Glucosylceramide synthase inhibition with lucerastat lowers globotriaosylceramide and lysosome staining in cultured fibroblasts from Fabry patients with different mutation types.

Fabry disease is an X-linked lysosomal storage disorder caused by mutations in the GLA gene coding for α-galactosidase A (α-GalA). The deleterious mutations lead to accumulation of α-GalA substrates, including globotriaosylceramide (Gb3) and globotriaosylsphingosine. Progressive glycolipid storage results in cellular dysfunction, leading to organ damage and clinical disease, i.e. neuropathic pain, impaired renal function and cardiomyopathy. Many Fabry patients are treated by bi-weekly intravenous infusions of replacement enzyme. While the only available oral therapy is an α-GalA chaperone, which is indicated for a limited number of patients with specific 'amenable' mutations. Lucerastat is an orally bioavailable inhibitor of glucosylceramide synthase (GCS) that is in late stage clinical development for Fabry disease. Here we investigated the ability of lucerastat to lower Gb3, globotriaosylsphingosine and lysosomal staining in cultured fibroblasts from 15 different Fabry patients. Patients' cells included 13 different pathogenic variants, with 13 cell lines harboring GLA mutations associated with the classic disease phenotype. Lucerastat dose dependently reduced Gb3 in all cell lines. For 13 cell lines the Gb3 data could be fit to an IC50 curve, giving a median IC50 [interquartile range (IQR)] = 11 µM (8.2-18); the median percent reduction (IQR) in Gb3 was 77% (70-83). Lucerastat treatment also dose dependently reduced LysoTracker Red staining of acidic compartments. Lucerastat's effects in the cell lines were compared to those with current treatments-agalsidase alfa and migalastat. Consequently, the GCS inhibitor lucerastat provides a viable mechanism to reduce Gb3 accumulation and lysosome volume, suitable for all Fabry patients regardless of genotype.

Stratification of Fabry mutations in clinical practice: a closer look at α-galactosidase A-3D structure.

BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage and multi-system disorder due to mutations in the α-galactosidase A (α-GalA) gene. We investigated the impact of individual amino acid exchanges in the α-GalA 3D-structure on the clinical phenotype of FD patients. PATIENTS AND METHODS: We enrolled 80 adult FD patients with α-GalA missense mutations and stratified them into three groups based on the amino acid exchange location in the α-GalA 3D-structure: patients with active site mutations, buried mutations and other mutations. Patient subgroups were deep phenotyped for clinical and laboratory parameters and FD-specific treatment. RESULTS: Patients with active site or buried mutations showed a severe phenotype with multi-organ involvement and early disease manifestation. Patients with other mutations had a milder phenotype with less organ impairment and later disease onset. α-GalA activity was lower in patients with active site or buried mutations than in those with other mutations (P < 0.01 in men; P < 0.05 in women) whilst lyso-Gb3 levels were higher (P < 0.01 in men; <0.05 in women). CONCLUSIONS: The type of amino acid exchange location in the α-GalA 3D-structure determines disease severity and temporal course of symptom onset. Patient stratification using this parameter may become a useful tool in the management of FD patients.

[Identification and economic evaluation of anesthesiologic secondary diagnoses on the basis of intraoperative medication]. / Identifikation und ökonomische Bewertung von anästhesiologischen Nebendiagnosen auf Basis von intraoperativen Medikamentengaben.

