Alameda County redux: replication in Michigan

Current concepts in the diagnosis and management of antiphospholipid syndrome and ocular manifestations

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with obstetrical complications, thrombotic complications involving both arteries and veins, and non-thrombotic manifestations affecting multiple other systems presenting in various clinical forms. Diagnosis requires the presence of antiphospholipid antibodies. The exact pathogenesis of APS is not fully known. However, it has recently been shown that activation of different types of cells by antiphospholipid antibodies plays an important role in thrombosis formation. Ocular involvement is one of the important clinical manifestations of APS and can vary in presentations. Therefore, as an ophthalmologist, it is crucial to be familiar with the ocular findings of APS to prevent further complications that can develop. Furthermore, the ongoing identification of new and specific factors contributing to the pathogenesis of APS may provide new therapeutic options in the management of the disease in the future.

Sociodemographic determinants of multiple unhealthy behaviours

Background: Although behaviours regarded as unhealthy are widespread, behaving in an unhealthy manner in several respects is relatively uncommon. However, people with multiple unhealthy behaviours exist and their number is larger than expected if the behaviours were not related to each other. The aim of this study was to examine sociodemographic determinants of multiple unhealthy behaviours, with special reference to independent and combined effects of the determinants. Methods : Data on unhealthy behaviours were derived from nationwide surveys among Finnish adults. The mean number of unhealthy behaviours practised on a daily basis and the probability of reporting three or four of these behaviours was examined across sociodemographic groups.

Results: Age, educational level and marital status predicted reporting of three or four unhealthy behaviours. Interactions were observed between education and age in both genders as well as between marital status and age in men and educational level and living area in women. Mean numbers of unhealthy behaviours showed similar patterns to having three or four unhealthy behaviours but few differences between the means were statistically significant and there were no interactions. Conclusion: The influence of each sociodemographic determinant on multiple unhealthy behaviours was relatively independent from the other sociodemographic determinants. As the effect of these determinants tends to be cumulative, engaging in multiple unhealthy behaviours is common in population subgroups with several unfavourable characteristics. In health promotion initiatives special attention should be paid to such population groups and their social circumstances.

Do Negative Emotions Predict Alcohol Consumption, Saturated Fat Intake, and Physical Activity in Older Adults?

This study examined anger, depression, and stress as related to alcohol consumption, saturated fat intake, and physical activity. Participants were 23 older adults enrolled in either an outpatient or in-residence executive health program. Participants completed (a) a health-risk appraisal assessing medical history and current health habits, (b) the State-Trait Anger Expression Inventory (STAXI), and (c) the Center for Epidemiological Studies-Depression Questionnaire. Bivariate correlations revealed that anxiety was negatively correlated with alcohol consumption. High levels of depression, trait anger, and outward anger expression style were positively associated with saturated fat intake. Trait anger was also associated with less aerobic exercise. Inward anger expression was positively correlated with regular participation in strength training. Results suggest that anger, anger expression style, and depression interact with healthy and unhealthy behavior patterns and that these interactions may be complex.

The Use of Hypnotics and Mortality--A Population-Based Retrospective Cohort Study

Background

Sleep disorders, especially chronic insomnia, have become major health problem worldwide and, as a result, the use of hypnotics is steadily increasing. However, few studies with a large sample size and long-term observation have been conducted to investigate the relationship between specific hypnotics and mortality.

Methods

We conducted this retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. Information from claims data including basic characteristics, the use of hypnotics, and survival from 2000 to 2009 for 1,320,322 individuals were included. The use of hypnotics was divided into groups using the defined daily dose and the cumulative length of use. Hazard ratios (HRs) were calculated from a Cox proportional hazards model, with two different matching techniques to examine the associations.

