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1.
Acad Pediatr ; 19(8): 891-898, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30986548

RESUMO

OBJECTIVE: To examine associations between housing instability and poor diet quality in a sample of urban parents and children. METHODS: Cross-sectional study of 340 parent/guardian-child dyads visiting a pediatric primary care center in Boston, Massachusetts. The parent/guardian (hereafter, parent) completed 2 Harvard Service Food Frequency Questionnaires, one regarding their own dietary intake and one regarding their child's intake, and an assessment of health-related social needs. Diet quality was measured using the Healthy Eating Index-2010 (HEI-2010; score range 0-100). Housing instability was defined as: 1) homeless or in sheltered housing, 2) doubled up with another family, 3) utilities threatened or shut off, or 4) concerned about eviction. Multivariable logistic regression was used to measure associations between unstable housing and lowest-quartile HEI-2010 scores, adjusting for parent age, race/ethnicity, education, income, and child age. RESULTS: Median (interquartile range) parent and child HEI-2010 scores were 63.8 (56.3-70.8) and 59.0 (54.2-64.7), respectively. Housing instability was found in 136 dyads (40%). In multivariable analysis, it was associated with increased odds of lowest-quartile total parent HEI-2010 scores (adjusted odds ratio [aOR], 1.9; 95% confidence interval [95% CI], 1.1-3.5) but not child scores (aOR, 1.4; 95% CI, 0.8-2.5). It also was associated with increased odds of lowest-quartile parent HEI-2010 dietary component scores for Total vegetables and Greens and beans (aOR, 2.0; 95% CI, 1.1-3.7 and aOR, 2.5; 95% CI, 1.3-4.8, respectively). CONCLUSIONS: In this urban primary care population, housing instability is associated with lower diet quality scores for parents but not children. Lower vegetable consumption appears to drive this association.

2.
Pediatrics ; 143(3)2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30755464

RESUMO

: media-1vid110.1542/5985300176001PEDS-VA_2018-2303Video Abstract BACKGROUND: Teen mothers often present with depression, social complexity, and inadequate parenting skills. Many have rapid repeat pregnancy, which increases risk for poor outcomes. We conducted a randomized controlled trial of a parenting and life skills intervention for teen mothers aimed at impacting parenting and reproductive outcomes. METHODS: Teen mothers were recruited from a teen-tot clinic with integrated medical care and social services. Participants were randomly assigned 1:1 to receive (1) teen-tot services plus 5 interactive parenting and life skills modules adapted from the Nurturing and Ansell-Casey Life Skills curricula, delivered by a nurse and social worker over the infant's first 15 months or (2) teen-tot services alone. A computerized questionnaire was self-administered at intake, 12, 24, and 36 months. Outcomes included maternal self-esteem, parenting attitudes associated with child maltreatment risk, maternal depression, life skills, and repeat pregnancy over a 36-month follow-up. We used generalized linear mixed modeling and logistic regression to examine intervention effects. RESULTS: Of 152 invited, 140 (92%) participated (intervention = 72; control = 68). At 36 months, maternal self-esteem was higher in the intervention group compared with controls (P = .011), with higher scores on preparedness for mothering role (P = .011), acceptance of infant (P = .008), and expected relationship with infant (P = .029). Repeat pregnancy by 36 months was significantly lower for intervention versus control participants. CONCLUSIONS: A brief parenting and/or life skills intervention paired with medical care for teens and their children has positive effects on maternal self-esteem and repeat pregnancy over 36 months.


