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Biomedical subjects

Angela Diaz

Publications and source records attributed to Angela Diaz.

14 recordsLinked to original sources
PubMed2006

Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.

Young patients and their parents often are unsure about what represents normal menstrual patterns, and clinicians also may be unsure about normal ranges for menstrual cycle length and amount and duration of flow through adolescence. It is important to be able to educate young patients and their parents regarding what to expect of a first period and about the range for normal cycle length of subsequent menses. It is equally important for clinicians to have an understanding of bleeding patterns in girls and adolescents, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate young patients' conditions appropriately. Using the menstrual cycle as an additional vital sign adds a powerful tool to the assessment of normal development and the exclusion of pathological conditions.

Adolescent↗
PubMed2006

An exploration of the ethical, legal and developmental issues in the care of an adolescent patient.

Providers of health care to adolescent patients face numerous challenges. In addition to increased risk for many health problems, adolescent patients may bring complex ethical, legal and developmental questions to bear as they seek medical services. This article describes the case of one such adolescent patient and discusses some of the attendant issues faced by her physician. For example, providing reproductive health care to teenage patients without the knowledge of parents or guardians requires familiarity on the part of providers with relevant state and federal law. Additionally, providers must be aware of financial barriers and they need to acquaint themselves with available services such as New York State's Family Planning Benefit Program. Attention to their patients' stages of cognitive and emotional development should inform providers' advice to adolescents, and an understanding of the importance that supportive adult relationships play during adolescence is essential to fostering healthy development. Open communication between adolescent patients and their parents or guardians should be encouraged, while maintaining the primary obligation of providing confidential care.

AIDS Serodiagnosis↗
PubMed2004

Evolution of epidemiologic methods and concepts in selected textbooks of the 20th century.

Textbooks are an expression of the state of development of a discipline at a given moment in time. By reviewing eight epidemiology textbooks published over the course of a century, we have attempted to trace the evolution of five epidemiologic concepts and methods: study design (cohort studies and case-control studies), confounding, bias, interaction and causal inference. Overall, these eight textbooks can be grouped into three generations. Greenwood (1935) and Hill (first edition 1937; version reviewed 1961)'s textbooks belong to the first generation, "early epidemiology", which comprise early definitions of bias and confounding. The second generation, "classic epidemiology", represented by the textbooks of Morris (first edition 1957; version reviewed 1964), MacMahon & Pugh (first edition 1960; version reviewed 1970), Susser (1973), and Lilienfeld & Lilienfeld (first edition 1976; version reviewed 1980), clarifies the properties of cohort and case-control study designs and the theory of disease causation. Miettinen (1985) and Rothman (1986)'s textbooks belong to a third generation, "modern epidemiology", presenting an integrated perspective on study designs and their measures of outcome, as well as distinguishing and formalizing the concepts of confounding and interaction. Our review demonstrates that epidemiology, as a scientific discipline, is in constant evolution and transformation. It is likely that new methodological tools, able to assess the complexity of the causes of human health, will be proposed in future generations of textbooks.

Epidemiologic Methods↗
PubMed2004

Fostering resilience in adolescent females.

The health of adolescent females can be compromised by new social morbidities resulting from high-risk behaviors. The presence of various risk factors will increase the chances of their becoming involved in these behaviors and decrease their ability to reach the milestones of this developmental age. Protective factors will moderate these risks. Physicians and other health care providers can help foster resilience in the face of adversity by developing a better understanding of these factors and using a multidisciplinary approach to care.

Adaptation, Psychological↗
PubMed2004

Adolescents and immunization: tips for the primary care provider.

Despite high immunization rates in this country, many adolescents do not receive all of the recommended vaccines. Each year, more than 3.5 million adolescents in the U.S. enter adulthood lacking recommended immunizations. This article will review the current recommendations for immunization for adolescents, including those for the meningococcal vaccine. The vaccine schedule is continually changing, and it is important that health care providers be up to date and utilize available resources with current information. Primary care providers should review and update immunization records with their adolescent patients on a routine basis.

Adolescent↗
PubMed2004

Foster children with special needs: The Children's Aid Society experience.

Children in foster care have many health needs. This article presents the model of the Children's Aid Society (CAS) of New York City in addressing these needs. In addition to their regular foster care program, CAS developed the Medical Foster Care (MFC) in response to the growing number of boarder babies (children with medical conditions who are abandoned at hospitals), and the Therapeutic Foster Care (TFC) for foster children with emotional and behavioral mental health problems. The MFC serves 145 children considered medically fragile, as evidenced by congenital diseases such as heart disease, renal agenesis, cerebral palsy, seizure disorders and mental retardation. The TFC serves 50 children with severe levels of emotional and behavioral symptomatology. As is indicated by the extensive services offered through CAS's regular foster care program, as well as MFC and TFC, these children require specialized treatment. In addition, systems of information maintenance and exchange surrounding the health care of foster children need to be improved. Often agencies are ill-equipped to do adequate background checks on these young people and as a result deliver them to foster care situations where their health needs are not revealed and therefore not addressed. Health care providers also need to stay informed on the overall subject of foster care, as their voices will probably be crucial in ensuring that the extensive needs of these children are adequately represented to government, medical and other service providers.

Adolescent↗
PubMed2004

Obtaining a history of sexual victimization from adolescent females seeking routine health care.

OBJECTIVE: To evaluate the clinical practice of direct physician inquiry of adolescent females during routine history taking and medical examination, with regard to their experience of childhood sexual abuse and/or assault. METHOD: During a one-year period, a female physician directly questioned 146 consecutive female patients, aged 12-22, who were being seen for routine medical histories and physical examinations, as to whether they had ever been sexually victimized. Patients who disclosed histories of sexual victimization were immediately counseled and provided with appropriate on-site mental health referrals. Follow-up of these referrals was conducted to determine if patients complied with referrals to seek mental health services. RESULTS: For 141 of the 146 patients, the physician was unaware of a history of sexual victimization. Of these 141 patients, thirty-two (23%) cases were identified using this clinical strategy. Almost all (93%) of these young women accepted referrals for on-site psychotherapy, and 81% kept their initial appointments for psychotherapy. CONCLUSIONS: The routine medical history and physical examination may be an appropriate setting for health care providers to accurately and comfortably elicit a history of sexual victimization from adolescent females, and provide appropriate referrals for mental health counseling.

Adolescent↗
PubMed2004

Legal and ethical issues facing adolescent health care professionals.

This article reviews the legal standards and ethical dilemmas surrounding the provision of care to adolescent patients. Uncertainty and ambiguity in this area has contributed to the underserving of the adolescent population. Usually, the legal right to consent to treatment resides with the adolescent's parent or legal guardian; however, there are many cases in which adolescents may provide their own consent. The determination that the adolescent is "mature" is one important factor. The law generally upholds a provider's determination of maturity of a patient. Minors also have the right to confidentiality in almost all situations in which they have the right to consent. The issue of confidentiality poses legal and ethical challenges to the provider in five discussed areas. Providers should be aware of the laws specific to their state, while keeping foremost the best interest of their patients. Providers should also encourage parental involvement and communication concerning treatment, while respecting adolescents' right to confidentiality.

AIDS Serodiagnosis↗
PubMed2004

CHIP: new opportunities in adolescent health care delivery.

Children's Health Insurance Programs (CHIP), usually targeted to infants, toddlers, and school-aged children, have been expanded to include adolescents. Adolescents need some form of health insurance in order to access needed care. Moreover, programs and services that provide them with health care must be adolescent-friendly, adolescent-focused and adolescent-sensitive, and include specialized training for primary care providers. Translating this philosophy into a successful health care delivery program involves addressing the psychological, institutional and financial barriers that make it difficult for adolescents to access health care. Overcoming these barriers, especially the financial ones, requires that primary care providers advocate for teenagers and take advantage of resources made available for them. CHIP provides a critical opportunity for policy-makers and health care providers to further improve adolescent health care and to more fully integrate adolescents into the health care system.

Adolescent↗
PubMed2003

Adolescent abortion: trends and techniques.

The adolescent years are often characterized by high-risk behaviors. These behaviors carry consequences with them, including pregnancy and abortion. Although the abortion rate for adolescents has been decreasing since 1990, not all groups have seen an equal drop; notably, those adolescents not in school and members of minority groups are experiencing slower rates of decline. Adolescents undergo the same methods of abortion as adults; however, they have unique psychosocial needs, such as parental involvement and the prevention of future unwanted pregnancies, which should be assessed.

Abortion, Legal↗
PubMed2002

Effect of abuse on health: results of a national survey.

