Tubo-ovarian abscess in virginal adolescents: exposure of the underlying etiology.

Tubo-ovarian abscesses (TOA) are acute complications of pelvic inflammatory disease (PID). PID is an infection of the upper genital tract that is usually caused by an ascending sexually transmitted infection. We present two cases of TOA in patients who deny any history of sexual activity or sexual abuse. In our first case a TOA was the primary manifestation of Crohn's disease. The TOA in our second case was attributed to a combination of obesity, constipation, recurrent urinary tract infections, and poor hygiene. In both cases the laparoscopic evaluation revealed purulent fluid collections in the fallopian tubes that were not evident on imaging. These cases support the use of laparoscopy for diagnosis in atypical cases.

Early detection of cardiac dysfunction: use of the myocardial performance index in patients with anorexia nervosa.

OVERVIEW: Patients with anorexia nervosa have functional cardiac abnormalities secondary to their nutritionally depleted state. These abnormalities include decreased left ventricular (LV) mass and varying degrees of LV systolic dysfunction. Assessment of LV diastolic function and quantitative assessment of right ventricular function are not routinely performed. The myocardial performance index (MPI) is a relatively new, simple, quantitative measure of global myocardial function. The purpose of this study was to evaluate left and right ventricular function in 13 patients with anorexia nervosa with the MPI and compare it to more commonly used echocardiographic measures of ventricular function.

Tuboovarian abscess in the adolescent.

Tuboovarian abscess is a serious consequence of pelvic inflammatory disease, especially in the adolescent population. Early diagnosis and treatment are essential to prevent further sequelae including infertility, ectopic pregnancy, and chronic pelvic pain. Not all patients, however, present with pelvic pain, pelvic mass, fever, and leukocytosis. We present the case of a sexually active 15-year-old black girl who presented with mild abdominal pain and excessive vaginal bleeding without pelvic mass, fever, or leukocytosis. Erythrocyte sedimentation rate was 66 mm/h. Pelvic ultrasound revealed bilateral complex ovarian masses. At laparoscopy, the patient had bilateral tuboovarian abscesses with extensive adhesions to the pelvic side walls. This case illustrates the need for a high index of suspicion of tuboovarian abscess in sexually active adolescents.

A comparison of methods for alcohol and marijuana anticipatory guidance with adolescents.

The purpose of this study was to compare adolescents' knowledge of alcohol after receiving either a computer-assisted instruction program or physician-delivered anticipatory guidance or no intervention. In addition, adolescents' satisfaction was compared between intervention groups. A total of 89 adolescents attending a general medical clinic were randomly assigned to one of three conditions. The participants were from low-to-middle income families, and the mean age was 15.5 years. A two-way analysis of variance found significant main effects for both group and sex. Those adolescents in both intervention groups were significantly more knowledgeable, and males demonstrated the highest knowledge scores. There was a significant interaction between group and sex, with females more satisfied with the computer-assisted instruction as compared to males who preferred anticipatory guidance. These data suggest that the use of computer technology during a well-adolescent health visit is effective and efficient in transmitting drug-related information.

Human growth hormone: a new substance of abuse among adolescents?

It has been estimated that as many as 250,000 adolescents are using anabolic steroids (AS). Recently, anecdotal reports suggest that athletes may also be using human growth hormone (HGH). The purpose of the present study was to determine the following: 1) if adolescents in two suburban midwestern high schools (83% white, 14% Asian, and 3% black) were using HGH; 2) knowledge of its effects; 3) reasons for use; and 4) concurrent AS use. After we obtained informed written consent, 224 male and 208 female 10th-grade students were surveyed using a 15-item questionnaire. Of male students surveyed, 5% (n = 11) reported past or present use of HGH, and one female student reported use. Our data suggest that among male adolescents surveyed, a majority had heard of this substance, and 31% of males reported knowing someone who was using HGH. Chi-square analysis found a significant association between AS and HGH use where seven AS users reported past or present use of HGH. Most HGH users were unaware of its side effects and reported first use between 14 and 15 years of age. No differences in sports activity, ethnicity, or age were found between users and nonusers of HGH.

Is AIDS education related to condom acquisition?

The acquisition and subsequent use of condoms are two important behaviors that sexually active adolescents must adopt to reduce the transmission of human immunodeficiency virus (HIV). The aims of this study were: first, to evaluate whether combining prescriptions for free condoms with anticipatory guidance would increase the number of adolescents actually using the prescription-redemption plan; and second, to see if education about acquired immunodeficiency syndrome (AIDS) might make adolescents more willing to obtain an HIV blood test. Adolescents were randomly assigned to one of three groups, but only those who were sexually active were included in the data analyses. Each participant was given a prescription to be redeemed for free condoms at the hospital pharmacy, and each was privately offered a confidential, free HIV blood test. Education about AIDS did not increase the likelihood that adolescents would take the blood test, since only seven subjects did so. Our logistic regression model showed the most significant variables influencing a teenager to obtain condoms were gender, socioeconomic status, lifetime number of partners, and experimental condition. Anticipatory guidance concerning HIV promoted the use of the prescription-redemption plan especially among more sexually active males who come from middle-class families.

