ANSWER
This cross-sectional study used special education and Medicaid data from Philadelphia, Pennsylvania, for 2002. The sample comprised 51,234 Medicaid-eligible children aged 12–17 years, with 8015 receiving special education services. Claims associated with STI diagnoses were abstracted, and logistic regression was used to estimate the odds of STIs among children in different special education categories.

RESULTS\there were 3% of males, and 5% of females treated for an STI through the Medicaid system in 2002. Among females, those in the mental retardation (MR) category were at the greatest risk (6.9%), and those in the emotionally disturbed or “no special education” category were at the lowest risk (4.9% each). Among males, STIs were most prevalent among those classified as mentally gifted (6.7%) and lowest among those in the MR category (3.0%). In adjusted analyses, males with specific learning disabilities and females with MR or who were academically gifted were at excess risk for STIs.
ORDER WITH US AND GET FULL ASSIGNMENT HELP FOR THIS QUESTION AND ANY OTHER ASSIGNMENTS (PLAGIARISM FREE)

CONCLUSIONS
The finding that children with learning disabilities are at similar or greater risk for contracting STIs than other youth suggests the need to understand further their risk behaviors and the potential need to develop prevention programs specific to their learning needs.

Keywords: child and adolescent health, children with disabilities, human sexuality, reproductive health, risk behaviors
This study aimed to examine the risk of contracting a sexually transmitted infection (STI) among children with learning disabilities. Nearly 7 million students in the United States experience cognitive, emotional, or behavioral problems with learning that result in the use of special education services, almost 50% of whom are between the ages of 12 and 18. 1 These youth contend with academic, social, and emotional difficulties, many of which first become apparent or are amplified during adolescence. Adolescents with special education needs are more likely than their peers to drop out of school,2,3 have lower self-esteem,4,5 experience greater loneliness and emotional distress,6–8 and developmental disorders. 9,10 Many youths with problems that affect learning also are more vulnerable to exploitation and peer pressure due to higher levels of dependency on others and reduced social and communication skills. 11

Due largely to these increased stressors, adolescents with learning difficulties participate more frequently in activities with significant health risks, including engaging in risky sexual behaviors.

12,13 The consequences of these behaviors may be exacerbated by a health-related knowledge deficit; adolescents with learning difficulties often possess low levels of accurate sex-related knowledge and gross misconceptions about reproduction and STIs. 14,15

This higher prevalence of risk behaviors suggests that there may be an increased risk for STIs among adolescents receiving special education services. The few studies investigating the prevalence of STIs among these youth suggest different relative risks associated with disability type. However, analyses have been conducted only among children with a few types of disabilities. For example, adolescents with conduct disorder or hyperactivity are more likely to contract an STI than their peers. 16,17 In contrast, individuals with severe cognitive impairments are at a decreased risk for contracting most STIs. 18–20 Findings largely come from studies of individuals in residential settings; it is possible that STIs are higher for cognitively impaired individuals who are better integrated into their communities.

While these studies address sexual health risks among adolescents in 2 of the most common special education categories—emotional disturbance (ED) and mental retardation (MR)—to date, no published study has investigated the prevalence of STIs among youth in the largest special education category: those with learning disabilities (LD) (LD). Adolescents in LD comprised 57% of all adolescents receiving special education services in 2004. MR and ED, while the second and third largest categories, together, comprised only 22% of adolescent special education students in 2004. 1 Adolescents with LD might be expected to be at high risk for contracting STIs because of deficits in executive functioning that interfere with making healthy choices. 21 For example, these adolescents can have difficulties connecting actions to consequences, can have poorer planning abilities, and tend to be more impulsive than other adolescents. 22–24

If adolescents with various disabilities are at greater risk for contracting STIs, it may have important implications for intervention development, with unique interventions required for children with specific impairments. To address this issue, we examined the treated prevalence of STIs among youth receiving special education services.

Go to: \sMETHODS \sData Sources and Sample.
The School District of Philadelphia provided information on special education eligibility for all children in Philadelphia, Pennsylvania (the calendar year 2002), who were between the ages of 12 and 17 years, on January 1, 2002. These data were merged with Pennsylvania Medicaid eligibility and health care claims data for the same period using a name, birth date, and sex to create a unique identifier. The sample comprised 51,234 Medicaid-eligible children aged 12–17 on January 1, 2002. The University of Pennsylvania and the City of Philadelphia institutional review board approval was obtained before analyses.

