SALMETEROL MULTI-CENTER ASTHMA RESEARCH TRIAL SMART ; : RESULTS FROM AN INTERIM ANALYSIS Katharine Knobil, MD; Steven Yancey; K. Kral; Kathleen Rickard, MD. GlaxoSmithKline, Research Triangle Park, NC. PURPOSE: SMART assessed the safety of salmeterol S ; added to current asthma therapy in patients naive to long-acting -agonists. METHODS: This 28-week study compared S 42 mcg bid MDI ; and placebo P ; . The primary endpoint was combined number of respiratoryrelated deaths or life-threatening experiences intubation and ventilation ; . Secondary endpoints included asthma-related deaths and combined asthma-related deaths or life-threatening experiences. SMART was stopped in January 2003 following the planned interim analysis due to findings in African Americans AA ; and enrollment difficulties. RESULTS: A total of 26, 353 patients completed the study; S 13, 174 and P 13, 179. Caucasians C ; comprised 71% of the population compared to 18% in AA. Baseline ICS use was 49% in C and 38% in AA. There was no significant difference in primary outcome S 48; P 42 ; or in time to onset of the primary event. No significant differences were seen between S and P in the incidence of any secondary endpoint, with the exception of asthma-related death which occurred rarely and was significantly higher in S vs vs. 4 ; . AA patients receiving S experienced a higher incidence of asthma-related deaths vs P 8 difference in C 5 Asthma-related death was lower in ICS users 6 in 12, 254 ; vs non-ICS users 11 in 14, 099 ; regardless of treatment, and asthma-related deaths occurred more frequently in S who did not use ICS. Similar results occurred in C and AA. CONCLUSIONS: The interim analysis was inconclusive. SMART was not designed to address subpopulation differences. AA race and asthma severity was associated with increased risk of outcomes. Whether outcomes are related to pharmacological, genetic, or factors associated with poor asthma control ie, delay in seeking medical attention, inadequate use of controller mediations ; remains unknown. CLINICAL IMPLICATIONS: Asthma can be a serious and lifethreatening disease, and AA have been shown to be at greater risk compared with other ethnic subpopulations. Therefore, asthma management plans and pharmacotherapy should be tailored for individual patients. DISCLOSURE: All authors are GSK employees. THE MOSAIC STUDY: REDEFINING CLINICAL SUCCESS IN PATIENTS WITH AECB Robert Wilson, MD. Royal Brompton Hospital, London, United Kingdom PURPOSE: The MOSAIC study: A multicenter, multinational, randomized, double-blind study to compare moxifloxacin oral tablets to standard oral antibiotic regimen given as first-line therapy in outpatients with acute infective exacerbations of chronic bronchitis. The MOSAIC study is unique and improved in its design. Specifically, it includes: established pre-exacerbation baseline; multicomparator, randomized, double-blind study; and short- and long-term follow-up. MOSAIC has been submitted to CHEST for publication and is currently under review. METHODS: 1, 935 patients with chronic bronchitis were enrolled while stable. Data were collected on patient age, smoking status, concomitant medication use, lung function, severity and duration on chronic bronchitis. 733 patients had an exacerbation and were randomized into either 5 day oral moxifloxacin 400 mg qd, or a 7b day comparator: amoxicillin 500 mg tid, clarithromycin 500 mg bid, or cefuroxime axetil 250 mg bid. Investigators could preselect their choice of comparator. Primary endpoint was clinical success at 7 - 10 days posttreatment. Patient's need for additional antimicrobial therapy was assessed at 7 - 10 days posttreatment. Long-term follow-up was recorded time until next AECB episode. Study included 103 centers in 19 countries throughout the world. Countries included: Austria, Belgium, Finland, France, Germany, Greece, Hungry, Norway, Poland, Portugal, Slovenia, Spain, Switzerland, United Kingdom, Israel, Mexico, Argentina, Brazil, and Australia. RESULTS and CLINICAL IMPLICATIONS: In patients with AECB, moxifloxacin demonstrated significantly higher bacteriological success rates. Among patients of the per protocol population with sputum samples both before and after treatment, 65 71 91.5% ; patients receiving moxifloxacin and 64 79 81.0% ; on comparator showed bacteriological success. This was statistically significant 95% CI; 0.4, 22.05 ; . There was significantly greater clinical resolution after 5 days of treatment with moxifloxacin vs 7 days of comparator. Clinical cure was seen in 251 354 71.0% ; patients in the moxifloxacin and 236 376 63.0% ; in the comparator of the ITT population 95% CI: 1.4, 14.9 p 0.05 ; , and 191 274 70% ; vs 185 298 62% ; in the per protocol population 95% CI; 0.3, 15.6; p 0.02 ; . Significantly fewer moxifloxacin patients required additional antimicrobial therapy than the comparator group during the follow-up period. In both the ITT and per protocol populations, significantly higher proportions of patients in the comparator 15% and 15% in the two populations ; required further antibiotic treatment than in the moxifloxacin 9% and 10%, p 0.006 and 0.050 ; . Significantly prolonged AECBfree interval mean SD ; times to the next AECB were 132.8 67.5 ; days and 118.0 67.9 ; days for the moxifloxacin and comparator, respectively, and the difference was statistically significant p 0.03.
