Despite pharmacologic advances, medication non-adherence continues to challenge primary care providers in blood pressure (BP) management.
Medical, nursing and pharmacy students (n = 11) were recruited and trained as health coaches for uninsured, hypertensive patients (n = 25) of a free clinic in an uncontrolled open trial. Pre-post analysis was conducted on BP, medication adherence, frequency of home BP monitoring, and healthy behavior (e.g., diet, exercise). Patient satisfaction and feasibility of a student coach model was qualitatively evaluated.
In the 12 patients who completed the intervention, an increase in medication adherence as measured by the Brief Medication Questionnaire was observed (P < 0.01), with a 11 mmHg reduction in systolic BP (P = 0.03). Qualitative data showed patient satisfaction with the intervention and other healthy behavior change.
This feasibility study shows use of student health coaches to combat medication non-adherence in uninsured, hypertensive adults is promising.
health coach; hypertension; medication adherence
The remarkable decline in cardiovascular disease (CVD) experienced in developed countries over the last 40 years appears to have abated. Currently, many CVD patients continue to show cardiac events despite optimal treatment of traditional risk factors. This evidence suggests that additional interventions, particularly those aimed at nontraditional factors, might be useful for continuing the decline. Psychosocial stress is a newly recognized (nontraditional) risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, (a) clustering of traditional cardiovascular risk factors, (b) endothelial dysfunction, (c) myocardial ischemia, (d) plaque rupture, (e) thrombosis, and (f) malignant arrhythmias. A better understanding of the behavioral and physiologic associations between psychosocial stress and CVD will assist researchers in identifying effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality.
cardiovascular disease; psychosocial interventions; psychosocial stress; review
Psychosocial stress is a nontraditional risk factor for cardiovascular morbidity and mortality that may respond to behavioral or psychosocial interventions. To date, studies applying such interventions have reported a wide range of success rates in treatment or prevention of cardiovascular disease (CVD). The authors focus on a natural medicine approach that research indicates reduces both psychosocial and traditional risk factors for cardiovascular disease—the Transcendental Meditation (TM) program. Randomized controlled trials, meta-analyses, and other controlled studies indicate this meditation technique reduces risk factors and can slow or reverse the progression of pathophysiological changes underlying cardiovascular disease. Studies with this technique have revealed reductions in blood pressure, carotid artery intima-media thickness, myocardial ischemia, left ventricular hypertrophy, mortality, and other relevant outcomes. The magnitudes of these effects compare favorably with those of conventional interventions for secondary prevention.
cardiovascular disease; psychosocial stress; review; Transcendental Meditation
The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups.
coping; depression; HIV; sexual identity; symptoms; social support
Fatigue in chronic fatigue syndrome (CFS) is usually assessed with retrospective measures rather than real-time momentary symptom assessments. In this study, the authors hypothesized that in participants with CFS, discrepancies between recalled and momentary fatigue would be related to catastrophizing, anxiety, and depression and to variability of momentary fatigue. They also expected that catastrophizing, anxiety, and depression would be associated with momentary fatigue. The authors asked 53 adults with CFS to carry electronic diaries for 3 weeks and record their experiences of momentary fatigue. The authors assessed participants' fatigue recall with weekly ratings and administered questionnaires for catastrophizing, depression, and anxiety. Recall discrepancy was significantly related to the variability of momentary fatigue. In addition, catastrophizing, depression, and momentary fatigue were all significantly related to recall discrepancy. Catastrophizing, depression, anxiety, and momentary negative affect were all significantly associated with momentary fatigue. The findings suggest that momentary fatigue in patients with CFS is related to modifiable psychological factors.
affect; chronic fatigue syndrome; fatigue; measurement; pain
The first author recruited parent–adolescent dyads (N = 192) into after-school prevention education groups at middle schools in southeast Texas. This author placed participants in either (1) an Interactive Program (IP) in which they role-played, practiced resistance skills, and held parent–child discussions or (2) an Attention Control Program (ACP) that used the same curriculum but was delivered in a traditional, didactic format. Questionnaires administered at the beginning and end of the 4-session program and again after booster sessions in 3 subsequent semesters provided measures of social controls (eg, communication with parents) and self controls (eg, protection against risk) on the youths' sexual health behaviors. Linear mixed models adjusted for gender, age, and ethnicity showed that the IP, in comparison with the ACP, achieved significant gains in social control by increasing parental rules about having sex and other risky behaviors and also enhanced students' self-control by increasing their knowledge about prevention and enhancing resistance responses when pressured to have sex.
