Sociocultural influences and care of dying children in Japan and the United States

Depression is a common cause of sexual dysfunction, but also antidepressant medication is often associated with sexual side effects. This article includes two related studies. The first double-blind, placebo-controlled study was conducted in men with lifelong rapid ejaculation and aimed to assess putative differences between the major selective serotonin reuptake inhibitors (SSRIs) (fluoxetine, fluvoxamine, paroxetine, and sertraline) with regard to their ejaculation-delaying effect. Sixty men with an intravaginal ejaculation latency time (IELT) of 1 minute or less were randomly assigned to receive fluoxetine 20 mg/day, fluvoxamine 100 mg/day, paroxetine 20 mg/day, sertraline 50 mg/day, or placebo for 6 weeks. During the 1-month baseline and 6-week treatment periods, the men measured their IELT at home using a stopwatch. The trial was completed by 51 men. During the 6-week treatment period, the geometric mean IELT in the placebo group was constant at approximately 20 seconds. Analysis of variance revealed a between-groups difference in the evolution of IELT delay (p = 0.0004); in the paroxetine, fluoxetine, and sertraline groups there was a gradual increase to about 110 seconds, whereas in the fluvoxamine group, IELT was increased to only approximately 40 seconds. The paroxetine, fluoxetine, and sertraline groups differed significantly (p < 0.001, p < 0.001, p = 0.017, respectively) from placebo but the fluvoxamine group did not (p = 0.38). Compared with baseline, paroxetine exerted the strongest delay in ejaculation, followed by fluoxetine and sertraline. There was no clinically relevant delay in ejaculation with fluvoxamine. In men with lifelong rapid ejaculation, paroxetine delayed ejaculation most strongly, whereas fluvoxamine delayed ejaculation the least. The second double-blind, placebo-controlled study was carried out in men with lifelong rapid ejaculation (IELT < or = 1 minute) and in men with lifelong less-rapid ejaculation (IELT > 1 minute) to investigate whether data about SSRI-induced delayed ejaculation in men with rapid ejaculation may be extrapolated to men with less-rapid ejaculation. After measurement of IELT at home (using a stopwatch) during a 1-month baseline assessment, 32 men with an IELT of 1 minute or less (group 1) or more than 1 minute (group 2) were randomly assigned to receive paroxetine 20 mg/day or placebo for 6 weeks in a double-blind manner. Patients continued to measure their IELTs at home during the 6 weeks of the study. At baseline, 24 patients consistently had IELTs of one minute or less (group 1), and eight patients had IELTs of more than 1 minute (group 2). The geometric mean IELT was 14 seconds in group 1 and 83 seconds in group 2. Twelve patients in group 1 and five in group 2 were randomized to the paroxetine 20 mg/day. The percentage increase in the geometric mean IELT compared with baseline in patients treated with paroxetine was 420% (95% confidence interval [CI], 216-758%) in group 1 and 480% (95% CI, 177-1,118%) in group 2 (p = 0.81). After 6 weeks of treatment with paroxetine, the geometric mean IELT was 92 seconds in group 1 and 602 seconds in group 2 (p < 0.001). Therefore, the paroxetine-induced percentage increase in IELT seems to be independent of the baseline IELT. This suggests that ejaculation-delaying side effects of some SSRIs investigated in men with lifelong rapid ejaculation may be generalized to men with less-rapid ejaculation.     

Reciprocal models of child behavior and depressive symptoms in mothers and fathers in a sample of children at risk for early conduct problems.

Although much has been written about transactional models in the study of parenting practices, relatively few researchers have used this approach to examine how child behavior might be related to parental well-being. This study used latent growth curve modeling to test transactional models of age 2 child noncompliance, parental depressive symptoms, and age 4 internalizing and externalizing behaviors using a subsample of families in the Early Steps Multisite Study. In unconditional models, maternal depressive symptoms showed a linear decrease from child ages 2 to 4, whereas paternal depression did not show significant change. Observed child noncompliance at age 2 showed significant associations with concurrent reports of maternal depressive symptoms and trend-level associations with paternal depressive symptoms. For both parents, higher levels of initial depressive symptoms were related to increased age 4 child internalizing behaviors. The findings provide support for reciprocal process models of parental depression and child behavior, and this study is one of the first to present empirical evidence that fathers' depressive symptoms have bidirectional associations with their children's behavior in early childhood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of adaptive assertiveness in Mexican and United States children.

