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Biomedical subjects

D Futterman

Publications and source records attributed to D Futterman.

15 recordsLinked to original sources
PubMed2000

Promoting early detection of human immunodeficiency virus infection among adolescents.

While a significant and increasing number of adolescents are infected with the human immununodeficiency virus (HIV), few youth are identified as seropositive and even fewer are linked to medical care and social services. If more youth were identified, transmission to sexual partners and offspring would be reduced and individuals could benefit from treatment. Prior to initiating wide-scale early detection for HIV, we must (1) examine alternative strategies of conducting pretest and posttest counseling; (2) address barriers to prevention and testing within the HIV system of care; and (3) mount community-level intervention campaigns that address youth at high risk of infection.

Adolescent↗
PubMed2000

HIV and AIDS in adolescents.

HIV infection in adolescents continues to challenge health care providers, policy makers, and advocates for youth. Primary care providers working with parents of adolescents and at-risk youth are in a unique position to identify or help develop HIV prevention and care programs that address many needs. Effective interventions are those that move beyond moralism to realism and a willingness to engage youth and their families. Youth at high risk for HIV should be identified and engaged in primary care as soon as possible. HIV-infected youth need intensive individual and group interventions to keep themselves healthy and reduce transmission to others. Incumbent on all providers is to make adolescents' services visible, flexible, affordable, confidential, culturally appropriate, and available for all youth.

Adolescent↗
PubMed1997

Lesbian and Gay Youth: Care and Counseling.

Adolescents face many barriers in accessing appropriate primary care. Among the most underserved are lesbian, gay, and bisexual youth who are often neglected by traditional systems of care. This is a reference guide that provides background knowledge, substantive references, and detailed information on the stressors, health needs, experiences, and developmental challenges facing lesbian and gay youth. The first part focuses on experiences and needs of lesbian and gay adolescents-health challenges, identity development, their experiences, vulnerabilities, and risks, and confidentiality and legal issues that are of concern. The second part deals with primary care and disease prevention objectives in this group of adolescents-most frequent health concerns, issues of transgendered youth, special populations, primary interventions and anticipatory guidance, medical assessment, treatment, and prevention, and mental health concerns, assessment, and treatment. The third part presents an overview of HIV infection in all adolescents, with a focus on issues of concern for lesbians and gay males. It covers issues of HIV counseling, testing, and prevention as well as clinical care and prevention. Several appendices offer additional resources for primary care needs of lesbian and gay adolescents, resources for parents and youth, recommended reading for providers, adolescent HIV counseling and testing protocols and clinical care protocols.

Journal Article↗
PubMed1996

A profile of human immunodeficiency virus-infected adolescents receiving health care services at selected sites in the United States.

OBJECTIVE: To determine the demographic/clinical profile of human immunodeficiency virus (HIV)-infected adolescents in care at selected sites. METHODS: We mailed surveys requesting prevalence data from physicians in government-funded HIV research and care programs on HIV-infected youth (10-21 years) receiving care. RESULTS: A total of 49% responses yielded information on 978 subjects. Vertical, blood, and sexual were predominant transmission modes. Three-quarters were of an ethnic/racial minority; 50% were female. The earliest median CD4 count was 0.467 x 10(9)/liter (467/microliter). Percent asymptomatic varied by transmission: vertical (16%), blood products (40%), male-male sexual (67%) and female-male sexual (M:73%) (F:74%). Clinical indicated Pneumocystis carinii pneumonia prophylaxis was differentially prescribed: vertical (96%), blood (89%), and sexually (male-male-47%) (female-male: M: 36% and F: 56%). Of these youth 78% are not represented in national AIDS case data. CONCLUSIONS: Examination of numerator data from selected sites indicates three transmission-driven adolescent HIV epidemics with different characteristics. Minority youth are disproportionately represented; many vertically infected infants are surviving to adolescence; sexual activity is a significant transmission avenue. HIV-infected youth appear to enter care with considerable immunosuppression. Clinical profiles and treatment patterns appear to differ by transmission mode. Further study is needed on adolescent HIV disease progression and determinants of access to care and treatment.

