Phototherapy in individuals with and without subsyndromal seasonal affective disorder.

Antidepressant and energizing effects of bright light exposure (phototherapy) have been widely reported to occur in patients with seasonal affective disorder. We have attempted to evaluate whether other segments of the population might benefit from phototherapy, most notably individuals with subsyndromal seasonal affective disorder, as well as healthy individuals with no winter difficulties (controls). We have studied 20 subjects in each of these two categories and have found that bright artificial light did not alter mood and behavior in controls. In contrast, individuals with subsyndromal seasonal affective disorder responded favorably to treatment with bright environmental light. A dose of 5 hours of bright light exposure, divided between morning and evening, was more effective than 2 hours of exposure. This finding may have practical implications for establishing optimal environmental lighting conditions for those individuals whose winter difficulties do not meet criteria for seasonal affective disorder.

Measurement of organochlorine levels in postprandial serum or in blood collected in serum separator tubes.

Whether organochlorine blood levels in fasting and postprandial specimens provide equivalent measures of exposure and the extent to which collecting blood in tubes containing material to separate serum and blood cells corrupts the specimen are unclear. In this paper, we present data from two studies that address both of these issues. In the first study, 27 women provided fasting blood in plain, silicone-coated Vacutainer tubes (red-topped) and in similar tubes containing serum separator gel (SSTs), as well as a postprandial specimen in a red-topped tube. The specimens collected in SSTs were left to stand overnight, with the gel in contact with the sample. In the second study, the blood of 12 industrial incinerator workers was collected in red-topped tubes and in SSTs. Blood in SSTs was left in contact with the gel for 5 days. Serum organochlorine residue levels ([1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] (DDE)) and polychlorinated biphenyls) in samples collected in red-topped tubes were highly correlated with levels measured in samples collected in SSTs (all Pearson r values were > or = 0.79). Postprandial and fasting organochlorine levels were also highly correlated (Pearson r values > or = 0.89). Our results indicate that timing of the collection of blood in relation to meals and use of SSTs to collect blood specimens did not greatly affect the relative classification of subjects with respect to serum level of DDE or polychlorinated biphenyls. The longer the specimen was in contact with the SST gel, however, the lower the level of organochlorine that was detected and, at least for DDE, the greater the misclassification caused.

Cardiovascular effects of tricyclic antidepressants in childhood asthma: a case series and review.

Children with asthma frequently have significant anxiety and depression that interfere with treatment outcome. Although the use of antidepressants may be helpful, in the one published study of antidepressant use in pediatric asthma, significant side effects necessitated discontinuance; these side effects were increased motor activity, impulsive behavior, insomnia, postural hypotension, premature auricular contractions, diastolic hypertension, and generalized seizure. The objective of this retrospective chart review was to examine whether antidepressants could be tolerated and administered safely to children on asthma medications. Forty pediatric inpatients (mean age 13.3 years, range 7-19) with varying levels of asthma severity (5 mild, 11 moderate, 24 severe) and an average duration of asthma treatment of 10.0 years were administered antidepressants while also taking an average of 5 medications for asthma (range 2-7). Ten of the patients had an additional comorbid medical diagnosis. There were 17 children diagnosed with a primary affective disorder; 7 with a primary anxiety disorder; and 16 with both an affective and anxiety disorder. Thirty-six children ultimately were continued on an antidepressant: 13 on desipramine, 9 on nortriptyline, 6 on imipramine, 4 on fluoxetine, 3 on bupropion, and 1 on sertraline. Significant cardiovascular side effects (tachycardia, hypertension, and postural hypotension) occurred in 4 subjects on tricyclic antidepressants (TCAs) and 1 subject on a non-TCA (fluoxetine); 3 of these subjects were able to continue treatment with an antidepressant. Two subjects were taken off antidepressants because of hypomanic symptoms (increased motor activity, mood lability, impulsive behavior, and insomnia). No medications were discontinued because of electrocardiogram changes, arrhythmias, or seizures. Doses of TCAs were comparable to those in previous studies, but the asthma medications differed. Discussion of current anti-asthmatic medications and potential for interactions with antidepressants is included.

Body image, perceived pubertal timing, and adolescent mental health.

