Older and feeling unsafe? Differences in underlying vulnerability, anxiety and life satisfaction among older adults.

Objectives: Feeling safe in the daily environment is important in late life. However, research on configuration of vulnerability factors for perceived unsafety in older adults is scarce. The current study aimed to identify latent subgroups of older adults based on their vulnerability for perceived unsafety.Method: We analyzed the data from a cross-sectional survey of residents in senior apartments in a mid-sized Swedish municipality (N = 622).Results: The results of the latent profile analysis based on frailty, fear of falling, social support, perceived neighborhood problems, and trust in others in the neighborhood indicated the presence of three profiles. These profiles were labelled as compromised body and social networks (7.2%), compromised context (17.9%) and non-vulnerable (74.9%). Profile membership was statistically predicted by age, gender, and family status and profiles differed in perceived unsafety, anxiety and life satisfaction.Conclusion: Overall, the study findings suggested the existence of latent subgroups of older people based on patterns of vulnerability.

The association between screen time and reported depressive symptoms among adolescents in Sweden.

BACKGROUND: How screen use is associated with adolescents' mental health has been widely debated in public media during the last decade, but there is still lack of information about if and how the associations vary between types of electronic media. OBJECTIVE: This study aimed to examine how time spent on types of screen use (social media, gaming alone, gaming in groups and watching TV) was associated with depressive symptoms among adolescents in Sweden, and whether gender moderated these associations. METHODS: We analysed data from the Swedish section of the Children of Immigrants: Longitudinal Survey in Four European Countries. The final sample consisted of 3556 eighth grade adolescents in 2011 (51% girls). We used logistic regression analysis to estimate the odds ratio of feeling depressed often versus less often/not at all using time spent on different types of screen use as predictor variables. Additionally, we tested interaction effects between gender and the predictor variables. RESULTS: Our results showed that spending more than 2 hours on social media was associated with higher odds of feeling depressed often compared with spending 2 hours or less. Not watching TV was associated with higher odds of feeling depressed often compared with watching TV. These patterns did not differ across genders. Gaming alone and gaming in groups were not associated with depressive symptoms. CONCLUSIONS: Our findings suggest that more frequent social media use and not watching TV were associated with a higher level of depressive symptoms.

This study examined how time spent on four types of screen use including social media, gaming alone, gaming in groups and watching TV was associated with depressive symptoms among adolescents in Sweden, and whether these associations differed for girls and boys. We analysed data from the Swedish section of the Children of Immigrants: Longitudinal Survey in Four European Countries. The final sample consisted of 3556 eighth grade adolescents in 2011 (51% girls). We used logistic regression analysis to estimate the odds ratio of feeling depressed often versus less often/not at all using time spent on different types of screen use as predictor variables. In addition, we tested interaction effects between gender and the predictor variables. Our results showed that social media use and not watching TV was associated with higher odds of feeling depressed often. Gaming alone and gaming in groups were not associated with higher level of depressive symptoms. These patterns did not differ across genders.

Gene × Environment contributions to autonomic stress reactivity in youth.

Dysregulated physiological stress reactivity has been suggested to impact the development of children and adolescents with important health consequences throughout the life span. Both environmental adversity and genetic predispositions can lead to physiological imbalances in stress systems, which in turn lead to developmental differences. We investigated genetic and environmental contributions to autonomic nervous system reactivity to a psychosocial stressor. Furthermore, we tested whether these effects were consistent with the differential susceptibility framework. Composite measures of adverse life events combined with socioeconomic status were constructed. Effects of these adversity scores in interaction with a polygenic score summarizing six genetic variants, which were hypothesized to work as susceptibility factors, were tested on autonomic nervous system measures as indexed by heart rate and heart rate variability. Results showed that carriers of more genetic variants and exposed to high adversity manifested enhanced heart rate variability reactivity to a psychosocial stressor compared to carriers of fewer genetic variants. Conversely, the stress procedure elicited a more moderate response in these individuals compared to carriers of fewer variants when adversity was low.

