Couples' adjustment to breast disease during the first year following diagnosis.

The objectives were to determine (a) the extent to which psychosocial, demographic, and medical variables predict women's and husbands' adjustment to breast disease during the first year following diagnosis; (b) the degree of autocorrelation among and intercorrelation between partners' adjustment scores; (c) the extent to which baseline levels of adjustment predict adjustment 1 year later; and (d) the extent to which one partner's adjustment affects the other partner's adjustment. A stress-coping framework guided this study. The sample consisted of 131 couples, 58 couples received a cancer diagnosis and 73 received a benign diagnosis. Couples were interviewed at 1 week, 2 months, and 1 year postdiagnosis. Structural equation modeling was used to analyze the data. The strongest predictors of adjustment for women were severity of the illness and hopelessness and for husbands, their own baseline level of adjustment. Husbands' and wives' levels of adjustment at 1 year had a significant direct effect on each other's adjustment.

Surgical outcomes after breast cancer surgery: measuring acute lymphedema.

BACKGROUND: Studies of lymphedema have used inconsistent measures and criteria. The purpose of this pilot study was to measure the onset and incidence of acute lymphedema in breast cancer survivors using strict criteria for limb evaluation. MATERIALS AND METHODS: Eligible women were those undergoing breast cancer surgery that included axillary staging and/or radiation therapy of the breast. Arm volume, strength, and flexibility were measured preoperatively and quarterly. Lymphedema was defined as a greater than 10% increase in limb volume. Additional strength and flexibility assessments were done at these times. RESULTS: In 30 evaluable patients, half underwent modified radical mastectomy and half lumpectomy, with half of the lumpectomy patients undergoing axillary node staging. Of the 30 patients 27% were Stage 0; the rest were Stage I (27%), IIA (13%), IIB (23%), and IIIA (7%). One subject was IIIB postoperatively. There were 2 women with a 10% or greater change in limb volume; the change was detected in one woman at 3 months (5% incidence) and in the second woman at 6 months (11% incidence). Both had undergone mastectomy and axillary dissection and one of these two women had symptoms of tingling and numbness in the affected arm that began at 3 months. Overall, 35% of the sample experienced symptoms by 3 months, which included numbness, aching, and tingling of the entire upper extremity, but without volume changes. The relationship between undergoing modified radical mastectomy and experiencing symptoms in the affected limb at 3 months was significant (P = 0.05). CONCLUSIONS: In this interim report strict methods of measurement and limb volume comparisons detected acute lymphedema at 3 months in 5% of the sample, and at 6 months in 11% of the sample. Furthermore, symptoms were detected in 35% without volume changes at 3 months postoperatively, which may warn of lymphedema occurrence within the next 3 months. This may assist clinical evaluation of symptoms in the postoperative period and support early referral to lymphedema experts.

Couples' patterns of adjustment to colon cancer.

The objectives for this longitudinal study were to: (a) compare colon cancer patients' and their spouses' appraisal of illness, resources, concurrent stress, and adjustment during the first year following surgery; (b) examine the influence of gender (male vs female) and role (patient vs spouse caregiver) on study variables; (c) assess the degree of correlation between patients' and spouses' adjustments; and (d) identify factors that affect adjustment to the illness. Fifty-six couples were interviewed at one week post diagnosis, and at 60 days and one year post surgery. Based on a cognitive-appraisal model of stress, the Smilkstein Stress Scale was used to measure concurrent stress; the Family APGAR, Social Support Questionnaire, and Dyadic Adjustment Scale were used to measure social resources; the Beck Hopelessness Scale and Mishel Uncertainty in Illness Scales were used to measure appraisal of illness; and the Brief Symptom Inventory and Psychosocial Adjustment to Illness Scale were used to measure psychosocial adjustment. Repeated Measures Analysis of Variance indicated that spouses reported significantly more emotional distress and less social support than patients. Gender differences were found, with women reporting more distress, more role problems, and less marital satisfaction, regardless of whether they were patient or spouse. Both patients and spouses reported decreases in their family functioning and social support, but also decreases in emotional distress over time. Moderately high autocorrelations and modest intercorrelations were found among and between patients' and spouses' adjustment scores over time. The strongest predictors of patients' role adjustment problems were hopelessness and spouses' role problems. The strongest predictors of spouses' role problems were spouses' own baseline role problems and level of marital satisfaction. Interventions need to start early in the course of illness, be family-focused, and identify the couples at risk of poorer adjustment to colon cancer.

The quality of life of African American women with breast cancer.

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.

Couples' adjustment to breast cancer and benign breast disease: a longitudinal analysis.

