Sense of coherence and health: evidence from two cross-lagged longitudinal samples

Longitudinal analysis of the mediating role of self-perception of aging in the relationship between frailty and intrinsic capacity: A cross-lagged mediation model

OBJECTIVES

The causal relationship between intrinsic capacity and frailty in older adults, as well as the underlying temporal mechanisms, remained poorly understood. The study aimed to investigate the causal association between intrinsic capacity and frailty while exploring the potential mediating role of self-perception of aging.

MEASUREMENTS

A survey was conducted with a sample of 429 participants who completed measures of intrinsic capacity, self-perception of aging, and frailty at baseline and were followed for one year. The relationships between these variables were assessed using an autoregressive cross-lagged model.

RESULTS

The study found reciprocal associations between intrinsic capacity and frailty (p < 0.01). Furthermore, the results indicated that self-perception of aging partially mediated the effect of frailty at baseline (T1) on intrinsic capacity at one-year follow-up (T2) (β = -0.02, confidence interval: [-0.055, -0.004]). However, the reverse causation was not observed.

CONCLUSIONS AND IMPLICATIONS

This study demonstrates a bidirectional causal relationship between intrinsic capacity and frailty in older adults. Self-perception of aging plays a significant mediating role in this relationship. Older adults with a worse level of frailty should be made aware of the potentially vicious cycle related to self-perception of aging, which can negatively affect their intrinsic capacity. Maintaining a positive self-perception of aging may help preserve physical and psychological reserves, maintain intrinsic capacity, and slow the decline of frailty.

The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China

Childhood trauma is strongly linked to emotional distress. However, few studies have explored the impact of sense of coherence (SOC) on the relationship between childhood trauma and emotional distress in college students. This study aimed to explore its impact on the relationship between childhood trauma and emotional distress. Analyzing data from 2307 Chinese college students, we found that SOC moderated the association between childhood trauma and anxiety/depression levels. Females showed higher SOC and lower anxiety/depression despite experiencing more childhood trauma. Multiple linear regression revealed that anxiety was negatively associated with SOC(P < 0.001) and grade(P = 0.027), and positively with childhood trauma(P < 0.001) and male gender(P = 0.004). Similarly, the depression exhibited similar associations. SOC moderated negatively the relationship between CTQ and anxiety, as well as between CTQ and depression. Childhood trauma is associated with increased emotional distress risk among college students, but a strong SOC can reduce this risk.

Sense of coherence and Covid-19 related stress: A three-wave longitudinal study

Sense of coherence (SOC) is the fundamental concept of the salutogenic approach to health promotion. The main aim of the current longitudinal study is to consider whether SOC has had a positive effect in reducing people's levels of stress during the prolonged time of the pandemic or rather stress has posed a threat to SOC. A large sample of Italian adults completed an online questionnaire at three different moments of the Covid-19 pandemic (from March 2020 to May 2021). To test the reciprocal associations between SOC and stress we estimated a cross-lagged panel model. Results questioned the stability of SOC, which changed across the different moments of the pandemic, and its causal role with respect to stress since, after controlling for gender and age, it emerged a significant effect only from stress to SOC. The implications of these results and the further expansions of the study are discussed.

Sense of coherence and health in women: a 25-year follow-up study

BACKGROUND

Health and Sense of Coherence (SOC) has been shown to be intertwined and argued to have a reciprocal relationship. The theory of SOC implies relatively stable scores during adulthood, however there are few longitudinal studies on the association between SOC and mental and somatic health. The main aim of the present study was to examine how SOC and self-rated health (SRH) are related during 25 years of follow-up.

METHODS

Using paper questionnaires distributed by postal services, 415 mothers were followed from childbirth and 25 years prospectively. SOC was measured at three, 12 and 25 years after inclusion. Self-reports on health status were obtained at the 25-year follow-up. The association between SOC and self-reported health as well as the effect of sociodemographic factors and experience of stressful life events was assessed through regression models.

RESULTS

SOC scores increased between three and 12 years after inclusion, and slightly decreased at the 25-year follow-up. Women of good health had a higher SOC-score at all three measurements compared to women of poor health. Multiple logistic regression showed that the likelihood of reporting good health increased with the number of times the women had reported SOC-scores above the 75th percentile. Moreover, women who had not been through a divorce were close to 60% more likely to report good health compared to women who had been through a divorce, whereas women not reporting stressful life events during the past two years were more than twice as likely to report good health. Symptoms below cut-off for postpartum depression and not having been through a divorce were associated with SOC scores above the 75th percentile.

CONCLUSION

This 25-year follow-up study of a cohort of women reports good stability of SOC assessments in the vast majority of women. There was a stronger and more stable SOC in women with better health. The findings are in line with other studies on the predictive value of SOC and self-perceived health.

Temporal relationship between sleep duration and obesity among Chinese Han people and ethnic minorities

BACKGROUND

No studies have assessed the association between sleep duration and obesity in Chinese ethnic minorities. Whether the relationship between sleep duration and obesity is different between Chinese Han people and Chinese ethnic minorities remains unclear. The study aimed to explore the relationship between sleep duration and obesity among Chinese Han people and Chinese ethnic minorities.

METHODS

We applied data from the Guizhou Population Health Cohort Study (GPHCS), which 9,280 participants were recruited in the baseline survey from 2010 to 2012, and 8,163 completed the follow-up survey from 2016 to 2020. A total of 5,096 participants (3,188 Han Chinese and 1,908 ethnic minorities) were included in the ultimate analysis. Information on sleep duration (total 24-hour sleep time), body mass index (BMI), and waist circumference (WC) was collected at the baseline and follow-up survey, respectively. Cross-lagged panel analyses were conducted to explore the temporal relationship between sleep duration and obesity for Han people and ethnic minorities.

RESULTS

For Han people, the results from cross-lagged panel analyses indicated that baseline sleep duration was significantly associated with follow-up BMI (β_BMI = -0.041, 95% CI_BMI: -0.072 ~ -0.009) and follow-up WC (β_WC = -0.070, 95%CI_WC: -0.103 ~ -0.038), but baseline BMI (β_BMI = -0.016, 95% CI_BMI: -0.050 ~ 0.018) and baseline WC (β_WC = -0.019, 95% CI_WC: -0.053 ~ 0.016) were not associated with follow-up sleep duration. In addition, the relationship between baseline sleep duration and follow-up BMI was gender-specific and significant only in the Han people female (β_BMI = -0.047, 95% CI_BMI: -0.090 ~ -0.003) but not in the Han people male (β_BMI = -0.029, 95% CI_BMI: -0.075 ~ 0.016). For ethnic minorities, the results indicated that there was no relationship between sleep duration and obesity at all, either from sleep duration to obesity (β_BMI = 0.028, 95%CI_BMI: -0.012 ~ 0.068; β_WC = 0.020, 95%CI_WC: -0.022 ~ 0.062), or from obesity to sleep duration (β_BMI = -0.022, 95%CI_BMI: -0.067 ~ 0.022; β_WC = -0.042, 95%CI_WC: -0.087 ~ 0.003).

CONCLUSION

The relationship pattern between sleep duration and obesity across Han people and ethnic minorities is different. Future sleep-aimed overweight and obesity intervention should be conducted according to population characteristics.

Daily life coping-Helping stress-afflicted people manage everyday activities

BACKGROUND

Symptoms of stress are widespread in the working population and associated with long-term sickness absence and poor work functioning. Occupational therapy (OT)-based interventions are effective in improving return-to-work (RTW)-rates in stress-afflicted long-term sickness benefit beneficiaries (SBBs). No Danish standard on OT-RTW for stress-afflicted SSBs exists.

