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Biomedical subjects

S G Millstein

Publications and source records attributed to S G Millstein.

51 records · Page 3Linked to original sources
PubMed1988

Traumatic partial foot amputations in adults. A long-term review.

A retrospective study of 260 industrial amputees was undertaken to determine the long-term functional results of partial foot amputations following trauma. Follow-up ranged from 1 to 68 years with a mean of 16 years. Of 113 partial foot amputees (118 amputations) who had retained their original amputation, the functional end-results were 43% good, 38% fair and 19% poor. Lisfranc and Chopart amputations were better than those at transmetatarsal or digital levels. Of 260 initial amputations 49 (19%) were revised to a Syme's or a below-knee amputation.

Adolescent↗
PubMed1987

The use and limitations of endocervical Gram stains and mucopurulent cervicitis as predictors for Chlamydia trachomatis in female adolescents.

We evaluated the presence of polymorphonuclear cells on endocervical Gram stains and clinical indices of cervicitis as predictors of Chlamydia trachomatis infection in 193 sexually active female adolescents; 148 (77%) subjects had no complaints. C. trachomatis was isolated from 34 (18%) subjects. The incidence of C. trachomatis differed by race: it was isolated from 30% of black subjects and 7% of nonblack subjects. Polymorphonuclear cells on Gram stains were found to be associated with the presence of C. trachomatis (chi 2 = 33.2, p less than 0.0001). The sensitivity, specificity, and positive predictive value for polymorphonuclear cells to predict the presence of C. trachomatis were 91% (31/34), 65% (103/159), and 36% (31/87), respectively. When examined by ethnicity, polymorphonuclear cells remained significantly associated with C. trachomatis for black subjects (chi 2 = 24.3, p less than 0.001) but not for nonblack subjects (chi 2 = 2.49, p less than 0.1). Mucopurulent discharge, friability, or erythema-edema of ectopy were not reliable indicators for C. trachomatis. Endocervical Gram stains alone are useful to identify populations at risk for C. trachomatis infection. Caution must be advised when interpreting data from different population groups because of the variability in C. trachomatis prevalence.

Adolescent↗
PubMed1987

Microflora of the urethra in adolescent boys: relationships to sexual activity and nongonococcal urethritis.

Urethral cultures were obtained from 90 adolescent youth, 16 of whom denied previous sexual activity. Among the sexually active boys was a group of 32 with clinically significant pyuria, consistent with the diagnosis of urethritis, on a first-part urinalysis (FPU) specimen. To relate differences in urethral microflora to sexual activity, 42 sexually active patients with a negative FPU were compared with the never sexually active group. The profile of anaerobic, but not aerobic, bacteria isolated from the urethra was related to the presence or absence of previous sexual activity. Mycoplasma species and Ureaplasma urealyticum were isolated from sexually active patients only, and may be markers of sexual activity in adolescent boys. Of the 32 patients with FPU evidence of urethritis, 22 (69%) had cultures positive for Chlamydia trachomatis, and an additional three (9%) had cultures positive for Neisseria gonorrhoeae. The findings in sexually active patients with a positive FPU were otherwise similar to those of sexually active patients without evidence of urethritis. C. trachomatis appears to be the most important agent of urethritis among adolescent boys with a positive FPU.

Adolescent↗
PubMed1987

Concepts of health and illness: different constructs or variations on a theme?

Although health and illness concepts are thought to be important mediators of health and illness behaviors, little work has been done examining health concepts, and no research has examined the two conceptual structures simultaneously. This study examined concepts of health and illness in 218 adolescents between the ages of 11 and 18 years. Results were consistent with the hypothesis that concepts of health and illness are not opposite ends of a single health dimension, but reflect different and overlapping constructs. The degree of overlap varied as a function of age, with health concepts showing less emphasis on "the absence of illness" with greater maturity. The results suggest that models of health behavior that focus on illness avoidance neglect many components of health salient to lay persons.

Adolescent↗
PubMed1987

The value of stump split skin grafting following amputation for trauma in adult upper and lower limb amputees.

