Papers by Traci Kazmerski
Epilepsy & Behavior
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Journal of Cystic Fibrosis
BACKGROUND As people with cystic fibrosis (CF) are living longer, men with CF increasingly face b... more BACKGROUND As people with cystic fibrosis (CF) are living longer, men with CF increasingly face both general and disease-specific sexual and reproductive health (SRH) concerns. This study explored the SRH experiences and preferences of men with CF in health care in the era of widespread use of highly effective CF modulator therapies. METHODS We recruited men with CF aged 18 years and older to participate in a qualitative descriptive study using semi-structured telephone interviews to explore experiences and preferences related to CF SRH care. Two independent researchers coded interview transcripts and conducted content and thematic analysis using an inductive approach. FINDINGS We interviewed 24 participants (mean age 33.7 ± 11.8 years, range 19-60) and identified five major themes: 1) CF SRH concerns, specifically infertility, can have negative impacts on men's perceptions of masculinity, relationships, and mental health; 2) As life expectancy increases, addressing male SRH is increasingly important in CF care; 3) Men with CF experience lack of SRH counseling and care; 4) Conversations about SRH should begin in early adolescence and be addressed regularly by CF providers in a stepwise fashion; 5) Men with CF value peer support and SRH information featuring the experiences of other men with CF. CONCLUSIONS Men with CF acknowledge the need for comprehensive CF care that includes SRH and value early, stepwise, provider-initiated SRH conversations. Future work should seek a broader understanding of the impact of SRH on the mental health of men with CF as these concerns can have significant effects on the lives and self-identities of men with CF.
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UNSTRUCTURED The United States has abysmal reproductive health indices that, in part, reflect sta... more UNSTRUCTURED The United States has abysmal reproductive health indices that, in part, reflect stark inequities experienced by people of color and those with preexisting medical conditions. The growth of “femtech,” or technology-based solutions to women’s health issues in the public and private sectors, is promising; yet these solutions are often geared towards health literate, socioeconomically privileged, and relatively healthy white cis-women. In this viewpoint, we propose a set of guiding principles for building technologies that proactively identifies and addresses these critical gaps in health care for people from socially and economically marginalized populations who are capable of pregnancy, as well as those with serious chronic medical conditions. These guiding principles require that such technologies: 1) include community stakeholders in the design, development, and deployment of the technology, 2) are grounded in person-centered frameworks, and 3) address health dispariti...
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Journal of Cystic Fibrosis, 2021
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The Journal of pediatrics, 2021
OBJECTIVE To evaluate pediatric subspecialists' practices and attitudes regarding sexual and ... more OBJECTIVE To evaluate pediatric subspecialists' practices and attitudes regarding sexual and reproductive healthcare for adolescent and young adult women for whom they prescribe teratogens. STUDY DESIGN We surveyed pediatric subspecialists at 1 tertiary care pediatric hospital. Items assessed attitudes and practices related to sexual and reproductive healthcare for adolescent and young adult women prescribed teratogens, and barriers and facilitators to sexual and reproductive healthcare provision. We used descriptive statistics, χ2 tests, and logistic regression to analyze results. RESULTS There were 200 subspecialists from 17 subspecialties who completed the survey; 77% reported prescribing teratogens to adolescent and young adult women and 18% reported caring for a patient who became pregnant while taking a teratogen. Overall, 99% indicated that it is important to address sexual and reproductive healthcare. Respondents endorsed confidence in sexual and reproductive healthcare ...
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Journal of Patient Experience, 2021
Optimal information sharing between people with cystic fibrosis (PwCF), caregivers, and clinician... more Optimal information sharing between people with cystic fibrosis (PwCF), caregivers, and clinicians is key to managing CF. Based on research indicating the CF community’s interest in improved care conversations, the Cystic Fibrosis Foundation partnered with the Academy of Communication in Healthcare to customize their relationship-centered communication training program for CF and pilot the Partnership Enhancement Program (PEP). Facilitated by interprofessional certified CF clinicians, PEP consisted of a full-day workshop and follow-up session with CF care teams. Over 98% of survey responses highly rated the applicability of the skills to respond to PwCF, and caregivers needs more effectively.
