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PubMedDate not supplied

Nature of spousal supportive behaviors that influence heart transplant patient compliance.

Heart transplant patient survival is dependent on strict adherence to a specific medical regimen including medication administration, infection control, diet, and exercise. The literature suggests that transplant patients are predisposed to noncompliance by virtue of the multiple factors involved in the regimen; it also suggests that spousal support may play a significant role in assisting patients to attain the regimen goals. The purpose of this descriptive study was to determine the nature of spousal behaviors influencing compliance. The method for this study involved designing an open-ended interview guide that elicited responses from married subjects, 6 to 18 months after transplantation, regarding their perceptions of spousal support. Responses were cross-classified according to a social support typology and the four regimen domains; frequency of responses was rank ordered. Spousal behaviors identified as supportive were predominantly informational (46.66%) and tangible (38.09%) in nature; only 15.23% were emotional. The data suggest a perceived need by most subjects to receive additional instruction, guidance, and feedback from the spouse; also, there is a tendency for patients to depend on their spouses for their material needs, physical assistance, and transportation until they are more capable. The results imply that because of patient personality and behavioral changes after surgery, it may be easier for spouses to avoid emotional aspects of support; communicating with patients on a more concrete level. Implications for nursing and other health care providers lie in identifying and cultivating those spousal behaviors that serve to motivate the patient toward compliance and optimal home health care maintenance.

Behavior↗

PubMed1983

Demographic responses and socioeconomic structure: population processes in England and Wales in the nineteenth century.

This paper explores some theoretical and empirical aspects related to the theory of change and multiple response. The empirical analysis focuses on 600 relatively small and homogeneous geographical units of England and Wales for the period 1851-1910. These units are classified into six identifiable socioeconomic types and the analysis is male for each of them. Two interrelated tissues are studied. First, a set of explanatory variables, connected either with strain or with factors relieving strain, is constructed. The effects of these explanatory variables on nuptiality, marital fertility, and migration responses are examined for each socioeconomic type, with respect to their significance, intensity, and direction. The patterns of these effects show general consistency with multiphasic response considerations for all socioeconomic types. A significant finding in this part is that migration affects very strongly the intensity of the marital fertility decline response. The second issue deals with theoretically expected patterns of interrelationships among responses in terms of substitutability and complementarity. The theoretical interrelationships are compared with the empirical for each socioeconomic type; and in general, consistency is established. Moreover, these interrelationships can be interpreted for each socioeconomic type in a way that appears to be consistent with multiphasic response considerations. An important finding in this part is that emigration and marital fertility decline are substitute responses in agricultural-based districts. Implications of the findings are discussed.

Adolescent↗

PubMed2005

A neonate with anorectal malformation with rare limb defects report of a case.

A 2-day-old male infant, born of a non-consanguineous marriage and uneventful pregnancy was found to have anomalies of vertebral, anal, cardiac, tracheo-esophageal, radial and limb (VACTERL) association. The striking feature was the simultaneous occurrence of two rare limb defects of right upper and lower limb in the baby who also had imperforate anus and ventricular septal defect. These limb defects were-meromelia of the right upper limb (due to transverse deficiency of right humerus and absence of all the bony elements distally), and a short right lower limb due to co-existence of proximal femoral hypoplasia and fibular hemimelia. We could not trace the co-existence of these rare skeletal defects in any case with VACTERL association in the existing English literature, as was observed by us. The simultaneous occurrence of the defects involving distant anatomic sites supports the hypothesis of 'axial mesodermal dysplasia' in our patient, rather than 'caudal regression syndrome', as is popularly held in patients with anorectal malformation (ARM). Further, it points to occurrence of an early embryonic insult, probably taking place at blastogenic stage, when the developing embryo can be considered a polytopic development field. However, in absence of antenatal history suggestive of exposure to a known teratogen and a chromosomal analysis, it appears that the spectrum of anomalies in this neonate might have resulted secondary to early amniotic leak and temporary oligohydramnios.

Abnormalities, Multiple↗

PubMed1991

Baseline factors associated with smoking cessation and relapse. MRFIT Research Group.

BACKGROUND: Data on smoking cessation and relapse for 6 yers of the Multiple Risk Factor Intervention Trial were evaluated in univariate and multivariate analyses to determine the relationship between variables measured at the beginning of the trial and smoking cessation and relapse for special intervention and usual care participants. RESULTS: The variables positively associated with smoking cessation in both the SI and the UC groups included age, education, and past success in quitting; there was a negative association with the number of cigarettes smoked per day. The expectation of quitting was positively associated with cessation in the special intervention group only, while life events, alcohol, and the presence of a wife who smokes were significant predictors of reduced cessation for the usual care group. The special intervention program may have overcome obstacles which interfered with cessation among the usual care participants. Associations with relapse were generally stronger in the usual care group than in the special intervention group. For usual care participants, multivariate analyses showed that education, past success in quitting smoking, alcohol, and life events were associated with relapse rates. For special intervention participants, only alcohol emerged as a significant predictor. Conclusion. The data are relevant in terms of factors that govern smoking cessation and relapse for adult smokers who take part in formal intervention programs and for those who are left to modify their behavior on their own.

