Self-rated health among cardiovascular drug users in a study of Swedish twins

Fear can be elicited by physically-presented explicit threat stimuli or by more static contextual stimuli that are not an immediate source of danger. Research in both humans and animals suggest that fear produced by these two types of stimuli represents separate processes mediated by different brain structures. The present study used the startle reflex methodology to examine affective responses elicited by an explicit threat cue signalling a period of shock anticipation and by two types of contextual stimuli; darkness and attaching the shock electrodes. As expected, shock anticipation potentiated startle (fear-potentiated startle). Startle was also facilitated by darkness and by the placement of shock electrodes. Further, darkness increased fear-potentiated startle to an explicit threat cue, but did not affect the facilitation of startle produced by attaching the shock electrodes. It is suggested that affective responses to contextual stimuli should be considered when investigating both normal and pathological fear.     

Gender differences in fears related to coronary arteriography

OBJECTIVE: To compare levels of fear and the intensity of specific fears in women and men related to coronary arteriography (CA). DESIGN: Prospective survey. SETTING: A 1360-bed university hospital. Data were collected before, during, and after CA, and again 6 months later. SUBJECTS: The sample consisted of 54 women and 166 men undergoing scheduled CA. METHODS: To compare fear levels at different points of evaluation; two analyses of covariance for repeated measures were performed. RESULTS: On average, women had significantly higher mean scores of fear across the points of evaluation on the Visual Analogue Scale than men (P <.001). During the hospital stay, the most intense fear for both women and men was the fear of coronary artery bypass grafting and the uncertainty about the illness, whereas at home it was the fear of myocardial infarction. On average, women reported significantly intense fears more frequently than men across time. On average, men experienced more intensive fear of problems in their sex life than women (P =. 032). The changes in intensity of fears over time were not significantly different by gender, except in fear of pain (P =.013), health care staff not having enough time to care for the patient (P =.039), and health care staff discussing the patient's condition without the patient being present (P =.048). Age and prior CA were found to be significantly related to most of the fears at different points of evaluation, and to the changes of fears over time. CONCLUSION: There existed differences in the tendency to report intensity of fears by gender; however, the intensity of fears changed in a similar way over time. The results suggest that the few gender differences in fears that existed may be explained by the treatment chosen for the patients and the patients' acceptance of it. Therefore, it is important to adapt information and support according to the treatment chosen for the patient.     

IFN-tau suppresses both the autoreactive humoral and cellular immune responses and induces stable remission in mice with chronic experimental allergic encephalomyelitis

PURPOSE: The purpose of this study was to compare attitudes toward violence and weapon-carrying among seventh-grade students in three dissimilar U.S. communities. A second focus was to determine students' understanding of their parents' violence-related guidance and behavior. METHODS: Five hundred sixty-seven seventh-grade students (48% male, 46% white, 35% African-American, 13% Latino) completed a self-administered questionnaire in May or October 1991. RESULTS: Thirty-four percent of the students had fought at least once, and 7% more than four times during the previous month. Also, within that period, 5% had skipped school owing to fear of violence. Students whose parents used nonviolent disciplinary techniques fought less frequently than those whose parents relied on hitting and more violent disciplinary methods (p < 0.001). Fighting was significantly more common among students who believe their parents want them to fight if insulted (p = 0.001). Students who reported that they try to stay out of fights usually succeeded (p = 0.001). Those students who more frequently participated in and observed fighting were more likely to carry a weapon (p = 0.001). CONCLUSIONS: Fighting is a frequent occurrence in the lives of seventh-grade students. Students' understanding of their parents' attitudes and behavior correlate strongly with violent behavior. While many students feel that weapons confer safety, those students who actually carry weapons are much more likely to fight.     

Political conservatism as motivated social cognition.

