Gee R.E.,Louisiana State University |
Brindis C.D.,Bixby Center for Global Reproductive Health |
Brindis C.D.,University of California at San Francisco |
Diaz A.,Mount Sinai Adolescent Health Center |
And 5 more authors.
Current Opinion in Obstetrics and Gynecology | Year: 2011
Purpose of review: In July 2011, in response to language in the Affordable Care Act (ACA) the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services (HHS) tasked the Institute of Medicine (IOM) to develop a report on the clinical preventive services necessary for women. The committee proposed eight new clinical preventive service recommendations aimed at closing significant gaps in preventive healthcare. This article reviews the process, findings, and the implications for obstetrician gynecologists and other primary care clinicians. Obstetricians and gynecologists play a major role in delivering primary care to women and many of the services recommended by the Committee are part of the core set of obstetrics and gynecology services. Recent findings: The women's health amendment to the ACA (Federal Register, 2010) requires that new private health plans cover - with no cost-sharing requirements - preventive healthcare services for women. Congress requested that a review be conducted to ascertain whether there were any additional needed preventive services specific to women's health that should be included. Summary: The IOM Committee on Preventive Services for Women recommended eight clinical measures specific to women's health that should be considered for coverage without co-payment. The US Department of HHS reviewed and adopted these recommendations, and, as a result, new health plans will need to include these services as part of insurance policies with plan years beginning on or after 1 August 2012. The authors discuss the implications of the IOM recommendations on practicing clinicians and on their potential impact on women's health and well being. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Nooner K.B.,Montclair State University |
Nooner K.B.,The Nathan S Kline Institute For Psychiatric Research |
Linares L.O.,Mount Sinai Adolescent Health Center |
Batinjane J.,Montclair State University |
And 3 more authors.
Trauma, Violence, and Abuse | Year: 2012
Studies of posttraumatic stress disorder (PTSD) in adolescence published from 2000 to 2011 indicate that adolescents are at greater risk of experiencing trauma than either adults or children, and that the prevalence of PTSD among adolescents is 3-57%. Age, gender, type of trauma, and repeated trauma are discussed as factors related to the increased rates of adolescent PTSD. PTSD in adolescence is also associated with suicide, substance abuse, poor social support, academic problems, and poor physical health. PTSD may disrupt biological maturational processes and contribute to the long-term emotion and behavior regulation problems that are often evident in adolescents with the disorder. Recommendations are presented for practice and research regarding the promotion of targeted prevention and intervention services to maximize adolescents' strengths and minimize vulnerabilities. Public policy implications are discussed. © The Author(s) 2012.
Fox H.B.,Advance Health |
McManus M.A.,Advance Health |
Irwin Jr. C.E.,University of California at San Francisco |
Kelleher K.J.,Research Institute at Nationwide Childrens Hospital |
Peake K.,Mount Sinai Adolescent Health Center
Journal of Adolescent Health | Year: 2013
Little attention has been given to how primary care can be transformed to better meet the needs of adolescents. To help generate the evidence needed, The National Alliance to Advance Adolescent Health convened an invitational conference in 2012 in Washington, DC. Participants from various disciplines identified a set of prioritized recommendations pertaining to 3 topics: increasing adolescent and parent engagement and self-care management; improving preventive care and identifying conditions early; and integrating physical, behavioral, and reproductive health services. This commentary includes the top three recommendations for each topic area and concludes with a brief examination of federal and private funding prospects. © 2013 Society for Adolescent Health and Medicine. All rights reserved.
Linares L.O.,Mount Sinai Adolescent Health Center |
Jimenez J.,Mount Sinai Adolescent Health Center |
Nesci C.,Mount Sinai Adolescent Health Center |
Pearson E.,Mount Sinai Adolescent Health Center |
And 3 more authors.
Prevention Science | Year: 2014
Sibling aggression among maltreated children placed in foster homes is linked to other externalizing problems and placement disruption. The reduction of sibling conflict and aggression may be achieved via a multicomponent ecologically focused intervention for families in the foster care system. The focus of the study is to evaluate the feasibility and short-term effectiveness of a transtheoretical intervention model targeting sibling pairs and their foster parent that integrates family systems, social learning theory, and a conflict mediation perspective. In this pilot study, sibling pairs (N = 22) and their foster parent were randomized into a three-component intervention (n = 13) or a comparison (n = 9) group. Promoting Sibling Bonds (PSB) is an 8-week prevention intervention targeting maltreated sibling pairs ages 5-11 years placed together in a foster home. The siblings, parent, and joint components were delivered in a program package at the foster agency by a trained two-clinician team. Average attendance across program components was 73 %. Outcomes in four areas were gathered at pre- and postintervention: observed sibling interaction quality (positive and negative) including conflict during play, and foster parent reports of mediation strategies and sibling aggression in the foster home. At postintervention, adjusting for baseline scores and child age, intervention pairs showed higher positive (p < 0.001) and negative (p < 0.05 ) interaction quality and lower sibling conflict during play (p < 0.01) than comparison pairs. Foster parents in the intervention group reported a higher number of conflict mediation strategies than those in the comparison group (p < 0.001). Foster parents in the intervention group reported lower sibling physical aggression from the older toward the younger child than those in the comparison group (p < 0.05). Data suggest that the PSB intervention is a promising approach to reduce conflict and promote parental mediation, which together may reduce sibling aggression in the foster home. © 2014 Society for Prevention Research.
