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Contributions of object relations theory and self psychology to relational psychology and group psychotherapy.

Object relations theory and self psychology are psychoanalytic perspectives that are especially concerned with interpersonal relations and their mental representations. Object relations theory began as an intrapsychic "singleton" psychology with the work of Freud and Melanie Klein. It subsequently evolved into a multi-person psychology with the work of Bion on groups, as well as the clinical and theoretical contributions of Winnicott and Fairbairn. Kohutian self psychology, which emerged later, has been interested in the relations between the self and significant others as mirroring and idealizing "self-objects." Stolorow's "inter-subjective perspective" emerged from self psychology as a full-fledged multi-person point of view. This article considers the significance of contemporary object relations theory and self psychology as relational, multi-person perspectives in terms of their application to group psychotherapy, focusing upon the group-as-a-whole, projective identification, transitional space and object, and self/self-object relations as particularly useful constructs. A clinical vignette is provided.

Humans↗

The relative power output and relative lean body mass of World and Olympic male and female champions with implications for gender equity.

A uniform measure of the gender-related differential performance of female and male Olympic and World champions is proposed: relative power output applied to the environment. Laws of physics are employed to derive equations for estimating relative power output. In previous controlled laboratory studies, equally trained male and female athletes were shown to have a relative power output not significantly different from relative lean body mass. As to the estimated power output for 32 Olympic and World championship events contested between 1976 and 2004, eight in running, four in speed skating, three in jumping, twelve in swimming and five in rowing: 100% of the 32 event mean percentage differences in power output and 96% of the 411 event percentage differences in power output are within one standard deviation of the appropriate lean body mass percentage difference, consistent with equality of training. For 1952-1972, significantly higher percentage differences in power output are estimated in running and swimming compared with 1976-2004, consistent with women being less well trained than men during that earlier period. It is noted that efforts in recent years to provide equality of opportunity for female athletes coincide with equalization of estimated relative power output in competition with the relative lean body mass.

Body Composition↗

Relations between coping strategies and health-related quality of life in patients with spinal cord lesion.

OBJECTIVE: Although the use of appropriate coping strategies has been suggested to be a key factor in determining successful adjustment to severe physical illness/disability, little systematic support for this link has been found. We investigated relationships between spinal cord lesion-related coping strategies and health-related quality of life when studying for sociodemographic, disability-related and social support variables. DESIGN AND SUBJECTS: We studied 256 persons with traumatically acquired spinal cord lesion (=1 year) from a typical rural/urban Swedish area in a cross-sectional design. METHODS: Coping measure was the Spinal Cord Lesion-related Coping Strategies Questionnaire. Outcome measures were the Spinal Cord Injury Quality of Life Questionnaire, the Short-Form 36 Health Survey version 2.0, and a standardized global question of overall quality of life. Multiple regressions were performed. RESULTS: Coping strategies were clear correlates of health-related quality of life when sociodemographic, disability-related and social support variables were studied. The relationship between coping strategies and quality of life was: the more revaluation of life values (Acceptance) and the fewer tendencies towards dependent behaviour (Social reliance) the better the health-related quality of life. CONCLUSION: Our results suggest that greater focus needs to be directed to coping strategies and to ways of facilitating adaptive outcomes in rehabilitation.

Adaptation, Psychological↗

Lutein and zeaxanthin in the diet and serum and their relation to age-related maculopathy in the third national health and nutrition examination survey.

Relations of the carotenoids lutein and zeaxanthin in the diet and serum to photographic evidence of early and late age-related maculopathy (ARM) among persons over age 40 years (n = 8,222) were examined. Inverse relations of these carotenoids in the diet or serum to any form of ARM were not observed overall. There was a direct relation of dietary levels to one type of early ARM (soft drusen). However, relations differed by age and race. In the youngest age groups who were at risk for developing early (ages 40-59 years) or late (ages 60-79 years) ARM, higher levels of lutein and zeaxanthin in the diet were related to lower odds for pigmentary abnormalities, one sign of early ARM (odds ratio among persons in high vs. low quintiles = 0.1, 95 percent confidence interval: 0.1, 0.3) and of late ARM (odds ratio = 0.1, 95 percent confidence interval: 0.0, 0.9) after adjustment for age, gender, alcohol use, hypertension, smoking, and body mass index. Relations of these carotenoids to ARM may be influenced by age and race and require further evaluation in separate populations and in prospective studies.

Adult↗

Did the Medicare inpatient rehabilitation facility prospective payment system result in changes in relative patient severity and relative resource use?

