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Biomedical subjects

D P Orr

Publications and source records attributed to D P Orr.

At least 19 recordsLinked to original sources
PubMed1992

Child abuse and mental health among adolescents in dependent care.

Do adolescents in dependent care who have been abused or neglected demonstrate more mental health problems than their nonabused peers? This study examined relationships of child abuse, depression, and self-esteem among 82 adolescents (mean age 14.5 years, 52% male, 82.9% white) living in a dependent care facility. Of these, 32 adolescents were victims of child abuse or neglect. Upon admission, 54 adolescents were identified as depressed on the Beck Depression Inventory. Initial scores on the depression and self-esteem instruments did not differ by age, race, or history of maltreatment, though trends among subtypes of abuse were identified. Females had significantly lower self-esteem and tended toward more depression. Repeat evaluation 6 months after admission revealed significant improvement in both depression and self-esteem scores for the entire sample. As a group, however, the maltreated adolescents did not demonstrate significant improvement in depression, and a history of neglect was associated with less improvement. Depression in this dependent care sample was common, however, we did not identify the maltreated adolescents as having significantly more problems with self-esteem or depression. For some adolescents, dependent care may be an appropriate and helpful alternative.

Adolescent↗
PubMed1992

Factors associated with condom use among sexually active female adolescents.

A health belief model of condom use was used to identify factors associated with condom use in 390 sexually active female adolescents, aged 12 through 19 years, recruited at the time of a visit for reproductive health care. Fifty-six percent were white and the remainder black. Nineteen percent had genitourinary infections with Chlamydia trachomatis. Forty-six percent reported having had more than one sexual partner in the preceding year. Reported condom use for at least one specific reason (prevention of pregnancy, sexually transmitted disease, or acquired immunodeficiency syndrome) increased as behavioral, emotional, and sexually transmitted disease risk decreased, and as cognitive maturity and positive condom attitudes increased. Although uses of condoms to prevent pregnancy, sexually transmitted disease, and acquired immunodeficiency syndrome were positively intercorrelated, each made a contribution to explaining condom use at most recent coitus (odds ratios 2.95, 3.96, and 2.81, respectively). After statistical adjustment for the reported reasons for previous condom use, behavioral risk was the only additional factor associated with condom use at the most recent sexual encounter; women who participated in more risk behaviors (substance and alcohol use and minor delinquency) were less likely to have used a condom (odds ratio 0.61). Knowledge about sexually transmitted disease and acquired immunodeficiency syndrome, and concurrent use of contraceptive pills, were not related to condom practices. The data suggest that adolescents' perceptions about condoms, including the individual functions of condoms for contraception and for prevention of sexually transmitted disease, may be important in determining their use. Engaging in unprotected intercourse may be part of a larger behavioral domain that includes other unhealthy behaviors.

Adolescent↗
PubMed1991

Relationships of somatic symptoms to behavioral and emotional risk in young adolescents.

Junior high students (n = 1508) from a midwestern community completed a health behavioral questionnaire that asked the frequency of headache and abdominal pain and of a number of behavioral and emotional risk indicators. Headache (24%) and abdominal pain (13%) were frequently reported among these young adolescents, particularly among girls. Those reporting frequent somatic complaints also reported significantly more behavioral and emotional symptoms indicative of risk (p less than 0.001). Further, the interaction between somatic complaint and gender significantly affected risk status (p less than 0.01). This interaction was greater with behavioral risk: boys with both abdominal pain and headaches reported higher behavioral risk than all other groups (p less than 0.0001). Somatic symptoms continued to account for a significant amount of variance in behavioral risk after the effects of emotional risk and age were removed. This suggests that behavioral risk and emotional risk are independently associated with somatic complaints. The evaluation of persistent somatic complaints in adolescents, particularly in boys with abdominal symptoms, should include careful examination of emotional risk factors and other health-endangering behaviors such as substance use, early sexual activity, and delinquency.

