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Biomedical subjects

G Wyshak

Publications and source records attributed to G Wyshak.

At least 19 recordsLinked to original sources
PubMed2001

Infertility in American college alumnae.

OBJECTIVE: The objective of this paper is to present data on prevalence of infertility, causes and treatments based on self-reports of a sample of American college alumnae. METHODS: A sample of 3940 American college alumnae, ages 37 to over 70 years, completed a self-administered questionnaire relating to infertility, its causes, treatment and treatment outcomes. RESULTS: Of the entire sample (n=3940), 3.1% (n=121) had primary infertility; 14.0% (n=548) had secondary infertility and were treated; 4.7% (n=184) tried for more than 1 year without success but had pregnancies without treatment; and 62.4% had no problems with infertility; and 16% (n=616) did not try to get pregnant. The major causes were 'unexplained infertility' reported by 43.5%; low sperm count or low motility, 21.4%; and anovulatory cycles, 20.3%. Treatment by clomid was reported by 39.5%. The overall success rate, resulting from treatment was 45%. The highest success rate occurred when anovulatory cycles were treated with clomid. CONCLUSION: Prevalence of primary and secondary infertility in this sample of American women is approximately 17%, similar to that observed for Sub-Saharan Africa.

Adult↗
PubMed2001

Women's college physical activity and self-reports of physician-diagnosed depression and of current symptoms of psychiatric distress.

It is believed that physical activity is protective against depression. This paper investigates the association between women's athletic activity in the college and precollege years and physician-diagnosed depression in postcollege years. College alumnae (n = 3940), former college athletes and nonathletes, completed a detailed self-administered questionnaire that sought information on health histories up to the present time, including questions on history of physician-diagnosed depression and current symptoms of psychiatric distress. A negative association between college athletic activity and self-reported physician-diagnosed depression in the last 10 years was observed (adjusted odds ratio [OR] = 0.664, with 95% confidence limits [CL] 0.545, 0.808, p < 0.0001). Other factors significantly associated with depression are living with a spouse, at time of reporting-protective; self-rated current health good to poor compared with very good or excellent; alcoholism; and having a doctoral degree-risk factors. Current state variables based on the Rand Mental Health Inventory-5 (RMHI-5) were also more favorable among athletes. This is the first study to report a long-term beneficial association between women's college athletic activity and self-reported physician-diagnosed depression in the postcollege years and current symptoms of psychiatric distress. The findings support the Surgeon General's promotion of the health benefits of physical activity.

Adult↗
PubMed2001

Psychosocial training in U.S. internal medicine and family practice residency programs.

PURPOSE: Competence in the psychosocial aspects of medical care is necessary for primary care physicians to function effectively. This study investigated the psychosocial training internal medicine and family practice residents receive in U.S. programs. METHODS: In 1996, program directors of all U.S. internal medicine (IM) and family practice (FP) residency programs were surveyed regarding the format, content, and quantity of psychosocial training provided in their programs, their opinions on topics related to psychosocial training, and demographics of their programs. RESULTS: The response rate was 61%. Ninety-nine percent of FP and 62% of IM program directors reported requiring at least one psychosocial training experience. Family practice programs required an average of 352 hours (SD +/- 175; range 27-2,664) of psychosocial training compared with 118 hours (SD +/- 272; range 0-1,050) for IM programs. Most IM and FP program directors expected residents to achieve at least basic competency in virtually all psychosocial topic areas; however, FP programs provided a greater range of psychosocial experiences. FP program directors most often identified psychologists and IM program directors most often identified internists as providing the most psychosocial training in their programs. Both IM and FP program directors considered lack of curricular time to be the main obstacle to development of psychosocial training. CONCLUSION: Residents' competence in psychosocial areas is important to both IM and FP program directors. However, content and time devoted to psychosocial training vary considerably both within and between program types.

Clinical Competence↗
PubMed2000

Teenaged girls, carbonated beverage consumption, and bone fractures.

