Hostility Now, Depression Later? Longitudinal Associations Among Emotional Risk Factors for Coronary Artery Disease

Background/Purpose

Given that emotional risk factors for coronary artery disease (CAD) tend to cluster within individuals, surprisingly little is known about how these negative emotions might influence one another over time. We examined the longitudinal associations among measures of depressive symptoms and hostility/anger in a cohort of 296 healthy, older adults.

Methods

Participants completed the Beck Depression Inventory-II (BDI-II), Cook–Medley Hostility (Ho) scale, and Anger-In and Anger-Out subscales of the State–Trait Anger Expression Inventory at baseline and 6-year follow-up. We conducted a series of path analyses to evaluate the directionality of the depression–hostility/anger relationship.

Results

Baseline Ho scale was a predictor of 6-year increases in BDI-II (β?=?0.15, p?=?0.004), Anger-In (β?=?0.14, p?=?0.002), and Anger-Out (β?=?0.11, p?=?0.01). In contrast, baseline BDI-II, Anger-In, and Anger-Out did not predict change in any of the emotional variables. Additional path analytic models revealed that the pattern of relationships was not altered after controlling for demographic, biomedical, and behavioral covariates; anxiety symptoms; social support; and subjective sleep quality.

Conclusions

The present results suggest that the cognitive aspects of hostility/anger may precede and independently predict future increases in depressive symptoms but not vice versa. Our findings lead us to speculate that (a) hostility may exert part of its cardiotoxic influence by acting to precipitate and/or maintain symptoms of depression and that (b) the potency of depression interventions designed to improve cardiovascular outcomes might be enhanced by incorporating treatments addressing hostility.     

Does Exposure to Stressors Predict Changes in Physiological Dysregulation?

Background

The allostatic load framework implies that cumulative exposure to stressors results in multi-system physiological dysregulation.

Purpose

The purpose of this study was to investigate the effect of stress burden on subsequent changes (2000–2006) in physiological dysregulation.

Methods

Data came from a population-based cohort study in Taiwan (n?=?521, aged 54+ in 2000, re-examined in 2006). Measures of stressful events and chronic strain were based on questions asked in 1996, 1999, and 2000. A measure of trauma was based on exposure to the 1999 earthquake. Dysregulation was based on 17 biomarkers (e.g., metabolic, inflammatory, neuroendocrine).

Results

There were some small effects among men: chronic strain was associated with subsequent increases in dysregulation (standardized β?=?0.08, 95 % CI?=?0.01 to 0.20), particularly inflammation; life events were also associated with increased inflammation (β?=?0.10, CI?=?0.01 to 0.26). There were no significant effects in women.

Conclusions

We found weak evidence that stress burden is associated with changes in dysregulation.     

The SHED-IT Community Trial: A Randomized Controlled Trial of Internet- and Paper-Based Weight Loss Programs Tailored for Overweight and Obese Men

Background

There is limited evidence for effective obesity treatment programs that engage men.

Purpose

This study evaluated the efficacy of two gender-tailored weight loss interventions for men, which required no face-to-face contact.

Methods

This was a three-arm, randomized controlled trial: (1) Resources (n?=?54), gender-tailored weight loss materials (DVD, handbooks, pedometer, tape measure); (2) Online (n?=?53), Resources materials plus study website and e-feedback; and (3) Wait-list control (n?=?52). The interventions lasted 3 months and were grounded in Social Cognitive Theory.

Results

At 6 months, significantly greater weight loss was observed for the Online (?4.7 kg; 95 % CI ?6.1, ?3.2) and Resources (?3.7 kg; 95 % CI ?4.9, ?2.5) groups compared to the control (?0.5 kg; 95 % CI ?1.4, 0.4). Additionally, both intervention groups significantly improved body mass index, percent body fat, waist circumference, blood pressure, physical activity, quality of life, alcohol risk, and portion size, compared to controls.

Conclusions

Men achieved significant weight loss after receiving novel, minimal-contact, gender-tailored programs, which were designed for widespread dissemination.     

Structural Stigma and Cigarette Smoking in a Prospective Cohort Study of Sexual Minority and Heterosexual Youth

Background

Sexual minority youth are more likely to smoke cigarettes than heterosexuals, but research into the determinants of these disparities is lacking.

Purpose

This study aimed to examine whether exposure to structural stigma predicts cigarette smoking in sexual minority youth.

Methods

Prospective data from adolescents participating in the Growing Up Today Study (2000–2005) were utilized.

