OBJECTIVE: There are racial differences in adolescents' propensity to consume alcohol--with white adolescents tending to consume more alcohol than black adolescents--but there is no clear explanation for why such differences exist. The purpose of this study was to examine the relationship between religiosity, a cultural factor that is not well understood currently, and racial differences in adolescent alcohol use. METHOD: Participants were white and black ninth-grade adolescents (N = 899; 54% female, 57.5% white) involved in a 3-year longitudinal study of ways to reduce alcohol use and sexual risk-taking behavior among adolescents in Ohio and Kentucky. RESULTS: Findings indicate that religiosity is differentially associated with alcohol use and problem drinking for white and black adolescents. Religious service attendance was the most significant predictor of alcohol use for black adolescents, whereas religious fundamentalism was most important for white adolescents. In contrast, frequency of prayer was the significant predictor of problem drinking for black adolescents, whereas the level of importance placed on religion was the significant predictor for white adolescents. Important gender differences also emerged in both prediction models and are discussed. CONCLUSIONS: Since there is great heterogeneity among adolescents (in terms of race and gender) in their alcohol use and misuse, the "one-size-fits-all" approach to alcohol treatment and prevention is likely inappropriate. Moreover, conceptualizations of alcohol use and misuse, and its prevention and treatment, should include the consideration of such key cultural factors as religiosity.

Adolescent↗

PubMed2001

Musical hallucinations associated with seizures originating from an intracranial aneurysm.

Hallucinations are defined as sensory phenomena in the absence of external sensory stimuli. Auditory hallucinations have been shown to arise from many different intracranial lesions, but seizures manifesting as musical hallucinations triggered by unruptured intracranial aneurysms are rare. We present a case of persistent, episodic musical hallucinations associated with seizures that led to the discovery of 2 small intracranial aneurysms. Typical electroencephalographic findings for seizure activity were observed but resolved after surgical clipping of the aneurysms. Concomitantly, the patient's hallucinations resolved. The literature on musical hallucinations is reviewed.

Cerebral Angiography↗

PubMed2000

Carotid endarterectomy. Which patients can benefit?

Carotid endarterectomy for carotid artery stenosis is valuable for some patients, but not all. Results of clinical trials in symptomatic and asymptomatic patients provide guidance on use of this common vascular procedure. The authors of this article describe the controversies and concerns with the procedure and give their recommendations based on study results.

Adult↗

PubMed2000

Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience.

OBJECT: The authors report a retrospective analysis of 194 patients surgically treated at their institutions for symptomatic lumbar synovial cysts from January 1974 to January 1996. METHODS: Patient characteristics including age, sex, symptoms, signs, and preoperative neuroimaging studies were reviewed. Surgical procedures, complications, results, and pathological findings were correlated with preoperative assessment. One hundred ninety-four patients were surgically treated for symptomatic lumbar synovial cysts. Eighty percent were diagnosed and treated between 1987 and 1996. There were 100 men and 94 women with an average age of 66 years (range 28-94 years). The most common symptoms were painful radiculopathy (85%) and neurogenic single or multiroot claudication (44%). However, sensory loss (43%) and motor weakness (27%) were also presenting symptoms. Eleven percent of patients had undergone previous lumbar surgery prior to being referred to the Mayo Clinic. Preoperative neurological examination demonstrated motor weakness (40%), sensory loss (45%), reflex changes (57%), and variants of cauda equina syndrome (13%). In 19% of patients, normal neurological status was demonstrated. There was equal left/right-sided laterality, and eight patients presented with bilateral synovial cysts. The most commonly affected level was L4-5 (64%). All patients underwent laminectomy and resection of the cyst. Concomitant fusion was performed in 18 patients in whom clinical evidence of instability had been observed. However, subsequent fusion was required in only four patients who developed symptomatic spondylolisthesis. Surgery-related complications included cerebrospinal fluid leak (three patients), discitis (one patient), epidural hematoma (one patient), seroma (one patient), and deep vein thrombosis (one patient). One patient died 3 days after surgery of cardiac dysrhythmia. Follow-up data obtained for at least 6 months postoperatively were available in 147 patients. Of these, 134 (91%) reported good relief of their pain and 82% experienced improvement in their motor deficits. CONCLUSIONS: Lumbar synovial cysts are a more common cause of lumbar radicular pain than previously thought. Surgical removal of the cyst is a safe and effective treatment for symptomatic relief in patients with lumbar synovial cysts. A concomitant fusion procedure may be performed in select cases. In this study, only a few patients developed symptomatic spinal instability requiring a second operation.

