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PubMed1993

Self- and spouse ratings of anger and hostility as predictors of coronary heart disease.

Self- and spouse ratings of anger and hostility were examined as predictors of coronary heart disease (CHD) in 185 cardiac patients. Patients completed the Multidimensional Anger Inventory (MAI) and the Marlowe-Crowne Social Desirability (MCSD) Scale; the MAI (rewritten to 3rd person) was completed by patients' spouses or by a peer. Thallium scans were used to measure CHD status. Results showed that patient-rated MAI scores were inversely correlated with MCSD. There were no gender differences for patient-rated MAI scores, but spouse ratings showed gender effects for Anger-Arousal and Hostile Outlook: Women rated their husband higher than men rated their wife. Patients with positive thallium scans were no different from those without CHD on patient-rated MAI scores; however, spouse ratings indicated that those with CHD had higher Hostile Outlook and Anger-In scores. After accounting for the effects of traditional CHD risk factors, only spouse-rated hostility contributed significant incremental variance to the prediction of CHD status.

Adult↗
PubMed2001

Risk factors for atherosclerosis in survivors of myocardial infarction and their spouses: comparison to controls without personal and family history of atherosclerosis.

To explore the hypothesis that an interplay between genetic and environmental factors contributes to the development of coronary atherosclerosis, we compared the prevalence of risk factors for atherosclerosis among survivors of myocardial infarction (MI) and their spouses and apparently healthy men and women (spousal pairs) with no personal and family history of atherosclerosis in three generations. There were no significant differences in life-style and dietary habits between the groups. The daily vegetable and/or fruit intake was generally low and did not differ between the groups. Thirty percent and 25% of men and women did not consume any vegetables or fruits, respectively. All differences found in the male MI survivors and control men were also found between the female groups: MI survivors and their spouses were significantly more obese and had higher systolic and diastolic blood pressure and more pathologic plasma lipid levels compared with control males and females, respectively. Compared with the control men and women, MI survivors and spouses had higher plasma homocysteine (Hcgamma) levels (15.3 +/- 10.5, 11.9 +/- 4.0, 16.9 +/- 5.5, and 14.3 +/- 4.0, micromol/L, respectively, P = .01). The frequency of the homozygous C677T 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphism in MI survivors was twice that observed in their spouses and controls (12.1%, 4.8%, and 5.8%, respectively), but this difference did not reach statistical significance. A statistically significant association of the MTHFR genotype and Hcgamma concentration (multiple ANOVA) was shown. Neither the frequencies of apolipoprotein E (apoE) alleles nor Asp9Asn mutation of exon 2, Asn29lSer mutation of exon 6, and Ser447Ter of exon 9 of the lipoprotein lipase (LPL) gene varied significantly among the groups. A possible explanation for our findings is that individuals with a genetic predisposition for atherosclerosis and their spouses share a life-style that results in a higher body mass index (BMI) and waist to hip ratio (WHR). On the other hand, individuals with no family history of atherosclerosis, despite an unhealthy life-style similar to that in the affected families (diet and physical activity), had a lower BMI and WHR and more favorable metabolic parameters, including plasma Hcgamma. In conclusion, we have shown that a personal and/or family history of atherosclerosis corresponds to the prevalence and level of risk factors for atherosclerosis. A combination of life-style factors and inherited metabolic abnormalities, including high plasma Hcgamma, are the more likely explanation for our findings.

Analysis of Variance↗
PubMed1993

Being in control: a note on differences between caregiving and noncaregiving spouses.

Twenty-seven spouse caregivers of dementia patients and 33 noncaregiving (healthy) spouses, aged 54 to 90, described a stressful situation with their spouses and completed measures of perceived control and subjective well-being. Both groups were similar in their perceived lack of control over the spouse's behavior but differed in how control influenced positive affect. Perceived control over the spouse was negatively related to positive affect for the healthy couples but for caregivers it was positively related.

Aged↗
PubMed1993

Psychological distress in cancer patients and their spouses.

