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Personality, Emotions and Coping Styles: Predictive Value for the Evolution of Cancer Patients

Published online by Cambridge University Press:  10 January 2013

Violeta Cardenal ,
Mª Victoria Cerezo ,
Joaquina Martínez ,
Margarita Ortiz-Tallo  and
Mª José Blanca
Violeta Cardenal
Affiliation:
Universidad Complutense (Spain)
Mª Victoria Cerezo*
Affiliation:
Universidad de Málaga (Spain)
Joaquina Martínez
Affiliation:
Clínica Nuestra Señora de Belén de Murcia (Spain)
Margarita Ortiz-Tallo
Affiliation:
Universidad de Málaga (Spain)
Mª José Blanca
Affiliation:
Universidad de Málaga (Spain)
*
Correspondence concerning this article should be addressed to Mª Victoria Cerezo. Facultad de Psicología, Universidad de Málaga. Phone: +34-952132555. E-mail: mvcerezo@uma.es
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Abstract

This study had a twofold goal: to define differences in psychological aspects between cancer patients and a control group and to explore the predictive value of such aspects for the evolution of the disease two years later. Firstly, personality, anxiety, anger and depression were assessed in both groups. Results of t-analyses revealed significant group differences. In personality, cancer patients had higher levels of neuroticism and lower levels of extraversion, agreeableness and conscientiousness than the control group. In emotional variables, cancer patients had higher levels of anxiety and some aspects of anger, but there were no group differences in depression levels. Secondly, applying a quasi-prospective design, the predictive value of personality, emotions and coping styles for the evolution of cancer (favourable or unfavourable) was explored using generalized linear models and logistic regression. A four-predictor logistic model was fitted: Anger Expression-In, Resignation, Self-blame and Conscientiousness, indicating that the higher Anger Expression-in, Resignation, and Self-blame scores together with a lower Conscientiousness score, the more likely it is for patients' cancer to evolve unfavourably. These results indicate the crucial role of psychological aspects for the evolution of the disease and the need to include such aspects in the design of clinical interventions.

Este estudio tiene un doble objetivo: describir las diferencias en los aspectos psicológicos entre los pacientes con cáncer y un grupo control,y explorar el posible valor predictivo de estos aspectos en la evolución de la enfermedad dos años más tarde. En primer lugar, se evaluaron en ambos grupos variables de personalidad, ansiedad, ira y depresión. Los resultados de los análisis t mostraron diferencias significativas entre los dos grupos. En personalidad, los pacientes con cáncer mostraron niveles más altos de neuroticismo y niveles más bajos de extraversión, afabilidad y concienciación que el grupo control. En variables emocionales, los pacientes con cáncer presentaron puntuaciones más elevadas en ansiedad y en algunos aspectos de la ira, pero no hubo diferencias entre los grupos en los niveles de depresión. En segundo lugar, aplicando un diseño cuasi-prospectivo, se analizó el valor predictivo de la personalidad, las emociones y los estilos de afrontamiento en la evolución del cáncer (favorable o desfavorable), mediante modelos lineales generalizados y de regresión logística. Se ajustó un modelo logístico de cuatro predictores: Ira interna, Resignación, Autoculpación y Concienciación, indicando que altas puntuaciones en Ira interna, Resignación, Autoculpación, junto con puntuaciones bajas en Concienciación, presentaban mayor probabilidad de relacionarse con una evolución desfavorable del cáncer. Estos resultados apoyan el papel crucial de los aspectos psicológicos en la evolución de la enfermedad y la necesidad de incluirlos en el diseño de las intervenciones clínicas.

Keywords

personalityemotionscoping stylescancerpredictive valuepersonalidademocionesestilos de afrontamientocáncervalor predictivo
Type
Research Article
Information
The Spanish Journal of Psychology , Volume 15 , Issue 2 , July 2012 , pp. 756 - 767
Copyright
Copyright © Cambridge University Press 2012

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References

Afifi, A. A., & Clark, V. (1996). Computer-aided multivariate analysis (3rd Ed.). London, England: Chapman & Hall.CrossRefGoogle Scholar
Andersen, B. L., Yang, H-C., Farrar, W. B., Golden-Kreutz, D. M., Emery, C. F., Thornton, , … Carson, W. E. III (2008). Psychological intervention improves survival for breast cancer patients.Arandomized clinical trial. Cancer, 113, 3450–3458. http://dx.doi.org/10.1002/cncr.23969CrossRefGoogle ScholarPubMed
Ato, M., Losilla, J. M., Navarro, J. B., Palmer, A., & Rodrigo, M. F. (2005). Análisis de datos: Modelo lineal generalizado [Data analysis: Generalized linear model]. Girona, Spain: Documenta Universitaria.Google Scholar
Augustine, A. A., Larsen, R. J., Walker, M. S., & Fisher, E. B. (2008). Personality predictors of the time course for lung cancer onset. Journal of Research in Personality, 42, 1448–1455. http://dx.doi.org/10.1016/j.jrp.2008.06.006CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–71. http://dx.doi.org/10.1001/archpsyc.1961.01710120031004CrossRefGoogle ScholarPubMed
Bewick, V., Cheek, L., & Ball, J. (2005). Statistics review 14: Logistic regression. Critical Care, 9, 112–118. http://dx.doi.org/10.1186/cc3045CrossRefGoogle ScholarPubMed
Blasco, T., Pallarés, C., Alonso, C., & López López, J. J. (2000). The role of anxiety and adaptation to illness in the intensity of postchemotherapy nausea in cancer patients. The Spanish Journal of Psychology, 3, 47–52.CrossRefGoogle ScholarPubMed
Bleiker, E. M. A., Hendriks, J. H. C. L., Otten, J. D. M., Verbeek, A. L. M., & van der Ploeg, H. M. (2008). Personality factors and breast cancer risk: A 13-year follow-up. Journal of the National Cancer Institute, 100, 213–218. http://dx.doi.org/10.1093/jnci/djm280CrossRefGoogle Scholar
Block, C. A., Erickson, B., Carney-Doebbling, C., Gordon, S., Fallon, B., & Konety, B. R. (2007). Personality, treatment choice and satisfaction in patients with localized prostate cancer. International Journal of Urology, 14, 1013–1018. http://dx.doi.org/10.1111/j.1442-2042.2007.01875.xCrossRefGoogle ScholarPubMed
Butler, L. D., Koopman, C., Neri, E., Giese-Davis, J., Palesh, O., Thorne-Yocam, K. A., … Spiegel, D. (2009). Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychology, 28, 579–587. http://dx.doi.org/10.1037/a0016124CrossRefGoogle ScholarPubMed
Buttow, P. N., Hiller, J. E., Price, M. A., Thackaway, S. V., Kircker, A., & Tennant, C. C. (2000). Epidemiological evidence for a relationship between life events, coping style, and personality factors in the development of breast cancer. Journal Psychosomatic Research, 49, 169–181.CrossRefGoogle Scholar
Cardenal, V. (2001). Estilos psicológicos y enfermedad física: Variables psicosociales—el estilo de evitación emocional—y su influencia en el cáncer [Psychological styles and physical illness: Psychosocial variables—the emotionally avoidant style— and its influence on cancer]. Escritos de Psicología, 5, 36–52.Google Scholar
Cardenal, V., Ortiz-Tallo, M., Martín, I., & Martínez, J. (2008). Life stressors, emotional avoidance and breast cancer. The Spanish Journal of Psychology, 11, 522–530.CrossRefGoogle ScholarPubMed
