune status among adolescents and young adults (AYA) seeking outpatient medication treatment for opioid use disorder (MOUD).

Study Design: A retrospective medical chart review was conducted of AYA seeking MOUD between January 1, 2013 through December 31, 2015. Inclusion criteria included: diagnosis of opioid use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; received hepatitis serologic testing; and no evidence of prior or current hepatitis B infection. Hepatitis B immunization initiation was defined as a record of at least 1 hepatitis B vaccination; while receipt of at least 3 vaccinations indicated immunization completion. The presence of hepatitis B surface antibody (anti-HBs) was the primary outcome measure.

Results: Of the 193 patients that met eligibility criteria, the presence of anti-HBs was evident in 62 (32.1%). Hepatitis B immunization initiation and completion before presenting for MOUD was documented in 102 (52.9%) and 84 (43.5%). In multivariable logistic regression modeling, hepatitis B immunization initiation after infancy was associated with increased odds of having protective anti-HBs relative to immunization series initiation in infancy (OR 8.96, 95% CI 1.57-51.05). Completion of hepatitis B immunization series after infancy as compared to completion in infancy also increased the odds of protective anti-HBs (OR, 6.68, 95% CI 2.10-21.24).

Conclusions: Rates of immunity to hepatitis B were low in AYA seeking MOUD. It is important to immunize patients seeking MOUD for hepatitis B and follow up with checks for seroconversion.
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http://dx.doi.org/10.1097/ADM.0000000000000689DOI Listing
December 2020

Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescent Females.

Clin Obstet Gynecol 2020 09;63(3):544-552

Division of Adolescent Medicine, Nationwide Children's Hospital.

The diagnosis of polycystic ovary syndrome (PCOS) in adolescents is complicated by the overlap of normal puberty with features of PCOS. To address this difficulty, recent diagnostic guidelines have worked to modify adult diagnostic criteria for use in adolescents. These guidelines stress that a definitive diagnosis of PCOS is not needed to initiate treatment. Deferring diagnosis, while providing symptom treatment and regular follow-up, is one recommended option. Treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. The goals of treatment are to improve the quality of life and long-term health outcomes.
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http://dx.doi.org/10.1097/GRF.0000000000000538DOI Listing
September 2020

Medication Treatment and Health Care Use Among Adolescents With Opioid Use Disorder in Ohio.

J Adolesc Health 2020 07 8;67(1):33-39. Epub 2020 Apr 8.

Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.

Purpose: The opioid epidemic impacts both adolescents and adults, and overdose deaths continue to rise. Two medication treatments (buprenorphine and naltrexone) are effective for treating opioid use disorder (OUD) in office-based settings but are seldom prescribed to adolescents. The present study describes medication treatment for OUD and other care received by adolescents with OUD in a state at the center of the opioid epidemic.

Methods: This retrospective cohort study included adolescents (aged 12-18 years) enrolled in Ohio Medicaid with an index OUD diagnosis (August 1, 2012, to May 31, 2016). Analyses describe the proportion of adolescents who received medication for OUD, health care (general medical outpatient, behavioral health, hospitalization, and emergency department), and other medications (attention deficit/hyperactivity disorder, antidepressants, antipsychotics, benzodiazepines, and opioid analgesics) within 3 months after OUD diagnosis. The results are compared by age group (12-15 and 16-18 years).

Results: Among 626,508 adolescents enrolled in Medicaid, 2,097 met inclusion criteria. Overall, 4.6% received medication for OUD, whereas 9.8% received an opioid analgesic, within 3 months after OUD diagnosis. The proportion of older adolescents receiving medication for OUD was significantly higher than younger adolescents (5.9% vs. 1.2%; p < .001), whereas a higher proportion of younger adolescents received attention deficit/hyperactivity disorder medications, antidepressants, and antipsychotics. Low proportions of adolescents in both age groups received benzodiazepines (2.4% and 3.6%). During the 3 months after OUD diagnosis, 48.5% of adolescents had general medical outpatient visits, and 29% received outpatient behavioral health services.

Conclusions: Although a large proportion of adolescents with OUD have subsequent visits in outpatient settings, few receive medications to treat OUD.
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http://dx.doi.org/10.1016/j.jadohealth.2020.01.016DOI Listing
July 2020

Impact of Office-based Opioid Treatment on Emergency Visits and Hospitalization in Adolescents with Opioid Use Disorder.