One hundred and twenty adult patients were reviewed in whom split skin grafts were applied to the stump following traumatic amputation of the upper limb (44 amputees) or lower limb (76 amputees). The average follow-up period was seven and a half years after initial amputation. There was delay in prosthetic fitting in all patients. Approximately one third of patients complained of occasional minor ulceration, controlled by removing the prosthesis for a few days or modification of the prosthesis. Further revision surgery, including excision of the grafted skin often combined with proximal bone resection, but not removal of the proximal joint, was necessary in 29% of below-elbow amputees and approximately 50% of below and above-knee amputees. At the above-elbow level, use of skin grafts allowed prosthetic fitting because of preservation of sufficient length of the stump. Despite the fact that revision surgery may often be necessary, split skin grafting has a definite place in the early management of the stump following traumatic limb amputation in the adult. Preservation of stump length with the knee or elbow joint allows easier rehabilitation and lower energy expenditure when using the prosthesis. Partial foot amputation, when combined with skin grafting usually requires subsequent revision to a more proximal level to obtain a satisfactory result.

Amputation Stumps↗
PubMed1987

The value of revision surgery after initial amputation of an upper or lower limb.

The value of revision surgery when carried out more than six weeks after initial amputation of the upper or lower limb was assessed. When performed for stump and/or phantom limb pain alone, only 33/95 (35%) obtained satisfactory results after one revision; 25/95 (26%) of the patients required four or more surgical procedures without relief of pain. However, when carried out for local specific pathology, the results of surgical revision were 100% successful, even if the procedure had to be repeated once in 15% (28/189) of this group of patients. Transcutaneous nerve stimulation appeared to offer no long lasting relief of pain following amputation surgery.

Adult↗
PubMed1986

Prosthetic use in adult upper limb amputees: a comparison of the body powered and electrically powered prostheses.

Three hundred and fourteen adult upper limb amputees were reviewed retrospectively at the Ontario Workers' Compensation Board. A questionnaire was used to evaluate the use of body and electrically powered prostheses. Follow-up ranged from 1 to 49 years with a mean of 15 years. Results indicated that complete or useful acceptance of an electrically powered prosthesis was reported by 69 of 83 amputees (83%); 199 of 291 amputees (68%) used the cable operated hook, 57 of 291 (20%) used the cable operated hand and 40 of 83 (48%) used the cosmetic prosthesis. The majority of amputees used more than one prosthesis for their functional needs and should be fitted with more than one type of prosthesis. Acceptance of an upper limb prosthesis by 89% (196/220) of below-elbow, 76% (56/74) of above-elbow and 60% (12/20) of high level amputees indicates that for most upper limb amputees, their prostheses are well used and essential to their personal and employment activities.

Activities of Daily Living↗
PubMed1984

Sources of anxiety about pelvic examinations among adolescent females.

Sources of anxiety about pelvic examinations were examined in 84 female adolescents seen in an adolescent clinic. The most common concerns about the examination were: fear of the discovery of pathology; fear of pain; and embarrassment about undressing and about personal cleanliness. Adolescent concerns were highly associated with their level of anxiety prior to, during, and following the examination. The concern most highly associated with anxiety was fear of pain. Fear that the pelvic examination might be painful may be the most important concern to alleviate in the adolescent patient. The most frequent source of information about the pelvic examination was peers, and the most common specific message from peers was that the examination was painful. Provider messages were more diffuse and rarely mentioned the physical sensations associated with the procedure, which may have less impact on the adolescent than the specific warnings of peers.

Adolescent↗
PubMed1983

Acceptability of computer-acquired sexual histories in adolescent girls.

We investigated the acceptability and reliability of sensitive data collected via computer in adolescent patients. Subjects were 108 adolescent girls (ages 14 to 20 years), randomly assigned to one of three groups: (1) interactive computer interview, (2) face-to-face interview, or (3) self-administered questionnaire. Subjects were queried about their general health and sexual behavior. Adolescents interviewed by computer were more likely than subjects in other groups to state that they enjoyed the survey (P less than 0.001). There were no differences in anxiety or the reporting of sexual behavior among subjects in the three groups. Adolescents who stated that they would prefer a computer interview (40%) said they would be more comfortable with the computer, and perceived the method as being fun, interesting, confidential, private, and easy. Computer interviews cannot replace the skills of a sensitive physician, but may be an acceptable and valid means of collecting information from adolescents under certain conditions.

