Adolescent and pediatric gynecology最新文献

Study Objective: The extent to which maternity homes across our nation provide services for homeless, pregnant girls is unknown. We initiated the first investigation to identify and describe all of the group residential facilities in the United States for pregnant adolescents under the age of 18 years.

Design: We created a national list of maternity homes on a state-by-state basis through information gathered from local human services departments, local WIC offices, and from maternity homes that were aware of others in their region. We contacted an official at each maternity home by telephone to confirm the nature of the facility and to seek their participation in the project by answering a 28-item questionnaire to be sent by mail. Unreturned questionnaires were followed by a reminder letter and a duplicate questionnaire. The collected data were then organized and tabulated.

Results: From all 50 states, we found and contacted by telephone 215 maternity homes admitting girls under the age of 18 years (the number of homes ranged from 19 in California, to 0 in Wyoming) and a total of 174 (81%) completed and returned our postal questionnaire. Of responding homes, 10% had been in operation 100 years or more, 29% admitted girls dependent on illicit drugs or alcohol, 59% functioned as part of a larger organization, 20% were unlicensed, 89% received private donations, 23% received federal funds, and 42% offered private rooms. The most frequent maternal bed capacity was eight. Typically they had from two to four full-time employees. Benefits provided included childbirth classes (84%), social services (90%), dietary counseling (49%), accredited, on-site schooling (35%), and vocational training (54%). Prenatal care was mostly provided through private physicians (63%) and hospital-based prenatal clinics (59%), with 99% of deliveries in hospitals. The most frequent age of residents was 16 years, staying an average of 4.7 months antepartum and 2.4 months postpartum. The most frequent maximum allowed length of stay was up to 9 months. The mean number of babies bora per responding home in 1991 was 29.4.

Conclusion: In the United States, maternity homes for adolescents are an important source of services for approximately 6,000 pregnant teens each year.

Study Objective: The purpose was to examine the relationship between the perceptions of health status and related biobehavioral variables of female youth attending an outpatient adolescent gynecology clinic.

Background: Inquiry into a female patient's perception of personal health is important, especially when providing health services because females experience more days of restricted activity than males.

Design: A cross-sectional survey was employed using standardized measures of mental health and health status. The health status measure assesses the perception of the female's physical functioning or functional status, well-being, and general health. Self-report questionnaires were also completed on sexual behaviors and menstrual pain. Data were obtained from 160 females aged 12–21 years with a mean age of 16.8 years.

Results: Multiple regression analyses conducted on each of the three health status indices revealed that the endorsement of many symptoms of depression explained 26% of the variance in perceptions of functional status scores; symptoms of anxiety and depression as well as third party coverage accounted for 47% of the variance in perceptions of well-being scores; and symptoms of depression were responsible for explaining almost 30% of their general health perception.

Conclusions: The strength of the relationship between health status and related biobehavioral variables indicates that primary care OB/GYN would benefit from conducting some type of health status examination. Assessment of mental health status, especially characteristics or symptoms of depression, would inform health care practitioners, as these features may have a negative impact on the patient's health perceptions.

Study Objective: To analyze fine needle biopsy of the breast and nipple discharge cytology in young women (aged ≤30), and compare it to the findings obtained in a group of older women (aged ≥31).

Design: From January 1989 through December 1990, 258 adolescent and young women (aged ≤30) were examined for breast disease by fine needle aspiration (FNA) and nipple discharge cytology. Results were compared with those obtained from a group of 3,063 older women (aged ≥31).

Results: Of the 137 nipple discharge smears from young women, foam cells were found in 97% of the samples. Suspect or malignant cells were only found in nipple discharge from older women. FN As of the breast from young women were compared with the findings from the older group. Fibroadenoma was found to be more frequent (p < 0.01), atypical epithelial proliferation was not observed, and carcinoma was rare (1.5%) in the group of young women. Fibrocystic changes with epithelial proliferation without atypia were found in the same proportion in both age groups.

Conclusion: Criteria for biopsy of all epithelial proliferation should be very carefully considered in young women.

This review concentrates on the treatment for some of the more common causes of hypergonadotropic hypogonadism. Females with hypergonadotropic hypogonadism have constituted much of this data because those with chromosomally competent ovarian failure (CCOF) and chromosomally incompetent ovarian failure (CIOF) have the potential to conceive, and women with CIOF have been treated hormonally in attempts to increase growth. Males with chromosomally incompetent gonad failure (CIGF), most commonly 47,XXY, are not short, so this is not an issue. Pure 47,XXY males rarely are able to impregnate women unless they are mosaics. More data is needed in CIOF women before the final consensus of recombinant growth hormone (rGH) and oxandrolone can be reached. It is important to note that treatment with rGH has been restricted to study protocols, and only the treatment of growth hormone deficiency is FDA approved. Currently it appears prudent to discuss treatment options with patients having hypergonadotropic hypogonadism with respect to sexual development, reproductive potential, growth, and the prevention of complications such as osteoporosis and heart disease. It is the opinion of this author that if patients do desire to use rGH and oxandrolone, that they be treated by physicians directly involved in research protocols or after discussion with investigators who have experience in these treatment protocols. The induction of secondary sexual characteristics may be started after the completion of treatment for growth, which may be up to 3-5 years. If the woman does not desire therapy for growth, it appears reasonable to begin hormone replacement at ages 9–11, or at the time of diagnosis, if the individual is older. Like-wise, males may begin testosterone treatment beginning at about ages 10–12. Support, discussion about potential complications of the disease and the replacement medication, and psychologic considerations must be considered for the complete management in individuals with hypogonadism.