Religious attendance and loneliness in later life

PURPOSE OF THE STUDY

Studies show that loneliness is a major risk factor for health issues in later life. Although research suggests that religious involvement can protect against loneliness, explanations for this general pattern are underdeveloped and undertested. In this paper, we propose and test a theoretical model, which suggests that social integration and social support are key mechanisms that link religious attendance and loneliness.

DESIGN AND METHODS

To formally test our theoretical model, we use data from the National Social Life Health and Aging Project (2005/2006), a large national probability sample of older adults aged 57-85 years.

RESULTS

We find that religious attendance is associated with higher levels of social integration and social support and that social integration and social support are associated with lower levels of loneliness. A series of mediation tests confirm our theoretical model.

IMPLICATIONS

Taken together, our results suggest that involvement in religious institutions may protect against loneliness in later life by integrating older adults into larger and more supportive social networks. Future research should test whether these processes are valid across theoretically relevant subgroups.

Intervening to improve psychological outcomes for men with prostate cancer

BACKGROUND

Prostate cancer is the most common cancer in men in the Western world with well-described negative effects from treatments. However, outcomes are highly heterogeneous. A Phase 3 trial of a psycho-educational intervention was undertaken, aiming to reduce cancer-specific and decision-related distress and improve quality of life for men newly diagnosed with localised prostate cancer.

METHODS

Seven hundred forty (81.7%) men were recruited after diagnosis and before treatment and randomised to a tele-based nurse-delivered five-session psycho-educational intervention (N = 372) or usual care (N = 368). Participants were assessed before treatment and 2, 6, 12 and 24 months post-treatment. Outcome measures included cancer-specific and decision-related distress, cognitive judgmental adjustment, subjective well-being, and domain-specific and health-related quality of life. Social support was assessed as a potential moderator.

RESULTS

No unconditioned effects were found. Classification analyses on pre-randomisation measures distinguished three subgroups: younger, higher education and income men (N =  90); younger, lower education and income men (N = 106); and older men (N = 344). Younger, higher education and income men showed positive intervention effects for cancer-specific distress (p = 0.008) and mental health (p = 0.042). By contrast, for younger, lower education men, participation in the intervention was associated with decreases in cognitive judgmental adjustment over time (p = 0.006).

CONCLUSIONS

Response to intervention and adjustment over time varied according to previous sexual functioning, age, educational level and income. How to best intervene with younger, low education, low income men with prostate cancer is a critical future research question.

Interaction of personality traits with social deprivation in determining mental wellbeing and health behaviours

BACKGROUND

Associations between personality traits, mental wellbeing and good health behaviours were examined to understand further the social and psychological context of the health divide.

METHODS

In a cross-sectional study, 666 subjects recruited from areas of high and low socioeconomic deprivation had personality traits and mental wellbeing assessed, and lifestyle behaviours quantified. Regression models (using deprivation as a moderating variable) assessed the extent to which personality traits and mental wellbeing predicted health behaviour.

RESULTS

Deprived (vs. affluent) subjects exhibited similar levels of extraversion but higher levels of neuroticism and psychoticism, more hopelessness, less sense of coherence, lower self-esteem and lower self-efficacy (all P< 0.001). They ate less fruit and vegetables, smoked more and took less aerobic exercise (all P< 0.001). In the deprived group, personality traits were significantly more important predictors of mental wellbeing than in the least deprived group (P< 0.01 for interaction), and mental wellbeing and extraversion appeared more strongly related to good health behaviours.

CONCLUSIONS

Persistence of a social divide in health may be related to interactions between personality, mental wellbeing and the adoption of good health behaviours in deprived areas. Effectiveness of health messages may be enhanced by accommodating the variation in the levels of extraversion, neuroticism, hopelessness and sense of coherence.

Age of first suicide attempt in men and women: an admixture analysis

OBJECTIVES

To define different subgroups of suicide attempters according to age at onset of suicide attempts.

METHODS

Participants were 229 suicide attempters (147 females; 82 males) admitted to a general hospital in Madrid, Spain. We used admixture analysis to determine the best-fitting model for the age at onset of suicide attempts separated by sex.

RESULTS

The best fitted model for the age at onset of suicide attempts was a mixture of two gaussian distributions. Females showed an earlier age at onset of suicide attempts in both Gaussian distributions (mean ± S.D.) (26.98 ± 5.69 and 47.98 ± 14.13) than males (32.77 ± 8.11 and 61.31 ± 14.61). Early-onset female attempters were more likely to show borderline personality disorder than late-onset female attempters (OR = 11.11; 95% CI = 2.43-50.0).

CONCLUSIONS

Age at onset of suicide attempts characterizes different subpopulations of suicide attempters.

Hypoactive sexual desire disorder in premenopausal women: case studies

Hypoactive sexual desire disorder (HSDD) is the most common female sexual dysfunction (FSD) and is thus frequently encountered in the primary care provider and OB/GYN practices. Causes of low sexual desire may be hormonal, neurologic, vascular, psychologic, or a result of illness/surgery or medications. The condition is often left untreated because both women and clinicians feel embarrassed to bring up the topic and believe that there is no available treatment. The use of short, validated questionnaires, such as the Decreased Sexual Desire Screener, to be completed in the waiting room, can open up discussion between provider and patient. In addition, 2 other algorithms are designed for clinicians who are not specifically trained in FSD and can help in diagnosing and managing a broad range of conditions related to FSD. Treatment for low desire consists primarily of patient education and counseling, as well as treatment of underlying comorbid conditions, such as diabetes, obesity, or cancer. While testosterone products are approved in Europe for use in surgically postmenopausal women with HSDD, in the United States, no pharmacologic treatments are approved for the treatment of HSDD or any FSD. Testosterone products are being used off-label, but questions remain about their efficacy and safety in pre- and postmenopausal women. This article gives an overview of HSDD in clinical practice and provides 3 case descriptions to illustrate the treatment of low sexual desire in women with diverse histories.

