Estrogen replacement therapy and female athletes: current issues.

Physicians commonly recommend estrogen replacement as treatment for exercise-associated amenorrhoea. While the evidence shows that the basis of the amenorrhoea is estrogen deficiency, it is not clear that it is the only factor in the development of lowered bone density found in oligo-amenorrhoeic female athletes. Nutritional factors, significant in the development of the reproductive dysfunction, could also contribute to bone loss. No randomised, controlled studies of estrogen replacement in athletes have been published. However, one nonrandomised study of a small group of athletes does suggest that there are significant gains in bone density to be made by the initiation of estrogen therapy. More research is clearly needed.

Tamoxifen in breast cancer: symptom reporting.

Clinical studies have traditionally identified treatment-specific side effects by comparison of voiced side effects in treatment and placebo arms of a study. Highly motivated women in a clinical trial may underreport drug-induced symptoms for medications which may be considered lifesaving. Affective symptoms during treatment of early breast cancer with tamoxifen (an estradiol receptor antagonist) were reported as infrequent by the manufacturer. However, reports suggest a higher rate of depression during general use. The objective of the present study was to examine the frequency of symptoms that might be side effects of tamoxifen and to relate them to the way the women attributed such symptoms. The exploratory study involved semistructured telephone interviews of 25 women who were taking tamoxifen. Textual analysis of the information was used to examine the symptoms described by the women. They were also asked whether any symptoms were related to the medication. The symptoms and their attribution were evaluated against a background of self-perceived stress. The principal finding was a pattern of ambivalence in attributing symptoms to the drug. Of all the symptomatic changes noted, the women only attributed 51% to tamoxifen. Flushes, fatigue, and depression were reported most frequently during treatment; flushes were readily attributed to tamoxifen but depression and fatigue were attributed to another factor by half of the symptomatic women. Women who reported moderate to high levels of life stress were less likely to attribute symptoms to drug therapy. The results suggest that women taking tamoxifen may not attribute known drug side effects to use of the medication.

Psychological well-being and coping patterns in infertile men.

OBJECTIVE: To determine whether differences existed in mood and coping styles among fertile men, oligoasthenospermic men, or euspermic men whose wives were undergoing ovulation stimulation with clomiphene and IUI. DESIGN: A cross-sectional research design. SETTING: Hospital-based academic fertility clinic. PATIENT(S): 30 fertile men with currently pregnant wives, 30 euspermic and 30 oligoasthenospermic men in couples undergoing ovulation stimulation with clomiphene and IUI. INTERVENTION(S): Measures of psychological well-being and coping were administered. MAIN OUTCOME MEASURE(S): Biodemographic information, and psychometric measures of mood and coping. RESULT(S): There were no significant differences among the groups on any of the measures except the Family Inventory of Life Events (FILE), in which fertile men reported higher stress levels. FILE scores in all groups were moderate, indicating typical levels of family stress. CONCLUSION(S): Mood and coping in the three groups were similar. This study suggests that men's psychological adjustment to their own infertility and to unexplained infertility is generally healthy.

Irritability and sociability in women with symptomatic premenstrual change.

Sociability and irritability are commonly cited symptoms of premenstrual syndrome but there has been little investigation of these cycle related changes using clearly defined test instruments. We examined the two symptoms using symptom specific subscales from the Multiscore Depression Inventory (Berndt, 1983). Clear and consistent cycle related changes in irritability and sociability were seen in 20 women with prospectively validated symptomatic premenstrual change but not in a control group of 8 women without symptomatic premenstrual change. The study suggests that these variables can be measured using specific brief scales.

Prolonged cancer death. A family affair.

The frequency with which families have to deal with cancer death is increasing as the population ages. The prevalence of some cancers in younger people is also increasing. In this article the authors focus on helping families deal with the anticipated cancer death of a family member. The article includes a definition of those groups of people who form families in the 1990s and examines dimensions along which families vary such as belief systems. We discuss the needs of families when a family member has a terminal cancer diagnosis and outline coping strategies that are seen in families and ways in which nurses and other health care professionals can facilitate adaptive coping.

Intermenstrual affect in women with symptomatic premenstrual change.

