Health care utilization among homeless adolescents and young adults.

A probability sample of Californian homeless females was examined for health service utilization, comparing adolescents to older women. Adolescent homeless women reported higher outpatient visit use. Possessing public health insurance increased the odds of outpatient visits. Future research might use the outpatient setting to aid adolescents in exiting homelessness.     

Health status and access to health services among the urban homeless.

Self-reported health status and access to care were reported for 238 homeless adults in Los Angeles. One-third reported their health as fair or poor; women reported more health problems than men. Half (53 per cent) of the sample reported no regular source of care, and most (81 per cent) were without health insurance. Lack of financial resources and health insurance were reported as important barriers to care.     

Vitamin D status in adolescents and young adults with HIV infection

BACKGROUND: Vitamin D status affects immune function and thus may affect the progress of HIV infection. OBJECTIVES: Our goals were to assess vitamin D intake and status in subjects with HIV infection and in matched control subjects and to determine whether HIV infection was associated with vitamin D insufficiency. DESIGN: Plasma 25-hydroxyvitamin D [25(OH)D] concentrations and vitamin D intake were measured in a cross-sectional study of members of the Reaching for Excellence in Adolescent Health (REACH) cohort. RESULTS: The subjects were aged 14-23 y; 74% were female, and 72% were black. Mean (+/-SE) vitamin D intake from food was 30% greater (P = 0.023) in HIV-positive subjects (295 +/- 18 IU/d; n = 237) than in HIV-negative subjects (227 +/- 26 IU/d; n = 121). The prevalence of vitamin D supplement use was 29% (104 of 358 subjects) and did not differ significantly by HIV status (P = 0.87). Mean plasma 25(OH)D did not differ significantly (P = 0.62) between the HIV-positive (20.3 +/- 1.1 nmol/L; n = 238) and HIV-negative (19.3 +/- 1.7 nmol/L; n = 121) subjects, nor was HIV status a significant predictor of plasma 25(OH)D when multiple regression analysis was used to adjust for other variables. The prevalence of vitamin D insufficiency [plasma 25(OH)D < or = 37.5 nmol/L] in the subjects was 87% (312 of 359 subjects). CONCLUSIONS: HIV infection did not influence vitamin D status. The prevalence of vitamin D insufficiency in both HIV-positive and HIV-negative REACH subjects was high, perhaps because these disadvantaged, largely urban youth have limited sun exposure.     

Cystic fibrosis in adolescents and young adults.

With the early diagnosis of cystic fibrosis and the better management of these patients in childhood increasing numbers are surviving to adult life. The main problem requiring continuous medical care in the older cystic fibrosis patient is persisting and often progressive chest disease. For this reason the cystic fibrosis clinic for adolescents and young adults was started in the Western Infirmary in 1975. This paper presents our observations on 13 patients who had attended between 1975 and 1977. Eleven patients are alive and well and have shown no evidence of deterioration over this period. Ten are at school or in regular employment. With optimum medical supervision it is possible to give young adults with cystic fibrosis a worthwhile existence.     

C-reactive protein and dietary nutrients in urban Asian Indian adolescents and young adults

OBJECTIVE: The relationship between C-reactive protein (CRP), a surrogate marker of cardiovascular risk, and dietary nutrients is not known. We investigated the relationship between serum CRP levels and dietary nutrients in young Asian Indians residing in a major metropolitan city in north India. METHODS: Dietary nutrient intake values (24-h dietary recall and monthly consumption data) and serum CRP levels were studied in 359 healthy adolescents and young adults (312 male and 47 female) (mean age, 18.0 +/- 2.3 y; range, 14-25 y), after carefully excluding those with history of infections and smoking. Bivariate and multivariate logistic regression analysis was performed with CRP [raised (>3.0 mg/L)/normal] as the outcome variable and various dietary nutrients and anthropometric variables as covariates. RESULTS: Mean CRP level was 1.3 +/- 2.3 mg/L (range, 0.02-17.5 mg/L). Raised CRP levels (>3 mg/L) were noted in 9% study subjects (8.6% males and 12.8% females). After adjustment for other covariates, saturated fat emerged as the single most important nutrient contributing to increase in serum CRP levels. The odds of having a raised CRP level in subjects consuming more than 10% energy as saturated dietary fat were twice as compared to subjects having a normal saturated fat intake [Adjusted odds ratio (OR) (95% CI) = 2.0 (0.94-4.1)]. For every one percent decrease in energy intake by saturated fat, CRP level was calculated to decrease by 0.14 mg/L. For decreasing CRP levels to <1.0 mg/L (low risk for cardiovascular disease), Asian Indian adolescents and young adults should ensure saturated fat intake <7% of caloric intake. CONCLUSION: We suggest that daily saturated fat intake should be limited to <7% of caloric intake in urban adolescents and young adult Asian Indians to decrease their future cardiovascular risk.     

