Spousal concordance for substance use and anxiety disorders

Assortative mating -- the tendency for mate selection to occur on the basis of similar traits -- plays an essential role in understanding the genetic contribution to psychiatric illness. It also carries significant impact on clinical prognosis and is an important mechanism explaining spousal concordance. This study uses a family study design ascertaining 225 probands with substance abuse/dependence, anxiety disorders, and controls to address: (1) Is there spousal concordance or cross-concordance for substance use and/or anxiety disorders? (2) Is the spousal concordance or cross-concordance associated with worse clinical outcomes? (3) What is the mechanism of the concordance or cross-concordance? Results show a high magnitude of spousal concordance for substance use disorders with a third of the substance probands' spouses also substance dependent. In contrast, there was no spousal concordance for anxiety disorders. Couples were also concordant for having "no disorders." Both substance use and anxiety disorder concordance were associated with poorer global functioning and persistent illness. Assortative mating is a likely mechanism for spousal concordance given the elevated rate of substance use disorders among the relatives of spouses' of substance probands. Implications for family/genetic studies and the transmission of substance use disorders and "no disorders" include: (1) at the individual level, spousal concordance influences probands' course of illness, couples' marital functioning, and offspring's genetic and environmental context; and (2) at the population level, it shifts the general distribution of substance use disorders and "no disorders" by reducing the "average" couple concordance and increasing the number concordant and discordant couples at extremes of the distribution.     

Pesticide poisonings at a tertiary children's hospital in South Africa: an increasing problem

Context.?Exposure of children to pesticides and overt poisoning are an increasingly important problem in South Africa. Objective.?This study describes the profile of acute paediatric pesticide exposures and poisonings presenting to Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town South Africa from 2003 to 2008, identifies those poisonings due to illicit pesticides sold on the streets (“street pesticides”) and assesses the number of incidents in which the statutory requirement of notification to the local health authority is met. Methods. Cases were identified by review of the RCWMCH case and notification records and the local health authority notification records. Results. There were 306 patients with 311 incidents of acute pesticide exposure or poisoning. This represents 11% of all paediatric exposures and poisonings (N?=?2868) seen over the 6-year period. The number of pesticide incidents increased annually. Two hundred seventy-eight (91%) children were under 6 years old and 164 (54%) were males. Two hundred seventeen (70%) patients came from six socio economically diverse suburbs in the Cape Town Metropole, each of which ranges from informal settlements with extreme poverty to formal housing with lower to middle class populations. There was a summer predominance of acute pesticide exposures and poisonings. The commonest group of pesticides were 203 cholinergics (includes organophosphates and carbamates), 35 anticoagulants and 45 unknowns. One hundred incidents were classified as exposures as they were asymptomatic. Two hundred eleven symptomatic incidents, termed pesticide poisonings, required admission; 121 to High Care or Intensive Care Unit (ICU). The median length of stay in hospital was 3 days (range 0–52). There were 6 (2%) deaths. The large group of cholinergic exposures and poisonings (203) required 195 (96%) admissions; 120 (59%) to High Care or ICU. Of the 44 “street pesticide” exposures and poisonings, 33 were cholinergic poisonings and 21 required High Care or ICU. Eighty-seven (41%) of 211 poisonings requiring notification were recorded at the local health authority; all were instances of cholinergic poisoning. Conclusion.?The increasing number and the morbidity and mortality of acute paediatric pesticide exposure and poisoning is of great concern. Furthermore, the magnitude of the problem is masked by inadequate notification with the relevant health authorities.     

Spousal influence on smoking behaviors in a US community sample of newly married couples

Among married couples, partners often have similar characteristics and behaviors. Among individuals who smoke cigarettes, it is not uncommon for them to have a partner who also smokes. In fact, having a partner who smokes can influence the spouse's initiation of smoking, or return to smoking after a previous quit attempt. Additionally, it is possible that a nonsmoking partner can influence his/her spouse to stop smoking. Participants for this research are from a community sample of couples in the United States. They were recruited at the time they applied for their marriage license and followed through to their second wedding anniversary. Logistic regression models, controlling for demographics, were utilized to determine if a partner's smoking status predicted smoking initiation or relapse over the early years of marriage. Overall, there was some support that a partner's smoking status did influence the other's smoking, although more support was found for spousal influence on relapse than cessation. There was more support for husband's influence compared to wife's influence, nonsmoking wives were more likely to resume smoking in the early years of their marriage if their partners were smokers. Wives' smoking, however, did not predict husband initiation of smoking. These findings suggest that during the transition into marriage, spouses do influence their partners' behaviors. In particular, women are more likely to resume smoking, or return to smoking if their partners smoke.     

