摘要:

Ethnicity impacts the course of illness and medical treatment. There are enormous ethnic differences in care delivered to patients who are treated for pain. However, in addition to these social forces, there are enormous ethnic differences in physiological response to stimuli as diverse as diet, exposure to agonist infusions, or habitual patterns of response to stressors. The author’s clinical research studies on this topic for the last 20 years are reviewed in this article.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Current medical diagnosis reflects the prevailing biomedical model of disease. A need exists for a new system of diagnosis that, instead, is based on the psychosomatic model. This article presents an analysis of the underlying framework of the multiaxial system developed in recent years for diagnosis in Psychiatry that indicates its relevance to the psychosomatic model. It goes on to describe a new multiaxial system of diagnosis derived from that analysis that allows diagnosis to be stated as a process of adaptation in the environment, which includes biological, psychological, and social factors. The practical application of this system to the broad range of medical illnesses is explained and illustrated. This multiaxial approach represents a first step toward, and a stimulus for, the development of a better diagnostic system that can provide one basis for the crucial transformation of medical care to reflect the psychosomatic model of disease.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Research on ulcer psychosomatics has plummeted since the early 1970s, to the applause of many who argue that ulcer is simply an infectious disease. The purpose of this article is to discuss the relevance of ulcer psychogenesis in the age ofHelicobacter pylori.Methods:A critical literature review was conducted.Results:There is a substantial and methodologically sound body of prospective studies linking stress with the onset and course of peptic ulcer. Psychosocial factors can be estimated to contribute to 30% to 65% of ulcers, whether related to nonsteroidal antiinflammatory drugs,H. pylori, or neither. The observed association between stress and ulcer is accounted for, in part, by recall bias, misreported diagnoses, and confounding by low socioeconomic status (a source of stress and of ulcer risk factors, such asH. pyloriand on-the-job exertion) and by distressing medical conditions (which lead to use of nonsteroidal antiinflammatory drugs). Of the residual, true association, a substantial proportion is accounted for by mediation by health risk behaviors, such as smoking, sleeplessness, irregular meals, heavy drinking, and, again, nonsteroidal antiinflammatory drugs. The remainder results from psychophysiologic mechanisms that probably include increased duodenal acid load, the effects of hypothalamic-pituitary-adrenal axis activation on healing, altered blood flow, and impairment of gastroduodenal mucosal defenses.Conclusions:Peptic ulcer is a valuable model for understanding the interactions among psychosocial, socioeconomic, behavioral, and infectious factors in causing disease. The discovery ofH. pylorimay serve, paradoxically, as a stimulus to researchers for whom the concepts of psychology and infection are not necessarily a contradiction in terms.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The objective of this study was to test the hypothesis that negative affect is a prospective risk factor for hypertension among white and black persons.Methods:A population-based cohort of 3310 initially normotensive and chronic disease–free persons in the NHANES I Epidemiologic Follow-up Study was tracked through four follow-up waves (maximum, 22 years). The association between hypertension and baseline negative affect was analyzed using Cox proportional hazards regression, adjusting for baseline age, sex, race, education, smoking, alcohol use, diastolic and systolic blood pressure, body mass index, and change in body mass index as a time-dependent covariate. Negative affect was based on combined symptoms of depression and anxiety. Hypertension end points included 1) self-reported, 2) treated (prescription of antihypertensive medications), and 3) incident (blood pressure ≥160/95 mm Hg or treated) hypertension. Blood pressure measurements were obtained only at baseline and the first follow-up examination (maximum, 13 years).Results:Increased negative affect was associated with elevated risk for self-reported, treated, and incident hypertension at first follow-up. Through four waves of follow-up, high negative affect was associated with treated hypertension in baseline risk–adjusted models for white women (relative risk [RR] = 1.73, 95% confidence interval [95% CI] = 1.30–2.30), black women (RR = 3.12, 95% CI = 1.24–7.88), and all men (RR = 1.56, 95% CI = 1.08–2.25). Time-dependent covariate models produced similar RRs.Conclusions:Negative affect is predictive of development of hypertension. For treated hypertension, white women and all men with increased negative affect had similarly elevated RRs, whereas black women with increased negative affect had substantially higher RRs.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The purpose of this study was to examine whether several aspects of hostility as measured by the Cook-Medley Hostility Scale (ie, aggressive responding, hostile affect, cynicism, and overall hostility score) were determined in part by family factors (ie, genes and/or familial environments).Methods:Analyses were based on 680 European-American families (2525 individuals) from the NHLBI Family Heart Study (FHS), a population-based study of genetic and nongenetic determinants of CHD, atherosclerosis, and cardiovascular risk factors. The influence of family relationships, age, and education on the variation in each of the four hostility scores were estimated.Results:Significant familial resemblance in all hostility scores was found, accounting for 42% of the variance in total hostility, 30% in cynicism, 38% in aggressive responding, and 18% in hostile affect. Very little of this resemblance could be explained by similarities in education. Familial resemblance for cynicism was solely due to significant parent-offspring and sibling correlations (ie, no spouse resemblance), suggesting the possibility of genetic influences. Gender and generation differences were also evident in the familial correlations.Conclusions:Hostility aggregates in families. Both family environmental and genetic sources of resemblance are suggested for hostility.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity. We set out to establish whether middle-aged men with chronically low cholesterol levels (≤4.5 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar comparison was also made for measures of anger, hostility, and impulsivity.Methods:Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990–1991. These levels were remeasured in 1993–1994. Only those whose cholesterol level remained in the same range were included in the study. Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire.Results:Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score ≥15 or ≥17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases. No differences in anger, hostility, and impulsivity were observed between the two groups.Conclusions:Men with a lower cholesterol level (≤4.5 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter. These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID