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Biomedical subjects

N Haley

Publications and source records attributed to N Haley.

At least 19 recordsLinked to original sources
PubMed2004

Characteristics of adolescent street youth with a history of pregnancy.

UNLABELLED: This study examines characteristics of adolescent street youth with histories of pregnancy and documents important factors that merit consideration when providing global sexual health care. STUDY OBJECTIVE: To determine social and behavioral factors associated with a history of pregnancy among adolescent street youth. DESIGN, SETTING, PARTICIPANTS: In a prospective cohort study, female adolescent street youth (14-19 years) ever pregnant (AEP) were compared with adolescents never pregnant (ANP) using data from baseline questionnaires. RESULTS: Among the 225 participants, 41.8% were ever pregnant. Both groups were similar with respect to age (mean 17.8 years) and other socio-economic characteristics. However, AEP were more likely to have been kicked out of home (62.8% vs. 47.3%, P=0.022) and to have run away (78.7% vs. 64.9%, P=0.025) and were homeless younger (mean age: 13.9 vs. 14.7 years, P=0.011) and since a longer period (mean: 4.0 vs. 3.0 years, P=0.001). Both groups had problematic alcohol and drug use: 31.3% had a CAGE score >2; 72.2% had a DAST score >6. Almost half (44.0%) had ever injected drugs and AEP were younger at initiation into drug injection (15.2 years vs. 16.0 years, P=0.049). More AEP had experienced intra-familial or extra-familial sexual abuse (71.3% vs. 56.5%, P=0.024), and had had more than one abuser (71.6% vs. 50.0%, P=0.009). Among those abused by family members, abuse occurred at an earlier age for AEP (mean age: 7.4 vs. 8.9 years, P=0.090) and more AEP reported severe abuse: vaginal penetration (62.2% vs. 26.7%, P=0.004) and anal penetration (29.7% vs. 3.3%, P=0.005). CONCLUSIONS: Histories of severe sexual abuse and early injection drug use are extremely frequent in ever pregnant street adolescents. These factors need to be addressed when planning global health care and sexual health education.

Adolescent↗
PubMed2004

HIV risk profile of male street youth involved in survival sex.

OBJECTIVES: To compare HIV risk factors of male street youth involved in survival sex with those of their never involved peers and to describe the sexual activities of the involved youths. METHODS: From 2001 to 2003, street youth aged 14-23 years were recruited from street youth agencies in Montreal, Canada. Information was collected on sociodemographic characteristics, substance use, and sexual behaviours. Involvement in survival sex was defined as having ever exchanged sex for money, gifts, drugs, shelter, or other needs. Logistic regression was used to identify HIV risk factors associated with involvement in survival sex. RESULTS: Among the 542 male participants recruited, 27.7% reported involvement in survival sex. HIV risk factors independently associated with such involvement were injection drug using partners (modulated by length of homelessness), unprotected oral sex with male partners, steroid injection, history of sexual abuse, and drug injection. Among involved youths, 32.0% had only female clients, 41.3% only male clients, and 26.7% had clients of both sexes. Unprotected sexual activities were common with clients. However, even more risks were taken with non-commercial sexual partners. CONCLUSIONS: Male street youth involved in survival sex are at higher risk for HIV than their non-involved peers not only because of their unprotected commercial sexual activities. They have multiple other HIV risks related to non-commercial sexual activities, drug injection, and sexual abuse. All these risks need to be addressed when providing sexual health interventions for this population.

Adolescent↗
PubMed2002

Risk behaviours and prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital infections among Montreal street youth.

We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital tract infections among 302 Montreal street youth (223 boys) and identified associated risk factors. Study participants, 14-25 years old (average 20.9 years), meeting specific criteria for homelessness, were recruited in street youth agencies. Participation included a structured interview and provision of a urine specimen. Among sexually active youth, (n = 300) 30.0% had more than five heterosexual partners and 13.0% had at least one homosexual partner (last year), 10.7% had received money in exchange for sex (last six months) and 47.0% reported sexual relations resulting in pregnancy (lifetime). Among all youths, 82.1% had used at least one type of illicit drug, and 30.1% injected drugs at least once (last six months). The prevalence of C. trachomatis infection was 6.6% (95% CI 4.1-10.0%). Prevalence did not vary significantly by sex, age or any other variable, except history of pregnancy (10.4% among youth with history of pregnancy vs 3.6% among others, P = 0.02). No cases of N. gonorrhoeae infection were found.

