Cultural variations in emotions: a review. The psychological and anthropological literature on cultural variations in emotions is reviewed. The literature has been interpreted within the framework of a cognitive-process model of emotions. Both cross-cultural differences and similarities were identified in each phase of the emotion process; similarities in 1 phase do not necessarily imply similarities in other phases. Whether cross-cultural differences or similarities are found depends to an important degree on the level of description of the emotional phenomena. Cultural differences in emotions appear to be due to differences in event types or schemas, in culture-specific appraisal propensities, in behavior repertoires, or in regulation processes. Differences in taxonomies of emotion words sometimes reflect true emotion differences like those just mentioned, but they may also just result from differences in which emotion-process phase serves as the basis for categorization.


Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model. The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble post-traumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of a conditioned stimulus (CS), analgesia, and avoidance are reviewed with the view that these manifestations may be analogous to the PTSD symptom clusters of persistent arousal, reexperiencing, numbing, and avoidance, respectively. Finally, animal paradigms are suggested to test the validity of the model and specific hypotheses are derived from the animal literature regarding trauma variables that are predictive of particular PTSD symptom clusters.


Extraversion and vigilance performance: 30 years of inconsistencies. Deteriorating efficiency in detecting critical events is a pervasive phenomenon. It has been asserted that the personality dimension of extraversion-introversion (E-I) could serve as a selection device: Introverts would be superior in sustained attention. A meta-analysis revealed better performance of introverts, but the effect size was small because of a high incidence of inconsistencies. In a subset of the studies, the effect size was much larger: Introverts were superior in overall level of correct detections but not in maintaining efficiency over time. Inconsistent findings may partly have been caused by inappropriate use of univariate analysis of variance in repeated measures designs. The validity of some "classic" findings in the vigilance literature was questioned. The relationship of E-I to electrodermal speed of habituation was discussed. Finally, here also a trend was noted to move to new problems before solving old ones.


Emotional stress and eyewitness memory: a critical review. The eyewitness literature often claims that emotional stress leads to an impairment in memory and, hence, that details of unpleasant emotional events are remembered less accurately than details of neutral or everyday events. A common assumption behind this view is that a decrease in available processing capacity occurs at states of high emotional arousal, which, therefore, leads to less efficient memory processing. The research reviewed here shows that this belief is overly simplistic. Current studies demonstrate striking interactions between type of event, type of detail information, time of test, and type of retrieval information. This article also reviews the literature on memory for stressful events with respect to two major theories: the Yerkes-Dodson law and Easter-brook's cue-utilization hypothesis. To account for the findings from real-life studies and laboratory studies, this article discusses the possibility that emotional events receive some preferential processing mediated by factors related to early perceptual processing and late conceptual processing.


Psychological compensation: a theoretical framework. The 2 main objectives of this article are to review a variety of literatures in which the concept of compensation is used and to integrate the results of this review into a general framework of compensation. The review focuses on 4 domains of psychological inquiry: compensation for sensory handicaps, cognitive deficits, interpersonal losses, and brain injury. In the proposed framework, underlying dimensions and 4 basic steps in the progression of compensatory behavior are distinguished. The latter include origins, mechanisms, forms, and consequences. Finally, we describe ways in which researchers in particular domains can benefit from the global, process-oriented framework we propose. For most of the areas of compensation research reviewed, investigators can profit from a consideration of a broader selection of dimensions, additional steps in the process, alternative outcomes, and both objective and subjective assessment procedures.


Feeling good-doing good: a conceptual analysis of the mood at work-organizational spontaneity relationship. Five forms of organizational spontaneity are described (helping co-workers, protecting the organization, making constructive suggestions, developing oneself, and spreading goodwill). Organizational spontaneity is compared with the seemingly analogous constructs of organizational citizenship behavior and prosocial organizational behavior. Based on a selective review of the literature, a multilevel model of spontaneity is presented. Positive mood at work is a pivotal construct in the model and posited as the direct precursor of organizational spontaneity. Primary work-group characteristics, the affective tone of the primary work group, affective disposition, life event history, and contextual characteristics are proposed to have direct or indirect effects, or both, on positive mood at work. Motivational bases of organizational spontaneity also are described. The model and its implications are discussed.


Modulatory role of serotonin in neural information processing: implications for human psychopathology. Investigation of the role of 5-hydroxytryptophan (5-HT), which functions as a modulator in the central nervous system, across behavioral contexts suggests that a general principle of transmitter function may be derived that is independent of specific behaviors and specific neural loci. A functional principle of 5-HT action in neural information processing in the central nervous system is proposed. Extremes deviations in 5-HT activity result in biases in information processing that may have direct effects on behavior. Such biases may predispose to pathological conditions such as violent suicide and aggression.


Can test statistics in covariance structure analysis be trusted? Covariance structure analysis uses chi 2 goodness-of-fit test statistics whose adequacy is not known. Scientific conclusions based on models may be distorted when researchers violate sample size, variate independence, and distributional assumptions. The behavior of 6 test statistics is evaluated with a Monte Carlo confirmatory factor analysis study. The tests performed dramatically differently under 7 distributional conditions at 6 sample sizes. Two normal-theory tests worked well under some conditions but completely broke down under other conditions. A test that permits homogeneous nonzero kurtoses performed variably. A test that permits heterogeneous marginal kurtoses performed better. A distribution-free test performed spectacularly badly in all conditions at all but the largest sample sizes. The Satorra-Bentler scaled test statistic performed best overall.


How to build a baby: II. Conceptual primitives. A mechanism of perceptual analysis by which infants derive meaning from perceptual activity is described. Infants use this mechanism to redescribe perceptual information into image-schematic format. Image-schemas create conceptual structure from the spatial structure of objects and their movements, resulting in notions such as animacy, inanimacy, agency, and containment. These earliest meanings are nonpropositional, analogical representations grounded in the perceptual world of the infant. In contrast with most perceptual processing, which is not analyzed in this fashion, redescription into image-schematic format simplifies perceptual information and makes it potentially accessible for purposes of concept formation and thought. In addition to enabling preverbal thought, image-schemas provide a foundation for language acquisition by creating an interface between the continuous processes of perception and the discrete nature of language.


Origins of knowledge.

Origins of knowledge. Experiments with young infants provide evidence for early-developing capacities to represent physical objects and to reason about object motion. Early physical reasoning accords with 2 constraints at the center of mature physical conceptions: continuity and solidity. It fails to accord with 2 constraints that may be peripheral to mature conceptions: gravity and inertia. These experiments suggest that cognition develops concurrently with perception and action and that development leads to the enrichment of conceptions around an unchanging core. The experiments challenge claims that cognition develops on a foundation of perceptual or motor experience, that initial conceptions are inappropriate to the world, and that initial conceptions are abandoned or radically changed with the growth of knowledge.


How visual imagery interferes with vision. Mental visual imagery interferes with vision: the Perky (1910) effect. Is the effect optical, sensory, perceptual, attentional, or just a response bias? Acuity was measured (in undergraduates and graduates) using target lines, with and without images (of lines). Optics (fixation, pupil size, accommodation), response bias, global attention (effort; diversion of attention to imagery), perceptual assimilation (target incorporation by imagery) and perceptual masking (of target by imagery) all fail to explain the effect. Foveally, local attention plays a limited role, as the Perky effect in divided attention is half that in focused attention, but this interaction vanishes with extrafoveal targets. Images produce primarily sensory interference, mimicking a reduction in target energy.


A theory of humor elicitation.

A theory of humor elicitation. This article presents a general theory of humor elicitation that specifies the conditions in which humor is experienced in both social and nonsocial situations. The theory takes into account the interpretation of a stimulus event that is necessary to elicit humor, the difficulty of identifying the humor-eliciting features of this interpretation, and the cognitive elaboration of implications of the event. The influence of these factors is postulated to depend on subjects' information-processing objectives at the time a stimulus event occurs. The theory is used to conceptualize the humor elicited by jokes, witticisms, and social events that are neither intended nor expected to be humorous. Particular attention is given to the cognitive underpinnings of responses to ethnic humor and to the humor that is elicited by one's own behavior in social situations.


The four elementary forms of sociality: framework for a unified theory of social relations. The motivation, planning, production, comprehension, coordination, and evaluation of human social life may be based largely on combinations of 4 psychological models. In communal sharing, people treat all members of a category as equivalent. In authority ranking, people attend to their positions in a linear ordering. In equality matching, people keep track of the imbalances among them. In market pricing, people orient to ratio values. Cultures use different rules to implement the 4 models. In addition to an array of inductive evidence from many cultures and approaches, the theory has been supported by ethnographic field work and 19 experimental studies using 7 different methods testing 6 different cognitive predictions on a wide range of subjects from 5 cultures.


Development of an instrument to assess learning strategies. Items to measure learning strategies were extracted from students' written narratives about their study and learning habits. A resulting 79-item instrument was administered to 321 graduate and undergraduate students. From factor analysis of the correlation matrix four factors were identified: (I) reflective metacognition, (II) procedural metacognition, (III) rote memorization, and (IV) procrastination. There were significant positive correlations between GPA and Factors I and II and a significant negative correlation between Factor IV and GPA.