Comparison of two assessment tools of antidepressant side-effects: UKU scale versus spontaneous notification

BACKGROUND AND AIM OF THE STUDY: Overall, the efficacy of the newer antidepressants: serotonin selective reuptake inhibitors (SSRI), selective serotonin/norepinephrine reuptake inhibitor (SNRI), noradrenergic and specific serotonergic antidepressant (NaSSA) and tianeptine is similar to that of the tricyclics, and so their acceptability/safety becomes a selection criterion for the clinician. However, side-effect assessment comes up against several difficulties: distinguishing between somatic symptoms caused by the depression and those caused by the treatment -- which assessment tool to use (spontaneous notification, standardized scales that are not specific for the side effects caused by psychotropic drugs, standardised scales specific for the side effects caused by psychotropic drugs, meta-analysis, etc.) -- which data sources to consult (anecdotal reports, reviews, prospective studies), and which data set to use, etc. As a result, the question of the exhaustiveness and reliability of the data consulted by the clinician can arise. We therefore conducted a comparative study in patients treated with these newer antidepressants, of 2 antidepressants side-effect assessment tools: spontaneous notification (SN) versus the UKU scale, a standardised scale specific for the side effects of psychotropic drugs. METHODOLOGY: The depressed outpatients were selected from a psychiatric unit in a French psychiatric hospital and from a non-hospital consulting room. The main inclusion criteria were: male or female subjects, suffering from major depression without melancholia or psychotic features or suffering from mood disorders (according to DSM IV criteria), who had been treated for at least 4 weeks with one of the newer antidepressants. The main exclusion criteria were: any other psychiatric disorder, a serious physical disorder, treatment with neuroleptics, mood-changing drugs or other antidepressants, and patients who were not able to understand the questionnaire. The investigation was carried out by a clinical pharmacist. RESULTS: Fifty patients were included in the study. There were 18 men and 32 women. The mean age was 53.5 15.9 years [22 - 77], the mean period of treatment was 24 30.5 months [1 - 127] and 52% of the patients received concomitant medication with anxiolitic or hypnotic drug(s). The percentage of patients who reported at least one side effect was significantly higher for the UKU scale than for SN (84% vs 58%, p<0.01). The ratio between SN and UKU scale scores was 2/3. A similar pattern was found for the total number of side effects (n=177 vs n=47, p<0.001). The ratio between the total number of side effects for the SN and UKU scale was 1/4. The side effects were divided into five subgroups: psychiatric, neurovegetative, sexual, neurological and others. In all these subgroups, the number of side effects reported was significantly higher when the UKU scale was used than when SN was used. The values were as follows: psychiatric (n=44 vs n=15, p<0.001), neurovegetative (n=59 vs n=15, p<0.001), sexual (n=36 vs n=10, p<0.001), neurological (n=11 vs n=2, p<0.001) and other side effects (n=27 vs n=5, p<0.001). Nineteen side effects were only reported when SN was used (for example: dry eyes, incompatibility with alcohol, euphoria...). Twenty-four side effects were only reported when the UKU scale was used (for example: increased libido, loss of bodyweight...). The side effects had no impact on daily life in most of 80% of the patients; there was no significant difference between the patient's assessment of the discomfort caused by side effects and the clinician's assessment. In 90% of cases, the side effects did not lead to any change in the treatment. DISCUSSION: The findings of this study show that the collection of data regarding side effects depends on the assessment tool used: the number of side effects reported was significantly higher when the UKU scale was used than when SN was used. However, this finding must viewed with caution, because it has been showed that checklists can induce symptoms in suggestible patients. Neurovegetative troubles are the most commonly reported side effects, and neurological troubles the least often reported. This matches the tolerability profile of these antidepressants. The disorders that were least frequently spontaneously reported were the neurological, sexual and "other" side effects. These emerged only when the clinician asked the patient about them. The 19 side effects that were only reported when SN was used were side effects that were not included in the UKU scale or that had not been present during the three days before we started the investigation. The 34 side effects that were only reported when the UKU scale was used were either side effects with no apparent link with the treatment (for example: micturition troubles) or embarrassing effects (such as increased libido). CONCLUSION: Our findings show that the collection of data on side effects depends on the assessment tool used. These findings need to be confirmed by large-scale comparative studies, and the standardization of the assessment of side effects is a question that needs to be raised.     

