The relationship between stress and health care use: an investigation of the buffering roles of personality, social support and exercise.

The main and interactive effects of social support, physical exercise, and personal hardiness on objective measures of health were investigated using a longitudinal research design. Data were collected from 192 working adults. Results showed main effects for hardiness and exercise on the dependent variables of health care costs and the number of health insurance claims filed. Hardiness appeared to be associated with fewer health problems. Contrary to prediction, those who exercised more appeared to have greater health care use. Three-way interactions suggested that health care use was lowest for those high in all three resistance resources: exercise: hardiness: and social support. But, the converse of this reasoning, that absence of these resources is associated with higher levels of illness, was not entirely supported. The interactions suggested that hardiness in the absence of exercise and social support was associated with the highest health care costs. The highest number of claims was apparent for those exhibiting hardiness and exercise. Thus, the presence of exercise, hardiness, and social support seemed to decrease health care use, but the factors contributing to greater health costs and claims were more complicated to interpret.

AIDS knowledge and attitudes of health-care workers in Mexico.

AIDS threatens to spread rapidly in Mexico. In the present study, results of a survey of 204 Mexican employees in hospitals and doctors' offices indicated that those health-care workers were largely knowledgeable about the illness. A majority were willing to provide AIDS care, although they feared contagion. Multiple regression analyses indicated that (a) attitudes toward high-risk groups (intravenous drug users and homosexuals) and (b) fear of contagion were both related to intentions to provide care to AIDS patients.

PIP: A survey conducted in Ciudad Juarez, in the Mexican state of Chihuahua, investigated health care workers' (HCWs) AIDS knowledge, attitudes, and willingness to provide care to AIDS patients. Questioned were 171 HCWs employed in a public charity hospital and 33 from private physicians' offices. 24% of respondents were nurses and 22% were doctors; mean age was 28 years. On average, respondents answered 82% of the AIDS-related knowledge items correctly and 76% felt their education had prepared them to treat AIDS patients. Despite widespread awareness of the modes of HIV transmission and the universal precautions, 87% expressed concern about becoming infected with HIV through patient care. 81% indicated they were willing to treat AIDS patients. Most HCWs had positive (19%) or neutral (53%) attitudes toward homosexuals, but 44% expressed negative attitudes toward intravenous drug users. Multiple regression analysis found that attitude toward high-risk groups and fear of contagion, but not knowledge, were related to behavioral intention to provide AIDS care. This finding is consistent with research indicating that knowledge-based programs that fail to address the affective component of AIDS care are insufficient for changing AIDS care intentions and behaviors. Overall, AIDS patients in the border areas of Mexico, appear to be receiving more effective treatment than those in parts of the country with lower AIDS prevalence. Reports from the latter areas allege incidents of refusal to provide medical care to AIDS patients or the provision of substandard care.

Occupational stress, social support, and the costs of health care.

Relationships among health care costs, social support, and occupational stress are investigated. Health care cost data were collected over two years for 260 working individuals. Multiple regression analyses were used to control for initial health care costs, age, and gender in predicting later costs; independent variables were stress, strain, social support, and their interactions. Main effects and interactions each accounted for significant proportions of the variance in various health care costs.

Occupational stress and health care use.

This study investigated the relationship between health care use and (a) stressful work events; (b) strain; (c) social support; (d) type of job and industry; and (e) the individual characteristics of control, commitment, and length of time in position. A sample of 260 individuals (95 men, 165 women) from two different industries was used. Correlational analyses suggested that health care claims and costs were positively related to stressful work events and strain and negatively related to employees' length of time in position. Industry type also played a role in predicting the health care variables. Multivariate analyses suggested that environmental, stressor, and strain variables accounted for up to 16% of the variance in health care costs and 21.5% of the variance in number of health care claims.

An examination of methodological issues in burnout phase research.

This study explores the impact of three operationalizations of burnout phase on the relationship between burnout and health care utilization of 238 employed adults. Burnout was measured by the Maslach Burnout Inventory and health care utilization by insurance company records regarding these employees' health care costs and number of times they accessed health care services over a one-year period. Similar results were found for all three operationalizations of burnout phase. Burnout phase was also found to be related to experienced emotional strain under all three operationalizations.

Burnout and health care utilization.

This study explores the relationship between burnout and health care utilization of 238 employed adults. Burnout was measured by the Maslach Burnout Inventory and health care utilization by insurance company records regarding these employees' health care costs and number of times they accessed health care services over a one year period. ANOVAs were conducted using Golembiewski and Munzenrider's approach to define the burnout phase. Significant differences in health care costs were found.

Analysis of prognostic variables in hyperthermia treatment of 161 patients.

