Trina M. Anglin

How children perceive the medical evaluation for suspected sexual abuse

This study investigated how 99 children who were examined for suspected sexual abuse (SSA) perceived their own medical evaluation experiences. Each child was interviewed about the degree of pain and fear associated with the experience, the kindness of the doctor, general fear of doctor visits, and degree of fear associated with a hypothetical second examination. The majority of children did not perceive their SSA examination to be strongly negative. However children did report greater fear associated with the SSA evaluation compared to an ordinary doctor visit. Using multiple regression, general fear of doctor visits and fear and pain associated with the SSA examination contributed to the prediction of intensity of fear about a hypothetical second SSA evaluation. Perceived kindness of the doctor, patient sex and age, and physician sex and age did not contribute to the regression equation. The relatively low reported rate of intense distress associated with medical evaluation of SSA suggests that fear and pain can be minimized and effectively managed for many children. The results of the regression analysis suggest that previous negative medical experiences may play an important role in determining how a child interprets the experience of an SSA medical evaluation.

Relationship of AIDS-related attitudes to sexual behavior changes in adolescents

The impact of the acquired immunodeficiency syndrome (AIDS) epidemic on a group of adolescents was investigated by surveying 197 sexually active, predominantly African-American, urban high school students. Reported sexual behavior changes were evaluated in relation to AIDS-related knowledge and attitudes. Over 50% of the students decreased their frequency of sexual activity, increased their condom use, and/or decreased their number of partners. These students had significantly higher scores on a measure of worry about vulnerability to human immunodeficiency virus (HIV) infection than those whose behavior had not changed. AIDS knowledge, AIDS beliefs, and AIDS-related anxiety interacted with gender to affect sexual behavior change. Male students reporting decreased frequency of sexual activity, for example, had more accurate beliefs about AIDS than males reporting no decrease. Among female students, however, those reporting decreased frequency had less accurate beliefs than those reporting no decrease. These results highlight the importance of considering gender and specific sexual behaviors when designing AIDS education interventions.

Changes in adolescents' knowledge and attitudes about AIDS over the course of the AIDS epidemic

We compared AIDS-related attitudes of junior and senior high school students from 1988 to 1991 and across grade level to examine how effectively schools are addressing AIDS. Attitudes measured included knowledge and social anxiety about AIDS, as well as perceptions of vulnerability to HIV infection. Junior high school students (grades 7-9) were sampled three times, from 1989 to 1991. High school students (grades 10-12) were sampled four times, from 1988 to 1991. The 1991 junior high school sample had lower AIDS knowledge scores than the 1989 sample. Conversely, the 1991 high school sample had more accurate knowledge than earlier groups. With respect to grade level, 9th graders had more accurate knowledge than 7th and 8th graders, but knowledge did not increase from 10th through 12th grade. Anxiety about interacting with a person with AIDS and perceptions of vulnerability to HIV infection were unrelated to either sampling time or grade level. It is concluded that it will be important to redouble efforts to educate adolescents about AIDS and that particular attention needs to be paid to young adolescents.

The relationship of Magic Johnson's announcement of HIV infection to the AIDS attitudes of junior high school students

One month after Magic Johnson announced that he had tested positive for human immunodeficiency virus (HIV), 103 junior high school students were surveyed about the impact of his announcement on their desire to learn about acquired immunodeficiency syndrome (AIDS), their worries about vulnerability to HIV infection, and their anxiety about interacting with a person with AIDS (PWA). Students also were administered established AIDS‐related scales of knowledge, vulnerability worries, and social anxiety. Their scores on these scales were compared to the scores of different students from the same school sampled at three previous times. As expected, 58% of the students reported a desire to know more about AIDS, and 40% reported increased worries about vulnerability to HIV infection because of Magic Johnsons announcement. Contrary to expectations, 21% reacted with a report of increased anxiety about interacting with a PWA, whereas 12% reported less anxiety. Also contrary to expectations, when compared with the p...

Use of enzyme immunoassay for the rapid diagnosis of Chlamydia trachomatis endocervical infection in female adolescents

Enzyme immunoassay (EIA) has been proposed as an alternative to tissue culture for the detection of Chlamydia trachomatis in cervical specimens. The diagnostic efficacy of EIA was compared to tissue culture in 113 teenaged females attending an adolescent reproductive health program. Infection was diagnosed by tissue culture in 16% of subjects. Compared with tissue culture, EIA demonstrated a sensitivity of 100%, specificity of 88%, positive predictive value of 62%, and a negative predictive value of 100%. These data indicate that EIA is an acceptable alternative to tissue culture when screening for C. trachomatis endocervical infection in adolescent females.

