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Peer victimization is associated with an increased risk for depression, but there is less evidence on how certain factors such as friend support can buffer this association. This study investigated the associations between friend support and depressive symptoms among victimized and non-victimized adolescent girls and boys from South Korea.Participants includes 2258 students from the Korean Children and Youth Panel Survey, a nationally representative sample of middle school students in South Korea. Self-reported perceived friend support, depressive symptoms and peer victimization were measured using validated scales during middle school year 3 (mean age= 15.7 years).The association between peer victimization and depressive symptoms varied by sex (p for sex by peer victimization interaction0.05). Peer victimization was more strongly associated with same year depressive symptoms in girls (β=0.55) than boys (β=0.24). After controlling for key confounders, including prior year mental health symptoms, higher levels of friend support were found to attenuate the association between peer victimization and depressive symptoms (p for friend support by peer victimization interaction0.05). Peer victimization was associated with more depressive symptoms for adolescents with low and moderate friend support, but not those with high friend support.Peer victimization, depressive symptoms, and friend support, were self-reported and measured the same year.Friend support protects victimized South Korean adolescents from the negative effect of peer victimization on depressive symptoms, hence contributes to closing the gap in depression between victimized and non-victimized adolescents.

Semiconducting polymer based X-ray detectors doped with high-Z nanoparticles hold the promise to combine mechanical flexibility and large-area processing with a high X-ray stopping power and sensitivity. Currently, a lack of understanding of how nanoparticle doping impacts the detector dynamics impedes the optimization of such detectors. Here, we study direct X-ray radiation detectors based on the semiconducting polymer poly(9,9-dioctyfluorene) blended with Bismuth(III)oxide (Bi2O3) nanoparticles (NPs). Pure polymer diodes show a high mobility of 1.3 × 10-5 cm2/V s, a low leakage current of 200 nA/cm2 at -80 V, and a high rectifying factor up to 3 × 105 that allow us to compare the X-ray response of a polymer detector in charge-injection conditions (forward bias) and in charge-collection conditions (reverse bias), together with the impact of NP-loading in the two operation regimes. When operated in reverse bias, the detectors reach the state of the art sensitivity of 24 μC/Gy cm2, providing a fast photoresponse. In forward operation, a slower detection dynamics but improved sensitivity (up to 450 ± 150 nC/Gy) due to conductive gain is observed. High-Z NP doping increases the X-ray absorption, but higher NP loadings lead to a strong reduction of charge-carrier injection and transport due to a strong impact on the semiconductor morphology. Finally, the time response of optimized detectors showed a cut-off frequency up to 200 Hz. Taking advantage of such a fast dynamic response, we demonstrate an X-ray based velocity tracking system.

Purpose To assess toxicity outcomes of image-guided intensity-modulated radiation therapy (IG-IMRT) combined with permanent prostate seed implant in a cohort of patients with localized prostate cancer. Methods and Materials A retrospective analysis was performed on 67 patients with the median pretreatment prostate-specific antigen level of 5.4. The Gleason score was less than 7 in 7 patients, 7 in 52 patients, and greater than 7 in 8 patients. The median followup was 28.2 months (range, 12–89.5 months). Treatment consisted of 45 (n = 65) or 50.4 Gy (n = 2) at 1.8 Gy/fraction of IG-IMRT to the prostate and seminal vesicles. Eight patients had simultaneous irradiation of pelvic lymph nodes to 45 (n = 65) or 50.4 Gy (n = 2). After IG-IMRT, patients received transperineal prostate implant boost with either 103Pd (n = 65, the prescribed D90 of 100 Gy) or 125I (n = 2, D90 of 110 Gy). Eleven patients received androgen deprivation therapy with radiotherapy. Results Toxicity higher than Grade 3 was not observed. The combined incidence of acute and late Grade 3 genitourinary toxicity was 6%. The combined incidence of acute and late Grade 3 gastrointestinal toxicity was 3%. At least one episode of gastrointestinal bleeding on followup, which could be attributed to radiation, was recorded in 14.9% of patients. For patients achieving erections before radiation, the 3-year Kaplan–Meier potency preservation rate was 66.5%. Conclusions The early toxicity of the combination of IG-IMRT and low–dose rate brachytherapy boost in this study was favorable.