BACKGROUND: Complications and comorbidities are encodable in the German diagnosis related groups (G-DRG) system and can improve revenues. In this study, secondary diagnoses were identified through drug administrations during anaesthesia and were economically evaluated by regrouping these cases. METHODS: All intraoperative drug administrations from 2008 were extracted from a database. After exclusion of synonyms and procedure-specific drug administrations, all remaining drugs were matched to explicit secondary diagnoses. All cases were regrouped with their newly defined secondary diagnoses by G­DRG grouper software, and changes in cost weight were evaluated. RESULTS: A total of 29 drugs could be assigned to 18 secondary diagnoses. From 22,440 anaesthesia the § 21 data record could be extracted in 1,929 cases and was regrouped with 2,976 secondary diagnoses, according to additional proceeds of 125,330.25 € in 2008 and 103,542.35 € in 2014. Intraoperative secondary diagnoses influence cost weight only in small parts. The average increase in revenue in this study could have been about 50 € per case. From 2008 to 2014 secondary diagnoses were continuously devaluated, although some of them, e. g. afibrinogenemia, have were revaluated. DISCUSSION: Our retrospective method of making a diagnosis and assuming a correct indication of drug administration is inapplicable to daily routine. The anaesthesiologic documentation has to make drug administration and thereby the secondary diagnosis plausible.

Reducing nocturnal awakening and crying episodes in infants and young children: a comparison between scheduled awakenings and systematic ignoring.

Infants and toddlers (N = 33) exhibiting spontaneous awakening and crying episodes during the night were randomly assigned to one of three groups: scheduled awakenings, systematic ignoring or control. Scheduled awakenings consisted of a parent arousing and feeding or consoling the child 15 to 60 minutes before typical spontaneous awakenings. Once spontaneous awakenings were precluded, scheduled awakenings by parents were gradually eliminated. Systematic ignoring consisted of allowing the child to "cry it out" without parental attention except to ensure physical well-being of their child. Children in the scheduled awakening group and the systematic ignoring group awoke and cried less frequently than children in the control group during 8 weeks of treatment and during two follow-up checks, 3 and 6 weeks after treatment. Systematic ignoring was found to be more effective than the scheduled awakenings condition during 1 week of treatment; otherwise effects of the two conditions were similar. Implications of the use of these treatment procedures are discussed.

Reducing bedtime tantrums: comparison between positive routines and graduated extinction.

A total of 36 toddlers and preschool children exhibiting bedtime tantrum activity were randomly assigned to one of three groups: positive routines, graduated extinction, or control. Positive routines involved changing the child's bedtime to coincide with when he naturally fell asleep, as well as parent and child engaging in a series of four to seven enjoyable activities before the child being placed in bed. During the treatment period, bedtimes were systematically scheduled earlier such that the child went to bed at the time parents had originally used. Graduated extinction consisted of the parent putting the child to bed and ignoring the tantrum activity for increasingly longer amounts of time throughout the treatment. Children in these two treatment groups had tantrums less frequently and for shorter periods than control subjects during 6 weeks of treatment and during two follow-up observations 3 and 6 weeks after treatment. Although both treatments were more effective than waiting for the child to outgrow this problem, parents of the positive routine group reported significantly improved marital satisfaction, suggesting additional benefits of this treatment strategy.

Left-handedness as a risk factor for unintentional injury in children.

OBJECTIVE: To determine whether left-handedness is a risk factor for unintentional injury among children and adolescents. DESIGN: Case-control study. SETTING: Pediatric emergency department of Arkansas Children's Hospital. PATIENTS: 265 patients sustaining unintentional trauma aged 6 to 18 years and 494 control patients who did not have trauma were given a questionnaire to determine handedness, past unintentional injury, and parental perception of injury proneness. RESULTS: The frequency of left-handedness in the trauma group (18.1%) was significantly greater than frequency of 10.5% in the control group (P < .003, odds ratio = 1.80, 95% confidence interval 1.20 to 2.72). Multivariate analysis revealed handedness as the only significant variable between trauma and control (P < .04). The proportion of left-handers who had been hospitalized previously for injury treatment (20.0%) was larger than the proportion of right-handers, (12.0%) (P < .026, odds ratio = 1.84, 95% confidence interval 1.03 to 3.27). More parents of left-handers rated their child as "more clumsy than average" than parents of right-handers (26.0% vs 15.2%, P < .007). CONCLUSIONS: Left-handedness appears to be a risk factor for unintentional injury in children and adolescents in a pediatric emergency department population.

