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Troyer EA, Kohn JN, Castillo MFR, Lobo JD, Sanchez YR, Ang G, Cirilo A, Leal JA, Pruitt C, Walker AL, Wilson KL, Pung MA, Redwine LS, Hong S. Post-traumatic stress in older, community-dwelling adults with hypertension during the COVID-19 pandemic: An investigation of pre-pandemic sociodemographic, health, and vascular and inflammatory biomarker predictors. J Health Psychol 2024; 29:552-566. [PMID: 38088312 DOI: 10.1177/13591053231213305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
COVID-19 pandemic-related traumatic stress (PRTS) symptoms are reported in various populations, but risk factors in older adults with chronic medical conditions, remain understudied. We therefore examined correlates and pre-pandemic predictors of PRTS in older adults with hypertension during COVID-19. Participants in California, aged 61-92 years (n = 95), participated in a pre-pandemic healthy aging trial and later completed a COVID-19 assessment (May to September 2020). Those experiencing ⩾1 PRTS symptom (n = 40), and those without PRTS symptoms (n = 55), were compared. The PRTS+ group had poorer mental and general health and greater impairment in instrumental activities of daily living. Pre-pandemic biomarkers of vascular inflammation did not predict increased odds of PRTS; however, greater pre-pandemic anxiety and female gender did predict PRTS during COVID-19. Our findings highlight PRTS as a threat to healthy aging in older adults with hypertension; targeted approaches are needed to mitigate this burden, particularly for females and those with pre-existing anxiety.
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Kohn JN, Lobo JD, Troyer EA, Ang G, Wilson KL, Walker AL, Spoon C, Pruitt C, Tibiriçá L, Pung MA, Redwine LS, Hong S. Tai Chi versus health education as a frailty intervention for community-dwelling older adults with hypertension. Aging Clin Exp Res 2023; 35:2051-2060. [PMID: 37458963 PMCID: PMC10826892 DOI: 10.1007/s40520-023-02504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Frailty is associated with poor outcomes among older adults with hypertension and complicates its pharmacological management. Here, we assessed whether 12-weeks of instructor-guided, group Tai Chi (TC) practice improved frailty relative to Healthy Aging Practice-centered Education (HAP-E) classes in older adults with hypertension. METHODS Secondary analysis of a randomized controlled trial in San Diego County, USA, of 167 community-dwelling individuals aged ≥ 60 yrs (70% female; 72.1 ± 7.5 yrs), defined as non-frail (66%) or frail (34%) based on 53-item deficit accumulation frailty index (FI). Linear mixed-effects models were used to assess pre-to-post intervention differences in FI and logistic regression to explore differential odds of clinically meaningful FI change. RESULTS One hundred thirty-one participants completed post-intervention assessments. Frailty decreased pre-to-post intervention in the TC (ΔFI = - 0.016, d = - 0.39, - 0.75 to - 0.03), but not the HAP-E arm (ΔFI = - 0.009, d = - 0.13, - 0.52-0.27), despite no significant group differences between the TC and HAP-E arms (d = - 0.11, - 0.46-0.23). Furthermore, greater odds of improved FI were observed for frail participants in the TC (OR = 3.84, 1.14-14.9), but not the HAP-E (OR = 1.34, 0.39-4.56) arm. Subgroup analysis indicated treatment effects in TC were attributed to frail participants (frail: ΔFI = - 0.035, d = - 0.68, -1.26 to - 0.08; non-frail: ΔFI = - 0.005, d = - 0.19, - 0.59-0.22), which was not the case in the HAP-E arm (frail: ΔFI = - 0.017, d = - 0.23, - 0.81-0.35; non-frail: ΔFI = - 0.003, d = - 0.07, - 0.47-0.33). Frail participants were no more likely to drop-out of the study than non-frail (71% vs. 69% retained). CONCLUSIONS Twelve weeks of twice-weekly guided TC practice was well-tolerated, associated with decreases in frailty, and increased odds of clinically meaningful FI improvement at post-intervention.
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Affiliation(s)
- Jordan N Kohn
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US.
- Sam and Rose Stein Institute for Research On Aging, University of California San Diego, La Jolla, CA, 92093, US.