Results

Compared to the non-users, both users of benzodiazepines (HR = 1.81; 95% confidence interval [CI] = 1.78–1.85) and mixed users (HR = 1.44; 95% CI = 1.42–1.47) had a higher risk of death, whereas the users of other non-benzodiazepines users showed no differences. Zolpidem users (HR = 0.73; 95% CI = 0.71–0.75) exhibited a lower risk of mortality in the adjusted models. This pattern remained similar in both matching techniques. Secondary analysis indicated that zolpidem users had a reduced risk of major cause-specific mortality except cancer, and that this protective effect was dose-responsive, with those using for more than 1 year having the lowest risk.

Conclusions

The effects of different types of hypnotics on mortality were diverse in this large cohort with long-term follow-up based on representative claims data in Taiwan. The use of zolpidem was associated with a reduced risk of mortality.

Using the temporal self-regulation theory to examine the influence of environmental cues on maintaining a healthy lifestyle

OBJECTIVES

The aim of the current study is to explore the predictive utility of the temporal self-regulation theory (TST) for maintaining a healthy lifestyle (Hall & Fong, 2007, Health Psychology Review, 1, 6). According to TST, the influence of intention, self-regulation, and behavioural prepotency differs depending on the environmental context in which the behaviour is performed. This study examined the influence of perceptions about the supportiveness of the environmental context on TST-related factors.

DESIGN

Temporal self-regulation theory was tested using a prospective design with a 1-week follow-up.

METHODS

One hundred and fifty-two undergraduates were administered three executive functioning tasks and an online questionnaire regarding their intentions to maintain a healthy lifestyle, environmental responsiveness, and previous behaviour. One week later, they completed a follow-up questionnaire.

RESULTS

Participants who were supported by the environment were significantly more likely to maintain a healthy lifestyle than those distracted by the environment. Behavioural prepotency was significantly predictive of behaviour performance for 'supported' participants. Behavioural prepotency, planning, and response inhibition were significantly predictive of 'unsupported' participants' behaviour.

CONCLUSIONS

These findings provided preliminary support for the use of TST for the prediction of healthy lifestyle behaviour. Importantly, this study provided support for the contention that the influence of TST-related factors would vary according to the perceived supportiveness of the environment. These findings suggest that environmental responsiveness may be an important determinant to close the intention-behaviour gap for maintaining a healthy lifestyle.

Lifestyles and psychosomatic symptoms among elementary school students and junior high school students

OBJECTIVES

To examine the relationship between lifestyles and psychosomatic symptoms in children, we conducted a self-administered questionnaire survey of elementary school students and junior high school students in Japan.

METHODS

We designed an original questionnaire to investigate the lifestyles and psychosomatic symptoms of children. In 1997, responses to the questionnaires were elicited from public elementary school fourth grade students (then aged 9-10) and public junior high school seventh grade students (then aged 12-13). The survey was repeated annually for three years as the students advanced through school.

RESULTS

For both boys and girls, each cross-sectional analysis revealed a strong relationship between lifestyle behaviors and psychosomatic symptoms. Psychosomatic, symptoms scores varied according to daily hours of sleep, eating of breakfast, having strong likes and dislikes of food, bowel habits, and daily hours of television watching. Both boys and girls with "good" lifestyle, behaviors evaluated by the HPI (Health Practice Index) showed lower scores for psychosomatic symptoms.

CONCLUSIONS

These findings show that the lifestyle behaviors of children are significantly associated with psychosomatic symptoms and suggest that poor lifestyle behaviors are likely to increase physical and psychological health risks.

Personality and attitudinal correlates of healthy and unhealthy lifestyles in young adults

The relationship between healthy lifestyle and personality and attitudinal variables was analyzed with data collected from 809 men and 996 women aged 18-30 years in England, Belgium, Finland and Norway as part of the European Health and Behaviour Survey. A health practices index was constructed on the basis of performance of sixteen behaviours including smoking, alcohol consumption, exercise, sleep time and a variety of dietary and preventive practices. Scores on the health practices index were higher in women than men, but in both sexes the index was normally distributed. Consistently healthy practices were positively correlated with extraversion and optimism, and negatively associated with neuroticism, psychoticism and chance locus of control beliefs. These effects were maintained after controlling for social desirability, but together accounted for only a modest proportion of the variance in the health practices index. The results are discussed in relation to the factors characterising health conscious and unhealthy lifestyles.