Adolescent↗
PubMed2001

Risk factors for hepatitis C virus infection among street youths.

BACKGROUND: The relative contributions to risk of hepatitis C virus (HCV) infection resulting from unsafe sexual behaviours and exposures to blood (e.g., tattooing, body piercing and injection drug use) among youths at risk are not well known. We interviewed street youths about risk factors for HCV infection and documented their HCV antibody status. METHODS: From December 1995 to September 1996 we recruited 437 youths aged 14 to 25 years who met specific criteria for itinerancy. Data on sociodemographic characteristics and lifetime risk factors were obtained during a structured interview, and a venous blood sample was taken for HCV antibody testing. RESULTS: Many of the subjects reported behaviours that put them at risk for blood-borne diseases: 45.8% had injected drugs, 56.5% had at least 1 tattoo, and 78.3% had body piercing. The overall prevalence of HCV infection was 12.6% (95% confidence interval [CI] 9.7%-15.9%). In a multivariate logistic regression analysis, injecting drugs (adjusted odds ratio [OR] 28.4 [95% CI 6.6-121.4]), being over 18 years of age (adjusted OR 3.3 [95% CI 1.6-7.0]) and using crack cocaine (adjusted OR 2.3 [95% CI 1.0-5.3]) were independent risk factors for HCV infection. Having more than 1 tattoo (adjusted OR 1.8 [95% CI 0.95-3.6]) was marginally associated with HCV infection, and body piercing was not. INTERPRETATION: Drug injection was the factor most strongly associated with HCV infection among street youths. Given that injection drug users are the driving force of the HCV infection epidemic in Canada, increased intervention efforts to prevent initiation of drug injection are urgently needed to curb the epidemic.

Adolescent↗
PubMed2000

Prevalence of HIV infection and risk behaviours among Montreal street youth.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

Adolescent↗
PubMed2000

Lifestyle health risk assessment. Do recently trained family physicians do it better?

OBJECTIVE: To determine whether recently trained family physicians were more likely to routinely assess lifestyle health risks during general medical evaluations. To document physicians' perceptions of the difficulties of lifestyle risk assessment, of medical training in that area, and of how often they saw patients with lifestyle health risks. DESIGN: Anonymous mailed survey conducted in 1995. SETTING: Family practices in the province of Quebec. PARTICIPANTS: Stratified random sample of 805 active family physicians of 1111 surveyed; 25 were ineligible or could not be located, and 281 did not respond (74.1% response rate). MAIN OUTCOME MEASURES: Proportion of physicians graduating before and after 1989 who reported routinely (with 90% or more of their patients) assessing their adult and adolescent patients during general medical evaluations for substance use, sexual risk behaviours, and history of family violence and sexual abuse. RESULTS: Except for asking about drug use, recently trained family physicians did not report better assessment of lifestyle health risks during general medical examinations than family physicians who graduated more than 10 years ago did. In both groups, routine assessment averaged 82% for tobacco use, 68% for alcohol consumption, and 20% to 40% for sexual risk behaviours. Screening for family violence and sexual abuse was rare, but more frequently reported by older women physicians. Only 20% to 40% of recent graduates rated their medical training adequate for evaluating illicit drug use, family violence, and sexual abuse. CONCLUSION: Recently trained family physicians do not assess most lifestyle risk factors any better than their more experienced colleagues.

Adolescent↗
PubMed1999

Hepatitis B virus infection among street youths in Montreal.

