Impact and frequency of extra-genitourinary manifestations of prune belly syndrome.

INTRODUCTION: Prune belly syndrome (PBS) extra-genitourinary (extra-GU) manifestations are serious comorbidities beyond the genitourinary (GU) anomalies of this disease. We hypothesized an underestimation of the reported frequency and understated impact on quality of life (QOL) of extra-GU comorbidities in PBS survivors beyond the newborn period. To assess this, the frequencies of extra-GU manifestations of PBS in a contemporary cohort of living patients were compared to compiled frequencies from published literature. Second, the impact of extra-GU PBS manifestations on patient/family QOL was assessed via a non-validated open-ended survey. MATERIAL AND METHODS: From 2010 to 2013, PBS survivors were prospectively recruited locally or at three PBS Network National Conventions. The family/subject was asked to complete a detailed PBS questionnaire, non-validated QOL survey, and provide medical records for review. Clinical data were extracted from medical records for local patients. The frequencies of extra-GU manifestations were compared between the contemporary, living cohort and a published literature cohort derived from PubMed. RESULTS AND DISCUSSION: Seven of 706 published studies met criteria for frequencies tabulation of extra-GU PBS manifestations. This largest reported living PBS patient cohort (n = 65) was 99% male with mean age 10 years (1 month-45 years). The living PBS cohort had a statistically significantly higher incidence of gastrointestinal (63%), orthopedic (65%), and cardiopulmonary (49%) diagnoses compared to the compiled published cohort (n = 204). Eleven PBS males and 32 family members completed the QOL survey. Of these, 47% listed at least one non-GU problem (i.e. lung disease, skeletal problems, constipation) as negatively affecting their QOL; 42% listed at least one GU problem (i.e. self-catheterization, recurrent UTIs) as negatively affecting their QOL; 56% reported musculoskeletal surgery and 21% reported gastrointestinal surgery/medication as positively impacting their QOL. CONCLUSIONS: In this large contemporary series, surviving individuals with PBS had a significantly higher incidence of orthopedic, gastrointestinal, and cardiopulmonary diagnoses than previously reported in PBS publications. From the patient/family QOL perspective, non-GU PBS manifestations negatively impact their QOL and treatment of these non-GU conditions improves their lives. As urologic surgeons for these medically complex patients, it is extremely important to be aware of and prepare for the high incidence of non-GU PBS comorbidities directly impacting the medical and surgical treatment and QOL of PBS patients and their families.

Health-related quality of life in morphoea.

BACKGROUND: Little is known about the health-related quality of life (HRQoL) of patients with morphoea, and previous studies have yielded conflicting results. OBJECTIVES: To determine the impact of morphoea on HRQoL, and clinical and demographic correlates of HRQoL in adults. METHODS: This was a cross-sectional survey (n = 73) of the Morphea in Adults and Children cohort. RESULTS: Morphoea impairs HRQoL in adults. Patients were most impaired by emotional well-being and concerns that the disease would progress to internal organs. Patients with morphoea had worse skin-specific HRQoL than those with nonmelanoma skin cancer, vitiligo and alopecia (lowest P < 0·01). Participants had significantly worse global HRQoL scores than the general U.S. population for all subscales (all P < 0·01), with the exception of bodily pain. Comorbidity (r = 0·35-0·51, all P < 0·01), and symptoms of pruritus (r = 0·38-0·64, all P < 0·01) and pain (r = 0·46-0·74, all P < 0·01) were associated with impairment in multiple domains of skin-specific and global HRQoL. Physician-based measures of disease severity correlated with patient-reported HRQoL. CONCLUSIONS: Patients with morphoea experience a negative impact on HRQoL, particularly if symptoms (pruritus and pain) or concerns regarding internal manifestations are present. Providers should be aware of this when evaluating and treating patients.

Low HDL predicts differential blood pressure effects from two weight-loss approaches: a secondary analysis of blood pressure from a randomized, clinical weight-loss trial.

