Spouse caregivers of Alzheimer patients: problem responses to caregiver burden.

This paper reports on comparisons of patterns of responses by 199 spouses of Alzheimer disease patients to stresses of functioning as caregivers. Focusing on gender and age of spouses, we examine effects of the total burden of caregiving and perceived patient problems on a set of emotional and social responses of caregivers. We also examine ways in which depressive symptoms and anxiety of spouse caregivers were associated with patterns of their responses to caregiving stresses. Total patient problem burden was most strongly associated positively with caregiver anger-resentment toward the patient, followed by caregiver concerns about personal time restriction and limitation of social life. Among individual areas of patient problems, emotional lability of the patient rather than cognitive impairment appeared strongest by far in affecting caregiver response measures. Negative impact of caregiving on their social life and associations appeared to have particularly marked effects on effects on caregiver depressive symptoms and anxiety scores. Spouse caregivers did not differ by age in clinically significant ways in their patterns of reaction to stresses of caregiving. The study suggests the importance of considering potential spouse caregiver reactions in such areas as anger and aggressive response to patients, the impact of feelings of social deprivation and personal sacrifice, as well as the implications of caregiving stresses for patient care and maintenance of family cohesion and quality of life.

Vulnerability of husband and wife caregivers of Alzheimer disease patients to caregiving stressors.

This study assessed relationships between problem behaviors in 199 Alzheimer Disease patients and vulnerability factors in the well being and emotional health of their spouse caregivers. Among caregiver wives and the younger caregiver husbands (64 years old and under) the volume of patient problem behavior was significantly negatively associated with total scores on a summary well being measure. The association was not found within the older husband caregiver group. Considering five subdimensions of the summary well being scale (Anxiety, Depressive Symptoms, Positive Well Being, Vitality and General Health), correlational analyses showed that the total patient problems measure appeared to have impact primarily among wife caregivers, particularly those 64 years old and under. Multiple regression analyses showed that one patient problem behavior category, Emotional Lability, was the single strongest predictor of impaired well being of the caregiver among all five subdimensions of the caregiver well being measure. Although Destructive Behavior of the patient was not significant by itself, an Age by Destructive Behavior interaction showed that high levels of patient Destructive Behavior predicted high levels of Depression, Anxiety, and low levels of Positive Well Being more among younger caregivers. Husband caregivers had significantly higher Anxiety scores than wife caregivers. These findings document how particular patient problem behaviors can affect caregivers. They point up as well how both gender and age may help target which caregivers are most vulnerable to the stress of specific Alzheimer patient behavior problems. They also suggest the utility of examining specific dimensions of well being rather than a total score alone for purposes of understanding the relationship of particular patient behavior problems to caregiver emotional and physical health.

Pain perception, coping strategies, and stress management among periodontal patients with repeated surgeries.

The relationships between coping strategies, stress response during periodontal surgery, and perceived pain after each of two surgical procedures were studied in 42 adult women between the ages of 28 and 67 years. The presurgical use of coping by indirect action was positively correlated with decreased stress behavior during each surgery. The use of attention-coping strategies was significantly correlated with pain measures after each surgery, while avoidance-coping strategies were not. Age and patients' rating of pain were the best predictors of the use of attention coping. These findings suggest that preoperative preparation which includes information on enhancing attention-coping may assist some patients with postsurgical pain and discomfort.

Pre-surgery psychological characteristics, pain response, and activities impairment in female patients with repeated periodontal surgery.

This study assessed relationships between pre-surgery psychological characteristics and post-surgery pain response and impairment of life activities following each of two sessions of periodontal surgery. Forty-two female periodontal patients between the ages 26 and 67 participated. None had experienced previous peridontal surgery. Pre-surgery scores on dental anxiety, fatigue, and depression were positively associated with measures of post-surgery pain after the first surgery, and were negatively associated with positive well-being scores. A similar, though weaker pattern of associations was evident after the second surgery. Younger women reported significantly greater impairment of life activities during recovery than did the older women after both surgery episodes. The study points to the relevance of pre-surgery well-being and psychological stability as predictors of post-surgery pain and degree of impairment of life activities, as seen in the time sequence of repeated surgeries.

Pain response after psychological preparation for repeated periodontal surgery.

