Combined hormonal contraception Calderoni, Michele E; Coupey, Susan M
Adolescent medicine clinics
16, Številka:
3
Journal Article
This article discusses the different combined hormonal contraception methods. Combined methods, delivering both estrogen and a progestin simultaneously, are among the most effective, widely used ...hormonal contraceptive options. They also have the best noncontraceptive benefit profile for young women of all hormonal contraceptive options. Oral contraceptive pills (OCPs) are described as the standard combined hormonal method and are discussed in detail. Newer combined hormonal contraceptive delivery systems, the transdermal patch, vaginal ring, and injectable form, are compared with OCPs in terms of pharmacology, efficacy, and adverse events. Advantages and disadvantages of all methods are emphasized, with particular attention to adolescent development and acceptability.
Ego Development and Chronic Illness in Adolescents Silver, Ellen J; Bauman, Laurie J; Coupey, Susan M ...
Journal of personality and social psychology,
08/1990, Letnik:
59, Številka:
2
Journal Article
Recenzirano
To examine the effects of chronic illness on the psychological growth process known as ego development, scores were compared on the Loevinger Sentence Completion Test for 36 teens (16 boys, 20 girls) ...with chronic illness and 50 teens (16 boys, 34 girls) without chronic illness. Their ages ranged from 13 to 21 years, with a mean of 17.4 years. Most were Black (37%) or Hispanic (41%) and lived in poor or working-class neighborhoods. When age, sex, and Peabody Picture Vocabulary Test (
PPVT
) scores were controlled in multiple regression analyses, no direct association between ego development stage and presence of chronic illness, severity of illness, age at onset, or duration of illness was found. Analysis of the chronically ill group alone revealed a significant
PPVT
× Severity interaction, indicating that ego development in chronically ill teens is lower when illness is more severe and verbal
IQ
is higher.
Interviewing adolescents Coupey, S M
The Pediatric clinics of North America,
12/1997, Letnik:
44, Številka:
6
Journal Article
Recenzirano
Incorporating a functional approach within the traditional structure of the medical interview allows for improved communication with adolescent patients. Using these techniques results in improved ...patient satisfaction, more accurate psychosocial diagnosis, and better adherence to treatment recommendations. Many physicians think that using patient-centered interviewing techniques is time-consuming and inefficient, but, in fact, a higher quality and quantity of information usually is obtained per unit time using these techniques. An additional benefit is that this approach is more satisfying for the physician; the enhancement of the therapeutic relationship works both ways. Adolescents become more interesting as people; communication barriers become challenges to be creatively solved rather than annoyances to complain about. Adolescents need and deserve high-quality health care to grow into physically and mentally healthy adults, and effective physician-patient communication skills are the key to delivering that care.
Although the 1990s have seen a reduction in unintended pregnancy rates and improved contraceptive-use rates, the negative consequences of unintended pregnancy and STD acquisition continue to plague ...our youth. Primary health care providers, including pediatricians, play an essential role in further reducing unintended teen pregnancy and STD acquisition rates through the promotion of effective and consistent contraception. Pediatricians need to be aware that now, more than ever, nonhormonal contraceptive methods should be used by every sexually active youth, and counseling of both boys and girls should be routine. Although not as effective at preventing pregnancy as hormonal methods of contraception, many nonhormonal methods provide excellent STD protection. Condoms plus spermicide continue to be a very popular and effective method of pregnancy and STD prevention. The newer polyurethane male and female condoms provide alternative, safe barrier protection, although their efficacy at preventing HIV in vivo needs further study. Diaphragms and cervical caps, in conjunction with spermicide, also provide pregnancy and STD prevention, but not as effectively as male condoms plus spermicide. Although most likely to use condoms in association with another birth control method, adolescents often find dual-method use cumbersome and difficult to comply with. Finally, although IUDs and periodic abstinence are safe methods of birth control for older women in monogamous relationships, they are unlikely to be appropriate for most adolescents. In many respects, we have come full circle back to our "nonhormonal contraceptive roots." As we enter the twenty-first century, we have found that no single "miracle" approach can be used to reduce adolescent pregnancy and STD rates. Rather, pediatricians are obliged to offer nonhormonal methods of contraception, often in conjunction with other birth control methods, as a means of preventing unwanted STDs and pregnancy. Through a comprehensive community approach that uses sex education, abstinence programs, condom-availability programs, and contraceptive-skills training, however, pediatricians can play a central role in the promotion of effective and consistent contraception by adolescents.
Adolescent Medicine Strasburger, Victor C; Brown, Robert T; Braverman, Paula K ...
2005
eBook
Designed for quick reference in a busy office, this handbook is a concise, practical guide to everyday clinical problems in adolescent medicine. This ready-reference manual is written by noted ...experts to provide immediate, authoritative answers to questions about common medical and behavioral problems in teenagers. Numerous tables, bulleted lists, and charts help practitioners find information quickly, and a formulary offers guidance in prescribing for teenagers. Coverage includes every important topic in adolescent gynecology and up-to-date strategies for evaluating and treating obese teenagers. Other key concerns addressed include sports medicine, substance abuse, and adolescent violence and suicide.
In a survey of 167 physicians with expertise in adolescent health, 84% said they prescribe contraception to adolescents, but only 80% of these prescribe emergency contraception, generally a few times ...a year at most. Some 12% of respondents said they believe that providing emergency contraception to adolescents would encourage contraceptive risk-taking, 25% said they think it would discourage correct use of other methods and 29% said they think repeated use of the method could pose health risks. Physicians who were more likely than their colleagues to prescribe emergency contraception included obstetrician-gynecologists (92%), those who graduated from medical school after 1970 (77%) and those who describe their practice as being in an "academic" setting (76%). Physicians may restrict use of the method by limiting treatment to adolescents who seek it within 48 hours after unprotected intercourse (29%), by requiring a pregnancy test (64%) or an office visit (68%), or by using the timing of menses as a criterion for providing the method (46%). While 41% of physicians who provide emergency contraception counsel adolescents about the method during family planning visits, only 28% do so during visits for routine health care; 16% counsel women who are not yet sexually active about the method.
