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PubMedDate not supplied

Staphylococcus aureus carriage in adult peritoneal dialysis patients and their spouses.

OBJECTIVE: We hypothesized that carriage of Staphylococcus aureus among continuous ambulatory peritoneal dialysis (CAPD) patients was influenced by their spouses. Furthermore, this carrier status was compared to previous Staph. aureus peritonitis episodes in order to identify the influence of Staph. aureus carriage on peritonitis rate. DESIGN: A combined prospective surveillance study (Staph. aureus carriage) and retrospective chart review (Staph. aureus peritonitis). SETTING: A single peritoneal dialysis unit in a county hospital. PATIENTS AND METHODS: Cultures from patients (n = 32) and spouses (n = 16) were obtained twice, with a 1-month interval, from the anterior nares, the umbilical, and one groin area. All positive cultures were phage typed. Retrospective chart review of all episodes of Staph. aureus peritonitis among the patients was carried out. RESULTS: Twelve of 32 patients (37.5%) and 5 of 16 spouses (31%) evaluated were carriers. Half of the spouses of patients who were Staph. aureus carriers, were also carriers, as opposed to 20% of spouses of noncarrier patients (p = 0.30). Patients and spouses always shared the same phage type. Among patients, Staph. aureus was found in the nose only (n = 9), in all three regions (n = 2), and extranasally only (n = 1). If only one nasal culture was used to establish carriage, the sensitivity and negative predictive value would be 92% and 95%, respectively. A trend toward a higher incidence (p = 0.062) of Staph. aureus peritonitis was found among carriers (patients), 0.37 versus 0.28 peritonitis episode/dialysis-year. CONCLUSIONS: Only one positive nasal culture was necessary when carriage of Staph. aureus was to be established. Staph. aureus carriage was found more often in patients who had previously suffered from Staph. aureus peritonitis. The phage types isolated remained fairly constant, and the patients and spouses often had the same carrier state and shared the same phage types, although transmission does not always take place.

Adult↗

PubMed1998

Dental utilization by spouses of active duty U.S. military personnel.

This study explores dental utilization and access barriers to dental care for spouses of active duty U.S. military personnel as reported by their military sponsor. It also compares dental utilization of spouses and civilians. The data, collected using self-administered questionnaires between April 1994 and January 1995, are from 5,732 Army, Air Force, Navy, and Marine personnel with nonmilitary spouses. Comparative civilian data are from the most recent (1985-1986) U.S. oral health survey of working adults. Results show that dental utilization of military spouses parallels that of civilians. Cost was the most commonly cited barrier to dental care for spouses. Logistic regression results show that the likelihood of a spouse having seen a dentist within the past year is influenced by insurance status, sex, branch of service of sponsor, and rank of sponsor. Insurance status is the strongest predictor of dental utilization for spouses.

Adult↗

PubMed1992

Fulminant hepatitis related to transmission of hepatitis B variants with precore mutations between spouses.

A precore defective variant of hepatitis B virus has been indicated to cause fulminant hepatitis in various instances such as intrahospital outbreaks or mother-to-child transmission of hepatitis B virus. To learn whether similar variants are involved in interspouse transmission, we analyzed three cases of fulminant hepatitis B that developed in formerly healthy subjects whose only exposure to hepatitis B virus was contact with their longtime spouses, who were carriers of HBV and positive for antibody to HBe. The DNA clones for precore and S genes were propagated from patients and spouses and sequenced. Because of the conservation of S-gene sequences and the identity of subtypes between patient and spouse, it was suggested that patients were infected with hepatitis B virus from their spouses, not from other sources. A TGG-to-TAG mutation at the 28th codon of the precore gene of hepatitis B virus was commonly observed in all DNA clones from patients with fulminant hepatitis and from their spouses. A 29th-codon GGC-to-GAC mutation was additionally evident in DNAs from one patient-and-spouse couple. A significant rise in the circulating hepatitis B virus concentration was transiently observed in the index spouse of this case just before development of fulminant hepatitis in her husband. The increase in circulating HBV DNA was associated with a rise in abundancy of variants with mutations at both the 28th and 29th codons, compared with variants with only a 28th-codon mutation. The double mutation in hepatitis B virus DNA may either help the virus escape immune surveillance or replicate at a higher rate than before.

