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Women at risk of ovarian cancer.

This paper evaluates perceived cancer risk and worry about cancer among women with genetic risk of ovarian cancer. Women with a first-degree relative with ovarian cancer who were participating in screening were compared with a general population sample who had been screened the previous year and a group of community controls. The results showed that both worry about cancer and perceived risk were higher in the screening groups than in the controls. Estimates of general-population prevalence were on the optimistic side (only 31% estimating that more than one of 10 women would develop cancer in their lifetime) and were unrelated to any psychologic factors, genetic risk, or to personal experience of cancer, but were related to occupational status. In multivariate analyses, perceived personal cancer risk was higher in screening attenders and related to (lower) optimism and knowing more people with cancer. Cancer worry was also higher in screening attenders and associated with lower optimism and a monitoring coping style.

Adult↗

The war experiences and psychosocial development of children in Lebanon.

This study examines the number and types of war traumas children face growing up in a war-torn country and the relation of such traumatic experiences to their psychosocial development. A sample of 224 Lebanese children (10-16 years old) were interviewed using measures of war exposure, mental health symptoms, adaptational outcomes, and Post-Traumatic Stress Disorder (PTSD). The number and type of children's war traumas varied meaningfully in number and type by their age, gender, father's occupational status, and mother's educational level. As predicted, the number of war traumas experienced by a child was positively related to PTSD symptoms; and various types of war traumas were differentially related to PTSD, mental health symptoms, and adaptational outcomes. For example, children who were exposed to multiple war traumas, were bereaved, became victims of violent acts, witnessed violent acts, and/or were exposed to shelling or combat exhibited more PTSD symptoms. Children who were separated from parents reported more depressive symptoms and children who experience bereavement and were not displaced reported more planful behavior. Lastly, children who were separated from parents and who witnessed violent acts reported more prosocial behavior. Implications for program interventions and directions for future research on the effects of war on the psychosocial development of children are explored.

Adolescent↗

[Comparative study of substance dependence comorbidity in bipolar, schizophrenic and schizoaffective disorders].

Epidemiological studies such as the Epidemiological Catchment Area survey have shown that bipolar or schizophrenic patients are especially prone to display a comorbid substance use disorder. These studies have demonstrated that this comorbidity condition constitutes a major mental health problem owing to its high frequency. The aim of the present study was to assess the prevalence of a comorbid substance use disorder in a sample of psychotic patients, and to compare the pattern of street drug use in schizophrenic, schizoaffective and bipolar patients. Comorbidity of illicit substance use disorders was assessed with the Composite International Diagnostic Interview in 92 consecutive patients fulfilling the DSM III-R criteria for bipolar disorder (BP, n = 40), schizophrenia (S, n = 38) and schizoaffective disorder (SA, n = 14). The lifetime prevalence for any substance use was 25% in the total sample, and did not differ significantly between the three groups, although a higher prevalence was found in SA (BP: 20%, S: 23.7%, SA: 42.9%, NS). The current prevalence (previous six months) was 14.1%, in the total sample (BP: 17.5%, S: 7.9%, SA: 21.4%, NS). In the three diagnostic groups, the most commonly used drug was cannabis, followed by opiates and cocaine. These results do not confirm that schizophrenics might preferentially display abuse or dependence on psychostimulants, and highlight the possible role for the drug choice of the availability of the various illicit drugs in the geographical environment of the subject. Nearly half patients (47.8%) have a lifetime history of abuse or dependence on at least two different drugs. Age at onset of substance use disorder was earlier than or concomitant to that of schizophrenic and/or mood symptoms in most patients. This chronological pattern was the same in the three diagnostic groups. Clinical variables (age at onset, age at first hospitalization, number of hospitalizations) and sociodemographic variables (age, sex, educational level, marital and occupational status) did not significantly differ between patients with a lifetime history of drug abuse or dependence and those without. Patients presenting with a current abuse or dependence were younger than those without. These results confirm in a French sample of schizophrenic and/or mood disordered patients the high frequency of the comorbidity with substance use disorders.

Adult↗

[Blood prolactin under the effect of protirelin in spondylarthropathies. Treatment trial of 4 cases of reactive arthritis and 2 cases of psoriatic arthritis with bromocriptine].

Prolactin radioimmunoassay was carried out before and 15, then 30 min after intravenous infusion of protireline (0.2 mg) in 3 groups of male patients: 7 with reactive arthritis (HLA B27: 6; age: 25 +/- 6.3 yr), 13 with ankylosing spondylitis (HLA B27: 11; age: 33.2 +/- 14.7 yr), 5 with psoriatic arthritis (HLA B27: 1; age: 28.8 +/- 6.3 yr). The same test was carried out in sex-age-body mass index matched controls. Only the patients with reactive arthritis presented dynamic hyperprolactinaemia 15 and 30 min after protireline infusion and none of ankylosing or psoriatic arthritis groups. A complete failure of bromocriptine was observed in reactive arthritis. In 2 cases of psoriatic arthritis, adding bromocriptine to gold salts and nonsteroidal anti-inflammatory drug was followed by a drastic efficacy with spectacular improvement in clinical, biological and occupational status. Because none of the cases had hyperprolactinaemia, bromocriptine acted probably had an intrinic anti-inflammatory effect independent of its antiprolactinic effect.

