Understanding marriage and stress: essential questions and challenges

This paper explores the complex interplay between stressors and marital functioning, beginning with a discussion of how key concepts from the stress and coping literature can be extended to the study of dyads. Five essential questions are outlined as a means of advancing research in this domain, addressing protective dyadic processes, the competing demands of individual and dyadic coping agendas, the role of individual well-being in couples' stress and coping, stress in the broader context of couples' lives, and prospects for intervention. Following an overview of methodological and procedural challenges, the paper concludes by noting that research devoted to understanding marriages in the context of stress is at a crossroads, poised between a set of provocative questions, preliminary findings, and intervention possibilities on one hand, and important theoretical and empirical challenges on the other.     

The other side of the coin: Blunted cardiovascular and cortisol reactivity are associated with negative health outcomes

A cornerstone for research into the link between stress and health has been the reactivity hypothesis; cardiovascular reactivity to psychological stressors, if prolonged or exaggerated, can promote the development of cardiovascular disease. However, it has recently been argued that low or blunted reactivity is also associated with negative health outcomes. As such, in this special issue we present further evidence implicating that cardiovascular and stress hormone responses to acute stress at the other end of the response spectrum can also be considered a pathway to ill health. In this introductory article, we explore and review the origins of and potential mechanisms underlying blunted responses to acute stress. In so doing, we aim to highlight: what is currently known regarding this new conceptualization of the reactivity hypothesis; the potential explanations for blunted reactivity; the pathways underlying associations with health outcomes; and where this field is headed in terms of developing our understanding of the link between reactivity and health.     

适量饮酒与身体健康关系的研究进展

中国的酒文化源远流长,酒与我们的生活形影不离.短期大量饮酒或长期酗酒危害健康.但是,大量研究数据也发现适量饮酒能提高机体免疫力,对心脑血管等系统发挥保护性作用.因此适量饮酒对机体带来的益处日益受到关注.通过对适量饮酒对机体各系统的保护性作用做以总结,对适量饮酒的酒量提出一些建议.     

青少年人际信任与问题行为的相关研究

目的探讨青少年人际信任与问题行为的关系。方法采用儿童马氏量表(Mach Scale)和青少年自评量表(YSR)对山东某网瘾戒除学校42名学生和普通中学的52名中学生进行测试。结果①青少年的人际信任不存在性别、学生类型的差异F(1,90)=1.376,0.652;P>0.05;②青少年问题行为在性别、学生类型上存在显著差异F(1,90)=8.13,10.932;P<0.01,但在性别与学生类型上的交互作用不显著F(1,90)=0.432,P>0.05;③青少年的人际信任与问题行为存在显著负相关(r=-0.344,P<0.01)。结论青少年的问题行为受人际信任的影响,人际信任越低,问题行为出现的越多。     

基于脉搏波检测技术的心血管健康评测

脉搏波中蕴含丰富的生理病理信息,能反映心功能参数的早期变化趋势。因此,脉搏波信息的量化对心血管疾病具有重要的参考价值。从脉搏波的形成机制角度,阐述脉搏波与心血管生理病理信息的关系;从脉搏波的波形分析,阐述临床中应用脉搏波技术的心血管无创检测指标;将心血管的生理病理信息和脉搏波理论相结合,建立评测心功能健康状况的评价指标。基于脉搏波理论建立的心血管无创检测方法,有助于全面维护心血管健康,为心血管系统疾病的早发现、早预防、早治疗提供重要医疗手段;其次,可以简化临床检测过程,降低检测成本,实现心血管疾病适时地健康普检,降低心血管疾病的致死率和致残率。     

The effects of health coaching on adult patients with chronic diseases: A systematic review

Objective

The aim of this systematic review was to describe the effects of health coaching on adult patients with chronic diseases.

Methods

The reviewers searched electronic databases and performed a manual search for studies published from 2009 to 2013. The inclusion criteria covered health coaching for adults with chronic diseases by health care professionals. The studies were original, randomized controlled trials or quasi-experimental designs.

Results

Thirteen studies were selected using the inclusion criteria. The results indicate that health coaching produces positive effects on patients’ physiological, behavioral and psychological conditions and on their social life. In particular, statistically significant results revealed better weight management, increased physical activity and improved physical and mental health status.

