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Introduction: In hospitalized patients, continuous glucose monitoring (CGM) may improve glycemic control, prevent hypoglycemic events, and reduce staff workload compared with point-of-care (POC) capillary glucose monitoring., Methods: To evaluate CGM accuracy and safety of use in the inpatient setting, two versions of CGM sensors were placed on 43 and 34 adult patients with diabetes admitted to non-intensive care unit (ICU) medical wards, respectively. CGM accuracy relative to POC and safety of use were measured by calculating mean absolute relative difference (MARD) and by Clarke Error Grid (CEG) analysis., Results: CGM version 2 had improved accuracy compared with CGM version 1 with MARD 17.7 compared with 21.4%. CGM accuracy did not change with POC value or with time of sensor wear. On CEG, 98.8% of paired values fell within acceptable zones A and B., Conclusion: Despite reduced accuracy compared with the outpatient setting, both versions of CGMs had acceptable safety profiles in the inpatient setting.

Study Objectives: (1) To assess menstrual function in freshman cadets at a structured, rigorous military college utilizing a weekly e-mail questionnaire, (2) to compare these results to longer-term recall results from written questionnaires completed at the start and end of the same year, and (3) to determine if a relationship exists between personality attributes and menstrual regularity in this setting., Design, Setting, Participants: A questionnaire developed by the investigators about menstrual function was distributed weekly via e-mail and completed satisfactorily by 116 female freshman at the United States Military Academy (USMA), class of 1995. These data were compared to questionnaires completed by this same cohort at the start and end of the year, as well as to personality questionnaires distributed to some of these cadets as part of a larger study. Pearson's chi-square and analysis of variance were performed to determine statistical significance., Results: Weekly e-mail data revealed that only 1.7% of cadets had regular menstrual periods throughout the whole year. The remaining 98.3% were irregular: 10.3% mildly, 35.3% moderately, 30.2% severely, and 22.4% extremely irregular. Only 0.8% of subjects did not menstruate at all during the year. In comparison, on long-term recall data, 90% reported some change in menstrual function, with 48% specifically reporting menstrual irregularity. Those with the greatest irregularity prior to USMA and those who expected greater irregularity at USMA reported the greatest irregularity during the year. Irregularity was associated with coping and with commitment to health on personality questionnaires., Conclusions: On data collected via weekly e-mail, almost all freshman females at USMA experienced menstrual irregularity. This data, utilizing short-term recall, yielded different, more dramatic results than the data utilizing long-term recall. A link between menstrual irregularity and both coping and commitment suggests that menstrual irregularity may be adaptive in this environment.

Cadet basic training (CBT) at the U.S. Military Academy at West Point is an initial cadet experience designed to transition freshmen (new cadets) into the military. Challenge is an inherent component of CBT, and some challenging activities may be stressful. However, the nature and the impact of stress on health status have not been systematically investigated. An ethnographic technique, participant observation, was used to identify stressors and coping strategies among cadets aged 18 to 21 years participating in CBT. A company of 183 cadets, consisting of 123 new cadets and 60 supervising upperclass cadets from the U.S. Military Academy, was followed throughout the 6-week CBT in the summer of 1993. The investigator observed daily activities and participated in select field training experiences. Daily field observations were taped, and field notes were generated chronicling the experience. After CBT, 10 of the 60 upperclass cadets participated in a 20-minute structured interview. Field and interview notes were systematically reviewed to identify and categorize stressors and coping techniques. Stressors included anticipatory stress, time management pressures, sleep deprivation, performance evaluations, conflicts between teamwork and competitive grading, and inexperience in the leadership role. Coping techniques identified included perceiving social support, humor, and rationalization. Three new hypotheses were generated from the observations.

