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1.
Health Psychol Open ; 11: 20551029241244723, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38586533

RESUMO

This study examined the cardiovascular disease (CVD) risk profiles of male law enforcement officers (LEOs) and civilians. CVD risk profiles were based on data collected using traditional objective (e.g., resting BP, cholesterol), novel objective (e.g., ambulatory BP) and self-report measures (e.g., EMA social vigilance). A subset of male LEOs (n = 30, M age = 41.47, SD = 8.03) and male civilians (n = 120, M age = 40.73, SD = 13.52) from a larger study were included in analyses. Results indicated LEOs had significantly higher body mass index [BMI], 31.17 kg/m2 versus 28.87 kg/m2, and exhibited significantly higher trait and state social vigilance across multiple measures, whereas perceived stress was higher among civilians. Findings highlight the need for future research examining CVD risk associated with occupational health disparities, including attributes of individuals entering certain professions as well as experiential and environmental demands of the work.

2.
J Sleep Res ; : e14170, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38351626

RESUMO

Natural short sleepers (NSS)-individuals who report minimal sleepiness or daytime dysfunction despite habitually sleeping less than the recommended amount (i.e., <7 h)-are a focus of growing interest in sleep research. Yet, the predominance of research on NSS has relied on subjective reports of functionality. The present study examined subjective and objective sleepiness among actigraphy-verified NSS in comparison with recommended (7-9 h/day) length sleepers (RLS) who reported similarly minimal daytime dysfunction. The study tested the hypothesis that under conditions of low environmental stimulation, NSS have increased risk of drowsiness and sleep onset, regardless of perceived alertness. The NSS and RLS groups were identified via screening and verified with a 14 day assessment with actigraphy, sleep diaries, and morning ratings of sleep restoration. In-laboratory resting electroencephalography (EEG) data were analysed using a computerised EEG-based algorithm (Vigilance Algorithm Leipzig; VIGALL) to classify second-by-second changes in objective sleepiness ranging from cognitively active alertness to sleep onset. Results demonstrated that NSS exhibited significantly higher drowsiness and sleep onset ('microsleeps') across 15 min of resting EEG despite perceptions of lower subjective sleepiness compared to RLS. Findings suggest that irrespective of perceived sleep restoration and alertness, NSS appear to be at high risk of objective sleepiness that is rapidly unmasked under conditions of low environmental stimulation. Such apparent discrepancy between subjective and objective sleepiness has potentially important public health implications. Future research directions, including tests of mechanisms and tailored sleep extension intervention, are discussed.

3.
Health Psychol ; 43(2): 125-131, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38032612

RESUMO

OBJECTIVE: Technology is changing the way individuals socially connect. However, not much is known about how online forms of social exchanges might link to outcomes that predict longevity. This preregistered study examined the association between online social support and social negativity with self-rated health (SRH) and potential pathways responsible for such links. METHOD: In this preregistered analysis, a sample of 1,356 U.S. residents was recruited based on the U.S. Census track. Participants were at least 18-year-old social media users and completed the study online. Well-validated measures of online social support, online social negativity, general offline perceived support, internet addiction, social anxiety, and SRH were obtained. RESULTS: Main results indicate that both online social support and social negativity were related to better SRH. However, the association between social negativity and better SRH was due to its statistical overlap with online social support. The association between online social support and SRH was primarily mediated by offline social support. CONCLUSIONS: These results highlight the importance of considering how positive and negative online social interactions are related to health outcomes. It also highlights potential pathways that might be targeted for interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Assuntos
Mídias Sociais , Apoio Social , Humanos , Adolescente
4.
Int J Psychophysiol ; 190: 20-29, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37315587