Adult↗

PubMed2000

Test-retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis.

OBJECTIVE: To provide further validation of the treadmill test by assessing its "test-retest" reproducibility. PATIENTS AND METHODS: In this prospective study, 28 patients with severe lumbar spinal stenosis underwent exercise treadmill testing, first at a walking speed of 1.2 mph and then at the patient's preferred walking speed. All patients had a second treadmill examination or "retest." No treatment intervention was performed between the initial test and the retest. Time to first symptoms (TFS) and total ambulation time (TAT) were measured. Differences between the baseline examination and the retest examination were assessed by using the concordance correlation coefficient (CCC) as well as graphically. RESULTS: There was good reproducibility between baseline test and retest results for all 4 end points: 1.2 mph, TFS (CCC = 0.90); 1.2 mph, TAT (CCC = 0.89); preferred walking speed, TFS (CCC = 0.98); and preferred walking speed, TAT (CCC = 0.96). The median difference between trials was not significantly different from zero for any of the 4 outcomes. CONCLUSIONS: Exercise treadmill testing has good test-retest reproducibility. There was no learning phenomenon associated with the test procedure. The study further validates the clinical utility of exercise treadmill testing in patients with lumbar spinal stenosis and neurogenic claudication.

Aged↗

PubMed1999

Moderating and mediating effects of socioeconomic status, perceived peer condom use, and condom negotiation on sexual risk behavior among African-American and white adolescent females.

Explore the source record for details and available documents.

Adolescent↗

PubMed1999

Vascular pedicle rib graft in anterior transthoracic fusion procedures. Technical note.

A method is described in which anterior fusion of the thoracic vertebral column is performed using a rib strut graft maintained on its vascular pedicle. This straightforward technique is useful in selected patients undergoing anterior thoracic fusion procedures and can be used in conjunction with other anterior spinal implants. By maintaining bone graft blood supply, this technique promotes an optimum fusion environment, which may enhance the speed of graft incorporation and the ultimate strength of the construct.

Aged↗

PubMed1998

Use of the exercise treadmill to measure baseline functional status and surgical outcome in patients with severe lumbar spinal stenosis.

STUDY DESIGN: A prospective study of exercise tolerance on the treadmill before and after decompressive laminectomy in patients with severe lumbar spinal stenosis. OBJECTIVES: To determine whether treadmill testing provides useful information about baseline functional status and surgical outcome. SUMMARY OF BACKGROUND DATA: Historically, criteria for selecting patients for surgery and assessing postoperative outcome have been variable. Functional testing has not been used in a systematic fashion. METHODS: Fifty patients with severe lumbar spinal stenosis underwent decompressive laminectomy. Preoperatively and 3 months postoperatively, functional capacity was assessed on an exercise treadmill. Time to first symptoms and total ambulation time were recorded. The examination was stopped at the onset of severe symptoms or after 15 minutes. RESULTS: In the preoperative trial, mean time to first symptoms (+/- standard deviation) was 1.82 minutes (median, 0.58), and mean total ambulation time was 6.91 minutes (median, 5.22). In the postoperative trial, mean time to first symptoms increased to 11.93 minutes (median, 15) and mean total ambulation time increased to 13.26 minutes (median, 15). There was significant improvement after surgery in both time to first symptoms (P < 0.001) and total ambulation time (P < 0.001). CONCLUSION: Exercise stress testing on a treadmill is a safe, easily administered, and quantifiable means of assessing baseline functional status and surgical outcome in patients with neurogenic claudication due to lumbar spinal stenosis. Treadmill testing provides objective evidence that surgery is beneficial in most cases and is helpful in guiding subsequent management of patients with residual symptoms.

