A randomised test of the effect of medical v. lay idiom on assessment of perceived mental health condition in the USA.

AIMS: To test the impact of using different idioms in epidemiological interviews on the prevalence and correlates of poor mental health and mental health service use. METHODS: We conducted a randomised methodological experiment in a nationally representative sample of the US adult population, comparing a lay idiom, which asked about 'problems with your emotions or nerves' with a more medical idiom, which asked about 'problems with your mental health'. Differences across study arms in the associations of endorsement of problems with the Kessler-6 (a validated assessment of psychological distress), demographic characteristics, self-rated health and mental health service use were examined. RESULTS: Respondents were about half as likely to endorse a problem when asked with the more medical idiom (18.1%) than when asked with the lay idiom (35.1%). The medical idiom had a significantly larger area under the ROC curve when compared against a validated measure of psychological distress than the lay idiom (0.91 v. 0.87, p = 0.012). The proportion of the population who endorsed a problem but did not receive treatment in the past year was less than half as large for the medical idiom (7.90%) than for the lay idiom (20.94%). Endorsement of problems differed in its associations with age, sex, race/ethnicity and self-rated health depending on the question idiom. For instance, the odds of endorsing problems were threefold higher in the youngest than the oldest age group when the medical idiom was used (OR = 3.07; 95% CI 1.47-6.41) but did not differ across age groups when the lay idiom was used (OR = 0.76; 95% CI 0.43-1.36). CONCLUSION: Choice of idiom in epidemiological questionnaires can affect the apparent correlates of poor mental health and service use. Cultural change within populations over time may require changes in instrument wording to maintain consistency in epidemiological measurement of psychiatric conditions.

Associations of Perceived Discrimination With Impaired Functioning in a Population Sample With Psychological Distress.

OBJECTIVE: To test associations between perceived discrimination based on mental health status and impaired functioning in a population sample with psychological distress. METHODS: Interviews were conducted with a sample of respondents to the California Health Interview Survey with mild, moderate, or severe psychological distress. Perceived discrimination was assessed using 14 items covering four domains in which discrimination is reported: social, partner, institutional, and work. Associations of perceived discrimination scores (total score and domain scores) with impaired functioning, measured by the likelihood and number of days out of role, were estimated with statistical adjustment for demographic characteristics and serious psychological distress. RESULTS: Discrimination domain scores are significantly correlated (r ranging from .34 to .65).Total discrimination score is associated with having days out of role (OR = 1.20, 95% CI = 1.10-1.30) and with number of days out of role (5.5 days) after adjustment for demographics and psychological distress. The high correlation among the domain scores makes the attribution of association to particular domains uncertain. Removal of the effect of discrimination using model-based simulation reduces past-year days out of role by 39.4 (SE 11.3) days. CONCLUSIONS: This observational study supports the suggestion that discrimination against people with mental illness contributes to their impaired functioning in a diverse range of social roles. The results provide preliminary evidence that reduction in discrimination against people with mental illness could improve social functioning and work productivity. Correlations among domain scores make it difficult to draw conclusions about domain-specific associations.

Gait variability in Parkinson's disease: levodopa and walking direction.

BACKGROUND: Levodopa treatment has been shown to improve gait spatio-temporal characteristics in both forward and backward walking. However, effect of levodopa on gait variability during backward walking compared with forward walking has not been reported. AIMS OF STUDY: To study the effects of levodopa on gait variability of forward and backward walking in individuals with Parkinson's disease (PD). METHODS: Forty individuals with PD were studied. Their mean age was 68.70 ± 7.46 year. The average time since diagnosis was 9.41 ± 5.72 year. Gait variability was studied while 'OFF' and 'ON' levodopa when the participants walked forward and backward at their usual speed. Variability in step time, swing time, stride length, double support time, and stride velocity were compared between medication condition and walking direction. RESULTS: Variability of step time, swing time, stride length, and stride velocity decreased significantly during forward and backward walks (P < 0.001; P < 0.001; P = 0.003, P = 0.001, respectively) after levodopa administration. Variability of double support time was not changed after levodopa administration (P = 0.054). CONCLUSIONS: Levodopa had positive effects on gait variability of forward and backward walking in individuals with PD. However, variability in double support time was not affected by the levodopa.

Ultrasound guided location and resection of a suburothelial cavernous haemangioma of the bladder.

Complete endoscopic resection of bladder tumours can be difficult. This is particularly true when there is normal overlying mucosa, as in a cavernous haemangioma. We describe a case where intraoperative ultrasound was used to guide successful endoscopic resection.

