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A survival analysis of gender and ethnic differences in responsiveness to methadone maintenance treatment.

Survivorship analysis was applied to evaluate treatment responsiveness among four groups of heroin addicts (male and female Whites and Chicanos). Multiple outcome measures included rates of retention, incarceration, addiction, property crime, drug dealing, legal supervision, alcohol abuse, employment, and interpersonal involvement. Differential treatment responsiveness among groups was found depending on the measure in use and the time point of evaluation. Relationships between selected predictors and treatment retention were tested using the Cox proportional hazards model. Young male addicts who were using narcotics daily during treatment and who were unemployed and unmarried were at highest risk for dropping out of treatment.

Adult↗

Linkage studies of four fibrillar collagen genes in three pedigrees with Larsen-like syndrome.

We report seven children from three families who had a set of common clinical features suggestive of Larsen-like syndrome, including unusual facies, bilateral dislocations of the knees and elbows, club foot, and short stature. All of the patients originated from the island of La Réunion in the Indian Ocean. The occurrence of several affected sibs in these families and the large number of consanguineous marriages on this island are consistent with autosomal recessive inheritance of the disease. Based on this hypothesis, the pedigrees were used for linkage analysis in a candidate gene assay. Lod score calculations in a pairwise study with four different fibrillar collagen genes, COL1A1, COL1A2, COL3A1, and COL5A2, allowed us to exclude these genes as the mutant loci. Supporting this, electrophoretic analysis of collagens derived from fibroblast cultures failed to show defective molecules. We conclude that this syndrome is not a collagen disorder.

Abnormalities, Multiple↗

Family use of health care: United States, 1980.

Information on families' use of health care in 1980 is presented in this report. The data discussed here were gathered in the national household sample of the National Medical Care Utilization and Expenditure Survey. In this sample, information was collected on health problems, health care received, expenditures for care, health insurance, and related topics throughout calendar year 1980 from approximately 6,800 families in the U.S. civilian noninstitutionalized population. (The report entirely excludes families with military heads, even if they have civilian members.) For this report, a family was initially defined as (1) two or more persons living together who were related by either blood, marriage, adoption, or a formal foster care relationship or (2) a single person living outside such relationships. But because these data were collected across an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of the use of health services are calculated in annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals. Data on both multiple-person families (families that averaged 1.5 persons or more during the year) and one-person families (families that averaged less than 1.5 persons during the year) are presented in this report. Only findings for multiple-person families, however, are addressed in this section. It is multiple-person families that are usually referred to in discussions of families by both the general public and professional social scientists.

Data Collection↗

Ataxia-telangiectasia in Italy: genetic analysis.

Genetic analysis was performed on 72 Italian A-T families ascertained through 91 probands. The frequency of the A-T gene was estimated through Dahlberg's formula, which uses the frequencies of first cousin marriages among the patients' parents and in the general population were obtained from the collection of Catholic Church dispensations for the period 1910-1964. Accurate estimates of the disease frequency were made by subdividing data into 5-year periods and between provinces, in order to take into account temporal (decrease over time) and spatial (higher frequency in Southern Italy) heterogeneity. The estimate of the gene frequency for the whole sample was q = 0.012 +/- 0.0065, corresponding to a heterozygote frequency of 2.34% and to a disease frequency of 1 in 7090. When considering q before and after 1970, there was an apparent increase of heterozygote frequency from 1.69 to 3.43%, perhaps due to a better ascertainment of the disease in the latter period. A segregation ratio of 0.249 +/- 0.043 was obtained by analyzing the offspring of the 72 families under the model of incomplete multiple selection. This value is not significantly different from 0.25, as expected for an autosomal recessive disease.

Adult↗

Chronic family adversity and early child behavior problems: a longitudinal study of low income families.

A beginning step in the prevention of child psychopathology is the identification of conditions associated with a disproportionately high incidence of behavior problems. Rutter and colleagues (British Journal of Psychiatry, 1975, 126, 493-509) have reported a dramatic increase in the probability of child adjustment difficulties as a function of multiple family stressors. However, few investigators have tested this association beginning in infancy. The present investigation examines this relationship at the ages of 1 and 2 with behavioral adjustment at age 3 among 100 low-income families. Broad support was found for the family adversity hypothesis, though sex differences were evident regarding individual correlates of problem behavior.

