자연주의적 탐구조사(Naturalistic Inquiry)

A hypothesized need to form and maintain strong, stable interpersonal relationships is evaluated in light of the empirical literature. The need is for frequent, nonaversive interactions within an ongoing relational bond. Consistent with the belongingness hypothesis, people form social attachments readily under most conditions and resist the dissolution of existing bonds. Belongingness appears to have multiple and strong effects on emotional patterns and on cognitive processes. Lack of attachments is linked to a variety of ill effects on health, adjustment, and well-being. Other evidence, such as that concerning satiation, substitution, and behavioral consequences, is likewise consistent with the hypothesized motivation. Several seeming counterexamples turned out not to disconfirm the hypothesis. Existing evidence supports the hypothesis that the need to belong is a powerful, fundamental, and extremely pervasive motivation.

The need to belong: Desire for interpersonal attachments as a fundamental human motivation.

In this article, the author describes a new theoretical perspective on positive emotions and situates this new perspective within the emerging field of positive psychology. The broaden-and-build theory posits that experiences of positive emotions broaden people's momentary thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources. Preliminary empirical evidence supporting the broaden-and-build theory is reviewed, and open empirical questions that remain to be tested are identified. The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.

http://www.elaborer.org/cours/A13/lectures/Fredrickson2001.pdf

The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions.

Numerous studies show that happy individuals are successful across multiple life domains, including marriage, friendship, income, work performance, and health. The authors suggest a conceptual model to account for these findings, arguing that the happiness-success link exists not only because success makes people happy, but also because positive affect engenders success. Three classes of evidence--crosssectional, longitudinal, and experimental--are documented to test their model. Relevant studies are described and their effect sizes combined meta-analytically. The results reveal that happiness is associated with and precedes numerous successful outcomes, as well as behaviors paralleling success. Furthermore, the evidence suggests that positive affect--the hallmark of well-being--may be the cause of many of the desirable characteristics, resources, and successes correlated with happiness. Limitations, empirical issues, and important future research questions are discussed.

/pdf/the-benefits-of-frequent-positive-affect-does-happiness-lead-4k0h6bmoho.pdf

The Benefits of Frequent Positive Affect: Does Happiness Lead to Success?

Background 
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
Objectives 
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data Extraction 
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Results 
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
Conclusions 
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.

Please see later in the article for the Editors' Summary

/pdf/social-relationships-and-mortality-risk-a-meta-analytic-2ghmxi4ksm.pdf

Social Relationships and Mortality Risk: A Meta-analytic Review

Androgen deprivation therapy, particularly in the form of gonadotropin-releasing hormone agonists, is a common therapy for prostate cancer that is used in almost half of all patients over the course of their disease (1,2). This therapy is indicated for the palliation of metastases of prostate cancer and in locally advanced cancer when combined with radiation (3,4). Although the use of androgen deprivation therapy in other settings remains controversial (5), recent studies have shown a dramatic increase in use of androgen deprivation therapy for prostate cancer during the 1990s, even in contexts in which its benefit is unproven or highly improbable (2,6).

Because androgen deprivation therapy is a costly and potentially toxic therapy (7,8), it is important to understand the factors responsible for its use. Growth in the use of androgen deprivation therapy, even when there is weak or no evidence of benefit, indicates that factors other than typical patient and tumor characteristics may be driving its use. One possibility is as stated in Wennberg’s practice style hypothesis (9,10)—that is, when there is uncertainty about the optimal treatment course, use of medical interventions is determined by characteristics of the physician. In other words, the treatment provided depends more on the physician who is treating the patient than on specific characteristics of the patient’s disease. However, previous studies (11–14) that have used multilevel analyses to examine the contribution of the physician to variance in the use of various treatments (i.e., for diabetes or angina) or resources (i.e., hospitalizations or pharmacy expenditures) have found the physician’s contribution to be quite small, generally less than 10%.

To assess the importance of the physician as a determinant of the use of androgen deprivation therapy in prostate cancer, we conducted a multilevel analysis in a large population-based retrospective cohort by use of the Surveillance, Epidemiology and End-Results (SEER)-Medicare linked database (15,16). In particular, we compared the percentage of variance in the use of androgen deprivation therapy that was attributable to patient characteristics with the percentage that was attributable to the physician. Although we acknowledge the difficulties in defining appropriate care, we divided the prostate cancer patients into those for whom androgen deprivation therapy was evidence based (i.e., clinical trials showing survival benefit or improvements in palliation) and those for whom the benefit of androgen deprivation therapy was uncertain (i.e., no clinical trials showing survival benefit, or presence of conflicting data regarding benefits in the literature). We tested the hypothesis that most of the variance in the use of androgen deprivation therapy was attributable to the physician. We also tested the hypothesis that the variance attributable to the physician would be greater for situations in which the benefits of androgen deprivation therapy were uncertain.

