Stressors and adverse outcomes for female construction workers.

The authors examined the impact of a number of job stressors, including sexual harassment and gender-based discrimination, on female construction workers' level of job satisfaction and psychological and physical health. Results from a telephone survey with 211 female laborers indicated that having responsibility for others' safety and having support from supervisors and male coworkers was related to greater job satisfaction. Increased reported psychological symptoms were also related to increased responsibility, as well as skill underutilization, experiencing sexual harassment and gender-based discrimination from supervisors and coworkers, and having to overcompensate at work. Perceptions of overcompensation at work and job certainty were positively associated with self-reports of insomnia. Finally, sexual harassment and gender discrimination were positively related to reports of increased nausea and headaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pregnancy-specific stress, prenatal health behaviors, and birth outcomes.

Objective: Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. Design: Three structured prenatal interviews (N = 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. Main Outcome Measures: Gestational age at delivery, birth weight, preterm delivery (     

Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the United States

Unilateral microinjections of acetylcholine into the rat solitary tract nucleus evoked inhibitory effects in electrical activity of symmetrical portions of the diaphragm and external intercostal muscles. Administration of propranolol exerted excitatory respiratory responses. The findings suggest participation of cholin- and noradrenergic systems in inhibitory mechanisms of respiratory control. Different roles of the right and left solitary tract nuclei in their involvement in formation of efferent impulses to bilateral inspiratory muscles, are discussed.     

Unhealthy aggression: Intermittent explosive disorder and adverse physical health outcomes.

Objective: To examine the relationship between Intermittent Explosive Disorder (IED; a psychiatric diagnosis characterized by episodes of affective aggression) and adverse physical health outcomes. Design: A large epidemiological sample drawn from the Collaborative Psychiatric Epidemiological Surveys (N = 10,366), was used to compare participants with a lifetime diagnosis of IED (n = 929) to those without any history of IED (n = 9,437) on demographic variables (age, education, gender, race) common risk factors (smoking status, body mass index, substance use disorders, past accident or injury requiring treatment, major depression) and the presence of 12 adverse health outcomes. Main Outcome Measures: History of heart attacks, coronary heart disease, hypertension, stroke, lung disease, diabetes, cancer, arthritis, back/neck pain, ulcer, headaches, and other chronic pain. Results: Logistic regression analysis controlling for demographic and other risk factors indicated that IED was associated with 9 of the 12 adverse physical health outcomes (coronary heart disease, hypertension, stroke, diabetes, arthritis, back/neck pain, ulcer, headaches, and other chronic pain). Only cancer, heart attacks, and lung disease were not significantly related to IED. Conclusion: IED may be a risk factor for several significant adverse physical health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression.

Examined the effects of prenatal social support on maternal and infant health and well-being in a sample of 129 low-income pregnant women. Three aspects of support (amount received, quality of support received, and network resources) and 4 outcomes (birth weight, Apgar scores, labor progress, and postpartum depression) were studied. Results indicate that women who received more support had better labor progress and babies with higher Apgar scores. Women with higher quality support had babies with higher Apgar scores and experienced less postpartum depression. Also, women with larger networks had babies of higher birth weight. Further analyses indicate that the outcomes as a whole were more consistently predicted by instrumental rather than emotional forms of support. Finally, although there was some evidence for stress-buffering effects of support, the overall findings were more consistent with a main effect model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term developmental outcomes of low birth weight infants

