Adolescent Medicine Clinics RSS feed: Current Issue. http://www.adolescent.theclinics.com/?rss=yesElsevier Inc.en © 2006 Published by Elsevier Inc. All rights reserved. Adolescent Medicine Clinics1547-3368173October 2006 © 2006 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.adolescent.theclinics.com/article/PIIS1547336806000647/abstract?rss=yesTable of Contents10.1016/S1547-3368(06)00064-7Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4ixxivhttp://www.adolescent.theclinics.com/article/PIIS1547336806000659/abstract?rss=yesForthcoming10.1016/S1547-3368(06)00065-9Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4xvxvhttp://www.adolescent.theclinics.com/article/PIIS154733680600043X/abstract?rss=yesThis issue of Adolescent Medicine Clinics departs from the usual format of multiple review articles in a single topic area, and instead presents “hot topics” in adolescent health care. Those familiar with the Society for Adolescent Medicine's annual meeting program will recognize topics addressed in a similar, popular format. The topics were chosen to reflect areas where there is new knowledge or new developments (vaccines, metabolic syndrome, bone health, hormonal contraception, vaginal microbicides, Asperger syndrome), new behaviors that affect health (body art, alternative and complementary therapies, substance abuse) and new treatment approaches to “old” problems (bariatric surgery, acne management, expedited partner therapy for sexually transmitted infections, tobacco use, psychopharmacology for mood disorders).PrefaceRebecca Flynn O'Brien, John Kulig10.1016/j.admecli.2006.06.017Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4xviixviiihttp://www.adolescent.theclinics.com/article/PIIS1547336806000325/abstract?rss=yesHumans have engaged in body art, including piercing, tattooing, and scarification, for thousands of years. Although in modern times, these practices traditionally have been associated with criminal, psychiatric, or risk-taking behavior, piercing and tattooing have become part of the mainstream culture . With the increasing prevalence and popularity among adolescents and young adults over the past 30 years, clinicians need to be aware of how best to advise their patients about safe body art facilities and understand how to anticipate and treat potential complications .Body Art: Piercing, Tattooing, and ScarificationPaula K. Braverman10.1016/j.admecli.2006.06.007Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4505519http://www.adolescent.theclinics.com/article/PIIS1547336806000337/abstract?rss=yesInterest in complementary and alternative medicine (CAM) has increased significantly . The Cochrane Collaboration describes CAM as “a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems in a particular society or culture in a given historical period” . As of 1997, 64% of United States medical schools included elective or required CAM courses . Between 1994 and 2010, the number of CAM practitioners in the United States is projected to increase by 88%, and the number of conventional physicians who incorporate CAM into their practices will increase by 16% .Alternative and Complementary TherapiesCora Collette Breuner10.1016/j.admecli.2006.06.008Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4521546http://www.adolescent.theclinics.com/article/PIIS1547336806000374/abstract?rss=yesVaccinations have been a part of the childhood experience for generations. Adolescents receive booster vaccines for tetanus and diphtheria or, when not given at a younger age, measles, mumps, and rubella. In the early 1990s, the hepatitis B immunization series was recommended for adolescents as catch-up to the universal vaccination recommended for all newborns and infants . This immunization series presented practitioners with the challenge of helping adolescents comply with a preventive health care strategy that included three separate visits. Adolescents often have difficulty with schedule adherence . Rates of immunization completion for 2004 for the second MMR and the full hepatitis B series by the 13th birthday were 57% for Medicaid and 63% for commercial insurance carriers; regional variation occurred with 47% completion in the south-central region of the United States and 79% completion in New England . Many of these vaccinations may have been given during the patients' younger years. Adolescent immunization, although a challenge, is becoming an important component of preventive health care in this age group. Many new vaccines are targeted for young adolescents. This article discusses the newest vaccination recommendations for adolescents pertaining to the meningococcal and tetanus, diphtheria, and acellular pertussis (Tdap) vaccines and reviews detailed information about the human papillomavirus (HPV) vaccines developed for use in the United States. With the advent of these new vaccines, the potential exists to improve adolescent health significantly through prevention, adding new incentive to increase adolescent immunization rates for all indicated vaccines.Immunization Update: Pertussis, Meningoccocus, and Human PapillomavirusAmy B. Middleman10.1016/j.admecli.2006.06.012Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4547563http://www.adolescent.theclinics.com/article/PIIS1547336806000386/abstract?rss=yesAtherosclerotic