Asthma and internalizing behavior problems in adolescence: A longitudinal study

Objective: Clinical studies of asthmatic children have found an association between lung disease and internalizing behavior problems. The causal direction of this association is, however, unclear. This article examines the nature of the relationship between behavior and asthma problems in childhood and adolescence. Methods: Data were analyzed on 5135 children from the Mater University Study of Pregnancy and its outcomes (MUSP), a large birth cohort of mothers and children started in Brisbane, Australia, in 1981. Lung disease was measured from maternal reports of asthma/bronchitis when the children were aged 5 and maternal reports of asthma symptoms when the children were aged 14. Symptoms of internalizing behaviors were obtained by maternal reports (Child Behavior Checklist) at 5 years and by maternal and children's reports at 14 years (Child Behavior Checklist and Youth Self Report). Results: Although there was no association between prevalence of asthma and externalizing symptoms, asthma and internalizing symptoms were significantly associated in cross-sectional analyses at 5 and 14 years. In prospective analyses, after excluding children with asthma at 5 years, internalizing symptoms at age 5 were not associated with the development of asthma symptoms at age 14. After excluding children with internalizing symptoms at 5 years, those who had asthma at 5 years had greater odds of developing internalizing symptoms at age 14. Conclusion: Children who have asthma/bronchitis by the age of 5 are at greater risk of having internalizing behavior problems in adolescence.

A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample

This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings. (C) 2003 Elsevier Ltd. All rights reserved.

Valerian does not appear to reduce symptoms for patients with chronic insomnia in general practice using a series of randomised n-of-I trials

Objectives: To investigate the effectiveness of valerian for the management of chronic insomnia in general practice. Design: Valerian versus placebo in a series of n-of-1 trials, in Queensland, Australia. Results: Of 42 enrolled patients, 24 (57%) had sufficient data for inclusion into the n-of-1 analysis. Response to valerian was fair for 23 (96%) participants evaluating their 'energy level in the previous day' but poor or modest for all 24 (100%) participants' response to 'total sleep time' and for 23 (96%) participants' response to 'number of night awakenings' and 'morning refreshment'. As a group, the proportion of treatment successes ranged from 0.35 (95% CI 0.23, 0.47) to 0.55 (95% CI 0.43, 0.67) for the six elicited outcome sleep variables. There was no significant difference in the number (P = 0.06), distribution (P = 1.00) or severity (P = 0.46) of side effects between valerian and placebo treatments. Conclusions: Valerian was not shown to be appreciably better than placebo in promoting sleep or sleep-related factors for any individual patient or for all patients as a group. (C) 2003 Elsevier Ltd. All rights reserved.

Association between apolipoprotein E epsilon 4 and neuropsychiatric symptoms during interferon alpha treatment for chronic hepatitis C

Neuropsychiatric complications are common in patients with chronic hepatitis C undergoing treatment with interferon alpha. These side effects include alterations of mood, cognition, and neuroendocrine function and are unpredictable. In a number of neurological disorders characterized by neuropsychiatric symptoms and cognitive dysfunction, inheritance of an apolipoprotein E (APOE) epsilon4 allele is associated with adverse neuropsychiatric outcomes. The authors present evidence that the APOE genotype may influence a patient's neuropsychiatric response to interferon alpha treatment. The inheritance of APOE genotypes was examined in 110 patients with chronic hepatitis C treated with interferon alpha. A retrospective investigation was conducted by assessing the rates of psychiatric referral and neuropsychiatric symptoms experienced during treatment along with other complaints indicating psychological distress. A highly statistically significant association was seen between APOE genotypes and interferon-induced neuropsychiatric symptoms. Patients with an epsilon4 allele were more likely to be referred to a psychiatrist and had more neuropsychiatric symptoms during antiviral treatment than those without an epsilon4 allele. Additionally, patients with an epsilon4 allele were more likely to experience irritability or anger and anxiety or other mood symptoms. These data demonstrate that an individual's APOE genotype may influence the neuropsychiatric response to antiviral therapy with interferon alpha. Prospective studies evaluating the importance of APOE in susceptibility to interferon alpha-induced neuropsychiatric complications are needed. Moreover, pathways involving APOE should be considered in understanding the pathophysiology of interferon alpha-induced neuropsychiatric complications.

