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PubMedDate not supplied

Using willingness to pay to value close substitutes: carrier screening for cystic fibrosis revisited.

Evidence suggests that previous uses of willingness to pay (WTP) to value close substitutes may have failed to discriminate between the alternatives being evaluated. This paper reports on the application of a new technique for measuring WTP in such contexts. The alternatives evaluated are two methods of screening for cystic fibrosis carrier status. The results suggest that the new method is more discriminating. Furthermore, the paper provides evidence, from reasons for respondents' WTP valuations and regression analyses, that the use of open-ended WTP questions is not valid. This is in line with the recommendations of a recent, influential, report on the use WTP techniques.

Analysis of Variance↗

PubMed1997

Clinical diagnoses and disability of cognitively impaired older persons as predictors of stress in their carers.

BACKGROUND: Aspects of the caring relationship are often promoted as more important than the clinical features of the care recipient in predicting caregiver wellbeing. However, studies of consequences of caring for cognitively impaired people seldom include detailed measures of the diagnostic profile and disability of the care recipient. METHODS: Ninety community-living elderly persons with cognitive impairment were clinically assessed for severity on a range of illnesses. Their disability was examined via informant reports. Informants (88% of whom were primary carers) provided information on the behaviour and personality of the subject and reports of their own (informant) wellbeing. Using multiple regression, features of the subjects' clinical profile (severity of diseases, disability, behavioural problems and personality change) were examined as predictors of informant wellbeing. After controlling for subject clinical profile, we explored the additional associations between informant stress measures and other descriptors of the subject, caregiver and their relationship. RESULTS: The subjects' clinical characteristics, in particular disability and disturbed behaviour, were strong predictors of caregiver wellbeing, accounting for most of the explained variance. After control for the subjects' clinical profile, few of the sociodemographic, caregiver or relationship variables examined had any influence on caregiver outcome measures. The exceptions were caregiver time demands, older subject age and self-identification as primary carer. Coresidence was not associated with caregiver distress. CONCLUSION: Clinical characteristics of the care recipient are determinants of caregiver wellbeing, while socio-demographic, caregiver and relationship characteristics are less influential.

Activities of Daily Living↗

PubMed1980

An analysis of the age distribution of colon cancer in adenomatosis coli.

For the purpose of elucidating the genetic and environmental interaction in human carcinogenesis, the age distribution of colon cancer in adenomatosis coli (AC) patients in Japan and England were investigated and compated. According to the multiple mutation theory of carcinogenesis, the rate of tumor production is presented by a natural logarithm of the reciprocal of the survival fraction (the proportion on diagnosed colon cancer by age t either among AC patients or total colon cancer cases), and thus is given by a power function of t. The number of hits necessary for colon cancer development in AC patients was estimated to be 4.2 or 4.4 for males and 3.4 or 3.3 for females in Japanese cases, whereas it was 4.7 or 3.9 and 3.6 or 3.2, respectively, in English cases. The estimates are compatible between countries. On the other hand, from the age specific prevalence curve, number of hits in general population was estimated to be 5.0 for both sexes in Japan, which is approximately one hit less than the values for English general population, at least in males. The present results, when taking into account the geographic and/or chronologic variations in colon cancer frequency, suggest that the etiology of colon cancer in younger patients is primarily determined by a genetic predisposition whilst environmental factors are much more influential for the development of colon cancer in older patients.

Adolescent↗

PubMed1981

Selected prognostic variables for mammographic parenchymal patterns.