Context: There is a strong need to determine what effect, if any, menstruation has on the performance of duty as a Cadet at the United States Military Academy (USMA) at West Point, and to determine what impact, if any, the USMA environment has on the menstrual cycle., Study Objectives: To study menstrual function and premenstrual symptoms in a structured, rigorous military environment; determine the perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and evaluate the difficulties inherent to menstruation in a military setting., Design, Setting, and Participants: A survey about high school menstrual and premenstrual function, and the Premenstrual Assessment Form (PAF), were completed by all 158 freshman female Cadets in July 1991. In May 1992, 83 participants completed a survey assessing menstrual and premenstrual symptoms, including interference with activities during the year., Main Outcome Measures: Menstrual regularity, premenstrual symptoms, interference with activities., Results: Participants reported menstrual patterns and premenstrual symptoms in high school similar to other females their age. Most (62%) predicted a change in menstruation at the USMA, half were worried that physical symptoms would interfere with activities, one-fourth were worried that premenstrual symptoms would interfere with activities, and one-fourth were worried that obtaining and changing menstrual materials would interfere with activities. Almost all respondents (91%) reported changes in menstruation during the year, most commonly less regular, less frequent, shorter, lighter, and less crampy periods. Menstrual and premenstrual symptoms interfered with physical activities (66.2%, 61.4% respectively) more so than academic (50.6%, 45.7% respectively) or military activities (39.8%, 47.0% respectively). Female Cadets described significant difficulties with changing (62.6%), obtaining (51.8%), and disposing of (38.5%) menstrual materials., Conclusions: The data demonstrate major changes in menstrual function in over 90% of female Cadets; a significant perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and difficulties in obtaining, changing, and disposing of menstrual materials in a military setting. These findings have implications for females in the military, as well as for young women generally.

In this study, we searched for evidence for reactivation of three latent herpesviruses, Epstein-Barr virus (EBV), herpes simplex virus type-1 (HSV-1), and human herpesvirus 6 (HHV-6), in West Point cadets experiencing two different stressors. Blood samples were obtained from cadets before and after a 6-week training period known as "Cadet Basic Training" (CBT), at a baseline prior to final examinations, and then once again during the week of final examinations. Antibody titers to latent HSV-1, EBV, and HHV-6 were determined as a measure of the steady-state expression of latent virus. EBV virus capsid antigen (VCA) IgG antibody titers were unchanged in blood samples obtained prior to and immediately after CBT. However, EBV antibody titers were significantly higher in the blood sample obtained during examination week than in the baseline period before examination; they were also higher than antibody titers before/after CBT. None of the serum samples were positive for EBV VCA IgM antibodies, indicating that the changes in antibody titers to EBV were not associated with recent EBV infections in the class. No significant changes in antibody titers to HSV-1 or HSV-6 were found over the identical time periods, including examination week. Academic stress but not CBT modulated the steady-state expression of latent EBV, resulting in the reactivation of latent virus. The same stressors, however, did not affect the steady-state expression of latent HSV-1 or HSV-6, at least as measured by changes in antibody titers. The data provide additional evidence of the impact of different psychological stressors on the steady-state expression of latent herpesviruses., (Copyright 1999 Academic Press.)

Purpose: To determine adolescents' rooming preferences during hospitalization., Methods: A questionnaire designed by the authors was administered to 95 adolescents (59 inpatients and 36 outpatients) in 1996. Differences between groups were analyzed by Chi-square., Results: The adolescents were equally divided between a preference to room alone (40%) or with one other person (39%). Fewer adolescents (20%) preferred more than one other roommate. When analyzed by gender, females were significantly more likely than males to prefer to room alone [53% vs. 28% (chi(2) = 5.34; p < 0.05)]. The majority of both inpatient and outpatient groups (93%) indicated a preference for a companion-in particular their mother-to stay with them overnight in the hospital during medically difficult times., Conclusions: These findings support our recommendation that there should be equal numbers of single and double rooms in adolescent inpatient units to accommodate these divided preferences among adolescents. Individual adolescent rooming preferences should be elicited and honored whenever feasible.

Pediatricians differ on the optimal ways to discipline children. The major controversy surrounds the use of corporal punishment. In an effort to resolve this controversy, the American Academy of Pediatrics (AAP) cosponsored a conference entitled "The Short and Long-Term Consequences of Corporal Punishment" in February 1996. This article reviews scientific literature on corporal punishment and summarizes the proceedings from the conference. The authors conclude that, although the research data are inadequate to resolve the controversy, there are areas of consensus. Practitioners should assess the spanking practices of the parent they see and counsel parents to avoid those that are, by AAP consensus, dangerous, ineffective, or abusive.

