The construction and validation of a new scale for measuring emotional response style in adolescents

BACKGROUND: Research on children's emotional behaviour has been hampered by the lack of psychometric assessment scales. The present study reports on the construction and validation of a new self-report instrument to measure the emotional response styles of adolescents. METHOD: Exploratory and confirmatory factor analyses were carried out on the responses of three samples of adolescents aged between 11 and 14 years (total = 609) to an item pool derived from a scenario study. In addition to assessing reliability, the final form of the questionnaire was concurrently validated using a variety of related psychometric instruments as well as teacher ratings of pupils' behaviour. RESULTS: The factor analyses of the item pool yielded three independent factors labelled social anxiety, malevolent aggression, and social self-esteem. These categories correspond closely to the three dimensions that have emerged consistently from studies of children's temperament, labelled inhibited, undercontrolled and well-adjusted. The three factors comprising the final Emotional Behaviour Scale (EBS) all demonstrated satisfactory internal (coefficient alpha) and re-test reliability. Concurrent validation showed that the three factors were related in predictable ways to other related constructs, and comparisons with teacher ratings of pupils confirmed the relationship between the EBS subscales and children's actual social and emotional behaviour. CONCLUSION: The new scale offers a valid and reliable instrument for assessing adolescent emotional behaviour, and current work is aimed at extending the research to the assessment of young offenders.     

Management of unresectable stage III non-small cell lung cancer: the role of combined chemoradiation

Until the late 1980s, thoracic radiation therapy (TRT) was considered the standard of care for patients with stage III disease despite extremely poor 5-year survival rates. Several studies evaluating TRT combined with chemotherapy showed a survival advantage. Based on these data, combined modality therapy became accepted as the standard of care in this group of patients with good performance status and made the treatment of locally advanced non-small cell lung cancer (NSCLC) a multidisciplinary endeavor. Recent studies have shown that concurrent chemoradiotherapy offers a significantly greater survival advantage than sequential chemoradiotherapy and should be considered standard of care in stage III inoperable NSCLC. Although numerous Phase III trials have clearly demonstrated a survival benefit in those patients who receive combined modality therapy, many questions remain. The most effective combination of drugs, their optimal mode of administration, the use of either induction or consolidation therapy in addition to a backbone of concurrent therapy, and the details of TRT, including total dose, fractionation, acceleration, treatment volumes, and tumor targeting remain important issues to define. Although progress has been made in treatment for locally advanced NSCLC, the majority of patients still die within 5 years either from locoregional or distant progression of disease. This article will review the current data regarding treatment of this heterogeneous group of patients. In addition, a brief summary of new molecular therapies and chemotherapeutics will be presented.     

对食管癌多重治疗疗效的预测

Patients with locally advanced esophageal cancer have a dismal prognosis when treated exclusively by surgery. This fact prompted many investigators to apply neoadjuvant treatment strategies in an effort to improve survival. Results from phase Ⅲ randomized trials are encouraging however, they revealed that only patients with major histopathological response will benefit from treatment. Therefore, predictive molecular markers indicating response or non-response to neoadjuvant treatment would be extremely helpful in selecting patients for current and future treatment protocols. In this paper we review the role of the molecular markers ERCC1 (excision repair cross-complementing 1 gene) and c-erbB-2 (synonym:HER2/neu) in predicting response to radiochemotherapy and outcome for patients with locally advanced resectable esophageal cancers (cT2-4, Nx, M0). The results are promising and it appears that we might expect to unequivocally identify with ERCC1 and c-erbB-2 respectively, approximately up to one third of patients who fulfil the criteria for neoadjuvant treatment for locally advanced esophageal cancer but will not benefit from our treatment protocol. Integration of such markers in the clinical setting might prevent a substantial number of patients from expensive, non-effective and potentially harmful therapies, and could lead to a more individualized type of combined multimodality treatment in the near future.     

