Showing papers on "Poison control published in 2000"

The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work

Abstract: This paper presents a critical appraisal of resilience, a construct connoting the maintenance of positive adaptation by individuals despite experiences of significant adversity. As empirical research on resilience has burgeoned in recent years, criticisms have been levied at work in this area. These critiques have generally focused on ambiguities in definitions and central terminology; heterogeneity in risks experienced and competence achieved by individuals viewed as resilient; instability of the phenomenon of resilience; and concerns regarding the usefulness of resilience as a theoretical construct. We address each identified criticism in turn, proposing solutions for those we view as legitimate and clarifying misunderstandings surrounding those we believe to be less valid. We conclude that work on resilience possesses substantial potential for augmenting the understanding of processes affecting at-risk individuals. Realization of the potential embodied by this construct, however, will remain constrained without continued scientific attention to some of the serious conceptual and methodological pitfalls that have been noted by skeptics and proponents alike.

Choices, Values, and Frames

Abstract: We discuss the cognitive and the psy- chophysical determinants of choice in risky and risk- less contexts. The psychophysics of value induce risk aversion in the domain of gains and risk seeking in the domain of losses. The psychophysics of chance induce overweighting of sure things and of improbable events, relative to events of moderate probability. De- cision problems can be described or framed in multiple ways that give rise to different preferences, contrary to the invariance criterion of rational choice. The pro- cess of mental accounting, in which people organize the outcomes of transactions, explains some anomalies of consumer behavior. In particular, the acceptability of an option can depend on whether a negative outcome is evaluated as a cost or as an uncompensated loss. The relation between decision values and experience values is discussed. Making decisions is like speaking prose—people do it all the time, knowingly or unknowingly. It is hardly surprising, then, that the topic of decision making is shared by many disciplines, from mathematics and statistics, through economics and political science, to sociology and psychology. The study of decisions ad- dresses both normative and descriptive questions. The normative analysis is concerned with the nature of rationality and the logic of decision making. The de- scriptive analysis, in contrast, is concerned with peo- ple's beliefs and preferences as they are, not as they should be. The tension between normative and de- scriptive considerations characterizes much of the study of judgment and choice. Analyses of decision making commonly distin- guish risky and riskless choices. The paradigmatic example of decision under risk is the acceptability of a gamble that yields monetary outcomes with specified probabilities. A typical riskless decision concerns the acceptability of a transaction in which a good or a service is exchanged for money or labor. In the first part of this article we present an analysis of the cog- nitive and psychophysical factors that determine the value of risky prospects. In the second part we extend this analysis to transactions and trades. Risky Choice Risky choices, such as whether or not to take an umbrella and whether or not to go to war, are made without advance knowledge of their consequences. Because the consequences of such actions depend on uncertain events such as the weather or the opponent's resolve, the choice of an act may be construed as the acceptance of a gamble that can yield various out- comes with different probabilities. It is therefore nat- ural that the study of decision making under risk has focused on choices between simple gambles with monetary outcomes and specified probabilities, in the hope that these simple problems will reveal basic at- titudes toward risk and value. We shall sketch an approach to risky choice that

Simulating dynamical features of escape panic

Abstract: One of the most disastrous forms of collective human behaviour is the kind of crowd stampede induced by panic, often leading to fatalities as people are crushed or trampled. Sometimes this behaviour is triggered in life-threatening situations such as fires in crowded buildings; at other times, stampedes can arise during the rush for seats or seemingly without cause. Although engineers are finding ways to alleviate the scale of such disasters, their frequency seems to be increasing with the number and size of mass events. But systematic studies of panic behaviour and quantitative theories capable of predicting such crowd dynamics are rare. Here we use a model of pedestrian behaviour to investigate the mechanisms of (and preconditions for) panic and jamming by uncoordinated motion in crowds. Our simulations suggest practical ways to prevent dangerous crowd pressures. Moreover, we find an optimal strategy for escape from a smoke-filled room, involving a mixture of individualistic behaviour and collective 'herding' instinct.