The degree of psychosocial distress experienced by 15 cancer patients with newly diagnosed metastatic disease and their spouses was investigated. Of interest were mean changes over the six-month interval following diagnosis, and correlations between partners at 0, 3, and 6-7 months. The Psychosocial Adjustment to Illness Scale (PAIS) and the Family Environment Scale (FES) were used to quantify adjustment. Several PAIS subscales exhibited increasing distress over time for patients: Social Environment (p = 0.004), Vocational Environment (p = 0.028), and Psychological Distress (p = 0.029). FES Conflict increased over time (p < 0.005), while Intellectual Cultural Orientation declined (p = 0.02), both for spouses only. Of 24 patient-spouse PAIS correlations (7 subscales plus a global scale, at three times), 7 (29%) were 0.70 or greater (ps < 0.01). Of 30 FES correlations, 17 (57%) were 0.7 or higher (ps < 0.01). These results suggest that some stresses increase over time, and that spouses and patients share a similar perceived level of distress. Health professionals must address the psychological distress of the spouse as well as the patient.

Adult↗
PubMed1988

The spouse as a possible anginal warning system in silent myocardial ischaemia.

It has been previously shown that undercomplaining behaviour is involved in the 'silence' of Silent Myocardial Ischaemia (SMI). By means of symptom checklists completed blindly by both the patient and his spouse we found that: (1a) at an individual level, even in non-cardiac related symptoms areas (everyday illnesses), SMI patients have a lower propensity to complain than symptomatic patients; yet (1b) they describe the same level of worrying about symptoms as painful patients. (2) At a second level, when looking at patient-spouse discrepancies it appears that the spouse of the SMI patient describes the patient as having not only more symptoms but also as being less worried than he reports. On the contrary, the spouse of the symptomatic patient generally describes the patient as having fewer symptoms than he does and as being more worried by the symptom's appearance than he reports. These data support the denial hypothesis in SMI and allow us to consider the spouse not only as a good anamnestic collaborator in order to avoid information biases in SMI but also as a potential warning system that could be used in prevention and treatment strategies related to SMI.

Angina Pectoris↗
PubMed1988

Physicians' and spouses' predictions of elderly patients' resuscitation preferences.

"Substituted judgment," in which surrogate decisionmakers approximate patients' wishes, has been recommended for decision making for mentally incapacitated patients. To test understanding of patients' preferences by potential surrogate decisionmakers, we studied primary care physicians' (n = 105) and spouses' (n = 90) predictions of elderly outpatients' (n = 258) preferences for cardiopulmonary resuscitation (CPR) and CPR plus ventilator (CPR + V), assuming three baseline health states: current health, stroke, and chronic lung disease. Although more than three-quarters of physicians and spouses surveyed believed their predictions of patients' preferences were accurate, the accuracy of physicians' and spouses' predictions did not exceed that expected due to chance alone in 5 of 6, and 3 of 6 decisions, respectively. Physicians significantly underestimated patients' preferences for resuscitation in the stroke and chronic lung disease scenarios (p less than .01), and significantly overestimated them in the current health/CPR decision (p less than .05). Spouses overestimated patients' preferences for resuscitation in all decisions, significantly so in the three CPR + V decisions (p less than .05). These results suggest physicians and spouses often do not understand elderly outpatients' resuscitation preferences. Under these circumstances they are unlikely to provide accurate substituted judgments.

Aged↗
PubMed1982

Spouse concordance for fasting plasma glucose in non-diabetics.

Spouse concordance for fasting plasma glucose was determined in 1710 currently married spouse pairs from a retired community in Southern California who had married durations of from 1 year to more than 40 years. A highly significant concordance was found in marriages of all durations, with the highest concordance in marriages of short duration. Concordance for fasting plasma glucose was not explained by concordance for education, obesity, cigarette smoking, ingestion of whole milk or eggs, the use of antihypertensive medications or a family history of heart disease. Nor was the observed spouse concordance due to selective mortality of discordant spouse pairs. Although there was significant seasonal variation in fasting plasma glucose levels, spouse concordance was not entirely a function of seasonality of sampling. The data suggest that concordance for other environmental attributes--possibly specific nutrients--is responsible for fasting plasma glucose concordance.

Adult↗
PubMed1990

Heterosexual transmission of HIV-1 among employees and their spouses at two large businesses in Zaire.

