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Periodontal findings in spouses. A clinical, radiographic and microbiological study.

Clinical, radiographic and microbiological examination of periodontal conditions was carried out in 2 groups of married couples to assess similarities between husband and wife. The diseased probands (n = 10) exhibited advanced periodontitis and the healthy ones (n = 10) were periodontally normal. The clinical examination comprised the assessment of plaque, probing pocket depths, gingival bleeding on probing, suppuration, supragingival and subgingival calculus. The extent and type of alveolar bone loss was determined from panoramic radiographs. Bacterial samples were taken from the 6 deepest and most inflamed periodontal pockets and from stimulated saliva. The samples were cultured for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus and Peptostreptococcus micros. The mean detection frequency of moderately deep pockets (4-5 mm) and deep pockets (> or = 6 mm) was significantly higher in the diseased probands than in their spouses. The mean detection frequency of moderately deep pockets was significantly higher in the spouses of the diseased probands than in the spouses of the healthy ones. Deep pockets were found in 6 spouses of the diseased probands, whereas only in 2 spouses of the healthy ones. Both diseased proband and his/her spouse harbored A. actinomycetemcomitans, P. gingivalis, P. intermedia, C. rectus and P. micros in 4, 6, 9, 9 and 4 couples, respectively. Both healthy proband and his/her spouse harbored the pathogens in 0, 1, 9, 5 and 3 couples, respectively. P. gingivalis was found in 7 spouses of the diseased probands, but only in 2 spouses of the healthy ones.(ABSTRACT TRUNCATED AT 250 WORDS)

Aggregatibacter actinomycetemcomitans↗

Preventive health services and access to care for male veterans compared with their spouses.

The Veterans Health Administration is exploring ways to reform the current Veterans Affairs (VA) system in accordance with the changing health care environment of managed care. One proposal is for the VA to enlarge its patient base by expanding eligibility to include spouses of veterans. To compare reported preventive health care services received by male veterans and their spouses and to measure whether spouses would choose to receive their medical care through a VA medical center, we randomly selected 230 married male veterans and mailed self-administered questionnaires to be completed by them and their spouses; 170 (74%) eligible subjects completed the questionnaire. The mean age of the veterans and spouses was 73.6 and 67.4 years, respectively. Veterans reported significantly higher rates of receipt of recommended preventive services than their spouses in all 5 areas assessed, including blood pressure measurement; influenza, pneumococcal, and tetanus vaccinations; and serum cholesterol measurement. Veterans were significantly more satisfied than their spouses with their current health care. Finally, 83% (95% confidence interval, 77% to 89%) of spouses reported that they would choose to receive their medical care at the VA medical center is allowed to do so. These findings suggest that spouses of male veterans represent a sizable group that could be incorporated in the VA system, especially given their strong desire to do so.

Aged↗

Predictors of depressive symptoms among spouse caregivers in Parkinson's disease.

The objective of this work was to determine the predictors of depressive symptoms among spouse caregivers of Parkinson's disease (PD) patients. Little is known about the strain in giving care to PD patients and how the motor, cognitive, and behavioral complications of PD contribute to depression among spouse caregivers. Forty-five consecutive PD patients and their spouse caregivers agreed to be evaluated after a routine clinic visit. Patient demographic data and the presence of hallucinations, delusions, incontinence, and sleep disturbances were obtained. The patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS-motor section), Hoehn and Yahr (H&Y) staging, and the Mini-Mental State Examination (MMSE). Depressive symptoms were assessed using the 17-item Hamilton Depression Scale (HAMD-17) and the Beck Depression Inventory-II (BDI-II) on patients and spouses. Thirty men and 15 women had a mean age of 71.5 years (range 53-85), average PD duration of 10 years (range 1-26), a mean "on" H&Y stage of 2.8 and an MMSE mean score of 26 (range 13-30). There was good correlation between the HAMD-17 and the BDI-II scores in both patients (r = 0.69, P = 0.001) and spouses (r = 0.66, P < 0.001). A moderate correlation was noted between the spouse HAMD-17 score and the patient UPDRS-motor score (r = 0.34; P = 0.02), the age of PD onset (r = 0.33; P = 0.02) and patient HAMD-17 scores (r= 0.29; P = 0.05). A stronger correlation was noted between spouse HAMD-17 scores and the years of PD duration (r= 0.43; P = 0.003). There was a significant difference in the mean spouse HAMD-17 scores among PD patients with sleep disturbances versus those who did not (10.2 vs. 6.4; P = 0.04). However, on stepwise regression analysis, only the duration of PD remained significant (adjusted r = 0.17; P = 0.003). No difference was noted with hallucinations, delusions or incontinence. We concluded that the duration of PD appears to be the strongest predictor of depressive symptoms among spouse-caregivers in this small cohort.

