The cessation of marital intercourse.

The authors found that marital coitus had ceased for a definable period (median=8 weeks) in one-third of a sample of 144 men and 221 women who were relatively young and had been married an average of 11 years. An analysis of factors related to the social background and marital relationship of the respondents indicated that the cessation behavior of men is more highly predictable than that of women and that antecedents of this behavior differ markedly between the sexes. The authors suggest that, even among relatively young couples, marital intercourse is discontinous and problematic.

Housing, stress, and physical well-being: evidence from Thailand.

The proposition that poor housing and congested living conditions have a detrimental impact on health has been promulgated for at least 150 years. At a minimum, two major causal mechanisms are thought to be involved in the relationship between crowding and physical health. First, high levels of household crowding can produce stress that leads to illness. Second, through shared physical proximity, household congestion contributes to the spread of communicable disease. The outcomes can be exacerbated by poor quality housing. A significant body of research, conducted primarily in affluent countries, has documented the detrimental effects of housing conditions on a variety of illnesses, including various contagious diseases. Poor housing has even been linked to high infant and adult mortality rates. The view that poor housing conditions and household crowding inevitably leads to poor health is challenged, however, by several observers, who question the role played by both crowding and housing quality. Most existing research has been conducted in affluent countries. Little is known, however, about the nature of these relationships within the context of less developed countries, where health status and housing quality are generally much poorer and where levels of household crowding are generally higher. Determination of the effects, if any, of housing quality--including household crowding--on physical health in developing countries is particularly important given the rapid growth of their urban populations and the difficulty of increasing the physical infrastructure fast enough to keep pace with this growth. This paper reports on an investigation of the impact of housing conditions and household crowding in the context of one developing country, Thailand. Using data from a representative sample of households in Bangkok (N = 2017), our results provide reason for some skepticism regarding the influence on housing on health, at least in its objective dimensions. While the skepticism of some is based on a reading of the evidence in Western countries, we likewise find that, in Bangkok, objective indicators of housing quality and household crowding are little related to health. We do find, however, that subjective aspects of housing and of crowding, especially housing satisfaction and a felt lack of privacy, have detrimental effects on health. Furthermore, psychological distress is shown to have a potent influence on the physical health of Bangkokians. Our analyses suggest that all three factors have independent effects on health outcomes bearing on both men and women.

Chronic stress and psychological well-being: evidence from Thailand on household crowding.

This paper examines the effect of one form of chronic stress--household crowding--on psychological well-being, as measured by multiple inverse indicators of psychological well-being. We rely on data from a large (n = 2017) random sample of households in Bangkok, Thailand, a context that has a higher level and broader range of crowding than typically found in the United States. Objective household crowding is found to be detrimental to psychological well-being, controlling for a number of background characteristics. The effect of objective crowding is mediated by subjective crowding, which has strong, consistent and direct detrimental effects on well-being. There is no evidence of a gender effect. Extended family households are not uncommon in Bangkok, but the effects of objective and subjective crowding are similar in both two- and three-generation households, as well as in one- and multiple-couple households. The argument that subjective crowding is an effect, rather than a cause, of psychological well-being is examined and rejected. The findings suggest that crowding, as a chronic source of stress, constitutes a major threat to psychological well-being. Although the empirical analyses are based on data from one city, we frame the issue of household crowding in a historical and theoretical context in order to suggest in which cultural settings household crowding is most likely to have detrimental effects on psychological well-being.

Gender and health: some Asian evidence.

In Thailand, like the U.S., women's higher rates of illness and health service use imply that they are "sicker." But, as in the U.S., females live longer than males. Based on a large representative sample of Bangkokians, we find that married women report more sickness, are more likely to utilize health services and, according to self-reports, have poorer health. Western literature suggests five prominent explanations for gender differences in health: biological risks, acquired risks, psychosocial aspects of symptoms and care, health-reporting behavior, and prior health care and caretakers. However, analyses show that these explanations largely fail to account for morbidity differences between Thai men and women. The observed gender differences in health among Thais remain significant after eliminating pregnant women and new mothers, and after controlling for several aspects of acquired risk. Problems associated with the reproductive system among Thai women, along with greater psychological distress, appear to account for most of the gender differences in health. The theoretical implications of these findings are discussed. As for the apparent contradiction between gender differences in health and mortality in Thailand, the evidence indicates that Thai men, like their American counterparts, suffer from more serious chronic ailments that may explain their higher mortality rates.

Changing family structure and youthful well-being: assessing the future.

PIP: The declining prevalence of the nuclear family in the United States is examined, and the consequences for the healthy development of children are considered. Attention is given first to research supporting the claim that nuclear families provide the optimum environment for child rearing and then to studies presenting differing results. Methodological and conceptual issues concerning studies in family structure are discussed. The author concludes that family structure in and of itself has little effect on child development and that an alternative theory, de-emphasizing structural inputs, is needed.^ieng

Starting over. Why remarriages are more unstable.