Assuntos
Educação Infantil/psicologia , Mães/educação , Mães/psicologia , Poder Familiar/psicologia , Gravidez na Adolescência/psicologia , Adolescente , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Autoimagem , Inquéritos e Questionários
3.
Clin Pediatr (Phila) ; : 9922818812479, 2018 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-30461298

RESUMO

There is growing emphasis on using patient-reported outcome measures to enhance clinical practice. This study was a retrospective review of scores on the Childhood Asthma Control Test (C-ACT) and the Pediatric Symptom Checklist-17 (PSC-17) at a pediatric primary care center in Boston, Massachusetts. A total of 218 patients were selected at random using billing codes for well-child (WC) care and asthma, excluding complex medical conditions. Cutoff scores were used to identify uncontrolled asthma (C-ACT ⩽19) and clinically significant psychosocial symptoms (+PSC-17). Multiple logistic regression was used to measure associations between C-ACT ⩽19 and +PSC-17, adjusting for covariates. In multivariable analysis, C-ACT ⩽19 at WC visits was associated with +PSC-17 at WC visits (adjusted odds ratio = 3.2 [95% confidence interval = 1.3-8.6]). C-ACT ⩽19 at non-WC visits was also associated with +PSC-17 at WC visits (adjusted odds ratio = 3.1 [95% confidence interval = 1.2-8.9]). Patient-reported outcome measures of asthma control and psychosocial symptoms were positively correlated in this sample.

4.
Clin Pediatr (Phila) ; 57(4): 442-450, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28929794

RESUMO

We conducted 29 group visits targeting children with elevated body mass index (BMI) and their families. Visit activities focused on social support, mind-body techniques, exercise, and nutrition. Measures included attendance, family satisfaction scores, and per-patient change in BMI percentile. Ninety-six patients attended ≥1 group visit, mean 2.0 (SD ±1.8; range 1-14). Mean patient age was 9.6 years (SD ±2.4; range 4-15 years); 53.1% were female; 44.8% had a BMI 95th to 99th percentile for age/sex; 35.4% had a BMI >99th percentile. Mean attendance per group visit was 6.8 patients (SD ±3.8; range 1-16 patients). Mean family satisfaction scores were 9.8 (SD ±0.8) with 10/10 "would recommend to family or friends." Of 42 patients who attended ≥2 group visits, 5 (11.9%) experienced a ≥5 BMI percentile reduction between first and last visits; 3 (7.1%) maintained this reduction 2 years later. Group visits were associated with high family satisfaction scores, though few patients experienced a reduction in BMI percentile.


Assuntos
Obesidade Pediátrica/terapia , Atenção Primária à Saúde/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Programas de Redução de Peso/métodos , Adolescente , Índice de Massa Corporal , Boston , Criança , Pré-Escolar , Exercício , Feminino , Humanos , Masculino , Apoio Social , Resultado do Tratamento
5.
Clin Pediatr (Phila) ; 56(10): 934-941, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28436286

RESUMO

Innovative approaches within primary care are needed to reduce fragmented care, increase continuity of care, and improve asthma outcomes in children with asthma. Our objective was to assess the impact of coordinated team-based asthma care on unplanned asthma-related health care utilization. A multidisciplinary asthma team was developed to provide coordinated care to high-risk asthma patients. Patients received an in-depth diagnostic and family needs assessment, asthma education, and coordinated referral to social and community services. Over a 2-year period, 141 patients were followed. At both 1 and 2 years postintervention, there was a significant decrease from preintervention rates in urgent care visits (40%, P = .002; 50%, P < .0001), emergency department visits (63%, P < .0001; 70%, P < .0001), and inpatient hospitalization (69%, P = .002; 54%, P = .04). Our coordinated asthma care program was associated with a reduction in urgent care visits, emergency department visits, and inpatient hospitalizations among high-risk children with asthma.


Assuntos
Asma/terapia , Serviços de Saúde Comunitária/métodos , Educação de Pacientes como Assunto/métodos , Avaliação de Resultados da Assistência ao Paciente , Atenção Primária à Saúde/métodos , Avaliação de Programas e Projetos de Saúde , Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Equipe de Assistência ao Paciente , Cooperação do Paciente/estatística & dados numéricos , Risco
6.
Acad Pediatr ; 17(5): 497-503, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28302365

RESUMO

OBJECTIVE: To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. METHODS: Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. RESULTS: A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0). CONCLUSIONS: In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs.


