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Biomedical subjects

H Spivak

Publications and source records attributed to H Spivak.

8 recordsLinked to original sources

Patterns of teen exposure to a community-based violence prevention project.

This paper describes the implementation of a community-based youth violence prevention project that utilized an educational curriculum and a mass media campaign. The extent of penetration of the intervention into target areas and the degree of contamination of control areas are assessed, and the most frequently contacted forms of educational outreach are identified. Two sources of data, provider interviews and a random digit dialed telephone survey, were used to track the source and extent of teens' exposure to the intervention. Agency provider data revealed that 40% of the 92 contacted agencies actually conducted violence prevention education, reaching 22% of the target area teens. Approximately one-half of the surveyed teens reported some exposure to the program, with 13% of the teens in target areas reporting participation in interactive educational activities associated with the project. The most common source of exposure was the media campaign. Most teens report a single exposure, usually to the media campaign, although 29% report contact with more than one form of violence prevention education. While the project did not achieve community saturation, the data show that the community-based model of intervention for violence prevention is feasible and effective in reaching teenagers. This research highlights some difficulties in evaluating prevention programs, including reconciling community ownership with project identification, the ethics of curtailing services for control purposes, and factors influencing recall of participation.

Adolescent

Bacteremia in an ambulatory setting. Improved outcome in children treated with antibiotics.

We undertook a study of 414 bacteremic patients (167 with Haemophilus influenzae and 247 with Streptococcus pneumoniae bacteremia) to evaluate their clinical presentation, laboratory and clinical results, and subsequent outcomes. Patients with H influenzae bacteremia were more likely to have soft-tissue foci, poorer clinical appearance at presentation, and be at higher risk for subsequent serious focal infections, persistent bacteremia, and subsequent hospital admissions than patients with S pneumoniae. Patients with H influenzae bacteremia had a 21.1-fold increase in risk of meningitis (95% confidence interval [CI] of 3.8 to 78.0) compared with those with S pneumoniae. The odds ratio for initial lumbar puncture was 5.25 (95% CI [1.1-23.6]). Ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft-tissue infections, persistent bacteremia, or to require subsequent hospital admissions than untreated patients. The effect of treatment was greater for patients with S pneumoniae than those with H influenzae. Careful follow-up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft-tissue infections.

Adolescent

Adolescent interpersonal assault injury admissions in an urban municipal hospital.

To extend the study of the epidemiology of interpersonal violence into the area of nonfatal intentional injury, a retrospective study was undertaken of patients admitted to a major city hospital for intentional injury during a single year (1984-1985). This study focused on interpersonal assaultive injury, excluding sexual assault, child abuse, and self-inflicted injuries. Relevant injuries made up three-quarters of all admitted intentional injuries and represented a total of 671 patients (4.5% of all hospital admissions). The intentionally injured were compared to the catchment area population and to the remaining admitted hospital population, by age, sex, and race. Medical records of intentionally injured adolescents (n = 133) were reviewed and compared to a sample of adolescent homicide victims regarding the circumstance of the event and the relationship of victim to assailant. Relevant findings are that: (1) in the area served by this hospital, male adolescents are at relatively high risk for nonfatal intentional injury; (2) among adolescents, the majority of these intentional injuries are the result of interpersonal conflicts between acquaintances, paralleling the etiology of homicide: (3) a prevalence of missing data in the medical records of older male adolescents is symptomatic of the lack of attention that has been paid to understanding and preventing intentional injury among adolescents. It is concluded that: (1) more area-specific and hospital-based studies of intentional injury are needed as a guide to such preventive efforts; and (2) medical personnel providing acute care to victims of intentional injury are an important resource for this research and prevention effort.

Adolescent

Practitioners' forum: public health and the primary prevention of adolescent violence--the violence prevention project.

The Violence Prevention Project is a community-based outreach and education project directed toward reducing the negative social and medical outcomes of violence among adolescents. Community agency personnel are trained to work with youth on issues of anger and conflict resolution. A mass media campaign advertises the issue to the broader population. Interventions, such as the Violence Prevention Project, can use the public health strategies to increase awareness of the problem and associated risk factors, provide alternative conflict resolution techniques, and generate a new community ethos around violence. This approach holds great promise in an area in which after-the-fact legislative and punitive interventions have not worked.

Adolescent

Dying is no accident. Adolescents, violence, and intentional injury.

Violence and its consequences are a major issue to be addressed by the health care community. The magnitude and characteristics of the problem cry out for new, creative approaches and provide for some insight into the direction that needs to be taken. Some of the components related to violence are societal in scope and will require long-term strategies well beyond the immediate realm of the health care system. Others provide direction that more clearly present a role for health providers and public health planners. Although there will be no easy answers or solutions to this problem, it is essential that support be developed for experimental efforts. The health community cannot ignore this problem and can in fact make a real contribution to its resolution through prevention, treatment, and research.

Adolescent

Social barriers faced by adolescent parents and their children.

Pregnancy and childbearing are well recognized as having significant, long-term consequences for teenagers. Recent literature documents an array of negative outcomes for children born to adolescents, with a range of factors identified as contributing to the problems observed in these children. These include (1) the characteristics of those teenagers most likely to become parents, (2) the social and economic consequences of early childbearing, (3) the increased biologic vulnerability of children born to teenagers, and (4) the nature of parenting by teenagers. It has been acknowledged that adolescent parents tend to come from high-risk families, have poor academic achievement, and live in our most disadvantaged communities and therefore, biologic, economic, and behavioral factors contribute to the increased likelihood of teenagers having children who are vulnerable to physical and developmental problems. Teenaged parents face many obstacles to economic and social success, and these further influence the environment in which their children grow up. Adolescents also experience many difficulties in adjusting to parenthood and display a range of suboptimal parenting practices. Whereas some of these factors appear highly resistant to change, others have clear clinical, programmatic, and policy implications.

Achievement

Hunger debate.

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Child