Analyzing political conservatism as motivated social cognition integrates theories of personality (authoritarianism, dogmatism-intolerance of ambiguity), epistemic and existential needs (for closure, regulatory focus, terror management), and ideological rationalization (social dominance, system justification). A meta-analysis (88 samples, 12 countries, 22,818 cases) confirms that several psychological variables predict political conservatism: death anxiety (weighted mean r=.50); system instability (.47); dogmatism-intolerance of ambiguity (.34); openness to experience (-.32); uncertainty tolerance (-.27); needs for order, structure, and closure (.26); integrative complexity (-.20); fear of threat and loss (.18); and self-esteem (-.09). The core ideology of conservatism stresses resistance to change and justification of inequality and is motivated by needs that vary situationally and dispositionally to manage uncertainty and threat. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vaccination in elderly patients in rehabilitation: a missed opportunity?

BACKGROUND: Immunization against influenza is recommended for elderly persons in Switzerland, but no national guidelines are currently available regarding immunization of the elderly against pneumococcus and tetanus. In addition, almost no data are available regarding immunization rates of the elderly in the general population. In this study we explored the immunization status for influenza, tetanus and pneumococcus of a selected elderly population admitted to a Swiss rehabilitation facility. POPULATION AND METHODS: The study population (n = 145) were patients admitted to a rehab facility during 3 consecutive winter months. Data on demographics, immunization, previous functional status (BADL, IADL), cognitive (MMSE) and affective status (GDS) were collected upon admission. RESULTS: Subjects' mean age was 79.4 years, 32.4% were male, 42.8% had BADLs dependencies and 81.9% IADLs dependencies. Most patients had normal MMSE and GDS scores. Vaccination rates were 39.3% for influenza, 12.4% for tetanus and only 2.1% for pneumococcus. In univariate analyses, people immunized against influenza were older than those who were not (p = 0.01). This relationship remained in multivariate analyses, controlling for gender, functional, cognitive and affective status. Subjects aged 80 and over were 2.5 times (95% CI 1.2-5.5, p = 0.02) more likely to be immunized against influenza, but were less likely to be immunized against tetanus (OR 0.3, 95% CI 0.1-0.9, p = 0.04). Functional status was not significantly associated with any vaccination status. CONCLUSIONS: Immunization rate for influenza in this selected population is similar to those described in US surveys. The positive association between older age and flu vaccination is surprising and needs further investigation. These results also indicate a need to educate patients and physicians in order to increase vaccination use, especially against pneumococcus.     

The origins of specific phobias: Influential theories and current perspectives.

Fears are quick and adaptive responses that permit powerful reply to imminent threats. Less adaptive, phobias are extreme manifestations of fear to objects or situations in the absence of a proportional danger. Although the utility of fear is accepted, the nature of phobias is controversial. Initial theories favored a fear conditioning-based explanation, with vicarious and information learning pathways subsequently included as additional routes to the development of specific phobias. More recently, an important group of investigations strengthened the case for a nonassociative account of fear acquisition proposing that evolutionarily relevant fears can occur without any need of critical learning experiences. In parallel, there is some evidence for a dedicated fear module in the detection of threats, involving the amygdala, which is relatively independent from conscious cognitive control. Nonetheless, cognitive models stress learning and developmental factors and their role in the etiology and maintenance of phobic behavior. This article critically reviews each of these views and theories stressing their recent developments, weaknesses, and controversies with an aim to provide the groundwork for the construction of a more integrated position. Finally, the authors suggest encouraging trends in recent research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internal–external locus of control as a moderator of fear appeals.

161 midwestern US residents responded to a questionnaire that contained Rotter's Internal–External Locus of Control Scale, 1 of 4 fear messages, and scales measuring attitudes and intentions. Determination of the 4 fear messages was developed through 2 pretests using randomly selected judges. The subject of the fear messages was a health maintenance organization. ANOVA indicated that level of fear appeal and locus of control predicted attitude and intention. There was, however, no significant interaction. At all levels of fear appeal, external Ss tended to react more favorably to the message. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for high blood lead levels among the general population in Taiwan

