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Biomedical subjects

A C Hergenroeder

Publications and source records attributed to A C Hergenroeder.

At least 19 recordsLinked to original sources
PubMed2001

A survey of pediatric nephrologists on adolescent sexual health.

Chronic renal disease often has an adverse effect on adolescent physiologic and psychosocial development. The severity of the disease may necessitate that the pediatric nephrologist be the adolescent's main medical provider and the most available physician to screen for adolescent health risk behaviors. The purpose of this study was to determine pediatric nephrologists' practices of sexual history taking and diagnosis and treatment of sexually transmitted infections in their adolescent patients. A survey was performed on a convenience sample of 66 pediatric nephrologists attending an educational seminar on adolescent care at the 1997 national meeting of the American Society of Pediatric Nephrology. The outcome measures included physicians' reports of interviewing adolescents alone and screening for sexually transmitted infections. Fifty-six percent reported interviewing adolescents alone, 55% routinely ask female adolescents about sexual intercourse (53% ask males) and 10% routinely perform pelvic exams. Current practice in this selected sample of pediatric nephrologists, who by their attendance at the seminar may represent those most motivated to do screening, still leaves adolescents with chronic renal disease potentially at risk for sexually transmitted infections and pregnancy. Educational efforts should be directed at increasing routine confidential sexual history taking for adolescents with chronic renal disease.

Adolescent↗
PubMed2001

Development and evaluation of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee.

BACKGROUND: Pediatric residents need the knowledge and physical examination skills to evaluate common musculoskeletal injuries. The ankle and the knee are the 2 most common sites of musculoskeletal injury in young athletes. Methods for evaluating pediatric residents' knowledge and skills in examining the ankle and knee are needed. OBJECTIVES: 1) To describe the development of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee, and 2) to report the reliability of this method. METHODS: A written test and a Clinical Skills Assessment Examination (CSAE) with a rating index were developed by the investigators to evaluate pediatric residents' knowledge and skills in examining the ankle and knee. Fifty-eight pediatric residents completed the written test and examined the ankle and knee of one standardized patient at the beginning of a required 1-month adolescent medicine rotation. Forty-eight residents repeated the evaluation at the end of the month. The investigators rated the residents' performance of the CSAE and then assessed interrater reliability using Cronbach's alpha. Test-retest correlation was calculated to assess the reliability of the written test. RESULTS: Test-retest correlation for the written test was 0.72, establishing its reliability. Interrater reliability for rating the CSAE of the ankle and knee was 0.98 and 0.90, respectively. CONCLUSION: Pediatric residents' knowledge and skills in examining the ankle and knee can be reliably evaluated using the written test and CSAE described in this article. These could be used to assess the effectiveness of current curricula in improving pediatric residents' knowledge and skill in evaluating ankle and knee complaints and to assist in the design of future curricula. musculoskeletal, evaluation methods, resident curriculum.

Adolescent Medicine↗
PubMed2001

Pediatric residents' performance of ankle and knee examinations after an educational intervention.

BACKGROUND: Pediatric residents have the need for additional training in the care of common musculoskeletal injuries. OBJECTIVES: To implement and evaluate the effects of a teaching intervention on pediatric residents' knowledge and skills in performing the physical examination of the ankle and knee. STUDY DESIGN: Prospective, intervention, single-sample study design. METHODS: Pediatric residents (n = 58) on a 1-month adolescent medicine rotation received a teaching intervention after a baseline evaluation of their knowledge and skills. The teaching intervention was designed to improve their knowledge about and skills in performing physical examinations of the ankle and knee. The intervention included watching a videotape, followed by observation of the attending physician demonstrating the techniques on a standardized patient, followed by correct demonstration of the techniques by the resident. The residents' knowledge and skills were assessed at the end of the rotation and 9 months later. Knowledge was assessed using a written examination. Skills assessment was performed using a Clinical Skills Assessment Examination. RESULTS: At baseline, the residents performed 37% of the ankle and 18% of the knee physical examination techniques correctly. At 1 and 9 months, the residents' knowledge of ankle and knee examinations was greater than at baseline. The residents performed 77% of the techniques correctly at 1 month and 67% at 9 months. The residents performed 55% of the knee examination techniques correctly at 1 month and 47% at 9 months. The teaching intervention was rated highly by the residents. CONCLUSIONS: The residents' performance of ankle and knee examinations was suboptimal at baseline and improved significantly after the teaching intervention. Observed improvements persisted for a mean of 35 weeks. The teaching intervention described in this study could meet the need for improved ankle and knee examination skills, the 2 most common sites of skeletal injury in young athletes. The teaching model is novel in that it couples videotape and skills-based teaching methods with reliable evaluation methods. This model teaching method could be adapted for use in other pediatric residency training programs and other content areas. musculoskeletal, physical examination, resident curriculum.