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To ensure good quality, cost effective prescribing of all antipsychotics in order to provide optimal overall treatment through education, psychotherapy support and drug therapy. NB. Further guidance will be developed to cover the use of atypical antipsychotics in dementia, bipolar disorder and learning disability. 1. Licensed use of atypical antipsychotics Atypical antipsychotics are indicated: For a first episode of psychosis where early indications suggest the likelihood of an enduring condition e.g. schizophrenia Where patients already taking typical antipsychotic medication either: a ; suffer intolerable or dangerous adverse effects b ; have poorly controlled negative or positive symptoms c ; express a preference to change to atypical 2. Where negative symptoms predominate, for example, cefuroxime 250.
Figure 1. Molecular structures of cefuroxime sodium top ; and pseudoephedrine HCl bottom ; . The molecular weights of these compounds are 446.4 and 201.7, respectively.
7 patients who were treated with septrin or nitrofurantoin were initially given intravenous cefuroxime until fever subsided. Sixty-nine patients 90.8% ; were given treatment for 7 or more days. Duration of treatment was unknown in one referred case. Three patients were given 6 days of treatment and 1 treated for 3 days only. This patient was treated for 3 days because urinary tract infection was not highly suspected initially and parents refused further management when positive urine culture result came back. Audit point 2.3: The documented clinical findings were summarised in Table 5. There were inadequate documentation of signs of palpable kidneys, bladder, growth percentiles, spinal abnormalities and history of urine stream. Audit point 2.4: Fever did not subside after 48 hours of antibiotics treatment in 7 patients only and all of them had urine re-cultured but and
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Although many complementary and alternative medicine practitioners advocate aromatherapy for migraine, there is no objective clinical evidence for its efficacy. However, it is plausible that it could inhibit the development of migraine attacks by reducing stress and there are unlikely to be any side effects.
In this case, a beta-lactam ie, cefuroxime , cefotaxime sodium , ceftriaxone sodium, ampicillin sodium sulbactam sodium ; and an advanced macrolide ie, azithromycin, clarithromycin ; or respiratory fluoroquinolone ie, moxifloxacin hcl , gatifloxacin , levofloxacin, gemifloxacin mesylate ; would be appropriate and chloromycetin.
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Sinusitis cont'd ; Failure of first line agents: clinical deterioration after 72 h of antibiotic therapy no improvement post therapy Acute recurrent 4 episodes year and each episode 10 days duration and complete resolution between episodes Chronic symptoms 12 weeks S. pneumoniae M. catarrhalis H. influenzae Occasionally: S. aureus Group A Streptococci Anaerobes Second line agents Amoxicillin-clavulanate or Cefuroixme axetil -lactam allergy Azithromycin or Clarithromycin or NF or Gatifloxacin Levofloxacin or MoxifloxacinNF Amoxicillin -lactam allergy Doxycycline or TMP SMX 875mg PO bid or 500mg PO tid 500mg PO bid 500mg PO daily 500mg PO bid or NF XL daily 400mg PO daily 500mg PO daily 400mg PO daily 500mg PO tid 10 days 10 days 3 days 10 days 7-10 days 7-10 days 7-10 days 10 days - Need to consider resistant organisms, especially penicillin-resistant S. pneumoniae and -lactamase producing H. influenzae and
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Other second line antibiotics amoxicillin clavulanic acid, cefaclor, cefprozil, cefuroxime axetil and ofloxacin ; * The percentage of male in the cohort of corticosteroid users selected at RAMQ is 40.6%. * The Chi-square test for difference between rates of failure is associated with a p-value of 0.27.
