Relative risk of irritable bowel syndrome following acute gastroenteritis and associated risk factors.

SUMMARY: A prospective cohort study using electronic medical records was undertaken to estimate the relative risk (RR) of irritable bowel syndrome (IBS) following acute gastroenteritis (GE) in primary-care patients in The Netherlands and explore risk factors. Patients aged 18-70 years who consulted for GE symptoms from 1998 to 2009, met inclusion/exclusion criteria and had at least 1 year of follow-up data were included. Patients with non-GE consultations, matched by age, gender, consulting practice and time of visit, served as the reference group. At 1 year, 1·2% of GE patients (N = 2428) had been diagnosed with IBS compared to 0·3% of the reference group (N = 2354). GE patients had increased risk of IBS [RR 4·85, 95% confidence interval (CI) 2·02-11·63]. For GE patients, concomitant cramps and history of psycho-social consultations were significantly associated with increased risk. GE patients had increased risk of IBS up to 5 years post-exposure (RR 5·40, 95% CI 2·60-11·24), suggesting there may be other contributing factors.

Does ergonomic mismatch at school impact pain in school children?

Musculoskeletal pain in school-aged children is highly prevalent. While there are many potential factors relating to this discomfort, one unexplored factor is the ergonomic mismatch. The objective of this study was to determine whether the degree of mismatch between the body dimensions and the classroom furniture was associated with body discomfort. One hundred and thirty-nine children in a Midwestern U.S. school district participated in the study where demographic information, anthropometric measurements, self-reported regional body discomfort, and furniture measurements were collected. The results indicate an extremely high prevalence of ergonomic mismatch. Contrary to what was hypothesized, the ergonomic mismatch was not associated with body discomfort. The lack of association may have been a result of the extremely high prevalence of ergonomic mismatch as well as potential adaptations by the students. Although almost every student was found to not fit their desk and chairs, ergonomic mismatch had limited impact on the body discomfort. It appears that other factors such as backpack weight and time carrying may contribute more to the discomfort of students. However, caution is stress with regard to dismissing ergonomic mismatch factor as a potential risk factor since the extremely high prevalence may have washed out any effect.

Gender-specific predictors of genital herpes vaccine acceptance in a college population.

Vaccines represent one promising method for reducing the sexually transmitted disease (STD) epidemic. This study evaluated whether influences on the decision to accept a genital herpes vaccine differed by gender. In all, 518 college students completed a questionnaire on sexual history, health beliefs, and acceptance of a potential genital herpes vaccine. Each predictor variable plus a gender interaction term were analysed in separate logistic regression models. Follow-up analyses were performed by gender for outcomes that displayed significant interactions. Results indicated that a prior history of an STD and increased perception of risk for acquiring genital herpes were significant predictors of vaccine acceptance for men, while younger age and concerns about vaccine safety were significant predictors for women. Endorsement of a vaccine strategy targeting sexually experienced people was an influential factor for both genders, but was a much stronger one for women. Results suggest that gender-specific strategies may be crucial to genital herpes vaccine acceptance.

Adolescents' attitudes and experiences regarding levonorgestrel 100 mcg/ethinyl estradiol 20 mcg.

STUDY OBJECTIVE: Oral contraceptive pills (OCs) are a commonly prescribed method of birth control for sexually experienced adolescents. The purpose of the current study was to describe anticipated parental involvement and adolescent compliance with pill taking, and to describe experiences with a 20-mcg OC regarding satisfaction and side effects after six cycles. DESIGN: Anticipated parental involvement and anticipated compliance, and experiences with an OC, were assessed at baseline, and after the first and sixth cycles during a clinical trial of oral contraceptives, which required parental consent. SETTING: Three adolescent medicine clinics in New York, NY; Cincinnati, OH; and San Juan, Puerto Rico. PARTICIPANTS: The sample consisted of 43 female adolescents with a mean age of 17 years. RESULTS: The majority of adolescents living with a parent anticipated parental involvement, and few adolescents anticipated difficulties with consistent pill taking. For two side effects (weight and mood changes), more than 30% of the adolescents anticipated the occurrence or worsening of side effects. However, few adolescents actually experienced increases in any of the nine side effects assessed. Ninety-seven percent of adolescents in this trial reported being satisfied with a 20-mcg OC. CONCLUSIONS: Health care providers can assess adolescents' anticipated difficulties with compliance with daily pill taking, and desire for help from their parents. This information can be incorporated into counseling to promote consistent and correct use.

