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Some studies suggest that socio-economic status (SES) inequalities in health are smaller in women than men, but the evidence is inconsistent as to whether this applies across various health measures and life stages. The first aim of this paper was to establish whether the magnitude of social inequality in health differs for men and women during early adulthood, specifically in respect to self rated health, limiting long-standing illness, psychological distress, respiratory symptoms, asthma/wheezing, height and obesity; second, to determine whether explanations for socioeconomic inequality in poor self rated health differ for men and women. Analyses are based on longitudinal data from the British 1958 birth cohort study using information from birth to age 33. When gender differences in inequalities were examined using social class, no significant differences emerged across the seven health measures examined at ages 23 and 33. SES inequalities based on education, however, showed greater inequality among men at age 33 for limiting long-standing illness and respiratory symptoms, but greater inequality among women for poor rated health at age 23 and psychological distress at age 33. Hence, gender differences in the magnitude of health inequality were inconsistent across age and health measures. An analysis of the contribution of explanatory factors to social class differences in self-rated health suggested that causes of inequality were similar for men and women. However, some discrepancies emerged, notably in the greater contribution of job insecurity to class differences for men and in the greater contribution of age at first child for women. The magnitude and explanations for gender differences in SES health inequalities are likely to vary according to life stage and health measure.
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PMID:Social inequalities in health: are there gender differences? 1004 37

Many adolescents present with hirsutism and irregular menses. The challenge for the clinician is to distinguish physiologic anovulatory cycles from true menstrual disorders such as PCOS, and to differentiate PCOS from other causes of hyperandrogenism in hirsute adolescents. Common clinical features seen in adolescents with PCOS include hirsutism, acne, menstrual irregularity, and obesity. Biochemical abnormalities include hyperandrogenism, acyclic estrogen production, LH hypersecretion, decreased levels of SHBG, and hyperinsulinemia. Management strategies for a patient with PCOS include treatment of features which may cause distress to the adolescent, such as hirsutism, acne, and irregular menses, and prevention of long-term sequelae. Oral contraceptive pills, antiandrogens, and cosmetic treatments are used to treat hirsutism, acne, and menstrual irregularity. Oral contraceptive pills or medroxyprogesterone acetate are given to prevent endometrial hyperplasia and carcinoma. Counseling about weight loss and nutrition are essential, as weight loss may improve signs of hyperandrogenism and menstrual irregularity and may prevent NIDDM and cardiovascular disease. Insulin-sensitizing agents show promise in terms of decreasing hyperandrogenism, restoring ovulatory cycles, treating infertility, and preventing long-term sequelae. Finally, it is important to recognize that adolescents with PCOS may experience psychological distress because of the clinical manifestations of hyperandrogenism or when confronted with the information that they have a chronic illness. Psychological support should be available for these young women. Future research is likely to further elucidate the pathophysiology of PCOS, identify candidate genes, and clarify which adolescents are at risk for long-term sequelae. Prospective studies are needed to identify which therapies could potentially reduce the risk of infertility, diabetes, cardiovascular disease, and endometrial carcinoma in young women with PCOS.
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PMID:Polycystic ovary syndrome. 1037 Jul 13

In an open-label self-controlled study of 1,350 patients with stable angina pectoris (SAP), we previously demonstrated that 50 mg of isosorbide mononitrate (ISMN) slow release formulation once daily not only provided a better antianginal effect but also a better quality of life (QOL) than did the daily administration of multiple small doses of the compound. It is unknown whether certain patient characteristics contribute to this benefit. The objective of this article was to determine what independent factors contribute to this benefit. Multiple linear regression analysis was performed on the data from these 1,350 patients. Quality of life was assessed by the Marquis QOL-questionnaire for patients with angina and included the domains of immobility, pain, and psychological distress. For the purpose of this study, overall QOL was calculated as the pooled sums of the domain scores and expressed as mean scores on an ordinal scale of 10. Age did not influence the beneficial effect of nitrate therapy on QOL. Neither did gender, rhythmic disturbances, peripheral artery disease, or the concomitant use of calcium channel blockers or beta blockers. New York Heart Association (NYHA) angina classification was an independent variable: patients with a NYHA class I or II benefited less than did patients with NYHA III or IV (p = 0.02). Obese patients as well as hypertensive patients benefited less (p = 0.04 and 0.02), and smokers tended to benefit less also (p = 0.08). In contrast, hypercholesterolemia and diabetes mellitus improved the beneficial effect of nitrates on QOL (p = 0.03 and 0.05). The authors conclude that patients with coronary artery disease (CAD) and concomitant diabetes mellitus or hypercholesterolemia, a category particularly prone to early endothelial dysfunction and thus dysfunctional endogenous nitric oxide (NO) production, may benefit more from NO-donor therapy than patients without such concomitant conditions.
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PMID:Factors influencing efficacy of nitrate therapy for stable angina pectoris: a multiple linear regression analysis. 1113 92

