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Hypnosis modulates pain perception but the associated brain mechanisms in chronic pain conditions are poorly understood. Brain activity evoked by painful repetitive pin-prick stimulation of the left mental nerve region was investigated with use of fMRI in 19 patients with painful temporomandibular disorders (TMD) during hypnotic hypoalgesia and hyperalgesia and a control condition. Pain intensity and unpleasantness of the painful stimulation was scored on a 0-10 Numerical Rating Scale (NRS). NRS pain and unpleasantness scores during hypnotic hypoalgesia were significantly lower than in the control condition and significantly higher in the hypnotic hyperalgesia condition. In the control condition, painful stimulation caused significant activation of right posterior insula, primary somatosensory cortex (SI), BA21, and BA6, and left BA40 and BA4. Painful stimulation during hypnotic hyperalgesia was associated with increased activity in right posterior insula and BA6 and left BA40 whereas hypnotic hypoalgesia only was associated with activity in right posterior insula. Unexpectedly, direct contrasts between control and hypnotic hyperalgesia conditions revealed significant decreases in S1 during hyperalgesia. Direct contrasts between control and hypnotic hypoalgesia conditions demonstrated significant decreases in right posterior insula and BA21, as well as left BA40 during hypoalgesia. These findings are the first to describe hypnotic modulation of brain activity associated with nociceptive processing in chronic TMD pain patients and demonstrate that hypnotic hypoalgesia is associated with a pronounced suppression of cortical activity and a disconnection between patient-based scores and cortical activity in S1 during hypnotic hyperalgesia.

The purpose of this study was to investigate the association between repressive coping style and Acute Stress Disorder (ASD) in a sample of cancer patients. A total of 112 cancer patients recently diagnosed with cancer participated in the study. ASD was assessed by the Stanford Acute Stress Reaction Questionnaire, and repressive coping was assessed by a combination of scores from the Marlowe-Crowne Social Desirability Scale, and the Bendig version of the Taylor Manifest Anxiety Scale. Significantly fewer patients classified as "repressors" were diagnosed with ASD compared to patients classified as "non-repressors". However, further investigations revealed that the lower incidence of ASD in repressors apparently was caused by a low score on anxiety and not by an interaction effect between anxiety and defensiveness. Future studies have to investigate whether different psychological mechanisms are responsible for the lower incidence of ASD in repressors and true low-anxious patients.

Udgivelsesdato: 2 dec. 2009 INTRODUCTION: Idiopathic environmental intolerance (IEI) is characterized by non-specific symptoms attributed to exposure to environmental odours or chemicals at levels below those known to induce adverse health effects. A clarification of whether psychological processes involved in sensory perceptions are associated with IEI would add to our understanding of this complex disorder. PURPOSE: To examine if measures of somato-sensory amplification, autonomic perception and absorption are associated with IEI. METHODS: The study included individuals with self-reported or physician-diagnosed IEI. Participants (n = 732) completed questionnaires that included items on descriptive variables of IEI, the Somato-Sensory Amplification Scale (SSAS), the Autonomic Perception Questionnaire (APQ), the Tellegen Absorption Scale (TAS) and a Negative Affectivity Scale (NAS). RESULTS: Multiple, hierarchical linear regression analyses revealed significant positive associations between SSAS, APQ, and IEI, while small and inverse associations were seen between TAS and IEI. CONCLUSIONS: The association with SSAS and APQ suggests that perceptual personality characteristics are important in understanding this disorder

Purpose A growing number of patients with testicular cancer (TC) become long-term survivors. As a consequence, quality-of-life (QOL) issues become increasingly important. The objective of this study was to investigate QOL among Danish TC survivors. Methods A long-term follow-up assessment of all patients with TC treated at Aarhus University Hospital in Denmark between 1990 and 2000 was conducted. A total of 401 survivors (response rate, 66%) completed questionnaires concerning QOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30), depression (Beck Depression Inventory-II), fatigue (Multidimensional Fatigue Inventory-20), and health-related issues such as neurotoxic symptoms and Raynaud-like phenomena. On the basis of their treatment, participants were categorized as having received surveillance, radiotherapy, or chemotherapy. Results QOL among patients with TC was equal to that of men from the general population. Although patients who received chemotherapy reported higher levels of peripheral sensory neuropathy, ototoxicity, and Raynaud-like phenomena, treatment strategies were generally unrelated to QOL and depressive symptoms. Conclusion Overall, the patients in this study reported high levels of QOL. The results suggest that patients treated for TC should be informed about the anticipated good post-therapeutic QOL and the low risk of psychosocial and physical long-term effects.

