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L Temoshok

Publications and source records attributed to L Temoshok.

At least 19 recordsLinked to original sources
PubMed1993

Measuring performance decrements in aviation personnel infected with the human immunodeficiency virus.

There is controversy over whether cognitive impairment occurs in early human immunodeficiency virus (HIV) disease. When impairment is reported, findings are typically subclinical, affect only a minority, and their relationship to occupational functioning has not been established. Despite such findings, it has been recommended that HIV-seropositive pilots be disqualified from flying. This paper reviews research relevant to measuring performance decrements in HIV-infected aviators. Based upon current data, we conclude that although subtle neurobehavioral dysfunction may occur in some asymptomatic HIV-seropositive individuals, there is no research which has demonstrated associated decrements in aviation-related skills. Thus, it may be premature to recommend medical disqualification of all HIV-seropositive aviators. We propose, instead, that sensitive neurocognitive measures, incorporated into a comprehensive neurodiagnostic evaluation, could be used to evaluate asymptomatic HIV-seropositive aviators. Only those who are impaired on evaluation would be disqualified from flying. Concurrently, research investigating the relationship between abnormalities and aviation abilities would be conducted.

Aerospace Medicine↗
PubMed1991

Results of a one year longitudinal study of HIV antibody test notification from the San Francisco General Hospital cohort.

We examined the psychological impact of HIV antibody testing in 107 homosexual men in San Francisco. Seventy-eight percent of the seropositives but only 43% of the seronegatives correctly anticipated their results. Twelve months after notification (but not earlier), notified seropositives reported significantly greater increases in total distress than nonnotified controls. However, notified seronegatives demonstrated significantly lower levels of hopelessness than nonnotified controls at every follow-up assessment. Thus, knowledge of HIV antibody status appears to dispel a sense of gloom in persons who incorrectly believe themselves to be infected with HIV, but does not appear to induce significant distress in those whose expectation of a positive result is confirmed. Both groups reported lower distress than men with ARC or AIDS, suggesting that distress was related more to symptomatology than knowing antibody status. These results suggest the benefits of HIV testing for the considerable proportion of seronegative subjects believing themselves to be seropositive and should be weighted against the more limited induction of distress in seropositives who receive confirmation of their test result expectation. The benefits of testing are also supported by increasing knowledge of the usefulness of early intervention in HIV disease.

AIDS Serodiagnosis↗
PubMed1990

Evaluation of a hospital based substance abuse intervention and referral service for HIV affected patients.

This paper reports an outcome evaluation and needs assessment conducted by the AIDS and Substance Abuse Program (ASAP) of the San Francisco AIDS Health Project. The study was designed to: 1) evaluate effectiveness of a hospital based intervention and referral service for HIV affected substance abusers, and 2) gather information from this population regarding accessibility and barriers to drug treatment. Participants were 86 individuals consecutively referred to ASAP over an 8-month period. All received a brief needs assessment interview in addition to the standard ASAP evaluation protocol. Agency follow-up contacts were made for those individuals referred by ASAP to extended substance abuse treatment, with information limited to whether or not the client contacted the designated referral resource. Source of referral to ASAP, interest in treatment, and prior sexual risk behavior change were significant predictors of intervention outcome. Personal unreadiness and treatment program waiting lists were the most frequently reported obstacles to treatment. While most participants reported changing risk behavior in response to the AIDS epidemic, patterns of change differed according to intravenous drug use history.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Issues in psychoneuroimmunology research.

Careful design of studies is crucial for meaningful progress in this area of inquiry. Along with systematic evaluation of immunologic factors, clear understanding of antecedent factors is also important. Age, sex, and other sociodemographic factors might play a major role in how an individual reacts to a given situation when compared with another individual. Assessment of the impact of these factors on the immune system might be further complicated by immunosuppressive viruses like HIV or by the use of many common medications such as beta-blockers for hypertension (Kiecolt-Glaser & Glaser, 1988). Longitudinal studies are needed to understand the process of change and the dynamic patterning of psychosocial and immunologic relationships over time. Additionally, use of multimodal measures to assess psychological events such as stress is imperative (Baum, Grunberg, & Singer, 1982). It will not serve our understanding of psychological influences on the immune system to jump to the conclusion that an event is "stressful" because it seems as if it should be. Finally, establishing a "core" battery of widely accepted immune tests will be important in establishing comparability across studies. The standardization and acceptance of specific biochemical measures will facilitate the infusion of talented clinical and basic scientists into the area of psychoneuroimmunology.