Cardiovascular disease, depression and mortality: the Health In Men Study

BACKGROUND

Existing evidence from observational studies suggests that cardiovascular diseases (CVD) and depression may be causally related, although the direction of this association and its etiologic relevance remain uncertain. One way to further elucidate the nature of this relationship is by determining the joint effect of CVD and depression on a common outcome, such as mortality.

AIMS

To determine if CVD and depression interact to increase mortality in older men.

METHODS

This cohort study followed 4,805 older men for 6.0 years or until death using administrative record linkage information. At the time of entry into the study, participants provided systematic information about prevalent peripheral arterial disease, and coronary heart disease, and history of past stroke. Men with any of these conditions were considered to have CVD. Participants with a total score of 7 or more on the 15-item Geriatric Depression Scale were classified as depressed. Sociodemographic and clinical data were obtained using standard procedures.

RESULTS

Men with CVD had greater mortality hazard than men without CVD (HR = 1.5, 95% CI = 1.3-1.7), and men with depression had greater mortality hazard than men without depression (HR = 1.8, 95% CI = 1.3-2.6). The interaction between depression and CVD had no obvious effect of mortality (HR = 1.0, 95% CI = 0.6-1.5). All analyses were adjusted for age, education, living arrangements, Duke Social Support grouping, smoking, and history of diabetes, hypertension, and dyslipidemia.

CONCLUSION

Depression and CVD do not interact to increase mortality, which suggests that the successful management of CVD is unlikely to reduce mortality attributed to depression, and vice-versa.

Hostility and cellular aging in men from the Whitehall II cohort

BACKGROUND

Hostility is associated with a significantly increased risk of age-related disease and mortality, yet the pathophysiological mechanisms involved remain unclear. Here we investigated the hypothesis that hostility might impact health by promoting cellular aging.

METHODS

We tested the relationship between cynical hostility and two known markers of cellular aging, leukocyte telomere length (TL) and leukocyte telomerase activity (TA), in 434 men and women from the Whitehall II cohort.

RESULTS

High-hostile men had significantly shorter leukocyte TL than their low-hostile counterparts. They also had elevated leukocyte TA, with a significantly increased likelihood of having both short TL and high TA, compared with low-hostile individuals.

CONCLUSIONS

Because telomerase is known to counteract telomere shortening by synthesizing telomeric DNA repeats, particularly in the context of shortened telomeres, heightened TA might represent a compensatory response in high-hostile individuals. The relationship between hostility and disease is stronger in men than in women, and men generally have a shorter life expectancy than women. Our findings suggest that telomere attrition might represent a novel mechanism mediating the detrimental effects of hostility on men's health.

Naturalistic observation of health-relevant social processes: the electronically activated recorder methodology in psychosomatics

This article introduces a novel observational ambulatory monitoring method called the electronically activated recorder (EAR). The EAR is a digital audio recorder that runs on a handheld computer and periodically and unobtrusively records snippets of ambient sounds from participants' momentary environments. In tracking moment-to-moment ambient sounds, it yields acoustic logs of people's days as they naturally unfold. In sampling only a fraction of the time, it protects participants' privacy and makes large observational studies feasible. As a naturalistic observation method, it provides an observer's account of daily life and is optimized for the objective assessment of audible aspects of social environments, behaviors, and interactions (e.g., habitual preferences for social settings, idiosyncratic interaction styles, subtle emotional expressions). This article discusses the EAR method conceptually and methodologically, reviews prior research with it, and identifies three concrete ways in which it can enrich psychosomatic research. Specifically, it can (a) calibrate psychosocial effects on health against frequencies of real-world behavior; (b) provide ecological observational measures of health-related social processes that are independent of self-report; and (c) help with the assessment of subtle and habitual social behaviors that evade self-report but have important health implications. An important avenue for future research lies in merging traditional self-report-based ambulatory monitoring methods with observational approaches such as the EAR to allow for the simultaneous yet methodologically independent assessment of inner, experiential aspects (e.g., loneliness) and outer, observable aspects (e.g., social isolation) of real-world social processes to reveal their unique effects on health.

Heart rate turbulence during acute alcohol withdrawal syndrome

BACKGROUND

Alcohol withdrawal syndrome is associated with an increased incidence of cardiac arrhythmias and sudden cardiac death. Heart rate turbulence (HRT) parameters were applied during withdrawal to estimate cardiac regulation during treatment with clomethiazole.

METHODS

Twenty-two patients suffering from alcohol withdrawal syndrome were included in the study. Heart rate regulation was obtained by means of Holter ECG analyzing time intervals before medication, and 2 and 6h after medication. Slope and onset of HRT were calculated in addition to heart rate variability (HRV) parameters. Furthermore, we calculated the slope and the onset of ectopic beat-like events.

