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Venous thrombosis: a multicausal disease.

The risk factors for venous thrombosis differ from those for arterial vascular disease. During the past 5 years, knowledge about the aetiology of venous thrombosis has advanced with the discovery of several factors that contribute to the incidence of thrombosis, particularly the role of coagulation abnormalities. These abnormalities are common in the general population and therefore will be present simultaneously in some individuals. The resultant gene-gene and gene-environment interactions between risk factors are the key to the understanding of why a certain person develops thrombosis at a specific point in time.

Contraceptives, Oral↗

Association between early sexual abuse and adult HIV-risky sexual behaviors among community-recruited women.

OBJECTIVE: The first purpose was to determine whether sexual abuse involving penetration that occurred in childhood only, adolescence only, or both childhood and adolescence differently impacted whether community-recruited women had ever traded sex for money or drugs, their number of recent sex partners, and the number of times they had engaged in recent unprotected sex. The second purpose was to assess the mediating effects of adulthood rape, recent drug use, and recent sex with an injection drug user on these three HIV-risky sexual behaviors. METHOD: Women (n = 1,490) recruited from three US sites were questioned about their childhood and/or adolescent sexual abuse histories, adulthood rape experiences, recent drug use, and adult HIV-risky sexual behaviors via structured interviews. RESULTS: One-third of the women reported having experienced sexual abuse involving penetration in childhood and/or adolescence. Overall, regression analyses indicated a significant relationship between early sexual abuse and adult risky behaviors; rape in adulthood mediated this relationship for all three HIV-risky behaviors. Abuse that occurred in childhood only and abuse that occurred in both childhood and adolescence had a stronger impact on later risky behaviors than did abuse that occurred in adolescence only. CONCLUSIONS: Because childhood constitutes a critical period in individuals' sexual, social, and personal development, sexual abuse precipitated during this time may distort women's constructions of sex and sexuality. Women abused in childhood may therefore engage in HIV-risky sexual behaviors to a greater extent than women abused in adolescence as a result of these disruptions to their development. Rape in adulthood appears to intensify the effects of early sexual abuse,

Adolescent↗

Punishments: what predicts adult approval.

We surveyed 449 parents to assess: (a) the prevalence of different types of physical and emotional punishment during their childhoods: (b) the prevalence of current parental approval of these types of punishments, and (c) risk factors for current approval of physical and emotional punishments. Parents in waiting rooms of pediatric clinics were asked to complete an anonymous questionnaire about their childhood punishment experiences and their current approval of various types of punishment. Reported experiences and approval were as follows: 24% experienced and 6% approved of uncommon punishments (e.g., burned), 45% experienced and 17% approved of common punishments (e.g., shaken), and 94% experienced and 88% approved of very common punishments (e.g., spanked). Having experienced each type of punishment was a highly significant risk factor for currently approving of that type of punishment (p < .01 for each). Race, income, and education were not significant risk factors for approval of different types of punishment. Many parents have experienced harsh types of punishment during their childhoods. Efforts at identifying and educating parents who approve of harsh and/or abusive types of punishment should focus on those who have experienced harsh punishment rather than on particular racial or socioeconomic groups.

Adult↗

Parental abusive versus supportive behaviors and their relation to hostility and aggression in young adults.

The relation of parental support to abuse has rarely been considered in research on the sequelae of childhood abuse in adulthood. In this study, using the Exposure to Abusive and Supportive Environments Parenting Inventory (EASE-PI), young adults who reported higher emotionally abusive parenting (EA) consistently reported significantly lower love and support from both parents. The relation between physically abusive parenting (PA) and love/support depended upon gender of parent and child. EA was significantly related to higher hostility and higher aggression, as measured by the Buss-Durkee Hostility Inventory, for both men and women, and to reports of physical fights within the family, for women only. PA was significantly related to higher aggression but not higher hostility. Lower support by fathers, but not by mothers, was significantly related to higher hostility. However, lower support of daughters by mothers was significantly related to increased physical fights in the family. Results indicate that less severe abusive behaviors, especially EA, may have detrimental outcomes of hostility and aggression and that supportive behaviors by both mothers and fathers may be important factors in the outcome.

Adolescent↗

A comparison of psychological/psychiatric symptomatology of women and men sexually abused as children.

