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PubMed1998

Predictors of HIV infection among newly sentenced male prisoners.

The prevalence of individuals with or at risk for HIV infection in prisons and jails is severalfold higher than age-adjusted rates in surrounding communities. This HIV serosurvey of 975 newly sentenced male prisoners employed a new methodology that anonymously linked individual information to HIV serologic data. The HIV prevalence was 6.1%; multivariate regression analysis indicated injection drug use (OR = 18.9), black race (OR = 5.5), Hispanic ethnicity (OR = 3.4), psychiatric illness (OR = 3.1) and a history of having had a sexually transmitted disease (OR = 2.2) were independent predictors of HIV infection. Laboratory markers such as hypoalbuminemia, an elevated aspartate aminotransferase (AST) level, leukopenia, anemia, and thrombocytopenia suggest increased risk for HIV among prisoners, particularly in settings where HIV testing resources are scarce. This study, unlike those reported in other geographic regions, indicated that the majority (71%) of HIV-seropositive persons self-reported their HIV status. This finding may suggest that HIV-infected individuals will self-report their status if HIV care is comprehensive and consistent. The large number of HIV-infected individuals within prisons makes prisons important sites for the introduction of comprehensive HIV-related care. This is particularly relevant in that development of new guidelines issued for the management of HIV infection in which potent combination antiretroviral therapy has been demonstrated to decrease morbidity and mortality. The high prevalence of HIV-seronegative inmates with self-reported high-risk behaviors also suggests the importance of prisons as sites for the introduction of appropriate risk-reduction interventions.

Adolescent↗
PubMed2002

Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons.

OBJECTIVE: To understand better the barriers among orthopedic surgeons and primary care physicians in identifying and treating possible osteoporosis in patients hospitalized with a fragility fracture sustained spontaneously or from a fall no greater than standing height. METHODS: A 1-page, 7-question survey was sent to 35 admitting orthopedic surgeons and 75 primary care physicians at a midwestern managed care organization in March 2001. Returned surveys were collected until 30 days had passed since the mailing. Primary care physicians were board-certified family practitioners and internal medicine physicians. All orthopedists were admitting surgeons in the hospital system. Responders were anonymous, and posted surveys were returned to the Orthopaedic Collaborative Practice office. The surveys were color-coded to separate responses from orthopedic surgeons and primary care physicians. RESULTS: Thirty-one surveys were returned: 23 (31%) from primary care physicians and 8 (23%) from orthopedic surgeons. Survey respondents agreed that the responsibility for postfracture attention to nutritional needs, including calcium and vitamin D, rested with the primary care provider. When asked about barriers to recommending bone mineral density testing with dual energy x-ray absorptiometry, 9 primary care physicians (39%) thought this type of testing was unnecessary for treatment, and 4 primary care physicians (17%) thought a barrier was caused by patient frailty. Primary care physicians indicated that potential adverse effects of medication (n=14 [61%]) and cost of therapy (n=13 [57%]) were the main factors limiting treatment. When asked to identify the single most important barrier in treatment, 14 physicians (61%) indicated cost was the greatest deterrent. Twenty-one primary care physicians (91%) reported they would be more likely to treat a patient with osteoporosis if a safe medication with proven fracture risk reduction were available. Primary care physicians indicated they were more likely to treat independently living adults (n=12 [52%]) and women compared with men (n=15 [65%]). All orthopedic surgeons (n=8) were willing for all patients to be evaluated in consultation with a nurse practitioner. Primary care respondents were less apt to agree with a nurse practitioner referral (n=5 [22%]). Both primary care physicians (n=16 [70%]) and orthopedic surgeons (n=4 [50%]) agreed that there is a need for increased primary care education about managing osteoporosis in patients hospitalized with low-impact fracture. CONCLUSIONS: Orthopedic surgeons were consistent in their opinion that postfracture attention to osteoporosis should rest with the primary care physician. Primary care physicians agree but report that cost and possible adverse effects of medication are major barriers to this care. Despite therapies for high-risk postfracture patients showing relative safety and proven efficacy in reducing future fractures, deterrents to this care are focused on cost and potential adverse effects. Further education is needed to promote a standard of care for the postfracture patient that is directed toward the prevention of a subsequent fracture.

Aged↗
PubMed2003

Retained human tissues: a molecular genetics goldmine or modern grave robbing? A legal approach to obtaining and using stored human samples.