Adaptation, Psychological↗
PubMed1988

Patient and physician delay in melanoma diagnosis.

The sequence of events leading ultimately to the diagnosis and treatment of malignant melanoma was investigated. We conducted interviews with 275 patients and the physicians whom they had consulted regarding their suspicious lesions before their eventual referral to a melanoma center. An average of 1 year elapsed from the time that patients first noticed a new or changed lesion and the date of diagnosis. Major components of delay were attributable to both patients and physicians. An average of 6 months elapsed between patients' recognition of a new or changed lesion and their realization that the lesion was suspicious. For 21% of cases, at least 2 months elapsed between physicians' observation of lesions and a definitive diagnosis of malignant melanoma, and 13% were diagnosed a minimum of 4 months following a visit to the physician. Patients routinely cannot distinguish between melanomas and moles. Physicians do not always diagnose melanoma accurately or act promptly in response to suspicious lesions. We have yet to take adequate advantage of the unique opportunity for early detection and cure in this readily visible, rapidly increasing malignancy.

Adult↗
PubMed1988

Individual behavior differences related to induced tumor growth in the female Syrian hamster: two studies.

The relationship of individual behavioral differences to induced tumor growth and to Natural Killer (NK) cell activity was investigated in the Syrian hamster in the context of a long-term natural stressor (group social interaction). In the first sub-experiment, 90-day-old females had blood drawn for NK cell assays. Animals were then placed in groups of ten, and two samples of behavior were obtained on videotape. All hamsters were injected midback subcutaneously with malignant melanoma, developed tumors, and were sacrificed 35 days later. Eight reliable behaviors were coded from the videotapes and were factor analyzed, yielding two factors: "Activation" and "Inactivity." The first factor of "Activation" was correlated p less than .06, two-tailed) with autopsy tumor size. The experiment was repeated using females aged 210 days. Factor analysis generated two factors virtually identical to those previously found. The factor of "Activation" was again correlated with autopsy tumor size (p less than .05, one-tailed). For older animals only, the second factor of "Inactivity/dominance" was associated with higher NK cell activity for one of the two samples. A second study was conducted in order to replicate the factor structure of the first two sub-experiments, as well as the relationships of behavioral variables to tumor outcome variables. However, the design differed mainly in taking four rather than two samples of behavior; and in using as an outcome measure time to detection of palpable tumor, rather than autopsy tumor size. The factor analysis derived very similar factors. The second factor of "Inactivity" was correlated significantly (p less than .007, two-tailed) with tumor latency, which is congruent with the previous results. Overall, the results showed that: (a) individual behaviors in hamsters can be rated reliably, and cluster repeatedly across independent studies into certain patterns; and (b) the pattern interpreted as "Activation" was associated with poorer tumor outcome relative to the pattern of "Inactivity-(dominance)."

Animals↗
PubMed1987

Stress-behavior interactions in hamster tumor growth.