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.

Patterns of smokeless tobacco use by young adolescents.

The use of smokeless tobacco products by adolescents has reportedly increased. The purpose of this study was to examine the use of smokeless tobacco by young adolescents across geographic locations and to look at patterns of use and variables associated with continued use beyond experimentation. Participants were 2018 students in sixth through ninth grades. Forty-five percent were male and 76% were white. Use of smokeless tobacco products was reported by 12% of the total population, and 25% reported smoking. Smokeless tobacco use was associated with cigarette smoking, alcohol use, and parental substance abuse. Those reporting alcohol use were more than four times more likely to be users of smokeless tobacco than nondrinkers. We found increased age, being male, being white, smoking, drinking, perceived effects of smokeless tobacco use, and friends' smoking behavior to be significantly associated with continued use beyond experimentation. Smokeless tobacco use was reportedly greater in rural areas. Adolescents who reported initiating use between 6 and 8 years of age were using on a more frequent basis than those who had initiated use when older. This study demonstrated the need for targeting elementary schools for educational interventions aimed at reducing smokeless tobacco use.

Adolescent cybersurfing for health information: a new resource that crosses barriers.

OBJECTIVE: To examine adolescents' use of and attitudes toward accessing health information through the Internet. DESIGN: Cross-sectional, school-based survey. PARTICIPANTS: A socioeconomically and ethnically diverse sample of 412 suburban New York 10th graders (mean [SD] age, 15.8 [0.68] years). MAIN OUTCOME MEASURES: Accessing the Internet for health information. RESULTS: Half (49%) of the sampled adolescents had used the Internet to get health information. Topics most often explored through the Internet included sexually transmitted diseases; diet, fitness, and exercise; and sexual behaviors. Adolescents found Internet information to be of high value (using a composite gauging worth, trustworthiness, use, and relevance), with no significant differences related to sex, ethnicity, or mother's education. When considering 11 separate health topics, girls found it more valuable to have information on birth control, diet and nutrition, exercise, physical abuse, sexual abuse, and dating violence. Only for alternative medicine were there differences by ethnicity, and there were no differences based on mother's education for the value of having specific health information available through the Internet. CONCLUSION: For adolescents, the Internet is an accessed and valued information source on a range of sensitive health issues.

Smoking cessation in adolescents: the role of nicotine dependence, stress, and coping methods.

OBJECTIVES: To compare perceived reasons for continued smoking and withdrawal symptoms between current smokers and quitters in an inner-city adolescent population. To examine the relationship of nicotine dependence, stress, and coping methods between smokers and quitters and, using the Transtheoretical Model of Change, among adjacent smoking cessation stages. DESIGN: A cross-sectional study using a self-administered questionnaire. PARTICIPANTS: The study comprised 354 clinic patients between the ages of 12 and 21 years who reported past or present smoking. MAIN OUTCOME MEASURES: Demographic characteristics, smoking status, perceived reasons for continued smoking, attempts to quit, and withdrawal symptoms, as well as standardized scales assessing nicotine dependence, stress, and coping methods. RESULTS: The overall prevalence of smoking in this population was 26%. Smokers were significantly more likely to report smoking more cigarettes per day as well as higher levels of physical addiction (P<.01), greater levels of perceived stress (P<.02), and less use of cognitive coping methods (P<.02) than quitters (P<.005). However, comparison of consecutive stages revealed a significant difference only between precontemplation and contemplation in cognitive coping methods (P<.01). Three of 20 withdrawal symptoms (cravings, difficulty dealing with stress, and anger) were reported more frequently among current smokers who had attempted to quit in the last 6 months than among former smokers (P<.01). CONCLUSION: Interventions for inner-city adolescents who smoke should be designed to target those with the highest levels of nicotine dependence, stress, and decreased use of cognitive coping methods because they are the least likely to quit on their own, rather than developing stage-specific models.

Health risk behaviors among pregnant adolescents with older partners.

