Comparison of two violence prevention curricula for middle school adolescents.

OBJECTIVE: To compare the effectiveness of the Violence Prevention Curriculum for Adolescents to the Conflict Resolution: A Curriculum for Youth Providers among middle school students. METHODS: A sample (N = 225) of adolescents (males = 48%) representing 20% of the student population in two middle schools were administered a pretest questionnaire. Of these students, 89% were African-American, 10% were white, and 1% were Native-American and lived in public housing (40%) or in neighborhoods adjacent to public housing (60%). Each school was randomly assigned to one of the curricula. Each curriculum was administered during 10 50-min sessions held twice a week over 5 weeks. One week later, 209 students who completed the 10 sessions were tested with the same questionnaire. The data were analyzed with a repeated-measures analysis of variance. RESULTS: Students who received either curriculum reported significant decreases in their self-reported use of violence in hypothetical conflict situations, frequency of use of violence in the previous 30 days, and frequency of physical fights in the previous 30 days. The conflict resolution curriculum was more effective in reducing the frequency of fights resulting in an injury requiring medical treatment in the previous 30 days. CONCLUSIONS: Both curricula were successful in reducing three indicators of violence. However, the conflict resolution approach was more successful in reducing the frequency of more severe physical fights requiring medical treatment. The latter finding is of particular importance, because that physical fighting is the form of violence behavior in which young adolescents most often engage.

Office laboratory diagnosis of vaginitis. Clinician-performed tests compared with a rapid nucleic acid hybridization test.

BACKGROUND: The traditional diagnosis of vaginitis incorporates patient symptoms, clinical findings observed during vaginal examination, and laboratory analysis of vaginal fluid. The purpose of this study was to evaluate routine clinician-performed office laboratory diagnostic techniques for women with abnormal vaginal symptoms, and to compare these results with those obtained by a DNA hybridization test for Trichomonas vaginalis, Gardnerella vaginalis, and Candida species. METHODS: The study included 501 symptomatic women who were between the ages of 14 and 67 years. Three vaginal specimens were obtained for saline wet mount, potassium hydroxide (KOH) prep, amine "sniff", pH, and nucleic acid hybridization (T vaginalis, G vaginalis, and Candida sp) tests. Clinicians and medical technicians independently evaluated the wet mount, KOH prep, amine, and pH tests. A medical technician processed the DNA tests according to manufacturer's protocol. RESULTS: Of 499 subjects for whom complete data were available, vulvovaginal candidiasis was diagnosed in 20.0%, vaginal trichomoniasis in 7.4%, and bacterial vaginosis in 52.1%. Fourteen percent of subjects had multiple vaginal infections. The sensitivity and specificity of clinician microscopically diagnosed vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 39.6% and 90.4%, 75.0% and 96.6%, and 76.5% and 70.8%, respectively. The sensitivity and specificity of the DNA probe diagnosis of the same types of vaginitis were 75.0% and 95.7%, 86.5% and 98.5%, and 95.4% and 60.7%, respectively. When only women with multiple vaginal infections were considered, the percentages of correct clinician diagnoses for vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 49.3%, 83.6%, and 59.7%, respectively. For the DNA probe test, the percentages of correct diagnoses were 72.9%, 92.9%, and 90.0%, respectively. CONCLUSIONS: Primary care clinicians demonstrated a high specificity but low sensitivity when identifying vaginal trichomoniasis and vulvovaginal candidiasis by microscopic techniques. Correct microscopic diagnosis of bacterial vaginosis was even more difficult for clinicians, as was the diagnosis of multiple vaginal infections. Clinicians were not as accurate as the DNA probe test in diagnosing vaginal infections. Clinicians need more education in the laboratory diagnosis of vaginitis. Clinicians should carefully scrutinize each microscopic slide, systematically examine the slide for each type of vaginitis, and consider specimen pH and the presence of leukocytes, Lactobacillus organisms, or amine odor as additional clues to infection.

The association between weapon carrying and the use of violence among adolescents living in and around public housing.

PURPOSE: To test the hypothesis that adolescents who carry lethal weapons are more likely to engage in violent behavior than adolescents who do not carry weapons. DESIGN: Cross-sectional Survey. SUBJECTS: Black adolescents (N = 225) from a lower socioeconomic (SES) background living in or around nine Housing and Urban Development housing projects. MEASUREMENTS: An anonymous questionnaire containing scales from the CDC Youth Risk Behavior Survey and Self-Reported Delinquency Questionnaire was administered. Data were analyzed with Spearman rho correlation coefficients (r), followed by partial correlation coefficients controlling for age and gender. RESULTS: Thirty-five percent of males and 16% of females reported carrying a weapon during the previous 30 days. Frequency of weapon-carrying was correlated (r = .33, p < or = 0.0001). with the frequency of physical fights in the last month, but the relationship was stronger among males than females. Weapon-carrying was also associated (r = .20, p < or = 0.003) with frequency of receiving a serious injury during a fight and the frequency of attacking someone with a weapon with the idea of seriously hurting or killing them (r = .48, p < or = 0.0001). Although males were more likely to carry a hidden weapon than females, the frequency of weapon-carrying was more highly correlated with the frequency of carrying a hidden weapon by females (r = .63, p < or = 0.0001) than males (r = .49, p < or = 0.0001). Females who carried weapons were more likely than males to be involved in gang fights. Among males (r = .27, p < or = 0.008), frequency of weapon-carrying was correlated with frequency of attacking someone with whom they lived. This was not so among females (r = .02). CONCLUSION: These data support the hypothesis that the lower SES black adolescents in this sample who carried weapons were more likely to engage in violent behaviors than those who did not carry weapons.

