Personality and patient adherence: Correlates of the five-factor model in renal dialysis

The five-factor taxonomy of personality traits has received increasing attention in the literature regarding personality correlates of health outcomes and behaviors. We examined the association of the five NEO Five-Factor Inventory dimensions to medical regimen adherence in a sample of 72 renal dialysis patients. Results indicated that Conscientiousness (Dimension III) is a five-factor trait significantly associated with adherence to the medication regimen. No other NEO-FFI dimension was significantly associated with patient adherence.     

Heart-focused anxiety,illness beliefs,and behavioral impairment: Comparing healthy heart-anxious patients with cardiac and surgical inpatients

Psychological features and complaints of persons presenting to medical settings with heart-focused anxiety and noncardiac chest pain are poorly understood. Comparing 20 healthy heart-anxious patients to cardiac and surgical inpatients and nonpatient controls, we found that healthy heart-anxious patients (a) were as afraid of chest pain and heart palpitations as inpatients with heart disease, (b) were as incapacitated by symptoms and using medical services as much as both inpatient groups; and (c) reported higher levels of cardiac disease conviction, heart awareness, and behaviors designed to protect their heart than surgical patients and nonpatients. Compared to all other groups, healthy heart-anxious patients reported more panic and other anxiety disorders, hypochondriacal beliefs, physical symptoms, obsessive-compulsive concerns, and negative affect. Following a hyperventilation test, heart-anxious patients also indicated more distressing symptoms and thoughts, and felt less safe and in control than surgical patients and nonpatients. Results support efforts for a timely recognition, diagnosis, and behavioral treatment of persons with heart-focused anxiety.     

Children''s perceptions of chronic illness: the roles of disease symptoms, cognitive development, and information

This experiment considered the acceptance of chronically illchildren by their peers as a result of the peer's level of cognitivedevelopment, the type of disease, and the amount of informationprovided. The results of multivariate and univariate analysesof variance indicate that (a) children's comprehension of illnessescan be improved significantly with the provision of explanatoryinformation, although preoperational children are less ableto retain specifics, (b) preoperational children as well asuninformed children perceived themselves as significantly morevulnerable to contagion, (c) the more observable illness wasseen as significantly less attractive, and (d) provision ofinformation about the nature of a highly observable illnesstended to decrease rather than increase attraction.     

Behavior Problems in Children With Diabetes: Disentangling Possible Scoring Confounds on the Child Behavior Checklist

Objective: The Child Behavior Checklist (CBCL; T. M. Achenbach,1991), when used to assess the behavior of children with diabetes,may contain confounds because some behavioral items can havea physiologic etiology, and may skew reports of behavioral disturbance. Methods: Two techniques were used to disentangle possible scoringconfounds in the behavioral ratings of children with and withoutdiabetes: (1) the Somatic Complaints scale was deleted, or (2)Diabetes Items, identified a priori with 89% agreement by ninemedical personnel, were deleted. Results: As expected, with traditionally scored protocols, childrenwith diabetes obtained higher Internalizing and Total BehaviorProblem scores than controls. This group difference persistedwhether the Somatic Complaints scale or the Diabetes Items weredeleted. Conclusions: Compared to controls, children with diabetes obtainedmildly elevated scores on six of the eight CBCL scales, regardlessof scoring method, suggesting that their mildly elevated behavioralprofile is not confounded by physiologic symptomatology.     

Minnesota Multiphasic Personality Inventory (MMPI) cluster groups among chronically ill patients: Relationship to illness adjustment and treatment outcome

Cluster analysis of the MMPI has been utilized widely in the chronic low back pain literature to try to identify reliable patient subtypes predictive of treatment outcome. We extended this methodology to patients with heterogeneous chronic medical conditions by replicating prototypic MMPI cluster group profiles and by relating cluster groups to clinical baseline and outcome data. Subjects were two independent samples (n=254 and n=263) of chronically ill patients admitted to an inpatient medicine/psychiatry unit. Using a four-cluster solution, similar cluster profile groups were replicated in both samples. Consistent differences emerged between cluster groups on functional impairment, psychiatric diagnoses, depression, and psychosomatic symptoms. Cluster group membership also predicted changes in functional impairment and depression six months after treatment. Results are discussed in terms of similarities between chronic low back pain and chronic illness and tailoring treatment to different patient types.This research was supported in part by a grant from the Henry J. Kaiser Family Foundation.     

"军字1号"工程使用前后病案首页质量对照统计分析

为探讨“军字1号”工程使用前后的病案首页质量变化,本文通过作者所在医院近八年病案首页的质量调查统计,对“军字1号”工程使用前后的病案首页质量作了详细的对照分析比较,为进一步加强“军字1号”工程中的病案首页质量管理提供经验。     

Adherence-Facilitating Behaviors of a Multidisciplinary Pediatric Rheumatology Staff

Investigated the behaviors of pediatric rheumatology healthcare providers that were expected to be related to patient orparent adherence. Medical charts of 108 patients ages 1 to 20years diagnosed with Juvenile Rheumatoid Arthritis were examined.The 473 outpatient visits over 15 months yielded a total of2,578 treatment recommendations, but only 1,390 adherence-facilitatingbehaviors by medical staff were documented. Providing informationabout how often to perform the recommendation was the most commonstaff behavior. In contrast, care providers rarely indicatedthat they addressed their patients' concerns and barriers toimplementing the recommendations, or employed behavior modificationstrategies to increase adherence. Implications of these findingsfor development of programs designed to increase treatment adherencein children with chronic diseases requiring time-consuming,intrusive medical regimens are discussed.     

The importance of chronicity and controllability of stress in the context of stress-illness relationships

The primary purpose of the present study was to increase our understanding of the roles of chronicity and controllability in the measurement of stress within the context of stress-illness relationships. Controllability and chronicity were assessed directly using a modified version of the Everyday Problems Scale. In addition to this scale, measures of depression, psychosomatic symptoms, and social support were administered to 128 women and 100 men. The results indicated that, for both men and women, the number of stressors was the best single predictor of symptoms. However, for women, chronicity and controllability of the stressors accounted for a significant amount of the variance in health outcomes over and above that accounted for by the number of stressors endorsed; for men, the addition of neither chronicity nor controllability consistently increased the strength of the association. While available social support was not found to influence the stress-illness relationships, greater willingness to utilize social support was associated with lower levels of depression.     

Vasoactive intestinal peptide and bipolar affective illness. Evidence for an effect of lithium

In an attempt to evaluate the role of VIP in affective disorder, measurements of lymphocyte VIP receptors, and plasma and CSF VIP levels were made in unmedicated and lithium-treated euthymic bipolars and controls. Lithium decreased plasma (P = 0.01) and CSF (P = 0.05) VIP levels and increased the affinity (decreased the KD) of the VIP lymphocyte receptor (P less than 0.01). This effect may be relevant to the psychotropic action of lithium in manic-depressive illness.     

A Contextual Family/Systems Approach to Pediatric Psychology: Introduction to the Special Issue

Introduced the special issue on "Family System in PediatricPsychology" by organizing the papers around a series of themesrelevant to understanding families in pediatric psychology.Themes reflect the relationships between parent and child adjustment,family subsystems, legacies and traditions, social support systems,family interventions, the constancy of change in families, thechallenges of conducting longitudinal research, the inclusionof fathers, and the importance of a competency framework inpediatric family psychology. The paper concludes with recommendationsfor pediatric family psychology, including suggestions for increasingdiversity, expanding methodological approaches, and enhancingfamily competence.