Transmission of megawatt relativistic electron beams through millimeter apertures.

High-power, relativistic electron beams from energy-recovering linacs have great potential to realize new experimental paradigms for pioneering innovation in fundamental and applied research. A major design consideration for this new generation of experimental capabilities is the understanding of the halo associated with these bright, intense beams. In this Letter, we report on measurements performed using the 100 MeV, 430 kW cw electron beam from the energy-recovering linac at the Jefferson Laboratory's Free Electron Laser facility as it traversed a set of small apertures in a 127 mm long aluminum block. Thermal measurements of the block together with neutron measurements near the beam-target interaction point yielded a consistent understanding of the beam losses. These were determined to be 3 ppm through a 2 mm diameter aperture and were maintained during a 7 h continuous run.

A controlled trial investigating the effect of music therapy during an acute psychotic episode.

OBJECTIVE: To investigate the effects of music therapy, as an adjunct to pharmacological therapy during an acute psychotic episode. METHOD: Sixty participants were quasi-randomised into either a treatment or control group. Standardised psychological assessments [Brief Psychiatric Rating Scale (BPRS), Calgary Interview Guide for Depression, Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30) and Depression Anxiety Stress Scale (DASS21)] were conducted before and after the sessions to determine whether there were any significant changes in outcomes. RESULTS: Statistically significant changes in BPRS scores were seen in the treatment group (n = 25) compared with the control group (n = 24). No significant differences were seen in the results of the Calgary, NOSIE-30 or DASS21 scores. Despite the treatment group, having a 9.3% decrease in their length of stay in hospital as opposed to the control group, this did not reach statistical significance. No significant differences were found when comparing the two groups in their doses of antipsychotic, benzodiazepine, mood stabilising or antidepressant medication or at the 1-month follow-up assessment. CONCLUSION: Most of the variables tested in our study but one did not point at any advances of adding music therapy to pharmacological treatment. The finding of improvement in Brief Psychiatric Rating Scale could be an indicator of music therapy as a useful adjunct to pharmacotherapy during an in-patient hospital stay for the few patients amongst those suffering acute psychosis that accept to participate in music therapy.

Prospective study of early bereavement on psychological and behavioural cardiac risk factors.

BACKGROUND: Increasing evidence supports the role of emotional stress in the onset of cardiovascular disease. Although bereavement is a major emotional stress with both acute and more long-term features, the mechanism of its association with cardiovascular risk is not well understood, in particular because of limited studies of acute bereavement. The aim of the study was to identify psychological and behavioural changes in acute bereavement and potential modifiers of these changes. METHODS: Bereaved (n= 62) and non-bereaved individuals (n= 50) were evaluated within 2 weeks and at 6 months following loss using the Centre for Epidemiologic Studies -- Depression, Spielberger State Anxiety and Anger, Social Support Questionnaire and changes in appetite, cigarette and alcohol consumption, cortisol and lipids. RESULTS: Compared with non-bereaved, acutely bereaved had increased symptoms of depression (26.7 +/- 1.7 vs 5.9 +/- 0.7, P < 0.001), anxiety (47.4 +/- 2.0 vs 28.2 +/- 1.4, P < 0.001) and anger (median 16.0 vs 15.0, P < 0.001). Greater depressive symptoms were associated with being unprepared for the death, decreased sleep duration and younger age. Acutely, bereaved slept less than non-bereaved (5.8 +/- 0.2 vs 7.2 +/- 0.2 h, P < 0.001). Reduced sleep time was associated with increased anger and depression and decreased satisfaction with social support. Compared with the non-bereaved, the acutely bereaved had higher cortisol (median 306 vs 266, P= 0.003), reduced appetite (P < 0.001) and lower total cholesterol (median 4.9 vs 5.4, P= 0.006) and low-density lipoprotein (median 2.4 vs 2.9, P < 0.001). CONCLUSION: These results offer insight into the psychological, behavioural and physical changes that may contribute to cardiovascular risk in bereavement.

Longitudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis.