Results

Among sexual minority youth, living in low structural stigma states (e.g., states with non-discrimination policies inclusive of sexual orientation) was associated with a lower risk of cigarette smoking after adjustment for individual-level risk factors (relative risk [RR]?=?0.97; 95 % confidence interval [CI], 0.96, 0.99; p?=?0.02). This association was marginally significant after additional controls for potential state-level confounders (RR?=?0.97; 95 % CI, 0.93, 1.00; p?=?0.06). In contrast, among heterosexual youth, structural stigma was not associated with past-year smoking rates, documenting specificity of these effects to sexual minority youth.

Conclusions

Structural stigma represents a potential risk factor for cigarette smoking among sexual minority adolescents.     

A Prospective Examination of Exercise and Barrier Self-efficacy to Engage in Leisure-Time Physical Activity During Pregnancy

Background

Pregnant women without medical contraindications should accumulate 30 min of moderate exercise on most days of the week, yet many pregnant women do not exercise at recommended levels.

Purpose

The purpose the study was to examine barriers to leisure-time physical activity (LTPA) and investigate barrier and exercise self-efficacy as predictors of self-reported LTPA during pregnancy.

Methods

Pregnant women (n?=?160) completed questionnaires eliciting barriers to LTPA, measures of exercise and barrier self-efficacy, and 6-week LTPA recall at gestational weeks 18, 24, 30, and 36.

Results

A total of 1,168 barriers were content-analyzed, yielding nine major themes including fatigue, time constraints, and physical limitations. Exercise self-efficacy predicted LTPA from gestational weeks 18 to 24 (β?=?0.32, R ²?=?0.26) and weeks 30 to 36 (β?=?0.41, R ²?=?0.37), while barrier self-efficacy predicted LTPA from weeks 24 to 30 (β?=?0.40, R ²?=?0.32).

Conclusions

Pregnant women face numerous barriers to LTPA during pregnancy, the nature of which may change substantially over the course of pregnancy. Higher levels of self-efficacy to exercise and to overcome exercise barriers are associated with greater LTPA during pregnancy. Research and interventions to understand and promote LTPA during pregnancy should explore the dynamic nature of exercise barriers and foster women's confidence to overcome physical activity barriers.     

Six-Month Outcomes from Living Well with Diabetes: A Randomized Trial of a Telephone-Delivered Weight Loss and Physical Activity Intervention to Improve Glycemic Control

Background

Intensive lifestyle intervention trials in type 2 diabetes contribute evidence on what can be achieved under optimal conditions, but are less informative for translation in applied settings.

Purpose

Living Well with Diabetes is a telephone-delivered weight loss intervention designed for real-world delivery.

Methods

This study is a randomized controlled trial of telephone counseling (n?=?151) versus usual care (n?=?151); 6-month primary outcomes of weight, physical activity, HbA1c; secondary diet outcomes; analysis was by adjusted generalized linear models.

Results

Relative to usual care, telephone counseling participants had small but significantly better weight loss [?1.12 % of initial body weight; 95 % confidence interval (CI) ?1.92, ?0.33 %]; physical activity [relative rate (RR)?=?1.30; 95 % CI, 1.08, 1.57]; energy intake reduction (?0.63 MJ/day; 95 % CI, ?1.01, ?0.25); and diet quality (3.72 points; 95 % CI, 1.77, 5.68), with no intervention effect for HbA1c (RR?=?0.99; 95 % CI, 0.96, 1.01).

Conclusions

Results are discussed in light of challenges to intervention delivery.     

Conscientiousness and Medication Adherence: A Meta-analysis

Background

Approximately a quarter to a half of all people fail to take their medication regimen as prescribed (i.e. non-adherence). Conscientiousness, from the five-factor model of personality, has been positively linked to adherence to medications in several recent studies.

Purpose

This study aimed to systematically estimate the strength and variability of this association across multiple published articles and to identify moderators of this relationship.

Method

A literature search identified 16 studies (N?=?3,476) that met the study eligibility criteria. Estimates of effect sizes (r) obtained in these studies were meta-analysed.

Results

Overall, a higher level of conscientiousness was associated with better medication adherence (r?=?0.15; 95 % CI, 0.09, 0.21). Associations were significantly stronger in younger samples (r?=?0.26, 95 % CI, 0.17, 0.34; k?=?7).

Conclusion

The small association between conscientiousness and medication adherence may have clinical significance in contexts where small differences in adherence result in clinically important effects.     

Leptin and its Association with Somatic Depressive Symptoms in Patients with the Metabolic Syndrome

Background

This study aimed to determine the association between circulating leptin levels and total depressive symptoms as well as depressive symptom dimensions (cognitive and somatic) after controlling for important confounding factors.

