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Biomedical subjects

D P Krowchuk

Publications and source records attributed to D P Krowchuk.

At least 37 records · Page 2Linked to original sources
PubMed1995

Parents' knowledge of the purposes and content of preparticipation physical examinations.

OBJECTIVES: To determine whether parents of student athletes plan to use the preparticipation physical examination (PPE) as their student athlete's only annual health evaluation, to identify factors associated with this decision, and to assess their knowledge about the objectives of PPEs and more comprehensive examinations. DESIGN: Survey. SETTING: General community, school-sponsored PPEs. PARTICIPANTS: A convenience sample of parents or guardians of high school student athletes who obtained a school-sponsored, multiple-station format PPE were surveyed by using an anonymous paper-and-pencil questionnaire. Questionnaires were completed by the parents of 381 of 763 student athletes who obtained PPEs (participation rate, 49.9%). RESULTS: Thirty percent of the parents in this sample planned to use the PPE as their student athlete's only contact with a health care provider. Parents whose adolescent's health insurance provided for comprehensive health assessments were more likely than those without this benefit to plan a comprehensive care evaluation (75% vs 60%, respectively) (P = .01 by chi 2 analysis). In addition to addressing problems that might affect sports participation, parents thought that the PPE visit should evaluate medical problems that are unrelated to athletics (34%), perform health screening procedures (22%), assess social or behavioral issues (16%), and provide immunizations (7%). CONCLUSIONS: Many parents plan to use the PPE as their student athlete's only scheduled contact with a health care provider; this decision may be influenced by factors that are related to access to health care and misperceptions with regard to the mission of these specialized examinations. For these adolescents, important medical, social, and behavioral needs may not be met. Consideration should be given to including elements of the PPE in health assessments that are performed by individual clinicians or expanding the scope of large-group, multiple-station format PPEs.

Adolescent↗
PubMed1995

Compliance with return appointments for reproductive health care among adolescent Norplant users.

PURPOSE: Norplant's long duration of action may result in users being less motivated than non-users to return for reproductive health care appointments. This study determined compliance with scheduled return appointments among adolescents using Norplant and those using other methods of contraception. METHODS: We retrospectively reviewed the records of all teenagers (age < or = 18 years) who received Norplant between June 1991 and August 1993, as well as those of a comparison group of adolescents, matched for age and race, using other methods of contraception. Subjects receiving Norplant were given appointments for a two-week and an annual examination. Comparison subjects were given only an appointment for an annual examination. Norplant users not returning within 5 weeks or any subject not presenting within 12 months for an annual examination, were considered non-compliant. RESULTS: Eighty-eight adolescents received Norplant during the study period and the records of 85 were available for review. Only 48 of the 85 Norplant users returned for scheduled two-week check-up, while 18 of 43 subjects who had Norplant at least 12 months were compliant with annual examinations. The compliance rate with annual examinations among the 89 subjects not using Norplant was 38%, not dissimilar from that of the Norplant group. CONCLUSIONS: These data demonstrate that compliance with return appointments for reproductive health care among adolescent Norplant users is poor but not significantly worse than that of non-users of Norplant. Strategies promoting the benefits of return visits need to be improved for adolescents receiving contraception.

Adolescent↗
PubMed1994

How children perceive the medical evaluation for suspected sexual abuse.

This study investigated how 99 children who were examined for suspected sexual abuse (SSA) perceived their own medical evaluation experiences. Each child was interviewed about the degree of pain and fear associated with the experience, the kindness of the doctor, general fear of doctor visits, and degree of fear associated with a hypothetical second examination. The majority of children did not perceive their SSA examination to be strongly negative. However children did report greater fear associated with the SSA evaluation compared to an ordinary doctor visit. Using multiple regression, general fear of doctor visits and fear and pain associated with the SSA examination contributed to the prediction of intensity of fear about a hypothetical second SSA evaluation. Perceived kindness of the doctor, patient sex and age, and physician sex and age did not contribute to the regression equation. The relatively low reported rate of intense distress associated with medical evaluation of SSA suggests that fear and pain can be minimized and effectively managed for many children. The results of the regression analysis suggest that previous negative medical experiences may play an important role in determining how a child interprets the experience of an SSA medical evaluation.

