Sex differences in illness beliefs and illness behaviour in patients with suspected coronary artery disease

The aim of this study was to explore sex differences in illness beliefs and behaviour in patients with suspected coronary artery disease (CAD). Twenty-eight patients, 16 women and 12 men, were interviewed. The results show that both men and women think of CAD as a `men's disease' and have equal knowledge of CAD risk factors. However, especially the men considered their own risk of developing CAD lower than their estimated probability of their own sex and as low as their estimated risk for women. Both men and women did not attribute their symptoms indicative of CAD to their heart. Women, especially those who did not attribute their symptoms to their heart, had a longer patient delay than men, although their symptoms were indicative of CAD. To conclude, men as well as women should be made more aware of their own risk of developing CAD and of the manifestation of CAD symptoms. Physicians could be encouraged to ask patients more explicitly and thoroughly about their illness beliefs, to check their knowledge and inform them about CAD.     

Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating, and perpetuating factors

This naturalistic study describes potential etiological factors in outpatients with functional neurological symptoms recorded during a screening interview with a single psychotherapist in 59 consecutive patients. The most commonly identified predisposing/precipitating factors were trauma (78.0%), family dysfunction (62.7%), and bereavement (62.7%). Family dysfunction (54.2%) and affective disorder (42%) were the commonest perpetuating factors. Trauma was more common in non-epileptic seizures; health anxiety, in men; family problems, in women. This study demonstrates the heterogeneity of this patient population. Further research is indicated to explore differences in predisposing, precipitating, and perpetuating factors in different patient groups with functional symptoms.     

Predictors of pre-hospital delay among patients with acute myocardial infarction

Objective

To evaluate current literature on predictors of pre-hospital delay among patients with acute myocardial infarction (AMI).

Methods

Medline, CINHAL, and Psych Info databases were searched using keywords: attitude to illness/health, health beliefs, help/health seeking behavior, health behavior, psychosocial factors, treatment delay, socioeconomic factors, time factors, pre-hospital delay, and symptoms. These keywords were combined with AMI to identify literature published during 1995–2008.

Results

Twenty-six data-based research articles were identified. Delay varied across literature and median pre-hospital delay was often reported due to distribution skewness resulting from extremely prolonged values (1.5–15.2 h). Six categories of predictors influenced pre-hospital delay; socio-demographic, symptom onset context, cognitive, affective/psychological, behavioral, and clinical factors. Pre-hospital delay was shortest when the decision to seek healthcare was facilitated by family members or coworkers and when symptoms suggestive of heart attack were continuous and severe.

Conclusion and practice implications

Developing interventions programs to reduce pre-hospital delay for high-risk patients is warranted. Because decision delay is the only modifiable part by intervention, it is recommended that future investigations and interventions attend to decision time as the primary variable of interest instead of combining it with transportation time. Moreover, content of patient education need to emphasize on symptom awareness and recognition, and prompt and proper patient actions for optimum results. Also, in order to eliminate sampling bias resulting from investigating surviving AMI patients, it is recommended that future studies incorporate data from both surviving and surrogates of non-surviving AMI patients.     

Does geographical location influence the phenotype of Fabry disease in women in Europe?

Barba‐Romero M‐Á, Deegan P, Giugliani R, Hughes D. Does geographical location influence the phenotype of Fabry disease in women in Europe? This study examines the relationship between phenotype and geographical location of patients with Fabry disease in Europe. Data were taken from patients enrolled in the Fabry Outcome Survey (FOS), as of October 2007. A modified version of the Mainz Severity Score Index (FOS‐MSSI) was used to classify patients according to the severity of disease. European patients were grouped depending on country of residence (northern or southern European countries). Results are presented from 762 patients enrolled in FOS in Europe (357 men and 405 women); 66% lived in northern and 34% in southern countries. Median age at onset of symptoms of Fabry disease was similar in both sexes. No differences in disease severity were seen among men, according to place of residence; however, women living in northern countries had higher severity scores (p < 0.001) than those in southern countries. In men and women, FOS‐MSSI scores increased with age, irrespective of place of residence. The results suggest that expression of different phenotypic features in Fabry disease in women living in Europe may be influenced by extra‐genetic or epigenetic factors. These factors might be related to dietary or environmental influences that differ according to the patient's country of residence.     