Advances in neonatal medicine have resulted in the increased survival of infants at lower and lower birth weight. While these medical success stories highlight the power of medical technology to save many of the tiniest infants at birth, serious questions remain about how these infants will develop and whether they will have normal, productive lives. Low birth weight children can be born at term or before term and have varying degrees of social and medical risk. Because low birth weight children are not a homogeneous group, they have a broad spectrum of growth, health, and developmental outcomes. While the vast majority of low birth weight children have normal outcomes, as a group they generally have higher rates of subnormal growth, illnesses, and neurodevelopmental problems. These problems increase as the child's birth weight decreases. With the exception of a small minority of low birth weight children with mental retardation and/or cerebral palsy, the developmental sequelae for most low birth weight infants include mild problems in cognition, attention, and neuromotor functioning. Long-term follow-up studies conducted on children born in the 1960s indicated that the adverse consequences of being born low birth weight were still apparent in adolescence. Adverse sociodemographic factors negatively affect developmental outcomes across the continuum of low birth weight and appear to have far greater effects on long-term cognitive outcomes than most of the biological risk factors. In addition, the cognitive defects associated with social or environmental risks become more pronounced as the child ages. Enrichment programs for low birth weight children seem to be most effective for the moderately low birth weight child who comes from a lower socioeconomic group. Continued research and attempts to decrease the rate of low birth weight and associated perinatal medical sequelae are of primary importance. Ongoing documentation of the long-term outcome of low birth weight children needs to be mandated, as does the implementation of environmental enrichment programs to help ameliorate the long-term consequences for infants who are born low birth weight.     

Stress, anxiety, and birth outcomes: A critical review of the evidence.

Describes, discusses, and considers research exploring the relation of self-report assessments of life change and anxiety to birth outcomes. Although there is evidence from infrahuman research that exposure to stressors during gestation can result in unfavorable reproductive outcomes, in humans both global categorizations of obstetric outcome and measures of neonatal status are found to be inconsistently related to indices of stress or anxiety. Such findings seem to result from (1) a consistent commitment by investigators to a conventional correlational approach focusing on the use of self-report instruments and (2) disregard for the impact of important sociodemographic and biochemical factors on obstetric risk. Alternatives to the methodological strategies used in these studies are discussed. It is suggested that clearer findings could be provided by research adopting some of the controls and measurement techniques used in epidemiological analyses of the relation of psychosocial factors to illness. (157 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between negligent adverse events and the outcomes of medical-malpractice litigation

BACKGROUND: We have previously shown that in New York State the initiation of malpractice suits correlates poorly with the actual occurrence of adverse events (injuries resulting from medical treatment) and negligence. There is little information on the outcome of such lawsuits, however. To assess the ability of malpractice litigation to make accurate determinations, we studied 51 malpractice suits to identify factors that predict payment to plaintiffs. METHODS: Among malpractice claims that we reviewed independently in an earlier study, we identified 51 litigated claims and followed them over a 10-year period to determine whether the malpractice insurer had closed the case. We obtained detailed summaries of the cases from the insurers and reviewed the litigation files if the outcome of a case differed from the outcome predicted in our original review. RESULTS: Of the 51 malpractice cases, 46 had been closed as of December 31, 1995. Among these cases, 10 of 24 that we originally identified as involving no adverse event were settled for the plaintiffs (mean payment, $28,760), as were 6 of 13 cases classified as involving adverse events but no negligence (mean payment, $98,192) and 5 of 9 cases in which adverse events due to negligence were found in our assessment (mean payment, $66,944). Seven of eight claims involving permanent disability were settled for the plaintiffs (mean payment, $201,250). In a multivariate analysis, disability (permanent vs. temporary or none) was the only significant predictor of payment (P=0.03). There was no association between the occurrence of an adverse event due to negligence (P = 0.32) or an adverse event of any type (P=0.79) and payment. CONCLUSIONS: Among the malpractice claims we studied, the severity of the patient's disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff.     

Short-term memory and language outcomes after extreme prematurity at birth

The performance of 26 children (3;0-4;0 years) who were born before 32 weeks gestation was compared with the performance of 26 full-term children on a range of short-term memory and language measures. The measures tested vocabulary, expressive language, phonological short-term memory, and general nonverbal ability. Preterm children scored more poorly across the full range of measures. The mildly depressed performance of the preterm group on the short-term memory and language measures was attributable to the large deficits on these tests shown by a subgroup of approximately one third of preterm children identified as being "at risk" for persisting language difficulties using the Bus Story Test (Bishop & Edmundson, 1987). The findings indicate that preterm birth and associated hazards may constitute a significant risk factor for specific language impairment in a sizable minority of children.     

