Menstrual irregularities associated with athletics and exercise.

For women and girls, and dangers of excessively rigorous exercise regimens can include disturbances in reproductive function and a negative impact on bone density. Assisting female patients in finding a balance between the benefits and potential dangers of exercise is an important role for health professionals.

Recurrent abdominal pain: a potential precursor of irritable bowel syndrome in adolescents and young adults.

OBJECTIVES: To assess symptoms of irritable bowel syndrome (IBS) in patients with recurrent abdominal pain (RAP) 5 years after their initial evaluation, to identify the relation of IBS symptoms to functional disability and health service use, and to determine the extent to which IBS symptoms are associated with life stress and poor psychosocial adjustment. METHODS: Patients with RAP (n = 76) and control subjects (n = 49) completed a telephone interview; measures included the Bowel Disease Questionnaire, the Functional Disability Inventory, the Life Events Questionnaire, the Family Inventory of Life Events, the Center for Epidemiological Studies Depression Scale, the Self-Perception Profile for Adolescents, and the Health Resources Inventory. RESULTS: Five years after the initial evaluation, patients with RAP reported significantly more episodes of abdominal pain than did control subjects, as well as significantly higher levels of functional disability, school absence, and clinic visits for abdominal distress. Female patients with RAP were more likely than female control subjects to meet the Manning criteria for IBS. Among patients with RAP, higher levels of IBS symptoms were associated with significantly greater functional disability, more clinic visits, more life stress, higher levels of depression, and lower academic and social competence. CONCLUSION: Female patients with a history of RAP may be at increased risk of IBS during adolescence and young adulthood. Among adolescents and young adults with a history of RAP, IBS symptoms are likely to be associated with high levels of disability and health service use.

Maternal mortality in Kentucky.

This paper reviews maternal mortality in Kentucky over the 30 year period of 1966 through 1995. Data were reviewed from the minutes of the State Maternal Mortality Study Committee and the reports of the State Cabinet of Health Services, State Centers for Health Statistics. There has been a marked fall in the number of births during this 30 years and an even more dramatic reduction in maternal mortality. Identifiable causes for maternal death have changed over the years. Today, the three leading causes of maternal mortality in Kentucky mirror those of the nation, i.e., hemorrhage, pulmonary embolus, and toxemia.

Psychosomatic problems and stress in adolescence.

Psychosomatic problems are common in adolescents, and stress frequently plays a role in their development and maintenance. Armed with an understanding of the stressors experienced by adolescents, the individual's vulnerabilities and competencies and their level of social support, the physician can systematically assess each of these factors. Once the assessment is complete, a management plan can be formulated to address the particular psychosomatic problem. Symptom relief, stress reduction, and promotion of competence are important interventions that can be initiated by the primary care physician. When referrals are made for counseling and other stress management techniques, the primary care physician should maintain contact with the patient and family and remain an integral part of the management team. Incorporating brief discussions about the potential role of stress in health and illness into anticipatory guidance sessions may also help prevent the development of psychosomatic problems in adolescents.

Hepatitis B vaccination in adolescents: knowledge, perceived risk, and compliance.

PURPOSE: The purpose of this study was to evaluate adolescents' and parents' knowledge of hepatitis B, perceived risk of hepatitis B, and compliance with a three-dose vaccine series. METHODS: Two hundred adolescents were recruited into the study. Participants completed a questionnaire that examined hepatitis knowledge, sexual activity, contraceptive use, and perceived risk of acquiring hepatitis B infection at enrollment and the final 8-month follow-up visit. They also had blood drawn for determination of hepatitis B serology at these visits. Their parents completed a questionnaire at enrollment. RESULTS: A total of 174 (87%) participants completed the study. Adolescents initially had very little knowledge about hepatitis but did have significant improvement in their knowledge scores at the 8-month follow-up. Their parents were more knowledgable. Most teens perceived their risk of acquiring the hepatitis B infection as slight or none. Their perceptions of their risk of acquiring hepatitis B were not associated with sexual activity, contraceptive choices, or number of sexual partners. In contrast, the parents' perceptions of their teens' risk of acquiring hepatitis B were associated with the teens' sexual activity, contraceptive choices, and number of sexual partners. CONCLUSIONS: The adolescents studied had little knowledge about hepatitis or their personal risk. In contrast, the adolescents' parents were more knowledgable about hepatitis. The more informed the parent, the less sexual risk-taking behaviors the adolescent reported.

Concurrent and prospective screening for problem drinking among college students.