Methods

The study sample was comprised of 135 participants with the metabolic syndrome. Depressive symptoms were measured using the Beck Depression Inventory—II. Leptin was measured using a leptin-specific enzyme immunoassay. Inflammation was assessed using C-reactive protein and interleukin-6 levels.

Results

Leptin was significantly associated with somatic depressive symptoms (β?=?0.33, P?=?0.018), but not total depressive symptoms (β?=?0.27, P?=?0.067) or cognitive depressive symptoms (β?=?0.21, P?=?0.182), after controlling for age, gender, body mass index, and insulin resistance. Further adjustment for C-reactive protein and interleukin-6 levels did not alter the relationship (β?=?0.32, P?=?0.023) between circulating leptin levels and somatic depressive symptoms.

Conclusions

Leptin is independently associated with somatic depressive symptoms in patients with the metabolic syndrome.     

Factors Associated with Discontinuation of Bupropion and Counseling Among African American Light Smokers in a Randomized Clinical Trial

Background

African Americans are at risk of inadequate adherence to smoking cessation treatment, yet little is known about what leads to treatment discontinuation.

Purpose

The purpose of this study was to examine the factors associated with discontinuation of treatment in African American light smokers (≤10 cigarettes per day).

Methods

Bupropion plasma levels and counseling attendance were measured among 540 African American light smokers in a placebo-controlled randomized trial of bupropion.

Results

By week 3, 28.0 % of subjects in the bupropion arm had discontinued bupropion, and only moderate associations were found between the plasma levels and self-reported bupropion use (r _s?=?0.38). By week 16, 36.9 % of all subjects had discontinued counseling. Males had greater odds of discontinuing medication (OR?=?2.02, 95% CI?=?1.10–3.71, p?=?0.02), and older adults had lower odds of discontinuing counseling (OR?=?0.96, 95% CI?=?0.94–0.97, p?<?0.0001).

Conclusions

Bupropion and smoking cessation counseling are underutilized even when provided within the context of a randomized trial. Future research is needed to examine strategies for improving treatment utilization among African American smokers. Trial Registration No. NCT00666978 (www.clinicaltrials.gov).     

Impact of Baseline Weight on Smoking Cessation and Weight Gain in Quitlines

Background

The use and effectiveness of tobacco quitlines by weight is still unknown.

Purpose

This study aims to determine if baseline weight is associated with treatment engagement, cessation, or weight gain following quitline treatment.

Methods

Quitline participants (n?=?595) were surveyed at baseline, 3 and 6 months.

Results

Baseline weight was not associated with treatment engagement. In unadjusted analyses, overweight smokers reported higher quit rates and were more likely to gain weight after quitting than obese or normal weight smokers. At 3 months, 40 % of overweight vs. 25 % of normal weight or obese smokers quit smoking (p?=?0.01); 42 % of overweight, 32 % of normal weight, and 33 % of obese quitters gained weight (p?=?0.05). After adjusting for covariates, weight was not significantly related to cessation (approaching significance at 6 months, p?=?0.06) or weight gain.

Conclusions

In the first quitline study of this kind, we found no consistent patterns of association between baseline weight and treatment engagement, cessation, or weight gain.     

Blood Pressure and Fibrinogen Responses to Mental Stress as Predictors of Incident Hypertension over an 8-Year Period

Background

Heightened blood pressure (BP) responses to mental stress predict raised BP levels over subsequent years, but evidence for associations with incident hypertension is limited, and the significance of inflammatory responses is uncertain.

Purpose

We investigated the relationship between BP and plasma fibrinogen responses to stress and incident hypertension over an average 8-year follow-up.

Method

Participants were 636 men and women (mean age 59.1 years) from the Whitehall II epidemiological cohort with no history of cardiovascular disease and hypertension. They performed standardized behavioral tasks (color/word conflict and mirror tracing), and hypertension was defined by clinic measures and medication status.

Results

Of participants in the highest systolic BP reactivity tertile, 29.3 % became hypertensive over the follow-up period compared with 16.5 % of those in the lowest tertile, with an odds ratio of 2.02 (95 % CI 1.17–3.88, p?=?0.012) after adjustment for age, sex, grade of employment, body mass index, smoking, alcohol consumption, physical activity, follow-up time, subjective stress response, perceived task difficulty, perceived task engagement, and baseline BP. Similar associations were observed for diastolic BP reactivity (odds ratio 2.05, 95 % CI 1.23–3.40, p?=?0.006) and for impaired systolic BP post-stress recovery (odds ratio 2.06, 95 % CI 1.19–3.57, p?=?0.010). Fibrinogen reactions to tasks also predicted future hypertension in women (odds ratio 2.64, 95 % CI 1.11–6.30, p?=?0.029) but not men.