BACKGROUND: Tacrolimus (FK506) may represent a major advance in the management of allograft rejection after solid organ transplantation. In August 1994 a European heart transplantation pilot study was initiated to assess the efficacy and safety of tacrolimus when administered exclusively through an oral route. METHODS: Eighty-two heart transplant recipients were randomized to treatment (2:1 ratio) with either tacrolimus- (n=54) or cyclosporine-based therapy (n=28). RESULTS: No significant differences were evident between the two treatment groups in either rejection or survival rates at 1 year. Kaplan-Meier estimates of the freedom from rejection were 26.3% and 18.5%, respectively, for the tacrolimus and cyclosporine treatment groups (p=.444). Survival rates were 79.6% and 92.9% (p=.125). At 3 of the 5 centers, patients received antithymocyte globulin during the immediate postoperative period and fared better than those who did not (with acute rejection-free rates of 49.2% and 26.7% for tacrolimus and cyclosporine, respectively [p=.080], as opposed to 7.1% and 8.3% [p=.965]; patient survival rates of 84.6% and 93.3% [p=.382] vs 75.0% and 92.3% [p=.243]). The overall rates of infection, impaired renal function (31.5% vs 21.4%), and glucose intolerance (7.0% vs 4.3%) did not differ significantly between the tacrolimus and cyclosporine treatment groups. Tacrolimus seemed to possess an advantage with regard to a reduced requirement for antihypertensive therapy (59.5% vs 87.5%, p=.025). CONCLUSIONS: Immunosuppression with oral tacrolimus provides a viable alternative to treatment with cyclosporine, particularly when administered in conjunction with antibody therapy. Further studies are warranted to optimize the administration of tacrolimus in this indication.     

Effects of components of protection-motivation theory on adaptive and maladaptive coping with a health threat.

How do people cope with a threat when they do not plan to adopt an adaptive, protective reponse? We explored this question by examining the effects of information about a health threat and two aspects of coping ability, self-efficacy and response efficacy, on two adaptive and five maladaptive coping strategies (e.g., avoidance, wishful thinking). The results disclosed that the high-threat condition energized all forms of coping; it did not differentially cue specific coping strategies. The critical factor in determining the specific strategies used was the coping information. The high-response-efficacy and high-self-efficacy conditions strengthened adaptive coping and did not foster any maladaptive coping. A supplementary path analysis revealed an intriguing pattern of relations, including the finding that the most maladaptive strategy was avoidant thinking, which simultaneously reduced fear of the threat and weakened intentions to adopt the adaptive response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Source entitativity and the elaboration of persuasive messages: The roles of perceived efficacy and message discrepancy.

Compared with nonentitative groups, entitative targets are considered to elicit more elaborative processing because of the singularity or unity they represent. However, when groups serve as sources of persuasive messages, other dynamics may operate. The current research suggests that entitativity is intrinsically linked to perceptions of a group’s efficacy related to the advocacy, and this efficacy combines with the position of the appeal to determine message elaboration. When messages are counterattitudinal, entitative (efficacious) sources should elicit greater processing than nonentitative groups because of concern that the entitative sources may be more likely to bring about the negative outcomes proposed. However, when appeals are proattitudinal, sources low in entitativity (nonefficacious) should initiate more elaboration due to concern that they may be unlikely to facilitate the positive outcomes proposed. These hypotheses were supported in a series of studies. Preliminary studies established the entitativity–efficacy relation (Studies 1A and 1B). Primary persuasion studies showed that manipulations of source entitativity (Studies 2 and 3) and source efficacy (Studies 4A and 4B) have opposite effects on processing as a function of message discrepancy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing a state''s physician workforce priorities through the funding of graduate medical education: the TennCare model

OBJECTIVE: To investigate differences in second-, third-, and fourth-year medical students' knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward, and intentions to comply with, Universal Precautions (UP). DESIGN: Cross-sectional survey. PARTICIPANTS AND SETTING: Surveys about students' knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996. RESULTS: Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated healthcare workers' risk of infection from needlestick injuries (P<.001). Students' perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double glove for all invasive procedures with sharps (P<.001). Clinical students agreed more strongly with reporting only high-risk needlestick injuries (P=.057) and with rationalizations against using UP (P=.008). Preclinical students more frequently reported contemplating or preparing to comply with double gloving, wearing protective eyewear, reporting all exposures, and safely disposing of sharps, whereas students with clinical experience were more likely to report compliance. Clinical students also were more likely to report having "no plans" to practice the first three of these precautions (P<.001). CONCLUSIONS: Differences in knowledge, attitudes, and intentions to comply with UP between students with and without clinical experience may have important implications for the timing and content of interventions designed to improve compliance with UP.     

