Search

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health. [ABSTRACT FROM AUTHOR]

Researchers have established the role of heredity and lifestyle in the occurrence of hypertension, but the potential role of psychosocial factors, especially religiosity, is less understood. This paper analyzes the relationship between multiple dimensions of religiosity and systolic blood pressure, diastolic blood pressure, and hypertension using data taken from the Chicago Community Adult Health Study, a probability sample of adults (N=3105) aged 18 and over living in the city of Chicago, USA. Of the primary religiosity variables examined here, attendance and public participation were not significantly related to the outcomes. Prayer was associated with an increased likelihood of hypertension, and spirituality was associated with increased diastolic blood pressure. The addition of several other religiosity variables to the models did not appear to affect these findings. However, variables for meaning and forgiveness were associated with lower diastolic blood pressure and a decreased likelihood of hypertension outcomes. These findings emphasize the importance of analyzing religiosity as a multidimensional phenomenon. This study should be regarded as a first step toward systematically analyzing a complex relationship. [ABSTRACT FROM AUTHOR]

To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self-rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health. [ABSTRACT FROM AUTHOR]

Objectives: Visual hallucinations (VH) occur frequently in Parkinson's disease (PD) and dementia with Lewy bodies (DLB) and are much less common in other bradykinetic rigid syndromes. Pathological series suggest that the presence of VH is highly specific for Lewy body pathology. To address the issue of diagnosis in patients with parkinsonism, we developed instructions for a structured interview (Queen Square Visual Hallucination Inventory (QSVHI)), capable of rapidly screening for VH in the outpatient setting.Methods: 181 consecutive patients from a specialist movement disorders clinic were tested (115 with PD, 23 with progressive supranuclear palsy (PSP), 9 with multiple system atrophy (MSA), 5 with vascular parkinsonism, 19 with unclassifiable parkinsonism (UP) and 8 others), and 15 selected patients from other clinics and 14 neurologically normal controls. The characteristics of hallucinators and non-hallucinators were compared and the sensitivity, specificity and predictive values of VH for a clinical diagnosis of PD calculated.Results: Screening questions identified VH in only 38% of patients with PD. The QSVHI identified VH in 75% of patients with PD and 47% of those with UP. The specificity of VH identified by the QSVHI for PD was 91%, sensitivity was 62%, positive predictive value was 95% and negative predictive value was 48%.Conclusions: The QSVHI appears to be a sensitive method for identifying VH in a movement disorders clinic. VH occurred predominantly in PD and very rarely in PSP and MSA. Among patients with unclassifiable or undetermined parkinsonism, the presence of VH should be considered a red flag for underlying Lewy body pathology. [ABSTRACT FROM AUTHOR]

BACKGROUND: South Africa's history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools.MethodThe South African Stress and Health Study was a nationally representative in-person psychiatric epidemiological survey of 4351 adults (aged 18 years) that was conducted as part of the WHO World Mental Health (WMH) Survey Initiative between January 2002 and June 2004. Twelve-month prevalence and severity of DSM-IV disorders, treatment, and sociodemographic correlates were assessed with Version 3.0 of the WHO Composite International Diagnostic Interview (CIDI 3.0). RESULTS: The 12-month prevalence of any DSM-IV/CIDI disorder was 16.5%, with 26.2% of respondents with disorder classified as severe cases and an additional 31.1% as moderately severe cases. The most common disorders were agoraphobia (4.8%), major depressive disorder (4.9%) and alcohol abuse or dependence (4.5%). Twenty-eight percent of adults with a severe or moderately severe disorder received treatment compared to 24.4% of mild cases. Some 13.8% of persons with no disorder received treatment. Treatment was mostly provided by the general medical sector with few people receiving treatment from mental health providers. CONCLUSIONS: Psychiatric disorders are much higher in South Africa than in Nigeria and there is a high level of unmet need among persons with severe and moderately severe disorders. [ABSTRACT FROM AUTHOR]