Upper airway edema in 43 patients with hereditary angioedema

BackgroundUpper airway edema (UAE) occurs infrequently in hereditary angioedema (HAE), but still results in significant morbidity and mortality.ObjectiveTo assess patients with HAE and UAE to determine whether unique features exist that can predict the risk of UAE.MethodsClinical, laboratory, and genetic data were compared between 43 patients with HAE and 743 UAE attacks and those without UAE and normal controls after ethics committee approval.ResultsMost patients had their first episode of UAE in the second (25.6%), third (27.9%), and fourth (23.3%) decades of life, and the mean age at onset was 27.3 years. Evolution of UAE from initial to maximum symptoms was 4.6 hours on average, and most cases (69.8%) progressed within 4 hours. Dyspnea was the most frequent manifestation in per-episode (92.2%) and per-patient (97.7%) analyses. Men developed more asphyxiation attacks (19 vs 2) and underwent more tracheotomies (12 vs 2) than did women. UAE was associated with facial edema in half the studied patients. Patients with a positive family history of UAE had a high risk of UAE attacks.ConclusionSymptoms limited to the upper airway should be taken seriously. Dyspnea may be the only manifestation of UAE. UAE attacks most commonly start spontaneously and usually progress rapidly, as quickly as 30 minutes, from awareness of symptoms to maximum airway involvement. Patients with a positive UAE family history are predisposed to UAE attacks, and men appear to be more apt to develop asphyxiation than women.     

Strategies for Managing Osteoarthritis

Background

Although there are recommendations for the management of osteoarthritis (OA), little is known about how people with OA actually manage this chronic condition.

Purpose

The aims of this study were to identify the non-pharmacological and pharmacological therapies most commonly used for the management of hip or knee OA, in a community-based sample of adults, and to compare these with evidence-based recommendations.

Methods

A questionnaire was mailed to 2,200 adult members of Arthritis Queensland living in Brisbane, Australia. It included questions about OA symptoms, management therapies, and demographic characteristics.

Results

Of the 485 participants (192 men, 293 women) with hip or knee OA who completed the questionnaire, most had mild to moderate symptoms. Ninety-six percent of participants (aged 27?C95?years) reported using at least one non-pharmacological therapy, and 78% reported using at least one pharmacological therapy. The most common currently used non-pharmacological strategy was range-of-motion exercises (men 52%, women 61%, p?=?0.05) and the most common frequently used pharmacological strategy was glucosamine/chondroitin (men 51%, women 60%, ns). For the most highly recommended strategies, 65% of men and 54% of women had never attended an information/education course (p?=?0.04), and fewer than half (46% of women and 42% of men, p?=?0.03) were frequent users of anti-inflammatory agents.

Conclusion

The findings suggest that many people with knee or hip OA do not follow the most highly endorsed of the Osteoarthritis Research Society International recommendations for management of OA. Health professionals should be encouraged to recommend evidence-based therapies to their patients.     

Perceptions of cause of illness in acute myocardial infarction patients: a longitudinal study

Objective

To assess change in patient's attributions of illness over the long term in patients with acute myocardial infarction (AMI).

Methods

178 patients were asked during the index hospitalization and 2–2.5 years after discharge whether they thought each of 13 possible factors may have contributed to their illness. Two dichotomous variables, conventional attribution (attribution to traditional risk factors, CA) and psychosocial attribution (PA), were defined and assessed for each patient.

Results

General stress, cigarette smoking, and heredity were the most commonly mentioned attribution for the AMI. The proportion of individuals with positive CA increased at follow up. There was little congruence between patients’ attributions and actual self-reported risk factors, either at baseline or at follow up. Age, education, country of birth, and anxiety were found as independent predictors of illness attribution. The participation in a cardiac prevention and rehabilitation program (CPRP) did not contribute to a significant change in CA attributions.

Conclusion

Substantial proportions of patients have a poor understanding of the causes of their AMI both at onset of the illness and 2–2.5 years later, notwithstanding CPRP.

