Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System.

OBJECTIVE: To examine the relationship between self-reported body mass index (BMI) and health-related quality of life in the general adult population in the United STATES: RESEARCH METHODS AND PROCEDURES: Using data from 109,076 respondents in the 1996 Behavioral Risk Factor Surveillance System, we examined how self-reported BMI is associated with five health-related quality of life measures developed by the Centers for Disease Control and Prevention for population health surveillance. RESULTS: After adjusting for age, gender, race or ethnicity, educational attainment, employment status, smoking status, and physical activity status, participants with a self-reported BMI of <18.5 kg/m(2) and participants with a self-reported BMI of > or =30 kg/m(2) reported impaired quality of life. Compared with persons with a self-reported BMI of 18.5 to <25 kg/m(2), odds ratios (ORs) of poor or fair self-rated health increased among persons with self-reported BMIs of <18.5 (1.57, 95% confidence interval [CI]: 1.31 to 1.89), 25 to <30 kg/m(2) (1.12, 95% CI: 1.04 to 1.20), 30 to <35 kg/m(2) (1.65, 95% CI: 1.50 to 1.81), 35 to <40 kg/m(2) (2.58, 95% CI: 2.21 to 3.00), and > or =40 kg/m(2) (3.23, 95% CI: 2.63 to 3.95); ORs for reporting > or =14 days of poor physical health during the previous 30 days were 1.44 (95% CI: 1.21 to 1.72), 1.04 (95% CI: 0.96 to 1.14), 1.32 (95% CI: 1.19 to 1.47), 1.80 (95% CI: 1.52 to 2.13), and 2.37 (95% CI: 1.90 to 2.94), respectively; ORs for having > or =14 days of poor mental health during the previous 30 days were 1.18 (95% CI: 0.97 to 1.42), 1.02 (95% CI: 0.95 to 1.11), 1.22 (95% CI: 1.10 to 1.36), 1.68 (95% CI: 1.42 to 1.98), and 1.66 (95% CI: 1.32 to 2.09), respectively. DISCUSSION: In the largest study to date, low and increased self-reported BMI significantly impaired health-related quality of life. Particularly, deviations from normal BMI affected physical functioning more strongly than mental functioning.

Abused boys, battered mothers, and male involvement in teen pregnancy.

BACKGROUND: The relationship between boyhood exposure to physical abuse, sexual abuse, or to a battered mother and subsequent risk of impregnating a teenage girl has not previously been examined. METHODS: In a retrospective cohort study set in a primary care clinic for adult members of a large health maintenance organization, questionnaire responses from 4127 men were analyzed. Respondents provided the age of the youngest female whom they had impregnated, their own ages at the time, and information regarding childhood exposure to physical or sexual abuse and battered mothers. We calculated the prevalence and adjusted odds ratio (OR) for having impregnated a teenage girl according to these 3 adverse childhood experiences, regardless of the male's age at the time of impregnation. Using logistic regression, ORs were adjusted for the male's age at time of survey, race, and education. RESULTS: Nineteen percent of the men reported that they had ever impregnated a teenage girl. During childhood, 32% of respondents had been physically abused, 15% sexually abused, and 11% had battered mothers. Compared with respondents reporting no abuse, frequent physical abuse or battering of mothers increased the risk of involvement in teen pregnancy by 70% (OR: 1.7; 95% confidence interval [CI]: 1.2-2.5) and 140% (OR: 2.4; 95% CI: 1.1-5.0), respectively. Sexual abuse as a boy at age 10 years or younger increased the risk of impregnating a teenage girl by 80% (OR: 1.8; 95% CI: 1.3-2.4); sexual abuse with violence increased the risk by 110% (OR: 2.1; 95% CI: 1.2-3.4). We found a dose-response relationship between the number of types of exposures and the risk of impregnating a teenage girl; men who reported all 3 types of exposures were more than twice as likely to have been involved than those with no exposures (OR: 2.2; 95% CI: 1.4-3.5). CONCLUSIONS: Boyhood exposure to physical or sexual abuse or to a battered mother is associated with an increased risk of involvement in a teen pregnancy-during both adolescence and adulthood. Because these exposures are common and interrelated, boys and adult men who have had these experiences should be identified via routine screening by pediatricians and other health care providers and counseled about sexual practices and contraception. Such efforts may prevent teen pregnancy and the intergenerational transmission of child abuse and domestic violence.

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

CONTEXT: Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. OBJECTIVE: To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. MAIN OUTCOME MEASURE: Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. RESULTS: The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. CONCLUSIONS: A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.

Pharmacologic and dietary therapies in epilepsy: conventional treatments and recent advances.

A number of treatment options are currently available for the medical management of epilepsy. Conventional antiepileptic drugs (AEDs) include phenytoin, carbamazepine, valproic acid, ethosuximide, barbiturates, and benzodiazepines. Although these drugs control seizures, they may also cause blood dyscrasias, sedation, and cognitive impairment. Felbamate, gabapentin, lamotrigine, and vigabatrin are new AEDs believed to cause fewer side effects than conventional medications. Felbamate, however, has been linked with substantially increased incidence of aplastic anemia, and the other new AEDs have been studied for relatively short periods of time. Ketogenic diets, comprised of foods high in fat and low in protein and carbohydrate content, have been reported to improve seizure control. However, these diets are widely acknowledged to be unpalatable, making sustained compliance with dietary restrictions difficult. To promote long-term control of seizures, physicians must consider the side effects of therapeutic interventions for epilepsy, as well as their anticonvulsant efficacy.

