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Biomedical subjects

J L Waller

Publications and source records attributed to J L Waller.

At least 19 recordsLinked to original sources
PubMed1998

Prevalence of PTSD in a community sample of older adolescents.

OBJECTIVE: To examine prevalence and correlates of trauma and posttraumatic stress disorder (PTSD) symptoms and diagnosis in older adolescents aged 16 through 22 years. METHOD: The second cycle of a longitudinal epidemiological study in the Southeast included a semistructured interview assessing PTSD symptomatology administered to 490 adolescents. RESULTS: Approximately 3% of female subjects and 1% of male subjects satisfied the DSM-IV criteria for PTSD. Females reported more traumatic events than males, and black subjects reported more events than white subjects. Being female (odds ratio = 12.32), experiencing rape or child sexual abuse (odds ratio = 49.37), and witnessing an accident or medical emergency (odds ratio = 85.02) were associated with increased risk of PTSD. CONCLUSIONS: While relatively few adolescents satisfy the criteria for PTSD, most subjects who experienced a traumatic event reported some PTSD symptoms. Specific types of traumatic events were associated with occurrence of PTSD.

Adolescent↗
PubMed1998

Incidence and predictors of suicidal behaviors in a longitudinal sample of young adolescents.

OBJECTIVE: This analysis examines 1-year transition probabilities and baseline predictors for suicidal behaviors in young adolescents. METHOD: Adolescents from a two-stage, community-based longitudinal study were classified into suicidal behavior categories (attempt, plan, ideation, and none) for baseline and follow-up years. Transition probabilities for movement among categories were calculated, and polytomous logistic regression analysis was used to examine predictors of suicidal behaviors. RESULTS: Among those with no suicidal behaviors at baseline, 1-year incidence rates were 1.3% for attempts and 1.7% each for plans and ideation. Increasing family cohesion was protective for suicide attempts (odds ratio [OR] = 0.9). Female subjects were more likely than males to report plans (OR = 8.9) and ideation (OR = 4.1). Increasing impulsivity (OR = 2.3), prior suicidal behavior (OR = 10.6), and undesirable life events (OR = 1.1) were significant predictors of plans. CONCLUSIONS: While there are a number of predictors of suicidal behaviors, the false-positive rate is high. Focusing on proximal risk factors, particularly stressors in adolescent development, may overlook the fundamental role of underlying mental disorder and familial factors--both biological and environmental. Suicide and suicidal behaviors are the result of a constellation of adverse factors requiring a range of interventions for prevention.

Adolescent↗
PubMed1997

Incidence of major depressive disorder and dysthymia in young adolescents.

OBJECTIVE: An epidemiological study conducted between 1987 and 1989 in a single school district in the southeastern United States investigated the incidence, transition probabilities, and risk factors for major depressive disorder (MDD) and dysthymia in adolescents aged 11 to 16 years. METHOD: Diagnoses were based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, which was administered to 247 mother-adolescent pairs at 12-month intervals. RESULTS: One-year MDD and dysthymia incidences were 3.3% (n = 11) and 3.4% (n = 9), respectively. Transition probabilities demonstrated movement from disorder to no disorder over time. Family cohesion (odds ratio = 0.95) was the only significant predictor of incident MDD. No factors were significant for dysthymia. While baseline MDD was a significant risk factor for depression at follow-up, 80% of subjects with baseline MDD did not meet the criteria for diagnosis at follow-up. CONCLUSION: Findings suggest perceived family support or cohesion may be more important to adolescent mental health than family structure.

Adolescent↗
PubMed1996

Incidence of obsessive-compulsive disorder in a community sample of young adolescents.

OBJECTIVE: To investigate the incidence, transition probabilities, and risk factors for obsessive-compulsive disorder (OCD) and subclinical OCD in adolescents. METHOD: A two-stage epidemiological study originally designed to investigate depression was conducted between 1987 and 1989 in the southeastern United States. For the screening, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children was administered to 488 mother-child pairs. Baseline screening and diagnostic data from the first year the subject completed an interview and follow-up diagnostic data from subsequent years were used. RESULTS: The 1-year incidence rates of OCD and subclinical OCD were found to be 0.7% and 8.4%, respectively. Transition probabilities demonstrated a pattern of moving from more severe to less severe categories. Of those with baseline OCD, 17% had the diagnosis of OCD at follow-up; 62% moved to the referent group. Of those with baseline subclinical OCD, 1.5% had OCD at follow-up and 75% moved to the referent group. Black race (odds ratio [OR] = 23.38), age (OR = 4.02), desirable life events (OR = 0.78), undesirable life events (OR = 1.21), and socioeconomic status (OR not estimable) were significant predictors of incident OCD. Age (OR = 2.30), desirable life events (OR = 0.92), and undesirable life events (OR = 1.13) were significantly associated with incident subclinical OCD. CONCLUSION: An initial diagnosis of subclinical OCD was not significantly predictive of a diagnosis of OCD at 1-year follow-up. The overall morbidity remained higher at follow-up in the baseline OCD group than in the baseline subclinical OCD group. The baseline subclinical OCD group was more dysfunctional at follow-up than was the baseline referent group. Further research concerning differences in symptomatology and impairment between OCD and subclinical OCD is warranted.

