6 Contraceptive Compliance in the Private Sector

LANGUAGE DELAY I N 2 YR. OLD CHILDREN OF ADOLESCENT MEDICINE We have previously reported t h a t adolescent mothers are more p h y s i c a l and l e s s v e r b a l with t h e i r i n f a n t s , e s p e c i a l l y while teaching d i f f i c u l t t a s k s , and t h a t t h e i r i n f a n t s v o c a l i z e l e s s by 8 months of age. A r e c h i l d r e n of adolescent mothers a t r i s k f o r language delay? The p r e s e n t study hypothesized t h a t 2 yr. o l d c h i l d r e n of adolescent mothers (CAM) would have lower r e c e p t i v e and expressive language s c o r e s and t h a t t h e s e s c o r e s would be r e l a t e d t o m u l t i p l e s o c i a l and demographic high r i s k f a c t o r s . Twenty primiparous, Caucasian, low t o middle c l a s s mothers (half ( 17 years of age a t c h i l d ' s b i r t h ) and t h e i r 2 y r . o l d c h i l d r e n were studied. The Caldwell Home Inventory was scored by an unbiased observer during a two-hour home v i s i t . The Bayley Scales (MDI and PDI) and t h e Mullen Scales of Early Learning (Language Expressive (LEO) and Language Receptive (LRO)) were administered by another unbiased examiner during a c l i n i c v i s i t . Tympanography was performed and sociodemographic information was obtained. CAM had lower LRO (p<.01) and LEO (p<.001) s c o r e s , but no d i f f e r e n c e s were observed i n MDI, PDI and tympanograms. Children whose mothers possess 2 or more of t h e following: S maternal age, S SES, Seducation, S family support, o r SHOME t o t a l s c o r e had lower LRO (p<.001) and LEO (p<.01) scores. We conclude t h a t SCAM a r e a t r i s k f o r language delay which i s r e l a t e d t o m u l t i p l e s o c i a l and demographic r i s k f a c t o r s a s s o c i a t e d with adolescent childbearing. ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT VENTRICULAR (LV) FUNCTION IN HEALTHY ADOLESCENTS FOLLOWING MAXIMAL SUPINE EXERCISE. Victor C. Baum, Robert A. Englander, Lynne L. Levitsky, Pritzker Sch. of Med., Univ. of Chicago., Michael Reese Hosp., Dept. of Pediatrics, Chicago, Ill. To determine echocardiographic responses t o exercise in normal adolescents, 26 healthy adolescents (ages 10.7-17.7 yrs) had M-mode echocardiograms of the LV and aorta (Ao) prior t o and immediately following maximal exercise on a supine bicycle ergometer. The ventricular septum and LV posterior wall were digitized. Fractional shortening (FS), Ao systolic time intervals (PEP/ET) and approximate velocity of circumferential fiber shortening (Vcf) were calculated. Maximal r a t e of contraction and relaxation indexed for maximal diameter (dD/dt-sys and dD/dt-dias, diameters/sec) were determined from the digitized trace. The average of 3 resting cycles was compared t o the first adequate post-exercise study. All studies were completed within 3 minutes of cessation of exercise. Data are mean 2 SE. All values changed significantly following exercise (p<.001). FS Vcf PEP/ET dD/dt-s s dD/dt-dias pre .3450l 1.182.04 .26+.01 -2.34+.& 3.072.19 post .43+.02 2.29+.12 .22+.02 -5.58+.44 6.605.44 We present-normative a a t a on eciiocardiograph7c measurements of LV function in healthy adolescents following maximal supine exercise against which data from patients with suspected LV dysfunction can be compared. These data differ from those reported from adults during sub-maximal exercise. This technique is simple, does not involve radiation, and thus may be applied t o relatively normal pediatric populations. PARTY: DEPRESSION IN ADOLESCENTS AND YOUNG 5. BEACH ADULTS IN A RESORT COMMUNITY. Carolyn L . Gould, Richard L. Gorman, Marc S. Jacobson (Spons. by OF REFEEDING ON BODY HABITUS IN MALa2 EFFECTS NOURISHED ADOLESCENTS WITH ANOREXIA NERVOSA. MariorieA.Boeck,GeorqeJ.Schwartz,AlbertEinstein