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Biomedical subjects

Justin M Nash

Publications and source records attributed to Justin M Nash.

16 recordsLinked to original sources
PubMed2006

Effect of personal cancer history and family cancer history on levels of psychological distress.

This study examined the impact of personal and family cancer history on psychological distress. Regression analyses were conducted on a nationally representative sample of adult individuals who participated in the 2000 National Health Interview Survey, USA. Effects on distress of a personal cancer history, any family cancer history, or mother, father, sister or brother with a cancer history were examined. The interaction of personal and family cancer histories and three-way interactions with gender were also assessed. Analyses indicate that having either a personal or family cancer history is linked with significantly greater psychological distress and there is evidence of an interaction. Three-way interactions with gender were not found. Consistent with prior research, results demonstrated that cancer survivors are more distressed than the general population. Results extend prior research by indicating that having a first-degree relative with cancer increases risk for distress, and having personal and family cancer histories may exert a synergistic effect on distress.

Adolescent↗
PubMed2006

The contribution of pain-related anxiety to disability from headache.

Disability associated with headache cannot be fully accounted for by pain intensity and headache frequency. As such, a variety of cognitive and affective factors have been identified to help explain headache-related disability beyond that accounted for by pain levels. Pain-related anxiety, a multidimensional construct, also has been found to contribute to disability in headache sufferers. What is not known is whether pain-related anxiety is unique in contributing to disability beyond the role of headache-specific cognitive factors and emotional distress. The present study examines the influence of pain-related anxiety on disability, after controlling for pain, cognitive (self-efficacy and locus of control), and affective factors (emotional distress) in a sample of 96 primary headache sufferers. Pain, headache-related control beliefs, and emotional distress accounted for 32%, with locus of control related to health care professionals contributing unique variance. In the full model, with the addition of pain-related anxiety, only pain-related anxiety was a unique predictor of disability. These findings suggest that pain-related anxiety may have a unique and important role in contributing to disability in headache sufferers.

Absenteeism↗
PubMed2006

Understanding psychological stress, its biological processes, and impact on primary headache.

Psychological stress is generally acknowledged to be a central contributor to primary headache. Stress results from any challenge or threat, either real or perceived, to normal functioning. The stress response is the body's activation of physiological systems, namely the hypothalamic-pituitary-adrenal axis, to protect and restore functioning. Chronic activation of the stress response can lead to wear and tear that eventually can predispose an individual to disease. There are multiple ways that stress and headache are closely related. Stress can (a) be a predisposing factor that contributes to headache disorder onset, (b) accelerate the progression of the headache disorder into a chronic condition, and (c) precipitate and exacerbate individual headache episodes. How stress impacts headache is not often understood. However, stress is assumed to affect primary headache by directly impacting pain production and modulation processes at both the peripheral and central levels. Stress can also independently worsen headache-related disability and quality of life. Finally, the headache experience itself can serve as a stressor that compromises an individual's health and well-being. With the prominent role that stress plays in headache, there are implications for the evaluation of stress and the use of stress reduction strategies at the various stages of headache disorder onset and progression. Future directions can help to develop a better empirical understanding of the pattern of the stress and headache connections and the mechanisms that explain the connections. Further research can also examine the interactive effects of stress and other factors that impact headache disorder onset, course, and adjustment.

Analgesics↗
PubMed2005

Behavioral headache research: methodologic considerations and research design alternatives.

Behavioral headache treatments have garnered solid empirical support in recent years, but there is substantial opportunity to strengthen the next generation of studies with improved methods and consistency across studies. Recently, Guidelines for Trials of Behavioral Treatments for Recurrent Headache were published to facilitate the production of high-quality research. The present article compliments the guidelines with a discussion of methodologic and research design considerations. Since there is no research design that is applicable in every situation, selecting an appropriate research design is fundamental to producing meaningful results. Investigators in behavioral headache and other areas of research consider the developmental phase of the research, the principle objectives of the project, and the sources of error or alternative interpretations in selecting a design. Phases of clinical trials typically include pilot studies, efficacy studies, and effectiveness studies. These trials may be categorized as primarily pragmatic or explanatory. The most appropriate research designs for these different phases and different objectives vary on such characteristics as sample size and assignment to condition, types of control conditions, periods or frequency of measurement, and the dimensions along which comparisons are made. A research design also must fit within constraints on available resources. There are a large number of potential research designs that can be used and considering these characteristics allows selection of appropriate research designs.