RESULTS

Heart rate variability parameters indicated a minor reduction of vagal modulation during withdrawal syndrome. Especially, the fractal scaling exponent BBI alpha1 (4-16) indicated the autonomic shift. In contrast to HRV parameters, no significant changes were observed in the HRT parameters. Significant correlations were observed between severity of withdrawal, as assessed by the AWS scale, and the fractal scaling exponent BBI alpha2 (16-64), and the onset and the slope of HRT of ectopic beat-like activity.

CONCLUSION

Increased sympathetic modulation during withdrawal and clomethiazole treatment is not associated with changes of heart rate turbulence parameters predictive of cardiac death after myocardial infarction.

Associations between dimensional personality measures and preclinical atherosclerosis: the cardiovascular risk in Young Finns study

OBJECTIVE

To assess how multidimensional personality-trait theories, such as the Psychobiological Model of Temperament and Character, and the Five-factor Model of Personality, are associated with subclinical atherosclerosis as indicated by carotid intima-media thickness (IMT). The analysis was designed to tolerate non-linear development in which the same personality profiles can have multiple final outcomes and different antecedent profiles can have the same final outcome.

METHODS

605 men and 844 women (average age 31.6year, s.d.=5.0, range=24-39) provided data on IMT and traits of the psychobiological model, 725 men and 1011 women were assessed for IMT and the five-factor model (age 37.7year, s.d.=5.0, range=30-45). Robust multidimensional Hotelling's T(2) statistic was used to detect personality differences between participants with high IMT and others. Model-based clustering method further explored the effect.

RESULTS

Those with a high level of subclinical atherosclerosis within the sample (highest IMT-decile) had a combined higher persistence (i.e., were perseverative or perfectionistic), more disorganized (schizotypal) character, and more antisocial temperamental configuration than others (P=0.019). No effect was found for the five-factor model (P=0.978). Traditional methods that did not account for multidimensionality and nonlinearity did not detect an association.

CONCLUSION

Psychological well-being may have positive effects on health that reduce atherosclerosis in the population as a whole. Increased subclinical atherosclerosis was associated with a profile that combines known risk factors, such as cynical distrust and hostile tendencies. More frequent use of statistical procedures that can cope with non-linear interactions in complex psychobiological systems may facilitate scientific advances in health promotion.

Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the Heart and Soul Study

Exposure to traumatic psychological stress increases risk for disease events and mortality in patients with cardiovascular disease (CVD). While the biological mechanisms of these effects are not known, inflammation may play a key role as it is both elevated by psychological stress and involved in the development and progression of CVD. In a prospective study of patients with stable CVD (n=979), we examined if higher lifetime trauma exposure was associated with elevated levels of inflammation at baseline and at five-year follow-up, and with greater increases in inflammation over time. Inflammation was indexed by a composite score incorporating the inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and resistin. In follow-up analyses, we adjusted for sociodemographic factors, psychiatric disorders and health behaviors that were significantly associated with trauma exposure. Higher trauma exposure was associated with elevated inflammation at baseline (β=.09, p=.01) and at five-year follow-up (β=.09, p=.03). While levels of inflammation increased from baseline to follow-up in the sample, there was no significant association between trauma exposure and rate of change in inflammation. Findings were robust to adjustments for sociodemographic factors and psychiatric disorders, but health behaviors appeared to contribute to the association between trauma and inflammation at follow-up. This is the first large-scale demonstration of an association between lifetime trauma exposure and inflammation. High lifetime exposure to traumatic stress may contribute to an accelerated rate of CVD progression through elevated inflammation.

Menstrual exacerbation of schizophrenia symptoms

OBJECTIVE

To better understand premenstrual exacerbations of schizophrenia in women and weigh treatment options.

METHOD

A PubMed literature search was conducted, using the search terms 'schizophrenia', 'psychosis', 'menstrual exacerbation', 'hormones' and assessing relevance to premenstrual exacerbation of schizophrenia symptoms.

RESULTS

Exacerbations are usually distinguishable from periodic or menstrual psychosis, a relatively rare condition. Controversy continues about whether low estrogen periods of the month lead to an increase in schizophrenia symptoms among women of reproductive age or whether some women suffer from both schizophrenia and premenstrual dysphoric disorder (PMDD). No treatment trials of specific interventions have been conducted so that physicians must decide on a case-by-case basis whether to raise antipsychotic doses premenstrually, try estrogens or estrogen/progesterone combinations or selective estrogen receptor modulators, or target PMDD symptoms.

CONCLUSION

Clinicians need to be aware of premenstrual symptom aggravation in a large minority of women with schizophrenia. Treatment strategies will depend on the nature of the symptoms that are exacerbated. Optimal treatment needs to be adjusted to the individual woman.

Tobacco addiction and the dysregulation of brain stress systems

Tobacco is a highly addictive drug and is one of the most widely abused drugs in the world. The first part of this review explores the role of stressors and stress-associated psychiatric disorders in the initiation of smoking, the maintenance of smoking, and relapse after a period of abstinence. The reviewed studies indicate that stressors facilitate the initiation of smoking, decrease the motivation to quit, and increase the risk for relapse. Furthermore, people with depression or an anxiety disorder are more likely to smoke than people without these disorders. The second part of this review describes animal studies that investigated the role of brain stress systems in nicotine addiction. These studies indicate that corticotropin-releasing factor, Neuropeptide Y, the hypocretins, and norepinephrine play a pivotal role in nicotine addiction. In conclusion, the reviewed studies indicate that smoking briefly decreases subjective stress levels but also leads to a further dysregulation of brain stress systems. Drugs that decrease the activity of brain stress systems may diminish nicotine withdrawal and improve smoking cessation rates.

