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PubMed1986

Services and educational approaches to adolescent pregnancy.

A historical review of adolescent pregnancy might be helpful if it could be studied for a particular country or in our own country for a particular state or city. Early information would for the most part be unreliable and where available, highly prejudicial. By providing contraceptives, family planning, counseling and abortion it was believed that teenage pregnancy could be prevented. It cannot be said that these techniques have failed. Maturing and self-discipline, however, are required to use the services properly that have been provided. Yet, neither maturity nor self-discipline is a major component of the adolescent life style. As more knowledge and understanding of adolescent pregnancy has become available, it has become apparent that this information has to be integrated into a comprehensive health care program. The Bronx Committee for the Community's Health, an incorporated group of eleven community health centers, is a unique model in the formation of a comprehensive, coordinated and accessible health care delivery system. A sixteen-week curriculum for 10-13 year olds, the Very Important Person (V.I.P.) program, teaches youngsters about developmental changes during puberty, and about reproductive physiology. There is an effort to promote health education for parents and children and to involve the parents in as many activities as possible in the schools, and in the community. There must be continued education for the nation's black leaders to enable them to relate specifically to the expressed needs and desires of black teens and their families. Continued efforts must be expended for political and legislative support to follow through on these initiatives until results can be evaluated and normal, healthy development of black teenagers can be assured.

Adolescent↗
PubMed1991

[Methods for the evaluation of a health intervention in developing countries: the case in the Arsi region, Ethiopia].

Since 1989 an evaluation study of the impact of a Primary Health Care (PHC) program is being carried out in Arsi region, Ethiopia. The principal aim of the study is to estimate the mortality rates in those villages mainly involved in PHC activities. A sample of 80 villages will be recruited to allow significant differences in mortality of 20 per thousand between less treated and best treated villages. Considering the absence of routine demographic data, a population census and demographic surveillance of the recruited villages have been carried out. All the activities related to the study are considered together with the principal logistic and methodologic problems.

Adult↗
PubMedDate not supplied

Why did maternal mortality decline in Matlab?

In 1991, an article on the Maternity Care Program in Matlab, Bangladesh, reported a substantial decline in direct obstetric deaths in the intervention area, but not in the control area. The decline was attributed primarily to the posting of midwives at the village level. In this article, data are presented from the same period and area on a variety of intermediate events. They indicate that the decline in deaths was probably due to the combined efforts of community midwives and the physicians at the Matlab maternity clinic. Their ability to refer patients to higher levels of care was important. The data further indicate that the decline in deaths depended upon the functioning of the government hospital in Chandpur, where cesarean sections and blood transfusions were available. Midwives might also have made a special contribution by providing early termination of pregnancy, which is legal in Bangladesh.

Abortion, Induced↗
PubMed1996

Contraceptive methods: do Hispanic adolescents and their family planning care providers think about contraceptive methods the same way?

This article describes how a family planning clinic-based program to prevent repeat pregnancy among Hispanic adolescents in Los Angeles used qualitative research to understand client contraceptive behavior. Background information on Hispanic adolescent reproductive patterns and an overview of paths to motherhood among teen clients are provided to contextualize the results. Participants sorted contraceptive methods on perceived similarities and ranked them on effectiveness, safety, and use-preference. Multidimensional scaling was used to identify and compare conceptual models. Both providers and teens grouped methods by effectiveness and mode of action, but acceptability and ease of method use were also important for teens. Providers found participation a worthwhile educational experience that facilitated self-reflection about their own biases and better understanding of their clients' needs. This method could be applied in many clinical settings where education and counseling are important in treatment and where patients and providers are likely to have different conceptual models regarding therapy.

Adolescent↗
PubMed1997

Prospects for the direct electron crystallographic determination of zeolite structures.

Recently two successful zeolite structures based on experimental electron crystallographic data have been published. Diffraction and image data based on the silicate portion of the zeolite, mordenite, which are perturbed by dynamical (as well as secondary) scattering, have been simulated by a multiple-beam dynamical scattering program. Structure analyses with these data show that the above claims are not unreasonable, given a high enough accelerating voltage for the electron beam. If, for example, 2.9 A resolution micrographs are taken from a 120 A thick crystal in a 200 or 400 kV electron microscope, the crystallographic phases found by image analysis (Fourier filtration) are accurate enough to be extended by the Sayre equation to the (atomic) resolution limit of the electron diffraction pattern (for example from a 105 A thick crystal illuminated by a 1,200 kV electron source). The resultant potential map can be interpreted to find most of the atomic positions and the remaining ones will appear during the progress of a Fourier refinement.

Aluminum Silicates↗
PubMed1996

Topology prediction for helical transmembrane proteins at 86% accuracy.

