Biomedical subjects
D O Chastain
Publications and source records attributed to D O Chastain.
Facultative myiasis by Megaselia sp. (Diptera: Phoridae) in Texas: a case report.
Facultative myiasis caused by larval Megaselia sp. is reported in a human in Texas. On two occasions during 24 h, the youth experienced a "crawling sensation deep in [his] throat" which caused him to cough, expelling a living Megaselia sp. larva. The site of the infestation was presumed to be the sinuses or upper respiratory tract. The symptoms resolved upon expulsion of the larvae, and no additional complications were observed in the patient.
Pediatricians' use of chaperones when performing gynecologic examinations on adolescent females.
This study assesses the influence of the interest and skill in adolescent health care on a pediatrician's use of a chaperone during the pelvic examination. A national sample of 558 pediatricians selected at random and 384 members of the American Academy of Pediatrics' Section on Adolescent Health (SAH) completed questionnaires assessing their perceived skills in and practice of adolescent medicine. Some 90.4% of the non-SAH males and 31.0% non-SAH females always used a chaperone compared to 69.4% of SAH males and 12.5% of SAH females (p less than or equal to 0.05). The actual frequency of chaperone use was less among SAH members than non-SAH pediatricians (p less than or equal to 0.013) and less among females in both groups (p less than or equal to 0.0001). Among male physicians, the variables found to have the strongest association with a less frequent use of chaperones included the frequency that oral contraceptives were prescribed, perceived skill in providing contraceptive counseling, percent of adolescents in the pediatrician's practice, and the frequency with which confidential services were provided. These correlations were stronger among SAH members than non-SAH pediatricians. Among female SAH members, not using a chaperone was associated with a higher perceived skill in managing sexually transmitted diseases, the frequency with which they performed pelvic examinations, and the percent of adolescents in their practice. Among non-SAH female physicians, the perceived skill to perform a pelvic examination and provide contraceptive counseling were associated with increased chaperone use. These data suggest that many factors other than gender and medicolegal influences are associated with the physician's decision concerning the use of a chaperone.
Recommended changes in pediatric education: the impact on pediatrician involvement in health care delivery to adolescents.
In an attempt to examine the extent of implementation of the recommendations issued by the Task Force on Pediatric Education for increased emphasis on adolescent medicine during residency training, pediatricians' perceptions of their skills and abilities to provide health care to adolescents were evaluated. A sample of 558 pediatricians selected at random and 385 members of the American Academy of Pediatrics' Section on Adolescent Health (SAH) completed a 41-item questionnaire. The physicians' perceived levels of skill in ten areas were analyzed while simultaneously assessing the impact of SAH membership, year of graduation from medical school, gender, and percentage of practice time devoted to adolescents on each issue. SAH members, as expected, ranked their levels of skill significantly higher than did the other pediatricians in all areas surveyed. A significant percentage of the SAH pediatricians, however, indicated that their skills were acquired through postresidency fellowship training. There was an increasing trend among all pediatricians in their perceived levels of skill to deliver health care to adolescents during the past several decades, but there has been no appreciable increase in such perceived skill levels since the task force issued its recommendations. In fact, pediatricians graduating from medical school in the decade prior to 1976 who are not SAH members ranked their skills higher than did non-SAH pediatricians who graduated in the past 10 years. These data lead to the conclusion that the recommendations of the Task Force on Pediatric Education have not been adequately implemented.