Practice implications

The health care system can ill afford complacency with regards patient education and understanding.     

Factor VIII activity among young Mexican patients with acute myocardial infarction

BACKGROUND: Atherothrombotic disease is the leading cause of death worldwide. Most casualties are due to acute myocardial infarction (AMI). Patients younger than 45 years account for 5-10% of AMI cases. These patients generally do not display typical atherothrombotic risk factors. METHODS: Our cross-sectional study included adult patients under 45; men and women with AMI were included. A control group of healthy individuals matched for age, sex, and blood group was included to determine the role of several atherothrombotic risk factors on AMI. One hundred and sixty patients were included, the control group was comprised by 77 males (m) and 83 females (f) RESULTS: Our results indicate that 25% of patients (23 m and 18 f) had increased FVIII compared with 8.8% of control subjects. Mean FVIII activity for patients and controls was 134 mg/dl (95%CI=114) vs. 118 mg/dl (95%CI=128-140), respectively (p=0.001). Prevalence of elevated FVIII was higher than the one found for hypertension or diabetes mellitus. HDL cholesterol was higher among patients than controls. Quantitative variables associated with AMI were high FVIII activity, blood monocyte count and HDL cholesterol. CONCLUSIONS: Classical atherothrombotic risk factors do not fully explain AMI events in the young. High levels of FVIII activity is a moderate but common risk factor in young people suffering AMI.     

Circulating immune complexes containing chlamydial lipopolysaccharide in acute myocardial infarction

The presence of circulating immune complexes (IC) was studied using two detection methods specific for chlamydial lipopolysaccharide (LPS) in paired serum samples of 44 patients (30 men and 14 women) with acute myocardial infarction (AMI). Forty-four random controls were individually matched for locality, age and sex with the AMI patients. As specificity controls for the IC assays single serum samples from 29 patients with diseases characterized by the presence of circulating IC were used. Fifty-seven per cent of AMI patients, 12% of their random controls and 10% of the patient controls were shown to have chlamydial LPS-specific immune complexes in their sera (P less than 0.0001, AMI versus random and patient controls). This finding provides further evidence of the possible association of chronic chlamydial infection with AMI.     

The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study

OBJECTIVE: To describe the prevalence of menopausal symptoms, define the mean age of menopause, and determine contributory factors, which influence the experience of symptoms among Singaporean women of different racial groups. DESIGN: Cross-sectional nation-wide study of a random sample of 1000 women drawn from the entire population of Singaporean female (Chinese, Malay, and Indian) citizens between 45 and 60 years of age. Face-to-face interviews using structured questionnaires were conducted. RESULTS: The response rate was 69.9%. The mean age of natural menopause was 49.0 years. This was not significantly different between the three ethnic groups. Increasing parity delayed the age of menopause (P=0.007). Muscle and joint ache was the most commonly reported symptom (52.6%). Although the prevalence of significant hot flushes in the general study population was low (3.9%), it was the most commonly reported complaint by peri-menopausal women (14.6%). Prevalence of significant hot flushes decreased with time from menopause (P=0.007) and completely disappeared beyond the fifth year of menopause. Recent unhappy events were associated with an increased risk of symptoms (P<0.001). Women of Chinese origin experienced a lower risk of menopausal symptoms when compared with other ethnic groups (P<0.05). CONCLUSION: The mean age of menopause was 49.0 years among Singaporean women. Ethnicity and recent unhappy events were two major factors, which influenced the risk of experiencing menopausal symptoms. Among the three ethnic groups studied, Chinese women were the least likely to experience disturbing menopausal symptoms. The overall prevalence of menopausal symptoms was low when compared to studies on women in western societies.     

Pain to hospital times after myocardial infarction in patients from Dalmatian mainland and islands, southern Croatia

Aim

To analyze pre-hospital delay in patients with myocardial infarction from mainland and islands of Split-Dalmatian County, southern Croatia.