Conjecture exists about the influence of numerous risk-factors for breast cancer on mammographic parenchymal patterns. To allow more precise documentation of the common variables considered influential in alterations of breast parenchyma, we conducted a randomized retrospective analysis. Of 10,132 women participants in the Louisville Breast Cancer Detection Demonstration Project, every tenth participant was randomly selected for evaluation using SPSS statistical programming. Each accessioned patient had discriminant analysis for the risk factors of age, parity, age at birth of first child, family history, personal history, previous history of breast biopsy, and exogenous estrogen therapy. One-thousand-and-two women were examined for the significance of the selected prognostic variable association with Wolfe mammographic parenchymal patterns (WMPP). Each prognostic factor was tested by chi-square analysis for the low-risk pattern (N1P1) versus the high-risk pattern (P2DY). A high correlation existed between the age of patient and WMPP (P = 0.0002) in the subjects evaluated (50--85 years, mean 60). Similarly, a very significant correlation was evident between WMPP and parity (P = 0.0002), age at birth of first child (P = 0.0014), family history of breast cancer (P = 0.097), and history of previous breast biopsy (P = 0.0066). Little correlation existed between the Wolfe parenchymal pattern classification and a personal history of breast cancer (P = 0.7779) or the use of exogenous estrogens (P = 0.5776).

Age Factors↗

PubMed1986

Genetics and cytogenetics of pediatric cancers.

It is clear that genetic factors play an important role in the development of some human cancers. These factors may be particularly influential in the pediatric age group because environmental exposures have been minimal. Several pediatric solid tumors, including retinoblastoma and Wilms' tumor, are hereditary. Specific constitutional chromosome abnormalities have been found in these patients, thus implicating certain gene regions as being involved in tumorigenesis. Molecular genetic studies have provided insight into the events occurring at the DNA level in these gene regions. The role of genetics in the development of sporadic pediatric malignancies is also beginning to be elucidated as specific acquired chromosome abnormalities are being discovered in the malignant cells of these otherwise karyotypically normal individuals. This paper will review selected hereditary and nonhereditary pediatric cancers that demonstrate the importance of genetic considerations in the diagnosis and management of children with cancer.

Acute Disease↗

PubMed1989

Cytogenetic findings and prognosis in neuroblastoma with emphasis on marker chromosome 1.

The relationship between cytogenetic findings and prognosis in 51 pediatric patients with neuroblastoma is described. Patients were classified into the following four groups based on karyotypic findings: (1) near diploidy, 42 to 47 chromosomes (n = 11); (2) hyperdiploidy, 50 to 56 chromosomes (n = 4); (3) near triploidy, 60 to 77 chromosomes (n = 33); and (4) hypotetraploidy, 80 to 83 chromosomes (n = 3). Patients with near diploid or hypotetraploid karyotypes also had several structural abnormalities including marker chromosome 1, with or without double minutes (DM) or homogeneously staining regions (HSR). Most of these patients were 1 year of age or older and had advanced tumors. The patients who were in the hyperdiploid or near triploid category had few structural abnormalities; all of them, except one, were younger than 1 year of age, had localized tumors, and are long-term, disease-free survivors. Kaplan-Meier analysis of survival rates disclosed a significant difference favoring the latter group (P less than 0.001). N-myc gene amplification was found in five patients of the former group but in no patients of the latter group. The presence or absence of DM or HSR in the former group had no statistically demonstrable effect on survival. However, the presence of marker chromosome 1 appears to indicate a poor prognosis. Five patients with Stage IV-S disease had near triploid abnormalities similar to findings in patients with localized tumors. We propose that localized and Stage IV-S neuroblastomas can be classified as one disease category, and that patients with near diploid or hypotetraploid karyotypes are clinically distinct from those having hyperdiploid or near triploid karyotypes. We consider that chromosomal pattern is a more influential prognostic factor than age, disease stage, or N-myc gene amplification.

Child↗

PubMed1990

A standard dose of radiation for "microscopic disease" is not appropriate.

