Search PubMed⌕ Search

Biomedical subjects

S J Emans

Publications and source records attributed to S J Emans.

At least 19 recordsLinked to original sources
PubMed1992

Contraceptive compliance with a levonorgestrel triphasic and a norethindrone monophasic oral contraceptive in adolescent patients.

OBJECTIVE: This study was undertaken to assess the impact of two low-dose oral contraceptive pills on compliance and side effects in adolescent patients. STUDY DESIGN: The use of a levonorgestrel-containing triphasic pill (N = 114) was compared with that of a monophasic (1 + 35) norethindrone-containing pill (N = 110) at two different sociodemographic sites. RESULTS: No significant difference in compliance or pill satisfaction was observed between the pills. Socioeconomic factors were the overriding predictors of compliance. At 3 and 12 months of follow-up, there were significantly fewer complaints of overall side effects (p less than 0.001 and p = 0.004, respectively), breakthrough bleeding (p = 0.017 and p = 0.018), and pill amenorrhea (p = 0.002 and p less than 0.001) among users of the triphasic pill. Mean weight change at 12 months was +1.1 kg for the monophasic pill and -0.1 kg for the triphasic pill. All known pregnancies occurred among noncompliant city clinic patients. CONCLUSIONS: Adolescents experienced fewer side effects with the triphasic pill than with the monophasic one, but compliance was the same.

Adolescent↗
PubMed1992

Sexual abuse of children and adolescents.

Clinicians are seeing greater numbers of children and adolescents suspected of being sexually abused. In the past, the interpretation of the medical findings was hampered by a lack of knowledge of normal anatomy and genital flora in the nonabused prepubertal child. The quality of more recent studies has been improved by the use of more appropriate controls and by the thorough evaluation of reportedly normal girls to ensure that they are truly nonabused. Such studies have provided the clinician with more accurate medical data with which to support the diagnosis of child sexual abuse.

Adolescent↗
PubMed1992

Appearance of the hymen in prepubertal girls.

The recent increase in requests for genital examinations in girls who may have been sexually abused has necessitated detailed information not previously available on normal anatomy of the prepubertal girl. This study was undertaken to document the genital anatomy of 211 girls between the ages of 1 month and 7 years who presented for well child care or nongynecologic complaints and who had no history of sexual abuse. Each child's genitalia was examined and photographed, with findings reported reflecting those observed photographically. The study population consisted of 36% blacks, 33.6% white non-Hispanics, 29.9% Hispanics, and 0.5% Asians. Subjects had a mean age of 21 +/- 20.6 (SD) months. Extensive labial agglutination sufficient to obscure the hymen was noted in 5% (10/211) and partial agglutination in an additional 17% (35/211). A significant difference was noted in hymenal configuration by age, with a fimbriated hymen the most common type (46%) in infants aged 12 months or younger and a crescentic hymen the most common (51%) in girls older than 24 months (P less than or equal to .001). No significant difference was noted in hymen configuration by race. Hymenal bumps (mounds) were observed in 7%, hymenal tags in 3%, vestibular bands in 98%, longitudinal intravaginal ridges in 25%, and external ridges in 15% of subjects in whom the anatomy under study could be visualized. Hymenal notches (clefts) occurred superiorly and laterally on the hymenal rim but none were found inferiorly on the lower half of the hymen. A narrow rounded hymenal ring with a transection was observed in only 1 (0.5%) of 201 subjects and was not considered a normal finding.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

First catch urine sediment for Chlamydia trachomatis and Neisseria gonorrhoeae culture in adolescent males with pyuria.

Traditionally, only symptomatic males or those with a history of exposure are tested for sexually transmitted diseases (STDs). Since urethral infections with Chlamydia trachomatis and Neisseria gonorrhoeae are frequently asymptomatic, a practical, sensitive, and acceptable screening method is desirable. Fifty sexually active males with pyuria (age 13 to 22 years old) diagnosed with 1+ or 2+ leukocyte esterase (LE) dipstick on first catch urine (FCU) were further evaluated by culture of urethral swabs and centrifuged FCU samples for N. gonorrhoeae and C. trachomatis. Eighty-six percent had one or more positive cultures: 17 (34%) N. gonorrhoeae, 18 (36%) C. trachomatis, and 8 (16%) both organisms. FCU culture for N. gonorrhoeae had a 100% sensitivity, specificity, and positive and negative predictive value when compared to urethral swab cultures. FCU culture for C. trachomatis had a 32% sensitivity, 95% specificity, 89% positive predictive value, and a 53% negative predictive value compared to urethral culture. On the basis of the results of this study, one urethral swab can be eliminated when evaluating male adolescents for urethritis by using spun FCU culture for N. gonorrhoeae. Continued efforts should be made to develop optimal tests to detect STDs which are reliable and encourage compliance in this high-risk group.

Adolescent↗
PubMed1990

Estrogen deficiency in adolescents and young adults: impact on bone mineral content and effects of estrogen replacement therapy.