Aged↗

Coronary artery bypass surgery--impact upon the patient's spouse.

The spouses of 65 coronary artery bypass graft surgery (CAGS) patients were assessed to determine levels of psychological symptoms and social impairment both before and 12 months after surgery. There was substantial psychological morbidity in spouses pre-operatively, with from one-third to one-half having clinically significant levels of depression and/or anxiety symptoms. Pre-operatively there was also significant global psychosocial impairment in the spouse. Of the specific domains of psychosocial adjustment, recreational and psychological adjustment was most severely affected, vocational/domestic adjustment and sexual adjustment being less impaired, and extended family relationships showing minimal impairment. There was significant improvement in spouses' psychological and global psychosocial adjustment at 12 months, with recreational adjustment showing the greatest improvement. Significant improvements also occurred in vocational adjustment but not in domestic or sexual adjustment. Neither physical, psychological nor social adjustment variables preoperatively in either the patient or spouse were predictive of psychological morbidity in the spouse (anxiety or depression) at 12 months. Similarly there were no significant patient or spouse preoperative predictors of social adjustment in the spouse at 12 months. However, the patients post-operative psychological morbidity and the spouses social and psychological morbidity were related.

Adult↗

Alzheimer's disease afflicted spouses who remain at home: can human dialectics explain the findings?

When one spouse has Alzheimer's disease (AD), marital interactions tend to decline. Findings from this study suggest that level of spousal interactions influence longitudinal outcomes for afflicted spouses. Thirty AD spouses and their spouse caregivers were assessed at baseline (time 1) and two years later (time 2). Continued in-home care at time 2 is predicted by high levels of positive spousal interactions, high caregiver commitment, good caregiver health, and shorter time as caregiver (all assessed at time 1). The same variables but in an inverse relationship predict which AD spouses are deceased at time 2. Nursing home placement is predicted by AD spouses' higher educational level, unhappy marital relationships, and low caregiver commitment. Afflicted spouses' cognitive and functional impairment levels, their physical health and depression do not predict outcomes. A theoretical explanation is developed drawing on Riegel's dialectical theory of human development and Bowlby's attachment theory. It is suggested that interactions between spouses are crucial for afflicted spouses' survival.

Activities of Daily Living↗

Cognitive, interpersonal, and behavioral predictors of patients' and spouses' depression.

BACKGROUND: This study examined the relationship between five theory-based variables and the severity of depression. The variables were self-concept, self and spouse ascribed hostility, spouses' level of depression, and involvement in home activities. METHODS: Based on DSM-IV criteria and Beck Depression Inventory (BDI) scores, 75 wife-depressed couples and 59 husband-depressed couples were included in the study. In addition to the BDI, both spouses completed questionnaires relating to self-concept, self- and spouse ascribed hostility, and involvement in home activities. RESULTS: Multiple regression analyses for male and female patients and spouses revealed that in the four groups self-concept was significantly related to the severity of depression. Irrespective of clinical status, involvement in home activities was significantly associated with the severity of depression of women. The relationship between spouse ascribed hostility and the level of depression of both spouses in husband-depressed couples approached significance so did the relationship between patient's and spouse's level of depression in wife-depressed couples. In husband-depressed couples the association between spouses' level of depression reached significance. CONCLUSIONS: The shared and gender-related predictors of severity of depression support an integrative theoretical approach to depression and offer practical implications.

Adult↗

Spouse attitudes toward the person with aphasia.

