Psychosocial predictors of postpartum depression in diverse groups of women.

The purpose of this study was to test the extent to which a causal model developed from a theoretical formulation of postpartum depression was consistent with data collected from three groups of postpartum women. In this cross-sectional, correlational design, the samples consisted of primarily middle-class, Caucasian mothers of term infants and preterm infants, and low-income, African American mothers of term infants. Instruments included the CES-D Depression instrument, the Postpartum Support Questionnaire, Rosenberg's Self-Esteem instrument, and a question regarding closeness to partner. The causal model was tested with structural equation modeling. Importance of support, support received, and closeness to partner were significant predictors of both self-esteem and depression. Predictors of postpartum depression are the same across diverse samples of women, as proposed in the causal model.

The link of social support and postpartum depressive symptoms in African-American women with low incomes.

PURPOSE: To describe the relationship between postpartum support and depressive symptoms in a sample of African-American women of low socioeconomic status. DESIGN: Descriptive correlational design using a convenience sample. METHOD: Fifty-seven African-American women at 4 to 6 weeks' postpartum were interviewed as they waited for their infant to receive a well-baby exam. Identification of amount and type of postpartum support received, as well as the importance of each type of support was measured using the Postpartum Support Questionnaire. Depressive symptoms were measured using the CES-D depression instrument. RESULTS: There was a high incidence of symptoms of depression, and depressive symptoms were associated with support being very important to the woman. CLINICAL IMPLICATIONS: Importance of support is a better predictor of outcomes than how much support a woman receives. Communication of need for support and establishing boundaries with family members are recommended.

An intervention to increase use and effectiveness of self-care measures for breast cancer chemotherapy patients.

Outpatient chemotherapy treatment shifts the managing of side effects from health care providers to patients and families. The primary purpose of this quasi-experimental study was to determine whether women who receive an intervention of three telephone calls and oral and written self-care measures for specific side effects will use more self-care measures and have higher effectiveness scores as measured by the Exercise of Self-Care Questionnaire (ESCQ) after treatment 4 than women who receive standard care. A second purpose was to determine if women scoring higher on the Exercise of Self-Care Agency (ESCA) Scale before chemotherapy used more and effective self-care measures during chemotherapy than women scoring lower on this scale. Forty-eight women beginning chemotherapy for breast cancer completed the ESCA pretreatment and were interviewed using the ESCQ during a sequence of therapy. The experimental group (n = 26) received additional self-care measures. Subjects with higher ESCA scores before chemotherapy treatment used more self-care measures to alleviate chemotherapy side effects. A telephone call and written self-care measures after the second, third, and fourth chemotherapy treatments did not increase use or effectiveness of self-care measures. The implications of assessing patients' self-care agency before chemotherapy are discussed and a nursing intervention recommended.

Social support and adjustment in women following coronary artery bypass surgery.

Social support expected, discrepancies in support (differences between support expected and received), and self-esteem were used to predict emotional (tension and depression) and functional outcomes (recreation, housework, and social life) in a sample of women who had coronary artery bypass surgery (N = 86). Women were interviewed before hospital discharge (T1) and 1 (T2) and 3 (T3) months later. Higher self-esteem was associated with lower depression and tension (T3) and less disruption in social interaction (T2 and T3) and recreation (T3). Results suggest that social support may influence outcomes through enhancement of self-esteem. Directions for further study are given.

The Postpartum Support Questionnaire: reliability and validity.

Support has been found to be related to perinatal health, resulting in the development of the Postpartum Support Questionnaire based on the four categories of support (informational, material, emotional and comparison) identified by House (1981) and Cronenwett (1985). Data from four studies (N = 207) provided evidence of the psychometric properties of the instrument. Internal consistency reliability was demonstrated (alpha = .90 to .94 for total instrument). Test-retest reliability ranged from .69 to .79 for total scores and .30 to .79 for for categories of support. Measures of concurrent validity with the Personal Resource Questionnaire .85 were .42 and .48 at 6 and 8 weeks postpartum. Confirmatory factor analysis using LISREL 7 supported the four categories of support, but the use of these factors separately remains to be demonstrated.

Effects of chemical stimulation of the rostral and caudal ventrolateral medulla on cerebral and renal microcirculation in rats.