Testing the Health Practices in Pregnancy Questionnaire-II

OBJECTIVE

To revise and test a 34-item self-administered questionnaire that measures health practices important to pregnancy outcome.

DESIGN

Three studies were conducted: a content validity study with nurse experts, a content validity study with pregnant women, and a cross-sectional study using mailed surveys to test the reliability and construct validity of the Health Practices in Pregnancy Questionnaire-II (HPQ-II).

SETTINGS

Nurse-midwifery and obstetric physician practices.

PARTICIPANTS

Clinical experts (n = 8) and pregnant women (n = 10 for Study 2; n = 312 for Study 3).

MAIN OUTCOME MEASURE

The HPQ-II, a self-report instrument that measures pregnancy health practices.

RESULTS

Content validity was established with two reviews of the HPQ-II conducted by clinical experts and pregnant women and by a satisfactory Content Validity Index. Construct validity was supported by statistically significant correlations with a measure of prepregnancy health practices, scores on individual prepregnancy health practice items, and a theoretically related measure of women's attitudes toward their pregnancies and babies. Reliability (internal consistency) was satisfactory.

CONCLUSIONS

This instrument promises to be useful in research and practice involving health practices during pregnancy.

Health values and health-information-seeking in relation to positive change of health practice among middle-aged urban men

BACKGROUND

Preventive health practice is an important component of health promotion strategy. The objectives of this cohort study were to assess changes of health practices over 3 years among middle-aged Japanese men and to examine the factors related to their positive changes in lifestyle.

METHODS

Three hundred thirty-four randomly selected men in Tokyo completed two face-to-face structured interviews, one in 1998 and the other in 2001. Daily health practices, health values, health-information-seeking, socioeconomic characteristics, and health status were assessed. A Health Practice Index (HPI) was calculated to reflect overall health behavior. According to the change of HPI, the mode of change in general health practice between the first and second interview was classified as positive change, no change, and negative change.

RESULTS

Percentages of the subjects who engaged in eight identified healthy practices ranged from 31.7% to 54.5% at baseline. The follow-up interval revealed the adoption of each particular healthy or unhealthy practice as 5.7% to 33.6%. A high value placed on health independently associated with positive change of general health practice (OR = 2.95, 95% CI = 1.23 to 7.08), and inversely associated with negative change (OR = 0.45, 95% CI = 0.18 to 1.10); consciously seeking health information associated with positive change (OR = 2.16, 95% CI = 1.07 to 4.36) after controlling for socioeconomic and health status.

CONCLUSION

Considerable opportunity remains for urban middle-aged men to further improve their health behavior. Health values saliency, sensitively designed health information, and health status perception, as well as socioeconomic status, should be considered for successful promotion of healthy lifestyle among the adult male population.

Development of a health risk appraisal for the elderly (HRA-E)

The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly. The goal of the HRA-E system is to prevent functional decline. Samples of eligible subjects from the American Association of Retired Persons (AARP), a group practice, and a senior center were extended invitations to participate. Those responding affirmatively to the invitation were given a questionnaire and evaluation form. Each person who returned the questionnaire received his or her personal report and a second evaluation form. Four months after receiving their reports, respondents were questioned about behavior changes during the interim. Preliminary findings, based on 1895 respondents, indicate that nearly all participants found the questionnaire easy to complete and were pleased with its overall length. In addition, most participants read their reports, and many planned to take action, based on report recommendations. In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.

Leisure-time physical activity and other health behaviours: are they related?