Sexual initiation: predictors and developmental trends.

BACKGROUND: Early initiation of sexual intercourse is associated with increased risk for acquiring sexually transmitted diseases. GOAL: To examine variables related to sexual initiation and developmental changes in the reasons why adolescent girls have sexual intercourse. STUDY DESIGN: A longitudinal study of girls recruited from an adolescent medicine clinic was performed. RESULTS: Logistic regression showed that girls who described their families as being expressive, having a moral-religious emphasis, providing supervision, and having greater maternal education, and who experienced menarche at an older age were older at sexual initiation. On the basis of contingency analyses, younger girls were less likely to report attraction or love, and more likely to report peers having sex as a reason for sexual intercourse at initiation. A generalized estimating equation analysis indicated that girls at younger ages are more likely to report curiosity, a grown-up feeling, partner pressure, and friends having sexual intercourse as reasons for intercourse. Girls at older ages are more likely to report a feeling of being in love, physical attraction, too excited to stop, drunk or high partner, and feeling romantic as reasons for having sexual intercourse. CONCLUSIONS: Prevention programs should include a focus on familial characteristics and susceptibility to peer norms. They should be conducted with sensitivity to the developmental changes in intimate relationships that occur during adolescence.

Adolescent girl's coping with an STD. Not enough problem solving and too much self-blame.

STUDY OBJECTIVE: Approximately three million teenagers are infected with an STD each year. The ways in which an adolescent girl copes with an STD may have implications for future risk and for psychological adjustment. The purpose of the current study was to compare whether coping with an STD was similar to coping with other stressors. SETTING: Urban, hospital-based adolescent medicine clinic. DESIGN AND PARTICIPANTS: Sixty-seven girls with a mean age of 15.9 (sexual debut was 13.8) yr completed the KIDCOPE in response to both an STD acquisition and an interpersonal stressor within the previous 6 months. RESULTS: Problem solving was used less often, and self-blame was used more often, in response to an STD acquisition. Frequency of use of self-blame was not correlated with perceived helpfulness. CONCLUSIONS: These findings suggest that clinicians need to help adolescent girls manage STD acquisition from the perspective of problem solving rather than self-blame.

Early exposure to lead and juvenile delinquency.

Cross-sectional studies have reported an association between lead (Pb) levels in bone and delinquent behavior in later childhood and adolescence. This is the first prospective longitudinal study of Pb and child development to address this question with comprehensive assessments of toxicant exposure and other developmental cofactors. A prospective longitudinal birth cohort of 195 urban, inner-city adolescents recruited between 1979 and 1985 was examined. Relationships between prenatal and postnatal exposure to Pb (serial blood Pb determinations) and antisocial and delinquent behaviors (self- and parental reports) were examined. Prenatal exposure to Pb was significantly associated with a covariate-adjusted increase in the frequency of parent-reported delinquent and antisocial behaviors, while prenatal and postnatal exposure to Pb was significantly associated with a covariate-adjusted increase in frequency of self-reported delinquent and antisocial behaviors, including marijuana use. Use of marijuana itself by Cincinnati Lead Study (CLS) teens was strongly associated with all measures of delinquent and antisocial behavior. This prospective longitudinal study confirmed earlier clinical observations and recent retrospective studies that have linked Pb exposure with antisocial behavior in children and adolescents. Both prenatal and postnatal exposure to Pb were associated with reported antisocial acts and may play a measurable role in the epigenesis of behavioral problems independent of the other social and biomedical cofactors assessed in this study.

Evaluation of workers' perceived sense of slip and effect of prior knowledge of slipperiness during task performance on slippery surfaces.