cardiovascular disease (ASCVD) is the number one cause of death in adults in westernized societies . It is accepted that obesity plays a central role in the pathophysiology and natural history of ASCVD, as well as of type 2 diabetes mellitus (DM), another known risk factor in the development of ASCVD. Furthermore, it has long been recognized that specific metabolic symptoms often cluster in individuals and collectively convey increased cardiovascular risk . The metabolic syndrome (MS), initially referred to as syndrome X or insulin resistance syndrome, was first described by Reaven in 1988 as a connection between resistance to insulin-stimulated glucose uptake and hypertension, dyslipidemia, type 2 DM, and ASCVD. Studies within the last decade demonstrate that the process of atherosclerosis begins in early childhood and is strongly associated with various risk factors, including body mass index (BMI), blood pressure (BP), and serum lipids . Obesity is a common cause of insulin resistance in children and adolescents and is correlated with various cardiovascular risk factors . Additionally, the incidence of type 2 DM has been increasing at an alarming rate in children and adolescents . Because it is clear that the MS exists in adults, and many of the variables appear to be present in childhood, it appears reasonable to accept the existence of the MS in children and adolescents. This statement carries important implications for recognizing the children who are at risk, performing appropriate screening, and treating, if not preventing, the medical complications of the MS.Supersize Teens: The Metabolic SyndromeRollyn M. Ornstein, Marc S. Jacobson10.1016/j.admecli.2006.06.018Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4565587http://www.adolescent.theclinics.com/article/PIIS154733680600026X/abstract?rss=yesThe prevalence and severity of obesity have increased rapidly and dramatically in the last 3 decades in the United States in adults and children. Not only has the prevalence of obesity among American adults (defined as a body mass index [BMI] ≥30 kg/m2) doubled from 14.5% to 30.9%, but also the prevalence of extreme obesity (defined as BMI ≥40 kg/m2) has quadrupled to affect 6.4% of women and 3.3% of men . Children and adolescents have not been immune from this obesity epidemic. During the same time period, the prevalence of overweight (defined as BMI >95% for age and gender) doubled for children age 6-11 years and tripled for adolescents age 12-19 . It has been estimated that more than 1 million adolescents between the ages of 13 and 21 years have a BMI greater than 35 kg/m2 .Bariatric Surgery in Adolescents: An UpdateStavra A. Xanthakos, Stephen R. Daniels, Thomas H. Inge10.1016/j.admecli.2006.06.001Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4589612http://www.adolescent.theclinics.com/article/PIIS1547336806000404/abstract?rss=yesAcne vulgaris is a nearly universal phenomenon among adolescents in the western world. In the United States, acne affects approximately 42 million people, or 15% of the general population. Among adolescents, its prevalence is estimated at 80% to 85% typically , although one study of Australian children revealed that as many as 98% of boys show signs of acne between 16 and 18 years of age . This skin disorder represents one of the most common complaints for patients visiting pediatricians and dermatologists, with over 5 million prescriptions for oral antibiotics and 1.4 million prescriptions for isotretinoin written annually, specifically for acne . Although acne is frequently considered an adolescent disorder, a large percentage of young adults continue to show signs of the disease. Among adults older than 25 years of age, as many as 40% of men and 54% of women continue to suffer from outbreaks of acne .Current Concepts in Acne ManagementAlbert C. Yan10.1016/j.admecli.2006.06.014Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4613637http://www.adolescent.theclinics.com/article/PIIS1547336806000271/abstract?rss=yesBone health has become an increasingly “hot topic” in adolescent medicine since it has been established that the peak bone mass achieved during childhood and adolescence is an important predictor of future osteoporosis risk . Under normal conditions in the setting of good health, bone density and bone size increase during periods of rapid skeletal growth and pubertal development. Expected gains in bone mineral content are affected by a variety of factors, including nutritional status, physical activity, medication exposures, chronic disease, and genetic factors. To optimize bone strength and to prevent future problems, it is necessary that these factors be recognized, and that appropriate monitoring of bone health occurs. In addition to reviewing methods of bone densitometry that are currently available to clinicians, this article presents specific clinical scenarios that can have an impact on skeletal health that are commonly faced by adolescent medicine practitioners.Bone Health in AdolescentsAmy D. DiVasta, Catherine M. Gordon10.1016/j.admecli.2006.06.002Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4639652http://www.adolescent.theclinics.com/article/PIIS1547336806000416/abstract?rss=yesHormonal methods of contraception have been used around