Heterogeneous summation in human infants.
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Conditioning, Classical↗
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Minimally invasive direct coronary artery bypass grafting: midterm results and quality of life.
BACKGROUND: There is increasing interest in minimally invasive direct coronary artery bypass grafting (MID-CABG); however, there is still little information about midterm results and postoperative quality of life. METHODS: From March 1995 to March 1998, 64 patients underwent MIDCABG at our hospital. Their mean age was 60+/-9.5 years; 22 (34.4%) had unstable angina. All patients were followed-up by both direct visit and questionnaire to assess the postoperative quality of life. RESULTS: There were no perioperative deaths nor conversions to sternotomy; the perioperative myocardial infarction rate was 1/64 (1.6%). Predischarge angiography showed overall and unobstructed patency rates of 96.8% (62 of 64) and 93.8% (60 of 64), respectively. At follow-up (25+/-11.4 months) actuarial survival was 100%, and survival free of myocardial infarction was 98.4%+/-1.6% at 3 years. Both the Physical Activity Score and the Psychological General Well-being Index improved significantly after the operation, with percentage improvements of 31% and 23%, respectively, at 12 months postoperatively. CONCLUSIONS: In selected patients MIDCABG can be a reliable and safe option. Patients who undergo this procedure are free of major complications and enjoy a good quality of life after surgery.
Aged↗
The mental representation of ordinal sequences is spatially organized.
In the domain of numbers the existence of spatial components in the representation of numerical magnitude has been convincingly demonstrated by an association between number magnitude and response preference with faster left- than right-hand responses for small numbers and faster right- than left-hand responses for large numbers (Dehaene, S., Bossini, S., & Giraux, P. (1993) The mental representation of parity and number magnitude. Journal of Experimental Psychology: General, 122, 371-396). Because numbers convey not only real or integer meaning but also ordinal meaning, the question of whether non-numerical ordinal information is spatially coded naturally follows. While previous research failed to show an association between ordinal position and spatial response preference, we present two experiments involving months (Experiment 1) and letters (Experiment 2) in which spatial coding is demonstrated. Furthermore, the response-side effect was obtained with two different stimulus-response mappings. The association occurred both when ordinal information was relevant and when it was irrelevant to the task, showing that the spatial component of the ordinal representation can be automatically activated.
Adult↗
Transparent motion and object-based attention.
The difficulty in processing two stimuli at once increases with their separation. Therefore to demonstrate constraints in dividing attention between objects, the effects of their spatial separation must be controlled. Duncan used superimposed objects to achieve this, and showed that judging two attributes is more accurate if they concern one object than if they concern two objects (Duncan, J. 1984. Journal of Experimental Psychology: General, 113, 501-517). However, critics claim that differences in the spatial or spatial-frequency extent of attention exist between these conditions. We studied transparent motion defined by two sets of differently colored dots that were interspersed in the same region of space, and matched in spatial and spatial frequency properties. Each set moved in a distinct and randomly chosen direction. We found that simultaneous judgments of speed and direction were more accurate when they concerned only one set than when they concerned different sets. Furthermore, appraisal of the directions taken by two sets of dots is more difficult than judging direction for only one set, a difficulty that increases for briefer motion. We conclude that perceptual grouping by common fate exerted a more powerful constraint than spatial proximity, a result consistent with object-based attention. Evidence that this type of object-based attention operates at early stages of vision is examined.
Adult↗
Bone mineral density and depression: a community study in women.
In a community sample of 102 Portuguese white women we evaluated the relationship between osteoporosis and indexes of psychopathology and well-being. Depressive symptoms were assessed by the Beck Depression Inventory (BDI), psychopathology by the Hopkins Symptom Checklist-90 Revised (SCL-90-R), and quality of life using the Psychological General Well-Being Index. A questionnaire comprising social, demographic, clinical, and behavioral characteristics was also used. The sample prevalence of osteoporosis was 47.1%. Women with osteoporosis presented significantly higher scores on the total BDI (16+/-9 vs. 13+/-10, p=0.045) and lower scores in the hostility (0.8+/-0.6 vs. 1.2+/-0.7, p=0.012) and phobic anxiety (1.1+/-0.8 vs. 1.5+/-0.9, p=0.041) subscales of the SCL-90-R. No differences were found regarding mean general well-being scores (62+/-17 vs. 64+/-19, p=0.665). This study showed that women with osteoporosis have significantly higher levels of depressive symptoms and a corresponding higher prevalence of depression, independent of other factors strongly associated with osteoporosis, such as age or body mass index.
