[Comparative characteristics of new PTFE vascular patches in experiment].

Presented herein are the findings of a comparative experimental study of 64 novel patches made of porous polytctrafluoroethylene (PTFE). The PTFE explants with various number of technological layers were examined both in vitro and in vivo. The authors performed plasty of the canine aorta with explants followed by morphological assessment of the tissues with PTFE at various terms of follow up. Based on the results obtained during intraoperative assessment of the patches' properties and histological examination thereof, we selected better patches for plasty of the aorta and major arteries to be implemented into clinical practice.

Two years after a job loss: long-term impact of the JOBS program on reemployment and mental health.

Analyses of data from a randomized field experiment with 1,801 participants (A.D. Vinokur, R.H. Price. & Y.Schul, 1995) examined the long-term effects of a job-search workshop (JOBS) and the independent effects of demographic and psychological factors on reemployment and mental health outcomes. Two years after the JOBS workshop, the experimental group had significantly higher levels of reemployment and monthly income, lower levels of depressive symptoms, lower likelihood of experiencing a major depressive episode in the last year, and better role and emotional functioning compared with the control group. Baseline job-search motivation and sense of mastery had both direct and interactive effects (with experimental condition) on reemployment and mental health outcomes, respectively. The interactive effects demonstrated larger benefits for those who had initial low levels of job-search motivation and mastery.

Mastery and inoculation against setbacks as active ingredients in the JOBS intervention for the unemployed.

Earlier analyses of the JOBS II intervention for unemployed job seekers demonstrated that the intervention facilitated reemployment, reduced depressive symptoms, and improved role and emotional functioning (A. D. Vinokur, R. H. Price, & Y. Schul, 1995). The present study focuses on mediational processes of the active ingredients targeted by the intervention. Structural equation modeling analysis demonstrated that an enhanced sense of mastery had mediating effects of reemployment, financial strain, and reduction in depressive symptoms. Another active ingredient, inoculation against setbacks, was shown to protect those who suffered the setback of losing a job after temporarily regaining one. The inoculation protected them from experiencing the high level of depressive symptoms that was typical of their counterparts in the control group.

Hard times and hurtful partners: how financial strain affects depression and relationship satisfaction of unemployed persons and their spouses.

The process linking unemployment and economic hardship to depression and marital or relationship satisfaction in couples was examined. Using structural equation modeling, the authors tested models in which financial strain and partners' symptoms of depression influence the behavioral exchange of the couples in terms of social support and social undermining and, in turn, the effects of support and undermining on relationship satisfaction and depressive symptoms. The analyses were based on longitudinal data from 815 recently unemployed job seekers and their spouses or partners. The results demonstrated that financial strain had significant effects on depressive symptoms of both partners, which in turn led the partner to withdraw social support and increase social undermining. Reduced supportive and increase undermining behaviors had additional adverse effects on satisfaction with the relationship and on depressive symptoms.

Close relationships and adjustment to a life crisis: the case of breast cancer.

When life crises occur, significant others are thought to help alleviate distress and resolve practical problems. Yet life crises may overwhelm significant others, eroding their ability to provide effective support. The accuracy of these contrasting accounts of relationship functioning was evaluated in a study of 102 breast cancer patients and their significant others, interviewed at 4 and 10 months after diagnosis. Results largely confirmed the negative account of relationship functioning. Although significant others provided support in response to patients' physical impairment, they withdrew support in response to patients' emotional distress. Moreover, support from significant others did not alleviate patients' distress or promote physical recovery. These results reveal limits to the effectiveness of close relationships in times of severe stress.

Impact of the JOBS intervention on unemployed workers varying in risk for depression.

