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Biomedical subjects

B Stanton

Publications and source records attributed to B Stanton.

At least 55 records · Page 3Linked to original sources
PubMed1994

Anal intercourse among preadolescent and early adolescent low-income urban African-Americans.

OBJECTIVE: The purpose of this study, which was conducted as part of a larger study on adolescent risk behaviors, was to determine the frequency of anal intercourse among preadolescent and early adolescent youths. DESIGN: Survey. SUBJECTS: Three hundred fifty-one low-income urban African-American youths aged 9 to 15 years. MAIN OUTCOME MEASURES: A questionnaire assessing self-reported acquired immunodeficiency syndrome-risk behaviors was administered via a "talking" computer. The outcome measure was anal intercourse. RESULTS: Of the 137 youths (39%) who had engaged in any sexual intercourse (vaginal or anal), 50 (36%) had engaged in anal intercourse, including 41 (35%) sexually active boys and nine (43%) sexually active girls. Youths who had engaged in anal intercourse were significantly more likely to report having been sexually molested and having engaged in several delinquent behaviors than were virgins or youths who had engaged in coitus only. CONCLUSIONS: Efforts at preventing acquired immunodeficiency syndrome that target low-income urban African-American early adolescents should include the high-risk nature of anal intercourse.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Child health: equity in the non-industrialized countries.

Significant improvements have been made in infant and child survival globally in recent decades. In spite of a substantial literature describing achievements to date and strategies for continuation of this progress, there has been relatively little attention directed toward the issue of equity in global child health outcomes. This paper briefly reviews global improvements in child health outcomes over the past four decades, but then provides evidence that there has been substantial variation in these improvements, both between nations and within non-industrialized nations. The identifying characteristics of high risk populations are summarized. The specific diseases and disease complexes associated with mortality in populations with different mortality rates are presented as background to a discussion of the anticipated increase in 'effort' (both personnel and material resources) that will be necessary for sustained improvement in child survival. In this context, the Acquired Immunodeficiency Syndrome is likely to further increase disparities in health outcomes. Finally, prospects for increased equity in the future are discussed.

Child↗
PubMed1994

Correcting respiratory rate for the presence of fever.

This study defines what degree of respiratory rate (RR) elevation can be attributed to fever using a double blind randomized pre- and post-acetaminophen comparison of vital signs of febrile children presenting to an outpatient clinic. Inclusion criteria were aged between 6 weeks and 24 months, fever between 38.5 and 40.1 degrees C, no serious illness such as sepsis, and no recent receipt of antipyretics or antibiotics. RRs counted over 1 min and rectal temperatures were recorded by a trained observer before, and 1 and 1.5 hours (hr) after receipt of 10-15 mg/kg/dose of either acetaminophen (A) or placebo (P). Randomization produced groups A (n = 54), and P (n = 50) with similar mean age (12.3 vs 12.8 mo.), gender distribution (57 vs 54% female), baseline temperature (39.1 vs 39.1 degrees C), baseline RR (44 vs 45), and hours of fever prior to visit (42 vs 37 hr). The most common diagnoses were otitis media (49%), viral syndrome (18%), upper respiratory infection (16%) or gastroenteritis (7%). The mean temperature decrement of group A was 0.4 degrees C at 1 hr and 0.9 degrees C at 1.5 hr compared to slight increases in fever of 0.3 degrees C at 1 hr and 1.5 hr in group P. Significant decreases in RR occurred in group A compared to group P at 1 hr (7.0 vs 1.9, p = 0.009) and 1.5 hr (10.8 vs 4.0, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaminophen↗
PubMed1994

A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications.

