Psychiatric service utilization differences by sex and locale

Underutilization of psychiatric services by men relative to women may reflect discrepancies between the male sex role in Western societies and the patient role. We hypothesize that this will be more important in a rural than a nonrural setting for two reasons. First, the relative lack of anonymity in a rural setting makes more evident incongruities between sex role conventions and actual behaviour. Second, because of the increased cultural heterogeneity of urban areas, traditional sex roles are less clearly delineated. These considerations suggest that the ratio of males to females receiving treatment in a rural setting should be lower than in a nonrural setting. It was found that for treated incidence the ratio of males to females was significantly lower in a rural than in a non-rural setting (p less than .01); for treated prevalence a lower male to female ratio was found in the rural than the nonrural setting, although this did not achieve statistical significance.     

Oral health and the quality of life.

The study of the impact of oral diseases and conditions on individuals and societies has been slow to develop but has made major progress during the 1980s. Not only did improvements in understanding oral quality of life require developing and using more social and behavioral outcome measures, it required reassessing clinical indices. Reports on oral quality of life to date are often based on investigations that originally had other purposes; consequently there is inconsistent evidence about the associations among oral health, general health, and quality of life. In fact, in much of the cited literature the evidence is equivocal. Yet, in more recent research designed specifically to investigate quality of life (Meei-Shia Chen, PhD, personal communication, 1991), it is evident that orofacial conditions, diseases, and pain can be disruptive and can have considerable impacts at both the individual and societal levels in terms of reduction in normal activities; conversely, medical and social conditions can affect oral health. It is notable that across studies there is an incongruence between health care professional and patient assessments of quality of life--they view the issues differently. Although oral diseases are very prevalent, the early symptoms are often not severe, leading many individuals to disregard them, or if acknowledged, to define them as normal or unimportant. This may reflect a form of fatalism, i.e., their oral health is as good as could be expected. It is necessary to assess oral health and quality of life over time. Individuals indicating satisfaction or dissatisfaction with appearance, function, and self-esteem at one point in time are doing so against a framework of immediate or long-term expectations. In regard to specific procedures, such as surgery or dentures, it is necessary to know what the individual expects if the health care professional is to provide improvements in perceived and actual quality of life. Similarly, it is difficult to provide meaningful interpretation of self-assessed physical and social functioning and appearance against clinical measures, if the level of earlier dysfunction is not known. For example, in the case of full denture wearers, the evidence might be interpreted to suggest that these individuals have excellent oral quality of life. Without taking into account the extent of physical and social dysfunction and poor appearance prior to the dentures, and the consequent improvement against this base, it is impossible to evaluate and consequently improve quality of life. Understanding this process requires longitudinal studies.(ABSTRACT TRUNCATED AT 400 WORDS)     

The estimated direct medical cost of sexually transmitted diseases among American youth, 2000

CONTEXT: Each year, millions of U.S. youth acquire sexually transmitted diseases (STDs). Estimates of the economic burden of STDs can help to quantify the impact of STDs on the nation's youth and on the payers of the cost of their medical care.
METHODS: We synthesized the existing literature on STD costs to estimate the lifetime medical cost per case of eight major STDs–HIV, human papillomavirus (HPV), genital herpes simplex virus type 2, hepatitis B, chlamydia, gonorrhea, trichomoniasis and syphilis. We then estimated the total burden of disease by multiplying these cost-per-case estimates by the approximate number of new cases of STDs acquired by youth aged 15–24.
RESULTS: The total estimated burden of the nine million new cases of these STDs that occurred among 15–24-yearolds in 2000 was $6.5 billion (in year 2000 dollars). Viral STDs accounted for 94% of the total burden ($6.2 billion), and nonviral STDs accounted for 6% of the total burden ($0.4 billion). HIV and HPV were by far the most costly STDs in terms of total estimated direct medical costs, accounting for 90% of the total burden ($5.9 billion).
CONCLUSIONS: The large number of infections acquired by persons aged 15–24 and the high cost per case of viral STDs, particularly HIV, create a substantial economic burden.     

