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Identification of psychobiological stressors among HIV-positive women. HIV Neurobehavioral Research Center (HNRC) Group.

This research describes major stressors in the lives of women who have been infected with the human immunodeficiency virus (HIV). Thirty-one HIV antibody positive (HIV+) women infected primarily through heterosexual contact participated in a two hour semi-structured interview detailing the circumstances, context, and consequences of all stressful life events and difficulties experienced within the preceding six months. Qualitative methods of data analyses were utilized (Miles & Huberman, 1984). HIV-related life events and difficulties were classified into primary and secondary stressors based on the stress process model (Pearlin et al., 1981). Problems arising directly from one's seropositivity were defined as primary stressors. Stressful life events and difficulties occurring in other role areas were defined as secondary stressors. Six categories of HIV-related stressors were identified and quantified. Primary stressors were health-related, and included both gynecological problems (e.g., amenorrhea) and general symptoms of HIV infection (e.g., fatigue). Secondary stressors related to child and family (e.g., future guardianship of children), marital/partner relations (e.g., disclosure of HIV+ status), occupation (e.g., arranging time-off for medical appointments), economic problems (e.g., insurance "hassles"), and social network events (e.g., death of friends from AIDS). This research indicates that HIV-positive women are exposed to multiple stressors; some may be viewed as unique to women, whereas others may be considered common to both sexes. Identification of stressors has implications for the design of medical and psychiatric interventions for women.

Adult↗

A pilot study of factors associated with resilience to substance abuse in adolescent sons of alcoholic fathers.

This pilot study evaluated the association between substance abuse outcome and putative protective factors in sons of alcoholic fathers. A battery of questionnaires was anonymously self-administered to 24 sons of alcoholic fathers ages 16-19 years to identify relationships between alcohol and/or drug abuse and factors hypothesized to be related to parental alcoholism. Of the 24 subjects, 13 were categorized through self-identification and self-report screening measures as having alcohol and/or drug problems and 11 were categorized as not having substance abuse problems. Boys without substance problems: (1) had significantly higher maternal occupational status (p = .01); (2) experienced more good life events (p < .001), and (3) had a more internally oriented locus of control (p < .001). Good events and internal locus of control were highly correlated with each other (r = .620, p < .01). The fact that these preliminary findings are consistent with other literature despite marked methodologic and sample differences indicates that these putative components of resilience are robust and deserve further study towards improved substance abuse prevention in those at high risk.

Adolescent↗

Attitudes, opinions, and sexual development of 205 homosexual women.

Two hundred and five homosexual women, aged 15 to 50, were surveyed as to their attitudes and experiences in the areas of education, religion, family experiences, marriage, friendship, personal happiness, sexual development and satisfaction, psychological adjustment, and occupational status. The investigation discovered a high rate of only-child status among lesbian women, a tendency toward ambivalence of opinion on many issues, and a general lack of insight into self and others. Comparisons with other research on female homosexuality were made.

Adaptation, Psychological↗

Normative data for the HADS from a large non-clinical sample.

OBJECTIVES: To provide normative data for the Hospital Anxiety Depression Scale (HADS). DESIGN: Repeated measures and correlational. METHODS: The HADS was administered to a non-clinical sample, broadly representative of the general adult UK population (N = 1792) in terms of the distributions of age, gender and occupational status. Correlational analysis was used to determine the influence of demographic variables on HADS scores. RESULTS: Demographic variables had only very modest influences on HADS scores. The reliability of the HADS is acceptable; the Anxiety and Depression scales are moderately correlated (.53). Tables to convert raw scores to percentiles are presented for females and males. CONCLUSIONS: The present normative data allow clinicians to assess the rarity of a given HADS score, and thus provide a useful supplement to existing cut-off scores.

Adolescent↗

Evidence for controlled heroin use? Low levels of negative health and social outcomes among non-treatment heroin users in Glasgow (Scotland).

