A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care.

OBJECTIVES: A comorbid diagnosis of cancer and dementia (cancer-dementia) may have unique implications for patient cancer-related experience. The objectives were to estimate prevalence of cancer-dementia and related experiences of people with dementia, their carers and cancer clinicians including cancer screening, diagnosis, treatment and palliative care. METHOD: Databases were searched (CINAHL, Psychinfo, Medline, Embase, BNI) using key terms such as dementia, cancer and experience. Inclusion criteria were as follows: (a) English language, (b) published any time until early 2016, (c) diagnosis of cancer-dementia and (d) original articles that assessed prevalence and/or cancer-related experiences including screening, cancer treatment and survival. Due to variations in study design and outcomes, study data were synthesised narratively. RESULTS: Forty-seven studies were included in the review with a mix of quantitative (n = 44) and qualitative (n = 3) methodologies. Thirty-four studies reported varied cancer-dementia prevalence rates (range 0.2%-45.6%); the others reported reduced likelihood of receiving: cancer screening, cancer staging information, cancer treatment with curative intent and pain management, compared to those with cancer only. The findings indicate poorer cancer-related clinical outcomes including late diagnosis and higher mortality rates in those with cancer-dementia despite greater health service use. CONCLUSIONS: There is a dearth of good-quality evidence investigating the cancer-dementia prevalence and its implications for successful cancer treatment. Findings suggest that dementia is associated with poorer cancer outcomes although the reasons for this are not yet clear. Further research is needed to better understand the impact of cancer-dementia and enable patients, carers and clinicians to make informed cancer-related decisions.

Drug-induced toxicity and patient reported outcomes in rheumatoid arthritis patients following intensive treated-to-target strategy: does ceasing therapy due to toxicity worsen outcomes in long term?

AIM: While the introduction of the treat-to-target (T2T) strategy has been an important advance in the management of rheumatoid arthritis (RA), the potential for increased toxicity due to use of concurrent drugs could adversely affect patient reported outcomes (PROs). The objective was to determine whether the cessation of therapy due to toxicity affects long-term improvement in PROs in patients treated according to T2T strategy. METHODS: A total of 149 patients from an inception cohort of early RA were included. The occurrence and severity of toxicity were monitored at each visit over 3 years. PROs studied were function (measured using health assessment questionnaire); pain, fatigue and patient global assessment (PtGA) all assessed using a 100 mm visual analogue scale; helplessness and health-related quality of life (HRQoL). For each PRO, effect of drug withdrawal was measured by comparing mean change in PROs among patients with no/temporary vs. permanent withdrawal. In addition, effects of frequency of drug withdrawals, weeks to withdrawal and number of drugs withdrawn were analysed using linear regression. RESULT: After 3 years, 56 (37.4%) patients ceased at least one drug permanently due to toxicity. Patients with no/temporary withdrawal (n = 93) achieved significantly greater improvement in function (mean change = -0.54 vs. -0.31, p = 0.033), pain (mean change = -39.82 vs. -5.02, p = 0.018), fatigue (mean change = -29.14 vs. -14.76, p = 0.015) and PtGA (mean change = -29.64 vs. -17.00, p = 0.018) compared with their counterparts. Higher frequency of withdrawals was associated with lesser improvements in function, pain, fatigue and PtGA, while the number of drugs withdrawn and the weeks to withdrawal had lesser effects. However, the cessation of the drugs due to their toxicity did not have a significant association with HRQoL and helplessness. CONCLUSION: Improvements in function, pain, fatigue and PtGA at 3 years were diminished for patients who ceased drugs due to toxicity while broader measures of HRQoL were not affected.

An Overview of Treating People with Comorbid Dementia: Implications for Cancer Care.

With increasing prevalence of both cancer and dementia in the UK, due to an ageing population, oncology healthcare professionals will experience higher numbers of people with both conditions. As dementia is highly heterogeneous and symptoms vary from individual to individual, it presents specific challenges for healthcare professionals, people with dementia and caregivers alike. This overview will describe current theories that explain the association between cancer and dementia, report prevalence rates and highlight the evidence on the impact of having a diagnosis of dementia on outcomes along the cancer pathway from cancer symptom detection to cancer treatment outcomes. It suggests that although prevalence rates of cancer and dementia are typically lower than other comorbidities, people with cancer and dementia have poorer cancer-related outcomes. This includes later stage cancer diagnoses, fewer cancer treatment options and an increased risk of death compared with people who have cancer alone or other comorbid conditions. Considerations for cancer treatment decision making and management are proposed to improve patient experience for this group.