To determine whether women seeking treatment for symptomatic premenstrual change have ongoing psychological disturbance, we undertook a cross-sectional, comparative study across four groups of reproductive-age women. Subjects were 35 patients with symptomatic premenstrual change and no psychiatric history, 35 women without symptomatic premenstrual change, 35 patients with affective disorders, and 35 women from the community at large. All women except those in the community sample were tested in the intermenstrual phase (after menses but before the 12th cycle day). Psychological tests administered were Profile of Mood States, State-Trait Anxiety Inventory, Institute for Personality and Ability Testing (IPAT) Anxiety Scale, IPAT Depression Scale, General Health Questionnaire and the Family Inventory of Life Events (FILE). Demographic data and information concerning present and past stresses were also collected. Women with symptomatic premenstrual change were distinguishable from psychiatric patients on assessment of intermenstrual mood state. They were no different from women within the community at large or from non-symptomatic women. When symptomatic women reported on time periods, which include the premenstrual phase of the cycle, we found results at variance with those obtained in relation to current state mood. While not unlike the women from the community at large in longer term affective characteristics, they were consistently different from non-symptomatic women and sometimes indistinguishable from psychiatric patients. Women with symptomatic premenstrual change also reported higher levels of past external stresses than women taken from the community at large.

Fluid intake in women with premenstrual syndrome.

Fluid intake was measured at 3 phases of the menstrual cycle in twenty women with prospectively validated premenstrual syndrome and 8 women with prospectively validated absence of cyclic symptoms. There was no cycle related change in fluid intake in either group but fluid intake was significantly lower in women with PMS than in controls at all phases of the menstrual cycle. All subjects but one denied voluntary fluid restriction. The mechanism, therefore, appears subconscious and may be related to perceived increase in fluid retention.

"So mean and cranky, I could bite my mother": an ethnosemantic analysis of women's descriptions of premenstrual change.

Textual analysis was used to examine responses to an open ended question about women's experiences of premenstrual change. The question was the final item of the Premenstrual Assessment Form (PAF), a retrospective PMS questionnaire. Of the 336 women who answered the PAF, 261 provided a written narrative summary. We found a logical hierarchy of distinctions covering the presence or absence of changes, their timing, and attributive aspects, and a final cumulative distinction in which women provided information about the consequences of their premenstrual change. Although attribute aspects mirrored the PAF, distinctions in timing and in the cumulative effect of changes differed. The analysis suggests that questionnaires could be designed which more precisely reflect premenstrual change.

Preventing Sexually Transmitted Diseases: Effecting behavioural change.

The discouraging results of early efforts to educate the public about sexually transmitted diseases indicated that the goals of STD preventive action must be longer term and must change attitudes and behaviour as well as educate. They must also avoid an ostrich mentality about the sexual involvement of young people. This article examines more recent approaches to teaching about sexuality in general and STD prevention in particular.

Chlamydia trachomatis: Clinical aspects of preventing tubal infertility and ectopic pregnancies.

Genital infection with Chlamydia trachomatis is common, often asymptomatic, yet capable of causing extensive pelvic damage leading to infertility and tubal ectopic pregnancy. Reducing the impact of chlamydial infection involves developing and applying reliable criteria for screening sexually active adolescents and adults, using accurate screening methods for both women and men, ensuring that patients comply with the very effective treatment regimens, and effecting behavioural change that will diminish the risk of STD transmission.

Assessment of premenstrual complaint using the Premenstrual Assessment Form: comparison of two populations.

The Premenstrual Assessment Form (PAF) provides frequencies of diagnoses for subjects meeting the criteria for typological classifications which are similar in New York and Edmonton, suggesting that the instrument is stable in assessing premenstrual complaint. However, the frequency with which an unselected population meet the criteria suggests that more strict criteria and/or a "severity index" would be appropriate. It seems likely that a modified form of the PAF could fulfil some of the intentions of its originators.

Menstrual mythology and sources of information about menstruation.

Surveys suggest that, despite extensive scientific knowledge of the biologic rhythms and physical changes associated with reproduction and despite the availability of excellent educational material about sexuality including menstruation, young peoples' knowledge of reproductive physiology is inadequate. Superstitions, illogical beliefs, and misinterpretations are more common than accurate understanding. The present article reviews menstrual mythology and describes sources of information for young people. Family and specialist physicians as well as educators in school or in the community need to recognize the limitations of the present methods of sexuality education, must realize that understanding of reproductive processes may be very incomplete, and should be prepared to work cooperatively with informal sources of information (peers, parents, and commercial companies). In addition, menstrual education needs to move away from the focus on hygienic management to that of healthy sexuality and acceptance of self.

