Emotional adjustment over 1 year post-diagnosis in patients with cancer: understanding and predicting adjustment trajectories.

PURPOSE: The aim of this study was to determine the prevalence of basic trajectories in emotional adjustment in cancer survivors and identify predictors of long-term change. METHODS: We assessed 421 patients with cancer after diagnosis and 6 and 12 months later. Measures comprised anxiety, depression, perceived support, desired support, and illness intrusiveness. RESULTS: Anxiety decreased over time, whereas depression increased as did need for support. About one third of initial diagnostic classifications (into low distress, symptoms, or clinical level of distress) changed from one assessment to the next. Lower age and higher illness intrusiveness predicted which patient showed worse adjustment over time. CONCLUSION: To avoid both over- and undertreatment of distressed individuals, repeated measurements are needed to identify actual adjustment trajectories. Initial assessment of emotional reaction to a diagnosis is not a reliable predictor of long-term adjustment. Patients should be made aware that completion of initial medical treatment even when accompanied by a positive prognosis does not in and of itself forecast how well patients adjust during survivorship.

Disease stage predicts post-diagnosis anxiety and depression only in some types of cancer.

BACKGROUND: We hypothesised that patients with advanced disease or a cancer type that has a poor prognosis may be more likely to report anxiety and depressive symptoms after diagnosis; younger age and female gender may moderate these effects. METHODS: Patients (n=3850) were consecutively assessed with PSSCAN, a standardised, validated tool, at two large cancer centres between 2004 and 2009. RESULTS: Female patients reported more anxiety and depressive symptoms (P=0.003 to P<0.001) compared with men and a healthy comparison group. Older age was associated with fewer anxiety (P=0.033 to P<0.001) and fewer depressive symptoms (P<0.001), but this was not true for lung cancer. Presence of metastases was associated with more anxiety symptoms in patients with gastrointestinal (P=0.044; R(2)Δ=0.001), lung (P=0.011; R(2)Δ=0.016), and prostate (P=0.032; R(2)Δ=0.008) cancer, but this was not true for breast cancer. Furthermore, early disease stage was associated with fewer depressive symptoms among older prostate cancer patients (P=0.021; R(2)Δ=0.008). Men with early lung cancer reported fewer anxiety (P=0.020; R(2)Δ=0.013) and depressive (P=0.017; R(2)Δ=0.016) symptoms than men with advanced disease or women. CONCLUSION: As hypothesised, disease stage was directly associated with emotional distress, except for patients with breast cancer. Furthermore, age and gender moderated some of these effects.

Measurement reliability for acupoint activity determined with the prognos ohmmeter.

The concepts of meridians and acupoints are critical to traditional Chinese medicine but are met with skepticism in Western medicine. Empirical validation of these concepts is in its beginning stages and still hampered by problems with measurement. A promising avenue and foundation for validity testing is the demonstration that acupoint activity can be reliably measured via determination of electrical resistance at well-defined body surface points. In this article, efforts are described to maximize measurement reliability; we tested a variety of protocols to determine which method of data aggregation is associated with maximal reliability. Twenty-one healthy individuals were subjected to 5 repeated measurement cycles to test the predicted increase in reliability with increasing number of aggregated measurements. Reliability, defined as internal consistency, was indeed highest for 5 measurements (mean alpha = .88). Even the aggregate of only three measures was quite reliable (alpha = .84). Reliability for measuring acupoints on the left side of the body was roughly .05 higher than on the right side. Consistent with previous literature, we conclude that with repeated measures the reliability of electrical resistance measurements at acupoints is high and that a strong foundation for validation research is now laid.

A Box-Cox normal model for response times.

The log-transform has been a convenient choice in response time modelling on test items. However, motivated by a dataset of the Medical College Admission Test where the lognormal model violated the normality assumption, the possibilities of the broader class of Box-Cox transformations for response time modelling are investigated. After an introduction and an outline of a broader framework for analysing responses and response times simultaneously, the performance of a Box-Cox normal model for describing response times is investigated using simulation studies and a real data example. A transformation-invariant implementation of the deviance information criterium (DIC) is developed that allows for comparing model fit between models with different transformation parameters. Showing an enhanced description of the shape of the response time distributions, its application in an educational measurement context is discussed at length.