Udgivelsesdato: 2009-Sep-1 BACKGROUND:: This study aimed to evaluate prevalence and risk factors for emotional and behavioral problems in dependent children of cancer patients using a multinational research design. METHODS:: The sample comprised 350 ill parents, 250 healthy partners, and 352 children. Parents assessed the child's psychological functioning using the Child Behavior Checklist, parental depression using the Beck Depression Inventory, family functioning using the General Functioning subscale of the Family Assessment Device, quality of life using short-form questionnaire, and adolescents (N = 168) self-reported psychological functioning using the Youth Self Report. RESULTS:: Children and adolescents, in particular latency-aged boys and adolescent girls, were of higher risk of psychosocial problems than norms. There was a higher risk of problems when the father was ill than when the mother was ill, but it remains unclear whether this difference was due to the different diagnoses of fathers and mothers, gender or other factors. The best predictor of internalizing problems in children and adolescents was parental depression, and the best predictor of externalizing problems in children and adolescents was family dysfunction. CONCLUSIONS:: The results indicate the need for a family-oriented approach to psychological support of cancer patients. Cancer 2009. (c) 2009 American Cancer Society.

Udgivelsesdato: 2009-Jun-18 The estimated prevalence of insomnia in cancer patients varies between 20% and 50%, which is substantially higher than the general population. To date, little is known about the risk factors for insomnia in patients with cancer. This study examines the prevalence and predictors of insomnia in a population-based sample of women with ovarian cancer. Participants were 772 women participating in the Australian Ovarian Cancer Study - Quality of Life Study. Insomnia was assessed using the Insomnia Severity Index (ISI). Demographic, disease and treatment variables, and psychosocial variables, including anxiety and depression, support care needs and social support and coping, were investigated as potential predictors of insomnia. Twenty-seven percent of women reported sub-clinical symptoms of insomnia (ISI score 8-14) and 17% reported clinically significant insomnia (ISI score 15-28). Three variables were significant predictors of clinically significant insomnia: young age (

The purpose was to analyse 1) whether fatigue is related to physical functioning and utilization of health services at one-year follow-up in a young and old sample and 2) to compare the results of two different measures of fatigue.The study is a longitudinal cohort study based on 182 young (age 20-35) and 199 older (age 70-85) community-dwelling individuals recruited from nine general practitioners in Aarhus, Denmark. Physical functioning was measured by the physical health scale from the SF-12-questionnaire. Data on health care utilization were extracted from the county's central register during one year. Fatigue was measured as Vitality-Tiredness by a question from the SF-12 questionnaire and Mobility-Tiredness by the Avlund Mobility-Tiredness Scale on fatigue in six daily activities.The predictive value of the two measures varied by the age of the participants. The Vitality-Tiredness Scale was related to the outcome measures in both samples, while the Mobility-Tiredness Scale was only predictive in the old population. In the young sample the associations were attenuated by the covariates, while the estimates in the old sample remained strong and significant in the adjusted analyses.Fatigue is related to subsequent physical functioning and use of health services at one year follow-up, both in young and old individuals.

Cancer patients frequently report cognitive complaints following chemotherapy, but the results from the available studies, mainly of women with breast cancer, are inconsistent. Our aim was to compare cognitive function of men with testicular cancer (TC) who had orchiectomy and chemotherapy (bleomycin, etoposide, cisplatin) with men who had orchiectomy only or orchiectomy and radiotherapy. Thirty-six chemotherapy patients and 36 nonchemotherapy patients were tested 2–7 years after treatment for TC with standardized neuropsychological tests. Chemotherapy and nonchemotherapy patients displayed similar performances on cognitive tests (p values adjusted for multiple comparisons: .63–1.00). Moreover, there was no difference in the proportion of cognitively impaired patients in the chemotherapy group (5.6%) compared to the nonchemotherapy group (8.3%) (χ2 = 0.22, p = .64). Our results are discordant with previous findings indicating cognitive impairment following chemotherapy and suggest that TC patients do not need to fear long-term cognitive consequences following chemotherapy. (JINS, 2009, 15, 296–301.)

