The objective of this review was to evaluate the evidence for the hypothesis that psychological stress influences antibody response to immunization in humans.
A critical review of the literature was ...conducted.
The evidence supports an association between psychological stress and suppression of humoral immune (antibody) response to immunization. This association is convincing in the case of secondary immune response but weak for primary response. The lack of consistent evidence for a relation with primary response may be attributed to a failure to consider the critical points when stress needs to be elevated in the course of the production of antibody. Lower secondary antibody responses were found among patients with chronically high levels of stress (severe enduring problems or high levels of trait negative affect). These responses were found most consistently among older adults. Lower secondary responses were also found for those reporting acute stress or negative affect, but only in studies of secretory immunoglobulin A antibody in which psychological and antibody measures were linked very closely in time. Health practices did not mediate relations between stress and antibody responses; however, there were indications that elevated cortisol levels among stressed patients could play a role. Evidence also suggests the possible influences of dispositional stress-reactivity and low positive affect in the inhibition of antibody production.
The literature supports a relationship between psychological stress and antibody responses to immunizations. The data are convincing in the case of secondary response but weak for primary response. More attention to the kinetics of stress and antibody response and their interrelations is needed in future research.
Highlights • The presence of baseline interstitial lung abnormalities (ILA) in patients with advanced non-small-cell lung cancer (NSCLC) is significantly associated with shorter overall survival. • ...It could be regarded as a reproducible prognostic marker in patients with NSCLC. • It is important for radiologists to mention ILA on baseline CT of NSCLC patients because awareness of the presence of ILA may help optimize clinical management and outcome.
To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection.
After reporting the extent of participation in 12 types ...of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and monitored for the development of a common cold.
Quarantine.
A total of 276 healthy volunteers, aged 18 to 55 years, neither seropositive for human immunodeficiency virus nor pregnant.
Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication.
In response to both viruses, those with more types of social ties were less susceptible to common colds, produced less mucus, were more effective in ciliary clearance of their nasal passages, and shed less virus. These relationships were unaltered by statistical controls for prechallenge virus-specific antibody, virus type, age, sex, season, body mass index, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1 to 3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds.
More diverse social networks were associated with greater resistance to upper respiratory illness.
The current study presents a Rasch-derived short form of the Center for Epidemiologic Studies-Depression scale (CES-D) for use as a depression screening tool in the general population. In contrast to ...short forms developed with reliance on classical measurement techniques, those developed using techniques based on item response theory produce a measure that offers true interval scaling, provide enhanced information about responders with extreme scores, and expand understanding of the underlying latent structure. Cross-validation of the Rasch-derived CES-D short form supported its utility and structural validity across samples. Tests of structural validity using latent variable modeling methodology indicated that a hierarchical, single-factor model of depression had the best fit for the original full form and the Rasch-derived short form of the CES-D. This finding challenges depression researchers and theorists to reconsider the interfactor relationships in the study and assessment of depression.
Background
The Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS‐Cog) is used to assess decline in memory, language, and praxis in Alzheimer's disease (AD).
Methods
A latent state–trait ...model with autoregressive effects was used to determine how much of the ADAS‐Cog item measurement was reliable, and of that, how much of the information was occasion specific (state) versus consistent (trait or accumulated from one visit to the next).
Results
Participants with mild AD (n = 341) were assessed four times over 24 months. Praxis items were generally unreliable as were some memory items. Language items were generally the most reliable, and this increased over time. Only two ADAS‐Cog items showed reliability >0.70 at all four assessments, word recall (memory) and naming (language). Of the reliable information, language items exhibited greater consistency (63.4% to 88.2%) than occasion specificity, and of the consistent information, language items tended to reflect effects of AD progression that accumulated from one visit to the next (35.5% to 45.3%). In contrast, reliable information from praxis items tended to come from trait information. The reliable information in the memory items reflected more consistent than occasion‐specific information, but they varied between items in the relative amounts of trait versus accumulated effects.
Conclusions
Although the ADAS‐Cog was designed to track cognitive decline, most items were unreliable, and each item captured different amounts of information related to occasion‐specific, trait, and accumulated effects of AD over time. These latent properties complicate the interpretation of trends seen in ordinary statistical analyses of trials and other clinical studies with repeated ADAS‐Cog item measures.
Highlights
Studies have described unfavorable psychometric properties of the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS‐Cog), bringing into question its ability to track changes in cognition uniformly over time. There remains a need to estimate how much of the ADAS‐Cog measurement is reliable, of that how much is occasion specific versus consistent, and of the consistent information, how much represents enduring traits versus autoregressive effects (i.e., effects of Alzheimer's disease AD progression carried over from one assessment to the next).