Used a novel behavioral task, the assertiveness pull scale, and unobtrusive measures (e.g., number of questions asked of E) to assess the development of assertiveness of 154 boys and girls of 3 age groups (5-6, 7-9 and 10-12 yrs) in 4 populations. Urban middle-class Anglo-American children were significantly more assertive than semirural poor Anglo-American and Mexican-American children, who did not differ from each other but who were both significantly more assertive than rural poor Mexican children. Assertiveness increased with age for all groups, but at a slower rate among rural Mexican than among US children. No significant effects due to sex were observed. Results parallel population and age findings of previous studies of competitiveness. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disaster-related psychiatric care system in the United States

We report herein the case of a 57-year-old man in whom malignant lymphoma originating in the gastric remnant was confirmed 25 years after a subtotal gastrectomy with Billroth II reconstruction had been performed for gastric ptosis. Gastroscopy revealed an ulcerated tumor on the fornix, and histologic examination of the endoscopic biopsy specimens demonstrated malignant lymphoma. Thus, total gastrectomy with splenectomy, pancreatectomy, and resection of the previously anastomosed jejunal stoma were performed. Histologic examination of the stomach remnant confirmed a diagnosis of B-cell lymphoma of the large-cell type. Although we were unable to study the surgical specimen from the initial operation, the possible relationship between pseudolymphoma and malignant lymphoma has been presented in the literature, which is reviewed following this case report.     

Syndromal structure of psychopathology in children of Thailand and the United States.

Are the syndromes of child psychopathology similar across cultures? Yes, in most comparisons of Western cultures. Here the authors compared Thailand and the United States, Eastern and Western cultures differing markedly in racial/ethnic composition, religious-philosophical traditions, and beliefs and practices regarding children. Exploratory factor analysis and a useful kappa approach were used to compare Child Behavior Checklist factor structure in Thai and American children aged 6 to 11. A few syndromes (e.g., somatic problems) showed strong cross-cultural agreement; most did not. Among the narrowband syndromes (e.g., aggression, anxiety), more than half the cross-cultural comparisons showed concordance kappas at or below .40. Such differences in syndromal structure have implications for child classification, assessment, psychopathology, and treatment research, both across and within cultures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The risk of Guillain-Barré syndrome after tetanus-toxoid-containing vaccines in adults and children in the United States

OBJECTIVES: This study examined whether there is a risk that tetanus-toxoid-containing vaccines could cause Guillain-Barré syndrome and, if so, how large the risk is. METHODS: This study was based on previous active surveillance epidemiological studies of Guillain-Barré syndrome and vaccination history. RESULTS: A background rate of 0.3 cases of Guillain-Barré syndrome per million person-weeks has been estimated. By chance, 2.2 people with the syndrome would have received tetanus-toxoid-containing vaccine within the 6 weeks before onset, yet only 1 person had done so. Data on children show similar results. CONCLUSIONS: If an association exists, it must be extremely rare and not of public health significance.     

Effects of concerns about child care among single, employed black mothers with preschool children

This study investigated whether differences in child care arrangements and mothers' attitudes about leaving their child in nonmaternal care were associated with maternal psychological well-being and perceptions of children in a sample of single, employed, low-income, Black mothers who were former welfare recipients. Feelings of discomfort with regard to nonmaternal care were associated with higher levels of maternal depressive symptomatology, which, in turn, predicted more negative perceptions of children. Preference for employment and increased working hours were associated with greater life satisfaction. Maternal education and the gender of the child were important moderating variables. Type of child care arrangement was nonsignificant. Policy implications are discussed.     

