Reproductive Health CHOICES for Young Adults with Sickle Cell Disease or Trait: Randomized Controlled Trial Outcomes over Two Years.

Interventions to assist reproductive health decision-making in populations affected by sickle cell disease (SCD) or trait (SCT) lack proven efficacy over time. Our aim was to compare effects of CHOICES, a Web-based multimedia education program on implementing informed reproductive plans, and usual care education (e-Book) on reproductive knowledge, intention, and behavior over 24 months. We randomized 234 participants with SCD (n = 138) or SCT (n = 96) (age 18-35 years, 35 % male, 94 % African American) to CHOICES and e-Book groups. Participants completed a sickle cell-specific reproductive measure before and four times after the intervention (6, 12, 18 and 24 months). Compared to the e-Book group the CHOICES group had significantly more improvement in knowledge over time (p = .004) but not intention (p = .18) or behavior (p = .69). At baseline, 114 (48.7 %) participants reported having partners who would not put the couple at risk for their children inheriting SCD. Of the 116 (49.6 %) at-risk participants, a higher poroportion of those who were in the CHOICES group chose partners that reduced their risk by the last visit than the e-Book group (p = .04). Study findings provide important insights for designing a national trial of the CHOICES intervention focusing on subjects whose partner status puts them at risk for having a child with SCD.

Evaluation of the SCKnowIQ tool and reproductive CHOICES intervention among young adults with sickle cell disease or sickle cell trait.

The study purpose was to evaluate a computer-based questionnaire (SCKnowIQ) and CHOICES educational intervention using cognitive interviewing with childbearing-aged people with sickle cell disease (SCD) or trait (SCT). Ten control group participants completed the SCKnowIQ twice. Ten intervention group participants completed the SCKnowIQ before and after the CHOICES intervention. Most participants found the questionnaire items appropriate and responded to items as the investigators intended. Participants' responses indicated that the information on SCD and SCT and reproductive options was understandable, balanced, important, and new to some. Internal consistency and test-retest reliability were adequate (.47 to .87) for 4 of the 6 scales, with significant within-group changes in knowledge scores for the intervention group but not for the control group. Findings show evidence for potential efficacy of the intervention, but proof of efficacy requires a larger randomized study.

5-4-3-2-1 go! Coordinating pediatric resident education and community health promotion to address the obesity epidemic in children and youth.

This study investigated the feasibility and effectiveness of training pediatric residents to conduct a brief clinic-based behavioral intervention in coordination with community dissemination of a health promotion message developed by the Consortium for Lowering Obesity in Chicago Children. A total of 113 residents completed a short (<60 minutes) online training program. Some (64) residents distributed interview contact cards to patients they saw in their continuity of care clinics after training; others (45) distributed cards before training. A researcher interviewed 75% of the 509 patients 4 weeks after the visit. More patients of trained residents reported positive changes in behaviors which have been associated with lower obesity rates: increased intake of fruits and vegetables (28% vs 16%, P < .01), increased intake of water (30% vs 19%, P < .01), increased physical activity (40% vs 29%, P < .03), and decreased television time (36% vs 24%, P < .01). Brief training using the 5-4-3-2-1-Go! message seems to be feasible and effective.

A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes.

UNLABELLED: BACKGROUND AND MATERIALS AND METHODS: The outcome of patients completing 12 months of follow-up in a prospective longitudinal trial of the safety/efficacy of laparoscopic adjustable gastric banding (LAGB) for morbidly obese adolescents aged 14 to 17 years using a Food and Drug Administration Institutional Device Exemption for the use of the LAPBAND was analyzed. Baseline and outcome data were abstracted from a prospective database. RESULTS: Baseline (mean +/- SD) body mass index was 50 +/- 10 kg/m(2), and excess weight was 178 +/- 53 lb in 20 patients. Comorbidities included hypertension (45%), dyslipidemia (80%), insulin resistance (90%), metabolic syndrome (95%), and biopsy-proven nonalcoholic steatohepatitis (88%). At mean (SD) follow-up of 26 (9) months, % excess weight loss was 34% +/- 22% (n = 20) and 41% +/- 27% (n = 12), and the metabolic syndrome was resolved in 63% and 82% of the patients at 12 and 18 months, respectively. Hypertension normalized in all patients, along with improvement in lipid abnormalities and quality of life scores (P < .05). At 12 months, of the 5 patients with less than 20% excess weight loss, dyslipidemia and metabolic syndrome were resolved in 2 patients. CONCLUSION: At intermediate follow-up of a LAGB-based obesity treatment program, weight loss led to resolution or improvement of major obesity-related comorbidities in most patients, supporting the efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program and its long-term evaluation.