BACKGROUND: The Centers for Medicare and Medicaid Services implemented a prospective payment system (PPS) in 2002 for care provided by inpatient rehabilitation facilities (IRFs) to Medicare beneficiaries. OBJECTIVE: We sought to examine changes in the composition of Medicare beneficiaries in IRFs by examining the percentages of patients having worse functional or health status than the average for their payment groups (relative severity) and of patients having greater cost or longer length of stay than the average for their payment groups (relative resource use) before versus after IRF PPS; to examine whether observed changes in relative resource use were expected given predicted changes; and to explore whether these effects varied by IRF Medicare volume. METHODS: In an observational study of indicators of Medicare beneficiary relative severity and relative resource use, we studied cases paid for by Medicare during 1999 and 2002 having an acute care stay preceding their IRF stay (n = 363,542 in 1999 and 446,002 in 2002). RESULTS: Similar percentages of cases had longer than expected lengths of stay, greater-than-expected costs per case, and worse-than-expected functional status pre- versus post-IRF PPS. Cases under the IRF PPS had lower predicted probabilities of death 150 days after admission. Although predicted relative resource use remained steady, observed relative resource use decreased after IRF PPS. CONCLUSIONS: IRF patient composition has not changed meaningfully for Medicare beneficiaries, but patients within payment groups are being provided less care, which could be attributable to the IRF PPS, existing trends in decreasing length of stay, or both.

Aged↗

Relationally and physically aggressive children's intent attributions and feelings of distress for relational and instrumental peer provocations.

Numerous studies have demonstrated that physically aggressive children exhibit hostile attributional biases in response to instrumental peer provocations, a social information-processing pattern that has been recognized as a contributor to peer-directed aggression. The present studies (N = 127 and N = 535) were designed to extend past research by evaluating the intent attributions and feelings of emotional distress of relationally and physically aggressive children in response to instrumental and relational provocation contexts. Results indicated that physically aggressive children exhibited hostile attributional biases and reported relatively greater distress for instrumental provocation situations, whereas relationally aggressive children exhibited hostile attributional biases and reported relatively greater distress for relational provocation contexts. Implications of these findings for the understanding of factors that may contribute to relational as well as physical aggression are discussed.

Aggression↗

A meta-analysis of the relation between cumulative exposure to asbestos and relative risk of lung cancer.

OBJECTIVES: To obtain summary measures of the relation between cumulative exposure to asbestos and relative risk of lung cancer from published studies of exposed cohorts, and to explore the sources of heterogeneity in the dose-response coefficient with data available in these publications. METHODS: 15 cohorts in which the dose-response relation between cumulative exposure to asbestos and relative risk of lung cancer has been reported were identified. Linear dose-response models were applied, with intercepts either specific to the cohort or constrained by a random effects model; and with slopes specific to the cohort, constrained to be identical between cohorts (fixed effect), or constrained by a random effects model. Maximum likelihood techniques were used for the fitting procedures and to investigate sources of heterogeneity in the cohort specific dose-response relations. RESULTS: Estimates of the study specific dose-response coefficient (kappa 1.i) ranged from zero to 42 x 10(-3) ml/fibre-year (ml/f-y). Under the fixed effect model, a maximum likelihood estimate of the summary measure of the coefficient (k1) equal to 0.42 x 10(-3) (95% confidence interval (95% CI) 0.22 to 0.69 x 10(-3)) ml/f-y was obtained. Under the random effects model, implemented because there was substantial heterogeneity in the estimates of kappa 1.i and the zero dose intercepts (Ai), a maximum likelihood estimate of k1 equal to 2.6 x 10(-3) (95% CI 0.65 to 7.4 x 10(-3)) ml/f-y, and a maximum likelihood estimate of A equal to 1.36 (95% CI 1.05 to 1.76) were found. Industry category, dose measurements, tobacco habits, and standardisation procedures were identified as sources of heterogeneity. CONCLUSIONS: The appropriate summary measure of the relation between cumulative exposure to asbestos and relative risk of lung cancer depends on the context in which the measure will be applied and the prior beliefs of those applying the measure. In most situations, the summary measure of effect obtained under the random effects model is recommended. Under this model, potency, k1, is fourfold lower than that calculated by the United States Occupational Safety and Health Administration.

Asbestos↗

Fatigue in employees with diabetes: its relation with work characteristics and diabetes related burden.

