Parental alcohol intoxication and adverse health outcomes among offspring. A 4-year follow up HUNT study among 2399 Norwegian adolescents.

This study aimed to investigate whether experience of parental alcohol intoxication was associated with adverse health outcomes among adolescents four years later. A population-based Norwegian cohort study of 2399 adolescents who participated in the Young-HUNT1 Survey 1995-97 (T1, 13-15 years old) was followed up four years later (T2) in 2000 (Young-HUNT2, 17-19 years old). Measures were based on adolescent self-report of exposure to parental alcohol intoxication, self-rated general health, mental distress (SCL-5) and lifetime hospital admission. Multivariable logistic regression analyses, adjusted for gender, age and parental education were applied. Results show that half of the adolescents (51%) had seen parents intoxicated at age 13-15 years. Four years later, those who had reported parental alcohol intoxication at T1 had increased odds of admission to hospital with odds ratios ranging from OR1.3; CI 1.0-1.7 to OR 2.2; CI 1.3-3.9, poorer self-rated health (odds ratio ranging from 1.8;1.2-2.6 to 2.0;1.1-3.7) and more mental distress (odds ratio ranging from 1.7;1.1-2.5 to 1.9;1.0-3.6). Furthermore, the increased frequency of experience of parental alcohol intoxication are associated with higher prevalence of admission to hospital and mental distress and lower levels of self-rated health. Findings from this large, representative population of Norwegian adolescents indicate that adverse health outcomes among adolescents in a general population are related to relatively common heavy drinking behaviours among parents.

Breed, age and gender distribution of dogs with chronic hepatitis in the United Kingdom.

Standardised histological criteria are now available for the diagnosis of canine chronic hepatitis (CH). CH is common in dogs, but no studies have reported breed, age and gender distributions in the United Kingdom (UK). The objective of this study was to determine which breeds had an increased risk for developing CH in the UK and to report the age and gender distribution for those breeds. The databases of six veterinary histopathology laboratories were searched for cases with a histological diagnosis of CH according to standardised criteria. The breed, age and gender of dogs was recorded and compared to a control population to calculate the odds ratio and 95% confidence intervals for developing CH. A total of 551 cases of CH were identified, consisting of 61 breeds. Nineteen breeds were represented by five or more cases. Breeds with an increased risk for developing CH included the American cocker spaniel, Cairn terrier, Dalmatian, Dobermann pinscher, English cocker spaniel, English springer spaniel, Great Dane, Labrador retriever and Samoyed. The median age at diagnosis for all breeds with CH was 8 years (range 7 months to 16 years). Dalmatians, Dobermann pinschers and English springer spaniels with CH were significantly younger than Cairn terriers, English cocker spaniels and Labrador retrievers with CH. Females were over-represented when all cases were examined together. In conclusion, several breeds in the UK have an increased risk of CH, some of which have not been previously reported.

Truancy, alcohol use and alcohol-related problems in secondary school pupils in Norway.

This study focuses on a vulnerable group of pupils often missed by mainstream school surveys. It explores alcohol use and alcohol-related problems for a sample of truants of secondary school age, comparing behaviours with a school-based sample from the same geographical area. Analyses are based on a survey among truants (n = 107) and a school survey (n = 3702) undertaken in Bergen, Norway. When compared with mainstream pupils, the truants reported an earlier alcohol debut and a higher frequency of drinking. They reported significantly higher levels of binge drinking (6+ units). Truants were four times more likely to report regular drunkenness and twice as likely to report problems associated with their alcohol consumption. In the truancy sample, boys were more likely to engage in regular and excessive drinking, while girls reported higher levels of problems linked to their drinking. Results suggest that higher levels of truancy were related to more frequent drinking, drunkenness and alcohol-related problems. There are strong indications for early intervention activities directed at truants, and registration of truancy in itself could be a simple and effective way of identifying pupils at risk of a wide range of social and health problems, including high levels of alcohol use.

Histopathologic, immunohistochemical, and cytologic analysis of feline myeloma-related disorders: further evidence for primary extramedullary development in the cat.

