***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to generate distinct clusters of women with breast cancer , and to evaluate differences between clusters with respect to decisional control , psychological adjustment , and frustration expression .  Thirty‐seven Stage I and 33 Stage II newly diagnosed breast cancer patients from two medical oncology clinics participated . A cluster analysis of the coping data produced three distinct patient clusters . The primary finding was that women from the low avoidance coping cluster were significantly better adjusted than women from the remaining clusters . Women from the low avoidance coping cluster also preferred more active involvement in treatment decision‐making . Further research is needed to prospect ively detail the mechanisms by which cognitive avoidance hampers psychological adjustment to cancer Life stress and coping responses jointly contribute to psychological adjustment in many chronic illness population s , but their significance in multiple sclerosis ( MS ) has not been extensively investigated . Physical disability , cognitive status , negative life stress  ,  coping strategies  , and depressive symptoms were prospect ively assessed in 27 adults with definite or probable MS . Of the original subjects , 22 provided two additional assessment s at 6-month intervals . After accounting for cognitive status and physical disability , life stress was positively correlated with current as well as future depressive symptoms ; the prospect i ve relationship was replicated within the second pair of prospect i ve data waves . Escape avoidance was the only coping strategy that added to the prediction of future mood symptoms , but this was not replicated . Results suggest that MS-related depressive symptoms are a function of prior disease-related impairment , life stress , and possibly escape avoidance coping At diagnosis , 59 breast cancer patients reported on their overall optimism about life ;  1 day presurgery , 10 days postsurgery , and at 3- , 6- , and 12-month follow-ups , they reported their recent coping responses and distress levels . Optimism related inversely to distress at each point , even controlling for prior distress . Acceptance , positive reframing , and use of religion were the most common coping reactions ; denial and behavioral disengagement were the least common reactions . Acceptance and the use of humor  prospect ively predicted lower distress ; denial and disengagement predicted more distress . Path analyses suggested that several coping reactions played mediating roles in the effect of optimism on distress . Discussion centers on the role of various coping reactions in the process of adjustment , the mechanisms by which dispositional optimism versus pessimism appears to operate , third variable issues , and applied implication OBJECTIVE To examine relationships between select positive psychological variables and life satisfaction in persons with spinal cord injury during acute rehabilitation and 3 months after discharge . DESIGN Prospect i ve observational design ; correlational and regression analyses . Eighty-seven adults who were participating in in-patient , acute rehabilitation for spinal cord injury in two metropolitan hospitals completed the following measures :  Benefit finding Scale , Hope Scale , Brief Symptom Inventory , COPE , Positive and Negative Affect Schedule  , and Satisfaction with Life Scale .  RESULTS Hypothesized relationships of hope and positive affect ( facilitator variables ) with greater life satisfaction during the initial acute rehabilitation period were supported . Facilitators , as measured at baseline , accounted for a significant amount of variance in life satisfaction above and beyond barrier variables ( depression , negative affect , and avoidant coping ) both during the acute rehabilitation phase ( R(2 ) change = .20 , p < .0001 ) and at 3 months after discharge ( R(2 ) change = .09 , p < .029 ) . CONCLUSIONS Findings suggest that positive psychological variables play a significant role in postrehabilitation subjective well-being for persons with spinal cord injury and may provide potential avenues for interventions to facilitate positive outcomes Primary objective : To study longitudinal changes in psychological coping strategies , social support , life orientation and health-related quality of life in the late period after traumatic brain injury ( TBI ) . Subjects : Thirty-one patients with TBI who were first investigated on average 2.3 years after injury and were prospect ively followed on average 5.7 years later . Methods : Estonian versions of the COPE-D Test , the Brief Social Support Question naire , the Life Orientation Test and the R AND -36 question naire . Results : During the late follow-up period health-related quality of life and resuming work did not improve significantly . Persons with TBI reported an increase in seeking social/emotional support ( p < 0.05 ) , frequent use of avoidance-oriented styles and reduced use of task-oriented styles . This was accompanied by low social support and low satisfaction with support , both of which were associated with health-related quality of life and resuming work after TBI . Although the patients had become more optimistic ( p < 0.05 ) , this did not correlate with their health status and social well-being . Conclusions : This prospect i ve study revealed maladaptive changes in the profile of coping strategies and an increase in optimism . As social support , satisfaction with support and health-related quality of life did not improve , then rehabilitation , social and psychological support are continuously needed This study examined the direct and mediated contributions of psychosocial variables to posttreatment physical functioning among 142 patients receiving cardiac rehabilitation .  Two models were proposed and tested . In the first model , psychosocial factors were correlated and made to predict baseline and 6-week physical functioning . The results showed that after controlling for age , illness severity , baseline physical functioning , and other psychosocial correlates , optimism and social support still significantly predicted better posttreatment physical functioning . In the second model , we explored both the direct and mediational relationships between psychosocial factors and physical health outcomes . Optimism and social support were found to contribute to health outcomes not only directly but also indirectly through the mediation of less engagement in detrimental coping and lower depressive symptoms , whereas hostility and negative coping only predicted outcomes indirectly through mediators . These findings highlighted the importance of addressing psychosocial issues and their interrelationships in cardiac rehabilitation Given the marked individual variability in psychological adjustment in response to breast cancer , it is important to specify factors contributing to adaptive survivorship . This longitudinal study of 70 women with Stage I or II breast cancer tested the ability of situation-specific coping strategies and a more stable attribute , hope , to predict adjustment prospect ively from the point shortly following diagnosis through the first year . Consonant with previous studies , coping through active acceptance at diagnosis predicted more positive adjustment across time , and avoidance-oriented coping predicted greater fear of cancer recurrence , over and above participant age and initial status on dependent variables . The hypothesis that coping through turning to religion would be more effective for less hopeful women was supported , and mixed support emerged for the hypothesis that approach-oriented coping strategies would yield greater adaptational benefits for women high in hope . Findings suggest that risk and protective factors for adjustment across the first year of survivorship can be identified even prior to definitive surgery for breast cancer , particularly when both dispositional characteristics such as hope and situation-specific coping strategies are considered 
    Output:
    
Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation .