William L. Risser

Prevalence of depression and other psychiatric disorders among incarcerated youths.

OBJECTIVE To determine the prevalence of selected psychiatric disorders among incarcerated youths, compare prevalence rates by sex and ethnicity, assess comorbidity, and determine previous diagnosis. METHOD From July-December 2000, a total of 1,024 incarcerated adolescents completed self-administered questionnaires that included the Beck Depression Inventory (BDI) and the Patient Health Questionnaire (PHQ), linked to DSM-IV, that assesses depression, drug and alcohol abuse, and somatoform, panic, and anxiety disorders. RESULTS From the BDI, 261/1,024 (25%) had moderate and 223/1,024 (22%) severe depression. From the PHQ, 100/1,024 (9.77%) had major depressive disorder, 420 (41%) drug abuse, 275 (27%) alcohol abuse, and 297 (29%) one of the other disorders. In comparisons by sex and ethnic group, noteworthy findings included no differences between the sexes for moderate and severe depression from the BDI or for major depressive disorder from the PHQ; less drug and alcohol abuse in African-American males and females; and more anxiety disorder in white males and in females. Sixty percent had one or more psychiatric disorder: comorbidity was particularly common between both depression and anxiety and drug and alcohol abuse. Of depressed youths, 20% had been previously diagnosed and treated, as had approximately 10% with other disorders. CONCLUSIONS Incarcerated youths had a high prevalence of psychiatric disorders, usually undiagnosed, and comorbidity was common.

Weight change in adolescents who used hormonal contraception.

PURPOSE (a) To compare weight change at 1 year between adolescents 13-19 years old who were using either depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OC), and (b) to determine if age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight. METHOD The setting was a Planned Parenthood Teen Clinic with chart review of variables of interest. Excessive weight was defined as weight gain > 10%. RESULTS Baseline variables were similar in the two groups, except that DMPA users (n = 44) had a greater mean BMI (t test, p = .05) than OC users (n = 86). Mean (standard deviation) and median weight gains at 1 year were 3.0 (4.5) and 2.4 kg in the DMPA users and 1.3 (3.9) and 1.5 kg in the OC users (difference in medians not significant, Wilcoxon rank sum test, p = .10). Fifty-six percent of DMPA and 70% of OC users lost weight or gained < 5% of their baseline weight (p = .17, Fisher exact test); 25% of DMPA users and 7% of OC users gained > 10% of their baseline weight (p = .006). Age, baseline BMI, or race/ethnicity did not affect the likelihood that either group would gain > 5% or > 10% of their baseline weight. Of adolescents who gained > 5% of baseline weight at 3 months, 13 of 14 (93%) gained even more weight at 12 months. CONCLUSIONS The majority of adolescents who used hormonal contraception for 1 year lost weight or gained < 5% of baseline weight. DMPA users were more likely than OC users to gain > 10%. Subjects who gained > 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

Weight-training injuries : common injuries and preventative methods

SummaryThe use of weights is an increasingly popular conditioning technique, competitive sport and recreational activity among children, adolescents and young adults. Weight-training can cause significant musculoskeletal injuries such as fractures, dislocations, spondylolysis, spondylolisthesis, intervertebral disk herniation, and meniscal injuries of the knee. Although injuries can occur during the use of weight machines, most apparently happen during the aggressive use of free weights. Prepubescent and older athletes who are well trained and supervised appear to have low injury rates in strength training programmes. Good coaching and proper weightlifting techniques and other injury prevention methods are likely to minimise the number of musculoskeletal problems caused by weight-training.

Implementation of a screening program for chlamydial infection in incarcerated adolescents.

Background In collaboration with the Houston Department of Health and Human Services, the authors implemented and evaluated a urine-based chlamydia screening program in incarcerated youth in Harris County, Texas, and assessed predictor variables for infection. Goal To implement and evaluate chlamydia screening in incarcerated youth. Study Design The authors determined prevalence of chlamydial infection, treatment rates, and predictor variables in 589 youth and repeated the measures 6 months later in 975 additional youth. Results Initially, the prevalence of infection was 9.6% in males and 28.1% in females; 88% of infected youth were treated while incarcerated. White males had a significantly lower prevalence of chlamydial infection; however, consistent condom use was not associated with a lower prevalence of chlamydia. In the 6-month assessment of chlamydia prevalence in 975 youth, prevalence and treatment rates remained high and predictor variables were similar. Conclusion The authors instituted a screening program for chlamydial infection in incarcerated youth that was performing well at reassessment 6 months later.