Adult↗

[Causes of postpartum intrauterine device rejection].

The objective of this study was to determine the causes of rejection to intrauterine device postpartum (IDP) in puerperal patients before they left the hospital. Two hundred puerperal patients who accepted IDP and two hundred patients who rejected IDP were studied. They received a questionaire to know the motives to accept or not IDP and degree of knowledge about it. There was not statistical differences between groups in relation to age, scholarity, religion, marital status, occupation and degree of knowledge, 51% had prenatal control, 62% of puerperal patients who rejected IDP did not have information about this contraceptive method, in 17% husband did not accept it and 9.5% have been influenced by negative rumors about IDP. In conclusion puerperal patients reject IDP mainly for lack of knowledge in relation to IDP and because their husbands did not accept it.

Adult↗

Inequality, deprivation and alcohol use.

There are major social inequalities in health within societies. Alcohol and tobacco are major preventable causes of ill health. Using data from the United Kingdom, this paper examines the social distribution of tobacco and alcohol consumption; the role that tobacco and alcohol may play in mediating or modifying social inequalities in health; and the implications of social distribution for policies to reduce harm associated with consumption of alcohol and tobacco. In the United Kingdom, as in many other countries, there is clear inverse association between socio-economic position and consumption of cigarettes. Over the past three decades, the decline in smoking has been more rapid in men and women in higher socio-economic groups. United Kingdom suggest that among employed men and women, the prevalence of non-drinking shows an inverse association with occupational status; heavy drinking differs little; and moderate drinking is more common among those of higher socio-economic status. Smoking accounts for perhaps 25% of the social class difference in coronary heart disease (CHD) mortality, more for lung cancer, less for some other diseases. healthier patterns of drinking may contribute to the lower CHD rates of higher social classes. Although other factors are clearly important in generating social inequalities, it is important to take the social distribution of alcohol and tobacco into account when formulating policy. For cigarette consumption, there is evidence that in lower socio-economic groups demand is more sensitive to price; higher socio-economic groups are more responsive to health education. There has been less research of this nature for alcohol. Available analyses suggest that price responsiveness of heavy drinking may be greatest in young men and in those with lower incomes. A pricing strategy has important equity implications.

Alcohol Drinking↗

[Artificially induced suppurative diseases].

128 cases of artificially caused purulent diseases have been analysed. All the cases were masked as chronic septicemia, recurrent abscesses, nonhealing wounds and fever of the unclear origin. The specific features of artificial diseases have been pointed out: social status, occupation, provoking factors, specific clinical signs--multiple hospitalizations, dominating location of postoperative scars and abscesses. Diagnostic principles, including psychological ang psychiatric testing are discussed. The neuro-psychiatric disorders were detected in most cases. Prevention of such diseases is analysed.

Abscess↗

Black women, work, stress, and perceived discrimination: the focused support group model as an intervention for stress reduction.

This exploratory study examined the use of two components (small and large groups) of a community-based intervention, the Focused Support Group (FSG) model, to alleviate employment-related stressors in Black women. Participants were assigned to small groups based on occupational status. Groups met for five weekly 3-hr sessions in didactic or small- and large-group formats. Two evaluations following the didactic session and the small and large group sessions elicited information on satisfaction with each of the formats, self-reported change in stress, awareness of interpersonal and sociopolitical issues affecting Black women in the labor force, assessing support networks, and usefulness of specific discussion topics to stress reduction. Results indicated the usefulness of the small- and large-group formats in reduction of self-reported stress and increases in personal and professional sources of support. Discussions on race and sex discrimination in the workplace were effective in overall stress reduction. The study highlights labor force participation as a potential source of stress for Black women, and supports the development of culture- and gender-appropriate community interventions as viable and cost-effective methods for stress reduction.

Adult↗

Mortality attributable to cigarette smoking in China.