AIMS

To describe and evaluate the feasibility of a seven-week OT-RTW intervention for stress-afflicted SBBs.

MATERIALS AND METHODS

Daily Life Coping (DLC) utilizes peer-learning and salutogenetic perspectives to address occupational imbalances experienced by long-term SBBs. Stress-afflicted SBBs (n = 54) in the municipality of Hilleroed were enrolled. Self-efficacy and well-being were measured before and after intervention using the general self-efficacy (GSE) scale and WHO-5 Well-Being Index (WHO-5). RTW-rates were measured at one-year follow-up. Participant feedback was collected using standardized evaluation forms.

RESULTS

Following the intervention, WHO-5 improved by 13.7 ± 16.5 points and GSE improved by 4.3 ± 4.8 points. Participant feedback was positive. At one-year follow-up, employment status data were available for 51 SSBs of these 58.8% achieved employment. High post-test GSE and WHO-5 scores were associated with employment at follow-up.

CONCLUSION

DLC led to significant improvements in self-efficacy and well-being. Preliminary results indicate benefits on RTW-rates.

SIGNIFICANCE

This study provides evidence of the feasibility of DLC in a municipal setting.

Bidirectional temporal relationships between uric acid and insulin and their joint impact on incident diabetes

BACKGROUND AND AIMS

This study aims to examine the temporal relationship between uric acid (UA) and insulin and their joint impact on T2DM in middle-aged adults.

METHODS AND RESULTS

The cohort consisted of 1351 non-diabetic adults who had serum UA and insulin measured twice at baseline and follow-up over 7.7 years on average, and incidence of T2DM in the outcome survey12.2 years later. After adjusting for covariates, the path coefficient from baseline UA to follow-up insulin was 0.082 (p < 0.001); the path from baseline insulin to follow-up UA was 0.060 (p = 0.030). In the mediation model with baseline UA as the predictor, total effect of baseline UA on incident T2DM was 0.089 (p = 0.016). The mediation effect through follow-up insulin on the UA-T2DM association was 28.1%. The direct effect of baseline UA on T2DM (0.064) became nonsignificant (p = 0.078). In the mediation model with baseline insulin as the predictor, total effect of baseline insulin on T2DM was 0.218 (p < 0.001). The mediation effect through follow-up UA on the insulin-T2DM association was 5.5%. The direct effect of baseline insulin on T2DM (0.206) remained significant (p < 0.001). The baseline hyperinsulinemia-follow-up hyperuricemia group showed the highest incidence rate of T2DM (27.9%).

CONCLUSIONS

The bidirectional temporal relationship suggests that UA and insulin influence each other in non-diabetic individuals, and the directionality plays pathogenic roles in the development of T2DM.

Effect of Club cell secretory proteins on the association of tobacco smoke and PAH co-exposure with lung function decline: A longitudinal observation of Chinese coke oven workers

BACKGROUND

Exposure to polycyclic aromatic hydrocarbons (PAH) and tobacco smoke is associated with epithelial damage and reduced lung function. Club cell secretory protein (CC16) is a known biomarker for lung epithelial cells. However, the potential relationships between PAH and tobacco smoke exposure, CC16 levels, and reduced lung function remain unclear.

OBJECTIVES

This longitudinal study aimed to explore the potential role of CC16 in the association of tobacco smoke and PAH co-exposure with lung function.

METHODS

We enrolled 313 workers from a coking plant in China in 2014 and followed them up in 2019. The concentrations of PAH and nicotine metabolites in urine were determined using high-performance liquid chromatography (HPLC) with a fluorescence detector and HPLC-tandem mass spectrometry, respectively. The plasma CC16 concentration was determined using an enzyme-linked immunosorbent assay.

RESULTS

An analysis of the generalized estimating equation showed that each 1-unit increase in log-transformation of the last tertile of trans-3'-hydroxycotinine (3HC) was associated with a 3.30 ng/ml decrease in CC16. Restricted cubic spline analysis revealed a significant nonlinear dose-effect association between cotinine (COT) and CC16 (P_nonlinear = 0.018). In the low- CC16 subgroup, we found a significant association between total nicotine metabolites and forced vital capacity (FVC%) (β: 1.45, 95% CI: 2.87, -0.03), and the associations of nicotine (NIC), COT, and 3HC with FVC% were all of marginal significance. High levels of total hydroxyl polycyclic aromatic hydrocarbons (ΣOH-PAH) and NIC in the urine had an interactive effect on the decline of CC16 (P < 0.05). Cross-lagged panel analysis indicated that the decrease in CC16 preceded the decrease in FVC%. CC16 mediated the association between elevated nicotine metabolites and decreased FVC% in the low- CC16 subgroup.

CONCLUSIONS

CC16 plays an essential role in the association of PAH and tobacco smoke exposure with reduced lung function. Coke oven workers with low plasma CC16 levels are more likely to experience decreased lung function after tobacco smoke exposure.

Interaction of polycyclic aromatic hydrocarbon exposure and high-fasting plasma glucose on lung function decline in coke oven workers: a cross-lagged panel analysis

Individuals with abnormal fasting plasma glucose (FPG) may be more susceptible to lung diseases associated with environmental pollutants. A cross-sectional survey of 629 workers in 2017 and a panel study of 304 workers from 2014 to 2019 were performed in China. The results showed that elevated total hydroxylated polycyclic aromatic hydrocarbon (ΣOH-PAH) concentration was associated with lower the percentage of predicted forced vital capacity (FVC%) among high-FPG workers (β for the cross-sectional analysis: -1.78%, 95%CI: -2.92%, -0.64%; β for the panel study: -1.10%, 95%CI: -2.19%, -0.02%). The absolute value of the cross-lagged path coefficient from FPG to FVC% (β₂ = -0.096) was significantly greater than that from FVC% to FPG (β₁ = 0.037). Our results suggest that FPG abnormalities may precede the lung function decline induced by PAH exposure and that high-FPG and high ΣOH-PAH levels have an interactive effect on lung function decline.

Association Between Sense of Coherence and Health Outcomes at 10 and 20 Years Follow-Up: A Population-Based Longitudinal Study in Germany

Background: The sense of coherence (SOC) is reported to influence health, but health may also have an impact on SOC. The objective of this study was to examine the longitudinal associations between SOC and selected self-reported and physician-assessed health outcomes over a period of 10 and 20 years and to determine the predominant direction of the associations.

Methods: We conducted a population-based, longitudinal study, involving 392 participants (188 females and 204 males; mean age 43.01 years) who were followed for a median of 10 and 18 years. Analyses of variance were carried out to examine the longitudinal associations between SOC at baseline and health outcomes (i.e., self-rated health status, SHS; physical health status assessed by a physician, PHS; self-reported satisfaction with life, SWL) at follow-ups. The direction of associations was examined using a cross-lagged model on correlation coefficients.

Results: There were significant group effects for SOC at baseline on SHS at 20-year follow-up (F = 4.09, p = 0.018, ηp² = 0.041), as well as on SWL at 10-year (F = 12.67, p < 0.01, ηp² = 0.072) and at 20-year follow-up (F = 8.09, p < 0.1, ηp² = 0.069). SHS (r = 0.238, p < 0.01), PHS (r = −0.140, p < 0.05) and SWL (r = 0.400, p < 0.01) predicted SOC at 10-year follow-up stronger than vice versa. The direction of associations between SOC and health parameters at 20-year follow-up was less consistent.

Conclusions: The long-term associations between SOC and self-reported and physician-assessed health may be reciprocal in community-dwelling adults. More research is needed to examine the predictive power of health on SOC and whether interventions targeted at improving health parameters, may impact SOC.

Blood Pressure and Left Ventricular Geometric Changes: A Directionality Analysis

[Figure: see text].

