The role of vital exhaustion in predicting the recurrence of vascular events: A longitudinal study

Background/objective

The aim of this study was to examine the role of vital exhaustion in predicting the recurrence of vascular events.

Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients

Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.     

Offering predictive testing for Huntington disease in a medical genetics clinic: Practical applications

Predictive testing for Huntington disease is presently offered in a select few medical genetics centers in the United States. This is in part due to the labor intensive counseling and psychological testing suggested by the research protocols. We discuss some specific suggestions for establishing programs for Huntington disease predictive testing within pre-existing medical genetics clinics to encourage more centers to offer presymptomatic testing. This will allow more at risk individuals the opportunity to consider predictive testing and cut down the expenses of traveling to the few predictive testing centers that currently exist. The counseling principals will remain similar to those discussed here, even following the identification of the Huntington disease mutation.     

Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.     

Normal values for Type A behaviour patterns in Danish men and women and in potential high-risk groups

The Jenkins Activity Survey (JAS) was administered to a normal population of randomly selected Danish adults, to patients consulting a cardiologist, and to physicians in order to compare those groups in terms of their coronary-prone (Type A) behaviour patterns. The standard procedure of rating the JAS was used in order to obtain scores for each of the four subscales: Type A (time urgency and ambitiousness), Factor S (speed and impatience) Factor H (hard-driving and competitive) and Factor J (job involvement). Gender differences were observed in the normal population for each of the four subscale scores, and age-related differences were obtained for Factor J. Elevated scores for Factor S were obtained by physicians and by people in the population who had a cardiovascular disorder. Physicians had also elevated scores for Factor J, whereas their Factor H scores tended to be reduced. No reliable differences in JAS subscale scores were observed between four groups of heart patients (i.e. angina pectoris, arterial hypertension, atrial fibrillation and atherosclerosis), although there was a tendency for Factor J to be elevated in atherosclerosis. The findings provide normal values for JAS scores in Danish men and women, and suggest that some facets of coronary-prone behaviour may be enhanced in Danish high-risk groups.     

An empirical study of the diathesis-stress theory of disease

One thousand, one hundred and twenty-one Jewish concentration camp survivors were compared with 367 Jewish controls who had not been in a concentration camp, and had not lost any family members in such a camp. Of interest was the mortality of camp and comparison groups, on the hypothesis that the stress of being in a camp would adversely affect inmates. It was found that former camp inmates were over twice as likely to die of cancer, coronary heart diesease, or other causes as the comparison subjects of similar age and sex composition, and that severity of stress was correlated with mortality in the expected direction. Diathesis, determined by means of a special interviewer-administrated questionnaire, was found to interact synergistically with stress in producing high mortality.     

Physical characteristics of residential psychiatric and substance abuse programs: Organizational determinants and patient outcomes

Described the Physical and Architectural Characteristics Inventory (PACI), which assesses the physical characteristics of hospital- and community-based psychiatric and substance abuse residential treatment programs for adults. Developed using data from 94 representative programs, the PACI has 7 dimensions that assess community accessibility, physical features that add convenience, aid recreation, and provide support for patients, and space for patient and staff functions. In comparison to community-based programs (n=63), hospital programs (n=31) had more social-recreational and prosthetic aids, safety features, staff facilities, and space. The PACI dimensions were also related to other organizational features, such as facility ownership and program size and staffing level. Programs with more physical amenities had patients who were more involved in self-initiated and community activities and were more likely to successfully complete the program and be discharged to independent living situations and paid jobs. Programs with more social-recreational and prosthetic aids, space, and access to community resources also had better patient outcomes. In addition, PACI dimensions were related to observers' ratings of facility attractiveness. Potential applications of the PACI and the full inventory of which it is a part are discussed.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

THE BEHAVIOR OBSERVATION INSTRUMENT: A METHOD OF DIRECT OBSERVATION FOR PROGRAM EVALUATION1

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.