Exposure to violence and victimization and depression, hopelessness, and purpose in life among adolescents living in and around public housing.

This study examines the relationships between exposure to violence and depression, hopelessness, and purpose in life among black adolescents living in or around public housing developments. Black adolescents (N = 225, males = 44%) ages 11 to 19 years in a southern city were administered an anonymous questionnaire. Depression was correlated with the exposure to violence (r = .28), family conflict (r = .29), and corporal punishment (r = .32) scales, perceived probability of being alive at age 25 years (r = -.14), socioeconomic status of head of household (r = .14), anticipated socioeconomic status as an adult (r = .21), and number of sexual partners (r = .22). Based on multiple regression analysis, corporal punishment, family conflict, educational level of head of household, and perceived probability of being alive at age 25 years explained 18% (p < or = .0001) of the variation in depression. Family conflict, corporal punishment, and unemployed head of household explained 11% of the variation in the hopelessness scale. Unemployed head of household, the corporal punishment scale, and number of sexual partners explained 9.7% of the variation in purpose in life. Even when accounting for other social factors, exposure to violence in the home was associated with psychological distress in this sample of adolescents.

Preliminary results suggesting exaggerated ovarian androgen production early in the course of polycystic ovary syndrome.

Excess ovarian androgen production might be a cause of the polycystic ovary syndrome (PCO). Previous studies have evaluated adult women with long-standing abnormality of the hypothalamic-pituitary gonadal axis. Abnormal ovarian function in such patients could be a primary or even a secondary finding. For that reason, this study was designed to evaluate ovarian androgen production in symptomatic adolescent females. Simultaneous adrenal suppression, by using dexamethasone, and ovarian stimulation, by using gonadotropin-releasing hormone (GnRH), were achieved in 12 patients. Following stimulation, blood was serially obtained over 8 hr to measure gonadotropin, estrogen, and androgen responses. Based on the androgen response, patients could be divided into two groups. Group A (five) had a significant increase (p less than 0.01) in free testosterone, whereas group B (seven) had no increase in any androgen, including free testosterone (significantly different from group A, p = 0.01). All patients in group A had enlarged or cystic ovaries, whereas only one-quarter patients in group B had enlarged ovaries (significantly different from group A, p less than 0.03). The pituitary and estrogenic response was similar in both groups. These preliminary data suggest that some patients with PCO (group A) have a primary abnormality in ovarian androgen production early in the course of their disease.

Diagnosing Chlamydia trachomatis urethritis by first-catch urine enzyme immunoassay in adolescent males.

This study evaluates a first-catch urine sediment enzyme immunoassay (EIA) to diagnose Chlamydia trachomatis urethritis in symptomatic adolescent males. Seven of 23 patients evaluated were diagnosed with sexually transmitted urethritis, five caused by C. trachomatis. First-catch urine sediment was accurate in diagnosing C. trachomatis urethritis when compared to urethral swab EIA (p less than 0.003). First-catch urine pyuria was also highly correlated with urethritis (p less than 0.05). First-catch urine testing is a simple, nonpainful method of screening adolescent males for urethritis, and first-catch urine sediment EIA for C. trachomatis is a rapid, painless method of diagnosis. A method for screening and diagnosis with these techniques is described.

Prevention of recurrent acute otitis media: chemoprophylaxis versus tympanostomy tubes.

Otitis media has long been recognized as one of the most common diseases of childhood. Several therapeutic modalities have been advocated for the prevention of recurrent episodes of acute otitis media (AOM). A blinded, prospective, randomized study was designed to determine the efficacy of tympanostomy tubes, antibiotic prophylaxis, and placebo. Children with recurrent AOM were entered in the study and followed for at least 6 months. A total of 65 children completed the protocol. Sixty-three of those were under the age of 4 years. Treatment failure was defined as two or more episodes of AOM or otorrhea in less than 3 months. Five of 22 children in the tympanostomy tube group failed, compared to 12 of 20 in the placebo group (p = .02). There were 8 or 21 treatment failures in the sulfisoxazole group. Children with otitis media with effusion (OME) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes. Tympanostomy tube insertion for prophylaxis of recurrent acute otitis is supported by these findings. Improvement of recurrent AOM was observed in the sulfisoxazole group, but was not statistically significant.