Adult↗
[Relationship between clinical and therapeutic variables and health-related quality of life in patients with hypertension. MINICHAL Study].
BACKGROUND AND OBJECTIVE: Our objective was to evaluate, through the health related quality of life (HRQoL) questionnaire MINICHAL, the influence of socio-demographic, clinical and therapeutic variables on health related quality of life of hypertensive patients. PATIENTS AND METHOD: An observational, prospective and multi-center study was carried out in hypertensive patients who were either starting or undergoing a modification of antihypertensive treatment. A total of three visits was done: a baseline visit and two follow-up visits at one and six months. At all three visits, several socio-demographic, clinical and therapeutic variables were recorded and HRQoL was measured using the MINICHAL questionnaire, the Spanish version of the Psychological General Well-Being Index, and a single question about the change in general health status. The objective was to evaluate the impact of these variables on HRQoL. RESULTS: 736 patients with hypertension were evaluated. In the multivariate analysis, gender, number of concomitant diseases, degree of hypertension, organ damage and educational level were all variables displaying a relation with HRQoL. After 6 months of treatment intensification, an improvement of HRQoL was observed. Moreover, a positive correlation was observed between the degree of reduction of blood pressure (BP) and heart rate and HRQoL improvement, especially in the State of mind dimension. CONCLUSIONS: In hypertension, a better BP control has a positive influence on HRQoL. As several clinical variables are negatively correlated with HRQoL, specific interventions are needed to correct modifiable factors.
Adult↗
Validation of a harmonized Spanish version of the IPSS: evidence of equivalence with the original American scale. International Prostate Symptom Score.
OBJECTIVES: To validate the use in Spain of a linguistically harmonized Spanish version of the International Prostate Symptom Score (IPSS Sp), and to compare it with the original American scale (IPSS Am). METHODS: Validity and reliability were studied in 59 patients with benign prostatic hyperplasia (BPH) (age >50 years) and 68 control subjects without BPH (age 18 to 49 years). Construct validity was assessed by correlating IPSS Sp scores with the EuroQol-5D (EQ-5D), the Psychological General Well-Being Index (PGWBI), and item 8 (quality of life) of the IPSS. Discriminatory power was assessed by calculating the area under the receiver operating characteristic (ROC) curve. Reliability was evaluated using the test-retest method, and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in preintervention versus postintervention scores in 26 additional patients with BPH (age >50 years) who underwent transurethral resection of the prostate. RESULTS: Correlations of the IPSS Sp were -0.07 to 0.36 with EQ dimensions; -0.29 with the EQ visual analogue scale score; 0.14 to 0.41 with PGWBI dimensions; and 0.72 with item 8 of the IPSS. ROC area was 0.95 +/- 0.02 (standard error). Using a cutoff point of 7, sensitivity was 83% and specificity was 98%. Test-retest reliability was 0.92 and Cronbach's alpha was 0.79. Mean preoperative and postoperative IPSS Sp scores were 25.56 and 8.48, respectively (P < 0.001 ). Overall effect size was 2.52. These results are similar to those of the original American scale. CONCLUSIONS: This Spanish translation of the IPSS is valid, reliable, and sensitive to clinical change and has demonstrated equivalent psychometric properties to the original American instrument. Scores obtained with the two instruments can therefore be reliably compared and aggregated when statistically appropriate.
Aged↗
Cortical spreading depression induced state dependency.
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Acoustic Stimulation↗
The relationship between religiosity and adjustment among African-American, female, urban adolescents.
African-American female adolescents living in urban environments are at risk for adverse adjustment outcomes, and thus it is imperative to identify protective factors. Religion has been found to be a significant protective resource against many types of maladaptive adjustment outcomes among adolescent samples. The present study accomplishes the following: (1) Provides a description of religiosity in a sample of African-American female teens; (2) examines religion as a resource for these adolescents by focusing on the association between religiosity and sexual activity, self-esteem, and general psychological functioning. Four-hundred ninety-two African-American females, ages 12-19, completed measures on religiosity, sexual activity, self-esteem, and psychological functioning. Most of the adolescents identified as Christian, reported a belief in God, and attended religious services. Greater overall religiosity was associated with greater self-esteem and better psychological functioning. Adolescents at different levels of self-religiosity, as well as family religiosity, evidenced significantly different self-esteem but not psychological distress or sexual activity. Adolescents with varying levels of church attendance demonstrated differences on all three outcomes. By identifying the ways in which religion may exert a positive impact on African-American female teens, mental health professionals can design interventions that have the potential to help improve the quality of life for these adolescents.
