Effects of gender and marital status on somatic symptoms of patients attending a mind/body medicine clinic

The role of sex and gender in somatic complaints among patients with coronary heart disease: A longitudinal study on acute and long-term changes

BACKGROUND

Somatic complaints are persistently reported in patients with coronary heart disease (CHD). Sex and gender influence health and well-being in a variety of ways, but it is unknown how they affect somatic complaints over time after percutaneous coronary intervention (PCI). Therefore, we examined the association between sex and gender on somatic health complaints during the first month (acute) and the first two years (recovery) after PCI.

METHODS

514 patients (Mage = 64.2 ± 8.9, 84.2% male) completed the somatic scale of the Health Complaints Scale (including the subscales: cardiopulmonary complaints, fatigue, sleep problems) at baseline, one, 12-, and 24-months post-PCI. In a follow-up study, they filled in additional questionnaires to gauge gender norms, traits, and identity. Linear mixed modeling analyses were used to assess the influence of sex, gender, their interaction, and covariates on somatic complaints for the acute and recovery phases separately.

RESULTS

A general decline in somatic complaints over time was observed during the acute phase, followed by a stabilization in the recovery phase. Females and individuals with more feminine traits, norms, and identities reported increased somatic complaints. Males with more pronounced feminine norms and females with more masculine norms likewise reported more somatic, cardiopulmonary, and fatigue complaints. Furthermore, age, cardiac history, and comorbid diseases partly explained the associations with somatic complaints.

CONCLUSION

While somatic complaints improve post-PCI, there are still conspicuous sex and gender differences that need to be considered. Future research should further elaborate upon these discrepancies and incorporate sex and gender in prevention and develop tailored interventions to diminish somatic complaints.

Ergonomic and individual risk factors for musculoskeletal pain in the ageing workforce

Background

The present study aimed to investigate the possible association between specific ergonomic and individual risk factors and musculoskeletal pain (MSP) in the back, shoulder, hip and knee region in workers aged 50-65y.

Methods

The study was a population based cross-sectional survey. The study population comprised citizens born between 1952–1966, living in Esbjerg municipality, Denmark, ultimo 2016 (n = 23,463). A questionnaire was sent electronically or by mail. The analysis included the working population only. A multivariate logistic regression was used for each of the following dependent variables; musculoskeletal pain for the past 3 months in the back, shoulder, hip and knee, where independent variables included ergonomic exposure, age, sex, body mass index (BMI) and leisure time physical activity (LTPA).

Results

The overall response rate was 58% and the data of individuals at work (n = 9,263) demonstrated several ergonomic exposures with increased odds for pain in specific regions. Exposure to back twisted or bend, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the back, whereas exposure to back twisted or bend, arms above shoulder and repeated arm movement were associated with pain in the shoulder. Exposure to back twisted or bend, repeated arm movement, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the hip. Important individual risk factors were also identified. Increasing age was significantly associated with increased pain in the hip but associated with less risk for pain in the back and shoulder. Males had higher odds for pain in the back and knee compared to females but lower odds for pain in the hip. BMI was particularly important for knee pain. The level of LTPA did not have an important association with MSP in any region.

Conclusion

There is a significant positive association between ergonomic exposures and musculoskeletal pain, which were specific for the back, shoulder, hip and knee. In addition, the data demonstrated a differential association with age, sex and BMI. This needs to be considered for the treatment and classification of musculoskeletal pain and for future preventive initiatives.

Epidemiology and Prevalence of Somatic Symptom Disorder at the Primary Care Level in Muscat, Oman: A Cross-Sectional Study

OBJECTIVES

Somatic symptom disorder (SSD) is a diagnostic classification to describe the occurrence of physical symptoms without organic cause. This study aimed to identify prevalence rates and associated characteristics of SSD among adults in primary care settings.

METHODS

This cross-sectional study took place between July 2020 and March 2021 and included a random selection of 3383 Omani adults attending 12 primary healthcare centres in Muscat Governorate. Screening was conducted using an Arabic version of the Somatic Symptom Scale-8 (SSS-8).

RESULTS

A total of 2000 adults participated in the study (response rate: 67.3%), of which most were female (71.7%) and under 50 years old (86.2%). Based on their SSS-8 scores, 602 participants (17.8%) had SSD, resulting in an overall prevalence estimate of 30.1% (95% confidence interval: 28.13-32.15). Significant associations were observed between SSD and age (p = 0.002), gender (p < 0.001), marital status (p = 0.030) and chronic comorbidities (p = 0.001). In addition, adjusted odds ratio estimates revealed SSD to be significantly associated with gender (p < 0.001), education level (p < 0.001) and chronic comorbidities (p = 0.001).

CONCLUSION

The estimated prevalence of SSD in primary care settings is high compared to reports from elsewhere in the Gulf region. There is an urgent need to enhance the diagnosis of SSD at the primary care level in order to reduce healthcare service overutilisation and patient dissatisfaction. Moreover, healthcare practitioners should be aware of the effect of age, gender, educational status and chronic comorbidities on somatic symptoms.

