Factors Associated with Physician Discussion of Health Behaviors with Adolescents

Behaviors developed in adolescence influence health later in life. The purpose of this study was to investigate the frequency of health care provider's discussion of health behaviors with overweight and non-overweight adolescents and identify demographic and health behaviors related to exercise, hours of television viewing, and weight issues associated with these discussions. A Cross sectional survey of urban adolescents was conducted. Trained interviewers administered surveys over a three month period in 2001 at an urban academic pediatric and adolescent clinic. The 252 adolescents surveyed had a mean age of 15 with 49% categorized as being at risk for overweight/overweight and 51% as normal weight using the CDC percentiles for BMI. While 16% of the adolescents reported that their physician or nurse discussed the amount of television they watched, rates of discussion related to exercise (58%), and weight (54%) were much higher. In multivariate analyses, health care provider discussions with adolescents regarding exercise were more common for overweight (O.R.=2.42, 95% C.I. [1.28–4.57]) and at risk for overweight (O.R.=1.98, 95% C.I. [1.03–3.81]) adolescents, whereas physician discussion of television viewing was not associated with weight. Discussions of weight were more common for female (O.R.=2.18, 95% C.I. [1.21–3.95]), African-American (O.R.=2.53, 95% C.I. [1.40–4.57]), and overweight (O.R.=3.92, 95% C.I. [1.97–7.81]) adolescents. Even after adjusting for weight, race and gender strongly influenced the frequency of discussions about weight in physician offices. Although health care providers frequently address weight and exercise with adolescents, more discussions related to sedentary behaviors such as television viewing may be warranted to address adolescent obesity.Received PhD in Epidemiology from University of California, San Diego. Research interests include smoking prevention and cessation among adolescents and health promotion interventions.Received MD from University of Missouri-Kansas City and MPH from Johns Hopkins University. Research interests include health services research and research in support of measurable, systematic improvements in the quality of medical care.Received medical degree from Christian Medical College, Punjab, India and Master of Public Health from University of Kansas School of Medicine. Research interests include diet and physical activity behaviors, role of the environment in obesity and obesity prevention, especially among children and adolescents.Received MBBS from Allama Iqbal Medical College, Punjab University, Lahore, Pakistan and MPH from University of Kansas Medical Center. Research interests include smoking cessation, database design, implementation, data management and analysis, and use of information technology in health care settings.Director, Cancer Prevention, Control, and Population Sciences, Kansas Cancer Institute. Received MD/MPH from Tulane University and MS from Harvard School of Public Health. Research interests include disparities in healthcare; smoking cessation among underserved populations, specifically African Americans; diet, nutrition, obesity, and physical activity.     

Budget Control in Virginia Public School Districts

This article examines the selection and use of a budget approval technique. Specifically, two research questions are addressed: (1) Does the use of a particular budget approval method by a governmental body impact the execution of the budget? (2) What characteristics of a local government are associated with its decision to use a particular budget approval method? Both research questions are addressed by analyzing data from public school systems in the Commonwealth of Virginia, specifically, whether using categorical budget approval differs in the accuracy of budgeting versus using a lump-sum approval method. Characteristics of Virginia school districts are also analyzed according to whether any of them are likely to be associated with school districts using a particular approval method. The remainder of this article is organized as follows: the next section describes the role of budgeting control in schools; subsequent sections review Virginia school district budgeting practices, develop the empirical model used to test the hypotheses, describe the sample, analyze the results of empirical tests and discuss implications of the findings.     

Does European Community Regional Policy Empower the Regions?

A central goal of the 1980s reforms of the European Community's regional development policy was to contribute to an increase in the discretionary authority of sub–national decision–makers in the Community's member states. This article assesses the degree to which this goal was attained through comparative studies of selected French and Italian regions. It concludes that only in those regions in which timely policy entrepreneurship on the part of regional–level elected leaders coincided with the pre–existence of a territorial policy Community for economic development did the transfer of resources from the Community contribute to regional empowerment.     

A Longitudinal Study of Self-Esteem: Implications for Adolescent Development

This study used a cluster analytic approach to identify self-esteem trajectories among adolescents over a four-year period from sixth to tenth grades (N = 1,160). Four self-esteem trajectories were identified that replicated previous research: (1) consistently high, (2) moderate and rising, (3) steadily decreasing, and (4) consistently low. Female adolescents were more likely to be in the steadily decreasing self-esteem group while male adolescents were more likely to be in the moderate and rising group. African American and white youth were equally distributed across groups. Using repeated measures analysis, we found that youth with consistently high and moderate and rising self-esteem reported developmentally healthier outcomes in Grade 10 than youth in the other two clusters. Outcomes included susceptibility to peer pressure, school grades, and alcohol use. Implications of these results for studying self-esteem and developmental change more generally are discussed.     