Previously, we introduced a neural network system predicting locations of transmembrane helices (HTMs) based on evolutionary profiles (PHDhtm, Rost B, Casadio R, Fariselli P, Sander C, 1995, Protein Sci 4:521-533). Here, we describe an improvement and an extension of that system. The improvement is achieved by a dynamic programming-like algorithm that optimizes helices compatible with the neural network output. The extension is the prediction of topology (orientation of first loop region with respect to membrane) by applying to the refined prediction the observation that positively charged residues are more abundant in extra-cytoplasmic regions. Furthermore, we introduce a method to reduce the number of false positives, i.e., proteins falsely predicted with membrane helices. The evaluation of prediction accuracy is based on a cross-validation and a double-blind test set (in total 131 proteins). The final method appears to be more accurate than other methods published: (1) For almost 89% (+/-3%) of the test proteins, all HTMs are predicted correctly. (2) For more than 86% (+/-3%) of the proteins, topology is predicted correctly. (3) We define reliability indices that correlate with prediction accuracy: for one half of the proteins, segment accuracy raises to 98%; and for two-thirds, accuracy of topology prediction is 95%. (4) The rate of proteins for which HTMs are predicted falsely is below 2% (+/-1%). Finally, the method is applied to 1,616 sequences of Haemophilus influenzae. We predict 19% of the genome sequences to contain one or more HTMs. This appears to be lower than what we predicted previously for the yeast VIII chromosome (about 25%).

Algorithms↗
PubMed1977

A psychological theory of child abuse.

This paper presents a detailed study of two patients hospitalized in a closed psychiatric unit on which the treatment program emphasized dynamically oriented individual psychotherapy and family therapy. The first patient was hospitalized following physical abuse of her four-year-old daughter, while the second was hospitalized for a postpartum depression eight weeks following the birth of her first child, a girl. Although the presenting pictures in these two patients were markedly different, the psychodynamic patterns were so similar that a detailed comparison of the two cases seems to offer useful insight into some of the psychological causes of child abuse.

Adult↗
PubMed1986

Targeting the adolescent male.

The National Urban League regards too early parenting among adolescents as an issue requiring high level, active attention from all segments of the Black community. Poverty, single parent households and adolescent pregnancies are not exclusively female problems. The role that males play has been missing from too many studies of these phenomena. In light of the fact that most sexual activity is male initiated, and most sexual behavior is male influenced, it becomes clear that there will be no resolution of the problem of teenage pregnancy without directing greater attention to the male. The issue of male responsibility is skirted too often due to parental pride on the part of mothers and fathers when their male children seek sexual relations with female partners. It is viewed as a sign that they are developing sexually within the norm. This is especially true, in many instances, in female headed households where the mother is concerned that she may not be providing her son with an adequate male role model. Sexual activity by female adolescents, however, is generally not condoned. This confusing double standard is further compounded by the disjointed fashion in which American society responds to adolescent sexuality on the whole. Although the home should be the focal point, many parents reluctantly admit an inability to communicate effectively about sex with their pre-adolescent children. Thus, the school, church, community and social agencies have all been enlisted in this task. The National Urban League's initiative in this area is expected to have significant impact on the course of adolescent sexuality and reproductive responsibility.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Adolescent pregnancy: networking and the interdisciplinary approach.

The networking approach to providing needed services to pregnant and parenting teenagers has numerous merits. An historical overview of the formation of the Brooklyn Teen Pregnancy Network highlights service agency need for information and resource sharing, and improved client referral systems as key factors in the genesis of the Network. The borough-wide approach and its spread as an agency model throughout New York City's other boroughs and several other northeastern cities is also attributed to its positive client impact, including: improved family communication and cooperation; early prenatal care with its concomitant improved pregnancy outcomes; financial support for teens; continued teen education; and parenting skills development. Resource information is provided regarding networks operating in the Greater New York metropolitan area. A planned Eastern Regional network initiative is under development.

Adolescent↗
PubMedDate not supplied

Socio-biological factors in underfive deaths in a rural area.

In 1985-86, 286 underfive deaths occurred among a population of 30,000 in a rural area of Haryana. Two hundred and eighty one were analysed for socio-biological factors related to under five mortality. Females had a higher mortality. About 2/3 of the deaths were in infants, and 90% in first 3 years. Most of the deaths (94%) occurred in the village itself, 58.4% did not seek any medical care during the terminal illness, 80-90% did not receive even a single dose of BCG, DPT or O.P.V., and 36.7% died in the first attack of illness. Though 68% had at least one episode earlier, 31.0% had been admitted in hospitals for an earlier episode of illness. In 42.8% of deaths, the birth order was IV or above. Deaths in socially and economically disadvantaged cases constituted 77.6%. The triad of diarrhea, ARI and malnutrition claimed 56% deaths. In 93% of the deaths, the mothers were illiterate and 96.4% were house wives. There was a sibling death earlier in the family in 78.3%, and 60.1% deaths were of those living in poor housing conditions. About 50% had radio for communication, 85.8% had bicycle for conveyance, and in 66.9% the family had piped water supply. All these findings have been discussed in the study.

Age Factors↗
PubMed1990

Effects of exercise testing, training and beta blockade on serum potassium in normal subjects.