J Pediatr 2020 04 7;219:236-242. Epub 2020 Feb 7.

Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH.

Objective: To determine if engagement in office-based opioid treatment decreases emergency department, urgent care visits, and hospitalizations for acute opioid-related events (OREs) among adolescents with opioid use disorder.

Study Design: This retrospective cohort study identified all emergent and outpatient visits among adolescents, age 10-19 years, referred for office-based opioid treatment between January 1, 2006 and December 31, 2016. Patients were dichotomized into 2 cohorts: those who did and did not engage in office-based opioid treatment. The primary end point was the difference in the proportion of visits over the study period for acute OREs between cohorts and within the office-based opioid treatment cohort before and after referral. Secondary end points assessed change in the proportion of outpatient visits for treatment unrelated to opioid use disorder.

Results: Four hundred five emergent and outpatient visits were identified: 285 (70.4%) in the office-based opioid treatment cohort and 120 (29.6%) in the non-office-based opioid treatment cohort. After office-based opioid treatment engagement, 27.8% of visits in the office-based opioid treatment cohort were for acute OREs vs 80.8% in the non-office-based opioid treatment cohort (OR, 0.092; 95% CI, 0.052-0.160; P < .001). Outpatient visits in the office-based opioid treatment cohort were 10.9 times that of non-office-based opioid treatment (OR, 10.9; 95% CI, 6.23-19.16; P < .001). Within the office-based opioid treatment cohort, emergent visits decreased from 76.1% to 27.8% (OR, 0.121; 95% CI, 0.070-0.210; P < .001) and the odds of outpatient services was 8.3 times more after engagement (OR, 8.27; 95% CI, 4.78-14.4, P < .001).

Conclusions: The absolute decrease in emergent visits for acute OREs was 53% in adolescents engaged in office-based opioid treatment, representing a relative decrease of 65.6% compared with adolescents not engaged. An analysis of visits before and after office-based opioid treatment demonstrated similar decreases, suggesting that office-based opioid treatment has a significant impact in decreasing acute OREs in the adolescent population.
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http://dx.doi.org/10.1016/j.jpeds.2019.12.058DOI Listing
April 2020

An exploratory study of depot-medroxyprogesterone acetate and bone mineral density in adolescent and young adult women with cerebral palsy.

Contraception 2020 04 11;101(4):273-275. Epub 2020 Jan 11.

Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH 43210, United States; Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.

Objective: To explore whether use of depot-medroxyprogesterone acetate (DMPA) in adolescent and young adult females with cerebral palsy is associated with lower bone mineral density (BMD).

Methods: A chart review of adolescent and young adult females with cerebral palsy who had undergone dual-energy X-ray absorptiometry, comparing BMD among those with (n = 19) and without DMPA (n = 84) exposure.

Results: BMD was similar in patients with and without DMPA exposure. All patients had low BMD, with average Z-scores of less than -2 at most sites.

Conclusion: Results suggest that DMPA is not associated with lower BMD in non-ambulatory adolescent and young adult females with cerebral palsy.
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http://dx.doi.org/10.1016/j.contraception.2019.12.009DOI Listing
April 2020

Home induction and outpatient treatment of kratom use disorder with buprenorphine-naloxone: A case report in a young adult.

Subst Abus 2020 23;41(3):311-314. Epub 2019 Oct 23.

The College of Medicine, The Ohio State University, Columbus, Ohio, USA.

: The use of the natural product, kratom, has increased significantly in recent years. The active compounds in kratom have been shown to produce both opioid and stimulant-like effects. While kratom is marketed as a safe, non-addictive method to treat pain and opioid withdrawal, there have been reports demonstrating that kratom is physiologically addictive and linked to overdose deaths. A limited number of case-reports are available describing treatment of kratom use disorder in middle-aged adults, generally in the context of chronic pain and in inpatient settings. Our case is unique in that we describe outpatient treatment of kratom use disorder in a young adult with comorbid attention deficit hyperactivity disorder (ADHD) and in the absence of chronic pain. : A 20-year-old college student with ADHD presented to an office-based opioid agonist treatment clinic (OBOT) for treatment of kratom use disorder. He was unable to attend inpatient or residential substance use treatment due to work and school obligations. Additionally, he had stopped taking his prescribed stimulant due to cardiac side effects. The OBOT team successfully initiated buprenorphine-naloxone (BUP/NAL) sublingual films via home induction to treat his kratom use disorder. The patient is being monitored monthly with plans to slowly taper his BUP/NAL dose as tolerated. : We present a case of a young adult male with kratom use disorder, complicated by a diagnosis of ADHD, successfully treated with BUP/NAL via home induction. The patient is currently kratom-free, reports improved mood and sleep patterns since initiating BUP/NAL, and is able to once again tolerate his ADHD stimulant medication. Healthcare providers should be aware of the use of kratom and consider utilizing BUP/NAL to treat dependence to this botanical drug.
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http://dx.doi.org/10.1080/08897077.2019.1671945DOI Listing
October 2019

Multifaceted Quality Improvement Initiative Improves Retention in Treatment for Youth with Opioid Use Disorder.