Base Sequence↗

PubMedDate not supplied

Morbid risks for major disorders and frequencies of personality disorders among spouses of psychiatric inpatients and controls.

Three hundred fifty-three psychiatric inpatients and their 192 living spouses and 98 control subjects and their 54 living spouses were examined and interviewed for affective, schizoaffective, schizophrenic (Research Diagnostic Criteria [RDC]), and personality disorders (DSM-III-R) using the Lifetime Version of the Schedule for Affective Disorders and Schizophrenia (SADS-L) and the Structured Clinical Interview for DSM-III-Personality Disorders (SCID). The morbid risks of spouses for unipolar depression were between .15 and .25, and those for other major disorders were below .03. The morbid risks of spouses of bipolar patients for unipolar depression exceeded those of other spouses by 50% without reaching statistical significance. Personality disorders were found in 44.6% of patients, in 8.4% of patients' spouses, and in 9.8% of healthy controls. There was only one couple in which the husband and wife had each had a major disorder before marriage. Only four husband-wife pairs suffered the same personality disorder. Spouses of patients do not have significantly more psychiatric disorders than healthy controls; therefore, assortative mating can only be of minor relevance in family studies.

Adult↗

PubMed1993

Needs of recovering cardiac patients and their spouses: compared views.

Identifying the needs of patients and spouses following an acute cardiac event is an essential first step in the development of nursing interventions to facilitate couples' psychosocial adaptation. Therefore, the self-perceived needs of 49 couples were compared 5 months following the patients' hospitalization for an acute cardiac event (i.e. myocardial infarction or coronary artery revascularization). Both patients and spouses identified the need for information as being most important compared with all other needs; however, significant discrepancies were found in ratings between patients and spouses. Needs which spouses rated as having a high priority included receiving information about the patient's feelings during the recovery period, having time alone, talking with the patient about concerns, and receiving information about the expected psychological recovery. Patients did not consider these same needs as they related to their spouses particularly important. Rather, they rated the need for information about their condition, the need to have honest explanations, and the need to talk with a health professional about their problems as having the highest priority. Many of the needs that both patients and spouses ranked as being important or very important were unmet in 40-70% of the cases. In this study, both patients and spouses expressed similar needs for information, but the type of information that they wanted differed and, in the majority of cases, these needs were not met by nurses and physicians.

Adaptation, Psychological↗

PubMed1992

The relationship between spouse solicitousness and pain behavior: searching for more experimental evidence.

In this study 42 chronic back pain patients participated twice in a treadmill test. During 1 of these 2 sessions, the partner was present. Walking time, pain intensity ratings, and heart rate were measured before and after the tests. From the results of previous studies it was expected that, in the presence of a relatively solicitous spouse, patients would report more pain, would have a shorter walking time, and would exert themselves less physically. Spouse solicitousness was measured in 2 ways: from the patient's perspective as well as from that of the spouse. Results based on the patient's interpretation of his/her partner's responses are not in accordance with previous findings. Results based on the spouse's view demonstrate, however, that patients with solicitous spouses do, in fact, report more pain and walk for a shorter duration in the presence of the spouse than patients with relatively non-solicitous spouses. Theoretical and practical implications are discussed.

Adult↗

PubMed1992

Cancer pain in the marital system: a study of patients and their spouses.

Forty married patients with metastatic cancer, who were receiving opioid medication for cancer pain, were interviewed for this study. They were asked about their pain and its treatment, their beliefs regarding cancer pain, their concerns about opioid analgesics, their mood state, and the nature of their interaction with their spouse in relation to these issues. The spouses of these cancer patients were interviewed separately about the same issues. For example, patients who were concerned about medication side effects tended to suffer high levels of pain before requesting additional analgesics. Spouses are shown in this study to be an important support for the patient and an essential source of information regarding the patient's pain and its management. For example, although spouses were generally accurate in their estimates of the patients' pain levels, in the case of relatively stoic patients, who may underreport their pain levels, the spouses' estimates were higher than the patients'. The results also indicate that patients underestimate the distress their pain causes to their spouses and that spouses tend to downgrade their own support to the patients. Implications and limitations of these findings are discussed.

