Prospective studies of the general population have isolated specific social and psychological factors as independent predictors of longevity. This study assesses the ability of these factors, plus two others said to influence survival in patients with cancer, to predict survival and the time to relapse after a diagnosis of cancer. Patients with unresectable cancers (n = 204) were followed to determine the length of survival. Patients with Stage I or II melanoma or Stage II breast cancer (n = 155) were followed to determine the time to relapse. Analysis of data on these 359 patients indicates that social and psychological factors individually or in combination do not influence the length of survival or the time to relapse (P less than 0.10). The specific diagnosis (F = 2.0, P = 0.06), performance status (F = 0.66, P = 0.62), extent of disease (F = 1.12, P = 0.89), and therapy (F = 1.08, P = 0.35) were also unrelated to the psychosocial factors studied. Although these factors may contribute to the initiation of morbidity, the biology of the disease appears to predominate and to override the potential influence of life-style and psychosocial variables once the disease process is established.
Dietary sources of thiamine (vitamin B 1 ) and thiamine-degrading enzymes (thiaminases) are thought to be primary factors in the development of thiamine deficiency among Great Lakes salmonines. We surveyed major forage fish species in Lake Michigan for their content of thiamine, thiamine vitamers, and thiaminase activity. Concentrations of total thiamine were similar (P Յ 0.05) among most forage fishes (alewife Alosa pseudoharengus, bloater Coregonus hoyi, spottail shiner Notropis hudsonius, deepwater sculpin Myoxocephalus thompsonii, yellow perch Perca flavescens, ninespine stickleback Pungitius pungitius, and round goby Neogobius melanostomus) and slightly lower in rainbow smelt Osmerus mordax. Concentrations of total thiamine were all above the dietary requirements of coldwater fishes, suggesting the thiamine content of forage fish is not the critical factor in the development of thiamine deficiency in Lake Michigan salmonines. Thiamine pyrophosphate was the predominant form of thiamine in most species of forage fish, followed by free thiamine and thiamine monophosphate. Total thiamine was slightly greater in summer collections of alewife and rainbow smelt than in spring and fall collections, but the same was not true for bloater. Thiaminase activity varied among species and was greatest in gizzard shad Dorosoma cepedianum, spottail shiner, alewife, and rainbow smelt. Thiaminase activity in alewife varied among collection locations, season (greatest in spring), and size of the fish. Size and condition factors were positively correlated with both total thiamine and thiaminase activity in alewife. Thus, thiamine and thiaminase activity in forage fishes collected in Lake Michigan varied among species, seasons, year caught, and size (or condition). Therefore, multiple factors must be considered in the development of predictive models for the onset of thiamine deficiency in Great Lakes salmonines. Most importantly, thiaminase activity was great in alewives and rainbow smelt, suggesting that these prey fish are key causative factors of the thiamine deficiency in Great Lakes salmonines.
A supportive family environment is thought to enhance the capacity of cancer patients to adapt to their illness and treatment. But families, like patients, vary in their ability to cope with the impact of a cancer diagnosis in a family member and in their ability to fulfill the patient's needs. Increased understanding of the interrelationships between the family's and patient's responses to illness is of fundamental importance to the care of the patient with cancer. A heterogeneous sample of 201 cancer patients and their relatives were studied to determine compatibility of psychological status and to isolate clinical and demographic variables associated with psychological distress. Self‐report tests of anxiety, mood disturbance, and mental health were applied. Despite large individual variation, the psychological status of patients and their matched relatives was closely correlated. The patient's treatment status affected both patients and their next‐of‐kin. Psychological well‐being worsened according to whether patients were receiving follow‐up care, active treatment, or palliative therapy. These data suggest a mutuality of psychological response between patients and their families. Supportive intervention for the patient or relative who manifests distress, therefore, should benefit both. Because patients and relatives involved with palliative treatment are most in need of psychological assistance, particular attention should be paid to this group, as is attempted in hospice care.
Assumptions that psychological attributes are specific to particular diagnoses characterize many investigations of chronically ill patients. We studied 758 patients, each of whom had one of six different chronic illnesses, to determine and compare their scores on the Mental Health Index. Five groups of physically ill patients (with arthritis, diabetes, cancer, renal disease, or dermatologic disorders) did not differ significantly from one another or from the general public, but all had significantly higher scores for psychological status when compared with the sixth group, patients under treatment for depression. There was a significant direct relation between higher mental-health scores and advancing age across all patient populations. Patients with recently diagnosed illness in all groups had poorer mental-health scores than did patients whose illness had been diagnosed more than four months previously. A direct relation between declining physical status and mental-health scores was observed. These results suggest that psychological adaptation among patients with chronic illnesses is remarkably effective and fundamentally independent of specific diagnosis.
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