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Biomedical subjects

G B Slap

Publications and source records attributed to G B Slap.

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

Unique needs of the teen in the health care setting.

Teenagers in the health care setting need age-appropriate services that target risk behaviors linked to adolescent morbidity and mortality. This article reviews the rationale and strategies for establishing preventive models of adolescent health services. The health needs and barriers to care, as perceived by both adult providers and adolescent consumers, are reviewed. This literature is then used to recommend how best to convey preventive messages in today's cost-conscious environment. The importance of program evaluation is discussed in conjunction with closely examining the effectiveness of preventive care in the promotion of adolescent health.

Adolescent↗
PubMed1995

Adolescents' perceptions of factors affecting their decisions to seek health care.

OBJECTIVE: To have adolescents, rather than adults, identify characteristics of health care providers and sites that affect their decision to seek care. DESIGN: Five stages conducted over a 10-month period: (1) focus groups to frame the study questions; (2) nominal group technique to generate student responses; (3) three surveys to assess response importance; (4) one survey to link the most important responses with the decision to seek care; and (5) focus groups to explain the variables associated with the decision to seek care. SETTING: The Philadelphia (Pa) School District. PARTICIPANTS: The study population consisted of all ninth graders from 39 of Philadelphia's 42 public high schools. The 6821 students who returned the final survey comprised the study sample (69% of in-school youth). RESULTS: In the final survey, students used a Likert scale (1 to 5) to describe the impact of 31 ideas on their decision to seek care. The most important characteristics were provider hand washing, clean instruments, honesty, respect toward teens, cleanliness, know-how, carefulness, experience, seronegativity for the human immunodeficiency virus, equal treatment of all patients, and confidentiality. There was little variation in the order of the items by sex, race, or socioeconomic status. Factor analysis showed that the most important of four identified latent factors related to infection control and provider competency. CONCLUSION: Four of the top 10 characteristics that affect an adolescent's decision to seek care involve cleanliness and infection control. These findings offer providers and planners straightforward, modifiable factors that teens believe influence their decision to seek care.

Adolescent↗
PubMed1994

Effect of high-sugar intake by low-income pregnant adolescents on infant birth weight.

PURPOSE: The objective of this study was to determine the effect of total sugar intake by pregnant adolescents from low-income families on infant birth weight and small-for-gestational-age (SGA) infants. METHODS: The study sample consisted of 337 adolescents, enrolled in a county-wide demonstration project in Camden, New Jersey, who delivered live, singleton newborns. The adolescents were divided into two groups at the 90th percentile for the study sample total sugar intake (206 g): high-sugar intake (> or = 206 g, n = 34) and low-sugar intake group (< 206 g, n = 303). RESULTS: The sample was 46% black, 30% white, and 24% Hispanic. The sample gestational age and birth weight (mean +/- SD) were 39 +/- 3 weeks and 3189 +/- 666 g, respectively. After adjusting for energy intake, the high- compared with the low-sugar intake group was more likely to consume higher total sugar and carbohydrate but lower protein and fat. Likewise, the high-compared to the low-sugar intake group consumed significantly more calcium and magnesium. After adjusting for possible confounding variables such as maternal age, ethnicity, marital status, parity, smoking, net weight gain, body mass index, energy intake, and gestational age at birth, adolescents on high- compared to low-sugar diets gave birth to infants weighing 215 +/- 104 g less (p = 0.04). The adjusted odds ratios were 3.41 (95% confidence interval, 1.14 to 10.23) for delivering a SGA infant among adolescents with high- compared with low-sugar intakes. CONCLUSIONS: Low-income adolescents consuming high-sugar diets are at increased risk for delivering lower birth weight and SGA infants.

Adolescent↗
PubMed1994

Evolving self-image, pubertal manifestations, and pubertal hormones: preliminary findings in young adolescent girls.