Methods

The study included all patients with myocardial infarction transported by ambulance to the University Hospital Split in 1999, 2003, and 2005. Pre-hospital delay was analyzed in the following intervals: pain-to-call, call-to-ambulance, ambulance-to-door, and door-to-coronary care unit interval. Patients were categorized according to the location from which they were transported: Split, mainland >15 km from Split, and islands.

Results

There were 1314 patients (62.9% men) transported and hospitalized for myocardial infarction. Total pre-hospital delay (pain-to-hospital) was significantly reduced from 1999 to 2005 (5.2 hours vs 4.3 hours, P = 0.011). Seventy-five patients (5.7%) were admitted to the coronary care unit within the recommended time-frame of less than 90 minutes, none of which was from the islands, while 248 patients (18.9%) were admitted more than 12 hours from the onset of pain.

Conclusion

Pre-hospital delay in patients with myocardial infarction in southern Croatia is still too long, especially in patients coming from outside of Split. Prognosis and survival of such patients may be improved by introducing changes to the health care system in remote areas, such as out-of-hospital thrombolysis, greater use of telemedicine, training of lay persons and paramedics in defibrillation, introduction of quality assessment mechanisms, and improved patient transport.Coronary or ischemic heart disease (CHD), manifesting as stable or unstable angina pectoris, acute myocardial infarction (AMI), functional heart impairment, cardiac arrest, or sudden heart failure, is the leading cause of death around the world. It affects approximately 17 million people worldwide, including 5 million a year in Europe (1).In Croatia, it was the leading cause of death in 2008, causing one-fifth of all deaths in both women and men (2). From 1979 to 2001, AMI mortality in the capital city of Zagreb was very high: 50% of all patients with AMI died, with 31% being out-of-hospital deaths (3). In the Split-Dalmatia county, primary health care institutions reported 1022 patients with AMI in 2002, and only 391 (38%) of them (249 men and 142 women) were admitted to University Hospital Split (4). We may conclude that 62% of patients did not receive adequate care, a reason for which may be the existence of only one general hospital in Split-Dalmatia County, which is also the only one with a coronary care unit (CCU).The mortality rate of AMI in the first 30 days after the onset of disease ranges from 30-50%, with about half of deaths occurring within the first 2 hours (5,6). In-hospital mortality of AMI in North America has decreased from 25-30% to 7-10% in the past 30 years. This decrease can be attributed to the introduction of CCUs, administration of beta blockers, and introduction of fibrinolytic therapy and percutaneous coronary intervention (PCI) (5,6).The greatest barrier to optimal treatment is the delay between the onset of symptoms and initiation of therapy. This delay is of interest given the time-dependent benefits associated with early use of coronary reperfusion therapy (7). In order to treat AMI effectively, the time span from the onset of the first symptoms to administration of fibrinolytic therapy or PCI, known as pain-to-needle time, should be shorter than 90 minutes (8,9). According to the second Euro Heart Survey on acute coronary syndromes, conducted in 190 medical centers in 32 countries, the median time from symptom onset to arrival to the emergency department in 2004 was 2.8 hours (range, 1.3-7 hours), while median pain-to-call time was 1.75 hours (range, 0.7-5.1 hours) (10).In Split, the average time interval from the onset of myocardial infarction symptoms to arrival to the coronary unit from 1981 to 1987 was 14.8 ± 11.6 hours (range, 2-72 hours). The authors of the study concluded that this interval should be substantially reduced in order to decrease the mortality associated with CHD (11).Pre-hospital delay assessment takes into consideration several intervals: pain-to-call, call-to-ambulance, ambulance-to-door, and door-to-CCU time. Pain-to-call time accounts for the greatest part of pre-hospital delay in urban areas, while the other intervals, which depend on the health care system, are more responsible for pre-hospital delay in rural and remote areas (12).The aim of this study was to analyze pain-to-door time in patients with myocardial infarction from mainland and islands of Split-Dalmatian County, compare it with previous studies, and provide recommendations for more effective practice.     