/pdf/determinants-of-androgen-deprivation-therapy-use-for-4mw6c3xv3e.pdf

Determinants of Androgen Deprivation Therapy Use for Prostate Cancer: Role of the Urologist

Context.—While the actions of popular figures are believed to influence the behavior
of the general public, including health care decisions, little research has
examined such an effect.Objective.—To determine whether a temporal association exists between use of breast-conserving
surgery (BCS) for treatment of breast cancer and Nancy Reagan's mastectomy
in October 1987.Design/Setting.—Population-based observational cohort study.Patients.—Two sources of data: (1) 82230 women aged 30 years and older who were
included in the Surveillance, Epidemiology, and End Results tumor registry
because of a diagnosis of local or regional breast cancer from 1983 to 1990;
and (2) 80057 female Medicare beneficiaries aged 65 to 79 years who received
inpatient surgery for local or regional breast cancer in 1987 or 1988.Main Outcome Measure.—Percentage of use of BCS vs mastectomy over time.Results.—Compared with women undergoing surgery for breast cancer in the third
quarter of 1987 (just prior to Mrs Reagan's mastectomy), women were 25% less
likely to undergo BCS in the fourth quarter of 1987 (odds ratio [OR], 0.75;
95% confidence interval [CI], 0.66-0.85) and in the first quarter of 1988
(OR, 0.76; 95% CI, 0.67-0.86). In subsequent quarters, the rate returned to
the baseline. In multivariate analyses, the decline was significant among
white but not nonwhite women. It was most prominent among women aged 50 to
79 years in the central and southern regions of the country, and most sustained
among women living in areas with lower levels of income and education.Conclusions.—Celebrity role models can influence decisions about medical care. The
influence appears strongest among persons who demographically resemble the
celebrity, and those of lower income and educational status.

https://jamanetwork.com/journals/jama/articlepdf/187322/joc71811.pdf

Effect of Nancy Reagan's mastectomy on choice of surgery for breast cancer by US women.

Antiinflammatory steroid action: Basic and clinical aspects

Background Among the elderly population, the risk for psychological distress increases with the number of chronic diseases and accompanying functional disability. The prevalence of chronic medical conditions and functional disability varies substantially across ethnocultural groups, however. Using data from the Hispanic EPESE, we previously reported that among older Mexican Americans, the total number of chronic medical conditions and the presence of functional impairment are strong predictors of depressive symptoms. Methods Using multiple regression, we examined the association between specific chronic diseases, individual functional disabilities, and depressive symptoms in this group of ethnic elders. Results Multiple regression models indicated that diabetes (OR = 1.25, 95% CI = 1.03-1.56), arthritis (OR = 1.42, 95% CI = 1.17-1.72), urinary incontinence (OR = 1.94, 95% CI = 1.46-2.59), bowel incontinence (OR = 2.28, 95% CI = 1.15-4.55), kidney disease (OR = 3.11, 95% CI = 1.13-8.58), and ulcers (OR = 2.56, 95% CI = 1.23-5.29) were predictive of high levels of depressive symptoms. Hip fracture, although recognized as having a substantial impact on functional status, was not found to be associated with depressive symptoms. History of stroke was not significantly associated with depressive symptoms in bivariate or multivariate analyses, but history of stroke with residual speech problems was predictive (OR = 2.16, 95% CI = 1.01-4.79). Among specific activities of daily living, only impaired ability to walk across a room (OR = 1.65, 95% CI = 1.04-2.73) or to bathe oneself (OR = 1.87, 95% CI = 1.12-3.12) proved to be predictive in multivariate analyses. Conclusions This constellation of chronic medical conditions and functional disabilities is very different from those reported to be associated with depressive symptoms in older non-Hispanic White and African Americans, and appears to comprise those conditions most associated with substantial physical impairment, pain, and discomfort.

/pdf/the-association-between-chronic-diseases-and-depressive-ox01qujkiq.pdf

The Association Between Chronic Diseases and Depressive Symptomatology in Older Mexican Americans

Background To our knowledge, no detailed analysis exists of the incidence and mortality of hepatocellular carcinoma (HCC) among Hispanics in the United States. In previous studies, the rates for Hispanics have not been reported separately from other racial or ethnic groups. Methods We used information on patients diagnosed as having HCC from 13 registries in the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute to calculate race-specific, age-adjusted incidence rates (AIR) between 1992 and 2002. We also used California and Texas state death records from between 1979 and 2001 to calculate race-specific, age-adjusted mortality rates for liver cancer excluding intrahepatic cholangiocarcinoma. For Hispanics and Asians/Pacific Islanders, the rates were calculated for native-born subjects and immigrants separately. Results In SEER, the yearly AIRs were higher by 1.2-fold in Hispanics than in blacks (6.3 vs 5.0 per 100 000 person-years of the underlying US population) and by 2.7-fold than in non-Hispanic whites (2.4 per 100 000 person-years) but lower than in Asians/Pacific Islanders (10.8 per 100 000 person-years). The median age at HCC diagnosis in Hispanics (64 years) was intermediate between whites (the oldest) and blacks (the youngest). Between the periods 1992-1995 and 2000-2002, there was a 31% increase in the incidence of HCC in Hispanic men and a 63% increase in Hispanic women. The race-specific, age-adjusted mortality rates were remarkably similar in California and Texas and were highest in immigrant Asian/Pacific Islanders followed by native Hispanics. The rates for native Hispanic men were more than twice as high as those for immigrant Hispanic men. For Texas, the rates for native Hispanic men were 65% higher than those for immigrant Hispanic men. Conclusion Hispanics in the United States have high rates of HCC that are second only to Asians/Pacific Islanders.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/413204/ioi70125_1983_1989.pdf

James S. Goodwin

Papers

Determinants of Androgen Deprivation Therapy Use for Prostate Cancer: Role of the Urologist

Effect of Nancy Reagan's mastectomy on choice of surgery for breast cancer by US women.

Antiinflammatory steroid action: Basic and clinical aspects

The Association Between Chronic Diseases and Depressive Symptomatology in Older Mexican Americans

Epidemiology of Hepatocellular Carcinoma in Hispanics in the United States