From early to late adolescence: alcohol use and anger relationships

Purpose: To evaluate the longitudinal relationship of alcohol use in early adolescence to anger in late adolescence.

Methods: Data were collected in Indianapolis, Indiana, from 1987 to 1993 as part of a large drug abuse prevention trial. Fifty percent of the 1201 students were female, 75%, white, and 69%, low socioeconomic status, who were surveyed in grades 6/7, 9/10, and 11/12. Subjects were asked four anger-related questions: “When I have a problem, I get mad at people,” “When I have a problem, I do bad things or cause trouble,” “When I have a problem, I say or do nasty things,” and “I am a hotheaded person.” Two additional items asked subjects to report the number of alcoholic drinks consumed and frequency of drunkenness in the past 30 days. Odds ratios (OR) were used to assess the predictive relationship of alcohol use in early adolescence to anger in late adolescence.

Results: Early use of alcohol increased the odds of later anger. Specifically, alcohol use in the past month in grade 6/7 increased the odds in grade 11/12 of saying or doing nasty things (OR = 8.23, p < .01), self-reported hotheadedness (OR = 9.72, p < .01), and high anger on a composite anger scale (OR = 4.84, p < .05). Drunkenness in the past month in grade 6/7 increased the odds of self-reported hotheadedness (OR = 6.17, p < .05) and high anger on the anger scale (OR = 3.20, p < .05) in grade 9/10 and doing something bad to cause trouble in grade 11/12 (OR = 24.97, p < .01). For subjects in grade 9/10, alcohol use in the past month increased the odds in grade 11/12 of doing something bad to cause trouble (OR = 2.79, p < .05), saying or doing nasty things (OR = 2.02, p < .05), and self-reported hotheadedness (OR = 2.51, p < .05).

Conclusions: The present study showed that alcohol use in early adolescence was associated with increased anger, both in middle and late adolescence, controlling for gender, age, and socioeconomic status. The findings suggest that alcohol and drug prevention programs delivered in early adolescence may have the capacity to prevent risk for later anger and related violent behavior.     

Diet, alcohol consumption, and serum lipid levels of the middle-aged and elderly in the Guangxi Bai Ku Yao and Han populations

Bai Ku Yao is an isolated subgroup of the Yao minority in China. The special customs and cultures including their clothings, intraethnic marriages, corn wine and rum intakes are still completely conserved to the present day. Little is known about the association of diet and alcohol consumption with serum lipid levels in this population. The aim of this study was to compare the differences in diet, alcohol consumption, and serum lipid levels of the middle-aged and elderly between the Guangxi Bai Ku Yao and Han populations. A total of 485 subjects of Bai Ku Yao and 501 participants of Han Chinese aged 40 and over were surveyed by a stratified randomized cluster sampling. Information on dietary intake and alcohol consumption was collected by standard questionnaires. Serum lipid levels were measured. Education level, height, weight, body mass index, waist circumference, blood pressure, hypertension, and total energy, fat, protein, dietary cholesterol, and salt intakes were lower in Bai Ku Yao than in Han (P < .05–.001), whereas physical activity level, carbohydrate, vegetal protein, and total dietary fiber intakes were higher in Bai Ku Yao than in Han (P < .001 for all). Serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) A1, and Apo B levels were lower in Bai Ku Yao than in Han (P < .001 for all). The levels of triglyceride, HDL-C, Apo A1, and the ratio of Apo A1 to Apo B in Bai Ku Yao were higher, but the levels of LDL-C and Apo B were lower in drinkers than in nondrinkers. The levels of triglyceride, HDL-C, LDL-C, Apo A1, Apo B, and the ratio of Apo A1 to Apo B in Bai Ku Yao were also influenced by the amount of alcohol consumed (P < .05–.001). High-density lipoprotein cholesterol levels in Han were higher and LDL-C levels were lower in drinkers than in nondrinkers (P < .01 for each). Serum total cholesterol, HDL-C, and LDL-C levels in Han were also associated with the amount of alcohol consumed (P < .05–.001). The differences in the lipid levels between the two ethnic groups may partially attribute to the differences in dietary habits and alcohol consumption.     

