Relationships among organ damage, social support, and depression in African American women with systemic lupus erythematosus.

OBJECTIVES: Systemic lupus erythematosus (SLE) disproportionately strikes African American women. Social support can potentially reduce disease impact. The purpose of this study is to understand the relationship between organ damage and depression in African American women and how social support influences this relationship. METHODS: We used a mixed methods design, analyzing self-reported data on lupus-related organ damage, depression, and social support in 437 African American women with SLE recruited in the Georgians Organized Against Lupus (GOAL) cohort. Moreover, we conducted interviews among 15 GOAL participants to gather patients' perspectives about the role of social support in people who live with lupus. RESULTS: We found a significant association between organ damage and depression ( r = 0.163, p = 0.001), as well as between depression and social support ( F = 17.574, p < 0.001). The quantitative analysis did not render social support as a significant moderator in the organ damage-depression relationship. Interviews, however, revealed that African American women with the most severe organ damage have the greatest need for support. CONCLUSIONS: Social support is a key resource for lupus patients with high disease burden. Overall, these findings highlight the importance of monitoring depressive symptoms in this population and developing interventions aimed to increase social support available to lupus patients.

Plexiform (multinodular) schwannoma. A tumor simulating the plexiform neurofibroma.

We describe a rare variant of schwannoma characterized by a interconnecting multinodular growth mimicking a plexiform neurofibroma. The schwannoma recurred twice. The second recurrence was not excised and has not increased in size for 1 1/2 years. The patient is alive and well, 3 years and 4 months after the first excision with no clinical evidence of metastasis.

Variations in national health care practices and behaviours and their influence on international research.

Multinational clinical trials are valuable to the understanding of global health problems, but they pose special problems. Our experience with a multinational trial of isoniazid (INH) preventive therapy for tuberculosis revealed marked variation among the seven participating countries in the amount of tuberculosis screening prior to the trial; this variation contributed to the observed differences in the risk of tuberculosis among the countries. The incidence of 'uncooperativeness' and drug side-effects, and the proportion of participants who complied with and completed treatment also varied significantly from country to country. These differences in completion and compliance served to differentially alter the expected risk of tuberculosis among the three regimens being studied. For all factors investigated, variation from country to country was greater than variation from dispensary to dispensary within a country. This suggests that cultural and other national characteristics are more potent determinants of health care practices and behaviours than patient and health care practitioner characteristics.

Female sterilization and subsequent ectopic pregnancy.

An 8-year retrospective study was conducted of the metropolitan Dayton, Ohio, area from January 1970 through December 1977. During this period of time there were 86,809 births and 721 tubal pregnancies. Thirty-three of the ectopic pregnancies were in patients who had previously undergone a tubal sterilization. The 7.4% rate (29 of 393) in the past 4 years indicates the increasing importance of previous sterilization as an etiologic agent in ectopic gestation.

Tricuspid atresia and pregnancy.

Tricuspid atresia is one of the rarest heart defects, and it is rarely associated with prolonged survival. This paper describes the third known case of pregnancy associated with tricuspid atresia. This is the first detailed report of the clinical course of a patient with this disorder. Complications included heart failure, multiple pulmonary emboli, cerebral embolization, and premature labor. Recommendations are made regarding patient care.

Predictors of coping with pain in mothers and their children with sickle cell syndrome.

OBJECTIVE: This study examined predictors of strategies used to cope with pain in children with sickle cell disease and their mothers. METHOD: Disease severity, socioeconomic status, child adjustment and adaptive behavior, maternal psychopathology, and family functioning were examined in 55 mother-child dyads to determine the predictive potential of these factors on engagement and disengagement coping. RESULTS: While controlling for socioeconomic status and psychopathology in the mothers, 15% of the variance in engagement coping was predicted by family adaptability. Disengagement coping was predicted by internalizing symptoms exhibited by the child, including a negative and pessimistic attributional style, which accounted for nearly one fifth of the variance. Finally, mothers who reported more active strategies for coping with their child's pain were more likely to endorse greater use of techniques to prevent and effectively manage pain in their children. CONCLUSIONS: Neither coping strategy was predicted by severity of disease presentation in the children, suggesting the importance of psychosocial factors in adapting to childhood chronic illness and that severity of disease may not necessarily be a marker for families at risk for adjustment difficulties. Findings were interpreted to support a systemic family model in promoting active and adaptive engagement coping in caretakers of children with sickle cell syndrome.

Health risk behaviors of adolescent participants in organized sports.

