Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic hepatitis C.

BACKGROUND AND AIMS: New therapies for HCV are rapidly emerging and providers are advising select patients to defer treatment and elect 'watchful waiting'. During the watchful waiting period, patients have been shown to have high rates of illness uncertainty and depression. We sought to answer the question of whether reassuring histological data (showing minimal fibrosis or no fibrosis progression over time) is associated with less illness uncertainty and depressive symptoms. METHODS: This was a single-centre outpatient prospective cohort study to determine whether stage of fibrosis, fibrosis progression and reasons for treatment deferral were related to illness uncertainty and depressive symptoms in patients following watchful waiting. RESULTS: Illness uncertainty was significantly related to depressive symptoms (r = 0.49, P < 0.01). More than half of the participants (54%) had moderate levels of uncertainty. About 40% of the participants were at risk for clinical depression (21.7% at mild to moderate risk and 18.5% at high risk). Treatment naïve subjects had lower mean scores on both the CES-D (depressive symptoms measure) and the MUIS-A (illness uncertainty measure) total score, MUIS-A Ambiguity subscale and MUIS-A Inconsistency subscale than subjects who failed treatment or were interferon intolerant or ineligible. Surprisingly, liver fibrosis stage and progression were not significantly associated with overall illness uncertainty or depressive symptoms. CONCLUSION: Patients with chronic hepatitis C on watchful waiting are at high risk for significant illness uncertainty and depressive symptoms. Reassuring histological data does not seem to correlate with less uncertainty or depressive symptoms.

Recurrent symptoms: well-being and management.

Although most older adults report one or more symptoms of a chronic health problem, little attention has been paid to the report of these symptoms over time and whether different symptom patterns affect well-being and symptom management in community-dwelling elders. Therefore, this study examined whether community-dwelling older adults in Ohio, U.S.A. who experience consistently recurring (a) arthritis or (b) cardiopulmonary symptoms report more depression and worse self-assessed health and show more symptom management than those who report inconsistent symptoms and if there are differences in well-being and symptom management over time. This secondary analysis used longitudinal data collected from a random sample of 387 older adults who reported their health complaints in four interviews over 27 months time. Subjects were included in this analysis if they reported either arthritis (n = 321) or cardiopulmonary (n = 232) symptoms at one or more times during 27 months, and then were classified as having either consistent (occurring at all four time points) or intermittent/inconsistent (occurring at three or fewer time points) symptoms. Data analysis included t-tests, chi-square tests, and Repeated Measures ANOVA. Results indicate that those with consistent symptoms reported greater depression and worse self-assessed health than those with less consistent symptoms. Specifically, those with consistent cardiopulmonary symptoms became more depressed over time. Those with consistent cardiopulmonary complaints were more likely than those with an inconsistent pattern to use an illness label to describe their symptoms. Those with consistent arthritis symptoms tended to use more self-care at all time points, to label their symptoms as an illness, and were more likely to consult a physician as their symptoms persisted. The implications of symptom recurrence on well-being, symptom management and the concept chronicity are discussed.

Interpreting bodily changes as illness: a longitudinal study of older adults.

Research on elders' health behavior has largely ignored the stage between experiencing a bodily change and defining it as an illness. This paper addresses the question of what explains such definitions of bodily complaints as illness symptoms. The issue is examined in a longitudinal study with a random sample of 350 community dwelling persons aged 65 and over. Multiple regression was used to analyze the effects of external stresses, psychological factors and health attitudes as well as contextual variables, on three types of illness representations. These consisted of giving the bodily changes an illness label, initiating contact with a physician, and/or using some form of self care. These illness representations were treated as outcome variables singularly and in combination. The findings revealed that the overall frequency of a person's bodily changes was the best predictor of an illness designation. Other significant predictors at Time 4 of the study included belief in the seriousness of a complaint, the occurrence of prior illness representations and self-assessed health. This research study on the elderly is unique in that it seeks to explain, within a longitudinal design, the intermediate step between the experience of a bodily change and the definition of the change as an illness.

Growth, phenology and reproduction of an arid-environment winter ephemeral Dimorphotheca pluvialis in response to combined increases in CO2 and UV-B radiation.

