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Biomedical subjects

Donald F Schwarz

Publications and source records attributed to Donald F Schwarz.

11 recordsLinked to original sources
PubMed2006

Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women.

CONTEXT: Adolescents are frequent users of hormonal contraception (HC), yet their adherence to these methods is often poor. Concerns about side effects, especially those affecting the menstrual system, are often given as reasons for contraceptive nonadherence or discontinuation. We sought to identify teens' concerns and misperceptions about the menstrual-related side effects of HC. METHODS: Open focus groups were conducted with both sexually active and virgin adolescent women aged 12-18 years who were recruited from the Philadelphia area. The adolescents did not have to be contraceptive users in order to participate. The question put to each group was, "What are the things you have heard about the birth control pill, Depo-Provera and Norplant?" Groups were audio-recorded, transcribed and analyzed using qualitative software. RESULTS: We conducted 13 female-only groups. Participants raised frequent concerns about menstrual-related side effects, believing that these side effects were evidence of possible negative effects of HC on their reproductive health. Four themes related to hormonal contraceptive-induced menstrual irregularity emerged from the groups. Theme 1: Menstruation is natural and should not be altered in any way. Theme 2: The menstrual period is necessary for cleansing of the body. Theme 3: "Spotting," intermenstrual bleeding and amenorrhea cause doubts about the method's effectiveness and worries about pregnancy. Theme 4: All menstrual irregularity, from intermenstrual bleeding to amenorrhea, causes worry about the effects on fertility and on physical health. CONCLUSIONS: Teens have concerns about the menstrual irregularity caused by HC. Providers understand that these side effects are minor and of little medical consequence. Yet, adolescent patients may be ascribing great significance to these effects and may be declining these methods because of fear and misperceptions.

Adolescent↗
PubMed2005

Discharge disposition of adolescents admitted to medical hospitals after attempting suicide.

OBJECTIVE: To test the hypothesis that discharge disposition for adolescents admitted to medical hospitals after attempting suicide varies as a function of hospital type and geographic region. DESIGN: Retrospective cohort analysis. SETTING: The nationally representative Kids' Inpatient Database for 2000. PARTICIPANTS: Patients aged 10 to 19 years with a diagnosis of suicide attempt or self-inflicted injury.Main Outcome Measure Likelihood of transfer to another facility vs discharge to home. RESULTS: Care for 32 655 adolescents who attempted suicide was provided in adult hospitals (83% of hospitalizations), children's units in general hospitals (10%), and children's hospitals (4%). More than half (66%) of medical hospitalizations ended with discharge to home, 21% with transfer to a psychiatric, rehabilitation, or chronic care (P/R/C) facility, 10% with transfer to a skilled nursing facility, intermediate care facility, or short-term acute care hospital facility, and 2% with death or departure against medical advice. After adjustment for individual patient characteristics, children's units were 44% more likely than adult hospitals to transfer adolescent patients to a P/R/C facility (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.07-1.94). Patients cared for outside the Northeast were significantly less likely to be transferred to a P/R/C facility (South: OR, 0.79; 95% CI, 0.65-0.97; Midwest: OR, 0.63; 95% CI, 0.49-0.80; West: OR, 0.29; 95% CI, 0.22-0.38). CONCLUSIONS: Most adolescents admitted to a medical hospital after a suicide attempt are discharged to home, and the likelihood of transfer to another facility appears to be influenced by the geographic location of the admitting hospital and whether it caters to children.

Adolescent↗
PubMed2005

Association between primary care practice characteristics and emergency department use in a medicaid managed care organization.

BACKGROUND: Many patients use emergency departments (EDs) for primary care. Previous studies have found that patient characteristics affect ED utilization. However, such studies have led to few policy changes. OBJECTIVES: We sought to determine whether Medicaid patients' ED use is associated with characteristics of their primary care practices. RESEARCH DESIGN: This was a cohort study. SUBJECTS: A total of 57,850 patients, assigned to 353 primary care practices affiliated with a Medicaid HMO, were included. MEASURES: Predictor variables were characteristics of primary care practices, which were measured by visiting each practice. The outcome variable was ED use adjusted for patient characteristics. RESULTS: On average, patients made 0.80 ED visits/person/yr. Patients from practices with more than 12 evening hours/wk used the ED 20% less than patients from practices without evening hours. A higher ratio of the number of active patients per clinician-hour of practice time was associated with more ED use. When more Medicaid patients were in a practice, these patients used the ED more frequently. Other factors associated with ED use included equipment for the care of asthma and presence of nurse practitioners and physician assistants. DISCUSSION: Modifiable characteristics of primary care practices were associated with ED use. Because the observational design of this study does not allow definitive conclusions about causality, future studies should include intervention trials to determine whether changing practice characteristics can reduce ED use. CONCLUSIONS: Improving primary care access and scope of services may reduce ED use. Focusing on systems issues rather than patient characteristics may be a more productive strategy to improve appropriate use of emergency medical care.