Bi-directional and temporal relationship between elevated alanine aminotransferase and hypertension in a longitudinal study of Chinese adults

OBJECTIVE

Despite the strong correlation between elevated alanine aminotransferase (ALT) and hypertension, their bi-directional and temporal relationship are currently unclear. Our study aimed to explore the bi-directional and temporal association between elevated ALT (ALT > 40 U/L) and hypertension.

METHODS

Measurements of alanine aminotransferase and blood pressure were obtained twice from 2013 to 2017 in 3314 Chinese adults without cardiovascular disease at baseline. Bi-directional and cross-lagged panel analyses were performed to dissect the temporal relationship between elevated ALT and hypertension.

RESULTS

Longitudinally, we found that baseline elevated ALT was strongly correlated with incident hypertension (odds ratios = 2.16, P = .001), and baseline hypertension was also significantly associated with incident elevated ALT (odds ratios = 1.64, P = .026). The cross-lagged path coefficients from baseline ALT to follow-up blood pressure were significantly greater than that from baseline blood pressure to follow-up ALT (β: 0.043 vs. 0.026, P < .05 for systolic blood pressure and β: 0.052 vs. 0.024, P < .05 for diastolic blood pressure).

CONCLUSION

Our results provide evidence for the bi-directional association of elevated ALT and hypertension among Chinese adults, and elevated ALT probably antedates the development of hypertension.

Temporal and mediation relations of weight loss, and changes in insulin resistance and blood pressure in response to 2-year weight-loss diet interventions: the POUNDS Lost trial

PURPOSE

Body weight and insulin resistance (IR) are closely correlated, and their temporal sequences in affecting blood pressure (BP) remain poorly defined. We examined the temporal sequences of weight loss and IR change, and their relations with BP in the Pounds Lost trial, a randomized weight-loss diet intervention study.

METHODS

The present study included overweight/obese adults, who were randomized in a 2 × 2 factorial design to low-calorie diets containing 20 or 40% fat and 15 or 25% protein (diets with 65, 55, 45 and 35% carbohydrate). Weight, IR, systolic and diastolic BP levels were measured at baseline, 6 and 24 months. After excluding the subjects who took antihypertensive drugs, cross-lagged path and mediation analyses were performed among 540 participants.

RESULTS

After adjusting for age, race, sex, and diet groups, the cross-lagged path coefficient from baseline weight to 24-month IR (β₁ = 0.135, P = 0.04) was significantly greater than the path coefficient (β₂ = 0.022, P > 0.05) from baseline IR to 24-month weight (P < 0.05 for the difference in βs), indicating that weight-loss preceded change of IR. The mediation effects of 24-month IR on the 24-month systolic BP and diastolic BP were estimated at 20.94% (P = 0.004) and 17.03% (P = 0.034), respectively.

CONCLUSIONS

Our data indicate that weight loss precedes change of IR, which mediates a significant proportion of the effects of weight loss on changes of BP in response to the diet interventions.

TRIAL REGISTRATION

NCT00072995 First Posted November 17, 2003 Last Update Posted January 30, 2013 this study was not 'retrospectively registered'.

Influence of uric acid on the correlation between waist circumference and triglyceride glucose index: an analysis from CHARLS

Background

Waist circumference (WC) and uric acid (UA) are significantly related. Still, their temporal sequence and how the sequence works on future risk of triglyceride glucose (TyG) are unknown, especially in the Chinese population.

Methods

Cross-lagged panel model was used to analyze the reciprocal, longitudinal relationships among a set of interrelated variables. The mediation model was constructed to test the effect of the relationship between WC and UA on TyG.

Results

A total of 5727 subjects were enrolled in our study population, of which 53.5% were women, and the mean age was 59.0 (standard deviation, 8.62) years. After adjusting for traditional confounding factors, the results showed that a higher level of baseline WC was significantly associated with a higher level of follow-up UA (β = 0.003, P = 0.031) and follow-up TyG (β = 0.003, P < 0.001);. Simultaneously, there was no statistical association between the level of baseline UA and the level of follow-up WC (β = − 0.009, P = 0.951). The mediation effects of UA on WC-TyG were estimated to be 18.1% in adults, and 36.2% in women.

Conclusions

The current study demonstrated that higher baseline level of WC probably preceded UA’ level in general population. In addition, UA mediated the relationship of WC to TyG, especially in females. And the possible mechanism would require further clarification.

Effects of Lifestyle Changes on the Mental Health of Healthcare Workers with Different Sense of Coherence Levels in the Era of COVID-19 Pandemic

Sense of coherence (SOC) is a psychological factor that contributes to mental health maintenance under stressful environment. Likewise, level of SOC might affect mental health among healthcare workers during the COVID-19 pandemic differently. In this study, we investigated the relationships between lifestyle changes and mental health (General Health Questionnaire-12: GHQ-12) among different level of SOC (weak, moderate, or strong by SOC-13). The data of 898 healthcare workers from cross-sectional survey dataset were extracted and analyzed. As results, based on GHQ-12 score, 86.1% of 244 participants with weak SOC, 60.1% of 606 participants with moderate SOC, and 31.3% of 48 participants with strong SOC had poor mental health. Both SOC levels and lifestyle changes (except alcohol consumption) had significant main effects on the GHQ-12 score. Analysis on the association between lifestyle changes and mental health status stratified by SOC level reveled that among participants with weak SOC, those who increased their leisure and activity time had reduced odds of poor mental health than those who made no changes (OR: 0.08, CI: 0.01 to 0.64). Healthcare workers with weak SOC were at risk of poor mental health during the COVID-19 pandemic, and lifestyle changes may improve their mental health.

The associations of executive functions with resilience in early adulthood: A prospective longitudinal study

BACKGROUND

Executive functions and resilience, the key components of an individual's ability to participate meaningfully and effectively in their environment, have become increasingly researched topics in psychology and education. However, little is known about the longitudinal associations of executive functions and resilience among emergent adults.

METHODS

We conducted a prospective study with 450 (baseline) participants aged 17-24 years; 420 of these participants also completed a 15-month follow-up. Participants answered questionnaires investigating socio-demographics, executive functions, and resilience, and results were analysed with multivariable logistic regression and cross-lagged analyses.

RESULTS

At baseline, the overall prevalence of low executive functions (T-score ≥ 60) among the sample was 18.2%. Relative to persistently low executive functions, newly developed or persistent high executive functions was significantly associated with higher level of resilience at follow-up (bOR = 8.26, 95% CI [2.57, 26.49]; bOR = 8.74, 95% CI [3.69, 20.70], respectively). Further cross-lagged analyses showed bidirectional relationships of executive functions and various executive functions subtypes with resilience.

LIMITATIONS

The use of self-report measures may lead to recall bias, and intervention or experimental studies are needed to examine causality. This study recruited participants from one vocational school, which may limit the generalisability of the results. Also, follow-up dropout was a potential bias in this study; the observed results should be interpreted with caution.

CONCLUSIONS

Our study proposes that enhancing executive functions may be associated with improved resilience, and vice versa. These findings could influence the development of targeted interventions via mental health professionals to support individuals' development.

Temporal relationship between body mass index and uric acid and their joint impact on blood pressure in children and adults: the Bogalusa Heart Study

OBJECTIVE

This study aimed to examine the temporal relationship between body mass index (BMI) and uric acid (UA), and their joint effect on blood pressure (BP) in children and adults.

METHODS

The longitudinal cohorts for temporal relationship analyses consisted of 564 and 911 subjects examined twice 5-14 years apart from childhood to adulthood. The cross-sectional cohorts for mediation analyses consisted of 3102 children and 3402 nondiabetic adults. Cross-lagged panel analysis models were used to examine the temporal relationship between BMI and UA, and mediation analysis models the mediation effect of UA on the BMI-BP association.

