Copyright (c) 2009 All rights reserved. http://works.bepress.com/may Recent documents in Yunsheng Ma en-us Mon, 13 Jul 2009 06:28:30 PDT 3600 http://works.bepress.com/may/43 http://works.bepress.com/may/43 Fri, 11 Apr 2008 10:45:44 PDT PURPOSE: Using a standardized measure of depression at three assessment points, to examine depression in medical students during their training. METHOD: Students entering the University of Massachusetts Medical School in the fall in 1987, 1988, and 1989 were mailed a recruitment letter and baseline questionnaire four weeks prior to the start of classes. Subsequent assessments took place in the middles of year 2 and year 4 and included only the students who had participated in the baseline assessment. The baseline assessment included the Center for Epidemiological Studies Depression (CES-D) scale, the Bortner Type A Behavior scale, the Spielberger Trait Anger scale, and the Spielberger Anger Expression scale. In addition, the baseline package included a rating of perceived stress, a demographics questionnaire, and a social-life survey. The follow-up assessments included the CES-D scale, the rating of perceived stress level, and the social-life survey. Analytic methods used were univariate descriptive statistics, correlation, and multiple-linear-regression analyses, two-sample t-tests, analysis of variance, and chi-square tests. RESULTS: Of the initial pool of 300 students, 264 responded at the baseline assessment (88% response rate; 53% men); 171 of these participated in the year-2 assessment (65% response rate; 51% men), and 126 participated in the year-4 assessment (48% response rate; 48% men); a total of 99 students participated in all three assessments. CES-D scores > or =80th percentile were obtained for 18% of the entering students. This rose to 39% at year 2 and 31% at year 4 (p = .0001). No gender difference was found at baseline; however, the women experienced higher depression levels than did the men at year 2 (p = .004) and at year 4 (p = .04). Overall, gender and increases in perceived stress (from baseline to year 2) were significant predictors of increased CES-D scores (from baseline to year 2; p = .01 and p = .0001, respectively). For the women, increased perceived stress, angerin, and frequency of social contacts outside work/school were significant predictors of the magnitude of increases in CES-D scores (baseline to year 2; p = .0001, p = .02, and p = .03, respectively). CONCLUSION: These preliminary data support the view that, upon entering medical school, students' emotional status resembles that of the general population. However, the rise in depression scores and their persistence over time suggest that emotional distress during medical school is chronic and persistent rather than episodic. Also, the women had more significant increases in depression scores than did the men. Milagros C. Rosal Analysis of Variance Anger Demography Depression Emotions Female Follow-Up Studies Forecasting Humans Incidence Interpersonal Relations Linear Models Longitudinal Studies Male Massachusetts Personal Satisfaction Schools, Medical Sex Factors Social Environment Stress Stress, Psychological Students, Medical Type A Personality http://works.bepress.com/may/42 http://works.bepress.com/may/42 Fri, 11 Apr 2008 10:45:40 PDT OBJECTIVES: Many studies assessing the role of sex hormones, like testosterone, on stress and hostility factors have been primarily conducted in selected atypical populations such as violent criminals as well as androgen users and abusers. Therefore, the main aim of the current study was to investigate the association between testosterone levels and two psychosocial variables: stress and hostility in a cohort of healthy individuals who were members of a health maintenance organization (HMO).METHODS: At five quarterly visits, psychosocial scales and blood draws were collected. Psychological stress was measured by using several scales that assessed different types of stress, including daily hassles, major life events and perceived stress. Similarly, different aspects of hostility were measured, among them cynicism, hostile affect and aggressive responding. Plasma collected from each visit was used for testosterone level determinations.RESULTS: Testosterone levels were significantly associated with stress in both males and females. However, whereas this association exhibited a "threshold effect" in males, it demonstrated a direct and continuous linear relationship between these variables in females. Hostility was not correlated with testosterone levels in neither males nor females.CONCLUSIONS: These results suggest that testosterone levels in normal males and females may be more reflective of an intricate balance between physiological responding and emotional coping to stressors than the hostility