Self-Rated Health Among Patients With Severe Traumatic Brain Injury and Their Close Relatives: The Role of Posttraumatic Stress Symptoms.

OBJECTIVE: Severe traumatic brain injury (sTBI) is accompanied by significant declines in self-rated health (SRH). Although such deteriorations in SRH are related to various consequences of sTBI, the effect of posttraumatic reactions (i.e., posttraumatic stress [PTS] symptoms) has been tested insufficiently to date, especially among civilians. The present investigation is based on Trajectories of Recovery After Severe Traumatic brain injury-Matters In families (TRAST-MI), a unique study among civilians with sTBI and their families. Previous research revealed that civilian sTBI has effects beyond the injured patient, influencing their close relatives as well. The aim of this study was to assess the association between PTS symptoms and SRH among patients with civilian sTBI and their close relatives. METHODS: Patients with sTBI (assessed by an Abbreviated Injury Scale of the head region score >3) and their close relatives participated in TRAST-MI. One hundred twenty-six patient-relative dyads were assessed at 3, 6, and 12 months after the injury. RESULTS: Multilevel modeling revealed that patients' PTS symptoms were associated with consequent SRH (slope = 0.42; p < .001), and relatives' PTS symptoms were associated with their respective SRH (slope = 0.2; p = .012). CONCLUSIONS: The findings of this study reveal that SRH of both patients with sTBI and their relatives are negatively affected by their own PTS symptoms. These findings underline the understanding that sTBI is not merely a medical trauma but rather a comprehensive psychosocial trauma, which has consequences for the whole family system.

The effect of mindful attention training for pain modulation capacity: Exploring the mindfulness-pain link.

OBJECTIVE: Mindfulness has been shown to be beneficial for chronic pain. The underlying mechanisms of the mindfulness-pain link, however, are yet to be established. Particularly, the effects of mindfulness on pain modulation, which is shown to be dysfunctional among chronic pain patients, barely has been tested. This study investigated whether a short mindful attention training based on Langerian mindfulness mitigates reductions in pain modulation. METHOD: Systemic quantitative-somatosensory testing of conditioned pain modulation (CPM) was conducted in 60 undergraduates, who were randomly assigned to one of three groups: (1) Pain-specific mindful attention training; (2) nonspecific mindful attention training; and (3) no mindful attention training. CPM was tested before and after the intervention. RESULTS: As hypothesized, a reduction in CPM magnitude was observed only in the control group, whereas this reduction was abolished in the two mindfulness groups. CONCLUSIONS: Langerian mindfulness may mitigate pain modulation reduction as observed in chronic pain, thus shedding light on its potential advantages.

Patients' recovery after severe TBI is associated with their close relatives' interpersonal functioning: a 12-months prospective cohort study.

OBJECTIVE: The aim of this study was to investigate the association between relatives' interpersonal functioning and patients' recovery after severe traumatic brain injury (TBI) across one year in Switzerland. Design: This prospective, multi-center cohort study is comprised of 188 adult patients with severe TBI (Abbreviated Head Injury Score > 3) and their relatives. Patients and relatives were assessed 3, 6, and 12 months post-injury. Main outcome measures: Interpersonal functioning (Patient Competency Rating Scale for Neurorehabilitation, PCRS-NR), Physical and Mental Health related Quality of Life (HRQoL, SF-12), and overall functioning (Glasgow Outcome Comma Scale Extended, GOSE). Results: Multilevel analyses showed that relatives' interpersonal functioning was positively associated with a) patients' mental HRQoL (p =.002; slope = 2.95; ß =.24) independently of age, b) a moderation time*patients' physical HRQoL among patients > 50 years of age (p <.045; slope = 2.63; ß =.2) and c) patients' GOSE among younger individuals (p <.001; slope =.60; ß =.23). Conclusion: These findings show that health and overall functioning are linked with interpersonal dimensions. Thus, the interplay between relatives and patients with TBI needs to be further investigated.

Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms.

Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients' close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives' physical health was predicted by relatives' PTS symptoms (Slope=-1.76; p = .043), and mental health was predicted by both patients' (Slope=-2.77; p = .034) and relatives' (Slope=-6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients' PTS symptoms (Slope=-.25; p< .001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.

El traumatismo craneoencefálico grave (TCEG) generalmente provoca una discapacidad duradera generalizada y está acompañado por una larga rehabilitación. Como es de esperarse, el TCEG también tiene consecuencias nocivas para los familiares cercanos de los pacientes. El agobio causado por la lesión y su gravedad explica algunas de las repercuciones en los familiares. Además, algunos resultados demuestran que los pacientes con TCEG y sus familiares desarrollan síntomas de estrés postraumático (EPT). Sin embargo, aunque la asociación entre los síntomas de EPT y la salud física y mental está bien documentada en la bibliografía, el efecto de los síntomas de EPT en los familiares de los pacientes con TCEG casi no se ha analizado. Este estudio analiza la influencia de los síntomas de EPT de los pacientes con TCEG y sus familiares en la salud física y mental y en el funcionamiento de los familiares. Se incluyó a pacientes que sufrieron un TCEG (escala abreviada de lesiones de la región craneana > 3) y a familiares cercanos en un estudio de cohorte prospectivo realizado en varios centros (TRAST-MI). Se evaluó a cien pacientes y a sus familiares a los dos, a los seis y a los doce meses después de la lesión. Entre los criterios de valoración se encontraron la calidad de vida relacionada con la salud (SF-12) así como el funcionamiento emocional, cognitivo, interpersonal y total (PCRS). La salud física de los familiares se predijo mediante los síntomas de EPT de los familiares (Pendiente = -1.76; p = .043), y la salud mental se predijo mediante los síntomas de EPT de los pacientes (Pendiente = -2.77; p = .034) y los familiares (Pendiente = -6.59; p < .001). El nivel de funcionamiento solo se predijo mediante los síntomas de EPT de los pacientes (Pendiente = -.25; p < .001). Los resultados enfatizan que el TCE debe considerarse una experiencia traumática amplia que va más allá del mero daño físico al cerebro y sus consecuencias directas, y que afecta a la persona lesionada y a sus familiares cercanos.

Association of Posttraumatic Stress Symptom Severity With Health-Related Quality of Life and Self-Reported Functioning Across 12 Months After Severe Traumatic Brain Injury.

OBJECTIVE: To investigate the relation between posttraumatic stress (PTS) symptom severity and health-related quality of life (HRQoL) after severe traumatic brain injury (TBI). DESIGN: Longitudinal prospective multicenter, cohort study on severe TBI in Switzerland (2007-2011). SETTING: Hospital, rehabilitation unit, and/or patient's living facility. PARTICIPANTS: Patients with severe TBI (N=109) were included in the analyses. Injury severity was determined using the Abbreviated Injury Score of the head region after clinical assessment and initial computed tomography scan. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: HRQoL (Medical Outcomes Study 12-Item Short-Form Health Survey Physical and Mental Component Summaries) and self-reported emotional, cognitive, and interpersonal functioning (Patient Competency Rating Scale for Neurorehabilitation). RESULTS: Multilevel models for patients >50 and ≤50 years of age revealed significant negative associations between PTS symptom severity and interpersonal functioning (P<.001 and P=.002), respectively. Among patients ≤50 years of age, PTS symptom severity was significantly associated with total functioning (P=.001) and emotional functioning (P<.001). Among all patients, PTS symptom severity was significantly associated with cognitive functioning (P<.001) and mental HRQoL (P=.01). CONCLUSIONS: Findings indicate that PTS symptoms after severe TBI are negatively associated with HRQoL and emotional, cognitive, and interpersonal functioning.

