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The portrait of James Israel by the German impressionist Max Liebermann: a selected pictorial view on the early twentieth century development of surgical urology in Berlin.

On the occasion of his retirement from the position as head of the Jewish Hospital in Berlin in 1917, the famous kidney surgeon James Israel (1848-1926) was portrayed by Max Liebermann (1847-1935). At that time both men were leading members of their professions--medicine and fine arts--and represented the Jewish community in Berlin. Private contacts between the surgeon and the artist had been established when Liebermann and his wife needed surgical treatment themselves some years before. Liebermann's later friendship with the surgeon Ferdinand Sauerbruch (1875-1951) culminated in one of the best-known portraits of a member of the medical profession. This biographical article from the history of medicine and fine arts reflecting the relation of these men provides a special view of the development of urological surgery in Berlin at the beginning of the twentieth century.

Berlin↗

The impact of social relationships on the maintenance of independence in advanced old age: findings of a Swiss longitudinal study.

The impact of social relationships on the maintenance of independence over periods of 12-18 months in a group of 306 octogenarians is assessed in this study. The study is based on the results of the Swilsoo (Swiss Interdisciplinary Longitudinal Study on the Oldest Old). Participants (80-84 years old at baseline) were interviewed five times between 1994 and 1999. Independence was defined as the capacity to perform without assistance eight activities of daily living. We distinguished in our analyses kinship and friendship networks and evaluated social relationships with the help of a series of variables serving as indicators of network composition and contact frequency. Logistic regression models were used to identify the short-term effects of social relationships on independence, after controlling for sociodemographic and health-related variables; independence at a given wave of interviews was interpreted in the light of social factors measured at the previous wave. Our analyses indicate that the existence of a close friend has a significant impact on the maintenance of independence (OR=1.58, p<0.05), which is not the case with the other variables concerning network composition. Kinship contacts were also observed to have a positive impact on independence (OR=1.12, p<0.01).

Activities of Daily Living↗

Psychological and social aspects in management of Alzheimer's patients: an inquiry among caregivers.

A survey in the cities of Genoa and Savona (Italy) was performed to examine stress levels in caregivers of patients with Alzheimer's disease in the context of a project of the Italian Ministry of Health named Cronos. It offered free anticholinesterase inhibitor therapy to patients who addressed dedicated Neurological Units; in this occasion caregivers could be invited to express the main difficulties encountered in managing demented people during an interview conducted by health personnel of the Neurophysiology Service. Caregivers were mainly women, daughters or spouses, with a medium educational level, retired, housekeepers, employees or teachers; they claimed a lowering of economic standard of living of the family owing to extra expenses for assistance. Satisfaction was expressed towards specialists, while support by general practitioners and other sanitary services was usually lacking and money contribution from the government or territorial services was considered inadequate. From the emotional point of view, caregivers claim loss of free time, friendships and hobbies, and feel isolated in the social context; sometimes the patient's death is thought of as a solution. A strong need for information and support is clearly emerging and any further interventions should take these requirements into consideration.

Aged↗

Post-circuit blues: motivations and consequences of crystal meth use among gay men in Miami.

Miami, Florida was at the vanguard of the rise of circuit parties and attendant club drug use-especially ecstasy, GHB, and ketamine-in the 1990s. Crystal methamphetamine, a drug of abuse among gay men for some years on the West coast, gradually moved east toward the end of the decade and recently became prevalent in Miami. This paper reports the results of focus group research into the motivations and consequences of crystal use among gay men in this new setting. Loneliness, fears about physical attractiveness due to aging and illness, and desires to lose sexual inhibitions were common motivations for using the drug. Continued use of crystal was often described as the cause of lost friendships, employment and long-term relationships, as well as sexual behaviors that put men at risk for HIV and other sexually transmitted infections. Implications for drug and sexual risk prevention interventions are discussed.

Adult↗

Reasonable partiality and animal ethics.

Moral psychology is often ignored in ethical theory, making applied ethics difficult to achieve in practice. This is particularly true in the new field of animal ethics. One key feature of moral psychology is recognition of the moral primacy of those with whom we enjoy relationships of love and friendship--philia in Aristotle's term. Although a radically new ethic for animal treatment is emerging in society, its full expression is severely limited by our exploitative uses of animals. At this historical moment, only the animals with whom we enjoy philia--companion animals--can be treated with unrestricted moral concern. This ought to be accomplished, both for its own sake and as an ideal model for future evolution of animal ethics.

Animal Experimentation↗

Involvement or isolation? The social networks of children with autism in regular classrooms.