Inaccurate documentation of HIV-positive status in adolescents visiting an urban emergency department.

PURPOSE: To identify the frequency of documentation of human immunodeficiency virus (HIV)-positive adolescents' serostatus during urban pediatric emergency room visits, and to examine possible differences between those whose HIV positive serostatus was and was not documented. METHODS: Between 1986 and 1996, 115 HIV-positive adolescents (41 male, 74 female) were followed for primary medical care at the Children's National Medical Center's adolescent HIV clinic (Burgess Clinic) in Washington, DC. A retrospective chart analysis of visits to the emergency room by these adolescent patients known to be HIV positive was conducted. RESULTS: Forty-nine of the HIV patients (ages 10-23 years) visited the hospital's emergency room a total of 124 times in the time following notification (range, 2 days to 15 years; mean, 2.6 years) of their seropositivity and joining the program. Twenty-nine of the patients had no HIV seropositivity recorded during one or more of their visits; this prevalence represents 38% of the 124 emergency room visits. Twenty of the HIV-positive emergency room patients had no seropositivity documented during any emergency department visit. Of all 124 visits, 45 involved potential health care worker exposure to the HIV virus. Diagnosis of acquired immunodeficiency syndrome, CD4 count, age, gender, and year of visit did not differ among those with and without HIV documentation. CONCLUSION: Human immunodeficiency virus-positive adolescents are seen in this emergency room and their records do not reflect their infection status. These data reinforce the need for universal precautions for every patient.     

Health services access and use among older adults in North Carolina: urban vs rural residents.

OBJECTIVES. This study compared health service use and satisfaction with health care among older adults living in urban vs rural counties in North Carolina. METHODS. A stratified random sample of 4162 residents of one urban and four rural counties of North Carolina was surveyed to determine urban/rural variation in inpatient and outpatient health service use, continuity of care and satisfaction with care, and barriers (transportation, cost) to care. RESULTS. Inpatient and outpatient service use did not vary by residence in controlled analyses. Continuity of care was more frequent in rural counties. Transportation was not perceived as a barrier to health care more frequently in rural than in urban counties, but cost was a greater barrier to care among rural elderly people. CONCLUSIONS. In this sample, older persons living in rural counties within reasonable driving distance of urban counties with major medical centers used health services as frequently and were as satisfied with their health care as persons in urban counties. Cost of care, however, was a significant and persistent barrier among rural elderly people, despite Medicare coverage.     

Cystic fibrosis in adolescents and young adults

Advances in knowledge and medical science have resulted in an increased life span and quality of life of patients with cystic fibrosis (CF). The median age of survival for CF patients is 32.3 years of age and patients 18 years of age or older now constitute one third of the total patients with CF. Because of these advances, a new patient population has emerged: the adolescents and young adults with CF. Adolescence is normally a time of great cognitive, social and developmental changes. Adolescents with CF not only have to deal with the normal changes expected, but also have to deal with the transition of assuming responsibility for their care from the parents and transitioning their care from a pediatric to an adult care team. Moreover, many of these young adults have to deal with the impact of the progressive deterioration of their CF disease. This review discusses issues of significance to this emerging patient population, including medical care, issues of disability, and psychosocial and other medical conditions associated with an increased life expectancy.     