OBJECTIVE: The purpose of this study was to explore gender differences in symptomatology among sexual abuse survivors utilizing a standardized measure of specific symptom patterns, the Symptom Checklist 90-Revised (SCL-90-R). METHOD: Gender differences in symptomatology of adults sexually victimized as children were examined. Participants were 162 women and 25 men entering an outpatient treatment program for adult survivors of childhood sexual abuse (CSA) in a university-based community mental health center. Symptomatology was measured using the Symptom Checklist 90-Revised (SCL-90-R). RESULTS: Although no differences appeared when examining the raw data, the results changed dramatically once the data were converted into T-scores and epidemiological SCL-90-R gender differences were taken into account. The findings indicate that men exhibited significantly more interpersonal sensitivity, depression, anxiety, and phobic anxiety than women in relation to their respective normative samples. CONCLUSIONS: The use of nonclinical T-scores in this study allows for the interpretation that men survivors of childhood sexual abuse (CSA) have higher levels of symptomatology than women survivors when compared to their respective normative samples.

Adolescent↗

Cancer genes in man.

We may conclude, from all of these considerations, that the burden of cancer falls unequally upon a population of individuals. Some normal persons develop cancer as a result of bad luck; they are victims of spontaneous processes or background processes such as gene mutation or chromosomal rearrangement. Others are susceptible because they are exposed to environmental agents that increase these background rates. But there are individuals who are predisposed to cancer because they carry mutations that are already on the path to cancer or carry genes that increase the prospect that such mutation will occur, either spontaneously or in response to an environmental agent. It is even possible that most environmental cancer also involves genetic predisposition.

Ataxia Telangiectasia↗

Efficacy of post-exposure prophylaxis with hepatitis B immunoglobulin in Norway.

The efficacy of hepatitis B immunoglobulin (HBIG) in preventing infection by hepatitis B virus (HBV) after exposure to blood or blood-containing secretions that carried hepatitis B surface antigen (HBsAg), was studied in an uncontrolled trial in Norway from 1976-1983. Of the 177 HBIG recipients, followed up for 5-24 months, 166 were exposed by needle-stick, splash on mucous membranes or open wounds, sexual contact or medical investigation. With few exceptions, this group was given a single injection of 1250 IU of antibody to HBsAg (anti-HBs) within 7 days after exposure. One person developed clinical hepatitis B (HB) of short duration and two others developed anti-HBs. Six infants with perinatal exposure were injected with three or four doses of about 1250 IU anti-HBs at intervals of 2-3 months. The first dose was given immediately after birth. One child developed clinical HB at the age of 14 months and recovered. Of five patients exposed by blood transfusion, four developed clinical HB; the fifth apparently developed passive-active immunity. One of the four probably became an HBsAg carrier. These patients, except the one without clearance of HBsAg, received one to seven doses of HBIG within 2 days after exposure. Administration of HBIG after needle-stick and similar types of exposure, as well as administration to infants at risk of contracting HB, seems to be of great value.

Female↗

Affective temperament traits measured by TEMPS-I and emotional-behavioral problems in clinically-well children, adolescents, and young adults.

OBJECTIVE: The identification of specific temperament dimensions as correlates or risk factors for psychopathology in infancy, childhood and adolescence might provide key information to elucidate causal mechanisms that underlie these relationships. METHODS: A non-clinical sample of 1010 students (518 males and 492 females) without major psychiatric disorders was given psychometric assessment using TEMPS-I (the Italian Semi-structured Interview version of the Temperament Evaluation of Memphis, Pisa, and San Diego) and EBC (Emotional and Behavioral Checklist in Infancy, Childhood and Adolescence). Grouping the subjects on the basis of the highest z-score obtained on each of the four temperament scales of TEMPS-I, it was possible to identify the dominant affective temperamental (AT) inclination of each individual: 283 (28.0%) subjects were classified as dominant depressive temperament, 446 (44.2%) as dominant hyperthymic, 221 (21.9%) as dominant cyclothymic, and 60 (5.9%) as dominant irritable. The effects of AT dominant groups on EBC scores were tested by one-way analysis of variance. To control for age and sex effects, we tested the differences within dominant AT groups by a multiple classification analysis (MCA). RESULTS: As expected, subjects with depressive temperament traits were characterized by social inhibition and lack of antisocial and hyperactive behavior. Cyclothymic subjects reported the highest number of emotional and behavioral problems, compared with the other dominant ATs (depressive, hyperthymic and irritable). In particular, a cyclothymic disposition was most frequently associated with anxiety-sleep disturbances, sensitivity to separation, eating disturbances in females and antisocial-aggressive behavior in males. The relationship between cyclothymic temperament and anxiety-sleep disturbances and antisocial-aggressive behavior increased with age. LIMITATIONS: Cross-sectional study based on retrospective evaluation. CONCLUSIONS: Within a juvenile population, depressive temperament is a construct partially overlapping with behavioral inhibition, while extremes of emotionality and behaviors occur preponderantly in those with cyclothymic traits. The cyclothymic disposition turned out to be the most 'morbid', and associated with both internalizing and externalizing disturbances.