Twelve-month prospective cohort study of patients with severe traumatic brain injury and their relatives: Coping, satisfaction with life and neurological functioning.

BACKGROUND: To examine the associations between the functioning of patients with severe traumatic brain injury (TBI), and their relatives' coping style and quality of life across 12 months post-injury. METHODS: Prospective, population-based cohort study assessing 188 patients with severe TBI (Abbreviated Injury Scale of the head region [HAIS] score >3), and their relatives, 3, 6 and 12 months post-injury. Data were drawn from a larger national study run in Switzerland (2007-2011). Patient assessment: Glasgow Coma Outcome Scale Extended (GOSE), Patient Competency Rating Scale for Neurorehabilitation (PCRS-NR). Relative assessment: Health-Related Quality of Life (HRQoL; 12-item short form health survey [SF-12]), Coping Inventory for Stressful Situations (CISS). Mixed linear models were run separately for ages >50 and ≤50 (i.e. bimodal distribution). RESULTS: Patients' GOSE score was associated with relatives' reported mental SF-12 scores across age (ps < 0.01). Relatives' CISS was associated with patients' PCRS score (age > 50 years): Total and cognitive functioning decreased as emotion-oriented coping increased (ps = 0.01), while interpersonal functioning increased as task-oriented coping increased (p = 0.01) and decreased as avoidance-oriented coping increased (p = 0.02). CONCLUSION: Patients' functioning and relatives' mental HRQoL and coping strategies are associated with each other.

Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury.

OBJECTIVE: The objective was to investigate disability and health-related quality-of-life (HRQoL) 3, 6 and 12 months after traumatic brain injury (TBI) in non-geriatric (≤ 65 years) and geriatric patients (> 65 years). METHODS: Patients ≥ 16 years who sustained a severe TBI (Abbreviated Injury Scale of the head region > 3) were included in this prospective, multi-centre study. Outcome measures were Glasgow Outcome Scale Extended (GOSE; disability), SF-12 (HRQoL). Mixed linear model analyses were performed. RESULTS: Three hundred and fifty-one patients (median age = 50 years; interquartile range (IQR) = 27-67) were included; 73.2% were male and 27.6% were geriatric patients. Median GOSE at 3, 6 and 12 months was 5 (IQR = 3-7), 6 (IQR = 4-8) and 7 (IQR = 5-8); this increase (slopetime = 0.22, p < 0.0001) was age dependent (slopeage*time = -0.06, p = 0.003). Median SF-12 physical component scale score at 3, 6 and 12 months was 42.1 (IQR = 33.6-50.7), 46.6 (IQR = 37.4-53.9) and 50.4 (IQR = 39.2-55.1); this increase (slopetime = 1.52, p < 0.0001) was not age dependent (slopeage*time = -0.30, p = 0.083). SF-12 mental component scale scores were unchanged. CONCLUSIONS: Disability decreased and HRQoL improved after TBI between 3-12 months. In geriatric patients this improvement was relevant for HRQoL only.

The Relatives' Big Five Personality Influences the Trajectories of Recovery of Patients After Severe TBI: A Multilevel Analysis.

This study examines the influence of the personality of relatives on the trajectories of recovery of patients with severe traumatic brain injury (TBI). The present subsample (N = 376) of a larger population-based, prospective, 12-month multicenter cohort study in Switzerland (2007-2011) consists of patients with severe TBI (age ≥ 16) and their relatives. The predictors are the NEO Five-Factor Inventory and time (trajectory of functioning of the patient over time). The outcomes are the patients' (a) neurological functioning; (b) reported emotional, interpersonal, cognitive, and total functioning post-injury; and (c) health-related quality of life (HRQoL). The covariates included Abbreviated Injury Scale score of the head region and age. Results for patients > 50 are (a) relatives' Extraversion influenced patients' total, interpersonal, and cognitive functioning; (b) relatives' Agreeableness influenced patients' interpersonal functioning; and (c) relatives' Conscientiousness influenced patients' physical HRQoL (ps < .05). Results for patients ≤ 50 are (a) relatives' Neuroticism influenced patients' neurological and emotional functioning, and (b) relatives' Extraversion influenced patients' emotional functioning and psychological HRQoL (ps < .05). The personality traits of the relative covary with the functioning of the patient, and psychological adaptation to the loss of function may progress at a later stage after physical health improvements have been achieved. Thus, a biopsychosocial perspective on the rehabilitation process is needed.