Country of birth, country of residence, and menopausal transitions and symptoms: British birth cohort and Australian Longitudinal Study on Women's Health

Objective: To explore endocrine-related and general symptoms among three groups of middle-aged women defined by country of birth and country of residence, in the context of debates about biological, cultural and other factors in menopause. Methods: British-born women participating in a British birth cohort study (n=1,362) and age-matched Australian-born (n=1,724) and British-born (n=233) Australian women selected from the Australian Longitudinal Study on Women's Health (ALSWH) responded to two waves of surveys at ages 48 and 50. Results: Australian-Australian and British-Australian women report reaching menopause later than British-British women, even after accounting for smoking status and parity. Hormone replacement therapy (HRT) use was lower and hysterectomy was more common among both Australian groups, probably reflecting differences in health services between Britain and Australia. The Australian-Australian and British-Australian groups were more likely to report endocrine-related symptoms than the British-British group, even after adjusting for menopausal status. British-British women were more likely to report some general symptoms. Conclusions: Symptom reporting is high among Australian and British midlife women and varies by country of residence, country of birth and menopausal status. Implications: The data do not support either a simple cultural or a simple biological explanation for differences in menopause experience.

Correlates of depressive symptoms in a representative sample of young Australian women

This paper presents a descriptive analysis of the prevalence of depressive symptoms among a national cohort of young Australian women, and the characteristics of those who experience them. It explores the associations between demographic and health-related variables and depressive symptoms in a representative sample of 9333 Australian women aged 22-27 years, from the Australian Longitudinal Study on Women's Health. Approximately 30% of these young women indicated that they were experiencing depressive symptoms, as indicated by the Center for Epidemiological Studies Depression Scale (CESD-10). After adjusting for age and rurality of residence, depressive symptoms were related to the following demographic variables: low income, low educational qualifications, a history of unemployment, not being in a relationship, and living arrangements other than living with a partner. Those health-related variables that were significantly associated with depressive symptoms included frequent visits to doctors and medical specialists, and a higher number of physical symptoms experienced and diagnoses made. More illicit drug use, higher use of cigarettes and alcohol, and lower exercise status were also significantly associated with depressive symptoms. This analysis supports the view that depression is one aspect of a multifactorial cluster of negative conditions across several domains of functioning, including physical ill-health, risky behaviours, and marginal social status. The complex interactions between these conditions, of which depression is only one, underscore the difficulties that arise in the treatment of depression and support the value of preventive interventions as an important public health strategy.

Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer

Objective. To document symptoms associated with borderline, early and advanced ovarian cancer and identify personal characteristics associated with early versus late diagnosis. Methods. Information concerning symptoms and diagnosis history was available from 811 women with ovarian cancer who took part in an Australian case–control study in the early 1990s. Women were classified into three groups for comparison based on their diagnosis: borderline, early (stage I–II) and advanced (stage III–IV) invasive cancer. Results. Sixteen percent of women with borderline tumors, 7% with early cancer and 4% with advanced cancer experienced no symptoms before diagnosis (P < 0.0001). Among women with symptoms, abdominal pain (44%) or swelling (39%) were most frequently reported; an abdominal mass (12%) and gynecological symptoms (12%) were less common. Compared to advanced stage cancer, women with early stage cancer were more likely to report an abdominal mass or urinary symptoms but less likely to report gastrointestinal problems or general malaise. General malaise and ‘other’ symptoms were least common in borderline disease. Older women, and those with higher parity or a family history of breast or ovarian cancer, were more likely to be diagnosed at an advanced stage of disease. Conclusions. Women who experience persistent or recurrent abdominal symptoms, particularly swelling and/or pain should be encouraged to seek medical attention and physicians should be alert to the possibility of ovarian cancer even in the absence of an abdominal mass. Further information about the prevalence of these symptoms in the general population is essential to assist physicians in patient management.