Clinicians attempting to evaluate any patient with bruxism or involuntary muscle movement, who is simultaneously being treated with an ssri drug, should be aware of the potential association and
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Table 4: Selection of antibiotics for sinusitis -- acute and chronic Most commonly prescribed antibiotics Amoxycillin Amoxycillin + clavulanic acid Roxithromycin Doxycycline Cefaclor Clarithromycin Cephalexin Co-trimoxazole Erythromycin Cefuroxome 1999 % 15.0 16.2 21.2 % 20.8 20.7 18.3 Comment Antibiotics recommended for severe cases only Amoxycillin is first line therapy in these patients.
284 Yee-Cabahug L and Espiritu-Quiza MF the average duration of the defervescence periods for three common infectious diseases given a particular antibiotic. Knowledge of the average defervescence periods of commonly utilized antibiotics will help prevent unnecessary or premature shifting of antibiotics to more expensive alternatives. Results of this study should be useful in providing clinical practice guidelines in the use of some ant]microbial agents with the goal of providing maximum health care at minimal cost. MATERIALS AND METHODS For patients with urinary tract infection, trimethoprim-sulfamethoxazole or TMP-SMZ 1600 320 mg day PC ranked first among the antibiotics commonly administered, with 23.]% of 299 patients receiving this drug. The second and third commonly used agents were ciprofloxacin 500-]000 rag day PO ; and norfloxacin 800 rag day PO ; , respectively. Table II ; Cefuroxiem 2250 mg day IV ; was the most commonly prescribed antibiotic for patients treated for pneumonia, with 32 patients ]4.5% ; receiving this drug. This was followed by penicillin-G 4-]8 million 'U * day IV ; and cephalexin 2000 rag day IV ; . Thirty patients ]3.6% ; were given penicillin-G and 26 patients ]1.8% ; were given cephalexin. Table II ; duration of the study period. loci of infection in decreasing Table I lists the various order of frequency and candesartan.
Title & Author Efficacy and tolerability of once daily oral telithromycin compared with clarithromycin for the treatment of community-acquired pneumonia in adults Dunbar LM, et al.3 2004 ; Study Design This is a randomized, doubleblind, parallel-group trial conducted at 54 centers with 493 patients enrolled. Patients aged 18 years with acute community-acquired pneumonia were randomized to receive 10 days oral telithromycin 800 mg once daily or clarithromycin 500 mg twice daily. Results Primary endpoint: Clinical cure rate Microbiological cure rate Efficacy: telithromycin clarithromycin Clinical cure rates were comparable between treatment groups, 88.3% 143 162 ; in the telithromycin group and 88.5% 138 156 ; in the clarithromycin group. Bacterial eradication rates were comparable between treatment groups 87.5% for telithromycin vs. 96.7% for clarithromycin ; . Safety: telithromycin clarithromycin Both treatments were fairly well tolerated; adverse events were experienced in 57.0% of the patients treated with telithromycin and 49.1% of those treated with clarithromycin; most of these adverse events were assessed as mild. Endpoints: Clinical cure rate Microbiological cure rate bacteria eradication rate ; Efficacy: telithromycin clarithromycin Microbiologic and clinical cures were similar for the 2 treatment groups. Clinical cure rate was achieved in 92.7% of telithromycin recipients and 91.1% clarithromycin-treated patients difference 1.6%; 95% CI 5.5 to 8.6 ; . Bacterial eradication was achieved in 91.3% of telithromycin-treated patients and 88.1% of clarithromycin recipients difference, 32%; 95% CI, -4.5 to 11 ; . Safety: telithromycin clarithromycin Treatment-related adverse events occurred more frequently in the telithromycin group than the clarithomcyin group 67.2% vs.57.5%, respectively ; . Diarrhea, nausea and vomiting were more common with telithromycin than with clarithromycin p 0.004, 0.01, and 0.001, respectively ; . Adverse events were generally mild. Endpoints: Clinical cure rate Microbiological cure rate bacteria eradication rate ; Efficacy: telithromycin cefuroxime axetil In clinically evaluable patients n 282 ; , post-therapy clinical cure rates were 86.4% with telithromycin and 83.1% with cefuroxime axetil. p value was not reported ; In bacteriologically evaluable patients n 53 ; , eradication or presumed eradication of the pathogen was achieved in 76.0% and 78.6% of telithromycin and cefuroxime axetil patients, respectively. p value was not reported ; Safety: telithromycin cefuroxime axetil Adverse events were mostly mild; the most common were diarrhea 12.8% vs. 11.8% ; and nausea 8.9% vs. 3.2% ; in telithromycin and cefuroxime axetil patients, respectively.
