RESUMEN
Cardiovascular behavioral medicine has significantly advanced the knowledge base regarding the mechanisms by which psychological and behavioral factors can impact cardiovascular function and has developed clear links between these factors and cardiovascular health and disease. More recent work has established numerous behavioral interventions that are efficacious, and in several cases demonstrated to be effective. However, despite these significant advances, translation to broad, real-world uptake and utilization has not been well studied, with consequential profound implications for health equity. The purpose of this article is to review what is known about effective implementation strategies to support the uptake of behavioral medicine interventions to improve cardiovascular health, to underscore the potential for developing additional implementation strategies for wide-scale uptake of effective cardiovascular behavioral medicine interventions, and to discuss the potential for developing additional implementation approaches while conducting early stage efficacy studies in this area. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Medicina de la Conducta , Terapia Conductista , Humanos , Ciencia de la ImplementaciónRESUMEN
Recent increasing rates of COVID-19 cases, hospitalizations, and deaths among non-Hispanic Whites have led to declining rate ratios at a time of continuing high burden of COVID-19 in American Indian/Alaska Native, Asian/Pacific Islander, African American, and Hispanic/Latino populations. The use of all epidemiological tools, including rate ratios and actual rates per 100,000 population, provides a more comprehensive assessment of the magnitude and trends of racial and ethnic disparities in COVID-19.
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COVID-19 , Pueblo Asiatico , Etnicidad , Hispánicos o Latinos , Humanos , Grupos RacialesRESUMEN
Early life adversities (ELA), include experiences such as child maltreatment, household dysfunction, bullying, exposure to crime, discrimination, bias, and victimization, and are recognized as social determinants of cardiovascular disease (CVD). Strong evidence shows exposure to ELA directly impacts cardiometabolic risk in adulthood and emerging evidence suggests there may be continuity in ELA's prediction of cardiometabolic risk over the life course. Extant research has primarily relied on a cumulative risk framework to evaluate the relationship between ELA and CVD. In this framework, risk is considered a function of the number of risk factors or adversities that an individual was exposed to across developmental periods. The cumulative risk exposure approach treats developmental periods and types of risk as equivalent and interchangeable. Moreover, cumulative risk models do not lend themselves to investigating the chronicity of adverse exposures or consider individual variation in susceptibility, differential contexts, or adaptive resilience processes, which may modify the impact of ELA on CVD risk. To date, however, alternative models have received comparatively little consideration. Overall, this paper will highlight existing gaps and offer recommendations to address these gaps that would extend our knowledge of the relationship between ELA and CVD development. We focus specifically on the roles of: 1) susceptibility and resilience, 2) timing and developmental context; and 3) variation in risk exposure. We propose to expand current conceptual models to incorporate these factors to better guide research that examines ELA and CVD risk across the life course.
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Acoso Escolar , Enfermedades Cardiovasculares , Maltrato a los Niños , Determinantes Sociales de la Salud , Adulto , Niño , Humanos , Acontecimientos que Cambian la Vida , Longevidad , Factores de RiesgoRESUMEN
E-cigarettes have surged in popularity over the last few years, particularly among youth and young adults. These battery-powered devices aerosolize e-liquids, comprised of propylene glycol and vegetable glycerin, typically with nicotine, flavors, and stabilizers/humectants. Although the use of combustible cigarettes is associated with several adverse health effects including multiple pulmonary and cardiovascular diseases, the effects of e-cigarettes on both short- and long-term health have only begun to be investigated. Given the recent increase in the popularity of e-cigarettes, there is an urgent need for studies to address their potential adverse health effects, particularly as many researchers have suggested that e-cigarettes may pose less of a health risk than traditional combustible cigarettes and should be used as nicotine replacements. This report is prepared for clinicians, researchers, and other health care providers to provide the current state of knowledge on how e-cigarette use might affect cardiopulmonary health, along with research gaps to be addressed in future studies.