Effects of calcium channel inhibitors on ethanol effects and pharmacokinetics in healthy volunteers

Previous studies have shown that calcium channel antagonists alter the effects of alcohol in animals and humans. We selected a phenylalkylamine, verapamil, and a dihydropyridine, nimodipine, to determine whether these drugs would affect the subjective or psychomotor effects of ethanol in humans. Subjects ingested verapamil (80 mg, PO), nimodipine (30 and 60 mg, PO), or placebo 60 min before drinking an alcohol (0.7 g/kg) or placebo beverage. Subjects' mood, psychomotor performance, physiological status, and blood alcohol levels were assessed up to 3 h after beverage ingestion. Alcohol increased “drunk” ratings and impaired psychomotor performance (p < 0.05). Blood alcohol levels were decreased by nimodipine pretreatment, but not by verapamil pretreatment. Subjective and psychomotor effects of alcohol were not altered as a function of nimodipine or verapamil pretreatment. Nimodipine, verapamil, and alcohol, either alone or in combination, had no effect on blood pressure or heart rate.     

Social influences on health-risk behaviors among minority middle school students

Purpose: To determine whether parent social influences are associated with health-risk behaviors more than peer social influences among young minority adolescents.

Methods: We conducted a cross-sectional survey of seventh-grade students in a public urban magnet middle school using a survey instrument adapted from the Centers for Disease Control and Prevention Youth Risk Behavior Survey. The sample consisted of all seventh-grade students in the school, and the survey was part of a needs assessment for a school-based health education program. We measured four health-risk behaviors: use of (a) tobacco, (b) alcohol, (c) onset of sexual activity, and (d) marijuana use; and five social influences: (a) parent disapproval of health-risk behaviors, (b) parent modeling of health-risk behaviors, (c) parent monitoring of health-risks, (d) peer disapproval of health risks, and (e) peer modeling of health-risk behaviors. The analyses included measures of the prevalence of health-risk behaviors, bivariate analyses to evaluate relationships between health-risk behaviors and social influences, and regressions analyses to determine the independent associations of the social influences with the four health-risk behaviors.

Results: Twenty percent of respondents reported using tobacco, over 50% used alcohol in the past year, 13.3% were sexually active, and 12% reported marijuana use. Parent influences were associated with differences in alcohol use, whereas peer influences were associated with differences in all measured health-risk behaviors: tobacco and alcohol use, sexual activity, and marijuana use. Regression analyses demonstrated that peer social influences were the only measures independently associated with abstinence from tobacco (p < .05), alcohol (p < .01), sexual activity (p < .05), and marijuana use (p < .05). In all analyses, peers emerged as the most consistent social influence on health-risk behavior.

Conclusion: This study suggests peers and peer group behavior may be better predictors of adolescent health-risk behaviors than parental social influences among young adolescents.     

Alcohol consumption, drinking pattern and blood pressure: analysis of data from the Italian National Research Council Study

The present analyses addressed the relationship between alcohol consumption, drinking patterns and hypertension in 6699 Italian men and women participating in a national project on arteriosclerosis risk factors. The results of the analyses are consistent with an association between heavy alcohol consumption and systolic blood pressure in both males and females. Higher diastolic blood pressure was associated with heavy alcohol consumption in men but not in women. Drinkers of wine both with and without meals have a higher prevalence of hypertension than abstainers in both sexes. We conclude that heavy alcohol consumption is associated with higher blood pressure values, and that the pattern of drinking could be an important determinant in the association between alcohol and hypertension.     

Primary care physicians’ screening of adolescent patients: a survey of California physicians

Purpose: To determine how often primary care physicians screen adolescents for important risk factors and to determine how rates of screening vary by physicians' specialty and practice setting, patients' age, and type of risk factor.

Methods: A stratified random sample of 343 California physicians who are Board certified in pediatrics, family practice, or internal medicine, and physicians in these specialties who specialized in adolescent medicine were surveyed about their screening practices using a mailed questionnaire. Subjects were asked the percentage of routine comprehensive physical examination during which they personally queried or screened each age group of adolescents (11-14 years old and 15-18 years old) for each of the following risk factors: high blood pressure, alcohol use, cigarette use, sexual activity, and drug use.

Results: The frequency with which primary care physicians reported actually screening younger and older adolescents for the various risks were approximately: 93% and 96% for high blood pressure, 70% and 84% for alcohol use, 74% and 82% for drug use, 67% and 83% for sexual activity, and 76% and 86% for smoking, respectively. For all risk factors, providers screened older adolescents more frequently than younger adolescents (p < 0.01). Finally, screening rates varied by specialty (p < 0.01) but not by practice setting.

Conclusions: This study found that California physicians frequently screen adolescents for a variety of risk factors. However, the reported rates may not be consistent with published guidelines. Interventions may need to be developed which focus on improving primary care physicians' adolescent-specific screening practices.     

Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost

The antiprogesterone mifepristone in combination with a suitable prostaglandin provides an effective method for induction of abortion in early pregnancy up to 63 days of gestation. The combination of 600 mg mifepristone followed by 1 mg of gemeprost vaginal pessary 48 h later is one of the standard regimens in practice, which is registered in several countries in Europe. In 1995, we reduced the doses for both mifepristone and gemeprost to 200 mg and 0.5 mg respectively, as this was shown to decrease significantly the incidence of side effects whilst maintaining a high efficacy. In this article, we report our experience with this regimen in routine clinical practice by analysing 3161 consecutive medical abortions retrospectively. Twelve case notes (0.4%) were not available, and for 310 (9.8%) women, the outcome was not known with certainty as they did not return for their follow up visit. Of the remaining 2839 women, 2732 (96.2%) had a complete abortion following their treatment. One-hundred-two (3.6%) women required an evacuation of the uterus: for incomplete abortion in 63 (2.2%) and ongoing pregnancy in 39 (1.4%). Three women had to undergo surgery for ectopic pregnancies. The surgical intervention rate was significantly higher at gestation of >49 days compared to ≤49 days (5.7% vs. 2.6%, p = 0.002) and at >56 days than among those at ≤56 days (6.7% vs. 3.1%; p <0.001). However, for incomplete abortion a significant increase was only seen at gestation >49 days compared to ≤49 days (3% vs. 1.6%, p = 0.017). The incidence of ongoing pregnancies increased significantly only after 56 days of gestation compared to ≤56 days (3.8% vs. 0.9%; p <0.001). Parity was related to the outcome with parous women having significantly more incomplete/ongoing abortions compared to nulliparous women (5.4% vs. 2.0%; p <0.001), although parous women did present earlier in pregnancy for termination than nulliparous women (p = 0.01). The incidence of complications was low: 165 (5.8%) women were given antibiotics for presumed genital infection and severe haemorrhage occurred in 11 (0.4%) women, of whom only two required blood transfusion. In summary, the recommended regimen with the reduced doses of mifepristone and gemeprost is highly effective, meeting the anticipated efficacy with a complete abortion rate of >95%. We have concluded from the data that gestation and parity are strong predictors for clinicians to anticipate the probability of a successful medical termination of pregnancy.     

Does elementary school alcohol, tobacco, and marijuana use increase middle school risk?

Purpose: To assess whether alcohol, tobacco, and other drug (ATOD) use in elementary school may have serious implications for continued ATOD use in middle school and beyond.

Methods: Longitudinal analyses were conducted on questionnaire data from 331 middle school students who had previously provided ATOD-use data during elementary school. Non-school personnel administered questionnaires in three participating school districts in three different states. The sample of students was ethnically and geographically diverse, including students from a range of low socioeconomic status backgrounds living in rural, urban or inner-city environments.

Results: Middle school alcohol use was almost three times as likely to occur if alcohol use had occurred in elementary school (OR = 2.94, p < .001). Elementary school use of tobacco and marijuana also greatly increased the likelihood of middle school use (OR = 5.35, p < .001 and OR = 4.25, p < .05, respectively).

Conclusions: Early use of ATOD is associated with greatly increased odds of later use, which has important implications for the timing of drug prevention programs. Preventive interventions designed for use in pediatric practice settings should commence no later than elementary school, during the middle childhood years.     

Retinol concentrations in liver and serum among children who died in a diarrheal hospital in Bangladesh

To determine the vitamin A status of children with severe illnesses, we compared retinol concentrations in the liver and serum, histopathology of liver, and clinical complications in subjects who died in a diarrheal hospital. The median age of the study children (12 boys and 11 girls) was 24 months. About 87% (20/23) of the children were severely malnourished, having a median weight-for-age z scores of −4.35 (range, −5.55 to −2.50). All children were admitted with a history of diarrhea. They had multiple diseases or complications leading to death, including pneumonia, septicemia, colitis, and protein energy malnutrition. Stool cultures yielded Shigella in 11, Vibrio cholera in three, and Samonella group-B in one. Liver and serum retinol concentrations were found inadequate in 79% (15/19) and 89% (17/19) of the subjects, respectively. Concentrations of retinol in the liver and serum correlated strongly even after controlling for liver weight (r = 0.72, p < 0.001) and weight-for-age z scores (r = 0.73, p < 0.001). Liver histopathology showed moderate to diffuse fatty changes in those children who had deficient liver retinol (< 0.07 μmol/g). These results indicate that children with fatal illnesses and complications have markedly decreased liver and serum retinol.     