The widespread retention of thousands of children's organs in the UK without parental consent has met with public outrage and calls for government intervention. These issues are brought to the fore by developments in molecular genetics that allow a person's full DNA sequence to be obtained from miniscule samples. The molecular genetic testing of retained organs and human tissue can greatly benefit family members and future research, but only if proposals to alter regulation can be successfully implemented. A review of present UK regulation indicates that it is both unclear and inadequate to ensure sufficient ethical/legal safeguards to satisfy public expectations. This paper reviews the legal and ethical status of previously retained samples. It discusses whether they may be regarded as abandoned if the patient cannot be traced and then used anonymously in ethically approved research. The legal status of retained samples is discussed as regards ownership and commerciality. This raises the question of who is the next of kin to give consent if the samples are to be regarded as gifted. Present proposals risk damaging the future by too much sensitivity. Getting the balance of interests right at this juncture is vital groundwork for such beneficial medical developments.

Child↗
PubMed2005

[Developing quality indicators in hospitals: the COMPAQH project].

BACKGROUND: To select a set of quality indicators (QI) in order to test them in a panel of 36 French hospitals METHODS: The COMPAQH (COordination for Measuring Performance and Assuring Quality in Hospitals) project is coordinated by the French National Institute for Medical Research and supported by the French Ministry of Health and the French National Evaluation and Accreditation Agency. This project has four objectives: (1) to select a set of QI -2003- (2) to implement them in 2004-2005 in a volunteer panel of hospitals (3) to compare the hospitals anonymously (4) to explore quality management implications. QI were selected with a four-step process: (1) Establishment of a list of national priorities for Quality Improvement in relation with the Ministry of Health. (2) setting up a potential list of QI regarding these priorities. The COMPAQH staff determined a preliminary set of 81 QI, based on data in the literature and evidence about the scientific soundness of quality measures and the effectiveness of methods for improving quality. (3) Evaluation of the preliminary list. Each QI was presented in a pamphlet describing its operational definition, rationale, methodology, workload and responsibility of data collection The hospital panel (representatives) ranked the 81 QI with a validated evaluation tool which contained four dimensions: Importance, Scientific acceptability, Feasibility, and Usability. (4) Development of a consensus on a final selection. Based on a structured voting process (Delphi method, two rounds), the hospital panel selected a comprehensive set of 42 QI among the 81. RESULTS: (1) Eight national priorities were defined: pain management, continuity of care, management of nutritional disorders, Iatrogenic risks (including nosocomial infections), patient satisfaction, follow-up of practice guidelines, management of human resources, accessibility. (2) A set of 42 QI were selected: a set of 6 core QI and 7 to 18 specific QI according to the hospital type. CONCLUSION: Such a set of QI provides a foundation for developing a quality measurement system in French hospitals. It requires a pragmatic view for implementing them and a coherence between the different objectives of use (internal and external use).

Accreditation↗
PubMed1995

Environmental tobacco smoke. The Brown and Williamson documents.

OBJECTIVE: To examine the tobacco industry's public and private responses to rising concern over the health effects of environmental tobacco smoke (ETS). DATA SOURCES: Documents from Brown and Williamson Tobacco Corporation (B&W), the British American Tobacco Company (BAT), and other tobacco interests provided by an anonymous source, obtained from Congress, and received from the private papers of a former BAT officer. STUDY SELECTION: All available materials, including confidential reports regarding research and internal memoranda exchanged between tobacco industry lawyers. CONCLUSIONS: Privately, B&W and BAT began conducting research related to ETS in the mid 1970s. BAT researchers appear to have determined that sidestream smoke produces irritation, that it contains toxic substances including N-nitrosamines, and that it is "biologically active" (eg, carcinogenic) in laboratory tests. During the 1980s, the primary purpose of BAT's research related to ETS was to develop a new cigarette that emitted less irritating and less biologically active sidestream smoke. Publicly, the tobacco industry has denied that exposure to ETS has been proven dangerous to health. It has criticized the methodology of published research on ETS, even when some of its own consultants have privately acknowledged that the research was valid. In addition, the industry has funded scientific research with the stated purpose of anticipating and refuting the evidence against ETS. The tobacco industry's strategy regarding passive smoking has been remarkably similar to its strategy regarding active smoking. It has privately conducted internal research, at least some of which has supported the conclusion that passive smoking is dangerous to health, while it has publicly denied that the hazards have been proven.