PIP: The influence of "anticipatory guidance" and prescriptions for free condoms on condom acquisition and acceptance of HIV testing was investigated in 3 groups of teens, a control group of 26 given condom vouchers only, a group of 20 instructed and counseled by adults, and a group of 31 similarly instructed and counseled by peers. The subjects, aged 13-21 years and from all socioeconomic groups, were recruited by advertising, word of mouth, and from an adolescent medicine clinic, and paid a small incentive for transportation. Besides the condom prescription and opportunity to have an HIV test, the teens received a lecture about HIV testing, viewed a video about HIV transmission and prevention, and received 15 minutes of counseling. Controls received the condom prescription only. 75% and 77% of the peer- and adult-instructed groups redeemed condom vouchers. 4 control and 3 intervention teens took the HIV test. Based on a demographic form and self-report of sexual behavior, logistic regression indicated that the factors linked with condom acquisition were: male gender, higher socioeconomic group, over 5 lifetime sexual partners, and intervention group. It is important to realize that adolescents often perceive the acquisition of condoms as a difficult step to take in risk-reduction behavior.

Effects of a peer-counseled AIDS education program on knowledge, attitudes, and satisfaction of adolescents.

Education programs for adolescents regarding acquired immunodeficiency syndrome (AIDS) have been advocated by many professionals to help minimize the risk of infection in this population. This study compares a peer-led vs. an adult-led AIDS education program on the knowledge, attitudes, and satisfaction of the adolescents with their education. Eighty-two male and female adolescents, ranging in age from 12 to 18 years, were randomly assigned to a peer (n = 27), adult (n = 28), and control (n = 27) group. Intervention consisted of receiving didactic information and viewing a videotape about AIDS transmission and prevention. All subjects completed the AIDS Knowledge Questionnaire-Revised, AIDS Attitude Survey, and a measure of consumer satisfaction. Statistical analyses revealed a significant effect for knowledge and attitudes toward practicing personal preventive behaviors and the seriousness of AIDS; both peer- and adult-led groups were superior to controls (p less than 0.05). With the exception of satisfaction with providers, no other significant effects were found across the intervention groups. Satisfaction with providers showed an effect for sex (p less than 0.05). Female adolescents reported more satisfaction with presenters than male adolescents did. Although both adult and peer counselors were equally effective in promoting knowledge gains and appropriate attitude changes, more questions were asked of the peer counselors. These data suggest that when education is presented by peer counselors, adolescents may be more likely to see AIDS as a personal danger and that peer counselors should be considered when designing comprehensive AIDS education programs.

The role of MRI in evaluation of an adolescent with a pelvic mass.

Abnormalities of the genital tract are common in adolescent females. Evaluation of pelvic pathology generally involves the use of ultrasonography. Recently, MRI has been shown to be effective in the diagnosis of pelvic pathology in adult females. Here, we present the case of an 11-year-old female with a pelvic mass in whom MRI proved to be an important diagnostic tool.

Adolescent wellness. Facilitating compliance in social morbidities.

The establishment of a well adolescent schedule needs to be developed similar to the scheduled clinical visits in pediatric care. However, providing adolescent wellness visits without appropriate financial reimbursement for time expended and without increased provider training may make "well" adolescent visits an unrealistic expectation. However, two major trends will significantly impact on the future of adolescent health care. These include a sharp increase in numbers of adolescents beginning in 1990 and the poverty within the adolescent population. These data suggest that obstacles, whether personal, financial, or educational, need to be addressed quickly in order to resolve these problems because of increasing numbers of adolescents and related morbidities through the year 2000. The increasing trend of juvenile poverty in this population has been significantly associated with a number of the new morbidities such as substance abuse, STD, pregnancy, and the latest morbidity, AIDS. Without a wellness schedule, it is likely that adolescents will continue to represent an underserved population; as a consequence, mortalities and morbidities will increase through the year 2000. The issue of adherence to prescribed medical regimens in the adolescent population is an interesting, complex, and especially challenging one when faced with the social morbidities. Although preliminary work in this area has progressed in the last 15 years, greater attention must be paid to the needs of adolescents in order to determine effective strategies that can minimize the effects of the current morbidities. It is important for the primary care physician not to become overwhelmed with the scope of problems that adolescents have or become discouraged because anticipatory guidance seems ineffective. Repeated dosages of anticipatory guidance should not be viewed as limitations or failures but rather as necessary and standard care. One should consider such interventions as similar to immunizations, in which certain vaccines result in life-long immunity. One would not eliminate the tetanus vaccine because the patient must receive periodic boosters. Similarly, as health care professionals, we should not consider interventions designed to preclude behavior or mental health problems as failures if periodic and developmentally appropriate relevant "boosters" are necessary. Anticipatory guidance is an extremely effective tool that every primary care physician has at his or her disposal to assist in the diagnosis of problematic behavior in adolescents and to preclude problems. Future research needs to focus on documenting strategies that can be utilized by physicians on a daily basis without excessive time or financial constraints.(ABSTRACT TRUNCATED AT 400 WORDS)

A comparison of three clinic-based AIDS education programs on female adolescents' knowledge, attitudes, and behavior.