Changes in health-promoting behavior following diagnosis with HIV: prevalence and correlates in a national probability sample.

Diet, exercise, smoking, and substance use patterns affect the course of illness and quality of life for people with HIV. In interviews with a national probability sample of 2,864 persons receiving HIV care, it was found that most had made health-promoting changes in one or more of these behaviors since diagnosis. Many reported increased physical activity (43%) and improved diet (59%). Forty-nine percent of cigarette smokers quit or cut down; 80% of substance users did so. Desire for involvement in one's HIV care and information seeking-positive coping were the most consistent correlates of change. Other correlates varied by health practice but included health status, emotional well-being, demographics, and attitudes toward other aspects of HIV care. Most people with HIV improve their health behavior following diagnosis, but more might be helped to do so by targeting these behaviors in future interventions.

Fertility desires and intentions of HIV-positive men and women.

CONTEXT: HIV-positive men and women may have fertility desires and may intend to have children. The extent of these desires and intentions and how they may vary by individuals' social and demographic characteristics and health factors is not well understood. METHODS: Interviews were conducted from September through December 1998 with 1,421 HIV-infected adults who were part of the HIV Cost and Services Utilization Study, a nationally representative probability sample of 2,864 HIV-infected adults who were receiving medical care within the contiguous United States in early 1996. RESULTS: Overall, 28-29% of HIV-infected men and women receiving medical care in the United States desire children in the future. Among those desiring children, 69% of women and 59% of men actually expect to have one or more children in the future. The proportion of HIV-infected women desiring a child in the future is somewhat lower than the overall proportion of U.S. women who desire a child. The fertility desires of HIV-infected individuals do not always agree with those of their partners: As many as 20% of HIV-positive men who desire children have a partner who does not Generally, HIV-positive individuals who desire children are younger, have fewer children and report higher ratings of their physical functioning or overall health than their counterparts who do not desire children, yet desire for future childbearing is not related to measures of HIV progression. HIV-positive individuals who expect children are generally younger and less likely to be married than those who do not. Multivariate analyses indicate that black HIlV-positive individuals are more likely to expect children in the future than are others. While HIV-positive women who already have children are significantly less likely than others both to desire and to expect more births, partner's HIV status has mixed effects: Women whose partner's HIVstatus is known are significantly less likely to desire children but are significantly more likely to expect children in the future than are women whose partner's HIV status is unknown. Moreover, personal health status significantly affects women's desire for children in the future but not men's, while health status more strongly influences men's expectations to have children. CONCLUSIONS: The fact that many HIV-infected adults desire and expect to have children has important implications for the prevention of vertical and heterosexual transmission of HIV, the need for counseling to facilitate informed decision-making about childbearing and childrearing, and the future demand for social services for children born to infected parents.

End-of-life discussions and preferences among persons with HIV.

CONTEXT: Deficits in advance care planning leave many patients and their physicians unprepared for decisions about end-of-life care. Even though the prognosis has improved for many persons with human immunodeficiency virus (HIV) infection, a need for planning remains. OBJECTIVE: To evaluate prevalence of end-of-life discussions, use of advance directives, and preferences concerning end-of-life care and their relationship with patient demographics, clinical status, psychosocial variables, and practitioner characteristics among HIV-infected persons. DESIGN, SETTING, AND PATIENTS: Cross-sectional survey of a US probability sample of 2864, which represents 231 400 adults receiving care for HIV, conducted from January 1996 to April 1997. MAIN OUTCOME MEASURES: Communication with physician regarding end-of-life issues, completion of an advance directive, preference for aggressiveness of care, and willingness to tolerate future permanent adverse health states. RESULTS: A total of 1432 patients (50%) discussed some aspect of end-of-life care with their practitioner and 1088 (38%) completed an advance directive. Patients were more likely to complete an advance directive after a physician discussion (odds ratio [OR], 5.82; 95% confidence interval [CI], 4.50-7.52). Practitioners discussed end-of-life care less with blacks (OR, 0.57; 95% CI, 0.39-0.83) and Latinos (OR, 0.74; 95% CI, 0.55-0.98) than with whites. Women (OR, 1.39; 95% CI, 1.05-1.84) and patients with children in the household (OR, 1.53; 95% CI, 1.12-2.10) communicated the most with practitioners about end-of-life issues. Patients infected with HIV via injection drug use (OR, 0.64; 95% CI, 0.45-0.89) and those with less education communicated the least with physicians about end-of-life issues. Less denial, greater trust in one's practitioner, and longer patient-practitioner relationship were associated with more advance care planning. CONCLUSIONS: Half of all persons infected with HIV are at risk of making end-of-life decisions without prior discussions with their health care practitioners. Blacks, Latinos, intravenous drug users, and less educated individuals need advance care planning interventions in clinical HIV programs.