Adolescent↗
PubMed1996

Tuberculosis infection in human immunodeficiency virus-positive adolescents and young adults: a New York City cohort.

OBJECTIVES: Adolescents with human immunodeficiency virus (HIV) infection are at increased risk for tuberculosis (TB), underscoring the importance of early identification of TB infection. The goals of this study were to assess the factors associated with the completion of evaluations for TB in a cohort of HIV-positive adolescents and young adults and to describe the prevalence of Mycobacterium tuberculosis infection and adherence to antituberculous treatment regimens. METHODS: A retrospective chart review was done for all HIV-positive adolescents and young adults, ages 13 to 21 years (n = 49), seen in a comprehensive care program from January 1991 through December 1992. Data collected included CD4 cell count, HIV clinical status, living situation, substance use history, and the completion of an annual evaluation for TB infection. The evaluation consisted of a tuberculin skin test (Mantoux test), using an intraepidermal injection of 0.1 mL of 5 tuberculin units of purified protein derivative (PPD) and a simultaneous Merieux multitest anergy panel. Chi-square analysis was used to assess the association between the completion of the evaluation for TB and both living status and substance use. RESULTS: Thirty-one (63%) of 49 patients completed evaluations for TB. Of the 31 completed evaluations, 18 were assessed by clinic staff on site, and 13 were assessed by other medical or trained nonmedical observers through community networking efforts. Neither homelessness nor illicit substance use were factors in the completion of the evaluation. Six (19%) of the 31 patients had positive PPD skin test results. Three had medical histories and chest radiographs suggesting active TB, and all were hospitalized for at least 2 weeks. Two had positive cultures for M tuberculosis, although the third also responded clinically to antituberculous therapy. All three were otherwise asymptomatic for HIV infection, with only moderately depressed CD4 cell counts. All three were homeless and used crack cocaine. After the initial treatment as inpatients, none completed treatment within the prescribed time period. CONCLUSIONS: The completions of the evaluations for TB were greatly facilitated by community networking, but innovative strategies to enhance both screening and treatment programs, such as training youth service providers in the community to read PPD skin tests, expansion of directly observed therapy services, and youth-centered programs for housing and substance use, need further development. The high prevalence of TB in the cohort underscores the need for providers to increase efforts to identify cases of TB infection among adolescents and young adults and to incorporate HIV risk assessment, counseling, and testing into their practices routinely.

Adolescent↗
PubMed1995

Comparison of HIV+ and HIV- adolescents: risk factors and psychosocial determinants.

According to the World Health Organization, half of the 14 million people with human immunodeficiency virus (HIV) worldwide were infected between the ages of 15 and 24 years. However, details about HIV-positive (HIV+) youths' risk-related behavior and social context have not been previously reported. OBJECTIVES. To outline detailed sexual and drug use practices, social and psychological status of HIV+ youth compared with a cohort of HIV-negative (HIV-) youth; and to examine the ability of the health belief and risk-taking models to predict sexual and drug use acts of HIV+ youth. METHODS. HIV testing was conducted on and a 207-item structured interview covering HIV risk-related acts, protective factors and background information was administered to 72 HIV+ and 1142 HIV- adolescents aged 13 through 21 years receiving care in an adolescent clinical care unit of a large medical center in New York City. Data were analyzed for adolescents reporting sexual intercourse (71 HIV+ and 722 HIV-) by logistic regression analysis of five domains to identify variables significantly associated with HIV seropositivity. RESULTS. Logistic regressions indicated significant differences in sexual risk acts based on serostatus and gender. Anonymous, blinded seroprevalence testing identified 11% more HIV+ adolescents than would have been identified by current counseling and testing practices. HIV+ adolescents were significantly more likely to be sexually abused (33 vs 21%, P < .05), engage in anal sex and survival sex (32 vs 4%, P < .01), unprotected sex with casual partners (42 vs 23%, P < .05), have had sex under the influence of drugs (52 vs 27%, P < .01), have a sexually transmitted disease (59 vs 28%, P < .01), use multiple drugs (43 vs 9%, P < .01) and engage in multiple problem behaviors (72 vs 30%, P < .01) than HIV- young people. HIV+ females reported more oral (69 vs 45%, P < .01) and/or anal (42 vs 12%, P < .01) intercourse compared to HIV- females. HIV+ males reported significantly higher rates of both insertive (82 vs 46%, P < .05) and receptive (51 vs 4%, P < .01) oral and anal (53 vs 13%, P < .01) intercourse than HIV- males. Protective factors were not significantly different for HIV+ and HIV- young people. CONCLUSIONS. Routine, confidential HIV counseling and testing should be considered for adolescents having unprotected sexual intercourse when age-specific services are available for HIV+ youth. Prevention programs should consider adolescents' history of abuse, homelessness, and other social as well as psychological dimensions in designing comprehensive care strategies to address HIV+ adolescents' multiple problem behaviors and living situations. Current theoretical models of health behaviors should be reconsidered, given the lack of their association to HIV risk acts of HIV+ youth. Age-specific services and interventions for HIV+ youth are urgently needed as HIV is spreading among youth worldwide.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Children of gay or lesbian parents.