Potential adverse outcomes of psychotropic and narcotic drug use in Canadian seniors

Infants who ingest high amounts of fluoride can be at risk of dental fluorosis. The authors analyzed the fluoride concentration of 238 commercially available infant foods. Fluoride concentrations ranged from 0.01 to 8.38 micrograms of fluoride per gram, with the highest fluoride concentrations found in infant foods containing chicken. Infant foods, especially those containing chicken, should be considered when determining total fluoride intake.     

Relationship of preoperative antiendotoxin core antibodies and adverse outcomes following cardiac surgery

This study assesses the reliability of a self-reported health questionnaire completed by 413 subjects aged 25-74 yr in the Erie County Periodontal Disease (ECPD) Study. Specific questions on general and oral health conditions were completed by each subject during a first visit and at a follow-up examination 2 yr later, and the two compared. Results showed that the overall measure of agreement between the two visits is substantial (average kappa, kappa = 0.80). Variation by gender and age were minimal. Questions regarding allergy to medications, oral treatment, reason for tooth extraction, health symptoms and history of systemic diseases exhibited high levels of agreement (kappa ranged from 0.71-0.90). Information on vitamin and mineral intake yielded kappa = 0.63. Oral conditions scored the lowest but were still acceptable (kappa = 0.57). These findings indicate that there were no significant discrepancies in self-reported responses to the health questionnaire used in the ECPD Study. Although the information provided by the subject may not be as accurate as compared to laboratory testing, it is nevertheless a reliable source of information which can be utilized cost-effectively in research studies.     

Distinguishing homelessness from poverty: A comparative study.

To separate the characteristics of the homeless from those of the housed poor, 144 adults were randomly sampled from several sites, yielding 3 groups: the currently homeless (n?=?59), the previously (but not currently) homeless (n?=?31), and the never-homeless poor (n?=?54). The homeless were significantly less likely to be receiving public benefits, were more likely to have a DSM-III (Diagnostic and Statistical Manual of Mental Disorders [3rd ed.; American Psychiatric Association, 1980]) diagnosis of substance abuse, showed higher levels of self-rated psychological distress and were more likely to be victims of recent domestic violence and to have been physically abused as children. The homeless did not differ from the comparison groups on DSM-III diagnosis of severe mental illness (schizophrenia or major affective disorder), physical health symptoms, and social support and social networks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low birth weight and cognitive outcomes: Evidence for a gradient relationship in an urban, poor, African American birth cohort.

This study is one of the first to investigate the relationship between low birth weight and cognitive outcomes in an urban, poor, prospectively designed African-American birth cohort. Multivariate analyses of the Pathways to Adulthood study, a subset of the Johns Hopkins Collaborative Perinatal study, compared low birth weight African-American children with normal birth weight African-American children on the Wechsler Intelligence Scale for Children (WISC) at seven years of age. When controlling for various sociodemographic factors, associations were obtained for the very low birth weight group (less than 2000 g) indicating an overall 7 point IQ difference. Milder associations were reported in the moderately low birth weight (MLBW) group (2000 to 2500 g) resulting in a 3 IQ point decrement compared to a normal birth weight reference group. There were no differential effects for gender. Our study revealed a gradient relationship between low birth weight/preterm birth and cognitive ability. Implications for school psychology prevention, assessment, and intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The old homeless and the new homelessness in historical perspective.

In the 1950s and 1960s, homelessness declined to the point that researchers were predicting its virtual disappearance in the 1970s. Instead, in the 1980s, homelessness increased rapidly and drastically changed in composition. The "old homeless" of the 1950s were mainly old men living in cheap hotels on skid rows. The new homeless were much younger, more likely to be minority group members, suffering from greater poverty, and with access to poorer sleeping quarters. In addition, homeless women and families appeared in significant numbers. However, there were also points of similarity, especially high levels of mental illness and substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial differences in birth outcomes: The role of general, pregnancy, and racism stress.

Objective: This study examined the role of psychosocial stress in racial differences in birth outcomes. Design: Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women. Main Outcome Measures: The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age. Results: Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites. Conclusions: These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women.