Conclusion

Health coaching improves the management of chronic diseases. Further research into the cost-effectiveness of health coaching and its long-term effectiveness for chronic diseases is needed.Practice implications Health care professionals play key roles in promoting healthy behavior and motivating good care for adults with chronic diseases. Health coaching is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care.     

Heat and social rank impact behavior and physiology of PRRS-virus-infected pigs

Changes in thermal environment can invoke a stress response in pigs, which in turn can potentially impact their immune system and disease susceptibility. We investigated effects of heat stress and social rank on behavior, immune responsiveness, and performance of pigs challenged with porcine reproductive and respiratory syndrome (PRRS) virus. Sixty-four 7-week-old PRRS-na?ve pigs were assigned to each of four experimental treatments consisting of a 2 x 2 factorial design: PRRS (PRRS- or PRRS+) and environmental temperature (24 degrees C or 32 degrees C). Blood samples were taken prior to and at days 7 and 14 post-inoculation, and alveolar macrophages were collected via bronchoalveolar lavage at day 14. Total white blood cell counts, natural killer cytotoxicity, macrophage numbers, macrophage subpopulations, and performance measures were all significantly affected by social rank, heat stress, and/or infection status of the pig. Heat stress and PRRS status also significantly influenced the amount of time pigs spent lying with or without contacting another animal. Cortisol and various immune measures were also affected by PRRS status. These results show not only that intranasal inoculation with PRRS virus affects physiological, behavioral, and performance measures in growing pigs, but that social rank influences pigs' immune responsiveness to PRRS as well. Moreover, heat stress does not have additive negative impact on physiological or performance traits in pigs challenged with PRRS virus.     

Stimulus-Specific Patterns of Cardiovascular Reactivity in Type A and B Subjects: Evidence for Enhanced Vagal Reactivity in Type B

Recent evidence suggests that the differences in cardiovascular reactivity between individuals exhibiting the Type A behavior pattern and those that do not are not limited to excessive betaadrenergic reactivity in Type A's. Research also suggests the possibility of a tendency for enhanced alpha-adrenergically and vagally mediated cardiovascular reactivity in Type B's. In the present study, Type A and Type B subjects were exposed to stressor stimuli known to elicit either betaadrenergic or alpha-adrenergic and vagal responses in the cardiovascular system. Heart rate, blood pressure, and forearm blood flow and vascular resistance responses were measured. The two Types did not differ in response to the beta-adrenergic stimulus (mental arithmetic). However, the alpha-adrenergic/vagal stimulus (cold face stimulus) produced more prolonged heart rate and blood flow responses in Type B subjects. Results suggest that Type B's show hyperreactivity (compared to Type A) when alpha-adrenergic or vagal cardiovascular responses are elicited. The nature of this hyperreactivity suggests possible mechanisms for reduced cardiovascular disease risk in Type B individuals.     

The bases of targeting behavior in health promotion and disease prevention

ObjectiveHealth behaviors shape more than 30% of one’s physical and mental health, as well as overall well-being. Yet, changing behavior is difficult. This paper aims first at operationalizing the concept of health behavior by focusing on its main components and determinants. Second, it gives insights into how to influence health behavior by providing an overview of some of the most commonly used approaches to the design of behavioral interventions.MethodsThis is a position paper that presents a selection of evidence-based theories, models and approaches to understand and address behavior.ResultsA health behavior broadly refers to every individual action affecting health, disease, disability, or mortality. Behavior is shaped by factors within the skin (biological, psychological) and outside the skin (interpersonal, environmental, policy). Behavior change has therefore to be addressed from an ecological perspective. Specifically, behavior change can be influenced by changing capability, opportunity and motivation. Depending on the specific determinants of the behavior at stake, there are numerous approaches that can be taken. The main steps to design interventions are: defining the problem, selecting and analyzing the target audience, setting objectives, designing the intervention, planning and implementing an evaluation.ConclusionBehaviors should not be targeted in isolation but within a socio-ecological approach that accounts for both their individual and environmental determinants.Practice implicationsThis paper provides practitioners with the bases of behavior change. It offers a road-map of the main factors to consider and shows how to address behavior by planning an intervention in all its main steps.     

