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PubMed1984

Satisfaction with health care. A predictor of adolescents' appointment keeping.

Adolescents are assuming greater responsibility for their own health care, yet have a high rate of broken appointments. The importance of satisfaction with their health care in determining appointment compliance has been demonstrated for adult patients. The purpose of the present study was to explore patient satisfaction among teenagers and its relationship to appointment keeping. A short, reliable instrument was developed to assess adolescent patients' satisfaction with their clinic care. The patient's satisfaction was highly correlated with subsequent compliance in coming for appointments. Satisfaction, hence, appointment keeping, was higher in females, older adolescents, those making their own initial clinic appointment, those with a positive body image, and those scoring high on a test of personal freedom.

Adolescent↗
PubMed1986

Pregnancy outcomes among adolescent and older women receiving comprehensive prenatal care.

This study compares three birth outcomes, gestational age, birthweight, and type of delivery, among adolescent and older mothers. Data were collected from 911 women who attended a comprehensive prenatal-care program in a large urban teaching hospital. Women aged 13-19 years were at increased risk for low-birth-weight babies (less than 2500 g) and for preterm infants of fewer than 38 weeks gestation, even with antenatal care, ethnicity, and other factors controlled. Results of bivariate analyses suggested that women aged 20-36 years are more likely than adolescent mothers to have a cesarean section; however, multivariate analyses suggested that maternal age was not an important factor in relation to type of delivery. Thus, even with similar comprehensive care, pregnant adolescents were at an increased risk of some adverse outcomes. However, the amount of antenatal care is a more important predictor of pregnancy outcome than is maternal age.

Adolescent↗
PubMed2001

A European hospital survey to determine the extent of psychological services offered to patients with severe burns.

Analogous to a hospital survey in North America (the US and Canada) a survey in Europe was performed to determine the extent of psychological services offered in burn units. The questionnaire used to acquire this information was exactly the same in both continents. One hundred and seventy questionnaires and self-addressed stamped envelopes were sent to the medical manager of the European burn units with the request to pass the questionnaire to the person who provides psychological care to patients in the burn units. The questionnaire was translated into four other languages. Response was 103 (62.8%). The questions posed inquired after what percentage of patients received psychological testing, psychological therapy, displayed symptoms of depression and post-traumatic stress, what percentage is given referral and if emotional follow-up is arranged. Also questions about whether staff members of the burn unit displayed symptoms of depression and post-traumatic stress were enclosed. Results indicated that few burn units in Europe provide formal psychological testing for their patients and in half of the European hospitals, less than 20% of the patients receive psychological therapy or counselling during their stay in the hospital. Aftercare services are also capable of improvement. Compared with North America, Europe provided less psychological services. No statistical differences were found between countries within Europe.

Burn Units↗
PubMed1995

Compliance with return appointments for reproductive health care among adolescent Norplant users.

PURPOSE: Norplant's long duration of action may result in users being less motivated than non-users to return for reproductive health care appointments. This study determined compliance with scheduled return appointments among adolescents using Norplant and those using other methods of contraception. METHODS: We retrospectively reviewed the records of all teenagers (age < or = 18 years) who received Norplant between June 1991 and August 1993, as well as those of a comparison group of adolescents, matched for age and race, using other methods of contraception. Subjects receiving Norplant were given appointments for a two-week and an annual examination. Comparison subjects were given only an appointment for an annual examination. Norplant users not returning within 5 weeks or any subject not presenting within 12 months for an annual examination, were considered non-compliant. RESULTS: Eighty-eight adolescents received Norplant during the study period and the records of 85 were available for review. Only 48 of the 85 Norplant users returned for scheduled two-week check-up, while 18 of 43 subjects who had Norplant at least 12 months were compliant with annual examinations. The compliance rate with annual examinations among the 89 subjects not using Norplant was 38%, not dissimilar from that of the Norplant group. CONCLUSIONS: These data demonstrate that compliance with return appointments for reproductive health care among adolescent Norplant users is poor but not significantly worse than that of non-users of Norplant. Strategies promoting the benefits of return visits need to be improved for adolescents receiving contraception.