Binge eating in simple obesity has recently been recognized as a serious clinical problem. In the obese population with binge eating, distinct characteristics have been found by many researchers, such as an early onset of obesity and diet, frequent body weight fluctuation, the amount of time spent dieting, extreme restriction of food intake and an unrealistic ideal of diet. Obese binge eaters also exhibit more psychiatric symptomatology such as distortion of body image, low self-esteem, low self-efficacy, a high level of depression, strong perfectionism, high impulsivity and comorbidity of personality disorders, especially a borderline personality disorder. Cognitive-behavioral therapy and interpersonal psychotherapy are promising for treatment of obese binge eaters. Supportive psychotherapy will add some help by ameliorating psychological distress.
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PMID:[Binge-eating in simple obesity]. 1126 13

The study was conducted to assess the prevalence and incidence of carpal tunnel syndrome (CTS) in a large modern footwear factory and to identify factors predictive of CTS. To this end, 199 workers were examined in 1996, and 162 of them were re-examined in 1997. Ergonomic and psychosocial risk factors of CTS were assessed by workpost analysis and self-administered questionnaire. The prevalence of CTS at baseline in 1996 and in 1997 was 16.6% (95%CI: 11.4-21.7) and 11.7% (95%CI: 6.7-16.8), respectively. The incidence rate of CTS in 1997 was 11.7% (95%CI: 6.7-7.8). No specific type of job performance was associated with CTS. Obesity (OR = 4.4; 95%CI: 1.1-17.1) and psychological distress at baseline (OR = 4.3; 95%CI: 1.0-18.6) were strongly predictive of CTS. Rapid trigger movements of the fingers were also predictive of CTS (OR = 3.8; 95%CI: 1.0-17.2). A strict control of thework by superiors was negatively associatedwith CTS (OR = 0.5; 95%CI: 0.2-1.3). The prevalence and incidence of CTS in this workforce were largely higher than in the general population and numerous industries. The study highlights the role of psychological distress in workers exposed to a high level of physical exposure and psychological demand.
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PMID:Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory. 1188 19

Birth weight is a popular topic, because it is precisely recorded, a major determinant of infant survival, associated with infant mortality, and health outcomes later in life. Low birth weight (LBW) is a predisposing factor for metabolic abnormalities such as atherosclerosis, renal disease, non-insulin diabetes mellitus, asthma, low IQ, hypertension, obesity, psychological distress. They have all been reported to be more common among those who were small at birth. Due to lack of studies suggesting a linkage between LBW and diseases of liver; evidences, which support the hypothesis on the creation of a link between LBW, an indicator of unfavourable intrauterine environment, and liver diseases emerging in the adult life, and possible direct associations of LBW with liver diseases, e.g., hepatitis, non-alcoholic fatty liver disease, cirrhosis, hepatoblastoma, or hepatocellular carcinoma were discussed. The associations between LBW and hepatitis vaccination as well as paediatric parental nutrition were also noted.
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PMID:Low birth weight: a possible risk factor also for liver diseases in adult life? 1367 7

Obesity is considered a primary risk factor for cardiovascular disease and related mortality. The current study aimed to investigate the efficacy of minimal invasive gastric banding (GB) surgery for reducing caloric intake in morbid obesity, and to analyze the effects of weight loss on body composition and metabolic and psychosocial outcomes. Twenty-six adult severely obese patients (mean body mass index [BMI], 48.1 kg/m(2); range, 42 to 56) underwent adjustable silicone laparoscopic GB. Nine additional obese patients who declined surgery were treated with metformin (2 g daily) and served as a small additional group (BMI, 50.5 kg/m(2); range, 41 to 68). Presurgery and 17 +/- 2.2 months postoperatively, body composition (fat mass [FM], lean body mass [LBM], body water) and serum parameters (lipids, glucose, thyrotropin-stimulating hormone [TSH]) were determined. Quality of life (QoL) was evaluated by a standardized self-rating questionnaire (Short Form-36 [SF-36]), and supplemented by measures of physical complaints and psychological distress. After GB, weight loss was 21 +/- 14.9 kg (14%, P <.001). It was associated with a decrease in FM by 14 +/- 8.6 kg (18%, P <.001), LBM by 4 +/- 2.7 kg (5%, P <.001), body water by 4 +/- 3.4 L (7%, P <.01), systolic blood pressure by 16 +/- 26.3 mm Hg (10%, P <.05), total cholesterol by 0.69 +/- 1.29 mmol/L (12%, P <.05), and low-density lipoprotein cholesterol (LDL-C) by 0.38 +/- 0.39 mmol/L (10%, P <.05). Highly significant interactions between surgery and time were noted for weight (P <.005), BMI (P <.005), and FM (P <.007, analysis of variance [ANOVA]). Preoperatively, 14 of 26 patients (54%) had high fasting blood sugar levels (type 2 diabetics) and 11 (42%) had impaired glucose tolerance, whereas postoperatively, for baseline glucose levels a trend to decrease was noted. Neither malabsorption nor anemia was observed. QoL improved after GB; in particular, physical functioning and well being increased (P <.01), and somatic complaints (eg, dyspnea and heart complaints, pain in legs and arms) markedly decreased (P =.008). In the metformin group, neither relevant weight loss nor a significant decrease of biochemical values was observed. Minimal invasive GB is a successful therapeutic tool for reducing FM in morbidly obese patients. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk.
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PMID:Metabolic and psychosocial effects of minimal invasive gastric banding for morbid obesity. 1466 54