Examining predictors of blood-pressure (BP) response to weight-loss diets might provide insight into mechanisms and help guide clinical care. We examined whether certain baseline patient characteristics (e.g. diet, medical history and laboratory tests) predicted BP response to two weight-loss diet approaches that differ in macronutrient content. One hundred and forty-six overweight adult outpatients were randomized to either a low-carbohydrate diet (N = 72) or orlistat plus a low-fat diet (N = 74) for 48 weeks. Predictors of BP reduction were evaluated using a structured approach and random effects regression models. Participants were 56% African-American, 72% male and 53 (±10) years-old. Of the variables considered, low baseline high-density lipoprotein (HDL) predicted greater reduction in BP in those patients who received the low-carbohydrate diet (p = 0.03 for systolic BP; p = 0.03 for diastolic BP and p = 0.02 for mean arterial pressure). A low HDL level may identify patients who will have greater BP improvement on a low-carbohydrate diet.

Diagnostic utility of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) in the elderly.

OBJECTIVE: To evaluate psychometric properties and comparability ability of the Montgomery-Asberg Depression Rating Scale (MADRS) vs. the Quick Inventory of Depressive Symptomatology-Clinician-rated (QIDS-C(16)) and Self-report (QIDS-SR(16)) scales to detect a current major depressive episode in the elderly. METHOD: Community and clinic subjects (age >or=60 years) were administered the Mini-International Neuropsychiatric Interview (MINI) for DSM-IV and three depression scales randomly. Statistics included classical test and Samejima item response theories, factor analyzes, and receiver operating characteristic methods. RESULTS: In 229 elderly patients (mean age = 73 years, 39% male, 54% current depression), all three scales were unidimensional and with nearly equal Cronbach alpha reliability (0.85-0.89). Each scale discriminated persons with major depression from the non-depressed, but the QIDS-C(16) was slightly more accurate. CONCLUSION: All three tests are valid for detecting geriatric major depression with the QIDS-C(16) being slightly better. Self-rated QIDS-SR(16) is recommended as a screening tool as it is least expensive and least time consuming.

Pharmacist recognition of potential drug interactions.

The ability of pharmacists to identify potential drug interactions was studied. Simulated medication profiles were created from a list of 16 drugs. Staff pharmacists and soon-to-graduate student pharmacists at a Veterans Affairs medical center each received a set of eight 2-drug profiles, four 4-drug profiles, two 8-drug profiles, and one 16-drug profile. Each set of profiles contained a number of pairs of drugs rated by the Drug Therapy Screening System as producing an interaction of moderate or major importance. The subjects were given one hour to screen the profile for the potentially interacting pairs. The subjects detected only 66% of the interactions in the 2-drug profiles, 34% of the interactions in the 4-drug profiles, 20% of the interactions in the 8-drug profiles, and 17% of the interactions in the 16-drug profile. None of the subjects detected all interactions in the 8- or 16-drug profiles. Both true-positive and false-positive rates of identification decreased significantly as the number of drugs listed on the profile increased. This primarily reflected a reduced tendency to report the presence of drug interactions, but there was additional evidence that the accuracy of identification also declined. The number of years of pharmacy training was the only demographic characteristic highly correlated with accuracy. More years of pharmacy education seemed to improve the ability to detect drug interactions. However, none of the pharmacists or students was able to detect all potentially interacting pairs in a profile containing 8 or 16 drugs. Computerized drug interaction profiles should be used by pharmacists to ensure recognition of all potential drug interactions.

On the dimensionality of the Buss/Perry Aggression Questionnaire.

Buss and Perry (1992, Personality and Social Psychology, 63, 452-459) developed a 29-item test that presumably measures four aggression-related dimensions (physical aggression, verbal aggression, hostility, and anger). This study examined the factor structure of the items with particular concern towards seeing how much of the structure previously noted was an artifact of differences in item distributions. Although the scales are intercorrelated to the point that they may not span four dimensions, the scales are in fact multivariate in that the structure is not an artifact of differences in item distributions found with other presumed multifactor scales.

On the utility of the West Haven-Yale Multidimensional Pain Inventory.