Serum insulin and ECG abnormalities suggesting coronary heart disease in the populations of Mauritius and Nauru: Cross-sectional and longitudinal associations

Cross-sectional associations between insulin and ECG abnormalities suggestive of ‘possible’ and ‘probable’ coronary heart disease (CHD) in the populations of Nauru (n = 568) and Mauritius (n = 3280) have been examined in both non-diabetic and diabetic subjects. Additionally, the longitudinal relationship between baseline insulin and incident ECG abnormalities has been explored in non-diabetic Nauruans (n = 177) over 5 years. Age-adjusted mean 2-hour serum insulin was generally higher in subjects with ECG abnormalities than those with a normal ECG, but the difference was significant only for non-diabetic Mauritian men (p < 0.01). There was no clear association between prevalence of ECG abnormalities and quintiles of fasting or 2-hr insulin in Mauritians, and in non-diabetic Nauruans there was a non-significant positive association between prevalence of ECG abnormalities and tertiles of 2-hr insulin. Logistic regression analyses showed a slight positive association between 2-hr insulin and ECG abnormalities in non-diabetic Mauritians (p = 0.06 in males, p = 0.09 in females), and non-diabetic male Nauruans (p = 0.054) independent of possible confounders. Fasting insulin was not associated in any group. In longitudinal analyses in Nauruans there were no significant differences in mean baseline fasting or 2-hr serum insulin between subjects who maintained a normal ECG and those who developed abnormalities consistent with ‘possible CHD’ (there were no changes suggestive of ‘probable CHD’). The incidence of ECG changes suggesting ‘possible CHD’ was slightly higher in the upper tertile of baseline fasting insulin in both sexes and 2-hr insulin in females, but when other factors were accounted for, multiple logistic regression analyses did not support this finding. Data from the populations of Mauritius and Nauru do not support a major role for serum insulin in ECG abnormalities suggestive of CHD.     

Abdominal pain in a 70-year-old Danish population An epidemiological study of the prevalence and importance of abdominal pain

In order to assess the prevalence and importance of abdominal pain in the elderly, an epidemiological study of a 70-year-old Danish population was carried out. Seventy two percent of 1119 randomly selected persons answered a questionnaire concerning abdominal pain. One year prevalence of abdominal pain was 28% among women and 17% among men (p < 0.01). Among those with abdominal pain no significant sex difference was found as regards location, severity, frequency, or medicine consumption. Eleven percent of the men and 19% of the women had abdominal pain which they considered to be of importance to their well-being in terms of frequency, severity, or need of medicine (sex difference: χ² = 10.18, DF = 2, p < 0.01). Participants who had no abdominal pain judged their general health to be better than those who had experienced abdominal pain (p < 0.01).

It is concluded that abdominal pain is frequent in a 70 year old population and influences the well-being of the subjects. Further studies are needed to evaluate whether subjects with abdominal pain have a poorer prognosis than subjects without.     

Gestational protein restriction induces a reduced number of glomeruli in the young

In order to study the effect of low protein content in maternal diet on kidney development of pups, Wistar female rats were fed isocaloric diets containing 4%, 8% or 20% protein throughout pregnancy and transferred to a commercial diet during lactation. Birth weight of pups was significantly lower (p < 0.05) only when mothers were fed 4% protein diet. Offspring of the 3 groups of dams were weaned on the 21^st day and sacrificed 7 days later. Significant reduction (p < 0.05) in the number of glomeruli but not in their diameter, glomerular sclerosis index or interstitial fibrosis index were found in the pups born to mothers fed both low protein diets. Plasma creatinine was significantly higher (p < 0.05) in offspring of both low protein diets, while homocysteine only in that born to the 4% protein fed mothers. So, our results are consistent with the hypothesis that maternal undernutrition can determine a reduction in nephron number and hence influence adult cardiovascular and renal diseases.     

