Effect of an individualised training programme during weight reduction on body composition: a randomised trial.

OBJECTIVE: To study the effect of a standardised training programme focusing on maintenance of fat free mass during weight reduction by energy reduction in obese children. DESIGN: Randomised trial of physical training programme and dietary advice (group A) versus dietary advice alone (group B). SUBJECTS: Thirty obese children and adolescents (14 group A, 16 group B) participated in the 12 week long programme; 20 children (10 group A, 10 group B) were also reassessed after one year. MEASUREMENTS: Fat free mass was estimated from the resistance index, obtained by bioelectrical impedance analysis at baseline, after four, eight, and 12 weeks in all subjects, and after one year in 20 subjects. RESULTS: The mean (SD) change in fat free mass was significantly different between the two groups after 12 weeks (group A, 2.68 (3.74) kg; group B, 0.43 (1.65) kg). The change in body weight after one year was inversely correlated with the change in fat free mass after 12 weeks (r = -0. 44), as assessed in the 20 subjects. CONCLUSIONS: A standardised training programme as used in this study can prevent reduction in fat free mass during weight loss in obese children. Reduction in fat free mass during weight reduction might be a risk factor for regain of weight.

Autosomal dominant familial Mediterranean fever--like syndrome.

UNLABELLED: We report a syndrome characterized by recurrent episodes of fever and serositis in an Austrian family. Three family members over two successive generations were affected. The febrile episodes had their onset at the age of 11-12 years, lasted 1-5 weeks, and occurred in intervals of 6-24 months. While the disorder resembles familial Mediterranean fever (FMF) clinically, ethnic distribution and other features suggest a distinct entity. Clinically, the attacks last longer than the usual FMF attacks, and in the male patients are associated with scrotal inflammation. Genetically, the disorder appears to be inherited as an autosomal dominant syndrome, whereas FMF is autosomal recessive. Molecular analysis made the involvement of a gene in the FMF region of chromosome 16p13.3 highly unlikely. CONCLUSION: An Austrian family with recurrent fever syndrome is reported. Ethnicity, clinical features, and molecular studies point to a distinct clinical entity.

Vascular responses by transcutaneous oximetry in adolescents with and without diabetes.

The vascular response of the skin was evaluated by transcutaneous oximetry (TcPO2) in the forearm in 119 adolescents with type I diabetes aged 10.4-19.8 (median 15.3) years, with a duration of diabetes 0.7 to 18.3 (median 7.8) years, and 49 nondiabetic adolescents aged 11.3-18.8 (median 15.5) years. Two different vascular stimuli were used: heating of the probe to 43 degrees C and 5 min of ischemia. Baseline TcPO2 after 13 min of equilibration at a probe temperature of 43 degrees C, postischemic maximum TcPO2, and the postischemic TcPO2 increase were significantly lower in the diabetic group compared to the control group (p = 0.0001, p < 0.0001, and p = 0.0001, respectively). In both the diabetic and the control groups, gender differences were found for baseline TcPO2 (p = 0.0001 and p = 0.0009, respectively) and postischemic maximum TcPO2 (p = 0.0001 and p = 0.005, respectively), the girls having consistently higher values. After controlling for gender by multiple linear regression analysis, duration of diabetes showed a significant effect on postischemic maximum TcPO2 (R2 = 22%, p = 0.02). The postischemic TcPO2 increase was not affected by gender. Lower values for the postischemic TcPO2 increase were related to higher GHb values (R2 = 4%, p = 0.03). Abnormal values for oximetry were associated only with some autonomic nerve function abnormalities. Differences in the vascular response to heat and ischemia as measured by transcutaneous oximetry can be demonstrated between adolescents with type I diabetes and nondiabetic controls, as well as between girls and boys. Lower values in diabetic subjects are weakly associated with diabetes duration and metabolic control, independent of gender.

Changes in lean body mass in obese children during a weight reduction program: effect on short term and long term outcome.