Breast-conserving therapy with adjuvant paclitaxel and radiation therapy: feasibility of concurrent treatment

As commonly used, adjuvant paclitaxel after doxorubicin in high-risk breast cancer patients results in a prolonged delay of the onset of radiation therapy after breast-conserving surgery. Concurrent delivery of breast irradiation with paclitaxel would allow for earlier initiation of radiation. We report on the toxicity of concurrent paclitaxel and breast irradiation after doxorubicin and cyclophosphamide. Twenty-four patients were treated with concurrent breast radiation and paclitaxel. All patients received four cycles of doxorubicin and cyclophosphamide followed by four cycles of paclitaxel, 175 mg/m2 every 3 weeks. The radiation therapy started after the first cycle in 3 patients, after the second cycle in 16, and after the third in 5. The breast received 4680-5040 cGy external beam irradiation, followed by a boost of 1000-2000 cGy. Fifteen patients received supraclavicular irradiation, and a posterior axillary supplement was used in five patients. Median follow-up after completion of irradiation was 11.5 months (range 2-29 months) with 21 patients followed >or=6 months, 12 followed >or=12 months, and 7 followed >or=18 months. Using Radiation Therapy Oncology Group (RTOG) acute toxicity scoring criteria, 7 patients experienced grade 1 skin and/or soft tissue reactions and 17 patients had grade 2 reactions. The average total duration of radiation treatment was 49 days (range 41-57 days). Only eight patients had radiation therapy interruptions for a median of 3.5 days (range 2-8 days): two more than 5 days. None had a chemotherapy dose reduction. One patient discontinued paclitaxel after the third cycle due to bilateral upper extremity neuropathy. No cases of pneumonitis or brachial plexopathy were seen. Concurrent treatment with every 3-week paclitaxel and breast irradiation was well tolerated. Additional study is needed to determine optimal timing, long-term toxicity, and potential benefits of concurrent radiation therapy and paclitaxel.     

Feasibility and Preliminary Effectiveness of Varenicline for Treating Co-Occurring Cannabis and Tobacco Use

Few studies have evaluated treatment for co-occurring cannabis and tobacco use. The objective of this pilot study was to evaluate the feasibility and preliminary effectiveness of varenicline for co-occurring cannabis and tobacco use. Participants who reported cannabis use on ≥5 days per week were recruited from an urban, outpatient opioid treatment program (OTP). Participants were randomized to either four weeks of standard OTP clinical care (SCC; medication-assisted treatment for opioid use disorder and individual behavioral counseling), followed by four weeks of SCC plus varenicline (SCC+VT), or to four weeks of SCC+VT followed by four weeks of SCC. All participants contributed feasibility and outcome data during both study phases. Of 193 persons screened, seven were enrolled. Retention at eight weeks was 100%. No adverse effects prompted varenicline discontinuation. Participants reported lower cannabis craving during the SCC+VT phase compared to baseline, and lower frequencies and quantities of cannabis use compared to both baseline and the SCC alone phase. In the SCC+VT phase, participants also reported fewer cigarettes per day. Among persons with co-occurring cannabis and tobacco use, varenicline is well-tolerated and may reduce cannabis craving, cannabis use, and tobacco use.     

A study of concurrent radiochemotherapy with paclitaxel in glioblastoma multiforme

Despite advances in neurosurgery and radiotherapy, the prognosis of patients with glioblastoma multiforme remains poor. Reports in the literature about the radiosensitizing properties of paclitaxel stimulated the authors to conduct a study using paclitaxel concurrently with radiation in a group of 18 patients who had residual disease postoperatively. Paclitaxel was delivered weekly as an intravenous infusion in a dose of 60 mg/m ² along with radiation to the primary lesion. A total of 108 cycles of paclitaxel was given. All the patients tolerated the treatment well. The main side effects were haematological, and neuropathy which was self-limiting. The overall 1-year survival rate was 70%, with 12 patients alive at 13 months. The median survival has not yet been reached although it is more than 13 months. Thus, paclitaxel can be safely delivered concomitantly with radiation in patients with glioblastoma multiforme. Larger, randomized trials are required to establish the comparative efficacy of paclitaxel as a radiosensitizer in glioblastoma multiforme.     