Antidepressant use in the elderly: association with demographic characteristics, health-related factors, and health care utilization.

The characteristics of antidepressant use and its correlates were assessed in the four Established Populations for Epidemiologic Study of the Elderly (EPESE) communities (n = 13,074). Women were significantly more likely to be treated with an antidepressant drug than men, and African-Americans were significantly less likely than whites to be using antidepressant medication. Of the health-related measures, poor self-perceived health, polypharmacy, disabilities in activities of daily living, and a history of stroke were associated with the use of antidepressants. Each utilization of health care variable, (number of doctors visits, overnight hospitalization in the past year, and use of a regular doctor), was associated with antidepressant use in at least two of the four communities. After entering variables in a multivariate regression model, higher antidepressant use was significantly associated with female gender, race, poor self-perceived health, and a greater number of contacts with doctors in the past year.

Photostimulation changes the pattern of luteinizing hormone secretion in turkey hens.

Changes in the secretory pattern of luteinizing hormone (LH) were determined in turkey hens during initiation of reproduction. Photosensitive hens were switched from a short day photoschedule of 6L:18D (light:dark) to 14L:10D and serially bled six times during the next 6 weeks of photostimulation and early after ovulatory cycles had begun. The pattern of LH secretion at 0-1 day of photostimulation was characterized by a low baseline concentration of LH with numerous low frequency, high amplitude pulses. This pattern changed at Days 4-5 and 11-12 of photostimulation (hens photostimulated but not yet laying) to a pattern characterized by a high baseline with few ill defined pulses of very short duration. Once the hens had initiated egg production, ovulatory surges of LH (duration of 358 +/- 104 min) were superimposed on the basic pattern seen during photostimulation. The ascending limb of the ovulatory surge was much shorter in duration than the descending limb. No diurnal variation was detected in baseline concentration before or during photostimulation or after egg production had begun. It was concluded that photosensitive turkey hens secrete LH in low frequency; high amplitude pulses superimposed on a low baseline. During photostimulation, this pattern changes to one characterized by a high baseline with few pulses of low amplitude and short duration. This pattern of secretion is stimulatory to the ovary and continues until egg laying begins when it is modified by ovulatory surges of LH, characterized by short duration ascending limbs and longer duration descending limbs, which are superimposed on the high baseline pattern noted during photostimulation.

Coordinate pattern of secretion of luteinizing hormone and testosterone in mature male turkeys under continuous and intermittent photoschedules.

Secretory patterns of luteinizing hormone (LH) and testosterone (T) were determined in sexually mature male turkeys housed under Continuous [14 h light (L): 10 h dark (D), n = 3)] or Intermittent [8 x (1L:2D), n = 3] photoschedules. Jugular vein cannulas were implanted on Day 0 and serial blood samples were taken at 5-min intervals for 12 h on Day 3 and again 4 to 7 d later. Most increases in T concentration were preceded by an increase in LH concentration for both photoschedules. Treatment differences for overall mean T [1.77 +/- .58 (SE) ng/mL], baseline T (.92 +/- .30 ng/mL), T peak number (6.1 +/- 1.2 per 12 h), T peak amplitude (2.77 +/- 1.70 ng/mL), or T peak length (79 +/- 24 min) were not significant (P > .05). The number of LH peaks was greater in the Continuous than Intermittent group (11.7 +/- .6 vs 6.8 +/- 1.4 per 12 h, P < .05), but there were no treatment differences in overall mean LH (4.56 +/- 2.09 ng/mL), baseline LH (4.10 +/- 2.11 ng/mL), LH peak amplitude (2.80 +/- .92 ng/mL), or LH peak length (15.9 +/- 3.1 min). There were no differences in T or LH concentrations between the photo- and scotophases in the continuous group, and pulses of both were seen in both phases in both lighting treatments. It was concluded that minor differences in patterns of LH secretion may occur between Continuous and Intermittent stimulatory lighting treatments in sexually mature male turkeys.

Risky decision making and allocation of resources for leukemia and AIDS programs.

Traditional judgment and decision-making paradigms were expanded to include differential reactions to persons with leukemia or AIDS. Experiments 1 and 2 adopted Tversky and Kahneman's risky-decision-making task and found support for different value functions for the 2 patient groups when choosing between treatment programs. From these results, the subjective value of saving a fixed number of lives appears to be greater for persons with leukemia than for persons with AIDS. Experiment 3 provided additional data concerning differential perceptions of the causes of AIDS. This proved to be a useful means of classifying Ss who did and did not devalue the lives of persons with AIDS.

Nonverbal behavior of the type A individual.

Forty-one health professional students were videotaped during three consecutive conditions: a 5-min wait for a tardy interviewer, the structured interview for determining the Type A behavior pattern, and a 5-min relaxation period. Afterward, subjects were classified as Type A or B based on audiotapes of the interview. The total amount of activity and the frequency or duration of Type A behaviors were compared between Type A and Type B subjects. In all three experimental conditions, Type A subjects moved their arms more than Type B subjects. During both the waiting and the relaxation periods, Type A subjects sat still less and spent more time exploring than did Type B subjects. During the interview, Type A subjects gestured more frequently than Type B subjects. Nonverbal behaviors correctly identified behavior pattern in 71% of the subjects. The addition of nonverbal behaviors improved the discrimination of behavior pattern above that obtained from verbal behavior alone. The greater activity, restlessness, exploratory behavior, and gestures of Type A persons are consistent with the two major etiologies proposed for the Type A behavior pattern.