profile of the individual. Jean A. King Adaptation, Psychological Adult Aggression Female *Hostility Humans Male Middle Aged Personality Reference Values Stress, Psychological Testosterone http://works.bepress.com/may/41 http://works.bepress.com/may/41 Fri, 11 Apr 2008 10:45:37 PDT We studied the effect of diet and body weight on recurrence and death in 472 women diagnosed with early-stage breast cancer in 1982-1984. From Cox proportional hazards regression models we found that the strongest effects were observed in premenopausal women. For example, after accounting for disease stage and age, reported baseline consumption (times/day) of butter, margarine, and lard (risk ratio (RR)=1.67; 95% confidence interval (CI)=1.17-2.39) and beer (drinks/day) (RR=1.58; 95% CI=1.15-2.17) increased the risk of recurrence. There also appeared to be an increased risk associated with consumption of red meat, liver, and bacon, corresponding to about a doubling of risk for each time per day that foods in this category were consumed (RR=1.93; 95 % CI=0.89-4.15). Relative body weight increased risk at the rate of 9% (RR=1.09; 95% CI=1.02-1.17) for each kg/m2 (equivalent to about 5.8 pounds for a woman 5'4" tall). For death, the results were similar, but relative weight was more strongly associated, increasing risk by 12% per kg/m2 (RR=1.12; 95% CI=1.03-1.22). James R. Hebert Adult Aged Aged, 80 and over Beer Body Mass Index *Body Weight Breast Neoplasms Cohort Studies Confidence Intervals *Diet Dietary Fats Disease-Free Survival Female Follow-Up Studies Humans Massachusetts Middle Aged Neoplasm Recurrence, Local Nutrition Surveys Proportional Hazards Models Prospective Studies Risk Factors Survival Analysis http://works.bepress.com/may/40 http://works.bepress.com/may/40 Fri, 11 Apr 2008 10:45:34 PDT OBJECTIVES: We describe a method of adding the glycemic index (GI) and glycemic load (GL) values to the nutrient database of the 24-hour dietary recall interview (24HR), a widely used dietary assessment. We also calculated daily GI and GL values from the 24HR.METHODS: Subjects were 641 healthy adults from central Massachusetts who completed 9067 24HRs. The 24HR-derived food data were matched to the International Table of Glycemic Index and Glycemic Load Values. The GI values for specific foods not in the table were estimated against similar foods according to physical and chemical factors that determine GI. Mixed foods were disaggregated into individual ingredients.RESULTS: Of 1261 carbohydrate-containing foods in the database, GI values of 602 foods were obtained from a direct match (47.7%), accounting for 22.36% of dietary carbohydrate. GI values from 656 foods (52.1%) were estimated, contributing to 77.64% of dietary carbohydrate. The GI values from three unknown foods (0.2%) could not be assigned. The average daily GI was 84 (SD 5.1, white bread as referent) and the average GL was 196 (SD 63).CONCLUSION: Using this methodology for adding GI and GL values to nutrient databases, it is possible to assess associations between GI and/or GL and body weight and chronic disease outcomes (diabetes, cancer, heart disease). This method can be used in clinical and survey research settings where 24HRs are a practical means for assessing diet. The implications for using this methodology compel a broader evaluation of diet with disease outcomes. Barbara C. Olendzki Blood Glucose Body Weight Chronic Disease Databases, Factual *Diet Diet Surveys Dietary Carbohydrates Female Food Food Analysis *Glycemic Index Humans Male Mental Recall Middle Aged Prognosis http://works.bepress.com/may/39 http://works.bepress.com/may/39 Fri, 11 Apr 2008 10:45:31 PDT Social desirability (the tendency to respond in such a way as to avoid criticism) and social approval (the tendency to seek praise) are two prominent response set biases evident in answers on structured questionnaires. These biases were tested by comparing nutrient intakes as estimated from a single 24-hour diet recall interview (24 HR) and a 7-day dietary recall (7DDR). Data were collected as part of the Worcester Area Trial for Counseling in Hyperlipidemia, a randomized, physician-delivered nutrition intervention trial for hypercholesterolemic patients conducted in Worcester, Massachusetts, from 1991 to 1995. Of the 1,278 total study subjects, 759 had complete data for analysis. Men overestimated their fat and energy intakes on the 7DDR as compared with the 24HR according to social approval: One unit increase in the social approval score was associated with an overestimate of 21.5 kcal/day in total energy intake and 1.2 g/day in total fat intake. Women, however, underestimated their dietary intakes on the 7DDR relative to the 24HR according to social desirability: One unit increase in the social desirability score was associated with an underestimate