Premium content register log in help advanced search - dictionary thesaurus encyclopedia all reference the web advertisement cefuroxime wikipedia, the free encyclopedia - cite this source cefuroxime is a second-generation cephalosporin antibiotic that has been widely available in the usa since 197 it is also available under the brand name ceftin and ciloxan.
Robert M. Hurwitz, M.D. was present with counsel Mr. Rick Delo. Carol Peairs, M.D., Medical Consultant summarized case for the Board. A medical malpractice settlement was made on behalf of Dr. Hurwitz. The plaintiff alleged Dr. Hurwitz prescribed an inappropriate amount of Dilaudid to a 16-year-old patient resulting in respiratory arrest. The Outside Medical Consultant sustained the 4 mg dosage of Dilaudid was too high. Dr. Hurwitz contended the patient's problems were due to the speed of administration of the Dilaudid from the nurses rather than the absolute dosage. Dr. Hurwitz said that at the time he saw the patient he had never had a patient present with symptoms for which he needed to obtain a pain consultation. Dr. Hurwitz said he did not obtain a pain consultation for the patient in this case because he did not read where that had been recommended in the chart. Dr. Hurwitz said he believed the patient's problem was due to rapid administration of the Dilaudid because only one dose of Naltrexone was needed to reverse the medication, showing the Dilaudid dose was probably not too high. Douglas D. Lee, M.D. led the questioning. Dr. Lee said he did not find the Dilaudid was administered too quickly, but he did find the dosage was too high as the Physician's Desk Reference PDR ; said an adult patient may receive up to 2mg of Dilaudid and this patient received 4mg of Dilaudid. Dr. Hurwitz said the patient was not receiving pain relief and the patient's mother was insistent that the dose continue to be increased. Dr. Hurwitz said he did not use Dilaudid often and so he consulted with a pharmacist who said he could taper up to a mg dose. Dr. Lee noted it should have occurred to Dr. Hurwitz to switch to another drug when the patient continued to receive no relief, rather than continually increasing the dose. Dr. Hurwitz said his practice pattern now is to use Dilaudid in a very small dose. Mr. Delo said Dr. Hurwitz was not negligent in caring for the patient as he consulted with the pharmacist prior to administering 4mg of Diluaudid and was told this was an appropriate dosage. The patient has subsequently had no long term side effects. Dr. Lee said he found the standard of care was breached because Dr. Hurwitz gave excessive doses of Dilaudid to a pediatric patient. MOTION: Douglas D. Lee, M.D. move moved for a finding of Unprofessional Conduct in violation of A.R.S. 32-1401 27 ; q ; - Any conduct or practice that is or might be harmful or dangerous to the health of the patient or the public. SECONDED: Ram R. Krishna, M.D. VOTE: 12-yay, 0-nay, 0-abstain recuse, 0-absent.
The NCCLS methodology compared to 23% by the DIN methodology. In contrast, at amoxicillin-clavulanate concentrations containing amoxicillin at 8 to ml, more isolates were found to be inhibited based on the NCCLS methodology. There were considerably more isolates inhibited by cefotaxime at all concentrations between 0.004 and 0.12 g ml with the NCCLS criteria than with the DIN criteria Fig. 2 ; . However, all but two strains were susceptible to 1 g ml, which is the lower DIN breakpoint. The MIC distributions for cefuroximw obtained by the NCCLS and DIN methodologies were very similar, the exception being a higher incidence of strains susceptible to 1 g the DIN methodology Fig. 3 ; . Effect of methodology on breakpoint categories. Implementation of breakpoints had a marked effect 2 74.4; P 2 0.001 ; upon differences between the NCCLS and DIN susceptibility categories for the amoxicillin-clavulanate results Table 2 ; . A total of 86.5% of strains were fully susceptible to amoxicillin-clavulanate by NCCLS guidelines in contrast to only 43.8% by DIN guidelines. Similarly, only 4.3% strains were resistant by NCCLS criteria compared to 21.1% by DIN criteria. DIN criteria also indicated a 5.9% resistance to cefu and desloratadine.