Value of the Mini-Mental State Examination and informants' data for the detection of dementia in geriatric outpatients. The Dutch version of the Mini-Mental State Examination was administered to 138 elderly patients who were referred to a geriatric outpatient clinic for a variety of reasons. An optimal cut-off point of 24/25 was found for the detection of dementia. At this cut-off point, the Mini-Mental State Examination was 87.6% sensitive and 81.6% specific in detecting dementia. The discriminative validity was influenced by education and by the presence of psychiatric disorders other than dementia. Informants' data showed better sensitivity and specificity than the Mini-Mental State Examination for the detection of dementia. The findings suggest that informants' data are a primary source of information for the detection of dementia in geriatric outpatients.


Fantasizers and dissociaters: data on two distinct subgroups of deep trance subjects. This study delineated two subgroups of highly hypnotizable subjects. The first (n = 19) entered trance rapidly, scored high on absorption, and described hypnosis as much like their rich and vivid waking fantasy life. The second subgroup of 15 took time to achieve a deep trance, saw hypnosis as very different from any prior experiences, and were more likely to exhibit amnesia for both hypnotic experience and waking fantasies.


Correlations of memory and learning with vision in aged patients before and after a cataract operation. The connection between memory and learning with vision was investigated by studying 100 cataract operation patients, aged 71 to 76 years, 25 of them being men and 75 women. The cataract operation restored sufficient acuity of vision for reading (minimum E-test value 0.40) to 79% of the subjects. Short-term memory was studied with series of numbers, homogenic and heterogenic inhibition, and long sentences. Learning was tested with paired-associate learning and word learning. Psychological symptoms were measured on the Brief Psychiatric Rating Scale and personality on the Mini-Mult MMPI. Memory and learning improved significantly when vision was normalized after the cataract operation. Poor memory and learning scores correlated with monocular vision before the operation and with defects in the field of vision, due to glaucoma and exceeding 20%, postsurgery. Monocular vision and defects in the visual field caused a continuous sense of abnormalness, which impaired old people's ability to concentrate on tasks of memory and learning. Cerebrovascular disturbances, beginning dementia, and moderate psychological symptoms obstructed memory and learning on both test rounds. Depression was the most important psychological symptom contributing to poor memory and learning scores after the cataract operation. The memory and learning defects mainly reflected disturbances in memorizing.


Role of personality characteristics in coping behaviors. The relations between coping behaviors and personality characteristics (introversion/extroversion) were examined in 176 Japanese female college students. Multiple regression analysis indicated that extrovertive individuals more often used not only seeking social support but also avoidance than did introvertive subjects. An implication for further research would be to analyze the interactions between personality influences and situational factors in coping behaviors.


Imaginal, sensory, and cognitive experience in spontaneous recovery from alcoholism. Although alcoholism is often regarded as an intractable disorder that requires intensive treatment, studies of the natural history of alcoholism indicate that unaided, spontaneous recovery may be the most common pathway to remission from alcoholism. Negative environmental consequences of alcoholic drinking have been invoked to explain spontaneous recovery, but a more compelling reason for sudden changes in drinking behavior concerns shifts in the personal meanings surrounding alcohol use. Extensive interviews in a multimodal format were conducted with two groups of alcoholics: one group comprised of 7 subjects who spontaneously recovered without treatment and the other group comprised of 9 people who believed formal treatment was necessary to abstain from drinking. Spontaneously recovered alcoholics reported experiencing vivid sensations and images at the time they decided to quit drinking, and they reported subsequent transformations of their personal identities. Active alcoholics reported no comparable experiences in imaginal, sensory, and cognitive modalities. Implications of the results for current alcoholism treatments are discussed.


Relationship between MCMI-II scales and normal personality traits. We correlated MCMI-II and 16 PF profiles of 145 couples in outpatient marital therapy and noted significant associations between these tests that were consistently and logically related to constructs which underlie the meaning of the MCMI-II scales. This provided good concurrent validity for both the Personality and Clinical Scales of the MCMI-II. These results add credence to research designed to study Millon's basic styles in normal populations.


Bipolar depression as the prelude to schizoaffective disorder. Contending that the mind of a creative person is often characterized by thin boundaries between the ego and the unconscious, this paper proposes how, on the manic side of bipolar depression, a creative ego may temporarily make great strides in intellectuality and creativity. However, as this process proceeds, a creative ego may lose its boundaries with the unconscious, and a schizoaffective disorder may emerge.


International comparisons: selected mental health data. The data set from the Organization for Economic Cooperation and Development (OECD) was explored to investigate the relationship of gross domestic product (which provides an indication of the wealth of a country) and the provision of psychiatric services (specifically inpatient psychiatric services) in selected OECD countries. Gross domestic product per capita correlated .84 with expenditure per capita on psychiatric hospitals but r was zero between number of beds per 1000 population and length of stay.


Gender and sex-role differences in young adult reactions towards "newborns" in a pretend situation. 104 college students were asked to fill out a questionnaire on sex-role orientation, act out a scene as a parent with a newborn baby (doll), rate their attitudes toward the baby using a semantic differential scale of 19 adjective pairs, and write an open-ended statement about the baby's future. Analysis indicated few differences in how men and women reacted to or described boy and girl babies and most of the variability in scores could be accounted for by interactions involving sex-role orientation. Sex-stereotyped women typically gave ratings similar to those given by androgynous women while sex-stereotyped men, when they differed from androgynous men, generally gave less positive ratings.


Extended normative data for the Logical Memory subtests of the Wechsler Memory Scale--Revised: responses from a sample of cognitively intact elderly medical patients. 66 cognitively intact geriatric medical patients (ages 70 to 99; M = 77 yr.) were given the Logical Memory subtests of the Wechsler Memory Scale--Revised to extend normative data. 43 women and 23 men, 35 white and 31 black persons made up this urban geriatric sample. A review of patients' medical histories and Mattis' Dementia Rating scores of 129 or greater were used to ensure a sample of cognitively intact patients. Analyses showed that Logical Memory scores were uncorrelated with education, race, sex, or age.


Grouping of children's helping behaviour. 215 school children aged 9 to 12 yr. were grouped according to their helping behaviour. The following variables were measured: helping, empathy, altruism, morality, attribution of responsibility, cognitive readiness to help, willingness to help, social desirability, and abstract thinking. In a factor analysis age and sex were included. Five factors were extracted and interpreted: empathetic helping, socially desirable helping, cognitive helping, intentionality, and rational helping. According to grouping analysis these five factors were weighted differently, and three groups were identified, (1) real helpers with high empathy, altruism, morality, and cognitive readiness to help, (2) normative helpers, motivated by social desirability or cognitive factors with poor empathy level, and (3) cognitively premature, rational helpers with poor empathy and with weak social desirability.


Capital punishment in Texas: comparison of some factors shared by 50 convicted murderers and their victims. The mean age of 50 convicted murderers at time of execution was compared to the mean age of their victims at time of death. The mean ages compared were not significantly different.


Depression, self-esteem, suicide ideation, death anxiety, and GPA in high school students of divorced and nondivorced parents. 131 subjects from a small north central Kansas high school participated and completed the Beck Depression Scale, Coopersmith Self-esteem Inventory short form with the Lie scale included, the Death Anxiety Scale, and the first 11 questions of the Beck Scale of Suicide Ideation. Background information collected from each subject included age, grade, marital status of parents, and sex. Grade point averages (on a 4-point scale) were taken from the students' files. On death anxiety girls had a significantly higher mean than boys while freshmen's and sophomores' scores were significantly higher than those of juniors and seniors but there was no difference between means of students of divorced and nondivorced parents. On self-esteem and GPA children of divorced parents scored significantly lower than children of nondivorced parents, but there was no difference between the sexes on self-esteem. On GPA girls scored significantly higher than boys. On depression the children of divorced parents scored higher than children of nondivorced parents but there was no sex difference.


University students' perceptions of deaf parents. A methodology for assessing attitudes toward nontraditional parents was developed. 54 university students with a mean age of 26.5 yr. (SD = 10.2 yr.) participated in a study which assessed attitudes toward deaf parents by asking subjects to rate the adoptive suitability of an unmarried applicant based on a scenario describing the individual as a deaf woman, deaf man, hearing woman, or hearing man. Women were perceived as more suitable to adopt daughters, and men were perceived as more suitable to adopt sons. Applicants' hearing status and gender influenced perceived suitability to adopt a son but not a daughter.


Development and testing of the AIDS Psychosocial Scale. The dramatic spread of AIDS globally has placed it high on the world health agenda. Since no medical or technological solution to the problem is near at hand and given the fact that the HIV virus is heavily reliant on human sexual behaviours for transmission, tackling the problem of AIDS rests on addressing change of sexual behaviour. Various psychosocial factors have been implicated as mediating between adequate knowledge and behaviour change, given the poor correlation between the two variables. The present study was aimed at developing and testing a scale to measure various psychosocial factors, including self-concept, defenses of denial, repression and rationalisation, peer pressure, and perceived empowerment expressed in locus of control and self-efficacy. Two studies are reported in which students at the University of the Western Cape, South Africa participated. Various statistical analyses in the two phases indicated that the AIDS Psychosocial Scale was sufficiently reliable and valid for use in examining psychosocial mediation in the AIDS area.


Crisis calls and lunar cycles: a twenty-year review. 12 studies are reviewed that have examined the relationships among crisis calls to police stations, poison centers, and crisis intervention centers and the synodic lunar cycle. On the basis of the studies considered it is concluded that no good foundation exists for the belief that lunar phase is related to the frequency of crisis calls. In addition, there is no evidence whatsoever for the contention that calls of a more emotional or "out-of-control" nature occur more often at the full moon.