RESULTS

After adjusting for age, race, sex and follow-up years in children, and additionally smoking and alcohol drinking in adults, the path coefficients (standardized regression coefficients) from baseline BMI to follow-up UA (0.145 in children and 0.068 in adults) were significant, but the path coefficients from baseline UA to follow-up BMI (0.011 in children and 0.016 in adults) were not. In mediation analyses, indirect effects through UA on the BMI-systolic BP association were estimated at 0.028 (mediation effect = 8.8%) in children and 0.033 (mediation effect = 13.5%) in adults (P < 0.001 for both). Direct effects of BMI on systolic BP (0.289 in children and 0.212 in adults) were significant. The mediation effect parameters did not differ significantly between Blacks and Whites.

CONCLUSIONS

Changes in BMI precede alterations in UA, and the BMI-BP association is in part mediated through BMI-related increase in UA both in children and in adults. These findings have implications for addressing mechanisms of obesity hypertension beginning in early life.

Pre-rehabilitation sense of coherence as a predictor of symptom change after rehabilitation

Sense of coherence (SOC) constitutes the key component of salutogenesis theory. It reflects individuals' confidence that their environment is comprehensible and manageable and that their lives are meaningful. Research demonstrates a strong cross-sectional relationship between SOC and mental health. However, little is known about SOC's temporal stability and its potential to predict changes in psychopathological symptom severity in different settings. The goal of the current study was to address this gap. The sample of the two-wave longitudinal study consists of 294 patients receiving inpatient psychotherapeutic (and psychopharmacological) treatment for various psychological disorders at a German psychosomatic rehabilitation clinic. SOC (Antonovsky, Social Science & Medicine, 1993, 36, 725-733) and outcome measures (i.e., general mental health problems, depression and anxiety symptoms) were assessed within two days of arrival and at the end of rehabilitation (week 5/6). SOC was significantly enhanced after treatment whereas psychopathological symptoms were significantly reduced. Regression analyses revealed that pre-treatment SOC was a significant negative predictor of post-treatment symptom severity for all outcome measures even after controlling for pre-treatment symptoms. The current findings provide first evidence that SOC is a significant unique predictor of symptom change. Future studies need to further investigate longitudinal associations between SOC and mental health outcomes in different settings.

Association of Serum Calcium and Insulin Resistance With Hypertension Risk: A Prospective Population-Based Study

Background

The temporal sequence between serum calcium and insulin resistance (IR) and their effects on hypertension are unclear. We studied the association between serum calcium and IR, with risk of hypertension events in a longitudinal cohort conducted in China.

Methods and Results

Data from 8653 subjects aged 20 to 74 years with an average follow‐up of 5.3 years were analyzed. Serum calcium, and fasting and 2‐hour serum glucose and insulin were measured at baseline and follow‐up. Cross‐lagged panel and mediation analysis were used to examine the temporal relationship between serum calcium and IR and its impact on hypertension incidence. The conjoint effects of serum calcium and IR at baseline on hypertension at follow‐up were observed (P=0.029 for HOMA_IR [hepatic IR] and P=0.009 for Gutt index [peripheral IR]). The cross‐lagged path coefficient (β₂) from baseline serum calcium to follow‐up peripheral IR were significantly greater than path coefficient (β₁) from baseline peripheral insulin resistance to follow‐up serum calcium (β₂ =−0.354 versus β₁=−0.005; P=0.027). However, no directional relationships were observed in the serum calcium↔hepatic IR analysis. The mediation effect of peripheral IR on the association of serum calcium at baseline with hypertension at follow‐up was estimated at 16.4% (P<0.001).

Conclusions

Our findings demonstrate that higher serum calcium levels probably precede peripheral IR, and this 1‐directional relation plays a role in the development of hypertension.

Body Mass Index Drives Changes in DNA Methylation: A Longitudinal Study

RATIONALE

Previous EWASs (Epigenome-Wide Association Studies) suggest that obesity may be the cause, not a consequence, of changes in DNA methylation (DNAm). However, longitudinal observations are lacking.

OBJECTIVE

To identify 5'-cytosine-phosphate-guanine-3' in DNA (CpG) sites associated with body mass index (BMI) and examine the temporal relationship between dynamic changes in DNAm and BMI in a longitudinal cohort.

METHODS AND RESULTS

Race-specific EWASs were performed in 995 whites and 490 blacks from the Bogalusa Heart Study. Suggestive CpG sites were further replicated in 252 whites and 228 blacks from the Georgia Stress and Heart Study. Cross-lagged panel analysis was used to examine the temporal relationship between DNAm and BMI in 439 whites and 201 blacks who were examined twice 6.2 years apart. In discovery and replication samples, 349 CpG sites (266 novel) in whites and 36 (21 novel) in blacks were identified to be robustly associated with BMI, with 8 (1 novel) CpG sites overlapping between the 2 races. Cross-lagged panel analyses showed significant unidirectional paths (P_FDR <0.05) from baseline BMI to follow-up DNAm at 18 CpG sites in whites and 7 in blacks; no CpG sites showed significant paths from DNAm at baseline to BMI at follow-up. Baseline BMI was associated with a DNAm score (calculated from DNAm levels at the associated CpG sites) at follow-up (P<0.001 both in blacks and in whites).

CONCLUSIONS

The findings provide strong evidence that obesity is the cause, not a consequence, of changes in DNAm over time.

Is there a relationship between psychological factors and TMD?

INTRODUCTION

Medical students are in a very demanding environment and are affected by high degree of stress. High levels of anxiety can affect a student's academic performance and also increase the risk of other health-related problems. This study aims to evaluate, thanks to the intensity of stress manifestations (4DSQ) together with the sense of coherence (SOC), the prevalence of TMD and oral parafunctions in students enrolled in the University of Medical Sciences. Moreover, it aims to evaluate the relationship between the psychosocial manifestations of stress and sense of coherence in relation to gender.

MATERIALS AND METHODS

A total of 324 students of Poznań University of Medical Sciences participated in this study. Students were assessed using a three-part questionnaire: one was to assess symptoms of TMD, the second part was 4DSQ, and the third was a SOC Questionnaire.

RESULTS

About one-third of the students in this study presented symptoms of TMD and perceived more intensively symptoms of distress, anxiety, somatization, and depression. They presented a higher level of somatic symptoms and a lower level of Sense of Coherence than students without TMD symptoms.

CONCLUSION

There is a strong negative relationship between the sense of coherence and the level of perceived distress, anxiety, somatization, and depression. Female students attending Medical School showed a higher level of somatization of stress but with a higher capacity to overcome challenges as compared to men.

Temporal relationship between inflammation and insulin resistance and their joint effect on hyperglycemia: the Bogalusa Heart Study

BACKGROUND

Inflammation and insulin resistance play crucial roles in the development of type 2 diabetes mellitus (T2DM). We aim to examine the temporal relationship between high-sensitivity C-reactive protein (hsCRP) and insulin resistance in non-diabetic adults and their joint effect on the development of hyperglycemia.

METHODS

The longitudinal cohort from the Bogalusa Heart Study consisted of 509 non-diabetic adults (360 whites and 149 blacks, mean age = 42.8 years at follow-up) who had hsCRP, fasting glucose and insulin measured twice at baseline and follow-up over 6.8 years. Cross-lagged panel model was used to examine the temporal relationship between hsCRP and homeostasis model assessment for insulin resistance (HOMA-IR). Information on incident T2DM was collected in a survey in 6.1 years after the follow-up survey.