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Enfermedades Cardiovasculares , Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Adolescente , Adulto Joven , Humanos , Nicotina/efectos adversos , Pulmón , Enfermedades Cardiovasculares/epidemiologíaAsunto(s)
COVID-19 , Negro o Afroamericano , Humanos , Conducta en la Búsqueda de Información , Salud Pública , SARS-CoV-2RESUMEN
The National Heart, Lung, and Blood Institute (NHLBI) has played an important role in funding the clinical science that supports many contemporary cardiology practice guidelines and in shaping the conduct of cardiovascular clinical trials. This Perspective outlines contemporary funding options as well as select important NHLBI policies, philosophy, and priorities.
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Enfermedades Cardiovasculares/terapia , Ensayos Clínicos como Asunto , Humanos , National Heart, Lung, and Blood Institute (U.S.) , Estados UnidosRESUMEN
BACKGROUND: Improving efficiencies in clinical research is crucial to translation of findings into practice and delivery of effective, patient-centered health care. This paper describes a project that monitored pragmatic clinical trials by working with investigators to track achievement of early phase milestones. The National Institutes of Health (NIH) Pragmatic Trials Collaborative Project supported scientifically diverse, low-cost, randomized, controlled, pragmatic clinical intervention trials. Funds were available through a cooperative agreement award mechanism, with the initial phase supporting trial planning and the subsequent 4-year awards funding trial implementation. A coordinating center provided evaluation and administrative support, which included capturing progress toward achieving milestones. METHODS: Six funded trials participated in monthly calls throughout the first year to identify and demonstrate metrics and deliverables for each milestone in the Notice of Grant Award. Interviews were conducted with investigators, trial team members, and NIH program officers/project scientists to discuss their perceptions of the impact and value of the management strategy. RESULTS: Five of six trials transitioned to the implementation phase with milestones ranging from 6 to 15 and quantifiable metrics ranging from 15 to 33, for a total of 121 deliverables. One third of the metrics (42, 35%) were trial-specific. Trial teams reported that the oversight was onerous but complemented their management strategies; program officers/project scientists found that documentation submitted for review was sufficient to assess trial feasibility; and investigators reported advantages to the phased award mechanism, such as leverage to secure commitments from stakeholders and collaborators, help with task prioritization, and earlier consultation with key members of the trial team. CONCLUSIONS: Implementing systematic approaches to identify milestones and track metrics can strengthen the evidence base regarding time and effort to plan and conduct pragmatic clinical trials. Investigators were unaccustomed to producing evidence of performance, and it was challenging to determine what documentation to provide. Efforts to standardize expectations regarding milestones that mark a significant change or stage in trial development or that represent minimum success criteria may provide guidance for more effective and efficient trial management. A framework with clearly specified metrics is especially critical for transparency, particularly when funding decisions are contingent on both merit and feasibility.
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Ensayos Clínicos Pragmáticos como Asunto , Proyectos de Investigación , Distinciones y Premios , Humanos , National Institutes of Health (U.S.) , Ensayos Clínicos Pragmáticos como Asunto/economía , Estados UnidosRESUMEN
As we commemorate the 70th Anniversary of the National Heart, Lung, and Blood Institute (NHLBI) and celebrate important milestones that have been achieved by the Division of Cardiovascular Sciences (DCVS), it is imperative that DCVS and the Extramural Research community at-large continue to address critical public health challenges that persist within the area of Cardiovascular Diseases (CVD). The NHLBI's Strategic Vision, developed with extensive input from the extramural research community and published in 2016, included overarching goals and strategic objectives that serve to provide a general blueprint for sustaining the legacy of the Institute by leveraging opportunities in emerging scientific areas (e.g., regenerative medicine, omics technology, data science, precision medicine, and mobile health), finding new ways to address enduring challenges (e.g., social determinants of health, health inequities, prevention, and health promotion), and training the next generation of heart, lung, blood, and sleep researchers. DCVS has developed a strategic vision implementation plan to provide a cardiovascular framing for the pursuit of the Institute's overarching goals and strategic objectives garnered from the input of the broader NHLBI community. This plan highlights six scientific focus areas that demonstrate a cross-cutting and multifaceted approach to addressing cardiovascular sciences, including 1) addressing social determinants of cardiovascular health (CVH) and health inequities, 2) enhancing resilience, 3) promoting CVH and preventing CVD Across the lifespan, 4) eliminating hypertension-related CVD, 5) reducing the burden of heart failure, and 6) preventing vascular dementia. These priorities will guide our efforts in Institute-driven activities in the coming years but will not exclude development of other novel ideas or the support of investigator-initiated grant awards. The DCVS Strategic Vision implementation plan is a living document that will evolve with iterative dialogue with the NHLBI community and adapt as the dynamic scientific landscape changes to seize emerging opportunities.
