Staying connected when coming apart: The psychological correlates of contact and sex with an ex-partner.

Although marital separation is an inherently social experience, most research on adults' psychological adjustment following a romantic separation focuses on intrapersonal characteristics, or individual differences (e.g., attachment style, personality, longing) that condition risk for poor psychological outcomes. We know little about how these individual differences interact with interpersonal processes, such as contact between ex-partners. In the current study, we sought to understand how adults' continued attachment to (and longing for) an ex-partner, and both nonsexual and sexual contact with an ex-partner (CWE and SWE, respectively), are related to adults' post-separation psychological adjustment among 137 (n = 50 men) adults reporting recent marital separations. Data revealed that (1) less separation acceptance was associated with poorer psychological adjustment; (2) among people having CWE, those reporting less acceptance reported significantly poorer adjustment relative to those reporting more acceptance; (3) among people reporting more acceptance, those having CWE reported significantly better adjustment relative to those not having CWE; (4) among people not having SWE, those reporting less acceptance reported significantly poorer adjustment relative to those reporting more acceptance; and (5) among people reporting less acceptance, those having SWE reported significantly better adjustment relative to those not having SWE. We discuss the findings in terms of adult attachment, pair-bonding, and the loss of coregulatory processes following marital separation.

Marital dissolution and blood pressure reactivity: evidence for the specificity of emotional intrusion-hyperarousal and task-rated emotional difficulty.

OBJECTIVE: To assess blood pressure (BP) reactivity as recently separated adults completed a laboratory task asking to mentally reflect on their relationship experiences. Marital separations and the experience of divorce are associated with increased risk for early mortality and poor health outcomes. Few studies, however, have investigated the potential psychophysiological mechanisms that may account for these broad-based associations. METHOD: Seventy recently separated or divorced community-dwelling adults (26 men) completed self-report measures of divorce-related psychological adjustment. During a laboratory visit, quasi-continuous BP was assessed across four task periods, including a divorce-specific mental activation task (DMAT). A task-rated emotional difficulty (TRED) index was computed based on participants' immediate appraisals of the task demands. RESULTS: After accounting for relevant health-related covariates and depressed mood, participants who reported higher degrees of divorce-related emotional intrusion and physical hyperarousal demonstrated significantly elevated resting BP at entry into the study. When assessing change from a within-person control task to the DMAT, a three-way interaction indicated that men reporting high TRED scores evidenced significant increases in BP, whereas men reporting low TRED scores evidenced significant decreases in BP. Women evidenced no significant changes in BP across study periods. CONCLUSIONS: Results suggest that divorce-related emotional intrusion-hyperarousal and real-time ratings of emotional difficulty (when people think about their separation experience) may play a specific role in BP reactivity, especially for men. These data shed new light on the potential mechanisms that may link marital dissolution and poor health.

Pediatric Coccidioidomycosis: Case Series From a California Pediatric Infectious Diseases Clinic.

BACKGROUND: Coccidioidomycosis is not as well described in the pediatric population as it is in the adult population. We describe clinical findings, diagnosis and management of coccidioidomycosis in 108 pediatric patients seen in an outpatient clinic in the California Central Valley, an area endemic for coccidioidomycosis. METHODS: We reviewed medical records of a convenience sample of pediatric patients (≤17 years of age) diagnosed with coccidioidomycosis who visited an infectious diseases clinic in Madera, CA, during January 1 to October 1, 2012. We described demographic characteristics, symptoms, diagnostic testing, extent of infection (acute/pulmonary or disseminated), treatment and management. RESULTS: Of 108 patients, 90 (83%) had acute/pulmonary coccidioidomycosis and 18 (17%) had disseminated disease. The median age at diagnosis was 9 years (range, 5 months to 17 years). Only 3 (3%) patients were immunocompromised. Before coccidioidomycosis diagnosis, 72 (82%) patients received antibiotics, and 31 (29%) had at least 1 negative coccidioidomycosis serology at the time of or before diagnosis. Coccidioidomycosis was diagnosed significantly later after symptom onset among patients with disseminated (median, 57 days) than with acute/pulmonary (median, 16 days) disease (p < 0.01). A total of 104 (96%) patients received antifungal therapy, 51 (47%) visited an emergency room and 59 (55%) were hospitalized with a median stay of 44 days (range, 1-272 days). CONCLUSIONS: Substantial acute/pulmonary and disseminated coccidioidomycosis was seen among pediatric patients at this infectious disease clinic in California. In endemic areas, increased coccidioidomycosis awareness and vigilance among families and providers is necessary to facilitate early diagnosis and appropriate management.