Coll. Med., Montefiore M.C., Dept. of Peds., Bronx, N.Y. Weight gain is one of the therapeutic goals for adolescents with anorexia nervosa. The quality of such weight gain in terms of tissue deposition has not been studied. We determined the distribution of weight gain between f a t and muscle tissue upon refeeding. Percent body f a t (from skin fold thickness), % muscle mass (from creatinine excretion) and muscular development (from corrected upper arm diameter) were obtained on 6 malnourished teenagers initially and upon refeedin Subjects (5 female, I male) ranged in age from 13-19 years ( ~ 1 5 7 ; average weight gain was 5.9 r 1.3(SE) kg. Two pts. , who were the most wasted and gained the most weight (43% and 23% of initial weight, respectively) put on o disproportionate amount of body f o t (285,263%). The % muscle mass and upper arm diameter remained essentially constant and considerably below normal for agelsex. The remaining 4 pts. increased their body weight by 8-12% and gained both muscle and f a t in similar proportions: the % body f a t increased by 27 5 6 (SE)% and muscle mass by 20 ?7%. Muscular development calculated from the square of the increment in upper arm diameter increased by 16 r 4%. We conclude that there a r e a t least two patterns of weight gain with refeeding. Pts. who were extremely malnourished with severe f a t and muscle wasting gained a disproportionate amount of fat, while those who were less malnourished gained by the accretion of similar amounts of f a t and muscle. Reasons for the observed differences may relate t o variations in f a t and muscle wasting, diet, habitus, and type and amount of exercise. Therapeutic goals should consider the quality, a s well a s quantity, of weight gain achieved during refeeding. . CALCIUM AND BONE MINERAL STATUS OF LACTATING TEENS CONSUMING VARIOUS CALCIUM INTAKES. Gar M. Chan, Kris Westover, Martha McMurry. Univers:ty of Utah, Department of P e d i a t r i c s , S a l t Lake City, Utah. Lactating adolescent mothers have been shown t o have decreased bone mineral content (BMC). The present study was t o evalua t e an increased d i e t a r y calcium (Ca) i n t a k e on t h e Ca and BMC of l a c t a t i n g teens. Three groups of women were studied: 14 adolescent (Low Adol) consuming 900 mg Ca (56% RDA), 20 adol e s c e n t s (High Adol) consuming 1600 o r 2000 mg (100 o r 125% RDA), and 12 a d u l t s consuming 1200 mg (100% RDA). All l a c t a t i n g s u b j e c t s were studied a t 2, 8 and 16 wks postpartum. Serum Ca, phosphorus, magnesium, a l k a l i n e phosphatase, 25-OH vitamin D parathyroid hormone (PTH), c a l c i t o n i n (CT) and albumin remained normal f o r a1 1 3 groups. By 16 wks, the CT l e v e l s were higher i n t h e Low Adol group compared t o t h e High Adol and a d u l t groups (13.78r5.06, MiSD vs 9.9453.12, 9.13i3.87 pg/ml , p<.05). PTH and CT l e v e l s increased during l a c t a t i o n f o r t h e Low Adol while t h e o t h e r 2 groups remained unchanged. BMC was s i m i l a r a t 2 wks, but a f t e r 16 wks, t h e Low Adol group had a decrease in BMC of 10% (pc.05). This was s i g n i f i c a n t l y d i f f e r e n t than t h e High Adol and a d u l t groups which maintained t h e i r BMC. All ado1 d i e t a r y Ca and P intakes were c o r r e l a t e d with changes i n t h e i r BMC during l a c t a t i o n ( r = 0.45, p<0.01 f o r Ca; r=0.47, p<.01 f o r P). By 16 wks, t h e a d u l t group had a higher BMC than e i t h e r t h e Low Adol (1.003 vs 0.866, p<.01) o r t h e High Adol (0.899, p<.02) groups. These r e s u l t s suggest t h a t bone l o s s during l a c t a t i o n f o r teens i s accompanied by increased PTH and CT l e v e l s and t h a t a high Ca i n t a k e appears t o p r o t e c t a g a i n s t t h i s bone lnss.. O3 Felix P. Heald). From the Department of P e d