Selective excavation and ozone therapy: new frontier of mini-invasive caries treatment in MIH paediatric patients. A case report.

BACKGROUND: The term hypomineralisation of molars and incisors (MIH), introduced in 2001 by Weerheijm et al., describes a clinical state of hypomineralisation of permanent molars with frequent involvement of the incisors. MIH is considered a global dental problem with a prevalence ranging from 2.4% to 40.2% in the entire world paediatric population. The continuous increase in the prevalence of enamel anomalies, including MIH, indicates the need to define new intervention protocols based on the technological advances that are revolutionising paediatric dentistry. The use of ozone associated with the selective and minimally invasive excavation of the dental tissue combines the antibacterial properties of the gas with an ultra-conservative approach aimed at the maximum conservation of the dental tissue. The operative protocol described can be an important tool in the prevention and treatment of MIH. The aim of this work is to illustrate an operative clinical protocol based on the combined use of selective excavation and ozone for the treatment of carious lesions in paediatric patients with MIH.

Health care needs of Indochinese refugee teenagers.

Although 50% of Indochinese refugees are under 18 years of age, previous studies have emphasized the prevalence of parasites, anemia, tuberculosis, and hepatitis, with few addressing age-related health care needs. In this study the specific health care needs of 80 Indochinese refugee teenagers, evaluated during a 4-year period, were determined. The Centers for Disease Control's suggested screening measures were used, and it was found that 52% had positive purified protein derivative skin tests, 38% lacked immunizations, 35% had stool specimens positive for parasites (prevalence and number of parasites greatest among Cambodians), 14% had blood tests positive for hepatitis B surface antigen, and 10% were anemic. Additional evaluations showed that 19% had hemoglobinopathies, 14% were in or below the fifth percentile for height and weight, 12% had goiters, 12% had skin disorders, 8% had positive hepatitis B surface antigen, 5% had visual defects, 5% had hearing loss, 5% had psychosomatic illness, and 4% had idiopathic scoliosis. Although suggested Centers for Disease Control screening measures may be adequate for younger Indochinese children, these data suggest that additional studies are necessary for teenagers. For the sexually active adolescent, identification of and counseling for hepatitis antigenemia and hemoglobinopathies are crucial. In addition, early identification of emotional and physical problems during screening may enhance assimilation into a new society and facilitate completion of the psychosocial tasks of adolescence.

Evaluation of a residency training program in behavioral pediatrics.

The impact of behavioral training upon first-year residents was evaluated by assessing attitudes with regard to 15 clinical "entities," including behavioral disorders, physical disorders, and "mixed" disorders. Each entity was rated at four times: beginning of the year, start of the behavioral rotation, end of the rotation, and end of the year. Multiple-choice questions were also included to assess knowledge regarding behavioral pediatrics. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders and mixed disorders, residents' self-reported competence increased with regard to diagnosis, management, advising parents, and knowledge of resources. Further, the greatest change occurred during the 2-month rotation. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the year. Ratings of faculty and housestaff interest remained constant across testing points, and residents' "desire to learn more" and prediction of "future relevance" showed a slight decrease over time, for all disorders. Knowledge regarding behavioral pediatrics increased significantly from the beginning of the year to the start of the rotation, and also during the rotation. These data demonstrate that changes in residents' perceived competence are directly related to their rotation experience, and suggest that behavioral issues can be introduced successfully during the first year of residency training.

American Academy of Pediatrics. Committee on Adolescence. Contraception in adolescents.

The risks and negative consequences of adolescent sexual intercourse are of national concern, and promoting sexual abstinence is an important goal of the American Academy of Pediatrics. In previous publications, the American Academy of Pediatrics has addressed important issues of adolescent sexuality, pregnancy, sexually transmitted diseases, and contraception. The development of new contraceptive technologies mandates a revision of this policy statement, which provides the pediatrician with an updated review of adolescent sexuality and use of contraception by adolescents and presents current guidelines for counseling adolescents on sexual activity and contraceptive methods.

When children have children: the teen pregnancy predicament.

Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.