The Consequences of Divorce for Adults and Children

Abstract: I use a divorce-stress-adjustment perspective to summarize and organize the empirical literature on the consequences of divorce for adults and children. My review draws on research in the 1990s to answer five questions: How do individuals from married and divorced families differ in well-being? Are these differences due to divorce or to selection? Do these differences reflect a temporary crisis to which most people gradually adapt or stable life strains that persist more or less indefinitely? What factors mediate the effects of divorce on individual adjustment? And finally, what are the moderators (protective factors) that account for individual variability in adjustment to divorce? In general, the accumulated research suggests that marital dissolution has the potential to create considerable turmoil in people's lives. But people vary greatly in their reactions. Divorce benefits some individuals, leads others to experience temporary decrements in well-being, and forces others on a downward trajectory from which they might never recover fully. Understanding the contingencies under which divorce leads to these diverse outcomes is a priority for future research.

Review of ecological effects of roads on terrestrial and aquatic communities.

Abstract: Roads are a widespread and increasing feature of most landscapes. We reviewed the scientific liter- ature on the ecological effects of roads and found support for the general conclusion that they are associated with negative effects on biotic integrity in both terrestrial and aquatic ecosystems. Roads of all kinds have seven general effects: mortality from road construction, mortality from collision with vehicles, modification of animal behavior, alteration of the physical environment, alteration of the chemical environment, spread of exotics, and increased use of areas by humans. Road construction kills sessile and slow-moving organisms, injures organisms adjacent to a road, and alters physical conditions beneath a road. Vehicle collisions affect the demography of many species, both vertebrates and invertebrates; mitigation measures to reduce roadkill have been only partly successful. Roads alter animal behavior by causing changes in home ranges, move- ment, reproductive success, escape response, and physiological state. Roads change soil density, temperature, soil water content, light levels, dust, surface waters, patterns of runoff, and sedimentation, as well as adding heavy metals (especially lead), salts, organic molecules, ozone, and nutrients to roadside environments. Roads promote the dispersal of exotic species by altering habitats, stressing native species, and providing movement corridors. Roads also promote increased hunting, fishing, passive harassment of animals, and landscape modifications. Not all species and ecosystems are equally affected by roads, but overall the pres- ence of roads is highly correlated with changes in species composition, population sizes, and hydrologic and geomorphic processes that shape aquatic and riparian systems. More experimental research is needed to com- plement post-hoc correlative studies. Our review underscores the importance to conservation of avoiding con- struction of new roads in roadless or sparsely roaded areas and of removal or restoration of existing roads to benefit both terrestrial and aquatic biota.

Sex differences in aggression between heterosexual partners: a meta-analytic review.

Abstract: Meta-analyses of sex differences in physical aggression to heterosexual partners and in its physical consequences are reported. Women were slightly more likely (d = -.05) than men to use one or more act of physical aggression and to use such acts more frequently. Men were more likely (d =. 15) to inflict an injury, and overall, 62% of those injured by a partner were women. The findings partially support previous claims that different methods of measurement produce conflicting results, but there was also evidence that the sample was an important moderator of effect size. Continuous models showed that younger aged dating samples and a lower proportion of physically aggressive males predicted effect sizes in the female direction. Analyses were limited by the available database, which is biased toward young dating samples in the United States. Wider variations are discussed in terms of two conflicting norms about physical aggression to partners that operate to different degrees in different cultures.

Pituitary-Adrenal and Autonomic Responses to Stress in Women After Sexual and Physical Abuse in Childhood

