The Effect of Recent Life Events Stress,Life Assets,and Temperament Pattern on Cardiovascular Risk Factors for Akron City Police Officers

Abstract

Police officers, as a group, experience many occupational demands with physiological and psychological effects that could be harmful to their health. A primary objective of this study was to analyze specific behavioral and physiological risk factors that could lead to hypertension and accelerated coronary artery disease. Three hundred thirty-one male Akron City police officers participated in the study. A group of volunteer males (n = 48) who worked in city clerical jobs were used as controls. Questionnaires were administered in order to measure such behavioral variables as recent life change, life assets, and temperament pattern. Blood chemistry and physiological variables were also measured. The police officers had higher diastolic blood pressure (DBP), norepinephrine (NE) levels, and recent life change unit (LCU) scores than the control group. Increased hostility and depression scores were associated with higher DBP and recent LCU scores and lower life asset unit (LAU) scores. Individuals with higher ?dominant” scores and moderate to high recent LCU scores had higher cardiovascular risk factors than those with moderate to high recent LCU scores who were ranked as ?subordinate.” Rotating shift workers had abnormally elevated NE levels, which, if not controlled, may lead to higher cardiovascular risk. Behavioral intervention programs have been introduced with the goals of reducing stress, increasing life assets, and teaching relaxation techniques.     

Cardiovascular risk factors and disease in general practice: results of the Nijmegen Cohort Study.

The relationship between risk factors and cardiovascular disease (CVD) was determined using data from the Nijmegen Cohort study, an 18-year prospective study. In 1977, cardiovascular risk factors were measured in 7092 Caucasian males and females from six general practices: age, smoking, serum cholesterol, blood pressure, body mass index and a family history of CVD were related to subsequent CVD mortality and morbidity. Most patients had more than one risk factor in particular among men. A significant relationship between risk factors and CVD was demonstrated. In men, a relative risk (RR) of 1.8 was found for both high blood pressure and smokers. A positive family history yielded a RR of 1.8. The risk increased gradually with the number of risk factors; 38% of the group with all risk factors suffered a CVD within 18 years. In women, comparable RRs were found but the low absolute risk of CVD should indicate against the treatment of cardiovascular risk factors.     

Web-based risk communication and planning in an obese population: exploratory study

Background

A healthy diet, low in saturated fat and high in fiber, is a popular medical recommendation in preventing cardiovascular disease (CVD). One approach to motivating healthier eating is to raise individuals’ awareness of their CVD risk and then help them form specific plans to change.

Objectives

The aim was to explore the combined impact of a Web-based CVD risk message and a fully automated planning tool on risk perceptions, intentions, and saturated fat intake changes over 4 weeks.

Methods

Of the 1187 men and women recruited online, 781 were randomly allocated to one of four conditions: a CVD risk message, the same CVD risk message paired with planning, planning on its own, and a control group. All outcome measures were assessed by online self-reports. Generalized linear modeling was used to analyze the data.

Results

Self-perceived consumption of low saturated fat foods (odds ratio 11.40, 95% CI 1.86–69.68) and intentions to change diet (odds ratio 21.20, 95% CI 2.6–172.4) increased more in participants allocated to the planning than the control group. No difference was observed between the four conditions with regard to percentage saturated fat intake changes. Contrary to our expectations, there was no difference in perceived and percentage saturated fat intake change between the CVD risk message plus planning group and the control group. Risk perceptions among those receiving the CVD risk message changed to be more in line with their age (change in slope_individual = 0.075, P = .01; change in slope_comparative = 0.100, P = .001), whereas there was no change among those who did not receive the CVD risk message.

Conclusion

There was no evidence that combining a CVD risk message with a planning tool reduces saturated fat intake more than either alone. Further research is required to identify ways in which matching motivational and volitional strategies can lead to greater behavior changes.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 91154001; http://www.controlled-trials.com/ISRCTN91154001 (Archived by WebCite at http://www.webcitation.org/62sBoGeOO)     

Anticipation resulting in elimination of the myotonic dystrophy gene: a follow up study of one extended family.