Cerezo, M. V., Ortiz-Tallo, M., & Cardenal, V. (2009). Expresión de emociones y bienestar en un grupo de mujeres con cáncer de mama: Una intervención psicológica [Emotional expression and well-being in a group of women with breast cancer: A psychological intervention]. Revista Latinoamericana de Psicología, 41, 131–140.Google Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd Ed.). Hillsdale, NJ: Erlbaum.Google Scholar
Conde, V., Esteban, T., & Useros, E. (1976). Revisión crítica de la adaptación castellana del Cuestionario de Beck [Critical review of the Spanish adaptation of Beck' Questionnaire]. Revista de Psicología General y Aplicada, 31, 469–497.Google Scholar
Cordero, A., Pamos, A., & Seisdedos, N. (1999). Inventario de personalidad NEO revisado (NEO PI-R): Inventario NEO reducido de cinco factores (NEO-FFI) [Revised NEO Personality Inventory (NEO PI-R): Reduced NEO Five-Factor Inventory (NEO-FFI)]. Madrid, Spain: TEA Ediciones.Google Scholar
Costa, P. T. Jr., & McCrae, R. R. (1992). The NEO-PI-R personality inventory manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Cousson-Gélie, F., Bruchon-Schweitzer, M., Dilhuydy, J. M., & Mutand, M. (2007). Do anxiety, body image, social support and coping strategies predict survival in breast cancer? Aten-year follow-up study. Psychosomatics, 48, 211–216. http://dx.doi.org/10.1176/appi.psy.48.3.211CrossRefGoogle ScholarPubMed
Dahl, A. A. (2010). Link between personality and cancer. Future Oncology, 6, 691–707. http://dx.doi.org/10.2217/fon.10.31CrossRefGoogle ScholarPubMed
Evans, E. (1926). A psychological study of cancer. Oxford, England: Dodd Mead.Google Scholar
Folkman, S., & Lazarus, R. S. (1998). Manual for the Ways of Coping Questionnaire. Palo Alto, CA: Consulting Psychologist Press.Google Scholar
Folkman, S., Lazarus, R. S., Gruen, R. J., & DeLongis, A. (1986). Appraisal, coping, health status, and psychological symptoms. Journal of Personality and Social Psychology, 50, 571–579. http://dx.doi.org/10.1037//0022-3514.50.3.571CrossRefGoogle ScholarPubMed
Font, A., & Cardoso, A. (2009). Afrontamiento en cáncer de mama: Pensamientos, conductas y reacciones emocionales [Coping with breast cancer: Thoughts, behaviours and emotional reactions]. Psicooncología, 6, 27–42.Google Scholar
Giese-Davis, J., Conrad, A., Nouriani, B., & Spiegel, D. (2008). Exploring emotion-regulation and autonomic physiology in metastatic breast cancer patients: Repression, suppression, and restraint of hostility. Personality and Individual Differences, 44, 226–237. http://dx.doi.org/10.1016/j.paid.2007.08.002CrossRefGoogle ScholarPubMed
Giese-Davis, J., DiMiceli, S., Sephton, S., & Spiegel, D. (2006). Emotional expression and diurnal cortisol slope in women with metastatic breast cancer in supportive-expressive group therapy: A preliminary study. Biological Psychology, 73, 190–198. http://dx.doi.org/10.1016/j.biopsycho.2006.04.003CrossRefGoogle ScholarPubMed
Graves, K. D., Schmidt, J. E., Bollmer, J., Fejfar, M., Langer, S., Blonder, L. X., & Andrykowski, M. A. (2005). Emotional expression and emotional recognition in breast cancer survivors: A controlled comparison. Psychology & Health, 5, 579–595. http://dx.doi.org/10.1080/0887044042000334742CrossRefGoogle Scholar
Greer, S. (1991). Psychological response to cancer and survival. Psychological Medicine, 21, 43–49. http://dx.doi.org/10.1017/S003329170001463XCrossRefGoogle ScholarPubMed
Hansen, P. E., Floderus, B., Frederiksen, K., & Johansen, C. (2005). Personality traits, health behavior, and risk for cancer: A prospective study of a Swedish twin cohort. Cancer, 103, 1082–1091.CrossRefGoogle Scholar
