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Use of Human Immunodeficiency Virus Postexposure Prophylaxis in Adolescent Sexual Assault Victims
Postexposure prophylaxis appears to be able to reduce the risk of human immunodeficiency virus transmission after sexual assault and national guidelines for its use have been published. Olshen and colleagues examined use of postexposure prophylaxis for 145 adolescents presenting to 2 urban emergency departments after sexual assault. Three fourths of patients were given prophylaxis for human immunodeficiency virus infection. The majority of these patients did not complete the prescribed 28-day course and 46% developed medication toxicity. A comprehensive follow-up system with case management will be necessary to encourage adherence to treatment and ensure follow-up.
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Improving Recognition of Adolescent Depression in Primary Care
As many as 20% of teenagers report that they have been depressed, but less than one third of these individuals receive treatment. To improve the identification and treatment of adolescent depression, primary care practitioners may need to adapt adult models of depression treatment. This systematic review examined methods used in primary care settings to identify adolescent depression. The review found that few practitioners use systematic depression identification methods despite growing evidence for the feasibility, validity, and effectiveness of this screening.
Age at Drinking Onset and Alcohol Dependence
More than one quarter of high school students begin drinking alcohol before the age of 13 years. Early onset of alcohol use is associated with many problems, both in adolescents and adults, including risk of injury, risk of unwanted and unprotected sex, other substance abuse, and school failure. This survey of 43 000 adults found that those who began drinking before the age of 14 years have nearly double the risk of alcohol dependence compared with those who started drinking after the age of 21 years. They were also 3 times more likely to have multiple episodes of alcohol dependence. For each additional year before the age of 21 years that individuals began drinking, the odds of developing alcohol dependence problems increased.
Kaplan-Meier survival curves describing the proportion of dependence-free individuals by age at drinking onset.
The Trial of Infant Response to Diphenhydramine
Many parents encounter frustration with poor infant sleep and often turn to their physician for advice and treatment. Half of the primary care pediatricians in this study reported prescribing antihistamines for sleep problems in infants in the past 6 months. This study was a randomized controlled trial of the use of diphenhydramine for infants 6 to 15 months of age who were reported to have sleep problems. The trial found no difference between diphenhydramine and placebo in decreased number of night awakenings. There was no difference in the time to fall asleep and no adverse effects were reported. Diphenhydramine appears to play no role in treating sleep problems in children.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2006;160(7):673. doi:10.1001/archpedi.160.7.673
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