A comparison of inner-city and upper-middle class youths' exposure to violence.

Exposure to violence in healthy adolescents has not been explored. We questioned 838 youths (ages 11-24 years; 620 females) from two medical clinics. The Exposure to Violence Questionnaire was completed by 403 inner-city adolescents (inner-city group), and 435 middle-to-upper class youths (resort group). Inner-city participants were more often victims, knew of victims, and witnessed more assaults, rapes, knifings, life-threatening events, and murders than their resort group counterparts. In both groups, males were more likely to have been victims, witnesses, and to have known victims personally than were females, except for sexually related crimes. In both settings, youths often did not seek medical or psychological help after victimization. Adolescents are exposed to a startling amount of violence. Violence prevention should be targeted to the inner-city male population.

Atherosclerosis during adolescence.

Interest in diseases of the arteries during the juvenile period is evident during the first half of this century. In the 1950s, it was clearly demonstrated that the early lesions of atherosclerosis were detectable in children and, especially, in adolescents. By the end of the 1960s, the scope of early atherosclerotic changes in the arteries of juveniles became firmly established. In the 1970s, the search for adult risk factors in juveniles began in earnest. In the 1980s, adult risk factors were identified in juveniles and correlated with pathologic changes. The therapeutic issues that involve life-long compliance in high-risk children and adolescents are unique to this age group.

Anthropometric predictors of low birth weight outcome in teenage pregnancy.

The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p less than 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly depletion (-24.9 mm2/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm2/wk) (p less than .05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants.

PIP: The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black US teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly deplection (-24.9 mm squared/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm squared/wk)(p 0.05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants. In conclusion, the LBW phenomenon in young teenagers may be due to an inadequate maternal accumulation of fat stores and/or an excessive mobilization of fat during gestation. Marginal fat reserves and a habitually limited food intake and/or stage of life cycle, despite a weight gain that is apparently compatible with successful adult pregnancy outcome, may diminish a teen mother's ability to sustain the rapid fetal weight gain during the 3rd trimester beyond approximately 35 weeks gestation. Appropriate nutrition and psychosocial and medical intervention may alter the LBW outcome.

Pelvic inflammatory disease associated with Neisseria gonorrhoeae and Chlamydia trachomatis: clinical correlates.

The purpose of this study was to determine whether selected clinical features can distinguish salpingitis associated with endocervical Neisseria gonorrhoeae from that caused by Chlamydia trachomatis in black, inner-city adolescents. We reviewed retrospectively the charts of teenagers presenting to a university hospital outpatient department between January 1982 and January 1984 who were diagnosed as having salpingitis. We included all teenagers who presented with a history of low abdominal pain plus (1) either cervical motion tenderness (n = 15), adnexal tenderness (n = 13), or both (n = 57); and (2) either cervical cultures positive for N. gonorrhoeae and negative for C. trachomatis (n = 31) or cervical cultures negative for N. gonorrhoeae and positive for C. trachomatis (n = 54). Discriminant analysis indicated that the presence of breakthrough vaginal bleeding (standard regression coefficient [SRC] = 0.301; P = 0.023), current usage of oral contraception (SRC = 0.408; P = 0.009), and an elevated erythrocyte sedimentation rate (SRC = 0.522; P = 0.0002) were significantly more often related to the presence of endocervical C. trachomatis. However, we found no significant differences between the two groups for other variables that have been described as distinguishing features (i.e., duration of pain, fever, and leukocyte count).

Sex mediated lipid metabolism in human aortic smooth muscle cells.

When human aortic smooth muscle cells in culture were treated with pharmacological doses of estrogen and testosterone for 48 hrs, the rate of cholesterol synthesis measured both by acetate incorporation and the 3, hydroxy 3-methylglutaryl Co enzyme A reductase (HMG-CoA) activity declined significantly as compared to control. However, the rate of cholesterol esterification increased by 132% and 45% in response to testosterone and estrogen respectively. Also, acetate incorporation into fatty acids and fatty acid synthetase enzyme activity increased by hormonal treatment but remained in the free form especially by estrogen. Testosterone treatment resulted in more esterification (p less than .025) of fatty acid than estrogen treatment. Incubation with hormones for 48 hrs resulted in enhanced uptake of 14C-labeled cholesterol along with increased accumulation of cellular cholesterol. Increased synthesis of phospholipid and triglyceride by estrogen may be responsible for excretion of cellular sterol and fat. These results indicate that sex-hormones have an important effect on the regulation of lipid metabolism in human aortic cells.

Cytotoxicity of cholesterol oxides and their effects on cholesterol metabolism in cultured human aortic smooth muscle cells.