Increased Coccidioidomycosis Among Inmates at a California Prison: Initial Investigation in 2005 to 2006.

Since 2005, coccidioidomycosis has increased among inmates at a California prison. Our initial investigation found an incidence of 3,323 cases/100,000 persons. Black race, age ≥41 years, and residence on Yard C were significantly associated with coccidioidomycosis ( p < .05). Inmates at this prison have continued to be at risk for coccidioidomycosis.

Coccidioidomycosis-Associated Deaths in California, 2000-2013.

The number of cases of coccidioidomycosis and associated hospitalizations increased in California during 2000-2013. During that period, a total of 1,098 death records listed coccidioidomycosis as a cause, averaging 78 deaths annually (range: 43-108). The death rate peaked in 2006 and was significantly higher among males than among females, among African American patients than among white patients, and among residents of the coccidioidomycosis-endemic region of California than among residents of the less endemic regions (p<0.001). A higher death rate was associated with increasing age and was highest (8.8 per 1 million population) among adults aged ≥75 years. Of coccidioidomycosis-associated deaths, 31.9% had a contributing cause of death of severe/disseminated disease, 31.8% of unspecified -coccidioidomycosis, and 28.3% of pulmonary unspecified coccidioidomycosis, per International Classification of Diseases codes. Diabetes was a contributing cause in 19.3% of deaths, and other immunocompromising conditions were a contributing cause in 15.9% of deaths. Populations at higher risk for coccidioidomycosis--associated deaths are similar to those at higher risk for coccidioidomycosis-associated hospitalizations and infection. Awareness for coccidioidomycosis among these groups and their providers is important for proper diagnosis and care.

Epidemiology of Pediatric Coccidioidomycosis in California, 2000-2012.

BACKGROUND: Reported coccidioidomycosis cases have increased in the southwestern US since 2000. However, there are few publications on pediatric coccidioidomycosis. We sought to describe the epidemiology of coccidioidomycosis in the California pediatric population during 2000-2012. METHODS: We reviewed surveillance and hospitalization datasets for years 2000-2012 and death datasets for years 2000-2010 to identify coccidioidomycosis-associated cases, hospitalizations and deaths in pediatric (≤17 years old) California residents. We calculated rates and described demographic characteristics of cases and hospitalized patients and, using Poisson regression, calculated bivariate relative risks to identify potential demographic risk factors. We identified immunocompromising conditions associated with hospitalization and death and calculated hospitalization charges. RESULTS: We identified 3453 cases, 1301 hospitalizations and 11 deaths associated with coccidioidomycosis in the California pediatric population. During 2000-2012, annual case and hospitalized patient rates increased and were highest in males, those in the 12-17 age group, and residents of the California endemic region. Compared with White children, African-American children were significantly more likely to be hospitalized (relative risk = 1.4, P = 0.01). Approximately 12.0% of those hospitalized and 27% of those who died had an immunocompromising condition. Hospitalized patients accrued $149 million in total hospital charges. CONCLUSIONS: Similar to recent increases among adults, reported pediatric coccidioidomycosis cases and hospitalizations have increased in California since 2000, disproportionately affecting certain demographic groups. The burden of coccidioidomycosis among California children emphasizes the need for more awareness and research into this reemerging fungal disease in endemic and nonendemic areas.

Attachment Anxiety, Verbal Immediacy, and Blood Pressure: Results from a Laboratory-Analogue Study Following Marital Separation.

Marital separation and divorce increase risk for all-cause morbidity and mortality. Using a laboratory analogue paradigm, the present study examined attachment anxiety, language use, and blood pressure (BP) reactivity among 119 (n = 43 men, 76 women) recently separated adults who were asked to mentally reflect on their relationship history and separation experience. We created a language use composite of verbal immediacy from participants' stream-of-consciousness recordings about their separation experience as a behavioral index of attachment-related hyperactivation. Verbal immediacy moderated the association between attachment anxiety and BP at the beginning of a divorce-specific activation task. Participants reporting high attachment anxiety who discussed their separation in a first-person, present-oriented and highly engaged manner evidenced the highest levels of BP at the start of the divorce-specific task. Results provide a deeper understanding of the association between marital dissolution and health and suggest that verbal immediacy may be a useful behavioral index of hyperactivating coping strategies.