Spanish validation of the cardiac self-efficacy scale: a gender invariant measure.

The aim is to validate the Spanish version of the Cardiac Self-Efficacy (S-CSE) Scale by examining its psychometric properties and to test the invariance for women and men. Two groups - 722 and 522- of patients completed the S-CSE Scale and other psychosocial measures during a medical revision several months after being diagnosed with cardiovascular disease. Construct validity was psychometrically evaluated using exploratory factor analysis (EFA) with a split of the first sample and confirmatory factor analysis (CFA) with a second split of the same sample. Scale structure was confirmed using the second sample. Convergent, discriminant, and external validity were tested. Results revealed that the S-CSE Scale was represented by three dimensions (control symptoms, control illness, maintain functioning) obtaining excellent reliability indexes and it appeared to be invariant for women and men. The S-CSE scale is a useful tool for monitoring the general well-being of these patients to promote individualized interventions.

Differential impact of stay-at-home orders on mental health in adults who are homeschooling or "childless at home" in time of COVID-19.

The COVID-19 pandemic has forced the confinement of most populations worldwide, through stay-at-home orders. Children have continued their education process at home, supervised by parents, who, in most cases, have adopted the role of prime drivers of their learning processes. In this study, the psychological impact of confinement was explored, as well as the relationship of the forced homeschooling situation with psychological well-being. During their confinement, 400 individuals residing in Spain-165 without children at home (Group 1), 104 parents who dedicated little time to homeschooling (Group 2), and 131 who dedicated more time to homeschooling (Group 3)-responded to an online questionnaire. The results show that confinement threatened the mental health of all the participants but especially Group 3 individuals, who had the highest loneliness, anxiety, and stress levels. Moreover, loneliness, perception of discomfort due to homeschooling, and anxiety exacerbated the stress experienced during confinement. Discomfort due to the homeschooling situation was especially relevant in explaining anxiety and stress for Group 3 individuals. These results suggest that forced homeschooling could be associated with the negative consequences that confinement has on individuals' mental health. Moreover, the results suggest that parents who dedicate more time to homeschooling feel more unprotected and more stressed due to the homeschooling in comparison to Group 2 individuals. Health professionals must pay special attention to parents who dedicate more time to homeschooling, and governments and schools must emphasize social support provision to families during homeschooling situations.

La pandemia de la COVID-19 ha impuesto el confinamiento de la mayoría de las poblaciones de todo el mundo mediante órdenes de quedarse en casa. Los niños han continuado su proceso de escolarización en sus hogares, supervisados por los padres, quienes, en la mayoría de los casos, han adoptado el papel de impulsores principales de sus procesos de aprendizaje. En este estudio se analizó el efecto psicológico del confinamiento, así como la relación de la situación forzada de enseñanza en el hogar con el bienestar psicológico. Durante su confinamiento, 400 personas residentes en España -165 sin niños en casa (grupo 1), 104 padres que dedicaron poco tiempo a la enseñanza en el hogar (grupo 2), y 131 que dedicaron más tiempo a la enseñanza en el hogar (grupo 3)- respondieron un cuestionario en línea. Los resultados demuestran que el confinamiento amenazó la salud mental de todos los participantes, pero especialmente la de las personas del grupo 3, quienes demostraron mayores niveles de soledad, ansiedad y estrés. Además, la soledad, la percepción de incomodidad a consecuencia de la enseñanza en el hogar, y la ansiedad agravaron el estrés sufrido durante el confinamiento. La incomodidad provocada por la situación de enseñanza en el hogar fue especialmente importante para explicar la ansiedad y el estrés de las personas del grupo 3. Estos resultados sugieren que la enseñanza forzada en el hogar podría estar asociada con las consecuencias negativas que tiene el confinamiento en la salud mental. Además, los resultados indican que los padres que dedican más tiempo a la enseñanza en el hogar se sienten más desprotegidos y más estresados debido a este tipo de enseñanza en comparación con las personas del grupo 2. Los profesionales de la salud deben prestar especial atención a los padres que dedican más tiempo a la enseñanza en el hogar, y los gobiernos y centros educativos deben brindar más apoyo social a las familias durante las situaciones de enseñanza en el hogar.