Pediatr Qual Saf 2019 May-Jun;4(3):e174. Epub 2019 May 16.

Nationwide Children's Hospital, Columbus, Ohio.

Introduction: There is a critical need to develop interventions that help adolescents and young adults with opioid use disorders (OUDs) connect with, engage in, and remain consistent with the treatment given that patients who develop long-term OUDs experience long-term medical and mental health sequelae.

Methods: We implemented quality improvement (QI) processes to increase early engagement and 6-month retention within a medication-assisted treatment clinic for youth with OUDs. QI interventions included motivational interviewing (MI) staff training, implementation of reduced initial treatment requirements, reduction of access barriers to treatment, and enhancement of patient treatment motivation. We monitored the impact of the interventions via a p-chart.

Results: A statistically significant shift was seen in the 6-month retention rate following both MI staff training and the use of reduced initial treatment requirements. Second visit return rate also experienced a statistically significant shift following transportation support and an incentive program.

Discussion: Our data demonstrate that following MI staff training, reduced initial clinic requirements, transportation support, and utilization of an incentive program, the second visit return rate, and 6-month retention rate improved within an outpatient medication-assisted treatment clinic for youth with OUDs.
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http://dx.doi.org/10.1097/pq9.0000000000000174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594786PMC
May 2019

Primary care provider adherence to reproductive healthcare guidelines in adolescents and young adults with disabilities: A retrospective matched cohort study1.

J Pediatr Rehabil Med 2019;12(3):317-324

Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, USA.

Purpose: Assessing provider adherence to preventative sexual and reproductive healthcare guidelines in adolescents and young adults (AYA) patients with physical and intellectual disabilities (PWD).

Methods: Records of PWD (N= 42) age 12-26 receiving health maintenance between 01/01/11-12/31/16 were reviewed for: (1) initiation and completion of human papilloma virus (HPV) vaccination series, (2) initiation and completion of meningococcal vaccination, (3) screening for human immunodeficiency virus (HIV), and documentation of (4) sexual, (5) menstrual, and (6) pregnancy histories. Unaffected age and gender-matched patients provided comparison data (Comparison Cohort, CC).

Results: The mean age of both groups was 17.3 years ± 3.8 and 40.5% were female. There was no significant difference between groups regarding the completion of HPV or meningococcal vaccine series. Among those 15+ years of age, 7.1% of PWD and 28.6% of CC were screened for HIV (p= 0.04). Sexual history was documented in 19.0% of PWD versus 73.8% of CC (p< 0.001). Among females, menstrual regularity was recorded in 11.8% of PWD versus 47.1% of CC (p= 0.02) and pregnancy history in 0.0% of PWD versus 29.4% of CC (p= 0.04).

Conclusions: Adherence to sexual health guidelines was suboptimal, and lower among PWD. Vaccination rates did not differ between the two groups.
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http://dx.doi.org/10.3233/PRM-180589DOI Listing
June 2020

Metabolic Syndrome in Adolescents with Polycystic Ovary Syndrome: Prevalence on the Basis of Different Diagnostic Criteria.

J Pediatr Adolesc Gynecol 2019 Aug 30;32(4):383-387. Epub 2019 Jan 30.

Nationwide Children's Hospital, Division of Adolescent Medicine, 700 Children's Drive, Suite LA3A, Columbus, Ohio.

Study Objective: Existing literature on the prevalence of metabolic syndrome (MBS) in adolescents with polycystic ovary syndrome (PCOS) is inconsistent, likely because of the application of differing diagnostic criteria. The objective was to assess the prevalence of MBS in adolescents with PCOS depending on the PCOS diagnostic criteria used.

