Unsupportive parenting moderates the effects of family psychosocial intervention on metabolic syndrome in African American youth.

BACKGROUND/OBJECTIVE: Family relationships have been linked to obesity and related disorders in youth, but few studies have provided causal evidence of this association. This study tested the impact of a family psychosocial intervention on components of metabolic syndrome-a condition driven largely by abdominal obesity-in African American youth. In particular, the study tested whether effects were strongest among those who started at highest risk, that is, with high levels of unsupportive parenting at baseline. SUBJECTS/METHODS: Randomized clinical trial of a community sample of 391 African American youth (mean age=11.2 years) conducted in 2001-2002, with follow-up metabolic syndrome assessment in 2014-2015. Participants were assigned either to receive a weekly family intervention or to a control group. The primary study outcome was the number of components of metabolic syndrome that were clinically elevated at age 25, including central adiposity, blood pressure, triglycerides, glucose and low high-density lipoproteins. Unsupportive parenting was measured by questionnaires at baseline. RESULTS: Significant interaction effects were found between group assignment and baseline unsupportive parenting on counts of metabolic syndrome components in youth (beta=-0.17, P=0.03). Among those who started with higher levels of unsupportive parenting at age 11, participation in the family intervention reduced the number of clinically elevated components of the metabolic syndrome at age 25 relative to the control group. No such effect was seen among those who started with good parenting. Mediation analyses suggested that changes in the psychosocial targets of the parenting intervention partially accounted for the effects amongst those high in unsupportive parenting at baseline (effect size=-0.350, s.e.=0.178). CONCLUSIONS: These findings suggest that efforts to improve family relationships may be able to ameliorate the detrimental effects that harsh and unsupportive parenting have on obesity-related outcomes such as metabolic syndrome in youth.

Pre-transplant emotional support is associated with longer survival after allogeneic hematopoietic stem cell transplantation.

Emerging evidence suggests that psychosocial factors pre-transplant predict survival in cancer patients undergoing hematopoietic stem cell transplantation (HSCT). These studies, however, typically have small sample sizes, short-term follow ups or a limited panel of medical covariates. We extend this research in a large, well-characterized sample of transplant patients, asking whether patients' perceived emotional support and psychological distress predict mortality over 2 years. Prior to transplant, 400 cancer patients (55.5% males; 82.8% White; Mage=50.0 years; 67.0% leukemia, 20.0% lymphoma) were interviewed by a social caseworker, who documented the patients' perceived emotional support and psychological distress. Subsequently, patients received an allogeneic HSCT (51.0% matched-related donor, 42.0% matched-unrelated donor and 7.0% cord blood). HSCT outcomes were obtained from medical records. Controlling for demographic characteristics (age, sex, race/ethnicity and marital status) and medical confounders (disease type, conditioning regimen, remission status, cell dosage, donor and recipient CMV seropositivity, donor sex, comorbidities and disease risk), ratings of good emotional support pre-transplant predicted longer overall survival (hazard ratio (HR)=0.61, 95% confidence interval (CI), 0.42-0.91; P=0.013). Pre-transplant psychological distress was unrelated to survival, however (Ps>0.58). Emotional support was marginally associated with lower rates of treatment-related mortality (HR=0.58, CI, 0.32-1.05; P=0.073). These findings are consistent with the hypothesis that emotional support contributes to better outcomes following HSCT. Future studies should examine whether intervention efforts to optimize emotional resources can improve survival in cancer patients.

Maternal warmth buffers the effects of low early-life socioeconomic status on pro-inflammatory signaling in adulthood.

The notion that family support may buffer individuals under adversity from poor outcomes has been theorized to have important implications for mental and physical health, but little is known about the biological mechanisms that explain these links. We hypothesized that adults who grew up in low socioeconomic status (SES) households but who experienced high levels of maternal warmth would be protected from the pro-inflammatory states typically associated with low SES. A total of 53 healthy adults (aged 25-40 years) low in SES early in life were assessed on markers of immune activation and systemic inflammation. Genome-wide transcriptional profiling also was conducted. Low early-life SES individuals who had mothers, who expressed high warmth toward them, exhibited less Toll-like receptor-stimulated production of interleukin 6, and reduced bioinformatic indications of pro-inflammatory transcription factor activity (NF-κB) and immune activating transcription factor activity (AP-1) compared to those who were low in SES early in life but experienced low maternal warmth. To the extent that such effects are causal, they suggest the possibility that the detrimental immunologic effects of low early-life SES environments may be partly diminished through supportive family climates.

