Search

The current study investigates the hypothesis that psychiatric patients display consistent interpersonal themes in narratives across different important interpersonal relationships. In response to a revised Relationship Anecdote Paradigm interview, 93 patients with a diagnosable disorder, based on Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) criteria, were asked to give 5 narratives about each of the following significant people in their lives: mother, father, same-sex best friend, and romantic partner. From the transcribed interview material, independent judges reliably rated the intensity of wishes, responses of others, and responses from self associated with a modified Core Conflictual Relationship Theme (CCRT) method (Luborsky & Crits-Christoph, 1990). Consistency of specific relational themes was assessed across multiple interactions with the same person and across different relationships. Although only 1% to 3% of the variance was explained by an individual's consistency, there was substantial variability in specific interpersonal themes across narratives, both across and within relationships (explaining 27% to 30% of the variance). The discussion addresses methodological issues that may have contributed to the current findings and the implications of these findings for the CCRT method, psychodynamic theory and practice in general, and the psychodynamic concept of transference in particular.

The covariate-adjusted population attributable risk (PAR) measures the proportionate reduction in disease prevalence in the target population when the putative risk factor is removed, after adjusting for covariate effects. This paper extends the model-based approach developed for retrospective and cohort studies to the cross-sectional sampling design. An appropriate logit linear model is utilized to estimate the covariate-adjusted attributable risk. The asymptotic variance of this complex ratio estimate is obtained using Taylor series expansions which incorporate the sampling variation of the estimated model parameters and the appropriate estimates of risk factor prevalence. These methods are illustrated with cardiovascular disease risk factor data from the second National Health and Nutrition Examination Survey (NHANES II).

Secular trends in blood pressure among young adults reflect the proportion of the population at risk of developing hypertension and may be markers of progress in primary prevention. National health examination data from three successive surveys were analyzed to assess blood pressure trends for adult blacks and whites aged 18-34 years in two body mass index (BMI; weight (kg)/height (m)2) strata (< 25 or > or = 25). Blood pressure was categorized into a four-point ordinal scale using the weighted, within-sex 50th, 75th, and 90th percentiles for 18- to 24-year-old adults in the 1960-1962 survey. The effects were analyzed with cumulative logit models with alpha = 0.01. The systolic blood pressure decreased moderately for 25- to 34-year-old males and for females except those aged 25-34 years with a BMI of > or = 25. Diastolic blood pressure increased among males with a BMI of > or = 25 and among white males with a BMI of < 25, but did not show a significant overall trend among females. A BMI of > or = 25 was associated with substantially higher blood pressure in each survey, except for one age-sex-race subgroup. Racial differences within BMI were less consistent than the differences across BMI strata. In summary, the situation with respect to hypertension among females may have improved during this time period but for males may have worsened with respect to diastolic blood pressure. Data for both sexes support a need for population-wide obesity prevention to reduce the incidence of hypertension.

To provide a contemporary profile of blood pressure and nutritional and sociodemographic relationships in the adult US population, data from the first National Health and Nutrition Examination Survey ( NHANES -I), 1971-1975, were analyzed. Systolic and diastolic blood pressures increased with increasing age, but trends were different by sex and race groups. Body mass index (weight/ height2 ) was the nutritional factor most strongly and consistently related to blood pressure. Among dietary constituents, alcohol consumption and calcium and phosphorus intake were the only variables having consistent and independent relationships to blood pressure. Sodium content of food and salt use had no relationship, and sodium/potassium food content had only an inconsistent association. Regarding serum nutritional measures, serum calcium was directly related and serum phosphorus was inversely related to blood pressure. Serum urate, serum aspartate aminotransferase, and hemoglobin were also independently related to systolic and diastolic blood pressures. There were few important differences by race or sex in these correlates. These observations from a representative sample of the US population have useful implications for prevention and treatment of high blood pressure.

