Adolescents' perceptions of factors affecting their decisions to seek health care.

OBJECTIVE: To have adolescents, rather than adults, identify characteristics of health care providers and sites that affect their decision to seek care. DESIGN: Five stages conducted over a 10-month period: (1) focus groups to frame the study questions; (2) nominal group technique to generate student responses; (3) three surveys to assess response importance; (4) one survey to link the most important responses with the decision to seek care; and (5) focus groups to explain the variables associated with the decision to seek care. SETTING: The Philadelphia (Pa) School District. PARTICIPANTS: The study population consisted of all ninth graders from 39 of Philadelphia's 42 public high schools. The 6821 students who returned the final survey comprised the study sample (69% of in-school youth). RESULTS: In the final survey, students used a Likert scale (1 to 5) to describe the impact of 31 ideas on their decision to seek care. The most important characteristics were provider hand washing, clean instruments, honesty, respect toward teens, cleanliness, know-how, carefulness, experience, seronegativity for the human immunodeficiency virus, equal treatment of all patients, and confidentiality. There was little variation in the order of the items by sex, race, or socioeconomic status. Factor analysis showed that the most important of four identified latent factors related to infection control and provider competency. CONCLUSION: Four of the top 10 characteristics that affect an adolescent's decision to seek care involve cleanliness and infection control. These findings offer providers and planners straightforward, modifiable factors that teens believe influence their decision to seek care.

Structure of L-prolyl-L-tyrosine monohydrate.

C14H18N2O4.H2O, Mr = 296.32, triclinic, P1, a = 5.524 (3), b = 6.621 (2), c = 10.307 (2) A, alpha = 78.82 (3), beta = 86.82 (4), gamma = 84.96 (4) degrees, V = 368.11 A3, Z = 1, Dx = 1.34 g cm-3, lambda(Mo K alpha 1) = 0.70930 A, mu = 1.10 cm-1, F(000) = 158, T = 298 K, final R = 0.044 for 2182 observed reflections. The molecule crystallizes as a zwitterion with the peptide backbone folded and a water molecule of hydration. The water molecule and the dipeptide molecule are involved in an extensive hydrogen-bond network.

Structure of nortriptyline hydrochloride.

C19H22N+.Cl-, Mr = 299.84, monoclinic, P2(1)/c, a = 5.070 (2), b = 34.088 (5), c = 9.976 (1) A, beta = 90.74 (2) degrees, V = 1724.0 A3, Z = 4, Dx = 1.16 g cm-3, lambda (Mo K alpha 1) = 0.70930 A, mu = 2.2 cm-1, F(000) = 640, T = 295 K, final R = 0.046 for 1381 observed reflections. The nortriptyline molecule crystallized with a 'butterfly' fold angle of 124.3 (2) degrees and an extended propylamino side chain. The amino nitrogen is involved in hydrogen bonds to two different chloride ions.

Thrombin as an adjuvant to reanastomosis of the fallopian tubes reduces implantations in the rabbit.

To study the efficacy of topically administered thrombin as an adjuvant in tubal microsurgery, 24 rabbits underwent a 1-cm resection and microsurgical anastomosis of both fallopian tubes and were randomized to either thrombin or cautery for hemostasis. Ovarian wedge biopsies were done on the left ovary. The animals were mated 4 to 5 weeks postoperatively with a buck of proven fertility. They were killed at 2 to 3 weeks' gestation to note the number of fetuses per patent tube and presence or absence of pelvic adhesions. There was no effect of topical thrombin on the crude pregnancy rate but it was associated with a marked reduction in the number of fetuses per patent tube, despite similar rates of pelvic adhesions between groups. Topically administered thrombin appeared to reduce fertility in this experimental model by an undefined mechanism.

[Variations in blood viscosity of insulin-dependent diabetic subjects controlled by artificial pancreas (author's transl)]. / Variations de la viscosité sanguine de sujets diabétiques insulinodépendants équilibrés par pancréas artificiel.

A study of blood viscosity at 3 rates of determination (0.232-0.348 and 1.16 sec-1) in insulin-dependent diabetic subjects controlled by artificial pancreas, shows a reduction in this parameter after 30 hours of feed back control. The relationship between these variations, the mechanical cohesion of the agglutinated red cells, and the deformability of these structures are discussed.