Abstract: ContextEvidence suggests that early adverse experiences play a preeminent role in development of mood and anxiety disorders and that corticotropin-releasing factor (CRF) systems may mediate this association.ObjectiveTo determine whether early-life stress results in a persistent sensitization of the hypothalamic-pituitary-adrenal axis to mild stress in adulthood, thereby contributing to vulnerability to psychopathological conditions.Design and SettingProspective controlled study conducted from May 1997 to July 1999 at the General Clinical Research Center of Emory University Hospital, Atlanta, Ga.ParticipantsForty-nine healthy women aged 18 to 45 years with regular menses, with no history of mania or psychosis, with no active substance abuse or eating disorder within 6 months, and who were free of hormonal and psychotropic medications were recruited into 4 study groups (n = 12 with no history of childhood abuse or psychiatric disorder [controls]; n = 13 with diagnosis of current major depression who were sexually or physically abused as children; n = 14 without current major depression who were sexually or physically abused as children; and n = 10 with diagnosis of current major depression and no history of childhood abuse).Main Outcome MeasuresAdrenocorticotropic hormone (ACTH) and cortisol levels and heart rate responses to a standardized psychosocial laboratory stressor compared among the 4 study groups.ResultsWomen with a history of childhood abuse exhibited increased pituitary-adrenal and autonomic responses to stress compared with controls. This effect was particularly robust in women with current symptoms of depression and anxiety. Women with a history of childhood abuse and a current major depression diagnosis exhibited a more than 6-fold greater ACTH response to stress than age-matched controls (net peak of 9.0 pmol/L [41.0 pg/mL]; 95% confidence interval [CI], 4.7-13.3 pmol/L [21.6-60.4 pg/mL]; vs net peak of 1.4 pmol/L [6.19 pg/mL]; 95% CI, 0.2-2.5 pmol/L [1.0-11.4 pg/mL]; difference, 8.6 pmol/L [38.9 pg/mL]; 95% CI, 4.6-12.6 pmol/L [20.8-57.1 pg/mL]; P<.001).ConclusionsOur findings suggest that hypothalamic-pituitary-adrenal axis and autonomic nervous system hyperreactivity, presumably due to CRF hypersecretion, is a persistent consequence of childhood abuse that may contribute to the diathesis for adulthood psychopathological conditions. Furthermore, these results imply a role for CRF receptor antagonists in the prevention and treatment of psychopathological conditions related to early-life stress.

Dysfunction in the Neural Circuitry of Emotion Regulation--A Possible Prelude to Violence

Abstract: Emotion is normally regulated in the human brain by a complex circuit consisting of the orbital frontal cortex, amygdala, anterior cingulate cortex, and several other interconnected regions. There are both genetic and environmental contributions to the structure and function of this circuitry. We posit that impulsive aggression and violence arise as a consequence of faulty emotion regulation. Indeed, the prefrontal cortex receives a major serotonergic projection, which is dysfunctional in individuals who show impulsive violence. Individuals vulnerable to faulty regulation of negative emotion are at risk for violence and aggression. Research on the neural circuitry of emotion regulation suggests new avenues of intervention for such at-risk populations.

Student Engagement in Instructional Activity: Patterns in the Elementary, Middle, and High School Years

Abstract: Although student engagement with the intellectual work of school is important to students' achievement and to their social and cognitive development, studies over a span of two decades have documented low levels of engagement, particularly in the classroom. Examining several theoretical perspectives that attempt to explain engagement through comprehensive frameworks, this study evaluates the effect on engagement of school reform initiatives that are consistent with the theories. The study also investigates whether patterns exist in students' engagement, whether the patterns are consistent across grade levels, and whether class subject matter (mathematics or social studies) differentially affects engagement. The sample includes 3,669 students representing 143 social studies and mathematics classrooms in a nationally selected sample of 24 restructuring elementary, middle, and high schools. Because of the nature of the nested data (students nested within classrooms nested within schools), the analysis is conducted using hierarchical linear modeling in its three-level application (HLM3L). The reform initiatives, which are consistent with the theories, eliminate personal background effects. Together with classroom subject matter, they substantially influence engagement. The results are generally consistent across grade levels.

Plan 9 From Cyberspace: The Implications of the Internet for Personality and Social Psychology:

Abstract: Just as with most other communication breakthroughs before it, the initial media and popular reaction to the Internet has been largely negative, if not apocalyptic. For example, it has been described as “awash in pornography”, and more recently as making people “sad and lonely.” Yet, counter to the initial and widely publi cized claim that Internet use causes depression and social isolation, the body of ev idence (even in the initial study on which the claim was based) is mainly to the con trary. More than this, however, it is argued that like the telephone and television before it, the Internet by itself is not a main effect cause of anything, and that psy chology must move beyond this notion to an informed analysis of how social iden tity, social interaction, and relationship formation may be different on the Internet than in real life. Four major differences and their implications for self and identity, social interaction, and relationships are identified: one's greater anonymity, the greatly reduced i...