| | - Judith D Lobo
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
| | - Emily A Troyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
| | - Gavrila Ang
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Kathleen L Wilson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Amanda L Walker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Chad Spoon
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Christopher Pruitt
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Lize Tibiriçá
- Sam and Rose Stein Institute for Research On Aging, University of California San Diego, La Jolla, CA, 92093, US
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
| | - Meredith A Pung
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Laura S Redwine
- Family Medicine and Community Health, Osher Center for Integrative Health, University of Miami, Miller School of Medicine, Miami, FL, 33136, US
| | - Suzi Hong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
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Kohn JN, Lobo JD, Troyer EA, Wilson KL, Ang G, Walker AL, Pruitt C, Pung MA, Redwine LS, Hong S. Tai chi or health education for older adults with hypertension: effects on mental health and psychological resilience to COVID-19. Aging Ment Health 2023; 27:496-504. [PMID: 35311437 PMCID: PMC9489818 DOI: 10.1080/13607863.2022.2053836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare the effectiveness of 12 weeks of community-based, in-person, group Tai Chi (TC) and Health Education (HAP-E) in improving health and wellbeing in older adults with hypertension and in promoting psychological resilience during COVID-19. METHODS A 12-week randomized controlled trial (RCT) in San Diego County, USA. Self-reported depressive symptoms, anxiety, sleep disturbances, gratitude, resilience, mental and physical health were assessed in-person pre- and post-intervention, and by long-term follow-up surveys during COVID-19. Linear mixed-effects models were used to assess study arm differences over time and logistic regression to identify predictors of positive intervention response. RESULTS Of 182 randomized participants (72.6 ± 7.9 yrs; 72% female), 131 completed the intervention. Modest improvements in health and wellbeing occurred post-intervention in both arms (Cohen's d: TC = 0.38, 95% CI: 0.25-0.51; HAP-E = 0.24, 0.11-0.37), though positive intervention responses were more than twice as likely in TC (OR = 2.29, 1.07-4.57). Younger age, higher anxiety, and poorer mental health at baseline predicted greater odds of response. Small declines in health and wellbeing were reported at the first COVID-19 follow-up, with smaller declines in the TC arm (Cohen's d: TC = -0.15, -0.31-0.00; HAP-E = -0.34, -0.49 to -0.19). Health and wellbeing stabilized at the second COVID-19 follow-up. Most participants (>70%) reported that the interventions benefitted their health and wellbeing during COVID-19. CONCLUSION TC and HAP-E improved health and wellbeing, though TC conferred greater odds of an improved mental health response. Declines in health and wellbeing were observed at pandemic follow-up, with smaller declines in the TC arm, suggesting increased resilience.
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Affiliation(s)
- Jordan N. Kohn
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Emily A. Troyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Kathleen L. Wilson
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Gavrila Ang
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Amanda L. Walker
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Christopher Pruitt
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Meredith A. Pung
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Laura S. Redwine
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
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Kohn JN, Lobo JD, Troyer EA, Wilson KL, Ang G, Walker AL, Pruitt C, Pung MA, Redwine LS, Hong S. Trends, heterogeneity, and correlates of mental health and psychosocial well-being in later-life: study of 590 community-dwelling adults aged 40-104 years. Aging Ment Health 2022; 27:1-10. [PMID: 35622016 PMCID: PMC9489818 DOI: 10.1080/13607863.2022.2078790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The goal of this study was to examine if mental health and psychosocial well-being differed between middle-aged (MA; 40-59 years), younger-old (YO; 60-79 years), and older-old (OO; 80+ years) adults with respect to their trends, heterogeneity, and correlates. METHODS Eighteen mental health and psychosocial well-being instruments were administered to 590 adults over age 40. Cross-sectional data also included self-report-based measures of sociodemographics, cognitive functioning, physical health and activity, and body mass index. RESULTS Age trends across instruments varied in magnitude and shape, but generally supported an inverted U-shaped trend in mental health and psychosocial well-being, with small increases from MA to YO age (d = 0.29) and smaller declines from YO to OO age (d = -0.17). A U-shaped association between age and mental health heterogeneity was also observed. The strongest correlates of mental health and psychosocial well-being differed by age (MA: perceived stress; YO: successful aging; OO: compassion toward others), as did the associations of a flourishing versus languishing mental health and well-being profile. CONCLUSIONS Our findings support the "paradox of aging," whereby declines in physical and cognitive health co-occur with relatively preserved mental health and well-being. Our findings indicate that variance in mental and psychosocial health does not increase linearly with age and support careful consideration of heterogeneity in mental health and aging research. Our findings also suggest that mental health and psychosocial well-being decouple from stress-related dimensions in MA and become increasingly associated with positive, other-oriented emotions in OO, broadly supporting socioemotional theories of aging.
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Affiliation(s)
- Jordan N. Kohn
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Emily A. Troyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Kathleen L. Wilson
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Gavrila Ang
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Amanda L. Walker
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Christopher Pruitt
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Meredith A. Pung
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Laura S. Redwine
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
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Redwine LS, Hong S, Kohn J, Martinez C, Hurwitz BE, Pung MA, Wilson K, Pruitt C, Greenberg BH, Mills PJ. Systemic Inflammation and Cognitive Decrements in Patients With Stage B Heart Failure. Psychosom Med 2022; 84:133-140. [PMID: 34654027 DOI: 10.1097/psy.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the role of systemic inflammation in reduced cognitive functioning in patients with early-stage heart failure (HF) while determining associations with other cardiovascular risk factors. METHODS Patients with stage B HF (n = 270; mean [standard deviation] age = 66.1 [10.1] years) were examined cross-sectionally for relationships among cardiovascular disease (CVD) and psychological risk factors, C-reactive protein (CRP), and Montreal Cognitive Assessment (MoCA) scores. A subsample (n = 83) at high risk for stage C HF (B-type natriuretic peptide levels ≥65 pg/ml) were followed up for 12 months for relationships between CRP levels and cognitive function. RESULTS Baseline smoking (χ2 = 6.33), unmarried (χ2 = 12.0), hypertension (χ2 = 5.72), greater body mass index (d = 0.45), and physical fatigue (d = 0.25) were related to higher CRP levels (p values < .05). Cross-sectionally, CRP levels were negatively related to MoCA scores, beyond CVD (ΔR2 = 0.022, β = -0.170, p < .010) and psychological risk factors (ΔR2 = 0.016, β = 0.145, p < .027), and related to mild cognitive impairment criteria (odds ratio = 1.35, 95% confidence interval [CI] = 1.00-1.81, p = .046). Across 12 months, B-type natriuretic peptide high-risk patients with CRP levels ≥3 mg/L had lower MoCA scores (23.6; 95% CI = 22.4-24.8) than did patients with CRP levels <3 mg/L (25.4; 95% CI = 24.4-26.5; p = .024). CONCLUSIONS Patients with stage B HF and heightened CRP levels had greater cognitive impairment at baseline and follow-up, independent of CVD and potentially psychological risk factors. Low-grade systemic inflammation may be one mechanism involved in cognitive dysfunction at early stages of HF.