Background Elevated levels of depressive symptoms are generally found among cancer patients, but results from existing studies vary considerably with respect to prevalence and proposed risk factors. Purpose To study the prevalence of depressive symptoms and major depression 3–4 months following surgery for breast cancer, and to identify clinical risk factors while adjusting for pre-cancer sociodemographic factors, comorbidity, and psychiatric history. Patients and methods The study cohort consists of 4917 Danish women, aged 18–70 years, receiving standardized treatment for early stage invasive breast cancer during the 2 1/2 year study period. Of these, 3343 women (68%) participated in a questionnaire study 12–16 weeks following surgery. Depressive symptoms (Beck’s Depression Inventory II) and health-related behaviors were assessed by questionnaire. The Danish Breast Cancer Cooperative Group (DBCG) and the surgical departments provided disease-, treatment-, and comorbidity data for the study cohort. Information concerning sociodemographics and psychiatric history were obtained from national longitudinal registries. Results The results indicated an increased prevalence of depressive symptoms and major depression (13.7%) compared to population-based samples. The pre-cancer variables: Social status, net-wealth, ethnicity, comorbidity, psychiatric history, and age were all independent risk factors for depressive symptoms. Of the clinical variables, only nodal status carried additional prognostic information. Physical functioning, smoking, alcohol use, and BMI were also independently associated with depressive symptoms. Conclusion Risk factors for depressive symptoms were primarily restricted to pre-cancer conditions rather than disease-specific conditions. Special attention should be given to socio-economically deprived women with a history of somatic- and psychiatric disease and poor health behaviors.

This study investigated the effect of hypnosis in patients with temporomandibular disorders (TMD) with focus on oral function and psychological outcomes. Forty women (mean age +/- s.d.: 38.6 +/- 10.8 years) suffering from TMD (mean duration 11.9 +/- 9.9 years) were randomized to four individual 1-hour sessions of either hypnotic intervention or a control condition of simple relaxation. Pain intensity was assessed three times daily on a 0-10 Numerical Rating Scale. Additional outcomes were TMD-associated symptoms assessed by the Research Diagnostic Criteria examination form and questionnaire, psychological symptoms (Symptom Check List 60), pain coping strategies (Coping Strategies Questionnaire), sleep difficulties (Pittsburgh Sleep Quality Index) and use of analgesics. Data were analyzed with between-groups within-subjects anovas. The hypnosis group significantly reduced the daily NRS pain scores from 4.5 +/- 2.1 at baseline to 2.9 +/- 2.4 after treatment (P < 0.001) compared to the control group where no significant changes were found (4.2 +/- 1.4 to 3.9 +/- 1.5) (P = 0.733). Number needed to treat for a 50% pain reduction was 4.0. The hypnosis group also increased use of the coping strategy 'reinterpreting pain sensations' from 5.2 +/- 6.9 to 10.3 +/- 6.8 (P < 0.001). Both groups exhibited significant reductions in the number of painful muscle palpation sites and pain on palpation (P < 0.004), in number of awakenings due to pain (P < 0.006), and in somatization, obsessive compulsive symptoms and anxiety (P < 0.004). Hypnosis thus appears to effectively reduce some aspects of complex TMD pain.

This preliminary study examined whether posttraumatic stress disorder (PTSD) was related to difficulties in identifying the mental states of others in a group of refugees. Sixteen Bosnian refugees, referred to treatment in an outpatient treatment center for survivors of torture and war-related trauma in Denmark (CETT), were compared to 16 non-PTSD Bosnian refugees and 50 non-PTSD Danish volunteers. PTSD was assessed by the Harvard Trauma Questionnaire and a clinical interview, and the ability to identify mental states was tested using the Reading the Mind in the Eyes Test (revised version) (Eyes Test). PTSD was found to be associated with lower scores on the Eyes Test, supporting the hypothesis that PTSD is related to an impaired ability to recognize displays of mental states as expressed by the eyes. We discuss the limitations of the study and implications for future research and therapeutic strategies.