The expression of genes encoding for COX-2, MPO, iNOS, and sPLA2-IIA in patients with recurrent depressive disorder

BACKGROUND

There is evidence that inflammation, oxidative and nitrosative stress (IO&NS) play a role in the pathophysiology of depression. There are also data indicating altered inflammatory gene expression in depressive disorder and that genetic variants of IO&NS genes are associated with increased risk of the disease in question. The aim of this study was to explore mRNA expression of four IO&NS genes PTGS2, MPO, NOS2A, and PLA2G2A coding respectively: cyclooxygenase-2 (COX-2), myeloperoxidase (MPO), inducible nitric oxide synthase (iNOS) and secretory phospholipase A2 type IIA (sPLA2-IIA).

METHOD

Expression of the mRNA was determined using quantitative real-time PCR, in peripheral blood cells of patients with recurrent depressive disorder (rDD) and normal controls.

RESULTS

The mRNA expressions of the genes encoding for COX-2, MPO, iNOS and sPLA2-IIA were significantly increased in the peripheral blood cells of depressed patients versus controls.

LIMITATIONS

Patients were treated with antidepressants.

CONCLUSION

Our results indicate and may confirm the role of peripheral IO&NS pathways in the pathophysiology of depression. The results represent a promising way to investigate biological markers of depression.

Ethnic differences in pain and pain management

Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers' treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes.

Physiological correlates of peer victimization and aggression in African American urban adolescents

This study examined physiological correlates (cortisol and α-amylase [AA]) of peer victimization and aggression in a sample of 228 adolescents (45% male, 55% female; 90% African American; M age = 14 years, SD = 1.6 years) who participated in a longitudinal study of stress, physiology, and adjustment. Adolescents were classified into victimization/aggression groups based on patterns with three waves of data. At Wave 3, youth completed the Social Competence Interview (SCI), and four saliva samples were collected prior to, during, and following the SCI. Repeated-measures analyses of variance with victimization/aggression group as the predictor, and physiological measures as outcomes, controlling for time of day, pubertal status, and medication use revealed significant Group × SCI Phase interactions for salivary AA (sAA), but not for cortisol. The results did not differ by sex. For analyses with physical victimization/aggression, aggressive and nonaggressive victims showed increases in sAA during the SCI, nonvictimized aggressors showed a decrease, and the normative contrast group did not show any change. For analyses with relational victimization/aggression, nonaggressive victims were the only group who demonstrated sAA reactivity. Incorporating physiological measures into peer victimization studies may give researchers and clinicians insight into youth's behavior regulation, and help shape prevention or intervention efforts.

Investigating partner abuse among HIV-positive men who have sex with men

High rates of partner abuse (PA) of all types-physical, sexual, and psychological-have been identified in studies of HIV-positive individuals. We examined both the prevalence and correlates of same-sex PA in HIV-positive men who have sex with men (MSM). Participants recruited from public outpatient HIV clinics (N = 168) completed CASI surveys about PA and current physical and mental health. Electronic medical record data were obtained for HIV biomarkers. Results indicate high rates of past year PA (physical, 19%; sexual, 17%; psychological, 51%; any, 54%), with rates comparable to, or higher than, those reported in recent studies of HIV-positive women and older studies of HIV-positive MSM. Overall, participants endorsing past year PA reported poorer mental but not physical health. Participants who endorsed past year physical PA, specifically, reported the largest number of mental health problems. HIV care providers should routinely assess PA, especially physical PA, in all MSM patients.

Normal oscillometric heart rate of term African infants in the early days of life

BACKGROUND

Heart rate (HR) measurement is an important means of evaluating clinical status of newborns. Differences in HR between caucasian and negroid infants have been reported. Clinical estimation of HR is less accurate than estimates using devices.

AIM

To establish the normal HR of term negroid newborns in the early days of life using an oscillometric device.

METHODS

The mean of three HR readings of consecutively recruited term newborns was obtained with Dinamp 8100 monitor (Critikon, Tampa, FL). On recruitment, the infants were aged between 1 and 4 days. Gestational age was determined by menstrual dates and the Dubowitz method.

RESULTS

A total of 473 term newborns were recruited, 229 (48.4%) of whom were males. Median HR was 132 (range 90-189) beats per minute (bpm). The lowest median HR (130 bpm) was obtained on the 3rd day of life and this was significantly different from the highest value of 138 bpm recorded on the 4th day of life (P = 0.025). The 5th and 95th percentiles were 111 and 158 bpm, respectively.

CONCLUSION

The lower limit of the range of oscillometrically generated normal HR in term African newborns in the early days of life is lower than that which is commonly used in clinical practice.