Reports the results of the JOBS II randomized field experiment that included a sample of 1,801 recent job losers, 671 of which participated in a modified version of the JOBS I intervention for unemployed workers (Caplan, Vinokur, Price, & van Ryn, 1989). The intervention focused on enhancing the sense of mastery through the acquisition of job-search and problem-solving skills, and on inoculation against setbacks. JOBS II was intended to prevent poor mental health and to promote high quality reemployment. The study tested whether the efficacy of the intervention could be increased by screening and oversampling respondents who were at higher risk for a significant increase in depressive symptoms. Results demonstrated that the intervention primarily benefited the reemployment and mental health outcomes of the high-risk respondents. This suggests the feasibility of enhancing the efficacy of this preventive intervention by targeting it for high-risk unemployed workers who could be identified prospectively.

Social support and undermining in close relationships: their independent effects on the mental health of unemployed persons.

Structural equation analyses were used to examine the impact of social support vs. social undermining (conflict) on mental health in longitudinal data from 1,087 recently unemployed respondents. The results demonstrated that social support and social undermining were not the opposite poles of the same factor, each having some impact independent of the other. Social undermining had statistically significant and strong adverse impact at each concurrent level of mental health. It also predicted improvement (but not a high level) in mental health in subsequent time waves. In contrast, social support had a significant beneficial impact on mental health only at Time 1. Compared with the volatile and extreme effects of social undermining, those of social support appear weaker but more stable. These findings are consistent with literature on the impact of life events (S. E. Taylor, 1991) and on marital interactions and satisfaction (J. M. Gottman & L. J. Krokoff, 1989).

How did it work? An examination of the mechanisms through which an intervention for the unemployed promoted job-search behavior.

Conducted process analysis of treatment mediation effects (Judd & Kenney, 1981) on longitudinal data from a large randomized field experiment with 928 recently unemployed persons. The experimental treatment included an intervention that succeeded in promoting quality reemployment outcomes, as described in earlier reports (Caplan et al., 1989; Vinokur et al., 1991). Using Ajzen's theory of planned behavior (Ajzen, 1985, 1988), the analyses examined the mediating effects of job-search self-efficacy, attitude, norms, and intention on job-search behavior. The results provided substantial support for the theory of planned behavior and demonstrated the mediational role of job-search self-efficacy. For both 1- and 4-month posttests, job-search self-efficacy was shown to mediate the effects of the intervention through its direct effects on job-search intention and on short term job-search behavior, as well as through its indirect effects on subjective norms and attitude. However, in the longer term 4-month posttest, exposure to the intervention had a direct effect on job-search behavior. This long-term direct effect of the intervention was hypothesized to reflect the influence of inoculation against setbacks which is essential for sustaining the long-term behavioral efforts involved in job seeking.

Impact of a preventive job search intervention on the likelihood of depression among the unemployed.

Drawing on coping resources theory, we evaluate the impact of a job search intervention on depressive symptoms in a randomized field experiment at three follow-up periods covering two and one-half years. Baseline depressive symptoms, low social assertiveness, and financial hardship were identified as significant risk variables predicting depressive symptoms at follow-up. These variables then were used to identify high- and low-risk individuals in both experimental and control groups. Results indicated that the job search intervention had its primary impact on persons identified as being at higher risk for depression. Furthermore, the intervention had an impact on both the incidence and prevalence of more severe depressive symptoms among high-risk individuals.

From field experiments to program implementation: assessing the potential outcomes of an experimental intervention program for unemployed persons.

Demonstrated a procedure suggested by Bloom (1984) to provide estimates for the effects of an intervention on its actual participants compared to global effects on study participants in the intervention group, whether or not they showed up. Analyses were based on data collected in a field experiment that tested a preventive intervention for unemployed persons (Caplan, Vinokur, Price & van Ryn, 1989). Effect size estimates were two to three times larger for the actual participant group than for the entire experimental group on employment outcomes (e.g., earnings) and mental health (anxiety and depression). Further analyses produced results showing that compared to participants, the nonparticipants achieved significantly higher levels of reemployment at posttests and did not differ significantly from participants on all other outcomes. The results suggest that persons who most needed the intervention and benefited from it were drawn into it through self-selection processes.

Long-term follow-up and benefit-cost analysis of the Jobs Program: a preventive intervention for the unemployed.