RESULTS

After adjusting for race, sex, age, body mass index, smoking, alcohol drinking and follow-up years, the path coefficient from baseline hsCRP to follow-up HOMA-IR (β2 = 0.105, p = 0.009) was significant and greater than the path from baseline HOMA-IR to follow-up hsCRP (β1 = 0.005, p = 0.903), with p = 0.011 for the difference between β1 and β2. This one-directional path from baseline hsCRP to follow-up HOMA-IR was significant in the hyperglycemia group but not in the normoglycemia group. In addition, participants with high levels of baseline hsCRP and follow-up HOMA-IR had greater risks of T2DM (odds ratio, OR = 2.38, p = 0.035), pre-T2DM (OR = 2.27, p = 0.006) and hyperglycemia (OR = 2.18, p = 0.003) than those with low-low levels.

CONCLUSIONS

These findings suggest that elevated hsCRP is associated with future insulin resistance in non-diabetic adults, and their joint effect is predictive of the development of T2DM.

The association of psychological factors and healthcare use with the discrepancy between subjective and objective respiratory-health complaints in the general population

BACKGROUND

We examined the prevalence of self-perceived respiratory symptoms (SRS) in the absence of any objective findings of respiratory pathology, and the association of such prevalence with psychological factors and healthcare use in the general population.

METHODS

The study was conducted among a nationally representative sample of Finnish adults (BRIF8901). Respiratory functioning was measured by a spirometry test. Structured questionnaires were used to measure SRS, physician visits and psychological factors of alexithymia, sense of coherence, illness worry and common mental disorders. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder, determined in a diagnostic interview, were excluded, giving a sample comprising 4544 participants.

RESULTS

Twenty-six per cent of the general population and 36% of those with no diagnosed severe psychiatric disorder or respiratory disease experienced SRS despite a normal spirometry result. Psychological factors were associated with SRS (0.0001 &lt; p &lt; 0.032), and on the number of physician visit explaining 42.7% of the difference in visits between individuals with and without SRS, respectively. Illness worry was associated most strongly with SRS [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.19-1.41, p &lt; 0.0001] and higher numbers of physician visits (OR 1.35, CI 1.32-1.38, p &lt; 0.00001), even after several adjustments.

CONCLUSIONS

Respiratory symptoms without objective findings are common in the general population. The study results underline the role of psychological factors in the reporting of respiratory symptoms and the associated medical burden, thereby indicating the functional nature of the symptomatology.

The relationship between sense of coherence and post-traumatic stress: a meta-analysis

Background: Antonovsky's concept of sense of coherence (SOC) - as a global orientation reflecting an individual's feeling of confidence in both the predictability of their internal and external environment and their ability to cope with stressful and challenging situations in life - shows a negative association with symptoms of post-traumatic stress. However, single studies varying in study characteristics provide heterogeneous effect size estimations. Objective: The purpose of the current study is to investigate the relationship between SOC and post-traumatic stress disorder (PTSD) symptom severity for the first time on a meta-analytical level. Method: The random-effects meta-analysis is based on zero-order correlations (r) and consists of 47 independent samples out of 45 studies (N = 10,883). Results: After correcting for sampling error, the mean correlation between SOC and PTSD symptoms was M(r) = -.41 (excluding four outliers: -.39). However, this effect could not be generalized to all types of PTSD samples owing to substantial remaining heterogeneity. Subsequent moderator analyses investigating the influence of different SOC and PTSD measures, trauma type and duration, mean age and gender imbalances per sample did not reveal significant moderating effects. Conclusions: The meta-analysis reveals a substantial correlation between SOC and PTSD symptom severity: higher SOC levels are associated with lower symptom severity. Thus, future research should progress to the question of whether the relationship between SOC and post-traumatic stress is causal, and by which factors it is moderated. Abbreviations: CD, Cook's distance; DSM, Diagnostic and Statistical Manual of Mental Disorders; (G)RR, general (and specific) resistance resources; IES(-R), Impact of Event Scale (Revised); PDS, Posttraumatic Stress Diagnostic Scale; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PTSD, post-traumatic stress disorder; SDR, standard deleted residual; SOC, sense of coherence; SOC-R, Sense of Coherence Scale - Revised.

Impact of cigarette smoking on the relationship between body mass index and insulin: Longitudinal observation from the Bogalusa Heart Study

OBJECTIVES

Despite the inverse association between cigarette smoking and body mass index (BMI), it is unknown whether the effect of smoking on insulin is mediated through decreased BMI. This study aims to examine the temporal relationship between BMI and insulin, the impact of smoking on this relationship and the mediation effect of BMI on the association between smoking and insulin levels.

METHODS

The longitudinal cohort consisted of 1121 adults (807 white and 314 black participants, mean age, 42.0 years at follow-up) for whom BMI and fasting insulin were measured twice, with an average follow-up period of 17.1 years. Cross-lagged panel and mediation analysis models were used to examine the temporal relationship between BMI and insulin, and the mediation effect of BMI on the smoking-insulin association.

RESULTS

Smoking was inversely associated with insulin (regression coefficient, -0.073; P = .015 at baseline and -0.121; P < .001 at follow-up), adjusting for age, race and gender. After additional adjustment for follow-up periods, the cross-lagged path coefficient from BMI to insulin (β, 0.226; P < .001) was significantly greater than that from insulin to BMI (β, -0.029; P = .208), with P < .001 for the difference. The path coefficient from BMI to insulin was significantly greater in non-smokers (β, 0.273; P < .001) than in smokers (β, 0.122; P = .046), with P = .013 for the difference. The mediation effect of BMI on the smoking-insulin association was estimated at 53.4% (P = .030) at baseline and 58.7% (P < .001) at follow-up.

CONCLUSIONS

These findings suggest that cigarette smoking has a significant impact on the one-directional relationship from BMI to insulin. The insulin-lowering effect of smoking is predominantly mediated through decreased BMI as the result of smoking.

Potential Mediating Biomarkers underlying the Association of Body Mass Index or Waist Circumference with Blood Pressure: Results from Three Population-based Studies

We conducted a comprehensive and in-depth assessment of body mass index (BMI) or waist circumference (WC) related to blood pressure (BP) and determined whether the association is mediated by the possible potential mediators in the cross-sectional survey of the Harbin Cohort Study on Diet, Nutrition and Chronic Non-communicable Diseases of 7094 participants aged 20–74 years, and validated the significant findings in the US National Health and Nutrition Examination Survey four cross-sectional cohorts (2005–2006, 2007–2008, 2009–2010, and 2011–2012) and the cohort data of the Harbin People’s Health Study (a median of 4.2 follow-up years). We observed that BMI or WC was positively associated with BP (all P-values < 0.0001). Mediation analyses consistently indicated that these associations were mediated mainly by insulin resistance (IR) as measured by the homeostasis model (HOMA-IR), followed by triglyceride (TG) and total cholesterol (TC), and fasting glucose (FG) in the three studies. The proportions via the mediation of insulin/HOMA-IR were 25~40%, TG and TC were 15~20%, and FG was 2~8%, respectively. These findings suggest that the mediators, insulin/insulin resistance, TG, TC, and FG, could be targeted for preventing hypertension among populations who were overweight or obesity.

Role of Personal Resources in Depression and Stress in Heart Transplant Recipients

BACKGROUND

Heart transplantation is the primary option for heart failure treatment and increases the survival rate and the quality of life for recipients. However, this surgical intervention induces numerous psychological problems, such as depression and anxiety. Protective factors and personal recourses are a significant force behind healthy adjustment to life stresses. The aim of this study was to assess the role of personal recourses in terms of depression and stress in heart transplant recipients.

METHODS

The study involved a sample of 131 post-heart transplant patients. Standardized instruments were used to measure the key constructs: Beck Depression Inventory Short Form for prevalence of depression, Perceived Stress Scale for prevalence distress, and Sense of Coherence (SOC-29), Life Orientation Test, and General Self-Efficacy Scale for measuring personal resources.