Consideration of non-Poisson distributions for lidar applications.

Poisson statistics are traditionally used to estimate the mean and standard deviation of the mean in time-range realizations of received photon counts from stationary processes in incoherent-detection lidar systems. However, this approach must be modified if the process under study is measurably nonstationary to account for any additional (and potentially unanticipated) variability. We demonstrate that the modified approach produces a different form for the estimated standard deviation of the mean for lidar return counts, which can also be applied to binning of higher-order data products. This modified technique also serves to determine optimum time-range integrations, diagnose system stability, and constrain operational modes.

Binge drinking among underage college students: a test of a restraint-based conceptualization of risk for alcohol abuse.

The authors tested a restraint-based model that binge drinking is a function of being tempted to drink alcohol while also being concerned about avoiding excessive alcohol intake. Underage (18- to 20-year-olds, 204 men and 225 women) college student drinkers completed measures that assessed the attraction to alcohol (e.g., temptation to drink, alcohol expectancies), concern about regulating alcohol intake (e.g., restriction of alcohol intake, reasons for limiting drinking), and alcohol-related outcomes (binge drinking, alcohol problems). In separate hierarchical multiple regressions, the attraction to alcohol accounted for significant amounts of additional variance in each of the alcohol outcomes. Concern about regulating alcohol intake accounted for additional variance, above that explained by attraction to alcohol. The results suggest that interventions for underage binge drinking should include training in the skills for regulating alcohol intake.

A national survey of stress reactions after the September 11, 2001, terrorist attacks.

BACKGROUND: People who are not present at a traumatic event may also experience stress reactions. We assessed the immediate mental health effects of the terrorist attacks on September 11, 2001. METHODS: Using random-digit dialing three to five days after September 11, we interviewed a nationally representative sample of 569 U.S. adults about their reactions to the terrorist attacks and their perceptions of their children's reactions. RESULTS: Forty-four percent of the adults reported one or more substantial stress symptoms; 91 percent had one or more symptoms to at least some degree. Respondents throughout the country reported stress syndromes. They coped by talking with others (98 percent), turning to religion (90 percent), participating in group activities (60 percent), and making donations (36 percent). Eighty-five percent of parents reported that they or other adults in the household had talked to their children about the attacks for an hour or more; 34 percent restricted their children's television viewing. Thirty-five percent of children had one or more stress symptoms, and 47 percent were worried about their own safety or the safety of loved ones. CONCLUSIONS: After the September 11 terrorist attacks, Americans across the country, including children, had substantial symptoms of stress. Even clinicians who practice in regions that are far from the recent attacks should be prepared to assist people with trauma-related symptoms of stress.

Temptation, restriction, and the regulation of alcohol intake: validity and utility of the temptation and restraint inventory.

OBJECTIVE: The Temptation and Restraint Inventory (TRI) is a measure of drinking restraint, the preoccupation with controlling alcohol intake. It contains two higher order factors pertaining to the temptation to drink and the restriction of alcohol intake. We tested the convergent and discriminant validity of the TRI in comparison to the Preoccupation with Alcohol Scale (PAS), the Reasons for Limiting Drinking Scale (RLD) and the Drinking-Related Locus of Control Scale (DRIE), each of which measures constructs analogous to the components of the TRI. We also tested the utility of the TRI, as compared to these related measures, for predicting typical drinking and alcohol problems. METHOD: A sample of 296 (50% male) moderate to heavy drinking adults completed the TRI, the PAS, the RLD, the DRIE and measures of typical (weekly) drinking and alcohol problems (SMAST). RESULTS: Correlations indicated that the TRI had excellent convergent and discriminant validity. The TRI's temptation factor (Cognitive and Emotional Preoccupation) was strongly and positively correlated with the PAS and the DRIE, and was weakly and positively correlated with the RLD. The TRI's restriction factor (Cognitive and Behavioral Control) was positively and moderately correlated with the DRIE and moderately to weakly correlated with the PAS and the RLD. In regressions predicting weekly drinking and SMAST scores, the TRI was particularly effective in accounting for the variance in SMAST scores. CONCLUSIONS: In comparison to measures of conceptually related constructs, the components of the TRI showed excellent convergent and discriminant validity. The TRI accounted for large portions of the variance in alcohol-related outcomes, using fewer items than measures of similar constructs.

