Psychosocial Stress and Prostate Cancer: A Theoretical Model

African-American men are more likely to develop and die from prostate cancer than are European-American men; yet, factors responsible for the racial disparity in incidence and mortality have not been elucidated. Socioeconomic disadvantage can lead to psychosocial stress and may be linked to negative lifestyle behaviors. Regardless of socioeconomic position, African-American men routinely experience racism-induced stress. We propose a theoretical framework for an association between psychosocial stress and prostate cancer. With the context of history and culture, we further propose that psychosocial stress may partially explain the variable incidence of prostate cancer between these diverse groups. Psychosocial stress may negatively impact teh immune system leaving the individual susceptible to malingnancies. Behavioral responses to psychosocial stress are amenable to change. If psychosocial stress is found to negatively impact prostate cancer risk, interventions may be designed to modify reactions to environmental demands

Experiencing Physical Violence During Pregnancy: Prevalence and Correlates

Violence during pregnancy directly impacts the mental and physical health of pregnant women. We assessed the prevalence and correlates of physical violence around the time of pregnancy in a representative sample of 6,718 women in South Carolina. Physical violence, defined as being physically hurt by husband or partner or being involved in a physical fight was reported by 10.9% of recently pregnant women. These were correlates of violence: experiencing increased numbers of stressful life events, being unmarried, having increased parity, being on Medicaid, and having an unwanted pregnancy. Screening to identify violence in pregnancy in health care settings is vital to maternal and child health. However, identifying violence is not enough; community resources and clinic-based support are needed to help women deal with violence in their lives

Patients as Subjects for Research: Ethical Dilemmas for the Primary Care Clinician-Investigator

Background: Past studies suggested an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). In 1987, University of North Carolina (UNC) Hospitals Family Practice Center clinicians were approached for a control population to study this association. Methods: One hundred fives patients attending the UNC Hospitals Neoplasia Clinic with biopsy-proven CIN 2 or 3 and 268 control patients attending the UNC Family Practice Center for a routine Papanicolaou smear were enrolled in this case-control study. Case and control patients consented to having an additional cervical specimen taken and to being interviewed. The cervical specimens were classified by the Southern blot and polymerase chain reaction techniques for HPV. Resuilts: Early results suggested the control patients who had HPV were at high risk of developing CIN. Interventions were made to inform these patients of this risk and need for closer follow-up, causing a wide range of patient reactions. The final results showed no association of HPV with CIN, indicating the early interventions were premature. Conclusions: Physicians engaged in research need to be prepared to deal with the discovery of health risks in the otherwise normal control patients. They bear the ethical responsibility of scrutinizing study design and methods and planning communications with patients from the inception of a study

Predisposing Psychological Factors in the Development of Reflex Sympathetic Dystrophy: A Review of the Empirical Evidence

Objective: To examine the literature for evidence that psychological factors predispose certain individuals to development of reflex sympathetic dystrophy (RSD). Data Sources: English-language journal articles that described psychological data on patients diagnosed with RSD, identified through Medline search and bibliography reviews. Study Selection: All studies reporting data on psychological factors in adult, adolescent, or child patients with RSD were included. Data Extraction: We extracted data regarding psychological factors in patients with RSD and assessed validity of these studies through evaluation against seven basic research criteria. Data Synthesis: Of the 20 articles reviewed, 15 reported the presence of depression, anxiety, and/or life stress in patients with RSD. However, the methodological quality of these studies was generally poor, with most meeting three or less of the seven validity criteria. In particular, the absence of prospective designs restricts conclusions concerning whether psychological factors are etiologically related to RSD. Conclusions: The data reviewed are consistent with a theoretical model in which depression, anxiety, or life stressors may influence development of RSD through their effects on [alpha]-adrenergic activity. However, conclusions regarding etiological significance of these factors are not possible due to the dearth of high-quality studies. Suggestions for prospective research are described

Correlates and Consequences of Early Initiation of Sexual Intercourse

This cross-sectional analysis of the 1991 CDC Youth Risk Behavior Survey explored factors associated with an early age at first sexual intercourse. Almost 18% of White males, 49% of Black males, 5% of White females and 12% of Black females were sexually active before age 13. Carrying a weapon to school, fighting, and early (\u3c age 13) experimentation with cigarettes and alcohol were associated with early initiation of sexual activity for all four race and gender groupings. Those initiating sexual activity early had greater numbers of partners but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease (STD). Interventions to postpone sexual activity need to be tailored to the ethnic and gender differences observed in these analyses. Interventions must begin before age 13 and should be comprehensive school-based efforts