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Affiliation(s)
- Laura S Redwine
- From the College of Behavioral and Community Sciences (Redwine), University of South Florida, Tampa, Florida; Departments of Psychiatry (Hong, Kohn) and Family Medicine and Public Health (Hong, Kohn, Pung, Pruitt, Mills), University of California School of Medicine, San Diego, California; Division of Cardiology (Martinez), University of Miami Miller School of Medicine; Behavioral Medicine Research Center (Hurwitz), University of Miami, Miami; Department of Psychology (Hurwitz), University of Miami, Coral Gables; Division of Endocrinology, Diabetes and Metabolism (Hurwitz), Miller School of Medicine, University of Miami, Miami, Florida; Department of Medicine (Greenberg), University of California School of Medicine, San Diego, California; and Department of Public Health Sciences (Redwine), University of Miami Miller School of Medicine, Miami, Florida
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Kohn JN, Troyer E, Guay-Ross RN, Wilson K, Walker A, Spoon C, Pruitt C, Lyasch G, Pung MA, Milic M, Redwine LS, Hong S. Self-reported sleep disturbances are associated with poorer cognitive performance in older adults with hypertension: a multi-parameter risk factor investigation. Int Psychogeriatr 2020; 32:815-825. [PMID: 31647051 PMCID: PMC8011648 DOI: 10.1017/s1041610219001492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Given the evidence of multi-parameter risk factors in shaping cognitive outcomes in aging, including sleep, inflammation, cardiometabolism, and mood disorders, multidimensional investigations of their impact on cognition are warranted. We sought to determine the extent to which self-reported sleep disturbances, metabolic syndrome (MetS) factors, cellular inflammation, depressive symptomatology, and diminished physical mobility were associated with cognitive impairment and poorer cognitive performance. DESIGN This is a cross-sectional study. SETTING Participants with elevated, well-controlled blood pressure were recruited from the local community for a Tai Chi and healthy-aging intervention study. PARTICIPANTS One hundred forty-five older adults (72.7 ± 7.9 years old; 66% female), 54 (37%) with evidence of cognitive impairment (CI) based on Montreal Cognitive Assessment (MoCA) score ≤24, underwent medical, psychological, and mood assessments. MEASUREMENTS CI and cognitive domain performance were assessed using the MoCA. Univariate correlations were computed to determine relationships between risk factors and cognitive outcomes. Bootstrapped logistic regression was used to determine significant predictors of CI risk and linear regression to explore cognitive domains affected by risk factors. RESULTS The CI group were slower on the mobility task, satisfied more MetS criteria, and reported poorer sleep than normocognitive individuals (all p < 0.05). Multivariate logistic regression indicated that sleep disturbances, but no other risk factors, predicted increased risk of evidence of CI (OR = 2.00, 95% CI: 1.26-4.87, 99% CI: 1.08-7.48). Further examination of MoCA cognitive subdomains revealed that sleep disturbances predicted poorer executive function (β = -0.26, 95% CI: -0.51 to -0.06, 99% CI: -0.61 to -0.02), with lesser effects on visuospatial performance (β = -0.20, 95% CI: -0.35 to -0.02, 99% CI: -0.39 to 0.03), and memory (β = -0.29, 95% CI: -0.66 to -0.01, 99% CI: -0.76 to 0.08). CONCLUSIONS Our results indicate that the deleterious impact of self-reported sleep disturbances on cognitive performance was prominent over other risk factors and illustrate the importance of clinician evaluation of sleep in patients with or at risk of diminished cognitive performance. Future, longitudinal studies implementing a comprehensive neuropsychological battery and objective sleep measurement are warranted to further explore these associations.