We investigated the effects of neurons in the rostral and caudal ventrolateral medulla (RVL and CVL) on cerebral and renal microcirculation in rats. Rats were anesthetized with chloralose, paralyzed with tubocurarine, and artificially ventilated. Cerebral and renal blood flows (CBF and RBF) were measured simultaneously using laser-Doppler flowmetry. Chemical stimulation of the RVL neurons by microinjection of the excitatory amino acid L-glutamate increased arterial pressure (AP), whereas that of the CVL neurons decreased AP. Stimulation of the RVL neurons also elicited a stimulus-locked increase in CBF and a decrease in RBF. The percent change in CBF and RBF was dose-dependent as stimulus intensity was increased. Cerebral and renal vascular resistance (CVR and RVR) levels were calculated from changes in CBF or RBF and changes in mean AP. The percent reduction in CVR and percent elevation in RVR were also dose-dependent. Chemical stimulation of the CVL neurons elicited a stimulus-locked decrease in CBF and an increase in RBF. The percent reduction in CBF and percent elevation in CVR were dose-dependent. The percent reduction in RVR was also dose-dependent, while the percent elevation in RBF was not significant. Blood withdrawal reduced AP by a similar degree to CVL stimulation, but did not significantly decrease CBF. The results suggest that RVL and CVL neurons integrate cerebral and systemic microcirculation.

[Effect of calcium antagonist (benidipine) and alpha 1 blocker (urapidil) on renal hemodynamic responses to two acute environmental stresses in spontaneously hypertensive rats (SHR)].

Renal hemodynamic responses were studied in spontaneously hypertensive rats (SHR) and Wistar-Kyoto Rats (WKY) to two acute stresses: environmental stress (foot shock (FS) and air jet (AS)). The effects of calcium channel blocker (benidipine) and alpha 1 blocker (urapidil) on these responses were studied using an ultrasonic pulsed Doppler flowmeter. The increments in mean arterial pressure (MAP) and renal vascular resistance (RVR) were greater in SHR during both stresses. On the other hand, the decrease in the renal blood flow (RBF) with these stresses almost disappeared with renal denervation. These renal hemodynamic responses in SHR disappeared with alpha 1 blocker (urapidil), but not with calcium channel blocker (benidipine). The sympathetic nervous system became hyperactive in SHR under environmental stress, Which induced specific renal hemodynamic change. These results suggest that investigations on essential hypertension should focus on clarifying not only systemic hypertensive reaction, but also changes in renal hemodynamics. Furthermore, it is necessary for antihypertensive therapy to take these hemodynamic changes into consideration.

Differential regional hemodynamic changes produced by L-glutamate stimulation of the locus coeruleus.

The locus coeruleus (LC) exerts an inhibitory influence on the cardiovascular system. Microinjection of the excitatory amino acid, L-glutamate, into the LC elicits a decrease in arterial pressure as a result of a decrease in total peripheral resistance (TPR). The aim of the present study was to examine the role of the LC in the regulation of the regional hemodynamics. Employing anesthetized rats, the blood flow to the renal, mesenteric and hind-limb vascular beds was measured with an electromagnetic flowmeter. The changes in regional blood flow and vascular resistance evoked by chemical stimulation of the LC were examined separately in each region. During the depressor response elicited by LC stimulation, the hind-limb and renal vascular resistance was significantly decreased, while the mesenteric resistance was unchanged. The vasodilatation appeared to be more prominent in the hind-limb muscle than in the systemic circulation. Renal nerve denervation attenuated the decrease in renal vascular resistance elicited by LC stimulation. However, a small part of this response still remained in the denervated kidney. The present results suggest therefore that: (1) LC neurons exert differential hemodynamic effects on the hind-limb muscle, renal and mesenteric vascular beds; (2) the largest contribution to the decrease in TPR is related to vasodilatation in the hind-limb muscles; and (3) the renal vasodilation elicited by LC stimulation is not mediated solely by the renal innervation.

Altered basal firing pattern and postactivation inhibition of locus coeruleus neurons in spontaneously hypertensive rats.

We compared the spontaneous unit activity and inhibition of impulse activity following antidromic activation (postactivation inhibition, PAI) of locus coeruleus (LC) neurons in spontaneously hypertensive rats (SHR) with those of LC neurons in Wistar-Kyoto rats (WKY). Spontaneous spikes of the LC were analyzed by interspike time histograms. The basal unit activity and variation coefficient of the interspike interval were decreased in SHR. The duration of the PAI which was yielded by antidromic activation from the dorsal noradrenergic bundle was shortened in SHR. These findings suggest that SHR LC neurons possess an altered basal firing pattern and inhibitory mechanism.