Adaptation, Psychological↗

Social support, life events, and stress as modifiers of adjustment to bereavement by older adults.

As part of a larger panel study, interviews were obtained from 3 samples of older adults: 45 persons who had recently lost a spouse, 40 who had lost a parent or child, and 45 who were not bereaved. Assessments were conducted before and after the deaths. In the widowed sample, health remained quite stable, but depression increased sharply, then remained elevated. Changes were minimal in the sample who had lost a parent or child and in the nonbereaved sample. Multiple regression procedures were used to identify factors that contribute to depression and health 9 months after the spouse's death. Postbereavement depression was associated with higher prebereavement depression, higher financial pressures, higher global stress, fewer new interests, and lower social support. Health was a function of prebereavement health, new interests, financial pressures, and global stress. In general, life events and resources had stronger effects in the widowed sample than in the comparison samples.

Adaptation, Psychological↗

Training non-psychologists in the treatment of sexual dysfunction with special reference to the training of marriage guidance counsellors.

This paper describes a study in which marriage guidance counsellors were trained in the treatment of sexual difficulties. This study is discussed in the wider context of the literature concerned with training issues in the treatment of sexual function problems. The results of the training programme give clear evidence that non-professionals can be trained to produce results similar to those of a professional and it is argued that issues discussed in the literature concerning the training of professionals in the treatment of sexual difficulties are also applicable to non-professionals.

Counseling↗

The many-voiced cultural story line of a case of diabetes mellitus.

An ethnographic approach is used to conduct and describe my research into a case of chronic illness and to assist the family physician's interventions. What at first appeared to be a frustrating, difficult-to-control case of diabetes mellitus was later revealed to be an intricate drama involving multiple voices and issues: marital, life stage, family, religious, occupational, regional, economic, and physician family-of-origin. Questions such as who has the disease?, what is the disease?, what keeps the disease going?, who is the patient?, and who is the clinician? are explored in the context of this case. The case was "solved" when the loss and sadness of aging was discovered and accepted during a cathartic session involving the diabetic patient, her husband, their family physician, and myself, a consultant.

Aging↗

Predictors of death following ICU discharge.

In order to study possible predictors of early after-discharge mortality (EADM), 700 consecutive patients discharged alive from three intensive care units (ICUs) were followed up 2 months after their admission. The observed mortality was 7.3%. Univariate analysis indicated a strong statistically significant association of the following variables with mortality: initial simplified acute physiological score (SAPS) greater than 10, therapeutic intervention score in the first 24 h of admission greater than 20, age greater than or equal to 65, length of stay in the ICU greater than 10 days, and low educational level. The multiple logistic regression analysis included as predictive independent variables the SAPS, organs or systems failure, age, and length of stay. The model built upon these four variables was able to identify a group of patients at high risk (21-46%) of EADM. We conclude that some simple variables can be used as useful markers of patients groups at high risk of EADM.

Adult↗

Associates of self-reported fertility status and infertility treatment-seeking in a rural district of Malawi.

BACKGROUND: This study examines the demographic, fertility preference, health/infection and behavioural factors associated with self-reported fertility problems and infertility treatment-seeking in a rural district of Malawi. METHODS: Data come from a population-based survey of 678 women and 362 men. RESULTS: Having a higher ideal number of children than actual number of children, i.e. a 'child deficit', is highly associated with women's reported fertility impairment and treatment-seeking. Other factors associated with women's infertility treatment-seeking are being educated and reporting infertility in self or spouse. In contrast, being in a polygamous union, having exchanged money or goods for sex, and having multiple sex partners are significantly associated with men's reported fertility impairment. Significant factors associated with men's infertility treatment-seeking are having no education, having a long waiting time to pregnancy and having a 'child deficit'. CONCLUSIONS: There is a sex difference in which factors are associated with reported fertility impairment. Fertility preference variables are more often significantly related to women's reported fertility impairment, whereas sexual behaviours are more often significantly related to men's reported fertility impairment.