Age Factors↗

PubMed1996

Annual summary of vital statistics--1995.

Recent trends in the vital statistics of the United States continued in 1995, including decreases in the number of births, the birth rate, the age-adjusted death rate, and the infant mortality rate; life expectancy at birth increased to a level equal to the record high of 75.8 years in 1992. Marriages and divorces both decreased. An estimated 3,900,089 infants were born during 1995, a decline of 1% from 1994. The preliminary birth rate for 1995 was 14.8 live births per 1000 total population, a 3% decline, and the lowest recorded in nearly two decades. The fertility rate, which relates births to women in the childbearing ages, declined to 65.6 live births per 1000 women 15 to 44 years old, the lowest rate since 1986. According to preliminary data for 1995, fertility rates declined for all racial groups with the gap narrowing between black and white rates. The fertility rate for black women declined 7% to a historic low level (71.7); the preliminary rate for white women (64.5) dropped just 1%. Fertility rates continue to be highest for Hispanic, especially Mexican-American, women. Preliminary data for 1995 suggest a 2% decline in the rate for Hispanic women to 103.7. The birth rate for teenagers has now decreased for four consecutive years, from a high of 62.1 per 1000 women 15 to 19 years old in 1991 to 56.9 in 1995, an overall decline of 8%. The rate of childbearing by unmarried mothers dropped 4% from 1994 to 1995, from 46.9 births per 1000 unmarried women 15 to 44 years old to 44.9, the first decline in the rate in nearly two decades. The proportion of all births occurring to unmarried women dropped as well in 1995, to 32.0% from 32.6% in 1994. Smoking during pregnancy dropped steadily from 1989 (19.5%) to 1994 (14.6%), a decline of about 25%. Prenatal care utilization continued to improve in 1995 with 81.2% of all mothers receiving care in the first trimester compared with 78.9% in 1993. Preliminary data for 1995 suggests continued improvement to 81.2%. The percent of infants delivered by cesarean delivery declined slightly to 20.8% in 1995. The percent of low birth weight (LBW) infants continued to climb in 1994 rising to 7.3%, from 7.2% in 1993. The proportion of LBW improved slightly among black infants, declining from 13.3% to 13.2% between 1993 and 1994. Preliminary figures for 1995 suggest continued decline in LBW for black infants (13.0%). The multiple birth ratio rose to 25.7 per 1000 births for 1994, an increase of 2% over 1993 and 33% since 1980. Age-adjusted death rates in 1995 were lower for heart disease, malignant neoplasms, accidents, and homicide. Although the total number of human immunodeficiency virus (HIV) infection deaths increased slightly from 42,114 in 1994 to an estimated 42,506 in 1995, the age-adjusted death rate for HIV infection did not increase, which may indicate a leveling off of the steep upward trend in mortality from HIV infection since 1987. Nearly 15,000 children between the ages of 1-14 years died in the United States (US) in 1995. The death rate for children 1 to 4 years old in 1995 was 40.4 per 100,000 population aged 1 to 4 years, 6% lower than the rate of 42.9 in 1994. The 1995 death rate for 5- to 14-year-olds was 22.1, 2% lower than the rate of 22.5 in 1994. Since 1979, death rates have declined by 37% for children 1 to 4 years old, and by 30% for children 5 to 14 years old. For children 1 to 4 years old, the leading cause of death was injuries, which accounted for for an estimated 2277 deaths in 1995, 36% of all deaths in this age group. Injuries were the leading cause of death for 5- to 14-year-olds as well, accounting for an ever higher percentage (41%) of all deaths. In 1995, the preliminary infant mortality rate was 7.5 per 1000live births, 6% lower than 1994, and the lowest ever recorded in the US. The decline occurred for neonatal as well as postneonatal mortality rates, and among white and black infants alike.

Global Health↗

PubMed1981

[Treatment of alcoholism. Study of the efficacy of 4 therapeutic orientations].

