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Biomedical subjects

R A Feinstein

Publications and source records attributed to R A Feinstein.

At least 19 recordsLinked to original sources
PubMed2001

Condom use by adolescents.

The use of condoms as part of the prevention of unintended pregnancies and sexually transmitted diseases (STDs) in adolescents is evaluated in this policy statement. Sexual activity and pregnancies decreased slightly among adolescents in the 1990s, reversing trends that were present in the 1970s and 1980s, while condom use among adolescents increased significantly. These trends likely reflect initial success of primary and secondary prevention messages aimed at adolescents. Rates of acquisition of STDs and human immunodeficiency virus (HIV) among adolescents remain unacceptably high, highlighting the need for continued prevention efforts and reflecting the fact that improved condom use can decrease, but never eliminate, the risk of acquisition of STDs and HIV as well as unintended pregnancies. While many condom education and availability programs have been shown to have modest effects on condom use, there is no evidence that these programs contribute to increased sexual activity among adolescents. These trends highlight the progress that has been made and the large amount that still needs to be accomplished.

Adolescent↗
PubMed2001

Care of the adolescent sexual assault victim.

Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.

Adolescent↗
PubMed1999

Adolescent pregnancy--current trends and issues: 1998 American Academy of Pediatrics Committee on Adolescence, 1998-1999.

Although the prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and society, many adolescents continue to become pregnant. Since the last statement on adolescent pregnancy was issued by the Academy in 1989, new observations have been recorded in the literature. The purpose of this new statement is to review current trends and issues on adolescent pregnancy to update practitioners on this topic.

Adolescent↗
PubMed1999

American Academy of Pediatrics. Committee on Adolescence. Contraception in adolescents.

The risks and negative consequences of adolescent sexual intercourse are of national concern, and promoting sexual abstinence is an important goal of the American Academy of Pediatrics. In previous publications, the American Academy of Pediatrics has addressed important issues of adolescent sexuality, pregnancy, sexually transmitted diseases, and contraception. The development of new contraceptive technologies mandates a revision of this policy statement, which provides the pediatrician with an updated review of adolescent sexuality and use of contraception by adolescents and presents current guidelines for counseling adolescents on sexual activity and contraceptive methods.

Adolescent↗
PubMed1998

Medical status of adolescents at time of admission to a juvenile detention center.

PURPOSE: To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility. METHODS: Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination. RESULTS: Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up. CONCLUSIONS: A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

Adolescent↗
PubMed1997

Procreative experiences and orientations toward paternity held by incarcerated adolescent males.

PURPOSE: To describe the procreative experiences and the attitudes related to paternity held by a sample of incarcerated adolescent males. METHODS: All adolescent males who were admitted to a long-term correctional facility between July 1994 and October 1994 were asked to participate in a confidential, face-to-face interview. RESULTS: One hundred twenty-five incarcerated adolescents agreed to participate in the study. Over one-quarter (25.6%) of the respondents reported having ever gotten a girl pregnant; 40.6% of fathers reported having caused more than one pregnancy. A majority of respondents believed that fathering a child would be desirable, that they would be capable of being a father to a child, and that they could be responsible for the baby and mother. Fathers were more likely than nonfathers and black respondents were more likely than white respondents to report that they, their parents, and their friends would be pleased were they to get girls pregnant. Black respondents were more likely than white respondents to believe that they could be a good father to a child. CONCLUSIONS: The general perceptions that fathering a child as a teenager is desirable and that they could be good fathers to their children will make the prevention of pregnancy and parenting difficult in this population. Incarcerated adolescents should be educated about parenting prevention using interventions that take into consideration their attitudes and perceptions of teenage parenting.

Adolescent↗
PubMed1996

Risk for gonococcal and chlamydial cervicitis in adolescent females: incidence and recurrence in a prospective cohort study.