Poor compensatory function for sleep loss as a pathogenic factor in patients with delayed sleep phase syndrome

OBJECTIVE: Delayed sleep phase syndrome (DSPS) is a condition in which the patient is unable to reset or phase-advance his/her sleep timing properly after transient sleep delay and consequently shows persistent sleep phase delay. Prior studies suggested that DSPS is associated with a phase delay in the circadian pacemaker, but there was no evidence to explain the patient's inability to reset sleep phase. SUBJECTS AND METHODS: We used an ultra-short sleep-wake schedule together with simultaneous measurement of dim light melatonin rhythm after 24-hour sleep deprivation to allow the differential observation of diurnal sleep propensity fluctuation both from circadian and homeostatic aspects in 11 patients with DSPS (17-37 years; 8 men, 3 women) and 15 healthy controls (19-32 years; 8 men, 7 women). SETTING: NA. PATIENTS OR PARTICIPANTS: NA. INTERVENTIONS: NA. RESULTS: DSPS patients showed less ability to compensate for previous sleep loss during their circadian day and first hours of their circadian nighttime determined by dim light melatonin onset compared with controls, while controls compensated for previous sleep loss at most circadian times. Though shapes of dim light melatonin rhythm did not differ between the groups, phase angle between melatonin and sleep propensity rhythms was wider in DSPS patients than in controls. CONCLUSIONS: These findings suggest that poor compensatory function for sleep loss predisposes DSPS patients to failure to reset their sleep phase. Our results provide implications for understanding not only the pathophysiology of DSPS but also the biological basis for why some people can change their sleep schedule easily according to personal or social demands while others cannot.     

Marital status transitions and psychological distress: longitudinal evidence from a national population sample

BACKGROUND: Evidence is conflicting as to whether the association between marital status and psychological distress is due to selection (i.e. distress influences marital status) or causation (marital status influences distress). We investigate: (i) whether differences in psychological distress pre-date marital transitions; (ii) whether levels of distress change following transitions; and (iii) potential mediating and moderating factors. METHODS: Data on psychological distress (indicated by the Malaise Inventory) and marital status at ages 23 and 33 were analysed for 4514 men and 4842 women from the 1958 birth cohort. RESULTS: Higher levels of distress were found among the divorced and lower levels among the single and the married. Selection was seen in the lower initial mean symptoms of those who married (1.69 for men; 2.84 for women) compared to those remaining single (2.41 for men; 3.26 for women). Causation was indicated by the relative deterioration in distress of those who divorced compared to the continuously married (an increase of 0.31 and 0.03 respectively for men), especially in women (a decrease of 0.18 versus 0.71). This was most evident in women who were downwardly mobile and those with children. Recently separated men and women showed especially large increases in distress. CONCLUSIONS: The relationship between marital status and psychological distress involves selection and causation. Findings failed to support ideas of marriage being protective (through social support), or detrimental (through family roles). Divorce increased distress, with both acute and longer-term components moderated by secondary factors such as childcare and declining socioeconomic status.     

Women in academic general surgery.

PURPOSE: To portray the professional experiences of men and women in academic general surgery with specific attention to factors associated with differing academic productivity and with leaving academia. METHOD: A 131-question survey was mailed to all female (1,076) and a random 2:1 sample of male (2,152) members of the American College of Surgeons in three mailings between September 1998 and March 1999. Detailed questions regarding academic rank, career aspirations, publication rate, grant funding, workload, harassment, income, marriage and parenthood were asked. A five-point Likert scale measured influences on career satisfaction. Responses from strictly academic and tenure-track surgeons were analyzed and interpreted by gender, age, and rank. RESULTS: Overall, 317 surgeons in academic practice (168 men, 149 women) responded, of which 150 were in tenure-track positions (86 men, 64 women). Men and women differed in academic rank, tenure status, career aspirations, and income. Women surgeons had published a median of ten articles compared with 25 articles for men (p <.001). Marriage or parenthood did not influence numbers of publications for women. Overall career satisfaction was high, but women reported feeling career advancement opportunities were not equally available to them as to their male colleagues and feeling isolation from surgical peers. Ten percent to 20% of surgeons considered leaving academia, with women assistant professors (29%) contemplating this most commonly. CONCLUSION: Addressing the differences between men and women academic general surgeons is critical in fostering career development and in recruiting competitive candidates of both sexes to general surgery.     