1. Fagard RH, Van Den Ended M, Leelman N, et al. Survey on treatment of hypertension and implementation of World Health Organization International Society of Hypertension risk stratification in primary care in Belgium. J Hypertens 2002; 20 7 ; : 1297-302.
On the basis of research evidence 4 , VAADA believes that education-based prevention initiatives are more effective when targeted at specific population groups, rather than at the population generally. Therefore, we believe that education around the misuse of pharmaceutical drugs should be Targeted at specific population groups, including o CALD communities o People in residential aged care o Injecting drug users o Those suffering chronic pain o Those suffering from post-traumatic stress Delivered through GPs, pharmacists, and other potential dispensers of pharmaceutical drugs o VAADA considers that GPs and pharmacists are ideally situated to deliver education and other brief interventions on the issue of misuse of pharmaceutical drugs Conducted in collaboration with communities, where o Specific, respected members of communities are involved o Resources are given to the community to support it in delivering education to its members and serophene and cefuroxime, for example, cefuroxine axetil 500mg.
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Many palliative care patients will become constipated through a combination of anticholinergic drugs, reduced food and fluid intake and lack of mobility. Patients often believe that a reduced dietary intake will automatically result in a reduced frequency of defaecation. Whilst volumes may be altered the patient should be encouraged to maintain a regular bowel habit by taking laxatives, if necessary.
Percentage of these strains were still susceptible to chloramphenicol. Ampicillin-resistant H. influenzae were mainly resistant to chloram-phenicol, but were still susceptible to amoxicillin-clavulanate, cefuroxime and azithromycin. All strains of M. catarrhalis produced -lactamase enzymes. These strains were fully susceptible to all quinolones tested, and gatifloxacin was the most active agent. All comparators were active against all isolates tested of M. catarrhalis Table 3 ; . K. pneumoniae isolates were susceptible to ceftazidime and to the quinolones used in the study. Ciprofloxacin was slightly more active than respiratory quinolones against this bacteria. Respiratory quinolones and ciprofloxacin were active against 70 percent of ceftazidime-resistant K. pneumoniae MIC50 did not exceed 2 mcg ml, and approximately 70 percent of isolates were susceptible ; . Table 4 summarizes the susceptibility pattern of K. pneumoniae. DISCUSSION This study demonstrates that the three major respiratory bacterial pathogens, namely S. pneumoniae, H. influenzae and M. catarrhalis are highly susceptible to the so-called "respiratory quinolones". In this study, gatifloxacin was the most active agent for S. pneumoniae. If trovafloxacin and grepafloxacin were included in the analysis, trovafloxacin is the most active agent for this bacteria, regardless of penicillin susceptibility. M. catarrhalis was most susceptible to gatifloxacin, excluding trovafloxacin. H. influenzae was most susceptible to gatifloxacin, regardless of ampicillin susceptibility and gatifloxacin was 2 times as effective as levofloxacin and ciprofloxacin. K. pneumoniae is major respiratory pathogen, especially in immunosuppressed hosts.18 This bacteria was most susceptible to ciprofloxacin, regardless of ceftazidime susceptibility. The findings in this study are similar to those reported in other parts of the world.8-10, 19-22 Anti and
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Calcium, osteoporosis and, 67-69 California Smokers' Helpline, 16 Cancer, 5 quitting smoking and, 14 smoking-related, 14 surgery, 57 Cape Cod COPD Support Group, 53 Capillary network, lung, function of, 3 Carbon dioxide, exhalation of, 3 Carbon monoxide, in tobacco smoke, 17 Carcinogens, in tobacco smoke, 17 Cataracts, from smoking, 62 Caverject, for erectile dysfunction, 64 Ceftin, 22 Cefuroxime, 22 Celexa, 71 Cheese, phlegm production with, 59 Chest x-ray, 7, 10 Chewing gum, nicotine, 18, 62 Chronic bronchitis acute exacerbation of, 20, 21 cigarette-induced, 20 types of, 21 Chronic obstructive pulmonary disease. See COPD Cigarettes. See Smoking Cinnamonum Aromaticum, for erectile dysfunction, 65 Cipro, 22, 25 Ciprofloxacin, 22 Citalopram, 71 Clarithrmycin, 22 Coenzyme Q, antioxidant effects, 60 Collins, David D., MD, biography of, 85 Combination inhalers, 27 Combivent, 25, 27 Compressed gas cylinders, oxygen, 32 Compressor machines, 24 Concentration, difficulty with, withdrawal from nicotine and, 15 COPD breathlessness with, 5 causes of, 5 defined, 5 depression, 70-73.
