Psychosocial stress impairs working memory at high loads: an association with cortisol levels and memory retrieval.

Stress and cortisol are known to impair memory retrieval of well-consolidated declarative material. The effects of cortisol on memory retrieval may in particular be due to glucocorticoid (GC) receptors in the hippocampus and prefrontal cortex (PFC). Therefore, effects of stress and cortisol should be observable on both hippocampal-dependent declarative memory retrieval and PFC-dependent working memory (WM). In the present study, it was tested whether psychosocial stress would impair both WM and memory retrieval in 20 young healthy men. In addition, the association between cortisol levels and cognitive performance was assessed. It was found that stress impaired WM at high loads, but not at low loads in a Sternberg paradigm. High cortisol levels at the time of testing were associated with slow WM performance at high loads, and with impaired recall of moderately emotional, but not of highly emotional paragraphs. Furthermore, performance at high WM loads was associated with memory retrieval. These data extend previous results of pharmacological studies in finding WM impairments after acute stress at high workloads and cortisol-related retrieval impairments.

Assessing quality of life in chronic non-specific lung disease--a review of empirical studies published between 1980 and 1994.

Chronic non-specific lung disease (CNSLD), a chronic disease with considerable prevalence and mortality rates, is not only a medical problem, it also has significant psychological and social consequences for the patients concerned. Quality of life research on CNSLD has been rather underdeveloped for quite a long period of time, but has recently become an important topic in research as well as in patient care. In order to get insight into the state of the art of empirical research on quality of life (QOL) in CNSLD, a review of the literature between 1980-1994 on this topic is presented. Special attention is paid to definitions and operationalizations of the QOL concept as well as on questionnaires used to assess QOL and the aims of QOL research. Analysis reveals that QOL is seldom defined clearly and is operationalized in a variety of ways. Most studies have a descriptive nature or pertain to clinical trials. The negative impact of CNSLD on QOL is well-documented and shows the importance of incorporating assessment of QOL in research as well as in patient care. Future research is called for, which should be theory-driven, taking into account recent developments concerning disease-specific measures of QOL.

Contraceptive use and attitudes in reunified Germany.

Contraceptive use and attitudes were assessed in a random sample of 1064 German women. The majority (76%) of the sexually active, fertile women who were not pregnant and did not wish to get pregnant at the time of the survey were using very reliable contraceptive methods, namely oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. Comparison with a previous survey showed that contraceptive practice in West Germany had improved considerably since 1985. Attitudes towards the most reliable methods available (OCs, IUDs and sterilization) were found to be ambivalent. Perceived side effects and health risks were a particular matter of concern to the respondents. Although most respondents (88%) recognized that condoms prevent the transmission of AIDS, 66% of those who had occasional sexual partners did not use barrier methods. It is concluded that German contraceptive practice is reasonably effective and that if attitudes were to become more realistic the level of effectiveness could even be raised.

PIP: The sample for this 1992 survey of contraceptive use and attitudes was obtained by random-walk sampling, whereby field workers from a survey agency that collaborated in carrying out the study followed designated routes throughout the country, starting from 257 predetermined locations. They identified subjects 15-45 years old by visiting their homes and inviting the woman in each household to participate in the study. Of the 1064 women surveyed, 75.7% were defined as being exposed to the risk of conception; 3.8% stated they were infertile, 4.2% were currently pregnant, 4.0% intended to get pregnant, and 15.6% were not sexually active. The barrier methods used comprised condoms (10.4%), diaphragms (0.9%), spermicides (0.6%), and combinations of condoms and spermicides (0.4%), of diaphragms and spermicides (0.1%), and of diaphragms and condoms (0.2%). Although most respondents (88%) recognized that condoms prevent the transmission of AIDS, 66% of those who had occasional sexual partners did not use barrier methods. 75.7% of exposed German women used reliable methods, namely OCs, IUDs, and sterilization. Women from what had been East Germany cited the common reasons mentioned for using contraceptives as often as did women from what had been West Germany (p 0.05), except for AIDS and sexually transmitted disease prevention (1.1% and 5.8%, respectively, p 0.05) and alleviation of skin disorders (2.3% and 12.5%, respectively, p 0.01). Information on contraception was obtained mainly from gynecologists (67.7%) and friends (30.9%). Comparison with a previous survey showed that contraceptive practice in the former West Germany had improved considerably since 1985. Attitudes towards the most reliable methods available (OCs, IUDs and sterilization) were found to be ambivalent. Perceived side effects and health risks were a particular matter of concern to the respondents. Certain disadvantages of OCs and IUDs were less frequently perceived by women from the former East Germany than by women from the former West Germany, whereas "East German" women were more frequently of the opinion that sterilization was a major and risky operation. German contraceptive practice is reasonably effective, and if attitudes were to become more realistic the level of effectiveness could even be raised.

