GABAergic stimulation regulates the phenotype of hippocampal interneurons through the regulation of brain-derived neurotrophic factor

PURPOSE: Information concerning the differences between older and younger women with breast cancer, treated with standard therapy, is lacking from many prospective series. The purpose of this study is to identify factors that influence treatment decisions and determine if women age 65 and older are treated differently than younger women. The outcomes of older women would then be compared to younger to determine if treatment differences influence outcome. METHODS AND MATERIALS: The records of 558 women with early invasive breast cancer who were treated with breast conserving surgery and radiation therapy were retrospectively reviewed. Four hundred thirty-two women under the age of 65 (range: 24-64) and 126 women age 65 and older (range: 65-85) were assessed for treatment differences including breast reexcision, extent of axillary dissection, extent of breast and nodal irradiation, and the use of chemotherapy or hormonal therapy. Differences in the treatment of the two groups were determined and the end points of local control, disease-free survival, and overall survival were compared. Median follow-up was 5.5 years. RESULTS: The two treatment groups had identical pathologic TNM staging with the exception that 21% of the older age group and 5% of the younger group did not undergo axillary dissection. Women age 65 and older were less likely to have a reexcision, extensive axillary dissection, chemotherapy, or nodal irradiation. They were more likely to receive hormonal therapy. Reexcision in older women was positively influenced by a family history of breast cancer and negatively influenced by a history of previous malignancy. None of the patients who were treated without and axillary dissection suffered a regional recurrence. Although local control was better in older patients, there were no differences in disease-free or overall survival for the two groups. DISCUSSION: The findings of this study reveal that older patients have significant treatment differences as compared to younger patients; however, despite these differences, similar local control and survival were achieved at 5 to 10 years. With the expected survival of older women increasing, the prospective evaluation of treatment options for older women should be considered.     

Factors affecting employment decisions about older workers.

Investigated effects of 2 factors on simulated employment decisions about older workers. 10 male and 38 female undergraduates made decisions about older workers in 2 hypothetical work situations. The design of the study was a 2 (absolute decision vs comparison decision)?×?2 (information vs no information) factorial with repeated measures on type of decision. Significant main effects were found for both type of decision and amount of information. No significant interaction effects were found. Increasingly favorable decisions were made about older workers when (a) the situation did not require a choice between an older worker and a younger worker and (b) behaviorally stated performance information about the older worker was provided. A separate study assessed the specificity of the factors' impact on older workers. 13 male and 35 female undergraduates made decisions about younger workers, using the same procedures used in the 1st study. These results indicate that, for younger workers, the effect of the type of decision depended on the amount of information. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why older adults make more immediate treatment decisions about cancer than younger adults.

Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Information needs, sources of information, and decisional roles in women with breast cancer

PURPOSE: To describe preferred and actual roles in treatment decision making among women with newly diagnosed breast cancer, to describe their sources of information, and to identify and prioritize their information needs. DESIGN: Cross-sectional survey. SAMPLE: Seventy-four women recently diagnosed with breast cancer. SETTING: Two tertiary, outpatient oncology clinics in Winnipeg, Manitoba, Canada. METHODS: Three measures were completed: control preferences card sort, Thurstone scaling of information needs, and ranking of information sources. MAIN RESEARCH VARIABLES: Decisional roles, sources of information, and information needs. FINDINGS: More women (43%) preferred and more (57%) actually assumed a passive role in treatment decision making. This is particularly true of older women. Although 37% of women preferred a collaborative role, only 19% were able to assume such a role. The women preferred personal sources of information (physician, nurse, friend, or relative) over written sources. A medical journal was more relevant to women with higher levels of education. Most information needs included stage of disease, likelihood of cure, and treatment options. The women ranked self-care issues and sexuality as least important; older women, however, ranked self-care issues as more important. CONCLUSIONS: Women who want collaborative roles in decision making may experience difficulty in achieving such roles. Personal sources of information were more important to women than written sources. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use a knowledge of women's priorities for information to guide information sharing. Nurses can assess women's desired roles in treatment decision making and facilitate women achieving their preferred roles.     

The treatment decision-making process: age differences in a sample of women recently diagnosed with nonrecurrent, early-stage breast cancer

This research utilizes retrospective, self-report data collected from a nonprobability sample of women recently diagnosed with nonrecurrent, early-stage breast cancer to better understand how the treatment decision-making process varies with patient age. Three important areas--context, decision-making style, and influencing factors--are examined using bivariate and multivariate analyses. Findings indicate that although patients recalled similar contextual attributes, they reported attitudes, behavior, and considerations that differed by age. Older women were less likely than their younger counterparts to have desired participation in therapy selection, sought out medical information, or considered the possibility of recurrence when making treatment decisions.     