Behavior Therapy↗
PubMed2005

Efficacy and effectiveness approaches in behavioral treatment trials.

The objective is to clarify the distinction between efficacy and effectiveness approaches and to discuss how these approaches can be used in a complementary way in the development, evaluation, and implementation of behavioral treatments for primary headache in various settings. Efficacy studies, with an emphasis on internal validity, are experiments that evaluate treatment response in an ideal, highly controlled research environment. Despite their methodological strengths, efficacy studies are limited in their ability to estimate the treatment effects that can be expected in clinical practice settings. Effectiveness studies, with an emphasis on external validity, are outcome studies with less controls that evaluate treatment response in settings more representative of clinical practice. Effectiveness studies, however, are limited in their ability to determine the causal link between treatment and response. Based on the four-phase model used in new drug development, a three-phase linear progression model is presented for behavioral treatment studies. This model provides for pilot testing, efficacy testing, and effectiveness testing of behavioral treatments so that there is appropriate evaluation from initial promise of a developing treatment to implementation and dissemination to various treatment delivery settings.

Behavior Therapy↗
PubMed2005

Moderators and mediators of behavioral treatment for headache.

Although work has been done establishing the efficacy of behavioral treatments for headache, almost no work has been done using appropriate methodology to evaluate what types of patients in which settings (termed "moderators") are likely to benefit from treatment and what treatment components account for treatment response (termed "mediators"). The current article provides an overview of moderators and mediators and their assessment and analysis as they pertain to clinical trials. The article also discusses the need for moderator and mediator hypotheses to be theory driven. A brief consideration of potential moderators and mediators of behavioral treatment for headache is then presented. The article concludes with a discussion of methodological issues to be addressed when conducting moderator and mediator analysis for behavioral treatment for headache.

Behavior Therapy↗
PubMed2005

Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup.

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidelines are complementary to and modeled after guidelines for pharmacological trials published by the International Headache Society, but they address methodologic considerations unique to behavioral and other nonpharmacological treatments. Explicit guidelines for evaluating behavioral headache therapies are needed as the optimal methodology for behavioral (and other nonpharmacologic) trials necessarily differs from the preferred methodology for drug trials. In addition, trials comparing and integrating drug and behavioral therapies present methodological challenges not addressed by guidelines for pharmacologic research. These guidelines address patient selection, trial design for behavioral treatments and for comparisons across multiple treatment modalities (eg, behavioral vs pharmacologic), evaluation of results, and research ethics. Although developed specifically for behavioral therapies, the guidelines may apply to the design of clinical trials evaluating many forms of nonpharmacologic therapies for headache.

Behavior Therapy↗
PubMed2004

Cognitive-behavioral group treatment for disabling headache.

OBJECTIVES: Severe, disabling headache is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. First-line prophylactic agents combined with triptans do not adequately benefit many disabled headache sufferers. We sought to investigate whether a cognitive-behavioral treatment targeting the psychological and behavioral factors that contribute to disabling headache may provide additional benefit and whether using a group format may provide a more intensive clinic-based treatment without increasing the cost of service delivery. DESIGN: We developed and piloted a cognitive-behavioral group treatment for chronic, disabling headache. We evaluated its effectiveness in decreasing headache, reducing symptomatic medication use, and improving quality of life. SETTING: A behavioral headache management program of an academic medical center. PATIENTS: Sixty-two individuals suffering from primary headache disorder with moderate to severe headache-related disability who completed treatment. INTERVENTIONS: Individuals completed a pretreatment evaluation, the 10-session cognitive-behavioral group treatment, and a 1-month-posttreatment evaluation. OUTCOME MEASURES: The impacts of treatment on headache (frequency, intensity, and duration), medication use, and quality of life were assessed. RESULTS: Separate multivariate analyses of variance revealed significant improvements in headache, symptomatic medication use, and quality of life. Overall, 50% of participants experienced at least a 50% reduction in headache frequency from pre- to posttreatment. CONCLUSIONS: The findings provide preliminary evidence that delivering a clinic-based, group-format cognitive-behavioral treatment to moderately to severely disabled headache sufferers can decrease headache activity, reduce symptomatic medication use, and improve quality of life.

Adult↗
PubMed2003

Psychologic and behavioral management of tension-type headache: treatment procedures.