The effects of pre-surgery intervention messages on postsurgical pain and recovery in 42 female patients were compared. Each participant was scheduled for at least two periodontal surgeries and exposed to one of four messages before each surgery. Auditory and visual messages classified as "control enhancement" were associated with reduction of pain after the second surgery with no effect after the first surgery.

Effects of antihypertensive medications on quality of life in elderly hypertensive women.

The impact of antihypertensive medications on the quality of life of elderly hypertensive women has rarely been systematically evaluated in large clinical trials using drugs from the new generations of pharmaceutic preparations. We carried out a multicenter, randomized double-blind clinical trial with 309 hypertensive women aged 60 to 80 years to assess effects of atenolol, enalapril, and isradipine on measures of quality of life over a 22-week period. The patients had mild to moderate hypertension. Hydrochlorothiazide was added to treatment if monotherapy was inadequate in lowering blood pressure. At the conclusion of the trial the three drug groups did not differ in degree of reduction of diastolic blood pressure or in supplementation with hydrochlorothiazide. Over the 22-week trial, linear trend analysis showed no differences between the treatment groups in change from baseline on quality of life measures of well-being, physical status, emotional status, cognitive functioning, and social role participation. Regarding each of 33 physical side effects over the 22 weeks, we found no general difference between atenolol, enalapril, and isradipine groups on measures of change in distress over symptoms except for enalapril patients who worsened in distress over cough (P = .001) and atenolol patients who worsened in distress over dry mouth (P = .014). Centering on three medications that are relatively new additions to the armamentarium for blood pressure control, the findings underline the increasing opportunities for the physician to select drugs that can control blood pressure while maintaining the quality of life of elderly hypertensive women.

The sexual functioning of elderly hypertensive women.

To assess the sexual interest and behavior of a large cohort of 60-80-year-old women with mild to moderate hypertension, data from a large multicenter study were analyzed. Of the 142 hypertensive women with partners, 87 (61%) were sexually active and 55 (39%) were sexually abstinent. The sexually active women were somewhat younger, had higher household incomes, and reported higher ratings of subjective sexual interest than did the abstinent women. For sexually abstinent women, two major factor appeared to determine the level of sexual activity: their partner's level of sexual desire and his health. Of particular note is the finding that the majority of women in both groups indicated moderate or high satisfaction with their sexual life. When the sample was divided into "younger" elderly (age 69 or below) and "older" elderly (70 or above), the percentage of women displaying moderate or high sexual interest was quite similar (76% and 65%, respectively). Difficulty achieving orgasm and lack of vaginal lubrication were the two most common sexual complaints. Scores on quality of life measures did not differ significantly between the sexual abstinent and active women at baseline.

Hypertensive black men and women. Quality of life and effects of antihypertensive medications. Black Hypertension Quality of Life Multicenter Trial Group.

A multicenter, randomized double-blind clinical trial was conducted among 306 black men and women with mild to moderate hypertension to determine effects of atenolol, captopril, and verapamil SR on measures of quality of life. Patients were randomly assigned to a stable or forced-dose titration sequence. After an 8-week treatment period, the rate of withdrawal from treatment because of adverse effects was low and did not differ by drug treatment group or titration level. Patients taking verapamil SR showed a significantly greater reduction in mean blood pressures than patients treated with atenolol or captopril. Along with absence of worsening on any quality of life total scale scores examined over the treatment period, we found either improvement or no change in the total scale scores for all three treatment groups. Among both male and female patients, comparisons between drug treatment groups showed no differences in degree of change on the total scale scores. In comparisons within each treatment group, improvement in scores of male patients after 8 weeks appeared among those taking atenolol in general well-being and physical symptoms reduction; among male patients taking captopril in general well-being, physical symptoms, and sexual performance; and among male patients receiving verapamil SR in scores in irritability, sleep, and the Digit Span test. Improvement in scores among female patients taking atenolol was found in scores on general well-being, physical symptoms, and sleep; among women taking captopril on general well-being, physical symptoms, and irritability; and among women taking verapamil SR on general well-being. Patients in all treatment groups improved on measures of visuomotor functioning. The research shows that with the three newer generation antihypertensive medications studied, blood pressure control was achieved during the treatment period without negative effects on quality of life scales, along with findings of improvement on some measures. Given the special clinical features of hypertension in black patients, the study underlines as well the potential and utility of systematic tracking of measures of quality of life, while monitoring blood pressures in this patient population.