BACKGROUND: Up to 31% of sexually active adolescent girls have genital infection with Chlamydia trachomatis. Partner notification and treatment is key to decreasing the high prevalence of this ...sexually transmitted disease and preventing reinfection. This study was undertaken to examine girls' attitudes and perceptions about partner notification and treatment after diagnosis with chlamydia infection, and to determine rates of partner notification and treatment.
METHODS: A 37-item questionnaire examining sexual behavior and communication with sex partners was developed for this study using focus groups of adolescent female patients served at a large urban medical center with high rates of chlamydia infection. The questionnaire was administered to a convenience sample of female patients at the medical center aged 10-21 yrs., 1-3 months after they were diagnosed with a positive cervical chlamydia test. Subjects were 30 girls: xage = 18.6 ± 1.5 yrs; 65% Hispanic, 23% black. They were surveyed 1.9 ± 0.9 mo after chlamydia diagnosis when they returned for a follow up visit.
RESULTS: For the 30 subjects, x̄ age at coitarche was 14.6 ± 1.5 yrs; modal number of life time sex partners was 4 (range 1-40), 23/30 (77%) had only 1 partner in the past three months, 6/30 had 2 partners. 57% were still with the partner whom they believed transmitted the index infection. 83% of subjects reported notifying at least 1 sex partner about the infection. From an array of 6 possible reasons for partner notification, the 2 most often endorsed were: “I did not want my sex partner to give the infection back to me” (15/30); “I wanted to let my sex partner know that he had given me the infection” (11/30). From 8 possible choices of sex partners' reaction, the 2 most often endorsed were: “My sex partner accepted the news well” (16/30); “My sex partner got upset” 7/30 (23%). Of 7 choices of reasons for not notifying their partners, the 2 most common were: “I was afraid that my sex partner would physically hurt me” (1/5); “I knew my sex partner would be very upset” (2/5). 16/30 (53%) of subjects knew and 11/30 (37%) did not know whether the partner had received treatment; 2 girls knew their partners were not treated and 1 didn't answer.
CONCLUSIONS: While it may be reassuring that a large majority of adolescent girls in this study did notify their partners about chlamydia infection, it is concerning that only about half the girls knew whether their partner had been treated. These findings suggest that more efforts to encourage open communication between sex partners and to follow up on male partner treatment may be indicated.
To identify continuation rates of depot medroxyprogesterone acetate (Depo-Provera) and characteristics of long-term users in a population of inner-city, minority adolescents with high pregnancy ...rates.
Retrospective medical record review.
An inner-city adolescent clinic and an adolescent pregnancy program.
A review of the medical records of 250 females aged 13 to 20 years (mean +/- SD, 16.8 +/- 1.1 years), 62.9% Hispanic and 34.2% African American, receiving a first depot medroxyprogesterone acetate injection for contraception between August 1993 and June 1996 was conducted using a standardized form. The mean +/- SD age at menarche of the subjects was 11.6 +/- 1.4 years, and the mean +/- SD age at first intercourse was 14.1 +/- 1.3 years; the mean number of lifetime sex partners was 2.4. Of the subjects, 73.6% had used condoms, 32.0% used oral contraceptives, and none used implants. Of the 201 subjects for whom there were data in the medical records regarding prior fertility, 172 (85.6%) had been pregnant, and 145 (72.1%) had a child. Life table analysis was used to measure depot medroxyprogesterone acetate continuation rates and to compare subgroups of adolescents.
Depot medroxyprogesterone acetate continuation rates were found to be 70.3% at 6 months, 48.3% at 9 months, 31.5% at 12 months, and 12.8% at 24 months. The most common reason for depot medroxyprogesterone acetate discontinuation was missed appointments (41.7%). Subjects were followed up for a mean +/- SD of 1.3 +/- 0.7 years after discontinuation of depot medroxyprogesterone acetate use; 46.7% became pregnant. Among those 156 adolescents who discontinued depotmedroxyprogesterone acetate use, 40.0% restarted the method at some later time. Continuation of depot medroxyprogesterone acetate use was more likely if age at first intercourse was younger than 13 years (P = .04). Continuation rates were not related to age, ethnicity, age at menarche, number of sex partners, use of other contraceptives, prior pregnancy, or having a child.
In this study, just less than one third of the adolescents continued depot medroxyprogesterone acetate use for 1 year or longer. This suggests that depot medroxyprogesterone acetate does not function as a long-term method for most inner-city adolescents. The only characteristic that was associated with successful continuation of depot medroxyprogesterone acetate use was young age at first intercourse, implying that experience may be the main determinant of continuation.
This article discusses the common health problems of adolescents with an emphasis on the differences between those affecting girls and boys. Statistics are given for mortality, hospitalization, and ...out-patient health visits from several different sources. Accidents and violence are the leading causes of death in adolescents but they affect boys much more often than girls. Teenaged girls are frequently hospitalized for health problems related to sexual behavior, mainly pregnancy and delivery related care and sexually transmitted diseases. Emotional and psychosomatic disorders are very common among adolescents of both sexes. Three general considerations important for the provision of health care to adolescents are discussed in detail. These include privacy and confidentiality, prevention of adverse health consequences of risk-taking behaviors, and the utilization of professionals from several different health care disciplines.
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