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We contrast Western medical views of chronic fatigue syndrome (CFS) etiology, diagnosis, and treatment with views maintained by a predominantly female CFS population. We argue that the failure of Western medicine to demonstrate a viral etiology for CFS led to a paradigmatic shift in research perspectives, which then embraced psychiatric and sociocultural explanations for CFS. As a result, CFS was delegitimized as a biomedical phenomenon within medical, academic, governmental, and public arenas. We compare alternative social constructions of CFS with issues pertaining to multiple sclerosis (MS), an illness that similarly predominates among women. Patient perspectives suggest that the history of medical attitudes toward CFS may eventually parallel the transformations that occurred in relation to MS. In particular, the discovery of biological markers for CFS may lay to rest the categorization of CFS as largely within the psychiatric realm.

Purpose: While workplace sexual harassment has received a great deal of attention in both the popular media and scientific literature, less attention has been directed to the differential occurrence of sexual harassment among lesbians, gay men, and heterosexual men and women, and the relationships between these experiences and alcohol-related outcomes. Additionally, the distribution of alcohol-related outcomes of non-sexual forms of workplace harassment among these groups have not been adequately explored., Method: Using data from a university-based study of workplace harassment and alcohol use (N = 2492), we focus on exposure to workplace harassment and alcohol-related outcomes for lesbians, gay men, and bisexuals compared to heterosexual men and women., Results: Lesbian/bisexual women did not differ significantly from heterosexual women in their experiences of workplace harassment. However, stronger linkages between harassment and increased alcohol consumption and problems were found for lesbian and bisexual women than for heterosexual women. Gay/bisexual men, on the other hand, experienced significantly more sexual harassment than heterosexual men, but did not report a corresponding increase in alcohol use and abuse., Implications: Implications for future research on sexual identity, alcohol use, and workplace harassment are discussed.

Background: Most previous estimates of the prevalence of chronic fatigue syndrome (CFS) have derived largely from treated populations, and have been biased by differential access to health care treatment linked with sex, ethnic identification, and socioeconomic status., Objective: To assess the point prevalence of CFS in an ethnically diverse random community sample., Design and Participants: A sample of 28,673 adults in Chicago, Ill, was screened by telephone, and those with CFS-like symptoms were medically evaluated. MAIN OUTCOME MEASURES AND ANALYSES: Self-report questionnaires, psychiatric evaluations, and complete medical examinations with laboratory testing were used to diagnose patients with CFS. Univariate and multivariate statistical techniques were used to delineate the overall rate of CFS in this population, and its relative prevalence was subcategorized by sex, ethnic identification, age, and socioeconomic status., Results: There was a 65.1% completion rate for the telephone interviews during the first phase of the study. Findings indicated that CFS occurs in about 0.42% (95% confidence interval, 0.29%-0.56%) of this random community-based sample. The highest levels of CFS were consistently found among women, minority groups, and persons with lower levels of education and occupational status., Conclusions: Chronic fatigue syndrome is a common chronic health condition, especially for women, occurring across ethnic groups. Earlier findings suggesting that CFS is a syndrome primarily affecting white, middle-class patients were not supported by our findings.

Objectives: This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use., Methods: Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n = 2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status., Results: The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and abuse were significantly linked to most mental health outcomes for men and women., Conclusions: Interpersonally abusive workplace dynamics constitute a significant public health problem that merits increased intervention and prevention strategies.

Previous estimates of the prevalence of fatigue and chronic fatigue have derived largely from treated populations and have been biased by differential access to health-care treatment linked with gender, racial/ethnic and social class status. This study involves a community-based prevalence study of prolonged fatigue and chronic fatigue. It addresses: (1) the rate of prolonged fatigue and chronic fatigue in a socioeconomically and ethnically diverse sample of 28,673 adults in Chicago; and (2) establishes the relative prevalence of prolonged fatigue and chronic fatigue across race/ethnicity, socio-economic status and gender. Univariate and multivariate statistical techniques were utilized to delineate the overall rate of prolonged fatigue and chronic fatigue in the Chicago population and its relative prevalence by gender, race/ethnicity, and social class. Findings indicated that fatigue is common in urban populations, but that prolonged fatigue and chronic fatigue occur in about 5.00 to 7.68 percent and 2.72 to 4.17 percent, respectively, of the sample of the population. Highest levels of fatigue were consistently found among women and those with lower levels of education and occupational status.