Assuntos
Assistência Alimentar , Abastecimento de Alimentos , Atenção Primária à Saúde , Encaminhamento e Consulta , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Seleção de Pacientes
7.
BMC Public Health ; 16(1): 874, 2016 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-27558506

RESUMO

BACKGROUND: Despite recommendations that 11-12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates. METHODS: We conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24), their caregivers (n = 24), and nurses (n = 18), and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion. RESULTS: Themes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, "newer" vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections. CONCLUSIONS: Optimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families' concerns about vaccine safety and efficacy.


Assuntos
Afro-Americanos/psicologia , Cuidadores/estatística & dados numéricos , Hispano-Americanos/psicologia , Infecções por Papillomavirus/etnologia , Vacinas contra Papillomavirus/administração & dosagem , Adolescente , Afro-Americanos/estatística & dados numéricos , Atitude do Pessoal de Saúde , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Infecções por Papillomavirus/prevenção & controle , Médicos , Vacinação/estatística & dados numéricos
8.
Pediatrics ; 137(3): e20153673, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26933205

RESUMO

More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children.


Assuntos
Serviços de Saúde da Criança , Assistência à Saúde/organização & administração , Política de Saúde , Pediatria/organização & administração , Atenção Primária à Saúde/organização & administração , Criança , Humanos
9.
Matern Child Health J ; 19(12): 2707-13, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26152891

RESUMO

OBJECTIVES: Children with medical complexity (CMC) are a growing population in pediatric primary care practices, and families caring for these children face increased medical, developmental, education and social needs. The objective of this study was to quantify hospital-wide social work services utilization by CMC compared to non-medically-complex children (non-CMC) to inform the development of family-centered care models that support these vulnerable patients and families. METHODS: Social work department records from a tertiary children's hospital were used to compare CMC aged 0-17 (n = 564) with age- and sex-matched non-CMC (n = 1128) over a 16-month retrospective period. The main outcomes measures were the proportion of patients who used social work services and mean number of hours of services provided per patient, both by social work providers in the primary care setting and throughout the hospital. RESULTS: A greater percentage of CMC used social work services than non-CMC (60.3 vs. 18.9%), and CMC used more hours per child (5.50 h/child vs. 0.69). In multivariate analysis, medical complexity was associated with 6.23-fold greater odds of using social work services (95% CI 4.94-7.85) and with 8.07 times more hours of services per child (95% CI 6.30-10.34), independent of primary health insurance, age, or sex. CONCLUSION: This study confirms that CMC use significantly more social work services in the medical setting. This must be considered when designing proactive medical home models to provide high quality family-centered care for this population, and further research is needed to elucidate the factors that drive this utilization.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Crianças com Deficiência/reabilitação , Serviço Social , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos
10.
Clin Pediatr (Phila) ; 54(10): 976-82, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25676833

RESUMO

BACKGROUND: Missed appointments complicate primary care services. OBJECTIVE: To determine factors associated with missed pediatric appointments. DESIGN/METHODS: A convenience sample of 1537 patients who missed appointments were called and 386 (25%) families completed the 26-item survey. Those with high no-show rates were compared with the rest using χ(2) and Fisher's exact tests. Initial covariates with P < .2 were included in a multivariate logistic regression model. RESULTS: Common reasons for missing appointments were the following: forgot (27%), transportation problems (21%), and time off of work (14%). The high no-show group had more African Americans (P = .030) and older patients (P = .003). Higher no-show rates correlated with well child visits (P = .029) and perception of "excellent health" (P = .022). In the logistic regression model, well child appointments (odds ratio = 2.56) and increasing age in years (odds ratio = 1.11) were associated with higher no-show rates. CONCLUSIONS: Efforts to decrease no-show rates should target older patients and well child visits.