RESUMO

Conceptual models of psychosocial influences on short-term changes (i.e., reactivity) in vagally-mediated heart rate variability (vmHRV) emphasize self-regulatory effort and social threat versus comfort. However, these two general perspectives have been tested separately in nearly all cases, limiting conclusions about the relative importance or possible interactive effects of effortful self-regulation and social stress. The present study compared effects of effort to regulate emotional expression and social stress versus safety on vmHRV reactivity during an interpersonal interaction, in a 2 (self-regulate emotion vs. express emotion freely) × 3 (positive vs. neutral vs. negative interaction valence) × 2 (male vs. female) between-subjects randomized factorial design. A sample of 180 undergraduates (90 women; 69 % White) discussed a current events topic (i.e., human-caused climate change) with a prerecorded partner, presented as a live interaction over a computer. Self-reports of affective responses, self-regulation effort, and appraisals of the partner's behavior, as well as observer ratings of participants' behavior during the interaction, supported the effectiveness of self-regulation and interaction valence manipulations, although the former manipulation may have been somewhat weaker than the latter. Primary analyses of high-frequency heart rate variability (HF-HRV) and root mean square of successive differences (RMSSD) in heart beat intervals recorded at baseline and during the interaction revealed larger decreases in vmHRV during negative than neutral or positive interactions, but no effects of self-regulation instructions. Overall, results indicated more robust effects of social stress on vmHRV reactivity, relative to effects of self-regulatory effort.


Assuntos
Regulação Emocional , Humanos , Masculino , Feminino , Regulação Emocional/fisiologia , Frequência Cardíaca/fisiologia , Emoções/fisiologia , Relações Interpessoais , Autorrelato
5.
BMJ Open ; 13(2): e068623, 2023 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-36797025

RESUMO

INTRODUCTION: Type 2 diabetes is prevalent among US adults. Lifestyle interventions that modify health behaviours prevent or delay progression to diabetes among individuals at high risk. Despite the well-documented influence of individuals' social context on their health, evidence-based type 2 diabetes prevention interventions do not systematically incorporate participants' romantic partners. Involving partners of individuals at high risk for type 2 diabetes in primary prevention may improve engagement and outcomes of programmes. The randomised pilot trial protocol described in this manuscript will evaluate a couple-based lifestyle intervention to prevent type 2 diabetes. The objective of the trial is to describe the feasibility of the couple-based intervention and the study protocol to guide planning of a definitive randomised clinical trial (RCT). METHODS AND ANALYSIS: We used community-based participatory research principles to adapt an individual diabetes prevention curriculum for delivery to couples. This parallel two-arm pilot study will include 12 romantic couples in which at least one partner (ie, 'target individual') is at risk for type 2 diabetes. Couples will be randomised to either the 2021 version of the CDC's PreventT2 curriculum designed for delivery to individuals (six couples), or PreventT2 Together, the adapted couple-based curriculum (six couples). Participants and interventionists will be unblinded, but research nurses collecting data will be blinded to treatment allocation. Feasibility of the couple-based intervention and the study protocol will be assessed using both quantitative and qualitative measures. ETHICS AND DISSEMINATION: This study has been approved by the University of Utah IRB (#143079). Findings will be shared with researchers through publications and presentations. We will collaborate with community partners to determine the optimal strategy for communicating findings to community members. Results will inform a subsequent definitive RCT. TRIAL REGISTRATION NUMBER: NCT05695170.


Assuntos
Diabetes Mellitus Tipo 2 , Estilo de Vida , Adulto , Humanos , Projetos Piloto , Diabetes Mellitus Tipo 2/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Brain Behav Immun ; 109: 168-174, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36681360

RESUMO

INTRODUCTION: Individuals with greater affect variability (i.e., moment-to-moment fluctuations possibly reflecting emotional dysregulation) are at risk for greater systemic inflammation, which is associated with cardiovascular disease. Some evidence suggests that affect variability is linked with poorer health indicators only among those with higher average levels of affect, particularly for positive affect (PA), and that associations may be non-linear. The present study sought to examine whether links between both PA and negative affect (NA) variability and inflammation are moderated by average level of affect. METHODS: Participants (N = 300, 50 % female, ages 21-70, 60 % non-Hispanic White, 19 % Hispanic, 15 % non-Hispanic Black) completed a lab assessment and provided a blood sample to measure systemic inflammation (i.e., TNF-α, IL-6, CRP). Affect was collected via a two-day ecological momentary assessment protocol where reports were collected about every 45-min during waking hours. Momentary affect ratings were averaged across both days (i.e., iM), separately for PA and NA, for each participant. Affect variability was calculated as the person-specific SD (i.e., iSD) of affect reports, separately for PA and NA. Linear and quadratic interactions were tested. Models included covariates for sex, race, and body mass index. RESULTS: There were significant interactions between NA iM and NA iSD predicting TNF-α (b = 6.54; p < 0.05) and between PA iM and PA iSD predicting IL-6 (b = 0.45; p < 0.05). Specifically, the association between these affect variability indicators and inflammatory markers were suggestive of a positive association among those with higher average affect but a negative association among those with lower average affect. There was no evidence of non-linear associations between affect and inflammation. DISCUSSION: Incorporating interactive effects between affect variability and average affect may be an important consideration in understanding affective-inflammatory associations.


