Negative affectivity and health-related quality of life

OBJECTIVES: Although personality is known to influence patients' self-ratings of health, its effects on reports of health-related quality of life (HRQOL) have not been fully described. We examined the relationship between a dimension of personality called negative affectivity (NA; a general disposition to experience negative mood states) and HRQOL, controlling for age and common chronic physical and mental diseases. METHODS: We used data from 3 samples of veterans: the Department of Veterans Affairs (VA) Normative Aging Study (NAS), the Veterans Health Study (VHS), and the VA Women's Health Project (VA WHP). For each of the 8 SF-36 scales and the physical and mental component summary scales, 2 regression models were estimated, the first of which included only chronic diseases and age and the second of which added NA. RESULTS: NA was consistently negatively associated with SF-36 scale scores in bivariate analyses. The regression models indicated that across the 3 samples, NA explained between 0% and 13.9% additional variance in the scales, with the least additional variance in the physical function domains (range 0-2.6%) and the most in the mental function domains (range 0-13.9%). Results from the summary scales were similar: NA explained none of the variance in the physical component summary and 3.5% to 10.4% in the mental component summary. These results were largely consistent across the 3 samples. CONCLUSIONS: These results suggest the importance of NA in patients' ratings of HRQOL beyond that of age and chronic conditions. Thus, clinicians and researchers who rely on measures such as the SF-36 to assess health status should consider that personality, as well as underlying health, can affect self-ratings of HRQOL.     

Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy

Between 1966 and 1982, 46 patients with previously untreated malignant tumors of major salivary gland origin received combined surgery and postoperative radiotherapy. They were compared with 46 patients treated with surgery only between 1939 and 1965, who were matched according to prognostic criteria. Radiation doses ranged from 4000 to 7740 cGy (median, 5664 cGy). The 5-year determinate survival rates for patients given combined therapy with stage I and II disease vs patients given surgery only was 81.9% vs 95.8%, while for stages III and IV it was 51.2% vs 9.5%, respectively. Local control for stage III and IV disease in patients given combined therapy vs patients given surgery only at 5 years was 51.3% vs 16.8%. For patients with nodal metastases, 5-year determinate survival for the combined-therapy group vs the surgery-only group was 48.9% vs 18.7%, and the corresponding local-regional control was 69.1% vs 40.2%. The results of this analysis suggest that postoperative radiotherapy significantly improves outcome for patients with stage III and IV disease and for patients with lymph node metastases.     

Shelters for houseless youth: a follow-up evaluation

This study followed 345 Israeli youngsters who had been residents of two shelters for runaway and homeless youths, 6-12 weeks after their departure. Telephone interviews were conducted with the youngsters, their parents, and social workers in the community. A majority of the youngsters had either returned to their family homes, or had been placed out of home. Their residential stability was found to be low. Post-shelter place of residence was related to length of stay at the shelter, amount of contact with their family while at the shelter, and manner of departure. Our findings lead to a typology of shelter uses, and also raise questions about the extent to which shelters achieve their declared goals.     

Association of fibrin and interleukin 8 in human oral squamous cell carcinoma

OBJECTIVE: We have recently demonstrated that fibrin induces a specific, dose- and time-dependent upregulation of the angiogenic factor interleukin 8 (IL-8) from human oral squamous cell carcinoma (OSCC) cells in vitro. In this study we begin to test the hypothesis that fibrin induces IL-8 expression from tumor cells in vivo by studying their in vivo association in OSCC. STUDY DESIGN: The presence of fibrin(ogen) was initially evaluated in 20 archival human OSCCs by means of immunohistochemistry with a polyclonal antibody. The presence of fibrin and IL-8 was then studied in 19 sections from 8 different patients' head and neck tumors (including 6 OSCCs) by means of immunohistochemistry with a monoclonal antibody against fibrin. These 8 tumors had been treated with inhibitors of new fibrin formation and degradation immediately after surgical removal. RESULTS: Fibrin staining was found in 100% of the tumor sections tested. IL-8 staining was found in the cytoplasm of tumor cells in 100% of the studied tumors, including areas adjacent to fibrin. CONCLUSIONS: These data demonstrate an in vivo association between fibrin and IL-8 in OSCC. These studies support our hypothesis that fibrin induces expression of protumorigenic factors such as IL-8 from tumor cells in vivo.     

Outcome of laparoscopic ventral hernia repair in correlation with obesity,type of hernia,and hernia size

BACKGROUND: The morbidity and overall recovery time of ventral hernia repair can vary significantly depending on the hernia type or size and on other factors, such as the body mass index (BMI). The purpose of our study was to investigate the effects of type of hernia, hernia size, and BMI on the outcome of laparoscopic ventral hernia repair. METHODS: Fifty patients who underwent laparoscopic ventral hernia repair were retrospectively reviewed and stratified according to hernia type (incisional, IVH/primary, PVH), hernia size, and BMI. These subgroups were compared in regard to operative time, resumption of diet, hospital stay, pain control, and complication rate. RESULTS: Laparoscopic IVH repair was associated with a longer operative time (143 vs. 98 minutes, p = .02) and length of stay (2.2 vs. 0.6 days, p = .03) than PVH repair. The narcotic requirements were higher in the IVH group, but the difference did not reach statistical significance. Larger hernias were associated with a longer operative time (p = .04) and increased narcotic requirement (p = .03). The morbidity of the laparoscopic repair was not significantly affected by the hernia type or size. The BMI did not significantly alter any of the parameters examined. CONCLUSIONS: Laparoscopic repair of incisional and larger hernias is a technically demanding procedure that requires a longer operative time. In contrast to PVH repair, laparoscopic IVH repair usually cannot be performed on an outpatient basis. Surgeons need not be discouraged from recommending the laparoscopic approach for patients with large IVHs or with severe obesity because the morbidity remains low.     

Spinal neurenteric cyst presenting in infancy with chronic fever and acute myelopathy

The authors describe the clinical, radiologic, and pathologic features of a neonatal spinal neurenteric cyst (NC) presenting with long-lasting fever and acute myelopathy, and compare this observation with other infants reported in the literature. This observation shows that NC must be considered in the differential diagnosis of acute myelopathy with persistent fever in infancy. Fever is attributed to degenerative changes in the NC, triggering inflammatory cell infiltration and tumor necrosis factor alpha secretion.     

The "re-entry group"--a transitional therapeutic framework for mentally ill patients discharged from the hospital to community clinics.

An effective transition of the psychiatric patient from the hospital to the community clinic is vital to the continuity of care. This study shows a short-term group, the "re-entry group," to be more effective in this transition than are patients discharged from a psychiatric hospital by the traditional process. We used a psychoeducational approach to facilitate active participation and compliance with outpatient therapy. Outcome variables included absorption of patients into the clinic, continued therapy, compliance with treatment, rehospitalization, level of knowledge regarding illness and medication, quality of rehabilitation, and attitude towards treatment.