Chinese medicine users in the United States. Part II: Preferred aspects of care

In what ways are computer networking practices comparable to face-to-face therapy? With the exponential increase in computer-mediated communication and the increasing numbers of people joining topically based computer networks, the potential for grass-roots therapeutic (or antitherapeutic) interchange is greatly augmented. Here we report the results of research into exchanges on an electronic bulletin board devoted to the topic of suicide. Over an 11-month period participants offered each other valuable resources in terms of validation of experience, sympathy, acceptance, and encouragement. They also asked provocative questions and furnished broad-ranging advice. Hostile entries were rare. However, there were few communiques that parallel the change-inducing practices more frequent within many therapeutic settings. In effect, on-line dialogues seemed more sustaining than transforming. Further limits and potentials of on-line communication are explored.     

Depressive symptoms in mothers and children: Preschool attachment as a moderator of risk.

Drawing from transactional models, the authors examined whether attachment security measured at age 3 (a potential source of differential vulnerability) interacts with the course of maternal depressive symptoms over an 8-year period (a potential source of differential exposure) in predicting children’s self-reported depressive symptoms at age 11. Participants were from the NICHD Study of Early Child Care (N = 938). Results from growth curve modeling and analysis of covariance suggest that preschool attachment quality moderates the influence of subsequent maternal depression on children. In particular, variability in the course of maternal depressive symptoms predicted offspring depressive symptoms only among those children with an insecure attachment history. A potential protective effect of early attachment security was evident among children exposed to the most chronic levels of maternal depression. Of the children with different patterns of insecure attachments, those with behaviors classified as disorganized appeared most vulnerable to also becoming depressed if paired with a mother experiencing ongoing depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking

OBJECTIVE: Little data on rectal bleeding in the U.S. population are available. We therefore sought to assess the prevalence of different types of rectal bleeding, their association with potential risk factors including other colonic symptoms, and predictors of health care seeking in a U.S. community. METHODS: We used a crossectional survey by mail, applying a previously validated self-report symptom questionnaire. Our population comprised an age- and gender-stratified random sample of Olmsted County, Minnesota residents aged 20-64 yr. RESULTS: In total, 1643 responded (77%). Rectal bleeding was reported by 235 subjects (age- and gender-adjusted prevalence, 15.5 per 100; 95% confidence interval [CI], 13.6-17.4); 218 found blood on wiping, 74 noted blood coating the stools, and 46 reported dark blood mixed in the stools. The prevalence of rectal bleeding was significantly higher in younger persons (18.9%, 20-40 yr vs 11.3% > 40 yr; p < 0.001). By stepwise logistic regression analysis, constipation (odds ratio [OR] = 3.03; 95% CI, 2.09-4.41) and diarrhea (OR = 1.90; 95% CI, 1.25-2.84) were independent predictors of rectal bleeding. Among those with rectal bleeding, 13.9% (95% CI, 9.6-19.1%) had visited a physician for bowel problems in the prior yr; only a history of abdominal surgery was an independent predictor of physician visits but this explained just 15.9% of the deviance. CONCLUSIONS: In otherwise healthy young and middle-aged persons, approximately one in seven have a history of rectal bleeding and this is more frequent in younger people; only a minority seek health care and this is not related to symptom status.     

Mental disorders and access to medical care in the United States

OBJECTIVE: The authors examined the barriers to receipt of medical services among people reporting mental disorders in a representative sample of U.S. adults. METHOD: The sample was drawn from adults who responded to the 1994 National Health Interview Survey (N=77,183). The authors studied the association between report of a mental disorder and 1) access to health insurance and a primary provider, and 2) actual receipt of medical care. Multivariate techniques were used to model problems with access as a function of mental disorders, controlling for demographic, insurance, and health variables. RESULTS: While people who reported mental disorders showed no difference from those without mental disorders in likelihood of being uninsured or of having a primary care provider, they were twice as likely to report having been denied insurance because of a preexisting condition or having stayed in their job for fear of losing their health benefits. Among respondents with insurance, those who reported mental illness were no less likely to have a primary care provider but were about two times more likely to report having delayed seeking needed medical care because of cost or having been unable to obtain needed medical care. CONCLUSIONS: People who reported mental disorders experienced significant barriers to receipt of medical care. Efforts to measure and improve access to health care for this population may need to go beyond simply providing insurance benefits or access to general medical providers.     