Adolescent↗
Effect of population screening and treatment for Helicobacter pylori on dyspepsia and quality of life in the community: a randomised controlled trial. Leeds HELP Study Group.
BACKGROUND: Infection with Helicobacter pylori is the main cause of peptic-ulcer disease. Treatment of this infection might lower the prevalence of dyspepsia in the community and improve quality of life. We investigated this possibility in a double-blind randomised controlled trial. METHODS: Individuals aged 40-49 years were randomly selected from the lists of 36 primary-care centres. A researcher interviewed participants with a validated dyspepsia questionnaire and the psychological general wellbeing index (PGWB). H. pylori status was assessed by the carbon-13-labelled urea breath test. Infected participants were randomly assigned active treatment (omeprazole 20 mg, clarithromycin 250 mg, and tinidazole 500 mg, each twice daily for 7 days) or identical placebo. Participants were followed up at 6 months and 2 years. FINDINGS: Of 32,929 individuals invited, 8455 attended and were eligible; 2324 were positive for H. pylori and were assigned active treatment (1161) or placebo (1163). 1773 (76%) returned at 2 years. Dyspepsia or symptoms of gastro-oesophageal reflux were reported in 247 (28%) of 880 in the treatment group and 291 (33%) of 871 in the placebo group (absolute-risk reduction 5% [95% CI 1-10]). H. pylori treatment had no significant effect on quality of life (mean difference in PGWB score between groups 0.86 [-0.33 to 2.05]). INTERPRETATION: Community screening and treatment for H. pylori produced only a 5% reduction in dyspepsia. This small benefit had no impact on quality of life.
Adult↗
Alleged sexual abuse at a day care center: impact on parents.
OBJECTIVE: This report describes the cascade of stressful events and secondary life changes experienced by parents in a case of alleged sexual abuse at a day care program. The study evaluated parents' Posttraumatic Stress Disorder (PTSD) symptoms and general psychological responses to the stressful events 4 years after the alleged abuse, and explored predictive factors of parental distress. METHODS: A total of 39 parents were interviewed about stressful events, life changes, and social support. Current distress reactions, psychological wellbeing, and locus of control were assessed with a battery of standardized measures. RESULTS: Hearing about the sexual abuse, testifying in court, hearing the verdict, and being exposed in media reports were all rated by the parents as distressing events. The majority of the parents experienced secondary life changes after the alleged sexual abuse. Four years after the alleged sexual abuse, one-third of the parents reported a high level of PTSD Intrusive symptoms and one-fourth reported a high level of PTSD Avoidance symptoms. There was a significant positive correlation between a measure of psychological wellbeing and PTSD. Secondary life changes and locus of control significantly predicted PTSD. CONCLUSION: This study demonstrates that the alleged sexual abuse of children in day care and the resulting events in the legal system and the media constitute significant and chronic stressors in the lives of the children's parents. These findings underscore the need to expand the focus of trauma-related sequelae from the child victim to their parents and family.
Adult↗
Nefazodone treatment of dysthymic disorder an open, long-term, prospective pilot study.
Dysthymic disorder, described by the Diagnostic and Statistical Manual of Mental Disorders--4th edition (DSM-IV) criteria as a chronically depressed mood that occurs most of the day more days than not for at least 2 years and has a lifetime prevalence rate of approximately 3.3% [Gwirtsman, 1994. Psychopharmacol. Bull. 30 (1994) 45.]. This disorder, which is disabling, often goes unrecognized and its sufferers are often undertreated, but recent evidence has suggested that people with dysthymia may respond to antidepressant treatment. Based on effective outcomes in previous studies using fluoxetine (a 5-HT reuptake inhibitor) and ritanserin (a 5-HT2A antagonist), it was hypothesized that nefazodone, which is both a serotonin (5-HT) reuptake inhibitor (rather weak) and a 5-HT2A receptor antagonist, may provide an effective treatment for patients with dysthymic disorder. Six participants completed this 24-week pilot trial. A decrease in the Hamilton Rating Scale for Depression (HAM-D) scores was observed from baseline to Week 24, although most changes occurred in the first 4 weeks of participation. There was an improvement in anxiety symptomatology, both physiological and psychological. General functioning did not improve as observed by Global Assessment of Functioning Scale (GAF) scores. There may be some benefit to nefazodone for treatment of dysthymia, as indicated by positive results on HAM-D, Hamilton Anxiety Scale (HAM-AD), and Hopkins Symptom Checklist (HCL) scores within the first 4 weeks; however, it is possible that such dramatic results may be due to entry into the study alone, and not to medication.