Twenty-eight patients who underwent unilateral total knee arthroplasty and 20 patients who underwent simultaneous bilateral total knee arthroplasties participated in this study and were randomized to have either a fluted or round 10-mm diameter femoral intramedullary alignment rod used during surgery. The intramedullary rods were cannulated and connected with pressure tubing to a monitor which provided measurements of pressure at the tip of each rod. Arterial blood gas measurements on room air were obtained before and on the morning after surgery. An arterial line was placed and an arterial blood gas measurement was obtained at the time of skin incision and again after tourniquet release. Pulmonary shunt was calculated from the arterial blood gas measurements. Intramedullary pressure during rod insertion was significantly higher for the groups of patients having the round compared with the fluted rod. The change in pulmonary shunt during surgery was lowest for the patients in the unilateral group having the fluted rod and highest for the patients in the bilateral group having the round rod. A fluted rather than a round intramedullary alignment rod should be used to minimize intramedullary pressure and pulmonary shunting during unilateral and bilateral total knee arthroplasties.

Chronic fatigue syndrome (CFS) emerged as a diagnostic category during the last decade. Initial research suggested that CFS was a relatively rare disorder with a high level of psychiatric comorbidity. Many physicians minimized the seriousness of this disorder and also interpreted the syndrome as being equivalent to a psychiatric disorder. These attitudes had negative consequences for the treatment of CFS. By the mid-1990s, findings from more representative epidemiological studies indicated considerably higher CFS prevalence rates. However, the use of the revised CFS case definition might have produced heterogeneous patient groups, possibly including some patients with pure psychiatric disorders. Social scientists have the expertise to more precisely define this syndrome and to develop appropriate and sensitive research strategies for understanding this disease.

Control and social gratification at work and in other social roles have been shown to be predictive of depression in general adult populations, yet the potential importance of these factors in the postpartum period has not been explored. This study examines the influence of self-reported social gratification, support, and control at work and in the parenting role on depressive symptomatology for both men and women in the postpartum period. A model including perceptions of control, social gratification, and support in these two life domains is tested at 6 months postpartum in a sample of 108 first-time parents. When this model is compared to a parallel model using information obtained 6 months before the birth, strong support for the increased significance of these variables in the postpartum period is found. The need to include work and role-related variables in a comprehensive stress-diathesis model of postpartum depression for both men and women is discussed.

Thirty patients who underwent total hip arthroplasty and 18 patients with medically treated arthritis participated in this study. Both groups of patients underwent a cardiovascular fitness exercise test on entering the study and 6 months, 1 year, and 2 years later. Fitness was assessed by patient performance on a graded maximal exercise test using a bicycle ergometer and metabolic cart. In the group of total hip arthroplasty patients, significant improvements in exercise duration (P = .011), maximum workload (P = .0013), peak oxygen consumption (P = .0036), and percentage of predicted maximum oxygen uptake achieved (P = .0002) were observed during the follow-up evaluation. In the group of control patients, decreases in exercise duration (P = .0001), maximum workload (P = .0001), and workload at anaerobic threshold (P = .0108) occurred without a significant change in the other measures of cardiovascular fitness. The results indicate that resumption of routine physical activities after total hip arthroplasty is associated with a corresponding improvement in cardiovascular fitness.

Thirty tibial tubercle osteotomies were performed to obtain exposure and facilitate patellar tracking in 29 patients who underwent total knee arthroplasty. The thickness and width of the bone fragment were gradually tapered from proximal to distal. Fixation was obtained with three or four titanium screws. Average follow-up period was 18 months. Twenty-nine of the osteotomies healed primarily. In one patient, postoperative displacement of the tibial tubercle developed requiring additional screw and suture fixation. Extended tibial tubercle osteotomy is a useful technique during difficult total knee arthroplasty. Poor tibial bone stock is a relative contraindication. The authors recommend that a long tapered bone fragment that is 1.5 to 2 cm thick at the level of the tibial tubercle be elevated and fixation achieved with screws.

