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Biomedical subjects

I F Litt

Publications and source records attributed to I F Litt.

At least 109 records · Page 6Linked to original sources
PubMed1982

Role of self-esteem and autonomy in determining medication compliance among adolescents with juvenile rheumatoid arthritis.

This study was designed to improve understanding of adolescents' compliance with medical regimens. Compliance with salicylate therapy among adolescents with juvenile rheumatoid arthritis was examined in relationship to two of the most important issues of adolescent psychosocial development--self-image and autonomy. Standardized instruments that assessed these variables were administered to 38 adolescents with juvenile rheumatoid arthritis during the year in which compliance was determined, utilizing serum salicylate measurements. Patients and disease-related characteristics were also recorded, and interactions with personality variables were examined. The data show that adolescents with juvenile rheumatoid arthritis who comply with their medical regimen are those who have high self-esteem and are allowed more autonomy than the noncompliers. The longer the duration of the illness and the more symptoms present at onset, the poorer was self-concept, and hence compliance, at adolescence.

Adolescent↗
PubMed1981

Compliance with salicylate therapy in adolescents with juvenile rheumatoid arthritis.

We compared adolescents' compliance with medical regimens with that of younger children and identified characteristics of noncompliant adolescents. Compliance among 82 patients with juvenile rheumatoid arthritis (JRA) was monitored using serum salicylate levels. Fifty-five percent of adolescents and 55% of children were found to have good compliance. Among adolescent patients with JRA, however, the following factors were associated with salicylate therapy non-compliance: longer duration of disease (more than six years); earlier age at onset (under 9 years); later time of referral to a subspecialist; shorter duration of subspecialty clinic care; and fewer clinic visits. Knowledge of these variables will facilitate development of intervention strategies tailored to meet the age-specific needs of this population with chronic illness.

Adolescent↗
PubMed1981

Epidemiology of adolescent dysmenorrhea.

Dysmenorrhea is the leading cause of recurrent short-term school absenteeism among adolescent girls. Controversy surrounds the relative role of psychologic and biologic variables in the pathogenesis of dysmenorrhea. Therefore, data from 2,699 menarcheal adolescents, drawn from a national probability sample of 12 to 17-year-old girls (the National Health Examination Survey), were analyzed by bivariate and multivariate analytic techniques for biologic, psychologic, and demographic correlates of dysmenorrhea. Of 1,611 adolescents (59,7%) who report dysmenorrhea, 14% frequently miss school because of cramps. The greatest proportion of variation of independent variables in a stepwise multiple regression analysis in this study was predicted by gynecologic or postmenarcheal age. Preparation for menarche, a psychologic variable, did not predict either dysmenorrhea or subsequent school absence. Socioeconomic status was positively correlated with dysmenorrhea although race was not. However, black students (23.6%) miss more school because of dysmenorrhea than white students (12.3%) even when socioeconomic status is held constant. Data in this study suggest that biologic variables play a substantial role in the pathogenesis of dysmenorrhea.

Absenteeism↗
PubMed1980

Identifying adolescents at risk for noncompliance with contraceptive therapy.

The sociomedical characteristics of 96 sexually active adolescent females have been studied in order to understand noncompliance with the contraceptive prescription, an important antecendent of adolescent pregnancy. Compliance was found to correlate positively with postmenarchal age, frequency of intercourse, autonomy in making and paying for a clinic appointment specifically for the purpose of obtaining contraception, and acceptance of a method at the time of the initial clinic visit. These findings serve to alert the pediatrician to the adolescent at risk for noncompliance before the experience of failure, and in so doing to identify those in need of special assistance to ensure the success of contraceptive measures.

Adolescent↗
PubMed1980

Compliance with medical regimens during adolescence.

In summary, compliance behavior among adolescents is complex and imcompletely understood. Although the study of compliance is important for understanding the adolescent's stage of psychological development, relationships with authority figures, and the beginning of the youngster's career as a consumer of health care, its ultimate importance lies in the prospect of improving the likelihood that medication will be utilized appropriately. The first step in the process involves systematic monitoring of compliance rather than doing so only when noncompliance is clinically suspected. When compliance is found to be problematic for an adolescent, resorting to "scare" techniques or re-education is rarely effective. A more positive outcome may be achieved by determining the circumstances under which the youngster was successful in complying and attempting to tailor-make the regimen accordingly. Barriers to compliance, such as the presence of side effects, previous negative experience with the medicine, and lack of conviction about the diagnosis of appropriateness of therapy, should always be explored. Other potential intervention strategies for improving compliance have been discussed. In the final analysis, however, as Jonson has noted, all strategies aimed at improving compliance must provide the patient with insight into his own situation and himself, as well as his capability of doing something other than conforming when he judges it best.

Adolescent↗
PubMed1980

Laparoscopy for presumed nonacute salpingitis: a new look at an old problem.

The increased prevalence of venereal disease among adolescents has resulted in a rise in nonacute salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of presumed nonacute salpingitis in 29 adolescents. The patients had a mean duration of symptoms of 5.5 months, 50% had a recent history of discharge and/or bilateral pelvic pain, and on examination 50% had pain on motion of the cervix, 75% had adnexal tenderness, and 50% had a palpable adnexal fullness or mass. Anatomic findings at laparoscopy included normal pelvic structures in 8, active salpingitis in 13 and nonacute disease in 8. The anaerobic, aerobic, and viral peritoneal cultures obtained at laparascopy from 22 patients resulted in no growth in 18. The four with positive cultures had one organism identified in three cases and two organisms in one case. Anatomic findings were more helpful in diagnosis than the bacteriologic analysis, and our results suggest that laparoscopy increases diagnostic accuracy in the management of presumed nonacute salpingitis.