To evaluate the effects of exercise testing, training and beta blockade on serum potassium, 40 normal subjects (24 men, 16 women, mean age 33 years) had 4 maximal exercise tests with venipuncture for serum potassium before and less than or equal to 40 seconds after each test. After initial exercise testing, they were randomized to atenolol 50 mg daily, atenolol 100 mg daily, propranolol 80 mg twice daily or placebo. All began a 9-week dynamic exercise program for 8 weeks followed by a 1-week drug-free washout period. Tests were done after weeks 1, 8 and 9. A significant mean increase (p less than 0.05) in serum potassium occurred with maximal exercise in the atenolol 50 mg and propranolol groups after 1 week of treatment (mean +/- standard deviation, 4.78 +/- 0.29 to 5.09 +/- 0.43 mEq/liter and 4.81 +/- 0.55 to 5.30 +/- 0.33 mEq/liter). By week 8 after training, all beta blockade groups showed an increase in postmaximal exercise test serum potassium (atenolol 50 mg, 4.78 +/- 0.29 to 5.11 +/- 0.26 mEq/liter; atenolol 100 mg, 4.95 +/- 0.41 to 5.16 +/- 0.36 mEq/liter; propranolol, 4.81 +/- 0.55 to 5.05 +/- 0.29 mEq/liter). After washout, only the placebo group showed an increase in postmaximal test serum potassium (4.99 +/- 0.46 to 5.35 +/- 0.27 mEq/liter). Data indicate that hyperkalemia with maximal exercise testing increases after training with atenolol and propranolol compared to placebo and that this effect resolves once treatment is discontinued.

Adult↗
PubMed1990

A model for the prospective analysis of perinatal deaths in a perinatal network.

This prospective study assesses factors that contribute to perinatal mortality. The study population includes the 1362 perinatal deaths that occurred among 85,402 live births between 1983 and 1987 at hospitals of the University of Chicago Perinatal Network. After peer review of demographic, clinical, and pathologic data, each perinatal death was classified in one of the following categories: (1) the result of congenital malformation incompatible with life, (2) unavoidable, (3) potentially avoidable by patient, by health provider, or by both, or (4) of undetermined responsibility. Of 1362 deaths, 12.3% involved congenital malformations incompatible with life, 56.9% were classified as unavoidable, 28.1% were judged potentially avoidable, and 2.7% due to undetermined causes. Of potentially avoidable deaths, 36% were due to patient factors (primarily noncompliance), 59% to health provider factors, and 15% to combined patient and provider factors. There was a significant reduction in the potentially avoidable cases during the study period. The maximum attainable reduction in perinatal mortality under optimal conditions is calculated. Intervention plans to achieve this goal are discussed.

Chicago↗
PubMed1986

The ability of women to recall their oral contraceptive histories.

Self-reported contraceptive histories were obtained at interview from 99 women and compared with prospectively collected data from the Oxford-Family Planning Association cohort study. The effect of different memory aids was evaluated and an assessment was made of the completeness and accuracy of contraceptive histories recorded in general practice notes. Accuracy of recall of total duration of use was sufficiently good to establish the presence or otherwise of a duration-response relationship and could be improved by the use of a contraceptive calendar. Recall of specific brands used was less accurate. In studies where accurate information on use of particular preparations is required, the use of a photo album is recommended, supplemented by data obtained from general practice records to improve the accuracy of dates. General practice records on their own are not sufficiently complete to be used as a sole source of exposure data in studies in which it is important to obtain a complete oral contraceptive history.

Adult↗
PubMed1992

Agreement between oral contraceptive users and prescribers: implications for case-control studies.

Case-control studies examining the effects of oral contraceptives (OC) are prone to misclassification bias due to errors in assessment of OC use. Concern about inaccurate exposure histories has increased since current studies require women to recall OC use over prolonged periods of time. In preparation for a case-control study of breast cancer and OC use, an investigation was carried out to assess agreement between women's lifetime histories of OC use (covering a period of up to 20 years) and prescribers' records. OC histories were obtained during personal interview with 218 women who had used OC at some point in their lives (127 breast cancer patients, 91 controls). Recall was aided by an album with color photographs of all OC marketed in the Netherlands from 1962 onwards (n = 65), and a calendar that covered the women's life span from date of birth to menopause. The participants were asked for the names of all physicians who prescribed OC for them. The rate of response from the prescribers was high (94%), but only half of the forms provided useful information. Patient-prescriber agreement on brand names (including dosage) was 70%. About half of the women agreed with their prescribers on starting dates to within less than a year's difference. Approximately the same percentage of agreement was found for stopping dates. Multiple linear regression indicated that agreement on brand names and dates of usage was lower for women of low socioeconomic status, for healthy women (as compared to breast cancer patients) and for periods of pill use that had to be recalled from the more distant past. Agreement on total duration of use was high enough to permit testing of a moderately strong duration-response relationship in a case-control study.

Adult↗