Biomedical subjects
Publications and source records attributed to A Joffe.
In a survey of children and adolescents, one fourth of respondents reported having experienced an assault or abuse in the previous year. Violence is not restricted to inner cities. Marijuana use among eighth graders has more than doubled since 1991.
OBJECTIVE: To compare outcomes among adolescents who use levonorgestrel implants, oral contraceptives, or other methods of birth control. DESIGN: Prospective, longitudinal study of 166 females who were followed up for 6 months. Fifty-four used implants, 64 used oral contraceptives, and 48 used condoms alone or with spermicide, or no contraceptive. Outcomes were measured by patient interview and medical chart review. SETTING: Inner-city, hospital-based adolescent and teenaged mother and baby clinic between April 1, 1992, and May 31, 1993. PARTICIPANTS: Sexually active 12- to 18-year-old females at least 1 year postmenarche who had no contraindications to use of hormonal contraceptives. MAIN OUTCOME MEASURES: Sexual activity, pregnancy rates, condom use, incidence of sexually transmitted disease, patient satisfaction continuation rates, and side effects. RESULTS: Despite similar reports of sexual activity, one subject who used the implant (2%) vs 13 subjects who used oral contraceptives (20%), and eight subjects who used other methods (17%) became pregnant (chi 2, P < .50). Condom use did not differ among groups (chi 2, P > .60). Overall, 30% of subjects contracted a new sexually transmitted disease; rates did not differ by method (chi 2, P = .92). Implant users were more likely than oral contraceptive users to continue their method (87% vs 50%; chi 2, P < .001) despite similar satisfaction scores (one-way analysis of variance, P = .52). Implant users were more likely to experience irregular menses, mood swings, acne, and hair loss (chi 2, P < .05). CONCLUSIONS: In this population, the levonorgestrel implant is an effective method of pregnancy prevention and is associated with high satisfaction and continuation rates at 6 months. Implant users are not at greater risk than others for sexually transmitted disease. Health care providers should continue to stress the use of barrier methods to all sexually active adolescents.
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OBJECTIVE: Substance use by pregnant teenagers is an important public health problem, but published data on alcohol and illicit drug use by parenting teenagers are virtually nonexistent. This study determined the prevalence of alcohol and drug use in adolescent mothers in the first 4 months postpartum and explored associated psychosocial characteristics. METHODS: Teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled consecutively during a routine third trimester prenatal visit. Alcohol use since delivery was determined by self-report at 4 months postpartum using an instrument developed for the 1984 Survey of Drug Abuse Among Maryland Adolescents. Illicit drug use was measured with anonymous quantitative urine drug screens at 2 and 4 months postpartum. Depressive symptoms, stress, and social support were assessed at 2 and 4 months postpartum using validated, self-administered instruments. Differences in demographic characteristics, peer group influences, and psychosocial variables between substance users and nonusers were evaluated. RESULTS: Participants (125/129 eligible) were predominantly African-American, mean age 16.3 years. Completed assessments were obtained from 110 at 2 months and 105 at 4 months postpartum. Forty-two percent screened positive for illicit drugs at a postpartum visit or reported using alcohol since delivering their baby and were classified as substance users. Thirty-one percent of subjects reported alcohol use since delivery. Marijuana was the most prevalent illicit drug (14%), followed by opiates (5%), and cocaine (4%). When substance users were compared with nonusers, 44% versus 24% scored depressed (P = .02), 62% versus 43% had high stress (P = .04), and 62% versus 44% reported a high need for social support (P = .07). Results of logistic regression, after controlling for age, indicated that illicit substance and/or alcohol use was 3.3 times greater for those who were depressed, 2.8 times greater if they reported friends' using illicit drugs, and 6.7 times greater if the adolescent reported smoking cigarettes since delivery. CONCLUSIONS: This study indicates that alcohol and drug use are common among this sample of postpartum teenage mothers and that depression, stress, high support need, and peer group drug use are associated factors. Although this study cannot determine whether depression and stress precede or result from use of substances, attention to these factors appears warranted in the care of adolescent mothers.
Case reports suggest that infants with Kawasaki disease have atypical presentations and a high complication rate, likely related to delayed diagnosis and treatment. To date, no study of consecutive cases has compared infants with older children who have both atypical and typical Kawasaki disease. We retrospectively reviewed 44 cases of Kawasaki disease treated at our hospital from March 1980 to 1990: 11 (25%) were infants; 9 (20%) had atypical Kawasaki disease, of which 5 (56%) were infants; the male to female ratio was 1.7:1. Infants had a higher incidence of atypical Kawasaki disease (5 [45%] versus 4 [12%]; P = .007) and of coronary artery complications (7 [64%] versus 3 [9%]; P = .002), and coronary artery complications developed in all of the infants with atypical Kawasaki disease (5 [100%] versus 0 [0%]; P < .01). Yet, the other manifestations and laboratory changes were at least as common as in the older children. Coronary artery complications did not develop in any patient who received early intravenous immune globulin therapy. We suggest that in infants with Kawasaki disease, accepted criteria are too restrictive to allow early diagnosis and effective treatment. Until a definitive test is available, clinical judgment is required in the diagnosis of atypical Kawasaki disease. Intravenous immune globulin is known to be safe, and its early use in patients with suspected atypical Kawasaki disease is appropriate.