Adolescent↗

Parental agreement on child-rearing orientations: relations to parental, marital, family, and child characteristics.

Recent research on parental agreement on child-rearing values has found it to be positively related to effective parenting. The exact nature of the relation, however, is not clear. Are they different constructs, or is agreement simply one more variable that describes effective parenting? A sample of 136 families and their preschool children was studied by observation and an extensive self-report questionnaire package. Parental agreement was assessed using the Block Child-rearing Practices Report. Hierarchical multiple regression analyses revealed that the agreement score rarely added any information not already provided by the parental effectiveness scores. A Q-factor analysis revealed that the agreement score actually represented agreement to a standard of good parenting. The parents who were high agreers were good parents who agreed with other good parents, while the low agreers were ineffective parents who disagreed with other parents, good or bad. Implications of these results for future research on parental agreement are discussed.

Child Rearing↗

Decision making of satisfied and dissatisfied married couples.

Ten satisfied and ten dissatisfied married couples described how they make decisions of low, moderate, and high levels of difficulty. Responses were coded as reflecting the use of equity, need-based, situational, or other norms. Results were consistent with previous findings that a state of equity is associated with marital satisfaction but also indicated that multiple norms are used in decision making of both satisfied and dissatisfied couples. Decision difficulty influenced use of both situational and need-based norms. A trend was found for satisfied husbands but not wives, to make greater use of need-based norms than dissatisfied husbands when decisions were high in difficulty. The results are interpreted as supporting a distinction between equity as a state and equity as a process and as supporting an instrumental value theory of norm use.

Adaptation, Psychological↗

The prevalence of depressive symptoms among Mexican Americans and Anglos.

The study reports epidemiologic field survey data on the distribution of depressive symptoms among Anglos (n = 637) and two Mexican-American subsamples (n = 551) living in Santa Clara County, California. One of the Mexican-American subsamples was interviewed in English (n = 330) and the other in Spanish (n = 221). Analysis of variance indicated that those with low educational achievement, females, those in disrupted marital statuses, and those under 30 years of age had significantly higher levels of depressive symptoms than their counterparts. The prevalence of depressive symptoms for the Anglo and Mexican-American English-speaking samples was very similar and much lower than that reported by the Spanish-speaking Mexican-American subsample. Differences in educational levels appear to be accounting for many of the variations in depressive symptoms between the Anglo and English-speaking subsamples and the Spanish-speaking one. The authors suggest that the lack of language skills along with low educational achievement may be indicating a relative lack of acculturation and societal integration which in turn may be accounting for some of the increased symptoms among the Spanish-speaking subsample. The results of multiple stepwise regression analyses indicate that age, sex, marital status, and educational attainment explain relatively low and fluctuating amounts of the total variance. These analyses also indicate that social and demographic factors are differentially related to depressive symptoms for each of the subsamples. The variables education, female, and separated were significant in all of the equations, but their order of entrance and the amount of variance explained by them varied.

Adolescent↗

Race and weight change in US women: the roles of socioeconomic and marital status.

BACKGROUND: The prevalence of overweight among Black women in the US is higher than among White women, but the causes are unknown. METHODS: We examined the weight change for 514 Black and 2,770 White women who entered the first Health and Nutrtion Examination Survey (1971-75) at ages 25-44 years and were weighed again a decade later. We used multivariate analyses to estimate the weight-change effectgs associated with race, family income, education, and marital change. RESULTS: After multiple adjustments, Black race, education below college level, and becoming married during the follow-up interval were each independently associated with an increased mean weight change. Using multivariate logistic analyses, Black race was not independently associated with an increased risk of major weight gain (change greater than or equal to +13 kg), but it was associated with a reduced likelihood of major weight loss (change less than or equal to -7 kg) (odds ratio - 0.64 [95% CI -0.41, 0.97])]. Very low family income was independently associated with the likelihood of both major weight gain (OR - 1.71 [95% CI - 1.15, 2.55]) and major weight loss (OR - 1.86 [95% CI - 1.18, 2.95]). CONCLUSIONS: Amont US women, Black race is independently associated with a reduced likelihood of major weight loss, but not with major weight gain. Women at greatest risk of weight gain are those with education below college level, those entering marriage, and those with very low family income.

