Clinical Briefs

Am Fam Physician. 2000 Jun 15;61(12):3742-3749.

AAP Report on the Use of Contraception in Adolescence

The Committee on Adolescence of the American Academy of Pediatrics (AAP) has issued a statement on contraception and adolescents. The statement appears in the November 1999 issue of Pediatrics.

According to the AAP committee, the risks and negative consequences of sexual intercourse during adolescence are of national concern. Promoting sexual abstinence among adolescents is a priority of the AAP. In the past, the AAP has addressed adolescent sexuality, pregnancy, sexually transmitted disease and contraception. With the development of new contraceptive technologies, a revision of this policy statement is necessary. This statement provides physicians with an updated review of adolescent sexuality and use of contraception by adolescents and offers current guidelines for counseling adolescents on sexual activity and methods of contraception.

The AAP committee makes the following recommendations:

  • Physicians should encourage and promote sexual abstinence to their adolescent patients at every appropriate opportunity.

  • Physicians should provide non-judgmental education and preventive counseling about sexuality to their adolescent patients.

  • Physicians should counsel their sexually active patients about the consequences of sexual activity, including pregnancy and sexually transmitted disease.

  • Physicians may provide basic contraceptive services for patients in their offices, offering an environment that is conducive to trust and confidentiality. Physicians may also refer patients to another appropriate site for services while maintaining primary care of the adolescent.

  • Physicians who choose to provide basic contraceptive services for their patients should update their skills and information about adolescent sexuality and gynecology. The benefits of oral contraceptives are listed in the accompanying table.

  • Physicians should be aware that it is acceptable to prescribe oral contraceptives up to three months before the first pelvic examination.

  • Physicians who offer contraceptive services to adolescents should provide appropriate follow-up to ensure compliance. Time should be allocated for counseling, education, problem solving and periodic reassessment of the patient's contraceptive needs.

Benefits of Oral Contraceptives

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Urinary Antigen Test for Streptococcal Pneumonia

The U.S. Food and Drug Administration (FDA) has approved a new test for the detection of streptococcal pneumonia. The NOW S. pneumoniae Urinary Antigen Test is the first self-contained urine test that can detect streptococcal pneumonia. This test will allow physicians to accurately diagnose the disease in 15 minutes and prescribe the correct medication before the patient leaves the office.

Streptococcal pneumonia is caused by the S. pneumoniae bacteria. According to the manufacturer of NOW, streptococcal pneumonia is difficult to diagnose without testing; diagnosis by symptoms alone is accurate in only 3 percent of cases. Streptococcal pneumonia results in 25,000 deaths per year in the United States and is the leading cause of death worldwide. In North America, approximately 480,000 to 800,000 persons per year are hospitalized because of streptococcal pneumonia.

“Without having a definite diagnosis, doctors often hedged their bets by prescribing broad spectrum antibiotics to cover all conceivable pathogens despite the fact that S. pneumoniae is the most common cause of bacterial pneumonia,” says Dr. Victor Yu, professor of medicine at the University of Pittsburgh. “Ironically, broad spectrum antibiotics often cover the other causes of pneumonia, but are not as potent against S. pneumoniae.”

“With the availability of this rapid test, doctors can now know immediately, and with confidence, that the cause of the pneumonia is S. pneumoniae. Then, they can select the best antibiotics and prescribe them right away. Immediate treatment with targeted antibiotics means that patients get relief faster and they are less likely to develop complications,” states Dr. Yu. “Targeted antibiotics are also cheaper than the broad spectrum antibiotics.”

Trends in HIV Infection Among Minority Groups

Racial and ethnic minority populations account for an increasing proportion of cases of acquired immunodeficiency syndrome (AIDS) in the United States, including cases of men who have sex with men. A new report shows recent trends in the incidence of AIDS and related deaths among racial and ethnic minority men who have sex with men. The report also compares data on diagnoses of human immunodeficiency virus (HIV) with diagnoses of AIDS from 1996 through 1998 among racial and ethnic minority men who have sex with men in 25 states that have conducted confidential HIV surveillance and AIDS case surveillance since 1994. The findings appear in the January 14, 2000 issue of Morbidity and Mortality Weekly Report.

Researchers analyzed trends in the incidence of AIDS in the United States from 1989 through 1998 among men who were at least 13 years of age who have sex with men. The trends were analyzed by race/ethnicity, age and geographic area of residence.

The report discusses characteristics of men who have sex with men with AIDS; trends in the incidence of AIDS and related mortality among men who have sex with men with AIDS; and HIV and AIDS diagnoses among men who have sex with men in 25 areas with HIV/AIDS surveillance.