OBJECTIVE: To determine the possible association between carbonated beverage consumption and bone fractures among teenaged girls given the awareness of the concern about the impact of carbonated beverage consumption on children's health. SETTING: An urban high school. METHODS: A cross-sectional (retrospective) study. Four hundred sixty 9th- and 10th-grade girls attending the high school participated in this study by completing a self-administered questionnaire relating to their physical activities and personal and behavioral practices. The school system and the Harvard School of Public Health Institutional Review Boards approved the study. The girls' self-reports on physical activity, carbonated beverage consumption, and bone fractures are analyzed. RESULTS: In the total sample, carbonated beverage consumption and bone fractures are associated: odds ratio = 3.14 (95% confidence limit, 1.45, 6.78), P = .004. Among physically active girls, the cola beverages, in particular, are highly associated with bone fractures: odds ratio = 4.94 (95% confidence limit, 1.79, 13.62), P = .002. CONCLUSIONS: The results reported confirm previous findings, but the mechanism by which cola drinks are associated with bone fractures in physically active girls has neither been fully explored nor determined. Nevertheless, national concern and alarm about the health impact of carbonated beverage consumption on teenaged girls is supported by the findings of this study. The results have policy implications for improving the dietary practices and health of children.

Adolescent↗
PubMed2000

Breast cancer among former college athletes compared to non-athletes: a 15-year follow-up.

A growing body of evidence indicates that physical activity is protective against breast cancer. In 1996-97, we conducted a 15-year follow-up of 5398 college alumnae comprised of former college athletes with their non-athletic classmates. Participants completed a detailed mailed questionnaire on their health history from 1981-82 to the present. Excluding women who had died and non-deliverable questionnaires, 84.7% (n = 3940) of the participants in our earlier study responded to the questionnaire; the response rate for former athletes was 86.6% (n = 1945), for non-athletes, 83.0% (n = 1995). Results confirmed our earlier findings. Based on self-reports, former college athletes had a significantly lower risk of breast cancer than the non-athletes. The OR for the 15-year incidence of breast cancer is 0.605 with 95% confidence interval (CI) (0.438-0.835); the 15-year incident breast cancers were 64 among the athletes and 111 among the non-athletes. Among women under 45 the protective effect of physical activity on the risk of breast cancer is considerably greater; odds ratio (OR) = 0.164, 95% CI (0.042-0.636). Athletic activity during the college and pre-college years is protective against breast cancer throughout the life span, and more markedly among women under 45. These results confirm our earlier findings and the findings of other investigators.

Aged↗
PubMed2000

Tubal ligation, menstrual changes, and menopausal symptoms.

One of the problematic effects of tubal sterilization is menstrual changes or disorders, although the results of studies in this area have been inconsistent and inconclusive. Recently, there has been growing evidence that tubal sterilization protects against ovarian cancer, possibly through physiological transformations that result in ovarian dysfunction and decline. This report explores the possibility that the biological mechanism of ovarian dysfunction and decline may affect the menstrual and menopausal changes that result from hormonal imbalances. Using data from a homogeneous population of college alumnae assessed for health status, athletic history, and lifestyle characteristics, we focused on a premenopausal subgroup of women in the age range of 40-44 years and with at least one pregnancy. Multivariate analyses were performed to compare sterilized women (n = 56/516, 11%) in this subgroup with nonsterilized women (89%). The two groups were alike in mean age, mean parity, body mass index, smoking history, physical activity levels, and athletic status. Factors that significantly distinguished sterilized women from nonsterilized women were perimenopausal symptoms, such as flushing, sweating, breast pain, vaginal dryness, and pain associated with menstrual cycles.

Adult↗
PubMed1999

Adverse birth outcomes among native-born and immigrant women: replicating national evidence regarding Mexicans at the local level.

OBJECTIVES: For almost two decades, the literature has consistently described an epidemiologic paradox relating to better birth outcomes among high-risk groups, particularly new immigrants from Mexico and Southeast Asia. We hypothesize that regardless of their sociodemographic profile, Mexican immigrants will exhibit lower rates of low birth weight and preterm deliveries than native-(U.S.) born women of Mexican origin, non-Hispanic White and Black women, and Puerto Rican Women. METHODS: We studied 57,324 live-born singleton infants born to residents in the city of Chicago in a linked data set of 1994 birth-death records. Multivariate logistic regression was used to analyze race/ethnicity differentials in two pregnancy outcome measures, low birth weight and preterm birth. RESULTS: Overall better birth outcome is related to maternal immigrant status regardless of race/ethnic groups. Immigrant Mexican women had a significantly lower risk of both low birth weight [adjusted odds ratio (AOR): 0.78, 95% confidence interval (CI) 0.66-0.91] and preterm births (AOR: 0.75, 95% CI 0.65-0.86) and were at 28% and 33% lower risks of delivering a low birth weight infant or a premature infant, respectively, than non-Hispanic White women.