Patients who have osteoarthrosis involving weight-bearing joints typically have a gradual decline in physical activity, which is often associated with cardiovascular deconditioning. After joint replacement, many patients resume routine walking and recreational activities, which may improve aerobic capacity. The purpose of the present study was to determine the effect of total knee arthroplasty on cardiovascular fitness. Nineteen patients who had had total knee arthroplasty (the arthroplasty group) performed an exercise test for cardiovascular fitness preoperatively. Sixteen of these patients were tested again at one year postoperatively and thirteen, at two years postoperatively. Sixteen patients in whom osteoarthrosis of the knee was being treated medically (the control group) were tested at the time of enrollment in the study and one year later. Nine of these patients also were tested two years after enrollment. All of the patients completed the Arthritis Impact-Measurement Scales (AIMS) at each examination. Fitness was assessed by the performance of a progressive maximum exercise test with use of a bicycle ergometer and a metabolic cart. All patients achieved the anaerobic threshold. One year postoperatively, the patients in the arthroplasty group demonstrated an increase, which approached significance, in maximum oxygen consumption (measured in milliliters of oxygen per minute) (p = 0.07), maximum oxygen consumption corrected for body weight (p = 0.08), and percentage of predicted maximum uptake of oxygen (p = 0.06). Two years after the total knee arthroplasty, the patients had a significant improvement with regard to all three parameters (p = 0.008, 0.005, and 0.005, respectively). The patients in the control group demonstrated a significant decrease in duration of exercise and in maximum workload at one year (p = 0.003 and 0.005, respectively) and at two years (p = 0.008 for both parameters). Physical activity had increased in the arthroplasty group but not in the control group, as demonstrated by the results of the Arthritis Impact-Measurement Scales. These findings demonstrate a trend toward improvement in cardiovascular fitness one year after total knee arthroplasty and a significant improvement two years postoperatively for patients who had been able to resume routine functional activities because of the arthroplasty. These improvements compared favorably with the static pattern or the decline in the measures of fitness that were observed in the control group. Our results should be considered preliminary because of the relatively small number of patients who were studied.

Sociologists who embrace the stress or alienation paradigms generally focus on explaining problem drinking in low status occupations. By contrast, this paper argues that a broadened conceptualization of stress and alienation which incorporates abusive work relationships has utility for explaining male and female drinking outcomes in both high and low status occupations. We provide empirical data on the relationship between perceived abusive experiences and drinking outcomes in a cohort of male and female physicians in their internship year of training. The data show that perceived sexual harassment, discriminatory treatment and psychological humiliation relate to various drinking outcomes in men and women, controlling for drinking prior to the internship year. While females were more likely to report experiencing abuse, these perceived experiences had deleterious effects on drinking outcomes for both genders. Personal vulnerability (narcissism) brought into the training environment somewhat influenced the later reporting of abusive experiences by males but not by females. Regression analyses showed that, for both males and females, work-place abusive experiences in interaction with personality vulnerability best explained drinking outcomes. The implications of these results for the design of future alcohol-related work-place studies are discussed.

Objective: The transition to parenthood has been occurring within the context of the increasing labor force participation of women and potential stress-related costs of "nontraditional" as well as "traditional" gender role choices of new parents. This study addressed the extent to which gender role-related stressors lead to increased problem drinking across the transition to parenthood., Method: Fifty-five married couples expecting their first child were obtained from seven Chicago area hospitals and surveyed with a mailed questionnaire at two points in time: (1) during the second trimester of pregnancy and (2) at 6 months following childbirth. The study examined both wives' and husbands' changes in problem-related drinking by comparing problem drinking during the 6 months prior to pregnancy (retrospectively assessed at Time 1) with drinking during the 6 months following childbirth using a modified form of the Michigan Alcoholism Screening Test. In addition, the study contrasted problem drinkers with nonproblem drinkers following parenthood with regard to role overload (overwhelming demands from work and family roles), role deprivation (loss of work role following parenthood) and role deterioration (decreased support from role relationships)., Results: The data show increased problem drinking for both mothers and fathers but fail to support either role overload or role deprivation hypotheses. However, the data are congruent with the role deterioration perspective., Conclusions: If these findings are replicated, future studies of gender roles and alcohol abuse should focus greater attention on the perceived quality of social roles beyond noting their presence or absence.

Background: Stress among medical students has been linked to poor academic performance, while supportive social relationships have been associated with the alleviation of psychological stress. This study examines social support as a potential buffer against stress and hence as a potential strengthener of students' academic performances., Method: A cohort of 153 third-year students at the University of Illinois College of Medicine at Chicago was asked in the fall of 1990 to complete a questionnaire assessing role stress (stress involving competing demands between school and social and/or family life), social support, and sources of support (outside or inside medical school). Grades for the five major clerkships through which all the students rotated during their third year were collected from student transcripts. Statistical analyses of the relationships among academic performance, stress, and social support included factor analysis, hierarchical multiple-regression analysis, and Pearson correlational analysis., Results: Data from 120 students (78% of the cohort) were used for correlational analysis. Of these students, 79 (66%) were men and 41 (34%) were women. Because eight of the questionnaires contained incomplete data, 112 questionnaires (73%) were used for multiple-regression analysis. No buffering effect was found for social support. Rather, social support from outside the medical school explained significant variance in academic performances and in role stress. Higher levels of outside support were associated with poorer clerkship grades for women, but with lower levels of stress for men. Also, total support (outside and inside combined) was negatively related to clerkship grades for the entire sample., Conclusion: The results suggest that contrary to the study's hypotheses, social support in general is related to lower levels of academic performance for both men and women, and that the negative effects of support from outside the medical school context may be particularly salient for women. These results are understandable given the nature of medical training, which places great demands on students' time. Therefore, it may be more appropriate for medical schools to promote time-management strategies than support-building interventions, especially for women.

