WORKSHOP #1
DESIGN AND EXECUTION OF RANDOMIZED CLINICAL TRIALS INVOLVING BEHAVIORAL INTERVENTIONS – Part I.
Kaufmann P. G.1, Powell L. H.2, Freedland K. E.3
1National Heart, Lung and Blood Institute, Bethesda, MD, USA
2Rush University Medical Center, Chicago, IL, USA
3Washington University, St. Louis, MO, USA
Randomized controlled trials are the gold standard for evaluating efficacy and effectiveness of interventions in biomedical clinical research. Their implementation in behavioral medicine poses specific challenges that warrant careful consideration.
This workshop is designed to provide a basic overview of the most salient principles that underlie the conduct of valid randomized behavioral clinical trials. Material will include a discussion of equipoise and blinding, efficacy and effectiveness, pragmatic trials, large simple trials, multisite trials, relationship of pilot studies to outcomes in the main trial, a consideration of Phases of trials, applicability of “Good Clinical Practices” as promulgated by regulatory agencies, issues in analysis including intent-to-treat, responder, and per-protocol analyses, primary and secondary endpoints, ancillary studies, and the structure and function of data and safety monitoring committees.
CORRESPONDING AUTHOR: Peter G. Kaufmann, PhD, National Heart, Lung and Blood Institute, USA; kaufmann@nih.gov
WORKSHOP #2
MECHANISMS OF HEALTH BEHAVIOUR CHANGE
Schwarzer R.
Freie Universität Berlin, Psychologie, Berlin, Germany
The purpose is to introduce health psychologists to some principles that have been found relevant in the study of health behaviour change.
Topics are, for example, the distinction between stage and continuum models, the path analytic design of popular health behaviour models, the role of behavioural intentions and of distal and proximal factors that influence outcomes such as physical activity, dental hygiene, smoking cessation, sun safety and dietary behaviours.
Participants will understand constructs such as self-efficacy, outcome expectancies, health-specific optimism, planning, and action control. Examples of the measurement of such constructs will be given.
Particular attention will be given to mediators and moderators. We will discuss the rationale for mediation and moderation and will also practice the computation of such models, providing examples in SPSS. Participants will be informed about the above topics and will become capable of specifying and examining models of health behaviour change.
We will use a flexible instructional format that includes brief presentations, small-group collaboration, and plenary discussions.
This workshop would be suitable for graduate and post-graduate students as well as for investigators who are new to this field of research.
CORRESPONDING AUTHOR: Prof. Dr. Ralf Schwarzer, Freie Universität Berlin, Germany; ralf.schwarzer@fu-berlin.de, www.RalfSchwarzer.de
WORKSHOP #3
HOW TO CREATE AND ADAPT EDUCATIONAL INTERVENTIONS FOR DIVERSE GROUPS: CONCEPT TO FINAL PRODUCT
Meade C. M.
Senior Member and Professor, Population Science, Health Outcomes & Behavior
Moffitt Cancer Center, Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
Meeting the challenge of a strong research agenda in behavioral medicine requires an understanding and consideration of culture and literacy in intervention development, and entails a high degree of interdisciplinary collaboration to effectively incorporate such components into meaningful research outcomes.
This pre-conference tutorial workshop highlights a series of systematic steps and strategies for creating audiovisual materials (printed, electronic, multimedia, etc), which are part of interventions aimed to impact health disparities. This workshop calls attention to a learner-centered mindset for creating materials that are dynamic, salient, and responsive to audience language and literacy demands.
The facilitator draws on current literature and her extensive communications and media background to outline steps that underscore key components important to this process: 1) interdisciplinary collaboration; 2) learner involvement and engagement; 3) use of iterative planning steps; 4) conduct of formative research; 5) incorporation of elements of design, and 6) ongoing refinement procedures.
To illustrate this process, Dr. Meade shares examples from ongoing studies including how an existing English-language stress management training intervention (DVD/booklet), was “transcreated” for use in another study involving Spanish-speaking Latinas about to begin chemotherapy. Commonly-faced logistical and practical aspects of this process, including budget considerations, will also be delved into as part of this workshop.
The appropriate audience for the workshop includes students, junior investigators, and those at any career level who intend to include audiovisual materials as part of their studies. A number of helpful resources and worksheets will be made available to support skill development.
Objectives: Highlight how culture and literacy inform the development of audiovisual materials. Apply a learner-centered mindset to the development of educational interventions. Explain the steps to transcreate an intervention for a new audience. Discuss challenges and practical considerations when advancing a concept to final product.
Format: Combines didactic presentations, group discussions and in–class exercises.
CORRESPONDING AUTHOR: Cathy D. Meade, PhD, RN, FAAN , Moffitt Cancer Center, USA; cathy.meade@moffitt.org
WORKSHOP #4
APPLICATIONS OF STRUCTURAL EQUATION MODELS IN BEHAVIORAL MEDICINE RESEARCH
Llabre M.M.
University of Miami, Miami, FL, USA
Structural equation modeling (SEM) is a broad and flexible methodology for analyzing data whose structure may be specified in the form of linear models.
There are two components to the general model: the measurement model and the structural model. When both components are applied, SEM allows the estimation of effects and the testing of hypothesized causal relations free from measurement error.
One important application of SEM is the analysis of growth models. In latent growth models (LGM), the two components of SEM may be mapped onto data from repeated measures designs to address questions about change over time.
This workshop will introduce the basic concepts of SEM and LGM and illustrate the potential these models bring to different areas in behavioral medicine research. Particular emphasis will be given to the analysis of LGM in longitudinal studies and cardiovascular reactivity.
The concepts will be illustrated with several examples including a measurement model of medication adherence, estimation with data missing by design, and examining predictors of cardiovascular reactivity and recovery from different stressors. The emphasis will be on the specification of the models and the interpretation of results.
CORRESPONDING AUTHOR: Maria M. Llabre, PhD, University of Miami, USA; mllabre@miami.edu
WORKSHOP #6
DESIGN AND EXECUTION OF RANDOMIZED CLINICAL TRIALS INVOLVING BEHAVIORAL INTERVENTIONS – PART II.
Kaufmann P. G.1, Powell L. H.2, Freedland K. E.3
1National Heart, Lung and Blood Institute, Bethesda, MD, USA
2Rush University Medical Center, Chicago, IL, USA
3Washington University, St. Louis, MO, USA
This advanced workshop on Randomized Behavioral Clinical Trials will present in-depth features of intervention development, the critical aspects of control groups, and the important influence that the selection of clinically significant primary outcome measures can have on the interpretation of results.
The presentation will address features of interventions that govern design, optimization, and early testing of behavioral interventions and how confounding can be avoided using methods to foster retention and follow-up.
Features of various control group options that are consistent with existing knowledge and clinical practice will be discussed in the context of the objectives of a clinical trial.
Selection of outcome measures will include discussion of multiple targets of interventions, multiple expressions of symptoms, and criteria for combining outcome measures.
The session will draw on existing clinical trials literature in behavioral medicine and related fields. While the session will assume a degree of familiarity with clinical trials, the presentations and discussion from the floor should be of interest to individuals over a wide range of experience in clinical research.
CORRESPONDING AUTHOR: Peter G. Kaufmann, PhD, National Heart, Lung and Blood Institute, USA; kaufmann@nih.gov
WORKSHOP #7
DEVELOPING INTERNET-BASED HEALTH BEHAVIOUR CHANGE INTERVENTIONS
Leanne Morrison, Laura Dennison, Lucy Yardley
University of Southampton, Southampton, UK
This is an introductory level workshop intended for any researcher or health professional interested in creating, delivering, and evaluating health behaviour change interventions using digital technologies (e.g. Internet, Smartphones).
The workshop will: a) discuss the role of digital technologies in the delivery of health behaviour interventions and address issues relevant to their development, delivery, and evaluation, and b) introduce and demonstrate open source software (the LifeGuide) that has enabled a growing community of researchers and health professionals to create, share, and evaluate their own digital interventions.
Digital technologies are a popular means of delivering health behaviour interventions since they have the potential to increase the reach of an intervention and provide ‘tailored’ advice based on the specific needs and characteristics of the user, at a time and place convenient to them. However, the development of digital interventions is often restricted by the need to programme each intervention individually – once programmed they cannot be easily modified. The LifeGuide is open source software that allows researchers and health professionals with no programming skills or resources to flexibly create, modify, deliver, and evaluate their own digital interventions. This workshop will introduce the LifeGuide software, present examples of the diverse range of features and components of digital interventions that can be created using the LifeGuide, and explain how the LifeGuide can be used to trial and evaluate interventions. We will provide an interactive demonstration of the LifeGuide software and describe what it is like to use LifeGuide from the researcher’s perspective. The future of digital interventions will also be discussed, including demonstration of how we can capitalise on Smartphone technology and virtual social networks to support behaviour change. The workshop will end with an opportunity for participants to ask questions and discuss the issues raised throughout the workshop.
CORRESPONDING AUTHOR: Leanne Morrison, University of Southampton, UKlm; 904@soton.ac.uk
WORKSHOP #8
IDIOGRAPHIC METHODS: INDIVIDUAL BEHAVIOR CHANGE OVER TIME
Wayne F. Velicer1, Bettina Hoeppner1
1Cancer Prevention Research Center, University of Rhode Island, USA
2Department of Psychiatry, Center for Addictive Behaviors, Harvard Medical School, USA
Idiographic methods focus on the time-dependent variation within a single individual or unit (intra-subject variability) in contrast to methods which focus on group-level relationships (inter-subject variability). Idiographic methods are widely used in other disciplines, such as engineering, business, and economics but only recently are being employed in the behavioral sciences. This method is an alternative to the dominant scientific approach in the behavioral sciences, the nomothetic approach, which focuses on group level analysis.
An inter-individual analysis may yield different results than an intra-individual analysis. Equivalent results will occur only if the two conditions specified by the Ergodic Theorems are met: (1) Each individual trajectory has to obey the same dynamic laws, and (2) Each individual trajectory must have equal mean levels and serial dependencies. These theorems appear unlikely to be met in practice but we have seldom had data adequate to test them. Available examples do not provide support for these conditions.
In addition, idiographic methods have several advantages. First, idiographic methods can address different research questions and may provide more insight into the data. Second, idiographic methods can be used in applied settings, such as businesses, schools, clinics and hospitals. More traditional between-subject research designs may not be appropriate, or, in some instances, impossible to implement in such settings. Third, idiographic methods have important advantages for investigating patterns of change across time. Some questions that can be investigated in this context include whether intervention effects are temporary or permanent, whether the intervention produces the same pattern of change for each person or unit. Fourth, idiographic methods can be used to determine the generating function for the behavior of interest. Fifth, idiographic methods can address the relationship between variables over time.
In this presentation, four different examples from behavioral medicine will be used to illustrate the types of problems that can be studied using idiographic methods, including a nicotine harm reduction study, a study of the patterns of adherence in a sleep apnea, an intervention study which identifies different patterns of arousal in children with autism, and the use of time series analysis to evaluate the effects of a Hepatitis C intervention for persons with HIV.
The studies illustrate how idiographic methods can provide a method of addressing unique and important research questions. In addition, the workshop will provide the opportunity for participants to analyze some of the data from the examples presented.
CORRESPONDING AUTHOR: Wayne F. Velicer, University of Rhode Island, USA; velicer@uri.edu
WORKSHOP #9
WIRELESS ASSESSMENT OF STRESS AND PHYSIOLOGICAL REACTIONS IN THE REAL WORLD
Arnetz B. B.
Wayne State University, Detroit, MI, USA and Uppsala University, Uppsala, Sweden
A major limitation to today’s approach to link psychosocial stressors to biological disease processes and effective prevention is the lack of feasible technologies that allows for ecological momentary assessments of psychosocial stress and physiological responses and feed-back such data for instant analysis.
Today, such technologies are only available in the laboratory settings, severely limiting its ecologic validity. In recent years there has been a remarkable development in the area of wireless sensor technologies that allows for body area network that is connected to a remote server using smart phones.
We have developed and field tested for feasibility a body area network that allows for the instant and real-life assessment of cardiovascular responses as a person go about their daily life.
A remote smart web-based server triggers messages to the person’s Smartphone when cardiovascular data indicates increased biological stress. The smart web server is programmed with algorithms that allows for the process to be automated.
The workshop will discuss recent development in means to assess psychosocial and physiological stress using bodily sensors and smart phones. Furthermore, a simple and cheap system that is readily deployable in stress research and behavioral interventions will be discussed.
The workshop does not require any prior knowledge in body area networks.
The workshop will use non-technical and down-to-earth language.
CORRESPONDING AUTHOR: Prof. Bengt B. Arnetz, Wayne State University, USA; barnetz@med.wayne.edu
Wednesday
August 29, 2012
ICBM 2012 Satellite Forum
09.00 – 16.00
GETTING RESEARCH INTO POLICY AND PRACTICE: ADVANCING THE SCIENCE FOR DISSEMINATION AND IMPLEMENTATION IN BEHAVIORAL MEDICINE
Chaired by: Brian Oldenburg (Chair, International Collaborative Studies Committee), Carina Chan (Chair, ISBM Early Career Network - INSPIRE) and Vish Viswanath (Chair, Organizational Liaison Committee)
Historically, researchers and policy makers have focused most of their attention on developing and testing empirically supported interventions. Much less attention has been paid to what is needed to implement and sustain these in a range of real-world settings. Many empirically supported interventions are less effective and/or fail to reach their target audiences when implemented within existing service structures and systems, and few are sustained over the long term. Clearly, if effective public health programs are not widely adopted and implemented, their potential to improve people’s health is significantly impaired. This challenge is exacerbated by the different values and perspectives that exist between practitioners, program implementers, policy makers and researchers. Practitioners often find evidence-based interventions difficult to conduct in community settings especially when there is such limited information about how to adapt programs to the local context. Furthermore, public health decision-makers and program implementers are often reluctant to consider ‘new’ interventions when effectiveness has not been demonstrated in their particular setting or country. By contrast, researchers are usually more concerned with the internal validity of their programs rather than generalizability and external validity.
Effective dissemination, implementation and translation for public health and behavioral medicine interventions require the triangulation of evidence from formal trials with case studies, expert opinion, network analysis, systems thinking, as well as assessments of the local context. These combine information about scale, resources and structuring, with the practical experiences of the end-users. This combination of evidence from different fields and perspectives is essential. These steps requires methods, study design and approaches which most researchers are not formally trained in.
CORRESPONDING AUTHOR: Dr Carina Chan, Chair, ISBM Early Career Network – INSPIRE, Monash University, Jeffrey Cheah School of Medicine and Health Sciences , Petaling Jaya , Malaysia; carina.chan@monash.edu
Poster Session A
P1
AVAILABILITY OF MEDICAL STAFF IN ROMANIA, BULGARIA AND HUNGARY TO PRACTICE IN VARIOUS COUNTRIES OF THE EUROPEAN UNION - PRELIMINARY RESULTS
Covaliu B.1, Mocean F.1, Del Olivo del valle Gómez M.2
1 University of Medicine and Pharmacy Iuliu Hatieganu, Department of Public Health, Cluj-Napoca, Romania
2 Universidad de Oviedo, Department of Public Health, Oviedo, Spain
Purpose: Assessing preferences of medical professionals (physicians, resident physicians, nurses) on the countries that they wish to practice their profession.
Material and methods: The study included 8116 people (100%) from Romania, Hungary and Bulgaria that have participated during March 4th- April 10th, 2011 in career fairs specialized for the medical sector. Of these, 1248 (%) were medical doctors - specialists, 1426 (%) - resident physicians, 3297 – students in medical sciences, 409 – dentists, 410 pharmacists, 822 (%) – nurses and 504 with another profession in the medical field.
Results: were collected using a questionnaire, in which subjects expressed their willingness to work in different health systems in Europe. Data were statistically processed using Microsoft Excel.
Results: Out of 3557 health professionals in Romania, 3531 (99.27%) want to find a different job than the current one and 26 (0.73%) of them were not looking for a job. Among those who sought a job, 537 (15.09%) want to work in Romania and are ready to work in other countries as well, 120 (3.37%) - want to work exclusively in Romania, 236 (6.63%) want to work exclusively in France, 176 (4.94%) want to work exclusively in Germany, 360 (10.12%) want to work exclusively in England, and 1869 (52.54%) are ready to work in several medical systems, while 259 (7.28%) did not answer this question. Similar results were found in Bulgaria and Hungary, reported to the size of the population.
Conclusions: The study demonstrated a great availability of health professionals to relocate and practice in a country other than their own.
Keywords: labor migration, specialized medical professionals, health systems, the EU, medical system.
CORRESPONDING AUTHOR: Covaliu Bogdan, UMF Iuliu Hatieganu, Cluj-Napoca; bogdancovaliu@gmail.com
P2
THE LEVEL OF ACCULTURATION AND USE OF HEALTH SERVICES AMONG REGISTERED ELDERLY KOREANS LIVING IN AN URBAN AREA OF JAPAN
Oh CH., Saito E.
Tokyo Metropolitan University Graduate School of Human Health Sciences, Department of Nursing Sciences, Tokyo, Japan
Purpose: The present study aimed to clarify the level of acculturation of registered elderly Koreans living in an urban area of Japan and their use of health services. Acculturation has been shown to be associated with significant changes in health behavior, health, and morbidity among ethnic minority groups. Koreans are the second largest registered minority group in Japan, after Chinese (2011). It is thought that many Koreans deal with health conditions on their own due to their unstable living environment and poor socioeconomic status. Similar to the Japanese population, the number of elderly Koreans is increasing. However, to date, no research in the field of nursing has investigated registered elderly Koreans.
Methods: Data were collected using the embedded descriptive case study design reported by Yin (2008). In 2011, semi-structured interviews were conducted on 10 registered elderly Koreans (7 women, 3 men) living in an urban area of Japan. For data analysis, a pattern matching technique was used, in which several pieces of information from one or more cases are related to a theoretical proposition. We employed the definition of acculturation used by Berry (2010).
Result: Six participants were first-generation residents of Japan and 3 were second-generation residents. All participants had contributed to the long term insurance system, but 8 participants had left the pension plan and did not receive pension payments. The participants were found to have two levels of acculturation. The first level was “integration”, in which they used health services effectively, but maintained some degree of cultural identity and customs, while at the same time seeking, as a member of an ethno-cultural group, to participate as an integral part of the larger social network. The second level was “separation”, in which they used health services as needed, but emphasized the importance of holding onto their original culture, while at the same time hoping to avoid interaction with the larger social network.
Conclusion: We found that the degree of the use of health services differed according to the participants’ level of acculturation. Therefore, it is important for public health nurse to consider the registered foreigner's acculturation level when approaching them.
Keywords: Acculturation, Minority health
CORRESPONDING AUTHOR: Oh Chu Hyang, Tokyo Metropolitan University; ohchuhya@hs.tmu.ac.jp
P3
DEPRESSION AND DISTRESS IN ADULTS WITH TYPE 2 DIABETES: DOES THE NEIGHBOURHOOD ENVIRONMENT MATTER?
Gariepy G.1, Schmitz N.2
1 McGill University, Epidemiology and Biostatistics, Montreal, Canada
2 Douglas Mental Health University Institute, McGill University, Research, Montreal, Canada
Background: Depression and distress are frequent in people with diabetes and can have detrimental effects on disease prognosis and outcomes. The place where people live is thought to affect mental health above and beyond the characteristics of individuals. The neighborhood environment could be particularly important to people with diabetes, who rely more on their local area for resources and support. Yet, no study has examined the associations between social and physical characteristics of neighborhoods and mental health in the diabetic population.
Objective: To investigate if neighborhood characteristics are associated with depression and diabetes distress in adults with type 2 diabetes.
Methods: We used data from a community sample of 600 adults with type 2 diabetes from Quebec, Canada. We collected information on perceived neighborhood environment from a telephone interview. We conducted a factorial analysis to combine the neighborhood questionnaire items into meaningful constructs. We assessed depressive symptoms from the Patient Health Questionnaire and diabetes-specific distress from the Diabetes Distress Scale. We performed logistic regressions, adjusting for socioeconomic, lifestyle and health variables.
Results: Factorial analysis uncovered 3 important neighborhood constructs: order (social and physical order; 13 items), culture (social and cultural environment; 10 items) and access (land use and access to services and facilities; 9 items), with higher score indicating better neighborhood qualities. All 3 constructs were significantly associated with high depressive symptoms; order and culture were associated with high distress [high depressive symptoms adjusted OR (AOR) 0.8 (95% confidence interval 0.7-0.9), 0.8 (0.6-0.9) and 0.8 (0.7-1.0) and high distress AOR 0.8 (0.7-0.9), 0.8 (0.7-0.9) and 0.9 (0.8-1.1), for order, culture and access scores, respectively].
Conclusion: Neighborhood characteristics are associated with high depressive symptoms and diabetes distress in people with type 2 diabetes. Clinicians should consider the neighbourhood environment of their diabetic patients when assessing and addressing mental health. Public health interventions to improve the neighborhood environment may help protect the mental health of people with diabetes.
Keywords: depression, mental health, diabetes, environment, physical environment
CORRESPONDING AUTHOR: Gariepy Genevieve, McGill University, Montreal; genevieve.gariepy@douglas.mcgill.ca
P4
EPILEPSY PERCEPTIONS AND HEALTH-RELATED QUALITY OF LIFE STATUS OF ORANG ASLI IN TERENGGANU, MALAYSIA
Lua PL., Talib NS., Neni WS., Abdul Latif AZ.
University Sultan Zainal Abidin, Centre For Clinical & Quality of Life Studies , Kuala Terengganu, Malaysia
Orang Asli represents the indigenous minority people of Peninsular Malaysia. It is believed that even until today, they are still lagging behind in terms of disease perceptions, health education and healthcare facilities. Consequently, their awareness, knowledge and attitudes (AKA) towards chronic diseases (e.g. epilepsy) and health-related quality of life (HRQoL) status are still not well understood. Our study aimed to assess the general level of epilepsy AKA and HRQoL status in a cross-sectional sample of Orang Asli from Sungai Berua village, Terengganu, Malaysia. Descriptive and non-parametric statistics were employed for data analysis (SPSS 16). The Malay AKA Epilepsy and WHOQOL-BREF were administered consecutively. Only 22 out of 30 available respondents (response rate = 73.3%) consented participation (median age = 25.5 years; female = 90.9%; married = 90.9%; housewife = 68.2%; education ≤ primary school = 86.4%; monthly income ≤ MYR 500/USD 158.5 = 100%). Across all respondents, their AKA (median = 82.5; range 0 - 170.0) and HRQoL status (median = 13.6; range 8.9 - 17.0) seemed moderate. Interestingly, they possessed better Knowledge on epilepsy (median = 40.0, range 20.0 - 55.0) compared to Awareness (median = 20.0, range 0 - 50.0) and Attitude (median = 20.0, range 0 - 40.0). Among all the HRQoL domains, Social Relationship was reported as the most favourable (median = 16.0, range 4.0 – 20.0) while Environmental issues emerged the least favourable (median = 12.0, range 8.0 - 15.5). In conclusion, both disease perceptions and HRQoL issues among Orang Asli still require attention particularly in aspects concerning Awareness, Attitude and Environment. Essentially, tailored health education strategies are vital for improvement.
Keywords: epilepsy, health beliefs, low-income and minority groups, quality of life
CORRESPONDING AUTHOR: Lua Pei Lin, University Sultan Zainal Abidin; Peilinlua@unisza.edu.my
P5
RACIAL/ETHNIC DISPARITIES IN OBESITY AMONG MINORITY ADOLESCENTS IN THE UNITED STATES MAY EXIST INDEPENDENTLY OF SOCIOECONOMIC FACTORS
Fradkin C., Wallander J.
University of California, Psychology, Merced, USA
Past research has documented racial/ethnic disparities in obesity among adolescents that place non-Hispanic African American and Hispanic youth at higher risk than their non-Hispanic white counterparts. While many of these studies attribute differences in weight status to socioeconomic factors, there is a dearth of information that examines risk for adolescent obesity within income and educational strata. This research examined whether racial/ethnic disparities in obesity risk in adolescents can be attributed to family socioeconomic factors.
A multi-site study enrolled 4,186 children from one of the three major racial/ethnic groups in the U.S. (Hispanic = 38%, African American = 36%, White = 26%). Measurements of body mass index (BMI) were taken in 5th and 7th grades. Parents provided demographic information on the household.
Complex sampling analysis revealed marked disparities in obesity among racial/ethnic minority children. When stratified by household income level, obesity rates of the least obese non-Hispanic African American and Hispanic 5th graders exceeded those of the most obese non-Hispanic white 5th graders, independent of household income level. Likewise, obesity rates of the least obese Hispanic 7th graders exceeded those of the most obese non-Hispanic white 7th graders, independent of household income level. When stratified by caregiver education level, obesity rates of the least obese non-Hispanic African American 5th and 7th graders exceeded those of the most obese non-Hispanic white children 5th and 7th graders respectively, independent of caregiver education level.
These findings suggest that there are striking racial/ethnic disparities in adolescent obesity that exist independently of household income and education, and provide basis for further exploration of the relationship between family socioeconomic factors and obesity in children.
Keywords: obesity, adolescents, socio-economic status, disparities
CORRESPONDING AUTHOR: Fradkin Chris, University of California, Merced; chrisfradkin@gmail.com
P6
SUBJECTIVE SES AS A PREDICTOR OF PERCEIVED STRESS AMONGST INDIAN YOUTH
Katzenstein M., Fruchter Y., Ganz D., Marquez C., Veres S., Suchday S.
Yeshiva University, Clinical Psychology (Health Emphasis), New York, USA
Introduction: The current study investigated the relationship between perceived stress and subjective social status, within urban youth in India, a country which has experienced vast changes due to increase in income, emphasis on education, and industrialization. It is hypothesized that decreased subjective social standing will predict increased perceived stress. In addition, the effects of Westernization on perceived stress were examined.
Methods: Sample consisted of 398 college students, 66% female, with a mean age of 18.6 (SD = 1.13) enrolled at St. Xavier’s College in Mumbai, in 2003 and 2005. Perceived stress was assessed using the Perceived Stress Scale, a 10-item scale that asks participants to rate recent stressful experiences. Subjective social standing was measured using The MacArthur Scale of Subjective Social Status ladder for community and national comparisons. Westernization was measured using The Westernization and Acculturated Distress (WAD) scale, a 49-item scale that asks participants to rate distress related to cultural westernization.
Results: Mean score on Perceived Stress was 18.3 (SD = 7.02). Mean score on the totaled ladders was 13.5 (SD = 2.62), and mean score on the WAD was 157.6 (SD = 19.7). The correlation (r = -.326) between perceived stress and subjective social standing was significant (p < .001), indicating that the lower someone subjectively placed themselves in the community, the higher their perceived stress. In fact, subjective social standing, was shown to be an independent predictors of perceived stress (β = -.88, p < .001). There was a significant correlation between the WAD and perceived stress (r = .290, p < .001), indicating that increased negative effects of westernization are related to higher self-reported stress.
Conclusion: Results demonstrate that subjective social standing and Westernization has a significant impact of perceived stress within a sample of urban Indian youth. These results have implications for negative health outcomes and the continued understanding of the effects of globalization.
Keywords: acculturation, adolescents, social stress, social support
CORRESPONDING AUTHOR: Ganz Debora, Ferkauf Graduate School; debganz@gmail.com
P7
CLASS, GENDER AND COHORT DIFFERENCES ON WORK-FAMILY PATTERNS IN THE UK
Lacey R.1, McMunn A.1, Sacker A.2
1 University College London, Department of Epidemiology and Public Health, London, United Kingdom
2 University of Essex, Institute of Social Science Research, Colchester, United Kingdom
Background: Substantial changes in the work and family lives of men and women are well-documented, but their relationship with health and wellbeing remains unclear. As a first step towards assessing the health impact of social change in women’s and men’s work-family life courses, participation in paid and unpaid domestic work, and family forms are characterised using longitudinal typologies from British birth cohort studies. Socioeconomic, gender and cohort differences in these typologies are examined.
Objectives and methods: This study characterises cohort differences in women’s and men’s participation in paid work, unpaid domestic work and family forms in Britain using longitudinal typologies. Socioeconomic differences in these typologies across cohorts are also examined. Participants of three British birth cohort studies are included: the National Study of Health and Development (NSHD) born in 1946, the National Child Development Study (NCDS) born in 1958, the 1970 British Cohort Study (BCS70). Work-family typologies will be constructed using longitudinal data on employment status and hours worked, marital and partnership status (including cohabitation) and the number and ages of children (in and out of the household) from each adult data sweep. Information on responsibility for household chores and childcare were collected at ages 33 and 42 in the NCDS and ages 30 and 34 in the BCS70. Reflecting the dramatic changes in this area, this information was not collected in the NSHD. Socioeconomic position is measured using educational qualifications, household income and occupational class in childhood and adulthood. Optimal matching analysis will be used to assess observed individual work-family histories in relation to their distance from pre-determined ideal-type sequences.
Results: It is hypothesized that results will show increasing individual diversity, and decreasing gender differences, in work-family life courses across cohorts. It is hypothesized that decreases in gender differences will be greater in socioeconomically advantaged households.
Keywords: Family, Gender, Health
CORRESPONDING AUTHOR: McMunn Anne, UCL, London; a.mcmunn@ucl.ac.uk
P8
HEALTH PROTECTIVE EFFECTS OF PRACTICING RELIGION IN A POST-COMMUNIST COUNTRY
Konkoly Thege B, Székely A, Pilling J., Kopp M.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
The relationship between religiosity and health has been investigated in the western world for decades. However, very little data are available from the post-communist region of Europe, where religion was suppressed both at the individual and institutional levels for decades. The aim of the present study was to lessen this gap.
In 2002 in the frame of a national representative study of the population above 18 years of age 12,643 persons (Mage = 47.6 yrs; SD = 17.9yrs; 44.8% male) were interviewed in Hungary thirteen years after the regime change. The relationship of mental and physical health indicators with religious worship and personal importance of religion - controlling for gender, age, and education - were analyzed using logistic regression and general linear model procedures. In 2002 in the total adult population 25% percent of the respondents considered themselves as non-believers, 18% did not practice their religion, 27% were believers in their own way, 17% practiced rarely, and 13% regularly practiced their religion in their own church. Our results showed that being religious and the higher personal importance of religion were largely associated with better mental health (e.g., better well-being and more meaning in life) and more favorable physical health status (better self-rated health, less health-damaging behaviors, less days on sick leave). Persons being religious in their own way, tended to show more unfavourable results across several variables when compared to those practicing religion regularly in a religious community or even to those considering themselves as non-religious.
We can conclude that after an anti-religious totalitarian political system practicing religion remained a very significant health protecting factor in the Hungarian population.
Keywords: religious worship, importance of religion, physical health, mental health, Central- Eastern Europe
CORRESPONDING AUTHOR: János Pilling, Semmelweis University,Budapest; pillingdr@gmail.com
P9
FEMALE CIRCUMCISION (FC) IN MALAYSIA: MEDICALIZATION OF A RELIGIOUS PRACTICE
Dahlui M., Wong YL., Choo WY.
University Malaya, SPM, Faculty of Medicine, Kuala Lumpur, Malaysia
Female genital mutilation/FC causes serious and irreversible damage to the physical, psychological and sexual health of many women and girls. FGM/FC is one of the most devastating human rights violations against female infants, adolescent girls, and women who are incapable of giving consent due to age or coercion. The increasing trend of trained health providers (HP) carrying out FGM/FC is maintaining high prevalence of FGM/FC despite these negative consequences. WHO has thus been advocating for the prohibition of medicalization of FGM/FC. In Malaysia, FC is practised among Muslims. Malaysia has ratified WHO resolution to eliminate FGM/FC. This paper presents findings of a study to determine the extent of FC being conducted by trained HP, latter’s perceptions/beliefs, FC procedures, and impact on FC prevalence. Mixed methods were used: a cross sectional survey of 307 HP (269 trained and 38 traditional HP) and in-depth interviews with selected sample on perceptions/beliefs about FC. All FC practitioners were Malay Muslim and female, viz. 56 general practitioners (GP) in private clinics and 32 traditional midwives (TM). FC procedures involved braising and minute cutting of the prepuce (tip of clitoris). Both GP and TM used small knives and scissors but only GP applied sterilization. No adverse effects or long term complications were reported. HP cited reasons given by clients for performing FC as religious obligation, to control female’s sexual desire and hygienic purposes. Malay Muslim FC practitioners agreed that FC for Muslim females is an honourable Islamic practice and it probably has a role in controlling female sexual desire. Majority believed that FC should be done although more TM than GP perceived so. Medicalization of FC is thus apparent in Malaysia although comparatively FC is a minor procedure with no adverse side effects. Yet, medicalization of FC constitutes a misuse of professional medical role and may wrongly legitimize FC as medically safe/beneficial. As there is no such medical benefit, medicalization of FC should be abandoned to facilitate elimination of FC practice.
Keywords: religion, beliefs, female circumcision, medicalization, Malaysia
CORRESPONDING AUTHOR: Wong Yut Lin, University Malaya, Kuala Lumpur; wongyl@ummc.edu.my
P10
STORIES OF SUPPORT COUNSELOERS FOR DV OFFENDERS ON ASPECTS OF PERINATAL STAGE CONFLICTS
Kojima R.
Ritsumeikan University; Doctoral Course of Sociology, Kyoto, Japan
There is an accumulation of research focusing on changes in marital relationships. Their findings can be used for analyzing changes associated with becoming parents. Shoji (2006) focused on coping with marital conflicts and reported that contemplation and reinterpretation of the self and the spouse, as well as the reason for the conflict happens when coping in a compromising manner. The present author (2005) conducted an interview survey with six couples that had their first child during the prenatal to postnatal period in 2000. Results indicated that couples that experienced marital conflicts coinciding with pregnancy and childbirth had deepened mutual understanding as a result of help from midwives, to encouraging them to compromise and to cope. However, given that domestic violence (hereafter DV) is sometimes caused by prenatal to postnatal marital conflicts, it is necessary to examine the experiences of such couples. Nevertheless, DV offenders are in a process of conflict, and thus, their stories are not easily delivered. Moreover, telling the stories sometimes results in psychological problems such as flashbacks. Therefore, this study was based on stories gathered from counselors who support DV offenders. The purpose of this study was to understand and identify the types of perinatal stage marital conflicts that result in DV, as well as the role of support providers.
Keywords: family, gender
CORRESPONDING AUTHOR: KOJIMA Rieko, Ritsumeikan University, Kyoto; kokojak3436@gmail.com
P11
PSYCHOLOGICAL DISTRESS IN WOMEN PRESENTING WITH VAGINAL DISCHARGE IN PAKISTAN
Khan N.1, Flach C.2, Kausar R.3, Howard L.2
1 University of the Punjab, Centre for Clinical Psychology, Lahore, Pakistan
2 King's College London, Department of Public Health, London, United Kingdom
3 University of the Punjab, Applied Psychology, Lahore, Pakistan
There is strong evidence of an association between gynaecological morbidity and somatic complaints and emotional distress. Women with Vaginal Discharge are reported to experience more psychological distress compared to general population. The current study aimed to assess psychological distress in women reported with vaginal discharge and those reporting with other gynaecological problems in Lahore, Pakistan. It was hypothesized that women presenting with vaginal discharge are likely to experience more psychological distress as compared to those presenting without vaginal discharge. Women presenting with and without vaginal discharge were recruited from the gynecology clinics of both private and public sector hospitals of Lahore, Pakistan. A total of 425 women were contacted and 377 (89%) consented to participate in the study. An in-depth interview and General Health Questionnaire was used to assess psychological distress in women reporting with gynaecological problems. Several gender disadvantage variables showed significant association with CMDs: marriage at young age, pregnancy during adolescence, husband verbal abuse and physical abuse, concern about husband habit, low level of social integration, low level of autonomy in decision making, and lack of family support were associated with Common Mental Disorders (CMDs).
Keywords: vaginal discharge, common mental disorders (CMDs)
CORRESPONDING AUTHOR: Khan Nashi, University of the Punjab, Lahore; nashi.khan@gmail.com
P12
KNOWLEDGE ON SPECIFIC REPRODUCTIVE RISKS AND ITS IMPACT ON COUPLES’ EMOTIONAL ADJUSTMENT TO PREGNANCY IN ADVANCED MATERNAL AGE: AN EXPLORATORY STUDY
Guedes M., Canavarro M.C.
University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
The postponement of first child birth has been a growing trend in economically developed countries (OCDE, 2011). However, researchers have described this reproductive decision as commonly uninformed, regarding the impact of age on fertility, risks for maternal, fetal and infant health and assisted reproduction technologies’ treatments (Cooke, Mills, & Lavender, 2010). Among women, a lower level of knowledge on specific reproductive risks has been frequently related to higher symptoms of anxiety during pregnancy (Lampinem, Vehvilaïnen-Julkunen, & Kankkunen, 2009). Nevertheless, little is known about their partners’ level of knowledge and its impact on couples’ emotional adjustment to pregnancy.
This exploratory study aimed to assess knowledge on specific reproductive risks of primipara women who experienced pregnancy in advanced maternal age (35 years and older), comparatively to their partners. Moreover, it aimed to evaluate the impact of this level of knowledge on couples’ emotional adjustment during the third trimester of pregnancy.
The sample was constituted by 42 couples, who were recruited in the Genetic and Human Reproductive Service of the Hospitais da Universidade de Coimbra, EPE. Both couples´ members completed the Knowledge on specific reproductive risks scale (Tough et al., 2006) during prenatal diagnosis routines, as well as the Brief Symptom Inventory-18 (Derogatis, 2001; Canavarro, Nazaré, & Fonseca, 2008) during the third trimester of pregnancy.
Both couples' members showed a low level of knowledge on specific reproductive risks related to advanced maternal age. However, men revealed a marginally higher level of knowledge comparatively to women (Pillai's Trace = 0.22, F(1, 41) = 2.59, p = .05), especially regarding the impact of age in fertility and risks for maternal health (F (1, 41) = 6.67, p = .01). Men’s higher level of knowledge was associated with higher levels of psychopathological symptomatology among men (F (2, 30) = 4.36, p = .03) and women (F (2, 30) = 25.41, p < .001), explaining respectively 52% and 86% of the variance.
These results tend to emphasize the preventive role of health professionals to promote informed reproductive decisions. They also seem to highlight the importance of couple-centered interventions focused on reproductive risks, life styles and reproductive health, in order to enhance couples’ perception of control and facilitate emotional adjustment to pregnancy in advanced maternal age.
Keywords: pregnancy; advanced maternal age; knowledge on specific reproductive risks; couple-focused; mental health; prevention
CORRESPONDING AUTHOR: Guedes Maryse, University of Coimbra (Portugal); maryseguedes@gmail.com
P13
PREVIOUS REPRODUCTIVE HEALTH AND ITS IMPACT ON COUPLES’ EMOTIONAL ADJUSTMENT TO PREGNANCY IN ADVANCED MATERNAL AGE: AN EXPLORATORY STUDY
Guedes M., Canavarro M. C.
University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
Postponement of first child birth has been a growing trend in economically developed countries (OCDE, 2011). This decision has been commonly described as a result of women’s perceptions of psychological readiness and professional, financial and marital stability (Cooke, Mills, & Lavender, 2012). Nevertheless, little is known about the previous reproductive health of primipara women aged of 35 or over and its impact on couples’ adjustment to pregnancy.
This exploratory study aimed to characterize the previous reproductive health of primipara women who experienced pregnancy in advanced maternal age (35 years or over). It also aimed to evaluate its impact on couples’ emotional adjustment during the third trimester of pregnancy.
The sample was constituted by 42 couples, who were recruited in the Genetic and Human Reproductive Service of the Hospitais da Universidade de Coimbra, EPE. Both couples´ members completed a brief reproductive health questionnaire during the prenatal diagnosis routines as well as the Brief Symptom Inventory-18 (Derogatis, 2001; Canavarro, Nazaré, & Fonseca, 2008) during the third trimester of pregnancy.
Most couples (61.3%) did not previously experience reproductive health problems. However, 16.1% of the couples experienced reproductive health problems in advanced maternal age, mainly related to obstetrical complications (miscarriage or ectopic pregnancy) in a previous pregnancies (14.9%); 4.8% of these couples had difficulties to conceive but only 3.2% underwent medical treatments. Moreover, 22.6% of the couples suffered reproductive health problems previously to advanced maternal age, mainly related to difficulties to conceive (19.4%); most (17.7%) of them underwent medical treatments. Women showed higher levels of psychopathological symptomatology comparatively to men (Pillai’s Trace = 0.26, F(1, 30), p = .03). Among women, previous reproductive health problems were related to marginally higher levels of psychopathological symptomatology; conversely, men who did not experience previous reproductive health problems reported marginally higher levels of psychopathological symptomatology (Pillai’s Trace = 0.20, F(1, 30), p = .08).
These results tend to emphasize the preventive role of health professionals to promote informed reproductive decisions. They also highlight the importance of couple-centered interventions that assess reproductive trajectories, in order to better understand emotional adjustment to pregnancy in advanced maternal age and to prepare clinical interventions focused on couples’ specific needs.
Keywords: reproductive health; pregnancy; advanced maternal age; couple-focused; mental health; prevention
CORRESPONDING AUTHOR: Guedes Maryse, University of Coimbra (Portugal); maryseguedes@gmail.com
P14
“IT’S NOT THAT I DON’T WANT (BABY) …I’VE NO CHOICE BUT TO ABORT”: MALAYSIAN WOMEN’S RIGHT AND ACCESS TO CONTRACEPTION AND LEGAL ABORTION AMIDST CULTURAL BIAS
Wong YL.1, Low WY.2, Tong WT.2, Choong SP.3, Jegasothy R.4
1 University of Malaya, SPM &Centre for Population Health, Faculty of Medicine, Kuala Lumpur, Malaysia
2 University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia
3 Klinik Rakyat, Family Planning Centre, Penang, Malaysia
4 Hospital KL, O & G, Kuala Lumpur, Malaysia
Despite provision of contraception services for the past 40 years, contraceptive prevalence is stagnating at 51%, unmet need is 25% and unintended pregnancies among young unmarried women is rising in Malaysia. Abortion surveillance and database is lacking although there was liberalization of abortion law in 1989. This paper presents findings of a qualitative study on women’s abortion experiences to assess fulfilment of their rights and access to reproductive health. In-depth interviews were conducted with purposive sample of 31 abortion seekers of diverse ethnicity. Women’s age ranged from 21-43 years. Majority were married and working but earning low income. Pregnancies averaged at 4, each woman had an average of 2 children, and 2 abortions. Financial difficulties in raising children were main reason to abort though they perceived that abortion is religiously unacceptable. Other reasons included inability to cope with yet another baby as the last child was too young; had completed family; or could not have a child out of wedlock. Many were unsure of the abortion law but tended to perceive that it is illegal. Majority had difficulty accessing abortion information and services because of its clandestine nature as abortion is perceived to be illegal. They reported that public hospital staffs were judgemental, labeling abortion as ‘wrong’ and ‘sinful’. Many women practised contraception but confined to ‘non-modern’ methods such as withdrawal and “calendar” method. Fear of side effects, lack of spousal cooperation, and misinformation about contraception were cited as reasons for non-adherence and contraception failures. Insights from women’s experiences point to the following. Abortion though permitted by law but when restricted or rendered inaccessible violates women’s right to sexual reproductive health. Cultural bias and ignorance of abortion must be eliminated so that Malaysian women can access safe, open and affordable abortion services. Contraception promotion must be comprehensive and effective to address the stagnated contraceptive prevalence and to prevent unintended pregnancies.
Keywords: gender, women's health, abortion, cultural bias, Malaysia
CORRESPONDING AUTHOR: Wong Yut Lin, University Malaya, Kuala Lumpur; wongyl@ummc.edu.my
P15
SEX STEROIDS AND GENDER-RELATED BEHAVIOUR IN CHILDREN: STUDY ON PATIENTS WITH CONGENITAL ADRENAL HYPERPLASIA
Grubic M., Bogdanic A., Dumic M.
University Hospital Centre Zagreb, Pediatrics, Zagreb, Croatia
Congenital adrenal hyperplasia (CAH) is a genetic disorder characterized by a deficiency in the hormones cortisol and aldosterone and an over-production of the hormone androgen, which is present at birth and affects sexual development. This is the reason patients with CAH are often used within studies exploring effects of hormones on human behavior. Behavioral studies have shown that children and adults with CAH, especially girls and women, differ in behavior and interests from unaffected same-sex individuals.
Aim of this study was to examine the influence of androgen exposure on gender related behaviour (GRB) in children by establishing the differences in GRB between children with different types of CAH and healthy children. Behaviours that we examined were: type of play (active, athletic, rough and tumble, quiet) and aggressiveness (using Play Activity Questionnaire; Finnegan et al. and Aggressiveness and Prosocial Behaviour Scale for Children; Vlahović-Štetić, Žužul).
Participants were 53 girls and 24 boys (aged between 4 and 17 years) with CAH and 77 healthy controls (matched by age and gender).
We compared three groups of CAH patients classified by disease severity: salt wasting, simple virilizing and non-classical variant, among themselves and with healthy controls (matched by age and gender).
Our expectations that girls with CAH will differ from control group in examined aspects of gender-related behavior and show more masculine behavior in comparison with non-CAH groups have been confirmed.
Girls with CAH are more often involved in games normally preferred by boys, are more active, less involved in quiet games and show increased aggression when compared with non-CAH girls. Behavior masculinization is more pronounced in severe forms of CAH and girls with non-classical form of disorder do not differ in gender-related behavior from comparable control group.
We found no difference in examined behaviors between boys with CAH and comparable control group.
Our findings support a contribution of sex steroids to differences in gender-related behaviour and aggressiveness among girls with different types of CAH and healthy peers.
Keywords: gender related behaviour, sex steroids, congenital adrenal hyperplasia, children
CORRESPONDING AUTHOR: Bogdanić Ana, KBC Zagreb; abogdani@gmail.com
P16
WEIGHT CHANGES DURING MENOPAUSE: A CHARACTERIZATION
Pimenta F., Leal I., Maroco J., Rosa B.
Instituto Superior Psicologia Aplicada, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Objective: It has been evidenced that menopause has a significant and independent effect on the increase of the body’s fat mass in peri-menopausal women (e.g., Ho, Wu, Chan, & Sham, 2010). This study explores in which period middle-aged women started to present excessive weight, and investigates the variation of body weight around the time of the menopausal transition.
Method: This is a cross-sectional research and encompasses a community sample of 497 Portuguese women in peri- and post-menopause. Menopausal statuses were determined with STRAW criteria (Soules et al., 2001). A questionnaire to explore weight history (current weight, height, weight before the beginning of menstrual changes, beginning of excessive weight in participants with obesity and overweight) was built for this study.
Results: The vast majority of women (69%) gained weight from pre-menopause to current menopausal status (peri- or post-menopause), 13% lost weight and 18% maintained their weight. Women who had gained weight and were in peri-menopause had a mean increase of 5.6 kg (SD = 3.863), comparing with the weight they had before menstrual changes had started; participants in post-menopause gained a mean of 7.5 kg (SD = 6.185). The chi-square test (for independence) showed that the weight variation (loss, maintenance and gain) was not independent of menopausal status (χ 2(2) = 18.907; p < .001).
Of the 497 participants, 206 were overweight (BMI > 25kg/m2) or were obese (BMI > 30kg/m2). Of these women, 87 (42%) identified menopause has the moment where excessive weight began and 55 – 27% - allocated it in early adulthood.
Conclusions: This study evidences that, in this community sample of middle-aged Portuguese women, most participants gain weight from pre- to peri-/post-menopause. Additionally, a considerable percentage of women state that excessive weight starts during menopause. Given the difficulty of the weight loss process and the negative impact of overweight/obesity on health, prevention of weight gain in pre-menopause is recommended.
Keywords: weight control; gender; health; weight changes; menopause
CORRESPONDING AUTHOR: Pimenta Filipa, ISPA - Instituto Universitário; filipa_pimenta@ispa.pt
P17
MENOPAUSE: PREDICTORS OF WEIGHT GAIN
Pimenta F., Leal I., Maroco J.
Instituto Superior Psicologia Aplicada, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Objective: Weight gain during midlife is frequent in women. This study explores the predictors of weight gain in women in peri- and post-menopause.
Method: This is a cross-sectional study, encompassing a community sample of 497 women in peri- and post-menopause who provided information about weight before the menopausal transition and current weight. Structural equation modeling was used to investigate a causal model of weight increase. The studied variables included socio-demographic characteristics (age, marital status, parity, professional status, educational level and household annual income), physical and psychological health and menopausal status, lifestyle (alcohol and coffee intake, smoking and physical exercise), body shape concerns, depression, stress and life events.
Menopausal status was determined according to STRAW criteria (Soules et al., 2001). Body shape concerns were measured with the Body Shape Questionnaire (Cooper et al., 1987). Depression and stress were assessed with the Depression, Anxiety and Stress Scales (Lovibond & Lovibond, 1995; Pais-Ribeiro et al., 2004). Moreover, the Life Events Survey was used to evaluate the impact of life events on weight gain (Sarason et al., 1978; Silva et al., 2003). All instruments used were validated for Portuguese.
Results: The significant predictors of weight gain were educational level (β = -.146; p = .017), physical exercise (β = -.111; p = .021), having a recent psychological problem (β = .191; p < .001), transition from peri- to post-menopause (β = .147; p = .013) and body shape concerns (β = .313; p < .001).
Conclusions: Given the difficulty associated to the weight loss process and the negative impact of overweight/obesity on health and wellbeing, prevention of weight gain in pre-menopause is recommended. This study emphasises several risk factors for weight increase around the menopause period; as a result, risk groups should be given considerable attention taking into account the characteristics which account for a significant prediction of weight gain.
Keywords: weight control; women's health; weight gain; predictors; structural equation modeling
CORRESPONDING AUTHOR: Pimenta Filipa, ISPA - Instituto Universitário; filipa_pimenta@ispa.pt
P18
TEACHERS, HEALTH AND WELLBEING: A CROSS-SECTIONAL STUDY IN A PORTUGUESE FEMALE SAMPLE
Santos-Rita J.1, Patrao I.2
1 Higher School of Health Technology of Lisbon – Lisbon Polytechnic Institute, Lisbon, Psychology, Lisbon, Portugal
2 Instituto Superior Psicologia Aplicada, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Due to social changes in the last decades, the educational challenges involve new skills and new requirements from teachers. Research in the occupational health field has shown that teachers are considered one of the most vulnerable professional groups to occupational stress and burnout. The persistence of tasks associated with the traditional female role puts into greater balance between daily wellbeing and work-life conflict. Several studies pointed to a negative association between work-life conflict and health, namely in the individual perception of health and wellbeing, in all professions. On the other hand, teachers’ educational practices are a critical skill area, thus they should be trained and supported in order to develop successful strategies to promote positive relationships. It seems that there are mutual influences between personal and professional contexts that can contribute to teachers’ adjustment and wellbeing, and even more demanding tasks for female teachers.
In order to better understand this aspect, we performed a cross-sectional study to assess the relationship between emotional adjustment, occupational stress and educational practices used by female teachers. A sample of 505 Portuguese female teachers, of elementary, middle and high public schools filled the Cuestionario Burnout Profesorado – Revisado – CBP-R (Moreno-Jiménez, Hernandez & Guitierrez, 2000, European Portuguese version Patrão, Santos-Rita & Maroco, 2011), the Depression and Anxiety Scale EADS-21 (Lovibond &Lovibond, 1995, European Portuguese version Pais-Ribeiro, Honrado & Leal, 2004) and the Educational Practices and Relationship Management Questionnaire for Teachers (Santos-Rita & Patrão, 2009).
The results indicate high levels of burnout, experienced by teachers suffering from high levels of depression and/or anxiety. Educational practices revealed to be inadequate, emphasizing a decreased wellbeing and less satisfactory relationships with colleagues, students and families. It will be important to develop intervention programs to promote individual and organizational skills, focusing on health behavioral change and healthy lifestyles, adopting an integrated comprehensive approach, though Occupational Health Medicine.
Keywords: stress, occupational health, women's health
CORRESPONDING AUTHOR: Santos-Rita Joana, ESTESL, Lisbon; jmrita@estesl.ipl.pt
P19
GENDER RELATED DIFFERENCES IN PREDICTING HEALTH RELATED BEHAVIOUR: LITHUANIAN STUDY
Jarašiūnaitė G.1, Riklikienė O.2, Miškinis K.3
1 Vytautas Magnus university, Department of Psychology, Kaunas, Lithuania
2 Lithuanian University of Health Sciences, Department of Nursing, Kaunas, Lithuania
3 National Health Insurance Fund under the MoH, Strategy Department, Vilnius, Lithuania
Research studies show the difference between gender and health related behaviour. It is said that man engage in more risky and health adverse behaviours, while woman engage in more preventive behaviours, as well as more treatment seeking and self-care for illness (Verbrugge 1985; Gochman, 1997, Williams, 2003). Some of the findings support the gender role self-concept related with masculinity and weaker gender perceptions on health related behaviour (Waldron, 1988; George, Östlin, 2002; Fleming et al, 2000; Williams, 2003). Other studies indicate factors related with health literacy. It is said that men are less knowledgeable about health in general, specific diseases and their risk factors then woman (Courtenay, 2000); less able or likely to access, interpret and apply information to maintain and improve health (Galdas et al, 2005) and exhibit low levels of health literacy even about male-specific health issues (Singleton, 2008).
According to Lithuanian statistics on 2005, more women were vaccinated from influenza; blood pressure was also measured more often to women than men. After being diagnosed with higher blood pressure women (43.8%) were more likely to change their lifestyle than men (30.9%), equally more woman (88.7%) than man (76.6%) used medications in case to lower their blood pressure.
On 2011 representative survey of 1068 Lithuanian residents (495 men and 573 women, aged 18 and above)about health care system in Lithuania also revealed several important aspects about gender related differences in predicting health related behaviour. Women knew about 5 preventive programmes financed by national compulsory health insurance system better than men who kept preventive programs as waste of time. There were significant gender related differences in responsibility for personal health between men and women; knowledge about generic and branded medicines, and about compulsory health insurance policy was also better in women.
Keywords: gender, health behaviors
CORRESPONDING AUTHOR: Jarašiūnaitė Gabija, Vytautas Magnus University; gabija.jarasiunaite@gmail.com
P20
WHY ARE OLDER ADULTS ADJUSTED TO AGING? VALIDATION OF THE ADJUSTMENT TO AGING SCHEDULE (ATAS-33)
Von Humboldt S., Leal I.
Instituto Superior Psicologia Aplicada, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: There has been little attention in the research literature on adjustment to aging. This research aims at examining the relationships between older adults’ adjustment and aging.
Methods: The measures used to in the study were selected to assess the reliability and validity of one new instrument, Adjustment to Aging Schedule (ATAS-33). Measures were completed using a variety of culturally appropriate methods, including mail-outs, self-administration and interviews. For the purposes of this study, the Health Survey Questionnaire (SF-6D), one measure of cognitive functioning - the Mini-Mental State Examination (MMSE) and demographics, were included. All variables had less than 1% missing values and there complete data were available for 709 older adults (mean age 82.4, SD = 6.45, (range 74-102)) from eight different nationalities. Exploratory factor analyses were run for data reduction and for exploring theoretical structure. Controlling for age, gender and country of origin, we assessed the level of adjustment of elderly people, and its effect on aging.
Results: The sampling adequacy was confirmed by the Kaiser-Meyer-Olkin test (KMO = 0.775) and the total variance explained by this eight-factor structure is 75.09%. Adjustment to aging appears to be a catalyst to attitudinal markers of maturity and internal development which in turn impact quality of life and aging, across cultures. All estimates were statistically significant (p < .01).
Conclusions: This cross-cultural study illuminates links among adjustment and aging in older age, warranting further study across cultures among frailer populations over time. Recommendations for future research on older adults' adjustment and clinical practice are also presented.
Keywords: aging; geriatrics; health promotion; older adults; research methods
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon; sofia.humboldt@gmail.com
P21
ADJUSTMENT TO AGING AND SUBJECTIVE AGE IN PORTUGAL AND ROMANIA: A COMPARATIVE MULTIPLE CORRESPONDENCE ANALYSIS FOR LATENT CONSTRUCTS
Von Humboldt S., Leal I.
Instituto Superior Psicologia Aplicada, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: To analyze the determinants of adjustment to aging (AtA) and subjective age (SA) identified by older adults and to investigate the differences of latent constructs that can work as major determinants in AtA and SA in an older Portuguese and Romanian population.
Methods: Measures were completed, including demographics and interviews. Complete data were available for 38 older adults aged between 74-90 years (M = 80.6; SD = 5.4), from Portugal and Romenia. Data was subjected to content analysis. Representation of the associations and latent constructs were analyzed by a Multiple Correspondence Analysis (MCA).
Results: The most prevalent response of the interviewed participants for determinants to AtA was ‘health status, physical and intellectual functioning’ (18.1%). ‘With apprehension’ and ‘good enough’ (both 27.0%) were identified as the most frequent SA responses. Findings showed a model for each nationality. AtA and SA for Portuguese elderly were explained by a three-factor model: ‘regardful’, ‘engaged’ and ‘conciliated’. A three-dimension model formed by ‘perseverant’, ‘congruent’ and ‘enjoyers’ was indicated as a best-fit solution for Romanian elderly.
Conclusions: AtA and SA are strongly explained by increased likelihood of specific constructs in its definition. AtA is related to SA in older adults in both countries, although in different degree.
Keywords: aging; geriatrics; health; older adults; quality of life
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon; sofia.humboldt@gmail.com
P22
THE IMPACT OF PERSON-CENTERED THERAPY ON OLDER ADULTS’ SELF-ESTEEM AND CONGRUENCE
Von Humboldt S., Leal I.
Instituto Superior Psicologia Aplicada, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: The increase of older adults in the population has emphasized the need for consideration of what it takes to live this phase of life with a sense of quality and satisfaction. This research aims at evaluating how person-centered therapy (‘PCT’) facilitates the degree of self-esteem and congruence of older adults.
Methods: Information was gathered by a research tool composed of three parts: (a) a demographic questionnaire and (b) the Self-Esteem Scale (‘SES’) and (c) one measure of cognitive functioning - the Mini-Mental State Examination (MMSE). The research sample comprised 40 elderly people between the ages of 65-93, from both genders, who completed eight sessions of PCT. All variables had less than 1% missing values.
Results: After the therapeutic process, results indicated an increase of the participants’ degree of self-esteem. It was verified a positive effect of PCT on older adults’ self-esteem, which was achieved by an increase of their congruence level.
Conclusions: Interventions with older adults may benefit from clearly understanding self-esteem as an important component for promoting successful aging and reducing health disparities. Recommendations for future research on older adults’ PCT impact on self-esteem, as well as suggestions for PCT with older adults are also presented.
Keywords: aging; geriatrics; health; health promotion; older adults
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon; sofia.humboldt@gmail.com
P23
A PILOT STUDY OF THE BENEFITS OF TRADITIONAL AND MINDFUL COMMUNITY GARDENING FOR HEALTHY AGING AMONG URBAN OLDER ADULTS
Okvat HA.1, Okun MA.2, Davis MC.2, Zautra AJ.2, Knopf RC.3
1 VA Boston Healthcare System, Behavioral Medicine, Boston, USA
2 Arizona State University, Department of Psychology, Tempe, AZ, USA
3 Arizona State University, Osher Lifelong Learning Institute, School of Community Resources and Development, Phoenix, USA
Healthy aging has been conceptualized as staying cognitively, physically, and socially active. As the population of older adults and the percentage of people living in urban areas are both increasing, it is important to find ways to promote city-dwelling, older adults’ cognitive vitality, physical activity, and social integration. Based on empirical review of the benefits of gardening, community gardening was conceptualized as a parsimonious intervention to promote all three aspects of healthy aging.
The present study was a pilot study to examine the feasibility of conducting a randomized, controlled trial of community gardening and to provide an initial assessment of a new intervention—“Mindful Community Gardening,” or mindfulness training in the context of gardening. In addition, this study examined through quantitative and qualitative methods whether community gardening, with or without mindfulness training, enhanced various endpoints associated with subjective well-being.
Fifty community-dwelling adults between the ages of 55 and 79 were randomly assigned to one of three groups: Traditional Community Gardening (TCG), Mindful Community Gardening (MCG), or Wait-List Control. The TCG and MCG arms each consisted of two groups of 7 to 10 participants meeting weekly for nine weeks. TCG involved typical gardening activities undertaken collaboratively. MCG involved the same, but with the addition of guided development of non-judgmental, present-focused awareness.
It was found that it is feasible to conduct randomized, controlled trials of community gardening with urban older adults. There was a statistically significant increase in two different aspects of mindfulness for the TCG and the MCG arms. The interventions did not measurably impact other quantitative outcomes in this small, high functioning, pilot sample. Qualitative analysis of interview data from 12 participants in the TCG and MCG groups revealed that participants in both groups perceived multiple benefits from their involvement in this community intervention, including improved mood, relaxation, increased physical activity, social support, and generativity. Lessons from this pilot study are reviewed for future research and practice using similar interventions to promote healthy aging.
Keywords: aging, community intervention, health promotion, mindfulness, mood, older adults, quality of life, resilience, social support
CORRESPONDING AUTHOR: Okvat Heather, VA Boston Healthcare System; heather.okvat@asu.edu
P24
ARE ELDERLY PEOPLE LIVING ALONE OR LIVING WITH A SPOUSE AT AN INCREASED RISK FOR CERTIFICATION OF LONG-TERM CARE NEED IN JAPAN?
Saito E.1, Kaneko C.2, Ueki S.3, Yasumura S.2
1 Tokyo Metropolitan University, Department of Nursing Sciences, Tokyo, Japan
2 Fukushima Medical University, Faculty of Medicine, Fukushima, Japan
3 Tohoku Bunka Gakuen University, Faculty of Health and Social Services, Sendai, Japan
Purpose: In recent years, major changes in living arrangements have occurred in Japan. For example, from 1985 to 2005, the number of elderly people living alone increased from 1.18 million people to 3.87 million people. This tendency is continuing and according to estimated figures, the total number of elderly people living alone will reach 7.17 million in 2030. The purpose of this population-based cohort study was to compare the risk for certification of long-term care need in elderly people living alone with the risk among elderly people living with a spouse only.
Methods: Subjects were 185 elderly people (aged 70 years and older) living alone or living with their spouse who participated in a health examination in a rural area of Japan in 2004. The number of elderly people who received certification of long-term care need was observed over a 5-year period.
Results: Among the 185 subjects, there were 32 new certifications (17.3%) during the observation period. The number of certifications of long-term care need among subjects aged 80 years and older was significantly higher than that among subjects aged 79 years and younger. The number of certifications of long-term care need among men was not significantly different from the number among women. Over the 5-year period, significantly more elderly people living alone received certification (14/54, 25.9%) than elderly people living with a spouse only (18/131, 13.7%) (p = 0.04). According to Cox regression analysis adjusted for age, there was no statistically significant difference in the number of certifications of long-term care need between elderly people living alone and living with a spouse only (95% confidence interval, 0.6 to 2.6; p = 0.58).
Conclusion: The problems faced by elderly people are the result of not only aging and physical independence, but also living arrangements and social activities. Therefore, a diverse range of lifestyles must be examined. Furthermore, there is a need for variation in services based on difference in living arrangements.
Keywords: aging, family, longitudinal research
CORRESPONDING AUTHOR: Saito Emiko, Tokyo Metropolitan University; saito@hs.tmu.ac.jp
P26
THE EFFECTS OF RELIGION IN QUALITY OF LIFE OF AN INTERNATIONAL SAMPLE OF ELDERLY
Costa C.
Instituto Superior Psicologia Aplicada, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Aims: The aging process requires the individual’s adaptation to resulting losses and changes. In old age, individuals might search for existential meaning, through religion. Moreover, there is a need to collect empirical data to understand the contribution of religion in the adaptation of elderly to aging. This study aims at examining the relevance of religion for the elderly and at analyzing how different religions may be relevant to the quality of life (QoL) of elderly people.
Methods: The sample comprised 118 participants over 74 years old, from eight different nationalities, including Portuguese, German, English and Romanian; with no psychiatric disorders. For the purposes of this study, the Assessment of Gains in Health Scale (SF-6D), one measure of cognitive functioning - the Mini-Mental State Examination (MMSE) and demographics, were included.
Results: Findings indicated that QoL score was higher for taoist participants (
= 5.3), followed by protestants (
= 4.9), when compared to participants without religious beliefs (
= 4.1). German participants indicated a higher QdV score (
= 5.3) whilst Romanian showed the lowest QdV score (
= 3.9). There was no association found between QoL and religion or nationality.
Conclusions: This study makes a valuable contribution for the incorporation of religion as an intervenient in QoL in old age, enlightening its contribution to healthy aging and behavioral strategies. Recommendations for future research on older adults’ QoLand clinical practice are also presented.
Keywords: Behavioral Strategies; Elderly, Health Promotion, Quality of Life, Religion
CORRESPONDING AUTHOR: Costa Catarina, ISPA, Lisboa; cat_s_costa@hotmail.com
P27
ASSESSING THE IMPACT OF RELIGION IN THE QUALITY OF LIFE OF AN OLDER POPULATION
Costa C.
Instituto Superior Psicologia Aplicada, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Aims: One of the motivations of human existence is linked to the search for meaning and value in life. In advanced age, elderly are affected by the end of life and death. These matters can be addressed through religion. Moreover, religion and spirituality are related to the physical and psychological well-being of elderly people. This study aims at assessing the association of religion to quality of life (QoL) and at analyzing the effects of religion on the six dimensions of quality of life: (i) Physical Functioning; (ii) Role Limitations; (iii) Social Functioning; (iv) Pain; (v) Mental Health and (vi) Vitality.
Methods: The sample comprised 118 people over 74 years, from eight different nationalities, with no psychiatric disorders. For the purposes of this study, the Assessment of Gains in Health Scale (SF-6D), one measure of cognitive functioning - the Mini-Mental State Examination (MMSE) and demographics, were included.
Results: Findings indicated that taoist participants showed the highest score for social function score (
= 6.0), whilst protestants showed the highest score for role limitations (
= 5.8). There were no association between religion and QoL.
Conclusions: Religion has proved to be a cross-cultural catalyst for personal investment, internal development and maturity. This study contributed to enlightening the relevance of religion to older adults’ QoL. Recommendations for future research and behavioral approaches on older adults’ QoLand clinical practice are also presented.
Keywords: Behavioral Approach, Elderly, Health Promotion, Quality of Life, Religion
CORRESPONDING AUTHOR: Costa Catarina, ISPA, Lisboa; cat_s_costa@hotmail.com
P28
DEVELOPMENTAL CHANGES OF BODY DYSMORPHIC CONCERN IN JAPANESE POPULATION: A CROSS-SECTIONAL WEB-BASED SURVEY
Tanaka M.1, Tayama J.2, Arimura T.3
1 Hirosaki University, Department of School Health Science, Faculty of Education, Hirosaki, Japan
2 Nagasaki University, Center for Health & Community Medicine, Nagasaki, Japan
3 Kyushu University, Department of Psychosomatic Medicine, Fukuoka, Japan
Background: There have been many previous studies about body dysmorphic concern (BDC) in adolescent samples. However, little is known about BDC in middle and old ages. The purpose of this study was to investigate the developmental changes of BDC in Japanese population.
Methods: We conducted a cross-sectional web-based survey. Samples were collected from the database of Macromill INC in Japan. This database has over one million registrants who were individual respectively. Participants agreed to this survey were 2060 individuals (male = 1030, female = 1030) ranging from 20 to 69 years of age. They filled out the questions about their demographic features and the Japanese version of Body Image Concern Inventory (J-BICI). J-BICI has three subscales and assesses the behavioral and cognitive aspects of BDC. These subscales were as follows; Safety Behavior for one’s own appearance flaws (SB), Avoidant Behavior from one’s own appearance flaws (AB), and Negative Evaluation for one’s own appearance (NE). The same number of participants were assigned to the age (20s, 30s, 40s, 50s, and 60s) and sex (male and female) conditions. To examine the effects of age, sex, and age-sex interaction on BDC, we performed two-way analysis of variance (ANOVA) with the scores of J-BICI subscales and total as dependent variables.
Results: The results showed that there was significant main effect of age (F 4,2050 = 58.28; p < .001), sex (F 1,2050 = 456.04; p < .001) and interaction (F 4,2050 = 6.32; p < .001) on the score of SB. The simple main effect of age was significant in the sex condition (p < .001). The simple main effect of sex was also significant in the age condition (p < .001). On the score of AB, there was significant main effect of age (F 4,2050 = 30.29; p < .001) and sex (F 1,2050 = 33.58; p < .001). There was also significant main effect of age (F 4,2050 = 60.00; p < .001) and sex (F 1,2050 = 235.25; p < .001) on the score of NE. However, there was no significant interaction in both AB (F 4,2050 = 1.38; p = .238) and NE (F 4,2050 = 1.51; p = .196). In addition, there was significant main effect of age (F4,2050 = 66.47; p < .001), sex (F 1,2050 = 281.45; p < .001), and interaction (F 4,2050 = 2.81; p < .05) on the total score of J-BICI. Both the simple main effect of age in the sex condition and the simple main effect of sex in the age condition were significant (p < .001). Post hoc analysis revealed that there were tendencies that BDC in young ages (20s and 30s) were higher than middle and old ones (40s, 50s and 60s) in both male and female and that BDC in female were higher than male in all ages.
Conclusion: These findings suggested that it might be possible that the conditions of being young ages and female were the risk factors for high BDC in Japanese populations. In the future, we need to clarify the age-specific body areas of excessive dysmorphic concern.
Keywords: Aging, Culture, Internet, Mental health
CORRESPONDING AUTHOR: Masanori Tanaka, Hirosaki University, Japan; m-tnk@cc.hirosaki-u.ac.jp
P29
IS MEDICALLY-CERTIFIED SICKNESS ABSENCE RELATED TO A LONG-TERM REDUCTION OF PHYSICAL HEALTH FUNCTIONING? AN 18-YEAR FOLLOW-UP IN THE WHITEHALL II STUDY
Westerlund H.1, Chungkham HS.1, Kivimäki M.2, Head J.2
1 Stockholm University, Stress Research Institute, Stockholm, Sweden
2 University College London, Department of Epidemiology and Public Health, London, United Kingdom
Background: Medically-certified sickness absence is a marker of increased risk for disability pension and pre-mature mortality, but the extent to which sickness absence predicts future health functioning remains unclear.
Objectives: To examine if sickness absence is related to limitations in physical health functioning over the long-term.
Methods: Sickness absence records of 5,070 civil servants participating in the Whitehall II study were collected for a 3-year period preceding a questionnaire survey in 1991-1993. Surveys on functioning were repeated every 2-3 years up to 2007-2009. Presence of longstanding illness at baseline was assessed by a survey question about diagnosed diseases. Growth curve models of the trajectories of SF-36 physical health functioning were fitted using mixed modelling over the 18-year period for older and younger men and women separately.
Results: On average, physical functioning deteriorated over time, especially after the age of 70. Physical health functioning was substantially lower in the participants who had taken two or more medically certified (>7 days) sickness absences during the 3-year period compared with those who hade taken none, and this was seen in both younger and older women and men. This difference remained virtually unchanged during the whole 18-year follow-up, and was comparable to the difference between participants with and without longstanding illness. Participants who had taken one medically-certified absence had a somewhat lower physical functioning throughout the follow-up compared with those who had taken none.
Conclusion: Lower physical health functioning among employees who take medically-certified sickness absence persists over a long time period. This could contribute the link between sickness absence, future ill-health, disability pension, and mortality. In addition, the results indicate that repeated medically-certified sickness absence, which is often readily available in medical and company records, is a viable marker for the identification of individuals at high risk of long-term poor health functioning.
Keywords: aging health
CORRESPONDING AUTHOR: Westerlund Hugo, Stockholm University, Stockholm; hugo.westerlund@stress.su.se
P30
WORK STRESS IS ASSOCIATED WITH DIABETES AND PRE-DIABETES IN GERMAN INDUSTRIAL MALE WORKERS
Li J.1, Jarczok MN.1, Loerbroks A.1, Schoellgen I.1, Siegrist J.2, Bosch JA.3, Mauss D.4, Fischer JE.1
1 Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
2 University of Duesseldorf, Department of Medical Sociology, Duesseldorf, Germany
3 University of Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands
4 Allianz Germany, Department of Occupational Medicine, Munich, Germany
Objectives: The relationship between work stress and cardiovascular disease is well-established. However, it is not clear whether psychosocial stress in workplace is related to diabetes or not. The aim of the study was to examine the association of work stress with diabetes and pre-diabetes in a sample of German industrial workers.
Methods: In this cross-sectional occupational study (N = 2674, 77% male), work stress was measured by the effort-reward imbalance questionnaire, diabetes and pre-diabetes were diagnosed by glycated hemoglobin A1c criterion or fasting plasma glucose criterion supplemented by self-reports.
Results: The overall prevalence rates of diabetes and pre-diabetes were 3.5% and 42.2%, respectively. After adjusting for numerous potential confounding factors, effort-reward imbalance at work was associated with diabetes (OR 1.30 (95%CI 1.08-1.56)) and pre-diabetes (OR 1.26 (95%CI 1.04-1.52)) in men, whereas the effects in women were somewhat less strong and did not reach statistical significance.
Conclusions: The findings indicate that work stress in terms of effort-reward imbalance is associated with diabetes and pre-diabetes in German industrial male workers. If supported by prospective evidence, results point to a new approach towards primary prevention of diabetes.
Keywords: Worksite health; Stress; Diabetes
CORRESPONDING AUTHOR: Li Jian, Heidelberg University, Germany; lijian1974@hotmail.com
P31
THE WORK ABILITY AND THE EXECUTIVE COGNITIVE FUNCTION: AN EMPIRICAL STUDY WITH A NURSES PORTUGUESE SAMPLE
Costa JC., Santos IM., Almeida HA., Silva CS.
University of Aveiro, Department of Education, Aveiro, Portugal
Executive functioning (EF) refers to the set of neurocognitive processes that facilitate novel problem solving, modification of behavior in response to environmental changes, planning and generating strategies for complex actions. All these skills are important to purposeful and goal-directed behavior as determinants dimensions in the work ability process. So, this raise the possibility that the integrity of these cognitive abilities could have a significant impact in subject’s working performance (work ability), as well as they can be a determinant factor in his career success. In this sense, the aim of this study was to analyse the impact of the deterioration of planning and abstract reasoning’s in work ability. With a sample of 71 nurses (mean age 39 years, 21% male and 79% female), it was administered the Portuguese version of Work Ability Index, the Halstead Category Test (HCT) (a well-established neuropsychological measure that assess multiple domains of non-verbal abstract reasoning) and the Tower of Hanoi (TH), (a well-established neuropsychological measure that assess the abilities of problem-solving and planning). Considering the analysis of the results, we found that the work ability index showed a significant negative correlation with the measure of preservation of HCT (r = .-345, p < 0.01) and the total number errors (r = .-2,90, p < 0,05). Concerning the TH, the work ability index showed a significant negative correlation regarding the timing of completion of the test (r = .-2,55 p < 0.05). This way, these results may suggest that the decline of executive cognitive functions, namely the ability to planning, problem-solving and abstract reasoning exert a detrimental effect in work ability. Our data emphasize the importance of developing and implementing programs and preventive strategies for health promotion in working setting, encompassing the subcomponents of executive cognitive functions, in order to contribute to a better development of the work ability.
Keywords: Work ability, Executive function, Abstract Reasoning
CORRESPONDING AUTHOR: Costa Jorge, University of Aveiro; jorgemcosta@ua.pt
P32
PREDICTORS OF WORK ABILITY AND QUALITY OF LIFE AMONG EMERGENCY MEDICINE EMPLOYEES IN CROATIA
Milosevic M.
University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Croatia, Department of Occupational and Environmental Medicine, Zagreb, Croatia
Aim: To examine predictors of work ability and quality of life among emergency medicine employees in Croatia.
Background: An important personnel management challenge is to explore factors that stimulate or hinder the development of individual work ability and quality of life throughout a career.
Methods: The study was performed from May 2010 to July 2010 in the Zagreb Institute of Emergency Medicine with 425 employees: 252 (59.3%) medical staff (91 EP’s, 158 nurses/medical technicians and 3 laboratory engineers/technicians) and 173 (40.7%) non-medical: 122 drivers, 14 vehicle technicians, 2 tailors and 23 administrators. The self-administered questionnaire was used: assessed their work ability and their quality of life (QoL). Work ability was measured by the Work Ability Index (WAI) developed by the FIOH, and QoL by the Quality of Life questionnaire (WHOQL-BREF) developed by the WHO. 125 people (39 emergency physicians, 38 nurses/medical technicians and 48 drivers) returned completed questionnaires, giving a response rate of around 30%.
Results: Binary logistic regression assessed the impact of various factors on the likelihood that participants had a poor WAI score (WAI < 37) and included 16 independent variables (occupation, gender, WHOQOL-BREF domains, occupational stress factors, work experience and marriage). The full model containing all predictors was statistically significant (N = 125, X2 = 81.3 p < 0,001) indicating that the model was able to identify participants who had a poor work ability. The model as a whole explained between 47.8% (Cox and Snell R2) and 73.8% (Nagelkerke R2) of the variance in work ability status and correctly classified 92.0% of cases. The participants who had a lower score in the physical domain were 1.64 (1/0.78) times more likely to have a poor WAI and participants who had more professional and intellectual demands were 1.09 times more likely to have a poor WAI, when all other factors were controlled for in the model.
Conclusions: Similar studies have found the opposite effect: with high intellectual demands stimulating the employee to perform better. Thus, better work organisation and swifter implementation of the new EM residency programme is needed.
Keywords: emergency medicine, quality of life, work ability, work organization
CORRESPONDING AUTHOR: Mustajbegovic Jadranka, University of Zagreb, Zagreb; jmustajb@snz.hr
P33
THE EMOTIONAL IMPACT OF DIFFICULT CONVERTATIONS WITH PATIENTS: A STUDY WITH STUDENTS AND PHYSIOTHERAPISTS
Grilo AM., Gomes AI.
Instituto Politécnico do Lisboa, Department of Social Sciences and Humanities, Lisbon, Portugal
Introduction: Helpful physiotherapists do not simply dispense services, but provide them in a manner that reflects patient’s needs and understanding of his disease or disability (Darragh, Almquist & Krook, 2000). In fact, communication with the patient should occupy a prominent place in rehabilitation, but some results indicate that physiotherapists encounter many challenging conversations during their everyday work (Gard, Gyllensten, Salford & Ekdahl, 2000). Yet, health schools curriculum offers few means to prepare them for difficult situations. The aim of this work is to identify students’ and physiotherapists’ anxiety levels in difficult communications situations.
Methods: The study involved 60 2nd year students and 60 4th year students of physiotherapy from School of Health Technology in Portugal and 60 Portuguese physiotherapists. Data were collected through videotaped different scenarios representing problematic situations within the physiotherapist-patient interaction. These situations were related to specific assertive communication themes, like handling emotional expression, making requests, answering questions/requests, giving criticism and receiving criticism. Subjects have to answer in direct speech to the simulated patient in the video and then filled out a six-point Likert scale, focused on the students` and the physicians` perception of their anxiety.
Results: The results shows that there are significant differences between the perception of anxiety levels of the three groups in each of the six assertive themes. It tends to be higher in the groups of students (2nd and 4th years) than in the group of professionals. Thus, 2nd year students are those with higher levels of anxiety and the group of physiotherapists seems to have lower scores. Comparing the levels of perceived anxiety triggered by the different assertive themes, it appears that answer the question/ request is the one that triggers higher for the three groups of subjects, followed by the themes of emotionality, i.e, emotional expression in deficit and excessive emotional expression.
Discussion: These results should be considered in designing training programs for communication skills in pre-and post-graduate educational request.
Keywords: Anxiety, Rehabilitation, Emotions
CORRESPONDING AUTHOR: Grilo Ana, Instituto Politecnico. Lisbon; ana.grilo@estesl.ipl.pt
P34
ETHICAL DILEMMAS OF JAPANESE PSYCHIATRIC NURSES
Urakawa K.1, Yokoyama K.2, Hagi N.3
1 Mie University, Department of Stress Science, Graduate School of Medicine, Tsu, Mie, Japan
2 Juntendo University, Faculty of Medicine, Department of Epidemiology and Environmental Medicine, Tokyo, Japan
3 Yokkaichi Nursing and Medical Care University, Department of Psychiaric Nursing, Yokkaichi, Mie, Japan
According to the Japanese Nursing Association (1997), the ethical dilemmas that nurses encountered in their daily nursing practice included problems related to relationships with physicians, providing information to patients, problems between nurses, and imbalances in the abilities of nurses and the difficulty of their duties. However, there have been few studies evaluating ethical dilemmas in psychiatric nursing area.
In the study presented here, we investigated ethical dilemma faced by Japanese psychiatric nurses in two mental hospitals in Mie prefecture, by means of a postal questionnaire survey. The questionnaire included the item “conflict due to the relationship between nurses and physicians,” in addition to items regarding the four areas of clinical ethics developed by Jonsen et al. (treatment, self-determination, quality of life, and circumstances of the patients). A total of 284 nurses were asked to anonymously report the presence or absence of a dilemma for the above five items, and to give a detailed explanation by free comments. Eighteen-three nurses completed the form (29.2% of recovery). Survey period was February and March, 2004.
Forty-three nurses (51.8%) reported that they had a dilemma, whereas 22 (24.1%) had no dilemma; the remaining 11 nurses said “I do not know.” Thirty-eight nurses (45.8%) answered they had a sense of value and belief, while 31 (37.3%) answered they did not have; 14 (16.9%) did not answer. A sense of value and belief was significantly associated with the occurrence of dilemmas (p < 0.001, chi-square test). A qualitative analysis of free comments showed that ethical dilemmas were roughly divided into the following four categories: 1) compulsory care for patients, 2) circumstances in which family did not cooperate with them, 3) care in which individual patient’s need was ignored, and 4) care which had no consistency. These findings help to clarify the current states of difficulty of providing team nursing at psychiatric words in accordance with ethical problems.
Keywords: Ethical issues, Psychiatric nurses, Sense of value and belief, Self-determination
CORRESPONDING AUTHOR: Urakawa Kayoko, Mie University; adiemus@nurse.medic.mie-u.ac.jp
P35
IMBALANCE BETWEEN WORKING ENVIRONMENT AND FAMILY LIFE OF REGISTERED NURSES: A MULTILEVEL MODELING ANALYSIS
Holendro CH.1, Leineweber C.1, Tishelman C.2, Westerlund H.1, Lindqvist R.2
1 Stockholm University, Stress Research Institute, Stockholm, Sweden
2 Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. In Sweden, nursing staff is one of the occupational groups with the highest rates of long-term sickness absence. One way of dealing with the RN shortage is to keep staff healthy and willing to continue to work. This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict, a known risk factor for turnover and sickness absence. A multilevel model was fit with RN at the 1st, and department at the 2ndlevel using cross-sectional RN survey data from the Swedish portion of a 15-nation project (7982 women and 568 men from 369 hospital departments). We found that 6% of the variability in work-family conflict was on the department level, with 83% of the variability explainable by the nurse practice environment measured by aggregated ratings of: staffing adequacy, RNs involvement in hospital affairs, relationship with physicians, nursing quality of care, and leadership & support for nurses. Higher proportion of RNs in total nursing staff supporting nursing personal, staffing adequacy and involvement in hospital affairs were all significantly related to lower work-family conflict. Age, sex, length of work experience, and RNs’ self-reported job satisfaction accounted for 9% of the individual-level variance in the final parsimonious model. These results suggest that organizational factors related to the practice environment have significant impact on the risk of work-family conflict among RNs.
Keywords: work-family conflict, work environment factors, registered nurses, multilevel
CORRESPONDING AUTHOR: Chungkham Holendro Singh, Stress Research Institute; holendro.chungkham@stressforskning.su.se
P36
THE EFFORT-REWARD IMBALANCE MODEL AS PREDICTOR OF PORTUGUESE NURSES’ STRESS RESPONSES AND JOB ATTITUDES
Simães C.1, McIntyre T.2, McIntyre S.3, Silva M.4
1 University of Minho, School of Nursing, Braga, Portugal
2 University of Houston, Texas Institute for Measurement, Evaluation and Statistics (TIMES) & Department of Psychology, Houston, USA
3 University of Houston-Clear Lake, School of Human Sciences & Humanities, Houston, USA
4 University of Minho, School of Psychology, Braga, Portugal
Work-related stress among health professionals has been identified as an important health problem around the world, including Portugal. This study sought to test the variables of the Effort-Reward Imbalance model (ERI) as predictors of stress responses and organizational outcomes amongst Portuguese nurses. The role of overcommitment for work place health is also considered. The sample consists of 310 female hospital-based nurses, from the northern region of Portugal (Age: M = 33.83; SD = 8.70). Measures were a Socio-demographic and Professional Questionnaire, and the Portuguese versions of the Effort Reward Imbalance Inventory (ERI), to assess job effort and reward, effort-reward imbalance ratio and overcommitment; the General Health Questionnaire (GHQ-12) and the Brief Personal Survey-Revised (BPS-R), to measure stress responses; and the Organizational Climate Questionnaire (QuACO) to measure job attitudes regarding organizational climate. A subgroup of 59 nurses was also assessed using biological indicators of stress, i.e. salivary cortisol levels at the time of awakening (e.g. Ct(+0), Ct(+30), CAR, TMCR). Data from GHQ-12 revealed clinical levels of psychological distress in 75.8% of the total sample (2/3 cut off). The ERI model produced significant independent effects for both nurses’ stress responses (e.g. psychological distress, pressure overload) and job attitudes (e.g. global satisfaction with meetings and work environment). Overcommitment emerged as a significant moderator of the relationship between perceived occupational stress and nurses’ stress responses (e.g. pressure overload). It was also an important predictor of salivary cortisol measures: Ct(+0) (ß = .28) and TMCR (ß = .26). The total variance explained by all predictors and hierarchical tested models ranged from 3.5% to 29.0%. Results highlight the incidence of psychological distress in Portuguese nurses and point to the relevance of the ERI model variables in explaining stress responses and job attitudes in this context. Findings can guide intervention development to improve occupational health for women in the nursing profession.
Keywords: Occupational Stress, Hospital Nurses, ERI model
CORRESPONDING AUTHOR: Simães Clara, University of Minho, Braga; csimaes@ese.uminho.pt
P37
PERSONAL RESOURCES AND SUPPORT WHEN REGAINING THE ABILITY TO WORK – AN INTERVIEW STUDY WITH EXHAUSTION DISORDER PATIENTS
Norlund S.1, Fjellman-Wiklund A.2, Nordin M.1, Stenlund T.2, Ahlgren C.2
1 Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden
2 Umeå University, Department of Community Medicine and Rehabilitation, Umeå, Sweden
Objectives: The aim of this study was to explore experiences and thoughts in the process of returning to work in employed patients with Exhaustion Disorder, with focus on engagement and support.
Methods: Twelve patients with Exhaustion Disorder (burnout) who had been referred to a Stress Rehabilitation Clinic were interviewed. Grounded Theory was used as the qualitative method.
Results: A core category, regaining the ability to work, was developed. Alongside, two categories, internal resources and the external support system, were described as being important in the process. The internal resources were expressed through three key features (sub-categories), perceived validation, insights and adaptive coping skills. The external support system was diverse and described by the sub-categories practical/structural and/or emotional support. Four external actors were identified; the workplace, health care, the Social Insurance Agency, and the union. The supervisor was described as the most important external actor.
Conclusions: Internal and external resources are intertwined in the process of regaining the ability to work. The internal resources and external support can directly increase the probability to regain the ability to work. Moreover, these resources can affect each other and thus indirectly have an effect on the process.
Keywords: social support, coping, rehabilitation
CORRESPONDING AUTHOR: Sofia Norlund, Umeå University, Umeå; sofia.norlund@envmed.umu.se
P38
LONGITUDINAL EFFECTS OF WORK-FAMILY SPILLOVER: IMPACTS ON PSYCHOLOGICAL DISTRESS AMONG JAPANESE DUAL-EARNER COUPLES WITH PRESCHOOL CHILDREN
Shimada K.1, Shimazu A.1, Bakker AB.2, Demerouti E.3, Kawakami N.1
1 University of Tokyo, Mental Health, Tokyo, Japan
2 Erasmus University, Work and Organizational Psychology, Rotterdam, The Netherlands
3 Eindhoven University of Technology, Industrial Engineering & Innovation Sciences Human Performance Management Group, Eindhoven, The Netherlands
Introduction: Contemporary society has greater numbers of dual-earner couples and the need to keep balance between work and family roles is becoming an important issue. As existing studies in the field of occupational health mainly focus on negative side of spillover between work and family roles, there are few studies that examined the positive side of spillover. Moreover, few studies have investigated the long-term effects of work-family spillover. The purpose of the present study is to examine the effects of multiple types of work-family spillover on psychological distress using longitudinal data.
Methods: Out of 2,992 dual-earner parents with preschool children in Tokyo, who answered the baseline survey (T1), 1,638 agreed to participate in the one-year follow-up (T2). Valid responses were obtained by 928parents (416 males, 512 females; follow-up rate: 60.8%). Multiple regression analyses on T2 psychological distress were conducted by gender, whereby predictor variables (T1) such as, demographics, psychological distress, job demands/resources, family demands/resources, four dimensional work-family spillovers (work-to-family negative spillover, work-to-family positive spillover, family-to-work negative spillover, family-to-work positive spillover), were entered into the equation.
Results: Work-to-family negative spillover and psychological distress (T1) had positive impacts on psychological distress at T2 for males. Neither family-to-work negative spillover nor bidirectional positive spillovers had significant impacts for males. For females, family demands and psychological distress (T1) had positive impacts on the outcome, whereas family autonomy had a negative impact. However, neither negative nor positive spillovers had significant impacts for females.
Discussion: Among spillovers, only work-to-family negative spillover had significant positive impacts on psychological distress for males. Among females, none of four spillovers had impacts on psychological distress. Results reveal that factors having long-term impacts on psychological distress vary according to gender, which is to say, in order to improve psychological health, knowledge and skills to manage the interference of work with family are important for males and that those to reduce family demands and increase family autonomy are important for females.
Keywords: Health outcomes, Mental health, Public Health, Gender
CORRESPONDING AUTHOR: Shimada Kyoko, University of Tokyo, Tokyo; kshima@m.u-tokyo.ac.jp
P39
RELIABILITY AND VALIDITY OF THE JAPANESE-TRANSLATED SWEDISH DEMAND-CONTROL-SUPPORT QUESTIONNAIRE
Mase J., Ota A., Inoue K., Iida T., Ono Y.
Fujita Health university, Public Health, Toyoake, Japan
Objectives: Karasek’s Job Content Questionnaire (JCQ) is a self-administered instrument and has served as a de facto standard to assess psychosocial work environment according to the Demand-Control-Support (DCS) model. Meanwhile, the Demand-Control-Support Questionnaire (DCSQ) is used mainly in Scandinavian countries. The DCSQ uses frequency response format instead of agree-disagree with risk of acquiescence. We translated it into Japanese, i.e., the Japanese-translated version of the DCSQ (J-DCSQ), and investigated its reliability and validity.
Methods: The subjects were volunteer 212 women workers in 18 nursery schools in Japan. Psychological demands (PD: calculated with 5 items), decision latitude (DL: 6 items), and social support (SS: 6 items) were assessed with the J-DCSQ. One-week test-retest reliability and internal consistency were estimated by means of intra-class correlation coefficient (ICC), weighted kappa and Cronbach’s alpha, respectively. Concurrent validity was evaluated with Spearman’s correlation coefficient for which the Japanese-version JCQ (J-JCQ) was used as the reference. Factorial validity was evaluated with factor analysis.
Results: ICCs were 0.81, 0.82, and 0.80 for PD, DL, and SS, respectively. Weighted kappa were from 0.58 to 0.75. Correspondingly, Cronbach’s coefficient alphas (the mean inter-intra correlation) and Spearman’s correlation coefficients were 0.64 (0.27), 0.63 (0.22), 0.86 (0.50) and 0.74, 0.60, 0.59 for PD, DL, SS. Factor analysis suggested an uncorrelated 3-factor construction. The first factor included the complete set of SS items. The second factor was consisted of a combination of 3 PD and 2 DL items. The third factor was consisted of 2 DL items. The factor loadings of other 2 PD and 2 DL items were under 0.4.
Conclusions: The J-DCSQ exhibited as equivalent reliability as the J-JCQ. The present findings suggested adequate concurrent validity of the J-DCSQ. Factor analysis did not present factor structure of the J-DCSQ as theoretically hypothesized. Previous studies also reported similar factor structure of the J-JCQ as three subscales, PD, DL and SS. Further studies are needed to its validity. The J-DCSQ would become an alternative to J-JCQ with the risk of acquiescence.
Keywords: Stress, Occupational Health
CORRESPONDING AUTHOR: MASE Junji, Fujita Health University; mase@fujita-hu.ac.jp
P40
HEALTH INEQUALITIES AMONG JAPANESE WORKERS: JAPANESE STUDY OF HEALTH, OCCUPATION AND PSYCHOSOCIAL FACTOR
S RELATED EQUINITY (J-HOPE)
Tsutsumi A.1, Inoue A.2, Kurioka S.3, Miyaki K.4, Takahashi M.5, Shimazu A.6, Kosugi Y.7, Enta K.8, Eguchi H.9, Kawakami N.6
1 Kitasato University School of Medicine, Department of Public Health, Kanagawa, Japan
2 University of Occupational and Environmental Health, Department of Mental Health, Fukuoka, Japan
3 University of Occupational and Environmental Health, Department of Health Policy and Management, Fukuoka, Japan
4 National Center for Global Health and Medicine, Department of Clinical Research and Informatics, Tokyo, Japan
5 National Institute of Occupational Safety and Health, Health Administration and Psychosocial Factor Research Group, Kanagawa, Japan
6 The University of Tokyo Graduate School of Medicine, Department of Mental Health, Tokyo, Japan
7 Kosugi Health Management Office, -, Toyama, Japan
8 Health Care Center, Central Japan Railway Company, Shizuoka, Japan
9 Shinshu University School of Medicine, Department of Preventive Medicine and Public Health, Matsumoto, Japan
Aim: The analysis aims to describe the baseline characteristics of the study population of an ongoing five-wave panel study of Japanese workers to elucidate mechanisms underlying the social disparity in health.
Method: We analyzed 9848 workers aged 18-69 from 12 enterprises registered until the end of 2011. Job strain, effort-reward imbalance, organizational justice, social capital, work engagement, and psychological distress were evaluated, and stress-related biomarkers including IL-6, CRP, homocysteine, DHEA and cortisol were measured, in addition to conventional cardiovascular risk factors. Social class were categorized in terms of 3 relevant socioeconomic indices—occupation: manager, professional or technician and others including clerk, service, laborer, or non-classifiable; education: up to high school and college or more; income: up to \5000000 (annual household) and \5000000 or more. Morbidities were defined based on questionnaire and health examinations. We did sex-specific analyses adjusted for age.
Results: In men, upscale workers work longer than downscales, at all socioeconomic indices. Adverse psychosocial job characteristics, smoking and sedentary lifestyle were prevalent among downscales. Hypertension, dyslipidemia and current alcohol drinking were prevalent among less-educated men. However, diabetes, dyslipidemia and alcohol drinking were prevalent among higher-income men. IL-6 was higher among lower-income men. DHEA levels were higher among less-educated but higher-income men.
Same as men, upscale women of any indices work longer. Smoking and sedentary lifestyle were prevalent among downscales and less-educated workers were hypertensive. Women with lower occupational and educational classes were more obese than the respective counterparts. Dyslipidemia was prevalent among lower occupational class. Homocysteine levels were higher among downscale women. However, upscale women were more effort-reward imbalanced and higher occupational class women were psychologically distressed.
Conclusion: Morbidities including psychosocial job characteristics were unevenly distributed across socioeconomic strata among Japanese workers. Some unfavorable profiles were associated with upscale and the associations were different by socioeconomic indices and genders.
Keywords: Cardiovascular disease, Gender, Socio-economic status, Stress, Worksite health
CORRESPONDING AUTHOR: Tsutsumi Akizumi, UOEH, Japan; akizumi@kitasato-u.ac.jp
P41
PSYCHOSOCIAL WORK DIMENSIONS, EXPOSURE TO VIOLENCE, AND BURNOUT IN RELATION TO ATTITUDES TOWARDS THE USE OF FORCE AMONG SWEDISH PATROLLING POLICE OFFICERS
Karlson B.1, Larsson MR.1, Österberg K.2
1 Lund University, Psychology, Lund, Sweden
2 Lund University, -, Lund, Sweden
Introduction: Police work involves stressors specific to police work and to general organizational aspects of work. Some of the latter has previously been identified as risk factors for burnout, particularly to increased degree of the burnout sub-dimension cynicism. Cynicism has in turn been related to a positive attitude to the use of force to solve problems. In the present study the relationships between psychosocial work dimensions, exposure to threat and violence, burnout, and attitudes towards the use of force to solve problems were studied.
Methods: 509 patrolling policemen having worked as police officers 0-41 (Md = 4) years, participated in the study (50% response rate). They responded to a questionnaire measuring demographic variables, general psychosocial work dimensions (work load, control, community, reward, justice, and value conflicts) by Areas of Work Life Survey, exposure to threat or violence the last year, burnout by Maslach Burnout Inventory, and attitudes towards the use of force. Attitude was analysed as dependent variable with the other were block-wise entered into a regression analysis as predictor variables.
Results: In relation to an external reference group from the general population the police group reported lower degree of emotional exhaustion and cynicism and a higher sense of professional efficacy. They scored somewhat poorer than the reference group on the work dimensions of control, organizational justice and value conflict. In the regression analysis 17.2% of the variance (adjusted R 2) in the attitude variable was explained. All blocks of variables contributed significantly to R 2 change. The variables particularly contributing in the final model were: short tenure as police officer, a high work load, having been exposed to violence the last year, and higher degree of cynicism.
Conclusions: In spite of an overall favourably reported psychosocial work environment, and good well-being, high work load as well as cynicism was related to positive attitudes towards the use of force, which is in line with previous studies from other countries. In addition, exposure to violence and a relative short experience as police officer contributed to positive attitudes towards the use of force.
Keywords: attitudes, stress, risk factors
CORRESPONDING AUTHOR: Karlson Björn, Lund University, Lund; bjorn.karlson@psychology.lu.se
42
TREATMENT OF POSTTRAUMATIC STRESS DISORDER IN AMERICAN SOLDIERS
Melamed B G.1, Skip R.2
1 University of Hawaii, Department of Psychology, Honolulu, Hawaii, USA 2 University of Southern California, Department of Psychiatry and Mental Health, Santa Barbara, USA
Results of treatment of PTSD in soldiers who served in Iraq and Afghanistan will compare Virtual Reality and Prolonged Exposure therapies. In war, we face issues related to: Behavioral health issues; Traumatic brain injury; PTSD: Infectious disease: Toxic exposures: Nutritional changes: Medication side effects; Alcohol and drug abuses. In addition relationship to psychological consequences to survival issues and loss due to Home Violence as seen in family members immediately after World Trade Center disaster and 4 years later. The data revealed that PTSD was much lower than Depression. Depression did abate over time in families with dead relatives, however, family members were 60% likely to still show Clinical Depression. Alcoholism was related to race (African Americans) showed a greater tendency to drink after the event. Data on 99 subjects followed for 4 years found that those with lower Hope Scores and tendency to use Avoidance Coping led to more depression remaining at this time. There was greater similarity in responses to Hurricane Katrina to those who vicariously experienced World Trade Center, especially by repeated TV re-exposure. New research on US war veterans is needed to look at long term resilience and relationships between coping styles, PTSD and recovery from depression.
Keywords: violence, PTSD, war, World Trade Center, Hurricane Katrina
CORRESPONDING AUTHOR: Melamed Barbara, University of Hawaii; barbara@drmelamed.net
P43
VIRTUAL REALITY VERSUS PROLONGED EXPOSURE IN TREATING PTSD IN THE MILITARY
Melamed B G.
University of Hawaii, Department of Psychology, Honolulu, USA
The National Academy of Science (IOM) concluded that current research on the treatment of PTSD in U.S. veterans is inadequate to answer questions about interventions, settings, and lengths of treatment that are applicable. Peterson, et al. (Special Issue, 2011) and Otis et al. Special Issue, 2011) and the two articles on Virtual Reality and Telehealth (Rizzo et al., 2011; Stetz, et al 2011) provide empirical evidence for the efficacy of PE and Cognitive Processing. In PE patients are educated about the development and treatment of PTSD, are taught slow breathing techniques to promote relaxation, and practice imaginal and in vivo exposure to promote habituation to the feared trauma memory. CPT relies more on cognitive restructuring and emphasis on the individual creating impact statements about the trauma. Although PTSD patients typically avoid thoughts and situations that are reminders of the trauma, PE and CPT requires confrontation of trauma memories by having patients repeatedly tell the trauma story (imaginal/narrative exposure) and confront feared situations associated with the trauma (in vivo exposure) (Foa, et al., 2007). Yet the studies presented and those being conducted in the theater of war, suggest that once the war fighter is exposed and taught cognitive strategies in as few as 4–11 sessions they may re-enter the battlefield with more efficient functioning, a better chance of survival and less likelihood of developing PTSD. Once we understand the mechanisms underlying effective exposure (e.g., How much arousal needs to be evoked to have sufficient exposure?) we will be able to determine the application of Virtual Reality Exposure Therapy (VRET) and when it would be indicated. Currently the US Army is trying to make PYSD an injury rather than a disorder. Discussion focuses the advantages and disadvantages of this on DSMV and treatment costs, effectiveness and delivery agent.
References
Foa E. et al. (2007 Prolonged Exposure Therapy for PTSD. Therapist Guide: NY: Oxford Press.
INSTITUTE OF MEDICINE (IOM) 2007 Committee on Treatment of PTSD http://www.nap.edu/catalog/2007
Melamed, B.GSpecial Issue: Strengthening Our Soldiers (SOS) and Their Families: Contemporary Psychological Advances Applied to Wartime Problems. Journal of Clinical Psychology in Medical Settings: June 2011 18 (2).
Peterson et al. (2011) Assessment and Treatment of Combat-Related PTSD JCPMS 18 (2) 164-175.
Rizzo et al. (2011) Virtual Reality Goes to War. 176-188
Stetz et al. (2011) Technology Complementing Military Behavioral Health Efforts at Tripler Army Medical Center. JCPMS,v0l 18-2188-196.
Keywords: cognitive therapy, prolonged exposure, virtual reality
CORRESPONDING AUTHOR: Melamed Barbara, University of Hawaii; barbara@drmelamed.net
P44
FISH OIL FOR ATTENUATING POSTTRAUMATIC STRESS SYMPTOMS AMONG RESCUE WORKERS AFTER THE GREAT EAST JAPAN EARTHQUAKE: A RANDOMIZED CONTROLLED TRIAL
Nishi D.1, Koido Y.2, Nakaya N.3, Sone T.4, Noguchi H.5, Hamazaki K.6, Hamazaki T.7, Matsuoka Y.8
1 National Disaster Medical Center, Department of Psychiatry, Tokyo, Japan
2 National Disaster Medical Center, Head Office, Japan Disaster Medical Assistance Team, Tokyo, Japan
3 Kamakura Women’s University, Department of Nutrition and Dietetics, Kamakura, Japan
4 Tohoku Fukushi University, Department of Rehabilitation, Sendai, Japan
5 National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
6 University of Toyama, Department of Public Health, Toyama, Japan
7 University of Toyama, Department of Clinical Sciences, Toyama, Japan
8 National Center of Neurology and Psychiatry, Translational Medical Center, Tokyo, Japan
Background: The Great East Japan Earthquake left about 20,000 dead or missing. Previous studies showed rescue workers are at high risk for posttraumatic stress disorder (PTSD). This study aimed to determine whether fish oil supplementation could attenuate PTSD symptoms among rescue workers following the Great East Japan earthquake.
Methods: In this single-blind, randomized trial, rescue workers who provided consent to participate were randomly allocated to a fish oil plus psychoeducation group or a psychoeducation alone group. The primary outcome was PTSD symptoms assessed by the Impact of Event Scale-Revised (IES-R) at 12 weeks after fish oil supplements were shipped to the participants. All analyses were by intention to treat.
Results: Of the 172 participants enrolled between April 2 and 12, 2011, 86 were assigned to each of the two groups. Only 1 participant in the psychoeducation alone group was lost to follow-up. When adjusted for age, sex, and IES-R score at baseline, no significant difference in primary outcome was seen between the two groups (-0.9, 95% CI, -3.0 to 1.2; P = .39). Remarkably, change in the IES-R score of women in the two groups from baseline to 12 weeks was -3.9 (95% CI, -7.5 to -0.3; P = .04) when adjusted for age and IES-R scores at baseline.
Conclusions: This trial did not show the effectiveness of fish oil supplementation for the prevention of posttraumatic stress symptoms in rescue workers. However, supplementation reduced PTSD symptoms significantly in women. Fish oil may offer a safe strategy for preventing PTSD in women.
Keywords: Posttraumatic stress disorder, Fish oil, Omega-3 fatty acid, Prevention, Earthquake, Randomized controlled trial
CORRESPONDING AUTHOR: Nishi Daisuke, National Disaster Medical Center; d-nishi@umin.ac.jp
P45
PSYCHOMETRIC PROPERTIES OF THE WORLD HEALTH ORGANIZATION’S VIOLENCE AGAINST WOMEN INSTRUMENT IN A MALE AND FEMALE POPULATION-BASED SAMPLE IN SWEDEN
Nybergh L.1,2, Taft C.3,4, Krantz G.1,2
1Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
2The Västra Götaland Region Competence Centre on Domestic and Sexual violence, Gothenburg, Sweden
3Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
4The University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
Background: The World Health Organization’s Violence Against Women instrument (VAWI) assessing psychological, physical and sexual intimate partner violence (IPV) was developed to standardize methodologies and facilitate cross-cultural comparisons of exposure to violence. It has been used widely but few studies have investigated its psychometric properties. Furthermore, few studies have investigated such properties for instruments assessing IPV separately for women and men in randomized, population-based samples.
Aim: To explore the psychometric properties of the VAWI in a randomized cross-sectional study in a Swedish male (N = 399) and female (N = 573) population aged 18-65 years.
Methods: Internal reliability and validity were assessed by means of Cronbach’s alpha and principal components analysis (PCA). External validity was assessed by comparing exposure rates with published prevalence rates and with those obtained from a concurrently administered instrument (NorVold Abuse Questionnaire); moreover, a known group’s comparison was performed among the female sample.
Results: Cronbach’s alphas were satisfactory. For women, a pre-determined three-component solution largely corroborated the hypothesized three-component conceptual model of the VAWI. The instrument was able to discriminate between groups known from previous studies to differ in exposure to physical and/or sexual violence. Past-year prevalence of physical and sexual violence was similar to that reported in other Nordic studies; however, earlier-in-life prevalence was lower in the current study. For men, the PCA did not corroborate the hypothesized model and other constructs were found based on the severity of the violence items. Past-year prevalence of physical and sexual violence was higher than in other Nordic studies; earlier-in-life prevalence of physical violence was lower and sexual violence was higher. Reported exposure rates were higher than those obtained from the NorVold Abuse Questionnaire for both women and men.
Conclusions: The VAWI indicated good validity and internal reliability in a Swedish population. However, the underlying constructs seem to differ for women and men, which points to the need for research instruments assessing IPV to be validated separately in male and female samples.
Keywords: Gender, methodological issues
CORRESPONDING AUTHOR: Nybergh Lotta, Gothenburg University; lotta.nybergh@socmed.gu.se
P46
PRELIMINARY PSYCHOMETRIC PROPERTIES OF THE EXPERIENCES IN CLOSE RELATIONSHIPS—RELATIONSHIP STRUCTURES QUESTIONNAIRE IN TWO SPANISH SAMPLES
Almendros C.1, Carrobles J. A.1, Gamez-Guadix M.2, Garcia Sanchez R.1, Salazar N.1
1 Universidad Autonoma de Madrid, Biological and Health Psychology, Madrid, Spain
2 Universidad de Deusto, Clinical Psychology, Bilbao, Spain
The Experiences in Close Relationships - Relationship Structures Questionnaire (ECR-RS, Fraley, Heffernan, Vicary & Brumbaugh, 2011) was designed to assess two dimensions of attachment: avoidance and anxiety, in multiple contexts, deriving from the widely used Experiences in Close Relationships – Revised (Brennan, Clark & Shaver, 1998). The aim of this work was to examine the psychometric properties of the ECR-RS in Spanish women reporting over a partner relationship.
Two groups of women participated in this study. One was composed of 120 women victim of intimate partner violence (IPV), living on shelters or attending women assistance centers. Their mean age was 35.80 (SD = 11.18), they have been a mean time of 9.92 years (SD = 9.74) in the relationship and, for those who had left (90.6%), they had been out a mean time of 2.13 years (SD = 2.91). The second was made up of 112 women Spanish university students from the Community of Madrid. Their mean age was 23.98 (SD = 6.04). Mean time in the relationship was 3.71 years (SD = 4.86) and 38.4% of them had finished the relationship a mean time of 3.15 years (SD = 3.63) before. A cross-sectional design for obtaining data was used. Beside the ECR-RS, several instruments for the measurement of psychological abuse (Subtle and Overt Psychological Abuse Scale; SOPAS; Marshall, 1999), physical and sexual abuses (Revised Conflict Tactics Scales; CTS-2; Straus et al., 1996) and psychological distress (Brief Symptom Inventory; BSI; Derogatis, 1975) were used.
Results: A descriptive analysis of the items showed low item-total correlation values for items 4 and 10 of the original ECR-RS for the sample of women victims of IPV. Factorial analyses showed adequate indicators for the original factor structure. Both the avoidance and anxiety subscales showed appropriate internal consistency values, and both correlated with the different forms of abuse and psychological distress.
Conclusions: This study provides preliminary psychometric properties of the ECR-RS for Spanish population as applied to partner relationships and how attachment and abuse in partner relationships affect women’s health.
Keywords: Measurement; Women's health
CORRESPONDING AUTHOR: Almendros Carmen, Universidad Autónoma de Madrid; carmen.almendros@uam.es
P47
PSYCHOMETRIC PROPERTIES OF THE ENGLISH VERSION OF THE PSYCHOLOGICAL ABUSE EXERTED IN GROUPS SCALE (EAPA-G)
Rodríguez-Carballeira A.1, Almendros C. 2, Saldaña O.1, Martín-Peña J.1, Escartín J.1, Porrúa C.1, Varela-Rey A.1
1 Universidad de Barcelona, Social Psychology, Barcelona, Spain
2 Universidad Autonoma de Madrid, Biological and Health Psychology, Madrid, Spain
The aim of this work was to study the psychometric properties of the English version of the Escala de Abuso Psicológico Aplicado a Grupos (EAPA-G). This is a new instrument intended to assess the severity of implementation of various abusive strategies perpetrated by manipulative groups.
These strategies can be classified into six categories (Rodríguez-Carballeira et al., 2005): emotional abuse, isolation, manipulation and control of information, control of private life, indoctrination within an absolute and Manichean belief system, and imposing an exclusive/unique and extraordinary authority. The severity of each of the abusive strategies was evaluated through a Delphi study.
The first version of the EAPA-G was in Spanish and it was composed of 92 items on a 5-point Likert scale. Now there are English and Japanese versions and a reduced version of 52 items in the three languages.
Two samples, the first comprising 144 self-identified former members of various abusive groups, and the second comprising 206 students from a Southern University in the USA who were former members of a variety of non abusive groups, participated in the study. Participants responded to a battery of instruments that included the EAPA-G, the Group Psychological Abuse Scale (GPA; Chambers, Langone, Dole and Grice, 1994; Almendros, Carrobles, Rodríguez-Carballeira and Jansà, 2003), which is a preexisting scale to assess psychological abuse in manipulative groups, which is limited in contents to our view, and other instruments to assess the characteristics of the victims and their environment, the situation of victimization, and psychological distress.
The factorial structure, internal consistency, diagnostic validity, and discriminatory power of the English version of the EAPA-G were examined. The items analysis showed that the 52 items selected for the reduced version were appropriate. The factorial structure fits with the initial theoretical proposal. The scale seems to have adequate psychometric properties in terms of reliability and convergent validity with the GPA.
Therefore, the EAPA-G seems to be a useful instrument to measure psychological abuse perpetrated by manipulative groups. Assessing psychological abuse is important given its potential impact on the mental health of the people involved in these groups.
Keywords: Measurement; Assessment
CORRESPONDING AUTHOR: Almendros Carmen, Universidad Autónoma de Madrid; carmen.almendros@uam.es
P48
PTSD IN FEMALE VICTIMS OF GENDER VIOLENCE: IMPLICATIONS DEPENDING ON THE CIRCUMSTANCES OF ABUSE
Rivas-Diez R., Sánchez-López MP. Universidad Complutense de Madrid, Personalidad, Evaluación y Tratamientos Psicológicos II (Psicología Diferencial y del Trabajo), Madrid, Spain
Introduction: Violence gender has caused considerable social alarm. Better awareness of the characteristics and problems of the female victims is necessary to be able to provide adequate psychological attention.
Objectives: To identify the specific characteristics of PTSD in female victims of gender violence, stating what are the symptoms of this disorder are usually present, identify some of the most important variables that characterize women seeking assistance this problem (type of abuse, duration and frequency, if living with the abuser, etc.).
Methods: Participants: The sample consists of 97 Chilean battered women. These women attended to different Centers of Women (National Women´s Service) in various regions of the capital of Chile (Santiago).
Instruments: Semi-structured interview for victims of abuse: assesses sociodemographic characteristics of victims and circumstances of abuse, it was designed for this research. The PTSD Symptoms Severity Scale (Echeburúa et al., 1997): assesses the severity and intensity of the symptoms of this disorder according to the diagnostic criteria of the DSM-IV-TR (American Psychiatric Association, 2000) in victims of different traumatic events.
Results: 75.3% of the participants developed the PTSD disorder. The results show that the most typical symptoms of PTSD are: re-experiencing (the presence of unpleasant and recurring memories about the abuse and psychological and physiological distress on recalling the events); avoidance symptoms (avoidance of thoughts, feelings or conversations related to what has been experienced, loss of interest in significant activities and restriction of emotional life); and hyperactivation symptoms (permanent state of hypervigilance and startle response). The frequency and severity of the violence (not the duration of abuse) are the two variables referring to the situation in greater influence on the level of traumatic symptoms.
Conclusions: This data will be useful to understand the problems and consequences of abuse and to target interventions to be made to alleviate the plight of these women in cases where it appears PTSD.
Keywords: Women´s health, gender
CORRESPONDING AUTHOR: Rivas-Diez Raquel, Univ. Complutense de Madrid; rrivasdi@psi.ucm.es
P49
CONTINGENT CONDITIONS TO ENDING OF COUPLE’S VIOLENCE.
Mercado D., Santos CA.
National Autonomous University of Mexico, School of Psychology, Mexico City, Mexico
The couple’s violence is a public health issue, it is systematic, occurs in a long period and in conditions that suit its perpetuation. Some women are capable of getting away from this context, even though it could take them years to do so.
The objective of this study was to describe some of the contingent conditions for either separation or permanency into the couple’s violence. Twenty seven women volunteered, all with couple’s violence, they were already going to a support institution for domestic violence. Twenty of them were separated from the aggressor, 7 were still into the relationship. A semi-structured interview was applied.
Results: showed more terrorist violence in separated women and more situational violence in those that were not. When the violence started women did not reply violently, they tried to avoid it with several strategies, when they did not work was when they began to defend themselves violently, still some did not defend themselves. The ones that were separated were more defensive and had more non violent confrontation strategies. Eighteen percent had never tried to split, the rest had between 1 to 8 tries. The main reasons to separate were: intense violence, infidelity and drugs. The main reasons not to go out were: economic 34%, fear of dealing with life alone 25%, love 10%. In the group that remained in the relation 14% had learn to set limits. In contrast, when they split away temporarily, only 8% had economic disturbances but 65% because of reasons related to lost, missing, love and loneliness. They returned to the relationship because of the aggressors promises. Twenty four percent of them attributed violence to the, aggressive, overbearing and sexism characteristics to their partner, and 17% to drug addictions.
The perception of lack of success in avoiding violence and of a blurry future of the relationship was stronger in the separated women, and of being partially capable of avoiding violence and of being listened was higher in the ones that were not separated. Intensification of violence and lack of solution perspectives seem to be important for women’s take the decision of run out from couple violence. Formal psychological and legal support enhances woman’s empowerment to end with this public health problem.
Keywords: Public health, assessment, couple-focused, couple violence
CORRESPONDING AUTHOR: Mercado Dolores, National University of Mexico; doloresm@unam.mx
P50
EVALUATION OF THE THERAPEUTIC PROCESS OF WOMEN WITH COUPLE’S VIOLENCE
Mercado D., Salazar A. V., Viveros A. L.
National Autonomous University of Mexico, School of Psychology, Mexico City, Mexico
The purpose of this studio was to evaluate the process of psychological support therapy to women in violence situation offered by a government institution. The permanence of women in couple’s violence can be explained by cultural factors that adjudicate women the responsibility for the wellbeing of the family members, the submissive role to male authority, fear associated with separation, such as financial capability, not being able to come along with the family, to loneliness or the increase of violence, as well as psychological defenses such as negation or violence normalization. For a woman to get free from a couple’s violence situation she should change beliefs, behaviors and emotions that keep her inside and do not allow her to leave couple’s violence. This program is targeted to strengthen the women and help them to free from the violent situation.
Three hundred and two women volunteer which attended to a psychological support program for attention to couple’s violence victims, 56 were the first time they attended, 100 with from 2 to 4 sessions, 80 with 5 to 8 sessions, 66 with 9 to 13 sessions. The instrument “Feminine believes, behaviors and emotions towards couple’s violence” was used, it has 56 items that are responded by a Likert scale of 6 spaces from never to always. It evaluates believes, behaviors and emotions that hold back women from getting out of a violence situation, as well as an aspiration factor for a better life. It is a transversal design.
ANOVA produced, with exception of the factor Aspiration for a better life, significant effects with a p < 0.05 in the subscales of: Irrational Responsibility, Guilt, Submission, Dependency, Fear to change, Negation and Violence normalization, in all of the cases the significance was because the measures decreased as the number of sessions increased. This indicates the gradual response in getting rid of guilt beliefs, submission, dependency and fears related to the right of living violence free life. It is suggested that when the women looked for psychological help, they had already started the process to free themselves from violence. And that therapy support gave them those tools and strength to feel secure of their decisions they have taken and the ones they will take.
Keywords: Social support, Measurement, Health behavior, Quality of life
CORRESPONDING AUTHOR: Mercado Dolores, National University of Mexico; doloresm@unam.mx
P51
WORKING TOWARDS ENDING CHILD SEXUAL ABUSE: OPEN DOOR PROJECT
Zara A.
Istanbul Bilgi University , Department of Clinical Psychology, Istanbul, Turkey
The sexual violence is one of the major problem towards children in Turkish society where these issues involves many psychological, social and cultural factors which need to be assessed in order to be altered. The violence towards children in a society is not only the responsibility of the aggressors but also it is the responsibility of all individuals in that society. The society as a whole should recognise the violence problem and do something about it to prevent it happening. One of these prevention methods is to increase public awareness on violence and trauma towards children in order to develop appropriate and healthy attitudes in individuals. In order to achieve this, many mental health workers should be able to work together. Therefore, Istanbul Bilgi University Psychology students have set up the BILGI AÇIK KAPI (BAK) Group (www.bilgiacikkapi.com) as a project in order to:
1. Increase the public awareness on the effects of sexual violence on children,
2. Provide effective coping and problem solving information to hard-to-reach groups such as traumatised people,
3. Provide financial and professional support to NGO’s working towards ending sexual violence.
Keywords: Sexual abuse, mental health, prevention, PTSD, violence, trauma
CORRESPONDING AUTHOR: Zara Ayten , Bilgi University, Istanbul; aytenz@bilgi.edu.tr
P52
SLEEP DISORDERS AND PHYSICAL ABUSE: A NATION-WIDE REPRESENTATIVE STUDY IN HUNGARY
Győrffy ZS.1, Torzsa P.2, Sándor I.1, Csoboth CS.1, Novak M.1, Kopp M.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 Semmelweis University, Department of Family Medicine, Budapest, Hungary
Objectives: Violence against women is a serious abuse of basic human rights and has been declared a major public health concern. The relationship between physical abuse and physical and psychological symptoms is well-known, however data regarding the association between physical abuse and sleep disorders is limited.
Aim: To document the prevalence of reported abuse and investigate the association between physical abuse and insomnia among females.
Method: Cross-sectional analyses were conducted on the female sample (N = 6987) of the Hungarostudy 2002, a nation-wide representative survey. The survey contained sociodemographic questions and a Hungarian version of Athens Insomnia Scale (AIS). To analyze differences among physically abused and non-abused women, independent t-tests were used. Binary logistic regression was used to determine the association between physical abuse and sleep disorders.
Results: Physical abuse was found to be associated with sleep disorders. Abused women reported higher prevalence of sleep problems than non-abused women (p < 0,05). In the abused women’s group we found higher (>10) AIS scores and all of the items of AIS reported higher prevalence than non-abused women. Physical abuse was found to be associated with sleep disturbances (OR = 1,707), problems with staying asleep (OR = 1,552) and decrease of daytime performance (OR = 2,024) after controlling the effect of age, smoking, coffee consumption, presence of pain, shift work, depressive symptoms and healthcare utilization.
Conclusions: Women experiencing physical abuse have a significantly higher risk of sleep disorders. The relationship between physical abuse and insomnia deserves further investigation in order to determine the possible pathways of this association.
Keywords: Women's health, Sleep disorders
CORRESPONDING AUTHOR: Győrffy Zsuzsa, Semmelweis University, Budapest; gyorffy@chello.hu
P53
ATTITUDES AND PERCEPTIONS ASSOCIATED WITH REPORTED ALCOHOL IMPAIRED DRIVING AMONG YOUNG ADULTS IN ISRAEL
Bord S., Gesser-Edelsburg A., Baron-Epel O.
University of Haifa, School of Public Health, Haifa, Israel
Background: Alcohol impaired driving (AID) increases both the chance of being involved in a traffic accident, and the severity of the injury. The drivers' attitudes and perceptions towards AID have been shown in the literature to be associated with AID.
Objective: To identify attitudes and perceptions associated with reported driving after various quantities of alcohol consumed.
Methods: Data were collected between August and October 2010 from 610 internet users aged 19-35. The study questionnaire included socio-demographic data, attitudes and perceptions towards AID and self reported driving after various quantities of alcohol consumed: (a) reported driving after no alcohol consumed (b) reported driving after drinking 1-2 servings of alcoholic beverages (“Legal” AID) (c) reported driving after drinking 3-4 servings of alcoholic beverages ("Illegal” AID), and (d) reported driving after drinking 4 servings of alcoholic beverages or more (“Extreme” AID).
Results: Twenty five percent of the responders reported "Illegal" or "Extreme" AID. "Illegal" and "Extreme" AID were associated with age, where the older respondents (26-35) reported higher frequency of AID. In addition, perception of the punishment severity and perceived quality of driving were also associated with both "Illegal" and "Extreme" AID. Responders who reported "Illegal" or "Extreme" AID perceived the punishment severity and their quality of driving as higher. However, drivers' perception of the risk of being involved in an accident due to AID was associated only with "Illegal" AID. Drivers reported driving after drinking 0-2 alcoholic beverages perceived the risk as higher compared to drivers reported "Illegal" AID. Gender was only associated with "Extreme" AID, where men reported more "Extreme" AID compared with women.
Conclusions: Men reported a higher frequency of driving after drinking 4 servings of alcoholic beverages or more, however, driving after 2-3 servings was equally reported by men and women. The perception of the risk of being involved in an accident due to AID may only prevent those reporting "Illegal" AID, but not those reporting "Extreme" AID. These findings can help develop effective oriented intervention programs and mass media campaigns to reduce AID.
Keywords: Alcohol, Attitude(s), Risk perception
CORRESPONDING AUTHOR: Bord Shiran, University of Haifa, Haifa; shiranbord@gmail.com
P54
PRELIMINARY RESULTS FROM A COGNITIVE-BEHAVIOURAL TREATMENT OF ALCOHOL ABUSE: THE PAUSE PROJECT (PROJECT OF SELF MANAGEMENT)
Coriale G.1, Bilotta E.2, Cosimi F.1, Porrari R.1, De Rosa F.1, Ceccanti M.1
1 Sapienza University of Roma, Department of Clinical Medicine, Roma, Italy
2 Sapienza University of Roma, Department of Developmental and Social Psychology, Roma, Italy
Introduction: In the last decades big progresses have been made in the clinical use of Cognitive-Behavioural Therapy applied to alcohol abuse (Monti, 1999; Sibilia, 2001). CBT implies that excessive alcohol use is a maladaptive way of coping (Marlatt, 1985;Bandura 1986). Coping problems can be solved through a series of combined cognitive and behavioural interventions (Kadden, 1994). We conducted a randomized experimental study to test the efficacy of Cognitive-Behavioural Counselling (CBC) in reducing alcohol abuse and enhancing compliance compared to Motivational Enhancement Counselling (MEC).
Methods: Sample: Ninety three participants affected by current alcoholism were enrolled in the study. Participants were randomly assigned to two experimental conditions: CBC (N = 44; mean age: 47.6; s.d.: 10.3) and MEC (N = 48; mean age: 45.8; s.d.: 9.6). Participants were recruited from a 15-day inpatient alcohol program in the Alcohol Abuse Center of the Faculty of Medicine, Sapienza University of Rome, Italy.
Measures: A questionnaire containing the Lifetime Drinking History-L.D.H. (Skinner & Sheu, 1982) and Time Line Follow Back –T.L.F.B. (Sobell & Sobell, 1992) were used to assess alcohol consumption from the first year of regular drinking to the present and specific amounts of alcohol use in the last month before enrolling in the rehabilitation program.
Data Analyses: The Kaplan-Meier curve was calculated to observe the compliance after three months from the beginning of the rehabilitation programs. A series of Anova were performed to test the differences between the two groups concerning alcohol abuse.
Results: The two groups (CBC and MEC) did not differ on alcohol consumed and severity of alcohol dependence. The Kaplan Meier curve showed that after three months of treatment, 82% of CBC participants remains in the rehabilitation program, versus the 40% of the motivational group (p < .05).Moreover, the CBC group participants consumed less alcohol units (mean:13,3; SD: 35,9) than the motivational group counterparts (mean: 56,9; SD: 105,9) (t = -1,9; p < .05). These preliminary results suggest CBC counseling may be more effective in terms of compliance and alcohol units consumed than motivational counseling.
Keywords: Alcohol(ism), CBT, Compliance
CORRESPONDING AUTHOR: Coriale Giovanna, Sapienza University, Rome; gcoriale@tin.it
P55
SATISFACTION AND COPING MECHANISMS WITH DRUG ADDICTION THERAPIES: THE PATIENTS’ PERSPECTIVE Lua P. L., Talib N. S.
University Sultan Zainal Abidin, Centre for Clinical & Quality of Life Studies, Kuala Terengganu, Malaysia
The vast majority of drug addicts often suffer from negative consequences and complicated life situation. To achieve drug abstinence, both coping ways and satisfaction towards medical care are crucial issues. This study intended to 1) describe the baseline patient satisfaction (PS) level and preferred coping strategies and 2) assess PS and coping mechanisms pre- and post-intervention. Patients on Methadone Maintenance Treatment (MMT) in Terengganu, Malaysia were randomised into either MMT or MMT plus Auricular Acupuncture (M + A) groups. All received the standard MMT while M + A participants underwent concurrent AA session thrice weekly for 2 months (total = 24 sessions, each session = 30 minutes). The following outcomes were evaluated pre- and post-intervention: PS (using Patient Satisfaction With Pharmaceutical Care Questionnaire) and coping style (utilising the Malay Brief COPE). Data analysis was carried out using SPSS 16.0 employing descriptive and non-parametric statistics. Participations were received from 97 eligible male patients (median age = 36.0 years; Malay = 97.9%; single = 57.8%; rural residents = 59.8%; ≥SPM education/Cambridge O’ level = 56.7%; ≥15 years of addiction = 58.8%). After screening for dropouts (attendance rate of <8 sessions and failure to complete entire study), only 68 patients were considered for subsequent analysis (MMT = 40; M + A = 28). At pre-intervention, both groups did not differ significantly in the parameters investigated. During post-intervention, no significant difference was detected for satisfaction level but coping-wise, Substance Use was significantly and more frequently adopted by M + A patients compared to MMT respondents (p < 0.05). On separate analysis, those who received MMT alone adopted Active Coping, Venting and Self-Blame significantly more frequent post-intervention (p < 0.05). Nevertheless, no significant difference for coping styles of M + A patients was exhibited over-time (p > 0.05).The addition of AA therapy into the standard MMT treatment did not seem to influence PS and their coping ways. MMT patients were frequently driven by their emotions (negative coping) when facing addiction problems.
Keywords: addictive behaviors, complementary and alternative, coping, outcome expectations
CORRESPONDING AUTHOR: Lua Pei Lin, Universiti Sultan Zainal Abidin; peilinlua@unisza.edu.my
P56
COMBINATION OF METHADONE AND AURICULAR ACUPUNCTURE FOR DRUG ADDICTION: EFFECTS ON CLINICAL OUTCOMES AND WELL-BEING
Lua P. L., Talib N. S.
Universiti Sultan Zainal Abidin, Centre for Clinical & Quality of Life Studies , Kuala Terengganu, Malaysia
Methadone substitution treatment for opioid dependency has so far received a reasonable level of acceptance throughout Malaysia. However, the evidence for Auricular Acupuncture (AA) as a potential complementary therapy for drug addiction problems is still limited. Our study intended to compare 1) the clinical outcomes of Methadone Maintenance Treatment (MMT) alone and MMT plus AA (M + A) with regard to methadone dose and smoking habit and 2) health-related quality of life (HRQoL) profile pre- and post-intervention. Participants from MMT centres in Terengganu, Malaysia were randomly assigned either to MMT or M + A. Both groups received the standard treatment of MMT while M + A respondents underwent concurrent AA session thrice weekly for 8 weeks (each session = 30 minutes). The following outcomes were evaluated pre- and post-intervention: daily methadone dose, number of cigarettes smoked/week and HRQoL status (using WHOQOL-BREF). Data was analysed employing descriptive and non-parametric statistics (SPSS 16). A total of 97 eligible male patients (MMT = 42; M + A = 55) consented participation (median age = 36.0 years; Malay = 97.9%; single = 57.8%;≥SPM education/Cambridge O’ level = 56.7%). Attendance rate of <8 sessions and non-completion of post-intervention questionnaires were considered as dropouts. Pre-intervention, both groups (MMT = 40; M + A = 28) only differed significantly by HRQoL profile (better for MMT patients). Post-intervention, M + A patients reported significantly reduced number of cigarettes smoked (p = 0.004) compared to the MMT cohort, whereas no significant difference was detected for methadone dose and HRQoL outcomes. On separate group analysis, the number of cigarettes smoked by the MMT cohort had also significantly been lowered (p = 0.001) although their drug dose and HRQoL outcomes did not exhibit any over-time statistical significance. For M + A patients, except for methadone dose, both cigarette number and HRQoL outcomes have been significantly improved post-intervention (p < 0.05). The relatively encouraging effects of AA on smoking habit and overall well-being imply that it could be beneficial as an adjunct to MMT in managing drug addiction problems and requires extensive investigations due to limited studies of this nature in our country.
Keywords: addictive behaviors, complementary and alternative, quality of life, substance abuse
CORRESPONDING AUTHOR: Lua Pei Lin, Universiti Sultan Zainal Abidin; peilinlua@unisza.edu.my
P57
ASSERTIVENESS SKILLS TRAINING PROGRAM AND ITS RELATION ON COLLEGE STUDENTS’ SUBJECTIVE NORMS AGAINST SUBSTANCE ABUSE
Barati M.1, Allahverdipour H.2
1 Hamadan University of Medical Sciences, Public Health, Hamadan, Iran
2 Tabriz University of Medical Sciences, Health Education & Promotion, Tabriz, Iran
Introduction & Objective: The prevalence of substance abuse among college students is increasing drastically and requires immediate skill-based substance abuse intervention such as assertive skills. The purpose of this study was to develop the healthy behavior to change the subjective norms of students in order to decrease their tendency towards substance abuse.
Materials & Methods: A pre and post nonequivalent control group design study carried out on college students. A total number of 140 students were selected through randomized cluster sampling and randomly assigned to the intervention (n = 70) and the control (n = 70) groups. The data-gathering tool consisted of a self-report questionnaire assessing the variables of moral, descriptive, and injunctive norms. After the diagnostic evaluation, assertive skills promoting program was applied to persuade the participants against substances abuse. Respondents in the control and experimental groups completed questionnaires at baseline and 2 months after the intervention.
Results: The result showed that educational manipulation had significant effect on intervention group’s average response for moral norms (t = -3.36, P < 0.001), descriptive norms (t = -3.07, P < 0.003), and injunctive norms for persuading substance abuse (t = -3.79, P < 0.000).
Conclusion: These findings suggest that assertive skills training would be an efficient tool in drug abuse prevention programs among adolescents that should also be included in the comprehensive school health programs.
Keywords: Adolescents, Assertiveness Skills, Subjective Norm, Substance Abuse
CORRESPONDING AUTHOR: Allahverdipour Hamid, TBZMED; allahverdipourh@tbzmed.ac.ir
P58
EVALUATION OF THEORY OF PLANNED BEHAVIOR-BASED EDUCATION IN PREVENTION OF MDMA (ECSTASY) USE AMONG UNIVERSITY STUDENT
Barati M.1, Allahverdipour H. 2
1 Hamadan University of Medical Sciences, Public Health, Hamadan, Iran
2 Tabriz University of Medical Sciences, Health Education & Promotion, Tabriz, Iran
Background and Objectives: Existing data show that using psychoactive drugs has increased among youths in recent years. Meanwhile, theory of planned behavior is an effective method to prevent non-healthy behaviors. Using this model as a theoretical framework, the aim of the present study was to evaluate the effect of educational preventive programs and resistance skills against substance use and perceived behavior control among university students in Hamadan.
Materials and Methods: A quasi-experimental study was carried out among university students in Hamedan city during 2008-2009. A total number of 140 students were selected through randomized cluster sampling and were randomly assigned to intervention and control groups. A questionnaire, based on the theory of planned behavior, was applied to assess the variables of attitudes toward substance use, subjective norms, perceived behavior control, intention and ecstasy use.
Results: The result showed that educational programs had significant effect on the average response for attitude toward drug abuse (P < 0.001), subjective norms (P < 0.001), perceived behavior control (P < 0.001), intention (P = 0.013) and ecstasy abuse (P = 0.004) in intervention group.
Conclusion: These findings suggest that applying the theory of planned behavior along with preventive methods are efficient tools for preventing the drug abuse.
Keywords: Ecstasy, Substance Abuse, University Student, Hamedan
CORRESPONDING AUTHOR: Allahverdipour Hamid, TBZMED; allahverdipourh@tbzmed.ac.ir
P59
NATIONAL TOBACCO CONTROL POLICIES AND SMOKING BEHAVIOR OF JAPANESE WORKERS, 2001-2010
Suka M.1, Miwa Y.2, Ono Y.2, Yanagisawa H.1
1 The Jikei University School of Medicine, Department of Public Health and Environmental Medicine, Tokyo, Japan
2 Tokyo Health Service Association, Tokyo, Japan
Background: Japan has the highest smoking prevalence among the G7 countries. After setting Healthy Japan 21 in 2000, the Japanese government has accelerated its tobacco control efforts.
Objective: To examine recent changes in smoking behavior of Japanese workers with evolving national tobacco control policies.
Methods: Using annual health examination data of Japanese workers aged 20-59 years (51,000 men and 29,000 women), age-adjusted smoking prevalence was calculated for each year between 2001 and 2010. Those who smoked daily in each year were followed to ascertain their smoking status at one year, calculating smoking continuation rates. If they had stopped smoking at one year, their smoking status was ascertained again at two year, calculating smoking resumption rates.
Results: For male workers, smoking prevalence was 50.2% in 2001, and has steadily declined every year (≤-2% year-on-year) since the Health Promotion Law, including a clause restricting smoking in public places, was enacted in 2003. It sharply dropped to 36.7% (-8.5% year-on-year) in 2010 when tobacco prices increased by 1.4 USD/pack (+36.7%). Annual smoking continuation rates were stable at around 95% between 2002 and 2009 while implementing non-price measures (no smoking designations, advertising restrictions, warning labels, youth access regulations, and health insurance coverage for smoking cessation treatments), then dropped to 91.2% (88.2% for 1-19/day smokers, 93.8% for 20+/day smokers) in 2010. Annual smoking resumption rates fluctuated between 20-27% independently of national tobacco control policies. For female workers, smoking prevalence rose from 15.5% in 2001 to 17.0% in 2003. It subsequently entered a downward phase, reaching 11.4% in 2010. No significant change was found in annual smoking continuation rates (fluctuating between 86-91%) or annual smoking resumption rates (fluctuating between 19-31%).
Conclusion: Smoking prevalence has declined in recent years, especially for male workers. The implementation of national tobacco control policies may in part contribute to the decline in smoking prevalence. The drastic increase in tobacco prices in 2010 seems the single most effective measure to prompt smokers to quit or reduce smoking. It is important for smokers and quitters to have continuous support to avoid continuation and resumption of smoking, along with creating smoke-free work environments.
Keywords: Tobacco Control, Behavior Change, Worksite health
CORRESPONDING AUTHOR: Suka Machi, The Jikei University; suka@jikei.ac.jp
60
SECONDHAND SMOKE IN PUBS AND THE ENFORCEMENT OF THE LAW RESTRICTING SMOKING BY LOCAL AUTHORITIES IN ISRAEL
Satran C.1, Drach-Zahavy A.2, Hammond SK.3, Baron-Epel O.1
1 The University of Haifa, Department of Public Health, Haifa, Israel
2 The University of Haifa, Department of Nursing, Haifa, Israel
3 University of California at Berkeley, Department of Public Health, Berkeley, USA
Background: Israel has a national law restricting smoking in public places, including pubs since 2007. The local authorities are obliged to enforce the law.
Aims: 1) To assess the levels of Second hand smoke (SHS) in pubs in Israeli towns; 2) To assess the enforcement of the law by the local authorities and to identify the association between SHS in the pubs and the reported enforcement; 3) To identify barriers and enhancers of the law enforcement.
Methods: Passive airborne nicotine devices were used to measure indoor SHS in non-smoking areas in 72 pubs in 29 Israeli towns. In addition, quantitative and qualitative face-to-face semi-structured interviews were conducted with 73 local authority's (48 managers and 25 elected officials), in 25 towns. Data was collected during 2009-2010. The interviews were analyzed using textual content approach for categories and themes identification.
Results: SHS was found in 92% of the pubs, while the median nicotine concentration in the pubs was 14.3μg/m3 [SD = 23.2].
Although enforcement is the local authorities' duty by law, only one local authority reported full enforcement of the law; six reported partial enforcement and 18 do not enforce the law in pubs at all.
There was no correlation between the levels of enforcement of the law and the airborne nicotine in the pubs.
The main themes we identified as barriers to law enforcement were lack of resources, and conflicts of interests between enforcing the law and the pubs financial losses. There were mixed reactions to the ban on smoking in pubs and to the effectiveness of fines.
Conclusions: Generally, law enforcement was low and did not result in decreasing levels of SHS in the pubs. There is a need for a national intervention, both among pub goers and among local authority officials to raise enforcement. This may be achieved by developing a national enforcement agency and public campaigns to ensure smoke-free area in pubs.
Keywords: Secondhand smoke, tobacco control, policy, law enforcement, local authorities, pubs
CORRESPONDING AUTHOR: Satran Carmit, The University of Haifa; satran@research.haifa.ac.il
P61
PSYCHOLOGICAL AND BEHAVIORAL EFFECTS OF THE PUBLIC SMOKING BAN IN HOSPITALITY VENUES ON CURRENT SMOKERS
Gebhardt WA.1, Van der Heiden S.1, Dijkstra A.2, Willemsen M.3
1 Leiden University, Department of Health Psychology, Leiden, The Netherlands
2 University of Groningen, Social Psychology, Groningen, The Netherlands
3 Maastricht University, CAPHRI, Department of Health Promotion, Maastricht, The Netherlands
An online-survey study with over 1000 smokers was conducted to investigate perceived effects of the Dutch smoking ban in hospitality venues on smoker self-concepts and smoking behavior.
15% of the respondents reported to smoke less since the ban and 9% smoked more. Higher socio-economic status (SES) smokers were more likely to have reduced smoking (18% vs. 10%; X2 = 6,48; p = .04). 80% of respondents reported to have done one or more serious quit attempts since the ban.16% of responders had become (much) more motivated to quit, while 13% had become (much) less so. For 10% smoking had become (much) less part of their self-identity (smoker identity), while another 10% said that it had become (much) more so. Being a non-smoker (abstainer identity) had become a (much) stronger part of their identity for 16% of smokers, but for 20% this was (much) less the case. Higher SES smokers reported a stronger decrease in smoker identity and a stronger increase in abstainer identity. 28% of smokers had become (much) more concerned with their smoking (self-awareness), while 9% had become (much) less so. Moreover, 22% had become (much) more concerned with the impression they made on others while smoking (other-awareness), while 11% had become (much) less so.
Regression analyses revealed that all measures, particularly the difference in abstainer identity and self-awareness, were strong correlates of the change in motivation to quite (R2 = 35%). Smaller, but significant relationships were found between the reduction in number of cigarettes smoked and the differences in abstainer identity and self-awareness (R2 = 19%).
Among continuing smokers salient differences exist regarding how the ban has affected self-conceptions, motivation to change and acceptance of future policies. About 1/5 of smokers is more motivated to quit and has changed their self-conceptions accordingly, while about a similar number is less motivated and is more robust in their views and behavior.
Keywords: smoking policy social class
CORRESPONDING AUTHOR: Gebhardt Winifred, Leiden University, Leiden; gebhardt@fsw.leidenuniv.nl
P62
THE PRECAUTION ADOPTION PROCESS IN SECONDARY PREVENTION
Londoño Pérez C.1, Rodriguez I.2
1 Universidad Católica de Colombia, Departament of Psychology, Bogotá, Colombia
2 Universidad Católica, Departament of Psychology, Bogotá, Colombia
The present study, that used a quasi-experimental pre-test post-test design for paired groups, aimed at assessing the effect of an intervention based on the so called Precautions Adoption Process (PAP) in the reduction or cessation of smoking in university students from three Higher Education Institutions. The research took into account some key elements of PAP: motivation, vulnerability perception, susceptibility, cost and benefit, decisional balance and change, as a result of cognitive functioning and planning in the first place, and later to the passage through seven consecutive stages. Starting from these elements, an intervention program was developed and implemented in six work sessions. At the end, results from pre-test and post –test measurements of both the experimental and control groups were compared. In order to classify participants for each one of these groups several instruments were used: The Classification of Cigarette Consumers Questionnaire (C4) by Londoño, Rodríguez & Gantiva (in press), the Expectations Regarding Cigarettes Questionnaire (CEC) by Londoño & Rodríguez (2007) and the Motivation Questionnaire (Temptation). Results showed significant differences between groups in the level of consumption, expectations and motivation (Londoño & Rodríguez, 2007). These and other important findings are discussed.
Keywords: Precaution Adoption Process, cigarette consumption, secondary prevention and adolescents
CORRESPONDING AUTHOR: Londoño Constanza, Universidad Católica de Colombia, clondono@ucatolica.edu.co
P64
THE EFFECT OF DEPRESSION AND WITHDRAWAL SYMPTOMS ON SMOKING CESSATION
Csala I., Egervari L., Dome P., Lazary J.
Semmelweis University, Department of Clinical and Theoretical Mental Health, Budapest, Hungary
Background: It is proven that withdrawal symptoms can mitigate the success of quitting. Depression plays an important role in success rate of quitting, however data on relationship between quitting outcome and depression are contradictory. Furthermore, this problem has been complicated by the new quitting agent, varenicline due to its depressogenic side effect. The aim of our study was to examine the relationship between depression, withdrawal symptoms and quitting outcome.
Methods: We recruited 255 smokers from 15 Hungarian Quitting Centers. Cessation was supported by varenicline (n = 164) or only by psychoeducation (n = 91). Treatment protocol consisted of 4 consultations within 3 months (0, 2, 4, 12 w). Zung Self Rating Depression Scale (ZSDS), Fagerstrom Test for Nicotine Addiction (FTND), and Minnesota Nicotine Withdrawal Scale-Self report (MNWSS) were completed at each consultation. Quantity of smoking was monitored by breath CO measure. Parental Bonding Instrument (PBI) was used for measure of early childhood experiences by questions on mother’s behavior.
Results: We found that success rate of quitting depended on depression score and withdrawal symptoms: persons with low ZSDS0w score had 1.6-fold higher chance to quit smoking (p = 0.038); while increased MNWSS2w score almost doubled the risk for quitting failure (p = 0.43). By the end-point of treatment ZSDS decreased in total sample (p = 0.001) and also in subgroup of patients with successful treatment (p = 0.005). Moreover, higher ZSDS score at baseline predicted consequently higher MNWSS scores at each consultation (all p-values <0.0001). Besides, ZSDS score was determined by maternal ‘affectionless control’, which was assessed by the PBI (p = 0.004). These findings were independent form type of therapy.
Conclusion: Baseline depression, influenced by early life experiences, seems to play an important role in quitting success via influencing withdrawal symptoms. Therefore, screening the candidates for symptoms of depression, as well as providing adequate treatment before initializing cessation is recommended in order to avoid repeated failures.
These studies were supported by the Norvegian Financial Mechanism (HU0125).
Keywords: smoking, depression
CORRESPONDING AUTHOR: Csala Iren, Semmelweis University, Budapest; csalus@gmail.com
P65
PREVENTING SMOKING BEHAVIORS IN ADOLESCENTS: PERCEPTIONS OF PARENT-CHILD COMMUNICATION ABOUT TOBACCO USE IN TICINO
Scalici F., Schulz P J.
University of Lugano, Institute of Communication and Health, Lugano, Switzerland
The increase of young smokers in European countries has become a serious problem. Different approaches had been developed to face this issue: public campaigns and school-based interventions just to name a few. To address this problem, a new approach based on parent-child communication has been developed in the literature (Ramos, Jaccard & Dittus 2010). Parents are viewed as change agents who are valuable sources of information and advice to shape their children’s behaviors. To increase parent-child communication level is a good way to either prevent or reduce tobacco consumption among adolescents. The literature suggests that parent-child communication is a “protective factor” to prevent adolescents’ risk behaviors (Dittus, et al. 1999; 2000; Litrownik et al. 2000; Whitaker & Miller 2000) and that parents influence their children especially with regards to health issues (Steinberg 2001).
Against this background, we conducted an empirical study to evaluate parent-child communication in the field of tobacco consumption. Data were collected via self-administered questionnaires among a random sample of 11 to 16 year-old students from all middle schools in Ticino (N = 5’560). In our paper, we will first present results concerning the adolescents’ perception of communication quality with their parents, the relationship satisfaction and the trustworthiness (Ramos, Jaccard, et al. 2006). Secondly, data regarding adolescents’ perception of the peer group relation will be analyzed based on the theoretical framework of Fishbein & Triandis’s expectancy and social norms model (2001). Finally, the results of this study will be discussed in the perspective of a culture specific parent-based intervention model that give parents information and skills to help their children avoid the negative consequences of tobacco consumption.
Keywords: Adolescents, Prevention, Smoking, Parent-child transactions, Risk behaviors
CORRESPONDING AUTHOR: Scalici Francesca, Lugano University; francesca.scalici@usi.ch
P66
PREVALENCE AND PSYCHOSOCIAL CORRELATES OF CURRENT SMOKING AMONG ADOLESCENT STUDENTS IN THAILAND, 2005
Sirichotiratana N.1, McKnight-Eily L.2, Arrazola R.3, Merritt R.3, Malarcher A.3
1 Mahidol University, Public Health, Bangkok, Thailand
2 Centers for Disease Control and Prevention, Epidemiology and Biostatistics, Atlanta, USA
3 Centers for Disease Control and Prevention, Epidemiology, Atlanta, USA
Introduction: There are a few research studies on the psychosocial correlates of smoking among adolescents in many countries. These correlates need to be identified to target those who are at high risk of cigarette smoking and providing smoking prevention and intervention efforts.
Objectives of this study are to
a) explore the prevalence of current smoking, and
b) to explore the prevalence and significance of associated psychosocial smoking correlates by sex among Thai students grade 7 through 9.