BACKGROUND: Street youths are at high risk for many health problems, including sexually transmitted diseases and bloodborne infections. The authors conducted a cross-sectional anonymous study from December 1995 to September 1996 involving street youths in Montreal to estimate the prevalence of risk behaviours for hepatitis B virus (HBV) infection and of markers of past and present HBV infection. METHODS: Participants were 437 youths aged 14 to 25 meeting specific criteria for itinerancy who were recruited in collaboration with the 20 major street youth agencies in Montreal. Sociodemographic and lifetime risk factor data were obtained during a structured interview, and a blood sample was taken to test for HBV markers (hepatitis B surface antigen and antibodies to the hepatitis B core antigen). Univariate analyses and multivariate logistic regressions were conducted. RESULTS: The mean age of the subjects was 19.5 years; 69.3% (303/437) were males. Many subjects had high-risk behaviours: 45.8% (200/437) had injected drugs, 24.5% (107/436) had engaged in prostitution, and 8.7% (38/437) reported having a sexual partner with a history of unspecified hepatitis. The prevalence rate for one or both HBV markers was 9.2% (40/434) (95% confidence interval [CI] 6.7%-12.3%). Multivariate logistic regression analysis showed that being over 18 years of age (adjusted odds ratio [OR] 4.5, 95% CI 1.8-11.7), having injected drugs (adjusted OR 3.5, 95% CI 1.5-8.3) and having had a sexual partner who had unspecified hepatitis (adjusted OR 3.2, 95% CI 1.3-7.5) were all associated with HBV infection. INTERPRETATION: Street youths are at high risk for HBV infection. Early and complete HBV vaccination among this vulnerable population is urgently needed.

Adolescent↗
PubMed1999

Do physicians assess lifestyle health risks during general medical examinations? A survey of general practitioners and obstetrician-gynecologists in Quebec.

BACKGROUND: In Canada several guidelines have been published for the screening of lifestyle health risks during general medical examinations. The authors sought to examine the extent to which such screening practices have been integrated into medical practice, to measure physicians' perceived level of difficulty in assessing these risks and to document physicians' evaluation of their formal medical training in lifestyle risk assessment. METHODS: An anonymous mail survey was conducted in 1995 in Quebec with a stratified random sample of 1086 general practitioners (GPs) and with all 241 obstetrician-gynecologists (Ob-Gyns). The authors evaluated the proportion of physicians who reported routine assessment (with 90% or more of their patients) of substance use, family violence and sexual history during general medical examinations of adult and adolescent patients; the proportion of those who find inquiring about these issues difficult; and the proportion of those who evaluated their medical training in lifestyle risk assessment as adequate or excellent. RESULTS: The overall response rate was 72.6%. Among adult patients, 82.2% of the GPs reported routinely assessing tobacco use, 67.2% alcohol consumption, 34.2% illicit drug use and 3.2% family violence; the corresponding proportions for assessment among adolescent patients were 77.1%, 61.8%, 52.9% and 5.6%. Comparatively fewer Ob-Gyns reported routinely assessing these issues (56.1%, 28.6%, 20.4% and 1.3% respectively among adults and 62.7%, 35.2%, 26.8% and 2.8% respectively among adolescents). In the area of sexual history, condom use was routinely assessed by more Ob-Gyns than GPs (47.0% v. 28.2%); however, the proportion of Ob-Gyns and GPs was equally low for assessing number of partners (24.8% and 23.1%), sexual orientation (18.8% and 16.9%) and STD risk (26.2% and 21.2%). The vast majority of GPs and Ob-Gyns reported finding it difficult to assess family violence (86.5% and 93.0%) and sexual abuse (92.7% and 92.4% respectively). Over 80% of the physicians felt that they had had adequate or excellent medical training in assessing risk behaviours for heart disease and STD risk. The proportion who felt this way about their training in screening for illicit drug use, family violence and sexual abuse ranged between 12.7% and 31.6%. INTERPRETATION: Although morbidity and mortality associated with smoking, alcohol consumption, illicit drug use, unsafe sexual practices, family violence and sexual abuse have been well documented, routine screening for these risk factors during general medical examinations has yet to be integrated into medical practice.

Adolescent↗
PubMed1999

Sexual health risk assessment and counseling in primary care: how involved are general practitioners and obstetrician-gynecologists?

OBJECTIVES: This study examined physicians' evaluation of sexual health risks during a general medical examination and sexually transmitted disease (STD) counseling during consultations for adolescent contraception and treatment of an STD. METHODS: An anonymous mail survey was conducted in 1995 with a stratified random sample of 1086 general practitioners and all 241 obstetrician-gynecologists practicing in Quebec, Canada. RESULTS: Fewer than half of the respondents reported routinely inquiring about condom use and number of sexual partners during a general medical examination. Female general practitioners engaged in more sexual health risk assessment and counseling than male general practitioners. CONCLUSIONS: This study suggests a low level of involvement in STD prevention by generalists and obstetrician-gynecologists.