PURPOSE: Recent studies indicate that negative self-image increases in white females during early adolescence. This study was designed to examine the effects of physical and hormonal change during puberty on evolving self-image. METHODS: The study sample consisted of 54 girls aged 10-14 yrs (mean 12.2 +/- 0.9). Evaluations at baseline and one-year follow-up included the Self-Image Questionnaire for Young Adolescents (SIQYA), physical examination, and assays of serum FSH, LH, estradiol, testosterone, and DHEAS. Tanner stage was assessed separately for breast and pubic hair, and the girls were classified as early-, mid-, or late-maturers for each. RESULTS: Pearson correlations between baseline and follow-up scores on the nine SIQYA scales ranged from 0.28-0.72 (P < 0.05); three scales demonstrated declining function (P < 0.05). At baseline, 39 girls (72%) were pre-menarcheal compared to 27 (50%) at follow-up. Mean body mass index (BMI) increased from 18.62 +/- 2.38 to 19.01 +/- 1.84 (P < 0.001), Tanner stages each increased by one, and pubertal timing did not change. LH and testosterone increased (P < 0.05) over the year, DHEAS decreased (P < 0.01), and FSH and estradiol did not change. Stepwise linear regression revealed that change in breast stage was positively correlated with change in Body Image score and change in Adjustment score (beta weights 0.46 and 0.41, respectively). Change in testosterone was negatively correlated with change in Adjustment score (beta weight of -0.46). After controlling for baseline score, change in breast stage was positively correlated and FSH was negatively correlated with follow-up Body Image score (beta weights of 0.40 and -0.24, respectively). CONCLUSION: We conclude that the rate of breast development and FSH level have independent, opposite effects on body image during early adolescence.

Adolescent↗
PubMed1994

Pregnancy among American Indian adolescents: reactions and prenatal care.

PURPOSE: Adolescent childbearing is twice as common among Native Americans as among all US races combined. Despite this, little is written about the psychosocial context or prenatal care of pregnant Native American adolescents. The objective of this study was to explore the reactions and prenatal care of Navajo and Apache adolescents delivering infants at Shiprock Indian Hospital, New Mexico, between January and March 1991, and Whiteriver Indian Hospital, Arizona, between May and June 1991. METHODS: Of the 25 eligible adolescents aged 19 years and younger, 15 Navajo and 5 Apache participants were interviewed within 24 hours of delivery. The interview consisted of 121 questions divided into 5 areas: sociodemographics, personal and family reactions to the pregnancy, knowledge and attitudes toward prenatal care, barriers to care, and ways to improve access to care. RESULTS: The mean age was 17.4 +/- 1.1, 6 were married, and 13 were primiparous. According to the Maternal Health Services Index, 5 adolescents received adequate, 13 intermediate, and 2 inadequate prenatal care. During the pregnancy, 3 adolescents used tobacco, 3 used alcohol, and none admitted to other drugs. Although only 1 adolescent planned the pregnancy, 15 were not using contraception when they became pregnant. In exploring reactions to the pregnancy, 13 adolescents were afraid to tell their families and 4 concealed the pregnancy until confronted. During the pregnancy, 7 adolescents described loneliness and 6 expressed suicidal ideation. Although over half reported no barriers to obtaining prenatal care, barriers that were noted by the remainder included transportation, family problems, and missing school. CONCLUSION: We conclude that pregnancy among many American Indian adolescents is unplanned and characterized by uncertainty and fear of disclosure, resembling the reactions to pregnancy of other adolescent populations. Furthermore, despite universal access to health services, many American Indian adolescents continue to experience barriers to care and receive intermediate or inadequate prenatal care. These preliminary findings suggest further research may help clarify how adolescent reactions to pregnancy and knowledge of prenatal care affect health care utilization.

Adolescent↗
PubMed1993

Adolescents and access to health care.

The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of health care settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across health care, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America's adolescents will not have access to appropriate health services. Current efforts to minimize current health care expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America's youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years. 76 Additionally, The Robert Wood Johnson Foundation has just announced a $23.2 million state-community partnership grant program to increase availability of school-based health services for children and youth with unmet health needs.77 As health care reform efforts move forward,both careful definition of the services adolescents need and adequate financing for these services are essential to ensure access to care for all adolescents.

