Self-concept measures and childhood obesity: a descriptive analysis.

Little is known about the possible effects of age, race, gender, or degree of obesity on measurements of self-concept in children. Our study of 130 obese children enrolled in an outpatient obesity clinic showed that their mean overall score on the Piers-Harris (P-H) Children's Self-Concept Scale was within the norms. However, certain subgroups scored low, with nonwhite children displaying the lowest self-esteem, particularly younger girls and adolescent males. For boys, the severity of obesity was inversely associated with the overall score and the intellectual school status subscale. Girls scored lower on anxiety. Younger white males scored the lowest on popularity. Our findings thus suggest that there is heterogeneity in self-concept measures among obese children, and that the use of subscales might provide greater insight and also possibly enhance sensitivity of the P-H in the investigation of obesity and self-concept.

Syncope and presyncope associated with probable adverse drug reactions.

The purpose of this study was to determine whether syncope and presyncope were associated with drug therapy in 70 patients referred to a tertiary care ambulatory clinic. Drug use information was obtained, validated, and classified by its potential to cause syncope and presyncope. Utilizing a standardized adverse drug reaction algorithm, nine (13%) of the 70 patients were rated as having probable drug-induced syncope and presyncope events. Overall, 12 medications were implicated. Patients with probable adverse drug reactions were older, and taking more medications, or taking an antihypertensive. Seven of the nine patients with probable adverse drug reactions were previously classified as having syncope of unknown origin after their initial clinic evaluation. Syncope and presyncope are commonly associated with adverse drug reactions, especially in the elderly and those taking multiple medications.

Effects of socioeconomic and clinical factors on survival in multiple myeloma.

It was recently reported that low socioeconomic status (SES) in multiple myeloma (MM) patients is associated with a poorer prognosis. To reassess this finding in another group of MM patients, we used data from interviews of 153 MM patients seen at Duke University Medical Center over a 6-year period. Medical records were also reviewed for data on traditional clinical prognostic factors. Using proportional hazard survival analysis, no SES variables were associated with survival. Current income, highest income, occupation, type of dwelling, years of education, and crowding did not enter the stepwise regression model at alpha = .10. In contrast, many clinical factors predicted prognosis (calcium, P = .019; percent plasma cells on initial bone marrow, P = .019; history of transfusions, P = .015; WBC count, P = .007; pathologic fractures, P = .001; and urate, P less than .001). Thus, we do not confirm the previously reported association between social class and myeloma survival.

Papanicolaou smear history of patients developing cervical cancer: an assessment of screening protocols.

The American Cancer Society recently has suggested changes in the frequency of Papanicolaou smear screening which, if followed, would alter current practice considerably. This study assessed the impact of the Papanicolaou smear screening interval on the prevention of advanced disease. Between July 1, 1980 and June 30, 1984, 264 women were evaluated and treated for primary epithelial carcinoma of the cervix (64% had stage I disease). Ninety-seven women (37%) had had a normal Papanicolaou smear within three years of diagnosis, including 48 women (18%) whose last normal Papanicolaou smear was within a year of diagnosis. The cytologic history was unavailable for 81 women (31%). Patients with a screening interval of greater than six years were more likely to be older, of lower socioeconomic status, and black, as compared with patients in the more frequently screened groups. Patients with a screening interval of 36 months or less were similar to those with a 37- to 72-month interval with respect to age, racial characteristics, and socioeconomic status. In this similar group of patients, a screening interval of 37-72 months was associated with a significantly larger proportion of advanced stage disease than found in more frequently screened patients. A policy of screening more frequently than every three years may therefore lead to increased survival among women who develop cervical cancer despite cytologic screening.

Symptomatic coronary artery disease in patients aged 21 to 30 years.

One hundred one young people (88 men, 13 women) aged 30 years or younger with arteriographically proved obstructive coronary artery disease (CAD) were identified and reviewed for risk factor prevalence. The men were compared with an age and date-of-catheterization matched control group who were arteriographically normal. Significant risk factors were cigarette smoking (p = 0.001), familial CAD (p = 0.002) and familial CAD manifested by age 50 years or younger (p = 0.005). Serum cholesterol values were significantly higher in the CAD group (p = 0.0001), but in most (54%) were still less than 250 mg/dl. Arteriography showed a spectrum of CAD: 1-vessel in 57, 2-vessel in 21 and 3-vessel in 22. One patient had significant left main CAD. Follow-up was obtained for all of the 94 American subjects. One-year mortality was 3% and 5-year mortality was 20%. The causes of death were predominantly cardiac: myocardial infarction in 10 patients, congestive heart failure in 2 and sudden death in 6; 3 patients died of noncardiac causes.

Serum prolactin levels after epileptic seizures.

We prospectively studied serum prolactin (PRL) elevation after different types of documented seizures in 17 patients. Marked PRL elevations above normal and above three times baseline were seen at 15 or 30 minutes after 20 of 25 (80%) generalized tonic-clonic, 13 of 30 (43%) complex partial, and 1 of 10 (10%) simple partial seizures. Although marked postictal PRL elevation is a sensitive indicator of recent epileptic seizures, a normal 15- or 30-minute postictal PRL level does not exclude an epileptic seizure.

Fifteen year survival study of patients with obstructive coronary artery disease.

Survival rates were determined for a group of 598 patients in whom severe coronary disease was demonstrated by arteriography; initially they were treated medically and were followed-up for 15 years. Deaths due to noncoronary causes were uncommon (5% of total) in the first 5 year period but were frequent (36%) in the third period. Survival rates were 48%, 28%, 18%, and 9% for patients with single-, double-, triple-, and left main artery disease, respectively. Abnormalities documented by ventriculography were related to survival. In 386 patients who would have been candidates for bypass surgery, survival rates were 58%, 35%, 26%, and 11% for those with single-, double-, triple-, and left main artery disease, respectively. Cardiac survival curves for single-, double-, and triple-artery disease in candidates for surgery and curves constructed on the basis of 3% mortality per artery per year corresponded fairly closely. When an abnormal electrocardiogram (ECG) is considered as a single variable in multivariate analysis, 5 year survival rates of candidates for surgery were influenced by the following in order of importance: abnormal ECG, symptoms at least 5 years in duration, triple-artery disease, double-artery disease, and arteriosclerosis obliterans. A simple prognostic stratification was devised that used only ECGs and duration of symptoms for each subset based on the number of arteries affected.

Coronary artery surgery in women compared with men: analyses of risks and long-term results.

A surgical experience with 2,445 consecutive women who underwent isolated bypass grafting was analyzed for comparison with 18,079 consecutive men. Severe or unstable angina occurred preoperatively in 60% of women and 45% of men (p less than 0.001). Despite less three vessel disease (44 versus 56%, p less than 0.001) and better left ventricular contraction (normal in 60% of women and 53% of men [p less than 0.001]), women had a higher operative mortality rate (2.9 versus 1.3%). When matched for age, severity of angina and extent of coronary atherosclerosis, women still had twice the operative mortality of men. In matched patients, body surface area was the strongest predictor of operative risk, even when the model was adjusted for gender. When the model was adjusted for body surface area, gender was not an important predictor of operative death. The smaller size of women, rather than their sex, appears to explain the difference in operative mortality. After a mean interval of 2 years, women had a lower overall graft patency rate (76.4%) than men (82.1%) (p less than 0.001). At 5 and 10 years postoperatively, a higher percent of men were angina-free. Yet, survival for women (90.6%) and for men (93.0%) at 5 years, and at 10 years (78.6 and 78.2%, respectively) was not dissimilar.