PURPOSE: Previous studies suggest that combining the CAGE questionnaire with the Perceived Benefit of Drinking Scale (PBDS), information about an adolescent's use of tobacco, and best friend's drinking pattern is a useful composite screening measure for problem drinking. The present study was undertaken to evaluate this composite screening measure prospectively as a predictor of subsequent problem drinking among late adolescents across 3 years of college. METHODS: A random sample of 452 college freshmen entered a longitudinal study of alcohol use at the beginning of their freshman year. A total of 184 (58%) completed follow-up measures of alcohol use 32 months later. Outcome measures included the quantity and frequency of alcohol use and a composite measure of specific alcohol-related problems. RESULTS: CAGE scores, PBDS scores, tobacco use, and best friend's drinking patterns as reported at college entry together explained 33% of the variance in the quantity/frequency measure and 37% of the variance in the alcohol-related problems measure from the end of the junior year. These same variables as reported at the end of the junior year explained 50% of the variance in the quantity/frequency measure and 61% of the variance in the alcohol-related problems measure. The composite screening measure as reported at college entry had a sensitivity of 73%, specificity of 70%, positive predictive value (PPV) of 63%, and negative predictive value (NPV) of 78% for students at high risk for problem drinking at the end of the junior year. A similar concurrent composite screening measure consisting of the same variables reported at the end of the junior year had a sensitivity of 88%, specificity of 56%, PPV of 60%, and NPV of 83% for high-risk drinkers. A total of 70-73% of students could be correctly categorized by each composite screening measure. These composite screening tests had significantly better test characteristics than the CAGE or PBDS alone. CONCLUSIONS: College students' responses to the CAGE, PBDS, tobacco use, and their friends' drinking remain consistent over 3 years and correlate with concurrent and future risk for problem drinking. These variables explain significant variance in drinking and alcohol-related problems and may constitute a useful screening measure for current and future problem drinking.

Relation of alcohol expectancies to changes in problem drinking among college students.

OBJECTIVE: To evaluate the relation between alcohol expectancies and problem drinking during 3 years of college. DESIGN: Cohort with 3-year follow-up. SETTING: Private university campus. PARTICIPANTS: A random sample of 260 students entered a longitudinal study of alcohol use at the beginning of their freshman year. One hundred eighty-four students completed follow-up measures at the end of their junior year. Respondents were 90% white, with a mean (+/-SD) age of 17.9 +/- 0.5 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: A standardized measure of expectations and subjective evaluations of outcomes associated with drinking, quantity and frequency of alcohol use, and a composite measure of alcohol-related problems. RESULTS: Students were divided into nondrinking, low-risk, and high-risk groups for problem drinking. A repeated-measures multivariate analysis of variance indicated significant interaction effects for risk group by expectancy scale (P < .009) and for expectancy scale by time (P < .001). The three risk groups differed significantly from each other on positive outcome expectations at entry into college and positive expectations and negative outcome evaluations at the end of the junior year. Students who became problem drinkers during college had significantly higher positive outcome expectation scores at both times and developed less concern for negative outcomes by the end of their junior year. The few initial problem drinkers who moderated their drinking during college demonstrated an increased concern for negative outcomes by their junior year. CONCLUSIONS: Alcohol expectancies are associated with differing patterns of alcohol use and are longitudinally related to subsequent changes in alcohol use and problem drinking.

Long-term health outcomes in patients with recurrent abdominal pain.

Investigated somatic and emotional symptoms, functional disability, and health service utilization in 31 former RAP patients and 31 former well patients who had originally been interviewed 5 to 6 years earlier. Both former patients and their mothers were interviewed for this follow-up study. Medical records were obtained for those patients who reported receiving new diagnoses for abdominal pain since their initial assessment. Results indicated that only one of the former RAP patients was later diagnosed with organic disease that clearly accounted for his earlier abdominal pain. Nonetheless, at follow-up former RAP patients reported significantly higher levels of abdominal pain, other somatic symptoms, and functional disability (including school/work absence) than did former well patients. Mothers reported higher levels of internalizing emotional symptoms in former RAP patients than in former well patients.

Relationship of alcohol expectancies to problem drinking among college women.

PURPOSE: To evaluate the stability of expectancies about alcohol and their ability to prospectively explain drinking patterns and the occurrence of alcohol-related problems among college freshman women. METHODS: College women (n = 120) completed a standardized measure of expectations and subjective evaluations of positive and negative outcomes associated with drinking and a questionnaire assessing drinking patterns and common alcohol-related problems at both the beginning and end of the school year. Ninety percent of the students were Caucasian with a mean age of 17.9 years (SD = 0.5). RESULTS: Students' positive and negative outcome expectations and their subjective evaluations at the beginning of the year were significantly correlated with drinking patterns at the end of the year (p's < .05). During the year, students at low risk for problem drinking developed stronger positive attitudes toward the effects of alcohol upon courage, became less concerned about potential behavioral impairment, and perceived less negative effects upon self-perception. High risk students showed a significant decline in their positive attitudes toward the effects of alcohol upon their sociability. Expectancies about alcohol at the beginning of the school year explained 33% of variance in subsequent drinking (F = 6.17; p < .0004) and 20% of the variance in alcohol-related problems occurring during the year (F = 3.26; p < .02). Outcome evaluation scales at the beginning of the year explained more variance in subsequent drinking and alcohol-related problems than did outcome expectation scales. CONCLUSIONS: Alcohol outcome expectations and their subjective evaluations were relatively stable across the freshman year for these college women. Alcohol expectancies on entry into college explained significant amounts of variability in drinking behavior and the occurrence of alcohol-related problems during the subsequent freshman year. Students' attitudes toward perceived outcomes may be more important than the perceived likelihood of the outcomes themselves.

Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence, and parental somatic symptoms.

This prospective study of 197 pediatric patients with chronic abdominal pain examined the role of negative family life events and several potential moderator variables (child social and academic competence, parental somatic symptoms, and child sex) in child somatic complaints 1 year after a clinic visit. Results indicated that (a) among children low in social competence at the time of the initial clinic visit, higher levels of subsequent negative life events predicted higher levels of somatic complaints at follow-up; (b) among boys in families with high levels of negative life events, those whose mothers were characterized by high levels of somatic symptoms had higher levels of somatic complaints at follow-up; and (c) children whose fathers were characterized by high levels of somatic symptoms showed higher levels of somatic complaints at follow-up, regardless of the level of life events. Possible mechanisms accounting for these findings are discussed.

Longitudinal evaluation of a screening measure for problem drinking among female college freshmen.

OBJECTIVE: A previous study suggested that combining the CAGE (cutting down of drinking, feeling annoyed by criticisms of drinking, feeling guilty about something that happened because of drinking, having an eye-opener) questionnaire with the Perceived-Benefit-of-Drinking Scale, an adolescent's use of tobacco, the age at which an adolescent first started drinking, and an adolescent's best friend's drinking pattern is a useful composite screening measure for problem drinking among adolescents. The present study was undertaken to evaluate prospectively this composite screening measure as a predictor of subsequent problem drinking among college women during their freshman year. DESIGN: Cross-sectional. SETTING: Private university student health service. PARTICIPANTS: A random sample of 248 college freshman women entered a longitudinal study of alcohol use at the beginning of their freshman year. One hundred twenty (48%) completed follow-up measures of alcohol use at the end of the year. Respondents were 90% white, with a mean age of 17.9 years (SD = 0.5 years). MAIN OUTCOME MEASURES: An index of the quantity and frequency of alcohol use and a composite measure of specific alcohol-related problems. RESULTS: The CAGE questionnaire score, the Perceived-Benefit-of-Drinking Scale score, the student's tobacco use, the student's best friend's drinking pattern, and the age at which the student first started drinking as reported at the beginning of the year together explained 38% of the variance in subsequent drinking habits and 26% of the variance in alcohol-related problems reported during the freshman year. Use of the composite screening measure significantly increased sensitivity and specificity beyond that obtained with the CAGE questionnaire or the Perceived-Benefit-of-Drinking Scale alone for problem drinking. CONCLUSIONS: The CAGE questions, the Perceived-Benefit-of-Drinking Scale, the student's tobacco use, the student's best friend's drinking pattern, and the age at which the student first started drinking may together constitute a clinically useful screening measure for subsequent problem drinking among female college freshmen.

Screening for problem drinking among college freshmen.