Evaluating health related quality of life in outpatients receiving anti-cancer treatment: results from an observational, cross-sectional study

Background

The aim of the study was to assess health-related quality of life (HRQOL) in outpatients receiving anti-cancer treatment.

Methods

Observational, cross-sectional, single-center study that assessed HRQOL in cancer patients receiving antineoplastic treatment.

Results

A total of 184 patients were included in the study; the median total FACT-G score was 66 ± 12.9; the scores for the physical well-being, social/family well-being, emotional well-being and functional well-being domains were 17.8 + 4.8, 19.1 ± 4.4, 14.8 ± 3.8 and 14.3 ± 4.7 respectively. Patients with adverse events had poorer HRQOL compared to those without them (FACT-G score 62.2 vs. 67.3; p < 0.05). In the multivariate analysis the variables associated with poorer HRQOL in the form of a gradient were tumor stage and performance status (ECOG); female sex was also associated with poorer HRQOL.

Conclusion

In our study, the neoplastic disease and anti-cancer treatment toxicities had an impact on HRQOL. Patients had poorer scores in the functional well-being domain and higher ones in the social/family well-being domain. Variables associated with worse HRQOL were tumor stage, performance status (ECOG) and female sex.

Sleep disturbances and back pain : Systematic review and meta-analysis

BACKGROUND

In today's society, sleep disturbances and back pain are both common problems which threaten health. Although some studies have focused on the effects of sleep disturbances on back pain, no meta-analysis has been done. The purpose of this study is to systematically review and perform a meta-analysis on the effects of sleep disturbances on back pain.

METHODS

A literature search in PubMed, Scopus and EMBASE with keywords until June 2019 was performed. The eligible articles were evaluated qualitatively and the results were pooled using random effects. The publication bias and the degree of heterogeneity were examined.

RESULTS

In all, 21 studies were included in the meta-analysis. Sleep disturbances were associated with back pain (odds ratio 1.52; confidence interval [CI] 1.37-1.68; P < 0.001). In men, the odds ratio was 1.49 (CI 1.34-1.65; P < 0.001). In women, the odds ratio was 1.56 (CI 1.33-1.81; P < 0.001). Begg's test (P = 0.856) and Egger test (P = 0.188) did not show any publication bias. A funnel plot and trim-and-fill method showed publication bias, and heterogeneity was also high.

CONCLUSIONS

Sleep disturbance is associated with risk of back pain. Improving sleep can be a deterrent against back pain. Therefore, interventions to reduce sleep disturbances can help to improve health. On the other hand, the relationship between sleep disturbances and back pain can be two-sided, and back pain can also lead to sleep disturbances. Not only in view of the lifetime prevalence and the multifactorial impairments of those affected, but also in consideration of social and economic burdens, this issue will remain of considerable importance.

General Population Norms for the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale

BACKGROUND

The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale is an internationally used validated measure. General population-based age- and sex-specific percentile norms are, however, not published to date, although these are needed as reference for the interpretation of clinical research data.

OBJECTIVES

To assess the FACIT-Fatigue Scale in a large representative sample of the German general population to examine psychometric characteristics and factorial structure and to provide population-based norms.

METHODS

A nationally representative face-to-face household survey was conducted in Germany using the FACIT-Fatigue Scale. Item characteristics were examined. Internal consistency was determined using the Cronbach α. Dimensionality was analyzed using confirmatory factor analysis (CFA) and bifactor analysis. Scale score differences relating to sex and age were assessed. Sex- and age-specific percentiles were computed for the entire scale range.

RESULTS

Of 2426 participants, 55.7% were women, and the mean age was 49.8 ± 17.4 years. The FACIT-Fatigue Scale mean was 43.5 ± 8.3. Cronbach α was high at 0.92. Although fit indices of the CFA were below desired levels (root mean squared error of approximation = 0.144, comparative fit index = 0.846, and Tucker-Lewis index = 0.815), item loadings in the CFA and bifactor analysis confirm the scale's unidimensionality. Women were more fatigued than men, and participants who were 70 years or older showed higher fatigue scores than younger respondents. Thus, sex- and age-specific population-based percentiles were provided.

CONCLUSIONS

Reliability and validity of the German translation of the FACIT-Fatigue Scale were confirmed. This study provides general population-based sex- and age-specific FACIT-Fatigue Scale percentile norms for the first time, thereby contributing to a meaningful interpretation of clinical research data.

Characteristics of adult smokers presenting to a mind-body medicine clinic

Mind-body interventions can improve vulnerabilities that underlie smoking behavior. The characteristics of smokers who use mind-body medicine have not been explored, preventing the development of targeted interventions. Patients ( N = 593) presenting to a mind-body medicine clinic completed self-report measures. Patients were 67 percent never smokers, 27 percent former smokers, and 6 percent current smokers. Current smokers were younger; more likely to be single, unemployed, or on disability; and report greater depression symptoms, greater pain, and lower social support ( ps < .05).Current smokers who use mind-body medicine have unique psychosocial needs that should be targeted in mind-body smoking cessation interventions.