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Affiliation(s)
- Jordan N Kohn
- Department of Psychiatry, University of California, San Diego, USA
| | - Emily Troyer
- Department of Psychiatry, University of California, San Diego, USA
| | | | - Kathleen Wilson
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Amanda Walker
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Chad Spoon
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Christopher Pruitt
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Gary Lyasch
- Department of Psychiatry, University of California, San Diego, USA
| | - Meredith A Pung
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Milos Milic
- Department of Medicine, University of California, San Diego, USA
| | - Laura S Redwine
- College of Nursing, University of South Florida, Florida, USA
| | - Suzi Hong
- Department of Psychiatry, University of California, San Diego, USA
- Department of Family Medicine and Public Health, University of California, San Diego, USA
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Mills PJ, Taub PR, Lunde O, Pung MA, Wilson K, Pruitt C, Rutledge T, Maisel A, Greenberg BH. Depressive symptoms in asymptomatic stage B heart failure with Type II diabetic mellitus. Clin Cardiol 2019; 42:637-643. [PMID: 31017303 PMCID: PMC6553353 DOI: 10.1002/clc.23187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The presence of concomitant Type II diabetic mellitus (T2DM) and depressive symptoms adversely affects individuals with symptomatic heart failure (HF). HYPOTHESIS In presymptomatic stage B HF, this study hypothesized the presence of greater inflammation and depressive symptoms in T2DM as compared to non-T2DM Stage B patients. METHODS This cross-sectional study examined clinical parameters, inflammatory biomarkers, and depressive symptoms in 349 T2DM and non-T2DM men with asymptomatic stage B HF (mean age 66.4 years ±10.1; range 30-91). RESULTS Fewer diabetic HF patients had left ventricular (LV) systolic dysfunction (P < .05) although more had LV diastolic dysfunction (P < .001). A higher percentage of T2DM HF patients were taking ACE-inhibitors, beta-blockers, calcium channel blockers, statins, and diuretics (P values < .05). T2DM HF patients had higher circulating levels of interleukin-6 (IL-6) (P < .01), tumor necrosis factor-alpha (P < .01), and soluble ST2 (sST2) (P < .01) and reported more somatic/affective depressive symptoms (Beck Depression Inventory II) (P < .05) but not cognitive/affective depressive symptoms (P = .20). Among all patients, in a multiple regression analysis predicting presence of somatic/affective depressive symptoms, sST2 (P = .026), IL-6 (P = .010), B-type natriuretic peptide (P = .016), and sleep (Pittsburgh Sleep Quality Index [P < .001]) were significant predictors (overall model F = 15.39, P < .001, adjusted R2 = .207). CONCLUSIONS Somatic/affective but not cognitive/affective depressive symptoms are elevated in asymptomatic HF patients with T2DM patients. Linkages with elevated inflammatory and cardiac relevant biomarkers suggest shared pathophysiological mechanisms among T2DM HF patients with somatic depression, and these conditions are responsive to routine interventions, including behavioral. Copyright © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Paul J. Mills
- Department of Family Medicine and Public HealthUniversity of California San DiegoSan DiegoCalifornia
| | - Pam R. Taub
- Department of MedicineUniversity of California San DiegoSan DiegoCalifornia
| | - Ottar Lunde
- Department of MedicineUniversity of California San DiegoSan DiegoCalifornia
| | - Meredith A. Pung
- Department of Family Medicine and Public HealthUniversity of California San DiegoSan DiegoCalifornia
| | - Kathleen Wilson
- Department of Family Medicine and Public HealthUniversity of California San DiegoSan DiegoCalifornia
| | - Christopher Pruitt
- Department of Family Medicine and Public HealthUniversity of California San DiegoSan DiegoCalifornia
| | - Thomas Rutledge
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
| | - Alan Maisel
- Department of MedicineUniversity of California San DiegoSan DiegoCalifornia
- Division of CardiologySan Diego VA Health Care SystemSan DiegoCalifornia
| | - Barry H. Greenberg
- Department of MedicineUniversity of California San DiegoSan DiegoCalifornia
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Redwine LS, Pung MA, Wilson K, Chinh K, Duffy AR. Differential Peripheral Inflammatory Factors Associated with Cognitive Function in Patients with Heart Failure. Neuroimmunomodulation 2018; 25:146-152. [PMID: 30352444 DOI: 10.1159/000493142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/19/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cognitive deficits are common in patients with heart failure (HF), and can negatively affect self-care, predict rehospitalizations, and increase mortality rates 5-fold. Inflammation can produce vascular pathology, reducing cerebral blood flow to brain regions necessary for optimal cognitive function. The purpose of the investigation was to identify a pattern of peripheral blood inflammation-related biomarkers associated with cognitive impairment in patients with HF. METHODS Forty-five outpatients (median age = 67 years, SD = 9.9) were recruited from University of California, San Diego (UCSD) and Veterans Affairs San Diego Healthcare Systems (VASDHS), diagnosed with New York Heart Association Stages I-III HF. Participants were administered the Montreal Cognitive Assessment (MoCA) as a measure of global cognitive impairment, and blood was analyzed for plasma biomarkers, interferon-γ, tumor necrosis factor-α (TNFα), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), brain-derived neurotrophic factor (BDNF), interleukin-8 (IL-8), matrix metallopeptidase-9 (MMP-9), IL-6, C-reactive protein (CRP), and serum amyloid-A (SAA). RESULTS Almost half the patients scored below the threshold on the MoCA, indicating at least mild cognitive impairment. A factor analysis produced three biomarker factors: vascular inflammatory factor-1: TNFα, sICAM1, sVCAM1; neuroinflammatory factor-2: BDNF, MMP-9, IL-8; peripheral inflammatory factor-3: IL-6, CRP, SAA. Only vascular inflammatory factor-1 was significantly associated with cognitive function (MoCA) (ΔR2 = 0.214, beta = -0.468, p = 0.008). CONCLUSIONS In this cohort with HF, vascular inflammation appears related to poorer cognitive function. This could indicate targets for treatment to reduce cognitive deficits in HF. However, this is a preliminary study, and further research is needed.