OBJECTIVES: No longitudinal studies have concurrently evaluated predictors of anxiety, depression, and fatigue in people with multiple sclerosis (PwMS). This study determined factors that best predicted anxiety, depression, and fatigue in MS patients from a large pool of disease, cognitive, life-event stressor (LES), psychosocial, life-style, and demographic factors. DESIGN: A 2-year prospective longitudinal study evaluated predictors of psychological distress and fatigue in PwMS. METHODS: One hundred and one consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. LES, anxiety, depression, and fatigue were assessed at baseline and at 3-monthly intervals for 2-years. Disease, cognitive, demographic, psychosocial, and life-style factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. RESULTS: Depression strongly predicted anxiety and fatigue, and anxiety and fatigue strongly predicted later depression. Psychological distress (i.e. anxiety, depression) was also predicted by a combination of unhealthy behaviours (e.g. drug use, smoking, no exercise, or relaxation) and psychological factors (e.g. low optimism, avoidance coping), similar to the results of community-based studies. However, state-anxiety and fatigue were also predicted by immunotherapy status, and fatigue was also predicted by LES and demographics. CONCLUSIONS: These results suggest that similar factors might underpin psychological distress and fatigue in MS patients and community-well samples, although MS treatment factors may also be important. These results might assist clinicians in determining which MS patients are at greatest risk of developing anxiety, depression, or fatigue.

Effects of health insurance and race on early detection of cancer.

BACKGROUND: The presence and type of health insurance may be an important determinant of cancer stage at diagnosis. To determine whether previously observed racial differences in stage of cancer at diagnosis may be explained partly by differences in insurance coverage, we studied all patients with incident cases of melanoma or colorectal, breast, or prostate cancer in Florida in 1994 for whom the stage at diagnosis and insurance status were known. METHODS: The effects of insurance and race on the odds of a late stage (regional or distant) diagnosis were examined by adjusting for an individual's age, sex, marital status, education, income, and comorbidity. All P values are two-sided. RESULTS: Data from 28 237 patients were analyzed. Persons who were uninsured were more likely diagnosed at a late stage (colorectal cancer odds ratio [OR] = 1.67, P =.004; melanoma OR = 2.59, P =.004; breast cancer OR = 1.43, P =.001; prostate cancer OR = 1.47, P =.02) than were persons with commercial indemnity insurance. Patients insured by Medicaid were more likely diagnosed at a late stage of breast cancer (OR = 1.87, P<.001) and melanoma (OR = 4.69, P<.001). Non-Hispanic African-American patients were more likely diagnosed with late stage breast and prostate cancers than were non-Hispanic whites. Hispanic patients were more likely to be diagnosed with late stage breast cancer but less likely to be diagnosed with late stage prostate cancer. CONCLUSIONS: Persons lacking health insurance and persons insured by Medicaid are more likely diagnosed with late stage cancer at diverse sites, and efforts to improve access to cancer-screening services are warranted for these groups. Racial differences in stage at diagnosis are not explained by insurance coverage or socioeconomic status.

Parental loss in childhood: relationship to adult psychiatric impairment and contact with psychiatric services.

Both parental death in childhood and parent-child separations (from causes other than death) were assessed in a community survey of psychiatric disorder and in an equivalent sample of psychiatric outpatients from the same community. Symptomatic disorder (psychiatric caseness) and psychiatric illness behavior (patient status) were examined. Symptomatic disorder was defined by comparing community (unreferred) cases with noncases. Illness behavior was specified by comparing the psychiatric outpatients with the community cases. Parental death in childhood bore no relation to either symptomatic disorder in the community sample (psychiatric caseness) or to psychiatric illness behavior (patient status) in adult life. Parent-child separations similarly had no relation to adult symptomatic disorder but were significantly associated with psychiatric illness behavior.

The psychosocial adjustment of Australian Vietnam veterans.

The authors reviewed the case records of a random sample of 126 Australian Vietnam veteran inpatients, recorded the diagnostic and background data, and made new DSM-III diagnoses. Neurotic disorders accounted for 49% of the primary or secondary diagnoses. Only 10% of the overall sample had a primary diagnosis of posttraumatic stress disorder but 27% of the veterans who had seen combat had a primary diagnosis of the disorder. Twenty-nine percent of the overall sample were given a primary diagnosis of alcohol abuse or dependence. The early developmental environment of the overall sample frequently included poor parent-child relationships, high rates of parental separation, and family histories dominated by parental alcohol abuse.

The psychological effects of being a prisoner of war: forty years after release.

Forty years after the end of World War II, the authors compared a random sample of former Japanese-held Australian prisoners of war (POWs) with a group of non-POW combatants of the same era. The POWs were significantly more depressed than were the control subjects, but the two groups did not differ in prevalence of anxiety symptoms or alcohol problems. Apart from a higher rate of postwar duodenal ulcer in the POWs, the two groups had similar degrees of medical morbidity.