Patients with Parkinson's disease who develop disabling levodopa-induced motor fluctuations have a stronger therapeutic response than those who experience a more modest but stable response. A difference in the histopathological lesion between the two groups might be responsible. Case records from 97 patients with pathologically proven Parkinson's disease were reviewed to determine the pattern of levodopa response. Pathological findings for fluctuating and non-fluctuating cases were compared. Patients with motor fluctuations had a younger age of onset and longer disease course (P < 0.001), although mean age at death was almost the same. Four milestones of advanced disease (frequent falls, visual hallucinations, cognitive disability and need for residential care) occurred at a similar time from death in each group; this interval was not proportionate to the disease duration. There were no significant differences in the severity or distribution of Lewy body or other pathologies. Irrespective of the pattern of levodopa response, patients reach a common pathological endpoint at a similar age, and the duration and manifestations of end-stage disease are alike. A non-linear or exponential time relationship may govern the late clinical and pathological progression of Parkinson's disease. [ABSTRACT FROM AUTHOR]

The weightless environment of space imposes specific physiologic adaptations on healthy astronauts. On return to Earth, these adaptations manifest as physical impairments that necessitate a period of rehabilitation. Physiologic changes result from unloading in microgravity and highly correlate with those seen in relatively immobile terrestrial patient populations such as spinal cord, geriatric, or deconditioned bed-rest patients. Major postflight impairments requiring rehabilitation intervention include orthostatic intolerance, bone demineralization, muscular atrophy, and neurovestibular symptoms. Space agencies are preparing for extended-duration missions, including colonization of the moon and interplanetary exploration of Mars. These longer-duration flights will result in more severe and more prolonged disability, potentially beyond the point of safe return to Earth. This paper will review and discuss existing space rehabilitation plans for major postflight impairments. Evidence-based rehabilitation interventions are imperative not only to facilitate return to Earth but also to extend the safe duration of exposure to a physiologically hostile microgravity environment. [ABSTRACT FROM AUTHOR]

Clinical syndromes associated with progressive supranuclear palsy-tau pathology now include progressive supranuclear palsy-parkinsonism (PSP-P), in addition to classic Richardson's syndrome (RS) and pure akinesia with gait freezing (PAGF). Although pathological heterogeneity of progressive supranuclear palsy (PSP) has also been established, attempts to correlate this with clinical findings have only rarely provided conclusive results. The aim of this study was to investigate whether regional variations in the types of tau lesions or differences in overall tau load may explain the clinical differences between the RS, PSP-P and PAGF. Quantitative tau pathology assessment was performed in 17 brain regions in 42 cases of pathologically diagnosed PSP (22 RS, 14 PSP-P and 6 PAGF). Neurofibrillary tangles, tufted astrocytes, coiled bodies and thread pathology were quantitated and a grading system was developed separately for each region. Using these grades the overall tau load was calculated in each case. To establish a simplified system for grading the severity of tau pathology, all data were explored to identify the minimum number of regions that satisfactorily summarized the overall tau severity. The subthalamic nucleus, substantia nigra and globus pallidus were consistently the regions most severely affected by tau pathology. The mean severity in all regions of the RS group was higher than in PSP-P and PAGF, and the overall tau load was significantly higher in RS than in PSP-P (P = 0.002). Using only the grade of coiled body + thread lesions in the substantia nigra, caudate and dentate nucleus, a reliable and repeatable 12-tiered grading system was established (PSP-tau score: 0, mild tau pathology, restricted distribution; >7, severe, widespread tau pathology). PSP-tau score was negatively correlated with disease duration (Spearman's rho -0.36, P = 0.028) and time from disease onset to first fall (Spearman's rho -0.49, P = 0.003). The PSP-tau score in PSP-P (median 3, range 0-5) was significantly lower than in RS (median 5, range 2-10, Mann-Whitney U, P < 0.001). The two cases carrying the tau-H2 protective allele had the two lowest PSP-tau scores. We have identified significant pathological differences between the major clinical syndromes associated with PSP-tau pathology and the restricted, mild tau pathology in PSP-P supports its clinical distinction from RS. The grading system we have developed provides an easy-to-use and sensitive tool for the morphological assessment of PSP-tau pathology and allows for consideration of the clinical diversity that is known to occur in PSP. [ABSTRACT FROM AUTHOR]

This article provides an overview of racial and ethnic disparities in health in the United States. It describes limitations linked to the quality and method of presentation of the available data. It also considers the complex ways in which immigrant status, race, and SES combine to affect health and outlines important directions for research that would enhance our understanding of the ways in which social factors can lead to changes in health status. [ABSTRACT FROM AUTHOR]