Effects of incentive size and timing on response rates to a follow-up wave of a longitudinal mailed survey.

Young adults who had previously participated in a longitudinal survey of youth were sent a questionnaire. They were randomly assigned to receive a $20 prepayment, a $20 postpayment, or a $25 postpayment for participation in the latest survey. Those in the large incentive condition were 7 percentage points more likely to return a survey than those in the smaller, postpayment group. Prepayment had a smaller, less reliable effect. Effects of incentive magnitude and timing were consistent at each month of the study period; only better high school grades distinguished early responders from late responders. Nonresponders had characteristics suggestive of low social conformity and were more likely than responders to be African American and male and have low SES. The discussion centers on motivations for participating in research and differences in the incentives likely to promote continued response versus initial study enrollment.

Amphetamine treatment during the preweanling period produces enduring changes in striatal protein kinase A activity.

The purpose of this study was to determine whether chronic exposure to amphetamine during the preweanling period causes enduring changes in behavioral and neuronal functioning. In two experiments rats were injected with saline or amphetamine (2.5 or 5.0 mg/kg) on postnatal days (PD) 11-15. Rats then received a challenge injection of saline or 2.5 mg/kg amphetamine on PD 23 or PD 90 and locomotor activity was measured. After behavioral assessment, rats were killed, and their dorsal striata and nucleus accumbens were dissected and later assayed for protein kinase A (PKA) activity. Interestingly, amphetamine treatment during the preweanling period produced an enduring decline in dorsal striatal and accumbal PKA activity that was still apparent in adulthood. These reductions in PKA activity were not related to the occurrence of locomotor sensitization, because rats did not exhibit a sensitized locomotor response when challenged with amphetamine at PD 23 or PD 90.

Coping, conflictual social interactions, social support, and mood among HIV-infected persons. HCSUS Consortium.

This study considers the interrelationships among coping, conflictual social interactions, and social support, as well as their combined associations with positive and negative mood. Research has shown that each of these variables affects adjustment to stressful circumstances. Few studies, however, examine this full set of variables simultaneously. One hundred forty HIV-infected persons completed a questionnaire containing measures of coping, social support, conflictual social interactions, and positive and negative mood. Factor analyses showed that perceived social support and conflictual social interactions formed separate factors and were not strongly related. Compared to perceived social support, social conflict was more strongly related to coping behaviors, especially to social isolation, anger, and wishful thinking. Conflictual social interactions were more strongly related to negative mood than was perceived social support. Coping by withdrawing socially was significantly related to less positive and greater negative mood. The findings point to the importance of simultaneously considering coping, supportive relationships, and conflictual relationships in studies of adjustment to chronic illness. In particular, a dynamic may occur in which conflictual social interactions and social isolation aggravate each other and result in escalating psychological distress.

The role of women's alcohol consumption in evaluation of vulnerability to sexual aggression.

The authors examined the impact of alcohol consumption on women's risk perceptions and intended behaviors in a hypothetical situation in which the potential for establishing a relationship with an attractive man was coupled with the potential for sexual aggression. Fifty-nine single women, ages 21-29, were randomly assigned to 1 of 3 beverage conditions: (a) alcohol (dose sufficient to raise blood alcohol level to .08); (b) placebo, in which they were led to believe that they had consumed alcohol but had not; or (c) no alcohol, in which they neither expected nor received alcohol. Compared with women in the no-alcohol condition, women in the alcohol condition (a) rated the male character in the vignette more positively, (b) anticipated less risk and more benefit resulting from a series of behaviors likely to facilitate the relationship while increasing sexual vulnerability (e.g., engaging in consensual sexual activities), and (c) anticipated greater involvement in those behaviors. The placebo appeared to exert similar but weaker effects.

kappa-Opioid receptors in the substantia nigra pars reticulata mediate the U-50,488-induced locomotor activity of preweanling rats.