OBJECTIVE: To study the changes in body composition during a weight reduction program in obese children and adolescents. DESIGN: A short-term longitudinal study. SUBJECTS: Forty-one obese children and adolescents (19 M, 22F, age 8.5-14.8 [median 11.8] years. MEASUREMENTS: Lean body mass (LBM) was estimated from Resistance Index (RI) obtained by Bioelectrical Impedance Analysis (BIA) before and after the 3 week program. RESULTS: Mean percentage weight for height at baseline was 151 (s.d. 20)% and significantly decreased at the end of the three weeks (139 (s.d. 18)%, P = 0.005). The mean percentage body fat also decreased (from 46.0 s.d. 5.8% to 41.5 s.d. 6.5%, P = 0.0015). All individuals lost body fat during the three weeks, whereas the change in LBM was heterogeneous. The individual change in body fat was inversely correlated with the change in LBM (r = -0.64, P = 0.0001). After 4 months, 18 out of the 41 children could be reevaluated for height and weight. The regain in body weight during these 4 months was inversely correlated with the change in LBM during the weight reduction program (r = -0.55, P = 0.018). CONCLUSIONS: Changes in LBM during a weight reduction program can predict the short term result those children who manage to increase LBM having the greatest reduction in body fat. Changes in LBM during weight reduction seem also to predict the longterm outcome, a reduction in LBM being associated with greater regain of weight. Weight reduction programs for obese children should focus not only on weight loss but also on maintenance or increase of lean body mass to improve longterm results.

The prospective assessment of autonomic nerve function by pupillometry in adolescents with type 1 diabetes mellitus.

The study aimed to compare the longitudinal assessment of automatic nerve function by computerized infrared pupillometry and standard cardiovascular tests in adolescents with diabetes. Adolescents (n = 150) were assessed at two time points (T1 and T2). The median time interval between assessments was 1.5 (range 0.9-3) years. At T1 the median age was 14.5 (range 8.3-19.5) years and the median duration was 6.5 (range 1.1-16) years. The pupillary variables assessed included the resting pupil diameter, the maximum constriction velocity, and the reflex amplitude of constriction. Heart rate reflexes were assessed in response to deep breathing, the Valsalva manoeuvre, and on standing from a lying position (30/15 ratio). Between visits there was a significant decrease in maximum constriction velocity (6.0 mm s-1 vs 6.3 mm s-1, p = 0.0001) and resting pupil diameter (6.2 mm vs 6.3 mm, p = 0.001). At reassessment pupillary abnormalities increased from 32 (21%) to 45 (30%), with 17 (54%) of the initial abnormalities persisting. Adolescents with abnormally slow maximum constriction velocity compared to those with normal maximum constriction velocity had a higher glycated haemoglobin (HbA1c%) at T2 (p = 0.02) and between assessments (p = 0.01). Cardiovascular test abnormalities did not increase between visits and the persistence of initial abnormalities was low (21%). In summary, pupillometry appears a more sensitive test of automatic nerve dysfunction in adolescents with diabetes than assessment of cardiovascular reflexes.

Echocardiographic load-independent indices of contractility in children and adolescents with type I diabetes: effect of metabolic control and insulin on left ventricular performance.

A case-control study was carried out in a tertiary referral teaching hospital to evaluate left ventricular contractility in children and adolescents with type 1 diabetes and to study factors influencing left ventricular contractility. Thirty-four children and young adults with type 1 diabetes (age 10.8-21.8 years) were randomly selected from approximately 400 patients of the same age range in the outpatient department and compared with 16 non-diabetic controls (age 7.3-21.2 years). The relation of end-systolic wall stress to velocity of circumferential fiber shortening as a standard deviation score (SDS) from the normal range described by Colan et al. was used to assess left ventricular contractility. In the diabetic group the effect of age, duration of diabetes, metabolic control, insulin dose, and autonomic function on left ventricular contractility were studied. It was found that the end-systolic wall stress-velocity of circumferential fiber shortening relation was not different between diabetic subjects and controls [+0.52 (SEM 0.21) vs +0.90 (SEM 0.26) SDS, p = 0.3]. In the diabetic subjects, the end-systolic wall stress-velocity of circumferential fiber shortening relation was positively correlated with glycated hemoglobin (r = 0.37, p = 0.03) and insulin dose per kilogram of body weight (r = 0.36, p = 0.04). Those two variables together explained 24% of the variability in the end-systolic wall stress-velocity of circumferential fiber shortening relation. Twenty-eight of the diabetic subjects were also assessed for cardiac autonomic function. Disturbances of cardiac autonomic function were not associated with increased contractility.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of the introduction of dietary sucrose on metabolic control in children and adolescents with type I diabetes.