Intergroup emotions: explaining offensive action tendencies in an intergroup context.

Abstract: Purdue University Three studies tested the idea that when social identity is salient, group-based appraisals elicit specific emotions and action tendencies toward out-groups. Participants' group memberships were made salient and the collective support apparently enjoyed by the in-group was measured or manipulated. The authors then measured anger and fear (Studies 1 and 2) and anger and contempt (Study 3), as well as the desire to move against or away from the out-group. Intergroup anger was distinct from intergroup fear, and the inclination to act against the out-group was distinct from the tendency to move away from it. Participants who perceived the in-group as strong were more likely to experience anger toward the out-group and to desire to take action against it. The effects of perceived in-group strength on offensive action tendencies were mediated by anger. The annals of history and contemporary news sources bear overwhelming witness to the variety of ways in which out-groups are devalued, discriminated against, and sometimes decimated by the members of other groups. One group is shunned and avoided, a second economically exploited, another belittled and scape- goated, and yet another systematically murdered. In contributing a social psychological perspective to the understanding of negative intergroup behavior, social psychologists have typically focused on prejudice---a negative evaluation of a group and its mem- bers-as the cause of discrimination. Despite the insights provided by such an approach (for reviews, see Brewer & Brown, 1998; Dovidio, Brigham, Johnson, & Gaertner, 1996; Fiske, 1998; Macrae, Stangor, & Hewstone, 1996; Mackie & Smith, 1998a), conceptualizing prejudice as a negative evaluation of a group has proved of little help in explaining the wide variety of negative reactions to out-groups (Mackie & Smith, 1998a, 1998b; Schnei- der, 1996; E. R. Smith, 1993). Why does one out-group attract fear or contempt while another becomes the target of anger? If out- groups uniformly attract negative evaluation, what factors explain the impulse, desire, intention, or tendency to move against some groups and away from others? Unfortunately, very little work has been done to differentiate action tendencies elicited in intergroup contexts (Grant & Brown, 1995; Mackie & Smith, 1998a; Messick & Mackie, 1989; Wright, Taylor, & Moghaddam, 1990; important Diane M. Mackie and Thierry Devos, Department of Psychology, Uni- versity of California, Santa Barbara; Eliot R. Smith, Department of Psy- chological Sciences, Purdue University. This research was supported by National Science Foundation Grant SBR 9209995, a Swiss National Science Foundation Fellowship, and National Institute of Mental Health Grants RO1 MH46840 and KO2 MH01178. Thierry Devos is now at the Department of Psychology, Yale University. Correspondence concerning this article should be addressed to Diane M. Mackie, Department of Psychology, University of California, Santa Barbara, California 93106-9660. Electronic mail may be sent to mackie @psych.ucsb.edu. 602 exceptions are discussed later). The research reported here consti- tutes an initial empirical investigation of a novel theoretical ap- proach to answering these questions. Although intergroup theorists have by and large concentrated on negative attitude or evaluation as a precursor to discrimination, emotion theorists have typically differentiated both the diversity of feelings that may be directed toward a particular target and the specificity of behavior that can follow from those feelings. Ap- praisal theories of emotion (Frijda, 1986; Roseman, 1984; Scherer, 1988; C. A. Smith & Ellsworth, 1985), in particular, conceptualize personal emotions as complex reactions to specific situations or events that include quite differentiated cognitions, feelings, and action tendencies. Specific emotions experienced by an individual are triggered by appraisals (cognitions or interpretations) of whether an event appears to favor or harm the individual's goals or desires and whether the individual has the resources to cope or not, for example. Depending on their particular configuration, cogni- tive appraisals trigger specific emotional experiences (Ellsworth & Smith, 1988; Roseman, Spindel, & Jose, 1990; C. A. Smith & Ellsworth, 1985) and these emotional experiences in turn promote certain behaviors (Frijda, Kuipers, & ter Schure, 1989; Roseman, Wiest, & Swartz, 1994). Anger at another individual, for example, is typically conceptualized as resulting from appraisals that the other has harmed the self and that the self is strong. Such anger in turn leads to tendencies to aggress against that other person. Appraisal theory was developed to explain personal emotions experienced by individuals, and this focus was maintained in an important application of it to the intergroup context. Dijker (1987; Dijker, Koomen, van den Heuvel, & Frijda, 1996) asked native Dutch participants their emotional reactions to individual members of naturally occurring out-groups, with the assumption that these reactions depended on the nature of interpersonal interactions that participants had experienced. Respondents reported feeling a range of distinct negative and positive emotions about out-group mem- bers indicating that their personal emotions were indeed influenced by their individual experiences in encounters with other groups.

