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.     

The Relationships Among Differing Loss Experiences,Adjustment, Beliefs,and Coping

Abstract

Losses are often equated for conceptual purposes, and it is often assumed that different types of losses result in similar grief reactions and exert similar effects on cognitive structures and coping patterns. This article examines the expectancies, beliefs, coping patterns, and psychological adjustment associated with loss due to death, parental. divorce, or illness and disability in a college student population. Loss groups did not differ from each other or from a no-loss group on cognitive variables, coping, or psychological adjustment. In instances in which associations between the cognitive measures and either coping or adjustment were indicated, the typical pattern was for loss groups to differ from the no-loss condition but not from each other.     

Test anxiety,emotional responding under guided imagery,and self-talk during an academic examination

Abstract

This investigation examined the assumption that phenomenological responses created by guidedimagery procedures pertinent to test anxiety are topographically similar to emotional responses experienced during an actual examination. Participants were divided on facilitating versus debilitating test anxiety and exposed to subclinical doses of stimulus-response propositions that involved test-taking, fear, and physical activity using the induction technique employed by Lang et al. (1980). Patterns of emotional responses obtained after each induction were compared to the pattern elicited immediately prior to students' final course examination as well as self-talk during the examination. Results indicated that exposure to test-related imagery elicited a pattern of emotional responding that was different than exposure to fear or action imagery but was nearly identical to emotional responses found before examinations. Negative emotional states before the examination also were associated with higher frequencies of negative self-statements during the examination. Treatment implications of these findings were explored.     

Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. We highlight unique challenges in working with counselors unaccustomed to traditional clinical supervision. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted 1 year following implementation, and interviews with key organization executives and administrators.     

A China–New Zealand comparison of forgiveness

The present study examined the practice of forgiveness among participants from China (N = 172) and New Zealand (N = 91). We tested a theoretical model describing the relationships between collectivism, individualism, and forgiveness. Participants from China were more collectivistic and less individualistic than were participants from New Zealand. Overall, participants from New Zealand were more forgiving than were participants from China. Collectivism was positively related to decisional forgiveness in Chinese participants. Decisional forgiveness independently predicted conciliatory behaviour among participants from China, but this was not the case for participants from New Zealand. Thus, the hypothesized model received qualified support.     

Applicant Gender and Family Structure: Effects on Perceived Relocation Commitment and Spouse Resistance

Within the context of a controlled laboratory study, the effects of applicant gender, marital type (single earner, dual earner), and parental status (child, no child) on perceptions of job applicant commitment to a move involving geographic relocation and expected family resistance to the move were investigated. The results indicated that gender and family structure variables interacted in their influence on the dependent variables. Participants also provided reasons for their ratings of perceived commitment. Content analysis revealed 4 themes underlying participant responses: family concerns, goals and motivation of applicant, experience of applicant, and individual differences.     

A naturalistic longitudinal evaluation of counselling in primary care

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.     

A Comparison of Latent Inhibition and Learned Irrelevance Pre-Exposure Effects in Rabbit and Human Eyeblink Conditioning

The learning of an association between a CS and a US can be retarded by unreinforced presentations of the CS alone (termed latent inhibition or LI) or by un-correlated presentations of the CS and US (termed learned irrelevance or LIRR). In rabbit eyeblink conditioning, there have been some recent failures to replicate LI. LIRR has been hypothesized as producing a stronger retardation effect than LI based on both empirical studies and computational models. In the work presented here, we examined the relative strength of LI and LIRR in eyeblink conditioning in rabbits and humans. In both species, a number of preexposure trials sufficient to produce LIRR failed to produce LI (Experiments 1 & 3). Doubling the number of CS pre-exposures did produce LI in rabbits (Experiment 2), but not in humans (Experiment 4). LI was demonstrated in humans only after manipulations including an increased inter-trial interval or ITI (Experiment 5). Overall, it appears that LIRR is a more easily producible pre-exposure retardation effect than LI for eyeblink conditioning in both rabbits and humans. Several theoretical mechanisms for LI including the conditioned attention theory, stimulus compression, novelty, and the switching theory are discussed as possible explanations for the differences between LIRR and LI. Overall, future work involving testing the neural substrates of pre-exposure effects may benefit from the use of LIRR rather than LI.