Are malnutrition and stress risk factors for accelerated cognitive decline? A prisoner of war study.

We set out to test the hypothesis that severe malnutrition and stress experienced by prisoners of war (POWs) are associated with cognitive deficits later in life. We assessed 101 former Australian POWs of the Japanese and 108 veteran control subjects using a battery of neuropsychological tests, a depression scale, a clinical examination for dementia, and CT. We divided the POWs into high weight loss (>35%) and low weight loss groups (<35%). We found no significant differences in cognitive performance between the POWs and control subjects or between high and low weight loss groups on any of the tests or in the prevalence of dementia. Scores on the depression scale showed that the former POWs had more depressive symptoms than the control subjects a decade previous, but the difference had diminished over time. This study does not support the hypothesis that malnutrition is a risk factor for accelerated cognitive decline nor the theory that severe stress can lead to hippocampal neuronal loss and cognitive deficits. Cognitive deficits in earlier studies of former POWs may have been associated with concurrent depression.

Is experience as a prisoner of war a risk factor for accelerated age-related illness and disability?

OBJECTIVE: To determine whether the experience of internment as a Prisoner of War (POW) during World War II was associated with a higher prevalence of chronic disease and diminished functional performance in later life. DESIGN: A retrospective and prospective cohort design. SETTING: Concord Repatriation General Hospital, Sydney, Australia. PARTICIPANTS: A random sample of 101 Australian, male, ex-prisoners of the Japanese and a comparison group of 107 non-POW combatants from the same theatre of war. MEASUREMENTS: Outcome variables were self-perceived health status, hospital admissions and length of stay, number of prescription medications used, number of somatic symptoms reported, number and types of medical diagnoses, a neurology of aging clinical examination, and the Instrumental Activities of Daily Living (IADL) and Physical Self Maintenance Scales (PSMS). RESULTS: Prisoners of War reported more somatic symptoms (mean 7.2 vs 5.4, P = .002) than non-POWs, had more diagnoses (mean 9.4 vs 7.7 P < .001), and used a greater number of different medications (mean 4.5 vs 3.4, P = .001). There were no differences in hospital admissions or length of stay. Among 15 broad categories of diagnosis, differences were confined to gastrointestinal disorders (POWs 63% vs non-POWs 49%, P = .032), musculoskeletal disorders (POWs 76% vs non-POWs 60%, P = .011), and cognitive disorders (excluding head injury, dementia, and stroke) (POWs 31% vs non-POWs 15%, P = .006). Of the 36 signs in the neurology of aging examination, POWs had a significantly higher proportion of seven extrapyramidal signs and six signs relating to ataxia. POWs were more likely to be impaired on the IADL scale than were non-POWs (33% vs 17%, P = .012) but not significantly more likely to be impaired on the PSMS. CONCLUSIONS: There were few differences between POWs and controls, and those differences were relatively small. Our findings do not support a major role for a catastrophic life stress in the development of chronic illness and disability in later life. However it is possible that the POW experience played a part in premature, abnormal, or unsuccessful aging in some individuals.

Serologic evidence of Yersinia infection in patients with anterior uveitis.

Anterior uveitis is a common inflammatory eye disease associated with the HLA-B27 phenotype. Bacteriologic cofactors have been implicated in the pathogenesis of several diseases associated with HLA-B27. Using a sensitive enzyme-linked immunosorbent assay, we examined the incidence of previous Yersinia infection in a group of 28 consecutive patients with anterior uveitis. Twelve patients had a significantly increased antibody response to Yersinia, 8 of whom were HLA-B27 positive. Eight patients had IgM antibodies, possibly indicative of recent infection. There were no positive Yersinia serologic findings in our control group of 28 subjects, 13 of whom were HLA-B27 positive. A strong association was found between previous Yersinia infection and the development of anterior uveitis in HLA-B27-positive and HLA-B27-negative patients.

Psychosocial adjustment and the quality of the mother-child relationship at four months postpartum after conception by in vitro fertilization.

