Development of a Culture-Common Formal Characteristics of Behavior - Temperament Markers Inventory (FCB-TMI-CC).

The goal was to create a brief temperament inventory grounded in the Regulative Theory of Temperament (FCB-TMI-CC), with a user-friendly, online applicability for studies in different cultures. As the regulative role of temperament is strongly revealed under meaningful stress, the study was planned within the time of the COVID-19 pandemic. To ensure high diversity in terms of culture, economic and environmental conditions, data from nine countries (Poland, United States of America, Italy, Japan, Argentina, South Korea, Ireland, United Kingdom and Kazakhstan) were utilized (min. N = 200 per country). Validation data were gathered on the level of COVID-19 stressors, posttraumatic stress disorder (PTSD), depression, anxiety and stress symptoms, and Big Five personality traits. Multigroup confirmatory factor analysis served as the basis for the inventory's construction. The final culture-common version includes 37 items (5-6 in each of the 7 scales) and covers the core aspects of temperament dimensions. Temperament structure was confirmed to be equivalent across measured cultures. The measurement is invariant at the level of factor loadings and the reliability (internal consistency) and theoretical validity of the scales were at least acceptable. Therefore, the FCB-TMI-CC may serve as a valuable tool for studying temperament across diverse cultures and facilitate cross-cultural comparisons.

Resilience and recovery from total knee arthroplasty (TKA): a pathway for optimizing patient outcomes.

Identifying and promoting resilience factors may offer novel strategies for optimizing the recovery of patients following orthopedic surgery. Prior research has suggested that self-efficacy, positive affect, vigor, and vitality may function as resilience factors in the face of chronic pain. The present study examines these resilience factors in a prospective, cognitive-affective-behavioral pathway to recovery. Patients (n = 110) undergoing unilateral, total knee replacement surgery completed self-report assessments of study variables. Self-efficacy was assessed 2 ½ weeks prior to surgery, positive affect the day after surgery, vitality and vigor one-month following surgery, and post-operative pain at one- and three-months following surgery. Control variables included gender, pain, and depressive symptoms prior to surgery. Path analysis revealed significant coefficients from pre-operative self-efficacy to positive affect during hospitalization (ß = .246, p = .017), as well as to vitality (ß = .323, p = .001) and vigor (ß = .387, p < .001) at one-month following surgery. Both indicators of energy predicted better post-operative recovery (one-month: vitality ß = -.254, p = .016; vigor ß = -.329, p = .002); three-months: vitality ß = -.192, p = .047, vigor ß = -.201, p = .044). Findings support a cognitive-affective-behavioral pathway to recovery.

Physiological Indices of Stress Prior to and Following Total Knee Arthroplasty Predict the Occurrence of Severe Post-Operative Pain.

OBJECTIVE: The severe pain and disability associated with osteoarthritis often motivate individuals to undergo arthroplastic surgery. However, a significant number of surgical patients continue to experience pain following surgery. Prior research has implicated both the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) in the sensitization of pain receptors and chronic pain conditions. This study uses a prospective, observational, cohort design to examine whether physiological stress responses before and after surgery could predict post-operative pain severity. SUBJECTS: Participants included 110 patients undergoing total knee arthroplasty. METHODS: Physiological indices of stress included the measurement of catecholamine and cortisol levels in 15-hour urine samples collected prior to and 1 month following surgery, as well as in-hospital heart rate and blood pressure (before and after surgery), which were abstracted from medical records. Patients completed the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Bellamy et al., J Orthop Rheumatol 1: , 95 (1988)] 2.5 weeks prior to surgery and at a 3-month follow-up. RESULTS: Contrary to expectations, lower stress hormone levels at baseline were related to more severe post-operative pain. Data at later time points, however, supported our hypothesis: cardiovascular tone shortly before surgery and urinary levels of epinephrine 1 month following surgery were positively related to pain severity 3 months later. CONCLUSION: Results suggest that the occurrence of post-operative pain can be predicted on the basis of stress physiology prior to and following arthroplastic surgery.

Trauma history as a resilience factor for patients recovering from total knee replacement surgery.

UNLABELLED: Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills). OBJECTIVE: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR). DESIGN: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure. RESULTS: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (ß = -.259, p = .006) and three-month follow-up assessments (ß = -.187, p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients' trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance: ß = -.200, p = .037). CONCLUSION: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery.