Maternal and infant care: comparisons between Western Europe and the United States

A series of studies between 1986 and 1990 gathered data on maternal and infant care in ten Western European countries with lower infant mortality rates than the United States and compared the findings both within the European countries and in aggregate with the United States. Results from these studies reveal great variation among the study countries in how perinatal care is financed, staffed by professional and nonprofessional health workers, and provided by public clinics or private offices, and in the number of and locale of the recommended number of prenatal visits. Invariably consistent among the study countries is the nearly complete enrollment of childbearing women in early and continuous prenatal care, and the strong linkage of that care to a generous spectrum of social supports and financial benefits. None of the benefits generally pertains in the United States. The relevance of these observations for the United States suggests that current policies intended to lower economic barriers to a highly medicalized version of maternity care may yield disappointing results unless the perinatal sequence is linked to a more generous set of maternity-related social supports and financial benefits than is now contemplated.     

The program in psychology at the United States Air Force Academy.

The attempt has been made to formulate learning outcomes or educational goals for the USAFA courses in psychology in terms of knowledge and understandings, habits and skills, and attitudes and values. 2 courses are outlined: (a) basic psychology which includes consideration of Scientific Method and Measurement, Individual Differences, Growth and Development, Motivation, Emotion, and Perception, Learning and Thinking, and Adjustment and Personality; (b) psychology in the Air Force which includes Engineering Psychology, Personnel Psychology, Leadership, and Problems of Military Adjustment. Conduct of the courses includes the use of "provocative and stimulating examples and illustrative materials" and psychological films are used liberally. "Effort is made to allow all students to have some contact throughout the academic year with each of the seven instructors in the department." Classes are restricted to 12 students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Injury risk among children of low-income U.S.-born and immigrant mothers.

The number of immigrants in the United States is at an all time high, yet psychologists have largely ignored the domain of immigrant health. This article considers 1 aspect of immigrant health, risk for pediatric injury. A sample of over 5,000 5-year-old children from impoverished families was studied; approximately 13% had immigrant mothers. Children of immigrants had a significantly lower rate of injury in the prior year. This was particularly true of non-White children of immigrants. Three possible mediators for this finding--assistance with parenting, parenting style, and health care accessibility--were considered, but none explained the difference. The need for further research on the topic and implications of results for injury prevention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of the practice and science of child custody and access assessment in the United States and Canada.

Many psychologists in the United States and Canada provide child custody and access (C&A) assessments as part of their clinical services. There are guidelines based on ethical standards that inform this specialization, which include the recommendation that providers be familiar with the empirical bases of their work. This article provides an overview of guidelines, the assessment process, and the empirical basis for C&A assessment. Although there is limited evidence of traditional standards of direct empirical utility of such assessments, there are relevant research areas that include the impacts of separation and divorce on children, family relationships, and coparenting processes. Each is critical to understanding children's welfare, a parent's capacity to act in the best interests of a child, and the coparenting environment that may follow separation and divorce. Given the importance of minimizing postdivorce conflict within a coparenting environment, the indirect scientific evidence that supports C&A assessment can also be used to pursue more amicable solutions through mediation and parent education. Although research is growing supporting these alternative practices as well as C&A assessment itself, much more is needed. Psychologists who offer these services will find this article to be a useful overview of current practice and science, and for those contemplating involvement in these services, the article highlights issues to be considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Engineering psychology in the United States.

Describes the origins and history of engineering psychology noting the successes: (1) Explosive expansion and growth, (2) a wide range of research efforts and engineering applications, (3) interest and acceptance by engineering associates, (4) an increasing number of graduate training programs in departments of psychology as well as schools of engineering, and (5) general benefits to psychology as a science and profession. The deficiencies in engineering psychology are attributed to too great an involvement between art and science. (20 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)