PIP: The birthrate among both white and African-American US young women 15-19 years old declined steadily from 89.1 live births per 1000 women (LB/1000) in 1960 to 51.3 LB/1000 in 1985, as a result of the availability of contraception and abortion. The rate has since risen to 62.1 LB/1000 in 1991. In contrast, the birthrate among unmarried young women 15-19 years old increased from 15.3 LB/1000 in 1960 to 42.5 LB/1000 in 1990. The birthrate among white unmarried adolescents more than tripled over the past three decades. The Johns Hopkins University School of Public Health revealed a rise in overall sexual activity from 28% in 1972 to 50% in 1979 in interviews of a national sample of 15-19 year olds. After the Supreme Court decision in Roe v. Wade, 232,440 abortions were performed in 1973 to 15-19 year olds and that number rose to 444,780 by 1980. Title IX of the Civil Rights Act prohibited the exclusion of girls from schools on the basis of pregnancy. In 1977 the Supreme Court struck down a statute that prohibited the sale of nonprescription contraceptives to minors under 16. Reports by the Centers for Disease Control and Prevention identified 1,559,110 legal abortions in 1987, of which 26.1% were to women younger than 20 years old. The adolescent seeking an abortion faces clinical disclosure and parental consent. According to a 1985 poll, 85% of Americans approve of sex education. Nearly 60% of 12-17 year olds surveyed in 1986 said that they had taken a course or had a class on sex education. However, in a 1988 survey of over 4000 public school teachers, only 84% of teachers were in programs that included sexual decision making, abstinence, and birth control methods. Adolescent childbearing may represent normative behavior for those coping with the stress of poverty. Adolescent pregnancy is associated with low birthweight, preterm labor and delivery, poor maternal weight gain, hypertension, anemia, and sexually transmitted diseases.

Adolescent body image during pregnancy.

This study compares the body perceptions of pregnant teenagers with those of their never-pregnant peers. Forty-three third-trimester pregnant girls were matched by age, race, socioeconomic status, and pubertal development to 43 never-pregnant girls. Subjects were given the Tennessee Self-Concept Scale (TSCS), a self-administered questionnaire consisting of 100 self-descriptive statements which are divided into nine subscales. When compared with never-pregnant girls, the pregnant girls have a higher overall self-esteem, a more positive body image, a surer self-identity, and feel more productive as a family member, but appeared limited in their capacity for self-criticism.

Qualities of adolescent mothers' parenting.

PURPOSE: This study examined the interrelations among adolescent mothers' parenting attitudes, parenting confidence, and parenting stress and the potential differences in these dimensions by mothers' age, race and parity, and age and sex of child. METHODS: Subjects were 119 former adolescent mothers (M age = 20.2 years) from predominantly poor, minority backgrounds (50% Hispanic, 27% African-American, 17% non-Hispanic white). All subjects completed questionnaires about their parenting qualities twice an average of 10 weeks apart. All children were at least one year of age (M age = 37.2 months; range 12-50 months). RESULTS: Results indicated that for some mothers there exists a triple jeopardy of low parenting confidence, high parenting stress, and inappropriate parenting values. Young maternal age at delivery and young maternal age at the time of this study were associated with low child acceptance. Non-Hispanic white mothers had significantly more favorable parenting values than did African-American and Hispanic mothers, and African-American mothers reported significantly greater caretaking confidence than did Hispanic mothers. No parity or sex of child effects were found. CONCLUSIONS: These results suggest the presence of meaningful patterns of convergence and within-group variation for the psychological qualities of adolescent mothers' parenting.

PIP: This study examined the interrelations among adolescent mothers' parenting attitudes, parenting confidence, and parenting stress and the potential differences in these dimensions by mothers' age, race, and parity, and age and sex of child. Subjects were 119 former adolescent mothers (mean age = 20.2 years) from predominantly poor, minority backgrounds (50% Hispanic, 27% African American, 17% non-Hispanic White). All subjects completed questionnaires about their parenting qualities twice an average of 10 weeks apart. All children were at least 1 year of age (mean age = 37.2 months; range 12-50 months). Subjects' parenting attitudes were assessed by the Adult-Adolescent Parenting Inventory, a 32-item questionnaire. The Maternal Self-Report inventory was used to assess the mothers' self-esteem or their confidence in the mothering role. To assess the stress experienced with parenting, the Parenting Daily Hassles scale was used. Results indicated that for some mothers there exists a triple jeopardy of low parenting confidence, high parenting stress, and inappropriate parenting values. Mothers who reported feeling high parenting stress had low confidence in themselves as mothers, low empathy to their children's needs, and low acceptance of their children. Mothers who were older at the time of the study placed greater value on physical punishment and had less confidence in their caretaking abilities. Young maternal age at delivery and young maternal age at the time of this study were associated with low child acceptance. Non-Hispanic White mothers had significantly more favorable parenting values (greater empathy to child's needs and less value of physical punishment) than did African-American and Hispanic mothers, and African-American mothers reported significantly greater caretaking confidence than did Hispanic mothers. No parity or sex of child effects were found. These results suggest the presence of meaningful patterns of convergence and within-group variation for the psychological qualities of adolescent mothers' parenting.