Adolescent↗
PubMed2003

Environmental allergens and asthma in urban elementary schools.

BACKGROUND: Asthma in school children is rising, and indoor allergens are very common triggers of asthma attacks; however, the risk of the school environment on asthma has not been well studied. OBJECTIVE: To determine the presence and the levels of common aeroallergens in schools, where asthma prevalence rates are high. METHODS: Settled dust samples were collected from 12 Baltimore City public elementary schools, and they were analyzed for the following allergens: cockroaches (Bla g 1/2), dust mites (Der f 1/p 1), dog (Can f 1), cat (Fel d 1), and mouse (Mus m 1). School asthma prevalence rates were correlated with allergen levels, and association between allergen levels and other risk factors present in the schools' environment was examined. RESULTS: The mean and range levels were 1.49 U/g (0 to 8) for Bla g 1/2; 0.38 microg/g (0 to 11.9) for the Der f 1/p 1; 1.44 microg/g (0.1 to 9.6) for Can f 1; 1.66 microg/g (0.2 to 12) for Fel d 1; and 6.24 microg/g (0.3 to 118.3) for Mus m 1. Dust mite, cat and dog allergens were significantly in rooms with carpet and/or area rugs, compared to rooms with bare floors (P < 0.05). Asthma prevalence rates varied from 11.8 to 20.8% between schools and positively correlation with the mean levels of Bla g 1/2 in the schools (P = 0.001). CONCLUSIONS: Common allergens that are known to trigger asthma were detected in all school environments, where asthma prevalence rates were high. However, the overall allergen levels were low, indicating that other factors, including exposures in the homes of asthmatic patients, may have more relevance to sensitization and symptoms than school exposures.

Air Pollutants↗
PubMed1991

Intention versus behaviour in parental sex preferences among the Mukogodo of Kenya.

The relationship between parents' stated sex preferences for children and actual parental behaviour towards sons and daughters is examined among the Mukogodo, a group of traditional pastoralists in rural Kenya. Although their cultural values are male-centered and they tend to express a preference for sons, Mukogodo parents actually appear to be more solicitous of daughters, and the Mukogodo have a strongly female-biased childhood sex ratio. Studies of stated sex preferences should therefore be coupled with attempts to assess actual parental investment in sons and daughters.

Child, Preschool↗
PubMed2002

Immunoglobulin G antibodies of children exposed to microorganisms in a water-damaged school.

The aim of this study was to determine whether exposure to fungi (molds and yeasts) among children attending a water-damaged school was reflected by the children's immunoglobulin G (IgG) response to microorganisms typical of water damage and whether the presence of these IgG antibodies was associated with respiratory symptoms and morbidity. The relationships between positive IgG antibodies and atopy, described as elevated allergen-specific immunoglobulin E (IgE) antibodies, were also examined. The study population consisted of a randomly selected group of exposed children attending a water-damaged school and a group of unexposed children of the same age. Serum samples for analyses of IgG and IgE antibodies were drawn from the children. The respiratory morbidity, the number of positive IgG antibodies to nine microorganisms indicating water damage, and IgE sensitization to common environmental allergens (Phadiatop) were studied. The mean number of positive IgG findings was significantly higher among the exposed children. The number of positive IgG antibodies did not correlate with respiratory illnesses or symptoms at the individual level even though the exposed children who had positive IgG antibodies to four or more microorganisms in the total group comparison tended to have higher respiratory morbidity. In the exposed group, a negative correlation was found between the number of positive IgG antibodies and the total value of allergen-specific IgE antibodies. As among adults exposed to microorganisms at work, IgG antibodies in children seem to be a relevant indicator of exposure to microorganisms in a water-damaged school on the group level.

Allergens↗
PubMed2003

Mold-specific immunoglobulin G antibodies in a child population.