Adolescent↗

Psychosocial predictors of depressive symptomatology level in postpartum women.

This study explored a multifactorial model for the prediction of the intensity of depressive symptoms in postpartum women. Data were gathered from 213 pregnant women during the second trimester of pregnancy and at 6 months postpartum. Participants were assessed according to a number of psychosocial variables. A path analysis indicated that four variables had a direct effect on postpartum depressive symptomatology level: lower occupational status, prenatal depression level, more distal stressors and a personal psychiatric history. Eight variables, which reflected past and present experiences, showed an indirect effect. The implications of these findings are discussed.

Adult↗

Anorexia in the elderly.

Weight loss and anorexia occur commonly in the elderly. While in many cases the anorexia can be attributed to associated disease processes, it does appear that a true anorexia of aging exists. Animal studies have suggested that older rodents have an excessive satiety effect of cholecystokinin and a decreased opioid feeding drive. Other older persons develop anorexia in association with depression. In these subjects, excess corticotropin-releasing factor may be the neurotransmitter involved in the pathogenesis of the anorexia. In Alzheimer's disease, decreases in norepinephrine and neuropeptide Y may be involved in the anorexia seen in the these patients.

Aged↗

[Impact of caregiving on the health of family caregivers].

OBJECTIVES: To identify the type of care provided by informal carers of dependent persons and the repercussions this care might have on the health of the carers, and to find the characteristics of both informal carers and cared-for people. DESIGN: An observational cross-sectional study. SETTING: This study was conducted in various towns in the province of Barcelona between January and December 1997 in primary health care. PARTICIPANTS: Those taking part were 240 informal carers (IC) for dependent persons. MEASUREMENTS AND MAIN RESULTS: The ICUB 97 questionnaire was the data-gathering instrument. It was validated previously by the research team and based on the fourteen needs of the Virginia Henderson nursing model. The questionnaire was filled in at a personal interview. The level of dependence of people cared for was evaluated with the Barthel and Philadelphia Geriatric Center indices. The analysis of the results reflected that the greater the level of dependence of the person cared for, the more care is provided by the carer. The main repercussions of caring on the health of the carers were: back pain (73%), tiredness (72%), reduced leisure time (73%), insomnia (65%), anxiety (72%) and changes in family life (54%). Repercussions that correlated most closely with the fact of caring were: sleep disorders, family economy, personal development and leisure, middle age and having few educational qualifications. CONCLUSIONS: Most carers are middle-aged women performing multiple care tasks. This work causes their quality of life to deteriorate.

Aged↗

The value of clinical experience to a non-clinician: combining midwifery practice with teaching.

This paper explores the value of clinical experience to midwives and other health care providers who work in other than clinical situations. The value of this experience may relate to personal or educational goals. Due to the lack of attention to this topic in the midwifery literature, the author recounts her own experience and compares it with the nursing and health visiting literature. Differing expectations feature as an issue. The value of this arrangement, for teaching, research and personal development more than compensate for the difficulties identified.

Clinical Competence↗

Toward psycho-cultural approach in middle eastern societies.

Western psychological theories of mental health create an illusion that the tenets (development, personality, psychopathology, psycho-evaluation, and therapy) they encompass are universal in nature. Asians, Africans, and South Americans (collective societies), however, differ substantially along these domains from Europeans and North Americans (individualistic societies). This article summarizes these cultural differences and introduces five other articles on this theme pertaining to cross-cultural differences.