Adolescent↗
PubMed1998

A naturalistic study of the chronic fatigue syndrome among women in primary care.

Chronic fatigue syndrome (CFS), a controversial illness without clear etiology, causes profound debilitation in its sufferers. This study explored subjects' perceptions of the variables that mediated the course of their illness and identified coping strategies in 15 women with CFS referred from the practice of a primary care physician. Exploratory semistructured interviews were adapted from Kleinman's Illness Narratives. Four instruments were used: the Beck Depression Inventory, the Sickness Impact Profile, a modified Karnofsky scale, and the Defense Mechanism Rating Scale. Of the 15 women, 60% reported improvement and/or recovery at the time of the interview. Improvement was associated with social support and lower levels of depressive symptoms. Health status was influenced by how subjects perceived their illness, their future, and the doctor's prognosis; and by the physician's early diagnosis, validation of the CFS, and intensive medical follow-up. Obsessional and healthy neurotic defense levels predominated, which differs from historical comparison groups with dysthymia and panic disorder. Psychological adaptation to CFS is similar to adaptive coping in other chronic illnesses: subjective perceptions of health status can predict functional status. Physician validation is particularly important given the controversial status of CFS. Maintaining relationships with others--doctor, work, family, and group/spiritual activities reflected healthy coping strategies that promoted hope and attitudinal shifts. The finding of a mixture of neurotic and healthy defenses and a low proportion of defenses associated with personality disorders has not been previously reported in the CFS literature and warrants further investigation.

Adaptation, Psychological↗
PubMed1997

Association between endometriosis, dysplastic naevi and history of melanoma in women of reproductive age.

Women with melanoma and its precursor lesions, dysplastic naevi, have a higher prevalence of reproductive disorders than women without melanotic lesions. This association appears strongest among young women with dysplastic naevi and endometriosis. The purpose of this study was to evaluate patients with laparoscopy-confirmed endometriosis for the presence of dysplastic naevi. A total of 66 endometriosis patients and 35 controls completed a detailed questionnaire and underwent an extensive dermatological examination for the presence of dysplastic naevi. In all, 41% of patients aged < or = 32 years had dysplastic naevi, compared with 8% of controls (P = 0.038). In addition, 29% of patients with endometriosis reported a family history of melanoma compared with 10% of controls (P = 0.039). This study demonstrated an association between endometriosis and dysplastic naevi in younger women of reproductive age and found an associated family history of melanoma among endometriosis patients. These observations may be useful in the evaluation and care of young women by both gynaecologists and dermatologists.

Adult↗
PubMed1996

Violence, mental health, and substance abuse in patients who are seen in primary care settings.

OBJECTIVE: To explore the associations among having feelings of anger, being the perpetrator or victim of violent acts, having symptoms of psychiatric distress, and being substance abusers in patients who were seen in primary care settings. DESIGN AND SETTING: A brief self-administered questionnaire was completed by adults who were attending ambulatory clinics of a community hospital and of a neighborhood health center. PARTICIPANTS: Seventy-three percent of the participants were women; 45% were Hispanic or Portuguese, 10% were African American, 35% were white, and 10% were of other ethnic or racial backgrounds; and most were of a lower socioeconomic status. RESULTS: Feelings of anger and acts of violence were most highly associated as follows: (1) among men, with being hit as a child, use of drugs, and symptoms of nervousness; (2) among all women, with a drinking problem and "being down"; and among white women, with a drinking problem, being down, and being hit as a child or as an adult or both. Consequences of being hit as a child were feelings of anger and drug use among men, drinking problems among all women, and psychiatric symptoms among white women. CONCLUSIONS: An 18-item self-administered questionnaire can provide useful information on symptoms of psychiatric distress and substance abuse. These symptoms may be associated with feelings of anger and violence-both for the perpetrator and victim. This questionnaire may aid practitioners in the detection and management of physical and psychologic problems.