Elective irradiation of sites of potential occult tumor spread is often part of a patient's radiation therapy program. The required radiation dose (D) depends on the probability that occult disease exists (P(occ)), the number of sites at risk (A), the number of tumor clonogens present (Ni), their radiation sensitivity, and the desired control rate. An exponential model of cell survival is used to quantify the importance of these factors. Control Probability = [1 - Pocc x (1 - e-Ni x (SF2)D/2)]A; SF2 = surviving fraction after 2 Gy. Implications for clinical radiation therapy include: 1. Since the number of clonogens in an occult site may vary from 10 degrees to 10(8), Ni is the major determinant of the required dose. The intrinsic radiation sensitivity of the clonogens (SF2) is also extremely important in determining the dose. Other factors are less influential since they vary less. 2. The variability of Ni (8 logs) is larger than the variation in cell number seen with gross disease (1 cm3 versus 1000 cm3, 3 logs). When Ni approximately 10(8), the required dose approaches that needed for small volume gross disease (10(9) cells, 1 cm3). 3. The dose prescribed to elective sites should reflect the risk of occult disease based on the primary tumor site, stage, and grade. 4. Regions where clinicoradiologic evaluation is difficult (e.g., pelvis and obese neck) require higher doses because macroscopic tumor deposits may exist. 5. Relatively low doses (10 to 30 Gy) are often thought to be inadequate for microscopic tumor. However, similar doses have been reported to sterilize microscopic tumor in ovarian, rectal, bladder, breast, and head and neck carcinomas. Relatively low doses should not be discounted since they may be useful in select cases when normal tissue tolerances and/or previous irradiation treatment limit the radiation dose.

Cell Survival↗

PubMed1994

Involving older Americans in the war on tobacco. The American Stop Smoking Intervention Study for Cancer Prevention.

The American Stop Smoking Intervention Study for Cancer Prevention (ASSIST) is a collaborative effort of the National Cancer Institute, the American Cancer Society, state health departments, and other public and private organizations to develop comprehensive tobacco use control programs in 17 states. The two main goals of the project are to reduce adult smoking prevalence to 15% or less and to reduce the rates of smoking initiation among adolescents by 50% by the year 2000. There is strong consensus within the tobacco-control field of what needs to be done to accomplish these goals. The key elements of a comprehensive tobacco control effort include (1) an excise tax policy based on raising the real price of tobacco, (2) a ban on all forms of tobacco advertising and promotion, (3) product regulation to reduce the harmful constituents found in tobacco and enforce the use of strong and prominent package warnings, (4) the enactment of policies that protect nonsmokers from inhaling tobacco smoke, (5) comprehensive efforts to eliminate minors' access to tobacco products, (6) ongoing and adequately funded efforts to educate the public about the harmful effects of tobacco, (7) the availability of cessation assistance to persons interested in discontinuing the use of tobacco, and (8) the ending of all financial assistance to the tobacco-growing industry. Because older Americans represent a growing and political influential segment of our society, the enactment of effective tobacco control policies depends in part on generating support for such measures among older citizens. This article outlines several ways in which organizations such as American Association of Retired Persons and the American Cancer Society can work together to advocate meaningful tobacco control policies (e.g., higher excise taxes, clean indoor air laws, etc.).

Adolescent↗

PubMed1995

Nutritional aspects of breast cancer.

Nutrition, in its broadest sense, plays a clear role in breast cancer, identified through its relationship to such known risk factors as rate of growth and development, age at menarche, adult height, postmenopausal body weight, and fat distribution. The relative importance of daily diet is hotly debated. There is no agreement on the relative importance of nutrition's effect, the responsible food groups and nutrients, nor the age or ages at which it can be influential. Evidence linking breast cancer and diet comes from human ecologic and observational studies as well as a body of experimental feeding studies in rats and mice. The population studies, including increasing numbers of migrant studies, and the animal experiments suggest that high-fat diets promote breast cancer, particularly among older women. Studies that compare diets of persons with and without breast cancer and those that record breast cancer incidence among women with different dietary histories have been inconclusive enough as to warrant randomized intervention trials. Recognition of differences between the risk factors for premenopausal and postmenopausal women and increasing insight into the ages at which known risk factors exert their influence have helped in the design of these trials. Human feeding studies and the trials themselves are identifying metabolic changes and their biomarkers as well as biomarkers for changes in fat and nutrient intakes. The Women's Health Initiative Dietary Modification Trial was designed to show whether a sustained (9-year) low-fat, high-fruit-and-vegetable eating pattern will lower the incidence of breast cancer among women who will be between ages 59 and 88 when the trial ends, the time of peak incidence. Meanwhile, the Women's Intervention Nutrition Study will learn in approximately 5 years whether a low-fat, adjuvant eating pattern will improve the prognoses of postmenopausal women with early and moderate stage breast cancer and whether tamoxifen should be used as at least part of their treatment. The results of these trials will have important applications for both public health and the provision of medical care.