The Self-Efficacy Scale for Adherence to the Mediterranean Diet (SESAMeD): A scale construction and validation.

The Mediterranean diet has several beneficial impacts on health. Self-efficacy may be crucial for adhering to the diet. This study set out to develop a reliable and valid instrument that would enable measurement of the extent to which people are confident about their ability to adhere to the Mediterranean diet: the Self-Efficacy Scale for Adherence to the Mediterranean Diet (SESAMeD). The study was carried out in two stages. In Stage 1, a pilot questionnaire was administrated to 170 students to reduce and refine items. In Stage 2, the validity and reliability of the scale were evaluated among a sample of 348 patients who have suffered from cardiovascular disease. After items reduction, the scale consisted of 22 items. The factor structure of SESAMeD was tested across exploratory factorial analysis and confirmatory factorial analysis, with both analyses confirming a robust adjustment for the bi-factorial structure. The two factors identified were (a) self-efficacy for the avoidance of determined unhealthy foods not recommended in the Mediterranean diet and (b) self-efficacy for the consumption of determined healthy foods recommended in this diet. The pattern of relations between the SESAMeD and the SESAMeD subscales and other different psychological variables (outcome expectancies, motivation, affective balance, and life satisfaction) supported the validity of the bi-factorial structure and provided strong evidence of construct validity. The instrument can help health professionals and researchers to assess patients' confidence of their ability to adhere to the Mediterranean diet, a psychological variable that may affect adherence to this healthy food consumption pattern.

Proteomic analysis reveals heat shock protein 70 has a key role in polycythemia Vera.

JAK-STAT signaling through the JAK2V617F mutation is central to the pathogenesis of myeloproliferative neoplasms (MPN). However, other events could precede the JAK2 mutation. The aim of this study is to analyze the phenotypic divergence between polycytemia vera (PV) and essential thrombocytemia (ET) to find novel therapeutics targets by a proteomic and functional approach to identify alternative routes to JAK2 activation. Through 2D-DIGE and mass spectrometry of granulocyte protein from 20 MPN samples, showed differential expression of HSP70 in PV and ET besides other 60 proteins. Immunohistochemistry of 46 MPN bone marrow samples confirmed HSP70 expression. The median of positive granulocytes was 80% in PV (SD 35%) vs. 23% in ET (SD 34.25%). In an ex vivo model KNK437 was used as an inhibition model assay of HSP70, showed dose-dependent inhibition of cell growth and burst formation unit erythroid (BFU-E) in PV and ET, increased apoptosis in the erythroid lineage, and decreased pJAK2 signaling, as well as a specific siRNA for HSP70. These data suggest a key role for HSP70 in proliferation and survival of the erythroid lineage in PV, and may represent a potential therapeutic target in MPN, especially in PV.

Inhibition of related JAK/STAT pathways with molecular targeted drugs shows strong synergy with ruxolitinib in chronic myeloproliferative neoplasm.

This study aimed to assess the antitumour effects, molecular mechanisms of action, and potential synergy of ruxolitinib with sorafenib, KNK437, dasatinib, and perifosine, in Philadelphia-negative chronic myeloproliferative neoplasms (MPN). Cytotoxic and cytostatic effects of the different compounds were determined in the JAK2 V617F-positive cell lines, HEL and Ba/F3 (JAK2V617F EPOR) , and in primary mononuclear and bone marrow CD34-positive cells from 19 MPN patients. Ruxolitinib [50% inhibitory concentration (IC50 )(PV)  = 15 nmol/l], as well as sorafenib (IC50 PV=8µmol/l), KNK437 (IC50 PV=100µmol/l ), and perifosine (IC50 PV=15µmol/l ), were able to inhibit proliferation in cell line models and in primary cells from MPN patients. Dasatinib, KNK437, and sorafenib showed a strong synergistic effect in combination with ruxolitinib [combination index (CI)(PV)  < 0·3]. Western blot confirmed that ruxolitinib blocked ERK, and consequently STAT5 activation, sorafenib inhibited ERK, P38 and STAT5, dasatinib blocked SRC and STAT5, and KNK437 decreased the stability of the JAK2 protein, reducing its expression. Inhibiting JAK2-related proliferative pathways has the potential to inhibit cell proliferation in MPNs. Furthermore, the combination of ruxolitinib with inhibitors that target these pathways has a strong synergistic effect, which may be due to decreased activation of the common effector, STAT5.