Objective The predictive value of perceived risk of breast cancer has previously mainly been compared to statistical risk models. We aimed to compare the women's perceived risk with the observed risk of a breast cancer diagnosis. Methods Women referred to mammography at a Danish public hospital ( N =1021) were asked to complete a questionnaire about 2 weeks before the examination. The women were asked to rate their perceived risk of having breast cancer on a six-point scale with the anchor points very low risk (1) and very high risk (6). The perceived risk was compared with the diagnosis from the mammography 1–3 weeks later. Multivariate logistic regression was used to adjust for age, category of referral, family history of breast cancer, and previous mammography. Results The questionnaire was completed by 665 (65%) of the women. Compared to women without breast cancer, a larger percentage of women with breast cancer had estimated their risk as high. The risk difference was 16.5% (95% CI 2.5–30.6), using a cut-off between 4 and 5 on the six-point scale. The odds ratio was 3.6 (95% CI 1.4–8.9) after adjustment for age, category of referral, family history of breast cancer, and previous mammography. The sensitivity, specificity, and predictive value were 0.17, 0.96, and 23%, respectively. Conclusion Women who rated their risk as high had a statistically significant increased risk of having a breast cancer diagnosed at the subsequent mammography. The odds ratio based on the women's risk perceptions remained of the same magnitude after adjustment for category of referral, suggesting that information given by the women contains independent predictive value.

Udgivelsesdato: 2009-Jun Age differences in emotional control and their consequences were examined in women referred to mammography on the suspicion of breast cancer but with benign results of the examination. Under natural experimental conditions, the levels of emotional control and distress were measured 1 week prior to the examination as well as 4 and 12 weeks after the examination in 717 younger women (ages 19-39), middle-aged women (ages 40-59), and older women (ages 60-85). A higher level of emotional control was found in the older women; this indicates that, in these birth cohorts, emotion-focused coping is more prevalent in old age than in young adulthood, even when similar stressors are experienced. The analyses revealed an interaction between age and emotional control; higher levels of control were related to a reduction in distress during the course of the study in older women, whereas emotional control was unrelated to changes in distress in younger and middle-aged women. The findings support the life span theory of control, which suggests that secondary control strategies are more adaptive in old age.

Udgivelsesdato: 2009-Dec Since the early 1980s, the interdisciplinary field of psychoneuroimmunology has explored the complex bi-directional interactions between brain, behavior, and the immune system. Taken together, this research has expanded the limits of the questions we can ask about the organism by challenging the biomedical paradigm of the immune system as predominantly "autonomous". Psychoneuroimmunology has played a key role in establishing a biological basis for the ancient idea that the mind can play a role in health and disease. This article describes the development of psychoneuroimmunology and reviews a number of key findings concerning psychological phenomena of potential relevance to understanding brain-behavior-immune interactions, including learning, emotions, stress, and the role of sensory processes.

In a number of studies it has been shown that psychological factors in general and specifically emotional factors can be correlated to changes in immunological function and defence mechanisms. Although the mediating pathways between the central nervous system and the immune system still remain unclear, it is known that some of the 'classical stress hormones' such as cortisol and catecholamines have modulatory effects on different immunological parameters. In this investigation we wished to study the effect of brief hypnotically induced emotional states on monocyte chemotaxis and endocrinological parameters. Eleven highly hypnotically susceptible volunteers were, while in a deep trance, given suggestions to re-experience earlier life experiences involving intense anger and depression in random order. Before concluding hypnosis subjects were given suggestions to re-experience a feeling of happiness and well-being. Monocyte chemotactic activity in sera and serum levels of cortisol, as well as venous plasma levels of the catecholamines epinephrine, norepinephrine, DOPA and DOPAC, were measured before hypnosis, after each emotional state and immediately after hypnosis. The results showed a significant differences (P less than 0.02) in chemotactic activity between the angry and the depressed emotional states, the depressed state exhibiting a decreased chemotactic index compared with the angry state. Chemotactic index after the happy relaxed emotional state also showed a significant (P less than 0.01) increase compared with both chemotactic index before hypnosis and chemotactic activity after the angry and depressed state. Though there were significant differences between emotions and between emotions and the before-hypnosis-condition, no clear-cut significant differences between the emotional states of anger and depression could be detected for serum cortisol levels and catecholamine plasma levels. Significant positive correlations (P less than 0.01) for differences in chemotactic activity and differences in plasma DOPA levels between emotional states was found. When investigated in vitro, DOPA did not in itself exhibit monocyte chemotactic properties. No other significant correlations between differences in chemotactic activity and other endocrinological parameters could be detected. Soluble interleukin-2 receptors in serum were also measured. No significant differences were found.