Humans↗
PubMed2003

Reliability of a structured method of selecting abstracts for a plastic surgical scientific meeting.

There is no generally accepted method for assessing abstracts that are submitted for a medical scientific meeting. This article describes the development and prospective evaluation of such a method applied to the 220 abstracts submitted for the 2000 Annual Meeting of the European Association of Plastic Surgeons. Structured abstracts were evaluated in three categories: aesthetic surgery, basic research, and clinical study. Each anonymous abstract was assessed separately by 10 reputable European plastic surgeons. These reviewers used a structured rating questionnaire which resulted in a score given by each reviewer to each abstract between -6 and +6. The scores of all 10 reviewers were added for each abstract, and the papers were accepted in each of the three categories on the basis of this abridged score. To evaluate the reliability of this structured method of selection, the interrater agreement among the reviewers was tested by means of kappa analysis and the Cronbach alpha coefficient. The kappa values for agreement among reviewers regarding acceptability of abstracts were low, but the alpha coefficient indicated an acceptable degree of reliability of the average reviewers' ratings for all categories. Using a structured questionnaire can be helpful in the objective assessment of abstracts for a scientific meeting and may facilitate comparison of abstracts. Meritocratic dichotomy of abstracts by the reviewers is advocated to further improve reliability of the rating. Even though reliability generally increases with the number of reviewers, the annual increase of submitted abstracts may necessitate a decrease in the number of reviewers for each abstract.

Abstracting and Indexing↗
PubMed2003

Anxiety and feelings of medical students conducting their first gynecological examination.

We examined the anxiety of medical students when they conduct their first gynecological examination. The students (226) from two universities completed anonymous questionnaires providing measures of state and trait anxiety and anxiety and confidence feelings, before and after conducting their first bimanual and speculum examination. This took place during a structured, self-directed learning session and involved examination of a professional patient. Students state anxiety was significantly elevated immediately before and fell to below baseline levels after the examination (p < 0.001). Students' reported feelings of increased confidence during the examination (p < 0.001). Students who had personally had a Pap smear test were most anxious before (p < 0.003) but during the examination, students who had experienced a gynecological exam felt less anxious (p < 0.002). The students experiencing the greatest decreases (before to after) in state anxiety were those who had never experienced sexual intercourse (p < 0.005). Most students (96%), particularly those who were more anxious during the examination (p < 0.001) and who experienced a greater decrease in anxiety from before to after the examination (p < 0.008) would recommend this method of learning to other students. In summary, medical students are anxious when they conduct their first gynecological examination, appear to be influenced by their personal experiences and appreciate methods of learning that reduce their anxiety.

Adult↗
PubMed2002

[Assessment of the impact of physical activity on the health status of elderly people].

OBJECTIVE: The aim of this research study carried-out in 1999 was to assess the impact of various forms of activity (physical, pro-social and intellectual-mental) on health status of the group of people aged 65 and more. METHODS: A tool used to conduct the research was anonymous questionnaire. After a preliminary assessment of 2072 questionnaires for a further analysis, 1910 questionnaires (92.6%) have been selected. Health status has been assessed on the basis of the following epidemiological parameters: information on illness and health problems, hospitalisation, disability, mobility, and body weight, depression, limited life enthusiasm, assessment of satisfaction resulting from contacts with other persons, identification of problems connected with ageing. Activity has been assessed on the basis of responses to the open and closed questions. The statistic tests: Chi 2, logistic regression, Pearson's correlation were used. RESULTS: Active persons assessed their health condition more positively, they suffered from fewer CVD's and their health condition was more stable, many had a better psycho-social status, and they less often used medical services (hospitalisation). Legal and biological disability, except 1st disability category and persons who were immobile did not constitute any barrier to become active. Similarly, diseases didn't exclude activity, except very severe pathologies. In the group of active persons overweight subjects constituted a minority, while no active person was obese. Majority of respondents has admitted that their health condition has deteriorated drastically at the age of 63-64. CONCLUSION: Activity of persons over 65 year old is one of many independent determinants and indicators of positive ageing.

Activities of Daily Living↗
PubMed1995

Emergency management of asthma in children: impact of NIH guidelines.

