Peter J. Fagan

Identifying Causes of Disagreement Between Self-Reports and Spouse Ratings of Personality

Self-reports and spouse ratings of personality traits typically show less-than-perfect agreement, but powerful moderators of agreement have not yet been identified. In Study 1, 47 married couples completed the Revised NEO Personality Inventory to describe themselves and their spouses. Extent of agreement was not consistently moderated by response sets; the age, intelligence, or education of the respondent; or the length or quality of the relationship. In Study 2 these couples were interviewed about reasons for substantial disagreements, and an audiotape was content-analyzed. Sixteen reasons were reliably coded, including idiosyncratic understanding of items, reference to different time frames or roles, and unavailability of covert experience to the spouse. Faking good, assumed similarity, and other variables prominent in the psychometric literature were relatively unimportant. Findings (1) suggest that attempts to improve the validity of self-reports and ratings may need to be refocused and (2) underscore the desirability of routinely obtaining multiple sources of information on personality.

The course and correlates of high hospital utilization in sickle cell disease: Evidence from a large, urban Medicaid managed care organization

Although most patients with sickle cell disease (SCD) are hospitalized infrequently and manage painful crises at home, a small subpopulation is frequently admitted to emergency departments and inpatient units. This small group accounts for the majority of health care expenses for patients with SCD. Using inpatient claims data from a large, urban Medicaid MCO for 5 consecutive years, this study sought to describe the course of high inpatient utilization (averaging four or more admissions enrolled per year for at least 1 year) in members with a diagnosis of SCD and a history of hospitalizations for vaso‐occlusive crisis. High utilizers were compared with the other members with SCD on demographics, medical and psychiatric comorbidity, and use of other health care resources. Members who were high utilizers had more diagnostic mentions of sickle cell complications than low utilizers. However, the pattern of high inpatient utilization was likely to moderate over successive years, and return to the pattern after moderation was uncommon. Despite this, a small subpopulation engaged in exceptional levels of inpatient utilization over multiple years. Am. J. Hematol., 2009.

Sexual functioning of female eating‐disordered patients

Many theories about relating eating disorders with sexual development and experience have been proposed. The authors employed a normed psychometric instrument, the Derogatis Sexual Functioning Inventory (DSFI), to study empirically sexual characteristics of subtypes of eating-disordered patients. Forty-four female inpatients were divided into three subcategories; restricting anorexics (AR), bulimic anorexics (AB), and subjects exhibiting bulimia nervosa (BN). Starved anorexics were first allowed to attain their goal weight range before participating in the study. The three groups did not differ demographically. Comparing the eating-disordered group as a whole to the DSFI norms showed these patients to have quite poor sexual functioning and satisfaction. The “Sexual Functioning Index” representing the global DSFI score put these patients below the first percentile when compared to the normative sample. Nine out of the ten scales of the DSFI failed to show a significant difference between patient subgroups. Only the “fantasy” scale distinguished the AR subgroup with its paucity of sexual fantasy from the BN subgroup who were in the average range, with AB in between. These results are somewhat contrary to other studies comparing outpatient bulimics and anorexics and suggest that patients with eating disorders severe enough to warrant hospitalization represent a more homogenous group regarding their psychosexual characteristics.

Sexual functioning and psychologic evaluation of in vitro fertilization couples

Couples requesting in vitro fertilization (IVF) may be sexually dysfunctional either as an etiologic factor in their infertility or because they experience decreased sexual satisfaction as a reaction to previous infertility treatment. The present study assessed the sexual functioning and psychologic status of 45 married couples who had requested IVF. The couples were given complete psychosexual evaluation by senior staff members of the Sexual Behaviors Consultation Unit and each participant completed the Derogatis Sexual Functioning Inventory (DSFI). Seven couples (15.5%) were experiencing a sexual dysfunction and 13 individuals (14.4%) were given Diagnostic and Statistical Manual of Mental Disorders III diagnoses. In total, 19 individuals (21%) of the sample were found to have either a sexual dysfunction or psychologic disorder. Couples with a sexual dysfunction were more likely (P = 0.05) to have unexplained infertility. Norms for psychologic evaluation as part of IVF are suggested and the role of such evaluation discussed.