We have re-examined an extended myotonic dystrophy (DM) family, previously described in 1955, in order to study the long term effects of anticipation in DM and in particular the implications for families affected by this disease. This follow up study provides data on 35 gene carriers and 46 asymptomatic at risk family members in five generations. Clinical anticipation, defined as the cascade of mild, adult, childhood, or congenital disease in subsequent generations, appeared to be a relentless process, occurring in all affected branches of the family. The cascade was found to proceed asynchronously in the different branches, mainly because of an unequal number of generations with mild disease. The transition from the mild to the adult type was associated with transmission through a male parent. Stable transmission of the asymptomatic/mild phenotype showed a female transmission bias. We further examined the extent and causes of gene loss in this pedigree. Gene loss in the patient group was complete, owing to infertility of the male patients with adult onset disease and the fact that mentally retarded patients did not procreate. Out of the 46 at risk subjects in the two youngest generations, only one was found to have a full mutation. This is the only subject who may transmit the gene to the sixth generation. No protomutation carriers were found in the fourth and fifth generations. Therefore it is highly probable that the DM gene will be eliminated from this pedigree within one generation. The high population frequency of DM can at present not be explained by the contribution of asymptomatic cases in the younger generations of known families, but is probably caused by the events in the ancestral generations.     

Increasing knowledge of cardiovascular risk factors among African Americans by use of community health workers: the ABCD community intervention pilot project

African Americans have higher rates of cardiovascular disease (CVD) and poorer outcomes compared to others. The American Diabetes Association and the National Diabetes Education Program have promoted use of the ABC approach (glycated hemoglobin A1c, blood pressure, cholesterol) for identifying and controlling the leading indicators of CVD risk. In the present study, researchers added a D factor, for depression, because this disorder is common and also predictive of CVD risk and of control of diabetes. Particularly among low-income African Americans, depression is frequently not targeted or treated. The current study tests the effectiveness of recruiting African Americans in churches and training community health workers (CHWs) to educate their peers about CVD and risk reduction. For the intervention group, CHWs participated in a 16-hour training session and delivered a 6-week tailored educational program with counseling sessions and demonstrations. The control group received a weekly lecture by clinical experts. The CHW active-learning intervention was more effective than lectures by clinical experts in increasing the knowledge of CVD risk. The only significant difference in clinical measures reflected a worsening of HbA1c levels in the control group; the CHW intervention group showed a slight improvement. Participants also learned self-management skills, such as taking blood pressure, measuring glucose, and reading labels. Nevertheless, more longitudinal research and a larger sample size are needed to confirm the impact of CHWs in community settings to change factors associated with CVD risk.     

Direct observation of physical activity and dietary behaviors in a structured environment: Effects of a family-based health promotion program

The effects of cardiovascular risk reduction are typically assessed by self-reported behavior change and physiological outcomes. There is a need to enhance evaluation protocols by including direct observation measures of targeted health behaviors. To improve the evaluation of a family-based diet and physical activity change program, families were observed during a planned visit to the San Diego Zoo. This standardized environment afforded many options for dietary intake and physical activity. Thirty families who had participated in a 1-year intervention program and 30 control families were observed. Caucasian and Mexican-American families were equally represented. Observations in this standard environment discriminated between intervention and control families, and the findings indicated that intervention effects generalized to this novel setting. Intervention families consumed fewer calories, ate less sodium, and walked further than did control families. Ethnic differences were noted.This work was supported by NHLBI Grant HL-30872 to Philip R. Nader.     

Greater ability to express positive emotion is associated with lower projected cardiovascular disease risk

Positive emotion is associated with lower cardiovascular disease (CVD) risk, yet some mechanisms remain unclear. One potential pathway is via emotional competencies/skills. The present study tests whether the ability to facially express positive emotion is associated with CVD risk scores, while controlling for potential confounds and testing for sex moderation. Eighty-two men and women underwent blood draws before completing self-report assessments and a performance test of expressive skill. Positive expressions were scored for degree of ‘happiness’ using expression coding software. CVD risk scores were calculated using established algorithms based on biological, demographic, and behavioral risk factors. Linear regressions revealed a main effect for skill, with skill in expressing positive emotion associated with lower CVD risk scores. Analyses also revealed a sex-by-skill interaction whereby links between expressive skill and CVD risk scores were stronger among men. Objective tests of expressive skill have methodological advantages, appear to have links to physical health, and offer a novel avenue for research and intervention.     

Biological relationships and frontal sinus similarity in skeletal remains with known genealogical data

Frontal sinus analysis has potential utility for detecting biologically related individuals. However, the methodological approach to its evaluation, as well as its informative value, have been questioned. The aim of this work is to introduce a new approach to evaluating the frontal sinus using the ‘external supraorbital line’ (ESOL) and to determine whether there are sex differences within families in frontal sinus measurements and whether frontal sinus similarity reflects known genetic relationships in both measurements and morphology. We examined the skeletal remains of 41 adult individuals (25 males, 16 females), all members of one family over four generations (19th to 20th centuries), including individuals with very close consanguinity. CT images of skulls were acquired, and both the dimensions and morphology of the frontal sinuses were analyzed using their portions above the ESOL. No significant sex differences were found within families based on frontal sinus dimensions. Significant relationships were found between biological distance and the maximum height and morphology of the frontal sinuses. The greatest degree of similarity was found among closely related individuals. Additionally, in several cases, there was a greater degree of similarity between first cousins or grandparents and their grandchildren than among siblings or parents and their children. Total surface, volume and width are not significant indicators of relatedness. Known genetic relationships are also supported by individual morphological features. Variability within families with very close consanguineous relationships was lower than within families with common degrees of consanguinity, although differences are significant only for some variables.     

The effects of communicating cardiovascular disease risk as 'fitness age' on behavioral intentions and psychological outcomes

ObjectivesThere is increasing interest in ‘biological age’ formats to convey the risk of chronic disease. Fitness Age is a relatively new construct that may be useful for younger people who perceive cardiovascular disease (CVD) risk as less relevant. The current study tested whether Fitness Age increases behavioral intentions and psychosocial outcomes compared to formats commonly used for middle aged adults: Heart Age and percentage risk.Methods180 young adults were randomized to 1 of 3 risk formats: Fitness Age, Heart Age, or lifetime percentage risk of CVD. To make the intervention more personally relevant, participants were assigned to receive a low or high risk result based on self-reported lifestyle factors. Validated measures were used for intentions, worry, perceived risk and credibility.ResultsPercentage risk and Heart Age resulted in greater lifestyle change intentions and more accurate numeric risk perception than Fitness Age. High risk results were perceived as less credible but more worrying.ConclusionsFitness Age may be detrimental for risk perception and behavior change for young adults. Percentage risk and Heart Age formats were equally effective.Practice ImplicationsLabels for biological age formats matter when developing risk communication tools, and Fitness Age would not be a recommended format.     

MENTORING RELATIONSHIPS,POSITIVE DEVELOPMENT,YOUTH EMOTIONAL AND BEHAVIORAL PROBLEMS: INVESTIGATION OF A MEDIATIONAL MODEL

Mentoring programs show promise for preventing emotional and behavioral problems among at‐risk youth, but little is known about processes that may be most critical to achieving this end. This study explored indicators of positive youth development (PYD; competence, confidence, connection, care and compassion, character) as mediators of associations of mentoring support with youth emotional and behavioral problems. The sample included 501 youth participating in a study of the Big Brothers Big Sisters program in Canada (mean = 11.16 years old; 52% girls, and 44% White). Measures were youth self‐report, with the exception of the use of both youth and parent report measures of emotional and behavioral problems. Results of structural equation modeling analyses were consistent with PYD mediating the association between mentoring support and emotional and behavioral problems, regardless of informant. The association between mentor support and PYD, however, was limited to youth in active mentoring relationships.     