Incubation of monolayers of cultured human aortic smooth muscle cells with oxygenated sterols (25-hydroxycholesterol, 7-ketocholesterol, or cholesterol 5,6-epoxide) markedly inhibited growth though the viability of the culture was not affected. The effects on growth was concentration dependent, and 25-hydroxycholesterol was the most potent inhibitor of cellular growth as measured by decreased incorporation of thymidine into DNA and suppression of HMG-CoA reductase activity. The inhibitory effect of 25-hydroxycholesterol on cellular growth was not reversible if the cultures were grown in medium with normal fetal calf serum. However, in medium with delipidated serum, addition of purified cholesterol partially prevented growth inhibition induced by 25-hydroxycholesterol. Purified cholesterol, independently or in combination with tocopherol had no toxic effect on cellular growth. Addition of cholesterol oxides to the incubation medium stimulated lysosomal activation and release of acid phosphatase into the culture medium. The effect was concentration dependent and inversely related to cellular growth.

Teenagers' choices regarding the presence of family members during the examination of genitalia.

This study was designed to assess the outcome of offering teenagers the option of being accompanied by a family member during examinations involving the genitalia. Data were collected from patients' first visits, in an 18-month-period, to an adolescent clinic serving a Black, inner-city population. Of 1358 such patients visits (73% females), 550 (40.5%) patients were accompanied to the clinic by a family member. Chi-square analysis revealed: 1) for both sexes, the youngest teenagers (age 11-13 years) were accompanied significantly more often than those aged 14-16 years, who in turn were accompanied significantly more often than the oldest group (age 17-20 years); and 2) although males tended to be accompanied more often than females, this effect was significant only for teenagers aged 14-16 years. Of the 550 accompanied patients, 207 had a genital examination and 190 of these were offered the option of having a family member present. Fifty percent of the patients accepted; there was no significant relationship between patients' age or sex and acceptance. Physicians judged the outcome of the 94 cases with family member present. Having the family member present was viewed as beneficial for the patient and/or the physician in 86% of the cases, and 13% were neutral (no benefit/no problem).

Follow-up of adolescent trauma victims: a new model of care.

A comprehensive model of service delivery for the rehabilitative care of adolescents with closed head injuries is presented. Our data show that the Glasgow Coma Scale score on hospital admission correlates with the length of time required for follow-up. Adolescents with mild closed head injuries require more follow-up than adults with comparable injuries because of adolescent developmental stages that complicate the recovery process. Anticipatory guidance has helped the patient and family cope with stresses. Finally, we have identified a typical pattern of difficulties during the recovery process including: impaired judgment, reduced attention span, irritability, short-term memory loss, and ongoing memory deficits.

Atherogenesis in white carneau pigeons. Effects of low-level cholestane-triol feeding.

Cholesterol auto-oxides have been shown to be angiotoxic in vivo and in vitro. Whether this toxicity is itself an atherogenic risk factor has not been established. In this study White Carneau pigeons were gavage-fed either 0.05% pure cholesterol or 0.05% pure cholesterol with trace levels of cholestane-triol (cholestane-3 beta,5 alpha,6 beta-triol) for 3 months. These are amounts similar to estimated U.S. dietary intake levels. Aortic lipids, aortic calcium and coronary artery histopathology were assessed. Aortic total cholesterol, cholesterol ester, and cholesterol ester/cholesterol ratio were: 1.87 vs 1.70 mg/g, 1.23 vs 1.01 mg/g, and 25 vs 26% for the cholesterol vs cholesterol + triol groups, respectively. These values are similar to published values at this duration and level of cholesterol feeding and are not statistically significantly different from each other. Aortic accumulation of calcium in the cholesterol + triol group was 1.16 +/- 0.35 mg/g, whereas in the cholesterol-fed group it was 0.82 +/- 0.27 mg/g, an increase of 42% (P greater than 0.02). Coronary artery atherosclerosis, as measured by percent mean lumenal stenosis, was 5.23% +/- 5.4, in the cholesterol + triol group as compared to 2.80% +/- 1.4 in the cholesterol group, an increase of 87% (P less than 0.01). These results suggest that dietary exposure to low levels of cholestane-triol, is atherogenic to a greater degree than exposure to pure cholesterol alone.

Cardiac sarcoplasmic reticulum. Effects of an atherogenic diet during the neonatal and juvenile period.

The effect on the cardiac sarcoplasmic reticulum of an atherogenic (1% cholesterol) diet fed during the neonatal vs the juvenile period of life was studied in Yorkshire swine. Male piglets were randomly assigned at birth to 1 of 4 groups: group I (control), group II (lactation feeding), group III (juvenile period feeding) and group IV (lactation and juvenile feeding). All animals were killed at 55 weeks of age and cardiac sarcoplasmic reticulum (SR) isolated for assay of calcium uptake, Ca2+-Mg2+ ATPase activity, and lipid analysis by thin-layer chromatography and gas chromatography. The amount of cholesterol/mg SR protein and the cholesterol/phospholipid ratio were higher in the animals fed during lactation (groups II and IV) and lower in those fed only during the juvenile period (group III). Phospholipid fatty acid patterns as measured by gas chromatography were unaltered in any group. Calcium uptake was markedly diminished in all experimental conditions: group II 47%, group III 65% and group IV 96%. Compared to the observed changes in calcium transport, the ATP hydrolytic activity was relatively less affected. Only in group IV a significant decrease (41%) was seen. Groups II and III show no change in ATP hydrolytic activity. The decrease in calcium uptake and altered cholesterol/phospholipid ratio without effect on ATP hydrolytic activity is consistent with an uncoupling of calcium transport related to the atherogenic diet in early life.