Longitudinal functional brain imaging study in early course schizophrenia before and after cognitive enhancement therapy.

OBJECTIVE: Schizophrenia is characterized by impaired -social and non social cognition both of which lead to functional deficits. These deficits may benefit from cognitive remediation, but the neural underpinnings of such improvements have not been clearly delineated. METHODS: We conducted a functional magnetic resonance (fMRI) study in early course schizophrenia patients randomly assigned to cognitive enhancement therapy (CET) or enriched supportive therapy (EST) and treated for two years. Imaging data over three time points including fMRI blood oxygen level dependent (BOLD) data were acquired during performance of a cognitive control paradigm, the Preparing to Overcome Prepotency (POP) task, and functional connectivity data, were analyzed. RESULTS: During the two years of treatment, CET patients showed a continual increase in BOLD activity in the right dorsolateral prefrontal cortex (DLPFC), whereas EST patients tended to show no change in prefrontal brain function throughout treatment. Increases in right DLPFC activity were modestly associated with improved neurocognition (ß = .14, p = .041), but not social cognition. Functional connectivity analyses showed reduced connectivity between the DLPFC and the anterior cingulate cortex (ACC) in CET compared to EST over the two years of treatment, which was associated with neurocognitive improvement. CONCLUSIONS: These findings suggest that CET leads to enhanced neural activity in brain regions mediating cognitive control and increased efficiency in prefrontal circuits; such changes may be related to the observed therapeutic effects of CET on neurocognitive function.

Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients' relatives: a multilevel analysis.

OBJECTIVE: The objective of the present investigation was to examine the association of mindful creativity with the trajectory of recovery (emotional, interpersonal, cognitive, and total functioning) of patients with severe TBI. METHODS: This was drawn from a subsample of an adult prospective cohort study on severe TBI in Switzerland; patients and their relatives were assessed at 3, 6, and 12 months (patients N = 176, relatives N = 176). Predictor measures were assessed using Mindful Creativity Scale-short form and time (trajectory of functioning of the patient over time). Outcome measures were assessed using Patient Competency Rating Scale for Neuro-rehabilitation (PCRS-NR; measuring emotional, interpersonal, cognitive, and total functioning post-injury). All measures were assessed at each time point. Mixed linear models were run separately for ages >50 and ≤50 (i.e., bimodal distribution). RESULTS: Patients' mindful creativity showed no significant association with patients' functioning across time in any of the models. In all age groups, interpersonal functioning decreased across time (slope>50 = -4.66, p = .037; slope≤50 = -7.19, p = .007). Interestingly, in age group ≤50, interpersonal functioning increased when looking at relative mindful creativity by time (slope = 1.69, p = .005). Additionally, relatives mindful creativity was significantly associated with patients' functioning in age group ≤50: (a) patients' total functioning (slope = 0.18, p = .03) and (b) cognitive functioning (slope = 0.72, p = .020). CONCLUSIONS: Relatives' mindful creativity was significantly associated with patients' functioning after severe TBI. Implications for treatment and future research are discussed.

Trajectories of smoking behavior as a function of mood and satisfaction with life: What matters most?

