Peripheral dose measurements with diode and thermoluminescence dosimeters for intensity modulated radiotherapy delivered with conventional and un-conventional linear accelerator.

The objective of this paper was to measure the peripheral dose (PD) with diode and thermoluminescence dosimeter (TLD) for intensity modulated radiotherapy (IMRT) with linear accelerator (conventional LINAC), and tomotherapy (novel LINAC). Ten patients each were selected from Trilogy dual-energy and from Hi-Art II tomotherapy. Two diodes were kept at 20 and 25 cm from treatment field edge. TLDs (LiF:MgTi) were also kept at same distance. TLDs were also kept at 5, 10, and 15 cm from field edge. The TLDs were read with REXON reader. The readings at the respective distance were recorded for both diode and TLD. The PD was estimated by taking the ratio of measured dose at the particular distance to the prescription dose. PD was then compared with diode and TLD for LINAC and tomotherapy. Mean PD for LINAC with TLD and diode was 2.52 cGy (SD 0.69), 2.07 cGy (SD 0.88) at 20 cm, respectively, while at 25 cm, it was 1.94 cGy (SD 0.58) and 1.5 cGy (SD 0.75), respectively. Mean PD for tomotherapy with TLD and diode was 1.681 cGy SD 0.53) and 1.58 (SD 0.44) at 20 cm, respectively. The PD was 1.24 cGy (SD 0.42) and 1.088 cGy (SD 0.35) at 25 cm, respectively, for tomotherapy. Overall, PD from tomotherapy was found lower than LINAC by the factor of 1.2-1.5. PD measurement is essential to find out the potential of secondary cancer. PD for both (conventional LINAC) and novel LINACs (tomotherapy) were measured and compared with each other. The comparison of the values for PD presented in this work and those published in the literature is difficult because of the different experimental conditions. The diode and TLD readings were reproducible and both the detector readings were comparable.

Anxiety and cardiovascular symptoms: the modulating role of insomnia.

BACKGROUND: Anxiety and insomnia are associated with cardiovascular (CV) symptoms. We assessed whether the relation between anxiety and CV symptoms is modulated by insomnia. METHODS: Independently living women (n = 1,440; mean age = 59.36 +/- 6.53 years) were recruited by cluster sampling technique. We obtained data on demographic characteristics, health beliefs, access to health care, CV symptoms, sleep, stress and anxiety levels. RESULTS: Overall, 56% of the sample reported insomnia; 46% reported CV symptoms, and 54% were highly anxious. There was a greater likelihood for highly anxious women and those experiencing insomnia to report CV symptoms (r(s) = 0.31* and r(s) = 0.32*, respectively). In logistic regression analysis, the adjusted odds ratios for reporting CV symptoms were 1.39 for patients with insomnia and 2.79 for those with anxiety. With control for insomnia, we observed a 3-fold reduction in the magnitude of the association between anxiety and CV symptoms (r(p) = 0.09*). Stepwise adjustments for sociodemographic factors, CV risk markers, and factors anchoring health beliefs and access to health care showed lesser impact on the relationships. With simultaneous control for those covariates, the correlation was r(p) = 0.13*; * p < 0.01. CONCLUSION: The association of CV symptoms with anxiety is partly accounted for by insomnia.

Attachment styles in older European American and African American adults.

OBJECTIVES: Differential attachment styles have been linked to differential emotion regulation and ability to cope with stress in samples of young adults. There are few data on attachment styles in older adults despite the fact that attachment relationships are said to play a significant role in psychological well-being throughout the life span. The goal of the study was to examine attachment patterns in older adults. METHODS: Participants were 800 community-dwelling older European Americans and African Americans (M = 74 years) living in a large urban community. Attachment measures included the family and friend intimacy subscales from the Network Analysis Profile and the Relationship Scales Questionnaire. RESULTS: In contrast to findings with younger individuals, where the majority of respondents have been found to be secure (i.e., comfortable with closeness and dependency), the majority of the present sample were found to be dismissing/avoidant (i.e., uncomfortable with closeness, compulsively self-reliant). European Americans scored higher than African Americans on attachment security, whereas African Americans scored higher than European Americans on dismissing attachment. However, the assessment of relatedness based on the Network Analysis Profile, where respondents named their closest kin, indicated that African Americans had higher scores than European Americans, though their networks were smaller. DISCUSSION: Age and ethnicity differences appear to reflect cohort effects related to the impact of economic hardship on families earlier this century and racial prejudice. The high rates of dismissing attachment and low rates of secure attachment in this large urban population suggest that these individuals may be at risk for social isolation and poor health as they become older and more frail.

Ethnic differences in self-reported sleep problems in older adults.