Hardt, J., Gillitzer, R., Schneider, S., Fischbeck, S., & Thüroff, J. W. (2010). Coping styles as predictors of survival time in bladder cancer. Health 2, 429–434. http://dx.doi.org/10.4236/health.2010.25064CrossRefGoogle Scholar
Härtl, K., Engel, J., Herschbach, P., Reinecker, H., Sommer, H., & Friese, K. (2010). Personality traits and psychosocial stress: Quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psycho-Oncology, 19, 160–169. http://dx.doi.org/10.1002/pon.1536CrossRefGoogle ScholarPubMed
Heffner, K. L., Loving, T. J., Robles, T. F., & Kiecolt-Glaser, J. K. (2003). Examining psychosocial factors related to cancer incidence and progression: In search of the silver lining. Brain, Behavior, and Immunity 17, 109–111. http://dx.doi.org/10.1016/S0889-1591(02)00076-4CrossRefGoogle ScholarPubMed
Hopko, D. R., Bell, J. L., Armento, M. E. A., Robertson, S. M. C., Hunt, M. K., Wolf, N. J., & Mullane, C. (2007). The phenomenology and screening of clinical depression in cancer patients. Journal of Psychosocial Oncology, 26, 31–51. http://dx.doi.org/10.1300/J077v26n01_03CrossRefGoogle Scholar
Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York, NY: Wiley & Sons.Google Scholar
Hou, W. K., Law, C. C., & Fu, Y. T. (2010). Does change in positive affect mediate and/or moderate the impact of symptom distress on psychological adjustment after cancer diagnosis? A prospective analysis. Psychology & Health, 25, 417–431. http://dx.doi.org/10.1080/08870440802559375CrossRefGoogle ScholarPubMed
Lieberman, M., & Goldstein, B. (2006). Not all negative emotions are equal: The role of emotional expression in online support groups for women with breast cancer. Psycho-Oncology, 15, 160–168.CrossRefGoogle ScholarPubMed
Lillberg, K., Verkasalo, P. K., Kaprio, J., Teppo, L., Helenius, H., & Koskenvuo, M. (2002). A prospective study of life satisfaction, neuroticism and breast cancer risk (Finland). Cancer Causes & Control, 13, 191–198.CrossRefGoogle ScholarPubMed
López-Martínez, A. E. (2003). Hacer frente al cáncer [Coping with cancer]. Málaga, Spain: Aljibe.Google Scholar
McGregor, B. A., & Antoni, M. H. (2009). Psychological intervention and health outcomes among women treated for breast cancer: A review of stress pathways and biological mediators. Brain, Behavior, and Immunity, 23, 159–166. http://dx.doi.org/10.1016/j.bbi.2008.08.002CrossRefGoogle ScholarPubMed
Merz, E. L., Malcarne, V. L., Ko, C. M., Sadler, M., Kwack, L., Varni, J. W., & Sadler, G. R. (2010). Dyadic concordance among prostate cancer patients and their partners and health-related quality of life: Does it matter? Psychology & Health, 6, 651–666. http://dx.doi.org/10.1080/08870441003721251Google Scholar
Miguel-Tobal, J. J., & Cano-Vindel, A. (1994). Inventario de Situaciones y Respuestas de Ansiedad (ISRA) [Inventory of Situations and Responses of Anxiety]. Madrid, Spain: Tea Ediciones.Google Scholar
Miguel-Tobal, J. J., Casado, M. I., Cano-Vindel, A., & Spielberger, C. D. (2001). Inventario de Expresión de Ira Estado-Rasgo–STAXI [State-Trait Anger Expression Inventory-STAXI]. Madrid, Spain: TEA Ediciones.Google Scholar
Nagano, J., Kono, S., Toyomura, K., Mizoue, T., Yin, G., Mibu, R., … Imaizumi, N. (2008). Personality and colorectal cancer: The Fukuoka Colorectal Cancer Study. Japanese Journal of Clinical Oncology, 38, 553–561. http://dx.doi.org/10.1093/jjco/hyn067CrossRefGoogle ScholarPubMed
Nakaya, N., Bidstrup, P. E., Eplov, L. F., Saito-Nakaya, K., Kuriyama, S., Tsuji, I., … Johansen, C. (2009). Mental vulnerability and survival after cancer. Epidemiology, 20, 916–920. http://dx.doi.org/10.1097/EDE.0b013e3181b5f3b0CrossRefGoogle ScholarPubMed