Since health-risk behaviors are often encountered in clusters among adolescents, it was hypothesized that adolescents with poor school attendance would be associated with more health-risk behaviors (e.g., substance use, violence) than those who attend school regularly. This study assessed the relationship between poor school attendance and health-risk behaviors, and described health-risk behaviors and self-esteem among adolescents seeking employment. In this cross-sectional study, school attendance (poor vs. regular attendance) was related to health-risk behaviors by asking 122 subjects seen at a New York City Working Papers Clinic to complete both a 72-item questionnaire about their health-risk behaviors and the 58-item Coopersmith Self-Esteem School Form Inventory. Chi-square and Fisher's Exact Tests were performed. The poor and regular attenders of school differed significantly in only 5 out of 44 items pertaining to health-risk behaviors. Self-esteem measures for the two groups did not differ from one another or from national norms. In this sample, depression "in general" (global) and "at home," but not "at school," were associated significantly with suicidal thoughts/attempts and serious past life events (e.g. family conflict, sexual abuse). There were no significant associations between depression or self-esteem and illicit substance or alcohol use. We found few associations between poor school attendance and health-risk behaviors in this sample of employment-seeking adolescents. The poor and regular attenders of school were similar in most aspects of their health-risk behaviors and self-esteem.

Purpose: The study's objective was to determine the prevalence of abnormalities in weight, eating attitudes, and eating behaviors among an urban teenage population., Methods: Measures of weight, height, and blood pressure were obtained from 1,001 students attending regularly scheduled physical education classes in a New York City high school the population of which was 66% black and 23% Hispanic. The mean age was 16 years old; 55% were female and 45% were male. Approximately three quarters of the students completed the Eating Attitudes Test (EAT-26), Rosenberg Self-Esteem Scale, Spielberger Trait Anxiety Inventory, and a questionnaire on eating behaviors., Results: By percent ideal body weight (%IBW), 25% of students were obese (>20% above IBW), 18% were overweight, and 5% were underweight. Abnormal EAT scores (>21), were found in 6% of males and 15% of females. Students reported that they had engaged in the following nutritional behaviors at least three times in the past week: eating candy (59%), skipping breakfast (58%), skipping lunch (42%), eating fast foods (28%), and skipping dinner (14%). Self-esteem was high in 60%, medium in 21%, and low in 19%. Mean self-esteem was significantly higher (P < .0001) than established norms. Self-esteem and anxiety were inversely correlated (r = .40, P < .001), and low self-esteem and high anxiety were both associated with high EAT scores (r = .29, P < .001). Self-esteem and anxiety of obese students did not differ from those who were of normal weight., Conclusions: Among this population of urban high school students there were: (a) a large number of overweight adolescents; (b) a significant subgroup with eating attitudes suggestive of an eating disorder; and (c) high levels of self-esteem and normal levels of anxiety, which were independent of weight status.

Knowledge of AIDS, attitudes toward AIDS and condoms, and behavioral changes because of AIDS were studied in 771 students, Grades 9-12 (mean age, 16 years) who completed anonymous questionnaires in gym classes of a New York City high school. Students demonstrated good knowledge of AIDS, with some misconceptions, and significant concerns about AIDS, with some behavioral changes, but most continued to engage in high-risk behaviors. These data indicate that efforts aimed at HIV/AIDS prevention in adolescents must translate knowledge and concerns into behavioral change.

Purpose: To study positive and negative correlates of sports participation in inner-city youth., Methods: We distributed anonymous questionnaires to 838 students in gym classes of an urban New York City High School. Forty five percent of students were male and 55% female, with mean age 16.0 years; 64% in grades 9-10, and 36% in grades 11-12; 63% black, 27% Hispanic, and 10% other; and 30% A/B students, 38% C students, and 32% D/F students., Results: All students reported some involvement in sports: 37% in 1-2 sports, 29% in 3-4 sports 24% in > or = 5 sports; 20% played on local teams, and 12% on junior or senior varsity. Approximately one-third each reported no weekday sports participation (30%), 1-2 hours per day (34%), or > or = 3 hours (36%); and 34% reported no participation on weekends, 26% reported 1-2 hours per day, and 40% > or = 3 hours. Basketball, volleyball, baseball, and weight lifting were the most common sports. Enjoyment, recreation, and competition were the most commonly reported reasons for participation. While 86% of subjects considered school "extremely" or "very" important, 35% considered sports "extremely" or "very" important. However, many believed they would "definitely" or "probably" receive an athletic scholarship (52% males, 20% females). Males reported more (p < .05) weekday, weekend, and team participation, and greater expectations (p <.001) of a future in sports. Sports involvement was not statistically associated with academic performance or scores on either the Rosenberg Self-Esteem Scale or Depression Self Rating Scale. Steroid use, at least once, was reported by 11% of males and 4% of females. Thirteen percent of students (21% males, 6% females) tried to gain weight for sports and 20% of both males and females tried to lose. Sports injuries within the past year were reported by 15% of students, and approximately three-quarters could correctly answer each of five questions about basic first aid., Conclusions: The data indicate that most of these urban youth had athletic involvement, many had unrealistic expectations for their futures, and some utilized unhealthy behaviors in an attempt to enhance performance. Among these students, no association was found between sports involvement and academic performance, self-esteem, or depression.