Genome-wide transcriptional profiling linked to social class in asthma.

OBJECTIVES: Low socioeconomic status (SES) is one of the most robust social factors associated with disease morbidity, including more severe asthma in childhood. However, our understanding of the biological processes that explain this link is limited. This study tested whether the social environment could get "under the skin" to alter genomic activity in children with asthma. DESIGN AND PARTICIPANTS: Two group design of children with physician diagnosed asthma who came from low or high SES families. OUTCOMES: Genome-wide transcriptional profiles from T lymphocytes of children with asthma. RESULTS: Children with asthma from a low SES background showed overexpression of genes regulating inflammatory processes, including those involved in chemokine activity, stress responses and wound responses, compared with children with asthma from a high SES background. Bioinformatic analysis suggested that decreased activity of cyclic AMP response element binding protein and nuclear factor Y and increased nuclear factor kappaB transcriptional signalling mediated these effects. These pathways are known to regulate catecholamine and inflammatory signalling in immune cells. CONCLUSIONS: This study provides the first evidence in a sample of paediatric patients diagnosed with asthma that the larger social environment can affect processes at the genomic level. Specifically, gene transcription control pathways that regulate inflammation and catecholamine signalling were found to vary by SES in children with asthma. Because these pathways are the primary targets of many asthma medications, these findings suggest that the larger social environment may alter molecular mechanisms that have implications for the efficacy of asthma therapeutics.

Serum endocannabinoid content is altered in females with depressive disorders: a preliminary report.

BACKGROUND: Preclinical research has suggested that the endocannabinoid system may be involved in the etiology and/or treatment of depression; however, there are no published studies examining circulating endocannabinoid content in patients with clinical depression. METHODS: This study examined the endocannabinoids (anandamide; AEA) and 2-arachidonylglycerol (2-AG) in serum from ambulatory, medication-free female patients diagnosed with minor or major depression, and in controls matched for demographic characteristics. RESULTS: Serum 2-AG content was significantly decreased in patients diagnosed with major depression, and this decrease was correlated significantly and negatively with duration of the depressive episode, such that 2-AG content was progressively lower the longer the depressive episode. While AEA was not associated with major depression PER SE, a strong negative correlation was found between serum AEA content and Hamilton ratings for cognitive and somatic anxiety, suggesting that AEA content may relate to the anxiety dimension of affective disorders. In subjects with minor depression, serum AEA was significantly elevated, with 2-AG content demonstrating a similar, but statistically insignificant trend. DISCUSSION: These are the first clinical data to indicate that the endocannabinoid system may be disturbed in affective disease, and suggest that future research is required to determine the relevance of these changes with respect to disease manifestation and pharmacotherapy.

Psychological interventions and the immune system: a meta-analytic review and critique.

This article reviews evidence for the hypothesis that psychological interventions can modulate the immune response in humans and presents a series of models depicting the psychobiological pathways through which this might occur. Although more than 85 trials have been conducted, meta-analyses reveal only modest evidence that interventions can reliably alter immune parameters. The most consistent evidence emerges from hypnosis and conditioning trials. Disclosure and stress management show scattered evidence of success. Relaxation demonstrates little capacity to elicit immune change. Although these data provide only modest evidence of successful immune modulation, it would be premature to conclude that the immune system is unresponsive to psychological interventions. This literature has important conceptual and methodological issues that need to be resolved before any definitive conclusions can be reached.

Psychological stress and antibody response to immunization: a critical review of the human literature.

OBJECTIVE: The objective of this review was to evaluate the evidence for the hypothesis that psychological stress influences antibody response to immunization in humans. METHODS: A critical review of the literature was conducted. RESULTS: The evidence supports an association between psychological stress and suppression of humoral immune (antibody) response to immunization. This association is convincing in the case of secondary immune response but weak for primary response. The lack of consistent evidence for a relation with primary response may be attributed to a failure to consider the critical points when stress needs to be elevated in the course of the production of antibody. Lower secondary antibody responses were found among patients with chronically high levels of stress (severe enduring problems or high levels of trait negative affect). These responses were found most consistently among older adults. Lower secondary responses were also found for those reporting acute stress or negative affect, but only in studies of secretory immunoglobulin A antibody in which psychological and antibody measures were linked very closely in time. Health practices did not mediate relations between stress and antibody responses; however, there were indications that elevated cortisol levels among stressed patients could play a role. Evidence also suggests the possible influences of dispositional stress-reactivity and low positive affect in the inhibition of antibody production. CONCLUSIONS: The literature supports a relationship between psychological stress and antibody responses to immunizations. The data are convincing in the case of secondary response but weak for primary response. More attention to the kinetics of stress and antibody response and their interrelations is needed in future research.