OBJECTIVE To compare tumor control and changes in audiometric parameters of acoustic neuroma patients treated with either linac-based stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) at Allegheny General Hospital. STUDY DESIGN Twenty-three patients with acoustic neuroma were treated between February 2003 and April 2009 with either SRS (n = 13) or SRT (n = 10). The median age for all patients was 69 years and the median size of lesions was 1.2 cm (range 0.5-2.2 cm). The prescribed dose was a single dose of 1250 cGy for all SRS patients compared to 2500 cGy in 5 daily fractions for SRT patients. All patients had pre- and post-procedure audiometry including hearing acuity assessed using pure tone average (PTA), speech discrimination score (SDS), and speech reception threshold (SR). The results of treatment type and tumor variables resulting in hearing degradation were evaluated and compared. RESULTS At a median follow-up of 13 months (range 3-36 months), only 1 of 13 patients treated with SRS and 2 of 10 patients treated with SRT develped progression of disease. However; all patients developed deterioration in PTA, SDS, or SR on the treated side. There were no statistically significant audiometric differences between patients treated with SRT or SRS and tumor response was similar regardless of irradiation technique. CONCLUSION Both SRS and SRT provide excellent local control rates for the treatment of acoustic neuroma. While SRS demonstrated a trend toward worsening of SDS and the treatment of lesions >1.2 cm demonstrated a trend toward worsening of PTA, neither reached statistical significance. Our data suggest that single dose irradiation using the SRS technique should be considered primarily for patient convenience. All patients treated with radiotherapy for acoustic neuromas should undergo formal hearing testing before and after treatment.

This paper presents the cognitive test battery used in the Cascade Study (Cardiovascular Determinants of Dementia) for examining the consequences of cerebral white matter lesions and atrophy. The test battery includes nine different tasks assessing memory, executive function, and global cognitive function. Three episodic memory tasks were used in combinations to assess the role of attention and speed on encoding. Estimates of short- and long-term memory capacity were also derived from these three memory tasks. Semantic memory production / frontal lobe functions were assessed by means of a word fluency test. The Letter Digit Substitution test and the Stroop test were used to assess speed of processing and attention. Motor speed was measured with the Purdue Pegboard test, and global cognitive function was assessed by the Mini Mental State Examination. Overall performance data for the whole Cascade sample and for each of eight study centers are presented for each test. Possible reasons for performan...

Study objective: This study investigated which risk factors might explain social inequalities in both depressive symptoms and physical functioning and whether a common set of risk factors might account for the association between depressive symptoms and physical functioning. Design: A longitudinal prospective occupational cohort study of female and male civil servants relating risk factors at baseline (phase 1: 1985–8) to employment grade gradients in depressive symptoms and physical functioning at follow up (phase 5: 1997–9). Analyses include the 7270 men and women who participated at phase 5. Setting: Whitehall II Study: 20 London based white collar civil service departments. Participants: Male and female civil servants, 35–55 years at baseline. Main results: Depressive symptoms were measured by a subscale of items from the 30 item General Health Questionnaire. Physical functioning was measured by a subscale of the SF-36. Employment grade was used as a measure of socioeconomic position as it reflects both income and status. The grade gradient in depressive symptoms was entirely explained by risk factors including work characteristics, material disadvantage, social supports, and health behaviours. These risk factors only partially explained the gradient in physical functioning. The correlation between depressive symptoms and physical functioning was reduced by adjustment for risk factors and baseline health status but not much of the association was explained by adjustment for risk factors. Among women, the association between depression and physical functioning was significantly stronger in the lower grades both before and after adjustment for risk factors and baseline health. For women, there was only a significant grade gradient in depressive symptoms among those reporting physical ill health. Conclusions: Some risk factors contribute jointly to the explanation of social inequalities in mental and physical health although their relative importance differs. Work is most important for inequalities in depressive symptoms in men, and work and material disadvantage are equally important in explaining inequalities in depressive symptoms in women while health behaviours are more important for explaining inequalities in physical functioning. These risk factors did not account for the association between mental health and physical health or the greater comorbidity seen in women of lower socioeconomic status. The risk of secondary psychological distress among those with physical ill health is greater in the low employment grades.