PURPOSE: This study attempted to determine the incidence and risk for gonococcal and chlamydial cervicitis among sexually active urban adolescent females. METHODS: The study design is a prospective cohort study. A cohort of 216 sexually active females were followed with repeat sexually transmitted diseases screening for 12-24 months. Subjects positive on any retest (FU) were compared with those who remained negative on all FU. Subjects were interviewed for history and screened for endocervical gonococcal and chlamydial infection. RESULTS: The number of visits per patient ranged from 2 to 9 (median, 3). The initial Chlamydia trachomatis and Neisseria gonorrhoeae rates were 23.2 and 11.6%, respectively. The cumulative FU positive rates were 20.8% for C. trachomatis and 17.1% for N. gonorrhoeae. Although the initial gonococcal infection was a significant risk for a subsequent infection by C. trachomatis (p = .05) and N. gonorrhoeae (p = .001), the initial C. trachomatis status was not predictive of subsequent infections. The number of partners was not predictive of subsequent infections with either. In the entire study period, 86 patients had at least one episode of C. trachomatis and N. gonorrhoeae infection was confirmed in 52; 20 patients had recurrent cervicitis. During the study, 101 episodes of C. trachomatis and 68 episodes of N. gonorrhoeae infections were identified. Those with recurrent cervicitis (9.3%) were responsible for 33% of all cervicitis episodes identified during the study. CONCLUSIONS: Adolescents in our study were at high risk for cervicitis, particularly as a result of C. trachomatis. Risk for subsequent C. trachomatis cervicitis was the same among initially positive and negative groups. Our data underscore the importance of repeat screening for sexually transmitted infections and treatment of contacts of adolescent females.

Adolescent↗
PubMed1996

Screening adolescent athletes for exercise-induced asthma.

OBJECTIVE: To pilot test an exercise-induced asthma (EIA) screening program using a submaximal step-test and pulmonary function test (PFT) to identify athletes with EIA and to determine if a physical examination or self-reported history could be used to predict the existence of EIA. DESIGN: Screening and diagnostic testing using a convenience sample. SETTING: Birmingham, Alabama, during athletic preparticipation examination (PPE). SUBJECTS: Fifty-two African-American, male football players aged 14-18 years being evaluated for participation in scholastic athletics. No athlete refused participation. Four were excluded because of need for further evaluation unrelated to any pulmonary condition. INTERVENTION: Each athlete completed a medical history, allergy history, physical examination, preexercise pulmonary function test (PFT), submaximal step-test, and a series of postexercise PFTs. MAIN OUTCOME MEASURES: Major outcome measurements were changes in forced expiration volume in 1s (FEV1) or peak expiratory flow rate (PEFR) after completing an exercise challenge. RESULTS: Seventeen of 48 athletes had a > or = 15% decrease in PEFR after exercise. Nine of 48 athletes had a > or = 15% decrease in FEV1 after exercise. The only self-reported item that differentiated subjects with normal and abnormal PFTs was a personal history of asthma (p < 0.05). CONCLUSION: Many athletes can be identified as having abnormal PFTs by use of a submaximal step-test as an exercise challenge. Self-reporting questionnaires and PPEs do not appear to be sensitive enough to identify athletes with this condition. If validated by future studies, this protocol could be used for the diagnosis of EIA.

Adolescent↗
PubMed1991

Physical activity and fitness assessment.

Physical inactivity is a risk factor for the development of atherosclerosis. Members of a state chapter of the American Academy of Pediatrics were assessed about their practice behaviors and knowledge related to physical activity and fitness assessments. During health supervision evaluations 19% obtained a physical activity history and 7% measured a heart rate response to exercise. When assessing physical fitness 24% obtained an activity history which included kind, intensity, duration and frequency. 64% limited their physical fitness evaluation to an inspection of general appearance and weight, while 1% used a bicycle ergometer or treadmill, 4% used a step-test and 10% ran a child in place. Only 42% used the information to make recommendations about physical activity. 75% were not familiar with ACSM or AHA recommendations about exercise. Barriers cited to increasing physical activity and fitness assessments included lack of physician time, office space, staff time, and physician training. This survey demonstrates the need for increasing the awareness level of pediatricians about the role of exercise in preventing CHD and the need to incorporate such evaluations into their routine practice.

Alabama↗
PubMed1989

Chlamydia trachomatis cervical infection and oral contraceptive use among adolescent girls.