BACKGROUND: Worldwide, tobacco use causes more than 5 million deaths per year. The present study investigated possible preventative factors of nicotine dependence, such as mood and Satisfaction With Life (SWL). METHODS: Longitudinal Internet survey of 1957 individuals assessed three times at a two week interval (2007-2010). OUTCOME MEASURES: Cigarette Dependence Scale (CDS), feeling prisoner to cigarettes, smoking cessation, reduction, and relapse. PREDICTORS: Time (i.e. trajectory of dependence over time), smoking status (daily, occasional or ex-smoker), mood, and SWL. All measures were assessed at each time point. RESULTS: Both SWL, and mood, respectively were significantly associated with dependence (slopeSWL=-0.03, slopeSWL=-0.11, ps<0.001). With respect to feeling prisoner to cigarettes, mood but not SWL showed a significant association (slopeSWL=-0.14, p<0.001). Occasional, and ex-smokers showed significantly greater decrease in psychological dependence, as mood increased, than daily smokers (slopeoccasional=-0.28, poccasional=0.011; slopeex=-0.27, pex<0.001). Smoking cessation decreased over time, and both mood, as well as SWL had a significant impact on cessation (ORmood=1.43, pmood<0.01, ORSWL=1.15, pSWL=0.042). Reduction in smoking was predicted by SWL only (ORSWL=1.21, p=0.043), whereas relapse was predicted by mood only (ORmood=0.55, p<0.01). LIMITATIONS: The participants were self-selected. Possible confounding relationships (e.g., medication) have to be further assessed. CONCLUSIONS: Cigarette dependence, feeling prisoner to cigarettes, cessation, and reduction are significantly influenced by both mood and SWL. Treatments may thus tackle mood regulation, SWL, and nicotine dependence in tandem.

Preoperative and early postoperative quality of life after major surgery - a prospective observational study.

BACKGROUND: Changes in health-related quality of life (HRQoL) several days after surgery have rarely been investigated. We aimed to estimate the perioperative change of HRQoL, to identify patients with clinically relevant decrease in postoperative HRQoL and to establish factors associated with this decrease in HRQoL at day 30 after major surgery. METHODS: Patients scheduled for major surgery at a university hospital were enrolled. Based on the HRQoL SF-12 questionnaire, the preoperative physical component summary (PCS) score, preoperative mental component summary (MCS) score, and postoperative PCS and MCS scores at day 30 were recorded. Minimal clinically important difference (MCID) was defined as those with a decrease of at least one half of the standard deviation (SD) of preoperative PCS or MCS scores. Differences between the groups with or without decreased HRQoL were investigated using univariate comparisons. A multiple logistic regression model was performed to evaluate the predictive value of potential perioperative variables. RESULTS: The mean ± SD preoperative PCS score was 38.5 ± 10.6, postoperative score was 35.1 ± 7.8 (p = .004) in 85 patients. Thirty-five patients (41.2%) had a clinically relevant decrease of the postoperative PCS score. A normal to high preoperative exercise metabolic capacity measured with metabolic equivalent of task (MET) (p = .01) was a predictor of the decrease in postoperative PCS. The mean preoperative MCS scores (p = .395) were 42.2 (SD 12.8) preoperative, and 43.45 (SD 12.4) postoperative, respectively. CONCLUSIONS: Major surgery decreases postoperative PCS scores of HRQoL at 30 days. A normal to high exercise capacity was a predictor of a clinically relevant decrease of postoperative PCS scores. TRIAL REGISTRATION: 07-107 (Ethical Committee NAC of Geneva University Hospitals).

Correlations between brain structure and symptom dimensions of psychosis in schizophrenia, schizoaffective, and psychotic bipolar I disorders.