i a t r i c s , University of Maryland, School of Medicine, Baltimore. Depression and s u i c i d e a r e recognized a s major problems among adolescents and young a d u l t s . L i t t l e i s known of t h e epidemiology and r i s k f a c t o r s a s s o c i a t e d with depression. We studied t h e prevalence of depression i n a presumably low r i s k group. The study was conducted a t a general youth c l i n i c i n Ocean City, Maryland between June 3 , 1984 and September 2, 1984. This c l i n i c serves teen and young a d u l t summer workers, vacationers and some permanent r e s i d e n t s . All p a t i e n t s between t h e ages of 13 and 25 were asked t o complete t h e CES-D depression s c a l e . This i s a standardized survey instrument which measures depress i v e symptomatology among general populations. Demographic data and diagnosis were a b s t r a c t e d from t h e medical record. 581 p a t i e n t s returned a v a l i d questionnaire. Data c o l l e c t i o n was complete f o r 94% of t h e questionnaires. Overall, 29% of our sample scored i n t h e depressed range. This i s s i g n i f i c a n t l y g r e a t e r than t h e 17% noted i n t h e general population (p<0.05). Depression was not r e l a t e d t o t h e duration of residence a t t h e r e s o r t . I t was a l s o unrelated t o t h e p a t i e n t ' s socioeconomic s t a t u s , educational level o r age. Females were s i g n i f i c a n t l y more depressed than males. The only diagnosis which was s i g n i f i c a n t l y r e l a t e d t o depression was pregnancy. We conclude t h a t depressive symptomatology i s a s i g n i f i c a n t problem among adolescents and young a d u l t s but t h a t i t s presence i n s p e c i f i c p a t i e n t s i s not p r e d i c t a b l e . CONTRACEPTIVE COMPLIANCE I N THE PRIVATE SECTOR. Grace, S. Jean Emans, Elizabeth R. Woods (Sponsored by Warren Drupe). Childrenqs H o s p i t a l , Harvard Medical School, Boston, MA. Erratic' contraceptive usage i s a major f a c t o r i n teenage pregnancy. Many s t u d i e s have addressed t h e p r e d i c t o r s of non-compliance i n t h e use of o r a l c o n t r a c e p t i v e s i n adolescent c l i n i c s . This study was designed t o focus on t h e previously ignored p r i v a t e s e c t o r , examining t h e i r c o n t r a c e p t i v e behaviors and p r e d i c t o r s of t h e i r compliance. P a t i e n t s from a suburban p r i v a t e p r a c t i c e of adolescent medicine were compared t o t h e adolescent c l i n i c population of The Children's Hospital. P r o f i l e s commonly a s s o c i a t e d with c o n t r a c e p t i v e compliance were recorded a t t h e i n i t i a l and r e t u r n v i s i t s . Study s u b j e c t s were randomly assigned t o 2 groups receiving e i t h e r s i m p l i f i e d o r d e t a i l e d i n s t r u c t i o n s on p i l l usage and management of bleeding and amenorrhea. A l l p a t i e n t s were provided 3 packs of Norinyl 1+35 and scheduled f o r a 3 month r e t u r n v i s i t . 5 1 p r i v a t e and 60 c l i n i c p a t i e n t s (15-22 y r s ) were studied. Of t h e p r i v a t e p a t i e n t s 42 made t h e i r own appointments, 29 without p a r e n t a l knowledge; 77% were s e x u a l l y a c t i v e b e f o r e f i r s t v i s i t , 30% having never used contraception. 82% of p r i v a t e and 47% of c l i n i c p a t i e n t s returned a t 3 months. P r i o r completion of a course of a n t i b i o t i c s d i d n o t p r e d i c t O.C. compliance. The type of i n s t r u c t i o n ( s i m p l i f i e d vs. d e t a i l e d ) d i d n o t a f f e c t p i l l usage (p=.10). The many epidemiologic f a c t o r s a s s o c i a t e d with r e c e i v i n g h e a l t h c a r e i n t h e p r i v a t e s e c t o r were major determinants of compliance (p<.001). ' Estherann