OBJECTIVES: This longitudinal study focused on 126 long-term heroin users who had never been in specialist treatment for use of any drug. The primary aim of the study was to assess whether this 'hidden' population resembled heroin users identified with drug treatment agencies, or alternatively, to test whether heroin could indeed be used in a controlled, non-intrusive fashion for an extended period of time. DESIGN AND METHODS: Recruitment was achieved through chain-referred purposive sampling methods, and data were collected through two semi-structured interviews. 67% of participants were re-recruited for follow-up. RESULTS: Participants had levels of occupational status and educational achievement comparable to that in the general UK population, and considerably higher than typically found in heroin research. At the conclusion of the study, six participants had entered treatment. While there was evidence of intensive risky patterns of drug use among the sample, there was equal evidence for planned, controlled patterns of use. Some drugrelated negative health and social outcomes had occurred on a lifetime basis, but ongoing problems were rare, and heroin was not a significant predictor in either context. In contrast to typical samples of heroin users, high levels of negative health and social outcomes did not appear to be inevitable within this sample. Frequency of heroin use was predicted by attributional items, indicating the importance of psychological factors in drug use and addiction. CONCLUSIONS: Drug research should more fully incorporate previously hidden populations to more fully inform theory and practice. The pharmacological properties of specific substances should not be assumed to inevitably lead to addictive and destructive patterns of drug use.

Adult↗

Variables affecting BMI evolution at 2 and 5 years after vertical banded gastroplasty.

BACKGROUND: Vertical banded gastroplasty (VBG) has been found to result in significant reduction in body mass index (BMI) during the first postoperative year. We investigated the impact of some intrinsic and extrinsic factors on long-term BMI evolution in morbidly obese patients who underwent VBG, with the aim of establishing a long-term weight-loss prognosis. METHODS: 67 consecutive morbidly obese patients who underwent VBG were followed for 2 years; of these, 34 were followed 3 more years, for a total follow-up of 5 years. BMI was monitored and correlated with demographic (preoperative BMI, obese relatives, age and gender) and lifestyle variables (physical activity, habitual dietary transgression and occupational status). RESULTS: Global BMI fell from 47.5 at the time of the intervention to 32.1 when patients were examined 12 months after surgery. From the second year, an upward trend was observed, and at 5 years, mean BMI was above 35, considered in the high-risk range. Modifiable variables affecting lifestyle have shown significantly favorable effects on BMI evolution. Among intrinsic variables, BMI before surgery and obese parents also affect long-term evolution. CONCLUSION: Different variables should be considered in order to establish a long-term weight-loss prognosis for each patient, thus making it possible to act more specifically on modifiable variables.

Adult↗

Social correlates of cigarette smoking cessation: findings from the 1995 microcensus survey in Germany.

BACKGROUND: An increasing percentage of smokers are quitting this unhealthy behavior during their life course. The aim of this study is to analyze which social factors play an important role regarding ex-smoking in Germany. METHODS: Data were derived from the 1995 German Microcensus, which is a representative survey for the population in Germany. Included in the analysis were 44,553 current smokers and 23,780 ex-smokers. The independent variables were education, occupational status, family status, unemployment/social welfare, household income, and community size. A two-stage statistical modeling procedure was used, initially to assess the most important effects of the independent variables on smoking cessation and secondly, to analyze the cumulative effects of the independent variables. RESULTS: The most striking effects observed for smoking cessation were family status and education. For example, in males aged 30 to 49 years, the percentages of ex-smokers of all ever smokers were 44.7% for married males with high education compared with only 14.6% for males with low education. The corresponding percentages for females were 44.0% and 17.6%. CONCLUSIONS: Such striking differences in the social polarization of smoking cessation in Germany demonstrate the importance of anti-smoking policies and new strategies that avoid a further increase in the social inequality of smoking behavior.

Adolescent↗

One-year follow-up of patients with cluster C personality disorders: a prospective study comparing patients with "pure" and comorbid conditions within cluster C, and "pure" C with "pure" cluster A or B conditions.

