Concordance of human papillomavirus in the cervix and urine among inner city adolescents.

OBJECTIVES: To evaluate concordance for human papillomaviruses (HPVs) between cervix and urine in sexually active adolescents. METHODS: Cervical swabs and urine were collected from 80 adolescents in Baltimore, MD. Specimens were tested for 34 HPVs by PCR and for cancer-associated HPVs by Hybrid Capture (HC II) Probe B. Cervical vs. urine prevalence was evaluated by logistic regression with general estimating equations. Risk factors for prevalence and viral burden were evaluated by Fisher's exact and Kruskal-Wallis tests, respectively. RESULTS: HPV prevalence by PCR, for any HPV, was very high in the cervix (90.0%) and somewhat lower in urine (75.0%) (odds ratio, 1.07; 95% confidence interval 1.07 to 1.34). Only one adolescent was HPV-positive in urine alone. Among HPV-PCR positives at either or both sites, concordance was 82% for presence of any HPV and 40% for specific HPV types. Multiple infections were common at both sites. On an average, HC II viral burden (relative light unit ratio) was 9-fold higher in cervix than in urine (median, 47.3 vs. 4.9; P = 0.005) but correlated poorly between the two sites of the same individual (r = 0.14). Compared with normal adolescents, those with squamous intraepithelial lesions had a much higher prevalence of HPV by HC II in cervix (100% vs. 28.6, P<0.0001) as well as in urine (86.7% vs. 35.4%, P = 0.002) and a significantly higher viral burden in the cervix (median, 141.8 vs. 7.3, P = 0.0045) but not in urine (median, 22.7 vs. 4.38; P = 0.13). CONCLUSION: There was a very high prevalence of HPV in cervix and urine of sexually active adolescents. Testing urine for HPV may be useful in epidemiologic investigations and in monitoring of infected women.

Defining anemia in a preadolescent African American population.

Preadolescents often have poor nutritional habits. Demands for rapid growth require essential nutrients, vitamins, and minerals. The purpose of this study was to determine the prevalence/incidence of anemia in this age group and to identify possible predictors of anemia in African American preadolescents. A retrospective chart review of 455 African American preadolescents enrolled in two school-based clinics was conducted. Thirty percent of the sample had hematocrit values below 37% for males and below 35% for females. These data showed that anemia is an understated problem among African American preadolescents. No identifiable predictors were found; therefore routine screening for anemia is an essential component of the preadolescent annual health examination.

School-based clinics: the Baltimore experience.

Adolescents are at risk for a wide range of problems necessitating creative approaches to the delivery of health care. Baltimore City has responded to this challenge by opening seven school-based clinics (SBCs) that provide comprehensive health and social services to adolescents. This article summarizes the history of SBCs, the range of services, and the role of community involvement. A major focus of this article is the independent role of the nurse practitioner as clinical expert and educator.

Toward a more objective approach to pupil assessment.

The findings of an investigational study comparing a hand held tongue depressor pupil gauge with a printed millimeter scale sheet are the focus of this article. A historical perspective of the development of various millimeter measurement scales and devices is included as well as a brief overview of the anatomy and physiology of the oculomotor (III) cranial nerve. The results of the study provide support for the use of millimeter scales as an effective means of measurement of pupil size. Increased reliability with the use of a hand held tongue depressor pupil gauge is demonstrated. Implications for nursing practice are summarized.