Numerous factors have been hypothesized to explain persistent findings of social inequalities in morbidity and mortality.1 Explanations include household income,2 differential health behaviors,2,3 early life environment,4,5 differences in access to medical care,6,7 and social relationships.8,9 More recently, the psychosocial work environment has been shown to play an important part in explaining health differentials,10,11 and neo–material interpretation (i.e., that inequalities result from differential accumulation of exposures and experiences that have their sources in the material world) have been hypothesized as another explanatory mechanism.12 This study examined—in 2 cultures with many similarities but also many differences (i.e., England and France)—the social gradient in health and possible risk factors in order to assess the degree of consistency of explanatory mechanisms. Life expectancy for men is virtually the same in both countries (∼74 years), although for women, it is about 3 years longer in France (∼83 years). Social inequalities in mortality and morbidity exist in both countries,13 but cause-specific patterns of mortality differ between England and France (cardiovascular disease being most prevalent in British men and neoplasms being most prevalent in French men). Given this pattern, should we expect to find similar social gradients in risk factors for poor health across different cultures, or does the answer lie with culture-specific risk factors? We explored the relations between socioeconomic position, health, and possible risk factors in 2 comparable samples on either side of the English Channel: the Whitehall II Study of British civil servants14 and the GAZEL Study of personnel at the Gas and Electricity Public Utilities of France.15 Many measures of morbidity used were identical or very similar, as were potential confounders and mediators. The objectives of this study were to determine (1) whether the social gradient for measures of morbidity and risk factors found among British civil servants was also observed among French public employees and (2) whether the same factors contributed to the gradient in health across the studies. (Note. In this article the terminology of the Whitehall II Study is used: “spells” refers to periods of time, “sickness absence” to illness-related absence from work.)

Gender differences in social support tend to suggest that women have larger social networks and both give and receive more support than men. Nevertheless, although social support has been identified as protective of mental health, women have higher rates of psychological distress than men. We examine the prospective association between social support and psychological distress by gender in a cohort study of middle aged British Civil Servants, the Whitehall II study. In this sample we found that women have a larger number of close persons than men although men have larger social networks. We also found that the effects of marital status, social support within and outside the workplace and social networks on subsequent occurrence of psychological distress were similar for men and women independently of baseline mental health status.

The National Survey of Mid-life Developments in the United States (MIDUS) is one of several studies that demonstrate socioeconomic gradients in mortality during midlife. When MIDUS findings on self-reported health, waist to hip ratio, and psychological well-being were analyzed for their possible roles in generating socioeconomic differences in health, they revealed clear educational gradients for women and men (i.e., higher education predicted better health). Certain potential mediating variables, like household income, parents’ education, smoking behavior, and social relations, contributed to an explanation of the socioeconomic gradient. In addition, two census-based measures, combined into an area poverty index, independently predicted ill health. The results suggest that a set of both early and current life circumstances cumulatively contribute toward explaining why people of lower soeioeconomic status have worse health and lower psychological well-being.

Background. Few studies have examined prospectively both the direct and buffering effects of types of social support and social networks on mental health. This paper reports longitudinal associations between types of social support and psychiatric morbidity from the Whitehall II study.Methods. Social support was measured by the Close Persons Questionnaire and psychiatric morbidity by the General Health Questionnaire at baseline (1985–1988) and at first follow-up (1989) in 7697 male and female London-based civil servants aged 35–55 years at baseline. The cohort was followed up and baseline measures were used to predict psychiatric disorder measured by the General Health Questionnaire at second follow-up (1991–1993).Results. Longitudinal analyses showed that low confiding/emotional support in men and high negative aspects of close relationships in men and women were associated with greater risk of psychiatric morbidity even after adjustment for baseline General Health Questionnaire score. There was no evidence of a buffering effect among men or women who experienced life events or chronic stressors. Controlling for a personality measure of hostility did not affect the observed relations.Conclusions. The present findings illustrate that different types of support are risk factors for psychological distress and that they operate in different ways for men and women. Direct effects of emotional support are predictive of good mental health in men and negative aspects of close relations predict poor mental health in both men and women. Emotional support is predictive of good mental health in women whereas, confiding alone is not.

Objectives A cross-sectional epidemiologic survey was conducted among prison staff in France to investigate the relationships between work conditions and mental health. Methods The sample included men and women 20 to 64 years of age belonging to all categories of prison personnel (prison guards, administrative staff, socioeducational workers, technicians, health care workers, and managers). A postal self-administered questionnaire was used to assess sociodemographic factors, work conditions, and physical and mental disorders. Multiple logistic regression analyses were conducted to determine the effects of work conditions and social relationships on the mental health of prison staff. Results The results presented in this report only concern depressive symptomatology (measured by the French version of the Center for Epidemiologic Studies Depression Scale), anxiety (measured by the state version of the State-Trait Anxiety Inventory), and sleep disorders. The percentage of mental disorders was higher among prison staff than that determined for other occupational samples. Guards comprised the prison staff least affected by these symptoms. Conclusions The results show that, in our sample, the factors concerning the subjective evaluation of work conditions and social support were more closely related to mental disorders than work conditions. In addition, seniority was associated with depressive symptoms and anxiety among the men.

