Sense of coherence and biomarkers of health in 43-year-old women

Evaluating ‘Power 4 a Healthy Pregnancy’ (P4HP) – protocol for a cluster randomized controlled trial and process evaluation to empower pregnant women towards improved diet quality

Background

In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality.

Methods/design

This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women.

Discussion

This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase.

Trial registration

The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12543-z.

Relación entre sentido de coherencia y diabetes mellitus: una revisión sistemática

Resumen El objetivo fue sintetizar las mejores evidencias científicas sobre el efecto del sentido de coherencia en el desarrollo de la enfermedad, tratamiento e indicadores biomédicos de control metabólico y desarrollo de complicaciones de personas en riesgo de desarrollar diabetes y en diabéticos. El método utilizado fue la revisión sistemática. Búsqueda y selección por dos revisores independientes en las bases de datos Scopus, Web of Science, PubMed, Ebsco, Science Direct y manuales, disponibles hasta 2017, en español e inglés, en población con edad superior a 18 años. De un total de 154 estudios, 20 artículos fueron incluidos en la revisión sistemática. Más de la mitad de los estudios utilizaron la versión SOC-13 para la verificación del sentido de coherencia y el indicador de control metabólico más frecuente fue la hemoglobina glucosilada. Además, 14, de los 20 estudios, encontraron una relación estadísticamente significativa entre el sentido de coherencia y la diabetes. Se concluye que el sentido de coherencia tiene una fuerte correlación con la diabetes en las diferentes fases de la enfermedad y está relacionado con la reducción del riesgo para el desarrollo de la enfermedad, la reducción de los valores de hemoglobina glucosilada y la aparición de complicaciones de la diabetes mellitus.

SALUTOGENESIS AND CARDIOVASCULAR HEALTH IN ADULTS: A SCOPING REVIEW

ABSTRACT Objective: to identify and synthesize evidence that relates the salutogenic theory proposed by Antonovsky with cardiovascular disease in adults. Methods: we conducted a scoping review as proposed by Arksey and O’Malley. Bibliographic databases were searched for original research articles about salutogenesis and cardiovascular health. The search yielded 29 studies that met the previously defined inclusion criteria. The results were evaluated and summarized in the form of a narrative. Results: the findings of the studies pointed to a correlation among a strong sense of coherence, high quality of life and a greater likelihood of adopting healthy behaviors. Furthermore, the articles showed that social support improves perceived health and well-being of adults with cardiovascular disease. Conclusions: as a central concept of the salutogenic theory, a sense of coherence represents a topic of interest for nursing professionals. Through their interventions, nurses can strengthen and improve people’s skills in the quest for and maintenance of their own health.

Are Three Items Sufficient to Measure Sense of Coherence?

Abstract. The present study aimed at evaluating if the three-item sense of coherence (SOC) scale developed by Lundberg and Nystrom Peck (1995) can be effectively used for research purpose in both nonclinical and clinical samples. To provide evidence that it represents adequately the measured construct we tested its validity in a nonclinical (N = 658) and clinical sample (N = 764 patients with cancer). Results obtained in the nonclinical sample attested a positive relation of SOC – as measured by the three-item SOC scale – with Antonovsky’s 13-item and 29-item SOC scales (convergent validity), and with dispositional optimism, sense of mastery, anxiety, and depression symptoms (concurrent validity). Results obtained in the clinical sample confirmed the criterion validity of the scale attesting the positive role of SOC – as measured by the three-item SOC scale – on the person’s capacity to respond to illness and treatment. The current study provides evidence that the three-item SOC scale is a valid, low-loading, and time-saving instrument for research purposes on large sample.

Association between social participation and hypertension among older people in Japan: the JAGES Study

Hypertension is an important risk factor for cardiovascular disease, the leading cause of mortality in the world. Although previous studies have focused on individual-level behavioral risk factors associated with hypertension, there has been little research on how interacting with others, that is social participation, affects hypertension. To address this research gap, this study examined the association between social participation and hypertension in Japan, a country with a high prevalence of hypertension possibly linked to rapid population aging. Data were used from 4582 participants aged more than 65 years who participated in the Japan Gerontological Evaluation Survey (JAGES) with blood pressure data collected during a health check-up. The frequency of participation in vertical organizations (characterized by hierarchical relationships) and horizontal organizations (characterized by non-hierarchical, egalitarian relationships) was measured by a questionnaire. In a Poisson regression analysis, participation in vertical organizations was not associated with hypertension, whereas participation in horizontal organizations at least once a month was inversely associated with hypertension (prevalence ratio: 0.941). This association remained significant after adjusting for social support variables, although further adjustment for health behaviors attenuated the association. As the frequency of going out and average time spent walking were both associated with hypertension, physical activity may be a possible pathway that connects social participation and hypertension. The results of this study suggest that expanding social participation programs, especially those involving horizontal organizations, may be one way to promote better health among older people in Japan.