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Affiliation(s)
- Laura S Redwine
- Department of Psychiatry, University of California San Diego, San Diego, California,
- College of Nursing, University of South Florida, Tampa, Florida,
| | - Meredith A Pung
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Kathleen Wilson
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Kelly Chinh
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Allyson R Duffy
- College of Nursing, University of South Florida, Tampa, Florida, USA
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Mills PJ, Peterson CT, Pung MA, Patel S, Weiss L, Wilson KL, Doraiswamy PM, Martin JA, Tanzi RE, Chopra D. Change in Sense of Nondual Awareness and Spiritual Awakening in Response to a Multidimensional Well-Being Program. J Altern Complement Med 2017; 24:343-351. [PMID: 29216441 DOI: 10.1089/acm.2017.0160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examined the effects of a comprehensive mind-body program on sense of nondual awareness and spiritual awakening. DESIGN AND INTERVENTION The study compared the effects of participation in an intensive 6-day Ayurveda-based mind-body program that addressed physical, emotional, and spiritual domains as compared with a control condition. SETTING Resort setting. SUBJECTS Participants were 69 healthy women and men (mean age 53.9 years; range 32-86). OUTCOME MEASURE The primary outcome was the Nondual Embodiment Thematic Inventory (NETI). RESULTS A significant group by time interaction (p = 0.029) indicated that after the intervention, participants in the mind-body program showed a significant increase in NETI scores (p < 0.03), which was sustained 1 month later (p < 0.01). CONCLUSION Findings suggest that an intensive program providing holistic instruction and experience in mind-body practices can lead to a significant and sustained shift in perception of self-awareness, one that is likely favorable to well-being.
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Affiliation(s)
- Paul J Mills
- 1 Department of Family Medicine and Public Health, University of California , San Diego, La Jolla, CA
| | - Christine Tara Peterson
- 1 Department of Family Medicine and Public Health, University of California , San Diego, La Jolla, CA.,2 The Chopra Foundation , Carlsbad, CA
| | - Meredith A Pung
- 1 Department of Family Medicine and Public Health, University of California , San Diego, La Jolla, CA
| | - Sheila Patel
- 1 Department of Family Medicine and Public Health, University of California , San Diego, La Jolla, CA.,3 Mind-Body Medical Group, The Chopra Center for Wellbeing, Carlsbad, CA
| | - Lizabeth Weiss
- 3 Mind-Body Medical Group, The Chopra Center for Wellbeing, Carlsbad, CA
| | - Kathleen L Wilson
- 1 Department of Family Medicine and Public Health, University of California , San Diego, La Jolla, CA
| | - P Murali Doraiswamy
- 4 Department of Psychiatry and Duke Institute for Brain Sciences, Duke University, Durham, NC
| | - Jeffery A Martin
- 5 Sophia University, Transformative Technology Laboratory, Palo Alto, CA
| | - Rudolph E Tanzi
- 6 Department of Neurology at Harvard University and Genetics and Aging Research Unit, Harvard Medical School, Boston, MA
| | - Deepak Chopra
- 1 Department of Family Medicine and Public Health, University of California , San Diego, La Jolla, CA.,2 The Chopra Foundation , Carlsbad, CA.,3 Mind-Body Medical Group, The Chopra Center for Wellbeing, Carlsbad, CA
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10
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Abstract
OBJECTIVE Allostatic load (AL) is a cumulative index of physiological dysregulation, which has been shown to predict cardiovascular events and all-cause mortality. On average, African Americans (AA) have higher AL than their White American (WA) counterparts. This study investigated whether differences in discrimination, negative affect-related variables (e.g., experience and expression of anger, depression), and health practices (e.g., exercise, alcohol use, smoking, subjective sleep quality) mediate racial differences in AL. METHOD Participants included healthy, AA (n = 76) and WA (n = 100), middle-aged (Mage = 35.2 years) men (n = 98) and women (n = 78). Questionnaires assessed demographics, psychosocial variables, and health practices. Biological data were collected as part of an overnight hospital stay-AL score was composed of 11 biomarkers. The covariates age, gender, and socioeconomic status were held constant in each analysis. RESULTS Findings showed significant racial differences in AL, such that AA had higher AL than their WA counterparts. Results of serial mediation indicated a pathway whereby racial group was associated with discrimination, which was then associated with increased experience of anger and decreased subjective sleep quality, which were associated with AL (e.g., race → discrimination → experience of anger → subjective sleep quality → AL); in combination, these variables fully mediated the relationship between race and AL (p < .05). CONCLUSION These results suggest that discrimination plays an important role in explaining racial differences in an important indictor of early disease through its relationship with negative affect-related factors and health practices. (PsycINFO Database Record
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Affiliation(s)
| | - Meredith A Pung
- Department of Psychiatry, University of California, San Diego
| | - Joel E Dimsdale
- Department of Psychiatry, University of California, San Diego
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11
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Mills PJ, Wilson KL, Pung MA, Weiss L, Patel S, Doraiswamy PM, Peterson CT, Porter V, Schadt E, Chopra D, Tanzi RE. The Self-Directed Biological Transformation Initiative and Well-Being. J Altern Complement Med 2016; 22:627-34. [DOI: 10.1089/acm.2016.0002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Paul J. Mills
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Fellow, Samueli Institute, Alexandria, VA
| | - Kathleen L. Wilson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Meredith A. Pung
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | | | - Sheila Patel
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | | | - Christine Tara Peterson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | - Valencia Porter
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | - Eric Schadt
- Genetics and Genomics Sciences, Mount Sinai Hospital, New York, NY
| | - Deepak Chopra
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | - Rudolph E. Tanzi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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12
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Mills PJ, Redwine L, Wilson K, Pung MA, Chinh K, Greenberg BH, Lunde O, Maisel A, Raisinghani A, Wood A, Chopra D. The Role of Gratitude in Spiritual Well-being in Asymptomatic Heart Failure Patients. ACTA ACUST UNITED AC 2015. [PMID: 26203459 DOI: 10.1037/scp0000050] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p<0.01), less depressed mood (r=-.41, p<0.01), less fatigue (r=-.46, p<0.01), and better self-efficacy to maintain cardiac function (r=.42, p<0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p<0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, p<.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, p<.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value.