Assuntos
Interleucina-6 , Fator de Necrose Tumoral alfa , Humanos , Feminino , Adulto Jovem , Adulto , Masculino , Inflamação , Avaliação Momentânea Ecológica , Afeto/fisiologia
8.
Int J Psychophysiol ; 183: 61-70, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36403804

RESUMO

Social-evaluative threat plays a key role in research on stress, health and related psychophysiological mechanisms such as cardiovascular reactivity (CVR). Social-evaluative threats can activate two broad social motives: striving for status, achievement and influence, and/or striving for acceptance, inclusion, and connection. Prior research emphasizes threats related to status (e.g., task performance) or combined threats to status and acceptance, obscuring their independent effects. Further, because prior research has mostly utilized single stressors, it is not clear if effects of social-evaluative threats involving status and acceptance on CVR persist or adapt quickly over repeated exposures. To address these issues, 139 undergraduates (93 females) were randomly assigned to undergo two repetitions of a stressful role-played interaction with a pre-recorded antagonistic partner under one of four conditions in a factorial design: low evaluative threat, high status threat only, high acceptance threat only, or a combined threat. In a single laboratory session, systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were recorded during baseline and two stressor exposures. Task-induced CVR demonstrated significant adaptation across exposures. Both forms of social evaluative threat produced additional CVR, and these differences between high and low social-evaluative threat were generally maintained across exposures. Hence, threats to social status and acceptance have independent and sustained effects on CVR across multiple stressor exposures, even in the context of overall adaptation of cardiovascular responses.


Assuntos
Sistema Cardiovascular , Estresse Psicológico , Feminino , Humanos , Pressão Sanguínea/fisiologia , Adaptação Fisiológica , Hostilidade , Frequência Cardíaca/fisiologia
9.
J Clin Psychol ; 79(3): 871-885, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36223526

RESUMO

OBJECTIVE: Nonsuicidal self-injury (NSSI) frequently functions to regulate shame-based emotions and cognitions in the context of interpersonal stress. The present study sought to examine how sleep quality (SQ) may influence this process in a laboratory setting. METHODS: Participants included 72 adults (Mage = 24.28; 36 with a lifetime history of NSSI) who completed a self-report measure of prior month SQ and engaged in a modified Trier social stress task (TSST). State shame ratings were collected immediately before and following the TSST, as well as 5 min post-TSST, to allow for the measurement of shame reactivity and recovery. RESULTS: No significant results emerged for NSSI history and SQ as statistical predictors of shame reactivity. However, NSSI history was significantly associated with heightened shame intensity during the recovery period of the task, and this was moderated by SQ. Simple slopes analyses revealed a conditional effect whereby poorer SQ (1SD above the mean) was associated with greater intensity of shame during recovery, but only for those with a history of NSSI. CONCLUSION: Poor SQ may contribute to worrisome emotional responses to daytime stressors in those at risk for NSSI.