Serum gamma-glutamyl transferase in alcoholics, moderate drinkers and abstainers: effect on gt reference intervals at population level

AIMS: To clarify in the association between amount of ethanol consumption and serum gamma-glutamyl transferase (GT) levels. METHODS: GT values were measured from 195 individuals with a wide variety of well-documented ethanol consumption assessed by detailed personal interviews using a time-line follow-back technique. These included 103 heavy drinkers (90 men, 13 women) and 92 healthy volunteers (54 men, 38 women) who were either abstainers (n = 30) or moderate drinkers (n = 62). For comparisons, data were collected from GT measurements for establishing GT reference intervals from 2485 healthy volunteers including 1156 abstainers and 1329 moderate drinkers. RESULTS: GT values in the individuals whose mean ethanol consumption exceeded 40 g of ethanol per day were significantly higher than those in the moderate drinkers with a mean consumption of 1-40 g/day (P < 0.001) or in abstainers (P < 0.001). The GT values in the group of moderate drinkers also exceeded those of the abstainers (P < 0.001). The upper normal GT limits obtained from the data from abstainers were markedly lower (men 45 U/l, women 35 U/l) than those obtained from the population of moderate drinkers (men 66 U/l, women 40 U/l). CONCLUSIONS: Serum GT concentrations may respond to relatively low levels of ethanol consumption, which should be considered when defining GT reference intervals. The continuous increase in alcohol consumption at population level may lead to increased GT cut-off limits and hamper the detection of alcohol problems and liver affection in their early phase.     

Differential parental communication with adolescents who are disabled and their healthy siblings

Purpose: To examine the levels of parental communication and differential conversational styles with adolescents who are disabled and their healthy siblings, to better understand why the adolescent who is disabled has a higher risk of psychosocial problems during the transition into adulthood.

Methods: Families who had a disabled adolescent and at least one other adolescent who was not disabled were videorecorded during dinner at home. Twenty adolescents (12 girls and 8 boys) and their families participated. Analyses were conducted on the 392 interactions.

Results: Not only did the healthy adolescents participate in family interactions at higher frequencies than the adolescents who were disabled F(1, 383) = 14.00, p < .001, but the interactions were also more meaningful with healthy adolescents, F(2, 383) = 5.25, p < .01. Furthermore, healthy siblings had significantly greater conversational control than did their siblings with disabilities, χ² [1] = 14.36, p < .001. Parents responded more negatively when adolescents who were disabled initiated a topic in comparison with their response to the healthy siblings, F(2, 69) = 5.44, p < .01. Finally, adolescents with disabilities were ignored more often than their healthy siblings, z = −3.75, p < .001, and they did not monopolize the conversation as often as did their healthy siblings, z = −3.91, p < .001.

Conclusion: These results suggest that adolescents who are disabled may be at a disadvantage when engaged in family interactions in contrast with their healthy siblings.     

Scientific abstracts at the society for adolescent medicine meetings:: A 3-decade comparison

Purpose: The purpose of this study was to review abstracts accepted for presentation at the annual national meeting of the Society for Adolescent Medicine (SAM) over the past 3 decades for subject content and research design.

Methods: Retrospective review was conducted of research abstracts for 3 years, selected at random, for the 1990s and then matched at 10-year intervals for the previous 2 decades. The major categories for subject content were: medical, psychosocial, health services, and miscellaneous; for research design categories were: retrospective, observational, experimental, and miscellaneous. Subsequent publication was also assessed.

Results: The most notable change over the 3 decades in subject content was a shift from medical topics (58% to 19%) to psychosocial topics [20% to 52% (p < .001)] of abstracts, the latter largely accounted for by increases in topics pertaining to high-risk behaviors. There was a substantial decrease in abstracts concerning medical aspects of chronic illness (p < .001), well-adolescent care, growth and development, and psychosocial aspects of chronic illness (p < .02). Regarding research design, the proportion of retrospective studies decreased over the 3 decades (p < .02); the most prevalent design was observational, with an increase in studies using established databases (p < .02). Less than 15% represented an experimental design. Studies using qualitative analysis appeared for the first time in the 1990s. The percentage of presentations which eventuated in published reports increased from 35% to 63% over the 3 decades (p < .02).

Conclusion: A significant shift occurred in subject con- tent of scientific abstracts from a medical to a psychosocial emphasis. The proportion of retrospective designs decreased, and qualitative analyses emerged. The likelihood of later publication of the studies increased.     