Adolescent Medicine↗
PubMed1999

Serum concentrations of insulin, insulin-like growth factor-I and insulin-like growth factor binding proteins are different between white and African American girls.

OBJECTIVES: To determine whether serum insulin-like growth factor (IGF)-I and IGF binding protein (IGFBP) concentrations are different between African American and white girls. STUDY DESIGN: Serum glucose and hormone concentrations were measured in blood samples collected after a 12-hour fast from 79 white and 57 African American healthy girls between 9 and 17 years of age. Tanner stages of pubic hair development were evaluated by physical examination, and body composition by dual energy x-ray absorptiometry. RESULTS: The African American girls were older and sexually more mature and had higher fat mass, higher serum insulin and free IGF-I concentrations, higher serum free IGF-I to total IGF-I ratio, but lower serum IGFBP-1 concentrations than the white girls. After controlling for sexual maturation and fat mass, the serum concentrations of total IGF-I, bound IGF-I, and IGFBP-3 in the white girls became significantly higher than those in the African American girls. The higher concentrations of total IGF-I in the white girls were due to a proportional increase in the concentrations of bound IGF-I that coincided with a similar increase in serum IGFBP-3 concentrations. CONCLUSIONS: Higher serum insulin concentrations in the African American girls are associated with lower serum IGFBP-1 concentrations and increased bioavailability of free IGF-I, which may contribute to their accelerated growth compared with their white counterparts.

Absorptiometry, Photon↗
PubMed1999

Validity of self-assessment of pubertal maturation in African American and European American adolescents.

PURPOSE: To evaluate interobserver reliability of physician assessments of pubertal maturation and to evaluate the validity of self-assessment compared to physician assessments of pubertal maturation by girls in a multiethnic sample. METHODS: The study design is descriptive. A total of 107 8-17-year-old healthy volunteers from settings with large minority populations in the Houston metropolitan area were recruited for a study on adolescents' energy needs. The two outcome measures were interobserver reliability between two physicians' assessments of breast and pubic hair, and the self-assessment of breast and pubic hair maturation compared to physicians' assessments. RESULTS: The kappa coefficient for physician interobserver agreement for breast maturation was 0.5. The kappa coefficient for physician interobserver agreement for assessment of pubic hair was 0.79. The kappa coefficient for the validity of self-assessment of breast development was 0.34, and that for self-assessment of pubic hair was 0.37. CONCLUSION: Interobserver agreement for physician assessment of breast maturation was low and self-assessment of breast maturation was not reliable in this group of adolescent girls. However, whereas physician interobserver agreement for pubic hair was good, self-assessment of pubic hair maturation was not reliable in this group of adolescent girls.

Adolescent↗
PubMed1999

Pubertal African-American girls expend less energy at rest and during physical activity than Caucasian girls.