BACKGROUND: Asthma is the most common chronic disease of childhood. In 1991 the National Institutes of Health (NIH) published guidelines for the diagnosis and management of asthma, yet little is known about their impact on clinical practice. OBJECTIVE: To examine the impact of the NIH guidelines on the emergency management of asthmatic children in the United States. METHODS: A short anonymous survey concerning the emergency management of childhood asthma was mailed to 234 Directors of Pediatric Emergency Medicine in all Pediatric Residency Training Programs in the United States. The survey consisted of questions originally used in a similar study conducted in 1988 and an additional question relating to the impact of the NIH guidelines. RESULTS: One hundred and thirty-seven (59%) completed surveys were returned. Compared with the results of the 1988 survey, more physicians routinely use pulmonary function testing (73% versus 47% in 1988, P < .001), inhaled beta-agonists as the initial drug of choice (98% versus 17%, P < .001), and early corticosteroid administration (82% vs 21%, P < .001) in their emergency management of asthmatic children. Fifty percent of survey participants believe that NIH guidelines changed their emergency management of childhood asthma. CONCLUSIONS: Significant changes in the emergency management of asthmatic children have occurred since the publication of the NIH guidelines.

Asthma↗
PubMed1994

Histologic changes in prostate carcinomas treated with leuprolide (luteinizing hormone-releasing hormone effect). Distinction from poor tumor differentiation.

BACKGROUND: Treatment of patients with prostate carcinoma using drugs with antiandrogenic effects is increasingly common. One of the most popular agents is leuprolide (with or without flutamide), an agonist of luteinizing hormone-releasing hormone (LH-RH). Prostates exposed to antiandrogenic agents develop distinctive pathologic changes. The ability of a group of 18 pathologists to recognize these LH-RH effects on prostate cancers and to distinguish them from poor tumor differentiation was tested using a Delphi technique. METHODS: The Delphi method maximizes the opportunity for individual contributions by eliminating opportunities for group dynamics and confrontational interaction. In this study, participants were provided with a set of duplicate transparencies and a list of written definitions of both poor tumor differentiation and LH-RH effect. They were instructed to examine the cases privately using the definitions provided and to distinguish poor tumor differentiation from LH-RH effect. Responses of the participants were shared anonymously, and each was asked to reexamine the cases in light of this knowledge. RESULTS: After a learning experience accomplished by one round of examination and feedback, LH-RH effect could be correctly distinguished from poor tumor differentiation in greater than 90% of cases by 83% of the participants. A small percentage of cases confounded complete consensus, although every case was correctly identified by most participants. CONCLUSIONS: The pathologic effects associated with androgen deprivation with leuprolide (plus flutamide) are sufficiently distinctive to be recognized by knowledgeable pathologists. In most cases, the tissue shrinkage representing a favorable response to the drug can be distinguished from solid or infiltrating patterns of poorly differentiated carcinoma.

Cell Differentiation↗
PubMed2002

Familial dysautonomia: detection of the IKBKAP IVS20(+6T --> C) and R696P mutations and frequencies among Ashkenazi Jews.

Familial dysautonomia (FD) is an autosomal recessive congenital neuropathy that occurs almost exclusively in the Ashkenazi Jewish (AJ) population. Mutations in the IkappaB kinase complex-associated protein (IKBKAP) gene cause FD. Two IKBKAP mutations, IVS20(+6T --> C) and R696P, have been identified in FD patients of AJ descent. The splice site mutation IVS20(+6T --> C) is responsible for > 99.5% of known AJ patients with FD, and haplotype analyses were consistent with a common founder. In contrast, the R696P mutation has been identified in only a few AJ patients. To facilitate carrier detection, a single PCR and allele-specific oligonucleotide (ASO) hybridization assay was developed to facilitate the detection of both the IVS20(+6T --> C) and R696P mutations. Screening of 2,518 anonymous AJ individuals from the New York metropolitan area revealed a carrier frequency for IVS20(+6T --> C) of 1 in 32 (3.2%; 95% CI, 2.5-3.9%), similar to the previously estimated carrier frequency (3.3%) based on disease incidence. No carrier was identified for the R696P lesion, indicating that the mutation was rare in this population (< 1 in 2,500). This sensitive and specific assay should facilitate carrier screening for FD mutations in the AJ community, as well as postnatal diagnostic testing.