Purpose: We sought to determine the extent of exposure to violence and its relationship to other mental health risks among an urban teenage population., Methods: Students attending regularly scheduled physical education classes completed a Violence Survey, a Suicidal Ideation Survey, the Depression Self-Rating Scale (DSRS), and the Adolescent Alcohol Involvement Scale. Of the 630 students who completed the anonymous assessment 45% were male, 55% female, 61% black, 30% Hispanic; 54% grades 9-10, and 46% grades 11-12., Results: Half of the students reported knowing someone who had been murdered, 61% indicated they had witnessed a robbery, 59% had witnessed a beating, 37% had witnessed a shooting, and 31% had witnessed a stabbing. Mental health problems reported by these students included: depression (DSRS score > 13) in 31%, suicidal ideation in 16%, suicide attempts in 10%, drinking > 1 x per month in 21%, and drinking daily in 5%. Univariate analysis revealed that students who witnessed a shooting or stabbing were more likely (p < .05) to be both male and black. Multivariate analysis revealed that students reporting knowing someone who was murdered were twice as likely to report suicidal ideation and four times as likely to report suicide attempts. Witnessing a stabbing was associated with twice the likelihood of reporting suicide ideation and three times the likelihood of reporting suicide attempts. Witnessing a shooting was associated with twice the likelihood of alcohol use. Witnessing a beating or robbery had no significant relationship to measured variables., Conclusions: Among this population of urban teenagers there are many who have witnessed violence and a subgroup who have witnessed shootings and stabbings and are at increased risk for mental health problems. A comprehensive medical and psychosocial history should include a violence assessment for all urban teens.

Behavior problems and family functioning were investigated in a sample of 10 adolescent girls with chronic fatigue syndrome (CFS), 10 matched healthy adolescent girls, and 10 adolescents with childhood cancer in remission. Based on the adolescent girls' reports, the CFS group had significantly higher scores than the cancer and healthy comparison adolescent girls on somatic complaints and also significantly higher scores than the cancer controls on internalizing symptoms and depression. Parent reports resulted in significantly higher scores in the CFS group than the adolescent girls from the healthy comparison groups on internalizing scores and somatic complaints. There were no significant differences on any family variables.

School-based health centers are a rapidly growing model for provision of comprehensive, primary health care to elementary, middle, and senior high school students. They offer an exciting new training opportunity that is nontraditional, multidisciplinary, and relevant to future practice. The programs funded by the Robert Wood Johnson Foundation found that trainees made a significant contribution to their projects. The value of school-based health centers as training sites extends to trainees, schools, and the future growth of school-based health centers. Integration of medical and mental health services and delivery of services by a multidisciplinary team are essential components of school-based health centers. These characteristics make school sites well suited to the training needs and practice opportunities sought by a number of disciplines, including developmental and behavioral pediatrics. A school-based health center rotation may be particularly important in developmental and behavioral pediatrics because many trainees may be called on to consult with schools in their future careers, and this rotation may provide their only school-related experience.

