Hierarchy of the main factors predicting the decision to go to the doctor in a general population sample: A factorial survey design.

OBJECTIVE: To obtain a hierarchy of the main factors that predict the decision to go to the doctor when symptoms are not yet linked to a specific disease. METHOD: 64 representative vignettes, combinations of nine factors, were presented to 168 adults between 28-60 years of age. RESULTS: Multilevel multiple regression models were used to rank the main factors predicting urgency to see a doctor in order of importance: the interference of symptoms in daily activities (B = -1.29; p < .001), fear (B = -0.96; p < .001), pain (B = -0.90; p < .001), access to medical care (B = -0.64; p < .001) and confidence in the doctor (B = -0.27; <.05). Moreover, gender (B = 0.56; p < .05) and educational level (B =-0.31; p < .05) explained part of the interindividual variation in the daily symptoms' interference. CONCLUSION: When a specific disease has not yet been diagnosed, daily symptoms' interference is the factor that most strongly increases the urgency to visit a doctor, especially among men and among people with a higher level of education. PRACTICE IMPLICATIONS: To reduce delay, generic health prevention campaigns should place more emphasis on possible interference in daily activities than on the meaning of symptoms for health.

Chronic stress and calcium oxalate stone disease: influence on blood cortisol and urine composition.

OBJECTIVE: To evaluate the influence of chronic stress (CS) on urine composition of calcium oxalate (CaOx) stone patients and controls. METHODS: This case-control study enrolled 128 patients during a period of 20 months. The cases were CaOx stone formers with a recent stone episode. Controls were matched by sex and age. Dimensions of CS were evaluated in cases and controls by validated self-report questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout, and satisfaction with life. Blood and urine samples were collected to determine cortisol levels and urinary composition. RESULTS: More relations between CS dimensions and blood and urine parameters were observed in cases than in controls. In cases, the blood cortisol level was related positively with the number of stressful life events (P = .03), intensity of these events (P = .04), and anxiety (P = .04). In addition, urinary magnesium (P = .03) and pyrophosphate (P = .05) levels were positively related with satisfaction with life and burnout, respectively. In contrast, urinary magnesium levels were negatively related with perceived stress (P = .01), anxiety (P = .016), and depression (P = .03). In controls, the number of stressful life events and the intensity of stressful life events was related positively with magnesium (P = .06, P = .02) levels and negatively with blood cortisol levels (P = .03, P = .004). CONCLUSION: Based on the variation between cases and controls in relations between CS dimensions and biochemical parameters, we hypothesize that CS may trigger a differential biological response in CaOx stone formers and controls, which in turn may promote or protect against CaOx stone formation.

Chronic stress and calcium oxalate stone disease: is it a potential recurrence risk factor?

Chronic emotional stress is associated with increased cortisol release and metabolism disorders. However, few studies have evaluated the influence of chronic stress on calcium oxalate (CaOx) stone disease and its recurrence. A total of 128 patients were enrolled in this case-control study over a period of 20 months. All patients were CaOx stone formers with a recent stone episode (<3 months); 31 were first-time stone formers (FS) and 33 recurrent stone formers (RS). Dimensions of chronic stress were evaluated with self-reported validated questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout and satisfaction with life. An ad hoc self-reporting questionnaire was designed to evaluate stress-related specifically to stone episodes. Blood and urine samples were collected to determine cortisol levels and urinary composition. In addition, epidemiological data, socioeconomic information, diet and incidences of metabolic syndrome (MS) were reported. Overall, no significant differences were observed in the scores of cases and controls on any of the questionnaires dealing with stress. The number (p < 0.001) and the intensity (p < 0.001) of perceived stressful life events were higher in RS than in FS, but there were no differences between the two groups in other dimensions of stress. RS had higher glucose (p = 0.08), uric acid (p = 0.02), blood cortisol (p = 0.01), and urine calcium levels (p = 0.01) than FS. RS also had lower economic levels (p = 0.02) and more frequent incidences of MS (p = 0.07) than FS. Although no differences were observed in cases and controls among any dimension of chronic stress, the number and intensity of stressful life events were higher in RS than in FS. These differences correlate with variations in blood and urinary levels and with metabolic disorders, indicating an association between chronic stress and risk of recurrent CaOx stone formation.

Effects of posttraining damage to the pedunculopontine tegmental nucleus on conditioned stimulus transfer in two-way active avoidance in rats.

The effects of posttraining excitotoxic lesions of the pedunculopontine tegmental nucleus (PPTg) on two-way active avoidance after changing the conditioned stimulus (CS) used during prelesion training were examined. Prelesion training was carried out with either a tone or a light as the CS, and this CS was changed during postlesion training. Replacing the tone with a light reduced the performance of control and lesioned rats, but the degree of reduction was higher in the latter. Replacing the light with a tone had slight detrimental effects in lesioned rats but not in controls. Thus, posttraining PPTg lesions slowed down the reacquisition of shuttle-box avoidance under conditions of CS transfer, an effect that may be attributable to disruption of attention and/or gating of sensory stimuli.

Análisis de la influencia de la conducta en la ilusión de control / Influence analysis of action on the illusion of control

En este trabajo se valora la importancia de la conducta en la generación de ilusión de control. Para ello se han utilizado tres pruebas no contingentes basadas en el paradigma de los juicios de contingencia. Una de ellas permite la conducta voluntaria, otra presenta una conducta dirigida y la tercera, sin conducta, únicamente permite predecir. El juicio emitido por los sujetos en cada una de las pruebas indica que los sujetos generan mayor ilusión de control en aquella situación en que se puede decidir la conducta a realizar, y que, aunque en menor magnitud, la sobreestimación del juicio también aparece en las otras dos pruebas, que presentan juicios iguales si bien parecen diferir en el razonamiento subyacente al mismo. Los resultados se discuten en relación a los posicionamientos teóricos aparentemente divergentes descritos en los trabajos de Thompson, Armstrong y Thomas (1998) y Teigen (1994). (AU)