G. van Breukelen

Behavioral risk factors of sudden cardiac arrest

OBJECTIVE The purpose of this study was to investigate the association between sudden cardiac arrest (SCA) and the behavioral factors exhaustion and nonexpression of emotions. METHODS Case-control study of 99 victims of SCA and 119 coronary controls, matched for gender and age. RESULTS Victims of SCA were more often assessed as exhausted and as closed by their family members than controls. A significant interaction between exhaustion and closeness on the risk of SCA was observed. Those who were exhausted and did not express their emotions had a sevenfold greater risk of SCA. CONCLUSION The behavioral factor of exhaustion and nonexpression of emotions may contribute to the identification of persons at elevated risk for SCA.

Feasibility of randomized controlled trials in liver surgery using surgery-related mortality or morbidity as endpoint

There is a shortage of randomized controlled trials (RCTs) on which to base guidelines in liver surgery. The feasibility of conducting an adequately powered RCT in liver surgery using the dichotomous endpoints surgery‐related mortality or morbidity was examined.

Development of a composite endpoint for randomized controlled trials in liver surgery

The feasibility of randomized controlled trials (RCTs) in liver surgery using a single‐component clinical endpoint is low as such endpoints require large sample sizes owing to their low incidence. A liver surgery‐specific composite endpoint (CEP) could solve this problem. The aim of this study was to develop a liver surgery‐specific CEP with well‐defined components.

Parenting style and adolescent smoking cognitions and behaviour

Parenting style and smoking-related cognitions have both successfully predicted adolescent smoking behaviour. Data were collected among 482 Dutch adolescents to examine whether effects of parenting styles (authoritative, permissive, authoritarian, rejecting, neglecting, measured by underlying dimensions support, strict control, and psychological control) on adolescent lifetime smoking were mediated by cognitions (pro-smoking attitude, social norm, self-efficacy, intention) and to study the role of gender in this process. Support was not significantly associated with smoking behaviour. The inverse relation between strict control and smoking was partly mediated by attitude and intention, both associated with increased smoking. Psychological control related directly to increased lifetime smoking. Combinations of dimensions creating the specific styles were not associated with cognitions or behaviour. Maternal and paternal parenting were equally associated with smoking cognitions and behaviour; nor were effects moderated by adolescent gender. Interventions to prevent adolescent smoking initiation should aim at increasing strict control and reducing psychological control.

Intended Coping Responses to Cancer Symptoms in Healthy Adults: The Roles of Symptom Knowledge, Detection Behavior, and Perceived Threat

Background: To date, the causal effects of the knowledge of cancer-related symptoms and detection behavior on coping with cancer-related symptoms have not been identified. Therefore, the current study explored the effects of active or passive detection of supposedly well-known or less-known cancer-related symptoms on intended coping responses. In addition, we were interested in the extent to which these effects are driven by heightened perceptions of threat. Methods: In an experimental study using a 2 × 2 within-subject design, 221 Dutch adults from the general population responded to a survey study sent to their homes (18.4% response). They were asked to read scenario information about four cancer-related symptoms that were (a) well known or less known and (b) actively or passively detected (e.g., self-examination versus unusual blood loss). The authors measured intended coping responses to the detection of cancer-related symptoms as either adaptive (e.g., visiting a general practitioner) or maladaptive (e.g., denial of the symptom). Results: As expected, the findings revealed that well-known symptoms resulted in more anticipated adaptive coping and less anticipated maladaptive coping than less-known symptoms. Unfortunately, the findings also suggest that the active as opposed to passive detection of cancer symptoms (e.g., self-examination versus unusual blood loss) is likely to result in more maladaptive coping. These effects were mediated by heightened perceptions of threat. Conclusions: Future health education programs that aim to motivate people to be more active in the early detection of cancer symptoms should first focus on increasing peoples knowledge about the early warning signs of cancer. (Cancer Epidemiol Biomarkers Prev 2008;17(4):818–26)

Psychological Risk Factors of Sudden Cardiac Arrest

This study tested the hypotheses that Vital Exhaustion (VE) increases the risk of sudden cardiac arrest (SCA) and that non-expression of emotions modifies the risk of VE. Data came from 99 victims of SCA and 103 healthy controls matched for gender and age. Victims of SCA were more often assessed as exhausted and as being closed by their family members than controls, the estimated relative risks being 2.81 (95% CI 1.1-7.3) and 2.28 (95% CI 1.1-4.6), respectively. No significant interaction between exhaustion and being closed on the risk of SCA was observed. These findings indicate that a state of exhaustion and being closed belong to the risk indicators of SCA.

Authors' reply: Feasibility of randomized controlled trials in liver surgery using surgery-related mortality or morbidity as endpoint (Br J Surg 2009; 96: 1005–1014)

Sir We read this article with interest. Although we agree with the technical merits of the anastomotic technique that Kleespies and colleagues have described, we are concerned about the authors’ failure to consult with Professor Blumgart about this study before its publication. Doing so would seem to be appropriate academically as the authors have formally attached Professor Blumgart’s name to this technique of pancreaticojejunostomy for the first time. In addition, the authors of the published report have incorrectly referenced the procedure to the fourth edition of Surgery of the Liver and Biliary Tract when in fact the procedure is well highlighted in the third edition of this book (Figure 56.18)1. It should be noted that we have analysed and presented our institutional experiences with this novel technique2. In our larger series of 187 patients from the USA, we reported a similarly low postoperative mortality rate of 1·6 per cent and a very low rate (6·4 per cent) of clinically significant (grade B and C) pancreatic fistula2,3. There were no deaths related to pancreatic anastomotic failure in our series. We agree with the authors’ assertion that the anastomosis is favourable as it avoids shear forces that may lead to disruption of the pancreaticojejunal anastomosis, but also believe that the anastomosis is preferred because it permits excellent visualization for creation of a tension-free duct-to-mucosal anastomosis. Furthermore, the mild compression provided between the pancreas and jejunal serosa afforded by this technique may help reduce leaks from accessory pancreatic ducts. These reported experiences favour the widespread application of this unique anastomosis for pancreaticojejunal reconstruction after pancreaticoduodenectomy. S. R. Grobmyer, D. A. Kooby, S. N. Hochwald and L. H. Blumgart University of Florida, Gainesville, Florida, Emory University School of Medicine, Atlanta, Georgia, and Memorial Sloan-Kettering Cancer Center, New York, New York, USA DOI: 10.1002/bjs.6953