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A Joffe

Publications and source records attributed to A Joffe.

At least 37 records · Page 2Linked to original sources
PubMed1996

Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls.

BACKGROUND: Up to 25% of adolescent girls in the USA are iron deficient. This double-blind, placebo-controlled clinical trial assessed the effects of iron supplementation on cognitive function in adolescent girls with non-anaemic iron deficiency. METHODS: 716 girls who enrolled at four Baltimore high schools were screened for non-anaemic iron deficiency (serum ferritin < or = 12 micrograms/L with normal haemoglobin). 98 (13.7%) girls had non-anaemic iron deficiency of whom 81 were enrolled in the trial. Participants were randomly assigned oral ferrous sulphate (650 mg twice daily) or placebo for 8 weeks. The effect of iron treatment was assessed by questionnaires and haematological and cognitive tests, which were done before treatment started and repeated after the intervention. We used four tests of attention and memory to measure cognitive functioning. Intention-to-treat and per-protocol analyses were done. FINDINGS: Of the 81 enrolled girls with non-anaemic iron deficiency, 78 (96%) completed the study (39 in each group). Five girls (three control, two treatment) developed anaemia during the intervention and were excluded from the analyses. Thus, 73 girls were included in the per-protocol analysis. Ethnic distribution, mean age, serum ferritin concentrations, haemoglobin concentrations, and cognitive test scores of the groups did not differ significantly at baseline. Postintervention haematological measures of iron status were significantly improved in the treatment group (serum ferritin 27.3 vs 12.1 micrograms/L, p < 0.001). Regression analysis showed that girls who received iron performed better on a test of verbal learning and memory than girls in the control group (p < 0.02). INTERPRETATION: In this urban population of non-anaemic iron-deficient adolescent girls, iron supplementation improved verbal learning and memory.

Adolescent↗
PubMed1996

Depressive symptoms, stress, and social support in pregnant and postpartum adolescents.

OBJECTIVE: To assess prospectively the incidence and course of depressive symptoms among pregnant and postpartum adolescents and explore the roles of stress and social support as influencing factors. METHODS: Pregnant teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled during their third trimester of pregnancy and followed up through 4 months post partum. Depressive symptoms and social support were measured with validated, self-administered instruments during the third trimester and at 2 and 4 months post partum. Stress was measured during the prenatal and postpartum periods. RESULTS: Study participants (N=125) were predominantly black (93%), and wee aged 12 to 18 years. Completed assessments were obtained from 114 subjects at 2 months post partum and 108 at 4 months. Forty-two percent had significant depressive symptoms in the third trimester, with 36% and 32% having scores that indicated depression at 2 and 4 months post partum. Stress levels increased significantly from the third trimester to the postpartum period (P < .01) and were positively associated with depressive symptoms. Receiving social support from the adolescent's mother or the infant's father, especially in the postpartum period, was significantly associated with lower rates of depression. Reporting conflict with the infant's father was strongly associated with increased rates of depressive symptoms. CONCLUSIONS: Results indicate that depressive symptoms are common among pregnant teenagers and postpartum adolescents. Stress and social support appear to be important mediators. Identifying those teenagers with high stress and conflict and low levels of support will help identify those who are at particular risk for depressive symptoms.

Adolescent↗
PubMed1996

Evaluation of pulmonary function and polysomnography in obese children and adolescents.

Obese adults have an increased prevalence of pulmonary disorders. Although childhood obesity is a common problem, few studies have evaluated the pulmonary complications of obesity in the pediatric population. We, therefore, performed pulmonary function tests (PFTs), polysomnography, and multiple sleep latency tests (MSLTs) in 22 obese children and adolescents [mean age, 10 +/- 5 (SD) years; 73 percent female; 184 +/- 36 percent ideal body weight], none of whom presented because of sleep or respiratory complaints. PFTs were normal in all but two subjects. Ten (46 percent) subjects had abnormal polysomnograms. There was a positive correlation between the degree of obesity and the apnea index (r = 0.47, P < 0.05), and an inverse correlation between the degree of obesity and the Sa0(2) nadir (r = -0.60, P < 0.01). The degree of sleepiness on MSLT correlated with the degree of obesity (r = -0.50, P < 0.05). We conclude that obese children and adolescents have a high prevalence of sleep-disordered breathing, although in many cases it is mild. Obstructive sleep apnea syndrome (OSAS) improved following tonsillectomy and adenoidectomy. We recommend that pediatricians have a high index of suspicion for OSAS when evaluating obese patients, and that polysomnography be considered for these patients.