Used as an adjunct or alternative to medication treatment, psychologic and behavioral approaches to tension-type headache decrease headache frequency, affective distress, and headache-related disability. These approaches directly address the psychologic and behavioral factors that contribute to the disorder and to the individual headache episodes. There is well-established evidence of efficacy for the three broad approaches: relaxation training, electromyographic biofeedback training, and cognitive-behavioral stress management. Treatment has been difficult to access, with most care provided by behavioral specialists in tertiary care settings using clinic-based or home-based treatment protocols. Recent attempts to make treatment more accessible to a wider range of tension-type headache sufferers include using medical personnel to deliver treatment from physician practices and using existing and emerging technologies to provide care in a purely self-administered format without face-to-face contact with therapists. These attempts are promising, but remain preliminary; therefore, there is a need for further development and testing.

Behavior Therapy↗
PubMed2003

American Headache Society members' assessment of headache diagnostic criteria.

OBJECTIVE: We assessed the views of physicians interested in headache as to the diagnosis of the most commonly occurring and currently controversial headaches. BACKGROUND: The International Headache Society (IHS) classification system has received wide professional endorsement and considerable empirical support, but in the United States, their adoption by clinicians may be proceeding more slowly. Questions remain, including what diagnostic criteria for migraine and tension-type headache clinicians may continue to favor over those outlined by the IHS, to what extent is the "transformed migraine" diagnosis used in clinical practice, and how is analgesic rebound headache diagnosed with regard to the various quantitative measures of analgesic use. METHODS: Members of the American Headache Society rated the importance of IHS and non-IHS diagnostic criteria for migraine and tension-type headache and for analgesic rebound headache. Respondents also described their use of the proposed transformed migraine diagnosis. RESULTS: Two-thirds (67.3%) of the respondents reported use of the IHS criteria or the IHS criteria in conjunction with clinical judgment. For migraine and tension-type headache, IHS criteria were rated with high importance, but some respondents reported using additional non-IHS diagnostic criteria and de-emphasizing certain IHS criteria. For chronic headache, almost two-thirds (63%) of respondents reported using the transformed migraine diagnosis. For analgesic rebound headache, respondents preferred to make the diagnosis based on medication consumption that is lower than amounts stipulated in the IHS classification system. CONCLUSIONS: There remains a number of physicians interested in headache who do not use the IHS classification system, who modify the IHS criteria in practice, and who use the "transformed migraine" diagnosis for patients with chronic daily headache.

Analgesics↗
PubMed2003

A structural representation of migraine diagnostic criteria: the experts' view.

OBJECTIVE: To generate an empirically derived structural representation of migraine diagnostic criteria in a group of international headache experts using the Pathfinder network scaling algorithm in order to evaluate the validity of the migraine criteria used in the International Headache Society (IHS) classification system. BACKGROUND: Because it is a disease entity that lacks objective defining markers, developing valid diagnostic criteria for migraine is a challenge. The IHS committee relied on expert consensus to develop their classification system in 1988. Expert consensus also was used to evaluate the validity of the IHS classification system, but further studies employing alternative methods still are needed. METHODS: Headache experts representing the Executive Committee of the IHS and the Board of Directors of the American Headache Society analyzed 14 criteria (7 IHS and 7 non-IHS) considered relevant in diagnosing migraine. Their ratings were submitted to the Pathfinder algorithm to generate a network structure reflecting the experts' conceptualization of migraine diagnostic criteria. RESULTS: The expert network had 3 groupings: headache characteristics (eg, phonophobia, unilateral pain, throbbing pain), biological contributing factors (eg, family history, hormonal relationship, relief with sleep), and triggering factors (eg, worse with stress, food triggers). The IHS criteria were clustered together in the center portion of the network. A t test showed that each IHS criterion was closer conceptually to other IHS criteria than to non-IHS criteria. Graph theory indices revealed that the most central criteria were unilateral pain, moderate/severe intensity, and nausea/vomiting. CONCLUSION: The structural representation of migraine diagnostic criteria from these international headache experts is consistent with the migraine diagnostic criteria set forth in the IHS classification system and thus provides further support for the validity of migraine criteria in the IHS system.

Algorithms↗
PubMed2003

Training the transdisciplinary scientist: a general framework applied to tobacco use behavior.

