Adolescents with psychosomatic problems.
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Abdominal Pain↗
Biomedical subjects
R T Brown
Publications and source records attributed to R T Brown.
An acute phase response factor/NF-kappa B site downstream of the junB gene that mediates responsiveness to interleukin-6 in a murine plasmacytoma.
The immediate early gene, junB, is induced by interleukin-6 (IL-6) in plasmacytomas. In order to identify enhancers that mediate this effect, we cloned upstream and downstream sequences flanking the gene into a luciferase reporter gene vector containing the junB promoter and evaluated the IL-6 inducibility of these sequences by transient expression in an IL-6-dependent plasmacytoma cell line. Although a 6.5-kilobase fragment of upstream flanking sequence did not increase the IL-6 inducibility of the junB promoter, a 222-base pair fragment was identified in 2.1 kilobases of down-stream flanking sequence that both up-regulates the promoter and confers inducibility by IL-6. Point mutation of an acute phase response factor (APRF) site within this region significantly reduced up-regulation of the promoter in cells grown continuously in IL-6, as well as inducibility upon restimulation of cells with IL-6 after withdrawal from the growth factor. Point mutation of an NF-kappa B site sharing five nucleotides with the APRF site reduced up-regulation of the promoter but not inducibility by IL-6, whereas mutation of two other NF-kappa B sites in the 222-base pair fragment had no effect on expression. Western blotting of nuclear proteins purified by DNA affinity chromatography revealed inducible binding of Stat3 and constitutive binding of NF-kappa B p65 to the APRF/NF-kappa B site.
Animals↗
Sustained attention and inhibitory control in children with sickle cell syndrome.
Comparing sustained attention and inhibitory control among youth with sickle cell syndrome (SCS) and nondiseased sibling controls, this study found significant differences in multiple components of attention and inhibitory control as a function of chronological age. Older SCS youth were found to have increased attention and reflectivity. Although it has been argued that SCS youth without overt neurological impairments might evidence microvascular infarction, the present study, which employed commonly utilized neurocognitive and behavioral measures, does not lend support to the notion of generalized deficits in the absence of specific laboratory findings. Disease parameters including hemoglobin levels, days hospitalized, and emergency room visits were not significantly correlated with performance on any of the measures. Within the limitations of this particular study, results were interpreted to refute the notion of disease-related neurocognitive impairments for SCS youth. Further, the development of attentional skills for SCS youth is suggested to proceed similarly to that of normally developing youth.
Journal Article↗
A prospective study of adolescents who choose among levonorgestrel implant (Norplant), medroxyprogesterone acetate (Depo-Provera), or the combined oral contraceptive pill as contraception.
OBJECTIVES: Levonorgestrel implants (Norplant) and medroxyprogesterone acetate injections (Depo-Provera) represent additional contraception options for adolescents. The purpose of this study was to examine prospectively clinical profiles among adolescents who chose one of the two long-term contraceptives compared with profiles among those who chose the combined oral contraceptive pill (OCP). METHODS: Girls who needed contraception and did not require confidentiality were presented with a contraceptive menu consisting of Norplant (n = 58), Depo-Provera (n = 66), or OCP (n = 75). At baseline and follow-up visits over 6 months, patients were interviewed regarding gynecologic history, side effect symptoms, and satisfaction. The average age of subjects was 15.5 years (range 11 to 20 years); 66% were African-American and 34% white. RESULTS: Significantly more teens who chose Depo-Provera (73%) reported having used some method of birth control previously than those selecting either Norplant (30%) or OCP (26%). Adolescents who chose either Norplant (34%) or Depo-Provera (43%) were significantly more likely to have been pregnant previously than those choosing OCP (12%). Those selecting Depo-Provera were significantly more likely to report a history of genital infection with Chlamydia trachomatis (42%) than those in the other two contraceptive groups (22%). Prevalences of reported recent depression and fatigue before initiation of treatment were high, exceeding 35% across the three groups. A total of 105 and 40 adolescents were assessed at 3 and 6 months, respectively. At follow-up, more than 80% of OCP users maintained regular menstrual cycles, whereas over 80% of those choosing Norplant or Depo-Provera had disrupted cycles. Complaints of nausea and dizziness among Norplant users and fatigue among Depo-Provera and OCP users increased significantly between the baseline and follow-up visits. Reports of local reactions to the Norplant device were common but not clinically significant. Blood pressure readings, facial acne, and body mass index did not change over time in any treatment group. Subjects in the Norplant and Depo-Provera groups appreciated freedom from daily compliance to maintain contraceptive effectiveness and the "hidden" nature of the method. Appointment compliance at the end of 6 months was 78% for Depo-Provera, 40% for Norplant, and 46% for OCP. CONCLUSIONS: The implant and injection forms of contraception appear to be especially popular among girls with previous pregnancies or birth control use. The common occurrences of medical symptoms and sexually transmitted diseases before initiation of therapy underscore the importance of baseline evaluation. Norplant users may be warned about nausea and dizziness as well as minor local symptoms around the insertion site and unpredictable uterine bleeding patterns. Adolescent patients choosing Depo-Provera may expect amenorrhea by the end of 6 months of therapy along with possible fatigue. Early intervention may be needed with adolescents who choose Norplant or OCP to encourage better compliance with follow-up appointments.