Monocrotaline is a very potent toxin, producing significant effects of pneumotoxicity, hepatotoxicity, and teratogenicity, as well as carcinogenicity. In addition, the compound has been clearly shown to be mutagenic after metabolic activation. The goal of the experiments reported here was to confirm the reported clastogenesis induced by this agent in vivo and to evaluate the impact of modulation of metabolic activity by phenobarbital, a potent P-450 inducer (both Phase I and Phase II enzymes). The method used in addressing this problem relied on a new technique for monitoring clastogenesis in vivo, i.e., the acridine orange micronucleus assay method originally exploited by Hayashi et al. [1990]. The result of our experiments confirmed monocrotaline to be an effective clastogen in vivo, using the acridine orange method of assessment. The peak in induction of micronuclei occurred on the second day following intraperitoneal administration of the drug. Administration of phenobarbital prior to monocrotaline did appear to modulate the micronucleus induction. At 30 mg/kg bw monocrotaline, the pretreatment with phenobarbital appears to increase the intensity of monocrotaline clastogenesis, while the effect at higher doses (60 and 125 mg/kg bw) is a reduction in potency, presumably reflecting increased importance of Phase II metabolism for monocrotaline at these doses. Thus the study reported here confirms the potent in vivo clastogenesis of monocrotaline, and provides evidence for a dose-related shift in mechanism for the phenomenon.

Purpose: To determine the presenting complaints of students visiting a high school nurse's office and seek associations between specific presenting complaints and psychosocial problems., Methods: One hundred eighty-six students visiting the school nurse in a suburban high school were surveyed with a questionnaire developed by the investigators. Categorical data were compared utilizing chi-square or Fisher's Exact Test. Associations were determined by the Kruskal-Wallis Test., Results: Headaches (25%), infections (17%), stomach aches (12%), and dizziness or tiredness (12%) were the most common presenting complaints. Students indicated that "not sleeping well" and "stress" were two factors that most frequently played a role in their visits. Most students wanted either to rest or await going home; few were interested in receiving medical care or talking to the nurse. Specific complaints of headache, dizziness or tiredness, and no specific symptom were associated (p < .05) with not sleeping well, family problems, stress, school problems and depression., Conclusions: Complaints of headache, dizziness or tiredness, and no specific symptoms may be used as markers for exploring possible psychosocial problems underlying a visit to the school nurse. If school nurses are to address psychosocial issues, they will need to look beyond stated reasons to unstated reasons for visits. Ways to achieve this expanded level of care are discussed.

Sixty strains of Bacillus mycoides were isolated from each of two sites and characterized by their responses to standard metabolic tests used in bacterial taxonomy, by multilocus enzyme electrophoresis (MLEE), and by restriction-fragment-length polymorphism (RFLP) analysis of Southern blots probed with both a conserved DNA fragment derived from a Salmonella typhimurium ribosomal cistron and with two cosmid probes derived from B. mycoides ATCC strain 6463. Both MLEE and RFLP analyses indicated that the collection contained two genetically distinct sets of strains (I and II); one of these sets was further differentiated genetically by the same analyses (IIA and IIB). Standard taxonomic analysis did not distinguish these sets of strains; biochemical test profiles were similar for all isolates. The genetic distance between groups I and II is as great as that observed for recognized species of bacteria. It is proposed that these groups are sibling species having a common evolutionary descent and that their metabolic phenotype has been conserved, whereas their DNA and protein sequences have diverged. No strong evidence of geographic differentiation between strains from the two sites appeared in either genetic or phenetic characters., (© 1994 The Society for the Study of Evolution.)

There are no data to suggest that children who have gay or lesbian parents are different in any aspects of psychological, social, and sexual development from children in heterosexual families. There has been fear that children raised in gay or lesbian households will grow up to be homosexual, develop improper sex-role behavior or sexual conflicts, and may be sexually abused. There has been concern that children raised by gay or lesbian parents will be stigmatized and have conflicts with their peer group, thus threatening their psychological health, self-esteem, and social relationships. These fears and concerns have not been substantiated by research. Pediatricians can facilitate the health care and development of these children by being aware of these and their own attitudes, by educating themselves about special concerns of gay or lesbian parents, and by being a resource and an advocate for children who have homosexual parents.