OBJECTIVE: To examine psychological adjustment to early motherhood at 4 months postpartum in mothers who conceived by IVF-ET. DESIGN: Controlled clinical study. SETTING: Healthy human volunteers in an academic research environment. PATIENT(S): Sixty-five primiparous women undergoing IVF-ET and 62 age-matched primiparous women with no history of infertility. INTERVENTION(S): Completion of questionnaires, interviews, and videotaped interaction. MAIN OUTCOME MEASURE(S): Maternal self-reports of psychosocial adjustment and behavioral ratings of quality of mother-infant interaction based on a videotaped observation scored blind to IVF-ET status. RESULT(S): Mothers who conceived by IVF-ET did not differ from control mothers on measures of anxiety, postnatal depression, marital satisfaction, or use of support services. However, they reported lower self-esteem and lower maternal self-efficacy, and they rated their infants as more temperamentally difficult. (Ratings of temperament difficulty for the infants of mothers who conceived by IVF-ET are within the normal range when compared with Australian normative data for this age group.) The videotapes revealed no group differences in maternal behaviors, but the infants of mothers who conceived by IVF-ET displayed more negative behaviors in response to an interactive stress. Group differences were accounted for largely by those mothers who underwent more than one treatment cycle and by their infants. CONCLUSION(S): Overall, the results are reassuring for parents who conceive by IVF-ET. However, specific adjustment measures reveal some minor difficulties and suggest that mothers who conceive by IVF-ET may benefit from increased support in the early postpartum months.

Parental adjustment and attitudes to parenting after in vitro fertilization.

OBJECTIVE: To examine the psychosocial and parenthood-specific adjustment and attitudes to parenting at 1 year postpartum of IVF parents. DESIGN: Prospective, controlled study. SETTING: Volunteers in a teaching hospital environment. PATIENT(S): Sixty-five primiparous women with singleton IVF pregnancies and their partners, and a control group of 61 similarly aged primiparous women with no history of infertility and their partners. INTERVENTION(S): Completion of questionnaires and interviews. MAIN OUTCOME MEASURE(S): Parent reports of general and parenthood-specific adjustment and attitudes to parenting. RESULT(S): The IVF mothers tended to report lower self-esteem and less parenting competence than control mothers. Although there were no group differences on protectiveness, IVF mothers saw their children as significantly more vulnerable and "special" compared with controls. The IVF fathers reported significantly lower self-esteem and marital satisfaction, although not less competence in parenting. Both IVF mothers and fathers did not differ from control parents on other measures of general adjustment (mood) or those more specific to parenthood (e.g., attachment to the child and attitudes to child rearing). CONCLUSION(S): The IVF parents' adjustment to parenthood is similar to naturally conceiving comparison families. Nonetheless, there are minor IVF differences that reflect heightened child-focused concern and less confidence in parenting for mothers, less satisfaction with the marriage for the fathers, and vulnerable self-esteem for both parents.

Adversity and the nature of psychiatric disorder in the community.

It is argued that in their account of mood disturbances, psychiatrists have traditionally distinguished their concepts of depressive illness from distress on the grounds that social adversity provides a completely adequate explanation for the latter, but not for the former. We have already shown in our comparison of a psychiatric out-patient sample with a community sample from the same area that symptoms in the former were more likely to be multiple, severe and of diagnostic significance (J.K. Wing et al. 1981a). In this paper we test the hypothesis that disorders in the community are more likely to be cases of distress. We predict that the association between such cases and social adversity will be stronger than for psychiatric out-patients and that the difference will be accounted for by the differences in clinical picture between the groups. In general our data confirm these predictions.

Adversity and working class vulnerability to minor affective disorder.

In this paper, we examine the proposition that members of lower social classes are more likely than those from higher classes to develop minor affective disorders in the face of adverse experiences. This was examined using data from a psychiatric survey of the general population of Camberwell, S.E. London, U.K. Working class subjects experienced significantly more adversity than their middle class counterparts. However, the relationship between life events and psychiatric disorder was consistent and considerable in the working class group. It was attenuated or non-existent in middle class subjects, depending on the particular categorisation of the data. Log-linear analyses suggested that the basis of this finding was unclear. Both the results and the underlying reasons for them merit further investigation.

Resuscitation. Patient and staff attitudes in the context of cancer.