The addition of measures of market knowledge, search behavior, and choices available contributed significantly to explaining borrower outcomes. The authors concluded that the superior performance of the "full" model in explaining whether a borrower obtained a prime or subprime loan implies that credit risk alone may not fully explain why borrowers end up in the subprime market. Rather, their paper supported the alternative view that the current mortgage delivery system produces an allocational inefficiency wherein households of similar economic, demographic, and credit risk characteristics do not pay the same price for mortgage credit.
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A positive cannabinoid work place drug testing following ingestion of commercially available hemp oil preparation has been reported. THC metabolite was present in volunteers 80h post ingestion of 40-90 mL of hemp seed oil. THC is present in other hemp oil products like hemp bar, hemp flour and hemp liquor. Hemp Ale drink Fredrick Brewing Company, Fredrick, MD ; does not contain THC because it is removed from hemp oil and
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Bottom Line Health interviewed Karon Karter, a certified Pilates instructor in Dallas. She is the author of Pilates Lite--Easy Exercises to Lose Weight and Tone Up Fair Winds ; . She has taught Pilates to beginners, cancer survivors, marathoners and other athletes.
Daily Communication Log Book to inform the youth about the infants activities when they area in school or absents. The logbook documented each infant diapers changes, feedings times, mood, incidents, naps, play times, bath times, sickness, and any other information that the youth need to know about her infants. The program also had a Child Care Injury Report Form, and a five section Children's File Tracking Form, that were available for use as needed. Instructions copied from the Caring for Our Children book related to how to clean and sanitize the Child Care Center, including frequency, were posted. The Child Care Center area was very clean and odor free. The Center was fully furnished and stocked with multiple size diapers, talcum powder, rash creams, bottles and nipple sterilizers. All the infants' toys in the program followed the guidelines of the National Association for the Education of Youth Children NAEYC ; . The toys covered all areas of education including language, cognitive, and social skills. The Center had a refrigerator for the infants' food and milk, and an Evacuation Crib. At the review time the program had seven youth attending the program. Four of them were pregnant and three have infants, and were in post partum status. Observation indicated that always was at least one staff member with the youth and the infants. The program had a separate individual healthcare record for each pregnant female, and a separate regular individual record for each infant. Observation and an interview with the Child Care Director reflected that the area where bottles are prepared was clean and well organized. Only one infant required bottle preparation, and the mother prepared the bottle before bringing the infant to the Child Care Center. A review of the seven youth individual healthcare files and program documentation confirmed that all youth were provided pre-natal care, peril-natal care, and post-birth care, as well as health education, as applicable. Care was provided by the program staff, University of Miami staff, the Community Health of South Dade, Inc., the Children's Psychiatric Center, Inc. CPC ; , the Miami -Dade Family Learning Partnership, the Obstetrician Gynecologist, a Pediatric Dr., a Dentist, a nutritionist, the Florida Department of Health Healthy Stars Program, Women Infants and Children WIC ; , and the "Mommy and Me" program. In addition, the Catholic Charities of the Archdiocese of Miami, Inc., provided youth with breastfeeding education, parenting education, nutrition education, and care coordination. Infants are not permitted to sit for more than the recommended intervals. The program uses a car sit only for transportation, and youth also use always slings or front packs. Although the program policy required that the biological father, and the fathers by relationship be included in the activities of the program, parenting classes and educational classes, for different reasons that was not the current practice at the time of the review. The father of one of the infants is not aware that his son was born and there has been no contact with him after the youth told him that she was pregnant. She has a contact telephone number for him, but the telephone number is disconnected. The second father has been authorized by the Judge to come to the program and visit his daughter, but since he is still a minor and on probation, he is not allowed to leave the county where he resides without being accompanied by his mother, and she is not willing due to previous relationship issues. As for the father of the third infant, he is aware of his daughter's existence and maintains contact with the youth through her mother and plans to visit the program. All youth surveyed confirmed that they received prenatal, obstetrical or gynecological services when needed at this program. The two parents that responded the survey indicated that program staff kept them informed of any changes in youth's medical condition. One rated the program's healthcare services as "Excellent", and the other as "Good". External Control Factors None.
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