Patterns of DSM-III-R alcohol dependence symptom progression in a general population survey

Age of onset reports obtained retrospectively for each symptom of DSM-III-R alcohol dependence (AD) are used to study patterns of lifetime symptom progression in a large general-population survey of people in the United States. It is shown that symptom progression among a substantial majority of respondents can be summarized as movement across three clusters. Cluster A is defined by symptoms of role impairment/hazardous use (A4), use despite social, psychological or physical problems (A6), and drinking larger amounts or over a longer period of time than intended (A1). Cluster B is defined by tolerance (A7) and impaired control (A2, A3). Cluster C is defined by withdrawal (A8, A9) and giving up activities in order to drink (A5). Clusters are shown to follow a time sequence, with at least one symptom in Cluster A usually occurring first, followed by symptoms in Clusters B and C. In all, 83.4% of the symptom cluster transitions estimated from retrospective age of onset reports are consistent with this progression. Progression to AD is differentially predicted by symptom profiles reported at the age of first symptom onset, with persons reporting Cluster C symptoms most likely to progress subsequently to AD. Furthermore, profiles of AD defined by the highest symptom cluster present at AD onset are differentially predicted by prior personal and parental histories of psychopathology and, among men, are predictive of diagnosis persistence.     

Risk factors for adolescent substance abuse and dependence: Data from a national sample.

A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for Diagnostic and Statistical Manual of Mental Disorders- (4th ed.; American Psychiatric Association, 1994) defined substance abuse/dependence. Age and ethnicity data were available for 3,907 participants. Major findings were (a) adolescents who had been physically assaulted, who had been sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse/dependence; (b) posttraumatic stress disorder independently increased risk of marijuana and hard drug abuse/dependence; and (c) when effects of other variables were controlled, African Americans, but not Hispanics or Native Americans, were at approximately 1/3 the risk of substance abuse/dependence as Caucasians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common genetic risk factors for conduct disorder and alcohol dependence.

The association between retrospectively reported childhood conduct disorder (CD) and a history of alcohol dependence (AD) was examined in a sample of 2,682 male, female, and unlike-sex adult twin pairs. There was a strong association between CD and AD in both men (tetrachoric r?=?.34, odds ratio?=?2.8) and women (tetrachoric r?=?.53, odds ratio?=?9.9). Genetic factors accounted for most of the association between CD and AD liability in men and women, with the remainder of the association being due to nonshared individual-specific environmental factors. Genetic influences common to CD and AD accounted for 17% and 35% of the genetic variation in AD liability in men and women, respectively, and accounted for 11% and 23% of the total variation in AD liability in men and women, respectively. The results suggest that there are common genetic risk factors for CD and AD or that CD itself is an important genetically influenced risk factor for AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for ectopic pregnancy: a meta-analysis

OBJECTIVE: To review current knowledge on the risk of ectopic pregnancy (EP), with the exception of contraceptive methods. DESIGN: Meta-analysis. SETTING: Case control and cohort studies published between 1978 and 1994 in English, French, German, or Dutch, retrieved by Medline search, crossover search from the papers obtained, and hand-search on recent medical journals. PATIENTS: A total number of 6,718 cases of EP in 27 case control studies and 13,049 exposed women in 9 cohort studies. MAIN OUTCOME MEASURES: Detected studies were tested for homogeneity. If homogeneity was not rejected, Mantel-Haenszel common odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: Previous EP, previous tubal surgery, documented tubal pathology, and in utero diethylstilbestrol (DES) exposure were found to be associated strongly with the occurrence of EP. Previous genital infections (pelvic inflammatory disease [PID], chlamydia, gonorrhoea), infertility, and a lifetime number of sexual partners > 1 were associated with a mildly increased risk. For gonorrhoea, PID, previous EP, previous tubal surgery, and smoking, a higher common OR was calculated when using pregnant controls compared with using nonpregnant controls. CONCLUSIONS: The strong risk in women with a previous EP, previous tubal surgery, documented tubal pathology, or in utero DES exposure justifies the exploration of a screening policy for EP among these women. If a risk factor reduces fertility chances, the OR detected when using pregnant controls is higher than the OR calculated using nonpregnant controls.     