Suicide and lunar cycles: a critical review over 28 years. 20 studies which have examined the relations between completed suicide or attempted suicide and suicide threats with the synodic lunar cycle are reviewed. Most studies indicated no relation between lunar phase and the measures of suicide. The positive findings conflicted, have not been replicated, or were confounded with variables such as season, weekday, weather, or holidays. It is concluded that there is insufficient evidence for assuming a relationship between the synodic lunar cycle and completed or attempted suicide.


The Bem Sex-role Inventory as an index of response tendencies to scales in Likert format. 7 women, classified as Masculine on the basis of their scores on the Bem Sex-role Inventory, tended to use the extreme values of agree strongly and disagree strongly on the Likert format associated with the East-West Questionnaire more frequently than did women classified as Feminine, Androgynous, or Undifferentiated (ns = 39, 31, and 21, respectively). The Undifferentiated women were inclined to use the moderate response alternatives. The 73 men used the no opinion response option significantly more than did the 98 women. These findings suggest that strength of beliefs as measured on scales in Likert format may be an index of sex-role preference.


Narcissism and object relations.

Narcissism and object relations. Questionnaire measures of the narcissistic personality disorder can predict healthy and unhealthy self-functioning. That this outcome might support Heinz Kohut's psychoanalytic psychology of the self was tested in a sample of 354 undergraduates. In canonical correlations, factors from the Narcissistic Personality Inventory were associated more strongly with grandiose than with idealizing immaturities in Kohut's bipolar self, while difficulties in interpersonal relationships (i.e., poor object relations) were associated more strongly with idealizing deficits. Zero-order and partial correlational data were congruent with Kohut's hypothesis that self-grandiosity can include elements of both "pathology" and relative mental health, but canonical correlations did not support Kohut's claim that narcissism can be described in a bidimensional self-structure.


College vs junior high school students' knowledge of alcohol as a teratogen. This study assessed knowledge possessed by male and female junior high school and college students (N = 422) about the teratogenic effects of alcohol. Although most students were aware that alcohol is a teratogenic substance, they demonstrated little knowledge of the nature and timing of possible specific negative effects.


Contributions to the history of psychology: XC. Evolutionary biology and heritable traits (with reference to oriental-white-black differences): the 1989 AAAS paper. Genetic distance estimates calculated from DNA sequencing indicate that in years since emergence from the ancestral hominid line, Mongoloids = 41,000, Caucasoids = 110,000, and Negroids = 200,000. Data also show that this succession is matched by numerous other differences such that Mongoloids > Caucasoids > Negroids in brain size and intelligence (cranial capacity = 1448, 1408, 1334 cm3; brain weight = 1351, 1336, 1286 gm.; millions of excess neurons = 8900, 8650, 8550; IQ = 107, 100, 85); maturational delay (age to walk alone, age of first intercourse, age of death); sexual restraint (ovulation rate, intercourse frequencies, sexually transmitted diseases including AIDS); quiescent temperament (aggressiveness, anxiety, sociability); and social organization (law abidingness, marital stability, mental health). This pattern is ordered by a theory of r/K reproductive strategies in which Mongoloids are posited to be more K-selected than Caucasoids and especially more than Negroids. (K-selected reproductive strategies emphasize parental care and are to be contrasted with r-selected strategies which emphasize fecundity, the bioenergetic trade-off between which is postulated to underlie cross-species differences in brain size, speed of maturation, reproductive effort, and longevity.) It is suggested that this pattern came about because the ice ages exerted greater selection pressures on the later emerging populations to produce larger brains, longer lives, and more K-like behavior. One theoretical possibility is that evolution is progressive and that some populations are more "advanced" than others. Predictions are made concerning economic projections and the spread of AIDS.


Meaning of craving in research on addiction. The meaning of the word craving varies as illustrated by Kozlowski and Wilkinson's reports of ambiguities in use amongst cigarette smokers. We extended this line of investigation to problem drinkers who sought a goal of controlled drinking versus abstinence, to professionals involved in the addictions area, and to university students. Significant differences in meaning were noted particularly among the problem drinkers (N = 256 between 17 and 60 years of age). Reasons for this are offered.


Chaos, an omen of transcendence in the psychotherapeutic process. Here some of the basic ideas assembled under the recently coined term chaos theory are applied to the process of psychotherapy. Utilizing some ideas from chaos theory, "chaos" is defined in psychological terms as a state of overwhelming anxiety and is interpreted as the first indication of potential psychological growth. The concepts of Analytical Psychology and the modality of sandtray therapy are used to illustrate the type of therapeutic approach this theoretical work proposes in the transcendent cycle. Psychotherapy simply facilitates a transformation, wherein clients are guided through the chaos they are experiencing so that they may grow beyond their current psychological limitations.


Suicide, homicide and unemployment: a methodological note. In multiple regression analyses, the monthly time-series suicide and homicide rates for the USA from 1957-1986 were associated with unemployment and marriage rates. In contrast, annual time-series suicide and homicide rates were not as strongly associated with the social variables.


Ability and personality correlates of children's attitudes and aspirations. This study examined to what extent personality types are related to children's attitudes and aspirations after taking into account relationships between ability and the attitude and aspiration measures. Data were collected from 500 12-yr.-old Australian children. In the analysis the children were classified into four personality groups who were labeled as extravert-adjusted, extravert-anxious, introvert-adjusted, and introvert-anxious. The findings suggest the general proposition that children's personality types have strong associations with school-related attitudes after taking into account associations between children's intellectual ability and their attitudes. In contrast, children's personalities tended not to be related to measures of educational and occupational aspirations.


Role reward and role stress in managerial and professional women. The importance of balancing personal and work demands has become increasingly relevant in recent years as large numbers of women move into the labour market full time. The present study was designed to examine differences in role rewards and stress amongst a group of 163 managerial and professional women. Subjects completed a questionnaire about the stress and rewards associated with their work and family roles. Although no significant differences were found between managerial and professional women, the mean scores indicated the role of employee is both the most rewarding and the most stressful. Findings are discussed in terms of sample occupation and changing home-work patterns.


Problem-solving appraisal in the association of life stress and depression: a South African study. This study focuses on the role that appraisal of problem-solving skills plays in the relationship of stress to distress. 450 black South African university students completed the Life Experiences Survey, the Problem Solving Inventory, and the Centre for Epidemiological Studies Depression Scale. Multiple regression analysis indicated a direct effect for problem-solving appraisal on depression, but no support could be found for the stress-buffering effects of problem-solving appraisal.


A short form of the Wechsler Preschool and Primary Scale of Intelligence for use in Iran. Data from the standardization of the Wechsler Preschool and Primary Scale of Intelligence in Shiraz, Iran (193 girls, 203 boys 4 to 6.5 yr. old) were used to develop a short form. Four subtests (Vocabulary, Arithmetic, Picture Completion, and Block Design) were selected on the basis of their high correlations with Full Scale IQs. The validity coefficients were high and significant. The standard errors for the short form were 4.0 to 6.0 points. The short form classified correctly about 73% of the subjects by category of intelligence but tended to underestimate the IQs of subjects of high intelligence and to overestimate the IQs of subjects with low intelligence. Further work is required.


Relationship between the Millon Clinical Multiaxial Inventory and the Millon-II: value of scales for Aggressive and Self-defeating personalities in Posttraumatic Stress Disorder. This study addressed two issues, the interrelationship between the Millon Clinical Multiaxial Inventory (MCMI) and the Millon II (MCMI-II) and the value of the new personality scales, Aggressive and Self-defeating, in a sample with diagnoses of combat-related Posttraumatic Stress Disorder. 100 confirmed cases of combat-related Posttraumatic Stress Disorder were given a battery of measures including both Millon inventories and the Minnesota Multiphasic Personality Inventory (basic scales and selected subscales). They were rated on discharge status during a structured treatment program. Basic treatment and background information were also obtained. Analysis showed scores on the MCMI-II scales were higher but generally reflective of MCMI scales and that the Self-defeating personality style tends to be reflective of greater psychopathology, suicidal problems, treatment/disposition difficulties, overreporting of symptoms, and intensity of problems. Discussion encouraged the use of the MCMI-II with special emphasis given to the Self-defeating style in this group with Posttraumatic Stress Disorder.


Self-esteem, anxiety, and drug use.

Self-esteem, anxiety, and drug use. This pilot study evaluated the relationship between self-esteem, anxiety, and drug use in a nonclinical sample of 30 men, ages 16 to 43 years, who completed and returned inventories on self-esteem, trait anxiety, and drug use which they had received by mail. Analysis showed a significant negative correlation between self-esteem and drug use and a significant positive correlation between trait anxiety and drug use. Also, a significant negative correlation was found between self-esteem and trait anxiety. Implications are discussed.


Depression, self-esteem, suicide ideation, and GPAs of high school students at risk. 131 subjects completed the Beck Depression Inventory, Coopersmith's Self-esteem Inventory--Short Form, the first 11 questions of the Beck Scale of Suicide Ideation, and gave some background information. The students receiving free or reduced-cost lunches scored lower on self-esteem, while students who had been absent more than 15 times scored higher on depression and suicide ideation and had lower GPAs than students who were not absent as often but had similar scores on self-esteem. Students who were below the 25th percentile on the SRA Composite score had lower GPAs. 9 students in special education in Learning Disabilities and Behavioral Disordered categories had scores similar to those of 121 regular education students on depression, self-esteem, suicide ideation, and GPA. Indicators for children at-risk provide clues about how children think about themselves, others, and the world in which they live.