Self-reported side effects from antihypertensive drugs. A clinical trial. Quality of Life Research Group.

We report on the distress associated with physical symptoms in 761 male hypertensive patients enrolled in a clinical trial of the effects of captopril, methyldopa or propranolol on quality of life. Educational level at entry into the trial showed a negative association with a series of physical symptom distress items among patients not previously treated with antihypertensive medications but no association with symptoms among the previously treated. Over the 24 weeks of therapy captopril as monotherapy was associated with no change from baseline in distress in all symptoms examined. In contrast, distress increased in the methyldopa treated patients for dry mouth and blurred vision. Propranolol treated patients had increased "trouble getting breath," bradycardia, shortness of breath or wheezing, and blurred vision. Between group comparisons revealed significant differences favorably comparing captopril to both methyldopa and propranolol in regard to fatigue, and blurred vision, as well as to methyldopa alone for dry mouth and "feeling worn out." There were significant differences as well between captopril and propranolol with patients on propranolol worsening in bradycardia. Other comparisons of patients on propranolol and methyldopa monotherapy showed propranolol patients worsening in bradycardia and loss of taste, but methyldopa patients reported more dry mouth and feeling worn out than those on propranolol. The addition of hydrochlorothiazide to therapy worsened total physical symptom distress scores for methyldopa and propranolol patients. This study confirms the value of methods which assess the degree of distress associated with symptoms commonly reported by hypertensive patients receiving antihypertensive medications. This approach can be useful in establishing a treatment regimen least likely to cause distress and can be of value in preserving quality of life, preventing noncompliance, and withdrawal from treatment.

Sexual symptoms in hypertensive patients. A clinical trial of antihypertensive medications.

The effects of captopril, methyldopa, and propranolol hydrochloride on reported distress over sexual symptoms over a 24-week treatment period were examined as part of a multicenter, randomized, double-blind clinical trial in which 626 men with mild to moderate hypertension participated. On entry into the clinical trial, 58% of patients taking antihypertensive medications and 44% of men not receiving antihypertensive drugs reported distress over one or more sexual symptoms. Among 304 patients treated with monotherapy who completed the trial, total symptoms distress scores of treatment groups did not differ from each other in change from baseline to week 24, but in particular, problems of maintaining an erection were significantly worsened with propranolol therapy. Among 177 patients treated with monotherapy plus a diuretic, total sexual symptoms distress scores worsened among the groups taking methyldopa or propranolol, with significant worsening in all individual symptoms among patients taking propranolol, and problems in maintaining an erection and in ejaculation among patients receiving methyldopa. Among patients treated with captopril plus a diuretic, no change from baseline appeared in scores for any of the sexual symptoms. The findings underline the importance of taking an adequate sexual history and document that selection of antihypertensive drugs may significantly affect the incidence of sexual symptoms.

Longitudinal study of craniofacial growth in Macaca fascicularis.

This paper is an analysis of normal craniofacial growth in adolescent crab-eating macaques (Macaca fascicularis). Eight female adolescent monkeys were used in this study. Their individual craniofacial growth was studied for a 24-month period utilizing tantalum implants and roentgenographic cephalograms. Throughout the observation period, each monkey consistently showed a class I molar relationship with a good overjet and overbite. The amount of anterior displacement of the maxilla and the mandible was significantly dominant compared to the vertical displacements at every observation period. The midface exhibited a maxillary differential growth pattern in which the premaxilla displaced superiorly and the posterior maxilla moved inferiorly, resulting in a counterclockwise rotation of the entire maxilla. Growth of the lower anterior teeth and alveolar bone compensated for the incremental vertical spaces which were induced by superior displacement of the premaxilla and inferior repositioning of the chin. In addition, the amount of anterior displacement of the upper and lower anterior teeth were significantly larger than that of the premaxilla and the chin. The dentocraniofacial growth pattern in Macaca fascicularis was quite similar to that seen in Macaca mulatta.

Inbreeding effects on dental morphometrics in Papio hamadryas.