INTRODUCTION: Structural alterations may correlate with symptom severity in psychotic disorders, but the existing literature on this issue is heterogeneous. In addition, it is not known how cortical thickness and cortical surface area correlate with symptom dimensions of psychosis. METHODS: Subjects included 455 individuals with schizophrenia, schizoaffective, or bipolar I disorders. Data were obtained as part of the Bipolar Schizophrenia Network for Intermediate Phenotypes study. Diagnosis was made through the Structured Clinical Interview for DSM-IV. Positive and negative symptom subscales were assessed using the Positive and Negative Syndrome Scale. Structural brain measurements were extracted from T1-weight structural MRIs using FreeSurfer v5.1 and were correlated with symptom subscales using partial correlations. Exploratory factor analysis was also used to identify factors among those regions correlating with symptom subscales. RESULTS: The positive symptom subscale correlated inversely with gray matter volume (GMV) and cortical thickness in frontal and temporal regions, whereas the negative symptom subscale correlated inversely with right frontal cortical surface area. Among regions correlating with the positive subscale, factor analysis identified four factors, including a temporal cortical thickness factor and frontal GMV factor. Among regions correlating with the negative subscale, factor analysis identified a frontal GMV-cortical surface area factor. There was no significant diagnosis by structure interactions with symptom severity. CONCLUSIONS: Structural measures correlate with positive and negative symptom severity in psychotic disorders. Cortical thickness demonstrated more associations with psychopathology than cortical surface area.

Mindful Creativity Scale (MCS): Validation of a German version of the Langer Mindfulness Scale with patients with severe TBI and controls.

BACKGROUND: Mindfulness may have an impact on the recovery process in patients who have suffered severe traumatic brain injury (TBI). In order to make an instrument for measuring mindfulness within the German speaking clinical community available, a short, easily usable scale and a cross-cultural adaptation is needed. OBJECTIVES: To validate the Langer Mindfulness Scale (LMS) with German-speaking patients with severe TBI and their relatives (healthy controls). RESEARCH DESIGN: In a prospective cohort study of patients with severe TBI, test-re-test interviews were carried out at 6-month intervals. SAMPLE: A total of 225 participants responded to the first survey and 230 completed the second survey. MEASURES: LMS, self-report questions on personality, openness and attention, as well as health and clinical evaluations (including cognitive and behavioural assessments). RESULTS: On the basis of factor analysis, principal component analysis and item response analysis, the initial 21-items were reduced to six items. The resulting unidimensional scale showed high internal consistency (α = 0.82) and good test-re-test reliability (intra-class correlation for total score = 0.46). External validity was confirmed for the entire sample. CONCLUSION: It was concluded that the German short form of the original LMS (MCS) is a valid and reliable measure of mindful creativity.

Recent advances in understanding schizophrenia.

Schizophrenia is a highly disabling disorder whose causes remain to be better understood, and treatments have to be improved. However, several recent advances have been made in diagnosis, etiopathology, and treatment. Whereas reliability of diagnosis has improved with operational criteria, including Diagnostic and Statistical Manual of Mental Disorders, (DSM) Fifth Edition, validity of the disease boundaries remains unclear because of substantive overlaps with other psychotic disorders. Recent emphasis on dimensional approaches and translational bio-behavioral research domain criteria may eventually help move toward a neuroscience-based definition of schizophrenia. The etiology of schizophrenia is now thought to be multifactorial, with multiple small-effect and fewer large-effect susceptibility genes interacting with several environmental factors. These factors may lead to developmentally mediated alterations in neuroplasticity, manifesting in a cascade of neurotransmitter and circuit dysfunctions and impaired connectivity with an onset around early adolescence. Such etiopathological understanding has motivated a renewed search for novel pharmacological as well as psychotherapeutic targets. Addressing the core features of the illness, such as cognitive deficits and negative symptoms, and developing hypothesis-driven early interventions and preventive strategies are high-priority goals for the field. Schizophrenia is a severe, chronic mental disorder and is among the most disabling disorders in all of medicine. It is estimated by the National Institute of Mental Health (NIMH) that 2.4 million people over the age of 18 in the US suffer from schizophrenia. This illness typically begins in adolescence and derails the formative goals of school, family, and work, leading to considerable suffering and disability and reduced life expectancy by about 20 years. Treatment outcomes are variable, and some people are successfully treated and reintegrated (i.e. go back to work). Despite the effort of many experts in the field, however, schizophrenia remains a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan. Comprehensive treatment entails a multi-modal approach, including psychopharmacology, psychosocial interventions, and assistance with housing and financial sustenance. Research to date suggests a network of genetic, neural, behavioral, and environmental factors to be responsible for its development and course. This article aims to summarize and explain recent advancements in research on schizophrenia, to suggest how these recent discoveries may lead to a better understanding and possible further development of effective therapies, and to highlight the paradigm shifts that have taken place in our understanding of the diagnosis, etiopathology, and treatment.