The influence of gender on symptoms associated with obstructive sleep apnea

BACKGROUND

It has been reported that the clinical expression of obstructive sleep apnea (OSA) may differ in women and men.

OBJECTIVE

The objective of this study was to evaluate the influence of gender on reported OSA-related symptoms in a large clinical population of patients.

METHODS

The database from the sleep laboratory of a tertiary care center was examined. Adult patients who had undergone a diagnostic polysomnography and completed the Berlin questionnaire, a sleep questionnaire, and the Epworth sleepiness scale were selected. Multiple logistic regression analysis was performed to assess the relationship between OSA-associated symptoms and different potential explanatory variables.

RESULTS

The study sample included 1084 patients, median age was 53 years, 46.5% (504) were women, 72.7% (788) had OSA (apnea/hypopnea index ≥ 5), and 31.2% were obese. After adjusting for age, body mass index, and apnea/hypopnea index, men were more likely to report snoring (OR 4.06, p < 0.001), habitual or loud snoring (OR 2.34, p < 0.001; 2.14, p < 0.001, respectively) and apneas (OR 2.44, p < 0.001), than women. After controlling for multiple variables, female gender was an independent predictive factor for reported tiredness (OR 0.57, p 0.001), sleep onset insomnia (OR 0.59, p 0.0035), and morning headaches (OR 0.32, p < 0.001). Reports of excessive daytime sleepiness, nocturia, midnight insomnia, and subjective cognitive complaints were not significantly associated with gender.

CONCLUSION

Women with OSA were more likely to report tiredness, initial insomnia, and morning headaches, and less likely to complain of typical OSA symptoms (snoring, apneas) than men.

The Impact of Skin Problems on the Quality of Life in Patients Treated with Anticancer Agents: A Cross-Sectional Study

PURPOSE

Patients treated with anticancer agents often experience a variety of treatment-related skin problems, which can impair their quality of life.

Materials and Methods

In this cross-sectional study, Dermatology Life Quality Index (DLQI) and clinical information were evaluated in patients under active anticancer treatment using a questionnaire survey and their medical records review.

RESULTS

Of 375 evaluated subjects with anticancer therapy, 136 (36.27%) and 114 (30.40%) were treated for breast cancer and colorectal cancer, respectively. We found that women, breast cancer, targeted agent use, and longer duration of anticancer therapy were associated with higher dermatology-specific quality of life distraction. In addition, itching, dry skin, easy bruising, pigmentation, papulopustules on face, periungual inflammation, nail changes, and palmoplantar lesions were associated with significantly higher DLQI scores. Periungual inflammation and palmoplantar lesions scored the highest DLQI.

CONCLUSION

We believe our findings can be helpful to clinicians in counseling and managing the patients undergoing anticancer therapy.

Prevalence and correlates of sleep disturbance among older women in Vietnam

AIMS AND OBJECTIVES

To explore prevalence and correlates of sleep disturbance among women aged 60 and over in Vietnam.

BACKGROUND

Sleep disturbance can negatively influence human's health. Sleep disturbance is likely to increase with age, and women appear to be more likely to experience sleep disturbance than men. Knowledge about sleep disturbance in women aged 60 and over in Vietnam is under-researched.

DESIGN

The study presents results from a cross-sectional survey of 440 women aged 60 and over from 16 rural and urban suburbs in Vietnam from August 2014-January 2015 METHODS: Structured questionnaires were used to gather data about residence, age, marital status, educational attainment, employment status, income, body mass index, physical activity, exercise, perceived stress, general health status, number of chronic diseases and sleep disturbance. Descriptive analysis, bivariate correlation and binary logistic generalised linear model were used for data analysis.

RESULTS

Among older women in Vietnam, (i) the prevalence of sleep disturbance was 38.9%; (ii) the most commonly problem was difficulty maintaining sleep, followed by sleep latency, reduced sleep quality, early waking and daytime sleepiness, (iii) body mass index and physical health were significantly associated with sleep disturbance status.

CONCLUSIONS

Sleep disturbance was relatively common among older women in Vietnam. Overweight increased their sleep disturbance while physical health was negatively associated with their sleep disturbance.

RELEVANCE TO CLINICAL PRACTICE

This article provided evidence about sleep problems among older women in Vietnam and suggested that interventions targeting weight control and physical health promotion would be useful to improve their sleep problems.

A community-based cross-sectional study of fatigue in middle-aged and elderly women

BACKGROUND

Fatigue has been widely studied in the general population; however, limited studies have investigated it in the female population. The objectives of this community-based study were to (1) investigate the prevalence of fatigue, (2) explore the relationship between gynecological history and experiences of fatigue, and (3) identify risk factors for fatigue in middle-aged and elderly women.

