Using research to guide culturally appropriate drug abuse prevention.

Several ways in which research can be an important tool in creating culturally appropriate prevention programs are suggested. To illustrate cultural variability, we present data from a study of 5th-grade African-American and European-American students. These data describe rates of early initiation, levels of exposure to identified risk factors, and degree to which identified risk factors predict substances initiated. Results indicate that European-American Ss have higher rates of tobacco and alcohol initiation, that the same risk factors predict the variety of substances initiated for African-American and European-American Ss, and that several differences exist in the level of exposure to risk factors between the 2 groups. Implications of the findings for developing culturally appropriate drug abuse prevention are discussed.

Psychological distress, caregiving, and metabolic variables.

This study examined relationships between chronic stress and insulin/glucose in two groups of nondiabetics, M age = 69.4: spouse caregivers (CGs) of persons with Alzheimer's disease (n = 73) and age- and gender-matched spouses of nondemented controls (COs) (n = 69). Fasting insulin/glucose and psychological variables were assessed twice (Time 1, Time 2) over a 15-18 month period. CGs had significantly higher insulin levels at Times 1 and 2 than did COs even when obesity, exercise, gender, age, alcoholic drinks, hormone replacement therapy (HRT), lipids, and hypertension (HTN) were considered in the analyses. CGs generally reported significantly more psychological distress (higher burden, depression, hassles, and lower uplifts) than did COs at each time. Differences in psychological distress at Time 1 between CGs and COs did not mediate the insulin difference in the groups at Time 1, but differences in distress at Time 2 between CGs and COs did mediate their difference in insulin at Time 2. Although caregiver status was not associated with glucose at Time 1 or Time 2, psychological distress was positively associated with glucose at Time 2. Moreover, psychological distress at Time 1 was associated with higher glucose at Time 2 after controlling for glucose at Time 1. These data suggest that relationships between psychological and physiological distress exist both cross-sectionally and over time. These results may be important because higher insulin and glucose levels are associated with increased coronary risk and coronary heart disease.

[Peridural morphine administration in restless legs status]. / Peridurale Morphiumanwendung bei Restless-Legs-Status.

The restless-legs syndrome is known to occur in a familial form. The paraesthesias, which are hard to define, are sometimes compared to a painful sensation that can be alleviated only by movement. The pathomechanism of the syndrome and its aetiology are still unknown. A 67-year old patient was admitted as an emergency with most severe pain in her legs. In her family the syndrome occurred in an autosomal dominant form. A long-standing history of abuse of various analgesics was known. Initially the symptoms could not be influenced by any of the various drugs given; even epidural bupivacaine showed no effect. Dramatic relief, however, was obtained by epidural morphine. The maintenance therapy with oral morphine sulfate provided equally good results.

Characterizing patient dysfunction in Alzheimer's-type dementia.

Although Alzheimer's-type dementia (ATD) is characterized by global intellectual deterioration, few systematic efforts have been made to characterize overall dysfunction of ATD patients. The Sickness Impact Profile (SIP) was administered to ATD patients and family members to determine the concurrent validity of family member assessments of functional status. Using the Mini-Mental State score and modified Dementia Rating Scale as validation criteria, family member SIP scores showed consistently higher correlations with the Mini-Mental State and modified Dementia Rating Scale than did patient scores. Comparing family member SIP scores for ATD and nondemented patients revealed that ATD patients maintained high levels of psycho-social dysfunction at both initial evaluation and 1-year follow-up. By contrast, ATD patients showed high levels of physical dysfunction relative to nondemented patients only at follow-up. Physical deterioration over time is also suggested by comparison of ATD patient initial and follow-up scores. This study documents the well-known psychosocial dysfunction in ATD and emphasizes the importance of physical dysfunction as the disease progresses.

Insulin and glucose: relationships with hassles, anger, and hostility in nondiabetic older adults.

Relationships of psychosocial factors (anger, hostility, hassles, and caregiving) with fasting insulin and glucose levels were examined. Samples included two groups of nondiabetic adults (mean age = 69.4 years): spouse caregivers (CG) of individuals with diagnoses of Alzheimer's disease (AD) (N = 78) and spouses of nondemented controls (CO) (N = 72) matched for age and gender. The groups were assessed twice with a 15-to 18-month hiatus. To obtain more stable assessments, all biopsychosocial measures were averaged over time. Psychosocial factors were associated with insulin and glucose, even after controlling for significant health variables: obesity, lipids, and cardiovascular disease. As hypothesized, CG with high anger-out/hostility (AOHO) had significantly higher glucose levels than all other group combinations. The glucose levels for subjects with high hassles or high AOHO were significantly higher than those for subjects who were low on both of these factors. For insulin, a three-way interaction occurred among AOHO, hassles, and gender-hormone replacement therapy (HRT); in women taking HRT, no relationships occurred between insulin with AOHO and hassles. In women not taking HRT, those with high AOHO and high hassles had significantly higher insulin levels than the other three combinations, whereas in men, those with either high AOHO or high hassles had significantly higher insulin levels than men who were low on both of these factors. Given these results, future research should examine the degree to which interactions between metabolic processes with psychosocial variables, gender, and HRT have long term health consequences in nondiabetics.

Coastal oceanography sets the pace of rocky intertidal community dynamics.

The structure of ecological communities reflects a tension among forces that alter populations. Marine ecologists previously emphasized control by locally operating forces (predation, competition, and disturbance), but newer studies suggest that inputs from large-scale oceanographically modulated subsidies (nutrients, particulates, and propagules) can strongly influence community structure and dynamics. On New Zealand rocky shores, the magnitude of such subsidies differs profoundly between contrasting oceanographic regimes. Community structure, and particularly the pace of community dynamics, differ dramatically between intermittent upwelling regimes compared with relatively persistent down-welling regimes. We suggest that subsidy rates are a key determinant of the intensity of species interactions, and thus of structure in marine systems, and perhaps also nonmarine communities.