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Purpose: This paper describes the development and psychometric properties of the Diabetes Problem-Solving Measure for Adolescents (DPSMA)., Methods: The DPSMA is a structured, interview-based questionnaire that examines how adolescents with type 1 diabetes solve diabetes-related self-management problems. Seventeen diabetes-related self-management problem vignettes were derived from a survey of adolescents and their parents. The vignettes were reviewed and finalized by a multidisciplinary team of diabetes experts. A sample of 43 adolescents, 13 to 17 years old, with type 1 diabetes, was used to establish the psychometric properties of the instrument., Results: The scale demonstrated acceptable internal consistency and interrater reliability. Predicted relationships with scores on concurrently administered measures of adherence, diabetes quality of life, and metabolic control provided support for construct validity., Conclusions: The results suggest that the DPSMA has acceptable internal consistency, interrater reliability, and construct validity. It may be a useful tool to help healthcare providers understand the diabetes-related problem-solving abilities of their adolescent patients.

Objective: There are scant data regarding outpatient adherence in quiescent ulcerative colitis aside from patients enrolled in controlled clinical trials. We conducted a prevalence study to determine the medication adherence rate of maintenance therapy and to identify possible risk factors for nonadherence., Methods: Outpatients with clinically quiescent ulcerative colitis for >6 months on maintenance mesalamine (Asacol, Procter and Gamble, Cincinnati, OH) were eligible. Patients were interviewed regarding disease history, and demographics were obtained from medical records. Refill information for at least 6 months was obtained from computerized pharmacy records. Adherence was defined as at least 80% consumption of supply dispensed. Using nonadherence as the outcome of interest, stratified analysis and regression modeling were used to identify significant associations., Results: Data were complete for the 94 patients recruited. The overall adherence rate was found to be 40%. The median amount of medication dispensed per patient was 71% (8-130%) of the prescribed regimen. Nonadherent patients were more likely to be male (67% vs 52%, p < 0.05), single (68% vs 53%, p = 0.04), and to have disease limited to the left side of the colon versus pancolitis (83% vs 51%, p < 0.01). Sixty-eight percent of patients who took more than four prescription medications were found to be nonadherent versus only 40% of those patients taking fewer medications (p = 0.05). Age, occupation, a family history of inflammatory bowel disease, length of remission, quality-of-life score, or method of recruitment (telephone interview vs clinical visit) were not associated with nonadherence. Logistic regression identified that a history of more than four prescriptions (odds ratio [OR] 2.5 [1.4-5.7]) and male gender (OR 2.06 [1.17-4.88]) increased the risk of nonadherence. Two statistically significant variables, which were protective against nonadherence, were endoscopy within the past 24 months (OR 0.96 [0.93-0.99]) and being married (OR 0.46 [0.39-0.57])., Conclusion: Nonadherence is associated with multiple concomitant medications, male gender, and single status. These patient characteristics may be helpful in targeting those patients at higher risk for nonadherence.

Fear of bodily sensations has received extensive attention in relation to panic disorder, and more recently, other types of anxiety pathology and chronic pain problems. Extending this work, the present study examined fear of bodily sensations and its underlying dimensions in emergency room patients with Noncardiac Chest Pain (NCCP; n = 63). We posited a "differential specificity" hypothesis, expecting that specific cardiopulmonary fears would be more strongly associated with NCCP symptoms relative to other bodily fears. As hypothesized, participants reported cardiopulmonary sensations as significantly more fear-provoking than numbness, dissociation, and gastrointestinal sensations. Additionally, regression analysis indicated that after accounting for theoretically relevant demographic variables and health status, cardiopulmonary fear was the best predictor of a composite index of cardiac complaints intensity, even after removing variance related to the absolute number of cardiac complaints. We discuss these findings in relation to the specific role for the fear of cardiopulmonary sensations in chest pain complaints, with implications for better understanding the underlying psychological processes involved in NCCP.

Although comparative studies differentiate noncardiac chest pain (NCCP), panic disorder, and coronary artery disease (CAD), little research has examined the defining features of NCCP, such as cardiac complaints, medical utilization, and learning history. We administered self-report measures to 80 Emergency Department (ED) patients with a primary complaint of chest pain who were subsequently found to not have CAD. Forty-eight percent of the ED utilization variance was accounted for by NCCP duration, age, cardiac distress symptoms, and prior exposure to both siblings' and friends' cardiac distress symptoms. In turn, 67% of the variance in cardiac distress symptoms was explained by education, age, NCCP duration, number of illnesses, noncardiac panic symptoms, prior exposure (friends), and prior observation of others' cardiac distress. No effects emerged for gender, ethnicity, avoidance, or depression. Results suggest that beyond the effects of age and distress intensity, prior exposure to other people's cardiac distress may influence NCCP.

Temperature biofeedback (TBFB) is designed to alter cutaneous temperature in treated extremities by providing information corresponding to minor temperature fluctuations in the context of therapeutic structure and reinforcement. Toe TBFB may improve vascular flow and walking tolerance in patients with peripheral vascular disease. This case study documents improved walking in a diabetes patient with lower extremity complications, and suggests TBFB might increase lower extremity temperature and blood flow volume pulse in uncomplicated diabetes. Ankle-brachial index (ABI) and walking function were assessed in a 60-year-old woman with type 2 diabetes and intermittent claudication, before and after five sessions of TBFB applied to the ventral surface of the great toe. Toe temperature increased during feedback phases but not during baseline phases. Improvements were seen in ankle-brachial index, walking distance, walking speed, and stair climbing. This case indicates the need for extended and controlled study of TBFB for improved vascular and ambulatory function in diabetic claudication.