Self-perception of asthmatic children and modification through self-management programmes. To examine the influence of asthma on patients' self-perceptions, 48 children with light to moderate asthma and 41 healthy children were selected to complete Harter's Self-perception Profile for children. No differences between the groups were observed. Then, to assess the effects of a psychological asthma treatment programme on self-perception, 27 of the asthmatic children were selected and allocated to three groups of 9 patients. The first of these groups received an asthma self-management programme, the second received that programme plus training in progressive relaxation, and the third (as control) only standard pharmacological treatment. Immediately after intervention and at 6- and 12-mo. follow-ups subjects again completed Harter's profile on which no significant changes were observed.


Does spousal participation in Gamblers Anonymous benefit compulsive gamblers? Extent of gambling-free periods was compared for 90 compulsive gamblers, 44 with spouses who participated in Gamblers Anonymous and 46 with spouses who did not. Although the results were in the direction of a beneficial effect of spousal participation, the relationship was statistically nonsignificant.


Use of formal assessments among providers of residential services for the seriously mentally ill. A survey of use of formal scales in assessment was sent to 1381 agencies that provide residential services to the seriously mentally ill. 271 residential agencies responded. A majority of respondents who used formal assessments used in-house measures. Scales were used most often in client care decisions. A substantial minority of respondents reported being somewhat or very dissatisfied with existing scales. Lack of predictive ability and staff time required were the most frequently cited difficulties. The study indicates a need for better assessments to aid client-care planning, and promote interagency communication.


Birth order, neuroticism, and psychoticism among Iranian children. To investigate the effects of birth order, parents' education, and parents' occupation on four dimensions of the Junior Eysenck Personality Questionnaire, 262 elementary school students (100 boys and 162 girls) were selected randomly from four elementary schools in Shiraz. Analyses showed the main effects of birth order were significant on Neuroticism and Lie scales. Further, the effects of mothers' occupation on the Lie scale and fathers' education on the Neuroticism scale were significant.


Psychological development in men: generativity and involvement with young children. The personality development of 50 white men was investigated in terms of Eriksonian generativity and involvement with young children. Generativity was not related to caregiving; however, it was associated with social involvement. Generativity was also associated with several aspects of male personality including self-esteem, locus of control, and instrumentality.


Sex differences in depression of Iranian adolescents. The purpose of this study was to investigate sex differences on a depression scale for Iranian adolescents. High school students (100 girls and 100 boys), selected randomly from four high schools in Shiraz, completed the Zung Self-rating Depression Scale. Analysis showed no significant differences on the five subscales of Zung's depression scale for boys and for girls. Also, there were no sex differences on the total score for depression. However, comparisons with Byrne's groups of British boys and girls indicated differences for Iranian boys and girls on 2 individual items reached significance, whereas for the British groups differences were significant for 11 of the 20 items.


Psychiatric and alcoholic admissions do not occur disproportionately close to patients' birthdays. The relationship between admission dates and patients' birthdays was examined for 200 psychiatric and 200 alcoholic patients from a Veterans Affairs Medical Center. Chi-squared analyses indicated that admission dates for subjects of both populations did not occur disproportionately close to their birthdays.


Relation of parental education and life status to academic achievement by Xhosa children. This study investigated the relationship between parental education and academic achievement of 1021 Xhosa pupils (369 boys and 652 girls) whose ages ranged from 13 to 17 years (M age, 15.6 yr.). The sample included 712 children for whom both parents were alive and 308 children for whom either or both parents were deceased. Children were chosen at random from the Standard 7/Year 9 population of Transkei, South Africa. A simple questionnaire was administered students to identify whether one or both parents were dead or both parents were living. A second questionnaire was administered parents or parent surrogates to obtain their formal education. The marks obtained by the pupils in the Standard 7 external examination conducted by the Department of Education of the Government of Transkei in seven subject areas were aggregated as the criterion measure. Analysis of variance showed significant effects of parental education on academic achievement of children regardless of whether the children's parents were deceased or alive.


Feminism and anorectic tendencies in college women. Anorexia is a debilitating disorder which affects significant numbers of young women. Brumberg has suggested a causal relationship in young women between feminism and anorexia. In this study, traditional-aged female college students completed the Attitudes Toward Women Scale and the Eating Attitudes Test. The hypothesized relationship between feminism and anorexia was not found.


Artistic orientation as a clinical indicator of chronic career indecision in adult children and grandchildren of alcoholics. This study has empirically assessed whether artistic orientation and avoidance are good predictors of chronic career indecision for college-attending adult children and grandchildren of alcoholics. The sample consisted of 143 freshman and sophomore introductory psychology students attending a county college in the northeast. Osipow's Career Decision Scale total scores of artistically oriented children and grandchildren of alcoholics were not significantly higher than scores of those who were not artistic. As predicted, the Career Decision Scale total scores of avoidant subjects were significantly higher than those of nonavoidant subjects. As expected in both instances, no differences were found between artistic subjects and nonartistic subjects or between the avoidant and nonavoidant subjects. The findings suggest (1) that the artistic career-undecided children of alcoholics observed by Schumrum and Hartman in 1988 were, in fact, members of a broader avoidant group and (2) that the relationship between career indecision and avoidant personality style does vary according to family status of whether subjects are adult children and grandchildren of alcoholics.


Positive and negative social support in a chronic illness. A measure of social support was developed and administered to 207 patients with chronic fatigue syndrome. Positive social support was related to anxiety, and negative social support was related to both anxiety and depression.


Gender differences in the personality features of British managers. In this study were examined the personality profiles of 132 British managers from the civil services, using the 16 PF. The data were compared to norms for the British adult population. The results suggested that managers scored higher on traits associated with intelligence, dominance, confidence, and extroversion. This pattern did not differ as a function of gender. Gender differences apparent in the general population were hardly evident among managers. Finally, the strength of traits associated with management increased as a function of the managerial grade. Yet this pattern was more distinct among men than women.


Interaction of instructions with the recall strategy actually used in a paired-associates learning task. Previous research suggests that interactive imagery produces memory performance superior to separation imagery, although the effects of instructions are less clear. Paired-associate learning was used to examine the effects of instructions (general memory, separation imagery, and interactive imagery) on recall, the frequency of using memory strategies (nonimaginal, separate image, and interactive image), and strategies' effectiveness. The numbers of correctly recalled items were fewer for subjects given general memory instructions than for subjects given separation or interactive imagery instructions which were not different from each other. Subjects reported using a variety of strategies. However, subjects given separation imagery instructions were more likely to report an interactive image than a separate image, and equally as likely to use interactive imagery as subjects given interactive imagery instructions. The present data suggest that subjects can effectively use a variety of memory strategies.


Using humor in psychotherapy with a sex offender. Humor was used during psychotherapy with a 22-year-old child molester. The humor appeared to help establish rapport and led to his admission of desires to rape and torture adult women. Here exchange of humor seemed to be a helpful adjunct to psychotherapy.


Hemisphericity style and belief in ESP.

Hemisphericity style and belief in ESP. 108 students were classified as preferring either a style of left or right hemisphericity using Zenhausern's Preference Questionnaire. The students then completed two scales designed to measure belief in extrasensory perception (ESP). Students who scored as preferring a right style scored higher on belief in ESP than those who preferred a left style. The results are consistent with previous findings which suggest a connection between right hemisphere functions (e.g., imagery) and belief in ESP.


An experimental analysis of classically conditioned nausea during cancer chemotherapy. This study investigated classical conditioning in women undergoing outpatient adjuvant chemotherapy for breast cancer. Breast cancer chemotherapy outpatients were randomly assigned either to an Experimental Group (exposed to a distinctive stimulus before each infusion of chemotherapy) or to a Control Group. After repeated infusions of chemotherapy, patients' responses to the experimental stimulus were assessed in a location not associated with chemotherapy. Experimental Group patients had increased nausea (self-reported on a visual analog scale) following the presentation of the experimental stimulus at this test trial, whereas Control Group patients did not. Two other measures of nausea corroborated these results. Post hoc statistical analyses confirmed predictions based on conditioning theory. This conditioning model of anticipatory nausea bears witness to the relevance of classical conditioning in clinical medicine.


Consistent sex differences in cortisol responses to psychological stress. In four independent studies, sex differences in cortisol responses to psychological stress were investigated in healthy adolescents and adults (total n = 153). Public speaking and mental arithmetic in front of an audience (Studies 1-3) reliably induced increases in free cortisol levels in both sexes with 2- to 4-fold increases above baseline levels. Mean cortisol responses were 1.5- to 2-fold higher in men compared with women. In Study 3, cortisol profiles were additionally investigated after human corticotropin-releasing hormone (h-CRH) and bicycle ergometry until exhaustion. Here, both sexes showed very similar adrenocortical responses. Furthermore, men showed elevated cortisol levels in anticipation of the psychological stress situation without actually having to perform the tasks (Study 4). Under this condition cortisol concentration was unchanged or decreased in women. From these data we conclude that the observed sex difference does not reflect an overall lower responsiveness of the female adrenal cortex. Although these studies do not provide conclusive data, we suggest sex differences in cognitive and/or emotional responses to distressing psychosocial situations which in turn may influence cortisol secretion.