Method: The Global Youth Tobacco Survey (GYTS) is a school-based, cross-sectional survey which provides systematic global surveillance of youth tobacco use prevalence and related behaviours. A two-stage cluster sample design was used. A total of 19,874 students, represented 5 regions of Thailand completed the survey. Student participation was voluntary and anonymous using self-administered survey procedure.
Results: Among current smokers, 60.1% reported thinking that smoking is harmful compared to 85.1% of non-current smokers. More than 2 out 3 current smokers reported exposure to second-hand smoke at home (69.2%) in comparison to less than half of their non-smoking peers (44.3%). There were some significant differences between non-smoking female and male students. Female non-current smokers (88.5%) were significantly more likely to report believing that smoking was harmful than males (80.8%) More than 4 out of 10 (46.1%) female non-current smokers and male non-current smokers (42.1%) reported second-hand smoke exposure at home.
Discussion: Current smoking was found to be correlated with many of the psychosocial factors examined in this study. Results provide insight into potential influences on Thai adolescents decision to smoke. The significant correlates should be viewed as opportunities to target anti-tobacco efforts among adolescent populations.
Conclusions: The findings suggest that cigarette smoking is a significant problem among adolescents in Thailand. The associations found in this analysis can assist in identifying areas of further exploration for research and targeted prevention efforts to address current smoking among adolescent students in Thailand.
Recommendations: Further research examining the aspects of peer influence, culture and sex differences in the correlates of current smoking are needed to focus tobacco prevention and smoking cessation efforts.
Keywords: Tobacco control, Smoking
CORRESPONDING AUTHOR: Sirichotiratana Nithat, Mahidol University; nithats@gmail.com
P67
GRAPHIC HEALTH WARNING (GHW) LABELS ON CIGARETTE PACKS: DOES THEIR IMPACT ON ADOLESCENTS EVENTUALLY WEAR OUT?
White V., Bariola E., Wakefield M.
Cancer Council Victoria, Centre for Behavioural Research in Cancer, Melbourne, Australia
Background: While research suggests that GHW labels increase adolescents’ cognitive processing of labels and awareness of smoking related diseases, the longevity of these effects is not known. Australia introduced 7 GHW in 2006, with a further 7 GHW introduced in 2007.
Aim: To assess the impact of GHW labels on adolescents’ cognitive processing of labels, cigarette pack image and awareness of illnesses 5 years after their introduction.
Method: Four cross-sectional surveys of students aged 13-17 from major urban areas in one Australian state undertaken: i) prior to GHW introduction (Baseline N = 3660); ii) 6-months (1st follow-up (1FU, N = 2650), iii) two years (2FU, N = 3359) and iv) 5 years (3FU, N = 3842), after GWH introduction. Students answered questions on cigarette pack exposure, cognitive processing of warning labels (1 “never” to 5 “every time”), pack image and awareness of smoking related diseases. Students were classified into smoking status groups based on cigarette use and smoking intentions. ANOVA examined change in mean scores and χ2 change in proportions. Analyses adjusted for age and gender.
Results: Among students seeing cigarette packs in past 6 months (65-75% of respondents) cognitive processing of labels increased significantly between baseline and 2FU (all p < 0.01). However, cognitive processing declined between 2FU and 3FU (all p < 0.01) with mean scores at 3FU similar to or lower than baseline (e.g. frequency of attending to warnings; means: baseline = 2.6, 1FU = 2.8, 2FU = 2.9, 3FU = 2.6). Decreases were consistent across smoking groups. In contrast, pack image became progressively more negative (p < 0.01) and less positive (p < .01) over time (e.g., negative image means: baseline = 3.0, 1FU = 3.3, 2FU = 3.6, 3FU = 3.9). Proportion of all students aware that smoking causes mouth cancer, emphysema, gangrene and stroke (GHW label messages) increased over the study period including between 2FU and 3 FU (all p < 0.01).
Conclusions: Cognitive processing of GHW reduced among adolescents after 5 years. However as awareness of GHW labels’ health messages increased and the pack image became more negative over the entire study period, results suggest GHWs may contribute to a more enduring impact on improved awareness of health effects of smoking and denormalisation of tobacco use.
Keywords: adolescents, smoking, graphic warning labels
CORRESPONDING AUTHOR: White Victoria, The Cancer Council Victoria; vicki.white@cancervic.org.au
P68
PHYSICAL ACTIVITY WITH BODY MASS INDEX, ALCOHOL CONSUMPTION, AND CIGARETTE SMOKING AMONG EAST ASIAN COLLEGE STUDENTS
Seo D-C.1, Torabi MR.1, Chin M-K.2, Lee CG.1, Kim N.1, Huang S-F.3, Chen CK.4, Mok MC.5, Wong P.6, Chia M.6
1 Indiana University, Applied Health Science, Bloomington, USA
2 HOPSports Inc., HOPSports, Valencia, USA
3 Tzu Chi University, Physical Education Center, Hualien, Taiwan
4 University Sains Malaysia, School of Medical Sciences, Kelantan, Malaysia
5 The Hong Kong Institute of Education, Department of Psychological Studies, and Assessment Research Centre, Hong Kong, China
6 Nanyang Technological University, NIE, Nanyang Walk, Singapore
Purpose: To examine the level of moderate physical activity (MPA) and vigorous physical activity (VPA) among a representative sample of college students in six East Asian economies and compare their relation with weight category, alcohol consumption and cigarette smoking.
Setting: Twenty-one colleges in 6 East Asian economies (response rate = 78%).
Subjects: College students (N = 16,558).
Analysis: Multiple logistic regression models of MPA and VPA were separately performed for each economy, controlling for age, gender, living area before college, military experience, paid employment, and religion. All the analyses were performed using SAS 9.2with clustering effects accounted for.
Results: Being a heavy drinker increased the odds of engaging in VPA in 5 economies (adjusted odds ratio (AOR) = 1.56 to 2.65). Cigarette smoking was not associated with MPA in any economy and was only associated with VPA in China (AOR = 1.54) and Taiwan (AOR = 1.48), indicating smokers are more likely to engage in VPA than nonsmokers.
Conclusions: The relation between college students’ VPA and alcohol consumption and between MPA and cigarette smoking is similar across the East Asian economies whereas the relation between VPA and smoking varies substantially.
Keywords: Alcohol, Physical activity, Tobacco use
CORRESPONDING AUTHOR: Seo Dong-Chul, Indiana University, Bloomington; seo@indiana.edu
P69
STRESS, FATIGUE AND SCHOOL VIOLENCE IN TEENAGERS
Bob M.1, Lotrean L.2, Gabor-Harosa F.2, Schmidt N.1, Mocean F.2
1 University of Medicine and Pharmacy Cluj-Napoca, Department of Morphology, Cluj-Napoca, Romania
2 University of Medicine and Pharmacy Cluj-Napoca, Department of Community Medicine, Cluj-Napoca, Romania
Introduction: The educational environment of society and family has tremendous influence on personality development and behavior in teenagers.
Objectives: Our research aimed at identifying the main causes of distress in school environment in teenage students.
Methods: We ran an observational, descriptive study. An original 38 items-questionnaire was completed by a valid population sample of 267 teenage students (100%) in 4th, 6th and 9th grade from a rural school.
Results and discussions: Our study reveals that school-induced stress and fatigue three or more days every week were accused by 17% of 4th grade students, and was significantly increased among 6th graders (38%, p < 0.05 at Chi2 test) and 9th graders (49%). Fatigue during week-end was declared by 16.7% of 4th graders, and was significantly increased in 6th graders (38.8%) and in 9th graders (52.5%). The main causes for school-related stress and fatigue according to students are: parents pressure for high grades (80%), not enough sleep (50%), not enough leisure time (46%), not enough workout (42%), too many classes or too difficult subjects (37.9%), too elaborate home assignments (34,7%), etc.
The main school violence manifestations identified by students were: students hitting students (40%), fights between students (39%), destruction of school property (31%), alcohol consumption by students (25%), students hitting teachers (25%), students swearing at teachers (25%).
Conclusion: The school-related stress, fatigue and violence identified in this teenage population sample are results of defective education on communication strategies, received in school and at home.
Better communication between student, school and family is important, since it should lead to an increased stress resistance that prevents school-related fatigue, increases tolerance to fellow students and stimulates active involvement in health-promoting activities at individual and community level.
Designing and implementing an interdisciplinary model of healthy educational environment should keep teenagers healthy and health-oriented, enabling motivated study in school and at home, hence preventing stress, intellectual fatigue and school violence.
Keywords: Stress, Fatigue, Social stress, Environment, Health promotion, Community intervention, Public health
CORRESPONDING AUTHOR: Bob Mihai, University of Medicine, Cluj; mihaihoratiubob@gmail.com
P70
WORKPLACE BULLYING AND LONGTERM CONSEQUENCES ON SLEEP – A TWO YEAR FOLLOW-UP STUDY
Hansen AM.1, Hogh A.2, Garde AH.3, Persson R.3
1 University of Copenhagen, Department of Public Health, Copenhagen, Denmark
2 University of Copenhagen, Department of Psychology, Copenhagen, Denmark
3 National Research Centre of the Working Environment, Copenhagen, Denmark
Background: It has been demonstrated that targets of bullying report more problems such as more psychological distress, somatic, depressive and anxiety symptoms, as well as stress and poorer general health than non-bullied employees. Sleep is a major path for restitution and vital for our health and well-being. Bullying is a work stressor that affects the health and well-being of the targets. Since bullying may induce stress, and stress may cause sleep problems, it seems conceivable that the negative health effects observed among bullied are mediated via poor sleep.
Purpose: To estimate the risk for subsequent sleep problems at follow-up two years later among bullied and witnesses of bullying.
Methods: A total of 3382 respondents (67.2% women and 32.8% men) completed a baseline questionnaire about their psychosocial work environment and health. The overall response rate was 46%. At follow-up two years later 2273 (response rate 33%) responded and of these 1671 also participated at baseline (49% of the 3382 respondents at baseline).
Results: We found a significant linear association between the frequency of bullying at baseline and poor sleep in terms of disturbed sleep, awakening problems and quality of sleep at baseline and at follow-up. Similar associations were found between witnessing bullying and sleep problems. We also found increased OR for long-term sleep problems among occasionally bullied and partly among frequently bullied. However, the associations weakened when adjusting for sleep problems at baseline. We did not find increased OR for long-term sleep problems among witnesses of bullying.
Conclusion: We found that reporting bullying at baseline predicted disturbed sleep and awakening problems among occasionally bullied and non-significantly among frequently bullied. Witnessing bullying at baseline did not predict poor sleep at follow-up.
Keywords: Bullying, witnesses, disturbed sleep, awakening problems, somatic symptoms
CORRESPONDING AUTHOR: Hansen Åse Marie, University of Copenhagen; stk935@sund.ku.dk
P71
THE IMPACT OF IMPRISONMENT ON HEALTH PERCEPTION
Alves J., Maia A.
University of Minho, School of Psychology, Braga, Portugal
The impact of incarceration on health, especially in women, has not been an aim of research. The purpose of this study is characterize the health status of women in prison (N = 148), including the analysis of the impact of incarceration on the perception of health status of these women, comparing two groups: those who perceive their current health as better (54.7%, N = 81) and those who perceive their current health as poor (45.3%, N = 67) when compared to the time before arrest. Participants filled out self-report questionnaires (medical history, physical and psychological complaints, anxiety and depression) and a health risk behaviours checklist. Univariate analysis revealed that the ones that report improvement in health have less physical (t (146) = 2.76,p =. 001) and psychological complaints (t (146) = 3.17, p =. 002), anxiety (t (146) = 2.48, p =. 014) and depression (t (146) = 1.97, p =. 05). Previous medical supervision (x2 (1) = 7.01, p =. 008) and chronic diseases (x2 (1) = 10.04, p =. 002) are associated with a decrease of health quality, but previous substance use (x2 (1) = 8.24, p =. 004) is associate with an increase in quality. A logistic regression analysis was run in order to evaluate the contribution of these variables on the health perception. The full model was significantly reliable (x2 (7) = 34.45, p = .000) and accounted for between 20.8% and 27.8% of variance. Overall 68.9% of predictions were accurate. However only previous medical supervision, drug use and chronic disease were significant predictors of the impact of imprisonment on health perception. The values of coefficient revealed that lack of previous medical supervision increase the odds of positive impact by a factor of 2.38, the absence of chronic diseases increases the odds of positive impact by a factor of 14.67, and having used drugs increases the odds of positive impact by a factor of 66.0. These results show the need to take into account previous health conditions to understand the impact of prison on health, and specially the relevance of some conditions as drugs consumption. The positive impact of imprisonment on drug users and women who hadn't medical supervision, reinforcing the idea that incarceration provides opportunities to act on the health of risk population.
Keywords: Women's health; Health Behaviors; Prison
CORRESPONDING AUTHOR: Alves Joana, Universidade do Minho, Braga; joanafalves@msn.com
P72
MENTAL HEALTH AND DEPRESSION IN INFORMAL CARERS OF DEPENDENT PEOPLE POST STROKE
André S.1, Cunha M.1, Rodrigues V.2
1 Instituto Politécnico de Viseu, School of Health, Viseu, Portugal
2 Universidade de Trás-os-Montes e Alto Douro, School of Health, Viseu, Portugal
The Strokeis a disease that threatens the quality of life in the elderly not only for its high incidence and mortality, but also by increased morbidity it causes, especially physical dependence and / or emotional changes. And the care of dependent elderly at home by their relatives (carers) requires the adoption of a widely varied range of strategies for him to "deal", noting that many empirical studies document the association of socio-demographic, clinical and with psychosocial quality of life and mental functioning of informal caregivers. In this context, the objective of the study is the mental health of informal carers.
The research model adopted follows the model cross sectoral or cross, following a line of analysis explanation, with which it seeks to explore how personal and situational variables have an impact on mental functioning (mood and mental health), the caregiver informal. A non-probability sample of convenience, was composed of 636 carers (83.8% female and 16.2% male) aged M = 50.19 years. The protocol of data collection included Questionnaire Assessment of Informal Caregiver overload; Inventory Beck Depression Inventory and Scale Screening for Mental Health.
The results showed that 62.8% of caregivers did not have depression, and 16.1% have mild depression, moderate in 12.0% and only 9.1% had depression serious. The score on the mental health, reflecting that 49.5% have good mental health, 37.1% have poor mental health and 13.4% is reasonable health.
Carers with more positive mental functioning, scored with better self-concept, lowest overhead in size implications for personal life, satisfaction with the family role, needs and reactions to emotional overload, more social support, better functionality and family better socioeconomic level. Carers with poorer mental functioning, i.e., poorer mental health, depressive symptoms had more severe and scored with a greater vulnerability to stress, a greater burden on the dimensions family support, financial burden, perception of efficacy and mechanisms of control and trait of neuroticism more sharp.
The results support that the variables age, socioeconomic status, family function, overload, social support, self-concept, personality traits, vulnerability to stress, age of the dependent and the dependency ratio predict the mood of carers. The variables age, socioeconomic status, family function, overload, social support, self-concept, personality traits, vulnerability to stress, age and the dependent elderly dependency ratio predict mental health of informal caregivers, which suggests that health professionals should include in the planning of health actions that are addressed.
Keywords: Mental health, Depression, Carers, Health behaviors
CORRESPONDING AUTHOR: Cunha Madalena, Polytechnic Institute of Viseu; madac@iol.pt
P73
THE ROLE OF SELF-REGULATION AND HEALTH BEHAVIORS FOR CAREGIVER’S HEALTH
Lucidi F.1, Grano C.2
1 Sapienza University of Roma, Department of Development and Socialization Processes Psychology, Roma, Italy
2 Sapienza University of Roma, Department of Psychology, Roma, Italy
Caring for a family member with Alzheimer disease (AD) is generally regarded as a chronically stressful process, with potentially negative physical health consequences, concerning, in particular, stress hormones, antibodies, and global reported health. Several authors argue that research is needed that relates caregiver stressors to illness and clarifies mediating roles for psychosocial distress and emotional regulation. To these issues, 3 studies will be presented. The studies involved 737 participants between 60 and 96 years of age. Of these, 126 were caregivers of patients with Alzheimer disease, 268 were caregivers of patients with arthritis or cardiovascular disease, and 343 were no caregivers. In the first study, we compared the scores on negative affect variables and quality of sleep across groups. Measures included the Geriatric Anxiety Inventory (GAI; Pachana et al., 2007), The Geriatric Depression Scale (GDS; Yesavage et al.,1983), the Maastricht Questionnaire (Appels et al., 1987) to measure Vital Exhaustion, and the Pittsburgh Sleep Quality Index (Buysse et al.,1989). Between groups ANOVA indicated that Alzheimer patients’ caregivers exhibited greater health risk on all the measures evaluated.
In the second study, we were interested in investigating whether self-regulative variables and health behaviors may mediate the relationship between AD Caregiver burden and psychological distress. Measures included the Screen for Caregiver Burden (Vitaliano et al. 1991), the Perceived Stress Scale (PSS; Cohen et al., 1983), the Revised Scale for Caregivers Self-efficacy (Sfeffen et al., 2002) and the International Physical Activity Questionnaire (Craig et al., 2003). To measure psychological distress we used the same measures of the first study. Structural equation models were used to test these relationships. Results indicated that self-efficacy and physical activity mediated the relationship between caregiver burden and psychological distress. In the third study we evaluate the efficacy of a program aimed to emotionally support AD caregivers. Within group ANOVA indicated that the program decreased the level of caregivers’ burden. Implications for future interventions aimed to decrease caregiver burden and psychological distress in AD caregivers are presented.
Keywords: Caregiver, Health Behaviours
CORRESPONDING AUTHOR: Battagliese Gemma, Sapienza University, Rome; gemma.battagliese@uniroma1.it
P74
SAVING AND PROMOTING HEALTH OF PERSONS UNDER HIGH COGNITIVE LOAD
Costrikina I.1, Korg T.2, Bocharov O.3
1 Moscow State University of Psychology and Education, Department of Social Intellegent, Moscow, Russia
2 Fitness Center, Kineziology Department, Moscow, Russia
3 City Government of Moscow, Department of a Youth Policy, Moscow, Russia
Health and investment in health is a problem for many people from different countries because wealth, social mobility and many factors e.g. quality of life depend on health. More and more people are involved in processes imposing high cognitive load. Fifty years ago high cognitive load corresponded with high professional and social level only, whereas today a modern, different type of work causes high level cognitive load. Leaving behind questions related to general intelligence and ability to keep up with cognitive load, we focus on the issue of saving and promoting mental and somatic health.
The majority of the population is involved in computer activity and have high level of cognitive load similar to those who are involved in intensive visual work. Moreover, maintenance workers who are working in forced postures experience not only increased load on the spine and ligaments, but also an increase in postural muscle activity to maintain postural balance. Cognitive load and general physical load correlate with cognitive process, emotional state, and general motor activity.
The purpose of the study was to study the effective methods of rehabilitation and psycho-physiology regulation. Our research included 300 participants (operators, microscopists, active users of PC) between age 18-60, with experience from 3 up to 30 years and refraction from -6 , 0 up to 4.5 diopters. According to the survey more than 70% of them were in need of rehabilitation. We used three types of rehabilitation: 1. sessions including vibrating massage and gymnastics (general developmental exercises); 2. sessions of segmental acupressure in combination with general developmental exercises; 3 sessions of segmental acupressure combined with corrective exercises. We recommended complex rehabilitation to people with asteno-physical complaints with a pronounced degree of chronic fatigue, high levels of situational and personal anxiety.
As a result of treatment astheno-physical complaints disappeared (90%), and the degree of chronic fatigue significantly decreased (2.5). There was a decreasing trend in situational and personal anxiety. Accommodation volume increased by an average of 1.48 diopters.
The study revealed significant statistical differences between groups of different therapies. Differences were found in the level of anxiety (0.005), self-rated physical health, self-efficacy, and gender differences.
Keywords: Health behaviors, Quality of life, Self-efficacy, Physical activity, Psychophysiology
CORRESPONDING AUTHOR: Costrikina Ines, Psychology University, Moscow, psyresearcher@hotmail.com
77
THE STATUS OF ORTHOREXIA NERVOSA: A REVIEW OF THE LITERATURE
Varga M .1, Van Furth E. F.2
1 Semmelweis University, Institute of Behavioral Sciences, Budapest, Hungary
2 Center for Eating Disorders Ursula, -, Leidschendam, Netherlands
Orthorexia nervosa (ON) is an alleged eating disorder that surfaced in the media some ten years ago.
Aim: To review literature on the prevalence and risk factors of orthorexia nervosa.
Methods: We searched Medline and Pubmed using several key terms relating to ON and we checked the reference list of the articles we found. From these articles we extracted data on prevalence and risk factors.
Results: 11 evidence based studies were found. The prevalence rate for ON was 6.9% in the general population and ranged from 35-58% in the risk groups. However these studies used different methods to asses ON and different study populations. Healthcare professionals, medical students, artists are at a higher risk for ON. Risk factors include obsessive compulsive features, eating related disturbances and higher socioeconomic status. The annual number of papers on ON has increased in recent years.
Discussion: The definition and diagnostic criteria of ON are poorly defined. This makes a comparison between studies difficult. The validity and the psychometric properties of the assessment instruments for ON are weak. Further studies with improved assessment instruments are needed to identify specific ON symptoms and characteristics of individuals with ON.
Keywords: orthorexia nervosa, health, eating behaviours, risk groups
CORRESPONDING AUTHOR: Varga Márta, SE Inst. of Behavioral Sciences; vmarta104@yahoo.com
P78
AN INTERCULTURAL COMPARISON. RISK FACTORS PREDICTORS FOR BINGE EATING BEHAVIOR BETWEEN MEXICAN AND SPANISH GIRLS
Gomez-Peresmitre G.1, Acosta MV.2, Pineda G.3, Platas Acevedo S.1, Guzman Saldana R.4
1 Universidad Nacional Autonoma de Mexico, Faculty of psychology, Mexico City, Mexico
2 Universidad de Almeria, España, Facultad de Humanidades y ciencias de la Educacion, Almeria, España
3 Universidad Autonoma de Baja California, Facultad de ciencias Administrativas y Sociales, Ensenada B.C., Mexico
4 Universidad Autonoma del Edo. de Hidalgo, Instituto de Ciencias de la Salud A.A. de Psicologia, Mexico City, Mexico
Background: The increased frequency of binge eating behavior and its relationship to overweight and obesity has been expressed as an international health problem, i.e., the tendency to binge eating is associated with body mass index. A positive association between binge magnitude and body mass index has also been shown.
Objective: To detect the risk factors predictors for binge eating behavior related to body image (ideal and actual figures, body dissatisfaction and BMI) and to disordered eating (restricted dieting, body weight and eating behavior concerns, psychological compensation, internal and external control eating behavior).
Participants: The total non-probabilistic sample was N = 525: Mexican women (n = 253, M = 16.5 years, SD = 1.3) and Spanish women (n = 272, M = 17.2 years, SD = 1.6)
Hypothesis: The Mexican group’s risk factors related to body image and to disordered eating will produce the highest beta weights (β), as well as the major explained variance (R2) in the binge eating behavior, compared with the Spanish group.
Instruments: The instruments showed good psychometrical properties.
Results: Four significant risk factors were found for Mexican women model (eating behavior of psychological compensation, concerns by weight and food, BMI, and eating internal control) with ‘eating behavior of psychological compensation’ the most important (β = .77, p = .000). The explained variance on the dependent variable (binge eating) was (R 2ajust = 0.69). Three significant risk factors (eating behavior of psychological compensation, BMI, and eating external control) compounded the Spanish model. Eating behavior of psychological compensation was also the important factor (β = 0. 62, p = 0.000). The explained variance on binge eating behavior was R 2ajust = 0.42. Based on the results obtained, the hypothesis was accepted.
Discussion: The features of the risk factor predictors and their emotional nature gained the highest beta weight in both groups. The groups shared BMI factor as a predictive of binge eating behavior.
Keywords: binge eating, risk factors, obesity
CORRESPONDING AUTHOR: Gomez-Peresmitre Gilda, National University of Mexico; gildag@unam.mx
P79
PARENTING STYLE AND SOME PERSONALITY TRAITS AS RISK FACTORS OF EATING DISORDERS OF ADOLESCENT GIRLS
Nikolaeva N., Abdulsamadova L., Meshkova T.
Moscow State University of Psychology and Education, Clinical Psychology and Special Education, Moscow, Russia
Family and psychological features influence eating behavior of children and adolescents. We suppose that maternal/paternal parenting style can provoke some eating behaviors in adolescent girls, as dieting, restrictive eating, emotional eating, and can cause eating disorders (ED). The aim of this study was to investigate parental styles and adolescent girl’s personality traits influencing on the risk of eating disorders (ED). 107 school girls (mean age 15.3, Sd = 1.3) were tested by Eating Attitude Test (EAT-26, Garner et al., 1982), Parent-Adolescent Interaction Inventory (PAII, Markovskaya, 2006), and Risk Factors of Eating Disorders Inventory (RFEDI, Meshkova). EAT-26 consists of 26 items and focuses on eating behavior problems (dieting, bulimic behavior, weight preoccupation etc.). High EAT-26 total scores suggest the risk of ED. PAII consists of ten 5-point Likert scales (total 60 items) about adolescent’s opinion of maternal/paternal parenting (directivity, punishment use, overcontrol, emotional contact, acceptance-rejection, cooperation, agreement, consistency, maternal/paternal authority, good relationships). RFEDI was developed in Russian language for measuring risk factors of ED, including attitudes towards eating and body shape, social environments, personal traits (Perfectionism, Emotional Instability, Alexithymia etc.). Spearman rank correlations have shown, that there were positive relationships between EAT-26 total scores and maternal overcontrol (R = 0.41, p < 0.05), and negative relationships with paternal/maternal consistency (R = –0.32; R = –0.27, p < 0.05). Maternal overcontrol correlates negatively with paternal consistency (R = –0.29, p < 0.05). Positive relationships between daughter’s perfectionism, daughter’s alexithymia and mother’s overcontrol were found (R = 0.30; R = 0.30, accordingly, p < 0.05). Positive relationships between girls EAT-26 total scores and their perfectionism (R = 0.37, p < 0.05), alexithymia (R = 0.40, p < 0.05), and emotional instability (R = 0.37, p < 0.05) were shown. We suppose that relationships in families with overcontrolling mother determine family parenting style that can provoke some psychological traits as perfectionism and alexithymia, and contribute to ED of adolescent girls.
Keywords: Health Behaviors, Eating Behaviors, Personality, Parenting Style
CORRESPONDING AUTHOR: Nikolaeva Nataliya, MSUP, Moscow; sp_natalia@mail.ru
P80
A QUALITATIVE STUDY OF OVERWEIGHT AND OBESE ROYAL NAVY PERSONNEL’S EXPERIENCES WITH WEIGHT MANAGEMENT
Garip G.1, Yardley L.1, Brasher K.2, Bridger R.2
1 University of Southampton, School of Psychology, Southampton, United Kingdom
2 Institute of Naval Medicine, Royal Navy, Gosport, United Kingdom
Background: Overweight and obesity in the Royal Navy (RN) in the UK have reached concerning rates, which have implications for the operational capability of the RN. Obesity-related health problems result in considerable financial costs for the RN and in lost man days at work. Various types of weight management support exist in the RN; however, some overweight and obese personnel continue to struggle with their weight. Adapting an existing web-based weight loss programme may be a cost effective way for supporting overweight and obese personnel with their weight management efforts. This study aims to understand what factors in the RN environment overweight and obese personnel perceive as influencing their weight management experiences.
Methods: Twenty-one overweight and obese personnel took part in a one-to-one, face-to-face, semi-structured interview. Transcripts were analysed using inductive thematic analysis as described by Braun and Clarke (2006).
Findings: Participants perceived the following factors as influencing their weight management experiences in the RN: the naval environment and culture, influences of others, motivations to manage weight, perceptions of self with regard to excess weight, perceptions of weight management, and explanations for successful and unsuccessful weight management.
Discussion: Findings suggest that even in an environment where resources for weight management are easily accessible and available; some overweight and obese RN personnel may lack the motivation, knowledge and skills to make use of these resources and to successfully manage their weight. The interviews provided new insights about weight management in a predominantly male sample, and the findings were useful for informing modifications to the existing web-based weight loss programme.
Keywords: health behaviour change; weight loss
CORRESPONDING AUTHOR: Garip Gulcan, University of Southampton, UK, gg1g09@soton.ac.uk
P83
ACADEMIC STRESS, COPING STRATEGIES AND HEALTH BEHAVIORS IN UNDERGRADUATE MEDICAL STUDENTS
Diaconescu L V.1, Mihailescu A .1, Dumitru O.2
1 University of Medicine and Pharmacy Carol Davila, Bucharest , Department of Medical Psychology, Bucharest, Romania
2 Hospital Prof Dr Al. Obregia, Department of Psychiatry, Bucharest, Romania
Background: Undergraduate medical students experience a lot of distress during their study (Spangler et al, 2002) when they make efforts to cope with both academic and adjustment issues. Coping styles adopted may be active or avoiding strategies, which may be followed by health risk behaviors (Loureiro et al, 2008). The aim of the study was to establish the level of stress and find coping strategies, potential risk behaviors at undergraduate medical students and study the relationship between them.
Methods: The participants were 152 students randomly selected from first year of medical university: 71 foreign students (mean age 21.48years) and 81 Romanian students (mean age 19.42 years). We have administered Higher Education Stress Inventory, HESI (Dahlin et al), COPE questionnaire (Carver et al), and a life-style inventory and a questionnaire about adjustment problems, developed by us and used for the first time. T-test, one way ANOVA and p < 0.05 as level of significance were used in statistic analysis.
Results: All students reported high academic stress, with no significant difference between Romanians and foreigners (total score on HESI: 72,80 vs 71,11). Romanians had more complaints on HESI factors "workload", “financial problems” and “worries” (p < .001). As coping strategies, Romanian students preferred planning, suppression of competing activities, use of emotional support (p < 0,001), while for foreign students the most frequent were positive reinterpretation, mental and behavioral disengagement, substance use (p < 0,05).
We remarked adjustment problems significantly different in foreigners compared to Romanians: distance from family (F = 21.95, p < 0.001), distance from friends (F = 10.83, p < 0.001), problems with accommodation (F = 11.36, p < 0.001). All students are employing the same methods for helping them adjust. There were health behaviors changes in both groups of students with significant differences (p < 0.05) for consuming more coffee in Romanians and more smoking in foreigners.
Conclusions: Psychological counseling is necessary from the first year of student’s life in order to address the inappropriate coping strategies and risk behaviors in the first months of faculty which could be alarm signals regarding adjustment to stress in their future career as physicians.
Keywords: Stress, Coping, Health behaviors
CORRESPONDING AUTHOR: Diaconescu Liliana Veronica, UMF, Bucharest; idiac2002@yahoo.com
P84
EXPLORING THE RELATIONSHIP BETWEEN QUALITY OF SLEEP AND LEARNING SATISFACTIONS ON THE NURSING COLLEGE STUDENTS IN TAIWAN
Lin MH.1, Chen TN.1, Lee CH.1, Hsu HC.1, Wang BY.2, Lin LH.3, Kao WC.4
1 Chang Gung University of Science and Technology, Department of Nursing, Tao-Yuan, Taiwan
2 Landseed Hospital, Department of Nursing, Tao-Yuan, Taiwan
3 Shuang Ho Hospital, Department of Nursing, Taipei, Taiwan
4 Chang Gung University of Science and Technology, Department of Information Management, Tao-Yuan, Taiwan
Background: Quality of sleep is essential element for learning and memory. Students with sleep disturbance would affect cognitive ability and decrease learning performance.
Purpose: The purpose of this study was to explore the relationship between quality of sleep and learning satisfaction on nursing college students.
Methods: A cross-sectional with correlation study design was employed. 200 students were recruited from the nursing college in northern Taiwan. Pittsburgh Sleep Quality Index and Learning Satisfaction Scale were used for data collection. SPSS for window 17.0 was used for data analysis.
Results: Findings showed: (1) 53% of participants rated their sleep quality as poor; (2) the global learning satisfaction of participants varied between highly satisfaction and satisfaction; (3) the global learning satisfaction was significantly negative related to “subjective sleep quality”, “use the sleep pill”, and “daytime dysfunction”(p < .05), finally, students who were interested in nursing can be explained 10.2% of the total amount of variances in learning satisfaction.
Conclusions/implications for clinic practice: The findings can provide information regarding nursing students’ sleep status and learning satisfaction to school teacher. The information would be helpful as evidences when laying out nursing curriculum to strengthen students’ sleep hygiene and learning of affective domain in the future.
Keywords: Abnormal sleep, Health education
CORRESPONDING AUTHOR: Lin mei-hsiang, "Chung Gung, ROC"; mhlin@gw.cgust.edu.tw
P85
IS PROFESSION ASSOCIATED WITH FEAR OF DEATH?
Zana Á.1, Konkoly Thege B.1, Limpár I.2, Henczi E.3, Golovics P.4, Hegedűs K.1
1 Semmelweis University, Behavioural Science Institute, Budapest, Hungary
2 3Q Educational & Training Center, Budapest, Hungary
3 Zala County Hospital, Zalaegerszeg, Hungary
4 Semmelweis University, Faculty of Medicine, Budapest, Hungary
Research aims: The study examined the association between profession and fear of death. Knowing the attitude of healthcare workers towards death is very important, because their efficiency is associated with their fears. Our aim was to explore which attitudes related to death and dying arouse the strongest fear in participants and find out which training or other intervention will help the helpers to make death-related communication more open, decreasing inner anxiety and improving communication with dying patients and relatives.
Methods: Our quantitative survey took place between 2006 and 2011 in Hungary. Physicians, medical students and other healthcare workers, priests, psychologists, and non-healthcare workers (N = 1062) were asked about their attitude to death by means of the Multidimensional Fear of Death Scale (Neimeyer & Moore 1994, Zana et al 2006).
Results: Profession was significantly associated with the total MFODS score (p < .001) and with all fear of death factors, with the only exception of the seventh factor expressing fear for the body after death. The only systematic trend that emerged was that priests usually had the lowest scores. A notable exception was the sixth factor measuring the fear of conscious death, for which psychologists had the lowest scores. Further, concerning the second factor expressing fear of the dead, doctors and other healthcare workers did not differ substantially from priests. In this case, these groups showed significantly less fear compared with psychologists and non-healthcare workers.
Conclusions: Fear of death seems rather to be present in professions dealing less directly with the dead and dying. Knowledge of the most fearful components helps to find targeted assistance in the work and the daily life, too.
Keywords: Fear of death, mental health, profession, carers
CORRESPONDING AUTHOR: Zana Agnes, Semmelweis University, Budapest; zanagi@net.sote.hu
P86
BURNOUT SYNDROME AND THE USE OF COPING STRATEGIES AT DOCTORS DAILY EXPOSED TO PALLIATIVE CASES
Popa Velea O.
University of Medicine and Pharmacy Carol Davila - Bucharest, Department of Medical Psychology, Bucharest, Romania
Aim: This study examined the association between burnout syndrome and the distribution of preferred coping strategies at doctors working with incurable patients in several representative Romanian clinical services.
Method: 43 doctors, dealing daily with incurable adults, 57 dealing daily with incurable children and 44 controls were tested using COPE questionnaire (Carver et al., 1989) and Maslach Burnout Inventory (Maslach & Jackson, 1986) to determine their preferred coping strategies and burnout scores. The average experience of participants with palliative patients was in all cases higher than 7 years, with a mean of 15,33 (adults) and 16,44 (children). Statistical analysis comprised unpaired Student's t test and one way analysis of variance (ANOVA) to evaluate the effects of coping and demographic variables on burnout scores. Relationships between these variables and burnout were examined by using Pearson correlation coefficients. The relative contribution of different factors to burnout was evaluated using hierarchical linear regression analysis.
Results: Doctors working with incurable cases had a much more substantial use of emotion-centered strategies, such as positive reinterpretation, mental and behavioral disengagement, focus on emotions, denial and religious coping (p < 0,05). Denial, mental disengagement and religious coping were especially prevalent in doctors dealing with children with incurable diseases, compared to other two groups (p < 0,05). The burnout score was higher in both groups of doctors dealing with incurable patients, compared to the control group.
Discussions: The results of this study show a high inefficiency of Romanian doctors working with palliative cases to deal with daily professional stress. Supplementary actions (including psychotherapeutic assistance and active screening for burnout) should be used, to ensure a better efficiency and work satisfaction of these doctors.
Keywords: burnout, palliative, coping strategy
CORRESPONDING AUTHOR: Ovidiu Popa Velea, UMF Carol Davila, Bucharest; opopavelea@hotmail.com
P88
FACTORS ASSOCIATED WITH DEPRESSIVE SYMPTOMS IN A HONG KONG COMMUNITY SAMPLE OF PEOPLE WITH CHRONIC PHYSICAL CONDITIONS
Nan H.1, Lee P.1, McDowell I.2, Stewart SM.3, Lam TH.1
1 The University of Hong Kong, Department of Community Medicine, Hong Kong, China
2 University of Ottawa, Department of Epidemiology and Community Medicine, Ottawa, Canada
3 University of Texas Southwestern Medical Center at Dallas, Department of Psychiatry, Dallas, USA
Aim: Depression occurs commonly in people with chronic illness and is predicted to become one of the two most burdensome diseases worldwide by 2020. Family support is an important Asian cultural value that we hypothesized could protect people with chronic illness from developing depression. We investigated variables associated with depressive symptoms in a Chinese sample with chronic conditions, focusing on the possible protective role of family relationships.
Methods: Data were obtained from the Hong Kong Jockey Club FAMILY Project cohort study in 2009 - 2011, which included 6,195 respondents (age ≥15) with self-reported chronic conditions. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived family support and neighborhood cohesion were also assessed.
Results: The prevalence of depressive symptoms (PHQ-9 ≥5) was 17.0% in those with at least one chronic condition, and was more prevalent in women than in men (19.7% vs. 13.9%; p < 0.001). Satisfaction with family support followed life stress and number of chronic conditions in explaining the third largest variance (standardized coefficients of -0.11, 0.42, and 0.14 respectively, all p < 0.001) in multivariate analyses where body mass index, problem drinking, physical inactivity, and unmarried status were significantly but weakly associated with depressive symptoms. Higher family satisfaction played a stronger protective role against depressive symptoms among women compared to men (p < 0.01).
Conclusion: Acute life stress, including diagnosis of a disease, explains most variance with depressive symptoms in chronically ill Chinese individuals. The culturally salient variable, family support may be an important protective factor in Chinese cultures for individuals with chronic conditions.
Keywords: Depressive symptoms; chronic conditions; family functioning; Chinese; PHQ-9
CORRESPONDING AUTHOR: NAN Hairong, University of Hong Kong, HK; nan.fang08@gmail.com
P89
THE COMPARISON OF FUNCTIONAL STATUS BETWEEN PSYCHOSIS PATIENTS WHO RECEIVED COMMUNITY MENTAL HEALTH SERVICES AND MENTAL HOSPITAL PATIENTS
Idaiani Sri
Ministry of Health of Republic of Indonesia, National Institute of Health Research and Development, Jakarta, Indonesia
Background: Aceh Province is the first province in Indonesia that has been developing the community mental health program. since 2007. The purpose of this study was to compare the functional status of psychosis patients who received community mental health program in community health centers and patients who was only treated to mental hospital.
Methods: This study was conducted in 2011 in Aceh. The design of this study was cross sectional, subjects were psychosis patients; consisted of 194 from community health centers and 112 from mental hospital. The patients were 230 male and 76 women, the average duration of illness was13, 6 years. Patients live in Banda Aceh and partly in the district of Aceh Besar. The rater’s were11 mental health nurses who had trained for this study. The data was collected by visiting patient in their house. The functional status of patients was assessed by Health of Nations (HoNOS) Aceh version that have been tried in advance and had been assessed the agreement among nurses. The numerical data was assessed by two different test of the mean, while the categorical data was assessed by chi square.
Results: The mean of functional status of patients from community health centre was 6.8 and 7.1 for mental hospital patients (p = 0.00)
Conclusion: patients who received community mental health services have a better functional status than patients who only seek treatment at a mental hospital. The community mental health program should be continued to patients with mental disorders, especially for psychosis patients.
Keywords: community mental health, Aceh, functional status, psychosis
CORRESPONDING AUTHOR: Idaiani Sri,NIHRD; sriidaiani@yahoo.com
P90
STATE ANXIETY IN SURGICAL PATIENTS
Cunha M., Lopes P., Aparício G., Albuquerque C.
Instituto Politécnico de Viseu, School of Health, Viseu, Portugal
The state anxiety is an emotion commonly experienced by surgical patients and documented in the literature as a determinant of their well-being, arrogating to preoperative visit as protector of its occurrence and an important indicator of patient satisfaction. Thus, we studied the state anxiety in order to:
- Explain the influence of socio-demographic variables in state anxiety;
- To determine the influence of preoperative visit at the level of state anxiety.
The transversal observational study was conducted in a non-probabilistic sample of 180 pre-surgical patients (55.6% women and 44.4% men) with mean age of 57.25 years, using the Zung Anxiety Scale.
The level of anxiety is high in 51.7% patients (worse in women), mild in 39.4% and moderate in 8.9%. The state anxiety is higher in women (M = 37.39) than men (M = 34.01) (U = 2852.5, p =. 001), and also more severe in the less educated (H = 12,949, p =. 024 ) and older (r =. 233, p =. 002). Age explains 5.4% of the variability in state anxiety. Patients who received preoperative visit were less anxious, but without statistical significance (X2. =. 756, p =. 685).
It is inferred that sex, age and education influence the anxiety state, imposing consider them when planning a visit to the preoperative surgical patients.
Keywords: State Anxiety; Surgery
CORRESPONDING AUTHOR: Cunha Madalena, Polytechnic Institute of Viseu; madac@iol.pt
P91
PREDICTING PROSTATE CANCER SCREENING ATTENDANCE AMONG UNDERSERVED AFRICAN AMERICAN AND WHITE MEN USING THE ATTITUDE – SOCIAL-INFLUENCE – EFFICACY MODEL
Lidell M., Aumiller B., Kluhsman B., Dominic O., Spleen A., Perry-Smith R., Lengerich E.
Penn State Milton S. Hershey Medical Center, Public Health Sciences, Hershey, USA
Purpose: This study examined (1) motivating factors (social influences) for prostate cancer screening with education and with the cognitive element of informed-decision making; (2) the role of social support in prostate cancer screening; and (3) the intention to be screened among medically underserved, low-income African American (AA) men of the recommended screening age of ≥ 50 years and older residing in Harrisburg, Pennsylvania.
Methods: 151 eligible AA engaged in one of five community-based prostate screening offered. Survey 1 (pre-test) and Survey 2 (post-test) assessing soicodemographic variables (age, sex, race/ethnicity, marital status, level of education, level of income, poverty level, insurance status, and employment status) and screening health behaviors (prostate screening status, intention to screen, attitude, belief and knowledge about prostate cancer and screening, attendance of a prostate cancer education session, role of social influence on their decision-making to get screened, and cues to action to get screened for prostate cancer) were administered prior to screening.
Results: We found significant differences (p = 0.04) between agreement on the necessity of screening by race and ethnicity. The social construct indicated that on average screening decisions for men in all groups were affected by their social structure. Men who attended the screening session without an education session (compared to men attending the screening with an education session) were more influenced by their social contacts (p = 0.03). Differences in individual social measures for AA were also observed. AA were more likely to agree with the following statement, “My church thinks I should be screened” (p = 0.03). AA were in agreement with self-efficacy for screening than non-AA men (p = 0.03). 42% of the individuals who attended the prostate cancer screening reported being influenced by another individual in their decision to be screened for prostate cancer. Most participants indicated their significant other had informed them of the opportunity to be screened for free and that significant other gave additional information important to their decision.
Conclusions: A targeted approach for prostate screening among AA may be better than the non-targeted approach.
Keywords: health disparities, self-efficacy, low-income- minority groups, prostate cancer screening
CORRESPONDING AUTHOR: Dominic Oralia, Penn State; odominic@hes.hmc.psu.edu
P92
TRAIT AND EXPERIMENTALLY-MANIPULATED DISGUST INTERACTIVELY PREDICT AVOIDANT DECISION-MAKING IN COLORECTAL CANCER SCENARIOS
Consedine N.1, Reynolds L.1, McCambridge S.1, Bissett I.2
1 University of Auckland, Psychological Medicine, Auckland, New Zealand
2 University of Auckland, Surgery, Auckland, New Zealand
Background: Patients increasing role in treatment decision-making has lead to study of the links between emotions and decision-making. This literature is limited in two ways. First, many studies are cross-sectional, allowing commentary about links but not causality. Second, research has focused on fear and embarrassment but neglected disgust despite theory suggesting it may be a highly health-relevant emotion; symptoms, screening tests, treatments, and their side effects frequently contain disgust elicitors. Because disgust promotes the avoidance of elicitors, it may impact health decision-making.
Methods: 55 men and women completed dispositional measures of disgust sensitivity and frequency before a laboratory visit. Participants were randomized to an olfactory disgust induction or a control condition before completing behavioral decision-making tasks deliberately structured to highlight the more versus less disgusting aspects of colorectal cancer symptoms, screening, drug treatment options, side effects, and surgical choices.
Results: Manipulation checks on experience and behavior confirmed the elicitation of disgust in the experimental condition. Although there were no main effect differences in decision-making across conditions, 2 (condition) x 2 (high/low trait disgust sensitivity(DS)) ANOVA and chi-square analyses showed that decisions were predicted by both trait DS and by interactions between condition and trait DS. Greater trait DS predicted greater delay when confronted with hypothetical symptoms requiring fecal testing, a greater likelihood tolerating embarrassing over disgusting drug side effects, and ranking disgusting side effects (e.g., flatulence, diarrhea) as more off-putting to treatment. Further, high DS persons in the disgust condition were more likely to delay when hypothetical symptoms required collection of a fecal sample and required greater prompting to touch a stoma bag.
Conclusions: Prior work implies that emotions such as fear and embarrassment encourage behavioral “avoidance” in decision-making contexts. The current study extends this work by highlighting the causal role of disgust in colorectal cancer decision-making, suggesting that state and trait disgust may interact to “push” patients down distinct decisional pathways.
Keywords: emotions; decision-making; cancer
CORRESPONDING AUTHOR: Consedine Nathan, University of Auckland, Auckland; n.consedine@auckland.ac.nz
93
ASSOCIATION OF ANXIETY WITH SELF-CARE BEHAVIOURS AND PHYSICAL COMPLICATIONS IN TYPE 2 DIABETES AFTER CONTROLLING FOR DEPRESSION
Smith KJ., Schmitz N.
McGill University, Psychiatry, Montreal, Canada
Background: Within the scientific community there is an interest in psychological variables that are associated with self-care and physical complications in type 2 diabetes. The majority of research in this field concentrates on depression, an outcome shown to be strongly associated with the performance of the self-care regimen and physical outcomes. However, there is evidence that anxiety could also be important to assess. The aim of this study was to assess the impact of clinically significant anxiety on self-care behaviours and physical complications after controlling for depression.
Methods: The Evaluation of Diabetes Treatment study is a longitudinal community-based telephone survey of 2,000 Quebec residents with type 2 diabetes. The baseline portion of this interview was conducted in autumn 2011. Participants were administered a variety of questionnaires including sociodemographic questions, healthcare behaviours and presence of depression (PHQ-9). Clinically significant anxiety symptoms were assessed using a cutoff of ≥10 on the GAD-7. Data were analysed using logistic regression and adjusted for sociodemographic variables and depression.
Results: Preliminary results from 1,689 participants indicate that the prevalence of clinically significant anxiety in this population is 35.3%. Presence of clinically significant anxiety is associated with an increased likelihood of reporting poor eating habits, (1.90 (1.46-2.48), often forgetting to take medication, (1.91 (1.20-3.05), 1 diabetes complication, (1.67 (1.25-2.24) , 2 or more diabetes complications, (2.59 (1.93-3.46), 1 chronic condition, (1.61 (1.14-2.28), 2 or more chronic conditions (2.84 (2.04-3.95) and reporting poor diabetes control (2.03 (1.54-2.68).
Discussion: This data provides evidence that even after controlling for presence of depression, clinically significant anxiety is associated with decreased performance of self-care behaviours and an increased likelihood of having physical complications. This data indicates the importance of anxiety in diabetes and the need for further research into this psychological outcome.
Keywords: Anxiety; Diabetes
CORRESPONDING AUTHOR: Kimberley Smith, McGill University; kimberly.smith@douglas.mcgill.ca
P94
FERTILITY PRESERVATION IN ENDOMETRIOSIS – A POSSIBLE NEW INDICATION?
Vereczkey A.1, Czegle I.2, Margittai É.1, Higi V.1
1 Versys Clinics, Human Reproduction Institute, Budapest, Hungary
2 Semmelweis University, Department of Medicine, Budapest, Hungary
Endometriosis is the abnormal growth of endometrial cells in a location outside of the uterus, e.g. on the ovaries, salpinges, outer surfaces of the uterus or intestines and elsewhere in the pelvic cavity. Endometriosis affects women in their reproductive years, and is one of the leading causes of pelvic pain and infertility in U.S. and Western Europe. The reasons for the decreased fertility are not completely understood, however they involve anatomical, biochemical and hormonal factors.
In severe endometriosis – and in case of inadequate response to medical treatment - the definite solution is surgical, typically carried out by laparoscopy. Endometrial implants may be excised or obliterated by CO2 laser. While surgical treatments are effective, the recurrence rate of the disease is quite high, and repeated operations might result in the destruction of reproductive tissues, mainly the ovaries.
An important task is the preservation of patients’ fertility with the commonly available methods, since many women are nulliparous in the moment of the diagnosis. Fertility preservation is a newly acknowledged technique for preserving eggs, ovarian tissue, testicular tissue and sperm, mostly in case of malignancy. In our study we aimed to examine women’s approach for fertility preservation with severe endometriosis and to map the circumstances, types and conditions which they would undertake to preserve their fertility. Our preliminary results based on data gained from Hungarian women affected by endometriosis (ave.age: 33.88) shows that 94.5% of the patients were aware of the fact that endometriosis decreases chances for pregnancy, 27.8% heard about fertility preservation, 55.5% would surely, 38.9% would probably consider undertaking the method to preserve their fertility. Their compliance for this technique underlies the importance of widening the indication list for fertility preservation, and to enlarge our study for international endometriosis centers.
Keywords: health behavior, OB-GYN disorders
CORRESPONDING AUTHOR: Vereczkey Attila, Versys Clinics, Budapest; attila.vereczkey@versysclinics.com
P95
COMPARATIVE STUDY OF MENTAL RESISTANCE OF FERTILE-AGED WOMEN, POTENTIAL IMPACT OF THE PSYCHOLOGICAL IMMUNE-SYSTEM TO THEIR OFFSPRINGS AND LIFELONG POSSIBILITY OF THE MENTAL PREVENTION
Antal M., Bugán A.
University of Debrecen, Faculty of Public Health, Institute of Behavioural Sciences, Debrecen, Hungary
I prepared my study in 2011 to measure the quality of the psychological immunity of the different maternal status of fertile-age women. There was a distinction between three basic categories in relation to motherhood-statuses: groups of the fertile age childless women, the pregnant women and the 0-2 year-old child care mothers.
Principally, it seems highly important that womankind due to biological and social function are an establishing potency for the following generation. Furthermore, based on analogy of the procedure of the body and soul as a result of the early mother-child relationship, the psychological condition of women is cardinal and a predestinative factor determining the later quality of life of their children. Therefore, the focus of interest was to emphasise what kind of general characteristic can be shown between various women's statuses, what significant changes can be observed in the psychological immune profile of the different life situations women, especially for socially active mothers. During the research I used the three subsequents and factors of the Psychological Immune System Inventory, published in 1997 by Olah and Stattin. The ultimate goal of my investigation is to indicate the positive psychological effect of the community, which I believe to be inherent in the form of group, as a naturally psychological factor, without the intervention of experts to assist the individual to a better psychological development and maintenance. This thesis was demonstrated by using the complete group of mothers, separately studied the group of the “community visitor” and the "stay at home" mothers, observing the potential difference in their psychological condition. Although, there were no chance for longitudinal researches, the most heterogeneous samples possible had been used, meaning education, age and residence, the results were submitted to correction statistical procedures. The results suggest that the above mentioned women statuses show significant differentiations in their psychological immune profiles, which could be stronghold to planning mental health promotion programs. A prominent and important research experience was, that the factors of mental coping skills of socially active " community visitor "mothers outweigh the so-called "stay at home" group largely, presumably they possess more stable mental structure and broadcast it toward their offspring and the social environment, thus underlining the long-term and natural psychological preventive impact of community life.
Keywords: women's health, mental health, parent-child transactions, social support, health promotion, prevention
CORRESPONDING AUTHOR: Antal Margarita Zoe, University of Debrecen, Debrecen; martaantal@yahoo.co.uk
P96
LIFESTYLE DEFENSE MECHANISMS (RED/NH), SELF-EFFICACY (SE) MEASURES AND PHYSICAL SELF-CONCEPT OF THE TENNESSEE SELF-CONCEPT SCALE FOR EVENING COURSE STUDENTS AT THE SEMMELWEIS UNIVERSITY
Sipos K., Győry-Gritz ZS., Tóth L.
Semmelweis University, Faculty of Physical Education and Sport Sciences , Budapest, Hungary
The aim of the study is the examination of the relationship of coping styles, self-efficacy and physical self-concept in connection with demographic questions (age, gender, marital status, number of dependent children, etc), physically active/inactive lifestyle, smoking habit, frequency of medicine use. Sample (N = 155) contains five groups: emergency medical technicians (n = 19), medical nurses (n = 55), optometrists (n = 47), midwifes (n = 13), physiotherapists (n = 11), and students of recreation (n = 10) of evening courses at the Semmelweis University.
Male/female ratio is 18,7 /81, 3%; average age is 33,67 (SD = 8,57). Physically active subjects (N = 74); smokers: 31% of the sample. The sample is divided into subgroups according to demographic variables, smoker/no-smoker, and physically active/ sedentary lifestyle.
Methods: The Hungarian versions of the Lifestyle Defense Mechanisms Inventory’s two subscales (RED/NH), the Schwarzer et al (1993) “Generalized SE”, “SE Towards Physical Exercise” and “SE Towards the Temptation to Smoke” scales; together with the Physical Self-Concept subscale of the Tennessee Self-Concept Scale are the psychometric variables.
Results: gender difference occurs in mean age (p <0,000) and number of dependent children (p <0,001). Females’ age and number of children for them are higher. Smokers – non-smokers’ comparison reveals higher self-efficacy towards the temptation to smoke (p <0,000), and self-efficacy towards physical exercise (p <0,014) for non-smokers.
Four factors are determined according to factor analysis. Factor 1 (self-efficacy towards the temptation to smoke: 0,868; cigarettes per day: -0,817), factor 2 (physical self-concept: 0,892; generalized self-efficacy: 0,764; and self-efficacy towards physical exercise: 0,486), factor 3 (number of dependent children: 0,897; calendar age: 0,848; factor 4 (need for harmony: 0,792; rational/emotional defensiveness: 0,775).
In the Linear regression analysis model the generalized self-efficacy is the most frequent significant predictor of physical self-concept in different subgroups. The second significant predictor of physical self-concept is the self-efficacy towards physical exercise.
Keywords: physical self-concept, self-efficacy, lifestyle defense mechanisms
CORRESPONDING AUTHOR: Sipos Kornél, Semmelweis University, Budapest; sipos@tf.hu
P97
WHAT IS IT THAT WE NEED TO CONTROL IN THE SELF-REGULATION OF BEHAVIOUR?
Borland R.
Cancer Council Victoria, Melbourne, Australia
This paper draws on over 25 years of evaluating the impact of tobacco control interventions and the difficulties smokers have in controlling their smoking to theorise about the role of affective factors (emotions, urges etc) in relation to cognitive efforts at self-control. The theory distinguishes between two systems which are tuned to different contingencies for action: one a reactive, system, essentially our animal selves which is tuned to environmental contingencies and which is the medium through which we behave, and the second our conceptual selves which acts in relation to a conceptualisation of what the person would like to achieve; i.e., their goals. It is theorised that affective charge is the prime determinant of action. Addictions are quintessential examples of where the two systems generate conflicting behavioural tendencies. Rationally generated goals, unless imbued with some affective force, are not sufficient to overcome affectively charged action tendencies to persist in addictive behaviours that emerge from conditioned and other associations with the behaviour we might want to change. It is further theorised that affective reactions to behaviours are retained in memory more strongly than conceptualisations of the source of the affect. It will be so in any situation where experience does not negate the affective reaction. Consequence of this is that reactance to what may be seen as an unnecessary or exaggerated linking of behaviours with negative consequences (e.g., fear evoking communications), may result in undesirable short term outcomes, but will have long term positive effects on inhibiting those behaviours as long as the affective associations are maintained. It is most likely for believed future adverse consequences as immediate experiences do not directly negate the anxiety created by the possibility. Self-regulatory action involves imbuing behaviours with the appropriately valenced affect that will stimulate the desired behaviour change. Recent research on smoking cessation will be used to demonstrate the plausibility of the theory.
Keywords: Health Behaviour Change, Theory
CORRESPONDING AUTHOR: Borland Ron, Cancer Council Victoria; ron.borland@cancervic.org.au
P98
THE IMPORTANCE OF DOMAIN IN THE EVALUATION OF QUALITY OF LIFE IN THE CHILDHOOD
Urzua A.
Universidad Católica del Norte, Department of Psychology, Antofagasta, Chile
Despite the increased research involving quality of life (QoL), there are no studies to explore the impact that it might have on an assessment. This assessment is based on the importance that the children give to each one of the domains that compose their QoL. Therefore, the existing differences in the evaluation are analyzed with a quantitative methodology and under a correlational transversal design. When this evaluation takes place, each child understands the importance of each dimension that is inquired of them in the evaluation. This assessment evaluated 600 children from public, private, and semi-private schools in the city of Antofagasta. Each child had an average age of 12 years old, and the assessment was distributed equally by gender, using a specific questionnaire by the name of KIDSCREEN-27. Results show differences in the perception of the QoL between genders, types of schools, and differences in age. These results are maintained considering the raw scores as decided by importance. There are minor differences between the domain best evaluated and worst evaluated. When ranking by importance, the most evident aspects are age and type of school. The discovered results contribute to the understanding of the cognitive processes involved in the QoL evaluation.
Keywords: quality of life, childhood
CORRESPONDING AUTHOR: Urzua Alfonso, Univ. Católica del Norte, Chile; alurzua@ucn.cl.
P99
ASSOCIATION BETWEEN SELF-EFFICACY, HEALTH BELIEFS, HEALTH BEHAVIOR, AND HEALTH OUTCOMES IN ASIAN AND PACIFIC ISLANDER ADULTS WITH TYPE 2 DIABETES: A STRUCTURAL EQUATION MODEL APPROACH
Inouye J.1, Li D.2, Davis J.3, Arakaki R.3
1 University of Hawaii, Department of Nursing, Honolulu, Hawaii, USA
2 University of Hawaii, Department of Public Health Sciences, Honolulu, Hawaii, USA
3 University of Hawaii, Medicine, Honolulu, Hawaii, USA
Background: Diabetes is a chronic disease that affects about 11.3% of all people aged 20 years and older in the United States according to the 2011 National Diabetes Fact Sheet. Asian Americans are among the fastest growing racial and ethnic groups in the United States with higher prevalence of diabetes (8.4%) than non-Hispanic whites (7.1%). To assess the association between self-efficacy (MDQ), health beliefs (DHBS), health behavior (SDSCA), and health outcomes such as glycosylated haemoglobin (HbA1c), depression, quality of life (DQOL), and general health (SF-36) in Asian and Pacific Islander adults with type 2 diabetes, we used structural equation modeling (SEM) in a cross-sectional study of behavioral and physiological factors from 207 Asian and Pacific Islanders with type 2 diabetes.
Methods: Using the SEM approach, we proposed that health beliefs (DHBS) and self-efficacy (MDQ) are directly related to each other; self-efficacy (MDQ) directly affects health behavior (SDSCA) and health behavior directly affects health outcomes such as glycosylated haemoglobin (HbA1c), depression, quality of life (DQOL), and general health (SF-36).
Results: The final SEM models show that self-efficacy (MDQ) has a positive association with both health beliefs (DHBS) and health behavior (SDSCA). Higher health behavior (SDSCA) scores were associated with lower HbA1c values, lower depression scores, higher quality of life, and better self-appraised general health.
Conclusion: The SEM models indicated the association of self-efficacy and health beliefs on health behavior, and health behavior has direct effects on multiple health outcomes. The SEM models highlighted the important role of self-efficacy during the process of producing the final health outcomes. This provides some evidence for the focus on self-efficacy in future intervention-based studies among Asian and Pacific islanders with type 2 diabetes.
Keywords: Depression, Diabetes, Health behaviors, Health beliefs, Quality of life, Self-efficacy
CORRESPONDING AUTHOR: Inouye Jillian, University of Hawaii at Manoa; jinouye@hawaii.edu
P100
SOCIOECONOMIC DIFFERENCES IN HEALTH BEHAVIORS
Nakata T.
Hokusei Gakuen University, School of Welfare, Sapporo, Japan
The aim of this study is to examine the relationship between health behaviors and social stratification. It is often said that healthy lifestyle forms a connecting link between health and social class. However, there are some exceptions. For example, people who have to work in collaboration with their colleagues tend to have a meal together. Therefore, the relationships are tested qualitatively using ordered logit regression analysis in this study.
This study employed "Japanese Study of Stratification, Health, Income, and Neighborhood (J-SHINE)", which was a large-scale dataset for examine concerning social stratification and health in 2009. The sample included people who is from 25 to 50 years old male and female (n = 4381). And participants resided in 23 wards and neighboring cities in the Metropolis of Tokyo, Japan. The independent variables in this study were three health habitus, which were "alcohol drinking" and "exercise" and 'smoking'. And dependent variables were age, gender, status in employment, household income, educational level, marital status, length of business hours, size of the companies that respondents were working, and Self-Rated Health.
The results of the analysis are as follow; 1) some high-status characteristics affect health behavior and vice versa. For example, low status in employment related to drinking and exercise habit and who is working in big firms tend to be non-smoker. 2) Some high-status aspects incline to bad habit. High status in employment tends to drinking and low status in employment tends not to drink. 3) There are some contradictory results. Both high and low income have an impact on drinking.
This results from this study that applies non-linear models show that both high and low social statuses connected with healthy lifestyle. To seek the other factors that mediate the relationship between social class and healthy behaviors, like ideologies like healthism or behaviors that is internalized by discipline, remain to be solved.
Keywords: Health behaviors, Social class
CORRESPONDING AUTHOR: Nakata Tomoo, Hokusei Gakuen Univ., Sapporo; tnakata@hokusei.ac.jp
P101
APPLYING TRANSTHEORETICAL MODEL (TTM) TO HEARING PROTECTION BEHAVIORS AMONG FIREFIGHTERS IN THE UNITED STATES (US)
Hong O.1, Chin D.1, Feld J.2, Vogel S.2
1 University of California, San Francisco, School of Nursing, San Francisco, USA
2 NorthShore University, HealthSystems, Illinois, USA
Background: Hearing loss due to noise exposure is a significant problem among about over one million firefighters in the US. This permanent and irreversible problem can be almost 100% preventable by the use of personal hearing protective devices (HPDs).
Purposes: To apply TTM and determine stages of change in hearing protection behavior; and to examine relationships of the stages of change with cognitive perceptions on the use of HPDs and hearing ability in firefighters.
Method: A total of 461 US firefighters (mean age = 45years, Caucasian or White = 80%, male = 92%) who completed hearing tests and the pretest survey as a part of ongoing hearing protection and cardiovascular disease prevention interventions were included. Hearing ability was assessed by a standard audiometric test. Stage of change was determined using the algorithm developed by the research team. Cognitive perceptions on the use of HPDs and hearing ability were compared by the stage of change.
Results: The majority of participants (64%) were in the preparation stage and less than 7% were in the active stage (action/maintenance).Participants in the active stage demonstrated significantly greater benefits, self-efficacy, and interpersonal influence; and fewer barriers than those in the inactive (precontemplation, contemplation, or preparation) stages. Objectively measured hearing ability was significantly better for firefighters in the active stage.
Conclusion: The study demonstrated the usefulness of TTM for firefighters’ hearing protection behavior and supports a stage-matched tailored intervention to move firefighters from the inactive stages to the active stage of hearing protection use, in turn to prevent hearing loss.
Keywords: stages of change, hearing protection, cognitive perceptions, firefighters, hearing ability
CORRESPONDING AUTHOR: Chin Dal Lae, University of California, SF; dal.chin@ucsf.edu
P102
A USER-DRIVEN PERSPECTIVE TO CREATING AND USING HEALTH STICKS
Kuosmanen P.1, Pekkarinen S.2, Kempas K.2, Melkas H.2, Valve R. 1, Karisto A.3
1 University of Helsinki, Centre for Continuing Education, Lahti, Finland
2 Lappeenranta University of Technology, Lahti School of Innovation, Lahti, Finland
3 University of Helsinki, Department of Social Research, Helsinki, Finland
The paper focuses on 'hStick' (health stick), an innovative concept being developed in a large Finnish R&D project focusing on two innovative concepts, the hStick and the 'mStick' (reminiscence stick). The hStick is a modernised version of the so-called SOS Passport, in which various health-related data may be saved. It includes the basic information (blood group, illnesses, medication, etc.) that are needed in the case of acute illnesses or injuries. The hStick functions as a means for self-care as well as promotion of one's own health, because a comprehensive selection of information on health and health behaviour may be saved in the stick (e.g., results of various clinical measurements and fitness tests). It may also include the personal living will.
There is an ongoing trend in Finland that health care customers are encouraged to take more responsibility for their health. A problem arises when a service provider or a customer him/herself needs to have access to the customer's health information. Health care information systems of different service providers are still not compatible; customer information is not transferred between information systems of different service providers. This often leads to a situation where no-one - even the patient/customer him/herself - has a holistic perception of his/her health condition. One aim of the hStick is to gather the personal health information in one place and stimulate people to monitor and promote their own health more systematically.
This research assesses impacts and usability of the hStick in different environments. The development of the contents and structure of the hStick have been conducted with a user-driven perspective. In the first phase, the hStick was piloted among five user groups. During the pilots, user experiences were collected and analysed with the help of various techniques (focus groups, interviews, observation, ethnographic techniques).
The results show that the hStick can be accepted easily and is quick to implement when it functions as a means for monitoring one's own health, learning self-care and giving feedback (e.g., concerning physical exercise related to one's personal targets). The stick has also proven to be useful when travelling abroad. Main challenges concerning the hStick are related to information security and fear of viruses.
Keywords: health promotion, technology, participatory research
CORRESPONDING AUTHOR: Valve Raisa, University of Helsinki, Lahti; raisa.valve@helsinki.fi
P103
SUN PROTECTION: EXPLORING PROTOTYPE PERCEPTIONS
Morris K.1, Swinbourne A.1, Harrison S.2
1 James Cook University, Psychology, Townsville, Australia
2 James Cook University, Tropical Medicine and Rehabilitation Sciences, Townsville, Australia
Background and Objectives: In Australia, public health messages have warned of the dangers of excessive UV exposure for more than thirty years, predominantly through promoting increased sun protection and decreased deliberate sun tanning. Research has pushed for increased knowledge of risks, and a reduction in positive attitudes toward tanning. These messages target the reflective, intentional element of behaviour. While this approach has shown some success, it is limited in its ability to be adapted to regions such as North Queensland where comparatively few people intentionally sunbathe. Despite this, the incidence of skin cancer in North Queensland is among the highest in the world. This would indicate that much of the damage due to UV exposure happens whilst going about normal daily activities - by incidental sun exposure. Incidental exposure is not planned or deliberate, thus theoretical modeling used in research should reflect this. The overall aim of the current study is to adopt a dual-processing framework to examine the psychosocial variables associated with incidental sun exposure.
Method: The current study explored perceptions associated with sun-related prototypes. Prototypes are social constructs with social consequences. In a sun protection paradigm these are perceptions about the typical person who deliberately suntans, the typical person who protects themselves from the sun, and the typical person who acquires a tan incidentally. Semi-structured interviews were initially conducted as an exploration followed by a survey which sought to identify the specific characteristics of each of the ‘prototypes’.
Results: Preliminary results indicated that distinct prototypes exist within a sun protection paradigm. Unlike perceptions surrounding incidental tanners and sun protectors, participants held negative perceptions toward the deliberate tanner prototype. Furthermore, individuals tend to align with the incidental prototype - despite engaging in deliberate tanning behaviours. These unrealistic self-perceptions may influence whether individuals attend to health promotion messages which aim to reduce deliberate tanning behaviours.
Conclusions: Individuals’ prototype perceptions may influence not only sun protective behaviours but also attention to health information. Alignment with a ‘prototype’ that is incongruent with actual behavior, while holding negative perceptions toward the deliberate tanner may polarise individuals and inhibit behavioural change. Thus, current health promotion campaigns may not be applicable to North Queensland and other climates where comparatively few people deliberately tan.
Keywords: Health behaviour, Health promotion, Sun safety
CORRESPONDING AUTHOR: Morris Kayla, James Cook University; kayla.morris@jcu.edu.au
P104
SUN BEHAVIOURS AND ILLNESS PERCEPTIONS IN PATIENTS SUFFERING FROM MELANOMA
Vurnek Zivkovic M., Dediol I., Ljubičić I., Šitum M.
University Hospital Centre Zagreb, Zagreb, Croatia
Background: Melanoma is one of the most aggressive skin tumours which accounts for only 3% of all skin cancers, but is responsible for more than 80% of all skin cancer related deaths. One of the major risk factors for melanoma is ultraviolet radiation, which makes sun protection extremely important. Sun protection is a major issue for melanoma patients who have 500 greater chance of developing another melanoma than the general population.
Objective: In this study we examined the perception of melanoma and sun behaviours among melanoma patients and we compared their results with the general population.
Methods: In total, 240 participants were included in the study: 120 patients suffering from melanoma and 120 participants from the general population. The Sun Behaviour Patterns Questionnaire and the Brief Illness Perceptions Questionnaire were used in this study to assess sun behaviours and perception of melanoma.
Results: Melanoma patients have negative attitude towards sunbathing: 63% avoid sunbathing and 25% spend time in the sun only during swimming in the sea otherwise seeking shade, while participants in the control group have more positive attitude toward sunbathing and spend more time in the sun. Results indicate too short time of using sunscreen protection during the year and too small number of people using adequate SPF value, in both melanoma and control group.
Conclusion: The results show inaccurate perception of melanoma, relatively good knowledge about ultraviolet radiation and slightly negative attitudes towards sun protection among both melanoma patients and the general population. These results will be used to develop an educational programme and to create leaflets and posters about melanoma for the patients, but could also serve as a basis for the health prevention campaign for melanoma.
Keywords: cancer, health behaviours
CORRESPONDING AUTHOR: Vurnek Zivkovic Maja, UHC, Zagreb; maja.vurnek@gmail.com
P105
PREDICTING SYRINGE-SHARING INTENTION AMONG CHINESE MALE INJECTING DRUG USERS: AN APPLICATION OF AN EXTENDED HEALTH ACTION PROCESS APPROACH
Tsui HY.1, Lau TF.1, Wang R.2, Chen H.3, Liu C.4, Liu J.5
1 The Chinese University of Hong Kong, Centre for Health Behaviours Research, School of Public Health and Primary Care, Hong Kong, China
2 Center for Disease Control and Prevention, Head Office, Dazhou, China
3 Centers for Disease Control and Prevention, Division of HIV/AIDS, Dazhou, China
4 Centers for Disease Control and Prevention, Head Office, Hengyang, China
5 Center for Disease Control and Prevention, Division of HIV/AIDS, Hengyang, China
Injecting drug use is a major driver of HIV infection in different parts of the world, including mainland China. Syringe-sharing by injecting drug users (IDU) is a very efficient way of HIV transmission. Understanding the underlying factors associated with the risk behavior is of public health importance. This study examined the use of an extended Health Action Process Approach (HAPA), incorporating the addition of anticipated negative affect after syringe-sharing, to predict behavioral intention to avoid syringe-sharing. Data obtained from a cross-sectional survey of 456 Chinese male active IDU (injecting drugs during the last six moths) between the ages of 18 and 45 in mainland China were reported. An anonymous structured questionnaire measuring specific constructs of the motivational phase of the HAPA (including conditional injecting risk perceptions (HIV acquisition as well as transmission to others), outcome expectancies, self-efficacy, and behavioral intention), anticipated negative affect, and background characteristics were developed to collect data. Of all respondents, 28.7% aged between 18 and 30; 27.9% have senior high schools education; 32.9% were currently married; 23.9% injected drugs for 10 years or more; 68.9% injected drugs at least once a day; and 11.2% shared syringes with others in the last six months. Adjusted for significant background factors (use of Methadone Maintenance Treatment or Syringe Exchange Program, multiple sex partnership, and survey sites), perceived risk of contracting HIV via syringe-sharing (Adjusted Odds Ratio (AOR) = 2.11; 95% Confidence Interval (CI) = 1.26-3.54), syringe non-sharing negative outcome expectancies (AOR = 0.58; 95% CI = 0.34-0.99), and syringe non-sharing self efficacy (AOR = 2.76; 95% CI = 1.51-5.06) predicted intention to avoid sharing syringes with others. These HAPA variables remained significant after the addition of anticipated negative affect (AOR = 1.30; 95% CI = 1.05-1.60). Both perceived risk of transmitting HIV to others via syringe-sharing and syringe non-sharing positive outcome expectancies were univariately non-significant. The study demonstrated the utility of the extended HAPA in understanding syringe-sharing behaviors among male Chinese IDU. This informs future design of theory-based interventions.
Keywords: HIV; Health Behaviors; Theory
CORRESPONDING AUTHOR: Tsui HY, Chinese University, Hong Kong; hytsui@cuhk.edu.hk
P106
PSYCHOSOCIAL DETERMINANTS OF PARENTS’ INTENTION TO VACCINATE THEIR NEWBORN CHILD AGAINST HEPATITIS B
Harmsen IA.1, Lambooij MS.2, Ruiter RAC.1, Mollema L.3, Veldwijk J.2, Van Weert YJW.3, Kok G.1, Paulussen TGW.4, De Wit GA.2, De Melker HE.3
1 Maastricht University, Work & Social Psychology, Maastricht, The Netherlands
2 National Institute of Public Health and the Environment, Centre for Prevention and Health services research, Bilthoven, The Netherlands
3 National Institute of Public Health and the Environment, Centre for infectious disease control, Bilthoven, The Netherlands
4 TNO, Quality of Life, Leiden, The Netherlands
Background: From October 2011, the Netherlands started to vaccinate all newborns against hepatitis B. The aim of the present study was to get insight in the psychosocial factors that determine parents’ intention to vaccinate their child against hepatitis B, and to test whether intention to vaccinate is a good predictor of actual vaccination behaviour. This study was conducted before the introduction of the universal hepatitis B vaccination.
Methods: In total, 2000 parents of newborns (0-2 weeks old) received a self-report questionnaire measuring intention towards hepatitis B vaccination and its psychosocial determinants (response rate 45.6%). Participants were invited for follow-up research and offered the opportunity to have their child vaccinated against hepatitis B.
Findings: The findings showed that the large majority of parents intend to vaccinate their child against hepatitis B. The intention to vaccinate was most strongly determined by parent’s attitude towards hepatitis B vaccination, which in turn was positively associated with perceived benefits of the vaccination and perceptions of their child’s susceptibility to hepatitis. The majority of invited parents had their child vaccinated at follow-up (83.7%). Intention was found to be a significant predictor of vaccination behaviour although less strong than expected.
Discussion: It is concluded that Dutch parents were positive towards hepatitis B vaccination in terms of both intention and behaviour. To further sustain parents’ positive attitudes towards hepatitis B vaccination, educational campaigns should strengthen the benefits of vaccination next to emphasizing the child’s risk to hepatitis B infection.
Keywords: Infection, Health behaviors, Decision making, Theory, Children's health
CORRESPONDING AUTHOR: Harmsen Irene, Maastricht University; irene.harmsen@rivm.nl
P107
PSYCHOSOCIAL ASPECTS IN SURGICAL VASCULAR PATIENTS
Diaconescu L V.1, Diaconescu I.2
1 University of Medicine and Pharmacy Carol Davila - Bucharest , Department of Medical Psychology, Bucharest, Romania
2 Institute of Cardiovascular Disease “Prof.dr. C.C.Iliescu”, Vascular Surgery, Bucharest, Romania
Background: Peripheral occlusive arterial disease implies damage of blood-axes of the legs; patients suffer of pain and severe ischemic lesions extending to gangrene and amputation limb-threatening. Venous disease is represented by hydrostatic varicose veins of the legs with discomfort, swelling of the legs and in advanced stages ulcerative lesions
The study’s aim was to analyze the relationship between anxiety, depression, perceived stress and social support at patients with peripheral vascular disease.
Method: The study included a number of 54 patients (38 men and 16 women, mean age = 54,98; SD = 9,31) diagnosed with arterial disease (39 patients) and with venous disease (15 patients). There were applied (before surgery) psychological tests: Anxiety and Depression Scale (HADS, Zigmond and Snaith), Perceived Stress Scale (PSS, Cohen and Williamson), The Duke-UNC Functional Social Support Questionnaire (FSSQ).
Results: Women had higher levels of anxiety and depression than men (ns), higher scores on perceived stress scale (32,94 vs 29, t = -2,26; p < 0,028) but lower scores on social support scale (25,50 vs 30,42, t = 2,13; p < 0,038). Patients with arterial disease had higher scores at anxiety (10,31 vs 8,33, t = 2,58; p < 0,012), depression (7,36vs 5,40, t = 2,05; p < 0,045) and perceived stress (31 vs 28, ns) and lower scores at social support scale (27,62 vs 32,47, t = -2,05; p < 0,045) than patients with venous disease. Both anxiety and depression positively correlated with perceived stress (0,639 respective 0,410; p = 0,01) and negatively with social support (-0,574, respective -0,522; p = 0,01). Age negative correlated with social support (-0,464; p = 0,01).
Conclusions: The indication for surgical treatment of vascular disease is a distress factor, leading to anxiety and depression. The increased anxiety at patients with arterial disease compared with those with venous disease can be explained by greater severity of this group of diseases, higher surgical risks, more frequent complications and a high risk of amputation. Low social support mainly observed in some elderly patients indicate, on the one hand the restriction of support network at this age and, on the other hand, its usefulness especially in the case of diseases that require surgery and postoperative recovery.
Keywords: Anxiety, Depression, Social support, Cardiovascular disease
CORRESPONDING AUTHOR: Diaconescu Liliana Veronica, UMF, Bucharest; idiac2002@yahoo.com
P108
ATTACHMENT THEORY AND ENDOTHELIAL DYSFUNCTION IN POST-MYOCARDIAL INFARCT PATIENTS
Strodl E.
Queensland University of Technology, School of Psychology, Brisbane, Australia
Endothelial dysfunction is an important risk factor for future cardiac events in coronary heart disease patients. Previous research has shown an association between psychological factors such as mood and endothelial dysfunction. This study aimed to extend this research by exploring the association between dimensions of attachment and endothelial dysfunction. A pilot study recruited 24 participants hospitalised with myocardial infarction who displayed elevated levels of Troponin or Creatine Kinase. Endothelial dysfunction was assessed using high resolution ultrasound equipment to measure Flow Mediated Dilation. The participants completed measures of depression, anxiety, anger and attachment. While there were no associations between depression, anxiety or anger and endothelial dysfunction in this study, there was a moderately strong association between endothelial dysfunction and an attachment dimension termed Relationships as Secondary. Relationships as Secondary are constructs that describe a tendency to gain self worth from achievements rather than from relationships. There are similarities between this construct and the construct of Type A Behaviour Personality. The results of the study therefore suggest that Attachment Theory, and in particular the construct Relationships as Secondary, may provide a promising psychological construct to explore the psychophysiological mechanisms associated with coronary heart disease. In addition to presenting the findings of the study, a model will also be presented that uses Relationships as Secondary to explain previous findings of a link between the experience of depression and anger with the occurrence of coronary events.
Keywords: Coronary Heart Disease; Psychophysiology
CORRESPONDING AUTHOR: Strodl Esben, QUT; e.strodl@qut.edu.au
P110
FACTORS ASSOCIATED WITH DEPRESSION AMONG JAPANESE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS
Ichikura K.1, Matsuoka S.2, Kobayashi S.3, Suzuki T.4, Nishimura K.3, Shiga T.4, Suzuki S.5, Hagiwara N.4, Ishigooka J.3
1 Tokyo Medical & Dental University, Section of Liaison Psychiatry & Palliative Medicine, Tokyo, Japan
2 Tokyo Women’s Medical University, Department of Nursing Sciences, Tokyo, Japan
3 Tokyo Women’s Medical University, Department of Psychiatry, Tokyo, Japan
4 Tokyo Women’s Medical University, Department of Cardiology, Tokyo, Japan
5 Waseda University, Faculty of Human Sciences, Saitama, Japan
Introduction: Implantable cardioverter defibrillators (ICDs) are increasingly used for the prevention of sudden cardiac death in patients with life-threatening ventricular arrhythmias. Most ICD recipients are reported to experience depressive symptoms. However little is known of the factors associated with depression in ICD recipients, especially in Japan. The purpose of this study was to identify the impact of sociodemographic, disease-specific, and behavioral factors on depression in ICD recipients in Japan.
Methods: Of all 221 ICD recipients at Tokyo Women Medical University Hospital between 2010 and 2011, 183 participated in our studies. The questionnaire consisted of Beck Depression Inventory (BDI) - 2 and Avoidance Behavior (“I have avoided activity which is likely to trigger ICD shocks.”). Multivariate logistic regression was used to calculate ORs and 95% CIs after controlling simultaneously for potential confounders. Variables considered in the models were sex, family, history of ischemic cardiac disease, history of ICD shocks, avoidance behaviors, and BDI scores.
Results: A total of 118 (64.5%) participants completed all questions in this study. Frequency of self-reported moderate depression was 22.6%; medium depression was 8.4%; and severe depression was1.9%. Avoidance behavior was the only aspect of depression independently associated with sex, family, history of ischemic cardiac disease and history of ICD shocks (OR = 1.72; 95%CI 1.09-2.71).
Conclusion: Our results indicated that most ICD recipients experienced depression in Japan, and the symptoms were related to their avoidance behavior. We recommend that healthcare professionals consider to focus on avoidance behavior when they deal with depression among ICD recipients.
Keywords: Depression, Cardiovascular disease
CORRESPONDING AUTHOR: ICHIKURA Kanako, TMDU, Tokyo; ichikura.lppm@tmd.ac.jp
P111
OPTIMIZING PREOPERATIVE EXPECTATIONS IN HEART SURGERY PATIENTS: A RANDOMIZED CONTROLLED TRIAL
Laferton J.1, Auer C J.1, Shedden Mora M.1, Moosdorf R.2, Rief W.1
1 University of Marburg, Department of Clinical Psychology, Marburg, Germany
2 University of Marburg, Department of Cardiac and Thoracic Vessel Surgery, Marburg, Germany
Patients’ expectations have been identified as an important factor for treatment outcome of several medical conditions. Recent studies suggest a relationship between pre surgery expectations and recovery even after highly invasive procedures like heart surgeries. However, few studies have tried to utilize expectations to enhance patients’ health. Self regulation and illness perception theory with an emphasis on the role of expectations offer a promising framework for designing such an intervention. Purpose: The goal of this study is to evaluate an intervention prior to coronary artery bypass grafting (CABG) in order to optimize patients’ expectations. Method: 60 patients waiting for elective CABG have been randomly assigned to one of three groups: Expectation manipulation intervention (EMI), supportive therapy (SP) or standard medical care (SMC). EMI and SP patients received two individual sessions and two phone calls prior to surgery. Patients’ expectations were assessed before and after the psychological intervention. Additionally all patients were asked how much they would like to talk about their expectations concerning surgery, about their feelings concerning surgery or how much they didn’t want to talk about surgery at all. After the intervention satisfaction with EMI or SP was assessed (7 items scale; score ranging from 5-35). Results: 70.6 percent of all patients expressed the wish to target their expectations, 53.0 percent wanted to talk about their feelings and only 33.3 percent said that they would rather avoid talking about surgery. Satisfaction with the intervention was very high and did not differ significantly between EMI (M = 31.6) and SP (M = 32.4). Pre-post intervention analysis shows a significant improvement of expectations in the EMI group compared to the control groups. Long-term follow up will be finished in the future. Discussion: The results indicate that the majority of patients prefers to talk about their expectations concerning surgery and that they are very satisfied with either EMI or SP. This underlines the need for pre-surgery interventions. Most importantly patients’ expectations in the EMI group improved in comparison to both control groups. Future analysis will show whether improved expectations lead to better recovery from CABG.
Keywords: Coronary heart disease, Health beliefs, Intervention, Outcome expectations, Randomized controlled trial
CORRESPONDING AUTHOR: Laferton Johannes, Phillips University, Marburg; laferton@staff.uni-marburg.de
P112
FACTORS INFLUENCING QUALITY OF LIFE IN CHRONIC HEART FAILURE
Porojan MD., Poanta LI., Carstoc E., Dumitrascu DL.
University of Medicine and Pharmacy Cluj-Napoca, Department of Internal Medicine, Cluj-Napoca, Romania
Background: Cardiovascular diseases still represent the main cause of mortality in Romania. Guidelines pay a significant attention to psycho-social and psycho-educational interventions aimed to improve cardiovascular patients’ quality of life (QoL) and to reduce risk factors.
Aim of the study: To assess the QoL in patients with chronic heart failure (CHF) and the factors influencing QoL.
Material and method: The validated Romanian version of SF-36 questionnaire has been applied in 100 patients (51 females and 49 males, average age ± SD = 69 ± 12,02) diagnosed with chronic heart failure (NYHA class I to IV). 91 patients suffer from ischemic heart disease (IHD), 80 patients from arterial hypertension (AH), 40 patients from diabetes mellitus (DM) and 20 patients from chronic obstructive pulmonary disease (COPD).
Results: Questionnaire’s Alpha Cronbach analysis revealed unfavorable results for items: Role limitations due to physical health, Role limitations due to emotional problems, Social Functioning and General health.
Male gender is negatively correlated with items: Physical functioning, Energy/fatigue and Social functioning (r = 0.0527, r = 0.053, r = 0.0598). Patients’ age is negatively correlated with items: Physical functioning, Energy/fatigue, Social Functioning and Role limitation due to emotional problems (r = 0.1281, r = 0.1207, r = 0.1087, r = 0.064).
NYHA class is negatively correlated with items: Physical functioning, Energy/fatigue and Social functioning (r = 0.1976, r = 0.092, r = 0.15). Statistical analysis revealed a negative association between IHD and Social functioning and Pain scales (r = 0.1318, r = 0.0397). There are no statistically significant correlations between AH, DM or COPD and QoL domains.
Conclusions: QoL in patients with CHF is influenced, besides the disease, by many other variables. Age, sex, associated diseases and NYHA class significantly influence QoL scores.
The management of CHF must include the QoL domains, in addition to standard therapy.
Keywords: quality of life, cronic heart failure, cardiovascular disease
CORRESPONDING AUTHOR: Porojan Mihai, Cluj-Napoca Medicine University; porojan78@yahoo.com
P113
CONTROLLABILITY FOR HEALTH PREDICTS DEPRESSIVE SYMPTOMS IN PATIENTS WITH HEART FAILURE
Matsuoka S.1, Ichikura K.2, Kobayashi S.3, Suzuki T.4, Nishimura K.3, Siga T.4, Hagiwara N.4, Suzuki S.5
1 Tokyo Women’s Medical University, Graduate School of Nursing, Tokyo, Japan
2 Tokyo Medical & Dental University, Graduate School of Medical & Dental Sciences, Tokyo, Japan
3 Tokyo Women’s Medical University, Department of Psychiatry, Tokyo, Japan
4 Tokyo Women’s Medical University, Department of Cardiology, Tokyo, Japan
5 Waseda University, Faculty of Human Sciences, Saitama, Japan
Introduction: Depression is common among patients with heart failure (HF). Depressive symptoms have a profound effect on morbidity, mortality, and health-related quality of life among patients with HF. Although physical functioning, perceptions, and social support are important in predicting depressive symptoms among patients with HF, the relative importance of each of these factors remains unclear. The purpose of this study was to determine the associations between depressive symptoms and heart failure physical functions, social support, self-efficacy, and cognitive control.
Methods: Of all 201 inpatients with HF, 165 (82.1%) participated in our survey. The subjects answered the questionnaire that comprised the following measures: demographics, clinical factors, Patient Health Questionnaire-9 (PHQ-9), the self-efficacy scale for health behaviour (subscales: active coping behaviour with disease and controllability for health), and cognitive control scale.
Results: Of the total patient group, the mean age was 61.84 years (range: 34–83 years), and 39.4% of the patients were older than 70 years of age. Overall, 61.9% were male and 38.1% were female. A total of 22.1% ware classified as having depressive symptoms (PHQ-9 > 10). Further, correlation analyses indicated that depressive symptoms were significantly associated with living alone, NYHA class, cognitive control, and controllability for health score. Including these variables in one regression equation predicting depressive symptoms indicated that controllability for health was the only variable to predict depressive symptoms independent of other significant bivariate predictors.
Conclusions: Even if there are physical limitations, controllability for health reduces depressive symptoms. This cognitive factor may play a salient role in the treatment of depression in patients with HF.
Keywords: Depression, Cardiovascular disease, Self-efficacy, Cognitive factors
CORRESPONDING AUTHOR: Shiho Matsuoka, Tokyo Women’s Medical University; matsuoka.shiho@twmu.ac.jp
P114
NO ASSOCIATIONS BETWEEN ALCOHOL CONSUMPTION AND IDIOPATHIC DEEP VENOUS THROMBOSIS
Hotoleanu C., Dumitrascu DL.
1 University of Medicine and Pharmacy Iuliu Hatieganu, Medicala II Department, Cluj-Napoca, Romania
Background: it is well known that low to moderate alcohol consumption can protect against coronary artery disease, whereas heavy drinking is associated with increased cardiovascular risk; these effects were less studied in deep venous thrombosis (DVT); several data show the decrease of the DVT risk in case of low to moderate consumption, whereas other studies failed to reveal any effect.
Aim and Method: We aimed to study the role of light to moderate, respective heavy alcohol consumption, in idiopathic DVT. We enrolled, after informed consent, 34 patients with idiopathic DVT and 34 sex and age matched controls (mean age: 61.63, respective 60.44 years old). Light to moderate alcohol consumption was defined as less than 15 drinks (alcohol units)/week or less than 5 drinks/day (4 in women); heavy drinking was defined by at least 15 drinks/week or 5/day (4 in women).
Results: we identified light to moderate drinking in 21 DVT cases (61.76%) and in 24 controls (70.58%), p = 0. 608, OR = 0.67, [95% CI, 0.2448 –1.8504], whereas heavy drinking was found in 13 DVT cases(38.24%), respective 9 controls (26.47%), p = 0.437, OR = 1.71, [95% CI, 0.6145- 4.8122], showing no significant associations with DVT (no protective role, neither risk factor). One control denied any form of alcohol consumption. Although women presented preponderantly light to moderate consumption, 14 in DVT group (66.6%) and 18 in controls, (75%), there were no significant differences according to the sex in the pattern of drinking, between DVT group and controls, p = 0.742.
Conclusions: there are no significant associations between alcohol consumption and the DVT risk. In our study, light to moderate consumption has not proved a protective role for DVT.
Keywords: alcohol, cardiovascular disease
CORRESPONDING AUTHOR: Hotoleanu Cristina, UMF Iuliu Hatieganu, Cluj-napoca; cdhotoleanu@yahoo.com
P115
A STUDY OF NEURAL TISSUE IMPLANTATION FOR THE TREATMENT OF PARKINSON'S DISEASE: CAN QUALITY OF LIFE AT BASELINE PREDICT PATIENT OUTCOME 10 YEARS LATER?
Fazio E.1, McRae C. 2
1 University of Denver, Counseling Psychology, Denver, United States
2 University of Denver, Counseling Psychology, Denver, USA
Background: Parkinson’s disease (PD) is a chronic, progressive condition that affects the physical, emotional, and social functioning of individuals. Freed et al. (2001) conducted a double-blind sham surgery-controlled trial to investigate the effectiveness of neural tissue implantation for the treatment of advanced PD. The authors of that study examined the effects of the surgery across the dimensions of physical and neurological functioning following the one year period of the double-blind. A concurrent quality of life (QoL) study was conducted to determine if there were differences in QoL when comparing those who received the neural tissue implantation with those who received the sham surgery (McRae et al., 2004). Authors also examined outcomes based on perceived treatment, or type of surgery patients thought they received. Results indicated there were few differences based on actual treatment, but numerous differences and changes over time based on perceived treatment. While there is little research on the effectiveness of neural tissue implantation as a treatment for PD, there is even less literature on longitudinal effects of this treatment. This study examined longitudinal QoL among participants who received the neural implant surgery beginning in 1995.
Methods: Participants included 11 of the 29 people who were in the original QoL study. The remaining 18 participants had either died or could not be located. Participants completed questionnaires that assessed the Physical, Emotional and Social dimensions of QoL. Regression analyses were used to determine whether any baseline variables predicted current Physical functioning.
Results: Results indicated that perceived Social support at baseline significantly predicted participants’ Physical functioning over ten years later (p < .05). Level of Physical functioning was consistent across time; i.e., participants who reported better Physical functioning at the most recent assessment also had better Physical functioning at baseline when compared to the total original QoL sample (p < .05).
Conclusions: Results indicated that greater perceived Social support before surgery was related to better Physical functioning 10 years later in this very unique sample of PD patients.
Keywords: Social support, Parkinson's disease, quality of life
CORRESPONDING AUTHOR: McRae Cynthia, University of Denver, Denver, CO; cmcrae@du.edu
P116
PREDICTORS OF QUALITY OF LIFE AMONG PERSONS RECEIVING DEEP BRAIN STIMULATION: A LONGITUDINAL STUDY
Chiang K.1, McRae C. 2
1 Brown University, Biological and Health Psychology, Providence, USA
2 University of Denver, Counseling Psychology, Denver, USA
Background: Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder that primarily affects movement, but also affects emotional and social functioning. Evidence suggests that quality of life (QOL) in PD improves after Deep Brain Stimulation (DBS) neurosurgery, one of the interventions currently available to treat PD. Because most DBS studies have assessed only short-term QOL outcomes (3 to 36 months), little is known about its long-term effects. This study assessed QOL among DBS recipients approximately 8 years post-surgically.
Methods: The original sample of 28 individuals responded to assessments at baseline, 12, 24, and 36 months; 16 (6 females and 10 males) participated in the long-term follow-up study. Average age was 63.5 years (SD = 8.1); average disease duration was 20.6 years (SD = 5.7). All underwent bilateral subthalamic nucleus (STN) DBS over a one and a half year period. QOL was evaluated with the Parkinson’s Disease Questionnaire-39 (PDQ-39), consisting of 8 subscales measuring differing QOL aspects. Linear regression analyses were used to determine which demographic and disease related variables at baseline predicted QOL at long-term follow-up (M = 7.6 years after surgery; SD = 1.3).
Results: Regression analyses indicated that longer disease duration predicted less Stigma (β = -.367, t = -2.844, p ≤ .007), better Emotional Well-Being (β = -.392, t = -3.045, p ≤ .005) and greater perceived Social Support (β = -.780, t = -2.352, p ≤ .03). Age (being older) was also a predictor of less Stigma (β = -.468, t = -5.023, p ≤ .001). Time since surgery predicted greater Cognitive Impairment (β = .211, t = 2.119, p ≤ .04).
Conclusions: It appears that age and having experienced PD for a longer period of time are related to less stigma in regard to PD, which typically becomes a very obvious condition over time. Longer disease duration also appears to be associated with better emotional functioning and more social support among patients who have received DBS. Additional research with a larger sample is needed to investigate the long-term trajectory of improvement and decline in QOL and to learn more about the effect of DBS on PD patients and how to help patients cope with changes over time.
Keywords: Quality of Life, Parkinson's Disease, Deep Brain Stimulation
CORRESPONDING AUTHOR: McRae Cynthia, University of Denver, Denver, CO; cmcrae@du.edu
P117
ACCEPTANCE AND COMMITMENT THERAPY FOR FIBROMYALGIA SYNDROME
Bigatti S.1, Steiner J.2, Merwin R.3, McCracken L.4
1 Indiana University Purdue University Indianapolis, Department of Public Health, Indianapolis, USA
2 Indiana University Purdue University Indianapolis, Department of Psychology, Indianapolis, USA
3 Duke University Medical Center, Psychiatry and Behavioral Sciences, Durham, USA
4 Kings College London University, Health Psychology, London, United Kingdom
Fibromyalgia (FM) is a chronic pain condition that is often resistant to treatment. Patients with this condition often struggle for control over their pain in ways that create more disability and distress and not less. Acceptance and Commitment Therapy (ACT) is a treatment that addresses maladaptive avoidance and control and helps patients instead to channel their energy into developing a rich life in a way that allows the pain to be a part of it. The present pilot study tested whether an 8-week ACT intervention could improve physical, social, and emotional functioning of FM patients from baseline to post treatment and 12 week follow-up. To date, 24 female participants (mean age = 46.19, SD = 12.9) have been randomly assigned to an ACT or attention control group, and the final six have been recruited but not yet randomized. Method: Participants attended individual treatment once weekly for eight weeks, receiving either ACT or an education/attention control. Assessments of physical (Fibromyalgia Impact Questionnaire, PROMIS Physical Functioning Scale, Pain Visual Analog Scale, Brief Fatigue Inventory), social (PROMIS Satisfaction with Social Roles), and emotional functioning (PHQ-9) were completed prior to the intervention, immediately following treatment, and 12 weeks after completion. Results: Paired sample comparisons of ACT group revealed statistically significant improvements from baseline to post intervention, which were maintained at 12 week follow-up for overall fibromyalgia impact (t = 3.83, p = .003), depression (t = 2.60, p = 0.03), and social functioning (t = -4.99, p =0.001). Statistically significant improvements from baseline to post intervention were also found for pain (t = 2.25, p =0.048) and fatigue (t = 3.86, p = 0.003) that were not maintained at final assessment. There were no significant improvements at any time point for physical functioning. Group comparisons will be made once all data collection has ended, and presented at the conference. Conclusions: ACT shows promise as an effective intervention to reduce FM symptoms and improve functioning.
Keywords: Pain Fatigue Functioning Depression
CORRESPONDING AUTHOR: Bigatti Silvia, IUPUI, Indianapolis; sbigatti@iupui.edu
P118
MUSCLE POWER AND SELF-EFFICACY BELIEFS AS A DETERMINING FACTOR FOR PHYSICAL FUNCTION IN PEOPLE WITH OSTEOARTHRITIS OF THE HIP
Bieler T.1, Magnusson P.1, Kjær M.2, Beyer N.1
1 Bispebjerg Hospital, Musculoskeletal Rehabilitation research Unit, Department Physical Therapy, Copenhagen, Denmark
2 Bispebjerg Hospital, Institute of Sports Medicine – Copenhagen, Copenhagen, Denmark
Background: In persons with unilateral osteoarthritis of the hip (HOA) the affected leg is weaker compared with the non-affected. HOA is a leading cause of pain, disability, poor self-reported health and limitation in social activities, and self-efficacy beliefs appear to be important in understanding the functional decline that occurs.
Objectives: The purpose of this study was to investigate the relationships between muscle strength and power, self-efficacy beliefs and physical function in a subset of patients in a randomized controlled trial investigating the short and long term effects of home based exercise, strength training and Nordic Walking in patients with HOA.
Method: Elderly persons with primary unilateral symptomatic HOA were included. Outcome measures were maximal isometric Quadriceps torque/body weight (Quadriceps torque/BW), leg extension muscle power/body weight (muscle power/BW), objectively measured physical function: timed stair climbing (Stair), 30s sit-to-stand (STS), and 6-minute walk test (6MW), self-reported physical function (WOMAC) and self-efficacy beliefs in conjunction with stair climbing.
Results: The participants (n = 30) were 70 ± 6 years (mean ± SD). The relationship between muscle strength/power and physical function was stronger in the affected leg compared with the non-affected. In the affected leg the relationship between muscle power/BW and physical function (Stair: rs = -0.788; STS: rs = 0.797; 6MV: rs = 0.823, p = 0.0001) was stronger compared to Quadriceps torque/BW (Stair: rs = -0.446; STS: r = 0.613; 6MV: r = 0.705, p < 0.013-0.0001). Self-reported physical function was significantly correlated with muscle power/BW (rs = 0.415, p = 0.02) but not with Quadriceps torque/BW (rs = 0.110, p = 0.564). The relationship between self-efficacy beliefs and muscle power/BW (rs = 0.620, p = 0.0001) was stronger compared to Quadriceps torque/BW (rs = 0.440, p = 0.02)). Self-efficacy beliefs were significant correlated with both physical function (Stair: rs = -0.540, STS: rs = 0.576, 6MV: rs = 0.606 (p < 0.001-0.0001)) and self-reported physical function (rs = 0.730, p = 0.0001).
Conclusion: In persons with HOA the relationships between muscle power/BW and objectively measured physical function, self-reported physical function and self-efficacy beliefs were stronger compared to Quadriceps torque/BW. Further, self-efficacy beliefs are related to both self-reported and objectively measured physical function.
Keywords: Chronic Disease, Musculoskeletal disorders, Disability
CORRESPONDING AUTHOR: Bieler Theresa, Bispebjerg Hospital; theresa.bieler@get2net.dk
119
STEPPING UP: FLEXIBLE WEB-BASED SELF-MANAGEMENT INTERVENTION FOR PEOPLE WITH MUSCULOSKELETAL AND MENTAL HEALTH CONDITIONS
Dodson S.1, Batterham R.1, Ginifer Y.1, Buchbinder R.2, McCabe M.3, Bentley S.4, Cavill S.5, Osborne R.1
1 Deakin University, Public Health Innovation Unit, Melbourne, Australia
2 Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
3 Deakin University, Department of Behavioural Sciences, Melbourne, Australia
4 Deakin University, School of Medicine, Melbourne, Australia
5 Southern Health, OA Hip & Knee Service, Melbourne, Australia
Musculoskeletal conditions are a common cause of severe, long-term pain and disability. The burden of chronic disease can potentially be reduced through self-management programs, and the internet is increasingly being used as a viable delivery option. Stepping Up, a web-based self-management intervention based on best practice in adult education and CBT was developed to enable people to improve their physical and psychosocial health. A unique feature of the program was that each participant received a tailored program of between 5 and 15 modules based upon a collaborative discussion of needs and circumstances. This study aimed to test the intervention in a real world setting.
Method: Participants were 40 adults (33% men) with a range of musculoskeletal conditions. The mean age was 48 (range 22 to 85 years). Many reported a mental health diagnosis (33%), and 49% reported multiple chronic conditions. Participants took part in a low intensity program; initial phone interview, a personalised set of modules to work through independently over 4-10 weeks, weekly email support and phone review. Outcomes included pre-post questionnaires, and clinician and self-reported improvements in symptoms and behaviour.
Results: Significant improvements were observed in the Emotional Distress, Skill and Technique Acquisition and Social Integration and Support scales of the Health Education Impact Questionnaire (effect size: -0.55; 0.77; 0.43 respectively, P < 0.05 for all). Improvement in Health-related Quality of Life was very large: 0.11 utility units (P < 0.01 minimally important difference >0.06 units). Over 50% of participants gave comments of high praise about the program at follow-up, and over 90% listed specific changes in behaviour that they directly attributed to the program. The most frequent response to questioning about helpful aspects of the program was that it was the program as a whole and the way it fitted together. Conclusion: These findings indicate that the Stepping Up web-based self-management support intervention can achieve significant improvements in emotional distress, behaviours, skills, and social support. Acceptability is also very high. Future work will expand the program to other conditions and build in web-based clinician training.
Keywords: Chronic Disease, Depression, Anxiety, e-Health, Health behavior change, Musculoskeletal disorders, Self Management, Web-based
CORRESPONDING AUTHOR: Dodson Sarity, Deakin University, Melbourne; sarity.dodson@deakin.edu.au
P121
A COMPARISON OF THE EFFECTS OF TWO TREATMENT MODELS FOCUS ON CBT ON RESPONSES TO CHRONIC BACK PAIN
Shakib M., Hashamian K.
Alzahra University, Department of Psychology, Tehran, Iran
Objective: The purpose of this study was to compare the efficacy of cognitive–behavioural therapy focused on graded exposure versus focused on attention management on reducing pain-related fear, pain intensity, depression and increasing the pain acceptance in Iranian chronic back pain patients.
Method: The research was employed case study with multiple baseline design with control group. 15 Iranian chronic back pain patients were selected among patients had referred to Tehran Clinics and were randomly assigned to 2 experimental and 1 control groups. Then CBT focused on exposure was applied for experimental group 1 and CBT focused on attention management was applied for experimental group 2, for 9 sessions and control group assigned into waiting–list for treatment. Pain intensity were measured as daily assessments during baseline and treatment phase and depression, fear of movement and pain acceptance were assessed weekly.
Result: The results of visual and statistical analysis indicated that there were significant differences in all variables between experimental groups 1, 2 with control group (P < 0.01) and there were significant differences in fear of movement and pain acceptance between experimental groups 1, 2 and these results remained at the 3 month follow-up period.
Conclusion: this research suggested that both treatment conditions had equal significant effects on reduction in pain intensity, depression, although CBT focused on exposure had most effectiveness on reduction in fear of movement and increase in pain acceptance.
Keywords: chronic back pain, CBT focused on graded exposure, CBT focused on attention management
CORRESPONDING AUTHOR: Shakib Minoo, Alzahra University,Ttehran; m.sh.shakib@gmail.com
P122EMPATHY FOR PAIN PATIENTS DEPENDS ON INGROUP/OUTGROUP DECISIONS: AN FMRI STUDY
Ruckmann J.1, Bodden M.2, Dodel R.3, Rief W.1
1 University of Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany
2 University of Bonn, Department of Clinical Psychology and Psychotherapy, Bonn, Germany
3 University of Marburg, Department of Neurology, Marburg, Germany
Showing empathy and understanding how others feel, think and behave, is crucial for social functioning. A close relationship between empathy, social cognition and psychological disorders is assumed. Pain empathy is as an example for empathy in general. It is modulated by different factors. These are situational variables, as well as target features and observer characteristics. Several studies have shown that empathy is also related to group membership and the social relation between the person showing empathy and the person receiving empathy (e.g. ethnicity). The current study investigates the influence of experimentally induced group membership on empathy for pain.
Thirty-two right-handed, healthy volunteers participated in an fMRI-experiment. Group membership was manipulated by a minimal group paradigm. To assess neural processes associated with pain empathy, we assessed fMRI reactions during the presentation of pictures showing hands and feet in painful and non-painful everyday situations. These pictures were experimentally assigned to either ingroup or outgroup members. Participants were instructed to empathize with persons shown on the pictures. They also had to rate the intensity of the pain the person on the photograph may have, using a visual analog scale.
There was no ingroup bias in pain intensity ratings. Although, participants watching ingroup members experiencing pain showed higher neural activation in regions of the affective pain matrix (ACC, anterior insular cortex). Higher activation in these areas indicates a stronger feeling of empathy. In neutral situations, these differences between brain activation patterns between ingroup and outgroup members were not found. Additionally, a positive correlation between self-reported empathic concern and pain-related neural activation was confirmed.
These findings confirm neural correlates of differences in pain empathy for members of ingroups and outgroups. Self-reported empathic concern and neural activation are significantly related. Our findings underline the relevance of pain empathy for interactional processes with patients suffering from pain and somatization.
Keywords: fMRI, pain
CORRESPONDING AUTHOR: Ruckmann Judith, University of Marburg, Marburg; ruckmann@staff.uni-marburg.de
P123
ETABP: EXPOSURE-BASED TREATMENT FOR AVOIDANT BACK PAIN PATIENTS – DEVELOPMENT OF A TREATMENT PROTOCOL AND A RANDOMIZED CONTROLLED TRIAL
Riecke J., Holzapfel S., Rief W., Glombiewski JA.
University of Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany
Chronic low back pain (CLBP) is one of the most common health problems in Western societies. The focus of new CLBP treatments lies on tailored interventions for specific subgroups. Pain patients with substantial pain-related fear represent a subgroup, and exposure in vivo could be the indicated treatment. Purpose: We plan to include 120 patients in an RCT comparing exposure in vivo to standard CBT for fear avoidant CLBPP in an outpatient setting in Germany. The purpose of the present study is to develop a protocol to assess the feasibility of exposure in vivo (ETABP) in comparison to standard CBT. Intervention: We modified a protocol developed by Vlaeyen et al. (2007) for a German outpatient setting (psychotherapy clinic). Additionally, a comparable CBT protocol was designed. Both treatments consist of 15 weekly individual sessions. ETABP mainly comprises 5 (short form) to 10 (long form) exposures to movements that have been avoided due to fear of (re)injury. The treatments were enriched with behavioral experiments. The CBT arm includes three modules: graded activity, relaxation techniques, and cognitive interventions.
Method: 21 CLBPP were randomly assigned to ETABP or to standard CBT. The inclusion criteria were CLBP and an increased level of fear avoidance. Outcome measures were recorded at baseline, week 10, week 15 and 6 months. The primary outcomes were disability (PDI) and pain severity (NRS). As secondary outcomes fear avoidance, catastrophising and physical activity were assessed. After the intervention we investigated the global perceived effect and satisfaction with ETABP or CBT.
Results: The treatment was well accepted and satisfaction with the intervention was very high with higher ratings for CBT. In the ETABP condition more dropouts (n = 5) were observed. Short term data showed differences in physical disability with a tendency toward more reduction for ETABP than CBT.
Conclusion: The proposed ETABP protocol is an effective and accepted treatment for avoidant CLBPP in an outpatient setting. The advantages in comparison to standard CBT are a more specific approach regarding fear avoidance and the promising effects on reducing disability via pain related fear.
Keywords: Musculoskeletal disorders, randomized controlled trial
CORRESPONDING AUTHOR: Riecke Jenny, Philipps University Marburg; rieckej@staff.uni-marburg.de
P124
CHRONIC BACK PAIN- THE STATUS OF EVIDENCE OF PSYCHOLOGICAL INTERVENTIONS
Kröner-Herwig B.
Univerity of Göttingen, Clinical Psychology and Psychotherapy, Göttingen, Germany
The European guideline on chronic non-specific back pain gave a quite sobering account on the medical treatment options for this disorder, recommending only a few options as helpful and efficacious.
Since CBP is one of the most prevalent and t costly disorders in western countries, disabling individuals in their performance of daily activities and reducing quality of life, the question,
We analyzed the status of evidence of psychological and interdisciplinary interventions on the basis of meta-analyses of RCT studies and recently published original research studies.
Within a behavioral medicine perspective various treatment approaches have been examined, including the well- known self-regulations strategies like relaxation and biofeedback, the early operant techniques, the newly developed confrontation treatment based on treatment of phobias, multimodal cognitive- behavioral treatments most of the and last but not least Acceptance and Commitment Therapy including interventions from the Buddhist meditation practice. As special format we considered multidisciplinary therapy where in general psychological interventions are integrated into a multimodal systematic approach integrating different disciplines.
On the basis of a large magnitude of studies we come to the conclusion that psychological treatments have proven their efficacy and can be recommended on level I according to EBM, but we also found out that the size of efficacy is modest showing mostly small to moderate effect sizes. Not only on pain itself but also on quality of life, disability and return to work positive outcomes have been observed. Reliable differences in the efficacy of different psychological treatments have not yet been statistically maintained. The modest success has been somewhat disappointing, since earlier studies suggested a general superiority of psychological and multidisciplinary treatment strategies.
Some authors have suggested that the limits of efficacy of psychological intervention have not yet been established, as in many studies the quality of treatment has probably been low regarding the amount of intervention offered to highly chronic patients, the adaptation of the treatment to the patient’s individual syndrome and the competence of the therapists.
Keywords: back pain, psychological treatment
CORRESPONDING AUTHOR: Kröner-Herwig Birgit, Göttingen,University Göttingen; bkroene@uni-goettingen.de
P125
HEADACHE DISORDERS IN CHILDREN AND ADOLESCENTS: THEIR ASSOCIATIONS WITH PSYCHOLOGICAL, BEHAVIOURAL AND SOCIO-ENVIRONMENTAL FACTORS
Kröner-Herwig B., Gaßmann J.
University of Göttingen, Clinical Psychology, Göttingen, Germany
The cross–sectional study on a randomly drawn population sample of children and adolescents (n = 3399; age 9-15 yrs.) aimed at the assessment of patterns of associations between psychosocial variables and particular headache types, i.e. migraine (MIG), tension-type headache (TTH) and a headache category denoted as unclassifiable headache. A no-headache group served as a control. Data on headache and psychological trait variables (e.g. internalising symptoms), behavioural factors (e.g. physical activities) and socio-environmental factors (e.g. life events) were gathered by questionnaire. Logistic regression analyses were conducted with headache types as dependent variables. The pattern of correlations was largely congruent between the headache disorders. Associations were closest regarding maladaptive psychological traits (in particular internalising symptoms with an OR >4 regarding MIG) when compared to socio-environmental factors and particularly the behavioural factor. Unfavourable psychological traits and socio-environmental strains demonstrated distinctly stronger associations to MIG than to TTH. Psychological traits explained more variance in the occurrence of paediatric headache disorders than parental headache. Sex specific analyses showed similarities as well as differences regarding the correlations, while in general the associations were stronger in girls. A common path model as forwarded by Kato et al (2009) may explain the parallelism in bio-psychosocial vulnerability.
Keywords: Headache, children
CORRESPONDING AUTHOR: Kröner-Herwig Birgit, Göttingen,University Göttingen; bkroene@uni-goettingen.de
P126
HIGHER SCORES, BUT LESS FEAR? GENDER DIFFERENCES IN FEAR-AVOIDANCE
Holzapfel S., Riecke J., Rief W., Glombiewski J.
University of Marburg, Clinical Psychology and Psychotherapy, Marburg, Germany
Theoretical Background: Substantial evidence indicates that women report more fear than men (McLean et al., 2009). But, data from different countries and different pain diagnoses show that men score significantly higher on the Tampa Scale for Kinesiophobia (TSK), a self-report instrument measuring fear-avoidance beliefs in chronic pain patients (Roelofs et al., 2011). In the present study, we investigated gender specific reactions to feared movements.
Methods: 86 chronic low back pain patients (CLBP) and 41 healthy controls (HC) (55% female) were administered the Photograph Series of Daily Activities (PHODA), the TSK, the Pain Anxiety Symptoms Scale (PASS-20) and the Fear Avoidance Beliefs Questionnaire (FABQ). Afterwards they were asked to perform movements previously rated as most fearful (e.g. bending forward, lifting a water box) and to rate their state fear on a Visual Analog Scale (VAS) and a Numeric Rating Scale (NRS).
Results: Male CLBP patients scored higher on the TSK than female patients (F = 5,571; p < .05), but reported less fear on VAS (F = 3,047; p < .10) and NRS (F = 7,522; p < .05) scores. Gender differences on item-level showed significantly higher scores for males for TSK-Items 2, 7 and 17 (p < .05)(e.g. „Pain always means I have injured my body”, „If I were to try to overcome it, my pain would increase“). No gender differences were observed on other fear-avoidance measures like PASS (F = 0,071; p > .05) or FABQ (F = 0,810; p > .05). There were no gender differences in healthy controls in TSK-scores (F = 0,443; p > .05), VAS (F = 1,191; p > .05) and NRS (F = 0,103; p > .05) ratings.
Discussion: The results show that gender differences have to be taken into account when assessing and treating fear-avoidance in CLBP patients. Item analyses imply that men’s pain concepts might be more biologically oriented. Thus, therapeutic interventions should put special emphasis on changing male patients´ pain concepts towards a biopsychosocial perspective. During exposure to feared movements male patients might underestimate their actual fear.
Keywords: Pain, Gender
CORRESPONDING AUTHOR: Holzapfel Sebastian, Philipps-University, Marburg; sebastian.holzapfel@uni-marburg.de
P128
MEDICALLY UNEXPLAINED SYMPTOMS: DO HIGH SYMPTOM REPORTERS SHOW DEFICITS IN EMOTIONAL AWARENESS AND THEORY OF MIND?
Golm D., Barke A., Tonassi T., Dittko N., Kröner-Herwig B.
University of Göttingen, Clinical Psychology and Psychotherapy, Göttingen, Germany
Background: The term “medically unexplained symptoms” refers to somatic symptoms, which are not caused by an organic illness or cannot be fully explained by one. Up to 50% of patients in primary care have unspecific somatic complaints. Among commonly reported symptoms are headache, palpitations and bloatedness. Up to 82% of patients fulfill partially or at least for a short time the diagnostic criteria of a somatoform disorder. A recently conducted study on patients with somatoform disorders suggested an etiological mechanism whereby deficits in emotional awareness result in patients misrepresenting emotional states as bodily symptoms. They also found that persons with somatoform disorders showed impaired performance in a theory of mind task. We hypothesized that if there was an association between emotional awareness, theory of mind and bodily symptoms, those associations should also be found in a sample of participants reporting a high level of medically unexplained symptoms.
Method: We examined 51 participants who were characterized as high (n = 28; mean age: 50.0; SD: 10.7) and low (n = 23; mean age: 42.7; SD: 12.0) symptom reporters by means of the Beschwerdeliste (BL), a questionnaire to assess unspecific bodily symptoms. The participants filled in the Emotionale Kompetenzfragebogen (EKF), a questionnaire which assesses – among other things –awareness of one’s own emotions and of the emotions of other persons. The participants also performed two theory of mind tasks: the Faux-pas Test and a computer-based paradigm to identify others’ emotions and intentions.
Results: High symptom reporters showed lower scores in the emotional awareness subscale of the EKF, but performed as well in the two theory of mind tasks as the low symptom reporters.
Conclusions: High rate of bodily symptoms seems to be associated with lower emotional awareness even in a non-clinical sample. However, in this population we failed to find any impairment in the theory of mind.
Keywords: Emotions, Health
CORRESPONDING AUTHOR: Golm Dennis, University of Göttingen; dgolm@psych.uni-goettingen.de
P129
QUESTIONNAIRE-BASED ASSESSMENT OF SOMATOFORM SYMPTOMATOLOGY AND OF THE NEWLY PROPOSED COMPLEX SOMATIC SYMPTOM DISORDER
Klaus K.1, Rief W.1, Brähler E.2, Martin A.3, Glaesmer H.2, Mewes R.1
1 University of Marburg, Clinical Psychology and Psychotherapy, Marburg, Germany
2 University of Leipzig, Medical Psychology and Sociology, Leipzig, Germany
3 University of Erlangen-Nürnberg, Department of Psychosomatic Medicine and Psychotherapy, Erlangen, Germany
Background: Single somatoform symptoms can be very impairing and might legitimate a DSM-IV diagnosis, e.g. pain disorder. Studies investigating the prevalence of somatoform complaints in the general population principally implement questionnaires. The new proposed “Complex Somatic Symptom Disorder” (CSSD) will not make a distinction between symptoms’ medical or non-medical etiology. It is unknown if current questionnaires for the assessment of somatoform disorders (i.e., the PHQ-15 which is recommended by the DSM-V work group) identify individuals suffering from CSSD.
Purpose: To evaluate the power of current questionnaires for identifying single impairing somatoform symptoms and also CSSD in comparison with a structured interview (as gold standard).
Method: Different methods and instruments were used to ascertain fifteen impairing somatic complaints in the German general population (N = 253). A structured telephone interview was conducted and participants subsequently completed two questionnaires: the “Patient Health Questionnaire” (PHQ-15, assessing usually medically unexplained complaints in the prior 4 weeks) and the “Screening for Somatoform Disorders” (SOMS-2, assessing impairing somatoform symptoms within the past 2 years).
Results: Agreement of interview-based and questionnaire-based data ranged from slight to moderate – both for PHQ-15 and SOMS-2. Maximum conformity with the interview was revealed for pain (PHQ-15: κ ≤ .39, SOMS-2: κ ≤ .27) and sexual symptoms (PHQ-15: κ = .51, SOMS-2: κ = .25). CSSD (Interview: n = 48) was especially included in the upper severity categories of the PHQ-15 (<5: 7%, 5- < 10: 25%, 10- < 15: 59%, ≥15: 73%). SOMS-2 discriminated well between subjects with and without CSSD (somatization index DSM-IV: M = 6.2, SD = 4.2 vs. M = 3.0, SD = 3.0, p < .001).
Conclusion: Depending on the assessment the collected data differed widely. Epidemiological studies should decide between valid interviews conducted by experts or economic self-rating questionnaires. In fact, studies based on self-report might have to revise prevalence rates. If CSSD will be established in DSM-V most diagnostic instruments must be validated and adapted accordingly.
Keywords: Assessment, Methodology
CORRESPONDING AUTHOR: Klaus Kristina, University of Marburg, Marburg; kristina.klaus@staff.uni-marburg.de
P130
OVERLAP OF FUNCTIONAL SOMATIC SYNDROMES – FINDINGS FROM A NON-CLINICAL SAMPLE
Fischer S.1, Ehlert U.2, Nater U.1
1 University of Marburg, Clinical Biopsychology, Marburg, Germany
2 University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
Background and Aim: Functional somatic syndromes (FSS) are defined by clusters of bodily symptoms not explained by a medical condition. There is evidence on overlap between FSS. The validity of these nosological entities has thus been questioned. However, most studies have been conducted in patient samples, possibly being subject to referral bias. Also, in population-based studies, FSS diagnoses are usually made without controlling for differential diagnoses. Finally, no study has so far assessed 17 FSS simultaneously. The objective of our study was to estimate overlap between multiple FSS in a population-based sample.
Methods: A total of 3’054 students were recruited for participation in an online survey. To assess prevalence rates of 17 FSS (e.g., chronic fatigue syndrome, fibromyalgia), we developed and administered a questionnaire based on international research diagnostic criteria. Fulfillment of criteria led to diagnoses of ‘self-reported FSS’. Participants were labeled as having a ‘medically unexplained FSS’ if they reported that no abnormalities were detected after at least one healthcare visit.
Results: Among the 3’054 participants (mean age = 24.6, SD = 5.6), 2’242 were women (73.4%). The number of ‘self-reported FSS’ranged from one to eight, with 631 (62.2%) reporting one, 239 (23.6%) two, 92 (9.1%) three, 35 (3.5%) four, 13 (1.3%) five, three persons (0.3%) six, and one person reporting eight FSS occurring concomitantly. The range of ‘medically unexplained FSS’ was one to four, with 227 (78.6%) reporting one, 49 (17.0%) two, 12 (4.2%) three and one person reporting four FSS concomitantly.
Conclusion: This is the first study investigating a vast number of FSS. Overlap was lower compared to studies in clinical settings. Our finding of only few people suffering from multiple FSS is in line with population-based studies. However, a significant drop in overlap frequency occurred when taking into account differential diagnoses. Future research efforts on overlap between FSS should take into account referral bias when interpreting study results, and rigorous approaches in excluding medical conditions should be adopted.
Keywords: Chronic fatigue syndrome, Irritable bowel syndrome, Co-morbidities
CORRESPONDING AUTHOR: Fischer Susanne, Philipps University Marburg; susanne.fischer@uni-marburg.de
P131
STABILITY OF HEALTH CARE UTILIZATION IN PERSONS WITH SOMATOFORM DISORDERS AND CONTROLS IN THE GENERAL POPULATION
Mewes R., Rief W.
University of Marburg, Departement of Clinical Psychology, Marburg, Germany
Purpose: Many studies confirmed the association between somatoform disorders and increased health care utilization. However, most of these studies used retrospective assessments of health care utilization and were conducted in selective samples of primary or secondary care attendees. Therefore, the predictive validity of the association between somatoform disorders and health care utilization is still questionable and will be investigated in the present study.
Methods: A sample of persons with an at least mono-symptomatic somatoform disorder derived from the German general population was compared to a sample of persons without such a disorder (controls) in terms of stability of health care utilization (HCU) and predictors for HCU at follow-up. Both samples were interviewed at baseline and one year later using a structured approach asking for somatic symptoms, health care utilization in the last 12 months, and psychological factors. The baseline sample consisted of 321 persons; 1-year follow-up data were received from 244 persons (76% of baseline sample, 111 with an at least mono-symptomatic somatoform disorder).
Results: At baseline and follow-up, persons with an at least mono-symptomatic somatoform disorder showed almost twice as many doctor visits as the controls (p ≤ .001). HCU at both time points was highly correlated: r = .52 for the controls and r = .73 for the persons with a somatoform disorder (both p ≤ .001). In regression analyses using HCU at follow-up as the outcome variable and HCU at baseline, age, and gender as predictors, only HCU at baseline was a significant predictor in the somatoform disorder group (r² = .54, p ≤ .001) and HCU and higher age at baseline were predictors in the control group (r² = .32, p ≤ .001). The inclusions of diagnostically relevant psychological factors as additional predictors (i.e. health anxiety, excessive time and energy devoted to symptoms or health concerns, concerns about medical seriousness) lead to the same results.
Conclusions: Health care utilization is a very stable behaviour, especially in persons with a somatoform disorder.
Keywords: illness behaviour, longitudinal research
CORRESPONDING AUTHOR: Mewes Ricarda, University of Marburg; mewesr@uni-marburg.de
P132
MODERN HEALTH WORRIES, MEDIA REPORTS, AND THE PERSONALITY TRAIT OF ABSORPTION
Witthöft M.1, Freitag I.1, Nußbaum C.1, Bailer J.2, Jasper F.1, Rubin GJ.3
1 University of Mainz, Department of Clinical Psychology and Psychotherapy, Mainz, Germany
2 Central Institute of Mental Health, Department of Clinical Psychology, Mannheim, Germany
3 King's College London, Psychological Medicine, London, United Kingdom
Worries about potential health threatening effects of modern life (e.g. electric devices and pollution) represent a growing phenomenon in Western countries. Although research on Modern Health Worries (MHW) has increased in recent years, knowledge about the causes of MHW is still sparse. In two experimental studies, we investigated whether typical television news reports affect MHW. In Study 1, 130 college students were randomly assigned to a 10 minutes film on either a patient suffering from idiopathic environmental intolerance (IEI) or a control film about cystic fibrosis. Although a main effect of the IEI film on MHW was not detectable, participants high on the personality trait of absorption revealed increased MHW after watching the IEI film. Thus, absorption proved to be a significant moderator in the first study. In Study 2, 83 college students were randomly assigned to either a film on the dangers of electromagnetic fields or a control condition (a film about mobile phone theft). Worries about radiation (but not other MHW) were found to be elevated after watching the film on the dangers of electromagnetic fields compared to the control film. Absorption did not serve as a moderator of this effect. The results of both studies reveal a significant and specific influence of short sensational mass media reports on MHW. The influence of potential moderators such as absorption remains to be clarified in future studies.
Keywords: Modern Health Worries
CORRESPONDING AUTHOR: Witthöft Michael, University of Mainz, Mainz; witthoef@uni-mainz.de
P133
STRESS AND FUNCTIONAL GASTROINTESTINAL DISORDERS IN A NON-CLINICAL SAMPLE
Markert C.1, Fischer S.1, Ehlert U.2, Nater U.1
1 University of Marburg, Clinical Biopsychology, Marburg, Germany
2 University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
Background and Aim: Functional gastrointestinal disorders (FGID) are defined by a constellation of gastrointestinal symptoms for which (after medical examination) no structural pathology can be identified. It has previously been suggested that stress may be a risk factor for FGID. The objective of our study was to examine the role of stress in FGID.
Methods: A total of 3054 students in Switzerland were examined via a survey on physical and mental health. Subjects meeting the symptoms required for a Rome III diagnosis of an FGID were asked about healthcare visits and differential diagnoses. Sociodemographic data and information on psychiatric comorbidity was collected (Patient Health Questionnaire), and facets of stress were assessed by administering the BFI-10 (emotional instability), the CTQ-SF (childhood trauma), the LTE (life events), the SSCS (chronic stress), and the PSRS (perceived stress reactivity).
Results: Among the examined subjects (mean age 24.6, SD = 5.6, 2242 women), 3.3% fulfilled criteria for at least one FGID. Of those, 67.8% had consulted a healthcare practitioner. Prevalence rates were 57 (1.9%) for functional dyspepsia, 39 (1.3%) for irritable bowel syndrome, 14 (0.5%) for functional chest pain of presumed esophageal origin, and 2 (0.1%) for globus. Compared with subjects with no FGID, subjects with at least one FGID had a higher probability of displaying comorbid disorders (major depressive disorder: p < .001, panic disorder: p < .05, or any other anxiety disorder: p < .001). When controlling for comorbidity, stress reactivity related to social conflicts was the only significant predictor of FGID (OR = 2.79; p < .01). Emotional abuse (β = .20), critical life events (β = .23), and chronic stress (β = .44) contributed significantly to explaining 42% of total variance of overall number of somatic symptoms in FGID.
Conclusion: FGID prevalence rates and psychiatric co-morbidity were similar to previous studies (e.g. Suarez et al., 2010). Various forms of stress were found to be associated with FGID. Our results point to a pivotal role of stress in the development and maintenance of FGID. Healthcare providers are required to adequately address stress-related issues when dealing with FGID.
Keywords: web-based, Stress, Irritable Bowel Syndrome, Quality of Life
CORRESPONDING AUTHOR: Markert Charlotte, University of Marburg; charlotte.markert@staff.uni-marburg.de
P134
THE EFFECTS OF PERSONALITY ON IRRITABLE BOWEL SYNDROME
Tayama J.1, Nakaya N.2, Hamaguchi T.3, Tomiie T.4, Shinozaki M.5, Saigo T.1, Hayashida M.1, Fukudo S.5
1 Nagasaki University, Center for Health & Community Medicine, Nagasaki, Japan
2 Kamakura Women’s University, Department of Nutrition & Dietetics, Kanagawa, Japan
3 Occupational Therapy Saitama Prefectural University, Occupational Therapy, Saitama, Japan
4 Health Sciences University of Hokkaido, School of Psychological Science, Sapporo, Japan
5 Tohoku University, Graduate School of Medicine, Department of Behavioral Medicine, Sendai, Japan
Background: Patients with IBS (irritable bowel syndrome) may exhibit several pathophysiological conditions: dysmotility of the lower gastrointestinal tract, visceral hypersensitivity, and psychological abnormalities. Typical psychiatric symptoms experienced by IBS patients include severe feelings of depression and anxiety. Depression reduces the threshold for bowel sensitivity. One risk factor for depression is neurotic personality type. This study investigated two hypotheses: 1) Persons with IBS demonstrate greater neuroticism than those without IBS, and 2) degrees of association between the severity of IBS and neuroticism differ, depending on IBS subtype.
Methods: Study participants consisted of 557 university students, who completed personality assessments (Temperament and Character Inventory [TCI] and the Eysenck Personality Inventory [EPI]), the IBS severity index (IBSSI), and Kessler 6 (K6) to evaluate psychological distress. Statistical significance was analyzed via one-way ANOVA. The Wilcoxon signed rank test was used to compare the two groups. Correlation analysis was performed to determine the strengths of relationships between neuroticism and the IBSSI.
Results: The overall IBS prevalence rate was 25.7%. Significant differences in neuroticism between groups with and without IBS were not observed. Degrees of neuroticism and K6 scores were both significantly higher in persons with diarrhea-subtype IBS than in persons without IBS. Compared to groups with other IBS subtypes, the correlation between neuroticism and IBSSI was strong (r = 0.21) in the group with diarrhea-subtype IBS.
Discussion: No significant difference was observed in neuroticism scores between persons with IBS and those without it, and therefore hypothesis 1 was not supported. However, as neuroticism scores in persons with diarrhea-subtype IBS were significantly higher than in persons without IBS, hypothesis 2 was supported. In diarrhea-subtype IBS, neuroticism may increase depressive symptoms and aggravate digestive symptoms via activation of the hypothalamic–pituitary–adrenal axis.
Keywords: irritable bowel syndrome, neuroticism
CORRESPONDING AUTHOR: Jun Tayama, Nagasaki University, Nagasaki; jtayama@nagasaki-u.ac.jp
P135
ACCELEROMETER AND AUTONOMIC NERVOUS SYSTEM RESPONSE TO PHYSICAL EXERCISE IN PATIENTS WITH IRRITABLE BOWEL SYNDROME
Toyohiro T.1, Shimizu K.2, Tayama J.3, Tomiie T.4, Saigou T.3, Kanazawa M.5, Sakurai K.2, Fukudo S.5
1 Saitama Prefectural University, School of Health Science, Department of Occupational Therapy, Koshigaya, Japan
2 Niigata University of Health and Welfare, School of Health Science, Department of Occupational Therapy, Niigata, Japan
3 Nagasaki University, Center for Health & Community Medicine, Nagasaki, Japan
4 Health Sciences University of Hokkaido, School of Psychological Science, Sapporo, Japan
5 Tohoku University, Graduate School of Medicine, Department of Behavioral Medicine, Sendai, Japan
Irritable bowel syndrome (IBS) is considered to be a physical disorder that mainly affects the bowel, and is clinically characterized by lower abdominal pain or discomfort, as well as significant psychological stress. We previously reported on the possibility of improving IBS pathophysiology through passive abdominal muscle stretching, as indicated by chromogranin A, a biochemical index of sympathetic/adrenomedullary system activity. However, the degree to which patient intervention in the areas of physical exercise and management of daily activity can improve IBS symptoms is unknown. The purpose of the present study was to investigate the effects of intervention on autonomic stress response and loco-motor activity in patients with IBS. Forty adult participants with IBS were allocated randomly to either an exercise group (EG, n = 20) or a wait-listed control group (CG, n = 20). The EG received a four-week intervention consisting of abdominal muscle stretching, physical exercise of the pelvis, and 15 minutes of walking, with constant recording by accelerometer. Salivary α-amylase (sAA) was obtained prior to the stressor (mental arithmetic performed during distracting noise) and repeatedly during recovery to measure autonomic reactivity. Heart rate variability (HRV) was also monitored throughout stress/recovery phases. Both sAA and HRV tests were performed at pre/post intervention. After the intervention, the accelerometer count (steps/day) in the EG was significantly higher than that of the CG (t-test; p < 0.01). Levels of sAA declined significantly during stress in the EG (two-factor analysis of variance; p < 0.05), and significantly lower autonomic response (LF/HF) during recovery was observed in the EG compared with the CG. Anxiety during stress was reduced in the EG. No difference between groups was found in gastrointestinal symptoms. Although no beneficial effect on IBS symptoms was observed, the four-week intervention had immediate effects on physiological variables and some neurological factors.
Keywords: Irritable bowel syndrome, Stress, Health behaviors, Physical activity
CORRESPONDING AUTHOR: Hamaguchi Toyohiro, SPU, Saitama; hamaguchi-toyohiro@spu.ac.jp
P136
ODOR-RELEASED SOMATIC SYMPTOMS; THE CROSS-SECTIONAL HORDALAND HEALTH STUDY
Gundersen H.1, Harris A.2, Bråtveit M.1, Moen B.1
1 University of Bergen, Department of Public Health and Primary Health Care, Bergen, Norway
2 Uni Research, Uni Health, Bergen, Norway
Background: The aetiology behind odor-released somatic symptoms is unknown. Both immunological and psychiatric causes have been suggested. The aim of this study was to investigate the occurrence of immunological and psychiatric symptoms in individuals with odor-released somatic symptoms compared to individuals with similar symptoms that were not released by odor. A second aim was to investigate if individuals with somatic symptoms, both odor-released and not odor-released reported more hay fever, asthma, anxiety and/or depression compared to those without somatic symptoms.
Methods: In total 13,799 individuals, 6,007 men and 7,792 women, 40-45 years of age answered a questionnaire including 16 questions on somatic symptoms based on the ICD-10 symptom criteria of somatization disorder, whether the symptoms were odor-released, and questions about hay fever and asthma. Psychiatric symptoms were measured with the Hospital Anxiety and Depression Scale (HADS). To be characterised as individuals with odor-released somatic symptoms participants had to respond that they almost always had odor-released symptoms from at least two different organ systems.
Results: 38 (0.6%) men and 106 (1.4%) women had odor-released chronic somatic symptoms, whereas 88 (1.5%) men and 192 (2.5%) women had similar symptoms which were reported not to be odor-released. Adjusted analyses showed an increased risk of hay fever and asthma in the group with odor-released symptoms compared to those with similar somatic symptoms that were not odor-released. There were no differences between the two groups on HADS. However when we compared those who reported somatic symptoms, both odor-released and not odor-released (n = 442), with those who did not reported somatic symptoms (n = 13,375), the first group showed an increased risk of anxiety and depressive symptoms.
Conclusion: Somatic symptoms are associated with an increased risk of psychiatric symptoms, independently of whether the symptoms are odor-released or not. However, immunological symptoms like asthma and hay fever are more frequently reported in individuals with odor-released somatic symptoms. Immunological and psychiatric symptoms seem both to be associated with odor-released chronic somatic symptoms. However, immunological symptoms like asthma and hay fever are more frequently reported in individuals with odor-released somatic symptoms
Keywords: Somatic symptoms, chemical sensitivity; anxiety; depression; asthma; hay fever
CORRESPONDING AUTHOR: Harris Anette, Uni Health; anette.harris@uni.no
P137
E-HEALTH METHODS SUPPORT THE ACQUISITION OF GUIDED ATTENTION IN TINNITUS TREATMENT
Mussgay L., Schauss S., Rueddel H.
St Franziska Stift, Psychosomatic Hospital, Bad Kreuznach, Germany
To counter the negative emotional impact of persistent tinnitus symptoms the technique of guiding attention away towards other sources of sensory input is a successful and often used therapeutic strategy. In addition to the immediate effect of attenuating the tinnitus, a sense of control is established. In order to achieve its maximal effectiveness, the attention guiding technique has to become automatic, thus requiring an extensive training phase. Our study evaluated, if the training can be efficiently supported by cell phones used to prompt patients to exercise and, in addition, to provide information about the attention guiding procedure when needed.
Included were inpatients of our Psychosomatic Hospital, suffering from tinnitus. Inpatient treatment covered a period of about 6 weeks and consisted of group therapy sessions with special emphasis on tinnitus and its management, physical exercises, skills training and individual psychotherapy. In addition the experimental group (EG, n = 16) was provided with a cell phone that prompted patients 4 times a day to carry out attention guiding exercises and to report the type of exercise chosen. Prompting was skipped, if patients had already reported self-initiated exercises. A control group (CG, n = 16) was instructed to exercise as well, however without prompting. Reporting was done retrospectively with a daily questionnaire.
In the average, EG patients exercised 3.7 times a day, CG patients 3.3 times, EG patients asked for help information 13 times during the exercise period. Regarding the type of attention guiding exercise most often relaxation was applied (22%), followed by short walks in combination with selectively attending to various sensory sources (16%), physical exercise (12%), listening to music (12%) or engaging in conversation (12%). Both groups profited significantly from treatment (pre-post, general level of functioning, p < .000). As regards tinnitus distress the EG exhibited significantly lower scores (p = .003) in the tinnitus questionnaire (TF, Goebel & Hiller) at discharge compared to CG. Catamnestic scores (6 month) were still lower in EG, albeit no longer significantly due to a subsequent decrease in CG and a slight increase in EG. Our results emphasize the introduction of e-health methods for the acquisition of automatized behaviors.
Keywords: Rehabilitation, e-health, mobile phone
CORRESPONDING AUTHOR: Mussgay Lutz, St.-Franziska-Stift; l.mussgay@fskh.de
P138
COMPARING THE EFFECTIVENESS OF COGNITIVE BEHAVIORAL THERAPY (CBT) ENRICHED WITH EMOTION REGULATION TRAINING (ENCERT) WITH STANDARD CBT IN PATIENTS WITH MULTIPLE SOMATOFORM SYMPTOMS: PILOT STUDY RESULTS
Gottschalk JM.1, Bleichhardt G.1, Kleinstäuber M.2, Krämer AC.2, Berking M.1, Rief W.1
1 University of Marburg, Department of Clinical Psychology, Marburg, Germany
2 University of Mainz, Department of Clinical Psychology, Mainz, Germany
Purpose: Multiple somatoform symptoms (MSS) are associated with increased health care use and psychological interventions consistently did not exceed medium effect sizes. Since many MSS patients lack emotional awareness the integration of emotion regulation training could enhance the effects of psychological interventions. In this non-randomized controlled pilot study we prospectively evaluated whether CBT enriched with emotion regulation training (ENCERT) achieves higher success rates in patients with MSS than standard CBT.
Intervention: Both treatment conditions consist of 20 weekly individual sessions. ENCERT contains: 1) psychoeducation, 2) teaching relaxation techniques for coping with stress, 3) teaching non-judgmental awareness of body perceptions, 4) modifying illness behavior and accepting unpleasant body perceptions, 5) attention defocusing on positive perceptions plus emotional self-support, 6) analyzing interpretation processes to understand situational cues, and 7) change of behavior and interpretations.
Method: The study took place in the outpatient departments of the universities of Marburg and Mainz with each center providing one intervention. Patients presenting at least 3 medically unexplained somatic symptoms for a minimum of 6 months were included. Outcome assessments took place before and after completion of therapy. Primary outcome is the somatic symptom severity during the last 7 days (SOMS-7). Other outcomes are emotion regulation skills, illness behavior, general psychopathology, disability, quality of life, symptom intensity, and subjective impairment. Results: The CBT condition (n = 35) shows a significant reduction with medium effect size in both the intensity (F(1,34) = 33.85, p < .001; d = 0.62) and the number (F(1,34) = 23.29, p < .001; d = 0.66) of somatic symptoms. Full data for the ENCERT group will be available until March 2012. Preliminary analyses indicate effect sizes of > .80 for intensity and number of somatic symptoms, which are considerably higher than for the standard CBT group.
Conclusion: The results of this pilot study suggest that ENCERT could be more effective than standard CBT in patients with MSS. Our next step is the preparation of a large randomized, controlled multicenter trial.
Keywords: somatoform disorder, pilot study, CBT, emotion regulation, effectiveness
CORRESPONDING AUTHOR: Gottschalk Japhia-Marie, Universität Marburg, Marburg; gottschj@staff.uni-marburg.de
P139
RELATIONSHIP BETWEEN VOLUNTARY AND INVOLUNTARY AUTOBIOGRAPHICAL MEMORIES, EARLY MALADAPTIVE SCHEMAS, ATTACHMENT STYLES AND INTERPERSONAL RELATIONS
Balola M.1, Cláudio V. 1, Raimundo L.2, Vieira L.2
1 Instituto Superior Psicologia Aplicada, Health and Psychology Unit, Lisbon, Portugal
2 Instituto Superior Psicologia Aplicada, -, Lisbon, Portugal
Initial experiences established with parent figures determine the formation of early schemas, which develop during the course of life, focusing on the individuals’ relationship with their internal and external world. These schemas consist of early memories (implicit or explicit) concerning emotional experiences. Several studies have concluded that early dysfunctional schemas, lead to changes in the individuals’ relationship with themselves and with others. We researched autobiographical memories, establishing a relationship with early maladaptive schemas, attachment styles and interpersonal relations.
The sample includes 52 participants aged between 18 and 52 years old. The evaluation protocol consists of the following instruments: Autobiographical Memory Task, Diary of Involuntary Autobiographical Memories, Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Schemas Questionnaire, Adult Attachment Scale (EVA) and Inventory of Interpersonal Problems (IIP-64). We used the Portuguese version of all the above mentioned instruments.
The results indicate a greater recall of autobiographical memories for positive valence. With regard to the level of recall of voluntary and involuntary autobiographical memories, no significant differences were found. We correlated the above results with depression and generalized anxiety. Thereafter we discussed the results highlighting the importance of information processing, early maladaptive schemas, attachment styles and interpersonal relations of the individual.
Keywords: Clinical applications, Depression, Anxiety
CORRESPONDING AUTHOR: Balola Michele, ISPA-IU, Lisbon Portugal; michelebalola@gmail.com
P140
THE INFLUENCE OF THE CHRONOTYPE ON THE CORTISOL AWAKENING RESPONSE
Abbruzzese E A., Klingmann A., Ehlert U.
University of Zurich, Department of Clinical Psychology and Psychotherapy, Zurich, Switzerland
The chronotype describes the behavioral daytime preference. The chronotypical preference depends on several factors, such as the intensity of light irradiation and entrainment or polymorphisms of the so-called clock genes. Humans show large interindividual differences in the organization of their behavior within the course of a 24h-day. This can be specifically stated in terms of the structure of the sleep-wake cycle and can be explained by the interindividually varying adjustment of the internal biological clock to the external daytime and nighttime. Accordingly, morning types show earlier bedtimes and waking-up times compared to evening types. Evening types in particular often experience the problem of a deficient fit between their inherent biological clock and the social clock (e.g. work schedules etc.). The discrepancy between working days and free days might therefore result in a sleep deficit during the week, which is compensated at weekends. The health-related aftermaths of such “social jetlags” are not yet sufficiently clear.
Like most other endocrinological parameters, cortisol also follows a strong circadian rhythm, with a peak immediately after awakening, the so-called cortisol awakening response (CAR). The clear function of this peak has not yet been revealed. Since glucocorticoids in general are assumed to play a key role in the timing and synchronization of the internal clock and the regulation of the transcription in the DNA, a well-tuned CAR might be crucial for the synchronization of one’s own organism to the environment.
Since a stable circadian rhythm seems to be health-protective, we aimed to determine the association between the chronotype and the CAR in 25 healthy men. Our results suggest that evening types show a lower total amount of cortisol, but a significantly prolonged phase of cortisol increase within the first hour after awakening. Our data might suggest that an inadequate synchronization between inert chronotype and environment results in an extenuated CAR.
Keywords: biobehavioral mechanism, health behavior
CORRESPONDING AUTHOR: Abbruzzese Elvira , University of Zurich, Zurich; elvira.abbruzzese@uzh.ch
P141
ROTATING SHIFT WORK IS ASSOCIATED WITH INCREASED OXIDATIVE STRESS IN EGYPTIAN FEMALE NURSES
Fouad A.1, Fahim A.1, Younis S.2, Abdel-Halim A.1
1 Suez Canal University, Community Medicine Department, Ismailia, Egypt
2 Suez Canal University, Clinical Pathology, Ismailia, Egypt
Background: Shift work is usually referred to working at times other than the day-time hours of 8:00 a.m. to 5:00 p.m. It is considered as a significant source of occupational stress and dissatisfaction that can have a marked impact on alertness, performance, safety, and health. Oxidative stress is usually associated with increased free-radical formation, causing increased concentrations of reactive oxygen species which are claimed for the pathogenesis of lifestyle-related diseases. This study aimed at investigating the relationship between shift work and oxidative stress in female nurses.
Methods: An analytical cross-sectional study was carried out in Suez Canal University hospital in Ismailia; Egypt, and involved two groups of female participants; 68 nurses representing rotating shift workers and 68 non-shift workers (non-shift nurses & non-healthcare workers). Plasma Total Antioxidant Capacity (TAC) was measured as a biomarker for oxidative stress. A self-administered questionnaire was used including sociodemographic, lifestyle and work characteristics.
Results: In this study 52.3% of shift working nurses depend on fast food, while 80.6% of non-shift workers depend on regular meals (p < 0.001) . The mean duration of employment was statistically significantly longer in shift workers compared to non-shift workers (4.25 ± 1.8, 3.45 ± 1.4, respectively; p = 0.006). There was a statistically significant decrement in TAC among shift working nurses compared to non-shift workers (1.59 ± 1.29 vs. 1.85 ± 0.95 mmol/L, p = 0.001). Irregular roster design (OR = 9.75; 95% CI = 1.35–70.24) and consequent days-off less than 2 days (OR = 1.49; 95% CI = 1.01–2.2) were the main predictors for oxidative stress among shift working nurses (p = 0.024 & 0.043, respectively).
Conclusion: Shift working nurses had a statistically significantly higher oxidative stress than non-shift workers; roster design and consequent days-off were the main predictors for oxidative stress among shift workers.
Keywords: shift work, oxidative stress, nurses
CORRESPONDING AUTHOR: Fouad Ahmed, Suez Canal University, Ismailia; fouad_occ@yahoo.com
P142
EFFECT OF DIURNAL PREFERENCE ON SLEEP PERCEPTION
Haraszti RA.1, Purebl GY.1, Salavecz GY.1, Dockray S.2, Steptoe A.3
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 University College Cork, School of Applied Psychology, Cork, Ireland
3 University College London, Department of Epidemiology and Public Health, London, United Kingdom
Morningness-eveningness has been found to be coupled with impaired sleep quality and social jetlag. However, biased sleep perception has not been taken into consideration when analyzing self-administered questionnaires on sleep timing data.