Interoceptive and exteroceptive attention have opposite effects on subsequent somatosensory perceptual decision making

Evidence suggests that interoceptive and exteroceptive attention might have different perceptual effects. However, the effects of these different types of body-focused attention have never been directly compared. The current research investigated how interoceptive and exteroceptive attention affect subsequent performance on the somatic signal detection task (SSDT). In Experiment 1, 37 participants completed the SSDT under usual testing conditions and after performing an interoceptive heartbeat perception task. This task led to a more liberal response criterion, leading to increased touch reports in the presence and absence of a target vibration. This finding is consistent with suggestions that attending internally contributes to physical symptom reporting in patients with medically unexplained symptoms (MUS). In Experiment 2, 40 participants completed the SSDT before and after an exteroceptive grating orientation task. This task led to a more stringent response criterion, leading to decreased touch reports in the presence and absence of the target, possibly via a reduction in sensory noise. This work demonstrates that internal and external body-focused attention can have opposite effects on subsequent somatic perceptual decision making and suggests that attentional training could be useful for patients reporting MUS.

Risk of cardiovascular and all-cause mortality: impact of impaired health-related functioning and diabetes: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

OBJECTIVE

There is an established link between health-related functioning (HRF) and cardiovascular disease (CVD) mortality, and it is known that those with diabetes predominantly die of CVD. However, few studies have determined the combined impact of diabetes and impaired HRF on CVD mortality. We investigated whether this combination carries a higher CVD risk than either component alone.

RESEARCH DESIGN AND METHODS

The Australian Diabetes, Obesity and Lifestyle (AusDiab) study included 11,247 adults aged ≥ 25 years from 42 randomly selected areas of Australia. At baseline (1999-2000), diabetes status was defined using the World Health Organization criteria and HRF was assessed using the SF-36 questionnaire.

RESULTS

Overall, after 7.4 years of follow-up, 57 persons with diabetes and 105 without diabetes had died from CVD. In individuals with and without diabetes, HRF measures were significant predictors of increased CVD mortality. The CVD mortality risks among those with diabetes or impaired physical health component summary (PCS) alone were similar (diabetes only: hazard ratio 1.4 [95% CI 0.7-2.7]; impaired PCS alone: 1.5 [1.0-2.4]), while those with both diabetes and impaired PCS had a much higher CVD mortality (2.8 [1.6-4.7]) compared with those without diabetes and normal PCS (after adjustment for multiple covariates). Similar results were found for the mental health component summary.

CONCLUSIONS

This study demonstrates that the combination of diabetes and impaired HRF is associated with substantially higher CVD mortality. This suggests that, among those with diabetes, impaired HRF is likely to be important in the identification of individuals at increased risk of CVD mortality.

Stimulation of gastric slow waves with manual acupuncture at acupuncture points ST36 and PC6--a randomized single blind controlled trial

BACKGROUND

To investigate the effects of stimulated and non-stimulated manual acupuncture at ST36 and PC6 on gastric myoelectrical activity and autonomic function.

METHODS

A total of 65 healthy volunteers were randomly assigned to a 1: 1: 2 ratio to receive either 15 min of verum acupuncture (VA) with stimulation followed by 15 min of VA without stimulation (nsVA), or 15 min of nsVA followed by 15 min of VA with stimulation (sVA), or 30 min of sham acupuncture (SA). Measures of autonomic function included electrogastrogram, electrocardiogram, impedance cardiography and assessment of blood pressure, breathing frequency, and electrodermal activity. Outcome parameters were compared between VA and SA, and between sVA and nsVA. The percentage of regular gastric slow waves (normogastria) was defined as the primary outcome.

KEY RESULTS

The percentage of normogastria was not significantly different between VA and SA. Differences in secondary outcomes such as power spectrum of gastric slow waves and heart rate variability parameters were pronounced in the comparison of sVA and nsVA. During sVA, the percentage of normogastria was lower (P = 0.005), the percentage of bradygastria was higher (P = 0.003) and power ratio was higher (P < 0.001), systolic blood pressure was lower (P = 0.039) and RMSSD was higher (P < 0.001) as compared with nsVA.

CONCLUSIONS & INFERENCES

Our study suggests that manual stimulation of acupuncture needles at ST36 and PC6 affects gastric myoelectrical as well as cardiac activities in healthy volunteers. The effect of stimulation in acupuncture deserves further investigation.

Anxiety and depression in various functional gastrointestinal disorders: do differences exist?

OBJECTIVE

To examine the differences in the prevalence and severity of anxiety and depression in patients with functional dyspepsia (FD), nonerosive reflux disease (NERD), irritable bowel syndrome (IBS) and healthy controls.

METHODS

Consecutive patients undergoing an index endoscopic examination for various symptoms were interviewed. All the three functional gastrointestinal disorders (FGIDs) were diagnosed according to the Rome III criteria. Anxiety and depression were diagnosed using a locally validated version of the hospital anxiety and depression scale.

RESULTS

A total of 248 patients were recruited (62 in FD, NERD, IBS and control groups each) with no differences in the basic characteristics. There was a higher prevalence of anxiety and depression in FD, NERD and IBS groups than that in the control group (43.5%, 45.2% and 67.7% vs 14.5%, P<0.001; and 22.6%, 33.9% and 38.7% vs 6.5%, P<0.0001). Using the cut-off score (>8) for anxiety or depression, IBS patients had a higher rate of anxiety than FD (P=0.01) and NERD (P=0.02), while no significant differences in depression rates were observed among all three groups.

CONCLUSION

[corrected] Anxiety is more common in patients with IBS than in those with FD and NERD, indicating a possible causal link in the former.

Vaccination response following aerobic exercise: can a brisk walk enhance antibody response to pneumococcal and influenza vaccinations?