Aged↗

PubMed1997

Hormonal and humeral considerations in hypertensive disease.

This article has discussed the classic hormonal causes of hypertension. Pheochromocytoma and hyperaldosteronism have been discussed, and a clinical approach to evaluation of patients for these problems has been presented. Other humeral factors that influence volume pressure homeostasis have been discussed. It is likely that pharmacologic agents affecting these other factors will become available to patients with hypertension in the future.

Animals↗

PubMed1997

The impact of Hurricane Andrew on deviant behavior among a multi-racial/ethnic sample of adolescents in Dade County, Florida: a longitudinal analysis.

Findings from a longitudinal study are presented on the relationships between the problems and stresses resulting from Hurricane Andrew and posthurricane minor deviant behavior. The sample (N = 4,978) included Hispanic, African-American, and White non-Hispanic middle school students enrolled in Dade County, Florida public schools. Two waves of data were collected prior to the hurricane; a third was obtained approximately 6 months following the storm. Results indicated that females were likely to report higher levels of hurricane-related stress symptoms than males. After controlling for prehurricane levels of minor deviance, family support, and race/ethnicity, hurricane stress symptom level remained a significant predictor of posthurricane minor deviant behavior. The findings lend support to stress theories of social deviance.

Adolescent↗

PubMed1996

Perioperative use of botulinum toxin for movement disorder-induced cervical spine disease.

Patients with cervical dystonia or tics of the nuchal muscles can develop serious cervical spine disease. We report a series of four patients who received botulinum toxin injections to control their movement disorders prior to their required surgery. One patient with cervical tic-induced radiculomyelopathy required botulinum toxin injection postoperatively to facilitate stabilization of the cervical fusion. Two patients with torticollis-induced cervical radiculomyelopathy, and one patient with dystonia-induced C5 fracture, had botulinum toxin injected preoperatively to facilitate postoperative recovery. Botulinum toxin appears to be a useful adjunct in the treatment of cervical movement disorders prior to or following surgery for associated cervical spine disease.

Adult↗

PubMed1996

A replication and elaboration of the esteem-enhancement model.

Adolescents treated in clinical settings for drug use problems are often observed to have low self-esteem. This has led some researchers to the belief that mood or personality characteristics of adolescents predispose them to drug use. However, longitudinal field studies have failed to confirm a direct relationship between low self-esteem and substance abuse (Petraitis et al. 1995). Evidently, if an important causal relationship exists between self-esteem and drug use in the nonclinical adolescent population, it is complex and mediated by other factors. To address this issue, explanatory theories are needed that can organize the relationships between drug abuse and its antecendent causes including low self-esteem. One of the few theoretical approaches that has been put forward for empirical verification is the esteem-enhancement theory of Kaplan, Johnson, and Bailey (1986a, 1987, 1988).

Adolescent↗

PubMed1996

Disaster related stresses, depressive signs and symptoms, and suicidal ideation among a multi-racial/ethnic sample of adolescents: a longitudinal analysis.

Longitudinal findings are presented on the relationships between disaster related stresses, depression scores, and suicidal ideation among a multi-racial/ethnic sample of adolescents (N = 4,978) all of whom have been exposed to Hurricane Andrew. Regression analysis showed that being female, hurricane generated stresses, low levels of family support, pre-hurricane suicidal ideation, and post-hurricane depression scores were significant predictors of post-hurricane suicidal ideation. Path analysis revealed that being female, low socioeconomic status, pre- and post-hurricane depression, high stress scores, low family support, and pre-hurricane suicidal ideation had significant direct/indirect effects on post-hurricane suicidal ideation.

Adaptation, Psychological↗