Feline myeloma-related disorders (MRD) are rare neoplasms of plasma cells. The multistep transformation model of myeloma in humans is based on the premise that plasma cells undergo neoplastic transformation primarily within the intramedullary compartment and that over time they become poorly differentiated and metastasize to extramedullary locations. Historically, diagnostic criteria used for human multiple myeloma have been applied to the cat, with the assumption that feline MRD commonly arises in the intramedullary compartment. Our objectives were to describe the features of feline MRD confirmed by cytology, histopathology, histochemistry, and immunohistochemistry and to categorize these tumors. A priori hypotheses were 1) tumor category predicts survival and 2) cats with well-differentiated tumors commonly have extramedullary involvement in contrast to human myeloma patients. This multicenter, retrospective study identified 26 MRD cases. There was good agreement between histopathologic and cytologic tumor categorization. Histochemistry and immunohistochemistry were shown to be valuable adjunct tests in the diagnosis of MRD. Cats with well-differentiated tumors had increased median survival relative to those with poorly differentiated tumors (254 versus 14 days). We have reported that marked extramedullary involvement at initial clinical presentation is significantly more common in the cat than in human MRD patients. In this study, we demonstrate that cats with well-differentiated tumors more commonly have extramedullary involvement than human myeloma patients with well-differentiated tumors (90% versus 20%, P < 0.0002). These results contrast strongly with the human myeloma model of primary intramedullary neoplastic transformation and suggest that primary extramedullary neoplastic transformation may be more common in feline MRD.

Pain in childhood and adolescence: diagnosis, smokescreen or everyday complaints?

UNLABELLED: A large number of adolescents complain of headaches, backache, abdominal pain and pain in the limbs. CONCLUSION: Teachers and health personnel should be educated in health promoting strategies to avoid medicalisation of health complaints, and to promote functional ability through structural approaches.

[Psychological and somatic complaints among adolescents]. / Psykiske og somatiske plager blant ungdom.

BACKGROUND: Health promotion and disease prevention among adolescents should include efforts to reduce the burden of health complaints. In order to develop systematic preventive approaches, epidemiological research is needed. This study focuses on prevalence, gender differences, and intercorrelations among such complaints. MATERIAL AND METHODS: The data were drawn from a nationwide (Norwegian) survey among pupils in compulsory school grades 6, 8, and 10 (age 11, 13, and 15); response rate 79%. RESULTS: Among 15-year-olds, most health complaints were more prevalent among girls than among boys. A principal components analysis revealed a dimension from primarily psychological to primarily somatic complaints. Among 15-year-olds, 18% reported at least one daily psychological complaint and 14% reported at least one daily somatic complaint. Sum-scores for psychological and somatic complaints were constructed, the intercorrelation being 0.56 among 15-year-olds. Girls scored significantly higher than boys on both sum-scores. Among girls there was a marked increase in scores with age (particularly for somatic complaints). INTERPRETATION: The high prevalence of complaints among both genders and the increase with age among girls implies that preventive action is needed. The intercorrelations among complaints indicate common etiological processes.

Subjective health complaints in adolescence--reliability and validity of survey methods.

This paper studies test-retest reliability and validity of one measure of adolescent health complaints. The test-retest included an eight-item symptom checklist developed for the survey of Health Behaviour in School-aged Children (n=344). Qualitative analysis showed adequate validity for most items. For the total sample, all items were found to have adequate intraclass correlation coefficients (ICC) in the range 0.61-0.75. There were inter-item differences and girls generally received the higher values. Most changes were within one category. Adolescents' understanding of 16 complaints was studied by interviews with 38 adolescents. A few items showed ambiguity in interviews despite adequate test-retest stability.

Subjective health complaints in adolescence. A cross-national comparison of prevalence and dimensionality.