Adult↗

PubMed2004

Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study.

This study tested the separate and combined effects of spouse-assisted pain coping skills training (SA-CST) and exercise training (ET) in a sample of patients having persistent osteoarthritic knee pain. Seventy-two married osteoarthritis (OA) patients with persistent knee pain and their spouses were randomly assigned to: SA-CST alone, SA-CST plus ET, ET alone, or standard care (SC). Patients in SA-CST alone, together with their spouses, attended 12 weekly, 2-h group sessions for training in pain coping and couples skills. Patients in SA-CST + ET received spouse-assisted coping skills training and attended 12-weeks supervised ET. Patients in the ET alone condition received just an exercise program. Data analyses revealed: (1) physical fitness and strength: the SA-CST + ET and ET alone groups had significant improvements in physical fitness compared to SA-CST alone and patients in SA-CST + ET and ET alone had significant improvements in leg flexion and extension compared to SA-CST alone and SC, (2) pain coping: patients in SA-CST + ET and SA-CST alone groups had significant improvements in coping attempts compared to ET alone or SC and spouses in SA-CST + ET rated their partners as showing significant improvements in coping attempts compared to ET alone or SC, and (3) self-efficacy: patients in SA-CST + ET reported significant improvements in self-efficacy and their spouses rated them as showing significant improvements in self-efficacy compared to ET alone or SC. Patients receiving SA-CST + ET who showed increased self-efficacy were more likely to have improvements in psychological disability. An intervention that combines spouse-assisted coping skills training and exercise training can improve physical fitness, strength, pain coping, and self-efficacy in patients suffering from pain due to osteoarthritis.

Adaptation, Psychological↗

PubMed1994

Spouse similarity for psychological distress and well-being: a population study.

While spouse similarity for psychiatric morbidity has been the object of numerous studies, most of these focused on clinical samples and, consequently, the interpretation of their results is limited by the existence of a selection bias. In this study, conducted on a sample of 845 general population couples, significant spouse similarity was observed for psychological distress and well-being, characterized by a marked symmetry in the relation between spouses' scores. The sex differences observed in many earlier studies would appear essentially to be artefactual. Spouse similarity was also found to be significant in the subpopulation of couples married less than two years, which pointed to assortative mating for psychological distress and well-being. While many studies have found educational dissimilarity and age difference between spouses to be associated with certain health variables, such as high blood pressure and coronary heart disease, these variables do not have a significant influence on individual levels of psychological distress and well-being. Spouse similarity for socio-demographic characteristics does not play a significant role in explaining spouse similarity for mental health. Consequently, assortative mating for psychological distress and well-being would appear to be primarily due to personal preference.

Adaptation, Psychological↗

PubMed1987

Long-term effects of losing a spouse or child in a motor vehicle crash.

In this article we examine the long-term effects of the sudden, unexpected loss of a spouse or child. In the spouse study, interviews were conducted with 39 individuals who had lost a spouse in a motor vehicle crash 4 to 7 years ago and with 39 matched controls. In the parent study, interviews were conducted with 41 parents who had lost a child in a crash and with 41 matched controls. Control respondents were matched to bereaved respondents case-by-case on the basis of sex, age, income, education, and number and ages of children. Significant differences between bereaved spouses and controls were revealed on several indicators of general functioning, including depression and other psychiatric symptoms, social functioning, psychological well-being, reactivity to good events, and future worries and concerns. For the most part, these differences persisted when variables such as present family income and present marital status were statistically controlled. Comparisons between bereaved and control parents also revealed significant differences on some measures of general functioning (especially depression), but these were not as pervasive as the differences obtained in the spouse study. Responses to questions about current thoughts and feelings suggest that the deceased continued to occupy the thoughts and conversations of bereaved spouses and parents. Moreover, a large percentage of respondents (from 30% to 85%, depending on the question), continued to ruminate about the accident or what might have been done to prevent it, and they appeared to be unable to accept, resolve, or find any meaning in the loss. Taken together, the data provide little support for traditional notions of recovery from the sudden, unexpected loss of a spouse or child.