Error orientation in a decision-making simulation program: differences between promotion vs. prevention focus.

Changing situations develop work environments where workers must generate strategies to learn and persist from continuous errors and setbacks. Previous research has shown that errors enhance motivation, break the routine, lead to creative solutions, and reduce frustration; however, this positive aspect seems to have a stronger presence if personal factors and contextual background support such a focus. The main aim of this paper was to analyse, with an experimental design, how different frames about errors and negative feedback (error promotion versus error prevention) affected performance and decision-making processes in a complex simulation task, taking into account individual attitude towards errors. The sample included 40 employees of a Spanish transportation company (37.5% were women and 62.5% were men). Firstly, participants answered a questionnaire about their individual Error Orientation. Then, they were randomly assigned to an experimental condition to carry out a complex decision-making task through a multimedia simulator, which aimed to expose the participant to factors that influence the dynamics of innovation and change, elements that are present in all modern organizations. None of the participants had previous experience in the task. Performance was measured through different aspects: (1) final performance values: adopters, points, time to make decisions and time after receiving negative feedback; (2) the decision-making process. Results showed that error orientation is related to final performance, especially error risk taking and error communication. The effect of the experimental condition was higher for the time to make decisions after receiving negative feedback and for the time to complete the simulation program. Those who worked under the error prevention condition took significantly longer to perform the task. Although our results show non-consistent effects, which frame than the other (promotion versus prevention) is better to make decisions is discussed. A promotion frame prioritizes flexibility, openness, and rapid progress, but does so by sacrificing certainty, and careful analysis. The most crucial factor may be which one best fits the demands of the task at hand.

Manifestations and Reinforcement of Heteronormativity in the Workplace: A Systematic Scoping Review.

This scoping review systematizes the evidence available to date on the manifestations of heteronormativity in the workplace. The reviewed literature shows that, at an organizational level, heteronormativity is reproduced in the configuration of space, organizational policies, and the monitoring of their accomplishment by leaders. At an interpersonal level, employees interact with others based on heterosexual presumptions, they reward what is aligned with heteronormativity, and censor what is not. Finally, individuals acting of their own volition may perform their gender in ways that strengthen the presumption of heterosexuality and communicate heteronormativity alignment. This review offers suggestions for future research in the field of heteronormativity in the workplace and includes theoretical and practical implications for the creation of inclusive organizations.

"To be, or not be satisfied in NPOs": a serial multiple mediation and clustering analysis of paid staff and volunteers' profiles.

Introduction: Non-profit organizations (NPOs) are a complex working context whose main characteristic resides in the dichotomy between paid staff and volunteers. Despite its benefits for goal achievement, this circumstance can be also a challenge, for both groups' interaction, for their comprehension of their own role and to HR management. The aim of this study was to explore factors that may contribute to promote job satisfaction among NPOs' members. Methods: Combining two different data analyses, serial multiple mediation analyses and cluster analyses, first we analyze whether there are differences between paid staff and volunteers in perceived intrapersonal conflict and performance and its effect on job satisfaction, and second, we analyze whether there is an additional profiles distribution that reflects more adequately the reality of NPOs, despite the formal roles that coexist in these organizations (paid staff and volunteers). Results: Results confirm that paid staff and volunteers differ on their perceived job satisfaction level, with volunteers being more satisfied. This relationship is serially mediated by role conflict, role ambiguity, and performance. Another characteristic of the NPOs is that the dichotomy between paid staff and volunteers does not capture well the reality of the labor relations between members of both groups and the organization. To explore this phenomenon, we perform a cluster analysis based on paid staff and volunteers' perceptions. Cluster analyses demonstrate the existence of three rather homogenous profiles. Discussion: Additionally, practical implications for HR management in NPOs and future research lines to understand this organizational context dynamics are also discussed.