Gender Patterns of Socioeconomic Differences in Premature Mortality: Follow-up of the Hungarian Epidemiological Panel

Background

Gender differences in premature mortality rates and in the size of socioeconomic inequalities in mortality vary across countries.

Purpose

We aimed to quantify the gender differences in the association between socioeconomic status (SES) and premature all-cause mortality and to analyse whether psychosocial factors might associate between SES and mortality among men and women separately in the middle-aged Hungarian population.

Method

Men (n?=?1130) and women (n?=?1529), aged 40–69 years, participants in the Hungarian Epidemiological Panel (2002) were followed up for 3.5 years for total mortality. Cox proportional hazard models were used to evaluate the association between several socioeconomic measures and total death.

Results

During the follow-up, 99 men (8.8%) and 53 women (3.5%) died. The age-adjusted hazard ratios and the Rothman’s synergy indexes showed that each measure of socioeconomic position was more deleterious in men compared with women. When investigating potential explanatory factors for the SES–mortality association, we found that adjustment for severe depression resulted in the most pronounced reduction in the regression coefficients for the association between most socioeconomic factors and male premature death. There was no indication that depression would mediate between SES and mortality in women. Work stress factors, poor lifestyle and low social support also contributed to the explanation of the link between socioeconomic disadvantage and premature death in men.

Conclusion

Middle-aged Hungarian men seem to be considerably more vulnerable to the chronic stress of material disadvantage than women. This effect modification by gender might partly be explained by a stronger connection between low SES and depressive symptoms in men.     

Missed opportunities to impact fast response to AMI symptoms

The potential for reducing cardiovascular disease mortality rates lies both in prevention and treatment. The earlier treatment is administered, the greater the benefit. Thus, duration of time from onset of symptoms of acute myocardial infarction to administration of treatment is important. One major factor contributing to failure to receive efficacious therapy is the delay time from acute myocardial infarction (AMI) symptom onset to hospital arrival. This paper examines the relationship of several factors with regard to intentions to seek care promptly for symptoms of AMI. A random-digit dialed telephone survey (n = 1294) was conducted in 20 communities located in 10 states. People who said they would wait until they were very sure that symptoms were a heart attack were older, reported their insurance did not pay for ambulance services, and reported less confidence in knowing signs and symptoms in themselves. When acknowledging symptoms of a heart attack, African-Americans and people with more than a high school education reported intention to act quickly. No measures of personal health history, nor interaction with primary care physicians or cardiologists were significantly related to intention to act fast. The study confirms the importance of attribution and perceived self-confidence in symptom recognition in care seeking. The lack of significant role of health history (i.e. those with chronic conditions or risk factors) and clinician contact highlights missed opportunities for health care providers to educate and encourage patients about their risk and appropriate action.     

Prolactinomas in men: clinical characteristics and the effect of bromocriptine treatment

Thirty-seven men with prolactin (PRL) producing pituitary adenomas were studied to elucidate if patient's delay might cause the predominance of large tumours in men as compared to women in whom microadenomas predominate. We found two clinical subgroups; one presented with short duration of symptoms, dominated by local signs from the growth of notably large tumours, the other exhibited a long history of disease with hypogonadism as the dominating symptom. There was a correlation between tumour size and PRL levels. The age at the time of diagnosis showed no correlation to duration of symptoms, size of adenoma or PRL levels. Four patients with small adenomas, moderate hyperprolactinemia and short duration of symptoms showed signs of hypergonadotropic hypogonadism. Surgery or irradiation, performed in 14 patients, did not normalize PRL levels. Bromocriptine was equally beneficial in the two clinical subgroups, improving clinical symptoms and normalizing PRL levels in all but three patients. The study shows that the predominance of large tumours in men does not depend on patient's or doctor's delay, but on a high frequency of presumably rapidly growing PRL producing tumours. In the majority of patients, these tumours do not give signs of hypogonadism before the tumour is revealed by local signs of tumour growth.     