Adult↗

PubMed1979

Training, role models, and research activity among clinical psychologists.

Compared clinical psychologists (N = 270) with high and low publication rates through questionnaire responses. Highs report dissertation experiences more positively influenced their research motivation. Although the most influential professor in both groups was typically clinical, more highs found the professor emphasized another orientation, particularly empirical research, over clinical expertise. Highs report more time available, collaboration opportunities, and organizational acceptance for their research. Both groups favor empirical methods, although highs and lows agree that a small proportion of psychological research makes a significant contribution. Individual preferences probably interact with situational characteristics, both in training and work settings, to determine research activity.

Academic Dissertations as Topic↗

PubMed1988

The Level of Expressed Emotion Scale: a new measure of expressed emotion.

The Level of Expressed Emotion (LEE) scale was developed to provide an index of the perceived emotional climate in a person's influential relationships. Unlike existing measures, the scale was constructed on the basis of a conceptual framework described by expressed emotion theorists. In addition to providing an overall score, the 60-item scale assesses the following four characteristic attitudes or response styles of significant others: Intrusiveness, emotional response, attitude toward illness, and tolerance/expectations. The scale underwent extensive psychometric development procedures: (1) theoretically based item generation; (2) pilot testing with normal and psychiatric populations to select the final items; and (3) construct validation within a schizophrenic population. The results were quite favorable and indicate that the LEE scale has sound psychometric properties of internal consistency; reliability; independence from sex, age, and amount of contacts; and construct validity.

Adaptation, Psychological↗

PubMed1989

The contributions of self-defeating philosophies, perceived helplessness, and repression to anxiety among psychiatric patients.

Four of the most influential psychological explanations for the development of anxiety attribute it to (1) repressed awareness of undesirable emotions; (2) the emergence of unacceptable feelings from the unconscious; (3) adherence to irrational, self-defeating philosophies; and (4) perceived helplessness/lack of control over one's affairs. To test these theories, the authors administered the Trait Anxiety, Denial, Irrational Beliefs, and Locus of Control scales to 190 psychiatric inpatients. Appropriate zero-order, attenuation-corrected, multiple, and partial correlations were run. Denial was correlated negatively with Trait Anxiety; this is consistent with the view that awareness of unpleasant emotions generates anxiety, but does not support the claim that it is the result of repression. The correlations of Trait Anxiety with the Irrational Beliefs scale were substantial. However, its relationships with Locus of Control were limited and nonsignificant after the effects of the Denial and Irrational Beliefs scales were removed statistically. The findings lend support to the positions that anxiety results from self-defeating philosophies and/or the emergence of unpleasant thoughts about oneself, but give only modest support to the "perceived helplessness" hypothesis and seem to contradict the "excessive repression" explanation.

Adjustment Disorders↗

PubMed1989

WISC-R stability and re-evaluation of learning-disabled students.

This study investigated the temporal stability of WISC-R IQ scores for learning-disabled subjects (N = 113). All study subjects were administered the WISC-R for an initial evaluation (M age = 8 years, 3 months) and a follow-up re-evaluation (M age = 11 years, 7 months). Pearson product-moment correlations yielded coefficients that were considerably lower than those previously reported: r = .55, p less than .001 for the Verbal IQs; r = .63, p less than .001 for the Performance IQs; and r = .58, p less than .001 for the Full Scale IQs. Results of t-test analyses indicated that only the Verbal IQ scores were significantly different when the initial evaluation (M = 89.4) was compared to the re-evaluation (M = 85.3), p less than .001. The results suggest that the WISC-R may be less stable for the learning-disabled population than for other groups and that the average 3-year test-retest time lapse was an influential factor in the reduced reliability of this instrument.