The effect of sucrose in the diet of children and adolescents with type I diabetes on long-term metabolic control was studied. For a mean observation period of 83 (range 42-127) days, a diet containing 5% of total calories as refined sugar was recommended to 11 children (group A, mean age 15.0, SD 5.4 years), while another 13 children remained on their usual 'sucrose-free' diet (group B, mean age 16.0, SD 5.7 years). The mean observation period in this group was 77 (41-103) days. All children had a dietary assessment at baseline and at follow up using a 7-day food record. At baseline, sucrose intake as a proportion of total daily calories was similar in the two groups (group A 1.4, SD 1.9% vs group B 2.0, SD 2.3%; P = 0.5). At follow-up, sucrose intake increased significantly in group A (5.1, SD 2.5%; P = 0.0008) but not in group B (2.7, SD 3.3%; P = 0.5). Metabolic control assessed by haemoglobin level (HbA1c) was not different between the groups at baseline (group A 8.5, SD 1.2 vs group B 8.8, SD 1.8%; P = 0.7) nor at follow-up (9.1, SD 1.4 vs 9.0, SD 2.5%; P = 0.9). Within group A, the individual change in HbA1c correlated with the individual change in sucrose intake (r = 0.61, P = 0.05), this correlation being strongly influenced by two individuals with an increase in sucrose consumption substantially exceeding 5%. Percentage intake of protein, carbohydrate and fat did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Amyloid goiter in a child with familial Mediterranean fever.

A 7 year-old Turkish boy presented with a euthyroid goiter, which was noted during evaluation of familial Mediterranean fever. Amyloid deposits in the thyroid were found on fine-needle aspiration biopsy. Slight involution of the goiter within seven months may be attributed either to colchicine therapy or to treatment with levothyroxine and iodide.

Effect of actual glycaemia on pupillary function in children with type 1 diabetes.

The objective was to study the effect of actual glycaemia on autonomic function. Autonomic function was assessed by computerised infrared video-pupillometry in 10 children with type 1 diabetes (age 10.5-15.8, median 13.7 years, diabetes duration 1.1-10.0, median 3.8 years) on 6 occasions (07:30, 12:00, 17:30 h on days 1 and 10, respectively). Blood glucose was measured by a reflectance meter immediately prior to each pupillometry study. To allow for inter-individual differences in pupillary variables (resting pupil diameter (RPD), reflex amplitude (RA), maximum constriction velocity (MCV)) the variation of each variable from the mean for the individual (difference between the actual value and the mean value from the 6 measurements (delta RPD, delta RA, delta MCV)) was used in calculations. None of the three pupillary variables showed a significant correlation with the blood glucose value (delta RPD: r = 0.072, P = 0.59; delta RA: r = -0.008, P = 0.96; delta MCV: r = -0.080, P = 0.55). It is concluded, that autonomic function in children with Type 1 diabetes as determined by computerised infrared video-pupillometry is not affected by actual glycaemia.

Melanotic macules following Blaschko's lines in McCune-Albright syndrome.

Hyperpigmented macules are a characteristic feature of neurofibromatosis and the McCune-Albright syndrome. Whereas neurofibromatosis 1 has an autosomal dominant mode of inheritance, it has been suggested that McCune-Albright syndrome is the result of a lethal gene surviving by mosaicism. Recent molecular studies have supported this concept by providing evidence of a somatic mutation of the gene encoding the G protein. We report two patients with McCune-Albright syndrome whose melanotic macules show a clear relation to the lines of Blaschko. The lines of Blaschko are thought to represent the dorso-ventral outgrowth of two different cell populations during embryogenesis, thus reflecting genetic mosaicism. A survey of published photographs of patients with McCune-Albright syndrome in the literature revealed additional cases with macules following Blaschko's lines. In other cases, the configuration of the macules was reminiscent of the flag-like rectangular pattern of pigmentation found in human chimaeras. A very early somatic mutation may have similar effects on the pigmentation pattern as a chimaeric state, which is the result of the double fertilization of an ovum. Café-au-lait spots in 10 of our own patients with neurofibromatosis 1 could not be associated with either Blaschko's lines or the rectangular pattern of pigmentation in chimaeras. We conclude that, in contrast with the café-au-lait spots in autosomal dominant neurofibromatosis 1, the configuration pattern of melanotic macules in McCune-Albright syndrome in many cases characteristically reflects the mosaic state of the organism.

SHORT syndrome and insulin resistance.