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Affiliation(s)
- Paul J Mills
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA ; Department of Psychiatry, University of California, San Diego, La Jolla, CA ; UC San Diego Center of Excellence for Research and Training in Global Integrative Health, University of California, San Diego, La Jolla, CA ; Chopra Center for Wellbeing, University of California, San Diego, La Jolla, CA
| | - Laura Redwine
- Department of Psychiatry, University of California, San Diego, La Jolla, CA ; UC San Diego Center of Excellence for Research and Training in Global Integrative Health, University of California, San Diego, La Jolla, CA
| | - Kathleen Wilson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Meredith A Pung
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Kelly Chinh
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Barry H Greenberg
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Ottar Lunde
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Alan Maisel
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Ajit Raisinghani
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Alex Wood
- Department of Behavioral Science, University of Stirling, Stirling Scotland
| | - Deepak Chopra
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA ; Chopra Center for Wellbeing, University of California, San Diego, La Jolla, CA
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13
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Mills PJ, Wilson K, Iqbal N, Iqbal F, Alvarez M, Pung MA, Wachmann K, Rutledge T, Maglione J, Zisook S, Dimsdale JE, Lunde O, Greenberg BH, Maisel A, Raisinghani A, Natarajan L, Jain S, Hufford DJ, Redwine L. Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients. J Behav Med 2014; 38:407-15. [PMID: 25533643 DOI: 10.1007/s10865-014-9615-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022]
Abstract
Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure.
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Affiliation(s)
- Paul J Mills
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr. #0804, La Jolla, CA, 92093-0804, USA,
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14
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Abstract
OBJECTIVE Living in adverse neighborhood conditions has been linked with greater prevalence of cardiovascular disease (CVD). We aimed to learn whether perceived neighborhood problems are related to attenuated nocturnal blood pressure (BP) dipping, a risk factor for CVD morbidity. METHOD A sample of 133 adults (71 male, 62 female; 80 White, 53 Black) underwent 24-hr ambulatory blood pressure monitoring. The neighborhood problem scale (NPS) was used to assess neighborhood environmental stressors. RESULTS Nocturnal dipping in systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure was reduced in individuals with higher NPS scores (p < .05). Hierarchical regression analyses revealed that neighborhood problems explained 4%-6% of the variance in SBP, DBP, and MAP dipping (p < .05) even after adjusting for several theoretical confounders such as social status, age, gender, race, body mass index (BMI), smoking, exercise, depression and discrimination. CONCLUSION Neighborhood problems may contribute to attenuated BP dipping beyond the effect of known risk factors.
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Affiliation(s)
- Frank Euteneuer
- Department of Psychiatry, University of California, San Diego
| | - Paul J Mills
- Department of Psychiatry, University of California, San Diego
| | - Meredith A Pung
- Department of Psychiatry, University of California, San Diego
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Philipps Universität
| | - Joel E Dimsdale
- Department of Psychiatry, University of California, San Diego
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15
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Jiménez JA, Redwine LL, Rutledge TR, Dimsdale JE, Pung MA, Ziegler MG, Greenberg BH, Mills PJ. Depression ratings and antidepressant use among outpatient heart failure patients: implications for the screening and treatment of depression. Int J Psychiatry Med 2013; 44:315-34. [PMID: 23885515 DOI: 10.2190/pm.44.4.c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the characteristics of antidepressant use among heart failure (HF) outpatients. METHODS Self-reported data on antidepressant use, Beck Depression Inventory (BDI) ratings, and demographics, as well as HF diagnosis severity, was collected from 218 New York Heart Association (NYHA) Classes I-IV HF outpatients (mean age 57.29 years). RESULTS The overall prevalence of depressive symptoms (BDI > 10) was 43.1% (n = 94); 23.4% had a prior diagnosis of depression. Thirty-three percent of patients were taking antidepressants but, despite this treatment, 64% still showed at least mild-moderate depressive symptoms (BDI > or = 10) compared to 34% of patients not currently receiving antidepressants (p = 0.05). When asked if their mood had improved as a result of antidepressant therapy, 45% reported responses ranging from "halfway back to normal" to no improvement at all; BDI scores were related to self-reports of how well antidepressant therapy affected patient's mood (p < .01). Among patients receiving antidepressants (primarily SSRIs), 26% did not have a formal depression diagnosis prior to receiving antidepressants, and 39.1% reported never having had a dose adjustment in antidepressant medication. Similar numbers of patients were prescribed antidepressants by primary care physicians as mental health providers, while much fewer cardiologists prescribed antidepressants. CONCLUSIONS Findings provide insight into practice and provider patterns related to antidepressant use in HF. HF patients treated with antidepressants still show high rates of depressed mood, and follow-up and monitoring of effectiveness of antidepressant therapy needs attention. Effective treatment of depression could support improved clinical outcomes and better quality of life for HF patients.