Adolescent↗
PubMed1995

Adolescent medicine.

In a survey of children and adolescents, one fourth of respondents reported having experienced an assault or abuse in the previous year. Violence is not restricted to inner cities. Marijuana use among eighth graders has more than doubled since 1991.

Adolescent↗
PubMed1995

Outcomes of adolescents using levonorgestrel implants vs oral contraceptives or other contraceptive methods.

OBJECTIVE: To compare outcomes among adolescents who use levonorgestrel implants, oral contraceptives, or other methods of birth control. DESIGN: Prospective, longitudinal study of 166 females who were followed up for 6 months. Fifty-four used implants, 64 used oral contraceptives, and 48 used condoms alone or with spermicide, or no contraceptive. Outcomes were measured by patient interview and medical chart review. SETTING: Inner-city, hospital-based adolescent and teenaged mother and baby clinic between April 1, 1992, and May 31, 1993. PARTICIPANTS: Sexually active 12- to 18-year-old females at least 1 year postmenarche who had no contraindications to use of hormonal contraceptives. MAIN OUTCOME MEASURES: Sexual activity, pregnancy rates, condom use, incidence of sexually transmitted disease, patient satisfaction continuation rates, and side effects. RESULTS: Despite similar reports of sexual activity, one subject who used the implant (2%) vs 13 subjects who used oral contraceptives (20%), and eight subjects who used other methods (17%) became pregnant (chi 2, P < .50). Condom use did not differ among groups (chi 2, P > .60). Overall, 30% of subjects contracted a new sexually transmitted disease; rates did not differ by method (chi 2, P = .92). Implant users were more likely than oral contraceptive users to continue their method (87% vs 50%; chi 2, P < .001) despite similar satisfaction scores (one-way analysis of variance, P = .52). Implant users were more likely to experience irregular menses, mood swings, acne, and hair loss (chi 2, P < .05). CONCLUSIONS: In this population, the levonorgestrel implant is an effective method of pregnancy prevention and is associated with high satisfaction and continuation rates at 6 months. Implant users are not at greater risk than others for sexually transmitted disease. Health care providers should continue to stress the use of barrier methods to all sexually active adolescents.

Adolescent↗
PubMed1995

Association between postpartum substance use and depressive symptoms, stress, and social support in adolescent mothers.

OBJECTIVE: Substance use by pregnant teenagers is an important public health problem, but published data on alcohol and illicit drug use by parenting teenagers are virtually nonexistent. This study determined the prevalence of alcohol and drug use in adolescent mothers in the first 4 months postpartum and explored associated psychosocial characteristics. METHODS: Teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled consecutively during a routine third trimester prenatal visit. Alcohol use since delivery was determined by self-report at 4 months postpartum using an instrument developed for the 1984 Survey of Drug Abuse Among Maryland Adolescents. Illicit drug use was measured with anonymous quantitative urine drug screens at 2 and 4 months postpartum. Depressive symptoms, stress, and social support were assessed at 2 and 4 months postpartum using validated, self-administered instruments. Differences in demographic characteristics, peer group influences, and psychosocial variables between substance users and nonusers were evaluated. RESULTS: Participants (125/129 eligible) were predominantly African-American, mean age 16.3 years. Completed assessments were obtained from 110 at 2 months and 105 at 4 months postpartum. Forty-two percent screened positive for illicit drugs at a postpartum visit or reported using alcohol since delivering their baby and were classified as substance users. Thirty-one percent of subjects reported alcohol use since delivery. Marijuana was the most prevalent illicit drug (14%), followed by opiates (5%), and cocaine (4%). When substance users were compared with nonusers, 44% versus 24% scored depressed (P = .02), 62% versus 43% had high stress (P = .04), and 62% versus 44% reported a high need for social support (P = .07). Results of logistic regression, after controlling for age, indicated that illicit substance and/or alcohol use was 3.3 times greater for those who were depressed, 2.8 times greater if they reported friends' using illicit drugs, and 6.7 times greater if the adolescent reported smoking cigarettes since delivery. CONCLUSIONS: This study indicates that alcohol and drug use are common among this sample of postpartum teenage mothers and that depression, stress, high support need, and peer group drug use are associated factors. Although this study cannot determine whether depression and stress precede or result from use of substances, attention to these factors appears warranted in the care of adolescent mothers.