There are no data to suggest that children who have gay or lesbian parents are different in any aspects of psychological, social, and sexual development from children in heterosexual families. There has been fear that children raised in gay or lesbian households will grow up to be homosexual, develop improper sex-role behavior or sexual conflicts, and may be sexually abused. There has been concern that children raised by gay or lesbian parents will be stigmatized and have conflicts with their peer group, thus threatening their psychological health, self-esteem, and social relationships. These fears and concerns have not been substantiated by research. Pediatricians can facilitate the health care and development of these children by being aware of these and their own attitudes, by educating themselves about special concerns of gay or lesbian parents, and by being a resource and an advocate for children who have homosexual parents.

Adolescent↗
PubMed1993

Human immunodeficiency virus-infected adolescents: the first 50 patients in a New York City program.

To address the unique manifestations of human immunodeficiency virus (HIV) among adolescents aged 13 through 21 years, a comprehensive evaluation and treatment program for high-risk and HIV-positive adolescents was developed in New York City in 1987. Among HIV-infected youth, mean age of testing was 18.2 years. One third of the HIV-positive patients were female and four fifths were African-American or Hispanic. No significant differences were found between HIV-positive (n = 50) and HIV-negative (n = 43) patients for age at first intercourse, injecting or other illicit drug use, history of sexually transmitted diseases, or survival sex (exchange of sex for money or drugs). HIV-positive males were more likely than HIV-negative males to have engaged in anal intercourse and to report a history of sexual abuse. Among infected females, 82% acquired HIV through heterosexual intercourse. Almost half (48%) of HIV-positive adolescents had significant immune dysfunction at the time of their initial visit (CD4 < 500/mm3) and were eligible for zidovudine. Many HIV-positive adolescents continued high-risk behaviors such as intercourse without condoms, particularly those with ongoing dependence on drugs or alcohol. With the epidemic of HIV infection increasing nationwide among adolescents, specialized, comprehensive programs are needed to counsel and treat HIV-infected adolescents and youth in high-risk situations.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Pregnancy and HIV.

Explore the source record for details and available documents.

AIDS Serodiagnosis↗
PubMed1990

HIV infection and AIDS during adolescence.

It is clear from the evidence that a growing number of adolescents are acquiring HIV infection and developing AIDS. The impact this epidemic will have on all teenagers is overwhelming. Given the high prevalence of risk-related sexual behaviors, many adolescents are likely to become HIV infected, thus requiring extensive medical and psychosocial services. Other adolescents will lose a parent, relative, or friend to AIDS, and these adolescents will similarly require special services and psychological counseling. Thus, there is an immediate need for the development of methods for (1) providing all adolescents with age-appropriate and culturally relevant interventions for prevention and risk reduction, (2) identifying high-risk adolescents and triaging them to different levels of care and risk reduction counseling, and (3) providing ongoing medical and psychosocial treatments. Accessing adolescents at risk for HIV infection will require networking between the health care system and youth-serving and community-based agencies, particularly agencies servicing high-risk adolescents. We must begin addressing these needs now, in order to prevent further infection and to provide appropriate care for those adolescents who are or will become infected with HIV.

Acquired Immunodeficiency Syndrome↗