Design, Setting, And Participants: A retrospective chart review of female patients (N = 37), ages 11-22 years, diagnosed with PCOS between January 2013 and December 2017. Patients were included only if they had received screening allowing comparison across all PCOS diagnostic criteria: National Institutes of Health, Rotterdam, Androgen Excess Society, Amsterdam, Endocrine Society, and the Pediatric Endocrine Society (PES). The presence of MBS was established using the International Diabetes Federation criteria. The proportion of patients having MBS was then calculated for each PCOS diagnostic criteria subgroup.

Interventions And Main Outcome Measures: For the entire study cohort, MBS was present in 17/37 patients (45.9%). The highest prevalence of MBS was among the subgroup of patients meeting the PES PCOS diagnostic criteria (13/25; 52.0%), whereas the lowest prevalence was in the subgroup meeting the Amsterdam PCOS criteria (6/15; 40.0%). Those diagnosed using the PES criteria also had the highest percentage of patients with 3 or more risk factors for MBS.

Results And Conclusion: The prevalence of MBS varied according to the specific PCOS diagnostic criteria and was highest when PES guidelines were used. The PES criteria are adolescent-specific and have thus refined the diagnosis of PCOS for this population. Our results highlight the importance of validated adolescent-specific PCOS diagnostic criteria.
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http://dx.doi.org/10.1016/j.jpag.2019.01.006DOI Listing
August 2019

Experiences of Gender Minority Youth With the Intrauterine System.

J Adolesc Health 2019 07 26;65(1):32-38. Epub 2019 Jan 26.

Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio.

Purpose: The aim of the study was to evaluate the experience of menstruating adolescents identifying as male or gender nonconforming with the levonorgestrel-releasing intrauterine system (LNG-IUS) as a method of menstrual suppression and compare to that of cisgender youth (CGY) using the LNG-IUS for noncontraceptive indications.

Methods: A retrospective chart review of gender minority youth (GMY), aged 12-22 years, who self-selected the 52 mg LNG-IUS for menstrual suppression between June 2014 and January 2018. GMY were then matched for age and time of insertion with CGY. Subjects were contacted by telephone to further explore LNG-IUS experience such as if the device was still in place, method satisfaction, current bleeding patterns, and for GMY improvement in menstrual distress.

Results: Thirty GMY had the LNG-IUS inserted during the study period, and 20 GMY were matched with CGY for age and time of insertion. GMY were significantly more likely to receive sedation for LNG-IUS insertion (50% vs. 15%, p = .04). Otherwise, the LNG-IUS experience was similar between groups, including mean number of telephone/office visit encounters for an LNG-IUS concern, expulsion and reinsertion rates, and need for additional medications to control bleeding. On average, the mean months of use was 14.5 ± 8.6 months in GMY and 14.6±11.5 in CGY (p = .97). LNG-IUS removal was documented in three (15%) of GMY and five (25%) of CGY. Improvement in menstrual distress was reported by 80% of GMY after the insertion of the LNG-IUS.

Conclusions: Overall experience with the LNG-IUS was similar for GMY and CGY, and menstrual distress and bleeding pattern improved in the majority of GMY who self-selected this method for menstrual suppression.
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http://dx.doi.org/10.1016/j.jadohealth.2018.11.010DOI Listing
July 2019

A pilot randomized controlled trial of omega-3 fatty acid supplementation for the treatment of anxiety in adolescents with anorexia nervosa.

Int J Eat Disord 2018 12 26;51(12):1367-1372. Epub 2018 Oct 26.

The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.

Objective: To evaluate the effectiveness and tolerability of omega-3 polyunsaturated fatty acid (PUFA) supplementation for treatment of trait anxiety among adolescent females with restrictive anorexia nervosa (AN).

Method: A pilot double-blind, placebo-controlled randomized trial of adolescent females with AN (N = 24) entering Partial Hospitalization Program (PHP) from January 2015 to February 2016. Participants were randomized to four daily PUFA (2,120 mg eicosapentaenoic acid/600 mg docosohexaenoic acid) or placebo capsules for 12 weeks. A 9-item questionnaire of side effect frequency assessed medication tolerability. The Beck Anxiety Inventory-Trait measured anxiety at baseline, 6, and 12 weeks. Linear mixed models evaluated associations between randomization group and study outcomes. Twenty-two and 18 participants completed 6 and 12 weeks of data collection, respectively.

Results: Medication side effect scores were low and were not significantly different between randomization groups at Week 6 (p = .20) or 12 (p = .41). Mean trait anxiety score significantly (p < .01) decreased from baseline to 12 weeks in both groups, and the rate of change over the course of time did not differ between omega-3 PUFA and placebo groups (p = .55).