This investigation evaluated the attitudes of individuals towards their aphasic spouse. Using modified Q-methodology, 15 spouses of fluent aphasic patients, 15 spouses of nonfluent aphasic patients, and 30 matched controls completed a 70-item Q-sort. The spouses of nonfluent aphasic patients had a significantly greater number of negative attitudes toward their spouses than the spouses of fluent aphasic patients. The spouses of patients in both aphasia groups had a significantly greater number of negative attitudes toward their spouses than the matched controls. The most common attitudes of spouses of patients in both aphasic groups divided into six factors: compliance, desirability, egocentricity, independence, maturity, and sociability.

Aphasia, Broca↗

Husband-wife diet concordance and changes in dietary practices by surviving spouses of cancer cases.

Diet concordance and changes in dietary practices by surviving spouses of cancer cases were investigated by studying 69 husband-wife pairs during an eight-year period spanning the death from cancer of one spouse. The data base consisted of reports for each cancer case from the Adventist Health Study (AHS) where a surviving spouse was available. Two questions were addressed. 1. Do husbands and wives eat similar diets? 2. Did survivors change their diet practices during the eight-year period? Three sets of dietary data were compared with the AHS food frequency questionnaire: reports made in 1976 by cases; reports made in 1976 by their spouses (initial); and the spouses' reports in 1984 (current). Diet concordance and dietary changes for 35 key food groups were evaluated both for individual foods and across foods by computing recall scores. The results were analyzed with univariate and multivariate methods. Comparison of means and Spearman rank-order correlations revealed good initial concordance between the spouses, which was not significantly related to age, sex, or education. However, eight years later subsequent to the deaths of the cases, the agreement was poor because the surviving spouses had changed their diets. The changes in dietary practices were significantly related to education and body mass index in univariate analysis but not in analysis of covariance. These results indicate that retrospective recall by spouses for the cases rather than the spouses' own current reports should be used as an estimate for the deceased cases. Repeated recalls are necessary to increase reliability.

Adult↗

Blood pressure concordance between spouses.

In 1982, 4,474 noninstitutionalized residents of Connecticut who were 18 years or older were interviewed as part of the Connecticut High Blood Pressure Program. This cross-sectional study was undertaken to determine the prevalence of hypertension among the 2.1 million adults in the state. Spouse correlations for systolic and diastolic blood pressures were examined in 1,260 white spouse pairs. Upon demonstrating a significant correlation in blood pressure between spouses (r = 0.262 for systolic and 0.248 for diastolic, p less than 0.001), subsequent stepwise multiple regressions were used to determine which aspects of the shared marital environment might influence the spouse concordance. Variables related to each spouse as well as variables reflecting similarity between spouses were analyzed. When spouse concordance in blood pressure was examined controlling for age, obesity, dietary salt intake, socioeconomic status, income, education, occupation, smoking, and exercise of both spouses and similarities in these variables, the correlations between spouses' blood pressures remained significant.

Adolescent↗

Psychological well-being of spouses of stroke patients during the first year after stroke.

OBJECTIVE: To investigate whether spouses' psychological well-being changed between the first weeks after their partner's stroke and four months and one year later, and to study the relationship between spouses' psychological well-being and objective characteristics of the stroke patients. DESIGN: Prospective, longitudinal study. SETTING: Hospital care and follow-ups. SUBJECTS: Sixty-seven consecutively enrolled spouses to first-ever stroke patients < 75 years. MAIN MEASURES: The Psychological General Well-Being (PGWB) Index. Clinical examination of the stroke patients. The Barthel Index. RESULTS: The spouses' psychological well-being was significantly lower in the first weeks after their partner's stroke as compared with norms. At four months, it had increased significantly. Between four months and one year, individual changes were observed in both positive and negative directions; thus, the mean level of the group remained constant. The spouses' psychological well-being in the first weeks was significantly related to the patients' sensorimotor impairments, while it was related at four months to cognitive impairment and the patients' abilities in self-care. At one year, psychological well-being was related to remaining sensorimotor and cognitive impairments. A significant relationship was also seen between the spouses' and the stroke patients' emotional health. CONCLUSIONS: The spouses' psychological well-being increased after the first chaotic weeks. The presence of visible impairments initially seemed to affect spouses' emotional health, while cognitive and emotional impairments became more evident in everyday life. In the long term, however, the spouses' individual life situations and coping abilities seem to be of relatively increasing importance for their continued well-being.

Adaptation, Psychological↗

Stress, social support, and symptoms of depression in spouses of the medically ill.

This study investigated the level and frequency of depressive symptoms in spouses of dialysis patients, as a function of a) severity of patient disease, b) level of stress experienced by the spouse, and c) perception of support from the ill partner. The subjects were forty patients who had begun dialysis in the last year and their spouses. Measures of depression, impact on family, perceived social support, and disease severity were applied. Significant depressive symptoms were reported by 20 percent of spouses. Symptom severity was not correlated with age, sex, or occupation of the spouses, nor with level of depression or functional impairment of the dialysis patients. The amount of social support received from the ill partner accounted for 37 percent of the variance in spouse depression, while social and financial stressors reported by the spouse explained 13 percent of the variance in spouse symptoms. These findings suggest that depressive symptoms in spouses of dialysis patients are associated with the social and economic consequences of the illness for the family but even more so with the amount of perceived support from the patient. The determinants of this perceived support need further exploration.

Adaptation, Psychological↗

Needs of the grieving spouse in a hospital setting.

In an attempt to determine whether the spouse whose mate is terminally ill or had died can recognize his own needs and whether he, himself, perceives that he has been helped by nurses, 27 spouses were interviewed during the terminal illness of their mates. Subsequently, 18 mates died; 14 of the spouses were interviewed after the death event. Data were collected by means of tape-recorded semistructured interviews, with the exception of one written second interview. Eight needs of grieving spouses were noted. Twenty-five spouses identified all eight needs and the other two spouses identified five and seven needs, respectively. The fact that the needs were identified did not mean, however, that these needs had been met. Spouses believed nurses had been helpful to the dying mates. The spouses recognized that the nurses' primary responsibility was to the patients and felt that nurses were too busy to help the families. The death event did not alter the identified needs and concerns of the spouses. Eighty-seven percent of the needs identified in the second interview had been identified in the first interview.

Adult↗

Quality of life for spouses of CAPD patients.

The overall purpose of this study was to describe the quality of life (QoL) for spouses of continuous ambulatory peritoneal dialysis (CAPD) patients and to determine what factors are the best predictors of the spouses' perceived QoL. Thirty-eight spouses of CAPD patients from 2 dialysis units completed a demographic data form, the Jalowiec Coping Scale, the Dyadic Adjustment Scale, and the Quality of Life Index. The primary CAPD nurses completed the End Stage Renal Disease Severity Index on the ill partner. The results showed that 21% of the spouses perceived their QoL as high, 55% perceived their QoL as moderate, and 24% perceived their QoL as fair to poor. The results indicated that the QoL for the spouse is similar to that of CAPD patients with the exception of the family domain. On the family domain, the spouses scored significantly lower. Marital adjustment was the best predictor of QoL for the spouse. Income was the next best predictor. These two variables combined for a predictive value of 85%. Understanding the effect that a chronic illness has on the spouse will assist nurses in providing quality care for both the patient and the spouse.

Adaptation, Psychological↗

Screening spouse abusers for child abuse potential.

This study investigated the ability of the Child Abuse Potential (CAP) Inventory to screen for child abuse in a group of spouse abusers. Eighty-seven untreated male spouse abusers and 95 nonabusers were administered the CAP Inventory. All of the subjects were active duty, United States military personnel. The completed, valid protocols revealed that 36.5% of the spouse abusers had elevated child abuse scores, while only 9.1% of the nonabusers had elevated abuse scores. An analysis of variance indicated that the spouse abusers had significantly higher mean abuse scores. Four concurrent reports of child abuse were made in the spouse abuse group. Two of these spouse/child abusers had valid protocols, and both scored significantly higher than those spouse abusers with no reported child abuse. The finding that over 36% of the spouse abusers had elevated child abuse scores supports Walker's (1979) finding that one-third of spouse abusers are child abusers. A limitation in this study is that no longitudinal data were obtained to determine whether those with elevated child abuse scores who were not reported for child abuse subsequently would abuse their children.

Adult↗

Cancer risks to spouses and offspring in the Family-Cancer Database.

