Hostility,conflict and cardiovascular responses in married couples: a focus on the dyad

This study examined the relations of one’s own total trait hostility and one’s spouse’s hostility as influences on cardiovascular (CV) responses to couple interactions (including conflict discussions) in 45 married couples aged 24—50. Systolic blood pressure and cardiac index (CI) reactivity to conflict discussion and recovery after conflict was greater in low hostile males if they were interacting with high hostile wives (p < .02). Vascular resistance index (VRI) reactivity to interactions was greater in high hostile husbands with high hostile wives (p < .05). Women showed no adverse CV effects of having a hostile spouse when their own hostility was low. Instead, seeming to anticipate the subsequent couple interactions, wives from duos in which both partners were high in hostility had higher baseline VRI levels and lower baseline CI compared to wives from duos in which both were low in hostility (ps < .05), and they simply maintained these group differences with no greater CV reactivity during the interactions. Findings suggest that CV responses before, during, and after marital discussions, particularly those characterized by conflict, may be influenced not only by one’s own hostility but by the hostility of one’s partner as well.     

Blood pressure, gender, and parental hypertension are factors in baseline and poststress pain sensitivity in normotensive adults

We studied 38 men and 36 women to learn whether a brief speech stressor reduced normotensive humans thermal pain sensitivity, whether baseline and poststress pain threshold and tolerance varied with blood pressure (BP) and hemodynamic measures, and whether these relations differed by gender and parental hypertension (PH). PH-women with low resting BPs had lower baseline pain tolerance than did all other groups (ps < .05), and this group alone exhibited stress-induced analgesia (ps = .008). In women, pre- and poststress pain tolerance varied directly with rest and stress BP (ps < .05). In men, BP and pain measures were not related, but high cardiac index during stress was associated with low baseline pain tolerance (p < .01). The present findings support the hypothesis that pain sensitivity and cardiac stress response share a common mechanism, but they yield little support for the hypothesis that analgesic responses to acute stress contribute to hypertension etiology via an instrumental learning process. We are grateful to Robin Campbell for her technical assistance and to Dr. Alan L. Hinderliter for his assistance in screening volunteers for participation in this study. This research was supported by Grant R01-HL3t533 from the National Health, Lung, and Blood Institute, Bethesda, MD     

Breast Cancer-Specific Intrusions are Associated with Increased Cortisol Responses to Daily Life Stressors in Healthy Women Without Personal or Family Histories of Breast Cancer

Studies indicate that women fear breast cancer more than any other disease and that women’s levels of breast cancer-specific intrusions are related to their perceived risk of breast cancer. Here, we explore possible biological consequences of higher breast cancer risk perceptions and intrusions in healthy women without personal or family histories of the disease. We hypothesized that women with higher perceived risk would have more intrusions about breast cancer, which would constitute a background stressor sufficient to increase hypothalamus-pituitary-adrenal axis (HPA) responsivity to daily stress. HPA responses to an ordinary life stressor (work) were assessed in 141 employed women (age=37.2±9.2) without personal or family histories of breast cancer. Urinary cortisol excretion rates were assessed with timed sample collections at work, home, and during sleep. Repeated measures ANOVA revealed a significant Group by Time interaction with higher work cortisol levels in women with breast cancer-specific intrusions compared to women without intrusions (p < 0.02). Regression analyses revealed a significant association between risk perceptions and intrusions (p < 0.001). Regression analysis with intrusions and risk perceptions predicting work cortisol indicated a significant contribution of intrusions (p < 0.04), but not risk perceptions (p=0.53). Overestimation of breast cancer risk is associated with higher levels of breast cancer-specific intrusions that can result in increased cortisol responsivity to daily stressors. This heightened responsivity could have long-term negative health implications.     