Conclusion: Omega-3 PUFA supplementation was well tolerated in adolescent females with AN. Although power to detect differences was limited, we found no evidence that omega-3 PUFA benefited anxiety beyond nutritional restoration.
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http://dx.doi.org/10.1002/eat.22964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061649PMC
December 2018

A pilot study of hormonal contraceptive use and bone mineral density in young women with sickle cell disease.

Pediatr Blood Cancer 2018 12 11;65(12):e27398. Epub 2018 Sep 11.

Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio.

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http://dx.doi.org/10.1002/pbc.27398DOI Listing
December 2018

Computerized Self-Administered Substance Use Screening in a General Adolescent Clinic.

Clin Pediatr (Phila) 2018 09 19;57(10):1232-1235. Epub 2017 Dec 19.

1 Nationwide Children's Hospital, Columbus, OH, USA.

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http://dx.doi.org/10.1177/0009922817748398DOI Listing
September 2018

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies.

Transl Pediatr 2017 Oct;6(4):248-255

Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, the Ohio State University College of Medicine, Columbus, OH, USA.

Controversy continues about the underlying etiopathogenesis, diagnostic criteria, and recommendations for polycystic ovary syndrome (PCOS) in adolescents. Recent literature has recognized these deficiencies and evidence based expert recommendations have become more available. The purpose of this chapter is to offer primary care providers a practical understanding and approach to the diagnosis and treatment of PCOS in adolescents. Although the presence of polycystic ovary morphology (PCOM) is included as a key diagnostic criterion of PCOS in adults, it is currently not recommended for the diagnosis in adolescents. As such, the diagnosis of PCOS in adolescents currently hinges on evidence of ovulatory dysfunction and androgen excess. Recommended evidence of ovulatory dysfunction includes: consecutive menstrual intervals >90 days even in the first year after menstrual onset; menstrual intervals persistently <21 or >45 days 2 or more years after menarche; and lack of menses by 15 years or 2-3 years after breast budding. Recommended evidence of androgen excess include: moderate to severe hirsutism; persistent acne unresponsive to topical therapy; and persistent elevation of serum total and/or free testosterone level. Importantly, a definitive diagnosis of PCOS is not needed to initiate treatment. Treatment may decrease risk of future comorbidity even in the absence of a definitive diagnosis. Deferring diagnosis, while providing symptom treatment and regular/ frequent follow-up of symptomology, is a recommended option. The treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. Goals of treatment are to improve quality of life and long-term health outcomes. Lifestyle modifications remain first-line management of overweight and obese adolescents with PCOS. Combined oral contraceptives (COC) are first line pharmacotherapy for management of menstrual irregularity and acne, and metformin is superior to COCs for weight reduction and improved dysglycemia. COCs and metformin have similar effects on hirsutism, but often need to be paired with other treatment modalities to achieve further improvement of cutaneous symptoms. Clinicians should be cognizant that PCOS is associated with significant metabolic and psychological comorbidity and screen for these issues appropriately.
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http://dx.doi.org/10.21037/tp.2017.09.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682369PMC
October 2017

A Retrospective Chart Review of Contraceptive Use among Adolescents with Opioid Use Disorder.

J Pediatr Adolesc Gynecol 2018 Apr 21;31(2):122-127. Epub 2017 Nov 21.

The Ohio State University College of Medicine, Columbus, Ohio; The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio.

Study Objective: To describe contraceptive use among female adolescents initiating outpatient treatment for opioid use disorder.

Design: Retrospective chart review.

Setting: Outpatient clinic providing medication-assisted treatment for substance use disorders to adolescents and young adults.

Participants: Nonpregnant female adolescents who presented for treatment from January 1, 2013 to January 31, 2016 (N = 123).

Interventions: None.

Main Outcome Measures: Prescription contraceptive use at baseline and initiation of a new method within 90 days.

Results: Of 123 female adolescents who presented for treatment of opioid use disorder, 113 (91.9%) reported sexual activity and 80 (65.0%) were not using prescription contraception at intake. Previous pregnancy was reported by 43 (35.0%) and 20 (16.3%) were positive for a sexually transmitted infection. Contraceptive counseling was not documented for 73 (59.3%) patients. Among patients with no prescription contraception at baseline, 56 of 80 (70.0%) initiated a method within the study window. Significant predictors (odds ratio [OR]; 95% confidence interval) of contraceptive initiation included previous pregnancy (8.6; 1.39-52.99), education of less than a high school diploma/general equivalency diploma (7.4; 1.63-33.41), and return for follow-up visit (9.8; 2.18-43.69).