STUDY OBJECTIVES: To date, conflicting observations have been made regarding ethnic differences in sleep patterns. Plausibly, differing sampling strategies and disparity in the cohorts investigated might help explain discrepant findings. To our knowledge population-based studies investigating ethnic differences in sleep complaints have not addressed within-group ethnic heterogeneity, although within-group health disparities have been documented. DESIGN: Volunteers (n =1118) in this study were community-residing older European Americans and African Americans residing in Brooklyn, New York, which were recruited by a stratified, cluster sampling technique. Trained interviewers of the same race as the respondents gathered data during face-to-face interviews conducted either in the respondent's home or another location of their choice. Data included demographic and health risk factors, physical health, social support, and emotional experience. Relationships of demographic and health risk factors to sleep disturbances were examined in multiple linear regression analyses. Within-group differences in sleep complaints were also explored. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Of the factors showing significant associations with sleep disturbance, European American ethnicity was the most significant predictor (r2 = 0.20). Worse sleep and greater reliance on sleep medicine were observed among European Americans. Caribbean Americans reported less sleep complaints than did U.S.-born African Americans, and immigrant European Americans reported greater complaints than did US-born European Americans. CONCLUSIONS: As expected several health risk factors were predictive of sleep disturbance among urban community-dwelling older adults, but ethnicity was the most significant predictor. The present data suggest both between-group and within-group ethnic differences in sleep complaints. Understanding of demographic and cultural differences between African Americans and European Americans may be critical in interpreting subjective health-related data.

A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer's disease.

A sample of 31 female nursing home patients with late-stage Alzheimer's disease participated in a double-blind clinical trial of the antidepressant medication sertraline. Measures of depression included various objective scales and two measures of facial expressions of emotion coded during a semistructured interview using a facial affect coding system. Repeated-measures ANOVAs at baseline and at the 8-week endpoint indicated that on all measures, both the treatment and placebo groups improved over time, with three of six measures showing a significant time effect. The "knit-brow" facial measure approached significance for a Treatment x Time effect. Thus, sertraline had no significant benefits over placebo. However, if, as we hypothesize, the knit-brow response is more sensitive to signs of depression in advanced dementia, our study justifies the further investigation of the use of sertraline in this population.

Racial differences in neuropsychiatric symptoms among dementia outpatients.

This study, based on evaluations of 240 outpatients with Alzheimer's disease or multi-infarct dementia, examines whether race has any independent effects on the prevalence and levels of related neuropsychiatric symptoms. After the authors controlled for 14 potentially confounding variables, race had a significant independent effect on the levels of psychotic and depressive symptoms, the former being greater among blacks and the latter among whites. There were no differences in symptoms between U.S.-born African Americans and African Caribbeans. Although it is likely that racial differences reflect variations in symptoms brought in for evaluation, the absence of intraracial differences suggests the possibility of an underlying biological process.

Personality change in adulthood: loci of change and the role of interpersonal process.

This study examined personality change in two domains--dispositional tendencies (emotion traits) and characteristic adaptations (views of self) over eight years in a sample of older adults (M = 63.4). Stability coefficients for anxiety, depression, interest, anger, anger-in, anger-out, and aggression ranged from .47 to .75; only anger-out showed significant change over the eight years. On the other hand, respondents reported moderate changes in perspectives, goals, personality, feelings, and ways of relating and the ratings of outside informants were significantly correlated with self-reports of change for all but goals. Personality change was associated with positive and negative interpersonal life events of an intimate nature such as marriage, divorce, and death of loved ones that took place over the past eight years, and was not associated with other high and low points in lives involving careers, changes in residence, and more distant social relationships.

Interracial and intraracial differences in neuropsychiatric symptoms, sociodemography, and treatment among nursing home patients with dementia.

Using an adaptation of George's (1989) social antecedent model of psychopathology, this article examines interracial and intraracial differences in neuropsychiatric symptoms, sociodemography, and treatment among nursing home patients with dementia. The final sample consisted of 164 U.S.-born African Americans, 54 African Caribbeans, and 68 Caucasians. Although there were appreciable interracial differences in sociodemographics, there were minimal clinical differences. This finding may reflect both racial differences in pathways to institutionalization and the homogenization of clinical characteristics created by new governmental standards for nursing homes. There were no substantial differences between African Americans and African Caribbeans. Use of medication to treat neuropsychiatric symptoms was low, and may have reflected difficulties in diagnosis and concerns about the abuse of medications.

Attachment style and emotion regulation in dementia patients and their relation to caregiver burden.

One hundred and sixty-eight patients with mid- to late-stage dementia and their caregivers participated in a study of the relation between patient emotional characteristics, dementia symptomatology, and caregiver burden. Measures included premorbid attachment style, premorbid emotion regulation style, and behavioral symptoms of dementia. The attachment patterns (secure, avoidant, ambivalent) of these elderly patients resembled those obtained in samples of younger individuals in terms of emotion regulation characteristics; however, the distribution of attachment styles was significantly different, with a lower proportion of ambivalently attached individuals in the present sample. In terms of the behavioral symptoms of dementia, ambivalent patients had more depression and anxiety than secure and avoidant patients; the latter patients experienced more activity disturbance than ambivalently attached individuals and were higher on paranoid symptomatology than securely attached persons. Caregivers of securely attached individuals experienced less total burden than did caregivers of both insecure groups. In regression analysis, attachment style accounted for the largest proportion of unique variance in the prediction of caregiver burden (8%); only 1 of 7 patient symptoms contributed a significant independent effect, namely depressed affect, which accounted for 4% of the variance.