Clinical and laboratory assessment of cardiovascular risk in children: Guidelines for screening, evaluation, and treatment

The early lesions of atherosclerosis begin in childhood and are related to antecedent cardiovascular disease (CVD) risk factors. Environmental and genetic factors (eg, diet, obesity, exercise, and certain inherited dyslipidemias) influence progression of such lesions. Identification of youth at risk for atherosclerosis includes an integrated assessment of these predisposing factors. Treatment starts with a diet low in total and saturated fat and cholesterol, use of water-soluble fiber, plant stanols and plant sterols, weight control, and exercise. Drug therapy, for example, with inhibitors of hydroxymethylglutaryl-CoA reductase, bile acid sequestrants, and cholesterol absorption inhibitors, can be considered in those with a positive family history of premature CVD and low-density lipoprotein cholesterol >160 mg/dL after dietary and hygienic measures. Candidates for drug therapy often include those with familial hypercholesterolemia, familial combined hyperlipidemia, the metabolic syndrome, polycystic ovarian syndrome, type 1 diabetes, and the nephrotic syndrome. Such dietary and drug therapy appears safe and efficacious. Early identification and treatment of youth with CVD risk factors and dyslipidemia are likely to retard the atherosclerotic process. Optimal detection and treatment of high-risk children either from the general population or from families with premature CVD will require a comprehensive universal screening and evaluation program.     

Age, rank, and personality effects on the cortisol sedation stress response in young chimpanzees

Primates and other mammals exhibit a glucocorticoid response to somatic and psychosocial stressors. The pattern and degree of response varies both within and between species, but the factors affecting within-species variability have rarely been considered. Here we describe the 90-min serum cortisol response of 14 juvenile and adolescent chimpanzees to the stress of sedation with ketamine hydrochloride. We show age differences in both baseline cortisol and time of peak cortisol, with younger individuals (ages 4-5 years) showing higher baseline levels and an earlier peak response than older individuals (ages 8-9 years). However, we found no sex or rank-related differences in any of the sedation measures: baseline cortisol, cortisol peak time, peak cortisol level, or cortisol change from baseline. We also examined the relationship between these sedation stress measures and behavioral style score, and found that individuals scoring high in the "mellow" behavioral style component showed a greater stress response than individuals scoring lower in this component. Future studies should consider the role of individual differences in age and personality in the cortisol response to stress.     

Changing coronary heart disease risk-factor status: The effects of three behavioral programs

Seventy-five persons (57 male and 18 female) with a high risk of coronary heart disease (CHD) were randomly assigned in equal numbers to three 8-week behavioral treatment programs. All three treatments were designed to alter simultaneously a number of risk-elevating behavior patterns, in the expectation that change in any one behavior pattern would reinforce change in others. Weight, blood pressure, and aerobic fitness were regularly assessed in all subjects. Serum lipids were also measured, but less frequently. All three interventions produced significant beneficial changes in the major objective measures, and the changes were well maintained after 12 months. The most improved group exhibited the following mean changes: weight loss of 9.2 kg, reductions in blood pressure of 12.9/8.8 mm Hg, improvement in aerobic capacity of 33%, reduction in serum cholesterol of 0.45 mmol/liter, and reduction in current overall CHD risk of 41%. The effectiveness of the interventions was positively related to the degree to which the programs emphasized training in, and detailed application of, behavioral change principles.     

Developing pathways to assist parents to exit the child protection system in Australia

The prevalence of child abuse and neglect is an international concern that justifies the existence of child protection systems. An important first principle for all such statutory child protection systems is to ensure that the system itself does no further harm. It can be argued that there are specific circumstances within which well‐meaning services have the potential to do harm: specifically, processes and actions that disempower parents by reducing their autonomy and capacity for positive action. Exploring the circumstances in which reduced parental autonomy impacts negatively on families is an important first step in developing procedures for working with families that not only avoid harm but are orientated to produce meaningful change. Two evidence‐based programs are described that together have the potential to assist child protection practitioners to develop a collaborative helping partnership with families, clarify goals for change and support parents to achieve meaningful improvement in their family functioning. The programs described are both manualised and have empirical support for their effectiveness. The potential benefits for both families and practitioners working within child protection agencies in the two programs are described.     