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Use of cigarettes, alcohol, and other drugs among pregnant adolescents is just beginning to be documented. This study sought to determine the prevalence and associated risk factors of cigarette, alcohol, and other drug use among school-age adolescents attending a comprehensive teenage pregnancy program. All enrollees completed a self-administered questionnaire and provided a breath sample for carbon monoxide analysis. Urine was obtained for quantitative determination of drug metabolites at the initial and one third-trimester visit. A chart review determined medical provider recognition of cigarette, alcohol, and other drug use. Results were analyzed for 93% of 229 eligible patients. Seventeen percent were positive for alcohol or other drug use by questionnaire self-report, provider report, or initial urine screen. Eleven percent were positive by urine screen alone at either the initial or third-trimester visit. Medical providers were successful in identifying nearly all of the cigarette smokers, but fewer than half of the alcohol drinkers and few of the other drug users. Forward stepwise multiple regression determined the most efficient model for predicting alcohol and other drug use. A report of having been high at school and personal or friends' use of cigarettes were the most significant risk factors. Results indicate a high prevalence of alcohol and other drug use and suggest a need for changes in current practice related to the detection and management of such drug use in pregnant adolescents.
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Hepatic vein thrombosis or the Budd-Chiari syndrome is an uncommon condition which rarely occurs in teenagers. The condition involves obstruction of blood flow from the liver with progressive congestion and hepatic failure. The etiology is often idiopathic but may involve conditions that increase thrombogenic tendencies. Oral contraceptives are known to increase the risk of a number of thrombotic conditions and have been associated with the Budd-Chiari syndrome. Although millions of teenagers have used oral contraceptives without incident, occasionally we are reminded of their potential serious complications. The case of a 19-year-old who developed hepatic vein thrombosis while using oral contraceptives is presented.
Although they provide birth control and are easier to use, oral contraceptives (OCPs) are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowledge, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their first year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p less than .03) and greater perceived vulnerability to STDs (p less than .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy.
To establish the psychometric properties of the state form of the Depression Adjective Check List (DACL) with elderly Israeli, a 1981 Hebrew version of the DACL by Lomranz, Lubin, Eyal, and Medini, along with the Zung Self-rating Depression Scale and Cantril's Self-anchoring Striving Scale, were administered to 86 independently functioning elderly persons (35 men and 51 women) living in a home for the aged. Reliability estimates (alphas and test-retest) were moderate to high; validity estimates (concurrent and construct) were again moderate to high. It was concluded that the state form of the Depression Adjective Check List is suitable for use with elderly Israeli.
Health counseling is a fundamental aspect of health care for adolescents and is a natural extension of the concept of anticipatory guidance. It is a dynamic process involving active participation by adolescents. Pediatricians are a valued source of health-relevant information, but must also recognize how their attitudes and beliefs can affect the counseling process. Knowledge of the multitude of changes occurring during adolescence and an understanding of the role of health-risking behaviors in meeting various developmental needs are critical to successful counseling. Particular attention must be focused on ways to help adolescents develop the skills necessary to maintain health-promoting lifestyles and to resist peer pressure to engage in health-risking behaviors.
This study defines the variables that predict rehospitalization of infants born to teen mothers. Rehospitalization was defined as hospital admission during the first year of life subsequent to hospitalization at birth. Normal birth weight (NBW), but not low birth weight (LBW), infants of adolescent mothers had higher rehospitalization rates than infants of older mothers. NBW infants of young vs. older mothers had significantly higher rehospitalization rates for gastroenteritis. Among infants of adolescent mothers, the variables associated with increased risk of rehospitalization were unemployed household head, presence of a congenital anomaly or developmental delay, and an unusually high or low number of well child care visits. Although individual variables were significant at the bivariate level, in combination, these variables were poor predictors of which infants would be rehospitalized. Our study suggests that all teen mothers of NBW infants may require additional education to prevent excess rehospitalization of their infants.
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This study was designed to assess the benefits and barriers accruing to breast-feeding as perceived by pregnant adolescents, and to establish whether these perceptions distinguished between adolescent mothers who chose to breast versus bottle feed. Surveys were completed by 254 young women attending prenatal clinics. Overall, 19.3% indicated their intent to breast-feed. When categorized by intended method of infant feeding (breast versus bottle), breast-feeding mothers cited more benefits and fewer barriers associated with that method of infant feeding. Overall, perceived benefits were more successful than perceived barriers in distinguishing between the groups of respondents. For those interested in promoting breast-feeding among adolescent mothers, our data support an emphasis on the diverse benefits of this method of infant feeding. Our results also suggest the usefulness of peer role models in correcting misinformation and encouraging breast-feeding among adolescent mothers.