One hundred oncology and hematology cancer patients from a major teaching hospital and their treating doctors were studied regarding their attitudes toward cardiopulmonary resuscitation (CPR). A descriptive approach was used, incorporating semistructured interviews of patients and medical staff and established questionnaire measures, examining knowledge of and attitudes toward disease and treatment, and projected attitude toward CPR and current psychological functioning. One-third of the patient sample anticipated a time when they would not consent to cardiopulmonary resuscitation. This was significantly associated with good disease prognosis. Patients with a psychiatric past history were also overrespresented. It appears that patient attitude to treatment withdrawal and refusal of CPR is related to disease progression and likely to change over time. This supports a dynamic and evolving model of advance directives rather than any fixed decree. Medical staff reported that they planned to provide half the sample with intensive medical treatment (including Intensive Care support in the event of their cardiac arrest), and 32% were designated for ward-based resuscitation only. Eighteen percent would not be resuscitated. These patients were older, had more treatment side effects, and a poorer quality of life. Those patients with either a psychiatric past history or higher ratings of depressive affect were also overincluded in the doctors' "Do-Not-Resuscitate" (DNR) group. These results suggest that there are other qualitative factors (e.g., current psychological functioning and past psychiatric history) that contribute to DNR decisions beyond the usual disease-based criteria seen in formal DNR protocols.

Resuscitation in cancer. Comparison of patient and health staff preferences.

One hundred oncology patients from a major teaching hospital and their treating health staff were studied in the second phase of research examining attitudes towards cardiopulmonary resuscitation (CPR). A descriptive approach was used incorporating semistructured interviews of patients and established questionnaire measures, examining knowledge of and attitude towards disease and treatment, psychological functioning, and current and projected attitude toward resuscitation. Health staff also participated in a semistructured interview. This phase of the project focused particularly on a direct comparison of patient and staff assessments. In current circumstances, 10% of patients refused resuscitation. This was associated with disease of good prognosis. In a future hypothetical deteriorated scenario presented to patients, 39% declined resuscitation. This was associated with a past history of suicidal behavior. In current circumstances, health staff designated 14% of patients "Do-Not-Resuscitate" (DNR)--this was associated with a number of variables considered to predict poor outcome in resuscitation. In the future scenario, staff designated 54% of patients DNR--this was associated again with poor resuscitation outcome variables, but also independently, with a past psychiatric history. Comparison of patient and health staff preferences for resuscitation showed moderate yet significant concordance in current circumstances but not in the future scenario. The findings indicate firstly the feasibility of discussing resuscitation preferences with seriously ill patients and secondly an urgent need to improve patient and staff discussions regarding resuscitation, as staff and patients' attitudes to resuscitation differ.

Work-related stress and depressive disorders.

The 1980s and 1990s has seen a considerable change in the workforce structure in industrialised economies. Employees are commonly faced with greater demands and less job security, both of which are likely to be stressful, thus psychological disorders especially depression may increasingly be caused by work-related stressors. An issue of this journal in 1997 (Vol. 43, No. 1) was indeed devoted to stress in the workplace and since then, these workplace changes have progressed and a review seems timely. Because interpreting results of cross-sectional studies is limited by a potential reciprocal relation between work stressors and depression (since "effort after meaning" can influence how "distressed" individuals report stressors at work), this review largely focuses on prospective or predictive studies to minimise this bias. Not surprisingly, the findings from occupational stress research is consistent with the more general life event stress literature showing that specific acute work-related stressful experiences contribute to "depression" and, more importantly perhaps, that enduring "structural" occupational factors, which may differ according to occupation, can also contribute to psychological disorders. There are significant implications for employees, their families, employers and indeed the wider community.

Type A behaviour and other psychological factors in peptic ulcer disease.

A variety of personality traits and psychological symptom states have been reported to be associated with peptic ulcer disease. In the present study, male patients with confirmed duodenal or gastric ulcer(s) are compared with patient and non-patient control groups in terms of Type A behaviour, the Eysenck personality dimensions, hostility, state and trait anxiety, and depression. By comparison with cardiac patients, the peptic ulcer groups obtained lower Type A scores but were similar on the other variables. By comparison with age and sex matched community controls. GU patients obtained higher trait anxiety and psychoticism scores while the DU group had higher state anxiety levels. The implications of these findings in terms of the role of psychological factors in the aetiology of peptic ulcer disease are discussed.

Psychological dysfunction in psychiatric and general nurse trainees.

The often held belief that psychiatric professionals are more psychologically disturbed than similar non-psychiatric professionals was not supported by the present study. Indeed in a comparison of two groups of nurse trainees, general nurse trainees showed a small but significantly greater degree of psychopathology than psychiatric nurses. When confounding variables and social desirability response set was taken into account, general nurse trainees had significantly higher scores on neuroticism, trait and state anxiety and depression. The groups did not differ on psychoticism (antisocial traits), extraversion, hypochondriasis or, work or social impairment. In terms of use of illicit drugs, the psychiatric nurses used only more cannabis than general nurses which was accounted for by females alone.