Cephalometric evidence for a dominantly inherited predisposition to cleft lip-cleft palate in a single large kindred

Several studies have demonstrated an association between facial shape in parents and the presence of oral clefts in their offspring. However, these observations have been of little practical value because it has been assumed that facial shape was just one predisposing component among many in a multifactorial model of inheritance. Cephalometric analysis of a large family with 5 generations of affected individuals suggests that facial shape can be used to identify presumed carriers of a major gene associated with an increased risk for oral clefts. Discriminant function analysis indicates that such at risk individuals can be recognized effectively through a combination of increased midfacial and nasal cavity widths, reduced facial height, and a flat facial profile. The ability to identify minimally affected gene carriers within families would provide critical information needed in the search for molecular markers that segregate with the genetic risk for clefting. © 1994 Wiley-Liss, Inc.     

Do aggressive/destructive toddlers lack concern for others? Behavioral and physiological indicators of empathic responding in 2-year-old children

Ninety-nine 2-year-olds, out of a larger sample of 474 children, were classified as high (n = 49) or low (n = 50) in externalizing (aggressive/destructive) behaviors based on maternal reports assessed twice across a 2-month period. During a laboratory assessment, these toddlers participated in two empathy-eliciting tasks, from which affective, behavioral, and physiological measures were derived. Relations among measures of empathy were examined both within and across episodes and aggression groups. Analyses indicated that different indices of empathy were related to each other, both within and across empathy situations. In addition, aggressive children displayed more behaviors indicative of empathy than did nonaggressive children. Finally, a pattern of physiological responding to another's distress was evident across both groups of children, and some results indicated that greater physiological regulation was related to less empathy-related behavior. Results are discussed in terms of the developing nature of empathy and its changing association with both self-regulation and aggression.     

The relationship between post-traumatic stress disorder, depression and cardiovascular disease in an American Indian tribe

BACKGROUND: Empirical findings suggest that psychiatric illness is associated with cardiovascular disease (CVD). The purpose of this study was to compare the strength of the association of lifetime post-traumatic stress disorder (PTSD) and lifetime major depression on CVD among Northern Plains American Indians.METHOD: A total of 1414 participants aged 18-57 years completed a structured interview that assessed psychiatric diagnoses, alcohol abuse/dependence, self-reported CVD, and traditional CVD risk factors including age, sex, education, diabetes, high blood pressure, and smoking. Logistic regression analyses compared the odds ratios of CVD in participants with and without diagnosed PTSD or major depression.RESULTS:The rates of lifetime PTSD and major depression were 15% and 8% respectively. CVD was more commonly reported by participants with PTSD than by those without PTSD (12% v. 5%, p相似文献   

THE RELATIONSHIP BETWEEN STIMULUS INFORMATION, REACTION TIME, AND CORTICAL HABITUATION

This investigation was an attempt to study systematically the effects of uncertainty, or stimulus information, on habituation rate. Subjects were randomly assigned to one of three conditions varying in uncertainty. EEG alpha desynchrony duration, electrodermal conductance change, and reaction time were the dependent measures. The results showed uncertainty to have no significant effect on any of the neurophysiological measures. There was a significant effect on the reaction time measure. There was no significant correlation between the EEG and electrodermal response measures, nor was there any correlation between either of these measures and reaction time. Results indicated that habituation could occur in the presence of cortical and behavioral arousal. It was concluded that information may be most meaningfully measured behaviorally and that habituation parameters are dependent upon the physiological system being measured.     

Web-Based Self-Assessment Health Tools: Who Are the Users and What Is the Impact of Missing Input Information?

Background

Web-based health applications, such as self-assessment tools, can aid in the early detection and prevention of diseases. However, there are concerns as to whether such tools actually reach users with elevated disease risk (where prevention efforts are still viable), and whether inaccurate or missing information on risk factors may lead to incorrect evaluations.