The present survey studies, in a group of 145 alcoholics from the National Institute on Alcoholism in Costa Rica, the effectiveness of four therapeutic orientations in alcoholism: behavioral, psychosocial, occupational and multiple. The survey was carried out in a harmless population of alcoholics, and it aims to work out and to test treatment designs suitable to the uncovered level or prevention respecting to alcoholism, the secondary one. Each one of the groups receiving the diverse treatments stayed as in-patient under similar conditions. The treatment had a two-week duration; once finished, the patient was discharged and continued with a one-year follow-up. The outcomes are the following: 1. Treatment. The occupational and behavior-oriented treatments present a five months abstinence period as an estimate average effectiveness. The psychosocial-oriented treatments reach a seven months abstinence period. Its major effectiveness is due to the specific action this orientation develops on the patients having the worst prognosis. The integration, in a treatment, of orientations corresponding to different theoretical frames can determine reciprocal inhibition phenomena among orientations and lower the general effectiveness level. 2. Diagnosis. The personalities defined as depressive and paranoiac according to their prevailing basic anxiety, and the presence or absence of a conjugal tie holds an estimate link with the abstinence the patient showed when he was discharged from treatment. The prognosis value of this characteristic disappears when it is then direct object of a therapeutic orientation (psychosocial) given that this characteristics are sensitive to changes by action in a specific treatment.

Alcoholism↗

PubMed2004

Ethical issues in psychiatric genetics.

As knowledge grows regarding the genetic bases of psychiatric disorders, a variety of ethical issues will need to be confronted. Current evidence suggests that the etiology of most psychiatric disorders rests on a combination of multiple genes and environmental factors. As tests for the genes involved become more easily available, pressures will arise to use them for prenatal testing, screening of children and adults, selection of potential adoptees, and pre-marital screening. Common problems that will need to be addressed include popular misunderstanding of the consequences of possessing an affected allele, impact of knowledge of one's genetic make-up on one's sense of self, and the discriminatory use of genetic information to deny persons access to insurance and employment. Although most states have some legislation aimed at preventing discrimination, the laws' coverage is spotty and federal rules are lacking. Physicians may find that newly available genetic information creates new duties for them, including warning third parties who may share the patient's genetic endowment. And genetics research itself has raised questions about when to disclose information to subjects and their family members about the genes that are being studied, and how to define the subjects of the research when information is collected about family members other than the proband. Knowledge of these dilemmas is a first step to resolving them, something that the medical profession will need to attend to in the near-term. Neglect will lead others to set the rules that will control medical practice, including the practice of psychiatry, in the new world of genetic medicine.

Adoption↗

PubMed2001

Gender influences on career opportunities, practice choices, and job satisfaction in a cohort of physicians with certification in sports medicine.

OBJECTIVE: To examine the gender differences in practice patterns, experiences, and career opportunities for family physicians who practice sports medicine. DESIGN: Descriptive, self-administered questionnaire. PARTICIPANTS: Family physicians with Certificate of Added Qualification (CAQ) in sports medicine were surveyed. The survey was sent to all women with a CAQ in Sports Medicine and a random sample of 20% of the men with CAQs in sports medicine. MAIN OUTCOME MEASURE: Survey consisted of multiple choice, Likert scale, and opened-ended questions. The data was analyzed with contingency tables, with gender as the dependent variable. RESULTS: Response rate to the survey was 75%, which included 42 females and 102 males. Demographics of our population demonstrated some gender differences. Males were of higher average age (41.1 vs. 38.1), and more likely to be married and have children. Practice types, location, and time spent in sports medicine did not differ with the exception of training room and event coverage. Males were more likely to cover all levels of training room except at the Division I level, where the percent of males and females covering training rooms were equal. Males were also more likely to cover all types of sporting events. Job satisfaction and reasons for choosing current jobs did not show significant gender differences. However, factors affecting career opportunities did vary. Professional relationships with athletic trainers and coaches were perceived to be different by males and females surveyed. CONCLUSIONS: Our survey of sports medicine physicians showed some gender differences in practice patterns relative to training room and sporting event coverage. Surprisingly, there were not many differences in the factors that affected job choice and factors affecting job opportunities with the exception of gender itself. However, our study does not conclude how or when gender begins to affect the female sports medicine physician's career opportunities.

Adult↗

PubMed1999

A novel deficiency of mitochondrial ATPase of nuclear origin.