Objective: A number of cross-sectional studies have reported reduced cognitive function incancer patients receiving chemotherapy compared with other cancer patients and healthycontrols, suggesting that chemotherapy could be associated with cognitive side-effects. Recentlypublished prospective studies question this hypothesis, but it is still unclear whether cancerpatients should regard cognitive problems as a potential risk when receiving chemotherapy.Methods: In the present study we examine whether cancer patients (n534) receivingchemotherapy differed in cognitive changes during treatment compared with cardiac patients(n512) and healthy controls (n512) tested at 3–4 months interval.Results: Our results showed no differences with respect to changes in cognitive performanceover time between cancer patients in chemotherapy, cardiac patients, and healthy controls. Inaddition, the number of individuals showing reliable decline or improvement on cognitive testsdid not differ between groups.Conclusion: Taken together, our results do not support a hypothesis of cognitive side-effectsof standard-dose chemotherapy in breast cancer patients.Copyright r 2008 John Wiley & Sons, Ltd.Keywords: cancer; oncology; chemotherapy; cognitive side-effects; cognitive tests

The subjective dimensions of pruritus and their associations with psychological symptoms and quality of life were explored in a sample of 40 psoriasis patients. The patients completed a scale with descriptors from the Structured Itch Questionnaire together with measures of depression, distress, sleep quality and pruritus-related quality of life. Psoriasis severity was assessed with the Psoriasis Area and Severity Index. Factor analysis of descriptors confirmed both an affective and a sensory pruritus severity dimension. Multivariate statistics, controlling for age, gender, disease duration and severity, showed affective, but not sensory, pruritus severity to be a significant predictor of depressive symptoms, global distress, impairment of sleep, and pruritus-related quality of life. Mediation analyses indicated that impaired sleep quality partly mediated the association between pruritus severity and psychological symptoms. The results confirm that pruritus is multidimensional and indicate that the affective dimension may be the most important predictor of pruritus-related psychological morbidity, and that the association may be mediated by its negative impact on sleep quality.

Udgivelsesdato: 2008-May There is widespread public concern about the potential adverse health effects of mobile phones in general and their associated base stations in particular. This study was designed to investigate the acute effects of radio frequency (RF) electromagnetic fields (EMF) emitted by the Universal Mobile Telecommunication System (UMTS) mobile phone base stations on human cognitive function and symptoms. Forty adolescents (15-16 years) and 40 adults (25-40 years) were exposed to four conditions: (1) sham, (2) a Continuous Wave (CW) at 2140 MHz, (3) a signal at 2140 MHz modulated as UMTS and (4) UMTS at 2140 MHz including all control features in a randomized, double blinded cross-over design. Each exposure lasted 45 min. During exposure the participants performed different cognitive tasks with the Trail Making B (TMB) test as the main outcome and completed a questionnaire measuring self reported subjective symptoms. No statistically significant differences between the UMTS and sham conditions were found for performance on TMB. For the adults, the estimated difference between UMTS and sham was -3.2% (-9.2%; 2.9%) and for the adolescents 5.5% (-1.1%; 12.2%). No significant changes were found in any of the cognitive tasks. An increase in 'headache rating' was observed when data from the adolescents and adults were combined (P = 0.027), an effect that may be due to differences at baseline. In conclusion, the primary hypothesis that UMTS radiation reduces general performance in the TMB test was not confirmed. However, we suggest that the hypothesis of subjective symptoms and EMF exposure needs further research.

The present study measured the effects of relaxation and guided imagery on cellular immune function. During a period of 10 days 10 healthy subjects were given one 1-hour relaxation procedure and one combined relaxation and guided imagery procedure, instructing the subjects to imagine their immune system becoming very effective. Even though no major changes in the composition of the major mononuclear leukocyte subsets could be demonstrated a significant increase in natural killer function was demonstrated. These data suggest that relaxation and guided imagery might have a beneficial effect on the immune defense and could form the basis of further studies on psychological intervention and immunological status. Udgivelsesdato: 1990-null

Health staff-patient communication is increasingly considered an important issue in cancer research. However, questionnaires addressing satisfaction with communication limit the issues patients can raise, do not address the context of communication and often show a strong positive skew in responses. Thus, qualitative studies of communication are also needed. Fifteen breast cancer patients were interviewed 3 months after finishing adjuvant treatment. They were asked to tell a 10 minute narrative and recall five experiences from treatment. Themes were extracted using categories derived from previous research while at the same time being sensitive to new elaborations and categories. The participants reported both positive and negative communication-related experiences from a wide range of treatment situations. Two major themes emerged: Information giving as professional care-giving and meeting emotional needs. The analysis suggests that appropriate information giving may have several functions, such as re-establishing the patient's future and reducing worst-case fantasies. Meeting emotional needs was seldom reported as directly talking about negative emotions, but rather through a variety of health staff behaviours. Also, the analysis points to problems in expecting or even pressurizing patients to feel and display negative emotions. The results highlight that meeting medical and emotional needs of patients may be closely intertwined in concrete treatment situations. Udgivelsesdato: 2007-null