Abdominal Pain↗
PubMed1991

Premature sexual activity as an indicator of psychosocial risk.

Although unprotected premature sexual activity is associated with well-defined biologic risks of sexually transmitted disease and pregnancy, the concomitant psychosocial risks are less well documented. The strength of association (odds ratio) of coital status with other risk behaviors and feelings was examined in 1504 junior high school students. Among the 12 through 16-year-old students, 63% of the boys and 36% of the girls were nonvirginal (had had intercourse at least once). The proportion of sexually experienced boys and girls increased with age. Nonvirginal boys and girls were significantly (P less than .001) more likely than their virginal cohorts to engage in other activities considered risky. The odds ratios for nonvirginal youth ranged from 3.5 for girls having used drugs other than alcohol or marijuana, to 10.4 for girls having used marijuana. Nonvirginal boys and girls were also at significantly greater risk for engaging in minor delinquent acts and having school problems. Nonvirginal girls (but not boys) were 6.3 times more likely to report having attempted suicide. The strength of associations with feelings was weaker. Nonvirginal girls were at slightly greater risk for reporting feeling lonely, feeling upset, and having difficulty sleeping. A significant proportion of the students reported sexual experience and ever use of alcohol or marijuana (45% of boys, 27% of girls). There were strong age effects so that by age 15 years, 63% of the boys and 50% of the girls reported experience with both activities. The data suggest that early sexual experience among adolescents is associated with other potentially health-endangering behaviors and that the syndrome of problem behaviors is important in this age group.

Adolescent↗
PubMed1990

Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting.

In this replication study of adolescents in a nonclinical setting, the prevalence of reported problem behaviors, emotions, and abuse is evaluated, and the impact of abuse on multivariate emotional and behavioral risk is assessed. A total of 3998 students (69%) in a rural midwestern community in grades 7 to 12 participated in the study. Almost 20% of the students reported some form of physical and/or sexual abuse, with more girls than boys reporting sexual abuse (chi 2 = 48.5, P less than .001). Some problem behaviors (alcohol use) and emotions (trouble sleeping, difficulty with anger) were common among all adolescents and some were strongly associated with a history of abuse (especially, considering or attempting suicide, running away, laxative use, and vomiting to lose weight). Higher emotional and behavioral risk scores among abused students were confirmed. The effects of physical and sexual abuse on risk scores were independent and additive; no interaction was observed. An interaction of gender and sexual abuse on problem behavior was observed, with problem behavior being significantly greater among sexually abused boys. The results confirm increased risk of problem behaviors and negative feelings among abused adolescents when compared with nonabused peers, and better define influences of gender and abuse type on emotional and behavioral risks.

Adolescent↗
PubMed1989

Reported sexual behaviors and self-esteem among young adolescents.

Six hundred seventy-seven adolescents in grades 7 through 9 of a blue-collar, midwestern junior high school responded to a survey of sexual behavior and self-esteem. The focus of this study was on the relationship between sexual experience and self-esteem. Fifty-five percent of the students reported having had at least one coital experience; 7% reported having intercourse about once a week. The proportion of sexually experienced adolescents increased with age; 28% of 12-year-olds, 52.7% of 13-year-olds, 60.1% of 14-year-olds, 73.6% of 15-year-olds, and 90% of 16-year-olds reported having intercourse on at least one occasion. More boys of all ages were sexually active than girls. Six percent of students had had, or were suspicious of having had, a sexually transmitted disease; 7.8% were involved in a pregnancy. The average of the self-esteem scores for girls was significantly lower than the average for boys. There was an interaction effect between gender and coital history for self-esteem. Girls who reported having had intercourse had lower self-esteem scores than those who did not. On the other hand, self-esteem of sexually experienced and inexperienced boys did not differ, nor did self-esteem of virginal boys and girls. Boys and girls with a history of sexually transmitted diseases had lower self-esteem than all others. Pregnancy, on the other hand, did not seem to affect self-esteem of the sexually experienced adolescents. This cross-sectional study does not permit determination of whether the lower average self-esteem among certain girls was antecedent to or a consequence of sexual experience.