Adolescent↗
The female adolescent athlete and iron.
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Adolescent↗
Psychosocial and family functioning in children with sickle cell syndrome and their mothers.
OBJECTIVE: The purpose of this study was to compare the psychiatric functioning of 61 sickle cell youth and their families with nondiseased sibling controls. METHOD: Functioning assessed by multiple informants included indices of behavioral, cognitive, and family/interpersonal functioning, self-esteem, life events, coping strategies, temperament, adaptive behavior, and parental psychopathology. RESULTS: Key findings were that sickle cell patients evidenced more depressive symptoms and associated attributional style, and externalizing behavioral difficulties than did nondiseased siblings. With age, sickle cell youth evidence increasing adaptive behavior deficits and internalizing symptoms. Illness severity was related to symptoms of internalizing behavior and fewer daily living skills. Associations were found between maternal and child coping. CONCLUSIONS: It is recommended that psychiatric consultations routinely be conducted with these children, particularly at times of family stress and developmental transitions. Psychiatric interventions should focus on ameliorating emotional difficulties via enhancing adaptive coping strategies.
Adaptation, Psychological↗
Parental psychopathology and children's adjustment to leukemia.
OBJECTIVE: The primary purpose of this study was to examine the relationship between parental psychopathology and psychosocial functioning of children in whom acute lymphocytic leukemia (ALL) has been diagnosed. METHOD: The sample consisted of 61 mother-child dyads. Twenty-one (34%) mothers met DSM-III-R criteria for at least one psychiatric disorder based on a Structured Clinical Interview for Diagnosis (SCID). RESULTS: Findings revealed that compared with children whose mothers did not meet DSM-III-R criteria for a psychiatric disorder, children with mothers who evidenced a psychiatric disorder self-reported more anxiety and a maladaptive attributional style and were reported by their mothers as evidencing more depression and a range of internalizing behavioral symptoms. CONCLUSIONS: Although our earlier research suggested that ALL children show relatively few symptoms of psychopathology, the present report reveals high rates of psychiatric difficulties in the mothers of ALL youth. These findings and their implications are discussed within a model that incorporates behavioral pediatrics and developmental psychopathology.
Acute Disease↗
What, me worry? A survey of adolescents' concerns.
Adolescence is generally regarded as a time of transition demanding considerable adaptation. Failing to successfully negotiate the developmental hurdles associated with this period can have serious physical and psychosocial consequences (e.g., teenage pregnancy, suicide, disruption of social relationships, poor school performance). Efforts to identify problems that adolescents typically experience have been useful in facilitating a better understanding of this developmental phase. However, the perceived concerns or worries of adolescents themselves have been neglected as an additional source of useful information. This study assessed the worries of 622 adolescents between the ages of 12 and 20 years on an 80-item self-report measure, the "Things That Worry Me" scale. Findings indicated consistent concerns related to terrorism, adolescents' self-esteem, parents' physical and mental health, and adolescents' dating and sexual relationships. Gender- and race-specific differences are discussed and implications for future research and clinical applications are offered.
Adolescent↗
Costochondritis in adolescents. A follow-up study.
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Adolescent↗
Neurocognitive aspects of pediatric sickle cell disease.
Studies pertaining to the neurocognitive functioning and learning of children in whom sickle cell disease is diagnosed are reviewed, and findings suggest diffuse neurocognitive deficits, with much variability across subjects. A hypothesis is presented about the cumulative nature of such deficits in children who have not sustained cerebral vascular accidents. Important methodological shortcomings in the literature are identified and recommendations are made for future neurocognitive research with children in whom sickle cell disease has been diagnosed. Studies pertaining to the psychosocial development of these children are also reviewed, and it is concluded that behavioral problems, low self-esteem, and disturbances of body image are frequently characteristic of these children. Recommendations are made including early special education and psychosocial intervention programs for children with sickle cell disease.
Adolescent↗
Cognitive, neuropsychological, and academic sequelae in children with leukemia.
The literature concerning the cognitive and neuropsychological sequelae of children in whom leukemia has been diagnosed indicates that these children exhibit deficits in cognitive and neuropsychological functioning and academic achievement in response to the iatrogenic effects of central nervous system (CNS) irradiation. Preliminary studies suggest that similar emanative effects may follow intrathecal chemotherapy, an alternative to CNS irradiation for children given a favorable prognosis. It is concluded that treatment advances have lengthened the life expectancy of many children with leukemia, thereby changing their prognosis to a more favorable one. This has resulted in a recognition of the difficulties accompanying school reentry. In light of their documented neuropsychological, academic, and social adjustment problems, many of these children require special education services.
Achievement↗
Health needs of incarcerated youth.