METHODS

Based on a cross-sectional health study that employed a multi-instrument questionnaire, 1272 women aged 45years or older dwelling in the community were included. The Chinese version of Chalder Fatigue Scale (CFS) was used to assess fatigue, and socio-demographic, health-related, and gynecological data were also collected. Fatigue was defined as a total CFS score≥4.

RESULTS

The prevalence of fatigue among women aged over 45years was 33.9%. Multivariate logistic regression analysis identified that older age, single marital status, lower education level, the presence of chronic diseases, underweight, hospitalization in the last year, postmenopause, and a higher number of live births were associated with an increased risk of fatigue (P<0.05).

CONCLUSIONS

Our results indicated that fatigue was common in middle-aged and elderly females. Being postmenopausal and having more than three live births were the particular gynecological factors contributing to fatigue in the general population.

Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care--an observational study

Background

Prolonged stress may lead to mental illness, but the prevalence of stress in a working age population seeking primary health care for whatever reason, is unknown. This paper seeks to examine to what extent this group perceives stress, as well as symptoms of burnout/exhaustion, depression and anxiety.

Methods

In 2009, 587 primary health care patients aged 18–65 years (377 women, 210 men), with an appointment with a primary health care physician, participated in the study.

A screening questionnaire with questions about age, gender, marital status, employment, reason for medical consultation, and the QPS Nordic screening question about stress was distributed:” Stress is defined as a condition where you feel tense, restless, anxious or worried or cannot sleep at night because you think of problems all the time. Do you feel that kind of stress these days? There were five possible answers; “not at all” and ”only a little” (level 1),“to some extent” (level 2),“rather much” and “very much” (level 3). In a second step, symptoms of burnout/exhaustion (Shirom-Melamed Burnout Questionnaire and the Self-rated Exhaustion Disorder instrument) and anxiety/depression (Hospital Depression and Anxiety scale) were assessed among those with higher levels of perceived stress.

Results

345 (59%) of the study patients indicated stress levels 2 or 3 (237 women and 108 men). Women more often indicated increased levels of stress than men. Two thirds of the participants expressing stress levels 2–3 indicated a high degree of burnout, and approximately half of them indicated Exhaustion Disorder (ED). Among highly stressed patients (level 3), 33% reported symptoms indicating possible depression and 64% possible anxiety.

Conclusion

More than half of this working age population perceived more than a little stress, as defined, women to a greater extent than men. Symptoms of burnout and exhaustion were common. A high level of perceived stress was often accompanied by symptoms of depression and/or anxiety.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-015-0252-7) contains supplementary material, which is available to authorized users.

The perspective of psychosomatic medicine on the effect of religion on the mind-body relationship in Japan

Shintoism, Buddhism, and Qi, which advocate the unity of mind and body, have contributed to the Japanese philosophy of life. The practice of psychosomatic medicine emphasizes the connection between mind and body and combines the psychotherapies (directed at the mind) and relaxation techniques (directed at the body), to achieve stress management. Participation in religious activities such as preaching, praying, meditating, and practicing Zen can also elicit relaxation responses. Thus, it is time for traditional religions to play an active role in helping those seeking psychological stability after the Great East Japan Earthquake and the ongoing crisis related to the nuclear accident in Fukushima, Japan, to maintain a healthy mind-body relationship.

Factors associated with sleep disturbance in women of Mexican descent

AIMS

The aims were to identify the most useful parameters of acculturation in relation to self-reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent.

BACKGROUND

Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States.

DESIGN

This study was a secondary analysis of cross sectional survey data.

METHODS

Personal factors were incorporated into a modification of the conceptual framework of impaired sleep to guide our secondary analysis of self-reported sleep disturbance. Data were collected from a convenience sample of 312 women of Mexican descent of childbearing age (21-40 years) located in an urban California community were collected and previously analysed in relation to depressive symptoms and post-traumatic stress disorder. The general sleep disturbance scale (in English and Spanish) was used to assess sleep disturbance. Data was collected in 1998 from September through December.

RESULTS

Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self-reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income and higher depressive symptoms) were statistically significant in accounting for 40% of the variance in sleep disturbance.

CONCLUSION

When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribing a sleep medication.

Multidimensional predictors of fatigue among octogenarians and centenarians

BACKGROUND

Fatigue is a common and frequently observed complaint among older adults. However, knowledge about the nature and correlates of fatigue in old age is very limited.

OBJECTIVE

This study examined the relationship of functional indicators, psychological and situational factors and fatigue for 210 octogenarians and centenarians from the Georgia Centenarian Study.

METHODS

Three indicators of functional capacity (self-rated health, instrumental activities of daily living, physical activities of daily living), two indicators of psychological well-being (positive and negative affect), two indicators of situational factors (social network and social support), and a multidimensional fatigue scale were used. Blocked multiple regression analyses were computed to examine significant factors related to fatigue. In addition, multi-group analysis in structural equation modeling was used to investigate residential differences (i.e., long-term care facilities vs. private homes) in the relationship between significant factors and fatigue.