Adolescent↗
PubMed1994

Dermatologic services provided to children and adolescents by primary care and other physicians in the United States.

To determine the frequency and types of pediatric dermatologic problems encountered by primary care physicians, dermatologists, and other physicians, we examined data from the 1990 National Ambulatory Medical Care Survey, a continuing study of physician practice in the United States. In 1990, 163.3 million physician office visits were made by patients 18 years of age or younger for all diagnoses; of these, 126.2 million were to primary care physicians. Among visits to these providers, a primary, secondary, or tertiary cutaneous concern or diagnosis was recorded in 12.3 million visits (9.7%). Of these patients with a primary cutaneous concern, 68% of visits were made to primary care physicians, 21% to dermatologists, and 10% to other physicians. For encounters in which primary care physicians reported a primary dermatologic diagnosis (9.6 million visits, 7.6%), the majority of diagnoses (86-93%) were in one of five categories: skin infections, dermatitis, parasitic infestations, acne, or urticaria. This analysis demonstrates the great frequency with which cutaneous disease occurs in ambulatory medicine, and reinforces the importance of dermatologic education in the training of primary care physicians.

Acne Vulgaris↗
PubMed1993

Magnetic resonance imaging in the evaluation of lymphangioma circumscriptum.

BACKGROUND: Lymphangioma circumscriptum is characterized clinically by grouped vesicles, some of which may be filled with serosanguineous fluid. The depth and extent of involvement of lymphangioma circumscriptum cannot be adequately estimated from the cutaneous examination. OBSERVATION: We describe two patients with lymphangioma circumscriptum evaluated by magnetic resonance imaging. Magnetic resonance imaging accurately demonstrated the true extent of involvement. CONCLUSIONS: With magnetic resonance imaging to delineate the entire lesion of lymphangioma circumscriptum, one can (1) provide education to the family regarding the extent of involvement and (2) prevent incomplete invasive surgical procedures from being performed.

Adolescent↗
PubMed1992

Relationship of AIDS-related attitudes to sexual behavior changes in adolescents.

The impact of the acquired immunodeficiency syndrome (AIDS) epidemic on a group of adolescents was investigated by surveying 197 sexually active, predominantly African-American, urban high school students. Reported sexual behavior changes were evaluated in relation to AIDS-related knowledge and attitudes. Over 50% of the students decreased their frequency of sexual activity, increased their condom use, and/or decreased their number of partners. These students had significantly higher scores on a measure of worry about vulnerability to human immunodeficiency virus (HIV) infection than those whose behavior had not changed. AIDS knowledge, AIDS beliefs, and AIDS-related anxiety interacted with gender to affect sexual behavior change. Male students reporting decreased frequency of sexual activity, for example, had more accurate beliefs about AIDS than males reporting no decrease. Among female students, however, those reporting decreased frequency had less accurate beliefs than those reporting no decrease. These results highlight the importance of considering gender and specific sexual behaviors when designing AIDS education interventions.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Genital human papillomavirus infections in adolescents: implications for evaluation and management.

Genital infections caused by human papillomaviruses (HPV) have become the most prevalent sexually transmitted disease in the United States. Rates of infection with these agents are particularly high among adolescents. The most common clinical expression of genital HPV infection is condyloma acuminata, a condition that dermatologists are frequently called on to treat. The identification of external genital warts in a teenager raises questions that impact directly on the patient's evaluation and management. Issues of importance include the likelihood that occult infection exists at other sites in the genital tract, the risks associated with HPV infection, and the need, if any, for further diagnostic assessment, including that necessary to detect the presence of coexisting sexually transmitted infections. This article examines these and associated issues and provides information that will be of value to the dermatologist caring for adolescent patients with genital warts.

Adolescent↗
PubMed1991

Knowing someone with AIDS: the impact on adolescents.