Assuntos
Comportamento Autodestrutivo , Distúrbios do Início e da Manutenção do Sono , Adulto , Humanos , Adulto Jovem , Qualidade do Sono , Vergonha , Emoções , Comportamento Autodestrutivo/psicologia , Cognição
10.
Anxiety Stress Coping ; 36(5): 636-648, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36371799

RESUMO

BACKGROUND AND OBJECTIVES: Although dispositional optimism and pessimism have been prospectively associated with health outcomes, little is known about how these associations manifest in everyday life. This study examined how short-term optimistic and pessimistic expectations were associated with psychological and physiological stress processes. METHODS: A diverse sample of adults (N = 300) completed a 2-day/1-night ecological momentary assessment and ambulatory blood pressure (ABP) protocol at ∼45-minute intervals. RESULTS: Moments that were more optimistic than typical for a person were followed by moments with lower likelihood of reporting a stressor, higher positive affect (PA), lower negative affect (NA), and less subjective stress (SS). Moments that were more pessimistic than typical were not associated with any affective stress outcome at the following moment. Neither optimism nor pessimism were associated with ABP, and did not moderate associations between reporting a stressor and outcomes. DISCUSSION: These findings suggest that intraindividual fluctuations in optimistic and pessimistic expectations are associated with stressor appraisals.


Assuntos
Pessimismo , Adulto , Humanos , Pessimismo/psicologia , Motivação , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Personalidade , Afeto
11.
J Fam Psychol ; 37(1): 31-36, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36395028

RESUMO

Partialing correlated predictors to test independent effects is an essential tool in couple research. In actor-partner models, partners' parallel scores are partialed in tests of unique associations with outcomes. Correlated aspects of couple functioning are also often partialed within individuals to examine separate effects. Partialed versions of measures are typically interpreted as assessing the same construct as original unadjusted variables, but in fact their meaning can change. Extending a prior report on changes in construct validity resulting from partialing partners' parallel scores, the present analyses examined effects of partialing measures of positive and negative relationship variables within individuals, specifically perceived support from the partner and relationship conflict. In 300 middle-aged and older couples, we utilized participants' interpersonal circumplex ratings of their partner's typical behavior during marital interactions to compare interpersonal correlates of unadjusted and within-person partialed forms of the Quality of Relationships Inventory Support and Conflict scales. Compared to unadjusted scores, partialed support scores (i.e., adjusted for conflict) were substantially less closely associated with ratings of partner's warmth, and were associated with a less submissive (i.e., less agreeable, cooperative) form of warmth. Compared to unadjusted scores, partialed conflict scores (i.e., adjusted for support) were substantially less closely correlated with ratings of the partner's hostility, and were associated with a more controlling (i.e., critical, coercive) form of hostility. Results were nearly identical for wives and husbands. Partialing correlated scores within individuals can alter the construct validity of relationship measures, suggesting the need for careful reporting and interpretation in couple research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Parceiros Sexuais , Cônjuges , Pessoa de Meia-Idade , Humanos , Idoso , Parceiros Sexuais/psicologia , Cônjuges/psicologia , Casamento/psicologia , Heterossexualidade , Hostilidade , Relações Interpessoais
12.
J Pers ; 91(3): 683-699, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-35988017

RESUMO

INTRODUCTION: Negative affective symptoms (e.g., anxiety, depression, and anger) are correlated and have parallel associations with outcomes, as do related personality traits (i.e., facets of neuroticism), often prompting statistical control (i.e., partialing) to determine independent effects. However, such adjustments among predictor variables can alter their construct validity. In three studies, the interpersonal circumplex (IPC) and a related analytic approach (i.e., Structural Summary Method) were used to evaluate changes in interpersonal correlates of negative affective characteristics resulting from partialing. METHODS: Samples of undergraduates (Sample 1 n = 3283; Sample 2 = 688) and married couples (n = 300 couples) completed self-report (three samples) and partner rating (sample 3) measures of anxiety, depression and anger, and IPC measures of interpersonal style. RESULTS: Anxiety, depression, and anger had expected interpersonal correlates across samples. Partialing depression eliminated interpersonal correlates of anxiety. When anxiety was controlled, depression measures were more strongly associated with submissiveness and less closely associated with low warmth. Adjustments involving anger magnified differences in dominance versus submissiveness associated with the negative affects. DISCUSSION: Removal of overlap among negative affective measures via partialing alters their interpersonal correlates, potentially complicating interpretation of adjusted associations.


