The re-emergence of thalidomide: results of a scientific conference.

BACKGROUND: The use of thalidomide during the 1950s resulted in teratogenic effects in thousands of infants. Although thalidomide is currently approved for the treatment of a complication of leprosy, it is commercially available to treat other diseases through a controlled distribution system. This article presents a summary of a scientific conference organized to assess clinical research on thalidomide, its new clinical applications, and the social and ethical implications for its use. METHODS: Summaries of 10 presentations and two panel discussions were developed from the authors's, oral presentations, conference slides, responses to questions, and supporting literature. RESULTS: Thalidomide shows promise in treating several diseases, including HIV/AIDS, rheumatoid arthritis, Crohn's disease, and multiple myeloma. The STEPStrade mark (System for Thalidomide Education and Prescribing Safety) Program has been developed by Celgene, the commercial manufacturer of thalidomide, to ensure compliance with prescription and usage protocols. A surveillance system is also in place to monitor and report compliance patterns. CONCLUSIONS: Despite the tragic past associated with thalidomide, the drug shows promise as a treatment for many clinical disorders. The challenge is to answer lingering questions of risks and benefits through clinical trials and discovery, to monitor participation and compliance with protocols developed to avoid use of the drug during pregnancy, and to continue to search for safer and more effective treatment options.

The relationship of perceived age and sales of tobacco and alcohol to underage customers.

The ability of store clerks to estimate the age of their customers is critical in preventing illegal sales of tobacco and alcohol to underage individuals. To avoid illegal sales of tobacco products to minors, the Food and Drug Administration created a policy in 1997 requiring store clerks to request identification of anyone perceived to be underage 27. A similar age standard has not been implemented for alcohol. The purpose of this article is to assess whether age 27 is adequate for minimizing tobacco sales to those under age 18 and whether this age is also a useful standard for minimizing illegal alcohol sales to those under age 21. The analysis is based on age estimates from 49 gas station and convenience store clerks. Each clerk estimated ages of 45 people filmed on video whose actual ages ranged from 15 to 29. T-tests, analysis of variance, contingency tables and logistic regression were used to analyze the data. Store clerks found it more difficult to estimate ages of female customers than male customers. In addition, the store clerks significantly underestimated age of male customers under 18 and of female customers under 21. In contrast, the clerks significantly overestimated age of customers 21 years and older. Among underage customers, the store clerks' age, gender, work experience, education, and training in requesting identification had no influence on ability to judge age, nor did it have a strong influence on whether an underage customer was considered 18 or older or 21 or older. The results suggest that age 27 is adequate for minimizing illegal tobacco sales. Adoption of a similar or slightly older age may be appropriate for minimizing illegal alcohol sales.

A report of two smokeless tobacco surveys and associated intervention strategies among Utah adolescents.

Smokeless tobacco is an increasingly popular substance, especially among male adolescents. We determined the prevalence of smokeless tobacco use and evaluated selected factors associated with it among 8,902 students in grades 7 through 12 in the Davis County, Utah, School District. The students responded anonymously in their classrooms to a 16-item self-reporting questionnaire. Results indicated that smokeless tobacco usage was predominately a male phenomenon in all grades and schools, as illustrated by prevalence rates "within the past week" for junior high school students (male: 15.0%; female: 1.1%). Modal responses regarding users' source of supply revealed "friends" as the leading source for junior high students (43.1%) and direct purchase for senior high students (62.2%). Peer usage or nonusage of smokeless tobacco was found to be directly and proportionately correlated with smokeless tobacco users' participation in the school activity designated "sports" for both junior high (39%) and senior high school students (36.2%). Subsequently, clinical evaluation of high school male athletes was undertaken. To our surprise, the rate of lesion detection among members of this group, previously judged to be the subjects most likely to use smokeless tobacco, fell far short of the anticipated rate. We believe the reason for the low rate may be the result of numerous efforts to educate students and coaches, the reinforcement of existing tobacco use policies by the Davis County School District, and the reiteration to smokeless tobacco vendors of the terms of the Utah laws relative to smokeless tobacco sales. This health-endangering behavior deserves a concerted educational thrust by health professional, parents, and teachers, with emphasis on prevention.

Adolescent suicide: character traits of high-risk teenagers.

Adolescent suicide rates are increasing and are currently higher than ever recorded. Thus, it has become essential for health professionals, counselors, and parents to become familiar with characteristics of the high-risk teenager. This article examines personality traits and life circumstances which place an adolescent at higher risk for suicide. Among the variables examined are: depression, acute suicidal behavior, poor family relationships, alcohol and drug use, recent loss, failure in school, and other characteristics. As adolescents pass through difficult life stages successfully, teenage suicides will decrease. Professional helpers and parents must be able to recognize the signs which are discussed and take an active role in prevention and/or intervention.