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Biomedical subjects

L S Neinstein

Publications and source records attributed to L S Neinstein.

At least 19 recordsLinked to original sources
PubMed1992

Comparison of cytobrush with Cervex-Brush for endocervical cytologic sampling.

This study was designed to compare the quality of the Papanicolaou (Pap) smear and side effects associated with the Ayres spatula/cytobrush combination and the Cervex-Brush. We evaluated 165 Pap smears, of which 84 (51%) were cytobrush/spatula specimens, and 81 (49%) were from Cervex-Brush specimens. The cytobrush/Ayres spatula combination and the Cervex-Brush alone were equally successful in detecting squamous cells, however, the cytobrush/Ayres spatula combination was significantly better in picking up endocervical cells than the Cervex-Brush (p less than 0.01). There were no significant differences between the two techniques in degree of bleeding and pain in adolescents. The combination of the cytobrush and spatula appears to be superior to the Cervex-Brush alone in producing adequate Pap smears.

Adolescent↗
PubMed1991

Hypercholesterolemia in adolescents: effectiveness of screening strategies based on selected risk factors.

This study evaluates the efficacy of the American Academy of Pediatrics' current recommendations for identifying hypercholesterolemia in teenagers. These guidelines advocate a screening strategy that is targeted only at high-risk individuals. Detailed information regarding risk factors for hypercholesterolemia was obtained from 1001 adolescents or their parents at three urban teen clinics during routine health assessments. In addition, serum cholesterol was measured in all adolescents. The population under study was 38.2% Hispanic, 33.5% white, 15.4% black, and 11.3% Asian, with a mean age of 15.6 years (range: 12 through 21 years); 52% were female. Based on the cholesterol values, the study population was divided into two groups: (1) normal cholesterol level, less than 200 mg/dL (n = 937, mean cholesterol value = 157 mg/dL) and (2) elevated cholesterol level, greater than or equal to 200 mg/dL (n = 64, mean cholesterol value = 228 mg/dL, range = 200 through 366 mg/dL). Application of the 1985 American Academy of Pediatrics criteria for selected screening identified 30 of 64 individuals with hypercholesterolemia (sensitivity = 47%). Criteria similar to 1988 recommendations identified 40 of 64 teenagers (sensitivity = 62%). A combination of 1985 and 1988 criteria yielded a sensitivity of 44 of 64, or 69%. The specificity of these criteria was 74%, 60%, and 53%, respectively. Despite the utilization of the 1985, 1988, or a combination of both American Academy of Pediatrics criteria for hypercholesterolemia screening, this study demonstrates that many adolescents with abnormal cholesterol levels would not be identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Life-threatening desmoid tumor.

An 18-year-old girl presented with severe chest pain and shortness of breath. She was found to have a large desmoid tumor filling the right chest cavity. The etiology of the desmoid tumor is unknown but is thought to be associated with an underlying genetic defect and local trauma. These tumors may be estrogen sensitive and are more frequent in females of reproductive age. The case demonstrates the difficulty in treating these tumors effectively.

Adolescent↗
PubMed1990

Menstrual problems in adolescents.

Menarche is a significant event in the course of puberty. Although the age of menarche varies among adolescents, it occurs in most adolescents at an SMR of 4. With the onset of ovulatory cycles, local prostaglandins are released, often causing dysmenorrhea. This usually responds to PSIs. Abnormal uterine bleeding usually is the result of anovulatory cycles. However, complications of pregnancy, systemic illnesses, and local pathology must be considered. Significant bleeding usually responds to hormonal therapy. Amenorrhea may result from abnormalities affecting the hypothalamus, pituitary, or ovaries. The evaluation should be done in a logical, orderly fashion. In addition, pregnancy must always be considered first in the differential diagnosis.

Adolescent↗
PubMed1989

Detection of Chlamydia trachomatis. A study of the direct immunofluorescence technique and a review diagnostic limitations.

Because of the high prevalence of Chlamydia trachomatis in adolescent females and the high cost of chlamydia cultures, we evaluated the use of the direct fluorescein conjugated monoclonal antibody test (DFA) in diagnosing C. trachomatis in adolescent females. Chlamydia trachomatis was found in 37 (20.1%) of 184 cultures. The sensitivity of the direct smear as compared with the culture was 89% and the specificity was 99%. The results of recent studies of the DFA and chlamydiazyme tests are reviewed as well as the problems in comparing techniques.

Adolescent↗
PubMed1989

Comparison of cytobrush with cotton swab for endocervical cytologic sampling.