Spanish Validation of the Technostress Creators Scale.

BACKGROUND: The COVID-19 pandemic has changed the way organizations operate, forcing many of them to opt for remote-working as an alternative to the face-to-face mode. This global phenomenon has increased the importance of studying the psychosocial risks linked to the use of Information and Communication Technologies (ICTs), such as technostress. This study aims to provide validity evidence for the Technostress Creators Scale in Spain and to test its measurement invariance in terms of gender. METHOD: We analyzed the psychometric properties of the scale, its factor solution, and gender invariance in a sample of 931 employees from Spain. RESULTS: The Exploratory Factor Analysis (EFA) showed that the Spanish version maintained the five factors from the original version: techno-overload, techno-invasion, techno-complexity, techno-insecurity, and techno-uncertainty. The instrument demonstrated adequate reliability. The results of the Confirmatory Factor Analysis (CFA) also replicated the five-factor structure of the English version. Additionally, measurement invariance tests indicated differences between genders. CONCLUSIONS: The resulting Spanish scale has 18 items, which is shorter than the original version. The implications and limitations of the Spanish version of the instrument are detailed in the discussion.

Effectiveness of an eHealth intervention to improve subjective well-being and self-efficacy in cardiovascular disaease patients: A pilot non-randomized controlled trial.

AIM: To evaluate the effectiveness of a multicomponent, eHealth-based self-efficacy intervention to promote subjective well-being and self-efficacy in patients with cardiovascular disease, exploring sex differences. DESIGN: A pilot study of a two-arm non-randomized controlled trial. METHODS: Forty-two cardiovascular patients (31% women) participated in the study. The experimental group received a personalized psychoeducational session and a 14-days eHealth intervention. Subjective well-being (positive and negative affect) and self-efficacy (chronic and cardiac) were assessed at baseline, post-psychoeducational session, post-eHealth intervention and at two follow-ups. RESULTS: The levels of the experimental group in positive affect, at post-eHealth and follow-up 1, and self-efficacy, at post-eHealth, and both follow-ups, were statistically significantly higher compared to the control group (all ps < .05). When considering sex, the intervention was effective only for men. The results highlight the potential of eHealth interventions for cardiac patients and underline the importance of considering a gender perspective in their treatment.

Mobile Health Requirements for the Occupational Health Assessment of Health Care Professionals: Delphi Study.

BACKGROUND: In recent years, owing to the COVID-19 pandemic, awareness of the high level of stress among health care professionals has increased, and research in this area has intensified. Hospital staff members have historically been known to work in an environment involving high emotional demands, time pressure, and workload. Furthermore, the pandemic has increased the strain experienced by health care professionals owing to the high number of people they need to manage and, on many occasions, the limited available resources with which they must carry out their functions. These psychosocial risks are not always well dealt with by the organization or the professionals themselves. Therefore, it is necessary to have tools to assess these psychosocial risks and to optimize the management of this demand from health care professionals. Digital health, and more specifically, mobile health (mHealth), is presented as a health care modality that can contribute greatly to respond to these unmet needs. OBJECTIVE: We aimed to analyze whether mHealth tools can provide value for the study and management of psychosocial risks in health care professionals, and assess the requirements of these tools. METHODS: A Delphi study was carried out to determine the opinions of experts on the relevance of using mHealth tools to evaluate physiological indicators and psychosocial factors in order to assess occupational health, and specifically, stress and burnout, in health care professionals. The study included 58 experts with knowledge and experience in occupational risk prevention, psychosocial work, and health-related technology, as well as health professionals from private and public sectors. RESULTS: Our data suggested that there is still controversy about the roles that organizations play in occupational risk prevention in general and psychosocial risks in particular. An adequate assessment of the stress levels and psychosocial factors can help improve employees' well-being. Moreover, making occupational health evaluations available to the team would positively affect employees by increasing their feelings of being taken into account by the organization. This assessment can be improved with mHealth tools that identify and quickly highlight the difficulties or problems that occur among staff and work teams. However, to achieve good adherence and participation in occupational health and safety evaluations, experts consider that it is essential to ensure the privacy of professionals and to develop feelings of being supported by their supervisors. CONCLUSIONS: For years, mHealth has been used mainly to propose intervention programs to improve occupational health. Our research highlights the usefulness of these tools for evaluating psychosocial risks in a preliminary and essential phase of approaches to improve the health and well-being of professionals in health care settings. The most urgent requirements these tools must meet are those aimed at protecting the confidentiality and privacy of measurements.