Assuntos
Sintomas Afetivos , Relações Interpessoais , Humanos , Ansiedade/psicologia , Cônjuges/psicologia , Autorrelato
13.
Physiol Rep ; 10(18): e15407, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36117385

RESUMO

Atrial fibrillation (AF) is the most common arrhythmia in the United States, affecting approximately 1 in 10 adults, and its prevalence is expected to rise as the population ages. Treatment options for AF are limited; moreover, the development of new treatments is hindered by limited (1) knowledge regarding human atrial electrophysiological endpoints (e.g., conduction velocity [CV]) and (2) accurate experimental models. Here, we measured the CV and refractory period, and subsequently calculated the conduction wavelength, in vivo (four subjects with AF and four controls), and ex vivo (atrial slices from human hearts). Then, we created an in vitro model of human atrial conduction using induced pluripotent stem (iPS) cells. This model consisted of iPS-derived human atrial cardiomyocytes plated onto a micropatterned linear 1D spiral design of Matrigel. The CV (34-41 cm/s) of the in vitro model was nearly five times faster than 2D controls (7-9 cm/s) and similar to in vivo (40-64 cm/s) and ex vivo (28-51 cm/s) measurements. Our iPS-derived in vitro model recapitulates key features of in vivo atrial conduction and may be a useful methodology to enhance our understanding of AF and model patient-specific disease.


Assuntos
Fibrilação Atrial , Sistema de Condução Cardíaco , Adulto , Átrios do Coração , Frequência Cardíaca , Humanos
14.
J Fam Psychol ; 36(8): 1462-1472, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35708956

RESUMO

In research on couples, statistical adjustment (i.e., partialing) for correlations between partners' parallel scores is common and useful, as in the actor-partner interdependence model. Original and partialed scores are typically interpreted as assessing the same construct, but this may not be a valid assumption. Other approaches to nonindependence-such as common fate modeling-may better represent some couple constructs. This study of 300 couples utilized participants' interpersonal circumplex ratings of partners' typical behavior during marital interactions to evaluate the interpersonal meaning of unadjusted and partialed forms of the Marital Adjustment Test (MAT), a measure of overall relationship quality, and the Quality of Relationships Inventory-Support (QRI-S) and Conflict (QRI-C) scales, which measured perceived support from and conflict with the partner. After partialing partners' scores, MAT and QRI-S scores were substantially less closely associated with ratings of partners' warmth, their primary expected interpersonal correlates. Partner-partialed QRI-C scores were substantially less closely correlated with ratings of partners' hostility and were associated with a somewhat more controlling form of hostility. In contrast, partialing partners' trait optimism scores resulted in minimal changes in interpersonal correlates of this personality characteristic. Couple-level MAT, QRI-S, and QRI-C variables representing overlapping variance across partners while partialing unshared variance in spouses' scores (i.e., common fate scores) had highly similar interpersonal correlates when compared to unadjusted versions. Potential alterations in construct validity resulting from partialing partners' scores warrant interpretive caution, and alternative analytic frameworks (e.g., the common fate model) may better maintain the construct validity of some dyadic measures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Relações Interpessoais , Cônjuges , Humanos , Cônjuges/psicologia , Casamento/psicologia , Hostilidade , Personalidade
15.
Clin Ther ; 44(7): 982-997.e2, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35667900