Medical and psychiatric symptoms in women with childhood sexual abuse. Although there is increasing awareness of the short-term psychological and social adaptations to childhood sexual abuse, little is known about the long-term effects of such abuse, particularly its effect on subsequent medical utilization and the experience and reporting of physical symptoms. We re-analyzed data from a previous study of 100 women scheduled for diagnostic laparoscopy (50 for chronic pain, 50 for tubal ligation or infertility evaluation) who received structured, physician-administered psychiatric and sexual abuse interviews. Women were regrouped by severity of childhood sexual abuse, and we compared the groups with respect to lifetime psychiatric diagnoses and medically unexplained symptom patterns. Unadjusted odds ratios showed that risk for lifetime diagnoses of major depression, panic disorder, phobia, somatization disorder and drug abuse, and current diagnoses of major depression and somatoform pain disorder were significantly higher in the severely abused group compared with women with no abuse or less severe abuse. Logistic regression analysis demonstrated that number of somatization symptoms, lifetime panic disorder and drug dependence were predictive of a prior history of severe childhood sexual abuse. Psychiatric disorders and medical symptoms, particularly chronic pelvic pain, are common in women with histories of severe childhood sexual abuse. Clinicians should inquire about childhood sexual and physical abuse experiences in patients with multiple medical and psychiatric symptoms, particularly patients with chronic pelvic pain.


The concept of psychosomatic disorder.

The concept of psychosomatic disorder. The clinical concepts related to the assessment of psychosocial factors in the medically ill are reviewed, with particular reference to the DSM-III-R categories of adjustment disorders, psychological factors affecting physical conditions, and somatoform disorders. The clinical and heuristic value of the concepts of psychosomatic disorder and abnormal illness behavior is underscored.


Lymphocyte subset and cellular immune responses to a brief experimental stressor. To evaluate effects of acute mental stress on aspects of cellular immunity, lymphocyte populations and phytohemagglutinin (PHA)-stimulated T-cell mitogenesis were measured in 33 healthy young men, both before and immediately following subjects' performance of a frustrating, 21-minute laboratory task (Stroop test). Relative to baseline evaluations, post-task measurements showed a significant reduction in mitogenesis and alterations in various circulating lymphocyte populations; the latter included a diminished T-helper/T-suppressor cell ratio and an elevation in the number of natural killer cells. Eleven subjects assigned to a control (unstressed) condition exhibited no changes in lymphocyte populations, but did show an increase in T-cell proliferation, compared with pretask measurements.


Psychopharmacological agents in physical disorders. Psychotropic drugs act on multiple organ systems, but their intended action is related to their effect on neurohormones and receptors in the limbic area of the brain. These drugs are also employed with benefit in a number of diverse physical disorders including immunological (arthritis), gastrointestinal (peptic ulcer, ulcerative colitis), neurological (epilepsy), and hematological (leukopenia) conditions. While their clinical efficacy enhances our armamentarium to treat these disorders, understanding their mode of action in treating the physically ill patients may yield the missing link between the psyche and the soma.


Eating habits and eating disorders during pregnancy. A general population sample of 100 primigravid women was studied prospectively to describe the changes in eating that occur in pregnancy with particular reference to cravings and aversions and the behavior and attitudes characteristic of clinical eating disorders. Assessment was by standardized interview. Dietary cravings and aversions were found to be common and largely confined to early pregnancy. Eating disorder features decreased in severity early in pregnancy but increased later on. Dietary cravings rarely resulted in episodes of overeating like those seen in patients with eating disorders. In this study of a general population sample, no evidence was found of a relationship between pregnancy outcome and the severity of eating disorder features prior to pregnancy.


Do cardiovascular responses to laboratory stress relate to ambulatory blood pressure levels?: Yes, in some of the people, some of the time. Because the correspondence between laboratory measures of blood pressure and heart rate responses to stress and ambulatory measures is less than optimal, this study tested two hypotheses: Are ambulatory measures of blood pressure elevated during periods of perceived stress, relative to no stress? Are ambulatory blood pressures elevated during perceived stress among those individuals who exhibit elevated blood pressure and heart rate responses to laboratory stress? These questions were addressed in a sample of employed, middle-aged men and premenopausal and postmenopausal women, who vary in reproductive hormone status, and in risk for coronary heart disease. All participants performed a series of laboratory studies while their physiological parameters were monitored and then wore an ambulatory blood pressure monitor for a day and a half. This monitor recorded blood pressure every half hour during the waking hours and at the same time the participants assessed their mood states. After excluding participants who reported no variability in stress levels, those who were cardiovascular reactors to a laboratory speech task exhibited elevated ambulatory blood pressure levels during periods of perceived stress. Furthermore, in general, periods of perceived stress were associated on a within subject basis with elevated ambulatory blood pressure. These results suggest that the correspondence between laboratory and field measures of blood pressure would be improved by taking into account the environmental circumstances during the ambulatory assessments and the person characteristics of reactor-nonreactor to laboratory stress.


Repressive coping and blood lipids in men and women. Studies have suggested that a repressive coping style, characterized by defensiveness against negative emotions, may be related to several adverse health outcomes. This study examined whether repressive coping is associated with blood lipids, and whether this association is influenced by age or sex. One hundred fourteen healthy adults completed the Marlowe-Crowne scale (MC) and the Bendig version of the Taylor Manifest Anxiety scale (TMAS) prior to having their blood drawn after an overnight fast. Hierarchical regression analyses showed a significant interaction of sex, MC, and TMAS on total cholesterol (F(1, 104) = 4.41, p < 0.05), after controlling for the influence of age, body mass index, and other main effects and interactions. Results showed that male repressors (high MC; low TMAS) had the highest cholesterol levels, while truly low anxious males (low MC; low TMAS) had the lowest levels. The opposite pattern was noted for women. There were no interactive effects of age and coping style on lipids. The results suggest that males who repress negative emotions may be at greater risk for atherosclerotic diseases.


The multi-dimensional nature of active coping: differential effects of effort and enhanced control on cardiovascular reactivity. Some studies show that enhanced control increases cardiovascular reactivity; other studies show decreases. This disparity may be due to a confound: enhanced control may reduce reactivity, but effort accompanying active coping may increase it. The present study was designed to vary level of control and availability of active coping responses, while maintaining effort constant. Sixty female undergraduates performed word-search puzzles while blood pressure and heart rate were monitored. They were divided into three groups: In condition 1, reinforcement was contingent on the subjects' performance only; in conditions 2 and 3, reinforcement was contingent on the joint performance of the subject and a poorly performing confederate. In condition 2, subjects could help their partners (active coping); in condition 3, they could not (passive coping). Effort was constant across groups. Cardiovascular responses were significantly greater in the passive coping condition than in the other two, indicating that with effort held constant, enhanced control diminishes reactivity.


Role of early developmental factors in susceptibility to disease. Early developmental factors implicated in subsequent infant and child development are presented. The orientation adopted emphasizes both the interplay between constitutional and environmental factors and the mutual interaction between the child and its environment. The present paper concentrates on pre- and perinatal factors and maternal psychopathology affecting mainly the early mother-child interaction and, in turn, child developmental outcome.


Factor analysis of the Toronto Alexithymia Scale: elucidation of a polythetic construct. The Toronto Alexithymia Scale (TAS) offers a reliable method to measure alexithymia, a personality construct describing individuals endorsing the inability to identify and report emotions, processing a minimal fantasy life, utilizing an analytic cognitive style, and tending to somatize. Utilizing four cohorts of both patients and controls, a three-factor solution emerged from a principal-components analysis utilizing a varimax rotation. The factors of inability to identify and report feelings, an analytic cognitive style, and paucity of fantasy life were independent and internally reliable. These data are reviewed in the context of previous research and offer three subscales for future investigations utilizing the Toronto Alexithymia Scale.


Chronic idiopathic pain, mianserin and 'masked' depression. In this study an attempt was made to provide controlled empirical evidence for the hypothesis that chronic idiopathic pain might be a specific form of 'masked depression'. For this purpose, chronic pain patients supposed to be suffering from a 'masked depression' were compared to patients with organic pain and coexistent depression, patients with only organic pain, and patients with only depression, in a double-blind placebo-controlled therapeutic trial with mianserin. Although mianserin appeared to have effective antidepressant properties in this study, no pain improvement was found in any of the three chronic pain groups. These results challenge the validity and clinical relevance of the 'masked depression' concept for chronic idiopathic pain.


Strengthening the public health system.