[How calcification in the atherosclerotic aorta can be associated with both a lower risk of recurrent stroke in clinical studies and an increased number of strokes in an autopsy study: interpretation based on selection bias]. / Hoe calcificatie in de atherosclerotische aorta kan samengaan zowel met minder recidiefherseninfarcten in klinisch onderzoek als met een toegenomen aantal herseninfarcten in obductieonderzoek: interpretatie op basis van selectiebias.

Studies evaluating the role ofcalcification in the relationship between aortic atherosclerosis and stroke have led to contradictory conclusions: clinical studies show that aortic calcification is linked to a reduced risk of recurrence in stroke patients, while an autopsy series found a positive association between aortic calcification and stroke. The controversy can be explained by assuming that the risk associated with aortic atherosclerosis varies among individuals. Low-risk patients would live longer and have more time to develop calcification. Consequently, calcification would be a sign of low risk. This explains the apparent recurrence-reducing effect of calcification in stroke patients. The association between aortic calcification and stroke found in an autopsy series does not contradict this hypothesis but supports it: application of Berkson's fallacy shows that calcification is linked to lower mortality.

Relative importance of psychologic traits and severity of ischemia in causing angina during treadmill exercise. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.

OBJECTIVES: This study was conducted to compare the influence of psychologic traits versus ischemia severity on the occurrence of angina during treadmill exercise. BACKGROUND: Some studies suggest that angina is associated with certain psychologic traits, whereas others show an association with more severe ischemia. The relative influence of these two factors and the extent to which they interact are not known. METHODS: Off-drug treadmill exercise testing and a battery of psychologic tests were performed on 122 patients with known coronary artery disease. Psychologic tests measured sensitivity to physical symptoms, denial and deception, type A behavior, anger, hostility, depression, marital adjustment and amount of external stress. Stepwise logistic regression was used to determine the independent association of psychologic traits, ischemic threshold and exercise tolerance with the occurrence of angina. RESULTS: Angina during treadmill exercise was reported by 66 of 122 patients. On univariate testing, angina was positively associated with sensitivity to physical symptoms (p < 0.001), type A behavior (p = 0.021) and depression (p = 0.032) and was negatively associated with exercise tolerance (p < 0.001) and work load threshold for ischemia (p < 0.01). Multivariate analysis revealed independent and additive associations of angina with sensitivity to physical symptoms (p = 0.003), exercise capacity (p = 0.003) and work load threshold for ischemia (p = 0.018). Once these were included in a logistic model, depression and type A behavior were no longer significant. Other psychologic traits showed no association with angina. CONCLUSIONS: Sensitivity to physical symptoms, ischemic threshold and exercise tolerance are independently associated with angina, with sensitivity to physical symptoms having the stronger influence. The physiologic and psychologic mechanisms underlying symptom perception have an influence on angina that is independent of and additive to the severity of underlying ischemia.

Exposure treatments for focal phobias. A review.

The effectiveness of in vivo exposure is evaluated in a comprehensive review of outcome studies on phobia treatments. A strictly data-based analysis focuses on issues of analog vs clinical research, methodological quality of designs, utilization of generalized measures, and maintenance of therapeutic change. In vivo exposure appears to be an effective treatment, both short- and long-term, and some decision rules for the clinical application are provided. However, from a researcher's point of view many methodological weaknesses (such as frequent lack of follow-up; unrealistic behavioral measures; and the utilization of unnecessarily complicated, and at times confusing, designs) are noted. A considerable consensus on the major procedural variables and on positive overall outcome justifies the clinical utility of the procedure. Detailed suggestions for further treatment comparisons are outlined, and a cautionary note on the potential of such a data-based review are added.

Psychosocial interventions for patients with coronary artery disease: a meta-analysis.