OBJECTIVE: To determine if pregnant adolescents with older (> or = 5 years) adult (> or = 20 years) vs same-age (+/- 2 years) male partners are at increased health risk. DESIGN: Medical charts of pregnant adolescents who participated in a structured interview as part of their prenatal care were reviewed. SETTING: Outpatient maternal and child health clinic at a university teaching hospital. PATIENTS: A total of 503 white, African American, and Mexican American adolescents, aged 12 to 17 years, who initiated prenatal care between January 19, 1992, and December 19, 1994, were consecutively sampled. MAIN OUTCOME MEASURE: We hypothesized that female adolescents paired with older-adult vs same-age partners would be more likely to report recent substance use, high-risk sexual behaviors, and partner-directed violence. RESULTS: Of the sample, 26% (n = 129) had an older adult partner, whereas 44% (n = 222) had a same-age partner. The remaining adolescents who did not fit either definition (n = 152) were excluded from further analysis. Logistic regression analyses demonstrated that girls with older-adult partners were more likely to have initiated sexual intercourse before 13 years (odds ratio [OR] = 2.1), have discontinued school (OR = 2.8), have used marijuana in the past 30 days (OR = 2.9), be married or living with their partner (OR = 3.2), and desire their current pregnancy (OR = 2.1). These young women also were more likely to report that their partner was employed (OR = 2.8), had other children (OR = 7.4), and used alcohol during the week (OR = 2.0). No association between tobacco use or partner-directed violence and partner age was observed. CONCLUSION: Pregnant adolescents with older-adult male partners report risk behaviors that may affect their health and that of their unborn child but are not more likely to experience partner-directed violence.

The behavioral risks and life circumstances of adolescent mothers involved with older adult partners.

OBJECTIVE: To investigate behavioral risks and life circumstances of adolescent mothers with older (> or =5 years) adult (> or =20 years old) vs. similar-aged (+/-2 years) male partners at 12 months' postpartum. METHODS: Nine hundred thirty-one adolescent females were interviewed after delivery and were mailed surveys to complete at 12 months' postpartum. Analysis by chi(2) and t test was used to identify differences in behavioral risks (planned repeated pregnancy, substance use, and intimate partner violence) and life circumstances (financial status, school enrollment, and social support) for adolescent mothers with older adult vs similar-aged partners. Additional stratified analyses were conducted to evaluate the extent to which living with an adult authority figure or being with the father of her infant born 12 months previously might alter observed relationships. RESULTS: At 12 months following delivery, 184 adolescent mothers (20%) reported having an older adult partner, whereas 312 (34%) had a similar-aged partner. The remaining adolescent mothers (n = 239) were excluded from further analyses. Adolescent mothers with older adult partners were significantly less likely to be employed or enrolled in school and were more likely to report planned repeated pregnancies. These adolescent mothers also received less social support. No differences were observed in intimate partner violence or the mother's substance use. Adolescent mothers with older adult partners who did not live with an adult authority figure seemed to be at greatest risk. CONCLUSIONS: The negative educational and financial impact of coupling with an older vs. similar-aged partner seems greater for those mothers who no longer reside with an adult authority figure. These adolescent mothers are also at greater risk of planned rapid repeated pregnancy. Given their limited educational attainment and family support, a subsequent pregnancy may place these young women at considerable financial and educational disadvantage.

Ethnic differences in depressive symptomatology among young women.