We report a new type of fatal mitochondrial disorder caused by selective deficiency of mitochondrial ATP synthase (ATPase). A hypotrophic newborn from a consanguineous marriage presented severe lactic acidosis, cardiomegaly and hepatomegaly and died from heart failure after 2 days. The activity of oligomycin-sensitive ATPase was only 31-34% of the control, both in muscle and heart, but the activities of cytochrome c oxidase, citrate synthase and pyruvate dehydrogenase were normal. Electrophoretic and western blot analysis revealed selective reduction of ATPase complex but normal levels of the respiratory chain complexes I, III and IV. The same selective deficiency of ATPase was found in cultured skin fibroblasts which showed similar decreases in ATPase content, ATPase hydrolytic activity and level of substrate-dependent ATP synthesis (20-25, 18 and 29-33% of the control, respectively). Pulse-chase labelling of patient fibroblasts revealed low incorporation of [(35)S]methionine into assembled ATPase complexes, but increased incorporation into immunoprecipitated ATPase subunit beta, which had a very short half-life. In contrast, no difference was found in the size and subunit composition of the assembled and newly produced ATPase complex. Transmitochondrial cybrids prepared from enucleated fibroblasts of the patient and rho degrees cells derived from 143B. TK(-)human osteosarcoma cells fully restored the ATPase activity, ATP synthesis and ATPase content, when compared with control cybrids. Likewise, the pattern of [(35)S]methionine labelling of ATPase was found to be normal in patient cybrids. We conclude that the generalized deficiency of mitochondrial ATPase described is of nuclear origin and is caused by altered biosynthesis of the enzyme.

Abnormalities, Multiple↗

PubMed1987

Effects of passive smoking in the Multiple Risk Factor Intervention Trial.

The Multiple Risk Factor Intervention Trial (MRFIT), conducted in 1973-1982, provided a unique opportunity to study the effect of passive smoking on men whose wives smoke. MRFIT participants who reported at entry that they had never smoked tobacco products were classified according to the smoking status of their wives. Men with wives who smoked had similar mean levels of serum thiocyanate (54.3 vs. 53.9 mumol/liter, p = 0.83) but higher mean levels of expired carbon monoxide (7.7 vs. 7.1 ppm, p = 0.001). Lower levels of pulmonary function (by maximum forced expiratory volume in one second) were also observed in these men (3,493.1 vs. 3,591.9 ml, p = 0.04). The relative risks, for men whose wives smoked compared with men whose wives did not smoke, for the endpoints coronary heart disease death, fatal or nonfatal coronary heart disease event, and death from any cause were 2.11 (p = 0.19, 95% confidence interval (CI) 0.69-6.46), 1.48 (p = 0.13, 95% CI 0.89-2.47), and 1.96 (p = 0.08, 95% CI 0.93-4.11), respectively. When smokers who quit prior to entry were included in the analyses, the relative risks, for men whose wives smoked compared with men whose wives did not smoke, for the above endpoints were 1.45 (p = 0.25, 95% CI 0.77-2.73), 1.19 (p = 0.29, 95% CI 0.85-1.65), and 1.72 (p = 0.01, 95% CI 1.12-2.64), respectively. These relative risk estimates did not change appreciably after adjusting for other baseline risk factors. The results suggest that passive exposure to cigarette smoke may have a deleterious impact on the health of nonsmokers and that nonsmokers may be at an increased risk of death through passive exposure to cigarette smoke.

Adult↗

PubMed1995

Knowledge, beliefs, and prior screening behavior among blacks and whites reporting for prostate cancer screening.

OBJECTIVES: A survey to determine prostate cancer-related knowledge, beliefs, and prior screening behavior was administered to men participating in prostate cancer screening events at nine major sites in the southeast. Since prostate cancer disproportionately affects blacks, a primary focus of the analysis was to determine if differences in responses exist between racial groups. METHODS: A 20-question, multiple-choice survey to ascertain prostate cancer knowledge and beliefs, demographics, and health care access information was administered at nine major southeastern sites participating in Prostate Cancer Awareness screening events. Potential differences between the responses of blacks and whites were tested using the Cochran-Mantel-Haenszel test (P < 0.05), adjusting for differences among sites. RESULTS: Major findings of this study on 286 black and 1218 white men are as follows: (1) only 28% of black or white men report that their doctor ever discussed a test for prostate cancer with them; (2) blacks were less likely to have a regular doctor (P = 0.03) or ever to have had a digital rectal examination (P < 0.001) or prostate-specific antigen testing (P = 0.005); (3) blacks were less likely to report knowing someone with prostate cancer (P < 0.001) and were more apt to report their acquaintances experiencing post-treatment impotence than whites (P = 0.03); they were less likely to report that "a man with prostate cancer can lead a normal life" (P < 0.001) or that "men can have prostate cancer without symptoms" (P < 0.001); (4) a substantial number of all men did not know that race and/or heredity are risk factors; and (5) "peace of mind" was the leading reason why men (63% of whites and 50% of blacks) attended prostate cancer screening events. CONCLUSIONS: There are a number of similarities among black and white men regarding knowledge and beliefs related to prostate cancer. Important differences, however, in access to screening, perception of the disease and its treatment, and knowledge of risk factors exist between racial groups and represent significant barriers to early detection among African Americans.

Black or African American↗