Method: The Composite Scale of Morningness, Jenkins Sleep problems Scale and basic questions on estimated work day and weekend sleep length have been administered to 200 healthy working women in order to explore their sleeping habits. In addition all participants completed a sleep diary for two days.
Results: Sleep timing data validated the chronotype assessment (p = 0.000). Evening types reported poorer sleep quality (p = 0.036). No evidence was found, however, for a significant effect of chronotype on the shift of sleep timing between workdays and leisure days. Neither did calculated sleep duration differ between chronotypes. Evening types, interestingly, significantly overestimated their leisure day sleep durations.
Conclusions: More caution is needed when assessing social jetlag and sleep duration based on self-estimation. Misperception of sleep is likely to be a possible pathway along which chronotype influences perceived health.
Keywords: morningness-eveningness, social jetlag, sleep perception
CORRESPONDING AUTHOR: Haraszti Reka Agnes, Semmelweis University, Budapest; rharaszti@gmail.com
P143
SLEEP DURATION AND AMBULATORY BLOOD PRESSURE IN ADOLESCENTS
Meininger J.1, Eissa M.2, Chan W.3, Gallagher M.4, Nguyen T.4
1 University of Texas Health Science Center at Houston, Schools of Nursing and Public Health, Houston, United States
2 University of Texas Health Science Center at Houston, Medical School, Houston, United States
3 University of Texas Health Science Center at Houston, School of Public Health, Houston, United States
4 University of Texas Health Science Center at Houston, School of Nursing, Houston, United States
Insufficient sleep has been linked to hypertension in adults, but previous studies of children and adolescents on the association between sleep duration and blood pressure (BP) have produced inconsistent results. This cross-sectional study tested the hypothesis that sleep duration, both during the day and at night, would be negatively associated with ambulatory BP measured over 24 hours in adolescents 11 to 16 years old.
The sample, which was drawn from schools in an urban area in southeastern Texas, USA, included 377 adolescents 11 to 16 years old. Demographically, the sample was 54% female, 37% African American, 31% Hispanic, 29% non-Hispanic white, and 3% other ethnic/racial groups. The sample included 9.6% who were pre-hypertensive (>90th and < =95th percentile); 4.2% who were hypertensive >95th; 21.5% had body mass index (BMI) > = 95th percentile; and 17.8% had BMI > =85th and < 95th percentile for age, gender and height. Ambulatory systolic (SBP) and diastolic (DBP) pressures were measured for 24 hours on a school day; actigraph readings and diary recordings were used to define the duration of sleep at night and naptime during the day. Covariates included demographic factors (age, gender, ethnic group, mother’s education); obesity indices (BMI, waist circumference, percent body fat); sexual maturation (Tanner stage). At the time of each BP measurement while awake, the adolescents recorded position (sitting, standing, reclining); and location (school, home, other). Mixed models were used to test day and night sleep duration as predictors of 24-hour SBP and DBP, controlling for covariates.
Controlling for duration of sleep during the day, each additional hour of nighttime sleep was associated with a SBP - 0.45 mm Hg, p = .0003; controlling for nighttime sleep each additional hour of day time sleep was associated with SBP -0.44 mm Hg, p = .0085. DBP was related to day time sleep only (-0.32 mm Hg, p = .008). These associations cannot be explained by the influence of obesity on both sleep and BP, as indices of obesity were controlled as covariates. The small magnitude of the effect size for the association between sleep and BP will be interpreted in the context of the potential impact on population health and the need for further research to explicate the role of sleep in cardiovascular and metabolic health of adolescents.
Keywords: Blood Pressure; Adolescents; Sleep
CORRESPONDING AUTHOR: Meininger Janet, University of Texas HSC, Houston; janet.c.meininger@uth.tmc.edu
P144
EXISTENCE OF SOCIAL ANXIETY, DEPRESSION AND SLEEP PROBLEMS IN JUNIOR HIGH-SCHOOL STUDENTS
Yamada S.1, Nakaya T.1, Yamamoto R.2, Nomura S.3
1 Iwate Prefectural University, Faculty of Social Welfare, Iwate, Japan
2 Joetsu University of Education, Division of Clinical Psychology, Health Care and Special Support, Niigata, Japan
3 Waseda University, Faculty of Health Sciences, Saitama, Japan
Introduction: Interpersonal problems are showed as factors of occurrence and maintenance of non-attendance at school. Social anxiety disorder (SAD) is one of the factors affecting interpersonal problems. Also, truant students commonly report a variety of psychological symptoms such as anxiety/depression before they completely refuse to go to school. Sato (2006) showed that the child of 10% or more shows depression at clinical level. And Individuals with SAD or depressive symptoms are often accompanied by sleep impairments. The purpose of this study was to examine SAD and depression focusing on sleep impairment.
Method: Six hundreds and forty-two junior high-school students (309 male, 333 female) completed the questionnaire which consists of (a)the Japanese version of Liebowitz Social Anxiety Scale for Children and Adolescents(Okajima et al., 2008), (b) the Japanese version of Social Anxiety Scale for Adolescents(Okajima et al., 2009), (c)the Japanese version of Depression Self-Rating Scale for Children (Murata et al.,1996), (d)the Japanese version of Pittsburgh Sleep Quality Index (Doi et al., 1998).
Result: The percentage amongst participants who suspected of SAD was 17.45% and depression was 20.71% of whole data. Also, the percentage amongst participants who had low “sleep quality” was 26.95%, “sleep onset insomnia” was 23.68%, and “Daytime Dysfunction” was 25.39%. The PSQI score was investigated with t test to examine the difference between SAD(depression) and non-SAD (non- depression). Result indicated that SAD scored significantly higher than non-SAD on “sleep quality”(t = 2.26), “sleep onset insomnia”(t = 2.59), “Sleep Disturbance”(t = 3.09) and “Daytime Dysfunction”(t =4.91,ps < .05 ~ 01). Also, depression scored significantly higher than non-depression on “sleep quality”(t = 8.88), “sleep onset insomnia”(t = 8.01), “Sleep Duration”(t = 6.30), “Sleep Disturbance”(t =7.99) and “Daytime Dysfunction”(t =8.00, ps < .01).
Discussion: These results showed that about 1/4 of junior high school students have SAD, depression, and sleep problems, and students with SAD/depression have significantly more sleep problems than those without SAD/depression. The early intervention in SAD, depression, and sleep problems is considered to become prevention of non-attendance at school.
Keywords: Anxiety, Depression, Sleep disorders
CORRESPONDING AUTHOR: Yamada Sachie, Iwate Prefectural University, T; y-sachie@iwate-pu.ac.jp
P145
SLEEP PROBLEMS AND SELF-MANAGEMENT OF SLEEP AMONG JAPANESE UNDERGRADUATES
Yamamoto R.1, Hirota Y.2, Yamatsuta K.3, Maki I.4, Yamada S.5, Hojo R.6, Nomura S.7
1 Joetsu University of Education, Division of Clinical Psychology, Health Care and Special Support, Niigata, Japan
2 Waseda University, Graduate School of Human Sciences, Saitama, Japan
3 Sangyo-Noritsu (SANNO) University, School of Information-Oriented Management, Kanagawa, Japan
4 Osaka Kyoiku University, Department of Psychology, Osaka, Japan
5 Iwate Prefectural University, Faculty of Social Welfare, Iwate, Japan
6 Joetsu University of Education, Division of Humanities and Social Education, Niigata, Japan
7 Waseda University, Faculty of Human Sciences, Saitama, Japan
Aim: Sleep problems (insomnia or excessive daytime sleepiness) are common among Japanese undergraduates. These problems are risk factors for mental disorders and are detrimental to either their quality of life or their academic performance. Thus, it is crucial to establish universal interventions for effective self-management of sleep problems as part of the school health service. The aim of this study was to investigate sleep problems and self-management of sleep among Japanese undergraduates.
Methods: Five hundred and fifty-eight undergraduates completed a questionnaire about sleep problems, self-management of sleep and needs for educational intervention. We analyzed 492 valid responses (258 male, 234 female, mean age = 20.0 yrs, SD = 2.4 yrs.). This study was approved by the Ethics Committee of Joetsu University of Education.
Results: The percentage of the participants who had at least one kind of sleep problem was 44.7% of the whole data, while that of those who had two kinds or more was 25.0%. The largest sleep problem was “excessive daytime sleepiness” (30.9% of the participants who complained about sleep problems). The second largest one was “sleep onset insomnia” (29.1%), and 93.6% of the participants who had reported sleep problems wanted to improve the problems. On the other hand, the percentage of the participants who had consulted a physician or health specialist was only 1.4%, the percentage of those who had attempted self-treatment was only18.6%, and the percentage of those who had done nothing was 76.4%. Supposing that the students would receive evidence-based universal intervention, the educational media that the participants wanted to use the most was “text based website information” (56.8%) followed by “still picture- or moving picture-based information”. Moreover, the mean amount of time which participants might invest in the intervention was 3.1 hours, but the distribution had bimodal peaks (median = 1.5 hours, mode = 1 hour).
Discussion: Many university students have sleep problems, especially sleep onset insomnia or excessive daytime sleepiness, and want to improve their sleep, but they leave these problems unaddressed. Cost effective and high accessible internet intervention, for example using mobile phone or tablet personal computer, will be needed.
Acknowledgement: This study was supported by Grant-in-Aid for Young Scientists (B) from the Japan Society for the Promotion of Science (Project No. 23730649).
Keywords: Mental health, Health behavior, Sleep disorders
CORRESPONDING AUTHOR: Yamamoto Ryuichiro, Joetsu University of Edu, Japan; ryuitiro@juen.ac.jp
P146
SPECTRAL CHARACTERISTICS OF SLEEP EEG IN RELATION TO INSOMNIAC AND DEPRESSIVE SYMPTOMS OF KIDNEY TRANSPLANT RECIPIENTS
Rónai K. Z.1, Lázár S. A. 1,2, Szentkirályi A. 1,3, Zoller R. 1,4, Gombos F. 5, Lindner A. 1,6, Zsolt L. 7, Papp I. 7, Turányi C. 1, Szőcs J. 1, Lendvai Zs. 1, Fornádi K.1,6, Molnár M. Z.1,8,9, Mucsi I.1,8,10, Bódizs R. 1, Novák M. 1,11
1Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary,
2Centre for Brain Repair, Department of Clinical Neurosciences University of Cambridge, Cambridge, United Kingdom
3Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
41st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
5Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
6Department of Neurology, Semmelweis University, Budapest, Hungary
7Department of Physics, Babes-Bolyai University, Cluj-Napoca, Romania
8Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
9Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, USA
10Division of Nephrology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
11Neuropsychiatry Program, University of Toronto, Toronto, Canada
Introduction: The prevalence of insomnia (I) and depression (D) is high among kidney transplant recipients and the comorbidity of the two disorders is frequent. According to current theory, hyperarousal of the central nervous system (CNS) might play a role in the pathomechanism of both conditions. The hypervigilant state of the CNS is characterized by high frequency activity (HFA) of the EEG. We investigated the potential relationship of isomniac and depressive symptoms versus HFA in sleep among kidney transplant recipients.
Methods: Forty-five kidney transplant recipients participated in the study (27 males and 18 females, mean age 48.2 ± 13.07 years, BMI 25.81 ± 4.01kg/m2, GFR 49.97 ± 18.05ml/min). Symptoms of insomnia and depression were measured by the Athens Insomnia Scale (AISL) and the Center for Epidemiologic Studies-Depression Scale (CES-D), respectively. After one-night polysomnography the sleep structure and detailed spectral profile were characterized. HFA was assessed by the absolute spectral power within the beta1 (15.25-25 Hz), beta2 (25.25-35 Hz), and gamma (35.25-45 Hz) frequency bands.
Results: Subgroup of patients with insomnia exhibited significantly higher beta1 and gamma activity during REM sleep as compared to patients without insomnia (p < 0,005; for both comparisons). In patients with high depression score only beta1 activity was (p < 0,005) increased compared to low depression score subgroup. The AISL score correlated with the beta1 power in REM (r = 0,363; p < 0,005) and in non-REM (r = 0,317; p < 0,005), with the gamma power in REM (r = 0,317; p < 0,005) and in non-REM (r = 0,371; p < 0,005). The CES-D score had no significant correlation with the power spectra.
Conclusion: The correlation between the symptoms of insomnia and the increased neurocognitive activity of the CNS during sleep was shown for the first time in this population; thus the CNS hyperarousal might play a causal role in the emergence of insomnia among kidney transplant recipients.
Keywords: quantitative EEG, sleep disorders, insomnia, depression, kidney transplantation, hyperarousal, beta spectrum
CORRESPONDING AUTHOR: Ronai Katalin, Semmelweis University, Budapest; ronaikatalin.zs@gmail.com
P147
VARIATIONS IN THE SECRETION OF SALIVARY DHEA AFTER AWAKENING AND ITS ASSOCIATION WITH SUBJECTIVE SLEEP QUALITY
Ohira M.1, Suguri K.2, Nomura S.3
1 Shiga University, Faculty of Education, Otsu, Japan
2 Nagaoka University of Technology, Management & Information Systems Engineering, Nagaoka, Japan
3 Nagaoka University of Technology, Top Runner Incubation Center for Academia-Industry Fusion, Nagaoka, Japan
Change in the secretion of salivary dehydroepiandrosterone (DHEA), a steroid hormone, while asleep and its association with subjective sleep quality were addressed. We developed our own saliva collection technique. The saliva was collected while the subject was asleep. This is a non-invasive and non-disturbing manner in contrast to the conventional blood collection method that imposes greater psycho-physiological impacts on subjects.
Subjects, eight male university students, were instructed to take a 6-hour sleep from 0:00 midnight until 6:00 in the morning in an environmentally controlled room, with heart rate (HR) recording and saliva collection. A subjective sleep quality inventory was given to subjects after awakening. In results, DHEA concentration remained at the same level for the sleep period and showed remarkable increase right after awakening: it went up approximately five times higher than that of during the night. DHEA did not show any difference among the subjects while they were asleep. In contrast DHEA was significantly higher after awakening in the subjects who marked higher score in the factor “unpleasant awakening (UA)” of the inventory. Moreover the variation in DHEA level after awakening, shows, significant correlation with the score of UA. No difference in HR was found among subjects after awakening. However, interestingly HR of the subjects who marked higher UA, and thus higher DHEA, after awakening remained significantly higher in the first half of the sleeping period.
In this study, the variations in salivary DHEA, while asleep and after awakening were successfully illustrated by our own developed saliva collection apparatus. Especially to our knowledge no study ever showed the remarkable increase of DHEA at the onset of awakening. Moreover such a remarkable releasing of DHEA was found to associate with subjective sleep quality and HR in the first half of the night. Since DHEA is known to increase against psychosocial stressors just like cortisol, higher DHEA releasing at awakening might be a part of physiological stress-related response. In conclusion our new methodology could open the possibility of the idea of biochemical assessment of subjective sleep state, i.e. the objective estimation of “Quality of Sleep” in our daily life.
Keywords: Psychoneuroendocrinology, Research methods
CORRESPONDING AUTHOR: Ohira Masako, Shiga University, Otsu; ohira@edu.shiga-u.ac.jp
P148
REORGANIZATION AND CHANGES OF PHYSIOLOGICAL STRESS MARKERS
Hinge Carlsson R.1, Netterstrøm B.1, Hansen AM.2, Hurwitz Eller N.1, Blønd M.3, Lindhart Nielsen M.1, Kristiansen J.2
1 Bispebjerg Hospital, Department of Occupational and Environmental Medicine, Copenhagen, Denmark
2 National Research Centre of the Working Environment, -, Copenhagen, Denmark
3 Nykøbing Falster Hospital, Department of Occupational Medicine, Copenhagen, Denmark
Objectives: The aim of this study was to investigate the association between reorganization and changes of physiological stress markers.
The hypothesis is that:
1. Reorganization causes changes in physiological stress markers during follow up in the form of increased sympathetic activity, increased HPA-axis activity catabolism of the metabolic system and decreased activity of the immunological system.
2. These changes can be explained by different exposure related to the reorganization.
Methods: The follow-up study OSH (Organization, Stress and Health) studied the health consequences of a major reorganization of non-state public offices effectuated in Denmark on 1 January 2007. In 2006 and 2008 we collected clinical and questionnaire data from 359 participants. During follow-up 201 employees merged (Merger group), 113 got new jobs (New job group) and 45 stayed in the same job (Control group).
The physiological stress markers included: Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate variability (HRV; total power (TP) and low frequency/high frequency (LF/HF), work and sleep), salivary cortisol at awakening (S0), awakening cortisol response (ACR), serum dihydroepiandosterone (DHEA-S), glycated haemoglobin (HbA1c), high density lipoprotein cholesterol (HDL), total cholesterol (TCHOL), body mass index (BMI) and waist hip ratio (WHR).
Changes in levels of these physiological stress markers (2006-2008) were analysed.
Results: SBP, S0, ACR, HbA1c, TCHOL, BMI and WHR increased significantly whereas HDL cholesterol decreased among women. Among men, ACR, HbA1c and BMI increased significantly whereas HDL and TP, work decreased. However, no significant differences between the exposure groups could be detected.
Conclusion: We found significant association between reorganization and changes of physiological stress markers. However, this observation could not be explained by different exposure related to the reorganization.
Keywords: psychophysiology, stress
CORRESPONDING AUTHOR: Hinge Carlsson Rikke, Bispebjerg Hospital, Copenhagen; rhinge@hotmail.com
P149
SOLUBLE CYTOKINE RECEPTORS AND ITS RELATIONSHIP WITH AFFECTIVE, SOMATIC AND BEHAVIORAL FEATURES OF DEPRESSION
Dannehl K.1, Euteneuer F.1, Schwarz MJ.2, Rief W.1
1 University of Marburg, Clinical Psychology and Psychotherapy, Marburg, Germany
2 Ludwig-Maximilian University Munich, Psychiatry and Psychotherapy, Munich, Germany
Background: Cell-mediated immune activation may play a role in the pathogenesis of depression as indicated by findings of increased soluble tumor necrosis factor receptors (sTNFR) levels and recent meta-analytic evidence for elevated soluble interleukin 2 receptor (sIL-2R) concentrations. However, little research has been done on how these soluble cytokine receptors are differently related to specific features of depression. Therefore, we aimed to compare circulating levels of the soluble cytokine receptors sIL-2R, sTNF-R1 and sTNF-R2 in patients with depression disorder and healthy controls. We also explored the potential relationship between these cytokine receptors and different features of depression.
Methods: We included 25 patients with major depression and 22 healthy controls. Serum levels of sIL-2R, sTNF-R1 and sTNF-R2 were analyzed. Psychometric measures included the assessment of cognitive-affective symptoms, somatic symptoms, avoidance behavior and current mood states.
Results: Patients with depression showed increased levels of sIL-2R (p < 0.01) compared to healthy controls. Differences in sTNF-R1 (p = 0.094) and sTNF-R2 (p = 0.078) marginally failed to reach significance. Correlational analyses revealed that increased concentrations of sIL-2R were related to somatic measures (i.e. Screening for somatoform symptoms severity index, number of somatoform symptoms, somatic subscale of the Beck Anxiety inventory, somatization subscale of the Brief Symptom Inventory) but not to avoidance behavior, cognitive-affective variables or current mood states.
Conclusion: The blood levels of sIL-2R were significantly higher in patients with depression than in controls. Moreover, there are differences in associations between sIL-2R and distinct features of depression.
Keywords: Soluble interleukin 2 receptor; Soluble tumor necrosis factor receptor; Depression; Somatic symptoms; Anxiety; Mood states
CORRESPONDING AUTHOR: Dannehl Katharina, Philipps Universität Marburg; dannehl@staff.uni-marburg.de
P150
IN VIVO BETA-ADRENERGIC RECEPTOR SENSITIVITY AND INFLAMMATORY IMMUNE MARKERS IN HEALTHY INDIVIDUALS
Euteneuer F.1, Mills PJ.2, Rief W.1, Ziegler MG.3, Dimsdale JE.2
1 University of Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany
2 University of California, San Diego, Department of Psychiatry, San Diego, USA
3 University of California, San Diego, Department of Medicine, San Diego, USA
Several stress-related conditions that are considered to involve sympathetic overactivation are accompanied by increased levels of inflammatory immune markers. Chronic sympathetic overactivity is accompanied by increased stimulation of the beta-adrenergic receptor (beta-AR). While prior research suggests that one mechanism by which sympathetic stimulation may facilitate inflammation is via beta-AR activation, little work has focused on the relationship between circulating inflammatory immune markers and beta-AR function within the human body (in vivo). We examined whether decreased beta-AR sensitivity, an indicator of prolonged beta-adrenergic overactivation and a physiological component of chronic stress, is related to elevated levels of inflammatory immune markers. Ninety-three healthy participants underwent the chronotropic 25 dose isoproterenol test to determine in vivo beta-AR function. Circulating levels of C-reactive protein, interleukin 6, and soluble tumor necrosis factor receptor 1 were assessed. Beta-AR sensitivity was lower in people with higher C-reactive protein concentrations (r = 0.326, p = .003). That relationship remained significant after controlling for sociodemographic and health variables such as age, sex, ethnicity, body mass index, mean arterial blood pressure, heart rate, leisure-time exercise, and smoking status. No significant relationship was found between chronotropic 25 dose and interleukin 6 or soluble tumor necrosis factor receptor 1. This study demonstrates a link between in vivo beta-AR function and circulating inflammatory immune markers in humans. Future studies in specific disease states may be promising.
Keywords: Stress, immune function
CORRESPONDING AUTHOR: Euteneuer Frank, Philipps University, Marburg; frank.euteneuer@staff.uni-marburg.de
P151
PSYCHOSOCIAL STATE AFTER BARIATRIC SURGERY DEPENDS ON THE SEROTONIN TRANSPORTER PROMOTER POLYMORPHISM
Defrancesco M., Libaert J., Kinzl J.
Medical University Innsbruck, Department of General and Social Psychiatry, Innsbruck, Austria
Background: Bariatric surgery is the method of choice in the treatment of morbid obesity. Different genotypes of the serotonin transporter gene (5-HTT) are known to impact the prevalence of psychiatric disorders and the psychosocial state in obese individuals. In this study, we examined the influence of the 5-HTTLPR polymorphism on physiologic and psychosocial measures in morbidly obese women after bariatric surgery.
Methods: We examined women 1 to 5 years after bariatric surgery using a semi-structured interview and the Beck Depression Inventory, the Ardelt-Moorhead Quality of life questionnaire, the NEO Five-Factor Inventory and a Resilience scale. The 5-HTTLPR polymorphism (s/s, s/l, l/l) was genotyped using mouth swabs. The influence of genotype on outcome variables was analysed by one-way ANOVA, independent t-test and analysis of covariates.
Results: 73 women were enrolled in this study between January 2004 and September 2009. Significantly lower quality of life (p
Conclusion: Quality of life, mood, and resilience but not weight loss after bariatric surgery are negatively influenced by the s-allele of the 5-HTTLPR polymorphism. We recommend considering the genotype of the 5-HTTLPR polymorphism for optimal post-operative care following bariatric surgery.
Keywords: Genetics, Obesity
CORRESPONDING AUTHOR: Defrancesco Michaela, Psychiatry Innsbruck; michaela.defrancesco@i-med.ac.at
P153
ASSESSMENT OF SALIVARY ALPHA-AMYLASE. DO NOT NEGLECT THE LARGE DIURNAL FLUCTUATIONS
Garvin P.1, Raetegui RAS.2, Winquist F.2
1 Linköping University, Department of Medicine and Health Sciences, Linköping, Sweden
2 Linköping University, Department of Physics, Biology and Chemistry, Linköping, Sweden
In recent years, assessment of alpha-amylase in saliva (sAA) has gained much interest as a potential marker in psychobiology, suggested to at least in part reflect adrenergic activity. It is not clear however how study designs should be optimized when assessing sAA. As of today, most studies use fixed time points when collecting saliva for evaluation of sAA.
In this study we have been following three subjects in everyday life settings, two male students and one male professor. Assessments of sAA were made starting as possible after awakening continuing throughout the day. The three subjects were followed under two days (n = 14 to 31 per day). In parallel, a simple log was kept during the days of assessment, to track down physiological and psychological stressful events throughout the day.
The results reveal that some, but not all, peaks in sAA could be explained by reported stressors such as physical activity or taking a cold shower. There were however several peaks and considerable variation of sAA level that cannot be easily explained by reported stressors. Of note, the level of sAA at awakening was almost identical for two subjects when comparing the two consecutive days.
Based on these data, we conclude that it may be cumbersome to use sAA at fixed time points. We propose that sAA just after awakening may be the time point of highest relevance, when studying sAA as a marker in psychobiology.
Keywords: Stress; Methodology; Psychophysiology
CORRESPONDING AUTHOR: Peter Garvin, Linköping University, Linköping; peter.garvin@liu.se
P154
DIURNAL PREFERENCE COUPLED TO SALIVARY CORTISOL, HEART RATE VARIABILITY AND EMOTIONAL RHYTHMS
Haraszti RA.1, Purebl GY.1, Salavecz GY.1, Dockray S.2, Steptoe A.3
1 Semmelweis University, Department of Behavioural Sciences, Budapest, Hungary
2 University College Cork, School of Applied Psychology, Cork, Ireland
3 University College London, Department of Epidemiology and Public Health, London, United Kingdom
Diurnal preference has been defined by sleep timing and validated by body core temperature rhythms. Social jetlag theory recently drew attention to the importance of shifts between actual sleep timing on work days and preferred sleep timing on weekends. Yet, it is unclear if other rhythms of the body can perform a shift between work days and weekends in order to adapt better to social time.
Methods: The Composite Scale of Morningness was administered to 200 healthy working women. Each subject has undergone two 24 hour sessions, one over a working and one over a weekend day. Sessions involved periodic sampling of saliva for cortisol analysis, actigraphy and heart rate variability monitoring via Actiheart (Cambridge Neuroscience) and Ecological Momentary Assessment to determine happiness, stress level, frustration, pain, fatigue, sense of control and degreee of haste. Data were analyzed by TSA Cosinor 6.3.
Results: The phase of negative emotion- and cortisol level rhythms were coupled to chronotype (p < 0.05). Negative emotions also significantly manifested phase shifts towards later timepoints on weekend days. None of the biological measures showed a similar pattern. Actigraphy confirmed diurnal preference assessment and showed social jetlag phenomenon in both chronotypes.
Conclusions: Preference of sleep timing is not likely to be able to phase-shift hormonal parameters, while it has a clear influence on emotions. Autonomous tone oscillates on a circadian fashion but it does not tend to correlate with morningness-eveningness.
Keywords: Morningness-eveningness, salivary cortisol, heart rate variability, ecological momentary assessment
CORRESPONDING AUTHOR: Haraszti Reka Agnes, Semmelweis University, Budapest; rharaszti@gmail.com
P156
EUSTRESS INDUCED BY COMPETITION DECREASES SALIVARY CORTISOL LEVELS IN HEALTHY YOUNG MALES
Nagy T.1, Harmat L.2, Kovács K J.3, Polyák Á.3, Bárdos GY.4, Fülöp M.1
1 Hungarian Academy of Sciences, Institute of Cognitive Neuroscience and Psychology, Budapest, Hungary
2 Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden
3 Hungarian Academy of Sciences, Institute of Experimental Medicine, Budapest, Hungary
4 Eotvos Lorand University, Institute of Health Promotion and Sport Sciences, Budapest, Hungary
Introduction: Although Hans Selye’s stress theory distinguished positive and negative stress (or eustress and distress) (Selye, 1975), 20th century research almost exclusively focused on the latter (cf. Denson, Spanovic, & Miller, 2009). Lazarus and Folkman’s (1984) coping model stated that cognitive evaluation of the stressor is essential since only those stimuli are likely to enhance negative effects of stress which are considered threatening. That is why people are capable of enjoying activities which can be seen as dangerous or stressful in different circumstances (Csíkszentmihályi, 1990). Such an example is competition which can be considered a distressing or joyful activity (Fülöp, 2009). According to our hypotheses, eustress activates the sympathetic part of the stress system – similar to distress –, but does not activate the HPA system. We did not opt out the possibility that eustress might even attenuate the HPA activity, given that people often use eustress inducing activities for recovering from stress (e.g. Reinecke, 2009).
Aim of the study: To examine psychophysiological and endocrine effects of a non-physical competitive activity which is considered both pleasant and arousing by participants.
Method: Based on a pilot study we chose to use a video game contest (Nagy, 2011). Participants (40 healthy, young males) had to compete in pairs against each other. We used within-subject approach and analyzed cardiovascular and psychological measures through 8 phases (baseline, 6 competition phases and recovery). Pre- and postcompetition saliva samples were also taken to measure cortisol and testosterone changes. We used two independent groups. In the first there was no distinction according to the outcome of the competition, in the second, the winner gained more reward than the loser.
Results: Participants reported positive feelings and heightened arousal, which was supported by cardiovascular (HR and HRV) measures. In contrast, salivary cortisol levels were significantly decreased under both conditions (η p 2 = .38). However cardiac reactivity showed different patterns for the two groups: the equally rewarded group displayed a gradually increasing sympathetic activity while the unequally rewarded group had gradually soothing response (η p 2 = .23).
Keywords: Stress, Coping, Psychoneuroendocrinology, Psychophysiology, Cardiovascular reactivity, Cortisol
CORRESPONDING AUTHOR: Nagy Tamás, ELTE, Budapest; nagytamas.hungary@gmail.com
P157
THE INFLUENCE OF COPY NUMBER VARIATIONS OF THE AMY1 GENE ON BASAL AND STRESS-RELATED CHANGES IN SALIVARY ALPHA-AMYLASE
Nater U.1, Dimulescu I.2, Unger E.2, Rajeevan M.2
1 University of Marburg, Clinical Biopsychology, Marburg, Germany
2 Centers for Disease Control and Prevention, Chronic Viral Diseases Branch, Atlanta, USA
Background: Salivary alpha-amylase (sAA) is used extensively as a marker of the autonomic nervous system (ANS) in behavioral medicine. While it is known that salivary alpha-amylase gene (AMY1) copy number variation (CNV) correlates with its expression, there are no reports on the impact of AMY1 gene dosage on its use as a marker of ANS regulation. In this study, we evaluated the contribution of AMY1 CNV to inter-individual differences in basal and stress-related sAA activity.
Methods: Subjects belonged to the first follow-up surveillance of chronic fatigue syndrome in GA, USA. Baseline sAA morning profile and awakening response (AAR) at 0, 30, 45 and 60 minutes after awakening were determined for 613 subjects. Stress reactivity in sAA was determined in a subset of 41 healthy subjects undergoing the Trier Social Stress Test (TSST). AMY1 CNV was determined using whole blood DNA and LightCycler 480 based quantitative PCR. AMY1 and 36B4 (reference gene) reactions were done in triplicate. CNV was calculated based on absolute quantification using a 2-fold standard curve ranging from 40ng to 0.625ng per reaction of Coriell DNA NA07919 reported to have 2 copies of AMY1/cell.
Results: AMY1 CNV ranged from 1 to 15 diploid copies/cell. Subjects were classified into eight CNV groups for association with sAA morning profile and AAR. AMY1 CNV showed a positive gene dosage response with sAA morning profile (p = 0.003), AAR (p = 0.0070), area under the curve total (AUC total) (p = <0.001), and AUC increase of the morning profile (p = 0.003). Subjects in the stress reactivity study were classified into three CNV groups. In agreement with AAR, subjects with higher copies of AMY1 exhibited higher sAA reactivity (p = 0.021) and higher AUC total (p = 0.023) in the TSST. All significant associations between AMY1 CNV and sAA measurements were independent of potentially contributing factors (age, sex, race, illness status).
Conclusion: AMY1 CNV was identified as a key genetic determinant of inter-individual differences in basal and reactive levels of sAA. Past and future studies using sAA as a marker of ANS should be interpreted in the light of the contribution of this heritable genetic variation in stress signaling.
Keywords: stress, biobehavioral mechanisms
CORRESPONDING AUTHOR: Nater Urs, University of Marburg, Marburg; nater@uni-marburg.de
P158
ACUTE STRESS REDUCES MICROBICIDAL POTENTIAL OF EX VIVO ISOLATED HUMAN MONOCYTE-DERIVED MACROPHAGES
Kuebler U.1, Wirtz PH.2, Sakai M.3, Stemmer A.3, Ehlert U.1
1 University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
2 University of Bern, Biological and Health Psychology, Bern, Switzerland
3 Swiss Federal Institute of Technology Zurich, Nanotechnology Group, Zurich, Switzerland
Acute psychological stress induces changes in circulating blood leukocytes, but its effect on leukocytes in peripheral tissues is largely unknown. Activated tissue macrophages are important in early phases of wound healing particularly by killing microbes. We hypothesized that (a) acute psychological stress reduces the microbicidal potential of human monocyte-derived macrophages (HMDM) and (b) these reductions relate to stress hormone release.
Forty-one healthy men (mean age 35 ± 1 yr) were randomized to either stress (n = 24) or control group (n = 17). While the stress group underwent the Trier Social Stress Test (TSST; combination of mock job interview and mental arithmetic task), controls did not. Assessing the microbicidal potential, we investigated PMA-activated superoxide anion (O -2 ) production by ex vivo isolated HMDM immediately before and after stress, and during recovery up to 60 min after TSST / rest. Moreover, we repeatedly measured plasma norepinephrine and epinephrine levels as well as salivary cortisol.
The groups significantly differed in their HMDM microbicidal potential (p = .01) in reaction to stress. Post hoc testing revealed that while HMDM of the control group displayed a significant increase in O -2 production over time (p = .02), the cells of the stress group did not (p = .83). Immediately and 10 minutes after stress O -2 production by HMDM was lower in stressed subjects as compared to controls (p’s < .05). Statistical mediation testing revealed that higher norepinephrine levels mediated lower amounts of O -2 responses.
Our results suggest that acute psychological stress reduces the microbicidal potential of HMDM probably by norepinephrine release. This might have implications for stress-induced impairment in wound healing.
Keywords: Psychoneuroimmunology, Stress, Injury, Immune function, Norepinephrine, Cortisol
CORRESPONDING AUTHOR: Kuebler Ulrike , University of Zurich, Zurich; u.kuebler@psychologie.uzh.ch
P159
CORTISOL, SUBJECTIVE HEALTH COMPLAINTS AND COPING IN PATIENTS WITH UNSPECIFIC LOW BACK PAIN
Sveinsdottir V.1, Harris A.1, Ursin H.1, Hansen Å M.2, Eriksen H R.1
1 Uni Research, Uni Health, Bergen, Norway
2 National Research Centre for the Working Environment, Copenhagen, Denmark
Musculoskeletal pain is the main reason for long-term sick leave in Norway. Non-specific conditions with no clear somatic pathology (Subjective Health Complaints – SHC) like muscle pain, mood changes, and tiredness, are prevalent all over the world. The comorbidity is high and the complaints are often attributed to “stress”. Salivary cortisol is an increasingly popular biological marker for stress, and is generally characterized by high reactivity in the morning followed by lover evening values. The purpose of this study was to investigate whether patients with low back pain (LBP) differed from the normal characteristic profile, and whether possible deviations were related to coping or SHC. The theoretical basis for the study is the Cognitive Activation Theory of Stress (CATS). 305 LBP patients on long-term sick leave participated in the study (45.8% men and 54.2% women, aged 20-60). Cortisol was measured by saliva samples upon awakening, after 30 minutes, in the afternoon and evening. The patients answered questionnaires about SHC, coping, social support, pain, fatigue, and fear avoidance. The sample showed a seemingly normal and characteristic cortisol profile with a large awakening cortisol response, and lower levels in the afternoon and evening. However, there were some weak but significant negative correlations between cortisol reactivity (awakening response and cortisol decrease) and severity of SHC, pain and fatigue. The lack of stronger significant findings is remarkable with respect to the expected associations between cortisol, health, and coping.
Keywords: Cortisol, stress, psychoneuroendocrinology, health, coping, social support, pain, fatigue
CORRESPONDING AUTHOR: Sveinsdottir Vigdis, Uni Health, Bergen; vigdis.sveinsdottir@uni.no
P160
THE REGULATION THEORY STRESS MODEL: A SCIENTIFIC MODEL FOR THE INVESTIGATION OF BEHAVIOUR DEPENDENT RELATIONSHIPS IN BLOOD PRESSURE REGULATION
Svitavsky M.
University of Innsbruck, Cardiology, Innsbruck, Austria
The following article presents a psychosomatic model for behaviour-related blood pressure regulation. From this model can be derived scientifically verifiable hypotheses which were investigated for instance in our parallel published study "Reduced perception of stress increases cardiovascular strain for infarct patients" (ICBM 2012). A simple feedback loop represents a process in medicine with which a measured value is compared with a nominal value for a control variable which is to be kept constant and is reported to a regulating centre (regulator), whereby in the case of a difference (control deviation), which itself is the result of the influence of disturbance variables, control signals are sent to a correction mechanism (actuators): negative feedback. In the psychosomatic feedback loop model of blood pressure regulation the following elements are defined as follows: Nominal value = resting diastole, control variable = measured value of the diastole at the time x, disturbance variable = psychological stress (e.g. concentration), control deviation = the measured difference of the "nominal value - control value", control unit = circulatory centre in the medulla oblongata, negative feedback = a) activation of pressoreceptors (physiological) and b) perception of stress (psychological), actuator = a) vascular smooth muscle (physiological) and b) behavioural reduction: e.g. pauses (psychological). From this model the following problem was derived and investigated in our second publication: Are there statistically significant differences in patients suffering cardiovascular illnesses between those with myocardial infarctions and those without in terms of a) stress perception, b) stress regulating behaviour and c) cardiovascular stress?
Keywords: Health behaviors, Stress
CORRESPONDING AUTHOR: Svitavsky Markus, Innsbruck University, Innsbruck; svitavsky.markus@arcor.de
P161
"STRESS" IN THE NEW WORLD - CONSIDERATIONS REGARDING THE CHANGE IN RESEARCH EMPHASES DURING THE CONTEXT OF EXILE OF HUNGARIAN NEUROPHYSIOLOGIST HANS SELYE (1907-1982) IN MONTREAL
Stahnisch W.
University of Calgary, Community Medicine Department, Calgary, AB, Canada
The massive loss of nearly thirty per cent of all academic psychiatrists and neurologists in Germany, Austria and Hungary between 1933 and 1945 in many ways also destroyed the basis of German-speaking neuroscientific and psychiatric research, as has been pointed out by many historiographical studies over the past decades. In return, the process of forced-migration of politically oppositional and Jewish scientists and physicians from Nazi-occupied Europe has often been interpreted – and was thus also downgraded in a certain way – as a process of a mere “brain gain” for the North American research landscape. Research literature on the receiving countries, such as Canada and the United States of America, has tended to primarily focus on the intellectual, academic and institutional dimensions of the forced-migration process, while the individual fate and destiny as well as the social problems of many émigré-neuroscientists are still very much under-researched. This presentation focuses on the specific case example of the Hungarian neurophysiologist Hans Hugo Bruno Selye (1907-1982), who had studied medicine at the German University in Prague and, following to his graduation, travelled for additional research training to the premier US medical school at Johns Hopkins University, Baltimore. His case example is very instructive as Dr. Selye had not been obliged to stay in North-America during times of the Nazi Regime in Central Europe, but like many émigré neuroscientists expressively decided to stay and move on to McGill University. After his arrival in Montreal, Dr. Selye pursued a most impressive career as a neurophysiologist, becoming the “father of stress” and was repeatedly nominated for the Nobel Prize in Physiology or Medicine. This presentation will primarily focus on the question of the “personal stress” for the émigré neuroscientist to build, change and adapt his research program as well as his own behaviour as a scientist, while being exposed to a very different research community (emphasis on application versus pure knowledge pursuit), finding a place as an interdisciplinary researcher in a research landscape organized in departments (interdisciplinarity versus disciplinarity in biomedical research), and finally the personal insecurity as an individual researcher abroad, who had to leave his family behind during times of Nazi and Soviet Totalitarianism in Central Europe, 1933 to 1956.
Keywords: Stress, Culture, Behavior Change, Psychophysiology
CORRESPONDING AUTHOR: Dr Stahnisch Frank W., University of Calgary, Alberta; fwstahni@ucalgary.ca
P162
STRESS: THE PREDICTIVE INFLUENCE OF LIFE EVENTS AND MENOPAUSAL STATUS
Pimenta F., Leal I., Maroco J.
Instituto Superior Psicologia Aplicada, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Objective: Midlife is filled with challenges and unique stressors for women; both contextual and individual characteristics might be associated with stress levels (e.g., Darling, Coccia, & Senatore, 2012).This study aims at exploring if life events and menopausal status, controlling for confounding variables, can predict stress in middle-aged women.
Method: A community sample of 1,003 Portuguese women, aged between 42 and 60 years, in pre-, peri- or post-menopause, filled in a questionnaire to collect socio-demographic, health and menopause-related, and lifestyle information. Menopausal status was determined using the STRAW criteria (Soules et al., 2001). Stress levels were measured with a validated version of the Depression, Anxiety and Stress Scales (Pais-Ribeiro et al., 2004) and life events by the Life Experiences Survey (Silva et al., 2003). Structured equation modelling was used to build a causal model between the dependent variable (stress) and the several independent ones (socio-demographic, health and menopause-related characteristics, lifestyle and life events).
Results: Significant predictors of stress included household income (β = -.074; p = .047), transition from pre- to peri-menopause (β = .082; p = .028), transition from peri- to post-menopause (β = .151; p = .003), psychological health status (β = .255; p < .001), physical health status (β = .075; p = .015) and recent life events (β = -.383; p < .001).
Conclusion: Although menopausal status was a significant predictor of stress (namely, the transition from pre- to peri-menopause, and from peri- to post-menopause), the presence of stressful life events seems to be a stronger predictor of stress-related symptoms. Other variables should be taken into account, in middle-aged women, as risk factors for the development of stress (specifically, lower income, and the presence of a health or a psychological problem).
Keywords: Stress; Women's health; Life events; menopause; structural equation modelling
CORRESPONDING AUTHOR: Pimenta Filipa, ISPA - Instituto Universitário; filipa_pimenta@ispa.pt
P163
POSITIVE ASSOCIATIONS BETWEEN STRESS EXPERIENCED IN EVERYDAY LIFE AND IN THE LABORATORY
Skoluda N.1, Doerr J.1, Thoma M.2, Ehlert U.3, Nater U.1
1 University of Marburg, Clinical Biopsychology, Marburg, Germany
2 Brandeis University, Psychology, Waltham, USA
3 University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
Background: Associations between stress levels in everyday life and controlled laboratory conditions remain a controversial topic. The aim of the present study was to compare psychological and physiological stress levels assessed in a real-life setting with laboratory stress levels.
Methods: Thirty-five healthy male students (age M = 24.4, SD = 2.6 yrs) took part in the study. The first part of the study consisted of a two-day period within which subjects collected saliva and rated their stress levels on a visual analogue scale immediately after awakening, 30min later, at 9am, and then every two hours for a total of nine times a day while maintaining their regular daily activities. Salivary alpha-amylase (sAA) was assessed as a marker for autonomic nervous system activity at each time point. In the second part, subjects were invited to two laboratory sessions on two separate days, with randomized exposure to either a standardized stress test (cold pressor test, CPT, stress condition) or a rest condition (reading magazines). Again, sAA and subjective stress were assessed repeatedly during both conditions.
Results: During both days, sAA levels showed a distinct diurnal rhythm, with a trough in the morning and a steady increase over the course of the day (time effect p < .001). Self-reported stress levels significantly fluctuated over the course of the two days (time effect p = .022). In the laboratory part, the CPT resulted in significant increases in sAA and in self-reported stress levels (time effect: p = .001, interaction effect, p = .001). Regression analyses revealed that overall sAA levels in everyday life predicted sAA levels in both laboratory conditions (p < .001). The same held true for subjective stress levels (p < .001). It was also found that overall subjective stress levels in everyday life predicted the psychological laboratory stress response (p = .026). Furthermore, a trend was found for the sAA awakening response predicting overall sAA in the stress condition (p = .067).
Conclusions: Stress levels in everyday life were shown to predict psychological as well as physiological stress levels in the laboratory. Further, subjects with high stress levels in everyday life experienced a more pronounced psychological stress response to a laboratory stressor.
Keywords: Stress, Psychophysiology, Measurement
CORRESPONDING AUTHOR: Skoluda Nadine, University of Marburg; skoluda@uni-marburg.de
P164
REDUCED PERCEPTION OF STRESS INCREASES CARDIOVASCULAR STRAIN FOR INFARCT PATIENTS
Svitavsky M.
University of Innsbruck, Cardiology, Innsbruck, Austria
The empirical study is derived from our parallel published "Regulation theory stress model" (ICBM 2012) and investigates the following questions: In a randomly selected sample of 45 outpatients at Innsbruck University Hospital, between 25 infarct patients and 20 infarct-free patients with other cardiovascular symptoms and statistically comparable infarct risk, are there statistically significant differences at: a) stress perception, b) stressreducing behaviour, c) cardiovascular strain? Statistically the infarct and control group are comparable as regards age spread, gender distribution and infarct risk profile. In an experimentally controlled induction of mental stress, all patients had to write down 130 numbers dictated from a tape in 3,5 minutes. At the same time, their heart rate (extremity ECG as per Einthoven), systolic and diastolic blood pressure (wrist blood pressure measurement as per Riva-Rocci) were measured twice before, three times during and twice after the exposure to stress at one-minute intervals. The perception of stress was measured by correlating the physiological time series measurement of systole, diastole and heart rate on the one hand, with the subjective estimated values of a four-step rating scale on the other. The control group had a statistically highly significant more sensitive perception of stress (p < .005) and took breaks during the induction of stress statistically remarkable earlier (p = .07) than the infarct group. During the stress period were in the control group both, the heart rate as well as the diastolic level, statistically significantly lower (p < .05), than in the infarct group. Within the psychosomatic feedback loop model of blood pressure regulation are a) the perception of stress = the psychological part of the negative feedback and b) breaks = the psychological part of the correction mechanism. The results of the study show that well-functioning perception of stress protects against and reduced perception of stress increases cardiovascular strain and infarct risk.
Keywords: Health behavior, Stress
CORRESPONDING AUTHOR: Svitavsky Markus, Innsbruck University, Innsbruck, svitavsky.markus@arcor.de
P165
STRESS REACTIVITY AND HEALTH RISK BEHAVIORS IN A SAMPLE OF RUSSIAN YOUNG ADULTS
Bogolyubova O.1, Shaboltas A.1, Ababkov V.2
1 Saint-Petersburg State University, Department of Psychology, St-Petersburg, Russia
2 Saint-Petersburg State University, Department of Psychology, Saint-Petersburg, Russia
It is well known that a range of diseases and health conditions can be attributed to certain forms of high risk behavior (e.g. unprotected sexual intercourse, smoking, substance abuse). Modern research demonstrates that stress, especially chronic and/or traumatic stress, contributes to the development of these behaviors. Stress reactivity represents individual’s behavioral and biological response to new and/or stressful situations. Individual reactivity to stress is considered to be a relatively stable trait. On a biological level the release of hormone cortisol represents activation of the HPA axis in reaction to stress. The levels of cortisol expression characterize the psychobiological stress reaction of an individual and can be affected by a number of factors, including behavioral factors such as chronic stress, exposure to significant stress in childhood (e.g. in maltreated individuals) etc. The goal of this study was to investigate the connections between adverse childhood experiences, stress reactivity in two experimentally manipulated stressful situations and health related risk behaviors in a sample of young adults. The experimental situations included two different social stressors: (1) public speaking and (2) interaction with a stranger of opposite sex. Risk behaviors (sex behaviors, tobacco smoking, alcohol intake, drug use) and childhood experiences (physical and sexual victimization, neglect, exposure to domestic and community violence etc.) were assessed by means of self-report questionnaires. Cortisol was measured in saliva samples (three measures per experimental situation). Experimental situations took part on different days with an interval of no more than one week. The sample consisted of young males and females (n = 100; 20 – 30 years old) recruited via the social networking web sites and advertisement in local universities. The results of the study demonstrated relatively high rates of victimization and other types of childhood adversity in the study sample. The behavioral and biological reactions to stressful situations were described. Regression analysis was employed to demonstrate the impact of childhood stress on current psychobiological reaction to stress and self-reported risk behaviors of young adults.
Keywords: Health, Health behaviors, psychoneuroendocrinology, stress
CORRESPONDING AUTHOR: Bogolyubova Olga, SPbSU, St-Petersburg; bogoliubova@yahoo.com
P166
PSYCHOLOGICAL PROBLEMS, CAUSES OR SOURCES OF STRESS, AND COPING STRATEGIES AMONG MEDICAL STUDENT AT THE UNIVERSITY OF TRIPOLI . LIBYA
Buni A.
University of Tripoli, Department of Community Medicine, Tripoli, Libya
It has been estimated that stress- related disorders will be one of the leading causes of disability by the year 2020. Some studies indicated that medical students have higher incidence of stress than other students in other professions. However such studies are almost non existent or at least very few in medical schools of Libya.
Objectives: This study aimed to determine and assess the prevalence of psychological problems, causes or sources of stress, and coping strategies among medical students at the university of Tripoli, Libya.
Method: To achieve the objectives of this study, 605 students from the fourth year medical students "males 145 (24%) and females 460 (76%) were asked to complete a modified questionnaire on the "Influence of studying on student health, just one month before the Libyan revolution of February 17 - 2011.
Result: 25% of the sample study reported that they suffer psychological problems, 79% reported that their studying influenced their habits in drinking excess tea and coffee. Causes and sources of stress include fear of failure in examination 60%; crowded lectures halls 56%; fear during practical and clinical discussions 77%; insufficient time to study 86%; content of curriculum "overloading" 85%; fear of infection in hospitals 72%; anxiety from clinical and oral examination 47% and 33% respectively; fear from curriculum especially in the third academic year 57% (they call it the cemetery year)
The coping strategies used by students include religious faith 92%; talking to friends and parents 54% and 43% respectively;.70% of students reported that they had not received any education about stress management during their study.
Conclusion: Results indicated that medical students need some kind of psychological and social support, and guidance and counseling program to help them improve their academic performance ,as well as their mental and social health.
Keywords: Stress, medical students
CORRESPONDING AUTHOR: Buni Ahmed, University of Tripoli -Libya; ahmedmbuni@hotmail.com
P167
MEDICAL STUDENTS’ PSYCHOSOMATIC SYMPTOMS DURING THE TERM-TIME AND THE EXAMINATION PERIOD
Csala I.1, Cserhati Z.2, Nemeth E.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 Semmelweis University, Institute of Cognitive Neuroscience and Psychology, Budapest, Hungary
Background: Medical education can be harmful for many students’ physical and mental health (Carter et al. 2001). High prevalence of depression, anxiety, and substance use has been found among medical students. Increased level of stress, which can be detected during the university especially in the examination period, may cause psychosomatic symptoms. The aim of this study was to analyze the effect of the examination period on medical students’ subjective health complaints.
Methods: We recruited 259 medical students in the term-time from the 1st, 3rd, and 5th years and we followed 140 of them in the examination period. For measuring somatization we recorded a frequency score from 0 to 4 experienced by students for 13 symptoms of Patient Health Questionnaire-15 (PHQ-15). We formed a symptomatic score for each individual by summing their frequency scores for the 13 symptoms. We used the symptomatic score to assess the general condition of the students.
Results: The symptomatic score increased in the examination period in all three groups (1st, 3rd, and 5th year students, with p < 0.001 in all groups). Comparing the groups we found that 1st year students showed higher symptomatic score than 5th year students in the term time (p = 0.019), whereas this difference disappears in the examination period. 11 of the symptoms, including stomach pain (p < 0.001), back pain (p < 0.001), headaches (p < 0.001), chest pain (p = 0.002), dizziness (p < 0.001), feeling heart pound (p < 0.001), shortness of breath (p = 0.029), constipation or diarrhea (p < 0.001), nausea (p < 0.001), tiredness (p < 0.001), and trouble sleeping (p < 0.001) showed up with a significantly higher frequency in the examination period in total sample. The most common symptoms were tiredness, headache, trouble sleeping, and back pain.
Conclusion: Examination period is stressful for medical students, therefore they show more psychosomatic symptoms than in the term time. The most vulnerable are the 1st year students, who are exposed to whole new difficulties in the university but do not have effective skills to cope with those. Rethinking of the curricula, stress management courses and student counseling could be useful to reduce stress.
Keywords: stress, health
CORRESPONDING AUTHOR: Csala Iren, Semmelweis University, Budapest; csalus@gmail.com
P168
A STUDY OF RELATIONSHIPS BETWEEN AUTONOMOUS UNIVERSITY-LIFE MOTIVATION SCALE AND THE STRESS SELF-RATING SCALE FOR UNIVERSITY STUDENTS IN JAPAN
Fukuzumi N., Aoki K., Yamaguchi S.
Tokyo Denki University, Graduate School of Advanced Technology and Science, Tokyo, Japan
Objectives: In this study the Autonomous University-life Motivation Scale was developed in the framework of the organismic integration theory (Ryan & Deci, 2000), and its reliability and validity were examined. The relationship between Autonomous University-life Motivation Scale and the stress self-rating scale for university students was also examined.
Methods: Participants were 265 university students (male; 221, female; 44). They completed the Scale of Autonomous University-life Motivation in which we expected five subscales: amotivational, external, internalized, identified, and intrinsic reasons following previous studies and the stress self-rating scale for university students (Ozeki, Haraguchi & Tsuda, 1994). The stress self-rating scale for university students consists of seven subscales, emotional response; depression, emotional response: anxiety, emotional response: anger, cognitive-behavioral response: emotional response, cognitive-behavioral response: withdrawal, somatic tiredness and activation of autonomic nervous system. Statistical Package for Social Science (SPSS version 14.0) has been used for the statistical analyses.
Results and Conclusions: The results were as follows: Positive correlation coefficient was observed between amotivational and stress responses (seven subscales) {r = 0.23 ~ 0.51, p < 0.01}. Positive correlation coefficient was observed between external and stress responses (seven subscales) {r = 0.16 ~ 0.34, p < 0.01}. Positive correlation coefficient was observed between internalized and stress responses (six subscales) {r = 0.14 ~ 0.27, p < 0.05}. Negative correlation coefficient was observed between internalized and stress responses (two subscales) {r = -0.20 ~ -0.24, p < 0.01}. Negative correlation coefficient was observed between intrinsic and stress responses (four subscales) {r = -0.12 ~ -0.24, p < 0.01}.
Keywords: Stress, Motivation
CORRESPONDING AUTHOR: Fukuzumi Noriaki, Tokyo Dneki University, Tokyo; n.fukuzumi@gmail.com
P169
SOCIAL ROLE BURNOUT AND THE IMPACT ON HEALTH: DOES PERSONALITY PLAY A ROLE?
Hagemann L., Kaplan E., Suchday S., Veres S.
Yeshiva University, Clinical Psychology (Health Emphasis), New York, USA
This study investigates the effect of “social role burnout” (i.e. burnout related to the engagement in excessive interpersonal relationships) and personality traits, specifically Type D (negative affect/social inhibition) on baseline health indicators. A community sample of twenty-four adults (17 females, 7 males), aged 18 and older, was obtained from the New York City area. Subjects were assessed for burnout rates (Shirom-Melamed Burnout Measure), Type D characteristics (DS14) and social and interpersonal involvement (SNI). Baseline blood pressure and heart rate was also measured. It is hypothesized that personality type mediates SMBM and SNI with baseline health indicators. Results showed a significantly strong correlation between DS14 and SMBM (r = .53, p < .001). A regression analysis indicated that DS14 total scores significantly predicted diastolic blood pressure (b = -.59, t(23) = -2.42, p < .05), but was not significantly related to other variables, supporting that for this sample, personality did not prove to be a mediator. SNI was found to be unrelated to DS14 scores and health indicators. This young, socially diverse sample may engage in numerous social roles as a buffer or coping mechanism to experienced stress. Future research requires a larger, more diverse sample, including those with increased rates of familal, parental and employment roles.
Keywords: Social stress, personality, health
CORRESPONDING AUTHOR: Lauren Hagemann, Yeshiva University; hagemann_l@yahoo.com
P170
EFFECTS OF REHABILITATION PROGRAMS FOR PATIENTS ON LONG-TERM SICK LEAVE BECAUSE OF BURNOUT: A 3-YEAR FOLLOW-UP OF THE REST-STUDY
Stenlund T., Nordin M., Slunga Järvholm L.
Occupational and Environmental Medicine, Umeå University, Public health and Clinical Medicine, Umeå, Sweden
Objective: To evaluate long-term effects of two different rehabilitation programs for patients on long-term sick leave because of burnout.
Design: A randomized controlled trial (the REST-study).
Patients: Seventy patients (51 women and 19 men) with burnout answered the questionnaires at the 3-year follow-up after the end of the intervention (response rate 65%).
Methods: Patients were randomized to two different 1-year group programs: (A) cognitively oriented behavioural rehabilitation in combination with Qigong; and (B) Qigong alone. Data on psychological measures, sick leave and use of medication were compared between the programs.
Results: Patients in program A significantly felt more recovered from their burnout, reported lower levels of burnout, used more cognitive tools learned from the program, and had reduced their use of medication for depression. No significant differences were found between the groups in sick leave rates; both groups had improved.
Conclusion: A multimodal rehabilitation for patients with burnout including cognitively oriented behavioural rehabilitation and Qigong showed positive effects 3 years after the end of intervention. The results indicate that for many burnout patients on sick-leave it takes time to implement cognitive tools and to establish new behaviours.
Keywords: randomized controlled trial, stress
CORRESPONDING AUTHOR: Stenlund Therese, Umeå University, Umeå; therese.stenlund@physiother.umu.se
P171
THE ASSOCIATION BETWEEN BRAIN’S DEFAULT MODE NETWORK AND ANHEDONIA: A RESTING STATE FMRI STUDY
Kunisato Y.1, Okamoto Y.2, Okada G.2, Nishiyama Y.2, Kanai Y.3, Sasaki-Aoki S.4, Yoshimura S.2, Katsuragawa T.1, Suzuki S.1, Yamawaki S.2
1 Waseda University, Faculty of Human Sciences, Tokorozawa, Japan
2 Hiroshima University, Department of Psychiatry and Neurosciences, Hiroshima, Japan
3 Tohoku Gakuin University, Department of Human Science, Sendai, Japan
4 Hiroshima University, The Graduate School of Integrated Arts and Sciences, Hiroshima, Japan
Introduction: Anhedonia is common symptom of many mental disorders studied in behavioral medicine including major depression, schizophrenia, substance abuse and Parkinson's disease. Recently, neural substrates of anhedonia have been studied using fMRI. However resting state functional network of anhedonia remains unclear. We examined the relation between anhedonia and default mode network in resting state brain activity.
Methods: Resting-state fMRI scans were acquired for 66 right-handed adults (20 males, 46 females, mean age = 21.20 years) who completed the Snaith-Hamilton Pleasure Scale (Snaith et al., 1995), which assess the anhedonia symptoms. Participants were collected 6 minute resting state functional MRI scans on a 1.5 Tesla MRI scanner (120 EPI volumes; TR = 3 sec; TE = 40ms; flip angle = 90 deg; slice thickness = 4mm no gap). Participants were instructed to close their eyes and remain awake. After the functional scan, anatomical images were acquired. The first 5 images were discarded and the subsequent 115 images were used for further analysis. Image preprocessing was carried out using Statistical Parametric Mapping (SPM8) software. After preprocessing, group independent component analysis was carried out using group ICA of fMRI toolbox in order to identify the default mode network component. Then, we conducted a simple regression analysis to examine the correlation between the default mode network and anhedonia using SPM8, and set significant correlations at the threshold of a voxel-wise p < 0.005 (uncorrected) that belonged to a cluster of activation with an extent of at least 30 voxels.
Results: Anhedonia correlated positively with left insula (r = .50), right medial prefrontal cortex(r = .52), right precuneus (r = .45) and left temporal pole(r = .42). While, anhedonia correlated negatively with left caudate (r = -.49), left postcentral gyrus (r = -.45) and left fusiform gyrus (r = -.47).
Discussion: The findings suggest that the higher anhedonic person shows the higher functional network with insula and midline brain area, and lower functional network with caudate. Anhedonia was characterized by low functional network with caudate which relates positive emotion and high functional network with insula which relates negative emotion.
Keywords: Anhedonia, Emotions, Mood, resting state fMRI, neuroimaging
CORRESPONDING AUTHOR: Yoshihiko Kunisato, Waseda University, Tokorozawa; ykunisato@gmail.com
P172
THE PSYCHOPHYSIOLOGY OF THE FLOW EXPERIENCE
Harmat L.1, De Manzano Ö.1, Theorell T.2, Ullén F.1
1 Karolinska Institutet, Department of Cognitive Neurology, Stockholm, Sweden
2 Stockholm University, Department of Stress Science and Psychosomatic Medicine, Stockholm, Sweden
Psychological flow is a subjective experience of enjoyment and concentration that typically occurs during performance of tasks that are challenging but matched in difficulty to a person's skill level (Csikszentmihalyi & Csikszentmihalyi, 1988). Here, we present data from two studies where physiological correlates of flow were measured. In study 1 , piano playing was used as a flow inducing behavior. Spontaneous differences in flow between repeated performances of the same piece were studied. State flow was rated by the participant after each performance. A significant relation was found between flow and heart period, blood pressure, heart rate variability, activity of the zygomaticus major muscle and respiratory depth. In study 2, the computer game "Tetris" was used as a model behavior, and the level of flow was experimentally manipulated. There were three conditions, corresponding to difficulty levels of the game: Simple, Optimal, and Difficult. Pilot data showed that the Optimal condition reliably evoked the highest level of flow. This design allows a within-person comparison of physiological correlates of flow (Optimal) and attention during subjective boredom (Simple) and cognitive overload (Difficult). We will compare the findings in the two studies and discuss them in relation to current models of emotion, attention and expertise, arguing that the flow state may be both phenomologically and physiologically different from effortful attention.
References
Csikszentmihalyi, M., & Csikszentmihalyi, I. (1988). Optimal experience. Psychological studies of flow in consciousness. Cambridge Univ Press.
Keywords: cardiovascular reactivity, psychophysiology, stress
CORRESPONDING AUTHOR: Laszlo Harmat; Semmelweis University, Budapest, laszloharmat@yahoo.com
P173
AUTONOMIC CARDIOVASCULAR CONTROL IN DEPRESSION: EFFECTS OF EMOTION INDUCTION BY SAD MUSIC
Mussgay L., Rueddel H.
St Franziska Stift, Psychosomatic Hospital, Bad Kreuznach, Germany
Deficits in autonomic cardiovascular control are hypothesized to be relevant factors contributing to the increase in morbitity in depressive cardiovascular disease patients. Convincing data, however, are still lacking. For the induction of a sad mood state music has been used occasionally. Our study bears on this issue and pursues the question, if in depressives deficits of autonomic regulation can be shown in response to a sad mood state induced by sad music.
Into the study 23 depressive inpatients of our Psychosomatic Hospital have been enrolled (age: 38 yrs; 20 women). At the beginning (t1) as well as at the end of their inpatient treatment phase (t2) patients took part in identical recording sessions in our laboratory. During both sessions measures of autonomic cardiovascular control (blood pressure (SBP, DBP), heart rate (HR), heart rate variability (HRV (TP, VLF, LF and HF) as well as baroreflex sensitivity (BRS)) were registered for 5 min in a resting state, in response to a mental challenge, and when listening to sad music. Sadness of music was rated on a visual analogue scale (0-100). State depression was assessed with the ADS.
Sadness of music at t1 was rated with 21, at t2 with 43. Two subgroups were formed by median split on the basis of the change in depression from t1 to t2 (greater improvement, n = 14; less improvement, n = 9). Depression at t1 was equal in both groups (ADS: 28 versus 29). Treatment improved scores from 29 to 11. Analysis of the parameters of autonomic control yielded highly significant differences (<.0005) between the experimental conditions (rest and music versus mental challenge for HR, SBP, DBP, TP, VLF, LF, HF, BRS). Heart rate was lower in response to music compared to rest (p = .005); systolic blood pressure was higher in music compared to rest (p = .02). Comparison of parameters of autonomic control between both groups yielded higher values of total HRV (group x condition: F = 5.3; p = .03) for mental challenge and music, and as tendency in the HF-band at rest and for music (group x condition: F = 2.9; p = .06). The VLF-band exhibited a tendency for a reduced variability at rest (group x condition: F = 2.7; p = .08).
A more pronounced improvement of depression during treatment goes along with better HRV at rest and in response to a music induced sad mood state as regards total power and within the parasympathetic frequency band. Thus or findings support the notion of HRV being an indicator of general emotional health. The reduction of HRV within the VLF range may point to a lesser degree of rumination at rest in patients with more improvement in depression.
Keywords: psychophysiology, cardiovascular reactivity, depression, emotions
CORRESPONDING AUTHOR: Mussgay Lutz, St.-Franziska-Stift; l.mussgay@fskh.de
P174
ALLEVIATION OF THE STRESS-INDUCED HYPOTHALAMUS-PITUITARY-ADRENAL (HPA) SYSTEM ENHANCEMENT BY BLUE COLOR
Nomura S.1, Ito K.1, Irfan CMA.1, Hasegawa-Ohira M.2
1 Nagaoka University of Technology, Top Runner Incubation Center for Academia-Industry Fusion, Nagaoka, Japan
2 Shiga University, Faculty of Education, Otsu, Japan
The effect of color on the physiological stress-response was investigated. Salivary cortisol and dehydroepiandrosterone (DHEA) which represent one of a major stress-reaction pathways, namely hypothalamus-pituitary-adrenal (HPA) system, and the salivary immunoglobulin A (IgA), alpha-amylase (SAA), and chromogranin A (CgA) which represent the other major stress-reaction pathways, namely sympatho-adrenal medulla (SAM) system, were assessed for the subjects who were engaged in a simple mental calculation task as an acute psychological stressor.
Twenty-three male university students voluntary participated in this study. After 10 minutes of a rest period as the initialization process, the subjects were instructed to perform a simple mental calculation task for 30 minutes with wearing any one of three different color glasses, which were red, blue, and clear (control). Subsequently subjects took 15 minutes of rest as the recovering procedure with wearing the same color spectacles. All subjects went-through each color conditions with randomized order (within-subjects design). Saliva samples were collected at every 3 minutes during the experiment.
In results, all concentration of salivary secreted substances, cortisol, DHEA, IgA, SAA, and CgA, showed transient elevation during the task period and then decline in the subsequent recovery period. This is a typical physiological stress-response against acute psychological stressors as represented by the activations of HPA and SAA system. On the other hand, with regard to colors, only cortisol showed significant difference in the level for distinct spectacle conditions. Salivary cortisol showed the stress-response in each color condition. However, the total secretion of the cortisol during the task period or during the whole experiment period was significantly lower in the blue condition than that of control condition (p < .05). The total secretion of DHEA showed the same trend but not significant.
The results suggest an alleviative effect of blue color on HPA system, which is one of a major physiological stress-reaction pathway. It might be responsible in part for the close link between colors and physiology, while it is an empirical assumption that “red color makes one feel warm (Hue-heat hypothesis)” so far.
Keywords: Stress, Cortisol, Environment
CORRESPONDING AUTHOR: Shusaku Nomura, Nagaoka University of Technology; nomura@kjs.nagaokaut.ac.jp
P175
RELATIONSHIP BETWEEN EXPRESSION OF LAUGHTER AND RELIEVING STRESS IN NURSES.
Saeki Y.1, Miki A.1, Haginoya H.1, Kuroda R.1, Hoshino J.2, Hayashi K.3, Kawaguchi T.1
1 University of Tsukuba, Department of Nursing Sciences, Tsukuba, Japan
2 University of Tsukuba, Department of Intelligent Interaction Technologies, Tsukuba, Japan
3 Laughwell co., Ltd., Department of Community Health Sciences, Tsuchiura, Japan
Purpose: It has been known that laughter is effective in relieving stress. This study was designed to clarify whether there was a relationship between expression of laughter and relieving stress in Japanese nurses.
Methods: Fifty-six Japanese nurses who work in a university hospital participated in this study (33.7 + 9.0 yrs, M = 13, F = 43). Electrocardiogram (ECG) and digital plethysmography (DPG) in the middle finger were measured as autonomic nervous function, and Profile of Mood State (POMS) and Depression and Anxiety Mood Scale (DAMS) were used as psychological evaluations. Furthermore, “Smile Scan”, which can assess smiles in real-time and rates each smile by assessing a numerical value (0~100 points), was used to evaluate degree of smile in each subject. Following resting period with measuring ECG and DPG, Stroop Color Word Conflict Test (CWT) was applied to the subjects as a psychological stress. After that, subjects watched VTR on the screen, in which constructed some pictures inducing laughter for about 30 minutes. Approval for the present study was obtained from University of Tsukuba Ethical Committee.
Results: All subjects were divided into 3 groups depending on the rate obtained from Smile Scan; expressions group (0~25 points, N, n = 30), smile group (26~75 points, S, n = 13), loud laughter group (above 76 points, L, n = 13). Low frequency (LF) / high frequency (HF) in spectral analysis of DPG increased during CWT in all groups, indicating that sympathetic nerve activity must enhance by CWT. While LF/HF decreased immediately after the end of CWT in S and L groups, continued high level to the end of experiment in N group. In L group, LF/HF increased during watching the VTR followed by decreasing at the end of it. Psychological measurements using POMS showed improvement of many factors except confusion and affirmative mood improved in DAMS in 3 groups.
Disccusion: Since sympathetic nervous system enhanced by CWT continued high level during watching the VTR in N group, it was suggested that they might not be relieved from under stress even though they could feel improvement of their mood. It seems that the person who could laugh under condition causing laughter could psychologically and physiologically relieve their stress.
Keywords: laughter, stress, autonomic nervous system, psychological state
CORRESPONDING AUTHOR: Saeki Yuka, University of Tsukuba, Tsukuba; yuka911s@yahoo.co.jp
P176
REACTION TO AN AUDIOVISUAL STRESSOR AND ITS CHANGE DUE TO RELAXATION TRAINING IN INDIVIDUALS WITH POSITIVE AND NEGATIVE AFFECTIVITY
Jarašiūnaitė G., Perminas A.
Vytautas Magnus university, Department of Psychology, Kaunas, Lithuania
Probably it would be impossible to find a description of a disease, in which stress was not mentioned as one of etiological or progress stimulating factors. Stress does not necessarily cause diseases directly, but it had been proved to be a disease-enhancing factor. According to K. Thompson(2006), people with negative affectivity are more responsive to stress, while positive emotions reduce the negative effects of stress on the body’s physiological systems (K. Thompson, 2006).
19 men and 71 women aged between 18 and 30 (mean age 21,9 ± 2,5) were subjects of the study. The participants were randomly assigned into 3 different groups. Two groups received 4 relaxation training sessions (progressive muscle relaxation or biofeedback relaxation) once a week, between two measurements of their reaction to an audiovisual stressor. The third group was a control group. Its reaction to the audiovisual stressor was also measured, but its participants did not receive any relaxation training. Subjects completed the positive and negative schedule (PANAS-X) created by D. Watson and L. A. Clark (1994) to measure negative and positive affectivity. Body temperature, skin conductance, heart rate and respiratory rate were recorded while measuring participants’ reaction to the audiovisual stressor.
The results of the study showed that subjects with high negative affectivity had higher psychophysiological reaction to an audiovisual stressor while individuals with high positive affectivity reacted less. Individuals having high positive affectivity showed better results in reducing their physiological reaction to an audiovisual stressor after relaxation trainings.
Keywords: Stress, emotions, relaxation, reactivity
CORRESPONDING AUTHOR: Jarašiūnaitė Gabija, Vytautas Magnus University; gabija.jarasiunaite@gmail.com
P179
EFFECTS OF TAOIST QIGONG ON IMMUNE CELL COUNTS: IS THIS CLASSICAL CHINESE EXERCISE AN EFFECTIVE IMMUNOMODULATORY TOOL?
Manzaneque JM.1, Vera FM.1, Rodriguez FM.1, Vadillo M.1, Bendayan R.1, Blanca MJ.1, Alonso A.2, Fernandez-Arcaz N.2
1 University of Malaga, Department of Psychobiology and Methodology of Behavioral Sciences, Malaga, Spain
2 Carlos Haya Regional Hospital, Immunology Service, Malaga, Spain
Qigong is an ancient Chinese psychosomatic discipline which aims at mind-body integration by means of specifically designed slow movements. One of the main traditions within this discipline is the Taoist school of qigong. This particular school emphasizes naturalness, and uses specific body movements and a relaxed state of mind to improve health and increase longevity. Albeit, in the last decade qigong has been demonstrated to display several physical as well as psychological benefits, Taoist qigong has not been investigated to date. Likewise, given that the influence of qigong on the immune system may account for some of its beneficial features, exploring the effects of qigong on immune parameters is not only a most interesting field of research, but it is also a clinically relevant task. Thus, the present study was specifically designed to assess the effects of Taoist qigong practice on immune cell counts in healthy subjects. Forty naive subjects participated in the study, of which twenty-three were allocated to the experimental group while the rest were assigned to the control group. Experimental subjects underwent a qigong training program consisting of five days of practice per week for the period of one month. Analysis of covariance (ANCOVA) and Mann-Whitney "U" tests were performed as statistical analyses. Results show that after completing the qigong program, experimental subjects exhibited lower levels of leucocytes, lymphocytes and LUC cells than control. Our findings, therefore, reveal that the practice of Taoist qigong for a short period of one month induced a noteworthy immunomodulatory action, which lends itself to interesting clinical implications. Future studies should assess the clinical relevance of this modulation of immune function displayed by qigong.
Keywords: Taoist qigong, immune cell counts, leucocytes, lymphocytes, immunomodulatory
CORRESPONDING AUTHOR: Manzaneque Juan M., University of Malaga; Malaga, manzaneque@uma.es
P180
MODULATORY ACTION OF QIGONG ON ADAPTIVE IMMUNITY
Vera F. M.1, Manzaneque J. M.1, Rodriguez F. M.1, Vadillo M.1, Bendayan R.1, Blanca M. J.1, Alonso A.2, Fernandez-Arcaz N.2
1 University of Malaga, Department of Psychobiology and Methodology of Behavioral Sciences, Malaga, Spain
2 Carlos Haya Regional Hospital, Immunology Service, Malaga, Spain
Qigong is an ancient form of health maintenance, dating back thousands of years, which is part of Traditional Chinese Medicine. Practice of qigong, of which there are many different systems, typically entails mind, body and breath training. Given this interesting holistic approach, within the last decade qigong has received a considerable attention in biomedical research due to its remarkable biological effects and its broad therapeutic potential profile. Albeit we have already reported effects of qigong on immune function in other investigations, measures were then assessed one day after the qigong program ended. Thus, the effects that qigong may induce shortly after practice remain virtually unknown. Therefore, this research was carried out for the purpose of shedding light on the immediate effects of the practice of qigong on immune parameters. Forty-five naive subjects participated in the study, of which twenty-five were allocated to the experimental group and the rest were assigned to the control group. The day before the experiment commenced and one hour after the last session of practice concluded, one month later, blood samples were drawn from all subjects for the quantification of immune parameters (neutrophils, monocytes, eosinophils, as well as T and B lymphocytes). Analysis of covariance (ANCOVA) was performed as statistical analyses. Results show that one hour after completing the qigong program, experimental subjects exhibited higher values in the number and the percentage of B-lymphocytes, as compared to control. These results, therefore, reveal that qigong exerts a significant immumodulatory action on a particular and relevant component of adaptive immune response. Further studies should confirm these results and fully assess the potential clinical implications that may arise from these findings.
Keywords: qigong, adaptive immunity, modulatory, B-lymphocytes
CORRESPONDING AUTHOR: Manzaneque Juan M., University of Malaga, Malaga; manzaneque@uma.es
Biobehavioural processes in Coronary Artery Bypass Graft (CABG) surgery: understanding mechanisms and implementing interventions
S181
BIOBEHAVIOURAL PROCESSES IN CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY: UNDERSTANDING MECHANISMS AND IMPLEMENTING INTERVENTIONS.
Steptoe A.
University College London, Department of Epidemiology and Public Health, London, United Kingdom
Coronary artery bypass graft (CABG) surgery is one of the most common revascularisation procedures used for coronary heart disease patients in Europe and the USA. CABG has been shown to have negative emotional effects in some patients, and both severe depression in the clinical range and subclinical milder depression are common sequelae. Moreover, depressive symptoms after CABG have been shown to be associated with a host of poorer clinical outcomes and increased mortality in these patients. Many patients continue to experience physical symptoms related to the surgical procedure, such as pain, fatigue and swelling, in the months following CABG.
This symposium will present recent data concerning the links between depression, quality of life and long-term cardiac outcomes following CABG. Research from two fields of investigation will be presented from researchers in Germany, the USA and the UK. Firstly, studies of the mechanisms underlying the relationship between depression and poor surgical recovery after CABG, including results related to impaired quality of life and sleep disturbance. Secondly, findings from intervention studies that have been designed to reduce depression in CABG patients. The symposium will illustrate the exciting opportunities for research into mechanisms and improved clinical care for patients undergoing CABG.
Symposium chair: Andrew Steptoe, University College London, London, UK.
Symposium speakers:
1. Friederike Kendel, Charité - Universitätsmedizin, Berlin, Germany: Depression, health-related quality of life, and associations with mortality.
2. Lydia Poole, University College London, London, UK: Pre-operative sleep disturbance is associated with physical and emotional recovery in the days and months following cardiac surgery.
3. Kenneth Freedland, Washington University School of Medicine, St. Louis, MO, USA: Treatment of cognitive and somatic symptoms of depression after coronary bypass surgery.
The symposium Chair will act as Discussant.
Keywords: Coronary heart disease; surgery
CORRESPONDING AUTHOR: Steptoe Andrew, UCL, London; a.steptoe@ucl.ac.uk
S182
DEPRESSION, HEALTH-RELATED QUALITY OF LIFE, AND ASSOCIATIONS OF SELF-REPORTED VARIABLES WITH MORTALITY
Kendel F.
Charité - University Medical Center Berlin, Institute of Medical Psychology and Medical Sociology, Berlin, Germany
Objectives: The aim was to investigate (1) the relationship between depression and quality of life in persons undergoing coronary bypass surgery (CABG) and (2) the association of these self-reported variables with mortality.
Methods: A total of 1559 patients admitted to the German Heart Institute Berlin between 2005 and 2008 for CABG were included in this prospective study. Survey and medical record data were obtained 1-3 days before and 1 year after surgery. Depression at baseline and follow-up was assessed using the Patient Health Questionnaire (PHQ-9), quality of life with the 36-Item Short-Form Health Survey. The bidirectional association between depression and quality of life was analysed with a cross-lagged path analytic model. Multivariable proportional hazard models were used to determine if depression and self-rated quality of life at baseline were associated with 1-year all-cause mortality.
Results: Baseline depressive symptoms predicted a decrease in health-related quality of life after CABG, but not the other way around. Poor quality of life at baseline was associated with higher rates of mortality after adjusting for the demographic, socioeconomic, and clinical risk factors.
Conclusions: The results emphasize the vitally important role self-reported parameters play in the CABG recovery process. In particular, preoperative inquiry about depression and self-rated quality of life may provide important information on patient well-being and on patient risk after the surgery.
Keywords: coronary heart disease, quality of life
CORRESPONDING AUTHOR: Kendel Friederike, Charité Berlin; friederike.kendel@charite.de
S183
PRE-OPERATIVE SLEEP DISTURBANCE IS ASSOCIATED WITH PHYSICAL AND EMOTIONAL RECOVERY IN THE DAYS AND MONTHS FOLLOWING CARDIAC SURGERY Poole L.1, Kidd T.1, Jahangiri M.2, Steptoe A.3
1 University College London, Department of Epidemiology and Public Health, London, United Kingdom
2 St George's University of London, Department of Cardiac Surgery, London, United Kingdom
3 University College London, Department of Epidemiology and Public Health, London, United Kingdom
The purpose of this study was to examine the relationship between pre-operative sleep disturbance and post-operative emotional and physical recovery in patients undergoing coronary artery bypass graft (CABG) surgery. Some patients show a decline in quality of life following CABG surgery and physical symptoms including pain may not fully resolve following surgery. Research has shown that sleep disturbance may contribute to poorer adaptation following CABG surgery. Sixty-nine CABG patients undergoing elective CABG surgery (with or without valve replacement) were recruited (aged 68.13 ± 9.55 years) to participate in a prospective study assessing self-reported sleep disturbance, depression symptoms, health status, physical symptoms and pain 2-3 weeks before surgery (T1) and 3-5 days (T2) and 6-8 weeks (T3) after surgery. Baseline sleep was entered in linear multiple regression analyses to predict physical and emotional recovery, with age, gender, ejection fraction, euroSCORE, baseline anxiety and depression symptoms as covariates. Sleep disturbance before surgery was associated with greater physical symptoms at T2, poorer physical health status at T3 and greater depressive symptoms at T3 (p < 0.05), but not with pain or mental health status. These results suggest that poor sleep may be implicated in recovery from CABG surgery and future work exploring the causal mechanisms may contribute to the development of interventions to promote better sleep.
Keywords: Coronary heart disease; surgery
CORRESPONDING AUTHOR: Lydia Poole, UCL, London; lydia.poole.09@ucl.ac.uk
S184
TREATMENT OF COGNITIVE AND SOMATIC SYMPTOMS OF DEPRESSION AFTER CORONARY BYPASS SURGERY
Freedland K., Steinmeyer B., Carney R.
Washington University School of Medicine, Department of Psychiatry, St. Louis, USA
Background: Depression is an established risk factor for morbidity and mortality in patients with coronary heart disease, but there is conflicting evidence as to whether the cognitive and somatic symptoms of depression differ in terms of their prognostic significance. Recent studies suggest that somatic symptoms may be stronger predictors of medical outcomes after acute coronary syndrome, but that cognitive symptoms may be stronger predictors after CABG surgery. This research has created interest in the question of whether different forms of treatment have differential effects on cognitive and somatic symptoms of depression.
Methods: In a secondary analysis of data from 123 participants in a randomized controlled trial of treatments for depression after CABG surgery, we examined the effects of cognitive behavior therapy (CBT) and supportive stress management (SSM) on cognitive and somatic symptoms. We also modeled the effects of nonstudy antidepressant medications on these symptoms. The outcome measures were the cognitive and somatic subscales of the Beck Depression Inventory (BDI).
Results: Mixed models of both subscales yielded results that were very similar to the previously published results of the BDI total score analysis (Freedland et al., 2009). In particular, there were significant group X time interactions on both subscales (cognitive, p < .0001; somatic, p < .002), and no effect of antidepressant medication on either subscale. Subsequent tests revealed that both CBT and SSM had slightly larger effects on cognitive than somatic symptoms at the 3-month post-treatment assessment, and that antidepressants had similar (but small) effects on cognitive and somatic symptoms at 3 months.
Conclusion: These findings do not support the view that different forms of treatment may be differentially efficacious, either for the cognitive or for the somatic symptoms of depression.
Keywords: Coronary heart disease; surgery
CORRESPONDING AUTHOR: Freedland Kenneth, Washington University, St. Louis; freedlak@bmc.wustl.edu
Breast Cancer Research in the Americas: New Partnerships In Breast Cancer Control And Prevention
S185
BREAST CANCER RESEARCH IN THE AMERICAS: NEW PARTNERSHIPS IN BREAST CANCER CONTROL AND PREVENTION IN NORTH, CENTRAL AND SOUTH AMERICA
Ramirez A.
University of Texas Health Sciences Center at San Antonio, Epidemiology and Biostatistics, San Antonio, USA
Breast cancer is one of the leading cancers in the world yet there is a paucity of data on Latinos and breast cancer. The majority of breast cancer research has been conducted in North America and Europe. Expanding the pool of researchers, patients and programs to other countries, especially those less developed, is increasingly seen the next critical step in the fight against breast cancer. The National Cancer Institute and the Susan G. Komen for the Cure Foundation have made significant financial and programmatic commitments in the Latin Americas to promote research, outreach and education about breast cancer control and prevention. Additionally, breast cancer control and prevention interventions in the US aimed at Latino populations are also under scrutiny for adaptation in Latin American settings. These efforts have resulted in several new and dynamic research partnerships among a wide variety of different stakeholders in public health in these nations. This symposia will present current efforts of the NCI, the SG Komen Foundation and US researchers that focus on reducing cancer health disparities among Latinos in the US and Latina America. Dr. Amelie Ramirez will chair the panel as well as describe a multi site study conducted among low income US Latinas to examined breast cancer ‘time to diagnosis’ disparities. Dr. Jorge Gomez will describe multi-national breast cancer genetics research and biospecimen repository development in Central and South America. Dr. Karla Unger will highlight the benefits of using promotoras to increase access to breast cancer screening services among low-income Mexican women. Dr. Catherine Olivaros will review several Komen research programs and unique partnerships currently underway in South America.
Keywords: Cancer Latino
CORRESPONDING AUTHOR: Gallion Kip, UTHSCSA, San Antonio; gallion@uthscsa.edu
S186
EXAMINING “TIME TO DIAGNOSIS” BREAST CANCER SCREENING DISPARITIES AMONG LATINAS
Ramirez A.
University of Texas Health Sciences Center at San Antonio, Epidemiology and Biostatistics, San Antonio, USA
The study compared time from initial abnormal breast screen to definitive diagnosis between navigated and non-navigated patients among Latina women in 6 US cities. Subjects presented radiologic classification of initial abnormality (BIRADS) 3, 4, or 5 detected on a mammogram, clinical breast exam, magnetic resonance imaging, or ultrasound between. Navigated patients received assistance by locally trained navigators using a patient-centered model. Non-navigated patient data was obtained via retrospective medical chart review. Among 480 women follow-up data was available for 425 (88.5%). BIRADS status was the only significant predictor of timely diagnosis. More than 95% of subjects achieved definitive diagnosis within 180 days. Median time to definitive diagnosis was significantly reduced among navigated vs. non-navigated Latinas (20 days versus 27 days, hazard ratio [HR] 1.32, p = .007) yielding a 132% increase in rates of diagnosis among navigated women. This effect was primarily observed in women with an initial BIRADS 3 result, especially when adjusted for clinically directed waiting periods between initial and follow-up screening examinations. Among navigated patients, only between-BIRADS variation rather than sociodemographic characteristics, the number of barriers to care, insurance status or type or site-specific variables were associated with timely or time-to-diagnosis. Patient-centered navigation to assist Latina women with breast screening abnormalities reduces median time-to-diagnosis by approximately 25% when types of screening abnormality and barriers to care are addressed at patient level. Community-based interventions may be the most effective means to reduce cancer health disparities when addressing the needs of underserved populations.
Keywords: cancer Latinos
CORRESPONDING AUTHOR: Gallion Kip, UTHSCSA, San Antonio; gallion@uthscsa.edu
S187
MOLECULAR PROFILING OF STAGE II AND III BREAST CANCER IN LATIN AMERICAN WOMEN RECEIVING STANDARD-OF-CARE TREATMENT
Gomez J.
National Cancer Institute, Office of Latin American Cancer Program Development (US-LACRN), Washington, USA
The United States-Latin America Cancer Research Network (US-LA CRN) launched its first breast cancer pilot study in 2010 in 20 hospitals and research facilities in Argentina, Brazil, Chile, Mexico, and Uruguay. The primary goal is to characterize molecular profile distribution (luminal A, luminal B, HER2-like, and basal) in Latin American women with non-metastatic stage II or III breast cancer. Molecular profiles are correlated with epidemiological, histological, and clinical data, including pathologic response to standard neoadjuvant chemotherapy. This prospective cohort study (1) will not dispense investigational drugs, (2) will characterize molecular profiles of breast cancer in Latin America and (3) will examine associations between response to neoadjuvant therapy and molecular profiles. Tissue samples for gene expression profiling will be collected during routine core biopsies or surgery. Core biopsies and surgical resection specimens will undergo histopathologic evaluation and tumor ER, PgR, HER2, and Ki67 status assessment. Next, patients will be sorted by hormone receptor and HER2 status and receive standard neoadjuvant chemotherapy. Tissue samples will be re-assessed for residual cancer burden for pathologic response to neoadjuvant treatment and gene expression. Five-year patient follow-up will determine associations between molecular profiles and disease evolution after standard treatment. Besides providing data on the effectiveness of standard chemotherapy in Latin American women, the study will establish biobanks in participating countries to conduct new clinical trials on complex genomic and pathologic biomarkers and investigational therapies. Studying the molecular profile of breast cancer in Latin America will improve diagnosis and treatment, correlate molecular subtypes with long-term survival and response to therapy, and identify indolent-disease subpopulations of cancer patients, perhaps enabling future personalized cancer management. Dr. Gomez will provide outcomes of the study to date and reflect on the implications of creating international biobanking repositories and gene studies in Latin America.
Keywords: cancer genetics
CORRESPONDING AUTHOR: Gallion Kip, UTHSCSA, San Antonio; gallion@uthscsa.edu
S188
USING PATIENT NAVIGATION FOR BREAST CANCER AMONG LATIN AMERICAN WOMEN
Ungar-Saldana K.
Fundacion Cimab, Science Advisory, Mexico City, Mexico
Cimab Foundation is a non-governmental, non-profit organization whose goal is to attack the problem of breast cancer from the root, which means the lack of information on breast cancer by educational campaigns about the methods of detection of this disease. Since 2010, a patient navigation project has worked to reduce barriers and improve access to breast cancer screening services among low-income women residing in communities in and around Monterrey, Mexico. Five social workers were trained as breast cancer awareness trainers and patient navigators. These trainers and patient navigators in turn educate female community members to become promoters of breast cancer screening in their communities. Additionally, we organize “community health brigades” where breast clinical exams done by specialists are offered without charge and free mammograms are scheduled for women aged 40 and older. Patient navigators accompany women to their mammograms, oversee that the interpreted studies get to the patients in a 2-week time frame and facilitate further diagnostic tests and admittance to a cancer hospital if needed. An evaluation of breast cancer awareness and screening practices is being conducted among a sample of participants to the “community health brigades”.
Keywords: cancer Latinos
CORRESPONDING AUTHOR: Gallion Kip, UTHSCSA, San Antonio; gallion@uthscsa.edu
S189
INCREASING BREAST CANCER ADVOCACY AND HEALTHCARE IN LATIN AMERICA
Oliveras C.
Susan G. Komen for the Cure, Susan G. Komen Global Health Advocacy Alliance, Dallas, USA
The Susan G. Komen Global Health Advocacy Alliance is an international initiative to promote breast health advocacy and to increase awareness of and access to breast screening services, especially among the poor. One effort in Latino America partners Komen with non-governmental organizations (NGOs) to train advocates and conduct breast cancer education in concert with existing programs that are already testing for HIV/AIDS, tuberculosis and malaria. Another effort joins Komen with the NCI’s Office of Latin American Cancer Program Development, in 5 countries (Argentina, Brazil, Chile, Mexico and Uruguay) to support the development of programs for cancer research, clinical trials, training programs, technology and local advocacy capacity building. In Costa Rica, Brazil, Mexico and Peru, Komen is working with the World Health Organization to study cost effectiveness of breast cancer control interventions. Working with local Health Ministries, this project analyses existing health infrastructure, epidemiological data and cancer data to identify and develop culturally appropriate and cost feasible breast cancer outreach and education programs. Finally Komen has initiated a new 3 year partnership with the Caterpillar Foundation that will award grants to local NGOs in Sao Paulo, Brazil; Panama City, Panama and Monterrey, Mexico to establish comprehensive early detection programs, build local capacity, and provide financial support directly to community organizations. The presentation will discuss these programs, their outcomes to date and future plans for national and regional breast cancer control and prevention collaborations in Latin America.
Keywords: cancer Latinos
CORRESPONDING AUTHOR: Gallion Kip, UTHSCSA, San Antonio; gallion@uthscsa.edu
Social Context, Health Behavior and Childhood/Adolescent Health
O190
BREASTFEEDING AND SOCIAL MOBILITY IN TIMES OF SOCIAL CHANGE
Sacker A.1, Bartley M.2, Kelly Y.1, Cable N.2
1 University of Essex, Institute for Social & Economic Research, Colchester, United Kingdom
2 University College London, Epidemiology and Public Health, London, United Kingdom
Breastfeeding has been associated with higher cognitive scores, better test results and fewer socio-emotional problems in childhood. These outcomes in turn predict the probability of upward social mobility. This study examines the relationship between breastfeeding and inter-generational social mobility. We use data from two British birth cohorts to examine the hypotheses that breastfeeding increases the chances of upward social mobility and that it is more beneficial to less advantaged children. Rates of breastfeeding were higher in the 1958 National Child Development Study (43% breastfed for 1 month or more) than the 1970 British Birth Cohort (21% for 1 month or more). Breastfeeding was also more socially patterned by 1970, with more advantaged mothers being more likely to breastfeed – a situation which is still evident today. Total social mobility among men and women was broadly similar in the two cohorts. We used a propensity score matching approach to match breastfed and non-breastfed cohort members on a large range of characteristics to more effectively estimate the hypothesised causal effect of breastfeeding on social mobility. Social class of origin was based on father’s class. Both class of origin and own social class in adulthood were measured by the Registrar General’s social class (RGSC). We modelled the odds of upward social mobility for those in RGSC II-V and of downward social mobility for those in RGSC I-IV conditional on being breastfed for 1 month or more, social class of origin and the interactions between social class and breastfeeding categories. Results show that for the 1958 cohort, breastfeeding increased the odds of upward mobility in both men (1.25, 95% CI 1.04-1.51) and women (1.45, 95% CI 1.19-1.76), independent of social class of origin. Similarly breastfeeding reduced the odds of downward mobility for men (0.78, 95% CI 0.62-0.98) and women (0.81, 95% CI 0.66-1.00). Breastfeeding had the same effect among members of different social strata. Results for the 1970 cohort are compared with these findings for the 1958 cohort and implications drawn for children growing up today.
Keywords: Social class; Resilience; Longitudinal research; Health behaviors
CORRESPONDING AUTHOR: Sacker Amanda, University of Essex; Colchester; asacker@essex.ac.uk
O191
DIFFERENCES IN PERSONAL AND SOCIAL ENVIRONMENTAL CORRELATES OF ENERGY BALANCE BEHAVIORS AMONG SCHOOLCHILDREN ACROSS EUROPE
Singh AS.1, Te Velde S.2, Chin A Paw MJM.1, Androutsos O.3, Brug J.2
1 VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Amsterdam, The Netherlands
2 VU University Medical Center, EMGO Institute for Health and Care Research, Department of Clinical Epidemiology and Biostatistics, Amsterdam, The Netherlands
3 Harokopio University, Department of Nutrition & Dietetics, Athens, Greece
Purpose: Knowledge about the potential correlates of energy balance-related behaviours (EBRBs) is essential to guide interventions. The aim of the present study was to assess personal and social environmental correlates of EBRBs among 10- to12-year-old children in Europe.
Methods: A school-based survey among 10-12 year old children was conducted in eight European countries using a standardized protocol. Children completed a self-administered questionnaire measuring EBRBs and personal and social environmental factors. Age-adjusted covariance analyses were carried out, for the full sample and for each country separately. Descriptive analyses were conducted, looking at differences according to country and gender.
Results: More than 7000 children participated in the study. Children reported a more positive general attitude towards fruit juices than towards soft drinks. They reported good availability for soft drinks and fruit juices and very good availability for breakfast products in their home environment. Children’s attitude with regard to physical activity (PA) was very positive; their attitude towards watching TV was rather neutral. Children are well aware of the recommendations with regard to PA and television watching.
Conclusions: Children’s knowledge and attitude towards some EBRBs is good, although attention is needed for fruit juices and TV watching. There is also room for improvement for creating a home environment that is less obesogenic, across all European countries.
Note
This work is presented on behalf of the ENERGY-consortium. The ENERGY-project is funded by the Seventh Framework Programme (CORDIS FP7) of the European Commission, HEALTH (FP7-HEALTH-2007-B).
Keywords: correlates, children, physical activity, sedentary behavior, soft drink consumption, fruit juice consumption
CORRESPONDING AUTHOR: Singh Amika, VU University medical center; a.singh@vumc.nl
O192
SOCIOECONOMIC INEQUALITIES IN CARDIOVASCULAR MORTALITY: THE ROLE OF CHILDHOOD SOCIOECONOMIC CONDITIONS AND ADULTHOOD RISK FACTORS
Kamphuis CBM.1, Turrell G.2, Giskes K.2, Mackenbach JP.1, Lenthe, van FJ.1
1 Erasmus MC, University Medical Center, Department of Public Health, Rotterdam, The Netherlands
2 Queensland University of Technology, School of Public Health, Brisbane, Australia
Objective: To study the role of childhood socioeconomic conditions and adulthood risk factors for explaining socioeconomic inequalities in cardiovascular diseases (CVD) mortality in adulthood.
Design and setting: The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991 and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and adulthood risk factors (health behaviours, material circumstances, psychosocial factors). Analyses included 5,395 men and 6,306 women, and Cox proportional hazard ratios (HR) were calculated.
Main outcome measures CVD mortality.
Results: A low adulthood SEP was associated with increased CVD mortality for both men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95% CI: 1.04-3.10). The largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: -73 to -20) and behavioural factors for women (60%; 95% CI: -191 to -28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.31 (95% CI: 0.97-1.78) for men and 1.19 (95% CI: 0.65-2.15) for women.
Conclusions: Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Efforts to reduce health inequalities should consider the influence of socioeconomic circumstances across the life course and specifically target adulthood risk factors
Keywords: cardiovascular disease; socio-economic status; health behaviors
CORRESPONDING AUTHOR: Kamphuis Carlijn, Erasmus University, Rotterdam; c.kamphuis@erasmusmc.nl
O193
UPPSALA TRIPLE P STUDY: A CLUSTER RANDOMISED TRIAL TO EVALUATE DISSEMINATION OF POSITIVE PARENTING PROGRAM AT PRESCHOOLS
Salari R., Fängström K.
Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
We employed a population-based approach to evaluate the reach and effectiveness of low intensity levels of Triple P – Positive Parenting Program when delivered by professionally trained teachers at their respective preschools.
Twenty one preschools were randomly assigned to either dissemination of Triple P (levels 2 and 3) or to the waitlist control condition. Participants in the study were 324 mothers and 228 fathers of children aged 3 to 5 years. Parents completed a set of questionnaires, including measures of externalising and internalising problems in children, parenting practices, parental satisfaction, inter-parental relationship, and parental adjustment. All parents in the intervention preschools were offered the program, but they could choose to accept or refuse the invitation.
Of 213 mothers and 150 fathers in the intervention preschools, 63 mothers (29.6%) and 25 fathers (16.75%) participated in at least one Triple P session over the 18-month period. We compared baseline measures for parents in the intervention preschools who did and did not attend the program later. Mothers who attended the program reported higher levels of problem behaviours in their children and lower parental satisfaction and efficacy, compared to non-attenders. Fathers who attended the program reported higher level of emotional problems in their children and higher levels of depression in themselves, compared to non-attenders. A series of repeated measures ANOVAs were used to compare the outcome measures for the two conditions at 18 months after baseline. Compared to the parents in the waitlist preschools, parents in the intervention preschools reported significant improvement only on one of the measures. Compared to fathers in the waitlist condition, fathers in the intervention condition reported lower levels of inconsistent parenting (p < .01). At baseline, inconsistent parenting was shown to be associated with child behaviour problems. Improvements in parental sense of efficacy for both mothers and fathers approached the significance level (p < .10).
These results suggest that an at-risk population self-selected themselves into the preventive program. However, to address all their needs appropriately, we might need to offer more high intensity interventions (levels 4 and 5) alongside the low intensity options.
Keywords: Population health, randomized controlled trial, prevention, children
CORRESPONDING AUTHOR: Salari Raziye, Uppsala University, Uppsala; raziye.salari@kbh.uu.se
O194
STUDYING FACTORS OF RISK AND PROTECTION IN EATING DISORDER BEHAVIORS
Meshkova T.1, Mitina O. 2, Aleksandrova R.1, Kelina M.1, Nikolaeva N.1
1 Moscow State University of Psychology and Education, Department of Clinical Psychology and Special Education, Moscow, Russia
2 Lomonosov MSU, Moscow State University of Psychology and Education, Laboratory of quantitative psychology, Moscow, Russia
To reveal the risk factors of eating disorders a special questionnaire was constructed. It measures different aspects of eating behaviors, family relations and family attitudes towards eating and figure, relations with friends and teachers, social environment (fashion tendency etc.), personal traits, health problems. To make the results more reliable several other questionnaires were used: Eating Attitude Test (EAT-26), Russian version of “Children's Report of Parental Behavior Inventory” (CRPBI), self-esteem and level of aspirations. The subjects were 661 girls and young women between ages 12 and 23, high school and college students from Moscow and Ryazan (regional center of Russia). It was shown that factors preventing or ameliorating disorders differ from one age phase to another and in the capital and middle size city. At the age of 15 girls realized physical changes in their body, and if they fail to receive mental support from the family or significant others in the new status (having difficult emotional self-access and are not able to reduce emotional instability and depression), they fall back into former conditions (anorexic behavior, physical exercises). The girls in the later period having overcome the fear of becoming an adult (including first sexual experience) they usually do not want to return to adolescence. They feel more separation from the family and surrounding people, are more experienced in the emotional self-access and use eating as a tool of emotional regulation. In this period they try to be more independent. The protection factors which were outgoing from the family become weaker and opposite: negative factors which can produce family relations can be more powerful in that time. Comparing two subsamples according place of living we can say that age differences are more significant in the megalopolis than in the regional city. Since eating disorder is in most cases not a separate problem, but is included in the complex relations among different attitudes, motivations, preferences and social environment complex moderation and mediation analysis using structural equation modeling was used to reveal the relationships.
Keywords: adolescents, eating behaviors, risk factors, population health
CORRESPONDING AUTHOR: Meshkova Tatiana, MSUPE, Moscow; tmesh@mail.ru
O195
MOTHERS’ BEHAVIOR AND CHILDREN’S HEALTH
Nikolaeva EI.1, Verenkova VS.2
1 Herzen State Pedagogical University, Child's Psychophysiology and Psychology Department, Saint-Petersburg, Russia
2 Eletz State University, Department of Psychophysiology and Psychology, Eletz, Russia
The purpose of the report was to understand how mothers’ emotional behavior could influence the possibility of child’s recovery after the birth. About 95% of newborn infants in Russia have received the diagnoses from birth. These disorders are caused by mothers’ pathology during pregnancy. By the end of their first year about 40% of children and by the end of the second year about 60% of children recover. We used emotional intelligence assessment test and mothers’ attachment assessment test. The study included 100 mothers with their 100 children of the first and second years. The following two sets of procedures were used to carry out the aim of the study. The first set of procedures involved describing the distinct features concerning the health of children in their first or second year of life. A comprehensive appraisal of the children’s health was conducted based on health criteria (Golubeva et al, 2002), information obtained from the individual medical records of the children, aged up to two years. The second set of procedures was aimed at examining the psychological features of the mothers with children up to two years old and included the following procedures: a questionnaire evaluating the attitude of a mother toward a child during its first two years of life (Vereshagina & Nikolaeva, 2009) and the questionnaire to evaluate emotional intelligence (Lyusin, 2004). The most common diagnoses given to children at birth were perinatal encephalopathy and motor disturbance syndrome. There is no difference between mothers of children in the first and second years of life with respect to levels of attachment: 54 percent of the mothers in each group have a low level of attachment, and 44 percent and 42 percent, respectively, have an average level. Only 2% and 4% of the mothers with children in the first and second years of life have a high level of attachment. No mothers were found to suffer from maternal deprivation. A positive prognosis in relation to the children’s health during the first year of life depends on the level of a mother’s acceptance of her child; the higher the rating on the acceptance--non-acceptance scale, the healthier the child. The probability of a child’s recovery during the first two years of life cannot be predicted based on the mother’s ratings for emotional intelligence.
The work is supported by grant RGNF12-16-48010
Keywords: Health, children's health, health behavior
CORRESPONDING AUTHOR: Nikolaeva Elena, Herzen University, Petersburg; klemtina@yandex.ru
Health and Performance related to Workstress
O196
TO ERR IS HUMAN: THE INFLUENCE OF BURNOUT ON MEDICAL MISTAKES
Panagopoulou E.1, Tsigka E.2, Montogmery A.3
1 Aristotle University of Thessaloniki, Medicine, Thessaloniki, Greece
2 Aristotle University of Thessaloniki, Department of Family Medicine, Thessaloniki, Greece
3 University of Macedonia, Department of Educational Psychology and Health Psychology, Thessaloniki, Greece
Despite advancements in patient safety procedures medical errors continue to increase within hospital settings. Preliminary evidence has identified burnout as one risk factor for medical errors. However, very little information exists on the types of errors that are more likely to occur from physicians suffering from burnout.
Aim: This study is part of the ORCAB project, a multi-center project examining the effects of burnout on quality of care. The project is funded under the FP7th Research Framework. The aim of this study was to examine the associations between physician burnout and two different types of medical errors: omissions, referring mainly to memory lapses and attentional slips, and medical mistakes occurring as a result of false judgment, or violation of hospital procedures.
Methods: 510 surgeons, and internal medicine specialists from 12 different centers in 5 different countries participated in the study. Burnout was assessed using valid versions of the MBI for each participating country. Medical errors were assessed using a scale developed, and validated for the purposes of the study. Participants had to indicate in a visual analogue scale the frequency of occurrence of several types of omissions, or mistakes during the past six months.
Results: Controlling for the effects of gender, age, years of experience, burnout was predictive of medical omissions for both surgeons and internal medicine specialists (p < .01).
Conclusions: Results indicate that burnout does not influence clinical judgment. At the same time, it interferes with cognitive processes, such as memory and attention and can therefore endanger clinical practice.
Keywords: occupational health decision making
CORRESPONDING AUTHOR: Panagopoulou Efharis, Aristotle University; efharis@the.forthnet.gr
O197
JOB BURNOUT, JOB ENGAGEMENT AND SUB-OPTIMAL CARE AMONG GREEK HEALTHCARE PROFESSIONALS
Montgomery A.1, Georganta K.1, Tsiga E.2, Panagopoulou E.2
1 University of Macedonia, Department of Education and Social Policy, Thessaloniki, Greece
2 Aristotle Medical School, Lab of Hygeine, Thessaloniki, Greece
Aim: Burnout reduces the ability of healthcare professionals to provide the best quality of care possible and increases the risk that they will make mistakes. Moreover, healthcare professionals who deal directly with patients on a daily basis report even higher burnout levels. The well being of healthcare professionals has a direct impact on the quality of care delivered to patients. The aim of the following paper is to evaluate the relationship between job burnout, job engagement and sub-optimal care.
Method: Participants were healthcare professionals from university clinics from the city of Thessaloniki, Greece. Survey data were collected from a sample of 379 health care professionals. The sample included physicians (29%), nurses (38%) and medical residents (33%) working in both medical and surgical units of a University Hospital. Self-reported data on job burnout, job engagement, affectivity and reported sub-optimal care were collected.
Results: Controlling for affectivity, hours worked and work experience, within the total sample sub-optimal care was significantly associated with depersonalisation (beta = .31, p < .001), but not emotional exhaustion, vigour or dedication. In terms of mean differences, physicians, in comparison with residents, reported higher levels of both vigour (p < .001) and dedication (p < .001). Residents, in comparison with physicians reported higher levels of both emotional exhaustion (p < .05) and depersonalization (p < .05), while nurses also reported higher levels of emotional exhaustion (p < .05) in comparison with physicians.
Conclusions: The quality of care delivered to patients is crucial, and the well being of healthcare professionals is symbiotically connected with the care of the patients. The present study demonstrates that depersonalization is a key reason as to why patients may be receiving sub-optimal care. The data suggest that residents in particular are an at-risk group. The present study is cross-sectional thus it is difficult to infer causality. However, the results have important implications for both medical education and the organisational experience of healthcare professionals within hospitals.
Keywords: burnout, engagement, sub-optimal care
CORRESPONDING AUTHOR: Montgomery Anthony, University of Macedonia; antmont@uom.gr
O198
BURNOUT AND QUALITY OF CARE: EVIDENCE FROM A ROMANIAN HEALTH PROFESSIONALS’ SAMPLE
Spanu F.1, Baban A.1, Dumitrascu D.2, Bria M.1
1 Babes-Bolyai University, Department of Psychology, Cluj-Napoca, Romania
2 Iuliu Hatieganu University of Medicine and Pharmacy, Department of Internal Medicine, Cluj-Napoca, Romania
Aim: There is substantial evidence showing that burnout mediates between work demands and the quality of personal and working life among health professionals. Recent studies have shown that medical personnel experiencing high levels of burnout also report lower level of quality of care provided to their patients. The aim of our research was to investigate if perceived work demands impact the quality of care provided by health professionals, and whether this relationship is mediated by burnout.
Method: Survey data were collected from a sample of 311 health professionals in Romania, as part of the ORCAB European project. The sample included physicians (N = 74), nurses (N = 146) and residents (N = 91) working in both medical and surgical units of a University Hospital. Self-reported data on burnout (Maslach Burnout Inventory), suboptimal care and work demands (organizational demands, physical demands and emotional demands) were collected. All scales show good internal consistency coefficients. The mediation model was tested using Structural Equation Modeling, in AMOS. Bootstrapping was used in order to investigate whether the mediated path is significant.
Results: Fair support was found for the hypothesized model (χ2 = 49.159, df = 7, GFI = .953, CFI = .930, NFI = .918, RMSEA = .113). Significance test for the indirect effect showed that burnout mediates the impact of job demands on quality of care (β = .631, p = .001).
Conclusions: Our data revealed that job demands impact the quality of care provided to the patients and that health professionals’ burnout mediates this relationship. These results have implications for designing interventions aiming at improving quality of care. They show that efforts should start with improving the quality of the work experience in the medical field.
Keywords: Occupational health, Health outcomes
CORRESPONDING AUTHOR: Spanu Florina, Babes-Bolyai University, Cluj; florinaspanu@gmail.com
O199
HIGH WORK STRAIN OF HEALTH CARE PERSONNEL IS ASSOCIATED WITH POOR GLYCEMIC CONTROL AMONG TYPE 2 DIABETES PATIENTS FROM THE SAME PRIMARY CARE HEALTH CENTER - A MULTI-LEVEL ANALYSIS
Suominen S.1, Koponen A.2, Virtanen M.3, Simonsen N.2, Vahtera J.1
1 University of Turku, Department of Public Health, Turku, Finland
2 Folkhälsan Research Center, Research program of Public Health, Helsinki, Finland
3 Finnish Institute of Occupational Health, Organization and management, Helsinki, Finland
Introduction: Previous studies suggest an association between favourable psychosocial work environment of the health care personnel and good treatment outcome within several patient groups.
Aim: The aim of the present study was to explore whether balance between perceived work demands and work control, i.e. work strain, among primary care health center (PCHC) personnel is associated with glycemic control of treated type 2 diabetes patients.
Material and methods: A survey of the psychosocial work environment of the personnel (doctors and nurses) in 18 PCHCs in 5 municipalities in Finland was carried out in 2006 as a part of the longitudinal Ten Town Study. Register data of work unit characteristics from 2006, as e. g. rate of sickness absence among personnel was gathered from the municipalities running the PCHCs and with appropriate consent linked to the survey data.
General population data on mean income in 2006 and unemployment rate in 2007 from the area the PCHC served was delivered by Statistics Finland.
Sex and age of patients (N = 8 975) with type 2 diabetes and their HbA1c values (<7% vs. > = 7%) on glycemic control were collected from the patient registries of the health care centers and made anonymous.
The individual personnel and patient data were linked on the level of the PCHC and analyzed with multi-variate multi-level logistic regression modeling using R software.
Results: Perceived high work stain (high demands, low control) among personnel associated significantly (OR 1.44, p < 0.01) with poor glycemic control among type 2 diabetes patients when variables describing work unit characteristics and population data at the area level were controlled for. Social support from the supervisor did not associate with glycemic control.
Conclusion: Developing psychosocial work environment by decreasing work strain can improve glycemic control of type 2 diabetes patients. Thus, it can be speculated that such measures could have positive effect on the outcome of treatment of several other public health problems.
Keywords: Managed care, Worksite heatlh, Effectiveness
CORRESPONDING AUTHOR: Suominen Sakari, University of Turku; sakari.suominen@utu.fi
O200
RELATIONSHIPS BETWEEN ORGANIZATIONAL CULTURE, HEALTH BEHAVIOURS AND EMOTIONAL WELL-BEING IN BULGARIAN HEALTH PROFESSIONALS
Alexandrova-Karamanova A.1, Dimitrova E.2, Panayotova Y.1, Naydenova V.3
1 Health Psychology Research Center, -, Sofia, Bulgaria
2 Institute for Population and Human Studies – Bulgarian Academy of Sciences, Department of Demography, Sofia, Bulgaria
3 Sofia University “St. Kliment Ohridski”, Department of Work, Social and Educational Psychology, Sofia, Bulgaria
Introduction: Work specifics of medical profession characterize it as stressful, demanding and with high level of responsibility, thus implying greater risk for health professionals’ health and well-being. Nevertheless, organizational culture in hospital settings and its impact on health and well-being of health professionals has rarely been in the focus of research, particularly in Bulgaria.
Aim of the study: To identify which aspects of organizational culture are relevant for health professionals’ risk, protective health behaviours and emotional well-being.
Methods & sample: The data is from a quantitative survey (part of the ORCAB project) conducted among doctors, nurses and residents in University hospitals in Sofia. By means of correlation and regression analyses we identify the organizational factors influencing health protective and health risk behaviours of hospital staff as well as their emotional well-being (positive & negative affectivity) at work. The predictors included in the models are: types of organizational culture (Clan, Market, Hierarchy and Adhocracy) and Physical, Emotional, Organizational and Cognitive work demands. We also control for hospital, staff position, weekly work hours and demographic characteristics.
Main findings: The results show that organizational culture types are predictors of negative affectivity and risk health behaviours; work demands are predictors of negative affectivity and both protective and risk health behaviours. Higher strength of the organizational culture and lower work demands are generally related to better emotional well-being, higher frequency of health protective behaviours and lower frequency of risk health behaviours.
Discussion & implications for practice: The findings reveal that hospital organizational culture has a significant impact on health professionals’ functioning, which may affect patient safety and quality of care patients receive. The results are relevant to the development of organizational change intervention at participating hospitals (next stage of the ORCAB project), allowing a focus on the change of specific aspects of organizational culture that bear higher risk for health professionals’ health and well-being.
Keywords: Occupational health, health behaviours, emotions
CORRESPONDING AUTHOR: Alexandrova-Karamanova Anna, Health Psychology Center, Sofia; annaalexandrova@yahoo.com
O201
INFLUENCE OF COPING AND (SOCIAL) SUPPORT ON WORK ABILITY AMONG OLDER WORKERS
Van der Klink JJL., Koolhaas W., Groothoff JW., Brouwer S.
University Medical Center Groningen, Public Health, Groningen, The Netherlands
Aims: Many older workers face increased vulnerability to their work ability. Aims of this study were: a) to examine the association of coping and social support on work ability; and b) to determine the role of support in mediating the association of coping strategies with work ability.
Methods: Data of this cross-sectional study were obtained from workers older than 45 years (N = 14565). Work ability was measured by the Work Ability Index (WAI). The Utrecht Coping List was used to assess active, emotional and avoidance coping. Organisational, co-worker and community support were measured with a standardized scale. Effect of coping strategies and perceived support on work ability were investigated with linear regression analysis. Mediation of support on the relation between coping and work ability was tested using a multistage regression approach.
Results: Differences between a poor/moderate and good/excellent work ability were significant for all variables in the univariate analyses. In the multivariate model occupation, coping strategies and co- worker and community support remained significant (p < .001). On active coping, community support explained 12,5% of the variance in work ability (β = 0.349, p < .01), and together community support and active coping explained 13,7% or the variance in work ability (β = 0.265, p < .01). The effect on work ability was less with community support as a mediator but remained significant thus continuing to exert a direct effect on work ability. Also on emotional coping, community support predicted work ability (β = 0.349, p < .01), and the contribution of interference with emotional coping to work ability was reduced (β = -0.206, p < .01), indicating that community support partially mediated effects of emotional coping on work ability. On avoiding coping co-worker support contributed to the inverse prediction of work ability (β = -0.382, p < .01), and the contribution of interference with avoidance coping to work ability was reduced (β = -0.323, p < .01).
Discussion: Because the cross/sectional design only associations between coping styles, support and work ability can be established. Community support mediates the effects of active and emotional coping on work ability; co-worker support mediated the effects of avoidance coping.
Keywords: Coping, Social support, Work Ability
CORRESPONDING AUTHOR: van der Klink Jac, University MC Groningen; j.j.l.van.der.klink@med.umcg.nl
Smoking Cessation: Novel Intervention Approaches
O202
NEIGHBOURHOOD DISADVANTAGE AND SMOKING CESSATION AND ITS CONTRIBUTION TO NEIGHBOURHOOD INEQUALITIES IN SMOKING STATUS: A MULTILEVEL LONGITUDINAL STUDY
Turrell G.1, Hewitt B.2, Miller S.1
1 Queensland University of Technology, School of Public Health, Brisbane, Australia
2 University of Queensland, Institute of Social Science Research, Brisbane, Australia
Introduction and aims: Individual smokers from disadvantaged backgrounds are less likely to quit, which contributes to widening inequalities in smoking. Residents of disadvantaged neighbourhoods are more likely to smoke, and neighbourhood inequalities in smoking may also be widening because of neighbourhood differences in rates of cessation. This study examined the association between neighbourhood disadvantage and smoking cessation and its relationship with neighbourhood inequalities in smoking.
Design and methods: A multilevel longitudinal study of mid-aged (40-67 years) residents (n = 6915) of Brisbane, Australia, who lived in the same neighbourhoods (n = 200) in 2007 and 2009. Neighbourhood inequalities in cessation and smoking were analysed using multilevel logistic regression and Marko chain Monte Carlo simulation.
Results: After adjustment for individual-level socioeconomic factors, the probability of quitting smoking between 2007 and 2009 was lower for residents of disadvantaged neighbourhoods (9.0%-12.8%) than their counterparts in more advantaged neighbourhoods (20.7%-22.5%). These inequalities in cessation manifested in widening inequalities in smoking: in 2007 the between-neighbourhood variance in rates of smoking was 0.242 (p ≤ 0.001) and in 2009 it was 0.260 (p ≤ 0.001). In 2007, residents of the most disadvantaged neighbourhoods were 88% (OR 1.88, 95% CrI 1.41-2.49) more likely to smoke than residents in the least disadvantaged neighbourhoods: the corresponding difference in 2009 was 98% (OR 1.98 95% CrI 1.48-2.66).
Conclusion: Fundamentally, social and economic inequalities at the neighbourhood and individual-levels cause smoking and cessation inequalities. Reducing these inequalities will require comprehensive, well-funded, and targeted tobacco control efforts and equity based policies that address the social and economic determinants of smoking.
Keywords: Smoking, socio-economic status, longitudinal, tobacco control
CORRESPONDING AUTHOR: Turrell Gavin, QUT, Brisbane; g.turrell@qut.edu.au
O203
REACH OF BRIEF INTERVENTION TO INCREASE THE INTENTION TO QUIT SMOKING: THREE APPROACHES OF PROACTIVE RECRUITMENT
Meyer C.1, Ulbricht S.1, Grothues J.2, Rumpf H-J.2, John U.1
1 University of Greifswald, Institute of Epidemiology and Social Medicine, Greifswald, Germany
2 University of Lübeck, Department of Psychiatry and Psychotherapy, Lübeck, Germany
Aim: The research question was whether sufficiently large proportions among populations may be recruited for brief intervention using three approaches of recruitment. Each of them included two studies.
Methods: In the phone-based approach 1 for a first study a random sample of phone numbers had been drawn in Germany. In a second study all families with a child below 4 years were addressed. Approach 2 was a setting-approach. In a first study a random sample of general medical practices and in the second study a random sample of dental practices had been drawn. Each consecutive patient at age 18 to 70 was contacted. In the setting- and life-event-based approach 3 girls and women at age 14 to 25 were addressed in gynecological practices. The second study of approach 3 included the recruitment of women after having given birth on obstetric wards. The aim in the majority of the six studies was abstinence from tobacco smoking. Brief interventions were based on the Transtheoretical Model of Intentional Behavior Change and on Motivational Interviewing.
Findings: In approach 1, study 1, six thousand and seventy-three households that included smokers were contacted. Among the smokers, 50.3% participated in the intervention study. In study 2, among 1,287 contacted families with one or more smokers, 71.6% participated in the study. In approach 2, among 2,074 eligible patients in general medical practices 79.8% took part. Among 303 patients in dental practices, 77.3% were ready to participate in the study. In approach 3, among 869 eligible patients in gynecological practices 80.4% (study 1), and among 1,128 mothers on the obstetric wards 77.2% were recruited. All samples included a majority of smokers who did not intend to quit smoking in the next six months.
Conclusions: The proactive strategies implemented in the three approaches to recruit smokers for brief interventions provided promising proportions of participants.
Keywords: Population impact; Smoking cessation; Brief Interventions; Motivation Interviewing; Transtheoretical model
CORRESPONDING AUTHOR: Meyer Christian, University of Greifswald; chmeyer@uni-greifswald.de
O204
SMOKING INTERVENTION USING TEXT MESSAGING AND SOCIAL NETWORKING: THE TXT-2-QUIT STUDY
Bock B.1, Foster R.2, Deutsch C.2
1 Brown University, Psychiatry, Providence, USA
2 Live Inspired LLC, Providence, USA
There is growing interest in behavioral interventions delivered through mobile platforms. We conducted an 8-week smoking cessation program developed using recommendations from focus groups. The program was delivered primarily through SMS text messages and included social networking for peer support along with tailored messages based on user feedback. In a randomized pilot trial we compared this program (TXT) to a control condition (Mojo) of daily non-smoking-related motivational texts. Outcome variables include 24-hour (self-reported) and 7-day (cotinine verified) abstinence.
Adults smoking >3 cigarettes/day who used text messaging were eligible. Individuals (191) were screened for eligibility online (66%) or by phone (34%). Of those screened, 39% did not complete the online enrollment after screening, 12% did not wish to come to the in-person visit for orientation, 8% were declined to participate and 9% were ineligible.
Results: Enrolled participants (N = 60) averaged 32 years of age (range: 18-61), and were primarily non-Hispanic white (70%); Black (22%), or bi/multi-racial (6%); 20% were Hispanic. Most had completed 12 (21%), 14 (36%), or 16 (24%) years of education. The sample was evenly split between those who worked part time (<35 hrs/week) full time (35+ hrs/week), and those who were unemployed. Participants smoked an average of 16 cigarettes/day (SD = 8.4; range 4-40). Most (73%) had not made a serious quit attempt (>24 hrs) in the past year.
For 24-hour abstinence, intention to treat analyses showed that at the 8 week (end of treatment) assessment, 25.0% of TXT and 17.4% of Mojo groups reported abstinence (OR = 1.43). At the 3-month follow up 21.4% of TXT and 8.7% of Mojo group reported abstinence (OR = 2.46).
For 7-day abstinence, at the 8 week (end of treatment) assessment 21.4% of TXT and 13.0% of Mojo groups achieved abstinence (OR = 1.64). At the 3-month follow up 17.9% of TXT and 4.3% of Mojo group were abstinent (OR = 4.11).
These results indicate that mobile technology has significant potential for aiding smoking cessation in people’s everyday lives. Participants’ positive responses to the program’s social networking and tailored messaging capabilities suggest that these features warrant further study as tools for promoting smoking cessation.
Keywords: Smoking, Text Message, Mobile Health
CORRESPONDING AUTHOR: Bock Beth, Brown Medical School, Providence; bbock@lifespan.org
O206
CANCER SCREENING: A TEACHABLE MOMENT FOR LIFESTYLE CHANGE OR A HEALTH CERTIFICATE EFFECT?
Van der Aalst C. M.1, Van Klaveren R. J.2, Willemsen M. C.3, De Koning H. J.1
1 Erasmus MC, University Medical Center, Department of Public Health, Rotterdam, Netherlands
2 Erasmus MC, University Medical Center, Rotterdam, Netherlands
3 CAPHRI School for Public Health and Primary Care, Maastricht University, Health Education & Promotion, Maastricht, Netherlands
Worldwide, the burden of cancer is still increasing, which is in a high degree due to an increased adaptation of (cancer related) risk-behaviour. Several cancer screening programmes are effective in reducing cancer mortality, but evidence about the impact of these programmes on future lifestyle is scarce. Our review showed that cancer screening might be a teachable moment, but a major concern is the potential health certificate effect (review 1). The impact of lung cancer screening was investigated amongst smokers of the Dutch-Belgian randomised controlled lung cancer screening (NELSON) trial (trial 1 and 2).
Two random samples were selected of 50-75 years old male smokers at high risk for developing lung cancer randomised to the screen (n = 641) or control arm (n = 643) of the NELSON trial. Smoking behavioural change was investigated at randomisation (T0), 2 years (T1, trial 1) and 4 years of follow-up (T2, trial 2). At T1, prolonged abstinence was reported in 14.5% of the screen arm smokers and 19.1% of the control arm smokers (p < 0.05). After 4 years, these rates were 24.3% (screen arm) and 29.3% (control arm) (p = 0.09). Multivariate analysis showed that lower baseline nicotine dependency and randomisation to the control arm increased the likelihood of being abstinent from smoking at follow-up. Multivariate analysis showed that the allocation to the control arm (T1, T2), the level of education (T1), the motivation to quit smoking (T1) and the level of nicotine dependency (T2) were predictors of smoking abstinence at follow-up (T1 and T2) (p < 0.05)
In conclusion, although all trial participants were inclined to quit smoking more than average, male smokers who received CT screening for lung cancer were statistically significant less likely to quit smoking, possibly due to a false feelings of reassurance caused by screening. Research is urgently needed to battle this effect and to increase the potential of cancer screening to reduce the burden of (lifestyle-related) cancer.
Keywords: smoking, tobacco use, cancer screening
CORRESPONDING AUTHOR: van der Aalst Carlijn, Erasmus MC; c.vanderaalst@erasmusmc.nl
O207
EXPLAINING TOBACCO DISPARITIES IN SWITZERLAND: THE ROLE OF SOCIAL SUPPORT
Diviani N., Schulz P J.
University of Lugano, Institute of Communication and Health, Lugano, Switzerland
Background: People’s health is the result of a complex interaction of different determinants – e.g. the individuals’ socioeconomic status, the availability of social support or existing public policies. Disparities in smoking related to socioeconomic status, in particular to educational level, have been widely acknowledged by several studies worldwide and most of the efforts to reduce smoking and cancer disparities have relied on education. In Switzerland, smoking and cancer rates are higher than in other developed countries, but the country presents lower than average health inequalities related to socioeconomic status. The Swiss model of universal healthcare leads us to rule out a major impact of public policies as well, and to hypothesize that an important role in explaining smoking disparities in Switzerland is played by another determinant of health, namely the presence or absence of the support of a social network.
Methods: To assess the role of social support in predicting tobacco disparities in Switzerland, data on tobacco use, availability of a social network, and education collected in a representative sample of the Swiss population (N = 17,760) in the context of the 2007 Swiss Health Survey have been analyzed.
Results: Respondents with lower educational level (compulsory education or less) did not present higher smoking rates but, on the contrary, with a smoking rate of 23.1%, this group was the one with the lowest percentage of smokers (p < .001). As regards social support, respondents reporting not having a person with whom they can discuss about personal problems presented significantly higher smoking rates than the others (p < .001). Specifically, a particularly important role is played by the presence or absence of familiar support, with respondents reporting not having a reference person within the family or seeing family members only one a year or less presenting higher smoking rates (p < .001).
Discussion: Tobacco control interventions targeted to low-education groups that have been successful in other countries may not obtain the same results in Switzerland. Swiss policy makers should consider the possibility to develop new strategies aimed at providing people the social support they lack within their social and familiar environment.
Keywords: smoking; health disparities; social support
CORRESPONDING AUTHOR: Diviani Nicola, Università di Lugano, Lugano; nicola.diviani@usi.ch
Models and Theory- based Interventions for Risk Reduction
O208
COMPARATIVE EFFECTIVENESS OF HEALTHY DIRECTIONS-2, A MULTIPLE RISK FACTOR INTERVENTION FOR PRIMARY CARE SETTINGS
Emmons K.M.1, Puleo E.2, Viswanath V.1, Gillman M.W.3, Bennett G.G.4, Haines J.5, Sprunck-Harrild K.1, Greaney M.1
1 Dana-Farber Cancer Institute, Medical Oncology, Boston, USA
2 University of Massachusetts, Amherst, School of Public Health, Amherst, MA, USA
3 Harvard School of Public Health, SPH Nutrtion;HMS Population, Boston, USA
4 Duke University, Psychology and Neuroscience, Durham, USA
5 University of Guelph, Family Relations and Applied Nutrition, Ontario, Canada
Effective and scalable interventions addressing multiple risk behaviors are needed. Healthy Directions-2 (HD2) was a theory-driven cluster RCT to promote improvement in five cancer risk factors in the context of primary care: smoking, physical activity (PA), and intakes of red meat (RM), fruits and vegetables (FV), and multi-vitamins (MV). The primary sampling unit was the provider, randomized to three arms: 1) usual care (UC); 2) web or print intervention materials (HD2); or 3) HD2 materials plus 2 brief coaching calls (HD2+). Secondary sampling units were patients within practice (n = 2,440); they were racially/ethnically diverse (46% non-white) with only 3.0% meeting all behavioral recommendations at baseline. Follow-ups were post 6-month intervention, and at 18 mos. Primary outcome was change in multiple risk factor (MRF) score. Change in individual risk factors was a secondary outcome.
HD2 and HD2+ led to improvements in MRF score, vs UC; 34% of UC participants had improved MRF scores at 6 mo., vs 49% and 50% in HD2 and HD2+ respectively (p < .0001), with similar results at 18 mo. (p < .003). Individual risk factor analyses focused on those participants with a specific risk factor at baseline. At 6 mo., HD2+ led to greater increases in the number of participants that met PA guidelines than either UC or HD (55%, 37%, and 37% respectively, p < .005), but there were no differences at 18 mo. Both HD2 and HD2+ led to increased MV use at 6 and 18 mo., (p’s < .0005), decreased RM intake at 18 mo. (p < .04), and marginally increased FV intake at 6 mo. (p < .08) vs UC. HD2 led to marginal increases in FV compared with either HD2+ or UC at 18 mo. (p < .08). There were no significant differences in smoking. Cost-effectiveness analyses are underway.
HD2 demonstrated that the two intervention conditions had equivalent levels of effect in reducing multiple risk factors in a large population of primary care patients, and equal impact on individual risk factors; an exception was physical activity, where the addition of coaching proved more effective. This study provides important information re the limited additional impact of counseling over materials-based interventions, for reduction of population risk for preventable disease.
Keywords: Cancer, Health Behavior Change
CORRESPONDING AUTHOR: Emmons Karen, Dana-Farber Cancer Inst, Boston; karen_m_emmons@dfci.harvard.edu
O209
APPLICATION OF THEORY IN DEVELOPING A PEER-SUPPORT BASED INTERVENTION TO IMPROVE SELF-MANAGEMENT FOR CARDIAC PATIENTS WITH DIABETES
Wu C-J., Chang A. M.
Queensland University of Technology, School of Nursing, Brisbane, Australia
While the literature demonstrates the lack of a theoretical base for many health intervention programs, some studies do refer to an underpinning theory, but provide little detail on how the theory is applied to interventions being tested for effectiveness. A theoretical framework is crucial to specifying the fundamental elements for guiding the development of intervention programs and selection of appropriate outcomes. Without explicitly knowing the theoretical basis for the intervention elements, it is difficult to replicate a particular intervention, thus reducing repeated testing of the effectiveness of an intervention. There is some research supporting the use of Bandura’s Social Cognitive Theory in health intervention programs for changing people’s individual health behaviours. Self-efficacy is a core construct of this theory, and strategies including mastery, vicarious experience, verbal persuasion and self-appraisal are advocated to promote patient’s adoption of self-management. This paper illustrates the application of using the self-efficacy construct and aims to demonstrate how a framework can be used in developing the main components of an intervention program and in the delivery of a peer-support based cardiac-diabetes self-management program. More explicit depiction of the theoretical components of such intervention programs would ensure meta-analyses of studies of self-management programs had greater homogeneity. Provisional findings indicate that a self-efficacy theory-based intervention program for those with chronic disease has the potential to improve effectiveness in managing their conditions.
Acknowledgements: The full study was supported by funding from the Department of Health & Ageing through the ‘Sharing Health Care Initiative’ Research Grant in Australia.
Keywords: peer support, self-management, theory, self-efficacy, cardiac, diabetes
CORRESPONDING AUTHOR: Wu Chiung-Jung (Jo), QUT; c3.wu@qut.edu.au
O210
IMPROVEMENT IN DIETARY KNOWLEDGE, ATTITUDE AND BEHAVIOR OF PATIENTS WITH TYPE 2 DIABETES MELLITUS: RESULTS FROM A TAILORED WEB-BASED DIETARY EDUCATION PROGRAM (MYDIDEA)
Ramadas A.1, Quek KF.1, Oldenburg B.2, Chan CKY.1, Zanariah H.3
1 Monash University, Jeffrey Cheah School of Medicine and Health Sciences, Petaling Jaya, Malaysia
2 Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
3 Hospital Putrajaya, Department of Medicine, Putrajaya, Malaysia
Introduction: Despite the fact that the Internet is a convenient and effective intervention delivery medium, there are only a few successful web-based studies reported with type 2 diabetes mellitus (T2DM) patients. Furthermore, none of these interventions focused on dietary management of these patients.
Rationale & Objective: We designed a two-armed randomized-controlled trial (myDIDeA) to improve dietary knowledge, attitude and behavior (DKAB) the patients with uncontrolled HbA1c (>7.0) via a 6-month web-based dietary education program.
Methods: T2DM patients (n = 128) from the outpatient clinics at three public hospitals were recruited with informed consent, and then randomized into the e-intervention (n = 66) or the control (n = 62) group. The e-intervention group received an intensive six-month dietary intervention through the study website, which was developed based on various established guidelines and recommendations but personalized according to the participants’ dietary stages of change, in addition to the usual standard treatment at the outpatient clinics. In contrast, the control group continued their usual standard treatment for patients with T2DM in the hospitals. Data were collected at baseline, 6 months post-intervention and at 12 months follow-up using validated instruments. All data were analyzed with IBM® PASW® Statistics 17.0.
Results & Discussion: Despite within group analysis showing an increase in the mean DKAB in both groups (p < 0.001), Bonferroni post-hoc analysis between groups revealed significantly higher mean DKAB scores in e-intervention group at post-intervention (p < 0.01) and follow-up (p < 0.001), compared to baseline. Similar to the total DKAB score, those in the e-intervention group showed significantly higher dietary knowledge and attitude score compared to the control group (p < 0.01). However, only the participants in the e-intervention group have shown significant improvement in the dietary behavior score at post-intervention and follow-up (p < 0.001).
Conclusion: myDIDeA was found to be a successful intervention program to improve the overall DKAB score, due to the improvement in the knowledge and attitude sub-domains.
Keywords: Diet, Diabetes, Behavior Change, e-Health, Intervention, Randomized controlled trial
CORRESPONDING AUTHOR: Ramadas Amutha, Monash University, Sunway; amutha80@gmail.com
O211
POPULATION IMPACT OF COMPUTER TAILORED INTERVENTIONS FOR SMOKING CESSATION IN GENERAL MEDICAL PRACTICES: AN EXPERIMENTAL EVALUATION BASED ON THE RE-AIM APPROACH
Meyer C.1, Ulbricht S.1, Rumpf H-J.2, John U.1
1 University of Greifswald, Institute of Epidemiology and Social Medicine, Greifswald, Germany
2 University of Lübeck, Department of Psychiatry and Psychotherapy, Lübeck, Germany
Background: Although brief physician-delivered advice to stop smoking is both effective and cost-effective, implementation in routine clinical practice is still insufficient. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting. The aim of the present study was to combine measures of efficacy used in clinical trial with other components determining population impact as described in the “Reach, Efficacy – Adoption, Implementation, Maintenance” (RE-AIM) framework developed by Glasgow and colleagues.
Method: 151 practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions. We assessed three dimensions of population impact: (1) adoption, i.e., the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within 7 months; (3) effectiveness, measured as smoking abstinence at 12-months follow-up.
Results: Among the practices, 70% adopted the program with no significant differences across study groups. Treatment was provided to 3086 adult smokers. Negative binomial regression analysis revealed that the number of interventions provided was higher in practices allocated to the tailored letter and combination intervention groups by 215% (p < .01) and 127% (p = .02), respectively, compared to the brief advice intervention group. Among the patients who received the combination of both intervention, the odds of point abstinence from smoking was increased by 65% (p = .02) and 32% (p = .01) compared to the brief advice and tailored letters intervention respectively. Comparing the number of abstinent patients at follow-up revealed that the tailored letter and combination interventions were superior to the brief advice intervention.
Conclusions: Computer-based interventions alone or in addition to conventional practitioner-delivered advice can foster the participation of general medical practices in tobacco control. The comprehensive evaluation of the different components determining the population impact revealed that the most relevant improvement can be attributed to “Reach”. Future methodological research should target the development of standards for research designs to assess the population impact.
Keywords: RE-AIM; Smoking Cessation; Primary medical care; Computer expert systems; Brief interventions
CORRESPONDING AUTHOR: Meyer Christian, University of Greifswald; chmeyer@uni-greifswald.de
O212
COMMUNITY HEALTH WORKERS IN CHRONIC DISEASE SELF-MANAGEMENT
Esperat C.1, Inouy J.2, Gonzalez E.3, Feng D.4, Song H.1
1 Texas Tech University Health Sciences Center, School of Nursing, Lubbock, USA
2 University of Hawaii, School of Nursing and Dental Hygiene, Honolulu, Hawaii, USA
3 Drexel University, College of Nurisng & Health Professions, Philadelphia, USA
4 Texas Tech University, Human Development and Family Studies, Lubbock, USA
Purpose: The purpose of the study was to examine the effects of using community health workers on behavior change and clinical outcomes in under-served minority populations with chronic illness. The Transformation for Health conceptual framework, based on the work of Paulo Friere, a Brazilian philosopher, was used to guide this study, allowing integration of existing theories and constructs in explaining the process of transformational behavior.
Method: A Patient Navigation Program (PNP), using community health workers (Promotoras) for chronic disease self-management was implemented at a nurse-managed primary clinic in East Lubbock, Texas. Patients (N = 152) with diabetes, hypertension, asthma, and co-morbidities of obesity and/or depression participated in the study. Using community health workers, patients with chronic illness were followed for two years. HgA1c, blood pressure and lipid profiles were collected to monitor clinical outcomes. The Patient Health Questionnaire, Self Efficacy for Diabetes Management Survey (SED), Self Efficacy for Managing Chronic Disease (SEMCD) instrument and Summary of Diabetes Self Care Activities (SDSCA) Questionnaire were used to monitor behavioral changes. Descriptive statistics and paired t-tests were used to analyze clinical and behavior changes between baseline and at 24 months.
Results: The hospitalization rate of asthma patient (n = 27) was reduced significantly from 51.6% (12 months prior to TPS) to zero during navigation program (χ2 = 18.9, p < .001). Paired t-test shows an average reduction of 1.14% on HbA1c level in diabetes patients (n = 125), which was significantly reduced from average 9.1% to 7.8% (t124 = 7.49, p < .001). The average scores for SED, SEMCD and SDSCA were significantly improved 1.12 (t55 = -5.07, p < .001), 0.99 (t70 = -3.98, p < .001) and 0.77 (t53 = -4.59, p < .001), respectively after enrollment in the program. The mean score for the Opportunity for Nurturance subscale of the social provisions instrument was significantly decreased 0.58 (t77 = 2.35, p < .05) after enrollment in the PNP. Overall, these findings provide support for the effectiveness of community health workers in facilitating clinical and behavioral changes among the patients of the Patient navigation program.
Keywords: Chronic illness, Community intervention, Health behavior change
CORRESPONDING AUTHOR: Esperat Christina, Texas Tech University, Texas; christina.esperat@ttuhsc.edu
O213
PREDICTING ALCOHOL CONSUMPTION AND BINGE DRINKING IN COMPANY EMPLOYEES: AN APPLICATION OF PLANNED BEHAVIOUR AND SELF-DETERMINATION THEORIES
Hagger M.1, Lonsdale A.2, Hein V.3, Koka A.3, Pasi H.4, Lintunen T.4, Lindwall M.5, Rudolfsson L.5, Chatzisarantis N.6
1 Curtin University, School of Psychology and Speech Pathology, Perth, Australia
2 Oxford Brookes University, Department of Psychology, Oxford, United Kingdom
3 Tartu University, Faculty of Exercise and Sports Sciences, Tartu, Estonia
4 University of Jyvaskyla, Department of Physical Education, Jyvaskyla, Finland
5 University of Gothenberg, Department of Psychology, Gothenburg, Sweden
6 National Institute of Education, Physical Education and Sports Science, Singapore, Singapore
This study tested an integrated model of the psychosocial determinants of alcohol-related behaviour among company employees from four nations. A motivational sequence was proposed in which motivational orientations from self-determination theory influenced intentions to consume alcohol within guideline limits and alcohol-related behaviour via the mediation of the theory of planned behaviour variables of attitude, subjective norms, and perceived behavioural control (PBC). A three-wave prospective design using self-reported psychological and behavioural measures. Company employees (N = 486, males = 225, females = 261; M age = 30.41, SD = 8.31) from four nations (Estonia, Finland, Sweden, and UK) completed measures of autonomous and controlled motivation from self-determination theory, attitudes, subjective norms, PBC, and intentions from the theory of planned behaviour, and self-reported measures of past alcohol consumption and binge-drinking occasions at the first time point (time 1). Follow-up psychological and behavioural measures were taken one month later (time 2) and follow-up behavioural measures taken a further 2 months later (time 3). Path analyses supported the motivational sequence with identified regulation (time 1) predicting intentions (time 1), and alcohol units consumed (time 2). The effects were indirect via the mediation of attitudes and PBC (time 1). A similar pattern of effects was found for the effect of time 2 psychological variables on time 3 units of alcohol consumed. There was little support for the effects of the psychological variables on binge drinking behaviour. Findings provide new information on the psychosocial determinants of alcohol behaviour in company employees and the processes involved. Results may provide impetus for the development of interventions to reduce alcohol consumption.
Keywords: alcohol, binge drinking, intentions, identified regulation, autonomous motivation
CORRESPONDING AUTHOR: Hagger Martin, Curtin University, Perth; martin.hagger@curtin.edu.au
Behavioral Medicine in China - Prospects and Challenges
S214
BEHAVIORAL MEDICINE IN CHINA - PROSPECTS AND CHALLENGES
Oldenburg B.
Monash University, Public Health, Melbourne, Australia
Chair: Carina Chan, Malaysia
Presenters:
Xuefeng Zhong: Peer Support interventions for Diabetes and Community Health Centers in China
Ding Ding: Preventing smoking initiation among rural-to-urban migrant women in China
Joseph Lau: The role of behavioral medicine research in HIV research in China
Discussant: Brian Oldenburg
China will have a population of almost 1.5 billion people by 2030. Although life expectancy has improved remarkably over the past 20 years, many public health challenges remain, including rising non-communicable diseases (NCDs), emerging infectious diseases and environmental issues. Recent times have also seen the rapid rise of the same lifestyle risk factors that are driving the NCD epidemic in other countries.
Behavioural medicine can play an important role in disease prevention and health promotion. However, the professional and research disciplines that contribute to the inter-disciplinary field of behavioral medicine in other countries do not have the same traditions in China, e.g, very few universities in China offer any health psychology training and there is also a lack of interdisciplinary research in public health and related fields.
Three examples of behavioral medicine research in China will be presented and each presenter will discuss how s/he undertook the study and the challenges and issues that confronted them. Zhong Xuefeng will present on the development and evaluation of a novel peer-support intervention for diabetes that was conducted in community health centers. Ding Ding will present on smoking prevention among rural-to-urban migrant women and potential policy strategies in mainland China. Joseph Lau will illustrate the opportunities and challenges of applying behavioural medicine research approaches in HIV-related research in China. The discussion will focus on the uniqueness of behavioral medicine research in China due to its cultural traditions and health care system. Further discussion will address the opportunities and challenges in establishing stronger behavioural medicine traditions in China for the future.
Keywords: public health, multiple risk factors, health policy
CORRESPONDING AUTHOR: Oldenburg Brian, Monash University; brian.oldenburg@monash.edu
S215
PEER SUPPORT INTERVENTIONS FOR DIABETES AND COMMUNITY HEALTH CENTERS IN CHINA
Xuefeng Z.
Anhui Provincial Center for Disease Control and Prevention, Health Education, Hefei city, China
Chinese government policy directs that services of Community Health Centers (CHCs) are organized around neighborhoods and housing complexes. Accordingly, CHC professional teams serve specific sites to provide basic clinical and preventive services including chronic disease management. In collaboration with the Center for Disease Control & Prevention (CDC) in Anhui Province, peer supporters were trained by CHC and CDC teams, co-led monthly peer support meetings with CHC professionals, and organized activities (e.g., morning walking, Tai Chi, food shopping) as well as providing individual support to neighbors. A community randomized control trial design was used to evaluate the effectiveness of the community-based peer-led support program (PLSP) in improving self-management practices among individuals with diabetes. Six sub-communities were randomly sampled from seventeen cities. Three sub-communities were assigned randomly to experimental groups and others to comparison groups. Total 726 volunteer diabetes patients were recruited and were assigned randomly to experimental (n = 365) and comparison (n = 361) groups. Both quantitative and qualitative methods were employed to evaluate the effectiveness and feasibility of the program implementation during July 2009 to August 2010. The results indicated that the PLSP for diabetes self-management can improve diabetes diet and physical activities significantly by increasing the level of knowledge about SM, self-efficacy on SM, and perceived social support. It can also significantly improve participants' fasting plasma glucose (FPG), two-hour postprandial plasma glucose (2hrPPG), and moderately improve health status. Peer supporters report the cooperation with the CHCs as a key strength of their program. Despite the close relationship with the CHCs, peer supporters and their neighbors see their activities as very much part of their neighborhoods. In contrast to western images of Chinese culture discouraging the sharing of emotions, peer support provided opportunities for emotional exchange. This is because cultural norms against burdening one’s family with negative feelings are lessened with non-family peers with diabetes.
Keywords: Health Behaviour change Diabetes Public Health
CORRESPONDING AUTHOR: Zhong Xuefeng, Institute of Health Education; zhongxuefeng64@hotmail.com
S216
PREVENTING SMOKING INITIATION AMONG RURAL-TO-URBAN MIGRANT WOMEN IN CHINA: CONNECTING A BEHAVIOURAL EPIDEMIOLOGICAL STUDY WITH POLICY DISCUSSIONS
Ding D.1, Wan X.2, Shin S.3, Raymond H.4, Liu H.2, Yang G.2, Novotny T.3
1 University of California San Diego, Family Preventive Medicine, La Jolla, USA
2 Peking Union Medical College, School of Basic Medicine, Beijing, China
3 San Diego State University, Graduate School of Public Health, San Diego, USA
4 San Francisco Department of Public Health, San Francisco, USA
China is the world’s largest producer and consumer of tobacco. Although the current smoking prevalence among women is low (2.4%), an increase is expected as a result of change in cultural norms and tobacco marketing campaigns directed towards women. The subgroup that is particularly at risk is the 105 million rural-to-urban migrant women, as they experience more stress in daily living and are more vulnerable to a range of risk behaviours. In summer 2011, we conducted a survey study of 2229 migrant women from 10 provincial capitals in China through local CDC offices. The study included several key steps: 1) developing and programming a handheld computer data collection (HCDC) system, 2) training Chinese collaborators to use the HCDC system for data collection and data transfer, 3) pilot testing the HCDC system, 4) data collection, 5) data analyses, 6) disseminating research findings through a policy meeting. Findings from the study suggested that migration and associated social stressors (e.g. discrimination) were associated with higher susceptibility to smoking. To prevent smoking onset of migrant women in China, several specific policies and other strategies were proposed at the policy meeting, such as regulations of cigarette marketing and worksite surveillance. This study is an example of public health research in China using a novel data collection method and a translational behavioural medicine component.
Keywords: Smoking, Tobacco Control, Research to practice translation, Research method
CORRESPONDING AUTHOR: Ding Ding, UCSD, San Diego; dding@projects.sdsu.edu
S217
THE ROLE OF BEHAVIORAL MEDICINE RESEARCH IN HIV RESEARCH IN CHINA
Lau TF.