Health providers are becoming increasingly aware that adolescents are a population at risk for acquired immune deficiency syndrome (AIDS) and have identified education as essential for prevention. This study evaluates three clinic-based programs designed to determine the effects of education on knowledge and attitudes regarding AIDS and condom acquisition. Seventy-five sexually active females attending adolescent health clinics were randomly assigned to one of three groups: 1) controls (C) receiving no education; 2) education (E) alone consisting of a brief lecture on AIDS: and 3) enhanced education (EE) where the lecture was provided as well as a videotape describing the importance of condom use. All participants completed the AIDS Knowledge Questionnaire-Revised, the AIDS Attitude Survey, a self-report measure of condom use and received a coupon that could be exchanged for free condoms from the hospital pharmacy. A significant effect was found for knowledge, where both E and EE were superior to controls (p less than .001). No statistical differences were noted across groups regarding attitudes or condom acquisition. However, all adolescents in the EE group who reported prior condom use obtained condoms from the pharmacy as compared to the other groups (p less than .05). Our results suggest that educating adolescents in medical settings can improve their knowledge about AIDS. Didactic lectures in combination with videotape presentations on condom use appeared to be the best format for reinforcing an adolescent's existing behavior.

Adolescents and AIDS. Female's attitudes and behaviors toward condom purchase and use.

Condom use has been advocated as a method to prevent human immunodeficiency virus (HIV) transmission. Although condoms are not uniformly popular with adolescent males, adolescent females' beliefs about condom use are unclear. To assess the specific health attitudes and behaviors as they relate to condom purchase by adolescents, we surveyed 99 adolescent females between 12 and 19 years of age (50 black, 49 white) who were attending a comprehensive adolescent health clinic. The respondents were from low to middle socioeconomic backgrounds and 85% were sexually active. A 41-item survey was developed and focused on four areas: comfort or embarrassment with menses (EM), basic knowledge of acquired immunodeficiency syndrome (AIDS) (KA); comfort in discussing contraception with partner (CC) and risk of contracting AIDS (AR). Chi-square analyses of the four factors determined that decreased EM was related to increased age (p less than 0.05), sexual activity (p less than 0.05), and CC (p less than 0.05). Older adolescents also demonstrated greater CC (p less than 0.05). Increased KA was related to contraceptive use (p less than 0.02) as well as CC (p less than 0.02). Descriptive analyses showed that 62% of the sample reported that a fear of AIDS had influenced their contraceptive behavior, but only 17% of the females reported purchasing or using a condom to prevent AIDS transmission. These findings suggest that although adolescent females have an awareness about AIDS, their behavior remains unchanged.

Female adolescents' compliance with contraceptive regimens.

Although today's adolescents have access to a variety of contraceptive options, they remain inconsistent and suboptimal users of these methods. A particularly frustrating problem for those caring for adolescents is the issue of noncompliance with contraceptives, which is an important antecedent of adolescent pregnancy. In the future, new fertility-related developments such as subdermal hormonal implants may reduce the likelihood of noncompliance. For the present, however, systematic monitoring rather than only when noncompliance is suspected is essential in enhancing adolescents' contraceptive compliance.

PIP: Factors affecting compliance of adolescent users of contraception are extensively reviewed, and compiled into a model relating attitudes and behaviors to compliance. The 1st group of factors affect frequency of intercourse: length of the sexual relationship, sexual values, religiosity, postmenarcheal age. A teen's sexual standards and behavior must be congruent before sexual frequency increases to a level where she perceives herself at risk of pregnancy. Before acknowledging sexual behavior, teens deny it and avoid planning contraception. Young adolescents typically operate under a state of cognitive egocentricism or "personal fable" such that they perceive themselves invulnerable to many risks, such as pregnancy. A girl's perceived risk of pregnancy depends on knowledge of risks, previous pregnancies or "scares," previous non-contraception without pregnancy, previous contraceptive practice. Other variables affecting perception of pregnancy include the possible positive or negative evaluation of pregnancy. Becoming pregnant is not always considered negative by young people, it may be done to gain attention, acceptance by peers, commitment by the partner. The model was tested on 2 sets of data, which verified several variables as important in teen contraceptive noncompliance: number of years of sexual experience, religious attendance, coital frequency, noncompliance with initial method, not acquiring a method of 1st clinic visit, and frequency of family planning clinic visits. Ways of improving compliance, reported in the literature, were summarized.