Background: Anticipatory nausea (AN) during chemotherapy has been difficult to control with conventional antiemetics. AN can lead cancer patients to delay or discontinue chemotherapy, possibly compromising the treatment. Purpose: The aim is to investigate the possible influence on the development of AN of individual differences in absorption, somato-sensory amplification, and autonomic perception—measures theorized to be related to sensory perception and autonomic reactivity. Methods: Prior to treatment, 125 women (M age = 48.5 years) undergoing adjuvant chemotherapy for breast cancer rated their expected severity of side effects and completed the Tellegen Absorption Scale, the Somato-Sensory Amplification Scale , and the Autonomic Perception Questionnaire. AN, as well as anticipatory vomiting (AV), distress, and worry/anxiety, were measured prior to the fourth, sixth, and last cycle of chemotherapy. Posttreatment nausea (PN), vomiting, and fatigue were measured after the first, fourth, sixth, and last cycle. Results: 34% of the women reported AN before 1 or more cycles. When controlling for treatment characteristics and other known predictors, AN was significantly associated with high absorption in addition to severity of PN, pretreatment worry/anxiety, and not receiving radiotherapy between chemotherapy sessions. AV was not associated with any of the variables investigated. Our data suggest that the association is strongest in the early phases of treatment. Conclusions: Our results partly confirm the results of a previous study showing absorption and autonomic perception as predictors of anticipatory side effects in cancer patients receiving chemotherapy. Individuals high in absorption may be more autonomically reactive to aversive stimuli and, subsequently, more conditionable. Additional radiotherapy could be a competing stimulus, reducing the conditioning of chemotherapy-related nausea. Further studies investigating possible psycho-physiological mechanisms in the development of AN are needed.

Objective To evaluate the evidence on the efficacy of psychosocial interventions for improving pregnancy rates and reducing distress for couples in treatment with assisted reproductive technology (ART). Design Systematic review and meta-analysis. Data sources PsycINFO, PubMed, EMBASE, CINAHL, Web of Science and The Cochrane Library between 1978 and April 2014. Study selection Studies were considered eligible if they evaluated the effect of any psychosocial intervention on clinical pregnancy and/or distress in infertile participants, used a quantitative approach and were published in English. Data extraction Study characteristics and results were extracted and the methodological quality was assessed. Effect sizes (ES; Hedges g) were pooled using a random effects model. Heterogeneity was assessed using the Q statistic and I2, and publication bias was evaluated using Egger’s method. Possible moderators and mediators were explored with meta-analyses of variances (ANOVAs) and meta-regression. Results We identified 39 eligible studies (total N=2746 men and women) assessing the effects of psychological treatment on pregnancy rates and/or adverse psychological outcomes, including depressive symptoms, anxiety, infertility stress and marital function. Statistically significant and robust overall effects of psychosocial intervention were found for both clinical pregnancy (risk ratio=2.01; CI 1.48 to 2.73; p

Objective To identify prognostic risk factors in patients with occupational hand eczema (OHE). Design Cohort study with 1-year follow-up. Setting Danish National Board of Industrial Injuries Registry. Patients All patients with newly recognized OHE (758 cases) from October 1, 2001, through November 10, 2002. Interventions Participants received a questionnaire covering self-rated severity, sick leave, loss of job, depression, and health-related quality of life. One year after the questionnaire was returned, all responders (N = 621) received a follow-up questionnaire, and 564 (91%) returned it. Main Outcome Measures Persistently severe or aggravated OHE, prolonged sick leave, and loss of job after 1-year follow-up. Results During the follow-up period, 25% of all patients with OHE had persistently severe or aggravated disease, 41% improved, and 34% had unchanged minimal or mild to moderate disease. Patients with atopic dermatitis fared poorly compared with other patients. Patients younger than 25 years fared clearly better than older groups. Furthermore, severe OHE, age 40 years or greater, and severe impairment of quality of life at baseline appeared to be important predictors of prolonged sick leave and unemployment. Patients with lower socioeconomic status also had a high risk of prolonged sick leave, job change, and loss of job. Contact allergy was not found to be a risk factor for poor prognosis. Conclusions Atopic dermatitis, greater age, and low socioeconomic status may be reliable prognostic factors in early OHE. Quality of life and standardized severity assessment may also be valuable tools to identify patients at high risk of prolonged sick leave and unemployment.