Results of continual devaluation of cardiothoracic surgical codes by the HCFA between 1984 and 1999.

BACKGROUND: The devaluation of surgical procedural services by Medicare began in 1989 as a result of the federal government's adoption of the Resource Based Relative Value Scale, a method of redistribution of payments to physicians from surgical to primary care services. This method gave to the Health Care Financing Administration (HCFA) effective and complete control of Medicare payments to physicians for the first time. The resultant decrease in the nominal dollar value is well understood, but the effect of changes in inflation frequently is not calculated into the reported loss. METHODS: A method of determining the true extent of this devaluation using the nominal dollar decrease plus the effect of inflation was presented in 1995. RESULTS: Since then, repeated devaluation by the HCFA and other third parties plus continual inflation has further eroded the remuneration for cardiothoracic surgical services. Three different sets of data are used to determine the devaluation of five cardiothoracic operations. One set shows the change between 1988 and 1998; one the change between 1988 and 1999; and one the change between 1984 and 1999. CONCLUSIONS: Depending on the geographic location, it appears that the remuneration for pulmonary procedures between 1988 and 1999 decreased 35% to 60%. Similarly, depending on the years reviewed (between 1984 and 1999) and the geographic location, the fee for cardiac procedures decreased 46% to 69%.

Increased natural killer-cell mobilization and cytotoxicity during marital conflict.

Natural killer (NK) cells are reproducibly mobilized into the circulation in response to intense physical exercise or acute psychological stress, and altered expression of adhesion molecules potentially contributes to NK-cell mobilization. Studies of leukocyte mobilization during acute stress have used psychological stressors which facilitate tight experimental control but have limited applicability to everyday life. We therefore used a laboratory model of marital conflict as an experientially meaningful acute stressor to elucidate relationships among conflict, cardiovascular reactivity, and altered leukocyte phenotype and function. Forty-one ethnically diverse, nondistressed, healthy married couples were asked to discuss a specific problem in their marriage for 15 min. Blood pressure and heart rate were measured before, during, and after the discussion, and blood was remotely drawn at the same time points to quantify numbers of specific leukocyte subsets, NK-cell adhesion molecule expression, and NK cytotoxicity. Couples responded to the conflict task with cardiovascular reactivity; increases in the percentages of circulating NK cells and CD8(+) T cells and decreases in the percentage of circulating CD4(+) T cells; decreases in the percentage of NK cells that express L-selectin; and increases in NK-cell cytotoxicity without a commensurate increase in per-cell cytotoxicity. Rapid downregulation or shedding of L-selectin (CD62L) from NK cells did not contribute to their mobilization during conflict. Instead, CD62L(-) NK cells were mobilized while CD62L(+) NK cells were selectively retained in the vascular marginating pool and/or in extravascular tissue. From a broader perspective, the data support the hypothesis that altered trafficking of specific leukocyte subsets is an integral component of the fight-or-flight response to an acute stressor.

Pathways linking major depression and immunity in ambulatory female patients.

OBJECTIVES: The goals of this study were to investigate whether depression is associated with cellular immunity in ambulatory patients and to identify neuroendocrine and behavioral pathways that might account for this relationship. METHODS: We studied 32 women who met Diagnostic and Statistical Manual of Mental Disorder, fourth edition, criteria for major depressive disorder and 32 healthy female control subjects. The groups were matched for age and ethnicity. None were taking medication, and all were free of disease involving the immune system. RESULTS: Depressed subjects had reduced proliferative responses to the mitogens concanavalin A and phytohemagglutinin compared with control subjects. Natural killer cell activity was reduced among older depressed subjects but enhanced among younger depressed subjects. Although depression was associated with elevated circulating levels of norepinephrine and estradiol, these hormones could not account for the immunologic differences between depressed and control subjects. Depression was also associated with greater tobacco and caffeine consumption, less physical activity, and poorer sleep quality. Mediational analyses were consistent with physical activity acting as a pathway through which depression was associated with reduced lymphocyte proliferation. CONCLUSIONS: Ambulatory patients with mild to moderately severe depression exhibit reduced mitogen-stimulated lymphocyte proliferative responses and altered natural killer cell cytotoxicity. The relationship between depression and proliferative responses may be mediated by physical activity.