Adolescent↗
PubMed1980

Pubertal changes in daytime sleepiness.

Nineteen children (8 girls, 11 boys) were evaluated in a total of 47 three-day sessions across three summers. Children were ranked according to Tanner's stages of secondary sexual characteristics. Nocturnal sleep was recorded from 2200 to 0800 hr each night. Multiple sleep latency tests were given at 2 hr intervals from 0930 each day. Nocturnal sleep time and REM sleep time remained constant across Tanner stages. Slow wave sleep time declined progressively across Tanner stages, with a 40% reduction from prepuberty to maturity. Daytime sleepiness was significantly greater in subjects at Tanner stages 3 and 4 than at Tanner stages 1 and 2. Subjects at Tanner stage 5 tended to be as sleepy as Tanner stage 3 and 4 subjects but did not differ significantly from the less mature subjects. No gender differences were found in daytime sleepiness for children at similar Tanner stages. More mature children were significantly sleepier at 1330 and 1530 than in the late afternoon and evening.

Adolescent↗
PubMed1980

Juvenile detention: another boundary issue for physicians.

It is estimated that there are 500,000 youngsters in detention in the United States per year. Detention facilities offer a unique environment in which adolescents at high risk for medical problems can be identified and treated. A health care program within the secure juvenile detention facility for New York is described in order to demonstrate how an academic medical center can effect improvement in the health status of underserved, incarcerated youth while meeting professional educational objectives for health trainees. Results of medical services are given for the past 11 years. Medical problems were diagnosed in 46% of the 47,288 adolescents examined. The conditions were grouped into those related to the legal status of the youngsters, socioeconomic background, and/or the institutional setting. The interrelationship of medical conditions with legal, ethical, and youth advocacy issues were demonstrated. The setting affords on opportunity to train primary care physicians with special emphasis on issues such as the nature of the doctor-patient relationship, confidentiality, and patient advocacy, while providing a necessary service to medically disadvantaged adolescents.

Academic Medical Centers↗
PubMed1980

Adolescents' self-assessment of sexual maturation.

The variability in time on onset and progression of puberty warrants the use of stage of sexual maturation rather than chronologic age in assessing biological and behavioral measures during adolescence. The necessity to undress the teenage has seriously curtailed the application of stage of sexual maturation to behavioral and developmental research. This study demonstrated that adolescents can accurately assess their own developmental stage according to Tanner's standard photographs. Self-ratings by 43 females, aged 9 to 17, and 23 males, 11 to 18, were compared to those based on physical examination by one of the investigators. Agreement with the physician rating occurred for breast stage in 37/43, for female pubic hair stage in 40/43, and for male combined pubic hair and genital stage in 21/23 (kappa coefficients: 0.81, 0.91, 0.88). The excellent agreement between physician and adolescent's assessment compared favorably with the interrater agreement of professionals. This study suggests the value of utilizing adolescent self-staging in research. In addition, this exercise provides teenagers with an objective way to understand the wide range of normal pubertal development and to follow their own sexual maturation.

Adolescent↗
PubMed1979

Illicit drug use among urban adolescents. A decade in retrospect.

Over the past decade (1967 to 1977), 76,000 adolescents were screened for a history and somatic signs of illicit drug use at a detention center for juveniles and at an adolescent inpatient unit of a university-affiliated hospital. Dramatic changes in the patterns of drug abuse are reported. Opiate use was prominent in the first half of the decade with a peak in 1970 to 1971 and marijuana use more prominent in the last five years. Inhalant abuse as represented by glue and halogenated cleaning fluids was documented only early in the decade, while the existence of stimulant and depressant abuse follows still other patterns over the decade. Hospital admissions for serious somatic complications of illicit drug use, namely, overdose, drug-related death, hepatic coma, detoxification, and viral hepatitis, were correlated only with trends in the use of opiates. Awareness of drug abuse patterns among adolescents is important for the health professional so that complications can be diagnosed and treated and educational efforts properly directed.

Adolescent↗
PubMed1978

Perihepatitis associated with salpingitis in adolescents.

Perihepatitis, one manifestation of complicated gonorrhea, is infrequently diagnosed and reported. This study was undertaken to examine the incidence of gonococcal perihepatitis in adolescents as well as to study the effect, if any, of this condition on tests of liver function. Accordingly, the records of 137 adolescents with salpingitis were evaluated. Right upper quadrant tenderness or hepatic enlargement was noted in 27, while amino transferase level elevations were observed in 19 of the 59 in whom these tests were performed. All findings resolved promptly following initiation of intravenous penicillin therapy. The observation of hepatic dysfunction in 27% of these adolescents suggests that perihepatitis occurs more frequently than reported in adults and should be considered in the evaluation of the conditions of adolescents with salpingitis or upper abdominal tenderness.

Adolescent↗
PubMed1976

Isoniazid hepatitis in adolescents.

Prophylactic isoniazid therapy is currently recommended for adolescents with positive tuberculin reactions because of the risk of activation of tuberculosis in this age group. Since this drug has been associated with hepatic dysfunction in adults, the present study was undertaken to evaluate its effect on liver function in teen-agers. Accordingly, liver function tests were performed on 178 adolescents prior to and following administration of INH. Abnormalities in SGPT values were encountered in 10% of these patients and occurred in the main within the first 10 weeks of testing, suggesting INH maybe hepatotoxic. However, jaundice was notably absent in the patients with enzyme elevations and prompted a further investigation into the possible effect of INH on bilirubin metabolism. Thus, Sprague-Dawley rats were given four daily injections of INH. These animals manifested increased hepatic bilirubin glucuronyl transferase activity when compared with control rats, supporting the hypothesis that enzymatic induction may be responsible for the absence of jaundice in our adolescent subjects.

Adolescent↗