This study was designed to compare the Ayres spatula/cytobrush combination with the Ayres spatula/cotton swab combination as to the quality of the Pap smear in adolescent females. We evaluated 111 Pap smears, of which 60 (54%) were from cotton applicators/spatula combination and 51 (46%) were from cytobrush/spatula combination. Seventy-nine percent of the specimens with the cytobrush showed good cellular yield, compared to only 50% of the specimens obtained with a cotton applicator (p less than 0.05). The adequate specimen rate for endocervical cell content was 68% for the cytobrush versus 56% for the cotton applicator (p = not significant). The adequacy rate was less for trainees than for attending physicians, but the difference was less marked for those using the cytobrush. The cytobrush does have some impact on improving adequacy rates for Pap smears. However, this study was unable to determine whether this is a cost-effective addition to the Ayres spatula or cotton swab. The problem of inadequate Pap smears deserves more scrutiny among various health care systems.

Female↗
PubMed1989

Abdominal and flank pain as presenting symptoms of schwannoma.

Spinal cord tumors have been reported to cause abdominal, flank, and back pain. This case report describes an extensive evaluation of an adolescent male presenting with flank, abdominal, and back pain leading to the diagnosis of a schwannoma. The case underscores the need to consider spinal cord tumors in the differential diagnosis of abdominal and/or flank pain.

Abdomen↗
PubMed1989

Prior training and recommendations for future training of clinical research faculty members.

A survey was conducted of the first authors of half of the research papers published in 18 leading peer-reviewed medical journals over a six-month period in 1986. The first authors of every other article (that is, alternate articles) published during this period were sent a questionnaire that assessed their previous research training and their recommendations for training of clinical research faculty members. Of the 772 physicians sent the questionnaire, 482 responded. Of these, 57% had had some research training in medical school, 52% had received such training during residency, and 87% had received it during their fellowships. Fifty-six percent had taken a formal statistics course, 31.4% had taken some computer training, and 87% had received research supervision in a nonstructured format (that is, no formal course work). Introductory biostatistics was the only formal course in any of the seven subject areas listed in the questionnaire that more than one-third of the respondents had taken, yet at least two-thirds recommended that researchers take formal courses in all of the seven areas listed. The investigators recommend for medical students and postgraduate trainees a graduated experience of research training and exposure that includes formal courses.

Adult↗
PubMed1988

Asymptomatic Chlamydia trachomatis infections in teenage males.

This study examined the prevalence of Chlamydia trachomatis infections of the urethra in asymptomatic teenage males in a juvenile detention setting. Gonorrhea cultures, chlamydia smears using the direct immunofluorescent antibody (DFA) technique, and 15-20 ml of a first-catch urine (FCU) sample were obtained. Of the 227 adolescent males screened, 205 had experienced sexual intercourse. Twenty-seven (13.2%) of the sexually active adolescents had positive DFA smears for C. trachomatis. Three (1.5%) had positive Neisseria gonorrhoeae cultures. A urine leukocyte count of greater than 10 per high-power field gave a 91% specificity but only a 26% sensitivity for a positive DFA. The high prevalence of chlamydia in this population and the relative low cost of the DFA screen for chlamydia make this a useful procedure for discovering unsuspected disease, particularly in a high-risk population. The FCU screen for leukocytes was of limited value in identifying asymptomatic infection.

Adolescent↗
PubMed1987

A review of Society for Adolescent Medicine abstracts and Journal of Adolescent Health Care articles.

Adolescent medicine research has dramatically increased over the past 20 years. The object of this study was to assess the status of design in adolescent health care research. All abstracts of presentations at the 1978-1985 Society for Adolescent Medicine (SAM) Meetings are included as well as all articles from the Journal of Adolescent Health Care (JAHC) from 1980 through September of 1985. The abstracts were analyzed for basic design, subject, sample size, study site, number of authors, and type of statistical analysis. A descriptive design comprised 32.8% of the SAM abstracts and 62.9% of the JAHC articles. An observational design comprised 57.8% of the SAM abstracts and 35.5% of the JAHC articles. An experimental design comprised 9.3% of the SAM abstracts and 1.6% of the JAHC articles. Of the 203 abstracts, 46% involved medical and 45.6% psychosocial topics. The JAHC articles were also fairly equally divided. Descriptive studies have decreased from 1978 to 1985 whereas observational studies have increased. The medium sample size of SAM abstracts increased from 1978 (83) to 1985 (100). Statistical methods were only analyzed for JAHC articles. Sixty-one percent used either no methods or used descriptive statistics only. The major statistical tests used were contingency tables, t-tests, analyses of variance, and Pearson correlations. Adolescent medicine research from these two sources usually involves descriptive and observational designs. The few clinical trials conducted involved small sample sizes. An increase in experimental and collaborative projects is needed.