RESULTS

Blocked multiple regression analyses indicated that two indicators of functional capacity, self-rated health and instrumental activities of daily living, both positive and negative affect, and social support were significant predictors of fatigue among oldest-old adults. The multiple group analysis in structural equation modeling revealed a significant difference among oldest-old adults based on residential status.

CONCLUSION

The results suggest that we should not consider fatigue as merely an unpleasant physical symptom, but rather adopt a perspective that different factors such as psychosocial aspects can influence fatigue in advanced later life.

Demographic correlates of fatigue in the US general population: results from the patient-reported outcomes measurement information system (PROMIS) initiative

OBJECTIVE

To investigate demographic correlates of fatigue in the US general population using a new instrument developed by the Patient-Reported Outcome Measurement Information System (PROMIS). First, we examined correlations between the new PROMIS instrument and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and the SF-36v2 Vitality subscale. Based on prior findings, we further examined several demographic correlates of fatigue: whether women would report higher levels of fatigue compared to men, and whether married people would experience lower levels of fatigue compared to unmarried people. We also explored the relationship between age, education, and fatigue.

METHODS

Analyses were based on fatigue ratings by 666 individuals from the general population. Fatigue was assessed with the new PROMIS instrument, the FACIT-F, and the SF-36v2 Vitality subscale. Differences in fatigue were examined with independent samples t-tests and univariate ANOVAs.

RESULTS

The three fatigue instruments were highly intercorrelated. Confirming prior reports, women reported higher levels of fatigue than men. Married participants reported significantly less fatigue than their unmarried counterparts. Univariate ANOVAs yielded a main effect for participants' age; younger participants gave significantly higher fatigue ratings. We also found a main effect for participants' education. Participants with a masters or doctoral degree had significantly lower ratings of fatigue than participants with some college education and education up to high school.

CONCLUSION

Female gender, not being married, younger age and lower educational attainment were each associated with increased fatigue in the general population and the three fatigue instruments performed equally well in detecting the observed associations.

Perceived social support and life satisfaction in persons with somatization disorder

BACKGROUND

Life satisfaction and perceived social support been shown to improve the well-being of a person and also affect the outcome of treatment in somatization disorder. The phenomenon of somatization was explored in relation to the perceived social support and life satisfaction.

AIM

This study aimed at investigating perceived social support and life satisfaction in people with somatization disorder.

MATERIALS AND METHODS

The study was conducted on persons having somatization disorder attending the outpatient unit of LGB Regional Institute of Mental Health, Tezpur, Assam. Satisfaction with life scale and multidimensional scale of perceived social support were used to assess life satisfaction and perceived social support respectively.

RESULTS

Women reported more somatic symptoms than men. Family perceived social support was high in the patient in comparison to significant others' perceived social support and friends' perceived social support. Perceived social support showed that a significant positive correlation was found with life satisfaction.

CONCLUSION

Poor social support and low life satisfaction might be a stress response with regard to increased distress severity and psychosocial stressors rather than a cultural response to express psychological problems in somatic terms.

A proposed approach to suicide prevention in Japan: the use of self-perceived symptoms as indicators of depression and suicidal ideation

The incidence of suicide in Japan has increased markedly in recent years, making suicide a major social problem. Between 1997 and 2006, the annual number of suicides increased from 24,000 to 32,000; the most dramatic increase occurred in middle-aged men, the group showing the greatest increase in depression. Recent studies have shown that prevention campaigns are effective in reducing the total number of suicides in various areas of Japan, such as Akita Prefecture. Such interventions have been targeted at relatively urban populations, and national data from public health and clinical studies are still needed. The Japanese government has established the goal of reducing the annual number of suicides to 22,000 by 2010; toward this end, several programs have been proposed, including the Mental Barrier-Free Declaration, and the Guidelines for the Management of Depression by Health Care Professionals and Public Servants. However, the number of suicides has not declined over the past 10 years. Achieving the national goal during the remaining years will require extensive and consistent campaigns dealing with the issues and problems underlying suicide, as well as simple screening methods for detecting depression. These campaigns must reach those individuals whose high-risk status goes unrecognized. In this review paper, we propose a strategy for the early detection of suicide risk by screening for depression according to self-perceived symptoms. This approach was based on the symposium Approach to the Prevention of Suicide in Clinical and Occupational Medicine held at the 78th Conference of the Japanese Society of Hygiene, 2008.

Panic disorder, cardiac diagnosis and emergency department utilization in an epidemiologic community sample

OBJECTIVE

We examined the association between panic disorder (PD), physician-diagnosed cardiac disease (CD), and the interaction of these variables in relation to health care utilization, as measured by emergency department (ED) visitations, in an epidemiologic sample.

METHODS

Subjects were identified from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of 43,093 adult respondents from the United States who completed face-to-face computer-assisted structured clinical interviews.