Variables
Receipt of Special Education Services Special education eligibility was coded based on the following 13 mutually exclusive categories that the US Department of Education uses: autism, hearing and visual impairment, emotionally disturbed, hearing impairment, multiple disabilities, MR, other health impairment, orthopedic impairment, specific learning disability, speech/language impairment, traumatic brain injury, visual impairment, or mentally gifted (MG) (MG). 25 These 13 categories were collapsed into 6 mutually exclusive categories so that all children were labeled as receiving no special education services, specific LD, MR, ED, MG, or another special education category. Unlike many states, Pennsylvania requires that school districts identify gifted students and provide them with individualized education programs (22 Pennsylvania Code, chapter 16). (22 Pennsylvania Code, chapter 16). Although children in the MG category do not constitute a group with learning disabilities, they provide an important comparison group. Learning problems are prevalent in an urban, relatively impoverished sample, even among those not receiving special education services. Those in the MG category may more likely comprise an academically successful group of adolescents without accompanying learning problems.
Receipt of STI Treatment Use of Medicaid-reimbursed health care services for STIs was coded using the following diagnostic codes from the International Classification of Diseases, 9th Edition. 26 Diagnoses included herpes (054); hepatitis B (070.2, 070.30, 070.31, 070.32, and V026.1); other hepatitis, not including hepatitis C (070.59, 070.9, and V026.9); chlamydia (077, 078, and 079); human immunodeficiency virus (042, V08, and 795.71); syphilis (091 through 097); gonorrhea (098 and V027); trichomoniasis (131); or another venereal disease (099 and V028) (099 and V028). Candida and hepatitis C were not included because of the unknown probability of transmission through means other than sexual contact in this population. Children were coded as having received treatment for an STI if they had at least 1 Medicaid claim associated with any of these diagnoses. Because of the small proportion of youth receiving any given diagnosis (see Table 1), an analysis of the risk associated with each diagnostic category was impossible.
Table 1: Special Education Category Sample Description (n = 51,234)

Value of the Special Education Category
None (n = 43,219)
ED (n = 928)
LD (n = 4604) MR (n = 1008)
MG (n = 938)
Other (n = 537)% with STI* 3.9 3.2 4.7 4.5 5.6 4.8.011
Age in years (standard deviation)
14.8 (1.7) (1.7)
14.5 (1.6) (1.6)
14.8 (1.7) (1.7)
14.4 (1.6) (1.6)
14.4 (1.6) 14.6 (1.7) (1.7)
.001% male* 48.2 80.2 55.5 63.8 43.6 42.0.001 % black* 67.0 72.2 70.3 67.9 56.3 63.1.001 % white
13.9 17.2 15.2 15.2 15.0 19.1 \s% Latino 6.0 4.0 6.9 6.6 6.7 5.6 \s% Asian 9.9 3.4 % other ethnicities 5.0 0.3 1.2 1.5 8.0 6.2 6.4 9.0 8.0 4.8
Launch in a new window
LD stands for a specific learning disability.

*A difference test was performed using Pearson’s chi-square. A difference test was performed using an analysis of variance.
Demographics From the Medicaid eligibility files and the special education database, age, gender, and race/ethnicity were extracted. When there were conflicting values, the most frequently occurring value in the data set was used.
Analyses of Data
To compare demographic characteristics across special education categories, analysis of variance for continuous variables and chi-square tests for categorical variables were used. The percentage of children receiving an STI diagnosis was calculated for each special education category, stratified by gender. Because potential interactions between special education category and sex were observed, logistic regressions were performed separately for males and females to determine adjusted associations between special education category and the presence of a treated STI while controlling for age and ethnicity.

Navigate to: RESULTS
Table 1 shows the demographic characteristics of children in each special education category. The differences in mean age between groups were minor but statistically significant (F = 121.6, df = 5, p.001). There was a significant relationship between the special education category and gender, with a higher proportion of males classified as ED and a lower proportion classified as “other” (2 = 1613.6, df = 5, p.001). Race/ethnicity had a statistically significant relationship with special education placement (2 = 616.2, df = 20, p.001). African Americans were more likely to be classified as ED and less likely to be classified as MG. A higher proportion of whites were classified as “other,” while a lower proportion received no special education. The proportion of children treated for an STI ranged from 3.9% of those receiving no special education services to 5.6% of those in the MG category (p =.001).

Table 2 shows the prevalence of each STI in children who receive and do not receive special education services. Because children may be diagnosed with more than one STI, the sum of the columns exceeds the percentage of infected individuals. Chlamydia was the most common STI in both groups, affecting more than 3.5% of adolescents and accounting for 85% of infected individuals in both groups. Herpes was the next most common STI, found in 0.19% of non-special education children and 0.32% of special education children, accounting for 4.6% and 7.1% of infected individuals in each group, respectively.