Adolescent↗
PubMed1995

Atypical and complicated Kawasaki disease in infants. Do we need criteria?

Case reports suggest that infants with Kawasaki disease have atypical presentations and a high complication rate, likely related to delayed diagnosis and treatment. To date, no study of consecutive cases has compared infants with older children who have both atypical and typical Kawasaki disease. We retrospectively reviewed 44 cases of Kawasaki disease treated at our hospital from March 1980 to 1990: 11 (25%) were infants; 9 (20%) had atypical Kawasaki disease, of which 5 (56%) were infants; the male to female ratio was 1.7:1. Infants had a higher incidence of atypical Kawasaki disease (5 [45%] versus 4 [12%]; P = .007) and of coronary artery complications (7 [64%] versus 3 [9%]; P = .002), and coronary artery complications developed in all of the infants with atypical Kawasaki disease (5 [100%] versus 0 [0%]; P < .01). Yet, the other manifestations and laboratory changes were at least as common as in the older children. Coronary artery complications did not develop in any patient who received early intravenous immune globulin therapy. We suggest that in infants with Kawasaki disease, accepted criteria are too restrictive to allow early diagnosis and effective treatment. Until a definitive test is available, clinical judgment is required in the diagnosis of atypical Kawasaki disease. Intravenous immune globulin is known to be safe, and its early use in patients with suspected atypical Kawasaki disease is appropriate.

Child↗
PubMed1994

Fire and ice.

Explore the source record for details and available documents.

Adolescent↗
PubMed1994

Intervention in hypercholesterolemic college students: a pilot study.

PURPOSE: Since atherosclerosis begins in childhood and cholesterol levels can track from adolescence to adulthood, early intervention to lower elevated levels may be important. Our objective was to test the effectiveness of a health education intervention in hypercholesterolemic college students. METHODS: Thirty-nine university students with plasma low-density lipoprotein cholesterol (LDL-C) levels > or = 75th percentile (2.84 mmol/L, 110 mg/dL) were randomized into two study groups. The control group (n = 19) attended a lecture and viewed a brief video on diet and cholesterol. The intervention group (n = 20) participated in 7 weekly sessions on nutrition and behavior modification. At baseline and 8 weeks later, all subjects completed standardized tests assessing knowledge and attitudes regarding cholesterol, saturated fat, fiber, and heart-healthy lifestyles. Lipid profiles were analyzed at baseline, 8 weeks, and 8 months after study initiation. RESULTS: The groups did not differ at baseline in terms of knowledge, attitudes or lipid profiles. At the 8-week post-test, the intervention group's knowledge was superior to that of the control group (p = < 0.001). Both groups showed improvement in their attitude toward a heart-healthy diet. At the 8-week follow-up, the intervention group lowered their mean plasma LDL-C by 0.21 mmol/L (8 mg/dL) whereas the control group's level fell by an average of 0.05 mmol/L (3 mg/dL) (p = 0.40). At the 8-month follow-up, LDL-C levels increased from baseline in both groups, but the control group levels rose significantly more than the intervention group (0.34 mmol/L vs. 0.05 mmol/L, p = 0.045). Students whose baseline LDL-C was > or = 95% (3.36 mmol/L, 130 mg/dL) benefitted more from the intervention than those with levels > or = 75% but < 95%. CONCLUSIONS: We conclude that a 7-week intervention results in significant improvement in nutritional knowledge and protects hyperlipidemic college students with levels > or = 95% from significant increases in LDL-C.

Adolescent↗
PubMed1994

Psychosocial factors associated with the use of bicycle helmets among children in counties with and without helmet use laws.

We examined the extent to which psychosocial factors, in addition to the presence of a law, are associated with the use of bicycle helmets. A mailed questionnaire was completed by 3494 children in fourth, seventh, and ninth grades in three Maryland counties: Howard County, which had a law requiring child bicyclists to wear helmets and an educational campaign; Montgomery County, which had an educational campaign but no law; and Baltimore County, which had neither. Overall, 19% of the respondents reported having worn a bicycle helmet on their most recent ride. In a multiple logistic regression, children's use of helmets in all three counties was significantly associated with their beliefs about the social consequences of wearing helmets and the extent to which their friends wear helmets. Significant interactions were also found, suggesting that in the presence of a law, an educational campaign, or both, children's use of helmets was associated more with social concerns than with parental influences or cognitive factors, such as beliefs about the need for helmets or perceptions of risk. To increase helmet use, the issues of stylishness, comfort, and social acceptability of wearing helmets need to be addressed and more widespread adoption of bicycle helmet laws should be encouraged.