Does American acculturation affect outcome of Mexican-American teenage pregnancy?

The purpose of this study was to determine whether pregnant Mexican-American teenagers who are acculturated to American lifestyles have different medical and psychosocial problems from those who are more recent immigrants. Consecutive pregnant Mexican-American (or Mexican) teenagers attending a university obstetrics clinic for teenagers were divided into two groups based on country of birth of parents and teen, citizenship, preferred language, and years of U.S. residence. There were 60 in the acculturated group (G1) and 56 in the recent immigrant group (G2). Acculturated teenagers were younger at first sexual intercourse, completed more years of schooling, and sought earlier prenatal care (p < 0.05 for all above). Both groups delivered full-term singletons of average birth weight (mean = 3337 g +/- 477 g). All G2 fathers were Mexican, older (p < 0.05), more likely to be married to G2 teens (p < 0.001), and employed (p < 0.01). The G1 fathers completed more years of schooling (p < 0.05), and 10% were non-Mexican. These data underscore the need to consider acculturation, as well as ethnicity in understanding the experience of pregnant teenagers.

Psychosocial and economic factors associated with infant feeding intentions of adolescent mothers.

The infant feeding intentions of 64 primiparous, adolescent females, ages 14-18 years, were studied to assess factors which differentiated those who chose breastfeeding from those who did not. The study population consisted of 43 Hispanic, 9 black, 7 non-Hispanic white, and 5 Filipino or Southeast Asian subjects interviewed after delivery. Among the Hispanics, 31 primarily spoke Spanish, and 12 primarily spoke English. A total of 72% intended to breastfeed, and 22% planned to exclusively formula feed. Those teens who intended to breastfeed were significantly older, more often married, more likely to be Hispanic and Spanish speaking, and less likely to have been in school during the pregnancy. In addition, teens were more likely to choose breastfeeding if they had been breastfed themselves or exposed to other women who breastfed. These data suggest that the younger, non-Hispanic, single teen who is enrolled in school and lacking exposure to breastfeeding is the most in need of breastfeeding-promotion programs.

A comparative study of adolescent and adult mothers who intend to breastfeed.

The purpose of this study was to compare reasons for choosing to breastfeed, timing of the infant feeding decision, and intended duration of breastfeeding between adolescent and adult mothers. The study population consisted of primiparous teens and adults who were matched by ethnicity, and interviewed within 48 hours postpartum at the University of California, San Diego Medical Center from August to December, 1989. Of the 48 women in each age group, there were 40 Hispanics, 5 non-Hispanic whites, 2 blacks, and 1 Southeast Asian. Results showed that the teens differed from their adult counterparts in that they cited naturalness or convenience less often as a reason for breastfeeding. The adolescent mothers were also less likely than the adults to make the decision to breastfeed before the pregnancy, than during pregnancy or after birth. There was no difference in intended duration of breastfeeding between these two groups: the majority of women planned to breastfeed for less than 26 weeks. Early introduction of infant feeding education may serve to increase the adolescent's knowledge base from which to make the decision to breastfeed. Even though the adolescents intended to breastfeed for as long as the adults, they may benefit from increased exposure to prenatal care and childbirth classes as well as from a supportive school or work environment in order to achieve success in breastfeeding.