From 1977-1982, 161 patients were treated using hyperthermia as an adjuvant in Phase I trials. Microwave applicators (MW), capacitively coupled plates (RF plates), interstitial localized current fields (LCF), and magnetic induction heating (MI) techniques were used together with radiation in 135 patients, with chemotherapy in 10 patients, and alone in 16 patients. Tumor volume response categories were no response (NR, less than 50% decrease); partial response (PR, 50% less than or equal to volume decrease less than 100%); and complete response (CR, complete disappearance). The CR rates and total response rates (CR + PR) were 38/160 (24%) and 90/160 (56%), respectively. There were highly significant differences among techniques in CR vs PR + NR (p = .001), and in CR + PR vs NR (p less than .0005). Response did not vary significantly with histologic category. Overall toxicity was 16%, and did not vary significantly with technique (p = .193). In the patient group treated with hyperthermia and radiation, multivariate analysis revealed that a set of three variables had prognostic importance for CR: technique (p = .011), radiation dose (p = .019), and tumor volume (p = .001, negatively correlated). A good correlation also existed between CR and the minimum tumor temperature averaged over all treatments, TMIN (p less than .0005). Temperature variables themselves were correlated with tumor volume. Minimum T correlated negatively with volume (p = .017) and TMAX correlated positively with volume (p = .026). In fewer than 50% of patients could minimum T greater than 40.7 degrees C be achieved. Our conclusions are: TMIN, tumor volume, radiation dose, and heating technique have prognostic value for initial response; variation in CR vs technique reflects variation in tumor volume treated and in minimum temperature achieved with these techniques; and acute toxicity of treatment is infrequent, but serious toxicity is possible with the interstitial technique.

Merging hospitals and physician support.

This study gives empirical documentation of physician support for a recent hospital merger. Results indicated that physicians from private practice, from the medical specialty of anesthesiology, and those least satisfied with hospital administration were also the least supportive of the merger. Formal involvement in the merger process, via task force membership, did relatively little to increase physician support for the merger. However, a significant correlation between perceived input into the merger process and support for the merger indicates positive aspects of involvement, even though this may not have occurred through the formal structure of task forces. Implications for managing physicians and hospital mergers is discussed.

Dose-rate dependence of heat radiosensitization.

The dose rate dependence of heat radiosensitization was studied using rat astrocytoma cells in culture and a clinically relevant protocol of heat dose and heat radiation sequence. Cells were treated with a minimally toxic heat dose of 43 degrees C for 30 minutes, after which they were irradiated with varying doses of radiation at dose rates ranging from 0.567 to 300 cGy/min. This heat dose substantially reduced the extrapolation number (n), but had little effect on Do of the radiation survival curve at dose rates of 50 cGy/min or greater. At dose rates less than 10 cGy/min, 43 degrees C for 30 min had little effect on n and only for the lowest dose rate studied (0.567 cGy/min) was there a significant reduction in Do (60%). The thermal enhancement ratio did not vary inversely with radiation dose rate over the dose rate range studied but, instead, was maximal at the two dose rate extremes (0.567 and 300 cGy/min). These data demonstrate that a clinically relevant heat dose enhances very low dose rate, as well as high dose rate, ionizing radiation, but suggest that little benefit is to be gained from using dose rates intermediate between conventional radiotherapeutic high dose rates or dose rates representative of interstitial implants.

Hyperthermia by magnetic induction: II. Clinical experience with concentric electrodes.

Thirty-one patients with visceral or extensive superficial malignant tumors of various histologies and sites have been evaluated for our hyperthermia protocols employing magnetic induction at 13.56 MHz with concentric electrodes associated with a commercially available device. Response data in patients completing combined hyperthermia and radiation treatment was difficult to analyze because of the short survival of these patients with advanced disease. Acute toxicity, however, was limited to 2/31 patients with minor skin blistering from excessive superficial heating. In this report we focus on clinical thermometric results. In 6/31 (19%) of patients, portions of the tumor achieved greater than or equal to 42.5 degrees C. In 3/31 (10%), nearly all the tumor achieved greater than or equal to 42.5 degrees C. Those tumors successfully heated to greater than or equal to 42.5 degrees C throughout were relatively superficial. In 22/31 (71%), temperature greater than or equal to 42.5 degrees C were not achieved at any measured site. Maximum applied power levels were limited by development of painful superficial hot spots in 21/31 (68%), by diffuse discomfort or systemic intolerance in 9/31 (29%), by maximum power output from the generator in 1/31, or by other factors in 2/31 patients. Some patients had both local and systemic discomfort that limited power levels. Based upon analysis of the thermometric results, we discuss the anatomic sites and tumor depths for which this technique is most applicable.