The winter ephemeral Dimorphotheca pluvialis was grown in open-top chambers in ambient or elevated CO2 (350 or 650 micromol mol(-1)), combined with ambient (2.39 to 7.59 kJ m(-2) d(-1)) or increased (4.94 to 11.13 kJ m(-2) d(-1)) UV-B radiation. Net CO2 assimilation rate and leaf water use efficiency increased in elevated CO2, but increased UV-B did not affect gas exchange. Leaf biomass was greater under increased UV-B, but vegetative biomass was unaffected in elevated CO2. Initiation of reproduction was delayed, and proportional investment in reproductive biomass at harvest was reduced in elevated CO2. Increased UV-B stimulated reproduction, particularly in ambient CO2, but also in elevated CO2 at a later stage. Changes in reproductive phenology and prolonged development in elevated CO2 during the stressful late season could indirectly be detrimental to reproductive success of D. pluvialis, but stimulation of reproduction by enhanced UV-B may to some extent mitigate this.

The influence of uncertainty in illness, stress appraisal, and hope on coping in survivors of breast cancer.

On the basis of Mishel's uncertainty in illness theory, Lazarus and Folkman's stress on appraisal and coping, and Herth's perspective of hope, this cross-sectional, correlational study was designed to examine the influence of uncertainty, stress appraisal, and hope on coping in 71 survivors of breast cancer. Uncertainty was measured by the Mishel Uncertainty in Illness: Community Scale, stress appraisal by the Stress Appraisal Index, hope by the Herth Hope Index, and coping by the Ways of Coping Questionnaires (WCQ).

Elderly persons' interpretation of a bodily change as an illness symptom.

Based on a community random sample of 406 elderly, factors that persuade an elderly person to interpret a bodily change as a symptom of illness are described. Three measures of such illness interpretation among 27 different bodily changes are used in analysis: giving an illness label to the change, consulting a physician for it, and/or using self-care for treatment. The three types of representations across all 27 bodily changes taken together, as well as among five typical complaints most commonly experienced, are reported. The findings show that the perceived seriousness of the bodily change and the general health context of the older person in which it has occurred are conducive to interpreting a bodily change as an illness symptom.

Gender differences in health and health actions among community-dwelling elders.

This secondary analysis of data from a study of elders' health examined gender differences in the psychological and physical health and the health actions made in response to specific physical complaints in a random sample of 491 community-dwelling older adults (mean age of 75.3 years). Significant gender differences in anxiety, depression, and body awareness were found, although there were no differences in self-assessed health or total number of health problems reported. There were some gender differences in the types of health problems experienced. Subjects tended to use self-care actions, particularly over-the-counter medications and home remedies, more so than professional consultation. Different patterns of care emerged for women and men, with women somewhat more inclined to use self-care and men more likely to seek professional consultation.

Health of grandmothers as caregivers: a ten month follow-up.

This study examined changes, over 10 months, in self-assessed health, depression, anxiety, stress, coping and support in a convenience sample of 74 grandmothers living in the same home as grandchild(ren) and to compare them with grandmothers who had either primary (n = 49) or partial/supplemental (n = 25) responsibility for their grandchildren's care. Grandmothers showed high stability over ten months time, with many reporting elevated depression and parenting stress at both time points. Depression was associated with greater parenting stress, primary responsibility for caregiving, and with avoidant and minimizing coping. Better self-assessed health was linked with less parenting stress, and less formal and instrumental support. Study findings are discussed.

Health, stress, coping, and social support in grandmother caregivers.

The purposes of this study were to examine health, stress, coping, and supports of grandmothers who live with one or more grandchildren and participate in their care, and to examine whether differences exist between grandmothers with primary and partial responsibility for their grandchildren's care. A convenience sample of 90 women was recruited from various sites, and participants completed a self-administered questionnaire. There were no differences between grandmothers who had primary responsibility for raising their grandchildren (n = 58) and those who did not (n = 32) in self-assessed health, anxiety, or depression; in coping; or in typical grandparenting stresses. Grandmothers with primary responsibility reported significantly greater parenting stresses and less instrumental and subjective social support. Grandmothers in both groups reported high depression and anxiety scores and favorable scores on grandparenting stresses. Implications for grandmother caregivers are discussed.