Personality variables related to compulsive eating in college women

Investigated personality variables related to compulsive eating (episodic bouts of uncontrolled, excessive eating) in college women. Based on scores on the Compulsive Eating Scale, two groups were selected from a large sample of college women (mean age = 19) and classified high (N = 23) or low (N = 23) with regard to compulsive eating. Participants were administered the Sixteen Personality Factor Test, Social Desirability Scale, Locus of Control Scale, and Bem Sex Role Inventory. Results showed a number of significant differences between high and low groups. On the 16PF, high Ss showed higher inner tension, greater suspiciousness, and less emotional stability (ps <0.001). High Ss were more external in locus of control (p <0.02) and showed a greater need for approval (p <0.025). Sex role data showed a higher Masculine self-ideal (p <0.001) for the high group. There appear to be meaningful differences in personality variables that are related to compulsive eating, Results are discussed in terms of current theories of compulsive eating.     

HIV-infected mothers’ perceptions of uncertainty,stress, depression and social support during HIV viral testing of their infants

To explore relationships between mothers’ uncertainty about infant HIV serostatus with stress, distress, depressive symptoms, and social support during infant HIV testing. This prospective longitudinal study of 20 HIV-infected mothers involved a prenatal visit and five postpartum visits clustered around infant HIV viral testing. Maternal uncertainty about infant HIV serostatus significantly decreased over time (p < 0.001). Before testing, uncertainty was inversely related to social support (r = −0.67), and positively related to perceived stress (r = 0.54), interpersonal social conflict (r = 0.57), symptom distress (r = 0.62), and depressive symptoms (r = 0.50); these relationships persisted throughout the infant testing period. Mothers with depressive symptoms during pregnancy demonstrated significantly more uncertainty within a few weeks after birth than mothers without depressive symptoms (p < 0.05). Several weeks after learning their infants were HIV negative, mothers’ uncertainty was only associated with social conflict (r = 0.49). Maternal uncertainty about infant HIV status declined significantly over time. There were no changes in perceptions of stress, distress or social support. Mothers with depressive symptoms experienced greater uncertainty about infants’ HIV status. Strategies to enhance support and treat depressive symptoms may reduce the uncertainty, stress, and distress HIV-infected mothers experience during viral testing of their infants.     

Perceived availability of different types of social support among cynically hostile women

One hundred and ninety six young women completed the Cook-Medley Hostility (Ho) scale and a measure of the perceived availability of social support. Results of partial correlations that adjusted for the confounding effects of neuroticism showed total hostility was most strongly associated with appraisal support (r = −.40, p < .001) and most weakly associated with appraisal support (r = −.19, p < .01). These findings help contribute to a more precise understanding of the specific nature of the support deficits experienced by high hostile women. In addition, other findings suggest that different aspects of the Ho scale are differentially related to social support. Specifically, deficiencies in the perceived availability of support appear to be most strongly linked to cynicism. © 1996 John Wiley & Sons, Inc.     

Effects of long-term exercise training on cardiac autonomic nervous activities and baroreflex sensitivity

Reductions in tonic vagal controls of the heart and depressed baroreflex sensitivity (BRS) have been associated with a postural fall in blood pressure (BP) and the incidence of cardiac events among older people. We examined the hypothesis that BP regulation during orthostatic challenge as well as heart rate variability (HRV) at rest can be better maintained in long-term exercise-trained, healthy, older men (aged 60–70 years). Subjects were classified into two groups; long-term exercise-trained (LTET, n=14) and sedentary (SED, n=10) according to their history of physical activity. Prior to the dynamic BRS assessment, supine resting autonomic cardiac modulation was assessed by means of time domain HRV [standard deviation of ECG R–R interval (RRISD) and the coefficient of variation (CV)]. The BRS was assessed during 60° head-up tilting by simultaneously measuring beat-by-beat systolic blood pressure (SBP) and ECG R–R interval changes. The BRS gain was determined by the regression slope coefficient based on the extent of the SBP fall and the corresponding ECG R–R shortening during the orthostatic challenge. The results indicated that the LTET group manifested greater ECG R–R interval fluctuations with significantly higher resting RRISD and CV, compared with the SED group [59.5 (10.4) versus 27.7 (7.8) ms, p<0.05; 5.5 (0.8) versus 2.8 (0.7)%, p<0.05], respectively. Using dynamic BRS testing during the acute orthostatic challenge, the LTET group showed a significantly higher BRS gain than the SED [6.4 (0.8) versus 3.8 (0.6) ms·mmHg⁻¹, p<0.017] group. These results indicate that CV and BRS are well maintained in healthy, LTET older individuals when compared with their sedentary peers. Our data suggest that this augmented autonomic cardiac modulation reflects better parasympathetic responsiveness in LTET individuals. Data provide further support for long-term exercise training as another possible cardioprotective factor that might decrease susceptibility to ventricular fibrillation as well as assist arterial BP at the onset of an orthostatic challenge in older men. Electronic Publication     