Assessing risk for completed suicide in patients with alcohol dependence: Clinicians' views of critical factors.

The assessment of potential for suicide among patients with a diagnosis of alcohol dependence has consistently been a dilemma for clinicians. Specifically, a problem for both clinicians and researchers has been determining what risk factors distinguish patients with suicidal ideation from those that are in danger of completed suicide. Identifying what clinicians who specialize in substance abuse view as critical in the assessment and treatment of suicidal patients is a first step in gaining a greater understanding of suicide risk within an alcoholic population. The views of these clinicians are presented and compared with empirical findings on the subject. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for subarachnoid hemorrhage: a systematic review

BACKGROUND AND PURPOSE: Knowledge of modifiable risk factors for subarachnoid hemorrhage (SAH) is important in terms of prevention. We therefore conducted a systematic review of studies on risk factors for SAH, with emphasis on sufficiently precise criteria for the diagnosis of SAH. METHODS: To identify studies we performed a Medline search from 1966 to 1994 and searched the reference lists of all relevant publications. Studies were included only if they fulfilled predefined methodological criteria. Case-control studies were included if the diagnosis of SAH was proved by CT, angiography, or autopsy in at least 70% of patients. Longitudinal studies were included if the criteria for SAH were based on a review of the medical records. RESULTS: Nine longitudinal studies and 11 case-control studies were included. Significant risk factors were as follows: (1) smoking (relative risk [RR] for longitudinal studies, 1.9; 95% confidence interval [CI], 1.5 to 2.3; odds ratio [OR] for case-control studies, 3.5; 95% CI, 2.9 to 4.3); (2) hypertension (RR, 2.8; 95% CI, 2.1 to 3.6; OR, 2.9; 95% CI, 2.4 to 3.7) and (3) drinking 150 g or more of alcohol per week (RR, 4.7; 95% CI, 2.1 to 10.5; OR, 1.5; 95% CI, 1.1 to 1.9). Use of oral contraceptives, hormone replacement therapy, hypercholesterolemia, and physical activity were not significantly related to the risk of SAH. CONCLUSIONS: We conclude that smoking, hypertension, and alcohol abuse are important risk factors for SAH. Reduction of exposure to these risk factors might result in a decreased incidence of SAH.     

Attitudes of consultant anaesthetists to the Calman proposals: a questionnaire survey

We undertook a postal survey to determine the views of all consultant anaesthetists within the North West (Mersey) Regional Health Authority on the Calman proposals for a consultant-based service; replies were received from 110 (84%). Fifty (45%) indicated that they would not resume emergency residential duties, 32 (29%) indicated that they would withdraw from the emergency duty rota, 12 (11%) said they would withdraw/retire from the NHS and 27 (25%) would change hospital under these circumstances. Most consultants had experience in the major anaesthetic sub-specialties within the preceding 5 years (obstetrics 67%, ITU 81%, major trauma 91%). Consequently the need for retraining amongst consultant anaesthetists prior to resuming residential emergency duties would be low. When questioned about the impact on anaesthetic services, 67 (61%) felt the proposals would be detrimental whilst 23 (21%) felt there would be beneficial effects. Most consultants remain antagonistic toward the Calman proposals, with a reluctance to return to residential duties.     

Risk factors for elementary school drinking: Pubertal status, personality, and alcohol expectancies concurrently predict fifth grade alcohol consumption.

Little is known about the correlates and potential causes of very early drinking. The authors proposed this risk theory: (a) pubertal onset is associated with increased levels of positive urgency (the tendency to act rashly when experiencing intensely positive mood), negative urgency (the tendency to act rashly when distressed), and sensation seeking; (b) those traits predict increased endorsement of high-risk alcohol expectancies; (c) the expectancies predict drinker status among fifth graders; and (d) the apparent influence of positive urgency, negative urgency, and sensation seeking on drinker status is mediated by alcohol expectancies. The authors conducted a concurrent test of whether the relationships among these variables were consistent with the theory in a sample of 1,843 fifth grade students. In a well-fitting structural model, their hypotheses were supported. Drinker status among fifth graders is not just a function of context and factors external to children: it is predictable from a combination of pubertal status, personality characteristics, and learned alcohol expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abortion and reproductive performance of cattle in northern Nigeria: a questionnaire survey