Forty healthy industrial workers (age: 41.0+/-14.9 years) were tested for postural stability for three simulated tasks: (1) standing upright; (2) rapid trunk movement; and (3) lateral reach during lifting. These tasks were performed on four levels of slippery surfaces under different environmental lighting with new or workers' own old shoes. Prior to postural stability tests, each subject was given the opportunity to assess the surface slipperiness that he or she would encounter in the subsequent postural stability tests. A perceived sense of slip (PSOS) scale was administrated immediately after each test to determine subjects' PSOS. Subjects' postural sway and instability during task performance was determined by using a strain gauge type force platform. Results from this study indicate that subjects who were cautious in assessing surface slipperiness had less postural instability during task performance. Subjects could perceive the likely slips due to the change in task (p=0.0001) and surface slipperiness (p=0.0001). The PSOS scale is reproducible, easy to use, and provides a simple way to evaluate potential slip hazards in the workplace. Results from this study should aid understanding of the factors critical to maintaining postural stability on slippery surfaces, and will help to develop guidelines for safety training and identify slip hazards in the workplace.

Factors influencing condom use and STD acquisition among African American college women.

To identify factors that influence condom use and the risk of acquiring sexually transmitted diseases (STDs) among African American college women, the authors surveyed a sample of 123 sexually experienced undergraduate women at a state university. The college women who were older, had initiated sex earlier, or had more recent sexual partners were more likely than others in the study to report a history of an STD. The findings have implications for prevention and intervention programs for African American college women.

Attitudes regarding vaccinations of STDs and other diseases.

The purpose of this study was to examine, among 2 groups of individuals with different risk profiles, the similarity of their attitudes towards vaccines for sexually transmitted diseases (STDs) and non-STDs. Subjects were recruited from an undergraduate psychology class at an urban university (n=518) or were participants in genital herpes vaccine trials (n=87). The participants were asked to complete a questionnaire regarding their attitudes about vaccines for selected diseases. The results of this study revealed that, in general, both groups supported vaccination for most diseases. There were differences, however, between groups regarding 3 diseases: measles, genital warts, and chlamydia. The vaccine trial participants were more likely to accept vaccines for measles and the college students were more likely to accept vaccines for chlamydia and genital warts. The results of this study suggest that negative attitudes regarding vaccination to control STDs may not be a significant barrier to use.

College students' knowledge and perceptions of genital herpes.

Given the rising prevalence of herpes simplex virus type 2 (HSV-2) and the lack of accurate information about STDs in general, it is important to understand specific aspects of knowledge and attitudes regarding genital herpes acquisition among college students. This study examined the knowledge and attitudes regarding HSV-2 among college students by recruiting subjects (n=518) from an undergraduate psychology class to complete a questionnaire. The percentage of students answering individual knowledge items correctly ranged from 67% to 99%. The media was a common source of information, and almost one-third of the students anticipated that their care provider would think negatively of them should they acquire the disease. There were gender differences in care-seeking behaviour, knowledge, and attitudes, with females having a more negative view of themselves if they acquired the disease. This study pointed to the challenges in ensuring accurate knowledge about genital herpes that will encourage preventive behaviours without causing undue alarm or shame.

Relationship between serum glucose and injury severity score in childhood trauma.

PURPOSE: The aim of this study was to examine the relationship between initial serum glucose and injury severity score (ISS) in children with multiple trauma. METHODS: Charts from all patients 0 to 19 years of age admitted to a children's hospital in 1995 with acute multiple trauma were reviewed. Data collected included initial serum glucose level, heart rate (HR), systolic blood pressure (SBP), Injury Severity Score (ISS), age, gender, location of trauma, and need for intravenous fluids or epinephrine. Data were analyzed using multiple linear regression. RESULTS: A total of 185 charts were reviewed. The mean ISS was 11.3; the mean glucose was 162.8 mg/dL. After adjusting for age, gender, HR, SBP, and administration of epinephrine or fluid bolus, a significant direct relationship between serum glucose and ISS was found (r = 0.52, P < .01). A stronger relationship was found in children less than 2 years old (r = 0.60, P = .04). CONCLUSIONS: A significant direct relationship exists between glucose and ISS in children with multiple trauma. High glucose values may indicate more severe injury, especially in children less than 2 years old.

College students' attitudes regarding vaccination to prevent genital herpes.