The complexity of public health problems, including the problem of tobacco use behaviors, calls for formal efforts to train transdisciplinary scientists. These scientists can approach problems by using new conceptual frameworks and methodological tools that integrate different disciplinary perspectives. Transdisciplinary training focuses on developing strong scientists with superb core skills while protecting against creating scientists who are "jack of all trades, master of none." Transdisciplinary training is relatively new, with no accepted training model in place. In this paper, we provide a general framework for transdisciplinary training at the advanced graduate and postgraduate levels, with particular reference to tobacco use behaviors. We identify the core attitude, knowledge, and skills competencies that are essential to conducting tobacco use research with a transdisciplinary approach. We outline the structural components of transdisciplinary training that allow for the development of the competencies and discuss what facilitates the transdisciplinary training process. We also discuss the numerous challenges and obstacles to transdisciplinary training. These include the readiness of early-career trainees to undergo transdisciplinary training, professional development risks taken by trainees, administrative and budgetary obstacles inherent in traditional academic institutional structures, and the limited opportunities established scientists have for transitioning their research programs in a transdisciplinary direction. If these obstacles can be overcome, the potential exists for a new generation of transdisciplinary scientists to be trained and be well positioned to make important and unique advances in our understanding of tobacco use and other public health problems.

Career Mobility↗
PubMed2002

The influence of placebo awareness on stimulant drug response in a double-blind trial.

RATIONALE: Critics have called into question findings from double-blind placebo-controlled studies because subjects are given drug administration instructions informing them of a placebo condition. The assertion that these drug administration instructions bias estimates of effectiveness has undergone surprisingly little empirical investigation. OBJECTIVES: The primary objective of this study was to determine whether drug administration instructions informing subjects of a placebo condition affect the drug response and affect the saliva concentration of the stimulant. METHODS: We assessed caffeine responses and levels of saliva concentration of caffeine in 52 subjects who were randomly assigned to receive one of two drug administration instructions: (a) placebo-informed instructions (i.e., individuals informed of the placebo) analogous to those used in double-blind studies and (b) placebo-uninformed instructions (i.e., individuals informed they are taking an active stimulant). RESULTS: On most measures (systolic blood pressure, heart rate, hand steadiness, reaction time, fatigue, and tension), drug administration instructions did not significantly influence caffeine response. Instructions also had no significant effect on saliva concentration of caffeine. However, only individuals who were uninformed of the placebo condition showed significant diastolic blood pressure and vigor increases with 125 mg caffeine, and significant hand steadiness impairment and vigor increases with 325 mg caffeine compared to placebo. CONCLUSIONS: These overall findings suggest that a limited bias is introduced by drug administration instructions. The results do not support any suggestion that information about the existence of a placebo condition dramatically influences conclusions drawn about drug responses in placebo-controlled trials.

Affect↗
PubMed2002

Cognitive-behavioral issues in the treatment and management of chronic daily headache.

Chronic daily headache is a heterogeneous group of daily or near-daily headaches that afflicts close to 5% of the general population and accounts for close to 35% to 40% of patients at headache centers. First-line drug or cognitive-behavioral therapies administered alone have minimal impact on reducing the frequency or severity of headaches. However, combined drug and cognitive-behavioral therapy shows promise in providing the most benefit for this often intractable condition. Cognitive-behavioral therapies focus on preventing mild pain from becoming disabling pain, improving headache-related disability, affective distress, and quality of life, and reducing overreliance on medication. For cognitive-behavioral therapies to be effective, it is important to address complicating factors, including medication overuse, psychiatric comorbidity, stress and poor coping, and sleep disturbance.

Amitriptyline↗
PubMed1993

Pain state as artifact in the psychological assessment of recurrent headache sufferers.

The finding that recurrent headache sufferers, particularly tension headache sufferers, obtain higher scores on psychological symptoms measures than controls was replicated in 262 recurrent (tension, mixed, and migraine) headache sufferers and 26 controls. However, closer examination of the data revealed that psychological symptoms were elevated only in patients who experienced head pain at the time of assessment. This finding raises the possibility that previously reported elevations in psychological symptoms have resulted from uncontrolled differences in the pain state of respondents. Retrospective reports of headache activity also were related to pain state. In contrast, a measure of perceived control of factors affecting headaches was unrelated to pain state. As a result, locus of control (but not psychological symptoms) successfully differentiated recurrent headache sufferers from controls even when headache sufferers were tested when pain free. These results suggest that psychological symptom measures may yield misleading results when used with individuals with pain disorders.

Adult↗