Adolescent↗
PubMed1982

Emerging patterns of tampon use in the adolescent female: the impact of toxic shock syndrome.

From November 1980 through January 1981, we queried 714 post menarchal adolescents (ages 12 to 19) about menstrual product use at menarche (T1), during summer 1980 (T2), at last menstrual period (T3), and about intended product for next menstrual period (T4). The percentage of adolescents reporting use of tampons at each point in time were: T1, 3.1 per cent; T2, 24.1 per cent; T3 (following the media coverage of toxic shock syndrome [TSS]), 19.3 per cent; and T4, 19.5 per cent. Prior to TSS coverage there was a shift toward tampon use in 141 of the 672 subjects who used napkins (21 per cent) and no increase in napkin use. Following media coverage, shifts toward tampon use among napkin users decreased to 2.3 per cent while 32.9 per cent of the 168 summer tampon users (T2) shifted to the use of napkins; reasons for the shift were significantly associated with TSS (p less than .001). Ethnicity (White) was highly associated with reported tampon use. Following TSS coverage, adolescents in all ethnic groups decreased their tampon use at the same rate.

Adolescent↗
PubMed1982

Predictors of tampon use in adolescents after media coverage of toxic shock syndrome.

Adolescents who use tampons represent the population most susceptible to toxic shock syndrome. We surveyed 714 adolescents from two high schools and three hospital-based clinics to examine patterns of tampon use before and after media coverage on toxic shock syndrome. Predictors of behavior change in adolescent users of tampons were examined in the context of a theoretical model of preventive health behavior. Subjects were 168 adolescents, ages 13 to 19 (mean age, 15.19; mean gynecologic age, 3.4); 50% of the subjects were white; 19%, Asian; 16% black; 7%, Hispanic; and 6%, other. After extensive publicity on toxic shock syndrome, 33.9% of the subjects changed their habits of tampon use; 27.5% stopped using tampons and 6% decreased their use of tampons. Linear logistic regression analyses identified two factors that distinguished adolescents who decreased or stopped use of tampons after publicity on toxic shock syndrome from those who did not: greater likelihood of Rely tampon (Procter & Gamble) use before publicity (p = 0.014) and the belief that they were especially susceptible to toxic shock syndrome (p = 0.013).

Adolescent↗
PubMed1981

Appointment-keeping behavior in adolescents.

Adolescent appointment-keeping behavior was investigated prospectively in 245 first-scheduled appointments in a general youth clinic within a pediatric ambulatory setting, to determine if older adolescents were more compliant when they made their appointments and less compliant when their appointments were made by their parents. Among single variables (age, sex, and who made the appointment), rates of kept appointments varied considerably. The highest rates of compliance were found in males, under the age of 15, whose parents made the appointment. The lowest rates were found in females, over the age of 15, who made their own appointment. A multiple regression analysis was used to determine which of the variables was most important in predicting compliance. The most important factor was appointment source. Whether parents make the appointment for their sons and daughters (irrespective of age) was the most important predictor of compliance, emphasizing the importance of parental involvement in scheduling appointments.

Adolescent↗
PubMed1981

Conceptions of illness in young adolescents.

This study examined conceptions of illness in young adolescents. A group of 77 urban junior high school students aged 11 to 15 years were asked for their definitions of illness. Themes occurring in definitions of illness were identified and coded according to a previously developed coding scheme. Evidence in support of a developmental process underlying conceptions of illness was found by examining adolescents' definitions and comparing them with child and adult norms established in prior research. Results for adolescents showed the frequency of use of specific themes to fall between child and adult norms. The strongest evidence in support of a developmental trend was seen in definitions of illness pertaining to changes in daily activities. However, the relative frequency of adolescents' definitions was more like that of children than adults, indicating that whereas adolescents used a greater frequency of adult-like themes, they did so within a framework more descriptive of children. Qualitative aspects of definitions of illness showed age-linked differences with adolescents generating more adult-like, conceptually sophisticated definitions than children. In addition to developmental differences, similarities in definitions of illness were also found; among all age groups the most common delineators of illness were physical symptoms. Psychosocial themes were less frequently mentioned. Clinicians who discuss with their adolescent patients the ways in which illness affects social interaction may be communicating more effectively than practitioners who focus solely on signs and symptoms of physical disease.

Adolescent↗