Using established predictors of post-traumatic stress to explain variations in recovery outcomes among orthopedic patients.

The present studies examine whether information contained in medical records can be used to predict outcomes following two orthopedic procedures: repair of hip fracture and total knee replacement. Study 1 reports the acute, in-hospital recovery data from the medical records of 119 hip fracture patients. Study 2 is a prospective, longitudinal investigation of 3-month postoperative recovery of 110 total knee replacement patients. Patients characterized by a greater number of post-traumatic stress risk factors experienced poorer outcomes following orthopedic surgery. Our results suggest that patients at risk for negative outcomes can be identified by information readily available to medical personnel.

Predicting symptoms of post-traumatic stress among patients undergoing orthopedic surgery on the basis of routinely collected cardiovascular data.

The present study examined whether in-hospital assessments of heart rate and blood pressure predicted symptoms of post-traumatic stress (PTS) in 110 patients undergoing total knee replacement surgery. After controlling for conceptually relevant factors, in-hospital cardiovascular functioning predicted symptoms of PTS three months following surgery. Specifically, lower pre-surgical and post-surgical systolic and diastolic blood pressure predicted more symptoms of avoidance and PTS (total). In contrast, higher heart rate prior to and shortly following surgery predicted marginally more intrusive thoughts. The present findings suggest that routinely collected medical data may provide a means to identify patients at risk for problematic outcomes following surgery.

Symptoms of postsurgical distress following total knee replacement and their relationship to recovery outcomes.

OBJECTIVE: Prior research has suggested that posttraumatic stress symptoms may occur in the context of medical events. Further, these symptoms are often comorbid with conditions associated with pain. Therefore, the current study examined the occurrence of distress following arthroplastic surgery and the relationship of these symptoms to postoperative recovery. METHODS: Patients (N =110) undergoing unilateral, total knee replacement (TKR) surgery were assessed at three time points proximal to their surgery: approximately 2 weeks prior to surgery (T1), 1 month following surgery (T2) and 3 months following surgery (T3). Patients completed survey assessments of recovery outcomes (Western Ontario and McMaster Universities Osteoarthritis Index) and distress (The Impact of Event Scale [IES]) following surgery (T2 and T3). RESULTS: A significant percentage (20%) of patients undergoing TKR reported noteworthy levels of postsurgical stress 1 and 3 months following surgery. Further, this distress was associated with a more difficult recovery following TKR, characterized by more severe pain and greater functional limitations. After controlling for potential confounding variables, regression analyses suggested that postsurgical stress was cross-sectionally related to pain perception and longitudinally predicted subsequent functional limitations and global assessments of recovery. DISCUSSION: To our knowledge, this is the first study to examine postoperative distress (using the IES) following TKR. The present study adds to the growing body of literature documenting the impact of psychological processes on postoperative recovery.

The impact of gender and hypothalamic pituitary adrenal activity on depressive symptoms following surgical stress.

The impact of gender and cortisol levels on depression following planned surgery was examined in 95 men and women. Patients were assessed prior to surgery and at one and three months following surgery. Higher cortisol levels conferred greater risk for depression at one and three months following surgery. This effect was stronger for men than women at one month following surgery, but did not differ between genders at three months post-surgery. Results support a mechanistic role of HPA alterations in depression following a surgical stressor that differs in strength between men and women.

In-hospital levels of C-reactive protein and IL-6 predict post-operative depressive symptoms among patients undergoing total knee replacement surgery.

Behavioral changes observed following immune system activation are similar to many of the hallmark symptoms of major depressive disorder (MDD), including appetite change, lethargy, fatigue, negative mood and anhedonia. Acute phase proteins, such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been implicated in the production of sickness behavior, and research has revealed significant differences in the levels of these acute phase proteins between depressed and non-depressed individuals. The current study examined whether early post-operative IL-6 and CRP levels predicted subsequent depressive symptoms in 110 patients undergoing total knee replacement surgery (TKR). In-hospital levels of IL-6 and CRP predicted depressive symptoms at three-months following surgery, as indicated by significant main effects and a significant interaction term. Specifically, lower levels of in-hospital CRP and higher levels of IL-6 in-hospital predicted more depressive symptoms three-months following surgery. The finding that levels of acute phase proteins soon after surgery predict subsequent depressive symptoms, if replicated, extends prior research on the relationships between IL-6, CRP, and depression. Further, this predictive relationship suggests the possibility of early identification of individuals at risk for the subsequent development of post-operative depression.