Adolescent↗
PubMed1997

Pattern of child sexual abuse by young aggressors.

OBJECTIVE: The aim of the study was to determine whether sexual victimization of children by young aggressors differs from adult aggressors. METHOD: A case review was performed on medical records of children less than 12 years of age referred in 1992 to the Child Protection Clinic at a tertiary care pediatric hospital. RESULTS: Medical evaluation for sexual abuse was carried out on 316 children, 79% girls, 21% boys, mean age 6 +/- 2.7 years. Among known perpetrators, 39 were less than 16 years and 15 were between 16 and 19 years old. Young aggressors were more likely to abuse older female victims (p = .0009). They also were reported to engage in more genital/genital and genital/anal acts (p < .001). The aggressor's young age was found to be an important determinant related to a history of penetrative forms of sexual abuse (OR = 4.015, 95% C.I. 2.0581; 7.8319). Genital examination was specific for abuse (Adam's Class IV or V) in only 6.3% of victims, but significantly more often when the perpetrator was between 16-19 years old (p = .003). CONCLUSIONS: Adolescent aggressors appear to engage in more genital/genital and genital/anal sexual abuse than older aggressors. Victims of aggressors age 16 to 19 had a higher risk of having specific findings on the anal/genital examination.

Adolescent↗
PubMed1997

Do women physicians do more STD prevention than men? Quebec study of recently trained family physicians.

OBJECTIVES: To examine differences attributable to sex of family physicians in their practices and in their perceptions of sexual history taking and safer sex counseling, and to ascertain whether sex of physicians influences counseling about condoms. DESIGN: Cross-sectional survey. SETTING: Quebec family practices. PARTICIPANTS: Recently graduated (1991) Quebec family physicians: 54 men and 92 women. MAIN OUTCOME MEASURES: Frequency and content of sexual history, frequency of safer sex counseling, perceived level of comfort in taking a sexual history, perceived adequacy of medical training to take sexual histories, perceived difficulty with sexual history taking according to patients' characteristics, and perceived effectiveness of safer sex counseling. RESULTS: Response rate was 80% of 183 physicians contacted. There were few differences attributable to sex of physician in family physicians' practices and perceptions regarding sexual history taking. Men's perceptions regarding the difficulty of sexual history taking did not vary according to patient's sex, but most women reported more difficulty with male patients. Male physicians reported more difficulty with teenagers; female physicians experienced more difficulty questioning adults. More than 85% of male and female physicians reported recommending condom use to a patient in their practice at least weekly. Women physicians seemed to do more condom-related counseling than their male colleagues, even after controlling for other variables. Salaried practice in a local community health centre did not influence condom-related counseling. CONCLUSIONS: Women family physicians are more inclined than men to counsel patients about condom use. Increasing numbers of women in family practice could have a beneficial effect on prevention of STDs and undesired pregnancies.

Adolescent↗
PubMed1995

STD risk assessment and risk-reduction counseling by recently trained family physicians.

PURPOSE: To survey recently trained family physicians about their practices and perceptions regarding sexual history taking, drug-use history taking, and safe-sex counseling. METHOD: The study was conducted with all 1991 graduates from the four family practice residency programs in Quebec, Canada. Data were collected in 1992 by using a mailed questionnaire. RESULTS: A total of 148 (80%) of the 186 contacted physicians responded. The physicians reported taking a sexual history less frequently than a drug-use history when seeing patients for a general medical examination (42% versus 71%) or a first pregnancy visit (75% versus 91%). When taken, the sexual history was often too superficial to detect risk behaviors. Consequently, safe-sex counseling was infrequent. Over 20% of the physicians worried about patients' discomfort, were uneasy discussing sexual matters, and did not feel properly trained in sexual history taking. Graduates from the family practice residency at the school that offered training in human sexuality performed better sexual history taking than did graduates from the residencies at the other schools. CONCLUSIONS: Although infections from sexually transmitted diseases and the human immunodeficiency virus are important causes of morbidity and mortality, family physicians are still not actively involved in their prevention. The study suggests that medical education might be deficient in this area and that more training in human sexuality should be provided for family physicians.

Attitude of Health Personnel↗
PubMed1993

Parental and patient perceptions about encopresis and its treatment.