RESULTS

We found that sense of coherence, optimism, and self-efficacy proved to be significant predictors for the prevalence of both depression and stress.

CONCLUSIONS

These result suggest that the assessment of coping strategies and sense of coherence in heart transplant recipients requires exploration. Evaluating coping strategies and sense of coherence before surgery seems significant and begins with developing skills in this domain.

Relations of mother's sense of coherence and childrearing style with child's social skills in preschoolers

BACKGROUND

We examined the relationships between mothers' sense of coherence (SOC) and their child's social skills development among preschool children, and how this relationship is mediated by mother's childrearing style.

METHODS

Mothers of 1341 Japanese children, aged 4-5 years, completed a self-report questionnaire on their SOC and childrearing style. The children's teachers evaluated their social skills using the social skills scale (SSS), which comprises three factors: cooperation, self-control, and assertion.

RESULTS

Path analyses revealed that the mother's childrearing mediated the positive relationship between mother's SOC and the cooperation, self-control, and assertiveness aspects of children's social skills. Additionally, there was a significant direct path from mother's SOC to the self-control component of social skills.

CONCLUSIONS

These findings suggest that mother's SOC may directly as well as indirectly influence children's social skills development through the mediating effect of childrearing. The results offer preliminary evidence that focusing on support to improve mothers' SOC may be an efficient and effective strategy for improving children's social skills development.

Long-term Impact of Temporal Sequence from Childhood Obesity to Hyperinsulinemia on Adult Metabolic Syndrome and Diabetes: The Bogalusa Heart Study

This study aims to delineate the temporal relations between body mass index (BMI) and insulin in childhood and their impact on adult metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM).The longitudinal cohort consisted of 609 whites and 339 blacks who had BMI and fasting insulin measured twice in childhood (mean age = 10.5 years at baseline and 15.9 years at follow-up). Incident MetS and T2DM were identified in adulthood (mean age = 30.5 years). Cross-lagged panel and mediation analysis models were used. After adjusting for age, race, gender, and follow-up years, the cross-lagged path coefficient of BMI → insulin (β = 0.326, p < 0.001) was significantly greater than that of insulin → BMI (β = −0.023, p = 0.207) in childhood, with p < 0.001 for the difference in βs. The path coefficient for BMI → insulin was significantly greater in MetS than in non-MetS groups (0.510 vs 0.190, p < 0.001), and greater in hyperglycemia than in normoglycemia groups (0.503 vs 0.285, p = 0.026). The mediation effect of childhood insulin on the BMI-MetS and BMI-hyperglycemia associations was estimated at 19.2% (p < 0.001) and 18.3% (p < 0.001), respectively. These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this one-directional relation plays a significant role in the development of MetS and T2DM in adult life.

Preoperative sense of coherence associated with the 10-year outcomes of lumbar spinal stenosis surgery

A prospective 10-year follow-up study was conducted to determine the significance of the preoperative sense of coherence, with respect to the preoperative and 10-year clinical characteristics, among lumbar spinal stenosis patients ( N = 99). In addition, the predictive value of the preoperative sense of coherence regarding the 10-year surgery outcome was also evaluated. In a logistic regression analysis, a weak preoperative sense of coherence and low functional ability predicted the patients' functional ability 10 years after the surgery. Moreover, those patients with weak sense of coherence before surgery showed poorer functional ability 10 years after the surgery, but not preoperatively. A weak preoperative sense of coherence seems to associate with poorer long-term outcome after surgery; therefore, various rehabilitation strategies are discussed.

Chapter 7. Sickness absence and psychiatric disorders

There is limited scientific evidence that women have a higher frequency and incidence of sickness absence due to psychiatric diagnoses. Because of conflicting findings, there is insufficient evidence on gender differences in the duration of sickness absence. Because of conflicting findings, there is also insufficient evidence on the association between age and sickness absence with psychiatric diagnoses. There is insufficient evidence on the association of sickness absence due to psychiatric diagnoses with work-related factors, factors related to family and social networks outside of the job, and psychosocial factors in childhood and adolescence since none of the individual factors were investigated in more than a single study. The results were conflicting (insufficient evidence) in five studies that investigated whether individuals with psychiatric disorders were at greater risk for sickness absence and disability pension, irrespective of the diagnosis on the sickness certificate. The four studies that used alcohol diagnoses to identify alcohol problems found increased sickness absence irrespective of the diagnosis on the certificate (expressed as more sick-leave days or an increased risk for prolonged sickness absence in individuals with alcohol problems). Furthermore, two of the studies found an increased risk for disability pension in women diagnosed with alcohol problems. There is insufficient evidence because of too few studies. The results are conflicting with regard to the association between high alcohol consumption and sickness absence, irrespective of the diagnosis on the certificate (insufficient evidence).

Sense of coherence and its determinants: A comparative study of the Finnish-speaking majority and the Swedish-speaking minority in Finland

Background: Despite similar living conditions among the Finnish-speaking majority and the Swedish-speaking minority in Finland, the latter is a more advantaged group e.g. in terms of socioeconomic status and health. This study investigated (1) the level of sense of coherence (SOC), (2) the structure of generalized resistance resources (GRRs), and (3) associations of GRRs with SOC among Finnish- and Swedish-speaking Finns. Methods: The data derived from the Health and Social Support (HeSSup) Study. The sample comprised 22,937 Finnish men and women aged 20—54, including an additional sample from the Swedish-speaking population (n=2,967). The response rate was 40%. Ordinary regression analysis was used. Results: Swedish-speaking women scored 0.9 (p=0.005) and men 0.6 (p=0.05) points higher on SOC scale compared with Finnish-speaking respondents. The minor difference in the SOC level between the language groups was explained by Finnish speakers' worse psychosocial living conditions in childhood and working conditions in adulthood. Only one interaction was found: parents' divorce during childhood was associated with a significant decrease of SOC scores only for Finnish speakers. Otherwise the same GRRs had similar effects on both Finnish- and Swedish-speaking men's and women's SOC. Conclusion: The only key difference between Finnish- and Swedish-speaking Finns concerned the unequal distribution of GRRs. An increase in GRRs among Finnish speakers would probably strengthen their SOC. However, the slightly stronger level of SOC among Swedish-speaking compared with Finnish-speaking Finns is unlikely to explain the possible differences in well-being between the two language groups.

Role clarity, fairness, and organizational climate as predictors of sickness absence

Aims: The majority of the research on the effects of the psychosocial work environment on sickness absenteeism has focused on components of job strain and social support among public sector employees without stratification by socioeconomic status. The authors examined less-studied work-related psychosocial predictors of sickness absence in the private sector by socioeconomic status. Methods: Questionnaire data on psychosocial factors at work were used to predict the rates of recorded short (1 - 3 days), long (4 - 21 days), and very long (over 21 days) sickness absences among 3,850 white- and blue-collar male and female employees in a large-scale enterprise. Multivariate Poisson regression models were adjusted for age, prior absence, and psychosocial factors at work. Results: In white-collar men, low role clarity was associated with a 3.0 (95% CI 1.3 - 7.1) times greater rate of very long absences than high role clarity. Low fairness in the division of labor predicted a 1.3-fold (95% CI 1.1 - 1.5) rate of long absences in blue-collar men. In blue-collar women, poor organizational climate was associated with a 1.6 (95% CI 1.0 - 2.5) times greater rate of short absence spells than favorable organizational climate but among white-collar women all associations between work-related psychosocial factors and sickness absenteeism were weak. Conclusions: These findings indicate that the actions to reduce psychosocial risk factors of sickness absence should match the specific needs of each socioeconomic group.