Tested 25 adolescents who reported knowing a person with AIDS or HIV (PWA) and were matched by gender, race, grade, school type, and academic achievement with 25 adolescents who reported not knowing a PWA. The groups were compared with respect to their knowledge, beliefs, and social anxiety about AIDS and with respect to their worries about personal vulnerability to HIV infection. Social anxiety was significantly lower in those reporting knowing someone with AIDS than in the matching group. No significant differences between the two groups were found for knowledge, beliefs, or vulnerability worries. The implications of these findings for research on AIDS interventions with adolescents are discussed.

Achievement↗
PubMed1991

Peripheral white blood cell counts and bacterial meningitis: implications regarding diagnostic efficacy in febrile children.

In order to investigate the clinical value of peripheral white blood cell variables for the diagnosis of bacterial meningitis among young, febrile children, we compared total peripheral white counts, total segmented neutrophil counts, total band counts, and the ratio of immature-to-total neutrophils (I:T ratio) among 46 children with bacterial meningitis, 130 children with aseptic meningitis, and 56 febrile children with culture confirmed extrameningeal bacterial infection. Children with bacterial meningitis were comparable to those with aseptic meningitis with respect to median total white blood cell counts and median total segmented neutrophil counts but had a significantly higher median total band count (1760/microliters vs 378/microliters, P = 0.0001) and a significantly higher median I:T ratio (0.40 vs 0.09, P less than 0.001). In contrast, children with bacterial meningitis were comparable to those with an extrameningeal bacterial infection with respect to median total band count but had a significantly lower median total peripheral white count (10,650/microliters vs 15,300/microliters, P = 0.0013), a lower median total segmented neutrophil count (4511/microliters vs 6796/microliters, P = 0.023), and a significantly higher median I:T ratio (0.40 vs 0.15, P less than 0.001). Children with meningitis who were bacteremic at presentation had a significantly lower total white cell count (P = 0.001) and significantly higher I:T ratio (P = 0.005) when compared with children who had an extrameningeal infection and concurrent bacteremia at presentation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The psychosocial effects of acne on adolescents.

To describe the psychosocial impact of acne on adolescents, and, in particular, to assess whether self-concept is affected by medical treatment, we evaluated 39 teenagers presenting for care to a community-based dermatologist. Prior to and following treatment, subjects completed a self-assessment questionnaire, the Piers-Harris self-concept scale, and underwent an objective assessment of acne severity. Fifty-eight percent of subjects were dissatisfied with their facial appearance and this in turn was correlated with feelings of embarrassment and social inhibition (for each, r = 0.48, P less than or equal to 0.005). Subjects' rating of acne severity, but not the dermatologist's, was correlated with dissatisfaction with facial appearance (r = 0.45, P less than or equal to 0.005). Despite these findings, the mean Piers-Harris total t-score (55.4 +/- 7.4) was within the normal range. Fourteen subjects (36%) returned for follow-up and 71% of these were judged by both the dermatologist and themselves to have improved. Following therapy, significant reductions in the adverse consequences of acne were observed with 42% of subjects reporting that their facial appearance was more acceptable to peers, 50% being less embarrassed, and 58% feeling less socially inhibited. Minimal improvement in mean Piers-Harris total t-score was observed (54.6 to 57.4, P = 0.004, paired t-test). Our data demonstrate that acne is perceived by adolescents to have important negative personal and social consequences, and that improvement in these areas may accompany medical treatment.

Acne Vulgaris↗
PubMed1989

High school athletes and the use of ergogenic aid.

To determine high school athletes' attitudes toward and use of ergogenic aids, we surveyed 295 students presenting for preparticipation examinations. In general, young athletes believed that steroids and amphetamines were not efficacious in enhancing sports performance and that their use was potentially harmful. Subjects reported minimal use of steroids (1%) and amphetamines (2%), and only a minority would consider their use. As a group, however, male athletes were more likely to believe that steroids were effective (32% vs 13%) and to consider the future use of these agents (14% vs 0) compared with female athletes. The majority of high school athletes believed that supplemental protein or vitamins could improve performance and that their use caused little or no health risk. These data suggest that young athletes may require information regarding the limited benefits and potential risks associated with the use of ergogenic aids.

Adolescent↗