Adolescent↗
PubMed2005

Fragmented care for inner-city minority children with attention-deficit/hyperactivity disorder.

OBJECTIVES: To identify systematic problems in coordinating care for inner-city minority youths with attention-deficit/hyperactivity disorder. METHODS: We recruited participants from inner-city minority communities in a single metropolitan area for a focus group study. We held separate meetings for pediatricians, mental health therapists, school staff, and parents (both black and Latino). We audiotaped and transcribed the meetings. We identified themes by consensus and used root cause analysis as a conceptual framework to guide our analysis. RESULTS: We held 13 focus group meetings. Participants uniformly perceived insufficient communication and coordination of care. Five themes representing system and human factors that contributed to this fragmentation in care emerged: (1) a lack of consensus about who should oversee care; (2) changes in health care providers or teachers; (3) uncertainty in the diagnosis, insufficient training, and few resources; (4) distrust and blame that emerged when relationships among people who care for the child were absent or otherwise inadequate; and (5) lack of support from employers, friends, and family to engage in collaborative care. CONCLUSIONS: Using a root cause analysis framework, we identified system- and human-level factors that were perceived to impede communication and coordination of care for this population of children with attention-deficit/hyperactivity disorder. These results suggest that better organizational policies that define provider responsibilities and accountability, support the coordination of care, bridge relationships between agencies, and provide additional education and resources may improve collaboration. Additional study is needed to assess the generalizability of these finding to other settings.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Public spending on elders and children: the gap is growing.

Social welfare programs support the income, education, nutrition, and medical care needs of many of this country's elders and children. Over the past twenty years, however, three times as many children as elders have lived in poverty, and poverty rates for children have consistently exceeded those for the elderly. Given the continued disparity in poverty rates, it is important to track levels of public spending for each group and the generational balance in allocating limited public funds. This Issue Brief evaluates trends in social welfare spending for children and the elderly from 1980 to 2000, and the relationship of national economic trends to public spending patterns.

Adult↗
PubMed2003

A case-control study of female-to-female nonintimate violence in an urban area.

OBJECTIVES: The aims of this study were to describe the characteristics surrounding female-to-female nonpartner violence and to identify independent factors associated with risk of female-to-female intentional injuries. METHODS: A case-control investigation was conducted among women who resided in an urban, low-income community and presented for emergency department care for injuries inflicted by female nonpartners. RESULTS: Women were typically victimized by women they knew (88%), in outdoor locations (60%), and in the presence of others (91%). Those found to be at risk for injury typically were young and socially active, used marijuana, and had experienced other kinds of violence. CONCLUSIONS: The present results showed that women injured by female nonpartners had limited resources, experienced disorder in their lives, and were the victims of violence within multiple relationships.

Adolescent↗
PubMed2003

Effect of a follow-up professional home cleaning on serial dust and blood lead levels of urban children.

Children residing in Philadelphia, Pennsylvania, who were enrolled in a clinical trial of oral chelation therapy (n=73) were studied to determine the effects of a follow-up professional lead dust cleaning of their homes 18 mo after an initial cleaning and commencement of therapy. Home dust lead levels were determined from dust-wipe specimens collected from the kitchen and playroom floors, and from a playroom windowsill, prior to, immediately following, and 3 and 6 mo after the second cleaning. Children's blood lead levels were assessed at 3-mo intervals before and after the follow-up cleaning. Professional cleaning produced immediate decreases in dust lead levels; however, dust lead re-accumulated to precleaning levels within 3-6 mo. Frequent, repeated cleanings may be required if blood lead or dust lead levels are to be reduced and sustained at low levels in urban homes.

Air Pollution, Indoor↗
PubMed2002

How to reach sexual minority youth in the health care setting: the teens offer guidance.