Temporal Relationship Between Childhood Body Mass Index and Insulin and Its Impact on Adult Hypertension: The Bogalusa Heart Study

Although obesity and insulin resistance are closely correlated, their temporal sequences in early life and influence on adult hypertension are largely unknown. This study aims to delineate the temporal relationship patterns between body mass index (BMI) and insulin in childhood and their impact on adult hypertension. The longitudinal cohort consisted of 990 adults (630 whites and 360 blacks) who had BMI and fasting insulin measured twice 5.4 years apart in childhood (mean age, 10.5 years at baseline and 15.9 years at follow-up) and blood pressure measured 14.7 years later in adulthood (mean age, 30.5 years). Cross-lagged panel and mediation analysis models were used to examine the temporal relationship between childhood BMI and insulin and its impact on adult hypertension. After adjusting for age, race, sex, and follow-up years, the cross-lagged path coefficient (β=0.33; P<0.001) from baseline BMI to follow-up insulin was significantly greater than the path coefficient (β=-0.02; P>0.05) from baseline insulin to follow-up BMI in childhood with P<0.001 for the difference in βs. Blacks and whites showed similar patterns of the temporal relationship. The path coefficient (β=0.59; P<0.001) from BMI to insulin in the hypertensive group was significantly greater than that (β=0.24; P<0.001) in normotensive group, with P<0.001 for the difference in βs between these 2 groups. The mediation effect of childhood insulin on the childhood BMI-adult hypertension association was estimated at 21.1% (P<0.001). These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this 1-directional relation plays a role in the development of hypertension.

Sense of coherence and periodontal health outcomes

OBJECTIVE

Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC.

MATERIALS AND METHODS

The study sample comprised 276 individuals, aged 18-60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24-46); (b) SOC2 = moderate (47-51); (c) SOC3 = strong (52-65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables.

RESULTS

Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively).

CONCLUSIONS

Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.

Temporal Relationship Between Elevated Blood Pressure and Arterial Stiffening Among Middle-Aged Black and White Adults: The Bogalusa Heart Study

This study assessed the temporal relationship between elevated blood pressure (BP) and arterial stiffness in a biracial (black-white) cohort of middle-aged adults aged 32-51 years from the semirural community of Bogalusa, Louisiana. Measurements of aortic-femoral pulse wave velocity (afPWV; n = 446) and large- and small-arterial compliance (n = 381) were obtained at 2 time points between 2000 and 2010, with an average follow-up period of 7 years. A cross-lagged path analysis model was used to examine the temporal relationship of elevated BP to arterial stiffness and elasticity. The cross-lagged path coefficients did not differ significantly between blacks and whites. The path coefficient (ρ2) from baseline BP to follow-up afPWV was significantly greater than the path coefficient (ρ1) from baseline afPWV to follow-up BP (ρ2 = 0.20 vs. ρ1 = 0.07 (P = 0.048) for systolic BP; ρ2 = 0.19 vs. ρ1 = 0.05 (P = 0.034) for diastolic BP). The results for this 1-directional path from baseline BP to follow-up afPWV were confirmed, although marginally significant, by using large- and small-artery elasticity measurements. These findings provide strong evidence that elevated BP precedes large-artery stiffening in middle-aged adults. Unlike the case in older adults, the large-arterial wall is not stiff enough in youth to alter BP levels during young adulthood.

The connection between organizational climate and well-being at work

Purpose

– The purpose of this paper is to examine the connections between organizational climate and well-being at work.

Design/methodology/approach

– Connections between perceived organizational climate and well-being at work were studied through quantitative data gathered from 24 public day-care centers in Finland.

Findings

– The unit-level analyses revealed that different types of organizational climates were connected to different types of job well-being in the unit. Organizational climate types were differentially connected to stress and cynicism, but were not connected to work engagement. Employees in units where work climate was collectively evaluated as particularly weak reported significantly lower well-being than those in units with better work climate. The most positive climates – “relaxed and friendly” and “encouraging and supportive of new ideas” – seemed to be more strongly connected to well-being than negative climates.

Originality/value

– The study confirmed and clarified the link between organizational climate and job well-being and emphasized how different climate types have varying types of connection to well-being at work.

Sense of coherence and 22-year all-cause mortality in adult men

BACKGROUND

Sense of coherence (SOC) is a central construct in Antonovsky's salutogenic theory, which focuses on people's health-promoting and health-protecting characteristics. We examined prospectively the association of SOC with all-cause mortality during 22 years (1989-2011).

METHODS

The data of 585 men from the Israel longitudinal study of Glucose Intolerance, Obesity, and Hypertension (The Israel GOH) comprised the analytic sample. Participants were 48-67 years old at study entry (1989). Information on sociodemographic, medical history and health-related risk factors were obtained at baseline through a face-to-face interview. Participants completed Antonovsky's 29-item SOC scale. Information on all-cause mortality was obtained from the Israeli Mortality Register (1989 through 2011). We evaluated the effect of SOC on time-to-death using multiple Cox proportional hazard regression.

RESULTS

Controlling for sociodemographic, smoking status and morbidities, there was strong evidence of an association between SOC and 22-year all-cause mortality [adjusted hazard ratio (aHR)=0.992, 95% CI 0.986-0.998 per unit]. Strong SOC was associated with a 35% reduction in all-cause mortality relative to weak SOC (aHR=0.653, 95% CI 0.454-0.939). There was no convincing evidence of a survival advantage for individuals with intermediate level of SOC relative to persons reporting weak SOC (aHR=0.821, 95% CI 0.595-1.134).

CONCLUSIONS

Our study provides strong evidence of an association between SOC and mortality, above and beyond potential confounding factors and established risk factors. Considerable more research is needed on the role of SOC in health and survival and the potential pathways linking SOC and health.

Sense of coherence changes with aging over the second half of life

Sense of coherence (SOC), a concept reflecting meaningfulness, comprehensibility, and manageability of life, has been demonstrated to have strong connections to positive outcomes such as good health. However, less is known about how SOC changes over the second half of life as age-related deficits accumulate. We used longitudinal samples of mature adults that included the oldest-old to track change in SOC from age 55 to 101. Growth curves using an accelerated longitudinal design were estimated for 1809 individuals who contributed 4072 observations from five national Swedish surveys between 1991 and 2010/11. Results indicated that deficits in health and social resources were largely responsible for the precipitous decline in SOC after age 70. When controlling for these deficits, SOC increased continuously into advanced old age. We conclude that the capacity to comprehend, manage, and find meaning in life--the component elements of SOC--strengthens over the last years of life, suggesting a positive ontogenic development that runs parallel but opposite to the negative impact of health and social decline.

Association between sense of coherence in adolescence and social benefits later in life: a 12-year follow-up study

OBJECTIVES

Local government concerns over expenditure on social and healthcare are growing. The aim of the present study was to explore the association between a weak 'sense of coherence' (SOC) in teens and their subsequent risk of receiving social and healthcare benefits during young adulthood, and to monitor how SOC developed during this period.

DESIGN

Prospective cohort study.

SETTING

North Denmark Region.

PARTICIPANTS

773 Pupils from seventh and eighth forms who answered a questionnaire in 1998.

OUTCOME MEASURES

Different social benefits (from the Danish DREAM database embracing disbursed public social benefits). Change in SOC score from 1998 to 2010.

RESULTS

722 had answered seven items of the original SOC-13 questionnaire (denoted by SOC-7). Girls with a weak SOC-7 (the lowest 1st quartile) in 1998 had a significantly increased risk of receiving unemployment benefits (RR 1.3 (1.1 to 1.6)), social assistance (RR 1.8 (1.3 to 2.5)) and sickness benefits (RR 1.5 (1.2 to 2.0)) compared with girls with a strong SOC-7. For boys, only minor protective and non-significant differences were found. The SOC answers from 1998 and 2010 were compared (n=394). SOC increased significantly and mostly in girls.