BACKGROUND: The purpose of this work was to study the prevalence and dimensionality of subjective health complaints in a cross-national population of adolescents. METHODS: The analyses were based on data from a WHO cross-national survey, Health Behaviour in School-aged Children (HBSC). The study included a representative sample of 11, 13 and 15-year-old adolescents from Finland, Norway, Poland and Scotland. Data were collected in 1993-1994 and the total sample included 20,324 adolescents. Subjective health complaints were measured by the HBSC Symptom Checklist (HBSC-SCL), including headaches, abdominal pain, backache, feeling low, irritability, nervousness, sleeping difficulties and dizziness. Descriptive analyses, MANOVA and structural equation modelling (EQS) were conducted. RESULTS: Patterns of reporting were consistent for all four countries. A large number of students reported a high level of symptoms. The reporting of most symptoms increased with age. Girls reported significantly more symptoms than boys and the gender differences also increased with age. Structural equation modelling suggests a model of two correlated factors, which can be labelled psychological and somatic. CONCLUSION: The findings of this study indicate that students report a high level of subjective health complaints already at the age of 11 years. The reporting of most symptoms increases with age and more so for girls than for boys. The finding of two dimensions that differ qualitatively, suggests that these dimensions may have different etiologies.

The pregnant smoker's experience of ante-natal care--results from a qualitative study.

OBJECTIVES: 1) To obtain insight into pregnant smokers' experience of the information received from doctor and midwife at the ante-natal clinic. 2) To develop an understanding of pregnant women's own ideas of how health personnel can help them stop smoking. DESIGN: Qualitative study with strategic sampling. 33 pregnant smokers took part in an in-depth interview in the third trimester. SETTING: Home of patients, or surgeries in Hordaland county, Norway. PARTICIPANTS: Daily smokers during the last three months before conception, and still smoking in the 16th-18th week of pregnancy. RESULTS: Pregnant women lacking motivation to stop smoking seemed to be most satisfied with ante-natal care. The women interviewed saw doctors and midwives as responsible for raising the subject of smoking, and blamed them for disinterest. The findings suggest that pregnant smokers may be classified into four categories ("it could have been worse", "self-delusion", "self-confident", and "rational"), and that intervention should be tailored to meet each woman's perception of control over smoking behaviour.

Elder abuse.

Though we live in a violent society, hurting the elderly and children--those who are most defenseless--seems especially deplorable. This month's Iowa Medicine examines the problem of elder abuse. The following articles by Iowa physicians discuss how to recognize it and what to do about it.

Patients with dementia and their caregivers 3 years after diagnosis. A longitudinal study.

OBJECTIVES: To document caregivers' perceptions of the deterioration in functional ability of persons with dementia over time, to identify the most problematic behavior for caregivers at two stages of dementing illness, and to compare the perceived informational needs of caregivers at diagnosis and 3 years later. DESIGN: Single cohort. Surveys were mailed at time 1 and respondents were followed up after 3 years (time 2). SETTING: Midwestern hospital dementia assessment clinic with a family physician director. Continuing care was by community physicians. SUBJECTS: Thirty elderly patients with dementia who were evaluated at the dementia clinic. Data were provided by their caregivers. RESULTS: Patients' scores on the Activities of Daily Living section of the questionnaire declined (bathe self, P = .03; transfer from bed or chair, P = .03; and groom self, P = .06). Significant deterioration in behaviors over time was found in incontinence (P = .04). Fewer patients were depressed at time 2 (P = .02). The patient behaviors found most troublesome at time 1 were worrying about memory loss, losing or hiding things, feeling blue, experiencing restlessness, having difficulty calculating, experiencing a lack of interest, and having false ideas. At time 2, the greatest problems were having a short attention span, failing to recognize persons or things, experiencing a lack of interest, experiencing restlessness, repeating himself or herself, forgetting where he or she is, speaking incoherently, and being incontinent. Questions caregivers most wanted answered at time 1 concerned possible treatment, the future course of illness, and the cause of the symptoms. At time 2, the concerns were the future course of illness, possible treatment, and disease inheritance. There was significantly more interest in family agreement about care (P = .004) and the need for legal guardianship (P = .001) at time 2. CONCLUSIONS: Caregivers' perceptions of the most frequent and troublesome behaviors of patients with dementia were documented at different stages of the disease. The importance caregivers attached to their requests for information reflected changing but continuing needs for reassurance about the patient's diagnosis and treatment and for help with the psychosocial consequences of dementia. Physicians must be aware of caregivers' needs at different stages of the disease process and be equipped to help them appropriately.