The Chinese University of Hong Kong, Centre for Health Behaviours Research, School of Public Health and Primary Care, Hong Kong, China
HIV research and care work require interdisciplinary input, as pointed out by a number of researchers. Behavioral medicine is however, a relatively new topic in China and historically, social sciences departments were separated from medical universities. In this presentation, we shall consider the published evidence concerning the prevention and control of HIV in China over the last 20 years in order to identify the proportion of them 1) using behavioral theories (e.g. Health Belief Model, Theory of Planned Behaviors) to explain risk behaviors, 2) using behavioral theories to guide design of interventions, 3) using mental health variables to explain risk behaviors and 4) involving first author and co-authors coming from social sciences departments (e.g. psychology and sociology) in China and overseas. The second part of the presentation will consider the presenters' behavioral research into HIV prevention among female sex workers who are injecting drug users and methadone users, to illustrate opportunities and potentials, as well as difficulties in applying behavioral theories and approaches in developing effective and sustainable interventions. The presentation will identify some of the barriers of translational research versus efficacy studies in this field in China.
Keywords: HIV, Health Behaviors, Theory, Interdisciplinarity, and Research to practice translation
CORRESPONDING AUTHOR: Lau Joseph, Chinese University of Hong Kong; jlau@cuhk.edu.hk
Translation of Research into Policy and Practice
O218
WORKPLACE TRANSLATION OF THE DIABETES PREVENTION PROGRAM: FORMATIVE AND PILOT STUDY RESULTS
DeJoy D.1, Padilla H.1, Vandenberg R.2, Wilson M.1
1 The University of Georgia, Department of Health Promotion and Behavior, Athens, USA
2 The University of Georgia, Department of Management, Athens, USA
Obesity has reached epidemic proportions in the U.S. and this has prompted many employers to initiate or expand efforts to help employees manage their weight. Progress has been hampered, however, by the lack of evidence-based interventions suitable for work settings. This presentation summarizes formative research and pilot study findings from a worksite translation of the Diabetes Prevention Program (DPP). Union Pacific Railroad provided the setting for this research at one of their locomotive maintenance facilities. There were 167 employees at this site (predominately white, middle-aged males). Formative data were collected through stakeholder interviews, focus groups, and observation of the work environment using a validated assessment tool. Major adaptations of DPP included converting intervention materials to a self-study format and replacing lifestyle coaches with an occupational health nurse and peer coaches. Key concepts of the DPP Lifestyle Balance manual were retained, with formatting, graphics, and modifications to make the manual more reader-friendly and suitable for self-study. The pilot study was a single-group design with three data collection points: baseline, 6 months (core intervention), and 12 months (maintenance). Sixty-seven employees were recruited into the pilot study. At baseline, the mean BMI and body weight for the sample were 32.1 ± 5.3 and 99.6 ± 19.6 kg, respectively. As with the original DPP, participants were expected to complete 16 lessons in 24 weeks, and the first session included supervised height and weight measurement and individual consultation with a dietitian or health educator to set personal weight loss and physical activity goals. Attrition was relatively low from baseline to 6 months (repeat participation rate = 88%) and 40 participants completed all three data collection points. Paired sample t-tests were used to compare BMI and body weight between groups. There was a significant reduction in BMI after the core intervention (31.8 ± 5.3 vs. 31.5 ± 5.3; p < 0.05) and this change was maintained for an additional 6 months. Overall, mean weight loss among participants was 1.4 kg (p < 0.05). Results are discussed in terms of population health and the challenges of translation research.
Keywords: Worksite Health, Research to Practice Translation, Obesity
Corresponding author: Padilla Heather, The University of Georgia; hmbowen@uga.edu
O219
CHALLENGES OF ETHICAL CLEARANCE IN INTERNATIONAL TRANSLATIONAL HEALTH POLICY RESEARCH
Aro AR.1, Fredsgaard M.1, Viehbeck S.2, Edwards N.2
1 University of Southern Denmark, Unit for Health Promotion Research, Esbjerg, Denmark
2 University of Ottawa, Institute of Population and Public Health, Ottawa, Canada
Ethical guidelines in many European countries were designed for individually-oriented biomedical health research. In many countries, current guidelines are inappropriate for health policy and public health research, with its societal focus. Furthermore, the practice of ethics reviews of health policy research varies considerably across countries. This poses challenges for international health policy research. The aim is to show first results and challenges of ethical clearance of an international translational health policy research program. The setting is the 7-country, 5-year European Commission (EC)-funded research program REPOPA (Research into Policy to enhance Physical Activity, www.repopa.eu). Denmark (DK), Canada (CS), Finland (FI), Italy (IT), The Netherlands (NL), Romania (RO) and U.K. are collaborators. REPOPA maps use of research evidence in policy making both via documents and expert interviews; carries out interventions among policy makers and academics to enhance cross-sector policy making; validates best practices and tools and evaluates the REPOPA process and its products. EC requires documentation about ethics clearance before research can start. The practice of ethical clearance in the countries was mapped by internet-survey, in-depth discussions among the partners and with ethics offices, and by a review of existing national ethics guidelines. DK, IT, RO and NL require no ethical clearance for this kind research and consequently have no agency to provide review and clearance. However, CA and UK require clearance for all parts of the program, from all partner countries. FI requires clearance for interviews and interventions with which it is involved. As the coordinating country, DK is expected to carry out an overall ethical clearance for the whole REPOPA program. This is a challenge, since DK has no agency to do this; the solution might be an ad hoc committee. Clearly this kind of international health policy research needs ethics guidelines development on the international level. This should be done in collaboration with different disciplines including health, political and social sciences and, ethics and legal experts as well as relevant ethics review boards with relevant expertise and experience.
Keywords: ethical issues, research to practice translation, health policy
CORRESPONDING AUTHOR: Aro Arja R., University of Southern Denmark; araro@health.sdu.dk
O220
THE TRANSLATION OF HIV PREVENTION RESEARCH INTO POLICY AND PRACTICE IN AFRICA
Setswe G.
School of Public Health and Preventive Medicine, Monash University Australia, Department of Health Sciences, Melbourne, South Africa
This presentation examines the relationship between behavioural HIV prevention research, policy development and implementation. The presentation starts by exploring whether we are getting the evidence from randomised controlled trials of interventions for reducing the risk of HIV and AIDS. It also explores whether research findings are adequately translated into prevention policies and whether HIV research findings are being made available to the research subjects and communities and whether research is being conducted in their interests or other interests.
With reference to some of the HIV prevention policies adopted by the African countries, or by member states, the presentation is asking whether these policies are ‘evidence based’ (i.e. rooted in research), or not. The presentation looks at barriers to implementation of HIV/AIDS programmes and examines ways of bridging the gap between research, policy and implementation.
Finally, this presentation examines whether there is sufficient coordination and dissemination of the research that is being initiated by different academic or research bodies within countries and within regions. It looks at whether there is a balance between academic freedom and the need – in the context of a devastating HIV/AIDS epidemic - to ensure that resources are not wasted via duplication or on research which cannot be translated into HIV prevention policies or programs.
Keywords: Policy; Research to practice translation
CORRESPONDING AUTHOR: Setswe Geoffrey, Monash University, Johannesburg; geoffrey.setswe@monash.edu
O221
SEVEN YEARS OF EXPERIENCE WITH THE IMPLEMENTATION OF THE WLS STRESS MANAGEMENT INTERVENTION IN HUNGARY
Stauder A., Cserháti Z.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
Background: The efficiency of an intervention is not only reflected by its effectiveness in a controlled research setting, but also by its sustainability and implementation in real life setting.
Aim: We report our experiences with the implementation of a complex, standardized stress management intervention, the internationally used, Williams Life Skills (WLS) program in Hungary.
Methods and results: The components of this 16 hours small group intervention are awareness of stressors, cognitive techniques to deal with negative thoughts and negative emotions, short relaxation techniques, problem solving, communication and interpersonal skills practice. After translation and some minor cultural adaptation of the program originally developed in the US, it was implemented among various target groups to improve their stress management skills. Questionnaire based follow-up studies showed significant (ps < 0,01) reduction of perceived stress (PSS10), anxiety (STAI-T), depression (BDI) and subjective somatic symptom (PHQ15) scores among distressed individuals, healthy employees and medical students after the training as well as at 6 or 12 month follow-up. In parallel, the training of professionals for facilitating WLS training has been started. In total 146 professionals started, and 94 have obtained the facilitator diploma until now. During the 7 years period over 2500 persons participated in the intervention, and there is still a raising interest in different settings, partly as a health promotion program, partly as a therapeutic intervention, with the involvement of various financial resources. The Hungarian version of the video based self-help version of the WLS program has also been available since 2008.
Conclusion: Besides scientific evidence, important components of the sustainability of this behavioral intervention are the satisfaction of the professionals who are delivering the program, the satisfaction of the participants, its standardized format and that the WLS program can be implemented within the existing system without extra resources.
Thanks to Virginia Williams and Redford Williams for the development of the program, and to the Hungarian Lifeskills Team (see www.eletkeszsegek.hu) for their high quality work.
Keywords: stress, multilevel intervention
CORRESPONDING AUTHOR: Stauder Adrienne, Semmelweis University, Budapest; staadr@net.sote.hu
O222
INTRODUCING PHYSICAL ACTIVITY INTERVENTIONS IN PRIMARY HEALTH CARE: A QUALITATIVE STUDY OF PERCEIVED FACILITATORS AND BARRIERS
Huijg JM.1, Van der Zouwe N.2, Gebhardt WA.1, Crone MR.3, Verheijden MW.4, Middelkoop BJC.3
1 Leiden University, Clinical, Health and Neuropsychology, Leiden, The Netherlands
2 Regional Public Health Service Hollands Midden, -, Leiden, The Netherlands
3 Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
4 TNO, Leiden, The Netherlands
Introduction: For an effective introduction of efficacious physical activity (PA) interventions in primary health care (PHC), it is important to know which factors influence the process. The aim of this qualitative study was to identify factors influencing the introduction (i.e., adoption, implementation, and continuation) of PA interventions in PHC, as perceived by stakeholders.
Methods: 28 semi-structured interviews were held with 6 intervention owners, 4 healthcare advisors, and 18 professionals involved in five PA interventions delivered in PHC in the Netherlands. Factors influencing the adoption, implementation, and continuation of these interventions were addressed. All interviews were audio-recorded and transcribed. Data were analyzed by means of Atlas.ti using grounded theory principles.
Results: Stakeholders reported a multitude of factors influencing the introduction of PA interventions in PHC. Factors were related to the 1. socio-political context (i.e., policy, financial support), 2 organization (i.e., management support, team work), 3. adopting person (i.e., knowledge and skills, perceptions on the intervention), 4. patient (i.e., perceptions on the intervention, experience with the intervention), 5. innovation (i.e., success, relative advantage), and 6. innovation strategy (i.e., training, research). Furthermore, some factors appeared to be particularly important to one of the distinct stages of the introduction process. For the adoption of PA interventions, professionals’ motivation and their perceptions on patients’ cognitions, motivation, behavior, and characteristics play a prominent role. Professionals’ knowledge and skills and the presence of facilities and resources have a strong influence on PA interventions’ implementation. Finally, factors most important to the continuation of PA interventions are typically related to governmental policies about PA promotion and financial support.
Conclusions: This study provides an overview of factors that are perceived by stakeholders to influence the introduction of PA interventions in PHC. Therefore this study provides new insights with regard to the design of effective implementation strategies, with special attention to the distinct stages of the process.
Keywords: Research to practice translation; Dissemination; Primary care; Physical activity; Intervention; Prevention
CORRESPONDING AUTHOR: Huijg Johanna, Leiden University; huijgjm@fsw.leidenuniv.nl
O223
BEING THE AGENT OF TRANSLATING RESEARCH INTO PRACTICE: EXPERIENCES OF MUNICIPALITY EMPLOYEES PARTNERING WITH RESEARCH GROUPS. A CASE STUDY
Varga G.
Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Background: The Swedish National Institute of Public Health has financed several practice-based studies in the municipalities, connecting them to universities over the last few years. These projects, like numerous other scientific programs in municipalities, typically have a short life. In this environment it is a difficult task to ensure that the know-how and research methodologies collected and worked out in a project are reused in subsequent projects. In order to assure sustainability and a well-functioning partnership between the municipality and the researchers, a few research groups have involved representatives from the municipalities in the project work both as leaders and as research staff partly from university budget. The aim of this study was to gain insights from the local research assistants on how they perceived the work with the universities.
Method: We conducted individual interviews with four assistants and asked them to tell their perceptions on the partnership. The material was analysed with narrative method combining thematic and structural analysis.
Results: The main topics the local research assistants recounted were the challenges of splitting the project responsibilities between the municipality and the university; the workload distribution between the research and their regular job; managing barriers through regular dialogues with politicians, practitioners and researchers; implementing changes to the project based on lessons learnt; and the benefits of the cooperation with researchers in their professional life, in their personal development, and furthermore for the general public.
Discussion: The ability of local research assistants in succeeding in combining the scientific requirements and the municipalities' obligations depend on their work experience and their level of prior research experience. All assistants described that their knowledge about research increased; two of the assistants reported significant personal development, the others obtained great insights about the key ingredients of successful cooperation with different stakeholders.
Conclusion: This study identified that proper stakeholder management, regular coaching of project assistants, and openness to changes in the project contribute the most to successful municipality-university partnership.
Keywords: Research to practice translation, Community intervention
Corresponding author: Varga Gabriella, Uppsala University, Uppsala; gabriella.varga@kbh.uu.se
Changing gender roles as social determinants of health
S224
CHANGING GENDER ROLES AS SOCIAL DETERMINANTS OF HEALTH
Kopp M.1, Bobrova N.2, Ádám SZ.1, Balog P.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 University College London, Department of Epidemiology and Public Health, London, United Kingdom
Background: Among the social determinants of health the ways of coping with changing gender roles seem to be of central importance. For strengthening gender equity in health it is fundamental to find new forms of combining the work and family life of women and men in a harmonious way. The disturbances in these processes are important risk factors of the premature morbidity and mortality, first of all among men and of impoverished mental health among women. Family and working place might enhance each other, but for this aim it is necessary to establish new forms of gender roles to be able to fulfil these parallel vocations for healthy and competent life.
The presenters of the symposium and the titles of the abstracts are:
Szilvia Ádám, PhD, Hungary: The role of gender in health.
Bobrova, Natalia, PhD, Russia, UK: Gender roles and hazardous drinking in Russia
Piroska Balog, PhD, Hungary: Gender differences in the health consequences of marital stress
Prof Maria Kopp, MD, PhD: Social support, marital status and premature mortality in the Hungarian population
Conclusion: the four speakers will discuss the connection between changing gender roles and health behaviour and health on the basis of epidemiological surveys in the suddenly changing societies of Russia and Hungary.
Keywords: gender, alcohol, family, premature mortality, social support
CORRESPONDING AUTHOR: Kopp Maria, Semmelweis University; Budapest; kopmar@net.sote.hu
S225
GENDER DISPARITIES IN STRESS AND HEALTH AMONG PHYSICIANS IN HUNGARY: A POTENTIAL PREDICITIVE ROLE FOR WORK-FAMILY CONFLICT
Ádám SZ., Győrffy ZS., Cserháti Z.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
Background: Mounting gender role pressures and increased participation of women in the medical profession may lead to high prevalence of work-family conflict (WFC), a specific form of stress, among female physicians. However, little is known about the manifestation and gender-specific stressors of WFC as well as its impact on the physicians’ health in a traditional cultural setting.
Aim: To explore the manifestation and potential sources of WFC and investigate its predictive role in adverse health outcomes among physicians in Hungary.
Methods: The prevalence of WFC were assessed by questionnaires (N = 420). The direction, type, and potential sources of WFC were explored by content analyses of semi-structured in-depth interviews (N = 123) using the demand-control-support model of stress.
Results: Female physicians (N = 219) reported significantly higher mean level and prevalence of WFC compared to men (N = 201). The predominant form of WFC was work-to-family conflict among physicians; however, significantly more female physicians experienced family-to-work conflict and strain-based WFC than men (39% vs. 18% and 68% vs. 20%, respectively). Significantly more male physicians experienced time-based work-family conflict than women. In regression analyses, high job demands, job strain, high workload and number of children, younger age, and lack of support in the workplace predicted WFC best (R2 0.59). Content analyses of interview data (N = 123) revealed significant gender differences in the provision of social support to physicians. Female physicians lacking parental, peer (i.e., access to same-sex professional role models/mentors, gender equity), or organizational support (i.e., family-friendly policies) experienced significantly higher WFC compared to appropriate control. Significantly more female physicians reported allergy. Female physicians scored significantly higher on the emotional exhaustion subscale of the MBI and significantly more female physicians experienced high levels of emotional exhaustion compared to male physicians. WFC emerged as a significant predictor of somatic as well as psychological morbidity including hypertension, neoplasms, burnout, and depression among female physicians.
Conclusions: These findings suggest that lack of social support may function as an antecedent to WFC experienced by female physicians. Furthermore, these results imply a potential path from WFC to poor somatic and psychological health in a scarcely researched population of physicians, and among female physicians, in particular, and provide further data for cross-cultural occupational stress research in a traditional cultural setting.
Keywords: work-family conflict, physicians, social support, antecedents, gender differences
CORRESPONDING AUTHOR: Ádám Szilvia, Semmelweis University, Budapest; adamszilvia@hotmail.com
S226
GENDER ROLES AND HAZARDOUS DRINKING IN RUSSIA
Bobrova N.
University College London, Epidemiology and Public Health, London, United Kingdom
Gender differences in drinking patterns and the reasons behind them were investigated in the Russian city of Novosibirsk using a mixed method design. The quantitative study was based on the Health, Alcohol and Psychosocial factors In Eastern Europe cohort and included 9363 men and women aged 45-69 years. In addition, 44 semi-structured qualitative interviews were conducted from a sub-sample of the cohort to explore in-depth a variety of drinking occasions and practices and to assist in explaining and interpreting the findings of a quantitative study.
The quantitative data revealed a large gender differences in drinking between men and women, with men consuming alcohol more frequently and in larger amounts, and a significantly larger proportion of men drinking in hazardous ways. For example, 34.5% of men and only 1.4% of women reported drinking five drinks (100 g) or more on a single occasion at least once a month. Having ten drinks (200 g) or more on one occasion at least once a month was reported by 13.9% of men and 0.3% of women.
Qualitative interviews have shown that these differences were largely related to gender roles and perceived gender identity: “a real woman” is supposed to drink a minimum amount of alcohol; by contrary “a real man” pursuing a traditional masculinity model can drink a lot. Women’s multiple responsibilities at home were leaving them little time to drink, hence, protecting them from hazardous drinking, whereas men’s total withdrawal from domestic responsibilities provided them more opportunities for leisure - which was often spent drinking. These differences were also reflected in occupational cultures and drinking patterns: women reported no drinking at the workplace, and no drinking after work with colleagues. Men, on the other hand, had quite a few drinking experiences related to their jobs which were triggered by access to ethanol at work, working away from home in exclusively male company, management that was tolerant of drinking at work, and work related-stresses. Finally, qualitative accounts revealed different gender role-related responses by men and women to stressful situations, especially during economic hardships.
Keywords: gender roles, alcohol, Russia
CORRESPONDING AUTHOR: Bobrova Natalia, University College London; nbobrova@hotmail.com
S227
GENDER DIFFERENCES IN HEALTH CONSEQUENCES OF MARITAL STRESS
Balog P.1, Falger P.2, Szabó G.3, Kopp M.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 Maastricht University, Social Psychiatry, Maastricht, The Netherlands
3 Semmelweis University, Institute of Health Sciences, Budapest, Hungary
Background: In post-modern society, marital distress may be a core factor in predicting adverse mental, physical, and social health outcomes in adulthood, including exhaustion and depression, addictive behaviour, absenteeism, divorce, and cardiovascular and other morbidity and mortality. Marital distress (Shortened Marital Stress Scale) most likely is associated with personality traits and may confer different health risks for men and women.
Method: Analysis of cross-sectional and follow-up data from representative national epidemiological panels in Hungary (2002-2006; total N = 12,680). We analysed data on all men and women younger than age 65 who were married/cohabitating and economically active at examination. Most hierarchical regression analyses were adjusted for age, education, SES, BMI, physical activity, and lifestyle factors and performed separately for men and women.
Results, Cross-Sectional: In men and women, marital distress was associated with hostility, low self-efficacy, low purpose in life, binge drinking, sleep complaints, anxiety, and vital exhaustion and depression (BDI). In men, but not in women, marital distress was also associated with smoking, alcoholism and current treatment for hypertension, the latter mediated through depressive symptoms. In women, but not in men, marital distress was associated with current treatment for depression.
Results, Follow-Up: In men and women, younger age, higher education, and marital distress contributed independently to divorce during follow-up, whereas subjective economic status and parental divorce were marginally associated. Moreover, marital distress was also conducive to elevated depression during follow-up. In separate analyses, vital exhaustion and depression in both men and women predicted CVD (hypertension, ischemia, myocardial infarction, and stroke) during follow-up. Since marital distress was associated with exhaustion and depression in the above cross-sectional analyses, future analysis will focus on marital distress as predictor of CVD endpoints.
Discussion: In these analyses, marital distress was associated with serious adverse mental and physical health outcomes, in particular hypertension in men and depression in women.
Keywords: gender, health, stress
CORRESPONDING AUTHOR: Balog Piroska, Semmelweis University, Budapest; balopir@net.sote.hu
S228
FAMILY RELATIONSHIPS AND RISK OF PREMATURE MORTALITY IN THE HUNGARIAN POPULATION
Kopp M., Székely A., Ádám SZ.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
Background: Gender differences in premature mortality rates are extremely high in Hungary. The question is the possible role of changing gender roles in these health related differences.
Aim: We aimed to quantify the relationships between family related social support characteristics and premature mortality among men and women separately in the Hungarian population.
Methods: Men (n = 1130) and women (n = 1529), aged 40-69 years, participants in the Hungarian Epidemiological Panel (2002) were followed for 3.5 years for total mortality. Cox-proportional hazard models were used to evaluate the association between family arrangements and family related social support measures and mortality.
Results: During the follow-up, 99 men (8.8%) and 53 women (3.5%) died. Each measure of family related social support characteristics was more deleterious in men compared to women, but the strength of this interaction was different for different social support measures. Singlehood, high marital stress and low social support from child/children were more important risk factors among men than among women.
Conclusion: In Hungary there are huge differences between the male and female gender roles. Middle-aged Hungarian men seem to be considerably more vulnerable to the chronic stress of low family related social support than women.
Keywords: Risk factors, social support, family, epidemiology, gender, premature mortality
CORRESPONDING AUTHOR: Kopp Maria, Semmelweis University, Budapest; kopmar@net.sote.hu
S229
HEALTH OF SINGLE PARENTS: IS LONE PARENTING A RISK FACTOR FOR POOR HEALTH?
Csoboth C., Susanszky E., Kopp M.
Semmelweis University, Behavioural Science Institute, Budapest, Hungary
Introduction: The number of single parents is increasing world wide. Nevertheless only a few studies analyze how the health of single parents is affected by being the sole caregiver of their children. Some findings indicate that lone parents experience a higher incidence of health problems than partnered parents. The objective of our presentation is to discuss data published regarding this important societal issue and to present data from our own research conducted in Hungary.
Methods: We analyzed data of a national representative cross-sectional survey (Hungarostudy 2006) of the Hungarian population. The survey contained sociodemographic questions and questionnaires measuring physical and mental health and associated psychosocial risk factors.
Results: Of the 1563 persons who declared to have young children in their household, almost one-tenth (9%) reported to be raising their child/children alone. Most of these single parents were mothers. 48% of single-parents evaluated their socioeconomic state far below the national average. These single parents also described their health significantly worse compared to parents rearing their children in a relationship (11% vs. 5%). A higher frequency of single parents complained of exhaustion and fatigue (21% vs. 15%) and reported more psychiatric disturbances (13% vs. 5%). Severe depression was more prevalent among single parents (10% vs. 6%) as was suicidal ideation (25% vs. 15%) and suicide attempt (13% vs. 5%).
Discussion: Our results suggest that both the physical and mental health of parents who raise their child/children by themselves can be worse compared to those parents who are raising their children in a relationship. Health policy makers need to pay attention more to this increasingly large group of adults who are at risk for poorer physical and mental health.
Keywords: single parents, physical and mental health, socioeconomic status
CORRESPONDING AUTHOR: Csoboth Csilla, Semmelweis University; csillacsoboth@yahoo.com
The impact of disasters on health: what do we know? What do we need to know?
S230
THE IMPACT OF DISASTERS ON HEALTH: WHAT DO WE KNOW? WHAT DO WE NEED TO KNOW?
La Greca A.
University of Miami, Psychology, Coral Gables, USA
Disasters occur worldwide and can be very devastating, contributing to substantial property damage, loss of life, and major life disruption. In fact, in just the first six months of the year, natural disasters across the globe made 2011 the most costly on record, with over $265 billion in property damage. This economic cost is in addition to substantial loss of life, with over 15,000 disaster-related deaths and thousands of individuals who remain missing. Some of the disasters contributing to this record-breaking year include the earthquake and tsunami in Japan, the earthquake in New Zealand, flooding in Australia, multiple events in the US (tornados, flooding, fires, earthquakes), and typhoons in the Philippines and Japan, among others. Although substantial work has documented the impact of disasters on individuals, families, and communities (Bonanno, Brewin, Kaniasty, & La Greca, 2010; Norris, 2002), much greater attention has been devoted to the psychological consequences of disasters than to their physical health impacts. Yet, disasters can contribute to physical health difficulties both through direct physical injury as well as through chronically stressful conditions that indirectly lead to physical health problems. This symposium will highlight approaches to understanding disasters’ impact on the physical health of children, adults, and/or communities. Across the presentations, a range of disasters (technological and natural disasters, terrorist events) and a range of physical outcomes (chronic illness, pain and medication use, somatic concerns, health-risk behaviors) will be addressed. The presentations also address implications for future research as well as for planning postdisaster interventions.
Natural Disasters’ Impact on Children: Does It Affect Health and Health Behaviors?
A.M. La Greca, B. Lai, and W. Herge
Beyond PTSD: Pain and Medication Use in Children Affected by Trauma
G. Dybe
Impacts of Technological Disasters on Physical and Behavioral Health: \Lessons from the Exxon Valdez Disaster
LA. Palinkas
Keywords: trauma, disasters, PTSD, disease, somatic symptoms, health behaviors
CORRESPONDING AUTHOR: La Greca Annette, University of Miami; alagreca@miami.edu
S231
NATURAL DISASTERS’ IMPACT ON CHILDREN: DOES IT AFFECT HEALTH AND HEALTH BEHAVIORS?
La Greca A., Lai B., Herge W.
University of Miami, Psychology, Coral Gables, USA
Children are a vulnerable population in disasters, as disasters not only disrupt children’s lives but also adversely affect their primary support systems. Over 20 years of research documents the psychological impacts of disasters on children. Across diverse events, findings reveal that disasters contribute to children’s symptoms of anxiety, depression, and posttraumatic stress (PTS). Yet, little is known about disasters’ impact on children’s health, despite the fact that acute and chronic stress, which are often present postdisaster, can contribute to poor physical health and disease. This presentation draws on two prospective studies of children in the aftermath of destructive disasters, Hurricanes Charley (n = 384) and Ike (n = 328), which examined the disasters’ impact on somatic complaints and health risk behaviors. Using a conceptual model of risk and resilience, we examined the impact of child characteristics, disaster-exposure, recovery stressors, and social support on children’s somatic symptoms. We found a dose-response association between disaster-exposure and children’s somatic symptoms, both concurrently and prospectively. Moreover, children’s PTS reactions mediated the association between stressors and somatic concerns. Following Hurricane Ike, we also examined children’s health behavior outcomes, finding that disaster-exposure predicted more sedentary behaviors in children. These findings point to the need for further research on the health impacts of disasters on youth, and suggest that postdisaster interventions should target both physical and mental health issues. Implications for disaster preparedness will also be discussed.
Keywords: trauma, disasters, health behaviors, somatic symptoms, PTSD
CORRESPONDING AUTHOR: La Greca Annette , University of Miami; alagreca@miami.edu
S232
BEYOND PTSD: PAIN AND MEDICATION USE IN CHILDREN AFFECTED BY TRAUMA
Dyb G.
University of Oslo, Dept. of Clinical Medicine, Oslo, Norway
Studies of disasters and other traumatic events in children and adolescents have documented a wide range of negative psychological consequences, such as anxiety, depression and PTSD. For example, following the tsunami disaster in Southeast Asia in 2004, we found that Norwegian children and adolescents with greater disaster exposure reported more symptoms of PTSD, and that this effect was stronger for youth whose parents were also distressed. However, less attention has been paid to associations between disaster events and children’s physical health and pain. Yet, studies suggest that pain is a common problem reported by individuals with PTSD, regardless of the type of traumatic event experienced. Here we report on our studies of Norwegian youth exposed to violence and sexual abuse. In our own studies of 16,000 adolescents, 6.1% of the girls and 1.6% of the boys in 10th grade reported being sexually abused the past year. Sexually abused youth reported significantly more pain (headache, back/neck pain, stomach pain) than non-abused peers. Moreover, the trauma-exposed youth reported using more pain killers and tranquillizers, suggesting that not only pain but also distress may trigger medication use. These findings suggest several avenues for further research on children postdisaster, and have implications for postdisaster intervention efforts.
Keywords: Children's health, Pain, Medication
CORRESPONDING AUTHOR: Dyb Grete, University of Oslo, Oslo; grete.dyb@nkvts.unirand.no
S233
IMPACTS OF TECHNOLOGICAL DISASTERS OF PHYSICAL AND BEHVIORAL HEALTH: LESSONS FROM THE EXXON VALDEZ OIL SPILL
Palinkas L.
University of Southern California, School of Social Work, Los Angeles, USA
This presentation introduces a conceptual framework for understanding the physical and behavioral health impacts of technological disasters based on the experience of the Exxon Valdez oil spill in 1989. Research conducted in the aftermath of that event documented significant associations between exposure to the oil and subsequent cleanup efforts and increased rates of generalized anxiety disorder, posttraumatic stress disorder, and depressive disorder; reports of alcohol and drug abuse and domestic violence; and use of mental health services. Spill cleanup workers, Alaska Natives, and families and children were especially vulnerable to these impacts. Adverse behavioral health outcomes were also found to be associated with patterns of spill-related social conflict, prolonged litigation over compensation for damages, cultural displacement, and reduced social support. However, exposure to the oil spill was also associated with significant increases in self-reports and physician-verified reports of heart disease, high blood pressure, diabetes, thyroid problem, cancer, asthma, ulcer, bronchitis, chronic cough and skin rashes. Cleanup workers were especially vulnerable to these physical health impacts. Drawing from the concept of corrosive communities and its relationship to theories of conservation of resources, cognitive activation, and risk and resilience, the conceptual model identifies three levels or tiers of impacts: biopsychosocial impacts that are direct consequences of the contamination of the physical environment; interpersonal impacts that are direct consequences of the biopsychosocial impacts; and physical and behavioral health impacts that are consequences of both the biopsychosocial and the interpersonal impacts. The conceptual framework may be used to anticipate and plan for long-term physical health impacts of other technological disasters, including the Deepwater Horizon oil spill in the Gulf of Mexico and the nuclear power plant disaster in Fukushima, Japan.
Keywords: disasters, stress, behavioral health, physical health
Corresponding author: Palinkas Lawrence, Univ. of Southern California; palinkas@usc.edu
Behavioral and Psychosocial Processes in CVD
O234
PSYCHOLOGICAL RESOURCES PROTECTS AGAINST MYOCARDIAL INFARCTION
Lundgren O.1, Garvin P.2, Kristenson M. 2
1 Linköping University, Department of Public Health and Community Medicine, Linköping, Sweden
2 Linköping University, Department of Public Health and Caring Sciences, Linköping, Sweden
Background: A large body of scientific data has revealed a clear association between psychological factors and the risk for ischemic heart disease. The vast majority of these studies have been focused on psychological risk factors, such as depression, anxiety, hostility and perceived stress. Surprisingly little interest has been offered to the other side of the coin; if psychological resources constitutes protection against ischemic heart disease. In large cross-sectional studies, a significant protective effect has been revealed (e.g. in INTERHEART), but there are only a handful of prospective studies with conflicting results.
Material & Methods: At baseline, data for traditional cardiovascular risk factors and questionnaire data for psychological resources and risk factors were obtained from a normal population of 1007 men and women, aged 45-69 years. Psychological resources were measured with the questionnaires Self-Esteem, Mastery, Sense of Coherence and Perceived Control. Psychological risk factors were Depression, Cynicism, Hostility, Hopelessness and Vital Exhaustion. At a six-year follow up, data of incidence or death in myocardial infarction, as well as interventions for instable angina pectoris, ware obtained from a registry from the Swedish ministry of health care.
Results: After adjusting for effects from lifestyle (smoking, diet, alcohol and physical activity) and known risk factors (age, sex, BMI, blood pressure, lipid levels), our analyses showed an independent protective effect of Self-Esteem (OR/SD in scale sum; 0.91, p = 0.007), Mastery (OR: 0.85, p = 0.001), Sense of Coherence (OR = 0.97, p = 0.04) on the risk of incidence in myocardial infarction. As expected, the psychological risk factors constituted a significant increase in disease risk.
Discussion: This is one of the first prospective studies to show that psychological resources have independent protective effects on the risk of myocardial infarction incidence. This knowledge is of importance for primary, as well as secondary preventive efforts in health care. It might also be informative for national and global public health initiatives.
Keywords: Coping Coronary artery disease
CORRESPONDING AUTHOR: Kristenson Margareta, Linköping University; Sweden; margareta.kristenson@liu.se
O235
EFFECTS OF DEPRESSION AND LOW PERCEIVED SOCIAL SUPPORT ON MEDICATION ADHERENCE AFTER ACUTE MYOCARDIAL INFARCTION
Freedland K E.1, Burg MM.2, Chait S.3, Steinmeyer BC.1
1 Washington University School of Medicine, Department of Psychiatry, St. Louis, USA
2 Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, USA
3 VA Boston Healthcare System, -, Boston, USA
Background: Nonadherence to cardiac medications and antidepressants may help to explain how depression and low perceived social support (LPSS) increase the risk of mortality after acute myocardial infarction (MI). We hypothesized that depression and LPSS during the first few weeks after an MI, and persistent depression and LPSS over the first 18 months after an MI, predict nonadherence to medications. Methods: Data on depression, LPSS, and self-reported adherence to aspirin, beta-blockers, calcium channel blockers, hypolipidemics, and antidepressants were collected at baseline (within one month of the index MI) and at 6- and 18-month follow-ups from 2,481 participants in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial. The Beck Depression Inventory (BDI) was used to assess depression, and the ENRICHD Social Support Instrument (ESSI) was used to assess LPSS. Multiple imputation was used to analyze incomplete data. A linear mixed model was fitted to examine the time-dependent effects of depression and LPSS on adherence during the follow-up period, adjusting for sociodemographic variables, the ENRICHD medical risk score, the number of medications prescribed at baseline, and the participant’s group assignment (treatment vs. control). Results: In the fully-adjusted model, the time-dependent (i.e., 6- and 18-month) BDI (β = -0.24, p < .001) and ESSI (β = 0.22, p < .01) scores predicted adherence. In contrast, the baseline BDI and ESSI scores were not predictive. Other significant predictors included the number of drugs prescribed (β = 0.80, p < .001) and Caucasian race (β = 3.30, p < .001). Discussion: These findings suggest that both persistent depression and persistent LPSS predict nonadherence to cardiac and antidepressant medications over the first 18 months after an acute myocardial infarction. Further research is needed to determine whether nonadherence mediates the effects of persistent depression and LPSS on post-MI morbidity and mortality.
Keywords: Adherence; Coronary heart disease; Depression; Social support
Corresponding author: Freedland Kenneth, Washington University, St. Louis; freedlak@bmc.wustl.edu
O236
A RANDOMIZED CONTROLLED TRIAL OF COGNITIVE BEHAVIOURAL THERAPY VERSUS STANDARD TREATMENT ON RECURRENT CARDIOVASCULAR EVENTS IN CORONARY HEART DISEASE PATIENTS
Gulliksson M.1, Burell G. 1, Vessby B.1, Lundin L.2, Toss H.2, Svärdsudd K.1
1 Uppsala University, Public Health and Clinical Medicine, Uppsala, Sweden
2 Uppsala University, Department of Medicine, Uppsala, Sweden
Background: Psychosocial factors are independently associated with increased risk of cardiovascular disease (CVD) morbidity and mortality, but the effects on CVD of psychosocial factor intervention is uncertain. We therefore performed a randomized controlled clinical trial of cognitive behavioural therapy (CBT) on CVD recurrence.
Methods: 362 women and men, aged 75 or less, discharged from hospital after a coronary heart disease (CHD) event within the past 12 months, were randomized to traditional care (reference group, n = 170) or to traditional care plus a CBT program (intervention group, n = 192), focused on stress management, with 20 two-hour sessions during one year, focusing on stress management. Median attendance to the CBT program was 85% per session. Outcome variables were all cause mortality, hospital admission for recurrent CVD, or recurrent acute myocardial infarction (AMI).
Results: During a mean 94 months of follow up the intervention group had 41% less fatal and non-fatal first recurrent CVD rate (HR 0.59, 95%CI 0.42-0.83, p = 0.003), 45% less recurrent AMI rate (HR 0.55, 95%CI 0.36-0.85, p = 0.007), and a non-significant 28% less all cause mortality (HR 0.72, 95%CI 0.40-1.30, p = 0.28) than the reference group after adjustment for other outcome affecting variables. In the CBT group there was a strong dose-response effect between intervention group attendance and outcome. During the first 2 years of follow-up there were no significant group differences in traditional risk factors.
Conclusions: The CBT intervention program decreased the risk of recurrent CVD and recurrent AMI. This may have implications for secondary preventive programs in CHD patients.
Keywords: cardiovascular disease, stress
CORRESPONDING AUTHOR: Burell Gunilla, Uppsala University, Uppsala; gunilla.burell@pubcare.uu.se
O237
COPING WITH CORONARY HEART DISEASE (CHD): THE BENEFICIAL EFFECT OF VIDEOTAPED INFORMATION ABOUT THE DISEASE ON ANXIETY LEVEL OF CHD PATIENTS
Ginting H.1, Näring G.2, Becker E S.2
1 Maranatha Christian University, Faculty of Psychology, Bandung, Indonesia
2 Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands
This study investigated the impact of information about heart disease on anxiety among patients with CHD. A group of 150 patients with CHD was randomly assigned to either a control group, or one of two experimental groups. The participants in the experimental groups watched a videotape containing comprehensive information about heart disease. Development of the intervention and scenario of the videotape were taken from the Myth and the Truth about heart disease (Furze, 2007). Participants in one experimental group additionally had an opportunity to ask questions to a general practitioner at the first viewing of the videotape. The participants in both of the experimental groups continued to watch the videotape at home for two weeks, once every two days. Before, right after the first viewing, and after two weeks, the participants completed the Heart Threat Related Word Stroop Task (HTRW Stroop), had their heart rate and their blood pressure measured and filled in the York Cardiac Beliefs Questionnaire (YCBQ) and the State Anxiety Inventory (STAI). Results indicated that right after watching the videotape with or without time for questions and after two weeks watching the videotape, the participants’ beliefs about heart disease were significantly more adaptive (p < .001 and p = .003) and their levels of anxiety were significantly lower (p = .021 and p = .01) than that of the control group. Furthermore, patients in the experimental groups had significantly lower heart rate (p = .004 and p = .033) and lower blood pressure (both systolic; p = .006 and p = .035 and diastolic; p = .007 and p = .009) than the control group after the intervention and their reaction time in HTRW Stroop was significantly faster (p = .003 and p = .01). This study provides strong evidence that delivering information about the disease to patients with CHD can lead the patients to adjust their beliefs about the disease and reduces the level of anxiety as is indicated by both explicit and implicit measures.
Keywords: coronary heart disease, information, videotape, beliefs, anxiety
CORRESPONDING AUTHOR: Ginting Henndy, Radboud University, Nijmegen; henndyg@yahoo.com
O238
CYCLING TO WORK AND SOCIAL CLASS: 30-YEAR RISK OF CORONARY HEART DISEASE AND ALL-CAUSE MORTALITY IN THE COPENHAGEN MALE STUDY
Mortensen OS.1, LaFontaine A.2, Gyntelberg F.1, Suadicani P.1
1 Bispebjerg Hospital, Department of Occupational Medicine, Copenhagen, Denmark
2 Georgia Health Sciences Hospital, Department of Family Medicine, Augusta, USA
Background: Cycling to work is very common in Denmark and more so among the lower social classes. The long-term health consequences of cycling to work are only sparsely studied. We examined the association of cycling to work on coronary heart disease- and all-cause mortality. We also examined if the association was equal in all social classes.
Methods: 30-year follow-up in the Copenhagen Male Study of 5,249 gainfully employed men aged 40-59 years. 274 men with cardiovascular disease at baseline and 59 men unable to ride a bike or with missing answers on the question on daily cycling were excluded, leaving 4,916 for the incidence study.
Information on daily amount of cycling and cycling to work was obtained from questionnaire items. Social class was measured according to Svalastoga and was modified into five classes (in analyses collapsed to high and low). Physical fitness (maximal oxygen consumption, VO2Max) was estimated using the Åstrand bicycle ergometer test, and information on death diagnoses was obtained from official national registers.
Results: In the 30-year follow-up period 580 men (11.8%) died from coronary heart disease and 2,644 (53.8%) died in total. Cox analyses adjusted for age, smoking, leisure time physical activity and physical fitness showed that there were only minor differences in total mortality between those who ride a bike to work and those who don’t HR 0.95 [0.87-1.03] and in coronary mortality HR 0.99[0.82-1.19]. However, when stratified on social classes there was a significant protective effect on all-cause mortality from cycling to work in the higher social classes HR 0.81 [0.70-0.94] but not in the lower social classes HR 1.04[0.93-1.15]. The same trends were found for coronary mortality HR 0.84 in the higher social classes and HR 1.07 in the lower social classes without reaching statistical significance.
Conclusion: The strength of the association of cycling to work and mortality depended on social class with more benefit found in higher social classes. In the higher social classes cycling to work is a choice as part of a healthy lifestyle, in the low social class cycling to work may reflect necessity.
Keywords: coronary heart disease, social class, physical activity
CORRESPONDING AUTHOR: Mortensen Ole, Bispebjerg University Hospital; omor0001@bbh.regionh.dk
O239
LIFE ENGAGEMENT LIMITS THE PROGRESSION OF CORONARY CALCIUM IN MIDLIFE WOMEN
Janssen I.1, Powell L H.1, Matthews K A.2, Sutton-Tyrrell K.3, Jasielec M S.1, Hollenberg SM.4, Everson-Rose S A.5
1 Rush University Medical Center, Preventive Medicine, Chicago, USA
2 University of Pittsburgh, Psychiatry, Pittsburgh, USA
3 University of Pittsburgh, Epidemiology, Pittsburgh, USA
4 Cooper University Hospital, Cardiology, Camden, USA
5 University of Minnesota, Medicine, Minneapolis, USA
Background: Studies of protective psychosocial factors for women focus mainly on factors such as social support and optimism. Little attention has been directed toward the impact of life engagement on physical health.
Methods: To examine the link between life engagement and progression of coronary calcification (CAC) among women at midlife, psychosocial assessments and CT scans were compared as part of the Study of Women's Health Across the Nation (SWAN) Heart ancillary study conducted from 2001-2005 in Chicago, IL and Pittsburgh, PA. Data from 338 women (33% black, 67% white; mean age, 50.8 ± 2.8) years) with 2 assessments an average of 2.3 years apart were analyzed. Life engagement was assessed as the sum of the 6-item purpose of life scale with each item rated on a 5-point scale from 1 to 5 with higher values indicating more purpose. CAC was assessed via electron beam computed tomography; progression was defined as an increase in CAC of >10 Agatston units and analyzed using log-binomial relative risk (RR) regression.
Results: Life engagement was high (mean 25.0 ± 3.3). In a multivariable model adjusted for baseline calcium, age, time between CT scans, race, menopausal status, HT use, education, systolic blood pressure, BMI, HDL cholesterol, and statin use, life engagement significantly predicted CAC progression. Each 1-SD higher life engagement was associated with decreased relative risk of CAC progression [RR = 0.84 (95%CI = 0.75-0.95) p = .006]. The effect did not differ by race and was independent of depression and social support.
Conclusions: Life engagement may be a novel and independent protective factor for subclinical disease progression in midlife women. More attention to this protective factor is needed. Supported by NIH/DHHS (grants AG012505, AG012546, HL065581, HL065591, HL089862).
Keywords: coronary artery disease, longitudinal research, resilience
CORRESPONDING AUTHOR: Janssen Imke, Rush University MC, Chicago; imke_janssen@rush.edu
Stress Reducing Interventions in Medical Settings
O240
NEURAL CORRELATES OF TINNITUS ANNOYANCE AND ITS REDUCTION AFTER COGNITIVE-BEHAVIORAL TRAINING: RESULTS FROM AN EMOTIONAL STROOP TASK
Golm D.1, Schmidt-Samoa C.2, Dechent P.2, Kröner-Herwig B.1
1 University of Göttingen, Clinical Psychology and Psychotherapy, Göttingen, Germany
2 University Medicine , Department of Cognitive Neurology, Göttingen, Germany
Tinnitus describes the perception of sound in the absence of external noise. About 5% of the population is affected by chronic tinnitus. About 20% of the tinnitus afflicted individuals experience severe distress due to the phantom noise. Negative cognitive emotional evaluation of tinnitus and its assumed consequences are commonly believed to be a major factor determining tinnitus-related distress. Models of tinnitus distress and recently conducted research propose a fronto-parietal-cingulate network to be more active in highly distressed tinnitus patients. The aim of the study was to identify brain regions, which are more active in highly distressed tinnitus patients during the processing of tinnitus-related stimuli in comparison to low distressed tinnitus patients and healthy controls. We examined three groups of age and sex matched participants; highly distressed tinnitus patients (n = 16; mean age: 53.38; SD = 12.33), low distressed tinnitus patients (n = 16; mean age: 52.25; SD = 11.73) and healthy controls (n = 16; mean age: 52.75; SD = 9.40) by the means of functional magnetic resonance imaging (fMRI). The participants underwent fMRI while performing an emotional Stroop task, which consisted of colored tinnitus-related words and neutral words. The participants had to name the color of each presented word via button press on a four-button-response pad. A subgroup of the highly distressed tinnitus patients received a cognitive-behavioral training, which aimed to reduce tinnitus-related distress. Responders to the training and age and sex matched low distressed tinnitus patients underwent the emotional Stroop task for a second time. The final results will be presented.
Keywords: FMRI, Emotions, Stress
CORRESPONDING AUTHOR: Golm Dennis, University of Göttingen; dgolm@psych.uni-goettingen.de
O241
INTERNET-BASED COGNITIVE-BEHAVIOURAL TREATMENT OF CHRONIC TINNITUS
Weise C.1, Kleinstäuber M.2, Andersson G.3
1 University of Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany
2 University of Mainz, Department of Clinical Psychology and Psychotherapy, Mainz, Germany
3 Linköping University, Department of Behavioural Sciences, Linköping, Sweden
Objectives: Tinnitus is a considerable problem for about 2-4% of the adult population. Cognitive behavioural treatments (CBT) have been shown to be effective in reducing tinnitus distress, however, the availability of individual counselling is limited. Therefore Internet-based CBT-approaches (iCBT) have been developed and showed promising results. The aim of our study was to investigate the efficacy of an iCBT to reduce tinnitus distress.
Methods: 124 patients with distressing chronic tinnitus were randomly assigned to either an Internet-based CBT (n = 62) or an online discussion group (n = 62), both lasting for 10 weeks. The iCBT group works on a self-help program including different tools to improve tinnitus coping. Patients receive individual weekly e-mail feedback. In the online discussion group, patients discuss different topics related to tinnitus, however not to tinnitus coping. Primary and secondary outcome were assessed pre and post treatment and 6 months after the end of the treatment.
Results: Significant interactions (time x group) in favour of the iCBT were found. Medium to large between-group effect sizes (Hedges' g) support these findings. After the end of the treatment, patients of the iCBT group reported significantly reduced tinnitus distress (F(1,117) = 43.28, p < .001; g = .88), increased tinnitus acceptance (F(1,117) = 37.83, p < .001; g = .80) and fewer depressive symptoms (F(1,117) = 22.92, p < .001; g = .43). Results of patients participating in the online discussion group were also improved, however significantly less articulated than in the iCBT group. Follow-up results indicated the stability of the improvements over 6 months.
Conclusion: The guided iCBT was highly accepted and led to significant and long-term stable improvements in tinnitus distress and associated variables. The efficacy of the iCBT was superior to the efficacy of the discussion group. Due to the use of an Internet-based approach, the treatment was available for patients situated all over the country. Thus, implementing Internet-based treatments might partially compensate for the lack of face-to-face treatments to reduce tinnitus distress. Further research is needed to investigate which factors influence the efficacy of Internet-based treatments.
Keywords: e-health, CBT, chronic disease, treatment
CORRESPONDING AUTHOR: Weise Cornelia, Philipps-University, Marburg; weise@uni-marburg.de
O242
THE EFFECTS OF A MULTIDISCIPLINARY STRESS TREATMENT PROGRAMME TARGETING STRESS REDUCTION AND RETURN TO WORK. A RANDOMIZED, WAIT-LIST CONTROLLED TRIAL
Friebel L., Netterstrom B.
Bispebjerg Hospital, Department of Occupational and Environmental Medicine, Copenhagen, Denmark
Background: Increasing numbers of patients are being referred to the medical sector with stress symptoms, and the number of employees being on sick leave due to persistent stress symptoms has increased rapidly in the last two decades having high costs both for the individual and society. Hence, we find a need for evidence based stress treatment programmes in general medical practice.
The aim of this study was to evaluate the effect of a multidisciplinary stress treatment programme on reduction in symptom levels and return to work (RTW) rate.
Methods: General Practitioners within the capital region of Denmark were invited to refer patients with persistent work related stress symptoms to the project. Inclusion criteria were being employed and on sick leave. Exclusion criteria were major psychiatric or somatic disease or abuse. 238 patients were referred and a total of 198 were included in the project. Using a randomized wait list control design, the participants were randomized into three groups: intervention group (69 participants), treatment as usual (TAU) group (71 participants) or wait list control (WLC) group (58 participants).
The stress treatment programme consisted of: Nine one-hour sessions aiming at: 1. Identification of relevant stressors. 2. Changing the coping strategies of the participants. 3. Changing workload and tasks. 4. Workplace dialogue. Each participant also attended a Mindfulness meditation course (2 hours a week in 8 weeks).
Treatment in the intervention group and TAU group lasted approx. 3 months.
Self-reported data on psychological symptom levels (MDI and SCL-92) were obtained at baseline, and at 3, 6 (only WLC group), and 12 months follow-up. Data on RTW were obtained by the therapists/occupational physicians in charge of the treatment.
Results: Reductions in symptom levels were significantly larger in the intervention group and TAU group compared to the WLC group (P = 0.001). Regarding RTW, 67 % of the participants in the intervention group had returned to work/the labor market full time after three month. This was significantly higher than in the TAU (36%) and WLC group (22%) (P < 0.001).
Conclusion: The stress treatment programme shows significant effects on reductions in symptom levels and return to work rate compared to a wait-list control group.
Keywords: Stress, Treatment, Occupational health, Rehabilitation, Randomized controlled trial
CORRESPONDING AUTHOR: Friebel Lene, Bispebjerg Uni. Hospital, Cph; lene_friebel@hotmail.com
O243
THE EFFECTS OF A COMPLEX THERAPEUTIC SUGGESTION INTERVENTION IN THE PREPARATION FOR OPHTHALMIC SURGERY
Kekecs Z.1, Jakubovits E.1, Gombos K.2, Janecskó M.3, Varga K.1
1 Eotvos University, Faculty of Education and Psychology, Department of Affective Psychology, Budapest, Hungary
2 Saint János Hospital and North Buda Unified Hospitals, Department of Ophthalmology, Budapest, Hungary
3 Semmelweis University, Clinic for Anaesthesiology and Intensive Therapy, Budapest, Hungary
Interventions using therapeutic suggestions in the perioperative period are extensively discussed in the literature, however, most of the studies are conducted on surgical procedures involving general anaesthesia.
In our current study we investigate the effectiveness of a complex intervention containing suggestion and relaxation techniques on the wellbeing, anxiety, perioperative parameters and recovery of patients undergoing cataract surgery. In this ophthalmic operation only topical anaesthesia is used, the patients are awake and have to cooperate with the surgeon during the procedure.
This was a randomized controlled study involving 84 patients enlisted for cataract surgery. The intervention group listened to a sound recording with positive suggestions and relaxation techniques, the control group got the regular ophthalmological treatment only, with no sound recording.
Intervention group subjects had better subjective wellbeing (p = 0,019), were more calm and relaxed during the procedure (p = 0,029) and were more cooperative with the surgeon in the operating theatre (p = 0,004). Physiological measures like heart rate (p = 0,045) and blood pressure (p = 0,034) data support the subjective measure findings too. We also found that patients in the intervention group had better visual acuity at the first control visit (the day after the surgery) (p = 0,035).
These findings suggest that using therapeutic suggestion techniques during the preparation for cataract surgery provides valuable benefits for patients and surgeons alike.
Keywords: Surgery, Clinical application, Anxiety, Relaxation
CORRESPONDING AUTHOR: Kekecs Zoltán, ELTE, Budapest; kekecs.zoltan@gmail.com
O245
THE EFFECT OF A POSITIVE PSYCHOLOGY INTERVENTION ON EXPLICIT AND IMPLICIT AFFECT VARIABLES AND SOMATIC COMPLAINTS
Brosschot JF.1, Van der Togt SAM.2, Verkuil B.1
1 Leiden University, Psychology, Leiden, The Netherlands
2 Leiden University Medical Center, Psychology, Leiden, The Netherlands
Objectives: The present study was conducted to investigate if a positive psychology intervention would lead to enhanced happiness and diminished symptoms of depression. Our goal was to replicate the findings of Seligman, Steen, Park and Peterson (2005) that showed that the positive psychology intervention “Three Good Things” (a week long focusing on positive events) resulted in increased happiness and decreased depressive symptoms up to six months follow-up. We tried to extend these results in two ways: (1) by measuring perseverative cognition (PC) and subjective health complaints (SHC), (2) and by measuring implicit affective variables: implicit positive (I-PA) and negative affect (I-NA) and implicit happiness (I-Happiness). We hypothesized that the “Three Good Things” intervention would lead to higher happiness and lower depression (replication Seligman et al., 2005), lower PC and SHC. In addition we expected decreases in I-NA and increases in I-PA and I-Happiness. We used a control intervention that was more similar in structure and time window (focusing on impressive things) than Seligman et al.’s (2005) control condition (focusing on childhood events).
Methods: A convenience sample of 282 participants was randomly assigned to the experimental condition “Three Good Things” and the control condition “Three Impressive Things”. Measurements were done at five subsequent time points: baseline, immediate posttest, one week posttest, one month posttest and three months posttest. Manipulation checks were administered at all four follow-up time points. A repeated measures design with intervention (condition) as ‘between-subjects factor’ and measurement (time) as ‘within-subjects factor’ was used.
Results: Participants in the “Three Good Things” intervention showed no increased happiness or decreased depressive symptoms across time. We also failed to show that PC and SHC diminished. However, we did find proof that the “Three Good Things” intervention leads to significantly lower I-NA and higher I-PA and I-Happiness across time. Moreover, participants that carried on the interventions and/or kept thinking about it, had decreased subjective health complaints (SHC)
Conclusion: Summarizing, on the one hand we failed to replicate the findings of Seligman et al. (2005). On the other hand we extend previous studies by showing that a positive psychology intervention has impact on implicit mood variables and SHC. This finding is in line with the ‘extended perseverative cognition hypothesis’, which proposes the existence of unconscious negative emotions (stress) and its influence on health.
Keywords: positive psychology; subjective health complaints, implicit emotions
CORRESPONDING AUTHOR: Brosschot Jos, Leiden University, Leiden; brosschot@fsw.leidenuniv.nl
Decision Making and Ethics
O246
A QUALITATIVE EXPLORATION OF THE DECISION TO SCREEN FOR COLORECTAL CANCER BY FOBT
Turnbull D.1, Oster C.1, Flight I.2, Zajac I.2, Wilson C.3
1 University of Adelaide, School of Psychology, Adelaide, Australia
2 Commonwealth Scientific and Industrial Research Organisation, Colorectal Cancer and Gut Health, Preventative Health Research Flagship, Adelaide, Australia
3 Flinders University of South Australia, School of Medicine, Adelaide, Australia
Colorectal cancer is an ideal target for early detection and prevention through cancer screening. This presentation will report on the results of an Australian qualitative study exploring the decision-making of screeners and non-screeners, who were involved in a randomized controlled trial of a decision support system for colorectal cancer screening. Using a maximum variability sampling frame, we conducted 4 focus groups and 30 telephone interviews. The presentation will focus on why people who were offered the Faecal Occult Blood Test (FOBT) decided to screen or not to screen, and what influenced them to take action and complete the test. We identified the main reason for respondents deciding to screen for CRC as ‘wanting to know’ their CRC status. However, wanting to know was not a simple ‘either-or’ decision, but functioned on a continuum ranging from wanting to know, through varying degrees of ambivalence, to not wanting to know. The majority of respondents expressed ambivalence with regard to CRC screening, and the main cue to action was the opportunity to screen without being too inconvenienced. Implications of the findings for the provision of screening opportunities for at-risk populations will be discussed.
Keywords: Cancer screening; decision making
CORRESPONDING AUTHOR: Oster Candice, University of Adelaide, Adelaide; candice@kranium.com
O247
FACTORS INFLUENCING THE ADOPTION, IMPLEMENTATION, AND CONTINUATION OF PHYSICAL ACTIVITY INTERVENTIONS IN PRIMARY HEALTH CARE: A DELPHI STUDY
Huijg J. M.1, Gebhardt W. A.1, Crone M. R.2, Verheijden M. W.3, Van der Zouwe N.4, Middelkoop B. J. C.2
1 Leiden University, Clinical, Health and Neuropsychology, Leiden, The Netherlands
2 Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
3 TNO, -, Leiden, The Netherlands
4 Regional Public Health Service Hollands Midden, -, Leiden, The Netherlands
Introduction: For an effective introduction of efficacious physical activity (PA) interventions in primary health care (PHC), it is important to know which factors influence the three main stages (i.e., adoption, implementation, and continuation) of this process. The aim of this two-round Delphi study was to achieve consensus among a group of experts on the relevance (i.e., importance and changeability) of factors that may impact the introduction, as identified from a systematic literature review and a qualitative study.
Methods: In the first round, 44 experts completed an electronic questionnaire in which they scored each potential factor on their importance for each stage of the introduction process, and their changeability. In the second round, a questionnaire based on the first round results was sent to the experts, in which they were asked to indicate their top-10 of most important factors to the different stages and to re-rate the changeability of the factors.
Results: Results showed experts agreed on the importance of various determinants to a specific stage. The presence of a public health problem, support of health insurance companies, support for the intervention and presence of intervention champions within the organization, and professionals’ positive perception regarding PA, the intervention’s effectiveness, and its fit with the target group were important to the adoption stage. Professionals’ skills, knowledge and experience of intervention effectiveness were important to the implementation stage. The presence of a network between PHC and local resources for PA practice, the availability of a list of those resources, and the interventions’ prospects were important to the continuation stage. Factors were not always stage-specific, e.g., the interventions’ financial feasibility, coverage of intervention costs for patients, and time to deliver the intervention were identified as important to all three stages. The results further indicated a lack of consensus on the changeability of the factors.
Discussion: This study suggests general and stage-specific factors that could be taken into account when designing appropriate strategies to introduce PA interventions in PHC. This is worthy of further examination in longitudinal and experimental studies.
Keywords: Research to practice translation; Dissemination; Primary care; Physical activity; Intervention; Prevention
CORRESPONDING AUTHOR: Huijg Johanna, Leiden University; huijgjm@fsw.leidenuniv.nl
O248
HOW PATIENT-CENTRED AM I? THE EFFECT OF CLINICAL EXPERIENCE IN FEMALE MEDICAL AND NURSING STUDENTS
Grilo A. M.1, Santos MC. 1, Santos-Rita J.1, Gomes A. I.1, French M.2
1 Instituto Politécnico do Lisboa, Department of Human Science, Lisbon, Portugal
2 Faculty of Medicine, Pilsen, General Medicine, Prague, Czech Republic
The importance of patient-centred care has recently been more emphasized by health educators. There is enough evidence that patient-centred care leads to better health outcomes, such as adherence to health treatments, patient satisfaction and general health status. According to international studies, female health care professionals are more patient-centred than male professionals. There is no consensus about the effect of clinical experience on patient-centred orientation, during the under-graduate course. The present study aims at assessing the role orientations in female medical and nursing students, in Portugal, according to their pre-clinical and clinical experience.
Medical students (n = 410) and nursing students (n = 444)from Portuguese Public Medicine and Nursing Schools filled in the Patient-Practitioner Orientation Scale (PPOS), an instrument developed by Krupat et al. (2000) that measures the role orientations of the doctor-patient relationship, ranging from patient-centred, to doctor or disease-centred. The scale was translated to Portuguese by French (2008) and adapted for this study. Subjects also filled in two six-point Likert scales, focused on the students’ view of their competence in clinical and communication situations. To compare medical students and nursing students, we considered two subgroups: pre-clinical and clinical clerkship.
The total PPOS score was significantly different (p < 0.001) among medical and nursing students. The pre-clinical and clinical clerkship medical students scored lower than the nursing students. Perception on the communication competence is very high (mean > 4) in pre-clinical groups. Only in nursing students, the total PPOS score and the perception on the communication competence increase with clinical experience.
In spite of the international movement toward communication as a core clinical skill, the culture of healthcare and the curricula of Portuguese traditional Medical Schools neglect patient-centred attitudes, which attempts to share information and respect for the totally and individuality of the patients.
Keywords: gender, population health
CORRESPONDING AUTHOR: Grilo Ana, Instituto Politecnico, Lisbon; ana.grilo@estesl.ipl.pt
O249
UNDERSTANDING PREFERENCES FOR PRE-BIRTH TESTING FOR GENETIC CONDITIONS USING A DISCRETE CHOICE METHODOLOGY
Brown M.
University of California, Public Health, Merced, USA
Discrete choice experiments (DCEs) are an increasing popular way of identifying the factors that people take into consideration when making decisions about their health or health care, and the relative importance of each factor. This study uses DCEs to examine the preferences for pre-birth testing for genetic conditions. 205 participants completed a DCE asking whether they or their partner would be willing to have a pre-birth genetic test. Based on extensive initial consultations, the factors identified as important for decision making included the type of condition being tested (e.g., diabetes), the likelihood of the condition being expressed (penetrance) and the age of expression, the cost of the test, and the conditions of the test (wait till results, pain and distance to the test site). The results indicating that people show greater interest and willingness to pay for genetic tests for positive traits, lower waiting times, less pain, and increased penetrance of the tests, with WTP estimates the lowest when there is pain involved with the tests and highest for positive traits with high penetrance. The results from this analysis help identify the factors important to people when considering genetic tests. In addition, the study also illustrates how DCEs can identify the relative importance of each of the aspects. The discussion highlights the usefulness and challenges with using DCEs for health research.
Keywords: genetics, economics
CORRESPONDING AUTHOR: Brown Paul, UC Merced, CA; pbrown3@ucmerced.edu
O250
PERCEPTIONS OF HEALTH CARE PROFESSIONALS REGARDING HEALTH CARE STANDARDS: THE CASE OF DIABETES TYPE 2 IN THE NETHERLANDS
Raaijmakers LGM.1, Bagchus C.2, Martens MK.2, De Vries NK.3, Kremers SPJ.1
1 Maastricht University Medical Centre, Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands
2 ResCon, Research & Consultancy, Amsterdam, The Netherlands
3 Maastricht University Medical Centre, Caphri, School for Primary Care and Public Health, Maastricht, The Netherlands
Objective: The main aim of this study was to obtain insight in the perceptions of health care professionals regarding the Netherlands Diabetes Federation Health Care Standard (HCS) for type diabetes and the hindering factors that play a role.
Methods: A cross-sectional questionnaire study was conducted among health care professionals (N = 1547) between June and November 2010.
Results: Of the health care professionals (N = 1302) 39.2% was in possession of the health care standard for type 2 diabetes, while 17% was unfamiliar with the HCS. Only 13.8% of the professionals that were somehow familiar with the HCS perceived themselves as working completely in accordance with the HCS. Professionals perceived the guidelines from their own professional group more as the norm for high quality diabetes care than they perceived the HCS to be the norm (mean = 4.0 SD 0.5; mean = 2.9 SD 1.3). The majority (72.8%) thought the HCS contributes to a large extent to insuring the quality of care and the feasibility of working in accordance with the HCS was judged considerably positive (mean = 3.9 SD 0.7).
We identified several differences in appreciation of the HCS between health care professionals. General practitioners most often perceived themselves as working in accordance with the HCS, while internists worked relatively less in accordance with the HCS. Diabetes nurses perceived the HCS less as the norm for high quality diabetes care compared to GP’s and internists. GP’s were more positive about the feasibility of working in accordance with the HCS in comparison to diabetes nurses and internists. Internists were the least positive about the contribution of the HCS to insuring quality of care.
The most important hindering factor professionals perceived was the lack of (access to) effective lifestyle interventions to guide people with (a higher risk of) diabetes.
Discussion: Professionals should be further educated about the content of the HCS and especially its additional value to the guidelines of the own professional group. In order to deal with the main perceived barrier, the familiarity with and access to lifestyle programs should be increased since programs that meet the conditions for cost-effective lifestyle programs are developed in the Netherlands and implemented in several pilot locations in primary care. Furthermore effectiveness and implementation trials are needed to ensure the quality of these programs.
Keywords: Diabetes, adherence
CORRESPONDING AUTHOR: Raaijmakers Lieke, Maastricht University Maastricht; lieke.raaijmakers@maastrichtuniversity.nl
O251
ETHICAL REFLECTIONS ON THE CURRENT AMERICAN HEALTH CARE REFORM
Solyom A. E.
Centra Health, Department of Psychiatry, Lynchburg VA, USA
For more than 60 years, the USA has stood alone among developed nations in failing to provide universal health care for her citizens – except for those who became eligible for the government provided Medicaid, Medicare and Veterans Administration services over the past 40 years. In all, Congress has been responsible for inexcusable deaths, chronic diseases, disabilities and suffering of millions by acting as if the right of insurance companies to profiteer from people's diseases and disabilities was more important than the right of people to health care. The medical profession also shares the responsibility by failing to confront the fundamental moral problem of unrealized rights and unattained justice.
The new law (PPACA and HCERA, 2010) extends health insurance to 95 percent of the population, increases patient safety, establishes coordinated patient centered care with payment for quality, supports primary and rural health care providers, expands community health centers and promotes preventive and public health services. It also provides multiple opportunities and challenges for the creative contributions by physicians in the implementation of its many parts, such as reducing wasteful redundant and unnecessary services by integrated patient care.
The law reduces the moral plight of millions lacking health insurance and improves patient safety and quality of care. Yet, it is ethically inadequate due to political and business constraints: 1. it still leaves about 15 million people (5 percent) without health insurance, 2. it allows the profiteering by insurance companies from people’s diseases and disabilities, i.e., it continues to view health care as a commodity not as a right.
The reform law represents an opportunity for a more just and higher quality health care system, but that cannot materialize without the moral and professional commitment and leadership of physicians, who have to affirm that: 1. the practice of medicine is a moral activity, 2. adequate physical and mental health is a prerequisite to basic human rights, 3. health care is not a commodity but a basic right, and should be provided to individuals and society by a non-for-profit system with equal access to quality services for everybody, 4. people’s health care needs are relative and flexible, and fair distribution of services includes appropriate variations, 5. care for people’s health entails reciprocity between individuals and society, i.e., the promotion of healthy lifestyle and the adherence to it by individuals and families are part of health care.
Keywords: Ethical issues, Health policy
CORRESPONDING AUTHOR: Solyom Antal, Lynchburg, VA, USA; aesolyom@ntelos.net
Psychosocial Interventions in Cancer: Strategies for Cancer Prevention and Control
S252
PRELIMINARY OUTCOMES OF A RANDOMIZED CONTROLLED TRIAL TO INFORM MATERNAL DECISIONS ABOUT COMMUNICATING CANCER GENETIC TEST RESULTS TO CHILDREN
Tercyak K.1, Patenaude A.2
1 Georgetown University, Department of Oncology, Washington, USA
2 Dana-Farber Cancer Institute, Department of Pediatric Oncology, Boston, USA
Genetic counseling and testing for BRCA1/2 mutations is a well-established part of the identification and management of hereditary breast/ovarian cancer risk. Thus, increasing numbers of women are confronting complex decisions about whether and how to communicate cancer risk information to their potentially at-risk relatives, including their minor-age children. To date, little research has been conducted on ways to support parental decisions about communicating cancer risk information to the family. In light of this, we developed a decision-support intervention and conducted a multisite randomized controlled trial to assess the impact of our decision support intervention on maternal disclosure of BRCA1/2 test results to children and related outcomes. Following pre-test genetic counseling, 100 mothers (M age = 44) completed a baseline telephone survey and were randomized to either a decision support intervention (DSI) or standard care (SC) group. Before receipt of their cancer genetic test results, mothers in the DSI group self-paced through a multistep decision guide based on the Ottawa Decision Support Framework, while mothers in the SC group accessed an educational booklet. An outcome survey was re-administered 1-month following post-test genetic counseling, and included child communication and intervention satisfaction assessments. The overall prevalence of disclosure of maternal cancer genetic test results to children (M age = 12) was 62%. Child disclosure was significantly higher in the DSI group (73%) vs. SC group (52%), X2 (1) = 4.67, p = .03. After adjusting for the effects of child age and maternal BRCA1/2 status, mothers in the DSI group remained more likely to communicate to children than those in SC, OR = 2.75, 95% CI = 1.01, 7.47: intervention satisfaction was significantly higher among DSI vs. SC mothers, t = 2.43, p = 0.02. Our results suggest that theory-based, self-paced decision support increases communication among mothers and their children about hereditary breast/ovarian cancer risk and is associated with greater satisfaction. We will discuss the implications of these findings for promoting and maintaining child and family health in the era of personalized medicine for the prevention and treatment of adult-onset cancer. We will also discuss the implications of our research for children's psychosocial quality of life and well-being in the context of identifying and managing familial cancer risks through clinical and population-based approaches.
Keywords: Decision making, Genetics, Children, Family
CORRESPONDING AUTHOR: Tercyak Kenneth, Georgetown University, Washington; tercyakk@georgetown.edu
O253
ASSESSING THE EFFICACY OF A WEB-BASED PERSONALISED DECISION SUPPORT TOOL FOR IMPROVING PARTICIPATION IN COLORECTAL CANCER SCREENING USING FAECAL OCCULT BLOOD TEST
Zajac I.1, Wilson C.2, Flight I.1, Turnbull D.3, Young G.2, Cole S.2, Gregory T.3
1 Commonwealth Scientific and Industrial Research Organisation, Preventative Health, Adelaide, Australia
2 Flinders University of South Australia, School of Medicine, Adelaide, Australia
3 The University of Adelaide, School of Psychology, Adelaide, Australia
Objective: Colorectal cancer (CRC) is a major public health problem in Australia. It is the second leading cause of cancer-related death and the most frequently diagnosed internal cancer. Despite the significant impact of this disease, population screening uptake using faecal occult blood test (FOBT) remains sub optimal. Therefore, this study explored the effectiveness of a web-based Personalised Decision Support (PDS) tool in terms of improving participation in this important preventive health behaviour.
Methods: Three-thousand four-hundred and eight (3,408) participants were recruited into this randomised controlled trial (RCT) and assigned to one of three trial conditions: Tailored PDS; Non-Tailored PDS; or Control (paper-based). Participants were asked to visit the web-based PDS tool to complete a questionnaire or complete a paper-based questionnaire in accordance with the condition they had been assigned to. The questionnaire addressed factors relating to FOBT participation, based on the Preventive Health Model. Those in the Tailored PDS condition received feedback tailored to their responses and stage of decision to screen. Participants who visited the PDS tool or who returned a completed paper-based questionnaire subsequently received an invitation to screen via FOBT that was consistent with Australia’s National Bowel Cancer Screening Program. This invitation was accompanied by either paper-based bowel cancer information (Control group only), or access to online information via the PDS.
Results: Analysis at the conclusion of the RCT revealed a statistically significant difference in participation between the three trial conditions [χ2 (2) = 14.93, p < .001]. FOBT participation rates were 78%, 84.8% and 84.1% for Control, Non-tailored and Tailored conditions, respectively.
Conclusion: Web-based Personalised Decision Support appears to have a positive impact on FOBT participation rates in Australia. However, there was no apparent additional effect of tailoring the content delivered to users based on our studies results as FOBT participation was essentially equal across PDS conditions. Tailoring is complex and costly and may not be necessary if the aim is simply to improve participation in a once-off screening invitation.
Keywords: Cancer Screening, Prevention
CORRESPONDING AUTHOR: Zajac Ian, CSIRO; ian.zajac@csiro.au
O254
CLINICAL SKIN EXAMINATION FOR THE EARLY DETECTION OF MELANOMA IN MEN 50 YEARS OR OLDER: RESULTS FROM A PROSPECTIVE RANDOMISED TRIAL
Janda M.1, Youl P.2, Baade P.2, Neale R.3
1 Queensland University of Technology, School of Public Health, Brisbane, Australia
2 Cancer Council Queensland, Brisbane, Australia
3 Queensland Institute of Medical Research, Brisbane, Australia
Aim: Men 50 years of older are at high risk to develop thick melanomas and die from melanoma. Using data from a randomised trial of a behavioural intervention (n = 930), we assessed baseline clinical, attitudinal and behavioural factors associated with visiting a doctor for a clinical skin examination (CSE).
Methods: A video-based intervention was designed (n = 469) and compared to brochures-only control (n = 461) to increase whole-body CSE in Queensland, Australia. The effects of baseline clinical factors (such as number of moles), attitudes, including perceived risk of developing skin cancer, and baseline behaviours including attending health checks in general, self- and clinical skin examination practices were explored in relation to likelihood of having at least one CSE during the 13-month study follow-up period using uni- and multivariable logistic regression analyses.
Results: Overall, 64% of men reported having had a CSE during the study follow-up period. Multivariable analysis showed that patients who were concerned about a spot or mole at baseline, or strongly agreed with seeing their doctor if they found anything suspicious on their skin were more willing to see a doctor for CSE. Baseline behaviours such as regularly visiting their doctor for health checks, having checked their own skin in the past 6 months and having their doctor ever deliberately check any part of their body for early signs of skin cancer also increased likelihood of a CSE. Baseline clinical factors such as having some or many moles, or having had a skin spot or mole removed in the past also increased willingness to have a CSE. Receiving the video-delivered intervention appeared to be more effective than receiving the control intervention in increasing uptake of CSE at the 7-month follow-up visit, but not the 13 months visit.
Conclusion: Our findings indicate that in addition to clinical factors such as previous removal of skin lesions and number of moles, men’s perceived risk of skin cancer, willingness to see a doctor for general health checks, and previous treatments for skin spots, were associated with uptake of CSE. Doctors’ visits for general health checks present an opportunity to discuss skin health with patients, especially those at high risk of melanoma.
Keywords: Screening, cancer, sun safety, behavior change, population health
CORRESPONDING AUTHOR: Janda Monika, QUT, Brisbane; m.janda@qut.edu.au
O255
MEDIATORS OF MINDFULNESS-BASED STRESS REDUCTION (MBSR) IN CANCER PATIENTS: ASSESSING THE TIMING AND SEQUENCE OF CHANGE
Labelle L.1, Campbell T.1, Carlson L. 2
1 University of Calgary, Psychology, Calgary, AB, Canada
2 University of Calgary, Department of Oncology, Calgary, AB, Canada
Objective: This longitudinal waitlist controlled study of MBSR explored the timing of MBSR-related changes in mindfulness, emotion regulation, and psychological outcome variables (symptoms of stress and mood disturbance), in cancer patients. The study also assessed temporal precedence of change in putative mediator variables, consistent with current models of the mechanisms of MBSR.
Methods: Patients were recruited from the MBSR program waitlist and were either registered for immediate participation (n = 135), or were waiting for the next program (n = 76). Participants completed questionnaires pre-, mid- and post-MBSR or waiting period. Piecewise hierarchical linear modeling was employed to assess changes over time as a function of condition (MBSR vs. waitlist) within the first and second halves of the intervention. Cross-lagged correlations and linear regression analyses were conducted to test for a group difference in the prediction of (1) later emotion regulation and outcome variable change from earlier mindfulness change, and (2) later outcome variable change from earlier emotion regulation change.
Results: An effect of MBSR on present-focused attention/awareness and nonjudgmental acceptance emerged early in the program (t = 4.22, p < .001; t = 2.47, p < .05). Negative perseverative thinking (rumination and worry) also changed early (t = -2.16, p < .05; t = -3.00, p < .01). The tendency to label emotions, act with present-focused awareness and nonreactivity developed later (t = 3.22, p < .01; t = 3.21, p < .01; t = 3.46, p < .01), as did changes in experiential avoidance (t = -2.80, p < .01), symptoms of stress (t = -3.63, p < .01) and mood disturbance (t = -2.25, p < .05). Early increases in nonjudgmental awareness correlated with subsequent decreases in worry (r = -.26, p < .05); this correlation was stronger in the MBSR group (t = -2.81, p < .01). However, early changes in rumination and worry also correlated with later changes in mindfulness, suggesting bi-directional relationships.
Conclusions: This is the first controlled study to examine the timing of changes during MBSR. Evidence that early increases in mindfulness lead to improved psychological functioning was weak. More detailed analyses of MBSR-related change will strengthen conclusions that can be drawn regarding mechanisms of MBSR.
Keywords: Mindfulness-based Stress Reduction; cancer
Corresponding author: Carlson Linda, University of Calgary, Calgary; lcarlso@ucalgary.ca
O256
SIDE BY SIDE: A COUPLES-BASED SKILLS INTERVENTION FOR BREAST CANCER PATIENTS
Zimmermann T.1, Heinrichs N.2
1 University of Braunschweig, Institute of Psychology, Braunschweig, Germany
2 University of Bielefeld, Institute for Psychology, Bielefeld, Germany
The cancer diagnosis is a stressful event that poses formidable and enduring challenges, not just to the women themselves, but also to their intimate partners. A conjoint process of mutual support has been suggested to be an effective coping strategy for patients who are married or in committed relationships. There are few interventions for couples facing cancer, although both partners maybe affected by the disease of one partner. The primary aim of this study was to gather data on the potential benefits of a brief psychological intervention (“Side by Side”) designed to assist women and their partners to cope with breast cancer.
Ninety couples were randomly assigned to either the couples’ component (“Side by Side”), or an information component containing the same educational materials, but no relationship focus. In addition to pre, post, 6 month follow-up and 12 month follow-up self-report measures, observational data on mutual supportive behavior when communicating about a cancer-related topic were collected.
Multi-level analyses suggest that females receiving Side by Side showed larger reductions in cancer-related distress and fear of progression post-intervention compared to women in control group. Furthermore, couples in the Side by Side intervention showed less avoidance in dealing with the cancer, more posttraumatic growth, and better communication skills and dyadic coping relative to the control group. Short-term changes in cancer-related functioning may be improved by enhancing couples’ dyadic coping skills during acute medical treatment of the disease. The findings highlighted the importance of helping both, the woman and her partner, to effectively cope with cancer in a couple’s context.
Keywords: cancer, couple-focused
CORRESPONDING AUTHOR: Zimmermann Tanja, University of Braunschweig; t.zimmermann@tu-bs.de
O257
COGNITIVE-BEHAVIORAL STRESS MANAGEMENT DECREASES NEGATIVE AFFECT AND ALTERS LEUKOCYTE TRANSCRIPTIONAL DYNAMICS IN WOMEN TREATED FOR BREAST CANCER
Antoni M.1, Lutgendorf S.2, Blomberg B.3, Carver C.1, Lechner S.4, Arevalo J.5, Cole S.5
1 University of Miami, Department of Psychology, Coral Gables, USA
2 University of Iowa, Department of Psychology, Iowa City, USA
3 University of Miami, Department of Microbiology and Immunology, Miami, USA
4 University of Miami, Department of Psychiatry, Miami, USA
5 UCLA, Department of Medicine, Los Angeles, USA
Background: Negative affect states are associated with pro-inflammatory transcriptional profiles in circulating leukocytes, and it follows that psychosocial interventions that decrease negative affect may alter leukocyte gene expression associated with inflammation. Such interventions may be particularly relevant in the context of cancer treatment, since inflammation may delay recovery and promote disease progression. This study tested whether a group-based Cognitive-Behavioral Stress Management (CBSM) intervention targeting negative affect and cognition might modulate distress-related transcriptional alterations in women undergoing treatment for non-metastatic breast cancer.
Methods: Women (N = 79) undergoing primary treatment of Stage 0-III breast cancer were randomized to a 10-week CBSM protocol (N = 45) or an active control condition (N = 34) completed the Affect Balance Scale (ABS) and provided peripheral blood leukocyte samples for genome-wide transcriptional profiling and bioinformatic analyses at baseline, 6-, and 12-month follow-ups.
Results: Mixed Model group X time analyses controlling for patient age, race, disease stage, hormone receptor status, and treatment, tested whether changes over time (from baseline to 6 mo to 12 month follow-up) are significantly different in women assigned to CBSM vs controls. Women assigned to CBSM showed increased ABS positive affect (p < .01), decreased negative affect (p < .001), and increased composite positive-negative affect balance scores (p < .0001), whereas controls showed negligible change over time on each dimension. We found 62 transcripts showed significantly greater than 50% down-regulation of genes associated with inflammation over time in CBSM-treated patients relative to controls, including genes encoding pro-inflammatory cytokines (IL1a, IL1b, IL6), the prostaglandin-synthesis enzyme COX2 (PTGS2), and inflammatory chemokines and their receptors (CCL2, CCL3, CCL3L1, CCL3L3, CCL4L1, CCL4L2, CCL7, CXCL1, CXCL2, CXCR7). We also found greater down-regulation of genes associated with cancer promotion in CBSM vs controls including those involved in tissue remodeling and epithelial-mesenchymal transition (G0S2, LMNA, MMP9, OSM). By the 12-month follow-up women assigned to CBSM continued to show only about half the gene expression for many inflammation genes and cancer promotion genes compared to controls. Gene Ontology analyses confirmed that CBSM down-regulated genes were characterized by involvement in pro-inflammatory cytokine activity (GO:0006954;GO:0005125; both p < .0001) and wound healing (GO:0009611; p < .0001). RT-PCR analysis confirmed microarray-indicated group differences in the relative abundance of 12 of 12 transcripts audited (all p’s < .0001). Promoter-based bioinformatic analyses implicated decreased activity of NF-kB/Rel and GATA family transcription factors and increased glucocorticoid receptor activity as potential mediators of CBSM-induced transcriptional alterations.
Conclusion: A 10-week group-based CBSM intervention can reduce negative affect, and increase positive affect in parallel with altering the profile of leukocyte gene expression in ways that may facilitate better recovery from treatment for breast cancer. Women assigned to CBSM showed less gene expression for inflammation and cancer-promoting cell-signaling which together might relate to hastened recovery from treatment and could influence longer-term outcomes. Since prior work has shown that these forms of psychosocial intervention are associated with increased survival and reduced disease recurrence over the subsequent decade in breast cancer patients, the present work may provide insights into how these interventions facilitate recovery in the first year after surgery, which may influence the trajectory of disease over the future.
Keywords: threat/anxiety, cognitive-behavioral stress management, gene expression, immune system, inflammation, cancer, stress
CORRESPONDING AUTHOR: Antoni Michael, University of Miami; mantoni@miami.edu
Conflict of Interest: Dr. Antoni reports receiving publication royalties from a book and related training materials that he has authored on CBSM treatments in health psychology.
Neuromodulation of health and disease
S258
NEUROMODULATION OF HEALTH AND DISEASE
Gidron Y.1, Hall P.2
1 VUB, Department of Medicine, Brussels, Belgium
2 University of Waterloo, Department of Applied Psychology, Salomons, Waterloo, Canada
The relevance of brain-immune communication for diseases has received little scientific consideration. This symposium will address neuromodulation of health and diseases. Ohira will present work on brain regions (OFC, DLPFC) which respond to peripheral immune changes (NK cells) during stress. Furthermore, he will present findings showing in people low on vagal nerve activity (indexed by heart-rate variability – HRV), that peripheral NK cell changes during stress correlate with brain stem activity, while in people high on HRV, ‘higher’ CNS levels (cingulate, medial prefrontal cortex) were associated with NK-cell changes. Thus, the vagus may influence recruitment of basic versus executive brain resources for immune-modulation during stress. Hall’s team will present studies on effects of executive control resources (ECR) on dietary behavior. The first talk will present results of an observational study where tests of ECR inversely predicted rates of fatty-food consumption, independent of confounders. The second talk will present findings of an experimental study testing the effects of brain stimulation of the left dorsolateral prefrontal cortex, to enhance ECR, on dietary behavior. This may be the first study testing causal relations between ECR and fatty food consumption in people. Gidron’s team will then present two studies on neuromodulation of diseases. First, the relation between hemispheric lateralization (HL) and onset of colds was tested in Argentinian students. Results revealed that only a factor named “strategic planning” (reflecting left-HL functions) significantly predicted reduced risk of colds, independent of confounders (e.g., gender, vaccination, health behavior, neuroticism). The second talk will present studies on vagal nerve activity (HRV) and prognosis in cancer. Results show that HRV significantly inversely predicts the tumor marker PSA in prostate cancer, and significantly positively predicts survival time in pancreatic cancer, independent of confounders. HRV also moderated effects of tumor stage on three tumor markers, supporting a hypothesized protective role of this nerve in cancer. Finally, effects of two non-invasive methods to activate vagal activity were tested, and only HRV-biofeedback, but not transcutaneous vagal nerve stimulation, increased HRV. Together, these studies advance our knowledge of neuromodulation of health and disease.
Keywords: Psychoneuroimmunology, Neuroregulation, Cancer, obesity, Immune function
CORRESPONDING AUTHOR: Gidron Yori, Free Univ. of Brussels (VUB); yori.gidron@vub.ac.be
S259
BRAIN FUNCTIONS REGULATING REDISTRIBUTION OF NATURAL KILLER CELLS ACCOMPANYING APPRAISALS OF STRESSORS
Ohira H.
Nagoya University, Department of Psychology, Nagoya, Japan
Psychological acute stress increases numbers of natural killer (NK) cells, which plays a critical role in innate immunity, in peripheral circulation within several minutes. This phenomenon is called redistribution of NK cells and has been thought to reflect facilitation of preventive defense in acute stress situations. The redistribution of NK cells is not a stereotyped response but is sensitive to psychological characteristics of stressors, thus is thought under control by the brain. We have explored neural mechanisms of such top-down regulation of NK cell distribution by the brain using simultaneous measurement of brain activity by positron emission tomography (PET) and numbers of NK cells in blood during cognitive acute stress tasks.
An uncontrollable stressor manipulated in a mental arithmetic task with significantly reduced redistribution of NK cells, compared to a controllable stressor. PET revealed that activation in the orbitofrontal cortex (OFC) and dorsolateral cortex (DLPFC) correlated with changes of numbers of NK cells, suggesting that these brain regions which are involved in cognitive appraisal of stressor controllability can regulate the redistribution of NK cells. The numbers of NK cells decreased gradually as participants acquired adaptive strategies in a stochastic learning task (habituation), however, the number of NK cells turned to increase when the contingency between options and outcomes changed (re-mobilization). Again, activation in the OFC and DLPFC, as well as the dorsal striatum showed correlation with the number of NK cells.
Some psychological and biological factors modulate such relationships between brain activity and NK cells. Participants with high chronic stress showed blunted brain activity in the OFC, DLPFC, and striatum in the learning task, and additionally showed lack of correlations between activation in such brain regions and NK cells. Furthermore participants with lower vagal tone thus lower regulating ability reflected by lower heart rate variability also showed similar pattern with participants with high chronic stress; blunted activation in the brain and lack of brain-NK cells association. Dysfunction of the top-down regulation of NK cells by the brain might be a risk factor of several illnesses.
Keywords: Neuroregulation, immune function
CORRESPONDING AUTHOR: Ohira Hideki, Nagoya University; ohira@lit.nagoya-u.ac.jp
S260
EXECUTIVE CONTROL RESOURCES AND FREQUENCY OF FATTY FOOD CONSUMPTION
Hall P.
University of Waterloo, Public Health, Waterloo, Canada
Contemporary models of health behavior increasingly describe self-regulatory processes as central. The act of self-regulation (i.e., striving toward one’s intentions or goals in an active way that involves subordination of non-compatible sub-goals, and avoidance of distractions) is more than a social construction. In fact, decades of research link the act of self-regulation with the operation of the frontal lobe, and specifically with the operation of the prefrontal cortex and associated structures. The modulatory relationship between the prefrontal areas of the brain and older areas governing appetitive responses serves as a primary rationale for positing that executive control resources (ECRs) are a central resource that assists with health behaviors that require resisting temptations. To the extent that such resources ensure successful execution of dietary behaviors, including the avoidance of appetitive foods that humans are wired by evolution to prefer, there should be some association between performance on executive function tasks and dietary behaviors. It should be the case, moreover, that performance on such tasks should selectively predict consumption of fatty foods and not necessarily consumption of non-fatty foods (which presumably do not require self-control to resist). The purpose of the present study was to examine: 1) the extent to which ECRs predict consumption of fatty foods, 2) the extent to which such prediction varies by age group, and 3) the selectiveness of the effect (for fatty foods vs. food in general). It was hypothesized that performance on tasks known to draw on ECRs would predict the frequency with which participants consumed fatty foods (but not non-fatty foods), and that this association may be slightly stronger among older adults than younger adults. To test this hypothesis, we recruited an age-stratified community sample of healthy adults between the ages of 18 and 90 (N = 208), and administered two well-established tests of ECR at baseline (the Stroop task and the Go-NoGo task). Participants subsequently completed the NCI Fat Screener at two time points, spanning two weeks of dietary behavior. We found that quicker reaction times on the Go-NoGo (β = .230, p = .001) and higher % correct on the Stroop (β = -.166, p = .021) both predicted reduced frequency of fatty food consumption (but not non-fatty food consumption) over the follow-up interval. The effects of ECR on fatty food consumption were robust to adjustment for demographics, BMI, and IQ. Finally, further analysis revealed no significant ECR x age interaction, suggesting that the effects of ECR on frequency of fatty food consumption were invariant by age group.
Keywords: health behaviors; cognitive factors
CORRESPONDING AUTHOR: Hall Peter, University of Waterloo, Waterloo; pahall@uwaterloo.ca
S261
THE ROLE OF THE VAGUS NERVE IN TUMOR PROGNOSIS – EMPIRICAL EVIDENCE AND A THEORETICAL MODEL
De Couck M.1, De Greve J.2, Marechal R.2, Van Laethem JC.2, Gidron Y. 2
1 VUB, Department of Medicine, Brussels, Belgium
2 VUB, Faculty of Medicine, Brussels, Belgium
Introduction: The role of microenvironmental factors (e.g., inflammation) and neural factors (e.g., sympathetic activity) in promotion of tumors has been recently shown. We developed a model proposing that the vagus nerve could possibly slow down tumors due to its inhibition of inflammation, sympathetic activity and oxidative stress. The present lecture presents results of several studies testing the relationship between vagal nerve activity and prognosis in several cancers. Finally, we present preliminary results on the ability to activate the vagus nerve non-invasively.
Methods & Results: In a sample of 72 colon cancer patients, heart-rate variability (HRV), a vagal nerve index, was derived from presurgical EGCs. HRV significantly predicted levels of the tumor marker CEA one year later, independent of tumor stage and treatment (r = -.43, p = .006). In a study on 113 prostate cancer patients, HRV significantly predicted the tumor marker PSA at 6 months, independent of confounders (r = -.363, p < .05). In stage 2 pancreatic cancer, HRV significantly predicted survival days (r = .356, p < .05). In several studies, we show that vagal activity moderates the effects of tumor stage on tumor markers. Finally, we tested the effects of two forms of deep breathing versus resting and versus watching a nature film on HRV. The two forms of deep breathing significantly increased HRV parameters better than the film and resting.
Conclusions: Our results, observed in several cancers, demonstrate that vagal never activity at diagnosis may predict various outcomes, independent of confounders, and may moderate the effects of tumor stage on prognosis. The experimental study shows that deep paced breathing can systematically increase HRV. These results support our model of the protective role of the vagus nerve in cancer. Future studies will test the effects and mechanisms of activating the vagus in cancer.
Keywords: Cancer, Neuroregulation, Psychoneuroimmunology
CORRESPONDING AUTHOR: Gidron Yori, Free Univ. of Brussels (VUB); yori.gidron@vub.ac.be
S262
DOES HEMISPHERIC LATERALIZATION PREDICT UPPER RESPIRATORY INFECTIONS IN ADULTS?
Killianova T.1, Fabre B.2, Berg G.2, Gidron Y.1
1 VUB, Faculty of Medicine, Brussels, Belgium
2 University of Buenos Aires, Faculty of Medicine and Biomedical Sciences, Buenos Aires, Argentina
Introduction: Hemispheric lateralization (HL) relates to a relatively stable tendency to activate or utilize functions associated with one cerebral hemisphere. Left-HL has been related to immune potentiation while right-HL to immune suppression. Only one study tested and found that right-HL predicted upper-respiratory infections (URI), however, it did not include objective immune outcomes. The present study aimed to replicate and extend that study by measuring HL with multiple tools and URI via self-report and a relevant immune marker.
Methods: N = 108 Argentinian university students took part in this study. At baseline, they completed the Zenhousern HL questionnaire, the line-bisection test and a verbal versus visual memory test, to measure HL. During 8 weeks, they were followed for development of URI, assessed by self-report and corroborated by salivary secretory Immunoglobulin A (SIgA) levels. Confounders including health behavior and neuroticism were considered as well.
Results: N = 25 people developed colds during follow-up. Left-HL measured by the line bisection test significantly correlated with baseline SIgA (r = .22, p < .05). Of all HL measures, only the Zenhousern factor of “strategic planning” (inversely) predicted risk of URI, independent of gender, health behavior, neuroticism, and chronic diseases, only in non-vaccinated people (p = .01), not in non-vaccinated ones.
Conclusions: This study partly confirms the role of left-HL (strategic planning) in predicting reduced risk of URI. Future studies need to examine whether activating the left hemisphere reduces the risk of URI, which could be of scientific and clinical importance to public health.
Keywords: Infection, Psychoneuroimmunology
CORRESPONDING AUTHOR: Gidron Yori, Free Univ. of Brussels (VUB); yori.gidron@vub.ac.be
Sleep and Health
O263
THE BIDIRECTIONAL ASSOCIATION BETWEEN DEPRESSION AND INSOMNIA. THE HUNT STUDY.
Sivertsen B.
Norwegian Institute of Public Health, Division of Mental Health, Bergen, Norway
Objective: Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia.
Methods: Data were collected from a prospective population-based study comprising the most recent waves of the Nord-Trøndelag Health Study (the HUNT2 in 1995-1997 and HUNT3 in 2006-2008). 24 715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2.
Results: Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2- and HUNT3 had an odds ratio of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors.
Conclusions: The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for onset of depression.
Keywords: insomnia, depression, longitudinal, epidemiology
CORRESPONDING AUTHOR: Sivertsen Børge, Norwegian Institute of Public Health, Division of Mental Health, Bergen; borge.sivertsen@psykp.uib.no
O264
SLEEPING PROBLEMS, SLEEP DURATION AND THE RISK OF DISABILITY PENSION. A PROSPECTIVE STUDY OF A SWEDISH GENERAL POPULATION SAMPLE
Canivet C.1, Östergren P-O.1, Staland Nyman C.2, Lindeberg S I.1
1 Lund University, Department of Social Medicine, Lund, Sweden
2 Gothenburg University, Department of Public Health and Community Medicine, Gothenburg, Sweden
Several studies have found insomnia and long sleep duration to be independently associated with subsequent disability pension. However, the issue of a possible gender-based pattern in this context has received little attention. The aim of the present study was to assess the impact of different sleeping problems and sleep duration on the rate of disability pension during a 12-year follow-up period.
The cohort was recruited by random invitations from the general population of Malmö, Sweden, aged 45–65 years in 1992; the participation rate was 41% (n = 14,555). The participants in this study were the 2,254 men and 2,065 women who were healthy and working at least 30 hours per week at baseline. Baseline data included sociodemographic factors, lifestyle, body mass index, the Job Content Questionnaire, social support and participation, ‘stress outside work’, self-rated health and an instrument assessing sleep quality and duration. Information on disability pension was obtained through record linkage from the National Health Insurance Register.
Disability pensions were granted to 9% of the men and 15% of the women during the follow-up period. Affirming moderate or very large problems with any of ‘initiating sleep’, ‘waking up during the night’, ‘waking up too early’, and ‘not feeling rested by sleep’ was defined as ‘problems with sleep’, and this was present in 33% of the women and 41% of the men. The age-adjusted hazard ratios for problems with sleep and subsequent disability pension were in men 1.8 (95% CI 1.4 to 2.4) and in women 1.6 (95% CI 1.3 to 2.0). In the full model, after adjustment for sleep duration and for potential confounders and/or mediators, these HRs decreased to 1.4 (95% CI 1.1 to 2.0) in men and 1.4 (95% CI 1.1 to 1.7) in women.
Short sleep duration, i.e. ≤6 hours/night on weekdays, was associated with having problems with sleep, long sleep duration was not. Only two percent of the population slept ≥9 hours/night. In women, but not in men, long sleep duration was strongly associated with the subsequent granting of a disability pension; the HR was 2.8 (1.7 to 4.6).
In conclusion, sleeping problems seem to be a significant risk-factor for disability pension in the middle-aged working population. There were also clear gender differences in the pattern regarding which type of sleeping problems that were most linked to disability pension.
Keywords: sleep disorders; gender; disability pension
CORRESPONDING AUTHOR: Canivet Catarina, Lund University; catarina.canivet@med.lu.se
O265
CHILDHOOD SLEEP PROBLEMS AND FAMILIAL SOCIOECONOMIC STATUS
Bøe T.
Uni Research, Uni Health, Bergen, Norway
Objective: This study explored the association between familial socioeconomic status, parental health, family structure and childhood sleep problems, and investigated the role of sleep problems as a mediator between familial socioeconomic status (SES) and childhood mental health problems.
Methods: Participants were 5,784 11-13 years old children from the Bergen Child Study. Data were collected on family economy and parental education levels, and on children’s difficulties initiating and/or maintaining sleep (DIMS), time in bed (TIB) and self-reported mental health problems.
Results: Sleep problems were significantly more common in children from lower SES families. Children from families with Poor and Average family economy had significantly higher odds of reporting DIMS compared to children from families with Very good economy (ORs = 3.5 and 1.7, respectively). The odds were reduced by 12-36% when adjusting for poor parental health and single parenting, but remained significant. Children from families with a Poor economy had increased odds of a short TIB, both in the crude model (OR = 1.9) and when adjusting for parental characteristics (OR = 2.2). Maternal education level was significantly associated with short TIB. Path analysis was conducted to investigate the potential mediating role of DIMS in the relationship between SES and mental health. The significant direct association between family economy and SDQ total problems score was found to be partially mediated by a significant indirect effect of sleep problems.
Conclusions: Sleep problems are common amongst children from families with a lower SES and may be a potential mechanism through which low SES is translated into mental health problems.
Keywords: Socio-economic status, Abnormal sleep , Children's health, Mental health
CORRESPONDING AUTHOR: Bøe Tormod, Uni Health, Uni Research; tormod.boe@uni.no
O266
SLEEP DEPRIVATION DURING PREGNANCY AND THE POST PARTUM PERIOD: DOES IT CONTRIBUTE TO POST PARTUM MENTAL ILLNESS?
Sloan E. P.
University of Toronto, Mount Sinai Hospital, Department of Psychiatry, Toronto, Canada
The effects of sleep deprivation, both acute and prolonged, are manifold. Marked transient physiological changes, including neurological, autonomic, immunolgic have been reported.
Pregnancy is a time when the majority of women experience some disruption to their sleep. In the first trimester, frequent urination and hyperemesis can be problematic. In the third trimester, gastric reflux, nasal congestion and discomfort due to increased fetal size play a role. During the post-partum months, care of the neonate results in a significant reduction in the total amount of sleep. While the majority of women accommodate to the reduction in the amount of sleep, for certain women, sleep deprivation can result in significant and potentially serious compromise in mental well-being. In this presentation, changes in sleep across pregnancy and in the post partum period are highlighted. The role of sleep deprivation in the pathogenesis of post-partum mental illness is discussed. Possible mechanisms, and in particular the role of the hypothalamic-pituitary-axis (HPA) will be presented. An approach to improving sleep quality and quantity in the immediate post partum period which we are currently researching will be presented.
Keywords: sleep deprivation, postpartum
CORRESPONDING AUTHOR: Sloan Eileen P., University of Toronto; esloan@mtsinai.on.ca
O267
SLEEP DISORDERS, QUALITY OF LIFE AND CLINICAL OUTCOMES IN PATIENTS WITH KIDNEY DISEASE, DIALYSIS AND KIDNEY TRANSPLANTATION- A “WAKE-UP” CALL
Mucsi I.1,2, Novák M.1,3
1Semmelweis University, Institute of Behavioural Sciences, Budapest
2McGill University Health Centre, Division of Nephrology, Montreal, Canada
3University of Toronto, Department of Psychiatry, Toronto, Canada
Chronic Kidney Disease (CKD) is a progressive condition with shortened survival and severely impaired quality of life (QoL) of patients. When the kidneys fail (end-stage renal disease), dialysis or transplantation (TX) is required. Both are intrusive, and psychologically, psychosocially demanding treatments. Successful kidney TX provides better survival and also better health related quality of life.
Sleep disorders are considered complex and multicausal in this population, and might be caused by biological/medical, psychological, social and lifestyle factors. Insomnia, sleep apnea syndrome and restless legs syndrome, are common both in patients on dialysis and TX patients but there is only limited data available about the association between sleep problems, quality of life and clinical outcomes in this patient population. Despite of the significant improvement in overall health after TX, still a significant proportion of kidney transplant recipients suffer from sleep disorders which negatively impact mental health and QoL. As we have shown earlier, the prevalence of both insomnia and restless legs syndrome is reduced in TX patients compared to patients on dialysis and it is similar to the prevalence observed in the general population. The prevalence of sleep apnea, however, is very high around 30% and likely contributes to the cardiovascular mortality of patients. In this talk we will review the impact of sleep problems, which are potentially treatable, on QoL and other clinical outcomes in patients with CKD. We suggest that diagnosis and management of sleep disorders may improve QoL, mental health and potentially, even impact survival in this population.
Keywords: chronic kidney disease, dialysis, kidney transplantation, sleep disorders, quality of life
CORRESPONDING AUTHOR: Novák Márta, Semmelweis University, Budapest; marta@nefros.net
O268
WORKAHOLISM AND SLEEP QUALITY AMONG JAPANESE EMPLOYEES: FINDING FROM A PROSPECTIVE COHORT STUDY
Kubota K.1, Shimazu A.1, Kawakami N.1, Takahashi M.2
1 The University of Tokyo Graduate School of Medicine, Department of Mental Health, Tokyo, Japan
2 National Institute of Occupational Safety and Health, Kanagawa, Japan
Previous studies reported association of workaholism (i.e., working excessively hard in a compulsive fashion) with poor sleep quality. However, these studies utilized mostly a cross-sectional design, which precludes causal inferences. Additionally, participants of previous studies were limited to nurses recruited only from hospitals in Japan. Therefore, the present study aimed to demonstrate the prospective association of workaholism with sleep quality among Japanese employees from various occupations.
A web-based prospective survey was conducted among registered monitors of a survey company. The questionnaire included workaholism, sleep quality (Pittsburgh Sleep Quality Index), job characteristics, and demographics. Overall, 13,564 monitors were invited to complete the first-wave survey (October 2010). Recruitment for the survey was stopped when the number of respondents exceeded 2,500. The first-wave respondents (n = 2,520) were invited to the second-wave survey (May 2011) and 2,061 answered.
A total of 378 respondents were excluded because of changes in job or employment during follow-up (n = 364) and missing values (n = 14), resulting in 1683 respondents for analysis (859 males and 824 females). Analysis of covariance (ANCOVA) was conducted to compare sleep quality (7 components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) at follow-up among workaholism groups (low, middle, and high). Covariates included demographics and baseline levels of sleep quality and job characteristics.
ANCOVA showed that high-workaholic group had significantly longer sleep latency at follow-up compared to low- and middle-workaholic groups (F = 4.69, p < 0.05). High-workaholic group also had significantly higher levels of daytime dysfunction compared to low-workaholic group (F = 5.02, p < 0.01). However, no significant differences were found among workaholic groups in overall sleep quality, sleep duration, habitual sleep efficiency, sleep disturbance, and use of sleep medication.
In conclusion, workaholism was associated with poor sleep quality at seven-month follow-up in terms of sleep latency and daytime dysfunction.
Keywords: Mental health, Sleep disorders, Stress
CORRESPONDING AUTHOR: Kubota Kazumi, The University of Tokyo, Tokyo; tothankyouall@gmail.com
Conflict of Interest: Grant-in-Aid for Scientific Research on Innovative Areas (Research in a Proposed Research Area) 2010 and 2011 (No. 4102 - 21119003) from the Ministry of Education, Culture, Sports, Science and Technology, Japan, supported the present study.
Using e-Health Technologies to Improve Psychological Wellbeing in Cancer Patients
S269
USING E-HEALTH TECHNOLOGIES TO IMPROVE PSYCHOLOGICAL WELLBEING IN CANCER PATIENTS
Prins JB.
Radboud University Nijmegen Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
How can e-Health technologies improve the quality of life during and after cancer treatment? This question will be addressed in a symposium that brings together experts in the field of developing, evaluating and implementing e-Health interventions for cancer patients. A broad overview will be offered with different types of interventions, ranging from non-guided fixed-structured interventions for adults, to virtual engagement for young cancer patients. First scientific results will be combined with an impression of these interventions and the challenges of conducting E-health research.
Chair of the symposium
Prof. dr. Judith [P.B.] Prins, Professor and chair of Medical Psychology
Presenters
1. Prof. dr. Irma [I.M.] Verdonck-de Leeuw - “Integrating e-Health in psychosocial care in cancer patients: shared decision making, screening, self-help, and stepped care”
2. Annemarie [A.M.J.] Braamse, MSc - “Online self-management for psychological distress in hematological cancer patients treated with autologous stem cell transplantation”
3. Sanne [S.W.] van den Berg, MSc -“The BREATH intervention: Online self-management to facilitate adjustment after curative breast cancer. Study protocol and pilot evaluation of usage”
4. Dr. Mette [M.T.] Høybye, PhD - “Virtual engagement. Reflections from an early pilot-testing of a virtual intervention for young cancer patients – thoughts on design, presence and usability of e-health interventions to promote well-being.”
Keywords: e-Health, Cancer, Intervention
CORRESPONDING AUTHOR: Prins Judith, Radboud University, Nijmegen; j.prins@mps.umcn.nl
S270
INTEGRATING E-HEALTH IN PSYCHOSOCIAL CARE IN CANCER PATIENTS: SHARED DECISION MAKING, SCREENING, SELF-HELP, AND STEPPED CARE
Verdonck-de Leeuw M.
VU University, Clinical Psychology, Amsterdam, The Netherlands
Cancer patients have to deal with various physical and psychological side effects of cancer and cancer treatment. Specific stressors as fear of death, interruption of life plans, and changes in body image and self-esteem lead to emotional distress in 25-30% of the patients. Therefore, it is important to monitor quality of life in a structured manner in clinical practice enabling to provide adequate supportive care in an early stage. In the Netherlands, government policy statements and national guidelines reflect broad scientific and social support for a structured, integrated approach to supportive care in cancer patients.
E-health applications including computerized decision support can be used as helpful tools in shared decision making and careful monitoring quality of life and outcome. However, it is important to integrate such e-health tools into supportive cancer care according to self management and stepped care principles in which several evidence-based interventions are offered in a structured way. This approach has the potential to improve the efficiency of supportive cancer care.
In this presentation, an overview will be given of running projects at VU University Medical Center, Amsterdam, The Netherlands, including the OncoCompass, a web-based knowledge and decision support system; OncoQuest, a touch screen computer system for monitoring quality of life in clinical practice; and various randomized controlled trials on innovative (stepped) care strategies including on-line interventions targeting symptoms and quality of life aspects in cancer patients.
The bottom line of these approaches is healthier patients, more satisfied care providers, and cost savings by empowering both professionals and patients.
Keywords: e-health cancer self management self-efficacy quality of life effectiveness cancer survivorship depression anxiety
CORRESPONDING AUTHOR: Verdonck-de Leeuw Irma, VU University Medical Center; im.verdonck@vumc.nl
S271
ONLINE SELF-MANAGEMENT FOR PSYCHOLOGICAL DISTRESS IN HEMATOLOGICAL CANCER PATIENTS TREATED WITH AUTOLOGOUS STEM CELL TRANSPLANTATION
Braamse AMJ.1, Van Meijel B.2, Visser O.3, Van Oppen P.1, Boenink AD.1, Eeltink C.3, Cuijpers P.4, Huijgens PC.3, Beekman ATF.1, Dekker J.5
1 VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
2 INHolland University of Applied Sciences, Mental Health Nursing, Amsterdam, The Netherlands
3 VU University Medical Center, Hematology, Amsterdam, The Netherlands
4 VU University , Clinical Psychology, Amsterdam, The Netherlands
5 VU University Medical Center, Rehabilitation Medicine, Amsterdam, The Netherlands
Background: Autologous stem cell transplantation following high-dose chemotherapy is acknowledged as one of the most stressful treatments in modern cancer care. Psychological distress (i.e. depression and anxiety) is a strong predictor of functional status and other aspects of quality of life in these patients. Psychological treatment is hypothesized to improve psychological distress, functional status and other aspects of quality of life. We offer treatment consisting of a stepped care program, including an internet self-help intervention.
Purpose: To present our experiences, possibilities and limitations of online therapy in hematological cancer patients treated with autologous stem cell transplantation.
Methods: In the context of a randomized controlled trial, 29 patients who underwent autologous stem cell transplantation were offered treatment with the online self-management intervention ‘Stress under control’.
Results: Of the 21 patients who chose to start with the intervention, 12 quit after lesson 1 or 2. The other 9 patients completed the whole intervention successfully; preliminary evaluation showed a reduction of psychological distress in this group. Reasons for the patients to quit treatment varied from experiencing little psychological distress to having too many psychological problems, and being unwilling to deal with psychological problems.
Discussion: In the treatment of psychological distress, internet therapy seems to be a valuable option for patients with hematological malignancies undergoing autologous stem cell transplantation. However, not all patients judge this treatment type to be helpful. Detailed assessment of the need for psychological treatment, in a face to face contact, seems to be important in this intensively treated patient group. Patients’ need for treatment should be assessed, and intensity of treatment (online therapy or immediate referral for more intensive treatment) should be tailored to the specific needs of the individual patient.
Keywords: e-Health; Cancer; Mental health; Intervention; Quality of life
CORRESPONDING AUTHOR: Braamse Annemarie, VUmc, Amsterdam; a.braamse@vumc.nl
S272
THE BREATH INTERVENTION: ONLINE SELF-MANAGEMENT TO FACILITATE ADJUSTMENT AFTER CURATIVE BREAST CANCER. STUDY PROTOCOL AND PILOT EVALUATION OF USAGE
Van den Berg SW .1, Gielissen MFM.1, Ottevanger PB.2, Prins JB.1
1 Radboud University Nijmegen Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
2 Raboud University Nijmegen Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
Background: After completion of curative treatment, breast patients are faced with a broad range of survivorship topics concerning physical, emotional and social recovery. The universality of these topics motivated the BREATH [BREAst cancer e-healTH] study to develop and evaluate an easily accessible self-management intervention to facilitate adjustment for all breast cancer patients. Because the actual usage of the intervention is possibly related to its effect, a pilot study was conducted to gain more insight in usage variables.
Methods: The non-guided self-management BREATH intervention guides patients chronologically through universal survivorship topics. The effectiveness of the BREATH intervention compared to usual care is currently being investigated in a multicenter randomized controlled trial. Both sample size calculation and intervention target are based on two primary outcomes: Decreasing the psychological impact of breast cancer (distress) and improving patients own strengths (empowerment). The intervention protocol has a fixed structure that covers four months, representing four different phases of recovery after breast cancer. The content of the intervention is based on breast cancer specific knowledge combined with techniques from cognitive behavioral therapy.
Results: An explorative pilot-study on usage of the intervention was conducted for a sample of 38 non-metastatic breast cancer patients (mean age 42.3 years) who completed primary treatment 3 months earlier in 5 hospitals in the Netherlands. Data were obtained from the ongoing BREATH trail. All patients were randomly allocated to the intervention group and completed the four-month BREATH intervention. Multiple usage variables were tracked (including frequency, duration of visits, activity) and linked to baseline patient characteristics (age, education, distress) in order to explore subgroups of usage. Results of descriptive statistics and regression analyses will be presented at the congress.
Conclusions: With the use of e-Health technologies, the BREATH intervention provides a non-traditional psychological self-management approach to promote well-being in all breast cancer survivors. Because the intervention is offered to a heterogeneous group of patients (both distressed and non-distressed), usage variables provide objective measures about the intervention uptake and need to be considered in the analyses of effectiveness.
Keywords: Cancer, e-Health, Intervention
CORRESPONDING AUTHOR: van den Berg Sanne, Radboud University, Nijmegen; s.vandenberg@mps.umcn.nl
S273
VIRTUAL ENGAGEMENT. REFLECTIONS FROM AN EARLY PILOT-TESTING OF A VIRTUAL INTERVENTION FOR YOUNG CANCER PATIENTS – THOUGHTS ON DESIGN, PRESENCE AND USABILITY OF E-HEALTH INTERVENTIONS TO PROMOTE WELL-BEING
Hoybye M T.
University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
Introduction: One of the reasons being discussed for the disparity in survival between adolescents and young adults with cancer to children is suboptimal adherence to treatment among the elder group.
New social media and computer games may have a particular potential to positively affect the behaviour of young cancer patients and increase their adherence to treatment through increased knowledge about cancer and increased self-efficacy.
This project seeks to promote treatment adherence and alleviate social isolation through a supportive and engaging behavioural intervention in an online real-time multi-player 3D-platform.
Methods and material: The project developed a web-based online 3D-environment. In February and March 2011, 12 young Danish cancer patients were recruited from the Oncology Department at Aarhus University Hospital to pilot test the feasibility of the prototype of the online environment. They answered a brief online survey and received introduction to the virtual environment.
Results: We learned that 100% of the participants used the internet, 60% used it daily. Main use of the internet was communication in online social networks (80%). None of the participants however participated in internet discussion groups on cancer.
The young patients tested basic features of the virtual environment, such as logging in, moving around their avatar and chatting with other patients. To test the creation of a small virtual community we had asked the young patients to connect with each other and the research team within the environment at four specific times, from where they might physically be present. However, these virtual meet-ups weren’t successful.
Discussion: Young patients are very engaged with online media and see the potential of an online platform. However, the intervention failed to integrate with the online spaces where the young patients are already present and interact. This is a major area of development for this application and intervention.
Taking outset in these reflections the challenges of online interventions in cancer support, to create real-life impact on patient outcomes, will be discussed, relating issues concerning design, presence and usability of e-health intervention to defined research endpoints and actual outcomes.
Keywords: Cancer, Adolescent, e-Health, Internet, Adherence, Health behavior
CORRESPONDING AUTHOR: Hoybye Mette Terp, University of Southern Denmark; metteterphoybye@gmail.com
Self-rated Health: Evidence for its Validity, Limits to its Validity, and Uses as a Measure of General Health
S274
SELF-RATED HEALTH: EVIDENCE FOR ITS VALIDITY, LIMITS TO ITS VALIDITY, AND USES AS A MEASURE OF GENERAL HEALTH
Benyamini Y.
Tel Aviv University, Bob Shapell School of Social Work, Tel-Aviv, Israel
Consistent evidence for the intriguing findings relating self-rated health (SRH) to future morbidity and mortality has raised continued interest in the possible uses of this measure, the reasons underlying its validity as well as the limits to its validity. This symposium spans four presentations that contribute innovative answers to these questions, followed by a discussion session. The first presentation, based on a National study from Hungary, shows that SRH reflects the effects of the financial situation on perceived health, at the personal and National level, and particularly the major political changes in 1990. The second presentation, based on a National study of midlife women in Israel, compares the majority population group to immigrant and minority groups and calls to question the role of socioeconomic versus cultural factors that affect health perceptions. The third presentation extends the evidence for the validity of SRH to nonagenarians from Finland, showing that although SRH is often rated as good, even at this old age SRH is related to diseases and functioning and is sensitive to changes in such measures. The fourth presentation, based on a study of middle-aged and old adults in Israel, shows that better health perceptions are associated with greater adherence to screening recommendations, an association that can partly explain the validity of SRH as a predictor of future morbidity. Together, the four studies describe a variety of uses for SRH and support its validity, at least within culture, throughout the entire span of adult years, yet also raise questions regarding the limits to its validity.
Chair: Yael BENYAMINI
Presenters and titles
Tamás MARTOS, Hungary
Economic growth, income and self-rated health in Hungary: trends between 1991-2010
Yael BENYAMINI, Israel
Health, Cultural and Socio-economic Factors Underlying Differences in Self-ratings of Health among Long-term Residents, Immigrants, and Arab Women in Midlife in Israel
Henrike GALENKAMP, the Netherlands and Finland
Is self-rated health among nonagenarians still sensitive for changes in disease and functioning?
Efrat NETER, Israel
Self rated health is prospectively associated with screening for the early detection of colorectal cancer (CRC)
Dorly J.H. DEEG, the Netherlands
Discussant
Keywords: Health, Measurement
CORRESPONDING AUTHOR: Benyamini Yael, Tel Aviv University, Tel Aviv; benyael@post.tau.ac.il
S275
ECONOMIC GROWTH, INCOME AND SELF-RATED HEALTH IN HUNGARY: TRENDS BETWEEN 1991-2010
Martos T.1, Kopp M.2
1 Semmelweis University, Institute of Mental Health, Budapest, Hungary
2 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
Individual variations in quality of life and more specifically, in self-rated health are often connected to income, income inequality and social status. Based on these findings, we make an attempt to describe the long term trend of self-rated health of the Hungarian population from the political changes in 1990 to the present days. Moreover, on the national level we connect these trends to the change of gross domestic product (GDP) of Hungary in the same time period and individual differences in net household income o the personal level. We analyze data from ten surveys (Hungarostudy, European Values Study, European Social Survey, total N = 27774 respondents) that assessed several important characteristics of well-being in Hungary in the last 20 years. On the whole results indicate the following important associations. (1) The years after political changes in 1990 proved to be a nadir regarding self-rated health in the Hungarian society. In the following years a significant increase may be hypothesized while this was followed by signs of stagnation and decrease up to the present. (2) On the national level, self-rated health is closely associated with the GDP (r = 0,6) and (3) on the personal level, the association of self-rated health with the net household income is relatively stable. Results indicate that economic conditions of living represent an important cultural factor for self-rated health in the Hungarian society.
Keywords: Self-rated health, Economics, Income, Hungary, Population health
CORRESPONDING AUTHOR: Martos Tamás, Semmelweis University, Budapest; martos@mental.usn.hu
S276
HEALTH, CULTURAL AND SOCIO-ECONOMIC FACTORS UNDERLYING DIFFERENCES IN SELF-RATINGS OF HEALTH AMONG LONG-TERM RESIDENTS, IMMIGRANTS, AND ARAB WOMEN IN MIDLIFE IN ISRAEL
Benyamini Y.1, Boyko V.2, Blumstein T.2, Lerner-Geva L.2
1 Tel Aviv University, Bob Shapell School of Social Work, Tel-Aviv, Israel
2 Sheba Medical Center, The Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Israel
Background: Self-ratings of health (SRH) have been consistently reported to predict mortality and morbidity, even after controlling for a wide variety of health-related measures. They have also been reported to differ by ethnicity, race, and socioeconomic status (SES). Our objective was to assess differences in SRH between three groups of midlife women and investigate possible explanations for these differences.
Methods: A representative sample of Israeli women ages 45-64 was selected from the following groups: Jewish long-term residents (n = 540), Immigrants from the former Soviet Union after 1989 (n = 151), and Arab women (n = 123). Women were interviewed in their homes, in Hebrew/Russian/Arabic respectively. All measures were self-reported and included a single-item assessing SRH as well as diseases, medication use, functional limitation, health care utilization, symptoms, depression, health behaviors, psychosocial measures, socioeconomic measures and socio-demographic information.
Results: The three groups greatly differed in most study measures. Poorest health was reported by Immigrants, followed by Arabs and least by long-term residents. These differences remained after controlling for: (1) age and marital status; (2) health and functioning; (3) health behaviors; (4) psychosocial measures and life events. Only after controlling for education and income, the difference between Arab women and long-term residents was eliminated and the difference between immigrants and long-term residents was somewhat reduced. When SES measures were adjusted for in the first step, along with the socio-demographic measures, the difference between Arab women and long-term residents was eliminated at this step.
Conclusions: The results underscore the complexity of comparing SRH across cultures and understanding its underlying bases: Though the groups vastly differ in health status, this does not fully account for the differences in their SRH, which therefore seem to be related to social and cultural factors. Adjusting for SES may result in overlooking important cultural differences and differences in life events and may thus underestimate the cultural sensitivity of SRH, and vice versa: Adjusting for social and cultural factors, may lead to underestimating the role of SES.
Keywords: Health disparities, ethnic differences, measurement
CORRESPONDING AUTHOR: Benyamini Yael, Tel Aviv University, Tel Aviv; benyael@post.tau.ac.il
S277
IS SELF-RATED HEALTH AMONG NONAGENARIANS STILL SENSITIVE FOR CHANGES IN DISEASE AND FUNCTIONING?
Galenkamp H.1, Deeg DJH.1, Huisman M.1, Braam AW.2, Jylhä M.3
1 VU University Medical Center, Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
2 Altrecht Mental Health Care, Department of Emergency Psychiatry, Utrecht, The Netherlands
3 University of Tampere, Tampere School of Health Sciences, Tampere, Finland
Introduction: With age, there is an increasing gap between self-rated health (SRH) and actual health status. It is unknown if SRH is still a sensitive measure for health status among the very old. This study investigates whether SRH among nonagenarians changes over time, and examines its susceptibility for changes in measures of disease and functioning.
Methods: In the Vitality 90+ Study, questionnaires were sent in 2001, 2003, 2007 and 2010 to all people aged 90 years and over living in Tampere, Finland. Three hundred thirty four nonagenarians (community-dwelling and institutionalized) filled in the questionnaire in 2001 and had at least one follow-up measurement. Self-rated health, the presence of eight chronic conditions and functioning in five activities were assessed. GEE analyses were applied to examine longitudinal change in SRH and the predictive value of number of diseases and functional status. In addition, moderating effects of depression and living situation were examined.
Results: Most nonagenarians rated their health as average (48.5%). Good SRH (36.5%) was more prevalent than poor SRH (15.0%). On average, no change in SRH occurred within two years follow-up, but declined SRH (22.3%) was associated with poorer baseline functioning and declined functioning. After six and nine years, clear declines in SRH were apparent, and were associated with increased diseases and declined functioning. The impact of diseases and functioning was smaller among institutionalized people (diseases OR = 0.90, p = 0.532; functioning OR = 1.18, p < 0.001) than among community-dwelling people (diseases OR = 1.30, p = 0.022; functioning OR = 1.44, p < 0.001). In addition, the detrimental effect of functioning on SRH was stronger in those without depression (OR = 1.33, p < 0.001) than in those with depression (OR = 1.17, p = 0.002)
Conclusions: Even in nonagenarians, SRH reflects declines in functioning and increases in number of diseases. In particular in community-dwelling and people without depression, poor health affects SRH. These results provide support for the usefulness of SRH as a measure of health among the oldest olds.
Keywords: Older adults, Health, Disability, Chronic illness, Assessment
CORRESPONDING AUTHOR: Galenkamp Henrike, VUmc, Amsterdam; h.galenkamp@vumc.nl
S278
SELF RATED HEALTH (SRH) IS PROSPECTIVELY ASSOCIATED WITH SCREENING FOR THE EARLY DETECTION OF COLORECTAL CANCER (CRC)
Neter E.1, Stein N.2, Rennert G.3, Hagoel L.3
1 Ruppin Academic Center, Behavioral science, Emeq Hefer, Israel
2 Carmel Medical Center, Department of Epidemiology and Community Medicine, Haifa, Israel
3 Technion, Department of Epidemiology and Community Medicine, Haifa, Israel
Background: Perceived health is a consistent predictor of mortality and other health outcomes. One of the mechanisms hypothesized to explain its validity as a predictor is that SRH affects the adoption of health behaviors, yet most relevant evidence is cross sectional. The present study focuses on the performance of the recommended CRC screening test (Fecal Occult Blood Test, FOBT) in a CRC early detection program. SRH was measured before the behavior was enacted and allows examining the association between SRH and this health behavior in a longitudinal design. The paper also examined if CRC risk perception and attitudes, efficacy and intentions to perform the screening test varied as a function of SRH.
Methods: 2200 men and women aged 50-74, eligible for CRC screening and who have underwent the test a year before, were mailed a test-kit. Half were interviewed by telephone, 1-2 weeks following mailing of the test-kit, and the other half two months later. The latter timing assessed the interviews' 'mere measurement' effect on performing the test.
Results: Participants who rated their health as better than others' performed the screening test 2 months (and 6 months) following invitation, more often than those who rated their health as similar to or lower than that of others' (60.5%, 58%, and 48.2%, respectively, χ2 = 10.58, p < .01), even though these participants' perceived CRC risk was significantly lower than that of those who rated their health as comparable or lower than others' (p < .05). Intentions, perceived efficacy for performing the test and attitudes towards the test did not vary significantly by SRH. CRC knowledge of those who perceived their health as better or similar to others' was higher than those who rated their health as lower than others'. Participants who rated their health as better than others' were more often men, single, and had a higher education.
A hierarchical multivariate analysis of CRC screening behavior was performed. It included demographic variables in the first step, knowledge, SRH and risk perception in the second step, and the interaction between SRH and risk perception in the third step. Age, education and gender were significant predictors, and so was SRH. The interaction between SRH and risk perception was non-significant.
Conclusions: Self rated health contributes to predicting CRC screening, better than other cognitive variables, after accounting for demographic variables.
Keywords: cancer screening, health behaviors
CORRESPONDING AUTHOR: Neter Efrat, Ruppin Academic Center; neter@ruppin.ac.il
Behavioral Aspects of Chronic Diseases
O279
THE CURVILINEAR RELATION BETWEEN EMOTIONAL AROUSAL AND MORTALITY IN A SAMPLE OF END STAGE RENAL DISEASE PATIENTS: A POSSIBLE CASE OF HORMESIS
Gillespie MW.
University of Alberta, Department of Sociology, Edmonton, Alberta , Canada
This paper describes the results of a Cox regression analysis of a subsample (n = 601) of respondents drawn from a University of Michigan study of the quality of life of Michigan patients suffering from end state renal disease (ESRD). The sample was selected from the Michigan kidney registry. The subsample consists of those patients for whom mortality status as of Nov. 30, 1986, along with the death date of the 13.5% who had died, was determined from the registry. These patients were interviewed in the summer months of either 1984 (n = 101) or 1985 (n = 400). My secondary analysis of these data focuses on the possible effects of emotional valence and arousal on mortality. I use the three-category ten item Bradburn Affect-Balance Scale to measure both valence and arousal. (The categories are never = 0, sometimes = 1, and often = 2.) Valence equals the difference between the sum of the responses to the five positive items and the sum of the five negative items. Arousal equals the sum of the responses to all ten items.
The main findings of my analysis are no relation between valence and mortality but a curvilinear relationship between emotional arousal and mortality. The nature of this curvilinear relation is that the mortality hazard ratio decreases with arousal at low levels of arousal and then increases with arousal at high levels. (HR = .37 & 1.05 for the linear and quadratic terms, respectively; p < .001, 2-tail test, for both estimates.) This curvilinear relation occurs when the regression is stratified by the respondent’s kidney transplant status. It also is unaffected by the inclusion of three control variables in the regression equation: the respondent’s bmi (HR = 1.05), a dummy variable that indexes diabetes as the cause of the respondent’s ESRD (HR = 1.70), and a three-item index that combines additional measures of feelings (HR = .50): self-reported health, high feelings of energy during the past month, and low feelings of sadness also during the past month. (The estimates for the three control variables are marginally significant at p < .05, 1-tail.) Finally, the curvilinear relation stands up when a plethora of other demographic, psycho-social, and health-related variables are tried. None of these controls is included in the final regression equation, however, because none significantly affects mortality (p < .05, 1-tail).My discussion of these results focuses on three contentious premises that underlie the existence and interpretation of this curvilinear relationship: (1) Valence and arousal, typically the first two principal components of a factor analysis of self-reported emotions, better represent the structure that underlies these reports than positive and negative affect, the two factors that typically result from the rotation of the principal components to simple structure. (2) Emotional arousal is the psychological manifestation of stress as defined by Selye as the “non-specific response to change.” (3) Calabrese’s use of the Yerkes-Dodson “law” to place the relation between stress and cognition in a hormetic framework can be extended to encompass the relation between emotion and morality, at least in the case of ESRD patients.
Keywords: emotions, renal/urological disorders
CORRESPONDING AUTHOR: Gillespie Michael, University of Alberta Edmonton; mgillesp@ualberta.ca
O280
THE IMPACT OF PSYCHOPATHOLOGY ON QUALITY OF LIFE IN COELIAC DISEASE
Sainsbury K.1, Mullan B.2, Sharpe L.1
1 University of Sydney, Clinical Psychology, Sydney, Australia
2 University of Sydney, Psychology, Sydney, Australia
Coeliac disease (CD) is a chronic autoimmune disorder, which when not adequately treated with a strict gluten free diet (GFD), is associated with serious long term health complications including intestinal and bowel cancers, osteoporosis, and infertility. Depression and anxiety, as well as reduced quality of life (QOL) are more common in this population than in healthy controls. In addition, emerging literature suggests that eating disorder pathology and coping behaviour may also impact on dietary adherence and QOL. Although a number of studies have examined QOL in CD the majority have been limited to correlations and have focused on a reduced number of potentially significant variables, meaning a comprehensive understanding of the interactions between mental health and disease characteristics in CD, and the consequent impact on QOL, is lacking. Measures of QOL, depression, anxiety, eating pathology, and coping skills, as well as demographic and disease information were completed by 390 participants with biopsy confirmed CD. Correlations and hierarchical regression analysis were used to determine the nature of the relationships between QOL, psychological and disease factors. Demographic and disease variables including the number of symptoms prior to diagnosis, time to improvement after initiation of a GFD, and additional food intolerances accounted for 14.1% of the variance in QOL, F (6, 341) = 9.3, p < .001. Psychological variables added an additional 26.9% to the model, F (11, 336) = 21.2, p < .001, although only depression made a significant independent contribution. Poorer QOL was associated with both a higher incidence of psychological and CD symptoms. The combination of disease characteristics and psychological difficulties within CD in this study allowed for a more comprehensive examination of the factors influencing QOL than has previously been undertaken. The negative impact of psychological problems on QOL suggests that targeted interventions should include the provision of psychological coping skills as well as purely dietetic based strategies to improve physical symptoms and management of CD.
Keywords: Quality of Life, Mental Health
CORRESPONDING AUTHOR: Sainsbury Kirby, The University of Sydney; ksai7668@uni.sydney.edu.au
O281
PERCEPTION OF CONTROL AND ACCEPTANCE INFLUENCE ANXIETY AND SUBJECTIVE HEALTH IN IBD
Saboonchi F.1, Jäghult S.2, Wellander R.3, Wettersjö A.4
1 Red Cross University College, Stockholm, Sweden
2 Karolinska Institutet, Department of Clinical Science, Stockholm, Sweden
3 Stockholm University, Institute for Psychology, Stockholm, Sweden
4 Stockholm University, Institute of Psychology, Stockholm, Sweden
Background: According to Leventhal’s common sense model of self regulation (CSM), the patients’ perception of illness functions as an antecedent to patient’s coping efforts. Coping strategies, in turn, are widely assumed to influence health outcomes and determine the emotional sequel of living with a chronic illness. Anxiety is a major psychological distress associated with the onset and escalation of Inflammatory Bowel Diseases (IBD), asserting a negative impact on quality of life and subjective health of the patients. A main domain of illness perception, perception of lack of control, is a potentially important predictor of anxiety. On the other hand, acceptance coping, which denotes that the individual accepts the events and experiences that are beyond his or her control, has been suggested to relieve emotional distress. The present study, thus, examined the effect of perception of control and acceptance coping on anxiety and subjective health in a small community sample of patients with IBD.
Methods: 32 patients diagnosed with IBD (19 Crohn’s diseases, 13 ulcerative colitis) completed a battery of questionnaires including Brief Illness Perception Questionnaire (B-IPQ), Short Health Scale (SHS), Brief COPE; and Hospital Anxiety and Depression Scale (HADS).
Results: Path analysis revealed a direct effect of perception of lack control on self-reported anxiety (Standardized Beta = 0.24 p < 0.05), Perception of lack of control also was shown to significantly and adversely influence subjective health (Standardized Beta = - 0.35 p < 0.01). Furthermore, acceptance coping was shown to predict lower degree of anxiety (Standardized Beta = -0.42 p < 0.01), and improved subjective health (Standardized Beta = 0.29 p < 0.05). The analysis also indicated partial mediation of acceptance coping on the effects of perception of lack of control on anxiety and subjective health.
Conclusions: The findings of the present study suggest that while perception of personal and treatment control of the disease constitutes an important determinant of subjective health and lower degrees of anxiety, the acceptance based coping skills, i.e. to learn to accept what lays beyond one’s control, is an equally important target variable in efforts to improve the IBD patients’ subjective wellbeing.
Keywords: Anxiety, Coping, Inflammatory Bowel diseases, Illness perception
CORRESPONDING AUTHOR: Saboonchi Fredrik, Sophiahemmet, Stockholm; fredrik.saboonchi@shh.se
O282
THE BALANCING MAN; SHARED PERCEPTIONS OF LIFE WITH A CHRONIC ILLNESS ACROSS THREE TYPES OF DISEASES (TYPE 2 DIABETES, COLD AND HEART DISEASE)
Engelund G., Møller Hansen U., Willaing I.
Steno Health Promotion Center, Patient Education , Gentofte, Denmark
Aims: In Danish municipalities responsible for the delivery of patient education the volume of patients is not always large enough for disease-specific patient education. Instead the education must apply to people with different diseases typically type 2 diabetes, COLD, and heart disease. Many studies of life with a chronic illness focus only on one disease or on a particular aspect of chronic illness and thereby overlook common patient experiences across chronic diseases.
The aim of this study was therefore to explore and describe shared experiences and perceptions of life with a chronic illness among patients with Type 2 diabetes, COLD, and heart disease.
Methods: The study was based on qualitative data from four highly active workshops with 25 patients with a chronic illness. Three workshops were conducted with patients with type 2 diabetes, COLD, and heart disease respectively whereas the last one had participants with one of the three diseases. Each workshop lasted four hours and different types of probes were used to gather data through participation, dialogue and reflective exercises about life with chronic illness. Data were obtained in the format of video, photos, written material, and field notes. The data were analyzed using a grounded theory approach with conceptualization, constant comparison, coding and discovery of categories.
Findings: The emerged core category ‘The Balancing Man’ hypothesizes that people with a chronic illness have a constant need for balancing their identity and life due to ongoing changes. The different changes and imbalances were conceptualised into four sub-categories: ‘Bodily Infirmities’, the experience of physical changes; ’Lowered Bar’, the experience of everyday life changes; ‘Challenging Relations’, the experience of social changes and ‘Changeable Moods’ the experience of emotional changes. The changes and imbalances appeared with different degree and effect in each individual and were shared more across the different diseases than within.
Conclusion: The knowledge about the shared perceptions of life with a chronic illness as expressed with the concept of ‘The Balancing Man’ can be useful for Health Care Professionals when planning and delivering group-based patient education across different diseases in order to recognize the changes and imbalances shared by the group and thereby also their needs. The findings also apply to the education of the individual patient since many patients often suffer from more than one chronic illness e.g. type 2 diabetes and heart disease.
Keywords: Chronic illness, Health education
CORRESPONDING AUTHOR: Engelund Gitte, Steno Diabetes Center, Denmark; gteg@steno.dk
O283
THE IMPACT OF ANXIETY, DEPRESSION AND EDUCATION LEVEL ON LONG-TERM MORTALITY AFTER CARDIAC SURGERY
Székely A.1, Cserép Z.2, Toth R.3, Balog P.4, Takó K.5, Juhász B.6
1 Semmelweis University, Department of Anesthesia and Intensive Care, Budapest, Hungary
2 Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
3 Semmelweis University, School of PhD Studies, Budapest, Hungary
4 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
5 Semmelweis University, Budapest, Hungary
6 Gottsegen Hungarian Institute of Cardiology, Department of Cardiac Surgery, Budapest, Hungary
Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 10 years after cardiac surgery.
After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for major adverse cardiac and cerebral events (MACCE) were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths. During a median follow-up of 9.8 years (25th to 75th percentile, 9.3 to 10.3 years), the mortality rate was 29.4 % (53 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.26, 95%CI:1.12-1.41), a higher preoperative STAI-T score (points; AHR:1.04, 95%CI 1.01-1.08), lower education level (school years; AHR:0.89, 95%CI:0.81-0.98), and the occurrence of MACCE during follow up (AHR:2.62, 95%CI:1.48-4.6). In the postdischarge model, the postoperative BDI score (points; AHR: 1.07, 95%CI: 1.03-1.12) was independently associated with mortality. Our results suggest that the assessment of psychosocial factors, particularly anxiety, depression and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.
Keywords: depression, anxiety, cardiac surgery
CORRESPONDING AUTHOR: Székely Andrea, Semmelweis University, Budapest; manci33@yahoo.com
O284
ENHANCING RESOURCEFUL SKILLS: AN INTERVENTION TO IMPROVE OUTCOMES OF FAMILY CAREGIVERS AND PERSONS WITH ALZHEIMER’S DISEASE
Gonzalez EW.1, Lippa CF,.2, Polansky M.3
1 Drexel University, College of Nursing & Health Professions, Philadelphia, USA
2 Drexel University, School of Medicine, Philadelphia, USA
3 Drexel University, School of Public Health, Philadelphia, USA
Purpose: This study examined the effects of enhancing resourceful skills on caregiver’s resourcefulness, anxiety, preparedness and frequency of care-recipient’s behavior problems while caring for persons with dementia.
Theoretical rationale: Enhancing resourceful skill in family caregivers is postulated to enable caregivers to achieve goals by self-regulation of negative emotions, apply problem-solving skills, cognitively reframe the caregiving issues and maintain confidence to function at an optimal level.
Methodology: A stratified randomized clinical trial (ethnicity and resourcefulness) was used to compare the effectiveness of enhancing resourceful skills versus the standard care in 102 family caregivers (47 experimental; 55 control). Outcomes were measured at baseline, 6 weeks and 3 months post intervention. Resourcefulness was measured using Rosenbaum’s (1982) Self-Control Scale. Anxiety was measured using the State-Trait Anxiety Inventory –State subscale (Spielberger et al, 1982). Caregiver preparedness was measured using Preparedness for Caregiving Scale (Archbold et al., 1990), Frequency of behavior problems was measured using the Revised Behavior Problem Checklist (Teri et al, 1992). Descriptive statistics and general linear model (univariate) were used to analyze the data.
Results: The ANCOVA analysis showed that after controlling for baseline resourcefulness, family caregivers in the intervention group demonstrated increased resourcefulness immediately post intervention (6 weeks) F(1,99) =15.74, p < .001 and at 3 months, F(1,70) = 4.18,p < .05 compared to those in the control group. At 6 weeks the intervention group reporting higher anxiety F(1,86) = 6.86, p < .01 was compared to the control group. There were no significant differences between groups on preparedness F(1,81) = .99,p = .32 and occurrence of behavior problems. At 3 months, there was a significant difference between groups on preparedness F(1,70) = 5.12, p = .03 although not on anxiety F(1,70) = 1.13,p = .29 and occurrence of behavior F(1,65) = 3.69,p = .06. However, anxiety in the intervention group decreased (mean = 35; SD = 11.5) while those in the control (mean = 40.4; SD = 11.7) group increased. Similarly, occurrence of behavior in the intervention group decreased while those in the control group increased. Enhancing resourceful skills improves caregiver resourcefulness, preparedness and decrease occurrence of patient behavior problems.
The project described was supported by Grant Number R15 NR0009490-01A1from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.
Keywords: Aging; Anxiety
CORRESPONDING AUTHOR: Gonzalez Elizabeth W, Drexel University; ewg22@drexel.edu
Workplace Interventions to Improve Health
O285
SYSTEMATIC REVIEW OF ACTIVE WORKSITE INTERVENTIONS TO REDUCE SICK LEAVE
Odeen M., Tveito T., Heide Magnussen L., Mæland S., Larun L., Eriksen H.
Uni Health/Uni Research, Bergen, Norway
Background: The workplace is increasingly being used as a venue for interventions where the goal is to prevent and to reduce sick leave, aimed at variety of medical conditions.
Objectives: This review attempts to give an overview of the general effectiveness of active interventions in the workplace aimed at preventing and reducing sick leave, across diagnostic categories.
Methods: Searches were conducted in Pubmed, Embase, Psych-info and ISI web of knowledge (December 2011). Inclusion criteria were studies where: 1) The participants were over 18 years, and have an active role in the intervention, 2) the intervention was done (at least partly) at the workplace or at the initiative of the workplace, and 3) sick leave was measured quantitatively. Two reviewers independently screened articles, extracted data and assessed risk of bias using the Cochrane risk of bias tool.
Results: From an original database of 1871 articles we assessed 75 for eligibility. 34 articles were included for analysis, with a total of 46 comparisons. Risk of bias analysis showed 4 high quality, 12 medium and 18 low quality studies. 12 Interventions from 10 different studies showed a statistically significant effect on sick leave, 7 of these were on back pain. Studies documenting positive or negative effect were significantly smaller (median n = 113) than studies with no effect (median n = 264). A qualitative synthesis of the data was done, and we found evidence of effect of the Sheerbrooke model and graded activity on sick leave. Furthermore, there was evidence that education and physical activity, done either separately or together, was not effective in reducing sick leave. For other interventions the results were too few or too divergent to make a judgment. When assessing the studies by diagnostic groups, interventions focusing on musculoskeletal and mental health complaints were most effective. None of the 16 interventions aiming at multiple health complaints or prevention were significant. Results were similar for high and low quality studies, and for studies using register data or self-report data on sick leave.
Conclusion: Active workplace interventions were generally not effective in reducing sick leave, but there were evidence of effect of the Sheerbrooke model and of Graded Activity.
Keywords: Worksite health, occupational health, intervention
CORRESPONDING AUTHOR: Odeen Magnus, Uni Heatlh, Bergen, Norway; magnus.odeen@uni.no
O286
BLOOD PRESSURE REDUCTION FOLLOWING INTERVENTION ON PSYCHOSOCIAL WORK FACTORS: A LONGITUDINAL STUDY
Trudel X.1, Gilbert-Ouimet M.1, Brisson C.2, Milot A.3, Vézina M.2, Masse B.4
1 URESP du Centre de Recherche FRSQ du CHA Universitaire de Québec, Department of Social and Preventive Medicine, Quebec, Canada
2 Laval University, Department of Social and Preventive Medicine, Quebec, Canada
3 Laval University, Department of Medicine, Quebec, Canada
4 University of Montreal, Department of Social and Preventive Medicine, Montreal, Canada
Background: Adverse psychosocial work factors have been shown to contribute to the development of chronic health problems, such as hypertension. Preventive interventions aimed at reducing psychosocial work factors have been conducted in workplaces. However, few studies have rigorously evaluated their effectiveness in reducing psychosocial work factors and improving blood pressure (BP). This study assessed the long term effects of a preventive psychosocial workplace intervention on ambulatory BP.
Methods: An intervention was conducted in a large public insurance company to reduce adverse psychosocial work factors. These factors and ambulatory BP were measured at baseline, 6- and 30-month post-intervention. Ambulatory BP measurements were taken every 15 minutes during a working day. Psychosocial work factors were measured using validated scales. Associations between exposure to psychosocial work factors and BP were also examined, using generalized estimating equations (GEE). The study sample consisted of 2132 workers and 4263 observations.
Results: During the entire study period, workers exposed to high psychological demands, job strain and effort-reward imbalance had mean blood pressure approximately 2 mmHg higher than workers not exposed to these factors. By the 6 and 30 month follow-up, three of the targeted factors had significantly decreased (high psychological demands, low reward and effort-reward imbalance). The 30 month follow-up also showed significant reductions in the prevalence of hypertension (16.4% to 12.5%), mean systolic BP (126.1 to 123.9 mmHg) and mean diastolic BP (80.6 to 78.8 mmHg).
Conclusion: These results suggest that interventions that aim to reduce adverse psychosocial work factors may lead to improvements in BP.
Keywords: Hypertension Intervention
CORRESPONDING AUTHOR: Trudel Xavier, Université Laval; xavier.trudel.1@ulaval.ca
O287
EFFECTS OF STRESS MANAGEMENT INTERVENTIONS ON WORK-FAMILY CONFLICT
Cserhati Z., Stauder A., Adam SZ., Konkolÿ Thege B., Pilling J., Purebl GY., Szekely A., Kopp M.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
Background: Work-family conflict is a form of interrole conflict in which the role pressures from the work and family domains are incompatible. Time-based, stress-based and behavior-based forms are differentiated. Work-family conflict can have various outcomes like decrease in work performance, burnout, psychological strain, depression and physical health complaints. Interventions targeting work-family conflict are mostly organization-focused, whilst individual factors like negative affect and coping strategies also serve as antecedents. Stress management interventions (SMIs) are individual-focused interventions which are proved to be beneficial in improving well-being and reducing stress-related complaints. Their effects on work-family conflict were not investigated earlier.
Methods: 472 employees from diverse background received one of two different types of 16-hours stress management interventions (Williams LifeSkills Program and risk reduction training) or a three-hour lecture on stress and coping (comparison group). Techniques used in cognitive behavioral therapy and relaxation were elements of both types of trainings, while risk reduction training put additional emphasis on healthy lifestyle components. In a one-year follow up, we included 259 participants. Work-family conflict was measured by the Carlson Multidimensional Scale. For work-related stress, the Siegrist Effort-Reward Imbalance Scale (ERI), for perceived stress, the Cohen Perceived Stress Scale (PSS10) was used.
Results: There was significant decrease in the level of stress-based work-family conflict (p < 0.001) and perceived stress (p < 0.05) in both SMI groups, while there was no significant change in comparison group. Behavior-based work-family conflict decreased significantly only in risk reduction training group (p < 0.01), time-based work-family conflict remained unchanged in all groups. Improvement in work-related stress was measured only in Williams LifeSkills group (p < 0.05).
Discussion: Stress-management interventions can be beneficial in reducing work-family conflict. Investigating the interactions between work-related stress or perceived stress and different forms of work-family conflict may require further research.
Research supported by the Hungarian Ministry of Health.
Keywords: stress, intervention, worksite health
CORRESPONDING AUTHOR: Cserhati Zoltan, Semmelweis University Budapest; csirzol@yahoo.com
O288
DOES WORKPLACE BULLYING INCREASE RISK OF ONSET OF A MAJOR DEPRESSIVE EPISODE IN FEMALE ELDERCARE WORKERS?
Rugulies R.1, Madsen I.1, Hjarsbech P.1, Hogh A.2, Borg V.1, Carneiro I.1, Aust B.1
1 National Research Centre for the Working Environment, -, Copenhagen, Denmark
2 University of Copenhagen, Department of Psychology, Copenhagen, Denmark
Background: Adverse psychosocial working conditions may play a role in the aetiology of major depressive episodes (MDE). The aim of this study was to analyze whether exposure to workplace bullying increases risk of onset of MDE among 5701 females employees in the Danish eldercare sector.