The dentition of nonhuman primates (Papio hamadryas) was utilized to investigate the hypothesis that inbreeding will affect mean tooth size and shape. More than five hundred dental casts were collected from baboons at the Institute of Experimental Pathology and Therapy in Sukhumi, USSR. In addition, inbreeding coefficients for each monkey were obtained from pedigree records, some going back seven to nine generations. Each tooth was measured and scored for the presence of discrete morphological structures. Inbred and outbred groups were differentiated and divided by sex. Statistical analysis shows that for the most part inbred monkeys exhibit larger teeth than outbred monkeys, in both male and female groups. When the tooth area of inbreds was compared to that of outbreds, the differences were significant. However, there were no significant differences in frequency of discrete traits. Therefore, it can be concluded that primate dentition is affected by inbreeding, although dental metrics is a more sensitive indicator than morphology.

A craniofacial growth maturity gradient for males and females between 4 and 16 years of age.

Differential growth of the craniofacial complex implies variation in ontogenetic patterns of development. This investigation quantifies the relative maturity--as defined by percent adult status--of nine cephalometric dimensions and stature. Analysis is based on 663 lateral cephalograms from a mixed longitudinal sample of 26 males and 25 females between 4 and 16 years of age. Graphic comparison of maturity status across the age range shows that variation is intergraded between the neural and somatic growth maturity patterns, as described by head height and stature, respectively. The maturity gradient moves from head height through anterior cranial base, posterior cranial base and maxillary length, upper facial height, corpus length, and ramus height to stature. After 9 years of age ramus height is less mature than stature. Anterior maxillary and mandibular heights diminish during transitional dentition and thereafter exhibit maturity patterns that compare to corpus length. Although females are consistently more mature than males, the gradient of variation between dimensions is sex independent.

Stature, head height, and growth of the vertical face.

Six hundred sixty-three cephalometric radiographs are used in a mixed longitudinal sample of fifty-one subjects (twenty-six males and twenty-five females) in order to determine patterns of vertical facial change during growth and to discern lower, mid-, and upper facial relationships with stature and head height. Results indicate that the absolute growth of the face is similar to the neural pattern and that throughout growth the face is larger among males than among females. However, when facial values are examined relative to stature and head height, the vertical face changes at a rate that resembles statural growth. Moreover, when relative growth values are standardized in order to reduce scaling differences, they indicate that, although relative growth for all three facial measures falls between neural and skeletal values, it is closer to the postcranial pattern of change than to the neural pattern. In addition, relative size of the upper face is highly correlated with relative size of the lower face. It is concluded that stature is of greater importance than head height in the prediction of vertical facial growth.

Craniofacial growth and size patterns during postnatal development.

Patterns of craniofacial growth and size relationships are described for a mixed longitudinal sample of 26 males and 25 females, followed serially from four years of age through adult status. The seven dimensions examined, derived from 663 lateral cephalograms, show differential patterns of negative allometric growth relative to statural increase. Relative growth is greatest for mandibular traits, followed by upper facial and neurocranial traits, respectively. Males exhibit greater relative growth than females. Craniofacial variation residual to allometry follows three independent patterns of association defined by principal component analysis. The components are age and sex independent, suggesting that after proportional changes related to absolute size or scale are controlled for, anterior facial, cranial height, and masticatory associations follow separate but proportionate patterns during growth.

Discrete dental trait asymmetry in Mexican and Belizean groups.

Discrete dental trait asymmetry was scored on four Mexican Indian and two Afro-Belizean groups. The Mexican populations show significantly higher mean asymmetry than the two populations from Belize even though the Belizean groups have larger teeth. Point biserial coefficients of correlation between asymmetry of discrete traits and tooth size is low and in most cases not significant. This study indicates that populational and ethnic differences exist in the asymmetry of discrete traits, suggesting that these traits may be used to investigate the etiology of dental asymmetry, and the relative roles of genetics and environment.

Discrete dental traits in four Tlaxcaltecan Mexican populations.

Seven hundred dental casts from four Tlaxcaltecan Indian populations of Mexico were analyzed for the incidence of ten discrete dental traits. The populations are of known historical origin, with Cuanalan and Saltillo transplanted from the Valley of Tlaxcala approximately 400 years ago. Given this temporal and geographical separation of these transplanted populations from the parental gene pool, statistically significant morphological divergence was observed. However, varying degrees of admixture with Spanish and possibly African colonists have complicated the interpretation of the results. Shovelling of incisors was shown to be the best discriminator of group differences. Mandibular molar patterns and mandibular incisor extension indicate that Cuanalan is closest to Saltillo while the valley communities. Tlaxcala and San Pablo, are closest to each other.