The impact of cardiac rehabilitation on lifestyles, psychological correlates and the clinical course of cardiac disease

Objectives: The aim of this research was to evaluate the impact of Cardiac Rehabilitation (CR) on risky lifestyles, quality of life, psychopathology, psychological distress and well-being, considering the potential moderating role of depression, anxiety and psychosomatic syndromes on lifestyles modification. The influence of CR on cardiac morbidity and mortality was also evaluated. Methods: The experimental group (N=108), undergoing CR, was compared to a control group (N=85) of patients affected by cardiovascular diseases, not undergoing CR, at baseline and at 1-month, 6- and 12-months follow-ups. The assessment included: the Structured Clinical Interview for DSM-IV, the structured interview based on Diagnostic Criteria for Psychosomatic Research (DCPR), GOSPEL questionnaire on lifestyles, Pittsburgh Sleep Quality Index, Morisky Medication Adherence Scale, MOS 36-Item Short Form Health Survey, Symptom Questionnaire, Psychological Well-Being Scale and 14-items Type D Scale. Results: Compared to the control group, CR was associated to: maintenance of the level of physical activity, improvement of correct dietary behaviors and stress management, enhancement of quality of life and sleep; reduction of the most frequently observed psychiatric diagnoses and psychosomatic syndromes at baseline. On the contrary, CR was not found to be associated with: healthy dietary habits, weight loss and improvement on medications adherence. In addition, there were no relevant effects on sub-clinical psychological distress and well-being, except for personal growth and purpose in life (PWB). Also, CR did not seem to play a protective role against cardiac recurrences. The presence of psychosomatic syndromes and depressive disorders was a mediating factor on the modification of specific lifestyles. Conclusions: The findings highlight the need of a psychosomatic assessment and an evaluation of psychological sub-clinical symptomatology in cardiac rehabilitation, in order to identify and address specific factors potentially associated with the clinical course of the heart disease.

A daily perspective on work interruptions

Diese Dissertation basiert auf einem theoretischen Artikel und zwei empirischen Studien.rnrnDer theoretische Artikel: Es wird ein theoretisches Rahmenmodell postuliert, welches die Kumulierung von Arbeitsunterbrechung und deren Effekte untersucht. Die meisten bisherigen Studien haben Unterbrechungen als isoliertes Phänomen betrachtet und dabei unberücksichtigt gelassen, dass während eines typischen Arbeitstages mehrere Unterbrechungen gleichzeitig (oder aufeinanderfolgend) auftreten. In der vorliegenden Dissertation wird diese Lücke gefüllt, indem der Prozess der kumulierenden Unterbrechungen untersucht wird. Es wird beschrieben,rninwieweit die Kumulation von Unterbrechungen zu einer neuen Qualität vonrn(negativen) Effekten führt. Das Zusammenspiel und die gegenseitige Verstärkung einzelner Effekte werden dargestellt und moderierende und mediierende Faktoren aufgezeigt. Auf diese Weise ist es möglich, eine Verbindung zwischen kurzfristigen Effekten einzelner Unterbrechungen und Gesundheitsbeeinträchtigungen durch die Arbeitsbedingung ‚Unterbrechungen‘rnherzustellen.rnrnStudie 1: In dieser Studie wurde untersucht, inwieweit Unterbrechungen Leistung und Wohlbefinden einer Person innerhalb eines Arbeitstages beeinflussen. Es wurde postuliert, dass das Auftreten von Unterbrechungen die Zufriedenheit mit der eigenen Leistung vermindert und das Vergessen von Intentionen und das Irritationserleben verstärkt. Geistige Anforderung und Zeitdruck galten hierbei als Mediatoren. Um dies zu testen, wurden 133 Pflegekräften über 5 Tage hinweg mittels Smartphones befragt. Mehrebenenanalysen konnten die Haupteffekte bestätigen. Die vermuteten Mediationseffekte wurden für Irritation und (teilweise) für Zufriedenheit mit der Leistung bestätigt, nicht jedoch für Vergessen von Intentionen. Unterbrechungen führen demzufolge (u.a.) zu negativen Effekten, da sie kognitiv anspruchsvoll sind und Zeit beanspruchen.rnrnStudie 2: In dieser Studie wurden Zusammenhänge zwischen kognitiven Stressorenrn(Arbeitsunterbrechungen und Multitasking) und Beanspruchungsfolgen (Stimmung und Irritation) innerhalb eines Arbeitstages gemessen. Es wurde angenommen, dass diese Zusammenhänge durch chronologisches Alter und Indikatoren funktionalen Alters (Arbeitsgedächtniskapazität und Aufmerksamkeit) moderiert wird. Ältere mit schlechteren Aufmerksamkeitsund Arbeitsgedächtnisleistungen sollten am stärksten durch die untersuchten Stressoren beeinträchtigt werden. Es wurde eine Tagebuchstudie (siehe Studie 1) und computergestützternkognitive Leistungstests durchgeführt. Mehrebenenanalysen konnten die Haupteffekte für die abhängigen Variablen Stimmung (Valenz und Wachheit) und Irritation bestätigen, nicht jedoch für Erregung (Stimmung). Dreifachinteraktionen wurden nicht in der postulierten Richtung gefunden. Jüngere, nicht Ältere profitierten von einem hohen basalen kognitivenrnLeistungsvermögen. Ältere scheinen Copingstrategien zu besitzen, die mögliche kognitive Verluste ausgleichen. rnrnIm Allgemeinen konnten die (getesteten) Annahmen des theoretischen Rahmenmodellsrnbestätigt werden. Prinzipiell scheint es möglich, Ergebnisse der Laborforschung auf die Feldforschung zu übertragen, jedoch ist es notwendig die Besonderheiten des Feldes zu berücksichtigen. Die postulieren Mediationseffekte (Studie 1) wurden (teilweise) bestätigt. Die Ergebnisse weisen jedoch darauf hin, dass der volle Arbeitstag untersucht werden muss und dass sehr spezifische abhängige Variablen auch spezifischere Mediatoren benötigen. Des Weiteren konnte in Studie 2 bestätigt werden, dass die kognitive Kapazität eine bedeutsamernRessource im Umgang mit Unterbrechungen ist, im Arbeitskontext jedoch auch andere Ressourcen wirken.