Between 1963 and 1991, the most dramatic increases in the prevalence of overweight in the United States have been reported in African-American girls. Lower basal energy expenditure and lack of physical activity are believed to be risk factors for excessive weight gain. We hypothesized that energy expenditure at rest and during physical activity are lower in pubertal African-American girls than in Caucasian girls. Basal metabolic rate and sleeping energy expenditure of 40 Caucasian and 41 African-American pubertal girls (matched for age, physical characteristics, body fat, and energy intake) were measured by whole-room calorimetry, energy expended for physical activity by the doubly labeled water method, sexual maturity by physical examination, body composition by dual-energy x-ray absorptiometry, physical fitness by treadmill testing, and energy intake by 3-day food record. After adjusting for soft lean tissue mass, the basal energy expenditure (1333 +/- 132 vs. 1412 +/- 132 kcal/day, P = 0.01) and energy expended for physical activity (809 +/- 637 vs. 1271 +/- 162 kcal/day, P < 0.01) were significantly lower in the African-American girls than in the Caucasian girls. The differences remained the same after controlling for differences in sexual maturity and/or physical fitness. The lower energy expenditure of the pubertal African-American girls suggests that they are at a higher risk of becoming overweight than their Caucasian counterparts.

Adolescent↗
PubMed1998

Serum leptin concentrations in Caucasian and African-American girls.

Because African-American girls are heavier, taller, and mature earlier than Caucasian girls, we hypothesized that the serum leptin concentration differs between the two groups. Serum leptin concentrations were measured by immunoassay in 12-h fasted blood samples collected from 79 Caucasian and 57 African-American girls between 8 and 17 yr of age. Body composition was measured by dual-energy x-ray absorptiometry, sexual maturity by physical examination, and physical fitness by treadmill testing. Serum leptin concentrations were positively correlated (P < 0.01) with maturation, body fatness, and insulin and were higher (6.6 ng/mL, P < 0.01) in the African-American girls after adjusting for age. The difference remained significant (P < 0.01) but was reduced to 3.2 ng/mL after controlling for differences in maturation, fat mass, and physical fitness. The higher serum leptin levels might play an important role in the accelerated growth and sexual maturation of African-American girls.

Adolescent↗
PubMed1997

Bone mineral changes in young women with hypothalamic amenorrhea treated with oral contraceptives, medroxyprogesterone, or placebo over 12 months.

OBJECTIVES: The objectives of this study were to assess (1) whether treatment with oral contraceptives, in comparison with medroxyprogesterone and placebo, improved bone mineral in women with hypothalamic amenorrhea and (2) whether treatment with medroxyprogesterone, in comparison with placebo, improved bone mineral in women with hypothalamic oligomenorrhea. STUDY DESIGN: The study was a randomized, controlled clinical trial. Twenty-four white women, aged 14 to 28 years, with hypothalamic amenorrhea or oligomenorrhea were prospectively enrolled for a 12-month intervention period. Amenorrheic subjects were randomized to receive oral contraceptives, medroxyprogesterone, or placebo. Oligomenorrheic subjects were randomized to receive medroxyprogesterone or placebo. Bone mineral was measured by dual-energy x-ray absorptiometry at baseline and at 6 and 12 months. RESULTS: In amenorrheic subjects spine and total body bone mineral measurements at 12 months were greater in the oral contraceptive group than in the medroxyprogesterone and placebo groups when baseline bone mineral measurements, body weight, and age were controlled for (p < or = 0.05). There were no differences in hip bone mineral calcium and bone mineral density measurements at 12 months among the three groups. In oligomenorrheic subjects there was no detectable improvement in bone mineral associated with medroxyprogesterone use. CONCLUSIONS: This study supports the hypothesis that oral contraceptive use in women with hypothalamic amenorrhea will improve lumbar spine and total body bone mineral.

Adolescent↗
PubMed1997

The preparticipation sports examination.

Although not a comprehensive health evaluation, the PSE is viewed as such by many parents and adolescents. In this regard, these athletes are getting a lower standard of care than recommended; however, the mechanism wherein the PSE can become a cost-effective comprehensive examination has not been established. The PSE is one method of injury prevention in that it is designed to identify medical conditions that would be worsened by participation in exercise and sports. Pediatricians should use this examination as a quality control point during the year to assess how medical conditions and musculoskeletal injuries have been diagnosed and managed in the context of sports.