We describe a further case of SHORT syndrome. This girl shows nearly all the typical manifestations reported in patients with SHORT syndrome. However, at 14 years she presented with non-ketotic hyperglycemia. At 16 1/2 years, the diagnosis of diabetes mellitus secondary to severe insulin resistance was made by intravenous insulin challenge. Insulin resistant diabetes mellitus seems to be a new finding in SHORT syndrome, not previously described in this condition.

[A rapid method of HbA1c determination in a pediatric diabetic patient sample]. / Schnellbestimmungsmethode von HbA1c in einem pädiatrisch diabetologischen Patientengut.

A new Method for HbA1c measurements (Abbott vision) was evaluated. 107 patients (45 F, 62 M) of a paediatric diabetes clinic participated. The mean age was 14.9 (5.8-26.3) years, the mean duration of diabetes was 7.6 (0.1-21.1) years. Measurements were performed immediately after capillary blood sampling, the result was available within 15 min. The automated HPLC-system Diamat was used as a reference method, blood samples were stored at 4 degrees C and analysed within 24 h after blood sampling. There was a close correlation between both methods (r = 0.96, P < 0.0001). In the lower range the results measured by Abbott Vision were slightly lower, whereas in the higher range the results were slightly higher (HbA1c (Abbott) = 1.53 + HbA1c (Diamat).0.84). The accuracy seems to be satisfactory for estimating metabolic control. The HbA1c-result is available within 15 min which means a major advantage for the management of children and adolescents with type I diabetes.

Severe hypoglycemia in children and adolescents with IDDM: frequency and associated factors.

Severe hypoglycemia is a very common complication in youths with insulin-dependent diabetes mellitus (IDDM). Seventy four children and adolescents were surveyed for a 1-year period to evaluate the frequency and associated factors of severe hypoglycemia. Patients or their parents completed a standardized questionnaire which inquired about severe and mild episodes, treatment, and prevention of hypoglycemia. Forty-four percent of the patients experienced at least one severe hypoglycemic episode [need for assistance (grade III), loss of consciousness with or without convulsions (grade IV)] during the survey period. The event rate was 0.77 episodes (grade III and IV) per patient-year. The group with severe hypoglycemic episodes was significantly older (mean age, 16.3 years; SD, 3.6 years versus mean age 13.7 years; SD, 4.9 years; p = 0.01) and had significantly longer duration of diabetes (mean, 8.2 years; SD, 4.3 years versus mean, 6.1 years; SD, 4.0 years; p = 0.04) than the group without severe hypoglycemic episodes. There were no significant differences in mean glycosylated hemoglobin (HbA1c), daily doses of insulin, type of insulin regimen, gender, and age at diagnosis between patients who reported severe episodes and those who did not. Mild hypoglycemia was reported by 72 patients. Fifty percent of the patients recognized potential precipitating factors. Older age and longer duration of diabetes seem to predispose the patient to severe hypoglycemia. This may be the result of a diminution of the counterregulation system including lower neuroadrenergic reaction, or the still unphysiologic treatment of diabetes. Continued vigilance and education is important in older adolescents with longer duration of diabetes.

Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibiting immunoglobulin.

Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibitor immunoglobulin (TBII), a thyroid-stimulating hormone (TSH)-receptor blocking antibody, is described in three male siblings born to a mother with autoimmune thyroiditis. These cases are believed to be the first described in Australia. The first child was found to have a serum TSH of 565 mU/L and had a negative thyroid scan when presented for neonatal screening. He was treated with thyroxine but became thyrotoxic at 3 months of age when he was on a dosage of 85 micrograms/m2 of body surface area. He was euthyroid 6 months after discontinuation of therapy. Nine years later a second hypothyroid sibling was born, with a serum TSH of 709 mU/L on day 4. Both mother and child were demonstrated to be strongly positive for TBII. Again this child was able to cease therapy by the age of 9 months. A third sibling, also TBII positive, was born 12 months after the second. His TSH was 90 mU/L and his serum thyroxine (T4) was 169 nmol/L. On this occasion, thyroid stimulation-blocking antibody was found to be present in the serum of both mother and child. Thyroxine therapy was ceased at 1 month. The family present a picture of varying degrees of transient neonatal hypothyroidism due to the transplacental passage of a maternal receptor blocking antibody. The condition is self-limiting, resolving when the immunoglobulin is cleared from the infant's circulation.