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Affiliation(s)
- Jessica A Jiménez
- SDSU/UCSD Joint Doctoral Program in Public Health and University of California, San Diego. La Jolla, CA, USA
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16
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Tomfohr L, Pung MA, Edwards KM, Dimsdale JE. Racial differences in sleep architecture: the role of ethnic discrimination. Biol Psychol 2012; 89:34-8. [PMID: 21925567 PMCID: PMC3245778 DOI: 10.1016/j.biopsycho.2011.09.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 07/26/2011] [Accepted: 09/04/2011] [Indexed: 10/17/2022]
Abstract
African Americans have been consistently shown to have less deep (slow wave sleep; SWS) and more light (Stages 1 and 2) sleep than Caucasian Americans. This paper explored whether discrimination, a stressor that uniquely impacts certain ethnic groups, contributes to differences in sleep architecture. The sleep of 164 African and Caucasian Americans was examined with laboratory based polysomnography (PSG). Experiences of perceived discrimination (The Scale of Ethnic Experience) and sociodemographic factors were also assessed. After adjusting for age, body mass index (BMI), socioeconomic status (SES) and smoking status, African Americans slept approximately 4.5% more total sleep time (TST) in Stage 2 sleep and 4.7% less TST in SWS than Caucasian Americans (ps<.05). Perceived discrimination was a partial mediator of ethnic differences in sleep architecture. Individuals who reported experiencing more discrimination slept more time in Stage 2 and less time in SWS (ps<.05). Results suggest that the impact of stress related to ethnic group membership plays a part in explaining differences in sleep architecture.
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Affiliation(s)
- Lianne Tomfohr
- San Diego State University & University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA 92093-0804, United States.
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17
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Abstract
Recently, there has been a growth of interest in factors that play a protective role in sleep. This study is an exploratory analysis investigating relations between daily hassles and uplifts (events appraised as pleasant) and measures of subjective and polysomnography (PSG)-assessed sleep in a group of healthy adults (N = 135). Hassles and uplifts were assessed with the Combined Hassles and Uplifts Scale (CHUS), subjective sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), and objective sleep was assessed with standard PSG. After controlling for covariates, uplifts intensity was associated with subjective sleep and PSG-assessed sleep. Specifically, increased uplifts intensity was associated with better subjective sleep, decreased time slept in Stage 2 sleep, and increased time slept in slow wave sleep (SWS). One's perception of the magnitude of positive events may play a role in sleep and should be examined in future investigations.
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18
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Abstract
OBJECTIVES To test the hypothesis that a nocturnal decrease of secretion of inflammation markers and catecholamines would be associated with mood and stress variables even after controlling for objective sleep variables. METHODS A total of 130 healthy volunteers participated in this study, spending 2 nights in the Gillin Laboratory of Sleep and Chronobiology at the University of California, San Diego, General Clinical Research Center. Blood samples were obtained before sleep (10:30 PM) and after awakening (6:30 AM) on the first day, and these samples were assayed for inflammatory biomarkers and catecholamines. On the second night, polysomnographic records were scored for objective sleep variables, e.g., total sleep time and wake after sleep onset. Self-rating scales for mood, stress, depression, and daily hassles were administered the second day. RESULTS The nocturnal decrease in interleukin-6 was smaller in people who reported more negative mood or fatigue and greater in those who reported more uplift events (e.g., with Profile of Mood States fatigue r(p) = -.25 to -.30). People with high stress or high depression levels had smaller nocturnal decreases of epinephrine. That relationship was even stronger when partial correlations were used to control for morning level and sleep variables. The associations between nocturnal changes of C-reactive protein, soluble tumor necrosis factor-receptor I, and norepinephrine with psychological states were nonremarkable. CONCLUSIONS The analyses of nocturnal change scores (difference scores) add substantial information compared with the traditional analyses of morning levels of immune variables and catecholamines alone. Subjective well-being is significantly associated with a greater nocturnal decrease of interleukin-6 and epinephrine. More research on nocturnal adaptation processes is warranted.
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Affiliation(s)
- Winfried Rief
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA.
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19
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Mills PJ, Shapiro D, Goldstein IB, Ottaviani C, Pung MA, Khandrika S, von Känel R, Rutledge TR. Metabolic predictors of inflammation, adhesion, and coagulability in healthy younger-aged adults. Obesity (Silver Spring) 2008; 16:2702-6. [PMID: 18820652 DOI: 10.1038/oby.2008.420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Elevated levels of inflammatory biomarkers are associated with the pathophysiology of cardiovascular diseases and are predictors of cardiovascular events. The objective of this study was to determine the unique contributions of metabolic factors as predictors of inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)), adhesion (soluble intercellular adhesion molecule-1 (sICAM-1)), and coagulation (D-dimer) in healthy younger-aged adults. Participants were 83 women and 92 men (mean age 30.04 years, s.d. +/- 4.8, range 22-39) of normal weight to moderate obese weight (mean BMI 24.4 kg/m(2), s.d. +/- 3.35, range 17-32). The primary data analytical approaches included Pearson correlation and multiple linear regression. Circulating levels of CRP, IL-6, sICAM-1, and D-dimer were determined in plasma. Higher levels of CRP were independently associated with higher BMI, a greater waist-to-hip ratio, female gender, and higher triglycerides (P < 0.001). Higher IL-6 levels were independently associated with a greater waist-to-hip ratio (P < 0.01). Higher levels of sICAM-1 were independently associated with higher BMI, higher triglycerides, and lower insulin resistance (P < 0.001). Higher D-dimer levels were independently associated with higher BMI and being female (P < 0.001). Having a higher BMI was most consistently associated with elevated biomarkers of inflammation, adhesion, and coagulation in this sample of healthy younger-aged adults, although female gender, insulin resistance, and lipid levels were also related to the biomarkers. The findings provide insight into the adverse cardiovascular risk associated with elevated body weight in younger adults.
