Publications by authors named "Jennifer O Howell"

5 Publications

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Pediatric Vulvar Lichen Sclerosus: A Survey of Disease Course.

J Pediatr Adolesc Gynecol 2021 May 11. Epub 2021 May 11.

Department of Dermatology, University of North Carolina at Chapel Hill. Electronic address:

Study Objective: To assess long-term outcomes of Lichen Sclerosus (LS) in the female pediatric population, specifically in relation to patient age, treatment type and duration, and remission.

Design: Retrospective chart review was conducted to identify female pediatric patients (0-18 years of age) who were diagnosed with LS between 1/1/2015 and 1/1/2020 at the University of North Carolina Dermatology and/or OB/GYN Departments. Patients were contacted via telephone for follow-up interviews consisting of a series of questions regarding patient age, symptom onset, time of diagnosis, treatment, and current symptoms.

Results: Out of the 128 patients identified, 61 patients consented and participated in follow-up interviews. At the time of study follow-up, 90% of participants reported their symptoms were improved. Patients reported using a variety of treatments, with medium- to high-potency topical steroids being the most common. At the time of follow-up, 87% of patients reported being asymptomatic, 70% of which were not using any form of maintenance therapy. Those who achieved symptom resolution did so at an average of 8.4 years of age. There was no significant difference in ages between asymptomatic patients on maintenance therapy and off maintenance therapy. There was a positive correlation found between the duration of LS treatment and time in remission (p<0.001). Increased patient age at time of follow-up also correlated positively with time in remission (p<0.001).

Conclusion: In our cohort, the need for continued maintenance therapy was not correlated with age or, by proxy, pubertal status. Thus, LS remission may be determined more by early and successful pharmacological interventions.
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May 2021

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 3.0.

J Pediatr Adolesc Gynecol 2021 Jun 30;34(3):291-296. Epub 2021 Mar 30.

Division of Adolescent Medicine & Young Adult Health at One Hundred Oaks, Nashville, Tennessee.

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as fellowship programs in adolescent medicine. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2018 publication with added content, resources, and updated references.
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June 2021

Developing a pilot curriculum to foster humanism among graduate medical trainees.

J Educ Health Promot 2018 10;7. Epub 2018 Jan 10.

Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA.

Background: Humanism is a central tenant of professionalism, a required competency for all residency programs. Yet, few residencies have formal curriculum for teaching this critical aspect of medicine. Instead, professionalism and humanism are often taught informally through role-modeling. With increased burnout, faculty professionalism may suffer and may compromise resident role-modeling. The objective of this study was to design a pilot curriculum to foster humanism in among residents and assess its ability to do so.

Materials And Methods: Two-phase exploratory sequential mixed methods study. Phase 1: a qualitative analysis of residents' narratives regarding challenges to humanistic behavior, and identified themes of compassion, fatigue, communication challenges, and work-life balance. Themes used as needs assessment to build curriculum. Phase 2: three sessions with themes taken from faculty development course. Participants and controls completed baseline and 60-day follow-up questionnaires assessing burnout, compassion, satisfaction, and ability to practice psychological medicine. Phase one included Obstetrics/Gynecology and internal medicine residents. Phase two included residents from the above programs, who attended at least 2/3 interactive sessions designed to address the themes identified above.

Results: Twelve participants began and ten completed curriculum (83%). The curriculum met course objectives and was well-received (4.8/5). Burnout decreased (-3.1 vs. 2.5, = 0.048). A trend toward improved compassion (4.4 vs.-0.6, = 0.096) for participants compared to controls was noted.

Conclusion: A pilot humanism curriculum for residents was well-received. Participants showed decreased burnout and trended to improved compassion scores. Development and evaluation of an expanded curriculum would further explore feasibility and effectiveness of the intervention.
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January 2018

Prepubertal Vaginal Bleeding: Etiology, Diagnostic Approach, and Management.

Obstet Gynecol Surv 2016 Apr;71(4):231-42

Program Coordinator/Nurse Consultant, NC Child Medical Evaluation Program, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.

Importance: Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to parents. A variety of practitioners, including obstetrician-gynecologists and pediatricians, may be asked to see patients with this presenting complaint, yet many do not receive adequate training in pediatric gynecology.

Evidence Acquisition: Review of the published literature in PubMed, focusing on the last 20 years, regarding the incidence, etiologies, diagnosis, and management strategies for the common causes of prepubertal vaginal bleeding.

Results: Careful history taking and pediatric-specific gynecological examination skills, including awareness of normal anatomy across the age spectrum and the ability to identify an estrogenized hymen, are keys to the appropriate assessment of this clinical problem.

Conclusions And Relevance: Prepubertal vaginal bleeding has many causes and requires a thorough targeted history and pediatric genitourinary examination, requiring knowledge of the variants of normal pediatric genitourinary anatomy. Most causes can be easily treated and are less likely to be due to sexual abuse or malignancy.
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April 2016

Incidence of opioid-managed pelvic pain after hysteroscopic sterilization versus laparoscopic sterilization, US 2005-2012.

Pharmacoepidemiol Drug Saf 2015 Aug 31;24(8):875-84. Epub 2015 Mar 31.

Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, USA.

Objective: Compare incidence of opioid-managed pelvic pain within 12 months after hysteroscopic and laparoscopic sterilization.

Methods: Using administrative claims, we identified women aged 18-49 years without recent history of childbirth who underwent hysteroscopic or laparoscopic sterilization between 2005 and 2012. We defined the outcome as ≥2 diagnoses for pelvic pain and ≥2 prescription fills for opioids. We calculated adjusted hazard ratios (HR) using Cox models and propensity score methods (matching and inverse-probability-of-treatment-weighting [IPTW]).

Results: We identified 71,875 eligible women (hysteroscopic n = 26,927 [37.5%], laparoscopic n = 44,948 [62.5%]). Of those, 236 (0.88%) hysteroscopic patients and 420 (0.93%) laparoscopic patients experienced the outcome (crude HR = 0.97, 95%CI: [0.83, 1.14]). Adjusted analyses also yielded near-null results (matched HR = 1.08, 95%CI [0.90, 1.31]; IPTW HR = 0.97, 95%CI [0.80, 1.18]). While most sensitivity analyses generated results close to the null, hazard ratios estimated using propensity score matching ranged from 0.65 to 1.53.

Conclusions: Among women without recent history of childbirth, we did not find compelling evidence of a clinically meaningful increase in the incidence of pelvic pain requiring opioids during the year after hysteroscopic sterilization. However, effects observed in sensitivity analyses may merit further investigation.
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August 2015