RESULTS

Among patients with CD, the 12-month prevalence of PD (6.0%; 613/10,239) was significantly higher than that among non-CD subjects (3.4%; 1106/32,854; adjusted odds ratio=2.4; 95% confidence interval=2.2-2.7). CD patients with PD had a significantly greater prevalence of angina, tachycardia and alcohol use disorders as compared with PD-negative patients. PD-positive patients reported significantly greater mean 12-month ED visits (1.2) as compared with the PD-negative patients (0.6; P<.001). PD and tachycardia were found to have a significant interaction effect on ED visits for males (F=25.1; df=1,7; P<.001) but not for females (F=1.2; df=1,7; P=.28), with age, income, race and alcohol use included as covariates.

CONCLUSIONS

Epidemiological data support a relationship between PD and CD that impacts ED utilization. These findings have potential implications for medical, psychiatric and ED-based screening and interventions.

Why Do Women Have Back Pain More Than Men?

OBJECTIVES

In comparison with men, women have a healthier lifestyle, are more rarely overweight, have less stressful occupations, or are not employed outside the home. The "gender pain bias" is the fact that women nevertheless have a higher prevalence of back pain. This paper looks at the possible underlying reasons for this as yet unexplained gender difference, using Stokols' socioecological health model as a basis.

METHODS

The first National Health Survey for the Federal Republic of Germany was carried out from October 1997 to March 1999. It comprised a representative total sample of 5315 persons between the ages of 20 and 64. The participants took part in a medical examination and answered a self-report form. chi test and logistic regression analyses were used to investigate correlations between self-reported low back pain and gender-specific biopsychobehavioral and sociophysical environmental factors.

RESULTS

Seven-day back pain prevalence in the Federal Republic of Germany is 32% for men and 40% for women. Prevalences are significantly higher for overweight subjects, persons with a marked somatization tendency or a low level of social support, physically inactive individuals, smokers, elderly subjects, the nonemployed, "blue collar workers" and lower socioeconomic groups. From a multivariate perspective, however, none of these factors reduces (and hence sufficiently explains) the gender difference. Factoring in the gender-specific somatization tendency reduces the odds ratios of women versus men from 1.42 to 1.23.

DISCUSSION

In view of the gender difference in pain prevalence, which remains stable despite a multivariate perspective, there is clearly a need for more research into the reasons underlying the gender difference. We believe that future studies should look at rarely investigated constructs such as "sex role expectancies," "anxiety," "ethnicity," and "family history" and take anatomic differences in muscle strength into account.

Somatic symptoms for predicting depression: one-year follow-up study in annual health examinations

It has recently been noted that screening for depression can improve clinical outcomes. The purpose of the present study was to examine whether somatic symptoms reported at health examinations predicted depression in the following year. Subjects were 1066 Japanese workers (732 men, mean age 35 years) attending annual health examinations at an institute in two successive years. A self-administered questionnaire including items of 12 major somatic symptoms was given to all the subjects. Then clinical interviews of the DSM-IV were used to diagnose major depression and minor depression in both years. In addition, the 17-item Hamilton Depression Scale (HDS-17) was measured as one of the outcomes of depression in the following year. The prevalence of major (minor) depression was 3.7 (7.8)% at baseline and 3.4 (5.9)% for the following year, respectively. The following year's HDS-17 scores were higher (all P < 0.05) in those who had complained of each somatic symptom at baseline than in those who had not. Three somatic symptoms (low back pain, dizziness, and abdominal pain) at baseline were significant risk factors of major depression for the following year. Dizziness at baseline significantly predicted major and minor depression for the following year as well. Somatic symptoms may be good predictors to screen for depression at health examination.

Prediction of major depression in Japanese adults: somatic manifestation of depression in annual health examinations

BACKGROUND

The present study examined whether somatic symptoms found in annual health examinations, could be predictive of major depression in the ensuing year.

METHOD

Subjects analyzed were 1027 non-major-depressive workers (706 men, mean age 35) attending annual health examinations at a research institute. All were Japanese and found not to be suffering from major depression when interviewed, according to the semi-structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A self-administered questionnaire containing items relating to twelve major somatic symptoms was completed by all the subjects. The same DSM-IV interviews for the diagnosis of major depression were conducted to calculate the odds ratio of baseline variables for depressive and somatic symptoms, physical examination items, and health-related life-styles for the prediction of major depression in the ensuing year.

RESULTS

The prevalence of major depression in the ensuing year was 2.5%. For four somatic symptoms (fatigue, lower back pain, dizziness, and nausea), the prevalence was higher (all p < 0.05) in those who complained of each somatic symptom at baseline than in those who did not. Furthermore, the multiple logistic regression analysis indicated that lower back pain and dizziness at baseline were independent risk factors of major depression in the ensuing year [odds ratio (95% confidence intervals), 3.2 (1.1, 8.9) and 6.0 (1.8, 20.1), respectively].