Non-Heteronormative Sexual Orientations at Work: Disclosure Dynamics and the Negotiation of Boundaries between Lesbian and Gay Employees and Their Co-workers.

This article focuses on the interactional dynamics which take place during disclosure of non-heteronormative sexual orientations at work. Since the disclosure might be considered a process through which lesbian and gay (LG) people share information about their personal life at work, Boundary Theory, which explores how people create boundaries between life domains, allows us to better understand disclosure dynamics. For this purpose, 39 Spanish lesbian and gay employees were interviewed. The results demonstrated that LG employees and their coworkers, affected by the socio-cultural context, are jointly responsible for the integration/segmentation of LG employees' personal and work domains, thus questioning the extent to which management of non-heteronormative sexual orientations is considered a strategic choice under the control of LG employees alone.

Development and Validation of the COVID-19 Worries and Fears Scale.

Objectives: How individuals perceive the risk of COVID-19 influences their mental health and protective behaviors. Therefore, the development of an instrument to capture COVID-19-related worries and fears is relevant. This study aims to develop and validate the CoV-WoFe to measure COVID-19-related worries and fears. Methods: An online questionnaire was completed by 593 participants during Christmas 2020 and by 328 participants during Summer 2021, from which 88 participants formed a longitudinal sample. Results: Analyses confirmed a robust adjustment for consistency over time and a gender-invariant bifactorial structure. Factor 1 represented worry about the health consequences of COVID-19 and Factor 2 represented the perceived physiological symptoms associated with fear of COVID-19. Construct validity was evidenced by: the expected relations between the CoV-WoFe and other theoretically related constructs; the serial mediating role of both dimensions in the relationship that security values establish with protective behaviors against COVID-19 and with anxiety; and the expected gender differences in the Cov-WoFe. Conclusion: The CoV-WoFe represents a short, valid, reliable, gender-invariant tool that is easy to apply in both the health professional and research context to assessCOVID-19-related worries and fears, which are variables of relevance for spread of the virus and for mental health.

Linear and non-linear relationships between job demands-resources and psychological and physical symptoms of service sector employees. When is the midpoint a good choice?

Related to the research of working conditions, the link between organizational factors and health was traditionally analyzed using linear models. However, the literature analysis suggests inconsistencies in linear models predicting workers' health levels. To clarify this issue, this exploratory research compares the linear and non-linear relationships between job demands-resources (task complexity, time pressure, contact with users, and job autonomy), and the psychological and physical symptoms of employees working in the main five service subsectors: commerce, horeca (hotels, restaurants, and cafés), public administration, education, and healthcare. With a final sample of 4,047 participants, our study data were extracted from the II Andalusian Working Conditions Survey. Following the theoretical framework of JD-R Model and considering the Vitamin Model theoretical approach for non-linear relationships, our results showed that there were significant differences among the five subsectors analyzed regarding the linear and non-linear relationships between job demands-resources and psychological and physical symptoms of employees. Furthermore, task complexity generated non-linear relationships in higher proportion than time pressure and contact with users. Likewise, non-linear relationships found showed a U-shape. Moreover, the findings of non-linear relationships suggested that medium levels of task complexity should not be exceeded to avoid further negative impact on psychological and physical symptoms for service sector employees, preserving their health. Finally, some general practical implications of work environment interventions are suggested.