Self-collected vaginal swabs for the quantitative real-time polymerase chain reaction assay of Atopobium vaginae and Gardnerella vaginalis and the diagnosis of bacterial vaginosis

The aim of this study was to assess the feasibility of using self-collected vaginal specimens for the quantitative real-time polymerase chain reaction (qPCR) assays of bacterial vaginosis (BV)-associated bacteria versus practitioner-collected swabs. A cross-sectional study included 190 pregnant women enrolled before 20 weeks’ gestation from September 2008 to November 2009. Self- and practitioner-collected swabs were taken during the same prenatal visit for each woman, qPCR assays performed for each, and the results compared. The quantification of the human albumin gene was used as an internal control to ensure sampling quality and accurate comparisons. The level of agreement of the qPCR assays for each microorganism was calculated with the Spearman product moment correlation coefficient and the kappa statistic. In all, 370 vaginal samples (185 self- and 185 practitioner-collected swabs) had a narrow range of values for the number of albumin gene copies and a significant correlation coefficient (Spearman’s rho = 0.532; p < 0.001). The agreement between both sampling methods was excellent (Spearman’s rho was 0.748 for Atopobium vaginae, 0.918 for Lactobacillus species, 0.940 for Gardnerella vaginalis; p < 0.001), especially for high concentrations of A. vaginae (≥10⁸ copies/mL; kappa value = 0.973; p < 0.001) and G. vaginalis (≥10⁹ copies/mL; kappa value = 0.903; p < 0.001). This study demonstrates the validity and reliability of self- versus practitioner-collected swabs for the molecular quantification of Lactobacillus species, G. vaginalis, and A. vaginae.     

Physiological stress responses in defensive individuals: Age and sex matter

The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe‐Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress.     

Psychological Distress and Exertional Angina in Men and Women Undergoing Thallium Scintigraphy

The relation between psychological factors and angina has mostly been studied in male patients with confirmed CAD and few have evaluated this relation during actual provocation of ischemia. This study evaluated gender differences in the association between psychological distress and angina pain experience in 907 Caucasian patients (479 women, mean age = 60 years) undergoing exercise stress testing with thallium scintigraphy. Data were analyzed separately for patients with and without exercise related ischemia using a series of 2 (low/high distress) × 2 (gender) ANOVAs as well as binary logistic regressions. Among all patients, distress and gender were associated with greater risk and intensity of angina pain during testing (p < 0.05) and more angina following exertion (p < 0.05) or stress (p < 0.05) at home. Conclusion: angina pain was more severe in women and individuals with high levels of distress, regardless of their ischemic status. A generalized hypersensitivity to pain/symptoms may be indicated in these patients.     