BACKGROUND: Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence. OBJECTIVE: To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease. METHODS: We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies. RESULTS: The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99). CONCLUSIONS: The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.

Individualized stress management for primary hypertension: a randomized trial.

OBJECTIVE: To test the efficacy of individualized stress management for primary hypertension in a randomized clinical trial with the use of ambulatory blood pressure (BP) measures. METHODS: Men and women aged 28 to 75 years with mean ambulatory BP greater than 140/90 mm Hg received 10 hours of individualized stress management by means of semistandardized treatment components. They were randomly assigned to immediate treatment (n = 27) or a wait list control group (n = 33). Participants on the wait list were subsequently offered treatment. Six-month follow-up data were available from 36 of the 45 participants who completed treatment. Measures were 24-hour ambulatory BP, lipid levels, weight, and psychological measures. RESULTS: Blood pressure was significantly reduced in the immediate treatment group and did not change in control subjects (-6.1 vs +0.9 mm Hg for systolic and -4.3 vs +0.0 mm Hg for diastolic pressure). When the wait list control group was later treated, BP was similarly reduced by -7.8 and -5.2 mm Hg, and for the combined sample, total change at follow-up was -10.8 and -8.5 mm Hg. Level of BP at the beginning of treatment was correlated with BP change (r = 0.45 [P<.001] and 0.51 [P<.001], respectively), and amount of systolic BP change was positively correlated with reduction in psychological stress (r = 0.34) and change in anger coping styles (r = 0.35-0.41). CONCLUSIONS: Individualized stress management is associated with ambulatory BP reduction. The effects were replicated and further improved by follow-up. Reductions in psychological stress and improved anger coping appear to mediate the reductions in BP change.

Skeletal stability following mandibular advancement with and without advancement genioplasty.

The correction of most cases of skeletal class II mandibular deficiency requires surgical advancement of the mandible for treatment of the malocclusion. Often genioplasty is included in the procedure to improve the soft tissue profile. Long-term skeletal stability is an important goal for the surgeon and orthodontist following bilateral sagittal split osteotomy (BSSO) and is influenced by the muscles attached to the mandible. Following the surgical advancement of the mandible, the suprahyoid muscle complex is stretched and even more so when the procedure is combined with surgical advancement of the chin. This retrospective comparative study determined the long-term skeletal stability of patients who had undergone surgical advancement of the mandible by means of BSSO with an advancement genioplasty, compared to those who had undergone mandibular advancement surgery (BSSO) without an advancement genioplasty. This study concluded that the postoperative hard tissue relapse following BSSO advancement, with or without genioplasty, was clinically insignificant.

Defensiveness status predicts 3-year incidence of hypertension.

OBJECTIVE: A growing body of research indicates that defensive personality styles (in particular, self-deception) may be related to higher resting blood pressure and stress reactivity levels. This study is the first, however, to examine the value of defensiveness as a prognostic indicator for the development of clinical hypertension. METHODS: Participants were 127 initially normotensive male and female adults who completed a comprehensive protocol including psychological testing, assessment of smoking, physical activity and body fat levels, and 8-12 h ambulatory blood pressure monitoring. Participants returned 3-years later for an identical follow-up protocol. Defensiveness was assessed using the Balanced Inventory of Desirable Responding. RESULTS: At 3-year testing, 15 of 127 participants (12%) met criteria for hypertension (i.e. ambulatory mean blood pressure > 140/90). Comparisons between defensiveness groups showed that 12 of 60 (20%) high defensiveness participants met hypertension criteria, whereas only three of 67 (4.5%) low defensiveness participants were hypertensive. Logistic regression equations adjusted for age, alcohol usage, bodyfat, self-reported exercise levels, smoking, and year-1 ambulatory blood pressure, revealed that membership in the high defensiveness group was associated with more than a sevenfold risk of 3-year hypertension (adjusted risk ratio, 7.5; 95% confidence interval, 1.5-39.2). CONCLUSIONS: These findings link defensive characteristics to an increased prospective risk of hypertension using state of the art ambulatory monitoring techniques, and were robust after controlling for established risk factors. We conclude that the current results add to the hypertension literature by demonstrating associations between personality and clinically relevant blood pressure criteria.