Accidents, Traffic↗

PubMed1993

Loneliness, depression, and social support of patients with COPD and their spouses.

Thirty clients with chronic obstructive pulmonary disease (COPD) and their spouses were interviewed to examine differences in the relationships among loneliness, depression, and social support. Data were collected during structured in-home interviews using the UCLA loneliness scale, the Center for Epidemiological Studies depression scale, and the social support questionnaire. The clients and spouses did not differ significantly on measures of loneliness and depression, with mean scores for both groups higher than those in other comparable groups. Spouses, however, tended to be a little lonelier than clients, and clients tended to be a little more depressed than spouses. The two groups were also similar with respect to the number of people in their social networks but different as to network composition. Spouses were less satisfied with their networks than clients. Social support satisfaction was linked to loneliness and depression for clients but not for spouses. Results of the study suggest that community nurses working in home settings must be sensitive to clients' and spouses' psychologic reactions to COPD, which may be expressed in feelings of loneliness and depression.

Aged↗

PubMed1994

Hepatitis C virus infection in spouses of patients with type C chronic liver disease.

OBJECTIVE: Survey for markers of hepatitis C virus (HCV) infection in spouses of patients with HCV-related chronic liver disease. DESIGN: Cross-sectional clinical, serologic, and molecular biological study of spouses of patients with HCV viremia and chronic liver disease. SETTING: University and city hospitals. PARTICIPANTS: Spouses (52 men and 102 women; mean age, 56 +/- 11 years) of 154 patients with HCV viremia (102 men and 52 women; mean age, 58 +/- 10 years), of whom 66 had chronic hepatitis, 49 had liver cirrhosis, and 39 had primary hepatocellular carcinoma. METHODS: Tests for HCV-associated antibodies were done using a second-generation enzyme immunoassay and immunoassays with synthetic oligopeptides deduced from the HCV core gene. Hepatitis C virus RNA was detected by polymerase chain reaction with primers deduced from the 5'-noncoding region and HCV genotypes by reaction with type-specific primers deduced from the HCV core gene. RESULTS: Hepatitis C virus-associated antibodies were detected in 42 (27%) spouses, of whom 25 were also positive for HCV RNA. Of 112 (73%) spouses without detectable antibodies, 2 had chronic liver disease. The development of markers of HCV infection in spouses increased with the duration of marriage, ranging from 1 to 60 years (30 +/- 11 years). CONCLUSIONS: Spouses of patients with HCV viremia and chronic liver disease have an increased risk for acquiring HCV, which is proportional to the duration of marriage. They should be followed routinely for markers of HCV infection and liver disease.

Aged↗

PubMed2001

Attachment insecurity and the distinction between unhappy spouses who do and do not divorce.

The hypothesis that attachment insecurity would be associated with remaining in an unhappy marriage was tested. One hundred seventy-two newly married couples participated in a 4-year longitudinal study with multiple assessment points. Hierarchical linear models revealed that compared with spouses in happy marriages and divorced spouses, spouses who were in stable but unhappy marriages showed the highest levels of insecurity initially and over time. Spouses in stable, unhappy marriages also had lower levels of marital satisfaction than divorced spouses and showed relatively high levels of depressive symptoms initially and over time. Results suggest that spouses at risk for stable, unhappy marriages can be identified early and may benefit from interventions that increase the security of spouses' attachment to each other.

Adult↗

PubMed2001

Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses.

This study investigated contextual determinants of psychological distress among 197 spouses of cancer patients. It was hypothesized that higher levels of patient functional impairment would lead to greater patient distress. Patient distress, in turn, would lead to lower spouse marital satisfaction and ultimately to higher spouse distress. Spouses completed measures of distress and marital quality at three time points. Cancer patients rated their functional impairment and psychological distress at the same time points. Results indicated that at all time points, greater patient impairment was associated with higher levels of patient distress, which, in turn, was related to lower marital satisfaction. However, marital quality was related to spouse distress at only 1 time point, but spouse distress was directly associated with patient distress at each time point. Implications for cancer patients and spouses are discussed.

Adult↗

PubMedDate not supplied

Comparison of psychologic stress responses in patients and spouses ten weeks after a cardiac illness event.