Nakaya, N., Bidstrup, P. E., Saito-Nakaya, K., Frederiksen, K., Koskenvuo, M., Pukkala, E., … Johansen, C. (2010). Personality traits and cancer risk and survival based on Finnish and Swedish registry data. American Journal of Epidemiology, 172, 377–385. http://dx.doi.org/10.1093/aje/kwq046CrossRefGoogle ScholarPubMed
Nakaya, N., Saito-Nakaya, K., Akechi, T., Kuriyama, S., Inagaki, M., Kikuchi, N., … Uchitomi, Y. (2008). Negative psychological aspects and survival in lung cancer patients. Psycho-Oncology, 17, 466–473. http://dx.doi.org/10.1002/pon.1259CrossRefGoogle ScholarPubMed
Nakaya, N., Tsubono, Y., Hosokawa, T., Nishino, Y., Ohkubo, T., Hozawa, A., … Hisamichi, S. (2003). Personality and the risk of cancer. Journal of the National Cancer Institute, 95, 799–805. http://dx.doi.org/10.1093/jnci/95.11.799CrossRefGoogle ScholarPubMed
Palesh, O., Butler, L. D., Koopman, C., Giese-Davis, J., Carlson, R., & Spiegel, D. (2007). Stress history and breast cancer recurrence. Journal of Psychosomatic Research, 63, 233–239. http://dx.doi.org/10.1016/j.jpsychores.2007.05.012CrossRefGoogle ScholarPubMed
Peduzzi, P., Concato, J., Kemper, E. Holford, T. R., & Feinstein, A. R. (1996). Asimulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology, 49, 1373–1379. http://dx.doi.org/10.1016/S0895-4356(96)00236-3CrossRefGoogle Scholar
Peng, C. J., Lee, K. L., & Ingersoll, G. M. (2002). An introduction to logistic regression analysis and reporting. Journal of Educational Research 96, 3–14. http://dx.doi.org/10.1080/00220670209598786CrossRefGoogle Scholar
Petticrew, M., Bell, R., & Hunter, D. (2002). Influence of psychological coping on survival and recurrence in people with cancer: Systematic review. British Medical Journal, 325, 1066–1076. http://dx.doi.org/10.1136/bmj.325.7372.1066CrossRefGoogle ScholarPubMed
Pinquart, M., & Duberstein, P. R. (2010). Depression and cancer mortality: A meta-analysis. Psychological Medicine, 40, 1797–1810. http://dx.doi.org/10.1017/S0033291709992285.CrossRefGoogle ScholarPubMed
Prasertsri, N., Holden, J., Keefe, F. J., & Wilkie, D. J. (2011). Repressive coping style: Relationships with depression, pain, and pain coping strategies in lung cancer out patients. Lung Cancer, 71, 235–240. http://dx.doi.org/10.1016/j.lungcan.2010.05.009CrossRefGoogle Scholar
Rando, B. (2010). La participación de profesionales sanitarios portugueses en la detección de donantes de órganos [The participation of Portuguese healthcare professionals in detecting organ donors]. Escritos de Psicología, 3, 8–14. http://dx.doi.org/10.5231/psy.writ.2010.1803CrossRefGoogle Scholar
Rando, B., Blanca, M. J., & Frutos, M. A. (2000). Modelo de regresión logística para la intención de hacerse el carné de donante de órganos y tejidos [Logistic regression model for the intention to take out an organ- and tissues-donor card]. Psicothema, 12, 464–469.Google Scholar
Rodríguez-Marín, J., Terol, M. C., López-Roig, S., & Pastor, M. A. (1992). Evaluación del afrontamiento del estrés: Propiedades psicométricas del Cuestionario de Formas de Afrontamiento de Acontecimientos Estresantes [Stress coping assessment: Psychometric properties of the Ways of Coping with Stressful Events Questionnaire]. Revista de Psicología de la Salud, 4, 59–84.Google Scholar
Schapiro, I. R., Ross-Petersen, L., Sælan, H., Garde, K., Olsen, J. H., & Johansen, C. (2001). Extroversion and neuroticism and the associated risk of cancer: A Danish cohort study. American Journal of Epidemiology, 153, 757–763. http://dx.doi.org/10.1093/aje/153.8.757CrossRefGoogle Scholar