Hostility, emotional expression, and hemodynamic responses to laboratory stressors: Reactivity attenuating effects of a tendency to express emotion interpersonally

The present study examined the interactive effects of hostility and a predisposition towards emotional expression or suppression in interpersonal situations. We also attempted to partially replicate findings from a recent investigation which provided evidence of lower myocardial and greater vascular responses in high-hostile relative to low-hostile individuals. Undergraduate students (n = 99) participated in a protocol consisting of rest periods, speech preparation and presentation, a social-evaluative mental arithmetic task, and a stress interview. After classifying participants into high/low hostility by high/low interpersonal emotional expression groups using median-splits, high-hostile individuals showed lower HR and SBP responses to speech preparation and reported greater threat appraisal and negative affect than low-hostile participants. High-hostile interpersonal expressors and male interpersonal expressors displayed lower DBP and TPR reactivity, respectively, than high-hostile or male suppressors. High-hostile expressors also reported lower levels of positive affect than high-hostile suppressors, and expressors reported lower threat appraisals than suppressors, irrespective of hostility. Findings are discussed in terms of an absence of conflict or ambivalence over interpersonal emotional expression for high-hostile expressors and are suggestive of potential health benefits of expressing emotion interpersonally for at-risk groups.     

Effects of health coaching on behavioral modification among adults with cardiovascular risk factors: Systematic review and meta-analysis

ObjectivesThis meta-analysis examined effects of health coaching on physical activities, dietary behaviors, health responsibility, stress management, and smoking behaviors among populations with cardiovascular risk factors.MethodsMultiple electronic databases were searched for randomized controlled trials utilizing health coaching for people with cardiovascular risk factors to lead behavioral changes. The included studies were pooled to estimate the effect size for health coaching interventions on each of the health behaviors.ResultsThis meta-analysis included 15 randomized trials. Motivational interviewing and education sessions were common coaching interventions with telephone calls or face-to-face contacts as the main contact methods. Health coaching for health behaviors showed small but significant effect sizes on physical activities, dietary behaviors, health responsibility, and stress management except for smoking behaviors.ConclusionThe study findings support that health coaching can induce positive behavioral changes among individuals with cardiovascular risk factors. Health coaching delivered by either expert or peer coaches would be easy to apply in clinical settings.Practical implicationsHealth care professionals should be aware that health coaching could provide effective motivation strategies to improve compliance of those who need to initiate and maintain their health behaviors. Health coaching could be easily delivered via telephone calls, text messages, or short-term face-to-face coaching.     

The effect of a naturalistic stressor on frontal EEG asymmetry, stress, and health

The aim of the current study was to investigate the effect of a naturalistic stressor, examination stress, on frontal EEG asymmetry, psychological stress, hormonal stress, and negative health. Forty-nine subjects were tested during periods of low and high examination stress. During the high examination stress period, subjects reported higher levels of stress on the Spielberger State Anxiety Inventory and Cohen's Perceived Stress Scale. However, no change in cortisol was detected across the two sessions. Furthermore, a shift from relatively greater left frontal activity during the low examination session to relatively greater right frontal activity during the high examination session was also found. Moreover, the increasing right frontal activity asymmetry associated with the high exam session compared to the low exam session correlated with increasing reports of negative health. No evidence was found for the prediction that cortisol mediated either the relationship between examination stressor and right frontal asymmetry or between right frontal asymmetry and negative health. In conclusion, while the findings from this study are compelling, the mechanism mediating increases in psychological stress, relatively greater right frontal activity, and increases in negative health from naturally occurring stressors is in need of further investigation.     

Exploring communication pathways to better health: Clinician communication of expectations for acupuncture effectiveness

Objective

This study tested a pathway whereby acupuncturists’ communication of optimism for treatment effectiveness would enhance patients’ satisfaction during treatment, which in turn would contribute to better pain and function outcomes for patients with osteoarthritis of the knee.

Methods

Secondary analysis from a 2 arm (real vs. sham acupuncture, high vs. neutral expectations) RCT. 311 patients with knee osteoarthritis received acupuncture over 10–12 sessions. Coders rated the degree to which acupuncturists communicated optimism for the treatment's effectiveness. Satisfaction with acupuncture was assessed 4 weeks into treatment. Pain and function were assessed 6 weeks following treatment.