This one-year, post-treatment prospective study of consecutively admitted patients to a national psychiatric in-patient clinic, compares patients belonging to four subgroups of DSM-III-R personality disorder (PDs): "pure cluster A (N = 21), "pure" B (N = 67), "pure" C (N = 251), and Axis II "comorbid" C (N = 138). Outcome was measured by SCl-90 and occupational status. Axis I disorders were controlled for in all analyses. Contrary to our hypothesis, patients in pure cluster C had no better outcome than either Axis II comorbid cluster C patients or patients with pure cluster A or B. Although pure C patients relapsed in symptom distress after discharge, comorbid C patients did not. C patients with an additional Histrionic PD were less at risk to be a case at follow up (GSI level > 1.00). Cluster C disorders as a whole had negative impact upon outcome in the total sample. These findings suggest the need for better treatment of patients with cluster C conditions.

Cluster Analysis↗

Social inequalities in suicide mortality: Spain and France, 1980-1982 and 1988-1990.

In this study we analyzed the socioeconomic differences in mortality from suicide in the economically active male population aged 25-64 years in Spain and France in 1980-1982 and 1988-1990; in the case of Spain the data came from the Eight Provinces Study (Regidor, Gutierrez-Fisac, & Rodríguez, 1995). Individuals were grouped into four categories: professional/managerial, clerical/sales/ service, agricultural, and manual workers. For 1980-1982, among those aged 25-44, professionals and managers had the lowest risk of mortality in Spain, and clerical/sales/service workers in France. These socioeconomic differences in mortality increased in 1988-1990. In 1980-1982, among those aged 45-64, clerical/ sales/service workers had the lowest risk of mortality from suicide relative to the other occupational groups in both countries, but this difference was not maintained in 1988-1990. Thus, differences in suicide mortality for men by occupational status depended in the present study upon both the nation studied and the time period chosen for study.

Adult↗

Employee drinking patterns and accidental injury: a study of four New England states.

The relationship between alcohol use and accidental injury was examined in an anonymous telephone survey of 1740 randomly sampled employed adults (49% men) residing in four New England states in 1982 and 1983. Respondents reported 383 accidents requiring medical attention during the year prior to the interview, 34 involving hospitalization. Of the accidents, 41% occurred at work, 32% during recreational and other activities, 19% at home and 8% in traffic incidents. Respondents were stratified by self-reported levels of alcohol consumption and were compared on accident rates. Drinking at work was also examined for an association with accident involvement. Logistic regression analyses controlled for variability associated with age, sex, marital status, occupation and drug use. Drinking at work was not significantly or independently associated with job accidents but an average daily intake of 5+ drinks elevated the relative risk, compared with abstainers, as follows: 1.7 for any accidental injury, 3.8 for injuries requiring hospitalization and 2.0 for job-based accidental injuries. The relative risks associated with the use of other psychoactive drugs were 1.7 for work accidents and 2.4 for accident-associated hospitalizations. Of the respondents, 13% reported having ever had a drug or alcohol problem and 2% reported a current problem. Fourteen percent reported that there were counselors at their jobs to help with such problems. Of those who had ever experienced a problem, 11% had sought help from outside programs and only 4% had sought help at work.

Accidents, Occupational↗

Prevalence and distribution of alcohol use and impairment in the workplace: a U.S. national survey.

OBJECTIVE: Although much research has explored overall alcohol use in the workforce, little research has explored the extent of alcohol use and impairment in the workplace. This study explored the overall prevalence, frequency, and distribution of alcohol use and impairment during the workday. METHOD: Data were collected from a national probability sample of 2805 employed adults using a random digit dialing telephone survey. Alcohol use within 2 hours of reporting to work, alcohol use during the workday, working under the influence of alcohol, and working with a hangover were assessed for the 12 months preceding the interview. RESULTS: Workplace alcohol use and impairment directly affect an estimated 15% of the U.S. workforce (19.2 million workers). Specifically, an estimated 1.83% (2.3 million workers) drink before work, 7.06% (8.9 million workers) drink during the workday, 1.68% (2.1 million workers) work under the influence of alcohol, and 9.23% (11.6 million workers) work with a hangover. The results also suggest that most workplace alcohol use and impairment occur infrequently. The distribution of workplace alcohol use and impairment differs by gender, race, age, marital status, occupation, and work shift. CONCLUSION: Workplace alcohol use and impairment are prevalent enough that additional research should focus on their causes and impact on employee productivity. Moreover, clear policies should be in place regarding alcohol use and impairment at work. But despite management's responsibility for the development and enforcement of such policies, managers report elevated rates of consuming alcohol during the workday, working under the influence of alcohol, and working with a hangover.