Objective

This study aimed to evaluate (1) evaluate whether a Web-based cardiovascular disease (CVD) risk communication tool (Heart Age tool) was reaching users at risk of developing CVD, (2) the impact of awareness of total cholesterol (TC), HDL-cholesterol (HDL-C), and systolic blood pressure (SBP) values on the risk estimates, and (3) the key predictors of awareness and reporting of physiological risk factors.

Methods

Heart Age is a tool available via a free open access website. Data from 2,744,091 first-time users aged 21-80 years with no prior heart disease were collected from 13 countries in 2009-2011. Users self-reported demographic and CVD risk factor information. Based on these data, an individual’s 10-year CVD risk was calculated according to Framingham CVD risk models and translated into a Heart Age. This is the age for which the individual’s reported CVD risk would be considered “normal”. Depending on the availability of known TC, HDL-C, and SBP values, different algorithms were applied. The impact of awareness of TC, HDL-C, and SBP values on Heart Age was determined using a subsample that had complete risk factor information.

Results

Heart Age users (N=2,744,091) were mostly in their 20s (22.76%) and 40s (23.99%), female (56.03%), had multiple (mean 2.9, SD 1.4) risk factors, and a Heart Age exceeding their chronological age (mean 4.00, SD 6.43 years). The proportion of users unaware of their TC, HDL-C, or SBP values was high (77.47%, 93.03%, and 46.55% respectively). Lacking awareness of physiological risk factor values led to overestimation of Heart Age by an average 2.1-4.5 years depending on the (combination of) unknown risk factors (P<.001). Overestimation was greater in women than in men, increased with age, and decreased with increasing CVD risk. Awareness of physiological risk factor values was higher among diabetics (OR 1.47, 95% CI 1.46-1.50 and OR 1.74, 95% CI 1.71-1.77), those with family history of CVD (OR 1.22, 95% CI 1.22-1.23 and OR 1.43, 95% CI 1.42-1.44), and increased with age (OR 1.05, 95% CI 1.05-1.05 and OR 1.07, 95% CI 1.07-1.07). It was lower in smokers (OR 0.52, 95% CI 0.52-0.53 and OR 0.71, 95% CI 0.71-0.72) and decreased with increasing Heart Age (OR 0.92, 95% CI 0.92-0.92 and OR 0.97, 95% CI 0.96-0.97) (all P<.001).

Conclusions

The Heart Age tool reached users with low-moderate CVD risk, but with multiple elevated CVD risk factors, and a heart age higher than their real age. This highlights that Web-based self-assessment health tools can be a useful means to interact with people who are at risk of developing disease, but where interventions are still viable. Missing information in the self-assessment health tools was shown to result in inaccurate self-health assessments. Subgroups at risk of not knowing their risk factors are identifiable and should be specifically targeted in health awareness programs.     

Cardiovascular risk factors of migrants in Port Moresby from the highlands and island villages,Papua New Guinea

This study examined cardiovascular disease (CVD) risk factors, i.e., obesity, blood pressures, and serum lipoproteins and apoproteins, in relation to sociocultural characteristics in two rural–urban migrant populations (n = 173 adult males and females) in Port Moresby, the capital of Papua New Guinea. Tari migrants from the highlands and Balopa migrants from the islands differ genetically. More importantly, the lifestyle of the latter is more Westernized than that of the former in both Port Moresby and their homelands. The results demonstrate that CVD risk factors vary markedly among the origin/sex groups and that the length of stay in Port Moresby on CVD risk factors was significant only in Balopa males, most of whom had professional or skilled full-time jobs and were considered to have more stress. This study identified different CVD risk factors in the migrant groups: obesity or fatness for the Balopa migrants, and serum lipoproteins and apoproteins, particularly lipoprotein(a), for the Tari migrants. Am. J. Hum. Biol. 12:655–664, 2000. © 2000 Wiley-Liss, Inc.