PIP: There has been a downward trend in the initiation and duration of breastfeeding in the US since 1984. This trend is particularly pronounced among adolescent mothers. The authors interviewed primiparous teens and adults matched by ethnicity to compare their reasons for choosing to breastfeed, the timing of the infant feeding decision, and the intended duration of breastfeeding. One group of mothers was of mean age 17.1 years in the range of 14-18 years, while the other group was of mean age 27.9 years in the range of 23-33 years. There were 48 women in each age group; forty Hispanics, five non-Hispanic Whites, two Blacks, and one southeast Asian. The participants were interviewed within 48 hours postpartum at the University of California, San Diego Medical Center during August-December 1989. Adolescent mothers cited naturalness or convenience less often than the older women as reasons for breastfeeding. The younger mothers were also less likely than the adults to make the decision to breastfeed before the pregnancy than during pregnancy or after birth. There was no difference in intended duration of breastfeeding between the two groups, with the majority of women planning to breastfeed for less than 26 weeks. The authors suggest that increased exposure to prenatal care and childbirth classes as well as supportive school and work environments may help younger mothers to successfully breastfeed.

Pregnancy risk among the younger sisters of pregnant and childbearing adolescents.

There is increasing evidence that younger sisters of childbearing teenagers are at increased risk for adolescent childbearing. We critically review this research and discuss three plausible theoretical explanations (social modeling, shared parenting influences, and shared societal risk) why the younger sisters of childbearing adolescents would themselves be at risk for teenage pregnancy. Considerations for preventive interventions aimed at the younger sisters of pregnant teenagers and directions for future research are discussed.

PIP: Social learning theory, shared parenting effects, and a shared societal risk interpretation are reviewed in order to fill the gap in understanding through what processes and under what conditions adolescent pregnancy and childbearing influence a sister's tendency toward adolescent childbearing. Each theory provides an explanation about the nature of the sister's influence on the sexual attitudes, behavior, and childbearing decisions of other children in the family. Social learning theory places emphasis on the active role of the sibling in socializing younger siblings. There may be a negative socialization process where sisters accept premarital sexual intercourse as the norm and accept single parenthood as a way to achieve adult status. The theory of shared parenting postulates that the parenting environment influences sisters through strategies of discipline and control, communication of values, and parental marital status of family structure. The theory of shared societal risk stipulates that it is the shared socioeconomic status and social class, particularly being poor, black, and from a single-parent family in an inner city neighborhood, that increases risk for early sexual initiation and pregnancy. Unfavorable social circumstances and tolerance for early unwed parenting in the black community contribute to the life course experiences of all sisters within a family. Prior to this discussion, 4 studies by Friede et al', Goldfarb et al', Hogan and Kitagawa, and Cox et al, are discussed as evidence that a strong relationship exists between the risks of adolescent sisters' childbearing. The findings of these studies show that in 3 out of 4 studies there is a 1.8-2 fold increased rate of childbearing among the sisters of pregnant and childbearing teenagers; the studies were nationally representative and involved large sample sizes. Considerations for interventions and directions for future research are also provided. Interventions must be attuned to the problems of identification, accessibility, and participation of the high risk group. A group discussion approach which includes sisters may be of benefit. Future research might consider comparisons of the 3 frameworks in order to answer how important each is in accounting for similar patterns of childbearing among sisters. Multidisciplinary approaches in behavioral pediatrics, family sociology, and developmental psychology would be beneficial.

Teaching behavioral pediatrics and to pediatric residents: the state o the art and description of a program.

In 1978, the Task Force on Pediatric Education strongly recommended that all pediatric residency programs include at least one full-time rotation and biosocial pediatric, preferably in the 1st or 2nd year. Since 1977, the University of Maryland has had a structured, integrated, required program in Behavioral Pediatrics, including 2 months in both the PL-1 and PL-2 years for a total of 4 months addition of elective experience is available in the PL-3 year. The development and description of this program is presented as well as a review to the relevant literature.

Outcomes and parent-child relationships of former adolescent mothers and their 12-year-old children.

This study compared former adolescent mothers and their 12-year-old children with adult child-bearing mothers and their children along three dimensions: mothers' life-course characteristics (e.g., educational attainment, employment status, current annual family income); children's scholastic, psychological, social, and behavioral adjustment; and dimensions of the parent-child relationship (e.g., companionship, affection, intimacy). Results showed that adolescent mothers had significantly lower levels of completed education than adult mothers, and children of teenage mothers exhibited more learning problems (as rated by self, mother, and teacher) than children of adult mothers. Younger childbearing mothers and fathers felt they provided less esteem enhancement support to their children than older childbearing parents. In addition, early childbearing mothers felt less satisfied with their mother-child relationships, and early childbearing fathers shared fewer companionate activities with their children than adult childbearing mothers and fathers, respectively. The long-term implications of adolescent parenting for the adolescent and her child are discussed.