Effects of social support on the clinical course of Crohn's disease

Social support has been found to be protective from adverse health effects of psychological stress. We hypothesized that higher social support would predict a more favorable course of Crohn's disease (CD) directly (main effect hypothesis) and via moderating other prognostic factors (buffer hypothesis).

The Impact of Greek Affiliation on Students’ Educational Objectives: Longitudinal Change in Clark-Trow Educational Philosophies

Change in 4,119 students' freshman to senior ratings of four educational philosophies (vocational, academic, collegiate, and nonconformist) provided four measures of educational impact. Repeated measures analyses of variance compared changes in philosophy as a function of Greek affiliation, controlling for sex, historical era, major, parents' education, scholastic aptitude, and academic motivation. Small but significantly different degrees of change in the collegiate and nonconformist philosophies suggested that Greek affiliation increased social interests and inhibited some forms of intellectual interests. These small differences across all students masked the moderating effect of major. In the nonconformist philosophy, for example, the Greek × major interaction reflected substantial Greek–independent differences among humanities majors, and progressively smaller differences or reversals among social science, physical science, and engineering majors. Possible interpretations of this interaction are offered.

Beta-Endorphin Modulates the Effect of Stress on Novelty-Suppressed Feeding

Although stress is implicated in the pathophysiology of mood and anxiety disorders, not all individuals who suffer stressful life events develop psychopathology. Differential susceptibility to stress may be influenced by genetically mediated differences in hypothalamic-pituitary-adrenal (HPA) axis activity and moderation of the stress response by the opioid peptide beta-endorphin (beta-E). The present study investigated genetic contributions to coping behavior by examining anxious behavior of transgenic mice with varying capacities to synthesize beta-E [B6.129S2-Pomc(tm1Low)/J; regulated by insertion of a premature stop codon into one or both copies of the proopiomelanocortin (POMC) gene], both under normal conditions and following 3 min of forced swim (FS). Ten minutes after this stress exposure or a control manipulation, acutely food-deprived female and male transgenic mice were subjected to a novelty-suppressed feeding (NSF) test, during which their interaction with an almond slice located in the center of an open field box was measured. There was an interaction between genotype and stress for latency to approach the almond and whether or not the almond was approached, such that mice with low or absent beta-E displayed a stronger aversion to novelty-feeding after stress exposure than did mice with normal levels. These data provide evidence for a moderating effect of beta-E on the behavioral response to stress. Genotypic differences in anxious behavior emerged when mice were stressed prior to behavioral assessment, suggesting that beta-E plays a role in coping behavior. These findings indicate that genetic variability in sensitivity of the beta-E system to stress may contribute, at least in part, to heritable differences in stress reactivity as well as vulnerability to stress-related psychopathology.

Sleep in spousal Alzheimer caregivers: a longitudinal study with a focus on the effects of major patient transitions on sleep

Findings on sleep disturbances in family dementia caregivers are conflicting. We studied the longitudinal effects of dementia caregiving and major transitions in the caregiving situation on caregivers' sleep and the effect of moderating variables.