BACKGROUND: Leg ulcers affect probably 2.5 million persons in the United States, and their prevalence is likely to rise as the population ages. They cause considerable disability, and the cost of treating these chronic wounds is enormous. OBJECTIVE: The purpose of this study was to assess the financial, social, and psychologic implications of leg ulcers. METHODS: Data were collected by standardized personal interviews with 73 patients with chronic leg ulcers. The interview covered several domains that were selected to determine the impact of a leg ulcer on overall quality of life. RESULTS: A significant number of patients had moderate to severe symptoms, principally pain, related to the leg ulcer. Eighty-one percent believed that their mobility was adversely affected by the ulcer; the dominant predictor of impaired mobility was swelling of the leg (p < 0.001). For younger, working patients, leg ulceration was correlated with time lost from work (p < 0.001), job loss (p < 0.01), and adverse effects on finances (p < 0.02). Fifty-eight percent of patients found caring for the ulcer burdensome. There was a strong correlation between time spent on ulcer care and feelings of anger and resentment. Sixty-eight percent of patients reported that the ulcer had a negative emotional impact on their lives, including feelings of fear, social isolation, anger, depression, and negative self-image. CONCLUSION: Leg ulcers pose a substantial threat to a variety of dimensions of a patient's quality of life.

Adult↗
PubMed1994

Social influences on the sexual behavior of youth at risk for HIV exposure.

OBJECTIVES: Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. METHODS: A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. RESULTS: Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. CONCLUSIONS: The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in children's social networks.

Adolescent↗
PubMed1994

Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore.

OBJECTIVE: To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization. DESIGN AND METHODS: We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers. MAIN OUTCOME MEASURES: Age-appropriate immunizations and preventive health care visits. RESULTS: By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age. CONCLUSIONS: Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.

Baltimore↗
PubMed1994

Sexual practices and intentions among preadolescent and early adolescent low-income urban African-Americans.

OBJECTIVE: To assess the sexual practices and the social and intrapersonal influences on sexual practices and intentions which have an impact on the risk for acquired immunodeficiency syndrome among pre- and early adolescent, low-income African-American youths. DESIGN: Cross-sectional cohort study conducted in nine recreation centers serving three public housing developments in an eastern city. PARTICIPANTS: Three hundred fifty-one African-American youths 9 to 15 years of age. OUTCOME MEASURES: Past and intended sexual intercourse, and past and intended condom use determined by a risk assessment instrument delivered aurally and visually via a "talking" MacIntosh computer. RESULTS: The median age was 11 years; 35% of youths had had sexual intercourse and 20% of virgins thought it likely that they would become sexually active in the next six months. Age and male gender were correlated with sexual activity. Of sexually active youths 62% had used a condom during their last episode of coitus and 60% expected to do so at the next episode. Among sexually active youths, 24% of boys and 35% of girls had had anal intercourse. Rates of foreplay (nonpenetrative sex) were low even among sexually active youths. The median number of sexual partners in the past six months was two. Social influences from parents, peers, and partners in an intimate relationship were important for all four sexual outcomes both by univariate analysis and after logistic regression. IMPLICATIONS: A high percentage of the low-income, urban African-American pre- and early adolescents in this study are engaging or intending to engage in high-risk sexual behaviors. Acquired immunodeficiency syndrome reduction interventions for early adolescents should incorporate the importance of social influences from multiple sources.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Drug trafficking among African-American early adolescents: prevalence, consequences, and associated behaviors and beliefs.

OBJECTIVE/METHODOLOGY: Drug trafficking by minority youths in low-income, urban areas has received considerable publicity from the mass media in the past half-decade. However, there has been corresponding little exposition of this problem in the medical literature. This review was undertaken to provide an overview of the epidemiology and consequences of drug trafficking among urban youths and to describe factors associated with drug trafficking. RESULTS: Existing data indicate that approximately 10% of male, urban, African-American early adolescents report having engaged in drug trafficking, with a higher percent of youths reporting having been asked to sell drugs and/or indicating that they expect to become involved in drug trafficking. Rates increase with advancing age. Reported rates of drug trafficking are comparable with rates of tobacco and alcohol use among early adolescents and are substantially higher than use rates of illegal drugs. Drug trafficking is associated with increased mortality, accounting for one third to one half of homicide-related deaths in some studies. The practice is also associated with other health-risk behaviors, including nonfatal violence, substance use, and incarceration. Perceived social pressures by family members and/or peers to engage in drug trafficking and the belief that a youth's wage-earning potential is limited to drug trafficking are highly correlated with involvement in this activity. CONCLUSIONS: Drug trafficking is a prevalent risk behavior among adolescents that has several negative health consequences.