Objective health measures often correlate poorly with the personal burden of illness. Thus, over recent years, there has been a growing interest in health-related quality of life (QOL) as an outcome measure when evaluating treatment effects and health. Self-report instruments are the most commonly used method for measuring QOL, and estimates of reliability and validity assist the selection of appropriate QOL measures. The primary criteria for evaluating QOL instruments are test-retest reliability, internal consistency, content validity, criteria validity, construct validity and responsiveness. Responsiveness refers to an instrument's sensitivity towards changes in health. Knowledge about the methods used when validating QOL instruments may increase confidence in QOL as a relevant outcome measure in medical science. In the clinical setting, using QOL measures may help patients communicate their problems and help doctors and nurses to identify patients' major concerns.

Alternative treatments such as spiritual healing and prayer are increasingly popular, especially among patients with life-threatening diseases such as cancer. According to theories of spiritual healing, this intervention is thought to influence living cells and organisms independently of the recipient's conscious awareness of the healer's intention. The aim of this study was to test the hypothesis that spiritual healing will reduce proliferation and viability of two cancer cell lines in vitro. Three controlled experiments were conducted with three different healers and randomised allocation of cells to five different doses of healing or control. Researchers conducting the assays and statistical analyses were blinded to the experimental conditions. Main outcome measures were MTT viability, 3H-thymidine incorporation and counts of an adherent human breast cancer cell line (MCF-7), and a nonadherent mouse B-lymphoid cell line (HB-94). Analyses of variance (ANOVAs) revealed no significant main or dose-related effects of spiritual healing compared to controls for either of the two cell lines or any of the assays (P-values between 0.09 and 0.96). When comparing healing and control across all three experimental days, doses, assays, and cells, 34 (51.6%) of 66 independent comparisons showed differences in the hypothesised direction (P = 0.90). The average effect size across cell lines, days, assays, and doses approached zero (Cohen's d = -0.01). The results do not support previous reports of beneficial effects of spiritual healing on malignant cell growth in vitro. Reported beneficial effects of spiritual healing on the well-being of cancer patients seem more likely to be mediated by psychosocial and psychophysiological effects of the healer-patient relationship

Objective: The aim was to investigate to which extent emotional repression is a premorbid coping tendency of cancer patients and/or a coping response to the threat posed by a cancer diagnosis. The results of one previous study of breast cancer patients suggest the latter possibility, and our aim was to replicate and extend these findings. Methods: Of 646 women referred to mammographic examination for breast cancer, 71 women were diagnosed with primary breast cancer. Repressive coping, defined as having high scores on defensiveness (Marlowe–Crowne Social Desirability Scale) and low scores on anxiety (Taylor Manifest Anxiety Scale), was measured (1) before, (2) 4 weeks after, and (3) 12 weeks after diagnosis. The women were not aware of their disease status before the examination, and there were no significant differences between groups in their perceived risk of having breast cancer. Results: Four weeks after diagnosis, increased repression (p

Cross-sectional studies have suggested an association between rumination and subjective health. The aim of the present study was to investigate in a longitudinal design whether rumination was related to self-reported physical health. A total of 96 young (age range 20–35) and 110 elderly (age range 70–85) participants completed questionnaires measuring rumination, negative affect, life events, and self-reported physical health at baseline and at 1-year follow-up. Multiple linear regressions showed a significant association between self-reported physical health at time 1 only for the elderly and negative affect mediated the association. At follow-up, rumination was significantly associated with self-reported physical health only for the young and the association was only partly mediated by negative affect. In conclusion, rumination is associated with poorer self-reported physical health, but the association depends on the age of the individual as well as time span studied.