[What determines smoking habits in pregnancy? A qualitative study among pregnant smokers]. / Hva bestemmer røykevaner i svangerskapet? En kvalitativ undersøkelse blant gravide røykere.

In this article we present results from a qualitative study among 33 pregnant smokers, who took part in an in-depth interview in the 27th-35th weeks of pregnancy. The aim was to obtain insight into pregnant women's own experience of smoking in pregnancy. The pregnant women interviewed were concerned about their smoking habits. In spite of this, they still expressed positive attitudes towards smoking, and many did not experience pregnancy as a favourable time to stop. The study shows that pregnant women still lack important knowledge about the dangers of smoking. Pregnant smokers' attitudes towards scientific facts, and the role cigarettes play in their everyday lives, are considered to be important variables in determining smoking in pregnancy. The pregnant women experienced that their partner and health-personnel played a minor role in changing smoking behaviour. The reasons the women gave for smoking in pregnancy are discussed in the light of current theories on changing health behaviour. Four key questions are proposed which can be used by doctor and midwife to obtain knowledge of pregnant women's perception of the seriousness of smoking and the associated risks, and of the gains and barriers connected with quitting.

Identification of contaminant coatings over rough surfaces using polarized infrared scattering.

An optical technique to identify the presence of chemical coatings over rough surfaces is described. It is based on the selective use of elements of the 4 x 4 Mueller matrix. The full-wave theory of electromagnetic scattering is used to predict six independent Mueller elements from randomly rough uncoated (dry) and coated (wet) surface materials as functions of the media complex dielectric coefficients, backscattering angle, and midinfrared wavelengths of laser-beam excitations that are polarization modulated. The set of independent elements at beam wavelengths and backscattering angles [M(mn) (lambda(i), lambda(i))] most sensitive to i optically thick contaminant coatings are statistically obtained from the full-wave database, and detection-parameter sets [lambda(i), lambda(i)] are inputs to another algorithm designed to identify the contaminant coating (when present and interacted by the irradiating beams). These algorithms facilitate the operation of a multi-CO(2) laser-ellipsometer facility now under development at the U.S. Army Chemical Research, Development, and Engineering Center for the remote detection of chemical or biological surface contaminants.

Alcoholism and other drug dependencies.

The disease of addiction is upon us and it is obvious that the elderly are not immune. There is every reason to believe from early reports that the elderly respond favorably to treatment, perhaps more so than their younger counterparts. It is believed that treating chemical dependency as a primary disease rather than as a symptom of something else has been a great boon in terms of improving recovery rates. Furthermore, group therapy is the main component of treatment in rehabilitation, as it affords the greatest opportunity to shift the dependence on chemical to a dependence on human beings. The physician is in a key position to help the elderly, because so many elderly need and use medical care. Intervention is highly recommended if the doctor is knowledgeable and skilled in this area and is willing to kindly confront the patient with a somewhat undesirable diagnosis. Rehabilitation regimens are becoming more plentiful throughout the country. If services are unavailable, however, there is always AA to fall back on or to recommend initially. Remember, fully one third of all AA members are older than 50 and that it is a source of acceptance, support, and an opportunity to depend on human beings instead of psychoactive chemicals. Remember too that few patients with addiction recover by themselves. It is worth remembering that this is an incurable disease in that once addicted, it is unlikely that anyone can ever use socially psychoactive chemical substances again. Use of psychoactive chemicals is fraught with danger for the physician and the patient and indeed may place the physician at risk for malpractice. There is great satisfaction to be gained from helping those afflicted with alcoholism and other drug dependencies. The gratitude displayed by those receiving help for this affliction is truly remarkable and one that will leave the clinician with a sense of "a job well done."