STUDY DESIGN: Two studies evaluated the West Haven-Yale Multidimensional Pain Inventory. This 52-item inventory contains 12 scales divided into 3 parts: 1) interference, support, pain severity, self-control, and negative mood; 2) punishing responses, solicitous responses, and distracting responses; and 3) household chores, outdoor work, activities away from home, and social activities. OBJECTIVES: The objective of study 1 was to investigate the internal structure of the Multidimensional Pain Inventory and its demographic correlates. The objective of study 2 was to explore its external correlates (construct validity). SUMMARY OF BACKGROUND DATA: The Multidimensional Pain Inventory appears promising because of its brevity, scope, ease of administration, and initial results. Despite this, it has attracted very little attention in the orthopedic literature since its introduction nearly a decade ago. METHOD: The internal structure was examined using oblique multiple group confirmatory factor analysis. Demographic correlates were examined using discriminant analysis. The external correlates were examined using multiple regression and discriminant analysis. RESULTS: The items' proposed structure fit well except that two pairs of scales are poorly separated: 1) activities away from home and social activities, and 2) solicitous responses and distracting responses. Correlations with external criteria are meaningful. CONCLUSIONS: The Multidimensional Pain Inventory meets standards of reliability and convergent validity, and it may be an improvement over current psychometric devices used to this same end.

On the utility of the SCL-90-R with low-back pain patients.

The SCL-90-R has become an increasingly popular measure of maladjustment. Its use beyond simply screening chronic low-back pain (CLBP) patients has been criticized, however, in part, because it appears to be a single-factor instrument. In fact, its nine major scales do share only one important common factor, i.e., general psychological discomfort. The scale most applicable to CLBP, however, somatization (SOM), has sufficient specific variance that it does not simply measure discomfort and predicts several other measures better than the SCL-90-Rs more reliable composite measure (GSI). Using SOM in conjunction with the GSI to separate psychological from physical discomfort is therefore both clinically and psychometrically appropriate. Other objections to the test are critically evaluated. The potential clinical relevance of the SCL-90-R is discussed.

Concurrent processes: the affect-cognition relationship within the context of the "mere exposure" phenomenon.

The affect-cognition relationship and Zajonc's (1968) "mere exposure" hypothesis were examined in two studies that involved ratings of: (1) preference and familiarity for geometric forms previously scaled for complexity and (2) preference or height and familiarity for male yearbook pictures previously scaled for attractiveness or height. Two exceptions to his hypothesis were noted: simple geometric forms and unattractive faces showed satiation, and faces seen once before were rated more attractive than both novel faces and faces seen twice before. Moreover, mere exposure effects were noted with a nonaffective dimension (height). The major finding was that presentation frequency generally manifested independent relations to affect and rated familiarity, as well as to height and rated familiarity, therefore evoking a concurrent response process (Eriksen, 1960).

Reexamination of Eisen, Zellman, and McAlister's Health Belief Model questionnaire.

Eisen, Zellman, and McAlister proposed a 22-item scale to measure four Health Belief Model (HBM) constructs as applied to adolescent contraceptive behavior. Their factor analysis led them to conclude that there were several discrepancies in their proposed scales. We suggest that they were unduly pessimistic. Although their proposed scales could stand improvement, they are adequate preliminary tools. The major reason they concluded that the scales were deficient was that they applied criteria that are generally appropriate for continuous data to their inherently discrete (categorical) item response data. A secondary consideration is that confirmatory methods of factor analysis can yield results that bear more directly on their proposed organization of items than the traditional exploratory methods that they used. A reanalysis of their data suggests that their proposed scales have fewer problems than they believed they had. Our results increase the likelihood of standardizing HBM measures.

PIP: Eisen, Zellman, and McAlister proposed a 22-item scale to measure four Health Belief Model (HBM) constructs as applied to adolescent contraceptive behavior. Their factor analysis led them to conclude that there were several discrepancies in their proposed scales. Bernstein and Keith suggest that they were unduly pessimistic. Although their proposed scales could stand improvement, they are adequate preliminary tools. The major reason they concluded that the scales were deficient was that they applied criteria that are generally appropriate for continuous data to their inherently discrete (categorical) item response data. A secondary consideration is that confirmatory methods of factor analysis can yield results that bear more directly on their proposed organization of items than the traditional exploratory methods that they used. A reanalysis of their data suggests that their proposed scales have fewer problems than they believed they had. Bernstein and Keith's results increase the likelihood of standardizing HBM measures.

Perceptual and response interactions in semantic priming.