From a health care point-of-view, the most needy adolescents in the United States are those who become incarcerated in the juvenile justice system. These youngsters have poor health care before incarceration is not much better. Their health problems range from the results of trauma to the consequences of sexual activity to severe psychological problems. Their health needs include: (1) prevention of health problems which contribute to behaviors for which youths are incarcerated; (2) comprehensive assessment and care; (3) continuity of care after discharge from the institutions; (4) comprehensive health education and health promotion; (5) professional, competent health care providers; (6) educated, sympathetic administrators and supervisory personnel; and (7) adequate financing of health services. Concerned health providers must become advocates for these adolescents and for their health care in correctional and political settings.
Adolescent↗
Chemotherapy for acute lymphocytic leukemia: cognitive and academic sequelae.
Iatrogenic cognitive impairments have been reported for survivors of childhood leukemia after prophylactic central nervous system therapy with craniospinal radiation. To determine whether chemotherapy alone might be a source of central nervous system damage, we assessed in a cross-sectional design the cognitive and academic functioning of 48 children with acute lymphocytic leukemia who were at various stages in their treatment or who had completed treatment. The off-therapy patients who had completed a 3-year course of chemotherapy were more impaired in tasks of higher-order cognitive functioning than were those children whose leukemia had been newly diagnosed and those children whose diagnoses had been 1 year earlier. Off-therapy patients also had concomitant diagnosable learning disabilities in mathematics. We recommend appropriate liaison and special education placements, as well as continued evaluation of cognitive and leaning functioning of children treated for moderate-risk acute lymphocytic leukemia who receive chemotherapy alone.
Achievement↗
Psychiatric and family functioning in children with leukemia and their parents.
The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.
Adaptation, Psychological↗
Compliance with breast self-examination instruction in high school students.
In a prospective study, we measured compliance with breast self-examination, using an anonymous questionnaire, in suburban high school students three months (n = 85) and eight months (n = 54) after group instruction. Post-instruction proficiency in performing the procedure and personal health beliefs regarding breast cancer were also evaluated. At three months, 40% of the group reported practicing breast self-examination at some time since instruction; 12% had performed the procedure timed correctly with their menstrual cycle. At eight months, only two girls (4%) had practiced breast self-examination at least once since the three-month evaluation. Proficiency scores overall were high, with 77% scoring 12 points or above on a 15-item questionnaire; however, scores were significantly lower in the 15-year-olds than in the older adolescents. No significant relationships were found between compliance and most personal health beliefs, previous instruction, or level of knowledge of the procedure. Attention should be directed toward assessing the ability and willingness to practice preventive health behaviors before instruction programs are instituted in this age group.
Adolescent↗
Update on pregnancy, condom use, and prevalence of selected sexually transmitted diseases in adolescents.
Adolescent pregnancy and its consequences continue as major sources of morbidity in the United States. A teenager who becomes a parent is at a significant disadvantage in becoming a contributing adult, both psychosocially and economically. The physician who cares for adolescents has the responsibility of helping parenting teens to find needed support so that they will be able to overcome this significant hurdle. Attention from public agencies has focused on increasing condom use as one approach to adolescent pregnancy prevention. The major advantage of using condoms is that they also prevent transmission of sexually transmitted diseases. Of note is that level of knowledge about condoms is not related to their use, and engaging in high-risk behaviors is related to a decreased likelihood of condom use. With rates of condom use estimated at less than 50%, rates of sexually transmitted disease remain high, as reported in recent surveys.
Adolescent↗
Cognitive status of children treated with central nervous system prophylactic chemotherapy for acute lymphocytic leukemia.
Treatment-related cognitive impairments have been reported for survivors of childhood leukemia following prophylactic central nervous system (CNS) treatment with craniospinal radiation. We examined the neurocognitive status of 46 children with acute lymphocytic leukemia (ALL) to assess the impact of a regimen consisting of systemic chemotherapy and prophylactic CNS chemotherapy. By comparing three groups of ALL children (i.e., patients whose diagnosis was recent, patients 1 year postdiagnosis currently receiving CNS prophylactic chemotherapy, and off-therapy patients who had been treated with chemotherapy for 3 years) and their healthy siblings on measures of sequential and simultaneous processing, we were able to examine the effects of CNS prophylactic and systemic chemotherapy at various points during treatment. Results indicate that the children who had received a 3-year course of chemotherapy (off-therapy patients) were more impaired on tasks involving right-hemisphere simultaneous processing than were sibling controls or ALL children whose diagnosis was recent and whose treatment had just begun. Age at diagnosis did not interact with the effects of chemotherapy. These findings support the need for continued evaluation of cognitive functioning in ALL, children receiving CNS prophylactic chemotherapy to identify potential harmful neurocognitive sequelae of treatment.
Journal Article↗
A comparison of never-hospitalized and previously hospitalized adolescents: self-esteem and locus of control.
Few empirical studies have been conducted to determine the influence of hospitalization on adolescents' psychosocial processes because younger children are regarded as more vulnerable. Therefore, the purpose of this self-report, retrospective study of 115 adolescents was to compare the self-esteem and locus of control of the never hospitalized to that of adolescents hospitalized during adolescence, prior to adolescence, and during and prior to adolescence. Although no significant differences were found, the findings raise questions about long-term effects of early experiences, especially among lower socioeconomic status youth. Also, general measures of self-esteem and locus of control may be unable to determine situation-specific effects.
Adolescent↗