A model for answering the substance abuse educational needs of health professionals: the North Carolina Governor's Institute on Alcohol and Substance Abuse.

Physicians can play an increased role in recognizing, intervening, and moderating their patients' misuse of alcohol and other drugs. This article explores the need for educational changes to permit physicians to develop skills in prevention, screening, and office-based treatment. It includes a personal account by one of the authors of his experience in recognizing deficiencies in substance abuse education both in his own medical school training and in today's health science curricula in the United States. It reviews prior initiatives by NIAAA/NIDA to address curriculum needs and describes an innovative collaborative model in North Carolina called the Governor's Institute on Alcohol and Substance Abuse. The Institute was created in 1990 as a nonprofit corporation to promote education, research, and communication among health professionals. Some of the Institute's programs are described, including its curriculum integration project in the state's four medical schools. The article concludes that the time is right to introduce substance abuse concepts into basic and continuing education for all health professionals.

Vaginal Chlamydia trachomatis infection in children with sexual contact.

To determine whether vaginal infections with Chlamydia trachomatis in children were associated with sexual contact, 50 children ages 1 to 12 years with a history of sexual contact and 34 children without such a history were studied. Vaginal, throat and rectal cultures for C. trachomatis and Neisseria gonorrhoeae were performed in all children. Three children with sexual contact and none of the children without a history of sexual contact had vaginal infections. The three infected children were asymptomatic and only one had had vaginal intercourse. None of the 10 children with a history of sexual contact and gonorrheal vaginitis had C. trachomatis isolated. Although C. trachomatis vaginal infections as detected by vaginal cultures are infrequent, we recommend that all girls being evaluated for sexual contact be routinely cultured for C. trachomatis so that those infected can be treated.

Sexual contact in children with gonorrhea.

This study was performed to determine if gonorrheal infections in children aged 1 to 12 years were frequently associated with sexual contacts. In our study all 14 children who had gonorrhea and who were over 4 years of age and 35% (six) of the 17 children who had gonorrhea and who were between 1 and 4 years old were found to have had sexual contact with older males who were almost always in the extended family. Our study supports the concept that gonorrhea in children over 4 years old is almost always associated with sexual contact. In children between 1 and 4 years old, a history of sexual contact is more difficult to obtain but may be elicited in more than a third of the cases. Hospitalization of the children and identification of extended family members with gonorrhea, followed by additional interviews, were useful procedures in determining who had had sexual contact with the children.

Child health care and "the new morbidity": toward a model for the linkage of private medical practice and the public schools.

A renewed, and somewhat overdue, emphasis on programs for children has become a widespread concern of the health and human services fields. This paper addresses the problems and potentials of achieving a greater degree of coordination of the child-oriented human services through an examination of the response and the interaction of the (largely private) medical care and the (largely public) educational systems with respect to the special situation of children with learning-related handicapping conditions. The perspectives and particular interests of each of these complex systems are described along with their special role in the detection, assessment, and intervention with regard to children with learning-related problems. A description is provided of the process through which children are placed in educational programs that give special recognition to their learning difficulties. Particular note is taken of those places where medical care providers can have an effective influence on the educational placement of the child. The paper concludes with four recommendations that should help to insure the interaction of child health and educational services for children with learning-related handicapping conditions.