In two experiments, subjects made pairs of lexical decisions verbally. In Experiment 1, masked stimuli appeared concurrently to the left and right of fixation; in Experiment 2, nonmasked stimuli appeared sequentially at fixation. The left-hand letter strings were judged more accurately in in Experiment 1, and the second letter strings were judged more accurately in Experiment 2. Each string in the pair could be either a word (e.g., fork) or a nonword anagram (e.g., frok). Consequently, the two strings in the pair could be related (e.g., fork-spoon, frok-spoon, etc.) or unrelated (e.g., fork-door, frok-door, etc.), independently of whether neither, either, or both strings were words. Semantically related stimuli induced consistent biases to respond "word," as noted in other studies. These biases were typically stronger for the event reported second. Minimal evidence was found for perceptual priming effects. The asymmetrical effects were consistent with spreading-activation-type mechanisms, but other considerations support a multiple-process view.

Cognitive biases and depression.

Compared symptomatically depressed, clinically remitted, and normal controls using cognitive measures designed to be traitlike and statelike in cross-sectional and longitudinal designs, respectively. Remitted depressives and normal subjects did not differ in their attributional biases, endorsement of dysfunctional attitudes, or interpretation of schema-relevant ambiguous events, but both groups differed from symptomatic depressives. Depressive episodes thus affect cognition, but cognitions measured by self-reports are more statelike than traitlike.

Semantic priming: subliminal perception or context?

Briefly presented, masked priming stimuli that cannot be identified by themselves can affect the processing of subsequent targets. The effect, which is sometimes viewed as a demonstration of unconscious processing, has been linked to the subliminal perception literature. Experiments 1 and 2 indicated that the identification of primes in the context of semantically related targets is superior to the identification of primes presented alone, and that the identification of primes in the context of semantically unrelated targets is inferior to the identification of primes presented alone. Experiment 3 indicated parallel findings in a recognition task. Consequently, an explanation of semantic priming in terms of the interactive nature of stimuli that are near to one another in time seems preferable to one based upon concepts of unconscious processing and subliminal perception.

Invariance in the MMPI's component structure.

Bernstein and Garbin (1985b) suggested that the Minnesota Multiphasic Personality Inventory's major clinical scales (excluding Scales ? and 5) can be approximated by an oblique three-component structure: (a) Profile Elevation, (b) Test-taking Attitudes, and (c) Optimism-Pessimism, collectively termed the salient weight model. In this study, we found that both this model and the MMPI's principal component structure remain invariant across race, sex, and, as previously noted, context of testing (job applicants vs. inmates in correctional institutions). We further noted that several alternative definitions of Profile Elevation provide equally satisfactory representation of the relations among the scales. This factor invariance is necessary, but not sufficient, for the MMPI to be viewed as unbiased.

A Confirmatory Factoring of the Self-Consciousness Scale.

Fenigstein, Scheier, and Buss (1975) developed a three subscale inventory designed to measure self-consciousness. Burnkrant and Page (1984) used confirmatory factor analysis to evaluate the scale and concluded that five items did not belong to their assigned scales and that one of the original subscales really measured two separable traits. Burnkrant and Page's conclusions may simply reflect incidental properties of the item statistics and could weaken the scale if adopted. Fenigstein et al.'s representation fits the data quite well in its original form. However, items on their social anxiety scale also tend to evoke relatively large variability over subjects and items on their public self-consciousness scale tend to evoke relatively little variability. In other words, items on their subscales differ nearly as much statistically as they do substantively.

A Comparison of Alternative Proposed Subscale Structures for MMPI Scale 2.

Scale 2 of the MMPI was subjected to confirmatory (Oblique Multiple Groups) factor analysis, following the procedures employed by Bernstein and Eveland (1982) in a related context. Various proposed subscale structures (those of Comrey, 1957; Harris & Lingoes, 1955; Weiner, 1948) were evaluated in two different populations: Job Applicants and Psychotherapy Outpatients. Particular effort was directed toward seeing how differences in item endorsement probability (response level) affect the item level structure of Scale 2 and, therefore, the proposed subscales. It was found that none of the proposed subscales explained the item level structure very well. The conclusion was that there is nothing to be gained by use of the proposed subscale systems compared to the use of Scale 2 as a whole. Although there is an apparently large set of factors present in Scale 2, these factors seem to reflect nonsubstantive aspects of item interrelationships.