Nature and Mindfulness to Cope with Work-Related Stress: A Narrative Review.

In recent years, work-related stress has grown exponentially and the negative impact that this condition has on people's health is considerable. The effects of work-related stress can be distinguished in those that affect workers (e.g., depression and anxiety) and those that affect the company (e.g., absenteeism and productivity). It is possible to distinguish two types of prevention interventions. Individual interventions aim at promoting coping and individual resilience strategies with the aim of modifying cognitive assessments of the potential stressor, thus reducing its negative impact on health. Mindfulness techniques have been found to be effective stress management tools that are also useful in dealing with stressful events in the workplace. Organizational interventions modify the risk factors connected to the context and content of the work. It was found that a restorative workplace (i.e., with natural elements) reduces stress and fatigue, improving work performance. Furthermore, practicing mindfulness in nature helps to improve the feeling of wellbeing and to relieve stress. In this paper, we review the role of mindfulness-based practices and of contact with nature in coping with stressful situations at work, and we propose a model of coping with work-related stress by using mindfulness in nature-based practices.

A Brief mHealth-Based Psychological Intervention in Emotion Regulation to Promote Positive Subjective Well-Being in Cardiovascular Disease Patients: A Non-Randomized Controlled Trial.

The emotional impact that a cardiovascular disease may have on a person's life can affect the prognosis and comorbidity of the disease. Therefore, emotion regulation is most important for the management of the disease. The aim of this study was to analyze the effectiveness of a brief mHealth psychological intervention in emotion regulation to promote positive subjective well-being in cardiovascular disease patients. The study sample (N = 69, 63.7 ± 11.5 years) was allocated to either the experimental group (n = 34) or control group (n = 35). The intervention consisted of a psychoeducational session in emotion regulation and an mHealth-based intervention for 2 weeks. Positive subjective well-being as a primary outcome and self-efficacy to manage the disease as a secondary outcome were assessed at five time points evaluated over a period of 6 weeks. The experimental group showed higher improvement in positive subjective well-being and self-efficacy for managing the disease compared to the control group over time. The experimental group also improved after the intervention on all outcome measures. Brief mHealth interventions in emotion regulation might be effective for improving positive subjective well-being and self-efficacy to manage the disease in cardiovascular patients.

Sir2 is induced by oxidative stress in a yeast model of Huntington disease and its activation reduces protein aggregation.

Huntington disease (HD) is a neurodegenerative disorder caused by expansion of CAG trinucleotide repeats, leading to an elongated polyglutamine sequence (polyQ) in the huntingtin protein. Misfolding of mutant polyQ proteins with expanded tracts results in aggregation, causing cytotoxicity. Oxidative stress in HD has been documented in humans as important to disease progression. Using yeast cells as a model of HD, we report that when grown at high glucose concentration, cells expressing mutant polyQ do not show apparent oxidative stress. At higher cell densities, when glucose becomes limiting and cells are metabolically shifting from fermentation to respiration, protein oxidation and catalase activity increases in relation to the length of the polyQ tract. Oxidative stress, either endogenous as a result of mutant polyQ expression or exogenously generated, increases Sir2 levels. Δ sir2 cells expressing expanded polyQ lengths show signs of oxidative stress even at the early exponential phase. In a wild-type background, isonicotinamide, a Sir2 activator, decreases mutant polyQ aggregation and the stress generated by expanded polyQ. Taken together, these results describe mutant polyQ proteins as being more toxic in respiring cells, causing oxidative stress and an increase in Sir2 levels. Activation of Sir2 would play a protective role against this toxicity.