The incidence of pelvic inflammatory disease in untreated women infected with Chlamydia trachomatis: a structured review

Because of the long-term consequences of pelvic inflammatory disease (PID), the cost-effectiveness of Chlamydia trachomatis screening depends in part on the incidence of PID in untreated, chlamydia-infected women. The aim of this study was to evaluate the original research assessing the incidence of PID following C. trachomatis infection. We conducted a thorough search of the literature and selected all available prospective cohort studies. Six studies had original data: the incidence of PID varied from 0% (97.5% confidence interval [CI] 0–12%) during one year of follow-up of 30 women to 30% (95% CI 12–54%) during 50 days of follow-up of 20 women. Studies that included asymptomatic women in other settings reported a lower incidence than those that evaluated women in sexually transmitted disease clinics. In conclusion, no study was of a size or quality to answer our research question definitively. Investigators and clinicians planning chlamydia-screening programmes need to be cognizant of the inconclusive incidence data.

Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women

US blacks carry a disproportionate risk of heterosexually transmitted HIV. This study aimed to evaluate the association between self-reported heterosexual anal intercourse and HIV. Using respondent-driven sampling (RDS), we recruited and interviewed 909 blacks from areas of high poverty and HIV prevalence in Houston, Texas, and who reported heterosexual sex in the last year. All individuals were tested for HIV. Weighted prevalence values were calculated to account for non-random recruitment associated with RDS. The weighted population prevalence of HIV infection was 2.4% and 2.5% among men and women, respectively. Education, employment status, income and crack cocaine use were not associated with HIV infection. Lifetime injection drug use (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.31–8.33%) and heterosexual anal intercourse (OR 2.41, 95% CI 1.02–5.73%) were associated with HIV infection. Individuals who reported both injection drug use and heterosexual anal intercourse had 6.21 increased odds of HIV (95% CI 2.47–15.61%). Our results suggest that heterosexual anal sex may be a vector for HIV transmission, especially in the context of injection drug use. Prevention strategies directed at curbing the HIV epidemic among black heterosexuals require that we correctly identify the risks so that appropriate interventions can be developed.

Gender Differences in Social Support and Depression among Injection Drug Users in Houston, Texas

Background: Injection drug is the second most frequent HIV/AIDS exposure in the United States. Social support and depression may mediate risky behaviors among drug injectors. Objectives: To describe differences in perceived social support and depressive symptoms between male and female injection drug users, and to describe factors associated with depressive symptoms. Methods: Using respondent-driven sampling, we recruited and interviewed injection drug users in Houston, Texas. Data were from the Centers for Disease Control and Preventions National HIV Behavioral Surveillance Program. We used the short Center for Epidemiologic Studies Depression Scale (CES-D 10) and scales for perceived social support from family, friends, and significant others from the Multidimensional Scale of Perceived Social Support. Four-hundred seventy-one participants had complete data and were included in this analysis. Results: Seventy-five percent of male and female participants had CES-D scores indicating depressive symptoms. In a multivariate logistic regression, depressive symptoms among men were positively associated with frequent use of speedballs (injecting heroin and cocaine together) and never having tested for HIV, and negatively associated with perceived social support from a special person. Among women, depressive symptoms were positively associated with currently smoking cigarettes, having no health insurance, and more years of injection drug use, and negatively associated with perceived social support from a special person. Conclusions: Lack of social support from a special person or significant other was associated with depressive symptoms in both males and females. Our findings suggest that depression and social support should be addressed when developing HIV prevention programs among injection drug users.

Prevalence and incidence of pelvic inflammatory disease in incarcerated adolescents.

Background Few recent studies have determined the prevalence and incidence of pelvic inflammatory disease (PID) among adolescents. Goal The goal of this study was to determine these parameters among incarcerated youths. Study Design Both on admission and during incarceration, consecutive adolescents entering the Harris County, Texas, Juvenile Detention Center were evaluated for symptoms of PID. One of two experienced clinicians examined adolescents with possible PID. For the diagnosis of PID, we used the minimal criteria of the CDC. Results In sexually active heterosexual or bisexual adolescents (N = 313), the prevalence of PID at admission was 4.5%; during the first 31 days of incarceration, the incidence density of PID was 3.3 cases/100 person-months, and the cumulative incidence was 2.2%. The prevalence among these youths of chlamydial and/or gonorrheal infection, as determined by urine or cervical testing, was 24.9%. Conclusion The high prevalence and incidence of PID underscore the need for effective programs to eradicate chlamydial and gonorrheal infections in high-risk youths.

Musculoskeletal Injuries Caused by Weight Training Guidelines for Prevention

Tens of thousands of U.S. children, adolescents, and young adults are using weights either recreationally, to train for sports, or to compete in weight lifting, power lifting, or body building contests. Weight use may cause significant musculoskeletal injury. This review summarizes for the clinician the best available information on injury risks and prevention.

Iron Deficiency in Adolescents and Young Adults.

In brief After childhood, iron deficiency is mainly a problem in females, but it also occurs in males aged 11 to 14 years. Inadequate dietary intake of iron is the major cause of iron deficiency, but factors such as gastrointestinal (GI) blood loss may contribute to this problem. Mild anemia may impair sports performance, and some research suggests that iron deficiency without anemia also has an adverse effect. The diagnosis of iron deficiency should be based on the patients serum ferritin and hemoglobin concentrations. Treatment requires therapeutic doses of oral ferrous iron for several months.