Psychogenic nonepileptic seizures (NES) are somatic manifestations of psychological distress. There is some evidence that weight problems are more common in patients with psychiatric illness. We have observed that patients admitted for video-EEG monitoring who we diagnosed with NES commonly have a larger body habitus than patients with epilepsy. The goal of this study was to test our hypothesis that there was a significant difference in body mass index (BMI) in patients with nonepileptic seizures compared with their epileptic counterparts. We compared the BMIs of 46 NES patients and 46 age- and gender-matched epileptic controls and found that the NES patients had significantly higher BMIs (30.5 vs 26.1, P=0.006) than controls. This remained true after controlling for weight-gain properties of antiepileptic drugs. These results are compared with the prevalence of overweight and obesity in the general population. Possible explanations of the findings and limitations of the study are discussed.
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PMID:Psychogenic nonepileptic seizures are associated with an increased risk of obesity. 1475 Dec 12

The aim of the current study was to determine the extent to which psychological distress is associated with cancer prevention practices among otherwise healthy adults in the community (N=30,223). Using data from the 2000 National Health Interview Survey, a series of multiple logistic regression analyses were used to estimate the associations between psychological distress and selected cancer prevention practices. Results indicate that psychological distress was directly associated with an increased likelihood of daily cigarette smoking, physical inactivity, and obesity. Only smoking status mediated the relation between psychological distress and perceived cancer risk. Individuals who reported higher psychological distress were more likely to engage in specific cancer screenings before reaching the recommended age. This effect was partially mediated by perceived cancer risk. The higher levels of cigarette smoking and physical inactivity among psychologically distressed adults support the need for integration of cancer prevention and mental health interventions to reduce specific cancer risk in high-risk adults. Further research is needed to differentiate the causal pathways and mechanisms linking heightened individual cancer risk, potentially comorbid mental disorders or psychological conditions, and cancer screening adherence.
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PMID:The associations between psychological distress and cancer prevention practices. 1573 14

This research examines the relationship between community unemployment and the physical and mental health of immigrants in comparison to non-immigrants in Montreal under the hypothesis that high unemployment in the community may generate more negative effects on the health of immigrants than on non-immigrants. Possible gender differences in these associations are also examined. Montreal residents were studied via multilevel analysis, using both individual survey data and neighbourhood data from 49 police districts. Individual-level data were excerpted from a 1998 health survey of Montreal residents, while neighbourhood data originated from survey data collected in the 49 Montreal police districts and the 1996 Canadian Census. The associations between community unemployment and self-rated health, psychological distress and obesity are examined, and hypotheses regarding the modifying mechanisms via which male and female immigrants may run a greater risk of poor health than non-immigrants when living in areas of high unemployment were tested. Between neighbourhoods, variations in the three health outcomes were slight, and differences in health were not associated with differences in community unemployment. The associations between community unemployment and health varied according to immigration status. At the individual level, immigrants do not differ from non-immigrants with respect to the three health indicators, except that second-generation males are slightly heavier. However, when living in areas of high unemployment, immigrants tend to report poor physical and mental health in comparison to non-immigrants. Among first-generation immigrants, community unemployment was associated with psychological distress. Among second-generation immigrants, the probability of obesity and poor self-rated health increased significantly for those living in areas with high unemployment, but these associations reached statistical significance only for men. Findings among first-generation immigrants are interpreted with respect to the effects of possible discrimination in areas with low job availability. Among second-generation men, poor physical health and obesity may be the result of poor health habits stemming from perceived lack of life opportunities.
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PMID:Community unemployment and immigrants' health in Montreal. 1647 14


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