AIMS: To examine the relations between work characteristics as defined by the Job Demand-Control-Support model (JDCS) (that is, job demands, decision latitude, and social support), diabetes related burden (symptoms, seriousness of disease, self care activities, and disease duration), and fatigue in employees with diabetes mellitus. METHODS: Employees (n = 292) aged 30-60 years, with insulin treated diabetes, filled in self administered questionnaires that assess the above mentioned components of the JDCS model and diabetes related burdens. RESULTS: Both work and diabetes related factors are related to fatigue in employees with diabetes. Regression analyses revealed that work characteristics explain 19.1% of the variance in fatigue; lack of support, and the interaction of job demands and job control contribute significantly. Diabetes related factors explain another 29.0% of the variance, with the focus on diabetes related symptoms and the burden of adjusting insulin dosage to circumstances. Fatigue is more severe in case of lack of social support at work, high job demands in combination with a lack of decision latitude, more burden of adjusting insulin dosage to circumstances, and more diabetic symptoms. Furthermore, regression analysis revealed that diabetic symptoms and the burden of adjusting the insulin dosage to circumstances are especially relevant in combination with high job demands. CONCLUSIONS: Both diabetes and work should be taken into consideration-by (occupational) physicians as well as supervisors-in the communication with people with diabetes.

Adult↗

Robust relational parsing over biomedical literature: extracting inhibit relations.

We describe the design of a robust parser for identifying and extracting biomolecular relations from the biomedical literature. Separate automata over distinct syntactic domains were developed for extraction of nominal-based relational information versus verbal-based relations. This allowed us to optimize the grammars separately for each module, regardless of any specific relation resulting in significantly better performance. A unique feature of this system is the use of text-based anaphora resolution to enhance the results of argument binding in relational extraction. We demonstrate the performance of our system on inhibition-relations, and present our initial results measured against an annotated text used as a gold standard for evaluation purposes. The results represent a significant improvement over previously published results on extracting such relations from Medline: Precision was 90%, Recall 57%, and Partial Recall 22%. These results demonstrate the effectiveness of a corpus-based linguistic approach to information extraction over Medline.

Abstracting and Indexing↗

A longitudinal study of health-related quality of life of first stroke survivors' close relatives.

BACKGROUND AND PURPOSE: Mental and social burdens of stroke patients' relatives have been investigated repeatedly, but there is little information about their quality of life (QoL). The purpose of the study was to describe the health-related QoL of stroke patients' relatives at 3 points in time after the stroke. METHOD: Sixty-four closest relatives of patients suffering from a disabling stroke were questioned at admission to inpatient rehabilitation as well as 6 months and 1 year after discharge with the SF36 (short form 36-item questionnaire) and about probable covariates. RESULTS: During inpatient rehabilitation relatives' perception of their physical role as well as of all mental health scales was significantly lower than the normative data. We found improvements in all scales except physical functioning between inpatient rehabilitation and 6 months after discharge. Deteriorations between 6 months and 1 year occurred in physical functioning, role physical, social functioning, role emotional and mental health. CONCLUSIONS: Changes in perceived health-related QoL indicate that relatives go through different stages while coping with the chronic illness of their family member during rehabilitation and in the first year after discharge. These findings may aid support and counseling.

Adaptation, Psychological↗

Chlamydia pneumoniae serology is associated with thrombosis-related but not with plaque-related microembolization during carotid endarterectomy.

BACKGROUND AND PURPOSE: Chlamydia pneumoniae has repeatedly been associated with atherosclerotic disease. Our study was designed to clarify whether this association is based on C pneumoniae-induced transformation of a stable into an unstable atherosclerotic plaque or on stimulation of hypercoagulability leading to increased thrombotic arterial occlusions by C pneumoniae infection. Transcranial Doppler ultrasonographic monitoring of the middle cerebral artery during carotid endarterectomy offers the opportunity to study, before removal of the plaque, atherothrombotic emboli dislodging from an unstable carotid plaque (plaque-related emboli) and emboli related to (excessive) thrombus formation at the endarterectomy site after removal of the plaque and restoration of flow (thrombosis-related emboli). METHODS: C pneumoniae IgA (> or =1/16) and IgG (> or =1/64) seropositivity was assessed in 53 patients with symptomatic carotid artery disease undergoing carotid endarterectomy. The removed carotid plaques were studied histologically to assess plaque instability. RESULTS: Plaque- and thrombosis-related emboli were registered in 43 patients with an adequate transtemporal window. IgA seropositivity (58%) was associated significantly with thrombosis-related embolization (P=0.030) but not with plaque-related embolization or with histological plaque instability. CONCLUSIONS: C pneumoniae serology is associated with microembolization after endarterectomy and restoration of flow. Since these microemboli represent platelet aggregations and are related to cerebrovascular complications, our data suggest that C pneumoniae infection contributes to cerebrovascular events in patients with carotid artery disease through stimulation of thrombosis.