LIMITATIONS

It is possible that somatic manifestations of depression are culturally bound phenomena and results might be generalizable only to Japanese workers.

CONCLUSION

Somatic symptoms reported at annual health examinations may be useful indicators for predicting major depression.

Gender and Somatosensory Amplification in Relation to Perceived Work Stress and Social Support in Japanese Workers

To examine gender-related differences in somatization among workers, 490 Japanese municipal office employees (248 women) completed the Medical Symptom Checklist, Somatosensory Amplification Scale (SSAS), and Profile of Mood States (POMS), along with questionnaires on their working environment. In women, SSAS scores were positively associated with perceived work stress, and negatively with social support levels (both p < 0.01). Female sex was significantly associated with SSAS scores (p < 0.01), controlling for the effects of total somatic symptom count, POMS tension-anxiety and depression scores, perceived working stress, and social support. The phenomenon of somatosensory amplification might be essential in estimating gender-specific symptoms in a working population.

Does visible atopic dermatitis affect quality of life more in women than in men?

BACKGROUND

Studies have suggested that women overreport symptoms in nondermatologic disease. Gender-dependent differences in patients' perception of dermatologic disease are poorly described. The description of possible gender differences in morbidity in a skin disease with comparable prevalence in men and women may therefore provide relevant data.

OBJECTIVE

The goal of this study was to examine gender-dependent differences in the self-reported morbidity of patients with atopic dermatitis (AD).

METHODS

Questionnaires from members of the Atopisk Eksem Forening (Danish Association of Atopic Eczema) aged > or = 15 years were analyzed. Data were gathered regarding age, sex, disease duration and severity, and localization of AD, including the results of the Dermatology Life Quality Index (DLQI), a quality-of-life questionnaire designed for use in adults (ie, patients aged > or = 15 years).

RESULTS

Questionnaires from 112 patients were analyzed. The final study population comprised 88 females and 24 males; mean age was 35.3 years (range, 15-77 years). For women, a significant positive correlation was found between DLQI score and disease severity (P < 0.001) and also between DLQI score and visible regions affected by disease (P = 0.001); these correlations were not observed in men. For the total number of body regions affected, a significant correlation with severity was found for women (P = 0.001) but not for men. No significant differences between men and women were noted for age, disease duration, overall disease severity, or quality of life as assessed using the DLQI.

CONCLUSION

Self-reported morbidity is highly consistent among women with AD, but not so among men. Normally visible areas of AD appear to affect women significantly more than men.

Relationship between major depression and high serum cholesterol in Japanese men

Although it has been argued that those with lower levels of serum cholesterol are likely to be depressive, the findings are inconsistent. The present study attempted to clarify the relationship between major depression and serum total cholesterol in a working population. Subjects were 987 Japanese men working at an institute, aged 20 to 64 years. In addition to blood examinations and physical measurements, clinical structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were used to detect major depression. The prevalence of major depression was higher in the hypercholesterolemics (serum total cholesterol levels > or = 5.69 mmol/liter) than in the normocholesterolemics (3.10-5.69 mmol/liter) (6.1% vs 1.8%, p < 0.05). Notably, there was no case with major depression among the hypocholesterolemics (< 3.10 mmol/liter). Through a multiple regression analysis, serum total cholesterol levels were positively predicted by the following four variables: major depression, age, body mass index, and skipping breakfast (all p < 0.01). Concerning those diagnosed with major depression, serum total cholesterol levels remained higher in the following year (p < 0.05), comparing to those without such diagnosis. Therefore, depression is associated with higher serum cholesterol levels in a population of Japanese male workers. The irregularity of eating behavior may be one of the factors mediating high serum cholesterol levels and major depression.

Autonomic activity, pain, and perceived health in patients on sick leave due to stress-related illnesses

OBJECTIVE

The aim of the present study was to compare autonomic activity, pressure-pain thresholds, and subjective assessments of health and behavior between patients with stress-related illnesses and healthy control subjects.

METHODS

Twenty sick-listed patients with stress-related illnesses and 20 age- and gender-matched healthy subjects performed tests of autonomic regulation and algometric tests, and completed questionnaires about physical and mental health and behavioral patterns.

RESULTS

Patients exhibited higher autonomic reactivity to cognitive and physical laboratory tasks (p < 0.05), and had lower pressure-pain thresholds in the shoulders and lower back than healthy control subjects (p < 0.05). Furthermore, the patients rated considerably poorer health and health behavior than the control subjects (p < 0.05).

CONCLUSIONS

The results indicate an engagement of the autonomic nervous system in stress-related illnesses. Furthermore, they show that patients with stress-related illnesses experience symptoms of musculoskeletal pain, and it is therefore recommended that assessments of musculoskeletal pain be incorporated in the clinical examinations and the rehabilitation of patients with stress-related illnesses.