It is commonly observed that women report higher levels of minor psychiatric morbidity than men. However, most research fails to control for the gendered distribution of social roles (e.g. paid work and domestic work) and so does not compare men and women in similar positions. In this short report, we examine the distribution of minor psychiatric morbidity (measured by the 12 item General Health Questionnaire) amongst men and women working in similar jobs within three white-collar organisations in Britain, after controlling for domestic and socioeconomic circumstances. Data from self-completion questionnaires were collected in a Bank (n = 2,176), a University (n = 1,641) and the Civil Service (n = 6,171). In all three organisations women had higher levels of minor psychiatric morbidity than men, but the differences were not great; in only the Civil Service sample did this reach statistical significance. We conclude that generalisations about gender differences in minor psychiatric morbidity can be unhelpful, as these differences may vary depending on the context of the study.

This study examined social network characteristics of adults aged 70 to 90 years in relation to widowhood and illness in France, Germany, Japan, and the United States. Participants were drawn from representative samples from each of the 4 countries (total N = 1,331). Resource deficit profiles based on whether respondents were widowed, ill, both, or neither were directly related to social network characteristics for German and Japanese adults, were differentially related by gender and age for French adults, and were not related to social networks of Americans. Country, gender, and age differences in total network size, proportion of close network members, and frequency of contact with network members are reported. Similarities and differences found in the associations between normative late-life deficits and social network characteristics in the 4 countries point to the importance of investigating sociocultural factors that mediate the impact of resource loss and afford life quality in very old age.

The factorial structure of the Center for Epidemiologic Studies-Depression (CES-D) scale has been examined on a large sample of multiple sclerosis (MS) subjects (n = 696), general practice patients (n = 1,308) and healthy workers (n = 342). The aim of this study was to verify if the CES-D is a valid and reliable scale to assess depressive symptomatology in MS. As previously reported in the literature, we found four factors that measure depressed affect, positive affect, somatic complaints or retarded activity and interpersonal relationships. The percent of total variance explained by the four factors was greater than 50% in each group. Cronbach’s α coefficients were 0.90 in the MS sample and 0.93 in the general practice sample, indicative of high reliability in both samples. From these results, we conclude that the CES-D can be used to screen for depression in epidemiological studies of this psychiatric disorder among MS patients.

Type 2 diabetes is associated with an increased risk of cognitive dysfunction. These effects seem particularly true for memory functions. This article examines how diabetes and the biological changes that occur with diabetes such as hyperglycemia, changes in insulin concentration, hypertension, and changes in lipid levels might lead to these alterations in cognitive functioning, with an emphasis on the mechanisms leading to changes in memory. OTH type 1 (insulin-dependent diabetes mellitus, or IDDM) and type 2 (non-insulin-dependent diabetes mellitus, or NIDDM) diabetes have detrimental effects on cognitive functioning (measures of verbal and numerical reasoning, attention, concentration, verbal and visual memory, and verbal fluency) and may increase the risk of dementia. In type 1 diabetes, chronic hyperglycemia and the recurrence of hypoglycemia appear to be associated with loss of cognitive ability (1‐3). A recent review of cognition in type 2 diabetes concluded that despite the poor design and lack of statistical power in many studies, type 2 diabetes appears to be associated with an increased risk of cognitive dysfunction in a wide array of cognitive tests (4). These findings are borne out in larger epidemiological studies (5,6). In particular, in those studies that examined it, loss of verbal memory was most consistently associated with diabetes. This article examines how diabetes and its risk factors might lead to these changes in cognitive functioning, with a particular focus on memory. M EMORY

Dementia is a highly prevalent disease that may have a cardiovascular component. White matter lesions and brain atrophy (brain abnormalities) are prevalent in dementia cases and might form part of the anatomical basis for the disease. We designed a multi-centre study, CASCADE (Cardiovascular Determinants of Dementia), to examine long-term (10-20 years) and short-term (5 years) cardiovascular risk factors for, and the cognitive consequence of, brain abnormalities. White matter lesions and atrophy are measured with magnetic resonance imaging. Cognitive function is measured with nine tests of memory and executive function. The studies included in CASCADE were ongoing and geographically spread throughout Europe to capture the cardiovascular risk gradient. In each study, a random sample of at least 100 subjects aged 65-75 years was selected who participated in the previous research examinations conducted by the respective centres. The objectives and design of the CASCADE project are described.

OBJECTIVES: The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants. METHODS: In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases. RESULTS: Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score. CONCLUSIONS: Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.