the world since the 1960s, when the first birth control pill, Enovid-10 (G.D. Searle & Co., Skokie, Illinois), was created by John Rock and Gregory Pincus, with the support of $3 million raised by Margaret Sanger from her friend Katherine McCormick . This pill contained 9.85 mg of the progestin norethynodrel and 150 μg of mestranol, approximately 10 times the amount of progestin and four times the amount of estrogen in today's pill, which resulted in some serious side effects. Since that time, much research has been done to develop more suitable forms of contraception.Advances in Hormonal ContraceptionNupur Gupta10.1016/j.admecli.2006.06.015Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4653671http://www.adolescent.theclinics.com/article/PIIS1547336806000295/abstract?rss=yesPrevention of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) is an urgent public health priority. An estimated 40.3 million people are now living with HIV infection, the highest level yet, with nearly 5 million newly infected in 2005 . In every part of the world, there has been a dramatic increase in the number of women infected, and most of these infections are acquired through heterosexual intercourse . Among 15- to 24-year-olds in several southern African countries, more than three quarters of those living with HIV infection are women, and in sub-Saharan Africa as a whole, young women are three times as likely to be HIV positive as young men . There are biologic and sociopolitical explanations for the spread of HIV among women. Women are more susceptible to seroconversion with vaginal intercourse than are men , and factors such as sexual trauma and presence of other STIs, especially genital ulcer diseases, increase risk of transmission. Poverty, sexual violence against women, and inequality make negotiation of condom use difficult for many women .Vaginal MicrobicidesRebecca Flynn O'Brien10.1016/j.admecli.2006.06.004Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4673685http://www.adolescent.theclinics.com/article/PIIS1547336806000301/abstract?rss=yesEssential to the control of bacterial sexually transmitted infections (STIs) is the prompt treatment of infected individuals and their sex partners. Treatment of sex partners can be facilitated through notification of sex partners of their exposure to STI, with corresponding efforts to convince the notified partners to seek evaluation and treatment . In the United States, Parran operationalized this principle beginning in the 1930s with public health professionals (disease intervention specialists) conducting notification of partners of syphilis-infected individuals . Disease intervention specialists are enjoined to interview infected individuals, but to keep their names confidential from the partners they notify. This practice, broadly known as provider referral, was implemented on a widespread, systematic basis for syphilis during the 1940s, with increasing availability of penicillin and process data reported from that time .Expedited Partner Therapy for Adolescents Diagnosed with Gonorrhea or Chlamydia: A Review and CommentaryMatthew Hogben, Gale R. Burstein10.1016/j.admecli.2006.06.005Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4687695http://www.adolescent.theclinics.com/article/PIIS1547336806000398/abstract?rss=yesThe following are some clinical scenarios: Case #1: A 16-year-old girl presents to the adolescent medicine provider requesting “the patch to quit smoking.” She has been smoking for about a year and smokes “probably about a half pack” or 10 cigarettes per day (cpd), usually with friends before and after school. When she is at a party, she may smoke more. She does not smoke every day. She never smokes at home and says her parents “totally don't know” that she smokes. She has tried to quit “cold turkey,” but it did not work.Tobacco Use Cessation for AdolescentsWilliam P. Adelman10.1016/j.admecli.2006.06.013Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4697717http://www.adolescent.theclinics.com/article/PIIS1547336806000362/abstract?rss=yesSports have become increasingly competitive over the past 2 to 3 decades. Although sports participation previously was primarily for recreation, sports have become intense in the young athlete population. It is now common news to hear of adolescents or young adults being drafted into professional sports before they finish college or high school. In addition, the competitiveness and increased rigor of sports now starts at a much younger age, as evidenced by an increase in the incidence of overuse injuries in elementary and middle school athletes. Success in sports, or winning, is considered by many to be the most important goal.Performance-Enhancing Drug Use in Young AthletesCarla Laos, Jordan D. Metzl10.1016/j.admecli.2006.06.011Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4719731http://www.adolescent.theclinics.com/article/PIIS1547336806000313/abstract?rss=yesOne of the often overlooked types of substance abuse by adolescents and young adults in the United States and around the world is the abuse of medications and other products sold without a prescription, or over-the-counter (OTC), to the public. The definition of OTC substance abuse is the intentional use of a commercially available substance to experience its