Frequency and severity of premenstrual symptoms in women taking birth control pills.

A retrospective study of a wide range of premenstrual symptomatology using the Premenstrual Assessment Form found little difference between women taking a low-dose birth control pill and non-pill-takers. These data are in keeping with older, but narrower, studies of women taking high-dose pills and raise questions about mechanisms of symptomatic and subclinical premenstrual changes.

Towards a definition of PMS.II: A factor analytic evaluation of premenstrual change in women with symptomatic premenstrual change.

We have examined the value of the Premenstrual Assessment Form (PAF) in 109 women with prospectively validated symptomatic premenstrual change. Results were compared with those of non-complaining women previously published (J Psychosom Res 1990; 34: 439-446.), there was considerable overlap in categorical and numerical scales so that selection of homogeneous populations of complainers could not be achieved. However, fewer than 7% of complainers had a total PAF numerical score in the normal range (defined as 2 SD above the mean total score of controls). Factor analysis of numerical scores in women with symptomatic premenstrual change suggested three factors similar to but not identical with those of non-complaining women. These were physiological depression, anxiety-volatility and increased well-being. While the negative syndromes are compatible with clinical experience, prospective investigation will be required to assess their homogeneity.

Premenstrual anxiety and depression: comparison of objective psychological tests with a retrospective questionnaire.

Increased anxiety and depression are among the most frequently reported psychological problems in women seeking help for severe symptomatic premenstrual change, but there has been little objective evaluation of these symptoms. We therefore examined the results of objective psychological testing in 40 women with no apparent psychiatric or psychological disorder who had reported moderate to extreme increased anxiety and depression on a retrospective assessment form. Scores on the State-Trait Anxiety Inventory and Institute of Personality and Ability Testing (IPAT) Depression Scale increased from the low symptom intermenstrual phase of the cycle (days 5-10) to the premenstrual phase (within the last 6 days of the cycle), suggesting that retrospective complaints of increased premenstrual anxiety and depression can be confirmed on objective psychological assessment. However, it was observed that the distribution of intermenstrual IPAT depression scores was bimodal. Cyclic changes varied among the tests depending upon the IPAT depression score. The study suggests that 2 populations may exist in this screened sample; one population appears to have "pure PMS" and the second groups manifests a premenstrual exacerbation of subclinical depression.

Towards a definition of PMS: a factor analytic evaluation of premenstrual change in non-complaining women.

Symptomatic premenstrual change remains enigmatic and much disputed. To establish baselines in a non-complaining population, we administered the Premenstrual Assessment Form (PAF) to 133 volunteers not seeking or using treatment for premenstrual symptoms. The PAF, a 95-item self report questionnaire, provides categorical, bipolar and quantitative data on a wide range of premenstrual symptoms. Only 27 women (20.3%) failed to meet criteria for at least one of the negative PAF syndromes suggesting that the criteria are lax for clinical investigative purposes. Most common syndromes were minor and major depressive syndromes (87, 65%) with atypical and hostile subtypes most common, general physical discomfort syndrome (82, 61.7%) and fluid retention syndrome (71, 53.4%). Factor analysis was used with the quantitative data to group symptoms. The analysis suggested three factors: a physiological depression (depression with physical change), an anxiety-volatility, and an increased well-being unrelated to other changes. The clearer delineation of premenstrual changes in non-complaining women will define the control group in research with premenstrually symptomatic complainers.

Advocacy, prejudice, and role modeling in the deaf community.

Prejudiced attitudes toward deaf people are a well-established phenomenon (Higgins & Nash, 1982; Moores, 1982; Quigley & Kretschmer, 1982). In recent years, however, a new phenomenon has appeared, and some members of the deaf population now openly express prejudice against the hearing (Boros & Stuckless, 1982; Nash & Nash, 1981). The phenomenon may be an interesting example of Allport's (1954) classical analysis: The victims of the prejudice may tend to reciprocate and/or internalize the prejudice to which they have been exposed. The purpose of our analysis is to examine this phenomenon in more detail, particularly from the perspective of social learning theory as described by Bandura and Walters (1963), Walters (1966), and Bandura (1977).