Sidney Cobb

Family structure in relation to health and disease. A review of the literature.

Family structure in relation to health and disease is reviewed. Par ental deprivation appears to be associated with some psychiatric and psychosomatic diseases such as suicide tuberculosis and accidents. A follow-up study of orphans is needed. The study of the relation of sibs hip size to health and disease has been relatively unproductive because of the multitude of interacting variables. The ratio of the number of eldest children to number of youngest children in a sample has proved to be a useful tool. Persons with duodenal ulcers have low ratios while persons eminent in intellectual pursuits people with asthma and patients with tuberculosis tend towards high ratios. That marital status has a marked relation to over-all mortality is most striking with respect to tuberculosis suicide and other violent deaths influenza and pneumonia syphilis and its sequelae and cirrhosis of the liver. The association between rheumatoid arthritis and termination of marriage with regard to morbidity is notable particularly for men. Methodologic problems are discussed.

The relation of symptoms to osteoarthritis

Abstract 1. 1. Morning stiffness and x-ray evidence of osteoarthritis do not show evidence of association in this population study. 2. 2. Only about 30 per cent of persons with radiologtic evidence of de generative changes in their joints complained of pain at the relevant sites. 3. 3. Pain and swelling in osteoarthritic joints are seldom found wdithout morning stiffness. The exception to this course is found in the acute Heberdens node. It should b e remembered in this connection that one inquiry about morning stiffness is often insufficient to pick up this manifestation. 4. 4. Persons with x-ray evidence of osteoarthritis but no morning stiffness have only a small chance of having pain at the relevant sites. 5. 5. The importance of distinguishing symptomatic and asymptomatic oesteoarthritis has been emphasized and the difference in symptom pattern between those with morning stiffness and the relatively few without it has been presented. 6. 6. The possibility that most of the symptoms of “osteoarthritis” are at least in part due to a rheumatoid component has been discussed.

Psychosocial factors in the epidemiology of rheumatoid arthritis

Abstract 1. 1. A sample of 1,323 persons was interviewed about history of arthritic symptoms and the occurrence of certain social factors. Respondents were classified as having a positive or negative Index of Rheumatoid Arthritis and the two groups were then compared on the social data. 2. 2. Low income, low education, and termination of marriage were associated with higher prevalence of the index for men. In the case of women the most striking factors were low education, having four or more children, reporting no spare time in the third decade of life, and worrying more than other people. The cumulative effect of grouping these factors in each sex was especially striking. 3. 3. In particular, education and income were interrelated, with high prevalence rates noted for respondents with low education and high income, and for respondents with high education but low income. 4. 4. The items found to be associated with a positive index were discussed in terms of the extent to which they could be considered stressful in our society, and suggestions for further research have been made.

On the estimation of the incubation period in malignant disease: The brief exposure case, leukemia☆

Abstract 1. 1. The incubation period of radiation-induced leukemia in adults is estimated to be about 5 years with 90 per cent of the cases occurring less than 10 years after exposure. 2. 2. Assuming genesis during gestation, there is a somewhat shorter incubation period for children. 3. 3. If one is willing to assume that the incubation period of leukemia induced by other means is approximately the same, there is now plain indication to search for other causes of leukemia up to 10 years before onset in adults, and during gestation or the first few weeks of postnatal life in the case of children. 4. 4. This approach to the estimation of the incubation period should prove profitable in other malignant diseases.

Psychosocial studies of rheumatoid arthritis: Parental factors compared in cases and controls

Certain psychosocial factors were studied in a group of female patients with rheumatoid arthritis and compared with two groups of controls. A disturbed relationship between patients and their mothers was observed. Conclusions concerning specificity and pathogenesis are not attempted. n n n nCerte factores psychosocial esseva studiate in un gruppo de patientes feminin con arthritis rheumatoide e comparate con duo gruppos de controlo. Un disturbate relation inter le patientes e lor matres esseva observate. Nulle essayo es facite de formular conclusiones de specificitate e pathogenese.

An epidemiologic look at the problem of classification in the field of arthritis.

Abstract The need for limiting definitions in the rheumatic disease field has been emphasized. Definitions must draw sharp lines between diseases and at the minimal severity at which a diagnosis is acceptable. This need is just as great for the clinician planning therapeutic trials as for the epidemiologist studying the distribution of disease in the population.

Further study of the nonparticipation problems in a morbidity survey involving clinical examination.

Abstract An investigation of acceptance and refusal of clinical examination in the course of a field study of arthritis has been presented. The subjects for study were subdivided into those who accepted the examination and indicated a willingness to come again, those who refused the examination and would refuse again, and those who vacillated. The vacillators are surprisingly numerous and of particular interest for they are persons who seem to display ambivalence in their attitudes toward medical personnel and institutions. This suggestion of ambivalence clearly needs to be investigated further, for the evidence presented is largely that of negative attitudes. The confirmed nonparticipants are notable for their minimal use of medical care and their belief that they are in good health. The principal reason given for refusing to participate is “prefer my own doctor.” This indicates the importance of having the unqualified backing of the practicing physicians in the community so that the personal physician of each person who refused for this reason can be asked to urge his patient to participate. Most of the persons interviewed do not consider that offering to pay people for participation would be helpful. However, only a very few believe it would scare people away. The importance of personal relationships, adequate communication, and third-party selling is brought out. We suggest that further research is needed. A study of this problem should be incorporated into the plans for every survey in which clinical examinations are to be performed.