Tobacco cessation and youth: the feasibility of brief office interventions for adolescents.

BACKGROUND: The prevalence of tobacco use among adolescents remains high and the great majority of adult smokers begin smoking prior to the age of 18. While there have been a number of primary prevention projects in communities and schools, less attention has been given to smoking cessation for adolescents. This paper reviews the literature on the theory and practice of cessation as applicable to adolescents. METHODS: The relevant literature was culled from a MEDLINE search and supplemented with secondary searches from those articles. RESULTS: There have been few studies on brief interventions for adolescent smoking cessation in health care settings. However, there are several models for smoking cessation that are either applicable to or designed for adolescents. Pharmacologic treatments are also beginning to be used. CONCLUSIONS: There is a great need for the development and evaluation of models for adolescent smoking cessation in health care settings. Recent developments, however, give cause for optimism in helping adolescent smokers in tobacco cessation.

Evaluation of two rapid tests for the diagnosis of Chlamydia trachomatis genital infections.

The performance of two new enzyme immunoassays (EIA) for the detection of Chlamydia trachomatis in a practice setting was compared. A consecutive series of 207 female patients seen at an inner-city sexually transmitted disease clinic were tested by cell culture, the Kodak SureCell (SC) and Abbott TestPack Chlamydia (TP) EIAs. In addition 210 male patients, selected by physicians on the basis of the fact that multiple urethral samples could be obtained, were tested by cell culture and SC. The prevalence of infection was 19% in the females and 12.5% in males. The sensitivity, specificity, positive predictive value and negative predictive value for the SC and TP were 88%, 95%, 81%, 97% and 59%, 99%, 95%, 91%, respectively, in the female population. The sensitivity of the SC was significantly greater than that of the TP (p less than or equal to 0.002). The performance values of the SC in men (in the same order) were 64%, 96%, 71% and 95%, respectively. The SC in male patients and the TP in female patients had low sensitivity. The sensitivity of the SC in female patients was significantly higher than that of the TP. However, the SC yielded more false positive results. To determine the utility of these tests in a practice setting further studies are required.

Comparison of the Kallested Pathfinder EIA, cytocentrifuged direct fluorescent antibody, and cell culture for the detection of Chlamydia trachomatis.

A total of 203 duplicate endocervical samples collected from patients at an adolescent health care center were tested for the presence of Chlamydia trachomatis by cell culture, Pathfinder enzyme immunoassay (EIA) (Kallestad) and cytocentrifuged direct fluorescent antibody (DFA). Compared to cell culture, the Pathfinder assay demonstrated a sensitivity and specificity of 85.2% and 100%, whereas the DFA procedure demonstrated to be 92.6% sensitive and 99.4% specific.

Comparison of three new nonculture tests in the diagnosis of Chlamydia genital infections.

This study compares three new rapid nonculture tests to cell culture with passage for the diagnosis of Chlamydia genital infections in sexually active adolescent and young adult females. Two hundred consecutive patients having a pelvic examination had cervical samples taken for the following: Papanicolaou smear, gonorrhea culture, Chlamydia cell culture, direct fluorescent antibody (DFA; Difco), isotopic DNA probe (Gen-Probe), and enzyme immunoassay (EIA; IDEIA III, Novo BioLabs). After resolution of discrepant results, 25 of the specimens were judged to be positive. The DFA identified 17 of the 25, with 3 false-positive results; the DNA probe identified 20 of the 25, with no false positive results; and the EIA identified 22 of the 25, with one false-positive result. The sensitivities, specificities, and positive and negative predictive values, respectively, were DFA, 68%, 98.2%, 85%, 95.5%; DNA probe, 80%, 100%, 100%, 97.2%; and EIA, 88%, 99.4%, 95.6%, 98.3%. These new rapid nonculture tests are comparable and relatively reliable, with trends favoring the EIA and the DNA probe. Further studies with larger samples are needed to determine their clinical utility.

Screening adolescents for depression and parent-teenager conflict in an ambulatory medical setting: a preliminary investigation.

Because more than 60% of adolescent visits to physicians last less than 10 minutes, simple screening devices to identify persons at risk for social morbidity are needed. The result of a pilot screening instrument for depression and parent-teenager conflict is described. A seven-item questionnaire (three items for depression and four items for parent-teenager conflict), the Beck Depression Inventory (BDI), and the Conflict Behavior Questionnaire (CBQ), were administered to 226 adolescents at a high-risk adolescent heath center. After the visit, the provider rated each patient on a five-point Likert scale for level of depression and parent-teenager conflict. The screening questionnaire and the provider ratings were compared with the BDI and CBQ for sensitivity, specificity, and predictive value. A majority of the subjects (61% for depression and 63% for parent-teenager conflict) had no positive screening responses and, of these, less than 3% were classified as being depressed or having parent-teenager conflict by the BDI or CBQ. There were three or four positive screening responses (three responses for the depression questions and 20 responses for the parent-teenager conflict questions) among 23 adolescents and all of these scored in the abnormal range on the BDI or CBQ. Approximately one third of the subjects had intermediate responses. With one positive response, the predictive value for depression and parent-teenager conflict was 17% and 24%, respectively, whereas with two positive responses the predictive values were 56% and 26%. It was shown by receiver operating characteristic curves that the combined sensitivity and specificity of the screening questionnaire was superior to that of the physician ratings.(ABSTRACT TRUNCATED AT 250 WORDS)

Preventive health screening in adolescent patients.

This article describes an approach to health screening and promotion in adolescents. Key concepts in interviewing adolescents are presented along with practical suggestions for health education. Emphasis is given to psychosocial topics that contribute to morbidity in adolescents that is potentially preventable.

Pyogenic osteomyelitis versus pseudo-osteomyelitis in Gaucher's disease. Report of a case and review of the literature.

Presented is a young girl with Gaucher's disease who developed acute bone pain accompanied by signs of inflammation and who was felt to have possible pyogenic osteomyelitis. The lack of significant pathogenic bacterial growth on culture and the findings at orthopedic surgery led the authors to conclude that this child probably represented a case of pseudo-osteomyelitis, but the isolation of an anaerobe from the operative culture of the involved bone leaves the exact diagnosis unclear. Since this child underwent an open surgical procedure, she was treated with antibiotics to prevent the possible development of chronic osteomyelitis. This anaerobic growth on culture, although strongly felt to be a contaminant, also played a role in this decision. She had an uneventful hospital course and subsequently has done well. It is suggested that great caution be taken before subjecting a patient with Gaucher's disease to orthopedic surgical procedures. If pyogenic osteomyelitis is strongly suspected, obtaining multiple blood cultures and culture by needle aspirate may be preferred over an open surgical procedure. The use of empiric antibiotic therapy without an attempt at further diagnosis is not recommended. If an orthopedic surgical procedure is necessary in a patient with Gaucher's disease, antibiotic coverage is indicated and long-term observation of the operative sight for drainage and/or other signs of chronic inflammatory changes in mandatory.