Quality adjusted survival analysis: A neglected application of the quality of well-being scale

Abstract

Background In survival analysis, those who are alive are statistically coded as 1.0 while those who are dead are coded as 0.0. Since everyone who remains alive is given the same score, a person confined to bed with an irreversible coma is alive and is counted the same as someone who is active and asymtomatic. The Quality of Well-being (QWB) scale defines levels of wellness on the continuum between death and optimum function and integrates morbidity and mortality into the same number. This paper demonstrates the effect of including mortality in QWB estimates for male adults with HIV infection.

Method This study involves follow-up of a cohort of 386 male adults participating in the San Diego HIV Neurobehavioral Research Center (HNRC). Patients were evaluated using the QWB at enrollment and at six month intervals. All patients were classified into three stages of HIV disease according to the Center for Disease Control (CDC) classification: CDC IV (symptomatic HIV disease), CDC II or III (asymptomatic infection) and uninfected male controls.

Results QWB scores were calculated with and without mortality included for men in each CDC class who completed a one year (N = 148) or two year follow-up (N = 60). At each evaluation, there were significant differences among CDC classes and inclusion of deaths increased the variance accounted for by CDC class at each evaluation.

Conclusions HIV infection has significant impacts upon both morbidity and mortality. Survival analysis captures only the mortality dimension, while quality adjusted survival analysis using the QWB includes both dimensions. We propose quality adjusted survival analysis as a more sensitive method for assessing outcome in HIV disease and other health conditions.     

Development of decisional balance and self-efficacy measures for adolescent sedentary behaviors

Writing about traumatic events can produce health benefits, yet emotionally non-expressive or cognitively avoidant individuals may be unwilling or unable to express their emotions. This study examined non-expression, cognitive avoidance, response to writing, and subsequent health. As part of a larger study, participants ( N = 71) with asthma or rheumatoid arthritis (RA) wrote about traumatic experiences for 20 min on three consecutive days. Alexithymia, denial, behavioral disengagement, mental disengagement, focus on/venting of emotions, avoidant thoughts, and health status were assessed at baseline, health status again 4 months after writing. Essays were coded for how personal and how emotional they were, and for narrative structure. Non-expression and cognitive avoidance were neither related to how personal or emotional essays were, nor to affective response to writing. High levels of denial or avoidant thoughts predicted less narrative structure. Avoidant thinking marginally predicted health improvements in RA patients. Results suggest that non-expression and cognitive avoidance do not interfere with writing in terms of emotional engagement, but may influence narrative use.     

Assessment and Development of Executive Function (EF) During Childhood

This review paper outlines the issues associated with the assessment of executive function (EF) in children and adolescents, and describes the developmental profile of executive processes across childhood. At the outset, EF is defined, and cognitive and behavioral impairments associated with executive dysfunction (EDF) are described. A developmental model of EF is proposed incorporating four discrete but inter-related executive domains (attentional control, cognitive flexibility, goal setting, and information processing) which operate in an integrative manner to enable “executive control”. Characteristics that constitute traditional EF measures are discussed, as are the problems associated with test interpretation. The ecological validity of EF tests and neuropsychological assessment procedures are examined, and adjunct methods of measurement are presented to enable a more comprehensive and valid assessment of EF. Based on developmental and normative studies, the maturation of executive domains is mapped. Attentional control appears to emerge in infancy and develop rapidly in early childhood. In contrast, cognitive flexibility, goal setting, and information processing experience a critical period of development between 7 and 9 years of age, and are relatively mature by 12 years of age. A transitional period is thought to occur at the beginning of adolescence, and shortly after “executive control” is likely to emerge. In order to confirm our current understanding of EF development and further enhance our understanding of brain-behavior relationships, longitudinal studies incorporating structural and functional neuroimaging are required.     

Functional neuroimaging of working memory in survivors of childhood brain tumors and healthy children: Associations with coping and psychosocial outcomes

Purpose: Pediatric brain tumors are the second most common cancer diagnosis in individuals under age 20 and research has documented significant neurocognitive, psychosocial, and emotional late effects. Associations among these deficits have not been adequately considered and the role of survivors’ coping with stress in relation to deficits is unknown. Further, research has yet to examine neurobiological processes related to neurocognitive, psychosocial, and emotional difficulties in survivors through the use of functional neuroimaging. Method: Questionnaire measures and functional neuroimaging were used to examine the neurocognitive, psychosocial, and emotional functioning and coping responses of survivors of pediatric brain tumors (N = 17; age 8–16) and healthy children (N = 15). Results: Survivors experienced elevated levels of psychosocial and behavioral/emotional difficulties relative to healthy controls and normative data. Increases in brain activation in prefrontal and other anterior regions in response to a working memory task were associated with better psychosocial functioning, use of engagement coping strategies, and less use of disengagement coping strategies. Regression analyses suggest coping accounts for a significant portion of the association between brain activation and behavioral/emotional functioning. Conclusions: This study extends late-effects research by examining neurobiological processes associated with psychosocial and emotional difficulties. These findings contribute to our understanding of difficulties in survivors and provide a foundation for research exploring these associations and mediators of deficits in future longitudinal studies.     

Dante’s Divine Comedy and modern depth therapy

The author discusses a connection between the modern analysand’s experience of depth therapy and the Christian pilgrim’s experience of confession, penitence and transformation as described by Dante in his Divine Comedy. She looks at structure and order in the context of psychotherapy. Taking Adriana Mazzarella’s ‘In Search of Beatrice’ as a guide, she examines a Jungian interpretation of the poem as an analogy of therapeutic initiation. She explores the idea of cultural complexes via the study of the medieval world view as one distinct from our own. She demonstrates the way in which study of the Comedy unexpectedly helped her survive an experience of long-term psychotherapeutic work.     

Two-Year-Olds' Object Retrieval Based on Television: Testing a Perceptual Account

Two-year-olds frequently fail to use information provided by video to find objects hidden in an adjacent room. Schmitt and Anderson (2002) hypothesized that they fail to map the 2-dimensional (2D) video image onto the 3D layout of the search space. Two experiments tested whether 2-year-olds can successfully use information from video when the search space is 2D or when the information is provided verbally (by telling the child where the toy is hidden). In both experiments, children performed poorly in the video conditions but performed well in direct live experience comparison conditions, contradicting Schmitt and Anderson's hypothesis. Performance was above chance on the first trial in the video conditions, suggesting that 2-year-olds do have a memory of the hiding location, albeit one that is easily disrupted by perseverative errors on subsequent trials. Overall, the results are most consistent with the hypothesis that very young children give priority to direct experience over mediated information.     

Finding Where and Saying Where: Developmental Relationships Between Place Learning and Language in the First Year

The relationship between emergent spatial understanding in different cognitive domains, including navigation and language, has rarely been studied using methods that allow for the examination of individual differences. In this study the authors explored emergent place learning and its relationship to early spatial language, namely prepositions, in 16- to 24-month-old children. Children were tested using a spatial task adapted from the Morris water maze, and the MacArthur Communicative Development Inventory. In the place-learning task, children were placed in a circular enclosure and a puzzle was hidden under the floor at one location. Before each trial, children were disoriented and placed in the maze at a different starting position. Their search types and success at finding the puzzle were coded. As expected, older children demonstrated more spatial searches and better place-learning skills (finding the goal), as well as greater overall expressive vocabulary. Place learning and language did not correlate with each other once age was partialled, with one crucial exception: a theoretically predicted correlation between prepositions and goal localization.