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Gastroenterology, 2021
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</j... more <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Women with inflammatory bowel diseases (IBD), such as Crohn's disease or ulcerative colitis, have normal fertility and can have healthy pregnancies and children. However, many have fewer children than the general population, with up to a third of women choosing "voluntary childlessness." Given that IBD diagnoses can elicit reproductive concerns related to contraception choice, pregnancy, and parenthood, this study explored the reproductive health decision-making experiences and preferences of women with pediatric-onset IBD.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In this qualitative study, we recruited women ages 18–44 years old with a childhood diagnosis of IBD who are followed by gastroenterology at one pediatric and one adult academic medical center in Western Pennsylvania to participate in individual, semi-structured interviews. We conducted interviews between July 2019 and July 2020, exploring experiences and attitudes toward parenthood, pregnancy, contraception, and family planning care provision. Interviews were audio-recorded and transcribed verbatim. Two independent coders performed analyses using a deductive and inductive coding approach and identified dominant themes and representative quotations. We conducted interviews until thematic saturation was reached.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Twenty-one women with IBD participated in interviews (average age 24.7 +/-5.9 years, range 18–43 years; average age of diagnosis 14.1 +/- 2.0 years). Five women had been pregnant, and 16 wanted to have children in the future. We identified 4 key themes: (1) Nulliparous women who do not currently desire pregnancy appear to lack reproductive health knowledge; (2) Women with IBD lack clarity regarding the role IBD plays in contraceptive choice; (3) Related to pregnancy, women are concerned about the heredity of IBD, antepartum disease activity, and the safety of their current medications; (4) Women with IBD typically default to their women's health provider for reproductive healthcare and counseling, but they expect their gastroenterologist to initiate relevant reproductive health discussions with them and to provide information in the context of their disease.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Women have concerns about the effects of IBD on pregnancy, parenthood, and contraceptive choice; however, many have had limited or no discussion with their gastroenterologist about these topics. They have gaps in their reproductive health knowledge and report receiving conflicting advice from different providers. Obtaining the perspectives of a larger sample of women with IBD and both women's health and gastroenterology providers may further guide the development of interventions to improve this aspect of comprehensive care.</jats:p> </jats:sec>
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Epilepsy & Behavior
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Nutrients
Food insecurity (FI) is defined as “the limited or uncertain access to adequate food.” One root c... more Food insecurity (FI) is defined as “the limited or uncertain access to adequate food.” One root cause of FI is living in a food desert. FI rates among people with cystic fibrosis (CF) are higher than the general United States (US) population. There is limited data on the association between food deserts and CF health outcomes. We conducted a retrospective review of people with CF under 18 years of age at a single pediatric CF center from January to December 2019 using demographic information and CF health parameters. Using a Geographic Information System, we conducted a spatial overlay analysis at the census tract level using the 2015 Food Access Research Atlas to assess the association between food deserts and CF health outcomes. We used multivariate logistic regression analysis and adjusted for clinical covariates and demographic covariates, using the Child Opportunity Index (COI) to calculate odds ratios (OR) with confidence intervals (CI) for each health outcome. People with CF ...
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Circulation
Background: Due to medical advances, women with congenital heart disease (CHD) are living longer,... more Background: Due to medical advances, women with congenital heart disease (CHD) are living longer, healthier lives and many are considering pregnancy. The hemodynamic changes of pregnancy can present high risks of morbidity and mortality for many women with CHD. As little is known about these women’s reproductive health experiences, this study examines their perceptions of pregnancy and family planning care as related to CHD. Methods: Women ages 18-45 years with a diagnosis of CHD associated with a WHO classification II-IV for pregnancy morbidity and mortality participated in individual, semi-structured interviews exploring their experiences and attitudes toward parenthood, pregnancy, contraception and family planning care provision. Interviews were audio-recorded, transcribed verbatim, and analysis was performed by two independent coders using an inductive coding approach. Results: Twenty women with CHD participated in interviews (average age 30.1 years, SD 5.85). Nine women had eve...
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The Journal of Pediatrics
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Journal of Child Neurology
Objective: To explore perspectives of pediatric neurologists regarding sexual and reproductive he... more Objective: To explore perspectives of pediatric neurologists regarding sexual and reproductive health care for adolescent women with epilepsy (WWE) and intellectual disability. Methods: We interviewed pediatric neurologists regarding sexual and reproductive health for WWE with intellectual disability. We audio-recorded and transcribed interviews and conducted qualitative analysis. Results: 16 pediatric neurologists participated. Themes included the following: (1) Pediatric neurologists have differing perspectives about how intellectual disability affects WWE’s sexual and reproductive health needs, (2) pediatric neurologists provide sexual and reproductive health counseling variable in content and frequency to this population, (3) pediatric neurologists tend to recommend longer-term methods of contraception for this population, and (4) pediatric neurologists are asked to be involved in decision-making around sterilization, yet express ethico-legal reservations. Conclusion: Our findin...