Adult↗
PubMed1995

Satisfaction with and effectiveness of medical care in relation to anxiety and depression. Patient and physician ratings compared.

This study examined 1) patient ratings of satisfaction with and effectiveness of medical care, and 2) physician ratings of treatment effectiveness, taking into account personal characteristics, health and mental health of 75 clinic attenders who scored below a cutoff on a screening questionnaire for hypochondriasis. Patients above the cutoff on this instrument, and a random sample of all those below the cutoff, then returned at a later date to undergo a research battery consisting of self-report questionnaires, and structured and semistructured interviews, including the Diagnostic Interview Schedule (DIS). About three-fourths of the patients were very satisfied with their medical care, and over half considered the medical care they received effective. Patients and physicians did not concur on the effectiveness of care (r = 0.029, p = 0.81; Kappa = 0.025). Depression was negatively correlated with satisfaction with medical care, r = -0.42, p = 0.0001; anxiety negatively correlated with perceived effectiveness of care, r = -0.41, p = 0.003. Physician rating of effectiveness of care correlated with physician rating of depression, age, and gender (more effective for older and male), (R2 = 0.27, p = 0.0388). We conclude that the lack of agreement between patients and physicians on effectiveness of care suggests the need for better communication. The finding that a depressive diagnosis is associated with dissatisfaction suggests more generally that psychiatric disorder may be an important determinant of patient satisfaction with medical care.

Activities of Daily Living↗
PubMed1994

Relationship between patient self-ratings and physician ratings of general health, depression, and anxiety.

OBJECTIVE: To examine the relationship between patient self-ratings and physician ratings of general health, depression, and anxiety and patient and physician ratings in comparison to Diagnostic Interview Schedule (DIS) diagnoses of depression and anxiety. DESIGN: Observational study. SETTING: A general medical outpatient clinic. PATIENTS: Clinic attendees. METHOD: Consecutive clinic attendees on randomly selected days completed a self-reported screening questionnaire for hypochondriasis, composed of the Whiteley Index and the Somatic Symptom Inventory. A random sample of patients (N = 79), 95% of whom had scores below the cutoff for hypochondriasis (n = 75) and 5% of whom had scores at or above the cutoff for hypochondriasis (N = 4), returned at a later date to complete a research battery consisting of self-reported questionnaires, structured and semistructured interviews, and a structured interview for diagnoses of anxiety and depression based on the DIS, which used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. OUTCOME MEASURES: Responses to questionnaires and interviews. RESULTS: Agreement between patients and physicians was statistically significant concerning patients' physical health, depression, and anxiety. Based on one question, both physicians' and patients' ratings of depression and anxiety compared favorably with DIS diagnoses. By means of receiver operating characteristics analysis, values for the areas under the curve and their SEs were as follows: for depression, 0.789 +/- 0.075 for patient self-ratings and 0.825 +/- 0.054 for physician ratings; for anxiety, 0.734 +/- 0.058 for patient self-ratings and 0.667 +/- 0.065 for physician ratings. CONCLUSION: One simple question about a patient's status with respect to depression or anxiety is sufficient to detect these disorders with high sensitivity and specificity, yielding values comparable to those yielded by instruments consisting of many items. Asking patients to rate their own levels of depression and anxiety may constitute one portion of the family physician's diagnostic assessment for these conditions.

Anxiety Disorders↗
PubMed1994

The relation between change in reports of traumatic events and symptoms of psychiatric distress.