Anabolic steroid use by male adolescents.

Anabolic steroids have recently been used by professional and college athletes to improve athletic ability by increasing muscle size and strength. A study was done to determine the extent of steroid use and knowledge about these drugs in a population of high school male adolescents in a southern state. A self-report questionnaire, which allowed multiple answers for each question, was administered to 853 male students in six high schools. Results indicated that an average of 11% had used or were using anabolic steroids. The following were assessed: the reasons for steroid use, the sources from which the students received information about steroids, their familiarity with the physiologic effects and complications of steroid use, and the extent of their involvement in sports. The results suggest that a segment of male adolescents are using anabolic steroids without fully understanding the risks of such behavior. Health care providers need to become knowledgeable about steroids so that they may better educate adolescents about the potential deleterious effects of these agents.

Adolescent suicide attempters presenting to a pediatric facility.

This study profiles the characteristics of adolescent suicide attempters and the treatment they received in a pediatric emergency room (ER). A retrospective chart review of 4,072 adolescents seen in the ER at a children's hospital (CH) from July 1984 to June 1985 was undertaken. Twenty-seven adolescents who had deliberately injured themselves were identified. The average age was 14 years 7 months (range 11-19 years). Fifty-two percent of the patients were white and 78% were female. Ingestion was the most common method (78%), followed by attempted hanging (11%), and wrist laceration (7%). After evaluation by a pediatrician in the ER, 30% of the patients were treated and released, 11% were transferred directly to a psychiatric hospital, and 59% were admitted to the CH, with an average hospital stay of 1.88 days. Once hospitalized, consultations from psychiatry (81%), social service (50%), psychology (19%), and neurology (6%) were obtained. At the time of discharge from either the ER or CH, the patients had a variety of plans for ongoing care, with 52% being referred to outpatient counseling, 37% being transferred to a psychiatric hospital, and 11% having no documented plan for ongoing care. These results demonstrate that the evaluation of suicidal adolescents cared for in a pediatric facility may be episodic and suggest the need for a comprehensive program to approach the problem.

Toxic pneumonitis in an adolescent following exposure to Snow Storm tablets.

Adolescence is often a time when experimentation with alcohol, cigarette smoking, and substance abuse occur. We report a rare complication of smoking, toxic pneumonitis, in an adolescent female who combined an over-the-counter novelty item, Snow Storm tablets, with cigarettes.

Pediatric residents' assessment of adolescents' experiences during pelvic examination.

We compared male and female pediatric residents' perceptions of adolescent females' attitude and experience during a pelvic examination. Females (n = 112) ages 12-19 years were randomly assigned to a male of female examiner and to a supine or semisitting pelvic-examination position. Pre- and postexamination questionnaires were completed by the patients. Female physicians were more accurate in assessing patient discomfort (p less than 0.006),pain (p less than 0.0004), and embarrassment (p less than 0.0006) during the pelvic examination. The correlation between the physicians' and the patients' assessments of the completeness of the examination was stronger for the male physicians (p less than 0.003). These relationships remained constant for both positions. The female physicians' appeared to base their perceptions of the patient-physician relationship partly on the emotional responses of the patient such as embarrassment, fear, and relaxation (p less than 0.02). In contrast, male physicians' perceptions were associated with patient expressions of pain and discomfort (p less than 0.02).

Side effects and compliance with low- and conventional-dose oral contraceptives among adolescents.

Oral contraceptives are the most popular birth control method for teenagers, yet many teens discontinue use of these contraceptives prematurely. The need to minimize any potential long-term medical complications from the use of contraceptive hormones must be balanced with the desirability of increasing acceptance of contraceptives by adolescents. There has been concern that the use of so-called "low-dose" estrogen preparations, although decreasing the likelihood of complications, may lead to side effects that make compliance less certain. The present study comparing two commonly used oral contraceptive preparations, one low dose, one conventional dose, tests the hypothesis that among adolescents an association exists between oral contraceptive side effects and compliance. Using a double-blind crossover method, 55 sexually active adolescent females received two months each of a preparation containing 35 micrograms ethinyl estradiol and 0.5 mg norethindrone and another containing 50 micrograms mestranol and 1.0 mg norethindrone. The 50-microgram preparation was associated with fewer side effects when administered during the first two months. No differences in side effects were noted in the latter two months, but there was a slight increase in weight gain when compared with the 35-microgram preparation. The most common side effect was inter-menstrual bleeding with the 35-microgram pill. There was no documented relationship between the occurrence of side effects and compliance.