Towards explaining time trends in adolescents' alcohol use: a multilevel analysis of Swedish data from 1988 to 2011.

BACKGROUND: Alcohol use has decreased among Swedish adolescents in the past few decades. We examined peer and parent factors (i.e. time spent with peers, time spent with parents and parental monitoring) that could contribute to explaining this trend by investigating their main effects and interaction effects with investigation years on alcohol use. We furthermore examined whether municipality-level socioeconomic conditions could contribute to explaining the trend. METHODS: We used data from a repeated cross-sectional study that took place eight times between 1988 and 2011. The study targeted all ninth grade students (15-16 years old) in Värmland County, Sweden. Adolescents (N = 22 257) reported their monthly alcohol use, time spent with peers and parents and parental monitoring. Municipality-level socioeconomic conditions were based on parent education levels. RESULTS: Logistic multilevel regression analyses showed that peer and parent factors and municipality-level socioeconomic conditions were associated with alcohol use among adolescents. The interaction effects between peer and parent factors and investigation years were not significant. The decreased trend in time spent with peers was associated with the decreased trend in frequency of alcohol use over time. CONCLUSIONS: The findings of the current study provide an indication that the decreased trend in alcohol use that has been observed in Swedish adolescents over the past few decades may be related to changes in adolescents' social interactions with peers.

Reasons for entering treatment reported by initially treatment-resistant patients with substance use disorders.

Many individuals with substance use disorders are resistant to entering formal treatment, despite the negative consequences that plague their own lives and the lives of concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) has been developed as an effective strategy for helping family members who are concerned about the alcohol/drug use of a loved one who refuses to seek treatment. The present study explored reasons and feelings that played a part in these resistant individuals' (identified patients [IPs]) decision to begin treatment. Written statements and feelings of 36 initially treatment-refusing IPs, who were engaged into treatment via their CRAFT-trained CSOs, were examined upon entering treatment. Self-report forms assessed three complementary domains about entering treatment: (1) feelings about coming for treatment, (2) important reasons for entering treatment, and (3) reasons for entering treatment narratives. It was shown that the occurrences of self-reported positive emotions and statements that expressed a positive wish for change outweighed negative feelings and statements. Although conceivably these CRAFT-exposed IPs may have provided different responses than other treatment-seeking populations, the current study's strong IP reports of positive feelings, reasons, and narrative statements regarding treatment entry nonetheless address potential concerns that treatment-refusing IPs might only enter treatment if felt coerced by family members and while experiencing salient negative feelings overall.

Adolescent Girls' Musculoskeletal Pain is More Affected by Insomnia Than Boys, and Through Different Psychological Pathways.

Prior research has established that insomnia is predictive of pain in adolescents and that psychological mechanisms have a crucial role in this relationship. Adolescent girls report more insomnia and pain than boys, yet little is known of gender differences in how insomnia influences pain. This study assessed gender differences in levels and trajectories of insomnia and pain during adolescence, and whether rumination and negative mood mediated the effect of insomnia on pain. Longitudinal survey data measured on 5 annual occasions (Nbaseline = 2,767) were analyzed in a multigroup longitudinal serial mediation model. A final model was generated with insomnia as the predictor, rumination and depressed mood as mediators, pain as the outcome, and gender as the grouping variable. The results showed that insomnia predicted pain in adolescents, with an effect 3.5 times larger in girls than boys. Depressed mood was the main mediator in boys. In girls, rumination was the only significant mediator. There were significant gender differences in the effects of insomnia on rumination and pain, and in the effects of rumination on depressed mood and pain, with stronger effects in girls. These results highlight that girls and boys should be considered separately when studying the relationship between insomnia and pain. PERSPECTIVE: Levels of insomnia and pain are progressively higher in adolescent girls than boys, across adolescence. The predictive strength of insomnia symptoms for future pain is 3.5 times greater in girls, with distinct gender-specific underlying pathways: rumination partially mediates this effect in girls, while depressed mood does so in boys.