Adolescent↗
PubMed1997

Interviewing techniques with adolescents in primary care.

PURPOSE: Privacy is of utmost concern to adolescents seeking advice regarding life-style and behavior choices. Lack of privacy and confidential health services are barriers to adolescents' access to health care. This study describes primary care physicians' practices with regard to inviting parent(s) to leave the room in order to interview the teen alone, and the factors associated with use of this technique. METHOD: A cross-sectional random survey of 1,630 pediatricians, internists, and family practitioners in a large metropolitan area was performed using a confidential mailed questionnaire. RESULTS: The majority of the physicians were in private practice, male, board certified, Caucasian, and did not have a subspecialty. Forty-nine percent of the respondents "almost always" or "always" invite parent(s) to leave the room in order to interview the teen alone. Physicians who were female, board certified, and completed residency from 1974-94 were most likely to use this technique. Among physicians who frequently employ this strategy, the decision to interview the teen alone varied according to the clinical scenario. Using logistic regression analysis, only gender and board certification were significantly related to use of this interviewing method. CONCLUSION: A large proportion of physicians do not interview their adolescent patients alone, therefore, not affording them privacy to discuss confidential health concerns. Future research should focus on developing and validating methods to teach physicians skills to interview adolescents privately.

Adolescent↗
PubMed1997

Management of ankle sprains.

This article reviewed the basics of ankle diagnosis and rehabilitation. It is hoped that after reading this, pediatricians will have more confidence in caring for these injuries.

Adolescent↗
PubMed1996

Leukocyte esterase dipstick as a rapid screening test for vaginitis and cervicitis.

STUDY OBJECTIVE: To assess the ability of vaginal and cervical leukocyte esterase (LE) dipstick to detect vaginitis and cervicitis. DESIGN: A prospective, cross-sectional study to assess the ability of the LE dipstick of vaginal secretions to detect trichomonads, candida, and bacterial vaginosis and the LE dipstick of vaginal and cervical secretions to detect gonococcal and chlamydia infection and polymorphonuclear cells (PMNs). SETTING: An inner-city shelter facility clinic. PARTICIPANTS: 183 sexually active, nonmenstruating females aged 13-21 years (Mean = 17.7, SD = 1.98 years): 47% black, 40% white, and 11% Hispanic. OUTCOME MEASURES: Sensitivity (SN), specificity (SP), positive and negative predictive values (PVP, PVN), with 95% confidence intervals, of vaginal and cervical LE dipstick > or = trace in detecting vaginal and cervical infections. RESULTS: A positive vaginal LE had a moderately high SN and PVN but poor SP and PVP in detecting trichomonas and candida vaginitis and bacterial vaginosis. A positive vaginal and cervical LE had a high SN and PVN but poor SP and PVP in detecting gonorrhea and chlamydia infection. A positive cervical LE had a moderate SN and low SP in detecting PMNs on Gram stain. CONCLUSIONS: The LE dipstick of vaginal and cervical secretions was only a moderately good screening test for vaginal infection but a good screening test for cervical infection.

Adolescent↗
PubMed1996

Are basal metabolic rate prediction equations appropriate for female children and adolescents?

The basal metabolic rate (BMR), which accounts for 50-70% of total energy expenditure, is essential for estimation of patient and population energy needs. Numerous equations have been formulated for prediction of human BMR. Most equations in current use are based on measurements of Caucasians performed more than four decades ago. We evaluated 10 prediction equations commonly used for estimation of BMR in 76 Caucasian and 42 African-American girls between 8 and 17 yr of age against BMR measured by whole-body calorimetry. The majority of the prediction equations (9 of 10) overestimated BMR by 60 +/- 46 kcal/day (range, 15-176 kcal/day). This overestimation was found to be significantly greater (P < 0.05) for African-American (77 +/- 17 kcal/day) than for Caucasians (25 +/- 17 kcal/day) in six equations, controlling for age, weight, and sexual maturity. We conclude that ethnicity is an important factor in estimation of the BMR and that the current prediction equations are not appropriate for accurate estimation of the BMR of individual female children and adolescents.