The possible modifying effect of social relations on the association between depression and mortality was examined in a community-based cohort study. A total of 3,777 randomly selected persons 65 years of age and older in southwest France were followed over a 5-year period from 1988 in the Personnes Agees Quid (PAQUID). At study entry, the prevalence of elevated depressive symptomatology was 12.9% for men and 14.7% for women, and the reported relative isolation was 14.1% for men and 26.0% for women. During a total of 16,984 person-years of follow-up, 849 deaths occurred. Among participants with high levels of depressive symptomatology, the age-adjusted mortality rate ratio was 2.10 (95% confidence interval 1.7-2.7) in men and 1.76 (95% confidence interval 1.4-2.3) in women. When compared with individuals with the most connections, men and women with few social network connections were also at increased risk of mortality: age-adjusted rate ratio = 2.69 (95% confidence interval 1.9-3.8) for men and 1.56 (95% confidence interval 1.0-2.4) for women. Satisfaction with social support had a small but nonsignificant effect on mortality risk. For women, the excess risks due to depressive symptoms and few network connections are observed only in the 65- to 74-year age group, after adjusting for health and health behaviors. Social relations did not significantly modify the depression-mortality associations for either men or women, although the depression-mortality effect was reduced by 12.8% in men. The latter findings do not appear to be compatible with the buffering hypothesis, whereby we would expect social relations to decrease the depression-mortality association. Nonetheless, there are independent effects from these two factors, and older men who are depressed and not socially connected are at increased risk of dying earlier.

It is important that the effects of work on mental health are investigated when work practices are changing rapidly and there is decreasing job security. This has been examined in the Whitehall II Study, a cohort study of 6895 male and 3413 female, London-based civil servants, aged 35-55 years at baseline in 1985. Work characteristics were measured by modified Karasek indices in a self-report questionnaire. Psychiatric disorder was measured by the 30-item General Health Questionnaire (GHQ). In longitudinal analyses in men and women, high work social support predicted lower GHQ scores, and high job demands predicted higher GHQ scores at follow-up. High work social support and high skill discretion were protective against taking short spells of psychiatric sickness absence. The protective effects of social support at work and the potential risk of job demands have implications for management, job design, training, and further research.

This study examined the association between social relations and mental health, specifically the relative contribution of social networks and social support to depressive symptomatology. The culturally unique representative sample consisted of 3,777 noninstitutionalized older persons living in southwestern France. The findings indicated that French older adults generally had more than 8 people in their networks, their networks consisted mostly of family members, and they felt understood by most of their network members. These older adults reported being satisfied with their social relations. Sociodemographic variables contribute (R2 = .143) to depressive symptomatology, as did social network (incremented R2 = .033) and social support (incremented R2 = .09) variables. Sociodemographic, social network, and social support variables together increased the variance explained still further (incremented R2 = .108). Results were consistent with similar analyses in the U.S. and indicated that social support variables account for more variance in depressive symptomatology than social network variables.

The aim of this article is to compare the prevalence of depressive symptoms and its correlates in an urban and a rural sample of 2797 persons of age 65 and over living in Southwest France. The crude prevalence rate of elevated depressive symptomatology, evaluated by the Center of Epidemiological Studies Depression (CESD) scale was 14.1% and 13.9% respectively in the rural and the urban area. After adjusting for potential confounders, the risk of elevated depressive symptoms is slightly higher in the urban area (p = 0.09). Factors found to be associated with the level of depression are the same in the rural and the urban area, and the magnitude of the effects is comparable. These results are compared with those of other studies and the observed differences are discussed.

The epidemiology of fatigue is not well known in France, and this study reports on factors associated with fatigue in a sample of 3,784 general practice patients. Prevalence rates according to several definitions of fatigue are presented and factors are examined that have been reported to be associated with fatigue. Although 41.2% of the sample report having experienced symptoms of fatigue for at least three days, only 7.6% declare fatigue as a reason for consulting a doctor. Women report more symptoms of fatigue, but they do not consult more often than men for this reason. Age is strongly correlated with fatigue, but this is found only for men. Socioprofessional category bears no relationship to fatigue as a reason for consultation, however, the diagnosis of fatigue is more often attributed to professionals and upper management than it is to office staff or skilled and unskilled workers. We do find a strong relationship between depressive symptomatology as measured by the Center for Epidemiologic Studies (CES-D) and fatigue; nonetheless, fatigue is neither sensitive nor specific to the diagnosis of depression.