PURPOSE: To assess differences in health-related behaviors between athletes and nonathletes. METHODS: In Grades 9-12 in seven high schools during the 1991-1992 academic year, 7179 (82%) students were asked to complete a survey with six categories of health-related behaviors associated with adolescent morbidity and mortality. Of the 6849 students who completed the survey, 4036 (56%) were classified as athletes. Analyses of differences were controlled for age, race, and gender. RESULTS: Athletes and nonathletes differed in specific health-risk behaviors. Nonathletes were more likely than athletes ever to have smoked cigarettes (15% vs. 10%) or used marijuana (24% vs. 23%), and fewer ate breakfast daily (34% vs. 45%), never added salt to food (18% vs. 22%), consumed calcium (56% vs. 64%), or consumed fruit or vegetables (40% vs. 47%) daily. More nonathletes reported frequent feelings of hopelessness (15% vs. 10%) and rarely or never using seatbelts (24% vs. 20%), but more athletes reported exceeding the speed limit by 10 mph (39% vs. 35%) and riding bicycles (40% vs. 28%) and/or motorcycles (13% vs. 8%) without helmets. These differences were statistically significant. CONCLUSIONS: Because of their behaviors, adolescent athletes put themselves at significant risk for accidental injuries. However, athletes appear less likely to smoke cigarettes or marijuana, more likely to engage in healthy dietary behaviors, and less likely to feel bored or hopeless.

Methodologies for informing beneficiaries of their rights: evaluating the Important Message from Medicare.

The Important Message from Medicare, a letter given to US Medicare patients upon hospital admission, was originally designed to allay the concerns of the Health Care Financing Administration (HCFA), Peer Review Organizations (PROs), and the beneficiary community that patients did not know their rights under Medicare and the PRO program. The effectiveness of the current Message may be adversely affected by the complexity of its language, the multifaceted admissions process, priorities of sick patients, and the demand for hospital resources. This study evaluated the effectiveness of the Message and various alternatives for informing beneficiaries of their rights. With HCFA financing, PROs in 10 states surveyed random samples of Medicare beneficiaries to measure knowledge of their rights under the current system and after the implementation of alternatives. This study found that there are alternative ways of informing Medicare beneficiaries of their rights which are more effective than the current Important Message from Medicare.

Predicting breast-feeding intention among low-income pregnant women: a comparison of two theoretical models.

This study examined the applicability of the transtheoretical model and a model derived from the theory of reasoned action for predicting breast-feeding intention among low-income pregnant women. Participants completed a 70-item self-report questionnaire assessing their breast-feeding attitudes, intentions, and support. A positive correlation existed between Stages of Change for breast-feeding and the number of Processes of Change used by respondents. A negative correlation existed between Stages of Change for breast-feeding and the number of negative breast-feeding beliefs held by respondents. Furthermore, women's normative beliefs and outcome beliefs were significantly correlated with breast-feeding intention in manners consistent with the model developed from the theory of reasoned action. After accounting for significant sociodemographic and lifestyle factors, the Processes of Change and outcome beliefs remained independently correlated with breast-feeding intention. These models are capable of predicting the intention to breast-feed and might offer an innovative approach for further breast-feeding research and intervention development.

Psychological and Behavioral Factors Predicting Attendance at a Community-based HIV Prevention Intervention.

To date, virtualiy no research has addressed individuals' characteristics which influence their participation in prevention interventions targeting the human immunodeficiency virus (HIV). Identification of these characteristics is important, for no intervention is effective if not attended. This study explored stage of condom adoption and selected other psychological and behavioral factors, to determine which of these predicted attendance at a clinic-based HIV intervention. Stage of condom adoption (p = .03) and frequency of drunkenness (p = .05) were significant predictors of attendance for persons with more than one sex partner. For persons with only one sex partner, self-efficacy and outcome expectations were identified. The implications of these findings are discussed.

Using behavioral science to improve fire escape behaviors in response to a smoke alarm.

Although the likelihood of fire-related death in homes with smoke alarms is about one-half that in homes without alarms, alarm effectiveness is limited by behavior. Only 16% of residents of homes with alarms have developed and practiced plans for escape when the alarm sounds. We reviewed literature to identify behavioral constructs that influence smoke alarm use. We then convened experts in the behavioral aspects of smoke alarms who reviewed the constructs and determined that the appropriate areas for behavioral focus were formulating, practicing, and implementing escape plans should an alarm sound. They subsequently identified important behaviors to be addressed by burn-prevention programs and incorporated the constructs into a behavioral model for use in such programs. Finally, we organized the available literature to support this model and make programmatic recommendations. Many gaps remain in behavioral research to improve fire escape planning and practice. Future research must select the target behavior, apply behavioral theories, and distinguish between initiation and maintenance of behaviors associated with planning, practicing, and implementing home fire escape plans.

The relationship of sexual abuse and HIV risk behaviors among heterosexual adult female STD patients.

Some effects of sexual abuse, for example, heightened sexual activity, are also risk factors for infection with the human immunodeficiency virus (HIV). Moreover, Social Cognitive theory suggests that the reduced self-esteem and increased sexual arousal that can result from abuse might alter self-efficacy for performing a behavior and expected outcomes of the behavior, making adoption of preventive behavior more difficult. Studies in the general population, adolescents, and male clients of sexually transmitted disease (STD) clinics, have found associations between childhood sexual abuse and HIV risk behaviors. This study was designed to measure: (a) whatever the association persists among female STD clinic clients; and (b) whether sexual abuse is associated with self-efficacy for condom use or condom use outcome expectations. Among the 83 female STD clinic clients studied, those sexually abused before age 18 had more sexual partners (p < .05), more positive hedonic outcome expectations for condom use (p < .01), and fewer positive partner-related outcome expectations for condom use (p < .05) than those never forced to have sex against their will. In summary, HIV risk behavior among female STD clients varies with childhood sexual abuse and Social Cognitive Theory suggests future directions for prevention.