Autonomic and peripheral nerve function in adolescents with and without diabetes.

In this study reference ranges were established for autonomic and peripheral nerve tests in 122 non-diabetic adolescents. Regression analysis was used to evaluate the effect of age and gender on neurological function. Increasing age was associated with: less heart rate variability during deep breathing (p = 0.03), higher thermal threshold for cold at the wrist (p = 0.009), and higher vibration threshold at the toe (p = 0.001) and medial malleolus (p = 0.01). Male gender was associated with higher Valsalva ratio (p = 0.0004), higher thermal threshold for hot at the foot (p = 0.002), and higher vibration threshold at the malleolus (p = 0.03). The REFVAL programme was used to determine parametric or non-parametric reference limits: the 5% limits for autonomic and 95% limits for peripheral tests. One hundred and eighty-one adolescents with diabetes were studied under identical conditions and similar effects of age and gender were found. Twenty-eight percent of the group with diabetes had at least one abnormal autonomic test result out of four (expected 18.5%); 24% had at least one abnormal peripheral test result out of six (expected 26.5%). Glycaemic control was associated with autonomic (p = 0.04) but not peripheral abnormalities. Using multiple regression analysis and adjusting for age and gender, there was no effect of diabetes duration or glycaemic control on neurological function.

Pupillary abnormalities in type I diabetes occurring during adolescence. Comparisons with cardiovascular reflexes.

OBJECTIVE: To evaluate computerized infrared pupillometry for the assessment of autonomic neuropathy in adolescents with type I diabetes. RESEARCH DESIGN AND METHODS: We measured resting pupil diameters and pupillary light reflexes in 142 adolescents with type I diabetes (72 boys and 70 girls, 10.4-19.8 yr of age, duration of diabetes 0.7-18.3 yr) and in 75 nondiabetic control subjects (29 boys, 46 girls, 11.3-19.8 yr of age). All study participants were assessed using four standard cardiovascular tests: maximum-minimum heart rate during deep breathing (mean of three cycles); heart-rate change during a Valsalva maneuver (Valsalva ratio, mean of three maneuvers); lying-to-standing heart-rate change (30:15 ratio); and lying-to-standing BP change. RESULTS: Mean resting pupil diameters were significantly smaller in the diabetic group: 6.28 +/- 0.06 vs. 6.77 +/- 0.11 mm, P < 0.0001); and significantly smaller with greater duration of diabetes (r = -0.29, P = 0.0006) and higher levels of GHb (r = -0.24, P = 0.004). Patients with retinopathy grade 30 or more (Wisconsin 191 grading) had significantly smaller resting pupil diameters: 5.9 +/- 0.16 vs. 6.4 +/- 0.12 mm, P = 0.008). The phasic light reflex as determined by reflex amplitude and maximum constriction velocity was significantly reduced in the diabetic group: 2.27 +/- 0.03 vs. 2.44 +/- 0.04 mm, P = 0.0009; and 6.68 +/- 0.12 vs. 7.24 +/- 0.16 mm/s, P = 0.007). Reduced reflex amplitude was related to a longer postpubertal duration of diabetes (r = -0.18, P = 0.04). We found no association between pupillary and cardiovascular tests. CONCLUSIONS: Infrared computerized pupillometry demonstrates subclinical diabetic autonomic neuropathy as early as adolescence. Its presence seems to be related to longer duration of diabetes and unfavorable metabolic control.

[Accuracy of blood glucose self-monitoring in children with type-I diabetes]. / Genauigkeit von Blutglukose-Selbsteinschätzungen bei Kindern mit Typ-I-Diabetes.

UNLABELLED: Children with type I diabetes often believe that they are able do gauge their blood glucose value without measurement. This study investigated how accurate these estimates are and which of the patient characteristics might affect accuracy. Nineteen children with type I diabetes (age 7.3-17.3 years, duration of diabetes 0.1-12.0 years) estimated their blood glucose immediately before a blood glucose measurement by reflectance meter. Ten to 54 estimations and measurements were done by each individual during a summer camp. According to the method of Cox et al. accuracy of estimates was evaluated by error grid analysis. Five zones were defined: accurate estimates (zone A); clinically benign errors (zone B); clinically dangerous errors (zone C, D, E). An overall accuracy index was calculated by subtracting the summed percentage of estimates in zones C, D, E from the percentage in zone A. The mean percentage of estimates in zone A was 41.5 (10.0-75.0)%, the mean overall accuracy index was 9.8 (-47.4-62.5)%. Except for mean blood glucose which was inversely correlated with accuracy index (r = -0.53, P = 0.02) none of the other patient characteristics showed an effect on accuracy index. CONCLUSIONS: Accuracy of blood glucose estimates is lower in children with type I diabetes than in adults and varies substantially between individuals. High mean blood glucose values are associated with a lower accuracy of estimates.