Adolescent↗

[Client characteristics at a center for treatment of drug dependence].

OBJECTIVE: Sociodemographic and psychopathological characteristics as well as treatment approaches to patients at an outpatient clinic for drug addicts are described. METHODS: Descriptive study based on randomly sampled medical charts and registration forms of subjects presenting for treatment from 1986 to 1993. RESULTS: The sample was made up predominantly of young white unmarried men, with low occupational status. The number of years of schooling was greater than that of individuals of the same age group in the general population. Thirty-six percent of the subjects were sons of broken-down marriages, 14% had been abandoned by parents during childhood and 14% had lost one of their parents by death. Fifty percent complained of an absent father in their upbringing. Sixteen percent of the patients reported physical abuse in their childhood and the father was the perpetrator in 68% of the cases. The mean age at which subjects started to use drugs was 17.4 years. Cocaine was by far the most abused drug, either alone (34%) or together with other drugs (52%). Slightly less than half of the individuals used marijuana, whereas one fifth were also addicted to alcohol. In the time interval covered by the study the proportion of cocaine abusers increased, whereas marijuana and intravenous drug users decreased among those subjects who attended the program. CONCLUSION: The results of this study provided information for services assessment and for the modification of the organization of the treatment of drug abuse.

Adolescent↗

[Correlates of smoking in pregnant women in six Brazilian cities].

OBJECTIVE: To evaluate sociodemographic and lifestyle correlates of smoking in pregnant women sampled from hospitals. METHODS: A cross-sectional study was conducted in 5,539 pregnant women aged 20 or more who sought medical attention in prenatal clinics of affiliate hospitals of the Brazilian National Health System in the cities of Manaus, Fortaleza, Salvador, Rio de Janeiro, São Paulo, and Porto Alegre from 1991 to 1995. Interviews were conducted using a standardized questionnaire that covered sociodemographics and smoking habits before and during pregnancy. Current smoking was defined as smoking at least one cigarette/day, former smoking as reporting having smoked at least one cigarette/day but having quit, and never smoking as never having smoked one cigarette/day. RESULTS: Smoking during pregnancy was associated with lower education (OR=2.13; CI 95%: 1.76-2.57) and greater parity (OR=1.84; CI 95%: 1.53-2.21). Positive associations were also found with increased gestational age and alcohol consumption. No significant association was found with skin color or occupation status. A protective effect was observed for women married or living with a partner (OR=0.55 CI 95%: 0.42-0.72). Having Manaus' women as a reference, Porto Alegre's women showed the greatest risk for smoking in pregnancy (OR=5.00; CI 95%: 3.35-7.38), followed by São Paulo's (OR=3.42; CI 95%: 2.25-5.20), Rio de Janeiro (OR=2.53; CI 95%: 1.65-3.88) and Fortaleza's (OR=2.56; CI 95%: 1.74-3.78). CONCLUSIONS: The study findings are similar to those described in the literature regarding education, parity, and marital status. However, no association with skin color was seen in the multivariate analysis. Former smokers had sociodemographic characteristics more similar to non-smokers than former smokers.

Adult↗

[Incidence of non-fatal work-related accidents in Southeast Brazil].

Incidence of work-related accidents in Botucatu, São Paulo, Brazil, was estimated according to gender, age, employment status, occupation, and type of work. A household survey was conducted by systematic random group sampling (195 census tracts). Information was collected from all residents 10 years or older in each household. Of those who had worked during the 90 days prior to the interview, we obtained information on occupation, job position, and employment contract. The study included 9,626 households (sample fraction 0.26). The proportion of non-fatal work accidents in the municipal area was 3.3% (95%CI: 2.7-3.9), higher for men 4.5% (95%CI: 3.6-5.5) and varying with type of employment contract and occupation. Compared to results from previous studies, we observed a decline in work-related accident risk.