Aging and decision making: driving-related problem solving

We examined age-related effects on decision making in a task environment familiar to most younger and older adults. Participants made route-selection decisions in real time. Participants received information about traffic density and expected speed limits of main and alternative routes, from which they determined the optimality of their present route versus alternative routes. The experiment evaluated the effects of information type, amount of congestion, alternative route speed limit, and age on speed and quality of decision making. Measures of optimal route selection revealed main effects of alternative route speed limit, congestion level, and message type, but there was not a main effect of age, and age did not interact with any variable. In terms of decision speed (but not quality of decision making), older participants were slower, and age interacted with alternative route speed and with message type. The data are interpreted in relation to previous data examining everyday problem solving and aging.     

High risk of breast carcinoma after irradiation of young women with Hodgkin's disease

BACKGROUND: Treatment-associated second neoplasms have emerged as a major threat to the continued survival of patients cured of Hodgkin's disease. In this study, the authors investigated the risk of breast carcinoma in an irradiated Hodgkin's disease population. METHODS: One hundred and eleven women younger than 60 years presenting between 1964 and 1984 with Stage I and II Hodgkin's disease who received mantle irradiation were retrospectively analyzed and compared with an age specific population. Median follow-up was 18 years (range, 10-30 years), and the median age at initiation of therapy was 24 years. Kaplan-Meier actuarial risks, relative risks (RRs) (the ratio of the observed to the expected cases) with 95% confidence intervals (CIs), and the log rank test for trends were calculated. RESULTS: Fourteen women developed breast carcinoma: 8 of 33 patients younger than 20 years at the time of irradiation, 5 of 48 patients age 20 to 29 years, and 1 of 30 patients age 30 years or older. Actuarial calculation predicted a 34.0% (CI, 14.2-53.8) risk of breast carcinoma at 25 years after therapy for the youngest group, 22.3% (CI, 4.1-40.5) for the group of intermediate age, and 3.5% (CI, 0-10.1) for the oldest group. The RR of breast carcinoma was 56 (CI, 23.3-107) for those 19 years or younger at the time of treatment, 7.0 (CI, 2.3-16.4) for those age 20-29 years, and 0.9 (CI, 0-5.3) for those 30 years and older. Excluding 1 patient who was age 38 years at the time of irradiation, the remaining 13 breast carcinomas were tightly clustered in women irradiated between the ages of 14 through 25, and were detected in years 11 through 25 after treatment, with 7 occurring in years 15 through 18. CONCLUSIONS: Women younger than 30 years, particularly those younger than 20 years, who have received mantle irradiation for Hodgkin's disease require meticulous follow-up for breast carcinoma. The high incidence of breast carcinoma in this patient population should be considered when making treatment decisions in young women with early stage Hodgkin's disease.     

Using an interactive video disk in breast cancer patient support

A randomised-controlled trial compared outcomes for women recently diagnosed with breast cancer who either received support and information from a multidisciplinary team or used a shared decision-making programme on an interactive video disk (IVD) system. Using the IVD did not have a significant effect on the decisions women made about treatment, yet it was evaluated positively by those who used it. The results suggest that the role of clinical staff is more significant than the form of information provided. Potential benefits for the IVD were apparent such as standardising the information received by patients, promoting evidence-based practice and providing a measure for quality assurance.     

Vulnerability of Older Adults to Deception in Prison and Nonprison Contexts.

Media reports frequently depict older adults as victims of deception. The public perceives these stories as particularly salient because older adults are seen as fragile victims taken advantage of because of trusting behaviors. This developmental investigation of deception detection examines older and younger adults interacting in 2 contexts, prison and the "free world," to discover whether older adults are vulnerable to deception. Younger prisoners were found to be lie biased. Older adults were better able to discriminate lies than younger adults, and this effect was localized primarily to older female adults. Findings indicate that discriminability strongly increases from younger to older age for women, whereas men do not show an improvement, as age increases, in making decisions about statement veracity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic differences in breast cancer outcomes among older patients: Effects of physician communication and patient empowerment.