Work-related stress in midlife and all-cause mortality: can sense of coherence modify this association?

BACKGROUND

Survival reflects the accumulation of multiple influences experienced over the life course. Given the amount of time usually spent at work, the influence of work may be particularly important. We examined the association between work-related stress in midlife and subsequent mortality, investigating whether sense of coherence modified the association.

METHODS

Self-reported work-related stress was assessed in 1393 Swedish workers aged 42-65 who participated in the nationally representative Level of Living Survey in 1991. An established psychosocial job exposure matrix was applied to measure occupation-based stress. Sense of coherence was measured as meaningfulness, manageability and comprehensibility. Mortality data were collected from the Swedish National Cause of Death Register. Data were analyzed with hazard regression with Gompertz distributed baseline intensity.

RESULTS

After adjustment for socioeconomic position, occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence (HR, 3.15; 1.62-6.13), a result that was stronger in women (HR, 4.48; 1.64-12.26) than in men (HR, 2.90; 1.12-7.49). Self-reported passive jobs were associated with higher mortality in the presence of a weak sense of coherence in men (HR, 2.76; 1.16-6.59). The link between work stress and mortality was not significant in the presence of a strong sense of coherence, indicating that a strong sense of coherence buffered the negative effects of work-related stress on mortality.

CONCLUSIONS

Modifications to work environments that reduce work-related stress may contribute to better health and longer lives, especially in combination with promoting a sense of coherence among workers.

Sense of coherence is significantly associated with both metabolic syndrome and lifestyle in Japanese computer software office workers

OBJECTIVES

Sense of coherence (SOC) is an individual characteristic related to a positive life orientation, leading to effective coping. Little is known about the relationship between SOC and metabolic syndrome (MetS). This cross-sectional study aimed at testing the hypothesis that workers with a strong SOC have fewer atherosclerotic risk factors, including MetS, and healthier lifestyle behaviors.

MATERIAL AND METHODS

One hundred and sixty-seven computer software workers aged 20-64 years underwent a periodical health examination including assessment of body mass index, waist circumference, blood pressure, blood lipid levels, fasting blood sugar (FBS) levels and lifestyle behaviors (walking duration, smoking status, nutrition, alcohol consumption, and sleep duration). During this period, the participants also completed a 29-item questionnaire of SOC and the Brief Job Stress Questionnaire to assess job stressors such as job strain and workplace social support.

RESULTS

Our results showed that the participants with a stronger SOC were likely to walk for at least 1 h a day, to eat slowly or at a moderate speed, and to sleep for at least 6 h. Compared with the participants with the weakest SOC, those with the strongest SOC had a significantly lower odds ratio (OR) for being overweight (OR = 0.31; 95% confidence interval (CI): 0.11-0.81), and having higher FBS levels (OR = 0.11; 95% CI: 0.02-0.54), dyslipidemia (OR = 0.29; 95% CI: 0.09-0.84), and MetS (OR = 0.12; 95% CI: 0.02-0.63), even after adjusting for age, gender and job stressors.

CONCLUSIONS

High SOC is associated with a healthy lifestyle and fewer atherosclerotic risk factors, including MetS.

Development of burnout in middle-aged working women: a longitudinal study

OBJECTIVE

The present study had two aims: first, to identify developmental patterns of burnout in middle-aged women from the working population and, second, to evaluate whether work-related and individual factors are associated with concurrent changes in burnout.

METHODS

The study design was longitudinal and used a random, population-based sample of urban middle-aged women. One baseline and two follow-up assessments were carried out during a 9-year period. At baseline, 142 women participated. Complete data were available for 116 women, who constituted the sample of the present study. Burnout was assessed using the Shirom-Melamed Burnout Questionnaire (SMBQ). In order to identify typical developmental patterns (trajectories) hierarchical cluster analysis was used. Within-group changes in burnout levels over time were analyzed using repeated-measures analysis of variance (ANOVA).

RESULTS

When using a variable-based approach, the results showed no significant changes in burnout over time. However, underlying these levels, six trajectories were identified. These clusters represented four different developmental patterns: high levels followed by recovery, increasing levels, increasing and diminishing levels, and stable levels.

CONCLUSIONS

In contrast to previous research suggesting that burnout is a stable construct over time, the present study identified distinct subgroups of women showing different developmental patterns of burnout during a 9-year period. Furthermore, our findings showed that the development of burnout was accompanied by concurrent changes in life stress as well as work-related and individual factors.