Results are reported from a 2 1/2 year follow-up of respondents who participated in a randomized field experiment that included the Jobs Program, a preventive intervention for unemployed persons. The intervention was intended to prevent poor mental health and loss of motivation to seek reemployment and to promote high-quality reemployment. The results of the long-term follow-up were consistent with those found 1 and 4 months after intervention (Caplan, Vinokur, Price, & van Ryn, 1989). The results demonstrate the continued beneficial effects of the intervention on monthly earnings, level of employment, and episodes of employer and job changes. These findings are supported by a benefit-cost analysis, which demonstrates large net benefits of the intervention to the participants and to the federal and state government programs that supported the project.

Clinical characteristics of malignant melanomas developing in persons with dysplastic nevi.

A total of 452 patients with dysplastic nevi (DN) were followed prospectively by repetitive, complete cutaneous examinations in order to determine the clinical features of early malignant melanomas (MM) arising in them. Sixteen patients (3.5%) developed 18 newly diagnosed MM during an average follow-up period of 27 months. Twelve of the 18 MM were in situ and all of the primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. The principal clinical clue to the diagnosis of MM was change in a preexisting pigmented lesion. Total-body photographs were very useful in helping to identify the early MM in these patients.

The process of recovery from breast cancer for younger and older patients. Changes during the first year.

A representative community sample of 274 breast cancer (BC) patients from the Metropolitan Detroit Cancer-Surveillance System was studied longitudinally during the year after their BC diagnosis. The adjustment of these patients to their disease was examined in terms of (1) the changes in their physical and mental health functioning; and (2) the factors that predict or facilitate the recovery process, including the independent and interactive effects of age. Comparison of the outcomes at 4 and 10 months after diagnosis manifested a significant and consistent improvement in physical functioning. In contrast, there was an absence of any improvement in indicators of mental health and well-being. Whereas the cross-sectional analyses demonstrated that stage of disease had an impact on physical impairment, the longitudinal analyses revealed that physical impairment at time 1 was the significant predictor of deteriorating mental health at time 2. Furthermore, younger age was shown to exacerbate the impact of impairment on mental health. The more seriously impaired younger patients experienced significantly greater deterioration in their mental health and well-being than similarly impaired older patients. However, older age was found to exacerbate the impact of more extensive surgery on symptoms that produce limitations in activity.

Job seeking, reemployment, and mental health: a randomized field experiment in coping with job loss.

Cognitive theories of adherence to difficult courses of action and findings from previous survey research on coping with a major life event--job loss--were used to generate a preventive intervention, tested by a randomized field experiment. The aim was to prevent poor mental health and loss of motivation to seek reemployment among those who continued to be unemployed and to promote high-quality reemployment. Ss were 928 recently unemployed adults from southeastern Michigan, representing a broad range of demographic characteristics; they were randomly assigned to either the experimental or control condition. The experimental intervention included training in job seeking with a problem-solving process emphasizing inoculation against setbacks and positive social reinforcement. A pretest was administered, followed by posttests 1 and 4 months after the experiment. The experimental condition yielded higher quality reemployment in terms of earnings and job satisfaction, and higher motivation among those who continued to be unemployed.

Dysplastic nevi. Markers for increased risk for melanoma.

A total of 452 white patients, classified into four dysplastic nevi groups, were followed prospectively by repetitive, complete cutaneous examinations using total-body photographs taken on entry into the study. Sixteen patients (3.5%) developed 18 newly diagnosed malignant melanomas (MM) during an average follow-up period of 27 months. Twelve of the 18 MM were in situ, and all of the six primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. Compared with reference populations, the number of MM detected significantly exceeded the number estimated to occur in the comparable age-matched control groups. These data support the concept of repetitive follow-ups of all groups of patients with dysplastic nevi.

Physical and psychosocial functioning and adjustment to breast cancer. Long-term follow-up of a screening population.