Child↗

PubMed1990

Comparisons of two expressed emotion scales with the Camberwell Family Interview.

The relationship of the Camberwell Family Interview (CFI) with two self-report scales purported to measure levels of expressed emotion was assessed. Fifteen schizophrenic patients and 22 of their relatives completed the Level of Expressed Emotion Scale (LEE) and the Influential Relationships Questionnaire (IRQ). The relatives of patients also participated in Camberwell Family Interviews (CFI). Results supported the value of the self-report measures in evaluating the affective environment of patients with schizophrenia.

Adult↗

PubMed1991

The acceptability of behavioral and emotional feedback depending upon valence and structure in personal growth groups.

Forty-eight students participated in a one-time personal growth group. Subjects were assigned to one of eight groups. Exercises were conducted to promote interpersonal contact, followed by feedback sessions. Four groups generated and exchanged feedback among group members. Statement lists were used as feedback in remaining groups. Within each set, one group delivered positive-behavioral; one, positive-emotional; one, negative-behavioral; and one, negative-emotional feedback. Positive feedback was more credible, desirable, and influential for recipients and donors; positive-behavioral feedback in particular was more credible. Donors rated unstructured feedback as more credible than structured feedback, with negative-structured feedback the least credible with donors and recipients. Findings are discussed in terms of research and application.

Adult↗

PubMed1994

Perceived interpersonal attitudes and psychiatric complaints in patients with essential hypertension.

The association between perceived interpersonal attitudes and psychiatric complaints in a group of hypertensives (N = 37) was evaluated. The Influential Relationships Questionnaire (IRQ), which measures perceived care, overprotection, and criticism, was administered to all patients. Hypertensives with psychiatric complaints (n = 14) were not different in terms of age, gender, obesity, smoking, alcohol intake, occupational stress, drug treatment, and baseline systolic and diastolic blood pressures compared to hypertensives without psychiatric complaints. They were, however, different in perceiving their social environment. Hypertensives with psychiatric complaints perceived their social environment as less caring, more overprotective, and more critical. Finally, patients without psychiatric complaints showed better outcome in terms of baseline vs. follow-up measures of systolic and diastolic blood pressures than did patients without psychiatric complaints.

Adolescent↗

PubMed1976

Reflections on the golden age of Columbia psychology.

This paper discusses the Golden Age (1920-1940) of the Columbia University psychology department and analyzes some of the sources of its strengths and weaknesses. Much of the credit goes to Robert S. Woodworth, the dean of American experimental psychology, who set up the objective eclectic orientation of the department, recruited a remarkable group of competent faculty members, and above all kept up a cooperative unified spirit in the department. Because the Columbia University psychology department was so influential during its Golden Age, its organization, staffing and departmental characteristics are analyzed. Probably the key to its success was the capability of a guiding genius, Robert S. Woodworth, who gathered a remarkable group of scholars about him. Woodworth's objective eclectic orientation provided the broadest possible approach within a rigorous experimental-statistical orientation. Woodworth's scholarly approach pervaded the department so that many of his colleagues also wrote pioneering encyclopedic works in their particular fields of specialization. The writings of the Columbia psychologists truly shaped the field.

Faculty↗

PubMed1987

David Hartley's Newtonian neuropsychology.

David Hartley's association psychology has been immensely influential. His vibrationist neurophysiology has, in contrast, been largely overlooked and forgotten. Hartley's vibration theory is examined. On the one hand it is shown how closely it is related to Sir Isaac Newton's mathematical physics and on the other how well it complements the association theory. The vibration theory, indeed, strongly influenced Hartley's associationist psychology and hence is of more than merely antiquarian interest. Although Hartley's understanding of the central nervous system has long been superseded, his general ideas prefigure some aspects of contemporary neurophysiology and philosophy of mind and thus provide a further reason for rescuing his vibrationism from oblivion.

England↗