Factors in risk perception

Abstract: Risk perception is a phenomenon in search of an explanation. Several approaches are discussed in this paper. Technical risk estimates are sometimes a potent factor in accounting for perceived risk, but in many important applications it is not. Heuristics and biases, mainly availability, account for only a minor portion of risk perception, and media contents have not been clearly implicated in risk perception. The psychometric model is probably the leading contender in the field, but its explanatory value is only around 20% of the variance of raw data. Adding a factor of "unnatural risk" considerably improves the psychometric model. Cultural Theory, on the other hand, has not been able to explain more than 5-10% of the variance of perceived risk, and other value scales have similarly failed. A model is proposed in which attitude, risk sensitivity, and specific fear are used as explanatory variables; this model seems to explain well over 30-40% of the variance and is thus more promising than previous approaches. The model offers a different type of psychological explanation of risk perception, and it has many implications, e.g., a different approach to the relationship between attitude and perceived risk, as compared with the usual cognitive analysis of attitude.

Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis

Abstract: Background Women who report childhood sexual abuse (CSA) are at increased risk for developing psychiatric disorders in adulthood. What is the diagnostic specificity and cause of this association? Methods In a population-based sample of 1411 female adult twins, 3 levels of CSA were assessed by self-report and cotwin report: nongenital, genital, and intercourse. Interviews with twins and parents assessed family background and diagnoses of psychiatric and substance dependence disorders. Odds ratios (ORs) were calculated by logistic regression. Results By self-report, 30.4% reported any CSA and 8.4% reported intercourse. Self-reported CSA was positively associated with all disorders, the highest ORs being seen with bulimia and alcohol and other drug dependence. The ORs were modest and often nonsignificant with nongenital CSA and increased with genital CSA and especially intercourse, where most ORs exceeded 3.0. A similar pattern of findings was seen with CSA as reported by the cotwin, although many ORs were smaller. Controlling for family background factors and parental psychopathology produced a small to modest reduction in ORs. In twin pairs discordant for CSA, the exposed twin was at consistently higher risk of illness. Conclusions Women with CSA have a substantially increased risk for developing a wide range of psychopathology. Most of this association is due to more severe forms of CSA and cannot be explained by background familial factors. Although other biases cannot be ruled out, these results are consistent with the hypothesis that CSA is causally related to an increased risk for psychiatric and substance abuse disorders.

Video games and aggressive thoughts, feelings, and behavior in the laboratory and in life.

Abstract: Two studies examined violent video game effects on aggression-related variables. Study 1 found that real-life violent video game play was positively related to aggressive behavior and delinquency. The relation was stronger for individuals who are characteristically aggressive and for men. Academic achievement was negatively related to overall amount of time spent playing video games. In Study 2, laboratory exposure to a graphically violent video game increased aggressive thoughts and behavior. In both studies, men had a more hostile view of the world than did women. The results from both studies are consistent with the General Affective Aggression Model, which predicts that exposure to violent video games will increase aggressive behavior in both the short term (e.g., laboratory aggression) and the long term (e.g., delinquency).

The global burden of injuries.