PURPOSE: To explore factors sexual minority youth believe make them feel safe in a health care setting. METHODS: Participants in three urban programs serving lesbian/gay/bisexual/transgendered and questioning (LGBTQ) youth engaged in a four-stage process to generate, prioritize, and explain their own ideas. In Stage III, 94 youth, aged 14 to 23 years, completed a survey comprised of the 34 highest rated items generated in earlier stages. Using a Likert scale, they answered, "How important are each of the following ideas in making you feel safe as an LGBTQ youth when you go for health care?" In Stage IV, youth discussed the results in focus groups. The Marginal Homogeneity Test divided the items into priority ranks and the Kruskal-Wallis test explored subgroup differences in item ratings. RESULTS: The 34 items were divided into six ranks. Five items shared the top rank: the clinician maintaining privacy, demonstrating cleanliness, offering respect, being well-educated, and being honest. The second rank was shared by the following: the clinician not talking down to patients, being a good listener, not downplaying patients' fears, being professional, holding a nonjudgmental stance of the LGBTQ lifestyle, and not assuming every LGBTQ youth has HIV. Interspersed among other ranks were items specific to the needs of sexual minority youth: the clinician not assuming LGBTQ sexual behavior was painful or dangerous; the clinician being educated about the gay lifestyle; clinician sensitivity to the needs of same-sex partners; staff sensitivity to the needs of closeted youth; having a choice of an LGBTQ provider; and the clinician not assuming heterosexuality. Youth who had not publicly disclosed their sexuality rated health information being offered in a private place higher (p =.01). CONCLUSIONS: LGBTQ youth value the same clinician characteristics desired by all adolescents: privacy, cleanliness, honesty, respect, competency, and a nonjudgmental stance. They clearly describe what attracts them (e.g., clinicians educated about their lifestyle) and what offends them (e.g., equating their sexuality with HIV). Clinicians need to achieve and convey a higher comfort level in addressing the special needs of sexual minority youth.

Adolescent↗
PubMed2002

Use of ligase chain reaction for laboratory identification of Chlamydia trachomatis and Neisseria gonorrhoeae in adolescent women.

STUDY OBJECTIVE: To compare the ligase chain reaction (LCR) with culture for the detection of Neisseria gonorrhoeae (GC) and with culture and direct fluorescent antibody (DFA) for identification of Chlamydia trachomatis (CT) in cervical specimens from adolescent women. DESIGN: A prospective study of test performance. SETTING: Two urban, hospital-based adolescent clinics. PARTICIPANTS: Adolescent women aged 12-22 yr undergoing pelvic examination for routine sexually transmitted disease (STD) screening or symptoms suggestive of an STD. MAIN OUTCOME MEASURES: LCR results were considered to be true positives if confirmed by culture and/or DFA (CT only). Discrepant LCR results were confirmed by testing an alternative locus. RESULTS: With 538 subjects, LCR for CT had a sensitivity of 98.4% (61/62) and specificity of 96.4% (459/476) prior to resolution and a sensitivity of 98.6% (70/71) and specificity of 99.6% (459/461) after resolution. With 1225 subjects, LCR for GC had a sensitivity of 90.0% (54/60) and specificity of 99.4% (1158/1165) prior to resolution and a sensitivity of 90.6% (58/64) and specificity of 100% (1158/1158) after resolution. CT culture alone identified 80% of the true positives and DFA alone only identified 72%. GC culture alone identified 94% of the true positives. CONCLUSIONS: LCR is an extremely sensitive and specific rapid test, utilizing a single swab and convenient room-temperature storage and transport of specimens. LCR testing of cervical specimens for CT in adolescent women is a better test for detecting CT infection than culture or DFA. LCR testing for cervical GC infection may provide an advantage over culture in circumstances in which optimal transport conditions and viability of the organism cannot be assured.

Adolescent↗
PubMedDate not supplied

Generational differences in U.S. public spending, 1980-2000.

The balance between spending on children and spending on the elderly is important in evaluating the allocation of public welfare spending. We examine trends in public spending on social welfare programs for children and the elderly during 1980-2000. For both groups, social welfare spending as a percentage of gross domestic product changed little, even during the economic expansions of the 1990s. In constant dollars, the gap in per capita social welfare spending between children and the elderly grew 20 percent. Unlike spending for programs for the elderly, spending for children's programs suffered during recessions. Public discussion about the current imbalance in public spending is needed.

Age Factors↗