Objective: In the present study, it was tested whether rumination—negative, recurrent thoughts—would be associated with immune parameters and health care utilization. Because rumination has been associated with sadness and subjective sleep quality, it was tested whether these factors mediated the possible effects of rumination. A young sample and an elderly sample were included to test for age differences in the association between rumination and health-related measures. Methods: A representative sample of 196 young subjects (20 to 35 years) and 314 elderly subjects (70 to 85 years) completed questionnaire measures of rumination, sadness, and subjective sleep quality. Immune measures included leukocyte counts, lymphocyte subsets, natural killer cell activity, and T-cell proliferation. Contacts with primary care physicians were registered for 1 year through central registers. Results: Rumination displayed a positive association with total leukocyte count, total lymphocyte count, and number of B cells among the elderly, and this was not mediated by sadness or subjective sleep quality. Rumination was also positively associated with number of telephone consultations during the follow-up for the elderly, and this was partly mediated by sadness and subjective sleep quality. Although total leukocyte counts correlated with number of telephone consultations at the follow-up, none of the immune parameters mediated the association between rumination and health care utilization. No significant associations were found for the young participants. Conclusion: The results suggest that rumination may be associated with health-related measures in the elderly. Thus, negative thoughts may be detrimental to health, independently of negative affect. Key words: rumination, immunity, health care, aging. NK natural killer cell; GP general practitioner; MMSE Mini-Mental State Examination; PBMC peripheral blood mononuclear cell; FCS fetal calf serum; PHA phytohemagglutinin.

The aim of the study was to investigate the association of physician communication behaviours as perceived by the patient with patient reported satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease in cancer patients. Questionnaires measuring distress, self-efficacy, and perceived control were completed prior to and after the consultation by 454 patients attending an oncology outpatient clinic. After the consultation, the patients also rated the physicians' communicative behaviours by completing a patient-physician relationship inventory (PPRI), and the physicians were asked to estimate patient satisfaction. The overall results showed that higher PPRI scores of physician attentiveness and empathy were associated with greater patient satisfaction, increased self-efficacy, and reduced emotional distress following the consultation. In contrast, lower PPRI scores were associated with reduced ability of the physician to estimate patient satisfaction. The results confirm and expand previous findings, suggesting that communication is a core clinical skill in oncology.

Increased anxiety is believed to correlate with increased pain sensitivity in men and women. However, one laboratory-based study and one clinical-based study have offered evidence to suggest that the effect of anxiety in modulating pain sensitivity is specific to men only. The aim of the present study was to examine further whether anxiety differentially effects men and women's report of experimentally induced pain.One hundred forty-four healthy university students (75 women, 69 men) were exposed to a contact heat pain procedure (ascending method of limits procedure, baseline temperature 30 degrees C, +/- 0.2 degrees C, rate of change 2.0 degrees C/s, cut-off limit 52 degrees C) and a cold pressor pain procedure (constant temperature +1 degrees C; +/-1 degrees C, cut-off limit 240 s).The results agreed with the previous two studies indicating a sex-specific effect of anxiety on pain report. Male participants scoring above the median on the Trait Anxiety Inventory reported significantly greater pain intensity, unpleasantness and showed lower pain tolerance compared to males scoring below the median on the cold pressor pain procedure, while no such differences in cold pressor pain report were found between high and low anxious women. No effect of anxiety was found on measures taken from the contact heat pain procedure, indicating that the sex-specific effect of anxiety on laboratory induced pain is dependent upon the method of stimulation used.Anxiety is an important factor when considering gender differences in pain perception and warrants further investigation.

Quality of life measures are widely used in dermatology as well as in rheumatology, but there are no large studies taking arthritis into consideration when studying quality of life in psoriasis. The aim of this study was to investigate psoriasis-related quality of life in a large sample of members of the psoriasis associations from the Nordic countries including an arthritis-related evaluation. The prevalence of reported arthritis within the groups was also estimated. An Arthritis Disability Index suitable for parallel use together with Finlay's Psoriasis Disability Index was constructed. A total of 5,795 members and 702 patients seen by Nordic dermatologists rated the severity of their disease and completed the Psoriasis Disability Index formula and a Psoriasis Life Stress Inventory, and if arthritis had been diagnosed, the Arthritis Disability Index formula. Approximately 30% of all psoriatic patients, irrespective of group, received a diagnosis of arthritis either by their dermatologist or a rheumatologist. Members previously hospitalized for their disease had a higher frequency of arthritis (41%) than those without a history of hospitalization (23%). The highest prevalence of arthritis was found in Norway (33.8%). Members with arthritis exhibited greater impairment of psoriasis-related quality of life, longer disease duration, and greater self-reported disease severity for psoriasis. Important predictors for impairment of arthritis-related quality of life were pain, number of affected joints, and restriction of joint mobility. These data show, that the prevalence of arthritis in psoriasis may be significantly higher than the previously accepted average of 7%. The results demonstrate that when studying quality of life in psoriasis, arthritis and arthralgia are important independent factors to be included in the evaluation.