Psychologic and physiologic aspects of acute dyspnea in asthmatics

The purpose of this study was to compare psychologic and physiologic variables during intense dyspnea to those at times of no or low dyspnea in people with asthma. Thirty-six adults ranging from 19 to 76 years old were tested when they first came to the emergency department in acute dyspnea and again when they had no or low dyspnea just prior to discharge. Clinical signs found to be higher during high dyspnea than low dyspnea were respiratory rate, pulse, wheezing, and accessory muscle use. Peak expiratory flow rates and oxygen saturation were significantly lower, while anxiety, depression, somatization, and hostility were higher during times of high dyspnea. The panic/fear, fatigue, dyspnea, hyperventilation/hypocapnia, congestion, and rapid breathing subscales of the Asthma Symptom Checklist were also higher during high dyspnea compared to low dyspnea.     

Risk-based versus alternative algorithms for antibiotic prophylaxis among women seeking early suction abortion: a cost-effectiveness simulation.

BACKGROUND: Particularly in resource-poor settings, simple, inexpensive, and cost-effective algorithms are needed to direct antibiotic prophylaxis to prevent sequelae of infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis-associated organisms among women undergoing abortion. GOAL: To assess the prevalence of and risk factors for infections among women seeking abortion in Bali, Indonesia, and to use these data in designing a cost-effective risk-based prophylaxis algorithm. STUDY DESIGN: A cross-sectional analysis and data-based simulation of risk-based and alternative prophylaxis algorithms were performed. RESULTS: The risk-based algorithm would have provided prophylaxis to 70% (95% CI, 53-83%) of women with cervical infection, 64% (95% CI, 54-74%) of those with bacterial vaginosis, and 57% (95% CI, 42-72%) of those with trichomoniasis. For cervical infection, the algorithm was more cost effective than all others evaluated. The cost-effectiveness was acceptable for bacterial vaginosis. CONCLUSIONS: Risk-based algorithms may be cost effective in identifying women likely to benefit from preabortion prophylaxis. Prospective evaluation is needed to validate these findings.     

Social class and psychiatric disorder. The examination of an extreme

Relationships between social status and various aspects of mental disorder have been of long-standing interest to both clinicians and researchers, and a large body of literature exists attesting to the importance of social status in understanding psychiatric illness and disability. Reports examining social status and schizophrenia suggest that relationships between socioeconomic status and psychiatric illness may rest heavily upon differences between the lowest socioeconomic stratum and the remainder of society. To investigate the extent to which relationships between socioeconomic status and psychiatric illness and disability reflect differences between a deviant lowest socioeconomic stratum and the remainder of society, data from 217 patients hospitalized for psychiatric disorder and reassessed at a 2-year follow-up were examined. At initial assessment, 17 patient characteristics were found to be associated with socioeconomic status; for seven of these 17 characteristics, the largest difference between classes was found between the lowest and the adjacent (next-lowest) social class. At follow-up, for five of 15 characteristics found to be related to social class, the greatest interclass difference occurred between the lowest and the adjacent social class. Both initially and at follow-up, significant associations between patient characteristics and social class remained when the lowest social class patients were excluded from the analyses.     

Life events and psychopathology severity: comparisons between psychiatric outpatients and inpatients

Relationships between life events stress variables and seven indices of psychopathology severity for a group of 97 never-hospitalized outpatients were compared with those of a previously studied group of 217 first-admission functional disorder psychiatric inpatients from the same geographical catchment areas. The hypotheses tested were that degree of life events stress would be correlated positively with indices of psychopathological severity and that the magnitudes of association would be higher for the outpatients. Bivariate correlations and stepwise multiple regression with other potential demographic and prognostic moderator variables provided evidence for significant, but somewhat differing, patterns in outpatient vs. inpatient stress/pathology relationships. Contrary to prediction, the magnitudes of significant and near-significant associations between life events and pathology severity were not different in the two samples.