Results

Patients experiencing better outcomes were more satisfied with acupuncture during treatment, were younger, and had better baseline pain and function scores. Satisfaction during treatment was greater when patients interacted with more optimistic clinicians and had higher pretreatment expectations for acupuncture efficacy.

Conclusion

Acupuncturists’ communication of optimism about treatment effectiveness contributed to pain and function outcomes indirectly through its effect on satisfaction during treatment. Future research should model pathways through which clinician–patient communication affects mediating variables that in turn lead to improved health outcomes.

Practical Implications

While clinicians should not mislead patients, communicating hope and optimism for treatment effectiveness has therapeutic value for patients.     

iLift: A health behavior change support system for lifting and transfer techniques to prevent lower-back injuries in healthcare

ObjectiveLower back problems are a common cause of sick leave of employees in Dutch care homes and hospitals. In the Netherlands over 40% of reported sick leave is due to back problems, mainly caused by carrying out heavy work. The goal of the iLift project was to develop a game for nursing personnel to train them in lifting and transfer techniques. The main focus was not on testing for the effectiveness of the game itself, but rather on the design of the game as an autogenous trigger and its place in a behavioral change support system. In this article, the design and development of such a health behavior change support system is addressed, describing cycles of design and evaluation.Methods(a) To define the problem space, use context and user context, focus group interviews were conducted with Occupational Therapists (n = 4), Nurses (n = 10) and Caregivers (n = 12) and a thematic analysis was performed. We interviewed experts (n = 5) on the subject of lifting and transferring techniques. (b) A design science research approach resulted in a playable prototype. An expert panel conducted analysis of video-recorded playing activities. (c) Field experiment: We performed a dynamic analysis in order to investigate the feasibility of the prototype through biometric data from player sessions (n = 620) by healthcare professionals (n = 37).Results(a) Occupational Therapists, Nurses and Caregivers did not recognise a lack of knowledge with training in lifting and transferring techniques. All groups considered their workload, time pressure and a culturally determined habit to place the patient's well being above their own as the main reason not to apply appropriate lifting and transferring techniques. This led to a shift in focus from a serious game teaching lifting and transferring techniques to a health behavior change support system containing a game with the intention to influence behavior. (b) Building and testing (subcomponents of) the prototype resulted in design choices regarding players perspective, auditory and visual feedback, overall playability and perceived immersiveness. This design process also addressed the behavior shaping capacities of the game and its place within the health behavior change support system. An expert panel on lifting and transferring techniques validated the provoked in-game activities as being authentic. (c) Regression analysis showed an increase of the game score and dashboard score when more sessions were played, indicating an in-game training effect. A post-hoc test revealed that from an average of 10 playing sessions or more, the dashboard score and the game score align, which indicates behavioral change towards executing appropriate static lifting and transferring techniques.ConclusionsData gathered in the final field test shows an in-game training effect, causing players to exhibit correct techniques for static lifting and transferring techniques but also revealed the necessity for future social system development and especially regarding intervention acceptance. Social system factors showed a strong impact on the games persuasive capacities and its autogenous intent.     

Impact of health literacy in patients with cardiovascular diseases: A systematic review and meta-analysis

ObjectiveTo clarify the impacts of health literacy on mortality, readmission, and quality of life (QOL) in the secondary or tertiary prevention of cardiovascular diseases (CVD) through a meta-analysis.MethodsSix electronic databases were searched on June 11, 2020. Observational studies involving patients with CVD, health literacy as an exposure factor and mortality, readmission, or QOL as outcomes were included in this study. Two researchers screened the retrieved articles and extracted data independently. The meta-analysis calculated the pooled relative risk of mortality and readmission. We also assessed the body of evidence based on Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsFollowing screening of 1616 studies, 16 observational studies were included. The mean rate of low health literacy was 32.8%. All studies focusing on QOL showed significant impacts of health literacy. Pooled relative risk was 1.621 (95% confidence interval: 1.089–2.412) for mortality and 1.184 (95% confidence interval: 1.035–1.355) for readmission, indicating significant effects of health literacy. GRADE assessment showed “LOW” certainty for each outcome.ConclusionLow health literacy was significantly associated with increased mortality and hospital readmission and decreased QOL in patients with CVD.Practice implicationsConsidering low health literacy in clinical practice is very important to improve prognosis of CVD patients.     