Children, adolescents, and war: the systematic engagement of youth in collective violence.

Increasingly health personnel are called on to address the needs of adolescents affected by armed conflict. Adolescents suffer as combatants, direct and indirect casualties, as dependents of combatants, and as citizens of countries whose resources are destroyed and/or consumed by war and other forms of organized violence. Survivors of war, ex-child soldiers, refugees, and others are found today in cities on all continents. This paper will review the epidemiology of armed conflict, especially with respect to children and youth, examine the etiology of youth involvement in armed conflict including social risk factors and developmental vulnerabilities, and review the peace-building efforts of the United Nations, communities, and youth themselves. Finally we will briefly review the efforts of those committed to the well-being of adolescents in the areas of advocacy and treatment.

Impact of participation in a community-based intimate partner violence prevention program on medical students: a multi-center study.

BACKGROUND: Physicians are generally poorly trained to recognize, treat or refer adolescents at risk for intimate partner violence (IPV). Participation in community programs may improve medical students' knowledge, skills, and attitudes about IPV prevention. OBJECTIVE: To determine whether the experience of serving as educators in a community-based adolescent IPV prevention program improves medical students' knowledge, skills, and attitudes toward victims of IPV, beyond that of didactic training. PARTICIPANTS: One hundred and seventeen students attending 4 medical schools. DESIGN: Students were randomly assigned to didactic training in adolescent IPV prevention with or without participation as educators in a community-based adolescent IPV prevention program. Students assigned to didactic training alone served as community educators after the study was completed. MEASUREMENT: Knowledge, self-assessment of skills and attitudes about intimate partner violence and future plans to pursue outreach work. RESULTS: The baseline mean knowledge score of 10.25 improved to 21.64 after didactic training (p

Short-term outcome in the first 10 morbidly obese adolescent patients in the FDA-approved trial for laparoscopic adjustable gastric banding.

BACKGROUND: We received the LAP-BAND Investigational Device Exemption (IDE) from the US Food and Drug Administration in December 2004 to conduct a prospective longitudinal trial examining the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in morbidly obese adolescents ages 14 to 17 years. OBJECTIVES: To report the short-term results of LAGB in the first 10 adolescents with complete 9 months of follow-up. PATIENTS AND METHODS: Baseline characteristics and outcome data were analyzed in 10 patients enrolled between March 2005 and February 2006. RESULTS: All of the patients were girls. Their mean body mass index (+/-SD) was 50 +/- 13 kg/m, and excess weight was 171 +/- 79 pounds. Comorbidities included depression (3 patients), sleep apnea (3), hypertension (6), dyslipidemia (7), insulin resistance (9), metabolic syndrome (9), and steatohepatitis (in 4 of 5 patients with liver biopsy). Operative time was 45 +/- 9 minutes, and discharges were within 23 hours of surgery. Band-related complications were as follows: 2 dehydration, 1 pouch dilation, and 1 port revision. All of the patients lost weight, with a 9-month excess weight loss of 30% +/- 16% (range 14%-57%). Hypertension and the metabolic syndrome were resolved in 100% of patients (P = 0.04) and 80% of the patients (P = 0.01), respectively, along with significant improvement in the Pediatric Quality of Life and Beck Depression Inventory scores and a trend toward improvement in high-density lipoprotein cholesterol abnormalities (P = 0.08). CONCLUSIONS: At short-term follow-up, weight loss occurred with minimal complications, leading to early resolution of major obesity-related comorbidities. Continued evaluation of the long-term safety and efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program is warranted.

Internet safety: adolescents' self-report.

We examined the association between adolescents' unsafe experience online, types of Internet activity, and safety practices using a questionnaire returned by 213 private school students (seventh through tenth grades) in spring 1999. One-fourth of respondents reported unsafe experiences. Types of unsafe experience varied with gender, Internet activity, and identity sharing.