The fundamental principles of ROC analysis are described. This method provides a means to assess the overall discriminant power of psychiatric rating scales for the full range of their scores. For each cut-off, an instrument has a sensitivity (true positive rate) and a specificity (true negative rate). High values of these coefficients are desirable although they are inversely related. ROC curves can be obtained by plotting the false positive rate and the true positive rate for different thresholds of the rating scale. The curves which would be obtained with a perfect, a worthless and a typical instrument are drawn to illustrate various situations found in ROC analysis. Among the several indices proposed, the area under the curve (AUC) is the most commonly used index to assess the overall discriminant power of an instrument. To calculate this area, the non parametric trapezoidal method is advocated. The area under the curve varies between 0.50 which corresponds to the chance line up to 1.0, a value associated with perfect accuracy. This parameter can be interpreted as the probability of classifying correctly the subjects of a pair where one is normal and one is diseased. Then, the appropriate statistic to compare several ROC indices is provided for the general case of independent observations. When the observations are paired, the standard error of the difference between two areas needs to be corrected.(ABSTRACT TRUNCATED AT 250 WORDS)

Object Whole-brain radiation therapy (WBRT) has been the traditional approach to minimize the risk of intracranial recurrence following resection of brain metastases, despite its potential for late neurotoxicity. In 2007, the authors demonstrated an equivalent local recurrence rate to WBRT by using stereotactic radiosurgery (SRS) to the operative bed, sparing 72% of their patients WBRT. They now update their initial experience with additional patients and more mature follow-up. Methods The authors performed a retrospective review of all cases involving patients with limited intracranial metastatic disease (≤ 4 lesions) treated at their institution with SRS to the operative bed following resection. No patient had prior cranial radiation and WBRT was used only for salvage. Results From November 2000 to June 2009, 52 patients with a median age of 61 years met inclusion criteria. A single metastasis was resected in each patient. Thirty-four of the patients each had 1 lesion, 13 had 2 lesions, 3 had 3 lesions, and 2 had 4 lesions. A median dose of 1500 cGy (range 800–1800 cGy) was delivered to the resection bed targeting a median volume of 3.85 cm3 (range 0.08–22 cm3). With a median follow-up of 13 months, the median survival was 15.0 months. Four patients (7.7%) had a local recurrence within the surgical site. Twenty-three patients (44%) ultimately developed distant brain recurrences at a median of 16 months postresection, and 16 (30.7%) received salvage WBRT (8 for diffuse disease [> 3 lesions], 4 for local recurrence, and 4 for diffuse progression following salvage SRS). The median time to WBRT administration postresection was 8.7 months (range 2–43 months). On univariate analysis, patient factors of a solitary tumor (19.0 vs 12 months, p = 0.02), a recursive partitioning analysis (RPA) Class I (21 vs 13 months, p = 0.03), and no extracranial disease on presentation (22 vs 13 months, p = 0.01) were significantly associated with longer survival. Cox multivariate analysis showed a significant association with longer survival for the patient factors of no extracranial disease on presentation (p = 0.01) and solitary intracranial metastasis (p = 0.02). Among patients with no extracranial disease, a solitary intracranial metastasis conferred significant additional survival advantage (43 vs 10.5 months, p = 0.05, log-rank test). No factor (age, RPA class, tumor size or histological type, disease burden, extent of resection, or SRS dose or volume) was related to the need for salvage WBRT. Conclusions Adjuvant SRS to the metastatic intracranial operative bed results in a local recurrence rate equivalent to adjuvant WBRT. In combination with SRS for unresected lesions and routine imaging surveillance, this approach achieves robust overall survival (median 15 months) while sparing 70% of the patients WBRT and its potential acute and chronic toxicity.

Clinical assessments, psychological examinations, biological parameters and other indices are commonly used in psychiatry to measure disease status. These evaluation tools are not perfect and, in general, they will fail to perfectly discriminate "cases" from normal controls. When a gold standard is available, their performances can be evaluated. If the results of a measurement are tabulated with true disease status in a contingency table, the proportions of cases and normals correctly identified (sensitivity and specificity) are useful coefficients of validity of the instrument studied. It is shown that unbiased estimates of the prevalence rate cannot however be derived directly from the proportion of sample respondents identified by a test. Practical examples with a psychiatric rating scale are provided which illustrate the importance and magnitude of this bias. Formulas are subsequently given which permit the calculation of the "true" prevalence rate from the proportion of screen positives when the sensitivity and the specificity of the test are known. The proportion of true cases among those individuals identified by a test is another important property of psychiatric measures, particularly for screening purposes. It is also called the positive predictive value and, like sensitivity and specificity, predictive values are probabilities for which high values are desirable. However, this critical characteristic of a test depends on the prevalence rate, the sensitivity and the specificity of the test used. Using an example, major changes in the probability of a screen positive individual to be truly diseased are shown to depend upon varying levels of the base rate of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose: To evaluate the effect of daily shifts observed with mega‐voltage cone beam CT (MV‐CBCT) localization on the IMRT dose distribution received by prostate cancer patients. Method and Materials: Eight patients who received a dose of 77.4 Gy to the PTV, which included the prostate and the seminal vesicles with a 1 cm margin, were selected for this retrospective study. Prior to each daily treatment fraction, the prostate was localized using MV‐CBCT, and the treatment couch position was corrected accordingly in the lateral (RL), longitudinal (SI) and vertical (AP) directions. The shifts for each of the 308 fractions were recorded, and the 308 corresponding dose distributions that the patients would have received if the shifts were not applied were calculated. Dose volume histograms (DVH) and mean dose for target and organs‐at‐risk were derived from these dose distributions, and compared to the treatment plan. Results: The average shifts for each patient were less than 6, 5 and 5 mm in the RL, SI and AP directions, respectively, with standard deviations ranging from 2 to 7 mm. The relative mean dose difference for the prostate was less that 1%, however effects as large as 15% and 20% were observed for the rectum and bladder, respectively. Rectum dose differences were correlated to AP shifts, while the bladder dose was affected by the SI shifts. Conclusion: For IMRT plans with a 1 cm margin, daily localization of the prostate is necessary to reduce the risk of bladder and rectum complication. The dose to these organs is very sensitive to systematic errors, while the effects of random errors cancel each other due to the essentially spherical shape of the dose distribution. Our results show that accurate patient positioning is an important step in any dose‐escalation and/or margin reduction strategy to further improve the therapeutic ratio.