Adolescent↗
PubMed1987

Effect of an adolescent medicine rotation on pelvic examination skills of paediatric residents.

This study evaluated the effects of an adolescent medicine rotation on paediatric residents' pelvic examination skills. Measurements were: self-evaluations pre- and post-rotation; nurse's evaluations of pelvic examination performance during the first and last week of the rotation; and patients' evaluations. The self-evaluation was also given at the start and at the end of the year to residents not taking the rotation. Twenty-four third-year residents were evaluated during the year. Eighteen subjects taking the rotation showed significant improvement post-rotation in the areas of competence, comfort, evaluation of training and importance to career, while the six residents not taking the rotation showed no change. The nurse's evaluation of the pelvic examination showed increases in comfort level, skill, awareness of adolescents' feelings, and ability to explain and reassure. Patient ratings were high at the beginning of the rotation and showed no significant change post-rotation. An adolescent medicine rotation significantly improved pelvic examination skills as assessed by self-ratings and a nurse's evaluation. A rotation in adolescent medicine can play a crucial role in developing gynaecological skills in paediatric residents.

Adolescent Medicine↗
PubMed1987

Vaginal Chlamydia trachomatis prevalence in sexually abused prepurbertal girls.

The prevalence rate of Chlamydia trachomatis in the vagina of prepubertal sexually abused children was examined. Additionally, the culture technique was compared to direct immunofluorescence assay (DFA) for diagnosing chlamydial infections in the vaginas of prepubertal children. The study group included 50 consecutive prepubertal girls examined for sexual abuse in an urban pediatric hospital's emergency room. Vaginal swabs were obtained for culture and direct immunofluorescence assays of C trachomatis and for gonorrhea culture. Of these, 8/47 (17%) of the Chlamydia cultures, 4/43 (9.3%) of the direct immunofluorescence assay specimens, and 0/49 gonorrhea cultures were positive for Chlamydia. All patients with positive findings by direct immunofluorescence assay also had positive chlamydial cultures. Of the four other patients with positive cultures for Chlamydia, two had negative findings by direct immunofluorescence assay and two had inconclusive results reported. Twenty-nine patients had a syphilis serologic study performed, and all had negative results. There was no significant difference between the Chlamydia-positive and -negative groups with regards to age, race, nature of the abuse, frequency of abuse, and symptoms or findings on physical examination. Although not statistically significant, children with cultures positive for C trachomatis reported rectal penetration five times and vaginal penetration twice as often as those children with C trachomatis-negative results. This study demonstrates a significant prevalence of vaginal chlamydial infections in sexually abused children. Vaginal cultures for C trachomatis should be included in the medical evaluation of sexually abused girls. The culture technique was superior to the direct immunofluorescence assay in this group of patients.

Bacteriological Techniques↗
PubMed1986

Pediatrician's self-evaluation of adolescent health care training, skills, and interest.

The 1978 Task Force Report on pediatric education encouraged increased participation by pediatricians in the health care of adolescents. A survey of pediatricians in the Los Angeles County area was conducted to assess the pediatrician's self-evaluation regarding the medical and psychosocial problems of the adolescent, the problems of the sexually active teenager, and the pelvic examination. A questionnaire was used to assess competence, level of comfort, ability to counsel, prior training, and the importance and relevance of these areas to pediatricians' practice. Areas of least and greatest competence were examined. Our results support the conclusion of the 1978 Task Force Report on pediatric education that there is inadequate training in adolescent health care issues. This appears to be especially true for issues relating to the sexually active teen and the pelvic examination.

Adolescent↗
PubMed1986

Weight gain in adolescent and young adult oral contraceptive users.

This study analyzed weight gain as a side effect of oral contraceptive use in teens and young adults. A retrospective chart review from 1978 to 1983 was conducted at two family planning clinics. Weight gain over 12 months was compared between females starting oral contraceptive pills and a control group using an IUD or a barrier method. One-hundred thirty-eight charts were included in the oral contraceptive group and 35 in the control group. There was no significant difference between the oral contraceptive group and control group in initial weight and weight after one year of use. Distribution of weight was also similar. There were no significant blood pressure changes. In the oral contraceptive group only five (3.7%) users listed weight gain as a side effect. The results suggest that for many young women who use oral contraceptive pills there is no greater risk of weight gain than for other sexually active young females.

Adolescent↗