Lower autonomic arousal as a risk factor for criminal offending and unintentional injuries among female conscripts.

BACKGROUND: Lower autonomic arousal is a well-known correlate of criminal offending and other risk-taking behaviors in men, but few studies have investigated this association in women. AIM: To test associations between autonomic arousal and criminal offending as well as unintentional injuries among female conscripts. METHODS: All women born 1958-1994 in Sweden who participated in voluntary military conscription (n = 12,499) were identified by linking Swedish population-based registers. Predictors were resting heart rate (RHR) and systolic blood pressure (SBP). Covariates were height, weight, and physical energy capacity. Main outcomes were criminal convictions (any, violent, and non-violent) from the National Crime Register. Secondary outcome was unintentional injuries requiring medical treatment or causing death. We used survival analyses to test for associations between predictors and outcomes. RESULTS: Low RHR, relative to high RHR, was associated with an increased risk of any criminal conviction, non-violent criminal convictions, and unintentional injuries. Low SBP, relative to high SBP, was associated with an increased risk of violent criminal convictions. CONCLUSIONS: Results support lower autonomic arousal, particularly lower RHR, as a correlate of criminal offending among women that warrants further examination, as the reported findings have potential implications for the prediction of future female crime.

Parental rearing behavior prospectively predicts adolescents' risky decision-making and feedback-related electrical brain activity.

The present study examined the role of parental rearing behavior in adolescents' risky decision-making and the brain's feedback processing mechanisms. Healthy adolescent participants (n = 110) completed the EMBU-C, a self-report questionnaire on perceived parental rearing behaviors between 2006 and 2008 (T1). Subsequently, after an average of 3.5 years, we assessed (a) risky decision-making during performance of the Balloon Analogue Risk Task (BART); (b) event-related brain potentials (ERPs) elicited by positive (gain) and negative feedback (loss) during the BART; and (c) self-reported substance use behavior (T2). Age-corrected regression analyses showed that parental rejection at T1 accounted for a unique and significant proportion of the variance in risk-taking during the BART; the more adolescents perceived their parents as rejecting, the more risky decisions were made. Higher levels of perceived emotional warmth predicted increased P300 amplitudes in response to positive feedback at T2. Moreover, these larger P300 amplitudes (gain) significantly predicted risky decision-making during the BART. Parental rearing behaviors during childhood thus seem to be significant predictors of both behavioral and electrophysiological indices of risky decision-making in adolescence several years later. This is in keeping with the notion that environmental factors such as parental rearing are important in explaining adolescents' risk-taking propensities.

Blunted feedback processing during risky decision making in adolescents with a parental history of substance use disorders.

Risky decision making, a hallmark phenotype of substance use disorders (SUD), is thought to be associated with deficient feedback processing. Whether these aberrations are present prior to SUD onset or reflect merely a consequence of chronic substance use on the brain remains unclear. The present study investigated whether blunted feedback processing during risky decision making reflects a biological predisposition to SUD. We assessed event-related potentials elicited by positive and negative feedback during performance of a modified version of the Balloon Analogue Risk Task (BART) among high-risk adolescents with a parental history of SUD (HR; n = 61) and normal-risk controls (NR; n = 91). HR males made significantly more risky and faster decisions during the BART than did NR controls. Moreover, HR adolescents showed significantly reduced P300 amplitudes in response to both positive and negative feedback as compared to NR controls. These differences were not secondary to prolonged substance use exposure. Results are discussed in terms of feedback-specific processes. Reduced P300 amplitudes in the BART may reflect poor processing of feedback at the level of overall salience, which may keep people from effectively predicting the probability of future gains and losses. Though conclusions are tentative, blunted feedback processing during risky decision making may represent a promising endophenotypic vulnerability marker for SUD.

Diminished error-related brain activity as a promising endophenotype for substance-use disorders: evidence from high-risk offspring.