To better understand the reasons why up to 80% of all HIV-1 infections in Zaire, but less than 5% in North America and Europe, are acquired through heterosexual transmission, and to assess the impact of HIV-1 infection on a large urban African workforce, we enrolled 7068 male employees, 416 female employees and 4548 female spouses of employees at two large Kinshasa businesses (a textile factory and a commercial bank) in a prospective study of HIV-1 infection. The HIV-1 seroprevalence rate was higher in male employees (5.8%) and their spouses (5.7%) at the bank than among male employees (2.8%) and their spouses (3.3%) at the textile factory. At both businesses HIV-1 seroprevalence was higher among employees in managerial positions (5.0%) than among workers in lower-level positions (3.0%; P less than 0.0001). In a multivariate analysis of male employees, receipt of a transfusion, a history of genital ulcer disease, working at the bank, urethritis, or being divorced or separated were independently associated with HIV-1 infection. During 1987 and 1988, AIDS was the most common cause of death among recently employed workers, accounting for 20 and 24% of all deaths at the textile factory and the commercial bank, respectively. The HIV-1 seroprevalence rate was higher among female workers (7.7%) than among the spouses of male workers (3.9%; P = 0.001). In multivariate analysis of the wives of workers, having an HIV-1-seropositive spouse, receipt of a blood transfusion, or a history of genital ulcer disease were independently associated with HIV-1 infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1993

Congruence in uncertainty between individuals with multiple sclerosis and their spouses.

The purpose of this study was to examine differences in the perception of illness uncertainty between husband and wife and to explore how these differences influence emotional well-being. Mood and family satisfaction were used as indicators of emotional well-being. The sample consisted of sixty-one married couples in which one spouse had multiple sclerosis. Results supported that both individual perceptions of illness uncertainty and congruence in perceived uncertainty between spouses may have negative effects on marital partners. For both spouses, those who reported higher levels of uncertainty were more likely to have lower moods and feel more dissatisfied with family life. However, the most crucial factor in determining family satisfaction for spouses with multiple sclerosis was their own perception of illness uncertainty, while for well spouses, it was the congruence between each partner's perception of the illness uncertainty.

Activities of Daily Living↗
PubMed1991

Effectiveness of three types of spouse-involved behavioral alcoholism treatment.

Treatment was provided to 45 alcoholics and their spouses in one of three out-patient behavioral treatment conditions: (1) minimal spouse involvement (MSI) (n = 14), (2) alcohol-focused spouse involvement (AFSI) (n = 12), or (3) alcohol-focused spouse involvement plus behavioral marital therapy (ABMT) (n = 19). Subjects were followed for 18 months after treatment. Subjects in all conditions reported significant decreases in frequency of drinking and frequency of heavy drinking, and reported increased life satisfaction. This information was corroborated by independent reports of the spouses. Patterns of outcome varied across the three treatment conditions, with ABMT subjects showing gradual improvement in proportions of abstinent days and abstinent plus light drinking days over the last 9 months of follow-up. Subjects in the other two treatment conditions showed gradual deterioration in proportion of abstinent days and abstinent plus light drinking days. Subjects assigned to the ABMT condition were less likely to experience marital separations, and reported greater improvement in marital satisfaction and subjective well-being than the other experimental groups. Clinical and theoretical significance of these findings are discussed.

Adult↗
PubMed1989

Education to assist spouses in coping with Alzheimer's disease. A controlled trial.

This study investigates whether a brief educational program, provided to spouses of patients with Alzheimer's disease, improved the caregivers' coping skills; it also questions whether the gender of the spouse had an effect on coping ability. The sample consisted of 40 spouses who were caring for the Alzheimer patient at home, 20 who participated in the educational program, and 20 controls. The instrument used for the study was the Health Specific Family Coping Index (HSFCI). This instrument provided a quantitative assessment of overall family coping with both potential and actual health problems in the psychosocial and physical domains of health. It is rated in nine domains: physical independence, therapeutic competence, knowledge of the condition, application of principles of personal hygiene, attitude toward health care, emotional competence, family living patterns, physical environment, and use of community resources. A home visit was made by a registered nurse prior to the educational intervention and at the end of the four-week intervention period. The HSFCI was completed at each visit. There were no pretreatment differences between the intervention and control groups in coping ability. Findings indicate that the educational program was beneficial in assisting spouses to feel greater competence in the face of the disease process and to function with greater independence. In the treatment group, the greatest significant increase was in the knowledge domain, followed by therapeutic competence and emotional competence. There was no overall relationship between gender of the spouse and coping ability.

Adaptation, Psychological↗
PubMed1989

Spouses' experiences during pregnancy and the postpartum: a program of research and theory development.