Adolescent↗
PubMed1995

Frequency of phobic disorder in a community sample of young adolescents.

OBJECTIVE: To investigate the frequency and phenomenology of clinical, subsyndromal, and subthreshold phobias in young adolescents. METHODS: A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale were administered to 487 mother-child pairs. RESULTS: Prevalence rates of clinical, subsyndromal, and subthreshold phobia were 2.3%, 14.5%, and 22.2%, respectively. One-year incidence rates were 0.4%, 8.0%, and 16.9%, with 43.0% of phobic subjects categorized at the same or a more severe level after a year. Females, blacks, subjects not living with both biological parents, and older adolescents were more likely to meet the diagnostic criteria for clinical phobia. The majority (77%) of subjects with clinical phobia experienced multiple phobias. Subsyndromal (52%) and subthreshold (74%) phobics were more likely to experience simple phobias only. CONCLUSIONS: Phobic symptoms are relatively common at a moderate level and in the majority of adolescents are somewhat transitory in nature. Characteristic symptomatology and comorbidity may facilitate earlier identification of subjects at risk of persistent symptomatology and in need of treatment.

Adolescent↗
PubMed1995

Race and gender differences in the treatment of psychiatric disorders in young adolescents.

OBJECTIVE: Most children and adolescents with mental illness remain untreated. Evidence suggests that race is a factor in the referral of children for treatment. This study examines race and gender differences in treatment of adolescent psychiatric disorders. METHOD: During a two-stage, school-based, epidemiological study of depression, data were collected on 478 adolescents. Instruments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale. RESULTS: Twenty-two percent of the sample had contact with professionals during the prior year, including 56% of adolescents with a psychiatric diagnosis. Significant odds ratios (ORs) were found between all diagnoses and treatment. Trends for undertreatment of females and African-Americans were evident in univariable and multivariable models. The OR (0.34) for African-American females was significant in the multivariable model. African-Americans were significantly more likely to receive only one or two treatment contacts. CONCLUSION: Data suggest race and gender differences in the treatment of adolescent psychiatric disorders. Possible explanations include referral bias, low cultural competence of mental health professionals, and cultural differences in the expression and tolerance of symptoms and help-seeking behaviors. Further study of factors influencing treatment decisions is needed.

Adolescent↗
PubMed1994

Confidence intervals for weighted proportions.

We investigate methods for the construction of confidence intervals for a proportion in a stratified two-stage sampling design with few events occurring in a small number of large, unequal size strata. The critical aspect is the incorporation of the weighting scheme into the construction of a single overall confidence interval. With small numbers of events, the binomial based methods may be inadequate since the normal approximation is not valid. Computer simulations compare coverage probability and bias for five methods of obtaining confidence intervals for proportions by combining: (1) binomial variances; (2) confidence intervals based on the F-distribution approximation to the cumulative binomial; (3) the binomial variance method with exact confidence limits when a zero prevalence occurs in any stratum; (4) confidence intervals based on the F-distribution using a rescaling factor; and (5) the binomial variance method with exact confidence limits using a rescaling factor. The method that performs best in terms of coverage probability is the combination of stratum specific confidence intervals based on the F-distribution using a rescaling factor. The methods involving the binomial variance tend to be negatively biased and the methods based on the F-distribution tend to be positively biased. Application of these methods with data from a study of adolescent depression that employs a stratified two-stage sampling design is consistent with these results.

Adolescent↗
PubMed1992

Major depressive disorder and dysthymia in young adolescents.

A two-stage epidemiologic study conducted between 1986 and 1988 in the southeastern United States investigated the frequency of major depressive disorder and dysthymia in 12-14 year olds. In stage one, the Center for Epidemiologic Studies Depression Scale, a life event schedule, and a family cohesion scale were administered to a community sample of 3,283 adolescents. In stage two, 488 mother-child pairs were interviewed utilizing the Schedule for Schizophrenia and Affective Disorders in School Age Children. Although mean Center for Epidemiologic Studies Depression Scale scores were significantly higher in females (25.60) than in males (19.50), prevalence estimates based on a summary of mother and child symptom reports for Diagnostic and Statistical Manual of Mental Disorders, Third Edition, major depressive disorder were similar: 9.04% in males and 8.90% in females. The prevalences of dysthymia were 7.98% in males and 5.00% in females. Previous investigations have reported lower rates and a female preponderance of major depression. Disagreement between mothers and children regarding the presence of symptoms may explain this contradiction. Significant odds ratios were found between major depression and not living with both natural parents (odds ratio (OR) = 3.89), undesirable life events (OR = 1.09), and perceived family cohesion (OR = 0.96). Not living with both natural parents (OR = 14.67) and socioeconomic status (OR = 0.44) were significant correlates of dysthymia.