Chronic fatigue syndrome is a disabling disorder that has been studied primarily in clinical settings. In the absence of an adequate epidemiological database, cultural stereotypes have influenced the characterization of chronic fatigue syndrome as "the yuppie flu," similar to the 19th century characterization of neurasthenia as a disease of the affluent. The limited epidemiological data available and the overall medical-sociological literature call this assumption into question. Only a community "true" prevalence study that is unbiased by help seeking and access to health care can provide an accurate assessment of the risk factors for and the public health ramifications of this disease.

When turning to our original questions, we offer the following tentative conclusions: 1. Although medical students as a group have a slightly higher percentage of use of alcohol, the pattern and prevalence of alcohol dependence is very consistent with their age mates in the general population. 2. There appears to be a pattern of increased alcohol problems with age among physicians and attorneys, as opposed to the general US population, which shows a diminution of alcohol-related problems over time. 3. There is no evidence for a marked increase in drug addiction and use of other prescription drugs among physicians. In fact, with the exception of tranquilizers and alcohol and psychedelics, which were used equally by physicians, medical students, residents, and their age mates, most other drug usage was slightly more prevalent in the general population than among students and residents. 4. Of particular concern is the finding of a lack of gender differences in problematic drinking with the pattern of female drinking rates for women approximating that of men by the end of medical school. 5. The most consistent predictive factor in alcoholism among physicians is the same as that in the general population: a family history of alcoholism. 6. Additional predictive factors of physician alcohol-related problems include a narcissistic type personality style that endorses the exploitation of others, a perception of low parental warmth in childhood, and particular stressors in the working or student environment such as being abused by others. Further predictive factors related to occupational stress await the results of ongoing perspective studies. 7. Physicians as a group probably respond more favorably to alcohol and drug addiction programs than do members of the general population. To a great extent, this is directly or indirectly due to the dire consequences of continued use, which include loss of hospital privileges and state licensure. It also would appear that required treatment and monitoring for alcohol and substance abuse has a positive effect on abstinence rates.

Psychiatric epidemiological research has focused disproportionate attention on traditionally female disorders such as depression. This paper shifts epidemiological gears to elaborate and test an etiological model of a traditionally male disorder, that of alcohol abuse. We argue that social-relational deficits (narcissistic orientations) lead to abuse of alcohol for stress reduction purposes, given interpersonally oriented stressors and the incapacity to form social supports. The model was tested in the context of training for a traditionally male occupation encompassing both social-relational demands and limited social supports. A cohort of medical students was surveyed from medical school entrance through a portion of clinical training. Time 1 social-relational deficits were predictive of time 3 alcohol abuse, partially as a function of social support deficits and, to a lesser extent, patient care-related stressors. Moreover, there was an initial gender difference in social-relational deficits and a trend-level gender difference in alcohol abuse that disappeared when social-relational deficits were held constant. By time 3, women did not differ from men in social-relational deficits or alcohol abuse.

This paper elaborates the conceptual frameworks and major results to date from an ongoing longitudinal study of alcohol problems in male and female future physicians. A medical student cohort was surveyed at medical school entrance and in the 2nd and 3rd years of training. Relative to life span developmental orientations, a sizable proportion of premedical school problem drinkers "matured out" of their earlier patterns after entrance into occupational training roles. Relative to occupational selection versus stress perspectives, medical school problem drinkers were equally divided between those manifesting onset prior to the initiation of training versus those manifesting onset during medical training. Overall, both male and female problem drinking declined during the preclinical years (in contrast to premedical school levels) but manifested a trend in the direction of a reversal of the previous decline after the initiation of clinical training. The major psychosocial predictor of alcohol abuse during clinical training involved social-relational deficits or narcissistic personality styles. Moreover, this relationship was mediated by social support deficits and patient care-related stressors. This cohort is currently being re-surveyed in the last year of medical school and will be followed again during residency training.