Rubella seronegativity in a low socioeconomic adolescent female population.

Ninety low socioeconomic adolescent females (aged 16-22 years, means 18.6 years) were screened for rubella immunity using a rubella IgG enzyme immunoassay. Data concerning past immunizations (with documentation, if possible), prior rubella disease, and previous pregnancies were gathered through direct interviews. Results revealed 20 percent (18/90 girls) were seronegative. Fifty-eight percent (42/72) of the seropositive girls and 50 percent (9/18) of the seronegative girls gave verbal reports of previous rubella immunization, but only 11 subjects (12.2%) could provide documentation of previous vaccination, including one seronegative subject. Thirty-one percent (28/90) of the study population had a history of one or more previous pregnancies (22 therapeutic abortions, 10 live births, and 8 spontaneous abortions). A comparison of the seronegativity rate between the 28 girls who were pregnant previously and the 62 girls who were never pregnant demonstrated a significantly higher seronegativity rate among those who had been pregnant (29% vs. 16%; chi 2 = 5.51; p less than 0.05). The results of this study suggest that the seronegativity rate in this age group is consistent with previous reports of rubella immunity, few adolescents can provide documentation of rubella vaccination, and presentation for abortion is an optimal time to vaccinate rubella susceptible females.

Physical growth and development: current concepts.

The process we call puberty is complex and still poorly understood. Some of the hormonal effects have been discussed, but much work remains before the specific mechanisms are defined. Genetic and nutritional influences affect puberty and further complicate the study of this population. Knowledge of the developmental sequence and SMR scale is useful in clinical practice. Understanding the changes that an adolescent is experiencing will help in the early diagnosis of abnormalities in growth and development. This knowledge will also serve as a guide in providing useful anticipatory guidance.

Repeat pregnancy among urban adolescents: sociodemographic, family, and health factors.

First-time adolescent mothers are at high risk for a repeat pregnancy. The present investigation, part of an ongoing longitudinal study, examined sociodemographic, family, and health factors associated with repeat Pregnancy in a clinic sample of urban, first-time adolescent mothers (ages 13 to 17 years). They were predominantly African-American and from low-income households. Repeat pregnancy within one year and between one and two years postpartum was determined from medical records. Summary statistics, point biserial correlations, and chi-square statistics were used to analyze the data. Results indicated that postpartum contraceptive method was associated with repeat pregnancy at Year 1; contraceptive use, maternal age, history of miscarriages, and postpartum contraceptive method were associated with repeat pregnancy at Year 2. It was concluded that efforts to prevent repeat pregnancies among first-time adolescent mothers should include the continuous monitoring of contraceptive use, as well as the promotion of long-acting contraceptives (e.g., medroxyprogesterone or progesterone implants). Further, counseling should be offered to adolescent mothers with a history offered miscarriages.

Medical and mental health needs of adolescent Indochinese refugees.

PIP: Since 1975 approximately 900,000 Indochinese refugees have immigrated to the US. In conducting a retrospective review of the medical records of Indochinese refugees between the ages of 11 and 21 years, this paper investigates the prevalence of health problems in adolescent Indochinese refugees studied, 85% had at least 1 medical disorder. At least 1 chronic condition associated with signifiant morbidity or functional impairment in daily life was found in 23%. 1 of the most prevalent health problems found in these adolescents was the lack of appropriate immunizations for age in 24%, despite their having been in the US for many months. There was a 15% prevalence of mental health disorders, including psychosomatic illnesses and alcohol abuse. The following suggestions should be considered when assessing the psychological status of the adolescent Indochinese refugees: 1) interpreters should be of the same gender as the patient; 2) an age-appropriate developmental assessment should be conducted; 3) delay the exploration of personal and sexual issues until the 2nd visit; 4) solicitation of the youth's experiences in leaving the home country will help the clinician and patient become better acquainted; 5) a drug history should be obtained; and 6) the clinician should develop a sense of how the adoescent's adjustment to life in the US has been.^ieng