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Affiliation(s)
- Paul J Mills
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.
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20
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von Känel R, Hong S, Pung MA, Mills PJ. Association of blood pressure and fitness with levels of atherosclerotic risk markers pre-exercise and post-exercise. Am J Hypertens 2007; 20:670-5. [PMID: 17531926 DOI: 10.1016/j.amjhyper.2007.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 10/19/2006] [Accepted: 01/01/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Physical fitness may attenuate the increased atherosclerotic risk in patients with systemic hypertension. We investigated the association of screening blood pressure (BP) and cardiorespiratory fitness with baseline levels and exercise-induced changes in levels of soluble atherosclerotic risk markers. METHODS Twenty-six otherwise healthy and unmedicated subjects with elevated BP (systolic BP and/or diastolic BP > or =130/85 mm Hg) and 40 subjects with normal BP underwent 20-min treadmill exercise at 65% to 70% of predetermined peak oxygen consumption (VO(2peak)). Interleukin (IL)-6, soluble intercellular adhesion molecule (sICAM)-1, von Willebrand factor (VWF) antigen, and plasminogen activator inhibitor (PAI)-1 antigen were measured at baseline (ie, pre-exercise), early postexercise, and late postexercise (ie, 25 min after exercise). RESULTS At baseline, higher screening mean arterial BP (MAP) independently predicted higher sICAM-1 levels (P = .031), and lower VO(2peak) independently predicted higher IL-6 (P = .016) and PAI-1 (P < .001) levels. Early and late postexercise lower VO(2peak) was associated with higher mean PAI-1 (P < or = .072) and IL-6 (P < or = .026) levels, and higher screening MAP was associated with higher mean sICAM-1 levels (P < or = .035). Higher VO(2peak) was associated with a greater PAI-1 increase from baseline to early postexercise in subjects with elevated BP (P = .045) but not in those with normal BP. CONCLUSIONS Circulating levels of some atherosclerotic risk markers at baseline and with exercise were higher with elevated BP and lower with better fitness. Greater fitness did not particularly protect subjects with elevated BP from potentially harmful responses of atherosclerotic risk markers to acute physical exercise.
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Affiliation(s)
- Roland von Känel
- Division of General Internal Medicine and Cardiovascular Prevention and Rehabilitation, Swiss Cardiovascular Center Berne, Department of Cardiology, University Hospital Berne, Berne, Switzerland
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21
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Zabinski MF, Wilfley DE, Pung MA, Winzelberg AJ, Eldredge K, Taylor CB. An interactive internet-based intervention for women at risk of eating disorders: a pilot study. Int J Eat Disord 2001; 30:129-37. [PMID: 11449446 DOI: 10.1002/eat.1065] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The Internet serves as a potentially effective method of treatment delivery through widespread education and interaction via synchronous Internet relay chat (IRC). The current study explores the feasibility of IRC in the delivery of an eating disorders prevention intervention. METHOD This small pilot study describes the delivery of an efficacious eating disorder treatment using a novel medium. The on-line sessions are based on cognitive-behavioral treatment and are facilitated by a moderator. In addition to feasibility, preliminary evidence of acceptability and efficacy for an on-line intervention with college-aged women is reported. RESULTS Results indicate that IRC is an acceptable and feasible format for treatment delivery. In addition, descriptive and qualitative data suggest that this method of treatment delivery is potentially effective. DISCUSSION This pilot study provides increased knowledge of the viability of treatment delivery over the Internet, specifically, a psychoeducational IRC for eating disorder prevention.
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Affiliation(s)
- M F Zabinski
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California 92120-4913, USA.
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22
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Zabinski MF, Pung MA, Wilfley DE, Eppstein DL, Winzelberg AJ, Celio A, Taylor CB. Reducing risk factors for eating disorders: targeting at-risk women with a computerized psychoeducational program. Int J Eat Disord 2001; 29:401-8. [PMID: 11285577 DOI: 10.1002/eat.1036] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This controlled study evaluated whether an 8-week program offered over the Internet would significantly decrease body image dissatisfaction, disordered eating patterns, and preoccupation with shape/weight among women at high risk for developing an eating disorder. METHOD Fifty-six college women were recruited on the basis of elevated scores (> or =110) on the Body Shape Questionnaire (BSQ). Psychological functioning, as measured by the Eating Disorder Inventory Drive for Thinness (EDI-DT) subscale, Eating Disorder Examination-Questionnaire (EDE-Q), and the BSQ, was assessed at baseline, posttreatment, and at 10-week follow-up. RESULTS All participants improved over time on most measures, although effect sizes suggest that the program did impact the intervention group. DISCUSSION Findings suggest that technological interventions may be helpful for reducing disordered eating patterns and cognitions among high-risk women. Future research is needed to assess whether such programs are effective over time for prevention of and reduction in eating disorder symptomatology.
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Affiliation(s)
- M F Zabinski
- Department of Psychology, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
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Prislin R, Nader PR, De Guire M, Hoy PL, Pung MA, Ross S, Goerlitz MJ, Sawyer MH. Physicians' immunization knowledge, attitudes, and practices: a valid and internally consistent measurement tool. Am J Prev Med 1999; 17:151-2. [PMID: 10490060 DOI: 10.1016/s0749-3797(99)00054-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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