Enhancing oral health via sense of coherence: a cluster-randomized trial

Sense of coherence (SOC) has been related to oral health behaviors and oral-health-related quality of life (OHRQoL) in observational studies. This cluster-randomized trial aimed to test the effect of an intervention to enhance SOC on OHRQoL in children. Twelve primary schools were randomly allocated to intervention and control groups. The intervention was comprised of 7 sessions over 2 mos, focusing on child participation and empowerment. The first 4 sessions were classroom activities, and the last 3 involved working on healthy school projects. Trained teachers who received a one-day course delivered the intervention. Socio-demographic and clinical data, together with self-reported measures of OHRQoL, SOC, and oral health beliefs, were obtained from 261 total 10- to 12-year-olds (133 in the intervention and 128 in the control groups). Data were collected at baseline, 2 wks after the intervention, and at three-month follow-up. Mixed-effects models indicated that the intervention increased SOC and improved OHRQoL, together with oral health beliefs and gingival health. The findings offer experimental evidence that OHRQoL can be influenced by SOC. SOC may also provide an avenue for oral health promotion (Australian New Zealand Clinical Trials Registry ACTRN12612000547842).

Mental health and sense of coherence among Swedish adults with cystic fibrosis

The purpose of this study was to describe mental health among adult Swedish patients with cystic fibrosis (CF) and to study if mental health and the salutogene factor sense of coherence (SOC) intercorrelate with good medical status. Women and men were compared. The patient group (n=59) attended the Stockholm CF Center. Mental health was measured with the General Health Questionnaire (GHQ-28) and the salutogenesis by SOC-3. Medical status included forced vital capacity and forced expiratory volume in 1 second in per cent of predicted as well as Body Mass Index. The differences within and between groups were tested with t-tests and the relations between the variables were described by Spearman's correlation coefficient. The patients had on the whole good mental health, but the group with a risk of mental ill-health (n=19) experienced life as difficult to manage, meaningless and hard to understand compared to the group with a small risk of mental ill-health (n=40). Women at risk of mental ill-health (n=10) experienced difficulties in managing life to a greater extent than women with a small risk of mental ill-health (n=16). Men at risk of mental ill-health (n=9) found life hard to understand. Mental health and SOC did not correlate significantly with the medical status of the CF patients. The conclusion was that there were comparably few problems of mental health among the patients with CF. The problems that were found were not related to the seriousness of their CF. Women had a more complex pattern of problems in mental health and SOC than men had.

The association of sense of coherence and coping profile with stress among research park city workers in Japan

Via a large scale cross-sectional study among Japanese white color workers, the authors aimed to elucidate: (1) the distributions of Sense of Coherence (SOC), which reflect stress coping abilities, (2) the distributions of the Brief Scale for Coping Profile (BSCP) which reflect coping profiles for stressors; (3) and the association between SOC and BSCP. Anonymous self-administered questionnaires were sent to 20,742 employees at educational and research institutions in Tsukuba Research Park City. A total of 12,009 (57.9%) workers completed and returned the questionnaire; 10,317 workers without missing data were analyzed. SOC scale scores and BSCP subscale scores differed by gender, age, and other demographic features. Among the BSCP subscales, workers whose SOC scale scores were higher tended to adopt a problem-focused coping profile, whereas workers whose SOC scale scores were lower adopted an emotion-focused coping profile. The coping profile that workers adopted depended on their background and demographic characteristics. Stronger SOC allowed one to adopt a problem-focused coping profile that allows for better coping with work-related stressors.

Sense of coherence and psychiatric morbidity in terms of anxiety and depression in patients with major depression before and after electric convulsive treatment

The specific aim of this study was to explore if the Sense of Coherence (SOC) Scale reflects and overlaps with standardized psychiatric assessments of depression and anxiety leading to the main hypothesis that the degree of depression decreases while the SOC scores remain stable. Fifteen patients with a diagnosis of major depression according to Axis I in DSM-IV and planned electric convulsive treatment (ECT) participated in the study. The clinician-rated instruments, Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Function (GAF), and the self-assessment instruments such as SOC and the Comprehensive Psychopathological Rating Scale-Self Rating Scale for Affective Syndromes (CPRS-S-A) were used before and after the treatment. The patients showed statistically significant improvements in clinician-rated depression (p < 0.001) and functional status (p < 0.001), and in self-rated anxiety (p = 0.001) and depression (p = 0.003). There was no significant improvement in SOC (p = 0.213). No significant correlations were found between the SOC scores and any of the measures except for GAF after treatment (r = 0.57, p = 0.039); the lower the SOC scores the greater was the functional dysfunction. In conclusion, the SOC Scale seems not to be a measure of psychopathology in terms of depression or anxiety merely.

'Adaptive' psychosocial factors in relation to home blood pressure: a study in the general population of southern Netherlands

BACKGROUND

Evidence is accumulating for an association between psychosocial stress and elevated blood pressure. However, studies focusing on adaptive psychosocial factors are scarce.