BACKGROUND AND OBJECTIVES: Vaccines represent an important strategy for the control of infectious diseases but are only effective if accepted by the public. Unique attitudinal issues may affect usage of vaccines to control sexually transmitted diseases (STDs). The object of this study was to examine among college students factors that may influence acceptance of a vaccine against genital herpes. GOALS: To examine attitudes regarding acceptance of vaccination for genital herpes by college students using aspects of health behavior theories. STUDY DESIGN: Subjects were recruited from an undergraduate psychology class to complete a questionnaire regarding attitudes and beliefs about receiving a potential genital herpes vaccine. RESULTS: Of the 518 subjects, 100 would not get the vaccine, 207 would, and 211 were unsure. In the final models, factors that influenced acceptance were low cost and an opinion that the vaccine should be recommended for everyone. Those who were unsure were more likely to be influenced by an opinion that the vaccine would be unsuccessful. While not remaining in the final models, those who believed they were at low risk of acquiring genital herpes were unlikely to accept a genital herpes vaccine. CONCLUSIONS: Our results indicate that most college students would not reject vaccination, a priori, against genital herpes. Vaccine acceptance may be maximized if vaccine cost is low, the public is educated regarding risk of acquiring genital herpes, and public health policy encourages universal vaccination.

Locus of control for general health and STD acquisition among adolescent girls.

PURPOSE: To examine adolescent girls' perception of control over general health and sexually transmitted disease (STD) acquisition. METHODS: Adolescents participating in a longitudinal study were asked questions regarding their perception of their locus of control. These questions, adopted from a previous measure, focused on six loci: internal control, control by parents, partners, peers, and health care providers, and chance. RESULTS: There were 128 girls (mean age, 17 years; range, 14.5 to 18.8); 82% were black and 18% white. Statistically significant associations were found between control of general health and STD acquisition for each locus of control subscale, with the exception of partner control. However, the girls reported significantly less control over STD acquisition than over general health for health care providers, parents, and by chance, and significantly more partner and internal control over STD acquisition than general health. The correlations between parental control over general health and over STD acquisition were inversely correlated with age. Partner control was positively related to current condom use, but internal control was not. CONCLUSIONS: The degree of the locus of control was specific for STD acquisition. Girls who believe they should be able to control STD acquisition may not be using condoms. The view of partners as having control over STD acquisition may represent joint communication or coercion. However, in general these findings support the development of female-controlled methods for STD prevention, such as topical microbicides.

Potential significance of airborne fiber dimensions measured in the U.S. refractory ceramic fiber manufacturing industry.

BACKGROUND: To determine dimensions of airborne fibers in the U.S. refractory ceramic fiber (RCF) manufacturing industry, fibers collected through personal air sampling for employees at RCF manufacturing and processing operations have been measured. METHODS: Data were derived from transmission electron microscopy analyses of 118 air samples collected over a 20-year period. RESULTS: Characteristics of sized fibers include: diameter measurements of <60; 0.19 to 1.0 micron, m of which 75% are less than 0.6 micron and length ranging from < 0.6 to > 20 micron, with 68% of fibers between 2.4 and 20 micron. CONCLUSIONS: Exposures in RCF manufacturing include airborne fibers with dimensions (diameter < 0.1-0.4 micron, length < 10 micron) historically associated with biological effects in pleural tissues. Air sampling data and a review of studies relating fiber size to pleural effects in animals and humans support the belief that information on fiber dimensions is essential for studies with synthetic vitreous fibers.

Adolescents' views regarding sexual history taking.

To address the health needs of adolescents, health care providers need to understand adolescent perceptions of the sexual history taking process. Adolescents (n = 113) were recruited from two sources of health care to complete a questionnaire regarding sexual history taking issues. The results revealed that there were differences in demographics, practice characteristics, and communication strategies between the private office and the hospital clinic. Attitudes and beliefs related to the discussion of sensitive issues were similar. Most adolescents would like health care providers to discuss sensitive topics directly. It is important for health care providers to feel comfortable initiating discussion of sensitive issues directly.

PIP: This study described adolescents' perception of their sexual history taken by health care providers. There were two stages of data collection. The first included focus group discussion, while the second was the administration of a sexual history-taking questionnaire. Adolescents were recruited from three locations (private pediatric practice, adolescent clinic setting, or a Job Corps Center) and were of a mean age of 16 years. Findings revealed differences in demographics and practice characteristics, as well as in strategies used when communicating with the care provider. However, there were similarities in attitudes and beliefs related to the discussion of sensitive issues. The majority of the adolescents believed that issues related to sexuality were important for their health care provider to discuss. Moreover, they preferred that their care provider address sexuality issues within a generally caring context; however, they also favored a direct approach.