Objectives: To examine racial/ethnic disparities in older women's health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables. Methods: A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS). Results: Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model. Conclusion: Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical decision-making in early breast cancer

OBJECTIVE: This in-depth review of the multidisciplinary approach to early breast cancer treatment (in situ, stage I and II) will update the surgeon about the indications, risks, and benefits of breast surgery, radiation therapy, adjuvant chemotherapy and hormonal therapy, and the importance of breast reconstructive surgery. SUMMARY BACKGROUND DATA: Breast cancer will occur in one of eight women in the United States during their lifetime and is the second leading cause of death in women from cancer. The practice of multidisciplinary breast cancer treatment has become the standard of care for the majority of breast cancer patients. If the surgeon is to retain the primary coordinating role in breast cancer management, then he or she must fully understand all modalities of oncology therapy and know how to deploy them to benefit individual patients. CONCLUSIONS: This article provides a framework for making clinical decisions about the appropriate combination and sequence of treatment for various presentations of early breast cancer.     

Mammography versus clinical examination of the breasts

Using published data from screening trials, this article compares two-modality (mammography and clinical examination) and single-modality (clinical examination alone) screening by evaluating cancer detection rates, program sensitivities, mode of cancer detection in two-modality screening, nodal status at time of detection, survival 10 years post-diagnosis, and breast cancer mortality 10 years after entry. Consistently, two-modality screening achieved higher cancer detection rates and program sensitivity estimates than either modality alone; mammography alone achieved higher rates than clinical examination alone; interval cancer detection rates between screening examinations were higher following clinical examination alone than mammography alone; single-modality screening with mammography failed to detect breast cancers identified by clinical examination alone; the sensitivity of mammography was lower in younger than older women, while the reverse was true for clinical examination; and mammography identified a higher proportion of node-negative breast cancer than clinical examination. We conclude that combining clinical breast examination with mammography is desirable for women age 40-49 because mammography is less sensitive in younger than older women. Careful training and monitoring are, however, as essential with clinical examiners as with mammographers.     

Levels of processing: Effect of number of decisions on prose recall.

Examined differential recall of prose materials as a function of the number of decisions made about the content during reading. It was hypothesized that number of decisions would provide a means of enhancing recall and of operationally defining levels of processing. Exp I with 14 undergraduates varied the number of decisions made about a prose passage. Exp II with 30 undergraduates attempted to resolve alternative explanations to numbers of decisions (i.e., redundancy of processing and time differences spent by readers with each question). The effect of decisions on recall according to where in the passage decisions were based was investigated in Exp III using 15 undergraduates. The results indicate that (a) recall is increased as the number of decisions is increased, (b) the effects on recall are noted only in conditions requiring decisions, and (c) recall of superordinate information, along with associated subordinate information, is enhanced beyond what is obtained by decisions based upon subordinate information. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast cancer care in older women: sources of information, social support, and emotional health outcomes

BACKGROUND: The authors studied older women with breast cancer and asked: 1) where do older women get information regarding breast cancer care and how helpful do they perceive each of these sources to be? and 2) what aspects of social support are associated with older women's general and breast cancer specific emotional health outcomes? METHODS: To be eligible, women had to be at least 55 years of age and newly diagnosed with TNM Stage I or II breast cancer. Data were collected from women's surgical records and a 35-minute, computer-assisted telephone interview. RESULTS: Nearly all women rated information that was provided by their breast cancer physicians as very or somewhat helpful. Written materials provided by breast cancer physicians also were frequently rated as very or somewhat helpful. Women's marital status, religious service attendance, ratings of their physicians' technical and interpersonal care, and perceptions of their own abilities to communicate with their physicians were significantly associated with both general and breast cancer specific emotional health outcomes (all P < 0.05). CONCLUSIONS: Although older women obtained information regarding breast cancer from a variety of sources, they relied heavily on their physicians for information. To care most effectively for this group of patients, an increased understanding of the relation between the processes and outcomes of breast cancer care is needed Identifying older women with breast cancer at risk for poor emotional health outcomes and developing methods to enhance physician-patient communication in this setting may improve these outcomes.     