Depression among African American nursing home patients with dementia.

The authors compared 218 black and 68 white nursing home patients with dementia for differences in the prevalence, recognition, and treatment of depression. There were no racial differences in depressive symptoms, but whites were significantly more likely to receive a diagnosis of "possible depression" and there were few racial differences in clinical, social, or demographic factors associated with depression. Depression was often unrecognized and undertreated in both racial groups; several depression instruments developed for use in dementia had good reliability and validity among blacks; and there were no significant differences in depressive symptoms or diagnosis between U.S.-born and Caribbean-born black patients. The absence of any appreciable interracial or intraracial differences in depression symptoms or diagnoses may reflect uniformity in nursing home selection criteria or lessening of mood differences that may have existed before admission.

A comparison of US-born African-American and African-Caribbean psychiatric outpatients.

This study compares US-born African Americans with African Caribbeans attending an urban psychiatric outpatient clinic on various items pertaining to sociodemographics, psychiatric history, current psychiatric illness, and physical health. A structured chart review was performed on a sample comprised of 135 native-born African Americans and 91 African Caribbeans who had attended the clinic during an 11-year period. A total of 28 clinical variables were examined. Nine clinical variables were found to significantly differentiate the two groups in bivariate analysis, and these were entered along with three demographic control variables into a logistic regression analysis. Seven variables attained significant independent effects. African Americans were differentiated from African Caribbeans on history of greater alcoholic abuse or dependence, presence of more delusions, worse health, longer history of previous outpatient treatment, and greater clinical improvement at 6 months. African Caribbeans were found to have a greater frequency of depression and aggressivity. These data underscore the importance of examining intraracial differences in mental illness as well as pointing to the potential benefits of using intraracial comparisons to interpret interracial analyses.

A comparison of US-born African-American and African-Caribbean psychiatric outpatients

This study compares US-born African Americans with African Caribbeans attending an urban psychiatric outpatient clinic on various items pertaining to sociodemographics, psychiatric history, current psychiatric illness, and physical health. A structured chart review was performed on a sample comprised of 135 native-born African Americans and 91 African Caribbeans who had attended the clinic during an 11-year period. A total of 28 clinical variables were examined. Nine clinical variables were found to significantly differentiate the two groups in bivariate analysis, and these were entered along with three demographic control variables into a logistic regression analysis. Seven variables attained significant independent effects. African Americans were differentiated from African Caribbean on history of greater alcholic abuse or dependence, presence of more delusions, worse health, longer history of previous outpatient treatment, and greater clinical improvement at 6 months. African Caribbeans were found to have a greater frequency of depression and aggressivity. These data underscore the importance of examining intraracial differences in mental illness as well as pointing to the potential benefits of using intraracial comparisons to interpret interracial analyses.(AU)

Relation between premorbid personality and patterns of emotion expression in mid- to late-stage dementia.

Twenty-seven nursing home patients with mid- to late-stage dementia participated in a study of the relation between preillness personality, as indexed by attachment and emotion regulation style, and current emotional behavior. Preillness measures were completed by family members and current assessments of emotion were supplied by nursing home aides and family members; in addition, emotion was coded during a family visit using an objective coding system for facial emotion expressions. Attachment style was found to be related to the expression of positive affect, with securely attached individuals displaying more positive affect than avoidantly attached individuals. In addition, high ratings on premorbid hostility were associated with higher rates of negative affect and lower rates of positive affect. These findings indicate that premorbid aspects of personality show continuity over time, even in mid- to late-stage dementia.

Emotional expression during mid- to late-stage dementia.

This study examined the quality of emotional responsivity in mid- to late-stage dementia patients. Eighty-two nursing home patients with a DSM-III-R diagnosis of primary degenerative dementia of the Alzheimer type served as subjects. Patients were staged using the Global Deterioration Scale. The level and type of patient affectivity were assessed by family reports, aide reports, and direct observation and coding of patient facial expressions during a family visit. All three measures indicated that patients with Alzheimer's disease expressed a range of affective signals. Some showed an intact and functional emotion system even during the last stage of the disease; one third of end-stage dementia patients expressed sadness at the departure of their relatives as coded by an objective facial affect coding system.

Type A behavior pattern and emotion expression in younger and older adults.

Eighty younger (less than 50 years, M = 28 years) and 80 older (more than 50 years, M = 69 years) Type A and Type B Ss were evaluated for Type A behavior pattern using the Structured Interview (SI) and given personality tests for anxiety, depression, anger, aggression, hostility, and anger-in-anger-out. Ss also underwent an emotion induction procedure. Videotapes of the emotion induction procedure (N = 160) and the SI (N = 80) were coded for facial expression of emotion. Type As did not differ from Bs on anxiety or depression but did on anger and aggression. Type As showed anger inhibition and anger bound to shame, as predicted by emotion socialization theory. The greatest number of differential effects were observed between age groups. Older individuals, in general, were more emotionally expressive than younger Ss across a range of emotions. Women appeared more conflicted about anger expression than men, and Type A women more so than Type A men.