Quality of Life Before and After Cataract Surgery: Research in a Sample of Polish Patients

The goal of this paper is to present possible change in quality of life (QoL) in older sample of people with vision disturbances. The patients were investigated twice: before (N = 193) and 4 month after the cataract surgery (N = 69), by means of the scale for vision functioning, and the Life Quality Questionnaire (Schalock & Keith, 1993) extend with the items measuring health related quality of life (HRQoL). Two problems were formulated: To what extent are visual defects associated with the decreased subjective QoL? What changes are observed in perceived QoL during the period of treatment of visual defects? The patients reported significant increase of HRQoL, however they did not report similar increase of a general QoL. Few reasons are considered: overlapping of the content of visual function scales and HRQoL and different indices of a general QoL and HRQoL, lack of a proper postoperative care, low socio-economic status of the participants, and too high expectation concerning better functioning after the surgery.     

Psychological Factors Associated with a Better Quality of Life Following Head-Up Tilt Testing

Quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained syncope (US). Little is known concerning the natural evolution of QoL following diagnosis. Psychological factors contributing to QoL improvement, such as psychological distress and self-efficacy remain to be explored. The objective of this study is to examine whether QoL changes 2 months and 6 months following head-up tilt (HUT) testing as well as to determine whether psychological factors are predictive of changes in QoL. Seventy-three patients undergoing HUT for recurrent syncope were interviewed 1 month before as well as 2 months and 6 months following HUT, using semi-structured interviews and questionnaires. Pre-HUT QoL was significantly worse than at the 2-month (p = 0.000) and 6-month follow-ups (p = 0.000). Psychological distress at baseline was associated with worse QoL 2 months post-HUT (Beta = .280; p = .024), independently of socio-demographic and clinical factors. Improved self-efficacy at follow-up predicted improvements in QoL (Beta = −.186; p = .023). Two and 6 months post-HUT, QoL is mproved in patients with recurrent syncope. Better QoL is predicted by low psychological distress and a heightened sense of self-efficacy following HUT. Strategies for enhancing self-efficacy and reducing psychological distress could be an efficient way to promote QoL in patients suffering from recurrent syncope.     

Quality of Life in Patients with Recurrent Vasovagal or Unexplained Syncope: Influence of Sex, Syncope Type and Illness Representations

Health-related quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained (US) syncope. Little is known regarding these patients’ QoL as pertains to their capacity to attain their life goals. Factors influencing QoL, such as sex, syncope type and illness representations have not been studied. Our objective is to examine the relationship between illness representations and QoL, as well as possible sex and syncope type differences. One hundred and four patients undergoing tilt-table testing (TTT) for recurrent syncope were interviewed one month before TTT, using questionnaires. Data were analysed using ANCOVAs, a-priori Helmert contrasts for illness representations, and regressions. Patients with US had a poor QoL compared to those with VVS [F(1, 91) = 10.46; p < 0.01], particularly in men (p < 0.01). Patients with higher perceived syncope severity showed an impoverished QoL relative to those with less severe perceptions [F(1, 91) = 5.47; p < 0.05]. A hierarchical regression revealed that illness representations mediate the impact of lifetime number of syncope on QoL. In conclusion, QoL is reduced in these patients, and is influenced by illness representations. Helping patients change their perceptions about their syncope may be an efficient way to promote QoL.     

Coronary Intervention Improves Disease Specific Health-Related Quality of Life but Not Individualised Quality of Life: A Potential Response Shift Effect?

To explore potential response shift effects with different quality of life (QoL) instruments in cardiac patients undergoing coronary intervention. Study Design and Setting: Recalibration was assessed with the disease specific health-related quality of life (HRQL) instrument MacNew in combination with a then-test approach. Reconceptualisation and reprioritisation were assessed with the individualised QoL instrument SEIQoL-DW. Significant treatment effects were seen on the MacNew (global Δ: 0.6 ± 1.1, p = 0.004) but not on the SEIQoL-DW (Δ: 3.3 ± 16, p = 0.37) 6 months after coronary intervention. No recalibration effect was found on the MacNew then-test, while with the SEIQOL-DW potential response shift effects of reconceptualisation and reprioritisation were seen. For the first time response shift effects were explored in cardiac patients undergoing coronary intervention. This study confirmed that there is a clinically significant improvement in disease specific HRQL over time following successful coronary interventions. However, no treatment effect was seen for individualised QoL with the SEIQoL-DW. This might be due to reconceptualisation and reprioritisation response effects. Future studies need to focus on exploring response shift effects, and the interrelationship between its different components, captured by different patient reported outcome instruments in larger patient groups undergoing coronary interventions.     

