Physical and psychosocial consequences of stroke in elderly Mexican Americans.

OBJECTIVE: The current study examines the psychosocial and physical predictors and consequences of stroke among elderly non-institutionalized Mexican Americans. DESIGN: A cross-sectional cohort study design was used. SETTING: The sampling frame included the Southwestern United States (Arizona, California, Colorado, New Mexico and Texas) where subjects were interviewed in their homes. PARTICIPANTS: A probability sample consisted of 3,050 Mexican Americans aged 65 or older. MAIN OUTCOME MEASURE: The main outcome measure was self-report of being diagnosed by a physician as having a stroke that required hospitalization. RESULTS: Those who ever had a stroke (N=159) were less likely to be able to perform activities of daily living than persons who never had a stroke (N=2,869). Rates of disability and prevalence of stroke appear to be higher in elderly Mexican Americans than in the general elderly population. Greater education and language acculturation were risk factors for having a stroke. CONCLUSIONS: The finding that Mexican Americans who are less acculturated are more healthy suggests that acculturation may increase morbidity and, potentially, mortality from stroke.

Migraine complicated by brachial plexopathy as displayed by MRI and MRA: aberrant subclavian artery and cervical ribs.

This article describes migraine without aura since childhood in a patient with bilateral cervical ribs. In addition to usual migraine triggers, symptoms were triggered by neck extension and by arm abduction and external rotation; paresthesias and pain preceded migraine triggered by arm and neck movement. Suspected thoracic outlet syndrome was confirmed by high-resolution bilateral magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brachial plexus. An unsuspected aberrant right subclavian artery was compressed within the scalene triangle. The aberrant subclavian artery splayed apart the recurrent laryngeal and vagus nerves, displaced the esophagus anteriorly, and effaced the right stellate ganglia and the C8-T1 nerve roots. Scarring and fibrosis of the left scalene triangle resulted in acute angulation of the neurovascular bundle and diminished blood flow in the subclavian artery and vein. A branch of the left sympathetic ganglia was displaced as it joined the C8-T1 nerve roots. Left scalenectomy and rib resection confirmed the MRI and MRA findings; the scalene triangle contents were decompressed, and migraine symptoms subsequently resolved.

Changes in the smoking behavior of elderly Mexican Americans in the Southwest from 1982-1984 to 1993-1994.

OBJECTIVES: The aim of this work was to examine changes in the smoking behavior of elderly Mexican Americans in the southwestern United States from the early 1980s to the early 1990s. METHODS: Data from the 1993-1994 Hispanic EPESE study (n = 2,809) on persons ages 65 to 74 and 75 to 84 residing in the five southwestern states were compared with data from the 1982-1984 Hispanic HANES study (n = 753, persons ages 55 to 74), which included a Mexican American sample from the same five southwestern states. RESULTS: Rates of current smoking in 1993-1994 for persons ages 65 to 74 were approximately half the rates for persons of the same age a decade earlier. Smoking rates for persons ages 75 to 84 in 1993-1994 were significantly lower than rates for persons ages 65 to 74 a decade earlier. Finally, rates for persons ages 65 to 74 in 1993-1994 were significantly lower than those for persons ages 55 to 64 in 1982-1984. CONCLUSIONS: Although some of the declines in smoking in recent years represent aging effects (including declines due to greater mortality among smokers), the much lower rates for same-age people (65 to 74) over the 10-year period are more significant in that they represent cohort differences. It appears that the broader public health message that is causing the general population to quit smoking is reaching the elderly Mexican American population of the Southwest.

Illicit substance use among adolescents: a matrix of prospective predictors.

This paper reviews findings from 58 prospective studies of illicit substance use (ISU) among adolescents. It arranges 384 findings according to three types of influence (viz., social, attitudinal, and intrapersonal) and four levels of influence (viz., ultimate, distal, proximal, and immediate). The bulk of evidence reconfirms the importance of several predictors of ISU (e.g., intentions and prior substance-related behavior, friendship patterns and peer behaviors, absence of supportive parents, psychological temperament), reveals that a few variables thought to be well-established predictors may not be (e.g., parental behaviors, parental permissiveness, depression, low self-esteem), and uncovers several variables where findings were either sparse or inconsistent (e.g., the role of public policies concerning ISU, mass media depictions of ISU, certain parenting styles, affective states, perceptions of parental disapproval for ISU, and substance-specific refusal skills). Directions for future research are discussed.