Strengthening the public health system. Although the American public health system has made major contributions to life expectancy for residents of this country over the past century, the system now faces more complex health problems that require comprehensive approaches and increased capacity, particularly in local and State public health agencies. To strengthen the public health system, concerted action is needed to meet these five critical needs: First, the knowledge base of public health workers needs to be supplemented through on-the-job training and continuing education programs. To this end, self-study courses will be expanded, and a network of regional training centers will be established throughout the country. Second, communities need dynamic leadership from public health officials and their agencies. To enhance leadership skills and expand the leadership role of public health agencies, focused personal leadership development activities, including a Public Health Leadership Institute, and national conferences will provide a vision of the future role of public health agencies. Third, local and State public health agencies need access to data on the current health status of the people in their communities and guidance from the nation's public health experts. To improve access to information resources, state-of-the-art technologies will be deployed to create integrated information and communication systems linking all components of the public health system. Fourth, local and State agencies need disease prevention and health promotion plans that target problems and develop strategies and the capacity to address them. To provide communities with structured approaches to this process, planning tools have been developed and distributed, and technical assistance will be provided to local and State health agencies to involve each community in planning,priority setting, and constituency building.Finally, public health agencies need adequate resources to fund prevention programs. To improve the use of existing Federal support and enhance the availability of new community resources, grant programs will be modified, and innovative approaches to local resource enhancement will be developed and shared.Activities in these five key areas are designed to improve the infrastructure of the public health system and its capacity to carry out effectively the core functions of public health assessment, policy development, and assurance of the availability of the benefits of public health. If the nation is to achieve the health objectives for the year 2000, the public health system-the individuals and institutions that, when working effectively together, promote and protect the health of the people-must be strengthened.


The multidrug-resistant tuberculosis challenge to public health efforts to control tuberculosis. After years of steady decline, there has been an unprecedented resurgence of tuberculosis (TB) in the United States and outbreaks of multidrug-resistant tuberculosis (MDR-TB). The authors assess the nature, epidemiology, and implications of MDR-TB; provide suggestions for preventing drug resistance among patients with drug-susceptible TB; and offer recommendations for managing patients with MDR-TB. They outline the National Action Plan to Combat MDR-TB. Close collaboration among medical practitioners and staff members of TB control programs is needed to ensure the most effective management of patients with TB and their contacts. This collaboration is one of the most important steps for successful control of MDR-TB.


Social and cultural factors in the successful control of tuberculosis. The burden of tuberculosis on the public health is staggering. Worldwide, annual incidence of new cases is estimated to be about 8 million. Almost 3 million deaths occur yearly. Early case identification and adherence to treatment regimens are the remaining barriers to successful control. In many nations, however, fewer than half those with active disease receive a diagnosis, and fewer than half those beginning treatment complete it. The twin problems of delay in seeking treatment and abandonment of a prescribed regimen derive from complex factors. People's confusion as to the implications of the tuberculosis symptoms, costs of transportation to clinic services, the social stigma that attaches to tuberculosis, the high cost of medication, organizational problems in providing adequate followup services, and patients' perception of clinic facilities as inhospitable all contribute to the complexity. Sociocultural factors are emphasized in this report because hitherto they have not been adequately explored. Salient among those sociocultural factors is the health culture of the patients. That is, the understanding and information people have from family, friends, and neighbors as to the nature of a health problem, its cause, and its implications. A knowledge of the health culture of their patients has become a critical tool if tuberculosis control programs are to be successful. Several anthropological procedures are recommended to help uncover the health culture of people served by tuberculosis clinics.


Czechoslovakia's changing health care system. Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.


Weighing costs and benefits of adequate prenatal care for 12,023 births in Missouri's Medicaid program, 1988. Numerous studies have shown that the receipt of adequate prenatal care is associated with improvements in pregnancy outcome, particularly a reduction in the risk of low birth weight. Since medical costs for these low birth weight infants are several times higher than for normal birth weight infants, one would expect that medical costs for newborns would be lower for babies whose mothers have had adequate prenatal care than for those with inadequate prenatal care. Explored in this paper is whether the reduction in Medicaid costs for newborn and post-partum maternal care is greater than the increase in prenatal costs for a Medicaid population. The analysis used a file of 12,023 Missouri Medicaid records linked with the corresponding 1988 birth certificates. A modified version of the Kessner index was used to define the adequacy of prenatal care. Prenatal care costs were $233 higher for pregnancies with adequate prenatal care than for those in which prenatal care was inadequate. Newborn and post-partum costs starting within 60 days after the birth were $347 lower for the adequate prenatal care pregnancies, resulting in a savings of $1.49 for each extra $1 spent on prenatal care. Among the other factors studied in determining this benefit to cost ratio were global billing, Supplemental Food Program for Women, Infants, and Children (WIC), and participation in Medicaid under the expanded eligibility provisions that were effective in Missouri in 1988.


Area-level predictors of use of prenatal care in diverse populations. Patterns and predictors of the use of prenatal care in Hawaii were examined by census tract, taking into account summary measures of socioeconomic status, environmental conditions, and aggregated indicators of pregnancy-related risk characteristics of mothers. The objectives of the study were to identify those census tracts with high levels of inadequate use of prenatal care services; to develop a model, based on census tract characteristics, to explain observed geographic variations in the use of prenatal care services; and to identify for further investigation specific localities with unanticipated patterns of use. Data were drawn from 1980 census reports and vital statistics live birth files for the period 1979-87. Regression analysis was used to develop a model that was able to predict 61 percent of the census tract variation in the percentages of inadequate use of prenatal care services. Increased proportions of mothers of Japanese and other Asian-descent and of adults with more than high school education were associated with low levels of inadequate use of prenatal care services. Increased proportions of high parity-for-age risk and Samoan mothers were associated with higher levels of inadequate use. Census tract maps of actual and predicted percentages and studentized residual values were used to identify areas with high and low rates of inadequate use of prenatal care services. The area-level methods used are believed applicable to health care planning in other areas with ethnically or socioculturally diverse populations.


Estimating the prevalence of mental disorders in U.S. adults from the Epidemiologic Catchment Area Survey. The National Institute of Mental Health Epidemiologic Catchment Area Survey is a comprehensive, community-based survey of mental disorders and use of services by adults, ages 18 and older. Diagnoses are based on the criteria in the "Diagnostic and Statistical Manual of Mental Disorders," third edition, and were obtained in five communities in the United States through lay-interviewer administration of the National Institute of Mental Health Diagnostic Interview Schedule. Results from the survey provide the public health field with data on the prevalence and incidence of specific mental disorders in the community, unbiased by the treatment status of the sample. The population with disorders is estimated, and the survey findings that respond to some of the most common requests for information about the epidemiology of mental disorders in the United States are highlighted briefly. Based on the survey, it is estimated that one of every five persons in the United States suffers from a mental disorder in any 6-month period, and that one of every three persons suffers a disorder in his or her lifetime. Fewer than 20 percent of those with a recent mental disorder seek help for their problem, according to the survey. High rates of comorbid substance abuse and mental disorders were found, particularly among those who had sought treatment for their disorders.


AIDS education for health care professionals in an organizational or systems context. Traditionally, health education for practicing health professionals, as well as members of the public, focuses on the individual and relies on changing personal behavior. However, health care for persons with acquired immunodeficiency syndrome (AIDS), and members of their families, mainly is delivered within health and human services organizations. Providing AIDS education for health care professionals in an organizational or systems context shifts the focus from the individual to the group and from changing a person's behavior to offering health care professionals opportunities for interaction. In an organizational or systems approach, they can address patient care issues collectively, share interdisciplinary knowledge, identify problems of common concern, plan coordinated and integrated responses, and provide mutual support. A strategy for planning AIDS education is proposed for key administrators, supervisors, and care providers, who are the gatekeepers, opinion makers, and role models of organizations. Addressing organizational, community, and health care delivery system issues as part of an education program provides a forum for defining problems and a basis for uniting professionals and developing solutions.


Needle sharing and participation in the Amsterdam Syringe Exchange program among HIV-seronegative injecting drug users. To enhance the prevention of human immunodeficiency virus infection, factors related to regular participation in the Amsterdam Syringe Exchange and the borrowing of syringes were studied in 131 HIV-seronegative injecting drug users in a 1989-90 survey. A total of 29 percent of the users reported borrowing syringes, that is injecting drugs at least once in the past 4-6 months with a needle or syringe previously used by someone else. Users at increased risk of borrowing are previous borrowers, long term moderate-to-heavy alcohol users, current cocaine injectors, and drug users without permanent housing. Regular clients of the syringe exchange, when compared with other injecting drug users, were found more often to be frequent, long term injectors. They borrowed slightly less often than other users, but this was not statistically significant, even after controlling for frequency of injecting or other potential confounders. The results suggest that, 5 years after the start of the Amsterdam Syringe Exchange, drug use characteristics govern an individual injecting drug user's choice of exchanging or not exchanging syringes. The conclusion is that it seems more important to direct additional preventive measures at injecting drug users with an increased risk of borrowing rather than at users who do not participate in the syringe exchange or who do so irregularly.


Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care. The monthly distribution of conceptions among adolescents and the proportion of adolescent pregnancies that are voluntarily terminated by induced abortion by month of conception are the objects of this study. Additionally, seasonal variations in the timing of initiation of prenatal care services by adolescents are investigated. Vital records files of single live births, fetal deaths, and induced terminations of pregnancy to residents in the State of South Carolina, 1979-86, were aggregated to estimate conceptions. There was a significant difference between adolescents and adults in the monthly distribution of conceptions. The peak month of adolescent conceptions coincided with the end of the school year. Pregnancies of adolescents occurring at this time further demonstrated later access of prenatal care services than conceptions occurring at other times of the year, most notably during the school term. These findings suggest that there is considerable opportunity for improving the availability of reproductive health care services for adolescents. The results specifically suggest the potential benefit of increasing adolescent pregnancy prevention efforts prior to high-risk events and increasing the availability of and access to health care and counseling services to adolescents during the school recess months of the summer.