This study examines the relationship between oral contraceptive use and Chlamydia trachomatis cervical infection in women less than 19 years of age. The clinical and epidemiologic data of 73 (19.4% prevalence rate) girls with chlamydial infection were analyzed, with special attention given to contraceptive use. The findings were compared with data from 303 girls who were chlamydia negative to assess the relationship between oral contraceptive use and C. trachomatis infection. Use of an oral contraceptive for 6 months or longer was associated with chlamydial infection (p = 0.005; odds ratio = 2.41; 95% confidence interval 1.53-3.29). Oral contraceptive use was not associated with an increased rate of Neisseria gonorrhoeae or Trichomonas vaginalis infection. Association of oral contraceptive use with chlamydial infection remained significant after adjustments were made for confounding variables in a logistic regression process (p = 0.013). This study suggests that oral contraceptive use may promote chlamydial infection of the cervix or enhance the detection of the C. trachomatis from the cervix in this population.

Adolescent↗
PubMed1989

Oral trauma in adolescent athletes: a study of mouth protectors.

The purpose of this study was to determine the extent of mouth protector use, as well as the amount and type of oral trauma associated with and without mouth guard wear in adolescent athletes. Coaches' perceptions and regulations involving the use of mouth protectors also were examined. Interviews were collected from 2470 junior and senior high school football players with all oral trauma being documented, regardless of the sport during which the injury occurred. Nine per cent of all players suffered from some form of oral injury while another 3% reported a loss of consciousness. Seventy-five per cent of the injuries occurred while not wearing mouth guards, and of this total 40% occurred during baseball and basketball. Fifty-six per cent of all concussions were suffered while not wearing mouth guards. Despite the ability of mouth protectors to significantly help reduce oral injuries, trauma related to sports is more prevalent than previously reported. This study supports the recommendation of mandatory mouth guards in baseball and basketball.

Adolescent↗
PubMed1988

Sexually transmitted diseases and sexual behavior in urban adolescent females attending a family planning clinic.

Specimens from the lower genital tract of 102 sexually active urban adolescent females were tested for the common sexually transmitted diseases (STDs). The results were correlated with concomitant clinical, demographic, and historic data. Forty-one percent (42/102) were infected with one or more of the following organisms: Chlamydia trachomatis (26/102), Trichomonas vaginalis (13/102), Neisseria gonorrhoeae (10/102), yeast (6/102), condyloma (5/102), and herpes simplex virus (1/44). Mixed infections were found in 13%. Fifty-nine percent were negative for any infectious agents. The presence of genitourinary symptoms were of no value in predicting an STD. The rate of positive physical findings was significantly higher in the STD-positive group than in the negative group (p = 0.03), but 28% of the STD-negative group had positive physical findings, and 50% of the STD-positive group had normal physical findings. A history of genitourinary complaints or presence of physical findings was not predictive of a positive STD culture. Oral contraceptive use of more than six months appears to be a risk factor for an STD. No other factors, including the number of sexual partners, were significantly correlated with the presence of an STD. This study supports the need for routine screening of sexually active urban adolescent girls for an STD.

Adolescent↗
PubMed1988

The prevalence of smokeless tobacco use among adolescent male athletes.

In assessing the prevalence and perceptions of use of smokeless tobacco among adolescent male athletes, several findings have public health implications. Almost a third of the sample had tried smokeless tobacco and 8% were current users. Racial differences between blacks and whites were remarkable. Differences in income strata and urban/rural settings were not significant. Peer influence was the major factor that initiated smokeless tobacco use. Abnormal mucosal findings were much more prevalent in those who had dipped smokeless tobacco than in those who had not. Most significant was a prevalence of oral leukoplakia in 5.2% of those who had ever dipped, which was 50 times that of nondippers. Using smokeless tobacco for more than 2 years or using more than three tins per week seemed to be of possible predictive value regarding the incidence of oral leukoplakia. Fifteen percent of current users had observable leukoplakia. Components necessary for effective intervention/prevention programs were elucidated with an emphasis on an increased role by dentists and other health professionals.

Adolescent↗
PubMed1986

Chronic chest pain in children and adolescents.

Chest pain is a common symptom of older children and adolescents. The majority of the conditions causing it are benign and self-limiting. Almost all diagnoses can be made with a thorough history and physical examination. Most important, the patient and parents need to be assured that there is no heart defect and that there is no imminent danger of dying.

Adolescent↗
PubMed1985

The effects of acute viral hepatitis on theophylline clearance.

The effects of acute viral hepatitis on theophylline clearance and maintenance dose requirements in a 12-year-old boy are described. Significant alterations in theophylline dosage may be required during the acute and recovery phases of viral hepatitis.

Acute Disease↗