Disentangling the Weight of School Dropout Predictors: A Test on Two Longitudinal Samples

The aims of this study are to identify the most powerful predictors of school dropout and to determine how stable they are over time. Two generations of White French-speaking boys and girls from 12 to 16 years old (n = 791 in 1974, n = 791 in 1985) completed a self-administered questionnaire on their psychosocial adjustment at least one year before leaving school. As expected, the analyses showed that school, family, behavioral, social, and personality variables could all predict dropping out of school in the two samples. Furthermore, these predictors were quite stable over time. However, statistical improvement measures in logistic regression analyses indicated that school experience variables (i.e., grade retention, school achievement, school commitment) were the best screening variables for potential dropouts. The contribution of other psychosocial variables, even though significant, did not improve very much the capacity to identify who will drop out of school. The discussion highlights the implications of the findings for secondary prevention and screening practices.     

Suicide by electrocution with low-voltage current

Three cases of suicide by electrocution with low-voltage current were observed in five years (1994-1998) by medical clinical forensic examiners of an Emergency Forensic Unit of the Paris suburb among 2,000 external death examinations. The cases involved one woman, aged 72 and two men, aged 38 and 41. In the last two cases, electric burns were retrieved under bared electric wires, placed on the arms or fingers in order to realize a hand-to-hand electric circuit involving the heart muscle. In the other case, the electric circuit between mouth and foot also involved the heart muscle. Household low-voltage current delivered (220 V in France) had a sufficient strength to induce local muscular paralysis and heart fibrillation. In the three cases, blood samples taken have retrieved very high levels of muscular enzymes (CPK, LDH) correlated to the mechanism of electric death. The rareness of suicide by electrocution and its forensic characteristics are detailed in order to help the clinical forensic examiners, prosecutors, and police officers concerned by such death examinations.     

Development and evaluation of a standard method for the quantitative determination of elements in float glass samples by LA-ICP-MS

Forensic analysis of glass samples was performed in different laboratories within the NITE-CRIME (Natural Isotopes and Trace Elements in Criminalistics and Environmental Forensics) European Network, using a variety of Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS) systems. The main objective of the interlaboratory tests was to cross-validate the different combinations of laser ablation systems with different ICP-MS instruments. A first study using widely available samples, such as the NIST SRM 610 and NIST SRM 612 reference glasses, led to deviations in the determined concentrations for trace elements amongst the laboratories up to 60%. Extensive discussion among the laboratories and the production of new glass reference standards (FGS 1 and FGS 2) established an improved analytical protocol, which was tested on a well-characterized float glass sample (FG 10-1 from the BKA Wiesbaden collection). Subsequently, interlaboratory tests produced improved results for nearly all elements with a deviation of < 10%, demonstrating that LA-ICP-MS can deliver absolute quantitative measurements on major, minor and trace elements in float glass samples for forensic and other purposes.     

Scanning electron microscopy analysis of experimental bone hacking trauma

The authors report on their macro- and microscopy study of bone lesions made by a sharp force instrument (a single blade knife), and a sharp-blunt instrument classified as a chopping weapon (a hatchet). The aim of this work was to attempt to identify the instrument by analyzing the general class characteristics of the cuts. Each weapon was used on human bones. The results indicate that macroscopic analysis is more problematic. The microscopic analysis assessed that characteristics examined were effective in distinguishing sharp from sharp-blunt injury to the bone. The microscope facilitates analysis unachievable with macroscopic methods, some three-dimensional characteristics not visible to the naked eye being clearly defined with its use. Emphasis has been placed on the value of SEM as an anthropologist's tool in bone lesion injuries.     

Treatment of paraphilia in young adults with leuprolide acetate: a preliminary case report series

Some juveniles who engage in sexual offenses may have a paraphilia, a psychiatric disorder characterized by a pervasive pattern of deviant and impairing sexual fantasies, thoughts, and/or behaviors. Though there is no known cure for these conditions, paraphilias can be effectively managed using a multimodal treatment approach. This may include the use of psychotherapeutic and pharmacological treatment interventions, including antiandrogen medications. One such agent, leuprolide acetate (leuprolide), a luteinizing hormone-releasing-hormone agonist, has been shown to be effective in reducing paraphilic symptoms in adult patients. To date, however, there is no published data on its use and effectiveness in adolescent and young adult paraphilic patients. This study consists of a case report series of six young adult patients treated with leuprolide. All subjects had been diagnosed with at least one paraphilia (i.e., Pedophilia, Sexual Sadism, Frotteurism, and Paraphilia Not Otherwise Specified). All subjects had been refractory to treatment in a residential program for adolescent sex offenders prior to initiation of leuprolide. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide. Clinicians rated four as much improved and two as moderately improved. The treatment was well tolerated in all six subjects. This preliminary case series supports the conclusion that leuprolide deserves further examination as a potentially safe and effective component in the treatment of young adult patients with paraphilia.     

Coercion, Cooperation, and Control: Understanding the Policy Impact of Administrative Courts and the Ombudsman in the Netherlands

This article examines the way in which administrative courts and the National Ombudsman in the Netherlands seek to control administrative action, and is aimed at developing a heuristic model that can also be useful in a wider context. Two styles of control will be introduced: "coercive" and "cooperative." An exploratory empirical study was conducted of two administrative agencies, investigating the implementation process of court and ombudsman decisions. This article argues that it is likely that the policy impact of the courts and the ombudsman is directly related to their style of control. More empirical research is needed to evaluate this hypothesis.