Genetic analyses of DSM-IV nicotine withdrawal in adult twins

BACKGROUND: We examined whether there are genetic influences on nicotine withdrawal, and whether there are genetic factors specific to nicotine withdrawal, after controlling for factors responsible for risk of progression beyond experimentation with cigarettes and for quantity smoked (average number of cigarettes per day at peak lifetime use). METHOD: Epidemiologic and genetic analyses were conducted using telephone diagnostic interview data from young adult Australian twins reporting any cigarette use (3026 women, 2553 men; mean age 30 years). RESULTS: Genetic analysis of the eight symptoms of DSM-IV nicotine withdrawal suggests heritability is intermediate for most symptoms (26-43%), and similar in men and women. The exceptions were depressed mood upon withdrawal, which had stronger additive genetic influences in men (53%) compared to women (29%), and decreased heart rate, which had low heritability (9%). Although prevalence rates were substantially lower for DSM-IV nicotine withdrawal syndrome (15.9%), which requires impairment, than for the DSM-IV nicotine dependence withdrawal criterion (43.6%), heritability was similar for both measures: as high as 47%. Genetic modeling of smoking more than 1 or 2 cigarettes lifetime ('progression'), quantity smoked and nicotine withdrawal found significant genetic overlap across all three components of nicotine use/dependence (genetic correlations = 0.53-0.76). Controlling for factors associated with risk of cigarette smoking beyond experimentation and quantity smoked, evidence for genetic influences specific to nicotine withdrawal (up to 23% of total variance) remained. CONCLUSIONS: Our results suggest that at least some individuals become 'hooked' or progress in the smoking habit, in part, because of a vulnerability to nicotine withdrawal.     

The menopausal experience of Greek women living in Sydney

OBJECTIVE: This study was undertaken to investigate the menopausal experience of Greek women as part of a wider survey of four immigrant groups living in Sydney, Australia (the others being Indian, Arabic, and Chinese) and to examine the relationship between common symptoms and various sociodemographic factors. DESIGN: A total of 217 women were interviewed about their menopausal experiences by experienced health workers using the 29-item Menopause-Specific Quality of Life questionnaire. RESULTS: A total of 217 women participated in the survey. The mean age at menopause for postmenopausal women was 48.6 years (95% CI: 47.7-49.5). More than 96% of the women had lived in Sydney for more than 20 years. A majority (57%) had only received primary education. It was found that the most commonly reported symptoms related to feelings of fatigue (66%) and a decrease in physical strength and stamina (>60%), and nearly as many (59%) complained of lower backache. Fifty percent of the women also complained of psychosocial symptoms, such as feeling nervous and memory loss. Hot flushes were reported by 43%, which is similar to other ethnic groups. The prevalence of vaginal dryness was 79.2% for postmenopausal Greek women in our study. CONCLUSION: Significant findings were found for retired Greek women in the pre- or perimenopausal stage and with psychosocial symptoms (P<0.05); there was also an association between postmenopausal obese and married women with sexual problems (P<0.05).     

Genetic and environmental influences on obsessive-compulsive symptoms in adults: a population-based twin-family study

BACKGROUND: The contribution of genetic factors to obsessive-compulsive (OC) symptoms has not been examined using a large population-based sample of adults. Furthermore, the extent to which there are qualitative and quantitative differences in genetic architecture between men and women with OC symptoms has not been elucidated. METHOD: We obtained the Young Adult Self Report Obsessive-Compulsive Scale (YASR-OCS) from a group of 5893 monozygotic (MZ) and dizygotic (DZ) twins, and 1304 additional siblings from the population-based Netherlands Twin Register. Structural equation modelling was used to decompose the variation in OC behaviour into genetic and environmental components and analyse quantitative and qualitative sex differences. RESULTS: Familial resemblance was the same for DZ twins and non-twin siblings, which means that there was no evidence for a special twin environment. The same genetic risk factors for OC behaviour were expressed in men and women. Depending on the choice of fit index, we found small (39% for men and 50% for women) or no sex differences (47% for both men and women) in heritability. The remaining variance in liability was due to individual-specific environment. CONCLUSIONS: OC behaviour showed a moderate heritability. At most, small quantitative sex differences were found in the genetic architecture of OC behaviour, and no qualitative sex differences.