Correlates of depressive symptomatology among older community-dwelling Mexican Americans: the Hispanic EPESE.

OBJECTIVES: The prevalence of depressive symptoms and associated risk factors is described, using data from the Hispanic EPESE, the first large, representative study of older Mexican Americans. METHODS: Multivariate logistic regression was used to examine the association between depressive symptoms and sociodemographics, chronic health conditions, disability, and cultural factors. RESULTS: Using the Center for Epidemiologic Studies of Depression scale, 25.6% of the 2,823 subjects reported high symptom levels. Rates among women (31.9%) and particularly men (17.3%) were higher than has been typically reported for older Mexican Americans and older adults in general. Consistent with previous studies of older adults, gender, lack of insurance, financial strain, chronic health conditions, and disability were found to be associated with depressive symptoms. Several cultural factors were also associated with increased risk, including immigrant status, levels of acculturation and assimilation, health locus of control, and recency of immigration. An interaction between gender and immigrant status was found such that, in relation to subjects born in the United States, female immigrants were at significantly higher risk for depressive symptoms, whereas male immigrants were at lower risk.

A 3-dimensional analysis of modes of cardiovascular adaptation: concepts, methods and preliminary findings.

OBJECTIVE: To present a 3-dimensional approach to displaying and interpreting processes of cardiovascular adaptation. DESIGN: Laboratory study of blood pressure changes in response to a protocol set in advance. The authors plotted the coordinates of 3711 cardiovascular change events (CVCEs) in 3-dimensional space defined by changes in systolic blood pressure, diastolic blood pressure and heart rate. This was followed by cluster analyses and preliminary estimates of reliability and construct validity. SETTING: The teaching hospitals of a large southwestern US medical centre. PARTICIPANTS: Approximately 100 female nursing personnel aged 25 to 50 years. INTERVENTIONS: Medical history, self-administered questionnaires, laboratory protocol of pressor challenges, rest periods. RESULTS: Nine distinct clusters ("species of response") were identified and replicated in randomly chosen halves of the sample. Postural, isomorphic and psychologic challenges generated several distinctive profiles of "rising" responses, and were also followed by distinctive "declining" responses. The frequencies of various cardiovascular reactions ("clusters") to the same protocol were correlated with psychosocial characteristics and hypertension risk indicators. CONCLUSIONS: The 3-dimensional approach reveals many features of cardiovascular adaptation not discernible from traditional univariate displays and analyses. This paradigm might prove useful for matching patients with hypertension by their cluster patterns to their most suitable medication, but it requires further validation by direct hemodynamic measurements.

Statistical methods for describing temporal order in longitudinal research.

BACKGROUND: Although traditional epidemiological statistical methods (e.g., logistic regression) are useful for describing predictive relationships in longitudinal panel studies in which changes in risk factor levels occur before change in the outcome variable, more sophisticated statistical methods must be used when the temporal order between variables is unknown. METHODS: Using national survey data, the current study shows how log-linear models and discrete-time survival analysis can be used to test for temporal order. The relationship between marijuana use and friends' use of marijuana is examined to illustrate these methods. RESULTS: Using traditional analytic strategies, it appears that friends use and marijuana use are predictive of each other. However, valid tests for temporal order reveal that both variables change concurrently, so there is no temporal order between these variables; rather, these variables tend to change concurrently. CONCLUSION: In many current areas of research, temporal order between theoretically important variables is unknown and traditional analytic strategies will yield misleading results. The fundamental problem with prior approaches is that no estimate of concurrent change is made. Without an estimate of concurrent change, estimates of prediction will be biased. The current study illustrates valid methods that can be used to describe temporal orderings.

The factor structure of the CES-D in two surveys of elderly Mexican Americans.