The report notes that characteristics of persons diagnosed with HIV infection without AIDS reflect more recent trends in the epidemic than do characteristics of persons with AIDS. Findings suggest that racial/ethnic minority men who have sex with men may become infected at younger ages compared with their white counterparts. Combined with AIDS data, HIV data highlight the extent of the need for prevention and treatment to reduce HIV-related morbidity and mortality in this population.

To reduce infection rates and improve the likelihood of survival, prevention programs for racial/ethnic minority men who have sex with men should focus on HIV-infected and uninfected populations. Community leaders of racial and ethnic minorities should promote dialogue about issues of sexual orientation to overcome social barriers to HIV prevention for racial/ethnic minority men who have sex with men.

AHRQ Releases New Resource to Help Persons More Than 50 Years of Age Stay Healthy

The Agency for Healthcare Research and Quality (AHRQ; formerly the Agency for Health Care Policy and Research), in collaboration with the Health Resources and Service Administration and the American Association of Retired Persons, has released a new resource from the AHRQ's Put Prevention into Practice program. “Staying Healthy at 50+” is intended to help older persons understand preventive care and incorporate it into their lives.

The AHRQ publication contains tips and recommendations on health habits, screening tests and immunizations for persons older than 50 years. It also includes easy-to-use charts for tracking personal health information, questions to ask physicians and resources to contact for additional health information.

“The information in ‘Staying Healthy at 50+’ comes from the research-based recommendations of the newly reconvened AHRQ-supported U.S. Preventive Services Task Force,” said John Eisenberg, M.D., director of the AHRQ. “In addition,

‘Staying Healthy at 50+’ is an important tool that can help us meet the prevention goals of our Nation.” “Staying Healthy at 50+” is available in English (AHRQ Publication No. AHRQ00-0002) or Spanish (AHRQ Publication No. AHRQ00-0010). Up to three free copies may be obtained by writing the AHRQ Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907 or by calling 800-358-9295. The publication is also available on the AHRQ Web site at http://www.ahrq.gov/ppip/50plus/index.html.

NCI Atlas of Cancer Mortality in the United States

The National Cancer Institute (NCI) of the National Institutes of Health (NIH) has recently published a book titled the “Atlas of Cancer Mortality in the United States, 1950-94.” The atlas highlights the geographic distribution of cancer death rates for more than 40 types of cancer in more than 3,000 counties in the United States.

The book also features 254 color-coded maps that pinpoint geographic areas with high or low cancer death rates, allow physicians to compare cancer mortality rates over several decades and provide important clues for further study into the causes and control of cancer. A number of tables and figures that break down the distribution of cancer mortality rates by gender, race and age are also included.

To order a free copy of the book (NIH Publication No. 99-4564), call the Cancer Information Service at 800-4-CANCER (800-422-6237). The book may also be accessed on the NCI Web site (http://www.nci.nih.gov/atlas).

HTAC Report on New Vaccinations

The Health Technology Advisory Committee (HTAC) has published a report on new vaccinations for Lyme disease, rotavirus, hepatitis A and pneumococcal disease. 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.

The report reviews the use of the new vaccines for Lyme disease (LYMErix), hepatitis A (Havrix and Vaqta), rotavirus (RotaShield, which was withdrawn in October 1999 after being linked to intussusception) and pneumococcal disease (Pneumovax 23 and Pnu-Immune 23). The report also serves to inform family physicians of the need for vigilant participation in the Vaccine Adverse Event Reporting System (VAERS) of the Centers for Disease Control and Prevention.

The HTAC report covers patient selection, effectiveness and cost of each vaccine and discusses the role of VAERS in vaccine safety. HTAC makes the following recommendations for vaccine safety:

  • The Lyme disease vaccine should not be administered universally. It is indicated only for persons 15 to 70 years of age living in high-risk geographic areas and engaging in high-risk behaviors (e.g., not checking for ticks after being in wooded areas, not using insect repellent with DEET).

  • The rotavirus vaccine has been suspended until further studies can rule out a link to intussusception.

  • The hepatitis A vaccine should be administered universally in high-incidence geographic locations and to any person in a high-risk category seeking protection.

  • The pneumococcal disease vaccine should be administered in certain high-risk groups to minimize illness and the emergence of resistant bacterial strains.

  • Continued research and development are critical to the identification and minimization of existing risk associated with vaccines.

  • The participation of family physicians in VAERS is needed if it is to be a more effective tool for determining vaccine safety and efficacy.

This report (document 991201) 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.


Copyright © 2000 by the American Academy of Family Physicians.
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