Aged↗

Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic.

STUDY OBJECTIVES: To study the prevalence, risk factors, and gender differences in symptoms related to obstructive sleep apnea. A secondary objective was to study gender differences in relation to referral to a sleep clinic for sleep investigations. DESIGN AND SETTING: A questionnaire study in a representative sample of the general population. A second cohort included patients referred for sleep apnea investigation between 1991 and 2000 in the same geographic region. PARTICIPANTS: A representative sample of 5,424 subjects aged 20 to 69 years living in northern Sweden. Responses were obtained from 4,648 subjects (85.7%). RESULTS: Of the male respondents, 17.9% stated that snoring was a problem or said that they had relatives who were concerned about witnessed sleep apnea, and of the female respondents, 7.4%. The prevalence of snoring and witnessed apneas increased with age. In men, there was a peak prevalence rate at 55 to 59 years of age, while the corresponding figure in women the peak prevalence rate was at 60 to 64 years of age. Having snoring as a problem and relatives who were concerned about witnessed sleep apnea were independently associated with male gender, age, and current smoking. Snoring as a problem also was associated with higher education. Women who snored reported significantly more daytime sleepiness than did men who snored. The estimated number of subjects aged 20 to 69 years who had snoring as a problem or had relatives who were concerned about witnessed sleep apnea in the population was 21,160. During the previous decade, 3,955 subjects had been referred to sleep laboratories, so < 20% of the estimated number of symptomatic subjects in the population had been referred during this 10-year period. The referral rate ratio for men/women after correction for population and prevalence of symptoms was 1.25:1 (p = 0.012). CONCLUSION: Experiencing snoring as a problem or having relatives who are concerned about witnessed sleep apnea are common findings in the population. However, during the last decade, only about 20% of the subjects with snoring as a problem or with relatives who are concerned about witnessed sleep apnea were referred to sleep laboratories. Women were significantly underrepresented in sleep laboratory referrals, even though women who snored experienced more subjective daytime sleepiness than men.

Adult↗

Sensitivity to relative reinforcer rate in concurrent schedules: independence from relative and absolute reinforcer duration.

Twelve pigeons responded on two keys under concurrent variable-interval (VI) schedules. Over several series of conditions, relative and absolute magnitudes of reinforcement were varied. Within each series, relative rate of reinforcement was varied and sensitivity of behavior ratios to reinforcer-rate ratios was assessed. When responding at both alternatives was maintained by equal-sized small reinforcers, sensitivity to variation in reinforcer-rate ratios was the same as when large reinforcers were used. This result was observed when the overall rate of reinforcement was constant over conditions, and also in another series of concurrent schedules in which one schedule was kept constant at VI ached 120 s. Similarly, reinforcer magnitude did not affect the rate at which response allocation approached asymptote within a condition. When reinforcer magnitudes differred between the two responses and reinforcer-rate ratios were varied, sensitivity of behavior allocation was unaffected although response bias favored the schedule that arranged the larger reinforcers. Analysis of absolute response rates ratio sensitivity to reinforcement occurrred on the two keys showed that this invariance of response despite changes in reinforcement interaction that were observed in absolute response rates on the constant VI 120-s schedule. Response rate on the constant VI 120-s schedule was inversely related to reinforcer rate on the varied key and the strength of this relation depended on the relative magnitude of reinforcers arranged on varied key. Independence of sensitivity to reinforcer-rate ratios from relative and absolute reinforcer magnitude is consistent with the relativity and independence assumtions of the matching law.

Animals↗

Is Helicobacter pylori involved in the pathogenesis of the gastritis characteristic of pernicious anaemia? Comparison between pernicious anaemia relatives and duodenal ulcer relatives.

The aim of the study was to evaluate whether Helicobacter pylori could be involved in the early stages of the severe corpus atrophy that is characteristic of overt pernicious anaemia and is usually H. pylori-negative. The behaviour of H. pylori infection and chronic gastritis was studied in 159 first-degree relatives of pernicious anaemia (PA) probands and was compared with that in 137 first-degree relatives of duodenal ulcer (DU) probands. DU is as a rule associated with H. pylori infection. PA relatives showed a markedly higher prevalence of severe corpus atrophy and of parietal cell antibodies than DU relatives. However, the prevalences of H. pylori did not show significant differences between the two groups of relatives. The age-specific prevalences of H. pylori infection increased similarly in both series of relatives up to geriatric age, together with an increase in the mean scores of corpus gastritis. However, in older age the prevalence of H. pylori in PA relatives showed a marked decrease, in spite of the increase in the mean gastritis score. The present result suggests the possibility that H. pylori is involved in the early PA stages that lead to severe corpus atrophy. The later progress of gastritis seems to be dependent on factors other than H. pylori, most likely 'autoimmune' mechanisms.