Purpose: To analyze the online image‐guided localization data from 846 ultrasound (US)and 350 MV‐CBCT couch alignments for patients undergoing IMRT of the prostate. Method and Materials: Daily volumetric MV‐CBCT and USimages were acquired for 11 and 23 patients, respectively, after each patient was immobilized in a vacuum cradle and setup to skin markers as the center‐of‐mass. The couch shifts applied in the lateral (left‐right/LR), vertical (anterior‐posterior/AP), and longitudinal (superior‐inferior/SI) directions, along with the magnitude of the three‐dimensional (3D) shift vector, were analyzed and compared for both methods. The percentage of shifts larger than 5 mm in all directions was also compared. CTV‐to‐PTV expansion margins were estimated based on the localization data with US and CB image‐guidance.Results: Systematic and random shifts from CB versus US were: laterally, 1.6 ± 3.8 mm vs. − 0.7 ± 6.9 mm; vertically, − 0.9 ± 5.4 mm vs. − 0.2 ± 6.4 mm; longitudinally, −1.4 ± 2.9 mm vs. −2.9 ± 5.2 mm. The mean 3D shift distance was smaller using CB (6.6 ± 3.6 mm vs. 9.1 ± 6.5 mm) with a p‐value < 0.05. The US data show greater variability. The percentage of US shifts larger than 5 mm were 33%, 40%, and 31% in the LR, AP, and SI directions, respectively, compared to 17%, 31%, and 7% for CB. Conclusion: MV‐CBCT localization data suggest a different distribution of prostate center‐of‐mass shifts with smaller variability, compared to US. The online MV‐CBCT image‐guidance data show that for treatments that do not include daily prostate localization,one can use a CTV‐to‐PTV margin that is 2.5 mm smaller than the one suggested by US data,hence allowing more rectum and bladder sparing and potentially improving the therapeutic ratio.

Purpose: Tolerance levels for dosimetric verification of IMRT plans are usually set at constant values. This QA process is not patient specific. It ignores the potential role of fraction size and treatment site in determining the clinical consequences of an error in dose calculation and/or delivery. The objective of this work is to develop dose tolerance levels for IMRT based on radiobiological parameters. Method and Materials: The linear quadratic cell survival model which accounts for the effects of both total dose and fraction size was used. A technique was developed to convert dosimetric tolerance levels between treatment schedules while maintaining a constant uncertainty in a radiobiological parameter. Specifically, a constant tolerance level in a radiobiological parameter is set, rather than in calculated/delivered dose. Calculations were performed for different treatment fractionations and α/β ratios mimicking a wide range of clinical situations. Results: Tumors with low α/β ratio (melanoma, prostate) are more sensitive to errors in total dose. Dosimetric tolerance for such tumors should be approximately 65% of those of other tumors. For such malignances, if a 3% error in calculated/delivered dose is acceptable for treatment of most tumors, this should be reduced to 2% for treatment of these more radiosensitive tumors. In addition, results show that in field late and early responding normal tissues are more sensitive to errors in dose than out of field tissues. Conclusion: Invariant tolerance levels are appropriate for a wide range of clinical IMRT schemes, especially given current uncertainties in clinical α/β values. Assuming that current dosimetric levels are appropriate for some clinical applications, the appropriate values are for all other applications are between 0.5–2 times the currently used values for IMRT QA. In conclusion, tolerance levels for dosimetric QA based on radiobiological parameters provide useful information and may be more appropriate for verifying calculated/delivered dose.