Assuntos
Agendamento de Consultas , Atenção Primária à Saúde , Serviços Urbanos de Saúde , Afro-Americanos , Criança , Demografia , Hispano-Americanos , Humanos , Modelos Logísticos , Massachusetts , Pediatria , Análise de Regressão , Inquéritos e Questionários
11.
Int J Pediatr ; 2014: 152586, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24672556

RESUMO

Objective. To examine body mass index (BMI) changes among pediatric multidisciplinary weight management participants and nonparticipants. Design. In this retrospective database analysis, we used multivariable mixed effect models to compare 2-year BMI z-score trajectories among 583 eligible overweight or obese children referred to the One Step Ahead program at the Boston Children's Primary Care Center between 2003 and 2009. Results. Of the referred children, 338 (58%) attended the program; 245 (42%) did not participate and were instead followed by their primary care providers within the group practice. The mean BMI z-score of program participants decreased modestly over a 2-year period and was lower than that of nonparticipants. The group-level difference in the rate of change in BMI z-score between participants and nonparticipants was statistically significant for 0-6 months (P = 0.001) and 19-24 months (P = 0.008); it was marginally significant for 13-18 months (P = 0.051) after referral. Younger participants (<5 years) had better outcomes across all time periods examined. Conclusion. Children attending a multidisciplinary program experienced greater BMI z-score reductions compared with usual primary care in a real world practice; younger participants had significantly better outcomes. Future research should consider early intervention and cost-effectiveness analyses.

12.
Pediatrics ; 133(4): e1047-54, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24664096

RESUMO

OBJECTIVE: We implemented a quality improvement initiative aimed at reaching a 95% immunization rate for patients aged 24 months. The setting was a hospital-based pediatric primary care practice in Boston, Massachusetts. We defined immunization as full receipt of the vaccine series as recommended by the Centers for Disease Control and Prevention. METHODS: The initiative was team-based and structured around 3 core interventions: systematic identification and capture of target patients, use of a patient-tracking registry, and patient outreach and care coordination. We measured monthly overall and modified immunization rates for patients aged 24 months. The modified rate excluded vaccine refusals and practice transfers. We plotted monthly overall and modified immunization rates on statistical process control charts to monitor progress and evaluate impact. RESULTS: We measured immunization rates for 3298 patients aged 24 months between January 2009 and December 2012. Patients were 48% (n = 1576) female, 77.3% (n = 2548) were African American or Hispanic, and 70.2% (n = 2015) were publicly insured. Using control charts, we established mean overall and modified immunization rates of 90% and 93%, respectively. After implementation, we observed an increase in the mean modified immunization rate to 95%. CONCLUSIONS: A quality improvement initiative enabled our pediatric practice to increase its modified immunization rate to 95% for children aged 24 months. We attribute the improvement to the incorporation of medical home elements including a multidisciplinary team, patient registry, and care coordination.


Assuntos
Imunização/estatística & dados numéricos , Pré-Escolar , Feminino , Hospitais , Humanos , Masculino , Atenção Primária à Saúde , Melhoria de Qualidade
15.
Clin Pediatr (Phila) ; 51(12): 1119-24, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22967813

RESUMO

Home-related injuries are overrepresented in children from low-income households. The objectives of this study were to determine frequencies of home safety behaviors and the level of agreement between parental self-report and observed safety practices in low-income homes. In a prospective, interventional home injury prevention study of 49 low-income families with children <5 years old, a trained home visitor administered baseline parental home safety behavior questionnaires and assessments. There was high agreement between caregiver self-report and home visitor observation for lack of cabinet latch (99%, 95% confidence interval [CI] = 88%-99%) and stair gate use (100%, 95% CI = 88-100%). There was lower agreement for the safe storage of cleaning supplies (62%, 95% CI = 46%-75%), sharps (74%, 95% CI = 59%-85%), and medicines/vitamins (83%, 95% CI = 69%-92%) because of the overreporting of safe practices. Self-reports of some home safety behaviors are relatively accurate, but certain practices may need to be verified by direct assessment.