1 CHLAMYDIA TRACHOMATIS (C.t) IN ADOLESCENT FEMALES

C.t is an important cause of sexually transmitted disease (STD) in adults and has been implicated as a cause of salpingitis and perihepatitis. As limited data are available regarding C.t in adolescents, 75 sexually active female teenagers were studied to determine the prevalence of C.t and other STDs including trichomonas, gonorrhea, herpes simplex (HS), syphilis, as well as cytomegalovirus (CMV). Relevant data were obtained on study patients to determine clinical patterns of C.t infection in this age population and possible relationships with other STDs. Cervical and/or urethral cultures from 17 subjects (23%) were positive for C.t; other pathogens identified were trichomonas (13%), CMV (12%), N. gonorrheae (11%) and HS (3%). 16% were infected with 2 or more agents. Tabular analyses revealed no relationship between C.t infection and the following variables: age, contraceptive method, number of recent sexual partners, parity, catamenia, history of STD, another simultaneously diagnosed STD and presence of CMV or HS-2 antibodies. 7 C.t(+) subjects were asymptomatic and abnormal physical findings in 10 occurred in association with other common STDs. C.t antibody Was not detectable in all C.t(+) subjects. These data demonstrate C.t is a common STD in adolescence which cannot be diagnosed on the basis of symptoms or physical exam. As C.t is a STD with potentially serious sequelae, screening by appropriate culture should be considered in sexually active female teenagers.

Rapid Diagnosis of Common Sexually Transmitted Diseases in Adolescents: A Review

Abstract: Sexually transmitted diseases (STDs) represent a significant health problem for adolescents in the United States. As a result, clinicians from a number of discplines, among them pediatrics and dermatology, may be called on to evaluate teenage patients with these infections. Traditionally, the diagnosis of many STDs has relied on isolation of the causative organisms in culture. While such procedures typically offer optimal diagnostic accuracy, they are often time consuming and expensive, and may not be widely available. In an attempt to remedy this, cultureindependent techniques have been developed to permit more rapid and economical diagnosis of these important pathogens. The strengths and limitations of these methods must be understood, however, for the tests to be used effectively.

Diagnostic Efficacy of Genitourinary Symptoms and Abnormal Vaginal Discharge for the Recognition of Lower Genital Tract Infection in Adolescent Females

Abstract Clinicians frequently rely on a history of genitourinary symptoms or the appearance of vaginal discharge to diagnose infections of the vagina and cervix. To determine the diagnostic efficacy of these clinical criteria, we studied 254 unselected abolescent females presenting for reproductive health care. Of the 254 subjects, 105 (41%) had one or more lower genital tract infections (LGTI). Genitourinary symptoms were found to have a sensitivity of 48%, specificity of 78%, positive predictive value (PPV) of 61%, and negative predictive value (NPV) of 68% for the detection of LGTI. When abnormal vaginal discharge was used as an indicator of LGTI, the sensitivity was 65%, specificity 89%, PPV 81%, and NPV 78%. These data suggest that genitourinary symptoms and the appearance of vaginal discharge are inadequate indicators of the presence or absence of lower genital tract infection in adolescent females.

EFFICACY OF ENZYME IMMUNOASSAY (EIA) FOR DETECTION OF CHLAMYDIA TRACHOMATIS (C. t.) INFECTION

The availability of a low cost, rapid method to detect C.t. antigen would encourage diagnostic testing for this important genital pathogen. We compared the efficacy of C.t. EIA to tissue culture isolation in 95 sexually active female adolescents. An endocervical swab specimen was tested for C.t. antigen and a second swab processed for culture in cycloheximide-treated McCoy cells using both iodine and a fluorescein-conjugated C.t. monoclonal antibody (FA) for detection of chlamydial inclusions. 24 subjects (25%) were C.t. culture (+). 23 specimens were positive by both iodine and FA; 1 was (+) by FA only. C.t. (+) and (-) subjects did not differ in regards to presence of symptoms or signs of genital tract infection. 18 of the 24 culture (+) subjects were EIA (+) (sensitivity 75%). C.t. inclusion counts in 4 of the 6 culture (+) EIA (-) specimens were low. 69 of 71 C.t. culture (-) specimens were EIA (-) (specificity 97%). In view of the high prevalence of C.t. in our population and its non-specific presentation, diagnostic testing for this pathogen is essential. In our study, EIA performed well as a diagnostic test with a (+) predictive value of 90% and a (-) predictive value of 92%. Potentially, EIA offers a cost-effective rapid screen which could expand testing of groups at high risk for C.t. infection.

Position statement on sports participation for adolescents with handicaps

Participation in exercise and athletic activity can give adolescents with handicaps the opportunity to establish important and satisfying social and emotional relationships with peers, enhance their self-image, acquire a sense of accomplishment, and develop their competitive spirit. Adolescents with handicaps, their parents, and their health-care providers must understand the demands of each chosen sport, assess the extent of the handicap, develop an appropriate program of conditioning and training, and be alert to any specific hazards or needs for special equipment. Because of the important contribution of athletic and recreational activities to social development and emotional and physical well-being, the Society for Adolescent Medicine strongly endorses and encourages the participation of adolescents with handicaps in all aspects of sports with appropriate guidance to minimize any health risk imposed by the handicap.