Adolescent↗
PubMed1989

Clinical evaluation of computer-assisted self-monitoring of blood glucose system.

The Glucometer M Diabetes Management System includes a glucose-reflectance meter with memory that can interface with a microcomputer for data manipulation and analysis. We evaluated the system in a short-term randomized control trial to determine its impact on metabolic control, self-monitoring of blood glucose (SMBG) testing behaviors, regimen self-adjustment, understanding of insulin-dependent diabetes mellitus (IDDM) treatment, attitudes about SMBG, and perceived quality of patient-physician interaction. Twenty-nine adolescent subjects (experimental) with IDDM were randomly assigned the Glucometer M system for 4 mo. Twenty-eight control subjects used meters without memory. All subjects returned twice to the clinic at 2-mo intervals during the study. At clinic visits, both groups reviewed their SMBG data with their physician. Reviews on experimental subjects were conducted with computer-generated data formats. Control subject reviews used traditional logbooks. Both groups showed a significant drop in glycosylated hemoglobin during the study period (P less than .001); however, there were no between-group differences. There were also no differences in SMBG testing behavior or self-reported regimen self-adjustment between groups or within groups compared with baseline. Compared with control subjects, experimental subjects indicated a significant increase in self-reported understanding of IDDM treatment (P = .002), perceived importance of testing (P = .006), and the quality of interaction with their physician (P less than .001). These data suggest that use of computer-assisted SMBG systems in the outpatient setting does not improve metabolic control over 4 mo. It may, however, contribute to improving communication between the patient and health-care providers.

Blood Glucose Self-Monitoring↗
PubMed1988

Abuse, feelings, and health behaviors in a student population.

Behavioral sequelae of child abuse are frequently cited, but there are few studies that examine the strength of association between behavioral effect and abuse for children in a nonclinical setting. Seven hundred twelve junior high school students (mean age, 13.5 years) were surveyed for self-report of personal experience with abuse, certain health behaviors, and self-esteem. Physical and/or sexual abuse was reported by 18.3% of students. Both types of abuse were associated with the following behaviors: running away; considering hurting oneself; suicide attempts; and the use of drugs, pot (marijuana), cigarettes, and laxatives. No clinically significant relationships were found between abuse and report of anger, sadness, or self-esteem. These data suggested that some feelings and behaviors were common among all adolescents sampled, while others were more common among abused adolescents. Recognition of strong associations should help direct clinical management. The results of this study confirm findings from some previous reports and indicate the need for further studies of children who are not in a clinical setting.

Adolescent↗
PubMed1988

Hormonal aspects of normal and abnormal behavior in adolescents. Study group report.

As stated initially, a significant proportion of health problems of youths have genetic predispositions and potentially identifiable antecedents of disease during childhood and adolescence. Until there is advancement in delineating the multiple dimensions and relationships of a psychobiologic developmental framework, interventions may fall short of their potential to either prevent or ameliorate these problems. To date, research has been limited by narrow definitions, lack of uniformity among measures, small samples, and homogenous populations. As a forward step, longitudinal investigations of subpopulations of youths may provide an opportunity for definitive study of the basic processes of puberty and be fruitful in evaluating the deleterious effects that stresses of contemporary life place on children and adolescents. In addition, efforts to communicate existing knowledge across disciplines and to approach psychobiologic research from an interdisciplinary perspective will enhance an understanding of the interplay of social, biologic, and environmental factors that are essential in the maturational process. This multidimensional approach with newer, broader perspectives is critical to advancing the development of a psychobiologic framework that will shed further light on the mechanisms of maturation and the interferences of this pubertal process that is the hallmark of adolescence.

Adolescent↗
PubMed1988

Pubertal maturation and cognitive maturity in adolescents.