The aim of this study was to investigate the effects of a mechanical stressor and individual behavior differences (separately and in combination) on tumor development in the female Syrian hamster. Studies by other investigators have documented the tumor-enhancing effects of such mechanical stressors as rotational stress. Previous studies by our group found that both size of tumor and time to tumor detection were significantly related to a dimension we call "activation." Eighty 100-day old female Syrian hamsters were placed in circular plexiglas environments in groups of 10. Nineteen days after introduction to the cages, a stress condition was imposed on half the animals (four cages). This consisted of shaking each cage of animals three times a week for three 10-minute intervals. Each group's behavior was videotaped in multiple samples to document pre- and poststress behaviors. Twelve days after the stress condition was initiated, each animal was injected subcutaneously midback with one melanoma tumor fraction. Animals were palpated every three days to determine time to detection of tumor. The videotaped behavior samples were coded for behaviors associated with "activation," inactivity, and interaction. Factor analysis resulted in basically the same first factor of activation found in our previous studies. Hamsters in the nonstressed groups had a significantly longer time to tumor development than those in the stressed groups (22.5 days vs. 12.6 days, p less than 0.005). While no prestress behaviors were associated significantly with time to tumor detection, the poststress activation factor was significantly correlated with longer time to tumor development in the stressed group (r = .61, p less than 0.0001). These results suggest that while the stress condition is more powerful than prestress individual behaviors in affecting the outcome variable, stress appears to interact with the individual behaviors related to "activation" to mitigate the negative effects of stress on tumor growth.

Animals↗
PubMed1987

Personality, coping style, emotion and cancer: towards an integrative model.

What this paper attempts, which may be different than previous reviews of the literature regarding the role of certain psychosocial factors and cancer initiation/progression, is to propose a model wherein seemingly discrepant findings may be integrated and understood. For this task, a representative but not an exhaustive review of studies was conducted, which revealed surprising consistencies, given the heterogeneity of designs, measures and cancer sites. Evidence converges on a constellation of factors that appears to predispose some individuals to develop cancer more readily or to progress more quickly through its stages. These factors include (a) certain personality traits or coping styles, which were discussed under the rubric of 'Type C'; (b) difficulty in expressing emotions; and (c) an attitude or tendency toward helplessness/hopelessness. Next, illustrative discrepancies across studies were presented. In order to make sense of these seemingly discrepant results, a process model of coping style and psychological-physiological homoeostasis was proposed. This model may be used to understand why some studies have found that Type C is associated with cancer outcome measures, while others have found that helplessness/hopelessness or emotional expression is related to outcome. We would expect that these differences are attributable to the point in the cancer and coping process at which psychological assessment was conducted.

Adaptation, Psychological↗
PubMed1986

Adolescents and AIDS: a survey of knowledge, attitudes and beliefs about AIDS in San Francisco.

To assess adolescents' knowledge, attitudes, and beliefs about AIDS in San Francisco, data were obtained from 1,326 adolescents. There was marked variability in knowledge across informational items, particularly about the precautionary measures to be taken during sexual intercourse which may reduce the risk of infection. We conclude that development and implementation of school health education programs on AIDS and other sexually transmitted diseases are needed in this population.

Acquired Immunodeficiency Syndrome↗
PubMed1985

The relationship of psychosocial factors to prognostic indicators in cutaneous malignant melanoma.

This study investigated the relationship between prognosis (estimated by histopathologic indicators) in cutaneous malignant melanoma and a comprehensive set of physical risk, demographic, psychosocial, and situational variables. These variables were derived from the medical examination, the pathology report, psychosocial self-report measures, and an hour-long videotaped interview with 59 patients from two melanoma clinics in San Francisco. Variables significantly correlated with tumor thickness were: darker skin/hair/eye coloring, longer patient delay in seeking medical attention, two correlated dimensions within an operationally defined 'Type C' constellation of characteristics, two character style measures, and less previous knowledge of melanoma and understanding of its treatment. Of these variables, delay was the most significant in a hierarchical multiple regression analysis in which tumor thickness was the dependent variable. Associations between tumor thickness and psychosocial measures of Type C were considerably stronger and more significant for subjects less than age 55, suggesting that the role of behavioral and psychosocial factors in the course of malignant melanoma is more potent for younger than for older subjects.

Adaptation, Psychological↗
PubMed1985

Biopsychosocial studies on cutaneous malignant melanoma: psychosocial factors associated with prognostic indicators, progression, psychophysiology and tumor-host response.