Ways of coping and biomarkers of an increased atherothrombotic cardiovascular disease risk in elderly individuals

Objective. To investigate the relationship between coping and atherothrombotic biomarkers of an increased cardiovascular disease (CVD) risk in the elderly. Methods. We studied 136 elderly caregiving and noncaregiving men and women who completed the Ways of Coping Checklist to assess problem-focused coping, seeking social support (SSS), blamed self, wishful thinking, and avoidance coping. They had circulating levels of 12 biomarkers measured. We also probed for potential mediator and moderator variables (chronic stress, affect, health behavior, autonomic activity) for the relation between coping and biomarkers. Results. After controlling for demographic and CVD risk factors, greater use of SSS was associated with elevated levels of serum amyloid A (P = 0.001), C-reactive protein (CRP) (P = 0.002), vascular cellular adhesion molecule (VCAM)-1 (P = 0.021), and D-dimer (P = 0.032). There were several moderator effects. For instance, greater use of SSS was associated with elevated VCAM-1 (P < 0.001) and CRP (P = 0.001) levels in subjects with low levels of perceived social support and positive affect, respectively. The other coping styles were not significantly associated with any biomarker. Conclusions. Greater use of SSS might compromise cardiovascular health through atherothrombotic mechanisms, including elevated inflammation (i.e., serum amyloid A, CRP, VCAM-1) and coagulation (i.e., D-dimer) activity. Moderating variables need to be considered in this relationship.

Low social support and poor emotional regulation are associated with increased stress hormone reactivity to mental stress in systemic hypertension

CONTEXT: There is strong evidence for a physiological hyperreactivity to stress in systemic hypertension, but data on associated or potentially moderating psychological factors are scarce. OBJECTIVE: The objective of the study was to identify psychological correlates of physiological stress reactivity in systemic hypertension. DESIGN: This was a cross-sectional, quasi-experimentally controlled study. Study participants underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. SETTING: The study was conducted in the population in the state of Zurich, Switzerland. SUBJECTS: Subjects included 22 hypertensive and 26 normotensive men (mean +/- sem 44 +/- 2 yr). MAIN OUTCOME MEASURES: We assessed the psychological measures social support, emotional regulation, and cognitive appraisal of the stressful situation. Moreover, we measured salivary cortisol and plasma epinephrine and norepinephrine before and after stress and several times up to 60 min thereafter as well as blood pressure and heart rate. RESULTS: We found poorer hedonistic emotional regulation (HER) and lower perceived social support in hypertensives, compared with normotensives (P < 0.01). Compared with normotensives, hypertensives showed higher cortisol, epinephrine, and norepinephrine secretions after stress (P < 0.038) as well as higher systolic and diastolic blood pressure (P < 0.001). Cortisol reactivity and norepinephrine secretion were highest in hypertensive men with low HER (P < 0.05). In contrast, hypertensives with high HER did not significantly differ from normotensives in both cortisol and norepinephrine secretion after stress. Epinephrine secretion was highest in hypertensives with low social support but was not different between hypertensives with high social support and normotensives. CONCLUSIONS: The findings suggest that both low social support and low HER are associated with elevated stress hormone reactivity in systemic hypertension.

Motives for cannabis use as a moderator variable of distress among young adults

This study examined the moderating effect of social and coping motives on distress among young cannabis-using adults. A random sample of 2031 young Swiss adults was interviewed by means of a computer-assisted telephone interview. Cannabis users showed more distress, less positive health behaviour and higher hedonism compared to non-users. Taking motive for use as a moderator variable into consideration, it became evident that only cannabis users with coping motives showed lower mental health, more symptoms of psychopathology, more psychosocial distress and more life events than non-users. Young adults with social motives for use on the other hand did not differ from non-users in terms of distress. These differences between cannabis users with social and those with coping motives remained stable over two years. In both subgroups, participants with regular cannabis use at baseline did not increase distress nor did participants with higher distress at baseline increase the frequency of their cannabis use. Our results suggest that secondary prevention for cannabis users should target especially young adults with coping motives for use.

The impact of the achievement motive on athletic performance in adolescent football players

Researchers largely agree that there is a positive relationship between achievement motivation and athletic performance, which is why the achievement motive is viewed as a potential criterion for talent. However, the underlying mechanism behind this relationship remains unclear. In talent and performance models, main effect, mediator and moderator models have been suggested. A longitudinal study was carried out among 140 13-year-old football talents, using structural equation modelling to determine which model best explains how hope for success (HS) and fear of failure (FF), which are the aspects of the achievement motive, motor skills and abilities that affect performance. Over a period of half a year, HS can to some extent explain athletic performance, but this relationship is not mediated by the volume of training, sport-specific skills or abilities, nor is the achievement motive a moderating variable. Contrary to expectations, FF does not explain any part of performance. Aside from HS, however, motor abilities and in particular skills also predict a significant part of performance. The study confirms the widespread assumption that the development of athletic performance in football depends on multiple factors, and in particular that HS is worth watching in the medium term as a predictor of talent.

