Effects of marital closeness on the transition from caregiving to widowhood

Objective: To examine the effects of marital closeness on indicators of well-being (depressive symptoms, grief, and relief) as spouses transition from the role of caregiver to that of widowed person.

Methods: 118 spouses of persons with end stage renal disease were interviewed prior to and after the death of the patient. Spouses reported on marital closeness, multiple indicators of pre-death strain as reflected by subjective health, depressive symptoms, caregiving burden, and caregiving satisfaction, as well as post-loss feelings of grief, depression, and relief.

Results: Hierarchical regressions indicated that post-loss grief was predicted by gender (b = 0.32, p < 0.001), self-reported health (b = ?0.28, p < 0.01), marital closeness (0.22, p < 0.05), and pre-loss depressive symptoms (b = 0.19, p < 0.10). Caregiver burden (b = 0.28, p < 0.05) and marital closeness (b = ?0.41, p < 0.001) before the death, predicted relief from the caregiver role post-loss. Subjective health (b = ?0.21, p < 0.05) and pre-loss depressive symptoms (b = 0.47, p < 0.001) predicted change in depressive symptoms over time.

Conclusion: These data highlight differences in the experiences of grief, relief, and depressive symptoms and suggest that marital closeness plays a central role. Results are interpreted in terms of theory regarding marital quality. Implications for interventions to improve the lives of caregivers and newly widowed spouses are discussed.     

Peritumoural vascular invasion: a major determinant of triple-negative breast cancer outcome

Purpose

Triple-negative breast cancers (TNBC) have the worst outcome of all breast cancer subtypes. Nevertheless TNBC are heterogeneous in terms of pathological, biological and prognostic behaviours. We explored clinical and pathological factors correlated with outcome in this phenotype.

Methods

We retrospectively studied clinical and pathological factors correlated with prognosis in a series of 344 early TNBC. Staining for blood (CD31) and lymphatic (Podoplanin) vascular endothelium markers was performed to best characterise peritumoural vascular invasion (PVI) in 108 cases available for pathological reviewing.

Results

Univariate and multivariate analyses performed on our whole cohort underlined PVI as an independent predictive factor of distant metastasis (p = 0.00012, HR = 2.72 [1.63-4.52]). Standardised pathological reviewing of 101 histologically confirmed TNBC showed that PVI, observed in 41% (28% by haematoxylin and eosin staining plus 13% by immunohistochemistry), was confirmed as the first prognostic factor in TNBC, particularly in node-negative tumours. Five-year metastasis-free survival in this subset was 87.5% and 50.8% without and with PVI, respectively (p = 0.003).

Conclusions

Vascular invasion diagnosis is improved by the combination of HES and IHC. Moreover it is a major prognostic feature and must take a greater part in therapeutic management of early TNBC with the possibility to adapt the adjuvant treatment according to the predicted relapse risk.     

Molecular predictors of response in aggressive T-cell lymphomas

Aggressive T-cell lymphomas are a heterogeneous group of malignancies of mature T and natural killer cells, many of which have recently been identified as distinct entities in the classification of non-Hodgkin lymphomas according to the World Health Organization. Owing in part to a limited understanding of the molecular features and pathogenesis of many of these disorders, treatment strategies using conventional lymphoma regimens have been used, with generally inferior outcomes. Recent data are now emerging from gene expression profiling and molecular analysis of tumors, which has led to development of novel, targeted therapeutic strategies and has provided a basis for more accurate diagnosis and prognostic characterization.     

Spatial Modeling of PM10 and NO2 in the Continental United States, 1985–2000

Background

Epidemiologic studies of air pollution have demonstrated a link between long-term air pollution exposures and mortality. However, many have been limited to city-specific average pollution measures or spatial or land-use regression exposure models in small geographic areas.

Objectives

Our objective was to develop nationwide models of annual exposure to particulate matter < 10 μm in diameter (PM₁₀) and nitrogen dioxide during 1985–2000.

Methods

We used generalized additive models (GAMs) to predict annual levels of the pollutants using smooth spatial surfaces of available monitoring data and geographic information system–derived covariates. Model performance was determined using a cross-validation (CV) procedure with 10% of the data. We also compared the results of these models with a commonly used spatial interpolation, inverse distance weighting.