Treatment-induced stable, moderate reduction in blood cell counts correlate to disease control in early rheumatoid arthritis.

BACKGROUND: Treatment of rheumatoid arthritis (RA) has become more intensive, thereby raising concerns regarding toxicities, including leucopenia. The objective was to analyse cell counts obtained as routine surveillance for adverse effects to assess the effect of intensive treatment and treatment dosage and to examine correlations to disease activity scores. METHODS: Patients with early RA were treated with combinations of disease-modifying anti-inflammatory drugs according to pre-defined rules, with dose adjustments contingent on residual disease activity and tolerance. RESULTS: Mean leucocyte, neutrophil and platelet counts fell with levels that correlated to disease activity scores. The strongest correlation was between platelets and disease activity scores. There was a modest, inverse correlation between methotrexate dose and monocyte and lymphocyte counts. No serious toxicity associated with the therapy was seen. CONCLUSION: Moderate reductions in cell counts are well tolerated in RA and appear to contribute to disease control.

Development and psychometric evaluation of a new measure of pain-related support preferences: the Pain Response Preference Questionnaire.

BACKGROUND: Behavioural conceptualizations of chronic pain posit that solicitous responses to pain behaviours are positively reinforcing and play a role in the development of chronic pain and disability. Recent research suggests that studies investigating this model were likely limited by the use of only a few narrowly defined categories of responses to pain behaviour. A measure of preferences regarding pain-related social support has the potential to improve behavioural models of chronic pain by identifying other potentially reinforcing responses to pain behaviour. OBJECTIVE: The Pain Response Preference Questionnaire (PRPQ) was created to assess preferences regarding pain-related social support. The purpose of the present study was to empirically develop PRPQ scales and examine their psychometric properties. METHODS: A large university student sample (n=487) free of chronic pain completed the 39-item PRPQ. Factor analysis was applied to the data from the present sample to empirically develop PRPQ scales. Using a second student sample (n=87), relationships between the PRPQ scales and theoretically related measures were examined to evaluate the construct validity of the scales. Factor analysis supported four factors that reflected preferences for emotional and instrumental support, assistance in managing pain and emotions, having one's pain ignored, and being encouraged to persist with one's activities. Based on this analysis, scales labelled solicitude, management, suppression and encouragement were created. Correlation analyses supported the construct validity of these scales. CONCLUSIONS: The PRPQ is a psychometrically sound measure of preferences of pain-related social support. Research with clinical samples is needed to further evaluate its psychometric properties and clinical utility.

Adult attachment insecurity is positively associated with medically unexplained chronic pain.

BACKGROUND: Attachment insecurity (i.e. anxiety in relationships and/or discomfort in close relationships) is associated with self-reports of physical symptoms, medically unexplained symptoms and health conditions involving pain. Medically unexplained chronic pain (MUCP) may represent a particularly severe form of symptom reporting that is also characteristic of individuals with insecure attachment. This study investigated relationships between adult attachment style ratings and past-year MUCP in a sample of the general U.S. population and the ability of attachment style ratings to account for variance in past-year MUCP beyond that accounted for by potential confounders. METHOD: Data from the National Comorbidity Survey Replication (N = 5645) were used. Attachment was assessed with an interview-administered version of a commonly used self-report measure of secure, anxious and avoidant attachment. MUCP was assessed with a brief interview. Depressive and anxiety disorders were included as covariates and were assessed with a fully structured interview based on DSM-IV criteria. RESULTS: The past-year prevalence of MUCP was 2.45% (95% CI = 2.07-2.83). The two insecure attachment styles (i.e. anxious and avoidant) were positively associated with MUCP. These associations remained statistically significant after adjusting for demographic variables and depressive and anxiety disorders. When the two insecure attachment styles were considered together, only avoidant attachment remained significantly associated with MUCP. CONCLUSION: Attachment insecurity ratings were positively associated with past-year MUCP and remained so after statistically adjusting for depressive and anxiety disorders. Further research aimed at understanding the mechanism(s) responsible for the association between attachment insecurity and MUCP is warranted. SIGNIFICANCE: Consistent with earlier research regarding transient physical symptoms, medically unexplained chronic pain was associated with attachment insecurity. Understanding the mechanisms responsible for this association could guide treatment innovations.

Development and evaluation of short forms of the Pain Catastrophizing Scale and the Pain Self-efficacy Questionnaire.