CONTEXT: The few published prospective studies of smoking and mortality in China have reported low relative risks, but the durations of follow-up were short. OBJECTIVE: To assess the mortality of ever- and never-smokers in a cohort after 20 years of follow-up. DESIGN, SETTING, AND SUBJECTS: A cohort analytic study in a machinery factory in Xi'an, China, involving 1696 people aged 35 years or older (1124 men and 572 women) examined in May 1976. MAIN OUTCOME MEASURES: All-cause and tobacco-associated mortality. RESULTS: A total of 56% of the men and 12% of the women were ever-smokers at baseline. Through August 31, 1996, 218 persons (173 men and 45 women) had died. The relative risks (95% confidence intervals [CIs]) for ever smoking (after adjusting for age, marital status, occupation, education, diastolic blood pressure, and triglyceride and cholesterol levels) for deaths resulting from all causes, all cancer, and coronary heart disease were, respectively, 2.42 (95% CI, 1.72-3.42), 2.50 (95% CI, 1.41-4.43), and 3.61 (95% CI, 1.35-9.67) in men and 2.32 (95% CI, 1.18-4.56), 1.98 (95% CI, 0.50-7.92), and 4.67 (95% CI, 0.78-27.8) in women. CONCLUSIONS: Previous prospective studies of smoking-related mortality in China tended to underestimate the risks, probably because of short durations of follow-up. We have demonstrated that smoking is a major cause of death in China, and the risks are similar to those seen in the United States and the United Kingdom. Thus, about half of the 300 million smokers in China will eventually die of smoking-related diseases if urgent tobacco-control measures are not instituted to prevent this growing epidemic.

Adult↗

Effect of ethnicity on adherence to diabetic regimen.

OBJECTIVE: Evaluating the effectiveness of treatment of diabetic patients in our institution led us to seek the relationship between adherence to diabetic regimens and several demographic variables. Of primary importance was ethnicity, which the practitioners believed affected adherence. Other variables researched were: marital status, gender, weight, age, type and duration of diabetes, socioeconomic status, occupation and education. PATIENTS: Adult diabetic patients (215) seen in the diabetic clinic of a large health maintenance organization who had their diabetes for at least 6 months. METHODS: Data were collected from interviews and medical records over a two-year period. RESULTS: Ethnicity, the major test variable, did not show a relationship to adherence. Two variables, gender and weight, showed a trend to significant relationship to adherence. Chi square and t tests were used, depending on the type of data. CONCLUSIONS: Since there is no difference in adherence between ethnic groups, standardized care protocols are warranted, since they are cost-efficient.

Adult↗

[Illness and social status--the special case of neurodermatitis].

Neither the prevalence of atopic dermatitis (AD) in children nor the magnitude of risk factors such as socioeconomic status or environmental pollution are well known in Germany. In cooperation with the public health service, we therefore carried out a cross-sectional study during a 1992 preschool examination in Hannover covering 4,219 children. Lifetime prevalence of atopic dermatitis was 10.5%; the range for prevalence in 49 districts of Hannover was 2.8-25.0%. The AD prevalence differed significantly between German and non-German children (12.4 vs. 2.1%) and among children from families of different socio-economic status (6.5% low; 18.1% high). Statistically significant associations between AD risk and social variables (family structure, nationality, socio-economic status, occupation) and the lack of definite associations with environmental factors support the hypothesis that life style may be an important risk factor for atopic dermatitis.

Adolescent↗

[Related factors contributing to the healthy lifestyle of urban employees through the PRECEDE model].

The purpose of this study was to assess the related factors to the healthy lifestyle of 1147 urban employees. The theoretical framework of this study was the PRECEDE model. The model included three factors: 1. predisposing factors cardiovascular disease knowledge, general self-efficacy, health related diet and exercise self-efficacy, attitude for maintaining healthy life-style, health value, health status and illness history of family); 2. enabling factors (health resource availability, health resource utility); and 3. reinforcing factors (social support, feelings of colleagues health practice); The three factors were measured by 12 scales, through which the reliability and validity were assessed. According to the stepwise multiple regression analysis, diet and exercise self-efficacy, attitude for maintaining healthy life-style, marital status, cardiovascular disease knowledge, health status, occupational level, social support and feel of colleague health practice were the significant factors which accounted for 38.2% of variance. Predisposing factors and reinforcing factors were the important factors of healthy lifestyle on urban employees.

Adult↗

Tissue viability: the facts and the law.

Accountability remains an integral part of nursing, irrespective of occupational status or setting. The leaflet reminds nurses involved in direct care, as well as those in advisory, educational or promotional roles, of the need to consider and fulfil professional obligations towards a vulnerable and expectant public. The need to select resources that will support, not replace, skilled nursing is crucial. As nurses expand their practice they may face greater risk of litigation, but the boundaries should be clarified through job descriptions, employer approved policy statements and UKCC standards. Being asked to account for actions or omissions of care may be perceived as daunting. However, complaints may help drive quality improvement as well as staff development. A sense of perspective is needed to prevent defensive practice, allowing the potential of autonomous and accountable professionals being realised in the delivery of tissue viability services.

Humans↗

Martial status and military occupational specialty: neither factor has a selective adverse effect on pregnancy outcome.