Results

For PM₁₀, distance to road, elevation, proportion of low-intensity residential, high-intensity residential, and industrial, commercial, or transportation land use within 1 km were all statistically significant predictors of measured PM₁₀ (model R² = 0.49, CV R² = 0.55). Distance to road, population density, elevation, land use, and distance to and emissions of the nearest nitrogen oxides–emitting power plant were all statistically significant predictors of measured NO₂ (model R² = 0.88, CV R² = 0.90). The GAMs performed better overall than the inverse distance models, with higher CV R² and higher precision.

Conclusions

These models provide reasonably accurate and unbiased estimates of annual exposures for PM₁₀ and NO₂. This approach provides the spatial and temporal variability necessary to describe exposure in studies assessing the health effects of chronic air pollution.     

Modeling parents and nurses' relationships

Over the past 20 years, the transition to parenting has been widely investigated as much in nursing as in psychology. The challenges of this developmental period, such as developing parenting efficacy, and the resources available to one or both parents have been explored. Different factors have been found to influence parents' perceived efficacy, such as the quality of social support, the quality of the marital relationship, and the level of stress and anxiety. Little attention has been paid, however, to the influence of nurses' relationships with parents on parents' development of parenting efficacy, especially with multiparous parents. This information is needed to better understand nurses' contribution to parenting development. A model of the primary variables of interest -- perceived parenting efficacy, critical events, and nurses' collaborative and help-giving practices -- is presented.     

Residual cognitive effects of uncomplicated idiopathic and cryptogenic epilepsy

We assessed residual cognitive deficits in young people with idiopathic and cryptogenic epilepsy. In the setting of an ongoing prospective study, we invited participants initially diagnosed and enrolled in the cohort 8–9 years earlier to undergo standardized neuropsychological assessment. Sibling controls were invited when available. We analyzed 143 pairs in which cases had idiopathic or cryptogenic epilepsy and both case and control had normal intelligence. Compared with that for siblings, the Full Scale IQ for cases was 3.3 points lower (P = 0.01) mainly due to slower processing speed, which was 5.6 points lower (P = 0.0004). Word reading (P = 0.04) and spelling (P = 0.01), but not other scores, were also lower in cases. Remission status and drug use did not influence findings. In young people of normal intelligence with idiopathic or cryptogenic childhood-onset epilepsy, substantial residual effects of epilepsy appear to be confined largely to slower processing speed.     

An evaluation tool for psychomotor performance during visual motor task: an application of information theory

On the basis of an approach inspired by Shannon's information theory, a Visual Motor Efficiency (VME) index is proposed. This index is an absolute measure of performance because it expresses a percentage of a perfect performance. By means of a Psycho Motor Performance Device (PMPD), this index is used to evaluate psychomotor performance during visual pointing task. Localising was carried out with the help of a unidirectional handle that only allows supination or pronation movements of the wrist to reach targets that appear on a computer screen in the form of a small square along the horizontal (left/right) and vertical (up/down) arms of a cross. The PMPD was designed so that the progress of the visual motor task would be immediately examined. In a pilot study dedicated to track the evolution of performance in six subjects for six consecutive days, we show that the degree of directional coherence between movement and effect produced is an important factor. Indeed the performance level is significantly lower when it is a question of pointing at targets located along the vertical arm compared to pointing at those along the horizontal. These results indicate that PMPD is a valid and sensitive measurement of human psychomotor performance in charting the progress of a subject during training.     

Circuit-based framework for understanding neurotransmitter and risk gene interactions in schizophrenia

Many risk genes interact synergistically to produce schizophrenia and many neurotransmitter interactions have been implicated. We have developed a circuit-based framework for understanding gene and neurotransmitter interactions. NMDAR hypofunction has been implicated in schizophrenia because NMDAR antagonists reproduce symptoms of the disease. One action of antagonists is to reduce the excitation of fast-spiking interneurons, resulting in disinhibition of pyramidal cells. Overactive pyramidal cells, notably those in the hippocampus, can drive a hyperdopaminergic state that produces psychosis. Additional aspects of interneuron function can be understood in this framework, as follows. (i) In animal models, NMDAR antagonists reduce parvalbumin and GAD67, as found in schizophrenia. These changes produce further disinhibition and can be viewed as the aberrant response of a homeostatic system having a faulty activity sensor (the NMDAR). (ii) Disinhibition decreases the power of gamma oscillation and might thereby produce negative and cognitive symptoms. (iii) Nicotine enhances the output of interneurons, and might thereby contribute to its therapeutic effect in schizophrenia.