Adolescent↗
PubMed1992

Barriers to adolescent prenatal care.

It is estimated that over one-half of all adolescent mothers receive inadequate prenatal care. Our objectives were to explore the barriers to care as perceived by adolescents and to develop a model to identify adolescents at risk for inadequate care. Structured interviews were conducted with 101 adolescents less than 17 years of age who delivered infants at an urban university hospital between September 1988 and January 1989. All the interviews were conducted within 48 hr of delivery by a single investigator. The Maternal Health Services Index was used to divide subjects into those who received inadequate care (Group 1, n = 37) and those who received intermediate or adequate care (Group 2, n = 64). Both groups were predominantly black (99%), poor (mean Hollingshead score = 2), and unmarried (99%). Groups 1 and 2 differed (p less than 0.05) in 12 variables pertaining to beliefs about prenatal care and course during the pregnancy. Of the 12 variables, 7 comprised a stepwise logistic regression model designed to maximally differentiate Groups 1 and 2--negative attitudes towards physicians (20% vs 6%), perceived importance of first trimester care (78% vs 94%), confusion about available prenatal services (24% vs 5%), lack of health insurance (41% vs 16%), exposure to pregnant friends (76% vs 95%), mean gestational age at recognition of pregnancy (15 wks vs 11 wks), and desire for an adolescent-only prenatal clinic (78% vs 58%). The adjusted odds ratios of the variables ranged in declining order from 15.4 to 4.7. The attributable risks, or etiologic fractions, of the variables ranged in increasing order from 0.19 to 0.49. Receiver-operating characteristic curve analysis of the model demonstrated a curve area of 0.89 +/- 0.04, significantly better than chance. We conclude that the model clarifies the barriers to care and helps identify pregnant adolescents who are likely to receive inadequate prenatal care.

Adolescent↗
PubMed1992

Adolescent suicide attempters: do physicians recognize them?

The single most important risk factor for adolescent suicide is a previous attempt. It is unclear if physicians can identify adolescents who have attempted suicide. Our objectives were to determine the prevalence of previous attempts in an adolescent clinic population, if physicians identify attempters, and if attempters demonstrate persistent distress. Of 332 patients aged 12-19 years attending a medical clinic, 48 (14.5%) reported a previous attempt. The physician's visit note documented that only 8 (16.7%) of the 48 attempters were asked about suicidal behavior. Attempters were more likely than nonattempters (p less than 0.05) to be female; to come to clinic without a guardian; to give a chief complaint pertaining to sexually transmitted disease, obstetrics-gynecology, or mental health; and to report previous mental health care. Attempters had poorer mean scores (p less than 0.05) on validated subscales for family relationships, social competence, depression, unpopularity, somatic complaints, thought disorders, delinquency, aggression, and identity. We conclude that suicide attempts are common among adolescent clinic patients, that physicians may not recognize attempters, and that attempters remain distressed and in need of care. Physicians who see adolescents for routine medical problems must consider the potential for self-destructive behavior, regardless of the presenting complaint.

Adolescent↗
PubMed1992

A longitudinal study of metacarpal bone morphometry in anorexia nervosa.

Osteoporosis is a known complication of anorexia nervosa. Although calorie and mineral malnutrition may contribute to changes in bone mass and morphometry, hypoestrogenism is thought to be the most important etiologic factor. In a seven-year longitudinal study of six women aged 19 to 35 years with adolescent-onset anorexia nervosa, the objective was to correlate menstruation and bone morphometry. At the onset of the study, five women were amenorrheic and had abnormal metacarpal bone morphometry. After seven years, three women remained amenorrheic and below 85% of ideal body weight. Anteroposterior roentgenographs of the nondominant second metacarpal taken at the beginning and end of the study revealed an increase in medullary canal diameter (p less than 0.03) and medullary area (p less than 0.04) and a decrease in combined cortical thickness (p less than 0.04) and percent cortical area (p less than 0.02). These findings suggest progressive endosteal resorption in the absence of compensatory periosteal apposition. Such bone remodeling characteristics are distinctly abnormal in this age group. The three women who regained menses showed up to one third less endosteal resorption and less cortical thinning than did the three women who remained amenorrheic. Resumption of menses may be an important milestone in preventing further cortical bone loss in anorexia nervosa.