Francis J.,Mount Sinai Adolescent Health Center |
Malbon K.,Tribeca Pediatrics |
Braun-Courville D.,Mount Sinai Adolescent Health Center |
Lourdes L.O.,Mount Sinai Adolescent Health Center |
Santelli J.,Columbia University
Journal of Adolescent Health | Year: 2014
Purpose: To examine the association between symptoms of depression and ambivalence about pregnancy in an inner-city adolescent female population. Methods: This study analyzed data from 220 urban minority adolescent females (ages, 15-19 years) presenting for contraceptive initiation in a comprehensive, free-of-cost, adolescent health center in New York City. Cross-sectional baseline data were examined to define the relationship between participants' ambivalence toward pregnancy (defined by responses to items previously used in the National Longitudinal Study of Adolescent Health) and symptoms of depression (assessed by the Center for Epidemiological Studies-Depression scale). After controlling for covariates, multivariate logistic regression was used to identify the unique contribution of symptoms of depression on the pregnancy ambivalent group. Results: Over one third of adolescent females self-reported ambivalence about pregnancy (n = 73, 33%). In our sample, 20% (n = 45) reported mild and 14% (n = 30) reported moderate-to-severe symptoms of depression. After controlling for potentially confounding factors, adolescent females who reported mild symptoms of depression had increased odds of reporting pregnancy ambivalence (adjusted odds ratio, 3.53; confidence interval, 1.64-7.62; p = .001) compared with those with minimal symptoms of depression. Conclusions: A substantial number of adolescents, despite planning to initiate contraception, were ambivalent about pregnancy; those reporting ambivalence were more likely to report mild symptoms of depression. When counseling adolescents about contraception initiation, clinicians should be aware that mild symptoms of depression may contribute to ambivalence about pregnancy. © 2014 Society for Adolescent Health and Medicine.
Steever J.,Mount Sinai Adolescent Health Center
Pediatric Annals | Year: 2014
Many transgender youth experience significant amounts of emotional distress regarding the incongruence between their internal gender identity and their physical body. Crossgender hormonal medical treatments, as managed by a multidisciplinary medical/mental health team, assist patients in transitioning to their desired gender by aligning the physical body to match the gender identity. The World Professional Association for Transgender Health Standards of Care and the Endocrine Society's Clinical Practice Guidelines provide a basic road map for practitioners. Expectations of the youth and the concerns of the family must be addressed and the youth psychologically supported during the transition period. Issues around future fertility should be explored as well. The goal of this article is to introduce the general pediatrician to cross-gender hormone treatments, their management, monitoring laboratory tests and clinical effects, and the issues surrounding their use in adolescents. © SLACK Incorporated.
Linares L.O.,Mount Sinai Adolescent Health Center |
Shrout P.E.,Mount Sinai Adolescent Health Center |
Nucci-Sack A.,Mount Sinai Adolescent Health Center |
Diaz A.,Mount Sinai Adolescent Health Center
Neuroendocrinology | Year: 2013
Objective: Few studies have examined hypothalamic-pituitary-adrenal axis stress reactivity and its relationship to histories of child maltreatment and physical aggression. We examined the relation of a history of childhood sexual abuse (CSA) and perpetration of dating violence to patterns of cortisol change before (resting) and after (reactivity) exposure to a laboratory stressor. Methods: In a sample of 40 disadvantaged sexually active female adolescent patients (ages 14-17 years), we collected self-reports of lifetime child maltreatment (5 types) and past-year female perpetration of physical assault (PA) acts toward a romantic partner. We assessed changes in salivary cortisol trajectories during resting and reactivity phases following the viewing of a teen dating violence vignette. Results: Reports of CSA (CSA+ group) were associated with reports of perpetration of severe dating PA (PA+ group), but the relation of these reports to laboratory-assessed patterns of cortisol changes following the stressor was opposite. As compared with subjects without victimization or perpetration histories (referent group), the CSA+ group showed the most pronounced positive slope (reactivity), whereas the PA+ group showed the least positive slope following the laboratory stressor after the overlap between these groups was statistically adjusted. While showing less reactivity to the laboratory stressor, the PA+ group had higher levels of resting cortisol, which stayed high during reactivity as compared to the referent group. Conclusion: The laboratory paradigm to elicit neuroendocrine stress-related cortisol reactivity appears to be a promising tool for identifying altered cortisol physiology among female adolescents with mixed histories of CSA and perpetration of dating PA. Copyright © 2012 S. Karger AG, Basel.