Abstract: The traditional view of injuries as "accidents", or random events, has resulted in the historical neglect of this area of public health. However, the most recent estimates show that injuries are among the leading causes of death and disability in the world. They affect all populations, regardless of age, sex, income, or geographic region. In 1998, about 5.8 million people (97.9 per 100,000 population) died of injuries worldwide, and injuries caused 16% of the global burden of disease. Road traffic injuries are the 10th leading cause of death and the 9th leading cause of the burden of disease; self-inflicted injuries, falls, and interpersonal violence follow closely. Injuries affect mostly young people, often causing long-term disability. Decreasing the burden of injuries is among the main challenges for public health in the next century--injuries are preventable, and many effective strategies are available. Public health officials must gain a better understanding of the magnitude and characteristics of the problem, contribute to the development and evaluation of injury prevention programs, and develop the best possible prehospital and hospital care and rehabilitation for injured persons.

Personality and risk-taking: common biosocial factors.

Abstract: The first part of this article describes a study of the relationships between personality and risk-taking in six areas: smoking, drinking, drugs, sex, driving, and gambling. The participants, 260 college students, were given self-report measures of risky behaviors in each of the six areas and the Zuckerman- Kuhlman five-factor personality questionnaire. Generalized risk-taking (across all six areas) was related to scales for impulsive sensation seeking, aggression, and sociability, but not to scales for neuroticism or activity. Gender differences on risk-taking were mediated by differences on impulsive sensation seeking. The second part discusses biological traits associated with both risk-taking and personality, particularly sensation seeking, such as the D4 dopamine receptor gene, the enzyme monoamine oxidase, and augmenting or reducing of the cortical evoked potential. Comparative studies show relationships between biological markers shared with other species and correlated behaviors similar to sensation seeking in humans. A biosocial model of the traits underlying risk-taking is presented. Many of life's decisions involve a balance between anticipated reward and risk. The wild rodent venturing into an open field balances the possibility of finding food against the chance of being devoured by a predator on the ground or from the sky. The married man or woman who

The effects of family and community violence on children.

Abstract: This review examines theoretical and empirical literature on children's reactions to three types of violence--child maltreatment, community violence, and interparental violence. In addition to describing internalizing and externalizing problems associated with exposure to violence, this review identifies ways that violence can disrupt typical developmental trajectories through psychobiological effects, post-traumatic stress disorder (PTSD), cognitive consequences, and peer problems. Methodological challenges in this literature include high rates of co-occurrence among types of violence exposure, co-occurrence of violence with other serious life adversities, heterogeneity in the frequency, severity, age of onset, and chronicity of exposure, and difficulties in making causal inferences. A developmental psychopathology perspective focuses attention on how violence may have different effects at different ages and may compromise children's abilities to face normal developmental challenges. Emphasis is placed on the variability of children's reactions to violence, on outcomes that go beyond diagnosable disorders, and on variables that mediate and moderate children's reactions to violence.

Research on the Nature and Determinants of Marital Satisfaction: A Decade in Review

Abstract: Scientific study of marital satisfaction attracted widespread attention in the 1990s from scholars representing diverse orientations and goals. This article highlights key conceptual and empirical advances that have emerged in the past decade, with particular emphasis on (a) interpersonal processes that operate within marriage, including cognition, affect, physiology, behavioral patterning, social support, and violence; (b) the milieus within which marriages operate, including microcontexts (e.g., the presence of children, life stressors and transitions) and macrocontexts (e.g., economic factors, perceived mate availability); and (c) the conceptualization and measurement of marital satisfaction, including 2-dimensional, trajectory-based, and social-cognitive approaches. Notwithstanding the continued need for theoretical progress in understanding the nature and determinants of marital satisfaction, we conclude by calling for more large-scale longitudinal research that links marital processes with sociocultural contexts, for more disconfirmatory than confirmatory research, and for research that directly guides preventive, clinical, and policy-level interventions.

