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Am Fam Physician. 2000 Jun 1;61(11):3469-3472.

Use of Oral Contraception Among Adolescents

The Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists (ACOG) has developed an educational bulletin on the benefits and safety of oral contraceptive (OC) use in adolescents. The bulletin (ACOG Educational Bulletin No. 256) replaces ACOG Committee Opinion No. 90, February 1991. The bulletin appears in the December 1999 issue of Obstetrics and Gynecology.

The bulletin states that OCs are the most popular method of contraception among female adolescents. Low-income adolescents who cohabit have the highest rate of OC failure. Adolescents are more likely to miss taking pills than adults are and may not take OCs consistently depending on their patterns of sexual activity. According to the committee, the rate of OC failure among adolescents is as high as 32 percent, compared with 5 percent among all typical users.

Adolescents must be given special attention during every office visit for contraceptive services. Physicians should educate patients on human sexuality and the prevention of sexually transmitted disease. Physicians should also emphasize confidentiality so that adolescents feel free to discuss contraception concerns.

The committee states that adolescents should be made aware of the beneficial effects of OCs on a number of conditions that can affect their lives.

Such conditions include dysmenorrhea, benign breast disease, functional ovarian cysts, iron deficiency anemia, acne and menstrual irregularity. OCs can also reduce the risk of ovarian and endometrial cancers, pelvic inflammatory disease, ectopic pregnancy and toxic shock syndrome. Although endometrial and ovarian cancers are rare in adolescents, if OCs are taken for more than one year, the protective effects last for at least 19 years after the discontinuation of use.

Adolescents may not take OCs once they are prescribed because of fear of complications or side effects. Most of these fears are unfounded, says the committee, and should be addressed with proper counseling. Fear of weight gain, menstrual irregularities, and other side effects such as nausea, breast tenderness and headaches are common reasons adolescents stop taking OCs. Patients should be informed that weight gain is infrequent with low-dose OCs. Breakthrough bleeding is not harmful and tends to resolve in a few cycles. Other side effects are rare and often resolve spontaneously. If irregular bleeding is a problem, adolescents should be screened for pregnancy and sexually transmitted disease, and be counseled about consistent OC use.

AAFP Annual Scientific Assembly

The Annual Scientific Assembly of the American Academy of Family Physicians (AAFP) will be held in Dallas, September 20–24.

This year, the program features hundreds of sessions in 52 major subject areas. There are 33 program elements, 22 of which are free to registrants. These elements include clinical seminars, audiovisual and computer options, lectures, dialogue sessions and clinical procedures workshops. Persons can accrue up to 47.5 hours of prescribed continuing medical education credit during the meeting. Also of interest are the scientific exhibits, physician placement exhibits and a wide array of technical exhibits.

AAFP members are invited to participate in the activities of the Congress of Delegates, which convenes September 18–20. Complimentary evening events include the fellowship convocation, the presidents' reception and the all-member event that will feature country music singer Reba McEntire. Numerous family activities, guest courses and activities for children will also be available.

AAFP members may register online (http://www.aafp.org/assembly) or by mail or fax. Early registration is encouraged to ensure adequate accommodations and access to high-demand courses that require preregistration. Participants will save $80 if they register by the June 28 early-bird deadline. After August 16, registration for assembly activities will be available on-site only. Information about the meeting can be obtained by calling the AAFP assembly hotline at 800-926-6890, or by e-mailing your request to assemblyinfo@aafp.org.

FDA Approval of Oxcarbazepine

The U.S. Food and Drug Administration (FDA) has approved oxcarbazepine (Trileptal) for the treatment of partial seizures as monotherapy in adults and as adjunctive treatment in children between four and 16 years of age.

Oxcarbazepine is available in tablets of 150 mg, 300 mg and 600 mg. In adults, adjunctive treatment should be initiated with a dosage of 600 mg two times per day. When converting to monotherapy, adults should be given 600 mg per day while simultaneously reducing the dose of the concomitant antiepileptic medications. Children should receive 8 to 10 mg per kg per day, not to exceed 600 mg two times per day.

Adverse events associated with the use of oxcarbazepine include cognitive symptoms such as psychomotor slowing, difficulty with concentration and speech or language problems; somnolence or fatigue; and coordination abnormalities, including ataxia and gait disturbances. Patients who are hypersensitive to carbamazepine should be told that approximately 25 to 30 percent of these patients may experience hypersensitivity to oxcarbazepine. The medication may also render hormonal contraceptives less effective.

Photographs of Objective Findings Associated with RSD Syndrome

The Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) recently published 16 color photographs on its Internet site that show the objective findings associated with reflex sympathetic dystrophy (RSD) syndrome.