Flow cytometric prescreening of cervical smears.

One-parameter (nuclear DNA) and two-parameter (nuclear DNA and protein or cellular light scatter) measurements of cervical smears were performed using an ICP 11 and a cytofluorograf 4800 respectively. A total of about 1000 cases was analyzed. For the estimation of nuclear DNA alone two fluorochromes were tested (ethidium bromide (EB) and mithramycin (MMC)) combined with three different methods of cell preparation. For the two-parameter measurements cells were double stained with EB and fluorescein isothiocyanate (FITC). Red fluorescence (EB) versus green fluorescence (FITC) or red fluorescence versus scatter were recorded. A computer analysis of the one-parameter histograms was performed using discriminant analysis and the results were compared with the cytodiagnosis of microscopic specimens stained with the Papanicolaou technique. The error rates of the flow cytometric (FCM) data were as follows: (a) standard EB staining, 11% false negative, 26% false positive, 6% unsatisfactory results; (b) pepsination of vital cells and EB staining, 12% false negative, 14% false positive and 4% unsatisfactory results; (c) MMC staining, 10% false negative, 65% false positive and 5% unsatisfactory results. Our two-parameter measurements prove that, as confirmed by cell sorting, red fluorescence versus scatter allows separation of at least three subpopulations in most analyzed samples: (a) anucleated cells; (b) leukocytes; and (c) intermediate and superficial cells.

Filling of the gallbladder as studied by computer-assisted Tc-99m HIDA scintigraphy: concise communication.

Gallbladder filling was studied using computer-assisted cholescintigraphy in normal subjects who had fasted overnight. The gallbladder tended to visualize earlier than the distal part of the common bile duct. It appeared at approximately the same time regardless of whether or not there was passage of activity into the duodenum. This suggests that filling is not dependent on contraction of the sphincter of Oddi. Sequential images demonstrated that the activity entering the gallbladder rapidly reached the fundus. Time-activity curves showed a gradual buildup of activity in the bile ducts followed by sudden entrance into the gallbladder. Time-activity curves of the gallbladder's proximal and distal parts showed signs of an exchange of activity, suggesting that the gallbladder's motor function is not quiescent during fasting. Gallbladder motility could explain the periodic irregularities on the time-activity curve. These irregularities were smaller but not less frequent after morphine administration.

Transient nonvisualization of the gallbladder by Tc-99m HIDA cholescintigraphy in acute pancreatitis: concise communication.

In five of seven patients with acute pancreatitis, Tc-99m HIDA scintigraphy failed to visualize the gallbladder. In all five patients the gallbladder was later found to be normal and in three of them normal filling was obtained at a repeat examination performed after the attack had subsided. Transient nonvisualization of the gallbladder in acute pancreatitis is probably due to disturbed motility of the biliary tree.

Pitfalls in randomized surgical trials.

Special problems may arise when the principles of the randomized trial are used to compare operative methods. In the trial design that is used at present, each surgeon performs the operatons to be compared in a random order. A prerequisite for a trial so designed to result in a fair comparison is that the participating surgeons are equally conversant with both techniques. If they are not, the design may imply systematic bias in favor of operations that are in wide use and bias in favor of technically simple procedures. An alternative to this design is given. Reports on trials should contain information about pretrial routine and level of training of participants.

Malignant tumors of the extrahepatic bile ducts.