复方苦参注射液联合NP方案治疗老年非小细胞肺癌

目的评价复方苦参注射液联合NP方案治疗70岁以上老年非小细胞肺癌(NSCLC)的疗效及安全性。方法65例老年Ⅱ~Ⅲb期NSCLC患者随机分为2组,治疗组33例接受复方苦参注射液联合NP方案化疗治疗,对照组32例不加用复方苦参注射液,其余同治疗组。以4周为1个周期,重复2个周期。观察近期疗效、毒副反应、生存质量以及体质量和免疫功能变化等。结果治疗组近期总有效率27%,对照组25%,2组比较无显著性差异(P>0.05);治疗组一定程度减少了化疗骨髓抑制及白细胞降低的不良反应,改善生存质量,减少体质量的降低,增强机体免疫力,与对照组比较有显著性差异(P均<0.05)。结论复方苦参注射液联合NP方案化疗治疗老年NSCLC患者是安全有效的,苦参有一定的减毒增效作用。     

A phase III trial of topotecan and whole brain radiation therapy for patients with CNS-metastases due to lung cancer

Brain metastases represent an important cause of morbidity in patients with lung cancer and are associated with a mean survival of less than 6 months. Thus, new regimens improving the outcome of these patients are urgently needed. On the basis of promising data raised in a phase I/II trial, we initiated an open, randomised, prospective, multicentric phase III trial, comparing whole brain radiation therapy (WBRT; 20 × 2 Gy) alone with WBRT+topotecan (RCT; 0.4 mg m⁻² day⁻¹ × 20). A total of 320 patients with CNS-metastases due to SCLC or NSCLC were projected. The primary end point was overall survival, whereas second end points were local response and progression-free survival. However, until the cutoff date of study completion (i.e., a study duration of 34 months), only a total of 96 (RCT:47, WBRT:49) patients had been recruited, and so an analysis was performed at that time point. Although the numbers of grade 3/4 non-haematological toxicities (besides alopecia 115 (RCT/WBRT: 55 out of 60) were evenly distributed, the 25 haematological events occurred mainly in the combined treatment arm (24 out of 1). Local response, evaluated 2 weeks after treatment, was assessable in 44 (RCT/WBRT: 23 out of 21) patients, showing CR in eight (3 out of 5), PR in 17 (11 out of 6), SD in 14 (8 out of 6) and PD in five (1 out of 4) patients (all differences n.s.). Neither OAS (RCT/WBRT: median (days)): 87 out of 95, range 3–752/4–433; HR 1.32; 95% CI (0.83; 2.10)) nor PFS (median (days)): 71 out of 66, range, 3–399/4–228; HR 1.28, 95% CI (0.73; 2.43) differed significantly. On the basis of these results and the slow recruitment, a continuation of the study did not seem reasonable. The available data show no significant advantage for concurrent radiochemotherapy for patients with lung cancer; however, the recruited number of patients is too low to exhibit a small advantage of combined treatment.     

Influence of co‐occurring mental and substance use disorders on the prevalence of problem gambling in Canada

Context/background Research has shown that problem gambling (PG) is associated with substance use disorders (SUD) and also with other mental disorders (MD). Nevertheless, evidence about the relative contribution of each type of disorder for the risk of gambling in the population is very limited. Objective Study the association of SUD, alone and in combination with MD, with the prevalence and severity of PG. Design Cross‐sectional national survey (Canadian Community Health Survey—Mental Health and Well‐Being) data collected through a multi‐stage stratified cluster design. Setting Population‐based household survey. Participants This analysis includes data on 36 885 participants (99.7% of the survey sample). Main outcome measures The prevalence and severity of PG were measured using the Canadian Problem Gambling Index. Prevalence of MD (mood and anxiety disorders) and SUD were defined according to the World Mental Health Survey Initiative Composite International Diagnostic Interview, following definitions of the DSM‐IV. Results Compared to the population, higher prevalence rates of PG are observed when the severity of SUD is higher, but are not impacted by the co‐occurrence of MD. For individuals with low risk and moderate risk/problem gambling, the prevalence rate difference (prevalence rate in the subgroup minus prevalence rate in the population) observed among substance dependents was reduced when MD co‐occurred (from a prevalence rate difference of 2.5; 99% confidence interval 1.6–3.8 to 1.6; 99% confidence interval 1.2–2.2 for low risk gamblers and from 3.7; 99% confidence interval 1.6–5.5 to 2.9; 99% confidence interval 2.0–4.3 for moderate risk/problem gamblers). Estimates were not statistically different. Conclusions Prevalence of all levels of PG increased with SUD severity, but the pattern did not appear to be affected by MD co‐occurrence. Results suggest particular attention be given to SUD in treatment‐seeking clients with co‐occurring disorders.