Trajectories in cigarette dependence as a function of anxiety: a multilevel analysis.

BACKGROUND: We assessed the association of anxiety with cigarette dependence over time, depending on smoking status (daily, occasional or ex-smoker); and the association of anxiety with (a) smoking cessation, (b) reduction, and (c) relapse. METHODS: A prospective Internet survey of 1967 ever smokers was assessed three times at 2 weeks interval, in 2007-2010. Cigarette dependence was assessed using the cigarette dependence scale. Predictors included time, smoking status (daily, occasional or ex-smoker) and anxiety. All measures were assessed at each time point. RESULTS: Dependence decreased over time (slope=-0.21, p<0.001), as did feeling prisoner of cigarettes (slope=-0.25, p<0.001). Both decreased faster between week 0 and week 2 then between week 2 and week 4 (slopes=0.25, and 0.13; p<0.01). Differences in anxiety across individuals were associated with dependence (slope=0.28, p=0.001), feeling prisoner of cigarettes (slope=0.38, p<0.001), cessation (OR=0.42, p<0.001), relapse (OR=1.81, p<0.01), but not with smoking reduction (OR=0.85, p=0.35). Change over time in anxiety (within individuals) was associated with dependence (slope=-0.11, p=0.04), nor feeling prisoner of cigarettes (slope=-0.21, p=0.02), predicted smoking cessation (OR=0.51, p<0.001), smoking reduction (OR=0.67, p=0.047), and relapse (OR=1.52, p=0.03). CONCLUSIONS: Cross-sectionally, cigarette dependence, feeling prisoner of cigarettes, and smoking cessation were associated with anxiety; whereas prospectively, smoking cessation, reduction, and relapse were predicted by state anxiety. Thus, anxiety is an important factor that is associated with smoking behavior. Implications for treatment are discussed.

Validation of a 10-item care-related regret intensity scale (RIS-10) for health care professionals.

BACKGROUND: Regret after one of the many decisions and interventions that health care professionals make every day can have an impact on their own health and quality of life, and on their patient care practices. OBJECTIVES: To validate a new care-related regret intensity scale (RIS) for health care professionals. RESEARCH DESIGN: Retrospective cross-sectional cohort study with a 1-month follow-up (test-retest) in a French-speaking University Hospital. SAMPLE: A total of 469 nurses and physicians responded to the survey, and 175 answered the retest. MEASURES: RIS, self-report questions on the context of the regret-inducing event, its consequences for the patient, involvement of the health care professionals, and changes in patient care practices after the event. We measured the impact of regret intensity on health care professionals with the satisfaction with life scale, the SF-36 first question (self-reported health), and a question on self-esteem. RESULTS: On the basis of factor analysis and item response analysis, the initial 19-item scale was shortened to 10 items. The resulting scale (RIS-10) was unidimensional and had high internal consistency (α=0.87) and acceptable test-retest reliability (0.70). Higher regret intensity was associated with (a) more consequences for the patient; (b) lower life satisfaction and poorer self-reported health in health care professionals; and (c) changes in patient care practices. Nurses reported analyzing the event and apologizing, whereas physicians reported talking preferentially to colleagues, rather than to their supervisor, about changing practices. CONCLUSIONS: The RIS is a valid and reliable measure of care-related regret intensity for hospital-based physicians and nurses.