BACKGROUND: To facilitate efficient screening and reduce the length of comprehensive self-report batteries, a four-item short form of the Pain Catastrophizing Scale (PCS) and a two-item short form of the Pain Self-Efficacy Questionnaire (PSEQ) have been developed and evaluated in samples of patients with arm and upper extremity pain. AIMS: The first aim of this study was to evaluate these short forms in a heterogeneous sample of patients seeking treatment for chronic musculoskeletal pain, using a priori criteria for determining adequate internal consistency, construct validity and sensitivity to change. In addition, the findings of past studies were used to identify items suitable for new and potentially stronger short forms of these measures. METHOD: Data were provided by 280 patients who completed the original PCS and PSEQ as part of an interdisciplinary rehabilitation programme. RESULTS: The previously developed four-item PCS and the newly developed six-item short form of the PCS both met the internal consistency and construct validity criteria. They did not meet the criterion regarding sensitivity to change. However, similar to what was obtained using the original PCS, large effect sizes were found when using these short forms to examine pre-treatment to post-treatment changes in catastrophizing. For the PSEQ, the new four-item short form was clearly superior to the other alternatives and met all three criteria. CONCLUSION: The strongest short forms of the PCS and PSEQ could facilitate the assessment of pain catastrophizing and self-efficacy in situations in which the use of the longer original measures is not feasible.

Serotonergic agents that activate 5HT2A receptors prevent NMDA antagonist neurotoxicity.

Phencyclidine, ketamine, and other agents that block NMDA glutamate receptors trigger a schizophrenia-like psychosis in humans and induce pathomorphological changes in cerebrocortical neurons in rat brain. Accumulating evidence suggests that a complex network disturbance involving multiple transmitter receptor systems is responsible for the neuronal injury, and it is proposed that a similar network disturbance is responsible for the psychotomimetic effects of NMDA antagonists, and might also be involved in the pathophysiology of schizophrenia. In the present study we present evidence that serotonergic agents possessing 5HT2A agonist activity prevent NMDA antagonist neurotoxicity in rat brain. It is proposed that 5HT2A agonists may also prevent the psychotomimetic effects of NMDA antagonists. Among the 5HT2A agonists examined and found to be neuroprotective are LSD and related hallucinogens. The apparent contradiction in proposing that these agents might have antipsychotic properties is resolved by evidence linking their hallucinogenic activity to agonist action at 5HT2C receptors, whereas antipsychotic activity would be attributable to agonist action at 5HT2A receptors.

Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services.

OBJECTIVE: To determine whether classification as pediatric "somatizers" identifies a group of children and adolescents at high risk for psychopathology, functional impairment, and frequent use of health services in a large, multisite study of pediatric primary care. METHOD: Parental reports of frequent aches and pains and visits to the doctor for medically unexplained symptoms in children aged 4 to 15 years were used to construct a classification of somatization in pediatric primary care. Affected and unaffected children and adolescents were compared on measures of demographics, family functioning, psychopathology, functional status, and service use. RESULTS: Classification as a somatizer was more common in adolescents, females, minority subjects, urban practices, nonintact families, and families with lower levels of parental education and was associated with heightened risk of clinician- and parent-identified psychopathology, family dysfunction, poor school performance and attendance, perceived health impairment, and more frequent use of health and mental health services. CONCLUSIONS: Children classified as pediatric somatizers are at heightened risk for psychiatric disorder, family dysfunction, functional impairment, and frequent use of health services. Additional research is warranted, and clinicians should recognize the need for careful assessment and potential behavioral health referral in this population.

Impact of adult attachment styles on pain and disability associated with arthritis in a nationally representative sample.

OBJECTIVE: The objective of this study was to evaluate Mikail et al.'s hypothesis that adult attachment styles are associated with important pain-related variables such as pain and disability levels. DESIGN: A cross-sectional design was used to examine the relation between measures of adult attachment styles and both pain and disability. SETTING: The data used were obtained from the National Comorbidity Survey, a large and nationally representative sample of community-dwelling individuals aged 15 to 54 years. In the present study, individuals (n = 381) in the National Comorbidity Survey with arthritis or related conditions were included. OUTCOME MEASURES: Ratings regarding three adult attachment styles (secure, anxious, and avoidant) were obtained by administering Hazan and Shaver's attachment self-report in an interview format. Pain and disability were assessed in a similar manner using four-point rating scales. RESULTS: Ratings of insecure attachment were positively and significantly correlated with both pain and disability. A multiple regression analysis revealed that pain severity and the rating of anxious attachment could account for 20.3% of the variance in disability. CONCLUSIONS: The attachment theory holds promise for understanding reactions to pain conditions, and Mikail et al.'s model warrants further investigation.

Does the social concerns component of the anxiety sensitivity index belong to the domain of anxiety sensitivity or the domain of negative evaluation sensitivity?