OBJECTIVE: To examine racial and ethnic differences in moderate to severe depressive symptoms among young women seeking reproductive health care. METHODS: Nine hundred four white, black, or Hispanic women between 14 and 26 years of age completed an anonymous questionnaire that assessed demographic and reproductive characteristics; recent substance use, including binge drinking; sexual behaviors; occurrence of assault; and depressive symptoms. Logistic regression analysis was used to develop adjusted odds ratios (OR) and 95% confidence intervals for correlates of depressive symptomatology for each racial or ethnic group. RESULTS: Twenty-one percent (68 of 321) of whites, 28% (88 of 316) of blacks, and 29% (77 of 267) of Hispanics reported moderate to severe depressive symptoms. White females with moderate to severe depressive symptoms were more likely to report sexual assault (OR = 3.1); being a high school dropout (OR = 2.6); unemployment (OR = 2.4); two or more episodes of binge drinking (OR = 2.1); and having a mother with less than a high school education (OR = 2.4). Black females with depressive symptoms were more likely to report smoking one to nine cigarettes per day (OR = 3.5); sexual assault (OR = 3.2); and unemployment (OR = 2.1). Hispanic females with depressive symptoms were more likely to report adolescent age (OR = 3.5); physical assault (OR = 3.2); and smoking one or more cigarettes per day (OR = 2.4). CONCLUSION: Twenty to 25% of young women, regardless of race or ethnicity, have moderate to severe depressive symptoms, and behavioral markers vary according to ethnicity.

A prospective, controlled study of the effects of hormonal contraception on bone mineral density.

OBJECTIVE: To compare the effect of depot medroxyprogesterone acetate (DMPA) and two types of oral contraceptives (OC) on bone mineral density (BMD) among women 18-33 years of age with those not using hormonal contraception. METHODS: Data from 155 women were analyzed. Depot medroxyprogesterone acetate was administered to 33 women; 63 women who chose oral contraception were randomly assigned to receive either a norethindrone-containing pill (n = 28) or a desogestrel-containing pill (n = 35). Fifty-nine women who did not use hormonal contraception served as controls. Lumbar spine BMD was determined using dual-energy x-ray absorptiometry at baseline and after 12 months of contraceptive use. We analyzed method-related percent change in BMD while controlling for body mass index, calcium intake, exercise, and smoking. We had approximately 90% power to detect a 2.5% difference between any two groups. RESULTS: Users of DMPA experienced a mean BMD loss of 2.74% over 12 months compared with controls who sustained a 0.37% loss (P = .01). Users of OCs generally demonstrated a gain (2.33% for norethindrone-containing pills, 0.33% for desogestrel-containing pills), which was different from controls among users of norethindrone-containing pills (P = .01), but not among users of desogestrel-containing pills (P = .99). Observed changes in BMD among DMPA users differed from women who used either type of pill (P < .002). CONCLUSION: Depot medroxyprogesterone acetate has an adverse effect on BMD, in comparison with OCs or nonhormonal methods, when used for 12 months. Results must be interpreted cautiously until it is determined whether these effects endure or are reversible.

Prevalence and risk factors of chorioamnionitis among adolescents.

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.

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)

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.

Stability of the relationships between anabolic steroid use and multiple substance use among adolescents.

BACKGROUND: In a previous study, we tested the hypothesis that because adolescent anabolic steroid users are concerned with increasing muscle size and strength they are different from other substance users and are unlikely to use other drugs. Alternatively, if the causal factors of anabolic steroid use are similar to those for use of other substances, then adolescent anabolic steroid users would be expected to report poly drug use. Study findings confirmed the second hypothesis. PURPOSE: To test the stability of the relationships between anabolic steroid use and poly drug use over a four month period among ninth grade students. METHODS: All ninth grade students (1422) enrolled in compulsory health science classes in a country school system who had previously completed a modified version of the Centers for Disease Control and Prevention's 1989 Health Risk Survey and the 1990 Youth Risk Behavior Survey in November 1990 were asked to repeat the survey in February 1991. RESULTS: A higher percentage of males (4.7 percent) than females (2.9 percent, P < or = 0.018) reported anabolic steroid use without a doctor's prescription. As was found in the initial study, frequency of anabolic steroid use was significantly (P < 0.001) associated with frequency of use in the last 30 days of cocaine, injectable drugs, alcohol, marijuana, cigarettes, and smokeless tobacco. When those variables were analyzed with multiple regression analysis, the same four variables continued to be the best predictors of the frequency of anabolic steroid use, although the order that the variables entered into the multiple regression model changed. Use of smokeless tobacco, shared needles, cocaine, and marijuana explained more variation in the frequency of anabolic steroid use in the replication study (48.5%) than initially (32.8%). CONCLUSIONS: These findings support the hypothesis that adolescent anabolic steroid users are also likely to use other drugs and are engaging in shared needle use. These relationships remained relatively stable over a four month period of time.