Stress, health, and depressive symptoms in older adults at three time points over 18 months.

This descriptive study is a secondary analysis of data that examined depressive symptoms in a random sample of 429 community-dwelling adults aged 65 years and older. Participants were classified as having consistently high (n = 20). consistently low (n = 327), or fluctuating (n = 82) levels of depressive symptoms, based on scores from the Center for Epidemiological Studies-Depression Scale (CES-D; L. S. Radloff, 1977) at three time points over the course of 18 months. Differences in stress (life events and daily hassles), health (self-assessed health and physical complaints), and biographic variables among the 3 groups were examined. One quarter of the sample reported high depressive symptoms at least once over 18 months. There were significant differences among the 3 symptom groups on each of the stress and health measures and on marital status. The findings support the relationship among stress, health, and depressive symptoms over time. Implications for clinicians and researchers are discussed.

Structural equation modeling and its relationship to multiple regression and factor analysis.

Using a conceptual and nontechnical approach, the meaning of structural equation modeling (SEM) and the similarities to, and differences from, more commonly used procedures such as correlation, regression, path analysis, and factor analysis are explained. Application of the statistical technique is presented using data from a study of the relationships among stresses, strains, and physical health in a random sample of 492 community-dwelling elders aged 65 and older. Advantages of each statistical procedure are described. Theoretical issues related to the use of each procedure are presented with emphasis on the need for a sound theoretical model and match between the statistical procedure and the aims of the analysis.

Health problems and health actions among community-dwelling older adults: results of a health diary study.

This study examined the health problems and health actions reported by a sample of older adults (N = 60) who maintained health diaries over a 4-week period. The diary sample was 78% (n = 47) White; 52% (n = 31) were women, with a mean age of 75 years (SD = 5.3). Content analysis was used to examine the types of health problems reported in the diaries, which health problems were likely to be considered an illness, and what health actions were reported. Respondents reported an average of four different types of health problems over the 4-week diary period. There were differences in symptom reports related to gender, age, or race. The most frequently reported health problems were musculoskeletal problems (n = 38), runny nose and respiratory problems (n = 24), gastrointestinal problems (n = 22), and headaches (n = 22). Only 36% of all health problems were considered to be illnesses. Subjects recorded a number of health actions in response to their health complaints, including over-the-counter (OTC) medication use (83%), prescription medication use (53%), self-care activities (72%), and professional consultation (43%). Specific strategies that subjects used to deal with various health problems, implications of the findings, and the usefulness of health diaries as a clinical tool are discussed.

Finite element calculations and fabrication of cantilever sensors for nanoscale detection

Finite element analysis (FEA) is used to study the effect of geometric variations on the properties of rectangular cantilevers and U-shaped Joule-heated cantilevers. Simulations of locally thinned cantilevers as well as of cantilevers modified by the implementing of a hole or a side cut are compared with fabricated cantilevers, which are tuned by focused ion beam (FIB) milling. By locally thinning the cantilevers, the resonance frequency and the spring constant are reduced. For a hole, the internal stress is increased while for a side cut, the lateral spring constant is decreased. Good agreement between the measured and the simulated resonance frequencies is observed. Simulations of the current density and the temperature distributions attained during the passage of current through a doped silicon layer are performed to optimize the design of Joule-heated cantilevers (U-shaped) for thermal gravimetric applications. A very uniform temperature distribution over a region near the apex can be realized by slitting the U-shaped cantilever. In such a way, the heating power can be minimized by effecting only a small variation in the geometry of a U-shaped cantilever. A simple fabrication process for the fabrication of Joule-heated cantilevers is presented, which consists mainly of a uniform conductive p-doped layer.

Site-directed molecular assembly on templates structured with electron-beam lithography.

We describe a simple method for patterning biomolecular films on surfaces with high resolution. A conventional polymeric resist is structured by electron-beam lithography. The exposed and developed patterns are then used for the directed self-assembly (SA) of a first molecule from solution. Removal of the remaining resist allows the SA of a second species. We illustrate the potential of the approach by assembling on gold (Au) substrates two alkanethiols of contrasting terminal functionality. The patterns have dimensions from the micrometer range down to 40 nm and an edge resolution of 3.5 nm.