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Cardiología/normas , Enfermedades Cardiovasculares/terapia , National Heart, Lung, and Blood Institute (U.S.) , Guías de Práctica Clínica como Asunto , Cardiología/economía , Cardiología/tendencias , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Humanos , Estados UnidosRESUMEN
The National Institutes of Health (NIH) has played a major role in promoting behavioral medicine research over the past 40 years through funding, review, and priority-setting activities and programs including scientific conferences, meetings, workgroups, intramural research, and training opportunities. In this review of NIH activities in support of behavioral medicine over the past four decades, we highlight key events, programs, projects, and milestones that demonstrate the many ways in which the NIH has supported behavioral and social sciences research and advanced the public health while contributing to the evolution of behavioral medicine as a scientific field.
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Medicina de la Conducta/historia , National Institutes of Health (U.S.)/historia , Salud Pública/historia , Investigación Conductal/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Ciencias Sociales/historia , Estados UnidosRESUMEN
OBJECTIVES: To provide recommendations for the selection of comparators for randomized controlled trials of health-related behavioral interventions. STUDY DESIGN AND SETTING: The National Institutes of Health Office of Behavioral and Social Science Research convened an expert panel to critically review the literature on control or comparison groups for behavioral trials and to develop strategies for improving comparator choices and for resolving controversies and disagreements about comparators. RESULTS: The panel developed a Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials. The model indicates that the optimal comparator is the one that best serves the primary purpose of the trial but that the optimal comparator's limitations and barriers to its use must also be taken into account. CONCLUSION: We developed best practice recommendations for the selection of comparators for health-related behavioral trials. Use of the Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials can improve the comparator selection process and help resolve disagreements about comparator choices.
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Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , National Institutes of Health (U.S.)/normas , Guías de Práctica Clínica como Asunto , Femenino , Humanos , Masculino , Selección de Paciente , Psicoterapia/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Estados UnidosRESUMEN
The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives. Inherent in this mission is the commitment to advance health equity research as an avenue for enhancing the health of all individuals. Additionally, the four goals and eight research objectives of the NHLBI Strategic Vision directly support the commitment to health equity. In this article, we present selected examples of the NHLBI Strategic Vision implementation approaches for advancing health equity research in our mission areas of heart, lung, and blood diseases. Examples of diseases for which the burden of health inequities and our strategic vision implementation approaches are discussed include hypertension, heart failure, vascular dementia, asthma, and sickle cell disease. Examples are provided of new avenues of Institute-solicited research to stimulate and address compelling scientific questions and critical challenges to advance health equity. We also highlight the emerging fields of implementation science and predictive analytics as important opportunities to accelerate the translation of discovery science into health impact for all and to advance health equity.