Accidents, Occupational↗

[Prevalence of ectopic pregnancy liable to surgical treatment in a public hospital from 1995 through 2000].

OBJECTIVES: To determine the prevalence of women with ectopic pregnancy submitted to surgical treatment at the HMCP from 1995 to 2000; as well as to evaluate some characteristics of these women and the treatment performed. METHODS: The study was retrospective. Data was obtained from medical register of women submitted to laparotomy with the diagnosis of ectopic pregnancy. Variables studied were: patient's age, place of birth and occupation, status of ectopic pregnancy (with or without rupture), type of surgery, complications and duration of hospital stay. Data was analyzed in a descriptive way, followed by logistic regression analysis. RESULTS: Ninety six cases were studied. Age of the majority of women (65%) ranged from 25 to 35 years; 6% were adolescents. Of all patients 30% were employed. Distribution according to status of pregnancy: the study showed that 66% presented rupture; 79% of the patients were submitted to salpingectomy with or without ooforectomy. COMPLICATIONS: The most frequent complication was acute anemia, including one death due to DIVC (disseminated intravascular coagulation), and 12% of the patients had to receive blood transfusion. The average time of hospital stay was of 3.63 days (SD+/-0.81). Prevalence of ectopic pregnancies did not change during the period of study and was responsible for 11.2% of the total number of laparotomies. CONCLUSIONS: For the period of this study, the number of women submitted to laparotomy due to ectopic pregnancy remained quite high and unchanged For control, this situation requires preventive measures at different levels. Ectopic pregnancy is a severe pathology and induces high rates of morbidity. It remains a challenge for gynecologists.

Adolescent↗

Alternate roles for the elderly: an example from a Midwestern retirement community.

Increasing numbers of individuals are surviving to retirement age in relatively good health. With the loss of the work role and other roles typically associated with middle age, they are faced with the dilemma of the "roleless role," an absence of well-articulated, age-appropriate expectations and standards of behavior by which to structure everyday life. Recent anthropological, sociological, and psychological studies indicate the possibility of the development of alternate roles and age-appropriate normative systems in age-homogeneous environments. An example of one such alternate behavioral system is provided from data collected on a small retirement community in the Midwest. A normative system seems to have developed in which personal qualities such as trust, friendliness, and concern for others are more highly valued than former achievements or occupational status. Residents most frequently cited as having made a good adjustment to aging were not necessarily those who were most active, but rather those individuals who showed a determination to "keep going," lacked self-pity, kept mentally alert and aware, were willing to help others, and showed a sense of responsibility to the community. Various roles were developed and were expected to be assumed by incoming residents: alternate "work roles," represented by committee memberships and volunteer activity; "family roles," represented by the supportive or helping relations adopted toward other residents; and leisure-type roles. These behavioral standards and expectations helped to structure the relationships and everyday life of residents within the community.

Aged↗

Secular change in birthweight among southeast Asian immigrants to the United States.

We analyzed the Washington State births in 1980-1986 to Southeast Asian parents whose birth place was coded as being outside of the US. The mean birthweight increased from 3188 grams in 1980-81 to 3283 grams in 1986, an annual increment of about 18 grams (95% CI = 11, 25 grams). The prevalence of low birthweight (less than 2500 grams) decreased from 7.2 percent in 1980-81 to 5.4 percent in 1986, an annual reduction of 6.4 percent (95% CI = 1.3, 11.2 percent). In an analysis of information ascertained from the birth certificate, the change of paternal occupational status (from student to employed) was associated with 27 percent of the reduction in the prevalence of low birthweight, independent of maternal age, infant sex, and prior gravidity. A similar temporal change of birthweight during the same period of time was not observed among infants of US-born Asian mothers. Among the women who had two consecutive births from 1984 to 1986, the improvement of birthweight for the second birth compared to the first birth was much greater in infants born to the Southeast Asian mothers than that to White mothers. Our study suggests that living in the United States after immigration from their native countries has had a positive impact on the birthweight of infants born to Southeast Asian immigrants.

Adult↗