To determine the relationship between puberty and cognitive development, 135 students, ages 11 through 19 years, were studied. The participants were 73% white, 55% female, and of predominantly middle-class backgrounds with a mean Hollingshead score of 37.1 +/- 16.3. Measures of general intelligence (IQ), cognitive complexity (conceptual level), and cognitive style (perceptual field dependence-independence) were administered. Students rated their own level of sexual maturity (Tanner stage). Mean Tanner stage of 4.0 +/- 0.9 was consistent with the mean age of 14.2 +/- 2.2 years. General intelligence was average (105 +/- 18.2). Most did not demonstrate the use of mature cognitive processes, as reflected in low conceptual level scores (1.19 +/- 0.5) and a more field-dependent cognitive style (7.9 +/- 4.9). Older adolescents (r = 0.377; p less than 0.001), females (r = 0.217; p less than 0.005), and those with a higher IQ (r = 0.329; p less than 0.001) were cognitively more complex. Using an analysis of covariance to control for colinearity of variables, differences in conceptual level and cognitive style as functions of levels of sexual maturity were compared. Once the statistically significant colinear effects of age, gender, and IQ (p less than 0.0001) were removed, no statistical contribution was left attributable to the level of sexual maturity. In other words, when the effects of age were controlled, more advanced Tanner stage was not a predictor of more mature cognitive processes. Physical growth and development during puberty do not appear to affect cognitive development.

Adult↗
PubMed1988

Pubertal maturation and adolescent self-esteem.

One hundred thirty-five students attending a suburban junior and senior high school were studied to examine the relationships between self-esteem and age, gender, and pubertal events. Forty-five percent of the subjects were male, and 24% were black. Mean Hollingshead Two Factor Index of Social Position was 37.1 +/- 16.3, reflecting their predominantly middle-class background. Self-esteem was not related to age but did correlate with intelligence (r = 0.233, p = 0.003). Females had significantly lower self-esteem than males (p = 0.001). Pubertal status (Tanner stage) did not affect self-esteem. However, our data suggest that a subtle relationship between timing of sexual maturation and self-esteem may exist for males. Perhaps more sensitive measures of early pubertal maturation (such as hormone levels) may clarify the extent of this relationship and the gender differences found prior to age 11 years.

Adolescent↗
PubMed1988

Historical and clinical factors associated with Chlamydia trachomatis genitourinary infection in female adolescents.

Five hundred sixty-eight adolescent female patients receiving routine gynecologic care at urban clinics were screened by culture for Chlamydia trachomatis infection at both the urethra and endocervix. Culture results for 562 were available from either or both sites. Positive cultures were obtained from 139 (25%). Urethral infection was not associated with either urinary tract symptoms or sterile pyuria, but urethral or endocervical infection was associated with cervical friability (P = less than 0.0001), endocervical mucopus (P = 0.0001), cervical erythema (P = 0.0002), and cervical ectopy or erosion (P = 0.01). Increased chlamydial infection rates were associated with older age (P = 0.01), history of more frequent intercourse (P = 0.01), and history of more than one lifetime partner (P = 0.023), with a marginal association for being black (P = 0.05). Method of contraception, reason for attending clinic, age at menarche, age at first intercourse, years sexually active, number of sexual partners in preceding 6 months, parity, and prior history of sexually transmitted disease were not associated with having chlamydial genitourinary infection.

Adolescent↗
PubMed1987

Adolescent health care: perceptions and needs of the practicing physician.