Including children with autism in regular classrooms has become prevalent; yet some evidence suggests such placements could increase the risk of isolation and rejection. In this study, we used social network methods to explore the involvement of children with autism in typical classrooms. Participants were 398 children (196 boys) in regular 2nd through 5th grade classes, including 17 children (14 boys) with high functioning autism or Asperger's syndrome. Children reported on friendship qualities, peer acceptance, loneliness, and classroom social networks. Despite involvement in networks, children with autism experienced lower centrality, acceptance, companionship, and reciprocity; yet they did not report greater loneliness. Future research is needed to help children with autism move from the periphery to more effective engagement with peers.

Autistic Disorder↗

A multilevel analysis of key forms of community- and individual-level social capital as predictors of self-rated health in the United States.

Communities may be rich or poor in a variety of stocks of social capital. Studies that have investigated relations among these forms and their simultaneous and combined health effects are sparse. Using data on a sample of 24,835 adults (more than half of whom resided in core urban areas) nested within 40 U.S. communities from the Social Capital Benchmark Survey, correlational and factor analyses were applied to determine appropriate groupings among eight key social capital indicators (social trust, informal social interactions, formal group involvement, religious group involvement, giving and volunteering, diversity of friendship networks, electoral political participation, and non-electoral political participation) at each of the community and individual levels. Multilevel logistic regression models were estimated to analyze the associations between the grouped social capital forms and individual self-rated health. Adjusting the three identified community-level social capital groupings/scales for one another and community- and individual-level sociodemographic and socioeconomic characteristics, each of the odds ratios of fair/poor health associated with living in a community one standard deviation higher in the respective social capital form was modestly below one. Being high on all three (vs. none of the) scales was significantly associated with 18% lower odds of fair/poor health (odds ratio = 0.82, 95% confidence interval = 0.69-0.98). Adding individual-level social capital variables to the model attenuated two of the three community-level social capital associations, with a few of the former characteristics appearing to be moderately significantly protective of health. We further observed several significant interactions between community-level social capital and one's proximity to core urban areas, individual-level race/ethnicity, gender, and social capital. Overall, our results suggest primarily beneficial yet modest health effects of key summary forms of community social capital, and heterogeneity in some of these effects by urban context and population subgroup.

Adolescent↗

Population-focused research: a broad-based survey of teens' attitudes, beliefs, and behaviours.

Population-focused research and practice is the cornerstone of community health nursing. A population group which is at significant risk for a number of health problems is adolescents. In this article, a report is given of a descriptive study of 2347 high school students, 15-19 years of age. These teens were largely from rural communities in the province of Newfoundland, Canada. They were surveyed to identify their attitudes, beliefs, and behaviours in a variety of life spheres. Results show friendship to be of primary importance to teens. Family also plays a key role in their lives. Relationships with adults, in general, are troubled. Significant gender differences emerged: for example, males are more open than females to causal sex, are more likely to use alcohol and to be more physically active than females; females value family life more, and have more difficulty in the area of self-esteem than their male counterparts. Teens' attitudes reflect many values of Canadian society at large, such as hard work, success and the importance of a good education. The data from this study emphasizes the need for community health programs for teenagers which take into account key characteristics of this target group. This research is a model for compiling data on any population group in the community. Such a model is portrayed as an effective and efficient means of providing baseline information crucial to the delivery of health strategies with specific population groups in the community.

Adolescent↗

A personal sketch of Frank Burton Walsh.

The author shares his memories of a 48-year friendship with Frank B. Walsh, known as the Father of American neuro-ophthalmology. Personal anecdotes reveal Walsh as a man of kindness, sensitivity and unusual humor, and they document the origins of such lesser known neuro-ophthalmic terms as "Walsh's sign of mad" and "the belly button nystagmus of Walsh."

Canada↗

Personality development following sexual abuse.

Thirty-seven girls and twelve boys who had been sexually abused at an average of 2.6 years previously were traced and reviewed. The nonoffending parents participated in a structured interview and the children were assessed using the Piers-Harris Self-Concept Scale and the Achenbach Child Behavior Checklist. Each child was matched with a child not known to have been sexually abused and these control children underwent a similar psychological assessment. Interviews with the nonoffending parents found that 76% of the children were thought to be less confident than before, 30% had fewer friends, and 20% were more aggressive. Increased sexual awareness was noted in 24%. School teachers reported that 28% still had behavior problems, 17% had repeated a year at school, and a further 17% had deteriorated in their school work. The sexually abused girls had significantly lower self-esteem than the control girls. There was no difference in self-esteem between the control and the sexually abused boys. There was a higher incidence of stranger assault in the boys compared with the girls. The Child Behavior Checklist completed by the parents, the Teacher Report Form, and the Youth Self-Report of the Child Behavior Checklist showed that a highly significant proportion of sexually abused children fell into the clinical range. Sexual abuse appears to have long-term adverse consequences for many of the victims. This may have implications for their ability to relate to others, for the adult friendships they will make, and eventually for the way they will relate to their own children.