A latent state–trait model with autoregressive effects in mild AD found most items to be unreliable, and each item to capture different amounts of occasion‐specific, trait, and autoregressive information. Language items, specifically, naming and the memory item word recall, were the most reliable.
Psychometric idiosyncrasies of individual items complicate the interpretation of their summed score, biasing ordinary statistical analyses of repeated measures in mild AD. Future studies should consider item trajectories individually.
It is essential that cancer patients understand anticipated symptoms, how to self-manage these symptoms, and when to call their clinicians. However, patients are often ill-prepared to manage symptoms ...at home. Clinical decision support (CDS) is a potentially innovative way to provide information to patients where and when they need it. The purpose of this project was to design and evaluate a simulated model of an algorithm-based CDS program for self-management of cancer symptoms.
This study consisted of three phases; development of computable algorithms for self-management of cancer symptoms using a modified ADAPTE process, evaluation of a simulated model of the CDS program, and identification of design objectives and lessons learned from the evaluation of patient-centered CDS. In phase 1, algorithms for pain, constipation and nausea/vomiting were developed by an expert panel. In phase 2, we conducted usability testing of a simulated symptom assessment and management intervention for self-care (SAMI-Self-Care) CDS program involving focus groups, interviews and surveys with cancer patients, their caregivers and clinicians. The Acceptability E-scale measured acceptability of the program. In phase 3, we developed design objectives and identified barriers to uptake of patient-centered CDS based on the data gathered from stakeholders.
In phase 1, algorithms were reviewed and approved through a consensus meeting and majority vote. In phase 2, 24 patients & caregivers and 13 clinicians participated in the formative evaluation. Iterative changes were made in a simulated SAMI-Self-Care CDS program. Acceptability scores were high among patients, caregivers and clinicians. In phase 3, we formulated CDS design objectives, which included: 1) ensure patient safety, 2) communicate clinical concepts effectively, 3) promote communication with clinicians, 4) support patient activation, and 5) facilitate navigation and use. We identified patient barriers and clinician concerns to using CDS for symptom self-management, which were consistent with the chronic care model, a theoretical framework used to enhance patient-clinician communication and patient self-management.
Patient safety and tool navigation were critical features of CDS for patient self-management. Insights gleaned from this study may be used to inform the development of CDS resources for symptom self-management in patients with other chronic conditions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Estrogen-Only Hormone Therapy and Dementia Wood Alexander, Madeline; Einstein, Gillian; Rabin, Jennifer S
JAMA : the journal of the American Medical Association,
05/2024, Letnik:
331, Številka:
18
Journal Article
The fornix bundle is a major white matter pathway of the hippocampus. While volume of the hippocampus has been a primary imaging biomarker of Alzheimer's disease progression, recent research has ...suggested that the volume and microstructural characteristics of the fornix bundle connecting the hippocampus could add relevant information for diagnosing and staging Alzheimer's disease. Using a robust fornix bundle isolation technique in native diffusion space, this study investigated whether diffusion measurements of the fornix differed between normal older adults and Alzheimer's disease patients when controlling for volume measurements. Data were collected using high gradient multi-shell diffusion-weighted MRI from a Siemens CONNECTOM scanner in 23 Alzheimer's disease and 23 age- and sex-matched control older adults (age range = 53–92). These data were used to reconstruct a continuous fornix bundle in every participant's native diffusion space, from which tract-derived volumetric and diffusion metrics were extracted and compared between groups. Diffusion metrics included those from a tensor model and from a generalized q-sampling imaging model. Results showed no significant differences in tract-derived fornix volumes but did show altered diffusion metrics within tissue classified as the fornix in the Alzheimer's disease group. Comparisons to a manual tracing method indicated the same pattern of results and high correlations between the methods. These results suggest that in Alzheimer's disease, diffusion characteristics may provide more sensitive measures of fornix degeneration than do volume measures and may be a potential early marker for loss of medial temporal lobe connectivity.
•An enhanced method for measurement of continuous fornix bundles is described.•Diffusion characteristics of the fornix were degraded in Alzheimer's disease.•Alzheimer's disease primarily affected the crus and body of the fornix.•Diffusion differences were observed controlling for fornix volume differences.
Asthma in Adults Rabin, Alexander S; Junck, Larry; Shankar, Hari M
The New England journal of medicine,
11/2023, Letnik:
389, Številka:
22
Journal Article
PDF