It is generally accepted that cancer is caused by environmental and inherited factors but these are only partially identified. Family studies can be informative but they do not separate shared lifestyles and genes. We estimate familial risks for concordant cancers between spouses in common cancers of both sexes in order to quantify cancer risks from the shared environment. The risks are compared to those seen between parents and offspring in order to estimate the inherited component. The nation-wide Family-Cancer Database was used as the source of family and cancer data. Standardized incidence ratios (SIRs) were calculated for concordant cancer in offspring by parental cancer and in spouses. Among the 23 cancer sites considered, all but two showed an increased SIR for offspring by father or mother. Only two sites, stomach and lung, showed an increase in SIR of concordant cancer among spouses. Additionally, pancreatic cancer and melanoma were increased in couples where at least one spouse was diagnosed before age 50. If both spouses presented melanoma before age 40, SIR was 3.82 for husbands. SIRs of colon, renal, and skin (squamous cell) cancers were unchanged by spouses' concordant cancer. Shared lifestyle among spouses seems to explain only a small proportion of cancer susceptibility. Because lifestyles are likely to differ more between parents and offspring than between spouses, familial cancer risks between parents and offspring are likely to be more due to heritable rather than environmental effects.

Adolescent↗

Psychological distress in spouses of men treated for early-stage prostate carcinoma.

BACKGROUND: The authors examined levels and predictors of psychological distress in the wives of men treated for early-stage prostate carcinoma (PCa). METHODS: Patients with PCa (N = 165) and spouses were interviewed to assess general and cancer-specific distress. Social and intrapersonal factors of spouses as well as clinical characteristics and quality of life of patients were assessed as potential predictors of spouses' distress. RESULTS: Spouses reported more cancer-specific distress than did patients (P < 0.001), but did not differ from patients in general distress. Several spouse-reported factors predicted higher spouses' distress, including less education (P < 0.005), worse marriage quality and less social support (Ps < 0.005), more negative social interaction with the patient (Ps < 0.001), lower self-esteem (Ps < 0.001), less positive coping (Ps < 0.005), searching for meaning (P < 0.001), not finding meaning (P < 0.005), and greater illness uncertainty (Ps < 0.001). Patients' bowel function and mental health also predicted greater spouses' distress (Ps < 0.005). CONCLUSIONS: The findings indicated that overall distress in spouses of early-stage patients with PCa was modest, and it was more likely to be predicted by psychosocial than medical factors.

Adaptation, Psychological↗

Spouses of persons with dementia: their healthcare problems, utilization, and costs.

Spouses of persons with dementia (PWD) often experience poor health outcomes related to the experience of living with the afflicted spouse. Using the Anderson and Aday Healthcare Utilization Model, we conducted a retrospective review of an administrative database from a private healthcare insurer to compare health problems that precipitate utilization, patterns of utilization, and costs of care of spouses of PWD (n = 979) to those of spouses of persons without dementia (n = 979). Spouses of PWD were treated for more anxiety disorders (OR = 2.97; 95% CI = 1.63-5.44), falls (OR = 7.72; 95% CI = 2.73-21.84), rheumatologic diseases (OR = 2.5; 95% CI = 1.24-5.06), and diabetes with no complications (OR = 1.53; 95% CI = 1.06-2.22), but less pneumonia (OR =.55; 95%; CI =.35-.88) than comparison spouses. Spouses of PWD had a higher number of emergency room (ER) visits (p =.01). There were no differences in costs between the groups. The findings can be used to develop interventions for spouses of PWD.

Accidental Falls↗

The effects of perceived versus enacted social support on the discriminative cue function of spouses for pain behaviors.

This study examined the effects of spouse social support on patient displays of pain behaviors. A standardized behavioral observation method was used to record pain behaviors in 110 chronic pain patients while the spouse was present and while the spouse was absent. Patients and their spouses also completed paper and pencil measures of spouse-provided social support as well as a demographic questionnaire. Results indicated that pain behaviors varied as a function of spouse presence and the type, or dimension, of support considered. Patients reporting higher levels of enacted support displayed a greater number of pain behaviors irrespective of spouse presence, consistent with the operant theory. When a measure of perceived support was used, the pain behaviors displayed differed, depending upon the level of support and spouse presence. Results are consistent with support-seeking and cognitive-behavioral models of the effects of social support on outcome. We discuss our findings within the context of a multidimensional model of support and pain and we caution against strict application of the operant model in treatment programs. Additional research is warranted to better understand the impact of support on the rehabilitation of patients with chronic pain.

Adult↗