Quality of Life Assessment for Physical Activity and Health Promotion

Despite the clear relationship of physical activity and quality of life (QoL), QoL measures are seldom targeted for physical activity and health promotion. The current research attempted to address that gap by developing a QoL measure based on a conceptual model that reflects positive health and is relevant for physical activity and health promotion programs. In the project, which extended over three phases, an initial 70-item QoL survey was administered to university students and community program participants (total n = 512) along with measures of satisfaction with life and physical activity. Exploratory and confirmatory factor analyses revealed clear social, emotional, cognitive, physical, spiritual and functional (ADL) QoL factors as well as integrated QoL. The resulting 32-item QoL Survey fits the conceptual model, demonstrates logical relationships with physical activity and has sufficient psychometric properties for use in related research and health promotion programs.     

Further Evidence of the Reliability and Validity of the Multidimensional Anxiety

The psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) were examined in adolescent psychiatric inpatient samples. In Study 1 (n = 287), confirmatory factor analyses provided satisfactory fit for the four-factor (comparative fit index; CFI = 0.856) and higher-order (CFI = 0.854) solutions. Using parcels as items, the fit of the four-factor model was improved substantially (CFI = 0.935). Next, in the bifactor analyses, support was attained for a model that included a general factor and four domain specific subfactors. In Study 2 (n = 195 inpatient youths), the MASC showed good scale reliability and concurrent validity. Results of the receiver operating characteristic curve and binary logistic regression analyses provided adequate evidence for discriminative validity. In Study 3 (n = 40), test–retest reliability of scores on the MASC-10 scale over a 3-week period was adequate (r _tt = 0.83, p < 0.001) for children ages 8 to 11 years.     

Health Related Quality of Life After Gastric Bypass Surgery

The majority of studies which have evaluated health related quality of life are limited in the duration of follow up. The objective of this study was to prospectively conduct an evaluation using a repeated cross sectional analysis of separate patient cohorts who were up to four years after gastric bypass surgery. Adult Roux-en-Y gastric bypass patients were recruited to the study. All patients were requested to complete a general health status questionnaire, the Short Form-36 (SF-36), before surgery or at their post operative out patient follow up visits. Patient weight was documented at each follow up visit. A cross sectional analysis was performed to evaluate SF-36 scores in each annual cohort. Data are reported as mean +/− S.D. Three-hundred-eight patients completed at least one SF-36 assessment [Initial assessment at the time of surgery, time 1, n = 245, 1y n = 149, 2y n = 70, 3y n = 59, 4y n = 61]. The SF-36 scores were greater (p < 0.05) in each of the separate post surgery cohorts for physical functioning, role limitations due to physical health, social functioning, pain, vitality, general health and the physical component summary (PCS) scores. While not comparing changes in scores within individuals over time, these data suggest early improvement especially in the physical dimension of health related quality of life. In this analysis, this finding was also observed in each of the separate cohorts up to 4 years after gastric bypass surgery.     

Face Emotion Processing in Depressed Children and Adolescents with and without Comorbid Conduct Disorder

Studies of adults with depression point to characteristic neurocognitive deficits, including differences in processing facial expressions. Few studies have examined face processing in juvenile depression, or taken account of other comorbid disorders. Three groups were compared: depressed children and adolescents with conduct disorder (n = 23), depressed children and adolescents without conduct disorder (n = 29) and children and adolescents without disorder (n = 37). A novel face emotion processing experiment presented faces with ‘happy’, ‘sad’, ‘angry’, or ‘fearful’ expressions of varying emotional intensity using morphed stimuli. Those with depression showed no overall or specific deficits in facial expression recognition accuracy. Instead, they showed biases affecting processing of low-intensity expressions, more often perceiving these as sad. In contrast, non-depressed controls more often misperceived low intensity negative emotions as happy. There were no differences between depressed children and adolescents with and without conduct disorder, or between children with comorbid depression/conduct disorder and controls. Face emotion processing biases rather than deficits appear to distinguish depressed from non-depressed children and adolescents.     