Conclusions

These data suggest that heightened cardiovascular and inflammatory reactivity to mental stress is associated with hypertension risk, and may be a mechanism through which psychosocial factors impact on the development of hypertension.

     

Classifying the Reasons Men Consider to be Important in Prostate-Specific Antigen (PSA) Testing Decisions: Evaluating Risks, Lay Beliefs, and Informed Decisions

Background

Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostate-specific antigen (PSA) test.

Purpose

This study aims to identify classes of reasons guiding men’s decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour.

Methods

First-degree relatives of men with prostate cancer (n?=?207) and men from the general population (n?=?239) of Australia listed reasons they considered when deciding whether to have a PSA test.

Results

Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9 %) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7 %). Informed decisions and health system class (26.5 %) included a lower proportion of men who had had a PSA test and greater proportions of highly educated and married men.

Conclusion

Understanding the reasons underlying men’s screening decisions may lead to a more effective information provision and decision support.     

Exercise Counseling to Enhance Smoking Cessation Outcomes: The Fit2Quit Randomized Controlled Trial

Background

Regular exercise has been proposed as a potential smoking cessation aid.

Purpose

This study aimed to determine the effects of an exercise counseling program on cigarette smoking abstinence at 24 weeks.

Methods

A parallel, two-arm, randomized controlled trial was conducted. Adult cigarette smokers (n?=?906) who were insufficiently active and interested in quitting were randomized to receive the Fit2Quit intervention (10 exercise telephone counseling sessions over 6 months) plus usual care (behavioral counseling and nicotine replacement therapy) or usual care alone.

Results

There were no significant group differences in 7-day point-prevalence and continuous abstinence at 6 months. The more intervention calls successfully delivered, the lower the probability of smoking (OR, 0.88; 95 % CI 0.81–0.97, p?=?0.01) in the intervention group. A significant difference was observed for leisure time physical activity (difference?=?219.11 MET-minutes/week; 95 % CI 52.65–385.58; p?=?0.01).

Conclusions

Telephone-delivered exercise counseling may not be sufficient to improve smoking abstinence rates over and above existing smoking cessation services. (Australasian Clinical Trials Registry Number: ACTRN12609000637246.)     

Sexual Orientation and Gender Differences in Markers of Inflammation and Immune Functioning

Background

Sexual minorities have documented elevated risk factors that can lead to inflammation and poor immune functioning.

Purpose

This study aims to investigate disparities in C-reactive protein (CRP) and Epstein–Barr virus (EBV) by gender and sexual orientation.

Methods

We used the National Longitudinal Study of Adolescent Health to examine disparities in CRP (N?=?11,462) and EBV (N?=?11,812).

Results

Among heterosexuals, women had higher levels of CRP and EBV than men. However, sexual minority men had higher levels of CRP and EBV than heterosexual men and sexual minority women. Lesbians had lower levels of CRP than heterosexual women.

Conclusions

Gender differences in CRP and EBV found between men and women who identify as 100 % heterosexual were reversed among sexual minorities and not explained by known risk factors (e.g., victimization, alcohol and tobacco use, and body mass index). More nuanced approaches to addressing gender differences in sexual orientation health disparities that include measures of gender nonconformity and minority stress are needed.     

Admission oxygenation and ventilation parameters associated with discharge survival in severe pediatric traumatic brain injury

Purpose

Current Brain Trauma Foundation guidelines recommend avoiding hypoxemia after severe pediatric traumatic brain injury (TBI). Yet, recent studies on optimum admission oxygenation and ventilation parameters associated with discharge survival in pediatric TBI are lacking.

Materials and methods

After IRB approval, a retrospective study involving pediatric patients ages ≤14 years with severe TBI (head Abbreviated Injury Scale (AIS) score of ≥3, Glasgow Coma Scale score of ≤8 on admission) admitted to Harborview Medical Center (level 1 pediatric trauma center), Seattle, WA, during 2003 to 2007 was performed. Admission demographics, clinical data, and laboratory characteristics were abstracted. Hypoxemia was defined as PaO₂?<?60 mmHg, hypocarbia was defined as PaCO₂?≤?35 mmHg, and hypercarbia was defined as PaCO₂?≥?46 mmHg.