Objective: To assess the prevalence, correlates, and mental health consequences of reported medical training-related abuses., Design: A longitudinal cohort study of 137 students surveyed from medical school entrance (time 1) through the winter of the fourth training year (time 4)., Setting: A state college of medicine., Outcome Measures: Reported training-related abuses (measured at time 4) and mental health status measured at times 1 and 4 (depressive and anxiety symptoms, hostility, problem drinking, escapist drinking, alcohol consumption levels, and gender role orientations)., Results: Seventy-two percent of students reported at least one abusive experience during medical training. Females were significantly more likely than males to report gender discrimination, exclusion from informal settings, discomfort from sexual humor, and unwanted sexual advances. Abuse was significantly related to most psychopathological outcomes, controlling for pre-existing psychopathology. Males low in masculinity and females low in femininity were most likely to report abuse., Conclusions: The data provide further support for the assumption that a high proportion of medical students not only experience the training process as abusive in nature but also suffer measurable psychopathological consequences. Efforts should be made to reform medical education, with a prominent focus on gender role-related issues.

This study addresses the course of alcohol-related problems in future physicians from the perspectives of occupational stress versus selection and life-span developmental frameworks. A cohort of medical students was surveyed at medical school entrance and during the early fall of the second training year. Self-report questionnaires assessed: alcohol-related problems (using a modified time-linked version of the MAST), pretraining psychosocial and psychopathological characteristics and experiences (symptomatic distress, motivations for drinking, personality attributes/deficits, familial history of problem drinking, family disruption and earlier parental bonding) and medical-training characteristics (perceived stressors and levels of social support). On the basis of MAST scores, respondents manifested the following drinking patterns: consistent nonproblem drinking (67.4%), problem exit or remission during medical training (19.4%), problem entrance or onset during medical training (6.3%) and problem chronicity involving problems before and during medical training (6.9%). Female students were overrepresented in the consistent nonproblem group. The major predictors of Time 2 problem onset and chronicity as opposed to problem remission involved pretraining factors: familial history of alcohol problems, Time 1 symptomatic distress and escape motives for drinking. Future reports will depict the prevalence and etiology of problem drinking manifested during the clinical portion of medical training.

Etiologic research on alcohol-related impairment in physicians has elucidated various risk factors including family history of alcoholism, symptomatic distress, personality deficits, and high academic achievement. This study of medical students points to the additional salience of future practice orientations involving technological/status versus interpersonal concerns. A cohort of students was surveyed at medical school entrance and again in the second training year. Alcohol abusers (particularly medical school onset cases) manifested significantly higher technological/status and lower interpersonal concerns compared to non-abusers. Differences across future specialty choices were also found. However, additional longitudinal research is necessary to clarify the causal directionality of these relationships.

Although women are assumed to be particularly vulnerable to depressive symptomatology after childbirth, the extent to which this symptomatology predominates over that found in men at this life cycle stage has not been addressed. This study examined gender differences in postpartum depressive symptomatology and the link between postpartum symptomatology and gender roles and relationships in a sample obtained from childbirth preparation classes. The data show no gender difference in depressive symptomatology at 2 months after childbirth. Women manifested a decrease in depressive symptomatology and men showed a slight increase from the preparenthood point. We partially link women's equivalent rather than higher distress levels to the protective effects of their varied social supports. By contrast, men depended primarily on their spouses, but both genders experienced a decrease in spouse support after childbirth. Female lack of support was more strongly associated with symptomatology in homemakers compared with employed women or women on maternity leave. Within the context of gender role changes, the data highlight benefits of female bonding in contrast to the "costs of caring" depicted by other researchers.

In this study, black, white, and Hispanic medical students are compared in terms of their psychosocial assets and mental health status when they entered medical school and after a year of medical training. The data show that the minority students entered medical school with some distinct advantages over the white students. The minority students reported greater social supports, higher self-esteem, lower anxiety, and more internal locus of control. After one year, however, the blacks manifested slightly lower self-esteem and higher levels of hostility and external locus of control. The Hispanics continued to report higher self-esteem and greater social supports but showed increased external locus of control and higher alcohol consumption. Policy implications for improvements in pre-entrance enrichment programs are discussed.

Time 1 data are presented from an ongoing longitudinal study of drinking patterns and problems of future physicians from medical school entrance through 2.5 years of training. The data in this report address the prevalence and psychosocial correlates of alcohol-related problems experienced prior to medical school training. A group of 167 students (91% of the cohort) was surveyed. Self-report questionnaires included: alcohol-related problems (the MAST), earlier parent-child relationships, personality characteristics (external locus of control, self-esteem, dependency, masculinity-femininity), life events, social supports, motivations for drinking and symptomatic distress. The male students manifested a higher mean level of alcohol problems, and the sexes differed at the trend level when the MAST was scored to distinguish "problem" from "nonproblem" drinkers (with 18.4% of the students reporting 5 or more problem points and 7.4% reporting 4 problem points). The significant correlates of alcohol problems included: perceived lack of earlier maternal affectivity (for men) and perceived lack of earlier paternal affectivity (for women), and lack of emotional support (for men). Moreover, escape motives for men were the motives most highly correlated with alcohol problems. Symptomatic distress (anxiety and hostility) was significantly correlated with alcohol-related problems in men but not women. Future reports will depict the psychosocial experiences and alcohol-related problems manifested by this cohort during medical training.