PIP: Previously divorced and remarried couples have a higher probability of divorce and decline in marital quality. Models which have explained this behavior focus on: willingness to leave marriage; selection; socioeconomic status; the remarriage market; and incomplete marriages. Each model is examined among a population of marrieds and remarrieds to distinguish attributes and the extent to which these attributes increase the probability of decline in marital quality or divorce. Data were obtained from a sample of 2033 marrieds 55 years old who were interviewed over the telephone in 1980, 1983, and 1988 in the Marital Instability Over the Life Course Study. Incomplete marriage was measured by whether and to what extent parents or parents-in-law made contact and the number of relatives that party was close to. Willingness to leave was based on attitudes to divorce and the ability to handle emotion and financial affairs if the marriage ended. Selection referred to poor marriage material (drugs or alcohol, criminal conduct, mismanagement of money, immature behavior. Socioeconomic status was reflected in occupational status, educational levels, and income. The marriage market was a measure of age, education, and religious differences. Marital quality was examined in terms of happiness, interaction, disagreement, and divorce proneness. Multiple classification analysis was used to compare attributes by marital history. The methods of Kessler and Greenberg were used to examine changes in marital quality over time in first time marriages and remarriages. The results indicate that individuals in remarriages have relationships with attributes which potentially lower marital quality and increase the probability of divorce. When both individuals have prior marriage and divorce experience, there is even lower social integration, greater willingness to leave marriage, higher probability of marrying as a teen, lower socioeconomic status, and greater likelihood of age differences. Remarriage variables and marital quality variables both showed linear relationships. Remarriage variables and marital quality variables both showed linear relationships. In the cross sectional analysis of the 1980 data there is a statistically significant relationship with attributes which potentially lower marital quality in 1980 indicates remarried persons are more prone to lower marital quality than people in first marriages.^ieng

Predicting divorce and permanent separation.

PIP: The ability of a scale, called the marital instability index, to predict divorce or permanent separation in the United States is examined. It is tested using data on a national sample of about 1,663 married persons under age 55 who were interviewed originally by telephone in 1980 and reinterviewed in 1983. The results show that high scorers on the scale are nine times more likely to divorce than low scorers. The process of moving from marital instability to divorce is also analyzed. The findings indicate that the marital instability index provides the basis for a comprehensive model predicting divorce, particularly if adequate information on alternative attractions to marriage and on barriers to divorce is available.^ieng

Divorce and marital instability over the life course.

"This study uses a [U.S.] national sample of married persons under age 55, interviewed in 1980 and again in 1983, to estimate why divorce and marital instability vary by age and duration of marriage. Results indicate that the accumulation of assets substantially reduces the propensity to divorce. We also find that several important correlates of divorce and instability (age at marriage, health, social integration, and income) interact with age and duration. In general, these factors seem to operate almost exclusively among young people and young marriages."

Principles of management of the vesicovaginal fistula.

The aetiology, pathological anatomy and management of the vesicovaginal fistula are reviewed. Closure of the vaginal route is preferred by most gynaecological surgeons and is suitable for low-lying fistulas. A suprapubic approach is more suitable for high or tethered fistulas and is favoured by urological surgeons. The importance of meticulous preparation and care in the management of this condition is stressed.

Infertility treatment. An approach for the general practitioner.

An approach to the management of the infertile couple in general practice is presented. Attention is paid particularly to those aspects of treatment which the interested practitioner may provide himself and the stage at which referral should be sought; insight is also given into some of the 'specialist aspects' of infertility.

Langerhans' cells and lymphocyte subsets in the female genital tract.

Cryostat sections of healthy cervical, vaginal and vulval epithelium were examined using immunohistological labelling techniques and a panel of monoclonal antibodies recognizing Langerhans' cells, T- and B-lymphocytes and HLA-DR antigen. The distribution of Langerhans' cells in squamous epithelium of the cervix, vagina and vulva showed a marked variation with the highest median values in the vulva (18.7 per 100 basal squamous cells) and the lowest in the vagina (5.5 per 100 basal squamous cells). There was also a substantial variation in number and distribution of lymphocytes of each of these three areas with a distinct preponderance in the transformation zone of the cervix. In addition, intraepithelial lymphocytes, predominantly of the T-cytotoxic suppressor sub-type were present at all sites with the greatest number in the transformation zone. We conclude from this study that lymphoid tissue of the cervical transformation zone has several unique characteristics which are not observed at other sites in the lower genital tract. We suggest that this tissue be designated 'cervical lymphoid tissue' and that it forms a part of the 'mucosal associated lymphoid tissue' (MALT) as noted at other mucosal sites exposed to the external environment.

The social demography of shared housing.

"Despite the prevalence of shared housing in Australia, almost one-third of all households, little is known about who are the people who share accommodation, and why they do so. Using a sample of 4,560 households, this paper presents a demographic profile of shared dwellings and tests some of the prevailing assumptions about why certain groups may have a propensity to share. Some of the implications of the findings for existing housing policies are pointed out and directions for future research are suggested."