Adolescent↗
PubMed1993

Effectiveness of family notification efforts and compliance with measles post-exposure prophylaxis.

Exposures to measles in medical settings have contributed to the recent resurgence of the disease in the United States. Following a measles exposure in two pediatric medical facilities serving an inner-city population, we investigated the effectiveness of a disease notification strategy and compliance of the exposed population with recommendations for post-exposure prophylaxis, two requirements of a successful intervention program. Of 106 families with children eligible for a prophylactic vaccination by standard guidelines, 64% were notified of exposure by telephone. Compliance was assessed by a brief telephone questionnaire based upon the Health Belief Model, and verified by medical records. Forty-six families were interviewed regarding their decisions to comply with the recommendations. Most (75%) families were compliant. Compliant parents perceived measles to be severe and their children to be in excellent health. In a multiple logistic regression analysis, only the perceived severity of measles significantly contributed to the model. We conclude that: infection control outreach may need to extend beyond telephone notification for an inner-city population, and that once notified, most people will comply with recommendations. The Health Belief Model explains compliance with infection control measures and may be useful in guiding public health interventions.

Communication↗
PubMed1993

Perceptions of vaccine efficacy, illness, and health among inner-city parents.

A resurgence of measles in the past decade has focused attention on the limitations of current immunization programs, particularly for inner-city, low-income populations. As part of a larger study of immunization rates, we discussed perceptions of disease severity and vaccine efficacy, as well as the prioritization of the tasks of parenthood, with 40 parents of infants living in inner-city Baltimore to discover their beliefs about immunization. Vaccines were considered only partly successful; susceptibility to chickenpox after vaccination was repeatedly cited as evidence of vaccine failure. Fever was seen as a primary indicator of illness; thus, vaccines were believed to cause, rather than prevent, illness. Immunization was not considered a high-priority parental responsibility. These findings suggest future interventions be aimed at changing parental perceptions of vaccines as ineffective and of fever after immunization as an indicator of illness. Finally, immunizations should be made easily available, even during clinic visits for a child's illness.

Baltimore↗
PubMed1993

Early initiation of sex and its lack of association with risk behaviors among adolescent African-Americans.

OBJECTIVE: High rates of adolescent homicide, pregnancy, substance abuse, and sexually transmitted diseases underscore the importance of interventions designed to reduce problem behaviors. However, the definition of "problem" behavior and the association with other activities may change between youth cultures. Therefore, greater attention to defining the "problem" behaviors to be targeted will permit more effective utilization of primary vs secondary intervention strategies and identification of high-risk individuals. DESIGN: Two studies of African-American adolescents regarding sexual intercourse, school truancy, substance abuse, and drug trafficking are presented. The first study involved 57 youths (10 to 14 years of age) from a pediatric primary health center and gathered data through pile-sorting. The second study of 300 youths (9 to 15 years of age) from six public housing sites used a questionnaire administered by a "talking" computer. Both studies assessed different self-reported behaviors, feelings about engaging in specific behaviors, and perceptions of friends' behaviors. RESULTS: While 40% of subjects reported having had sex, substantially smaller proportions reported school truancy (14%), illicit drug use (2% to 6%), or drug trafficking (6%). Analyses of reported behaviors, feelings, and perceived peer norms revealed that sex was consistently depicted as forming a different domain from other problem behaviors. CONCLUSIONS: Interventions that rely on primary prevention strategies for sexual intercourse and that identify sexually active youths as at risk for problem behaviors may not be appropriate for African-American adolescents growing up in resource-depleted urban areas.

Adolescent↗
PubMed1992

Guidelines for pragmatic assessment for health planning in developing countries.