Table 2: Prevalence of STIs treated (n = 51,234)

% (n = 8015) in Special Education

(n = 43,219) No Special Education

The p-value
Herpes
0.19 0.32 .001
.778 Hepatitis B 0.02 0.03
Other types of hepatitis
0.01 0.00 .604
Chlamydia
3.61 3.91 .032
0.10 0.15.107 human immunodeficiency virus
Syphilis 0.02 0.03 .224
Gonorrhea 0.07 0.07 .869
Trichomoniasis 0.04 0.03 .648
Other types of venereal disease
0.12 0.11 .987
STIs of any kind
4.10 4.53 .014
Launch in a new window
Figure 1 shows the percentage of youth in each special education category who have an STI, broken down by gender. At p.01, all sex differences were statistically significant. Females classified as MR had the highest risk of STIs (6.9%), while those classified as ED or “no special education” had the lowest risk (4.9% each). STIs were most common in males classified as MG (6.7%) and least common in males classified as MR (3.0%).

An external file containing a picture, illustration, or other data.
Figure 1 shows the percentage of youth aged 12-17 years who were treated for an STI by gender and special education category.

The results of the two logistic regression analyses estimating the adjusted association between the special education category and receiving an STI diagnosis are presented in Table 3. African American 12-year-old children who did not receive special education services made up the reference groups. Being classified as LD was associated with a 36% increase in the likelihood of having an STI in males. Latinos (odds ratio [OR] = 1.41), whites (OR = 1.72), and those of “other” ethnicity (OR = 1.79) were at higher risk than African Americans.

Table 3 Stratified Logistic Regression Predicting the Odds of a Treated STI*

Males Females OR 95% CI OR 95% CI OR 95% CI
Category of special education
ED 1.02 0.65–1.58 0.95 0.48–1.86
MR 1.12 0.68–1.82 1.37 1.01–1.88
Particular learning disability
1.36 1.10–1.67 1.20 0.97–1.48
MG
1.12 0.99–1.26 1.10 1.01–1.19
Other 1.08 0.97–1.21 1.03 0.92–1.16
Race/ethnicity
Asian 1.03 0.71–1.49 0.33 0.21–0.53
Latino 1.41 1.07–1.86 1.11 0.87–1.42
White 1.72 1.43–2.08 1.36 1.17–1.58
Other 1.79 1.41–2.26 1.41 1.18–1.70
Each year of age added 0.99 0.95-1.04 1.14 1.10-1.18
Launch in a new window
CI stands for a confidence interval.

*OR significant at p.05 is shown in bold typeface. African American 12-year-old children who did not receive special education services made up the reference groups.
Being classified as MR was associated with a 37% increase in the odds of having an STI in females while being classified as MG was associated with a 10% increase in odds. Again, white (OR = 1.56) and “other” ethnicity (OR = 1.41) women were at higher risk than African American females. Compared to African American females, Asian females had one-third the odds of being diagnosed with an STI. Unlike in men, older age was associated with an increased risk of an STI in women.

Visit: DISCUSSION
In 2002, 3% of Philadelphia public middle and high school Medicaid-eligible adolescent males and 5% of females were treated for an STI, according to this study. In comparison, national estimates of all STI-reported cases for all youth aged 10 to 19 years were less than 2% for males and less than 3% for females. However, screening efforts in school-based clinics in 2002 discovered a 13% prevalence of chlamydia, the most common STI, in adolescent females. 27 These comparisons suggest that the current findings represent a relatively high treated prevalence but are most likely an underestimation of STI prevalence in the community. The finding that females have a higher prevalence is consistent with previous research. 28–31

This study also discovered that students in some, but not all, special education categories were more likely than their peers to have a diagnosed STI. Females in the MR and MG categories were more likely than their peers to receive an STI diagnosis in adjusted analyses. At the same time, males in the specific learning disability category were also at increased risk.

The finding about females in the MR category contrasts with research on institutionalized people with cognitive impairment.

18,20 Prevalence may be higher in this sample because these females are more likely to be integrated into their communities than females in residential care, providing more opportunities for risky behavior or being coerced or exploited. According to other research, sexually active teenage females with low cognitive abilities were more than twice as likely as their sexually active peers to contract an STI or become pregnant. 32 There are also higher rates of sexual abuse and exploitation, particularly among females, among cognitively impaired children,33 which may increase STIs. It is also possible that the true prevalence of STIs among cognitively impaired females is not higher. Still, they are more likely to be diagnosed due to increased contact with health and social service systems.