Depressive symptoms were assessed in 86 couples during pregnancy and after childbirth. Although 59.3% (N = 51) of the couples contained at least one symptomatic spouse during the transition to parenthood, both spouses were symptomatic in only 11.1% (N = 4) of the affected couples during pregnancy and 12.5% (N = 4) after childbirth.

Gender differences in psychological distress among future physicians are addressed from contrasting role-related stress and socialization-based vulnerability perspectives. A medical student cohort was surveyed at medical school entrance and after one year of training, focusing on earlier familial relationships, personality and social support resources, perceived medical school stressors and alcohol consumption and depressive and anxiety symptomatology. Relative to socialization perspectives, the sexes manifested more similarities than differences at time 1, although the females manifested lower overall psychopathology, but greater perceived paternal overprotection in childhood. Relative to role stress perspectives, both sexes reported increased psychopathology by the time 2 point. The sexes did not differ in perceived medical school-related stressors, while females manifested better social supports at time 2. The psychosocial predictors of increased subjective distress for both sexes included perceived earlier familial relationships and medical school stressors. The only predictor of increased drinking (by males) was time 1 drinking level. Future research on gender roles and distress should assess both male and female modes of psychopathology and should address antecedents of role entrance in addition to the (presumed) consequences of role incumbency.

We describe the morphologic changes that follow division of the transverse carpal ligament in patients with carpal tunnel syndrome. Fifteen hands in 12 patients with carpal tunnel syndrome were studied with magnetic resonance imaging before operation and for 6 weeks after operation. Eight hands were studied at 8 months after operation. Carpal arch width, anterior displacement of the carpal canal contents, and carpal canal volume were measured by use of multiplanar reformation and three-dimensional reconstruction of magnetic resonance images. There was a 24.2 +/- 11.6% increase in carpal canal volume 6 weeks after carpal tunnel release (p less than 0.001). This difference persisted at 8-month follow-up. There was an anterior displacement of carpal canal contents 3.5 +/- 1.9 mm from its original position 6 weeks after operation (p less than 0.001). This palmar displacement persisted at the 8-month follow-up. There was no statistically significant increase in carpal arch width 8 months after carpal tunnel release. We believe that division of the transverse carpal ligament restores median nerve function by increasing the volume of the carpal canal. This volumetric increase results from an anterior displacement of the newly formed transverse carpal ligament and not from a widening of the bony carpal arch.

World-wide migratory patterns have led to an increasing interest in acculturation processes and their psychosocial and psychiatric sequelae. This paper reviews alternative theoretical approaches to the study of acculturation and identifies gaps in the current knowledge base. We then present empirical research on acculturation processes experienced by both Indian rural to urban migrants and White-Mestizo non-migrants in Lima, Peru. The study examined overall acculturation and five sub-dimensions: language use, customs, sociability, perceived discrimination and ethnic identity. The data show that second generation migrants are more highly acculturated across sub-areas and perceive less ethnic discrimination than first generation migrants. The first generation varied in acculturative level across sub-dimensions as a function of their age at the time of migration. Contrasts between the migrant and dominant group depicted a two-way process of culture change, but a process characterized by an inequality in the content exchanged in each direction. Socio-demographic correlates of acculturation were also found. These results are discussed in terms of the potential psychological consequences of alternative acculturative adaptations within the Peruvian social-structural context.

The narcissistic personality style is assumed to be highly prevalent in contemporary society, but little epidemiologic attention has been directed to its relative occurrence among different segments of the population. This study addresses gender differences in the manifestation of narcissistic personality traits and their differential association with low self-esteem and dysphoric mood. A Narcissistic Traits Scale was developed and administered along with measures of self-esteem and depressive symptomatology to a population of medical students. The data show no sex differences in overall narcissistic styles but demonstrate sex differences in the prevalence of given traits and in their differential association with low self-esteem and dysphoric mood. The clinical and research implications of these findings are discussed, along with suggestions for future research utilizing more representative community samples.