The effect of manidipine on renal hemodynamics in essential hypertensive patients: responses to acute stress.

The effects of the calcium antagonist manidipine 20 mg/day on changes in blood pressure and renal hemodynamics in response to acute stress by the mental arithmetic test (MAT) and the cold pressor test (CPT) were investigated in 14 patients with essential hypertension (median age: 50 +/- 2, WHO stage I-II). During the drug-free period, acute stress by both MAT and CPT caused an increase in the renal vascular resistance index (RVRI) [% change in RVRI, 17% for MAT (p < 0.05) and 26% for CPT (p < 0.01)] and an increase in blood pressure [% change in mean blood pressure (MBP): 17% for MAT (p < 0.001) and 16% for CPT (p < 0.001)]. CPT stress resulted in a reduction in RAFV (% change in RAFV: -12%, p < 0.05). Oral administration of manidipine resulted in hypotensive effects at rest [MBP: from 116 to 99 mmHg, p < 0.001], no change in RAFV (31.3 to 32.9 cm/sec, p = ns), and reduced RVRI (from 3.9 to 3.2 mmHg.sec/cm, p < 0.02). Manidipine inhibited the hypertensive response to acute stress by both MAT and CPT [% change in MBP: from 17% to 11% for MAT (p < 0.02) and from 16% to 11% for CPT (p < 0.01)] and also inhibited the increase in RVRI [% change in RVRI: from 17% to -1% for MAT (p < 0.05) and from 26% to 8% for CPT (p < 0.01)]. Manidipine has beneficial effects on blood pressure and renal hemodynamics at rest in patients with essential hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Life satisfaction and age concentration of the local area.

Data from a community sample of persons 60 years old and older were analyzed to determine if the concentration of older persons in the local area (operationally defined as census tracts) was related to the respondent's life satisfaction after controlling for the known effects of physical health, socio-economic status, social participation, and other microlevel variables. Results showed that the effect of age concentration is negative, but that this effect differs according to the frequency with which a respondent visits a close friend who lives outside the neighborhood and the number of voluntary associations to which the respondent belongs. The more frequently respondents visited outside the neighborhood, the greater the negative effect of age concentration. On the other hand, the more voluntary association memberships respondents had, the smaller the negative effect of age concentration.

Socioeconomic comparisons and life satisfaction of elderly adults.

The hypothesis that overall satisfaction with life is influenced by one's financial situation vis-a-vis significant others was tested. Respondents compared themselves financially to the relative, friend, and neighbor to whom they felt closest. Data from a 1980 community survey of persons 60 years of age and older showed that the better off financially respondents perceived themselves to be compared with the relative to whom they felt closest, the greater the life satisfaction. This effect was independent of functional health, age, sex, race, marital status, education, income, household size, and social participation. These findings suggest that life satisfaction reflects not only one's location in the broader stratification system but also one's location in a rather limited network of significant others.

Homogeneity of friendship networks of elderly blacks and whites.

Race and sex were found to be the most salient parameters of friendship. Multivariate analyses revealed that blacks tend to have less homogeneous friendship networks than their white counterparts only in regard to marital status. How close respondents felt to their friends, on the average, was positively related to the level of age and sex homogeneity of the network. Respondent's education was positively related to all five types of homogeneity. It was found that the size theorem from Blau's primitive theory of social structure accounted for some of the findings. Exceptions were in race and education homogeneity, where discrimination and social distance figured into possible explanations.

Determinants of life satisfaction: a note on a race-interaction hypothesis.

A "race interaction" hypothesis would suggest that factors important to the life satisfaction of whites may not be important to the life satisfaction of blacks. In this paper we suggest that dummy variable regression with interaction terms allows an assessment of differential effects by race. Using data from 438 white and 219 black elderly respondents, it is shown that most factors influencing life satisfaction of elderly people have similar effects among blacks and whites. Although greater numbers of impairments lead to lower life satisfaction for both races, the negative effect is considerably stronger among black than among white respondents.

Repeat admissions for perceived problem drinking. A social resources perspective.

Several propositions derived from a social resources perspective regarding differences in first and repeat admissions are examined using data taken from persons being treated for alcohol misuse and from persons not receiving treatment. Although objective behavior (drinking level) is very important as a predictor of first admissions, it is of less consequence in predicting repeat admissions. The data indicate a complex pattern of interaction effects among social resources and between them and drinking behavior in determining who comes to receive treatment and who is readmitted to treatment.