Sebastián, J., León, M., & Hospital, A. (2009). Variables psicosociales y cáncer de mama: Un estudio cuasiprospectivo de la personalidad tipo C [Psychosocial variables and breast cancer: A quasi-prospective study of type C personality]. Revista Latinoamericana de Psicología, 4, 461–479.Google Scholar
Sephton, S. E., Dhabhar, F. S., Keuroghlian, A. S., Giese-Davis, J., McEwen, B. S., Ionan, A. C., & Spiegel, D. (2009). Depression, cortisol, and suppressed cell-mediated immunity in metastatic breast cancer. Brain, Behavior, and Immunity, 23, 1148–1155. http://dx.doi.org/10.1016/j.bbi.2009.07.007CrossRefGoogle ScholarPubMed
Shigehisa, T., & Honda, H. (2006). Cancer patients' morbidity (I): Immunological status varies with psychological intervention in relation to personality. Annals of Cancer Research and Therapy, 14, 28–38. http://dx.doi.org/10.4993/acrt.14.28CrossRefGoogle Scholar
Spiegel, D., & Giese-Davis, J. (2003). Depression and cancer: Mechanisms and disease progression. Biological Psychiatry, 54, 269–282. http://dx.doi.org/10.1016/S0006-3223(03)00566-3CrossRefGoogle ScholarPubMed
Spielberger, C. D. (1988). State-TraitAnger Expression Inventory (STAXI). Odessa, FL: Psychological Assessment Resources.Google Scholar
Stanton, A. L., Danoff-Burg, S., Cameron, C. L., Bishop, M., Collins, C. A., Kirk, S. B., & Sworowski, L. A. (2000). Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. Journal of Consulting and Clinical Psychology, 68, 875–882. http://dx.doi.org/10.1037//0022-006X.68.5.875CrossRefGoogle ScholarPubMed
Stefanek, M. E., Palmer, S. C., Thombs, B. D., & Coyne, J. C. (2009). Finding what is not there: Unwarranted claims of an effect of psychosocial intervention on recurrence and survival. Cancer, 115, 5612–5616. http://dx.doi.org/10.1002/cncr.24671CrossRefGoogle Scholar
Stephen, J. E., Rahn, M., Verhoef, M., & Leis, A. (2007). What is the state of the evidence on the mind-cancer survival question, and where do we go from here? A point of view. Support Care Cancer, 15, 923–930. http://dx.doi.org/10.1007/s00520-007-0281-4CrossRefGoogle Scholar
Talley, A., Molix, L., Schlegel, R. J., & Bettencourt, A. (2010). The influence of breast cancer survivors' perceived partner social support and need satisfaction on depressive symptoms: A longitudinal analysis. Psychology & Health, 25, 433–449. http://dx.doi.org/10.1080/08870440802582682CrossRefGoogle ScholarPubMed
Turner-Cobb, J. M., Sephton, S. E., & Spiegel, D. (2001). Psychosocial effects on immune function and disease progression in cancer: Human studies. In Ader, R., Felton, D. L., & Cohen, N. (Eds.), Psychoneuroimmunology (3rd Ed.). San Diego, CA: Academic Press.Google Scholar
Vissoci, E. M., Vargas, S. O., & Morimoto, H. K. (2004). Stress, depression, the immune system, and cancer. The Lancet Oncology, 5, 617–25.Google Scholar
Vittinghoff, E., & McCulloch, C. E. (2007). Relaxing the rule of ten events per variable in logistic and Cox regression. American Journal of Epidemiology, 165, 710–718. http://dx.doi.org/10.1093/aje/kwk052CrossRefGoogle Scholar
Wasylkiw, L., & Fekken, G. C. (2002). Personality and self-reported health: Matching predictors and criteria. Personality and Individual Differences, 33, 607–620. http://dx.doi.org/10.1016/S0191-8869(01)00175-1CrossRefGoogle Scholar
Weihs, K. L., Enright, T. M., Simmens, S. J., & Reiss, D. (2000). Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer. Journal of Psychosomatic Research, 49, 59–68. http://dx.doi.org/10.1016/S0022-3999(00)00143-4CrossRefGoogle ScholarPubMed