Although the primary health care strategy implemented since the Alma Ata declaration of 'health for all' appears to have contributed to improvements in selected health outcomes, the current ad hoc approach to health assessment and planning has impeded more substantial gains. A comprehensive yet pragmatic framework for country-level health programmers is needed that would permit consideration of the multiple steps involved in policy formulation and implementation. In the present paper, drawing upon an epidemiologic model (Iterative Measurement Loop) and an economic model (Cost-Effectiveness Analysis), we present guidelines for a pragmatic assessment for health planning. A format is provided for the conduct of these tasks which is operational in nature, is specific to the target country (or relevant region), can simultaneously consider multiple interventions, and is comprehensible to persons without sophisticated medical and/or economic backgrounds. Such a format enables articulation and consideration of local concerns as well as national and global considerations.

Cost-Benefit Analysis↗
PubMed1992

Theory-driven behavioral intervention research for the control of diarrheal diseases.

Essentially all methods to reduce diarrheal morbidity and mortality require behavioral change. Research is required to design, implement and evaluate behavior-modifying interventions. Accumulated experience in the many involved disciplines should serve as a basis for this research. However, each of these disciplines is associated with different research perspectives and analytic assumptions; thus integration of these varied but potentially complementary experiences has been elusive. In the present paper, arguing that such perspectives and assumptions are embodied in discipline-based theory, we have developed a generic framework for the conduct of theory-based behavioral intervention research. We illustrate the application of this framework through two vignettes applying two of the theories and models to the development of hypothetical handwashing interventions.

Behavior Therapy↗
PubMed1992

A new EPI strategy to reach high risk urban children in Bangladesh: urban volunteers.

Many community based outreach programs in low income countries utilize illiterate women to provide health services. However, illiteracy may present special problems in immunization or other programs requiring extensive record-keeping and follow-up. In a trial involving twenty-nine volunteers from urban slum communities in Dhaka, Bangladesh, a community-based referral and record-keeping system for use by semi-literate and illiterate volunteers in immunization outreach activities was evaluated over a thirteen month period. The women were uniformly, regardless of literacy, able to use the system to effectively refer and follow-up clients. Although volunteer performance as measured by numbers of referrals was below initial targets, completion rates were high; 87% of children and 96% of women referred completed the full series of immunizations. By facilitating active community participation, the system provides a feasible approach to reducing the high drop-out rates currently associated with immunization programs.

Bangladesh↗
PubMed1990

Adrenal corticosteroid action on the thick ascending limb.

Several lines of evidence support the view that corticosteroids stimulate Na+, K+, HCO3-, and H+ transport by the TAL and that modulation of transport contributes to homeostasis of these ions. Although some details of the cellular and molecular mechanisms of corticosteroid action in the amphibian diluting segment are known, little is known about these pathways in TAL cells. In addition, the issue of mineralocorticoid versus glucocorticoid specificity and receptor localization in the TAL is not resolved. We anticipate that these intriguing issues will be addressed using TAL cells in culture and isolated TAL in conjunction with patch clamp, fluorescent probes and molecular biological approaches.

Adrenal Cortex Hormones↗
PubMed1989

User fees for health care in developing countries: a case study of Bangladesh.

In designing country health care programs to achieve the goals of the Alma Alta declaration of 'Health for All', developing countries have been confronted with the problem of increased health care needs and decreased available resources. Health economists have proferred several possible solutions to this fiscal shortfall, including cost-recovery measures through the imposition of user fees for curative services at government health facilities. Health care providers have been noticeably absent from discussions of the many possible implications of these fees; consequently, resultant programs and policies may be economically sound but may fail to place a sufficient emphasis on features designed to maintain and improve the health of the population. In the present paper we examine the possible impact of user fees on the health of individuals residing in Bangladesh, one potential candidate country for user fees. We note evidence that the existing government health care system appears already to be providing care to two of the most medically vulnerable groups in Bangladesh, the poor and women, and provide evidence that such fees may seriously interfere with maintaining this patient profile. We discuss the significant public health role that curative care provides for the individuals, their families and the wider community. We suggest that additional questions should be asked by health care providers, anthropologists and economists prior to institution of user fees in the government system and that such measures should first be introduced in an experimental format with a rigorous and comprehensive impact evaluation.

Bangladesh↗