PURPOSE: To examine the impact of gender, racial-ethnic group, and perceived pubertal timing on body image and adolescent mental health. METHOD: A three-stage, area probability sample was selected which included 877 teens (13-18 years) with diverse social and demographic characteristics. Interviews in English or Spanish were conducted in person. The content emphasized emotional distress and problematic behavior, exposure to social stressors, coping resources and behaviors, and socioeconomic and demographic characteristics of the adolescent and his or her family. RESULTS: Girls were more depressed and had lower self-esteem than boys, but not after controlling for body image. Hispanics were more depressed and had lower self-esteem than other racial-ethnic groups, a difference that remained when controlling for body image. African-Americans had the most positive body image, a finding that could not be attributed to higher self-esteem or fewer depressive symptoms. The impact of perceived pubertal timing on body image varied considerably by gender and across racial-ethnic group. CONCLUSIONS: Negative feelings about their bodies contribute to the higher prevalence of depressive symptomatology and lower self-esteem among girls. African-Americans appear to take pride in their bodies in a manner that sets them apart from other teenagers, suggesting they hold a different ideal. Relative to teenagers of other racial-ethnic backgrounds, Hispanics may be at elevated risk for mental health problems.

Differential response to targeted recruitment strategies to fitness promotion research by African-American women of varying body mass index.

OBJECTIVE: To assess patterns of recruitment into a community-based NCI-funded physical activity and dietary lifestyle change program targeting African-American women. DESIGN: Acquisition of a convenience sample to be screened for participation in a randomized, controlled prevention intervention. SETTING: African-American-owned and -operated health club located in an area of Los Angeles in which African Americans are concentrated. PARTICIPANTS: 893 African-American women. RECRUITMENT STRATEGIES: Social networking/word-of-mouth, staff presentations, mass and targeted media, and physician referral. MAIN OUTCOME MEASURE: Completion of screening questionnaire indicating a desire to enroll in the study. Screening questionnaire domains included self-reported height and weight, recent participation in organized weight loss programs, ability to walk one mile unassisted, current medication use, smoking status, personal medical history of cancer, sociodemographic variables, and recruitment source. RESULTS: Sociodemographic and anthropometric characteristics distinguished between respondents obtained through different recruitment strategies. In particular, women with a higher body mass index (BMI) were more likely than those with lower BMIs (P = .014) to be recruited through more personalized methods (eg, social networking). CONCLUSIONS: Culturally tailored recruitment strategies are critical in securing the participation of members of "hard-to-reach" populations, who are both under-represented in health promotion research and at high risk for chronic diseases.

Medical education in Atlanta and health care of black minority and low-income people.

In this W. Montague Cobb lecture, the author addresses the status of hospitals for the black minority and the poor in Atlanta, the founding of Morehouse School of Medicine, health care for the disadvantaged, the need for minority health care professionals, and the lack of health insurance among the poor. A greater educational effort is needed to bring about change in the high incidence of homicide, the unhealthy lifestyles, and the disproportionate number of AIDS cases in the black population.

The relationship between violent trauma and nonemployment in Washington, DC.

The purpose of this study was to determine the association of violent trauma with nonemployment status of victims and whether victims who knew their assailants were associated with a higher nonemployment rate than victims who did not know their assailants. Data were collected for 585 patients between 18 and 65 years of age. Patients were residents of Washington, DC, who presented with violent injuries to the emergency department at DC General Hospital between November 1989 and November 1990. Study participants were divided into two groups: those who knew their assailants (Group 1, n = 329) and those who did not know their assailants (Group 2, n = 256). The overall nonemployment rate for the sample population was 51% versus 29% for residents in the hospital catchment area (comparison population based on census data) (P < .001). Of patients in Group 1, 61% were nonemployed compared with 38% in Group 2 (P < .0001). Of male patients in Group 1, 55% were nonemployed compared with 33% in Group 2 (P < .0001). Of female patients in Group 1, 71% were nonemployed compared with 69% in Group 2 (P < .80). Results indicate that there is a significant association between victimization from violent trauma and nonemployment of the victim. In addition, male victims familiar with their assailants had a higher nonemployment rate than victims who did not know their assailants. We conclude that nonemployment seems to contribute to the violence in this population.