Primary Care Physicians’ Awareness, Experience and Opinions of Direct-to-Consumer Genetic Testing

The purpose of this study was to assess primary care physicians’ awareness, experience, opinions and preparedness to answer patients’ questions regarding direct-to-consumer (DTC) genetic testing. An anonymous survey was mailed to 2,402 family and internal medicine providers in North Carolina. Of the 382 respondents, 38.7% (n = 148) were aware of and 15% (n = 59) felt prepared to answer questions about DTC genetic tests. Respondents aged 50 or older were more likely to be aware of DTC genetic testing than those less than 40 years old (OR = 2.42). Male providers were more likely to feel prepared to answer questions than female providers (OR = 2.65). Among respondents who reportedly were aware, family practitioners were more likely than internists (OR = 3.30) to think DTC testing was clinically useful, and 18.9% had patients ask questions or bring in test results. The small percent of physicians who were aware of DTC genetic testing or felt prepared to answer questions about it suggests that education of providers will be necessary if testing becomes more widespread.     

Emotional Reaction to Fragile X Premutation Carrier Tests Among Infertile Women

Female fragile X premutation carriers are at ∼10-fold increased risk of premature ovarian failure (follicle stimulating hormone >40 mIU/mL, amenorrhea, age <40). A milder degree of premature ovarian aging (diminished ovarian reserve, where follicle stimulating hormone levels are typically 10–20 mIU/mL) results in infertility. Approximately 10% of fertility clinic patients have this diagnosis. A cohort of 20 women diagnosed with diminished ovarian reserve provided a blood specimen (confidential results), and completed structured questionnaires that assessed emotional reactions to potentially being a premutation carrier (pretest questionnaire, n = 20) and the posttest known carrier status (3 month follow-up questionnaire, n = 18 non-carriers). Responses were measured using 9-point scales, and analyzed with Fisher exact and Wilcoxon exact tests. While most participants did not view fragile X premutations as a serious medical condition, perceptions of seriousness were positively correlated with anger and regret about not knowing sooner of the potential association of these premutations with infertility. Overall, when women (pretest) imagined themselves as carriers, their self-esteem and Health Orientation Scale responses were unchanged with the exception of feeling more afraid (p = 0.004). Despite strongly wishing for negative test results, they were glad to know there might be a medical explanation for their infertility. Financial Support: This work was financially supported by a University of Virginia School of Medicine Research & Development Award.     

The Relation of Severity and Comorbidity to Treatment Outcome with Cognitive Behavioral Therapy for Childhood Anxiety Disorders

The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. Children (aged 8–12, n = 124) diagnosed with an anxiety disorder were treated with a short-term CBT protocol. Severity was assessed with a composite measure of parent-reported behavior problems. Two approaches to comorbidity were examined; “total comorbidity” which differentiated anxiety disordered children with (n = 69) or without (n = 55) a co-occurring disorder and “non-anxiety comorbidity’ which differentiated anxious children with (n = 22) or without a non-anxiety comorbid disorder (n = 102). Treatment outcome was assessed in terms of Recovery, represented by post-treatment diagnostic status, and Reliable Change, a score reflecting changes in pre- to post-treatment symptom levels. Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. Non-anxiety comorbidity operated as a strong predictor that explained all of the variance associated with severity for self-reported depressive symptoms. The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved.     

Construct Validity of ADHD-IN,ADHD-HI,ODD toward Adults,Academic and Social Competence Dimensions with Teacher Ratings of Thai Adolescents: Additional Validity for the Child and Adolescent Disruptive Behavior Inventory