Methods: We sent out questionnaires about working conditions and health to eldercare workers in 2004/2005 and again in 2006/2007. Response rates were 78.1% (9949 out of 12744) at baseline and 63.4% (6304 out of 9949) at follow-up. Mean time of follow-up was 20 months. Participants were given a definition of bullying and were subsequently asked "Have you been exposed to bullying at your current workplace within the last 12 months?", with the response categories "no", "yes, now and then", "yes, monthly", "yes, weekly", "yes, daily or almost daily". We created a 3-level exposure variable, with the categories (1) "no bullying" (reference group), (2) "occasional bullying" (combining "now and then" and "monthly) and (3) "frequent bullying" (combining "weekly" and "daily/almost daily"). MDE was assessed with the "Major Depression Inventory", an instrument that follows the DSM-IV diagnosis of major depression. The instrument had been previously validated in both clinical and population-based studies. We used multiple logistic regression analyses to investigate the prospective association between exposure to bullying at baseline and onset of MDE at follow-up among participants free of MDE at baseline. Further, we analyzed reciprocal effects, i.e. whether MDE at baseline predicted bullying at follow-up.
Results: The prevalence of bullying at baseline was 10.0% (occasional bullying) and 1.9% (frequent bullying), respectively. Onset rates of MDE at follow-up were 1.5%, 3.4%, and 11.3% in the groups of no, occasional and frequent bullying, respectively. Both occasional bullying (OR = 2.22, 95% CI = 1.31-3.76) and frequent bullying (OR = 8.45, 95% CI = 4.04-17.70) predicted onset of MDE, after adjustment for age, cohabitation, type of job, seniority, and length of follow-up. In the analyses on reciprocal effects, MDE at baseline did not predict bullying at follow-up (OR = 0.93, 95% CI = 0.47-1.84).
Conclusion: Exposure to workplace bullying strongly increased risk of MDE among female eldercare workers. MDE did not predict risk of bullying. Eliminating bullying at work may be an important contribution to the prevention of MDE.
Keywords: Depression; Occupational Health
CORRESPONDING AUTHOR: Rugulies Reiner, NRCWE, Copenhagen; rer@nrcwe.dk
O289
JOB DEMANDS AND DEPERSONALIZATION AMONG MEDICAL PROFESSIONALS. THE MODERATING ROLE OF PHYSICAL ACTIVITY
Bria M.1, Baban A.1, Spanu F.1, Lucacel R.1, Rotar I.2, Constantea N.2
1 Babes-Bolyai University, Psychology, Cluj-Napoca, Romania
2 Iuliu Hatieganu University of Medicine and Pharmacy, Faculty of Medicine, Cluj-Napoca, Romania
Aim: Moderate levels of physical activity have been shown to reduce the impact of work stress on mental health and work performance. In the organizational context, much of the research has focused on the buffering effect of job resources in the relationship work demands – burnout, while individual strategies have received less attention. The aim of the present research was to investigate the role of physical activity in reducing the impact of job demands on burnout.
Method: Data were collected from a sample of 311 health professionals in Romania (165 physicians and 146 nurses). Maslach Burnout Inventory was used to collect data on emotional exhaustion and depersonalization. Physical, organizational and emotional work demands in medical settings were measured using an instrument developed for the ORCAB European project. All scales show good reliability coefficients. Physical activity was measured using self reported data on the frequency of exercising / week. Moderation effects were tested using hierarchical regression in SPSS.
Results: A negative relationship was found between the frequency of physical activity and depersonalization, but not emotional exhaustion. Physical activity was found to moderate the impact of organizational demands (ΔR2 = .013, F(1, 305) = 4.963, p > .05, β = -.115), and emotional demands (ΔR2 = .019, F(1, 307) = 7.323, p > .01, β = -.140) on depersonalization. No similar effect was found for the relationship physical demands – depersonalization.
Conclusions: The results show that when confronting with the same level of organizational and emotional demands, health professionals that engage more frequent in physical activity report lower levels of depersonalization. These results have implications for interventions aiming at reducing burnout among health professionals, showing that individual strategies, like engaging in physical activity, might help decrease burnout symptoms.
Keywords: occupational health, physical activity
CORRESPONDING AUTHOR: Bria Mara, Babes-Bolyai Univ., Cluj-Napoca; marabria@psychology.ro
O290
WORKPLACE JUSTICE AND OTHER PSYCHOSOCIAL WORK HAZARDS IN ASSOCIATION WITH RETURN TO WORK IN MALE WORKERS WITH CORONARY HEART DISEASES: A PROSPECTIVE STUDY
SU TC.1, Cheng Y.2, DU CL.3
1 National Taiwan University, Internal Medicine, Taipei, Taiwan
2 National Taiwan University, Institute of Health Policy and Management, Taipei, Taiwan
3 National Taiwan University, Department of Occupational and Environmental Medicine, Taipei, Taiwan
Introduction: Return to work (RTW) is an important measure of success in the treatment of patients with CHD or AMI. In addition to medical factors, previous studies indicated that psychosocial work hazards, including job demands, job control and workplace justice are important predictors for the risk and prognosis of coronary heart diseases (CHD, including acute myocardial infarction and severe CHD). The study aimed to examine the impact of psychosocial work hazards on return to work at 12 months following the first onset of above diseases in a tertiary hospital of Taiwan.
Subjects and Methods: From Jan, 2008 though Nov, 2011, 327 male patients, 25-65 years of age, who were first diagnosed with AMI, severe CHD s/p CABG or POBAS and had a formal job before disease onset were recruited before discharge or within 2 weeks after discharge. Psychosocial work hazards were assessed by a standardized self-administered questionnaire, which included validated scales for job demands, job control and workplace justice, as well as items for other work characteristics such as work hours, shift work. A case manager collected questionnaires and checked for their completeness. Vascular risk factors and clinical information, such as blood sugar, serum lipids level and history of hypertension, diabetes status were also recorded from detailed chart review and personal communication at the recruitment, 4th and 12th months after the disease onset. Unsuccessful RTW was inquired at 4th and 12th months by structured questionnaire and reconfirmed at 12 months if patients failure to RTW
Results: After controlling for multiple confounding factors, workers with a high demand and low control job were more likely to have an unsuccessful RTW (OR (95% C.I.) =2.75 (1.13-6.71), p < 0.05) as compared to reference groups (other three quadrants of job strain model), while workers with higher level of workplace justice were less likely to have a unsuccessful RTW (OR = 0.21, P < 0.01). While we combined both workplace justice and work strain in the same model for multivariate analysis, workplace justice but not work strain remained a strong negative predictor of unsuccessful RTW in CHD patients, with an odds ratio (95% C.I.) of 0.24 (0.08-0.73).
Conclusion: These findings underscore the importance of psychosocial work factors, especially workplace justice, in predicting successful RTW. To facilitate successful RTW for CHD patients, it is important to incorporate interventions for the improvement of psychosocial work conditions.
Keywords: coronary heart disease, occupational health
CORRESPONDING AUTHOR: Du Chung-Li, NTU Hospital, Taipei; ddd213g@yahoo.com.tw
Psychophysiology and Functional Symptoms
O291
EPINEPHRINE AND NOREPINEPHRINE RESPONSES TO PHYSIOLOGICAL AND PHARMACOLOGICAL STIMULATION IN CHRONIC FATIGUE SYNDROME
Strahler J.1, Fischer S.1, Nater U.1, Ehlert U.2, Gaab J.3
1 University of Marburg, Clinical Biopsychology, Marburg, Germany
2 University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
3 University of Basel, Clinical Psychology and Psychotherapy, Basel, Switzerland
Chronic Fatigue Syndrome (CFS) is a disorder of unknown etiology characterized by severe fatigue lasting 6 months or longer. CFS has previously been associated with a state of disturbed (re-)activity of the sympathetic nervous system (SNS) that might be explained by an increased sensitivity to stressful stimuli. However, research on neuroendocrine markers of the SNS, such as epinephrine (E) and norepinephrine (NE) in CFS is scarce.
To investigate SNS reactivity in CFS patients, we mimicked real-life stress using a standardized cycle ergometry test until exhaustion (ERGO) (Study 1). Further, we implemented a highly standardized pharmacological challenge test (the Insulin Tolerance Test, ITT; Study 2). 21 CFS patients (10 women) were compared with 20 age-, sex- and BMI-matched healthy controls (9 women). Plasma E and NE were collected immediately before, as well as 10 and 30 min after the ERGO in Study 1 and injection of 0.15U/kg soluble insulin in Study 2.
Both ERGO and ITT induced significant catecholaminergic responses after stimulation (all p < .001). During the ERGO, baseline E (but not NE) levels were lower in CFS patients (p = 0.005). Catecholaminergic responses to the ERGO differed significantly between groups (E: p = 0.048; NE: p = 0.041). However, the inclusion of baseline E abolished this effect. In the ITT, groups did not differ at baseline or in their response (E: p = .235; NE: p = .842). Descriptively, CFS patients showed a reduced mean E response in both conditions (EERGO: p = .063; EITT: p = .216) while NE mean responses were significantly lower only during the ERGO (NEERGO: p = .032 NEITT: p = .909).
Our results suggest a marked catecholaminergic response to two different types of stress in CFS. Our results of lower baseline levels of E in CFS patients are in contrast to prior studies. Likewise, we report evidence of a hyporesponsive SNS in CFS, indicating a dampened sympatho-adrenal counterregulatory response to an active physical stressor and metabolic challenge in these patients. A better understanding of a dysregulation of the SNS might improve diagnosis and treatment options of CFS.
Keywords: Chronic fatigue syndrome, Exercise, Reactivity, Metabolic regulation
CORRESPONDING AUTHOR: Strahler Jana, University of Marburg, Marburg; strahler@uni-marburg.de
O292
NON-CARDIAC CHEST PAIN: THE ROLE OF PHYSICAL, PSYCHOLOGICAL, AND SERVICE-RELATED FACTORS IN THE PERSISTENCE OF PAIN AND HEALTH SERVICE USE
Sheehan A.1, McGee H.1, Jennings S.2, McAdam B.3
1 Royal College of Surgeons in Ireland, Psychology, Dublin, Ireland
2 Health Services Executive, Ireland, Population Health, Dublin, Ireland
3 Beaumont Hospital, Ireland, Cardiology, Dublin, Ireland
Introduction: Chest pain is one of the most frequent complaints in medical settings, yet more than half of cases have no detectable cause. These patients are typically discharged with a label of non-cardiac chest pain (NCCP). Patients with NCCP have been shown to have poor outcomes in terms of continued symptoms and persistent health service use. Predictors of poor outcomes have been largely unexplored.
Aim: This study sought to examine the predictors of persistent pain and health service use for patients in whom a cardiac diagnosis had been excluded.
Methodology: A prospective cohort study was initially conducted with 169 participants with chest pain who attended exercise stress testing and had normal test results. Baseline and one-year assessments were conducted using validated self-completion measures. A 92% follow-up participation rate was achieved.
Results: At one year follow-up, 69% reported continued pain. In addition, nearly half of participants had returned to their general practitioner and one in ten re-attended at the emergency department for the investigation of chest pain. Logistic regression analyses examined predictors of persistent pain and persistent health service use. The results indicated that physical, psychological and service-related factors were predictive of persistent pain, in particular, pain precipitated by movement, cardiac anxiety, and lack of communication about test results. When participants with continued chest pain were categorised into persistent healthcare users and non-persistent healthcare users, psychological factors including anxiety, cardiac anxiety, depression and illness perceptions distinguished participants with persistent healthcare use. These factors did not distinguish participants with no further chest pain from those with persistent pain who did not persist in healthcare-seeking behaviour.
Conclusion: Psychological factors appear to drive persistent service use in patients with NCCP and interventions targeting these are likely to reduce medical costs. A multi-disciplinary approach to understanding and managing NCCP is needed. Patients with NCCP are not a homogenous patient group and an individualised, stepped-care approach to management is warranted.
Keywords: Pain; Illness behaviour; Cognitive factors
CORRESPONDING AUTHOR: Sheehan Aisling, RCSI; aislingmichelle@gmail.com
O294
PERCEIVED DISCRIMINATION AND CARDIOVASCULAR RESPONSES: INTERACTIONS OF RACE AND GENOTYPE
Bishop GD.1, Zhang X.2, Ngau F.1, Tai ES.3, Lee J.3
1 National University of Singapore, Department of Psychology, Singapore
2 National University of Singapore, Duke-NUS Graduate Medical School, Singapore
3 National University of Singapore, Department of Medicine, Singapore
Objective: This research investigated the role of perceived discrimination (PD) in cardiovascular responses among Chinese, Indians, and Malays in Singapore.
Methods: 325 Singaporeans (147 Chinese, 88 Indian, 90 Malay; 177 females, mean age 48.2 yrs) engaged in two baseline periods and two laboratory tasks (mental arithmetic and anger recall) during which blood pressure and heart rate were recorded. As no interactions were obtained involving task, reactivity was averaged across tasks. Perceived discrimination was measured using the Perceived Discrimination Scale (Williams et al., 1997). Participants were also genotyped for the tri-allelic 5HTTLPR. Due to relative rarity individuals with two copies of the high active allele (HH) were not included in analyses.
Results: PD varied by race with Indians showing the lowest PD (p < .05). PD was higher among males than females (p < .05) and also higher among those with the two copies of the low acting allele (LL) for 5HTTLPR (p < .01) than was the case for those with one copy of the high acting allele (LH). Baseline measures for both SBP and DBP showed a significant interaction between race and PD (p < .05 for both) such that for Indians SBP baseline was higher as a function of higher PD whereas it was lower for Chinese. No effect was found for Malays. For DBP reactivity race, genotype and PD interacted (p < .005) such that for Chinese with the LH genotype higher PD was associated with lower DBP reactivity whereas this was not true for those with the LL genotype. For Indians with the LL genotype higher PD was associated with lower reactivity whereas this was not true for those with the LH genotype. For Malays the interaction was not significant. A near significant interaction between genotype and PD was found for heart rate reactivity (p < .06) such that individuals with the LL genotype showed a stronger positive relationship between PD and reactivity than was the case for those with the LH genotype.
Conclusions: These data show that PD varied by race, sex, and genotype. Further the effects of PD on cardiovascular responses varied by race and genotype with the strongest interactions of genotype and PD being for Chinese and Indians.
Keywords: blood pressure, ethnic differences, genetics
CORRESPONDING AUTHOR: Bishop George, Nat. Univ of Singapore; psygb@nus.edu.sg
O295
THE ASSOCIATION OF WHEEZING AND ASTHMA WITH MAJOR DEPRESSIVE EPISODES: AN ANALYSIS OF 245,727 WOMEN AND MEN FROM 57 COUNTRIES
Loerbroks A.1, Herr R.1, Subramanian SV.2, Bosch JA.3
1 Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg, Germany
2 Harvard School of Public Health, Department of Society, Human Development & Health, Boston, USA
3 University of Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands
Background: Epidemiological studies have shown that asthma is positively associated with depression. Most of this evidence stems from studies conducted in Western populations (e.g., Europe, North America and Australia). It is still elusive whether such findings generalize to non-western countries. To address this question, the present study investigated the association of asthma and wheezing with depression in a large multinational sample.
Methods: We used data from the 2002 World Health Survey. Participants reported physician-diagnosed asthma and attacks of wheezing within the last 12 months. Questions on depressive symptoms, their duration and persistence were used to define presence of a major depressive episode (MDE) within the last 12 months. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression for the entire sample, by continent (Australia, Europe, South America, Asia, and Africa), and by country. Complete information was available for 57 countries.
Results: Both asthma and wheezing were associated with MDE in the entire sample (OR = 2.45, 95%CI = 2.18-2.75 and OR = 3.16, 95%CI = 2.84-3.52, respectively). Similar associations were found for all continents with generally stronger ORs in South America, Asia, and Africa for both asthma (ORs > = 1.8) and wheezing (ORs > = 3.0).On the country-level, wheezing showed a consistent pattern of association with MDE. Similar patterns were found for asthma.
Conclusions: Despite a range of country differences that could affect the association of asthma with depression, such as access to health care, the results of this study indicate that the co-occurrence of asthma and depression is a universal phenomenon.
Keywords: Asthma, Depression, Epidemiology, World Health Organization
CORRESPONDING AUTHOR: Loerbroks Adrian, Heidelberg University; adrian.loerbroks@medma.uni-heidelberg.de
O296
PSYCHOBIOLOGICAL RESPONSES IN WOMEN WITH REGIONAL OR WIDESPREAD MUSCULOSKELETAL PAIN CONDITIONS
Riva R.
Stockholm University, Department of Psychology, Stockholm, Sweden
Musculoskeletal disorders (MSDs) are very common. Regional chronic shoulder and neck pain (SNP) and widespread chronic pain due to fibromyalgia syndrome (FMS) are examples of MSDs characterized by altered physiology of the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. The aims of the present study is to compare the cortisol awakening response (CAR) in SNP women, FMS patients and healthy controls, and to compare salivary cortisol levels, urinary catecholamine levels (adrenaline, noradrenaline, and dopamine), and cardiovascular responses in FMS patients and healthy controls. Self-ratings of sleep, anxiety, perceived stress, and pain were also investigated. CAR tended to be higher in SNP women than in healthy controls, whereas it was significantly higher than in FMS patients. Moreover, CAR was significantly lower in FMS patients than in healthy controls. Cortisol levels were lower in FMS patients than in healthy controls during the rest of the day as well. In addition, adrenaline and dopamine (but not noradrenaline) levels were significantly lower in FMS patients than in healthy controls. Resting heart rate was significantly higher in FMS patients than in healthy controls, but no differences emerged during stress provocation or unconstrained daily activities. Finally, SNP women and FMS patients reported more pain and health complaints than did healthy controls, but SNP women were less affected. Potential confounders (e.g., age, obesity, smoking habit, employment fraction, sleeping problems, and physical exercise) had no effects on the findings. Taken together, the findings show altered ANS and HPA axis regulation in FMS patients. Specifically, the hyperactive HPA axis found in SNP women (i.e., higher cortisol levels) might constitute a preliminary stage of a hypoactive HPA axis in FMS patients (i.e., lower cortisol levels). In view of this, an altered regulation of the HPA axis in the progression from regional to widespread MSDs may follow a temporal development.
Keywords: cortisol, musculoskeletal disorders, psychoneuroendocrinology, stress
CORRESPONDING AUTHOR: Riva Roberto, Stockholm University, Stockholm; roberto.riva@psychology.su.se
Psychosocial Factors and Interventions in Diabetes Management
O297
THE COURSE OF DEPRESSION IN PEOPLE WITH DIABETES: A PROSPECTIVE STUDY IN CANADA
Schmitz N.1, Gariepy G.2, Smith K.1, Badawi G.1, Malla A.1, Wang J.3, Boyer R.4, Strychar I.5, Lesage A.4
1 McGill University, Psychiatry, Montreal, Canada
2 McGill University, Department of Epidemiology and Public Health, Montreal, Canada
3 University of Calgary, Psychiatry, Calgary, AB, Canada
4 University of Montreal, Psychiatry, Montreal, Canada
5 University of Montreal, Nutrition, Montreal, Canada
Context: The longitudinal course of depression in general population samples is poorly understood, especially in the context of people with chronic conditions like diabetes.
Objective: The aim of the present study was to identify and describe pathways of depression in a community sample of people with diabetes in Quebec, Canada.
Design, Setting, and Participants: A prospective community based study (Diabetes Health and Wellbeing Study, DHS) in Quebec was carried out between 2008 and 2011 (n = 2003). Participants with self-reported diabetes were assessed at baseline and at 1, 2 and 3 years follow-ups.
Main: Outcome MeasuresMinor and major depression was assessed using the Patient Health Questionnaire (PHQ-9).
Results: Longitudinal latent class analysis was performed by using minor and major depression categories. Analysis yielded four clusters representing different pathways of depression: Cluster 1 (“no depression”; 67 %): participants had neither minor nor major depression over time. Cluster 2 (“slowly increasing prevalence of minor and major depression over time”; 20%): participants had low levels of depression at baseline but increasing levels of minor and major depression over time; while most of the Cluster 3 (“increasing major depression”; 6%) participants had high and increasing levels of major depression over time. Participants in Cluster 4 (“improved depression”, 7%) started with high levels of depression but progressed to low levels of depression. Clusters showed statistically significant differences in disability, lifestyle related behavior and socio-demographic characteristics (p < 0.01).
Conclusion: Our results provide important evidence of different pathways of depression in people with type 2 diabetes. Identification of four distinct groups of participants might improve our understanding of the course of depression and may provide a basis of classification for intervention.
Keywords: Depression, Diabetes
CORRESPONDING AUTHOR: Schmitz Norbert, McGill University; norbert.schmitz@mcgill.ca
O298
TRUST IN PHYSICIAN, SATISFACTION WITH HEALTH SERVICES, BELIEFS ABOUT MEDICINES, ADHERENCE AND GLYCEMIC CONTROL IN TYPE 2 DIABETES
Costa V., Pereira M G.
University of Minho, School of Psychology, Braga, Portugal
Background: At diagnosis, a large proportion of people with diabetes have to readjust their daily routines in order to integrate self-care behaviors related to diabetes. Social-cognitive variables regarding self-monitoring of blood glucose (SMBG) and relationship with health care system have an important impact on adherence and glycemic control in diabetes. The aim of this study is to analyze the relationship between trust in physicians, satisfaction with health services, beliefs about medicines, social-cognitive variables (intention, attitude, subjective norms, perceived behavioral control, action and coping planning), adherence and glycemic control in type 2 diabetes.
Method: 179 subjects with type 2 diabetes, diagnosed in the past 12 months, answered the instruments: Trust in Physician Scale (Anderson, & Dedrick, 1990), Patient Satisfaction Questionnaire (McIntyre, Pereira, Silva, Fernandes, & Correia, 1999), Questionnaire on Beliefs about Medicines (Horne, Weinman, & Hankins, 1999), Social-Cognitive Variables in Diabetes Self-Care Questionnaire (Pereira, Araújo-Soares & Costa, 2008), Revised Summary of Diabetes Self-Care Activities Measure (Toobert, Hampson, & Glasgow, 2000) and Medication Adherence Report Scale (Horne, 2001). Glycemic control was assessed by HbA1c value.
Results: Satisfaction with health care is positively related to SMBG, as well as to adherence to diet, beliefs about medicines, subjective norms and action planning. Trust in physician is positively related to beliefs about medicines, perceived behavior control, action planning, and adherence to oral anti-diabetics, SMBG and diet. In turn, trust in physician reveals itself as an important predictor of adherence to medicines and to SMBG, and intentions to perform SMBG predicts the adherence to this self-care behavior. Results also reveal a significantly relation between beliefs about medicines and intention, attitudes, subjective norms, perceived control and coping planning. Intention, subjective norms, perceived control, action and coping planning are associated with adherence to SMBG. Glycemic control is positively related to adherence to SMBG, intention, subjective norms and negatively related to action planning.
Conclusions: Results show that a positive relationship between type 2 diabetics and health professionals can influence the adherence and adoption of healthy behaviors related to diabetes. Thus, it is pertinent to emphasize, in the contexts of health, the importance of communication and interaction of health professionals with patients as a means of promoting adherence to the care required in the management of diabetes
Keywords: Diabetes, adherence, beliefs
CORRESPONDING AUTHOR: Costa Vera, University of Minho, Braga; vera.asc@gmail.com
O299
THE IMPORTANCE OF BEHAVIORAL MEDICINE INTERVENTIONS FOR DIABETES TO GLOBAL PUBLIC HEALTH
Turner RJ.1, Gellman MD.2
1 Quintiles, Integrated Clinical Services, -, Durham, USA
2 University of Miami, Department of Psychology, Miami, USA
Diabetes is a global public health concern of staggering proportions. In the United States the 2011 National Diabetes Fact Sheet noted that 25.8 million children and adults—8.3% of the population—have diabetes, and another 79 million have prediabetes. In 2011 the International Diabetes Federation observed that 366 million people had diabetes, a figure expected to rise to 552 million by 2030. Most people with diabetes live in low- and middle-income countries, which will also see the greatest increases over the coming decades.
Randomized clinical trials have convincingly demonstrated that behavioral approaches to the prevention of diabetes can be efficacious. The Diabetes Prevention Program, conducted at 27 centers in the United States, had three treatment groups: medication (metformin), medication placebo control, and lifestyle intervention. The 3,234 subjects were all 25 years of age or older, had impaired glucose tolerance, and a BMI of at least 24 kg/m2. The behavioral intervention was successful in reducing the risk for developing T2DM by 58% compared with a 31% reduction with metformin at 2.8 years of follow-up, and, importantly, was effective regardless of age, sex, and race. The Finnish Diabetes Prevention Trial reported very similar findings. It is now important to investigate the large-scale effectiveness of such behavioral interventions and to pursue their role in public health and health policy.
It is also noteworthy that pharmaceutical therapy for T2DM is currently in a state of crisis. Awareness of potential cardiovascular side-effects has led to new regulatory mandates that may severely restrict the flow of new anti-diabetic drugs. Additionally, nonadherence rates to available regimens are alarmingly high. Since nonadherence is a behavioral (and sociocultural) issue, Behavioral Medicine is extremely well positioned to provide greatly-needed assistance.
Behavioral Medicine approaches to diabetes prevention at the public health level should be pursued as vigorously as possible. Additionally, this presentation will provide examples of how scientists and physicians in Behavioral Medicine can work with various other organizations in the medical community to improve medication adherence when such therapy is indicated.
Keywords: Adherence, Diabetes
CORRESPONDING AUTHOR: Turner Rick, Quintiles, Durham; rick.turner@quintiles.com
O301
TAILORED SUPPORT FOR TYPE 2 DIABETES PATIENTS WITH AN ACUTE CORONARY SYNDROME AFTER DISCHARGE FROM HOSPITAL
Kasteleyn M., Gorter K., Rutten G.
University Medical Center Utrecht, Julius Centre, Utrecht, The Netherlands
Background: In Type 2 Diabetes Mellitus (T2DM) patients, an Acute Coronary Syndrome (ACS) may result in a decreased quality of life and depressive symptoms. We aim to develop and evaluate a tailored supportive intervention by a trained diabetes nurse to help them cope with the consequences of an ACS after discharge from hospital. Here we describe the development of the intervention and the first experiences.
Focus groups: To investigate their needs and wishes we conducted two semi-structured focus groups with 14 T2DM patients (71% male, aged 61-77 yrs). One focus group with three partners (2 males, aged 64-75) was conducted. Patients with an ACS mostly mentioned problems on physical exercise (n = 7), sexuality (n = 7) and medical treatment (n = 8). Fewer problems were experienced on diet (n = 1). The patients (n = 9) were not satisfied with the information and support offered by healthcare professionals. Partners had a lot of concerns about the patients as well (n = 3). Both patients and their partners welcomed our program.
Intervention: Trained diabetes nurses will visit the patients three times at home, following a strict protocol. The first visit (65 minutes) will take place within three weeks after discharge from the hospital, focusing on information exchange and self-efficacy. The second visit (45 minutes) is two weeks later, with the focus on self-efficacy and illness perceptions. The third visit (45 minutes), 2 months later, focuses on the future. Close relatives will be involved.
Training: Six experienced diabetes nurses were trained during a course by the executive researcher, a cardiac nurse, a GP and a psychologist. Furthermore, a patient with diabetes and an ACS was shared his experience of the period after discharge.
Pilot study: To optimize the intervention and to check the feasibility, we conducted a pilot study. Three patients were visited twice by three different diabetes nurses. Nurses and patients gave feedback, leading to a change in the duration of the visits and in questionnaires.
The trial: The effectiveness of this intervention will be tested in a RCT. Patients will be recruited by their cardiologist directly at discharge from the hospital. The control group (n = 100) will receive a telephonic consultation. Primary outcomes are diabetes related distress, health status, well-being and self-management behavior. Outcomes will be measured with questionnaires directly after discharge from the hospital and five months later. Currently we included 26 patients.
Conclusions: TDM who experience an ACS are in need of tailored support after discharge from the hospital. We developed a tailored intervention that is tested in a RCT.
Keywords: Diabetes, Self management, Self-efficacy, Coping and Coronary Heart Disease
CORRESPONDING AUTHOR: Kasteleyn Marise, UMC Utrecht; m.j.kasteleyn@umcutrecht.nl
O302
IS DEVELOPMENT OF A FEASIBLE PARTICIPANT-CENTRED LIFESTYLE INTERVENTION FOR PEOPLE WITH PREDIABETES IN GENERAL PRACTICE POSSIBLE? A TWO CIRCLE ACTION RESEARCH PROJECT
Maindal HT.1, Bonde A.2, Aagaard-Hansen J.2
1 Aarhus University, Department of Public Health, Aarhus, Denmark
2 Steno Health Promotion Centre, Gentofte, Denmark
Background and aim: Despite strong evidence for lifestyle interventions in diabetes prevention, the interventions are not always feasible and the clinical effects not replicable, when delivered in routine clinical care. The aim of the study was to develop and test a lifestyle intervention for people with prediabetes tailored to general practice in Denmark. The intervention should be feasible in terms of time, resources and competencies available in general practice, and effective in terms of health outcome indicators with the perspective of preventing diabetes.
Methods: General practitioners, practice nurses and researchers worked together to propose new courses of action in diabetes prevention. Two action research circles were used to integrate researcher’s approach with the practitioners’ strategies, practices, and knowledge of the local contexts. The first circle was exploratory whereas the second circle focused and tested lessons learned from the first circle. In total 64 patients were included in the project from eight general practices. Data collection included HbA1c and BMI on a patient level and process data on a practice level.
Results: An intervention feasible for use in general practice with nurses employed was developed. The intervention contained partly basic, constant components such as pedagogical approaches and structural procedures; and partly dynamic components, such as use of pedagogical material and sequences of behaviour changes targeted. The follow up data from 43 patients three months after inclusion showed statistically significant decreases in HbA1cand BMI. The actions research circles revealed a need for future upgrade of the practitioners’ competences in health promotion; and major limitations for the deliverance of the intervention in Danish general practice according to professional, organizational factors and economic remuneration.
Conclusion: The use of action research in the development of a lifestyle intervention targeted people with prediabetes contributed with new perspectives on pedagogical approaches, structural and implementation challenges in general practice. The evaluation suggested that the developed intervention may be effective in terms of prevention of diabetes, but the resource utilization and generalisability may be questioned.
Keywords: Diabetes, prevention, health behaviour change, Physician intervention
CORRESPONDING AUTHOR: Maindal Helle Terkildsen, Aarhus university, Aarhus; htm@alm.au.dk
Implementation Science? Translating the Efficacy of Drug Abuse Treatment Research into the Community
S303
IMPLEMENTATION SCIENCE – TRANSLATING THE EFFICACY OF DRUG ABUSE TREATMENT RESEARCH INTO THE COMMUNITY
Horigian V., Stoutenberg M.
University of Miami, Department of Epidemiology and Public Health, Miami, USA
Implementation science is a key element of translational research. This symposium will highlight the implementation of behavioral-based drug abuse treatment strategies through the National Drug Abuse Treatment Clinical Trials Network (CTN) of the U.S. National Institute on Drug Abuse. Recent research has produced advances in understanding drug abuse and addiction leading to the development of new treatments and therapies to help individuals with drug abuse problems. However, the efficacy of these treatments has been demonstrated primarily in specialized research settings. The CTN is an attempt to fulfill the promise of these advances by partnering with drug abuse treatment centers to provide a platform for the collaboration of academic investigators and community treatment agencies in community-based settings. The first session of this symposium, presented by Viviana Horigian, M.D., will describe the structure of the CTN and examples of successful, behavioral-based trials highlighting implementation science at work in a community setting. This session will highlight two multi-site randomized trials: Motivational Enhancement Treatment for Patients in Treatment for Substance Use Disorders (CTN 004) and Low Cost Motivational Incentives for Stimulant Abusing Patients in Outpatient Psychosocial Treatment Programs (CTN 006) and highlight their impact on current practice and adoption of interventions tested by the CTN. Second, Mark Stoutenberg, Ph.D., will provide an example of how the CTN platform can be used to implement behavioral-based efficacy trials. The STimulant Reduction Intervention using Dosed Exercise (STRIDE) is an ongoing, randomized controlled trial that examines the addition of exercise to treatment as usual in improving drug treatment outcomes in stimulant abusers. Finally, Rodrigo Marin Navarrete, Ph.D. (Unidad de Ensayos Clínicos, Mexico City) will provide an example of how the framework of the CTN is being replicated for use in an international setting, serving as a platform for behavioral-based implementation trials in Mexico. Based on these presentations the symposium will conclude with a discussion led by Dr. Marc Gellman focusing on the implications the CTN approach and the need for additional Implementation Science in Behavioral Medicine.
Keywords: Community intervention, addictive behaviors, effectiveness, evidenced based, research to practice translation
CORRESPONDING AUTHOR: Stoutenberg Mark, University of Miami; mstoutenberg@med.miami.edu
S304
THE NATIONAL DRUG ABUSE TREATMENT CLINICAL TRIALS NETWORK: BRIDGING THE GAP BETWEEN RESEARCH AND PRACTICE TO IMPROVE DRUG ABUSE TREATMENT.
Horigian V.
University of Miami, Department of Epidemiology and Public Health, Miami, USA
Over the past several years, research programs within the National Institutes on Drug Abuse have produced dramatic advances in understanding drug abuse and addiction. However, growing literature demonstrated the failure to properly disseminate, adopt, and implement these evidence-based discoveries. In response to this gap between research and practice, The National Drug Abuse Treatment Clinical Trials Network (CTN) was established by the National Institutes on Drug Abuse in 1999 to improve the quality of addiction treatment using science as a vehicle. This network brings together providers from community treatment centers and scientists from university-based research centers in partnership to cooperatively develop, validate, refine, and deliver new treatment options to patients in Community Treatment Programs. This session will present the structure of the CTN and its impact on practice highlighting results from two behavior-based randomized clinical trials in drug abuse treatment: Motivational Enhancement Therapy for Patients in Treatment for Substance Use Disorders (CTN 004) and Low Cost Motivational Incentives for Stimulant-Abusing Patients in Outpatient Psychosocial Treatment Programs (CTN 006). CTN 004 compared the effectiveness of motivational enhancement therapy (MET) with counseling as usual (CAU) for increasing retention and reducing substance use in a multisite randomized clinical trial of 461 patients treated in 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. MET resulted in more sustained substance use reductions than CAU among alcohol users, but there were no differences for primary drug users. These results prompted recognition and acceptance of rigorous training and supervision in Motivational Interviewing (MI) and MET. CTN 006 randomized 415 stimulant abusers in 8 community-based outpatient psychosocial drug abuse treatment programs to treatment as usual (TAU) with or without a prize draw incentive program. The abstinence-based incentive group had significantly better results in retention and abstinence outcomes. Findings from this study and other secondary analyses inspired treatment providers to the adoption and promotion of motivational incentives.
Keywords: community intervention, effectiveness, addictive behavior, research to practice translation
CORRESPONDING AUTHOR: Stoutenberg Mark, University of Miami; mstoutenberg@med.miami.edu
S305
CONDUCTING A RANDOMIZED CONTROLLED TRIAL DOSED EXERCISE IN A COMMUNITY SETTING
Stoutenberg M.
University of Miami, Department of Epidemiology and Public Health, Miami, USA
Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may also provide a therapeutic effect for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as cardiovascular diseases, weight gain, cognitive function, mood, and overall quality of life, as it has been demonstrated to improve many of these domains in other clinical disorders. Furthermore, behavioral evidence suggests that exercise may serve as a distraction from unwanted behavior and serve as a substitute in place of addictive substances, thereby positively affecting treatment outcomes. This symposium session outlines the methods in which the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), originally designed for behavioural-based, implementation trials, has been modified to serve as a platform for a behavior, randomized, clinical trial. The Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study is a multisite randomized clinical trial that compares the efficacy of exercise compared to health education as potential treatments for stimulant abuse. The STRIDE study is enrolling three hundred and thirty eligible individuals diagnosed with stimulant abuse or dependence who are receiving treatment in a residential setting. These participants are then randomized to one of two treatment arms: a Vigorous Intensity High Dose Exercise Intervention or a Health Education Intervention, in addition to Treatment as Usual. The treatment arms are structured such that the quantity of visits is similar to allow for equivalent contact between groups. In both arms, participants begin with 3 individually supervised sessions per week during a 12-week acute phase of the study. Following the 12-week acute phase, participants begin a 6-month continuation phase during which time they will attend one weekly supervised within their intervention. If proven to be efficacious, the addition of exercise to traditional behavioral counselling may provide a novel treatment strategy for stimulant disorders.
Keywords: community intervention, addictive behavior, exercise, randomized controlled trial
CORRESPONDING AUTHOR: Stoutenberg Mark, University of Miami; mstoutenberg@med.miami.edu
S306
DEVELOPING COLLABORATIVE NETWORKS ACROSS INTERNATIONAL BORDERS: THE CTN FLORIDA NODE ALLIANCE COLLABORATION WITH THE NATIONAL INSTITUTE OF PSYCHIATRY IN MEXICO
Marin Navarrete R.
National Institute of Psychiatry, Unidad de Ensayos Clínicos, Mexico City, Mexico
The National Institute of Psychiatry (NIP) Ramon de la Fuente Muniz is a decentralized public organization within the National Institutes of Health in Mexico. The NIP fulfills the functions of research, treatment, and training. The Clinical Trials Network (CTN) Florida Node Alliance (FNA) at the University of Miami has been implementing behavioral-based effectiveness trials for more than 10 years as part of the CTN, and given their expertise in Hispanic research and research with monolingual Spanish clients, is ideally suited to support the development of research infrastructure in Spanish speaking countries. This symposium session highlights the ongoing collaboration between the FNA and the NIP in providing the training and mentorship to enable the NIP to successfully launch future initiatives to improve the quality of drug abuse treatment throughout Mexico through the dissemination of evidence-based practices in community settings. The ultimate mission of this collaboration is to develop the infrastructure for the creation of a clinical trials network for addictions and mental health treatment in Mexico. The first six months of this collaboration consisted of a series of trainings and mentorship activities to develop the resources to implement effectiveness clinical trials. This included training in general research principles and assisting in the development of systems for clinical trial implementation and management and included specific training in clinical trials methodology, quality assurance, and data management. During the second six months the focus shifted towards providing hands on training and practical experience in preparation for the implementation of a randomized clinical trial to commence in the second year. The second year of this training collaboration is structured around implementing a randomized clinical trial (investigating the effectiveness of motivational enhancement therapy vs counseling as usual in individuals seeking drug abuse treatment) where ongoing practical experience and training is provided. The FNA is providing its expertise through the delivery of protocol specific training, the oversight of quality assurance systems in Mexico and management of the trial at participating sites.
Keywords: community intervention, effectiveness, research to practice translation, training
CORRESPONDING AUTHOR: Stoutenberg Mark, University of Miami; mstoutenberg@med.miami.edu
Psychosocial and Behavioral Aspects of HIV/AIDS
O307
PSYCHOLOGICAL RESOURCES IN WOMEN WITH HIV LIVING IN THE UNITED KINGDOM: BRIEF REPORT
Ferguson A.1, Holttum S.2, Gibson S.3, Fernie BA.3
1 Kings College London University, Academic Department of Rheumatology, London, United Kingdom
2 Canterbury Christ Church University, Department of Applied Psychology, Salomons, Tunbridge Wells, United Kingdom
3 South London and Maudsley NHS Foundation Trust, CASCAID, London, United Kingdom
Health related quality of life (HR-QOL) has become a relevant outcome for researchers in chronic diseases, including the Human Immunodeficiency Virus (HIV). However little is known about positive psychological resources such as resilience that are associated with HR-QOL. This cross sectional study investigated the relationships between HR-QOL and a number of positive resources that reflect ‘resilience’ (self-esteem, self-mastery, optimism and self-efficacy) in a mixed ethnicity group of HIV positive women in the UK. Fifty-nine women completed a battery of measures (utilising either online or paper versions) consisting of the Revised Life Orientation Scale (LOT-R), the Rosenberg Self-Esteem Scale (RSE), the Self − Mastery Scale (SMS), HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) and the Medical Outcomes Study HIV Health Survey (MOS-HIV). Demographic variables (age, number of children, and year of diagnosis) and a biomedical marker of disease progression (CD4 count) were also recorded. Correlation analyses showed that self-esteem, self-mastery and HIV-related self-efficacy (integration) were significantly and positively associated with physical HR-QOL. Optimism, self-esteem, self-mastery and both self-efficacy integration and perseverance were significantly and positively associated with mental HR-QOL. However no significant association was found between HR-QOL and demographic variables or CD4 count. The results are discussed in the context of HIV service provision in the UK with a review of the study’s limitations.
Keywords: HIV, Resilience
CORRESPONDING AUTHOR: Ferguson Anna, King's College London University; annaferguson@nhs.net
308
IMPACT OF SOCIAL AND BEHAVIOURAL FACTORS ON THE HIV/AIDS EPIDEMIC IN SOUTH AFRICA
Setswe G.
School of Public Health and Preventive Medicine, Monash University Australia, Department of Health Sciences, Melbourne, South Africa
Introduction: South Africa has over 5.6 million people living with HIV (PLHIV), but has made significant progress in scaling up some key interventions, with the main goals being to reduce the HIV incidence and to expand access to antiretroviral treatment to people in need. However, the number of new infections continued to outstrip the number of AIDS-related deaths - an indication that prevention efforts were failing to keep pace with the HIV epidemic.
Methods: A desk study was conducted on published and unpublished documents about HIV in South Africa, and a secondary data analysis of three bio-behavioural HSRC surveys and two national communication surveys (NCS) behavioural surveys through both bivariate and multivariate analysis
Findings and Discussion: Urban informal areas are associated with highest HIV prevalence compared to the other three types of location. In 2008, women living in urban informal areas were 57% more likely to be HIV infected than those in urban formal areas.
Frequency of reported multiple partners varied by race, was highest in African men. In 2009, 16.7% of men and 2.3% of women aged 16-55 reported >1 partner (among those who ever had sex). HIV prevalence was higher in respondents reporting more sexual partners. Women reporting >1 partner at the time of survey in 2005 were 4.3 times more likely to be HIV + (p = 0.0001).
Girls 15-19 years reporting age-disparate relationship with older were 72% more likely to be HIV + than those girls with similar-aged partners (HIV prevalence 29.5% vs. 17.2%). Men and women who have partners much younger or older than themselves were more likely to be HIV + compared to people who reported having partner of similar age only. Reported frequencies of transactional sex are 2 - 52% (F) and 4 - 30% (M) in different SA surveys.
About 2% of men reported ever having paid for sex in 2005. Having had sex with a sex worker almost trebled men’s odds for HIV infection. Three bio-surveys in sex workers reported HIV prevalence levels of around 60%.
In 2008, HIV prevalence among self-identified MSM was 9.9% (all men aged 25-49 years: 23.7% HIV+). There was a high frequency of self-reported unprotected anal sex and other risk behaviours among MSM and some evidence of sero-sorting when partners are acquired.
Conclusion: This study is provided evidence of social and behavioural factors that has impacted the HIV epidemic in South Africa.
Keywords: behavioral factors; social
CORRESPONDING AUTHOR: Setswe Geoffrey, Monash University, Johannesburg; geoffrey.setswe@monash.edu
O309
CONVENTIONAL VERSUS HOLISTIC HEALTHCARE SERVICES FOR HIV POPULATION: IMPACT ON HEALTH-RELATED QUALITY OF LIFE
Lua P. L.1, Abdul Rahman A. K.2, Sulaiman F. N.2, Hassan R.3, Abdul Aziz A. B.3
1 Universiti Sultan Zainal Abidin, Centre for Clinical & Quality of Life Studies , Kuala Terengganu, Malaysia
2 Hospital Sultanah Nur Zahirah, Department of Medicine, Kuala Terengganu, Malaysia
3 Hospital Sultanah Nur Zahirah, Department of Pharmacy, Kuala Terengganu, Malaysia
In view of HIV’s devastating impacts on overall life condition, specific healthcare services have been devised to ensure that patients’ clinical, economic and psychosocial concerns are adequately addressed in treatment management. Our prospective randomised study intended to compare health-related quality of life (HRQoL) outcomes between conventional care (Control; routine medical counselling) versus holistic care (Intervention; medical counselling + educational SMS + spiritual advice) among HIV patients. Sixty-two consenting out-patients (stabilised on HAART) from Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia were randomly selected into either the Control (n = 31) or Intervention arm (n = 31). HRQoL status was measured using the HIV/AIDS - Targeted Quality of Life (HAT-QoL) instrument. Data was analysed via descriptive and non-parametric techniques in SPSS 16.0. Most participants have been diagnosed for > 6 months (median age = 40; male = 61.3%; divorced/widowed = 40.3%; self-employed = 37.1%; ex-drug addicts = 51.6%). Pre-intervention, no significant HRQoL difference was reported between the two arms (except for Health Worries). Unexpectedly at post-intervention, the Control cohort had fared significantly better in Financial Worries compared to its counterpart (p = 0.009). Separately however, patients in both arms interestingly experienced significant improvement in Sexual Functioning over time (p Control = 0.024; p Intervention = 0.008). Although more elaborated, the holistic care did not seem beneficial with regard to HRQoL per se, suggesting that a further re-look at its components and implementation is necessary. The limited sample size may have also deterred more extensive detection of statistical significance. Nonetheless, efforts to improve the well-being of HIV population either through the provision of medication therapy or through non-pharmacological modalities must constantly be encouraged and supported.
Keywords: HIV, health education, health outcomes, quality of life
CORRESPONDING AUTHOR: Lua Pei Lin, Universiti Sultan Zainal Abidin; peilinlua@unisza.edu.my
O311
EFFECTS OF PSYCHOLOGICAL INTERVENTION ON ADHERENCE TO ANTIRETROVIRAL THERAPY OF HIV SEROPOSITIVE ADOLESCENTS
Salles C M., Seidl E M.
University of Brasilia, Institute of Psychology, Brasilia, Brazil
The present study aimed to analyze the effects of a psychological intervention over the antiretroviral treatment adherence behavior by seropositive adolescents with difficulties in adhering to Highly Active Antiretroviral Therapy (HAART). Conditioning aspects of adherence and non-adherence to HAART were investigated, along with self-efficacy expectancy to HAART adherence. The participants were three female adolescents, aware of their diagnosis, infected by the HIV virus through vertical transmission, with adherence indexes lower than 95%, or with other relevant difficulties to adherence, considering the number of pills prescribed in the therapeutic regimen in the previous three days, previous week and previous month. The study was characterized as a short-term longitudinal study, with a quasi-experimental design. The evaluation of the target behaviors was conducted before the psychological interventions (baseline), just after the ending of them and three months after that (follow-up). The instruments used were: interview guides for the adolescent and for the caregiver and self-efficacy scale to adherence to HAART. The medical record was consulted to search for information about laboratory measurements of viral load and CD4 cells. The interventions were directed to the building and strengthening of pro-adherence responses, using cognitive-behavioral and behavioral techniques. The data evaluation was intra-subject, with the subject being the measure of their own change control. The results of the study showed change in the pattern of involvement of all of the adolescents, promoting ingestion of drugs in the prescribed times and according to the level required for the treatment of HIV/aids (≥ 95%), expanding the descriptive verbal repertoire about the process of health maintenance towards treatment and a greater self-efficacy expectation related. It was concluded that the intervention had positive effects to the promotion of adherence to HAART among adolescents. Study was limited by the small number of cases. It is suggested that future studies should be developed so that the results can be compared. It is also hoped that the data presented can guide psychological interventions pro-adherence, in a prompt, continuous, regular and preventive approach.
Keywords: Adherence, AIDS, adolescents, psychological intervention
CORRESPONDING AUTHOR: Salles Caroline, Brasília University, Brasília; cbranco@unb.br
O312
A BIO-BEHAVIORAL INTERVENTION TO DECREASE INTRAVAGINAL PRACTICES IN HIV POSITIVE WOMEN IN ZAMBIA
Alcaide L .1, Mumbi M.2, Chitalu L.2, Jones L.3
1 University of Miami, Department of Medicine, Miami, United States
2 University of Miami, Pediatrics, Miami, Zambia
3 University of Miami, Behavioural Science Institute, Miami, United States
Intravaginal practices (VP) are the introduction of products inside the vagina for hygienic, health or sexuality reasons. In sub-Saharan Africa VP are common and strongly influenced by cultural and social beliefs. VP are associated with transmission and acquisition of HIV and Sexually Transmitted Infections. This pilot study tested a bio-behavioral intervention aimed to reduce VP in HIV positive women in the Zambian community.
Methods: HIV infected women were enrolled in 2 conditions: control and experimental. Women in both conditions completed questionnaires assessing sexual risk factors and VP. VP questionnaires were developed after conducting focus groups in the same community and included questions related to reasons for VP, products used for VP and perceptions about VP. Women enrolled in the control condition received brief traditional counseling about VP. Women enrolled in the experimental condition received a 20-30 minute individual session regarding VP using the information, motivation, behavioral skills model. Participants were assessed for VP 8 weeks after the baseline visit. Comparisons within conditions over time were conducted using McNemar statistics.
Results: 20 women were enrolled in the control and experimental condition respectively. At baseline, 100% of participants engaged in VP. Among women receiving the intervention findings were: decrease in the use of VP for hygienic reasons by 50% and for pleasure by 45% (McNemar = 1.03, p = 0.007); decrease in the use of water and cloths (McNemar = 0.84 and 1.32 respectively, p < 0.05); cessation of use of herbs and cloths, both very prevalent at baseline. Such differences were not observed in women enrolled in the control condition at follow up. Women enrolling in the experimental condition reported discussing about VP with their sexual partners (Chi square = 4.2, p < 0.05).
Conclusion: Our intervention was effective in decreasing VP in HIV infected women in Zambia. Our results suggest that a bio-behavioral intervention can decrease VP in HIV infected women in Sub-Saharan Africa. It may also be useful in increasing communication with sexual partners. Modifying VP should be considered a key element as part of multidisciplinary HIV prevention plans. This study was funded by a grant from NICHD, R01HD058481-S1.
Keywords: AIDS, women's health
CORRESPONDING AUTHOR: Alcaide Maria, University of Miami; malcaide@med.miami.edu
Poster Session B
P313
SLEEPING PATTERNS AND DAILY PHYSICAL ACTIVITY: IMPACT ON CHILDREN’S OVERWEIGHT
Aparicio G.1, Cunha M.1, Duarte J.1, Pereira A.2
1 Instituto Politécnico de Viseu, School of Health, Viseu, Portugal
2 Aveiro University, Department of Education, Aveiro, Portugal
Background: Despite several studies conclusions showed higher prevalence of overweight in teenagers and adults that sleep less hours than what is recommended, those evidences regarding young children are still scarce. However, there is consensus that less than 60 minutes of daily activity is associated to higher risk of overweight.
This study aimed to measure the sleeping patterns and daily physical activity in preschool children and explain its relation with overweight.
Methods: Cross-sectional and observational study, comprising 792 preschool children, average age 4,39 years old (SD = 0,911) residents in centre region of Portugal. Child sleep duration and physical activities was obtained from a record of daily hours provided by parents. Children’s anthropometric measurement was obtained, and the classification was based on the NCHS reference (CDC, 2000).
Results: From the sample of children, 31,3% were overweight, pre-obesity was higher for girls (20,5%) and obesity for boys (13,8%). During the week, children sleep in average 10,34 hours (SD = 0,67) per night, sleeping time varying between 8,30 and 13,0 hours without statistic significance between gender (t = -0,463; p = 0,6449). 70,4% of children are daily transported mostly by car, 67,2% usually play in the street, mainly boys, occupying on average about 60 minutes when they play, 53,4% spend about 1 hour in “screen time” and 78,6% do not practice any scheduled sport. After multivariate regression analysis, only “sleeping time” and “playing in the street” entered in the model analysis, revealing that the less sleeping time (r = -0,059; p = 0,026) and the less playing in the street (r = -0,059; p = 0,019) the higher BMI, revealing to be significant predictors of overweight.
Conclusion: Results suggest an inverse relationship between sleep time and playing outside home and the increase of the BMI percentile. Therefore, in children’s intervention programmes healthier lifestyles must be promoted and for these to be effective they should be supported by a positive approach, based on parent’s potential and their strongest points. This will revert in benefit of the growth and development of the child.
Keywords: Children's health, Obesity, Health behaviors
CORRESPONDING AUTHOR: Aparicio Graça, Polytechnic Institute of Viseu; gaparicio5@hotmail.com
P314
SCREENING FOR DEVELOPMENTAL AND BEHAVIORAL PROBLEMS: CAN PARENTAL CONCERNS CONTRIBUTE TO THE DETECTION OF SLEEP PROBLEMS IN EARLY CHILDHOOD?
Goes AR., Barros L.
University of Lisbon, Department of Psychology, Lisbon, Portugal
Background: The rising prevalence of developmental and behavioral disorders brought new recommendations regarding the use of validated screening tools. Clinicians are also recommended to rely on parental concerns to guide developmental and behavioral surveillance. Sleep problems in early childhood are common and have adverse associations with child behavior. The success rates of intervention and prevention programs for sleep problems emphasize the need for early detection.
Objectives: To investigate the usefulness of a screening tool based on parental concerns about child’s development (Parents’ Evaluation of Developmental Status – PEDS) in the detection of sleep problems.
Methods: 200 parents with children aged 20-72 months were recruited. Parents’ concerns were elicited using the PEDS. Sleep was evaluated by using a questionnaire about sleep habits (e.g. bedtime, waking time, sleep latency, night waking, method for falling asleep).
Results: Only 3% of parents reported concerns regarding child's sleep on PEDS. 12.8% reported a mild sleep problem, and 2.1% a severe one. However, several indicators of possible sleep problems were present: bedtime resistance (15.5%), difficulty in falling asleep (4.1%), long latency in falling asleep (35.9), night wakings (7.1%), and going to parents’ bed during the night (14.9%) were reported to happen 5-7 times a week. Using criteria for sleep problems, 71 children met criteria for a settling problem and 13 for a night waking problem. The duration of night sleep was associated with the number of concerns not predictive of developmental disabitilies (e.g. behavior, socio-emotional, self-help).
Discussion: Parents’ concerns have been proved to be an effective method to screen for developmental and behavioral problems. Sleep is an important correlate of childhood development and behavior and sleep intervention programs are highly effective. However, parents may not report their child's sleep problems spontaneously. A global screening tool may not be enough to detect sleep problems. The results support the need to specifically ask parents about their child's sleep habits and patterns. Anticipatory guidance about childhood sleep needs and positive habits may also contribute to raise parents’ awareness regarding their child sleep problems.
Keywords: Children, Sleep, Screening
CORRESPONDING AUTHOR: Barros Luísa Barros, Univeridade de Lisboa, Lisboa; lbarros@fp.ul.pt
P315
INFLUENCING FACTORS OF SCREEN TIME IN PRESCHOOL CHILDREN: AN EXPLORATION OF PARENTS’ PERCEPTIONS THROUGH FOCUS GROUPS IN SIX EUROPEAN COUNTRIES
De Decker E.1, De Craemer M.1, De Bourdeaudhuij I.1, Wijndaele K.2, Duvinage K.3, Koletzko B.3, Grammatikaki E.4, Iotova V.5, Usheva N.5, Fernández-Alvira JM.6, Zych K.7, Manios Y.4, Cardon G.1
1 Ghent University, Movement and Sports Sciences, Ghent, Belgium
2 Medical Research Council Epidemiology Unit, Cambridge, Institute of Metabolic Science, Cambridge, United Kingdom
3 Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany
4 Harokopio University, Department of Nutrition and Dietetics, Athens, Greece
5 Clinic of Paeditric Endocrinology, UMHAT ‘St. Marina’, Varna, Bulgaria
6 University of Zaragoza, Growth, Exercise, Nutrition and Development Research Group, Zaragoza, Spain
7 The Children’s Memorial Health Institute, The Children’s Memorial Health Institute, Warsaw, Poland
Introduction: Sedentary behaviour (e.g. sitting down, watching TV) is not only highly prevalent in adults, also preschool children spend significant proportions of their waking time being sedentary (1). Screen time (i.e. TV viewing, computer use) is the most commonly examined sedentary behaviour and has been associated with a number of health outcomes in this age group. Moreover, sedentary behaviour is identified as a predictor of obesity in adulthood. As parents play a key role in the health behaviours of preschoolers (2), identifying parental perceptions of preschoolers’ screen time in multi-country focus groups has the potential to provide important novel information for interventions focusing on decreasing this behaviour.
Methods: Focus groups were executed with parents of low and medium-high socioeconomic status in municipalities with a high prevalence of overweight in six European countries. All countries were trained in how they should execute the study and how they should report their findings. Key findings were reported by each of the countries. The country specific final reports were analysed and summarized using qualitative data analysis software.
Results: A total of 122 parents participated in 24 focus groups. Almost all parents reported that their child likes to watch TV and most parents did not express worries about their children’s TV viewing time. Education and the fact that the TV keeps the children quiet are considered to be the main benefits of watching TV. Computer and active games use at home are less frequent. Weather conditions and parental habits at home are the most important factors influencing children’s screen time.
Discussion: This study suggests that preschool children tend to like watching TV and that the TV is often used as a babysitter. Awareness about the importance of limiting TV time has to be raised. Alternatives for screen activities and information on how to set rules for screen time should be provided to parents to assist them in decreasing screen time.
References: Hinkley et al. Correlates of sedentary behaviour in preschool children: a review. Int J Behav Nutr Phys Act 2010;7:66-76
Olstad DL et al. Prevention of overweight and obesity in children under the age of 6 years. Appl Physiol Nutr Metab 2009;34:551-570
Keywords: children, obesity, intervention
CORRESPONDING AUTHOR: De Decker Ellen, Ghent University, Ghent, Belgium; ellen.dedecker@ugent.be
P316
PARENTAL PERCEPTION OF AUTISTIC SYPMTOMS IN CHILDREN AND PARENTAL LIFE SATISFACTION
Bognar V.
Eötvös Loránd University Budapest, Faculty of Social Sciences, Budapest, Hungary
The goal of the study is to investigate the relationship between the perception of autistic symptoms in children by their female primary caregivers (96% mothers) and caregivers’ life satisfaction. There is some evidence on the relevance of family and household functioning in this group of parents, but additional knowledge on this topic is needed. (Rao and Beidel, 2009; Manning, Wainwright, Bennett, 2011)
Methods: voluntary survey with members of the Hungarian Autistic Society (N = 232) – principal component analysis and Binary Logistic Regression; content analysis of semi-structured interviews (N = 20). Dependent variable: life satisfaction of female primary caregivers (not at all or not really satisfied (23.7%), generally or fully satisfied with her actual life (76.3%)). Autism perception dimensions: verbality, self-reliance, general and social behavior, strengths, eating disorder, sleeping disorder. Other control variables: time passed after the diagnosis, mental retardation and sex of the child; employment status, education level, partnership status, problem-centered coping of the caregiver, family functioning, financial crisis of the household in the previous year.
Results: we found (with CI level of 95% and significance level of p < 0,05): the chance of a low level of life satisfaction is: higher in case of worse complex autism perception (OR = 1.68, CI:1.18–2.37), more years passed after the diagnosis (OR = 1.07, CI:1.02–1.12) and financial crisis of the household (OR = 2.14, CI:1.06–4.34). Higher level of problem-centered coping decrease the chance of low life satisfaction (OR = 0.89, CI:0.83–0.95). In the case of the subsample of caregivers living in a partnership (N = 179) complex autism perception was not so important factor in the model (p < 0,1), however, the significance of the financial crisis (OR = 3.28, CI:1.38–7.78) has risen. Qualitative data give some retrospective information on the longitudinal psychosocial adaptation process of parents and family.
Conclusions: (1) Time passed after the diagnosis remained significant when controlling autism symptoms and several other factors. This indicates the importance of future psychosocial support for parents of young and adult autistic persons. (2) In case of family support high-functioning partnership and financial management of the household are relevant factors.
Keywords: parent-child transactions, coping, disability, family
CORRESPONDING AUTHOR: Bognar Virag, ELTE University, Budapest; viragbognar@gmail.com
P317
EFFECTS OF CLASS-WIDE SOCIAL SKILLS TRAINING FOR SPECIAL NEEDS CHILDREN
Koseki S., Koseki M.
Social & Health Research Center, Japan
In Japan, special needs education has received remarkable attention for using concrete strategies based on cognitive behavioral therapy and applied behavior analysis. In the last two or three years, it has been revealed that social skills training (SST) increases interactions between special needs children and other children and decreases psychological stress responses (Koseki, et al., 2010). This study aimed to clarify the effects of SST for special needs children. In particular, the behavioral interaction between special needs children and other children can be clarified through behavioral self-monitoring. Behavioral self-monitoring can be of two types: checking for own helping behavior, for example, “I lent my textbook to Mami” and checking for received helping behavior, for example, “Shun lent his textbook to me.” Through this self-monitoring protocol, the number of interactions in this class was revealed. SST was conducted for 29 fifth graders by the author and other staff. The target skill was “how to help each other in this class.” The children were split into three groups based on the self-monitoring results: the “high-skill group (N = 18),” which could execute social skills and perceive others’ execution of them, the “middle-skill group (N = 8),” which could either execute social skills or perceive them, and the “low-skill group (N = 3),” which could neither execute social skills nor perceive them. As a result, in all groups, scores for pro-social skills significantly increased (F(1, 26) = 6.62, p < .05) and those for psychological stress responses, “depression and anxiety” (F(1, 26) = 3.82, p < .05) and “irritability and anger” (F(1, 26) = 3.72, p < .05), significantly decreased. As explained above, it was suggested that SST enhanced the execution of pro-social skills and reduction of “depression and anxiety” and “irritability and anger.” Furthermore, self-monitoring was useful in assessing the interaction of the classroom group’s dynamics when executing the target skills and in the development of relationships among friends in the classroom. In the future, on the basis of this study, SST should be implemented effectively to assess social skills execution in students, select functional target skills, and discuss the effects of group intervention.
Keywords: stress, intervention
CORRESPONDING AUTHOR: Koseki Shunsuke, Aichi University of Education; skoseki@auecc.aichi-edu.ac.jp
P318
THE TREND OF HEIGHT, WEIGHT AND BLOOD HEMOGLOBIN STATUS IN JAPANESE JUNIOR HIGH SCHOOL STUDENTS.
Kanemaru R., Kondo T., Takata Y., Sakata Y.
University of Tsukuba, Graduate School of Comprehensive Human Sciences, Tsukuba, Japan
Introduction: The health issues caused by bad life style have been increased in Japanese adolescents. We need to catch their symptoms of health problem as soon as possible in order to intervene in the effective period.
Purpose: To examine the trend of adolescent height, weight and blood Hemoglobin status (HbA1c).
Method: The subjects were 1573 students in a Japanese junior high school, who were surveyed over a 10 year period from 2000 to 2009. We measured their height, weight and HbA1c values once a year. The trend analysis was used to examine the tendency of change about those values.
Result: First grade boys’ weight showed the decreasing trend in the 10 years (R2 = .446, p = .070). Their HbA1c values also showed the decreasing trend (R2 = .551, p = .035). On the other hand, their height did not show any trend of change.
Conclusion: Japanese boys who are just entered junior high school are getting thinner. In addition, their Hemoglobin statuses are getting worse. One of the reason that they are losing weight, in spite of they are not getting lower, might be their drive for thinness. Though many professionals have warned how it is dangerous to pursue thinness, young people don’t give up the desire. We need to teach them that pursuit of thinness leads to the bad blood health.
Keywords: Adolescents, Health
CORRESPONDING AUTHOR: Kanemaru Ryuta, University of Tsukuba, Japan; kanemaruryuta@gmail.com
P319
INCREASE IN QUALITY OF LIFE AND HEALTH PROMOTION IN RURAL AREAS SCHOOLS THROUGH HEALTH EDUCATION
Bob M.1, Mocean F. 2, Lotrean L.2, Prodea C.3, Gabor-Harosa F.2
1 University of Medicine and Pharmacy Cluj-Napoca, Department of Morphology, Cluj-Napoca, Romania
2 University of Medicine and Pharmacy Cluj-Napoca, Department of Community Medicine, Cluj-Napoca, Romania
3 Babes-Bolyai University, Department of Education, Cluj-Napoca, Romania
Introduction: The educational process can have a positive influence on socializing, thus on quality of life in general, on growth and development of children. However, if hygienic norms of infrastructure and functioning of schools are constantly broken, education in schools may lead to intellectual fatigue.
Objectives: The objective of this study is to gather the opinions and practices of students related to school activity and the tiredness provoked by it.
Methods: Anonymous questionnaires were filled by 267 school students from rural areas of one county of Romania in 2008.
Results and discussions: Most students stated that they feel tired at the end of a school day. 43.5% declared themselves tired at the end of the week in the first semester of the school year 2007/2008, while in the second semester the percentage has increased statistically significant (p <0.05 at χ2 test) to 79.5%. Only 26.00% of students declared that they failed to fully prepare their homework at home. Nevertheless, school and out-of-school activities made 80.50% of the respondents to consider the educational process difficult.
Conclusion: The study reveals that for health promotion in schools is necessary to implement reforms in the education process that can prevent fatigue, stress and violence among school students from rural areas, in order to optimize their quality of life.
Keywords: Quality of life, Health education, Environment, Fatigue, Health promotion
CORRESPONDING AUTHOR: Bob Mihai, University of Medicine, Cluj; mihaihoratiubob@gmail.com
P320
PSYCHOSOCIAL PREDICTORS OF ENHANCED COPING WITH TYPE 1 DIABETES IN CHILDREN AND ADOLESCENTS
Buttigieg K.1, Bergman P.2, Rodda C.2, Hay M.1
1 Monash University, Health Psychology and Behavioural Medicine Unit, School of Psychology and Psychiatry, Melbourne, Australia
2 Monash University, Department of Paediatrics, Melbourne, Australia
Introduction: Previous research has noted the difficulties faced by clinicians in identifying young people with type 1 diabetes who may be experiencing psychological distress, with illness management not necessarily a reliable indicator (Grey et al., 1998). This study explored psychosocial factors that may be helpful in identifying those children and adolescents coping well with their condition, versus those who are experiencing difficulties. In this paper, the results from an Australian cross-sectional study are presented.
Method: Eighty children and adolescents were recruited from a paediatric diabetes outpatient clinic in Melbourne, Australia. All participants had been diagnosed with type 1 diabetes for at least twelve months, and were aged 7-15 years old. During a clinic appointment or home visit, screening of depressive and anxiety symptoms (using the CDI and RCMAS-2) was undertaken. Diabetes-specific family support (DFBS), diabetes-related self-efficacy (DMSES), diabetes-related coping (ICI-C) and diabetes knowledge (DKN) were also assessed.
Results: The results of a discriminant function analysis identified a significant difference in the psychosocial characteristics of participants coping well with diabetes-related issues that 'upset', and those experiencing difficulties (Wilk’s lambda = .71, Chi square(7) = 22.9, p < .01). Mood symptoms (depression and anxiety), coping with diabetes-related tasks that are ‘hard to do’ for their diabetes, and self-efficacy were the psychosocial factors that best differentiated between these groups. 71.8% of participants were correctly classified using this model.
Conclusions: The results presented suggest that mood symptoms, coping with 'hard to do' aspects of diabetes and self-efficacy are important psychosocial factors in predicting coping with 'upsetting' aspects of diabetes. As these factors are potentially modifiable, these findings may assist in the development of coping interventions for children and adolescents with diabetes.
Keywords: Diabetes, Coping, Depression, Anxiety, Children, Adolescents, Mental Health, Children's Health
CORRESPONDING AUTHOR: Hay Margaret, Monash University, Melbourne; margaret.hay@monash.edu
P321
THE RELATIONSHIP BETWEEN PSYCHOSOCIAL FACTORS AND GENDER IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES
Buttigieg K.1, Bergman P.2, Rodda C.2, Hay M.1
1 Monash University, Health Psychology and Behavioural Medicine Unit, School of Psychology and Psychiatry, Melbourne, Australia
2 Monash University, Department of Paediatrics, Melbourne, Australia
Introduction: Screening for psychological concerns, such as depression and anxiety symptoms, is highly recommended in international clinical guidelines regarding the clinical care of children and adolescents with type 1 diabetes. This study explored the relationship between psychosocial factors and gender in young people who are living with type 1 diabetes.
Method: Eighty children and adolescents were recruited from a paediatric diabetes outpatient clinic in Melbourne, Australia. All participants had been diagnosed with type 1 diabetes for at least twelve months, and were aged between 7-15 years old. Screening of depression (CDI) and anxiety (RCMAS-2) symptoms was undertaken. Diabetes-related family support (DFBS), self-efficacy (DMSES), coping (ICI-C) and knowledge (DKN) were also assessed.
Results: A discriminant function analysis identified a significant difference in the psychosocial characteristics of girls versus boys, Wilk’s lambda = .760, Chi square(8) = 17.879, p < .05. The interpretation of the group centroids data suggests that males coped better with the ‘hard to do’ and ‘upsetting’ aspects of their type 1 diabetes, and were also less anxious than girls. 73.2% of participants were accurately classified using this model.
Conclusions: While psychological screening is recommended for all paediatric diabetic patients, girls appear more likely to display anxiety symptoms and coping difficulties.
Keywords: Children, Adolescents, Children's Health, Coping, Anxiety, Mental Health
CORRESPONDING AUTHOR: Hay Margaret, Monash University, Melbourne; margaret.hay@monash.edu
P322
DEPRESSION, ANXIETY AND TYPE 1 DIABETES: CASE STUDIES FROM AN AUSTRALIAN CROSS-SECTIONAL STUDY
Buttigieg K.1, Bergman P.2, Rodda C.2, Hay M.1
1 Monash University, Health Psychology and Behavioural Medicine Unit, School of Psychology and Psychiatry, Melbourne, Australia
2 Monash University, Department of Paediatrics, Melbourne, Australia
Introduction: Children and adolescents with type 1 diabetes may be more likely to experience depression and anxiety. This paper presents case studies illustrating the relationship between illness outcomes, family support and individual psychosocial factors.
Method: Eighty participants aged 7-15 years were recruited from a paediatric diabetes outpatient clinic in Melbourne, Australia. Participants had been diagnosed with type 1 diabetes for at least twelve months. Depression (CDI) and anxiety (RCMAS-2) screening was undertaken. Diabetes-related family support, self-efficacy, coping and knowledge were also assessed.
Results: Depression and/or anxiety symptoms were present in 14% of participants. Case studies of participants experiencing psychological distress are presented, with a view to providing “in-depth” examples of the relationship between depression, anxiety, diabetes management and individual psychosocial factors.
Conclusions: Some young people with type 1 diabetes may display psychological distress. The case studies presented suggest that the experience of depression and anxiety in children and adolescents in the context of type 1 diabetes also encompasses family and illness management factors.
Keywords: Depression, Anxiety, Mental Health, Children, Children's Health, Adolescents
CORRESPONDING AUTHOR: Hay Margaret, Monash University, Melbourne; margaret.hay@monash.edu
P323
DISTURBED EATING BEHAVIOURS IN CHILDREN WITH CHRONIC ILLNESS. A LONGITUDINAL TOTAL POPULATION BASED STUDY.
Hysing M.
Uni Health/Uni Research, Bergen, Norway
Background: Disturbed eating behaviour has been found in clinical and cross-sectional studies in children with chronic illness, but little is known about the development of disturbed eating over time and possible predictors.
Aim: To longitudinally assess change in rates over time in disturbed eating among children with and without chronic illness.
Method: Using data from a longitudinal total population study in Norway, The Bergen Child Study, data on eating disturbances, chronic illness and potential confounders were assessed at ages 7-9 and 11-13. Eating disturbances was assessed using the Eating Disturbance Scale (EDS-5: wave 2), and Eating Disturbance Inventory (wave 1).
Results: Children with chronic illness had an increased rate of parent-reported disturbed eating behaviour when they were 7-9 years old. There was also an increased rate of disturbed eating behaviour as measured by both parent and child report 4 years later. The role of emotional problems, BMI and body image on the development of disturbed eating will be further explored.
Conclusion: Children with chronic illness are at increased risk of developing disturbed eating behaviours, and preventive efforts for healthy eating habits are recommended.
Keywords: children, chronic illness, eating disorders
CORRESPONDING AUTHOR: Hysing Mari, RKBU; mari.hysing@psybp.uib.no
P324
RELATIONSHIP BETWEEN CHILDHOOD OVERWEIGHT, OBESITY AND ADVERTISEMENT
Töttösi A.1, Lelovics ZS.1, Zombori J.2
1 International Institute of Nutrition Research, -, Pécs, Hungary
2 Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
Introduction: Children become more and more the targets of food industry companies and also the media. The incremental generation had never been under the influence of the mass media to such extent. By the age of 14 children spend 18,000 hours in front of screens, and 14,000 hours behind desks. According to the researches of the German ZAW, 38% of children between the age of four and six cannot make a distinction between advertisements and TV programs. They can be influenced most easily because of their age. Attention is frequently aroused by showy and friendly cartoon characters to purchase a given product. Beside this, childhood obesity and overweight are increasing. More and more national and international programs were born to fight against widespread obesity but the efficiency of these efforts we can be questioned. Every year there are 400,000 new overweight and 85,000 new obese children in the EU. Based on this data there were 15 million obese children in the EU in 2010. Nowadays, watching TV is often linked to snacking. This is one of the most important problems of childhood obesity.
Methods: In order to map the knowledge of brands and elements of marketing, focus consulting was carried out amongst toddlers (n = 138, average age: 7.0+/-2.0years).
Results: 76.7% of school children know given figures of brands, moreover, products associated to figures and messages suggested by them. 55.6% of kindergarten kids know at least one specific figure of a brand. While the youngest children in kindergarten could characterize a figure by its externals, at the age of six they know products and can associate them with animals or cartoon figures related to brands.
Conclusion: Food for kids can affect the eating behaviour of children in a negative way (for example: there are no vegetables or fruit in the Hungarian TV programs). Children can hardly make a distinction between good and bad things, useful and less useful information. The children learn eating behaviour from their parents. Children of the obese parents become obese adults with chronic diseases. Therefore they should be taught the behaviour of conscious consumers. With the contribution of parents, schools, professions and legislation childhood obesity can be reduced.
Keywords: Eating behaviors, children
CORRESPONDING AUTHOR: Töttösi Adrienn, IIONR, Pécs; tottosi.adrienn@gmail.com
P325
THE IMPACT OF MODELLING PARENTS AND PEERS ON THE CHILD’S FRUIT AND VEGETABLE INTAKE IN NORDIC COUNTRIES
Lehto E.1, Roos E.1, Ray C.1, Yngve A.2, Ehrenblad B.2, Kristjansdottir A.3, Thorsdottir I.3
1 Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
2 Karolinska Institutet, Department of Biosciences and Nutrition, Stockholm, Sweden
3 University of Iceland, Unit for Nutrition Research, Reykjavik, Iceland
Background: Most of the children in Nordic Countries are not meeting the recommendations about daily fruit and vegetable (FV) intake. Among children, the impact of parents is crucial in the formation of eating habits. However, as children grow older also the peers start to have an influence on the child’s behaviour. The aim of the present study was to examine the impact of modelling the FV intake of parents and peers on the child’s FV intake in three Nordic countries.
Methods: Data was derived from Finland, Sweden, and Iceland, that took part in the cross-sectional Pro-Greens-study. Participants were children (n = 2043) at the age of 11-years who filled in a self-report questionnaire at school in 2009. The frequency of the FV intake was dichotomised to daily and non-daily intake. Agreeing with the statements concerning the daily FV intake of child’s own mother, father, and a best friend was regarded as modelling FV intake. Associations were explored with logistic regression analyses.
Results: The child’s daily fruit intake was associated with modelling the fruit intake of mother (OR 2.53, CI95% 2.09-3.08), father (OR 2.58, CI95% 2.17-3.08), and a best friend (OR 2.46, CI 95% 2.06-2.94). Associations were also observed between the child’s vegetable intake and modelling vegetable intake of mother (OR 2.78, CI95% 2.24-3.43), father (OR 2.38, CI95% 1.97-2.89), and a best friend (OR 2.12, CI95% 1.76-2.55). Inclusion of modelling the fruit or vegetable intake of mother, father, and a best friend in the same analysis diminished the impact of father in the case of vegetable intake and highlighted the impact of the fruit intake of the best friend. Further analyses showed that the associations between the child’s fruit intake and the fruit intake of both father and a best friend were weaker in Finland than in the two other countries.
Conclusions: Even though parents strongly influence the FV intake of a child, also the peers can affect the child’s eating behaviour. The impact of modelling peers should be taken into account especially when planning interventions that aim to increase the fruit intake among children. Also possible country and gender differences in the importance of the role models need to be examined in further longitudinal studies.
Keywords: children, health behaviors
CORRESPONDING AUTHOR: Lehto Elviira, University of Helsinki, Helsinki; elviira.lehto@helsinki.fi
P329
NURSES, PARENTS AND CHILDREN BEHAVIORS DURING PEDIATRIC IMMUNIZATION: TIPOLOGY OF BEHAVIORS AND ASSOCIATIONS
Pedro H., Faria J., Pereira AI., Barros L.
University of Lisbon, Department of Psychology, Lisbon, Portugal
Behaviors of parents and nurses during pediatric immunization procedures are associated with behavioral disturbance and with the child's subjective evaluation of anxiety (Blount et al., 2003).
The present study expands this evidence by developing a typology of the behavior of parents, nurses and children during pediatric immunization procedures and analyzing the association between these behavior typologies.
First, the behavior of nurses, parents and children during 220 procedures of pediatric immunization was observed, taped and coded. Then, a cluster analyses to identify different patterns of behavior was performed independently for parents, nurses and children.
5 clusters with similar patterns of adults behavior were identified for parents and nurses One larger cluster (44.1% parents; 24.5% nurses) is characterized by Low Activity. Other clusters integrate adults Active Coping Supporters (21.4% parents; 24.5% nurses), Passive Coping Supporters (17.7% parents; 19.1% nurses) and Reassuring (10.5% parents; 19.1% nurses). Two clusters with few subjects are differentially present in the two groups of adults: Active Coping supporters with Reassurance in nurses (12.7%) and Critical in parents (6.4%).
Regarding children’s behavior, 4 clusters were identified. A larger cluster (51.8%) is characterized by Low Activity followed by High Coping (20.5%), High Resistance (15.9%) and High Behavioral Distress (11.8%).
The results reveal significant associations between behavioral clusters of adults and children. Reassuring adults were associated with a higher percentage of High Resistance and High Behavioral Distress children. Passive Coping Supporters adults were associated with a higher proportion of High Coping children.
Children belonging to specific clusters show significant mean differences in self-reported anxiety. Higher anxiety levels were found in High Resistance (M = 3.91) and High Behavioral Distress (M = 4.36) children. And on children interacting with Reassuring (M = 3.48) and Critical (M = 3.43) parents and Reassuring (M = 3.32) and Active Coping Supporters with Reassurance (M = 3.96) nurses.
The results of this methodology based on the natural grouping of participants provide relevant information about the typologies of adults and children behavior during these medical procedures, and strengthen the results previously obtained with analysis focused on the association between behavioral categories (Blount et al., 2001).
Keywords: Children, anxiety, coping
CORRESPONDING AUTHOR: Barros Luísa Barros, Univeridade de Lisboa, Lisboa; lbarros@fp.ul.pt
P330
WHY DO ADOLESCENTS KEEP GETTING PREGNANT: IS THIS DUE TO INTENTION TO GET PREGNANT, NON-USE OF CONTRACEPTIVES, CONTRACEPTIVE FAILURE OR INCORRECT USE?
Pires R.1, Araújo-Pedrosa A.2, Carvalho P.3, Pereira J.2, Canavarro MC .1
1 University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
2 Centro Hospitalar e Universitário de Coimbra, Psychological Intervention Unit of the Maternity Doctor Daniel de Matos, Coimbra, Portugal
3 University of Beira Interior, Departament of Psychology, Covilhã, Portugal
Although there is a significant number of studies focusing on the distal predictors of the outcome of becoming pregnant or not during adolescence, less is known about the proximal causes of its occurrence. Different contraceptive behaviours - such as the non-use of contraceptives or their incorrect use - require different approaches to prevent pregnancy. Also, the non-use of contraceptives should be targeted with distinct interventions according to the reasons underlying it.
As Portugal has one of the highest European adolescent pregnancy rates, this cross-sectional study aimed to identify the proximal causes of pregnancy (through a semi-structured interview) among a sample of pregnant adolescents (N = 306).
Pregnancy mainly occurred in the context of a romantic relationship (97.4%), with an average duration of 19 months. About 36% of the adolescents reported the non-use of contraceptives, 19% of them due to intention to get pregnant. Among those who did not intended to get pregnant, the main reasons for the non-use of contraceptives were: 1) Not wanting/liking to use it (6,2%), 2) Having no information about contraceptive methods (2.9%), and 3) Having stopped taking the pill due to health problems or forgetfulness/Waiting to start pill (2.7%). About 64% of the participants reported the use of contraceptives at the time of the conception. Among them, 44% attributed pregnancy to “contraceptive failure” specified as condom rupture (17.6%), forgetting to take the pill (12.7%), pharmacological interference with the pill (6.5%) and inconsistent contraceptive use (5.0%).
These results provide specific knowledge about the contexts in which adolescent pregnancy occurs and may contribute to a greater specificity of family planning. In addition to the need for information about contraception, these results highlight the importance of assessing how contraception is used by adolescents as well as their representations about what constitutes a contraceptive failure or incorrect use. Promoting the correct use of contraception and providing alternative strategies to deal with contraceptive failure should be priorities of health promotion in this field.
Keywords: Adolescence, Pregnancy, Risk factors, Sexual behavior, Prevention
CORRESPONDING AUTHOR: Pires Raquel, University of Coimbra, Coimbra; pires.rsa@gmail.com
P331
PROMOTING HEALTHY SEXUAL BEHAVIOURS AMONG FEMALE ADOLESCENTS: IDENTIFYING RISK FACTORS FOR EARLIER SEXUAL INITIATION AND CONSIDERING SUBCULTURE SPECIFICITIES
Pires R.1, Araújo-Pedrosa A.2, Carvalho P.3, Pereira J.2, Canavarro MC.1
1 University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
2 Centro Hospitalar e Universitário de Coimbra, Psychological Intervention Unit of the Maternity Doctor Daniel de Matos, Coimbra, Portugal
3 University of Beira Interior, Department of Psychology, Covilhã, Portugal
Sexual initiation is a normative event during adolescence. However, it has been occurring at increasingly early ages, which has been associated with an increased risk for unwanted pregnancies and sexually transmitted diseases during adolescence. Focusing on the risk factors for earlier sexual initiation may enable the development of adequate efforts to prevent such consequences. As sexual activity tends to be influenced by context-specific norms, differences across subcultures may determine specific risk conditions.
In this cross-sectional study (N = 889), multiple regression models were built to assess the contribution of individual, familial, and community variables (Semi-structured interview; EMBU) for predicting age at first sexual intercourse (AFSI) among female adolescents. Moderator effects of ethnicity and urban-rural residence were also examined, in order to explore possible subcultural mechanisms underlying these associations.
Lower menarcheal age (β = .19, p < .001), maternal history of adolescent pregnancy (β = -.07, p = .02), non-nuclear family structure (β = -.07, p = .03), lower maternal emotional warmth (β = .09, p = .01), lower religious involvement (β = .01, p < .001) and unavailability of legal abortion (β = .39, p < .001) appeared to be risk factors for earlier AFSI (F(8, 746) = 27.80, p < .001, r 2 = .23). Abortion liberalization had a stronger effect of postponing sexual initiation in urban places (b = 1.56, p < .001) than in rural areas (b = 1.06, p < .001; interaction effect: b = -.48, p = .04). School frequency predicted earlier AFSI among Caucasians (b = .21, p = .05), while school drop-out appeared to be positively, but not significantly, associated with earlier AFSI for adolescents of ethnic minorities (interaction effect: b = -1.05, p = .04).
These results provide specific knowledge about social and behavioral aspects of sexual health promotion among adolescents. Preventive efforts aiming to delay sexual initiation should address individual, familial, and community risk conditions, including comprehensive multidisciplinary interventions on relationships and emotions. Subcultural specificities should be considered in order to increase the effectiveness of sexual health promotion actions among different ethnic groups and regional areas.
Keywords: Risk factors, Health promotion, Adolescents, Sexual behavior, Ethical issues, Culture
CORRESPONDING AUTHOR: Pires Raquel, University of Coimbra, Coimbra; pires.rsa@gmail.com
P332
THE ROLE OF RELIGIOSITY AND SPIRITUALITY IN ADOLESCENTS’ MENTAL HEALTH
Kovacs E.1, Piko B.2
1 Semmelweis University, Behavioural Science Institute, Budapest, Hungary
2 University of Szeged, Behavioural Science Institute, Szeged, Hungary
Religiosity/spirituality as health protective factors have been highly investigated in the contemporary research. They mostly provide crucial positive impact on health status indicators and mental health, namely, longer lifetime, better quality of life, sense of coherence, less anxiety, depression and suicide rates, and more effective coping strategies. However, little is known how these phenomena work among adolescents.
The main goal of the present study was to explore the religious/spiritual attitudes and the volume of religious activity among high school students, including religious affiliation, religious participation, acceptance of spiritual/religious beliefs, importance of religion and spiritual well-being.
Data collection of the questionnaire survey was conducted among 656 high school students in Szeged in 2010 (age range between 14-21 years, Mean = 16.5 years, S.D. = 1.5 years of age, 49.1% female). Associations between mental health status indicators – aggressive behavior, depressive symptomatology, satisfaction with life, optimism, and spiritual well-being (as dependent variables) and religiosity/spirituality factors (as independent variables) were assessed using Odds Ratios calculated by logistic regression analyses.
The findings showed that adolescents were less likely to show verbal and physical aggression when religion played an important role in their life (being religious and belonging to church) and when they were practicing religion (praying or participating at religious events). In terms of depressive symptoms, religiosity emerged as a risk factor. Moreover, religiosity/spirituality provided protection, namely, increased the level of satisfaction with life and optimism. Strong association was revealed between spiritual well-being and religiosity factors, it was significantly higher scored when youth consider religion important.
Exploring and monitoring religious/spiritual attitudes seem to be determinant in adolescence. The level of religiosity and spirituality might contribute to better mental health in this life period, however paradox research findings call the attention for conducting deeper research in the present topic.
Keywords: Religion/Spirituality, Adolescents, Mental health
CORRESPONDING AUTHOR: Kovacs Eszter, Semmelweis University, Budapest; kovacs.eszter@ymail.com
P333
FACTORS RELATED TO PSYCHOSOMATIC COMPLAINTS AND SELF-ESTEEM AMONG JAPANESE ELEMENTARY SCHOOL STUDENTS
Takata Y., Sakata Y.
University of Tsukuba, Graduate School of Comprehensive Human Sciences, Tsukuba, Japan
Purpose: To clarify factors related to psychosomatic complaints and self-esteem among Japanese elementary school students, and the relations among these factors.
Method: A questionnaire was administered to fourth- through sixth-graders at public elementary schools in X prefecture and P prefecture between October 2010 and January 2011. School nurses asked homeroom teachers to have their classes complete a health questionnaire. Homeroom teachers distributed the questionnaire to their classes, and the students completed and returned the questionnaires immediately. Multiple logistic-regression analysis was conducted with the scale score for psychosomatic complaints as the dependent variable and sex, grade, and other relevant factors as independent variables. Ethical considerations were explained orally at the time the questionnaire was administered and children who agreed to cooperate in the investigation filled in and submitted their questionnaires.
Result: Completed questionnaires with usable data were obtained from 1397 boys and 1394 girls. Overall, girls had lower scores for “general self-esteem” as compared to boys(boys 7.39 ± 2.61, girls 6.97 ± 2.77,p < .001). Sixth-grader’s girls had more psychosomatic complaints (sixth-graders 26.81 ± 15.54, fifth-graders 24.24 ± 15.50,p = .047) and lower scores for “general self-esteem” (sixth-graders 6.49 ± 2.88, fifth-graders 7.04 ± 2.67,p < .001) and “self-esteem at home” (sixth-graders 4.49 ± 1.54, fifth-graders 4.73 ± 1.28,p = .037) than fifth-graders. Multiple logistic-regression analysis adjusted for sex and age with the psychosomatic complaints scale score as the dependent variable revealed that children with high scores for “general self-esteem”(95%CI = 0.80 ~ 0.86,OR = 0.83), “self-esteem at home” (95%CI = 0.72 ~ 0.83,OR = 0.77), and “self-esteem at school” (95%CI = 0.60 ~ 0.73,OR = 0.66) had fewer psychosomatic complaints. In addition, children who went to bed between 9:00 and 10:00 p.m. (95%CI = 1.01 ~ 1.62,OR = 1.32), those who ate breakfast every day(95%CI = 1.15 ~ 2.67,OR = 1.75), and those went to the school nurse’s office less than once per month(95%CI = 1.52 ~ 3.31,OR = 2.24) had fewer psychosomatic complaints than other children.
Conclusion: The present results indicate that self-esteem and lifestyle are related to psychosomatic complaints among fourth- to sixth-grade elementary school students. These findings suggest that support to help children raise their self-esteem and improve their lifestyle is required.
Keywords: Adolescence, Children's health
CORRESPONDING AUTHOR: Takata Yuriko, University of Tsukuba, Ibaraki; takata@sakura.cc.tsukuba.ac.jp
P334
THE SUBJECTIVE EXPERIENCE OF THE DISEASE, CONCERNS AND NEEDS OF MOTHERS OF CHILDREN WITH CHRONIC ILLNESS - CONTRIBUTIONS FROM A QUALITATIVE STUDY TO THE INTERVENTION OF HEALTH PROVIDERS
Santos MA.
Instituto Politécnico do Lisboa, Escola Superior de Tecnologia da Saúde, Lisbon, Portugal
Parental adaptation to chronic illness is a dynamic process that is determined by the disease and its evolution and simultaneously by the development of the child and of the family. Health providers’ support for these parents requires the knowledge of the changes occurring throughout the process as well as the flexibility to adapt interventions to the concerns and the needs of children and parents.
Objectives: To understand the subjective experience of the disease and to identify concerns, needs and expectations of mothers of children with diabetes (n = 30) and cystic fibrosis (n = 30).
Methodology: A semi-structured interview was used to explore mothers’ meanings on three domains: (1) living with the disease; (2) concerns; (3) needs and expectations.
Mothers’ verbatim was audio taped, transcript and analysed, using a phenomenological approach.
Results: Mothers reported living with tranquillity, hope and acceptance, but also with fear, emotional instability and tiredness. In what regards to concerns, needs and expectations, three dimensions emerged: (1) the disease (e.g evolution, burden of the treatment), (2) the mother (e.g need for a life outside the disease; concern about the possibility of her own death (3) the child (e.g emotional support; educational issues). Mothers also referred changes in their needs and concerns during the experience of disease and related these changes to some determinants, namely: disease evolution, maternal progressive knowledge of the disease, development of family and parenting, and child’s development. Some differences were found between the two groups of mothers in what regards to needs and expectations. These differences are related to disease characteristics (e.g. prognosis; treatment procedures; predictability of health crisis)
The results provide new guidelines for the intervention of health providers: doctors, nurses, psychologists and other therapists. These guidelines are discussed in terms of their implications for the support to be provided to these parents.
Keywords: chronic illness; children; health providers
CORRESPONDING AUTHOR: Santos Margarida, ESTeSLisboa*; margarida.santos@estesl.ipl.pt
P335
THE PREDICTIVE VALIDITY AND EFFECTS OF USING THE TRANSTHEORETICAL MODEL TO INCREASE PHYSICAL ACTIVITY OF HEALTHCARE WORKERS IN A PUBLIC HOSPITAL IN SOUTH AFRICA
Skaal L., Pengpid S.
University of Limpopo, Department of Public Health, Pretoria, South Africa
Background: There have been studies conducted on the effectiveness of the Transtheoretical Model (TTM) in improving the level of physical activity at worksites worldwide, but no such studies were conducted in South Africa.
Purpose: The aim of this study was to determine the predictive validity and effects of using the Transtheoretical Model to increase physical activity of healthcare workers in a public hospital in South Africa. Methods: A quasi-experimental design in the form of single group, pretest-posttest design was used to examine the possible relationship between an exposure to interventions, attitude, knowledge and an increased level of physical activity. Two-hundred hospital staff (medical and nonmedical staff) were randomly selected for participation in the study. The following variables were measured: TTM stages of physical activity, knowledge and attitude, fitness levels, Body Mass Index (BMI), and level of exposure to the intervention. The intervention designed was based on the concepts of progressing stages of physical activity to the next level, in TTM stages sequences; 1) the pamphlets about physical activity and health, 2) the posters, fun run and sports day and 3) the second set of posters, daily radio programme and aerobic classes.
Results: Post-intervention, the participants increased significantly in their stages of physical activity, attitude and knowledge compared to pre-test. Mean scores of TTM (3.70) and Knowledge (3.65) were significantly (p < .05) higher at post-test. Overall accuracies of TTM at pre-test could predict correctly TTM at post-test by an average of 66.9 %. Conclusion: The use of TTM to identify the stage of physical activity of healthcare workers has enabled the researcher to design intervention programs specific to the stage of exercise behavior of staff. The predictors (TTM1), exposure levels, knowledge, attitude and processes of change have significant contributions to the outcome (TTM2).
Keywords: physical activity, outcome expectation
CORRESPONDING AUTHOR: Pengpid Supa, University of Limpopo; supaprom@yahoo.com
P336
DOES PHYSICAL ACTIVITY AT THE NATIONAL RECOMMENDATIONS PLAY A ROLE IN PREDICTING OVERWEIGHT AND OBESITY AMONG LESBIANS?
Cary M.1, Brittain D.2, Gyurcsik N.1
1 University of Saskatchewan, Kinesiology, Saskatoon, Canada
2 University of Northern Colorado, School of Human Sciences, Community Health Program, Greeley, USA
Lesbians have higher rates of overweight and obesity compared to heterosexual and bisexual women. Minimal research has examined factors that predict these higher rates, with no research examining whether adherence to the national recommendations of moderate to vigorous physical activity (MVPA) is a significant predictor. The purpose of our study was to investigate whether MVPA and demographic variables (i.e., education, age, race, income, partner status, employment status, general health status, and presence of other chronic conditions such as arthritis and heart disease) predicted body mass index (BMI) among lesbian women. Self-identified adult lesbians (N = 851) aged 18-74 years (M age = 40.55 ± 11.69 years) completed a 20-minute web-based survey that included demographic, MVPA, and BMI measures. On average, the sample was overweight (M = 29.0 ± 7.98 kg/m2). A hierarchical multiple regression analysis was performed in which the overall model significantly predicted BMI, R 2 adj. = .21, p < .001. Each of the three steps of the regression significantly predicted BMI: (1) MVPA:F(1,849) =72.60, p < .001, R2 adj. =.08; (2) education, age, race, and income: F(4,845) = 21.36, p < .001, R2 change = .03; and (3) partner status, employment, general health status, and presence of other chronic conditions: F(9,841) = 25.97, p < .001, R2 change = .11. Significant independent predictors included MVPA (β stand. = -.15, p < .001), race (β stand. = -.07, p < .02), general health status (β stand. = -.33, p < .001), and presence of other chronic conditions (β stand. = -.08, p < .02). Findings illustrate the predictive role that MVPA at the national recommendations may play in helping to reduce overweight and obesity among lesbians. Future research should examine additional individual obesogenic behaviors (e.g., dietary intake) as well as environmental-level factors that may impact overweight and obesity among lesbians. Furthermore, unique lesbian-specific factors that may alter adherence to obesogenic behaviors should be examined since past research has illustrated that lesbians may face sexual orientation-related barriers to adherence (e.g., connection with the lesbian community). Once identified, tailored public health programs can be designed for the lesbian population to reduce overweight and obesity.
Research funded by the Lesbian Health Fund, Gay and Lesbian Medical Association.
Keywords: Obesity, Physical Activity, Sexual Orientation
CORRESPONDING AUTHOR: Cary Miranda, Univ. of Saskatchewan, Saskatoon; miranda.cary@usask.ca
P337
DETERMINANTS OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR IN YOUNG PEOPLE: A REVIEW AND QUALITY SYNTHESIS OF PROSPECTIVE STUDIES
Uijtdewilligen L.1, Nauta J.1, Singh AS.1, Van Mechelen W.1, Twisk JWR.2,3, Van der Horst K.4, Chinapaw MJM.1
1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
2 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
3Department of Health Sciences, Section Methodology and Applied Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
4 ETH Zurich, Institute for Environmental Decisions (IED), Consumer Behavior, Zurich, Switzerland
Objective The aim of this systematic review was to summarise and update the existing literature on determinants of physical activity and sedentary behaviour in young people, considering the methodological quality of the studies.
Methods Prospective studies were identified from searches in PubMed and PsycINFO, from April 2004 through November 2010. The authors included studies investigating the association between determinants of overall physical (in)activity and/or sedentary behaviour in healthy children or adolescents. When a determinant was investigated for its association with physical (in)activity and sedentary behaviour assessed between ages of 4–12, or mean age ≤12, it was classified as ‘child determinant’. When a determinant was investigated for its association with physical (in)activity and sedentary behaviour assessed between ages of 13–18 or mean age >12, it was classified as ‘adolescent determinant’. Included articles were scored on their methodological quality and a best-evidence synthesis was applied to summarise the results.
Results The authors identified 30 papers, of which seven were of high methodological quality. Intention was found as a determinant of children’s physical activity. Determinants of adolescents’ physical activity were age (i.e., older children were more active), ethnicity (i.e., being of African–American descent determined being less physically active) and planning. The authors found insufficient evidence for determinants of sedentary behaviour.
Conclusion Studies on determinants of physical activity and sedentary behaviour were in general of poor methodological quality. To develop long-term effective interventions that increase physical activity and decrease time spent in sedentary behaviours in young people, we need more high quality prospective evidence on the determinants of these behaviours.
Keywords: children, adolescents, physical activity, longitudinal research
CORRESPONDING AUTHOR: Uijtdewilligen Léonie, VUmc, Amsterdam; l.uijtdewilligen@vumc.nl
P338
WHO IS AT RISK? INVESTIGATING THE DETERMINANTS OF PHYSICAL ACTIVITY IN YOUNG ADULT WOMEN
Uijtdewilligen L.1, Peeters GMEE.2, Van Uffelen JGZ.3, Twisk JWR.4,5, Singh AS.1, Brown WJ.2
1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
2 The University of Queensland, School of Human Movement Studies, Brisbane, Australia
3 Monash University, School of Primary Health Care, Primary Care Research Unit, Melbourne, Victoria, Australia
4 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
5Department of Health Sciences, Section Methodology and Applied Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Purpose: To identify socio-demographic, work and lifestyle-related determinants of physical activity (PA) in young adult women over 9 years, using specific statistical techniques for analysing longitudinal data.
Methods: Self-reported data were provided in 2000, 2003, 2006 and 2009 by 11,835 participants (aged 22-27 years in 2000) in the Australian Longitudinal Study on Women’s Health. Generalized Estimating Equations were used to examine univariable and multivariable associations of age, body mass index, country of birth, area of residence, education, marital status, number of children, occupational status, working hours, smoking, alcohol intake, and stress with PA status (active, ≥600 MET∙min/week; inactive, <600 MET∙min/week, according to public health guidelines).
Results: All variables were significantly associated with physical activity in univariable models. In the multivariable model, the lowest odds of being active (compared with the relevant reference categories) were for women born in Asia (OR = 0.54), having less than 12 years of education (OR = 0.79), being married (OR = 0.64) or in a de facto relationship (OR = 0.78), with at least one child (OR ranging from 0.70 to 0.72), and classified as non (OR = 0.65) or rare drinkers (OR = 0.79).
Conclusions: These results are among the first to confirm that socio-demographic, work-related and lifestyle factors are important determinants of PA in young adult women over time.
Keywords: physical activity, young adult women, longitudinal research
CORRESPONDING AUTHOR: Uijtdewilligen Léonie, VUmc, Amsterdam; l.uijtdewilligen@vumc.nl
P339
KAPS: AN INTERVENTION TARGETING MEDIATORS OF CHILDREN’S PHYSICAL ACTIVITY
Brown L.1, Salmon A.1, Hume E.1, Timperio P.1, Pearson L.2
1 Deakin University, Centre for Physical Activity & Nutrition Research, Melbourne, Australia
2 Loughborough University, School of Sport, Exercise & Health Sciences, Leicestershire, UK
Background and Aim: Previous intervention studies which aim to promote children’s physical activity (PA) have shown limited effectiveness, particularly in long term maintenance of behaviour change. This is thought to be due to a lack of understanding of mediating pathways through which interventions achieve changes in children’s PA. This paper presents the rationale and study design of the KAPS (Kids Physical Activity with Parental Support) study, which aims to examine the effectiveness of targeting potential mediators of change in children’s PA.
Methods: KAPS is a randomised controlled trial involving families of 10-12 year old children. The study recruited 59 Australian families where parents identified concerns over their child’s PA. KAPS targeted four potential mediators of change in children’s PA: parental support; accessibility to equipment and facilities; self-efficacy and a newly identified potential mediator, ‘fear of the unknown’. Intervention strategies included provision of equipment, activity cards, fortnightly parent and child newsletters, phone calls and e-mails, child and family activity planners, local facility booklets and free visits to local YMCA centres, each of which targeted one of the four potential mediators.
Baseline and post-intervention assessments included objectively measured child PA (accelerometry) and self- and parental proxy-reports of the potential mediators. Analyses will examine the potential mediating pathways using the product of coefficient method (Mckinnon) with bootstrapped CI’s.
Results: Recruitment of families was challenging and required a variety of methods to be employed to encourage participation. Preliminary findings have shown the need for individual intervention tailoring for families, the need for parents to be supported to facilitate their children to be more physically active and the importance of communication between researchers and families to provide feedback and encouragement throughout the intervention.
Conclusions: The findings of this study will provide a better understanding of the pathways through which interventions achieve behaviour change.
Keywords: Physical activity, mediators, children
CORRESPONDING AUTHOR: Brown Helen, Deakin University, Australia; hbrown@deakin.edu.au
P340
VALIDITY OF THE OMRON “WALKING STYLE PRO” PEDOMETER IN PRESCHOOL CHILDREN
De Craemer M., De Decker E., De Bourdeaudhuij I., Deforche B., Cardon G.
Ghent University, Movement and Sports Sciences, Ghent, Belgium
Introduction: The use of accelerometers and pedometers are objective methods to measure physical activity in preschoolers (1). However, accelerometers are expensive and the units of measurement (counts) have less intuitive utility compared to pedometer step counts. Pedometers are less costly and can be used in large-scale studies. However, most pedometer models only provide the total steps per day and preschoolers can easily reset these devices. The Omron Walking Style Pro pedometer advances older types as it holds a memory of the step counts, it provides an hourly summary of the steps taken and makes it feasible to determine the most active moment of the day. We aimed at validating this type of pedometer against the ActiGraph accelerometer (2).
Methods: A sample of 46 preschool children (4-6 yrs) wore an ActiGraph GT1M accelerometer and an Omron Walking Style Pro pedometer simultaneously for four consecutive days. Hourly step counts were compared. The study was conducted in May 2011.
Results: Analysis between hourly step counts from both devices revealed a high correlation (r = 0.95, p
Discussion and conclusion: The Omron Walking Style Pro pedometer is a valid instrument to measure physical activity in preschool children. Because of the relatively low cost, this device could be used in large-scale studies. This pedometer is only limited in recording detailed information on the intensity of the physical activity.
References
1. Oliver M et al. (2007). Physical activity in preschoolers: understanding prevalence and measurement issues. Sports Med; 37(12):1045-70.
2. Pate R et al. (2010). Measurement of physical activity in preschool children. Med Sci Sports Exerc; 42(3):508-12.
3. Holm S. (1979). A simple sequentially rejective multiple test procedure. Scand J Stat;6(2):65-70.
Keywords: Children, Measurement, Physical activity
CORRESPONDING AUTHOR: De Craemer Marieke, Ghent University, Ghent; marieke.decraemer@ugent.be
P341
ASSOCIATIONS BETWEEN PERCEPTIONS OF THE ROUTE TO SCHOOL AND MODE OF TRAVEL TO AND FROM SCHOOL IN ADOLESCENTS
Smith L.1, Salqhvist S.1, Cooper A.2, Ogilvie D.1
1 Medical Research Council Epidemiology Unit , Centre for Diet and Activity Research , Cambridge , United Kingdom
2 University of Bristol, Department of Exercise and Health Sciences , Bristol, United Kingdom
Purpose: Active travel (walking and cycling) to school is associated with higher overall physical activity levels than passive (motorised) travel. Adolescents with positive perceptions of their immediate neighbourhood environment are more likely to walk or cycle to school. Perceptions of the route to school are also likely to be a key influence on travel behaviour to and from school, but this hypothesis has not been tested in previous research. These analyses examine the association between perceptions of the route to school and mode of travel to and from school in adolescents.
Methods: Data were from 201 adolescents aged 12 to 17 from a high school in Hertfordshire, UK taking part in the iConnect study in spring 2010. Participants reported their usual mode of travel (dichotomised as active/passive) to and from school and their perceptions of the route to school (e.g. relating to traffic, crime, infrastructure). Perceptions of the route to school were collapsed into a single binary variable dichotomised as positive/negative. Associations were examined using multiple logistic regression models adjusted for ethnicity, school year and sex.
Results: 84% of adolescents reported positive perceptions of the route to school. Adolescents with positive perceptions of the route to school were more likely to walk or cycle to (OR 6.0; 95% CI 1.35 to 26.92) and from (OR 2.4; 95% CI 1.03 to 5.63) school than those with negative perceptions.
Conclusion: Results suggest that positive perceptions of the route to school are associated with active travel to and from school in adolescents. However, further studies in other samples would be required before making recommendations for intervention.
Keywords: Physical Activity; Environment
CORRESPONDING AUTHOR: Smith Lee, Medical Research Council; ls499@medschl.cam.ac.uk
342
MEDIUM AND LONG-TERM EFFECTS OF A CLASSROOM-BASED INTERVENTION ON CHILDREN’S INTENTIONS AND HABITS OF ACTIVE SCHOOL TRAVEL
Murtagh S.1, Rowe D A.1, McMinn D.2, Nelson N M.3
1 University of Strathclyde, School of Psychological Sciences and Health, Glasgow, United Kingdom
2 University of Aberdeen, School of Medicine and Dentistry, Aberdeen, United Kingdom
3 University of Derby, School of Culture and Lifestyle, Buxton, United Kingdom
Purpose: To investigate immediate, medium-term, and long-term effects of an educational intervention on children’s intentions and habits of walking to school.
Method: Participants were 150 children (8-9 years). Intention was measured using two items: ‘I plan to walk to school every day’ and ‘I intend to walk to school every day’. These were scored on a 4-point scale, scored from 1 (disagree in a big way) to 4 (agree in a big way). The Self-Report Habit Index (SRHI; Verplanken & Orbell, 2003) was used to measure both walking habit and car/bus habit. Responses were recorded on 5-point Likert scales scored from 1 (totally disagree) to 5 (totally agree). Measurement points were baseline (fall), post-intervention (winter), 5 months (spring), and 12 months (fall). A 6-week school-based intervention targeted at children and their parents was delivered immediately after baseline in the initial intervention group (I; n = 70), and following 5-month measures in the comparison group (C; n = 75). Data were analysed using 2-way (Time*Group) factorial ANOVAs , post hoc comparisons, and inspection of mean plots.
Results: The Time*Group interaction was non-significant for intention, walk habit and car bus/use habit (p > .05). Significant differences were observed between groups for intention (I > C), walk habit (I > C) and car/bus habit (I < C). Significant differences were observed between time points in levels of car/bus use habit. No significant differences were observed between time points in either intentions or walking habit (p < .05).
Conclusions: There was no beneficial effect on children’s intention or habits (walk or car/bus use) towards active travel following the intervention. This was regardless of whether the intervention was delivered in fall or spring. Children’s intentions to actively travel to school and walking habits were stable across time suggesting that there is no seasonal variation in these constructs. However, car/bus use habits significantly changed over time. Previous research has demonstrated the significance of this construct in predicting active school travel. Consequently, strategies to reduce the fluctuation of car/bus use habit in children are needed to maintain levels of active school travel all year round.
Keywords: Health, Behaviour change
CORRESPONDING AUTHOR: Murtagh Shemane, University of Strathclyde; shemane.murtagh@strath.ac.uk
P343
EXERCISING FOR WEIGHT AND SHAPE REASONS VS. HEALTH CONTROL REASONS: THE IMPACT ON EATING DISORDERS BEHAVIORS
Gonçalves S., Gomes A., Simães C.
University of Minho, School of Psychology, Braga, Portugal
The psychological and physiological benefits of exercise are well-known, and exercise participation is a positive experience for most people. However, this participation is also associated with body dissatisfaction (Silberstein, Striegel-Moore, Timko, & Rodin, 1988) as well as the development and maintenance of eating problems and eating disorders (Garner, Rosen, & Barry, 1998). One explanation for these negative effects is related to the motives people have for exercising, which can indicate whether individual participation in exercise is more or less autonomous and self-directed (Markland & Ingledew, 2007).
Thus, the first aim of this study was to investigate the prevalence of exercise motivated by weight and shape control reasons compared to health reasons in exercisers at fitness centers. The second aim was to evaluate differences between these two groups in terms of eating patterns.
In total, 301 participants (53.5% males) between 14 and 79 years of age (M = 25.8; SD = 8.89) were recruited for this study.
The evaluation protocol included the Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 1994; Portuguese adaptation by Machado, 2007) and a Demographic and sport information that was developed specifically for this study and allowed us to evaluate the motivation for exercise.
The results showed that almost 48% of the participants reported that their exercise is motivated by weight/shape reasons.
The logistic regression analysis revealed that participants in the weight and shape reasons group were significantly more likely to have a binge-eating episode and to report excessive exercising.
The multivariate analysis of variance showed that the weight and shape reasons group had higher scores on all the dimensions of EDE-Q. Likewise, this group scored higher on the EDE-Q global score.
In conclusion, weight and shape control reasons for exercise participation were very common. In addition, this group had significantly higher scores on all subscales of the EDE-Q which mean a higher tendency to eating disorder behaviors. So, it is important that researchers and clinicians be aware that exercise related to weight and shape reasons is not always a health-promoting behavior.
Keywords: Exercise; Eating behaviors; Adherence
CORRESPONDING AUTHOR: Gomes Rui, Universidade do Minho; rgomes@psi.uminho.pt
P344
USING GEOGRAPHIC INFORMATION SYSTEM AND WEBSITES WITH SELF-MANAGEMENT STRATEGY TO STUDY THE RELATIONSHIP OF ENVIRONMENT AND OBESITY AS WELL AS RELATED BEHAVIOR AND IMPLEMENT AN INTERVENTION WITH SCHOOL CHILDREN
Huang S.1, Shryu M.2, Hung W.2, Chang K.1
1 National Taiwan Normal University, Department of Health Promotion and Behavior, Taipei, Taiwan
2 National Taiwan Normal University, Department of Nursing, Taipei, Taiwan
Introduction: This research aims to explore the effectiveness of a theory-based, GIS technology integrated website on physical activity, consumption behaviors at the fast-food stores, and the BMI of school children.
Methods: A website designed with the strategy of self-management and supplemented with the function of Geographic Information System (GIS) was used to offer the intervention toward these children to increase their amount of physical activity, reduce the frequency of visiting fast-food stores and having healthy diet and decrease the BMI of the children. It took two years to complete the project.
The story line of the website which used the Chinese classical novel, as the framework for intervention was developed and the contents has been checked by the experts. The population of the intervention was the schoolchildren in Taipei City. Two elementary schools in each of three administration districts were used as the intervention sites, one school served as the experimental group, and the other one served as control group.
There were two kinds of intervention methods. The experimental I group used both the goal setting method and knowledge from the Chinese classical novel. The experimental II group used the knowledge website only. The control group school did not receive any intervention treatment besides regular teaching in the classes of health and physical education. Questionnaires of pretest, post-test, and delayed post test were collected. Only data from those 524 questionnaires with complete answer were analyzed. The response rate was 84.92%.
Results: For the immediate effect, the experimental group I had higher score on self-efficacy and time for physical activity than group II and the control group. The schoolchildren in group I and II had increased self-efficacy of healthy eating and decreased frequency of unhealthy eating behavior than the control group. After adjusting the effect of pretest, the scores of physical activity-related self-efficacy and duration of three-day walking in groups I and II were higher than those of control group; meanwhile, group I was higher than group II in these measurements.
Conclusion: Totally speaking, self-management website was effective in reducing unhealthy eating and improving physical activities for schoolchildren. The effect of improving self-efficacy of physical activity and improving duration of walking was also observed. The process and the results could be applied in the related studies and practical work.
Keywords: self-management, goal-setting, intervention, Internet, self-monitoring, schoolchildren, physical activity, eating behavior
CORRESPONDING AUTHOR: Huang Shu-Jen, NTNU, Taiwan; huangsj@ntnu.edu.tw
P345
DO PARTICIPANTS’ PREFERENCES FOR MODE OF DELIVERY (TEXT, VIDEO OR BOTH) INFLUENCE THE EFFECTIVENESS OF AN ONLINE PHYSICAL ACTIVITY INTERVENTION?
Vandelanotte C.1, Duncan M.1, Plotnikoff R.2, Mummery K.3
1 Central Queensland University, Institute for Health and Social Science Research, Rockhampton, Australia
2 University of Newcastle, Priority Research Centre in Physical Activity and Nutrition, Newcastle, Australia
3 University of Alberta, Faculty of Physical Education and Recreation, Edmonton, Canada
Background: In randomized controlled trials, participants can not choose their preferred mode of intervention delivery. As such, participants might refuse to participate or not engage fully if randomized to a non-preferred group. This might cause underestimation of the true efficacy of behaviour change interventions. This study examined whether receiving interventions that were either ‘matched’ or ‘mismatched’ with participants’ preferred delivery-mode influenced effectiveness in an online physical activity intervention.
Methods: Adults (n = 803), recruited via e-mail, were randomized into one of three modes of intervention delivery (text, video, combined) and received personal advice about physical activity via the internet. Intervention content was identical across groups. Participants were assessed at baseline, one week and one month. Before randomization, participants were asked which delivery-mode they would prefer, to categorise them as matched or mismatched. Repeated measures ANCOVAs, with Intention-to-treat, were applied to assess group differences.
Results: The text-mode (61.4%) was preferred over the combined-mode (26.9%) and video-mode (11.7%). Significant time effects were observed for all physical activity outcomes; indicating that physical activity increased over time for both matched and mismatched groups. The participants in the matched group improved physical activity outcomes slightly more when compared to those in the mismatched group, however no significant interaction effects were observed. The physical activity advice acceptability and website usability were generally high and no differences were found between the matched and mismatched groups. The only significant difference (t = 2.16; P = .031) was in relation to the total time spent on the website; those in the mismatched group spent significantly more time on the website (14.4 min) when compared to those in the matched group (12.1 min).
Conclusion: This study illustrates that participants’ preference regarding delivery-mode may not significantly influence intervention outcomes. As a consequence, allowing participants to choose their preferred delivery-mode may not increase efficacy for online interventions.
Keywords: physical activity, computer-tailoring, mismatch, preferences, delivery method, website-delivered, behaviour change intervention
CORRESPONDING AUTHOR: Corneel Vandelanotte, Central Queensland University; c.vandelanotte@cqu.edu.au
P346
ASSOCIATIONS OF PHYSICAL ACTIVITY AND SCREEN-TIME ON HEALTH RELATED QUALITY OF LIFE IN ADULTS
Davies A.
Central Queensland University, Institute for Health and Social Science Research, Rockhampton, Australia
Background: Physical inactivity and prolonged time spent in screen based activities are shown to be independently associated with a number of adverse physical and mental health effects. However, associations of the combined effect of physical activity (PA) and screen based activities on health related quality of life (HRQOL) remain largely undetermined.
Methods: During 2008-2010, self-reported HRQOL, PA, and screen-time data were collected for 3,796 Australian adults. Logistic regression was conducted to examine the associations of six combinations of PA (none, insufficient, sufficient), and screen-time (low, high) on HRQOL.
Results: In comparison to the reference category (sufficient PA and low screen-time) men and women who reported no physical activity and either low or high screen-time, were significantly more likely to report over 14 unhealthy days. Men reporting no or insufficient PA levels and high or low screen-time were also more likely to rate their health as poor or fair. In women this was only the case for those who reported no PA and high screen-time.
Conclusions: Although PA seems to be the most important factor in determining HRQOL, the combination of no physical activity and high screen-time demonstrated the greatest negative impact on HRQOL.
Keywords: Quality of life, physical activity
CORRESPONDING AUTHOR: Davies Cally, CQUniversity; c.davies@cqu.edu.au
P347
DETERMINANTS OF PHYSICAL ACTIVITY AMONG WOMEN IN SOUTH KERALA, INDIA
Mathews E.
Sree Chitra Tirunal Institute for Medical Science and Technology, Achutha Menon Centre for Health Science studies, Trivandrum, India
Background: Health interventions addressing the major chronic disease risk factors are very limited in developing country context compared to the developed nations despite the higher burden in developing countries. Interventions developed and successful in the western nations are inappropriate for replication the third world countries due to the cultural, societal and environmental differences between these nations. This study was conducted to understand the current prevalence of physical inactivity among women in South Kerala and identify the factors that influence physical (in) activity at intrapersonal, interpersonal and community level.
Methods: A cross sectional survey was done among 456 women (median age 42 years; range 18-64 yrs.) in Trivandrum, the capital city of the Indian state of Kerala in 2011. Participants were selected by multistage random sampling and details on demographic details, self-reported PA and determinants of physical activity at personal, interpersonal and community level were collected using a pre-tested structured interview schedule. Multiple logistic regression analysis was done to find the predictors of physical (in) activity.
Results: Physical inactivity prevalence among women was found to be 28% with highest prevalence among 33-47 years of age (48.6 per cent). Domain specific analysis shows high levels of physical inactivity at leisure and transportation, 97.8% and 37.1% respectively. Physically active women were more likely to have a past experience in sports, aware of the recommended levels of physical activity for health benefits and perceive exercise is important apart from the daily activity. Factors that facilitate physical activity significantly at intrapersonal level were advice from a health professional and at community level were safe roads, neighbourhood safety, exercising seen as a positive behaviour and the presence of sidewalks. Barriers to physical activity that were significant at community level were presence of stray dogs, heavy traffic, poor access to facilities and high crime rates.
Conclusion: Vital investments on modifying the environment conducive for activity, transportation polices along with health communication by physicians are crucial to promote physical activity.
Keywords: physical activity, environment, health promotion
CORRESPONDING AUTHOR: Mathews Elezebeth, SCTIMST, Trivandrum; elezebethmathews@gmail.com
P348
PREDICTORS OF MODERATE TO VIGOROUS PHYSICAL ACTIVITY AMONG ADULT LESBIANS
Brittain D.1, Dinger M.1, Gyurcsik N.2
1 University of Northern Colorado, School of Human Sciences, Community Health, Greeley, USA
2 University of Saskatchewan, College of Kinesiology, Saskatoon, Canada
Although participation in moderate and vigorous physical activity results in numerous health benefits, the majority of adult lesbians are not sufficiently active. Thus, a need exists to identify underlying individual and environmental-level factors associated with adherence to participation in physical activity. Identification of these factors will ultimately guide the design of effective programs and policies targeting an increase in regular participation in physical activity. The purpose of this study was to examine the relationships between demographic (i.e., age; race; education; income; body mass index; partner status; employment; general health status; chronic disease diagnosis; children residing at home) and environmental-level factors (i.e., connection with the lesbian community; public identification as a lesbian) to participation in recommended levels of moderate to vigorous physical activity (MVPA). Participants included 847 self-identified adult lesbians aged 18-74 years (M age = 40.47 years; SD = 11.62 years) who completed a 20-minute web-based survey assessing demographics, MVPA, connection with the lesbian community and public identification as a lesbian. Based on results from a logistic regression analysis, the predictive model that included all of the demographic and environmental-level factors significantly predicted participation in MVPA χ2 = 108.03, df = 12, N = 847, p < .001. When examining the predictor variables independently, connection with the lesbian community (OR = 1.013; CI = 1.002, 1.025), body mass index (OR = .948; CI = .929, .968), and general health status (OR = 1.756; CI = 1.449, 2.129) significantly contributed to the overall prediction of MVPA. Future research should extend on this study by continuing to examine the relationship between individual and environmental-level factors associated with MVPA among adult lesbians. In particular, future research should further examine the impact of connection with the lesbian community on participation in MVPA. An understanding of how the lesbian community may provide a protective factor to adherence in health behaviors such as MVPA could uncover distinct public health strategies needed to increase MVPA among adult lesbians.
Keywords: Physical activity, sexual orientation
CORRESPONDING AUTHOR: Brittain Danielle, University of Northern Colorado, Greeley; danielle.brittain@unco.edu
349
LEISURE TIME PHYSICAL ACTIVITY AMONG RURAL WOMEN IN SOUTH KERALA, INDIA- A QUALITATIVE STUDY
Mathews E.
Sree Chitra Tirunal Institute for Medical Science and Technology, Achutha Menon Centre for Health Science studies, Trivandrum, India
Background: Contribution of physical inactivity to the development of non communicable disease is well explored. Technological advances at home and workplace have made leisure time physical activity essential in the daily chores. Rising incidence of obesity and chronic diseases pose women at a greater risk with negligible women engaging in leisure time physical activity. This paper explores the perception towards physical activity and the social and structural impediments that hinder the behavioral change among rural women in South India.
Methodology: Data is generated from transcript of conversation, group meetings, in- depth interviews, focus group discussions and field experience of group interactive sessions conduced for people in different settings among women of 18 to 60 years of age, in the rural South India. An open-ended approach was utilized using an emergent study design informed by grounded theory with content analysis to analyze and interpret the data.
Results: Apart from the physical activity perceptions and barriers reported in other studies, few specific findings were regarding exercise as an activity that has to be undertaken in exercise settings meant for men. Time constraint was the constantly reported barrier among most women due to their overall household responsibility, household work sufficient for exercise, exercise perceived as against social norms and the outfit not accommodating for various activities.
Conclusion: Given the socio-cultural barriers and perceptions explored in this study, it is recommended that thrust be on tailored interventions propagating the importance of physical activity among women.
Keywords: Health behaviour change, physical activity
CORRESPONDING AUTHOR: Mathews Elezebeth, SCTIMST, Trivandrum; elezebethmathews@gmail.com
P350
ON-LINE DATABASE ON LOCAL PHYSICAL ACTIVITY RESOURCES AND DROP-OUT LEVELS AMONG GRADUATES IN CLUJ-NAPOCA, ROMANIA. PRELIMINARY RESULTS
Sandu P .1, Rus D.2, Chereches R.2, Baba C.3, Mocean F.1
1 University of Medicine and Pharmacy Iuliu Hatieganu, Community Medicine Department, Cluj-Napoca, Romania
2 Babes-Bolyai University, Center for Health Policy and Public Health, Cluj-Napoca, Romania
3 Babes-Bolyai University, Faculty of Political, Administrative and Communication Sciences, Cluj-Napoca, Romania
Background: Students are in very favorable conditions for practicing physical activities due to: free-access facilities, easy-to-reach free time and powerful social connections. However, as they graduate and move into a working environment, these conditions disappear. Moreover, personal triggers, like work and family responsibilities, financial shortage and physical limitations as well as low motivation increase drop-out levels. In this respect, easy to access information on the available health enhancing physical activities at a local level including environment, facilities and events is a factor that can contribute to the increase of physical activity levels amongst young adults that have just graduated from university and entered the labor force.
Objectives: (1) Gain information on local PA resources and opportunities from multi-sectorial public and private environments; (2) Build a comprehensive database of local PA resources and opportunities. (3) Develop an on-line database of local PA resources and opportunities
Methods: (1) Interviews with local stakeholders in order to obtain the necessary information; (2) Document analysis: conducted in order to assess the local resources and opportunities;
(3) Operationalizing database: Divide information by environment, provider, facility, event and schedule. (4) Transfer database on-line
Results: On-line database comprising local physical activity resources and opportunities: environment, facilities, providers, events and schedule.
Conclusion and follow up: The on-line database comprising all Cluj-Napoca physical activity resources and opportunities positively influence the levels of physical activity amongst young adults and increase the level of awareness regarding enhancing physical activity facilities.
Keywords: physical activity; information; young adults; drop-out; on-line database
CORRESPONDING AUTHOR: Sandu Petru, U.M.F. Cluj-Napoca; petrusandumd@gmail.com
P352
THE 6 MINUTES WALKING TEST AND SELF-EFFICACY IN OBESITY
Romain A. J.1, Attalin V.2, Hokayem M.3, Ninot G.4, Avignon A.2
1 University of Montpellier, France, Department of nutrition and diabetes, Montpellier, France
2 University Hospital of Montpellier, Department of nutrition and diabetes, Montpellier, France
3 INSERM, Physiology and Experimental Medicine, Montpellier, France
4 University of Montpellier, Department of exercise science, Montpellier, France
Background: self-efficacy is defined as “people’s judgment in their capabilities to organize and execute courses of action required to attain designated types of performance” can be measured according to its magnitude, strength and its generality to others related domains. The six-minute walk test (6MWT) is a safe, inexpensive and quick tool that has been shown to be highly reproducible in obese subjects and is therefore used as a fitness indicator in this population. In this study, we aimed to evaluate whether the 6MWT could be a useful tool to increase self-efficacy of obese subjects
Methods: 34 participants (26F/ 8M; 47.45 ± 15.57 years old, 37.87 ± 4.75 kg/m²) performed two 6MWT separated by a resting period of 45 minutes and completed 3 questionnaires on self-efficacy (SE): 1 on increasing distance to the 6MWT (SEDist), another on increasing mean number of daily steps (SEInc) and the last one on self-efficacy barriers (SEBarr) to physical activity. Each questionnaire was completed 3 times: before the 1st 6MWT (T0), during the resting period (T1) and after the 2nd 6MWT (T2). They were also asked their expectations of distance in meters before each 6MWT.
Results: Cronbach’s alpha ranged from 0.79 to 0.90 reflecting a good to excellent internal consistency. Expectations of distance at T0 were significantly correlated to SEDist at T0 (r = 0.62; p < 0.001). At T1 expectations of distance assessed were correlated with distance to the 1st 6MWT (r = 0.39; p < 0.05), distance to the 2nd 6MWT (r = 0.47; p < 0.01) and SEDist at T2 (r = 0.50; p < 0.01). Concerning measures of self-efficacy, SEDist increased through the 3 measurements [F(2, 64) = 13.30, p < 0.001, η²p = 0.36] as well as SEinc [F(2, 64) = 3.70, p < 0.05, η²p = 0.10] and SEBarr [F(2, 58) = 4.23, p < 0.05, η²p = 0.12]
Conclusion: The 6MWT may be a useful tool to increase self-efficacy of obese subjects, at least in the short term. As expected, the different measures of self-efficacy increased at each measurement. These increases could be due to success in the 6MWT, or to a better interpretation of their physiological states, two parameters known as sources of efficacy. The increase of SEBarr showed that the 6MWT could allow an increase of expectations to other situations related to daily life
Keywords: Obesity, physical activity, self-efficacy
CORRESPONDING AUTHOR: Romain Ahmed Jérôme, Montpellier University; romain.aj@gmail.com
P353
OBESITY REMAINS A SIGNIFICANT PUBLIC HEALTH CONCERN AND IS RELATED TO NUMEROUS MEDICAL CONDITIONS.
Webber L.1, Joyce C.1, Rice J.1, Johnson C.2, Rose D.2
1 Tulane University, Department of Biostatistics and Bioinformatics, New Orleans, USA
2 Tulane University, Department of Global Community Health and Behavioral Sciences, New Orleans, USA
Obesity remains a significant public health concern and is related to numerous medical conditions. Elementary school teachers and staff are important role models for children and are often called upon to teach health education practices. ACTION! A Worksite Wellness Program for Elementary School Personnel was a two-year intervention to increase physical activity and to promote healthy eating practices among all school staff. Participants came from 20 elementary schools in a large suburban school district in the Greater New Orleans, Louisiana area. Randomization of the schools took place after baseline measurement of height, weight, and blood pressure. Minutes of physical activity per day were assessed using the Actigraph accelerometer over a six-day period. The physical activity component of the intervention consisted of school policy changes (development of a Wellness Committee), promotional activities (such as bulletin boards, monthly newsletters, holiday challenges), after-school group fitness classes, pedometer challenges, development of walking paths and an adult wellness area on each school site. The measurements were repeated after the two-year intervention. For the 588 participants with complete accelerometry data at both baseline and the two-year follow-up, minutes of moderate to vigorous physical activity increased by 0.51 minutes in intervention schools compared to a decrease of 0.94 minutes in control schools (p = 0.046). Light minutes of activity decreased by 4.22 minutes in intervention schools compared to a decrease of 8.93 minutes in control schools (p = 0.44). This did not translate, however, into changes in Body Mass Index or blood pressure. The programs to increase physical activity were well-received by school personnel; however, changes within the school environment must be coupled with changes throughout the full day to reduce obesity. Health promotion programs targeting school personnel are an essential part of a comprehensive healthy school environment.
Keywords: Obesity, physical activity
CORRESPONDING AUTHOR: Webber Larry, Tulane University; lwebber@tulane.edu
P354
DOES SELF-EFFICACY FOR PHYSICAL ACTIVITIES ACTS AS A MEDIATOR VARIABLE PREDICT THE MENTAL HEALTH?
Shimizu Y.1, Ishii M.2
1 International Christian University, -, Tokyo, Japan
2 Tokyo Institute of Techonology, -, Tokyo, Japan
The aim of this study is to develop an Exercise Promotion Scale for University Students (EPSUS)and Exercise Interference Scale for University Students (EISUS), and to examine hypotheses based on the exercise behavior model which proposes that self-efficacy for physical activities acts as a mediator variable to predict the mental health of university students.
The first part of the study was a preliminary survey in which 1218 Japanese university students (336 males and 882 females, mean age = 18.92, SD = 1.75) were asked to complete a questionnaire. Exploratory factor analyses, confirmatory factor analyses, and reliability analyses were conducted, in order to develop the EPSUS and the EISUS. In the second part of the study, 240 participants (147 males and 93 females, mean age =19.97, SD =1.41) were asked to complete a set of questionnaires including a fact sheet, the EPSUS and EISUS that were developed in the first survey, the Self-Efficacy for Physical Activities for University Students (SEPAUS), and the Mental Health Pattern (MHP). Structural equation modeling was used to examine the hypothetical mediation models: EPSUS/EISUS/SEPAUS/MHP.
The results indicated that both the EPSUS and the EISUS include eight factors with 32 items, and each scale had satisfactory fit indices and Cronbach’s alpha reliabilities. The hypothetical models revealed that both EPSUS and EISUS had a non-significant direct association with MHP, but were significantly indirectly associated with MHP via SEPAUS as a mediator variable. In the first model, EPSUS was positively associated with SEPAUS and SEPAUS was negatively associated with MHP, while in the second model, EISUS was negatively associated with SEPAUS and SEPAUS was negatively associated with MHP.
The findings of this study partially support our hypothetical models. The results suggest that interventions that enhance EPSUS factors and reduce EISUS factors may be effective in promoting university students’ mental health. However, the study has limitations in understanding exercise behaviors because of its cross-sectional research design. In order to examine long-term intervention methods, a longitudinal research design will be needed, using physiological or behavioral measures in addition to the EPSUS, EISUS, and SEPAUS.
Keywords: mental health, exercise, self-efficacy
CORRESPONDING AUTHOR: Shimizu Yasuo, J.F.Oberlin University; maxleiden@yahoo.co.jp
P355
IS SELF-REGULATORY EFFICACY A MEDIATOR OF THE NEUROTICISM – PHYSICAL ACTIVITY RELATIONSHIP AMONG ADULTS WITH ARTHRITIS?
Gyurcsik N.1, Brittain D.2, Brawley L.1, Cary M.1
1 University of Saskatchewan, College of Kinesiology, Saskatoon, Canada
2 University of Northern Colorado, School of Human Sciences, Community Health Program, Greeley, USA
Participation in moderate and vigorous physical activity (mod + PA) is an effective strategy to help adults manage their arthritis, yet adherence is a problem. A need exists to understand theory-based factors responsible for adherence, including the identification of individual-level differences. Stable individual-level traits, including the Big 5 personality factors, may influence regular PA. Various personality traits (e.g., neuroticism, extraversion) have been associated with PA in the general population. However, potential mechanisms underlying this relationship are unknown. Among people with arthritis, self-regulatory efficacy to schedule and plan PA (SRE-S/P) is theorized as a predictor of mod + PA and is a motivational mechanism. Accordingly, our purpose was to examine whether SRE-S/P mediated the relationships between Big 5 personality traits and mod + PA in adults with medically diagnosed arthritis (N = 87; M age = 52 ± 3.61years). Our design was observational and prospective. At time 1, participants completed online measures of the Big 5 personality test (neuroticism, conscientiousness, extraversion, agreeableness, and openness), SRE-S/P, and demographics. At time 2, an online measure of the number of days of mod + PA during the two-week period was completed. Neuroticism was the sole significant personality correlate with PA (r = -.22, p < .05). Multiple regression analyses were conducted to examine whether SRE-S/P was a mediator. Neuroticism accounted for significant variance in SRE-S/P (R 2 adjusted = .05, p < .05). After controlling for the significant prediction of SRE-S/P to mod + PA, neuroticism was no longer a significant predictor of PA (p > .05). Analyses revealed that SRE-S/P was a partial mediator of the relationship between neuroticism and mod + PA. Findings support the notion that people who are higher in neuroticism (i.e., more emotionally unstable and anxious) may be less confident to schedule and plan PA. Understanding the individual trait differences of people may help with determining who is ready to engage in interventions targeting change in SRE-S/P. Triaging people with arthritis towards interventions that they are ready to accept is an important public health goal.
Funded by SSHRC grant #410-2005-2292.
Keywords: Arthritis; Chronic Disease; Exercise; Physical Activity; Behavior Change
CORRESPONDING AUTHOR: Gyurcsik Nancy, Univ Saskatchewan, Saskatoon; nancy.gyurcsik@usask.ca
P356
HIGH-INTENSITY PHYSICAL ACTIVITY REDUCES FUTURE DEVELOPMENT OF POOR MENTAL HEALTH IN JAPANESE ADOLESCENTS: SIX MONTHS FOLLOW-UP STUDY
Yamatsu K.1, Kumagai S.2
1 Saga University, Faculty of Culture and Education, Saga, Japan
2 Kyushu University, Institute of Health Sciences, Kasuga, Japan
Purpose: To determine whether physical activity or sedentary behavior reduces the risk for future development of poor mental health over 6 months among university students.
Method: Participants (N = 559) completed the International Physical Activity Questionnaires and the General Health Questionnaires 12 items at the May of 2010 (baseline data) and October of 2010 (follow-up data).
Results: Among 559 university students, 27.0% (male: 21.2%, female: 33.3%) of them had poor mental health at baseline. Using logistic regression analyses that controlled for several covariates, we found that high-intensity physical activity significantly reduced risk for future development of poor mental health (OR [Odds Ratio] = 0.487, 95%CI [confidence interval] = 0.247-0.962). Also, high levels of exercise self-efficacy significantly reduced future development of poor mental health (OR = 0.510, 95%CI = 0.261-0.996). However, no predictive effects were for total physical activity and sedentary behavior time.
Conclusions: These results suggest that increased high-intensity physical activity and/or exercise self-efficacy reduce development of poor mental health over 6 months among university students.
Keywords: Adolescents, Exercise, Longitudinal research, Mental health, Physical activity
CORRESPONDING AUTHOR: Yamatsu Koji, Saga University, Saga; kyamatsu@cc.saga-u.ac.jp
P714
COMBINED ASSOCIATIONS OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR WITH DEPRESSIVE SYMPTOMS AMONG JAPANESE ADULTS
Liao Y.1, Harada K.2, Shibata A.3, Ishii K.3, Nakamura Y.3, Inoue S.4, Oka K.3
1 Waseda University, Graduate School of Sport Sciences, Saitama, Japan
2 Japan Society for the Promotion of Science, Tokyo, Japan
3 Waseda University, Faculty of Sport Sciences, Saitama, Japan
4 Tokyo Medical University, Department of Preventive Medicine and Public Health, Tokyo, Japan
Background: Emerging evidence shows joint associations of physical activity (PA) and sedentary behavior (SB) with physical health (e.g., overweight), however, few studies have addressed on these associations with mental health (e.g., depression). Therefore, this study aimed to examine combined associations of PA and SB with depressive symptoms among Japanese adults.
Methods: An Internet-based survey was used to collect depression levels (Center for Epidemiologic Studies Depression Scale), self-reported time spent in PA and SB (short version of the International Physical Activity Questionnaire) and sociodemographic variables from 2,914 adults. Respondents were categorized into four PA/SB categories as per public PA guidelines (150 minutes/week) and the median of SB (2,700 minutes/week). Logistic regression analysis examined the odds ratios (ORs) of being depressed (depression scores, ≥16) according to the categories of PA and SB.
Results: After adjusting for sociodemographic variables, adults in the sufficient PA/high SB (OR, 0.60; 95% confidence interval [95%CI), 0.48, 0.75) and sufficient PA/low SB (OR, 0.60; 95%CI, 0.49, 0.75) category were significantly less likely to have depressive symptoms in comparison with the insufficient PA/high SB category. Similar patterns were found both in men and women.
Conclusions: Meeting physical activity recommendations are associated lower risks of depressive symptoms, regardless of time spent on sedentary behavior. The present results suggest that promoting physical activity might be an effective strategy to against depressive symptoms in both sexes.
Keywords: Physical activity, Depression
Corresponding author: Liao Yung, Waseda University, Japan; anthroliao@fuji.waseda.jp
P357
EDUCATION AND TRAINING IN BEHAVIORAL MEDICINE WORLDWIDE: RESULTS OF AN ISBM ONGOING SURVEY
Berman AH.1, Yasuichi K.2, Kothe E.3, Sherman K.4
1 Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
2 The University of Tokyo Graduate School of Medicine, Department of Stress Science and Psychosomatic Medicine, Tokyo, Japan 3 University of Sydney, School of Health Psychology, Sydney, Australia
4 Macquarie University, Department of Psychology, Sydney, Australia
Aim: The primary mission of the International Society of Behavioral Medicine (ISBM) Education and Training Committee is to facilitate international cooperation in education and training within the field of Behavioral medicine. As part of this mission, a survey to assess the current state of education in behavioral medicine was conducted among ISBM members during September-December 2011.
Method: Key members of ISBM were contacted via e-mail with a personal link to a background survey and were requested to send a general link to the online survey to members of their networks. Respondents who indicated that they taught behavioral medicine and were willing to provide further information completed online surveys assessing the types of courses offered for undergraduate, masters, doctoral and continuing education levels.
Results: Of the 91 key members contacted, 53 (58%) responded. Of the 243 individuals who accessed the general survey link, 71 (29%) responded. Background data were available for 124 respondents. The majority of participants were PhD-qualified, university academics based in Europe, US, and Asia/Pacific regions. Most respondents indicated that they had a clinical affiliation with psychology. Behavioral medicine was predominantly viewed as being currently subsumed within other disciplines, including psychology, public health and medicine. The majority also saw the field as developing further in the future. A qualitative analysis of respondents’ definitions of Behavioral medicine will be presented, together with ongoing results on the types and levels of education and training in Behavioral medicine
Conclusion: The results of the survey and the continued online collection of data on current education and training in behavioral medicine provide valuable information to guide future international cooperation in this area. These data may provide a platform from which the role of education in evidenced-based behavioral medicine can be expanded in the long term within the curricula of teaching programs for health professionals.
Keywords: Health Education, Interdisciplinarity
CORRESPONDING AUTHOR: Berman Anne H, Karolinska Institutet, Stockholm; anne.h.berman@ki.se
P358
THE RESEARCH AND PRACTICE OF BEHAVIORAL MEDICINE IN MEXICO: AN UPDATE
Rodiguez-Ortega G.1, Rojas-Russell M.2
1 National Autonomous University of Mexico, School of Psychology, Mexico, Mexico
2 National Autonomous University of Mexico, School of Psychology - Zaragoza, Mexico, Mexico
According to previous studies, in Mexico (Rodriguez & Rojas, 1998; Rodriguez & Jaén, 2004), from its beginnings behavioral medicine (BM) has been strongly bound to the field of Health Psychology. Those who identify themselves as BM researchers or practitioners usually are psychologists. Based on the epidemiologic profile of the country, the main subjects of study and attention of BM have been related to the management of chronic diseases. The objective of the present study was to update the information regarding the situation of the research and the practice of behavioral medicine in Mexico. Academic and health professionals from different universities and health care centers all over the country answered a survey via Internet. The questionnaire asked about core training and behavioral medicine training, ongoing research, training of human resources, scientific productivity and the perspective on the future of BM in Mexico. The main outcomes indicate a gradual incorporation to the behavioral medicine of professionals from other health disciplines different to psychology; nevertheless, the field is still dominated by psychologists. There have started to develop research related to health promotion, however they are still scarce compared to the burden of diseases related to lifestyle. Working scenarios related to the delivery of healthcare services rather than research, are increasing also. Finally, these changes in the overall context of health services in Mexico, as well as human resource training in health are discussed.
Keywords: Public health, Interdisciplinarity
CORRESPONDING AUTHOR: Rojas Mario, UNAM, Mexico; merr@unam.mx
Poster Session B
P359
DO WE NEED DIFFERENT APPROACH IN TEACHING MEDICAL COMMUNICATION SKILLS FOR STUDENTS OF DIFFERENT NATIONS?
Tóth I.1, Bán I.1, Füzesi ZS.2, Kesztyüs M.3, Kékesi SZ.4, Hambuch Kőhalmi A.5, Nagy L.1
1 University of Pécs, Institute of Family Medicine, Pécs, Hungary
2 University of Pécs, Institute of Behavioral Sciences, Pécs, Hungary
3 Fact Institute of Applied Social Science Research, -, Pécs, Hungary
4 University of Pécs, Faculty of Sciences, Pécs, Hungary
5 University of Pécs, Department of Languages for Specific Purposes, Pécs, Hungary
Introduction: In the Family Medicine Institute of Pécs University we teach medical communication skills in three languages (Hungarian, English and German) for the first year medical students. In order to improve the efficacy of teaching communication skills we have to know students’ attitudes towards the communication skills learning. The Communication Skills Attitudes Scale (CSAS) proved to be an internationally accepted and easily adaptable instrument for this purpose (1).
Aims: In our study we examined whether Hungarian, German and English program students have different attitudes towards the communication skills learning.
Method: CSAS questionnaires were filled in anonymously at the beginning of the seminars. Principal component analysis with varimax rotation was performed to define the factors. Different factors in each program were compared by independent t-test. SPSS ver. 10.5 was applied for analysis.
Results: We created a multiple factor model consisting of 7 factors. Factors were named as follows: 1- respect and interpersonal skills; 2- learning; 3- importance of communication within medical profession; 4 - excuse; 5 - counter; 6 - assessment; 7 - overconfidence. Students’ attitudes were mainly positive. We could confirm significant differences between the three programs in factor 1, 3, 5, 6 and 7.
Conclusion: Students agree that they should learn communication skills (factor 2). However they differed in judging the importance of communication knowledge within medicine. They think differently about respect toward patient and colleagues, the team work. Students have various motivational aims for learning communication skills. To explain the exact background reasons of our results we need further research. Furthermore our results raise the question whether we should use different approaches in teaching CS for students of different nations and to what extent we should unify our teaching materials and methods in the different programs.
1) Rees C., Sheard C., Davies S.: The development of a scale to measure medical student’s attitudes towards communication skills learning: the Communication Skills Attitude Scale (CSAS). Med Educ. 2002; 36 (2): 141-147.
Keywords: attitudes, motivation
CORRESPONDING AUTHOR: Toth Ildiko, Pécs University, Pécs; itoth2777@yahoo.com
P360
ALTERNATIVE WAYS FOR TEACHING MEDICAL STUDENTS
Kollar J.
University of Debrecen, Behavioral science, Debrecen, Hungary
University education has to face with new challenges by the XXI Century. Improvement of presentation methods, creativity, introducing new learning methods and teaching relaxation techniques should be included in the curriculi of students. Unfortunately most of the teachers are not very well informed about such ways and possibilities. In my presentation I would like to introduce a new method which has been already tested and proved to be successful in the Netherlands at Roosevelt Academy, Middelburg within the frameworks of Middelburg Center of Transatlantic Studies. The program focuses on five fields: 1) Creativity Improvement – Teaching simple methods for improving creativity. Such methods can be built into the everyday practice. 2) Presentation Methods – Teaching basic rules of presentations and acquiring knowledge about the latest presentation software programs. 3) Mnemotechnics – Learning new mnemotechnic methods that can make the process of learning a kind of fun. 4) Proper application of the internet – using RSS (Really Simple Syndication) for collecting information regarding any topics for e.g. for writing scientific papers, wise application of searching systems available on the internet and discovering sites important for teaching and learning. 5) Relaxation – Restoration the balance between mind, soul and body. By applying the method both teachers and students can be motivated for teaching and learning of better quality. The accreditation of the program in the system of postgraduate education of teachers has already been started in Hungary.
Keywords: Medicine, Health, Motivation, Relaxation
CORRESPONDING AUTHOR: Kollar Janos, Debrecen University, Hungary; janoskollar@gmail.com
P361
INNOVATIVE HEALTH EDUCATIONAL TOOLS; A WAY TO ENHANCE DIALOGUE AND PARTICIPATION
Engelund G., Møller Hansen U., Willaing I.
Steno Health Promotion Center, Patient Education , Gentofte, Denmark
Aims: Practical implementation of patient education with dialogue and participation as primary outcomes can be difficult. Patients may have problems articulating their experiences and challenges in relation to their chronic illness. Health care professionals, (HCP) on the other hand, may have problems facilitating a patient-centred, problem identifying dialogue.
The aim of this study was to investigate if probes, a method used in design processes, could be transformed into health educational tools to support HCP in facilitating dialogue and participation and to help patients reflect, articulate and share their experiences in order to generate relevant action.
Methods: Probes were designed for a qualitative research study of the patients’ needs for patient education with four purposes: 1) to create patient participation at workshops; 2) to create dialogue; 3) to provide information about life with chronic illness; 4) as inspiration for developing dialogue tools.
The transformation from probes to health educational tools was based on patients’ evaluation, researchers’ observations and identified patients’ needs from four workshops conducted with 25 patients with chronic illness. The tools were pilot-tested in a patient education program with 48 patients from four municipalities in Denmark. The tools went through further refinements based on evaluation from patients and HCP.
Results: A range of tools were developed with the purpose of inspiring patients in different ways to reflect, articulate and participate actively. The tools were structured around the use of pictures, peer quotes, provocative statements, objects, illustrated knowledge, playing and games. The various types of tools supported different learning styles and preconditions. The pilot test showed that use of the tools did create a high degree of reflection, articulation, participation and action orientation. Furthermore the tools supported the HCP in facilitating an effective patient education.
Conclusion: The point of the tools is to create active participation so as to bring about long-term change and targeted health promotional action among patients. The development and use of health educational tools is therefore useful to accomplish dialogue and participation in patient education where patient’s experiences, needs, challenges and competences are being met. These tools furthermore support the facilitation of participation and dialogues by the HCP. A broad implementation and evaluation at different patient education settings are important to carry out and are now taking place in order to determine the clinical usability of the developed tools.
Keywords: Health education, Methods, Research to practice translation
CORRESPONDING AUTHOR: Engelund Gitte, Steno Diabetes Center, Denmark; gteg@steno.dk
P362
THE HEALTH EDUCATIONAL JUGGLER; EXPLORING NEEDS FOR COMPETENCES IN HEALTH CARE PROFESSIONALS
Engelund G., Møller Hansen U., Rohde Voigt J.
Steno Health Promotion Center, Patient Education , Gentofte, Denmark
Aims: Patient education is a crucial element in treatment and care of patients with Type 2 diabetes and other chronic illness. Because of lack of significant effect patient educations may need new approaches. Literature indicates empowerment and participation are promising approaches. However, working with participatory methods is not often a part of the curriculum and experience among health care professionals (HCPs) like nurses, dieticians, physiotherapists etc. The need for competence development was explored in order to design a model for competence development among HCPs with the aim of providing participatory patient education for patients with chronic illness.
Methods: Different types of qualitative data was collected with 25 HCPs from patient educational settings in four Danish municipalities. Four workshops were conducted where data was collected through visual materials and group discussions focused on needs and challenges. Furthermore were Story Dialogue exercises about challenging teaching situations performed and data from observations of patient education sessions was collected. Videotapes, filled-out material and field notes were obtained. The analysis had a Grounded Theory approach with coding, constant comparison and conceptualisation.