A surprising discovery was that academically gifted female had significantly higher rates of treated infection. According to research, intellectually precocious females are also more socially and sexually intelligent and are more likely to have older sexual partners. 34 As a result, they may be more vulnerable to contracting STIs. 35 Academically gifted females may also have more health knowledge than their peers, resulting in better symptom recognition and treatment when an STI occurs. 36

Males with a specific learning disability were much more likely to be treated for an STI than males who did not receive special education services. Although this finding has not previously been reported, it is logical given the prevalence of executive functioning deficits, social vulnerabilities, and decreased health knowledge associated with various learning disabilities. 22–24 Females in this category, on the other hand, did not have a significantly increased risk. This disparity could be explained by the fact that males with learning disabilities are identified more frequently than females due to disruptive behaviors that draw teachers’ attention. 37 As a result of this differential ascertainment, more females with learning disabilities would receive no special education services, biasing the observed associations. Learning disabilities may also increase the risk of STIs in men more than in women due to these associated behaviors. Males with LD are more likely to have comorbid conditions such as attention deficit hyperactivity disorder (ADHD) and conduct disorder, which may contribute to increased risk-taking behavior and, as a result, infection risk. 38

Age and ethnicity also have significant effects. Females were at higher risk as they aged, but males were not. Older females may be more likely to initiate sex and have older partners than younger females. 29,35 Older females may also be more likely to seek gynecological care and be tested, whereas older males may be no more likely than younger males to seek sexual health care.

White and Latino males were more likely to be treated for an STI than African American males. Asians were less likely than African Americans to have a diagnosed STI, while whites were more likely. While the finding for Asian adolescents is consistent with previous research30, the finding for African American youth contradicts recent research suggesting a higher prevalence of STIs. 29,35,39,40

Given that risky behaviors are frequently associated with emotional and behavioral disturbances, we were surprised to find no excess risk associated with children in the ED category. This type of difficulty may be the least recognized among children in public schools,41, thus attenuating the observed risk. It is also possible that children in this category are less likely to be treated for STIs, which would have significant implications for screening.

Differences between current study findings and previous studies could be attributed to the fact that the current sample consisted of Medicaid-eligible youth from a single city; racial variation in sexual risk behavior may vary depending on socioeconomic status and regionally determined factors. Low-income African American and Asian adolescents in Philadelphia may engage in less risky sexual behaviors than low-income white or Latino youth, or they may engage in similarly risky behaviors but in networks with lower STIs, or they may be less likely to seek health care than other adolescents. 42

Limitations
One of the limitations is that the analyses relied on the School District of Philadelphia’s special education categorizations; disabilities may have been underrecognized or misclassified, potentially attenuating the observed risk. Another significant limitation is that STI cases were identified using Medicaid claims. This strategy introduces two potential problems that have been thoroughly discussed in previous studies using similar data. 43,44 For starters, it most likely underestimates the number of adolescents infected with STIs and thus should not be regarded as a true prevalence estimate. More specifically, if infected adolescents in different special education categories have different chances of receiving Medicaid-reimbursed STI treatment, it may introduce significant ascertainment bias. Individuals referred to the health or education system for other reasons may be more likely than their peers to be tested for STIs. Another limitation is that many Philadelphia public high school campuses have health centers where STIs are treated for free. Children in various special education categories may be more or less likely to use this service.

Implications
Despite these limitations, the findings have significant implications. If children with learning disabilities are more likely to contract STIs, it is critical to understand their risk behaviors and risk reduction needs. More sophisticated research into the prevalence of STIs in special education populations is required to determine the true impact of cognitive and emotional impairments on sexual health. Specific risk behavior correlates, and malleable factors in children with impairments should also be investigated, as they may differ from risk factors in other children.

Even if true prevalence is assumed to be the same across groups and the observed associations are related to the likelihood of treatment, there are significant implications. In this case, the findings indicate that some groups are at high risk of not receiving treatment, which could lead to increased disability and infection spread. Even if the prevalence of STIs is comparable between adolescents with learning disabilities and their peers, appropriate, effective preventive interventions tailored to the needs of children with disabilities are still needed. Special education students are frequently denied the opportunity to participate in school-based health or sex education programs45; when they do, the materials are not always appropriate to their needs. Several sexual health education programs for students with special needs have been developed, but they have not been rigorously evaluated and are not widely used. 45,46 There is a need for research into the appropriateness and effectiveness of existing prevention programs for disabled youth. New intervention programs that address the cognitive needs of disabled youth should be developed if necessary.

QUESTION

APA format

1) Minimum 9 pages (No word count per page)- Follow the 3 x 3 rule: minimum of three paragraphs per page

You must strictly comply with the number of paragraphs requested per page.