RESUMO

PURPOSE: Using data from real-world practice, this analysis compared outcomes in patients with rheumatoid arthritis (RA) initiating treatment with an oral Janus kinase inhibitor, tofacitinib, in combination with persistent, discontinued, or interrupted treatment with oral methotrexate (MTX). METHODS: This retrospective claims analysis (MarketScan® databases) included data from US patients with RA and at least one prescription claim for tofacitinib, dated between January 1, 2013, and April 30, 2017. Eligible patients were continuously enrolled for ≥12 months before and after treatment initiation, and initiated tofacitinib in combination with oral MTX, with at least two prescription claims for each. Patients were grouped according to treatment pattern (MTX-Persistent, MTX-Discontinued, or MTX-Interrupted). Tofacitinib treatment persistence, adherence, and effectiveness, as well as all-cause and RA-related health care costs, were assessed. FINDINGS: A total of 671 patients were eligible for inclusion; 504 (75.1%) were MTX-Persistent; 131 (19.5%), MTX-Discontinued; and 36 (5.4%), MTX-Interrupted. Rates of tofacitinib treatment persistence, adherence, and effectiveness at 12 months were similar between the MTX-Persistent and MTX-Discontinued cohorts. The percentage of patients switched from tofacitinib to another advanced disease-modifying antirheumatic drug within 12 months of tofacitinib initiation was greater in the MTX-Persistent cohort compared with that in the MTX-Discontinued cohort. RA-related health care costs at 12 months post-initiation were significantly greater in the MTX-Persistent cohort compared with those in the MTX-Discontinued cohort. IMPLICATIONS: The findings from this analysis of real-world data indicate that patients who initiate tofacitinib in combination with oral MTX may discontinue MTX and still experience outcomes similar to those in patients who persist with MTX, with lesser RA-related health care costs. These results support those from a previous clinical study on methotrexate withdrawal in patients with RA (NCT02831855).


Assuntos
Antirreumáticos , Artrite Reumatoide , Metotrexato , Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Estudos Clínicos como Assunto , Quimioterapia Combinada , Humanos , Metotrexato/administração & dosagem , Piperidinas , Pirimidinas , Estudos Retrospectivos , Resultado do Tratamento
16.
Obes Surg ; 32(7): 2272-2279, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35461403

RESUMO

PURPOSE: Overvaluation of shape and weight (OSW) involves defining self-worth by body shape/weight. Among persons seeking bariatric surgery, cross-sectional studies have found associations between OSW, depressive symptoms, and disordered eating. MATERIALS AND METHODS: Relationships among OSW, depressive symptoms, binge eating symptoms, and BMI were analyzed both cross-sectionally and over time among 145 adults who had bariatric surgery. Participants completed the following measures pre-surgery and 1.5 to 3 years post-surgery: Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale, Patient Health Questionnaire, and body weight and height. OSW was measured by averaging two items on the EDE-Q which ask participants to rate how much their weight/shape influences how they judge themselves as a person. Analyses included Wilcoxon signed-ranks, bootstrapped Pearson correlations, and bootstrapped hierarchical linear regressions. RESULTS: OSW was significantly associated with depressive symptoms and binge eating symptoms both pre- and post-surgery, but was not associated with BMI at either timepoint. Improvements in OSW were associated with concurrent changes in depression and binge eating; reductions in BMI were not significantly associated with changes in any of these variables. CONCLUSIONS: Findings suggest that self-evaluation is more important in regard to changes in depressive and binge eating symptoms than is BMI (and vice versa), and support the importance of assessing and treating psychological considerations among persons seeking bariatric surgery.


Assuntos
Cirurgia Bariátrica , Transtorno da Compulsão Alimentar , Bulimia , Obesidade Mórbida , Adulto , Transtorno da Compulsão Alimentar/psicologia , Imagem Corporal/psicologia , Bulimia/complicações , Estudos Transversais , Depressão/etiologia , Depressão/psicologia , Humanos , Obesidade Mórbida/cirurgia
17.
Curr Cardiol Rep ; 24(6): 761-774, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35380384

RESUMO

PURPOSE OF REVIEW: Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD. RECENT FINDINGS: Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.


Assuntos
Doença das Coronárias , Doença das Coronárias/prevenção & controle , Doença das Coronárias/psicologia , Emoções , Humanos
18.
Dermatol Ther (Heidelb) ; 12(4): 1027-1040, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35381975