Objective: To study whether reviewers aware of author identity are biased in favor of authors with more previous publications., Design: Randomized controlled trial., Setting: Editorial office of the Journal of Developmental and Behavioral Pediatrics., Participants: Two "blinded" and two "nonblinded" reviewers assigned to 57 consecutive manuscripts submitted between September 1991 and March 1992., Outcome Measures: Spearman rank correlation coefficients were used to compare the sum of rating scores of 1 to 5 (1, accept; 5, reject) given by the two blinded reviewers, the two nonblinded reviewers, and the editors to the number of articles published previously by the first and senior authors (as determined from requested curricula vitae). Blinded reviewers were sent a questionnaire asking whether they could determine the identity of the authors, how they knew, and whether they thought binding changed the quality or difficulty of their review., Results: The Wilcoxon Sign Rank Test disclosed no differences between blinded and nonblinded scores. The number of previous articles by the senior author was significantly correlated (P < .01) with blinded scores (r = -.45) and editors' decisions (r = -.45), but not with nonblinded scores; the number of articles by the first author was correlated (P < .05) with editors' decisions (r = -.35) but not with blinded or nonblinded scores. Fifty (46%) of 108 blinded reviewers correctly guessed the identity of the authors, mostly from self-references and knowledge of the work; 86% believed blinding did not change the quality of their review, and 73% believed it did not change the difficulty of performing a review., Conclusions: Blinded reviewers and editors in this study, but not nonblinded reviewers, gave better scores to authors with more previous articles. These results suggest that blinded reviewers may provide more unbiased reviews and that nonblinded reviewers may be affected by various types of bias.

Chronic illness can affect an adolescent's physical, cognitive, and psychosocial development, and, conversely, adolescent development can influence both the natural course and medical management of a chronic disease. Providers who are aware of this reciprocal relationship and the "feedback loop" to which it can lead can intercede and optimize the management of chronic illness in adolescents.

Previous studies have looked at the relationship between preoperative anxiety and postoperative course. However, few studies have looked at methods to decrease preoperative anxiety. To investigate preoperative anxiety and possible anxiety reduction strategies, the investigators devised a clinical study to examine the effects of television viewing on preoperative anxiety. The study compared patients who were not able to watch television in the preoperative setting with those who were. The investigators hypothesized that television viewing in the preoperative setting would decrease preoperative anxiety. A purposive sampling method was chosen so that the study population could be selected using certain criteria. The sample consisted of adult patients 18 to 77 years old who were admitted to the preoperative area at least 2 hours before surgery. A total of 76 subjects participated in the study. However, due to incomplete data on seven of the questionnaires, 7 of the subjects were rejected. Of the remaining 69 subjects, 39 had no television access and the remaining 30 did. Statistical comparisons of the two groups suggest that there was a significant difference in the anxiety levels of the two groups. As hoped, the hypothesis was proven correct: Those subjects who watched television in the preoperative area had significantly lower levels of anxiety than those who did not.

Objective: To provide recommendations regarding the establishment and maintenance of school-based clinics, based on analysis of data from a clinic located in a New York City high school., Design: Review of demographic, medical, and psychosocial data collected during student visits., Subjects: During 2 1/2 years, 1283 students were seen. The students were 53% girls and 47% boys; 65% black and 25% Hispanic; and 65% grades 9-10 and 35% grades 11-12., Results: There were 7920 visits. Visits were for acute or chronic medical problems (44%), physical examinations and immunizations (25%), gynecologic or sexuality-related issues (17%), and mental health concerns (14%). Psychosocial characteristics of the 378 students who enrolled during the 1989-1990 academic year indicated that only 27% lived with both natural parents, 55% were foreign-born, 37% had repeated a grade at least once, 44% were sexually active, 13% drank alcohol, and 14% had past or present suicidal ideation., Conclusions: These data demonstrate that a school-based clinic can be involved in the management of a wide range of health care needs for large numbers of at-risk youth. In addition, school-based clinics can serve as a major site for the teaching of medical students and residents, and as a valuable resource for clinical research.

Twenty-two subjects with Marfan syndrome (age range 11-24 years, mean 15.7 years) were studied to evaluate the impact of Marfan syndrome on their lives, level of psychosocial adaptation, concerns about their disorder, compliance with medical regimens, and knowledge of Marfan syndrome. Subjects were interviewed and then completed the Offer Self-Image Questionnaire and two questionnaires designed for the study. Parents also were interviewed. Subjects demonstrated normal psychosocial adaptation on the Offer Self-Image Questionnaire. Nevertheless, the subjects perceived that their lives would be significantly better without Marfan syndrome, especially in the areas of physical activities and self-image. They expressed concerns about their illness most often to their parents, less frequently to their doctors. Their compliance with medical regimens were suboptimal and similar to the published description of compliance among teenagers with other chronic illnesses. Their knowledge base was weakest in the areas pertaining to future childbearing. Thus, although these subjects showed normal psychosocial adaptation, doctors caring for them may foster better coping with Marfan syndrome by discussing self-image issues and Marfan syndrome-related concerns, and by encouraging compliance and imparting knowledge.