Findings: The analysis lead to the emergence of the core category ‘The Health Educational Juggler’ with four roles as sub-categories. Subsequently a competence model "The Health Educational Juggler" with four health educational roles was generated: a) the embracer role (the emphatic educator), b) the facilitator role (the managing educator), c) the translator role (the health professional educator), and d) the initiator role (the inspiring educator).These four roles are crucial for managing genuine patient involvement that leads to empowerment. To enhance patient education HCPs need to develop competences in and juggling with different health educational roles.
Conclusion: The study indicates that HCPs conducting participatory patient education need to develop specific role competences and to be able to juggle with the different roles in performing participatory patient education. Furthermore they need to take in new practices, reflecting on individual strengths and weaknesses as a part of the ongoing competence development. The model "The Health Educational Juggler" can be used as an analytical tool of HCP health educational competences, and as a model for competence development for HCPs.
Keywords: Health education, Behavior Change
CORRESPONDING AUTHOR: Engelund Gitte, Steno Diabetes Center, Denmark; gteg@steno.dk
P363
GENERAL PRACTITIONERS TRAINED IN BIOPSYCHOSOCIAL MEDICINE IMPROVE THE SATISFACTION OF CHRONICALLY ILL PATIENTS
ENACHESCU I.1, SADEAN I.2, DUMITRASCU D.1
1 University of Medicine and Pharmacy Cluj-Napoca, 2nd Medical Dept, Cluj-Napoca, Romania
2 National School of Political and Administrative Studies, FACULTY OF SOCIOLOGY, Bucharest, Romania
Introduction and aim: Chronically ill pts. present low degree of satisfaction with the healthcare providers. They require a comprehensive approach. We looked for the ability of general practitioners who followed a training in biopsychosocial medicine (BPS) to care IBS pts compared to GPs not familiarized with the BPS model.
Material-methods: We evaluated 100 consecutive chronic patients referred to a tertiary center. They were referred by GPs who followed courses on BPS in a specialized university center (Group A) or who were not trained in BPS (Group B). Pts were evaluated for the symptom intensity and frequency (symptom score 0-16); anxiety (STAI) and QoL (SF-36); satisfaction with the medical care (structured interview, assessment scale 1-10); time offered by GP.
Results: The pts had CHD (n = 66) with congestive heart failure (n = 23), cor pulmonale (n = 10(, diabetes mellitus (n = 14) (some pts had more than one condition). In Group A (n = 9 GPs) vs. Group B (n = 15 GPs), the number of pts was: N: 48 vs. 52; F/M: 24/24 vs. 28/24; age mean(SD): 61(11) vs. 60(12) yrs, high/not high education level: 21/27 vs. 25/72. Following data were obtained -all expressed as mean(SD), Group A vs. Group B: STAI I: 41.7(8.5)vs.48(11)(p < 0.01); STAI II:40.2(9.9)vs.47.1(8.8)(p < 0.01); SF36 each scale p < 0.05; satisfaction 7.5(4.1)vs. 5.8(3.3)(p < 0.01; time offered by MD: 7.0(4.6)vs. 4.0(3.3)(p < 0.05); knowledge of pts. on IBS: 6.6(2.6) vs. 4.7(3.2)(p < 0.05).
Conclusions: GPs trained in BPS are able to better care of their chronic pts, and this is reflected in all the parameters investigated: anxiety, QoL, satisfaction, time offered to pts, pts. Education
Keywords: anxiety , chronic disease , diabetes , health behavior
CORRESPONDING AUTHOR: Sădean Ileana, SNSPA, Bucuresti; ileana_sadean@yahoo.co.uk
P364
WHAT DO PATIENTS NEED? THE DEVELOPMENT OF A PATIENT-CENTRED MODEL FOR PATIENT EDUCATION
Engelund E., Møller Hansen U., Willaing I.
Steno Health Promotion Center, Patient Education , Gentofte, Denmark
Aims: The aim of the present study was to explore the health educational needs from a patient perspective in order to develop a patient-centred model for patient education.
Methods: Guided by a user-driven innovation process, Design Thinking, we explored the perceptions, views and experiences of patient education among patients with Type 2 diabetes, COLD and heart disease, eligible to or participating in group-based patient education in four Danish municipalities. Four interactive workshops were conducted with 25 adult patients with a chronic illness.
At the workshops customized probes were used in order to generate a dialogue about experiences with health and illness related themes. The four hour long workshops were video recorded and the analysis was based on a grounded theory approach. The emerged insights from the workshops were presented to a group of 25 health care professionals who were then asked to translate the insights into patients’ needs for patient education. The identified needs were categorised and grouped repeatedly until four fundamental needs for patient education emerged and a health educational model was developed.
Results: The following four needs form a patient-based health educational model for patient education: 1) Wholeness, 2) Clarity, 3) Timeliness, and 4) Connectedness.
Wholeness is about ensuring the link to the entire life of the patient:
“It’s about what your life is and what keeps you going. You cannot talk illness all the time. That will make you ill”
Clarity is about creating clarity about challenges and possibilities:
“The most important was that I realized that I cannot deal with this myself. I need help and support”
Timeliness is about choosing the right thing at the right time:
“I would like to have more time to unplanned discussions and to talk with the others”
Connectedness is about supporting the need to be social and connected:
“It is really good to talk to the person sitting next to you and to the group. It gives inspiration and ideas”
Conclusion: In order to meet the needs of patients the developed health educational model suggests that all four needs are central and should be addressed together. When education satisfies the needs, it can help to create coherence in patients' lives, clarity about their challenges and opportunities and provide knowledge at the right time and support their need for connectedness.
The model can be used as a planning tool for patient education programs as well as an analytical tool for the evaluation and quality assurance of the education delivered. Future implementation and effect studies are needed to assess the effect of the model and to assure and determine the quality of this patient-centred approach.
Keywords: Health education, Chronic illness
CORRESPONDING AUTHOR: Engelund Gitte, Steno Diabetes Center, Denmark; gteg@steno.dk
P365
INTEGRATION OF BEHAVIORAL HEALTH SERVICES INTO PRIMARY CARE PRACTICE: A NEEDS ASSESSMENT STUDY IN URBAN BHUBANESWAR, ODISHA ,INDIA
Pati S.
Indian Institute of Public Health , Public Health Foundation of India (PHFI), Bhubaneswar (Odisha), India
Due to the growing awareness of both the biological and psychosocial aspects of stressful medical conditions, integrated primary care has begun to emerge. Thus, medical and mental health conditions necessitate a comprehensive assessment and treatment approach to properly address all areas of concern. Present study explored the existing status of mental health in primary care practice in Bhubaneswar, the capital city of Odisha, India . It specifically examined why it is important to integrate mental health into primary care taking the example of a disease that necessitates integrated primary care. Diabetes Mellitus (DM) was chosen because of the unique interaction between the emotional, psychosocial, and medical components of the disease.
Primary care physicians working in urban municipality dispensaries (19) were interviewed in depth regarding their perception, attitude, and practice of providing mental health services to patients with DM. Physicains indicated that one third of their diabetic patients would benefit form supportive psychological and mental health services. Particularly the perceived need for depression care was given highest priority. Almost all physicians felt the importance of mental health in management of chronic and debilitating illnesses. However, they expressed their inability to deliver such services, the most common barrier cited for this being lack of adequate capacity - both skills and knowledge. A strong positive inclination to undertake requisite competence-based training was observed. Physicians were willing to integrate behavioral health services with the support of suitably trained additional health staff.
Primary care physicians, with their basic training focused on biological issues, may be ill equipped when presented with psychological or mental health problems. The integration of Behavioral Health Specialists into the primary care setting can help to bridge the gap. Keeping in view of the limited number of behavioral scientists and mental health specialists, it is advocated that primary care physicians could undergo tailor-made short-term training in behavioral health.
Keywords: Primary care, Mental Health, behavioral health specialist, Chronic Illness, Diabetes
CORRESPONDING AUTHOR: Pati Sanghamitra, IIPH, Bhubaneswar; sanghamitra.pati@iiphb.org
P366
LEARNER DRIVERS' ATTITUDES TO DRIVING, TO TRAFFIC SAFETY AND THE TENDENCY TO TAKE THE RISKY BEHAVIOR DYNAMICS
Arlauskienė R., Endriulaitienė A.
Vytautas Magnus university, Department of Psychology, Kaunas, Lithuania
Nowadays researchers actively discuss various reasons of external death, particularly the cases related to traffic accidents in which people are killed, become disabled, or people’s health is disturbed. This is not only a personal but also a social problem (Sadauskas, 2003; Adams, 2001). In 2010, there were 3560 traffic accidents in Lithuania (299 people died, while 4230 people were injured) (Lithuanian Statistical Yearbook, 2011). According to the number of casualties, Lithuania is not among the top ten safest countries. However, it could be achieved if the number of deaths per one million people was less than 60 a year. Meanwhile, in 2010, the number of deaths in traffic accidents per one million people was 92 (the Ministry of Transport and Communications, 2011). Various sources indicate that 40 to 90% of traffic accidents are caused by human behaviour, i.e. reasons of psychological behaviour (Užkuraitis, 2008; Bogdanavičius et al., 2007; Eby, 2004). Therefore, health behaviour and reduction of risks become an important object of psychological research (Žemaitienė et al., 2011), while traffic safety becomes an issue considering the quality of life.
Research indicate that in traffic accidents the high risk group is men from 17 to 25 years old (Underwood et al., 2003; Gray and Regan, 2005; Simons – Morton, Winston, 2006). Thus, the following problematic questions arise: what are the psychological risk factors of driving behaviour that lead to the death of young drivers on the road, how to control them, and what effective preventive measures can be applied. A special attention should be dedicated to those psychological factors that could be identified and influenced during the course of training. According to Yilmaz and Celik (2008), programs about driving risks that do not seek to change behaviour do not reduce the number of traffic accidents either. Moreover, behaviour starts with motivation, while motivation depends on intentions and attitude. The attitude is related to a psychological trend that is expressed in terms of a certain degree of acceptance or unacceptance (Cestac et al., 2011).
In this study, young drivers’ approach to driving, road safety and risk taking was researched. Two measurements of the constructs mentioned had been taken at the beginning of driving classes at driving schools and after 2 months. The second measurement took place after they completed their driving classes and had passed their exams. 257young drivers participated in the research. A significant statistical difference was found between the first and second measurements.
Keywords: health behaviors, risk factors, attitudes
CORRESPONDING AUTHOR: Renata Arlauskienė, Vytautas Magnus University; renata.arlauskiene@balticum-tv.lt
P367
INTRODUCING THE SUPREME PROJECT
Balazs J. 1,2, Gadoros J. 2, Kereszteny A.2,3, Germanavicius A.4, Hamilton R. 5, Masip C. 6, Sarchiapone M. 7, Värnik A. 8, Westerlund M. 9, Hadlaczky G. 9, Carli V. 9, Wasserman D. 9
1Eötvös Loránd University, Faculty of Education and Psychology, Department of Developmental and Clinical Child Psychology, Budapest, Hungary
2 Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
3 Semmelweis University, School of Ph.D. Studies, Budapest, Hungary
4 Clinic of Psychiatry of Vilnius University, Vilnius, Lithuania
5 Middlesex University, London, UK
6 Hospital Del Mar, Barcelona, Spain
7 Department of Health Sciences, University of Molise, Campobasso, Italy
8Estonian-Swedish Mental Health &Suicidology Institute, Ctr. Behav & Hlth Sci, Tallinn University, Tallin, Estonia
9National Swedish Prevention of Mental Ill-Health and Suicide (NASP), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Background: Internet and media are effective tools for disseminating information and education to adolescents and improving their mental health and well-being. The current poster introduces a project, named Suicide Prevention by Internet and Media Based Mental Health Promotion (SUPREME), which aims to develop an Internet and media based, multi-language, culturally adapted, mental health promotion and suicide prevention intervention.
Method: The SUPREME project is funded by the DG SANCO and the EAHC as well as by the participating centers. This multicenter study running between 2010-2013 comprises 7 countries: Estonia, Hungary, Italy, Lithuania, Spain, Sweden and the UK, with the coordination of the Karolinska Institute, Sweden.
The main goal of the SUPREME project is to develop and evaluate a multi-language, highly interactive website accessible to all but aimed at adolescents and young adults. The information and the activities of the website will focus on raising awareness about mental health and suicide, combating stigma, and stimulate peer help. The website will be monitored by professionals in order to prevent harmful behaviors. The effect of the website will be evaluated in school-based samples.
For the preparation of the website both a literature-review and web-survey is performed on the already existing preventive websites with suicide related information, that young people are likely to visit. In addition, focus groups interviews are completed with adolescents with and without mental disorders to collect information on their perceptions of what characteristics effective preventive websites entail.
Guidelines for best practices in the field of Internet and media usage for mental health promotion interventions are developed and disseminated among relevant actors on the basis of the results of the project.
Expected outcome. The results comprise evidence-based information on the most effective methods in Internet-based mental health promotion to reach the most vulnerable adolescents in need.
Conclusions: The long-term benefit realized by this project is to improve mental health among European adolescents and young adults directly through the intervention website as well as indirectly through the dissemination of guidelines.
Keywords: Adolescents, Internet, Mental Health, Prevention
CORRESPONDING AUTHOR: Balazs Judit, ELTE, Institute of Psychology; judit.agnes.balazs@gmail.com
P368
DIABETES AND HYPERTENSION: ASSESSING THE EFFECTS OF PHYSICAL ILLNESSES ON THE QUALITY OF LIFE OF ELDERLY PEOPLE
Cardoso D., Von Humboldt S., Leal I.
Instituto Superior Psicologia Aplicada, Health Psychology, Lisbon, Portugal
Aims: Aging with quality has become increasingly relevant in a context in which life expectancy has increased. This research aims at 1) examining the variation of physical functioning, role limitations, social functioning, physical pain, mental health and vitality of older adults with diabetes; and 2) determining the differences of the above dimensions within participants with hypertension.
Methods: 120 older adults with more than 73 years old constituted the convenience sample of this study. The instruments utilized were the Assessment Questionnaire for Health Gains (SF-6D), the Mini-Mental State Examination (MMSE) and demographics.
Results: Findings indicated variation in the impact of physical illness in the dimensions of QoL. Thus, subjects with diabetes indicated lower scores for social functioning (MPF = 4.5) and mental health (MVIT = 2.8). Subjects with hypertension indicated lower scores for Physical functioning (MPF = 4,2) and also mental health (MVIT = 3,06) but, generically, participants with hypertension showed lower scores when compared with participants with diabetes.
Conclusions: This study highlighted that hypertension and diabetes affect dimensions of older adults’ QoL, although in a different manner and that hypertension has a higher impact in this population. It is thus relevant to take into account these results for clinical practice and behavioral strategies for older populations.
Keywords: Behavioral Strategies, Diabetes, Elderly, Hypertension, Healthy Aging, Quality of Life
CORRESPONDING AUTHOR: Cardoso Dina, ISPA, Lisboa; dina.cardoso@gmail.com
P369
INFLUENCE OF DIETARY FACTORS ON ORAL QUALITY OF LIFE IN ADOLESCENTS
Costa J.1, Bica I.2, Montero J .3, Nunes M.4, Costa P.5
1 Instituto Politécnico de Viseu, Department of Health Promotion, Viseu, Portugal
2 Instituto Politécnico de Viseu, Departamento de Saúde Pública, Viseu, Portugal
3 Universidade de Salamanca, School of Medicine and Dentistry, Salamanca, Spain
4 Instituto Politécnico de Viseu, Health Education & Promotion, Viseu, Portugal
5 Universidade da Beira Interior - Covilhã, Medicine, Viseu, Portugal
Objective: To characterize the dietary habits of adolescents, analyze the impact of dietary factors on oral quality of life
Method: A epidemiological study was performed on 782 adolescents aged between 11 and 17 years belonging to the central region of Portugal. Subjects were asked about dietary habits and oral health-related quality of life (OHIP-49).
Result: CPOD = 2.32 (sd, 2,51). Most adolescents (68,3%) considered they have a healthy or very healthy diet. However they are mostly used to eat snacks between meals (45.0%) and 19% of adolescents consume cariogenic food between meals almost every day or every day. In general, OHIP score in our sample had an average of 3.3 items affected severely (sometimes or more frequently). The level of impact on "functional limitation" was the highest with an average of 3.3 ± 4.1 items affected frequently and social disability registered the least impact with 0.9 ± 2.9 items frequently reported. The habits of consumption of certain foods (goluseimas, popcorn, candy, pasta, bread with chocolate chips, fast food) proved to be significant risk factors of impact on quality of life.
Conclusion: Dietary factors are significantly related to the quality of life in oral Portuguese adolescents.
Keywords: dietary habits; oral quality of life
CORRESPONDING AUTHOR: Costa José, IPV, Viseu, Portugal; jsc.costa@gmail.com
P370
BELIEFS, ATTITUDES AND KNOWLEDGE ASSOCIATED TO THE PROSTATE BENIGN HIPERPLASIA IN MEXICAN MEN.
Cuevas C., Gomez G., Hernandez P.
Universidad Nacional Autonoma de Mexico, Clinical Psychology (Health Emphasis), Mexico City, Mexico
Background: In Mexico City the mortality from prostate cancer increases each year despite of health campaigns. From 2000 to 2009 the increment was of 16%. Nowadays the illness of prostate cancer is considered an excessive spending for the health sector in Mexico.
Where it comes to sexual health, in Mexico both men and women react adversely, because there is no culture of prevention, as they only go to the doctor when they have pain and abnormal symptoms, however, it is also because these examinations are invasive and most uncomfortable.
Aim: Our overall aim was to characterize beliefs, attitudes and knowledge associated with the Prostate Benign Hiperplasia.
Method: the studied population was a non probabilistic sample of 417 men above the age of 40 who did not have a diagnostic of prostatic illness and who live in Mexico City and metropolitan area. They were requested to answer a psychometric questionnaire with 85 items designed to measure beliefs, attitudes and knowledge associated with the prostate benign hyperplasia (CHPB, Sierra & Monsalve, 2004) with five Likert option answers that evaluate the three dimensions mentioned before about prostatic antigen examination. This questionnaire was validated and its reliability was calculated.
Results: Mean age 50 years old, SD = 8 years, with 50 items the questionnaire had a validity near 60% (13 factors) and the Cronbach Alpha value = 0.91. The main factors in order of importance were: Factor 1: beliefs in sexual performance; Factor 2: evasive attitude to medical exam; and Factor 3: knowledge about the prostate’s illness.
Discussion: Given these results, it is essential to develop integrative programs involving professionals in the field of mental and physical health, this way the public health campaigns must be dedicated to encourage men to undergo the prostatic antigen examination, modify false beliefs, negative attitudes and false knowledge.
Keywords: Health Education, Attitudes, Beliefs, Public Health
CORRESPONDING AUTHOR: Cuevas Renaud Corina, "UNAM, Mexico City"; corinacr@servidor.unam.mx
P371
SEXUAL EDUCATION IN ADOLESCENTS
Ferreira M., Nelas P., Albuquerque C., Aparício G., Duarte J.
Instituto Politécnico de Viseu, Escola Superior de Tecnologia da Saúde, Viseu, Portugal
Background: There are numerous challenges facing adolescents, particularly in the area of sexuality. The beginning of sexual activity can be considered a time of great impact on their lives and it is important to understand the motivations that led to initiation of sexual activity, attitudes and behaviors that have been adopted and which may influence their sexual and reproductive health.
Objective: Analyze the relationship between socio-demographic variables and attitudes towards sexuality, the motivations to have sex or not.
Method: This is a quantitative descriptive and explanatory cross-correlated study with a non-probability convenience sample of 145 students attending the high school education. The evaluation protocol includes socio-demographic questionnaire, the scale of attitudes towards sexuality (Nelas et al 2010) and the scale of motivation to do sex or not (Leal, Maroco 2010)
Results: The main interlocutors of the sexuality are friends (59,8%), in the second place is the mother (40,9%). In the sample, 12,7% have already had sexual relations, being that 43,1% began at the age of 14 years old, in which the boys started earlier their sexual relations. The majority (46,6%) presents favorable attitudes regarding to the sexuality and 40,4% unfavorable attitudes. The female students with 14 years old, who attend the 8th and 9th school year, living in the city, who talk with their mother about sexuality and have not started yet their sexual activity, present more favorable attitudes in relation to sexuality. The council, the sex, the mother, the friends and the school year are determinative factors of the attitudes towards sexuality. The study revealed a highly significant statistical difference between sex and adolescents motivation to have or not to have sex (p = 0.000), boys are the ones who show more motivation to have sex for health and hedonism reasons. Adolescents sex motivation is influenced by experiences of sexual and intimate relationship already experienced.
Conclusion: The implementation of a sex education program in schools must be based on previous studies that allow participants to develop stereotypes of intervention that meet the real needs of each adolescent. We must also consider variables such as age, gender, the reasons for having sex or not and the adolescent attitudes towards sexuality with assumptions relevant to the training in this area.
Keywords: Adolescents, Sexual behavior
CORRESPONDING AUTHOR: Ferreira Manuela, Polytechnic Institute of Viseu; mmcferreira@gmail.com
P372
FEAR OF DEATH AMONG MEDICAL STUDENTS AND THE IMPACT OF END-OF-LIFE EDUCATION (2005, 2010)
Hegedűs K., Zana Á., Konkolÿ Thege B.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
Research aims: To explore the elements of fear of death of medical students and to compare the effects of end-of-life education to their attitudes to death in 2005 and 2010. According to our hypothesis a more open communication about death and dying in society, health care and education may lead to lower level of fear of death among medical students in 2010 in comparison to 2005.
Study design and method: The Multidimensional Fear of Death Scale (MFODS) (Neimeyer and Moore, 1994; Zana et al, 2006) was completed by 201 medical students before (N = 93 in 2005; N = 108 in 2010) and just after the 30-hour end-of-life training course (N = 56 in 2005; N = 67 in 2010). The lecturers were the same in 2005 and 2010.
Results: In both 2005 and 2010 medical students scored highest on Fear for Significant Others and Fear of the Dying Process factors. Fear of death is higher in women than in men (p < .001). Among dental students fear of death was higher than among medical students (p < .001). Contrary to our hypothesis the initial fear of death has not changed significantly between 2005 and 2010, but the positive effect of the courses was higher in 2010 than in 2005 (total score p < .001), mainly in relation to the Fear of the Dying Process and the Fear of Conscious Death factors. These factors especially can be attributed to improving knowledge related to palliative care of dying patients, emphasized more in the end-of-life courses in 2010.
Conclusions: In the past centuries some elements of fear of death were low because of rituals and social care of the dying. At present these elements of fear of death show increased levels, but can be decreased by communicating openly about palliative care so improving the doctor-patient communication when working with dying patients.
Keywords: anxiety, attitudes, health behavior change, health education, health promotion
CORRESPONDING AUTHOR: Hegedus Katalin, Semmelweis University, Budapest; hegkati@net.sote.hu
P373
THE IMPACT OF HOUSING RESEARCH ON PUBLIC POLICY
Howden-Chapman P., Fougere G., Gillespie-Bennett J.
University of Otago, Public Health, Wellington, New Zealand
In 2001, the Housing and Health Research Group, at the University of Otago, Wellington, gained funding to generate cross-disciplinary knowledge to reduce inequalities in health, by addressing the quality and availability of housing in New Zealand. This paper aims to assess the extent to which research conducted by the Housing and Health Research Group has influenced public policy formation in New Zealand and to better understand how research can impact upon policy making. To determine the impact of the work done by the Group, a documentary analysis was undertaken of New Zealand print media for the period 1996-2010. Articles were manually searched and any article that mentioned housing was included in the analysis, giving a database of 1853 articles. The analysis found that media coverage on household quality increased between 1996 and 2010 with overall trends suggesting an increasing conceptual link between housing quality and health. In 2005 there was a seven-fold increase in articles, which based the health benefits of home insulation programmes on research. This trend again doubled in 2006 and saw a further increase to peak in 2008. In 2008 there were 364 articles written about home insulation and more than 80% of these mentioned health in association with home insulation. The time frame and context of these changes suggest that research conducted by the Housing and Health Research Group may have had an impact on these policies and may have been a factor in bringing these changes about. Furthermore, the increase in media attention also correlates with the release of preliminary results from the Groups’ Housing, Insulation and Health Study. An upturn in government funding in 2009 to insulate and install cleaner more efficient heating occurred after the release of study results may be partly or wholly attributable to the findings highlighted by research. The conclusions of this paper reinforce the importance of ensuring that research findings are timely and policy-relevant.
Keywords: Housing, policy, research, media, public health
CORRESPONDING AUTHOR: Bennett Julie, University of Otago, Wellington; jules@coolkiwi.com
P374
SUN PROTECTION METHODS SUPPLIED TO AND USED BY OUTDOOR WORKERS IN QUEENSLAND AUSTRALIA
Janda M.1, Stoneham M.2, Crane P.1, Sendall M.1, Youl P.1, Baldwin L.1, Kimlin M.1
1 Queensland University of Technology, School of Public Health, Brisbane, Australia
2 Curtin University, Perth, Western Australia
Aim: Outdoor workers are at high risk to receive large doses of ultraviolet radiation, and proper sun protection while at work is thus essential. The present investigation assessed the sun protection provided to and used by outdoor workers in Queensland, Australia. Data was obtained from the baseline survey before implementation of a health promotion intervention.
Methods: Outdoor workers (n = 142) were recruited from fourteen workplaces engaged in building and construction, farming, local government or public sector works industries. Data was collected using telephone interviews. We assessed workers demographic and phenotypic characteristics as well as the sun protection methods they used at work. We also asked about sun protection provided by the workplaces, and whether the workers were aware of a sun protection policy at their workplace. Descriptive statistical methods were used to summarise workers data. Chi-Square tests were used to compare workers working in the four different industries with regards to the above variables.
Results: Overall, 77% of workers were aware of a sun safe policy at their workplace. The most commonly used sun protection methods included wearing sunglasses (72%), long sleeved shirts (69%) and brimmed hats (60%), and the proportion of workers who reported the most commonly provided methods they were provided with by their workplace were sunscreen (92%), long sleeved shirts (84%) and sunglasses (72%). Comparison across the four different industries highlighted variation in use of and provision of sun protection methods across industry sectors, and factors associated with awareness for sun protective policy.
Conclusion: Sun protection is important for workers in outdoor occupations and the proportion of workers who are aware of a sun protection policy and who use one or more sun protection methods was high. This study provides a baseline for sun protection methods used by outdoor workers who are exposed to a high ultraviolet radiation environment all year round, allowing assessment of the effect of a health promotion program in the future.
Keywords: Cancer; health promotion; policy
CORRESPONDING AUTHOR: Janda Monika, QUT, Brisbane; m.janda@qut.edu.au
P375
MEDIA LITERACY PROGRAMS IN THE PREVENTION OF EATING DISORDERS: POTENTIALS, EFFECTIVITY AND LIMITATIONS
Szabó K., Túry F.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
In the current study the literature on studies introducing media literacy programs as potential methods in the prevention of eating disorders had been extensively reviewed.
The primary objective was to review and summarize the currently available media literacy programs regarding their methodology and effectiveness. In the past decades, media literacy came to the forefront in the international eating disorders literature. Different forms of mass media (e.g. television, magazines and internet) are being discussed to contribute to the development and maintenance of eating disorders. Hence, comprehensive media literacy prevention programs are utmost important.
Methods: Relevant articles meeting the selected search criteria from 1990 until 2012 derived from the databases Science Direct (http://www.sciencedirect.com/), Springer-Verlag GmbH (http://www.springerlink.com/), SAGE Publications Ltd (http://online.sagepub.com/)and PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) had been analysed.
Results: The most effective media literacy prevention programs were complex programs which contained elements that focused not solely on body image and eating habits related problems, but also put emphasis on combating social pressure and improving critical thinking in relation to societal standards and media messages. Detailed results will be discussed in terms of target groups, effectivity, methodology, limitations, and future directions.
Conclusion: Media literacy programs proved to be effective programs with the potential to reduce general and specific risk factors for eating disorders. Nevertheless, next to its strengths, several studies revealed limitations as well. Future directions regarding research and practice in the prevention of eating disorders with special focus on media literacy will be outlined.
Keywords: Prevention, eating behaviours
CORRESPONDING AUTHOR: Kornélia Szabó, Semmelweis University, Budapest; szabkor@net.sote.hu
P376
THE EFFECT OF ELECTROCONVULSIVE THERAPY ON BISPECTRAL INDEX SCORES IN PSYCHIATRIC INPATIENTS
Thimmaiah S.1, Thirthalli T.2
1Dr B R A M C, Department of Psychiatry, Bangalore, India
2 NIMHANS, Department of Psychiatry and Neurosciences, Bangalore, India
Background: Bispectral Index Score (BIS) is a measure of sedation during general anesthesia. BIS has been correlated with resting electroencephalography (EEG) –lower BIS scores indicating increased theta/delta activity. We investigated BIS in subjects through their course of ECT.
Method: Subjects were recruited from among inpatients prescribed ECT. Patients with clinically obvious medical/neurological disorders were excluded. BIS was recorded using a BIS monitor via surface electrode applied to the forehead, usually by 0830 hours IST. Prior to ECT, two consecutive BIS scores were recorded at one-minute intervals in the relaxed state. Subsequently, the patient was held in conversation and two BIS scores recorded at one-minute intervals. Recordings were repeated after the 3rdand 6thECT.
Results: 30 subjects were recruited [male = 8; female = 22] of whom 12 had schizophrenia or related disorders and 18 had mood disorders. One-way Repeated Measures ANOVA suggested a statistically significant drop in resting BIS scores over the course of ECT – the mean (SD) baseline BIS dropped from 91.60 (6.58), through 86.52(9.10) after the 3rdECT, to 79.7(20.17) after the 6thECT (F = 9.91; df = 1,29; p = 0.004). However, the drop in the BIS recorded during conversation was not significant - baseline BIS [94.7 (4.6)] dropped to 94.4 (4.0) after 3rdECT and to 93.05 (5.96) after 6thECT.
Conclusion: The drop in resting BIS scores during the course of ECT may be reflective of increased theta/delta activity. However, this decrease in resting BIS does not signify sedation as is evidenced by the lack of similar decrease in BIS during conversation.
Keywords: Bispectral index, Analysis of electroencephalgraphy
CORRESPONDING AUTHOR: Thimmaiah Rohini, RGUHS, Bangalore; drrohinimd@gmail.com
P377
RECRUITMENT FOR SMOKING CESSATION IN GENERAL PRACTICES
Ulbricht S.1, Gross B.2, Rumpf HJ.3, John U.4, Meyer C.1
1 University of Greifswald, Institute of Epidemiology and Social Medicine, Greifswald, Germany
2 University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
3 University of Lübeck, Department of Psychiatry and Psychotherapy, Lübeck, Germany
4 University of Greifswald, Institute of Epidemiology and Social Medicine, Haifa, Germany
Evidence revealed that the majority of smokers do not intend to quit, and reach of this majority and adoption of brief smoking cessation intervention (BSCI) in primary medical care is a challenge. We sought to address recruitment of patients for BSCI with focus on those who did not intend to stop smoking in the next six months. General practices were encouraged to recruit patients and offer BSCI in daily routine care. A personal brief advice intervention sample of patients (n = 525) and a tailored letters intervention sample (n = 1284) in routine care were analyzed in relation to a reference sample (n = 1610) that had been systematically recruited by a study nurse. We found that in the routine care samples higher proportions of smokers who at least considered smoking cessation within the next six months were recruited in comparison to the reference sample (brief advice, relative risk ratio: 2.6, 95 % confidence interval: 1.8-3.9; tailored letters, relative risk ratio: 1.9, 1.5-2.3). Among the brief advice intervention sample, a higher proportion of patients who considered to quit smoking within the next six months tended to be recruited than in the tailored letters condition. We conclude that minor support of practices may add to recruitment failure among smokers who do not intend to quit whereas smokers with some intention to quit are overrepresented in BSCI. Tailored letters intervention may more suit the need to provide BSCI to all smokers than general practitioner brief advice.
Keywords: tobacco use, population health, intervention
CORRESPONDING AUTHOR: Ulbricht Sabina, University, Greifswald; ulbricht@uni-greifswald.de
P378
FUNCTIONAL MODEL OF HEALTH BY PATIENTS AFTER BONE MARROWTRANSPLANTATION
Wrona-Polanska W.
Pedagogical University, Cracow, Poland, Department of Health Psychology, Cracow, Poland
A study on the relationship between level of health in patients after bone marrow transplantation (BMT) and their coping with stress is presented.
The theoretical basis of researches is Helena Wrona-Polanska’s Functional Model of Health (2003), in which health is a function of creative coping with stress.
Examined persons: 150 persons after bone marrow transplantation (BMT).
Methods: The questionnaires examining stress, coping strategies, personal resources, and grading scales of health and anxiety.
Results. Complex mathematical analyses showed that health depends on effective coping strategies with stress as well as personal resources. The key psychological health mechanisms are subjective resources, which through three paths: competence path, emotional path, and stress path, lead to health counteract stress.
The health of persons after BMT is a function of effective coping with stress. Illness is a function of ineffective coping with stress. The predictors of subjective health are personal and behavioral resources and level of stress.
Conclusions: The basis of health promotion by persons after BMT is to develop effective strategies of coping with stress and to increase personal resources.
Literature: Tworcze zmaganie sie ze stresem szansa na zdrowie. Funkcjonalny Model Zdrowia osob po transplantacji szpiku kostnego. Wydawnictwo Uniwersytetu Jagiellonskiego, Krakow 2011 (Creative coping with stress as a chance for health. Functional Model of Health by persons after Bone Marrow Transplantation, Jagiellonian University Publisher, Cracow 2011)
Keywords: health, health promotion, stress and coping, resources
CORRESPONDING AUTHOR: Wrona-Polanska Helena, Pedagogical University, Cracow; helena@wronapolanska.pl
P379
DEVELOPMENT OF A PARTICIPATORY ADHERENCE PROGRAMME AIMED AT PATIENTS WITH TYPE 2 DIABETES
Engelund G., Varming A.
Steno Health Promotion Center, Patient Education, Gentofte, Denmark
Aims: Many patients with type 2 diabetes (T2D) fail to keep blood glucose levels in line with guidelines. More efficient methods that work closely with patients to provide motivation and participation are needed to help to improve self-management and adherence to treatment. This study aims to develop individualised, goal-oriented, intervention modules that help health-care professionals (HCPs) provide clinical support particularly to patients who are on diabetes medication yet still have poor glycemic control, thereby also ultimately enhancing self-management capabilities and eventually improving medical adherence and reducing glucose levels.
Methods: Three, interconnected intervention modules with various tools were developed in cooperation with a diabetes nurse and a diabetologist. The tools included a variety of stimuli such as pictures, peer quotes, statements, and illustrations, and were designed to enhance dialogue, participation and learning so patients could make more informed decisions about handling their illness and make relevant actions. During the development process, we used formative evaluation by doing ongoing test- runs and improve usability of the modules and tools.
Twenty patients at a Danish diabetes clinic were invited to participate in the development and try-out of the modules. Each patient had three, individual consultations of 45 minutes with use of the new tools and a telephone consultation. Researchers made observations and audio recordings of all consultations and kept time records of who spoke and for how long to measure patients participation. Final evaluation interviews of the patients and HCPs were conducted, and the modules’ and tools’ usability by both groups was assessed by analysing impact on behaviour, attitudes and actions.
Results: The three modules’ dialogue and educational tools were narrowed down to 11. The try-out showed the tools provided new, relevant information and enhanced dialogue about patients’ life with diabetes, use of and attitudes toward medicine, and daily challenges. They helped patients reflect on their problems with poor glycemic control, set goals and take relevant action. Patients said they gained more from the consultations than they were accustomed to, and they felt the HCP understood them better and took them more seriously. The HCPs said the tools helped them reflect more on their own practices, identify patients’ real problems, and facilitate difficult conversations.
Conclusion: The intervention program helped HCPs to support patients with poor glycemic control. They helped patients to articulate their challenges and improve self-management behaviours.
Keywords: Adherence, Diabetes, Health education, Methods
CORRESPONDING AUTHOR: Engelund Gitte, Steno Diabetes Center, Denmark; gteg@steno.dk
P380
EFFICACY OF CLIENT-CENTRED REHABILITATION IN MULTIPLE SCLEROSIS
Eyssen I.1, Steultjens M.2, De Groot V.1, Knol D.3, Polman C.4, Dekker J. 1
1 VU University Medical Center Amsterdam, Netherlands, Rehabilitation Medicine, Amsterdam, The Netherlands
2 Glasgow Caledonian University, School of Health, Glasgow, The Netherlands
3 VU University Medical Center Amsterdam, Netherlands, Epidemiology and Biostatistics, Amsterdam, The Netherlands
4 VU University Medical Center Amsterdam, Netherlands, Neurology, Amsterdam, The Netherlands
Objectives: Despite the purported benefits of client-centred therapy, mixed findings about the efficacy have been found. This study aimed to assess the efficacy of client-centred rehabilitation, as compared to usual care rehabilitation, in patients with multiple sclerosis.
Method: 13 institutions and 269 outpatients participated in a cluster randomised controlled trial. Primary outcomes included measures of disability, participation and autonomy. Secondary outcomes included fatigue, generic health-related quality of life, quality and duration of therapy. Measurements were taken at baseline, 4 and 8 months.
Results: Primary outcome measures did not show significant differences between the two interventions. Secondary outcomes revealed significant differences on functional outcomes in favour of usual care rehabilitation. Process outcomes were in favour of the client-centred intervention. Further analyses showed that client-centred rehabilitation resulted in more intensive diagnostic evaluation and less intensive treatment, compared to usual care.
Conclusion: The present approach towards client centred rehabilitation seems to be counterproductive. It is suggested to adjust client-centred practice towards a more balanced approach, with less focus on diagnostic evaluation and more focus on treatment.
Keywords: Rehabilitation, Adherence
CORRESPONDING AUTHOR: Dekker Joost, VU University Medical Center; j.dekker@vumc.nl
P381
PARENTS IN NUCLEAR MEDICINE DEPARTMENTS: ISSUES SURROUNDING PREPARATION, INFORMATION AND HANDLING THE CHILD
Grilo A.1, Vieira L.2, Antonio A.2, Barros S.2
1 Instituto Politécnico do Lisboa, Department of Social Sciences and Humanities, Lisbon, Portugal
2 Instituto Politécnico do Lisboa, Higher School of Health Technology of Lisbon, Lisbon, Portugal
Introduction: Nowadays, in paediatric Nuclear Medicine (NM), the renal studies are the most performed, which include Renogram, Renal Schintigraphy and Cystography, which have similar characteristics, such as the need to immobilize the patient during image acquisition. In this sense, the full cooperation of the patient and the parents is essential to conduct the study, improving when they actively collaborate in the procedure, resulting in a feeling of satisfaction of the child and the parents.
Objective: To study the variables associated with the parents’ perception of paediatric patients who undergo NM studies.
Methods: 42 parents of paediatric patients filled out 2 questionnaires before and after the study.
The 1st questionnaire consisted of 16 questions of closed-response and 1 question of open-response, including characterization of the sample, information received about the procedures, and by whom it was provided and the feelings associated.
The 2nd questionnaire consisted of 9 questions of open-response. The relevance of the received information and the opinion of the companion were evaluated to improve medical care.
For data processing it was used descriptive statistics.
Results: 81% of the sample received oral information prior to the administration of the radiopharmaceutical, in 83,3% it was explained by the NM technologist. The parameters discussed were the arrival time at the service (88,1%), total time of the study (69%), preparation needed (69%), the procedure (69%) and parents instructions (31%). 28,6% didn’t receive instructions on how to proceed during the study.
Discussion: The most valuable points were: the relationship established between the NM technologist with the paediatric patient (14,3%), the preparation needed for the study (12%) and providing maximum information prior the study (12%).
Keywords: Renal/urologic disorders, Parent-child transactions; Technology (nuclear medicine)
CORRESPONDING AUTHOR: Grilo Ana, Instituto Politecnico. Lisbon; ana.grilo@estesl.ipl.pt
P382
CLAUSTROPHOBIA AND ADHERENCE IN MAGNETIC RESONANCE IMAGING PROCEDURE
Grilo A.1, Ribeiro M.2, Nogueira AM.2
1 Instituto Politécnico do Lisboa, Department of Social Sciences and Humanities, Lisbon, Portugal
2 Instituto Politécnico do Lisboa, Higher School of Health Technology of Lisbon, Lisbon, Portugal
Aim: Claustrophobia causes a huge discomfort to those who need to perform Magnetic Resonance examinations mainly due to the physical design of most equipment. This study aimed to maximize the success rate of Magnetic Resonance Imaging (MRI) clinical studies in claustrophobic patients by the identification of facilitative strategies.
Method: There was a descriptive/exploratory study. 62 claustrophobic patients filled out one questionnaire with open and close questions concerning the Technical, Technological and Psychological categories.
Results: 75.8% of respondents believe that the open field option MRI was the key factor for the success, 82.3% reported that the design of equipment is the main constraint and 62.9% said that the patient position and immobility is a major restriction to the success of this exam. It was revealed that were the R (100%) that give the needed information before the procedure. It was unanimously recognized the importance of the Radiographers role and their impact on the implementation of the adherence strategies.
Conclusions: The greater relevance by respondents was to the Technology and Technique categories due the equipment configuration and immobility during the exam. The Psychological dimension was important in view of the Radiographers are a main role in the strategies appliance to reduce anxiety to levels that allows the success of examination.
The Radiographers in MR setting, have to be properly prepared, to can easily identify the signs of a claustrophobic patients and to develop strategies to reverse the trend of its effects.
Keywords: Compliance; Technology (magnetic resonance); Physical environment
CORRESPONDING AUTHOR: Grilo Ana, Instituto Politecnico. Lisbon; ana.grilo@estesl.ipl.pt
P383
A PAIN EDUCATION PROGRAMME TO IMPROVE PATIENT SATISFACTION WITH CANCER PAIN MANAGEMENT: A RANDOMISED CONTROL TRIAL
Lin CC.
Taipei Medical University, Department of Nursing, Taipei, Taiwan
Aims: The patients' satisfaction with pain management is not merely an indicator, it is actually a contributor to medication adherence. However, very few studies investigate methods for improving patient satisfaction with pain management. The purpose of this study was (1) to evaluate the effectiveness of a pain education programme to increase the satisfaction of patients with cancer with regard to pain management and (2) to examine how patient satisfaction with pain management mediates the barriers to using analgesics and analgesic adherence.
Methods: This study used an experimental and longitudinal design. A total of 61 patient-family pairs (n = 122) were randomly assigned to either experimental or control groups. The instruments included the American Pain Society outcome questionnaire, the Barriers Questionnaire-Taiwan form, self-reporting evaluations of analgesic adherence and the Pain Education Booklet. The experimental group (n = 31) participated in a pain education programme, while those in the control group (n = 30) did not. The two groups were compared using generalised estimation equations after the second and fourth weeks. A Sobel test was used to examine the mediating relationships among patient satisfaction with pain management, barriers to using analgesics and analgesic adherence.
Results: The experimental group showed a significant improvement in the level of satisfaction they felt for physicians and nurses regarding pain management. For those in the experimental group, satisfaction with pain management was a significant mediator between barriers to using analgesics and analgesic adherence.
Conclusions: This research provides evidence supporting the effectiveness of a pain education programme for patients and their family members in increasing patient satisfaction with regard to the management of cancer pain.
Keywords: pain, adherence
CORRESPONDING AUTHOR: Chia-Chin Lin, Taipei Medical University; clin@tmu.edu.tw
P384
ADHERENCE TO THERAPEUTIC REGIMEN IN PRECUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY PATIENTS: A QUALITATIVE STUDY USING THE HEALTH BELIEF MODEL (HBM)
Páscoa C.1, Santos MC. 2
1 Centro Hospital de Lisboa Norte, Hospital de Stª Maria, Lisbon, Portugal
2 Instituto Politécnico do Lisboa, Escola Superior de Tecnologia da Saúde, Lisbon, Portugal
Background: No-adherence to therapeutic regimens is a recognised cause of increased mobility and mortality rates in cardiac patients and of excessive medical cost. Patient personal beliefs about their illness and its treatment have been proposed to be central to adherence. The Health Beliefs Model (HBM) proposes that patient "readiness to adhere" is based on four dimensions: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers; as well, as on cues to action; and on perceived self-efficacy.
Objective: Based on the HBM model this qualitative study aimed to identify determinants of adherence in patients with Precutaneous Transluminal Coronary Angioplasty attending a Cardiology Department in a Central Hospital in Lisbon
Methodology: Twenty one patients participated. A semi-structured interview was used and patients' verbatim audio-taped and fully transcript. A phenomenological content analysis was used.
Findings: Results reveal important differences between adherent and non-adherent patients in HBM dimensions: vulnerability; cost/benefits; consequences; and self-efficacy, and allowed to understand relations between these dimensions. Relationship was found between the lived experience of the illness and perceived severity. Depressive humour as well as two new dimension "relationship with health professionals" and " disease control" emerged as playing an important role in adherence.
Conclusion: These findings suggest that the Health Beliefs Model provides insight into psychosocial mechanisms that maintain adherence behaviour and that patients' personal model of illness should be addressed effectively in health professional-patient communication.
Keywords: Adherence; Cardiovascular disease; Health Beliefs
CORRESPONDING AUTHOR: Santos Margarida, ESTeSLisboa*; margarida.santos@estesl.ipl.pt
P385
REVIEW OF THE QUESTIONNAIRE TO EVALUATE THE ADHERENCE TO HIV TREATMENT (CEAT-VIH)
Remor E.
Universidad Autonoma de Madrid, Psicologia Biologica y de la Salud, Madrid, Spain
The purpose of this work is to review 25 completed studies (6 articles, 11 abstracts, 4 masters thesis and 4 doctoral dissertations) that have included the questionnaire to evaluate the adherence to HIV treatment (CEAT-VIH) developed by Remor (2002). CEAT-VIH is a patient-reported outcome multidimensional measure for the assessment of adherence to HIV treatment, and is available in different language versions. Completed studies were identified through academic bibliographic databases. Studies that identified CEAT-VIH questionnaire scores, sample descriptions, and tested relationships between the CEAT-VIH and study variables were selected for inclusion. All results from primary studies were summarized in tables for evaluation and comparison.
Review shown that Cronbach’s alpha coefficients ranged from .70 to .85 supporting the internal consistency reliability of the CEAT-VIH questionnaire. Hypothesized relationships between the CEAT-VIH and study variables (e.g., stress, depression, social support, compliance, complexity of treatment, pill numbers, CD4+, viral load) were supported strengthening the evidence for construct validity of the CEAT-VIH. Studies have reported valuable information regarding evidences of validity for the instrument (i.e., reliability, floor and ceiling effects, convergent and criterion validity, sensibility/specificity), as well. In the studies reported here, the CEAT-VIH has been used with a variety of individuals of different ages, gender, socioeconomic, and educational backgrounds. The CEAT-VIH has performed as a reliable and valid tool to measure adherence to HIV treatment and has been used with a wide range of study populations and countries (Brazil, Colombia, Mexico, Panama, Peru, Portugal, Romania and Spain).
Keywords: adherence HIV AIDS measurement
CORRESPONDING AUTHOR: Remor Eduardo, Universidad Autonoma de Madrid; eduardo.remor@uam.es
P387
WHAT FACTORS INFLUENCE THE MAINTENANCE OF A HEALTHY WEIGHT?
Allom V., Mullan B.
University of Sydney, School of Psychology, Sydney, Australia
Background: The prevalence of obesity in western society is increasing; leading to an increase in the number of people attempting to control their weight through dieting. Such attempts are notoriously difficult to maintain and are often unsuccessful. Despite the difficulty of adhering to dietary restriction, some people do manage to successfully manage their weight through eating practices. While there is a large body of research that has examined factors leading to unhealthy dietary practices, limited research has focused on those who are able to maintain a normal weight. What cognitive, behavioural and environmental factors distinguish those with a normal weight from those who are overweight? This qualitative research was aimed at determining these factors.
Methods: Thirty-five university students with a normal BMI participated in focus group interviews lasting approximately one hour. Sessions explored factors which facilitate or inhibit the maintenance of a healthy weight.
Results: Consistent themes described by participants were the negative connotations associated with the concept of ‘dieting’, consistent failure to maintain eating behaviour that involved heavy restriction of caloric intake, need for a ‘lifestyle change’ rather than a temporary diet and the role of friends, family and the environment on the maintenance of a healthy weight.
Conclusions: The information from these focus groups provides valuable insight into the practices and cognitions of those who are able to maintain a healthy weight. Interventions aiming to alter weight and dietary practices should take into account these motivating and inhibiting factors. Specifically, interventions should be framed in terms of a lifestyle change rather than a diet, should account for the role of other people and should avoid heavy restriction of caloric intake.
Keywords: Obesity, weight control, eating behaviours
CORRESPONDING AUTHOR: Allom Vanessa, University of Sydney, Sydney; vall2758@uni.sydney.edu.au
P388
TYPE 2 DIABETES: THE IMPORTANCE OF FAMILY AND WORK FOR THE COMPLIANCE WITH TREATMENT
Azzollini SC., Bail Pupko V.
University of Buenos Aires, Department of Psychology, Buenos Aires, Argentina
Objective: To analyze how patients who suffer from diabetes type II perceive the social support in two areas: family and work.
Research design and Methods: In this correlational research of patients with diabetes type II, who are treated in public hospitals of Buenos Aires city, a probabilistic random systematic sampling was selected composed of 337 patients (aged between 40-79). They were given several instruments, including a questionnaire about biographic, personal, work related, and social network related questions, and a self-care practices scale. All the instruments had been validated.
Results: Patients who considered that their jobs did not provide them possibilities of going to the doctor and perceived diminished ability to work practiced significantly less self-care than those who said the opposite. As far as family support is concerned, more than one-fourth of the sample reported that they only sometimes or never felt supported by their families and relatives got annoyed by their diet or the required care. In addition, almost half said that sometimes they felt that they depended on other people more than before. Those who perceived lack of support, diminished authority and annoyance on behalf of their family due to their diet, presented a significantly inferior adhesion in comparison to those who claimed the opposite.
Conclusion: According to the results, social support from both family and work enhance compliance with treatment by following the self-care prescriptions.
Keywords: Diabetes, social support, family, work, adherence
CORRESPONDING AUTHOR: Azzollini Susana Celeste, Conicet - UBA; susana1060@yahoo.com.ar
P389
MEASUREMENT OF DEPRESSION IN ADULTS WITH DIABETES
Carreira M.1, Anarte M.1, Marchante A.2, Manchola-Orozco C.2, Gupta A.3, Pulgaron E.2, Meneghini L.4, Delamater A. 2
1 University of Malaga, Health Psychology, Malaga, Spain
2 University of Miami, Pediatrics, Miami, USA
3 University of Miami, School of Medicine, Miami, USA
4 University of Miami, Medicine, Miami, USA
Depression is an important issue in the management of individuals with diabetes. Previous research has shown that depression is more common in patients with diabetes and is associated with poor glycemic control. Recently a new measure, the Diabetes Depression Inventory (DDI), was developed in Spanish to assess depression in adults with diabetes, and shown to be both reliable and valid. The DDI consists of 42 items each rated on a 7-point scale. The purpose of the current study was to examine the psychometric properties of an English translation of the DDI. The Spanish DDI was translated to English and then back-translated to Spanish, after which any wording discrepancies were resolved. Eighty patients with diabetes (mean age = 46.3 years; 25% Hispanic; 20% African American; 44% Type 1 diabetes; 56% Type 2) were recruited during an outpatient clinic visit and completed the English translation of the DDI as well as the Beck Depression Inventory-II (BDI-II), the Spielberger Trait Anxiety Inventory (STAI), the Diabetes Quality of Life Scale (DQOL), and the Self-Care Inventory (SCI, a measure of diabetes regimen adherence). Glycemic control was measured by glycosylated hemoglobin A1c (A1c), which was obtained at the clinic visit. Reliability of the DDI total scale score determined by Cronbach alpha was excellent (alpha = 0.96). Concurrent validity was obtained by correlation of the DDI with BDI-II (r = 0.80, p = .001). The total score for the DDI was also associated with DQOL (r = 0.76, p = .001) and STAI (r = 0.75, p = .001), indicating that more diabetes-related depression was associated with worse quality of life and greater anxiety. The DDI was also marginally associated with SCI (r = -0.21, p = .07), indicating that higher depression scores were related to lower adherence; however, DDI scores were not significantly associated with A1c. A similar pattern of results was obtained in patients with T1D as with T2D, and there was no difference in depression scores between patients with T1D and T2D. Total scores for the DDI were not related to education or gender, however African American patients reported higher depression scores than white patients (p = .03). These findings provide support for the reliability and validity of the English version of the DDI.
Keywords: Diabetes, Depression
CORRESPONDING AUTHOR: Delamater Alan, University of Miami; adelamater@med.miami.edu
P390
EMOTIONAL DISTRESS AND RISK PERCEPTION OF PATIENTS WITH DIABETES
Kausar R.1, Awan B.2
1 University of the Punjab, Lahore, Pakistan, Department of Applied Psychology, Lahore, Pakistan
2 UNIVERSITY OF THE PUNJAB, Department of Applied Psychology, Lahore, Pakistan
The present research aimed to investigate risk perception related to diabetes and its complications. It also aimed to assess the degree of emotional distress in patients with diabetes in relation to the potential problematic areas of diabetes. It was hypothesized that: a) there is a relationship between emotional distress and risk perception of patients with diabetes; b) there are significant gender differences in the in the level of emotional distress and risk perception of patients with diabetes. The sample comprised of 100 patients with diabetes and was recruited from one of the teaching hospitals in Lahore, Pakistan. Risk Perception Survey-Diabetes Mellitus (RPS-DM) Scale and Diabetes Distress Scale were used for assessment. Correlation analysis and independent sample t-test were used for analysis. The results revealed significant relationship between risk perception and emotional distress in patients with diabetes. Gender differences were found in the level of emotional distress. Female patients reported significantly more emotional distress as compared to male patients. Findings have important implications for management of diabetes and highlight importance of provision of psychological services for diabetic patients.
Keywords: Diabetes, Risk perception, Emotional distress, Gender differences
CORRESPONDING AUTHOR: Kausar Rukhsana, University of the Punjab, Lahore; rukhsana.saddul@gmail.com
P391
DIFFERENT DIMENSIONS OF PERFECTIONISM PREDICT DISORDERED EATING
Lombardo C.1, Battagliese G.1, Mallia L.1, David M.1, Lucidi F. 2, Violani C.1
1 Sapienza University of Roma, Department of Psychology, Roma, Italy
2 Sapienza University of Roma, Department of Development and Socialization Processes Psychology, Roma, Italy
Eating Disorders (EDs) are considered the third most common form of chronic illness among young women aged 14 to 19 years (Reijonen, et al. 2003). Their causes are elusive and multifaceted but several risk factors have been identified, among which personality traits and especially perfectionism, seem very relevant (e.g. Bardone-Cone et collegues, 2007; Egan et al., 2011). The aim of the present study was to confirm that perfectionism predicts the presence of disordered eating behavior.
Eight hundred and 27people (50.1% females) aged 20 to 60 (M = 39.75; SD = 11.91) participated to the transversal phase (T0) of a longitudinal study. At T0, trained interviewers administered through a face-to-face structured interview, the Multidimensional Perfectionism Scale (MPS-F; Frost et al., 1990), and Disordered Eating Questionnaire(DEQ, Lombardo et al., 2004), which allows to measure both eating disorders symptoms and the Body Mass Index (BMI). The DEQ was proposed again together with the Life Stress Events Scale (LSE, Holmes, Rahe, 1967) through a face to face structured interview after three months (T1). Participants who accepted to be interviewed again at T1 were 725.
A hierarchical regression model was conducted on the transversal data using the BMI at the first step and the two positive dimension of perfectionism, Personal Standards (PS) and Organization (O), and the two negative perfectionism dimensions of Parental Expectations and Parental Criticism (PEPC) and Concern over Mistakes and Doubting of Actions (CMD), at the second step. The dependent variable was the DEQ score.
Results evidence a significant regression function F(5,765) = 17.94; p < .001) which explains the 10% of the variance (R = .324; R² = .099).
The function indicates that eating disorders symptoms are predict by the BMI (β = .098; p = .005) and by the CMD (β = .278; p < .001) and O (β = -.122; p = .001) subscales of MPS-F. The perfectionism dimensions measured at T0, the BMI at T1 and the presence of Life Stress Events between T0 and T1 of the longitudinal study will be considered for predicting DEQ score measured at T1. Results of the longitudinal phase will also be analyzed.
Keywords: Perfectionism, Eating Disorders
CORRESPONDING AUTHOR: Battagliese Gemma, Sapienza University, Rome; gemma.battagliese@uniroma1.it
P392
EATING HABITS AMONG UNDERGRADUATE STUDENTS – ARE THE MALE DISORDERS INCREASING?
Mezei A.1, Tury F.1, Muranyi I.2
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 University of Debrecen, Department of Sociology, Debrecen, Hungary
Background: Eating disorders are common among adolescents and young adults, not only in the countries of the Western civilization, but also in Central-East Europe. Most of the cases are subclinical, and sufferers try to hide themselves from treatment, they rarely seek for help.
Methods: Undergraduate students were assessed in this research in secondary schools in an East Hungarian city (Nyíregyháza) about their health status, lifestyle, eating habits and body image.
Results: 48.4% of the 3633 students were males, and 51.6% females. 20% of the students consumes candies more than once a day, and 28% of them consumes soft drinks more than once a day. nine percent of the males and 23% of the females is on a diet. 13% of the females are under the BMI of 17.5, and 15.9% of the males are under the BMI of 18.5. Five percent of the females and nine percent of the males are obese, 2.2% of the females and 2.5% of the males are overweight. Five males (0.28%) has a simulated diagnosis of anorexia nervosa, but female cases were not found in this research.
Conclusion: According to our data the prevalence of male eating disorders are higher than that of females, which means that the characteristic sex differences in eating disorders may be decreasing.
Keywords: eating behaviour – modern civilization disorders – anorectic attitude – obesity
CORRESPONDING AUTHOR: Mezei Agnes, Semmelweis University, Budapest; mezei.agnes.psych@gmail.com
P393
DIETS USING MEAL REPLACEMENTS – EFFICACY OUTSIDE THE CLINICAL TRIAL
Chirila I.1, Paulik E.2, Florescu N.3
1 University of Medicine and Pharmacy, Hygiene and Environmental Health, Iasi, Romania
2 University of Szeged, Department of Public Health, Szeged, Hungary
3 National Institute of Public Health, Environmental Health, Iasi, Romania
Use of meal replacements seems to be an effective weight-loss strategy both in the short and long term in a clinical trial setting. But, there is no information about the efficacy outside a clinical trial where meal replacement products need to be purchased, and are frequently discontinued at an early stage.
The purpose of this retro-prospective study in Iasi, Romania was to assess the effectiveness of meal replacements diets in body weight management and the impact in body composition for working age people, when participants purchased the products and follow the weight loss program outside the clinical trial.
In weight loss programs (3.98 ± 2.29 months), 79 participants (56 women, 23 men) lost an average of -10.19 ± 6.12 kg of their body weight, -11.47 ± 9.15 cm in the abdominal perimeter,
-5.29 ± 5.46 of the percentage of body fat. Replacing two meals a day was an effective way to lose weight because of its simplicity and convenience of use. The cost of the products and monotony of the diet were the main causes of abandon the diet. Subsequently, in the period of maintenance of weight gained, subjects were followed for an average of 11.28 ± 8.1 months and for the entire group of participants was reached an average weight gain of +2.86 ± 3.02 kg compared to the minimum weight (31.5% of weight lost). Long-term maintenance was better in the subjects that replaced one meal a day, but is still a challenge and required further research.
Keywords: diet, weight loss, obesity, socio-economic status
CORRESPONDING AUTHOR: Chirila Ioan, UMF & RCNIPH, Iasi; pappvid@congressline.hu
P394
DISORDERED EATING AMONG PREADOLESCENTS BOYS AND GIRLS: THE INFLUENCE OF CHILDREN´S AND MOTHER'S VARIABLES
Gonçalves S.1, Silva A.1, Gomes A .1, Simães C. 2
1 University of Minho, School of Psychology, Braga, Portugal
2 University of Minho, School of Nursing, Braga, Portugal
It is well recognized that behaviors and attitudes, such as restrained eating, fear of fat, distortion of body image, binge eating, and purging are very common among preadolescents from both sexes. However, few studies have evaluated the role of some personnel and mother’s variables in the prediction of eating problems separately from children’ sexes.
Thus, this study was two main goals. The first one was analyzing eating behaviors and body satisfaction on boys and girls and also analyzing their mothers’ perceptions on these two domains. The second one was to evaluate the predictors of eating problems using some children variables (BMI, self-worth, and body satisfaction) and some mother’s variables (BMI, eating problems, and mother’s satisfaction with the body of their child).
In total, 111 children and respective mothers participated in this study. Children (54.1% girls) were between 9 to 12 years old (M = 10.08; SD = 0.81) and mothers were between 27 to 60 years old (M = 39.58; SD = 5.27). Children were asked to complete the Children’s Eating Attitude Test, and the Self-Perception Profile for Children. Mothers were asked to complete the Eating Disorders Examination Questionnaire, and the Child Eating Behavior Questionnaire. Children’s and mothers’ measures also include body mass index (BMI), and Collins Figure Drawings.
The Results showed that: i) no association was found between children´s BMI and mothers’ BMI for both sexes; ii) no differences were found between boys and girls on eating behavior; iii) most of the children revealed that they would like to have a body image distinct from the one they have; iv) likewise, most of the mothers referred the desire of a thinner body image for their children; v) greater BMI was related to higher body dissatisfaction on both sexes vi) the child's BMI and dissatisfaction with body image were predictors of eating disturbance in boys, and the self-worth, mother’s BMI, and eating behavior were predictors of girls eating disturbance.
In conclusion, these findings suggest that maternal influences on child eating disturbance differ according to child sex. Mother’s eating problems and BMI was related to girls eating problems, but no maternal influences were found for boys.
Keywords: Eating behaviors; Children's health; Gender
CORRESPONDING AUTHOR: Gomes Rui, Universidade do Minho; rgomes@psi.uminho.pt
P395
CREATION OF ART BOOKS WITH ADOLESCENTS DIAGNOSED WITH AN EATING DISORDER
Chaves E., McRae C.
University of Denver, Counseling Psychology, Denver, USA
Background: This preliminary study used a mixed methods approach to explore the effect of art therapy on self-esteem and distress in an adolescent eating disorder sample. Using the creation of therapeutic art books in a group format, adolescents spent three hours per week (1 session) creating their art books and sharing their work with others in the group. This art technique is relatively new and novel as an art therapy intervention. The purpose of the study was to investigate the technique's effectiveness at increasing perceptions of self-esteem and decreasing participants' distress and negative mood states.
Methods: Adolescents in an inpatient eating disorders unit at a children’s hospital were invited to participate in the study. Measures of global self-esteem and self-esteem related to art therapy were measured at baseline and end of the study using the Rosenberg Self-Esteem Scale and Hartz Art Therapy Self-Esteem Scale, respectively. The Subjective Units of Distress (SUDS) scale was used to measure participants’ current distress. Four visual analogue scales (VAS) were used to assess negative mood states commonly found in persons with eating disorders (depression, anxiety, anger, and shame). Both measures were administered before and after each group. Participants were interviewed about their experiences using the therapeutic art books after four weeks.
Results: Average age of participants (7 females, 1 male) was 16; 7 had diagnoses of Anorexia Nervosa. Results of paired-samples t-tests indicated that while global self-esteem scores did not change, self-esteem scores related to art therapy trended upward, though they did not reach statistical significance. Scores on the SUDS and VAS improved significantly after the first group session (p < .05 for all scales) and showed continual, though not statistically significant improvement over subsequent groups. Three major themes emerged from interviews: creation of art books was a welcome distraction from other issues, art expressed more than words, and sharing the art increased understanding of others.
Conclusions: This study indicated that the creation of art books in a group setting had positive value as measured by the SUDS and VAS and reflected in individual interviews.
Keywords: Eating disorders, adolescents, self-esteem, art books
CORRESPONDING AUTHOR: McRae Cynthia, University of Denver, Denver, CO; cmcrae@du.edu
P396
PERSONALITY CHARACTERISTICS OF GIRLS WITH EATING DISORDERS, UNITED IN THE INTERNET COMMUNITY.
Roshchina I., Petrova X.
Moscow State University of Psychology and Education, Department of Clinical Psychology, Moscow, Russia
This topic is actual due to the frequency and prevalence of eating disorders in recent decades, difficulties in the treatment of this pathology which are characteristic of a young age. Earlier clinical and psychological studies have shown that the basic psychological features of patients with anorexia nervosa are a sense of closure, irritability, low mood, increased anxiety, self-doubt, low self-esteem, distortion of the physical image of "I".
The purpose of this study - to identify the links between eating disorders and personal characteristics of the subjects participating Web sites related to the problems of feeding behavior.
Sample: 15 women aged 14 to 25 years. At the invitation to participate in the study responded participants to the Internet - community dedicated to eating disorders. Most of the girls who completed questionnaires, had never been observed by a psychiatrist about eating disorders. Nevertheless, their own recognition of existing problems with eating and analysis of the results of technique EAT-26 make it possible to use this data as a material to work on eating disorders. Girls surveyed are characterized by preoccupation of their shape and overweight, exhausting diet, exercise.
Methods: The test related to eating (EAT-26), Sandra Bem’s questionnaire for the study of masculinity-femininity, Eysenck’s Personality Inventory (EPI), Test of vitally meaningful orientations by D.A. Leontiev, self-esteem scale levels of anxiety by Charles D. Spielberger and YU.L. Hanin, the Technique of interaction between the parent and the child by I.M.Markovskaja. All participants have completed suggested tests anonymously.
Results: 1. there is a connection between eating disorders and neuroticism, 2. there is a connection between eating disorders and personal anxiety, and 3. there is a correlation between increased control by the mother and eating disorders, and 4. there is a connection between the high authority of parents and eating disorders.
We have hypothesized links between eating disorders and low levels of emotional richness of life as well as between eating disorders and reactive anxiety, but in this sample these hypotheses have not been confirmed.
The results can be used in psychotherapeutic work with girls with eating disorders, united in the Internet community.
An important aspect of the correction of eating disorders would be to create an information site with the participation of professionals (doctors, psychologists, specialists in the field of fitness, etc.)
Keywords: Eating behaviors, Personality
CORRESPONDING AUTHOR: Roshchina Irina, MSUPE, Moscow; ifroshchina@mail.ru
P397
THE KAISER PERMANENTE SOUTHERN CALIFORNIA BARIATRIC SURGERY FAMILY COHORT
Coleman K.1, Huang Y.1, Liu J.1, Xie B.2, Arterburn D.3, Beech B.4, Taveras E.5, Koebnick C.1
1 Kaiser Permanente Southern California, Research and Evaluation, Pasadena, USA
2 Claremont Graduate School, School of Behavioral and Organizational Sciences, Claremont, USA
3 Group Health Research Institute, Research, Seattle, USA
4 Wake Forest University, Public Health Sciences, Wake Forest, USA
5 Harvard Pilgrim Health Care, Research, Boston, USA
Background: Weight loss can have a “halo effect” where spouses and other adult family members may lose weight when another adult in the family undergoes treatment for obesity. However, almost nothing is known about how parental weight loss as a result of bariatric surgery affects their children’s weight.
Purpose: To provide descriptive information for a large cohort of bariatric patients with children/adolescents from a large integrated healthcare system with an extensive electronic medical record.
Methods: The parent/child pairs came from two clinical cohorts: the Kaiser Permanente Children’s Health Study with over 920,000 children/adolescents and the Kaiser Permanente Southern California Bariatric Surgery Registry with over 15,000 adults. Parent/child pairs were linked using the membership records and current residential address. At least one year of follow-up after surgery was available for all parent/child pairs. Parents’ date of surgery was the index date for enrollment in the cohort.
Results: Baseline descriptive data are presented for 4,079 parent/child pairs from 2008 - 2010. Almost a third (29%) of parents had more than one child/adolescent in the cohort. Parents were mostly mothers (80%), 30 – 50 years old (78%), 46% either Hispanic or nonHispanic Black, and 47% had completed at least some college based upon census estimates. At the time of surgery, parents weighed 271 + 63 lbs. Children/adolescents were primarily six and older (83%), 52% male, 16% overweight, 18% moderately obese, and 13% extremely obese. Children/adolescents of these parents were not any more overweight or obese than current national prevalence estimates.
Conclusions: This is a large cohort of bariatric patients and their children which will serve as a foundation for the study of mechanisms responsible for the relationship between parent weight loss and maintenance and their children’s weight and health.
Keywords: Children's health Obesity
CORRESPONDING AUTHOR: Coleman Karen, Kaiser Permanente; karen.j.coleman@kp.org
P398
IMPROVING QUALITY OF FOOD FREQUENCY QUESTIONNAIRE RESPONSE IN LOW-INCOME MEXICAN AMERICAN CHILDREN
Garcia-Dominic O.1, Echon R.2, Mobley C.3, Block T.4, Bizzari A.2, Michalek J.5
1 Penn State Milton S. Hershey Medical Center, Public Health, Hershey, USA
2 Social & Health Research Center, Bienestar and Neema Health Program, San Antonio, USA
3 University of Nevada Las Vegas, Medicine, Las Vegas, USA
4 NutritionQuest, Nutrition, Oakland, USA
5 University of Texas Health Sciences Center at San Antonio, Epidemiology, San Antonio, USA
The authors evaluated the validity and reliability of the Block Kids Food Frequency Questionnaire (BKFFQ) and the Block Kid Screener (BKScreener) in Mexican American children living along the Texas–Mexico border who participated in the National Institutes of Health–funded Proyecto Bienestar Laredo. The Bienestar/NEEMA health program is a school-based diabetes and obesity control program, and the Proyecto Bienestar Laredo is the translation of the Bienestar/NEEMA health program to 38 elementary schools in Laredo, Texas. Participants included 2,376 eight-year-old boys (48%) and girls (52%) from two school districts in Laredo. Two Food Frequency Questionnaire (BKFFQ and BKScreener) dietary intakes were collected, and an expert panel of nutritionist assigned a classification response quality of “Good,” “Questionable,” and “Poor,” based on playfulness (systematic or nonrandom) patterns and completion rates. In addition, both instruments were assessed for reliability (test–retest) in 138 students from a San Antonio School District. Children’s height, weight, percentage body fat, reported family history of diabetes, and Texas Assessments of Knowledge and Skills in reading and mathematics scores were collected. This study showed that for Mexican American children living along the Texas–Mexico border, within the time constraints of the classroom, BKScreener yielded better data than the BKFFQ.
Keywords: Diabetes, children, nutrition, dietary food recall, minority health, screening
CORRESPONDING AUTHOR: Dominic Oralia , Penn State; odominic@hes.hmc.psu.edu
P399
CONCURRENT VALIDITY AND RELIABILITY OF THE HUMAN FIGURE TEST OF THE VARIABLES: ANXIETY LEVEL, DEPRESSION AND IMPULSE CONTROL IN A SAMPLE OF OVERWEIGHT AND OBESITY
Rios M., Repetto P., Nicoletti D., Apfelbeck E.
Pontificia Universidad Católica de Chile, Psychology, Santiago, Chile
Graphic research tests have declined due to problems in validity and reliability. Similarly, obesity is a prevalent disease, without any clarity about the type of psychological evaluation in preoperative process. The aim of this study was to assess concurrent validity and reliability of the Draw a Person Test (DAP) in anxiety, depression and impulsiveness control in 60 overweight and obese adults treated at the Obesity Treatment Center UC. First, systematized graphical indicators of these variables through literature were reviewed and propose a scoring system to explain their behavior. Then, we assessed the association between these variables measured from DAP and the results of the BDI-I, STAI(E) and BIS-11. From twenty indicators used, three did not show interjudge reliability. In concurrent validity, despite not finding adequate sensitivity, five graphic indicators of depression showed greater than 80% specificity, two indicators on anxiety and four on impulse control. With ROC curve analysis, the scoring system for depression is the best discriminated subjects who don’t have depression. In conclusion, the Human Figure Test is a powerful tool to differentiate obese patients without depression.
Keywords: Obesity, anxiety, depression, measurement
CORRESPONDING AUTHOR: Rios Matias, University of Chile; matiasrios@gmail.com
P400
ASSOCIATION OF DIABETES WITH ANXIETY DISORDERS: A SYSTEMATIC REVIEW
Smith KJ.1, Clyde M.1, Beland M.1, Gariepy G.2, Page V.3, Badawi G.1, Schmitz N.1
1 McGill University, Psychiatry, Montreal, Canada
2 McGill University, Epidemiology, Montreal, Canada
3 McGill University, Biostatistics, Montreal, Canada
Background: There is an increasing interest in the association of diabetes mellitus with psychological disorders, in particular those disorders which have been shown to impact on disease progression and self-care. A group of psychological disorders shown to impact on both outcomes in people with diabetes are anxiety disorders. However, there has been little research which has specifically examined whether diabetes mellitus is associated with an increased likelihood of co-morbid anxiety disorders.
Methods: A systematic review was performed by three independent reviewers who searched for epidemiological articles that examined the association between anxiety disorders and diabetes in adults 16 or older. From 10,519 articles that were screened a total of eight studies were eligible for inclusion in the review.
Results: Of the eight studies examined in the systematic review, only four studies showed a significant and positive association between anxiety disorders and diabetes. The additional four studies provided no evidence for and association. However, there were notable problems between studies and with individual study quality.
Discussion: Previous research has demonstrated the negative impact of anxiety disorders on diabetes progression and self-care. However, the research examined for this review does provide evidence for a strong relationship between anxiety disorders and diabetes. Possible reasons for these inconclusive results and recommendations for future research shall be discussed.
Keywords: Diabetes; Anxiety
CORRESPONDING AUTHOR: Kimberley Smith, McGill University; kimberly.smith@douglas.mcgill.ca
P401
RELATIONSHIP BETWEEN DEPRESSION, SELF-CARE BEHAVIORS, FEELING OF PSYCHOLOGICAL BURDEN, AND GLYCEMIC CONTROL IN TYPE 2 DIABETES PATIENTS
Sasaki M.1, Miyao M.2, Nanao M.2, Okuyama T.2, Koshizaka M.2, Ishikawa K.2, Sata A.2, Mizuno Y.2, Kumano H.3, Suzuki S.4
1 Waseda University, Graduate School of Human Sciences, Saitama, Japan
2 Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Endocrinology and Metabolism, Tokyo, Japan
3 Waseda University, Faculty of Human Sciences, Saitama, Japan
4 Waseda University, Faculty of Health Sciences, Saitama, Japan
Introduction: Depression is a major psychopathological disorder seen in patients with diabetes, and these patients face a greater risk of depression than the general population. However, the care provided with regard to depression to patients with diabetes is insufficient. The purpose of this study was to explore the association between depression, self-care behaviors, the feeling of psychological burden, and glycemic control in type 2 diabetes patients.
Method: Subjects were 77 outpatients (insulin therapy, N = 30; oral drug therapy, N = 47, age: 70.17 ± 11.14) with type 2 diabetes. The measurement index used in this study is as follows. 1) The Summary of Diabetes Self-Care Activities Measure (J-SDSCA), 2) Dietary Behavior Questionnaire, 3) The Problem Areas in Diabetes Scale (PAID), and 4) Hospital Anxiety and Depression Scale (HADS). In addition, HbA1c (JDS) and BMI were measured. The subjects with insulin therapy were divided into a high-depression and a low-depression group on the basis of the cut-off score of HADS, and T-test was carried out.
Results: Depression in patients undergoing insulin therapy was significantly higher than those undergoing oral therapy (t(51.01) = 3.13, p < .01.). High-depression group with insulin therapy had lower adherence to diet therapy than the low-depression group (t(28) = 2.53, p < .05). Moreover, the former found controlling their appetite difficult (t(28) = 2.86, p < .01), and their feeling of psychological burden was significantly high (t(28) = 3.29, p < .01). The BMI of the high-depression group was significantly higher than that of the low-depression group (t(28) = 2.25, p < .05). Even though the level of HbA1c—which was checked to determine the glycemic control level—in the high-depression group (6.45 ±0.63) was better than that in the low-depression group (6.80 ± 0.98), no significant difference was found.
Discussion: Among type 2 diabetes outpatients, patients undergoing insulin treatment had better glycemic control, but their depression was observed to be higher than that of the patients undergoing oral therapy. The former’s adherence to diet therapy was not enough. Psychological support should be provided to patients undergoing insulin treatment in future.
Keywords: Diabetes, Depression, Adherence
CORRESPONDING AUTHOR: Sasaki Miho, Waseda University, Japan; sasa-miho@akane.waseda.jp
P402
THE ASSOCIATION OF FACTORS AFFECTING PARENTAL FOOD PURCHASING BEHAVIOUR WITH CHILDHOOD OBESITY
Sultan H., Pallan MJ., Adab P.
University of Birmingham, Department of Public Health, Epidemiology and Biostatistics, Birmingham, United Kingdom
Introduction: Child obesity is a significant public health problem in the UK. South Asian children in particular tend to have higher obesity prevalence than the national average, and are prone to suffering obesity related complications. Further research is needed to understand the role of parents in influencing childhood obesity, as this will inform development of appropriate preventive public health interventions.
Methods: We performed a cross-sectional analysis on data from the Birmingham healthy Eating and Active lifestyle in CHildren Study (BEACHeS) to assess whether factors affecting parental food purchasing behaviour were associated with childhood obesity. We developed three composite scores to measure the importance of certain factors related to food purchasing (Health, Marketing and Taste). We used logistic regression analysis to investigate the relationship between these parental influences and child overweight/ obesity.
Results: As marketing factors became more important for parents, the likelihood of their child being obese increased by 19% (adjusted OR 1.19, 95% CI 1.04 – 1.36, p 0.01). When calorific intake was included in this model, the likelihood of their child being obese increased by 44% (adjusted OR 1.44, 95% CI 1.12 – 1.87, p 0.004).
Conclusions: Even within a particular cultural context, such as South Asian communities, marketing influences appear to be associated with child overweight/ obesity status.
Keywords: Children, Obesity
CORRESPONDING AUTHOR: Sultan Hamira, Birmingham University, B'ham; hamira.sultan@nhs.net
P403
YUONG CHILDREN WITH TYPE 1 DIABETES: THE ASSOCIATION AMONG PARENTAL MANAGEMENT OF EATING BEHAVIOR, WORRIES OF HYPOGLYCEMIA, AND CONCERNS REGARDING PARTICIPATION IN PHYSICAL ACTIVITY
Streisand R.1, Herbert L.1, Monaghan M.1, Cogen F.2, DiPietro L.3
1 Children's National Medical Center, Center for Community & Clinical Research, Washington, United States
2 Children's National Medical Center, Department of Endocrinology and Metabolism , Washington, United States
3 George Washington University, Department of Exercise and Health Sciences , Washington, United States
Management of type 1 diabetes (T1D) in young children can be challenging for a variety of reasons including unpredictable eating behavior, variable levels of physical activity, and children’s difficulty communicating out-of-range blood glucose (BG) levels. Parents are responsible for closely monitoring young children’s food intake and physical activity levels in order to calibrate insulin doses and regulate BG levels. However, they are provided relatively little information about effectively balancing diabetes control with developmentally-appropriate physical activity and eating. Parents of young children may also worry about their child experiencing hypoglycemia, which may increase their concerns regarding diabetes management and related eating/physical activity patterns. The current analyses examined the hypothesis that parental perception of children’s eating behavior and hypoglycemia fear would be positively associated with concerns related to participation in physical activity. Parents of children ages 1-6 years old (n = 123; 89% mothers; 79% Caucasian;M child age = 5.38 years) completed self-report questionnaires assessing demographic characteristics, eating behavior, fear of hypoglycemia, and concerns related to physical activity as part of baseline data for an ongoing RCT to promote management of young children’s T1D. Most children were on an intensive insulin regimen (74%) and in good glycemic control (M A1c = 8.08%). Results suggested the majority of parents did not experience significant concerns regarding eating behavior and physical activity; however, 10% of parents endorsed eating concerns and 12% of parents endorsed at least one concern related to physical functioning. Child age was negatively correlated with parental eating and physical functioning concerns and, therefore, was included as a covariate in regression analyses. Controlling for age, parental perception of children’s eating behavior and hypoglycemia fear were significantly associated with 16% of the variance in concerns related to participation in physical activity (p < .05). Findings from these preliminary data suggest that parents’ perception of children’s eating behavior as well as worries about hypoglycemia may impact their willingness to have their child engage in physical activity. Behavioral intervention techniques for parents of young children with T1D may include strategies to encourage appropriate behaviors related to mealtimes, managing worries related to hypoglycemia, and promoting safe and consistent engagement in physical activity. Future longitudinal research will help elucidate the direction of these findings and determine the most appropriate starting place for intervention.
Keywords: diabetes, children's health
CORRESPONDING AUTHOR: Streisand Randi, CNMC, DC; rstreis@cnmc.org
P404
THE ASSOCIATION AMONG EATING BEHAVIOR, THE DESIRE TO BE SLIM, AND SELF-CONSCIOUSNESS IN JAPANESE FEMALE STUDENTS
Yamatsuta K.1, Nomura S.2
1 SANNO University, School of Information-Oriented Management, Kanagawa, Japan
2 Waseda University, Faculty of Human Sciences, Saitama, Japan
Background: Abnormal eating behaviors (AEB) have increased among Japanese female students. Previous studies suggest that high self-consciousness (SC), regardless of the desire to be slim, results in high scores on the Eating Attitude Test-26 (e.g., Yamatsuta, 2011). This study examines the association among the desire to be slim, SC, and AEB.
Methods: We used the Abnormal Eating Behavior Scale (AEBS) (Yamatsuta & Nomura, 2009), Self-consciousness Scale (Japanese version) (Sugawara, 1984), and Body Image Dissatisfaction (BID) Scale (Yamatsuta & Nomura, 2005) to analyze 554 female students (mean age 19.2 ± 1.0 yrs).
Results: To examine the difference in the AEBS scores between each SC group (classified into four groups: low-SC, high private-SC, high public-SC, and high-SC) and each BID group (two groups: high and low desire to be slim), we conducted a two-factor analysis of variance of the AEBS scores. There was a significant main effect in the BID group for the measures of “purging” and “extreme dieting” (purging: F(7, 546) = 7.62, p < .05; dieting: F(7, 546) = 78.02, p < .01). The “uncontrollable intake of excessive food” score indicated the interaction effect (F(7, 546) = 2.66, p < .05). In those belonging to the low-SC, Tukey’s multiple comparison method showed that “uncontrollable intake of excessive food” was not significant. With regard to the other groups, “uncontrollable intake of excessive food” was significantly lower in the low desire to be slim group than in the high desire to be slim group (p < .01).
Discussion: These results suggest that “desire to be slim” may lead to purging and extreme dieting. If SC is low, “desire to be slim” is not related to “uncontrollable intake of excessive food.” If SC is high and “desire to be slim” is strong, “uncontrollable intake of excessive food” may continue. Thus, for the prevention and treatment of purging and extreme dieting, we may need to study the desire to be slim. “Uncontrollable intake of excessive food” might lead to binge eating. So, in the prevention and treatment of binge eating, we need to consider the desire to be slim as well as the self-aspect.
Acknowledgement: This part of the investigation was supported by a Grant-in-Aid for Scientific Research (20730455).
Keywords: Eating behaviors, Body image dissatisfaction, Self consciousness, Prevention
CORRESPONDING AUTHOR: Yamatsuta Keisuke, SANNO University; yamatsuta@pure.ocn.ne.jp
P405
BEHAVIORAL RISKS AND BENEFITS TOWARDS VEGETARIAN DIET AMONGST ROMANIAN PEOPLE
Tarcea M.1, Nadasan V.1, Abram Z.1, Zugravu C.2, Rada C.3, Voidazan S.4
1 University of Medicine and Pharmacy, Department of Hygiene and Community Nutrition, Targu-Mures, Romania
2 University of Medicine and Pharmacy, Department of Hygiene, Bucharest, Romania
3 Romanian Science Academy, Department of Anthropology and Psychology, Bucharest, Romania
4 University of Medicine and Pharmacy, Department of Preventive Medicine, Targu-Mures, Romania
Aim: Assessment of behavioral risks and benefits towards vegetarian diet amongst Romanian people.
Methodology: We relied on a transversal epidemiological study, conducted in 2010 on a sample of 624 subjects country wide, who have filled out online, anonymously, a 40 – item questionnaire.
Results: In our sample the majority were female (76%), with an urban background (93.6%) and higher education (74.8%) with the predominance of young individuals. The vegetarians represent 12% of all, and the reasons for adopting this diet are primarily related to health status (70.2%), curiosity in young people (6.7%), or religious reasons (3.5%). Statistically significant, the vegetarians have a lower frequency of obesity against the group of omnivores, (p
Conclusion: Knowledge and practice of adopting a vegetarian diet are still at the beginning in our country and in a low frequency, however these nutritional patterns are worth monitoring in order to prevent risks arising from inherent deficiencies of poor nutrition.
Keywords: diet, behavior change, public health, assessment
CORRESPONDING AUTHOR: Tarcea Monica, Univ of Medicine, Targu-Mures; monaumf2001@yahoo.com
P406
HEALTH-RELATED QUALITY OF LIFE, SUBJECTIVE HEALTH COMPLAINTS, PSYCHOLOGICAL DISTRESS AND COPING IN PAKISTANI IMMIGRANT WOMEN WITH AND WITHOUT THE METABOLIC SYNDROME
Telle Hjellset V.1, Ihlebeak CM.2
1 University of Oslo, Institute of Health & Society, Oslo, Norway
2 Uni Health/Uni Research, Bergen, Norway
Background: The increasingly high number of immigrants from non-Western countries represents an important challenge for the public health sector. One particular concern is the high prevalence of The Metabolic Syndrome (MetS) among immigrants from South-East Asia.
Aim: The aim of the present work was to describe health-related quality of life, subjective health, psychological distress, and coping in Pakistani immigrant women, with and without MetS.
Methods: As a part of an intervention study in Oslo, Norway, female Pakistani immigrants (n = 198, age 25 to 63) answered questionnaires regarding health related quality of life, subjective health complaints, psychological distress, and coping.
Results: About 40 % of the participants had MetS, and this group showed significantly lower general health, lower physical function, and more bodily pain, than those without MetS. They also had more subjective health complaints, higher levels of somatisation, and scored significantly lower on active problem solving than participants without MetS. The prevalence of depression was high, and was comparable to the prevalence of depression reported in Norwegian chronic low back pain patients. In addition, there was a high level of psychological distress compared to the general Norwegian population, and compared to other Pakistani immigrants in Norway.
Conclusion: Pakistani immigrant women living in Oslo, Norway, seem to have a high prevalence of subjective health complaints and psychological distress, especially those with MetS.
Keywords: depression, distress, diabetes, immigrants
CORRESPONDING AUTHOR: Hjellset Victoria Telle, University of Oslo; v.t.hjellset@medisin.uio.no
Poster Session B
P407
VIEWS ABOUT WEIGHT GAIN DURING PREGNANCY AMONG MOTHERS OF HIGH BIRTH WEIGHT INFANTS: A QUALITATIVE STUDY
Shortt E.1, Delaney M.2, Wall P.1
1 University College Dublin, School of Public Health, Physiotherapy and Population Science, Dublin, Ireland
2 University College Cork, Department of Food Business & Development, Cork, Ireland
Background: High infant birth weight (macrosomia) is associated with an increase in adverse maternal and fetal outcomes. Excessive weight gain during pregnancy is an important risk factor for macrosomia in non-diabetic pregnancies. The use of qualitative methods to gain an in-depth understanding of views about weight gain during pregnancy among women whose first infant was macrosomic may provide an insight into the provision of weight management advice for pregnant women.
Aim: To explore views about weight gain during pregnancy among mothers, whose first infant was macrosomic
Participants: Second-time mothers, whose first infant was macrosomic (from a non-diabetic pregnancy) were recruited from the control group of a randomised controlled trial in a large Irish maternity hospital. A purposive sample of twenty one second-time mothers, who varied in terms of BMI at booking in their second pregnancy were recruited for interview.
Study design: In-depth semi-structured interviews were conducted with each of the participants at 6 months and 12 months post their second pregnancy. Inductive thematic analysis was used to analyse the transcripts.
Findings: Four themes were identified from the thematic analysis. The women were unconcerned about weight gain during pregnancy, as they considered it a natural and unavoidable part of pregnancy. The mothers believed in following the calls or cravings of the body to ensure a healthy infant, but this led some mothers to eat excessively. Many of the mothers cut back heavily on physical activity during pregnancy due to perceived risks to the baby. Physical conditions and physical discomfort during pregnancy were considered to limit women’s control over weight and lifestyle practices. Tiredness from work and minding a child as well as social isolation were perceived as barriers to a healthy lifestyle, although a supportive family environment was perceived to motivate women to engage in healthy lifestyle practices (e.g., by providing childcare).
Conclusions: Pregnant women may need to be advised to follow the calls of the body in moderation during pregnancy. They may also need education about the benefits of physical activity in pregnancy and how potential risks may be overcome (e.g., by switching to alternative activities). Interventions to promote healthy weight gain during pregnancy should take into account women’s lifestyles, bodily constraints and their beliefs about eating and physical activity during pregnancy.
Keywords: Pregnancy; Weight control; Physical activity; Eating behaviours; Obesity
CORRESPONDING AUTHOR: Shortt Emily, UCD, Dublin; emily.shortt@ucdconnect.ie
P408
MEDICAL SCREENING OR A SOCIAL EVENT? EXPECTANT PARENTS’ REACTIONS TO DETECTION OF SOFT MARKERS AT PREGNANCY ULTRASOUND EXAMINATION
Åhman A., Lindgren P., Sarkadi A.
Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Background: Expectant parents have positive feelings about pregnancy ultrasound and expect it to confirm the wellbeing of the fetus. Most often, these positive expectations are fulfilled but sometimes abnormalities of unclear significance are detected and parents have to face fears and difficult choices.
Objective: To explore expectant parents’ experiences when ultrasonographic ”soft markers” for chromosomal abnormities were discovered at second trimester ultrasound and factors influencing the decision about amniocentesis.
Design/Setting: A qualitative study at Uppsala University Hospital in Sweden where semi-structured, individual interviews were conducted with 11 women and 17 men (not couples), 6-12 weeks after the pregnancy ultrasound scan where a soft marker was discovered.
Findings: Both women and men attended the ultrasound screening unaware of the potential of the examination. When the soft marker was detected there was an obvious need for immediate, comprehensible information about the findings but, while men relied on facts when dealing with the situation, women also sought emotional support. Some participants felt they did not want to be informed about the soft markers at all or the risk for chromosomal abnormality. Our results also showed that men had an important role in this situation, especially in the process of making a decision about amniocenteses. The risk of miscarriage, attitudes to abortion, and need to reduce anxiety were factors that influenced the participants’ position.
Conclusions and implications for practice: Pregnancy ultrasound is experienced as a social event rather than a medical screening by expectant parents. Our results show that there is a need to develop methods and routines for information about ultrasound screening that address both expectant parent’s needs. The information should clearly state the medical screening aspect of the examination along with its potential and limitations. Expecting fathers play an important role in decision-making concerning fetal diagnostics. Enhancing couples’ knowledge and promoting their “informed choice” about the screening is therefore pivotal. Furthermore, practitioners conducting pregnancy ultrasound should have relevant knowledge to be able to provide immediate information about soft markers.
Keywords: Pregnancy, Screening, Information
CORRESPONDING AUTHOR: Åhman Annika, Uppsala University, Uppsala; annika.ahman@kbh.uu.se
P409
IDENTIFICATION OF PATIENTS WITH SMALL DENSE LOW-DENSITY LIPOPROTEIN USING TRIGLYCERIDE LEVELS: RESULTS FROM THE MIMA STUDY.
Fujiwara S., Kotani K., Tsuzaki K., Sano Y., Matsuoka Y., Takahashi K., Sakane N.
Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center., Division of Preventive Medicine and Diabetes Education, Kyoto, Japan
Introduction: Circulating low-density lipoprotein (LDL) particles have heterogeneously fractional characteristics. The presence of small dense low-density lipoprotein (sdLDL) is involved in the pathogenesis of cardiometabolic diseases, which are largely associated with human behavioral and lifestyle-related factors. Existing sdLDL can partly stem from hypertriglyceridemia. According to the mean LDL particle size, patients’ lipoproteinsare classified into non-atherogenic phenotype A and atherogenic phenotype B, the latter suggesting the presence of sdLDL. Identifying patients with phenotype B will be useful in preventing the development of cardiometabolic diseases. Although LDL particle size cannot easily be measured in clinics, serum triglycerides (TG) are routinely measurable. The objective of this study is to determine the TG level indicative of phenotype B.
Method: A total of 393 subjects (men/women 184/209, mean age 63.3 +/- 14.0 (SD) years) were examined as part of the community-based Mima study. Measurements took place following the overnight fasting of all participants. Phenotype B was defined as exhibiting a mean LDL particle size below 26.5 nm, which was determined with the gel-electrophoretic methods of the LipoprintTM System (Quantimetrix, Redondo Beach, CA). Serum lipids and glucose levels were enzymatically examined. Stratum-specific likelihood ratios were calculated between the TG level and the presence of phenotype B.
Results: The mean levels of body mass index were 24.1 +/- 3.3 kg/m2, TG 101.7 +/- 62.5mg/dl, LDL-cholesterol 116.2 +/- 30.1 mg/dl, high-density lipoprotein cholesterol 54.9 +/- 15.4 mg/dl and plasma glucose 102.3 +/- 30.4 mg/dl, respectively. The mean LDL particle size was 26.5 +/- 0.5 nm. There were 172 subjects (43.8%) with phenotype B. The likelihood ratio was 6.7 (95% confidence interval: 2.4-19.3) for the stratum with TG level above 190 mg/dl; 5.8 (2.0-16.8) with TG between 150 and 189 mg/dl; 2.9 (1.8-4.7) with TG between 110 and 149 mg/dl; 0.8 (0.6-0.96) with TG between 70 and 109 mg/dl; and 0.4 (0.2-0.5) with TG below 70 mg/dl. Subanalysis by gender yielded similar results.
Conclusion: Serum TG level of 110 mg/dl may be a possible threshold for identifying patients with the sdLDL property.
Keywords: Cholesterol, Evidence based, Lipid metabolism, Primary care
CORRESPONDING AUTHOR: Sakane Naoki, Kyoto Medical Center, Kyoto; nsakane@kyotolan.hosp.go.jp
P410
ANALYSIS OF SUICIDE ATTEMPTS WITH A FOCUS ON PRECEDING DISEASES, CAUSES AND METHODS
Horváth N. O., Tóth M., Kopp M.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
The OSPI project (Optimised Suicide Prevention programs and their Implementation in Europe) has a new area of intervention in Hungary, the city of Miskolc. It is a rural town in eastern Hungary, with approximately 170.000 inhabitants. Unfortunately, the prevalence of suicide is particularly high in this community.
Our database that was thoroughly analysed stem from the departments of toxicology, neurology and psychiatry. The main goal was to reveal those physical diseases that are most commonly related to suicide attempts. The importance of this information is high, because it can aid the work of the people in the social care system.
Furthermore, we examined the reason of the suicide attempts. Using the OSPI classification we can categorise the patients based on their motivation. The most common category is the “parasuicid pause”, when the person only tries to escape from a certain situation and calm down (39%). The “serious intent to die” is the second most common category, which is composed of people who really want to kill themselves, or are ambivalent with their mind after they have survived an unsuccessful attempt (38%). The patients in the third group do not have any real suicidal motivation, it is just a parasuicid gesture (5%). Since the direct self-harm is hardly to be separated from other suicidal acts our research include those as well (10%).
The most common method of suicidal attempts is medication. We have detailed data about the exact type and amount of the ingested pharmaceuticals. We found that the quantity of the swallowed pills is highly correlated with the seriousness of the intention. The most common drugs are anxiolytics, psycholeptiys and antiepileptycs (Rivotril, Frontin, Xanax). Patients often use some sort of cardiovascular medication as well. It is rather common that people drink alcohol along with the medicaments, and tend to take poisons like pesticides, hypo or hydrogen chloride. Other ways that lead to unsuccessful suicidal attempts consist of (in rare cases) hanging and burning, or more often stabbed and cut injuries in addition to drugs, or on itself.
In our database we have more than 2500 well-detailed cases from the last 3 years that give us the opportunity to analyse the suicidal attempts in a very particular way and we also have the opportunity to follow up the changes. We hope that this information helps the social care to prevent future suicidal attempts.
Keywords: Risk factors, Prevention, Chronic Disease
CORRESPONDING AUTHOR: Horváth N. Orsolya, Semmelweis University, Budapest; h.orsolya@hotmail.com
P411
USING A FOUR FACTOR SCORING METHODOLOGY WITH THE PEDIATRIC SYMPTOM CHECKLIST TO REDUCE TYPE 2 ERROR
Manning A.1, Dulmus C.1, Nisbet B.2
1 University at Buffalo, State University of New York, School of Social Work, Buffalo, USA
2 Spectrum Human Services, Behavioral Health Agency, Buffalo, USA
In the 21st century unmet mental health needs are increasingly being identified as potential causal factors for national, community and personal tragedy and yet the stigma surrounding even the discussion of mental health still remains. Part of the issue with discussing mental health is the need for broad based screening instruments that are both reliable and valid that reduce the likelihood of Type 2 error or false negatives. This study looks at the unidimensionality of the freely available Pediatric Symptom Checklist (PSC) and examines the potential benefits from implementing a multidimensional scoring structure. Early identification of mental health needs among children and adolescents is important to provide assessment and treatment in time to change negative outcome trajectories. This study looked at 2,760 cases of the Pediatric Symptom Checklist (PSC), a freely available mental health screener, at an average sized mental health clinic. Within this clinic sample the scores of 960 children and adolescents fell into Type 2 Error based on their PSC scores and subsequent assessment results. The published scoring for the PSC is a one factor model utilizing a single cut off score. For this study Exploratory Structural Equation Modeling (ESEM) was utilized to look at multiple factor solutions. A four factor solution was chosen and ROC curves were utilized to determine appropriate cutoff scores for each factor. After scoring this sample utilizing the 4 factor solution, Type 2 Error was reduced from 35% of the sample to 2% of the sample (960 to 48). This presentation will include a discussion of the limitations and the potenetial implications for clinical practice.
Keywords: Mental Health; Measurement; Children; Adolescents
CORRESPONDING AUTHOR: Manning Amy, University at Buffalo, SUNY; amymanning2002@yahoo.com
P412
TEACHERS’ CANCER-RELATED HEALTH BEHAVIOR
Molnár R., Erdős CS., Müller A., Paulik E., Nagymajtényi L.
University of Szeged, Department of Public Health, Szeged, Hungary
Background: Nowadays cancer prevention in schools becomes more and more important. The tasks of teachers and their personal example play prominent roles. The aim of this study was to explore the teachers' health behavior compared with control group (average population).
Methods: The cross-sectional study was delivered in the adult population of Southern Great Plain in Hungary (N = 590) and among teachers of secondary schools (N = 376). The data collection based on self-administered questionnaire focusing on demographic parameters, the knowledge of risk factors of tumors and attitudes toward and participation in cancer screenings, costumer types of internet using. Statistical analysis was performed by SPSS 17.0 for Windows. Simple descriptive statistics were used.
Results: A higher proportion of teachers were married or single and less divorced or widowed. They evaluated more often their general heath status as good or very good and rarely smoked. Their participation on medical examination or in screening was similar to the general population, but they took part more often in dermatological, dental examination, colon and breast cancer screening. Their attitudes and motivation about screening, cancer prevention, and the factors, which can cause cancer were similar to the average population.
Conclusions: The teachers’ health status – probably due to their higher educational level – was better, although their health behavior, attitudes related to cancers and cancer prevention was not different from the general population. As an important conclusion: those who teach the proper health behavior in the secondary schools, they can not set example for the younger generation. In Hungary the unfavorable cancer-related health behavior is general problem, higher educational level or a special job is not advantageous in this field.
Keywords: attitudes, behavior, cancer, screening
CORRESPONDING AUTHOR: Molnár Dr. Regina, University of Szeged, Szeged; regina.molnar.mail@gmail.com
P413
WHY SHOULD I STILL HAVE A PAP TEST? CONVEYING THE IMPORTANCE OF CERVICAL SCREENING AFTER BEING VACCINATED AGAINST THE HUMAN PAPILLOMAVIRUS
Mullins RM.1, Broun KH.2, Grainger MN.1
1 Cancer Council Victoria, Behavioral Research Center, Melbourne, Australia
2 Cancer Council Victoria, Prevention and Control Program, Melbourne, Australia
In 2007 a human papillomavirus (HPV) vaccination program began in Australia. In addition to an on-ongoing school-based program, a free program for women aged 18-26 was in place until the end of 2009. As the vaccine will not protect against all cervical cancer, it is still recommended that women have regular Pap tests.
It has been of concern that vaccinated women may not continue to screen if important HPV messages are not conveyed to them. Qualitative research at the time the vaccine was introduced indicated that understanding of HPV, the vaccine, and the link with cervical cancer was poor. One strategy to address this was the modification of a pre-existing television advertisement promoting Pap testing so that it included a message about the need for vaccinated women to have Pap tests.
Population-based surveys have monitored women’s uptake of the HPV vaccine and their knowledge that Pap tests were still needed after it, as well as their knowledge of the limitations of the vaccine, specifically that it cannot prevent all cervical cancer or treat cervical cancer or abnormalities.
By 2010 93.6% of women knew Pap tests were needed after the vaccine. Awareness was particularly high among those who had seen the most recent television advertisement (95.7%); were in the age group which had been eligible for free vaccination (98.5%) or had been vaccinated themselves (99.1%). Most women maintained that they would still have a Pap test even after vaccination (92.3%). However, knowledge of why this is necessary was far poorer, with just two-thirds knowing that the vaccine was not able to prevent all cervical cancer (64.3%) or that it could not treat cervical cancer or abnormalities (67.2%).
It is reassuring that so many women say they are aware that Pap tests are still needed after the vaccine, as emphasised in the mass media. However, some of the complexities about the link between cervical cancer, HPV and the vaccine are poorly understood and may impact on women actually having a Pap test. Different means of communication are being used to try to address some of these knowledge gaps. Australia has registries for both cervical screening and for HPV vaccination, and data linkage between the two is needed to monitor the situation as the vaccinated cohort ages.
Keywords: Behavior Change, Cancer screening
CORRESPONDING AUTHOR: Mullins Robyn, Cancer Council Victoria, Melb; robyn.mullins@cancervic.org.au
P414
WHO IS AT RISK FOR EMOTIONAL PROBLEMS AND HOW DO YOU KNOW? SCREENING PATIENTS FOR VULNERABILITY FOR EMOTIONAL PROBLEMS DURING AND AFTER FERTILITY TREATMENT.
Verhaak CM.1, Lintsen AME.2, Evers AMW.1, Van Dongen A.2, Braat DDM.2
1 Radboud University Nijmegen Medical Center, Department of Medical Psychology, Nijmegen, Netherlands
2 Raboud University Nijmegen Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, Netherlands
Background: Fertility problems are accompanied by a lot of emotional distress, resulting in a considerable part of female patients showing severe maladjustment after assisted reproductive technology. Early identification of women at risk enables the provision of timely psychosocial support and gives the opportunity of focusing psychosocial resources on those who need it most. This study investigated the psychometric characteristics of a screening tool SCREENIVF to identify women at risk for emotional problems in an early stage in the treatment and the feasibility to use it in clinical practice.
Methods: Risk factors for emotional maladjustment were identified in a previous study and incorporated in SCREENIVF which consists of 34 items on general and infertility specific psychological factors. 279 women finished SCREENIVF at pretreatment and three to four weeks after the pregnancy test. Linear Regression analyses were performed to investigate the predictive value of SCREENIVF, sensitivity and specificity as well as likelihood ratio’s were described . In addition uptake rates and patients experiences with SCREENIVF were administered during 6 months of implementation in 600 patients.
RESULTS: SCREENIVF successfully identified 75% of the patients as at risk or not at risk. The negative predictive value was high: 89%. The positive predictive value was low (48% in the total sample and 56% after unsuccessful treatment). Sensitivity was 69%, Specificity was 77%. Uptake rate was 78% and 95% of the patients recognized themselves in the risk profile.
Conclusions: For its use as a first screening for emotional problems, SCREENIVF is an acceptable instrument to identify women at risk. These women could be offered more detailed diagnostics e.g. in a diagnostic interview to further investigate to what extent they could benefit from psychological treatment.. High uptake rate and high recognition of results by patients prove feasibility of implementation SCREENIVF in clinical practice in outpatient clinic of reproductive medicine.
Keywords: screening, risk factors, women's health
CORRESPONDING AUTHOR: Verhaak Christianne, Radboud University Nijmegen; c.verhaak@mps.umcn.nl
P416
GUIDED SELF-HELP AS INTERVENTION FOR TRAUMATIC STRESS IN PARENTS OF CHILDREN WITH CANCER: CONCEPTUALIZATION, INTERVENTION STRATEGIES, AND TWO CASE STUDIES
Cernvall M.1, Carlbring P.2, Ljungman G.3, Von Essen L.1
1 Uppsala University, Department of Public Health and Caring Sciences, Uppsala, Sweden
2 Umeå University, Department of Psychology, Umeå, Sweden
3 Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Being a parent of a child diagnosed with cancer poses an enormous stressor. Indeed, several parents have difficulties adjusting to such a situation and react with symptoms of traumatic stress, depression and reduced quality of life. However, there is little conceptual work on behavioral mechanisms that contribute to suboptimal adaptation in these parents. We present a conceptualization in which experiential avoidance and rumination are suggested to contribute to increased levels of traumatic stress and sub-optimal adaptation. Based on this conceptualization, a recently developed intervention for parents of children with cancer, in the form of guided self-help, is presented. The intervention is based on cognitive and behavioral principles and targets arousal, avoidance and rumination specifically. Finally, we present two successful case-studies as an initial evaluation of this intervention. Participants were two mothers and using Jacobson & Truax (1991) criteria, both evidenced clinical significant and reliable improvements in symptoms of traumatic stress, depression and quality of life during the intervention and at follow up. Suggestions for future research are discussed.
Keywords: Cancer, Caregiving, Stress
CORRESPONDING AUTHOR: Cernvall Martin, Uppsala University, Uppsala; martin.cernvall@pubcare.uu.se
P417
THE RELATIONSHIP BETWEEN PSYCHOLOGICAL FACTORS AND PHYSICAL ACTIVITY IN THE TREATMENT OF PROSTATE CANCER WITH ANDROGEN DEPRIVATION THERAPY
Chipperfield K.1, Burney S.2, Fletcher J.2, Millar J.3, Smith R.3, Oh T.3, Walsh C.3, Frydenberg M.4
1 Monash University, School of Psychology and Psychiatry, Melbourne, Australia
2 Cabrini Institute, Cabrini Monash Psycho-Oncology Research Unit, Melbourne, Australia
3 Alfred Health, William Buckland Radiotherapy Centre (WBRC), Melbourne, Australia
4 Monash Medical Centre, Urology, Melbourne, Australia
A common form of treatment for advanced Prostate Cancer (PCa) is Androgen Deprivation Therapy (ADT). Despite its effectiveness as a treatment for disease progression, ADT can lead to psychological complications such as depression, anxiety and cognitive difficulties. A number of studies among patients with PCa have demonstrated the detrimental effects of ADT on quality of life (QoL) and well-being. The aim of this research, therefore, was to examine the impact of the side effects of ADT in this patient group. A questionnaire was administered to patients with PCa attending for treatment at the Alfred, Cabrini and Latrobe Regional Hospitals in Melbourne, Australia, during 2010 and 2011. Measures included: The International Physical Activity Questionnaire (IPAQ); The Hospital Anxiety and Depression Scale (HADS); The Short-Form 12-Item Health Survey (SF-12); The Functional Assessment of Cancer Therapy – Prostate (FACT-P); The FACT-Cognitive (FACT-Cog); and socio-demographic items. Patients aged between40 and 80 years and English speaking, who had received radiotherapy treatment for their PCa between 9 and 30 months ago were mailed the questionnaire. The response rate was 59% (378 participants). Patients were categorised into four treatment groups according to their type of treatment and length of time on ADT (Radiotherapy (RT) only; RT + 6 months ADT; RT + 2.5 years ADT; and RT + ADT indefinitely). Preliminary results of 127 patients suggest that QoL, psycho-social wellbeing and sexual functioning significantly diminished with increased length of time on ADT. No significant differences in cognitive functioning were identified between treatment groups. These findings highlight the need for clinicians to be aware of the effects of ADT treatment on QoL to make informed decisions about treatment based on the patient’s age and risk of disease progression and to emphasise the necessity of directing patients to appropriate forms of support including counselling and rehabilitation programs.
Keywords: Cancer; Depression; Anxiety; Physical Activity
CORRESPONDING AUTHOR: Chipperfield Kelly, Monash University, Melbourne; kelly.chipperfield@monash.edu
P418
PHYSIOLOGICAL BIOMARKERS OF CAREGIVING STRESS AND THEIR EFFECT ON PSYCHOLOGICAL AND PHYSICAL HEALTH OF THE CAREGIVERS
Cohen M.
University of Haifa, School of Social Work, Haifa, Israel
Long-term caregiving has a negative impact on caregivers' physical health and increases their risk of health problems and mortality. Recent studies suggest that high levels of psychological distress and physical exhaustion exist among caregivers of cancer patients for long periods. Several trajectories of the effect of psychological distress on health have been described in the literature, including activation of the hypothalamus-pituitary-adrenal axis and the parasympathetic pathways, which may result in disturbed secretion of stress hormones and dysregulation of immune functions.
While a substantive number of studies depicted the effect of caregiving for individuals with dementias on neuro-immune processes, research into these processes is generally lacking with regard to the specific stressors of caregiving for cancer patients. To address this issue, the current presentation reviews the literature, with special focus on the findings of our group. It reports the results of a longitudinal study of the effect of caregiving on neuro-immune functions of adult daughters of breast cancer patients, and their relation to perceived mastery, coping strategies and the dyadic relation with their mothers. Another aspect of caregiving stress to be reported is its effect on quality of sleep and fatigue in caregivers of patients receiving chemotherapy. Also, recent results on levels of pH in saliva in older individuals caring for spouses receiving chemotherapy, and their association with level of stress, will be presented. The effect of personal resources, especially perceived burden, mastery, emotional regulation and coping, are discussed.
Keywords: caregivers, stress, physiological biomarkers
CORRESPONDING AUTHOR: Cohen Miri, University of Haifa, Haifa; cohenm@research.haifa.ac.il
P419
THE ROLE OF SPIRITUALITY IN THE ADJUSTMENT TO CANCER
De Jager Meezenbroek EC.1, Visser A. 1, Van Dierendonck D.2, Visser AP.2, Garssen B.1
1 Helen Dowling Institute, -, Utrecht, Netherlands
2 Erasmus University, -, Rotterdam, Netherlands
In the present cross-sectional study it was investigated whether spirituality reduces the negative impact of cancer-related stressors on the well-being of a sample of cancer patients. Furthermore, we investigated whether spirituality was more important for the maintenance of well-being among these cancer patients than among a sample of healthy persons.
The cancer patients (N = 216) were mainly females (78%) with breast-cancer (62%) who had been diagnosed with cancer at least two months before assessment. Their mean age was 59 years. Persons with brain tumours were excluded. The mean age of the healthy persons (N = 117) was 54. Half of them were male. They did not have a chronic and/or life threatening disease.
The outcomes were well-being and distress. The predictors were seven aspects of spirituality (Meaningfulness, Trust, Acceptance, Caring for Others, Connectedness with Nature, Transcendent Experiences, and Spiritual Activities), pain, fatigue, and the perceived favourableness of the cancer diagnosis. To investigate the moderating effect of spirituality 14 hierarchical regression analyses were performed with interaction terms of each of the seven aspects of spirituality by pain, fatigue and prognosis in the final step (7 aspects of spirituality * 2 outcomes). Having a partner was included as a control variable. To investigate the moderating effect of group (cancer patient versus healthy participant) another 14 hierarchical regression analyses were performed with interaction terms of group by each of the seven aspects of spirituality in the last step. The control variables were: age, gender, educational level, having a partner, and serious life events. Bonferonni correction for multiple testing was applied in all analyses.
The aspects of spirituality did not buffer the impact of cancer-related stressors on well-being/distress. Two of the aspects showed main effect on the distress and well-being of the cancer patients: Trust was associated with less distress (B = -.43, 95%CI around B = -.67;-.19, β = -.26, p = .00), and Meaningfulness was associated with higher well-being (B = .36, 95%CI around B = .14;.58, β = .25, p = .00). Interestingly, the relationships of these aspects of spirituality with distress/well-being was stronger than those of pain and prognosis with these outcomes. The relationship between spirituality and well-being/distress was the same among the cancer patients and the healthy persons.
Keywords: Spirituality, Quality of life
CORRESPONDING AUTHOR: Visser Anja, Helen Dowling Institute, Utrecht; avisser@hdi.nl
P420
THE QUALITY OF LIFE OF CHILDREN SICK WITH CANCER UNDERGOING RADIATION THERAPY
Kreitler S.
Tel Aviv University, Department of Psychology, Tel-Aviv, Israel
Objectives: The study was designed to investigate the impact that radiation therapy would have on the quality of life (QOL) of the children and of the parents. Most of the studies about the effects of treatment on the QOL of pediatric oncology and hematology patients dealt with the impact of treatment in general, without separating radiation from chemotherapy.
Method: The participants were 45 pediatric oncology and hematology patients 6 to 18 yrs old who were undergoing radiation therapy or have completed it 2-3 months earlier. They were administered the Children’s Quality of Life Questionnaire (Kreitler and Kreitler) and a guided interview about emotional and other difficulties of the treatment and its side effects.
Results: Results indicate that radiation treatment has a strong impact on the children’s QOL especially the cognitive and emotional aspects, despite the fact that it does not involve the usually unpleasant side effects of chemotherapy. However, it evokes anxiety in the course of treatment and concerning future likely side effects, concerning cognitive functioning and body image.
Conclusion: In order to provide pediatric oncology patients the maximum support it is necessary to determine how different treatment components of radiation affect their QOL. The most important components are the emotional effects of the treatment.
Keywords: cancer, quality of life, radiation
CORRESPONDING AUTHOR: Kreitler Shulamith, Tel-Aviv University; krit@netvision.net.il
P421
IMPACT OF A TARGETED CRC SCREENING INTERVENTION AMONG LATINOS IN CENTRAL PA
Dominic O.1, Lengerich E.2, Gallant N.3, DeVizio S.3, Kambic
D.4, Curry W.5, Krebs N.6
1 Penn State Milton S. Hershey Medical Center, Department of Public Health Sciences, Biobehavioral Health, Hershey, USA
2 Penn State Milton S. Hershey Medical Center, Department of Public Health Sciences, Family & Community Medicine, Cancer Institute, Hershey, USA
3 Penn State Milton S. Hershey Medical Center, Department of Public Health Sciences, Hershey, USA
4 Penn State Milton S. Hershey Medical Center, Department of Public Health Sciences, Kambic Family Practice, Hershey, USA
5 Penn State Milton S. Hershey Medical Center, Department of Public Health Sciences, Family & Community Medicine, Hershey, USA
6 Penn State Milton S. Hershey Medical Center, Public Health Sciences, Hershey, United States
Although the incidence of colorectal cancer (CRC) is no higher among Latino men and women than among Whites, non-Latinos in the USA the five-year survival rates for Latinos are lower than they are for Whites. Differences in survival are due in part to Latinos being diagnosed at a later stage of the disease; an ethnic gap in the use of CRC screening explains some of these differences. In an effort to reduce this ethnic disparity among Latinos, screening rates among this population must increase. The specific objectives of this study are to develop, implement and evaluate a targeted CRC screening intervention to increase CRC screening uptake. We will measure actual CRC uptake in both the control and intervention arm as a method to determinate completion rates. The study design is a randomized, community-based, participatory design to determine completion of a provider-recommended, take-home FIT kit without (control) and with social support (intervention) among a sample of average-risk, urban and rural Appalachian Latino adults age 50 and older not currently adherent to national CRC screening guidelines (N = 264).Each consented participant will attend a one-time, community-based CRC screening opportunity offered at one of the eight study sites located in Central PA. Study results are forthcoming. The study is innovative because it brings together academic institutions and CBOs in a collaborative, CBPR study.
Keywords: Cancer Screening, Cancer, Latino, Disparities, Minority Health
CORRESPONDING AUTHOR: Dominic Oralia , Penn State; odominic@hes.hmc.psu.edu
P422
FACTORS INFLUENCING THE UTILIZATION OF PUBLIC HEALTH SCREENINGS IN HUNGARY
Erdős CS., Molnár R., Müller A., Paulik E., Nagymajtényi L.
University of Szeged, Public Health, Szeged, Hungary
Background: Malignant tumours mean a large public health problem in the European Union, so in Hungary too. The health-promoting behaviour of the Hungarian population (e.g. participation in screening programmes) is more unfavourable as in other European countries.
Objective: The aim was to explore the factors influencing the utilization of breast, cervical, colorectal and prostate cancer screenings.
Methods: A self-administrated questionnaire based study was delivered in the adult population of Southern Great Plain in Hungary (N = 590), focusing on demographic parameters, the knowledge of risk factors of tumours and of screening, attitudes toward and participation in cancer screenings. The mean age of females was 45 years, and 54 years among men, as the high risk group of cancers, and target population of screening programmes. Statistical analysis was performed by SPSS 17.0 for Windows.
Results: Knowledge about cancer-screenings and attendance of screenings showed significant differences by sex, education and financial circumstances. Screening participation rate was lower in men than in women. Men took a dim view of cancer’s prevention. Higher educated respondents were more informed about the risk factors of cancers, and they showed higher participation rate in screenings. People with financial problems (44.9% of respondents) showed lower rate of participation. More than two third of the respondents said that if they get health preferences (subsidy for medicaments), they will go more often to cancer-screenings.
Conclusion: Improving the knowledge seems to be an efficient way to reduce the social disparities in the primary and secondary prevention of cancers.
Keywords: screening, social disparities
CORRESPONDING AUTHOR: Erdős Csaba, University of Szeged, Szeged; erdoscsaba3@gmail.com
P423
ILLNESS PERCEPTION AND COPING IN BRAZILIAN WOMEN WITH BREAST CANCER
Kern de Castro E.1, De Aguiar Machado AC.1, Romeiro F.1, Lawrenz P.1, Both LM.1, Haas S.2
1 Universidade do Vale do Rio dos Sinos, Health Sciences Center, São Leopoldo, Brazil
2 Santa Rita Hospital, Department of Psychology, Porto Alegre, Brazil
Illness perception is referred to the way the subject understands his health problem and how he faces it. The coping consists of cognitive, behavioral and emotional strategies used has a response to stressful situations, with the purpose of preserving the subject´s mental and physical health. The present study examined illness perception and coping in Brazilian women suffering of breast cancer. Participants: 157 patients with mean age of 51.91 years (SD = 7.98). Instruments: sociodemographic and clinical data, Coping with Health Injuries and Problems (CHIP) and Revised Illness Perception Questionnaire (IPQ-R). Significant correlations were found between timeline cyclical and palliative coping (r = -0.166; p < 0.05); personal control and palliative coping (r = 0.243; p < 0.01); timeline cyclical and instrumental coping (r = -0.167; p < 0.05); consequences and instrumental coping (r = -0.184; p < 0.05); timeline cyclical and distraction coping (r = -0.218; p < 0.01); consequences and distraction coping (r = -0.179; p < 0.05); emotional perception and emotional coping (r = -0.262; p < 0.01). Linear regression analysis showed that palliative coping was predicted by treatment control and timeline cyclical dimensions, explaining 8.5% of its variance. On the other hand, consequences dimension was a predictor of instrumental coping (R2 = 0.032, p < 0.05), while timeline cyclical was a predictor of coping distraction (R2 = 0.047, p < 0.01). The emotional coping was explained only by emotional perception (R2 = 0.072, p < 0.01). The conclusion was that some dimensions of illness perceptions worked as predictors of coping strategies, enhancing the importance of interventions to clarify misperceptions about breast cancer and achieve more appropriate coping strategies.
Keywords: illness perceptions, coping, breast cancer
CORRESPONDING AUTHOR: Kern de Castro Elisa, Sinos Valley University, Brazil, elisa.kerndecastro@gmail.com
P424
THE INFLUENCE OF OPTIMISM AND COPING STRATEGIES IN THE QUALITY OF LIFE OF WOMEN WITH BREAST CANCER
Mera P.
Pontificia Universidad Católica de Chile, Departament of Psychology, Santiago, Chile
Several researchers have proposed that quality of life is negatively affected in women with breast cancer and have discussed the role of coping strategies and optimism on the adaptation to this condition. In the present study we investigated the relationship between quality of life among women with breast cancer, and optimism and coping strategies. Twenty-five women with breast cancer were asked to complete a series of instruments: WHOQOL-BREF, Life Orientation Test-Revised (LOT-R), Coping Strategies Inventory (CSI) and a questionnaire to collect sociodemographic and health data. Correlations were found between each of the independent variables (optimism and coping strategies) with quality of life and between the independent variables. A multiple regression analysis showed that the strongest predictor of quality of life is the coping, specifically two coping strategies, social support and self-criticism, which together account for a 50,7% of the variance of the quality of life. We discuss the theoretical and practical implications of these results in the development of multidisciplinary interventions, as well as the limitations of this study and suggestions for future research.
Keywords: quality of life - optimism – coping behavior – breast cancer.
CORRESPONDING AUTHOR: Mera Paulina, Universidad Catolica de Chile; paulina.mera@gmail.com
P425
SIDE EFFECT PREVENTION TRAINING - A PROGRAM TO ENHANCE BREAST CANCER PATIENTS´ QUALITY OF LIFE DURING ADJUVANT ENDOCRINE THERAPY.
Von Blanckenburg P.1, Schuricht F.2, Albert US.3, Rief W.1, Nestoriuc Y.1
1 University of Marburg, Department of Clinical Psychology, Marburg, Germany
2 University of Marburg, Department of Clinical Psychology, Marburg, Germany
3 University of Marburg, Department of Gynecology, Gynecological Endocrinology and Oncology, Marburg, Germany
Purpose: Adjuvant endocrine therapy can improve disease free survival and time to recurrence in breast cancer patients. At the same time, it is associated with adverse side effects that negatively affect patients´ quality of life and cause non-adherence. The recently demonstrated effect of individual expectations on side effect development suggests a role for psychological factors in the prevention of side effects. The aim of this study is to evaluate a cognitive-behavioral side effect prevention training for breast cancer patients.
Methods: In a controlled randomized design, 160 female breast cancer patients will be assigned to receive either side effect prevention training, standard medical care or a supportive program (attention control group) before the start of endocrine treatment. The training contents: psychoeducation to reduce concerns about side effects and strengthen necessity beliefs, training of side effect management and problem solving to enhance self-efficacy expectations about coping, relaxation and imagination training to decrease treatment distress. Primary outcomes are side effects and quality of life at follow-up. Response expectations, self-efficacy expectations about coping and control expectations about illness and treatment will be assessed as mediators.
Results: Concept and design of the study, and preliminary results will be presented. It is expected that the side effect prevention training will be highly accepted by the patients. Furthermore, the training is expected to improve patients´ expectations toward treatment, possible side effects, and their own coping skills.
Conclusion: To our knowledge, this is the first study investigating a psychological prevention program for side effects. Patient acceptance and satisfaction with the training as well as potentially beneficial effects for incidence and subjective distress from non-specific side effects, quality of life, and treatment adherence will be analyzed. Implications for a possible integration of psychological trainings in the clinical daily routine will be discussed.
Keywords: Cancer; Prevention; Quality of life; Treatment
CORRESPONDING AUTHOR: von Blanckenburg Pia, University of Marburg, Germany; pia.vonblanckenburg@staff.uni-marburg.de
P426
EXPECTED SYMPTOM COPING AND QUALITY OF LIFE IN BREAST CANCER PATIENTS RECEIVING ENDOCRINE THERAPY
Schuricht F.1, Von Blanckenburg P.1, Albert U-S.2, Rief W.1, Nestoriuc Y.1
1 University of Marburg, Clinical Psychology and Psychotherapy, Marburg, Germany
2 University of Marburg, Department of Gynecology, Gynecological Endocrinology and Oncology, Marburg, Germany
Purpose: Physical symptoms as well as medical side effects are known to seriously alter the quality of life in breast cancer patients undergoing endocrine therapy. The extend of these problems as well as the expectations of being able to cope with them during therapy strongly varies among patients. We assume that additionally to current physical complaints the coping expectancy before the beginning of therapy has a predictive influence on later quality of life.
Methods: We investigated 47 female patients with diagnosed breast cancer before undergoing adjuvant endocrine therapy (AET) with a mean age of 60 (SD = 8.07). Patients were asked to rate their expectancy on coping capability for each of 45 typical physical complaints on a visual analogue scale, in case those would develop during AET (measurement time-point T1). About three months after AET onset (T2), patients indicated which symptoms had actually occurred. Furthermore, they were asked to judge their current general quality of life (assessed by the global scale of the EORTC questionnaire). To analyze the variance of quality of life at T2 we computed stepwise regressions.
Results: Both variables “symptoms at T2” and “coping expectancy at T1” explained nearly 50% of the variation in quality of life at T2 (R2 = .49, corrected). Explained variance increased significantly by including coping expectations (p = 0.029). An additional consideration of age, cancer staging, or quality of life at T1 did not further improve the model.
Conclusions: The à priori expectancy of being able to cope with physical symptoms during AET seems to be almost as important for general quality of life as the degree to which symptoms actually occur. We therefore conclude that psychotherapeutic assistance in the creation of positive symptom coping expectancy of breast cancer patients starting AET can greatly improve patient’s future quality of life during medical intervention.
Keywords: Coping, Quality of life, Cancer
CORRESPONDING AUTHOR: Schuricht Franziska, Philipps University, Marburg; franziska.schuricht@staff.uni-marburg.de
P428
POSSIBILITIES AND DILEMMAS OF CANCER DISTRESS SCREENING IN ROMANIA
Dégi CL.1, Sárosi AZ.2, Mild B.2, Hanusz S.3
1 Babes-Bolyai University, School of Social Work, Cluj-Napoca, Romania
2 Diakonia Christian Foundation, Home nursing and palliative care program, Cluj-Napoca, Romania
3 Romanian Cancer Association, "Common Destinies" Group, Targu-Mures, Romania
Background: Cancer distress screening is new, unrecognized and still in early development in Romania. Scarcities in cancer distress screening in Romania are mainly explained by the dilemma of cooperation. There is little cooperation between health care and social care sectors, which would be imperative for high-quality cancer care – palliative care. Diakonia Christian Foundation and Romanian Cancer Association are partners in creating possibilities for common initiatives and interests between them.
Methods: Based on recommendations of the first extensive interdisciplinary research in Romania focusing on psychosocial aspects of hospitalized adult cancer patients we developed together with our partners a new cancer distress screening research project for cancer patients in palliative and supportive care. Our pilot project stands for assessment of bio-psycho-social and communication needs in cancer patients and their caregivers. FACT-G 4.0 and BDI screening instruments were used in this clinical sample: 162 cancer patients, of which 108 in supportive, rehabilitation group and 54 in palliative care. Statistical analysis included: comparative and associational statistics, co-variance tests.
Results: Among patients in palliative care average value of the quality of life scale is 59.92. On the physical, emotional, social / family and functional well-being subscales the average scores are: 12.51, 15.38, 20.18 and 13.11. Results in the supportive care sample are, as follows: 66.95, 16.66, 13.01, 18.76 and 18.16. Both statistically and clinically significant result were found only in relation to physical and functional well-being (p,005). However, with regard to overall, global and especially to the psychosocial quality of life there are no significant differences among cancer patients in treatment, rehabilitation and palliative care.
Conclusions and implications: Based on our research we propose the routine use of self-administered questionnaires in all oncology settings and services for better identification of psychosocial problems, needs. Our first and pilot cancer distress screening project can develop new data and strengthen development of a reliable psycho-oncology network in Romania.
Keywords: cancer, quality of life, social
CORRESPONDING AUTHOR: Dégi Csaba, Babes Bolyai University, Cluj; csabadegi@gmail.com
P430
ASSOCIATION OF CARE SATISFACTION AND PERCEIVED EMPATHY WITH PSYCHIATRIC MORBIDITY AND ADHERENCE AT CANCER PATIENTS
Popa Velea O., Cercel S., Popp I.
University of Medicine and Pharmacy Carol Davila - Bucharest , Medical Psychology, Bucharest, Romania
Background: Given literature reports emphasizing that empathy and perceived care satisfaction play a key role in ameliorating the prognosis of problematic (e.g. chronic or life-threatening) medical conditions, the aim of this study was to assess the strength of associations between care satisfaction and perceived empathy (as independent variables) with psychiatric morbidity and adherence (as dependent variables) at advanced cancer patients.
Method: 80 patients with digestive - stomach and colorectal - cancers (stage 2 or 3) (44 women and 36 men, mean age = 45,74) were evaluated for depression (CES-D questionnaire), anxiety (Cattell Scale), latent aggressiveness (Anger-In Scale) and adherence (Medication Adherence Rating Scale, MARS), in relation to care satisfaction (Visual Analogue Scale) and perceived empathy (Jefferson Scale of Patient’s Perceptions of Physician Empathy). Analysis of variance (ANOVA) was used to assess the amplitude of associations between these variables.
Results: Satisfaction with care was inversely associated with scores of anxiety (all components) (F = 14.19, p < .001), depression (F = 12.76, p < .0001), latent aggressiveness (F = 6.83, p < .01), and positively with adherence. From dependent variables, empathy correlated only with a component of anxiety (ergic tension) and only at men (F = 4.17, p < .03)
Discussion: The study highlights the higher importance of care satisfaction, compared to empathy, for diminishing incidence of psychiatric morbidity and increasing adherence at medium or advanced cancer patients.
Keywords: cancer, adherence, empathy, care satisfaction
CORRESPONDING AUTHOR: Ovidiu Popa Velea, UMF Carol Davila, Bucharest; opopavelea@hotmail.com
P431
ASSOCIATIONS BETWEEN INDIVIDUAL TRAITS, SELF-REPORTED MOOD AND SYMPTOMS OF STRESS, AND DIURNAL CORTISOL CONCENTRATIONS AMONG WOMEN WITH BREAST CANCER
Tamagawa R.1, Carlson L. 1, Speca M.1, Giese-Davis J.1, Doll R.2, Stephen J.2
1 University of Calgary, Department of Oncology, Calgary, AB, Canada
2 British Columbia Cancer Agency, Sociobehavioural Research Centre, Vancouver, Canada
Previous studies indicate that the dispositional tendency to be mindful in daily life is associated with positive emotional experiences and salutary self-reported health among cancer patients. However, we know little about how trait mindfulness, relative to other emotional styles often studied among cancer population such as suppressive and repressive emotional styles, is associated with subjective as well as objective indices of health.
This study sought to identify how individual traits of mindfulness, suppression, and repression are associated with self-reported mood disturbance and stress symptoms, and diurnal salivary cortisol concentrations among women with breast cancer.
A total of 277 breast cancer patients were recruited from tertiary cancer clinics in Calgary and Vancouver in Canada for a psychosocial intervention program. This study used the baseline data collected prior to the commencement of the intervention. Participants were asked to complete questionnaires assessing trait mindfulness, suppression, repression, symptoms of stress, and mood. They were also asked to donate a saliva sample four times a day (wakening, noon, 5pm, and bedtime) for three consecutive days.
High levels of mindfulness were associated with fewer stress symptoms and mood disturbance, while high levels of suppression were associated with poorer self-reported health, even after controlling the impact of disease characteristics, such as cancer stage and time since diagnosis. On the other hand, disease characteristics, rather than individual trait variables were significantly associated with the cortisol slope.
Individuals’ dispositional ways to manage negative emotions were associated with the experience of symptoms and aversive moods, but not objective indices of health when assessed by cortisol diurnal rhythms. Our results suggest that being aware of the present moment and accepting feelings as they arise, rather than deliberately inhibiting the experience of negative emotions, was salutary. Helping patients cultivate mindful insights and reduce deliberate inhibition may be a useful focus for psychosocial interventions.
Keywords: Cancer, Mindfulness, Personality, Cortisol, Mood, Health
CORRESPONDING AUTHOR: Tamagawa Rie, University of Calgary, rie.tamagawa@albertahealthservices.ca
P432
SURVEY OF ANXIETY: TRAIT/STATE, CARDIAC SELF-EFFICACY AND HEALTH BELIEFS OF PATIENTS WITH CORONARY HEART DISEASE WITH HISTORY OF TOBACCO SMOKING
Allahverdipour H.1, Heshmati R.2
1 Tabriz University of Medical Sciences, Health Education & Promotion, Tabriz, Iran
2 University of Tehran, Department of Psychology, Tehran, Iran
Introduction: Smoking is the most important preventable contributor to premature death, disability, and unnecessary health expense in many countries. It is a major risk factor for coronary heart disease (CHD). Psychological factors such as emotions and beliefs associated with smoking can affect the CHD.
Aim: the aim of this research was to investigate anxiety: trait/state, cardiac self-efficacy and health beliefs among coronary heart disease (CHD) patients who have history of tobacco smoking.
Method: in this correlational study 105 patients with CHD participated from Tehran Heart Center Hospital by convenience sampling method. Participants include all men/women, hospitalized and outpatients with coronary heart disease (CHD) in Tehran above the age of 25. Research-designed Questionnaires of demographic and clinical characteristics, cardiac self-efficacy Questionnaire, Seattle Angina Questionnaire, and research-designed health beliefs Questionnaire were used to gather data.
Results: results showed that the smoking with maintenance of function (r = -.23, p > 0.01) has positive and significant relationship. Logistics regression analysis showed that from all predictive variables, only low self-efficacy was able to predict continuing tobacco smoking variance in CHD (β = -0/83). The high level of Wald statistic for self-efficacy indicates the usefulness of it in the prediction of smoking.
Conclusion: These results suggest that self-efficacy to cease tobacco use has important role for tobacco smoking after cardiac attacks among patients who suffer CHD. These findings can be used to refine behavioral smoking cessation interventions to increase self-efficacy to quit smoking in CHD patients.
Keywords: trait anxiety; state anxiety; cardiac self-efficacy; health beliefs; smoking; coronary heart disease
CORRESPONDING AUTHOR: Allahverdipour Hamid, TBZMED; allahverdipourh@tbzmed.ac.ir
P433
WORKING WOMEN'S HEALTH, PERCEIVED STRESS, PERSONALITY TRAITS IN CONTEXT OF MARITAL STATUS
Asad S., Najam N.
University of the Punjab, Pakistan, Applied Psychology, Lahore, Pakistan
This study aimed to identify the differences in perceived stress, personality traits, and general health of working women with relation to their marital status (unmarried, married, separated/divorced, widows). A purposive sample of (n = 300) women from banks, hospitals, telecommunication, universities and companies dealing with pharmaceuticals. The age range of participants was from 21-59 years. The perceived stress of working women was measured by Working Women's Stressors Scale (WWSS) developed by researcher. Personality traits assessed by Five Factors Inventory (NEO-FFI) (Costa and McCrae, 1992). General health Questionnaire GHQ 28 (Goldberg & Hillier, 1979) was used to assess the general health of subjects. Major findings indicated that personality traits (neuroticism), stressors (daily/personal stressors) influenced professional women's general health (Somaticism, anxiety, social dysfunction, depression). Marital status emerged as an important factor explaining the differences between stress, personality and health of women. Widows scored highest on neuroticism, somaticism, family stressors, anxiety, social dysfunction, daily/personal stressors, work stressors, life events and catastrophes. Married women scored highest on extroversion, agreeableness, and conscientiousness. Separated women scored highest on depression. Furthermore, widowed women's health was more at risk than the health of the rest of the group. Marital status was directly related to stress and general health of women.
Keywords: Perceived stress, Personality Traits
CORRESPONDING AUTHOR: Asad Shamaila, Punjab, University, Pakistan; sham37@hotmail.com
P434
THE RELATIONSHIP BETWEEN PRE-OPERATIVE EXPECTATIONS AND POST-OPERATIVE HEALTH OUTCOMES. A META-ANALYTICAL REVIEW.
Auer CJ., Laferton J., Nestoriuc Y., Doering BK., Rief W.
University of Marburg, Clinical Psychology and Psychotherapy, Marburg, Germany
Background: Subjective health beliefs have been shown to impact on patients’ health. A specific form of health beliefs which has been of increased interest in health research recently are patients’ expectations about course and outcome. There are findings indicating an influence on e.g. greater functional improvement in low back pain, the prognosis of coronary heart disease and even the recovery from surgery. An established effect of patients’ expectations on post-surgical recovery could serve as the basis of an intervention which facilitates patients to recover more quickly after surgery. So far there has not been a systematic review to confirm the specific relationship between pre-operative expectations and post-operative health outcomes. With this systematic review we addressed the following two questions: First, is there an association between patients‘ preoperative expectations and recovery after surgery? Second, are these effects more likely to be observed in particular subgroups of patients or in studies that use particular methods or instrumentation?
Methods: We searched the databases Medline, CENTRAL and PsychInfo for English- and German-language articles published from 1970 until 2011 with a title or abstract containing at least 1 word from each of 3 sets: (1) a form of “expectation”, “expectancy”, “belief”, “illness cognition”, “optimism”, “self-efficacy” or “locus of control”; (2) different variants of surgery; and (3) a form of “recover”, “outcome”, “survival” or “improve”. Inclusion criteria were: (a) Patients undergoing a surgical procedure, (b) prospective design, (c) expectations measured pre surgery, (d) health outcome measured post surgery.
Results: Twenty-nine studies have been included. Intermediate analysis indicate a robust relationship between preoperative expectations and patients‘ recovery after surgery. The strength of this relationship depends on the kind of expectation assessed, on the outcome as well as on study quality.
Discussion: The results support the need for pre-operative expectation-based interventions across different kind of surgeries. Such “surgery-preparation” could lead to accelerated recovery after surgery which in turn could result in less health care utilization. In order to verify a causal relationship between pre-operative expectations and health outcomes randomized controlled trials are needed.
Keywords: Health beliefs, Health outcomes, Outcome expectations, Surgery
CORRESPONDING AUTHOR: Auer Charlotte, University of Marburg, Marburg; charlotte.auer@staff.uni-marburg.de
P435
DISEASE MANAGEMENT FOR CHRONIC AND TREATMENT RESISTANT DEPRESSION
Keitner GI.
Rhode Island Hospital, Brown University, Psychiatry, Providence, USA
Treatment options for persisting depressions continue to focus on symptom reduction in spite of the lack of evidence for effectiveness. A more realistic approach is a disease management program that emphasizes improvement in functioning, quality of life and relationships in the face of persisting symptoms of depression. This presentation will review findings from two studies testing such a program. The first was an open label pilot study of 14 patients with difficult to treat depression who participated in a 16 week adjunctive disease management program for depression. Patients reported significant improvement in their quality of life and psychological well being in spite of persisting depression. The second was a randomized controlled study of a 12 week adjunctive disease management program for depression (n = 17) vs. treatment as usual (n = 13). Patients participating in the disease management program reported significant improvement in their sense of purpose in life and perception of social support in contrast to the control group. Disease management programs that focus on a healthy life style (exercise, diet, sleep hygiene, stress reduction), functioning, meaning in life and social relationships can improve a sense of well being, purpose in life and social support even in the face of persisting symptoms of depression.
Keywords: Treatment resistant depression, self management
CORRESPONDING AUTHOR: Keitner Gabor, Brown University; gkeitner@lifespan.org
P436
THE ROLE OF SCHEMAS IN THE RECALL OF INFORMATION IN DEPRESSION
Cláudio V.1, Anahory Noronha M.2
1 Instituto Superior Psicologia Aplicada, Research Unit in Psychology and Health, Lisbon, Portugal
2 Instituto Superior Psicologia Aplicada, Clinical Psychology, Lisbon, Portugal
The objective of this study is to assess the relationship between information processing and recall in the major depression.
The approach used is based on a cognitive perspective, relates to emotions, depression and its memory characteristics.
We compared the response to a directed forgetting task in thirty major depressed subjects, fifteen panic subjects and thirty subjects without psychopathological disorder. Subjects with major depression were evaluated twice, with three months interval.
We used the clinical evaluation of the Portuguese version of the following instruments: Beck Depression Inventory, Hamilton Scale to Depression, Spielberger State-Trait Inventory, Schemas Questionnaire, Dysfunctional Attitudes Scale.
The results indicate the existence of negative biases in depressed subjects and they also show a loss of a positive bias, observed in the other two groups. The depressed subjects presented a preferential highly severe processing and recall of negative information. We associate this fact with the existence of negative contents of the self-schemas agreeing with the processing and recall of information within these contents.
We discussed these results underlining its importance for the genesis and maintenance of depression.
We also mentioned the importance of these aspects in the work developed with depressive individual using cognitive therapy.
Keywords: Depression; Schemas; Recall information; Cognitive therapy
CORRESPONDING AUTHOR: Claudio Victor , IISPA-I.U, Lisboa; vclaudio@ispa.pt
P437
PERSONALITY STYLES AND DEPRESSION IN FEMALE FAMILY CAREGIVERS
Cuéllar-Flores I.1, Sánchez-López M P.2, Rivas-Diez R. 2
1 Hospital Universitario de Getafe, Mental Health Service, Getafe, Spain
2 Universidad Complutense de Madrid, Personalidad, Evaluación y Tratamientos Psicológicos II (Psicología Diferencial y del Trabajo), Madrid, Spain
Background: Family caregivers have higher levels of depression (Pinquart & Sorensen, 2003). The majority of family caregivers are women, and they are more likely than men to report worse mental health. Cultural and personal factors have been proposed to explain the differences found (López & Crespo, 2008). The aim of this study is to test the role of personality styles regarding depression in female family caregivers.
Methods: The study employed a correlational approach and a cross-sectional design. The sample consisted of 63 Spanish women (age range, 35-86 years; mean age = 58.73; SD = 13.84), who were caregivers of a dependent family member. Measures used included Millon Index of Personality Styles (Millon, 2001) and Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983 –Spanish adaptation Caro & Ibáñez, 1992).
Findings: The results indicate that 34% of the caregivers were at risk for depression (cut-off point = 11 –Carroll et al. 1993), similar to earlier research in caregivers (Rodríguez et al., 2002). The subscales Pleasure-Enhancing and Other-Nurturing retained unique predictive variance in a multiple regression analysis, explaining 18% of variance of depression (F = 6.64, p < .01). The subscale Pleasure-Enhancing predicted less depression, whereas Other-Nurturing predicted higher depression.
Discussion: Previous research studies have demonstrated that women present lower scores on Pleasure-Enhancing and higher scores on Other-Nurturing (Bonilla-Campos & Castro-Solano, 2000; Sánchez-López, Casullo & Aparicio, 1999) than men. In this study, these personality styles have been found to be significantly related to depression in female caregivers. Some personality styles could function as risk factors for the female family caregivers’ mental health.
Keywords: Depression, Caregiver, Personality, Disability
CORRESPONDING AUTHOR: Cuéllar-Flores Isabel, Universidad Complutense, Madrid; icuellarflores@gmail.com
P438
EVALUATION OF MICROSTRUCTURAL WHITE MATTER LESIONS IN PATIENTS WITH SUBCORTICAL VASCULAR COGNITIVE IMPAIRMENT BY USING DIFFUSION TENSOR IMAGING(DTI)
Dong -., Lv -., Li -.
Hebei General Hospital, Neurology, Shijiazhuang, Hebei, China
Objective: To investigate the microstructural white matter lesions and its correlation with the cognitive function in patients with SIVD by using DTI.
Methods: 33 SIVD patients and 18 normal elderly controls (NC) matched in age and gender were recruited. The patients were divided into vascular dementia (VaD, n = 17) and vascular cognitive impairment no dementia (VCIND, n = 16) group. DTI images were acquired, and fractional anisotropy (FA), mean diffusivity (MD) of normal-appearing white matter (NAWM) in the frontal, parietal, temporal, occipital lobes and periventricular areas were determined. Multiple linear regression analysis of NAWM with cognition was performed for correlation with comprehensive cognitive function.
Results: (1) Compared with controls, patients with VaD had reduced FA in the bilaterial frontal, temporal, parietal lobes and left periventricular area (P<0.05). Additional areas showing increased MD were the left parietal lobe and bilaterial periventricular areas (P<0.05). VCIND patients demonstrated decreased FA value in the bilaterial frontal andparietal lobes (P<0.05). Patients with VaD had higher MD in the bilateral periventricular NAWM and lower FA in bilateral temporal lobes than VCIND patients (P<0.05). (2)MMSE score correlated with diffusivity in left periventricular NAWM (P = 0.023) . FA value in right parietal lobe positive correlated with MoCA and block design test (P = 0.030;P = 0.010). FA value in left frontal lobe positive correlated with trail making test (P = 0.014). Digit span test score negative correlated with diffusivity in right periventricular area (P = 0.012).
Conclusions: (1) The select microstructural white matter lesions in NAWM of SIVD patients could be showed byDTI. (2) FA and MD values in NAWM correlated significantly with cognitive performance.
Keywords: subcortical ischemic vascular disease; vascular cognitive impairment; neuropsychological tests; diffusion tensor imaging; microstructural white matter lesions
Keywords: Aging, Clinical applications; Cognitive factors; FMRI; Illness behavior
CORRESPONDING AUTHOR: Peiyuan Lv, Hebei General Hospital,China, d_yanhongniu@163.com
P439
SCIENTIFIC BASES OF IMPORTANCE OF EARLY DIAGNOSIS AND TREATMENT OF ALZHEIMER AND THE HINDRANCE CAUSED BY DENIAL
Kappéter I.
Hungarian Alzheimer Society, Budapest, Hungary
Recognition of the effect of cholinesterase inhibitors gives grounds for immediate thorough examinations when somebody has frequent problems with recalling, with ordering the data, with orientation in space. If the very probable diagnosis is Alzheimer type disease, it is worth to begin taking cholinesterase inhibitor and other treatments. The daily application of medication is necessary, also if significant improvement is observed. The reserves of the brain can be significant – particularly if somebody had used his brain a lot, in multiple tasks. This applies also in the monkeys having inclination to Alzheimer, and had been given a lot of variant tasks. This does not justify neglecting the treatment of people whose dementia progression is slower than by others. The person who has an Alzheimer type and/or Léwy body type “mild cognitive impairment plus” must not leave off medication even for few days. The family doctors of these patients have to recognize early any “plus” illnesses not recognized by patients themselves, and order quick examination and treatment of them.
In the first stage these patients can continue to live a full life by keeping active in work. They learn to utilise tools those support them. They will do that, if they are helped by loving and clever helper/s. If helper/s fail/s to learn useful skills to treat well these people, they may also fall ill, because of the lack of understanding, the terrible debates, and being chained to the obstinate patient. We teach the helpers who are willing to learn how to treat such patients well. Some helpers can live with demented ones without stress.
The greatest problem is that people as recognize that they have problems with their memory and some very simple cognitive functions, are susceptible to make a secret of it. This unconscious suppression to avert the disadvantageous dreadful experiences is a typical reaction of human beings. Many relatives, and general practitioners, and others are willing to collaborate with such denial. Leaders of the societies, countries, etc. are also susceptible to join this. Only in the past two years it was recognized by the leaders of the USA, WHO and UNO officials, that dementia is the fifth most important social epidemic, and it will be more and more important.
This is 2298 character including spaces and including the word abstract, the organizer of the Congress limited them to 2300 characters including spaces.
Keywords: Alzheimer Disease AD, Early diagnosis and treatment
CORRESPONDING AUTHOR: Kappéter István, Hungarian Alzheimer S., Budapest; kappnov@yahoo.com
P440
MISCONCEPTIONS ABOUT HEART DISEASE: A COMPARISON BETWEEN PATIENTS AND HEALTHY PEOPLE
Figueiras M., Monteiro R., Caeiro R., Trigo M.