Adult↗
Quality of life in long-term survivors of out-of-hospital cardiac arrest.
STUDY OBJECTIVE: The quality of life in long-term survivors of out-of-hospital cardiac arrest may be a good outcome measure after resuscitation. Therefore, the psychosocial situation and quality of life in such patients after successful resuscitation was evaluated. METHODS: Patients with out-of-hospital cardiac arrest in a community referred to a single tertiary care centre were compared with matched controls. Quality of life was evaluated in 50 consecutive arrest cases (40 males, 10 females; 60+/-13 years) 5-68 months (mean 31.7) after resuscitation according to American Heart Association protocols. RESULTS: The Psychological General Well-being Index questionnaire indicated no significant differences in anxiety, depression, vitality, general well-being, or self-control between patients and controls. However, the Nottingham Health Profile questionnaire demonstrated significant decreases in physical mobility (14.5+/-18.1 vs. 4.0+/-8.5, P=0.0001), energy levels (25.3+/-31.0 vs. 2.0+/-8.0, P=0.0001), emotional reactions (11.3+/-16.6 vs. 4.0+/-10.2, P=0.009), and sleep patterns (19.2+/-28.6 vs. 8.4+/-16.7, P=0.023) in the arrest patients. Little differences were measured with the Everyday-Life Questionnaire. 49 of the 50 arrest patients judged their situation after resuscitation worth living; no significant changes in familial, and psychosocial parameters occurred. CONCLUSIONS: The quality of life was associated with few changes in psychosocial profile after successful resuscitation. The subjective negative factors bore little impact on the quality of daily living in our patients. Thus, continued efforts to improve out-of-hospital resuscitation measures for cardiac arrest are justified since long-term survivors can expect a good quality of life after successful resuscitation.
Emergency Medical Services↗
The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy.
In a prospective controlled trial on 46 patients undergoing lumbar discectomy, three classes of variables (medical data including MRI-identified morphological abnormalities, general psychological factors and psychosocial aspects of work) were analyzed with regard to their predictive value for the outcome of lumbar disc surgery at 2 year follow-up. Multiple regression analyses were used to identify the best predictor variables of four different outcome measures (i.e. pain relief, reduction of disability in daily activities, return to work and surgical outcome). MRI-identified nerve root compromise and social support from the spouse were independent predictors of pain relief 2 years after surgery (R2 = 0.40, P < 0.01). Return to work 2 years after surgery was best predicted by depression and occupational mental stress (R2 = 0.36, P < 0.001). MRI-identified extent of herniation and depression were significant predictors of a good surgical outcome after lumbar discectomy (R2 = 0.61, P < 0.001). This study has demonstrated that the outcome of discectomy is critically dependent on which outcome variables are selected and that different sorts of predictor variables have a distinct influence on the various outcome variables. Obvious morphological alterations (i.e. disc extrusions, nerve root compromise) proved to be significant predictors of postoperative pain relief and improvement of disability in daily activities justifying a surgical treatment approach in these cases. The most important finding of this study was that return to work was not influenced by any clinical findings or MR-identified morphological alterations, but solely by psychological factors (i.e. depression) and psychological aspects of work (i.e. occupational mental stress).
Activities of Daily Living↗
Psychometric validation of two Italian quality of life questionnaires in menopausal women.
