Contributions of disease severity and perceptions of primary and secondary control to the prediction of psychosocial adjustment to Parkinson's disease.

Seventy-four people with Parkinson's disease (PD) completed questionnaires and were interviewed to determine the degree to which the severity of PD and perceptions of primary and secondary control over PD predicted psychosocial adjustment. Significant unique contributions to PD-related participation restrictions were made by disease severity (positive relationship) and perceived internal secondary control (negative relationship). Also, participation restrictions had a significant direct effect, and disease severity and perceived internal secondary control significant indirect effects, on both depressive symptomatology and life satisfaction. Results are consistent with theories that suggest the importance of enhancing internal secondary control processes in situations in which actual control over objective circumstances is limited, such as with chronic and progressive diseases like PD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic approaches to primary and secondary brain tumours

INTRODUCTION: This study examined the long-term effects of hysterectomy, with and without bilateral oophorectomy, and treatment with estrogen replacement on bone mineral density in older hysterectomized women. METHODS: Subjects were 346 women 60-89 years of age, who were participants in the Rancho Bernardo Study and attended a follow-up clinic visit in 1988-1991. Bone density was measured at the ultradistal wrist, midshaft radius, lumbar spine and hip. RESULTS: Of these women, 182 had a hysterectomy with conservation of one or both ovaries and 164 had a hysterectomy with bilateral oophorectomy. Current estrogen users had the highest bone densities; those who never used estrogen replacement had the lowest. Only 9.1% of oophorectomized women, compared to 19.2% of those with ovarian conservation had never used estrogen (P < .01). After adjustment for covariates including estrogen replacement therapy, hysterectomized women with ovarian conservation had marginally higher bone densities at the wrist (P < .09) and spine (P < .06) than oophorectomized women. We found significant differences only among women currently using estrogen (P < .05 for wrist and P < .01 for spine densities, respectively). Bone density did not differ at any site by oophorectomy status among past or never users of estrogen. CONCLUSIONS: Hysterectomized women who use estrogen replacement therapy have better bone density, regardless of a bilateral oophorectomy. In addition, bilateral oophorectomy may not have a long-term negative effect on bone density; hysterectomized women who do not use estrogen appear to have equivalent bone density whether or not they had a bilateral oophorectomy.     

Diagnostic implications of the B-mitten EEG pattern: relationship to primary and secondary affective dysregulation

Previous studies indicate that the B-Mitten EEG pattern is specific to psychiatric dysfunction and rarely encountered among normal control subjects. Our previous investigations have demonstrated a significant relationship between mittens and reactive as opposed to process schizophrenic disease. Re-analyses of mitten incidence in schizophrenics and nonschizophrenics suggests needed modification of our earlier B-Mitten-schizophrenia formulation. Present considerations indicate that the B-Mitten-reactive schizophrenia association is not primary but rather that the differential process-reactive schizophrenia mitten incidence may be a secondary epiphenomenon reflecting a more fundamental underlying process. Analyses are presented suggesting that the mitten dysrhythmia relates positively to dysphoric affective dysregulation in a manner which cuts across broad diagnostic boundaries. That the mitten pattern possibly suggests as yet unclarified subcortical dysfunction associated with symptoms of affective disturbance is a tentative hypothesis offered for consideration.     

Dysphoria: Relations to appraisals, coping, and adjustment.

Previous research has shown that individual differences in dysphoria are linked to adjustment, but the potential mediating influence of appraisals and coping has not been studied until now (R. Lazarus & S. Folkman, 1984). This study examined the direct and indirect influences of dysphoria on primary and secondary appraisal, coping, and psychological and physical adjustment in 361 college students. Results from conducting path analyses indicated that the link between dysphoria and adjustment was mediated by appraisals and coping. These results also suggest that dysphoria has both direct and indirect influences on adjustment. Implications for future research and development of appropriate interventions for working with dysphorics are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training.