Assuntos
Prevenção de Acidentes/estatística & dados numéricos , Acidentes Domésticos/prevenção & controle , Cuidadores , Pais , Equipamentos de Proteção/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Masculino , Pobreza , Estudos Prospectivos , Segurança , Autorrelato , Inquéritos e Questionários , População Urbana
16.
Am J Public Health ; 102(10): 1879-85, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22897537

RESUMO

OBJECTIVES: This study described a medical home model for adolescent mothers and their children, and their 1- and 2-year preventive care, repeat pregnancy, and psychosocial outcomes. METHODS: In this prospective, single cohort demonstration project, adolescent mothers (14-18 years old) and their children received care in a medical home. Demographic, medical and social processes, and outcomes data were collected at enrollment through 24 months. Change over time and predictors of repeat pregnancy were analyzed. RESULTS: A total of 181 adolescents enrolled, with 79.6% participating for 2 years. At 2 years, 90.2% of children were completely immunized. Children and adolescent mothers met standards for health care visits, and adolescent condom use improved. Rates of cumulative repeat pregnancy were 14.7% and 24.6%, school attendance 77.6% and 68.7%, and employment 21.2% and 32.3% at 1 and 2 years, respectively. CONCLUSIONS: A medical home model with comprehensive and integrated medical care and social services can effectively address the complex needs of adolescent parents and their children.


Assuntos
Saúde da Família , Centros de Saúde Materno-Infantil , Mães/psicologia , Assistência Centrada no Paciente , Gravidez na Adolescência/prevenção & controle , Apoio Social , Adolescente , Estudos de Coortes , Preservativos/estatística & dados numéricos , Feminino , Humanos , Massachusetts , Modelos Organizacionais , Projetos Piloto , Gravidez , Prevenção Primária , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Inquéritos e Questionários
17.
Curr Opin Pediatr ; 24(4): 446-52, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22790098

RESUMO

PURPOSE OF REVIEW: Adolescent childbearing in the United States continues to occur at high rates compared with other industrialized nations, despite a recent decline. Adolescent mothers and their offspring are at risk for negative outcomes. Recent literature exploring the consequences of teenage childbearing and interventions to ameliorate these consequences are presented. RECENT FINDINGS: Negative consequences of adolescent childbearing can impact mothers and their offspring throughout the lifespan. These consequences are likely attributable to social and environmental factors rather than solely to maternal age. Increasing educational attainment, preventing repeat pregnancy and improving mother-child interactions can improve outcomes for mothers and their children. Home, community, school and clinic-based programs are all viable models of service delivery to this population. SUMMARY: Connecting teen mothers with comprehensive services to meet their social, economic, health and educational needs can potentially improve long-term outcomes for both mothers and their offspring. Programs that deliver care to this population in culturally sensitive, developmentally appropriate ways have demonstrated success. Future investigation of parenting interventions with larger sample sizes and that assess multiple outcomes will allow comparison among programs. Explorations of the role of the father and coparenting are also directions for future research.


Assuntos
Comportamento do Adolescente , Depressão/prevenção & controle , Serviços de Planejamento Familiar/organização & administração , Relações Mãe-Filho , Poder Familiar , Gravidez na Adolescência/estatística & dados numéricos , Adaptação Psicológica , Adolescente , Comportamento Contraceptivo , Depressão/epidemiologia , Escolaridade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Gravidez na Adolescência/prevenção & controle , Apoio Social , Estados Unidos/epidemiologia
18.
Curr Opin Pediatr ; 24(4): 462-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22790099

RESUMO

PURPOSE OF REVIEW: Teen pregnancy has been subject of public concern for many years. In the United States, despite nearly 2 decades of declining teen pregnancy and birth rates, the problem persists, with significant disparities present across racial groups and in state-specific rates. This review examines recent trends, pregnancy prevention initiatives and family planning policies that address the special needs of vulnerable youth. RECENT FINDINGS: Unintended teen pregnancies impose potentially serious social and health burdens on teen parents and their children, as well as costs to society. Trends in teen pregnancy and birth rates show continued decline, but state and racial disparities have widened. Demographic factors and policy changes have contributed to these disparities. Research supports comprehensive pregnancy prevention initiatives that are multifaceted and promote consistent and correct use of effective methods of contraception for youth at risk of becoming pregnant. SUMMARY: There is strong consensus that effective teen pregnancy prevention strategies should be multifaceted, focusing on delay of sexual activity especially in younger teens while promoting consistent and correct use of effective methods of contraception for those youth who are or plan to be sexually active. There is a need for further research to identify effective interventions for vulnerable populations.