High intensity acute exercise at the time of vaccination has been shown to enhance the subsequent antibody response. This study examines whether an acute moderate intensity aerobic intervention prior to vaccination can enhance antibody response to pneumonia and half dose influenza vaccination. Sixty young (age (SD)=22.0 (6.1) years) and 60 older (age (SD)=57.5 (6.5) years) adults attended the laboratory on two separate occasions. At the first session, baseline antibody titres were determined, before participants completed either a brisk walk around campus at >55% of their age-predicted heart rate maximum, or a resting control condition, for 45 min. After the intervention, all participants received a full-dose pneumococcal vaccination and a half-dose influenza vaccination. Four weeks later, participants returned for a follow up blood sample. Multivariate ANOVA revealed an increase in total antibody titres against the influenza vaccine (F((12,106))=25.76, p<.001, η(2)=.75) and both the IgM (F((12,106))=17.10, p<.001, η(2)=.66) and IgG (F((12,106))=25.76, p<.001, η(2)=.75) antibody titres against the pneumococcal vaccine. However, there were no significant Time×Group interactions (p's all >.15), indicating that a 45 min brisk walk prior to vaccination did not affect antibody response to either the influenza or pneumonia vaccine. The results suggest that higher intensity exercise is necessary to augment antibody response to vaccination.

Racial and ethnic differences in diurnal cortisol rhythms in preadolescents: the role of parental psychosocial risk and monitoring

Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic-pituitary-adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-to-evening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.

Trends in ambulatory self-report: the role of momentary experience in psychosomatic medicine

In this article, we review the differences between momentary, retrospective, and trait self-report techniques and discuss the unique role that ambulatory reports of momentary experience play in psychosomatic medicine. After a brief historical review of self-report techniques, we discuss the latest perspective that links ambulatory self-reports to a qualitatively different conscious self-the "experiencing self"--which is functionally and neuroanatomically different from the "remembering" and "believing" selves measured through retrospective and trait questionnaires. The experiencing self functions to navigate current environments and is relatively more tied to the salience network and corporeal information from the body that regulates autonomic processes. As evidence, we review research showing that experiences measured through ambulatory assessment have stronger associations with cardiovascular reactivity, cortisol response, immune system function, and threat/reward biomarkers compared with memories or beliefs. By contrast, memories and beliefs play important roles in decision making and long-term planning, but they are less tied to bodily processes and more tied to default/long-term memory networks, which minimizes their sensitivity for certain research questions. We conclude with specific recommendations for using self-report questionnaires in psychosomatic medicine and suggest that intensive ambulatory assessment of experiences may provide greater sensitivity for connecting psychological with biologic processes.

Quality of life in major depressive disorder: the role of pain and pain catastrophizing cognition

OBJECTIVE

Pain symptoms are frequent complaints in patients with major depressive disorder (MDD). Although it is known that pain intensity and pain-related cognition predict quality of life (QOL) in patients with chronic pain, limited studies have examined their roles in MDD. The study aimed to determine whether pain and pain catastrophizing were independent predictors of QOL in MDD after accounting for the impact of anxiety and depression.

METHODS

This is a prospective, naturalistic follow-up study. Ninety-one Chinese patients were enrolled during an acute episode of MDD, 82 of them were reassessed 3 months later using the same assessment on pain, anxiety, depression, and QOL. Pain intensity was evaluated using a verbal rating scale and a visual analog scale. Quality of life was assessed using the 36-item Short Form Health Survey. Pain-related cognition was assessed at baseline with the Pain Catastrophizing Scale.

RESULTS

There was significant improvement in pain, anxiety, depression, and QOL from baseline to 3-month follow-up. Hierarchical regression analyses showed that pain intensity was significantly associated with QOL at baseline and 3 months. Pain complaint was more important than anxiety and depressive symptoms in predicting changes in both physical and psychosocial domains of QOL. After controlling for the severity of pain, anxiety, and depression, Pain Catastrophizing Scale score was independently associated with QOL in MDD.

CONCLUSION

The study supports the specific role of pain and pain-related cognition in predicting QOL in depressed patients. Further studies targeting pain-related cognition for improving the outcome of MDD are necessary.

Family orientation, language, and anxiety among low-income Latino youth

There is emerging evidence that Latino youth report higher levels of anxiety symptoms than children from other ethnic groups. Although often implicated, cultural variables have not been systematically evaluated to determine their relationship to anxiety symptoms in Latino youth. The present study examined family orientation values, as measured by family obligation and affiliative obedience, and their relationship to youth anxiety symptoms. The sample consisted of 133 Latino students (grades 5th through 7th) of low-income backgrounds in an urban public school setting. Structural equation models revealed that higher family orientation was associated with separation anxiety/panic (β=.32) and harm avoidance (β=.51). Models employing language proficiency and use mirrored those employing family orientation, suggesting that language fluency captures, in part, family socialization values. The results provide support for the impact of culture in the assessment and specific needs of Latino youth with anxiety problems.

Do Adults Adjust their Socioeconomic Status Identity in Later Life?*

Previous research shows that socioeconomic status (SES) identity, also referred to as perceived or subjective social status, is shaped by objective measures of status, socio-cultural influences and psychological attributes and predicts current and future well-being. Prior studies, however, have not examined whether older adults reassess their SES identity over time. In this study, we use two assessments of subjective social status measured six years apart in a sample of older Taiwanese adults to: 1) determine the degree to which respondents adjust their perceptions of social rank; and 2) identify the characteristics of individuals who are most likely to revise their assessments. We find that many older Taiwanese adults reassess their SES identity, but most respondents show small to moderate levels of change. Females, more highly educated respondents, and those who have a positive economic outlook tend to revise their subjective social status upward relative to their respective counterparts; those who become widowed during the period adjust their rankings downward compared with those who do not become widowed. These findings suggest that SES identity may be dynamic, highlighting the importance of collecting information on socioeconomic status identity at multiple points in the life course.