Conclusion: Young women who presented for opioid use disorder treatment were at high risk of adverse reproductive health outcomes. Most were sexually active and not using prescription contraception. Findings underscore the need for contraceptive counseling in this patient population. Optimally, these services would be provided in conjunction with substance use treatment. Improved contraceptive counseling documentation will allow evaluation of effective contraceptive counseling strategies for adolescents with opioid use disorders and might serve to inform future interventions.
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http://dx.doi.org/10.1016/j.jpag.2017.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866180PMC
April 2018

Severe Sepsis and Acute Myocardial Dysfunction in an Adolescent with Chlamydia Trachomatis Pelvic Inflammatory Disease: A Case Report.

J Pediatr Adolesc Gynecol 2018 Apr 13;31(2):143-145. Epub 2017 Oct 13.

Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio; The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.

Background: Although generally asymptomatic, severe Chlamydia trachomatis (C. trachomatis) infections have been documented. C. trachomatis has been associated with myocarditis as well as sepsis.

Case: A 19-year-old girl with type 1 diabetes mellitus developed sudden-onset mental status change and shock after resolution of diabetic ketoacidosis. Abdominal and pelvic imaging showed uterine and adnexal inflammation, and pelvic examination confirmed a diagnosis of pelvic inflammatory disease. The patient was intubated, required vasopressor support, and developed severe biventricular myocardial dysfunction. Infectious myocarditis workup was negative. Nucleic acid amplification testing from vaginal discharge was positive for C. trachomatis and Trichomonas vaginalis and negative for Neisseria gonorrhoeae.

Summary And Conclusion: C. trachomatis should be considered in the workup of septic shock, particularly in populations at high risk for sexually transmitted infections.
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http://dx.doi.org/10.1016/j.jpag.2017.10.004DOI Listing
April 2018

A Review of Expedited Partner Therapy for the Management of Sexually Transmitted Infections in Adolescents.

J Pediatr Adolesc Gynecol 2017 Jun 4;30(3):341-348. Epub 2017 Feb 4.

Nationwide Children's Hospital, Adolescent Medicine Division, Columbus, Ohio; The Ohio State University, Columbus, Ohio.

Adolescents are at high risk of acquiring and becoming reinfected with sexually transmitted infections. Partner notification and treatment are essential to preventing the spread of sexually transmitted infections. Expedited partner therapy (EPT) is a method of partner treatment used by medical providers to treat patients' sexual partners without direct medical evaluation or counseling. The objective of this article is to review the current literature regarding EPT effectiveness, patients' attitudes and acceptance of EPT, and providers' views and practices surrounding the use of this method of partner treatment. In this article potential concerns associated with EPT use, current policy statements, and the legal status of EPT are discussed. EPT results in improved or equivalent rates of reinfection in adolescents and adults with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Overall, patients are accepting of this method of partner treatment, however, providers continue to have concerns that limit its routine use. Additional studies in adolescents will help providers better understand if EPT is a useful method to prevent reinfection in this population.
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http://dx.doi.org/10.1016/j.jpag.2017.01.012DOI Listing
June 2017

Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth.

J Community Health 2017 Jun;42(3):437-443

Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.

Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by <5 % of surveyed youth. Significant predictors of having seen a doctor in the past 12 months included sexual minority status (OR 2.8, p = 0.04) and possession of health insurance (OR 4.9, p < 0.001). Female sex (OR 5.2, p < 0.001) and reported external barriers other than health insurance (OR 0.2, p < 0.001) were associated with having a regular care provider. Fear-based concerns were associated (OR 3.8, p = 0.02) with frequent ED visits, as was being insured (OR 2.2, p = 0.03). These results underscore the need to clearly define healthcare outcomes when investigating barriers to care among homeless and runaway youth as the impact of discrete barriers varies depending on outcome of focus.
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http://dx.doi.org/10.1007/s10900-016-0274-7DOI Listing
June 2017

Bone Mineral Density and Weight Changes in Adolescents Randomized to 3 Doses of Depot Medroxyprogesterone Acetate.

J Pediatr Adolesc Gynecol 2017 Apr 24;30(2):169-175. Epub 2016 Oct 24.