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Equidad en Salud , National Heart, Lung, and Blood Institute (U.S.) , Investigación , Asma , Cardiopatías , Enfermedades Hematológicas , Humanos , Enfermedades Pulmonares , Modelos Teóricos , Estados UnidosRESUMEN
Although deaths due to cardiovascular diseases have declined significantly since the 1970s, they remain the most common cause of morbidity and mortality in the United States. A large number of cardiovascular risk factors, such as smoking, obesity, and sedentary lifestyle, are modifiable. Psychologists and other behavioral scientists and practitioners are engaged in not only understanding the mechanistic links between behaviors and cardiovascular health but also developing effective interventions for improving health. The purpose of this special issue is to highlight some of the more innovative psychological research in cardiovascular health promotion, disease prevention, and management. Articles included in this issue focus on 2 primary areas. First, cutting-edge research on the current state of knowledge of modifiable health behaviors and their impact on cardiovascular health include articles on e-cigarette use as a putative risk factor, psychological factors involved in adherence to medications, the role of sleep in cardiovascular health, and innovative approaches to enhancing the treatment and recovery of patients with cardiovascular diseases. Second, outstanding research identifying the mechanisms by which psychological factors such as stress, depression, and anxiety impact cardiovascular disease include an overview of the current state of science examining psychological comorbidities that can accompany cardiovascular disease and influence outcomes, discussion of the neurocognitive processes that connect stress appraisal with biological functioning and diseases processes, and the role of genetics on behavioral interventions and clinical decision-making in the context of behavioral weight loss treatments. Our goal with these innovative articles is to stimulate additional advances in cardiovascular behavioral medicine. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Medicina de la Conducta , Enfermedades Cardiovasculares/psicología , Enfermedades Cardiovasculares/terapia , HumanosRESUMEN
Electronic cigarette (e-cigarette) use is rapidly increasing among youth and adults despite limited information regarding the long-term risks or benefits. The potential impact of e-cigarette use on public health is complex. E-cigarettes are sometimes considered as smoking cessation aids and, to the extent that they are successful in this regard, could have a net population benefit for adult smokers. However, limited knowledge exists about the long-term health effects of e-cigarette use, and research has suggested these novel tobacco products may lead to initiation and continued use among vulnerable populations, including youth. The current review aimed to summarize trends and available scientific information about e-cigarette use, focusing on the potential cardiovascular health risks and benefits, characteristics associated with e-cigarette use, and critical areas for future investigation to inform the research and clinical work of psychologists. Psychologists have a leadership role in mitigating health risks from smoking behavior, and there is a need for rigorous research assessing the impact of e-cigarette use on population health. In addition, psychologists are uniquely qualified to understand the underlying processes regarding decision-making and behaviors around e-cigarette use. Collectively, the research of psychologists in this area can have a substantial impact on patient education, policies, and the development of prevention and intervention programs to promote public health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Enfermedades Cardiovasculares , Sistemas Electrónicos de Liberación de Nicotina , Conductas de Riesgo para la Salud , Fumar , Enfermedades Cardiovasculares/epidemiología , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Humanos , Fumar/epidemiologíaRESUMEN
Chronic conditions constitute the leading cause of death and disability in the USA and constitute 86 per cent of the nation's annual healthcare expenses. Approximately half of all American adults have at least one chronic condition; 25 per cent of these Americans have two or more chronic conditions. The National Institutes of Health have funded many projects that explain epidemiology, risk factors, and prevention and treatment of chronic conditions, though research questions remain. This commentary discusses some past projects, current areas of interest, and funding opportunities from many NIH Institutes, Centers, and Offices.
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Investigación Biomédica , Enfermedad Crónica/prevención & control , Enfermedad Crónica/terapia , Humanos , National Institutes of Health (U.S.) , Estados UnidosRESUMEN
OBJECTIVE: Studies of sex differences in heart rate variability (HRV) typically have not accounted for the influence of family history (FH) of cardiovascular disease (CVD). This study evaluated sex differences in HRV response to speech stress among men and women (age range 30-49â¯years) with and without a documented FH of CVD. METHODS: Participants were 77 adults (mean ageâ¯=â¯39.8⯱â¯6.2â¯years; range: 30-49â¯years; 52% female) with positive FH (FH+, nâ¯=â¯32) and negative FH (FH-, nâ¯=â¯45) of CVD, verified with relatives of participants. Cardiac activity for all participants was recorded via electrocardiogram during a standardized speech stress task with three phases: 5-minute rest, 5-minute speech, and 5-minute recovery. Outcomes included time domain and frequency domain indicators of HRV and heart rate (HR) at rest and during stress. Data were analyzed with repeated measures analysis of variance, with sex and FH as between subject variables and time/phase as a within subject variable. RESULTS: Women exhibited higher HR than did men and greater HR reactivity in response to the speech stress. However, women also exhibited greater HRV in both the time and frequency domains. FH+ women generally exhibited elevated HRV, despite the elevated risk of CVD associated with FH+. CONCLUSIONS: Although women participants exhibited higher HR at rest and during stress, women (both FH+ and FH-) also exhibited elevated HRV reactivity, reflecting greater autonomic control. Thus, enhanced autonomic function observed in prior studies of HRV among women is also evident among FH+ women during a standardized stress task.
