Sickle cell disease pain: Relation of coping strategies to adjustment.

This study examines pain coping strategies in a relatively neglected pain population, sickle cell disease (SCD) patients. Seventy-nine patients diagnosed with SCD were given a structured interview to assess pain, activity level, and health care use during painful episodes. Patients also completed the SCL-90—R as an index of psychological distress and the Coping Strategies Questionnaire. Regression analyses controlled for age, sex, and disease severity measures. Results indicated that the coping strategies factors were important predictors of pain and adjustment. Individuals high on Negative Thinking and Passive Adherence had more severe pain, were less active and more distressed, and used more health care services. Individuals high on Coping Attempts were more active during painful episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with rehabilitation outcome in patients with low back pain (LBP): Prediction of employment outcome at 9-month follow-up.

Examined which admission and treatment change variables predicted return to work for 117 male patients (mean age 40.2 yrs) with work-related LBP. Pain and disability perception, coping strategies, depression, and functional status were examined at admission and discharge for Ss who participated in an interdisciplinary work rehabilitation program. Discriminant function analyses, using employment status 9 mo later as the dependent variable, resulted in correct classification rates of 79% when admission and treatment change scores were used as predictors. Psychological factors at admission were the salient variables that predicted employment outcome at follow-up. Of the treatment change variables, physical status and S's perception of his/her disability significantly predicted return to work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sickle cell disease pain in children and adolescents: change in pain frequency and coping strategies over time

Examined 9-month follow-up data obtained from children and adolescents with sickle cell disease (SCD) and their parents participating in a longitudinal study of pain coping strategies. Of 87 subjects completing the baseline assessment of pain coping strategies, 70 (80%) of their parents completed a structured pain interview assessing their child's health care use and activity reduction during painful episodes over the follow-up period. Regression analyses controlling for age and pain frequency revealed that baseline Coping Attempts were associated with higher levels of school, household, and social activity during painful episodes. Baseline Passive Adherence was associated with more frequent health care contacts during the subsequent 9 months. Increases in Negative Thinking over time were associated with further increases in health care contacts during the follow-up period. Comparing pain coping strategies assessed at baseline to pain coping strategies measured at follow-up revealed that pain coping strategies were relatively stable over time for younger children but changed more for adolescents.     

Renewal of DNA in Purkinje cell nuclei of mouse cerebellum. A 9-month follow-up autoradiographic study

3H thymidine was injected into pregnant mice in order to label the DNA in the dividing Purkinje cell (PC) precursors of the embryonic cerebellum. The retention of 3H-DNA was evaluated in PC nuclei of animals at the age of 25 days, 3, 6 or 9 months by light microscope autoradiography. The number of silver grains decreased in the whole nuclei by 13.6% and 19.6% in animals 6- and 9-month-old, respectively. In the nucleolar region, the loss of DNA radioactivity was more profound; the silver grain counts decreased by 22.6% and 29.1% in 6- and 9-month-old animals, respectively. No significant differences in the volume and dry mass concentration were found in the PC nuclei of 25 PD and 9 PM old animals. Therefore, the observed changes in grain density counts represent the actual measure of 3H-DNA loss, and/or "spontaneous" renewal of the DNA molecule in PC nuclei, as well as its higher expression in the nucleolar region. Furthermore, it follows from the comparison of our data with those present in the literature, that DNA synthesized in nerve cell precursors before their withdrawal from the mitotic cycle is more stable than that synthesized in postmitotic neurones. This suggests that the repair of DNA in mature neurones might be of an error-prone type.     

Predicting behavioral intentions and physical exercise: A test of the health action process approach at the intrapersonal level.

Objective: Theories of health behavior are usually tested on the between-person level. Associations between variables on the between- and the within-person level, however, can differ substantially. Thus, in order to better understand intrapersonal processes in the domain of health behavior, studies applying within-person analyses are needed. This study tested the Health Action Process Approach (HAPA) on the within- and between-person level in the context of physical exercise. Design: Participants were 265 first-year students who completed nine online questionnaires every second week. Data were analyzed by focusing on intrapersonal associations applying multilevel modeling. Main Outcome Measures: Intentions for physical exercise and self-reported physical exercise served as main outcome measures. Results: Analyses mainly confirm associations specified by the HAPA at the intrapersonal level: outcome expectancies and self-efficacy, but not risk awareness, were positively associated with intentions for physical exercise. Physical exercise in turn was positively associated with intentions, self-efficacy, action control, but not with action planning. Conclusion: The HAPA could be confirmed on the within-person level. Future studies should focus on testing other theories of health behavior at the within-person level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy plus contingency management for cocaine use: Findings during treatment and across 12-month follow-up.