The present study utilized an exploratory factor-analytic approach (i.e. principal-components analysis; PCA) to investigate whether the Social Concerns component of the Anxiety Sensitivity Index (ASI [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Systems.]) is best conceptualized as belonging to the domain of anxiety sensitivity (AS) and/or the domain of negative evaluation sensitivity (NES). A sample of university students (N = 216) was administered measures of both NES (i.e. Brief Fear of Negative Evaluation scale; Leary, 1983) and AS (i.e. ASI). Participants' responses to the items comprising these measures were subjected to a PCA with oblique rotation. Factors representing the NES construct and the three lower-order AS constructs (i.e. AS Physical, Psychological and Social Concerns) were obtained. Subscales derived from these four factors were positively and significantly correlated with one another and loaded on a single higher-order factor labeled Threat Sensitivity. Thus, the present findings suggest that the AS Social Concerns factor is distinct from NES and the other lower-order components of AS. However, correlational analyses and higher-order PCA indicated that the AS Social Concerns factor taps a blend of AS and NES as well as something unique and distinct from both global AS and NES.

A comparison of symptom checklist 90-revised profiles from patients with chronic pain from whiplash and patients with other musculoskeletal injuries.

STUDY DESIGN: A quasi-experimental design was used to compare the Symptom Checklist 90-Revised profiles (SCL-90-R) from a group of patients with whiplash injuries (n = 67) and a group with mixed musculoskeletal pain (n = 91). OBJECTIVES: To test the discriminant validity of the characteristic SCL-90-R whiplash profile as proposed by Wallis and Bogduk using a multivariate statistical technique. SUMMARY OF BACKGROUND DATA: On the basis of two studies by themselves and their colleagues, Wallis and Bogduk proposed a characteristic SCL-90-R profile evident in samples of patients with whiplash injuries. Their assertion has not been tested empirically in any published studies. METHODS: The participants in this study consisted of 158 patients at a rehabilitation hospital who completed the SCL-90-R under standard instructions and subsequently were diagnosed by a team comprising a chiropractor, physical therapist, and physician. The participants were categorized as having whiplash-associated disorders or pain caused by other musculoskeletal injuries. A profile analysis following Hotelling's method was used to determine the comparability of SCL-90-R profiles from the two groups. RESULTS: The profile analysis showed no statistically significant differences between the groups with regard to either the shape or the overall elevation of their psychological profiles. The SCL-90-R profiles from both groups were similar to those reported from other chronic pain syndromes, with elevations on the Somatization, Depression, Obsessive-Compulsive, and Psychoticism scales. CONCLUSIONS: The current study failed to support the validity of a distinctive SCL-90-R profile for patients with whiplash injuries. Instead, the results suggest that the psychological consequences of experiencing chronic pain from whiplash-associated disorders are similar to the psychological consequences of chronic pain from other musculoskeletal injuries.

Teacher discipline and child misbehavior in day care: untangling causality with correlational data.

Day-care centers provide an ideal, underused setting for studying the developmental processes of child psychopathology. The influence of day-care teachers' lax and overreactive discipline on children's behavior problems was examined, as was the influence of children's behavior problems on teachers' discipline. Participants were 145 children and 16 day-care teachers from 8 classrooms in a day-care center for children from low-income families. Two techniques are presented for estimating causal relations based on correlational data gathered from day-care centers: 2-stage least squares and simultaneous structural equation modeling. Across techniques, teachers' laxness strongly influenced child misbehavior, and child misbehavior influenced both teachers' overreactivity and laxness. Teachers' overreactivity did not influence child misbehavior

Use of a statewide system to improve health and safety in child care facilities.

BACKGROUND: The Early Childhood Education Linkage System (ECELS) in Pennsylvania (PA) models ideals of the national Healthy Child Care America (HCCA) Campaign. Little is known about how child care providers use these newly developed statewide systems and about how users compare with nonusers of such a system. OBJECTIVES: Our objectives were 1) to assess knowledge and use of ECELS among child care providers in PA, 2) to compare users and nonusers of ECELS with regard to health concerns, advice-seeking preferences, and infant sleep positioning, and 3) to assess satisfaction among users of ECELS. METHODS: Cross-sectional telephone survey of directors of 400 licensed child care centers (CCCs) and providers of 400 registered family child care homes (FCCHs) in PA. RESULTS: The proportion of children with certain special health care needs mirrored the prevalence in the national child population. Of the facilities surveyed, 88% of CCCs and 71% of FCCHs had heard of ECELS. Among these, 85% had used ECELS's services in the previous 12 months. Significantly more nonusers than users consulted doctors, whereas more users consulted health professionals from government agencies and used printed materials. Of those who enrolled infants, 46% of users and 41% of nonusers reported placing infants on their backs only to sleep. Users who placed infants on their backs were more likely than nonusers to have a written policy about the correct practice (55% and 26%, respectively; P =.02). Overall, 46% of users and 28% of nonusers reported having a sleep position policy (P =.02). Users were at least 95% satisfied with ECELS's services. CONCLUSION: This statewide system reached most child care providers surveyed: more outreach is needed to providers in FCCHs. The health concerns, safety practices, and advice-seeking preferences of child care providers described in this article can inform others who are developing similar collaborative services in each state. Further research on the impact of HCCA programs on health and safety practices (such as correct infant sleep positioning) is warranted.