A series of seven studies investigating biopsychosocial aspects of cutaneous malignant melanoma were conducted by a multidisciplinary group of researchers at the University of California, San Francisco. Two studies investigated the relationship of variables derived from a videotaped psychosocial interview and from self-report measures, and two histopathologic indicators: tumor thickness and level of invasion. Associations of psychosocial variables to prognostic indicators were stronger within the younger vs the older subject group. In a multiple regression analysis, patient delay in seeking medical attention emerged as the most significant variable predicting tumor thickness. A study of factors related to patient delay found longer delays in patients who had lesions on the back, less previous knowledge of melanoma, less understanding of its treatment and less minimization of its seriousness. Another study compared the repressive coping reactions--defined as the discrepancy between reported anxiety and that reflected in electrodermal activity--in melanoma patients, cardiovascular disease patients and disease-free controls. The melanoma group was significantly more 'repressed' on the combined self-report/physiological measure, as well as on other self-report measures of repressiveness. In order to investigate the relationship of psychosocial factors to more disease-relevant physiological variables, the next study focused on two clinical variables significantly predictive of disease outcome:mitotic rate of the tumor and lymphocytes at tumor site. Emotional expression of sadness and anger, rated from the videotaped interviews, was positively correlated with tumor-specific host-response factors and negatively correlated with mitotic rate. In another study, subjects who had died or had disease progression were matched on the basis of tumor and demographic characteristics with subjects who had no evidence of disease by follow-up. The unfavorable outcome group had higher scores on self-report scales of dysophoric emotion and distress which were administered one to three years previously. An experimental investigation of relationships among behavioral, physiological and tumor outcome variables in the Syrian hamster found that general activity was correlated positively with greater tumor growth following induction. These results were compared to those from the preceeding two human studies, and discussed in terms of a stress-arousal-coping model.

Adaptation, Psychological↗
PubMed1984

Factors related to patient delay in seeking medical attention for cutaneous malignant melanoma.

This study investigated the relationship between patient delay in seeking medical attention and prognostic indicators, tumor characteristics, and demographic and behavioral factors in 106 patients with cutaneous malignant melanoma. Patients with less readily apparent lesions, particularly on the back, had longer delays in seeking treatment, as might be expected. The prognostically unfavorable nodular melanomas were detected more frequently by patients themselves than they were found during visits to physicians for unrelated problems. In terms of behavioral variables, patients with less knowledge of melanoma or its appropriate treatment had significantly longer delays. Patients who minimized the seriousness of their condition were more likely to seek treatment sooner, perhaps because this reduced fear and anxiety about the disease or its treatment. For superficial spreading melanoma, delay was significantly and positively correlated with Clark's level of invasion, and also with tumor thickness when only noncoincidentally diagnosed patients were included; whereas for the nodular type, delay was significantly and positively associated with tumor thickness, whether the patient was coincidentally diagnosed or not. The significance of these findings for early detection, and hence improved prognosis of malignant melanoma, is discussed.

Adolescent↗
PubMed1984

Repressive coping reactions in patients with malignant melanoma as compared to cardiovascular disease patients.

Previous research has indicated that repressive styles of coping with stressful emotions may be associated with higher cancer incidence and poorer prognosis. Other studies have suggested that coronary-prone and cancer-prone individuals may be at opposite poles on the distributions of several coping and personality variables. In order to investigate whether these differences could be reflected in a measure that integrated psychological and physiological processes, the present study compared the repressive coping reactions of malignant melanoma patients to matched cardiovascular disease patients and disease-free controls (N of 20 in each group). Repressive coping reactions were operationally defined as the discrepancy between reported anxiety and that shown physiologically (electrodermal activity) in response to anxiety-provoking statements in an experimental procedure. The concurrent validity of this procedure was established through correlations with other indices of repressive tendencies which were administered to all subjects. Analysis of variance showed that the melanoma group was significantly more 'repressed' on these measures, while the cardiovascular disease patients were the least repressed or most sensitized. These differences in defensive posture were independent of disease severity, which suggested that they were not merely artifacts of differences in disease-related anxiety.

Adaptation, Psychological↗