An assessment of the impact of cystic fibrosis (CF) was conducted with 43 families. Semistructured parental interviews on family functioning, parent-child interactions, sibling and peer relationships, and medical issues were coded by two independent raters to identify "major," "minor", or "no" problems. Of the 62 questions presented, only 8 were viewed by more than 10% of parents as "major problems." The impact of hospitalization upon parents was the most prevalent "major problem." Parental communication was a "major problem" for 28% of the mothers but for only one father. Ten to 15% of the parents described "major problems" related to: their marital relationship, accepting the illness, feeling they should do more for their child with CF, feeling their other children had been deprived or complained about inattention, or their relationship with the ill child's grandparents. While most families were generally coping successfully, health care professionals should be alert to specific areas of potential problems.

Experimental and clinical studies have demonstrated that psychosocial factors may influence various immune responses. Recently, the relationship between psychologically stressful events and immunomodulation in humans has been reported. Few studies, however, have demonstrated clinically significant increases in infectious illness, or delayed recovery from infectious illness among humans as a result of stressful events. This study was undertaken to determine if children who experienced the greatest difficulty adjusting to kindergarten entry, a common event which is differentially stressful, would have the highest frequency of school absence (an index of illness). A randomly selected sample of 49 children entering kindergarten for the first time, and their families (patients of a suburban pediatric practice), were studied over a 6-month period utilizing health diaries, interviews with parents, parent ratings, physicians' records and ratings, and teacher ratings of children's behavior. We were unable to demonstrate a relationship between psychosocial factors and school absence among our sample of children. A possible explanation for this finding may be the relatively nondeviant character of the subjects studied. Another possibility is that kindergarten entry was not experienced as a stressful event for the children, most of whom had attended nursery school.

This essay proposes a two-track fellowship program in child psychiatry that would allow persons to enter child psychiatry training from a background in pediatrics, as well as from general psychiatry. Such flexibility would attract fellows from a new "pool" of applicants and increase the number of qualified physicians whose primary interest would be the mental health needs of children and adolescents. In addition, the plan would promote sharing of resources from both fields to child psychiatry and pediatrics, resulting in numerous programmatic and administrative advantages.

The W. T. Grant Foundation has funded training in behavioral pediatrics for pediatric residents at 11 medical centers. The approaches toward training taken by the 11 funded programs, based on information systematically collected by interviews conducted with departmental chairmen, faculty, and residents during a program visit to each medical center, are described. No single training site emerged as optimal for teaching behavioral pediatrics, although linking such teaching to a "low priority" setting was an educational obstacle. A serious problem in many programs was the lack of ongoing research in behavioral pediatrics. Success in teaching behavioral pediatrics was dependent upon faculty support and a mandatory experience in behavioral pediatrics for all residents.

Psychosocial factors affect resistance to a wide variety of diseases in animals. Stimuli often assumed to be noxious (e.g., electric shock, isolation housing) have been found to exert either potentiating or protective effects on an animal's response to potentially pathogenic stimulation. This variability has often been attributed to the influences of these stimuli on aspects of neuroendocrine or immunological function which are related to specific forms of pathogenic stimulation. The impact of a particular form of stimulation on the physiological state of the organism is also determined by the ability of the animal to cope with the stimulus environment. Factors shown to influence have included: (a) other aspects of the immediate environment at the time of stimulation; (b) prior experience with the same or other forms of stimulation; (c) the animal's ability to control its relationship to the stimuli by learning to escape or avoid them; (d) the availability of relevant feedback regarding stimulus onset (e.g., warning signal), and (e) the stage of the disease process at which stimulation is imposed. These findings by various investigators indicate that it may be inappropriate to place a priori value judgements on any form of psychosocial stimulation or stress either as conceptually or operationally defined. The adaptive value of the psychosocial environment will depend upon its perception by the animal, the animal's ability to cope with the stimulus environment, and the particular disease system being studied.