Elementary school children with mild-to-moderate depressive symptoms were randomly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program. The program focused on (a) primary control (changing objective conditions to fit one's wishes; e.g., through activity selection and goal attainment) and (b) secondary control (changing oneself to buffer the impact of objective conditions; e.g., altering depressogenic thinking, practicing mood-enhancing cognitions ) . At immediate posttreatment and 9-month follow-up, the treatment group showed greater reductions than the control group in depressive symptomatology on the Children's Depression Inventory and the Revised Children's Depression Rating Scale, and treated children, more than controls, shifted from above to within the normal range on both measures. Future research is needed to test treatment effects with severely depressed youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Source memory and divided attention: Reciprocal costs to primary and secondary tasks.

Source memory, in comparison with item memory, is more sensitive to frontal lesions and may require more strategic processing. Divided attention was used to restrict attentional resources and strategic processing on memory tasks. Participants encoded and retrieved items (i.e., words) and source (i.e., voice or spatial location) while concurrently performing a fingertapping (FT) or visual reaction-time (VRT) task. Memory accuracy costs under divided attention were greater for retrieval of source than item and were greater with VRT than FT. Similarly, costs to the secondary task were greater when concurrently retrieving source as opposed to item and were greater for VRT than FT. Effects were stronger when spatial location was used as the source task. Findings support the idea that processing source information requires more attentional resources and effort than processing item information. Furthermore, concurrent performance of VRT produced greater interference with a task that was more dependent on intact frontal functioning and better simulated the performance of patients with frontal dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring appraisals following acquired spinal cord injury: A preliminary psychometric analysis of the appraisals of disability.

Objectives: The current study aimed to develop a reliable and valid appraisal scale (The Appraisals of DisAbility: Primary and Secondary Scale; ADAPSS) for adult spinal cord injury (SCI) populations. Method: Items for the ADAPSS were generated using themes and quotes from a qualitative study exploring appraisals made by individuals with SCI. The ADAPSS was administered with 2 additional appraisal measures, a measure of anxiety and depression, a measure of social desirability and demographic information. The study used a cross-sectional questionnaire design with a test–retest component, sampling community-based individuals with SCI. Data analysis was undertaken on 237 completed questionnaires. Results: Factor analysis revealed the ADAPSS to have a 6-factor structure and the following subscales identified: (a) Fearful Despondency, (b) Overwhelming Disbelief, (c) Determined Resolve, (d) Growth and Resilience, (e) Negative Perceptions of Disability, and (f) Personal Agency. Conclusion: Preliminary analyses suggest the ADAPSS demonstrates reasonable reliability and validity and has potential as a therapeutic outcome measure. Future research should focus on the relationship between appraisals identified on the ADAPSS and their relationship to the coping strategies that individuals employ and adjustment to SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's health and the privatization of fertility control in Brazil

In Brazil, privatization of the public sphere and neglect of public health is part of a conservative modernization strategy that is dominated by elite groups. The politics of human reproduction, consistent with this pattern, have left women dependent on the private sector for access to the means of fertility control, in spite of the existence of a conceptually-advanced public programme for comprehensive health care for women--a programme which expressed the demands of, and is widely supported by, the women's movement. While both the rate of contraceptive use and the types of methods used (oral contraceptives and surgical sterilization) are modern, the privatization of fertility control has resulted in a complete separation between fertility control and health care for poor women, who are the vast majority. Evidence indicates that many, perhaps most, women accumulate the health effects of totally uncontrolled and incorrect use of oral contraceptives, including unwanted pregnancies and illegal abortions, in the end resorting to clandestine surgical sterilization, which is usually performed through unnecessary caesarean section. Data on reproductive morbidity and mortality, however, are virtually non-existent. International women's reproductive rights networks and alternative services for women have advocated greater empowerment for women, in terms of improved standards of self-care and increased power in the use of health services. As a result, a gender approach to reproductive health care is now being proposed for government programmes. The Brazilian case services as an example of the limits faced by such programmes when adopted in a wider context of unfavorable political conditions.     

The effects of preoperative preparation on postoperative outcomes: The moderating role of control appraisals.