The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio; Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio. Electronic address:

Study Objective: To assess the association between medroxyprogesterone acetate exposure and bone mineral density (BMD) loss and weight change in adolescents.

Design: Forty-eight-week prospective, randomized trial conducted May 2012-April 2014.

Setting: Recruitment occurred in the general community and outpatient clinics in central Ohio.

Participants: Self-referred sample of 34 female adolescents aged 12-21 years initiating depot medroxyprogesterone acetate (DMPA).

Interventions: Randomization to 1 of 3 DMPA doses (150, 104, or 75 mg) given intramuscularly every 12 weeks for 48 weeks.

Main Outcome Measures: Absolute and percent change in BMD from 0-48 weeks at the L1-L4 lumbar spine, total hip, and femoral neck; absolute and percent change in weight at 48 weeks.

Results: DMPA dose was associated with medroxyprogesterone acetate exposure as evidenced by a direct relationship (P < .001) between dose group and area under the concentration time curve. At 48 weeks, no significant BMD decreases were seen in the 75 mg dose group. The 104 and 150 mg dose groups experienced significant (P < .01) decreases in L1-L4 lumbar spine BMD (3.1% and 4.0%, respectively). The 150 mg group also had significant (P < .05) decreases in total hip (3.0%) and femoral neck (4.0%) BMD. No group differences in weight change were observed. No pregnancies occurred in any DMPA dose group.

Conclusions: Our data provide evidence of a dose-response relationship between DMPA and BMD loss. Intramuscular DMPA doses less than 150 mg can decrease risk of BMD loss in adolescents. The risk/benefit ratio of lower-dose DMPA should be further investigated in larger and more diverse adolescent populations.
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http://dx.doi.org/10.1016/j.jpag.2016.10.011DOI Listing
April 2017

Statewide opioid prescriptions and the prevalence of adolescent opioid misuse in Ohio.

Am J Drug Alcohol Abuse 2017 05 19;43(3):299-305. Epub 2016 Sep 19.

a Nationwide Children's Hospital , Division of Adolescent Medicine , Columbus , OH , USA.

Background: Little is known about the relationship between opioid prescribing practices and the prevalence of adolescent opioid misuse.

Objective: To examine the relationships between both opioid prescriptions filled by adolescents and adults and adolescents seeking treatment for opioid misuse in Ohio.

Methods: Analyses of large statewide databases from 2008 to 2012, including all 88 counties in Ohio. The Ohio Board of Pharmacy provided data regarding prescription opioids filled by adolescents (12-20 years, N = 50,030,820 doses) and adults (>20 years, N = 3,811,288,395 doses) by county of residence. The Ohio Department of Mental Health and Drug Addiction Services provided annual treatment admissions for adolescent opioid misuse by county of residence (N = 6446).

Results: Adults filled prescriptions for nearly 100 oral opioid doses per capita annually, while adolescents filled prescriptions for approximately 7 oral opioid doses per capita annually. In Bayesian Poisson modeling examining the effect of annual adult per capita dose on adolescent treatment admissions, adjusted for annual adolescent per capita dose and year, an increase of one in the annual adult per capita opioid dose resulted in an increase of 1.3% (RR = 1.013, 95% HPD CI = [1.008, 1.017]) in the rate of adolescent treatment admissions. This association corresponds to a 99.99% chance that the adolescent treatment rate increases when the annual per capita adult dose is increased by one unit.

Conclusion: The amount of opioids filled by adults in Ohio, although relatively stable from 2008 to 2012, is approximately 13 times that filled by adolescents and is significantly associated with adolescents seeking treatment for opioid misuse. Efforts to decrease adolescent opioid misuse should also focus on reducing adult opioid prescriptions.
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http://dx.doi.org/10.1080/00952990.2016.1216999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357590PMC
May 2017

Polycystic ovary syndrome in adolescents: a review of past year evidence.

Curr Opin Obstet Gynecol 2016 10;28(5):373-80

aChildren's Center, Mayo Clinic, Rochester, Minnesota bDivision of Adolescent Medicine, Nationwide Children's Hospital cCenter for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.

Purpose Of Review: Despite the fact that polycystic ovary syndrome (PCOS) is a common disorder, much remains unknown or controversial regarding the cause, diagnosis, and management of this disorder, particularly in adolescents where normal pubertal events can overlap with the PCOS phenotype.