Major depressive disorder during pregnancy and emotional attachment to the fetus

While there is good evidence that depression negatively impacts mother-to-infant emotional attachment in the postpartum period, the impact of depression in pregnancy on maternal emotions and cognitions about the fetus (often termed “maternal–fetal attachment” or MFA) is unclear. This study compared MFA scores from women meeting clinical criteria for Major Depressive Disorder (MDD) with scores from nondepressed women. Participants were 161 women enrolled at 23–36 weeks gestation, of whom 65 met criteria for MDD via the Structured Clinical Interview for the DSM-IV-TR during their second and/or third trimesters. Cranley’s Maternal Fetal Attachment Scale was administered at 26 and 36 weeks gestation. Generalized linear modeling was used to assess the effect of MDD, anxiety, and antidepressant use on MFA. MDD was negatively related to MFA (LR) = 4.58, df = 1, p < 0.04). Neither anxiety (LR = 0.22, p < 0.64), nor antidepressant use (LR = 0.20, df = 1, p < 0.66) were related to MFA. Depression severity was negatively related to MFAS scores (B = −0.005, SE = .002, p < 0.0012) when including the interaction of MDD group and HRSD scores in the model. This study is the first to demonstrate that clinically defined MDD during pregnancy negatively impacts MFA, suggesting that the basis for poor mother-to-infant attachment in postpartum MDD may have roots in pregnancy.     

An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women—a group intervention program

Around 7% of pregnant women suffer from blood- and injection phobia. The aim was to investigate if cognitive behavior group therapy (CBT) is effective in treating pregnant women’s blood- and injection phobia. Thirty pregnant women with blood- and injection phobia according to DSM-IV took part in an open treatment intervention. A two-session cognitive behavior group therapy was conducted. As controls, 46 pregnant women with untreated blood- and injection phobia and 70 healthy pregnant women were used. Repeated measures ANOVA were performed. The scores for the CBT treatment group on the “Injection Phobia Scale-Anxiety” were reduced both after each treatment session and postpartum (p < 0.001). Anxiety and depressive symptoms were also reduced (p < 0.001). Cognitive-behavior group therapy for pregnant women with blood- and injection phobia is effective and stable up to at least 3 months postpartum. It seems also to reduce anxiety and depressive symptoms during pregnancy.     

The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer

To investigate the efficacy of classical massage on stress perception and mood disturbances, 34 women diagnosed with primary breast cancer were randomized into an intervention or control group. For a period of 5 weeks, the intervention group (n = 17) received biweekly 30-min classical massages. The control group (n = 17) received no additional treatment to their routine health care. The Perceived Stress Questionnaire (PSQ) and the Berlin Mood Questionnaire (BSF) were used and the patients’ blood was collected at baseline (T1), at the end of the intervention period (T2), and 6 weeks after T2 (T3). Compared with control group, women in the intervention group reported significantly lower mood disturbances, especially for anger (p = 0.048), anxious depression (p = 0.03) at T2, and tiredness at T3 (p = 0.01). No group differences were found in PSQ scales, cortisol and serotonin concentrations at T2 and T3. However, perceived stress and cortisol serum levels (p = 0.03) were significantly reduced after massage therapy (T2) compared with baseline in the intervention group. Further research is needed to validate our findings.     

The histological appearance of oesophageal adenocarcinoma—an analysis based on 215 resection specimens

The current study was performed to determine whether the histopathological appearance of oesophageal adenocarcinoma (AC) differs significantly from that of cardiac or gastric AC. Therefore, HE-stained slides of 215 primarily resected oesophageal AC, 108 cardiac and 184 gastric AC were classified according to a variety of clinico-pathologic parameters. According to Lauren’s classification, oesophageal AC (1.4%) less frequently belonged to the diffuse type than cardiac (2.8%) and gastric AC (23.9%; p<0.0001). Tubular and papillary AC, as defined by the WHO classification, were more frequent among oesophageal (94.4%) than among cardiac (87.0%) and gastric AC (59.2%; p<0.0001). Solid carcinomas, according to Carneiro’s classification, were less frequent among oesophageal (2.8%) than among cardiac (10.2%) and gastric AC (9.2%; p<0.0001). Oesophageal AC were graded more frequently G1/G2 (53.9%) than cardiac (30.6%) and gastric AC (27.7%; p<0.0001). Among oesophageal AC, Lauren’s classification (p=0.0067), Carneiro’s classification (p=0.0170), tumour grade (p=0.0005), lymphatic vessel invasion (p<0.0001) but not WHO classification were histological predictors of postoperative survival. In conclusion, oesophageal AC displays the same histological spectrum as cardiac and gastric AC. However, the relative proportion of differentiated, gland-forming carcinomas is significantly more frequent in the oesophagus than in the cardia and in the stomach.     

