Diane M. Reddy

Postoperative cognitive dysfunction in older patients with a history of alcohol abuse.

Background: Postoperative cognitive dysfunction (POCD) affects a significant number of patients and may have serious consequences for quality of life. Although POCD is most frequent after cardiac surgery, the prevalence of POCD after noncardiac surgery in older patients is also significant. The risk factors for POCD after noncardiac surgery include advanced age and preexisting cognitive impairment. Self-reported alcohol abuse is a risk factor for postoperative delirium, but its significance for long-term POCD has not been investigated. The goal of this study was to determine whether neurocognitive function is impaired after noncardiac surgery during general anesthesia in older patients with a history of alcohol abuse. Methods: Subjects aged 55 yr and older with self-reported alcohol abuse (n = 28) and age-, sex-, education-matched nonalcoholic controls (n = 28) were tested using a neurocognitive battery before and 2 weeks after elective surgery (n = 28) or a corresponding time interval without surgery (n = 28). Verbal memory, visuospatial memory, and executive functions were assessed. A neurologic examination was performed to exclude subjects with potential cerebrovascular damage. Results: Significant three-way interactions (analysis of variance) for Visual Immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery more than it did in the other three groups. Conclusions: The results suggest that a history of alcohol abuse in older patients presents a risk for postoperative cognitive impairment in the domains of visuospatial abilities and executive functions that may have important implications for quality of life and health risks.

Sexual functioning in women with chronic pelvic pain: The impact of depression, support, and abuse

Many studies have documented associations among sexual functioning, depression, experiences of childhood sexual abuse, relationship support, and chronic pelvic pain, but none have addressed the interrelationships among all of these variables in a unified model. The aim of this preliminary study was to construct an integrative model predicting sexual functioning for women with chronic pelvic pain. Women (n = 63) with chronic pelvic pain completed measures of sexual functioning for use as the criterion variable, and measures of the impact of chronic pain, depression, experiences of sexual abuse, and relationship support as predictors. Depression mediated the effects of child sexual abuse and partially mediated the effects of relationship support on sexual behavior and satisfaction with the sexual relationship. In addition to its indirect relationship through depression, relationship support also independently predicted sexual function. Thus, in this nonclinical sample, the effects of child sexual abuse on sexual function depended on the extent of depressive symptoms, while the influence of relationship support depended in part on depression.

Sexual abuse and sexual functioning in a chronic pelvic pain sample

ABSTRACT Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.

Behavioral and Biochemical Effects of Job Loss and Unemployment Stress

Previous research on the effects of unemployment has focused upon both anticipation of job loss and long-term unemployment, typically using self-report and some biochemical measures of response to unemployment stress. The present study was concerned with behavioral and biochemical responses to unemployment. It was also designed to examine a somewhat different time course of unemployment than has been used in previous work. Results indicated that stress accompanies unemployment; looking at people who had been unemployed for up to four months, those who had been unemployed for greater lengths of time performed more poorly on a behavioral task and exhibited higher levels of urinary norepinephrine and epinephrine than did persons unemployed for shorter time periods or subjects who were employed.

Effect of relaxation on working memory and the bispectral index of the EEG

Beneficial effects of relaxation on cardiovascular and immune functions and on memory has been implied but an empirical relationship between task performance and anxiety reduction has not been reported. In this study, we investigated whether guided imagery of relatively short duration would decrease S-Anxiety and electroencephalogram Bispectral Index and improve working memory. 42 participants (age: M = 39, SD = 11, 14 men, 28 women, university students and VA Medical Center employees, recruited by their professor or by fellow employees) underwent relaxation by 16-min. guided imagery or no treatment (control). Spielbergers State-Trait Anxiety Inventory and the WAIS–III Letter-Number Sequencing Test were administered before and after relaxation. S-Anxiety and BIS Index decreased and the Letter-Number test score increased by 30% after relaxation but not in the control group. This score was higher for participants with low anxiety and BIS Index. There was no significant difference between the groups before treatment. The results suggest that guided imagery of short duration produces relaxation as measured by psychological and neurophysiological indices and improves working memory performance.

Psychological adjustment among women living with genital herpes

This study investigated the psychosocial factors that influence psychological adjustment among women with genital herpes, while taking into account the physical factors. Women with herpes (N = 105, age 18—30) completed an on-line survey about factors related to their diagnosis and herpes-related quality of life. Perceived stigma, acceptance coping, denial coping, support from the Internet, and support from religious/spiritual figures accounted for 65.9 percent of the variance in quality of life scores. The findings reveal the importance of specific coping strategies and sources of support on psychological adjustment to herpes. Furthermore, a significant interaction between stigma and acceptance coping suggests a complex relationship between these two psychosocial factors that warrants future research.