Research on Domestic Violence in the 1990s: Making Distinctions

Abstract: This review of the family literature on domestic violence suggests that two broad themes of the 1990s provide the most promising directions for the future. The first is the importance of distinctions among types or contexts of violence. Some distinctions are central to the theoretical and practical understanding of the nature of partner violence, others provide important contexts for developing more sensitive and comprehensive theories, and others may simply force us to question our tendency to generalize carelessly from one context to another. Second, issues of control, although most visible in the feminist literature that focuses on men using violence to control “their” women, also arise in other contexts, calling for more general analyses of the interplay of violence, power, and control in relationships. In addition to these two general themes, our review covers literature on coping with violence, the effects on victims and their children, and the social effects of partner violence. She wandered the streets, looking in shop windows. Nobody knew her here. Nobody knew what he did when the door was closed. Nobody knew. (Brant, 1996, pp. 281)

Prevalence and Consequences of Male-to-female and Female-to-male Intimate Partner Violence as Measured by the National Violence Against Women Survey

Abstract: Using data from a telephone survey of 8,000 U.S. men and 8,000 U.S. women, this study compares the prevalence and consequences of violence perpetrated against men and women by marital and opposite-sex cohabiting partners. The study found that married/cohabiting women reported significantly more intimate perpetrated rape, physical assault, and stalking than did married/cohabiting men, whether the time period considered was the respondent's lifetime or the 12 months preceding the survey. Women also reported more frequent and longer lasting victimization, fear of bodily injury, time lost from work, injuries, and use of medical, mental health, and justice system services.

Age at first alcohol use: a risk factor for the development of alcohol disorders.

Abstract: OBJECTIVE: This study aimed to describe the natural course of DSM-III-R alcohol disorders as a function of age at first alcohol use and to investigate the influence of early use as a risk factor for progression to the development of alcohol disorders, exclusive of the effect of confounding influences. METHOD: Data were obtained from a community sample (N=5,856) of lifetime drinkers participating in the 1990–1991 Mental Health Supplement of the Ontario Health Survey.RESULTS: Survival analyses revealed a rapid progression to alcohol-related harm among those who reported having their first drink at ages 11–14. After 10 years, 13.5% of the subjects who began to drink at ages 11 and 12 met the criteria for a diagnosis of alcohol abuse, and 15.9% had a diagnosis of dependence. Rates for subjects who began to drink at ages 13 and 14 were 13.7% and 9.0%, respectively. In contrast, rates for those who started drinking at ages 19 and older were 2.0% and 1.0%. Unexpectedly, a delay in progression to harm was observe...

Causes of the excess mortality of schizophrenia.

Abstract: Background The excess mortality of schizophrenia is well recognised, but its precise causes are not well understood. Aims To measure the standardised mortality ratio (SMR) and examine the reasons for any excess mortality in a community cohort with schizophrenia. Method We carried out a 13-year follow-up of 370 patients with schizophrenia, identifying those who died and their circumstances. Results Ninety-six per cent of the cohort was traced. There were 79 deaths. The SMRs for all causes (298), for natural (232) and for unnatural causes (1273), were significantly higher than those to be expected in the general population, as were the SMRs for disease of the circulatory, digestive, endocrine, nervous and respiratory systems, suicide and undetermined death. Smoking-related fatal disease was more prominent than in the general population. Conclusions Some of the excess mortality of schizophrenia could be lessened by reducing patients'smoking and exposure to other environmental risk factors and by improving the management of medical disease, mood disturbance and psychosis.

Risk factors for suicide in psychiatric outpatients: a 20-year prospective study.

Abstract: To determine the risk factors for suicide, 6,891 psychiatric outpatients were evaluated in a prospective study. Subsequent deaths for the sample were identified through the National Death Index. Forty-nine (1%) suicides were determined from death certificates obtained from state vital statistics offices. Specific psychological variables that could be modified by clinical intervention were measured using standardized scales. Univariate survival analyses revealed that the severity of depression, hopelessness, and suicide ideation were significant risk factors for eventual suicide. A multivariate survival analysis indicated that several modifiable variables were significant and unique risk factors for suicide, including suicide ideation, major depressive disorder, bipolar disorder, and unemployment status.