A comprehensive comparison of couples' adjustment to benign (n = 73 couples) and malignant breast disease (n = 58 couples) at the time of diagnosis and at two follow-up assessments at 60 days and 1 year is reported. Specific objectives were to: (a) compare the concurrent stress, resources, appraisal, and patterns of adjustment of couples in the benign and malignant groups; (b) compare the psychosocial responses of patients versus spouses; and (c) determine the amount of correspondence in levels of adjustment reported by patients and their husbands over time. Multiple instruments with reported reliability and validity were used to measure study variables: Smilkstein Stress Scale, Dyadic Adjustment Scale, Family APGAR, Social Support Questionnaire, Mishel Uncertainty in Illness Scale, Beck Hopelessness Scale, Brief Symptom Inventory, and Psychosocial Adjustment to Illness Scale. Mixed design analyses of covariance (ANCOVA) were used to assess differences between and among couples and examine changes in study variables over time. Significant differences were found in the resources, appraisal, and patterns of adjustment reported by couples in the benign and malignant groups. Couples facing breast cancer reported greater decreases in their marital and family functioning, more uncertain appraisals, and more adjustment problems associated with the illness. In addition, there was a high degree of correspondence between the levels of adjustment reported by women with breast cancer and their husbands over time. Couples who reported high distress or a high number of role problems at diagnosis were likely to remain highly distressed at 60 days and 1 year. Study findings underscore the importance of assisting couples, not just patients, to manage the adjustment difficulties associated with breast cancer.

The effects of an AIDS diagnosis on undergraduate nursing students' care of dying patients.

Nurse educators frequently deal with nursing students' discomfort in learning to care for dying patients. However, teaching students how to care for dying patients with acquired immune deficiency syndrome (AIDS) presents unique and interesting challenges. The authors describe the influence an AIDS diagnosis has on students' comfort levels in touching and talking to dying patients. Recommendations and teaching strategies to assist nurse educators are provided.

Functions and preferred methods of receiving information related to radiotherapy. Perceptions of patients with cancer.

A convenience sample of 83 patients with cancer were interviewed before and/or after a full course of radiotherapy, with 36 patients interviewed both times, to determine their perceptions about the functions served by the information received from standard care personnel. Patients indicated the preferred sources of receiving information. The results indicate that information served three main functions. Active participation was the most frequently cited function. There was no difference by gender, age, education, or socio economic status (SES) in type of functions cited. Disadvantages in receiving information were rarely cited but included receiving bad news and inaccurate or vague information. Many stated that they nevertheless still wanted the information. Verbal communication, especially form the physician, followed by written material, was the most popular choice for receiving information at treatment. Written material was more frequently cited as the preferred type of information at posttreatment. Nurses were mentioned as an information source more frequently at posttreatment than at pretreatment. Implications of the findings for practitioners working with patients with cancer are discussed.

Ontogeny of pancreatic oncofetal antigen.

Serum concentration of pancreatic oncofetal antigen (POA) was determined in human fetuses, newborns and pregnant women. The mean fetal concentration of POA (mean = 5.27 micrograms/ml) changed very little with gestational age. Also, only a weak correlation was found between POA concentration of newborns (mean = 5.15 micrograms/ml) and their birth weight. It appears that between the 19th and 40th weeks of gestation POA exhibits no fetospecific features, i.e. POA concentration did not exceed significantly the concentration of nonpregnant adults (mean = 6.10 micrograms/ml). A number of pathophysiological variables was correlated with POA concentrations of newborns. The most striking statistical differences were found between American black and white newborns and adults; the mean concentration of POA in sera of black full-term newborns was 5.38 micrograms/ml as compared to white newborns, where the mean concentration was 3.58 micrograms/ml. Similarly, black mothers had a mean concentration (mean = 12.21 micrograms/ml) significantly greater than white mothers (mean = 5.62 micrograms/ml).

A differential scanning calorimetric study of the bovine lens crystallins.

Differential scanning calorimetry was performed on the five major lens crystallin fractions [HM-alpha, alpha, beta H, beta L, and (beta s + gamma)] of the bovine lens as well as on more purified forms of alpha- and gamma-crystallins. All were found to be relatively thermally stable although the alpha-crystallin were found to at least partially unfold at an approximately 10 degrees C lower temperature than the beta and gamma fractions. Increasing protein concentration had little effect on gamma-crystallin thermograms but had marked effects on those of the alpha- and beta-crystallins. Increases in the thermal stability with increasing protein concentration for the beta-crystallins can be explained most simply by the known beta L/beta H equilibrium, but, in the case of the alpha-crystallins, excluded volume effects may be an important factor. In both cases, the increased stability at high concentrations could be of physiological relevance. As well as the expected endothermic unfolding transitions, all of the lens crystallins revealed exothermic peaks that correlate with protein precipitation. Interestingly, this phenomenon occurs only after extensive structural alteration in the case of the alpha-crystallins but is present very early in the initial stages of structural perturbation of the beta- and gamma-crystallins.

Increasing patients' knowledge of radiation therapy.