RSD, which is also known as complex regional pain syndrome, is an underrecognized and undertreated painful neurologic syndrome that may affect up to 1.5 million Americans. RSD is often caused by soft tissue injury; the subsequent pain and sensitivity to touch are far out of proportion to the original injury. According to the RSDSA, “RSD can become a debilitating, chronic, intractable pain nightmare” if it is not recognized and treated in the early stages.

The photographs were chosen to aid patients and physicians in the recognition of the disorder, diagnosis of related symptoms and timely treatment of RSD. Practice guidelines from the RSDSA are also available. These guidelines show physicians and patients who have RSD how to diagnose and treat the disorder.

The photographs can be viewed on the RSDSA Web site at http://www.rsds.org. For more information on RSD, call the RSDSA at 856-795-8845.

HTAC Report on the Use of Dental Implants

The Health Technology Advisory Committee (HTAC) has published a report on dental implants. HTAC was established in 1992 by the Minnesota state legislature. It is an independent, nonpartisan advisory body that evaluates new and emerging health care technologies based on existing scientific research and technology assessments.

According to the report, a dental implant is a surgically implanted device that replaces the lost roots of a tooth to which an artificial tooth, partial denture or denture can be attached. Dental implants may be the best option for persons who have a weakened jawbone, who cannot manage removable dentures or cannot properly chew food. The report discusses who should have implants and reasons for not having implants.

Complications usually include swelling, pain, bleeding, possible infection, partial numbness at implant sites and nausea. Nerve disturbances, which can be permanent, and bone fracture may also occur.

Cost for dental implants depends on the number of implants, type and design of the implant, and the materials used. Nationally, the retail cost varies from about $1,000 for one implant to a high of $80,000 for full mouth reconstruction.

All persons are not ideal candidates for implants, according to HTAC. They work best in persons with atrophy, those who have lost part of their jawbone or those who have trouble chewing. Also, persons who are concerned about how they look or sound may choose implants.

This report (document 000202) and others published by HTAC may be obtained by calling 651-282-6374 or by e-mail (htac@health.state.mn.us/). There is no charge for the reports. All reports are also available on the HTAC Web site at http://www.health.state.mn.us/htac/index./htm.

Anxiety Disorders in Children and Adolescents

According to a new monograph from the Anxiety Disorders Association of America (ADAA) and the National Institute of Mental Health, childhood anxiety disorders remain vastly underdiagnosed, undertreated and understudied despite their widespread prevalence. “Conference on Treating Anxiety Disorders in Youth: Current Problems and Future Solutions” is the first report to confirm the lack of research on anxiety disorders in children and adolescents.

Childhood anxiety disorders include separation anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder and generalized anxiety disorder. According to the ADAA, about 13 percent of children between nine and 17 years of age suffer from an anxiety disorder each year. Many young persons suffer from more than one anxiety disorder; depression and substance abuse often accompany these disorders. However, only 15 clinical trials have been conducted to date on childhood anxiety disorders.

The monograph highlights the following areas for future research:

  • Improve diagnostic categories to better capture the clinical picture of anxiety disorders in children.

  • Expand the number and type of study designs for research on behavioral and pharmacologic treatments.

  • Refine measures of effectiveness of treatment to include behavioral observation, laboratory and performance-based measures.

  • Conduct research on risk factors (such as family history, child's temperament, parenting behavior, and academic or social failure experiences) and on the existence and role of protective factors.

For more information on the ADAA, call 301-231-9259 or write 11900 Parklawn Dr., Ste. 100, Rockville, MD 20852-2624. Information is also available on the association's Web site (http://www.adaa.org).

FDA Approval of Remicade for Rheumatoid Arthritis

The U.S. Food and Drug Administration (FDA) has approved the use of infliximab (Remicade) with methotrexate for the treatment of patients with rheumatoid arthritis who have not responded to methotrexate therapy alone.

According to the Arthritis Foundation, infliximab is unlike other tumor necrosis factor antagonists that are self-injected; this medication is administered intravenously. It requires only six to eight treatments per year and meets the current criteria for Medicare reimbursement.

Infliximab should be used in combination with methotrexate to reduce the signs and symptoms of rheumatoid arthritis. The medication should be administered intravenously in dosages of 3 mg per kg at zero, two and six weeks, then every eight weeks thereafter. Patients should receive approximately eight doses during the first year of treatment. In the following years, patients should receive six doses.

According to the results of a clinical trial, the most common adverse effects with the use of infliximab include upper respiratory tract infections, headache, nausea, sinusitis, rash and cough. The incidence of serious adverse events or serous infections did not increase with the use of infliximab plus methotrexate when compared with the use of methotrexate alone. The incidence of infusion reactions with the use of infliximab was also low.

For more information on infliximab, visit the product Web site at http://www.remicade.com. For information on the management of arthritis, visit the Arthritis Foundation Web site at http://www.arthritis.org or call 800-283-7800.



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