Researcher allegiance in psychotherapy outcome research: an overview of reviews

Researcher allegiance (RA) is widely discussed as a risk of bias in psychotherapy outcome research. The relevance attached to RA bias is related to meta-analyses demonstrating an association of RA with treatment effects. However, recent meta-analyses have yielded mixed results. To provide more clarity on the magnitude and robustness of the RA-outcome association this article reports on a meta-meta-analysis summarizing all available meta-analytic estimates of the RA-outcome association. Random-effects methods were used. Primary study overlap was controlled. Thirty meta-analyses were included. The mean RA-outcome association was r=.262 (p=.002, I(2)=28.98%), corresponding to a moderate effect size. The RA-outcome association was robust across several moderating variables including characteristics of treatment, population, and the type of RA assessment. Allegiance towards the RA bias hypothesis moderated the RA-outcome association. The findings of this meta-meta-analysis suggest that the RA-outcome association is substantial and robust. Implications for psychotherapy outcome research are discussed.

When social accounts work: evidence from ultimatum games

This paper examines the mitigating effect of social accounts on retaliatory behavior in a miniultimatum game setting. Results from games with 108 German high school students support the hypothesis that an ex ante informational and sensitive message can decrease an individuals’ negative perception of an unfair offer and increase the acceptance of the outcome. Furthermore, the moderating effect of gender on retaliatory behavior is investigated. We show that an informational and sensitive message makes more of a difference for women in accepting unfair distributions than it does for men.

New Product Portfolio Performance in Family Firms

This study investigates the relationship between top management team (TMT) innovation orientation and new product portfolio performance in small and medium-sized family firms by exploring two family firm-specific sources of TMT diversity as moderators: the number of generations involved in the TMT and the ratio of family members in the TMT. Results indicate that family-induced diversity in the TMT has opposing moderating effects. Although a positive relationship exists between TMT innovation orientation and new product portfolio performance when multiple generations are involved in the TMT, TMT innovation orientation and new product portfolio performance experience a negative relationship when the ratio of family members in the TMT is high. The study discusses theoretical and managerial implications of the findings and develops avenues for future research.

Illegitimate tasks associated with higher cortisol levels among male employees when subjective health is relatively low: an intra-individual analysis

Objectives Illegitimate tasks refer to tasks that do not conform to what can appropriately be expected from an employee. Violating role expectations, they constitute “identity-stressors”, as one’s professional role tends to become part of one’s identity. The current study investigated the impact of illegitimate tasks on salivary cortisol. We analyzed data on an intra-individual level, that is, by examining fluctuations in illegitimate tasks and cortisol within individuals. Furthermore, we investigated the moderating role of perceived health, expecting that illegitimate tasks evoke stronger reactions when perceived health is relatively poor. Methods Illegitimate tasks, salivary cortisol, and perceived health were assessed in each of three waves (time lag: 6 months) in a sample of 104 male employees. Data were analyzed by multilevel analysis using group mean centering. Results Controlling for social stressors, work interruptions, and emotional stability, the experience of more illegitimate tasks was associated with increased cortisol release if personal health resources were low compared to one’s mean value of perceived health. Results cannot be explained by inter-individual differences. Conclusions This is the first study showing that illegitimate tasks predict a biological indicator of stress, thus confirming and extending previous research on illegitimate tasks. The moderating role of perceived health confirms its importance as a personal resource, implying augmented vulnerability when perceived health is below its usual value. It is plausible to assume that increased stress reactions due to relatively poor health may further weaken available personal resources. Both avoiding illegitimate tasks and restoring personal health seem to be crucial.

The additive and interactive roles of aggression, prosocial behavior, and social preference in predicting resource control in young children

Distinguishing between physical and social aggression, this study examined whether the predictive effect of aggression on resource control a) is moderated by prosocial behavior and b) corresponds to a linear or a curvilinear trend. Moderating effects of children’s social preference among peers and child sex in this context were also tested. Based on a sample of 682 kindergarten children (348 girls; average age 72.7 months, 3.6 SD), multilevel regressions revealed additive linear effects of social preference and prosociality on resource control. Moderate (but not high) levels of social aggression also facilitated resource control for disliked children. There was no such threshold effect for well liked children, who increasingly controlled the resource the more socially aggressive they were. In contrast, physical aggression hampered resource control unless used very modestly. The present study has a number of positive features. First, the distinction between physical and social aggression improves our understanding of the relation between aggression and social competence and sketches a more differentiated picture of the role of different forms of aggression in resource control. Second, this study combines the concept of resource control with the concept of social preference and investigates curvilinear effects of aggression. Third, the direct observation of resource control in the Movie Viewer increases the internal validity of this study.