The Physician Belief Scale and psychosocial problems in children: a report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network.

Clinicians' management of children with psychosocial problems may vary with their attitudes and beliefs. However, we lack sound instruments to assess these factors. This study examined the psychometric properties of the Physician Belief Scale (PBS). A modified version of the PBS was sent to clinicians who participated in two primary care research networks. Using factor analysis, we reduced the PBS to 14 items and 2 subscales. Cronbach's alpha values were high. Female clinicians, those using DSM-IV, and those having completed training earlier rated themselves as more psychosocially oriented. Identification and treatment of psychosocial problems were significantly related to scores on the Belief and Feeling subscale. The PBS provided only a modest amount of information regarding primary care practices. It is not clear if these limitations are attributable to the instrument or the many other barriers to effective psychosocial care.

Is there a negative association between anxiety sensitivity and arousal-increasing substances and activities?

Little research has addressed McNally's hypothesis [(1996). Anxiety sensitivity is distinguishable from trait anxiety. In: R. M. Rapee (Ed.), Current controversies in the anxiety disorders (pp. 214-227). New York: The Guilford Press.] that anxiety sensitivity (AS) should be negatively associated with the use of arousal-increasing substances. In the present study, we examined the relationship between AS and the self-reported use of two widely available stimulants--nicotine and caffeine--and exercise frequency in a sample of 256 university students. A measure of trait anxiety was also incorporated within the design. The associations between use of both substances and levels of AS and trait anxiety were weak and nonsignificant. Although inconsistent with McNally's hypothesis, some significant findings were found when the lower-order components of AS (i.e., fears of physical, psychological, and publicly observable symptoms of anxiety) were examined. The associations between exercise frequency and the anxiety measures, indicating a negative relationship, were generally consistent with McNally's hypothesis. Implications of these findings are discussed with reference to future investigation.

Parental problem drinking and anxiety disorder symptoms in adult offspring: examining the mediating role of anxiety sensitivity components.

Preliminary studies have implicated childhood exposure to parental problem drinking as a possible factor in the development of anxiety sensitivity (AS). The present retrospective study was designed to examine the role of exposure to distressing parental problem drinking behaviors, over and above the role of parental alcoholism, in the development of various AS components (psychological, physical, and social concerns) in the offspring. We also examined the possible mediating role of AS components in explaining relations between parental drinking problems and anxiety-related symptoms in the adult offspring. A sample of 213 university students provided retrospective reports of both distress related to parental drinking [Children of Alcoholics Screening Test (CAST)] and parental alcoholism [maternal and paternal forms of the Short Michigan Alcoholism Screening Test (SMAST)]. Participants also reported on their own current AS levels [AS Index (ASI)], general anxiety symptoms [State-Trait Anxiety Inventory-Trait subscale (STAI-T)], and lifetime history of uncued panic attacks [Panic Attack Questionnaire-Revised (PAQ-R)]. Scores on the CAST predicted AS psychological and physical concerns (but not social concerns) over and above participant gender and parental alcoholism measured by the SMASTs. Moreover, AS psychological concerns proved a consistent modest mediator of the relations between parental problem drinking on the CAST and both general anxiety and uncued panic outcomes in the offspring. Thus, exposure to distressing parental problem drinking behavior may be one factor that contributes to elevated AS psychological concerns in the child, which in turn may contribute to the development of anxiety disorder symptoms in the offspring.

Velopharyngeal incompetence.

The anatomy and physiology of the velopharyngeal mechanism are complex and not well understood. The pathogenesis and treatment of velopharyngeal incompetence have been discussed, and an illustrative case report of the use of a palatal lift appliance has been presented. Patients with velopharyngeal incompetence should be evaluated by a speech pathologist and the dentist; if indicated, an appropriate dental prosthesis should be used.