Likelihood Of Illness Research Articles

Asymmetry of doubt in medical self-diagnosis: The ambiguity of "uncertain wellness."

In 2 studies Ss received a clear or an unclear diagnosis, indicating either disease or no disease. In Experiment 1, Ss responded to a hypothetical bacteria test. In Experiment 2, Ss performed 2 saliva tests purportedly measuring risk for pancreatic disorders. Responses to the unclear well diagnosis were unique in several ways. Ss thought the test more invalid, inferred a greater likelihood of illness from a 2nd identical result, saw the disorder as more pernicious, and held no self-protective beliefs about the test or the disease. Moreover, desire for treatment among these Ss was as great as among those receiving a clear diagnosis of illness. Possible mechanisms are discussed, as are potential applications to clinical issues and to the development and maintenance of hypochondriacal health concerns.

The Age Threshold for Isoniazid Chemoprophylaxis

Isoniazid chemoprophylaxis recommendations include its use in persons who have positive tuberculin reactions, but neither recent conversion nor other activation risk factors, only if they are under age 35 years. Above this threshold, the isoniazid hepatitis risk is said to outweigh the benefit of preventing activation. Because this policy is controversial, we performed a decision analysis contrasting those who take with those who decline isoniazid therapy according to three outcome measures: life expectancy, likelihood of illness (isoniazid hepatitis and active tuberculosis), and likelihood of fatal illness. We found no threshold between ages 10 and 80 years by the measures of life expectancy and likelihood of fatal illness; isoniazid benefits outweigh risks for all, though the margin is small for the elderly. A threshold exists only in the likelihood of illness: isoniazid risks outweigh benefits for those aged 50 to 65 years. Only extreme variations of assumptions affect these findings. Chemoprophylaxis recommendations should include low-risk tuberculin reactors over age 35 years.

A Durkheimian hypothesis on stress

Commonalities among the events that appear on life events lists and among the types of social supports which have been found to reduce the likelihood of illness are reviewed in the life events literature in an attempt to find a context within sociological theory. Social integration seems to underlie the stress-illness process. In seeking a tradition from which to understand these facts, we selected Durkheim's works in the context of the homo duplex concept wherein social integration involves the interplay of individualism and social forces. After presenting a specific hypothesis for the stress literature, the paper concludes with implications and suggestions for empirical research.

Medical ramifications of the federal regulation of the Social Security Disability Insurance program: Social Security and medicine.

Social Security Disability Insurance is a federally created and regulated insurance plan. The definition of disability as it relates to work capacity is exclusively the purview of government administrators. The primary physician's opinion has little, it any, impact on decision. Administering this insurance scheme requires the quantification of illness as it relates to work capacity (disability). What has evolved is a program that insures for the amount of "disease." The assumption is that with more disease, there is a greater likelihood of illness, even illness manifest as work incapacity. Leaving this underlying assumption tacit is responsible for the adversary climate that envelops the physician, the patient-claimant, and the administrators. It is also responsible for the paucity of clinical investigations into the critical issue of the amount and form of illness a diseased person will have.

Drugs and the older person--a brief pharmacological overview.

I take great pleasure in chairing this first session of the Second Philadelphia Symposium on Aging. This year’s topic focuses on pharmacological intervention of aging processes, a subject of enormous fundamental and practical interest. Too little is known about the changes in drug effects in relation to the age of the individual, and yet drugs are being administered more extensively to patients as they grow older. It is quite obvious that with increasing age there is a greater likelihood of illness, and therefore a greater need to use therapeutic agents, frequently on a chronic basis. With the increased consumption of medications by the geriatric population, and indeed an increase in this population as well, there is a greater likelihood of adverse drug reactions. The chance of an undesirable pharmaceutical complication may be enhanced even further because of drug-drug interactions.

VIROLOGIC STUDIES OF ACUTE RESPIRATORY DISEASE IN YOUNG ADULTS

Hamre, D. and M. Beem (DepL Pediatrics, Univ. of Chicago, Chicago, III. 60637). Virologic studies of acute respiratory disease in young adults. V. Coronavirus 229E infections during six years of surveillance. Am J Epidemiol 96: 94–106, 1972.—In a surveillance study of acute respiratory disease in medical students that spanned six consecutive seasons between 1961 and 1968 and encompassed 937 student years of observation, infection with coronavirus 229E was identified by virus isolation and serologic studies. Virus isolation identified 12 infections, 8 in one season, 4 in another. Complement fixing (CF) antibody titer rises identified 133 infections that occurred in all six seasons of surveillance, involving from 15 to 35% of students in three seasons of “high” prevalence, and 1 to 5% in intervening seasons of “low” prevalence. Infection occurred in a winter-spring seasonal pattern and was associated with acute respiratory illness that was not clinically distinctive. Neutralizing antibody to 229E was commonly present in the sera of the students. The level of this did not appear to influence the occurrence of, or likelihood of illness with, reinfection as judged by CF seroconversion; however, the frequency of significant rise in neutralizing antibody titer with reinfection was inversely related to pre-infection levels of this antibody. Infection with other common respiratory viruses did not stimulate significant CF or neutralizing antibody titer rises to 229E.