Objective: To test the proposal that external health locus of control and self-efficacy would moderate the effects of a psychological preparation for surgery on outcomes for surgical heart patients. Main Outcome Measures: Psychological distress, pain, serum cortisol, and tumor necrosis factor alpha. Design: A total of 80 coronary artery bypass graft patients were given standard care plus a psychological preparation or standard care alone using a single-blind methodology with random assignment. Data on psychological and biological functioning were collected at admission (baseline) and discharge. Results: As predicted, external health locus of control and self-efficacy moderated the effect of the preparation on all outcomes. Results indicated that for high external health locus of control, the preparation was related to lower distress for people with high self-efficacy compared with those with low self-efficacy. When external health locus of control was low, the preparation was related to lower distress for those with lower self-efficacy. Conclusion: These findings caution against the use of preparations and education for surgical patients without accounting for control appraisals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cell morphogenesis of trichomes in Arabidopsis: differential control of primary and secondary branching by branch initiation regulators and cell growth

Cell morphogenesis, i.e. the acquisition of a particular cell shape, can be examined genetically in the three-branched trichomes that differentiate from single epidermal cells on the leaves of Arabidopsis thaliana. In normal development, the growing trichome cell undergoes two successive branching events, resulting in a proximal side stem and a distal main stem which subsequently splits in two branches. Using new and previously described trichome mutants, we have analyzed the branching pattern in single and double mutants affecting branch number or cell size in order to determine underlying mechanisms. Our results suggest that primary branching is genetically distinct from subsequent branching events and that the latter, secondary events are initiated in response to positive and negative regulators of branching as well as subject to control by cell growth. We propose a model of how trichome cell morphogenesis is regulated during normal development.     

Vertebral tumors: differential diagnosis between primary and secondary neoplasms

The authors discuss the criteria of differential diagnosis between primary and secondary tumors, emphasizing the role played by biopsy.     

Mind-body fitness: encouraging prospects for primary and secondary prevention

In recent years health promotion programs have generated many worthwhile psychologic and physiologic benefits but frequently with less than optimal long-term adherence. Incorporating approaches such as mind-body exercise with existing health promotion and cardiac rehabilitation services can improve self-efficacy and long-term adherence to healthy behaviors as well as improve personal stress management skills. Mind-body exercise couples muscular activity with an internally directed focus so that the participant produces a temporary self-contemplative mental state. This internal focus is in contrast to conventional body-centered aerobic and muscular fitness exercise in which there is little or no mindful component. Research on mind-body exercise programs such as yoga and tai chi reveal they have significant mental and physical value. There also are numerous primary and secondary preventive indications for cardiovascular disease in which mind-body exercise can play a primary or complementary role. Mind-body exercise programs will be a welcome and necessary addition to evolving disease management models that focus on self-care and decreased health care use.     

Mitral subvalvular apparatus: different functions of primary and secondary chordae

BACKGROUND: The aim of this study was to compare the function of the primary chordae attached to the free edge with that of the secondary chordae attached to the ventricular surface of the anterior mitral leaflet. METHODS AND RESULTS: An isolated working pig heart model was used. Three groups of 7 hearts were compared: Group A was the control group with intact leaflets. In group B, the primary chordae of the anterior leaflet were sectioned and the secondary chordae were left intact before assembly of the working heart model. In group C, the secondary chordae were sectioned and the primary chordae left intact. In group B, atrial and ventricular pressure evidenced dramatic mitral regurgitation. Video monitoring showed significant prolapse of the free edge of the anterior leaflet. Acute mitral regurgitation accounted for the decrease in aortic flow rate to 30 mL/min, significantly lower than in the control group (P=.006). In group C, sectioning of the secondary chordae left a competent mitral valve together with good coaptation of the anterior and posterior leaflets shown by video monitoring. However, aortic flow was lower than in the control group (P=.007), and ultrasonomicrometry evidenced impaired function (P=.009). CONCLUSIONS: This study suggests that the primary and secondary chordae of the mitral subvalvular apparatus have different functions. The primary chordae of the anterior leaflet appeared to be more involved in mitral valve competence, whereas the secondary chordae appeared to be more involved in left ventricular geometry and function.     

From chump to champ: People's appraisals of their earlier and present selves.