Mixed cryoglobulinemia in chronic virus diseases of the liver

OBJECTIVE: To establish the tolerance of breast irradiation by women aged 65 and older. DESIGN: Retrospective chart review. PATIENTS AND SETTING: Women undergoing partial mastectomy and postoperative radiation therapy at the H. Lee Moffitt Cancer Center and Research Institute between 1986 and 1990. Of 163 women eligible for the study, 100 were under age 65, and 63 were aged 65-78. MEASUREMENTS: Comparison of total treatment dose, treatment duration, number of treatment interruptions, incidence of cutaneous, mucosal, and hematological toxicity between women aged 65 and older and women younger than age 65. MAIN RESULTS: All study measurements were comparable among younger and older women: total radiation dose (P = 0.5); treatment interruptions (P = 0.063); treatment duration (P = 0.78); cutaneous toxicity (P = 0.37); anemia (P = 0.83); leukopenia (P = 0.07), and thrombocytopenia (P = 0.94). There was no mucosal toxicity, nor higher than grade 2 hematological or cutaneous toxicity. The incidence and severity of toxicity was not higher for women aged 70 and older. CONCLUSIONS: Postoperative breast irradiation is well tolerated by older women. Age is not a contraindication to breast preservation.     

Serological findings obtained in cattle herds immunised with the Brucella melitensis Rev.1 and the B. abortus B19 vaccine in Mongolia

To characterize selective uses of external memory aids, 42 younger and 38 older adults made decisions and then completed individual difference measures. Experimental manipulation of the availability of a memory aid allowed examination of the effects of having a memory aid available as opposed to the spontaneous use of that aid. Use of the memory aid resulted in longer decision times, more requests for information, and less rechecking of already viewed information. Younger and older adults with high abstraction scores and older adults with high vocabulary scores were more likely to use the aid. Patterns of use differed in that younger adults used the aid in the middle of their information gathering and older adults used the aid toward the end. Making a memory aid available for use during decision making affected decision-making processes of older adults; use of the aid was associated with greater crystallized and fluid intelligence.     

False memories for end-of-life decisions.

Objective: To examine people's false memories for end-of-life decisions. Design: In Study 1, older adults decided which life-sustaining treatments they would want if they were seriously ill. They made these judgments twice, approximately 12 months apart. At Time 2, older adults and their self-selected surrogate decision makers tried to recall the older adults' Time 1 decisions. In Study 2, younger adults made treatment decisions twice, approximately 4 months apart. At Time 2, younger adults tried to recall their Time 1 decisions. Main Outcome Measures: Percentage of participants who falsely remembered that their original treatment decisions were the same as their current decisions. Results: In Study 1, older adults falsely remembered that 75% of their original decisions were the same as their current decisions; surrogates falsely thought that 86% of older adults' decisions were the same. In Study 2, younger adults falsely remembered that 69% of their original decisions were the same as their current decisions. Conclusion: Age alone cannot account for people's false memories of their end-of-life decisions; we discuss other mechanisms. The results have practical implications for policies that encourage people to make legal documents specifying their end-of-life treatment decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of age, marital status, and physician-patient interactions on the care of older women with breast carcinoma

Understanding why older women with breast carcinoma do not receive definitive treatment is critical if disparities in mortality between younger and older women are to be reduced. With this in mind, the authors studied 302 women age > or =55 years with early stage breast carcinoma. Data were collected from surgical records and in telephone interviews with the women. The main outcome was receipt of definitive primary tumor therapy, defined either as modified radical mastectomy or as breast-conserving surgery with axillary dissection followed by radiation therapy. The majority (56%) of the women underwent breast-conserving surgery and axillary dissection followed by radiation therapy. After statistical control for four variables (comorbidity, physical function, tumor size, and lymph node status), patients' ages, marital status, and the number of times breast carcinoma specialists discussed treatment options were significantly associated with the receipt of definitive primary tumor therapy. The authors concluded that when older women have been newly diagnosed with breast carcinoma and there is clinical uncertainty as to the most appropriate therapies, patients may be better served if they are offered choices from among definitive therapies. In discussing therapies with them, physicians must be sensitive to their fears and concerns about the monetary costs and functional consequences of treatment in relation to the expected benefits.     

A health priorities model: application to mammography screening

This study describes and empirically tests a health priorities model. This model predicts underuse of regular mammography screening among adult women within the larger health context in which such decisions are made. The model incorporates women's comparative illness threats, comparative importance of health behaviors, and demographic variables. A telephone survey was conducted with a sample of women (N = 887) older than 50, in 40 rural communities in the state of Washington. Logistic regression analyses showed that women who perceived themselves at low risk for getting breast cancer and/or who perceived another disease (i.e. heart attack) as an equal or greater threat than breast cancer were less likely to be regular screeners of mammography. In addition, women who perceived other health behaviors as more important than regular mammography screening were less likely to be regular screeners than those women who perceived regular mammography screening as more important. Current or anticipated health problems were not related to screening behavior. The results are discussed in light of the practical, theoretical, and empirical implications.