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Biomedical subjects

S J Emans

Publications and source records attributed to S J Emans.

At least 73 records · Page 4Linked to original sources
PubMed1994

Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity.

We undertook a prospective study of 300 postmenarcheal female subjects (median age, 18.0 years) to examine (1) the relation of tampon use, sports participation, prior gynecologic examination, and consensual sexual activity to hymenal anatomy, (2) the factors leading to choice of tampons by girls not sexually active, and (3) factors related to ease of gynecologic examination. The sample included 100 subjects in group 1, who denied sexual intercourse and used only pads for menses; 100 subjects in group 2, who denied sexual intercourse and had used tampons; and 100 subjects in group 3, who gave a history of sexual intercourse. Sexually active subjects (81%) were significantly more likely than tampon users and pad users to have "complete clefts" in the lower hymen between the 2 o'clock and 10 o'clock positions (p < 0.001); tampon users were not significantly different from pad users (11% vs 5%). In subjects who were not sexually active, the presence of these complete clefts was not related to participation in sports or to prior pelvic examination. Although median hymenal opening diameter differed in the three groups (1.2 cm for group 1 vs 1.5 cm for group 2 vs 2.5 cm for group 3; p < 0.0001), the ranges of measurements were wide. Tampon users were significantly more likely than pad users to have mothers and friends, but not sisters, who had a favorable attitude toward tampon use. The best predictors of tampon use in a multivariate model were a favorable maternal attitude (odds ratio (OR), 5.3; 95% confidence interval (CI), 2.4, 12.1) and friends' use of tampons (OR 7.9; 95% CI 3.5, 18.1). Only 26% of speculum examinations in pad users were rated as easy compared with 56% of examinations in tampon users and 81% in sexually active young women (p < 0.001). The best predictors of ease of speculum examination were sexual activity (OR 15.9; 95% CI 1.9, 135.3) and tampon use (OR 3.6; 95% CI 1.0, 12.7). This large sample should provide useful data for physicians who testify in sexual assault cases and gives new information on the predictors of tampon use and ease of gynecologic examination in young women.

Adolescent↗
PubMed1993

Cholesterol screening in the adolescent.

Guidelines for screening populations for hypercholesterolemia are controversial. In pediatric patients, screening has been targeted to those with a family history of hypercholesterolemia or early myocardial infarction. Because specific guidelines for adolescents have not been developed, we undertook a study of cholesterol screening in 224 consecutive patients (mean age, 14.8 +/- 2.2 years; range, 11-20 years). In this study, 33 (14.7%) adolescents had levels above 185 mg/dL; 71 (32.7%) of the patients reported a positive family history for early myocardial infarction or elevated lipids. A positive family history obtained from the adolescent patient had a 36% sensitivity, 69% specificity, 17% positive predictive value, and an 87% negative predictive value compared with elevated cholesterol level. A positive history reported by the parent had a 65% sensitivity, 46% specificity, 16% positive predictive value, and an 89% negative predictive value. A positive family history obtained from either parent or adolescent had a 45% sensitivity, 69% specificity, 19% positive predicative value, and 89% negative predictive value. Family history by the adolescent was significantly different from parental history (p < 0.001). Family history is a poor predictor for cholesterol level in adolescents.

Adolescent↗
PubMed1993

A pilot study of AIDS education and counseling of high-risk adolescents in an office setting.

Little is known about interventions in office practices aimed toward reducing behaviors that put adolescents at risk for human immunodeficiency virus (HIV) acquisition. We therefore targeted a pilot study of HIV education and counseling to high-risk adolescents. Ninety adolescent patients (mean age, 17.6 +/- 2.0 years) were interviewed in a hospital-based adolescent clinic by two physicians and randomized to two groups: 1) a standard care group that was interviewed about high-risk behaviors at 0 and 2 months; and 2) an intervention group that was similarly interviewed but was also given a detailed discussion about HIV risks and prevention. At follow-up (mean, 2.6 +/- 0.8 months), 25% of patients reported less sexual activity (standard care, 32%; intervention, 18%) toward a trend. The reduction in mean number of partners per month was 0.4 +/- 0.9, (p = 0.0001). Fifty-four percent of the patients reported that they used condoms more often than previously with no significant difference between the two groups. Use of condoms ("always use") increased in both groups significantly (p = 0.03 standard care, p = 0.02 intervention). Use of condoms at last intercourse increased in the intervention group (37% to 42%, p = 0.03). In the interval, there were no significant differences between the groups in the number of newly diagnosed sexually transmitted diseases or in the number of patients seeking HIV testing. The number of patients stating that they shared needles decreased from 3 to 0. Both the intervention and standard care groups reported a reduction in high-risk behaviors that was temporally related to the discussion of this subject in the clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
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↗