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Biomedical subjects

B H Kaplan

Publications and source records attributed to B H Kaplan.

At least 19 recordsLinked to original sources
PubMed1992

Social health and the forgiving heart: the Type B story.

The evolution of the Type A hypothesis is well documented. The protective corresponding Type B construct has not evolved similarly. Using experiences from Friedman's Recurrent Coronary Prevention Project, on a speculative basis, four neglected protective processes are examined: uniqueness/self-esteem/autonomy, forgiveness, sociability, and "causal" wisdom attributions. A more integrative set of questions is proposed to expand our knowledge of adaptive fitness and success.

Adaptation, Psychological↗
PubMed1992

Using college alumni populations in epidemiologic research: the UNC Alumni Heart Study.

The UNC Alumni Heart Study (UNCAHS) is a prospective study of the role of psychosocial factors, in particular hostility, in the development of coronary heart disease. The target population is composed of persons who completed the Minnesota Multiphasic Personality Inventory while attending the University of North Carolina in the mid-1960s. Logistic regression analyses were used to determine whether hostility, demographic and other variables were significant determinants of the subjects' locatability and participation. It was found that MMPI hostility scores at initial testing were unrelated to either potential or actual locatability or participation. Thus there is no evidence that hostility is the source of selection bias in the UNCAHS. Selection into the study was predicted by age, sex, degree status and variables concerned with the conditions under which the MMPI was administered. It is concluded that follow-up studies of college cohorts may have study-specific sources of selection bias.

Adolescent↗
PubMed1992

Hexamethylmelamine and low or moderate dose cisplatin with or without pyridoxine for treatment of advanced ovarian carcinoma: a study of the Eastern Cooperative Oncology Group.

A total of 248 analyzable patients with Stages III-IV ovarian epithelial cancer (114 with and 134 without prior chemotherapy) were randomized to one of four cisplatin (DDP)-hexamethylmelamine (HMM) regimens. In each, HMM, 200 mg/m2 was given orally daily on days 8-21 of each 21-day cycle. DDP was given i.v. on Day 1 at a dose of 37.5 mg/m2 (regimens A and B) or 75 mg/m2 (regimens C and D). In addition, since pyridoxine administration has been reported to reduce the neurotoxicity of HMM, that agent was given at a dose of 300 mg/m2 orally on Days 1-21 in regimens B and D. Randomization was stratified for performance status (0-1, 2-3) and largest tumor diameter at entry (greater than 2- less than or equal to 10 cm, greater than 10 cm) for previously untreated patients, and for performance status and time from initial diagnosis to entry on study (less than or equal to 1 year, greater than 1 year) for previously treated patients. The overall response rate (PR + CR) was 54%, with 25% of patients achieving a complete response. The 61% response rate with the higher dose DDP regimens was significantly greater than the 47% response rate with the lower dose regimens (p = 0.031). Multivariate analysis identified higher DDP dose, age less than 60 years, no prior chemotherapy, small tumor bulk and favorable tumor grade as significant prognosticators for response. The overall median response duration was 8.3 months (range 1-70 months). Prior chemotherapy, pyridoxine administration, recent diagnosis, and large tumor size were identified by multivariate analysis as factors adversely affecting response duration. Patients treated with the higher dose DDP regimens had more severe nausea, vomiting, and neurotoxicity. This study demonstrates that the combination of DDP + HMM is an effective regimen for advanced ovarian carcinoma that yields response rates comparable to other more complex regimens, and that there is a dose-response relationship for DDP in ovarian cancer. Although pyridoxine administration significantly reduced neurotoxicity, its adverse effect on response duration suggests that the agent should not be administered with DDP or HMM. The mechanism by which pyridoxine may unfavorably affect response duration deserves further investigation.

Altretamine↗
PubMed1991

Social environment and social support.

Research on the relevance of social support to cancer has been plentiful since the first American Cancer Society workshop on methodological issues in behavioral and psychosocial science. Nonetheless, critical shortcomings continue to characterize the attempt empirically to establish such things as the extent to which social support predicts adjustment to cancer diagnosis and treatment. Prominent among these is the failure to adequately address large elements of the social structure, such as social class and urbanization, and to investigate how they shape the well being of persons with or at risk for cancer and their caregivers. We recommend that more psychosocial research on the link between social support and cancer be conducted within populations beset by poverty and without adequate access to health care. Funding is needed for the training and maintenance of multidisciplinary and multicultural teams of researchers working within community-based organizations and hospitals serving the underserved.