Breast cancer beliefs of women participating in a television-promoted mammography screening project. A survey of breast cancer and breast cancer screening beliefs was mailed to a random sample of 1,000 women who contacted a telephone bank in response to a television-promoted, reduced-cost mammography project. Beliefs and demographics of women in the sample who subsequently completed a mammogram were compared with those who did not. No statistically significant differences were found between participants (persons who completed a mammogram) and nonparticipants with respect to age, race, marital status, income, or educational preparation. Groups also did not differ significantly in the series of beliefs examined. Factor analysis revealed respondents' most salient beliefs about breast cancer and early detection of breast cancer. Evidence is presented to suggest a need for enhanced efforts to recruit minority group women to participate in mammography screening.


Sampler of findings from the 1986 national mortality followback survey on risk factors, disability, and health care. The National Center for Health Statistics conducted a mortality followback survey of a national probability sample drawn from all deaths of U.S. adults in 1986 and an oversampling of deaths of persons with selected characteristics. Responses were received from the next of kin or other close relatives of 16,598 adult decedents (88.6 percent). Data were collected through a mail questionnaire, followed by telephone or personal interviews with nonrespondents. Data were also collected from the hospitals and other health care facilities used by the decedent in the last year of life. Illustrative results are presented on the four major subject areas studied: risk factors for premature death, disability and care in the last year of life, socioeconomic differentials, and the reliability of selected items reported on the death certificate. Researchers are encouraged to explore the data tape to pursue indepth epidemiologic studies.


Vitamin supplement use and its correlates among elderly Japanese men residing on Oahu, HI. Use of vitamin supplements and the association with personal characteristics were investigated among 4,654 American men of Japanese ancestry in Hawaii. A total of 58 percent of the subjects who were ages 68 to 90 took vitamin supplements. Among supplement users, multivitamins were most commonly used (77 percent), followed by vitamin C (53 percent), E (43 percent), and A (10 percent). Ninety-two percent of users took at least seven pills per week when all types of pills were combined. Vitamin supplement users were more educated, more physically active, more likely to be married, and less obese than nonusers. They also slept less, smoked less, and drank less alcohol and caffeine. They took more analgesics and stomach medication and had fewer days of hospitalization in the previous 10 years compared with nonusers. Except for physical activity, use of stomach medicines, and hospitalization, the other characteristics were also positively correlated with the amount of vitamin pill intake. These findings indicate that vitamin supplement users have different health patterns compared with nonusers.


Survey of graduates of the Epidemic Intelligence Service as an approach to enhancing ethnic diversity among the nation's epidemiologists. A survey was conducted to improve the recruitment, training, and retention of epidemiologists in the Epidemic Intelligence Service (EIS) Program of the Centers for Disease Control. The authors compared minority graduates of the program and nonminority graduates in several areas: reasons for application, degree of satisfaction, appropriateness of preparation for epidemiologic practice, and current professional activities. A closed-ended questionnaire was mailed to all 87 minority graduates from the program during the period 1970-88, and to 172 randomly selected nonminority graduates. Of 259 graduates surveyed, 234 or 90.3 percent returned the questionnaire--89.6 percent of minority graduates and 90.7 percent of nonminority graduates. Virtually all graduates were satisfied with their EIS experience (95.2 percent), have encouraged others to apply (96.1 percent), and are the most frequent sources of initial contact of prospective officers (38.2 percent). Most EIS graduates (71.2 percent) were still working in epidemiology. Compared with the nonminority graduates, the minority graduates were more likely to be women and to be single. Minority graduates were less likely than non minorities to hold academic appointments (44.2 percent versus 60.0 percent) and less likely to work in academic settings as their primary job (11.5 percent versus 18.7 percent). At the same time, minority graduates were more likely to have learned of the EIS Program from academic advisors (32.1 percent versus 19.4 percent). Graduates express high levels of satisfaction with the EIS Program and continue to practice epidemiology following graduation. Few differences between the minority and nonminority graduates were found. Because fewer minority graduates are in academic settings to serve as mentors or role models, alternative recruitment methods must be developed to sustain a high level of interest among minority groups in the EIS Program.


An evaluation of the Vermont worksite smoking law. In view of the fact that the impact of statewide smoking laws on private worksite policies and the smoking behavior of employees has not been evaluated, two cross-sectional surveys were performed in Vermont to measure compliance with such a law: a random-digit telephone survey of employees and a subsequent mail survey of their employers. Employers were not aware that one of their employees had been surveyed. Roughly half (56 percent) of the employees and 66.5 percent of their employers described policies that are in compliance. Among all employers who described policies in compliance with the law, 68.1 percent of their employees also described compliant policies. Among all employees who described non-compliant policies, 48.8 percent had employers who described compliant policies. Overall, employees and employers agreed on how their policies stood with respect to compliance in 67.6 percent of cases. The prevalence and amount of smoking at work declined after the institution of the law but so did the prevalence and amount of smoking at home. Changes toward more restrictive policies were associated with reductions in cigarette consumption at work, but not with quitting. The study suggests that a large fraction of worksite smoking policies may not comply with a statewide worksite smoking law. The proportion of companies complying with such a law may be overestimated if information on compliance is obtained only from employers.


Group counseling at STD clinics to promote use of condoms. An intervention was developed to promote safer sex and condom use among patients seeking treatment for sexually transmitted disease (STD) at a public health STD clinic in Los Angeles, CA. The intervention consisted of a short group discussion on condom use, a presentation of a videotape portraying condom use as socially acceptable behavior, and a role-playing session concerning negotiating the use of a condom with one's sex partner. The study group was 551 persons who visited the clinic in 1988. Medical records of 426 (77 percent) were located and reviewed 7 to 9 months later. Among those, 220 had participated in the intervention and 206 were control subjects who had not participated in the intervention. The rates at which patients reacquired STD after treatment and after the intervention were compared between the intervention group and the control group. Men who participated in the intervention subsequently showed a lower rate of STD reinfection than those who did not. There was no evidence that the intervention reduced reinfection among women. The strongest predictor of reinfection was found to be a history of STD infection prior to the infection that was being treated at the time of the intervention. The results show that group interventions directed to STD patients can be effective in reducing STD reinfection among men.


Mothers' motivations to participate in a pregnancy health survey. An important question in interpreting epidemiologic data is why some persons agree to participate in a health survey while others do not. Information about why people agree to interview or answer a questionnaire could help researchers to devise procedures for a health survey and to chose information to be communicated in the interview or questionnaire so as to increase subjects' participation. The authors interviewed 180 mothers who gave birth to a child with a birth defect and 198 mothers whose children were born without a birth defect. The interviews were part of two case-control studies to determine risk factors for selected birth defects. In the course of the interviews, each mother was asked why she agreed to be interviewed, and whether anything about the survey procedures that were followed could be improved. Among both the case mothers and the control mothers the most common reason for agreeing to be interviewed was humanitarian, expressed as "to help others" or "to prevent what happened to my baby from happening to babies in the future." Case mothers, more frequently than control mothers, gave as their reason for participating either to help themselves, their child, their family, or to further scientific understanding. Emphasizing these as benefits of participation to those who are survey subjects at the time of the initial contact could increase the proportion who agree to respond.


Effect of disease on glomerular proteinases. Up to now, little is known about the self-perpetuating mechanism leading to terminal renal failure in chronic renal disease. The common pathological feature of progressive renal insufficiency is focal and segmental glomerulosclerosis. The experimental counterpart of this process is represented for instance by the models of streptozotocin diabetes, Adriamycin nephropathy and Goldblatt hypertension. In fact, the main initiating hallmark of glomerulosclerosis is an accumulation of glomerular proteins, whose balance is apparently influenced by the activity of glomerular proteinases. In isolated glomeruli of kidneys from the experimental animals, the total proteinase activity was assayed with the unspecific but sensitive azocasein assay. In fact, the activity was significantly reduced in all experimental models at acid and neutral pH when relating enzyme activity to the glomerular protein and DNA content. We believe, that our data of reduced glomerular proteinase activity in the animal models of glomerulosclerosis represent perhaps a new additional common pathogenetic mechanism. The glomerular protein accumulation could be a result of a synergistical interaction between hemodynamic factors and biochemical ones; the latter, we suggest to be a decrease of glomerular proteinase activity.


Subcutaneous erythropoietin in the treatment of renal anaemia. Erythropoietin was applied subcutaneously to 49 patients, 41 have been treated by hemodialysis, 3 by continuous ambulatory peritoneal-dialysis, 5 had chronic progressive renal failure. Mean initial dose of erythropoietin was 139.4 U/kg/week and maintenance dose 115.9 U/kg/week. In 43% of patients serum ferritin was decreasing during treatment, and in 20% it was low before the commencing of the treatment. During erythropoietin therapy vitamin B12 was decreasing in 22% of the patients, and the substitution was necessary in 18%. Only in 1 patient it was necessary to substitute also folic acid. There were no nonresponders among erythropoietin treated patients. Elevation of blood pressure was observed in half of the patients, hypertensive encephalopathy in 1, and thrombosis of arterio-venous fistula in 3.


