ObjectiveCancer researchers have found midlife couples to have poorer outcomes compared to older couples due to the off-time nature of the illness for them. It is unknown if young couples, who are under-represented in cancer studies and overlooked for supportive programs, are at further risk. This study explored the moderating roles of survivor age and sex on the associations between active engagement and protective buffering and depressive symptoms in couples surviving cancer.MethodsThe exploratory study comprised 49 couples 1–3 years post-diagnosis. Multilevel (...) modeling was used to explore the moderating roles of survivor age and sex, controlling for interdependent data.ResultsApproximately, 37% of survivors and 27% of partners met clinical criteria for further assessment of depression, with 50% of couples having at least one member meeting the criteria. Survivors and their partners did not significantly differ on depressive symptoms, active engagement, or protective buffering. Male survivors reported significantly higher levels of active engagement by their partners than female survivors and female survivors reported significantly higher levels of protective buffering by their partners than male survivors. We found some evidence to suggest that survivor age and sex may play moderating roles between active engagement and protective buffering and depressive symptoms. Older partners and female survivors appeared to experience more positive effects from engaging in positive dyadic behaviors than younger partners and male survivors.ConclusionFindings not only confirm the important role of dyadic behaviors for couples surviving cancer together, but also the important roles of survivor age and sex may play in whether such behaviors are associated with lower levels of depressive symptoms. Future research that examines these complex associations over time and across the adult life span in diverse populations is needed. (shrink)

The Irish poet W. B. Yeats once wrote, with great sapience and perception: Nor dread, nor hope attend A dying animal; A man awaits his end Dreading and hoping all. That death has ever been a problem to man is attested as far back as we can trace our species in the archaeological record—indeed, it seems to have been a problem even for that immediate precursor of homo sapiens, the so-called Neanderthal Man; for he buried his dead.

On behalf of the Robert Wood Johnson Foundation, I want to thank the Public Health Law Association and the American Society of Law, Medicine & Ethics for your leadership and the work that both you and the Centers for Disease Control and Prevention have done to grow this field. RWJF is pleased to co-sponsor this conference.The music that opened this talk is a clip from Warren Zevon, who encouraged us musically to “send lawyers, guns and money.” Zevon was a singer/songwriter (...) and social critic whose songs often took a jaundiced, somewhat cynical point of view. Even so, I know that I am probably stretching his meaning when I think of this song. I see “lawyers, guns and money” as his take on the major drivers of how change happens in a society. (shrink)

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians, we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a survey was sent to a random selection of ED residents and PAs. All respondents (...) were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5% of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than nonphysicians. (shrink)

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion, and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale were divided into two groups: High Spasticity Group (...) or a Low Spasticity Group. The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG. No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke. (shrink)

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

I. Pryor on McKinsey: " A. Pryor’s Version of McKinsey-style Reasoning 1. Given authoritative self-knowledge, I can usually tell the contents of my own thoughts just by introspection. So I can know the following claim on the basis of reflection alone: " McK-1: I am thinking a thought with the content _water puts out fires_.