OBJECTIVE: To examine the views hypochondriacal patients have of their physicians, and their physicians' assessments of the hypochondriacal patients. DESIGN: A sample of patients meeting DSM-III-R diagnostic criteria for hypochondriasis was obtained by screening consecutive medical outpatients. They underwent a battery of self-report questionnaires and structured interviews, their medical records were audited, and their physicians completed questionnaires about them. A random sample of nonhypochondriacal patients from the same clinic served as a comparison group. SETTING: A large general medicine outpatient clinic of an academic teaching hospital. PATIENTS: 41 DSM-III-R hypochondriacs and 71 comparison patients. MEASUREMENTS AND MAIN RESULTS: Hypochondriacal patients were more dissatisfied with their physicians than were comparison patients. Physicians rated the hypochondriacal patients as more frustrating to care for, more help-rejecting, and more demanding. Physician ratings of how hypochondriacal their patients were correlated significantly with their ratings of how frustrating they considered the patients (R2 = 0.36) and with objective measures of how hypochondriacal the patients were (incremental R2 = 0.08). Physician estimates of anxiety and depression in the hypochondriacal patients were not statistically related to patient anxiety and depression. In contrast, physician estimates of patient anxiety and depression were significantly associated with the presence of anxiety and depression in comparison patients. CONCLUSIONS: The physician's use of the term hypochondriasis is closely associated with his or her frustration with the patient and is associated with objective measures of the extent of hypochondriacal symptoms. In addition, the presence of DSM-III-R hypochondriasis impairs the physician's accuracy in assessing the levels of the patient's anxiety and depression.

Attitude of Health Personnel↗

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Age at menarche and unsuccessful pregnancy outcome.

We have examined the relation between age at menarche and unsuccessful pregnancy outcome among women under 40 years of age. Women with early menarche (under 12) and late menarche (14 or older) had a greater number of unsuccessful pregnancy outcomes than did women of intermediate age at menarche (12 or 13 years). The differences in means adjusted by covariance analysis for age, total number of pregnancies, age at first live birth and socio-economic status were statistically significant. Among Catholic women, who were unlikely to have had induced abortions at the time of the study, the differences by menarcheal age were greater than among non-Catholic women. These findings support those of Liestøl (1980) who recently reported a possible causal connection between menarcheal age and spontaneous abortion.

Abortion, Spontaneous↗

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Secular changes in age at menarche in a sample of US women.

In an epidemiological survey of the reproductive history of a large group of United States women who had given birth to at least one child, there was a secular trend in age at menarche between those born around 1920 and those born around 1940-45. The trend was linear and the increment 3.2 months (+/- 0.36) per decade. The women were White, well nourished, middle-class and resided in all parts of the United States.

Adolescent↗

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Pregnancy loss in mothers of multiple births and in mothers of singletons only.

We compared pregnancy loss in mothers of multiple births and in mothers of singletons only. The index of pregnancy loss used for purposes of the present analysis is: the ratio of total pregnancies to total maternities consisting of live births. Mothers of one set of like-sexed twins and mothers of one set of unlike-sexed twins had greater pregnancy loss than did mothers of singletons only. Women who had higher-order multiple births comprised only 5% of our sample; in terms of their pregnancy loss these women were similar to mothers of singletons only. Data on whether women ever had difficulty becoming pregnant, and the type of therapy received to aid in conception showed that mothers of twins had greater difficulty becoming pregnant than did mothers of singletons. Among women with difficulty becoming pregnant, pregnancy loss was greater than among those who reported no difficulty. In our sample, 4.3% of mothers of multiple births and 3.4% of mothers of singletons only received hormonal therapy, some of which included FSH or clomiphene citrate.

Abortion, Spontaneous↗

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Violence, mental health, substance abuse-problems for women worldwide.

