Lorena M. Siqueira

Tobacco use as a predictor of illicit drug use and drug-related problems in Colombian youth

PURPOSE To examine the extent to which personality and peer factors mediate the relationship between early cigarette use and later illicit drug use, as well as associated drug use problems, in a population of Colombian adolescents. METHODS A longitudinal study (2-year interval), using face-to-face structured interviews was begun in 1996 using a community-based sample, randomly selected from census data in three cities in Colombia, South America. The participants were 2837 adolescents with a mean age of 15.0 (SD +/- 1.6) years at time 1 (T1). Males comprised 52% of the sample and 65% resided with two parents. Approximately 78% (N = 2226) completed the second structured interview 2 years later (T2). The main outcome measures were marijuana use, other illicit drug use, and associated drug use problems at T2. Three series of logistic regressions were conducted. RESULTS The odds of marijuana use (adjusted odds ratio [AOR] = 1.64-2.01; confidence interval [CI]: 1.11-2.94), other illicit drug use (AOR = 1.77-2.49; CI: 1.03-4.19), and associated drug use problems (AOR = 2.25-3.47; CI: 1.45-5.26) at T2, was increased two- to three-fold among adolescents reporting cigarette use at T1, with control on the demographic, personality, and peer factors, as well as T1 drug use variables. CONCLUSIONS Earlier adolescent cigarette smoking was directly associated with later marijuana use, other illicit drug use, and problems with drug use.

Risk and Protective Factors for Binge Drinking Among Hispanic Subgroups in Florida

Abstract This study examines differences in risk and protective factors for binge drinking among six ethnic/national subgroups of Hispanic adolescents in Florida. We note differences in the frequency of binge drinking by gender and ethnic subgroup as well as differences in the salience of items drawn from the five domains of risk and protective factors among these subgroups. Rather than treating all Hispanics as a unitary culture, tailoring of prevention programs to address risk and protective factors that differentially affect national/ethnic subgroups may be a valuable strategy when adolescents live in communities that are relatively homogenous in terms of nationality/ethnicity.

Developing an SMS Intervention for the Prevention of Underage Drinking: Results From Focus Groups

ABSTRACT Background: There is growing evidence that text messaging—”short message service” (SMS)—is useful for health promotion and behavior change. SMS has become a preferred channel of communication among adolescents. Despite burgeoning interest, there remains a critical need for formative research regarding developmentally and culturally appropriate SMS-based health promotion with teenagers. Objectives. The primary objective was to develop SMS message protocols and procedures effective for reducing underage drinking among Hispanic teens. Using focus groups, we sought our target populations perspectives on SMS parameters including scheduling, frequency, content, themes, and confirmation-of-receipt. Method: We conducted, recorded, and transcribed six mixed-gender focus groups (20 adolescents, 4–5 per group) recruited from the Division of Adolescent Medicine at Miami Childrens Hospital. Alcohol-related and “attention control” text messages were assembled from two sources (http://www.mobilehealth4youth.org and the existing literature); these SMSs, along with SMS procedures, were the focus of discussion. The recordings and transcription were reviewed by two researchers who employed a qualitative iterative process analytical approach. Results: Findings revealed distinct preferences among teenagers about the scheduling, frequency, content, themes, and confirmation-of-receipt of SMSs. Moreover, teens were most enthusiastic about SMSs that addressed alcohol-related knowledge, self-efficacy, social support, or future orientation. Conclusion/Importance: Seeking our target populations perspectives on SMS parameters was essential for developing SMS message protocols and procedures with potential effectiveness for reducing underage drinking among Hispanic teens. It is strongly recommended that researchers or clinicians considering SMS-based interventions conduct a similar formative process prior to implementation.

A Vulvovaginal Mass in a 16-Year-Old Adolescent: A Case Report

BACKGROUND Vulvar varicosities might be misdiagnosed as vulvar venous malformations in the prepubertal or pubertal age. If seen isolated, they can mimic other masses that are usually seen in this anatomic area like a hernia or a cyst. Depending on the associated symptoms and clinical findings, imaging modalities investigate the nature of such a mass and might provide a therapeutic alternative besides surgery. CASE We report a case of an isolated asymptomatic vulvar varicosity in a 16-year-old adolescent. A pelvic ultrasound followed by a Doppler and a magnetic resonance imaging scan confirmed the diagnosis. We used guided direct sclerotherapy for successful treatment. SUMMARY AND CONCLUSION Optimal management and outcome are assured using a multidisciplinary approach. Guided sclerotherapy provides a safe, effective, and minimally invasive procedure to treat vulvar varicosities.

Hydrosalpinx in Postmenarchal Nonsexually Active Girls: A Review of 6 Cases in a Children's Hospital.