Instituto Piaget, Psychology, Almada, Portugal
Illness beliefs and misconceptions have proved to play a crucial role in adjustment and recovery from a multitude of illnesses, including heart disease. However, there’s a lack of information about the beliefs held by healthy people about cardiac disease. This study aimed to characterize and compare misconceptions about heart disease in patients and healthy people. Forty eight cardiac patients and 60 healthy participants completed a questionnaire which included self-report measures about cardiac misconceptions, positive and negative affectivity, dispositional optimism, health behaviors and demographic information. The results indicated that patients hold stronger misconceptions about cardiac illness and, at the same time, report lower levels of dispositional optimism than healthy people. However, the structure of misconceptions was similar in patients and non-patients, since the misconceptions more strongly endorsed were the same for both groups. This pattern of results suggests that the misconceptions held by patients are congruent with the lay representations of common sense, although they might be more strongly activated in the face of illness. This continuity of beliefs between lay people and patients gives support to the pertinence of developing interventions aimed at correcting the wrong ideas about cardiac illness held not only by patients but also by the general public.
Keywords: Health Beliefs; cardiovascular disease
CORRESPONDING AUTHOR: Figueiras Maria Joao, Instituto Piaget, Almada, mfigueiras@almada.ipiaget.org
P441
ARE SOCIO-DEMOGRAPHIC VARIABLES DETERMINANTS OF MISCONCEPTIONS ABOUT HEART DISEASE IN HEALTHY INDIVIDUALS? A PILOT STUDY
Figueiras M., Caeiro R., Monteiro R., Trigo M.
Instituto Piaget, Psychology, Almada, Portugal
The aim of the present study is to investigate the level of cardiac misconceptions in a community sample of healthy individuals. The 536 participants (both sexes) were recruited from the general population, and completed a self-administered questionnaire which included measures about cardiac misconceptions, personality traits (negative and positive affectivity) and demographic information. The results indicated that younger participants had a higher level of cardiac misconceptions about heart disease in general and about angina, than older ones. There were also significant differences in cardiac misconceptions about angina according to the level of education. Also, women had higher levels of cardiac misconceptions about heart disease in general, when compared to their male counterparts. Both positive and negative affectivity were independent of the level of cardiac misconceptions, as well as of health behaviours such as smoking and exercise. The results are suggestive of how information about cardiac misconceptions should be addressed across the life-span in order to target population groups where the delivery of correct information is particularly necessary.
Keywords: Health beliefs, cardiovascular disease
CORRESPONDING AUTHOR: Figueiras Maria Joao, Instituto Piaget, Almada; mfigueiras@almada.ipiaget.org
P442
IS HEALTH ANXIETY LINKED TO DISEASE-RELATED DISABILITY IN RHEUMATOID ARTHRITIS (RA)
Goodchild CE.1, Tang NKY.2, Scott D.3, Salkovskis PM.4
1 Kings College London University, Psychology, London, United Kingdom
2 Keele University, Arthritis Research UK Primary Care Centre, Keele, United Kingdom
3 Kings College London University, Rheumatology, London, United Kingdom
4 University of Bath, Psychology, Bath, United Kingdom
Background: The impact of RA on quality of life arises in large part from flares of pain, stiffness and fatigue and the interaction of these physical factors with psychological characteristics. Health anxiety is one such psychological factor that may play an important role in RA given the unpredictable nature of the disease. Health anxiety can be defined as the propensity to negatively interpret ambiguous bodily sensations that is associated with fear or excessive worry about illness.
Health anxiety is yet to be investigated in RA, but recent research conducted with other chronic pain populations has identified health anxiety as a prevalent characteristic that is associated with pain interference, catastrophic thinking and sleep disturbance. The aim of this study was to assess the presence of health anxiety in RA and examine its relationship with a selection of disability-related variables.
Method: Participants were 150 adults (aged 18-65 years) with established RA (diagnosis of >2 years). Participants’ perceptions of health anxiety were assessed using the Short Health Anxiety Inventory (SHAI, Salkovskis, Rime, Warwick, Clark, 2002). Disease-related measures included the Health Assessment Questionnaire (Kirwan & Reeback, 1986), International Physical Activity Questionnaire (IPAQ; Booth, 2000), Insomnia severity Index (ISI; Bastien, Vallières, Morin, 2001), Brief Pain Inventory (Cleeland, 1989), Profile of Fatigue (Bowman, Booth, Platts, 2004) and Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983).
Findings: There were significant positive correlations between health anxiety and all measures of pain, interference, fatigue and distress. Participants were allocated to either the high or low health anxiety group according to their scores on the SHAI. Participants with high health anxiety reported significantly greater pain, interference, physical disability, fatigue, depression, anxiety and sleep disturbance than those with low health anxiety
Discussion: The findings suggest that health anxiety may be involved in the development and maintenance of disability associated with RA. Targeting negative interpretations of symptoms during treatment may potentially alleviate disability and improve quality of life for those struggling to manage RA.
Keywords: chronic illness, cognitive factors, disability
CORRESPONDING AUTHOR: Goodchild Claire, King's College London, London; claire.goodchild@kcl.ac.uk
P444
ACUTE STRESS DISORDER SYMPTOMS, ANXIETY AND EXTENT OF INFORMATION AMONG THE PATIENTS SUFFERING FROM DENGUE FEVER
Kausar R., Zahra A.
University Of The Punjab, Applied Psychology, Lahore, Pakistan
The aim of our research was to examine acute stress disorder symptoms, level of anxiety and extent of information among the patients with dengue fever. It was hypothesized that, (a) acute stress disorder symptoms are likely to be higher in the patients suffering from dengue fever, (b) anxiety is likely to be higher in the patients suffering from dengue fever, and (c) patients suffering from dengue fever are likely to have low extent of information about dengue fever. The sample consisted of 100 dengue fever patients. The sample was selected from Mayo Hospital Lahore and public community through purposive sampling strategy. The age range of patients was 18 years to 60 years (M = 32.12, SD = 10.28). Acute Stress Disorder Scale (ASDS) and Beck Anxiety Inventory (BAI) were used to assess acute stress disorder symptoms and the level of anxiety among patients suffering from dengue fever. A self constructed disease related questionnaire was used asses patient’s extent of information. Within subject research design was used. The data was analyzed using frequency analysis. The results indicated that a significant number of patients were stressed and anxious because of dengue fever. Moreover, the extent of information of the patients was also low. The findings of the present research revealed that dengue fever had strong psychological impact on the patients suffering from this disease.
Keywords: Dengue, Acute Stress Disorder Symptoms, Anxiety, Extent of Information
CORRESPONDING AUTHOR: Kausar Rukhsana, University of the Punjab, Lahore; rukhsana.saddul@gmail.com
P445
PSYCHOLOGICAL IMMUNCOMPETENCE AS COPING, PERSONALITY FACTORS AND DEPRESSION IN PSORIASIS, IBD AND THYROIDISM
Kerekes ZS.1, Kiss E.2, Tiszberger M.3, Bors P.4, Tóth M.1, Mezősi E.5
1 Pecs University, Institute of Behavioral Sciences, Pécs, Hungary
2 Pecs University, Department of Psychiatry and Psychotherapy, Pécs, Hungary
3 Pecs University, Department of Economics, Pécs, Hungary
4 SzigetvarMed, Department of Psychiatry, Szigetvar, Hungary
5 Pecs University, Department of Internal Medicine, Pécs, Hungary
The aim of this pilot study is to find out whether there is any coping strategy, depression level and personality factors of the patients with psoriasis, IBD (includes M. Crohn and colitis ulcerosa) and thyroidism, which can play important role on coping with the chronic diseases. These specific system of coping strategies builds up the psychological immune system, which is a unique combination of individuals’ used coping strategies. Methods: We used the standardized, self-reporting versions of BDI (Beck Depression Inventory), PISI (Psychological Immune System Inventory) and TCI (Temperament and Character Inventory). Patients of the Medical Departments of University of Pécs have taken part in the examination: 37 people were diagnosed with psoriasis, 57 with thyroidism, 36 with IBD and we have data from 29 control persons. Results: There was no significant difference in depression indicators. We found that in use of self-respect; resilience; empathy; creativity are significantly higher (p ≥ 0,05) in the patient groups than in control group. Empathy and resilience is significantly (p ≥ 0,05) higher used as a coping strategy in thyroidism patient group, than in psoriasis patient group. Harm Avoidance and Self-directedness seem to be important factors in personality structure, which correlate (p < 0,01) with psychological immune system, and with BDI scores. Conclusion: More detailed test analysis is necessary to discover better the personality differences in future but considering the results we can improve coping strategies in these three patient groups, which may have a measurable effect on the quality of life.
Keywords: chronic disease, depression, coping, personality
CORRESPONDING AUTHOR: Kerekes Zsuzsanna, University of Pecs, Pecs, zsuzsanna.kerekes@aok.pte.hu
P446
A LONGITUDINAL STUDY OF HEALTH-RELATED QUALITY OF LIFE, FATIGUE AND PHYSICAL ACTIVITY IN CHRONIC KIDNEY DISEASE PATIENTS
Caltabiano M.1, Bonner A.2
1 James Cook University, Department of Psychology, Cairns, Australia
2 Queensland University of Technology, Department of Nursing Sciences, Brisbane, Australia
This study assessed the health-related quality of life (HRQoL), fatigue and physical activity levels of 28 persons with chronic kidney disease (CKD) on initial administration of an erythropoietin stimulating agent to increase haemoglobin levels, and at 3 months, 6 months and 12 months. The sample comprised of 15 females and 13 males whose ages ranged from 31 to 84 years. Physical activity was measured using the Human Activity Profile (HAP): Self-care, Personal/Household work, Entertainment/Social, Independent exercise. Quality of life was measured using the SF-36 which gives scores on physical health (physical functioning, role-physical, bodily pain and general health) and mental health (vitality, social functioning, role-emotional and emotional well-being). Fatigue was measured by the Fatigue Severity Scale (FSS). Across all time points the renal sample engaged in considerably less HAP personal/household work activities and entertainment/social activities compared to healthy adults. The normative sample engaged in three times more independent/exercise activities compared to renal patients. One-way Repeated measures ANOVAs indicated a significant improvement over time for SF-36 scales of role physical, vitality, emotional well-being and overall mental health. There was a significant difference in fatigue levels over time [F(3,11) = 3.78, p < .05]. Fatigue was highest at baseline and lowest at 6 months. The more breathlessness the CKD patient reported, the fewer activities undertaken, and the greater fatigue. There were no significant age differences over time for fatigue or physical activity. Age differences were only found for SF-36 mental health at 3 months (t = -2.41, df = 14, p < .05). Those younger than 65 years had lower emotional well-being compared to those aged over 65. Males had poorer physical health compared to females at 12 months. There were no significant gender differences on mental health at any time point. In the management of chronic kidney disease, early detection is necessary of a person’s inability to engage in routine activities due to fatigue. Early detection would enable timely behavioural and problem-solving interdisciplinary care interventions to optimise HRQoL and independent exercise.
Keywords: Renal/urologic disorders, Quality of life, physical activity
CORRESPONDING AUTHOR: Caltabiano Marie, James Cook University, Cairns; marie.caltabiano@jcu.edu.au
P447
POST-TRANSPLANTATION ANXIETY AND MENTAL REPRESENTATIONS OF THE NEW ORGAN ARE CORRELATED WITH CREATININE AND UREA LEVELS AFTER KIDNEY TRANSPLANTATION
Látos M.1, Barabás K.1, Lázár GY.2, Szederkényi E.2, Szenohradszky P.2, Marofka F.2, Csabai M.3
1 University of Szeged, Department of Behavioural Sciences, Szeged, Hungary
2 University of Szeged, Surgery, Szeged, Hungary
3 University of Szeged, Institute of Psychology, Szeged, Hungary
Transplant patients’ representations of their illness, body, and their emotional state significantly influences their recovery. In this study our primary aim was to examine the possible connections between post-transplant patients’ emotional and mood factors, illness and body representations, and kidney functions.
We tested patients with a combination of five instruments: 1. laboratory measurement of creatinine and urea levels, on the 5th and 10th days after transplantation as part of our routine clinical blood tests; 2. Spielberger’s State and Trait Anxiety Scale (STAIS; STAIT); 3. Beck’s Depression Scale; 4. a projective test comprised of a drawing task of the patient’s figure and the new organ; and 5. a questionnaire designed in-house.
Data was collected over a two-year period from December 2009 to December 2011. The study involved kidney transplant patients from the Surgery Clinic at the University of Szeged (Hungary), which included a psychologist as a member of the renal team. The study sample comprised 63 patients.
Analysis of our results revealed that patients with higher anxiety levels drew the kidney significantly larger in their projective drawing tests. Their 10th day creatinine and urea levels were also significantly higher. This leads us to consider that the organ’s normal intrapsychic integration and kidney functions are interrelated. If the graft is not integrated mentally in the body image, the representations of the ’foreign body’ can be associated with such psycho-neuro-immunological processes of anxiety, which eventually may lead to adverse physiological effects on kidney function.
With our in-house questionnaire we examined the patients’ attitudes and views about their disease and health in general. Patients with a higher anxiety felt that their successful recovery was firstly dependant on all of the medical personnel, and their own contribution was rather underestimated. This was in line with the general rule, that hospitalized patients, especially in serious conditions, assign more control to the hospital staff.
These result may serve as a basis for the development of complex treatment interventions which could help patients cope with the bio-psycho-social challenges of integrating new organs as part of their body and self.
Keywords: Organ transplant, Anxiety, Depression, Health beliefs
CORRESPONDING AUTHOR: Látos Melinda, University of Szeged, Szeged; latosmeli@gmail.com
P448
ETHICAL CONSIDERATIONS IN CONNECTION WITH COGNITIVE THERAPIES
Lőrincz J.
Semmelweis University, Behavioural Science Institute, Budapest, Hungary
The health and illness behaviours of individuals, their interpretation of other people's actions are shaped by ethical values as well.
An ethical theory must comply with an acceptable psychological (therapeutical) conception. Our starting-point is Hume's well-known thesis that morality is essentially practical. Moral motivation is internal to moral duty.
In a wider sense the aim of the cognitive therapy is to change non-effective thinking, specifically the deformed cognitive patterns of patients.
I would like to compare the approaches of the following scientists: the cognitive psychotherapy approach of R. Brandt (A Therapy of the Good and the Right, 1979) and A.T. Beck (Cognitive Therapy and the Emotional Disorders, 1976), and the contemporary theories of motivational internalism of B. Williams (Ethics and the Limits of Philosophy, 1985) and J. Searle (Rationality in Action, 2001). Since the cognitive psychotherapy of R. Brandt is not so well-known, I take his ideas as starting point and focus on the assessment and adjustment process of attitudes including desires, aversions, or pleasures, thereafter I compare it with the works of the above mentioned scientists
Keywords: Health behaviour, cognitive factors, motivation, ethical issues
CORRESPONDING AUTHOR: Lőrincz Jenő, Semmelweis University; lorjen@net.sote.hu
P449
EVALUATION OF THE LESIONS IN LEFT THALAMUS IN PATIENTS WITH SUBCORTICAL VASCULAR CONGNITIVE IMPAIRMENT USING 1H MAGNETIC RESONANCE SPECTROSCOPY AND DIFFUSION TENSOR IMAGING TECHNIQUE
Lv -., Dong -., Li -.
Hebei General Hospital, Neurology, Shijiazhuang, Hebei, China
Objective: To investigate the lesions of left thalamus and the correlation with executive function in patients with subcortical ischemic vascular disease (SIVD) by using 1H magnetic resonance spectroscopy (1H-MRS) and diffusion tensor imaging (DTI).
Methods: 14 patients with vascular dementia (VaD), 14 patients with vascularcognitive impairment no dementia (VCIND), and 14 normal controls (NC) were recruited. The quantitative analysis of N-acetylaspartate (NAA), myoinositol (mI), Choline (Cho) and Creatine (Cr) resonance signals in region of interests (ROI) located in the left thalamus were measured. Fractional anisotropy (FA) and mean diffusivity (MD) values in the same region were observed by DTI. The relationship were described among the MRS, DTI ratios and cognitive impairment reflected in MMSE and trail making test (TMT).
Results: The NAA/Cr ratio showed a gradual decrease in the left thalamus of SIVD patients compared with controls (F = 3.656, P = 0.038). No significant difference was found between VaD and VCIND patients. Compared with controls, patients with VaDand VCIND demonstrated increased MD value in the left thalamus (F = 3.882, P = 0.030). No significant difference between VaD and VCIND patients was observed (P>0.05). No correlation was found between NAA/Cr, mI/Cr, Cho/Cr value and DTI parameters in the ROI (P>0.05. A significant positive correlation was observed between TMTb time and Cho/Cr (r = 0.520, P = 0.001) and also MD value in the left thalamus(r = 0.305, P = 0.044).
Conclusions: The axonal loss or dysfunction and diffusion abnormalities in left thalamus could be found in early SIVD. Combining 1H-MRS with DTI could provide the valuable information about potential lesions of thalamus in patients with SIVD. The Cho/Cr and MD values in the left thalamus value might be correlated with executive function.
Keywords: Aging; Clinical applications; Cognitive factors; FMRI; Illness behavior
CORRESPONDING AUTHOR: Dong Yanhong, Hebei General Hospital,China, d_yanhongniu@163.com
P450
RELATION BETWEEN DISTURBED SLEEP WITH NOCTURNAL ITCH AND QUALITY OF LIFE IN PATIENTS WITH ATOPIC DERMATITIS
Miyamori M.1, Ando T.1, Hagiwara S.2, Sakano Y.1
1 Health Sciences University of Hokkaido, School of Psychological Science, Sapporo, Japan
2 Yamahana Dermatology Clinic , -, Sapporo, Japan
Introduction: Atopic Dermatitis (AD) is a chronic, pruritic and inflammatory skin disease. Sleep disturbance secondary to AD affects decreased patients’ quality of life (QOL), increased anxious (Linnet et al., 1999) and depressive symptoms (Shirata et al., 1995). In particular, nocturnal itch-scratching and disturbed sleep is frequently reported by AD patients (Chrostowska-Plak et al., 2009). Like chronic physical disorders, AD symptoms may be at increased risk of sleep disturbance via their increased risk of psychological distress and clinical disorders such as anxiety and depression (Thorburn et al., 2010). Therefore, it’s possible that AD patients’ higher anxiety and depression may be confounding factors the relation between sleep disturbances and lower QOL. The aim of this study was to explore direct associations between disturbed sleep affected nocturnal itch and QOL controlling confounders such as anxiety and depression.
Methods: Twenty-seven adult AD patients (10 female, 17 male; mean age, 29.5 ± 9.6 years), all patients had mild to severe AD, obtained informed consent and completed following the questionnaires: 1) the Japanese version of the Insomnia Severity Index (ISI-J), 2) Dermatology Life Quality Index (DLQI), 3) Hospital Anxiety and Depression Scale (HADS) and 4) Itch Rating Scale (daytime & nighttime).
Results: The means of ISI-J scores is 9.1 ± 6.1 (ISI-J cut-off score = 10), 8 participants were over cut-off score (30%). ISI-J correlated with DLQI and nocturnal itch (r = -.70, p < .00; r = .76, p < .00), after controlled variances of anxiety and depression (partial r = -.52, p < .01; partial r = .74, p < .00), but not correlated with daytime itch (partial r = -.09).
Conclusions: Results from this study demonstrate that disturbed sleep and nocturnal itch is associated with decreased QOL under control the effect of anxiety and depression. Therefore, an improving the satisfaction of sleep with reducing nocturnal itch may have beneficial effects on improved QOL. In addition, ISI-J can provide an important outcome measure reflecting disease severity and psychological health. It is necessary to assess the severity of nocturnal itch and sleep disturbance in the conduct of treatment with medications as well as psychological interventions.
Keywords: Abnormal sleep, Chronic Disease, Quality of life
CORRESPONDING AUTHOR: Michiko Miyamori, HSUH, Japan, mmiyamori@hoku-iryo-u.ac.jp
P451
INDIVIDUAL DIFFERENCES IN EMOTIONAL REGULATION PROCESSES AND THEIR RELATION TO WELL-BEING, AFFECT, PERCEIVED HEALTH AND RESILIENCE
Montorio I.1, Izal M.2, Cabrera I.1, Silvia S.1
1 Universidad Autonoma de Madrid, Psicologia Biologica y de la Salud, Madrid, Spain
2 Universidad Autonoma de Madrid, Psicologia Biologica y de la Salud, Madison, Spain
Background: Theory indicates that affect, resilience and perceived health is related to well-being. In addition, emotion regulation is essential in everyday life to maintain optimal level of well-being. However, few studies have provided empirical evidence to identify strategies of emotional regulation related to well-being, as well as it is unknown its interaction with affect, resilience and perceived health.
Objective: Incremental validity of emotional regulation strategies over Resilience, Positive Affect and Perceived Health was examined on well-being as criterium.
Method: 188 young adults participated in the study (age = 22; SD = 2.5; 74% of females). Life Satisfaction was used as an indicator of well-being. The sample was split up based on the life satisfaction median scores measured by SWLS (Pavot & Diener, 1993). Emotional Regulation was assessed with Emotional Processing Scale, affect with SPANE Scale, Resilience with Connor-Davidson Scale and Perceived Health through an ad-hoc measure.
Results: Lower life satisfaction participants showed higher levels of Suppression (t(185) = 5.2, p = .0), Unprocessed Emotions (t(185) = 2.7, p = .007), Unregulated Emotion (t(185) = 3.5, p = .0), and total Emotional Processing Scale scores (t(185) = 4.1, p < .001). A hierarchical regression analysis indicated that Suppression (p < .001), and Avoidance (p = .0) explained a significant percentage of variance in predicting life satisfaction after controlling for Resilience, Positive Affect and Perceived Health (total adjusted R2 = .51).
Conclusions: Results supported the hypotheses that emotional regulation was an independent and significant predictor of emotional well-being. In addition, when positive emotional regulation strategies are combined with an adequate capacity of resilience and positive affect, all this contributes to maintain life satisfaction.
Keywords: resilience, emotion
CORRESPONDING AUTHOR: Montorio Ignacio, Facultad de Psicologia; pappvid@congressline.hu
P452
PERCEPTION OF ILLNESS OF PEOPLE WITH CHRONIC DISEASE
Nogueira G.S., Seidl EMF.
University of Brasilia, Institute of Psychology, Brasilia, Brazil
Worldwide researchers have developed investigations that indicate the relevance of illness perception as a construct of utmost importance to all health professionals, based on Leventhal's self-regulation model. In Brazil, studies on illness perception are scarce. Thus, the objective of this study was to investigate illness perceptions of people with chronic diseases. A cross-sectional descriptive study was conducted with quantitative and qualitative techniques. The study included 324 patients of a university hospital diagnosed with HIV/AIDS (n = 65), diabetes (n = 65), hypertension (n = 65), psoriasis (n = 65) and asthma (n = 64). The instruments were: sociodemographic and medical questionnaires; and a Brazilian version of the Brief Illness Perception Questionnaire (Brief IPQ). The Brief IPQ consists of nine items that assess cognitive and emotional representations of illness. One of these items investigates the attribution of causes of disease. The higher the total score (maximum score 80), the greater perception of threat of illness. The results revealed that 59.9% (n = 194) of participants were women, aged between 18 and 85 (mean = 49.5, SD = 13.9). There was a trend toward more focused perception of illness threat in people with diabetes (mean = 43, SD = 11.5), psoriasis (mean = 42.9, SD = 11.97) and asthma (mean = 42.2, SD = 11.24). The most frequent causal attributions obtained by categorizing responses of the open ended question of the Brief IPQ were: sexual risk behavior for HIV/aids, eating habits/excessive sugar amongst people with diabetes, emotional causes within those with hypertension and psoriasis, and contact with mold/mite/dust with patients diagnosed with asthma. The majority of participants presented causal attributions that are consistent with widespread scientific knowledge regarding the etiology of the investigated diseases, but dysfunctional beliefs in relation to causes of such diseases were observed. Results suggest the need for psychological interventions, particularly cognitive-behavioral and psychoeducational, in order to promote a more realistic illness perception and help in adjusting to a chronic condition.
Keywords: chronic disease, cognitive factors
CORRESPONDING AUTHOR: Seidl Eliane, University of Brasilia, Brasilia, eliane.seidl@gmail.com
P453
MODERN HEALTH WORRIES IN VARIOUS FORMS OF ENVIRONMENTAL HYPERSENSITIVITY: THE VÄSTERBOTTEN ENVIRONMENTAL HEALTH STUDY
Nordin S., Palmquist E., Claeson A-S.
Umeå University, Department of Psychology, Umeå, Sweden
Concern about environmental and technological changes is common, resulting in worries about personal health (so-called modern health worries, MHW) due to, for example, air pollution, mobile phones and genetically modified food. Worries in general about personal health are known to contribute to poor health, and MHW is particularly strong in certain unexplained syndromes, such as chronic fatigue syndrome. To date there is limited documentation of the genesis of common forms of environmental hypersensitivity to: odorants and irritants (multiple chemical sensitivity), visits in certain buildings (nonspecific building-related symptoms), electromagnetic fields, and sounds. It is well documented that certain aspects of negative affect (e.g., anxiety and depression) are high in environmental hypersensitivity, but the scientific literature has little to say about health worry. The objective of the study was to investigate MHW in the four types of hypersensitivity. The study was conducted within the population-based Västerbotten Environmental Health Study in Sweden. A random sample, stratified for age and gender, of 8520 individuals aged 18 to 79 years, drawn from the municipal register, were invited to participate. Of these, 3406 (40.0%) participated. Of the participants, 259 reported being intolerant to odorants/irritants, 50 to certain buildings, 45 to electromagnetic fields, 223 to sounds, and 2371 were referents without these hypersensitivities. The MHW Scale was used, which consists of 25 items pertaining to the subscales environmental pollution, toxic interventions, radiation, and tainted food. Each item is to be rated regarding degree of worry about its impact on personal health. The results showed that all four hypersensitive groups, compared to the referents, had significantly higher scores on all four subscales of the MHW Scale. The results suggest that health worry is directed not only towards aspects of the own hypersensitivity, but also towards other environmental exposures and technological innovations. This evokes the question whether general health worries for these aspects may contribute to the development of multiple environmental hypersensitivites.
Keywords: Environment, Health, Public health, Risk perception
CORRESPONDING AUTHOR: Nordin Steven, Umea University; steven.nordin@psy.umu.se
P454
COMORBIDITY OF VARIOUS FORMS OF ENVIRONMENTAL INTOLERANCE
Palmquist E.1, Claeson A-S.1, Neely G.1, Stenberg B.2, Nordin S.1
1 Umeå University, Department of Psychology, Umeå, Sweden
2 Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden
During the last decades environmental intolerances (EIs) have puzzled psychologists and physicians. EIs are characterized by persons attributing several, multisystem symptoms to specific environmental exposures such as exposure to odorous/pungent chemicals, everyday sounds, electromagnetic fields (EMFs) or certain buildings. The symptoms are medically unexplained, non-specific and the symptom overlap between different types of EI is extensive, even though some symptoms are more common to certain types. Questions have been raised as to whether different EIs should be considered as having separate underlying mechanisms, which most studies previously have done, or if they are variations of the same condition. If the latter is true, the overlap between different types of EI should be larger than by chance. Whereas prevalence studies for the different types of EI are common, co-prevalence studies measuring the overlap between the conditions are rare. The aim of the study was to examine if the overlap between intolerance to odorous/pungent chemicals, certain buildings, EMFs and sounds is larger than the expected overlap if no association existed between them. The study was part of the Västerbotten Environmental Health Study in Sweden; a large questionnaire-based cross-sectional survey. 8520 adults (18-79 years) were randomly selected after stratification for age and sex, of whom 3406 (40%) participated. Individuals with intolerance to chemicals, certain buildings, EMFs and sounds were identified either through self-report, or by reporting to have been physician-diagnosed with a specific EI. The overlaps between self-reported and diagnosed intolerance to odorous/pungent chemicals, certain buildings, EMFs and sounds were greater than predictions based on coincidence. The overlap between EIs in the subpopulations consisting of self-reported or physician-diagnosed cases of the four types of EI were extensively larger than in the study population. Further, when participants reporting two or more EIs were eliminated the prevalence of each EI was markedly lowered. The results raise the question if different types of EI share similar underlying mechanisms, or at least that the sufferers of EI share some predisposition to acquire the conditions.
Keywords: Co-morbidities, Environment, Illness behavior
CORRESPONDING AUTHOR: Palmquist Eva, Umeå University, Umeå; eva.palmquist@psy.umu.se
P455
THE RELATIONSHIPS BETWEEN PSYCHOSOCIAL VARIABLES AND DISEASE MANAGEMENT SELFREPORTS AMONG PEOPLE WITH TYPE 2 DIABETES.
Pisanti R.1, Violani C.1, Morano S.2, Lucidi F. 3, Costanzi D.1, Nuzzi A.1, Carnovale A.2
1 Sapienza University of Roma, Department of Psychology, Roma, Italy
2 Sapienza University of Roma, Department of Endocrinology and Metabolism, Roma, Italy
3 Sapienza University of Roma, Department of Development and Socialization Processes Psychology, Roma, Italy
Background: For chronic illness such as diabetes, patients’ perceptions of their condition and its management are important factors associated in determining successful adjustment and self care of the condition.
Purpose: This study investigates the relationships among psychosocial variables relevant in the Health Belief Model and in the Social Cognitive Theory, and diabetes self management variables (e.g., general diet, specific diet, exercise, blood-glucose testing, foot care).
Method: Cross-sectional design involving adults diagnosed with Type 2 diabetes (N = 150). Health beliefs, self efficacy, outcome expectancies, and diabetes self-management were assessed through interviews. Metabolic control (HbA1c) and clinical data were obtained through a review of medical records
Results: Stepwise regression analyses indicated that perceptions of diabetes interference in daily life and disease severity explain approximately 7% (Beta = .27) of differences in metabolic/ glycaemic control. Self-efficacy expectancies for behaviours specifically linked to diabetes self-care activities are associated with adherence to diet regimen (6%; Beta = .26). Outcome expectancies about the effects of diabetes self-care and glycaemic monitoring on the prevention of complications were positively associated with foot care (9%; Beta = .30).
Conclusion: Psychological variables make an important and statistically significant contribution to the explanation of differences in self management and in clinical outcomes. Potentially, modification of personal views about diabetes could help to promote positive health outcomes for people with type 2 diabetes. This study highlights specific illness perceptions that could be targeted in future interventions.
Keywords: Diabetes, Health beliefs, self-efficacy, Outcome expectations; self disease management
CORRESPONDING AUTHOR: Pisanti Renato, "Sapienza", University of Rome, renato.pisanti@uniroma1.it
P456
THE CLINICAL PSYCHOPHYSIOLOGY AS AN INTEGRATION OF THE DIAGNOSIS AND OF THE TREATMENT EVALUATION IN EATING DISORDERS
Pruneti C A., Cosentino C., Sgromo D., Agostinelli F., Fante C., Innocenti A.
University of Parma, Italy, Division of Clinical Psychology, Parma, Italy
Objective: To assess the effectiveness of integrated therapy in a group of patients with Eating Disorders (EDs), focusing on the variations achieved by the sample, divided into two diagnostic subgroups AN (Anorexia Nervosa) and BN (Bulimia Nervosa), including the psychophysiological assessment of some parameters, among others, the skin conductance level (SCL) .
Results: Elevated levels of anxiety, depression, somatic symptoms, and hostility at the first assessment were observed in the whole sample of EDs. A significant reduction in patient-reported depressive symptoms was detected within six months following the onset of a cognitive – behavioral and pharmacological treatment. A slight improvement of anxiety and hostility was observed in the medium-long term. At the physiological level, a significant difference in the values of the SCL in baseline was noticed, that is the AN subgroup achieved values definitely lower than the BN subgroup. A significant increase in the same parameter was obtained in the subgroup with AN in the long term evaluation, with a normalization of the values with the BN subgroup.
Discussion: A partial desynchronization emerged between patients’ physiological and cognitive responses to treatment, and a significant psychophysiological difference emerged between the two subgroups. Improvement observed at the physiological level might be understood in light of new prospective theories that investigate the psychopathological characteristics associated with a given diagnostic category. Some experimental research demonstrates a tendency for females suffering from EDs to “exhibit” intense emotional reactions on the behavioral and verbal levels, despite experiencing little physiological activation. Thus, the greater physiological reactivity found in this study after the therapeutic intervention may be interpreted as reflecting the [WINDOWS-1252?] patients’ learning of new cognitive strategies for processing and managing their emotional experiences.
Conclusion: The psychophysiological assessment can certainly be could represent a useful methodology for a proper differential diagnosis and for the treatment evaluation in a prospective of integrated therapy.
Keywords: Eating Behaviors, Assessment, Psychophysiology, Treatment
CORRESPONDING AUTHOR: Pruneti Carlo A., University of Parma, Parma, carlo.pruneti@unipr.it
P457
DRAWINGS REFLECT A NEW DIMENSION OF THE PSYCHOLOGICAL IMPACT OF LONG-TERM REMISSION OF CUSHING’S SYNDROME
Tiemensma J.1, Daskalakis NP.1, Van der Veen E.1, Ramondt S.1, Richardson SK.1, Broadbent E.2, Romijn JA .1, Pereira AM.1, Biermasz NR.1, Kaptein AA.3
1 Leiden University Medical Center, Department of Endocrinology and Metabolism, Leiden, The Netherlands
2 University of Auckland, Psychological Medicine, Auckland, New Zealand
3 Leiden University Medical Center, Department of Medical Psychology, Leiden, The Netherlands
Context and objective: Drawings can be used to assess perceptions of patients about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions, quality of life (QoL), and clinical disease severity in patients after long-term remission of Cushing’s syndrome.
Design: Cross sectional study.
Subjects: We included 47 patients with long-term remission of Cushing’s syndrome. Patients completed the drawing test, the Illness Perception Questionnaire-Revised, the Short-Form 36, the EuroQoL-5D, and the Cushing QoL. The Cushing’s syndrome severity index (CSI) was used based on medical records.
Results: Drawings were strongly associated with the CSI and severity ratings of health professionals (all P < 0.02). In addition, patients perceived a dramatic change in body size during the active state of the disease compared to the healthy state before disease. Patients reported that their body did not completely return to the original size (i.e. before disease) after treatment. There were no clear associations between the drawings and QoL or illness perceptions. This indicates that drawings and QoL or illness perceptions do not share multiple common properties and measure different aspects/dimensions of the disease process.
Conclusion: Drawings are an interesting, low-cost, effective and relatively easy way to assess patients’ perceptions and reflect a new dimension of the psychological impact of long-term remission of Cushing’s syndrome. Drawings do not share common properties with parameters of QoL or illness perceptions, but do represent the clinical severity of the disease. The assessment of drawings may enable doctors to appreciate the perceptions of patients with long-term remission of Cushing’s syndrome, and will lead the way in dispelling erroneous beliefs.
Keywords: Chronic disease, quality of life, Beliefs
CORRESPONDING AUTHOR: Tiemensma Jitske, Leiden University Medical Center; jitsketiemensma@gmail.com
P458
PERCEIVED HEALTH-RELATED QUALITY OF LIFE IN WOMEN WITH XEROSTOMIA DUE TO SJÖGREN’S SYNDROME
Rojas-Alcayaga G.1, Herrera A.1, Espinoza I.2
1 Universidad de Chile, Behavioral science, Santiago, Chile
2 Universidad de Chile, Department of Oral Pathology, Santiago, Chile
Individuals with Sjögren’s Syndrome commonly suffer from xerostomia, the sensation of dry mouth. Nevertheless, little is known regarding the effects of the illness on the individual's experience of daily life. This article assessed the quality of life experienced by twelve women with xerostomia due to SS, who regularly attended the University of Chile’s Hospital Clinic. The data were analyzed using qualitative methods that adopted the principles of grounded theory. Three categories emerged from open and axial coding related to the individual's experience of the illness, psychological response and social interaction. Selective coding identified the core category as perceived self-limitation, which was based on the objective symptoms caused by xerostomia and characterization of the disease as incurable, progressive and rare. The perception of self-limitation was intensified when there was difficulty expressing the grief inherent in the diagnosis of SS. Further, the social environment contributed to the restructuring of identity insofar as it allowed the individual to maintain the self-concept of efficacy despite the limitations due to the disease.
We conclude that the quality of life of women suffering from hyposalivation due to SS depended on the extent to which individuals reconstructing their identity could maintain a feeling of efficacy despite the limitations produced by the illness.
Keywords: Chronic Disease, Quality of life, Health beliefs
CORRESPONDING AUTHOR: Rojas-Alcayaga Gonzalo, University of Chile. Santiago.; grojasalcayaga@yahoo.es
P459
MODELING PREDICTORS OF HEALTH RELATED QUALITY OF LIFE AFTER ACUTE CORONARY EVENTS – A FOLLOW-UP INVESTIGATION OF PATIENTS TREATED IN RESIDENTIAL CARDIAC REHABILITATION
Tiringer I.1, Simon A.2, Veress G.2, Kallai J.1
1 Pecs Universit y, Institute of Behavioral Sciences, Pécs, Hungary
2 State Cardiology Hospital, Residential Cardiac Rehabilitation, Balatonfured, Hungary
Background: Despite the popularity of the concept of health related quality of life (HRQL) relatively little is known about the pattern of associations between psychosocial characteristics (e. g. coping modes, control attitudes toward illness, perceived self-efficacy, social support, anxiety and depression symptoms), health status and HRQL parameters in patients after acute coronary events.
Aim: The main goal of this study was to develop common path models of quality of life at the time of baseline and of 15 month follow-up, and to test the fit of this models to the data from patients after acute myocardial infarction (AMI) and after coronary artery bypass graft surgery (CABG).
Patients and methods: Biomedical and psychosocial predictors of quality of life in patients after AMI (n = 276) and after CABG (n = 314) were investigated. 89% of patients sent back their 15 months’ follow-up questionnaires. Patients filled out the following questionnaires: SF-36, Hospital Anxiety and Depression Scale, Freiburg Q. of Coping with Illness, Control Beliefs about Illness and Health, General Self-efficacy. We also considered as predictors 6 minute walk distance (6MWD), left ventricular ejections fraction (LVEF), the number of comorbid diseases, hospitalization during follow-up period, age and sex. Starting from the Health Related Quality of Life model of Wilson and Cleary path models were developed separately from the baseline and the follow-up AMI and ACBG data by removing nonsignificant paths from models. Common models of AMI and of CABG conditions were developed separately for baseline and for follow-up quality of life. In the models the following parameters were considered as indicators: 6MWD and LVEF on the biological level, fatigue (2 reliable items of the SF-36 Vitality subscale) on the level of symptoms, SF-36 Physical Function subscale on the level of functional status and SF-36 General Health subscale on the level of health perception.
Results (all reported values are βs): The effects of internal control attitudes (0.12 (AMI) vs. 0.13 (CABG)) on perceived physical function, of depressive coping ( –0.15 (AMI) vs. –0.13 (CABG)) on perceived physical health were higher at the time of residential rehabilitation than 15 months later (|0.1|<). Depressive symptoms had a stable negative effect on the symptom status (fatigue) and on the perceived physical health especially at the time of follow up ( from 0.14 to 0.42). Anxiety symptoms influenced especially fatigue at baseline (0.20 (AMI) vs. 0.26 (CABG)). The tested final models showed very good fit to the data of AMI and of ACBG patients (X2/df < 1.3; CFIs > 0.995; RMSEAs < 0.035).
Conclusions: Psychological mediating factors of quality of life, especially depressive symptoms, should be taken into consideration in the rehabilitation process of patients after acute coronary events.
Keywords: Coronary heart disease; Coping; Quality of life
CORRESPONDING AUTHOR: Tiringer Istvan, Pecs University, Pecs, istvan.tiringer@aok.pte.hu
P460
THE INFLUENCE OF PSYCHOLOGICAL INTERVENTION ON THE STRESS RESPONSE LEVEL OF PATIENTS WITH BRONCHIAL ASTHMA
Wang YK.1, Xu WY.2, Su YP.2, Liu X.2
1 Hebei Normal University of Science & Technology, Department of Physical Education, Qinhuangdao, China
2 The First Hospital of Qinhuangdao, Department of Rehabilitation, Qinhuangdao, China
Objective: To discuss the influence of psychological intervention on the emotion, coping style and physiological response of patients with bronchial asthma.
Methods: Sixty patients with bronchial asthma are randomly divided into two groups: non-intervention group and intervention group; patients of the former are given routine treatment and patients of the latter are given psychological intervention together with routine treatment, which includes the explanation of asthma-related knowledge, gradual relaxation training and individual psychological guidance. Both of the two groups are measured according to emotion and coping style scale on the second day and the twenty-eighth day of the treatment. The contents of the measurements include: making psychological measurements by applying self-rating depression scale (SDS), self -rating anxiety scale (SAS), trait coping styles questionnaire (TCSQ) and observing psychological response; measuring skin electrical resistance level by using digital skin resistance meter and observing the active degree change of sympathetic nerve; measuring the cortisol level in the saliva by adopting radioimmunoassay. Another thirty healthy persons are chosen as the control group and the above-mentioned measurements are made.
Results: (1) Before the intervention, the differences of psychological and physiological indexes of patients with bronchial asthma of the two groups have no statistical significance (P > 0.05),but the differences between these two groups and the control group both have statistical significance (P < 0.05); (2) the differences of psychological and physiological indexes of patients with bronchial asthma of the intervention groups between after intervention and before intervention and the differences between intervention group and non-intervention groups at the corresponding time point have statistical significance (P < 0.05); (3) the differences of psychological and physiological indexes of patients with bronchial asthma of the non-intervention groups between after the invention and before the invention have no statistical significance (P > 0.05).
Conclusion: Implementing psychological intervention together with routine treatment can effectively reduce the stress response level of patients with bronchial asthma.
Keywords: Asthma; Psychotherapy
CORRESPONDING AUTHOR: Wang Yukuo, Hb Normal University of S & T, yukuowang@163.com
P461
EATING SELF-EFFICACY: DEVELOPMENT OF A SHORT-FORM WEL
Ames G.1, Heckman M.2, Clark M.3, Grothe K.3
1 Mayo Clinic, Psychology, Jacksonville, USA
2 Mayo Clinic, Biostatistics, Jacksonville, USA
3 Mayo Clinic, Psychology, Rochester, USA
Given the high recidivism rates following behavioral treatment of obesity, it is important to identify effective strategies to improve long-term outcomes. One potential strategy is to enhance eating self-efficacy. Self-efficacy for eating, or confidence in one’s ability to control eating in challenging situations, is an important predictor of the successful adoption and maintenance of weight management behaviors. The Weight Efficacy Lifestyle Questionnaire (WEL) is a commonly used measure of eating self-efficacy. The measure consists of 20 items and five situational factors including Negative Emotions, Availability, Social Pressure, Physical Discomfort, and Positive Activities. The primary aim of this study was to develop a short-form WEL (WEL-SF) that captures the important clinical information gathered by the long-form but reduces patient response burden. A secondary aim was to reexamine the factor structure in light of a previous investigation that failed to replicate the five-factor structure originally proposed in the WEL. Factor analysis methodology was used with a sample of obese patients (N = 1012) seeking weight loss treatment. The hypothesis was that the WEL would contain highly correlated items within the factors, and consequently could be shortened with minimal loss of clinically important information. A principal component factor analysis using an orthogonal varimax rotation resulted in a one-factor solution that explained 49% of the variance. Adding each individual factor up to five total factors explained only an additional 2% to 4% of the variance. Given the unexpected finding of a one-factor solution, factor analysis for the selection of the WEL-SF items was abandoned and alternative selection criteria were implemented. Items were selected based on the following five criteria: (1) lack of a ceiling effect for individual items, (2) high variability in patient responses, (3) lack of a strong correlation with other WEL items, (4) strong correlation with total WEL score, and (5) clinical judgment regarding importance and interpretability of individual items. Utilization of these criteria resulted in an 8-item measure. The correlation between the WEL-SF total score and WEL total score was extremely strong, with a Pearson’s r value of 0.968 and corresponding r 2 value of 0.937. The 8-item WEL-SF appears to be a psychometrically valid measure of eating self-efficacy that accounts for 94% of the variability in the 20-item version. Moreover, the short-form may enhance the practicality of measuring eating self-efficacy and reduce the response burden for obese patients in clinical and research settings.
Keywords: Self-efficacy, weight loss, eating behaviors, obesity
CORRESPONDING AUTHOR: Ames Gretchen, Mayo Clinic, Jacksonville, ames.gretchen@mayo.edu
P462
TEACHING COGNITIVE EMPATHY TO PHYSICIANS
Anderson D.1, Dow W.2, Leong S.3
1 Virginia Commonwealth University, School of Medicine, Richmond, United States
2 Virginia Commonwealth University, Department of Medicine, Richmond, United States
3 Virginia Commonwealth University, Department of Theatre, Richmond, United States
Background: Despite the importance of the doctor-patient relationship, physicians continue to struggle with developing rapport with patients. Part of this struggles stems from the difficulty medical educators have teaching and assessing skills in empathy. One framework for consideration of empathy is cognitive or role-taking empathy, where discrete actions contribute to or subtract from rapport. This framework is particularly useful in the educational environment because these actions can be targets for skill development in curricula.
We devised a series of studies in which professors of theatre taught empathy skills to physicians. As part of this work we conduced a phenomenological study into patient perceptions of “good” and “bad” doctors to define the domains most associated with “caring” behavior in one clinic.
Methods: Qualitative design with 20 patients interviewed and asked to relate specific encounters with “good” and “bad” doctors. Results were transcribed verbatim and subjected to a version of phenomenological analysis.
Findings: Then data revealed 5 themes and 5 sub-themes patients use to distinguish good doctors from bad ones:
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Physician Presence
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Emotional Presence
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Physical Presence
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Vocal Presence
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Awareness of Patient
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Knows /Understands
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Values / Includes
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Perceived Time
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Positive Medical Outcomes
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Consequences
Discussion: Empathy must be viewed as an important determinant of outcomes. Our approach suggests a way to define specific, observable actions of cognitive or role-taking empathy as a crucial first step in designing effective healthcare communication curricula and training interventions.
Keywords: Emotions, Mindfulness
CORRESPONDING AUTHOR: Anderson Aaron, Virginia Commonwealth University, adanderson@vcu.edu
P463
DEVELOPMENT AND VALIDATION OF WORKING WOMEN'S STRESSOR'S SCALE (WWSS)
Asad S., Najam N.
University Of The Punjab, Pakistan, Applied Psychology, Lahore, Pakistan
The global transition and upcoming economic challenges have compelled more women to join work force in the traditional society like Pakistan. They are struggling to maintain the balance between the paid work and home responsibilities. Consequently, there is increasing stress of significant proportion on Pakistani working women, and this is alarming. Therefore, it became necessary to assess the stress of the women. The present research aimed to identify the stressors of working women and to develop an indigenous tool to measure Pakistani working women's stressors. In this study the multidimensional Working Women's Stressors Scale (WWSS) was developed and validated. The study was based on both qualitative and quantitative research. It was carried out in three phases. Phase one was carried out in two steps: identification of women's stressors through focus group discussions and generation of items. Discussions about women's stressors were carried out on three groups of working women (n = 18). All groups consisted of doctors, bankers, university professors, telecommunication officers, and pharmaceutical employees aged between 26 and 57. The items generated for the questionnaire were based on the catagories found qualitatively. On the basis of these findings a 60 items (WWSS) was developed. Option "any other" in the questionnaire identified six more items for inclusion in the final WWSS scale and thus increased the number of items to 66. In phase two (pilot study, validation, and reliability testing) was carried out. To improve and to confirm the face validity, a pilot study was conducted on working women (n = 30). The age range of the participants was between 23 and 52. By deploying reliability analysis, the high value reliability coefficient with alpha (α = .85) was revealed. In the third phase factor analysis, and assessment of construct validity was carried out for the psychometric evaluation of (WWSS). Participants were working women (n = 300) from banks, hospitals, telecommunication, universities, and companies dealing in pharmaceutical and textiles, selected by purposive sampling technique. The age range of participants was 21.59 years with the mean of 31.37. It yielded overall significant Cronbach alpha (α. = 95). Six factors emerged from factor analysis i.e. family stressors (α = .97), daily hassles/personal stressors (α = .89), social stressors (α = .86), work stressors (α = .85), life events (α = .83), and catastrophic (α = .75).
Keywords: working women, stressors
CORRESPONDING AUTHOR: Asad Shamaila, Punjab, University, Pakistan, sham37@hotmail.com
P464
ADAPTATION OF THE MUSCLE APPEARANCE SATISFACTION SCALE IN HUNGARY
Babusa B.1, Urbán R.2, Czeglédi E.2, Túry F.1
1 Semmelweis University, Institut of Behavioral Sciences, Budapest, Hungary
2 Eotvos University, Faculty of Education and Psychology, Department of Educational Psychology and Health Psychology, Budapest, Hungary
Background: Muscle dysmorphia has been described as a male body image disorder, which is characterized by a pathological preoccupation with muscle size and muscularity. The Muscle Appearance Satisfaction Scale (MASS; Mayville, Williamson, Netemeyer,&Drab, 2002) is a 19-item self-report measure for the assessment of muscle dysmorphia symptoms. The questionnaire was developed to assess symptoms related to cognitive, behavioral and affective dimensions of MD. Limited studies have evaluated the psychometric properties of the MASS in different cultures and languages.
Aims: The aims were to examine the psychometric properties of the Hungarian version of the MASS (MASS-HU), and to investigate its relationship with self-esteem and exercise-related variables.
Methods: Two independent samples of male weight lifters (ns = 289 and 43), and a sample of undergraduates (n = 240) completed the MASS, Drive for thinness subscale of the Eating Disorder Inventory, and Rosenberg Self-esteem Scale.
Results: Exploratory factor analysis supported the original five-factor structure of the MASS only in the weight lifter sample with one item exception. The MASS-HU had excellent scale score reliability (α = .73-.87) and good test–retest reliability (r = .84-.91). The construct validity of the MASS-HU was tested with multivariate regression analyses which indicated an inverse relationship between self-esteem and muscle dysmorphia in both samples. In the weight lifter group, the aspects of muscle dysmorphia were also associated with current steroid and food supplementation use, fewer years of exercise, younger age, and lower BMI. In the undergraduates, aspects of muscle dysmorphia were associated with low drive for thinness and current weight lifting activity.
Discussion: The 18-item MASS-HU was found to be a useful measure for the assessment of muscle dysmorphia among male weight lifters. Study results also confirmed previous findings demonstrating the relationship between low self-esteem and muscle dissatisfaction among males. No study has investigated muscle dysmorphia symptoms in Central-Eastern Europe. The tendency might be the same in other Eastern European countries. Hopefully, the MASS-HU will encourage and stimulate further research and clinical work in the field of muscle dysmorphia in Hungary.
Keywords: muscle dysmorphia, Muscle Appearance Satisfaction Scale, exploratory factor analysis, self-esteem, weight lifters
CORRESPONDING AUTHOR: Babusa Bernadett, Semmelweis University, Budapest, bernadett.babusa@gmail.com
P465
GHQ-12 IN ROMANIAN PEOPLE: RELIABILITY, EXPLORATORY AND CONFIRMATORY FACTOR ANALYSIS
Brabete AC ., Sánchez-López MP., Rivas-Diez R.
Universidad Complutense de Madrid, Faculty of psychology, Madrid, Spain
Educational Objectives: At the end of this presentation, you may obtain the adjustment to Romanian population test with the psychometric properties, good sensitivity and specificity and easy to fill out. That’s the reason, it has become a common instrument in epidemiological studies.
Purpose: The purpose of this study was to analyze the internal consistency and the external and structure validity of the 12-Item General Health Questionnaire (GHQ-12) in the Romanian general population.
Methods: GHQ-12 (Goldberg & Williams, 1988) consists of 12 items, each one assessing the severity of a mental problem over the past few weeks using a 4-point Likert-type scale (from 0 to 3). Participants: A sample of 600 people (men and women), ages between 18 and 72 years was employed. Methods: Cronbach’s alpha was calculated to analyze internal consistency. External validity was analyzed by calculating the correlations between the total score of GHQ-12 and its three factors. The procedure to carry out the factor analysis of GHQ-12 was oblique rotations (direct oblimin).
Findings: Current phase of work: We are reviewing the data analysis.
Literature Reference
Goldberg, D., & Williams, P. (1988). A user’s guide to the General Health Questionnaire. Windsor, UK: NFER-Nelson.
Sánchez-López, M.P. & I., Dresch, V. (2008). The 12-Item General Health Questionnaire (GHQ-12): Reliability, external validity and factor structure in the Spanish population. Psicothema, 20 (4), 839-843.
Keywords: Mental health, Testing
CORRESPONDING AUTHOR: Brabete Andreea, Universidad Complutense, Madrid, ac.brabete@psi.ucm.es
P466
VERBAL-AUTONOMIC RESPONSE DISSOCIATIONS DURING ANGER AND SADNESS NARRATIONS: THE LINGUISTIC FINGERPRINT OF REPRESSION
Consedine N.
University of Auckland, Psychological Medicine, Auckland, New Zealand
Objectives: Identifying when emotions are being repressed is occurring is central to clinical interviewing, assessment, and treatment for an array of mental and physical disorders. The current report describes a linguistic approach to the identification of verbal-autonomic response dissociations (VADs) during the narration of anger- and sadness-provoking memories.
Methods & Design: Race and gender-matched samples of young, middle-aged, and older adults (N = 96), completed an experimental session in which they completed 10-minute, counter-balanced narrations of anger and sadness experiences while self-reported negative affect and heart rate (HR) data were recorded. VAD scores were computed by converting negative emotion and HR change scores to z-scores based on age group means and then subtracting each participant's standardized HR from their standardized NA score.
Results: Regressions in which the proportions of pronoun classes, common verbs, relativity words, and emotional words were used to predict dissociations between cardiovascular arousal and self-reported affect were run. Analyses showed that greater dissociation during anger narrations was predicted by fewer third person singular pronouns, past or present tense verbs, relativity, and sadness words and, marginally, by fewer third person plural and greater proportions of second person pronouns. The model for sadness was less illustrative, with first person plural usage predicting lower VAD and greater positive emotion word usage predicting greater VAD.
Conclusions: Repressing feelings, particularly when angry, appears to leave a linguistic fingerprint. As such, language-based analyses have the potential to objectively illuminate clinically-significant regulatory processes such as repression in ways that by-pass self-report and do not require specialized equipment. Automated analyses of the continual streams of linguistic data may supplement current approaches to the identification of repressive process.
Keywords: emotion; psychophysiology; personality
CORRESPONDING AUTHOR: Consedine Nathan, University of Auckland, Auckland, n.consedine@auckland.ac.nz
P468
INCOMPLETENESS OF DEATH REGISTRATION IN GHANA: THE ROLE OF MORTUARIES IN DEATH REGISTRATION
Gyimah C.
St Patrick's Hospital, Offinso, Ghana, Nursing and Midwifery, Offinso, Ghana
Background: Accurate worldwide information on the levels and patterns of mortality (deaths) is essential for planning and monitoring global public-health initiatives. The gold standard method for collecting such information is death registration. In high-income countries, death registration is effectively 100% complete, but the situation in many developing countries is very different. In most African countries, for example, less than one-quarter of deaths are officially recorded.
Methods: The study was done to find out how provision of mortuaries could help increase death registration coverage in Ghana from the current 25%. In a cross sectional survey of 20 districts (those with mortuaries and without), a structured questionnaire was administered to 204 relatives to seek their knowledge on deaths they registered in the year 2010; and 20 districts registrars of births and deaths to explore the problems associated with death registration.
Results: According to the relatives, 59.8% of the registered deaths expired at home compared to 33.3% deaths occurring in the hospitals and the remaining 6.9% were coroner’s cases. Again, among the relatives, 46.1% were not aware of death registration and let alone knowing why they should register a death of a relative. In all the 20 districts studied, 95% had no computer. Eighty five percent of the registrars had only secondary education. Seventy percent of the districts had just one employed staff and 15% of the districts had no employed staff. Conclusions or Significance: It was observed in the present study that, the districts with mortuaries registered more deaths as compared to the districts without mortuaries. It is therefore evident that death registration coverage will increase if mortuaries are provided in the districts. Public education should be intensified on the need to register deaths and the registry given the needed assistance to perform. A more holistic and durable programme should be put in place such as the keeping of community register for the entry of all deaths in every community (unit committee level).
Keywords: Measurement Methods
CORRESPONDING AUTHOR: Gyimah Charles, St. Patrick's Hospital, Offinso, gyimahc@gmail.com
P469
RECRUIT, ENGAGE AND ATTAIN CHILDREN IN BEHAVIORAL HEALTH RESEARCH – THE REACH FRAMEWORK
Schoeppe S.1, Duncan M.1, Oliver M.2, Badland H.3, Burke M.4
1 Central Queensland University, Institute for Health and Social Science Research, Rockhampton, Australia
2 Auckland University of Technology, Centre for Physical Activity and Nutrition, Auckland, New Zealand
3 University of Melbourne, McCaughey Centre, Melbourne, Australia
4 Griffith University, Urban Research Program, Brisbane, Australia
Introduction: Children are a common target group in behavioral health research. Yet their recruitment poses great challenges to researchers and few method papers provide guidance on effective recruitment and retention strategies.
Objective: To identify best practice and develop a framework for the recruitment and retention of children in behavioral health risk factor studies.
Methods: A systematic literature search in various databases (PubMed, Scopus, CINAHL, SportDiscus, PsychInfo) for papers published 1990-2011 was undertaken, focusing on cross-sectional and behavioral intervention studies with children aged 3-18 years. The literature review informed the development of a preliminary framework to Recruit, Engage and Attain Children in behavioral Health research (REACH). The REACH framework will be verified through consultation (using Delphi method) of international experts in pediatric physical activity and public health research who will provide expert opinion and lessons learned from recruiting children.
Results: The literature review yielded best practice recruitment and retention strategies summarised as the REACH framework: (1) Recruit: gain ethical clearance, hold information sessions with children, parents and setting-specific personnel, provide incentives with consent forms, send reminders for study consent; (2) Engage: explain purpose and benefits of study, use local advocates, set up effective communication channels, communicate suitably to children; (3) Attain: use incentives, build trust, make the study fun for children, reduce participant burden, conduct data collection/intervention conveniently for children, parents and personnel; use extensive follow-up procedures; (4) Children: consider child’s sex, age, developmental level, ethnicity and socio-economic status; (5) Health research: apply in cross-sectional or intervention studies, understand the nature of the pediatric health issue, learn from pilot and case studies.
Conclusions: Using combined recruitment and retention strategies appeared to be most effective to obtain sufficient numbers of children. The REACH framework can guide the recruitment of children into cross-sectional and intervention studies in community-based settings such as schools, clubs, and other youth-related organizations.
Keywords: recruitment, retention, children, behavioral health risk factor studies, framework
CORRESPONDING AUTHOR: Schoeppe Stephanie, CQUniversity, Australia, s.schoeppe@cqu.edu.au
P470
CROSS CULTURAL VALIDATION OF NEW MEASUREMENT TOOL (ZKA-PQ) FOR ALTERNATIVE FIVE FACTOR PSYCHOBIOLOGICAL MODEL OF PERSONALITY
Suranyi ZS.1, Vargha A.1, Aluja A.2
1 KRE Károli Gáspár University, Department of Psychology, Budapest, Hungary
2 University of Lleida, Department of Psychology, Lleida, Spain
Zuckerman, Kuhlman, Joireman, Teta, and Kraft (1993) have proposed a five-factor psychobiological model of personality (Alternative Five-Factor Model, AFF). Recently, a questionnaire with a hierarchical structure of factor-facet version (Zuckerman-Kuhlman-Aluja Personality Questionnaire, ZKA-PQ, Aluja, 2010) was developed. This instrument contains five factors (Aggressiveness, Activity, Extraversion, Neuroticism, Sensation Seeking) with four facets per factor.
Our aim was to compare the Catalan and Hungarian versions of questionnaire in order to validate the AFF psychobiological model and to see whether ZKA-PQ could serve as a base for cross-cultural personality measurements. As the AFF model contains basic factors that have strong biological-evolutionary basis, we can assume that AFF could be used regardless of cultures in order to unfold and compare the basic personality patterns.
1564 Catalan and 1647 Hungarian individuals filled out ZKA-PQ questionnaire on-line and anonymously. Alpha reliability coefficients on the average were above .85 for the five ZKA-PQ factors in both samples and were above .70 for the most facets. No significant differences were present between countries with regards to factors except for NE. The NE mean score was significantly lower in Hungarian sample (d = .87). Congruence coefficients between Catalan and Hungarian factorial structures (in congruence with proposed model) were 0.97, showing that the factorial structures for the Catalan and Hungarian language versions of the ZKA-PQ were equivalent.
The high internal consistencies for both countries along with the same factorial structure that replicated well the normative structure received in American and Spanish samples confirm the AFF model’s usability in psychobiological and also in cross-cultural comparative researches. The ZKA-PQ has proved to be an adequate tool to assess both lower- and higher-order personality traits with biological basis in different cultures. We would be happy to welcome researchers for cross-cultural and psychobiological cooperations and can provide a copy of the ZKA–PQ with the scoring key for interested researchers.
Keywords: Measurement, Testing, Ethnic differences
CORRESPONDING AUTHOR: Suranyi Zsuzsanna, Károli University, Hungary, zsuzsanna.suranyi@gmail.com
P471
ACCEPTABILITY OF FALSE EYELASHES IN ELDERLY JAPANESE. - DEVELOPMENT OF THE FALSE EYELASHES ACCEPTANCE QUESTIONNAIRE –
Takahashi K.1, Kayaba K.2, Sato Y.2
1 Graduate School of Saitama, Prefectural University, Koshigaya, Japan
2 Saitama Prefectural University, School of Health Science, -, Koshigaya, Japan
Objective: False eyelashes are one of the common makeup items in Japan. The growth rate of an eyelashes market expanded 300% from 2001 to 2011. Facial makeup of health care providers could make some impression on health care consumers. The impression plays important roles in health care and medication. However, no established measure for evaluating health care consumers’ acceptability of nurses’ false eyelashes are available in Japan. This study aimed to develop the false eyelashes acceptance questionnaire with satisfied reliability and validity.
Methods: We developed a questionnaire consisting of three charts covering visual impressions concerning "cleanliness", "kindness", and "seriousness". Each chart includes a descriptive title, a question relating to the above impressions, and an eight-point answer scale with seven pictures. Each set of pictures consists of photographs which represents a part of female face using gradually different length of false eyelashes (from “no wearing” to “wearing very long false eyelashes”). Examinees were asked to draw a line under the photograph they felt to be acceptable. Subjects were 134 participants of community-based health promotion programs for enhancing physical activity aged 50 years or more. To evaluate the test-retest reliability, the questionnaire was administrated twice at a four-week interval. Subjects’ and their friends’ experiences of using false eyelashes were used as variables to estimate concurrent validity. Spearman's correlation coefficient and Chi square test were used.
Results: Of 134 participants of the programs, 115 (86%) responded to the first administration. The retest was performed for 84 persons (12 men and 72 women). All subjects stated that they accepted the questionnaire without any confusion. Correlation coefficients between the scores of the two tests were 0.55 (95% confidence interval: 0.38-0.69) for cleanliness, 0.56 (0.40-0.70) for kindness, and 0.53 (0.35-0.67) for seriousness. Subjects who were younger or had used false eyelashes tended to accept longer false eyelashes.
Conclusions: The false eyelashes acceptance questionnaire we developed had moderate the test-retest reliability and concurrent validity for elderly healthy Japanese. Further study is needed to apply our questionnaire to health care consumers.
Keywords: False eyelashes, Questionnaire development, Elderly
CORRESPONDING AUTHOR: Takahashi Kiyoko, Graduate School of SPU, Saitama, kiyoko2005@jcom.home.ne.jp
P472
TACKLING FUEL POVERTY THROUGH THE WARM HOMES FOR ELDER NEW ZEALANDERS STUDY: AIMS AND METHODS OF A RANDOMISED COMMUNITY-BASED TRIAL
Viggers H.1, Howden-Chapman P.1, Crane J.2, Chapman R.3, WHEZ Research Group W.4
1 University of Otago, Department of Public Health, Wellington, New Zealand
2 University of Otago, Department of Medicine, Wellington, New Zealand
3 Victoria University of Wellington, School of Geography, Environment and Earth Sciences, Wellington, New Zealand
4 University of Otago, Public Health, Wellington, New Zealand
Objectives: To describe the aims and methods of a randomised, community-based trial, the Warm Homes for Elderly New Zealanders (WHEZ) study which examines the impacts of a NZ$500 winter electricity subsidy on the health of older people with Chronic Obstructive Pulmonary Disease (COPD).
Study aim: To evaluate whether targeted fuel subsidies reduce recurrent exacerbation rates (including those leading to hospitalisation) among older people with COPD and whether providing such subsidies is a cost-beneficial policy initiative.
Participants: People aged 55 years or over who had a clinician-diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; people aged 45 or over, who were specifically referred by a community health worker and met the other criteria, were also accepted. Only one participant was accepted from each dwelling.
Design: Participants were recruited from three communities from 2009 to early 2011. Households recruited by June (early winter in the southern hemisphere) 2010 were assigned to Wave 1, households recruited after that were assigned to Wave 2. All houses where owner consent was received were assessed for insulation status and where necessary and feasible, insulation was retrofitted free of charge to the occupant. After baseline data were received participants were randomised to either the “early” or “late” groups. “Early” group Wave One participants received the fuel subsidy during 2010; “late” Wave One and “early” Wave Two participants received the subsidy during 2011; “late” Wave Two participants will receive the subsidy during 2012. Follow-up measurements are taken in spring. Objective measurements, included spirometry and indoor temperatures and subjective measures, included questions about of health and wellbeing, heating, medication, and visits to health professionals are being collected and preliminary results will be presented. Objective data on health care usage include hospitalisation, primary care and pharmaceuticals are being collected. Assessments of electricity are being obtained through electricity companies using unique customer numbers.
Conclusion: A community trial has enrolled 520 older people with COPD in a study with a wave design to establish whether subsidising their household electricity accounts has an impact on their respiratory symptoms and hospitalisation.
Keywords: Randomised community trial, COPD; Housing; Health; Fuel poverty;
CORRESPONDING AUTHOR: Howden-Chaman Philippa, University of Otago, Wellington, philippa.howden-chapman@otago.ac.nz
P473
EFFICACY OF DEPRESSION TREATMENTS IN PATIENTS WITH DIABETES AND PATIENTS WITH CORONARY ARTERY DISEASE
Baumeister H.1, Hutter N.1, Bengel J.2
1 University of Freiburg, Insitute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Freiburg, Germany
2 University of Freiburg, Department of Rehabilitation Psychology and Psychotherapy, Freiburg, Germany
Background: With regard to the high prevalence rates and the impact of comorbid depression on both medical and psychosocial outcomes, there is a need for effective depression treatments in patients with depression or coronary artery disease (CAD). The objective of the present study was to systematically review the effects of psychological and pharmacological interventions for depression in these patients.
Methods: RCTs investigating psychological and pharmacological interventions for depression in adults with diabetes or CAD and depression were included. Primary outcome was depression severity. Secondary outcomes were disease-specific medical outcomes, mortality, healthcare costs and quality of life. A comprehensive search was conducted in MEDLINE, EMBASE, CENTRAL, DARE, HTA and EED on The Cochrane Library, PsycINFO, CINAHL, ISRCTN Register, CardioSource Registry and clinicaltrials.gov. Reference lists were examined and authors contacted. Two reviewers independently examined primary studies and extracted data. Random effects model meta-analyses were conducted.
Results: The database search identified 6,334 references. 32 trials fulfilled the inclusion criteria. Psychological interventions (SMD = -0.59 [95%CI: -0.94,-0.25]) and pharmacological treatments with SSRIs (SMD = -0.27 [-0.39,-0.14]) show a small to moderate beneficial effect on depression severity. Effects might be higher in patients with diabetes than in CAD patients (psychological interventions: -0.66 [-1.08,-0.24] vs. -0.36 [-1.28,0.55]; SSRIs: -0.39 [-0.64,-0.13] vs. -0.23 [-0.37,-0.08]). Treatment dose of psychological interventions was low in most trials (nine trials ≤ 8 sessions). The evidence base for all secondary outcomes is sparse, except for glycemic control in diabetes patients. SSRIs show a small to moderate effect on glycemic control (SMD = -0.37 [-0.61,-0.12]), while the evidence is inconclusive for psychological interventions.
Conclusion: Psychological interventions and SSRIs have a small to moderate effect on depression in diabetes and CAD patients. A low psychotherapeutic dose as well as a mixed study population of patients with different subtypes of depression (e.g. depression as part of an adjustment process, vascular depression, recurrent depression) might partly explain the unsatisfying small effects.
Keywords: diabetes, coronary artery disease, depression
CORRESPONDING AUTHOR: Baumeister Harald, University of Freiburg, Freiburg, harald.baumeister@psychologie.uni-freiburg.de
P474
THE RELATIONSHIPS OF SELF-RATED HEALTH AND COGNITIVE EMOTION REGULATION STRATEGIES
Miklósi M.1, Martos T. 2, Kocsis-Bogár K.1, Perczel Forintos D.3
1 Semmelweis University, School of Doctoral Studies, Budapest, Hungary
2 Semmelweis University, Institute of Mental Health, Budapest, Hungary
3 Semmelweis University, Department of Clinical Psychology, Budapest, Hungary
Objective: Self-rated health (SRH) was evidenced to be associated with increased risk of mortality in several studies. Since negative emotional states, such as depression, was shown to be strongly related to poor SRH, cognitive processes controlling emotional responses might have an impact on SRH. This study investigated the relationships between SRH and cognitive emotion regulation strategies.
Method: A sample of 257 undergraduate and graduate students answered a single general self-rated health question (‘In general, how would you rate your health?’ with response options of very good, good, fair, or poor) and completed the Cognitive Emotion Regulation Questionnaire measuring nine cognitive coping strategies (self-blame, acceptance, rumination, positive refocusing, refocus on planning, positive reappraisal, catastrophizing and other-blame). Logistic regression analysis was conducted to detect the effects of cognitive emotion regulation strategies on group membership (good/very good SRH vs. fair/poor SRH) controlling for gender, age and mother’s level of education as an indicator of socio-economical status.
Results: The non-significance of Hosmer and Lemeshow goodness-of-fit test (Chi-square = 2.624, df = 8, p = .956) showed the adequacy of the model. The likelihood of good/very good SRH was significantly positively related to the use of refocus on planning and positive reappraisal and significantly negatively associated to the use of catastrophizing. Results revealed that one additional point on the CERQ refocus on planning score increases the odds of good/very good SRH by about 19%. Similarly, one additional point on the CERQ positive reappraisal score increases the odds of good/very good SRH by about 15%, controlling for other variables in the model. On the other hand, for each point increase on the CERQ catastrophizing score, the odds of good/very good SRH decrease from 1.0 to 0.824, controlling for other variables in the model.
Conclusions: Specific cognitive emotion regulation strategies are strongly related to the perception of health. Targeting these cognitive factors may play an important role in prevention efforts.
Keywords: Coping, Cognitive factors, Self-rated health
CORRESPONDING AUTHOR: Martos Tamás, Semmelweis University, Budapest, martos@mental.usn.hu
P475
EXTERNALIZING PERSONALITY AND EXECUTIVE COGNITIVE FUNCTION: A STUDY WITH A NON-CLINICAL SAMPLE
Santos IM.1, Costa J. 1, Pareira AT.1, Vagos P.1, Rodrigues P.2, Oliveira AC.1, DeFilippis N.3, Silva CF.1
1 Aveiro University, Department of Education, Aveiro, Portugal
2 University of Beira Interior, Department of Psychology and Education, Beira, Portugal
3 Argosy University, College of Psychology and Behavioral Sciences, Atlanta, USA
Acting-out behaviors and poor behavioral control are directly related to a higher-order psychopathology factor that seems to underpin a number of the most commonly occurring mental disorders. This factor is labeled externalizing, and accounts for the covariance among childhood conduct problems, adult antisocial behavior, and substance-use disorders, being a high-risk factor for antisocial behavior and psychopathy. A common behavioral pattern reflected in many manifestations of externalizing is an apparent failure to learn from experience. This raises the possibility that externalizing may involve a deficit in executive cognitive function, such as the ability to self-monitor ongoing behavior, poor ability to solve novel problems, poor abstract reasoning and poor cognitive flexibility. To test this possibility, we examined the influence of externalizing on the capacity of problem solving, cognitive flexibility and abstract reasoning. For this purpose, a non-clinical sample of 37 individuals (25 females) between 18 and 46 years-old (M = 22.41) was selected on the basis of their scores on the Externalizing Inventory. Participants were divided into three groups of externalizing (high, average and low) and responded to the Halstead Category Test, a well-established neuropsychological measure of non-verbal reasoning. Performance was scored with recently developed subscales (categorization, perseveration, set loss and memory), which aim to provide a more valid and comprehensive measure of different types of complex reasoning. Significant differences were found for the subscale “Loss of Set – Conceptual”, χ2 (2) = 6.35, p < .05, where participants scoring high and average on the externalizing vulnerability performed significantly worse than participants scoring low. This suggests that a higher externalizing vulnerability is associated with an increased difficulty at the level of abstract concept formation and poor cognitive flexibility, when compared with the low externalizing group. These results are important to help understand the impact at the cognitive level of the externalizing factor, a personality vulnerability that is likely to have a neurobiological substrate, and contribute to a better conceptualization of the deficits associated with this dimension.
Keywords: Personality; Cognitive factors; Externalizing; Executive function; Abstract reasoning
CORRESPONDING AUTHOR: Santos Isabel, University of Aveiro, Aveiro, isabel.m.b.santos@gmail.com
P477
A PHENOMENOLOGICAL EXPLORATION OF THE LIVED EXPERIENCE OF RECEIVING A MENTAL HEALTH DIAGNOSIS
Milton A., Mullan B.
University of Sydney, Department of Psychology, Sydney, Australia
Background: Communications research examining the delivery of diagnostic news is uncommon in the psychiatric field when compared with other medical specialties. Most research in this area has focused on reporting differences in the rates of health professionals disclosing psychiatric conditions to service users. For example, there have been reports of low rates of disclosing certain diagnosis such as schizophrenia compared with other mental health issues such as depression despite research indicating that the majority of service users want to be informed about their diagnosis. Methods of delivering diagnostic news have received limited attention and there have been no large scale research projects that qualitatively explore consumer perspectives of receiving a psychiatric diagnosis.
Aims: The aims of the project were to gain a understanding of service users’ lived experiences of receiving a diagnosis from mental health professionals and explore their recommendations for best practice based using qualitative techniques.
Method: 45 interviews based on Interpretive Phenomenological Analysis (IPA) principals were conducted in community health facilities in Sydney, Australia. During the interviews mental health service users recounted their experiences of when news of a psychiatric diagnosis was delivered to them, described the impact of that news on their psychological and social well being, and provided best practice recommendations for this process. Transcripts were analysed using Nvivo software and IPA and themes were explored.
Results: The interview data revealed eight dimensions of the services users’ experience of learning about their mental health diagnosis: 1) the lead up to becoming diagnosed; 2) the impact of first hearing a diagnosis; 3) the adjustment to treatment; 4) illness concepts and stigma; 5) therapeutic alliance and mental health supports; 6) conversations that are not had; 7) management and recovery; 8) changes over time; 9) reflections on best practice.
Conclusions: In line with previous quantitative research, service users overwhelmingly advocate for honesty and openness in communication about diagnosis; however, they suggest that empathy and hope for recovery is integrated into an individualised process in which news and support is provided. Overall, the present research has implications for how health professionals communicate to service users when breaking news about a psychiatric diagnosis and may assist to form guidelines for delivering news of psychiatric diagnosis to service users.
Keywords: Health Communication, Mental health
CORRESPONDING AUTHOR: Milton Alyssa, University of Sydney, Sydney, amil2403@uni.sydney.edu.au
P478
SELF-ADMINISTRATION OF THE NEWEST VITAL SIGN IN PORTUGUESE YOUNG ADULTS: STUDY OF ITS INTERNAL RELIABILITY
Santos O.1,2, Oliveira A.2, Carvalho C.3, Lunet N.4,5, Azevedo A.4,5, Paiva D.5, Do Carmo I.6
1 University of Évora, Department of Psychology, Évora, Portugal
2 Portuguese Observatory of Obesity and Weight Control, -, Lisbon, Portugal
3 ISPA Universitary Institute, Psychology and Health Research Unit, Lisbon, Portugal
4 University of Porto Medical School, Department of Clinical Epidemiology, Predictive Medicine and Public Health, Porto, Portugal
5 University of Porto (ISPUP), Institute of Public Health, Porto, Portugal
6 Faculty of Medicine of Lisbon, -, Lisbon, Portugal
Background: Self-regulation of health behaviors is associated with health-related knowledge and, more specifically, with health-literacy related skills. The assessment of low health literacy prevalence is important for defining and evaluating the effectiveness of health promotion actions aiming to enhance health education. A well-known and widely used health-literacy screening tool is the Newest Vital Sign (NVS). This instrument has not yet been studied for the adult Portuguese population.
Objectives: To study internal reliability of the NVS among adults.
Methods: The study followed a cross-sectional survey design. NVS was applied in a self-administered format, at two faculty settings (from two different Portuguese cities).
Results: In total, 82 students (65 girls and 17 boys) participated in the study (age: mean = 22.2; standard deviation = 5.4 years). Students belonged to 2 different courses (55 from psychology and 27 from psychomotricity) and two different cities (40 from Évora, and 42 from Lisbon). NVS was well-received by students (no relevant burden was found), with and average time of application of about 10 minutes. Internal reliability was 0.6 (Kuder-Richardson coefficient). Factorial analysis (with Varimax Rotation) suggested the existence of two different factors.
Discussion/conclusion: Internal reliability of the Portuguese version was found to be somewhat lower than the ones found for English and Spanish versions. Nevertheless, it remains an acceptable reliability score when considering a 6-item tool (with a dichotomic scale of answer). Factorial analysis confirmed the fact that the scale assesses both numeric and text-location/text-understanding skills.
Keywords: health literacy, reliability, Portugal
CORRESPONDING AUTHOR: Santos Osvaldo, University of Évora, Portugal, osvaldorsantos@gmail.com
P479
THE CHANGES OF SELF- AND OTHERS-RATINGS FOR SPEECH PERCEPTION AFTER SPEECH EXPOSURE OF THE INDIVIDUAL COGNITIVE BEHAVIOR THERAPY FOR SOCIAL ANXIETY DISORDER
Shirotsuki K.1, Kodama Y.2, Nomura S.3
1 Tokai Gakuin University, Faculty of Human Relations, Gifu, Japan
2 Tokorozawa Mental Clinic, Psychiatry, Saitama, Japan
3 Waseda University, Faculty of Human Sciences, Saitama, Japan
Introduction: Studies on Social Anxiety Disorder (SAD) have focused on changes in negative self-perceptions resulting from psychotherapy. However, the process of change during exposure sessions in individual cognitive behavior therapy (ICBT) has not been clarified. Present study examined the differences between self-ratings and others-rating in the ICBT program for SAD.
Methods: The research ethics committee of Waseda University approved the protocol of the present study. SAD patients (N = 13, 6 men and 7 women; Mean age = 29.00, SD = 5.55) participated in the ICBT program after giving their informed consent. ICBT was consisted of six sessions. One session was conducted for 50-minutes per week. In this program, participants delivered a speech on eight occasions.
Measures: (1) The Speech Perception Questionnaire (SPQ): self-ratings (SPQ-self) and others-rating (SPQ-other) by Rapee and Lim (1992), (2) Subjective Units of Disturbance for subjective anxiety (SUD), (3) the Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987), (4) The Social Cost and Probability scale (SCOP; Shirotsuki & Nomura, 2009). The SPQ-other was administered by two clinical psychologists by using a videotaped speech after all participants completed the program.
Results: Paired t-tests showed that the LSAS and the SCOP significantly improved after this program (t(12) = 3.09, p < .01; t(12) = 3.04, p < .01). Additionally, a two-way (2 ratings × 8 occasions) analysis of variance showed that there was a significant interaction (F(4.11, 98.67)=9.73, p < .01). Post hoc tests using the Bonferroni method revealed that SPQ-self rating was improved between the first and other speech sessions (ps < .01). Conversely, there were no significant differences between the first and other speech sessions in SPQ-other ratings.
Discussion: The results showed that SAD symptoms significantly improved as a result of ICBT. This suggests that this program was effective in improving SAD symptoms. In addition, the SPQ scores suggested that self-ratings were more negative than others-ratings. Self-ratings gradually improved after exposure. Conversely, the others-ratings were more positive and had not changed significantly as a result of the program. These results are indicative of the distorted self-perception in SAD.
Keywords: Anxiety, Cognitive factors, Exposure
CORRESPONDING AUTHOR: Kentaro Shirotsuki, Tokai Gakuin University, Gifu, shiroken10@gmail.com
P480
PERSON AND VARIABLE ORIENTED APPROACH IN EXAMINING THE CONTRIBUTION OF RELIGIOSITY TO MENTAL HEALTH
Suranyi ZS., Szondy M., Vargha A.
KRE Károli Gáspár University, Department of Psychology, Budapest, Hungary
Meta-analyses of Wong, Rew and Slaikeu (2006) found a positive relationship between religiosity and mental health. Porta’s research (2006) showed that mindfulness has a moderating effect on this relation. Tagay et al (2006) stated that sense of coherence but not religiosity may be a protective factor for mental health and well-being. Gumilar (2011) has found that religiosity is inversely related to sensation seeking which has been found to be a potent predictor of a wide array of mental health problems.
Our aim was to examine the relationship between religiosity and mental health through moderator variables such as sensation seeking, mindfulness and sense of coherence. Further, we applied a person-oriented approach in order to examine the typical patterns of values that can lead to high life satisfaction. 198 individuals filled out Daily Spiritual Experience (DSE, Underwood, 2011), Sensation Seeking (SS scale in ZKA-PQ, Aluja, 2010), Sense of Coherence (SOC, Antonovsky, 1993), Life satisfaction (Diener, 1985) scales. 63% of respondents also filled out Mindfulness scale (FMI, Walach, 2006).
We have found that daily spiritual experience (DSE) does not have a linear relationship with constructs of positive psychology as life satisfaction (r = .095, p = .192), SOC (r = -.026, p = .774) or mindfulness (r = .015,p = .839). However, DSE is negative linearly related to SS (r = -.259,p = .000), which latter is negative linearly related to mindfulness (r = -.418, p = .000). Mindfulness is strongly related to SOC (r = .497, p = .000), which is linearly related to life satisfaction (r = .184, p = .041). Based on these results we have built an AMOS model which has produced acceptable fit indices (CMIN/df = 1.146, CFI = .998, RMSEA = .027 (.000-.193, PCLOSE = .395). Religiosity through low SS can result in high mindfulness, which through high SOC can lead to high life satisfaction.
Person-oriented analyses have shown only one typical pattern of values (low SS, high SOC, high DSE, high mindfulness) that yielded a significantly higher life satisfaction than the average (t(df = 18) = 4.31, p = .000).
Our presentation aims to give not only a summary of the above mentioned results but also aims to provide a methodological example how to combine variable and person-oriented approaches in researches of health psychology.
Keywords: Mindfulness, Religiosity/ Spirituality, Mental Health
CORRESPONDING AUTHOR: Suranyi Zsuzsanna, Károli University, Hungary, zsuzsanna.suranyi@gmail.com
P481
CHRONOLOGICAL CAUSAL RELATIONSHIPS BETWEEN SURVIVAL RATES, DIETARY AND LIFESTYLE HABITS, SOCIOECONOMIC STATUS AND PHYSICAL, MENTAL AND SOCIAL HEALTH IN ELDERLY URBAN DWELLERS IN TOKYO
Hoshi T.1, Yuasa M.2, Yang S.1, Shuo W.1, Fan K.1, Sakurai N.2, Fujiwara Y.1
1 Tokyo Metropolitan University Graduate School of Urban System Science, -, Tokyo, Japan
2 Juntendo University Graduate School of Medicine, -, Tokyo, Japan
Purpose: The purpose of this study was to determine causal relationships among health and lifestyle conditions, socioeconomic status, dietary and lifestyle habits and three health-related dimensions (physical, mental and social health status) in elderly urban dwellers in Tokyo, Japan.
Method: Of 16,462 eligible elderly individuals aged 65 years and older, 13,195 participants responded to the questionnaire survey conducted in September 2001 (a response rate of 80.2%). A follow-up survey was conducted in September 2004 and a total of 8,162 survivors were followed until the end of August 2007 through the municipal reside’s registry. Exploratory factor analysis defined five latent variables based on the 13 observed variables. From a cross-lagged effects variation model using structural equation modeling, causal relationships were analyzed using longitudinal data obtained at the 2001 and 2004 survey and the number of survival days between 2004 and 2007.
Results: We adopted and analyzed the statistically best-fitting models by sex using SEM. Figure1 shows the models for male participants, presenting causal relationships among the latent variables. The models fit the data very well with the following fit indices: NFI = 0.861, IFI = 0.872 and RMSEA = 0.025. R squared values also fit well: 81% for males and 71% for females. The models depict the pathways from underlying socioeconomic status in 2001 via the three health-related dimensions in 2001 and the healthy dietary and lifestyle habits in 2004 leading to the endogenous latent health and life conditions in 2004 for both sexes. In addition, the paths from the three health-related dimensions approached the healthy dietary and life habits variables. Fig. 1. Causal structure of health and life conditions with three latent variables for men.
Conclusion: It suggested that it might be of great importance in particular for elderly people to emphasize maintenance of mental well-being, physical activity, social communication and participation, and their income rather than urged improvement of their diet and health-related lifestyle.
Keywords: Healthy life expectancy, Life style Socio-economical factor Causal relationship
CORRESPONDING AUTHOR: HOSHI TANJI, Tokyo metropolitan university, star@onyx.dti.ne.jp
P482
MINDFULNESS AND MENTAL HEALTH: CONNECTION WITH EMOTIONS, SATISFACTION WITH LIFE, DEPRESSION, ANXIETY AND SENSE OF COHERENCE
Szondy M.1, Suranyi ZS.1, Hevesi K.2, Albu M.1
1 KRE Károli Gáspár University, Department of Psychology, Budapest, Hungary
2 Eotvos University, Faculty of Education and Psychology , Department of Psychology, Budapest, Hungary
Mindfulness refers to being completely in touch with and aware of the present moment, as well as taking a non-evaluative and non-judgmental approach to the inner experience. Previous studies and meta-analysis found strong connection between the level of mindfulness and positive mental and physical health outcomes. The aim of our study was to examine the moderating effect of mindfulness on the connection between positive, negative emotions and mental health outcomes (satisfaction with life, level of depression, anxiety and sense of coherence).
Our sample (N = 413) completed measures of mindfulness (Mindfulness Awareness Attention Scale, Brown & Ryan (2003),), sense of coherence (SOC, Antonovsky, 1993) and satisfaction with life scale (SWLS, Diener et al, 1985). 128 of the respondents also completed scales of depression (BDI, Beck et al, 1996), anxiety (STAI, Spilberger et al,1970) and positive, negative emotions (PANAS, Watson et al (1988).
Our correlational analysis revealed negative relationship of mindfulness to depression (r = -.472, p = .000), to anxiety (r = -.385, p = .000) and to negative emotions (r = -.546, p = .000), along with positive relationship to satisfaction with life (r = .277, p = .000) and to sense of coherence (r = .426, p = .000). There was no significant correlation between mindfulness and the level of positive emotions.
To check the moderating effect of mindfulness on the connection of mental health variables we created three groups based on the level of mindfulness (low, medium, high). The connection between positive emotions and satisfaction with life was much lower among individuals with high mindfulness (r = .202, p = .111), than among ones with low mindfulness (r = .601, p = .000). Similarly, the connection between negative emotions and depression was much weaker in the group of high mindfulness (r = .430 p = .000) than in group of low mindfulness (r = .539, p = .002). We have built multiple mediator models and estimated the path coefficients along with bootstrap intervals for the total and specific indirect effects with latest macro developed by by Hayes (Preacher and Hayes (2008).
Our results suggest the protective role of the high level of mindfulness: in the presence of mindfulness the negative emotions turn into depression at a lower rate and life satisfaction becomes more stable: it will be less determined by varying emotional states.
Keywords: mindfulness, mental health
CORRESPONDING AUTHOR: Szondy Mate, Károli University, Budapest, szondymate@gmail.com
P483
A MEASURE OF THE PSYCHOLOGICAL IMMUNE SYSTEM FROM A CHINESE PERSPECTIVE
Trost K.1, Demir R.2
1 Örebro University, Center for Health and Medical Psychology, Örebro, Sweden
2 Stockholm University, School of Business, Stockholm, Sweden
The present study focuses on studying the structure of a Chinese translation of the psychological immune competence inventory (PICI) covering 16 general protective factors in everyday life. The consistency of previously reported age and gender profiles of psychological well-being was examined. Analyses were based on data from 120 Chinese factory workers aged 20 to 55 years from various levels of the company. The internal consistency coefficients of the translated scales were higher than other versions of the PICI. Further confirmatory factor analyses replicated previous findings showing that the proposed four-factor model had adequate fit as did the three factor model. Besides confirming previously reported age and gender profiles, group differences were found between individuals from management, human resources, IT and production on certain aspects of the psychological immune system components. As expected, individuals in management positions were found to be higher on social monitoring capacities than those in the production level of the company. The present findings clearly demonstrate the adequacy of the Chinese version of the Psychological Immune Competence scales in female and male adult working. Discussion focuses on building a theoretical model for understanding the psychological immune competence measures across different work groups.
Keywords: Protective, Measurement, Worksite health
CORRESPONDING AUTHOR: Kari Trost, Örebro University, Örebro Sweden, kari.trost@oru.se
P484
SOCIO-DEMOGRAPHIC AND PSYCHOSOCIAL FACTORS ASSOCIATED WITH ANTENATAL DEPRESSION AMONG A SAMPLE OF WOMEN LIVING IN IRELAND
Shortt E., Wall P.
University College Dublin, School of Public Health, Physiotherapy and Population Science, Dublin, Ireland
Background: Despite the high prevalence of antenatal depression in westernised countries (around 13%), there has been no previous research examining the prevalence and predictors of antenatal depression in Ireland.
Aim: This study examines the prevalence of antenatal depression among a cohort of women living in Ireland and its relationship with socio-demographic and psychosocial factors.
Method: Pregnant women were recruited at their first antenatal care visit from a large Irish maternity hospital. A total of 984 women who completed the Edinburgh Postpartum Depression Scale (EPDS) during pregnancy were included in the study. The odds of scoring >12 on the EPDS were estimated for both socio-demographic and psycho-social measures.
Findings: The prevalence of antenatal depression was 15.4%. In unadjusted analyses, women with antenatal depression were younger, had lower educational attainment and were more likely to hold a medical card, be unemployed and not live with the baby’s father. Additionally, they were less likely to have private health insurance. Depressed women also reported significantly higher levels of stress and pregnancy specific distress, and were more likely to have a mistimed or unwanted pregnancy. In adjusted analyses, higher levels of stress (OR 1.45; 95% CI 1.35-1.54) pregnancy specific distress (OR 1.10 95% CI 1.06-1.14) and foreign nationality (OR 1.73; 95% CI 1.00-2.99) significantly increased the odds of antenatal depression.
Conclusions: A high prevalence of antenatal depression was observed in this large sample of women living in Ireland. Women with higher levels of stress and foreign nationals may be particularly vulnerable to antenatal depression. An understanding of the prevalence and predictors of antenatal depression can potentially improve detection and treatment.
Keywords: Pregnancy; Depression; Stress; Socio-economic status
CORRESPONDING AUTHOR: Shortt Emily, UCD, Dublin, emily.shortt@ucdconnect.ie
P485
CAESAREAN SECTION ON MATERNAL REQUEST: ATTITUDES OF SOUTH-EAST HUNGARIAN OBSTETRICIANS AND GYNECOLOGISTS
Dweik MD.
University of Szeged, Department of Obstetrics and Gynecology, Szeged, Hungary
Background: Hungarian cesarean section rate has shown a steep rise since the early nineties. One contributing factor to this trend might be the phenomenon of maternal request cesarean sections (MRCS), although there has not been such indication for performing C-section in Hungary, i.e. officially pregnant women do not have the choice to deliver by C-section in the absence of a firm medical indication.
Objective: To assess the personal opinion of South-East Hungarian obstetricians and gynecologists about MRCS and women who prefer MRCS as mode of delivery. Secondary aim was to reveal their attitudes towards cesarean section compared to vaginal delivery.
Method: In early 2010 anonymous questionnaires were distributed to 137 obstetricians and gynecologists with a response rate of 74,5%.
Results: It would be important to have an explicit indication for performing MRCS in Hungary according to 30,4% of respondents. Moreover, in case the legislation was more permissive and there was an official indication for performing MRCS, all in all 81 (79,4%) of obstetricians would feel ready to perform this operation, 12 (11,8%) of whom would even recommend this form of delivery to patients.
Conclusion: A shift towards free maternal choice can be seen in the attitude of Hungarian obstetricians and gynecologists that is in contrast with the official position of the Hungarian College of Obstetrics and Gynecology and also with the present Hungarian legislation.
Keywords: women's health, attitudes
CORRESPONDING AUTHOR: Diana Dweik, University of Szeged, Szeged, ddinji@yahoo.com
P486
PERSPECTIVES IN OBESITY: THE VIEW OF GENERAL PRACTITIONERS
Teixeira V.1, Pais-Ribeiro L.1, Maia C.2
1 University of Porto, Psychology, Porto, Portugal
2 University of Minho, Psychology, Braga, Portugal
Background: General practitioners’ beliefs about obesity have been considered one of the reasons compromising the success of obese people’s treatment. Quantitative research has been criticized for not being able to clarify how health physicians’ practices in the management of obesity are affected by the way they perceived obesity and obese people. This qualitative study was aimed to understand what these professionals think about the causes and consequences of this disease, the adherence behaviour of obese and how doctors perceived their role in the change process.
Method: Semi-structured interviews concerning beliefs, attitudes and practices about obesity were conducted with Portuguese general practitioners and data was analyzed according to Grounded Theory’s procedures.
Results: The main domains indicate that physicians are concerned about the obesity pandemic. However, their attitudes toward obese people are mainly negative. General practitioners use a “blaming the victim” speech, referring that obese refuse to change their behaviors and present a passive coping. Due to the lack of success and compliance, doctors feel frustrated, with low expectations of efficacy and are negative about their power or effect in the treatment.
Discussion: This issue should be taken into account during general practitioners’ education and training in order to make them aware of how their own beliefs and attitudes can influence their behavior in the management of obesity.
Keywords: obesity, beliefs, atittudes, general practitioners
CORRESPONDING AUTHOR: Teixeira Filipa, University of Porto (Portugal), filipa.v.teixeira@gmail.com
P487
‘’DOCTOR WHAT CAN YOU SEE?”: THE ROLE OF NON-MEDICAL FACTORS IN MEDICAL ERRORS.
Tsiga E., Panagopoulou E.
Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
Introduction: Medical errors are inextricably linked with human nature. Despite considerable improvements in patient safety procedures, medical errors continue to occur, indicating that a diversity of non-medical factors are involved in medical practice. The aim of this study was to investigate the role of time-pressure and patients’ physical attractiveness to physicians’ attention when reading a patient’s x-ray.
Methods: Two controlled-experiments were conducted for the purpose of the study. A chest x-ray showing a foreign object at the middle lobe of the right lung was used for the time pressure experiment, while an x-ray of the abdomen showing foreign objects (stones) in a patient’s bladder was used for the attractiveness experiment. 35 GP’s were asked to read the x-rays in both experiments, in two experimental conditions (time pressure: NO/YES; patient attractiveness: NO/YES). In the time pressure condition participants had 20 seconds to read the X-ray, while no time restraints were put in the non- time pressure condition. In the attractiveness condition participants were shown photographs of attractive or non-attractive hypothetical patients before reading their X-rays. The photographs were selected after a series of interater reliability tests among a group of 10 independent raters. The ability of GPs to identify the foreign object was evaluated.
Results: Time pressure had a significant influence on doctors’ attention when reading the chest x-ray, since 70% of the GP's did not identify the foreign object under time pressure, compared to 13% of GPs who did not identify the foreign object under the no-time pressure condition (p < .01). Similarly, 27.27% of the GPs did not identify the foreign object in the non-attractive patients, compared to 9% of GPs who did not identify the foreign object in the attractive patients (p < .01).
Conclusion: Time pressure and patients’ physical attractiveness had a significant impact upon doctors’ ability to read an x-ray. Results indicate that unless we systematically address the role of non-medical factors, medical errors will continue to occur with considerable consequences for patient safety and quality of care.
Keywords: decision making, primary care
CORRESPONDING AUTHOR: Tsigka Evangelia, Aristotle University, evelyntsiga@gmail.com
P488
PRESCHOOL TEACHERS’ PERCEPTIONS OF THEIR NEW ROLES AS TRIPLE P PARENT SUPPORT PRACTITIONERS IN SWEDEN: WHAT IT TAKES TO SUCCEED. AN ANALYSIS OF INTERVIEWS AND RESPONSES TO OPEN-ENDED QUESTIONS
Bokström P., Sarkadi A.
Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Background: During the last few years, parenting support programs have become increasingly common in Sweden. They are being delivered through various organisations, one of which is the preschool where close contact with both children and parents was assumed to be an excellent basis to deliver these programs. But introducing a new role to the traditional caretaking and educational role of preschool teachers brings with it an expansion of their regular work tasks and responsibilities. Furthermore, it requires greater flexibility from the preschool as an organisation.
Aim: To identify organisational factors and professional needs of preschool teachers that alleviated the implementation of Triple P as a parenting support program delivered by the preschools.
Methods: Questionnaires with open-ended questions were distributed to 40 Triple P practitioners from 19 different preschools in Uppsala Municipality, Sweden. This was then followed up by in-depth interviews with nine of the practitioners. Content analysis was used for the data from the questionnaires, while systematic text condensation was used for the interviews.
Results: Delivering parenting support programs within the preschools was not that big of a step to take from the preschool teachers current tasks. Not only do the teachers have theoretical knowledge on child development, but also an insight in the individual children that they are working with. It is also a natural part of their job to have private conversations with the parents about their concerns regarding the children. Delivering parenting support programs was, therefore, largely viewed as deepening and formalising their current role as advisors, rather than something to the contrary. This was fundamental in their willingness to take on the role of a Triple P practitioner. Support from the preschool head was also essential for the preschool teachers to feel legitimate and satisfied when delivering the program, but this had to be combined with scheduled time for program delivery, and a substitute teacher. The latter meant that co-workers would support the activity, which was a fundamental factor for teachers not to abandon their work with Triple P. Moreover, those who had chosen not to work with the program themselves tended to abandon Triple P.
Conclusions: Working with parenting support programs in the preschool setting is something that goes beyond the ordinary job description, and has to be voluntary and properly scheduled in order to work. It is also vital that new work tasks fit well with the current activity to be successfully implemented in an organisation.
Keywords: Children, Research to practice translation
CORRESPONDING AUTHOR: Bokström Pär, Uppsala University, Uppsala, par.bokstrom@kbh.uu.se
P489
‘WE SHOULD HAVE PARTICIPATED BEFORE WE HAD OUR FIRST BABY! SO MUCH ENERGY COULD HAVE BEEN SAVED!’- INTERVIEWS WITH COUPLES AFTER THE RELATIONSHIP EDUCATION PROGRAM (PREP) IN RURAL SWEDEN
Engsheden N., Fabian H., Sarkadi A.
Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Background: PREP (Prevention and Relationship Enhancement Program) is a preventive marital education program to help couples develop their communication and strengthen their relationship. The PREP-courses were offered to couples through a family health centre and through public services for parental support in two rural Swedish towns. The aim was to study the participants’ reflections on the course’s effect on their communicative behaviour, relationship and what strategies participants had retained from the PREP-course.
Design: Semi-structured individual (7), couple (3) and focus group (2) interviews were conducted with 28 persons (12 men and 16 women), 3-60 months after their participation in a PREP-course. Sixteen of the participants were married, ten were cohabiting and two had separated.
Findings: The participants felt more observant of their own communicative behaviour and more perceptive towards their partners. The couples used some of the communication skills taught in PREP and felt that their communication was more constructive; being a better listener was among the skills listed by the interviewees. Participating in the course, allocating the time and opening up for deeper discussions during the exercises made the couples feel closer to each other and perceive that their time was well invested. After the course, participants tried to allow more time for each other as a couple. Parents of young children found the methods for conflict management especially helpful. Couples who had separated at the time of the interview still found the course useful because they felt that they managed to communicate in a more constructive and respectful way in order to collaborate around their children.
Conclusions: The PREP-course has influenced the participants’ behaviour both on the individual and on the couple level. PREP raised participants’ awareness of their personal communicative behavior and provided them with tools to promote positive changes. Time spent together in a calm discussion and training communication skills gave couples a deeper understanding of each other. Five years after the course, participants still felt that they benefited from the course. PREP could be especially useful at times of transitions, for example, when couples are expecting their first child or when children are leaving home.
Keywords: behavior change, couple-focused, family, prevention
CORRESPONDING AUTHOR: Engsheden Natalia, Uppsala University, natalie.engsheden@kbh.uu.se
P490
WANTING TO ACTIVELY PROMOTE FATHERS: A QUALITATIVE STUDY ON SWEDISH CHILD HEALTH NURSES’ VIEWS OF FATHER INVOLVEMENT
Wells M., Varga G., Sarkadi A.
Uppsala University, Department of Medicine, Uppsala, Sweden
Introduction: Swedish Child Health Centers (CHCs) are visited by nearly all (98%) families in Sweden when the child is between 0 to 6 years old. However, mothers disproportionately visit and use the CHCs compared to fathers. Little research has been conducted on how Child Health (CH) nurses influence father involvement at the CHCs.
Aims: The present study explores Swedish CH nurse’s thoughts on paternal involvement and if and what changes CH nurses would like to make in order to include fathers in learning more about their child’s growth and development.
Methods: Interviews with 17 CH nurses were conducted using a 7 question interview guide. The Swedish CH nurses were selected for participation based on their geographic and socioeconomic locations. The interviews were analyzed using Malterud’s Systematic Text Condensation method.
Results: All CH nurses were Swedish females, with an average of 15.7 years of experience. Four themes emerged during the analysis: the CH nurse’s agenda, the CH nurses opinions about the father’s role, CH nurse’s perceptions of their role in involving fathers, and the Obstacles CH nurses face when trying to involve fathers. All CH nurses stated that fathers are relevant and important to their child. They stated that it was important for the father to find his role within the family. CH nurses warned that if the father did not stay involved, he would lose valuable insight into his child’s growth and development. CH nurse’s general attitudes were that it is up to the family to decide on the father’s involvement, and CH nurses viewed themselves as available professionals for all parents attending the CHCs.
Conclusions: CH nurses see themselves as active agents in promoting father involvement; however their rhetoric and their perceived actions did not always match.
Keywords: Health Policy, Health Communication
CORRESPONDING AUTHOR: Wells Michael, Uppsala University, Uppsala, michael.wells@kbh.uu.se
P491
“NOW I WANT TO KNOW IF I AM DOING IT ALL WRONG OR…WHAT IS IT WITH THIS CHILD? BECAUSE IF THERE IS A DIAGNOSIS I CAN UNDERSTAND” VIDEO INTERVIEWS WITH COUPLES WHOSE CHILD RECENTLY RECEIVED AN AUTISM DIAGNOSIS IN HUNGARY
Róza ZS .
KRE Károli Gáspár University, Department of Psychology, Budapest, Hungary
Background: Autism spectrum disorders comprise 3 main symptoms: (1) problems in communication and social interaction (2) limited or very specific interests, and (3) stereotypic, repetitive behaviours. Most children do not receive their diagnosis until they are 3-5 years old, although 76% of parents in a survey described they had observed unusual behaviour of their children before 35 months of age. So if parents observe problems early, but 42% only turn to or find the right experts after the child turns 3, questions of accessibility of services arise.
Aims. To investigate experiences of couples in their process of receiving the diagnosis of ASD and the effects of the child’s diagnosis on their couple relationship.
Methods: Videotaped in-depth interviews were conducted with 14 couples that had children 4,5-9 years of age with an ASD diagnosis (0,5-3 years prior to the interview). The interviews were transcribed verbatim and analysed using systematic text condensation.
Results: 6 themes emerged from the analysis: 1. Happy early couple relationship; 2. Something is wrong; 3. Fighting the battles; 4. Vanished plans; 5. Suffering from the environment’s reactions; and 6. Allied. Here we focus on themes 2 and 3. Something is wrong. Some parents realised early on that something was wrong, although many denied this for some time. Mothers often blamed themselves for not being competent enough in dealing with their child. Fathers were more prone to state there was a problem and started to look for information earlier in the process. Fighting the battles: All couples described their efforts to get a diagnosis using words such as fighting and championing. They felt left alone, questioned and frustrated, especially when clinicians were vague in their judgement of the child’s symptoms. Parents wanted to know what to do to help the child, but without a diagnosis they felt incapable. Often parents turned to the Internet to find more clues and many had already identified autism as a possible diagnosis when they finally met a professional with adequate competence. When they received the diagnosis, although parents experienced chock and sorrow, many also felt relieved.
Conclusions: Early intervention, including adjusting the environment to the needs of the autistic child, is essential to help children with ASD to reach their full potential. Parents can more easily deal with the diagnosis if they know what to do and get clear explanations. It seems that today, there is an unnecessary delay in diagnosing ASD in children despite the presence of highly competent specialised centres. Educational efforts to relevant professions dealing with surveillance and early education of children seems warranted.
Keywords: parent - child transaction, coping, couple-focused, family, disability
CORRESPONDING AUTHOR: Róza Zsuzsanna, KRE Károli Gáspár University, roza@dental.hu
P492
THE INTEGRATED MODEL OF CARE FOR INFLAMMATORY BOWEL DISEASE SUFFERERS IN AUSTRALIA: THE DEVELOPMENT OF THE PROTOCOL AND THE EFFECTS OF ITS IMPLEMENTATION
Mikocka-Walus A.1, Turnbull A. 2, Holtmann G.3, Andrews J.3
1 University of South Australia, Nursing and Midwifery, Adelaide, Australia
2 University of Adelaide, Psychology, Adelaide, Australia
3 Royal Adelaide Hospital, Gastroenterology, Adelaide, Australia
Background: Psychological co-morbidities are associated with poor outcome and increased health care utilization in patients with inflammatory bowel disease. A model of care that addresses the biopsychosocial dimension of disease is not routinely used to manage this condition. This paper describes the development of the protocol for and the effects of its implementation of the biopsychosocial integrated model of care for patients with IBD.
Methods: Three different approaches were used to guide and test the establishment of the model: 1) Collecting epidemiological data on mental health co-morbidities; 2)Targeting mental health problems; 3) Examining the effects of the model implementation.
Results: High rates of anxiety and depressive symptoms (36% and 13%, respectively) that are maintained over time were identified in consecutive IBD patients presenting at a tertiary teaching hospital. Patients with documented psychological co-morbidities were more likely to be hospitalised than those without (OR = 4.13, 95% CI: 1.25, 13.61). Improvements in disease activity, anxiety, depression, QOL and coping have been noted when cognitive-behavioural therapy (CBT) was provided to patients. A drop in the use of opiates (p = 0.037) and hospitalisation rates (from 48% to 30%) in IBD patients has been noted as a result of introduction of the changed model of care. In addition, the mean total cost of inpatient care was lower for IBD patients than controls [US$12,857.48 (US$15,236.79) vs. US$ 30,467.78 (US$ 53,760.20), p = 0.005].
Conclusion: Our data to date suggest that an integrated model of care for patients with IBD may yield superior long term outcomes in terms of medication use and hospitalization rates and reduce healthcare costs.
Keywords: mental health; public health; research to practice translation
CORRESPONDING AUTHOR: Mikocka-Walus Antonina, University of South Australia, antonina.mikocka-walus@unisa.edu.au
P493
NGA POU WAHINE: INTERVENTION RESEARCH TO PREVENT GAMBLING MISUSE FOR MAORI WOMEN IN NEW ZEALAND
Morrison L.
Taupua Waiora Maori Health Research, School of Public Health and Psycohosocial Studies, Auckland, New Zealand
Background: Māori women continue to misuse gambling more than non-Māori, leading to an increasing need for culturally appropriate interventions. Māori women are often described in research literature as being non-compliant as a result of not accessing gambling help services. Yet, little research has been undertaken on cultural and gender specific therapeutic methods to measure outcomes of behavioral change and gambling support systems for Maori women in New Zealand.
Objectives: To describe, the experiences and insights of an intervention programme used in the pilot study to determine its acceptability and applicability including measurement tools.
Method: In-depth interviews were undertaken with Maori women, family members and key stakeholders leading to refine the pilot and the processes of NPWI programme. The qualitative data were analysed using an inductive analysis, i.e., the themes, patterns and categories of analysis came from the data rather than being imposed on them before data collection and analysis to inform the full intervention.
Results: Participants believed their involvement influenced connection to their cultural identity, increased social support, knowledge and motivation to change gambling behaviour, greater awareness of self care and accessing external support to confront unresolved childhood and adult issues, i.e, sexual abuse and violent relationships. Barriers included literacy issues, limited resources, poor mental health and reticent women. Examples of these are presented in the paper.
Conclusions: The outcomes of the pilot study demonstrated that commitment to complete the programme had more to do with the use of culturally congruent metaphors and symbolism which Maori women understand, with which they can identify, are more likely to be accepted by those to whom the intervention is targeted. Maori facilitators who were trained provided appropriate information and education which assisted women to address gambling misuse and to remain committed to the intervention programme.
Keywords: Maori women, intervention research, indigenous, support group, gambling misuse
CORRESPONDING AUTHOR: Morrison Laurie, AUT Auckland, laurie.morrison@aut.ac.nz
P494
CONNECTING RURAL CANCER PATIENTS AND THEIR FAMILIES AND CARERS WITH PSYCHOSOCIAL SUPPORT: THE DEVELOPMENT OF A WEBSITE USING A PARTICIPATORY ACTION RESEARCH FRAMEWORK AND BEHAVIOURAL CHANGE THEORY
Gunn K.1, Turnbull D.1, McWha L.1, Davies M.1, Bidargaddi N.2, Olver I.3
1 University of Adelaide, Psychology, Adelaide, Australia
2 Country Health SA, Mental Health Research & Observatory Unit, Adelaide, Australia
3 Cancer Council Australia, -, Sydney, Australia
Rural cancer patients not only experience the psychosocial challenges associated with a diagnosis of cancer in any setting, but also face a number of additional stressors and barriers to psychosocial service use. Seventeen rural South Australian cancer patients completed semi-structured interviews about their perceptions of psychosocial services and how barriers to access could be overcome. The need for the development of a rurally-relevant resource on psychosocial services to not only inform this population about relevant psychosocial care but also address multiple attitudinal barriers to service use emerged through a thematic analysis. As a result, funding to develop a website was obtained from the State Government health body, the State peak cancer body and a university rural health school. This paper, based on Participatory Action Research principles, will describe how and why participants who identified problems and potential solutions in the first stage of the research (“insiders”), worked with the principal researcher (an “outsider”) to develop the interactive website, “Country Cancer Support”. The use of behavioral change theory to help overcome users’ attitudinal barriers to service use/ encourage help-seeking will also be detailed. For example, the website features quotes from rural cancer patients that convey approval of psychosocial service use by their peers (a behavioral change technique informed by the Theory of Reasoned Action, the Theory of Planned Behavior and the Information-Motivation-Behavioral Skills Model). Another example is the distress screening tool linked to a service directory that provides tailored information and feedback based on the Transtheoretical Model to encourage service use based on users’ particular level of readiness to change/access support. Pilot user satisfaction and acceptability testing of the website has demonstrated the value of employing the expert knowledge of consumers in conjunction with theory when developing such interventions, particularly among rural populations whose unique needs and perceptions are often overlooked or misunderstood. Preliminary results from a formal large-scale evaluation of the website’s usability, acceptability, reach and influence on users’ help-seeking intentions will also be discussed.
Keywords: participatory research, behavior change, cancer, web-based, information, community-intervention, e-Health
CORRESPONDING AUTHOR: Gunn Kate, University of Adelaide, Adelaide, kate.gunn@adelaide.edu.au
P495
IMMERSION IN FOREIGN CULTURE – INTERCULTURAL COMMUNICATION AT THE UNIVERSITY MEDICAL SCHOOL OF PÉCS, HUNGARY
Faubl N., Dr. Zuhorn F., Füzesi ZS.
University of Pécs, Behavioural Science Institute, Pécs, Hungary
Introduction, aims: The aim of our study was to evaluate how foreign medical students arriving to Hungary react to the totally unknown cultural environment, how their intercultural competence due to the new environment develop and how they can use it later on as practicing medical doctors in a multicultural environment.
Methods: The longitudinal study started in September 2009 first among German program students and later on among all of the English and German program medical students. Questionnaires were compiled with half-structured in-depth interviews and participant observation method. At the beginning of the study the questionnaires contained only opened questions to avoid researcher preconception and to better characterize the questions relevant for the research. One year later the opened questions were turned to closed questions with the help of the experiences gained. The foreign students were questioned concerning the topic several times: before arriving to Hungary, immediately after arrival, half a year, one and a half year, and several years later.
Results, conclusions: The following conclusions may be drawn on the basis of the evaluations done to date:
- Foreign students are motivated first of all to choose Hungary because of the possibility to start university studies.
- A great deal of them has previous experiences abroad, so the difficulties at start are not burdening for them.
- Questionnaires filled in half a year, one and a half year, or several years after starting studies show that a part of the students move in the direction of ethnorelativity, but others remain at different levels of ethnocentric phases. The latter may be explained by the essential motivation, i.e. focusing on studies, and the limited time they intend to spend in Hungary. The participant observations and the in-depth interviews done among upper semester students also support these conclusions. The long term aim of the follow up study is to reveal in details the initiation and development of intercultural competence and how this competence may be applied by foreign students coming to Hungary.
Keywords: Knowledge integration, Culture
CORRESPONDING AUTHOR: Faubl Nóra, University of Pécs, Hungary, nora.faubl@aok.pte.hu
Understanding the role of psychological factors in musculoskeletal disorders
S496
UNDERSTANDING THE ROLE OF PSYCHOLOGICAL FACTORS IN MUSCULOSKELETAL DISORDERS
Dekker J.
VU University Medical Center, Rehabilitation Medicine, Amsterdam, The Netherlands
Psychological factors play a crucial role in musculoskeletal disorders. Depression, fear, avoidance and other psychological factors are well-known risk factors for a poor prognosis: these psychological factors predict future pain and disability.
This field is moving in the direction of an improved theoretical understanding of the role of psychological factors in musculoskeletal disorders: knowledge on risk factors is being integrated into explanatory models or theories. Knowledge on risk factors as such is not enough, as a risk factor only provides prognostic information and does not offer an explanation of how pain and disability develop. Improved understanding of the role of psychological factor is an important step, as it contributes to our understanding of the etiology of pain and disability in musculoskeletal disorders. Improved understanding is expected to contribute to the development of more effective psychological interventions in musculoskeletal disorders.
The overall objective of this symposium is to present and discuss cutting edge research on the role of psychological factors in musculoskeletal disorders. Symposium contributors will present major advances in our understanding of the impact of psychological factors on pain and disability.
Dr. Hawker (Canada) will address the link between pain and depression in osteoarthritis. She will present evidence that pain determines subsequent depressed mood, through its effect on fatigue and disability. These effects lead to worsening of pain and disability over time. Dr. Holla (Netherlands) will address avoidance of activity in osteoarthritis. She will provide evidence that pain and negative affect cause patients to avoid activities, which results in lower muscle strength and disability. Dr. Kamper (Australia) will address fear of movement in whiplash injury. His research shows that fear of movement explains the relationship between pain and disability. Dr. Hurley (UK) will address the impact of treatment on health beliefs in chronic knee pain. He found that treatment seems to increase patients' beliefs in safety and utility of exercise and exercise self-efficacy, rather than beliefs about causation and prognosis.
Together, these presentations provide an overview of forefront research explaining the role of psychological factors in musculoskeletal disorders. The symposium provides a platform for discussions on further explanatory research and applications in clinical practice.
Keywords: Arthritis, Musculoskeletal Disorders, Pain, Depression, Anxiety
CORRESPONDING AUTHOR: Dekker Joost, VU University Medical Center, j.dekker@vumc.nl
S497 A LONGITUDINAL STUDY TO EXPLAIN THE PAIN-DEPRESSION LINK IN OLDER ADULTS WITH OSTEOARTHRITIS
Hawker A.
University of Toronto, Toronto, Canada
Objective: To evaluate whether osteoarthritis (OA) pain determines depressed mood, taking into consideration fatigue, disability, and controlling for other factors.
Methods: In a community cohort with hip/knee OA, telephone interviews assessed OA pain and disability (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC), fatigue (Multidimensional Fatigue Symptom Inventory), depressed mood (Center for Epidemiological Studies Depression Scale) and covariates (demographics, self-rated health, comorbidity, pain coping, pain catastrophizing, and social support) at three time points over two years. Drawing on previous research, a path model was developed to test the inter-relationships among the key concepts (pain, depression, fatigue, disability) over time, controlling for covariates.
Results: Baseline mean age was 76 years; 72% were female, 39% were living alone, and 27% had 3+ comorbid conditions. WOMAC scores indicated moderate OA symptoms and disability. From the final model with 529 subjects, adjusting for covariates, we found that: current OA pain strongly predicted future fatigue and disability, both short and long term; fatigue and disability in turn predicted future depressed mood; depressed mood and fatigue were inter-related such that depressed mood exacerbated fatigue and vice versa; and fatigue and disability, but not depressed mood, led to worsening of OA pain.
Conclusions: Controlling for other factors, OA pain determined subsequent depressed mood through its effect on fatigue and disability. These effects led to worsening of pain and disability over time. These results support the need for improved pain management in OA to prevent or attenuate the downstream effects of pain on disability and mood.
Keywords: arthritis, pain, disability, mood, health outcomes, longitudinal research
CORRESPONDING AUTHOR: Hawker Gillian, University of Toronto, Canada, g.hawker@utoronto.ca
S498
AVOIDANCE OF ACTIVITIES IN EARLY SYMPTOMATIC KNEE OSTEOARTHRITIS: RESULTS FROM THE CHECK COHORT
Holla J.1, Van der Leeden M.1, Knol D.2, Peter W.1, Roorda LD.3, Lems W.4, Wesseling J.5, Steultjens M.6, Dekker J.7
1 Reade, Rehabilitation Research, Amsterdam, The Netherlands
2 VU University Medical Center, Clinical Epidemiology and Biostatistics, Amsterdam, The Netherlands
3 Reade, Rehabilitation Medicine, Amsterdam, The Netherlands
4 VU University Medical Center, Rheumatology, Amsterdam, The Netherlands
5 University Medical Center Utrecht, Rheumatology and Clinical Immunology, Utrecht, The Netherlands
6 Glasgow Caledonian University, Institute of Applied Health Research and School of Health, Glasgow, United Kingdom
7 VU University Medical Center, Rehabilitation Medicine, Amsterdam, The Netherlands
Objective: Pain-related avoidance of activities is hypothesized to lead to lower muscle strength and thereby activity limitations. Negative affect (e.g. low vitality, depression) is thought to strengthen the tendency to avoid activities. The aim of the present study was to assess the validity of this ‘avoidance model’ in patients with early symptomatic knee osteoarthritis (OA).
Methods: Data of 151 participants of the Cohort Hip and Cohort Knee (CHECK) study were used in this cross-sectional study. The associations between pain, negative affect, avoidance, muscle strength and activity limitations were modeled (linear regression) using path analysis. Mediation of the relationship between pain and muscle strength by avoidance was tested using bootstrapping. Mediation of the relationship between avoidance and activity limitations by muscle strength was also tested. Moderation of the association between pain and avoidance by negative affect was tested using an interaction term.
Results: Pain and negative affect were associated with lower muscle strength via avoidance of activities (mediation by avoidance). Avoidance of activities was associated with activity limitations via lower muscle strength (mediation by muscle strength). Pain, negative affect, avoidance, muscle strength and activity limitations were also directly associated with each other.
Conclusion: The avoidance model seems to offer a valid explanation of the associations between pain, negative affect, avoidance of activities, muscle strength and activity limitations in patients with early symptomatic knee OA. Further confirmation in a longitudinal study is required.
Keywords: Pain, Coping, Musculoskeletal disorders, Physical activity, Disability
CORRESPONDING AUTHOR: Holla Jasmijn, Reade, Amsterdam, j.holla@reade.nl
S499
DOES FEAR OF MOVEMENT MEDIATE THE RELATIONSHIP BETWEEN PAIN INTENSITY AND DISABILITY IN PATIENTS FOLLOWING WHIPLASH INJURY? A PROSPECTIVE LONGITUDINAL STUDY
Kamper SJ.1, Maher CG.1, Costa LCM.1, McAuley JH.2, Hush JM.3, Sterling M.4
1 The George Institute, University of Sydney, Musculoskeletal Division, Sydney, Australia
2 Neuroscience Reseach Australia, -, Sydney, Australia
3 Faculty of Health Sciences, University of Sydney, -, Sydney, Australia
4 Centre for National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Brisbane, Australia
Pain and disability are cardinal symptoms of many musculoskeletal conditions, including whiplash associated disorders. While a strong association between the two constructs is well-recognized, the mechanism by which pain leads to disability is poorly understood. The Fear Avoidance Model is one theory proposed to explain this relationship in the field of musculoskeletal pain. The aim of this study was to test the capacity of the Fear Avoidance Model to explain the relationship between pain and disability in patients with whiplash-associated disorders. Using the method of Baron and Kenny, we assessed the mediating effect of fear of movement on the cross-sectional and longitudinal relationships between pain and disability. Two hundred and five subjects with neck pain due to a motor vehicle accident provided pain intensity (0-10 numerical rating scale), two measures of fear of movement (Tampa Scale of Kinesiophobia and Pictorial Fear of Activity Scale) and disability (Neck Disability Index) scores within 4 weeks of their accident, after 3 months, and after 6 months. It was found that baseline pain intensity has only a modest relationship with disability scores at follow-up (Pearson’s r = 0.43). Mediation analyses were consistent with the Fear Avoidance Model mediating approximately 20% to 40% of the relationship between pain and disability. Contrary to our initial hypothesis, the proportion of the total effect of pain on disability that was mediated by fear of movement did not substantially change as increasing time elapsed after the accident. The proportion mediated was slightly higher when fear of movement was measured by Tampa Scale of Kinesiophobia as compared with Pictorial Fear of Activity Scale. The findings of this study suggest that the Fear Avoidance Model plays a role in explaining a moderate proportion of the relationship between pain and disability after whiplash injury. While providing qualified support for the Fear Avoidance Model, these findings also highlight the multidimensional nature of pain-related disability and the need to investigate other explanations for the relationship between the two constructs.
Keywords: Pain; Disability; Cognitive factors
CORRESPONDING AUTHOR: Kamper Steven J, The George Institute, Sydney, skamper@george.org.au
S500
DOING IS BELIEVING: HEALTH BELIEFS BEFORE AND AFTER EXERCISED-BASED REHABILITATION FOR CHRONIC KNEE PAIN
Hurley M.1, Walsh N.2
1 St George's University of London, Faculty of Health and Social Care Sciences, London, United Kingdom
2 University of the West of England, Faculty of Health and Life Sciences, Bristol, United Kingdom
Background: An integrated exercise-based rehabilitation programme, Enabling Self-management and Coping with Arthritis knee Pain through Exercise (ESCAPE-knee pain), improves pain and physical disability of people with chronic knee pain. Qualitative interviews were used to understand how and why ESCAPE-knee pain works.
Methods: 29 people involved in the quantitative study evaluating the ESCAPE-knee pain programme, were interviewed before and after participation on the programme. Semi-structured interviews were used to explore participants' experiences of living with knee pain, their understanding and beliefs about their condition, and management strategies adopted. The same participants were re-interviewed after completing the programme to explore their experiences of the programme, its impact on their beliefs about knee pain and their views about the management of their condition.
Analysis: A thematic analysis was conducted. Interviews were audio taped, transcribed verbatim, read several times by two researchers independently to familiarise themselves with the data, met to identifying themes and agree a coding scheme and resolve differences in coding and interpretation.
Results: Initially people had poor understanding and negative, fatalistic beliefs about the management or prognosis for knee pain. Following the programme the majority of participants had positive experiences, improvement in pain, physical and psychosocial functioning, greater knowledge and understanding of their condition and treatment options, and in their ability to use exercise to control symptoms. Beliefs about the causation and prognosis of knee pain were unchanged, but concerns about possible dangers of exercise decreased. They appreciated how exercise could reduce symptoms (treatment beliefs) and their confidence in their ability to use exercise to control symptoms (exercise self-efficacy) increased. These improvements were attributed to the content and structure of the programme, and the care and guidance of the physiotherapist.
Conclusions: ESCAPE-knee pain improves physical and psychosocial functioning of people with chronic knee pain by increasing people's treatment belief in safety, the utility of exercise to control symptoms and exercise self-efficacy, rather than alteration in their beliefs about causation or prognosis.
Keywords: Pain; Exercise; Rehabilitation; Health beliefs
CORRESPONDING AUTHOR: Hurley Michael, St Georges University of London, michael.hurley@sgul.kingston.ac.uk
New approaches to understanding the needs of vulnerable populations
S501
NEW APPROACHES TO UNDERSTANDING THE NEEDS OF VULNERABLE POPULATIONS
Brown P.
University of California, Merced, Department of Public Health, Merced, USA
Understanding the needs of vulnerable populations, and distinguishing between an individual’s ‘needs’ and ‘wants,’ is a key challenge facing health providers, funders, and researchers in all health systems. The three papers in this symposium present new ways of identifying the needs of vulnerable populations. The first paper, by Anna Song (Assistant Professor of Psychology) focuses upon how we measure disparities and the extent to which analytic methods accurately capture the "burden" on a community. Dr. Song focuses on the impact of gambling on communities in California, and the extent to which vulnerable populations are overlooked using traditional epidemiological approaches. As such, this research takes a social epidemiological approach to needs identification. The second paper by Laura Wilkinson-Meyers (Assistant Professor in Health Services Research) examines the resources that disabled people need to live an ordinary life in the community in New Zealand. Dr. Wilkinson-Meyers uses a modified budget standards approach that is based on economic principles of costing and resource allocation. As the research was a partnership with disabled researchers in New Zealand, it highlights a number of aspects of translational and transdisciplinary research approaches as applied to the disabled community. The third paper by Chris Stephens (Professor of Psychology at Massey University) introduces a capabilities approach to understanding the needs of elderly people in New Zealand. Based on a framework initially proposed by Sen, the capability approach avoids problems associated with identifying the meaning of material goods by focusing on choices in purchasing, access to social participation, and freedom to access other valued needs. This approach represents a different way of viewing needs for a particular vulnerable population. Taken together, these three papers will address a common issue – needs identification – using three different approaches for three different populations.
Keywords: Disparities, Methodology
CORRESPONDING AUTHOR: Brown Paul, UC Merced, CA, pbrown3@ucmerced.edu
S502
USING GAMBLING-RELATED BURDEN TO IDENTIFYING VULNERABLE GROUPS AND HEALTH DISPARITIES
Song A.1, Saw A.2, Volberg R.3
1 University of California, Merced, Health Psychology, Merced, USA
2 University of California, Davis, Psychology, Davis, USA
3 Gemini Research, LTD, -, Northampton, USA
Background: Previous attempts to identify ethnic groups vulnerable to problem and pathological gambling have provided unclear results. For example, in the United States, the California Gambling Surveillance Survey identified African Americans as having the highest rates of pathological gambling, compared to all other ethnic groups. This same survey suggested that Asian Americans gamble less than other ethnic groups. This last finding is contrary to other studies and the gambling industry’s focus on Asians. The current study proposes that existing epidemiological practices do not adequately identify vulnerable groups and that measuring individual and community burden may be a useful framework to examine health disparities.
Methods/ Description: The current study reanalyzes the California Gambling Surveillance Survey, which was a telephone survey of 7,121 Californian adults. The survey included gambling behavior, gambling-related problems, gambling-related cognitions, and demographics as well as other psychosocial correlates. In addition, the survey included the NORC DSM-IV Screen for Gambling Problems (NODS), which is based on the DSM-IV criteria for gambling addiction.
Results/Outcomes: Compared to all other ethnic groups, African Americans have significantly higher rates of pathological gambling. Both African American and Asian Americans have higher levels of problem gambling. In terms of burden, both African and Asian Americans lose more money to gambling, think about past and future bets, and exhibit evidence of tolerance. Moreover, compared to other ethnic groups, Asian Americans are more likely to feel as though gambling is a problem in their community (F(4,7063) = 15.98, p < .001), and family (F(4,7049) = 33.18, p < .001).
Conclusions: These results demonstrate that some ethnic groups may disproportionately suffer from gambling-related consequences. In this regard, traditional methods used to identify vulnerable populations may be missing groups that bear significant gambling-related burdens. Moreover, these traditional methods may overlook cultural variation on how gambling problems manifest itself within an ethnic community.
Keywords: Health Disparities Methodological Issues Ethnic Differences Addictive behaviors
CORRESPONDING AUTHOR: Song Anna, University of California, Merced, avsong@gmail.com
S503
ADAPTING BUDGET STANDARDS TO IDENTIFY THE ADDITIONAL RESOURCES AND COSTS ASSOCIATED WITH DISABILITY
Wilkinson-Meyers L.1, Brown P. 2
1 University of Auckland, School of Population Health, Health Systems Section, Auckland, New Zealand
2 University of California, Merced, School of Social Sciences, Humanities and Arts, Merced, USA
Disabled people have long advocated for sufficient resources to live a life with the same rights and responsibilities as non-disabled people. Identifying the unique resource needs of disabled people relative to the population as a whole is critical for matters of priority setting and for funding consideration. Previous attempts to identify the resources and costs associated with disability have tended to rely on surveys of current resource use rather than focusing upon the resources that would be required to achieve a similar standard of living as non-disabled people. Many of these studies have been criticised for underestimating the needs of disabled people and for using approaches that are not acceptable to or appropriate for the disabled community. This paper presents the rationale for and details of an alternative methodology for identifying and prioritising the needs of disabled people using a mixed methods approach. The project represents a partnership effort between disabled researchers, a disability support organisation and academic researchers and uses a participatory approach to engage members of the disabled community in an exercise to build consensus about the resources required to reduce and remove barriers to participation in everyday living. A research design is presented that incorporates a social model of disability framework and an economic cost model based on budget standards to estimate the additional support, equipment, travel and time required to live an ‘ordinary life’ in the community. Both the theoretical and practical challenges of developing a methodology that is acceptable to the disabled community and service providers and funders will be discussed. The approach is presented as a useful model for identifying needs of groups for whom knowledge of experiences, circumstances and needs remains limited.
Keywords: Disability, Methodological Issues
CORRESPONDING AUTHOR: Wilkinson-Meyers Laura, University of Auckland, Auckland, l.wilkinson-meyers@auckland.ac.nz
S504
MEASURING LIVING STANDARDS OF OLDER PEOPLE USING SEN’S CAPABILITY APPROACH
Stephens C.1, Breheny M.1, Mansvelt J.2
1 Massey University, NZ, School of Psychology, Palmerston North, New Zealand
2 Massey University, NZ, School of People, Environment and Planning, Palmerston North, New Zealand
Living standards are an effective way to assess socioeconomic status in relation to health, but controversy remains about their assessment, particularly for older people. Sen’s capability framework shifts attention from material conditions to opportunities for choice enabled by material resources. Using this approach, living standards are understood to vary from constraint to freedom. To develop this promising approach, measures to assess capabilities are required. This paper reports on three stages in the development of a measure of living standards for older people based on Sen’s capability framework.
Qualitative Enquiry: To identify older people’s valued needs, semi-structured interviews were conducted with 143 men and women aged 63-93 who represented the range of deprivation, ethnic groups, and locations across New Zealand. Thematic analysis established 5 living standard domains important to all respondents: Physical Comfort, Social Integration, Contribution, Enjoyment, and Security.
Item Development Survey: Using the participants’ own words, items to assess the extent of freedom to pursue desired ends were developed in each of 5 domains. The 75 item questionnaire was tested for face validity in interviews. A revised version was administered in a postal survey of 2,000 over 65 years randomly selected from the New Zealand electoral roll. Exploratory factor analysis (PCA) of the responses reduced the items to 20. Five factors equating to the five theoretical domains were found. Owing to conceptual overlap between the domains the factors were allowed to correlate.
Validation survey: The twenty item instrument was included in a nationally representative survey of 3,500 New Zealanders aged 55 to 85. The factor structure of the measure was confirmed and convergent and divergent validity tested using correlations with measures of living standards (income, assets, hardship), physical and mental health (SF36), and quality of life (WHOQoL).
Results to date show that the ELSI-Elder, is a valid and reliable instrument to be used in the field to assess living standards and health. A capabilities approach solves problems of the meanings of material goods by focusing on freedom to access valued needs. Inequalities in these freedoms are related to inequalities in health across the gradient.
Keywords: Aging, Health disparities,
CORRESPONDING AUTHOR: Stephens Christine, Massey University, PN, c.v.stephens@massey.ac.nz
Behavioral Medicine Approaches in CVD
O505
ILLNESS PERCEPTIONS AND MISCONCEPTIONS ABOUT HEART DISEASE IN PATIENTS AND PARTNERS: A PILOT STUDY
Figueiras M., Monteiro R., Caeiro R., Trigo M.
Instituto Piaget, Psychology, Almada, Portugal
Illness perceptions of patients and partners have demonstrated a significant impact on recovery. The present pilot study has characterized and compared the illness perceptions and misconceptions about heart disease in Portuguese patients and their partners, as well as their association with mood (anxiety and depression) and personality traits (optimism and negative affect). The 46 patients (and 32 partners) completed a self-administered questionnaire which included measures of illness perceptions, cardiac misconceptions, mood, personality measures, drawings of the heart and demographic information. The results indicated that there are significant differences on patients’ illness perceptions and misconceptions according to sex, age, professional status and exercise behavior. The partners reported higher levels of concern and higher misconceptions about arguing than patients. The height and area of the patients’ drawings were associated with specific dimensions of illness perceptions about heart disease. This combined approach contributes to a better understanding about how personal beliefs and misconceptions about heart disease may influence adjustment.
Keywords: Coronary heart disease; Health beliefs
CORRESPONDING AUTHOR: Figueiras Maria Joao, Instituto Piaget, Almada, mfigueiras@almada.ipiaget.org
O506
DEPRESSIVE SYMPTOMS AND SUBCLINICAL ATHEROSCLEROSIS IN ANDEAN HISPANICS: RESULTS FROM THE PREVENCION STUDY
Chirinos D.1, Medina-Lezama J.2, Paz-Manrique R.2, Corrales-Medina F.2, Khan Z.3, Waheed Raja M.3, Chirinos J.3
1 University of Miami, Department of Psychology, Miami, USA
2 Santa Maria Catholic University, Research Institute, Arequipa, Peru
3 University of Pennsylvania, Philadelphia Veterans Administration Medical Center, Philadelphia, USA
Growing literature indicates that depressive symptoms are associated with subclinical atherosclerosis. The possible mediating pathways remain unclear, however recent reports indicate a possible mediating role of the Metabolic Syndrome (MetS). Limited research on the topic has involved Hispanics. This study aimed to determine the relationship between depressive symptoms and carotid intima-media thickness (cIMT) among unselected Andean Hispanic adults after adjusting for the MetS components (waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol and glucose levels). We studied 496 adults (211 men and 285 women) enrolled in a population-based study in Peru. cIMT was measured with high-resolution ultrasonography. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) depression score. Mean depression scores were 5.21 for men and 5.89 for women (P = 0.04). In univariate linear regression, depressive symptoms were significantly associated with cIMT in both men (β = 0.28; P < 0.001) and women (β = 0.17; P = 0.004). After adjusting for MetS components, depressive symptoms remained significantly associated with cIMT in men (β = 0.26; P < 0.001) but not in women (β = 0.05; P = 0.278). The relationship remained significant for men even after further adjustment for age and low-density lipoprotein cholesterol (β = 0.12; P = 0.031). We found an important, independent relationship between depressive symptoms and subclinical atherosclerosis among Andean Hispanic men but not women. The relationship between subclinical atherosclerosis and depressive symptoms in women was mediated by MetS components. Further research with prospective data is needed to elucidate the mediating role of the MetS in this relationship.
Keywords: Depression, Carotid Intima-Media Thickness, Andean Hispanics, Cardiovascular Disease, Latin America
CORRESPONDING AUTHOR: Chirinos Diana, University of Miami, FL, dchirinos-medina@psy.miami.edu
O507
EFFECTS OF DEGREE OF URBANISATION ON THE RISK OF RECURRENT ACUTE MYOCARDIAL INFARCTION BASED ON OVER 775,000 INCIDENTS FOLLOWED FOR 30 YEARS
Gulliksson M.1, Wedel H.2, Köster M.3, Svärdsudd K.1
1 Uppsala University, Public Health and Clinical Medicine, Uppsala, Sweden
2 Gothenburg University, School of Public Health, Gothenburg, Sweden
3 National Institute for Health and Welfare, Epidemiology, Stockholm, Sweden
Background: Geographical differences in first acute myocardial infarction (AMI) incidence between and within countries are well known. Whether similar differences in recurrent AMI risk between and within countries exist has been less well explored. We tested whether there are geographical differences in recurrent AMI risk within Sweden, and if so, what geographic factor best explains the differences.
Methods and Results: The study was based on the national Swedish myocardial infarction register, covering the time period 1972-2001 and containing more than one million AMI events. After exclusions of events occurring in individuals younger than 20 or older than 84, and events with uncertain first infarction and geographical status, 775,901 events remained for analysis. Considerable geographical variation in recurrent AMI risk was found. As measures of geographic variation, residential area coordinates (longitude and latitude), population size and population density (population per square kilometer) were used. After adjustment for the influence of age, sex, calendar year of incident (proxy for changing incidence and survival), recurrent AMI number and co-morbidity conditions (proxies for disease severity), population density remained as the only significant geographic determinant of recurrent AMI risk. The relationship between population density and risk was equal for men and women, non-linear with highest levels in areas with extremely low or high population density and lowest in areas with moderate density.
Conclusions: There was a considerable geographical variation in recurrent AMI risk, equal for men and women, best explained by residential area population density.
Keywords: cardiovascular disease, physical environment
CORRESPONDING AUTHOR: Burell Gunilla, Uppsala University, Uppsala, gunilla.burell@pubcare.uu.se
O508
COMPARATIVE STUDY BETWEEN TWO METHODS OF PRE-OPERATORY EVALUATION (ASA- AMERICAN SOCIETY OF ANESTHESIOLOGISTS VERSUS SOCESP- SOCIETY OF CARDIOLOGY OF SAO PAULO STATE) IN NON-CARDIAC SURGERIES FOR CARDIAC PATIENTS
Liporoni M., Marretto R., Mello A., Rodrigues C., Freitas A., Barbosa G., Junior S.
University of Uberaba , Cardiology, Uberaba, Brazil
Introduction: The approach of patients undergone to non-cardiac surgical procedures has been the focus of modifications and great scientific interest in the last years. Despite operation complications occur in low percentage, the high volume of procedures makes these absolute numbers become significant, not only to public health data in general, but specifically from the perspective of cardiology, since most of the complications that cause high morbity and mortality rates is of cardiovascular origin.
Objectives: To compare two scales of perioperative risk, the American Society Anesthesiologists (ASA) versus Society of Cardiology of Sao Paulo State, aiming to determine which has higher sensitiveness and specificity to predict intra and postoperative complications in non-cardiac surgeries for cardiac patients.
Materials and Methods: Descriptive and transversal study conducted in the wards of the University Hospital of the University of Uberaba between March and July of 2011 with fifty cardiac patients undergone to non-cardiac surgery. Data were obtained through bedside interviews with patients by researchers. They were evaluated using ASA’s and SOCESP’s scale. Statistical analysis was achieved utilizing the nonmatched Student t-test to compare the quantitative data, the chi-squared test for qualitative data, statistics of average and standard deviation.
Results: It was observed that there was a predominance of female patients among the surgeries done. The age range of higher representativeness was between 40 and 79 years old and the most related comorbidities were systemic hypertension, diabetes mellitus II and obesity. Most of surgeries were elective. According to SOCESP rank, most patients were of very low risk and according to ASA’s type II predominated. There were no surgical complications or deaths during the study period.
Conclusion: There was no significant difference between SOCESP’s and ASA’s scale regarding the risk of complications and deaths due to a surgery. However, at SOCESP’s it was observed the presence of patients classified as high risk while at ASA’s it was not observed, being this the only difference found between classifications.
Keywords: Surgery; Co-morbidities
CORRESPONDING AUTHOR: Liporoni Mariana, Universidade de Uberaba, mariliporoni@yahoo.com.br
O509
DEVELOPMENT AND EVALUATION OF A COMPUTER-ADAPTIVE TEST FOR THE ASSESSMENT OF FUNCTIONING IN DAILY LIVING, DEPRESSION AND ANXIETY IN REHABILITATION PATIENTS WITH CARDIOVASCULAR DISEASES (REHACAT-CARDIO)
Baumeister H.1, Abberger B.1, Haschke A.1, Bengel J.1, Kroehne U.2, Wirtz M.3
1 University of Freiburg, Insitute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Freiburg, Germany
2 German Institute for International Educational Research, -, Frankfurt, Germany
3 University of Education Freiburg, Department of Research methods, Freiburg, Germany
Background: The assessment of psychosocial aspects of patients with cardiovascular diseases needs to be economic and psychometrically sound. Computer-adaptive tests (CAT) combine these often mutually exclusive requirements. The present study aimed at the development and evaluation of a CAT for the assessment of functioning in daily living (FDL), depression and anxiety in rehabilitation patients with cardiovascular diseases (RehaCAT-Cardio).
Methods: The RehaCAT-Cardio is based on three unidimensional, calibrated item-banks for the domains FDL (33 items), depression (36 items) and anxiety (37 items). 138 participants from three cardiac rehabilitation units were assessed at the beginning and the end of rehabilitation with the RehaCAT-Cardio, HADS and SF-12. Items needed for test completion were assessed based on three different test termination criteria (SE of theta ≤ .32, ≤.40, ≤.50). Construct validity, sensitivity to change and test stability were calculated (r; standardized-response mean (SRM)).
Results: Patients needed between 6 and 28 items to complete each domain. This corresponded with a completion time between 35 seconds and 3:47 minutes per domain. Convergent validity (for SE ≤ .32: FDL: -.61; depression: .72; anxiety: .72) and discriminant validity (for SE ≤ .32: FDL: .30; depression: -.35; anxiety: -.41) proved to be high. Moderate to high change scores were found for depression and anxiety (n = 107; FDL: SRM = .35; depression: SRM = .58; anxiety: SRM = .82). Correlations between pre- and post-assessment were high, indicating high test stability (n = 107; daily functioning: r = .724; depression: r = .717; anxiety: r = .814).
Conclusion: The RehaCAT-Cardio is an economic and psychometrically sound assessment of three core domains of psychosocial health. Forthcoming subgroup analyses and simulation studies might help to further diminish the number of items needed for test termination.
Keywords: Cardiovascular disease, Computers, Assessment
CORRESPONDING AUTHOR: Baumeister Harald, University of Freiburg, Freiburg, harald.baumeister@psychologie.uni-freiburg.de
O510
COMMUNICATION ABOUT SEXUAL CONCERNS WITHIN HEALTH SERVICES FOR PEOPLE WITH CARDIOVASCULAR DISEASE: A COMPARISON OF SERVICE PROVIDERS’ AND SERVICE USERS’ VIEWS
Byrne M.1, Doherty S.2, Murphy A.W.3, McGee H. M.2
1 NUI, School of Psychology, Galway, Ireland
2 Royal College of Surgeons in Ireland, Department of Psychology, Dublin, Ireland
3 NUI, Discipline of General Practice, Galway, Ireland
Background: Sexual problems are prevalent among people with cardiovascular disease, adversely impacting on quality of life and wellbeing. Communication in this area is poor and health professionals are reluctant to address sexual issues with patients. Our aim was to compare the views of service users and service providers about communication experiences, barriers and preferences to develop services in Ireland.
Method: Telephone surveys were completed by 380 patients who had recently completed cardiac rehabilitation. Postal questionnaires were completed by 60 hospital cardiac rehabilitators and 61 general practitioners. All three samples were recruited in Ireland and were nationally representative.
Results: Sex was rarely discussed with health professionals, yet 50% of patients said they would have liked this opportunity. Men reported finding it easier than women to discuss sexual issues with a health professional. Barriers to discussing sexual issues for patients included: issue being raised in a group setting, not feeling ready to discuss sex and embarrassment. Most general practitioners (70%) don’t address sexual issues with their patients; they reported not raising the issue to avoid offending patients. The majority of cardiac rehabilitators (almost 61%) reported that sexual problems were poorly addressed within their service. Barriers for service providers included lack of time, lack of awareness of guidelines, no training and lack of confidence. Patients perceived fewer barriers to communication than health professionals. Proposed ways in which services could be improved in this area: training for staff, increase in referral services; clinical guidelines; resources for patients; and increased general education.
Conclusion: Services in this area could be improved by increasing awareness among service providers that the majority of patients would like to be asked about their sexual concerns, in a private setting. Training for health professionals, increasing awareness among the general public and developing support resources for patients are recommended.
Keywords: Sexuality; Coronary Heart Disease
CORRESPONDING AUTHOR: Byrne Molly, National Uni of Ireland, Galway, molly.byrne@nuigalway.ie
Health Behaviors Across the Lifespan
O511
WHAT TYPES OF OUTCOME EXPECTATIONS PREDICT YOUNG MEN'S FRUIT AND VEGETABLE INTAKE?
Hankonen N.1, Kinnunen M.2, Absetz P.2, Jallinoja P.2
1 University of Helsinki, Social Psychology, Helsinki, Finland
2 National Institute for Health and Welfare, Department of Lifestyle and Participation, Helsinki, Finland
Background: Social cognition models, such as the Health Action Process Approach (HAPA), typically hypothesize beliefs regarding behavioral outcomes to influence intentions and behavior. However, measurement is often restricted to few, long-term and health-related factors only. In order to plan more effective interventions, a more varied set of outcome expectations should be evaluated in target populations. We studied which outcome expectations predict fruit and vegetable consumption (FV) and its changes among young Finnish men in the military service.
Method: In the DefenceNutri Study, participants responded to questionnaires on social cognitive factors (HAPA variables) and a food frequency questionnaire on entering the military service (N = 2953) and after 6 months. The data was analysed using structural equation modeling (Mplus program).
Results: All types of outcome expectations (physical well-being, difficulty, social punishment, taste) were correlated with the intention to eat FV. Within the SEM model to test HAPA, expectancies regarding FV outcomes on physical well-being and taste remained significant predictors of intention to eat FV, along with self-efficacy and perceived health risk. Intention in turn predicted planning and FV eating behavior.
Changes in health cognitions during the six months in the military were negative: expectations of beneficial effects of FV on physical well-being decreased (p < .001), and expectations of social punishment for FV intake increased (p < .001). In testing the HAPA model in a longitudinal design, the relationships remained largely the same, except that the changes in planning did not predict changes in behavior. The explained variance in intention and behavior was low.
Discussion: Distinguishing between more specific domains of behavioural outcomes seems useful. Our findings suggest that messages on FV’s good taste and user experiences of beneficial influences on physical well-being might increase effectiveness of future interventions to promote FV consumption among young men.
Keywords: Health behavior change, Outcome expectations, Diet, Motivation, Longitudinal research
CORRESPONDING AUTHOR: Hankonen Nelli, University of Helsinki, nelli.hankonen@helsinki.fi
O512
WELL-BEING IN ADOLESCENCE – AN ASSOCIATION WITH HEALTH-RELATED BEHAVIOURS
Booker C.
Univerity of Essex, Institute for Social & Economic Research, Colchester, UK
Objectives: Health behaviours and well-being in youth may set the stage for better or worse health later in life. Well-being during adolescence may be influenced by health behaviours. The objective of this study was to investigate the demographic distribution of selected health behaviours, and their relationship with different indicators of well-being.
Design: Wave 1 of household panel study
Setting: UK
Participants: Data are from the youth panel – age 10 to 15 years - of Understanding Society, the UK Household Longitudinal Study (N = 4,899).
Main Outcome Measures: The Strengths and Difficulties Questionnaire (SDQ) measured low well-being. Markers of happiness in different life domains were combined to assess high well-being.
Results: Smoking and drinking was rare early in youth, while healthy eating and exercise habits were less common in older youth. Smoking, higher fruit and vegetable consumption and lower fast food consumption and sports participation were more common in girls. Only 3% of the youth who smoked and 2% of those who drank most frequently had high well-being. Those who ate more fruit and vegetables and did more sport had high well-being even after adjustments. Similarly, increased fruit and vegetable consumption and decreased crisps, sweets or fizzy drink consumption was associated with lower odds of low well-being, while increased fast food consumption was associated with higher odds of low well-being. Smoking, drinking and decreased sport participation were all associated with low well-being.