OBJECTIVE: To establish the psychometric properties of the Italian version of two quality of life (QOL) questionnaires in menopausal women: the psychological general well being index (PGWBI) and the women's health questionnaire (WHQ). METHOD: These questionnaires were translated into Italian and then self-administered to out-patient women a first time, 1 week later in stable women to assess reproducibility, and 3 months later to evaluate responsiveness over time. Baseline analyses included: factorial structure, multitrait analysis, internal consistency reliability, and clinical validity. RESULTS: Questionnaires were returned by 155 women (median age: 54 years, median duration of amenorrhoea: 56 months, median Kupperman index 26). Principal component analysis (PCA) of the PGWBI showed an important general factor and then, after rotation, three factors. The PCA of the WHQ showed ten factors. Only five reproduced the dimensions postulated à priori quite well. The item convergent validity was confirmed for all items of the major dimension of the two questionnaires, and the item divergent validity, although acceptable, was less satisfying for the PGWBI than the WHQ. The internal reliability was good (Cronbach's alpha > or = 0.70) for the PGWBI and for nine scales out of ten for the WHQ. The six dimensions of the PGWBI and most of the dimensions of the WHQ were significantly correlated to the Kupperman index, indicating the clinical validity of the instruments. The responsiveness to change in clinical status at 3 months was better in the PGWBI than in the WHQ with moderate effect size (around 0.5). CONCLUSION: The Italian versions of the PGWBI and the WHQ are reliable and useful for HRT clinical trials but the dimensional scores must be calculated bearing in mind the limitations in the structure. Other studies are needed to improve the factorial stability of certain WHQ dimensions. For the Italian version of the PGWBI, the validation process is to be completed by studies of mixed populations suffering from other types of disease.
Adult↗
Effects of estrogen therapy on well-being in postmenopausal women without vasomotor complaints.
OBJECTIVE: To establish whether estrogen treatment affects well-being in postmenopausal women without current or previous vasomotor symptoms. DESIGN: Forty postmenopausal women, aged 45-59 years, without current or previous vasomotor complaints, were included. They were randomized to masked treatment with either transdermal 17beta-estradiol 50 microg/24 h or to placebo. At baseline and after 12 and 14 weeks of treatment, the women completed a questionnaire which reflects well-being, the Psychological General Well-Being (PGWB) Index. RESULTS: The women scored high on the PGWB Index, both at baseline and after 12 and 14 weeks of treatment. There was no significant difference in well-being according to PGWB Index between the groups treated with estrogen and placebo, neither at baseline, nor after therapy. Furthermore, there was no difference in change during therapy between the treatment groups. CONCLUSION: There is a gradual decline in estrogen during the climacteric, and it is controversial to which extent this affects women's mental health. The PGWB scores in this study were high before therapy, reflecting that these women without previous or current vasomotor complaints represented a selected sample. Neither short-term estrogen treatment over 12 weeks nor addition with medroxyprogesterone acetate during 2 weeks improved well-being in postmenopausal women without vasomotor symptoms who had high well-being at baseline.
Administration, Cutaneous↗
Chronic non-malignant pain patients and health economic consequences.
UNLABELLED: A prospective cohort study on chronic non-malignant pain patients was performed to describe health consequences and changes in use of health care resources and social transfers following multidisciplinary pain treatment. Patients, referred to a Danish Multidisciplinary Pain Center (MPC), were evaluated during four periods: six months prior to referral, waiting list period, intervention, nine months follow-up. OUTCOME MEASURES: pain intensity (VAS), The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), The Psychological General Well-Being Index (PGWB), The Hospital Anxiety and Depression Scale (HAD). Use of health care resources and social transfers were retrieved from public registers. Statistically significant improvements were obtained in pain intensity, SF-36 bodily pain, PGWB index and subscores vitality, and general health at discharge and follow-up. Intervention costs amounted to EUR 1102 (SD 721). Health care costs were not significantly reduced, but significant reductions in social transfers were seen.
Adult↗
Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication.
With the objective of further optimizing the outcome of antireflux surgery, we have studied the importance of dividing the short gastric vessels when performing a laparoscopic total fundoplication. Ninety-nine consecutive patients with chronic gastroesophageal reflux disease (GERD) were enrolled in the trial. Forty-seven patients (25 men, age 52 +/- 1.6 years [mean +/- standard error]) were randomized to undergo a laparoscopic Nissen-Rossetti total fundic wrap with intact short gastric vessels, whereas 52 patients (29 men, 48 +/- 1.4 years) had complete division of these vessels. Quality of life was assessed by means of the psychological general well-being and gastrointestinal symptom rating scale indices. The 6- and 12-month follow-up data are reported. Two patients were converted to open surgery. Mobilization of the fundus significantly prolonged the operative time (120 vs. 104 minutes, P = 0.05); otherwise the complication rates were similar in the two groups. Both procedures were equally effective in controlling gastroesophageal reflux at 6 and 12 months' postoperatively. Division of the short gastric vessels had no significant impact on the point prevalence of postfundoplication complaints at the given follow-up time points. Quality of life was significantly improved by both operative procedures and remained "normal" throughout the follow-up period. Dividing all short gastric vessels had no impact on the functional outcome during the first year of recovery after a total laparoscopic fundoplication.
Adult↗