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Epilepsy & Behavior
OBJECTIVE To evaluate child neurologists' knowledge, attitudes, and practices regarding sexua... more OBJECTIVE To evaluate child neurologists' knowledge, attitudes, and practices regarding sexual and reproductive health (SRH) care for adolescent and young adult women with epilepsy (WWE). METHODS Child neurologists (including attending physicians, residents, fellows, and advanced practitioners) completed an online survey distributed through subspecialty listservs. We analyzed results using descriptive statistics, chi-square, and logistic regression. RESULTS Two hundred eight child neurologists completed the survey. Most believed that child neurologists should counsel young WWE on: teratogenesis (99%, n = 206/207), contraception-antiseizure medication interactions (96%, n = 194/202), pregnancy (95%, n = 198/206), contraception (89%, n = 184/206) and folic acid supplementation (70%, n = 144/205). Fewer respondents felt confident with such counseling (teratogenesis: 90%, n = 188/208, drug interactions: 65%, n = 133/208, pregnancy 75%, n = 156/208, contraception: 47-64%, n = 96-134/208, p < 0.05). Ninety-five percent (n = 172/181) reported ever discussing SRH with typically developing young WWE, compared to 78% (n = 141/181) for young WWE with mild intellectual disability (p < 0.01). One third (n = 56/170) who ever discussed SRH did not do so routinely. Respondents correctly answered 87% ± 5% of knowledge questions about SRH for WWE, 80% ± 4% of questions about teratogenic antiseizure medications, and 61% ± 7% of questions about contraception-antiseizure drug interactions. The greatest barrier to SRH care was time constraints (80%, n = 149/186). The majority (64%, n = 119/186) identified solutions including longer appointment times and co-managing SRH care with other specialties. CONCLUSIONS Findings reveal gaps in SRH care by child neurologists for adolescent and young adult WWE, especially those with mild intellectual disability. Provider-identified barriers and solutions may serve as targets to improve SRH care for this population.
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Journal of Adolescent Health
OBJECTIVES Numerous U.S. state legislatures have proposed bills to ban gender-affirming medical i... more OBJECTIVES Numerous U.S. state legislatures have proposed bills to ban gender-affirming medical interventions for minors. Parents and caregivers play a critical role in advocating for and supporting their transgender and gender-diverse youth (TGDY). We aimed to understand parent and caregiver perspectives about this potential legislation and perceived effects on their TGDY's mental health. METHODS We developed and launched a social-media based, anonymous online survey in February 2020 to assess parent and caregiver perspectives on proposed laws to ban gender-affirming medical interventions for minors. Participants were asked to respond to two open-ended questions about these laws; responses were coded to identify key themes. RESULTS We analyzed responses from 273 participants from 43 states. Most identified as white (86.4%) female (90.0%) mothers (93.8%), and 83.6% of their TGDY had received gender-affirming medical interventions before age 18 years. The most salient theme, which appeared in the majority of responses, described parent and caregiver fears that these laws would lead to worsening mental health and suicide for their TGDY. Additional themes included a fear that their TGDY would face increased discrimination, lose access to gender-affirming medical interventions, and lose autonomy over medical decision-making due to government overreach. CONCLUSIONS In this convenience sample, parents and caregivers overwhelmingly expressed fear that the proposed legislation will lead to worsening mental health and increased suicidal ideation for their TGDY. They implored lawmakers to hear their stories and to leave critical decisions about gender-affirming medical interventions to families and their medical providers.
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Pediatric Pulmonology
As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are consi... more As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are considering the full range of reproductive options for their futures, including parenthood, pregnancy, or pregnancy prevention. As the face of CF changes, the CF care model must adapt to meet the reproductive health needs of both parents and nonparents with CF. This article summarizes the reproductive goals and family-building concerns faced by people with CF, including fertility, pregnancy, and alternative paths to parenthood, the impact of parenthood on mental and physical health, and important future research.
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Diabetes
New diabetes devices are increasingly standard of care for pediatric type 1 diabetes management. ... more New diabetes devices are increasingly standard of care for pediatric type 1 diabetes management. Youth often need caregiver assistance to use these devices, including at school. The aim of this study was to assess school nurse confidence with devices, which, to our knowledge, no study has previously evaluated. School nurses in Pennsylvania were recruited to complete a questionnaire, designed by our group and demonstrating content validity, evaluating confidence in specific skills. Each item was scored on a 5-point scale with low confidence considered a response of 1-2, moderate confidence 3, and high confidence 4-5. Respondents (n=269) were 99% female, 96% white, and mean age was 52 years. The majority had experience with insulin pumps (95%) and continuous glucose monitors (CGM, 92%), but not sensor-augmented pumps (34%). Primary forms of device training were informal learning from parents (68%), other nurses (49%), or web searches (49%); fewer (37%) received formal training from a ...
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Critical Care of Children with Heart Disease
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ABSTRACTBackgroundMost pediatric studies of asthma and COVID-19 to date have been ecological, whi... more ABSTRACTBackgroundMost pediatric studies of asthma and COVID-19 to date have been ecological, which offer limited insight. We evaluated the association between asthma and COVID-19 at an individual level.MethodsUsing data from prospective clinical registries, we conducted a nested case-control study comparing three groups: children with COVID-19 and underlying asthma (“A+C” cases); children with COVID-19 without underlying disease (“C+” controls); and children with asthma without COVID-19 (“A+” controls).ResultsThe cohort included 142 A+C cases, 1110 C+ controls, and 140 A+ controls. A+C cases were more likely than C+ controls to present with dyspnea and wheezing, to receive pharmacologic treatment including systemic steroids (all p<0.01), and to be hospitalized (4.9% vs 1.7%, p=0.01). In the adjusted analysis, A+C cases were nearly 4 times more likely to be hospitalized than C+ controls (adjusted OR=3.95 [95%CI=1.4-10.9]); however, length of stay and respiratory support level did...
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Papers by Traci Kazmerski