African-American physicians and smoking cessation counseling.

While African American physicians can play a key role in encouraging black patients who smoke to quit, little is known about the views and activities of these physicians with respect to antitobacco programming. In the process of developing a protocol for encouraging physicians' smoking cessation intervention, 96 African-American physicians completed a survey indicating their knowledge, attitudes, and practices relating to stop smoking counseling. Few physicians reported patient help-seeking behavior and 47.9% cited lack of patient motivation as a key barrier to intervention. Only 46.8% believed that it is possible to accomplish a lot of cessation help in a few minutes time, and 34.4% believed that setting up and maintaining an office protocol would require a great deal of effort. Explaining health risks (71.9%) and enrolling patients in programs (66.6%) were perceived as keys to patient cessation; fewer than half of the physicians surveyed discuss specific strategies for quitting with their patients. Physicians indicated a willingness to offer more counseling in the future and were open to a range of strategies for learning more about effective approaches. Our findings support the need for dissemination of such information, particularly among specialists, to support antitobacco efforts among African-American physicians.

The role of aeromedical transportation in global disaster health care.

There are several unique aspects of aeromedical transportation that render it vital to the overall management of disaster emergencies. Valuable time can be saved in moving medical expertise, supplies, and equipment into the disaster area as well as in moving victims out of the hazardous area quickly and in large numbers. Chaotic ground traffic at and near the disaster scene as well as environmental obstacles en route often may be avoided. Large numbers of disaster victims can be cared for efficiently en route by proportionately fewer health care personnel than is possible using traditional land carriers due to the concentration of many patients in one aircraft. Patients with similar injuries (e.g., burns) can be routed to and concentrated in centralized institutions that specialize in the care of those specific injuries. The plans for execution of the foregoing should include the use of military troop-transport aircraft that may be converted easily for patient transport. Also, military personnel should be involved, as they are part of a highly organized structure that can be mobilized more easily and swiftly than can most civilian organizations. The United States Air Force aeromedical evacuation policies and management structure is reviewed with attention directed toward additions and adaptations of this system needed to allow it to serve global disaster response. Such a highly evolved system will require a governing body with global reach for purposes of coordination and management. The resources for such a system currently exist but such an organization has yet to be formed.

Identity formation and social maladaptation in foster adolescents.

The literature on identity formation in individuals from socially devalued racial and ethnic groups in the United States is summarized. Implications are discussed for a particular segment of at-risk adolescents--those in foster care residential group homes--who have received little published attention. The majority, in large urban centers, are African-American or Latino. These young people bear a disproportionate burden of such societal problems as unintended pregnancy and childbearing, academic underachievement and early educational discontinuation, substance abuse, and, ultimately, homelessness and more individually and socially costly forms of dependency (criminal justice, welfare, or mental health systems). It is postulated that their social maladaptation is reflective of identity disturbances created by the negative images of African-Americans and Latinos perpetuated by the dominant society and unfiltered by optimal parental racial socialization.

Building positive self-image in adolescents in foster care: the use of role models in an interactive group approach.

In a previous article (Yancey, 1992), the literature on identity development in individuals from socially devalued racial and ethnic groups was summarized. It was postulated that the social maladaptation of adolescents in residential group foster care is reflective of identity disturbances created by the negative images of African-Americans and Latinos perpetuated by the dominant society and unfiltered by optimal parental racial/ethnic socialization. The present article describes the development of a pilot preventive mental health intervention, the PRIDE (Personal and Racial/ethnic Identity Development and Enhancement) program, designed to provide components of parenting that are necessary for promoting positive self-image in ethnically marginalized adolescents and that are typically lacking in the group foster care milieu. PRIDE utilizes successful, ethnically relevant role models in interactive group sessions to create a significant cognitive and emotional experience for teens. While the utility of role modeling for at-risk youth is widely accepted, there is little research on the packaging, delivery, and influence of this intervention modality. This study demonstrates the feasibility of a "hybrid" role-modeling approach (intermediate in intensity of exposure and cost between one-to-one mentoring and career-day programs). Implications for further research on this type of intervention are discussed.