Lydia Temoshok

Factors related to patient delay in seeking medical attention for cutaneous malignant melanoma

This study investigated the relationship between patient delay in seeking medical attention and prognostic indicators, tumor characteristics, and demographic and behavioral factors in 106 patients with cutaneous malignant melanoma. Patients with less readily apparent lesions, particularly on the back, had longer delays in seeking treatment, as might be expected. The prognostically unfavorable nodular melanomas were detected more frequently by patients themselves than they were found during visits to physicians for unrelated problems. In terms of behavioral variables, patients with less knowledge of melanoma or its appropriate treatment had significantly longer delays. Patients who minimized the seriousness of their condition were more likely to seek treatment sooner, perhaps because this reduced fear and anxiety about the disease or its treatment. For superficial spreading melanoma, delay was significantly and positively correlated with Clarks level of invasion, and also with tumor thickness when only noncoincidentally diagnosed patients were included; whereas for the nodular type, delay was significantly and positively associated with tuomr thickness, whether the patient was coincidentally diagnosed or not. The significance of these findings for early detection, and hence improved prognosis of malignant melanoma, is discussed.

An Intensive Psychoimmunologic Study of Long-Surviving Persons with AIDS. Pilot Work, Background Studies, Hypotheses, and Methodsa

The Acquired Immune Deficiency Syndrome (AIDS) is both an infectious disease and one of immunologic aberration. While it is a “new” disease and one that has defied attempts to date to discover either a cure or a vaccine, our knowledge about both infectious and immunologically mediated diseases should be applicable to the AIDS problem. Further, the complexity of interacting variables in the pathogenesis of immune deficiency and consequent vulnerability to a variety of infections strongly suggests that AIDS is multifactoral’ and understandable from a biopsychosociul perspective.* Because AIDS is a disease of immune dysfunction, one that manifests itself by infection and/or neoplasia, and one that critically involves the central nervous system,’ AIDS is particularly amenable to a psychoneuroimmunologic a p p r ~ a c h . ~ Our current research is focused on long-term survivors of AIDS. While the prevalent belief among the general public, persons with AIDS, and even the professional community is that AIDS is invariably fatal, there is a small but growing number of individuals who are alive and well 3, 4, and even 5 years after an AIDS diagnosis. Such individuals may be compared against the average life expectancy for AIDS patients, which may range from 18 months to as little as 2 months, depending on which of its many forms the disease takes. Pneumocystis carinii pneumonia (PCP), which accounted for 60% of all AIDS patients a t the time of our study, is responsible for more AIDS deaths than any other infection. About 35% of AIDS patients have

A three city comparison of the public's knowledge and attitudes about AIDS

Abstract A survey of knowledge, beliefs and attitudes about AIDS was administered simultaneously in San Francisco, New York and London to a total of 399 persons. The aim was to investigate how such knowledge and attitudes may he influenced by social and cultural contexts, as well as by disease epidemiology. Across all samples of the general public (excluding risk group members) in the three cities, general fear of AIDS and anti-gay attitudes were significantly negatively correlated with knowledge about AIDS. In the London sample, general fear of AIDS and anti-gay attitudes were significantly and positively associated with both sexual and general health behavior change. Only sexual behavior change, however, was significantly correlated with general fear of AIDS and anti-gay variables for the New York sample. Neither of these variables was significantly associated with behavior change of any kind in the San Francisco sample. We accounted for these inter-city differences by proposing a four-stage model of pu...

Psychoneuroimmunologic Aspects of Human Immunodeficiency Virus Infection

Publisher Summary This chapter discusses psychoneuroimmunologic aspects of human immunodeficiency virus infection. HIV infection can be associated with a variety of neuropsychiatric manifestations. AIDS dementia complex (ADC) eventually afflicts the majority of AIDS patients and is now one of the cardinal criteria of the diagnosis of AIDS in an HIV-infected individual. Neuropsychiatric symptoms may be an initial or sole manifestation of AIDS. HIV spectrum disorders exquisitely illustrate the importance and complexity of bidirectional interactions between the immune system and the central nervous system, the substance of the field of psychoneuroimmunology. Sociocultural, psychological, behavioral, infectious, neuroendocrine, immunoregulatory, and neuroimmune aspects of this fascinating, devastating, and challenging disease intertwine. Significant advances in the biopsychosocial approach to understanding disease and to treatment and prevention of disease should ensue from the application of psychoneuroimmunology to the study of HIV infection. The complexity of the issues raised and the high degree of variability of the course of HIV infection point to the value and importance of longitudinal, prospective studies that may lead to the elucidation of variables with predictive power and to the possibility of useful interventions.

Evaluation of a hospital based substance abuse intervention and referral service for HIV affected patients.

This paper reports an outcome evaluation and needs assessment conducted by the AIDS and Substance Abuse Program (ASAP) of the San Francisco AIDS Health Project. The study was designed to: 1) evaluate effectiveness of a hospital based intervention and referral service for HIV affected substance abusers, and 2) gather information from this population regarding accessibility and barriers to drug treatment. Participants were 86 individuals consecutively referred to ASAP over an 8-month period. All received a brief needs assessment interview in addition to the standard ASAP evaluation protocol. Agency follow-up contacts were made for those individuals referred by ASAP to extended substance abuse treatment, with information limited to whether or not the client contacted the designated referral resource. Source of referral to ASAP, interest in treatment, and prior sexual risk behavior change were significant predictors of intervention outcome. Personal unreadiness and treatment program waiting lists were the most frequently reported obstacles to treatment. While most participants reported changing risk behavior in response to the AIDS epidemic, patterns of change differed according to intravenous drug use history.

Psychosocial Factors Associated with Prognostic Indicators, Progression, Psychophysiology, and Tumor-host Response in Cutaneous Malignant Melanoma

This chapter will present findings from a logically progressive series of studies investigating biopsychosocial aspects of cutaneous malignant melanoma conducted by an interdisciplinary group of researchers at the University of California, San Francisco (U.C.S.F.). Commencing in 1980, U.C.S.F. investigators have examined relationships between psychosocial factors and a variety of outcome measures. To facilitate a clear presentation of this body of work, each study will be briefly described including study objectives, methodology, and results. While some of these studies were originally summarized in a 1985 article [1], the present chapter describes additional studies and provides more extended discussion. During our discussion, we will integrate the findings across studies pointing out consistencies in research findings as well as reconciling any discrepancies. Finally, we will present a brief discussion of the implications of psychosocial research and these findings for future research and care of patients with cutaneous malignant melanoma.