I have summarized in this article data on the magnitude of health challenges faced by men in the United States. Across a broad range of indicators, men report poorer health than women. Although men in all socioeconomic groups are doing poorly in terms of health, some especially high-risk groups include men of low socioeconomic status (SES) of all racial/ethnic backgrounds, low-SES minority men, and middle-class Black men. Multiple factors contribute to the elevated health risks of men. These include economic marginality, adverse working conditions, and gendered coping responses to stress, each of which can lead to high levels of substance use, other health-damaging behaviors, and an aversion to health-protective behaviors. The forces that adversely affect men's health are interrelated, unfold over the life course, and are amenable to change. [ABSTRACT FROM AUTHOR]

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health. [ABSTRACT FROM AUTHOR]

This article provides an overview of the magnitude of and trends in racial/ethnic disparities in health for women in the United States. It emphasizes the importance of attending to diversity in the health profiles and populations of minority women. Socioeconomic status is a central determinant of racial/ethnic disparities in health, but several other factors, including medical care, geographic location, migration and acculturation, racism, and exposure to stress and resources also play a role. There is a need for renewed attention to monitoring, understanding, and actively seeking to eliminate racial/ethnic disparities in health. [ABSTRACT FROM AUTHOR]

Racial residential segregation is a fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. Despite the absence of supportive legal statutes, the degree of residential segregation remains extremely high for most African Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study determined the effects of changing from the 1940 to the 2000 standard million on monitoring socioeconomic and racial/ethnic inequalities in health. METHODS: Using the 1940, 1970, and 2000 standard million, we calculated and compared age-adjusted rates for selected health outcomes stratified by socioeconomic level. RESULTS: Changing from the 1940 to the 2000 standard million markedly reduced the age-adjusted relative risks for self-reported fair or poor health status of poor Americans compared with high-income Americans. CONCLUSIONS: Public health researchers and practitioners should give serious consideration to the implications of the change to the 2000 standard million for monitoring social inequalities in health. [ABSTRACT FROM AUTHOR]

PURPOSE: A large amount of research focuses on socioeconomic status (SES) to explain racial disparities in hypertension. But, little research has focused on associations between hypertension and the amount of exposure to or type of unfair treatment as an explanation for these disparities. We hypothesize that an association exists between prevalent hypertension and total exposure to unfair treatment in employment, housing, education, the legal system, and/or other service situations.METHODS: The YES Health Study is a pilot study of 98 Black and White adults, from low and middle SES neighborhoods, designed to examine macro and micro factors in the etiology and course of physical and mental health using quantitative and qualitative data. We modeled associations between hypertension and total exposure to unfair treatment in each of the five domains listed above, using full and race-stratified models, with adjustment for sex, age, neuroticism, education, and income.RESULTS: In the full model, we found no racial differences in hypertension, but a borderline significant association between hypertension and &ges;3 occurrences of unfair treatment in dealing with the police or courts vs. none (OR = 3.72, p = 0.056). In the race-stratified models, hypertension was not significantly associated with lifelong exposure to unfair treatment among White or Black adults, except for an association with &ges;3 occurrences of unfair treatment in employment vs. none for White adults (OR = 17.66, p = 0.022). White adults with lower education and Black adults older in age were also at significantly increased risk of hypertension.CONCLUSION: Hypertension was not associated with unfair treatment in the full model or for Black adults; however, our analysis was limited to acute stressors. Future research on the relationship between hypertension and unfair treatment should evaluate the extent to which unfair treatment is perceived as race-attributed and should examine the role of chronic stressors. [Copyright &y& Elsevier]