Adolescent↗

Stigma and incest survivors.

The impact of incestuous child sexual abuse continues to affect victims into their adult lives. Survey responses from college students indicate the predicted stigma surrounding this childhood event varies with gender as well as with length and type of relationship at the time of the disclosure. Women indicate differences in stigma when anticipating various types of relationships with male survivors. Particularly, women show dating as less comfortable than opposite sex friendship, and parenting as less comfortable than marriage. Men do not indicate these differences in stigma based on the type of relationship, but instead predict comfort with female survivors based on the length of relationship.

Adaptation, Psychological↗

Suicidal behavior among inner-city Hispanic adolescent females.

Suicidal behavior is disproportionately frequent among inner-city Hispanic adolescent girls. In an attempt to generate a multifactorial set of hypotheses to explain this behavior, 33 such subjects consecutively admitted for suicidal behavior and 15 demographically identical nonsuicidal subjects were assessed by means of a structured interview. Mothers of all subjects were also assessed. Attempts were nearly always impulsive and nonlethal, though often with a stated wish to die. Nearly all were overdoses, and were precipitated by conflicts with mother or boyfriend. Mothers could usually identify the precipitants. Attempters' parents were less often born in the U.S., their mothers seemed medically less healthy, and their extended families were more often supported by public assistance, and had a higher incidence of criminal and psychiatric problems. School performance was poorer among attempters, who had suffered more and earlier losses, especially of biologic fathers, with whom fewer had ongoing relationships. They more often had boyfriends, had begun sexual activity, had recently lost friends, and expressed a mistrustful stance toward friendships. Similarly, their mothers had fewer friends and more often expressed a mistrustful stance. Relationships with mothers seemed more intense, desperate, and even violent, and attempters were much more often parentified, i.e., mothering their mothers. Although both groups often assumed caretaking roles in their families, attempters were more negatively described by themselves and by their mothers. While knowledge of suicidal models was common in both groups, attempters' mothers knew of even more models than did their daughters or the nonsuicidal subjects or their mothers. Notably, more attempters' mothers had themselves made attempts. Families of most attempters were usually mobilized by the attempt. These findings permit the construction of a putative profile of risk factors that can be tested more rigorously.

Adolescent↗

Lifetime exit events and recent social and family adversities in anxious and depressed school-age children and adolescents--II.

The relative contribution made by three sets of social adversities preceding the onset of anxiety and depression in 8-16-year-olds is reported. These three sets of adversities are (i) lifetime exit events over the whole of the subject's life excluding those in the 12 months before onset of disorder in cases or day of interview for controls; (ii) recent family adversities; (iii) recent friendship difficulties and an absence of social achievements. Three cases compared with 35 controls experienced none of these sets of adverse social variables. Lifetime exit events exert significant independent effects on the likelihood of being a case in the presence or absence of the other two sets of factors. This suggests that the impact of multiple lifetime exits is not explained by the presence of recent adversities measured in this study. Twenty controls however experienced two or more of these sets of adversities with four experiencing all three. This suggests that some children appear protected from the pathological effects of these social adversities. The findings are not influenced by the sex or pubertal stage of the subjects and appear with equal likelihood in both anxious and depressive cases.

Achievement↗

The relationship of family dynamics/social support to patient functioning in IDDM patients on intensive insulin therapy.

A 6 month pilot study was conducted to examine the relationship between family dynamics/social support and patient functioning in diabetic patients on intensive insulin therapy. Intensified therapy was associated with improvements in the DUHP symptom score, MHI psychological well-being score, and in the DUHP social functioning score. In diabetic patients, regardless of therapy, extreme family dynamics were correlated with higher DUHP symptom scores and lower MHI psychological well-being scores at the initial measurement time. However, over the 6 month study period, extreme family dynamics were predictive of improvements in the DUHP symptoms score and in the quality of friendships in diabetic patients on intensive insuline therapy. In diabetic patients, regardless of therapy, higher levels of social support correlated with higher levels of psychological and social functioning at the initial measurement time, and with improvements in quality of family life over the 6 month measurement time. Higher social support was also associated with improvements in quantity of friends and the DUHP social functioning score in diabetic patients on intensive insulin therapy. The study also generated empiric support for co-evolutionary models of disease states/family dynamics/treatment systems by showing that 6 month changes in family dynamics were predicted by the initial FACES adaptability measure and the initial mean monthly glucose value. Intensified therapy predicted lower family cohesion and more family rigidity over the 6 month study period. These findings also suggest, when combined with the result that diabetic patients from more cohesive families experienced a rise in monthly mean glucose values, that some diabetic patients may become trapped in a vicious cycle which perpetuates poor glucose control and extreme family dynamics.