Interstitial thermoradiotherapy.

The results of a phase I clinical trial in which heat was combined with interstitial (low dose rate) radiation are described with emphasis on response and technical and physical aspects of heating. We treated 25 patients (27 lesions) using interstitial implants to locally recurrent, accessible tumors heated by radiofrequency currents to 43 degrees -45 degrees C for 30 minutes, with needle guides as electrodes. They were subsequently irradiated with either 192Ir or 226Ra. All patients had failed previous conventional treatments including surgery, chemotherapy, and, in most, near tolerance doses of irradiation. In all but one, a single hyperthermic treatment was given and the average dose of low dose irradiation was under 3,000 rad over 60 hours. No patient failed to respond, 63% achieved a complete disappearance of tumor in the treated volume, and 37% had partial response (50% less than volume reduction less than 100%). Duration of response was from 2 to 30 months, and no patient showed regrowth at the site treated. Normal tissue complications were minimal. Interstitial thermoradiotherapy is both a safe and an effective means of treatment in advanced or recurrent accessible disease.

Clinical hyperthermia: results of a phase I trial employing hyperthermia alone or in combination with external beam or interstitial radiotherapy.

Forty-three patients with advanced, locally accessible neoplasms were treated in a Phase I clinical trial employing hyperthermia alone or hyperthermia combined with either high-dose-rate external beam or low-dose-rate interstitial radiotherapy (interstitial thermoradiography). All patients had failed previous conventional therapeutic attempts, including various combinations of surgery, chemotherapy and radiation therapy. Many had received tolerance or near tolerance levels of prior radiation that restricted dose prescriptions in this trial to subcurative values. A number of tumors with different histologies were treated, including squamous cell carcinoma (14), adenocarcinoma (14), melanoma (8), malignant fibrous histiocytoma (2), and sarcoma (5). The response evaluation criteria used included no response (NR--less than 50% decrease in tumor volume), partial response (PR--50% less than or equal to tumor volume reduction less than 100%) and complete response (CR--complete tumor disappearance). For all tumor types, hyperthermia therapy alone resulted in a total response rate of 45% (27% PR, 18% CR). Hyperthermia combined with high-dose-rate external beam radiotherapy yielded a total response rate of 80% (53% PR, 27% CR). Seventeen patients treated with interstitial thermoradiography displayed a 100% total response rate (29% PR, 71% CR). By tumor histologies for all treatment groups, total response rates have ranged from 50% to 79% for all types except melanoma, which has shown a 100% (8/8) response rate to date. Response durations have varied from one to 24 months. Twelve of the 43 patients remain alive; three have no evidence of disease (NED) while nine have either stable local disease or are NED in the treated volumes but have metastatic disease. Complications have been minimal and have included one third-degree burn and three second-degree burns from fringing RF fields, one vaginal-rectal fistula, a superficial focal soft tissue necrosis, and some minor blistering. The results of this Phase I trial demonstrate that hyperthermia alone or combined with radiation can be safely applied in the treatment of malignant disease. Most importantly, the data suggest that hyperthermia, especially when combined with interstitial thermoradiography, can yield remarkable results in the eradication of local cancers.

Adriamycin/cis-platinum/cyclophosphamide combination chemotherapy for advanced carcinoma of the parotid gland.

Five patients were treated with a combination of Adriamycin/cis-platinum/cyclophosphamide for far-advanced and/or recurrent cancer of the salivary gland. Adriamycin, 40 mg/m2, and cis-platinum, 50 mg/m2, were given on day 1; cyclophosphamide, 200 mg/m2 daily for four days, was given by mouth on the third to sixty day of each monthly therapy course. Two patients achieved a complete remission, each lasting five months, and the three others had partial remissions from one to seven months (median six months) in duration. Therapy was well tolerated. Severe nausea and vomiting occurred on the first day of therapy but was self-limited. There was only mild to moderate leukopenia, no significant thrombocytopenia or elevations of serum creatinine, and no evidence of dose-limiting peripheral neuropathy. Adriamycin/cis-platinum/cyclophosphamide chemotherapy appears to be effective in the treatment of advanced parotid gland cancers.

Effects Of Role Conflict On Selected Physiological, Affective, And Performance Variables: A Laboratory Simulation.

A simulation methodology was employed to assess the cause and effect relationship between role conflict and selected physiological, affective, and performance measures. Multivariate analyses showed that these selected measures do differentiate between individuals exposed to conditions of role conflict and no role conflict. The study indicates the importance of utilizing interdisciplinary dependent measures and supports the use of simulation methodology in studying organizational stress.