Scripts for a set of patient education programs were developed by a multidisciplinary team of health care professionals to provide information to cancer patients receiving a 4-7 week course of external beam radiation therapy. The programs were designed to be presented sequentially at three critical points during a course of treatment: Pretreatment, Treatment Week 2, and Final Treatment Week. A total of 72 patients, 24 per program, with cancers of the lung, breast, or prostate, were assessed for their level of knowledge after hearing the audiotape appropriate to their treatment phase (posttest). Half of the patients, on a random basis, were also assessed prior to hearing their tape (pretest). This split design allowed the differentiation of true learning effects from effects of multiple assessments. Knowledge test items were developed from learning objectives for each program. Posttest results indicate a very high level of patient learning for all three programs, significantly exceeding the target of 75% correct. For patients tested twice, posttest scores were significantly higher than pretest scores. No testing effects were found for the Pretreatment and Treatment Week 2 programs. Final Treatment Week subjects who were pretested scored slightly higher on the posttest than their controls who were not pretested; however, additional analysis demonstrated true learning effects for this group as well. The results indicate that the programs are effective for increasing patients' knowledge regarding their treatment program, its side effects, and strategies to manage those side effects. Further research and intervention programs are discussed.

Pancreatic oncofetal antigen and carcinoembryonic antigen in breast and colon carcinoma.

Pancreatic oncofetal antigen (POA) and carcinoembryonic antigen (CEA) were determined in plasma of 195 patients with breast cancer and 90 patients with colon carcinoma. Increased levels of POA and CEA were seen in 19.0 and 25.6% of patients with breast cancer, respectively. Some but not all patients showed an increase in both markers. The incidence of abnormal concentrations of POA and CEA increased with the progress of the disease. POA appears to be a useful marker in breast cancer, especially in patients who have normal CEA levels. On the other hand, colon carcinoma patients showed increased POA concentrations considerably less frequently than CEA levels.

Effect of carbohydrate on protein solubility.

The effect of covalently attached carbohydrate on the solubility of a number of proteins has been examined by the PEG precipitation technique. Both increases and decreases in solubility are observed depending on the state of glycosylation, the type of protein, and temperature. It is concluded from this data and associated apparent thermodynamic parameters that a general role for carbohydrate in the solubilization of proteins is not currently experimentally supportable.

The effects of exercise on blood lipids and lipoproteins: a meta-analysis of studies.

The results of 66 training studies involving the measurement of human blood lipid and lipoprotein changes over time, conducted over the last 26 yr, and representing 2925 subjects (2086 experimental and 839 control) were collected and statistically aggregated using the meta-analysis technique. Across all types of subjects, treatments, sources, and research designs, the average exercising subject was found to have a reduction in total cholesterol of 10 mg X dl-1 (P les than 0.01), total triglyceride decreased by 15.8 mg X dl-1 (P less than 0.01), DHL-C increased by 1.2 mg X dl-1 (NS), LDL-C decreased by 5.1 mg X dl-1 (P less than 0.05), and total/HDL-C ratio showed a large decrease of 0.48 (P less than 0.01). None of the changes for the control groups were significant. Initial levels of total cholesterol, total triglyceride, HDL-C, and total/HDL-C ratio were strongly correlated with their respective changes as a result of training, regardless of the data partitioning. Higher initial levels of total cholesterol, total triglyceride, and total/HDL-C ratio resulted in greater decreases post-exercise (r = 0.48, 0.76, and 0.75, respectively; P less than 0.01), and lower initial levels of HDL-C resulted in greater post-exercise increases (r = 0.50; P less than 0.01). Overall, physical training seemed to produce beneficial changes in blood lipids and lipoproteins. However, researchers must be careful when examining the relationship between physical training and serum lipids and lipoproteins because initial levels, age, length of training, intensity, VO2max, body weight, and percent body fat have been shown in this meta-analysis to interact with exercise and serum lipid and lipoprotein changes.

Thermodynamic basis for the abnormal solubility of monoclonal cryoimmunoglobulins.

The thermodynamics of both normal and abnormal (disease-associated) protein solubility has been examined. It is shown that the atypical behavior of monoclonal cryoimmunoglobulins can be explained by the formation of one or a few additional electrostatic contacts or, less frequently, a larger number of van der Waals interactions in the protein-rich solid phase relative to normal immunoglobulin. It is hypothesized that cryoimmunoglobulins represent the outer edge of the solubility distribution of total serum immunoglobulin.

Sentence comprehension in preschool children: testing an adaptive egocentrism hypothesis.

A hypothesis proposing that preoperational egocentrism serves an adaptive function was used to predict the comprehension behavior of preschool children presented with sentences varying on a "personal" dimension. Personal sentences containing the subject's name were contrasted at 2 levels of syntactic complexity with impersonal sentences containing other familiar nouns. Significant effects were found for age, semantics, and syntax (all p's less than .001), with no sex effects or interactions. Personal sentences were better comprehended than impersonals at both levels of syntactic complexity. A second experiment was conducted to rule out "focusing of attention" as an alternative explanation. Variations in the likelihood of occurrence of the depicted event were added to the personal-impersonal contrast. High-probability personal sentences were significantly better understood than low-probability sentences, whether personal or impersonal (p less than .001). Results supported the adaptive egocentrism hypothesis in that sentence content describing the child and his personal experience facilitates the child's comprehension.