The halo vest is considered by us, as well as by the majority of orthopaedic surgeons, to be the best commercially available orthosis for control of the cervical spine. However, we have seen five patients with posterior ligament injury of the neck who sustained a recurrence of facet dislocation or subluxation while in a halo vest.

Societal changes in sex roles have led to an increased interest in the comparative drinking behaviors of men and women and in their psychosocial antecedents. The differential prevalence and psychosocial correlates of alcohol consumption in a cohort of 107 men and 46 women first-year medical students are addressed. Self-report questionnaires assessed quantity, frequency and variability in the consumption of beer, wine and distilled spirits; early parent-child relationships; internal-external locus of control; interpersonal dependency; social supports; and depressive symptomatology. From analyses of variance, the data show that the men consume beer more frequently and in greater quantities. The sexes do not differ in the consumption of wine or distilled spirits. In addition, several psychosocial variables relate to drinking patterns in opposite directions for men and women. Heavier drinking among women is significantly associated with perceived childhood parental warmth and low depressive symptomatology. The opposite is true for men, although these relationships are much weaker. Future research should address sex differences in the symbolic meaning and implications of alcohol use in different socioeconomic and occupational groups.

The ontogeny of acquisition of complement receptors (CR) on splenic B lymphocytes from mice of varying ages was examined. Reagents used for the identification of CR included antibody- and complement-coated erythrocytes (EAC), bacteria (BAC) and bacteria treated with complement alone (BC). When whole mouse serum used as the source of complement both EAC and BAC failed to bind to human erythrocytes (C3b receptor-negative), showed binding to Raji and Daudi cells (C3d receptor) and formed rosettes with human neutrophils (C3bi receptor). Therefore these reagents bore C3d and C3bi, but not intact C3b. Although EAc and BAC detected nearly equal percentages of CR lymphocytes in adult mice, BAC bound to a higher percentage of neonatal lymphocytes (8-12%) than did EAC (1-3%). The ability of BAC to detect EAC-negative lymphocytes among neonatal spleen lymphocytes appeared to be due to the increased sensitivity of this bacterial reagent for binding to CR. Further evidence of this enhanced sensitivity was that BAC were less inhibitable than EAC by soluble antigen-antibody-complement complexes.

Social supports have been viewed as central to psychological well-being, but little attention has been directed to the capacity to form supportive relationships. Psychoanalytic perspectives suggest that the quality of adult relationships is derived from earlier childhood attachment experiences. The authors tested this thesis by correlating medical students' perceptions of their earlier relationships with their parents with the perceived quality of their current social support networks. The data suggest the need for a more complex and psychodynamically relevant conceptualization of social supports, which has implications for therapeutic interventions to ameliorate support deficits.

This paper discusses contrasting assumptions in psychiatric epidemiological research regarding the relative significance of childhood and adult social experiences as etiological factors in adult psychopathology. It delineates a set of hypotheses that relate internal parental representations to subsequent depressed mood and to psychosocial assets assumed to mediate the relationships between parental representations and mood states. These hypotheses were prospectively tested using a cohort of medical students surveyed at medical school entrance and 7 months later. The data show that earlier paternal affectivity perceived at time 1 is inversely predictive of time 2 depressed mood, holding time 1 mood constant, whereas earlier maternal and paternal overprotection perceived at time 1 are directly predictive of time 2 depressed mood, holding time 1 mood constant. In addition, parental representations at time 1 are significantly linked to particular personality characteristics at time 1 and 2. However, it is not clear whether these personality characteristics are antecedents or consequences of depressed mood. The paper concludes with a discussion of theoretical and methodological issues involved in the retrospective assessment of remote social experiences as etiological factors in adult psychopathology.

Applications of computerized databases to the "Chemist's Review" of drug applications are presented with emphasis on the critical topics addressed in the controls review process and the time limitations imposed thereon.

Three-dimensional computer reconstruction of magnetic resonance images (MRI) of ten cadaveric specimens was used to determine carpal tunnel volume and carpal arch width. Magnetic resonance images-acquired data were compared with direct measurement of cadaveric carpal canal volume by means of a silicone-injection technique. Mean MRI three-dimensional reconstruction volume was 5.84 ml +/- 1.24 ml. Mean silicone-mold volume was 4.73 +/- 1.01 ml. A correction factor of 0.8161 was used to accurately calculate carpal tunnel volume from MRI-acquired data. There was no significant difference between calculated carpal tunnel volumes and silicone-mold volumes (p = 0.623), and there was a linear relationship between MRI-acquired volumes and silicone-mold volumes (correlation coefficient r = 0.97). Differences in MRI-volume determinations between observers were not significant (0.25 greater than or equal to p greater than 0.1). MRI three-dimensional reconstruction, a valid and reproducible technique for measuring carpal tunnel volume and dimensions, has considerable research potential for the evaluation of the relationship between the carpal canal and its contents before and after carpal tunnel release.