Adolescent↗
PubMed1991

Suicidal behaviors in young adolescents.

A two-stage epidemiologic study investigated the frequency of suicidal behavior in children 12-14 years of age. In the first stage, the Center for Epidemiologic Studies Depression Scale, a three-item suicide scale, a life-event schedule, and a family environment scale were administered during 1986 to a southeastern US community sample of 1,542 seventh and eighth grade students. In the second stage, 226 mother-child pairs were interviewed utilizing the Schedule for Schizophrenia and Affective Disorders in School Age Children (K-SADS). Subjects interviewed included students with high depression scores and a random sample of the remaining students. Prevalence estimates for moderate to severe suicidal ideation (K-SADS score greater than or equal to 4) were 4.0% (95% confidence interval (CI) 0.6-16.4%) in males and 8.7% (95% CI 2.4-23.3%) in females. The prevalences of suicide attempts were 1.9% (95% CI 0.0-13.2%) in males and 1.5% (95% CI 0.6-12.7%) in females. Significant relations were found between major depression and both suicide ideation (odds ratio = 6.19, 95% CI 1.53-24.94) and suicide attempts (odds ratio = 9.80, 95% CI 1.89-50.86). The undesirable life-events score was also a significant predictor of suicide ideation and suicide attempts.

Adolescent↗
PubMed1991

A longitudinal study of suicidal ideation in young adolescents.

As part of a longitudinal study of depression and suicidal ideation in adolescents, a three-item suicide screen was administered to 1,073 students for 3 consecutive years starting at the beginning of the 7th or 8th grades. Each year over 70% of respondents reported no suicidal thoughts, and less than 5.5% attained high suicide ideation scores. Blacks and females had higher scores, respectively, than did whites and males. The individual students' suicide scores were less stable than the overall distributions with 1- and 2-year correlations reaching 0.35 and 0.28, respectively. Only one student received a high score all 3 years. The best predictors of a given year's suicide score was the previous years' depression scores. Gender, undesirable life events, family adaptability, and family cohesion were significant but less consistent predictors.

Adolescent↗
PubMed1991

The CES-D as a screen for depression and other psychiatric disorders in adolescents.

The performance of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screen for depression was explored in a two-stage epidemiological study of adolescents. The study consisted of a CES-D screening stage completed by a school sample of 2,465 young adolescents and a structured psychiatric interview stage completed by 332 mother-adolescent pairs. Adolescents with interview validated depression had elevated screening scores (mean = 31.10, SD = 11.30) compared with individuals with no disorder (mean = 21.01, SD = 11.77). Using receiver operating characteristic curves, a cut point of 12 for males produced the best overall screening characteristics (sensitivity = 0.85, specificity = 0.49), while for females, a cut point of 22 was optimal (sensitivity = 0.83, specificity = 0.77).

Adolescent↗
PubMed1989

Automated control of postoperative hypertension: a prospective, randomized multicenter study.

Hypertension after a cardiac operation is a frequent phenomenon. Complications resulting from this include bleeding, disruption of vascular suture lines, subendocardial ischemia, and possible cerebrovascular accidents. Treatment with sodium nitroprusside has become accepted practice to prevent these complications. To improve control of arterial blood pressure, a closed-loop system for sodium nitroprusside administration was developed. A prospective, randomized multicenter study was carried out postoperatively in 180 cardiac surgical patients to evaluate the performance of this system compared with manual control of infusion. Adherence of mean arterial blood pressure to +/- 10% of the target blood pressure occurred 85% of the time with the automatic system and 61% of the time with manual regulation (p less than 0.0001). With the automatic system, there was less hypertension (9% versus 22%; p less than 0.0001) and hypotension (6% versus 22%; p less than 0.0001). The superior control of hypertension was achieved more rapidly with less requirement for nurse regulation of infusion rate. The superior control of blood pressure resulted in less chest tube drainage in the automatic mode (720 mL versus 840 mL; p less than 0.05).

Aged↗
PubMed1988

Contamination reduction during central venous catheterization.

This study examined a simple technique for reducing contamination during catheterization of the internal jugular vein. Sixty patients were assigned randomly to receive either a traditional iodophor skin cleansing or an alcohol cleansing, followed by application of an iodophor-impregnated sterile film. In the cleansed with iodophor alone group, 83% of the anesthesiologists' glove tips were contaminated, and 13% of the catheter tips were contaminated. In contrast, in the group in which the sterile film was employed, contamination of gloves and catheters was virtually eliminated.

1-Propanol↗