Forgiveness,Health, and Well-Being: A Review of Evidence for Emotional Versus Decisional Forgiveness,Dispositional Forgivingness,and Reduced Unforgiveness

The extant data linking forgiveness to health and well-being point to the role of emotional forgiveness, particularly when it becomes a pattern in dispositional forgivingness. Both are important antagonists to the negative affect of unforgiveness and agonists for positive affect. One key distinction emerging in the literature is between decisional and emotional forgiveness. Decisional forgiveness is a behavioral intention to resist an unforgiving stance and to respond differently toward a transgressor. Emotional forgiveness is the replacement of negative unforgiving emotions with positive other-oriented emotions. Emotional forgiveness involves psychophysiological changes, and it has more direct health and well-being consequences. While some benefits of forgiveness and forgivingness emerge merely because they reduce unforgiveness, some benefits appear to be more forgiveness specific. We review research on peripheral and central nervous system correlates of forgiveness, as well as existing interventions to promote forgiveness within divergent health settings. Finally, we propose a research agenda.     

Promoting advance care planning as health behavior change: development of scales to assess Decisional Balance, Medical and Religious Beliefs, and Processes of Change

Objective

To develop measures representing key constructs of the Transtheoretical Model (TTM) of behavior change as applied to advance care planning (ACP) and to examine whether associations between these measures replicate the relationships posited by the TTM.

Methods

Sequential scale development techniques were used to develop measures for Decisional Balance (Pros and Cons of behavior change), ACP Values/Beliefs (religious beliefs and medical misconceptions serving as barriers to participation), Processes of Change (behavioral and cognitive processes used to foster participation) based on responses of 304 persons age ≥ 65 years.

Results

Items for each scale/subscale demonstrated high factor loading (>.5) and good to excellent internal consistency (Cronbach α .76-.93). Results of MANOVA examining scores on the Pros, Cons, ACP Values/Beliefs, and POC subscales by stage of change for each of the six behaviors were significant, Wilks’ λ = .555-.809, η² = .068-.178, p ≤ .001 for all models.

Conclusion

Core constructs of the TTM as applied to ACP can be measured with high reliability and validity.

Practice implications

Cross-sectional relationships between these constructs and stage of behavior change support the use of TTM-tailored interventions to change perceptions of the Pros and Cons of participation in ACP and promote the use of certain Processes of Change in order to promote older persons’ engagement in ACP.     

Cardiovascular Responsivity, Type A Behavior, and Parental History of Heart Disease in Young Women

The purpose of this study was to examine the physiological responsiveness of Type A and Type B women during interpersonal and individual, competitive stressors. Extreme groups of Types A and B college-age women were monitored on heart rate and blood pressure while they engaged in an oral history quiz and the Stroop color/word test. Subjects were also subdivided by presence or absence of family history of coronary heart disease. Types A and B women did not differ on blood pressure levels or reactivity; Type A women did show a trend toward a greater increase in heart rate to the color/word task. Women with a positive family history had higher levels of systolic and a trend toward higher levels of diastolic blood pressure. There were no significant interactions of Type A/B with family history. Our conclusion is that Type A behavior is only very weakly, if at all, associated with physiological responsivity in young adult women.     

Cardiovascular and electrodermal responses to support and provocation: interpersonal methods in the study of psychophysiological reactivity

This study examined the joint and independent effects of experimentally manipulated social contexts and individual differences in hostility and perceived social support on physiological responses to a social stressor, while illustrating the use of the interpersonal circumplex for integrative social psychophysiological research. Undergraduate women completed a speech task in a supportive, neutral, or provoking context and completed measures of hostility and perceived social support. The provoking context evoked the largest blood pressure and heart rate (HR) responses, followed by the neutral and the supportive context. Social context also influenced HR and electrodermal reactivity during task preparation. Hostility elicited higher systolic blood pressure (SBP) reactivity during preparation, speech, and recovery. Perceived social support interacted with context to affect SBP and HR during speech and preparation. The roles of interpersonal characteristics and contexts in the physiological stress response and the utility of interpersonal methods in studying these associations are discussed.