Confirmatory factor analysis was used to test the construct validity of an attention-deficit/hyperactivity disorder-inattention, attention-deficit/hyperactivity disorder-hyperactivity/impulsivity, oppositional defiant disorder toward adults, academic and social competence factor model with teacher ratings of Thai adolescents (n = 872) with the Child and Adolescent Disruptive Behavior Inventory. The five-factor model resulted in an adequate fit in an absolute sense (i.e., CFI = .960; TLI = .985; RMSEA = .065; and WRMR = .883). All the items had significant and substantial loadings on their respective factors (i.e., > .78) with the five-factors showing discriminant validity. The five-factor model also resulted in similar results for boys and girls separately as well as younger and older adolescents. The current findings with the teacher version of the measure in conjunction with earlier research with mothers’ and fathers’ ratings of Brazilian, Thai, and American children (Burns et al., Psychological Assessment, 20, 121-130, 2008) and Thai adolescents (Burns et al., Psychological Assessment, 21, 635-641, 2009) provide increasing support for the construct validity of Child and Adolescent Disruptive Behavior Inventory within multiple cultures. Procedures are also outlined to improve the content validity as well as test the construct validity of forthcoming parent and teacher DSM-V ADHD/ODD rating scales.     

Emotional Intelligence in Social Phobia and Other Anxiety Disorders

This study examined the associations between clinical anxiety, domains of emotional intelligence (EI), and three clinician-rated indices of maladjustment. Of key interest was whether social phobia (SP) is unique among anxiety disorders in being characterized by lower levels of Interpersonal and, particularly, Intrapersonal EI, and whether these differentially predict maladjustment. Individuals with SP (n = 169) obsessive-compulsive disorder (n = 65) and panic disorder (n = 64), and nonclinical controls (n = 169) completed the short form self-report Emotional Quotient Inventory (EQ-i: S). All anxiety disorder groups showed lower total EI than controls, and differed among themselves with the SP group displaying the lowest levels of total EI and lower scores on two EQ-i:S subscales (Interpersonal and, more robustly, Intrapersonal). The Intrapersonal dimension alone predicted all indices of greater maladjustment in the SP group. These findings indicate a negative relationship between anxiety disorders and EI, and reaffirm the foremost link between Intrapersonal EI and SP and its functional outcomes.     

Attentional Performance in Children and Adolescents with Tic Disorder and Co-Occurring Attention-Deficit/Hyperactivity Disorder: New Insights from a 2 × 2 Factorial Design Study

The aim of the present study was to investigate the effect of both tic disorder (TD) and attention-deficit/hyperactivity disorder (ADHD) on attentional functions. N = 96 children and adolescents participated in the study, including n = 21 subjects with TD, n = 23 subjects with ADHD, n = 25 subjects with TD+ADHD, and n = 27 controls. Attentional performance was tested based on four computerized attention tasks (sustained attention, divided attention, go/nogo and set shifting). The effect of TD as well as ADHD on attentional performance was tested using a 2 × 2 factorial approach. A diagnosis of TD had no negative impact on attentional functions but was associated with improved performance in the set shifting task. By contrast, regardless of a diagnosis of TD, subjects with ADHD were found to perform worse in the sustained attention, divided attention and go/nogo task. No interaction effect between the factors TD and ADHD was revealed for any of the attention measures. Our results add to findings from other areas of research, showing that in subjects with TD and ADHD, ADHD psychopathology is often the main source of impairment, whereas a diagnosis of TD has little or no impact on neuropsychological performance in most cases and even seems to be associated with adaptive mechanisms.     

Childhood Predictors of Desistance and Level of Persistence in Offending in Early Onset Offenders

Childhood predictors of adolescent offending careers were studied in 310 boys from the longitudinal Pittsburgh Youth Study who started offending prior to age 12. Three main groups were distinguished: serious persisters (n = 95), moderately serious persisters (n = 117), desisters (n = 63), and an intermittent group (n = 35). Group membership was predicted using risk and promotive factors measured in childhood. Serious and moderately serious persisters could be distinguished well from desisters (29.2% and 32.3% explained variance). Distinction between the two persister groups proved somewhat more difficult (20.9% explained variance). More serious persisters than desisters showed disruptive behavior, while moderately serious persisters fell in between. Further, more moderately serious persisters were marked by social disadvantage. Family involvement, small family and positive peer relationships were promotive of desistance. Concluding, early onset offenders show considerable heterogeneity in their adolescent offending careers which seem to some extent to be predicted by different sets of risk and promotive factors.     