Objective: Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients., Method: The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms., Results: Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients., Conclusions: Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.

Examined glycemic associations with medical variables, activity, daily stress, and mood state in 72 older patients with non-insulin-dependent diabetes mellitus (NIDDM). On three occasions over a 2-week observation period, subjects provided measures of everyday life stress, negative mood state, and daily activities. At the end of this period, fructosamine was assayed to measure glycemic control throughout the assessment period. After controlling for medical variables (age, illness duration, body mass index, caloric intake, and activity) and the main effects of psychological factors (stress; anxious, angry, and depressed mood states), stress interacted with activity such that glycemic elevation was positively associated with stress for subjects below the activity median but not for those above the median. This was unattributable to any overall activity-related differences in fructosamine, stress, or mood. None of the mood states interacted with activity. The findings suggest that extremely low levels of activity may strengthen life stress-glycemia associations in NIDDM.

Background: Previous findings are unclear regarding the possible glycemic benefits of applying behavioral relaxation training in non-insulin-dependent diabetes mellitus (NIDDM)., Methods: Subjects with NIDDM were randomized to relaxation training (6 sessions of progressive muscle relaxation and imagery, n = 12) or control treatment (routine medical care, n = 10). Physiological measures were total glycosylated hemoglobin (GHb) and area under the 2-hour oral-glucose-tolerance curve (AUC). Psychological measures of generalized distress, anxiety and daily stress were also administered. All subjects were assessed before and after the 8-week intervention, and again at 16 weeks of long-term follow-up., Results: There were no postintervention group differences in physiological variables. Highly distressed subjects and those who rated their glucose as more stress responsive tended to practice relaxation less between sessions. Within the treated group only, lower preintervention stress responsivity was associated with greater improvement in GHb, and lower anxiety and distress levels predicted long-term improvement in AUC., Conclusions: It remains unclear whether relaxation training produces glycemic benefits in NIDDM. Perhaps the least anxious and stress-responsive patients only benefit from group-based relaxation training, whereas anxious individuals require intensive individually administered interventions.

Some aspect of psychosocial criteria is commonly utilized by most transplant programs in assessing candidates' acceptability for transplantation. However, regardless of the assessment methodology, information obtained in pretransplant assessments may be limited given the evaluative nature of the assessment as well as the sensitive nature of the contents. Indeed, transplant candidates may present themselves in a favorable fashion, minimizing any negative traits or psychological dysfunction which they perceive might prevent transplantation. Unfortunately, there are limited data addressing the extent to which transplant candidates may present themselves in an overly positive light. This investigation surveys the prevalence of social desirability in lung transplant candidates as well as its association with self-reports of perceived stress. Further, the relationship between social desirability and interviewer ratings of transplant candidacy is examined. Subjects included 24 patients in end-stage organ failure being evaluated for lung transplant candidacy. Subjects completed the Perceived Stress Scale and a brief version of the Marlowe-Crowne Social Desirability Scale. Additionally, subjects were interviewer-rated on the Psychosocial Assessment of Candidates for Transplantation. Results indicate social desirability is a prevalent phenomenon in lung transplant candidates, with more than half of the sample scoring at or above the 84th percentile on the social desirability measure. Further, self-reports of perceived stress are moderately and inversely associated with social desirability (r=-.55,p ≤ .01). Social desirability was unrelated to interviewer-ratings of transplant candidates acceptability (r=.13,p ≤ .56). Future research might include larger samples of subjects, other organ transplant candidates, and more detailed assessments of symptom distress.

Although there has been some study of the extralaboratory generality of stress effects on diabetic metabolism, analysis of the diabetic response to everyday life stress is needed. The secondary objective of this study was to investigate whether personal characteristics moderate the daily stress-glucose relationship. Twenty-five women with Type I diabetes completed measures of internality and self-esteem and subsequently monitored daily stress and blood glucose for 30 consecutive days. Data were analyzed by both time-series and conventional correlational analyses. Glucose was higher on high-stress days than on low-stress days, with one-third of the sample showing significant positive associations between stress and same-day glucose. However, stress showed little relation to next-day glucose. Personal characteristics failed to explain differences in stress-glucose associations. Implications for practice and future research are presented.

A model of daily stress and metabolic control in Type I diabetes was tested in which stress has dual effects upon glycemic level: (a) direct, through psychophysiological mechanisms, and (b) mediated, through regimen adherence. Learned resourcefulness was postulated to moderate both effects. Two approaches to measuring daily stress were also compared: stress mean and variability. Daily stress and adherence were measured in 62 adult diabetics on six occasions over 2 months, after which glycosylated hemoglobin levels were obtained. Stress had a direct association with metabolic control that was not mediated by adherence. Although learned resourcefulness failed to moderate this relationship, it did relate directly to metabolic control, in the unexpected direction. The variables combined to explain 37% of the variance in metabolic control. The utility of the intraindividual approach to daily stress measurement was supported.

This study examined the accuracy with which 20 young (18 to 24 yr.) and 32 old (55 to 85 yr.) adults were able to move their hands when not allowed to guide them visually. They tried to touch a target spot given either visually or kinesthetically, under conditions in which the target either remained present during the response or was discontinued prior to the response. They also tried to touch points on the face with eyes closed and wrote their names and common words with and without visual input. While there was slight evidence of age-related decline in accuracy of moving the hand to a target location in some conditions, older adults appear to use kinesthetic cues to the target location as effectively as visual cues. The absence of age effects on touching the face or writing with the eyes closed suggests that the kinesthetic and motor control systems are relatively well preserved in healthy older adults.