A sizable body of evidence indicates that prenatal maternal stress (PNMS) has an adverse impact on birth outcomes, including birth weight and gestational age at delivery. The authors hypothesized that effects of PNMS are attributable in part to dispositions such as pessimism that lead women to view their lives as stressful and that effects of PNMS and disposition on birth outcome are mediated by prenatal health behaviors. Using structural equations modeling procedures, the authors examined prospective impact of PNMS and dispositional optimism on birth weight and gestational age in a medically high-risk sample (N?=?129), controlling for effects of risk and ethnicity. After its strong inverse association with optimism was accounted for, PNMS had no impact on birth outcomes. Women who were least optimistic delivered infants who weighed significantly less, controlling for gestational age. Optimists were more likely to exercise, and exercise was associated with lower risk of preterm delivery. Results suggest that chronic stress in pregnancy may be a reflection of underlying dispositions that contribute to adverse birth outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foster care children and family homelessness

OBJECTIVES: This study examined the association between family homelessness and children's placement in foster care. METHODS: The prevalence of homelessness in a random sample of 195 young foster children was examined. RESULTS: Almost half of the birth parents of the foster children had experienced homelessness. Those children were more likely than other foster children to have siblings in foster care and to be place with nonrelatives. CONCLUSIONS: An extremely high prevalence of family homelessness was found among children in foster care. Policy implications of the association between family homelessness and placement into foster care are discussed.     

Drug and environmental factors associated with adverse pregnancy outcomes. Part II: Improvement with folic acid

OBJECTIVE: To provide a comprehensive review of periconceptional folic acid supplementation and factors affecting folate supplementation trials. DATA SOURCES: A MEDLINE search was conducted through December 1997. Additional sources were obtained from Current Contents and citations from the references obtained. Search terms included folate, folic acid, neural tube defect, spina bifida, and anencephaly. STUDY SELECTION: Relevant animal and human studies examining the effects of folate were reviewed. DATA EXTRACTION: Data collected included: type of study, folate dosing, dietary folate intake, serum and red blood cell folate concentrations, type of defect(s) studied, vitamin usage, parental risk factors, factors affecting trial results. DATA SYNTHESIS: Nine key factors have been identified that affect outcomes of folic acid supplementation trials. Daily doses of 0.8 mg decreased the occurrence and doses of 4 mg decreased the recurrence of neural tube defects in randomized clinical trials. Since lower folic acid doses were effective in nonrandomized trials, research is needed to determine the lowest effective dosage. Other benefits involving pregnancy outcome are suggested. CONCLUSIONS: Women of childbearing age should take a daily folic acid supplement to reduce the risk of pregnancies resulting in infants with a neural tube defect and other potential adverse pregnancy outcomes. Further health benefits from folic acid supplementation are reviewed in Part III of this series.     

Quality of community drinking water and the occurrence of late adverse pregnancy outcomes

1. The aim of the study was to investigate whether there were differential effects of three different anti-hypertensive medications (cilazapril, atenolol, nifedipine) on cognitive function. 2. A sub-group of patients participating in a large clinical trial of these three drugs, randomly allocated between the three drug conditions, received cognitive assessment at two points before the commencement of treatment and then after 12 and 24 weeks of treatment. Seventy-six patients began treatment, and 55 completed the full course. 3. Tests of learning and memory were designed specially for the study, with a different but comparable version administered on each assessment occasion, in a fixed order. 4. No significant differences between drug groups were found in any index of learning or memory, at any testing occasion. The results were the same whether or not treatment non-completers were included in the analysis.     

The effect of expanding Medicaid prenatal services on birth outcomes

OBJECTIVES: Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. METHODS: The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled pregnant women before and after initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state. RESULTS: The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states. Washington's low-birthweight rate decreased (7.1% to 6.4%, P = .12), while Colorado's rate increased slightly (10.4% to 10.6%, P = .74). Washington's improvement was largely due to decreases in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P = .01, for adults; 22.5% to 11.5%, P = .03, for teenagers), especially those with preexisting medical conditions. CONCLUSIONS: A statewide Medicaid-sponsored support service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women.