Adult↗

The increased interleukin-13 in patients with systemic lupus erythematosus: relations to other Th1-, Th2-related cytokines and clinical findings.

The levels of interleukin-13 (IL-13) in patients with systemic lupus erythematosus (SLE) were examined and related to other Th1-/Th2- related cytokines, clinical manifestations and other markers. Serum levels of IL-13 and other cytokines, soluble markers were measured by enzyme-linked immunosorbent assay (ELISA). Patients with active SLE had a significantly increased level of IL-13. Most patients with high levels of IL-13 had higher levels of IL-6, and some patients had high levels of gammaIFN. These patients were divided into two groups according to the patterns of these increased cytokines; one with a high level of only Th2 related cytokines (IL-13 or IL-6) and another with high levels of both Th2 related and Th1 related cytokines (gammaIFN or IL-2). The latter patients had high levels of soluble CD8 and CD23, and some of them had hemolytic anemia or pulmonary involvement, while most of the former patients had nephropathy. Thus, in SLE, the levels of IL-13 were increased, and the heterogeneity of increased Th2- and Th1-related cytokines was related to that of activation markers and clinical manifestations.

Adult↗

Set-related activity in the premotor cortex of rhesus monkeys: effect of triggering cues and relatively long delay intervals.

"Set-related activity" has been defined as a significant alteration in neuronal discharge rate during an "instructed delay period," a period when a previously instructed movement is being withheld. It has been argued that set-related activity in the primate premotor cortex, or at least a significant proportion of it, reflects motor preparation. In most previous investigations, however, in which visual stimuli have triggered the movement and simultaneously indicated its target, set-related activity might reflect either the anticipation of or attention to the trigger stimulus. The present report shows that set-related activity is robust and can be directionally selective when trigger stimuli do not indicate the target and when a trigger stimulus is absent. Another feature of previous studies has been the relatively brief intervals between the instruction and trigger stimuli (typically 3 sec or less). In the present study, we were able to observe the activity of a small number of cells during longer delay periods. Set-related activity persists, although it becomes less consistent, for as much as 7.5 sec after an instruction stimulus. These results support the hypothesis that set-related activity reflects the preparation for specific limb movements.

Animals↗

Redescription disembeds relations: evidence from relational transfer and use in problem solving.

How relational information becomes disembedded from its original context is an important issue for theories of cognition. Two experiments tested the hypothesis that a process called redescription disembeds relations, resulting in abstract and, therefore, more transferable and robust representations. In Experiment 1, participants solved simple problems involving an alternating sequence. Participants who discovered the alternating-sequence relation through redescription transferred the relation to a second type of problem more quickly and used it more consistently than did participants who had been directly instructed on the alternating-sequence strategy. Experiment 2 showed similar effects for participants who discovered the alternating-sequence relation through redescription, as compared with participants who had discovered the relation through information available in the display. The present results converge with previous experimental and correlational evidence that suggests that redescription creates abstract representations of relations.

Adolescent↗

Relative area and relative luminance combine to anchor surface lightness values.

The anchoring of lightness perception was tested in simple visual fields composed of only two regions by placing observes inside opaque acrylic hemispheres. Both side-by-side and center/surround configurations were tested. The results, which undermine Gilchrist and Bonato's (1995) recent claim that surrounds tend to appear white, indicate that anchoring involves both relative luminance and relative area. As long as the area of the darker region is equal to or smaller than the area of the lighter region, relative area plays no role in anchoring. Only relative luminance controls anchoring: The lighter region appears white, and the darker region is perceived relative to that value. When the area of the darker region becomes greater than that of the lighter region, relative area begins to play a role. As the darker region becomes larger and relative area shifts from the lighter region to the darker region, the appearance of the darker region moves toward white and the appearance of lighter region moves toward luminosity. This hitherto unrecognized rule is consistent with almost all of the many previous reports of area effects in lightness and brightness. This in turn suggests that a wide range of earlier work on area effects in brightness induction, lightness contrast, lightness assimilation, and luminosity perception can be understood in terms of a few simple rules of anchoring.

Humans↗