HYPOTHESIS: The magnitude of risk would be highest for those reporting both types of abuse compared with those reporting 1 type or none. OBJECTIVE: To examine the independent associations between physical or sexual abuse or both and self-reported health status, mental health, and health-risk behaviors among a national school-based sample of adolescent girls. DESIGN: A secondary data analysis of a cross-sectional survey. SETTING: A nationally representative sample of 3015 girls in grades 5 through 12 from 265 public, private, and parochial schools (with an oversampling of urban schools) completed an anonymous survey conducted by the Commonwealth Fund Adolescent Health Survey. PATIENTS OR OTHER PARTICIPANTS: Girls were eligible for this study if they responded to 2 questions assessing past physical and sexual abuse. RESULTS: Among the respondents, 246 (8%) reported a history of physical abuse; 140 (5%), sexual abuse; and 160 (5%), both. Logistic regression controlling for grade, ethnicity, family structure, and socioeconomic status found that those who reported both types of abuse compared with those who did not report any were significantly more likely to experience moderate to severe depressive symptoms (adjusted odds ratio [AOR], 5.10), moderate to high levels of life stress (AOR, 3.28), regular smoking (AOR, 5.90), regular alcohol consumption (AOR, 3.76), use of other illicit drugs in the past 30 days (AOR, 3.44), and fair to poor health status (AOR, 1.74). Finally, girls who reported both types of abuse were 2.07 times more likely to report moderate to high depressive symptoms compared with those reporting only sexual abuse (95% confidence interval, 1.14-3.74). CONCLUSIONS: The magnitude of risk for adolescents reporting both types of abuse compared with no abuse is much greater than that for either abuse type alone. However, compared with both types, no significant increase in risk was detected in those reporting physical abuse only, and only depressive symptoms increased in those reporting sexual abuse only.

Adolescent↗
PubMed2002

Efficacy of probiotic use in acute diarrhea in children: a meta-analysis.

Our objective was to determine the efficacy of probiotic use in reducing the duration of increased stool output in children with acute diarrheal illness. Eligible studies were limited to trials of probiotic therapy in otherwise healthy children <5 years old with acute-onset diarrhea. The main outcome variable was difference in diarrhea duration between treatment and control groups. Our meta-analysis of 18 eligible studies suggests that coadministration of probiotics with standard rehydration therapy reduces the duration of acute diarrhea by approximately 1 day [random-effects pooled estimate = -0.8 days (-1.1, -0.6), P < 0.001]. Differences in treatment effect between studies was assessed by calculating the Q statistic (Q = 204. 1, P < 0.001). In subsequent analyses limited to studies of hospitalized children, to double-blinded trials, and to studies evaluating lactobacilli, the pooled estimates were similar (-0.6 to -1.2 days, P < 0.001). In conclusion, bacterial probiotic therapy shortens the duration of acute diarrheal illness in children by approximately one day.

Acute Disease↗
PubMedDate not supplied

Detection of HPV DNA in cervical specimens collected in cytologic solution by ligation-dependent PCR.

OBJECTIVE: To determine the feasibility and sensitivity of detecting human papillomavirus (HPV) in specimens collected in Cytyc PreservCyt fluid (Boxborough, Massachusetts, U.S.A.) using ligation-dependent polymerase chain reaction (LD-PCR) and to demonstrate the diagnostic value of HPV DNA testing as an adjunct to cytology in the detection of cervical squamous intraepithelial lesions (SIL), especially in cases of atypical squamous cells of undetermined significance (ASCUS). STUDY DESIGN: LD-PCR is a recently invented DNA amplification technology that utilizes a capture probe for target isolation and 2 hemiprobes for target detection. The hemiprobes are designed in such a way that when they hybridize to their target, the 5' end of one probe and the 3' end of the other probe are brought together. Two hemiprobes can then be ligated into a full probe that can serve as a template for PCR amplification. A total of 94 cervical specimens were collected in cytologic fluid and tested with LD-PCR. The results were compared with those of the Digene Hybrid Capture II assay (HC II) (Beltville, Maryland, U.S.A.) and consensus PCR. RESULTS: The overall sensitivity for detecting HPV was 41.5% (39/94) by LD-PCR, 50% (47/94) by consensus PCR and 37.2% (35/94) by HC II. The prevalence of HPV by HC II, consensus PCR and LD-PCR were 87.5%, 100% and 87.5% in the high grade SIL group; 100%, 90.9% and 90.9% in the low grade SIL group; 30%, 52.5% and 40% in the ASCUS group; and 14.2%, 22.8% and 17.1% in women with normal cytology. These results indicate that all 3 methods have similar sensitivity in patients with SIL. However, there is greater variation in detection rates in the ASCUS and normal cytology groups. CONCLUSION: LD-PCR is a useful method of detecting HPV in liquid-based gynecologic cytologic preservatives, and HPV testing as a method adjunct to the liquid-based Pap test could be useful in detecting SILs, especially for the management of patients with ASCUS.

DNA Primers↗