This study examines change in the reporting of trauma events in relation to the reporting of severity of symptoms of psychiatric distress among refugees from Southeast Asia. Patients (N = 30) from a specialized clinic were interviewed on two occasions using a questionnaire which includes inquiry about traumatic events and about psychiatric symptoms. The changes in responses to the questionnaire, administered twice, 1 week apart, were assessed. In accord with other studies, results indicated that the number of trauma events reported correlates positively with severity of symptoms (r = 0.533, p = 0.002). Severity of symptoms of psychiatric distress increased slightly from time 1 to time 2 for 23 of the 30 symptoms. The reporting of trauma events varied between time 1 and time 2; the correlation coefficient ranged from 0.23 to 0.90, with a median 0.62 for the 17 trauma events. The important new finding is that of an inverse relation between total symptom score and the percent change in the reporting of trauma events on two occasions (r = -0.478, p = 0.009). Findings suggest that clinicians and researchers should give attention to variability in recall of traumatic events and reexamine the emphasis placed on the memory of traumatic events in the treatment of Posttraumatic Stress Disorder.

Adaptation, Psychological↗
PubMed1994

Carbonated beverages, dietary calcium, the dietary calcium/phosphorus ratio, and bone fractures in girls and boys.

PURPOSE: The aim of this study was to explore the association between carbonated beverage consumption, as well as other nutritional intake, and the occurrence of bone fractures in girls (mean +/- SD) 14.3 yr +/- 1.8 and boys 14.6 yr +/- 1.6. METHODS: Food-frequency questionnaires and medical histories were obtained from 76 girls and 51 boys. Subjects were recruited from a swimming club and physicians' offices; their physical characteristics are representative of the normal adolescent population. RESULTS: The data show a strong association between cola beverage consumption and bone fractures in girls [the adjusted odds ratio (OR) = 3.59; 95% confidence interval (CI) 1.21, 10.75; p = 0.022]. High intake of dietary calcium was protective (adjusted OR = 0.284; 95% CI 0.087, 0.920; p = 0.036). No association between the non-cola drinks and bone fractures was found. In boys, only total caloric intake was associated with the risk of bone fractures; the association was inverse. CONCLUSION: The high consumption of carbonated beverages and the declining consumption of milk are of great public health significance for girls and women because of their proneness to osteoporosis in later life.

Adolescent↗
PubMed1992

Psychiatric comorbidity in DSM-III-R hypochondriasis.

Forty-two DSM-III-R hypochondriacs from a general medical clinic were compared with a random sample of 76 outpatients from the same setting. Patients completed a research battery that included a structured diagnostic interview (Diagnostic Interview Schedule) and self-report questionnaires to measure personality disorder caseness, functional impairment, and hypochondriacal symptoms. Psychiatric morbidity in the hypochondriacal sample significantly exceeded that of the comparison sample. Hypochondriacs had twice as many lifetime Axis I diagnoses, twice as many Diagnostic Interview Schedule symptoms, and three times the level of personality disorder caseness as the comparison group. Of the hypochondriacal sample, 88% had one or more additional Axis I disorders, the overlap being greatest with depressive and anxiety disorders. One fifth of the hypochondriacs had somatization disorder, but the two conditions appeared to be phenomenologically distinct. Hypochondriacal patients with coexisting anxiety and/or depressive disorder (secondary hypochondriasis) did not differ greatly from hypochondriacal patients without these comorbid conditions (primary hypochondriasis). Because the nature of hypochondriasis remains unclear and requires further study, we suggest that its nosologic status not be altered in DSM-IV.

Comorbidity↗
PubMed1992

A structured diagnostic interview for hypochondriasis. A proposed criterion standard.

We developed a structured diagnostic interview for DSM-III-R hypochondriasis (SDIH) that is the first such clinician-administered instrument. The SDIH was administered to 88 general medical outpatients who scored above a predetermined cutoff on a hypochondriacal symptom questionnaire, and to 100 comparison patients randomly chosen from among those below the cutoff. Using the joint assessment method, interrater agreement on the DSM-III-R diagnostic criteria was 88% to 97% and agreement on the diagnosis was 96%. Concurrent validity was suggested by a significant correlation between the interview and the primary care physicians' ratings of hypochondriasis. A measure of external validity was demonstrated in that several clinical characteristics thought to be ancillary features of hypochondriasis were significantly more prevalent in interview-positive patients than in interview-negative patients. Finally, the SDIH appeared to have discriminant validity in that patients diagnosed as hypochondriacal had several other clinical features that distinguished them from the patients who scored above the cutoff on hypochondriacal symptomatology, but failed to be diagnosed as hypochondriacal with the SDIH.

Ambulatory Care↗