Adaptation, Psychological↗

Homosexual and bisexual men's coping with the AIDS epidemic: qualitative interviews with 10 non-HIV-tested homosexual and bisexual men.

This paper describes how the threat of HIV infection is appraised and coped with by homosexual and bisexual men. Very little is known about men who do not want to be HIV tested, thus non-HIV-tested homosexual and bisexual men have been interviewed in depth about themes concerning their lives during the AIDS epidemic. Men with sexual risk behaviour appeared to be very reluctant to participate, and therefore six men with safe sexual behaviour and four men with unsafe sexual behaviour were interviewed. The results showed that all the men were well informed about AIDS and preventive measures. Reasons for not wanting a test were fear of psychological distress caused by a possible positive test and the fact that no treatment is available. The men who had adopted safe sex appraised their sex lives to have suffered a minor loss but found that sexuality played a subordinate role compared to trust and friendship. The men with risk behaviour considered sexuality to play an important role in their lives. They found condoms a barrier to intimacy and used defensive strategies to manage stress. Most of them were able to exchange social support with their network but had difficulties in setting their own limits. All four men had experienced undertreated traumatic events in their past. The results indicate that knowledge of AIDS and satisfactory social support do not necessarily result in safe sexual behaviour. The role of undertreated traumatic events forming barriers against adopting safe sexual practices should be further studied. Proposals are put forward for future health education programmes.

Acquired Immunodeficiency Syndrome↗

Justice across the generations.

The title, 'justice across the generations', is reminiscent of expressions such as 'hands across the seas'. The latter is, of course, impossible in reality, but it symbolizes friendship between persons in far-flung lands. Is 'justice across the generations', likewise, no more than a hopeful metaphor, or is there, or at least should there be, some concrete reality to it? If so, what is, or should be, the substance of that reality? This text consists of some free association reflections, principally in the context of health care and mainly in the form of questions, on the concepts proclaimed in the title, namely, justice, across and generations, and what relevance these might have for our present and future societies.

Age Factors↗

Effects of social relationships on survival for women with breast cancer: a prospective study.

In this study we examine the relationship between a woman's social contexts at the time of diagnosis and her chances of having survived breast cancer four years later. A cohort of 133 women were followed prospectively after initial diagnosis and treatment and data were obtained from a questionnaire mailed soon after diagnosis and from hospital charts. Using multivariate methods to examine predictors of survival, two clinical factors, pathologic nodal status and clinical stage of disease, were significantly associated with survival. In addition we found significant and independent effects on survival of: number of supportive friends, number of supportive persons, whether the woman worked, whether she was unmarried, the extent of contact with friends and the size of her social network. Thus, the woman's social context, particularly contexts of friendship and work outside the home, are statistically important for survival. Using existing literature, further data analyses and interviews with some survivors, we speculate on the ways in which social contexts may influence survival and suggest research methods suitable to this question.

Adult↗

The psychological and social condition of hypertensives resistant to pharmacological treatment.

To characterize patients with therapy-resistant essential hypertension (TR) from a psychosocial point of view, 29 hypertensives, filling specified criteria for TR in a hypertension clinic were selected out of 800 patients screened. A control group of patients with established, but well controlled hypertension, pair-wise matching study patients for age and gender was also selected. TR patients were predominantly of working-class origin (68 vs 19% P less than 0.001). They tended to be more obese (BMI 28.7 +/- 5.5 vs 26.9 +/- 3.9 ns). TR tended to report fewer important life events, and reported significantly fewer positive events from the last 10 year period P less than 0.05. According to the EAI, their ability to channel emotions, especially anger, was impaired (P less than 0.01). So was their instrumental handling of emotions such as anger and sorrow (P less than 0.05). They experienced less of joy, and even had a more negative attitude towards that emotion (P less than 0.05). When adjusted for social class this latter difference was not statistically significant. Their degree of global emotional differentiation was lower (P less than 0.05). In the ISSI interview they had low scores for availability of emotional attachment (P less than 0.01), and friendship (P less than 0.05), but not for social integration. To conclude, when compared to well controlled hypertensives, TR exhibited the pattern, which has been shown to characterize young, asymptomatic, hypertensives in comparison to healthy subjects. These results must not be overinterpreted due to the limited sample.(ABSTRACT TRUNCATED AT 250 WORDS)

Affective Symptoms↗