One of the core features of individuals with a substance-use disorder (SUD) is the reduced ability to successfully process errors and monitor performance, as reflected by diminished error-related negativities (ERN). However, whether these error-related brain abnormalities are caused by chronic substance use or rather predates it remains unclear. The present study elucidated whether hypoactive performance monitoring represents an endophenotypic vulnerability marker for SUD by using a high-risk paradigm. We assessed the behavioral components of error-processing, as well as the amplitude of the ERN in the event-related brain potential (ERP) during performance of the Eriksen Flanker Task among high-risk adolescents of parents with a SUD (HR; n = 28) and normal-risk controls (NR; n = 40). Results revealed that HR offspring were characterized by a higher prevalence of internalizing symptoms and more frequent cannabis use, the latter having a significant influence on the ERN. Interestingly, risk group uniquely predicted the negativity amplitude in response to error trials above and beyond confounding variables. Moreover, we found evidence of smaller ERN amplitudes in (cannabis use-naïve) HR offspring, reflecting impaired early processing of error information and suboptimal performance monitoring, whereas no robust group differences were found for overall behavioral performance. This effect was independent of an overall reduction in brain activity. Taken together, although we cannot rule out alternative explanations, the results of our study may provide evidence for the idea that diminished error-processing represents a promising endophenotype for SUD that may indicate a vulnerability to the disorder.

Hypothalamic-pituitary-adrenal axis responsivity during adolescence in relation to psychopathic personality traits later in life.

Psychopathic personality traits have been linked to low physiological arousal, particularly among high risk and forensic samples. A core indicator of physiological arousal is the activity of the hypothalamic-pituitary-adrenal (HPA) axis; however, findings of a link between HPA axis functioning and psychopathic personality traits have been inconsistent. Furthermore, given sex differences in both HPA axis responsivity and psychopathic personality traits, the association may be expected to differ between men and women. The aim of this study was to investigate the association between HPA axis responsivity in mid-adolescence and psychopathic personality traits in early adulthood and determine whether the association was moderated by sex. We examined this link in a general population sample of twins (N = 556). Adolescents participated in a psychosocial stress task during which samples of salivary cortisol were collected (11-15 years) and reported psychopathic personality traits using the Triarchic Psychopathy Measure (19-20 years). Multilevel linear regression models were estimated in which psychopathic personality traits (boldness, meanness and disinhibition), and their interactions with sex, were regressed on HPA axis responsivity. The study was pre-registered on the Open Science Framework (osf.io/gs2a8). Preliminary analyses showed that cortisol levels did not increase significantly during the stressor task but decreased during recovery. Results showed that there was no association between HPA axis responsivity in mid-adolescence and psychopathic personality traits in early adulthood. The associations were not moderated by sex. Findings suggest that HPA axis responsivity in mid-adolescence did not serve as a biological marker for psychopathic personality traits among young adults from the general population.

Youth in the Netherlands study (JOiN): study design.

BACKGROUND: Adolescence is a critical developmental period regarding exposure to substances. Therefore, it is important to be able to identify those adolescents who are most vulnerable to substance abuse in the (near) future. The JOiN study was specifically designed to examine two endophenotypes of adolescent substance use in a normal risk (NR) and high risk (HR) sample of adolescents: (1) behavioural disinhibition, and (2) individual differences in stress sensitivity. METHODS: The NR adolescents were part of a longitudinal general population study at the Erasmus Medical Center in Rotterdam, the Netherlands of children and adolescents initially aged 6 to 18 years old. Three assessment waves have been nearly completed, and data are available of N = 711 participants for stress sensitivity measures, and of a subsample of N = 110 for electroencephalography (EEG) measures. Added to this study, HR adolescents who had at least one parent with a substance use disorder and who were treated by an outpatient clinic of a primary addiction care provider were approached via their parent(s). In total, N = 83 adolescents formed this HR sample. NR and HR adolescents participated in standardized stress procedure and EEG procedures in our laboratory. Questionnaires were filled out on background variables, behavioural and emotional problems, and substance use, and a diagnostic interview was conducted with adolescents and parents to assess psychopathology symptoms. DNA was collected through saliva or blood samples. DISCUSSION: The design of the JOiN study is optimal for examining the predictive role of endophenotypes of adolescent substance use. The combination of different methods, i.e. stress physiology, electrophysiology, genetics, and questionnaire data from several informants on a range of behaviours and environmental factors enables the investigation of the multifactorial nature of adolescent substance use.