Physical Health Consequences of Physical and Psychological Intimate Partner Violence

Abstract: Background: Past studies that have addressed the health effects of intimate partner violence (IPV) have defined IPV as violence based on physical blows that frequently cause injuries. To our knowledge, no epidemiologic research has assessed the physical health consequences of psychological forms of IPV. Objective: To estimate IPV prevalence by type and associated physical health consequences among women seeking primary health care. Design: Cross-sectional survey. Setting and Participants: A total of 1152 women, aged 18 to 65 years, recruited from family practice clinics from February 1997 through January 1999 and screened for IPV during a brief in-clinic interview; health history and current status were assessed in a follow-up interview. Results: Of 1152 women surveyed, 53.6% ever experienced any type of partner violence; 13.6% experienced psychological IPV without physical IPV. Women experiencing psychological IPV were significantly more likely to report poor physical and mental health (adjusted relative risk [RR], 1.69 for physical health and 1.74 for mental health). Psychological IPV was associated with a number of adverse health outcomes, including a disability preventing work (adjusted RR, 1.49), arthritis (adjusted RR, 1.67), chronic pain (adjusted RR, 1.91), migraine (adjusted RR, 1.54) and other frequent headaches (adjusted RR, 1.41), stammering (adjusted RR, 2.31), sexually transmitted infections (adjusted RR, 1.82), chronic pelvic pain (adjusted RR, 1.62), stomach ulcers (adjusted RR, 1.72), spastic colon (adjusted RR, 3.62), and frequent indigestion, diarrhea, or constipation (adjusted RR, 1.30). Psychological IPV was as strongly associated with the majority of adverse health outcomes as was physical IPV. Conclusions: Psychological IPV has significant physical health consequences. To reduce the range of health consequences associated with IPV, clinicians should screen for psychological forms of IPV as well as physical and sexual IPV.

An exploration of the drive for muscularity in adolescent boys and girls

Abstract: Much of the existing research on disordered eating has centered on the drive for thinness, which is most commonly observed in girls and women. The male standard of bodily attractiveness, however, is bigger, bulkier, and more muscular. Are boys and men motivated to be big and muscular in the same way that girls and women are motivated to be thin? The authors constructed a 15-item survey and administered it to 197 adolescents. The findings showed that the drive for muscularity measure displayed good reliability; that individuals high in the drive were more likely to be boys who were trying to gain both weight and muscle mass; that the drive was related to poor self-esteem and higher levels of depression among boys, but not among girls; and that the drive for muscularity was relatively unrelated to the drive for thinness.

All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work

Abstract: BACKGROUND: Physical activity is associated with low mortality in men, but little is known about the association in women, different age groups, and everyday activity. OBJECTIVE: To evaluate the relationship between levels of physical activity during work, leisure time, cycling to work, and sports participation and all-cause mortality. DESIGN: Prospective study to assess different types of physical activity associated with risk of mortality during follow-up after the subsequent examination. Mean follow-up from examination was 14.5 years. SETTING: Copenhagen University Hospital, Copenhagen, Denmark. PARTICIPANTS: Participants were 13,375 women and 17,265 men, 20 to 93 years of age, who were randomly selected. Physical activity was assessed by self-report, and health status, including blood pressure, total cholesterol level, triglyceride levels, body mass index, smoking, and educational level, was evaluated. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: A total of 2,881 women and 5,668 men died. Compared with the sedentary, age- and sex-adjusted mortality rates in leisure time physical activity groups 2 to 4 were 0.68 (95% confidence interval, 0.64-0.71), 0.61 (95% confidence interval, 0.57-0.66), and 0.53 (95% confidence interval, 0.41-0.68), respectively, with no difference between sexes and age groups. Within the moderately and highly active persons, sports participants experienced only half the mortality of nonparticipants. Bicycling to work decreased risk of mortality in approximately 40% after multivariate adjustment, including leisure time physical activity. CONCLUSIONS: Leisure time physical activity was inversely associated with all-cause mortality in both men and women in all age groups. Benefit was found from moderate leisure time physical activity, with further benefit from sports activity and bicycling as transportation.