A survey of knowledge and attitudes about HIV and AIDS among medical students.

Researchers have found that a significant number of medical students harbor attitudes that have a negative impact on their willingness to care for persons who are HIV positive or have AIDS. To assess current HIV and AIDS knowledge and attitudes, the authors administered a 25-item survey tailored for medical professionals to 63 preclinical medical students. Respondents' mean score on the knowledge scale was 6.25 (SD 1.63) out of a possible score of 10. Factor analysis suggested three major groupings of medical students with regard to attitudes. The largest group had generally positive attitudes about patients with HIV and AIDS; two subgroups, however, would tend to refer such patients to another physician. One subgroup reported feeling more uncomfortable with homosexual behavior and with HIV-seropositive patients than they did with patients with other infectious diseases. This group also expressed discomfort with physically touching HIV-seropositive clients. The other group expressed discomfort with taking a patient's sexual history. Effective educational interventions must take these findings into account.

An outbreak of hookworm infection associated with military operations in Grenada.

During 1983, a multinational military intervention took place on Grenada. After deployment, troops from several U.S. Army units noted signs and symptoms consistent with soil-transmitted helminthic infection. Of 684 soldiers screened five to seven weeks post-deployment, over 20% reported abdominal pain and/or diarrhea during or after the action. Eosinophilia of at least 10% was observed in 119 (22.5%) of 529 soldiers evaluated further; eosinophilia of 5-9% was documented in another 126 (23.8%) of the 529 soldiers. Stool examinations confirmed hookworm infection in 35 soldiers. One case of strongyloidiasis was also documented. Infection was attributed to ground exposure near homes with compromised sanitation. Units that joined the operation after the initial assault phase were at low risk of hookworm infection.

"Do not resuscitate" (DNR) orders and the anesthesiologist: a survey.

Anesthesiologists were surveyed to determine their experience and opinions regarding "Do Not Resuscitate" (DNR) orders in the perioperative period. Four hundred fifteen questionnaires were mailed and 193 (47%) were returned. One hundred sixty-one (87%) of 186 respondents had been requested to provide (and more than two-thirds had provided) monitored anesthesia care, regional anesthesia, or general anesthesia to a patient with a DNR order. Almost two-thirds of the respondents assume DNR suspension in the perioperative period and only half discuss this assumption with the patient/guardian. Less than 50% of respondents would require DNR suspension for a palliative procedure contrasted with > 60% for an elective procedure. After agreeing to a patient's decision to retain their DNR status, > 67%, > 58%, < 49%, and < 33% would utilize positive pressure ventilation with a mask, vasoactive drugs, endotracheal intubation, or defibrillation, respectively, in the event of a cardiopulmonary arrest in the perioperative period. These findings suggest much ambiguity regarding DNR orders in the perioperative period. Further discussion among physicians and patients is warranted.

Predicting injury risk in adolescent football players: the importance of psychological variables.

Explored the relationship of anger/aggression, attention, and stressful life events to injury while addressing the methodological limitations of prior studies. An additional objective was to determine whether the relationship of stressful life events to injury is mediated either by anger (directed either inward or outward) or by impaired attention, either vigilant (broad, external) or focused (narrow, internal). At the beginning of summer practice, 120 first-string high school football players completed measures of anger (Framingham Anger Scale), vigilant attention (Symbol Digit Modalities test), focused attention (Pursuit subtest, MacQuarrie Test of Mechanical Ability), and stressful life events (abbreviated form of the Social Readjustment Rating Scale as modified for use with adolescents by Coddington, 1972). Players were then followed through one season to identify those injured. Logistic regression indicated that high anger directed outward (p < .05) and low focused attention (p < .01) increased injury risk, while stressful life events and vigilant attention interacted. Injury risk was elevated when recent stress was present (p < .05), and increased as vigilance decreased, suggesting that stressful life events elevate injury risk by reducing vigilance.

Septic abortion.

PIP: 118 cases of septic abortion, including 9 cases of septic shock, are reviewed; no deaths were reported. Of those patients with septic shock, 2 had positive blood cultures (E. coli), 4 had negative cultures, and 3 did not have blood work. A logical plan of diagnosis and management is outlined which emphasizes early diagnosis and institution of massive intravenous broad spectrum antibiotic therapy in all cases, conservative afebrile evacuation of infected uterine contents, and no vasopressor or corticosteroid drugs. An addendum shows 22 more admission for septic abortion; 18 were treated by the described regimen, and 1 case developed septic shock. All cases were discharged alive and well, bringing the total to 130 cases of septic abortion including 10 cases of septic shock with no deaths.^ieng