Alternative Splicing↗
PubMed2006

Identification of genetic diversity by cultivating influenza A(H3N2) virus in vitro in the presence of post-infection sera from small children.

Antigenic variants probably arise in the field by escaping herd immunity. We have earlier found that sera from small children are more strain-specific than sera from adults and could therefore, provide favourable conditions for selecting antigenic escape mutants. We had access to small volumes of anonymous sera collected in Norway after the epidemic season 1999/00, which was dominated by the A/Panama/2007/99 (H3N2) variant. The HA gene of the representative strain of that season was genetically identical to A/South Australia/147/99 (H3N2) and was selected for this study. Two sera from children aged 4 and 3 years, respectively, and one adult (64 years old) were used to attempt selecting antigenic escape mutants. Virus was grown in MDCK cells in the presence of human serum and escaped variants were tested by haemagglutination-inhibition tests. Although variant strains were occasionally identified, their HA1 genetic sequence did not identify obvious changes at known antigenic sites. However, by cloning and subsequent sequencing, the genetic diversity of the parent virus was found to be significantly reduced when grown in the presence of human sera. Data also showed that the two children's sera selected additional mutants from those already present in the parent pool and that the two sera selected different mutants. On a community level, it is possible that antigenic changes could be accumulated in a step-wise manner when epidemic virus is transmitted from one small child to the next, each with a restricted and possibly variant antibody repertoire.

Animals↗
PubMed1996

Association of elevated umbilical cord blood creatine kinase and myoglobin levels with the presence of cocaine metabolites in maternal urine.

STUDY OBJECTIVE: To determine whether an association exists between antenatal cocaine exposure and elevated levels of creatine kinase (CK) and myoglobin in umbilical cord blood collected upon delivery. STUDY POPULATION: 105 anonymous maternal urines with corresponding infant umbilical cords bloods. METHODS: Maternal urines were screened for cocaine metabolites by the Syva EMIT assay, with positive specimens confirmed by gas chromatography/mass spectrometry. For all 8 positives, plus the first 47 of the negatives collected, matched infant cord blood specimens were analyzed for myoglobin by radioimmunoassay and CK by kinetic enzyme activity assay. Cord bloods matched to the remaining 50 cocaine-negative urines were not analyzed. A two-tailed Mann-Whitney test was used to evaluate the significance of differences in CK and myoglobin levels between the two groups. RESULTS: CK levels were evaluated twofold in the cocaine-positive group as compared to the cocaine negative group (mean 383 +/- 260 vs. 189 +/- 68 IU/L, p = 0.005). Myoglobin levels were twofold higher in the cocaine-positive group compared to the cocaine negative group (mean 55.9 +/- 37.1 vs. 33.3 +/- 26.8 ng/mL, p = 0.077). CONCLUSION: Antenatal cocaine exposure is associated with elevated cord blood CK, and possibly with elevated cord blood myoglobin. Additional studies, using larger study populations and more sensitive methods of detecting antenatal cocaine exposure, along with detailed follow-up examination of infants, are indicated.

Cocaine↗
PubMed1991

Pregravid weight, gestational weight gain and current weight of women delivered of twins.

To determine whether large gestational weight gains result in higher maternal body weight within two years post-partum, we administered an anonymous survey to 423 mothers of twins at the Annual Twinsday Festival in Twinsburg, Ohio, in 1989 and 1990. Data collected included pregravid and current weight, age and parity, gestational weight gain and length of gestation. Data were grouped by patient age (18-24 years, 25-34 years and 35-44 years), parity (primipara or multipara) and length of gestation as preterm (less than 37 weeks) and term (greater than or equal to 37 weeks). Statistical analysis included paired t-tests, unpaired t-tests and chi-square as appropriate. Except for multiparas in the oldest age category, the mean current weight was higher than pregravid weight for each age and age/parity category. Comparison across age categories showed in pattern of increasing pregravid weight with increasing age for the total study sample (all women) and for primiparas; among multiparas, this trend was not as evident. Our findings suggest that large weight gains in twin gestations do not result in higher maternal body weight within two years postpartum. Such gains are associated with better intrauterine growth and should be considered when formulating weight gain recommendations for twin gestations.

Adolescent↗
PubMed1989

Umbilical cord blood serosurvey for human immunodeficiency virus in parturient women in a voluntary hospital in New York City.