The factor structure of the Center for Epidemiological Studies-Depression Scale (CES-D) has not been well defined among elderly Mexican Americans. Although most prior research suggests the CES-D has four factors, prior research also suggests that the factor structure of the CES-D may vary with culture. In addition, previous theory and research on other depression inventories suggest only two factors: a general depression factor and a psychological well-being factor. The current study determines the number of factors for the CES-D in the Hispanic Established Populations for Epidemiologic Studies (H-EPESE) survey (N = 2,536) and in a previous study of elderly Mexican Americans living in San Antonio, Texas (N = 330). The factor analytic results argue strongly for the two-factor model, and this model is the only structure that yielded consistent results across subgroups (e.g., male vs female or Spanish vs English language of interview). We conclude that the CES-D has only two factors among elderly Mexican Americans.

A test of socioeconomic status as a predictor of initial marijuana use.

The current study examined the effects of socioeconomic status (SES) on adolescent marijuana use using data from a national longitudinal survey of subjects aged 11 to 17 (N = 1,725). Both direct and indirect measures of SES (e.g., Hollingshead's measure of SES, predicts marijuana use among adolescents. For males, our study found a nonlinear relationship between the Hollingshead measure and marijuana use that had not been identified in previous research. For females, the Hollingshead measure was nonsignificant when alcohol use and having friends who use marijuana were added to the model. This finding suggests that the effects of SES on marijuana use may be mediated by alcohol use and friends' use of marijuana. Weekly alcohol users were much more likely than nonusers to initiate marijuana use for both males (Odds ratio [OR] = 18.28, Confidence interval [CI] = 4.93-67.81) and females (OR = 11.75, CI = 3.22-42.86). Other significant variables for both sexes included having a job, having friends who use marijuana, and having used some alcohol in the past year. For males, grade point average (GPA), commitment to friends, urbanicity, time spent with friends, and peer strain were also significant predictors of initial marijuana use. For females, prior victimization and low school aspirations were significant. In sum, our findings suggest that psychosocial risk factors for marijuana use are substantially different for males than for females and that future researchers need to test for nonlinear relationships between SES and adolescent substance use.

A meta-analytic review of research on hostility and physical health.

A new meta-analysis of research on hostility and physical health was conducted that includes 15 studies used in previous meta-analytic reviews and 30 new independent studies. Overall, the results suggest that hostility is an independent risk factor for coronary heart disease (CHD). For structured interview indicators of potential for hostility, the weighted mean r was .18. After controlling for other risk factors for CHD, the widely used Cook-Medley Hostility Scale and other cognitive-experiential measures were most predictive of all-cause mortality (weighted mean r = .16) and, to a lesser extent, CHD (weighted mean r = .08). Similar to other areas of research, the increased use of high-risk studies in recent years produced an increase in null findings.

Using Log-Linear Models for Longitudinal Data to Test Alternative Explanations for Stage-Like Phenomena: An Example from Research on Adolescent Substance Use.

We show how log-linear models for multi-wave longitudinal data can be used to test hypotheses relating to stage-like relationships between variables. To illustrate our approach, we use an example from research on adolescent cigarette and marijuana experimentation. Previous research has documented that most adolescents experiment with substances in a stage-like sequence: first cigarettes and then marijuana. Several hypotheses have been suggested as potential explanations for this stage-like phenomenon. We show that traditional two-wave analyses give results that are difficult to interpret and that our multiple-wave analyses allow the testing of several theoretically interesting hypotheses. We also illustrate that log-linear models may be useful for testing hypotheses about stage-like phenomena in many other areas of psychological research. We suggest how several other techniques have the potential to be used as a multivariate analogue to the log-linear approach.

A test of the psychosocial vulnerability and health behavior models of hostility: results from an 11-year follow-up study of Mexican Americans.

Previous research has shown that interpersonal conflict and depression are cross-sectionally associated with hostility. Our objective was to determine whether hostility is longitudinally predictive of interpersonal distress and depression and to replicate previous research that suggests that hostility is a risk factor for other health behaviors (e.g., smoking and excessive alcohol use) and psychosocial health problems. We use data from the youngest generation of a three-generation, 11-year follow-up study of Mexican Americans, that represent 251 Mexican Americans between the ages of 18 and 42 years. Our indicator of hostility was the irritability subscale from the Buss-Durkee Hostility Inventory. After statistically controlling for marital status, language acculturation, education, age, and sex, irritability was found to predict subsequent heavy drinking, somatic symptoms associated with depression, psychosomatic symptoms, infectious disease, divorce, marital separation, ending a serious nonmarital relationship, not being married at the follow-up, and more negative feelings associated with divorce, marital separation, and ending a serious relationship. Our research supports theory and research suggesting that hostility is predictive of physical symptoms, poor health habits, and interpersonal conflict.