Adolescent↗
PubMed1994

Child abuse, sudden infant death syndrome, infectious disease, and vaccinations.

Clinicians all too often face the difficult dilemma of deciding whether a bone fracture in a young child was intentional. A structured expert consensus process suggests that all rib fractures; midshaft or metaphyseal fractures of the humerus; and fractures of the radius, ulna, tibia, or fibula in children younger than 1 year of age are highly likely to have been caused by abuse. Abused children are more likely to have negative social relationships with other children than their school-aged peers. Research on the causes of sudden infant death syndrome is still confounded by the likelihood that some deaths for which the label was misapplied are included in many studies; however, the presence of smokers in the household in the postnatal period appears to be yet another factor associated with increased risk. Congenital syphilis is on the rise. Detection of infants who have been infected is incomplete. Lack of prenatal care is strongly associated with infection. Cord serology is not sensitive enough to detect all possible cases. Testing of both maternal and neonatal sera results in detection of more infants at risk. Current tests still result in the treatment of some infants who are not themselves infected. Amoxicillin clavulante given twice daily rather then thrice, cefixime given once a day, and a single intramuscular dose of ceftriaxone have all shown acceptable--though not exceptional--cure rates for otitis media. Price is a consideration. Fewer courses of antibiotics would be necessary if more infants were breastfed. Exclusively breastfeeding to at least 4 months cuts the number of bouts of otitis media almost in half.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Capsules↗
PubMed1993

Adolescents and condom use.

Increasing condom use among adolescents is an essential component of a public health strategy aimed at decreasing rates of sexually transmitted infections and the spread of human immunodeficiency virus infection. This article reviews current data about the contraceptive and prophylactic characteristics of condoms. Data about current levels of use among adolescents and factors demonstrated to affect such use are also summarized. Except where data are scanty or nonexistent, the research studies are limited to those focusing primarily on adolescents and, occasionally, college students. Based on these data, suggestions for increasing condom use among adolescents are presented.

Adolescent↗
PubMed1993

Self-efficacy and intent to use condoms among entering college freshmen.

We examined self-efficacy theory's ability to explain adolescents' intent to use condoms. In this study, 673 males and 404 females (mean age, 17.8 years) about to begin college, completed health surveys measuring self-efficacy regarding condom use. Perceived self-efficacy differed by gender and sexual experience. Regression analysis demonstrated that frequency of past condom use, perceived ability to talk with new partner about condoms and to enjoy sex using condoms explained 16% of sexually active males' intent to use condoms (p < 0.05). For sexually active females, explanators included frequency of past use and perceived ability to enjoy sex with condoms (R2 = 29.8%, p < 0.05). For never sexually active males, perceived ability to convince partner to use condoms and to buy condoms explained 16.1% of intent (p < 0.05); among never sexually active females, only perceived ability to convince partner to use condoms was significant (R2 = 6.2%, p < 0.05). Efforts to increase condom use should enhance perceptions of ability to negotiate aspects of condom use.

Adolescent↗
PubMed1993

Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children's helmet use.

OBJECTIVES: The passage of a mandatory bicycle helmet law for children in Howard County, Maryland, provided an opportunity to compare legislation and education as strategies to increase helmet use. METHODS: In 1991, a survey was mailed to fourth-, seventh-, and ninth-grade students attending a stratified sample of public schools in Howard County and in two similar suburban/rural counties without helmet laws. RESULTS: Of 7217 students surveyed, 3494 responded (48.4%). Self-reported helmet use in Howard County rose from 11% to 37% after the law and accompanying educational campaign went into effect. Helmet use changed from 8% to 13% in Montgomery County, where educational efforts were undertaken, and from 7% to 11% in Baltimore County, where helmet promotion activities were minimal. Predictors of helmet use included having friends who wore helmets, believing helmet laws are good, being in fourth grade, living in Howard County, and using seatbelts regularly. CONCLUSIONS: Legislation combined with education appears to increase bicycle helmet use substantially more than does education alone. The Howard County law may be considered a successful model of a strategy to increase children's helmet use.

Adolescent↗