CONCLUSIONS

SOC-7 may serve as a predictor for social life event outcomes and hence facilitate an early identification and a selective approach to support teenage girls with a weak SOC. From adolescence to young adulthood, SOC-7 was of a relatively unstable nature.

Sense of coherence among cognitively intact nursing home residents--a five-year longitudinal study

AIM AND OBJECTIVES

To examine how stable the sense of coherence (SOC) is over a five-year period among residents of nursing homes (NH) who are not cognitively impaired and whether components of social support influence SOC.

BACKGROUND

Many studies have investigated the stability of SOC, and the findings have been inconsistent. Social support is a crucial resource in developing SOC. Few researchers have studied the stability of SOC and how various social support dimensions influence changes in SOC among older NH residents who are cognitively intact.

DESIGN

The study was prospective and included baseline assessment and five-year follow-up.

METHODS

The sample comprised 52 cognitively intact NH residents (Clinical Dementia Rating score ≤0.5). We obtained data through direct interviews using the Social Provisions Scale and Sense of Coherence Scale.

RESULTS

SOC increased statistically significantly from baseline to follow-up. The social support subdimension reassurance of worth predicted change in SOC after adjustment for sociodemographic factors. When controlled for baseline SOC, attachment was associated with change in SOC, but reassurance of worth was not.

CONCLUSIONS

The study indicates that the change in SOC over time during the 5 years of follow-up and the social support dimension attachment appear to be important components of change in SOC. Nursing personnel should be aware of the residents' individual needs for attachment and the importance of emotional support for personal strength and ability to cope.

Effects of evacuation in late adulthood: analyzing psychosocial well-being in three cluster groups of Finnish evacuees and non-evacuees

OBJECTIVES

We studied the long-term effects of early separation among aging Finnish evacuees and non-evacuees. A broad set of outcome variables reflecting the psychosocial well-being of both groups in 2005 was analyzed. The role of resilience was also analyzed.

METHOD

To identify persons with similar patterns of psychosocial well-being among both evacuated (n = 887) and non-evacuated persons (n = 1748), a cluster analysis was conducted, using the mixture model of latent class analysis/latent profile analysis method. The psychosocial well-being of the evacuees and non-evacuees in 2005 was predicted by multinomial logistic regression analysis, with the nominal cluster variable as the dependent variable.

RESULTS

Although the evacuees had experienced early separation trauma, they were not faring worse than the non-evacuees regarding psychosocial well-being in 2005. Favorable rearing home circumstances are a protective factor during the entire life span, when the psychosocial well-being of both groups was predicted in 2005. Sense of coherence was a significant predictor of psychosocial well-being. To rejoin the rearing family was stressful for many evacuees.

CONCLUSION

The results show that even long-term separation from one's parents during childhood must be understood as representing a developmental context which makes the emergence of problems either less likely or more likely, depending on other risk and protective factors in both the rearing home and the foster family. After the war, when the evacuees returned home the families should have received help and support to amend the reunion.

The potential of social enterprise to enhance health and well-being: a model and systematic review

In recent years civil society organisations, associations, institutions and groups have become increasingly involved at various levels in the governance of healthcare systems around the world. In the UK, particularly in the context of recent reform of the National Health Service in England, social enterprise - that part of the third sector engaged in trading - has come to the fore as a potential model of state-sponsored healthcare delivery. However, to date, there has been no review of evidence on the outcomes of social enterprise involvement in healthcare, nor in the ability of social enterprise to address health inequalities more widely through action on the social determinants of health. Following the development of an initial conceptual model, this systematic review identifies and synthesises evidence from published empirical research on the impact of social enterprise activity on health outcomes and their social determinants. Ten health and social science databases were searched with no date delimiters set. Inclusion and exclusion criteria were applied prior to data extraction and quality appraisal. Heterogeneity in the outcomes assessed precluded meta-analysis/meta-synthesis and so the results are therefore presented in narrative form. Five studies met the inclusion criteria. The included studies provide limited evidence that social enterprise activity can impact positively on mental health, self-reliance/esteem and health behaviours, reduce stigmatization and build social capital, all of which can contribute to overall health and well-being. No empirical research was identified that examined social enterprise as an alternative mode of healthcare delivery. Due to the limited evidence available, we discuss the relationship between the evidence found and other literature not included in the review. There is a clear need for research to better understand and evidence causal mechanisms and to explore the impact of social enterprise activity, and wider civil society actors, upon a range of intermediate and long-term public health outcomes.

Disentangling Sense of Coherence and Resilience in case of multiple traumas

BACKGROUND

Depressive and anxiety disorders (DAD) are a major public health problem. Trauma endured during childhood is known to increase the risk of DAD in adulthood. We investigate the hypothesis that Sense of Coherence (SOC) is a mediator between childhood trauma and depressive and anxious symptoms (DAD) in adulthood. We also explore the nature (personality trait or aptitude) of SOC and attempt to disentangle the concepts of resilience and SOC.

METHOD

Former hidden children (FHC), the Jewish youths who spent World War II in various hideaway shelters across Nazi-occupied Europe, were compared with a control group. In each group we measured the presence of multiple traumas, the resilience with the Resilience Scale for Adults, the DAD with the Hopkins Symptoms Checklist and the SOC with the SOC-13 self-report questionnaire. We tested a mediated moderation model with childhood Trauma as the predictor; Adulthood trauma as the moderator; SOC as the mediator; and DAD as the outcome variable.

RESULTS

Results were consistent with a sensitization model of DAD partially mediated by SOC. A first component of SOC was similar to an aptitude and another part of SOC was more similar to a personality trait.

LIMITATIONS

We are unable to differentiate if the sensitization process is a consequence of the nature of the trauma endured by FHC (long-standing exposure to extreme external events) or a consequence of the fact that this first trauma occurred during childhood.

CONCLUSION

Our results could account for the controversial debate regarding the life time stability of SOC.

Common Factors of Meditation, Focusing, and Cognitive Behavioral Therapy: Longitudinal Relation of Self-Report Measures to Worry, Depressive, and Obsessive-Compulsive Symptoms Among Nonclinical Students

Meditation has a long tradition with substantial implications for many psychotherapies. It has been postulated that meditation may cultivate therapeutic processes similar to various psychotherapies. A previous study used joint factor analysis to identify five common factors of items of scales purported to capture psychological states cultivated by meditation, focusing, and cognitive behavioral therapy, namely, refraining from catastrophic thinking, logical objectivity, self-observation, acceptance, and detached coping. The present study aimed to extend previous research on these five factors by examining their longitudinal relationship to symptoms of depression, obsession and compulsion, and worrying, with two correlational surveys without intervention. Potential mediators of their effect on worrying were also explored. Longitudinal questionnaire studies from two student samples (n = 157 and 232, respectively) found that (a) detached coping was inversely related to obsessive-compulsive symptoms about 5 weeks later; (b) detached coping was inversely related to depressive symptoms about 5 weeks later; (c) refraining from catastrophic thinking was inversely related to worrying, while self-observation was positively related to worrying about 2 months later; and (d) the relation of refraining from catastrophic thinking to worrying was mediated by negative beliefs about worrying, while the relation of self-observation to worrying was mediated by negative beliefs about worrying and monitoring of one's cognitive processes. As refraining from catastrophic thinking involves being detached from one's negative thinking and detached coping involves distancing oneself from external circumstances and problems, the results suggest that distancing attitudes are useful for long-term reduction of various psychological symptoms.