Serum IL-6 and MCP-1 concentrations in dogs with lymphoma before and after doxorubicin treatment as a potential marker of cellular senescence.

BACKGROUND: Chemotherapy can induce cellular senescence and a secretory phenotype characterized by an increased expression of inflammatory cytokines, such as IL-6 and MCP-1. Increased IL-6 and MCP-1 serum concentrations have been documented in dogs with lymphoma, but no studies have evaluated the effects of chemotherapy on cytokine concentrations. OBJECTIVES: To measure IL-6 and MCP-1 in 16 client-owned dogs with lymphoma, at baseline and before and after doxorubicin, as a potential marker for senescence and correlate cytokine concentrations with treatment response and toxicities. METHODS: Serum IL-6 and MCP-1 concentrations at baseline, 0-h, 3-h, 6-h, 24-h and 1 week post doxorubicin were measured using a canine ELISA. We hypothesized that IL-6 and MCP-1 concentrations would increase following doxorubicin as a result of induction of cellular senescence. RESULTS: IL-6 concentrations were unchanged from baseline to 0-h but significantly decreased 1 week post doxorubicin (p = 0.001) compared to 0-6 h (p = 0.045) and 24-h (p = 0.001) time points. MCP-1 concentrations significantly decreased from baseline to 0-h (p = 0.003). Compared to 0-6 h, MCP-1 concentrations transiently increased at 24-h (p = 0.001) and decreased at 1 week (p = 0.014) post doxorubicin. Changes in IL-6 and MCP-1 concentrations did not correlate with leukocyte count, response to treatment or chemotherapy toxicities. CONCLUSIONS: Changes in IL-6 and MCP-1 concentrations did not support doxorubicin-induced cellular senescence or correlate with leukocyte count, response to treatment or chemotherapy toxicity. However, our results suggest that remission status and doxorubicin treatment may influence cytokine concentrations and future studies are warranted to investigate the role of these cytokines as biomarkers.

The startle reflex as an indicator of psychopathic personality from childhood to adulthood: A systematic review.

The startle reflex has been suggested to operate as a psychophysiological marker of psychopathic personality, based on findings from studies using a range of different methodologies and participant samples. The present review aims at synthesizing existing evidence of the relationship between psychopathy and the startle reflex across task paradigms, psychopathic personality subtypes and subdimensions, participant samples (i.e., incarcerated/ clinical or non-offenders), and age groups using the triarchic model of psychopathy as a frame of reference. Systematic literature searches were conducted up until the 24th of March 2020 in PubMed, PsycINFO, and Web of Science. A total of 2311 potential studies were identified, out of which 40 met relevancy and quality criteria. Results indicate that reduced aversive startle potentiation is associated with psychopathic personality in general, but clusters of traits relating to the triarchic model constructs of boldness and meanness in particular. Available evidence suggest that startle paradigms could be meaningful for differentiating individuals with and without psychopathic personality. Findings support suggestions of psychopathic personality as a multifaceted, rather than a unitary construct. Reduced aversive startle potentiation has also been found in relation to psychopathic features in child-aged samples but work of this kind is limited and more research is needed. Future studies should focus on greater consistency in task paradigms and analytic strategies to enhance the capacity to compare and integrate findings across studies.

Classroom Disorder and Internalizing Problems Among Swedish Adolescents: Changes Between 1988 and 2011.