Adult↗
PubMed1991

Risk factors for injury during adolescence.

Injuries kill more American adolescents than all other diseases combined. It is unclear, however, if adolescents are able or willing to provide the information necessary to characterize their risk for injury. Our objective was to determine if adolescents hospitalized for severe injury are more likely than those hospitalized for acute illness to describe risk factors for injury such as: previous injury, family dysfunction, recent stress, or substance use. All patients completed the Offer Self-Image Questionnaire, the Life-Events Scale for Adolescents, the Adolescent Alcohol-Involvement Scale, and the NIDA Adolescent Drug Use Survey. There were no differences between injured and ill adolescents in demographics, impulse control, emotional tone, perceived family function, alcohol scores, or use of cigarettes, marijuana, or other illicit drugs. The groups differed significantly in sex, previous serious injury, previous hospitalization for injury, injury after alcohol or drug use, and life-event scores. The most common life stresses reported were parental or sibling hospitalization, death of a grandparent, school failure or suspension, getting a summer job, and breaking up with a girl/boy friend. Two variables comprised a stepwise logistic regression model designed to differentiate injured from ill adolescents: male sex and life-event score. We conclude that adolescent boys with recent stressful events may be at high risk for unintentional injury.

Adolescent↗
PubMed1991

A human immunodeficiency virus peer education program for adolescent females.

Black adolescent females living in urban environments are at high risk for human immunodeficiency virus (HIV) infection. Our objectives were to develop an HIV peer education program and to pilot-test its effect on knowledge and sexual behavior. Between September 1989 and March 1990, all females aged 12-19 years attending an inner-city, hospital-based adolescent clinic were invited to meet individually with trained peer educators (10 females aged 16-19 years) to discuss acquired immunodeficiency syndrome (AIDS) and its prevention. Each participant completed a modified version of the AIDS Knowledge and Attitudes Survey immediately before and 2-6 weeks after the counseling session. Of the 283 counseled patients, 241 (85%) completed the follow-up questionnaire and comprised the study sample. Mean age was 15.6 years, mean Hollingshead (parental occupational) score was 3.4, and 216 (90%) patients were black. Baseline knowledge about routes of transmission was high and did not improve on follow-up. Comparison of individual baseline and follow-up responses revealed improvements (p less than 0.05) in routes by which HIV is not transmitted, methods of prevention, individuals at risk, and general information about AIDS. The improvement in total score between baseline and follow-up was 38% for patients with low baseline scores, 13% for middle scores, and 3% for high scores (p less than 0.05). At baseline, 50 (21%) patients reported sexual intercourse within the preceding 2 weeks, compared to 33 (14%) at follow-up (p less than 0.05). Of the sexually active patients, 22 (44%) reported no condom use at baseline, compared to 11 (33%) at follow-up (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1989

Risk factors for low birth weight to adolescent mothers.

The medical records of mothers less than age 20 years who delivered infants weighing 2500 g or less (n = 112) and 2500 g or more (n = 465) were reviewed to identify factors associated with low birth weight. Of the 26 medical and sociodemographic variables examined, four entered a logistic regression model to differentiate low from normal birth weight mothers: five or fewer prenatal visits, a history of a prior low birth weight infant, illness during pregnancy, and trauma (surgery or injury) during pregnancy. The relative risks and adjusted odds ratios for low birth weight associated with these variables ranged from 1.99 to 4.31. Five or fewer visits accounted for the largest proportion of low birth weight, with an etiologic fraction of 0.43. The ability of the model to discriminate between low and normal birth weight mothers was modest; its sensitivity/specificity was 0.73/0.57 in the original sample and 0.62/0.49 in a separate validation sample (n = 329). The model clarifies the factors associated with adolescent low birth weight and suggests that intervention efforts should focus on early pregnancy identification and regular prenatal care.

Adolescent↗