Cortical perfusion in alcohol-dependent individuals during short-term abstinence: relationships to resumption of hazardous drinking after treatment

Relapse to hazardous levels of alcohol consumption after treatment for alcohol use disorders is common. Investigation of the neurobiological correlates of resumption of hazardous drinking is necessary to clarify the mechanisms contributing to relapse. Fifty-seven treatment-seeking alcohol-dependent participants (ALC) completed arterial spin labeling perfusion MRI of the frontal and parietal gray matter (GM) at 7 ± 3 days of abstinence (baseline). ALC participants were restudied after 35 ± 11 days of abstinence (assessment point 2: AP2). Twenty-eight nonsmoking, light-drinking control participants (nsLD) from the community were studied with perfusion MRI. ALC participants were followed over 12 months after baseline study and were classified as abstainers (no alcohol consumption; n = 19) and resumers (any alcohol consumption; n = 38) at follow-up. Cross-sectional and longitudinal perfusion was compared in abstainers, resumers, and nsLD. At baseline, resumers demonstrated significantly lower frontal and parietal GM perfusion than nsLD and abstainers. Abstainers and nsLD were not different on frontal or parietal GM perfusion. No significant longitudinal perfusion changes were observed in abstainers and resumers. At AP2, resumers showed significantly lower frontal GM perfusion than nsLD and abstainers, whereas no group differences were observed for parietal GM. Abstainers and nsLD were not different on frontal GM perfusion. The significantly decreased frontal GM perfusion in resumers compared with both abstainers and nsLD across the assessment interval suggests premorbid and/or acquired neurobiological abnormalities of the frontal GM in resumers.     

Reliability and physiologic correlates of the Harvard alumni activity survey in a general population

The reliability of the Harvard Alumni Activity Survey (HAAS) and its association with physiologic measures was assessed in a large sample of men and women aged 25–65 years residing in the Boston metropolitan area in 1987. Reliability was estimated by comparing HAAS energy expenditure reports (kcal/week) from two separate interviews conducted 7–12 weeks apart. The test-retest reliability coefficient was 0.58 for the entire sample, but was considerably higher (r = 0.69) for those whose activity patterns had not changed from one interview to the next. HAAS self-reports were compared to two physiologic measures known to be affected by physical activity: high density lipoprotein cholesterol (HDLC) and body mass index (BMI). The natural logarithm of weekly HAAS expenditures was positively correlated with HDLC (r = 0.14, p < 0.01) and negatively correlated with BMI (r = 0.13, p < 0.01) for all respondents. These statistically significant associations persisted when adjusted for other covariates influencing physiologic status. The reliability coefficients and physiologic correlations for the HAAS in this sample are comparable to those reported for physical activity instruments requiring more intensive data collection and scoring procedures.     

A comparative study of Norinyl 1/35 versus Brevicon in Panama City, Panama

A comparative study of Norinyl 1/35 and Brevicon was conducted at the APLAFA clinic in Panama City, Panama. The study sought to evaluate the differences in continuation rates and the frequency of selected side effects which might contribute to method discontinuation. The 300 subjects were randomly allocated to one of the two oral contraceptives. Women in the Brevicon group reported significantly more (p <0.05) intermenstrual bleeding, nausea, headaches, dizziness and vaginal discharge than women in the Norinyl 1/35 group. The total discontinuation rate at 12 months was 28.0 for the Norinyl 1/35 group and 46.7 for the Brevicon group, and this difference was significant (p <.01). Also, significantly more women (p <.01) in the Brevicon group discontinued for menstrual problems than women in the Norinyl 1/35 group. No pregnancies were reported during this study. While both oral contraceptives appear safe and effective, Norinyl 1/35 was more acceptable to this group of Panamanian women.     

Lung function, smoking and survival in severe alpha 1-antitrypsin deficiency, PiZZ

Lung function, smoking, age and mortality data in 158 adult severe alpha₁-antitrypsin deficient, PiZZ individuals, followed from 1963 to 1982 were analyzed. Low initial FEV₁ value was significantly associated with increased mortality (p < 0.005). A 3 yr mortality rate of 40% was found in individuals whose initial FEV₁ values were less than 30% of that predicted. In contrast, the corresponding 3-yr mortality among those whose initial FEV₁ values were between 30 and 65% of that predicted was only 7%. Smokers were found to have significantly lower FEV₁ levels (p = 0.008) and higher mortality (p < 0.005) than non-smokers. The difference between current and ex-smokers in mortality and FEV₁ level were not statistically significant (p = 0.9 and p>0.25, respectively). Cross-sectional analysis of the initial FEV₁ values indicated a significant decline (p < 0.005) of FEV₁ with increasing age. This decline was greater among smokers than non-smokers. Longitudinal analysis of FEV₁ rates of decline in 80 cases with follow-up FEV₁ measurements failed to detect any significant differences between smokers and non-smokers, but was performed late in the disease process. The application of these results to the planning of studies on replacement therapy, smoking intervention strategy and longitudinal follow-up is discussed.     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.