Patients' reasons for electing to undergo total knee arthroplasty impact post-operative pain severity and range of motion.

The present study examines the reasons cited by 103 patients for their electing to undergo total knee arthroplastic surgery and the relationship between these reasons and their post-operative pain and range of motion. Results suggest that individuals who describe different reasons for undergoing surgery vary in their post-operative recovery. Specifically, patients who cite pain as the reason they are undergoing surgery report greater levels of pain during the early post-operative period. In contrast, patients who describe goals of regaining mobility or a specific activity as their reason for undergoing surgery achieve a greater range of motion during early post-operative physical therapy. Individuals who express avoidance goals for undergoing total knee arthroplasty report more severe post-operative pain at 1 and 3 months following surgery compared to patients who express approach goals. Interventions targeted towards patients reporting pre-operative pain or avoidance goals may decrease subsequent post-operative pain and increase mobility.

Sleep disruptions mediate the relationship between early postoperative pain and later functioning following total knee replacement surgery.

Despite relatively standardized surgical procedures, patients undergoing total knee replacement (TKR) surgery differ dramatically in the speed of their recovery. Previous research has suggested a relationship between the experience of pain and sleep disruptions among patients with chronic pain or those undergoing surgery, such that more severe pain is associated with more frequent awakenings throughout the night. This study examined sleep disruptions 1 month following surgery as a mediator of the relationship between pain 1 month following surgery and functional limitations 3 months following surgery. A total of 110 patients scheduled to undergo unilateral TKR were examined at three time points: 2-3 weeks prior to surgery, 1 month following surgery, and 3 months following surgery. After controlling for presurgical levels of pain, sleep disruptions, and functional limitations, sleep disruptions 1 month following surgery partially mediated the relationship between pain 1 month following surgery and functional limitations 3 months following surgery. The present findings underscore the importance of adequate sleep during postsurgical recovery and suggest that interventions targeting sleep disruptions may improve the speed and quality of patients' recovery from TKR and other surgical procedures.

Zymosan: induction of sickness behavior and interaction with lipopolysaccharide.

The yeast particulate zymosan (Zy) activates innate immune system cells and induces cytokine secretion. There is also evidence that Zy can affect biologic responses to bacterial lipopolysaccharide (LPS) and that the pathways by which these two agents act upon immune cells are only partially distinct. The present experiments assessed the ability of Zy to elicit CNS-mediated sickness symptoms and to alter their responses to LPS. In Experiment 1, Zy induced elements of the sickness behavior syndrome dose-responsively in Long-Evans rats, as indicated by reductions in consumption of a highly palatable bait and in body temperature. In Experiment 2, Zy exerted a priming effect, sensitizing animals to subsequent LPS as measured by reductions in bait consumption, 24-h laboratory chow intake, and body temperature. Experiment 3 failed to provide evidence for LPS-to-Zy cross-tolerance but did indicate that the administration of Zy disrupts previously acquired LPS tolerance. These results suggest that the specifics of exposure to microbially derived innate immune activators have to be taken into account in investigating the biologic bases of sickness behaviors and developing models of coinfection.

Spouses' and physicians' perceptions of pain severity in older women with osteoarthritis: dyadic agreement and patients' well-being.

This study examined agreement between patients and two role partners (spouses and physicians) on patients' pain severity and the relationships between dyadic agreement and patients' well-being. We hypothesized that compared to disagreement between patients and role partners, dyadic agreement would be related to better psychological well-being (more disease-specific self-efficacy and positive affect, and less depression). Participants were 114 older women with osteoarthritis, their caregiving husbands, and their rheumatologists. Among patient-spouse dyads, agreement was associated with better well-being, especially when compared to spouses' underestimation of patients' pain. Contrary to predictions, patient-physician agreement was not related to better patient well-being. Agreement between patients and physicians was associated with less (rather than more) self-efficacy and positive affect when compared to physicians' underestimation of patients' pain.