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Biomedical subjects

James C Coyne

Publications and source records attributed to James C Coyne.

At least 19 recordsLinked to original sources
PubMed2007

Peer-support in coping with medical uncertainty: discussion of oophorectomy and hormone replacement therapy on a web-based message board.

The Facing Our Risk of Cancer Empowered (FORCE) website is devoted to women at risk for hereditary breast and ovarian cancers (HBOC). To understand the unique health concerns and emotional support needs of these women, we examined threads on the FORCE archived message boards with relevance to the broader HBOC community. We report on a thread discussing the controversial decision to use hormone replacement therapy (HRT) following prophylactic oophorectomy (PO). We used a qualitative research inductive process involving close reading, coding and identification of recurrent patterns, relationships and processes in the data. Twenty-nine women posted 177 messages over 7 months. Two main groups of women posted: (1) Women who were BRCA+, had completed PO, and were debating or adjusting their HRT options in terms of optimizing both quality and quantity of life. (2) Women who were BRCA+, were contemplating PO, but wanted to better understand the potential physical and psychological consequences of surgical menopause before deciding. Frustrated by physicians' lack of knowledge and contradictory media articles about the long-term consequences of HRT in BRCA+ women, they sought resources, emotional support and specific experiential knowledge from each other and generated a unique sense of community and a high level of trust.

Adaptation, Psychological↗
PubMed2006

Posttraumatic stress syndromes: Useful or negative heuristics?

The articles in this special issue provide a wide range of challenges to current conceptions, nosology, and assessment procedures for posttraumatic stress disorders. At best, they overcome the negative heuristic posed by these disorders, reopening issues that have preemptively been closed about dissociation, the presumed causal connection between a life threatening event and the symptoms of posttraumatic stress disorders, and the adequacy of checklist assessments of symptoms. They note discontinuities between current thinking about these disorders and the dominant thinking of the past. We make recommendations for more studies that similarly challenge the validity of current conceptions of posttraumatic disorders and dissociation, and the adequacy of checklist assessments of symptoms. With this goal, we note the value of studying ersatz posttraumatic stress response. Finally, we call for greater transparency in this literature with author disclosure of activity as expert witnesses.

Diagnosis, Differential↗
PubMed2006

Effect of marital quality on eight-year survival of patients with heart failure.

Recent evidence suggests that psychosocial factors such as self-efficacy, psychological distress, perceived social support, and marital quality have prognostic significance for morbidity and mortality after heart failure. Previously, we reported that interview and observational measures of marital quality obtained from 189 patients with heart failure (139 men and 50 women) and their spouses predicted all-cause patient mortality during the next 4 years, independent of the baseline illness severity (New York Heart Association class). We present additional follow-up results for this sample, with Cox regression analyses showing that a couple-level composite measure of marital quality continued to predict survival during an 8-year period (p <0.001), especially when the patient was a woman, and did so substantially better than individual (patient-level) risk and protective factors, such as psychological distress, hostility, neuroticism, self-efficacy, optimism, and breadth of perceived emotional support. In conclusion, relationship factors may be especially relevant in managing a difficult chronic condition such as heart failure, which makes stringent and complex demands on patients and their families.

Adult↗
PubMed2006

Gender-specific risk factors for mortality associated with incident coronary heart disease--a prospective community-based study.

BACKGROUND: Risk factors for mortality in community-residing persons developing congestive heart failure (CHF) and acute myocardial infarction (AMI) may differ for males and females. METHOD: Persons from the Groningen Longitudinal Aging Study with incident CHF (N=274) or AMI (N=198) were identified between 1993 and 1998 and their survival status was collected in 2001. Risk factors are assessed prior to the cardiac diagnosis. RESULTS: The 1-, 5-, 7-year survival rates were 65, 53, 50% for AMI and 74, 45, 32% for CHF. Multivariate analyses showed that male gender, high age, smoking, diabetes and low physical function were risk factors for mortality among persons with CHF. For AMI, 1 month mortality was related to high age and baseline low body mass index, while longer term mortality was related to male gender and high age. In addition, diabetes increased longer term mortality among females but not among males with AMI. Depression was not a risk factor for mortality for either condition in either gender. CONCLUSION: Males with CHF or AMI have worse survival rates compared to females. Risk factors for mortality are predominantly similar for males and females, except for diabetes which is a risk factor among females, but not males with AMI.

Aged↗
PubMed2006

Does marriage protect older people from distress? The role of equity and recency of bereavement.

The association between marital status and distress was examined in a largely neglected group, namely older people (65 and older; N = 1,649). In this 2-wave study, married persons were less distressed than single persons, but perceived equity within the marriage and recency of bereavement qualified these findings. Married persons who felt inequitably treated were more distressed than persons who had always been single. Married persons reported less distress than recently (= 2 years ago) widowed persons, but only equitably treated married persons reported less distress than persons widowed for more than 2 years. Increased distress between the 2 waves occurred in recently widowed persons, and there was a decrease in distress in persons who were widowed shortly before the 1st wave. No gender effects were found.