Psychological well-being and the dyadic relationship of Chinese menopausal women (and their spouses) attending hormone replacement clinics

This survey examined the general health and the marital relationship of 122 Chinese menopausal women and their spouses attending hormone replacement clinics. Climacteric symptoms of the participants were assessed by the modified Greene Climacteric Scale (GCS). The psychological well-being of the participants and their spouses was assessed by the 12-item Chinese General Health Questionnaire (GHQ), and their marital quality was assessed by the Chinese Dyadic Adjustment Scale (DAS). The GCS scores of our cohort were significantly higher than that of a community-based sample of menopausal Chinese women. About one-third of the participants and one-fifth of their spouses suffered from reduced psychological well-being. Although the DAS total scores of the participants and their spouses were comparable to those of the adjusted couples in a younger population, the affectional DAS subscores were significantly lower. The GCS scores of the menopausal women were significantly positively correlated with their GHQ scores but negatively correlated with their DAS scores. In summary, the menopausal women attending the hormonal replacement clinics, especially those with more dimacteric symptoms, suffered from significant psychiatric morbidity and marital maladjustment. The psychological dimension of the menopause should never be neglected.

Reporting of somatic symptoms as a screening marker for detecting major depression in a population of Japanese white-collar workers

OBJECTIVE

The objective of this study was to assess screening practices for detecting major depression in workers complaining of somatic symptoms.

METHODS

A total of 1443 Japanese white-collar workers (991 men and 452 women, mean age 34 years) completed a medical symptom checklist (major 12 somatic symptoms) and were diagnosed using the structured clinical interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

RESULTS

There were 42 cases (2.9%) with major depression in the total sample. Of the 902 subjects without somatic symptoms, only one (0.1%) was identified as having major depression. The prevalence of the disorder was positively associated (P<.001) with the total number of somatic symptoms, and the area under the receiver operator characteristic curve was 0.92 for men and 0.81 for women, which showed the sensitivity and specificity of the total number of somatic symptoms for detecting major depression.

CONCLUSION

The number of reported somatic symptoms is a simple and useful predictor of major depression.

Comments on "the Feldenkrais Method: a dynamic approach to changing motor behavior"

The Feldenkrais Method has recently been discussed to fit within a dynamic systems model of human movement. One basis for this discussion is that small changes in one system--for example, enhanced body awareness--has far reaching implications across the whole of human performance. An alternative view on the Feldenkrais Method is argued here. It is argued that the clinical data do not support the Feldenkrais Method as being an effective way to improve motor performance. Further, it is argued that positive outcomes in pain and other wellness measures following Feldenkrais interventions can be ascribed to self-regulation. As part of this discussion, the role of body awareness, attentional focus, and kinesthesia in motor leaning and control are explored.

Suicidal ideation and somatic symptoms of patients with mind/body distress in a Japanese psychosomatic clinic

To examine associations of suicidal ideation with somatic symptoms, 863 outpatients were studied in a psychosomatic clinic in Japan. All subjects were diagnosed according to the third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R and DSM-IV). They completed the Cornell Medical Index Questionnaire to assess suicidal ideation and 15 major somatic symptoms. Mood states were rated using the Profile of Mood States (POMS). In the study, 266 patients (31%) reported suicidal ideation. The age- and sex-adjusted odds ratios (typically in the range of 1.5 to 2.5) of somatic symptoms for suicide ideation showed significant differences (all ps < .05) for 13 of 15 symptoms. The total number of somatic symptoms predicted suicidal ideation (p < .05), controlling for the significant effects of sex, education, marital status, and the POMS Depression scale scores through multiple regression analysis. Evaluation of somatic symptoms might be important to assess suicidal ideation in a psychosomatic medicine population.

Relationship as an inherent component in healthy women's fatigue

The notion of fatigue has remained ambiguous despite more than 100 years of study. Fatigue is recognized as subjective in nature, and it is studied and clinically managed as primarily intrapersonal in scope, with treatment approaches often based in an established, if unfounded, hierarchy of assumptions. When a physiologic cause for fatigue is not identifiable, fatigue complaints often are considered illegitimate. This article builds on data from the literature and from the author's previous work in women's fatigue and relatedness to suggest that interpersonal relationships may serve to exacerbate healthy women's fatigue experiences. The importance of relationship to women's life experience and the inherently relational character of women's fatigue are discussed. The author proposes the importance of including interpersonal experiences as a component of the definition of fatigue for healthy women.

Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic

To examine the relationship between somatosensory amplification and three factors of alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), 48 outpatients attending a Japanese psychosomatic clinic and 33 comparative outpatients completed the Somatosensory Amplification Scale (SSAS), 20-item Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), and other self-rating questionnaires. The scores on the SSAS and the first and second TAS-20 factors were higher (all P<0.001) in the psychosomatic group than in the comparison group. The SSAS was positively associated (both P<0.01) with these two TAS-20 factors, controlling for the effects of age, sex, group, and POMS tension-anxiety and depression. Somatosensory amplification appears to be associated with difficulties identifying and describing feelings, not externally oriented thinking, in Japanese patients.