Coping dispositions and the stress appraisal process: The impact of defensiveness on emotional response to threat

Abstract The purposes of this study were threefold: (1) to examine how a coping disposition which by definition is stable across time and situation, can nevertheless contribute to an understanding of the stress appraisal and coping process; (2) to clarify what situational factors are threatening enough to invoke the operation of dispositional defenses; and (3) to increase understanding of defensiveness as a personality construct with particular emphasis on the physiological concomitants of subjective response to threat. Subjective and physiological responses of 61 defensive or nondefensive subjects were studied across two time periods: an anticipatory coping period (before the threat) and an aftermath period (after the threat). Performance data were also collected. Interactions between defensiveness and time period were found on both subjective and physiological measures demonstrating that coping dispositions exert a comprehensive and dynamic influence on the stress appraisal and coping process.

Barriers and Facilitators to HPV Vaccination: Perspectives from Malawian Women

The aim of this research was to elucidate potential barriers and facilitators to human papillomavirus (HPV) vaccination in Malawi, a sub-Saharan country. In Malawi, approximately 31 out of every 100,000 women develop cervical cancer annually, and 80% of those affected die from this malignancy. HPV vaccination may provide a feasible strategy for cervical cancer prevention in Malawi. However, important questions and concerns regarding cervical cancer and HPV vaccination acceptance among individuals and their communities must be considered prior to vaccine delivery. Qualitative interviews were conducted with 30 Malawian mothers aged 18–49 years from Chiradzulu District. Womens knowledge and beliefs about HPV, cervical cancer, and vaccination, and their social-ecological contexts were explored in-depth. Thematic analyses revealed that despite womens limited knowledge, cervical cancer was perceived to be a serious disease. Participants believed that as women, they were responsible for their childrens health. Women unanimously reported that they would vaccinate their children against HPV, especially if a health professional recommended it. Malawis health care infrastructure could present challenges to HPV vaccine programs; however, participants did not typically report this to be a barrier to vaccination. These data shed light on factors that may influence HPV vaccination acceptance and uptake in Malawi.

Influence of Communicator's Race on Efficacy of an HIV/STD Prevention Intervention Among African American and Caucasian College Students

OBJECTIVES The present research examined the influence of communicators race on the efficacy of intervention videos in the reduction of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among African American and Caucasian college females. DESIGN Experimental HIV/STD prevention digital versatile disks (DVDs) featured a White female as a primary or a secondary communicator relative to a Black female, while a control DVD featured 2 Black females. Respondents watched 1 DVD and completed questionnaires before and after viewing the DVD as well as 2 and 4 weeks later. SAMPLE 79 African American females and 88 Caucasian females participated. MEASUREMENTS Perceptions of the DVDs, HIV/STD risk, intentions to use condoms, and number of condoms purchased after viewing the videos were assessed. RESULTS The intervention was effective in increasing intentions to use condoms with a current partner across the follow-up periods. There was no effect of race of communicator on any variable for African American or Caucasians. CONCLUSIONS While communicators race did not affect this intervention, more research is necessary. Future studies should use multiple Black and White communicators to isolate the role of race and should be conducted where larger samples of African American college students can be recruited.

Cervical Cancer Prevention in Malawi: A Qualitative Study of Women's Perspectives

Researchers posit that cervical cancer knowledge is central to participation in prevention behaviors. However, of the many barriers to cervical cancer prevention in low- and middle-income countries, cervical cancer knowledge remains severely limited among communities at great risk for the disease. Malawi is one such country where the burden of cervical cancer is considerably high. Formative research targeting cervical cancer prevention is needed, particularly research that explores ways to deliver cervical cancer information efficiently and effectively to Malawian women. In this study, the authors aimed to garner Malawian womens understanding of cervical cancer and to shed light on preferences for health information delivery, including community health advocacy. Qualitative, in-depth interviews were conducted with 30 Malawian women and analyzed for recurring themes. In general, women had limited cervical cancer knowledge, which supported misperceptions about the disease, including factors pertaining to risk and prevention. Nonetheless, women reported that receiving cervical cancer information from trusted sources would help promote preventive behaviors. Women noted that they received most of their health information from hospital personnel, but distance was a barrier. Women also expressed interest in community health advocacy. Perspectives from Malawian women may be vital toward informing efforts to increase cervical cancer knowledge and prevention.