The authors present and test a theory of temporal self-appraisal. According to the theory, people can maintain their typically favorable self-regard by disparaging their distant and complimenting their recent past selves. This pattern of appraisals should be stronger for more important attributes because of their greater impact on self-regard and stronger for self-ratings than for ratings of other people. Studies 1 and 2 demonstrated that participants are more critical of distant past selves than of current selves, and Study 3 showed that this effect is obtained even when concurrent evaluations indicate no actual improvement. Studies 4 and 5 revealed that people perceived greater improvement for self than for acquaintances and siblings over the same time period. Study 6 provided support for the predicted effects of temporal distance and attribute importance on people's evaluation of past selves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Osteomyelitis of the foot: relative importance of primary and secondary MR imaging signs

STUDY OBJECTIVES: Dyspnea is most commonly assessed by questioning patients about their subjective perception of shortness of breath during physical exertion. Although speech production is altered by pulmonary disease, it has not been included in current dyspnea assessment tools. A questionnaire was developed to address reports of dyspnea during (1) physical activity, (2) speech activity, and (3) simultaneous speech and physical activity. DESIGN: An equal number of self- and experimenter-administered 30-item questionnaires was given to 203 patients with restrictive and obstructive pulmonary diseases. Their responses were analyzed statistically. RESULTS: The questionnaire had high internal consistency for individual items within each of the three sections. The sections were highly correlated but provided separate and distinct information. Factors extracted from each section were related to severity of dyspnea. Pairwise t tests demonstrated highly significant differences in subject responses to the three sections. The least dyspnea was experienced during speech activities, more during physical activities, and the most when speech and physical activities were combined. CONCLUSIONS: The questionnaire proved to be a quickly administered tool for providing information about the effect of dyspnea on activities of daily living. Because of the emphasis on dyspnea during speech production, it may be particularly useful for assessing patients who rely extensively on speaking ability for their livelihood.     

Salvation and its vicissitudes: Clinical psychology and political values.

Considers that the reluctance to discuss value implications in clinical psychology, and to regard it as value-free, stems from 2 sources: (a) the emphasis on psychology as a value-free science, and (b) the desire for independent and respectable professional image. Nevertheless, it is argued that the practice of clinical psychology has direct political implications, which are then outlined. Most clinical orientations today adopt a social control approach, which concentrates on individual maladjustment rather than system malfunctioning. Defining problems as personal or intrapersonal, rather than interpersonal or political, neutralizes potential threats to present political structures. Psychology then becomes parallel to religion in that it offers individual salvation, and not social or political change. Several recent developments, and especially the new understanding of personal problems in members of minority groups and women, are seen as possibly changing the political impact of clinical practice. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Scarecrow and the Tin Man: The vicissitudes of human sympathy and caring.

Why do some victims elicit outpourings of sympathy from those who are unaffected, while others do not? The authors propose a theoretical framework for making sense of the vicissitudes of sympathy based on the interaction between two qualitatively different mental processes. One, which the authors term "sympathy," is caring but immature and irrational. The other process, which the authors term "deliberation," is rational but uncaring. After proposing a framework for how these two factors interact, the authors first discuss a variety of factors that affect the strength of sympathy, including whether one is in the same state as the victim, one's past and vicarious experiences, proximity, similarity, vividness, and newness. Next, the authors discuss factors that affect the relative influence of deliberation. The framework helps to integrate a wide range of disparate experimental findings and provides a possible resolution to parallel debates taking place in psychology and economics over the nature of altruism. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Incentives, fertility control, and research.

Assuming that family limitation behavior is learned, an experimental analysis of contraceptive behavior would identify those incentives that are effective in limiting family size. Evidence concerning effective incentives is needed, but issues of sensitivity, ethics, and efficiency could inhibit, if not defeat, attempts to conduct such research. Given the necessary groundwork and rapport building, however, the research approach suggested would focus on behavior change. Following the rationale that behavior is maintained by its consequences, such research would assess a broad range of incentives including material, social, secondary, and vicarious incentives, feedback of consequences, aversive incentives, and response incentives. (31 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cupid's misses: Relational vicissitudes in the analyses of single women.

Addresses the interface between adult needs for intimacy and the psychoanalytic process between a certain population of single female patients and their male analysts. Relational vicissitudes of this patient–analyst pairing are discussed from a perspective that is both psychoanalytic and psychosocial. Influences of gender differences, sociological factors, and the existential nature of prolonged unchosen singlehood on the female analysand's subjective experience are discussed. This discussion is followed by an exploration of the ramifications of singlehood for the analytic process and for the analytic relationship. The concepts of primary intimacy and a primary relational void are introduced, and clinical illustrations are incorporated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)