A series of 76 patients treated for carcinoma of the extrahepatic bile ducts at three Swedish hospitals during the years 1952 to 1973 was studied. The mean age of the patients was 68 years. Gallstones were found in 22 patients, whereas 11 patients had undergone cholecystectomy earlier for gallstone disease. At operation widespread metastases were found less often in patients with cancer of the papilla of Vater than in patients with cancer of other locations. This is interpreted as indicating that patients with papillary carcinoma are treated in an earlier stagage of the disease. This interpretation is supported by the finding that these patients had a longer length of survival after bypass supported by the finding that these patients had a longer length of survival after bypass supported by the finding that these patients had a longer length of survival after bypass operations (11.5 months). In spite of treatment in an early stage, survival after radical surgery was disappointingly short (4.6 months). On the other hand, patients with cancer located above the papilla of Vater survived for 6.8 months after bypass operations as compared with 23.3 months after rescetion. The possibilities of radical surgery should be considered carefully, especially in patients in whom the malignancy is located above the papillary region.

Analysis of multicomponent mass spectra applying Bayesian probability theory.

In this paper we develop a method for the decomposition of mass spectra of gas mixtures, together with the relevant calibration measurements. The method is based on Bayesian probability theory. Given a set of spectra, the algorithm returns the relative concentrations and the associated margin of confidence for each component of the mixture. In addition to the concentrations, such a data set enables the derivation of improved values of the cracking coefficients of all contributing species, even for those components for which the set does not contain a calibration measurement. This latter feature also allows one to analyze mixtures that contain radicals in addition to stable molecules. As an example, we analyze and discuss the mass spectra obtained from the pyrolysis of azomethane, which contain the radical CH3 apart from nitrogen and C1- and C2-hydrocarbons.

Is response adaptation a threat to the high-low reactor distinction among female college students?

Examined cardiovascular-response adaptation patterns in high- versus low-cardioreactive women. Responses to a mental-arithmetic-plus-noise task were compared within trials (3 min each), across trials (three per session), and across two sessions separated by a 4-week interval. Forty-four normotensive women (mean age = 22.5 years) completed the study. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were monitored. Analyses of variance were employed to analyze the repeated-measures design and indicated consistent decreases in HR, SBP, and DBP response magnitudes across visits, trials, and minutes. Decreases in HR were greatest from Minute 1 to Minute 2 within each trial and, similarly, from Trial 1 to Trial 2 within each visit. BP responses showed a delayed onset of within-trial adaptation. Reactivity groups were formed for (a) SBP reactivity for HR and DBP analyses and (b) HR reactivity for SBP analyses. Although high reactors (top tercile) showed greater adaptation to task repetition in all responses compared to low reactors (lowest tercile), they also consistently displayed greater responses. Even during the final task, SBP and HR responses discriminated between high and low reactors.

Psychological response styles and cardiovascular health: confound or independent risk factor?

Using results from 2 large cardiovascular studies, the authors examined the utility of treating psychological response styles as confounds (e.g., factors undermining relationships with other self-report variables) versus distinct personality traits in the prediction of cardiovascular health. Study 1 consisted of a 3-year prospective study of ambulatory blood pressure levels in healthy adults (N = 125). Study 2 comprised a 12-week drug treatment program for ischemic heart disease patients (N = 95). Participants completed measures of psychological factors and self-deception and impression management in each study. Results consistently favored using response styles as direct predictors. Self-deception scores predicted elevated 3-year diastolic and systolic blood pressure changes in Study 1 and poorer treatment outcomes in Study 2. Statistically controlling for response style effects within the psychological factors generally did not improve predictions. These findings argue against the conceptualization of response styles as stylistic confounds.

Sex differences in social support, self-deception, hostility, and ambulatory cardiovascular activity.

The quality of the social network, ambulatory cardiovascular indices, and other health risks were assessed in 129 students. Ss carried an ambulatory monitor for a working day and completed a social support scale, an index of daily stress, and measures of anger expression, hostility, depression, and self-deception. Alcohol intake and skinfold thickness were assessed. Results indicated that quality of social support was related in an inverse manner to ambulatory systolic pressure in women only. Stepwise multiple regression confirmed that social support was an independent predictor of daily systolic pressure for women and was not confounded with subjective stress. For men, tendencies to self-deception and high hostility were independently related to elevated blood pressure and heart rate.