Humans↗
PubMed1991

Social support and the cancer patient. Implications for future research and clinical care.

This review assesses past progress, current practices, and future needs in research and clinical practice involving the social support needs of cancer patients. A review is given of the various conceptualizations of the social support/stress paradigm and of the state of the art of measuring social support. Then the current work in the field of social support and cancer is considered and an argument is made for the use of social support measures, which are relevant to the experiences of the cancer patient. Potential adaptations of an existing instrument (the Duke-UNC Functional Social Support Scale) are demonstrated, and a taxonomy of stages of cancer that would require additional types of social support measures and interventions is outlined. Interventions are discussed in terms of the traditional support groups as well as interventions by the oncologist and primary care physician. An argument is made for the inclusion of quality of life or functional measures as outcomes in clinical trials and the care of the cancer patient. Finally, the need to address the existential, philosophic, or religious issues surrounding cancer and its treatment is discussed.

Forecasting↗
PubMed1991

Seatbelt effectiveness and cost of noncompliance among drivers admitted to a trauma center.

Enactment of seatbelt legislation in Maryland presented the opportunity to compare seatbelt compliance among seriously injured drivers admitted to a Level I trauma center and to establish levels of severity, length of stay, and hospital cost differences among the study population. Fifty-five randomly selected drivers were examined from a total surgical population of 689. Seatbelt compliance rate was 41.8%, reflecting the rate in the community. Seatbelts reduced the total number of injuries by 34%, major injuries by 57%, and minor injuries by 20%. No deaths occurred among the belted group. The unbelted group had a mean Injury Severity Score two times as great as the belted group and were hospitalized 1.6 times longer at double the cost. Major injuries to the face, chest, and pelvic regions were prevented by the seatbelt. Among the belted group, severe injuries did occur to the head, neck, and abdominal regions. It is recommended that both air bags and automatic restraining devices be required for all drivers if the trauma occurring daily on highways is to be eliminated and acute hospital cost minimized.

Accidents, Traffic↗
PubMed1991

Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling.

Smokers requesting self-help materials for smoking cessation (N = 2,021) were randomized to receive (a) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (b) the same self-quitting guide with a support guide for the quitter's family and friends, (c) self-quitting and support guides along with four brief counselor calls, or (d) a control guide providing motivational and quit tips and referral to locally available guides and programs. Subjects were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control subjects achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-month quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates.

Behavior Therapy↗
PubMed1990

Epidemiologic analysis of a reported cancer cluster in a small rural population.

This study investigated a reported cluster of cancer deaths in the small rural community of Bynum, North Carolina. Residents felt the proportion of deaths involving cancer had been increasing since the mid-1960s. To address this concern, cancer mortality was investigated from 1947 to 1985 to determine 1) if the proportion of cancer deaths had increased since the mid-1960s, 2) if it differed from what should be expected based on comparison with the reference population of the state of North Carolina, and 3) if observed mortality was within the bounds of statistical probability. Results indicated that the proportion of cancer deaths remained relatively constant from 1947 to 1964 (ranging from 9% to 14%) but increased steadily after 1965 to a high of 58% (1980-1985). Standardized proportionate mortality ratios adjusted for age, sex, race, and calendar time indicated that from 1975 to 1985 cancer deaths were 2.4 to 2.6 times greater than expected. Cancer mortality exceeded the upper limit of 95 percent Poisson confidence intervals from 1975 to 1985, which suggested that the excess proportion of cancer deaths was not likely to represent random case clustering. These findings serve to illustrate the feasibility of and a methodology for assessing reports of clusters in small populations.

Adult↗
PubMed1989

The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey.

The association between depression and two-year mortality risk was assessed in 1,606 elderly community participants in the 1982-83 Epidemiologic Catchment Area-Piedmont Health Survey. Two depression measures were formed from the Diagnostic Interview Schedule (DIS) depressive symptom items. Neither measure was associated with mortality in univariate or multiple logistic regression analyses. The adjusted relative risk of mortality comparing the lowest to highest levels of a three-level depression variable was 0.9 (95% confidence interval = 0.5-1.4). Similar results were obtained with other versions of the depression variables, with each depressive symptom category, and within sex, chronic disease, widowhood status, and age groups. These results indicate that depression does not increase mortality in elderly adults, but the short follow-up, sample characteristics, and operationalization of depression may have affected this association.