Underlying the design of most adult epidemiologic stress-distress studies is the assumption that only social factors deriving from individuals' current environments or very recent pasts impact on their mental health status. The present study examined the link between perceived early parent-child relations and adult depressive symptomatology. It was hypothesized that perceived dysfunctional early parent-child relationships correlate with adult depressive symptomatology and adult internal personality resources (level of autonomy-dependency and internal-external locus of control) mediate this relationship. A cohort of students beginning medical school was administered self-report questionnaires measuring the above variables (final N = 153, 73% response rate). Using correlational and regression analysis, hypothesis 1 was supported and hypothesis 2 was partially supported. The authors discuss alternative causal interpretations of the correlational findings, and recommend future studies of the social origins of psychopathology which embrace a total life cycle model. These studies should ideally reflect interdisciplinary theoretical perspectives and encompass long-term prospective research designs or greater attention to the construction and validation of instruments for improved retrospective assessments.

The growth of cross-cultural psychiatry is now occurring at a time when psychiatry in general is emphasizing diagnostic clarity and the use of quantifiable and reliable methods of collecting clinical and research data. It is now imperative that cross-cultural psychiatry also examine its methods for developing instruments for use in cross-cultural research. This paper outlines a method for developing instruments designed in one culture for use in a second, and particular attention is given to cross-cultural validity or equivalence. Five types of equivalence are enumerated and defined: content, semantic, technical, criterion, and conceptual equivalence. These concepts are illustrated by examples from the authors' experience in research on internal migrants in Peru.

In a prospective study, 87 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured. Fifty percent of wrists and digits were immobilized for 3 weeks and 50% were mobilized early. Mean follow-up was 22 months. Thirty-six percent (31/87) of all ganglions treated showed a successful outcome. Twenty-seven percent (16/60) of dorsal carpal, 43% (6/14) of palmar carpal, and 69% (9/13) of palmar digital ganglions did not recur. Immobilization significantly improved the results of treatment of dorsal carpal ganglions. Forty percent (12/30) of those in the immobilization group and 13% (4/30) of those in the early mobilization group had a successful outcome (p less than 0.05).

Murine Kupffer cells, the tissue macrophages of the liver, were isolated by collagenase digestion, differential sedimentation over Metrizamide, and glass adherence. The resultant cell population was more than 86% phagocytic, and 95% of cells stained positively for alpha-naphthyl butyrate esterase activity. The cells also had cell surface receptors for complement (C) and the Fc portion of IgG. In addition, a large proportion of Kupffer cells was shown to bear Ia antigens: about half of the cells bore I-A subregion-encoded antigens and about half bore I-BJE or I-EC subregion-encoded antigens. Kupffer cell populations were capable of reconstituting antigen-stimulated proliferative responses of antigen-primed, macrophage-depleted, lymph node T cells. The ability to reconstitute proliferation was enriched in the adherent population and was resistant to radiation and treatment with an anti-Thy antiserum and C. We conclude that isolated murine Kupffer cells bear the Ia phenotype of accessory cells that function in antigen presentation and that Kupffer cells can participate in the induction of antigen-specific immune responses. These data suggest that Kupffer cells may play a role in modulating responses to enterically derived antigens.

Experiments on 119 New Zealand rabbits were performed to measure healing strength of femurs. Four pairs of normal rabbit femurs were also studied in vitro by use of a four-point bending test to measure bending rigidity. Rabbit-sized octagonal cross-sectioned intramedullary rods with 12%, 20%, 50%, 75%, and 100% of femoral bending rigidity were specially prepared. For each animal, one intramedullary rod was implanted in an osteotomized femur through a standard lateral approach, with the other femur serving as a control. The results from the 12% rigidity rods were widely variable. In the 20% and 50% rigidity groups, the callus diameter was increased over the 75% rigidity group through all phases of healing. The torque ratio in this group increased up to eight weeks and then converged to the ratios of the other rigidities. The 75% rigidity group had shown increase of angular displacement up to eight weeks, while the 20% and 50% rigidity groups continued to improve and reached control strength at 12 weeks of treatment. Furthermore, the 20% and 50% groups absorbed more energy to failure in the later stage of healing than the 75% and 100% rigidity groups. Rods of 20% and 50% rigidity stimulate external callus formation and improve the stability of healing bone.