Background: Hypertension is the second leading risk factor for death in South Africa, and rates have steadily increased since the end of Apartheid. Research on the determinants of hypertension in South Africa has received considerable attention due to South Africa's rapid urbanization and epidemiological transition. However, scant work has been conducted to investigate how various segments of the Black South African population experience this transition. Identifying the correlates of hypertension in this population is critical to the development of policies and targeted interventions to strengthen equitable public health efforts. Methods: This analysis explores the relationship between individual and area-level socioeconomic status and hypertension prevalence, awareness, treatment, and control within a sample of 7,303 Black South Africans in three municipalities of the uMgungundlovu district in KwaZulu-Natal province: the Msunduzi, uMshwathi, and Mkhambathini. Cross-sectional data were collected on participants from February 2017 to February 2018. Individual-level socioeconomic status was measured by employment status and educational attainment. Ward-level area deprivation was operationalized by the most recent (2011 and 2001) South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and diabetes diagnosis. Results: The prevalence of hypertension in the sample was 44.4% (n = 3,240). Of those, 2,324 were aware of their diagnosis, 1,928 were receiving treatment, and 1,051 had their hypertension controlled. Educational attainment was negatively associated with hypertension prevalence and positively associated with its control. Employment status was negatively associated with hypertension control. Black South Africans living in more deprived wards had higher odds of being hypertensive and lower odds of having their hypertension controlled. Those residing in wards that became more deprived from 2001 to 2011 had higher odds of being aware of their hypertension, yet lower odds of receiving treatment for it. Conclusions: Results from this study can assist policymakers and practitioners in identifying groups within the Black South African population that should be prioritized for public health interventions. Black South Africans who have and continue to face barriers to care, including those with low educational attainment or living in deprived wards had worse hypertension outcomes. Potential interventions include community-based programs that deliver medication to households, workplaces, or community centers. [ABSTRACT FROM AUTHOR]

The article announces that Ph.D. student D. Alex Patthoff has received 2012 Pellas-Ryder Award.

Objectives. We sought to better understand the determinants of oral health disparities by examining individual-level psychosocial stressors and resources and self-rated oral health in nationally representative samples of black American, Caribbean black, and non-Hispanic white adults. Methods. We conducted logistic regression analyses on fair or poor versus better oral health using data from the National Survey of American Life (n = 6082). Results. There were no significant racial differences. Overall, 28% of adults reported having fair or poor oral health. Adults with lower income and less than a high school education were each about 1.5 times as likely as other adults to report fair or poor oral health. Higher levels of chronic stress, depressive symptoms, and material hardship were associated with fair or poor oral health. Adults living near more neighborhood resources were less likely to report fair or poor oral health. Higher levels of self-esteem and mastery were protective, and more-religious adults were also less likely to report fair or poor oral health. Conclusions. Social gradients in self-rated oral health were found, and they have implications for developing interventions to address oral health disparities. [ABSTRACT FROM AUTHOR]

I have summarized in this article data on the magnitude of health challenges faced by men in the United States. Across a broad range of indicators, men report poorer health than women. Although men in all socioeconomic groups are doing poorly in terms of health, some especially high-risk groups include men of low socioeconomic status (SES) of all racial/ethnic backgrounds, low-SES minority men, and middle-class Black men. Multiple factors contribute to the elevated health risks of men. These include economic marginality, adverse working conditions, and gendered coping responses to stress, each of which can lead to high levels of substance use, other health-damaging behaviors, and an aversion to health-protective behaviors. The forces that adversely affect men's health are interrelated, unfold over the life course, and are amenable to change. [ABSTRACT FROM AUTHOR]

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health. [ABSTRACT FROM AUTHOR]

This article explores the potential benefits and defined risks associated with prophylactic surgical procedures for astronauts before extended-duration space flight. This includes, but is not limited to, appendectomy and cholecystesctomy. Furthermore, discussion of treatment during space flight, potential impact of an acute illness on a defined mission and the ethical issues surrounding this concept are debated in detail. [ABSTRACT FROM AUTHOR]