BACKGROUND: Internalizing problems have increased among Swedish adolescents. We examined whether classroom disorder was associated with internalizing problems and whether it explained the trends in internalizing problems. Furthermore, we examined whether school contextual factors were associated with internalizing problems and whether they moderated the association between classroom disorder and internalizing problems. METHODS: We used repeated cross-sectional survey data (1988-2011) among all 15- to 16-year-old students in Värmland, Sweden (N = 9491 boys, N = 9313 girls). School-level factors were the proportions of students with a low/average socioeconomic or an immigration background. RESULTS: Results from mixed effects models showed that classroom disorder was associated with internalizing problems across the years of investigation but did not explain the trends in internalizing problems. This association was moderated by the school-level proportion of students with a low/average socioeconomic background but not the school-level proportion of students with an immigration background. CONCLUSIONS: Students who perceived their classroom to be disorderly more often also reported more internalizing problems. Future studies are necessary to investigate other potential school factors that may explain the trends in internalizing problems.

A latent class analysis of changes in adolescent substance use between 1988 and 2011 in Sweden: associations with sex and psychosomatic problems.

AIMS: To characterize changes in patterns of adolescent substance use in Sweden between 1988 and 2011, and to assess whether sex and psychosomatic problems were associated with substance use and whether these associations changed over time. DESIGN: Secondary analysis of repeated cross-sectional survey data. Survey data were collected eight times and analyzed as four cohorts (1988-91, 1995-98, 2002-05 and 2008-11). SETTING AND PARTICIPANTS: The sample included all 15-16-year-olds in Värmland County, Sweden (n = 20 057). MEASUREMENTS: Binary-coded substance use measures included life-time use of alcohol and tobacco, getting drunk and past school year use of inhalants. An eight-item scale was used to assess psychosomatic problems. FINDINGS: A three-class model fitted the data best (i.e. non/low use, mainly alcohol use and polysubstance use). The patterns of substance use were different among cohorts; most notably, adolescents in the last cohort had lower odds of being included in the alcohol and polysubstance use classes rather than the non/low use class than in the earlier cohorts (all Ps < 0.001). Males had higher odds than females of being in the polysubstance use class rather than the non/low use class among the first three cohorts (all Ps < 0.001) but not the last. Sex was not associated with inclusion in the alcohol use class rather than the non/low use class. Adolescents who reported more psychosomatic problems had higher odds of being included in the alcohol and polysubstance use classes rather than the non/low use class (all Ps < 0.001). The associations of sex and psychosomatic problems with class inclusion did not change during the study period. CONCLUSIONS: Between 1988 and 2011, patterns of substance use among adolescents in Sweden shifted away from polysubstance use and alcohol use to non-use or low use. Associations between patterns of substance use and sex and psychosomatic problems remained largely consistent across the study period.

Mental Health Problems Among Adolescents in Sweden from 1995 to 2011: The Role of Immigrant Status and the Proportions of Immigrant Adolescents in Their Surrounding Community.

We compared the mental health of native and immigrant adolescents in Sweden from 1995 to 2011 and examined whether the municipality-level proportion of immigrant adolescents moderated the association between individual-level immigrant status and mental health. The sample (14,189 adolescents aged 15-16) was obtained from a repeated cross-sectional study conducted from 1995 to 2011. Adolescent self-report data (gender, immigrant status, economic situation, and mental health) and municipality-level data (proportion of immigrant adolescents) were used in multilevel linear regression analyses. Immigrant adolescents reported more mental health problems than their native Swedish peers. The long-term trend in mental health problems did not differ between the two groups. The association between individual immigrant status and mental health did not differ according to the municipality-level rate of immigrant adolescents. These findings highlight the need for public health attention to and efforts to address immigrant adolescents' mental health problems in Sweden.

Lymphocytosis and lymphadenopathy in a dog arising from two distinct lymphoid neoplasms.