Ultrasound and MRI findings in a case of childhood amyloid goiter.

Goiter secondary to amyloidosis is rare in clinical practice and only a few descriptions of its radiologic features have been reported. We present the ultrasound and MRI findings of thyroid amyloidosis in a 7-year-old Turkish boy with familial Mediterranean fever.

[Normal values for free thyroxine, free triiodothyronine, reverse triiodothyronine, thyrotropin, thyroglobulin and thyroxine-binding globulin in umbilical cord blood of healthy mature newborn infants]. / Normwerte für freies Thyroxin, freies Trijodthyronin, reverse Trijodthyronin, Thyreotropin, Thyreoglobulin und Thyroxin-bindendes Globulin im Nabelschnurblut gesunder reifer Neugeborener.

The venous cord blood levels of free thyroxine (fT4), free triiodothyronine (fT3), reverse triiodothyronine (rT3), thyrotropin (TSH), thyroglobulin (TG) and thyroxine binding globulin (TBG) were studied in 56 mature and healthy newborns. Newborns with a gestational age less than 37 or more than 42 weeks, a delivery by forceps or cesarian section, a birth-weight less than 2500 g, a pH-value of the cord-artery blood less than 7.15, an Apgar-value after 1 minute less than 7 were excluded from the study. All mothers were non-smokers. The values of fT4 were 18.66 +/- 4.18 pmol/L, of fT3 were 1.59 +/- 0.75 pmol/L, of fT3 were 2152 +/- 666 pg/ml, of TSH were 7.83 +/- 4.49 mU/ml, of TG were 44.61 +/- 23.84 ng/ml, and of TBG were 25.61 +/- 5.42 micrograms/ml. A weak negative correlation was found between the TG-value and the pH-value of the cord-artery blood (r = -0.27, y = 191.55 - 22.82.x, p less than 0.05), and between the fT4 values and the gestational age (r = -0.34, y = 67.53-1.22.x, p = 0.01). The rT3-values were positively correlated to the gestational age (r = 0.29, y = -4571 + 167.x, p less than 0.03).

[Sex education, sex behavior, contraception]. / Sexualaufklärung, Sexualverhalten, Kontrazeption.

Sexual behavior has changed during the last decades. Teenage fertility rate, and the number of gonococcal infections are both extremely high; the incidence of HIV-infections is increasing. Preventive measures include sex education. Sex education may help the adolescents to identify their own goals for sexual behavior, to avoid unintended and unwanted pregnancy, and to avoid sexually transmitted diseases.

PIP: Data indicate that in the US 10-20% of boys and 5-10% of girls have their 1st sexual intercourse at age 14 and 50% at age 17 during which 70% do not use safe contraception. In 1981 a total of 1 million teenagers became pregnant, and 400,000 underwent abortion. The incidence of gonorrhea is 1300/100,000 among adolescents aged 15-19, and AIDS is spreading among this age group. The role of sex education is vital in providing the right information mainly through the school, as parents often feel uneasy about the topic, and youth organization and religious community groups tend to be too ideological. The teachers have to be well-versed in the topic, but teams of doctors and social workers can also help with practical experience. The curriculum includes the biological basics, sexually transmitted diseases and their prevention, contraceptives, and responsible sexual behavior. Topics for discussion consist of choosing a partner, risk groups, prostitutes, promiscuity, drug use, homosexuality, condoms, and nonoxynol-containing vaginal sponges. Contraceptives include conventional methods (coitus interruptus, Knaus-Ogino, Billings, and basal temperature methods); barrier methods (condom, diaphragm, cervical cap); the IUD; highly effective hormonal contraception (low-dose estrogen and gestagen-containing pills are especially suitable for young people, but cyproteroneacetate-containing combination pills, pure gestagen-component minipills, and depot-gestagen pills also have to be considered); and postcoital measures (day-after pill, Yuzpe method, day-after IUD) that are least used because of moral and religious reasons.