Culture↗

A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting.

Back pain is a significant health care problem that has been managed unsatisfactorily in primary care settings. Providers typically address medical issues but do not adequately address patient concerns or functional limitations related to back pain. We evaluated a brief intervention for primary care back pain patients designed to provide accurate information about back pain, instill attitudes favorable towards self care, reduce fears and worries, assist patients in developing personalized action plans to manage their back pain, and improve functional outcomes. Patients enrolled in a large health maintenance organization were invited to participate in an educational program to improve back pain self care skills 6-8 weeks after a primary care back pain visit. Patients (n=226) were randomly assigned to a Self Care intervention or to Usual Care, and were assessed at baseline, 3-, 6-, and 12-months. The intervention involved a two-session Self Care group and an individual meeting and telephone conversation with the group leader, a psychologist experienced in chronic pain management. The intervention was supplemented by educational materials (book and videos) supporting active management of back pain. The control group received usual care supplemented by a book on back pain care. Participants assigned to the Self Care intervention showed significantly greater reductions in back-related worry and fear-avoidance beliefs than the control group. Modest, but statistically significant, effects on pain ratings and interference with activities were also observed.

Adult↗

Disruption of family rituals as a mediator of the relationship between parental drinking and adult adjustment in offspring.

This study investigated whether disruption of family-of-origin rituals and routines would mediate the relationship between family history of parental problem drinking (FH+, FH-) and two outcomes in adult offspring: adult children of alcoholics (ACOA) personality attributes and drinking problems. The self-reports of 143 students and 129 outpatients indicated that disruption of family routines and rituals mediated the relationship between family history status and both ACOA traits and problem drinking. These results suggest that the mediating effect of family-of-origin rituals and daily routines may explain some of the heterogeneity in adult outcomes of offspring from FH+ families, in both student and clinical samples.

Activities of Daily Living↗

Childhood hyperactivity, gender, and Cloninger's personality dimensions in alcoholics.

Cloninger described a classification system for subtyping alcoholics based on personality dimensions of novelty seeking (NS), harm avoidance (HA), and reward dependence (RD). The relationship between these dimensions and childhood hyperactivity was examined. Mild to moderate alcohol-dependent adults (68 male and 34 female) were administered Tarter's HK/MBD Childhood Symptom Checklist, Cloninger's Tridimensional Personality Questionnaire, and the Beck Depression Inventory. Alcoholics with childhood hyperactivity (38% of sample), regardless of gender, exhibited greater NS than did alcoholics without childhood hyperactivity. Female alcoholics scored significantly higher on RD compared to males. Findings suggest that high NS, proposed by Cloninger as a predominantly male feature, is related to childhood hyperactivity, independent of gender.

Adult↗

Creativity of undergraduates with and without family history of alcohol and other drug problems.

Noble, Runco, and Ozkaragoz (1993) provided evidence that alcoholics' children differ negatively from recovering alcoholics' and nonalcoholics' children in terms of personality characteristics related to creativity. They also found that divergent thinking test scores among the three groups of children are similar, yet the possibility exists that offspring compensate for the personality deficits and maintain productively creative lives in spite of the negative influence of parental substance use. This study investigated the impact of parental substance abuse problems on 163 undergraduates' creative achievement. With current alcohol consumption as a covariate, analysis of covariance results suggest that parental alcohol and drug problems do not have an appreciable effect on students' creative achievement, although marginally significant interaction of gender and family history provides limited evidence that gender may influence the impact of parental substance abuse on creativity. Because the true effects of parental substance abuse may not be felt for several years, future research should investigate these issues with older offspring.

Adolescent↗

Factors associated with untreated remissions from alcohol abuse or dependence.

This paper describes an epidemiologic-based sample of individuals who remitted from alcohol abuse or alcohol dependence, both with and without treatment, to abstinence or moderate drinking. Inspection of the severity, onset, and duration of alcohol problems experienced by these individuals suggests that there may be two primary categories of drinkers with distinct pathways to remission. The first is a population of individuals who experience significant problems for an extended period of time who then resolve to abstinence through the use of treatment services. The second is a population of individuals who drink heavily at some point in their lives, experience some problems, and then "mature out" of this stage in their life as they age and take on other life roles.

Adult↗