The effects of age, recency of breast cancer (BC) diagnosis, and severity of the disease on adjustment outcomes were investigated in a sample of 349 women from the 10,056 women screened for BC by the University of Michigan Breast Cancer Detection Demonstration Project between 1974 and 1981. In the 1985 follow-up, data were collected from the 173 surviving BC patients who had invasive BC, and from a matched control group of 176 women who were asymptomatic of BC. Fifty-five percent of the BC patients were 5 years past diagnosis and treatment at the time of data collection. The BC patients group as a whole did not differ from the asymptomatic control group on indicators of mental health, social and psychological well-being, or physical functioning. However, the BC group reported a greater number of diagnosed medical conditions that limited their activities, and taking more medications, than the asymptomatic group. Within the BC group, severity and recency of the cancer had strong independent adverse effects on several of the indicators of mental health and physical functioning. Advanced age had the same main effects in both groups: greater number of medications and diagnosed medical conditions that cause limitations in activities, but, in contrast, better mental health and well-being. Age had interactive effects with the recency and with severity of BC: more recent and severe cases of BC appeared to produce particularly serious difficulties in psychological adjustment for younger patients, and particularly serious medical problems and physical difficulties in adjustment for older patients.

Do consensus conferences work? A process evaluation of the NIH Consensus Development Program.

The purpose of this evaluation study is to identify problems and suggest modifications in the NIH Consensus Development Program. The current program consists of three-day conferences in which experts assess medical technologies for issues of efficacy, safety, conditions of use, and other related topics (e.g., costs and social impact). Eight consensus conferences held between 1980 and 1982 were studied in depth using a variety of methods; five of the conferences were investigated concurrently. In addition, archival material was examined for all but one of the 33 conferences held up to that time, and four planning meetings for future conferences were observed. The delay in publishing our findings provided an opportunity to examine the changes introduced by NIH; it also allowed us to avoid the criticism of numerous prior evaluations for finding fault with programs that are still developing. NIH adopted many of the recommendations in our evaluation report and has investigated others. Based on our evaluation and more recent evidence, however, we conclude that the major problem that was uncovered--selection bias, particularly with respect to the choice of questions and panelists--remains a significant threat to the credibility of the consensus process. More specifically, the results indicate that controversial issues cannot be properly addressed within the present conference format, although that was one of its major purposes. Recommendations for improving the consensus process are presented, as are their implications for a larger set of consensus activities that are currently being conducted.

Determinants of perceived social support: interpersonal transactions, personal outlook, and transient affective states.

During the last decade, the study of social support has relied heavily on recipients' reports of perceived support. However, such reports of support may reflect not only actual supportive interpersonal transactions but also the recipients' own personal and perceptual dispositions and comparatively transient mood states. This study examines these factors' independent effects on perceived support. Interpersonal transactions of social support were assessed in a longitudinal panel design using reports from 486 adult male respondents and their significant others (mostly wives). Using structural modeling techniques (LISREL VI), an unfolding series of statistical analyses were performed. The results provide strong support for a model in which recipients' perception of support is determined significantly and strongly by actual interpersonal transactions as reported by significant others, moderately by the recipients' negative outlook bias, and weakly by their anxiety and depression as indicators of their poor mental health. The implications of the results for future research are discussed.

Cognitive and affective components of life events: their relations and effects on well-being.

A model of how five key facets of life events are related to one another and influence mental health and functioning was examined. The facets are the experience of control over, anticipation of, pleasantness from, stress generated by, and adjustment to life events. Multivariate analyses of data from 420 adult male respondents yielded results that were largely consistent with the hypothesized model. The results suggested that control over and anticipation of life events influenced the perceived stress produced by the events and the ability to adjust to them. In turn, it appeared that such stress and adjustment influenced mental health and functioning. The effects of control and anticipation on mental health and functioning were indirect only. Contrary to our hypothesis, control seemed to heighten perceived stress; but control, as well as anticipation, appeared to increase the ability to adjust. Whereas previous studies found no effect of desirable events on well-being, this study found that pleasant events had a beneficial effect. The discussion examines the implications of the findings for future research.