The anatomy of the brachial plexus as displayed by magnetic resonance imaging: technique and application.

Full field of view coronal chest magnetic resonance imaging (MRI) routinely displays bilateral images of the brachial plexus, surface anatomy, and anatomic structures. Eighty patients had chest radiographs correlated with surgery for thoracic outlet syndrome. The PA chest film findings correlated with the surgical findings: smaller thoracic inlet on the concave side of the cervicothoracic spine scoliosis, shorter distance between the dorsal spine of the second or third thoracic vertebral body to the concavity of the first ribs, asymmetric clavicles and coracoid processes, synchondrosis of the first and second ribs, and muscle atrophy on the side of the clinical complaints. More than 235 patients were imaged. One hundred sixty-five of these were imaged with a 1.5-T unit and 3-D reconstruction MRI. Coronal, transverse (axial), oblique transverse, and sagittal plane T1-weighted, selected T2-weighted, and fast spine echo pulse sequences were obtained, 4- to 5-mm slice thickness, 40 to 45 cm full field of view, 512 x 256 matrix and 2 NEX. Two-dimensional time of flight (2D TOF), magnetic resonance angiography (MRA) sequences were obtained in selected patients. Coronal, transverse, and sagittal sequences were reformatted for evaluation. Saline water bags were placed between the neck and thorax to enhance the signal-to-noise ratio. Compromising abnormalities of the brachial plexus were confirmed at surgery. Compromise of the neurovascular supply seemed to be one etiology that could be demonstrated. The clinical history, technique, and anatomic bilateral brachial plexus imaging is stressed to improve patient care. The cervical rib is one of the compromising brachial plexopathies selected for this presentation.

Correlates of HIV risk among young adolescents in a large metropolitan midwestern epicenter.

This paper examines levels of participation in and correlates of AIDS-related risk behavior for young adolescents in high-risk communities as determined by proxy indicators such as rates of reported STDs and adolescent pregnancies. Seventh and eighth grade students from two middle schools and ninth grade students from the receiving high school were surveyed. Descriptive and inferential techniques examined grade, racial, behavioral, and gender differences in participation in risk (substance use and sexual activity) and protective (use of condoms and use of condoms and foam) behaviors. Grade, race, and sexual activity were significant correlates of both licit and illicit drug use. Gender, grade, race, and licit and illicit drug use were significant correlates of sexual activity. Results demonstrate that not only are adults and older teens at risk in these communities, but younger adolescents also are at risk. Findings indicate a need for comprehensive HIV prevention programs at younger ages.

Reviewing theories of adolescent substance use: organizing pieces in the puzzle.

This article reviews 14 multivariate theories of experimental substance use (e.g., alcohol and marijuana use) among adolescents, including those theories that emphasize (a) substance-specific cognitions, (b) social learning processes, (c) commitment to conventional values and attachment to families, and (d) intrapersonal processes. Important similarities and differences among these theories are addressed, as are the conceptual boundaries of each theory. In an attempt to integrate existing theories, a framework is proposed that organizes their central constructs into 3 distinct types of influence (viz., social, attitudinal, and intrapersonal) and 3 distinct levels of influence (viz., proximal, distal, and ultimate). Implications for future theory development are discussed.

Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging.