Factor Structure and Psychometric Properties of the Emotional Approach Coping Scale in Turkish University Students and Community Members

To evaluate emotional approach coping, including the dimensions of emotional processing and emotional expression, the Emotional Approach Coping Scale (EACS) is frequently used. This study aimed to examine the psychometric properties of situational EACS among Turkish participants (n = 557), including university students (n = 283) and community members (n = 274). The results revealed that a two-factor model showed significant goodness of fit for confirmatory factor analysis. Furthermore, multi-group comparisons based on sample groups (university students and community members) and gender groups demonstrated no significant differences between the constrained and unconstrained models. In addition to sufficient reliability of the EACS, the concurrent and discriminant validity of the scale were supported by association of the EACS with state anxiety and social desirability. The theoretical and practical implications of this study are discussed.     

Test of a Factor Mixture-Based Taxonic-Dimensional Model of Anxiety Sensitivity and Panic Attack Vulnerability among University and Clinical Samples in Mexico City

The aim of the present study was to evaluate a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) (Bernstein et al. Behavior Therapy 41:515-521, 2010), as measured by the ASI-3 (Taylor et al. Psychological Assessment 19:176-188, 2007), in regard to panic attacks, anxiety symptoms, and behavioral impairment among a university sample (N = 150, n _females  = 107, M _age = 21.3 years, SD = 4.3) and a clinical sample (N = 150, n _females  = 102, M _age = 39.0 years, SD = 12.0) from Mexico City, Mexico. Findings demonstrated cross-national support for the conceptual and operational utility of the AS taxonic-dimensional hypothesis (Bernstein et al. Journal of Anxiety Disorders 20:1-22, 2007b). Specifically, (1) the FMM-based AS taxon class base rate was significantly greater among the clinical relative to the university sample; (2) risk for panic attacks was significantly greater among the AS taxon class relative to the AS normative class; and (3) continuous individual differences in AS physical and psychological concerns, within the AS taxon class, were associated with level of risk for panic attacks, as well as panic attack severity and anxiety symptom levels. Similar AS taxonic-dimensional effects were observed in relation to degree of behavioral impairment across domains of functioning. The study results are discussed with respect to their implications for better understanding the nature of AS-related cognitive vulnerability for panic and related anxiety psychopathology.     

The Relationship Between Sluggish Cognitive Tempo,Subtypes of Attention-Deficit/Hyperactivity Disorder,and Anxiety Disorders

The objective of the present study was to examine the relationship between sluggish cognitive tempo (SCT), subtypes of attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders (AnxDs). One hundred and forty-one children (90 males, 51 females) aged 7–13 years were assigned to four groups, i.e., referred children with comorbid AnxDs and ADHD (n = 25), ADHD (n = 39), AnxDs (n = 41), and nonreferred controls (n = 36). Furthermore we explored the association between SCT and several neurocognitive measures (reaction time, verbal memory, and spatial memory). Diagnoses were established using Kiddie-SADS P/L. SCT was assessed using a 17-item mother-reported questionnaire. SCT correlated significantly with inattentiveness, regardless of the subtype of ADHD. Furthermore, we found significant differences in the levels of SCT among the four groups, with the highest SCT scores observed in the comorbid group. SCT correlated with variability in spatial memory; in contrast, there was no correlation between SCT and reaction time.     

Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.     

Providers’ Perceptions and Practices Regarding <Emphasis Type="BoldItalic">BRCA1/2</Emphasis> Genetic Counseling and Testing in African American Women

We examined healthcare providers’ perceptions of genetic counseling and testing in African American women at moderate to high-risk of carrying a BRCA1/2 mutation. We conducted 20 in-depth interviews with genetic counselors (n = 5), medical oncologists (n = 8), obstetrician/gynecologists (n = 2) and surgeons (n = 5). Interviews were audiotaped, transcribed and independently coded by two individuals using a content analysis approach. Seven themes emerged relevant to providers’ perceptions of African American women’s use of BRCA1/2 genetic services: access factors, cultural beliefs and preferences, effects of testing, patient motivators for genetic counseling and testing, patient-provider communication, reasons for provider referral, and reasons for patient refusal. Providers identified individual- and system-level barriers to African American women’s use of genetic services, including lack of follow-up after referrals to genetic specialists and challenges to obtaining financial coverage for under- and uninsured high-risk women. Results have implications for physician and patient education regarding appropriate referrals to and uptake of genetic services in at-risk African American women.