Acculturation and post-disaster mental health problems among affected and non-affected immigrants: a comparative study

BACKGROUND

It is unknown to what extent acculturation among disaster-affected immigrants is associated with mental health problems (MHP) compared to non-affected immigrants.

METHODS

We examined the associations between acculturation and post-disaster MHP among affected and non-affected immigrants in The Netherlands.

RESULTS

Among the affected group, keeping norms and values of original culture and limited skills to cope with the demands of the new society were independently associated with PTSD-symptomatology, anxiety, depression, hostility, and somatic problems at 18 months post-event. In the non-affected comparison group no associations were found. Interestingly, levels of acculturation did not differ between both groups, in contrast to MHP.

LIMITATIONS

The acculturation levels could be influenced by the experience of a disaster. However, levels did not differ statistically between the study groups. Furthermore, the groups were reasonably small and the response rates were, although not uncommon in health studies among immigrants, relatively low.

CONCLUSIONS

The findings of this unique study clearly suggest that post-disaster mental health policies should target low levels of skills to survive in the new society. Furthermore, the acculturation domain of keeping traditional norms and values can be contrary to the Dutch care after a disaster where self-efficacy and individualistic, cognitive functioning are the central goals. Further research is warranted to explore and examine post-event interventions aimed at increasing the levels of acculturation that may facilitate recovery.

Chemical and biological extraction of metals present in E waste: A hybrid technology

Management of metal pollution associated with E-waste is widespread across the globe. Currently used techniques for the extraction of metals from E-waste by using either chemical or biological leaching have their own limitations. Chemical leaching is much rapid and efficient but has its own environmental consequences, even the future prospects of associated nanoremediation are also uncertain. Biological leaching on the other hand is comparatively a cost effective technique but at the same moment it is time consuming and the complete recovery of the metal, alone by biological leaching is not possible in most of the cases. The current review addresses the individual issues related to chemical and biological extraction techniques and proposes a hybrid-methodology which incorporates both, along with safer chemicals and compatible microbes for better and efficient extraction of metals from the E-waste.

Socioeconomic status, race, and bone turnover in the Midlife in the US Study

Among a group of 940 US adults, economic adversity and minority race status were associated with higher serum levels of markers of bone turnover. These results suggest that higher levels of social stress may increase bone turnover.

INTRODUCTION

To determine socioeconomic status (SES) and race differences in levels of bone turnover.

METHODS

Using data from the Biomarker Substudy of the Midlife in the US (MIDUS) study (491 men, 449 women), we examined cross-sectional associations of SES and race with serum levels of bone turnover markers (bone-specific alkaline phosphatase [BSAP], procollagen type I N-terminal propeptide [PINP], and N-telopeptide [Ntx]) separately in men and women. Linear multivariable regression was used to control for body weight, menopausal transition stage, and age.

RESULTS

Among men, low family poverty-to-income ratio (FPIR) was associated with higher turnover, but neither education nor race was associated with turnover. Men with FPIR <3 had 1.808 nM BCE higher Ntx (P = 0.05), 3.366 U/L higher BSAP (P = 0.02), and 7.066 higher PINP (P = 0.02). Among women, neither education nor FPIR was associated with bone turnover, but Black women had 3.688 nM BCE higher Ntx (P = 0.001), 5.267 U/L higher BSAP (P = 0.005), and 11.906 μg/L higher PINP (P = 0.008) compared with non-Black women.

CONCLUSIONS

Economic adversity was associated with higher bone turnover in men, and minority race status was associated with higher bone turnover in women, consistent with the hypothesis that higher levels of social stresses cause increased bone turnover. The magnitude of these associations was comparable to the effects of some osteoporosis medications on levels of turnover.

The Minimum Clinically Significant Difference in Acute Nontraumatic Thoracoabdominal Pain in Adult Emergency Department Patients in Turkey

Objectives

To determine the minimum clinically significant difference (MCSD) in visual analog scale (VAS) pain scores for acute non‐traumatic thoracoabdominal pain (TAP) in the emergency department (ED) and to determine its association with sociodemographic features, location and duration of pain.

Methods

An observational survey of adult ED patients with TAP lasting less than 48 hours was conducted over a six‐week period. Demographic information and the duration and location of pain were recorded. Patients indicated their pain level on a 100‐mm VAS at baseline and at 20, 40, and 60 minutes thereafter. Subjects were also asked to rate their pain as ‘much less’, ‘a little less’, ‘about the same’, ‘a little more’, or ‘much more’ at the 20‐, 40‐, and 60‐minute time points. MCSD was calculated as the difference between the subsequent and preceding VAS scores if a patient reported pain as ‘a little less’ or ‘a little more’.

Results

Data was available for 306 of the 374 patients with TAP who presented during the study period. For pain comparisons (n=428) categorised as ‘a little less’ or ‘a little more’, the MCSD was 24.2 mm (95% CI 22.6‐25.7 mm). The MCSD value was not significantly different among the factors of gender, age, level of education, duration, or location of pain.