PURPOSE: This study identified predictors of older adolescents at risk for problem drinking. METHODS: College freshmen (n = 492) completed a questionnaire that addressed drinking patterns, risk factors for problem drinking, the CAGE questions, the Perceived-Benefit-of-Drinking Scale (PBDS), and the Children of Alcoholics Screening Test (CAST). They also responded to questions regarding alcohol-related problems including blackouts; alcohol-related injury, illness, violence, or legal problems; driving under the influence; and missing class. 50% of students were male with a mean age of 17.9 years (SD = 0.5). RESULTS: Higher scores on the CAGE and PBDS, use of tobacco, best friend's drinking pattern, and younger age at first drinking were associated with higher scores on a quantity/frequency drinking index and with reports of significantly more alcohol-related problems. Regression models using these variables explained 40% to 51% of the variance in drinking habits and alcohol-related problems. CONCLUSION: A composite screening measure had significantly better sensitivity and specificity than either the CAGE or PBDS alone in identifying older adolescents at high risk for problem drinking.

Alcohol expectancies, problem drinking, and adverse health consequences.

This study evaluated a measure of positive and negative expected effects of alcohol and their subjective evaluation in the identification of college freshmen at high risk for problem drinking and associated morbidities. It was hypothesized that greater expectations of positive outcomes and fewer negative evaluations of negative outcomes would be associated with reports of heavier drinking and more alcohol-related health problems. College freshmen (n = 328) completed a standardized measure of expectations and subjective evaluations of positive and negative outcomes associated with drinking, and a questionnaire assessing drinking patterns and common alcohol-related health problems. Fifty-two percent of students were male and the mean age was 17.9 years (SD = 0.5). Students' expectations of positive outcomes and their subjective evaluations of both positive and negative outcomes from drinking were significantly correlated with drinking and alcohol-related health problems indices (p < 0.001). Gender, expectation of positive outcomes, and evaluation of negative outcomes explained 29% of the variance in drinking and 15% of the variance in alcohol-related health problems indices. Heavier-drinking students and those reporting more health problems expected more positive effects on their sociability and sexuality (p < 0.03) and were less concerned about cognitive and behavioral impairment as a result of drinking (p < 0.001). Students with more health problems were less concerned that drinking would lead to risk-taking or aggressive behavior (p < 0.003). Positive and negative outcome expectancies and their subjective evaluations accounted for a significant portion of the variability in drinking and alcohol-related health problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychosocial correlates of recurrent childhood pain: a comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders.

Pediatric patients with recurrent abdominal pain (RAP) were compared with patients with peptic disease, patients with emotional disorders, and well children with regard to (a) emotional and somatic symptoms and (b) theoretically derived variables, including negative life events, competence, family functioning, and the modeling and encouragement of illness behavior. RAP patients had levels of emotional distress and somatic complaints higher than those of well children and lower than those of psychiatric patients, but not different from those of patients with peptic disease. RAP patients had fewer negative life events, better family functioning, and higher competence than children with emotional disorders. In comparison with well children and psychiatric patients, both RAP and peptic disease patients had a higher incidence of illness in other family members and perceived greater parental encouragement of illness behavior for abdominal symptoms.

Exercise-induced menstrual irregularities.

Exercise of sufficient rigor, particularly when coupled by weight loss and dietary restriction, is capable of producing reversible disturbances of reproductive function in many otherwise healthy women. However, it is clear that there are many health benefits for women who exercise regularly and in moderation. These include improved cardiovascular status, increased bone mineral content, improvement of dysmenorrhea and premenstrual syndrome symptoms, and general stress reduction. In addition, the inclusion of young women in high school and college athletics has provided many new opportunities. With these new opportunities, however, have come new challenges for physicians in assisting these women in maintaining optimal health.

Problem drinking among college freshmen.

Entering college freshmen (n = 308) completed a questionnaire which assessed drinking behaviors and identified students at risk for problem drinking as defined by the CAGE (focuses on Cutting down on drinking, Annoyance by criticism by others about drinking, Guilty feelings about drinking, and the use of an Eye opener) questionnaire and Perceived-Benefit-of-Drinking Scale (PBDS). Students were 50% male with a mean age of 17.9 years. In the past month, 17% had drunk on 10 or more occasions, and 18% had binged on 6 or more occasions. CAGE scores of 2 or greater were obtained by 21% and PBDS scores of 3 or greater by 29%, reflecting high risk for problem drinking. High-risk CAGE and PBDS scores were associated with frequent drinking and binging. Student reports of parental problem drinking were not associated with high risk for problem drinking. Intent to join a fraternity or sorority (the Greek system) was associated with frequent drinking, binging, and high-risk CAGE and PBDS scores. Approaches to screening for problem drinking which emphasize attitudes and beliefs may be useful. The Greek system appears to be attractive to high-risk students and should be a focus of prevention programming.