The detection of fear-relevant stimuli: Are guns noticed as quickly as snakes?

Potentially dangerous stimuli are important contenders for the capture of visual-spatial attention, and it has been suggested that an evolved fear module is preferentially activated by stimuli that are fear relevant in a phylogenetic sense (e.g., snakes, spiders, angry faces). In this study, a visual search task was used to test this hypothesis by directly contrasting phylogenetically (snakes) and ontogenetically (guns) fear-relevant stimuli. Results showed that the modern threat was detected as efficiently as the more ancient threat. Thus, both guns and snakes attracted attention more effectively than neutral stimuli (flowers, mushrooms, and toasters). These results support a threat superiority effect but not one that is preferentially accessed by threat-related stimuli of phylogenetic origin. The results are consistent with the view that faster detection of threat in visual search tasks may be more accurately characterized as relevance superiority effects rather than as threat superiority effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Components in a treatment of insect phobias.

Tested 3 components of a supportive but directive approach to overcoming mild aversion to insects. Ss were 28 female undergraduates in 3 treatment groups and 1 control group (n = 7 each). Treatment tapes used signal-safety conditioning messages, positive reinforcement, or negative reinforcement. Self-report and overt behavior measures of fear were recorded for 5 consecutive approach-assessment tests. Each treatment component was associated with significant (p     

Communication neuroscience as a tool for health psychologists.

Comments on the original article, "Increased attention but more efficient disengagement: Neuroscientific evidence for defensive processing of threatening health information" by L. T. E. Kessels, R. A. C. Ruiter, and B. M. Jansma (see record 2010-14873-005). Kessler et al present an example of Communication Neuroscience as a tool for understanding the mechanisms that lead some health messages to be processed in a way that facilitates impact whereas other messages are ignored. Kessels et al used event-related brain potentials (ERPs), a high temporal resolution method, to monitor neural activity in the moment that messages are presented. They use this technology to provide insight about the low-level attention processes through which individuals at highest risk (in this case, smokers) disengage from self-relevant health messages (threatening and nonthreatening smoking images). The findings of Kessels et al are convergent with prior theory and empirical work demonstrating that high threat messages may not achieve the desired effect if presented in isolation (Brown & Locker, 2009; Leventhal, Safer, & Panagis, 1983; Liberman & Chaiken, 1992). By using the tools of neuroscience, however, Kessels et al elucidate a mechanism that was not apparent through self-report or implicit (reaction time) measures. They demonstrate that high threat messages lead to increased attention capture, but more efficient disengagement when threatening messages are self-relevant; this in turn helps to explain why high threat messages may not have the desired effect, despite successfully capturing people’s attention. As such, this study illustrates one benefit of combining the tools of neuroscience with more familiar methods in health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of multicomponent interventions on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p=.022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p=.034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communication problems for patients hospitalized with chest pain

In many settings, primary care physicians have begun to delegate inpatient care to hospitalists, but the impact of this change on patients' hospital experience is unknown. To determine the effect on physician-patient communication of having the regular outpatient physician (continuity physician) continue involvement in hospital care, we surveyed 1,059 consecutive patients hospitalized with chest pain. Patients whose continuity physicians remained involved in their hospital care were less likely to report communication problems regarding tests (20% vs 31%, p =.03), activity after discharge (42% vs 51%, p =.02), and health habits (31% vs 38%, p =. 07). In a setting without a designated hospitalist system, communication problems were less frequent among patients whose continuity physicians were involved in their hospital care. New models of inpatient care delivery can maintain patient satisfaction but to do so must focus attention on improving physician-patient communication.     

Should improvement in rheumatoid arthritis clinical trials be defined as fifty percent or seventy percent improvement in core set measures, rather than twenty percent?