The reliability of French psychiatrists using DSM-III axis I disorders was studied using videotaped semi-structured diagnostic interviews, 136 psychiatrists with different levels of clinical experience classified 11 cases into six preselected diagnostic categories: Schizophrenia, Major Depressive Episode, Dysthymic Disorder, Cyclothymic Disorder, Other Psychiatric Diagnosis, No Present Psychiatric Diagnosis. A modified Kappa coefficient for multiple observers was used to calculate agreement and thereby estimate reliability. We obtained an overall Kappa of 0.55 for six categories, and when the Dysthymic and Cyclothymic Disorders were combined into one class, i.e. other specific affective disorders, the Kappa value increased to 0.64. The Kappa value for individual categories was best for Schizophrenia and Major Depressive Episode, and poor for Dysthymic and Cyclothymic Disorders. Clinical experience or prior knowledge of DSM-III criteria did not have a significant effect on reliability.

In order to compare the level of agreement between four evaluation criteria, data from an 18-month clinical trial with 181 schizophrenic patients were reanalyzed. In that study, assessments of the subjects were carried out with two psychiatric rating scales, Brief Psychiatric Rating Scale and Nurses' Observation Scale for Inpatient Evaluation (BPRS and NOSIE), and two clinical evaluations (psychiatrist and nurse). Results show that there was total agreement on the four outcome measures for only half of the subjects. After further analyses, we observed that the best agreement was between the two clinical assessments. The NOSIE had poor agreement with the other criteria and appeared less sensitive to moderate levels of improvement in the patients' clinical status. These results are discussed with respect to reliability and validity issues.

The incidence rate of respiratory (lung and upper respiratory tract) cancer related to the nickel industry was studied in the male population of New Caledonia over a 7-year period (1978-1984). The findings show no excess incidence of lung or upper respiratory tract (larynx, pharynx, nasal cavities) cancer cases in the population of nickel workers compared with the rest of the male population in New Caledonia. This result was corroborated by a case-control study which does not indicate any particular role of hazards specific to the nickel mining and refining industry. Our findings, which may be specific for the type of ore processed in New Caledonia, must nevertheless be confirmed by extending the study to a total of 10 years (1978-1987). The incidence rate of male respiratory cancer in New Caledonia was also compared to that of cancers of this type reported in certain regions of industrialized countries (Australia, France, U.K., USA). Such findings are very similar to those observed in New Caledonia, thereby confirming a predominant role of tobacco and alcohol consumption in a territory which, despite certain characteristics of a developing country, has life-style habits similar to those of industrialized countries.

RésuméCet article court présente la version française de l’échelle CES-D, instrument destiné á être employé en population générale. Les 20 items de l’échelle sont souvent présents chez les déprimés et sont issus d’instruments déjà validés dans la mesure clinique des états dépressifs. L’évaluation repose sur l’état au cours de la semaine précédente et les réponses sont du type jamais, très rarement, à fréquemment, tout le temps. Les études de validation de la version française ont été réalisées chez des malades psychiatriques hospitalisés, chez des malades psychiatriques ambulatoires et en médecine générale. Les instruments auxquels le CES-D a été comparé comportaient la MADRS, les catégories DSM III des troubles affectifs et un diagnostic ouvert de dépression. La note seuil utilisée aux Etats-Unis ne paraît pas être pertinente en France. Les résultats suggèrent une note seuil optimale de 17 pour les sujets masculins, 23 pour les sujets féminins. Nous soulignons qu’à l’heure actuelle ia valeur prédictive de cet instrument pour un sujet individuel n’a pu encore être evaluée.

The major health indexes based on the classical concepts of mortality and morbidity are reviewed while emphasizing their limitations: underestimation of health problems socio-economic impact, inadequacy for the evaluation of certain main objectives of health care delivery systems, purely negative measurement of health. This paper investigates the recent attempts to improve these aspects: extension of the concept of morbidity by the introduction of disability measurements and the development of a "positive health" concept. Finally, a discussion is presented of the major health indexes whose development is based on the use of these concepts and the main conceptual, methodological problems they give rise to.

A method, based on the Delphi technique, for evaluating occupational risks in a quantifiable manner was devised in the course of a case-control study on respiratory cancers in the nickel mining and refining industry in New Caledonia. There were four stages in the evaluation process: identification of eleven potential carcinogenic factors in the company during the 1930-1977 period; grouping of a limited number of work-stations; evaluation of exposure levels for the different factors for each workstation; computation of the cumulative value of exposure for each subject under study. A partial validation study shows that this kind of approach may prove useful for future occupational epidemiological studies.