Adolescent↗
PubMed1995

Bone mineralization, hypothalamic amenorrhea, and sex steroid therapy in female adolescents and young adults.

1. The vast majority of bone mineralization in girls occurs by the middle of the second decade. 2. Premature bone demineralization occurs in women with hypothalamic dysfunction manifest as amenorrhea and oligomenorrhea, associated with athletics, dancing, and eating disorders. 3. In young women with amenorrhea associated with weight loss, BMD loss will be occurring soon after the amenorrhea develops. Treatment to prevent BMD loss or promote BMD accretion should begin soon, probably within 6 months after amenorrhea occurs. 4. Women who recover from anorexia nervosa at a young age (< 15 years of age) can have normal total body BMD, but regional (lumbar spine and femoral neck) BMD may remain low. The longer the anorexia nervosa persists, the less likely it is that the BMD will return to normal. Girls and women with anorexia nervosa need to be rehabilitated early in the disease to maximize BMD accretion. 5. Conjugated estrogen, in doses that improve bone mineralization in postmenopausal women and in combination with medroxyprogesterone, has not been shown to improve BMD in young women with hypothalamic amenorrhea. The role of orally administered medroxyprogesterone at a dose of 10 mg per day, 10 days per month, in improving BMD in teenage girls with hypothalamic amenorrhea or oligomenorrhea remains to be established. 6. Treatment with OCP may have a beneficial effect on BMD in young women with hypothalamic amenorrhea, but this has not been established in a double-masked, randomized, controlled trial. Doing a double-masked trial using OCP will be difficult because estrogen-deficient subjects treated with OCP will be likely to have menstrual bleeding, whereas those treated with placebo will not. In addition, the risk of pregnancy in a sexually active subject, who does not know whether she is receiving OCP, is too great for some subjects. 7. Osteoporosis is a major cause of morbidity and death. Peak bone mass is a major determinant of the risk of osteoporosis, and the second decade is the critical period of peak bone mass acquisition; thus providers of health care for adolescents need to understand the factors that affect bone mineralization during this period, and advise patients accordingly.

Adolescent↗
PubMed1995

Ethnicity affects aerobic fitness in US adolescent girls.

The purpose of this investigation was to determine whether aerobic fitness (VO2max) differed between black (N = 40) and white (N = 53) adolescent girls who were similar in age (13.5 yr) and percent body fat (24.6%). Expired gases were collected continuously while each girl performed a standard Bruce protocol to volitional exhaustion on a motorized treadmill (TM). Heart rates (HR) were measured during the exercise testing via telemetry. Fat-free mass (FFM) was estimated with total body electrical conductivity (TOBEC). Average (+/- SD) maximum HR (black = 194 +/- 7; white = 198 +/- 8) and respiratory exchange ratios (black = 1.17 +/- 0.08; white = 1.22 +/- 0.09) did not differ between subject groups. Aerobic fitness was significantly lower (P < 0.01) lower in black versus white girls when VO2max was expressed relative to body weight (31.8 +/- 5.8 vs 38.5 +/- 6.8 ml.kg(-1).min(-1)) and body weight raised to the 0.67 power (120.9 +/- 19.5 vs 138.5 +/- 20.7 ml.kg(-0.67).min-1). Treadmill time to exhaustion was significantly less (P < 0.01) in the black (8.49 +/- 1.30 min) versus white (9.41 +/- 1.60) subjects. Also, black subjects demonstrated less ability to utilize O2 during maximal exercise at a given FFM. This suggests the black girls' FFM contained a smaller percentage of skeletal muscle mass that could be utilized during treadmill exercise. It is possible that lower aerobic fitness values seen in the black girls are related to a combination of anatomical, physiological and/or behavioral factors.

Adipose Tissue↗