This investigation was undertaken to determine whether there is a relationship between martial status or military occupational specialty (MOS) and pregnancy outcome in and active-duty population. In this prospective, descriptive study 312 active-duty women were identified as married or single and stratified into four groups on the basis of MOS: group I (n = 144), mild to moderate mental stress; group II (n = 43), intensive mental stress; group III (n = 72), exposure to hazardous material; and group IV (n = 53), physical stress. Each patient group was evaluated to determine the incidence of medical complications. One hundred ninety-three of the service women were married and 70 were single. There was no significant difference between pregnancy complications and martial status. In spite of considerable stress and hazardous exposure the incidence of medical complications of pregnancy observed among groups (group I = 67%, group II = 58%, group III = 48% and group IV = 53%) was not significantly different. On the basis of the findings of this study we conclude that martial status and MOS did not significantly influence military pregnancy outcome.

Female↗

Education, occupation and health status of people of age five years or more living in a high density urban area in Zimbabwe.

OBJECTIVE: To find out the education, occupation and health status of people aged five years or more living in a high density urban area in Zimbabwe. DESIGN: Cross sectional. SETTING: Households in Chitungwiza. SUBJECTS: Persons of age five years or more available in a household at the time of the survey. In 1990 and 1993, 822 and 1,023 people were surveyed, respectively. MAIN OUTCOME MEASURES: Educational level, employment, rate of smoking, nutritional status, blood pressure level, and rate of disability. RESULTS: After the age of 24 years, more males than females were observed in both periods. A much higher proportion (x2 = 20.34, df = 1, p < 0.001) of women were in informal employment in 1993 (28.6%) than in 1990 (12.9%). Meanwhile, about an equal proportion of men were in the informal sector in both periods (12.0% and 10.4% in 1990 and 1993, respectively). For females of age 15 years or more, fewer (40.8%) had attained secondary education than males (76.4%) in 1990 (x2 = 50.2, df = 1, p < 0.001). Overall, 208 (36.1%) men and eight (1.3%) women of age 15 years or more smoked. Raised blood pressure for both sexes increased significantly with age (x2 for linear trend = 20.21 for men and 65.81 for women, df = 1, p < 0.001 for both sexes). More women of age 45 years or more had raised blood pressure than men (x2 = 4.67, df = 1, p = 0.031). Many more women (8.0%) than men (0.7%) had a Ponderal Index of greater than 27 (x2 = 19.33, df = 1, p < 0.001). A total of 12 (1.5%) persons were disabled. CONCLUSION: Raised blood pressure and obesity mainly affected women and interventions to improve their health is recommended.

Adolescent↗

Relation of education and occupation-based socioeconomic status to incident Alzheimer's disease.

In this study, the authors evaluated whether the association between low educational level and increased risk of Alzheimer's disease (AD) and dementia may be explained by occupation-based socioeconomic status (SES). A cohort of 931 nondemented subjects aged > or = 75 years from the Kungsholmen Project, Stockholm, Sweden, was followed for 3 years between 1987 and 1993. A total of 101 incident cases of dementia, 76 involving AD, were detected. Less-educated subjects had an adjusted relative risk of developing AD of 3.4 (95% confidence interval: 2.0, 6.0), and subjects with lower SES had an adjusted relative risk of 1.6 (95% confidence interval: 1.0, 2.5). When both education and SES were introduced into the same model, only education remained significantly associated with AD. Combinations of low education with low or high SES were associated with similar increased risks of AD, but well-educated subjects with low SES were not at high risk. Low SES at 20 years of age, even when SES was high at age 40 or 60 years, was associated with increased risk; however, this increase disappeared when education was entered into the model. In conclusion, the association between low education and increased AD risk was not mediated by adult SES or socioeconomic mobility. This suggests that early life factors may be relevant.

Aged↗

[Social distribution of AIDS in Brazil, according to labor market participation, occupation and socioeconomic status of cases from 1987 to 1998].

The dynamics of the Brazilian AIDS epidemic was analyzed by occupation, taken as a proxy for individual socioeconomic status. The analysis comprised AIDS cases aged 20-49 and diagnosed in 1987-1998. The temporal trend in AIDS incidence rates was analyzed by sex, occupational category, and quintiles defined by a Brazilian scale for socioeconomic status (SES). The proportions of AIDS cases stratified by SES quintiles were analyzed by exposure category. Among men, incidence rates increased in the 1st time period in almost all occupational categories, decreasing among those classified as "non-manual" occupations during the 2nd period. Among females, an annual increment was observed from 1987 to 1998 in nearly all occupational strata. The highest relative increases were observed among the lowest SES scales for both sexes. The intravenous drug user (IDU) exposure category had the lowest socioeconomic status for both sexes, whereas the homo/bisexual category had the highest. The analysis highlighted a progressive change in the epidemic's social gradient during the period, with a faster spread among the lower socioeconomic strata.

Acquired Immunodeficiency Syndrome↗