A program of nursing research was established to test a theory proposing that wives and husbands have similar pregnancy-related experiences. The research was guided by a conceptual framework of the family as a living open system. Findings were conflicting from three studies that investigated the relationship between spouses' strength of identification and similarities in changes in various body image components during and after pregnancy; taken together the findings suggested that spouses do not have similar patterns of change in their body images during pregnancy and the postpartum. Two other studies investigated the relationship between spouses' strength of identification and similarities in their reports of physical and psychological symptoms during pregnancy and the postpartum. In these studies the spouses reported similar physical and psychological symptoms during pregnancy and the postpartum. There was no evidence, however, in any of the studies of a relationship between spouses' strength of identification and similarities in their pregnancy-related experiences. The validity of the theory of similar pregnancy-related experiences and the credibility of the conceptual framework of the family as an open system are questioned.

Body Image↗
PubMed1993

Antinuclear antibodies in patients with scleroderma (systemic sclerosis) and in their blood relatives and spouses.

OBJECTIVE: To test the postulate that there is a higher prevalence of antinuclear antibodies (ANAs) in serum samples from blood relatives and from spouses of patients with scleroderma than in control samples, and that this provides evidence for both genetic and environmental factors influencing autoimmunity in scleroderma. METHOD: Testing for ANAs was performed on 58 patients with scleroderma, 30 of their spouses, 74 first degree relatives, and 66 control subjects broadly age matched to the patients, their spouses, and about half of the relatives (siblings and parents). RESULTS: On the basis of an ANA titre of > 40 as positive, 12 (18%) of the controls, 55 (95%) of the patients, one (3%) of the spouses and five (7%) of the relatives would be classified as positive. Thirty seven (64%) of the patients had defined specificities (ACA, Scl 70, U1 (RNP)) but none of the controls, spouses, or relatives had antibodies of these specificities. CONCLUSION: These findings give no support to the postulate that environmental or genetic factors contribute to the ANAs in scleroderma.

Adult↗
PubMed1994

Study of urinary calcium excretion after oral calcium load in stone formers, their spouses and first-degree blood relatives.

Hypercalciuria has long been considered a common abnormality in stone formers, and familial predisposition to renal stone formation has also been reported. Renal stone formers, their spouses and first-degree blood relatives (the latter two groups of subjects had no previous or present history of stone disease) were investigated for their response to an oral load of 2 g calcium (as di-calcium phosphate). Serum calcium, phosphorus, uric acid, creatinine and urea were within the normal range in all the subjects initially as well as 4 h after the load. After the oral calcium load, 66.6% of the stone formers, 25% of the first-degree relatives and none of the spouses were hypercalciuric. Administration of 2 g calcium produced a significantly greater urinary excretion of calcium in stone formers (123.8 +/- 43 mg/8 h, p < 0.001) and their first-degree blood relatives (89.8 +/- 26 mg/8 h, p < 0.01) as compared to the spouses of stone formers (65.5 +/- 12.8 mg/8 h). A significant increase in urinary calcium excretion after calcium loading was also found among the stone formers (p < 0.01) as compared to their first-degree blood relatives. A significantly higher mean rise in calcium excretion (over the basal excretion) in calcium stone formers (p < 0.001) and their first-degree blood relatives (p < 0.01), as compared to the spouses of stone formers suggests a greater predisposition to renal stone disease in first-degree blood relatives than the spouses of the stone patients.

Administration, Oral↗
PubMed1998

Pilot study on patients' and spouses' attitudes toward potential genetic testing for bipolar disorder.

OBJECTIVE: The purpose of this pilot study was to gain information about attitudes of individuals with bipolar disorder and their spouses toward some of the ethical and social issues arising from rapidly advancing genetic research on bipolar disorder. METHOD: Patients with bipolar disorder and their unaffected spouses were asked to answer questionnaires assessing their knowledge and attitudes about treatment response rates for bipolar disorder, probability of inheritance, genetic testing, disclosure of genetic information, abortion, marriage, and child-bearing. RESULTS: The overwhelming majority of the patients and spouses said that they would take advantage of genetic tests for bipolar disorder if such tests were to become available. Most patients and spouses agreed that the benefits of knowing whether one carries a gene for bipolar disorder would outweigh the risks. The decisive majority of respondents also felt that they would not abort a fetus that carried a gene for bipolar disorder. Furthermore, most patients and spouses agreed that the knowledge that one of them carried a gene for bipolar disorder would not have deterred them from marriage or childbearing. CONCLUSIONS: The results of this study suggest that most individuals believe that they would benefit from the use of genetic testing for bipolar disorder if it were to become available. Follow-up studies using a broader patient sample and nonclinical control groups would be useful in further evaluating the issues addressed in this pilot study.