Sexual dysfunction and dual psychiatric diagnoses.

Controversy continues to exist about whether a sexual dysfunction is a discrete problem or it is symptomatic of more elaborate psychiatric disorder. To date no study of this question has been reported on patients evaluated using DSM-III criteria. To meet such a need, 592 patients with various sex-related complaints and their partners were evaluated at the Sexual Behaviors Consultation Unit of the Johns Hopkins Hospital over a 2-year period. Two hundred and eighty-eight patients (males = 223; females = 65) fulfilled DSM-III criteria for psychosexual dysfunction. Of these 30.5% (N = 68) of the males and 30.8% (N = 20) of the females were assigned concurrent Axis I/II diagnoses. Patients who had dual diagnoses reported more (P = .026) problems with alcohol. Despite equivalent psychosocial stressors on Axis IV they were rated less (P less than .01) adjusted on Axis V. Dual diagnostic profiles were described for each of the psychosexual dysfunctions. Results support the hypothesis that while the majority of patients with sexual dysfunction have a discrete disorder, there is another group whose sexual dysfunction is but one of several conditions which deserve treatment.

Examining the Effectiveness of Hydroxyurea in People with Sickle Cell Disease

This study investigated hydroxyurea use in people with sickle cell disease (SCD) outside of a research setting. Pharmacy data, outpatient visits, hospital admissions, and length of stay were assessed for all patients with SCD enrolled in a Medicaid managed care organization in Maryland. Three hundred and ninety (390) people with SCD were covered between the years 2001–2005. A large majority (85.9%) never had a claim for a hydroxyurea refill. Hydroxyurea users had higher admission rates than non-hydroxyurea users (5 vs. 1.5, p=.004). Patients who were in the highest tertile of refills of hydroxyurea had significantly fewer hospital admissions than patients in the lowest tertile (2.44 vs. 7.57, p=.043). Patients with the lowest hydroxyurea refill usage had significantly higher mean costs per month enrolled than those with the highest number (

Alcoholism in patients with sexual disorders.

4,553 vs.

Mean Streets of Cyberspace: Sex Education Resources on the Internet's World Wide Web

2,017, p=.031). Hydroxyurea was underutilized in this patient population. Patients with more regular refills of hydroxyurea had fewer admissions to the hospital and markedly decreased costs.

Sex Therapy and Research: A View from Health Services Research

The authors screened for alcoholism 145 consecutive patients who presented with sexual dysfunction or disorders. Using the Michigan Alcoholic Screening Test (MAST), 29% of the patients scored in the probable alcoholic range. Probable alcoholics were more likely to present without a partner and claimed higher sex drive than nonalcoholic patients. Probable alcoholic males reported less joy and vigor than probable alcoholic females, while the reverse held for the nonalcoholic groups. Blind to the MAST results, the staff made six alcohol-related diagnoses and referred one patient for alcohol treatment. The authors discussed the importance of training faculty and resident staff in the relationship of alcohol abuse associated with psychosexual dysfunctions.

The relationship between a worksite wellness clinic and hospital emergency department visits.

The purpose of the article is twofold: to alert the naive user of the World Wide Web that searching for sex therapy and sex education informational resources is a difficult task and, secondly, to invite the reader to access a web site designed by the authors (http://www.jagunet.com/~dgotlib/meanstreets.htm) that contains hyperlinks to a number of recommended sites.Because there is no centralized and continuously updated master index of sexuality resources on the World Wide Web, most naive users are required to employ commercial search engines. The authors describe the nature and bias of search engines: their tendency to locate sites with explicit sexual graphics and advertisements by those who seek to make profits from sexual services and supplies. Politically active sexual and gender groups have a strong presence on the Web. Frequently web sites lack credibility because of lack of authorship or credentials of author (if identified). The authors suggest basic guidelines for the novice Web user who seeks i...