Conclusions

The MCSD of ED patients with nontraumatic thoracoabominal pain in Turkey is 24.2 mm. The MCSD is not affected by gender, age, level of education, location, or duration of pain.

Catastrophic interpretations and anxiety sensitivity as predictors of panic-spectrum psychopathology in chronic obstructive pulmonary disease

OBJECTIVE

Panic-spectrum psychopathology (denoting panic attacks and panic disorder) is highly prevalent in chronic obstructive pulmonary disease (COPD), and the cognitive model of panic has been proposed as an explanation of this high prevalence. In the current cross-sectional study we investigated factors predicting panic-spectrum psychopathology in COPD, and hypothesized that, consistent with the cognitive model, both the catastrophic interpretation of shortness of breath and elevated anxiety sensitivity would be significant predictors when variance shared with confounding variables was controlled.

METHODS

Sixty-two participants with COPD were interviewed with the Anxiety Disorders Interview Schedule for DSM-IV, Panic Disorder section, and completed measures of interpretation of breathing difficulty, anxiety sensitivity, anxiety, depression, disease-specific quality of life, and stressful life events. Objective disease severity was measured using forced expiratory volume in the first second.

RESULTS

Direct logistic regression was performed, and worse depressive symptoms, more catastrophic interpretations of shortness of breath, higher anxiety sensitivity, higher magnitude of recent stressful life events, and worse disease severity were each found to be significant unique predictors of panic-spectrum psychopathology in COPD after shared variance was controlled.

CONCLUSIONS

The results of the study provide support for the cognitive model of panic, and also suggest a diathesis-stress explanation of the development of panic-spectrum psychopathology in COPD. The findings have implications for future preventative psychological interventions.

The relationship between depressive symptoms and medication nonadherence in type 2 diabetes: the role of social support

OBJECTIVE

Medication adherence promotion interventions are needed that target modifiable behavioral factors contributing to the link between depressive symptoms and poor adherence to diabetes self-care behaviors. In an effort to identify what factors contribute to this link, we examined the role of social support as a mediator of the relationship between depressive symptoms and medication nonadherence.

METHOD

We recruited 139 subjects with type 2 diabetes. Using an indirect effect test with bias-corrected (BC) bootstrapping, we tested whether depressive symptoms had an indirect effect on medication nonadherence through a lack of social support.

RESULTS

More depressive symptoms were associated with medication nonadherence (total effect=.06, P<.001), more depressive symptoms were associated with less social support (direct effect of the predictor on the mediator=-.96, P=.02), and less social support was associated with medication nonadherence (direct effect of the mediator on the outcome=-.01, P<.01). While the relationship between more depressive symptoms and medication nonadherence persisted with social support in the predicted pathway, the degree of this relationship was partially explained by a relationship between more depressive symptoms and less social support (indirect effect=.01, 95% BC bootstrapped confidence interval of .0005 to .0325).

CONCLUSION

Providing social support to patients with diabetes who have symptoms of depression may ameliorate some of the deleterious effects of depressive symptoms on medication nonadherence, but social support alone is not enough.

Stress appraisals and cellular aging: a key role for anticipatory threat in the relationship between psychological stress and telomere length

Chronic psychological stress is a risk factor for multiple diseases of aging. Accelerated cellular aging as indexed by short telomere length has emerged as a potential common biological mechanism linking various forms of psychological stress and diseases of aging. Stress appraisals determine the degree and type of biological stress responses and altered stress appraisals may be a common psychological mechanism linking psychological stress and diseases of aging. However, no previous studies have examined the relationship between stress appraisals and telomere length. We exposed chronically stressed female caregivers and non-caregiving controls (N=50; M age=62.14±6.10) to a standardized acute laboratory stressor and measured their anticipatory and retrospective threat and challenge appraisals of the stressor. We hypothesized that threat and challenge appraisals would be associated with shorter and longer telomere length respectively, and that chronic caregiving stress would influence telomere length through altered stress appraisals. Higher anticipatory threat appraisals were associated with shorter age-adjusted telomere length (β=-.32, p=.03), but challenge appraisals and retrospective threat appraisals showed no independent association with telomere length. Caregivers reported significantly higher anticipatory (β=-.36, p=.006) and retrospective (β=-.29, p=.03) threat appraisals than controls, but similar challenge appraisals. Although there was no significant main effect of caregiver status on telomere length, caregiving had a significant indirect effect on telomere length through anticipatory threat appraisals. Exaggerated anticipatory threat appraisals may be a common and modifiable psychological mechanism of psychological stress effects on cellular aging.

Acute effects of electromagnetic fields emitted by GSM mobile phones on subjective well-being and physiological reactions: a meta-analysis

The potential effects of radiofrequency electromagnetic fields (RF-EMF) emitted by GSM mobile phones on subjective symptoms, well-being and physiological parameters have been investigated in many studies. However, the results have been ambiguous. The current meta-analysis aims to clarify whether RF-EMF have an influence on well-being in self-reported sensitive persons, as well as in non-sensitive people. A literature search revealed 17 studies including 1174 participants. The single effects for various subjective and objective outcomes were meta-analytically combined to yield a single population parameter. Dependant variables were subjective (e.g. headaches) and objective parameters (e.g. heart rate variability) of well-being. The results show no significant impact of short-term RF-EMF exposure on any parameter. Future research should focus on the possible effects of long-term exposure.