BACKGROUND The objective of the study was to identify the presence of hydrosalpinx in postmenarchal nonsexually active girls in a childrens hospital and to review the available literature on hydrosalpinx in this population. CASES In a tertiary care childrens hospital, we performed a retrospective review of charts from January 1, 2000 to December 31, 2014 and identified six cases of hydrosalpinx in postmenarchal nonsexually active female adolescents ranging in age from 12 to 19 years old. The diagnosis of hydrosalpinx was made using imaging studies. Four of six patients were symptomatic at presentation, and two patients were diagnosed when seen for unrelated reasons. Five of these six girls had previous abdominopelvic surgery. Four girls were given empiric antibiotic treatment for presumed pelvic inflammatory disease related to hydrosalpinx. Two patients required surgical intervention that resulted in complete resolution of the hydrosalpinx. The oldest patient in the series underwent ultrasound-guided drainage of the pyo- and/or hydrosalpinx with subsequent recurrence with tubal ovarian abscess five months later. SUMMARY AND CONCLUSIONS The presence of hydrosalpinx might be discovered in the workup of pelvic pain in nonsexually active adolescents or on routine follow-up in patients with previous abdominal surgery, some of whom are asymptomatic. The underlying pathophysiology for hydrosalpinx in this population remains unclear. Among our cases, postsurgical adhesions appeared to be the most likely predisposing factor for tubular obstruction. Early detection and prompt diagnosis will allow for appropriate conservative or definitive treatment.

Factors associated with alcohol use among minority female adolescents receiving preventive text messaging for underage drinking

Background There is a high prevalence of alcohol use among adolescents, especially among Hispanic teens in middle adolescence. This emphasizes the need for developmentally appropriate and culturally sensitive underage drinking brief interventions. Texting (i.e. SMS) is extremely popular among U.S. teenagers, and its advantages as a brief intervention includes wide reach, low cost, easy standardization, automation of health message delivery, and the ability to include multiple recipients concurrently.

Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV- associated lipodystrophy: a case report and review of the literature

Abstract We report a case of a 17-year-old girl with a history of congenital human immunodeficiency virus (HIV) infection and lipodystrophy secondary to highly active antiretroviral therapy (HAART). She developed severe worsening of preexisting hypertriglyceridemia after treatment with oral contraceptive pills (OCP) for polycystic ovary syndrome. Her hypertriglyceridemia improved upon OCP discontinuation. Although it is known that estrogen combined with progestins have a negative effect on triglycerides and high-density lipoprotein (HDL) cholesterol levels, to our knowledge the association of HAART-related lipodystrophy and severe hypertriglyceridemia after OCP use has not been reported in the literature. We recommend avoiding the use of OCPs in patients with lipodystrophy due to the increased risk of worsening hypertriglyceridemia.

Chlamydia infections in children and adolescents.

1. Lorena M. Siqueira, MD, MSPH* 1. *Division of Adolescent Medicine, Miami Children’s Hospital, Miami, FL. * Abbreviations: CDC: : Centers for Disease Control and Prevention FDA: : Food and Drug Administration HIV: : human immunodeficiency virus LGV: : lymphogranuloma venereum MIF: : microimmunofluorescent MSM: : men who have sex with men NAAT: : nucleic acid amplification tests PID: : pelvic inflammatory disease STI: : sexually transmitted infection 1. The need for annual screening for chlamydia in sexually active adolescents and young adults is underrecognized because this infection is asymptomatic in most females (75%) and males (50%). 2. Difficulty in diagnosis arises from the range of possible symptoms at presentation of symptomatic infections and the type of testing that can be used in each situation. After completing this article the reader should be able to: 1. Recognize the spectrum of clinical manifestations of chlamydia infection in neonates, children, and adolescents. 2. Discuss the appropriate use of culture and nonculture diagnostic tests for chlamydia infections in various age groups. 3. List the current recommendations for screening and treatment of chlamydia infections. A 17-year-old girl presents with prolonged menstrual bleeding associated with severe menstrual cramping pain. Her menarche was at age 13 years. Subsequent menstrual cycles were monthly, lasting 5 days, with average flow associated with mild to moderate pain relieved by over-the-counter pain medications. The current cycle began a month ago and is associated with severe lower abdominal pain. She admits to sexual activity with one partner and uses condoms intermittently. On examination she is afebrile and in discomfort, with a heart rate of 120 beats per minute. She does not appear anemic and has good capillary refill. She has diffuse abdominal pain with significant tenderness in both the right lower and upper quadrants. Chlamydiae are small obligate, gram-negative, intracellular bacteria that contain both DNA and RNA and were formerly considered to be viruses. There are 3 species that are pathogenic to humans: Chlamydia trachomatis , Chlamydophilia pneumoniae, and Chlamydophilia psittaci . They fall within 2 genera in the family Chlamydiaceae . C trachomatis is in …