OBJECTIVE: To determine whether improvement of more than 20% in core set parameters should be required before patients are characterized as improved in rheumatoid arthritis (RA) clinical trials. METHODS: Data from 6 RA trials were reanalyzed to evaluate the discriminant validity (ability to differentiate active treatment from control) of 4 proposed definitions of improvement: the current American College of Rheumatology (ACR) definition (a 20% threshold for core set parameters [ACR 201), a 50% threshold (ACR 50), a 70% threshold (ACR 70), and an ordinal definition in which a patient could be classified in any of 3 categories (unimproved, ACR 20, or ACR 50). To evaluate the discriminant validity of these 4 definitions of improvement, we characterized each patient in each trial as improved or not, based on each definition, and computed a chi-square value differentiating the active treatment group from the control group, with the corresponding P value. RESULTS: With an increase in the threshold for improvement, the percentage of placebo-treated patients who were classified as experiencing response dropped dramatically in all trials, as did the percentage of patients receiving active therapy (second-line drug, combination therapy, tumor necrosis factor p75-Fc fusion protein) who were classified as experiencing response. Generally, the drop in active treatment response rates was greater than the drop in placebo response rates, leaving the difference between the 2 groups less at the higher thresholds. Therefore, chi-square values fell as the threshold for response was raised. The ordinal definition of improvement yielded chi-square values similar to those obtained using ACR 20 alone. CONCLUSION: Adopting a definition of efficacy in RA trials that requires 50% or 70% improvement in core set parameters would likely compromise statistical power and make it more difficult to distinguish between 2 treatments with different efficacy. ACR 20 should continue to be the primary measure of efficacy in RA trials, with higher thresholds for improvement being determined and reported as secondary efficacy measures.     

The provision of influenza vaccine to patients over 65 years by general practitioners

Influenza vaccination for all elderly persons is cost effective. Guidelines in Ireland recommend the vaccine for those with chronic illness and to the elderly in care. The aims of this study are to identify how influenza vaccine is provided to elderly patients and to get GPs opinions on what barriers there are to providing the vaccine to persons 65+ years. Of the 143 GPs contacted 117 (81.8%) replied, of whom 116 (99.1%) provide the vaccine to their patients. Ninety nine (85.3%) believe it to be effective in preventing influenza, and only 8 (6.9%) have reservations about the vaccine. Eighteen (15.5%) GPs had a difficulty in identifying those to be vaccinated and only 11 (9.5%) had a computerised system to assist them. Twenty two (19.0%) GPs had difficulty in getting sufficient vaccine for their patients. Ninety six (82.8%) GPs make the vaccine available to those for whom it is recommended and of these 61 make it available to all patients over 65 years. The main patient barriers to an influenza vaccination programme are the patients fear of getting influenza from the vaccine and that many patients do not consider the vaccine to be of value. Barriers identified for GPs are the low level of reimbursement to GPs for vaccinating eligible patients and the lack of proper systems that help identify and contact those who should be getting the vaccine. All of the barriers identified should be easy to overcome so that those who require influenza vaccine can reap the health and social gains that our health services advocate.     

A randomized, controlled trial of adding expired carbon monoxide feedback to brief stop smoking advice: Evaluation of cognitive and behavioral effects.

Objective: To determine the effect of adding biomarker feedback (expired air carbon monoxide) to standard quit advice on cognitive antecedents of behavior change and smoking cessation and to identify potential effect moderators and mediators. Design: Smokers (N = 160) were randomized to a control (quit advice plus leaflet) or an intervention condition (as control group plus carbon-monoxide level feedback). Cognitive measures were assessed immediately after the intervention and behavioral measures at 6 months' follow-up. Main Outcome Measures: Primary outcome measures were threat and efficacy appraisal, fear arousal, and intention to stop smoking. Secondary outcome measures were quit attempts within the last 6 months and 7-day point prevalence abstinence. Results: Threat appraisal was significantly enhanced in the intervention compared with the control group, t(158) = 2.29, p = .023, as was intention to stop smoking in the next month, t(151) = 2.9, p = .004. However, this effect on intention to stop smoking was short-lived. Groups did not differ in terms of quit attempts or abstinence at follow-up, but the intervention increased the likelihood of cessation in smokers with higher self-efficacy, χ2(1) = 5.82, p = .016. Conclusions: Carbon-monoxide level feedback enhances the effect of brief quit advice on cognitive antecedents of behavior change and smoking cessation rates but further research is required to confirm the longevity of this effect and its applicability to smokers with low self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)