The objective of this paper is to bring attention to the epidemic proportions and the burden of disease from the overlapping health and social problems of violence, psychiatric or psychological distress, and substance abuse. Research is needed to prevent, alleviate, and treat these global problems, particularly for women because, although these problems affect the entire population, there are more problems for women. An overview from diverse national and international literature on the three areas is presented. Among health care professionals--physicians, nurses, and others--there is a great need for increased awareness of the problems and culturally sensitive research to understand better the interrelations among violence and anger and mental disorders and substance abuse, not only in high-risk subgroups of the population such as inner-city youths, but also among women and others in the general population globally.

Cost of Illness↗

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Quantitative computed tomography for spinal density measurement. Factors affecting precision.

Quantitative computed tomography (QCT) was performed in duplicate on 84 patients to test the short-term precision of the technique. Statistical analysis of the data revealed that precision was not a function of spinal density. It appeared to be worse in osteopenic individuals only when expressed as a percentage. Precision was slightly better in male than in female patients. There is a 90% likelihood that a duplicate measurement will fall within 20 CT units of the first determination in female patients and within ten units in male patients.

Adult↗

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Patient generated dysphoria in psychiatric residents.

Caring for patients can induce intense emotions in psychiatrists. Although clinical experience suggests that such feeling can become a source of stress for the psychiatrists, particularly the first year resident, and interfere adversely with patient care, research in this area has been lacking. We studied a group of psychiatric residents in order to identify what patient conditions or characteristics induce the greatest dysphoria and adversely affect the quality of patient care. Serious medical illnesses induced the greatest dysphoria.

Adult↗

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Lower lifetime occurrence of breast cancer and cancers of the reproductive system among former college athletes.

The prevalence (lifetime occurrence) rate of cancers of the reproductive system (uterus, ovary, cervix, and vagina) and breast was determined for 5,398 living college alumnae, 2,622 of whom were former college athletes and 2,776 nonathletes, from data on medical and reproductive history, athletic training, and diet. The former athletes had a significantly lower risk of cancer of the breast and reproductive system than did the nonathletes. The relative risk (RR), nonathletes/athletes, for cancers of the reproductive system was 2.53, 95% confidence limits (CL) (1.17, 5.47). The RR for breast cancer was 1.86, 95% CL (1.00, 3.47). The analysis controlled for potential confounding factors, including age, family history of cancer, age at menarche, number of pregnancies, use of oral contraceptives, use of estrogen in the menopausal period, smoking, and leanness. Of the college athletes, 82.4% had been on precollege teams compared with 24.9% of the college nonathletes. We conclude that long-term athletic training lowers the risk of breast cancer and cancers of the reproductive system. The lowered risk may be related to changes in estrogen metabolism associated with increased leanness.

Adult↗

PubMedDate not supplied

Smoking and cysts of the ovary.

Endocrinologic and epidemiologic data indicate that cigarette smoking is antiestrogenic. We found that cigarette smoking is significantly associated with the occurrence of cysts of the ovary among 5,398 college alumnae ranging in age from 21 to 80 years. Data on ovarian cysts were obtained in response to the question: "Did you ever have ovarian cysts? If yes, age occurred and treatment." The prevalence (lifetime occurrence) of cysts of the ovary in the entire sample is 10.2%. Never smokers had a lower lifetime occurrence of ovarian cysts in every age decade than did former smokers or current smokers. The age-adjusted odds ratio (OR) for ever smokers compared to never smokers is 1.5 with 95% CL (1.2, 1.8), P less than .001. For former smokers compared to never smokers, the OR is 1.5, 95% CL (1.2, 1.9); for current vs. never smokers, the OR is 1.4, 95% CL (1.1, 1.8). Smoking was also associated with the earlier occurrence of cysts of the ovary. The 2,622 former college athletes in the sample were at significantly lower risk of ovarian cysts than were the 2,776 nonathletes; OR = 0.8, 95% CL (0.6, 0.9). Young women need to be made aware of the possible adverse effect of cigarette smoking on the ovary.

Adult↗