Assuntos
Aborto Induzido/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/estatística & dados numéricos , Educação Sexual/organização & administração , Aborto Induzido/tendências , Adolescente , Comportamento do Adolescente , Prática Clínica Baseada em Evidências , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/tendências , Humanos , Gravidez , Abstinência Sexual , Fatores Socioeconômicos , Estados Unidos/epidemiologia
19.
Matern Child Health J ; 16(4): 894-901, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21556696

RESUMO

Previous studies have suggested that adolescent mothers with higher social support have lower depressive symptoms. This is a longitudinal study of adolescent mothers to examine the association of social support and depressive symptoms over one year postpartum. This was a prospective study of adolescent mothers (N at baseline = 120, N at 1 year = 89; age < 19 years) enrolled in a teen tot program. Participants completed the Center for Epidemiological Studies Depression Scale for children (CES-DC) and the Duke-UNC Functional Social Support Questionnaire at baseline, 12 weeks, and 1 year. A score of ≥ 16 on the CES-DC was suggestive of major depression. The mean CES-DC scores of the adolescent mothers were ≥ 16 points at all three time points (baseline: mean = 18.7 ± 10.3; 53% ≥ 16; 12 weeks: mean = 18.4 ± 11.4, 57% ≥ 16; one year: mean = 20.0 ± 11.4; 57% ≥ 16). Social support had a significant, inverse association with depressive symptoms for all participants from baseline to 12 weeks with a stronger association for those with more depressive symptoms (score ≥ 16) at baseline (beta = -0.030 ± 0.007; P < 0.001) than for those with fewer depressive symptoms (score < 16) at baseline (beta = -0.013 ± 0.006; P = 0.021). From 12 weeks to one year, increased social support was only significantly associated with decreased depressive symptoms for those with a higher baseline level of depressive symptoms (beta = - 0.039 ± 0.009; P < 0.001). Depressive symptoms were prevalent among adolescent mothers. For more depressed adolescent mothers, higher levels of social support were associated with less depressive symptoms over the 1 year follow-up. Effective long-term interventions are needed to lessen depression and enhance social support.


Assuntos
Depressão Pós-Parto/epidemiologia , Mães/psicologia , Apoio Social , Adolescente , Arizona/epidemiologia , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Feminino , Seguimentos , Hispano-Americanos , Humanos , Bem-Estar do Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Pobreza , Gravidez , Gravidez na Adolescência , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Análise de Regressão , Inquéritos e Questionários
20.
Nature ; 469(7331): 534-8, 2011 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-21270893

RESUMO

Imprinted genes, defined by their preferential expression of a single parental allele, represent a subset of the mammalian genome and often have key roles in embryonic development, but also postnatal functions including energy homeostasis and behaviour. When the two parental alleles are unequally represented within a social group (when there is sex bias in dispersal and/or variance in reproductive success), imprinted genes may evolve to modulate social behaviour, although so far no such instance is known. Predominantly expressed from the maternal allele during embryogenesis, Grb10 encodes an intracellular adaptor protein that can interact with several receptor tyrosine kinases and downstream signalling molecules. Here we demonstrate that within the brain Grb10 is expressed from the paternal allele from fetal life into adulthood and that ablation of this expression engenders increased social dominance specifically among other aspects of social behaviour, a finding supported by the observed increase in allogrooming by paternal Grb10-deficient animals. Grb10 is, therefore, the first example of an imprinted gene that regulates social behaviour. It is also currently alone in exhibiting imprinted expression from each of the parental alleles in a tissue-specific manner, as loss of the peripherally expressed maternal allele leads to significant fetal and placental overgrowth. Thus Grb10 is, so far, a unique imprinted gene, able to influence distinct physiological processes, fetal growth and adult behaviour, owing to actions of the two parental alleles in different tissues.


Assuntos
Alelos , Comportamento Animal/fisiologia , Proteína Adaptadora GRB10/genética , Proteína Adaptadora GRB10/metabolismo , Impressão Genômica/genética , Animais , Sistema Nervoso Central/embriologia , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Mutação , Predomínio Social
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