The purpose of the present study was to determine the neuroanatomical location where kappa-opioid receptor stimulation induces locomotor activity in the preweanling rat. To confirm that the U-50,488-induced locomotor activity of preweanling rats is mediated by kappa-opioid receptors, 18-day-old rats were initially injected with vehicle or the kappa-opioid receptor agonist U-50,488 (5 mg/kg, s.c.) followed, 15 min later, by an injection of the kappa-opioid receptor antagonist nor-binaltorphimine (nor-BNI; 0, 2, 4, 8, or 12 mg/kg, s.c.). In subsequent experiments, 18-day-old rats were injected with vehicle or U-50,488 (5 mg/kg, s.c.) 15 min prior to bilateral administration (0.25 or 0.5 microl per side) of nor-BNI (0, 5, 10, or 20 microg) into the substantia nigra pars reticulata (SNR) or medial dorsal striatum (MDS). In the final experiment, 18-day-old rats received bilateral administration (0.25 microl per side) of vehicle or U-50,488 (0.0, 0.8, 1.6, or 3.2 microg) into the SNR. Results showed that systemically administered nor-BNI (0-12 mg/kg, s.c.) produced a dose-dependent reduction in the U-50, 488-induced locomotor activity of preweanling rats. The site of action for U-50,488's locomotor-activating effects appeared to be the SNR, because (a) bilateral administration of nor-BNI (5, 10, or 20 microg) into the SNR caused a complete attenuation of U-50, 488-induced locomotion, and (b) bilateral administration of U-50,488 into the SNR caused a dose-dependent increase in the locomotor activity of preweanling rats. Striatal injections of nor-BNI did not affect U-50,488-induced locomotor activity. When these findings are considered together it is apparent that stimulation of kappa-opioid receptors in the SNR is both necessary and sufficient for the occurrence of U-50,488-induced locomotor activity in the preweanling rat.

Effects of repeated methylphenidate treatment in the young rat: sensitization of both locomotor activity and stereotyped sniffing.

The behavioral effects of repeated methylphenidate (MPH) treatment were assessed in young rats. In 4 experiments, rats (starting at Postnatal Day 10 or 16) were pretreated on 5 consecutive days with saline or MPH (2.5-20.0 mg/kg i.p.). Sensitization was assessed after 1 or 7 abstinence days, with rats receiving a test day challenge injection of either a low dose of MPH (2.5 mg/kg) or the same dose of MPH as given during pretreatment. Results show that a test day injection of 2.5 mg/kg MPH produced a sensitized locomotor response in rats pretreated with 2.5-20.0 mg/kg MPH. This MPH-induced locomotor sensitization was evident only after 1 abstinence day. Various pretreatment doses of MPH (5, 10, 15, or 20 mg/kg) were capable of sensitizing the stereotyped sniffing of young rats, but only rats pretreated and tested with the highest dose (20 mg/kg) of MPH showed an augmented stereotyped sniffing response that was still robust after 7 abstinence days. Results indicate that young rats are capable of exhibiting sensitization after an extended abstinence period, which contrasts with previous research suggesting that psychostimulant treatment does not produce long-term sensitization in young rats.

Substance use among a regional sample of female nurses.

We assessed the prevalence of licit (e.g. alcohol) and illicit (e.g. cocaine) drug use, as well as prescription (e.g. tranquillizers) and over-the-counter medications (e.g. analgesics), in a regional sample of female nurses. Surveys were mailed to a random sample of 4000 nurses in Western New York. The survey focused on lifetime and current use of substances, negative consequences of alcohol consumption and dependence. Three mailings resulted in a return of 2400 (60%) surveys, of which 1951 (49%) were usable. We examined lifetime and current use in each of the four classes of substances in the context of nursing related-factors (e.g. type of nurse, nursing specialty, work setting) and demographic characteristics (e.g. age, marital status). There were significant differences within each of the different groupings. Lifetime experience of negative consequences were relatively rare and few nurses reported dependence on substances other than tobacco and caffeine.

Adolescent use of illicit drugs other than marijuana: how important is social bonding and for which ethnic groups?

We predicted Grade 12 use of illicit drugs other than marijuana ("hard" drugs) from characteristics at Grade 10, examining the protective value of social bonds and testing whether certain social bonds have greater importance for some racial/ethnic groups. We also explored the association of previous substance use with later "hard" drug use when social bonds and a broad range of other personal and environmental variables are statistically controlled. Bonds with family were inversely related to any use of illicit drugs other than marijuana; various forms of prior use were positively related to both any and frequent use. However, variables other than social bonds and prior use were equal or stronger predictors of both outcomes. Some differences were obtained across racial groups: African-Americans were less likely to use illicit drugs other than marijuana, Mexican-Americans were more affected by family factors than were other groups, and Asian-Americans were more affected by school failure. Implications for prevention are discussed.