Research conducted predominantly in the developed world suggests that there is an association between trauma exposure and suicidal behavior. However, there are limited data available investigating whether specific traumas are uniquely predictive of suicidal behavior or the extent to which traumatic events predict the progression from suicide ideation to plans and attempts. A national survey was conducted with 4351 adult South Africans between 2002 and 2004 as part of the World Health Organization World Mental Health Surveys. Data on trauma exposure and subsequent suicidal behavior were collected. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and lifetime suicidal behavior. A range of traumatic events are associated with lifetime suicide ideation and attempt; however, after controlling for all traumatic events in a multivariate model, only sexual violence (odds ratio = 4.7; confidence interval, 2.3 to 9.4) and having witnessed violence (odds ratio = 1.8; confidence interval, 1.1 to 2.9) remained significant predictors of lifetime suicide attempts. The disaggregation of the associations between traumatic events and suicide attempts indicates that they are largely caused by traumatic events predicting suicide ideation rather than by the progression from suicide ideation to attempt. This article highlights the importance of traumatic life events in the occurrence of suicidal thoughts and behaviors and provides important information about the nature of this association. Future research is needed to better understand how and why such experiences increase the risk of suicidal outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We examined mortality patterns across the lifespan of Native Hawaiians and compared mortality disparities across races. METHODS: We determined the age-specific and age-adjusted mortality rates of Native Hawaiians from 1990 to 2000 by using national census and vital registration data. RESULTS: Among Native Hawaiians aged younger than 1 year, expected deaths were 15% lower than for Blacks and 50% higher than for Whites. Among older adults, Native Hawaiians had higher rates of mortality compared with the general population, particularly in 1990 and 1995. Crude death rates for Native Hawaiians were similar to those for Blacks in 1990 and 1995 but were 20% lower than those for Blacks by 2000. Crude death rates for Native Hawaiians were 30% higher than for Whites in 1990 and 1995 and more than 40% higher than for Whites in 2000. CONCLUSIONS: Compared with Whites, Native Hawaiians and Blacks face similar challenges regarding infant and early-life mortality and increasing risks of mortality in mid-life and early old age. Our analyses document a need for renewed efforts to identify the determinants of ill health and commitment to address them. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the associations of poverty and food insecurity over a 2-year period with internalizing and externalizing problems in a large, community-based sample.Method: A total of 2,810 children were interviewed between ages 4 and 14 years at baseline, and between ages 5 and 16 years at follow-up. Primary caregivers reported on household income, food insecurity, and were administered the Child Behavior Checklist, from which we derived indicators of clinically significant internalizing and externalizing problems. Prevalence ratios for the associations of poverty and food insecurity with behavior problems were estimated.Results: At baseline, internalizing and externalizing problems were significantly more prevalent among children who lived in poor households than in nonpoor households, and among children who lived in food insecure households than in food-secure households. In adjusted analyses, children from homes that were persistently food insecure were 1.47 (95% CI = 1.12 to 1.94) times more likely to have internalizing problems and 2.01 (95% CI = 1.21 to 3.35) times more likely to have externalizing problems compared with children from households that were never food insecure. Children from homes that moved from food secure to insecure were 1.78 (95% CI = 1.07 to 2.94) times more likely to have externalizing problems at follow-up.Conclusions: Persistent food insecurity is associated with internalizing and externalizing problems, even after adjusting for sustained poverty and other potential confounders. These results implicate food insecurity as a novel risk factor for child mental well-being; if causal, this represents an important factor in the etiology of child psychopathology, and potentially a new avenue for prevention. [ABSTRACT FROM AUTHOR]

Smell identification tests (SITs) have been suggested as useful in the differential diagnosis of Parkinson's disease (PD). We have applied the 40 item University of Pennsylvania SIT (UPSIT-40) and/or the 16 item SIT from Sniffin Sticks (SS-16) to 193 nondemented PD patients and 157 controls and used logistic regression analysis to associate the SIT result with the probability of an individual patient having PD ("PD probability"). Reliability measures (95% CI) using the clinical diagnosis as a gold standard and a dichotomized result of the smell test into high (50% or more) or low (<50%) "PD probability" were: sensitivity 85.0% (78.8-89.7%), specificity 84.6% (77.3-89.9%) for the UPSIT-40; sensitivity 90.4% (83.5-94.7%), specificity 85.5% (76.2-91.7%) for the SS-16. Based on these findings we have created color coded visual tools (PD probability rulers) and applied them to 39 clinically uncertain parkinsonian syndromes (CUPS) patients who had been investigated with dopamine transporter SPECT scanning using [123-I]-FP-CIT SPECT (DaTSCAN) for suspected Parkinson's disease. In 32 of 36 CUPS cases (88.9%, kappa = 0.72) the probability ruler predicted the result of the DaTSCAN. We suggest smell tests could be used routinely in challenging cases where there is diagnostic uncertainty and help inform decision making relating to the need for neuro imaging. [ABSTRACT FROM AUTHOR]