Three hundred thirty-one Indiana physicians practicing general-family medicine (GP-FP), obstetrics-gynecology (OB-GYN), pediatrics (PED), internal medicine (IM), and psychiatry (PSYCH) were surveyed as to their perceptions about adolescent health and their perceived need for specific adolescent services and Continuing Medical Education (CME). Significant differences were noted in all specialty areas that were not accounted for by the sex or age of the physician. The majority of GP-FP and PED reported that adolescents (aged 11-19 years) made up at least 10% of their practice compared to fewer than 5% of IM practices. Fewer than 7% of the respondents had had no training about adolescent medicine; most (47.5%) had received some CME in adolescent medicine. Family planning was the service least likely to be: provided by PED, IM, and PSYCH, (p less than 0.0001); considered serious for these physicians' adolescent patients (p less than 0.0001); and of interest for CME by all physicians (p less than 0.0001). All specialities believed their adolescent patients to be minimally troubled by the most common problems of youth (p less than 0.0001), but did accurately perceive youth as having psychosocial and medical problems. Training about substance abuse, counseling, learning problems, and eating disorders were most desired. Few respondents wanted individualized, in-person training. The implications of these results are discussed.

Adolescent↗
PubMed1987

School-based, short-term group treatment for behaviorally disturbed young adolescent males: a pilot intervention.

Behaviorally maladjusted students represent a serious problem for schools. A short-term group counseling program was initiated as an alternative to out-of-school suspensions for male students in a middle school (grades six-eight). Thirteen adolescents were identified for group treatment. All received a standard psychiatric interview, and standard measures of self-concept, anxiety, cognitive complexity, and sexual maturity. Eleven students referred to the program had conduct disorders supported by Devereux Behavior profiles. Compared to 48 males of similar age (m = 12.5 years) without behavior problems, no significant differences were noted in self-concept or anxiety. Boys with behavior problems were less cognitively mature (p = .02) and were significantly (p = .001) more advanced in Tanner sexual maturity rating than the comparison group. A behavior management system using group rewards and consequences for individual behavior was utilized. Disciplinary problems decreased in the classroom during treatment but no long-term changes were noted following cessation of treatment. The data raises the question whether early sexual maturation modifies an adolescent's risk for psychological problems. Short-term group treatment may be effective in improving classroom behavior of behaviorally disturbed adolescent males.

Adolescent↗
PubMed1986

Surreptitious insulin administration in adolescents with insulin-dependent diabetes mellitus.

Six adolescents, 12 to 15 years old, with insulin-dependent diabetes mellitus were discovered to be secretively taking extra insulin, not with the intent of improving metabolic control. Large discrepancies between reported and observed insulin requirements were noted. Psychosocial problems antedated the discovery of surreptitious insulin administration in all. Psychological testing and psychiatric evaluation revealed a variety of psychiatric conditions; depression was common. In two patients surreptitious insulin administration was believed to represent suicidal behavior. In others, it appeared to represent symptom substitution when use of other health-threatening behaviors such as recurrent ketoacidosis was made increasingly difficult through appropriate intervention. Surreptitious insulin administration may be one symptom of serious underlying psychiatric dysfunction in adolescents with insulin-dependent diabetes.

Adolescent↗
PubMed1986

Cognitive maturity and self-management among adolescents with insulin-dependent diabetes mellitus.

The ability of adolescents with insulin-dependent diabetes mellitus (IDDM) to assume responsibility for self-management is complicated by normal psychosocial developmental tasks, including establishing independence from authority. We evaluated self-managerial behavior and its relation to cognitive maturity. Forty-one adolescents with IDDM (age range 12 to 21 years) and their parents, who were trained to self-adjust insulin on compensatory and anticipatory bases, participated. The data indicated that parents withdrew from the insulin adjustment process as their adolescents grew older. Parental participation had virtually ceased by the time the child reached age 15 years. Parental withdrawal, however, was not always balanced by the adolescent's assumption of responsibility for insulin adjustments. Older adolescents were statistically no more likely than younger adolescents to self-adjust insulin doses. Both self-adjustment and metabolic control (HbA1 values) among adolescents were, however, related to cognitive maturity. More cognitively mature adolescents were also more likely to perceive themselves as being in control of their illness. Thus, older adolescents who are less cognitively mature than their peers are sometimes given responsibility for self-managerial behaviors that they are unable to assume.

Achievement↗