Contingency management (CM) rapidly reduces cocaine use, but its effects subside after treatment. Cognitive-behavioral therapy (CBT) produces reductions months after treatment. Combined, the 2 might be complementary. One hundred ninety-three cocaine-using methadone-maintained outpatients were randomly assigned to 12 weeks of group therapy (CBT or a control condition) and voucher availability (CM contingent on cocaine-negative urine or noncontingent). Follow-ups occurred 3, 6, and 12 months posttreatment. Primary outcome was cocaine-negative urine (urinalysis 3 times/week during treatment and once at each follow-up). During treatment, initial effects of CM were dampened by CBT. Posttreatment, there were signs of additive benefits, significant in 3- versus 12-month contrasts. Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval.

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patients were initially functioning as well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses. (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)     

Psychophysiological treatment of migraine and tension headaches: A 12-month follow-up.

Conducted a 12-mo follow-up of the present authors' (1983) study population of chronic headache sufferers by telephone interviewing 31 chronic migraine and 25 chronic tension headache patients (aged 18–61 yrs) who had been treated with EMG, muscle relaxation, and fingertip temperature training to test a hypothesis of biofeedback placebo effects. A previous 3-mo follow-up had revealed that all treatments had produced significant improvement, and relaxation was not as good as the biofeedback devices for obtaining a reduction in monthly headache hours. At 12-mo follow-up, the 3-mo improvement was sustained overall, but migraineurs as a group appeared to regress slightly, while tension patients improved significantly in the interim. On the basis of a 50% reduction in symptomatology, biofeedback treatment was significantly superior to relaxation for tension headaches, although this had not been true at the 3-mo assessment. Temperature training was at least as effective as EMG for both headache groups. In view of these results, biofeedback treatment is viewed less as placebo administration and more as a secondary reinforcer of a specific but unknown physiological response. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking level of care to level of need: Assessing the need for mental health care for nursing home residents.

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mastectomy versus breast conservation surgery: Mental health effects at long-term follow-up.

Approximately 70% of 129 Stage 1 and Stage 2 breast cancer patients elected to have breast conservation surgery (BCS) and the rest chose mastectomy. Using the Profile of Mood States and Karnofsky ratings of physical functional status, patients were assessed 3–5 days following surgery and again 3 and 15 mo following surgery. Compared with mastectomy patients, patients who received BCS were rated as more functional by observers, but they perceived themselves as having less energy and less emotional support, especially over the 1st 3 mo of the recovery period. Results show that BCS was not a psychosocial panacea. Patients whose breasts were spared, especially younger patients, had psychological symptoms that were worse in the short run and, in the end, were similar to those of patients who chose mastectomies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continued impairment in persons at risk for bipolar affective disorder: Results of a 19-month follow-up study.

Conducted a 19-mo follow-up study of 45 undergraduates identified as being at risk for bipolar affective disorder by the General Behavior Inventory (GBI) by the authors and colleagues (see record 1982-01362-001). These Ss and 64 control undergraduates completed brief inventories reflecting their psychological impairment over the follow-up period. Overall, GBI cases continued to exhibit significant impairment relative to controls. Two cases had been hospitalized for major depressive episodes following suicide attempts. Significantly higher proportions of GBI cases (a) were referred for treatment by family or friends, (b) reported frequent suicidal ideation, and (c) frequently considered seeking treatment. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matching treatment focus to patient social investment and support: 18-month follow-up results.

Patients were randomly assigned to 1 of 3 treatments: brief broad-spectrum (BBS), extended relationship enhancement (ERE), or extended cognitive–behavioral (ECB). A hierarchical latent growth model was used to analyze the data of 188 patients (82%) followed for 18 months. ERE treatment was significantly more effective in increasing abstinence of patients entering treatment with a network unsupportive of abstinence or with a low level of investment in their network, whereas BBS treatment was more effective for patients with either (a) both a social network unsupportive of abstinence and a low level of network investment or (b) high investment in a network supportive of abstinence. ECB outcomes were neither as good as those matched nor as bad as those mismatched to the different exposures of relationship enhancement. This suggests that dose of relationship enhancement should be determined after assessing patient relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological adjustment of children with sickle cell disease: Stability and change over a 10-month period.

Rates of poor psychological adjustment of children with sickle cell disease remained relatively constant over initial and follow-up assessment points. 50 children (aged 7–12 yrs) and their mothers completed the initial protocol. 30 children completed the follow-up plus 5 additional children and their mothers. These Ss were aged 7–24 yrs at follow-up. With initial levels of adjustment controlled, children's strategies for coping with pain accounted for a significant increment in child-reported symptoms and mother-reported internalizing behavior problems at follow-up beyond the contribution of illness and demographic parameters and follow-up interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staff burnout and patient satisfaction: Evidence of relationships at the care unit level.