Prognostic predictors have not been defined for progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). Subtypes of both disorders have been proposed on the basis of early clinical features. We performed a retrospective chart review to investigate the natural history of pathologically confirmed cases of PSP and MSA. Survival data and several clinically relevant milestones, namely: frequent falling, cognitive disability, unintelligible speech, severe dysphagia, dependence on wheelchair for mobility, the use of urinary catheters and placement in residential care were determined. On the basis of early symptoms, we subdivided cases with PSP into 'Richardson's syndrome' (RS) and 'PSP-parkinsonism' (PSP-P). Cases of MSA were subdivided according to the presence or absence of early autonomic failure. Sixty-nine (62.7%) of the 110 PSP cases were classified as RS and 29 (26.4%) as PSP-P. Of the 83 cases of MSA, 42 (53.2%) had autonomic failure within 2 years of disease onset. Patients with PSP had an older age of onset (P < 0.001), but similar disease duration to those with MSA. Patients with PSP reached their first clinical milestone earlier than patients with MSA (P < 0.001). Regular falls (P < 0.001), unintelligible speech (P = 0.04) and cognitive impairment (P = 0.03) also occurred earlier in PSP than in MSA. In PSP an RS phenotype, male gender, older age of onset and a short interval from disease onset to reaching the first clinical milestone were all independent predictors of shorter disease duration to death. Patients with RS also reached clinical milestones after a shorter interval from disease onset, compared to patients with PSP-P. In MSA early autonomic failure, female gender, older age of onset, a short interval from disease onset to reaching the first clinical milestone and not being admitted to residential care were independent factors predicting shorter disease duration until death. The time to the first clinical milestone is a useful prognostic predictor for survival. We confirm that RS had a less favourable course than PSP-P, and that early autonomic failure in MSA is associated with shorter survival. [ABSTRACT FROM AUTHOR]

Our objectives were to describe the trajectories of biological risk factors of cardiovascular disease in young adults, and to study the association of socioeconomic status (SES) with aggregate risk scores that summarize longitudinal risk accumulation from multiple risk factors. We used data from a prospective, bi-racial, cohort study of 18-30-year-old adults in the USA, initiated in 1985, with 10-year follow-up. SES was measured by parental education level, financial hardship during the study, and the participant's education level by the end of the study. We studied growth patterns of seven biological risk factors for cardiovascular disease using a semi-parametric, class-mixture model to identify clusters of individuals with distinct growth trajectories. Risk scores that summarize risk from all seven risk factors were created to reflect risk at baseline, longitudinal risk change over 10 years, and total accumulated risk. Multivariable regression was used to study their associations with SES within each race/gender group. We found tracking of all seven risk factors: in each case, the cluster with the highest baseline value maintained its position as the highest-risk cluster over the next 10 years. After adjustment for age, lifestyle, and healthcare access, SES was associated inversely with baseline risk score in women (black and white), with risk change score in all four race/gender groups, and with accumulated risk score in women (black and white) and in white men. Our findings suggest that individuals with high overall cardiovascular risk in midlife can be identified by their relatively higher values of risk factors in younger ages and that socioeconomic differences in cardiovascular risk start accumulating early in life. [ABSTRACT FROM AUTHOR]

This article examines the test-retest reliability and predictive utility of a new self-report measure of subjective socioeconomic status (SES) with a large, multiethnic national sample. The measure showed adequate test-retest reliability, and was associated with self-reported health even after controlling for traditional measures of SES. Negative affect did not appear to confound the association between subjective status and health, but may operate as a mediating factor which explains the link between subjective status and health. Future studies on social class disparities in health should consider how subjective perceptions of SES influence health, and explore psychological processes mediating subjective beliefs about status and health outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The goals of this study were to estimate prospective mortality risks of city residence, specify how these risks vary by population subgroup, and explore possible explanations. METHODS: Data were derived from a probability sample of 3617 adults in the coterminous United States and analyzed via cross-tabular and Cox proportional hazards methods. RESULTS: After adjustment for baseline sociodemographic and health variables, city residents had a mortality hazard rate ratio of 1.62 (95% confidence interval [CI] = 1.21, 2.18) relative to rural/small-town residents; suburbanites had an intermediate but not significantly elevated hazard rate ratio. This urban mortality risk was significant among men (hazard rate ratio: 2.25), especially non-Black men, but not among women. Among Black men, and to some degree Black women, suburban residence carried the greatest risk. All risks were most evident for those younger than 65 years. CONCLUSIONS: The mortality risk of city residence, at least among men, rivals that of major psychosocial risk factors such as race, low income, smoking, and social isolation and merits comparable attention in research and policy. [ABSTRACT FROM AUTHOR]