Influence of long-term erythropoietin therapy on endocrine abnormalities in haemodialyzed patients. Endocrine abnormalities in patients with chronic renal failure are well documented. The present study aimed to assess the influence of long-term erythropoietin (EPO) therapy on endocrine abnormalities in haemodialyzed patients. Two groups of haemodialyzed patients, each of which comprised 17 subjects, were examined. The first one treated by EPO (EPO group) while the second one did not receive this hormone (NO-EPO group). A complete biochemical and hormonal check-up was performed before and at the 3, 6, 9 and 12 months of the study period. Normal values for the estimated parameters were obtained in appropriately selected sex and age-matched healthy subjects. After EPO therapy an increase of the haematocrit value from 21.8 +/- 0.9% to 32.6 +/- 0.9% was observed which was accompanied by a significant decline of plasma ferritin and saturation of transferrin. In patients of the NO-EPO group a significant although less marked rise of the haematocrit value (21.4 +/- 0.4% to 24.2 +/- 0.6%) was also noticed. EPO therapy did not change electrolytes (Na, K, Ca, inorganic phosphate), osteocalcin, creatinine, glucose and alkaline phosphatase plasma levels as well as plasma concentrations of calcium related hormones (PTH, calcitonin, 1.25(OH)2D3) and vasopressin (AVP). EPO treatment induced a significant decline of somatotropin (HGH), prolactin (PRO), follitropin (FSH), lutropin (LH), ACTH, cortisol, plasma renin activity, aldosterone, insulin (IRI), glucagon (IR-G), pancreatic polypeptide (PP) and gastrin plasma levels and an increase of plasma estradiol, testosterone and atrial natriuretic peptide (ANP). These EPO induced endocrine alterations were restricted mostly to the first 6 months of EPO administration.(ABSTRACT TRUNCATED AT 250 WORDS)


[Effect of recombinant human erythropoietin (rHu-EPO) on anemia and selected biochemical parameters in patients in the pre-dialysis period]. The effect of recombinant human erythropoietin (rHu-EPO) on anaemia and some biochemical parameters was investigated in 7 predialysis patients. A statistically significant increase in erythrocyte, haematocrit and haemoglobin levels was observed after 3 weeks of treatment and such changes were constant during the 6 month maintenance therapy. The mean urea and creatinine levels were comparable during the tested period in 4 of the studied patients. The other 3 patients did not completed the planed period and started the dialytic therapy because of progression of renal insufficiency. The latter group had more advanced renal failure and higher blood pressure prior to rHu-EPO treatment as compared with the patients who completed the study.


[Effect of recombinant human erythropoietin--rHu-EPO on the metabolism of children treated by long-term hemodialysis]. Recombinant human erythropoietin (EPO) was administered to 12 children with terminal renal failure aged 8-17 years subjected to hemodialysis for a mean period of 16 (S.D. = 19.7) month prior to EPO utilisation. The hormone was administered thrice weekly at an intravenous dose of 25-75 u/kg until Hb value of 100 g/l was obtained, and subsequently at maintenance doses for mean period of 7 (S.D. = 4.0) month. The urea kinetic modeling (UKM) algorithms allowed to compute protein catabolic rate (pcr) for each patient in modeling sessions performed once a month. The analysis included the effect of EPO upon: 1. peripheral whole blood count; 2. individual UKM parameters; 3. selected lab data describing the metabolic status of the patient (predialysis potassium, phosphorus, creatinine, total blood protein and albumin--and iron levels), in three randomized groups according to the value of pcr. Group I presented pcr less than 1.0 g protein/kg/day typical for malnutrition; group II--pcr = 1.0-1.4 g protein/kg/day--with appropriate protein catabolism; group III--pcr greater than 1.4 g protein/kg/day--hypercatabolic. The results from 188 pre-EPO modeling sessions and 78 sessions in the course of EPO treatment were compared. All the three groups revealed statistically significant increased Hb, Ht and erythrocyte count after EPO administration, which also resulted an increase of protein catabolism what is manifested in a decrease in the number of sessions by 26.1% in Group I and a corresponding increase by 13.5% and 12.6% in Groups II and III, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Interactions among emergent relations during equivalence class formation. The interactions among symmetry, transitivity, and equivalence tests during the formation of 3-member equivalence classes were studied with 14 college students. After training AB and BC, a test with BA, CB, AC, and CA was conducted concurrently. Failure led to serial testing with probes for CA equivalence, BA symmetry, CA equivalence, CB symmetry, CA equivalence, AC transitivity, and CA equivalence. For five subjects, equivalence tests were passed immediately once BA and CB symmetry as well as AC transitivity had been induced. Thus, symmetry and transitivity were precursors for successful performance on equivalence tests. The conjoint function of symmetry and transitivity was assessed with the equivalence probes. As the equivalence probes were passed immediately, the presence of symmetry alone and transitivity alone were sufficient for their conjoint function without additional intervention. For different subjects, transitivity alone and symmetry were induced either directly with BA, CB, or AC probes or indirectly with equivalence probes. Equivalence probes can also induce various combinations of symmetry and transitivity. Thus, different subjects formed classes in various patterns at different rates.


Increased responding to female stimuli as a result of sexual experience: tests of mechanisms of learning. Sexual experience increases the response of males to stimuli provided by female conspecifics in a variety of species. The mechanisms of learning involved in this type of phenomenon were explored in two experiments with Japanese quail. The results indicated that instrumental conditioning with copulatory opportunity is not necessary for the acquisition of responding to female cues, and responding is not facilitated by learning about the location of the female. However, the response of males to female stimuli (as well as to arbitrary stimuli associated with access to a female) was enhanced by the presence of sexually conditioned contextual cues. Substantial levels of responding also occurred to female stimuli in a context where the subjects never encountered a female quail before. This latter outcome is consistent with the possibility that stimuli from a female become directly associated with sexual reinforcement during the course of sexual experience. Similar forms of learning may be involved in the effects of sexual experience on the response of mammalian species to female odours.


Effects of an infusion of morphine into the accumbens nucleus upon acquisition of hypoalgesic and fear responses in rats exposed to a heart stressor. Four experiments examined the effects of an infusion of morphine into the accumbens nucleus upon the aversive conditioning that can occur in rats exposed to the heated floor of a hot-plate apparatus. An infusion of morphine into the accumbens nucleus but not into the caudoputamen or into the prefrontal cortex impaired the acquisition of a conditioned hypoalgesic (Experiment 1) and fear (Experiment 4) response. This impairment was dose-dependent (Experiment 2) and mediated by opioid receptors in the accumbens nucleus, because it was removed by a systemic (Experiment 3a) or by an accumbal (Experiment 3b) infusion of naloxone. The results were attributed to an antagonism between the reinforcement process for aversive conditioning and the appetitive properties of an accumbal infusion of morphine.


Conditioned tolerance to morphine hypoalgesia: compensatory hyperalgesia in the experimental group or conditioned hypoalgesia in the control group? Five experiments used rats to examine the role of noxious stimulation in the development of contextually controlled morphine hypoalgesic tolerance and in the mediation of this tolerance by an associated hyperalgesic response. There was evidence for contextually controlled tolerance to morphine's hypoalgesic effects and an associated hyperalgesic response in rats injected with morphine and trained with noxious stimulation, but not in rats repeatedly exposed to morphine in the absence of that stimulation (Experiments 1 and 5). Latent inhibition (Experiment 2) and extinction (Experiment 3) of tolerance also depended upon pairing drug-related cues with noxious stimulation. The level of sensitivity-reactivity to noxious stimulation in morphine-tolerant rats tested with the drug was related to the intensity of the noxious stimulation that had been paired with the test context (Experiment 4). The results were interpreted to mean that some of the evidence for a Pavlovian involvement in tolerance development can be explained in terms of morphine's interference with the acquisition, but not with the expression of the hypoalgesic response otherwise acquired by cues paired with noxious stimulation.


The purification and sequence analysis of an avian neuromedin U. In this study we have purified an avian homologue of neuromedin U from the chicken. Each step of the purification process was followed by a specific radioimmunoassay developed using porcine neuromedin U. Microsequence analysis characterised the peptide to be 25 amino acid residues long with the following sequence: Y-K-V-D-E-D-L-Q-G-A-G-G-I-Q-S-R-G-Y-F-F-F-R-P-R-N. Chicken neuromedin U has marked sequence similarity with the porcine peptide at its bioactive C-terminal region. Our findings demonstrate that the amino acid sequence of neuromedin U is markedly conserved in species which have diverged millions of years ago in evolutionary terms.


The vasoinhibitory activity of bovine chromogranin A fragment (vasostatin) and its independence of extracellular calcium in isolated segments of human blood vessels. Endothelium-independent vasoconstrictor responses in isolated segments of human internal thoracic artery (ITA) and saphenous vein (SV) were used as a bioassay system for the vasoinhibitory activity of bovine chromogranin A (CGA). Preincubation with vasostatin (0.8 micrograms/ml), containing the N-terminal domain of CGA, (CGA1-76, CGA1-113 and CGA1-143ff), inhibited the contractile responses evoked by 80 mM K+, 2.6 microM noradrenaline (NA), or 65 nM endothelin-1 (ET-1) in Ca(2+)-free solution in SV but not in ITA. The results demonstrate a vasoinhibitory activity in vasostatin and show that there is a marked difference between the arterial and venous segments in the Ca2+ independent component of the inhibitory response. A vascular role for the N-terminal domain of CGA is indicated, presumably by inhibiting Ca2+ release from intracellular stores in the human vein but not the artery.