The determination of immunoglobulin G (IgG) antibodies to molds has been used as an objective evidence of significant mold exposure. Until present, no data have been published on antibody responses to molds in healthy children living in normal housing conditions. The microbe-specific IgG antibody concentrations of 21 molds and 3 actinobacteria were determined by enzyme-linked immunosorbent assay (ELISA) in 103 1- to 6-year-old children (12.4% of the population of that age), and in 111 7- to 14-year-old school children (12.1%). The international standard sera were available, and the IgG concentrations of the test sera could be expressed in mg/l. On average, IgG concentrations increased in relation to age until the age of 6-7 years. At school age the increase still continued but more slowly. Actinobacteria were the only exceptions; all three tested strains Sreptomyces albus, S. griseus and S. halstedii resulted in rather high concentrations until 3 years of age. If the children lived in a farm, mold-specific IgG concentrations increased at an earlier age than in other children. The results between farmers' children and other children differed significantly before school age for 20 of the 24 microbes tested, the four exceptions being the 3 actinobacteria and the mold Aspergillus versicolor. The reference values must be age related, and separate references are needed for farmers' children before school age.

Actinobacteria↗
PubMed1987

Patient exposition and provider explanation in routine interviews and hypertensive patients' blood pressure control.

Hypertensive patients' expressing themselves in their own words (Exposition) and providers' giving information (Explanation) during medical interviews were hypothesized to be associated with subsequent blood pressure control. Transcripts of routine return visits to clinics in low-income areas of Houston, TX, were coded using the Verbal Response Modes (VRM) system. VRM indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home interviews 2 weeks after the clinic visits. Patient Exposition was significantly correlated with reductions in systolic and diastolic blood pressure from clinic visit to home interview, and Provider Explanation was significantly correlated with lower diastolic blood pressure at home interview. The results suggest that patients' and providers' verbal behavior in medical interviews should be included in predictive models of blood pressure control.

Adult↗
PubMed2001

Rural practice evaluation: how do rural physicians evaluate their working conditions?

Evaluating the quality of rural doctors' working conditions is essential for retaining physicians in rural areas. We carried out a trial to investigate those aspects of working conditions that are important to rural physicians and with which aspects they are satisfied or dissatisfied. Questionnaires were mailed to 204 doctors who were working in rural clinics in Japan. The professional conditions of rural clinic practices were classified into 17 items. The doctors were then asked to evaluate the importance of and degree of satisfaction with each item. Among the 17 items, the clinic's equipment, the municipal government's attitude and the base hospital were evaluated to be more important than the overall average. With regard to satisfaction, the distance to major cities, the municipal government's attitude and locum availability were rated significantly lower than that overall. There were some items where there was a discrepancy between the importance and the degree of satisfaction. Identifying these discrepancies may contribute to creating an environment that will raise the level of rural physicians' satisfaction.

Adult↗
PubMed1992

Mother's age, birth order and health status in a British national sample.

Using data from a longitudinal study of a national sample of British children, it is shown that mother's age and experience with child rearing are related to the attention paid to the child's health. Younger mothers, whose children are usually the first born, tend to be more concerned with health care facility use than are older mothers of children born subsequently. Younger mothers more often take their child to infant and toddler clinics, and are more likely to have their child immunized against the most threatening of childhood diseases. It is also the younger mothers who more often seek medical care for their children in addition to that provided in the infant and toddler clinics, more often have their child in hospital overnight, and more often report the child to be sickly (less healthy) than do older mothers with several children.

Adolescent↗
PubMed2006

Pharmacy fill patterns in young urban children with persistent asthma.

BACKGROUND: Medication adherence impacts healthcare utilization. Pharmacy records are useful to establish fill patterns. OBJECTIVE: Use pharmacy records to establish medication patterns fill patterns for comparison to healthcare utilization. Methods. Pharmacy records of 175 children with persistent asthma were collected and compared to healthcare utilization. RESULTS: Majority of subjects had significant healthcare utilization, low numbers of rescue medications, and poor controller medication fill rates. Those with more rescue medications had more healthcare utilization and more controller medications. CONCLUSIONS: Pharmacy fill patterns demonstrate few rescue and/or controller medication fills. Those with more rescue medications reported increased healthcare utilization despite controller medications.

Administration, Oral↗