Health-related quality of life in youth: a comparison between adolescents and young adults with uncomplicated epilepsy and healthy controls.

PURPOSE: To describe health-related quality of life (HRQOL) in adolescents and young adults with uncomplicated epilepsy and to compare it with a random sample of the general population. METHODS: Young people, aged 13-22 years, meeting the criteria and registered in four Swedish hospitals answered questionnaires (n = 158/193) on HRQOL together with 282 (n = 282/390) random controls living in the same areas in Sweden. The instruments used were "I think I am," "Youth Self Report," "Sense of coherence," and "Family APGAR." Data were analyzed by using factorial analysis of variance. RESULTS: Girls had a poorer HRQOL than boys. The epilepsy group reported lower competence (i.e., they were less active, had lower social competence and poorer school achievement). Both groups had an overall positive self-esteem. Differences between girls in the epilepsy and control groups were small, whereas differences among boys were more evident. Older age was related to poorer HRQOL in both groups. CONCLUSIONS: This study points out the importance of being observant of signs of stigmatization in adolescents with epilepsy.     

Vitamin D status in children,adolescents, and young adults with Crohn disease

BACKGROUND: Crohn disease (CD) and vitamin D deficiency are associated with decreased bone mineralization. OBJECTIVE: We examined the prevalence of and risk factors for hypovitaminosis D in children, adolescents, and young adults with CD. DESIGN: Growth, clinical characteristics, vitamin D intake ( micro g/d), and bone mineral density (g/cm(2)) were measured in a cross-sectional study of 112 subjects (44 females) who had CD and were 5-22 y of age. Hypovitaminosis D was defined as a serum concentration of 25-hydroxyvitamin D [25(OH)D] < 38 nmol/L. RESULTS: The mean (+/- SD) serum concentration of 25(OH)D was 59.7 +/- 26.9 nmol/L, and 16% (95% CI: 9.3%, 23%) of the subjects had hypovitaminosis D. Hypovitaminosis D was most prevalent during the winter (31%; P = 0.02), among the African Americans (56%; P = 0.01), in the subjects with CD confined to the upper gastrointestinal tract (44%; P = 0.05), and in the subjects with a greater lifetime exposure to glucocorticoid therapy (23.7 +/- 13.5 compared with 17.5 +/- 12.2 mg/d; P = 0.05). There was no association between hypovitaminosis D and either bone mineral density (P = 0.10) or average dietary intake of vitamin D (4.6 +/- 3.6 micro g/d; P = 0.87). CONCLUSIONS: In this sample of pediatric patients with CD, hypovitaminosis D was common and was associated with the winter season, African American ethnicity, CD confined to the upper gastrointestinal tract, and magnitude of lifetime exposure to glucocorticoid therapy. The occurrence of these factors should prompt assessment of 25(OH)D status and clinical care optimized by supplementing subjects who have low serum concentrations. The physiologic relevance of ethnicity on 25(OH)D status in children with CD remains to be determined.     

High mobile phone ownership but low internet access and use among young adults attending an urban HIV clinic in Uganda

Whilst there is increasing interest in the use of mobile phones and other technologies for improving health outcomes (mHealth), limited data exists on how young people living with HIV use these technologies to gather information and support their health. We sought to assess access and use of mobile phones and the internet among young adults living with HIV attending the Infectious Diseases Institute (IDI) clinic, Kampala. Data collection took place between March 2014 and January 2016 among young adults aged 18–24 years attending the IDI transition clinic in a cross-sectional survey using a semi-structured questionnaire. Of the 272 young adults interviewed, 75% were female and median age was 22.3 years (IQR: 20.6–23.5). Whilst there was a trend to females being more likely to use mobile phones compared to the males, this was not statistically significant (93.7% female versus 85.9%, p = 0.057). Fifty percent of mobile phone users used their phones for HIV-related activities such as medication reminders. General access and use of the internet was low at 34% and users were more likely to be males than females (45.5% versus 30.6%, p = 0.027). A third (32.3%) of the internet users used it to search for HIV-related information. Owning a mobile phone was associated with ease of access to HIV information and preference to receive messages via text messages (p < 0.05). Having internet access was associated with very easy access to HIV information and preference to receive information via email. Despite the rise in smartphones and internet access in Uganda, in this group both access to and use of standard mobile phones are higher than internet-based methods such as email. Using newer technologies to engage with patients especially young people is a great opportunity, but the innovations need to be tailored to the needs and technology access for different patient populations.     