Research on burnout has thus far focused primarily on the individual; however, in work environments in which teamwork is emphasized, it seems plausible that a meaningful group-level burnout construct could emerge. This theory was tested by examining burnout in psychosocial rehabilitation teams and its effects on patient satisfaction. Three hundred thirty-three staff from 31 behavioral health teams completed the Maslach Burnout Inventory; 405 of the clients they served completed the Consumer Satisfaction Scale. Multilevel analyses (hierarchical linear modeling) confirmed the existence of a meaningful team-level burnout construct. Team-level analyses revealed significant relationships between team burnout and patient satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Better at home: a continuous health care program for patients with advanced chronic respiratory disease

The objective of this study was to analyze the effect of continuous health care on the frequency of readmissions of patients with advanced chronic respiratory disease. The study was prospective, enrolling 26 patients (16 with COPD, 7 with bronchiectasis and 3 with pachypleuritis) who had been admitted at least 3 times within the past year. The patients were assigned to 3 groups: group A was the ambulatory monitoring group, with 8 patients who were able to travel to the hospital for monthly outpatient checkups; group B was the ambulatory pulmonary rehabilitation group, with 10 patients who were able to travel to the hospital and who needed rebreathing training (one weekly group session); and group C was the home care group, with 8 patients who were unable to travel to the hospital and who received weekly or biweekly house calls. All patients had telephone contact with the program team. Mean lung function values for the whole population were FVC 40 (11)%, FEV1 23 (7)% of reference, PaO2 55 (7) and PaCO2 55 (10) mmHg. A significant decrease in number of admissions (79 versus 18, p < 0.0001) was observed in both the first and second halves of the year in all three treatment groups: A, 25 to 2; B, 28 to 8; and C, 26 to 8 (p < 0.001). The reduction in health care costs over the previous year's expenditure was calculated to be 22,751,402 pesetas. We conclude that specialized health care that is continuous and personalized reduces the number of hospital readmissions of patients with advanced chronic respiratory disease. Moreover, the overall cost of care, without the need to make house calls to all patients.     

Physical, emotional, and sexual abuse among pain patients and health care providers: Implications for psychologists in multidisciplinary pain treatment centers.

Surveyed 200 back pain patients and 64 health care providers/staff on their physical, emotional, and sexual abuse histories as victims or perpetrators. Depending on the type of abuse, 27–36% of female patients, 6–23% of male patients, and 33–55% of female providers/staff were abuse victims. From 1–22% of female patients, 3–20% of male patients, and 3–25% of providers/staff were abuse perpetrators, depending on the type of abuse. A startling 94% of abuse perpetrators were also abuse victims. Among those who were both victim and perpetrator, 81% of physical-abuse perpetrators, 60% of sexual-abuse perpetrators, and 41% of emotional-abuse perpetrators were previously or concurrently some type of abuse victim. Implications for health care diagnoses and treatment decisions, caregiving by providers/staff, and the psychologist's role on multidisciplinary treatment teams are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting group-level outcome variables from variables measured at the individual level: A latent variable multilevel model.

In multilevel modeling, one often distinguishes between macro-micro and micro-macro situations. In a macro-micro multilevel situation, a dependent variable measured at the lower level is predicted or explained by variables measured at that lower or a higher level. In a micro-macro multilevel situation, a dependent variable defined at the higher group level is predicted or explained on the basis of independent variables measured at the lower individual level. Up until now, multilevel methodology has mainly focused on macro-micro multilevel situations. In this article, a latent variable model is proposed for analyzing data from micro-macro situations. It is shown that regression analyses carried out at the aggregated level result in biased parameter estimates. A method that uses the best linear unbiased predictors of the group means is shown to yield unbiased estimates of the parameters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use and community violence: A test of the relation at the daily level.

Prior research has consistently demonstrated an association between substance use and involvement in violence among individuals with mental illness. Yet little is known about the temporal quality of this relationship, largely because longitudinal data required to address this issue are not readily available. This study examined the relationship between substance use (alcohol, marijuana, and other drug use) and violence at the daily level within a sample of mentally ill individuals at high risk for frequent involvement in violence (N = 132). Results support the serial nature of substance use and violence, with an increased likelihood of violence on days following the use of alcohol or multiple drugs, but not the inverse relationship. Implications for the utility of substance use as a risk marker for the assessment of future violence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)