A survey on abortion and reproductive performance in cattle was carried out in the six northern States of Nigeria in 1972-73. Three hundred and ninetten herds with 8,970 breeding cows were sampled. One hundred and thirteen herds reported abortion (35 per cent); the lowest incidence was in local herds in Kano State and the highest was on government ranches. Twenty-six herds reported recurrent or chronic abortion. The majority of abortions in non-government herds was not reported to local veterinary authorities (75-8-100 per cent). Average age at first conception in government herds was 2-5 years and 3-5 years in local herds. The percentage of calf crop was highest in the government herds (67 per cent) compared with local Fulani herds (34-2-54-5 per cent) and the pregnancy rate was almost double in the government herds. The percentage of Fulani herds reporting repeat breeding varied from 16-6 to 58-8. Although the survey gave no information as to the causes of abortion or the financial loss, it indicated that bovine abortion was more widespread in the northern states of Nigeria, than previously thought.     

Smoking behavior of Styrian physicians--results of a 1995 questionnaire survey

Tobacco use among all physicians registered in the state of Styria was investigated at the beginning of the year 1995 using an anonymous questionnaire. In addition to the smoking prevalence among different specialties in medicine the main interest was focused on motives for smoking as well as for stopping it. Nearly all physicians were aware of the associated health risks. The overall prevalence of smoking was 14% which lay markedly below the Austrian average of 36%. 52% started smoking before the age of 18. In addition 70% of smoking doctors wanted to reduce or stop smoking within the next 6 months. The early start of smoking during adolescence emphasizes the importance of educational and special teaching programs because even in the medical profession there is a big difference between the intention to stop smoking and the actual success in doing so.     

General practitioner's perceptions of the route to evidence based medicine: a questionnaire survey

OBJECTIVES: To determine the attitude of general practitioners towards evidence based medicine and their related educational needs. DESIGN: A questionnaire study of general practitioners. SETTING: General practice in the former Wessex region, England. SUBJECTS: Randomly selected sample of 25% of all general practitioners (452), of whom 302 replied. MAIN OUTCOME MEASURES: Respondents' attitude towards evidence based medicine, ability to access and interpret evidence, perceived barriers to practising evidence based medicine, and best method of moving from opinion based to evidence based medicine. RESULTS: Respondents mainly welcomed evidence based medicine and agreed that its practice improves patient care. They had a low level of awareness of extracting journals, review publications, and databases (only 40% knew of the Cochrane Database of Systematic Reviews), and, even if aware, many did not use them. In their surgeries 20% had access to bibliographic databases and 17% to the world wide web. Most had some understanding of the technical terms used. The major perceived barrier to practising evidence based medicine was lack of personal time. Respondents thought the most appropriate way to move towards evidence based general practice was by using evidence based guidelines or proposals developed by colleagues. CONCLUSION: Promoting and improving access to summaries of evidence, rather than teaching all general practitioners literature searching and critical appraisal, would be the more appropriate method of encouraging evidence based general practice. General practitioners who are skilled in accessing and interpreting evidence should be encouraged to develop local evidence based guidelines and advice.     

Risk factors for multiple sclerosis: a case-control study in Israel

This case-control study was aimed at identifying environmental risk factors for multiple-sclerosis (MS). Ninety-three Israeli-born MS patients identified in country-wide studies and 94 age- and sex-matched controls were interviewed. The questionnaire covered a large span of factors at ages 0, 10 and onset of the disease, with particular emphasis on socioeconomic status (SES) and sanitary conditions (SAN). A significantly larger percentage of patients reported frequent respiratory educational levels than controls. The SES and SAN at age 10 were also systematically higher among patients, but significance was reached only when the frequencies of conditions indicating extremely low values of SES or SAN were compared. It is possible that the protective effect of low SES or SAN on risk of MS can be detected only when living conditions are well below average, as is frequent in developing countries.     

Comprehensive effects of alcohol: Development and psychometric assessment of a new expectancy questionnaire.