Adaptation, Psychological↗
PubMed2006

Expressed emotion, adaptation, and patient survival among couples coping with chronic heart failure.

Previous research (J. C. Coyne et al., 2001) that showed that marital functioning predicted mortality among patients with chronic heart failure (CHF) led to an examination of whether expressed emotion (EE) captured negative marital influences on patient survival. The authors assessed EE using 5-min speech samples obtained from patients (137 men and 47 women) and their spouses. Prevalence of EE was low, and patient and spouse EE were unrelated. Spouse EE was not associated with survival, after the authors controlled for severity of illness. Among patient EE variables, high EE status predicted survival, but in the opposite direction of what was anticipated. Overall, relations between EE and self-report measures of adaptation were weak and inconsistent. Despite the strength of findings concerning EE and psychiatric outcomes, EE does not show promise in predicting adaptation to CHF, and researchers and clinicians should instead seek to identify positive marital factors that may promote patient survival.

Adaptation, Psychological↗
PubMed2006

Paper and plastic in daily diary research: Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006).

The authors applaud A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) response to one-sided comparisons of paper versus electronic (plastic) diary methods and hope that it will stimulate more balanced considerations of the issues involved. The authors begin by highlighting areas of agreement and disagreement with Green et al. The authors review briefly the broader literature that has compared paper and plastic diaries, noting how recent comparisons have relied on study designs and methods that favor investigators' allegiances. The authors note some sorely needed data for the evaluation of the implications of paper versus plastic for the internal and external validity of research. To facilitate evaluation of the existing literature and assist in the design of future studies, the authors offer a balanced comparison of paper and electronic diary methods across a range of applications. Finally, the authors propose 2 study designs that offer fair comparisons of paper and plastic diary methods.

Adolescent↗
PubMed2006

Health disparities in care for depression possibly obscured by the clinical significance criterion.

BACKGROUND: In addition to symptoms, DSM-IV criteria for major depression require clinical significance, operationalized via reports of receipt of care or interference in functioning. The authors examined whether this confounding of symptoms with receipt of care and/or impairment affected racial differences in rates of major depression in the community. METHOD: Analysis of data from the 1999 National Health Interview Survey for a nationally representative community sample of 30,801 adults administered the depression module of the Composite International Diagnostic Interview-Short Form. RESULTS: There were no differences between African American subjects and white/other subjects when diagnosis was based solely on symptoms. Symptomatic African American individuals were less likely to endorse either receipt of care or interference in functioning, so that the clinical significance criterion served to reduce their rates of DSM-IV diagnosis. CONCLUSIONS: The clinical significance criterion underestimates of the rate of depression for African American individuals relative to white/other subjects, which may in turn underestimate their need for services.

Adult↗
PubMed2006

Psychological interventions for distress in cancer patients: a review of reviews.

We review a decade of review articles concerning psychosocial interventions for cancer patients. We find a distinct progression in the tone of interpretations of the literature, as better quality studies accumulate and the sophistication of reviews improves. The current literature does not make a compelling case for the value of these interventions for the typical cancer patient. The bulk of the literature reviews in this field take a narrative rather than a systematic approach, and serious compromises in standards are necessary to muster an adequate set of studies for review. The more rigorous the review, the less likely it is to conclude there is evidence that psychological interventions are effective.

Cognitive Behavioral Therapy↗
PubMed2006

Efficacy of psychosocial interventions in cancer care: evidence is weaker than it first looks.

With increasing sophistication, successive reviews find weaker evidence for the efficacy of psychosocial interventions to reduce distress among cancer patients. However, these appraisals may still be overly positive because of reviewers' uncritical acceptance of flaws in the design, analysis, and reporting of the results of such trials. Using randomized trials from high-impact journals, we show confirmatory bias, selective reporting of the most favorable of multiple outcome measures, suppressing of null results in subsequent citations of trials, and dropping of data for patients least likely to benefit from intervention. The conclusion that typical cancer patients do not benefit from interventions to reduce distress is strengthened when these endemic problems with the literature are taken into account. Required registering of the details of clinical trials and adherence to CONSORT reduces but does not eliminate bias in the literature.

Cognitive Behavioral Therapy↗
PubMed2005

Epidemiology of heart failure in a community-based study of subjects aged > or = 57 years: incidence and long-term survival.

BACKGROUND: Survival data from hospital-based or clinical trial studies of patients with chronic heart failure (CHF) do not represent survival in community-based settings. AIMS: To determine the incidence of CHF and the associated long-term survival in a community-based sample aged > or = 57 years and to assess the mortality risk associated with sex and age. METHODS: This study was part of the Groningen Longitudinal Aging Study. RESULTS: Annual incidence of CHF per 1000 ranged from 2.5 in middle aged adults (57-60 years) up to 22.4 in older females (> or = 80 years) and 28.2 in older males (> or = 80 years). The 1, 2, 5 and 7-year survival rates were 74%, 65%, 45%, 32% for patients with CHF, compared to 97%, 94%, 80% and 70% in a matched reference group without CHF. Higher age (> or = 76 years) was a risk factor for mortality (OR = 2.1) and male sex was a risk factor in those aged < or = 75 years (OR = 1.9) but not for older patients. CONCLUSION: Long-term survival rates for patients with CHF in the community were worse than the known survival rates from clinical trials. There is a need for studies describing the care of patients with CHF in the community, including the type of care, the provider, the quality of care and the outcome.