of 19.2 kcal/day in energy intake and 0.8 g/day in total fat. The results from the present study indicate that social desirability and social approval biases appear to vary by gender. Such biases may lead to misclassification of dietary exposure estimates resulting in a distortion in the perceived relation between health-related outcomes and exposure to specific foods or nutrients. Because these biases may vary according to the perceived demands of research subjects, it is important that they be assessed in a variety of potential research study populations. James R. Hebert Adult *Bias (Epidemiology) Diet Diet Surveys Female Humans Male Marital Status Mental Recall Middle Aged Nutrition Assessment Questionnaires *Self Concept Self Disclosure Sex Factors *Social Desirability http://works.bepress.com/may/38 http://works.bepress.com/may/38 Fri, 11 Apr 2008 10:45:27 PDT OBJECTIVES: To evaluate the effect of a provider counseling and office systems intervention in obstetric, pediatric, and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics on smoking and relapse rates in pregnant and postpartum women.METHODS: Five community health centers were randomized to special intervention (SI) or usual care (UC). Subjects (n =601) were current smokers or had quit with pregnancy. Prenatal and postpartum interviews assessed smoking status and related factors. Data were collected between May 1997 and November 2000.RESULTS: There was a statistically significant difference in 30-day abstinence rates between SI (26%) and UC (12%) conditions at the end of pregnancy among women who had not quit spontaneously with pregnancy (odds ratio [OR]=2.57, p =0.05). This effect remained at 1 month postpartum but was lost at 3- and 6-month postpartum follow-ups.CONCLUSIONS: Brief interventions delivered by healthcare providers during routine prenatal care increased smoking abstinence during pregnancy among women who did not quit spontaneously. Interventions extended into postpartum care did not affect relapse and smoking rates postdelivery. Lori Pbert Adult *Community Health Centers Female Follow-Up Studies Humans Massachusetts Patient Compliance *Postpartum Period Pregnancy Pregnancy Complications Program Evaluation Smoking Smoking Cessation http://works.bepress.com/may/37 http://works.bepress.com/may/37 Fri, 11 Apr 2008 10:45:24 PDT BACKGROUND: High sensitivity C-reactive protein (CRP) is a marker of acute inflammation recently recognized as an independent predictor of future cardiovascular disease and diabetes. The identification of modifiable factors, such as diet, that influence serum CRP concentrations may provide the means for reducing the risk of these diseases. Data on longitudinal associations between dietary fiber intake and CRP are currently lacking. OBJECTIVE: The purpose of this study was to examine longitudinal associations between dietary fiber intake and CRP. DESIGN: Data collection took place at baseline and quarterly (every 13 wk) thereafter for a total of 5 visits, each including measurements of body composition, CRP, diet, and physical activity. Relations between serum CRP and dietary fiber were assessed by using linear mixed models and logistic regression, adjusted for covariates. RESULTS: A total of 524 subjects had multiple measurements of CRP and dietary factors. The average total dietary fiber intake was 16.11 g/d. Average serum CRP was 1.78 mg/L. We observed an inverse association between intake of total dietary fiber (separately for soluble and insoluble fiber) and CRP concentrations in both cross-sectional and longitudinal analyses. The likelihood of elevated CRP concentrations was 63% lower (OR: 0.37; 95% CI: 0.16, 0.87) in participants in the highest quartile of total fiber intake than in participants in the lowest quartile. CONCLUSIONS: Our results suggest that dietary fiber is protective against high CRP, which supports current recommendations for a diet high in fiber. Yunsheng Ma Adult Aged Biological Markers Body Composition C-Reactive Protein Cardiovascular Diseases Cohort Studies Confidence Intervals Cross-Sectional Studies Dietary Fiber Exercise Female Humans Linear Models Logistic Models Longitudinal Studies Male Middle Aged Odds Ratio Prospective Studies Risk Assessment Risk Factors Solubility http://works.bepress.com/may/36 http://works.bepress.com/may/36 Fri, 11 Apr 2008 10:45:20 PDT Advance care planning requires an explicit and comprehensive discussion of patient values and conceptualization of quality of life. The Living Well open-ended interview intervention was developed to help patients and their health care agents to engage in a meaningful discussion of values so that decisions made in the last year of life are made with the patients' values in mind. We used qualitative and quantitative analysis to streamline this 10-question