The daily impact of pain from metastatic breast cancer on spousal relationships: A dyadic electronic diary study

Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. Although individuals often rely on their intimate partners to provide physical and emotional support when they are in pain, the daily impact of pain on the spousal relationship in the context of advanced cancer is unclear. To understand how relationships are affected by pain, 57 MBC patients and their partners completed electronic diary assessments 6 times a day for 14 days. Patients and partners rated the patient’s pain, their own mood (circumplex adjectives), the provision/receipt of social support, and the degree to which cancer interfered with their relationship. Multilevel mediation models with the couple as the unit of analysis were estimated. Partners and patients reported greater relationship interference when patients experienced more pain and less aroused (i.e., more tired, less peppy, less active) mood. Greater tired mood during the day accounted for 17% and 82% of the association between patients’ morning pain and their evening ratings of emotional and physical support from their partners, respectively. Partners did not directly respond to patients’ pain by providing emotional or physical support; however, they were more likely to provide support when patients experienced more tired and less active mood as a consequence of their pain. Results suggest that one way that pain may wear on couples’ relationships is through its adverse effects on patients’ daily mood. They also suggest that partners may base their provision of support on their perception of the adverse effects of pain on patients’ aroused mood.     

Spousal health and older adults’ biomarker change over six years: Investigation of gender differences

ObjectiveRelationship of spousal health and biomarkers over six years were examined.Methods and materialsNationally representative sample of 483 adults aged 54+ in Taiwan were followed for six years. Four classes of spousal health changes and three categories of biomarker indexes were examined. Biomarkers were assessed by counting the adverse progression on items of allostatic load (AL), cardiovascular disease biomarkers (CVD), and metabolic syndromes, respectively.ResultsWhen the health status of an individual’s spouse became worse, women increased their AL by 0.48 (P < 0.05), CVD by 0.56 (P < .001), and metabolic syndrome by 0.43 (P < 0.05). If the health status of a woman’s spouse remained poor, it increased her allostatic load by 0.60 (P < 0.05). These effects were only observed in women. In addition, when the health status of a men’s spouse became better, man’s biomarker profile on AL significantly improved by 0.80 (P < 0.05). No significant moderating effect of education was observed in this sample.ConclusionsMarried couples display concordance in both physical and mental health-related biomarkers, specifically, allostatic load. Women were more likely than men to experience adverse biomarker progress on all the biomarkers examined in this study when the status of their spouse became worse based on their subjective judgment, and men were more sensitive to positive health changes in their spouse than women.     

Regulatory pathways to the market: an overview

This paper presents an overview of the U.S. Food and Drug Administration's regulatory requirements for introducing medical device and diagnostic products into commercial distribution in the United States. For any specific product, the requirements vary depending upon the product's associated risks, classification, and when it or a similar product was first introduced into commercial distribution. Regulatory pathways available and/or required for a manufacturer to introduce a medical product into the U.S. marketplace are outlined.     

Estimating Increased Electronic Laboratory Reporting Volumes for Meaningful Use: ?Implications for the Public Health Workforce

Objective: To provide formulas for estimating notifiable disease reporting volume from ‘meaningful use’ electronic laboratory reporting (ELR). Methods: We analyzed two years of comprehensive ELR reporting data from 15 metropolitan hospitals and laboratories. Report volumes were divided by population counts to derive generalizable estimators. Results: Observed volume of notifiable disease reports in a metropolitan area were more than twice national averages. ELR volumes varied by institution type, bed count, and by the level of effort required of health department staff. Conclusions: Health departments may experience a significant increase in notifiable disease reporting following efforts to fulfill meaningful use requirements, resulting in increases in workload that may further strain public health resources. Volume estimators provide a method for predicting ELR transaction volumes, which may support administrative planning in health departments.     

The effect of spousal communication on contraceptive use in Central Terai, Nepal

Objective

Family planning has several social and health benefits; it can reduce maternal mortality and the number of unplanned pregnancies, as well as increase educational and economic opportunities [1] and [2]. Utilizing quantitative data from an endline household survey (July 2009) and data from focus group discussions, the Centre for Development and Population Activities (CEDPA) seeks to determine whether spousal communication increases contraceptive use among married women of child-bearing age in Nepal's Central Terai region.

Methods

Quantitative household survey and qualitative focus group discussions.

Results

Women who discuss family planning with their husbands (OR = 7.254), perceive husband approval on family planning (OR = 5.558) and have born a son (OR = 2.239) are more likely to use a modern contraceptive method. Qualitative data show that several other considerations can be motivating factors for contraceptive uptake.

Conclusion

While results do not explain the direction of causality, it is clear that spousal discussion and partner approval are significant in a woman's decision to use modern contraceptives in the Central Terai region of Nepal.

Practice implications

More research needs to be conducted on the effect of spousal communication and contraceptive use, in particular, the role of frequency, quality, and content of spousal communication, as well as individual motivations.