PubMed | Mount Sinai Adolescent Health Center
Type: Journal Article | Journal: Pediatrics | Year: 2010
It is largely unknown whether symptoms of inattention and hyperactivity/impulsivity of foster children decline over time after placement and what the role of the quality and stability of the foster placement is on the course of attention-deficit hyperactivity disorder (ADHD) symptom trajectories. Longitudinal studies of normative trajectories of symptom types in nonreferred children may assist in appropriately diagnosing ADHD and designing the clinical treatment for foster children.We described average level and slope of inattention and hyperactivity/impulsivity symptoms over time and examined parental (biological and foster) warmth and hostility and placement stability (number of foster-home moves and discharge from care) as reported by 3 informants (biological parent, foster parent, and classroom teacher) after considering maltreatment risks (child age, gender, sibling ADHD, and comorbidity) and use of ADHD medication.We studied 252 maltreated children in 95 families during 4 yearly waves, beginning shortly after placement; children were assessed whether they remained in or were discharged from foster care.Average level of inattention declined according to the biological parent, whereas hyperactivity/impulsivity symptoms declined according to both biological and foster parents. Higher inattention was associated with lower parental warmth (foster parent), higher parental hostility (biological, foster, and teacher), and discharge from care (biological parent). Higher hyperactivity was also associated with lower parental warmth (foster parent) and higher parental hostility (biological and foster parent), higher (average) number of foster-home moves, and discharge from care (biological report). Higher teacher-derived hyperactivity symptoms were associated with a history of child abuse (versus neglect); however, abused children showed a steeper decline of hyperactivity over time than those with neglect histories. Unexpected interactions were found for the impact over time of parental (foster) warmth and number of foster-home moves.Findings point to the clinical usefulness of attending to the parenting quality and placement stability as malleable factors affecting symptom reduction subsequent to placement.
PubMed | Mount Sinai Adolescent Health Center
Type: Journal Article | Journal: Neuroendocrinology | Year: 2013
Few studies have examined hypothalamic-pituitary-adrenal axis stress reactivity and its relationship to histories of child maltreatment and physical aggression. We examined the relation of a history of childhood sexual abuse (CSA) and perpetration of dating violence to patterns of cortisol change before (resting) and after (reactivity) exposure to a laboratory stressor.In a sample of 40 disadvantaged sexually active female adolescent patients (ages 14-17 years), we collected self-reports of lifetime child maltreatment (5 types) and past-year female perpetration of physical assault (PA) acts toward a romantic partner. We assessed changes in salivary cortisol trajectories during resting and reactivity phases following the viewing of a teen dating violence vignette.Reports of CSA (CSA+ group) were associated with reports of perpetration of severe dating PA (PA+ group), but the relation of these reports to laboratory-assessed patterns of cortisol changes following the stressor was opposite. As compared with subjects without victimization or perpetration histories (referent group), the CSA+ group showed the most pronounced positive slope (reactivity), whereas the PA+ group showed the least positive slope following the laboratory stressor after the overlap between these groups was statistically adjusted. While showing less reactivity to the laboratory stressor, the PA+ group had higher levels of resting cortisol, which stayed high during reactivity as compared to the referent group.The laboratory paradigm to elicit neuroendocrine stress-related cortisol reactivity appears to be a promising tool for identifying altered cortisol physiology among female adolescents with mixed histories of CSA and perpetration of dating PA.
PubMed | Mount Sinai Adolescent Health Center, Mount Sinai School of Medicine and Yeshiva University
Type: Journal Article | Journal: The Journal of infectious diseases | Year: 2016
Uptake of human papillomavirus (HPV) vaccine in the United States is slow, and the effectiveness of the vaccine has not been assessed in high-risk adolescent populations.We conducted a longitudinal study of 1139 sexually active, inner-city adolescent women receiving the 3-dose quadrivalent (4vHPV) vaccine. Cervical and anal specimens collected semiannually were tested using an L1-specific polymerase chain reaction assay. Postvaccination incidence of 4vHPV vaccine and nonvaccine HPV types, and risk of cervical cytological abnormalities, were assessed in relation to time to completion of all 3 vaccine doses.Compared to vaccine naive women at enrollment, vaccinated women had significantly lower incidence rate ratios of cervical infection with HPV6/11/16/18 (0.2; 95% confidence interval [CI], .1-.4) and the related types HPV31 and HPV45 (0.4 [95% CI, .2-1.0] and 0.3 [95% CI, .1-.6], respectively), as well as significantly lower incidence rate ratios of anal infection with HPV6/11/16/18 (0.4; 95% CI, .2-.7). Notably, we observed higher risks of cervical HPV6/11/16/18 infection (hazards ratio [HR], 2.9; 95% CI, 1.0-8.0) and associated cytological abnormalities (HR, 4.5; 95% CI, .7-26.0) among women immunized at 15 years of age who took 12 months (vs <12 months) to complete the 3-dose regimen.Among adolescents immunized at 15 years of age, a longer time to complete the 3-dose schedule was associated with an increased risk of anogenital HPV6/11/16/18 infection and an increased incidence of associated cervical cytological abnormalities.