From July 1, 1980 to December 2, 1982, all individuals at autopsy at the University of Michigan Medical Center greater than or equal to 65 years of age and selected individuals less than 65 years of age were examined for neuritic plaques and neurofibrillary tangles. Sections of the hippocampal, parahippocampal temporal gyrus, and fusiform gyrus were examined. In a total population of 199, each individual was classified as having none, few, or many of each lesion. The frequency of the joint presence of many plaques and tangles increased monotonically after age 71 years. There was no significant difference in the joint distribution of these lesions with sex or race. There was a strong correlation between the presence of one lesion and the other; the correlation for the two lesions was similar for males and females, but for blacks, it was significantly higher than for non-blacks. The distribution of these lesions in autopsy populations may be useful in identifying other related hypothetical risk factors for dementia of Alzheimer's type.

The relationship between blood pressure and blood lead levels in the second National Health and Nutrition Examination Survey (1976-1980) has been examined for white males aged 40-59 years. After adjustment for age, body mass index, nutritional factors, and blood biochemistries in a multiple linear regression model, the relationship of systolic and diastolic blood pressures to blood lead levels was statistically significant (p less than 0.01). There was no evidence of a threshold blood lead level for this relationship. Although these data alone do not prove a casual relationship between low blood lead levels and blood pressure, the findings are consistent with current epidemiologic and animal studies, indicating that a causal relationship is probable. To examine the potential health risks, the multiple logistic risk factor coefficients from the Pooling Project and Framingham studies were used to predict the impact of the 37% decrease in mean blood lead levels which occurred in adult white males from 1976 to 1980. As a result of this blood lead decrease, the calculations predicted a 4.7% decrease in the incidence of fatal and nonfatal myocardial infarction over 10 years, a 6.7% decrease in the incidence of fatal and nonfatal strokes over 10 years, and a 5.5% decrease in the incidence of death from all causes over 11.5 years. In addition, as a result of this blood lead decrease, the predicted number of white males in this age group with hypertension (diastolic blood pressure greater than or equal to 90 mmHg) decreased by 17.5%.

Glucose tolerance data from the second National Health and Nutrition Examination Survey were analyzed to determine factors predicting fasting plasma glucose levels and glucose tolerance in a representative US population. Central adiposity (subscapular skinfolds), age, and family history of diabetes were the major predictors of fasting levels and of glucose tolerance. For women, having a diabetic mother was significantly related to fasting glucose and glucose tolerance, but for men the proportion of siblings with diabetes was positively related. Multiple regression analyses, after adjustment for age and subscapular skinfolds, identified white cell count, systolic blood pressure, natural logarithm total iron binding capacity, and family history variables as being significant predictors of glucose tolerance in both sexes. In addition, several other variables were predictive for men or women, but not for both. These data confirm the importance of the major predictors of glucose tolerance and suggest provocative new associations in the general population.

Explicit formulas are provided for estimating the attributable risk ratio among the exposed and the entire target population utilizing matched-pairs data. Large-sample standard errors and corresponding confidence intervals are provided. These estimates can be obtained from the cross-classification frequencies of matched pairs by disease and exposure status in the usual 2 X 2 table. The key to the development of these formulas lies in recognizing that attributable risk among the exposed is a direct function of the odds ratio, and population attributable risk is a direct function of the odds ratio and exposure prevalence among only the cases (assuming a rare disease). The formulas presented in this paper require only a calculator for computation. The methodology is illustrated with data from a matched-pairs case-control study of oral conjugated estrogens and endometrial cancer.

Data from four National Health Examination Surveys conducted of the US population from 1960 to 1980 were analyzed to determine secular trends in obesity for white and for black adolescents and young adults of both sexes. Body mass index was categorized into four levels using cut points determined by the 50th, 75th, and 85th percentiles at the first survey in 1960-1962. The weighted proportions of persons in these body mass categories were determined, and statistical models were developed to describe secular trend and race effects. No consistent secular trends were found for white or black youths aged 12-17 years. No significant secular trends in obesity were found for white or black young males aged 18-34 years. Both for white and for black adult females, there were significant secular increases in the proportion of adult females in each of the successively heavier categories of body mass index. These increases were identical for white and for black adult females on the log-odds scale, but black adult females were already significantly heavier at the first survey. This race effect persisted throughout the entire time interval.