Treatment of encopresis in childhood is often a long and trying process. Children followed for secondary encopresis in a multidisciplinary clinic between 1984 and 1989 were sent a parent/child mail questionnaire seeking information on their understanding of encopresis as well as their opinions on current treatment modalities. Twenty-eight families responded (20 boys and 8 girls), the child's mean age was 9.8 years, and the mean time elapsed after diagnosis was 3.5 years. Parents and children reported that intestinal dysfunction (53%) and painful defecation (46%) were the most important causes of their encopresis. Treatment modalities including enemas were well accepted by both parents and children, with parents considering dietary changes the most useful treatment modality (p < .01). Children reported that regular "toilet routine" was the most helpful in reestablishing continence. Despite good comprehension of the problem and acceptance of the treatment modalities, the complete recovery rate after 3.5 years was only 35.7%, with no differences noted between responders and nonresponders. Encopresis is a chronic condition that persists in a significant proportion of patients, despite adequate patient and parental knowledge and patient acceptance of treatment.

Attitude to Health↗
PubMed1991

A new generation of oral hypoglycemics. Their use, measurement, and effects on insurance risk assessment.

The increased use of oral hypoglycemics among the more than 14 million diabetics in the United States and the development of new pharmaceutical formulations requires the continued surveillance of their use in the insurance applicant population. Routine monitoring of urine glucose or even blood glucose or fructosamine measurements often fail to detect the diabetic using oral hypoglycemics. Urine analysis for the use of first generation sulfonylureas has shown a declining prevalence of their use due to the increased number of prescriptions written for newer and more effective drugs. In order to monitor the use of these second-generation oral hypoglycemics, an immunoassay was developed to detect the use of glyburide, 1-[4-[2-(5 chloro-2-methoxybenzamido) ethyl]-phenyl] sulfonyl]-3-cyclohexylurea. After testing in a defined population of known users of this class of sulfonylureas, the assay was applied to a random population of 12,000 applicants applying for life insurance. Results demonstrate the predictive value of this assay in determining the prevalence of use of this drug in the insurance-buying population and its assistance in risk assessment.

Diabetes Mellitus↗
PubMed1986

Contribution of passive smoking to respiratory cancer.

This article reviews data from experimental and epidemiologic studies on passive smoking and makes 12 recommendations for further study. The physicochemical nature of passive smoke, the smoke inhaled by nonsmokers, differs significantly from the mainstream smoke inhaled by the active smoker. At present, measurement of urinary cotinine appears to be the best method of assessing exposures to passive smoking. Data indicate that the greater number of lung cancers in nonsmoking women is probably related to environmental tobacco smoke. Exposures in utero and very early in life to passive smoking may be important in relationship to the subsequent development of cancer and need further consideration. The short-term effects of environmental tobacco smoke on the cardiovascular system, especially among high-risk individuals, may be of greater concern than that of cancer and requires further study. Further study of increased risks of lung cancers in relation to environmental tobacco smoke exposure requires larger collaborative studies to identify lung cancer cases among nonsmokers, better delineation of pathology, and more careful selection of controls. In addition, studies of epithelial cells or specific cytology should be undertaken to determine evidence of cellular changes in relation to environmental tobacco smoke exposure. Animal inhalation studies with passive smoke should be initiated with respect to transplacental carcinogenesis, the relationship of sidestream smoke exposure with lung cancer, the induction of tumors in the respiratory tract and other organs, and the differences in the physicochemical natures of sidestream and mainstream smoke.

Air Pollutants↗
PubMed1984

Diet and follicular development.

In Caucasian women, the length of the menstrual cycle is 28 days with a SD of 3.9 days. Many factors including diet modify menstrual periodicity. We have determined the effect of a meatless vegetarian diet in Caucasian women on the length of the menstrual cycle and the episodic and luteinizing releasing hormone-stimulated release of luteinizing hormone. The effect of a Western diet on the menstrual cycle in urban Black South African women was also studied. In Caucasian women, the vegetarian diet decreased (p less than or equal to 0.01) the pituitary response to luteinizing releasing hormone and decreased (p less than or equal to 0.05) the episodic release of luteinizing hormone. A Western diet increased (p less than or equal to 0.01) the duration of the follicular phase in Black South African women. Thus diet is a factor modifying the episodic release of gonadotrophins and follicular maturation.

Adult↗