Lichen sclerosus. Therapy with clobetasol propionate.

OBJECTIVE: To assess the efficacy of treating lichen sclerosus with clobetasol propionate. STUDY DESIGN: A retrospective chart review of 81 consecutive symptomatic private practice and clinic patients with biopsy-proven lichen sclerosus were included. All subjects' punch biopsies, baseline histories and physical examinations were reviewed by the same examiner. Each subject's symptomatology and responses to previous treatment modalities were recorded. A standard regimen of 0.05% clobetasol propionate cream was initiated. Subjects were reevaluated at three months and asked to rate the improvement of symptoms. Follow-up examinations were conducted 6-12 months later on 36 subjects. Descriptive statistics and chi 2 analyses were performed. RESULTS: The mean age of subjects was 54 +/- 15.5 years (range, 15-86), and the average duration of treatment prior to clobetasol use was 6 +/- 6.9 years (range, 0.5-29). Twenty-seven subjects did not complete the study or were lost to follow-up. The average subject had tried 2.25 treatment modalities (range, 1-13). The most common symptoms were pruritus (98%) and irritation (61%), with complaints of burning and dyspareunia. Most subjects (76%) had labial involvement, with concomitant involvement of the clitoris (70%), perineum (68%) and perianus (32%). The majority (88%) of subjects had a primary lesion of white and crinkled tissue. With clobetasol, 77% of subjects had complete remission of symptoms, 18% had partial remission and 5% reported no change. A change in clinical appearance was noted for the complete-remission (32%) and partial-remission groups (46%). Twenty-two percent revealed no change. CONCLUSION: Clobetasol propionate cream is recommended for treatment of lichen sclerosus, with a 77% chance of complete remission of symptoms and a 47% chance of improvement in the clinical appearance of the vulva. Women may have to continue to use clobetasol as needed after finishing a base treatment course.

Married mothers' perceptions of their premature or term infants and the quality of their relationships with their husbands.

Twenty-eight mothers of premature infants and 37 mothers of term infants were examined for their perceptions of their infants and of their relationships with their husbands at two to four postpartum days and at six to eight postpartum weeks. The mothers tended to perceive their infants positively, whether or not the infants were born prematurely. Preterm mothers who compared their infants to an average premature infant were more positive than term mothers who compared their infants to an average term infant. An association was not found in either group between mothers' perceptions of their infants and of the quality of their relationships with their husbands. However, mothers with negative perceptions of their infants also tended to have difficult marriages.

Fostering primary and secondary prevention in public policy for pregnant adolescents.

The diverse factors associated with sexuality among adolescents and the specific issues related to contraception in this developmentally diverse group result in complexity in policy formation. The future of an adolescent may be determined solely on the basis of access to supportive physical and emotional services funded by public and private sector monies. The purpose of this paper is to briefly present contemporary and social policies regarding pregnant adolescent health care. Suggestions as to how these policies can be translated into public adolescent health models are provided. The strategies will be related to primary and secondary public policy interventions.

PIP: Public policy models which are strategically focused and longterm and are flexible, diverse, and creative, and discusses. The emphasis is on current social policies on adolescent and adolescent pregnancy health care and suggested improvements in viability or related primary and secondary public policy interventions that are possible. There are primary prevention models, the provision of sterilization for mature minors with children, incentives to providers for primary prevention, pregnancy marketing among high risk groups, improving access to adolescent preventive services, secondary pregnancy prevention policies, and adolescent Aid to Families with Dependent Children (AFDC) recipient outreach. It is concluded that policies must be carefully developed because of the complexity of the issues. Problems are present for adolescents seeking care. Entitlement programs such as Title XIX and Medicaid are not current with client needs nor is processing expedited. Cost reimbursement strategies need to be developed. Shortterm policies are of limited value. Recommended birth control methods need to be tailored to adolescents with multiple partners and those at risk of sexually transmitted diseases. Thus, the IUD is contraindicated. The availability of supportive emotional and physical services directly determines the future in a society that has a prominent sexually active adolescent population. Politically sensitive school-based clinical may not be as effective as public health affiliated and/or academically affiliated institutions which are not controversial and have both private and public support. Policy development should be promoted within health departments and legislatures in interagency agreements rather than within school administration. Without controversy and harassment, utilization is maximized. Client enhancement strategies for self-care health behavior have been successful abroad. Cash incentive strategies must not be perceived as bribes. Family size might be limited if state, local, or regional funds were made available for tubal ligation. Adolescents would be serviced better if funding ceilings allowed for adolescent reproductive health services. Periodic mailings to at-risk groups, such as AFDC adolescents, with location of health services, benefits of family planning, and access/transportation to services is an effective strategy. Multidimensional service approaches are efficient, help follow up, and may help shift financial support. Reducing the number of school dropouts and building self-esteem and self-sufficiency are recommended secondary strategies.

Estrogens + patient package insert = confused patients.

A brief review of the patient package inserts concept and estrogen pharmacology is presented. Then the need for patient education is discussed along with recommendations for a team approach to managing patient anxiety by helping patients understand the estrogen-containing products they are using.

PIP: This article takes issue with the physicians' handling of patient inserts in estrogen-containing medications when presenting such medication to a patient in need. This discussion follows a brief review of the rationale of the Food and Drug Administration of using package inserts and a review of estrogen uses, adverse reactions, cautions, and side effects. The author argues for a more cooperative approach to patient package inserts, which would require direct participation by the physician rather than simple passive reading by the patient. A questionnaire survey on patients' attitudes, knowledge, views, and sources of drug information on oral contraceptives, with particular attention to the role of the patient-oriented package insert, concluded that professional sources (physician, nurse, or pharmacist) were preferred over nonprofessional and media sources. A collaborative approach to drug education is recommended, and suggestions for implementation are set forth.