A stress scale that is brief and easy to administer would be clinically useful to assess patients' and spouses' psychological stress responses to a cardiac illness situation and provide objective data for health care recommendations. The purpose of this study was to: a) develop and test an instrument to evaluate the stress or difficulties associated with the recovery process after a cardiac event; and b) assess the similarities and differences between patients' and spouses' perceptions of stress. Stress was conceptualized to be reflected by two broad dimensions, namely environmental stress and individual stress. A correlational survey design was used to examine patients' (n = 180) and spouses' (n = 168) stress responses 10 weeks after the cardiac event. The findings suggested that the tool demonstrated satisfactory reliability and validity in measuring the patients' but to a lesser extent the spouses' stress responses. The three most significant stresses reported by most patients were uncertainty about if and when the illness might recur, not being able to participate in work or retirement activities, and adopting a low cholesterol diet. For the majority of spouses, the three most significant stresses were uncertainty about the husband's illness, increased demands within the marital relationship, and assuming more family roles. For those individuals trying to quit smoking or who quit immediately prior to the cardiac event, smoking was the most stressful change for patients and the second most stressful for spouses. Educational programs for cardiac patients and spouses need to provide information related to these stresses to offset the potentially adverse impact of stress and promote adjustment.

Adult↗

PubMed1992

What do cancer patients' spouses know about the patients?

A large body of research shows that social support in general and of family members in particular plays an important role in determining cancer patients' quality of life. We assumed that the spouse's information about how the patient experiences the situation determines the spouse's ability to help. The present study was designed to examine how much the spouse knows about the attitudes and experiences of their husband or wife who is a cancer patient, and whether this knowledge depends on the questions' structure, disease duration, its severity, or level of patient's information about the disease and prognosis. A questionnaire with multiple-choice and open-ended questions assessing 13 domains (e.g., fears and worries concerning health, functioning in the family, and anxiety) was administered to patients and their partners. Subjects were 55 head-and-neck cancer patients, 40 men and 15 women, with disease stages I to IV, grade of tumors G1 to G3-4, and disease duration of 0.5 to 21 years. The results showed that correspondence between the patients' and their spouses' responses was very low, and was not affected by the structure of the questions or the disease's duration and severity. Correspondence was high only in patients informed about their disease. In the discussion, it was pointed out that when the patient is informed, communication channels in the family are opened and this brings about an increase in the spouses's information about the patient and hence in the spouse's ability to provide the patient the needed social support as a psychotherapeutic agent and a friend. The cancer nurse may play a crucial role in instituting the patient-spouse dialogue.

Adult↗

PubMed1996

Transmission of hepatitis C virus between spouses: the important role of exposure duration.

OBJECTIVES: Although interspousal transmission of hepatitis C virus (HCV) has been studied, the factors responsible for it remain unclear. METHODS: To investigate the transmission of HCV between spouses and the related risk factors, 100 anti-HCV-positive index patients and their spouses were studied. RESULTS: Overall, anti-HCV was detected in 17 (17%) spouses, 15 of whom were also positive for HCV RNA, and 11 couples were infected with the same genotype. The anti-HCV-positive rate was higher in spouses married longer than 20 yr compared with those married less than 20 yr (22 vs 6%, p < 0.05), and the infection was correlated with the duration of their actual exposure to the index patients but not with serum HCV titers. The infected couples had more frequent sexual contacts and more commonly shared tooth-brushes than those with uninfected spouses. CONCLUSION: Spouses of patients with chronic hepatitis C have a higher risk of acquiring HCV that increases with longer marriage and duration of exposure, and they should be educated about how to avoid contracting HCV infection from their spouses.

Female↗

PubMed2001

Involvement in caregiving and adjustment to death of a spouse: findings from the caregiver health effects study.

CONTEXT: Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative. OBJECTIVE: To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death. DESIGN AND SETTING: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. PARTICIPANTS: One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52). MAIN OUTCOME MEASURES: Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies-Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants. RESULTS: Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P =.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 4.35; P =.04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P =.05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F(1,118) = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P =.99] and 0.46 vs 0.27 [P =.39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F(1,101) = 8.12; P =.005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P =.41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P =.12], respectively). CONCLUSIONS: These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss.

Aged↗