Recent Findings: We put forth a critical assessment of recent literature on PCOS in adolescents, with particular focus on new information regarding the pathogenesis, diagnosis, associated morbidities, and management.

Summary: Although the evidence is increasing, there is still a critical need for large, prospective studies of adolescents with PCOS. Given the current level of evidence, a definitive diagnosis of PCOS is not necessary to effectively identify and treat manifestations of this syndrome in adolescents. Currently, ovarian imaging is not recommended in the diagnostic evaluation of PCOS in adolescents until high-quality data for defining polycystic ovarian morphology are available in this age group. Weight loss remains the safest and most effective treatment option for obese or overweight adolescents with PCOS. Clinicians should be mindful of the significant associated psychological morbidity and effectively screen and manage these conditions in adolescents with manifestations of PCOS.
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http://dx.doi.org/10.1097/GCO.0000000000000301DOI Listing
October 2016

Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting.

Contraception 2016 07 3;94(1):81-6. Epub 2016 Mar 3.

Section of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.

Objective: The etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive method. Uptake remains limited in adolescents, a population at high risk for unintended pregnancy. The objectives of this study were to determine the 12-month discontinuation rate of the ENG implant among adolescents in an outpatient setting and to characterize risk factors for discontinuation.

Study Design: A retrospective chart review identified adolescent females aged 12 to 22years who received the ENG implant in one pediatric institution between January 1, 2011, and April 15, 2014. Patients were categorized into ENG discontinuers (removed prior to 12months) and ENG continuers (continued for ≥12months). Associations between demographic, clinical and postplacement characteristics with ENG discontinuation category were assessed with t tests, χ(2)/Fisher's Exact Tests and backwards stepwise logistic regression.

Results: Of the 750 patients who had an ENG implant inserted, 77 (10.3%) had the device removed prior to 12months of use. The mean length of implant use for those who discontinued was 7.5months. Problematic bleeding was the most commonly cited reason for discontinuation. Older age at time of insertion, history of pregnancy and ≥1 medical visit for implant concerns (not including removal) were independently predictive (p<.01) of method discontinuation.

Conclusion: The vast majority of adolescents continued the ENG implant at 12months, making it an excellent contraceptive choice for adolescents within the outpatient pediatric setting. Greater efforts should be made to increase its use by pediatric providers.

Implications: The ENG implant is an excellent contraceptive option for adolescents in the outpatient pediatric setting.
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http://dx.doi.org/10.1016/j.contraception.2016.02.030DOI Listing
July 2016

Three-injection intralymphatic immunotherapy in adolescents and young adults with grass pollen rhinoconjunctivitis.

Ann Allergy Asthma Immunol 2016 Feb 17;116(2):168-70. Epub 2015 Dec 17.

Nationwide Children's Hospital and Research Institute, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.

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http://dx.doi.org/10.1016/j.anai.2015.11.010DOI Listing
February 2016

Delayed Ego Strength Development in Opioid Dependent Adolescents and Young Adults.

J Addict 2015 17;2015:879794. Epub 2015 Nov 17.

The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA ; The Ohio State University, Columbus, OH 43210, USA ; Nationwide Children's Hospital, Columbus, OH 43205, USA.

Objective. To evaluate ego strengths, in the context of Erikson's framework, among adolescents and young adults diagnosed with opioid dependence as compared to non-drug using youth. Methods. Opioid dependent (n = 51) and non-drug using control (n = 31) youth completed the self-administered Psychosocial Inventory of Ego Strengths (PIES). The PIES assesses development in the framework of Erikson's ego strength stages. Multivariate linear regression modeling assessed the independent association of the primary covariate (opioid dependent versus control) as well as potential confounding variables (e.g., psychiatric comorbidities, intelligence) with total PIES score. Results. Mean total PIES score was significantly lower in opioid dependent youth (231.65 ± 30.39 opioid dependent versus 270.67 ± 30.06 control; p < 0.01). Evaluation of the PIES subscores found significant (p < 0.05) delays in all ego strength areas (hope, will, purpose, competence, fidelity, love, care, and wisdom). When adjusting for potential confounders, opioid dependence remained a significant (p < 0.001) independent predictor of total PIES score. Conclusion. Adolescents with opioid dependence demonstrated significant delays in ego strength development. A treatment approach acknowledging this delay may be needed in the counseling and treatment of adolescents with opioid dependence.
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http://dx.doi.org/10.1155/2015/879794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664807PMC
December 2015
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