Shaft/shaft-seal interface characteristics of a multiple disk centrifugal blood pump.

A multiple disk centrifugal pump (MDCP) is under investigation as a potential left ventricular assist device. As is the case with most shaft driven pumps, leakage problems around the shaft/shaft seal interface are of major interest. If leakage were to occur during or after implantation, potential events such as blood loss, clotting, blood damage, and/or infections might result in adverse effects for the patient. Because these effects could be quite disastrous, potential shaft and shaft seal materials have been investigated to determine the most appropriate course to limit these effects. Teflon and nylon shaft seals were analyzed as potential candidates along with a stainless steel shaft and a Melonite coated shaft. The materials and shafts were evaluated under various time durations (15, 30, 45, and 60 min), motor speeds (800, 1,000, 1,200, and 1,400 rpm), and outer diameters (1/2 and 3/4 inches). The motor speed and geometrical configurations were typical for the MDCP under normal physiologic conditions. An air and water study was conducted to analyze the inner diameter wear, the inner temperature values, and the outer temperature values. Statistical comparisons were computed for the shaft seal materials, the shafts, and the outer diameters along with the inner and outer temperatures. The conclusions made from the results indicate that both the tested shaft seal materials and shaft materials are not ideal candidates to be used for the MDCP. Teflon experienced a significant amount of wear in air and water studies. Nylon did experience little wear, but heat generation was an evident problem. A water study on nylon was not conducted because of its molecular structure.

Analysis of optimal design configurations for a multiple disk centrifugal blood pump.

A multiple disk centrifugal pump was analyzed as a blood pump for use in cardiac assistance or as a bridge to transplant device. The original configuration consisted of 6 parallel disks with 0.016 inch spacing between disks. This pump suffered from a degradation of flow with increasing afterload. A study was conducted to analyze flow performance as a function of afterload, preload, and motor speed. Configurations were examined including 4, 5, and 6 disks each with spacings of 0.15, 0.20, and 0.25 inches. Flow rates were examined for variations in afterload from 60-130 mm Hg, in preload from 0-20 mm Hg and for motor speeds of 1,250, 1,500, and 1,750 rpm. Analyses of afterload effects were intended to determine those configurations that produced less flow degradation with increasing afterload. Analyses of motor speed effects were intended to determine any configurations that produced greater flow increases with increasing motor speed. A hemolysis study was also performed. Both plasma free hemoglobin and the index of hemolysis were compared to data reported for other centrifugal blood flow devices. Results indicated that a 5 disk configuration with a 0.15 inch spacing produced optimal flow results with minimal degradation at higher afterloads. No optimal configuration based upon motor speed was indicated. Preload effects on pump performance were minimal. Hemolysis results indicated minimal blood damage with levels below those of many other centrifugal blood pump designs.

Psychosocial predictors of natural killer cell mobilization during marital conflict.

This study examined how specific emotions relate to autonomic nervous and immune system parameters and whether cynical hostility moderates this relationship. Forty-one married couples participated in a 15-min discussion about a marital problem. Observers recorded spouses' emotional expressions during the discussion, and cardiovascular, neuroendocrine, and immunologic parameters were assessed throughout the laboratory session. Among men high in cynical hostility, anger displayed during the conflict was associated with greater elevations in systolic and diastolic blood pressure, cortisol, and increases in natural killer cell numbers and cytotoxicity. Among men low in cynical hostility, anger was associated with smaller increases in heart rate and natural killer cell cytotoxicity. These findings suggest that models describing the impact of stress on physiology should be refined to reflect the joint contribution of situational and dispositional variables.

Personality and tonic cardiovascular, neuroendocrine, and immune parameters.