The potential spread of the human immunodeficiency virus (HIV) to childbearing women in areas of high acquired immunodeficiency syndrome (AIDS) endemicity is a major public health concern. As a private institution providing obstetric care to such a population of women, we undertook an anonymous HIV cord blood serosurvey to estimate the number of childbearing women at our institution at risk for perinatal transmission of the virus and to assess the success of our voluntary screening program to identify seropositive women. Between November 1987 and January 1988, cord blood samples from all clinic deliveries were analyzed for the presence of HIV antibody. For each sample obtained, the mother's age and site of prenatal care were known. Overall, 2.7% (six of 224) of the samples tested were seropositive; two of the 34 samples (5.9%) from teenage mothers were seropositive. All positive samples were from women who received prenatal care; none were identified through a voluntary screening program based on patient self-acknowledged risk-behavior assessment. This confirms that risk factor history elicited by personal interview is not a reliable screening tool for initiating HIV antibody counseling and testing. The high seropositive rate in teenagers is disturbing and needs further assessment.

AIDS Serodiagnosis↗
PubMed1995

The ideal of the anonymous analyst and the problem of self-disclosure.

The principle of analytic anonymity is critically reviewed. A connection between the technical stance of nondisclosure and idealization of the analyst is proposed. Some preliminary suggestions are offered concerning what kinds of information about the analyst are useful to communicate to a patient.

Defense Mechanisms↗
PubMed1996

Trinucleotide repeats at the FRAXF locus: frequency and distribution in the general population.

FRAXF, the third X-chromosomal fragile site to be cloned, has been shown to harbour a polymorphic compound triplet array: (GCCGTC)n (GCC)n. Expansion and methylation of the GCC-repeat and the neighbouring CpG-rich region result in chromosomal fragility. DNAs from 500 anonymous consecutive newborn males were examined to determine the incidence of various repeat numbers. The range of repeats was from 10-38, with the most common alleles having 14 (52.7%), 12 (16.6%), 21 (9.0%), and 22 (5.2%) triplets. Based on the distribution of repeat numbers, we suggest that the 21-repeat allele resulted from hairpin formation involving 7 GCC-repeats in a 14-repeat allele, accompanied by polymerase slippage. Examination of dinucleotide repeats near the FRAXF repeat will be important in testing this hypothesis. Since the clinical phenotype, if any, of FRAXF is unknown, this database will also be valuable for comparisons with repeat numbers in individuals from special populations.

Chromosome Fragile Sites↗
PubMed1998

Predictive model of weapon carrying among urban high school students: results and validation.

OBJECTIVES: The purpose of this study was to identify the behavioral, psychosocial, and demographic predictors of self-reported weapon carrying among secondary school students who attend urban public schools. METHODS: Self-reported weapon carrying was measured in a schoolwide anonymous health survey conducted in two demographically comparable high schools in 1992, in Boston, Massachusetts. Indicators of self-perception, depression, stressful life events, and adolescent risk behaviors of substance use and sexual behavior, along with self-reported weapon carrying, were measured. The students in both schools were racially heterogeneous, with the majority of about 80% from black or Hispanic backgrounds. A predictive model was developed using a forward stepwise logistic regression model in one inner-city high school, and tested in a second high school. RESULTS: Self-reported lifetime weapon carrying was 32% overall. The major predictors of weapon carrying among urban secondary school students are a combination of demographic, psychosocial, behavioral, and school-related factors. This analysis indicates consistency in eight markers predictive of weapon carrying: lower age, male gender, regular marijuana use, sexual experience, having witnessed a crime, having skipped school, suicidal ideation, and having hit or "beat up" someone. Race parental education, and family composition were not significant predictors. Significant predictors of weapon carrying were marijuana use and sexual experience, each of which was consistently high in both schools. CONCLUSIONS: The model-building and validation presented in this study provide empirical evidence for three important conclusions. First, weapon carrying is associated with multiple and interrelated factors which include demographic, psychosocial, behavioral, and school-related characteristics of high school-age adolescents. Second, students with more risk factors are more likely to carry a weapon, suggesting that the variables are independent markers. Third, this study identified marijuana use and being sexually experienced as both highly predictive of weapon carrying. Implications of this study for prevention point to the need for comprehensive multidisciplinary services in high school that include mental health counseling as well as health education efforts aimed at behavior change.

Adolescent↗