RESUMO

INTRODUCTION: Comparative data on the economic burden of alopecia areata relative to the general population are limited. The objective of this retrospective database analysis was to evaluate healthcare resource utilization and direct medical costs among patients with alopecia areata from the US payer perspective compared with matched controls. METHODS: Validated billing codes were used to identify patients with alopecia areata from the IQVIA PharMetrics Plus (2016-2018) who had continuous pharmacy and medical enrollment for 365 days both before (baseline period) and after (evaluation period) the index date. Demographic and clinical characteristics were characterized, and baseline comorbidities were assessed with the Quan Charlson Comorbidity Index. RESULTS: Using the exact matching feature from Instant Health Data, 14,340 patients with alopecia areata were matched with 42,998 control patients aged ≥ 12 years. Patients with alopecia areata had higher healthcare resource utilization and adjusted total all-cause mean medical costs versus matched controls ($8557 versus $6416; p < 0.0001), because of higher inpatient costs, emergency department visits, ambulatory visits, number of prescriptions and prescription costs, and other costs such as durable medical equipment and home healthcare. The number of inpatient visits did not significantly differ between the two groups. Mean ambulatory costs were $3640 for patients with alopecia areata and $2062 for controls, and mean pharmacy costs were $3287 and $1843, respectively (p < 0.0001 for both). Pharmacy costs related to immunologic agents represented 50.0% of the total difference in pharmacy spending between patients with alopecia areata and controls. Surgery on the integumentary system accounted for 9.5% of the total difference in ambulatory costs. CONCLUSION: Alopecia areata is associated with significant incremental healthcare resource utilization and costs relative to matched controls due to increased spending in areas such as surgical procedures and psychological and pharmacological interventions. Costs are primarily driven by ambulatory and pharmacy spending.

19.
Dermatol Ther (Heidelb) ; 12(4): 949-969, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35347660

RESUMO

INTRODUCTION: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease that negatively impacts overall health, quality of life (QoL), and work productivity. Prior studies on AD burden by severity have focused on moderate-to-severe disease. Here, we describe the clinical and humanistic burden of AD in Europe across all severity levels, including milder disease. METHODS: Data were analyzed from the 2017 National Health and Wellness Survey from adult respondents with AD in the EU-5 (France, Germany, Italy, Spain, and the UK). AD disease severity was defined based on self-reported assessments as "mild," "moderate," or "severe" and by Dermatology Life Quality Index (DLQI) severity bands. Self-reported outcomes for AD respondents by severity were assessed using propensity score matching. These outcomes included a wide range of selected medical/psychological comorbidities, overall QoL and functional status (EuroQol 5-Dimensions 5-Level and Short Form-36 version 2 questionnaires), and work productivity and activity impairment (Work Productivity and Activity Impairment questionnaire). RESULTS: In total, 4208 respondents with AD (mild AD, 2862; moderate AD, 1177; severe AD, 169) and 4208 respondents without AD were included in this analysis. Results showed greater burden across severity levels compared with matched non-AD controls. A higher proportion of respondents with mild-to-moderate AD, defined by DLQI severity bands, reported atopic comorbidities (P < 0.05) and a wide range of cardiac, vascular, and metabolic comorbidities, including hypertension, high cholesterol, angina, and peripheral vascular disease (P < 0.005), compared with non-AD controls. Relative to potential impacts of various medical and psychological burdens, respondents with mild-to-moderate AD reported higher activity impairment than controls (P < 0.0001). CONCLUSION: Clinical and humanistic burden was observed in European respondents with AD compared with matched non-AD controls across severity levels, with burden evident even in milder disease, highlighting the importance of improving disease management in early stages of AD.

20.
Artigo em Inglês | MEDLINE | ID: mdl-35055620

RESUMO

Social support has been linked to lower cardiovascular morbidity and mortality. However, most studies have examined perceived support as an intrapersonal construct. A dyadic approach to social support highlights how interdependence between individuals within relationships, including partner perceptions and interactions, can influence one's health. This study's overall purpose was to test actor-partner models linking perceived social support to inflammation. Ninety-four cisgender married couples completed perceived support measures and had their blood drawn for CRP and IL-6 to produce an overall inflammatory index. The primary results indicate that only a partner's level of perceived support was related to lower inflammation in their spouse. Our sample size, although moderate for inflammatory studies, was probably not large enough to detect actor influences. These data highlight the importance of taking a dyadic perspective on modeling perceived support and its potential mechanism.


Assuntos
Apoio Social , Cônjuges , Humanos , Inflamação , Relações Interpessoais , Parceiros Sexuais
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