Solutions occurring within complex systems such as recovery of species are urgently needed. One path forward involves action agendas that extend across the full range of stakeholder groups. Approaches that can foster cooperative behavior across a range of vested interests can create environments supporting species recovery. This paper reports the stakeholder identification process used to gather divergent opinions. A total of 923 priorities from 239 stakeholders were identified. Consensus approaches were utilized, resulting in 25 top priorities, selected by 61 stakeholders. This study demonstrates how consensus areas for action can be illuminated and supported by diverse stakeholder groups whose relationships have previously been indicated as antagonistic. Results indicate support for a range of actions that can be implemented to protect iconic fish species such as pearl perch and snapper in Southeast Queensland. Stakeholders supported actions that; change fishing practices for groups (recreational, commercial and charter); extended monitoring and reporting; improved compliance; changes to fishing management practices; extended fishing control measures and the construction of additional artificial reef habitats. • Details a deliberative approach to help people consider and understand the viewpoints of others. • Identifies 923 priorities to protect two threatened species, namely pearl perch and snapper. • Demonstrates a solution focussed method. [ABSTRACT FROM AUTHOR]

Background: Because depression is a multidimensional construct and few studies have compared the relative importance of its facets in predicting cardiovascular risk, we evaluated the utility of depressive symptom clusters in predicting the 5-year incidence of coronary artery calcification (CAC).Methods and Results: Participants were 2171 middle-aged adults (58% female; 43% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study who were free of cardiovascular disease. Depressive symptom clusters (z scores) were measured by questionnaires in 2000 to 2001, and CAC was measured by electron beam computed tomography in 2000 to 2001 and 2005 to 2006. There were 243 cases (11%) of incident CAC, defined as the absence of CAC at baseline and the presence of CAC at follow-up. Total depressive symptoms (odds ratio, 1.16; 95% confidence interval, 1.02-1.33; P=0.03) and the depressed affect cluster (odds ratio, 1.17; 95% confidence interval, 1.03-1.33; P=0.02) predicted incident CAC; however, the somatic, interpersonal distress, low positive affect, and pessimism clusters did not. The depressed affect-incident CAC relationship was independent of age, sex, race, education, and antidepressant use; was similar across sex and racial groups; and was partially accounted for by tobacco use and mean arterial pressure.Conclusions: In contrast to recent results indicating that the somatic cluster is the most predictive of cardiovascular outcomes, we found that the prospective association between depressive symptoms and incident CAC was driven by the depressed affect cluster. Our findings raise the possibility that there may not be 1 facet of depression that is the most cardiotoxic across all contexts. [ABSTRACT FROM AUTHOR]

We aimed to compare disability rates associated with physical disorders versus psychiatric disorders and to establish treatment rates of both classes of disorder in the South African population. In a nationally representative survey of 4351 adults, treatment and prevalence rates of a range of physical and psychiatric disorders, and their associated morbidity during the previous 12 months were investigated. Physical illnesses were reported in 55.2% of the sample, 60.4% of whom received treatment for their disorder. Approximately 10% of the samples show a mental illness with 6.1% having received treatment for their disorder. The prevalence of any mental illness reported was higher than that reported individually for asthma, cancer, diabetes, and peptic ulcer. Mental disorders were consistently reported to be more disabling than physical disorders and the degree of disability increased as the number of comorbid disorders increased. Depression, in particular, was rated consistently higher across all domains than all physical disorders. Despite high rates of mental disorders and associated disability in South Africa, they are less likely to be treated than physical disorders. [ABSTRACT FROM AUTHOR]

There are few population-level insights into the use of traditional healers and other forms of alternative care for the treatment of common mental disorders in sub-Saharan Africa. We examined the extent to which alternative practitioners are consulted, and predictors of traditional healer visits. A national survey was conducted with 3651 adult South Africans between 2002 and 2004, using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate DSM-IV diagnoses for common mood, anxiety, and substance use disorders. A minority of participants with a lifetime DSM-IV diagnosis obtained treatment from Western (29%) or alternative (20%) practitioners. Traditional healers were consulted by 9% of the respondents and 11% consulted a religious or spiritual advisor. Use of traditional healers in the full sample was predicted by older age, black race, unemployment, lower education, and having an anxiety or a substance use disorder. Alternative practitioners, including traditional healers and religious advisors, appear to play a notable role in the delivery of mental health care in South Africa. [ABSTRACT FROM AUTHOR]