A comprehensive measure of alcohol outcome expectancies was developed through the use of exploratory and confirmatory factor analyses. The questionnaire assesses both positive and negative expected effects of alcohol as well as the subjective evaluation of those effects. The measure was found to demonstrate adequate internal consistency, temporal stability, and construct validity. Criterion validity was demonstrated through structural regression analyses of the independent and combined influences of outcome expectancies and subjective evaluation on 3 measures of alcohol use. Information on Ss' dose-related expectancies provided further validation of the expectancy construct and yielded information about the effects people associate with drinking different amounts of alcohol. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for homelessness among schizophrenic men: a case-control study

OBJECTIVES: To identify risk factors for homelessness among the severely mentally ill, we conducted a case-control study of 100 indigent schizophrenic men meeting criteria for literal homelessness and 100 such men with no homeless history. METHODS: Subjects were recruited from shelter, clinic, and inpatient psychiatric programs in Upper Manhattan. Clinical interviewers employed standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. RESULTS: Homeless subjects showed significantly higher levels of positive symptoms, higher rates of a concurrent diagnosis of drug abuse, and higher rates of antisocial personality disorder. Homeless subjects experienced greater disorganization in family settings from birth to 18 years and less adequate current family support. Fewer homeless subjects than subjects in the never-homeless comparison group had a long-term therapist. These differences remained when demographic variables were adjusted statistically. CONCLUSIONS: Homeless schizophrenic men differed from their domiciled counterparts in all three domains we investigated; family background, nature of illness, and service use history. Findings are discussed in relation to policy and programs for the severely mentally ill.     

Workplace bullying in NHS community trust: staff questionnaire survey

OBJECTIVES: To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying. DESIGN: Questionnaire survey. SETTING: NHS community trust in the south east of England. SUBJECTS: Trust employees. MAIN OUTCOME MEASURES: Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job satisfaction scale, the support at work scale, and the propensity to leave scale. RESULTS: 1100 employees returned questionnaires-a response rate of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the victims of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2. 7) v 12.2 (2.3), P<0.001) and higher levels of job induced stress (mean 22.5 (SD 6.1) v 16.9 (5.8), P<0.001), depression (8% (33) v 1% (7), P<0.001), anxiety (30% (125) v 9% (60), P<0.001), and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P<0.001). Support at work seemed to protect people from some of the damaging effects of bullying. CONCLUSIONS: Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff.     

Personality and the genetic risk for alcohol dependence.

The extent to which the genetic risk for alcohol dependence (AD) and conduct disorder (CD) and their common genetic risk overlap with genetic factors contributing to variation in dimensions of personality was examined in a study of 6,453 individuals from 3,383 adult male and female same-sex and unlike-sex twin pairs from the Australian Twin Registry. The associations between the personality dimensions of positive emotionality, negative emotionality, and AD and CD risk were modest, whereas the associations between behavioral undercontrol and AD and CD risk were substantially higher. Genetic influences contributing to variation in behavioral undercontrol accounted for about 40% of the genetic variation in AD and CD risk and about 90% of the common genetic risk for AD and CD. These results suggest that genetic factors contributing to variation in dimensions of personality, particularly behavioral undercontrol, account for a substantial proportion of the genetic diathesis for AD and most of the common genetic diathesis for AD and CD among both men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug and alcohol use by Canadian university athletes: a national survey

To gauge the extent of drug and alcohol use in Canadian university athletes, we estimated the proportion of Canadian university athletes using social and/or ergogenic drugs through survey methods. A secondary purpose was to examine athletes' perceptions of the value of drug testing and drug education programs. Using a stratified random sampling procedure, 754 student athletes were surveyed in eight different sports from eight universities across Canada. Results showed that 17.7 percent of athletes have used major pain medications over the past twelve months, 3 percent reported use of weight loss products, 0.9 percent reported anabolic steroid use, 16.6 percent reported use of smokeless tobacco products, 94.1 percent reported use of alcohol, 65.2 percent reported use of caffeine products, 0.7 percent reported use of amphetamines, 1.0 percent reported use of barbiturates, 19.8 percent reported use of marijuana or hashish, 5.9 percent reported use of psychedelics and 0.8 percent reported use of cocaine/crack.