Data on the associations between leisure-time physical activity and other health behaviours are conflicting. The National Heart Foundation 1989 Risk Factor Prevalence Survey data were analysed to examine the associations between leisure-time physical activity and other life-style health behaviours in a national representative sample with adjustment for potential confounders. Multivariate stepwise logistic regression analysis using data from 9054 respondents aged 20 to 69 years showed that participation in leisure-time physical activity, even when it was not vigorous, was weakly associated with not smoking, following a special diet and moderate consumption of alcohol; it was inversely associated with obesity. These weak associations could influence health practices at a population level if, as has been hypothesised, the adoption of leisure activity promotes the adoption of other good health practices. Confirmation of earlier findings of cross-sectional associations between activity and other positive health practices justifies future prospective or experimental studies to determine the behavioural response to adoption of leisure-time physical activity.

Associations between major domains of personality and health behavior

Broad personality traits may be important predictors of health behavior patterns. Two studies are reported which examined the associations between five major personality dimensions and four major health behavior dimensions. Prior associations between health behaviors and neurotic and extraverted personality tendencies generally were replicated. However, Conscientiousness and Agreeableness, two domains of personality that have received little research attention, emerged as important personality predictors of health behaviors. The results indicate that personality is a reliable predictor of health behavior patterns. It is suggested that the importance of personality has been underestimated in past research by the failure to consider appropriate health behavior criteria and the omission of important personality dimensions, such as Conscientiousness and Agreeableness, when studying health behavior patterns.

Health and behavior: The coming together of science and practice in psychology and medicine after a century of benign neglect

For thousands of years, physicians had available only a few drugs with which to minister to patients and the practice of psychology was an integral and therapeutically powerful component in the practice of medicine. Thus, good "bedside medicine" consisting of empathy, compassion, and a nurturant attitude toward the ill individual was a major component of the physician's armamentarium until relatively recently. However, the explosion in scientific knowledge in biology, physiology, chemistry, and microbiology which began a century ago and has continued through the twentieth century helped produce several generations of physician specialists and subspecialists with little knowledge of the powerful role psychological factors play in health and illness. As a result, practitioners of medicine and practitioners of psychology have had little or no contact during most of this century. However, as advances in microbiology, public health, and nutrition have eradicated many of the infectious diseases, infirmities associated with one's lifestyle have replaced the latter as the major causes of death today. One offshoot of this shift is that after a century of benign neglect, physicians and psychologists have rediscovered a common ground in the arena labeled health and behavior. Some factors responsible for these recent developments are highlighted.

Issues related to participation in worksite health promotion: a preliminary study

PURPOSE

The purpose of this study was to identify characteristics associated with participation in worksite-based health promotion activities.

DESIGN

Follow-up interviews were used to identify demographic, attitudinal, and behavioral differences among three employee groups. Reasons employees chose not to participate in health promotion activities were also explored.

SETTING

All respondents were employed at a large midwestern university and were eligible to participate in free onsite health fairs and health promotion programs.

SUBJECTS

A stratified random sample of 89 nonparticipants, health fair participants, and behavior change program participants was interviewed.

MEASURES

The interview was comprised of questions related to demographic information, personal health habits, physical activity, perceived health status, perceived self-efficacy, worksite norms, health promoting lifestyle factors, and knowledge about health promotion activities.

RESULTS

ANOVA and chi-squared comparisons revealed few group differences. Graduate students and employees with advanced degrees were most likely to take part in health fairs. Behavior change program participants were older, clerical-technical staff members, and women. Faculty members were least likely to participate. A lack of time was the most often cited reason for nonparticipation.

CONCLUSIONS

The study was retrospective and the analyses limited due to low statistical power. The results suggest that different groups of employees are attracted to different types of health promotion activities.