Magnetic resonance images (MRI) of brachial plexus anatomy bilaterally, not possible by plain radiographs or CT, were presented to the Vascular Surgery, Neurology, and the Neurosurgery departments. Patients were requested for MRI of their brachial plexus. They were referred for imaging and the imaging results were presented to the faculty and housestaff. Our technique was accepted and adopted to begin referrals for MRI evaluation of brachial plexopathy. Over 175 patients have been studied. Eighty-five patients were imaged with the 1.5 Tesla magnet (Signa; General Electric Medical Systems, Milwaukee, WI) 3-D reconstruction MRI. Coronal, transverse (axial), oblique transverse, and sagittal plane T1-weighted and selected T2-weighted pulse sequences were obtained at 4-5 mm slice thickness, 40-45 full field of view, and a 512 x 256 size matrix. Saline water bags were used to enhance the signal between the neck and the thorax. Sites of brachial plexus compromise were demonstrated. Our technique with 3-D reconstruction increased the definition of brachial plexus pathology. The increased anatomical definition enabled the vascular surgeons and neurosurgeons to improve patient care. Brachial plexus in vivo anatomy as displayed by MRI, magnetic resonance angiography (MRA), and 3-D reconstruction offered an opportunity to augment the teaching of clinical anatomy to medical students and health professionals. Selected case presentations (bodybuilder, anomalous muscle, fractured clavicle, thyroid goiter, silicone breast implant rupture, and cervical rib) demonstrated compromise of the brachial plexus displayed by MRI. The MRI and 3-D reconstruction techniques, demonstrating the bilateral landmark anatomy, increased the definition of the clinical anatomy and resulted in greater knowledge of patient care management.

The television, school, and family smoking prevention and cessation project. VIII. Student outcomes and mediating variables.

BACKGROUND: This paper presents the student outcomes of a large-scale, social-influences-based, school and media-based tobacco use prevention and cessation project in Southern California. METHODS: The study provided an experimental comparison of classroom delivery with television delivery and the combination of the two in a 2 x 2 plus 1 design. Schools were randomly assigned to conditions. Control groups included "treatment as usual" and an "attention control" with the same outcome expectancies as the treatment conditions. Students were surveyed twice in grade 7 and once in each of grades 8 and 9. The interventions occurred during grade 7. RESULTS: We observed significant effects on mediating variables such as knowledge and prevalence estimates, and coping effort. The knowledge and prevalence estimates effects decayed partially but remained significant up to a 2-year follow-up. The coping effort effect did not persist at follow-ups. There were significant main effects of both classroom training and TV programming on knowledge and prevalence estimates and significant interactions of classroom and TV programming on knowledge (negative), disapproval of parental smoking, and coping effort. There were no consistent program effects on refusal/self-efficacy, smoking intentions, or behavior. CONCLUSIONS: Previous reports demonstrated successful development and pilot testing of program components and measures and high acceptance of the program by students and parents. The lack of behavioral effects may have been the result of imperfect program implementation or low base rates of intentions and behavior.

High-risk studies are influenced by indirect range restriction.

High-risk studies select subjects who are at high risk for existing or future disease. Therefore, the range of disease is restricted in high-risk studies. This paper shows that high-risk studies are vulnerable to a particular type of range restriction referred to as indirect range restriction. A simulation study is used to illustrate the effects of indirect range restriction on high-risk studies. The results suggest that indirect range restriction can have a substantial impact on the results of high-risk studies. In addition, a review of several areas of behavioral medicine research suggests that high-risk studies have produced many misleading findings. The range restriction approach can be used to estimate statistical power in high-risk studies, interpret the results of high-risk studies, and design future high-risk studies.

Meta-analysis of phenobarbital usage for prevention of intraventricular hemorrhage in premature infants: factors related to variation in outcome.

PURPOSE: To assess the efficacy of phenobarbital for the prevention of intraventricular hemorrhage (IVH) in premature infants and to identify study characteristics that were associated with beneficial or adverse effects. DATA IDENTIFICATION: Studies published from 1981 to 1994 were identified through a computerized search, and by searching the bibliographies of all identified articles. STUDY SELECTION: Ten randomized, controlled clinical trials were selected. DATA EXTRACTION: Data were extracted from each article, including the percentage of patients in the control and treatment groups with IVH, and key patient and study characteristics. RESULTS OF DATA ANALYSIS: Seven studies showed no statistically significant effects, two studies showed a beneficial effect of phenobarbital, and one study showed an adverse effect. The meta-analysis showed no significant difference in the percentage of IVH in treated and untreated infants when treatment effects were combined across all studies. However, prenatal administration of phenobarbital in two studies was associated with a beneficial effect. CONCLUSIONS: Overall, we did not find a significant beneficial effect of postnatal phenobarbital administration. The data suggests that prenatal phenobarbital is beneficial. Further evaluations of the efficacy of prenatal phenobarbital are warranted.