Age Factors↗
PubMed1989

Psychologic distress as a predictor of mortality.

In a 12-year follow-up study of 610 persons (239 black and 371 white) in Evans County, Georgia, psychologic distress as measured by total score on the Health Opinion Survey, a 20-item questionnaire, was a predictor of mortality. The hazard ratio, comparing the 95th percentile score with the median, was 1.93 (97.5% confidence interval (CI) 1.42-2.62), controlling for age, race, and sex; there was no interaction with these variables. A purer measure of distress symptomatology, based on 18 of the questionnaire items, was also predictive of mortality. The hazard ratio was 1.94 (97.5% Cl 1.33-2.82), controlling for age, race, sex, and the item, "Do you have any sickness or illness problems at the present time?"; no interactions with the latter variables were found. This pattern was not affected in any major way by several modifications of the analyses: 1) controlling also for smoking, serum cholesterol, Quetelet index (weight (kg)/height (m)2), diastolic blood pressure, a social network index, and a social class index; 2) excluding persons with a diagnosis (in 1968) of chronic heart disease, angina pectoris, myocardial infarction, stroke, transient cerebral ischemic attach, or diabetes mellitus, or whose deaths were due to neoplastic disease; and 3) restricting the analyses to the last half of the follow-up period to explore the role of incipient or early physical illness in producing the association. With the restricted samples, confidence intervals included 1.00, which may be attributed to both the substantially smaller samples and the slightly reduced strength of the effect. The evidence is consistent with a causal role for psychologic distress, as measured by the Health Opinion Survey, in subsequent mortality rates.

Adult↗
PubMed1989

Functional versus structural social support and health care utilization in a family medicine outpatient practice.

Three hundred forty-three family-practice patients were surveyed by questionnaire and medical record audit to evaluate the relationships between social support and medical care utilization. Social support was not associated with laboratory test ordering. The mean number of office visits per year was higher for patients with low versus high confidant support (4.71 vs. 3.81, P less than 0.10) and affective support (5.21 vs. 3.60, P less than 0.05). Mean total charges in 1 year were higher for patients with low versus high confidant support ($232 vs. $148, P less than 0.05) and affective support ($244 vs. $154, P less than 0.05). Poor confidant and affective support were both associated with longer visits. Structural measures of social support were not related significantly to any utilization indicator. These findings were maintained in multiple-regression models controlling for physical health and seven demographic characteristics. Second-order regression models revealed interaction by race, employment status, and sex. Blacks showed no effect of confidant support on office visits. Poor confidant support resulted in $201 more in total charges for the unemployed (P = 0.003) versus $49 more for the employed (P = 0.15). Women with low affective support had $119 more in charges (P = 0.001) versus $16 less for men (P = 0.82). The results suggest that low functional social supports are important determinants of increased medical service utilization and that they may have differential effects by race, sex, and employment status, all of which should be considered independently in future studies.

Adolescent↗
PubMed1988

Pilot study of adriamycin and amsacrine (m-AMSA) in patients with advanced breast cancer.

Twelve patients with recurrent and metastatic breast cancer were treated with a combination of adriamycin and amsacrine (m-AMSA) to evaluate its efficacy and toxicity. Adriamycin was given at 40 mg/m2 i.v. and m-AMSA at 50 mg/m2 i.v. every 3 weeks. No response was observed. One patient received an escalated m-AMSA dose at 70 mg/m2 and the same dose of adriamycin. She died of treatment-related leukopenia and infection. We conclude that the combination of adriamycin and amsacrine at the dose and schedule used in our trial has little antitumor effect in the treatment of advanced breast cancer.

Adult↗
PubMed1988

The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients.

A 14-item, self-administered, multidimensional, functional social support questionnaire was designed and evaluated on 401 patients attending a family medicine clinic. Patients were selected from randomized time-frame sampling blocks during regular office hours. The population was predominantly white, female, married, and under age 45. Eleven items remained after test-retest reliability was assessed over a 1- to 4-week follow-up period. Factor analysis and item remainder analysis reduced the remaining 11 items to a brief and easy-to-complete two-scale, eight-item functional social support instrument. Construct validity, concurrent validity, and discriminant validity are demonstrated for the two scales (confidant support--five items and affective support--three items). Factor analysis and correlations with other measures of social support suggest that the three remaining items (visits, instrumental support, and praise) are distinct entities that may need further study.

Adult↗