The number of words in each paragraph should be similar

Part 1: minimum 3 pages

Part 2: minimum 3 pages

Part 3: minimum 3 pages

Submit 1 document per part

2)¨******APA norms

The number of words in each paragraph should be similar

Must be written in the 3 person

All paragraphs must be narrative and cited in the text- each paragraph

The writing must be coherent, using connectors or conjunctive to extend, add information, or contrast information.

Bulleted responses are not accepted

Don’t write in the first person

Do not use subtitles or titles

Don’t copy and paste the questions.

Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 7 references (APA format) per part not older than 5 years (Journals, books) (No websites)

All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

Q3. Research is…………………………………………………. (a) The relationship between……… (b) EBI has to

6) You must name the files according to the part you are answering:

Example:

Part 1.doc

Part 2.doc

__________________________________________________________________________________

The number of words in each paragraph should be similar

Part 1: Capstone

Topic: Sexually Transmitted Diseases in Adolescents

PICOT question: Can the implementation of a 2-month program in schools in Miami on sexually transmitted diseases in adolescents aged 14 to 17 years improve their knowledge about the prevention of sexually transmitted diseases compared to their knowledge before the program’s implementation?

Tool: Survey and informal observation

1. Implementation/Conclusion (One paragraph)

a. Implement the change you are proposing- This should be a continuation of Part I and Part II (Check files)

2. Describe the practice change (One paragraph)

a. Place: Schools

b. Participants: Adolescents

3. Discuss how you would implement and assess the change (Three paragraphs)

a. Time frame

b. Setting

c. Participants

d. Barriers

e. External and internal factors.

4. How would you evaluate the change process? (One paragraph)

b. How would you measure or evaluate? income survey and out come survey

c. Is there a tool to measure?: Survey and informal observation

5. The literature review must support your change and implementation. (One paragraph)

a. Use leadership qualities and skills that will be utilized for successful completion of the project.

6. Discuss who will be invited to the proposal (One paragraph)

a. Who are the stakeholders?

b. How will you present the information to your stakeholders?

7. Conclusion (One paragraph)

a. The conclusion should have your Part I, II, II all put together in a thorough (Check file)

The number of words in each paragraph should be similar

Part 2: Capstone

Topic: Incompatibility of Intravenous Medications

PICOT question: Is it possible that the rate of errors due to incompatibility of intravenous medications is reduced by implementing a training program for ICU nurses for 8 weeks, compared to the rate of errors before training?

Tool: Survey and informal observation

1. Implementation/Conclusion (One paragraph)

a. Implement the change you are proposing- This should be a continuation of Part I and Part II (Check files)

2. Describe the practice change (One paragraph)

a. Place: ICU unit

b. Participants: ICU nurses

3. Discuss how you would implement and assess the change (Three paragraphs)

a. Time frame

b. Setting

c. Participants

d. Barriers

e. External and internal factors.

4. How would you evaluate the change process? (One paragraph)

b. How would you measure or evaluate? income survey and out come survey

c. Is there a tool to measure?: Survey and informal observation

5. The literature review must support your change and implementation. (One paragraph)

a. Use leadership qualities and skills that will be utilized for successful completion of the project.

6. Discuss who will be invited to the proposal (One paragraph)

a. Who are the stakeholders?

b. How will you present the information to your stakeholders?

7. Conclusion (One paragraph)

a. The conclusion should have your Part I, II, II all put together in a thorough (Check file)

Part 3: Capstone

Topic: Turnover Rates due to Burnout in Healthcare

PICOT question: Is it possible that in multiple settings, the turnover rate due to burnout is reduced after implementing a mental health program for nurses for 10 weeks, compared to the nurses’ turnover rate before the program?

Tool: Survey and informal observation

1. Implementation/Conclusion (One paragraph)

a. Implement the change you are proposing- This should be a continuation of Part I and Part II (Check files)

2. Describe the practice change (One paragraph)

a. Place: multiple settings

b. Participants: Nurses

3. Discuss how you would implement and assess the change (Three paragraphs)

a. Time frame

b. Setting

c. Participants

d. Barriers

e. External and internal factors.

4. How would you evaluate the change process? (One paragraph)

b. How would you measure or evaluate? income survey and out come survey

c. Is there a tool to measure?: Survey and informal observation

5. The literature review must support your change and implementation. (One paragraph)

a. Use leadership qualities and skills that will be utilized for successful completion of the project.

6. Discuss who will be invited to the proposal (One paragraph)

a. Who are the stakeholders?

b. How will you present the information to your stakeholders?

7. Conclusion (One paragraph)

a. The conclusion should have your Part I, II, II all put together in a thorough (Check file)