interview, and to generate hypotheses for future research. Interviews with 52 terminally ill patients were coded according to methodological weaknesses and content (support, spirit/feelings, palliative care, and quality of life). Node analysis revealed that three primary and three backup/probe questions yielded information that minimized misinformation, sampled from all four content areas, led to discussions of importance for good planning and decision-making, and may have led to earlier hospice admission than the national average. Two emerging themes, Generativity (passing on values or assets to the next generation) and essence (simple pleasures in everyday life), and were then quantitatively analyzed. People who mentioned generativity tended to be older, had a longer length of hospice stay, and a longer time to death after interview, compared to those who did not mention the theme. People who mentioned essence also tended to be older, but tended to have a shorter length of hospice stay and a shorter time to death after the interview. We conclude that this interview may improve access to hospice, and that generativity and essence are worthwhile themes for future research. Carolyn E. Schwartz Adult *Advance Care Planning Aged Aged, 80 and over *Attitude to Death Female Humans Interviews as Topic Male Middle Aged *Palliative Care *Quality of Life Social Support Spirituality http://works.bepress.com/may/35 http://works.bepress.com/may/35 Fri, 11 Apr 2008 10:45:17 PDT Fuyuan Country, in Yunnan Province, China has an extremely high lung cancer mortality both in males and non-smoking females. Out of 5768 deaths, 588 patients died of malignant diseases. Lung cancer was the number one cause of death among malignant diseases both in males and females. The rate of lung cancer death to the whole of malignant diseases was 56.2% for males and 55.0% for females. Indoor soot and combustion emission derived from smoky coal produced in northern Fuyuan exhibited high mutagenic activities against Salmonella typhimurium TA98 strain in Ames test. Resected lung tissues derived from the patients with lung cancer in Fuyuan contained significantly higher concentrations of benzo(a)pyrene than those in Japan, both in males and females (i.e., 608.7 +/- 477.1 pg/dry weight for samples of the patients in Fuyuan, 180.1 +/- 104.5 for Japanese non-smokers, and 207.5 +/- 98.8 for Japanese heavy smokers, respectively). These results suggest that mutagenic chemicals contained in coal as well as indoor environment may have a great influence on lung carcinogenesis in Fuyuan, Yunnan Province, China. Y. Nakanishi Air Pollution, Indoor Benzo(a)pyrene Carcinogens, Environmental China *Coal Environmental Pollutants Female Humans Incidence Lung Lung Neoplasms Male Mutagenicity Tests Salmonella typhimurium http://works.bepress.com/may/34 http://works.bepress.com/may/34 Fri, 11 Apr 2008 10:45:13 PDT OBJECTIVE: To describe seasonal variation in food intake, physical activity, and body weight in a predominantly overweight population.DESIGN: A longitudinal observational study.SETTING: Most of the study participants were recruited from a health maintenance organization (HMO) in central Massachusetts, USA. Additional individuals of Hispanic descent were recruited from outside of the HMO population to increase the ethnic diversity of this sample.SUBJECTS: Data from 593 participants, aged 20-70, were used for this investigation. Each participant was followed quarterly (five sampling points: baseline and four consecutive quarters) for 1-year period. Body weight measurements and three 24-h dietary and physical activity recalls were obtained on randomly selected days (including 2 weekdays and 1 weekend day) per quarter. Sinusoidal regression models were used to estimate peak-to-trough amplitude and phase of the peaks.RESULTS: Daily caloric intake was higher by 86 kcal/day during the fall compared to the spring. Percentage of calories from carbohydrate, fat and saturated fat showed slight seasonal variation, with a peak in the spring for carbohydrate and in the fall for total fat and saturated fat intake. The lowest physical activity level was observed in the winter and the highest in the spring. Body weight varied by about 1/2 kg throughout the year, with a peak in the winter (P<0.001 winter versus summer). Greater seasonal variation was observed in subjects who were male, middle aged, nonwhite, and less educated.CONCLUSIONS: Although there is seasonal variation in diet, physical activity and body weight, the magnitude of the change is generally small in this population.SPONSORSHIP: US National Heart, Lung and Blood Institute. Yunsheng Ma Adult Aged Body Weight *Diet Exercise Female Humans Longitudinal Studies Male Massachusetts Middle Aged Obesity Regression Analysis *Seasons Sex Distribution Time Factors