Assessing the quality of reports of randomized clinical trials : is blinding necessary?

Adjustment to threatening events: A theory of cognitive adaptation.

The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.

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Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry

Epstein-Barr virus.

The notion that chronic stress fosters disease by activating the hypothalamic-pituitary-adrenocortical (HPA) axis is featured prominently in many theories. The research linking chronic stress and HPA function is contradictory, however, with some studies reporting increased activation, and others reporting the opposite. This meta-analysis showed that much of the variability is attributable to stressor and person features. Timing is an especially critical element, as hormonal activity is elevated at stressor onset but reduces as time passes. Stressors that threaten physical integrity, involve trauma, and are uncontrollable elicit a high, flat diurnal profile of cortisol secretion. Finally, HPA activity is shaped by a person's response to the situation; it increases with subjective distress but is lower in persons with posttraumatic stress disorder.

If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans.

Perhaps for too long a time, psychiatrists have drawn their conclusions about behavior from the study of "patients" or deviants. Research on reactions to stress situations attempts to redress this imbalance by paying attention also to persons who handle life's contingencies well. The present paper reports observations on the adaptional behavior of 46 parents of 27 children under treatment for leukemia or other malignant diseases, carried out over a period of approximately 2 years at the Clinical Center of the NIH. Although each parent reacted to the stresses to which he was exposed in a unique and individual manner, a fairly uniform "natural history" of the sequence of adaptational techniques employed by the group as a whole could be observed and is summarized in the paper. The psychic instrumentalities responsible for the stages in this process are conceptualized as coping strategies which are either aided by personality defenses operating within an optimum range or interfered with by defenses when these...

Stress, defenses and coping behavior: observations in parents of children with malignant disease

Objective. —To study whether reviewers aware of author identity are biased in favor of authors with more previous publications. Design. —Randomized controlled trial. Setting. —Editoria office of theJournal of Developmental and Behavioral Pediatrics. Participants. —Two "blinded" and two "nonblinded" reviewers assigned to 57 consecutive manuscripts submitted between September 1991 and March 1992. Outcome Measures. —Spearman rank correlation coefficients were used to compare the sum of rating scores of 1 to 5 (1, accept; 5, reject) given by the two blinded reviewers, the two nonblinded reviewers, and the editors to the number of articles published previously by the first and senior authors (as determined from requested curricula vitae). Blinded reviewers were sent a questionnaire asking whether they could determine the identity of the authors, how they knew, and whether they thought blinding changed the quality or difficulty of their review. Results. —The Wilcoxon Sign Rank Test disclosed no differences between blinded and nonblinded scores. The number of previous articles by the senior author was significantly correlated (P Conclusions. —Blinded reviewers and editors in this study, but not nonblinded reviewers, gave better scores to authors with more previous articles. These results suggest that blinded reviewers may provide more unbiased reviews and that nonblinded reviewers may be affected by various types of bias. (JAMA. 1994;272:143-146)

The Effects of Blinding on Acceptance of Research Papers by Peer Review

Adjustment of 42 children with chronic arthritis and an equal number of healthy children selected as matched controls were studied by three methods—parental, school, and individual psychological ratings. Children with arthritis were identified as having more psychological problems than the control group. It is suggested from this study that children with arthritis, but with no disability, may have more emotional problems than the disabled child with arthritis and more than a control group. Psychosocial evaluation and support are suggested as a routine part of outpatient services for arthritic children and their families, and some methods from this study may be applicable for this purpose.

Psychological Problems of Children With Chronic Juvenile Arthritis

&NA; Rats were subjected to one of six intensities of electric shock administered for 30, 60, 120, or 240 sec., and then sacrificed immediately or 5, 15, or 60 min. later. Plasma corticosterone levels were determined and compared to values obtained from both unmanipulated controls and “handled” rats. It was found that merely placing the animals in the experimental cage increased corticosterone levels, and these levels were further elevated as shock intensity and duration were increased.

Plasma corticosterone response to parameters of electric shock stimulation in the rat

Psychological evaluation of 43 families, each with a child with cystic fibrosis, is reported. Personality testing of the parents showed that 32% of the fathers and 22% of the mothers obtained scores in the range suggestive of emotional disturbance. The Family-Concept O Sort assessment of family interaction indicated that the primary effect of having a child with cystic fibrosis was in terms of decreased family satisfaction and family adjustment. The results do not support previous estimates of an increased incidence of emotional disturbance in children with cystic fibrosis. Evidence for negative psychological impact of chronic illness on sibling development was also lacking. Future research would benefit from a focus on the strengths and resilience of children with cystic fibrosis and their families.

Stanford B. Friedman

Papers

Stress, defenses and coping behavior: observations in parents of children with malignant disease

The Effects of Blinding on Acceptance of Research Papers by Peer Review

Psychological Problems of Children With Chronic Juvenile Arthritis

Plasma corticosterone response to parameters of electric shock stimulation in the rat

Children With Cystic Fibrosis: I. Psychological Test Findings of Patients, Siblings, and Parents