A longitudinal assessment of the impact of health/fitness status and health behavior on perceived quality of life

This study extended cross-sectional research associating quality of life with health and fitness factors. Longitudinal analyses were performed on data collected from 519 U.S. Navy personnel to assess changes in quality of life with changes in health/fitness status and health behavior dimensions at 1-yr. and 2-yr. intervals. Multiple regression results showed that such changes were positively associated with changes in health/fitness status and behaviors related to accident control and wellness maintenance, with these predictors accounting for 8% of the variance in change in quality of life at the 1-yr. interval. At the 2-yr. interval, such change was associated with health/fitness status and accident control behaviors, accounting for 11% of the variance. Health behavior change made a unique contribution to change in quality of life after controlling for changes in health/fitness status at both intervals. Findings affirm modest yet consistent associations between changes in fitness and health variables and quality of life and suggest that improvements in health behavior influence quality of life independently of one's health/fitness status.

Preventive health behavior among black and white women in urban and rural areas

The relationship of race to preventive health behavior among women is examined using data from the 1985 National Health Interview Survey. We find that black women are less likely to engage in primary prevention behaviors such as exercising, non-smoking and maintaining a favorable weight. However, black women are more likely to engage in secondary prevention behaviors such as receiving a Pap test or a breast exam. These findings are surprising as they indicate a change in secondary prevention behavior among black women. The racial differences in exercising, maintaining a favorable weight and receiving a Pap test or a breast exam cannot fully be explained by the differing levels of socio-economic status, measured by education and income. However, the higher percentage of smoking among black women is due to their lower levels of education. Urban/rural residence modifies the effect of race on smoking and receiving a Pap test. Black women in urban areas are most likely to be smokers. Almost no difference exists between white women in urban and rural areas concerning their likelihood of receiving a Pap test, we find that black women in urban areas are much more likely to be screened for cervical cancer than black women in rural areas.

Development of a health habits scale

The present study is based on the assumption that health habits assessment can make a significant contribution to our understanding of physical and psychological well-being. Thus, the purpose of this study was to develop an easily administered, conceptually sound, and psychometrically adequate health habits scale for use in nursing and health research. A self-report scale consisting of 5 positive health items and 5 negative items was administered initially to a sample of more than 1500 American adults. Subsamples of this group were used in various psychometric evaluations of the scale. A second sample of more than 700 college and noncollege adults also completed the new health habits scale and a number of additional inventories thought to be related conceptually to the new scale. In general, the health scale showed high content validity, good agreement between self- and other-ratings, strong test-retest reliability, and consistent evidence of concurrent and divergent validity. The strengths of the scale are its inclusion of both disease-preventive and health-promoting behaviors, its brevity, and its psychometric development.

The European Health and Behaviour Survey: rationale, methods and initial results from the United Kingdom

The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning the importance of behaviours for health, and health knowledge, using a standardized protocol suitable for translation and administration in different countries of Europe. An inventory was developed from previous literature for the assessment of substance use, positive health practices, diet and eating habits, driving behaviour and preventive health care, beliefs concerning the importance of 25 activities for health, and knowledge about the influence of seven factors (including smoking, alcohol and diet) on major diseases. The first phase of the study involved administration of the inventory to approximately 200 male and 200 female university students aged 18-30 in 20 European countries. This report concerns data collected from 419 students in the U.K., together with analyses of short-term response stability. The inventory showed adequate short-term stability. Sex differences were observed in a number of behaviours, including consumption of fats and cholesterol, salt and fibre, dieting, exercise, sun-protection, driving speed, regular dental check-ups, frequency of brushing teeth, access to doctor and blood pressure measurement. Beliefs about the importance of behaviours for health were closely associated with the occurrence or frequency of the behaviours both within and between health behaviour categories. Little relationship was observed between health behaviour and awareness of the role of these same factors in disease. Important gaps in health knowledge were identified. Data concerning the frequency of health-related behaviours is crucial to the planning of health education and primary prevention programmes. The close association between beliefs and behaviour emphasises the importance of cognitive factors, while health knowledge appears to play a less direct role.