adolescent pregnancy prevention; HIV/STD prevention; parent involvement
The authors evaluated the relationships among childhood maltreatment, sexual trauma in adulthood, posttraumatic stress disorder (PTSD), and health functioning in women. Female Veterans’ Affairs (VA) primary care patients (N = 200) completed self-report measures of childhood maltreatment, adult sexual trauma, PTSD symptoms, and current health functioning. The authors used structural equation modeling to test models of the relationship among these variables. Childhood nonsexual maltreatment and adult sexual assault were positively associated with PTSD. Childhood nonsexual maltreatment (β = −.20) and PTSD (β = −.75) were significantly associated with poorer physical and mental health functioning. Adult sexual assault negatively affected health functioning through its association with PTSD. Thus, poor health outcomes associated with childhood maltreatment in women may be conveyed through PTSD. These findings should strengthen efforts directed at identifying and treating PTSD in female victims of childhood maltreatment with the aim of preventing or attenuating poor health outcomes.
childhood maltreatment; health outcomes; posttraumatic stress disorder; sexual trauma
Normal nonrandom fluctuations in daily human perfomance have been documented for years. Published research reports have shown patterns of workers' errors in reading gas meters, operators' delays in answering calls, drivers' drowsiness, sleepy locomotive engineers' automatic breaking, vehicle crashes, deaths resulting from disease, brief periods of sleep, and sleep latency in structured naps. The authors summarized these data sets and fitted them with a two-peak-per-day cosine curve derived from the population growth function used in chaos theory. Median parameters extracted from the curve fits predicted a sharp peak of sleepiness at 2:30 AM and a secondary peak at 2:30 PM. The shape of the curve was modified by a nonlinear sleep-deprivation factor. The model appeared to be biological rather than behavioral or social because it applied well to disease-related deaths. The authors also review measurement of sleepiness through electroencephalographic monitoring, self-reports, pupillography, and the Multiple Sleep Latency and the Maintenance of Wakefulness Tests.
circadian rhythm; electroencephalographic (EEG) monitoring; fatigue; public safety; sleep deprivation; sleepiness; testing
Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multi-modality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson’s disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program.
complementary and alternative medicine; chronic disease; Maharishi Vedic Medicine; natural medicine
To examine the NEO personality inventory-revised (NEO-PI-R) as a predictor of dietary quality in married couples, with focus on associations among: 1) each participant’s personality as a predictor of their own dietary assessment, and 2) each participant’s personality as a predictor of their spouses’ dietary assessment.
Participants were 850 couples from the University of North Carolina Alumni Heart Study (UNCAHS). NEO personality data was gathered during the baseline enrollment period from 1988–92. The dietary assessment was based on a modified version of the USDA Healthy Eating Index (MHEI) developed specifically for use in the UNCAHS; and data for calculating this measure were gathered from 1994–96. Analyses focused on examination of: 1) each participant’s NEO assessments with their own MHEI, and 2) each participant’s NEO assessments with their spouse’s MHEI.
Openness was associated with self ratings of dietary quality for both wives’ (r = .28) and husband’s (r =.27). Wives’ Openness levels were also related to their spouses’ ratings of dietary quality (r =.22). The primary facets of Openness accounting for the domain level findings were O2:Aesthetics and O4:Actions. The remaining personality domains (Neuroticism, Extraversion, Agreeableness, and Conscientiousness) were not associated with self or spousal ratings of dietary quality (r’s −.10 – .01).
Openness is associated with healthy eating habits—findings that may bear on disease prevention during midlife.
Personality; NEO-PI-R-Diet; Spouses
Prostate cancer is one of the most common forms of cancer among American men, and worry about the disease has psychological, behavioral, and biological consequences. To better understand prostate cancer–specific worry, the authors tested a model of the interrelationships among family history of prostate cancer, perceived risk of and worry about prostate cancer, and perceived risk of and worry about other diseases. Men who attended prostate cancer-screening appointments at a general urology practice (n = 209) were given a brief anonymous self-report measure. Structural equation modeling (LISREL) results indicated: (1) perceived risk of prostate cancer mediated the relationship between family history of prostate cancer and prostate cancer worry; (2) perceived risk of other diseases increased perceived risk of prostate cancer; and (3) prostate cancer worry and increased other disease worry.
anxiety; prostatic neoplasms; risk; risk factors