The South African population is exposed to multiple forms of violence. Using nationally representative data from 4351 South African adults, this study examined the relative risk for post-traumatic stress disorder (PTSD) associated with political, domestic, criminal, sexual and other (miscellaneous) forms of assault in the South African population. Violence exposure was assessed using the 'worst event' list from the WHO's Composite International Diagnostic Interview (CIDI) and a separate questionnaire assessing experiences of human rights abuses, and lifetime PTSD was assessed according to the APA's Diagnostic and Statistical Manual of Mental Disorders criteria using the CIDI. Findings indicated that over a third of the South African population has been exposed to some form of violence. The most common forms of violence experienced by men were criminal and miscellaneous assaults, while physical abuse by an intimate partner, childhood physical abuse and criminal assaults were most common for women. Among men, political detention and torture were the forms of violence most strongly associated with a lifetime diagnosis of PTSD, while rape had the strongest association with PTSD among women. At a population level, criminal assault and childhood abuse were associated with the greatest number of PTSD cases among men, while intimate partner violence was associated with the greatest number of PTSD cases among women. Recommendations for mental health service provision in South Africa and for future research on the relative risk for PTSD are offered. [ABSTRACT FROM AUTHOR]

BACKGROUND: The field of risk assessment has focused on protecting the health of individual people or populations of wildlife from single risks, mostly from chemical exposure. The U.S. Environmental Protection Agency recently began to address multiple risks to communities in the 'Framework for Cumulative Risk Assessment' [EPA/630/P02/001F. Washington DC:Risk Assessment Forum, U.S. Environmental Protection Agency (2003)]. Simultaneously, several reports concluded that some individuals and groups are more vulnerable to environmental risks than the general population. However, vulnerability has received little specific attention in the risk assessment literature. OBJECTIVE: Our objective is to examine the issue of vulnerability in cumulative risk assessment and present a conceptual framework rather than a comprehensive review of the literature. In this article we consider similarities between ecologic and human communities and the factors that make communities vulnerable to environmental risks. DISCUSSION: The literature provides substantial evidence on single environmental factors and simple conditions that increase vulnerability or reduce resilience for humans and ecologic systems. This observation is especially true for individual people and populations of wildlife. Little research directly addresses the topic of vulnerability in cumulative risk situations, especially at the community level. The community level of organization has not been adequately considered as an end point in either human or ecologic risk assessment. Furthermore, current information on human risk does not completely explain the level of response in cumulative risk conditions. Ecologic risk situations are similarly more complex and unpredictable for cases of cumulative risk. CONCLUSIONS: Psychosocial conditions and responses are the principal missing element for humans. We propose a model for including psychologic and social factors as an integral component of cumulative risk assessment. [ABSTRACT FROM AUTHOR]

Progress in studying the relationship between religion and health has been hampered by the absence of an adequate measure of religiousness and spirituality. This article reports on the conceptual and empirical development of an instrument to measure religiousness and spirituality, intended explicitly for studies of health. It is multidimensional to allow investigation of multiple possible mechanisms of effect, brief enough to be included in clinical or epidemiological surveys, inclusive of both traditional religiousness and noninstitutionally based spirituality, and appropriate for diverse Judeo-Christian populations. The measure may be particularly useful for studies of health in elderly populations in which religious involvement is higher. The measure was tested in the nationally representative 1998 General Social Survey (N = 1,445). Nine dimensions have indices with moderate-to-good internal consistency, and there are three single-item domains. Analysis by age and sex shows that elderly respondents report higher levels of religiousness in virtually every domain of the measure. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In this study we examined the relationship between indicators of socioeconomic status (SES) and mortality for a representative sample of individuals. METHODS: The sample included 3734 individuals aged 45 and older interviewed in 1984 in the Panel Study of Income Dynamics. In the current study, mortality was tracked between 1984 and 1994 and is related to SES indicators of education, occupation, income, and wealth. RESULTS: Wealth and recent family income were the indicators that were most strongly associated with subsequent mortality. These associations persisted after we controlled for the other SES indicators and were stronger for women than for men and for non-elderly than for elderly individuals. CONCLUSIONS: We found that the economic indicators of SES were usually as strongly associated with mortality as, if not more strongly associated with mortality than, the more conventional indicators of completed schooling and occupation. [ABSTRACT FROM AUTHOR]