Time Course of Endotoxin-Induced Airways’ Inflammation in Healthy Subjects

Few data are available on the kinetic of the airways’ inflammation induced by inhaled endotoxin in a given subject. The purpose of this study was to evaluate in healthy subjects the time-related endotoxin-induced airways’ inflammation. The cells counts from the induced-sputum were evaluated before, 6 and 24 h, and 7 days after an exposure to 20 mcg inhaled endotoxin, in eight pre-selected volunteers. To avoid interference of the induced-sputum procedure on the response to endotoxin, each time-point was evaluated in randomized order at 2-weeks interval after three separate inhalations of endotoxin. A significant rise of the relative number of lymphocytes (p < 0.05) and polymorphonuclear neutrophils (PMN; p < 0.02) and of the absolute number of PMN (p < 0.05) occurring at 6 h, followed by an increase of the absolute number of the total viable cells (p < 0.01), macrophages (p < 0.001), neutrophils (p < 0.01), and lymphocytes (p < 0.05) at 24 h after endotoxin inhalation. The inflammatory response recovered totally after 7 days. In human beings, the inhalation of endotoxin induced a transient airway inflammation after 6 h, peaked at 24 h and recovered after 7 days. When repeated endotoxin inhalations are used as a model of inflammation, a wash-out period of at least 7 days should be applied between each exposure in each subject.     

Interleukin-18 Binding Protein in the Sera of Patients with Wegener’s Granulomatosis

Introduction  In the present study, we examined the levels of the pro-inflammatory cytokine IL-18 and its natural inhibitor, the IL-18 binding protein (IL-18BP), in sera of Wegener’s granulomatosis (WG) patients at various stages of the disease. Patients and Methods  Sera from eight consecutive biopsy-proven systemic WG patients (four men and four women; age at diagnosis 58.4 ± 13.8 years) were obtained longitudinally with a follow-up period of 55.2 ± 30 months. Sera obtained from 50 healthy subjects were used as controls. Results and Discussion  Serum levels of IL-18, IL-18BP, and free IL-18 obtained during an active phase of the disease (Birmingham Vasculitis Activity Score, BVAS > 10) were more than twofold higher than levels in the same patients during inactive disease stages (BVAS < 5; P < 0.002; P < 0.006, and P < 0.03 for IL-18, IL-18BP, and free IL-18, respectively). During inactive stages, the levels of these markers were comparable to those of healthy controls. The elevated levels of IL-18 and IL-18BP in sera during active stages of disease suggest a possible role in the pathogenesis and course of the WG. Conclusion  Despite the elevated IL-18BP levels during active disease, free IL-18 remained higher than in the inactive disease stages, suggesting a potential benefit of administration of exogenous IL-18BP as a novel therapeutic approach for active WG.     

Shine light on sleep: Morning bright light improves nocturnal sleep and next morning alertness among college students

The relationship between daytime light, especially morning light and sleep, has not been well documented. People who work in an office spend most of their time indoors and thus have less access to high-level daylight. The current study employed a field intervention approach to investigate whether exposure to 1.5 h of bright electric light in the early morning for 1 workweek would benefit sleep among students who spent most of their time in an office at the university. Twelve students (24.92 ± 1.78 years) underwent a 2 workday baseline measurement and two inconsecutive 5 workday interventions (with 1 week washout) with morning bright light and regular office light (1000 lx, 6500 K vs. 300 lx, 4000 K, at eye level). The sleep outcomes were recorded with actigraphy and a sleep diary. In addition, self-ratings of daytime sleepiness, mood, mental fatigue, perceived effort, and next morning sleepiness were measured each workday. The results showed that exposure to morning bright light versus regular office light yielded a higher sleep efficiency (83.82% ± 1.60 vs. 80.35% ± 1.57, p = 0.02), a smaller fragmentation index (15.26% ± 1.31 vs. 17.18% ± 1.28, p = 0.05), and a shorter time in bed (7.12 ± 0.13 vs. 7.51 ± 0.12, p = 0.03). Meanwhile, an earlier sleep onset time, shorter sleep latency, and lower morning sleepiness were observed after a 5 workday morning bright light intervention compared with the baseline (ps <0.05), no such benefit was found for self-ratings (ps >0.05). These findings support existing evidence that morning bright light could function as an enhancer of sleep and alertness for office occupants.     