Abortion, Eugenic↗
PubMed2002

Increased T-lymphocyte apoptosis/necrosis and IL-10 producing cells in patients and their spouses in Icelandic systemic lupus erythematosus multicase families.

The objective of this study was to evaluate apoptosis and production of IL-10 in SLE patients, their spouses and first-degree relatives in Icelandic SLE multicase families. Previously, increased IL-10 production has been found in all three groups. As IL-10 has been found to induce apoptosis in SLE, the percentage of lymphocytes undergoing apoptosis was evaluated, as well as the possible correlation between apoptosis and IL-10 production. Apoptosis and IL-10 production were studied in SLE patients (n = 12) from SLE multicase families and their spouses (n = 12) and a matched control group of healthy individuals (n = 10). The proportion of T and B lymphocytes undergoing apoptosis at 0, 24, 48 and 72 h was detected by flow cytometry using Annexin V and PI staining and the rate of apoptosis was calculated. IL-10 production was studied simultaneously by ELISpot analysis of freshly isolated peripheral blood mononuclear cells. In addition, T lymphocyte apoptosis at t = 0 was investigated in a group of non-household first-degree relatives (n = 10) and controls (n = 10). Antinuclear and antilymphocyte antibodies were analysed in all the groups. The SLE patients as a group had a significantly increased percentage of T lymphocytes in apoptosis at 0 and 48 h and a significantly higher number of IL-10 producing cells as compared with the healthy controls (P = 0.03, 0.02 and 0.03, respectively). The spouses also had significantly increased percentage of T lymphocytes in apoptosis (t = 0) and a significantly higher number of IL-10-producing cells when compared with healthy controls (P = 0.01 and 0.02, respectively). There were no significant differences between the patients and their spouses. For apoptosis of B lymphocytes no difference was found between the groups. The SLE patients as a group had the highest rate of apoptosis. No correlation between the degree and rate of apoptosis and the number of IL-10-producing cells was detected. The first-degree relatives did not have increased percentage of T lymphocytes undergoing apoptosis at t = 0 compared with healthy controls. The SLE patients had higher titres of ANA compared with the other groups. No correlation was detected between the ANA titre and the percentage of lymphocytes undergoing apoptosis. There was no correlation between disease activity as measured by SLEDAI and apoptosis. In conclusion, our results suggest that environmental factors common to both SLE patients and their spouses are associated both with the increased apoptosis and increased spontaneous production of IL-10, thus providing support for the notion that both environmental and genetic factors influencing apoptosis are of importance for the development of SLE.

Antibodies, Antinuclear↗
PubMed1982

Medicaid program; deeming of income between spouses; categorically needy--Health Care Financing Administration. Proposed rule.

We propose to revise current Medicaid rules for determining the financial eligibility and the level of Medicaid payments for institutional care of aged, blind, and disabled categorically needy individuals when one spouse is institutionalized and the other spouse is not. We propose to reinstate the rules that were in effect prior to the court orders in the Gray Panthers litigation. The change would affect those States that, as permitted by statute, use more restrictive eligibility criteria than those applied nationally under the Supplemental Security Income (SSI) program. It would also apply in Puerto Rico, Guam, and the Virgin Islands. These amendments would revise the regulations permitting these jurisdictions, in situations where one spouse is institutionalized, to consider a portion of the income of one spouse as available to the other spouse whether or not the income is actually contributed.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Working with your spouse, children, or other close relatives.

Employing someone you're close to in your medical practice can have many advantages. Yet, as many doctors find, employing relatives can also have its pitfalls. This article describes the financial benefits of employing a loved one in your medical practice. It suggests the specific steps you will need to take to legitimize your spouse's, significant other's, or relative's employment. The author also explores the personal benefits and drawbacks of employing your spouse or significant other. She includes advice from other doctors and spouses who work together and establishes 15 ground rules for working with your spouse. Finally, the article includes a 10-question self-quiz for you and your spouse or significant other to help you decide if working together in your medical practice will strengthen or strain your relationship.

Employment↗