Results

One hundred ninety-four patients met inclusion criteria of which 162 (83.5 %) patients survived. Admission hypoxemia occurred in nine (5.6 %) patients who survived and eight (25 %) patients who died (p?<?0.001). Children with admission PaCO₂ between 36 and 45 mmHg had greater discharge survival compared with those with both admission hypocarbia (PaCO₂?≤?35 mmHg) and hypercarbia (PaCO₂?≥?46 mmHg). Admission PaO₂ 301–500 mmHg (adjusted odds ratio (AOR), 8.02 (95 % confidence interval (CI), 1.73–37.10); p?=?0.008) and admission PaCO₂?=?36–45 mmHg (AOR, 5.47 (95 % CI, 1.30–23.07); p?=?0.02) were independently associated with discharge survival.

Conclusions

Discharge survival after severe pediatric TBI was associated with admission PaO₂ 301–500 mmHg and PaCO₂?=?36–45 mmHg. Admission hypocarbia and hypercarbia were each associated with increased discharge mortality.     

Intracranial Pressure Dose and Outcome in Traumatic Brain Injury

Objective

Detecting and treating elevated intracranial pressure (ICP) is a cornerstone of management in patients with severe traumatic brain injury. The aim of this study was to determine the association between area under the curve measurement of elevated ICP and clinical outcome.

Methods

Single center observational study using prospectively collected data at a University hospital, level one-trauma center. Sixty prospective patients with severe traumatic brain injury were prospectively enrolled over a 2-year period. Intracranial pressure measurements were captured using a real-time automated, high resolution vital signs data recording system. Mortality and functional outcome were assessed at 30 days, 3 and 6 months using Extended Glasgow Outcome Scale.

Results

Increasing elevated intracranial pressure time dose was associated with mortality (OR 1.08; 95 % confidence interval [CI], 1.01–1.15, p = 0.03) and poor functional outcome at 3 (OR 1.04; CI 1.00–1.07, p = 0.03) and 6 months (1.04; CI 1.01–1.08, p = 0.02). However, there was no association between episodic ICP data and outcome.

Conclusions

These results suggest that pressure time dose measurement of intracranial pressure may be used to predict outcome in severe traumatic brain injury and may be a candidate biomarker in this disease.     

Effects of Anger Awareness and Expression Training versus Relaxation Training on Headaches: A Randomized Trial

Background and Purpose

Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches.

Methods

Young adults with headaches (N?=?147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment.

Results

On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls.

Conclusions

Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from an emotional expression or emotional reduction approach to chronic pain.     

Red Blood Cell Transfusion Increases the Risk of Thrombotic Events in Patients with Subarachnoid Hemorrhage

Background and Purpose

Red blood cell transfusion (RBCT) may increase the risk of thrombotic events (TE) in patients with subarachnoid hemorrhage (SAH) through changes induced by storage coupled with SAH-related hypercoagulability. We sought to investigate the association between RBCT and the risk of TE in patients with SAH.

Methods

205 consecutive patients with acute, aneurysmal SAH admitted to the neurovascular intensive care unit of a tertiary care, academic medical center between 3/2008 and 7/2009 were enrolled in a retrospective, observational cohort study. TE were defined as the composite of venous thromboembolism (VTE), myocardial infarction (MI), and cerebral infarction noted on brain CT scan. Secondary endpoints included the risk of VTE, poor outcome (modified Rankin score 3–6 at discharge), and in-hospital mortality.

Results

86/205 (42 %) received RBCT. Eighty-eight (43 %) had a thrombotic complication. Forty (34 %) of 119 non-transfused and 48/86 (56 %) transfused patients had a TE (p = 0.002). In multivariate analysis, RBCT was associated with more TE by [OR 2.4; 95 % CI (1.2, 4.6); p = 0.01], VTE [OR 2.3; 95 % CI (1.0, 5.2); p = 0.04], and poor outcome [OR 5.0; 95 % CI (1.9, 12.8); p < 0.01]. The risk of TE increased by 55 % per unit transfused when controlling for univariate variables. Neither mean nor maximum age of blood was significantly associated with thrombotic risk.

Conclusions

RBCT is associated with an increased risk of TE and VTE in SAH patients. A dose-dependent relationship exists between number of units transfused and thrombosis. Age of blood does not appear to play a role.     

Effects of a Multiple Health Behavior Change Intervention for Colorectal Cancer Survivors on Psychosocial Outcomes and Quality of Life: a Randomized Controlled Trial

Background

Multiple health behavior change can ameliorate adverse effects of cancer.

Purpose

The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life.

Methods

A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months.

Results

Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p?p?=?0.033), spirituality at 6 months (1.8, p?=?0.011), acceptance at 6 months (0.2, p?=?0.005), and quality of life at 6 (0.8, p?=?0.049) and 12 months (0.9, p?=?0.037).

Conclusions

The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. (Trial Registration Number: ACTRN12608000399392).