U-M study shows how fight styles affect marriage

It’s common knowledge that newlyweds who yell or call each other names have a higher chance of getting divorced. But a new U-M study shows that other conflict patterns also predict divorce.

A particularly toxic pattern is when one spouse deals with conflict constructively, by calmly discussing the situation, listening to his or her partner’s point of view or trying hard to find out what the partner is feeling, for example — and the other spouse withdraws.

“This pattern seems to have a damaging effect on the longevity of marriage,” says researcher Kira Birditt, first author of a study on marital conflict behaviors and implications for divorce published in the current issue of the Journal of Marriage and Family. “Spouses who deal with conflicts constructively may view their partners’ habit of withdrawing as a lack of investment in the relationship rather than an attempt to cool down.”

Couples in which both spouses used constructive strategies had lower divorce rates, Birditt found.

The researchers looked at how both individual behaviors and patterns of behavior between partners affected the likelihood of divorce. They also examined whether behavior changed over time, and whether there were racial or gender differences in behavior patterns and outcomes.

Astonishingly, the researchers found that 29 percent of husband and 21 percent of wives reported having no conflicts at all in the first year of their marriage in 1986. Nonetheless, 46 percent of the couples had divorced by year 16 of the study in 2002. Interestingly, whether or not couples reported any conflict during the first year of marriage did not affect whether they had divorced by the last year studied.

To test your marital fight style and compare it to study participants go to tinyurl.com/28msxzj.

­— Diane Swanbrow, News Service

Doctors need to help patients prepare better for health decisions

Twelve years ago, then 28-year-old graduate student Brian Zikmund-Fisher was forced into the toughest choice of his life: Die from a blood disorder within a few years or endure a bone marrow transplant that could cure him or kill him in weeks.

Zikmund-Fisher, now an assistant professor at the School of Public Health specializing in health communication, chose to gamble. After nine months of blood transfusions, a bone marrow match was found in Australia. Zikmund-Fisher spent another month in isolation until his new immune system began working.

“That experience taught me how to be a well-informed patient,” says Zikmund-Fisher, who studies medical decision making because of his own experience. “Unfortunately, today many patients don’t learn what they need to in order to make informed medical decisions.”

To document the challenges patients face in deciding their own medical care, Zikmund-Fisher and Mick Couper, a research professor in survey methodology at the Institute for Social Research (ISR), led a national survey of medical decisions featured this month in a themed issue of the journal Medical Decision Making. The study, which was carried out by ISR’s Survey Research Center, surveyed more than 3,000 U.S. adults about nine common medical decisions and concluded that the majority of patients don’t have sufficient information to make the best decisions.

“I want to raise the awareness of how important medical decision making is in the lives of all Americans and how unprepared most people are to make these decisions,” said Zikmund-Fisher, also an assistant professor in internal medicine at the U-M Health System. “I see this as a public health issue.”

— Laura Bailey, News Service

Complexity not so costly after all, analysis shows

The more complex a plant or animal, the more difficulty it should have adapting to changes in the environment. That’s been a maxim of evolutionary theory since biologist Ronald Fisher put forth the idea in 1930.

But if that tenet is true, how do you explain all the well-adapted, complex organisms — from orchids to bower birds to humans — in this world?

This “cost of complexity” conundrum puzzles biologists and offers ammunition to proponents of intelligent design, who hold that such intricacy could arise only through the efforts of a divine designer, not through natural selection.

A new analysis by Jianzhi “George” Zhang and coworkers at U-M and Taiwan’s National Health Research Institutes reveals flaws in the models from which the cost of complexity idea arose and shows that complexity can, indeed, develop through evolutionary processes. In fact, a moderate amount of complexity best equips organisms to adapt to environmental change, the research suggests. The findings were published online in the Proceedings of the National Academy of Sciences during the week of Sept. 27.

The study focused on a genetic phenomenon called pleiotropy, in which a single gene affects more than one trait. For simplicity, mathematical models of pleiotropy have assumed that all genes in an organism affect all of its traits to some extent. But Zhang’s group found that most genes affect only a small number of traits, while relatively few genes affect large numbers of traits.

What’s more, they found a “modular” pattern of organization, with genes and traits grouped into sets. Genes in a particular set affect a particular group of traits, but not traits in other groups.

All of these findings challenge the assumptions underlying the classic mathematical models that suggest complexity is prohibitively costly.

Former U-M graduate student Zhi Wang, now at Sage Bionetworks in Seattle, also was an author on the study.

— Nancy Ross-Flanigan, News Service

In-country OB/GYN training programs help doctor retention

Ghanaian Obstetrics and Gynecology residents say in-country training programs contributed to their decision to remain in their home country to practice medicine, new U-M research shows.

The retention of trained health care providers in developing countries is a key component to improving health and achieving the United Nations’ Millennium Development Goals, which aim to decrease maternal and child mortality. But the migration of health workers from developing to developed countries has resulted in a health care workforce crisis that continues to threaten progress in global health.

U-M research published last week in the journal Academic Medicine shows that the in-country program is one of three factors that contribute strongly to OB/GYN residents not migrating out of country to practice medicine.

“The most important factor is that there is a program in place for medical students to enter when they finish so they don’t have to leave the country for obstetrics and gynecology training,” says Dr. Frank Anderson, associate professor in the Department of Obstetrics and Gynecology, and a lead author in the study.

The Department of Obstetrics and Gynecology has been working with the two major academic medical centers in Ghana for more than 20 years — Korle-Bu Teaching Hospital (Accra, Ghana) and Komfo Anokye Teaching Hospital (Kumasi, Ghana). The program has played an ongoing role in supporting OBGYN training in Ghana.

“Partnerships between academic health centers in developed and developing countries provide opportunities to address the global health care crisis in a significant and sustainable way,” Anderson says, adding that such programs have longevity that other efforts can’t match.

The implications of this study are great, Anderson says. The Michigan model has shown that centers with established and well-functioning educational systems in long-term partnerships with academic health centers in developing countries can help create high-quality and sustainable training programs.

Additional U-M co-authors are Yvette Clinton and E. Yao Kwawukume.

— Margarita Bauza, UMHS Public Relations

Study: Employee wellness plans should include entire company

A study of employees at a west Michigan hospital showed some of the most unhealthy workers that U-M researchers had ever seen.

But in four years, the workplace wellness plan at Allegiance Health in Jackson had fueled some of the biggest improvements in employee health that those same researchers had ever witnessed.

The researchers were studying the hospital system to evaluate the health risk changes in employees in the four years after Allegiance implemented a workplace wellness program. The “It’s Your Life” program was unique because it included all employees, not just unhealthy ones, says Douglas Wright, a researcher at the School of Kinesiology Health Management Research Center, and lead study author.

Most wellness programs start with a health assessment and only the employees who meet pre-determined benchmarks of poor health qualify for additional assistance, Wright says.

It’s Your Life began in 2002, and Allegiance offered employees $200, spread over 24 paychecks, to take a health risk appraisal, be screened, attend three counseling sessions and complete three health learning modules. In subsequent years, the company lowered the incentive to $190 but gave it to employees in the form of a gift card that was filled with small amounts of money each time the employee completed another requirement. Having immediate access to the money earned, rather than waiting for it to show up in a paycheck, appeared to be associated with increased participation.

One of the reasons the program was so successful was because it was comprehensive, says Dee Edington, director of the HMRC. Edington has appointments in the School of Kinesiology and the School of Public Health.

The study appears in the Journal of Health & Productivity.

— Laura Bailey, News Service