Determinants of participation in cancer support groups: The role of health beliefs

Background: Although considerable attention has been directed toward cancer support groups, little is known about how often these services are actually used in clinical practice or the factors that influence participation. Purpose: Drawing in part on the Health Belief Model, this study examined group participation and its correlates among 425 patients with diverse malignancies treated at a large academic oncology center. Method: Patients were surveyed regarding utilization rates, health beliefs, and medical and demographic characteristics. Results: Only a small number of patients reported having participated in groups (8.0%). Consistent with the model, in univariate analyses, participation was significantly related to greater perceptions of illness severity (p < .0001), greater perceived benefits (p < .01), fewer perceived barriers (all p < .01), and greater cues for action (i.e., recommendation by family/friends, p < .000001). In multivariate analyses controlling for disease site and other covariates, the strongest predictors included recommendation by family/friends (OR = 5.04; CI = 1.98–12.81), perceived seriousness of the illness (OR = 4.07; CI = 1.42–11.60), and geographical residence (OR = 2.74; CI = 1.09–6.93). Conclusion: Results suggest that participation might be increased by involving the patient’s support network, improving access in underserved rural communities, addressing illness appraisals, and increasing outreach to certain diagnostic groups.     

Initiator status,family support,and adjustment to marital separation: A test of an interaction hypothesis

Fifty-six newly separated, volunteer participants (40 women, 16 men) were examined to determine if depressive symptomatology (as measured by the CES-D) was related to the respondent's active participation in the decision to separate from the spouse (initiator status) and the proportion of family members in their social support network. The relationship between initiator status and depressive symptomatology was marginally significant, F(l, 50) = 3.93, p = 0.053. There was an interaction between initiator status and the proportion of family members in the social network. For initiators, a low proportion of family members was related to increased depressive symptomatology (r = 0.15), whereas for noninitiators, a low proportion of family members was related to increased depressive symptomatology (r = - 0.37), a difference significant at p<.04. It is suggested that the functional ability of the network to be supportive is mediated both by aspects of the individual in need of support and by structural aspects of the network.     

Healthcare worker’s perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study

Summary Objective: We interviewed healthcare workers working in Toronto, Canada, regarding their experience of providing care to recent immigrant women suffering from postpartum depression. The objective was two-fold: 1) to identify potential barriers to care that recent immigrant women may encounter as perceived by healthcare workers; and 2) to identify challenges healthcare workers felt that they faced as providers of care to this population. Methods: Qualitative semi-structured interviews were conducted with 16 key informants from various disciplines employed by healthcare agencies providing care to postpartum immigrant women in Toronto. Constant comparative analysis was used to analyze the data. Results: Two main categories of barriers to care for recent immigrant women were identified: ‘practical barriers’ and ‘culturally determined barriers’. Practical barriers included knowing where and how to access services, and language difficulties. Cultural barriers included fear of stigma and lack of validation of depressive symptoms by family and society. The challenges experienced by healthcare providers working with this population were organized into two other categories: ‘professional limitations’, and ‘social/cultural barriers’. ‘Professional limitations’ included fear of incompetence, language barriers, and inadequate assessment tools. ‘Social/cultural barriers’ included the experience of cultural uncertainty. Conclusions: The results suggest that not only are there important barriers to accessing postpartum care for recent immigrant women, but it can also be challenging for healthcare workers to deliver such needed care. Understanding some of these barriers and challenges from the perspective of healthcare providers is an important step to remedying gaps and obstacles in the service system.