The effects of peer ridicule on depression and self-image among adolescent females with Turner syndrome.

PURPOSE: This study attempted to examine the effects of body image, height dissatisfaction, and peer ridicule on depression and self-image among adolescent females with Turner syndrome. METHODS: A prospective, cross-sectional survey examined 59 subjects' responses to standardized measures of depression, self-image, body image, height perception, and teasing. RESULTS: Descriptive statistics found the mean age of subjects to be 14.8 years (range: 13-19). Approximately 30% reported cardiac defects and 17% indicated kidney anomalies. Only five experienced spontaneous menses and 61% indicated they were receiving estrogen replacement therapy. Linear regression analyses examined the effects of body image, height perceptions, and peer ridicule on depression and self-image scores. The first regression analysis found a five-step model to account for 39% of the variance, with peer ridicule of general appearance being the most important variable. The second linear regression (R2 = .3248, P < .0004) also found peer teasing of general appearance to be significantly associated with self-image scores. Discrepancy scores between ideal versus current body shape or height, as well as teasing about these issues, appeared to be unrelated to depression and self-image among our subjects. CONCLUSION: These data suggest that peer ridicule is a domain that requires ongoing assessment by health care providers, as it appears to be an important contributor to mental health problems. Social skill interventions that emphasize strategies to manage teasing, assertively respond to negative statements, and teach effective coping skills are key variables to minimize the emotional discomfort these young women may experience.

Maternal influence on the decision to adopt Norplant.

PURPOSE: To examine maternal influence and related variables on adolescents' decision to adopt Norplant. METHODS: A prospective study of 121 adolescent females who received Norplant through a hospital-based outpatient adolescent gynecology service. Each patient completed self-report questionnaires about her decision process, sexual behaviors and standardized measures of depression and anxiety at their insertion appointment or first-follow-up appointment. RESULTS: Almost 40% of the sample reported that their mother significantly influenced their decision to use Norplant and 61% of all patients stated that they had informed their mother of their choice of this contraceptive method. Through logistic regression, six variables were found to be significantly associated with mother as the most important decision source. These included: obtaining information about Norplant from a parent, maintaining the same sexual partner, past pill use, and not knowing other adolescents who boast about using the Norplant system. CONCLUSION: These data suggest that when parental consent is not required, adolescent females disclose sensitive information regarding choice-making to their mothers when they decided to adopt Norplant.

PIP: A prospective study of 121 Norplant acceptors 12-21 years old recruited from a hospital-based adolescent gynecology service in Arkansas confirmed the importance of maternal influence on the acceptance process, even when state law does not mandate parental consent. These adolescents completed a questionnaire indicating the relative roles of various significant others in providing information about Norplant and influencing the decision-making process. The adolescent's mother was cited as the most important decision source by 45 (37%) young women; another 33 (27%) identified a health care provider. Although Arkansas does not require parental notification, 74 (63%) had told their mother of their decision to use Norplant. Maternally influenced adolescents were significantly more likely than those who identified health care professionals, girlfriends, and boyfriends as decisive to have obtained specific information about Norplant from their mother, to be former oral contraceptive users, and to have a consistent sexual partner. Overall, 99 (82%) adolescents reported they intended to use Norplant for at least two years. Although 44 (36%) expressed concerns about Norplant's cost, only two indicated this was a factor in their decision. The findings of this study offer reassurance to health care providers who seek to protect patient confidentiality yet encourage parent-teen communication about reproductive health.