Kwashiorkor in Baltimore.

Advanced cases of malnutrition are rare in the United States. Since it is rarely suspected, a correct diagnosis of malnutrition, even in extreme form, may easily be missed. We present a recent case of the kwashiorkor form of the syndrome of protein-energy malnutrition to emphasize its diagnostic features and to enhance early recognition and initiation of proper therapy. The misunderstanding of a physician's recommendations by a teen-aged mother may have initiated this illness.

Iron deficiency in black females during late adolescence.

The role of serum ferritin (SF) in detecting early iron deficiency and the associated risk factors in black adolescent females are evaluated. SF less than or equal to 12 ng/mL indicated low iron stores and a Hb less than or equal to 11.3 g/dL (5% ile for black females-Hanes Survey) anemia. Of the 103 females (means = 16.8 yr) screened in a Family Planning Clinic (FPC), 20.4% (21/103) had a low SF. Of these 21, 72% had a Hb greater than 11.3 g/dL. Chronologic age, gynecologic age, history of pregnancy, Tanner stage IV and V, and birth control method did not appear to be risk factors. However, longer rather than shorter use of oral contraceptives appeared to protect against iron deficiency. This study suggests that routine screening of iron status by hemoglobin and serum ferritin is warranted during annual FPC visits.

PIP: The role of serum ferritin (SF) in detecting earlyiron deficiency and the associated risk factors in black adolescent females are evaluated. SF or=12 ng/mL indicated low iron stores and a Hb or= 11.3 g/dL (5%ile for black females--Hanes Survey) anemia. Of the 103 females (chisquare=16.8 years) screened in a Family Planning Clinic (FPC), 20.4% (21/103) had a low SF. Of these 21, 72% had an Hb 11.3 g/dL. Chronologic age, gynecologic age, history of pregnancy, Tanner 4 and 5, and birth control method did not appear to be risk factors. However, longer rather than shorter use of oral contraceptives appeared to protect against iron deficiency. This study suggests that routine screening of iron status by hemoglobin and SF iss warranted during annual FPC visits.

Health professionals' predictions of teenagers' preferences regarding chaperones during physical examinations.

This study assessed the degree of concurrence between teenagers' stated preferences regarding chaperones and professionals' predictions about teenagers' responses. One hundred and fifty members of the Society for Adolescent Medicine received the Method section of a study investigating teenagers' attitudes about chaperones during examination of the genitalia. These professionals were asked to predict the teenagers' choices. Seventy professionals responded. Male and female professionals made highly similar predictions. Professionals' predictions were generally accurate, with four exceptions. Professionals underestimated some teenagers' desire to have a family member present (the case for females aged 14-16 yr and males 12-13 yr). They also underestimated young boys' and girls' reluctance to have an opposite-sexed nurse present. Regarding teenagers' reluctance to be alone with the physician, professionals did not appreciate the differential importance of age for males versus females. They also underestimated, for females and young males, the additive importance of the physician's sex and familiarity to the patient.

Scalp hair morphology in normal and diabetic children and adolescents.

The morphological characteristics of samples of scalp hair from normal children and adolescents (8-17 years) and from a group of diabetic children (8-11 years) were determined. In normal children, there were no sex differences. Significant increases in the diameters of both bulb and shaft were found when prepubertal (8-11 years) and pubertal (12-17 years) groups were compared. Diabetic females had smaller bulb diameters and diabetics of both sexes had reduced shaft diameters in comparison to normal children of similar age. These findings suggest previous nutritional deficits in male and female diabetics and the possibility of continued nutritional problems in the females.

Teenagers' preferences regarding the presence of family members, peers, and chaperones during examination of genitalia.

During physical examination that include the genitalia, teenagers are typically separated from their parents and females are provided with a chaperone. To assess teenagers' attitudes regarding this practice, 140 females and 60 males awaiting treatment in a general adolescent clinic were asked their opinion about a physical examination that include the genitalia. Teenagers indicated whether they would want to be accompanied during the examination, and by whom, as a function of the hypothetical clinical situation that varied the sex and familiarity of the physician. Choices reflected teenagers' age and sex, rather than physician characteristics. Young males and females strongly preferred to be accompanied, generally by a family member. With increasing age, males preferred to be alone with the physician whereas females preferred to be accompanied. Regardless of sex and age, virtually none chose the company of peers. Despite strong development differences, however, there also were pronounced individual differences among teenagers of the same age. Our results suggest that service delivery be adapted to the particular preference expressed by individual teenagers. Needs assessment for adolescent programs may best be achieved by conducting similar surveys in local clinical settings.