Age Factors↗
PubMed2005

Mood disorders in the medically ill: scientific review and recommendations.

OBJECTIVE: The purpose of this review is to assess the relationship between mood disorders and development, course, and associated morbidity and mortality of selected medical illnesses, review evidence for treatment, and determine needs in clinical practice and research. DATA SOURCES: Data were culled from the 2002 Depression and Bipolar Support Alliance Conference proceedings and a literature review addressing prevalence, risk factors, diagnosis, and treatment. This review also considered the experience of primary and specialty care providers, policy analysts, and patient advocates. The review and recommendations reflect the expert opinion of the authors. STUDY SELECTION/DATA EXTRACTION: Reviews of epidemiology and mechanistic studies were included, as were open-label and randomized, controlled trials on treatment of depression in patients with medical comorbidities. Data on study design, population, and results were extracted for review of evidence that includes tables of prevalence and pharmacological treatment. The effect of depression and bipolar disorder on selected medical comorbidities was assessed, and recommendations for practice, research, and policy were developed. CONCLUSIONS: A growing body of evidence suggests that biological mechanisms underlie a bidirectional link between mood disorders and many medical illnesses. In addition, there is evidence to suggest that mood disorders affect the course of medical illnesses. Further prospective studies are warranted.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Personal characteristics and depression-related attitudes of older adults and participation in stages of implementation of a multi-site effectiveness trial (PRISM-E).

BACKGROUND: No study has assessed attitudes about depression and its treatment and participation at each step of recruitment and implementation of an effectiveness trial. Our purpose was to determine the association between personal characteristics and attitudes of older adults about depression with participation at each step of the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) treatment effectiveness trial. METHODS: Information on personal characteristics and attitudes regarding depression and its treatment were obtained from all potential participants in PRISM-E. RESULTS: Persons who reported better social support were more likely to complete a baseline interview, but were less likely to meet with the mental health professional carrying out the intervention. Attitudes about taking medicines were significantly associated with uptake of the intervention, but not with earlier phases of recruitment. Persons were much more likely to have a visit with the mental health professional for treatment of depression if they were willing to take medicine for depression but did not endorse waiting for the depression to get better [odds ratio (OR) = 3.16, 95% confidence interval (CI) = 1.48-6.75], working it out on one's own (OR = 5.18, 95% CI = 1.69-15.85), or talking to a minister, priest, or rabbi (OR = 2.01, 95% CI = 1.02-3.96). CONCLUSION: Social support and other personal characteristics may be the most appropriate for tailoring recruitment strategies, but later steps in the recruitment and implementation may require more attention to specific attitudes towards antidepressant medications.

Aged↗
PubMed2005

Re-envisioning the training and practice of clinical psychologists: preserving science and research orientations in the face of change.

We argue for preservation of an expectation of psychologists that approach human problems from an evidence-based perspective. Acquisition of the requisite knowledge, skills, and practical experience require access to resources outside of graduate psychology programs. Whether adhering to a scientist-practitioner or practitioner-scholar model, psychologists must be "scientifically literate." Deficiencies are noted in the training of scientist-practitioner psychologists for the conduct of clinical trials and the dissemination and sustained implementation of evidence-based interventions.

Curriculum↗
PubMed2005

One size fits some: the impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention.

BACKGROUND: Despite their impact on outcomes, the effect of patient treatment attitudes on the cost-effectiveness of health-care interventions is not widely studied. This study estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention. METHOD: Twelve community primary-care practices were stratified and then randomized to enhanced (intervention) or usual care. Subjects included 211 patients beginning a new treatment episode for major depression. At baseline, 111 (52.6%) and 145 (68.7%) reported receptivity to antidepressant medication and counseling respectively. The intervention trained the primary-care teams to assess, educate, and monitor depressed patients. Twelve-month incremental (enhanced minus usual care) total costs and quality-adjusted life years (QALYs) were calculated. RESULTS: Among patients receptive to antidepressants, the mean incremental cost-effectiveness ratio was dollar 5,864 per QALY (sensitivity analyses up to dollar 14,689 per QALY). For patients not receptive to antidepressants, the mean incremental QALY score was negative (for both main and sensitivity analyses), or the intervention was at least no more effective than usual care. CONCLUSIONS: These findings suggest a re-thinking of the 'one size fits all' depression intervention, given that half of depressed primary-care patients may be non-receptive to antidepressant medication treatment. A brief assessment of treatment receptivity should occur early in the treatment process to identify patients most likely to benefit from primary-care quality improvement efforts for depression treatment. Patient treatment preferences are also important for the development, design, and analysis of depression interventions.

Adult↗