Adult↗

[A patient of Walker-Warburg syndrome with a haplotype different from that in Fukuyama-type congenital muscular dystrophy].

A 3-month-old female baby was diagnosed as having Walker-Warburg syndrome (WWS), based on the following clinical findings: type II lissencephaly associated with marked ventricular dilatation, cerebellar malformation, retinal malformation, elevated serum creatine kinase level and abnormal muscle CT findings. She was a product of parents with consanguineous marriage. She presented with severe hypotonia and profound psychomotor retardation since birth. She developed infantile spasms at 8 months of age, and vitamin B6 was very effective. A genetic analysis revealed the absence of the founder haplotype commonly seen in Fukuyama-type congenital muscular dystrophy (FCMD), suggesting that the WWS gene is not always identical to the FCMD gene. When she was examined at the age of 4 years, she had no apparent further psychomotor development. Her clinical symptoms were more severe than those of the typical FCMD.

Abnormalities, Multiple↗

Does somatization disorder occur in men? Clinical characteristics of women and men with multiple unexplained somatic symptoms.

Somatization disorder is thought to be rare or nonexistent in men. We examined this hypothesis by assessing gender differences in DSM-III-R diagnostic status, demographic and clinical characteristics, functional limitations, self-reported health status, and psychiatric comorbidity in 30 men and 117 women who were referred for multiple unexplained somatic complaints. Twelve men and 68 women met DSM-III-R criteria for somatization disorder. Among those meeting criteria, there were few differences on any of the dimensions that were assessed. Different referral sources for women and men suggested differences in physicians' perceptions of somatic symptoms in men and women. We concluded that somatization disorder exists in men, and that women and men with somatization disorder show similar clinical characteristics.

Adult↗

Demographic and reproductive factors for high seroprevalence of Chlamydia trachomatis among pregnant women in Japan.

In order to elucidate demographic and reproductive factors associated with Chlamydia trachomatis seropositivity, serological screening and questionnaire survey were conducted on pregnant women in Nagasaki Prefecture, Japan. Serum samples were taken from 1718 pregnant women between September and December, 1996, at the cooperative obstetric hospitals and clinics, and tested for the presence of antibodies to C. trachomatis using the enzyme immunoassay. A questionnaire was administered on a sub-sample (n -409), among whom 85 (20.8%) were seropositive. A multiple logistic analysis revealed that four characteristics showed a significant association with the seropositivity: (i) experience of premarital pregnancy, (ii) non use of condoms, (iii) short duration of education, and (iv) more frequent induced abortion. The unsafe sexual behavior of young people lacking proper knowledge of how to prevent STD is the most important intervention target for control of the C. trachomatis epidemic in Japan.

Abortion, Induced↗

The association of age and depression among the elderly: an epidemiologic exploration.

Advanced age among the elderly has been hypothesized to be a risk factor for depression, yet extant data do not uniformly support this hypothesis. The paucity of sufficiently large and representative samples of both the young-old and old-old and the failure to control for critical variables known to confound the association between advanced age and depression have prevented testing this hypothesis. The Duke EPESE (Establishment of a Population for Epidemiologic Studies of the Elderly) assessed 3,998 community-dwelling elders (65+) for depressive symptoms using a modified version of the CES-D and relevant control variables. Depressive symptoms were associated in bivariate analysis with increased age, being female, lower income, physical disability, cognitive impairment, and social support. In a multiple regression analysis, the association of age and depressive symptoms reversed when the above confounding variables were simultaneously controlled. The oldest old suffered fewer depressive symptoms when factors associated with both increased age and depressive symptoms were taken into account. Because many of these factors can be prevented (such as decreased income, physical disability, and social support), the uncontrolled association between age and depressive symptoms can potentially be modified.

Black or African American↗