Differences between adolescents and young adults at presentation to an eating disorders program.

OBJECTIVE: To describe differences between adolescents and adults in clinical presentation of eating disorders. METHODS: Data from the charts of 622 female patients treated for an eating disorder in a division of adolescent medicine between 1980 and 1994 were coded and computerized. General categories included demographic and family factors, weight loss and weight changes, eating-related behaviors, diagnosis and severity, and treatment issues. Differences between the 438 patients who were aged 9-19 years (adolescents) and 184 patients who were aged 20-46 years (adults) were analyzed. RESULTS: Adolescents were more likely than adults (p <.05) to have a diagnosis of "eating disorder not otherwise specified," lower global severity score, greater denial and less desire for help, weight loss > or = 3 lb/month, lower original and maximum weights, and history of fasting and elimination of junk food from their diets. Adults were more likely than adolescents (p <.05) to have >1 year of weight loss, greater total weight loss, history of binge eating and laxative use, history of diuretic and ipecac use, diagnosis of bulimia nervosa, and prior use of psychiatric medications. Adolescents and adults did not differ (p >.05) in parents' occupational level; height, weight, and percent ideal body weight at presentation; original percent ideal body weight; use of diet pills, elimination of meat and use of a low-fat diet; daily calorie intake; prior eating disorder hospitalizations; and hospitalization during the course of treatment. CONCLUSIONS: The findings in this study document and confirm that there are important differences between adolescents and adults that must be taken into account in the evaluation and treatment of patients with eating disorders.     

A case-control study of employment status and mortality in a cohort of Australian youth.

Recent studies have demonstrated a link in young populations between unemployment and ill health. The purpose of this study is to correlate mortality with employment status in two cohorts of young Australian males, aged 17-25 years, from 1984 to 1988. Two youth cohorts consisting of an initially unemployed sample (n = 1424 males) and a population sample (n = 4573 males), were surveyed annually throughout the study period. Those lost to follow-up during the survey period were matched with death registries across Australia. Employment status was determined from weekly diaries and death certificates and was designated as: employed or student; unemployed; not in the work force (excluding students). Conditional logistic regression, using age- and cohort- matched cases (deaths) and controls (alive), was used to estimate the odds ratio (OR) of dying with regard to employment status, taking into account potential confounders such as ethnicity, aboriginality, educational attainment, pre-existing health problems, socio-economic status of parents, and other factors. Twenty three male survey respondents were positively matched to death registry records. Compared to those employed or students (referent group), significantly elevated ORs were found to be associated with neither being in the workforce nor a student for all cause, external cause, and external cause mortality other than suicide. Odds ratios were adjusted for age, survey cohort, ethnicity, pre-existing physical and mental health status, education level, and socio-economic status of parent(s). A statistically significant increasing linear trend in odds ratios of male mortality for most cause groups was found across the employment categories, from those employed or student (lowest ORs), through those unemployed, to those not in the workforce (highest ORs). Suicide was higher, but not statistically significantly, in those unemployed or not in the workforce. Suicide also was associated, though not significantly, with the respondent not living with their parents when they were 14 years of age. No association was found between mortality and past unemployment experience, as measured by length of time spent unemployed, or the number of spells of unemployment experienced during the survey. The results of this study underscore the elevated risk to survival in young males as a consequence of being neither employed nor a student.     

Antiretroviral adherence issues among HIV-positive adolescents and young adults.

A total of 31 youth from a multidisciplinary adolescent human immunodeficiency virus clinic were surveyed to gain information about their adherence to complex antiretroviral regimens and elucidate factors that may be associated with adherence. Results indicated that 61% of subjects reported >90% compliance with their medications in the previous 90 days.