Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up.

Between 1984 and 1989, 129 Stage 1 and Stage 2 breast cancer patients were entered into a behavioral study in Pittsburgh. Approximately 70% of these patients had elected to have breast conservation (lumpectomy) surgery, with the remainder choosing mastectomy. Using the Profile of Mood States, a measure of perceived social support, and Karnofsky ratings of physical functional status, patients were assessed 3 to 5 days following surgery and again 3 and 15 months following surgery. The data were analyzed using a repeated-measures analysis of covariance, adjusting for aggressiveness of chemotherapy. Compared to mastectomy patients, patients who received breast conservation surgery were rated as more functional by observers, but they perceived themselves as having less energy and less emotional support, especially over the first 3 months of the recovery period. Because there is accumulating evidence that emotional support may act as a stress buffer in various populations and may have survival value, these findings may be particularly troublesome. This study shows that breast conservation surgery is not a psychosocial panacea. Patients whose breasts are spared, especially younger patients, have psychological symptoms that appear acutely worse in the short run and, in the end, are similar to those of patients who elect to have mastectomies. Therefore, patients choosing lumpectomies are not necessarily psychosocially better off than those electing to have mastectomies. Additionally, these patients, particularly younger patients, may require greater social support and potential mental health interventions than they seem to be receiving.     

Relational Entitlement,Early Recollections of Parental Care,and Attachment Orientation

The present study examined whether inadequate parental care has a long-term impact on pathological relational entitlement in romantic relations, and whether this impact is mediated by insecure attachment style. Our cohort of 335 Israeli adults completed Sense of Relational Entitlement (SRE), Experience in Close Relationships (ECR), and Parental Bonding Instrument (PBI) questionnaires. The results generally supported our hypotheses. Avoidant attachment style fully and negatively mediated the link between maternal adequate care and SRE total entitlement. Anxious attachment style fully and negatively mediated the link between PBI paternal adequate care and SRE total entitlement. Women were found to report more relational entitlement. These results support the notion that pathological relational entitlement has its roots in recollections of early parental care and attachment experiences. The results of the study are discussed in the context of adult attachment and romantic relationships.     

How to Assess a Model's Testability and Identifiability

Formal definitions are given of the following intuitive concepts: (a) A model is quantitatively testable if its predictions are highly precise and narrow. (b) A model is identifiable if the values of its parameters can be ascertained from empirical observations. (c) A model is redundant if the values of some parameters can be deduced from others or if the values of some observables can be deduced from others. Various rules of thumb for nonredundant models are examined. The Counting Rule states that a model is quantitatively testable if and only if it has fewer parameters than observables. This rule can be safely applied only to identifiable models. If a model is unidentifiable, one must apply a generalization of the Counting Rule known as the Jacobian Rule. This rule states that a model is quantitatively testable if and only if the maximum rank (i.e., the number of linearly independent columns) of its Jacobian matrix (i.e., the matrix of partial derivatives of the function that maps parameter values to the predicted values of observables) is smaller than the number of observables. The Identifiability Rule states that a model is identifiable if and only if the maximum rank of its Jacobian matrix equals the number of parameters. The conclusions provided by these rules are only presumptive. To reach definitive conclusions, additional analyses must be performed. To illustrate the foregoing, the quantitative testability and identifiability of linear models and of discrete-state models are analyzed. Copyright 2000 Academic Press.     

Performance appraisal reactions: measurement, modeling, and method bias

In this study, the authors attempted to comprehensively examine the measurement of performance appraisal reactions. They first investigated how well the reaction scales, representative of those used in the field, measured their substantive constructs. A confirmatory factor analysis indicated that these scales did a favorable job of measuring appraisal reactions, with a few concerns. The authors also found that the data fit a higher order appraisal reactions model. In contrast, a nested model where the reaction constructs were operationalized as one general factor did not adequately fit the data. Finally, the authors tested the notion that self-report data are affectively driven for the specific case of appraisal reactions, using the techniques delineated by L. J. Williams, M. B. Gavin, and M. L. Williams (1996). Results indicated that neither positive nor negative affect presented method biases in the reaction measures, at either the measurement or construct levels.