psychoactive effects instead of use of that product for its specific intended purpose. Much of the public and many health professionals are unaware that OTC products are abused, or they minimize the extent and impact of this type of abuse.Abuse of Proprietary (Over-the-Counter) DrugsJanet F. Williams, Patricia K. Kokotailo10.1016/j.admecli.2006.06.006Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4733750http://www.adolescent.theclinics.com/article/PIIS1547336806000349/abstract?rss=yesMisuse of prescription drugs has been a growing problem in the United States affecting all age groups, including adolescents . Recent years have produced many advances in medical management of chronic pain, depression and anxiety, and attention-deficit/hyperactivity disorder (ADHD). Many of the medications used to treat these disorders, such as the opioids, benzodiazepines, and psychostimulants, also have potential for abuse and dependence. The challenge for the clinician today is to maximize safe and effective treatment with available medication, while preventing the diversion of prescribed medication or the development of substance-related disorders in patients receiving these medications.Prescription Drug Misuse: A Growing National ProblemJonathan A. Hertz, John R. Knight10.1016/j.admecli.2006.06.009Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4751769http://www.adolescent.theclinics.com/article/PIIS1547336806000350/abstract?rss=yesAsperger's syndrome (AS) is a developmental disorder classified as one of the pervasive developmental disorders (PDDs). AS falls within a subgroup of the PDDs commonly referred to as autism spectrum disorders (ASDs) that includes AS, autistic disorder, and PDD–not otherwise specified. As conveyed by the term spectrum, ASD refers to a group of syndromes falling along a continuum of severity hallmarked by deficits in social interaction. In addition to this social disability, ASDs are characterized by significant difficulties with social communication and play and restricted, rigid, or repetitive behaviors and interests. Although diagnostic conceptualization continues to evolve, AS currently is differentiated from other ASDs by the relative preservation of linguistic and cognitive abilities despite characteristic social disability and circumscribed interests .Asperger's SyndromeJames McPartland, Ami Klin10.1016/j.admecli.2006.06.010Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4771788http://www.adolescent.theclinics.com/article/PIIS1547336806000283/abstract?rss=yesImagine John Doe comes to your office. He is a star lacrosse player, an honor student bound for an Ivy League College. You look forward to meeting with him and his family. His personality is magnetic. He tells you that he has a girlfriend and has a lot of friends who look up to him. As the clinician, you are not worried. He has it all. When you get a call that he had taken his dad's hunting rifle and shot himself in the head, you are in shock. You do not understand why. You wonder how you could have not seen it .Anyone can feel sad or moody at times. Mood disorders are more intense and difficult to detect and manage than normal feelings of sadness. Unless a clinician maintains an awareness of the existence of mood disorders in youth and screens for them, their presence can go undetected. As a result of the shortage of child and adolescent psychiatrists and increasing demand for child and adolescent mental health care, pediatricians and other primary care providers increasingly are now prescribing medications for depression and related disorders. Pediatric training and practice are not designed to promote the thorough mental health assessments that are the standards of training and care for child and adolescent psychiatrists.Adolescent Psychopharmacology: Drugs for Mood DisordersAnela Bolfek, Joseph J. Jankowski, Bruce Waslick, Paul Summergrad10.1016/j.admecli.2006.06.003Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4789808http://www.adolescent.theclinics.com/article/PIIS1547336806000428/abstract?rss=yesIn the June 2005 issue of the Adolescent Medicine Clinics, an error appeared in the article “Smoking in Movies: Impact on Adolescent Smoking” by Dr. James D. Sargent. Portions of the text (p. 350–356, 359–365) were from material prepared for the forthcoming National Cancer Institute Tobacco Monograph: The Role of the Media in Promoting and Discouraging Tobacco Use, for which Helen Dixon and James Sargent are contributing authors. The text for the section on “Smoking in Movies: Impact on Adolescent Smoking” (p. 350–352) was written by Helen Dixon for the above publication, based on her earlier literature review entitled “Portrayal of Tobacco Use in Popular Films: An Investigation of Audience Impact” (Doctoral Thesis, University of Melbourne, Melbourne, Austrailia, 2003). These sources were not acknowledged in the authorship listing for the article.Smoking in Movies: Impact on Adolescent SmokingJames D. Sargent10.1016/j.admecli.2006.06.016Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4Erratum809809http://www.adolescent.theclinics.com/article/PIIS1547336806000660/abstract?rss=yesIndex10.1016/S1547-3368(06)00066-0Adolescent Medicine Clinics 17, 3 (2006)2006-10-01Adolescent Medicine Clinics2006-10-01173S1547-3368(06)X0010-4811816