Tocainide kinetics in congestive heart failure.

Our subjects were 20 patients with life-threatening or symptomatic ventricular arrhythmias refractory to standard oral antiarrhythmic drugs but responsive to intravenous lidocaine. After evaluation of arrhythmias and treatment with intravenous lidocaine, oral tocainide dosage regimens were based on age, weight, and clinical status. During initial tocainide treatment, six plasma tocainide concentrations were recorded within a single dosing interval in 17 of 20 patients, by which standard kinetic parameters were calculated. Eventual trough steady-state tocainide plasma concentrations were predicted from the derived patient-specific kinetic parameters. Mean daily tocainide dose was 1800 mg (1200 to 2400). Mean daily tocainide doses (milligram per kilogram) did not differ significantly among responders and nonresponders or among patients with or without congestive heart failure. Mean peak and trough plasma concentrations 48 hr after initiation of therapy were 9.8 and 7.5 mcg/ml. Tocainide plasma concentrations did not correlate with responders and nonresponders or identify patients who were developing adverse reactions to tocainide. There were no significant differences in any of the calculated kinetic parameters as a function of response to tocainide or the presence of congestive heart failure, but there was a trend toward smaller volumes of distribution and higher average plasma concentrations at steady state in patients with congestive heart failure. There were no significant kinetic differences among patients with and without congestive heart failure, but a trend toward higher plasma concentrations in patients with congestive heart failure and the small number of patients suggests that further data collection is necessary before dosage recommendations can be made.

Life events and personal causation: some relationships with satisfaction and distress.

The factors that generate happiness or distress in people are not well understood, nor are factors that change such states. This study attempted to show that accounting for people's sense of personal causation could provide a clear understanding of the relationship between live events, personal activity, and measures of psychological well-being. After pretesting, three randomly selected groups of college students were given instructions either to (a) engage in 12 activities from a self-selected list of pleasurable activities, (b) engage in 2 activities from that list, or (c) return after 1 month for retesting only. Covariance analyses revealed that subjects instructed to engage in either 2 or 12 pleasurable activities reported greater pleasantness and a higher quality of life than controls; there were no differences between groups on reports of psychiatric distress. Prior negative life change was treated as a factor in the design and was found to interact with the activity instructions: Subjects reporting many prior negative changes exhibited less psychiatric distress along with greater pleasantness when instructed to engage in 12 activities rather than 2 or none. The results suggested that engaging in pleasant activities increases positive aspects of well-being in general, but may reduce distress only for subjects who are experiencing considerable life stress.

Some everyday life consequences of disability and bereavement for older adults.

The study analyzed daily event differences between groups experiencing the major stressors of conjugal bereavement and physical disability, and analyzed the association of everyday events with self-reports of mental health for different groups across a 3-month time span. Monthly interviews were conducted with 61 recently conjugally bereaved, 62 recently physically disabled, and 123 matched-comparison older adults between the ages of 60 and 80. The purpose of these interviews was to obtain a comprehensive assessment of the monthly frequencies of everyday life events. Self-reports of mental health were obtained from paper-and-pencil measures filled out after each interview. Causal models were used to analyze the best-fitting structure of event/mental health relationships for the first 3 monthly interviews. Undesirable events showed uniformly adverse effects on mental health. Desirable events benefited the psychological well-being of the disabled the most and had no positive effects on the mental health of the bereaved. The bereaved also evidenced less stability over time than other groups in the frequency of small undesirable events.

A perceived control intervention for at-risk older adults.

Models of event causation and affective processes were used to design an experimental intervention for older adults. Ss were 2 at-risk populations, recently disabled and recently bereaved, each with matched nonrisk controls. Ss were randomly assigned to a placebo-contact group, a no-contact control group, or a 4-session, 10-week intervention focused on enhancing perceived control. Dependent variables assessed were personal mastery, psychological well-being and distress, positive and negative affect, and measures of daily events and activities. The intervention was nested within a 16-month longitudinal assessment of stress and adaptation processes in a large sample of community residents. The intervention had mixed effects on reports of personal mastery, but it significantly increased engagement in desirable activities and significantly decreased psychological distress and negative affect. Effects tended to be short-lived, however. Effects of the intervention tended to be particularly significant for the disabled group.

Activity, event transactions, and quality of life in older adults.

A multidimensional assessment of activity and subjective well-being based on a cognitive model of event causation was tested in a sample of 60 older adults. Activity was conceptualized as involving the occurrence of an event, the presence or absence of a response to that event, and the hedonic tone of the outcome of that transaction. Events were categorized as to whether the environment or the individual initiated them: demands or desires, respectively. Well-being was conceptualized as having two independent components, positive and negative, assessed by positive and negative mood scales and general well-being and quality-of-life scales. Analyses showed that older adults who were responsive to events reported more positive well-being, but high responding was also associated with negative aspects of well-being. Demands interacted with desire responding and outcome; affective outcomes of desired actions were significantly influenced by the occurrence of demand events. Results are interpreted in an expanded model of activity theory.

Effects of disability and bereavement on the mental health and recovery of older adults.

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60-80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups.

Effect of information about role and outcome on alcoholics' attributional processes.

Alcoholics attributed an alcoholic's behavior to internal or dispositional factors. Alcoholics identified more closely with alcoholics who could succeed and nonalcoholics who failed than with nonalcoholics who could succeed and alcoholics who failed.

Diethylstilbestrol, genetics, teratogenesis, and tumor spectrum in humans.

Diethylstilbestrol (DES) is the first example of transplacental carcinogenesis in humans, as evidenced by an excess of clear cell adenocarcinoma of the vagina and cervix in exposed women. We hypothesize that: 1) in utero DES exposure will be responsible for a broader spectrum of cancer with variable age of onset as a function of latency effects in exposed humans of both sexes; 2) teratogenicity of DES will be more far-reaching than currently recognized and will harbor cancer implications in the face of known associations between teratogenesis and carcinogenesis; and 3) genetic heterogeneity will be a critical etiologic discriminant in DES associated cancer. This hypothesis embraces a prodigious body of data at the infrahuman level, as well as extant pharmacogenetic and ecogenetic observations in humans which signify heritable variations in response to environmental carcinogenic exposures. This hypothesis has important implications for drug testing with appropriate preventive strategies. Herein, particular restraints with monitoring through governmental legal channels must be employed. Past experience has clearly indicated negligence in shouldering this responsibility by both the pharmaceutical industry and government regulatory bodies.

Health downturns and predictors of suicidal ideation: an application of the Baumeister model.

Suicidal thoughts and attempts have been studied from a number of perspectives, but only recently has an attempt been made to incorporate many different psychological perspectives into one framework. Baumeister (1990) has integrated personality and social psychological perspectives into one sequential model, moving from instigating events to a final stage of suicidal thoughts. Employing a sample of older adult subjects undergoing the stresses of a recent health downturn, this study tested a four-stage model of suicidal ideation based on many of the components proposed by Baumeister. Structural equation modeling achieved a good fit to the data. Results are discussed in terms of the importance of including life events, particularly poor health, and cognitive variables such as confusions in thinking, in understanding suicidal ideation.