Relationship between perceived parental monitoring and young adolescent girls' sexual and substance use behaviors.

STUDY OBJECTIVE: The purpose of the study was to examine the independent effects of perceived parental monitoring on sexual experience, contraceptive, and substance use. DESIGN, SETTING, AND PARTICIPANTS: Adolescent females at an urban-based adolescent clinic (N = 174; 41% sexually experienced) rated the extent to which they were directly and indirectly monitored by their parents. MAIN OUTCOME MEASURES: These perceptions were compared with reported contraceptive use as well as substance use. Direct parental monitoring was best described using two dimensions: direct monitoring and direct monitoring when with peers. RESULTS: Direct monitoring was found to be associated with the use of hormonal birth control methods at last intercourse. Direct parental monitoring when with peers was found to be associated with less use of alcohol and cigarettes. CONCLUSIONS: These data suggest that parental monitoring is a relevant factor for primary care physicians to explore during treatment.

Heterosexual romantic relationships and sexual behaviors of young adolescent girls.

PURPOSE: To compare the heterosexual romantic relationships of a cohort sexually experienced and sexually inexperienced adolescent girls, to describe the perceptions of the appropriateness of the age of first intercourse, and to evaluate the reasons why sexually experienced girls chose to have sexual intercourse the first and the most recent times they had sexual intercourse. METHODS: Girls (n = 174) with a mean age of 14.5 years were recruited from an urban-based adolescent clinic to participate in a longitudinal study of psychosexual development. The subjects were interviewed regarding their views about relationships and sexual behaviors. For the purposes of this study, data were analyzed from the first wave of data collection. RESULTS AND CONCLUSIONS: The results of this study revealed that sexually experienced girls were more likely than sexually inexperienced ones to share unique information and spend time with their boyfriends, and to anticipate that their relationships would last longer. Regardless of sexual experience, 35% of their relationships were not mutually exclusive, which places the sexually experienced girls at risk for sexually transmitted infections. Most of the girls felt that they had been "too young" at the time of first intercourse. The reasons the adolescent girls gave for having intercourse the first time and the most recent time were correlated. It would be useful to incorporate the results of this study into subsequent research which identifies strategies to aid girls to postpone the initiation of intercourse, and maintain exclusive sexual relationships. Helping sexually experienced girls to consider why they have had intercourse in the past can aid future decision-making.

Adolescent girls' perceived prevalence of sexually transmitted diseases and condom use.

Little is known concerning sexually experienced and inexperienced adolescent girls' perceptions of the prevalence of condom use and sexually transmitted diseases (STDs). Girls (n = 174; 41% sexually experienced) rated the prevalence of condom use among friends and STDs among male and female friends and adolescents in general. Girls perceive the prevalence of STDs similarly across both gender and level of familiarity. For the most part, however, the girls perceived the prevalence among boys and girls more similarly than among friends and adolescents in general. No significant differences were found between sexually experienced and inexperienced girls in perceptions of condom use prevalence, but girls with a history of STD perceived condoms as used less frequently. Girls with an STD history perceived STDs as the most prevalent, followed by sexually inexperienced girls and then sexually experienced girls without a history of an STD. After an adolescent girl initiates sexual intercourse, STD experience could be a key variable in affecting her perceptions. Prevention programs can incorporate an understanding of patients' perceptions of condom use and STDs.

Impact of demographics, sexual history, and psychological functioning on the acquisition of STDS in adolescents.

Sexually transmitted diseases (STDs) are associated with significant morbidities for adolescents. This study sought to determine the relationship of demographic characteristics, sexual history, and psychological characteristics to actual acquisition of STD. Adolescents were recruited from their source of primary care: 44 males and 88 females matched on age and race. A series of logistic regression analyses were used to determine which of the independent variables were significantly associated with self-reported STD occurrences. When age, race, and gender were pretested, older age and being female were found to be associated with more episodes. The final model consisted of older age, female gender, greater number of lifetime partners, perceived greater frequency of STDs among adolescents in general, less negative feelings about STD acquisition, and being less likely to believe your friends would think you were bad. The findings indicate that acquisition of an STD is related to the demographic characteristics of age and gender, as well as to the number of lifetime partners and attitudes about STD acquisition. This information can be used to develop intervention programs.