Because the long-term effects of estrogen replacement in adolescents with ovarian failure and hypothalamic amenorrhea have not been previously studied, we conducted a 2-year study of 35 patients to determine factors contributing to baseline bone density measures (bone density, bone mineral content, and bone width) and the response to estrogen therapy. Estrogen-deficient patients were often profoundly osteopenic by single-photon absorptiometry of the radius and dual-photon absorptiometry of the spine, despite estrogen replacement. Variables that were significant predictors of better initial single-photon absorptiometry measurements included increased age, increased body mass index, spontaneous pubertal development, lack of radiation therapy, and lower serum osteocalcin. Patients treated with estrogen/progestin had stable cortical bone mineral content and bone density at the distal one-third of the radius, a slight improvement in bone density at the distal one-tenth of the radius, and on encouraging, but marginal, improvement in the z score (standard deviation from the mean) of bone mineral content at the distal one-tenth. The z scores for cortical bone width and bone density decreased, suggesting a possible relative worsening over time. In untreated estrogen-deficient girls, bone mineral content and bone density decreased (but not significantly); the z score of cortical bone width showed a significant decrease. Using dual-photon absorptiometry, a history of radiation therapy was found to be a predictor of lower bone density compared with age-matched controls. Estrogen progestin therapy did not result in changes in serum levels of lipids and antithrombin III, weight, or blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1989

Anorexia nervosa, athletics, and amenorrhea.

Menstrual dysfunction is common in adolescents who are involved in intensive athletic activity or who are limiting their nutritional intake excessively. The mechanism for hypothalamic amenorrhea in athletes and dieters is not yet fully understood. Other causes of menstrual dysfunction due to pregnancy, central lesions, hormone imbalance, or ovarian failure should be excluded in the athlete with amenorrhea. Amenorrheic patients who have sufficient estrogen effect on their endometrium to have withdrawal bleeding following exposure to progestins should be cycled with progestins on a regular basis to prevent endometrial hyperplasia. Estrogen replacement with cyclic progestin should be considered in the hypoestrogenic adolescent with prolonged amenorrhea. The long-term consequences of hypothalamic amenorrhea in adolescents remain to be determined.

Adolescent↗
PubMed1988

Treatment with dexamethasone of androgen excess in adolescent patients.

Fourteen hirsute girls, ages 12 to 22 years (mean +/- SD: 17.2 +/- 2.6 years), in whom 21-hydroxylase deficiency was excluded by a 1-hour intravenous alpha 1-24 corticotropin test, were evaluated by a 4-day dexamethasone test and then treated with a bedtime dose of dexamethasone (0.5 mg in 10 patients, 0.25 mg in four) for 0.6 to 3.4 years (1.3 +/- 0.8 years). Hirsutism decreased in four patients, did not change in nine, and increased in one. Of the 10 patients with irregular menses, only three developed regular cycles while taking dexamethasone. During long-term dexamethasone therapy, serum levels of testosterone decreased from 102 +/- 22 to 72 +/- 27 ng/dL, free testosterone from 35 +/- 11 to 19 +/- 8 pg/mL, and dehydroepiandrosterone sulfate from 396 +/- 138 to 171 +/- 101 micrograms/dL. Although free testosterone decreased to less than 15 pg/mL in eight of 14 patients with the suppression test, only four patients had free testosterone levels less than 15 pg/mL during therapy. Two of the 14 patients have had no recurrence of hirsutism or increase in serum androgens after 28 and 29 months, respectively, after dexamethasone therapy was discontinued. Oral contraceptives were given to nine patients inadequately responsive to bedtime dexamethasone therapy. The mean percent decrease of testosterone and free testosterone levels during oral contraceptive therapy was significantly greater than during long-term treatment with dexamethasone, and hirsutism lessened in all. We conclude that a single bedtime dose of dexamethasone is satisfactory only in patients who maintain serum free testosterone values less than 15 pg/mL without side effects. For other patients, either another glucocorticoid or, in most cases, ovulation suppression should be prescribed for adolescents with progressive hirsutism and elevated androgen levels.

17-Ketosteroids↗
PubMed1987

Dipstick leukocyte esterase activity in first-catch urine specimens. A useful screening test for detecting sexually transmitted disease in the adolescent male.

Although sexually active female adolescents are often routinely screened for sexually transmitted diseases, indications for culturing adolescent males for sexually transmitted urethral infections are controversial. A study of 54 sexually active males (14 to 22 years old) was undertaken to assess the reliability of using dipstick leukocyte esterase activity in first-catch urine specimens to detect urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Eighteen males had sexually transmitted diseases: N gonorrhoeae (nine patients), C trachomatis (eight patients), and N gonorrhoeae and C trachomatis (one patient). First-catch urine specimens with a 1+ (mild) or 2+ (moderate) reaction on dipstick testing had a leukocyte (WBC) count of 10 WBCs per high-power field or greater on microscopic analysis, with an 83% sensitivity, 100% specificity, a 100% positive predictive value, and a 92% negative predictive value for the presence of N gonorrhoeae, C trachomatis, or both. Clinical criteria for screening (urethral discharge, dysuria, or exposure to a sexually transmitted infection) plus a dipstick-positive first-catch urine specimen had a 94% sensitivity, 89% specificity, an 81% positive predictive value, and a 97% negative predictive value.

Adolescent↗
PubMed1987

Adolescents' compliance with the use of oral contraceptives.

To elucidate the factors that might influence compliance with oral contraceptive use among sexually active adolescents, we undertook a study of 209 unmarried adolescents initiating use of oral contraceptives in three different settings: an inner-city adolescent clinic, a birth control clinic in a midsized industrial city, and a suburban private practice. At the three-month follow-up visit, factors associated with compliance included older age, suburban residence, white race, health care in the suburban private practice, payment status, prior use of contraception, mother's unawareness of oral contraceptives, married parents, older boyfriend, lack of worry about being pregnant, and satisfaction with pill use. Compliance at long-term follow-up (13.5 +/- 3.7 months) was additionally associated with educational goals, father's education level, and absence of side effects. Ten pregnancies occurred during the study period among noncompliant site I patients. Inner-city clinic patients were at high risk of noncompliance and unplanned pregnancy.

Adolescent↗