PURPOSE

We examined the association between putatively adaptive psychosocial factors and home blood pressure in a population study in the Netherlands.

METHOD

Resting blood pressure was measured of 985 female and 777 male participants between 20 and 55 years of age in their home setting. Questionnaires assessing problem-focused coping (active coping), adaptive emotion-focused coping (positive reinterpretation) and social support were completed.

RESULTS

When controlled for age, marital and socio-economic status, body mass index, parental history of hypertension, physical exercise, smoking, alcohol, coffee, and--in women--oral contraceptives, positive reinterpretation was associated with a lower prevalence of elevated home blood pressure (>or=140/90 mmHg): OR = 0.60, 95% CI = 0.40-0.88 (P = 0.009). Although all three psychosocial variables were associated with both systolic and diastolic blood pressure level, in multivariable analyses, only the associations between systolic blood pressure and positive reinterpretation (beta = -0.09, t = 3.25, P = 0.001) and active coping (beta = 0.07, t = 2.65, P = 0.008) remained significant.

CONCLUSION

Independent of other factors, only positive reinterpretation of the situation appeared to be related to more favorable blood pressure levels.

Adaptation to Social Adversity Is Associated With Stroke Incidence

Background and Purpose— Laboratory-based studies have suggested that individual differences in cardiovascular reactivity and stress adaptive capacity are associated with stroke incidence. We test the hypothesis that sense of coherence (SOC), a marker of social stress adaptive capacity, is associated with incident stroke in a population-based prospective cohort study.

Methods— A total of 20 629 participants, aged 41 to 80 years, in the UK European Prospective Investigation into Cancer (EPIC)-Norfolk study, who had not previously experienced a stroke, completed assessments that included SOC and details of their experience of life events during adulthood. An index of adaptation was constructed from responses to questions concerning over 80 000 adverse life events.

Results— During 145 000 person-years of follow-up (mean 7.1 years), 452 participants experienced either a fatal or nonfatal stroke event. A strong (as opposed to a weak) SOC was associated with a reduced rate of stroke incidence (rate ratio 0.76; 95% CI, 0.60 to 0.96) after adjustment for age, sex, pre-existing myocardial infarction, diabetes, hypertension treatment, family history of stroke, cigarette smoking, systolic blood pressure, obesity, social class, education, hostility and depression. No sex difference in this association was observed. Measures of social adversity occurrence and impact were not associated with stroke incidence, whereas faster reported adaptation to adverse event exposure was associated with a reduced rate of stroke incidence (rate ratio 0.89; 95% CI, 0.81 to 0.98; per standard deviation change in adaptation score, adjusted for age and sex).

Conclusions— Stress adaptive capacity is a potentially important candidate risk factor for stroke.

Allostatic load and clinical risk as related to sense of coherence in middle-aged women

OBJECTIVE

To investigate how physiologic dysregulation, in terms of allostatic load and clinical risk, respectively, relates to sense of coherence (SOC) in women with no previously diagnosed pathology.

METHODS

At baseline, 200 43-year-old women took part in a standardized medical health examination and completed a 3-item measure of SOC, which they completed again 6 years later. According to data from the medical examination, two different measures of physiologic dysregulation were calculated: a) a measure of allostatic load based on empirically derived cut points and b) a measure of clinical risk based on clinically significant cut points.

RESULTS

In line with the initial hypotheses, allostatic load was found to predict future SOC, whereas clinical risk did not. In addition to baseline SOC and nicotine consumption, allostatic load was strongly associated with a weak SOC at the follow-up.

CONCLUSIONS

The better predictive value of allostatic load to clinical risk indicates that focusing solely on clinical risk obscures patterns of physiologic dysregulation that influence future SOC.

Resilience, misfortune, and mortality: evidence that sense of coherence is a marker of social stress adaptive capacity

OBJECTIVE

The purpose of this study is to test the hypothesis that sense of coherence (SOC) distinguishes adaptive capacity to adverse event experience.

METHODS

A population-based cohort of 20,921 men and women completed a postal assessment of their lifetime experience of specific adverse events and a measure of their SOC. Reports of 111,857 events allowed construction of measures of event impact and adaptation.

RESULTS

Those with a weak SOC reported significantly slower adaptation to the adverse effects of their event experiences than those with a strong SOC (P<.0001). During mean follow-up of 6.7 years, 1617 deaths were recorded. A one standard deviation increase in mean adaptation score (representing slower adaptation) was associated with a 6% increase in mortality rate (P=.03) after adjusting for age and sex. Measures of event occurrence and impact were less strongly associated with SOC and were not significantly associated with mortality.

CONCLUSION

These results suggest that SOC is a potential marker of an individual's social stress adaptive capacity, which is predictive of mortality.