Although there is now abundant evidence that certain personality features constitute risk factors for negative health outcomes, personality measures have received little attention to date in the behavioral immunology literature. The present study assessed the relationship between major dimensions of personality and tonic cardiovascular, neuroendocrine, and immunologic parameters in 276 healthy adults. Participants who scored low in agreeableness tended to have higher levels of systolic blood pressure, diastolic blood pressure, and epinephrine. Low levels of extraversion were associated with higher blood pressure, epinephrine, norepinephrine, and natural killer cell cytotoxicity. Neuroticism was generally unrelated to physiologic outcomes. Personality was not associated with leukocyte subset counts. The magnitude of relationships between personality and physiology was modest, with personality measures accounting for 1 to 7% of the variance in selected physiological parameters. Health practices did not mediate associations between personality and physiologic outcomes. However, a substantial proportion of the relationship between extraversion and natural killer cell cytotoxicity was accounted for by their common association with epinephrine and to a lesser extent norepinephrine. These findings are consistent with the notion that personality contributes to basal physiology and provide a foundation for further research on the relationship between personality and natural killer cell cytotoxicity.

Nondelinquent youths' stealing behavior and their perceptions of parents, school, and peers.

Correlates of stealing behavior were investigated in a sample of 167 nondelinquent 10- to 15-year-olds. Stealing was related to youths' attitudes toward parents and school, as well as reasons for stealing. Stealing was most frequent among older males. Attitude toward school was most consistently related to stealing behavior, though perceptions of family's values and the consequences of stealing were also important. Interventions with youths at risk for continued covert antisocial behaviors are discussed.

Cardiovascular and immune responses to acute psychological stress in young and old women: a meta-analysis.

OBJECTIVE: To describe the relationships between cardiovascular and natural killer (NK) cell number changes on acute psychological stress in women. METHOD: Data from eight different studies were analyzed. A total of 128 healthy female subjects, 85 younger (18-45 years) and 43 older (49-87 years), had been subjected to a speech stressor (N = 80) or a mental effort stressor (N = 48), mental arithmetic, or the Stroop test. Correlations between changes in NK cell numbers, systolic (SBP) and diastolic (DBP) blood pressure, and heart rate (HR) were computed. Meta-analysis programs were used to study correlations across studies and to examine whether correlations differed with stressors or age. RESULTS: In all studies, significant increases over baseline were observed for each variable. Across studies, the mean weighted r between changes in HR, DBP, and SBP was medium (rw = .25) to large (rw = .64). A medium to large average correlation between HR and NK changes (rw = .37) was observed, whereas average correlations of changes in NK cell numbers with blood pressure changes were small to medium (rw < or = .23). Correlations between changes in NK cell numbers and cardiovascular variables were homogeneous across studies, whereas mutual correlations between cardiovascular variables were heterogeneous. One moderator variable showed itself: correlations between HR and DBP reactions were larger in studies with older than younger subjects. CONCLUSION: NK cell changes and HR responses induced by acute stress in women are regulated, to some extent, by the same mechanisms. Neither the type of stressor nor age seem to be very important when considering correlations between NK cell and cardiovascular changes. This study integrates information about NK cell and cardiovascular responses in women that can be used as reference material in future studies.

Social relationships and the progression of human immunodeficiency virus infection: a review of evidence and possible underlying mechanisms.

We review studies examining the quality and quantity of social relationships as potential risk factors for differential progression of human immunodeficiency virus (HIV) infection. Several well-conducted prospective studies suggest that the health effects associated with the presence of supportive social relationships vary according to disease stage and mode of transmission. For gay or bisexual males in the early stages of infection, the presence of supportive social relationships appears to be a risk factor for accelerated disease progression. For individuals in the later stages of infection and those who acquire HIV via intravenous drug use or transfusion, supportive social relationships appear to be associated with health protective effects similar to those observed in other disease settings. We consider a variety of potential explanations for accelerated disease progression in gay men with extensive networks of personal relationships.

Social relationships and immune processes in HIV seropositive gay and bisexual men.

This three-year longitudinal study assessed the association between social relationships and human immunodeficiency virus (HIV) progression in individuals at risk for morbidity and mortality due to acquired immune deficiency syndrome (AIDS). Two-hundred five HIV seropositive men without AIDS completed measures of social integration and loneliness at baseline. Blood samples used to assess CD4 T-lymphocyte levels were collected at baseline and at six-month intervals for a three-year follow-up period. Contrary to expectation, lower levels of baseline loneliness predicted more rapid declines in CD4 levels over the follow-up period. This association was independent of baseline CD4 values, negative affect, and health practices. A series of mediational analyses revealed that sexual behavior, medication use, bereavement, coping, and a number of other variables were not mechanisms through which loneliness affected the immune system. Loneliness was not associated with time to AIDS diagnosis or time to AIDS-related mortality. These findings are consistent with the emerging view that social relationships can have deleterious, as well as protective, influences on health outcomes.