Contraceptive use and attitudes in Great Britain.

In order to update current knowledge on contraceptive use and attitudes in Great Britain (i.e. England, Scotland and Wales), a survey was conducted among 1753 randomly selected British women aged 15-45. Replies were received from 967 women (55.2%). Seventy-three percent (73%) of fertile, sexually active women who wished to avoid pregnancy were using reliable methods of contraception, viz. oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. However, it was found that adolescents and women over 40 who wished to avoid pregnancy were, nevertheless, especially likely not to be using any contraceptive method at all. The women surveyed were concerned about weight gain, cardiovascular and cancer risks associated with OC use, and infection and infertility risks associated with IUD use. Sixty percent (60%) perceived sterilization as a major and risky surgical operation. It was concluded that contraceptive practice in Britain had not improved greatly in recent years. The latest scientific findings regarding the true advantages and disadvantages of OCs, IUDs and sterilization, therefore, need to be brought to the attention of the lay public more effectively. Special efforts need to be directed towards providing adolescents and women over 40 with proper information. Physicians and the mass media could play a considerable role in this respect.

Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age.

OBJECTIVE: Our purpose was to compare the severity of typical climacteric complaints (vasomotor complaints and vaginal dryness) and 21 other complaints, considered atypical for the climacteric, in women with and without a uterus. STUDY DESIGN: A cross-sectional population questionnaire survey was sent to all women aged 39 through 60 years in Ede, the Netherlands. Subjects were 986 hysterectomized women (one or both ovaries present) and 5636 normal women (uterus and both ovaries present). Statistical analysis was performed by cross tabulations, chi 2 analysis, analysis of variance, meta-analysis of variance, and ratios. RESULTS: Hysterectomized women, especially those aged 39 to 41 years, report significantly more vasomotor complaints, vaginal dryness, and atypical complaints than do normal climacteric women of the same age. The higher prevalence of typical climacteric complaints in hysterectomized women largely explains their higher level of atypical complaints. CONCLUSION: Physicians should be alert to typical climacteric complaints after hysterectomy with ovarian conservation, especially in young women, because the literature indicates that hysterectomized women with ovarian conservation are overrepresented with regard to osteoporosis, cardiovascular disease, osteoarthritis, depression, and sexual problems.

Impact of climacteric on well-being. A survey based on 5213 women 39 to 60 years old.

OBJECTIVE: Our aim was to assess the influence of the severity of vasomotor complaints, menopausal status, and age on the severity of 21 general complaints considered atypical for the climacteric. STUDY DESIGN: A cross-sectional general population survey was conducted through questionnaires of 5213 women aged 39 to 60 years. Statistical analysis was performed by cross tabulation, analysis of variance, and multiple regression analysis. RESULTS: Severity of vasomotor complaints is related to the severity of all 21 general complaints, most pronounced for tenseness and tiredness. Because menstruating women report more severe atypical complaints than nonmenstruating women with similarly severe vasomotor complaints, the change in prevalence of atypical complaints according to menopausal status is rather small. Adjusted for vasomotor complaints, there is virtually no independent effect of age on atypical complaints. CONCLUSIONS: Severity of vasomotor complaints is related to an overall reduced well-being. When climacteric women are seen for atypical complaints it is vital to assess the severity of vasomotor complaints also because others have shown that the severity of vasomotor complaints is indicative of the rate of climacteric bone loss.

Symptom sensitivity and sex differences in physical morbidity: a review of health surveys in the United States and The Netherlands.

Health surveys have found higher female morbidity rates, as reflected by indices such as general health status, number of acute conditions or physical symptoms and medical care utilization. Such findings can lead to the conclusion that women are the "sicker sex" in terms of objective health status. However, the size of the sex difference varies with the different indices used to operationalize the morbidity concept. Apart from sex specific conditions, the female morbidity excess seems most substantial with regard to general health status, acute and mild chronic conditions and physical symptoms. Findings from a large health survey in the Netherlands, presented in this article, confirm this picture. Some major methodological sources of bias, that have been held responsible for part of the sex differences found in health surveys, such as the poor definition of the morbidity concept and aspects of the data collection process, are discussed. One explanation for the higher morbidity of women, i.e., the differential perception of physical symptoms by men and women, is elaborated in more detail. The authors suggest that part of the sex differences found in health surveys can be explained by a higher female symptom sensitivity, defined as a readiness to perceive physical sensations as symptoms of illness. Research supporting this symptom sensitivity hypothesis is reviewed and explanations are given. It is suggested that further research on sex differences in morbidity should control for methodological sources of sex bias and should focus explicitly on differences in the perception of physical symptoms by men and women.