Construction and Validation of a Brief Pandemic Fatigue Scale in the Context of the Coronavirus-19 Public Health Crisis.

Objectives: The chronic restrictions to mitigate the new SARS-CoV-2 virus may result in pandemic fatigue. This study set out to develop a short, reliable, valid, and gender-invariant instrument-the Pandemic Fatigue Scale (PFS). Methods: In the first phase, 300 students responded to a pilot questionnaire that allowed the reduction and refinement of the items. In the second phase, the validity, reliability, and invariance of the scale were explored among a sample of 596 participants. Results: Factor exploratory and confirmatory analyses confirmed a robust adjustment for the bifactorial structure that explained 79,36% of the variance. The two factors identified were 1) people's demotivation in continuing to follow the recommended protective behaviors (neglect) and 2) people's boredom regarding the pandemic-related information (boredom). The pattern of relations between the Pandemic Fatigue Scale and other variables-find through correlation, mediation, and path analyses-and the gender differences-find in the ANOVA analyses-provided strong evidence of the construct validity. Moreover, the PFS was shown to be invariant regarding gender in a multigroup factor confirmatory analysis. Conclusion: The instrument can be of utility for professionals and researchers to assess pandemic fatigue, a variable that can affect the adoption of protective measure to avoid catching and spreading the virus.

Positivity and Self-Efficacy Beliefs Explaining Health-Related Quality of Life in Cardiovascular Patients.

BACKGROUND: Psychological well-being and health-specific self-regulation have been associated with cardiovascular health. This study aimed to examine the longitudinal relationship of positivity and health-specific self-regulatory variables to health-related quality of life in patients with cardiovascular disease. METHODS: A sample of 550 cardiac patients completed a number of instruments (positivity, regulatory emotional self-efficacy, and cardiac self-efficacy scales, and the general health questionnaire SF-12) on two occasions 9 months apart, assessing their level of positivity, health-specific self-efficacy beliefs, and health-related quality of life. RESULTS: Mediational analyses demonstrated that health-specific self-efficacy beliefs mediate the relationship between positivity and health-related quality of life. In terms of self-efficacy in managing negative affect, the despondency-distress factor showed both direct and indirect effects on health, while the anger factor showed only an indirect effect. The results of the structural equation model demonstrated suitable indices of fit. CONCLUSIONS: Positivity may act as a disposition helps patients to use motivational strategies related to health, be more confident in their ability to regulate their emotions, and follow the recommendations of their cardiac medical team, enabling them to perceive a higher quality of life. These findings indicate the need to promote psychosocial interventions that include these variables.

Emotion regulation in patients with cardiovascular disease: development and validation of the stress and anxiety regulation strategies scale (STARTS).

BACKGROUND AND OBJECTIVES: Anxiety and stress influence the onset and prognosis of cardiovascular disease (CVD), but little is known about what CVD patients do when experiencing stress/anxiety. This study aimed to identify the behavioral strategies CVD patients use to regulate these emotions. DESIGN: Instrumental and longitudinal. METHODS: A theoretically-guided scale, the Stress and Anxiety Regulation Strategies (STARTS), was developed considering the target population's characteristics. CVD patients were recruited at three different points (NT1 = 721, NT2 = 566, NT3 = 311). RESULTS: At T1 exploratory factor analysis was conducted (random sample 1). The validity of the most parsimonious three-factor solution was subsequently found via confirmatory factor analysis at T1 (random sample 2), T2, and T3, revealing good and stable model fit. The factors represented strategies differentiated by the type and level of activity required (passive, intellectual, and physical strategies). The scale showed good test-retest reliability and internal consistency. Correlation and regression analyses with positive and negative affect, psychological wellbeing (stress, anxiety, depression), and cardiac self-efficacy provided evidence for the validity of STARTS score. Physical and passive strategies showed opposite patterns. CONCLUSIONS: The scale shows adequate psychometric properties for assessing the strategies used by CVD patients to regulate stress and anxiety.