A 10-year-old intact male Golden Retriever was presented to The Ohio State University Veterinary Medical Center for acute, non-painful facial swelling of the right mandibular region. On physical examination, the right mandibular swelling was found to represent marked lymphadenopathy of the submandibular lymph node. At this time, marked lymphadenopathy of the prescapular and popliteal lymph nodes was also appreciated. The CBC showed a moderate leukocytosis (38.4 × 109 cells/L, reference interval [RI] 4.8-13.9 × 109 cells/L) characterized by a moderate lymphocytosis (28.4 × 109 cells/L, RI 1.0-4.6 × 109 cells/L). Evaluation of peripheral blood and enlarged prescapular and popliteal lymph nodes revealed two morphologically different populations of homogeneous lymphocytes, with the lymphocyte population in the lymph nodes being distinct from that in the blood smear. Flow cytometry of peripheral blood revealed CD45-, CD5+, CD4-, CD8-, variably CD21+ neoplastic lymphocytes compatible with T-zone lymphocytes due to the absence of CD45 expression. Flow cytometry of the lymph node aspirate indicated a distinct population of CD21+ lymphocytes consistent with a B-cell phenotype along with a smaller proportion of the T-zone lymphocytes observed in the blood confirming the presence of two distinct populations of neoplastic lymphocytes, one involving T cells, and the other involving B cells.

Urbanicity, biological stress system functioning and mental health in adolescents.

Growing up in an urban area has been associated with an increased chance of mental health problems in adults, but less is known about this association in adolescents. We examined whether current urbanicity was associated with mental health problems directly and indirectly via biological stress system functioning. Participants (n = 323) were adolescents from the Dutch general population. Measures included home and laboratory assessments of autonomic nervous system and hypothalamic-pituitary-adrenal axis functioning, neighborhood-level urbanicity and socioeconomic status, and mother- and adolescent self-reported mental health problems. Structural equation models showed that urbanicity was not associated with mental health problems directly. Urbanicity was associated with acute autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity such that adolescents who lived in more urban areas showed blunted biological stress reactivity. Furthermore, there was some evidence for an indirect effect of urbanicity on mother-reported behavioral problems via acute autonomic nervous system reactivity. Urbanicity was not associated with overall autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity or basal hypothalamic-pituitary-adrenal axis functioning. Although we observed some evidence for associations between urbanicity, biological stress reactivity and mental health problems, most of the tested associations were not statistically significant. Measures of long-term biological stress system functioning may be more relevant to the study of broader environmental factors such as urbanicity.

Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial.

BACKGROUND: Self-management has increasingly been recommended as part of standard care for fibromyalgia, a common, poorly understood condition with limited treatment options. Data that assess popular self-management recommendations are scarce. We evaluated and compared the effectiveness of 4 common self-management treatments on function, symptoms, and self-efficacy in women with fibromyalgia. METHODS: A total of 207 women with confirmed fibromyalgia were recruited from September 16, 2002, through November 30, 2004, and randomly assigned to 16 weeks of (1) aerobic and flexibility exercise (AE); (2) strength training, aerobic, and flexibility exercise (ST); (3) the Fibromyalgia Self-Help Course (FSHC); or (4) a combination of ST and FSHC (ST-FSHC). The primary outcome was change in physical function from baseline to completion of the intervention. Secondary outcomes included social and emotional function, symptoms, and self-efficacy. RESULTS: Improvements in the mean Fibromyalgia Impact Questionnaire score in the 4 groups were -12.7 for the ST-FSHC group, -8.2 for the AE group, -6.6 for the ST group, and -0.3 for the FSHC group. The ST-FSHC group demonstrated greater improvement than the FSHC group (mean difference, -12.4; 95% confidence interval [CI], -23.1 to -1.7). The ST-FSHC (mean difference, 13.6; 95% CI, 2.3 to 24.9) and AE (mean difference, 13.1; 95% CI, 1.6 to 25.6) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey. Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC (14.8), AE (13.2), and ST (5.7) groups. Social function, mental health, fatigue, depression, and self-efficacy also improved. The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months. CONCLUSIONS: Progressive walking, simple strength training movements, and stretching activities improve functional status, key symptoms, and self-efficacy in women with fibromyalgia actively being treated with medication. The benefits of exercise are enhanced when combined with targeted self-management education. Our findings suggest that appropriate exercise and patient education be included in the treatment of fibromyalgia.