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Enfermedades Cardiovasculares/fisiopatología , Frecuencia Cardíaca/fisiología , Anamnesis/estadística & datos numéricos , Adulto , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
Stress is an established risk factor for negative health outcomes, and responses to everyday stress can interfere with health behaviors such as exercise and sleep. In accordance with the Science of Behavior Change (SOBC) program, we apply an experimental medicine approach to identifying stress response targets, developing stress response assays, intervening upon these targets, and testing intervention effectiveness. We evaluate an ecologically valid, within-person approach to measuring the deleterious effects of everyday stress on physical activity and sleep patterns, examining multiple stress response components (i.e., stress reactivity, stress recovery, and stress pile-up) as indexed by two key response indicators (negative affect and perseverative cognition). Our everyday stress response assay thus measures multiple malleable stress response targets that putatively shape daily health behaviors (physical activity and sleep). We hypothesize that larger reactivity, incomplete recovery, and more frequent stress responses (pile-up) will negatively impact health behavior enactment in daily life. We will identify stress-related reactivity, recovery, and response in the indicators using coordinated analyses across multiple naturalistic studies. These results are the basis for developing a new stress assay and replicating the initial findings in a new sample. This approach will advance our understanding of how specific aspects of everyday stress responses influence health behaviors, and can be used to develop and test an innovative ambulatory intervention for stress reduction in daily life to enhance health behaviors.
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Control de la Conducta , Ejercicio Físico/psicología , Sueño/fisiología , Estrés Psicológico/fisiopatología , Estrés Psicológico/psicología , Afecto , Investigación Biomédica , Cognición , HumanosRESUMEN
The goal of the NIH Science of Behavior Change (SOBC) Common Fund Program is to provide the basis for an experimental medicine approach to behavior change that focuses on identifying and measuring the mechanisms that underlie behavioral patterns we are trying to change. This paper frames the development of the program within a discussion of the substantial disease burden in the U.S. attributable to behavioral factors, and details our strategies for breaking down the disease- and condition-focused silos in the behavior change field to accelerate discovery and translation. These principles serve as the foundation for our vision for a unified science of behavior change at the NIH and in the broader research community.
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Control de la Conducta , National Institutes of Health (U.S.) , Desarrollo de Programa , Investigación Biomédica/métodos , Humanos , Estados UnidosRESUMEN
BACKGROUND: There continues to be debate about what constitutes a pragmatic trial and how it is distinguished from more traditional explanatory trials. The NIH Pragmatic Trials Collaborative Project, which includes five trials and a coordinating unit, has adopted the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS-2) instrument. The purpose of the study was to collect PRECIS-2 ratings at two points in time to assess whether the tool was sensitive to change in trial design, and to explore with investigators the rationale for rating shifts. METHODS: A mixed-methods design included sequential collection and analysis of quantitative data (PRECIS-2 ratings) and qualitative data. Ratings were collected at two annual, in-person project meetings, and subsequent interviews conducted with investigators were recorded, transcribed, and coded using NVivo 11 Pro for Windows. Rating shifts were coded as either (1) actual change (reflects a change in procedure or protocol), (2) primarily a rating shift reflecting rater variability, or (3) themes that reflect important concepts about the tool and/or pragmatic trial design. RESULTS: Based on PRECIS-2 ratings, each trial was highly pragmatic at the planning phase and remained so 1 year later in the early phases of trial implementation. Over half of the 45 paired ratings for the nine PRECIS-2 domains indicated a rating change from Time 1 to Time 2 (N = 24, 53%). Of the 24 rating changes, only three represented a true change in the design of the trial. Analysis of rationales for rating shifts identified critical themes associated with the tool or pragmatic trial design more generally. Each trial contributed one or more relevant comments, with Eligibility, Flexibility of Adherence, and Follow-up each accounting for more than one. CONCLUSIONS: PRECIS-2 has proved useful for "framing the conversation" about trial design among members of the Pragmatic Trials Collaborative Project. Our findings suggest that design elements assessed by the PRECIS-2 tool may represent mostly stable decisions. Overall, there has been a positive response to using PRECIS-2 to guide conversations around trial design, and the project's focus on the use of the tool by this group of early adopters has provided valuable feedback to inform future trainings on the tool.