Girls who smoked were significantly more likely to have low well-being than boys who smoked. Additionally, boys who participated in sport less frequently had significantly higher risk of low well-being than girls.
Conclusions: Generally, younger youth participated in more health-protective behaviours, while older youth reported more health-risk behaviours. Health protective behaviours were associated with high well-being while health-risk behaviours were associated with low well-being. Interventions to encourage healthy lifestyles among youth may not only benefit their future health but also their current well-being.
Keywords: adolescents, health behaviors, mental health
CORRESPONDING AUTHOR: Booker Cara, University of Essex, Colchester, cbooker@essex.ac.uk
O513
CHANGES IN HEALTH BEHAVIOURS OVER TEN YEARS IN YOUNG AUSTRALIAN WOMEN
Brown W.1, Uijtdewilligen L.2
1 University of Queensland, School of Human Movement Studies, Brisbane, Australia
2 EMGO Institute for Health and Care Research, VU University Medical Center, Department of Public and Occupational Health, Amsterdam, Netherlands
Background: The prevalence of behavioural risk factors is often reported for adults in ten year age groups, and patterns of change over the adult life span are fairly well established. Little is known however about the changes that occur within the first ten years of adult life, when patterns of risk for adult health are established.
Aim: To examine the changing patterns of inactivity, overweight, smoking and alcohol use in Australian women over ten years from age 18-23 to 28-33, and to consider the factors associated with these changes.
Methods: Data were from more than 6000 women in the 1973-78 cohort of the Australian Longitudinal Study on Women's Health who answered four surveys in 1996, 2000, 2003 and 2006.
Results: At age 18-23, the proportions not meeting guidelines were 5.1% for alcohol (risky drinking) 21% for weight (BMI > 25), 27.3% for smoking and 43.4% for inactivity. By 28-33, alcohol (3.5%) and smoking (17.9%) prevalence had declined, but prevalence of unhealthy weight (39%) and inactivity (49.3%) had increased. Patterns of changing risk across the 4 surveys were however complex, with few women consistently at risk: only 0.2% were risky drinkers, 10.6% were smokers, 16.1% were overweight and 11.1% were inactive at all 4 surveys. Conversely, 89.1% remained non-risky drinkers, 63.3% remained non-smokers, 54.2% maintained healthy weight, but only 19.2% remained active at all surveys. The remainder (10.7% for alcohol, 26.1% for smoking, 29.7% for weight and 69.7% for activity) changed their status (meeting/not meeting guidelines) at some stage during the 10 year period. Factors associated with change included socio-demographic characteristics and life stage changes such as completing education, getting married, having a baby and starting work.
Conclusions: Patterns of change in health risk behaviours during young adulthood are complex. Understanding who changes and why will inform efforts to promote and establish healthy behaviours in early adult life, so that future risk of chronic disease is reduced.
Keywords: Risk factors; women's health
CORRESPONDING AUTHOR: Brown Wendy, University of Queensland, wbrown@hms.uq.edu.au
O515
HEALTHY EATING CONSIDERATIONS IN THE EVERYDAY EATING PRACTICES OF IRISH ADULTS AGED 50-70: A QUALITATIVE STUDY.
Delaney M.1, McCarthy M.1, Shortt E.2
1 University College Cork, Department of Food Business & Development, Cork, Ireland
2 University College Dublin, School of Public Health, Physiotherapy and Population Science, Dublin, Ireland
Background: Along with rising trends in obesity and diet-related illnesses worldwide, nutritional information and advice concerning healthy eating have become increasingly prominent in the public domain in the last 30 years. Personal responsibility for health is often emphasised and individuals are advised to carefully monitor and control their food intake for optimal health and ageing; an approach dubbed the ‘healthy eating nutrition agenda’. However, despite growing awareness of such nutrition information in the population, eating practices rarely reflect idealised patterns. Further contextualised insight is needed into why this gap exists.
Aim: This research aimed to qualitatively explore older adults’ beliefs and experiences in relation to healthy eating in the context of their general food lives.
Method: In-depth semi-structured interviews on the lived experience of food and eating were conducted with a purposive sample of 50 men and women aged 50-70 who varied by diet and health status. An inductive thematic analysis was carried out on the data.
Findings: The ‘medicalisation of food’ was identified as a key theme with four sub-themes. Most participants observed a trend of increasing medicalisation of food over their lifetimes, although the extent to which they engaged with this new way of considering food varied. The basic tenet of food influencing health was generally accepted. However, common ‘healthy eating nutrition agenda’ assumptions that do not appear to acknowledge the complexity of this relationship provided grounds for resistance and challenge in participants’ discourse. For example, ‘one size fits all’ assumptions, such as the healthy BMI range and appropriate foods to eat were questioned by some participants based on their own embodied experiences and preferences. Furthermore, ignoring or problematising the complexity of the non-health related roles and functions of food, such as food as a source of pleasure and comfort, appeared to create ambiguity and distanced advice from the reality of participants’ lives.
Conclusion: Fundamental challenges to typical healthy eating communications may be identified when considering individual experiences. More open dialogue about these may facilitate public interest in making better food choices.
Keywords: Health behavior change, beliefs, older people, eating behaviours
CORRESPONDING AUTHOR: Delaney Mary, University College Cork, Cork, mary.delaney@ucc.ie
O516
THE ROLE OF HEALTH RELATED BEHAVIOURS ON COGNITIVE DECLINE IN A BRITISH BIRTH COHORT
Cadar D.1, Pikhart H.2, Mishra G.3, Kuh D.4, Richards M.1
1 University College London, Department of Epidemiology and Public Health, London, United Kingdom
2 University College London, Epidemiology and Public Health, London, United Kingdom
3 University of Queensland, Faculty of Public Health, Institute of Behavioural Sciences, Brisbane, Australia
4 University College London, Department of Epidemiology and Public Health, London, United Kingdom
Background: With a dramatic rise in population over the last century, the number of older people affected by cognitive impairment and dementia is set to increase. Recent evidence shows that healthy lifestyle behaviours could contribute to successful cognitive ageing (Sabia et al., 2009; Lee, Kim & Back, 2009).
Aim: The aim of this work was to examine the influence of multiple lifestyle behaviours on cognitive functioning and on cognitive decline over 20 years.
Methods: Participants were 1246 men and women from the 1946 British Birth Cohort, a representative sample of UK population monitored since birth. Health related behaviours were smoking (number of cigarettes smoked/day), physical activity (any sports or vigorous activity performed in the last month) and dietary choice (energy dense/nutrient poor versus healthier) collected in midlife at age 43 years. Cognitive function (verbal memory and visual search speed) was measured at both 43 and 63 years. Multiple linear regressions were used to examine the independent associations between each health behaviour and cognitive outcomes, while adjusting for father’s social class, childhood cognition, education, adult social class at the time of exposure and depression at both times of the outcome. These analyses were also mutually adjusted for the other health behaviours.
Results: All Individual health behaviours (smoking, exercise and dietary choice) at age 43 showed a significant sex adjusted association with verbal memory in midlife at age 43 years. However, after adjusting for all the covariates and the other health related behaviours, only the higher levels of physical activity (> 5 times/month) were associated with better memory and faster visual speed at age 43, independent of smoking and dietary choice. In contrast, smoking (< 10 cigarettes/day) was associated with lower visual search speed. Health related behaviours did not show an association with rate of cognitive decline in this study.
Conclusion: These results underline the potential benefit of a global approach to lifestyle factors. Engaging in healthy behaviours could contribute to a preservation of cognitive functioning but may not influence the rate of cognitive decline from midlife.
Keywords: Health behaviors, Cognitive factors, Smoking, Exercise, Diet
CORRESPONDING AUTHOR: Cadar Dorina, UCL, London, dorina.cadar.09@ucl.ac.uk
Behavioral and Emotional Risks in Weight Gain and Diabetes
O517
WHY WE EAT WHAT WE EAT: EATING MOTIVES AND THEIR INTERRELATIONS
Sproesser G.1, Strohbach S.1, Schupp H.2, Renner B.1
1 University of Konstanz, Psychological Assessment and Health Psychology, Konstanz, Germany
2 University of Konstanz, General Psychology, Konstanz, Germany
Understanding why people eat and why they select certain food items in everyday life is crucial for the creation of interventions to promote normal eating and to prevent the development of obesity and eating disorders. The Eating Motivation Survey (TEMS) was developed within a frame of three different studies. In Study 1, a total of 331 motives for eating and food choice were generated on the basis of different data sources (previous research, nutritionist interviews, and expert discussions). In Study 2, 1,250 respondents were provided with a set of 87 motives based on the responses from Study 1, yielding thirteen factors in exploratory factor analysis. In Study 3, 1,040 participants responded to a pool of 78 items revised and generated on the basis of Study 2. Confirmatory factor analysis yielded fifteen factors with a satisfactory model fit with RMSEA = .048 (CI .047-.049). The motive factors were liking, habits, need & hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image. Factor structure was generally invariant across gender and BMI which indicates a high stability for the Eating Motivation Survey scales. On the mean level, however, significant differences in motives for eating and food choice associated with gender, age, and BMI emerged. Interestingly, factorial correlations suggested that socio-cultural motives such as sociability, social norms, traditions, and social image concerns were not only highly related to each other but also to biological motives like visual appeal and pleasure. In contrast, health concerns were only related with the weight control motive (r = .42; p < .001) and natural concerns (r = .59; p < .001). In order to trigger sustainable eating behavior changes, health concerns may need to be positively related to social and biological incentives for eating. Implications of the fifteen distinct motives to eat and choose foods in everyday life are discussed.
Keywords: Assessment, Diet, Eating behaviors. Motivation
CORRESPONDING AUTHOR: Sproesser Gudrun, University of Konstanz, gudrun.sproesser@uni-konstanz.de
O518
HOW SICKENING IS SITTING? SEDENTARY BEHAVIOR AND CARDIOMETABOLIC HEALTH
Chinapaw M.1, Altenburg T.1, Rotteveel J.2, Dunstan D.3, Salmon J.3
1 EMGO Institute for Health and Care Research, VU University Medical Center, Public and Occupational Health, Amsterdam, Netherlands
2 VU University Medical Center, Pediatrics, Amsterdam, Netherlands
3 Deakin University, School of Exercise and Nutrition Sciences, Melbourne, Australia
Introduction: Recent epidemiological evidence shows that objectively assessed sedentary time is adversely associated with biomarkers of cardiometabolic health. Our study tested the hypothesized biological mechanism underlying the detrimental effect of prolonged sitting i.e., the metabolic effects of a lack of muscle activity, in a laboratory experiment.
Methods: Nineteen students in the age range of 18-23 years participated in this randomized cross over trial. Each participant completed two experimental conditions, separated by a one-week washout period. The experimental conditions are: 1) 8 hours continuous sitting; 2) 8 hours sitting with every hour moderate-intensity exercise breaks (8 min). Blood samples were collected hourly. Participants consumed a high fat mixed breakfast and lunch during the day.
Results: In receiver operating characteristic (ROC) analysis, area under the curve (AUC) of both triglyceride and glucose levels were higher in the sitting only condition compared to the sitting with exercise breaks condition.
Conclusions: This innovative sitting experiment suggests that prolonged sitting has acute detrimental effects on cardio-metabolic indicators in apparently healthy students.
Keywords: Health behaviors, Metabolic regulation
CORRESPONDING AUTHOR: Chinapaw Mai, VU University Medical Center, m.chinapaw@vumc.nl
O519
VALIDATION OF AN INSTRUMENT FOR MEASURING BARRIERS TO TYPE TWO DIABETES REGIMEN ADHERENCE
Jones L.1, Crabb S.2, Turnbull D.1, Oxlad M.1
1 The University of Adelaide, Psychology, Adelaide, Australia
2 The University of Adelaide, Public Health, Adelaide, Australia
Globally, Type Two Diabetes incidence is continuing to grow. Management of Type Two Diabetes often necessitates considerable lifestyle changes across multiple domains of life, and, for this reason, it is commonly reported that ideal management is both difficult and rare. Currently, no validated measure of barriers to effective Type Two Diabetes management exist specifically taking into account aspects relating to rural as well as urban contexts. This presentation will explore the barriers to effective Type Two Diabetes management in rural Australia and the adaptation and validation of an instrument to measure these barriers. A focus group (n = 8) and phone interviews with both people with Type Two Diabetes (n = 10) and with health professionals working with people living in rural and remote areas of Australia (n = 18) were conducted. Results of this thematic analysis informed the development of a self-report questionnaire including adaptation of the Diabetes Obstacles Questionnaire to include scale items relating to both rural and urban dwellers such as access to services (n = 289).
Thematic Analyses indicated that the main barriers to effective management in rural and remote areas relate to the broad themes of Access, Knowledge/Skills, Psychosocial, Social, Motivation and Maintenance of Changes. Principal component analyses provide support for the 8-dimensional structure of the original Diabetes Obstacles Questionnaire. An additional dimension relating to access to health services was found to be valid and reliable (factor scores > .51, Chronbach’s α = .89). This presentation will conclude with a discussion of the implications of the 9-factor solution of the Diabetes Obstacles Questionnaire for the management of Type Two Diabetes. The usefulness of the adapted version of the DOQ in both practice and research will also be discussed, along with future research directions.
Keywords: Diabetes; Self Management; Health behaviors
CORRESPONDING AUTHOR: Jones Laura , University of Adelaide , laura.jones@adelaide.edu.au
O520
PSYCHOSOCIAL CHANGES DURING WEIGHT LOSS AND SUBSEQUENT WEIGHT REGAIN
Brantley J.1, Myers H.1, Johnson D.2, Han H.2, Coughlin W.3, Funk L.4, Stevens J.4, Hollis F.4, Samuel-Hodge D.5, Jerome J.6
1 Pennington Biomedical Research Ctr, Behavioral Medicine, Baton Rouge, USA
2 Pennington Biomedical Research Ctr, Biostatistics, Baton Rouge, USA
3 Johns Hopkins University School of Medicine, Psychiatry and Behavioral Sciences, Baltimore, USA
4 Kaiser Permanente Center for Health Research, Center for Health Research, Portland, USA
5 University of North Carolina at Chapel Hill, Department of Clinical Psychology, Chapel Hill, USA
6 Towsen University, Department of Health Psychology, Towsen, USA
Overweight and obesity are a leading public health concern. Despite success with short-term weight loss, weight regain remains a challenge. The Weight Loss Maintenance Trial (WLM) was a multi-center, NHLBI-funded trial that enrolled 1685 overweight or obese adults (BMI 25-45 kg/m2) with hypertension or dyslipidemia. All enrollees were offered a 6-month, group behavioral weight loss program. Successful weight losers (lost > 4 kg,) were randomized into one of two weight maintenance interventions (personal contact or internet) or a usual care control group. Findings from the WLM and similar studies suggest that psychosocial variables such as self-efficacy, perceived stress and social support may influence weight management. There is also evidence these variables may change during weight loss, particularly in individuals with a limited history of weight loss attempts. Results of the present study indicated significant improvement (p ≤ 0.001) in psychosocial variables (perceived mental health, social support from friends and family for healthy eating and exercise, and perceived stress) from study entry to end of the weight loss intervention. Multiple regression analyses (n = 1027) examined whether changes in psychosocial variables during weight loss were associated with weight regain during a subsequent 30 month maintenance phase. The final model (R-Square = 0.1084) found an increase in perceived family support for healthy eating during weight loss to be associated with less weight regain (p < .05) during maintenance. Age, treatment type, and weight change during weight loss were also significant variables in the model (p < .01). Gender and race interactions will be highlighted. Findings suggest that attention to family support for healthy eating during weight loss may improve weight maintenance.
Keywords: Weight control
CORRESPONDING AUTHOR: Brantley Phillip, Pennington Research Ctr., phil.brantley@pbrc.edu
O521
CHANGES IN DEPRESSIVE SYMPTOMS AND RELATIVE BODY WEIGHT DURING 20 YEARS OF FOLLOW-UP
Konttinen H.1, Kiviruusu O.2, Huurre T.2, Haukkala A.1, Aro H.2
1 University of Helsinki, Department of Social Research, Helsinki, Finland
2 National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland
Background: There is increasing evidence that depressive symptoms and obesity are positively related. Some prospective studies have observed that obesity predicts the later development of depression, while others have found that depression predicts the later development of obesity. However, both of these pathways have rarely been investigated simultaneously in a prospective setting. The present study examined the bi-directionality of the associations between depressive symptoms and relative body weight at three time points during 20 years of follow-up. Methods: Participants of a Finnish cohort study in 1989 at 22 years (N = 1656) were followed up at 32 (N = 1262) and 42 (N = 1155) years by means of postal questionnaires. The body mass index (BMI) was based on self-reported weight and height and depressive symptoms were assessed using the short Beck Depression Inventory. Structural equation modelling was used to determine the longitudinal associations between depressive symptoms and BMI separately for men and women (cross-lagged autoregressive models and latent growth curve models). Results: Among women, depressive symptoms did not predict later BMI, or vice versa, but depressive symptoms and BMI were positively correlated at the age of 32 and 42 (r = 0.10 and r = 0.12, respectively). Among men, higher depressive symptoms at the age of 32 predicted greater BMI at the age of 42 (β = 0.10, p < 0.01), while the cross-sectional associations between depressive symptoms and BMI were non-significant. These cross-lagged models fitted the data adequately in both genders (χ² = 1.84, df = 2, p = 0.398 for women and χ² = 5.91, df = 2, p = 0.052 for men). Results from the latent growth models were consistent with those obtained from the cross-lagged models: men with higher initial levels of depressive symptoms experienced a faster rate of increase in BMI (β = 0.17, p < 0.05), whereas no such associations were observed in women. Conclusions: The findings suggest that elevated depressive symptoms predict weight gain among men, but not among women. In contrast, there was no evidence that higher body weight predicts later increase in depressive symptoms. Future prospective studies should explore whether different subgroups of change trajectories can be identified, especially among women.
Keywords: Depression, Obesity, Longitudinal research
CORRESPONDING AUTHOR: Konttinen Hanna, University of Helsinki, Helsinki, hanna.konttinen@helsinki.fi
O522
THE CONTRIBUTION OF PSYCHOSOCIAL FACTORS TO SOCIOECONOMIC DIFFERENCES IN TAKEAWAY FOOD CONSUMPTION
Miura K., Turrell G.
Queensland University of Technology, School of Public Health, Brisbane, Australia
Introduction: Research has shown that socioeconomically disadvantaged groups consume takeaway food more regularly which may partly account for their less healthy dietary patterns and high prevalence of overweight/obesity. However, reasons why there are socioeconomic differences in takeaway food consumption are unknown. This study investigates whether psychosocial factors contribute to socioeconomic differences in takeaway food consumption.
Method: A cross-sectional postal-survey was conducted among 1500 randomly selected adults aged 25–64 years in Brisbane, Australia in 2009 (N = 903, response rate 63.7%). Participants reported their usual overall takeaway food consumption, and the consumption of 22 specific takeaway items (times/week). These items were grouped into healthy and less healthy choices. Psychosocial factors assessed were: behaviours and attitudes toward cooking, diet and health-related beliefs, nutrition knowledge, and perception about takeaway foods (e.g. perceived value of takeaway food) and reasons to consume takeaway foods (e.g. too busy to cook). Socioeconomic position was ascertained by education. The data were analysed using general linear models adjusted for age and sex.
Results: Compared with participants who had a bachelor degree or higher, those with a diploma level of education consumed significantly higher levels of overall and healthy takeaway foods. This difference was partly explained by frequently spending less than 15 minutes preparing dinner (7.7%) and perception that cooking is a chore (42.7%). Those with a diploma level of education also consumed a significantly higher level of healthy takeaway foods compared with the highly educated group. These differences were partly explained by nutrition knowledge (6.7%) and frequently spending less than 15 minutes preparing dinner (9.3%). A significantly high level of less healthy takeaway foods were consumed by the least educated group compared with the most educated group. Observed differences were partly explained by diet and health-related beliefs (16.7%), nutrition knowledge (23.9%), and the perception that cooking is a chore (7.3%).
Conclusion: Strategies to change attitudes toward cooking, and increase nutrition and health-related knowledge may reduce socioeconomic differences in takeaway food consumption, especially less healthy options.
Keywords: Diet, Socioeconomic-status, Obesity, Chronic disease
CORRESPONDING AUTHOR: Miura Kyoko, QUT, Brisbane, k.miura@qut.edu.au
Psychosocial Processes in Cancer Prevention and Control
O523
ATTACHMENT STYLE, DISTRESS AND PSYCHOPATHOLOGY
Sanderman R.1, Holwerda N.1, Pool G.1, Hinnen CH.1, Sprangers MA.2, Ranchor AV.1
1 University Medical Center Groningen, Health Psychology, Groningen, The Netherlands
2 University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
Objective: In this presentation we will issue the importance of Attachment style when considering vulnerability of patients with a chronic somatic disease. Hence, a very brief overview of the theory will be presented indicating the role it can have in the coping process. The significance will be illustrated on the basis of a longitudinal research project. We will show the self-reported general distress and clinically diagnosed psychopathology, in insecurely and securely attached persons at three and 15 months after a cancer diagnosis.
Method: A heterogeneous group of 129 cancer patients received an attachment style interview (Attachment Style Interview, ASI) assessing adult attachment style, a clinical diagnostic interview (mini-SCAN) assessing psychopathology, and a questionnaire (Hospital Anxiety and Depression Scale, HADS) measuring self-reported general distress, three and fifteen months after diagnosis.
Results: At three months after diagnosis, insecurely attached patients had comparable levels of psychopathology (p = .094), but reported more general distress (p < .000). However, at fifteen months, insecurely attached patients showed more psychopathology (p = .002) and again reported higher levels of general distress (p = .003). Moreover, insecurely attached patients more often suffered from long-term psychopathology (34%) than securely attached (12.5%) patients (p = .007) (RR = 2.8).
Conclusion: Insecurely attached patients are vulnerable to experience heightened levels of general distress and psychopathology within one year after a cancer diagnosis. Furthermore, they are less resilient in recovering from their psychological problems than securely attached patients. Attachment theory seems to be interesting in order to understand more of the process of coping with a chronic somatic illness. Furthermore, ideally in the future knowledge of attachment style may help healthcare professionals to understand and predict who may be in need of support and to optimize care.
Keywords: Cancer, Coping, Personality, Depression
CORRESPONDING AUTHOR: Sanderman Robbert, University of Groningen, r.sanderman@umcg.nl
O524
BARRIERS TO CRC SCREENING AMONG LATINO ADULTS IN PA: RESULTS FROM THE ACCN
Garcia-Dominic O.1, Lengerich E.2, Wray L.3, Parrott R.4, Ochoa J.5, Aumiller B.2, Kluhsman B.2, Renderos C.6, Dignan M.7
1 Penn State Milton S. Hershey Medical Center, Public Health, Hershey, USA
2 Penn State Milton S. Hershey Medical Center, Public Health Sciences, Hershey, USA
3 Penn State University, Biobehavioral Health, University Park, USA
4 Penn State University, Communication Arts and Sciences, University Park, USA
5 Penn State University, Spanish, Italian, Portuguese and Comparative Literature, University Park, USA
6 Community Leader, Juniata and Mifflin Counties, Mifflintown, USA
7 Kentucky University, Internal Medicine, Lexington, USA
Objectives: To describe knowledge of and barriers to Colorectal Cancer (CRC) screening by sex and geography among Latino adults in Pennsylvania. Methods: 82 average-risk, Latino adults ≥ 50 years of age engaged in one of eight focus groups stratified by sex and urban/rural residency. We conducted the study in urban Dauphin County and rural Juniata County in PA because these counties had Latino communities with low CRC screening rates. Focus groups consisted of four components: (1) a closed-ended sociodemographic survey; (2) a group discussion about barriers to CRC screening; (3) a viewing of the 7-minute DVD, entitled “Get Screened for CRC: Here’s How;” from the American Cancer Society; and (4) a regrouping of participants after the DVD viewing to discuss acceptability of CRC screenings options as well as potential strategies to overcome barriers to CRC screening. Focus group data were audio taped, transcribed, and grouped into thematic units using content analysis. Results: We found significant differences in the reported barriers to CRC screenings by sex and geography. Identified barriers were placed into five domains: (a) physical environment, (b) structural, (c) sociocultural, (d) individual-level, and (e) physician-related. Conclusions: A targeted approach for CRC screening among Latinos may be better than the non-targeted approach.
Keywords: Barriers to CRC Screening, Cancer, minority health, ACCN, CBPR
CORRESPONDING AUTHOR: Dominic Oralia, Penn State, odominic@hes.hmc.psu.edu
O525
AVOIDANCE AND HYPERAROUSAL MEDIATE THE RELATIONSHIP BETWEEN REEXPERIENCING AND DYSPHORIA IN PARENTS OF CHILDREN WITH CANCER: A LONGITUDINAL ANALYSIS
Cernvall M.1, Ljungman G.2, Ljungman L.1, Silberleitner N.3, Von Essen L.1
1 Uppsala University, Department of Public Health and Caring Sciences, Uppsala, Sweden
2 Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
3 University of Konstanz, Department of Psychology, Konstanz, Germany
There is little theoretical and empirical work regarding the mechanisms underlying the development of traumatic stress among parents of children with cancer. Such work would add to the understanding of this phenomenon and could inform intervention strategies for this group. Cognitive processing theory stipulates that avoidance mediates the relationship between intrusive thoughts about trauma and psychological distress (Creamer, et al., 1992). Furthermore, evidence suggests that hyperarousal predicts emotional numbing in response to trauma (Litz, et al., 1997; Weems, et al., 2003). The purpose of this study was to investigate the mediating role of avoidance and hyperarousal in the relationship between reexperiencing and dysphoria among parents of children on cancer treatment.
We used data from a longitudinal study with three assessment points: T1 = 2 weeks after the child´s diagnosis (n = 249), T2 = two months after the child´s diagnosis (n = 234), and T3 = four months after diagnosis (n = 203). The PTSD-Checklist Civilian was used as a measure of symptoms of traumatic stress interpreted with Simms et al. (2002) four-factor theory of traumatic stress. Two models were evaluated with mediation analysis using bias corrected bootstrap estimation of indirect effects and 95% confidence intervals (CI; Preacher and Hayes, 2008). The first model included two indicators of avoidance at T2 as mediators of the relationship between reexperiencing at T1 and dysphoria at T3, while controlling for initial levels of included variables and gender. In the second model hyperarousal at T2 was added as a mediator.
In the first model there was a significant total indirect effect from reexperiencing to dysphoria via avoidance (0.048, CI = 0.012-0.116). However, only avoidance of activities or situations reminding of the child´s disease had a significant specific indirect effect (0.044, CI = 0.009-0.097). In the second model there was a significant total indirect effect from reexperiencing to dysphoria via avoidance and hyperarousal (0.140, CI = 0.076-0.233). However, only hyperarousal contributed with a significant specific indirect effect (0.110, CI = 0.061-0.212).
The current analyses suggest that avoidance and hyperarousal both are important targets for intervention in this population.
Keywords: Cancer, Caregiving
CORRESPONDING AUTHOR: Cernvall Martin, Uppsala University, Uppsala, martin.cernvall@pubcare.uu.se
O526
FACTORS ASSOCIATED WITH FEAR OF RECURRENCE TWO YEARS AFTER CANCER DIAGNOSIS
Mehnert A.1, Sundermann S.1, Koch U.1, Dinkel A.2
1 University Medical Center Hamburg-Eppendorf, Institute of Medical Psychology, Hamburg, Germany
2 Klinikum rechts der Isar TU Munich, Department of Psychosomatic Medicine and Psychotherapy, Munich, Germany
Background: Fear of cancer recurrence (FCR) is one the most frequent and continuing distressing symptoms in cancer patients. The purpose of this study was to examine the prevalence and course of FCR in cancer patients, and to investigate associations between demographic, medial and psychosocial factors. Furthermore, we aimed to identify predictors of FCR two years after cancer diagnosis
Methods: Patients with mixed tumor entities were consecutively recruited from cancer rehabilitation clinics and assessed at the beginning of the rehabilitation program (t0), at the end of the program (t1) and at one year follow-up (t2). A total of 1,281 patients were enrolled at t0 (75.5% participation rate). One year after rehabilitation (t2), evaluable questionnaires were returned by 883 patients. The following self-report questionnaires were applied: Fear of Progression Questionnaire (FoP-Q-SF), Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), NCCN Distress-Thermometer, Short-Form Health Survey (SF-8), and the Social Support Scale (ISSS).
Results: Participants were averagely 49 years old; 87% were female, 54% belonged to the middle social class. The most frequent tumor entities were breast cancer (61%), gynecological cancers (14%) and head and neck cancers (8%). At baseline, the total mean score on the Fear of Cancer Recurrence scale was M = 35.0 (SD = 8.7) (range 12–60). Using the cutoff value based on the mean value (± 1 SD), 135 patients (15.3%) were classified as having low FCR, 588 patients (66.6%) had moderate FCR, and 160 patients (18.1%) had high FCR at t0. Patients significantly improved over time in FCR (P < .001); however, the effect size was small (η² = .19). Hierarchical linear regression analysis was conducted in order to identify the variance in FCR at follow up accounted for by demographic, medical and psychosocial factors. The final model showed that higher FCR was predicted by lower social class, the absence of skin, colon and hematological cancers, palliative treatment intention, pain, and number of physical symptoms, depression, lower social support and detrimental interactions (R²adjusted = .34) (p < .001).
Conclusion: Findings emphasize the importance of effective psychological interventions to improve symptom FCR.
Keywords: Anxiety, Cancer, Rehabilitation
CORRESPONDING AUTHOR: Mehnert Anja, University Hamburg, mehnert@uke.de
O527
DYADIC EFFECTS OF CANCER-RELATED STRESS ON FRUIT AND VEGETABLE CONSUMPTION AMONG COLORECTAL CANCER PATIENTS AND THEIR FAMILY CAREGIVERS
Kim Y., Carver C., Shaffer K.
University of Miami, Psychology, Coral Gables, USA
Cancer diagnosis can be a major stressor not only to the patients but also to their family members, which can serve as a wake-up call, eliciting positive changes in lifestyle behaviors. Recent evidence has begun to document the extent to which stress related to cancer predicts the patient’s healthy lifestyle behavior changes. The parallel information among family members of cancer patients, however, remains lacking. Also lacking is information about how one’s stress impacts the health behavior of other persons in the family. This study is aimed to address these gaps, using dyads consisting of colorectal cancer patients and their family members who were recruited from community hospitals within 2 months post-diagnosis (T1). The individual participants completed questionnaire packets at three assessments: baseline (T1), 6 months (T2), and 12 months post-diagnosis (T3). Cancer-related stress was measured at T1. The 5-A-Day, which measures days of consuming 5 or more servings of fruit and vegetables was measured at T1 through T3. A total of 68 dyads provided valid data. Actor partner interdependence modeling (APIM) was conducted to test individual and dyadic effects, in combination with latent growth curve modeling to test the stress impact on the baseline and changes of FVC. The model fit the data: chi-square = 15.80 with df = 11, GFI = .95, CFI = .97, and RMSEA = .08. Results revealed that patient’s stress was positively related to increases in their fruit and vegetable consumption (FVC) across 3 assessment points (beta = 1.11, p < .006: individual effect) as well as increases in their family members’ FVC across 3 assessment points (beta = 1.06, p < .006: dyadic cross-over effect). Results suggest that perceiving the burden cancer imposes around the time of diagnosis not only affects individuals’ own change in healthy diet throughout the cancer treatment period but also serves as a wake-up call for the family members touched by the cancer, leading them to have more healthy diet. The findings have implications for developing cancer control and prevention programs targeting colorectal cancer patients and their family members, suggesting how to capitalize on the stress cancer imposes for encouraging the family to engage in health lifestyle behaviors.
Keywords: cancer, cancer survivorship, eating behaviors, family, health behavior change, longitudinal research, stress
CORRESPONDING AUTHOR: Kim Youngmee, University of Miami, ykim@miami.edu
O528
SUPPORTIVE INTERACTIONS AND COMMUNICATION IN COUPLES FACING CANCER
Hagedoorn M., Dagan M., Sanderman R.
University Medical Center Groningen, Department of Health Sciences, Groningen, The Netherlands
Objective: This longitudinal study examined dyadic coping in couples facing colorectal cancer. We will present an overview of our findings regarding changes in depressive symptoms over time in patients as well as their partners, as a function of (a) spousal (un)supportive behavior and perceptions of control; and (b) disclosure of emotions within the couple.
Method: Seventy newly diagnosed patients and their partners completed self-report measures, including (un)supportive behavior (SSL), personal control (Pearlin & Schooler’s Mastery), and depressive symptoms (CES-D) at two assessment points (i.e., 3 and 9 months post-diagnosis). Couples also engaged in a cancer-related conversation (5 months post-diagnosis). Each partner’s self-disclosures of thoughts and emotions were coded by independent observers. Multilevel analysis was used to examine predictors of changes in depressive symptoms over time in a dyadic context.
Results: Patients (B = 5.81, t = 2.40, p < .05) and partners (B = 6.80, t = 3.55, p < .001) who perceived more spousal support reported less distress over time, but only if they were relatively low in personal control. Partners who perceived more unsupportive spousal behavior reported more distress over time, again only if they were relatively low in personal control (B = -8.11, t = -2.47, p < .05). Self-disclosure in itself was not found to be associated with changes in depressive symptoms (ps > .05). Interestingly, decreases in depressive symptoms over time were found to be least prominent in couples in which the partner disclosed a lot whereas the patient disclosed little (patients: B = -111.27, t = -2.37, p < .05; partners: B = -51.30, t = -2.50, p < .01).
Conclusion: Supportive actions of spouses appear to be important especially for a vulnerable subgroup of patients and partners who perceive little personal control. In supportive communication, partners’ self-disclosure toward patients who disclose little appears to be harmful both for patients and their partners. These intra-individual and intra-couple differences are important to take into account in counselling couples facing cancer.
Keywords: couple-related, depression
CORRESPONDING AUTHOR: Hagedoorn Mariet, Groningen University, Groningen, mariet.hagedoorn@umcg.nl
E-health interventions for addictive behaviors
S529
E-HEALTH INTERVENTIONS FOR ADDICTIVE BEHAVIORS
Berman A. H.
Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
Symposium overview: Addictive behaviors constitute a serious global public health problem. Despite public health officials’ and treatment providers’ efforts to screen and offer treatment for such behaviors, only a small proportion of individuals with addictive behaviors are identified. An even smaller proportion of individuals with such behaviors access to tailored help for changing their habits. Recent research on e-health interventions in Norway and Sweden for problematic substance use and gambling suggests that the interventions reach groups not in contact with treatment providers, and that these simple automated interventions can have a positive health promoting effect for users. E-health interventions can be offered in various modalities, including internet, Interactive Voice Response (IVR), mobile phone applications including text messages, and electronic games. This symposium, with participants from Norway and Sweden, will present two randomized controlled studies testing web-based interventions for problematic users of alcohol and drugs, discuss studies using two different modalities for brief interventions targeting problematic alcohol use, as well as reflect on the nature of the working alliance between users and such media-based interventions.
Presenters:
1. Brendyren, H., PhD (presenter)
SERAF Norwegian Centre for Addiction Research, University of Oslo
Testing the efficacy of a web-based intervention for alcohol targeting at-risk drinkers (RCT)
List of authors: Håvar Brendryen, Fanny Duckert, Sverre Nesvåg & Ayna B. Johansen
2. Kristina Sinadinovic (PhD)
Karolinska Institutet, Stockholm, Sweden
Reducing illicit drug use with an internet-based brief intervention:
A randomized control trial
List of authors: Kristina Sinadinovic, Peter Wennberg, Anne H Berman
3. Anne H Berman, PhD
Karolinska Institutet, Stockholm, Sweden
Reflections on participant recruitment and retention in randomized controlled trials on brief e-health interventions for problematic alcohol use
List of authors: Anne H Berman, Mikael Gajecki, Claes Andersson, Kristina Sinadinovic, Peter Wennberg, Agneta Öjehagen
4. Ayna B. Johansen, PhD (presenter)
Norwegian Centre for Addiction Research, University of Oslo
Toward a theory of working alliance in media-based addiction programs.
List of authors: Johansen, A.B., Franzen, E., Bjelland, I., Wennesland, D. & Brendryen, H.
Keywords: e-health, alcohol, drugs, randomized controlled trial, methodological issues
CORRESPONDING AUTHOR: Berman Anne H, Karolinska Institutet, Stockholm, anne.h.berman@ki.se
S530
TESTING THE EFFICACY OF A WEB-BASED INTERVENTION FOR ALCOHOL TARGETING AT-RISK DRINKERS (RCT)
Brendryen H., Duckert F., Nesvåg S., Johansen AB.
University of Oslo, Norwegian Centre for Addiction Research, Oslo, Norway
Objectives: The objective of this study is to determine the effectiveness of a fully automated Internet based early intervention targeting at-risk drinkers.
Methods: Subjects were recruited by banner-ads in Internet newspapers, and underwent a screening procedure on the Internet, based on AUDIT and FAST. All subjects received brief normative feedback on their alcohol habits during the screening. By randomization, 160 subjects were allocated to a control group or to a treatment group. The treatment group received the intervention program providing daily follow up for two months. The treatment was fully automated and consisted of new and interactive material for each day during a two months period. The program consisted of, setting own drinking targets, daily logging of consumption, and psychoeducative content intended to improve motivation and mood, as well as ability and endurance in self-regulation. Additionally, the program provides support to the participants that reports an increased vulnerability for having a lapse, and to those reporting to have had a lapse, in the previous day(s).
Results: At two months follow up, we found no statistically significant difference in total alcohol consumption the last week between conditions. However, the number of days with sick leave during the last week was significantly higher in the control group (M = 0.5; SD = 1.6) compared to the treatment group (M = 0.02; SD = 0.2; t(59.8) = 1.7; p < .05).
Conclusions: The intervention did not reduce overall alcohol consumption among at-risk drinkers, compared to control, but may have reduced sick-leave.
Keywords: Alcohol, Internet, Intervention, Randomized controlled trial
CORRESPONDING AUTHOR: Brendryen Håvar, University of Oslo, brendryen@gmail.com
S531
WEB-BASED SELF-ASSESSMENT AND MONITORING FOR ILLICIT DRUG USERS RECRUITED VIA THE INTERNET:
Sinadinovic K.1, Wennberg P.2, Berman A. H.3
1 Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
2 Stockholm University, Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm, Sweden
3 Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
Objectives: To test the effects of a brief Internet-based intervention for problematic substance use, eScreen, in a two-armed randomized controlled design. eScreen offers self-screening with the AUDIT (Alcohol Use Disorders Identification Test) and the DUDIT (Drug Use Disorders Identification Test), in-depth self-reporting with Alcohol-E (Alcohol-Extended) and DUDIT-E (Drug Use Disorders Identification Test-Extended) questionnaires and an electronic diary. All self-reporting generates personalized feedback in a diagram showing individual consumption levels in comparison to population norms as well as progress over time and in written treatment recommendations.
Method: Participants with illicit drug use (DUDIT >0) were randomized into an intervention group with eScreen (n = 101) or an untreated control group (n = 101). Outcomes on alcohol and drug use were assessed after 3 and 6 months. Four different models were analyzed: Intention To Treat analysis (all allocated individuals), Modified Intention To Treat analysis (only those participating in at least one follow-up), Per Protocol analysis (only those from intervention group that accessed the intervention), Modified Per Protocol analysis (only those participating in at least one follow-up and those from intervention group that accessed the intervention).
Results: A significant decrease in substance use and substance-related problems occurred at the 3-month follow-up and remained stable at the 6-month follow-up. Three out of four analysis models show larger decrease in drug-related problems in the intervention group than in the control group. Two of the four analysis models show a continued decrease in alcohol use and in alcohol-related problems at the 6 month follow-up in the intervention group but not in the control group. No differences were found in the proportion of individuals that were free of substance use and in those that changed to a clinically lower lever of substance use at follow-up.
Conclusions: This first RCT study on Internet-based screening and brief intervention service targeting drug-using individuals from the general population provides some evidence that eScreen could be an effective intervention for reducing substance use.
Keywords: Addictive behaviors, e-Health
CORRESPONDING AUTHOR: Sinadinovic Kristina, Karolinska Institutet, Stockholm, kristina.sinadinovic@ki.se
S532
REFLECTIONS ON PARTICIPANT RECRUITMENT AND RETENTION IN RANDOMIZED CONTROLLED TRIALS ON BRIEF E-HEALTH (INTERNET AND IVR) INTERVENTIONS FOR PROBLEMATIC ALCOHOL USE
Berman A. H.1, Sinadinovic K.1, Gajecki M.1, Andersson C.1, Wennberg P.2, Öjehagen A.3
1 Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
2 Karolinska Institutet, Public Health Sciences, Stockholm, Sweden
3 Lund University, Psychiatry, Lund, Sweden
Aim: A minority of individuals with problematic alcohol use approach organized treatment services to redress their problems. Automated brief interventions attract segments of the population that otherwise do not access evidence-based assessment and treatment. This presentation compares participant recruitment and retention in two automated brief intervention research studies using web-based and Interactive Voice Response (IVR) modalities and targeting problematic alcohol users via online advertising.
Method: Two three-armed randomized controlled trials were conducted where eligible participants were 18 years of age with risky use according to the Alcohol Use Disorders Identification Test, AUDIT, scoring ≥6 for women and ≥8 for men. Participants in the web-based intervention were randomized to eScreen.se, a site for self-assessment and self-monitoring over time (A1); alkoholhjalpen.se, a site for structured CBT-/MI-based self-help (B1) or a control group (C1) and re-assessed at 3, 6 and 12 months. Participants in the IVR study were randomized to one of two four-week interventions (one very brief, assessing drinks per day once a week (A2) and the other offering interactive therapeutic conversations (B2) or a control group (C2) with re-assessment 6 months later.
Results: Over a period of 13.5 months, 633 participants were recruited to the web-based study. Over a period of 8 months, 54 participants were recruited to the IVR study, which is still ongoing. The proportion of women in the web-based study was 55% and 56% in the IVR study. The mean AUDIT score for the web-based participants was 20.8 (SD 6.9), and 21.0 (SD 5.2) for the IVR study. The proportion of web-based participants participating in follow-ups was 37.9%, 35.2% and 44.7% at 3, 6 and 12 months. For the IVR participants, 6-month follow-up results will be presented where available. Outcomes will be compared to the extent data are available at the time of presentation.
Conclusion: Web-based interventions appeal to a wider range of individuals, but IVR interventions also attract problematic alcohol users. Offering brief interventions for problematic alcohol use in multiple automated modalities could expand the range of individuals who access help for their problematic substance use, and reduce suffering in the individuals themselves and their surroundings.
Keywords: E-Health, Alcohol, Randomized Controlled Trial
CORRESPONDING AUTHOR: Berman Anne H, Karolinska Institutet, Stockholm, anne.h.berman@ki.se
S533
TOWARD A THEORY OF WORKING ALLIANCE IN MEDIA-BASED ADDICTION PROGRAMS
Johansen A.1, Franzen E.2, Wennesland D.1, Brendryen H.1
1 University of Oslo, Oslo, Norway
2 University of Oslo, Bergen, Norway
Aims: To formulate a working alliance theory in media-based addiction interventions.
Design and participants: A grounded theory synthesis of 3 qualitative studies in Norway. One study used structured interviews involving 9 university students evaluating an internet-based alcohol screening and intervention program. The second study used focus groups and individual interviews involving 9 male 23-45 year-old online gamblers evaluating a web-based therapeutic outreach program. The third study used individual interviews involving 9 18-25-year-old halfway house residents evaluating a drug-specific psychoeducational DVD. Findings: Although production quality and the use of drug culture specific references were important to credibility, they were not sufficient to establish alliance. Importantly, in the internet groups program problematizing could not get “ahead” of the users in terms of labeling or focus on problem severity. A contextual focus in program problematizing enabled users to attend to the information longer. The users sought normalizing and optimistic elements including the use of color and inclusion of success stories. While most participants were within the program target-groups, almost none identified as such and most described a “viewer-like” and distanced relationship with the program.
Conclusion: The studies show that a “consumer is always right” approach and thus the use of qualitative research is important to understand working alliance in media-based programs. The accuracy and integration of positive, cultural references may be an undervalued component in the establishment and maintenance of working alliance in media-based addiction programs.
Keywords: e-health, addictive behaviors
CORRESPONDING AUTHOR: Johansen Ayna, University of Oslo, ayna.johansen@medisin.uio.no
Suicide Prevention
O534
SUICIDE PREVENTION IN EUROPE: MAKING THE ECONOMIC CASE
Park A.
London School of Economics and Political Science, -, London, United Kingdom
This presentation will look at work on the economic case for the prevention of suicide in four European countries, undertaken as part of the current EU FP7 suicide prevention project Optimizing Suicide Prevention Programmes and their Implementation in Europe (OSPI-Europe; GA no.223138). Estimates of the lifetime social costs of suicide and deaths of indeterminate cause in Germany, Hungary, Ireland and Portugal are presented. Data on trends over time, age and gender breakdown and costs by different means of suicide in the four countries are also calculated. In addition, estimates of the costs of non-fatal suicide events are also presented, drawing on data collected on health care resource use data obtained during the project. Our work indicates that overall these costs are in excess of €30 billion if the human costs of suicide are taken into account, but even from a more conservative perspective, just looking at immediate costs to the public purse and lost productivity due to premature mortality they remain in excess of €6.5 billion. However, policy makers need to know not only about the costs of suicide, but what works in terms of suicide prevention, at what cost and in what context. Thus we have also undertaken an economic evaluation as part of OSPI to help provide this information. Comparing impacts on suicidal behaviour between the model regions of our four countries where OSPI has been implemented with comparable areas which did not have the OSPI programme, we will present some preliminary findings on the potential cost effectiveness of the OSPI suicide prevention approach.
Keywords: economics depression
CORRESPONDING AUTHOR: park a-la, LSE, London, a.park@lse.ac.uk
O535
PREVENTION OF SUICIDALITY AND IMPROVED CARE OF DEPRESSION BY COMMUNITY BASED INTERVENTIONS
Koburger N.1, Hegerl U.2
1 University of Leipzig, Faculty of Medicine, Leipzig, Germany
2 University of Leipzig, Department of Psychiatry and Psychotherapy, Leipzig, Germany
Depressive disorders as well as fatal and non-fatal suicidal behaviour are important mental health issues. Following WHO-analysis, depression is the third leading contributor to the global disease burden and in the European Union per year more than 58.000 people commit suicide. Due to the close relation of both, it is likely that preventive actions targeting depression have a positive impact on suicidal behaviour, in the sense that improved care and optimized treatment for depressed patients result in less suicidal acts. This was shown in the Nuremberg Alliance against Depression, a two-year four-level community based intervention programme associated with a 24% reduction of suicidal acts (completed + attempted suicides) compared to a baseline year and a control region[1]. Serving as a model project, this approach was further installed in Germany as well as internationally through the European Alliance against Depression (EAAD; two project phases; GA no.2003317 and 2005323)[2]. Community based multilevel interventions hence were conducted in more than 100 regions in Germany and Europe. Within the current FP7 suicide prevention project Optimizing Suicide Prevention Programmes and their Implementation in Europe (OSPI-Europe; GA no.223138), the approach was optimized and implemented in four European model regions[3].
People suffering from depression are motivated to seek help by projects as EAAD and OSPI-Europe. At the same time they are confronted with structural constraints arising from the health care system, which doesn’t seem to cover the demand for care. Guided internet-based self-management programmes have the potential to close part of this gap. The recently started project Preventing Depression and Improving Awareness through Networking in the EU (PREDI-NU; GA no.20101214) aims at the development and implementation of self-management-protocols in two target groups (adolescents, 15 to 24 years; adults, 25 years and older). In parallel a European awareness website on depression will be designed and uploaded. Those measures are thought to be effective methods to further improve the impact of community based interventions.
[1]Hegerl et al (2006), Psychol Med 36(9)
[2]Hegerl et al (2008), World J Biol Psychiatr 9(1)
[3]Hegerl et al (2009), BMC Public Health 9(428)
Keywords: Depression, community intervention, self-management, evidence based, internet
CORRESPONDING AUTHOR: Koburger Nicole, University of Leipzig, Leipzig, nicole.koburger@medizin.uni-leipzig.de
O536
COMMUNITY BASED INTERVENTION TO PREVENT DEPRESSION AND SUICIDE IN HUNGARY – EAAD, OSPI
Székely A., Cserháti Z., Kopp M.
Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
The Institute of Behavioural Sciences has conducted several intervention programmes to prevent depression and suicide in different regions in Hungary. The European Alliance Against Depression (EAAD) was formed in 2004 with funding from the European Commission as well as the Optimized Suicide Prevention Programs and their Implementation in Europe (OSPI). In both programs the Institute was responsible for the interventions in Hungary.
During the intervention programs our aim was to build community based local networks by training the GPs, community facilitators as well as by advertisement campaign towards the broad public. In the EAAD program the intervention region was Szolnok and its sub-region. Compared to the average of the previous 9 years in 2005, in the first year of the programme suicide rates decreased with 57%, in 2006 with 47% in Szolnok city. This means that the suicide rate was 30.1/100.000 in 2004, 13.1/100.000 in 2005 and 14.5/100.000 in 2006. The decrease was higher among men than among women. Most important elements of the programme: destigmatisation of depression and suicidal ideations, more help seeking, first of all among men, increasing number of calls at the hot-line services (50% male calls), increasing patient visits at the hospital’s psychiatry department.
In the OSPI program our intervention region was Miskolc, the third biggest city in Hungary. During the intervention period the region faced unusual problems (flood, elections, financial crisis), and the suicide rate was in line with those of other regions in Hungary. However we could achieve significant decrease in the number of suicide attempts. The decrease was 16,5% during the intervention period.
The results of our programs show that although the effects are not showing always the same pattern, nevertheless, enhancing social capital by strengthening local networks, using the capacity of the local helpers, establishing forums to help the collaboration between the helping professionals is an effective way to prevent suicidal behaviour.
Keywords: Community intervention, Depression, Prevention
CORRESPONDING AUTHOR: Székely András, Semmelweis University, Budapest, szekely7@gmail.com
O537
PSYCHOLOGICAL AND ETHNICAL BACKGROUND FACTORS OF SUICIDAL BEHAVIOR IN HUNGARY
Tóth M..1, Székely A.1, Ádám Sz.1, Zonda T.2, Kopp M.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 Hungarian Association for Suicide Prevention, Budapest, Hungary
Objective: The aim of the study is to examine the psychological and sociocultural factors in the background of suicide attempts in Borsod-Abaúj-Zemplém county, which has one of the highest suicide rates in Hungary, and which was the intervention region of the OSPI Suicide Prevention Program. In this study we also consider the ethnical differences in the examined sample.
Method: The research was carried out in the Toxicology Department of Miskolc County Hospital. We have interviewed 59 people during their hospitalization following their attempt to commit suicide. As a method we used half-structured interviews in which we asked the patients about their demographics, social and marital status, physical and mental illness. We asked in detail about the circumstances, the reason and the method of their suicide attempt. They filled out the Shortened Beck Depression Inventory and the Hopelessness Scale as well. Based on the interviews we were able to estimate the seriousness of the suicide attempts.
Results: The main risk factors of suicidal behavior are: lack of a partner, low level of education and unemployment. Direct risk factors are interpersonal conflicts (mainly with the partner and other family members), financial problems, grief, sleeping disturbance followed by physical illness. Patients who considered themselves as a member of the Roma minority (n = 30), had significantly less serious parasuicide attempts, however there was no significant difference between the level of depression in the two groups. The amount of pills taken are two times higher in the non-Roma group (n = 29). In the Roma group financial problems are the number one direct risk factors, while in the non-Roma group conflict with the partner is the main factor.
Conclusion: Considering the ethnicity in the background of suicidal behavior there are significant differences between the Roma and non-Roma groups. In the field of suicide prevention it would be important to take these distinctions into consideration to be more effective in both ethnical groups.
Keywords: suicidal behavior, ethnicity
CORRESPONDING AUTHOR: Toth Monika Ditta, Semmelweis University, Budapest, tmonika85@gmail.com
O538
EFFECTIVENESS OF DEPRESSION – SUICIDAL BEHAVIOUR AWARENESS TRAINING AMONG POLICE OFFICERS: OUTCOMES OF THE OPTIMISING SUICIDE PREVENTION PROGRAMMES AND THEIR IMPLEMENTATION IN EUROPE (OSPI-EUROPE) STUDY
Coffey C.1, Arensman E.1, Griffin E.1, Daly C.1, Schmidt S.2, Gottlebe K.2, Koburger N.2, Gusmao R.3, Kopp M.4, Van Audenhove C.5, McDaid D.6, Van der Feltz-Cornelis C.7, Hegerl U.2
1 National Suicide Research Foundation, National Health Services Research Institute, Cork, Ireland
2 University of Leipzig, Department of Psychiatry, Leipzig, Germany
3 University of Lisbon, Department of Psychiatry, Lisbon, Portugal
4 Semmelweis University, Department of Behavioral Medicine, Budapest, Hungary
5 Catholic University of Louvain (KUL), Department of Public Health and Primary Care, Brussels, Belgium
6 London School of Economics and Political Science, Department of Health Policy and Management, London, United Kingdom
7 National Institute of Mental Health and Addiction, Department of Clinical Psychology, Utrecht, The Netherlands
Since 2008, the evidence-based multi-level intervention, Optimising Suicide prevention Programmes and their Implementation in Europe (OSPI-Europe) has been implemented in four European countries: Germany, Portugal, Hungary and Ireland (1).
One element of the OSPI-Europe intervention was the provision of depression and suicidal behaviour awareness gatekeeper training programmes for people who may be in a position to recognise suicide risk and to intervene. Police officers are regularly in contact with suicidal individuals, particularly in the three months up leading to a suicide (2). The role of police as “gatekeepers” has been highlighted both internationally as well as nationally in a number of countries (3). Police officers were selected as a core target group for the OSPI-Europe Gatekeeper awareness training.
First findings from the intervention region in Ireland show that through the OSPI Train-The-Trainer programme the majority (78%, N = 494) of all police officers in a defined catchment area completed the gatekeeper training programme.
Evaluation questionnaires were collected at each training workshop in order to determine pre-post training changes among participants Stigma towards depression significantly decreased following the training programme whilst knowledge of suicide intervention increased. Importantly, confidence in dealing with suicidal people increased significantly following the training. The overall positive effects of the training programme with police officers in Ireland support the feasibility and efficacy of TTT to suicide prevention gatekeeper initiatives as a cost-effective model to increase awareness. During the conference, further outcomes based on comparison between the OSPI-Europe intervention countries will be presented.
1. Hegerl, U., et al. (2009). Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): An evidence-based multi-level approach. BMC Public Health, 9(428).
2. Linsley, K.R.., Johnson, N., & Martin, J. (2007). Police contact within 3 months of suicide and associated health service contact. The British Journal of Psychiatry, 190, 170-171.
3. WHO (2009). Preventing suicide-A resource for police, firefighters and other first line responders. Department of Mental Health and Substance Abuse, Geneva, Switzerland, World Health Organisation.
Keywords: Depression, community intervention, evidence based, police officers, awareness training
CORRESPONDING AUTHOR: Arensman Ella, NSRF, ella.arensman@nsrf.ie
O539
WHY DEPRESSIVE PATIENTS EXERCISE LESS: CONTRIBUTIONS OF MOTIVATIONAL AND VOLITIONAL DETERMINANTS
Krämer L., Helmes A., Bengel J.
University of Freiburg, Department of Psychology, Freiburg, Germany
Background: Depressive patients show lower levels of physical activity than non-psychiatric and psychiatric controls (Leas & McCabe, 2007). The present study aims at investigating the reasons for this inactivity. In accordance with the Health Action Process Approach (Schwarzer, 2008) motivational processes of intention formation and volitional processes of intention implementation were explored.
Methods: Sixty-one depressive outpatients (SKID-I) were compared to a sample of 97 non-psychiatric controls. At t1, all participants received a self-report questionnaire measuring intention to exercise as well as motivational variables (e.g. outcome expectations) and volitional variables (e.g. barrier management). Four weeks later (t2), they received a second questionnaire measuring actual exercise behavior within the last four weeks.
Results: An analysis of covariance (adjusting for age) revealed that depressive patients had a significantly reduced intention to exercise regularly (F(1,148) = 18.56; p < .001). Those depressive patients who did report exercise intention were less capable of transforming this intention into action four weeks later (χ²(1) = 9.68; p < .01). For the motivational variables, analyses revealed influences of depression on self-efficacy (F(1,143) = 32.15; p < .001) and negative outcome expectations (F(1,143) = 14.83; p < .001), but not on positive outcome expectations (F(1,142) = 1.50; p = .222). For the volitional variables, influences of depression were found for implementation intentions (F(1,108) = 13.79; p < .001) and preventive barrier management (F(1,108) = 6.25; p < .05), but not for acute barrier management (F(1,108) = 0.67; p < .796).
Conclusions: When designing exercise interventions for depressive patients, it is important to know the reasons for their physical inactivity. The current study highlighted that depressive patients show specific patterns of motivation (reduced self-efficacy, increased negative outcome expectations) and volition (reduced implementation intentions and preventive barrier management) which should be addressed with suitable intervention elements (e.g. Göhner & Fuchs, 2007). In this way, theories of health psychology can help to meet the important challenge of increasing physical activity in depressive patients.
Keywords: depression, physical activity, exercise, health behaviors
CORRESPONDING AUTHOR: Krämer Lena, University of Freiburg, Freiburg, kraemer@psychologie.uni-freiburg.de
To make patients change their life style - is it only a matter of communication ?
S540
TO MAKE PATIENTS CHANGE THEIR LIFE STYLE - IS IT ONLY A MATTER OF COMMUNICATION ?
Orth-Gomér K.1, Deter HC.2, Williams R.3
1 Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
2 Charité - University Medical Center Berlin, Department of Psychosomatic Medicine and Psychotherapy, Berlin, Germany
3 Duke University Medical Center, Department of Cardiology, Durham, USA
School medicine has been extremely efficient in the acute treatment of patients with life threatening diesease events. Within decades mortality in acute illness has been largely controlled. The two most common causes of death cardiovascular disease and cancer are good examples: today cancer is not lethal any more, but with today treatment more than half of cancer patients are cured and declared healthy. And before the time of the coronary care unite with constant cardiovascular monitoring, the one year mortality of cardiac patients was about 35%. Today it is less than 5%. This and other similar developments have not only reduced mortality and but also increased the number of patients who are living with chronic disease and who have to be cared for in inpatient and out patient departments. Secondary prevention particularly when it can be provided by health personnel other than physicians has become an important task of the health care systems. Pharmacological interventional methods make out the main sources of secondary preventive effort, and their efficiencies have been amply documented by the industry in numerous clinical trials. E.g. each post myocardial infarction patient is bound to be taking one beta blocker, one coenzyme a reductase inhibitor (statins) and one anticoagulation medication each day for the rest of his/her life in order to avoid recurrent disease events.
This involves high cost – for the patient and for society. However, modification of the individual patient life style has been recognized as an alternative, or rather as a complementary to pharmacological prevention. In times of squeezed economic resources this is particularly attractive.
Beliefs are common, however, that patients will change their unhealthy habits, if they are appropriately told to do so. The surprise may be strong when it is realized that this is not the case. Behavioral / psychosomatic knowledge is available and will be helpful in dealing with these tasks. We will address psychosocial determinants of unhealthy life styles including obesity (Weber ) sedentary life (Deter), and exaggerated stress reactivity (Orth-Gomer).
Discussions will include the coexistence of multiple unhealthy life styles and their dependance upon genetic and environmental conditions (R. Williams, discussant).
Keywords: physician intervention, behavioral change
CORRESPONDING AUTHOR: Deter Hans-Christian, Charité, deter@charite.de
S541
LIFESTYLE INTERVENTION IN OBESE PATIENTS – WHAT ROLE PLAYS THE ATTACHEMENT STYLE OF PATIENTS
Kiesewetter S., Kallenbach-Dermutz B., Weber C., Deter HC.
Charité - University Medical Center Berlin, Department of Psychosomatic Medicine and Psychotherapy, Berlin, Germany
Introduction: The long-term success of life-style interventions in the treatment of obesity is limited. Although psychological factors have been suggested to modify therapeutic effects, specifically the implications of the patient-therapist relationship have not been examined in detail. Methods: This study included 112 obese patients who participated in a one-year multimodal weight-reduction program. All volunteers documented their eating behaviour for 3 days before intervention. Based on eating protocols, an individual counselling was provided, with the recommendation of a daily calorie intake of 400-600 kcal less than the total energy expenditure. Meetings for all volunteers took place over the first 6 months once a week in groups consisting of 10-12 participants. In the first 90 minutes at the first 10 sessions nutrition-consultants accomplished group workshops with practical cooking exercises. The patients participated on average in 12 60- to 90-minute sessions of psychodynamic group therapy. Attachment style was analyzed by the Adult Attachment Prototype Rating (AAPR) and its relation to a one-year weight reduction program was studied. The patient-therapist-relationship was assessed using the Helping Alliance Questionnaire. Results: Patients loose more than 5% of there baseline BMI(38.3) Attachment style was secure in more than a half of participants and insecure (preoccupied and dismissing) in about 1/3. Interestingly a significantly (p < 0.05) higher weight-reduction was found in securely (SAI) compared to insecurely attached individuals (UAI). This estimation correlated positively also to the quality of helping alliance. Conclusions: The frequency of insecure attachment in obese individuals was comparable to that of the normal population. Our data suggest a greater weight-reduction for SAI than for UAI. The patient-therapist relationship was rated more positively in the better outcome group. Conclusion can be drawn that beside other factors like BMI, age, gender, psychiatric and somatic co-morbidity, the attachment style play a role in a interdisciplinary treatment program of obesity and has an influence on the effort to lose weight.
Keywords: obesity treatment
CORRESPONDING AUTHOR: Deter Hans-Christian, Charité, deter@charite.de
S542
PHYSICAL ACTIVITY AND CARDIOVASCULAR RISK FACTORS AND THEIR PREDICTION OF LONG TERM OUTCOME IN THE STOCKHOLM FEMALE CORONARY RISK STUDY
Orth-Gomér K.1, Zimmermann-Viehoff F.2, Weber C.3, Deter HC. 3
1 Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
2 Charité - University Medical Center Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
3 Charité - University Medical Center Berlin, Department of Psychosomatic Medicine and Psychotherapy, Berlin, Germany
Sedentary life style is known to correlate with other risk factors of coronary heart disease (CHD) and to increase risk and worsen prognosis of Coronary Heart Disease (CHD) in women. We investigated whether these factors were associated using two different assessments methods of PA, and if they are predictive according mortality 284 women (mean age 56 ± 7 y) with CHD from the Stockholm Female Coronary Risk (FemCorRisk) study were enrolled in the analysis. All subjects rated their exercise habits according to WHO on a 4-point scale from 1: predominantly sedentary to 4: high physical activity (PA). In a second analysis all subjects rated their emotional states and PA on a regular work day at 5 defined time points (1: breakfast, 2: after lunch, 3: 3-4p.m., 4: after dinner, 5: before sleeping). Physical activity was estimated as predominantly sedentary, light activity, moderate activity or physical strain;. Separate analyses were performed for work time and leisure time. Symptoms of anxiety and depression were rated by means of a 4-point Likert scale (from 1: “not at all agree” to 4: “completely agree”).
In the first analysis, women who were depressed, according to the symptoms questionnaire, showed reduced physical activity compared to non depressed women (p < 0.001), but groups did not significantly differ with regard to age, body mass index, resting blood pressure, disease severity (NYHA classification), marital status and menopausal status. In the second analysis, measuring mortality within 10 years, the physical activity groups were comparable with regard to the above mentioned background factors. sedentary life style was responsible for a higher fatal outcome.
The data confirmed our hypothesis of a more sedentary life style in female CHD patients with symptoms of depression. The diary measurements of PA showed a more specific interaction between PA and negative affectivity. However, conclusions from the diary assessments were limited, the general estimation of PA had a higher prognostic value among the investigated subjects.
Keywords: physical activity
CORRESPONDING AUTHOR: Deter Hans-Christian, Charité, deter@charite.de
S543
COGNITIVE BEHAVIORAL MODIFICATION TO REDUCE STRESS IN PATIENTS WITH CVD
Orth-Gomér K.1, Weber C.2, Deter HC.2
1 Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
2 Charité - University Medical Center Berlin, Department of Psychosomatic Medicine and Psychotherapy, Berlin, Germany
Introduction: Cardiovascular disease (CVD) is the most important cause of death in the western world, with about four million deaths in Europe and about 50 000 deaths every year in Sweden. It is also an important cause of disability and of repeated hospitalizations. The burden on society is important, as is the burden on the patient. Rehabilitation of patients with CVD has traditionally focused upon physical capacity and physical exercise. The strains and stresses of daily life are complex and demanding, and extend beyond the need to be physically fit. We have applied a cognitive group based therapy program in an urban setting. We report the effects on self rated stress levels and on anxiety and depression.
Results: In this report we describe the modified version of the program and examine its adequacy and feasibility in urban patients. In summary, depressive, anxious and stress symptoms decreased more in women than in men. The changes were significant – except for depression. In an other study sample, patients were treated with the same program, beneficial effects on mortality could be shown over ten years.
Discussion: We have described a cognitive, behavioral intervention program, tailored for patients who recovering from an acute clinical event. We have shown that it can be implemented. We have also shown that psychosocial stress measures decrease along with the implementation process: improvement of anxiety, depressive symptoms, social isolation and daily stress symptoms. This study and previous findings suggest that this programs may improve psychosocial and behavioral risk factors and prolong life.
Keywords: behavior change, cardiovascular disease
CORRESPONDING AUTHOR: Deter Hans-Christian, Charité, deter@charite.de
Challenges to Ensuring Adherence to HIV Medication: Assessments, Interventions and Modifying Factors?
S544
CHALLENGES TO ENSURING ADHERENCE TO HIV MEDICATION: ASSESSMENTS, INTERVENTIONS AND MODIFYING FACTORS”
Jones D.1, Weiss S.1, Peltzer K.2, Waldrop-Valverde D.3
1 University of Miami, Psychiatry and Behavioral Sciences, Miami, USA
2 Human Sciences Research Council, HAST, Pretoria, South Africa
3 Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, USA
Recent studies have illustrated that HIV antiretroviral (ARV) therapy results in both health outcomes and a 96% reduction in risk of transmission. However, if the benefits of large scale ARV distribution are to be maximized, education and motivation to optimize adherence must be systematically incorporated and evaluated in health care. Increased patient-provider communication to enhance adherence and treatment engagement accentuates the importance of evaluation of provider assessment of adherence in resource limited settings not having access to the gold standard of evaluation of treatment efficacy, viral load. Can providers accurately assess patient adherence and interpret conflicting data between patient self report, pharmacy records, pill count and their own assessment in order to recommend appropriate interventions? The use of peers to provide adherence counseling has become widespread; can peer-led support or provider prescription effectively overcome the potential modifiers of adherence intervention efficacy and establish long term adherence? This panel will address challenges to assessment of intervention outcomes (hospital-based clinical trial, Zambia), interventions to promote antiretroviral adherence at the community level (translational intervention, South Africa) and hospital setting (hospital-based clinical trial, India), and discuss factors that may act as modifiers of intervention efficacy in diverse settings (inner city hospitals and community clinics in the US and India). Deborah Jones (Chair, USA) “Enhancing long term adherence among HIV + patients Northern India”. Stephen M. Weiss (Discussant, USA)”Mining for the gold standard: Assessment of engagement in HIV treatment in Zambia”. Karl Peltzer (South Africa) “Efficacy of a lay health worker-led group antiretroviral medication adherence intervention among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: Results from a randomized trial”. Drenna Waldrop-Valverde (USA) “Modifiers of adherence intervention efficacy in diverse settings”
Keywords: adherence, intervention, assessment
CORRESPONDING AUTHOR: Jones Deborah, University of Miami, Miami, djones@med.miami.edu
S545
ENHANCING LONG TERM ADHERENCE AMONG HIV + PATIENTS NORTHERN INDIA
Jones D.1, Sharma A.2, Cook R.1, Vamos S.1, Waldrop D.3, Weiss S.1, Kumar M.1, Nehra R.2
1 University of Miami, Psychiatry and Behavioral Sciences, Miami, USA
2 Post Graduate Institute of Research & Education, -, Chandigarh, India
3 Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, USA
Background: Adherence to HIV antiretroviral (ARV) medication is a function of treatment engagement, and essential to both controlling HIV and limiting transmission. This study examined adherence and its psychosocial correlates among HIV + patients in Northern India. Methods. Participants (n = 80) were recruited from a hospital clinic and randomly assigned to a 3-month group intervention designed to enhance ARV adherence or the individual standard of care (SOC), and assessed monthly for 6 months. Measures of adherence included: prescription refill, pill count, and short- and long-term self report.
Results: Participants were primarily male (70%) with extremely low income and 4-9 years of education. Half (49%) had an HIV + spouse; of those, 18% were on ARVs. At baseline, short-term self-reported adherence was not associated with long-term self-report or pill count. Missing doses was negatively correlated with self-efficacy (r = -.26, p = .02), and positive beliefs about medication (r = -.25, p = .03) and its necessity (r = -.24, p = .03). At follow-up, pill count adherence baseline to 6- months post-intervention (F = 5.49, p = .02) among experimental condition participants improved in comparison with control participants. Among experimental participants, patient-provider communication was associated with fewer missed doses (r = .36, p = .04), while among control participants, patient-provider communication was negatively associated with pill count (r = -.35, p = .02).
Conclusions: Results support the implementation of interventions enhancing patient-provider communication, and more importantly, accurate assessment of adherence. A strategy for rapid pill count may be a useful adjunct for accurate adherence appraisal in the clinical setting. Future studies should explore the impact of peer support on adherence and treatment engagement. Study funded by NIH grant no. R21NR011131.
Keywords: HIV, India, Intervention, Assessment
CORRESPONDING AUTHOR: Jones Deborah, University of Miami, Miami, djones@med.miami.edu
S546
MINING FOR THE GOLD STANDARD: ASSESSMENT OF ENGAGEMENT IN HIV TREATMENT IN ZAMBIA
Weiss S.1, Jones D.1, Zulu I.2, Mumbi M.3, Chitalu N.3, Vamos S.1
1 University of Miami, Psychiatry and Behavioral Sciences, Miami, USA
2 Centers for Disease Control and Prevention, Preventative Health, Aachen, Zambia
3 Aarhus university, -, Aachen, Zambia
Zambia has made significant advances in providing widespread coverage of antiretroviral (ARV) therapy to HIV + patients, but it remains critical to engage patients and establish adherence health behaviors at the time of introduction of ARV medication. This study sought to increase engagement in HIV treatment among patients new to antiretroviral (ARV) medication use ARVs (n = 160) in urban Lusaka, Zambia. Participants were enrolled and randomized to a 3-month individual enhanced standard of care or a group intervention condition. Assessments included adherence (self report, provider evaluation, pill count, pharmacy fill record), health care utilization, health status and stigma. Participants (n = 160) were primarily married (53%), male (49%) aged 37, on ARV medications from 6 – 24 months with extremely low income and most (60%) having secondary school education. At baseline, all participants reported 100% adherence over 4 days, and 15% reported non-adherence in the past 3 months. Pharmacy records, pill count, patient report and provider evaluation were triangulated to evaluate adherence. Pill count adherence was not associated with short term self reported adherence or provider evaluation. At follow up, the number of sessions attended, level of drop out and the number of health care appointments attended did not differ between conditions. In contrast, participants in the intervention condition reduced the number of missed doses by pill count and maintained the reductions over time (F = 2.37, p = .04) in comparison with the individual condition. Thus, while adherence improved in the intervention condition, healthcare behavior did not appear to be a function of health care engagement. Similarly, while patient short term self report and provider evaluation were similar, neither predicted pill count adherence. Results suggest that sites utilizing task shifting to increase ARV coverage should increase the role of healthcare staff in provision of ARV-related information to enhance adherence as an adjunct to traditional patient education during visits with doctors and clinic officers. Clinicians should consider the use of provider-led peer group interventions, and implementation of novel strategies to increase accurate assessment of adherence.
Keywords: Zambia, adherence, assessment
CORRESPONDING AUTHOR: Weiss Stephen, University of Miami, sweiss2@med.miami.edu
S547
EFFICACY OF A LAY HEALTH WORKER LED GROUP ANTIRETROVIRAL MEDICATION ADHERENCE TRAINING AMONG NON-ADHERENT HIV-POSITIVE PATIENTS IN KWAZULU-NATAL, SOUTH AFRICA: RESULTS FROM A RANDOMIZED TRIAL Peltzer K.1,2, Ramlagan S.1, Jones D.3, Weiss S. M.3, Fomundam H.4, Chanetsa L.4
1HIV/AIDS/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
2Department of Psychology, University of Limpopo, Turfloop, South Africa
3Department of Psychiatry and Behavioural Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
4HIV/AIDS Pharmaceutical Care Program, Howard University, Pretoria, South Africa
Although studies show that high levels of adherence are achievable in African countries, there is still an urgent need to develop additional practical and feasible interventions to improve treatment retention, increase and maintain these high levels of adherence in HIV patients on ART if treatment failure and resistance is to be avoided. There is a lack of theory-based randomised controlled trials to examine the effect of antiretroviral adherence in sub-Saharan Africa. We assessed the effectiveness of a lay health worker lead structured group intervention in improving adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in South Africa. A total of 152 adult patients on ART and with adherence problems were randomized 1:1 to a standard adherence intervention package plus a structured three session group intervention or to a standard adherence intervention package alone. Self-reported adherence measures - the Adult AIDS Clinical Trials Group (AACTG) adherence instrument was used prior to, post intervention and at follow-up. Baseline characteristics were similar for both arms. Analysis of variance between intervention conditions on the adherence information knowledge test scores at pre- and post intervention showed a significant increase in the intervention compared to the control group at follow-up. Adherence motivation and skills did not significantly change among the intervention conditions over time. Analyses found a significant improvement of ART adherence and CD4 count and a significant reduction of depression scores over time in both intervention and control conditions; however, no significant intervention effect between intervention and control conditions was found. Lay health worker led Medication Adherence Intervention (MAI) may not be more effective than standard care in this resource-constrained setting.
Keywords: chronic illness, HIV
CORRESPONDING AUTHOR: Karl Peltzer, HIV/AIDS/STI and TB (HAST) Research Programme, KPeltzer@hsrc.ac.za
S548
MODIFIERS OF ADHERENCE INTERVENTION EFFICACY IN DIVERSE SETTINGS
Waldrop-Valverde D.1, Jones D.2
1 Emory University, School of Nursing, Atlanta, USA
2 University of Miami, Psychiatry and Behavioral Sciences, Miami, USA
Interventions to improve adherence to medications among persons living with HIV (PLWH) have generally been efficacious; however, limitations remain as to the magnitude of effects and the sustainability of improvements. An important consideration in designing, implementing, and evaluating interventions is whether certain variables may significantly modify an intervention’s strength. Analyses of subgroup characteristics may illuminate conditions under which an intervention is especially effective and also identify subgroups or conditions for which the intervention was less effective to provide clues as to how the intervention could be adapted to better fit these cases. The overall goal of this symposium is to discuss two effective medication adherence interventions tested in the US and India and to also recognize and understand potential effect modifiers of such interventions. In particular, the potential modifying variables that may be relevant to a given subpopulation of the epidemic, country, or specific region will be discussed. Subgroups including men who have sex with men, substance users, and PLWH who reside in resource poor settings and associated potential effect modifiers will be examined. Comorbidities common among PLWH and how these may interact with intervention efficacy/effectiveness will also be explored. This segment of the symposium will improve participants’ ability to understand and identify potential effect modifiers of intervention efficacy/effectiveness so that future iterations of successful adherence interventions can be targeted to those who may most benefit or may be adapted in ways that attend to subgroups vulnerable to intervention failure.
Keywords: adherence HIV
CORRESPONDING AUTHOR: Waldrop-Valverde Drenna, Emory University, Atlanta, dwaldr2@emory.edu
Promotion of Healthy Eating
O549
USING A VIRTUAL REALITY BUFFET TO ASSESS MOTHERS’ BEHAVIORAL RESPONSES TO FAMILY HISTORY ASSESSMENT OF THEIR CHILDREN’S RISK FOR OBESITY
McBride M.1, Persky -.1, Wagner K.2, Faith S.3, Ward S.3
1 National Institutes of Health, Social and Behavioral Research Branch, Bethesda, MD, USA
2 University of North Carolina at Chapel Hill, Health Behavior and Health Education, Chapel Hill, USA
3 University of North Carolina at Chapel Hill, Nutrition, Chapel Hill, USA
Genome discovery could enable personalized risk assessments for negative health outcomes in ways that may heighten the personal salience of and motivation for early adoption of risk-reducing behaviors. Concerns have been raised that when targeted to motivate disease prevention in children, such genetic risk assessments could increase parents’ anxiety and prompt negative parenting practices that could undermine their children’s healthy behaviors (e.g., over-regulation of children’s food intake). This study examines whether informing mothers of their children’s risk of becoming obese based on personal family history of obesity is associated with the mothers’ food choices for their children in a virtual reality-based buffet. Overweight mothers with a child 4-5 years old were assigned randomly to one of three informational interventions: 1) food safety information control, 2) behavioral childhood obesity information, or 3) behavioral information plus family history assessment of obesity risk. Those who received the family history-based risk assessment were given feedback of the index child’s risk of becoming an obese adult based on the weight of biological parents. After receiving the informational interventions, mothers were asked to fill a virtual plate with food items for the child from a virtual buffet. Mothers (n = 232) reported a mean BMI of 30.5, and mean age of 38 years; 75% were college educated, and 45% were white, 30% were African American, and 25% were from other race-ethnicities. There were no significant differences by experimental condition in total calories or nutrient content of the food selected by mothers for their child’s plate. Pooling the two obesity risk information groups compared to the control group showed that being in one of the obesity risk information groups (p = 0.001), or believing behavior plays a greater role in obesity risk than heredity (p = 0.03) were significantly associated with selection of fewer calories for the child’s plate. Indeed, behavioral risk factor information was more influential than family history information in overweight mothers’ food choices for their child. Plans to assess whether DNA test feedback for variants associated with increased risk of obesity (e.g. FTO) influence parents’ preventive behaviors on behalf of their children will be discussed.
Keywords: eating behaviors, children's health, genetics
CORRESPONDING AUTHOR: McBride Colleen, NIH, Bethesda USA, cmcbride@mail.nih.gov
O550
THE EFFECTS OF A PARENT-TARGETED EDUCATION INTERVENTION ON THE MANAGEMENT OF CHILDHOOD OBESITY
Lin YC.
National Taipei University of Education, Department of Education, Taipei, Taiwan
Background and Purpose: The recent rapid increase of childhood obesity has become a major public health concern in many developed countries. Parents and adult caregivers play an important role in the development of children’s eating and physical activity behaviors. Relatively few family-based intervention studies exist in weight management of children. The purpose of the present study was to evaluate the effects of a parent-centered education intervention on the management of childhood obesity.
Methods: 112 Families with at least one 7- to 12-year-old child who was overweight or obese from six elementary schools in Taipei and Taichung area of Taiwan were recruited to participate. A total of 76 families were non-randomly assigned to the experimental group and 36 families to the control group. The 16-week intervention consisted of monthly education workshops, home-based intervention activities and health education materials. Parents or adult caregivers completed a self-developed structured healthy lifestyle and parenting questionnaire. Children completed the healthy lifestyle questionnaire and their height and weight were measured by trained research assistants. Measures were collected before and after the intervention.
Results: Significant differences were found between the two groups in parents’ self-efficacy in child weight management, food-related parenting behavior and fruit intake. Children in the experimental group also significantly reduced time spending in computer or video games. No significant intervention effects were observed for change in children’s BMI-z score.
Discussion and Conclusions: The results showed that a parent-centered education intervention can promote parents to increase their self-efficacy in the management of childhood obesity, improve parenting behaviors and healthy eating habits. Longer intervention duration is needed to evaluate changes in diet, lifestyle and long-term weight loss of obese children.
Keywords: obesity, self-efficacy, health education
CORRESPONDING AUTHOR: Lin Yu-Chen Lin, Taipei Education University, yclin@tea.ntue.edu.tw
O551
HEART SMART: INCREASING HEALTH KNOWLEDGE AND SELF-EFFICACY IN ADOLESCENTS
Saab P.1, Countryman A.1, Chipungu K.1, McCalla J.1, Etzel E.1, Fitzpatrick S.1, Brown J.2, Juarez C.2, Williams L.2
1 University of Miami, Department of Psychology, Coral Gables, USA
2 Miami Science Museum, Center for Interactive Learning, Coral Gables, USA
Unhealthy lifestyle behaviors related to inactivity, poor nutrition, and stress are common among adolescents. Health education efforts to engage youth are needed to increase health knowledge and confidence for healthy behavior change. 544 (46% boys; 90% Hispanic) public school 10th graders (mean age 15.6 yrs),who were enrolled in a personal fitness or physical education course, were participants. Students were randomized to 1 of 4 conditions: a) usual classroom experience, b) cardiovascular-themed discussion activity at school, c) Heart Smart field trip, or d) Heart Smart field trip plus discussion activity. Heart Smart is an interactive science museum exhibition addressing the role of behavior in heart health and emphasizing physical activity, good nutrition, and stress management. Students completed health knowledge and self-efficacy assessment measures at baseline, post treatment, and follow-up (~1 month post treatment). Health literacy was also assessed at baseline.
A series of 2 (discussion activity) X 2 (field trip) X 2 (gender) factorial ANCOVAs (covarying physical education course, whether US born, health literacy, and baseline assessment) were conducted. Analyses were intention-to-treat. At post treatment, a field trip X discussion activity interaction (p = 0.02) showed that students randomized to field trip plus discussion activity had the highest levels of health knowledge. At follow-up, main effects of field trip (p = 0.03) and gender (p = 0.02) were found. Those randomized to any field trip condition had greater health knowledge compared to those who were not. Girls’ health knowledge exceeded boys’. Also, at follow-up, a field trip X gender interaction for confidence to make healthy behavior changes (p = 0.01) was obtained. Girls randomized to any field trip reported more self-efficacy compared to girls not randomized to field trip (ps < 0.01); there were no differences for boys (ps > 0.05).
Taken together, the data suggest that a brief and novel health education intervention (field trip to a heart health exhibition with or without a health discussion) leads to significant gains in health knowledge and self-efficacy about making healthy behavior change. The findings also suggest that girls, in particular, may likely benefit from such interventions. It remains to be demonstrated whether gains might be enhanced with interventions of longer duration. The findings underscore value of innovative Behavioral Medicine approaches to educate and engage youth.
Supported by SEPA NCRR NIH grant 5 R25RR023279
Keywords: health education, randomized controlled trial, health communication, adolescence
CORRESPONDING AUTHOR: Saab Patrice, University of Miami CG, psaab@miami.edu
O552
DOES INTERVENING ON SOCIAL IMAGES OF HEALTHY EATING INCREASE VEGETABLE CONSUMPTION AMONG YOUNG MEN?
Kinnunen MI., Hankonen N., Bingham C., Jallinoja P., Absetz P.
National Institute for Health and Welfare, Department of Lifestyle and Participation, Helsinki, Finland
Purpose: Although young men rate healthy eaters generally positively they consume much less fruit and vegetables than recommended for health benefits. One predictor of low fruit and vegetable consumption is that a typical vegetable eating peer is not seen as a masculine good buddy (Kinnunen et al, submitted). This study evaluates a theory-based intervention to increase the consumption of fruit and vegetables through promoting a positive, socially acceptable, masculine image (i.e. prototype) of vegetable eating peers among Finnish conscripts.
Methods: The present study is a part of the DefenceNutri Intervention Study. Intervention group was exposed to a campaign including posters and table triangle comics adverts linking vegetable eating with masculine imagery during a two week period in the second month and again in the sixth month of military service. Control group (N = 116) received no intervention, and the data was collected at 2008. Intervention arm (N = 99) data collection took place at 2009. To evaluate intervention effects, fruit and vegetable consumption and prototypes of typical Vegetable Avoider and typical Vegetable Chooser peers were measured at the beginning (T1) and at six months (T2) of military service.
Results: The control group and the intervention group reported similar prototypes (ps > .08) and fruit and vegetable consumption (t(213) = .20, p = .840) at T1. Repeated-measures ANOVA showed no significant between-subjects effects between the intervention and the control groups. However, the within-subject interactions of repeated-measures ANOVA showed that the eater prototypes became more healthy in the intervention group between T1 and T2; Vegetable Avoider prototype was perceived as less Respectable F(1,213) = 9.17, p = .003, and less Good-Looking F(1,213) = 5.84, p = .017, and Vegetable Chooser was perceived more Good-Looking F(1,213) = 3,98, p = .048) in the intervention group. In both groups, fruit and vegetable consumption declined during service but the decrease tended to be less sharp in the intervention group (F(1,213) = 3.54, p = .061).
Conclusions: The intervention was effective in promoting three out of six prototypes. The mediating mechanism of prototype on eating could not be verified with this sample size, although the results on eating suggest that the intervention helped to counteract the occurring decrease in fruit and vegetable consumption during the military service.
Keywords: Behavior Change; Eating behaviors
CORRESPONDING AUTHOR: Kinnunen Marja, Helsinki, marja.kinnunen@thl.fi
O553
PROMOTING HEALTHY EATING AND PHYSICAL ACTIVITY AMONG INDIGENOUS AUSTRALIAN MEN
Ricciardelli L., Mellor D., McCabe M.
Deakin University, Psychology, Melbourne, Australia
The aim of the present study was to understand the role of protective factors associated with the health and body image of Indigenous Australian men; and to find ways of promoting healthier patterns of eating and physical activity. There has been little research in the past that has focused on protective factors but studies have shown that focusing on positive factors is a way of promoting optimism and greater resilience among communities. Using a participatory action research framework, we have completed focus groups with 10 men, and 40 individual interviews with men aged between 18 and 40 years from three locations: Melbourne, Mildura and Broome. Across all three locations several of the men noted the importance of eating well and keeping physically active, and were highly committed to these health behaviours. In addition, in all locations the main protective factors were identification with Indigenous culture, supportive family and friends, “looking and feeling good”, and employment. Traditional hunting practices and traditional foods were aspects of Indigenous culture that appear to facilitate health. Family members and friends were discussed as important influences and role models who encouraged healthy eating habits. Feeling good and respecting yourself, and work were also identified as important positive influences to keep you motivated and active. These findings will now be fed back to community members and their families in order that we can work together to find solutions and make recommendations to improve men’s health.
Keywords: men's health, Australian Indigenous, physical activity, healthy eating
CORRESPONDING AUTHOR: Ricciardelli Lina Angela, Deakin University, lina@deakin.edu.au
O554
EPIDEMIOLOGY OF EATING DISORDERS IN A ROUMANIAN UNIVERSITY SAMPLE – A FOLLOW-UP
Túry F.1, Antal I.2, Szényei G.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 Babes-Bolyai University, Faculty of Sociology and Social Work, Cluj-Napoca, Romania
Aim: Eating disorders are often considered culture-bound syndromes, occurring mainly in industrialized Western countries. However, several epidemiological studies were published from Central-East European countries, which show that eating disorders are common in this region. The present paper analyzes the prevalence of eating disorders and some pathological eating behaviours in a Romanian university sample, with special regard to the changes in a 13-year span.
Method: A questionnaire screening was made containing general and demographic data and the Eating Disorders Inventory in a university sample in Cluj-Napoca. The first screening was performed in 1995, and the same test battery was used in the repeated study in 2008.
Results: No subjects meeting the criteria of anorexia or bulimia nervosa were found in the population (n = 553, 28.9% males, 71.1% females) in 1995. The prevalence of subclinical disorders was relatively high, subclinical anorexia nervosa occurred in 2.5% of females and in 0.6% of males, and subclinical bulimia nervosa was found in 3.8% of females and 2.5% of males. In 2008 741 students were screened (28.3% males, 71.7% females). The dissatisfaction with the body weight increased in 2008 among males as compared to the data from 1995 (19.4% versus 43.3%). The „Drive for Thinness” subscale of the EDI showed that there were no significant difference among the two female population, but this score increased among men in 2008 (mean in 1995: 1.01; mean in 2008: 2.66). The scores of the „Body Dissatisfaction” increased among males (0.86 versus 5.81). This score increased also among females (1.4 versus 6,62). In the „Bulimia’” subscale both males and females scored lower in 2008 than in 1995.
Conclusion: In spite of methodological limitations, the results stress the importance of eating disorders also in Romania, and the West-East dichotomy is an oversimplification as for the eating disorder morbidity. The newer results demonstrate an increasing significance of the eating pathology among males.
Keywords: Eating behaviors, Health behavior change
CORRESPONDING AUTHOR: Túry Ferenc, Semmelweis University Budapest, tury@t-online.hu
Novel and Advanced Methods in Behavioral Medicine Research
O555
AN 87-ITEM TAXONOMY OF BEHAVIOR CHANGE TECHNIQUES: BUILDING AN INTERNATIONAL CONSENSUS FOR THE REPORTING OF BEHAVIOR CHANGE INTERVENTIONS
Johnston M.1,3, Michie S.1, Abraham C.2, Francis J.3, Hardeman W.4, Eccles M.5, Richardson M.1, Cane J.1
1 University College London, London, United Kingdom
2 University of Exeter, Exeter, United Kingdom
3 University of Aberdeen, Aberdeen, United Kingdom
4 University of Cambridge, Cambridge , United Kingdom
5 Newcastle University, Newcastle, United Kingdom
Background: Behavioral medicine needs precise, unambiguous methods of specifying the content of behavior change interventions. This would advance effectiveness in replicating effective BCIs, synthesising evidence and understanding the causal mechanisms underlying behavior change. Whilst some reliable taxonomies of behaviour change techniques (BCTs) exist, a comprehensive set based on more rigorous methodology is required.
Objectives: To develop an extensive and consensually agreed taxonomy of BCTs with clear and distinct labels and definitions, investigate a hierarchical structure for the taxonomy, and lay the foundation for future international collaboration in this cumulative process.
Methods: In a systematic Delphi-type exercise, 14 experts rated 94 BCT labels and definitions from 6 published taxonomies in terms of active ingredients, overlap and redundancy, clarity, precision, distinctiveness and confidence of use. 18 experts then grouped the resulting BCTs in an online sort task allowing up to 24 categories with no a priori labelling. The results, along with comments from a wider international group and pilot coders, were used to produce a hierarchically structured BCT Taxonomy V1.
Results: The majority of BCTs required further work on their label and/or definition. 9 BCTs were added, 20 omitted and 4 divided, resulting in 87 BCTs. Cluster analysis identified 16 clusters with internal validity 0.57. Multi-scale resampling methods supported 12 clusters and strongly supported 7, including 72 of the 87 BCTs.
Conclusions: The resulting extensive, hierarchical list of consensually agreed, clear and distinct BCTs constitutes 'BCT Taxonomy V1' and was judged by the International Advisory Board to be usable for specifying interventions. The next steps are to encourage adoption and evaluate usefulness.
Keywords: behaviour change, methodology
CORRESPONDING AUTHOR: Johnston Marie, University of Aberdeen, Aberdeen, m.johnston@abdn.ac.uk
O556
AN IDIOGRAPHIC APPROACH TO INTERPERSONAL PHYSIOLOGICAL RESEARCH
Palumbo R.1, Liu S.2, Goodwin MS.3, Velicer WF.1, Molenaar PCM.2
1 University of Rhode Island, Department of Psychology, Kingston, USA
2 Penn State University, Human Development and Family Studies, University Park, USA
3 Northeastern University, Department of Health Sciences, Boston, USA
This study focused on the study of interpersonal physiology by using specialized idiographic analysis. The field of psychophysiology has explored a range of important relationships between physiological, cognitive and behavioral processes; however, research on interpersonal physiological relationships has been limited. Studies that have compared the physiology of pairs found significant correlations between autonomic processes of dyads. The presence of these physiological relationships has been linked to psychosocial constructs such as empathy and attachment, suggesting physiological components underling social dynamics. Unfortunately, the methodological approaches are underdeveloped. In this study, dyads were seated next to each other in a room and asked to remain still and quiet while baseline heart rate, electrodermal activity (EDA), finger skin temperature, and breathing rates were monitored. For the first 15 minutes participants sat back to back, followed by 15 minutes seated face to face. Idiographic analyses were conducted to examine physiological relationships among the dyads using frequency analysis. Four components were addressed: 1) Power Distribution over frequency, which shows the dominance of a frequency within a series; 2) Coherency between the two time series, analogous to a covariance in the frequency domain; 3) Phase Difference of the two series, indicative of a lead or lag in the relationship; and 4) Directed Transfer Function, which is equivalent to a regression coefficient and reflects the influence of one series on the other. The Power Distribution revealed a concentration around 30 cycles per minute (0.5 Hz). The Coherency resulted in a fluctuating pattern which increased during each half of the trial. The Phase Difference also showed alternating patterns of leaders. The Directed Transfer Function suggested each partner’s activity was predictive of the others at different times. These preliminary findings suggest that the electrodermal activity of one partner can both lead and be predictive of the patterns of another’s EDA. More research is required to refine the methods, analysis, and their interpretation.
Keywords: Measurement; Psychophysiology
CORRESPONDING AUTHOR: Palumbo Richard, University of Rhode Island, rpalumbo@my.uri.edu
O557
IDENTIFYING LONGITUDINAL PATTERNS OF ADHERENCE TO TREATMENT FOR SLEEP APNEA
Velicer W.1, Babbin S.1, Aloia M.2, Goodwin M.3
1 University of Rhode Island, Cancer Prevention Research Center, Kingston, USA
2 National Jewish Health and Philips/Respironics, Inc., Department of Medicine, Denver, USA
3 Northeastern University, Department of Health Sciences, Boston, USA
Increasing adherence to medical recommendations is crucial for improving health outcomes and reducing costs of health care. To improve adherence, we need a better understanding of behavior change over time. Adherence to Positive Airway Pressure (PAP) treatment for obstructive sleep apnea (OSA) was the focus of two idiographic studies. In the exploratory Study 1, time series analysis was used to examine adherence patterns over a year of treatment in 71 participants with moderate to severe OSA. Adherence patterns were visually classified into seven categories: (1) Good Users (24%); (2) Slow Improvers (13%); (3) Slow Decliners (14%); (4) Variable Users (17%); (5) Occasional Attempters (8%); (6) Early Drop-outs (13%); and (7) Non-Users (11%). Time series data analysis provides a method for examining adherence by examining the pattern of change over time. In the confirmatory Study 2, adherence was examined in an international sample of 161 participants, each with approximately 180 nights of data. Separate time series analyses were performed for each individual. Then a dynamic cluster analysis was performed to find homogenous subgroups of individuals with similar adherence patterns. A four-cluster solution was found. The subgroups were labeled: Great Users (17.2%; high mean and level, no slope), Good Users (32.8%; moderate mean and level, no slope), Poor Users (22.7%; low mean and level, negative slope), and Slow Decliners (moderate mean and level, negative slope, high variance). Participants in the subgroups were compared on a number of demographic, sleep apnea related, and psychosocial variables to establish external validity. Great Users reported the most self-efficacy (confidence to use PAP); Poor Users reported the most sleepiness; and Great Users reported the highest quality of sleep. Combining time series analysis and dynamic cluster analysis is a useful way to evaluate adherence patterns at both the individual level and subgroup level. Psychological variables relevant to adherence patterns, such as self-efficacy, could be the focus of interventions to increase PAP usage.
Keywords: Research Methods, Adherence
CORRESPONDING AUTHOR: Velicer Wayne, University of Rhode Island, velicer@uri.edu
O559
A MIXTURE DISTRIBUTION RASCH ANALYSIS OF THE SOMATOSENSORY AMPLIFICATION SCALE
Jasper F.1, Hiller W.1, Nater U.2, Ehlert U.3, Fischer S.4, Witthöft M.1
1 University of Mainz, Department of Clinical Psychology and Psychotherapy, Mainz, Germany
2 University of Marburg, Clinical Biopsychology, Mainz, Germany
3 University of Zurich, Department of Clinical Psychology and Psychotherapy, Zurich, Switzerland
4 University of Marburg, Clinical Biopsychology, Marburg, Germany
Somatosensory amplification refers to a person’s tendency to experience somatic sensations as inadequately intense and involves hypervigilance concerning bodily sensations. This construct plays an important role in the etiology and maintenance of somatoform disorders and especially hypochondriasis and severe health anxiety (Barsky, 2001). The most common instrument to assess this construct is the somatosensory amplification scale (SSAS) by Barsky, Wyshak, and Klerman (1990). We applied the SSAS in an internet sample of young adults (N = 3,031). We examined if the SSAS is Rasch scalable by means of either the partial credit or rating scale model. While the rating scale model assumes equal (threshold) distances between the categories of all SSAS items these distances may be item specific in the partial credit model. Moreover, we applied mixture distribution extensions of these models to identify subgroups that use the response set of the SSAS in a different way. The partial credit model with 2 latent classes showed a superior fit to all other models. Overall fit on item basis was satisfactory although the differentiation between two of the five item categories was very low in both classes. Class 1 consisted of about 54% of the participants and was characterized by a higher SSAS sum score, female gender, more somatic complaints, a higher amount of psychosocial stress, and slightly higher depressiveness. These results remained stable when we conducted separate analyses by gender. Besides, Class 1 was also characterized by an avoidance of the lowest answering category of the SSAS. In sum, the SSAS is Rasch scalable with the partial credit model and offers promising measurement qualities. Nevertheless, some questions remain concerning the construct validity of the SSAS that require further research.
Keywords: Methodological issues, Illness behavior, Health beliefs, information seeking, Internet
CORRESPONDING AUTHOR: Jasper Fabian, Johannes Gutenberg University, jasper@uni-mainz.de
O560
SEMI-CONTINUOUS ASSESSMENT AND ADAPTIVELY OPTIMIZED INSULIN DELIVERY WITH INDIVIDUAL DIABETES TYPE 1 PATIENTS
Molenaar CM .
Penn State University, Human Development and Family Studies, University Park, USA
In a replicated time series design 5 patients were assessed each 5 minutes during 3 consecutive days under natural living conditions. Assessments included 1) momentary blood glucose level, 2) insulin dose, 3) carb intake. To the 3-variate time series thus obtained for each patient, a patient-specific state-space model with arbitrarily time-varying parameters (TV-SSM) was fitted. The time-varying parameters describing the effects of insulin dose and carb intake on blood glucose can accommodate patient-specific time-varying lags in their actions. The TV-SSM was fitted to the data of each individual patient in a recursive way, i.e., in a way which is potentially realizable in real time. It was found that predictions of each individual patient's blood glucose level based on this TV-SSM 30 minutes ahead correlate more than. 90 with the actual blood glucose levels. The TV-SSMs for different patients appear to be patient-specific in different respects. It was found that the predicted effect of this adaptively optimized insulin delivery system is substantial, yielding substantial reductions of the deviations of each patient’s blood glucose level from the normal range of values.
Keywords: Methodology, Systems, Diabetes
CORRESPONDING AUTHOR: Molenaar Peter, PSU, University Park, pxm21@psu.edu
Gender and Health
O561
GENDER DIFFERENCES IN THE ASSOCIATIONS BETWEEN DEPRESSIVE SYMPTOMS AND SERUM FATTY ACID COMPOSITIONS
Tsuboi H.1, Watanabe M.2, Sakakibara H.3, Tatsumi A.4, Shimoi K.3, Yamakawa-Kobayashi K.5, Kobayashi F.6
1 Kanazawa University, Drug Management and Policy, Kanazawa, Japan
2 Aichi Medical University School of Medicine, Institute for Occupational Health Science, Nagakute, Japan
3 University of Shizuoka, Nutritional and Environmental Sciences, Shizuoka, Japan
4 Hamamatsu University School of Medicine, Community Health Nursing, Hamamatsu, Japan
5 University of Shizuoka, Food and Nutritional Sciences, Shizuoka, Japan
6 Aichi Medical University School of Medicine, Health and Psychosocial Medicine, Nagakute, Japan
Objective: Experimental and observational data suggest higher dietary intake of long-chain n-3 polyunsaturated fatty acids (PUFAs) may lead to decreased risk of depression in female population. To study the associations between serum FA compositions and depressive symptoms in men and women, the ratios of each FA were compared with perceived depression.
Methods: Cross-sectional studies were performed on 113 male workers recruited from a software development company, and on 137 female workers from a hospital and nursing homes in Japan. Depressive symptoms were assessed according to the Center for Epidemiologic Studies Depression (CES-D) scale. Serum FAs levels were measured by gas chromatography.
Results: In female participants, CES-D scores significantly inversely correlated with the serum percentages of total n-3 PUFAs and docosahexaenoic acid (DHA) + eicosapentaenoic acid (EPA) even after controlling for age, BMI, etc. (partial correlation coefficient = -0.17, -0.16; p < 0.05, <0.05, respectively). In contrast, the CES-D scores were not correlated with the serum ratio of total n-3 PUFAs or DHA + EPA in male participants. However, among men, CES-D scores were significantly positively correlated with the serum percentage of total saturated FAs (SFAs) and palmitic acid (PA) after adjusting for life style confounders (partial correlation coefficient = -0.19, -0.23; p < 0.05, <0.05, respectively).
Conclusions: Previous studies support our results concerning inverse associations between depressive symptoms and n-3 PUFAs among women, whereas the positive relationships between depressive symptoms and SFAs among men is a new finding. One possible explanation for the new finding is that chronic low-grade inflammation and oxidative stress increased by SFA can activate pathophysiological pathways of depression. The inflammatory pathway can also be involved in relieving depressive mood by anti-inflammatory and antioxidant effects of n-3 PUFA. These hypotheses may find a clue to the solution of biological mechanisms of the gender difference.
Keywords: Depression, Nutrition
CORRESPONDING AUTHOR: TSUBOI HIROHITO, Kanazawa University, Kanazawa, yayevgeny@livedoor.com
O562
AGE AND SEX DIFFERENCES IN THE RELATION BETWEEN EDUCATION AND PHYSICAL AND COGNITIVE FUNCTIONING AMONG MEN AND WOMEN AGED 76 YEARS AND OLDER
Kåreholt I.
Karolinska Institutet, Aging Research Center, Stockholm, Sweden
Introduction: The socioeconomic position (SEP) and health association is well studied; less is known about how the association varies with age. We study how the relation between education and physical and cognitive functioning vary by age.
Methods: A nationally representative sample of Swedes aged 76+ years was interviewed in 2010/2011 (n = 931) (non-response 14%). Men aged 80+ years and women 85+ were over sampled. (Sampling weights was used to control for this.) Physical functioning was measured by tests of lung function (peak flow), performance (9 tests of strength, range of motion, etc), and vision, and self-reported mobility (walking 500m, 100m, stairs, running 100m). Cognition was measured by the MMSE and a test of everyday competence. Global self-rated health (GSRH) was included as a comparison. Education was measured as number of years of education.
Results: Significant associations were found between higher education and better function (and better global self-rated health) for all indicators. All associations to education decreased with age except vision that only decreased for men. The associations between education and performance, mobility, everyday competence, and GSRH decreased more with age among women. The associations between education and lung functioning and MMSE decreased more with age among men.
Conclusions: Age patterns in the associations between education and functioning differ by indicator. In general education’s relation to both physical functioning and cognitive functioning and global self-rated health seems to decrease with age.
Keywords: Aging, Cognitive factors, Gender, Disability, Older adults, Socio-economic status
CORRESPONDING AUTHOR: Kåreholt Ingemar, ARC, Stockholm, ingemar.kareholt@ki.se
O563
LIFESTYLE-RELATED FACTORS EXPLAIN SEX DIFFERENCES IN SELF-RATED HEALTH IN THE SWEDISH WORKING POPULATION: THE SLOSH STUDY
Taloyan M., Leineweber C., Westerlund H.
Stockholm University, Stress Research Institute, Stockholm, Sweden
Background: Although self-rated health has been shown to predict morbidity and mortality, few studies have investigated this issue in employed population. The purpose of this cross-sectional study was to investigate (1) the prevalence of suboptimal self-rated health (SRH) in employed Swedish men and women (n = 7,445) and (2) to study whether the association between SRH and sex remained after adjustment for explanatory variables.
Methods: Logistic regression was used to calculate the odds ratios (OR) and 95% confidence interval (95%CI).
Results: Men had significantly higher odds of suboptimal SRH than women after adjustment for age and income, OR = 1.26 (95% CI 1.11-1.43). After inclusion of lifestyle-related factors in the final model the sex differences were rendered insignificant, OR = 1.11 (95% CI 0.94-1.31). Furthermore, regardless sex those who never consume alcohol had higher odds than those who drank 1-2 glasses alcohol a day.
Conclusions: The results of this study regarding higher prevalence and odds for suboptimal SRH in employed Swedish men than in women are contrary to a big number of studies on this issue. As self-rated health is an important indicator of health with a strong association with mortality, an excess risk of suboptimal self-reported health among employed men shows that there is a need of more attention to men’s health in both work places and medical practice.
Keywords: Gender, alcohol, diet
CORRESPONDING AUTHOR: Taloyan Marina, Stress Research Institute, marina.taloyan@stressforskning.su.se
O564
DIURNAL PREFERENCE AND HEALTH BEHAVIOUR IN A SAMPLE OF HUNGARIAN WORKING WOMEN
Purebl Gy.1, Haraszti R. A.1, Salavecz G.1, Dockray S.2, Steptoe A.3
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 University College Cork, School of Applied Psychology, Cork, Ireland
3 University College London, Department of Epidemiology and Public Health, London, UK
Several psychosocial factors have been investigated as possible correlates of health behaviour. Diurnal preference (morningness-eveningness) has not been a focus of recent health behaviour research, but previous studies have found correlations between evening preference and worse health status.
Method: The Composite Scale of Morningness, the Jenkins Sleep Problems Scale, the Patient Health Questionnaire (PHQ), Center of Epidemiological Studies Depression Scale (CESD), WHO Well-Being Scale, and a single item on the self-rated health were administered to 200 healthy working women (37.5 ± 10.7 years). Measures of fruit and vegetable intake, smoking, alcohol consumption, and everyday physical activity were also obtained. The effects of diurnal preference and possible interactions with chronic stress were tested.
Results: Evening preference was associated with higher smoking rates (p 0.005-0.046), less physical activity (p 0.063-0.032) and less healthy diet (p 0.017-0.011).. Chronic stress has no interaction with diurnal preference in our study.
Conclusions: Evening preferences are associated with poor health and less healthy behavioural preferences. Longitudinal studies are needed for the clarification of the causative relationships between health and diurnal preference.
Keywords: diurnal preference, health behaviour
CORRESPONDING AUTHOR: Purebl György, Semmelweis University Budapest, purgyor@net.sote.hu
O565
PERINATAL OUTCOME AT MATERNAL AGE 40 AND OLDER- CASE-CONTROL ANALYSIS IN SOUTHERN HUNGARY
Vanya M., Orvos H., Bártfai GY.
University of Szeged, Department of Obstetrics and Gynaecology, Szeged, Hungary
Background: It has been widely documented that maternal age in pregnancy is increasing in the world. Nowadays, many women delay their pregnancy even up to the 40th year of their life because different reasons such as occupational, educational and economical. Therefore, complete awareness of pregnancy outcomes in these ages for the midwifes and gynecologists is needed to protect the health of the mother and newborn.
Objective: Our case-control study was performed to compare the pregnancy and neonatal outcome of mothers aged of 40 years and older with those of 20-to 30 years-old women.
Material and Methods: Among 14935 women who delivered in the Department of Obstetrics and Gynaecology, University of Szeged between 1st of January, 2005 and 31st of December, 2010, 354 (2,37 %) were 40 years and older at the time of delivery. Twelve cases were excluded because of multifetal pregnancies. From the remaining 342 cases, 150 women (case group) were selected by simple random sampling and their perinatal data were retrospectively reviewed. They were compared with 150 20-to 30 year-old mothers (control group).
Results: The mean age for the case group was 41.26 ± 1.56 years and that for the control group was 25.88 ± 2.72 years. The mean birth weight was 3156.85 ± 732,42 g for the case group and 3226 ± 587,8 g. The incidences of cesarean section, low birth weight (0,05). Premature birth, congenital anomalies, low umbilical cord pH (< 7,2), low 5 minute Apgar score (0,05).
Conclusion: This study showed that mothers aged 40 years had a higher risk for cesarean section, possible due to deterioration of uterine activity with age and higher incidence of in vitro fertilisation. Diabetes, hypertension, as predisposing factors for low birth weight and IUGR, are also contributing factors for c-section. The correlation between advanced maternal age and low birth weight may be due to age related changes in the uterine vasculature.
Keywords: pregnancy over 40 year, low birth weight, intrauterin retardation
CORRESPONDING AUTHOR: Vanya Melinda, University of Szeged, Szeged, vmelinda74@gmail.com
O566
GENDER DIFFERENCES IN PSYCHOLOGICAL RESPONSES TO INFERTILITY-RELATED STRESS. A PRELIMINARY STUDY IN A HUNGARIAN SAMPLE
Cserepes R: E.1, Bugán A.1, Sápy T.2, Tóth Z.2
1University of Debrecen, Department of Behavioural Sciences, Debrecen, Hungary
2University of Debrecen, Department of Obstetrics and Gynaecology, Debrecen, Hungary
Background: Facing involuntary childlessness is often characterized by the questioned women and men as one of the most stressful experience in their life (Pottinger et al, 2006; Salvatore et al, 2001; Souter et al, 2002; Oddens et al, 1999; Lalos et al, 1985). Women with reproduction problems suffer in a higher degree from general stress, depressive and anxious symptoms than men (Oddens et al, 1999; Wischmann et al, 2001; Salvatore et al, 2001; Fassino et al, 2002; Verhaak et al, 2005; Chachamovich et al, 2010). So the members of the couple don’t give the same reaction to the infertility although the different reactions circulate within the relationship and influence each other’s well-being (Peterson et al, 2008).
The aim of the study is to investigate whether the psychological responses of infertile women and men to infertility-related stress are associated with such psychosocial aspects as couple relationship, attitudes about gender identity and gender roles, perceived bonding style of own parents and desire for a child.
Methods: 53 men and women with fertility problem at the fertility unit of the Medical and Health Science Centre in Debrecen (Hungary) took part in the study. Besides a demographic questionnaire, participants completed the Fertility Problem Inventory (FPI), General Health Questionnaire (GHQ-12), Life Meaning subscale of Rahe’s Brief Stress and Coping Inventory (LM), Dyadic Adjustment Scale (DAS), Masculinity-Femininity scale from Minnesota Multiphasic Personality Inventory (MF), Male-Female Relations Questionnaire (MFRQ), Hungarian version of Parental Bonding Inventory (H-PBI) and Leipzig questionnaire about motives for having a child (LKM). The scores of the male and female groups were compared with each other and with standardized scores.
Results: Men had higher scores than women on LM and lower on FPI and on its ’social concerns’ subscale (FPI1). Mean scores of our sample had a difference from the Hungarian standard scores on GHQ-12, LM, MF, mother overprotection and control subscales and father care and control subscales of H-PBI.
For infertile women rememberred control and overprotection from mother (H-PBI), quality of the relationship (DAS) and subjective meaning of their life (LM) predicted the global infertility-related stress (FPI), relationship concerns (FPI3) and need for parenthood (FPI5). For infertile men rememberred care from mother (H-PBI), attitude about gender roles (MFRQ), emotional and social motives for having a child (LKM1, LKM3), length and quality of the relationship (DAS) and length of wanting to have a baby played the role of predictors in the stress domains (FPI, FPI1, FPI3).
Discussion: Our results have an association with previous found discrepancies between men and women experiencing involuntary childlessness. At the same time we have to consider how many psychosocial factors influence the infertility-related stress and that stress react to other fields of life of the subjects. The findings of this study make a good base for our further investigations.
Keywords: gender, stress, quality of life
CORRESPONDING AUTHOR: Cserepes Réka Eszter, University of Debrecen, Debrecen, cserepes.reka@sph.unideb.hu
Psychosocial Determinants of Eating Behavior and Obesity in Multiple Populations
O567
THE WEST MIDLANDS ACTIVE LIFESTYLE AND HEALTHY EATING IN SCHOOL CHILDREN (WAVES) STUDY: OBJECTIVES; METHODS; INTERVENTION AND BASELINE CHARACTERISTICS OF THE STUDY POPULATION. ON BEHALF OF THE WAVES STUDY INVESTIGATORS.
Adab P., Pallan M., Lancashire E.
University of Birmingham, Department of Public Health, Epidemiology and Biostatistics, Birmingham, United Kingdom
Background: Overweight and obesity is an increasing global epidemic, particularly in childhood. In the UK, 9.8 % of children aged 4-5 are obese almost doubling to 18.7% in children aged 10-11 years (2009/10 data). Given the rising trend in obesity by cohort and over time, as well as the associated health risks, prevention interventions targeting young children are required. However, evidence for effective interventions is lacking.
Methods: The WAVES study is a cluster randomised controlled trial, funded by the UK National Institute of Health Research, that aims to assess the clinical and cost-effectiveness of a programme of activities to encourage healthy lifestyle choices among children aged 6-7 with the aim of helping them maintain a healthy weight. The trial is set in the West Midlands, UK, within a multiethnic population. The multifaceted 12 month intervention programme targets the school and family environments with elements to encourage both healthy eating and physical activity opportunities for children. The intervention development was informed by the UK MRC framework for complex interventions. The trial is powered to detect a difference in BMI z-score of 0.125 units between control and intervention arms at 3 and 18 months post-intervention. Secondary outcomes include other measures of body fat, diet and physical activity levels.
Results: 54 schools across the West Midlands are being recruited in 2 phases. Baseline measurements have been completed in the 27 phase 1 schools (650 participants, response rate = 56%), and the schools have been randomly allocated to intervention/control arms.
Among participants in phase I, half are of white ethnicity. The remainder are from South Asian, African-Caribbean and other ethnicities. The mean BMI standard deviation score (z-score) at baseline was 0.35 (SD 1.26) for boys and 0.23 (SD 1.10) for girls, using UK 1990 BMI reference charts. 25.2% (76/301) of boys and 19.5% (62/318) of girls were overweight or obese.
More detailed study methodology, details of the intervention programme and baseline data (including demographic, anthropometric, diet and physical activity levels) for control and intervention schools will be presented.
Keywords: Obesity, Children, Randomised controlled trial, Health behaviour change, Diet, Physical activity, Public health
CORRESPONDING AUTHOR: Lancashire Emma, Uni of Birmingham, Birmingham, e.r.lancashire@bham.ac.uk
O568
FAMILY AND NEIGHBOURHOOD ENVIRONMENTAL CORRELATES OF WEIGHT STATUS AND OBESOGENIC BEHAVIOURS AMONG CHINESE PRIMARY SCHOOL CHILDREN
Li B., Adab P., Cheng KK.
University of Birmingham, Public Health, Epidemiology and Biostatistics, Birmingham, UK
Background: The prevalence of childhood obesity is increasing rapidly in China. However, research on family and neighbourhood environmental determinants of childhood obesity and related health behaviour is limited in this population. We examined the relationship between family and neighbourhood environmental factors with weight status and related health behaviour among Chinese primary school- aged children.
Methods: Height and weight data from year 3 students (aged 8-10) at 4 primary schools, in socioeconomically-distinct urban districts in South China were obtained. The data were used to classify pupils as either overweight/obese or non-overweight using WHO 2007 reference. Parents were invited to complete a questionnaire which enquired about family composition, their perception of their built-neighbourhood environment, parental physical activity habits, and the child’s dietary and physical activity patterns. Logistic regression models were developed to examine the relationship between environmental and family factors and childhood overweight and daily physical activity level (engaging in at least 1 hour MVPA). Multiple linear regression was used to identify family and environmental correlates of the child’s dietary habits (consumption of unhealthy snacks, sugar-added drinks and fruit & vegetables), and duration of sedentary behaviours.
Results: A total of 497 children and their parents were included in the study. Children who lived with at least 2 grandparents in the household were significantly more likely to be overweight/obese than children who did not (adjusted OR = 1.89; 95% CI: 1.03-3.46). Children who spent most of their time with a grandparent outside school had a higher weekly consumption of unhealthy snacks and sugar-added drinks, compared with children who spent most time with parent(s) or other adults. Mother’s physical activity levels were positively associated with the child’s. We found no evidence for associations between parents’ perceived neighbourhood environment and the child’s weight status and related health behaviours.
Conclusion: This study highlights the important role of grandparents in determining children’s weight status in China and suggests an important target for future interventions for childhood obesity prevention in that population.
Keywords: childhood obesity, Chinese children, China, Family, Neighbourhood environment, dietary behaviours, physical activity
CORRESPONDING AUTHOR: Li Bai, University of Birmingham, zhenshilibai6048@hotmail.com
O569
HABITUAL EMOTIONAL EATING PREDICTS CARBOHYDRATE INTAKE - A NATURALISTIC STUDY
Kubiak T.1, Krog K.2
1 University of Mainz, Institute of Psychology, Health Psychology, Mainz, Germany
2 University of Greifswald, Institute of Psychology, Greifswald, Germany
Aims: To examine the impact of naturalistic stress on eating behavior and differential macronutrient intake in students. We were particularly interested if (a) an increase in perceived stress led to changes in eating behavior. Concerning the latter aim we expected differential effects in terms of the macronutrients consumed. Drawing on recent research on the association between carbohydrate metabolism and self-regulation and evidence on mood elevating effects of carbohydrates, we predicted that carbohydrate intake would increase with a concomitant increase in stress. We (b) examined habitual eating styles (such as emotional and restricted eating) as potential moderators.
Methods: N = 30 high school students were studied for four weeks before their final examinations took place. The final examination served as a naturalistic future stressor. The participants completed self-reports on affect and perceived stress using an electronic diary five times a day using signal-contingent sampling (Palm Z22 running PMAT software) and a paper-pencil diet log. Data on daily dietary intake was quantified in terms macronutrients (caloric intake, carbohydrates, fat, protein, alcohol) after the study was completed. Habitual eating styles (emotional eating, restrained eating) were assessed using the Dutch Eating Behavior Questionnaire.
Results: Employing mixed regression methods, we found that perceived stress and negative affect significantly predicted alcohol intake. No effects were found for total caloric intake and the other macronutrients. However, introducing the habitual eating style of emotional eating revealed a significant interaction: Students high on emotional eating only showed a marked increase in carbohydrate intake related to increased stress. Carbohydrate intake, in turn, was significantly related to an increase in subsequent positive affect.
Discussion and Conclusions: The interaction of emotional eating and stress underpins the notion of people high on emotional eating using eating behavior as a means of coping and regulating affect. Our results suggest that emotional eating in response to stress shows a preference for carbohydrates, which is in line with (experimental) research on carbohydrate metabolism, self-regulation, and affect. However, the results are in need of replication.
Keywords: Stress, Eating Behaviors
CORRESPONDING AUTHOR: Kubiak Thomas, University Mainz, kubiak@uni-mainz.de
O570
DOES A PALEOLITHIC-TYPE DIET HAVE A BETTER EFFECT THAN A CONVENTIONAL LOW-FAT DIET IN ACHIEVING LONG-TERM WEIGHT-LOSS AMONG OBESE POST-MENOPAUSAL WOMEN?
Sandberg S.1, Mellberg C.1, Ryberg M.1, Olsson T.1, Larsson C.2, Lindahl B.1
1 Umeå University, Public Health and Clinical Medicine, Umeå, Sweden
2 Umeå University, Food and Nutrition, Umeå &, University of Gothenburg, Food and Nutrition, and Sport Science, Gothenburg, Sweden
Background: There is a clear increase in the risk for cardiovascular disease after the menopause, associated with an accumulation of fat mass that tends to be abdominally stored. The most suitable diet for weight loss and avoidance of weight regain in obese subjects has not yet been defined. In short-term studies, a Paleolithic-type diet (PD) has been suggested to be beneficial for weight loss and metabolic balance, but long-term studies are lacking.
Objective: To study the long-term effect of a Paleolithic-type diet (PD), based on a higher intake of protein and unsaturated fatty acids and with a lower intake of carbohydrates, compared with a Nordic Nutrition Recommendations (NNR) diet (conventional low-fat diet). We evaluated body weight, waist circumference and total fat mass.
Design: Seventy-one obese post-menopausal women were randomised to a PD or a NNR group for two years. The PD aimed at a daily intake of energy (E%) from protein, fat and carbohydrates of 30, 40 and 30%, and the NNR of 15, 25 and 60%. The diets were consumed ad libitum. Body composition was measured by DEXA (Dual Energy X-ray Absorptiometry). The dropout rates were 15% after 6 months and 30% after 24 months. Mixed models were used for statistical evaluation.
Results: Body weight and waist circumference decreased significantly in both dietary groups during the first six months (mean weight reduction 8.1 kg and reduced waist 11.4 cm in the PD-group; 4.0 kg and 6.6 cm for the NNR-group, respectively; p < 0.01 for difference between groups). These effects were still significant within groups at 24 months (8.0 kg/12.1 cm and 5.1 kg/6.6 cm, respectively) but without difference between groups. Total fat mass was significantly reduced in both the PD and the NNR groups at 6 months (-6.7 and -3.4 kg) as well as at 24 months (-5.6 and -4.0 kg). At 6 months, a more pronounced fat loss was found for the PD group (p < 0.001 for difference between groups).
Conclusion: In this randomised controlled trial on postmenopausal obese women a Paleolithic-type diet had more pronounced effects than a conventional low fat diet on body weight and composition within 6 months while both diets had long-term beneficial effects.
Keywords: obesity, diet
CORRESPONDING AUTHOR: Sandberg Susanne, University of Umeå, Sweden, susanne.sandberg@envmed.umu.se
O571
BEHAVIOURAL AND ENVIRONMENTAL FACTORS RELATED TO BODY MASS INDEX AMONG GENERALLY OBESE PEOPLE WILLING TO PARTICIPATE IN A LIFESTYLE INTERVENTION (THE BEWEEGKUUR).
Rutten GM.1, Kremers SPJ.1, Meis J.1, Bemelmans WJE.2, Veenhof C.3, Savelberg HCM.4
1 Maastricht University, Department of Health Promotion, Maastricht, Netherlands
2National Institute of Public Health and the Environment, Centre for Prevention and Health services research, Bilthoven, Netherlands
3 Netherlands institute for health services research, Allied Health Care, Utrecht, Netherlands
4 Maastricht University, Department of Human Movement Sciences, Maastricht, Netherlands
Introduction: The increased proportion of adults with overweight and obesity may result in an increase of various chronic diseases, and, consequently, of health care costs. Lifestyle interventions such as the BeweegKuur that include lifestyle coaching, physical activity and dietary advice, have shown to be effective in the reduction of overweight and obesity. There are indications that sedentary behaviour and motivational determinants are related to BMI. This study aims to assess behavioural and environmental factors related to changes in BMI of BeweegKuur participants.
Methods: A sample of 29 BeweegKuur-practices participated in a questionnaire survey with 4 measurements: at baseline and at 4, 12 and 24 months. Data will be collected from July 2010 to July 2013. Measures include self reported physical activity and dietary behaviour, BMI, expectations and experiences with the BeweegKuur and motivational and environmental determinants of behaviour change and maintenance. Analyses will include descriptive statistics and multiple regression analysis.
Results: Baseline data show a mean BMI of participants (n = 182) of 31.6 (SD = 3.41). Participants’ mean age was 54 years (SD = 12.5), and 64% of the participants were female. On average spent 6.18 hours sitting a day. Fifty seven percent of the participants did not meet the national criterion of half an hour moderately intense physical activity a day, 53% ate unhealthy take away or fried food more than once a week, and 51% ate snacks or candy more than 7 times a week. Participants showed predominantly autonomous types of motivation for physical activity and a mixture of controlled and autonomous types of motivation for healthy dietary behaviour. Social support for healthy diet (b = .351; p = .001) and motivation for enhanced physical activity (b = .322; p = .026) were positively related, and self-efficacy for enhanced physical activity (b = -.301; p = .018) was negatively related to BMI. The results suggest a positive relation between BMI and minutes sitting per day (B = .155; p = .07)
Conclusions: In our generally obese sample, sedentary behaviour, motivation and self-efficacy for physical activity and social support were related to BMI, but types of motivation differed for physical activity and healthy dietary behaviour.
Keywords: Obesity, physical activity
CORRESPONDING AUTHOR: Rutten Geert, Maastricht University, Maastricht, g.rutten@maastrichtuniversity.nl
O572
THE MEANING OF OBESITY AND OBESITY TREATMENT BEFORE BARIATRIC SURGERY
Silva S., Maia A.
University of Minho, School of Psychology, Braga, Portugal
This study used a qualitative approach to comprehend how the obese conceptualize and deal with obesity and obesity treatment, with the particular aim of exploring the expectations and beliefs about the exigencies and the impact of bariatric surgery.
The study population included 30 obese patients (20 women and 10 men) with a mean age of 39.17 years (SD = 8.81) interviewed individually before surgery using open-ended questions. The interviews were audiotaped, transcribed and coded according to grounded analysis methodology.
Three main thematic areas emerged from the data: obesity, eating behavior and treatment. Obesity is described as a stable and hereditary trait. Although participants recognize that personal eating behavior exacerbates this condition, patients see their eating behavior as difficult to change and control. Food seems to be an ever-present dimension and a coping strategy, and to follow an adequate diet plan is described as a huge sacrifice. Bariatric surgery emerges as the only treatment for obesity, and participants highlight this moment as the beginning of a new life where health professionals have the main role.
Bariatric surgery candidates see their eating behavior as out of their control, and to commit to its demands is seen as a big sacrifice. For these patients, surgery is understood as a miracle moment that will change their lives without requiring an active role or their participation. According to these results, it is necessary to promote a new awareness of the weight loss process and to empower patients before and after bariatric surgery.
Keywords: Obesity, health behavior change
CORRESPONDING AUTHOR: Silva Susana, University of Minho, susanasofiapsilva@gmail.com
Is Caregiving Hazardous to Your Health?: Biological and Psychological Factors Linking Interpersonal Behaviors to Health
S573
IS CAREGIVING HAZARDOUS TO YOUR HEALTH?: BIOLOGICAL AND PSYCHOLOGICAL FACTORS LINKING INTERPERSONAL BEHAVIORS TO HEALTH
Kim Y., Scheiderman N.
University of Miami, Psychology, Coral Gables, USA
This symposium aims to address the health-related implications of stress from interpersonal relationship, such as caregiving stress and marital conflict, and to present supporting evidence regarding psychological and biological factors that are involved in this link. Using a national longitudinal survey data with cancer caregivers in the US, Dr. Kim pinpoints the significant role of perceived caregiving stress among cancer caregivers in development of numerous medical morbid conditions 3 to 6 years later, supporting the proposition that caregiving can be hazardous to one’s health. In a community-based longitudinal study in the US, Dr. Steel illustrates the significant association between caregiving stress and physical health outcomes, which was mediated by immune dysregulation. Dr. Ditzen, using the Swiss Household Panel cohorts, demonstrates the significant role of a psychological factor in the target link by showing that the presence of intense interpersonal conflicts predicted worry, which in turn predicted impaired health one year later.
All presenters also identify challenges and barriers in enrollment and retention of participants, and in developing psychosocial programs that can be disseminated to diverse community populations. Also addressed are unique challenges involved in physical health research that includes couples, or both patients and caregivers.
Finally, in his discussion, Dr. Scheiderman identifies the unique interpersonal processes of an illness or conflict that make significant toll on one’s health. He also compares the findings from diverse sources of interpersonal processes; and discusses the implications of these findings for behavioral medicine and public health perspectives.
Keywords: caregiving, health, cancer survivorship, stress, social support
CORRESPONDING AUTHOR: Kim Youngmee, University of Miami, ykim@miami.edu
S574
CAREGIVING STRESS PREDICTS DEVELOPMENT OF MEDICAL MORBIDITY AMONG CANCER CAREGIVERS
Kim Y.1, Carver C.1, Spillers R.2
1 University of Miami, Psychology, Coral Gables, USA
2 American Cancer Society, Behavioral Research Center, Atlanta, USA
The statement that caregiving can be hazardous to one’s health is supported mainly by evidence from studies of dementia caregivers. Caregiving for cancer patients displays a different pattern than caregiving for dementia. It is generally limited to the time of diagnosis and treatment and varies in the intensity of its demands. Investigating whether caregiving stress contributes to development of medical morbidities requires a long-term prospective longitudinal approach. Such data are currently unavailable with cancer caregivers. This study attempted to fill this gap by examining caregiving stress at 2 years after diagnosis of a relative with a cancer (T1) on the development of various medical morbidities at 5 (T2) and 8 (T3) years post-diagnosis. A total of 720 caregivers participated in a nationwide longitudinal study. Caregiving stress using the stress overload subscale of the Pearlin Stress Scale and the presence of a list of 40 medical morbid conditions were measured. Age, gender, education, income, employment status, and spousal relationship to the care recipient at T1 were included in the analyses as covariates. Results from logistic regression analyses revealed that caregiving stress significantly predicted the development of numerous medical conditions at follow-up assessments that were not present earlier, controlling for the covariates. Specifically, at 5 years, caregiving stress at 2 years predicted the incidence of chronic back pain, depression, pulmonary disease, obesity, eye problems, pneumonia, liver disease, frequent infection, and disease in the urinary tract (Exp(B)s > 1.43, ps < .04). At 8 years, caregiving stress at 2 years predicted incidence of kidney disease, fibromyalgia, and dementia (Exp(B)s > 2.59, ps < .05). Findings suggest that cancer caregivers whose caregiver role was perceived as overwhelming were more likely to develop medical morbidities 3 to 6 years later. Programs tailored to mitigate caregiving stress for cancer caregivers may protect them from prematurely declining health years later.
Keywords: cancer, cancer survivorship, caregiving, (co)-morbidities, health, longitudinal research, stress
CORRESPONDING AUTHOR: Kim Youngmee, University of Miami, ykim@miami.edu
S575
CANCER CAREGIVING: THE ROLE OF PERCEIVED STRESS ON IMMUNITY AND HEALTH
Steel J.1, Geller D. 2, Deborah D.2, Friday M.2, Kingsley K.2, Marsh W.2, Tsung A.2
1 University of Pittsburgh, Surgery and Psychiatry, Pittsburgh, USA
2 University of Pittsburgh, Surgery, Pittsburgh, USA
A plethora of research has demonstrated that family caregivers who report high levels of stress or burden are at increased risk for depression, immune system dysregulation, health problems, and mortality. The majority of research has been conducted in carers of those diagnosed with dementia and a paucity of research exists regarding family caregivers of those diagnosed with cancer. A total of 130 cancer caregivers were prospectively followed from diagnosis of their loved one with advanced cancer to 24 months post-loss. The Caregiver Quality of Life Index-Cancer and the Center for Epidemiological Studies-Depression were employed to measure stress and depression, respectively. A subset of caregivers (n = 42) provided serum to assess absolute and percent positive lymphocyte subsets. The majority of caregivers were female (84%) and spouses to the care recipient (85%). Trajectory analyses revealed three groups of caregivers who reported low, moderate, and high levels of stress. A curvilinear relationship between perceived stress and lymphocyte subsets was observed with absolute lymphocyte counts: (low stress = 1345; moderate stress = 2188; high stress = 1559; p = 0.04), percent positive CD56 (low stress = 8.9, moderate stress = 15.5; high stress = 11.5; p = 0.02) and NK cell number (low stress = 120, moderate stress = 45, high stress = 52; p = 0.02). Those who reported moderate to high levels of stress during caregiving developed new or had an exacerbation of a pre-existing health problem during the caregiving and bereavement periods (e.g., hyptertension 42%, hyperlipidemia = 17%; non-fatal heart attack 4%; non-fatal stroke 4%) or death (4%). Chronic stress may be associated with increased risk for health problems and mortality, with NK cell numbers potentially mediating this relationship. However, further research is needed to determine if cancer caregivers who report high levels of stress or burden, are similar to those caring for loved ones with dementia, and at increased risk for health problems and mortality.
Keywords: stress, caregiving, immune system functioning
CORRESPONDING AUTHOR: Steel Jennifer, University of Pittsburgh, steeljl@upmc.edu
S576
INTERPERSONAL CONFLICTS AND INDIVIDUAL HEALTH IN THE SWISS HOUSEHOL PANEL SHP
Ditzen B., Spoerri C., Ehlert U.
University of Zurich, Psychology, Zurich, Switzerland
Background: The quality of social relationships is associated with individual health and longevity, an effect which is thought to be mediated through the repeated activation of the psychobiological stress systems to interpersonal conflicts.
Methods: Data from two cohorts (2008 and 2009) of the Swiss Household Panel (SHP) were analyzed. All subject provided information if there had been serious interpersonal conflicts with or among related persons during the year prior to the investigation. Also, subjects self-rated how frequently they experienced the emotions joy, anger, sadness, and worry and evaluated their individual health on an 11-point Likert scale. Self-rated individual health from 6255 individuals (2707 of these men) in 2009 was interpreted as outcome variable, with interpersonal conflicts as predictor and prior health (2008), sex, and age included as control variables.
Results: N = 220 men and 390 women reported intense interpersonal conflicts in the year prior to the investigation. These conflicts were associated with impaired individual health (Beta = -.101, p = .017), an association which was partly mediated by worrying (Sobel Test; Chi-square = 2.33, p = .009).
Discussion: Although these effects are small, they suggest an influence of social relationships on individual health in this Swiss population-based sample; more specifically, this effect is modulated by the perception of interpersonal conflicts and worrying.
Acknowledgement: This study is based on data from the Swiss Household Panel (SHP). The SHP is situated at the Swiss Centre of Expertise in the Social Sciences FORS and financed from the Swiss National Science Foundation (SNF).
Keywords: social stress, health outcomes
CORRESPONDING AUTHOR: Ditzen Beate, University of Zurich, Zurich, b.ditzen@psychologie.uzh.ch
The effects of Socioeconomic Factors on Physical and Mental Health
O577
EARLY AND ADULT SOCIAL DETERMINISTS OF ADULT RESPIRATORY SYMPTOMS IN GREAT BRITAIN: FINDINGS FROM THE 1970 BRITISH BIRTH COHORT STUDY (BCS70)
Cable N.1, Bartley M.2, Sacker A.3, Kelly Y.3
1 University College London, Epidemiology and Public Health, London, United Kingdom
2 University College London, Department of Epidemiology and Public Health, London, United Kingdom
3 University of Essex, Institute of Social Science Research, Colchester, United Kingdom
Little is understood whether early determinants, individual or environmental, could mediate the well-known association between social position of origin and adult respiratory health, independently of adult determinants such as smoking and exercise. Using data obtained from the British residents who were born in 1970 (BCS70, N = 6,099), we examined the effects of early and adult determinants on the pattern of adult respiratory symptoms (none, phlegm, cough, or both). Early determinants are individual factors (smoking and exercise) and home environment (dampness and household smoking) at age 10. Adult determinants are household smoking status (none smoking, members only, self only, both self and members) and exercise at age 30. We used multinomial logistic regression to examine the association between father’s social position at birth of the participants, indicated by the Registrar’s General Social Class (RGSC) and adult respiratory symptoms. The effects of the sex of the participants, birth factors (birth weight and respiratory distress) and respiratory symptoms at age 10 (cough or phlegm) on the adult outcome were adjusted accordingly.
We found 20% of the study participants had either phlegm or cough at age 30, which most of them were free from either of the symptom at age 10. Adults with the least advantaged social background were likely to be experiencing cough (RRR = 1.58, 95%CI = 1.17-2.23) or cough and phlegm (RRR = 1.62, 95%CI = 1.20-2.20) at age 30 in reference to those without any respiratory symptoms. However the effect of father’s RGSC became non-significant after entering childhood individual or environmental determinants in the model.
Overall, household smoking status at age 30 showed a large effect on adult respiratory symptoms (X2 = 439.7, p < 0.001). Dampness in the house at age 10 (X2 = 30.7, p < 0.001) had a moderate effect on adult respiratory symptoms. The size of the effects from exercise at age 42 and smoking at age 10 was small compared to those factors.
In sum, addressing dampness at home of all children, especially those from socially disadvantaged background can be an early start to reduce social gradients in adult respiratory health, along with ongoing public health interventions to stop adults from smoking.
Keywords: Population health, smoking, home environment, social inequalities in health
CORRESPONDING AUTHOR: Cable Noriko, University Collge London, n.cable@ucl.ac.uk
O578
UNFAIRNESS AND SOCIOECONOMIC INEQUALITIES IN HEALTH-RELATED FUNCTIONAL DECLINE: THE DUTCH SMILE PROSPECTIVE COHORT STUDY
Bosma H.1, Gerritsma A.1, Klabbers G.1, Van Den Akker M.2
1 Maastricht University, CAPHRI, Social Medicine, Maastricht, The Netherlands
2 Maastricht University, CAPHRI, General Practice, Maastricht, The Netherlands
Background: Because socioeconomic inequalities have such profound implications for daily life, excesses in income distributive processes have raised heated discussions about whether there is something objectively unfair or unjust about the conditions in which people from lower socioeconomic groups live. Living in a putatively unfair society, it is striking to see that only so few examined whether a general experience of unfairness is particularly common in people who are allocated the smallest shares of resources and whether this unfairness experience relates to subsequent poor health outcomes.
Method: Seven-year prospective cohort data from the Dutch SMILE study among 1,282 persons older than 54 years were used. Physical and mental health-related functioning was measured with the SF36, socioeconomic status with income and education, and the experience of unfairness with an extended new measure that tapped into such experiences in both work and non-work domains. Both logistic and linear regressions were used.
Results: Unfairness was related to both physical (odds ratio = 1.57 (95% confidence interval: 1.17-2.11)) and mental (1.47 (1.07-2.03)) health-related decline, while low socioeconomic status was only related to mental decline (1.33 (1.06-1.67)). Although the experience of unfairness was more common in low socioeconomic status groups (39 versus 26%), both were for the largest part independently related to longitudinal health-related decline. This pattern of findings was confirmed in several sensitivity analyses.
Discussion: The general experience of unfairness, at work and beyond work, has substantial implications for both physical and mental functional decline in middle and older age. Although unfairness is more common in low socioeconomic positions, it foremost had independent effects on functional decline. However, rather than addressing and changing individual perceptions of unfairness, more research is needed to find out whether specific environments can be objectively defined as unfair and whether such environments can be effectively tackled in an attempt to truly improve public health.
Keywords: Health disparities, Quality of life
CORRESPONDING AUTHOR: Bosma Hans, Maastricht University, hans.bosma@maastrichtuniversity.nl
O579
A COMPARISON STUDY OF 12 MONTH PREVALENCE OF PSYCHIATRIC DISORDERS ACCORDING TO SUBJECTIVE AND OBJECTIVE SOCIAL POSITION IN JAPAN AND US
Honjo K.1, Kawakami N.2, Tsuchiya M.3, Sakurai K.2
1 Osaka University, Global Collaboration Center, Osaka, Japan
2 University of Tokyo, School of Public Health, Tokyo, Japan
3 National Institute of Occupational Safety and Health, -, Tokyo, Japan
Backgrounds: The different pattern of social gradients of health between western and eastern countries has recently been reported. However, no comparative studies on subjective social position (SSP) and mental health. The aim of this study was to examine and compare the association between subjective social position (SSP), and 12 month prevalence of psychiatric disorders in Japan and US.
Methods: We used the data from the World Mental Health Japan (WMH-J) conducted in 2002-2006 (weighted n = 1,497) and data of National Comorbidity Replication Survey (NCS) conducted in the US during 2000-2001 (weighted n = 5,329) which were a part of World Mental Health (WMH) Survey.
The 12 month diagnoses of anxiety disorders and mood disorders were calculated. SSP was measured using a 10 rung scale on subjective social position in the country. We categorized responses into3 groups: low (1-4), middle (5), and high (6-10).Age, gender, race and marital status were adjusted for as confounding factors.
The weighted 12 month prevalence of outcomes according to SSP was examined by using SUDAAN in order to adjust for clustering and weighting.
Results: The 12 month prevalence of anxiety disorders and mood disorders were 4.1% and 2.4% for Japan and 17.8% and 8.3% for the US. In Japan we found a U-shaped association between SSP and those psychiatric disorders, in particular mood disorders. The odds ratios (OR) for mood disorder in the middle SSP group and low SSP group were 0.39 (95%CI: 0.17, 0.88) and 1.16 (95%CI: 0.56, 2.43) in reference to the high SSP group.
On the other hand, in the US, a linear association was identified between SSP and two psychiatric disorders; the OR for anxiety disorder in the middle SSP group and low SSP group were 1.52 (95%CI: 1.26, 1.84) and 2.46 (95%CI: 1.97, 3.08) in reference to the high SSP group. Similar association was identified for mood disorders. The identified associations were not significantly attenuated after adjusting for education level and adjusted household income.
Conclusions: The 12month prevalence of psychiatric disorders was higher in US than in Japan. The association between SSP and psychiatric disorders were different between these countries. Social gradients in psychiatric disorders are steep in the US.
Keywords: Socio-economic status, Depression
CORRESPONDING AUTHOR: Honjo Kaori, Osaka University, khonjo@glocol.osaka-u.ac.jp
O580
EFFECTS OF TYPES AND SIZE OF SOCIAL TIES ON SOCIALLY PATTERNED DEPRESSIVE SYMPTOMS AMONG OLDER PEOPLE IN ENGLAND
Cable N.1, Bartley M.2, Sacker A.3, Chandola T.4
1 University College London, Epidemiology and Public Health, London, United Kingdom
2 University College London, Department of Epidemiology and Public Health, London, United Kingdom
3 University of Essex, Institute for Social & Economic Research, Colchester, United Kingdom
4 University of Manchester, The Cathie Marsh Centre for Census and Survey Research, Manchester, United Kingdom
Little is known about how types and size of social ties would contribute to the association between subjectively measured social position (SSP) and depression. The study examines the effects of the size of social ties on depressive symptoms among older people in England.
We used residents aged 50 and over in England who participated in the wave2(2004-5) of the English Longitudinal Study of Aging (ELSA). SSP was obtained from self-reported marking on a 10-rung ladder scale, with a score of 10 being best off. Presence of depressive symptoms was determined by scoring 4 or more on 8 items from the CES-D. The size of social ties was obtained from self-reported numbers on family members, children, and friends to whom the participants could ‘closely’ relate. We also used a rating for emotional distance with the partner. Those who did not have family members, children, friends or a partner are used as a reference in the analytical model.
We used logistic regression to examine the association between SSP, social ties, and presence of depressive symptoms. All estimates are adjusted for age and the wave specific survey weight is applied to all analyses to account for non-response. Presence of longstanding limiting illnesses, education, and income are treated as confounders. Men and women were analysed separately.
In this study, many participants placed them between 5 and 7 on the social ladder. Presence of depressive symptoms was found among 12% of the male respondents (4046, weighted) and 19% of the female respondents (4734, weighted). Many had up to 2 emotionally attached social ties of all types, and were emotionally close to their partner.
SSP was linearly associated with presence of depressive symptoms among the participants. Social ties did not largely attenuate the effect of SSP, independently associating with the outcome.
Having around 4 or 9 or more friends was negatively associated with presence of depressive symptoms in older men and women. However, in older women, not having any close friends was also negatively associated with presence of depressive symptoms (OR = 0.37, 95%CI = 0.20-0.69) compared to those who had no friends. Having no close children or 9 or more children was associated with an increased chance in presence of depressive symptoms in men, but this was not true for women. In both men and women, having a close partner was negatively associated with presence of depressive symptoms. However, limited to women only, having an emotionally detached partner was positively associated with depressive symptoms compared to women with no partner (OR = 2.44, 95%CI = 1.49-4.04).
In sum, nurturing close social ties with friends and a partner can promote mental health of older people.
Keywords: Depression, Gender, Family, social class
CORRESPONDING AUTHOR: Cable Noriko, University College London, n.cable@ucl.ac.uk
O581
CHANGE IN PERSONAL RESOURCES MODERATES THE EFFECT OF SOCIOECONOMIC STATUS ON DISTRESS SYMPTOMS: A 10-YEAR FOLLOW-UP AMONG YOUNG ADULTS
Kiviruusu O.1, Huurre T.1, Haukkala A.2, Aro H.1
1 National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland
2 University of Helsinki, Department of Social Research, Helsinki, Finland
Objectives: Previous research indicates that socioeconomic status (SES) is associated with personal resources. Less is known about whether SES also associates with changes in these resources. In this study we examined the impact of SES on changes in personal resources and whether these changes in turn moderate the effect of SES on distress symptoms in a prospective 10-year follow-up among young adults.
Methods: Subjects (N = 1239) were participants in two phases (1989, 22 years; 1999, 32 years) of a Finnish cohort study. The measurements were SES (basic education at 22 years, occupation at 32 years), distress symptoms (index of 17 somatic and mental complaints), and personal resources (self-esteem, meaningfulness, locus of control, and their composite measure).
Results: Lower SES (basic education) at age 22 predicted slower development of personal resources among females with betas of SES ranging from10 to .12 (p < .01) for different personal resources. At age 32 lower occupational status associated among both genders with slower resource development during the past 10 years (betas .10 - .21, p < .05). Change (operationalized as residualized change scores) in the composite measure of personal resources moderated the effect of SES on distress symptoms: at -1 SD of residualized resource change the simple slope of SES at age 22 on distress symptoms at 32 years was 1.43 (p = 0.004) among females and 1.31 (p = 0.016) among males, whereas at +1 SD of resource change the slopes were 0.37 (p = 0.460) and 0.84 (p = 0.118) for females and males, respectively. These slopes indicate that among those with less favourable resource development between ages 22 and 32, lower SES at 22 years associated with more distress symptoms 10 years later (controlling for the baseline level), but among those with more positive resource changes the effect of low SES was more close to zero and non-significant.
Conclusions: The results indicate that lower SES is associated with less favourable changes in personal resources. In a longitudinal setting SES differences in health seem to increase only when personal resources decrease during the same period. The results emphasize the importance of dynamic conceptualizations of personal resources in the SES–health research.
Keywords: Socio-economic status, Social stress, Resilience, Health disparities
CORRESPONDING AUTHOR: Kiviruusu Olli, THL, Helsinki, olli.kiviruusu@thl.fi
O582
LIFE CONTROL MEDIATES SOCIAL GRADIENTS IN HEALTH AND WELLBEING AMONG MIDDLE-AGED AUSTRALIAN WOMEN
Lee C.
University of Queensland, Psychology, Brisbane, Australia
There are well documented gradients across socioeconomic position in health and wellbeing in all societies. One mechanism proposed to explain this phenomenon is that relatively advantaged people have greater levels of control over their lives and their health, and are able to make health-promoting decisions more easily than those with fewer advantages. There is evidence from the Whitehall Studies to suggest that perceived control may be a more robust explanation of this effect than is objectively assessed level of control.
This cross-sectional analysis uses data from Survey 5 of the 1946-1951 (Mid-age) cohort of the Australian Longitudinal Study on Women’s Health. It Health. examines the mediating role of perceived life control (measured with the Life Control Scale – Bobak et al., 1998) on the relationships between socioeconomic status (an objective area-level indicator) and 17 self-report measures of physical health, health behaviours, health service use, and psychological wellbeing amongst a nationally representative sample of 10,492 Australian women aged 56 to 61.
As expected, there were strong socioeconomic gradients on all dependent variables. Further, all dependent variables showed gradients across levels of perceived life control. Mediation analysis was conducted using logistic regressions with and without adjustment for perceived life control: these analyses showed full or partial mediation of every relationship, with the strongest effects for measures of psychological wellbeing. These findings support arguments that perceived control is one mechanism whereby relative deprivation affects wellbeing even in affluent societies. Future research will examine the effects longitudinally.
Keywords: Socio-economic status; Women's health
CORRESPONDING AUTHOR: Lee Christina, University of Queensland, c.lee@psy.uq.edu.au
Graphic Health Comunications: Do They Work and, If So, How?
S583
GRAPHIC HEALTH COMUNICATIONS: DO THEY WORK AND, IF SO, HOW?
Cameron L.
University of California, Merced, Psychology, Merced, USA
The aim of this symposium is to explore the use of graphic depictions of health harms as a means of encouraging the adoption of healthier lifestyles. The presentations focus on the use of graphic health warnings on tobacco packaging, but the findings extend to other relevant uses of graphic imagery in health communications aimed at health promotion and risk reduction. These strategies have grown up in the face of evidence from experimental psychology suggesting that they are likely to be counterproductive. Classical experimental psychology tells us that negative reinforcement only suppresses behaviour rather than producing behaviour change, and that it can cause reactance which can be counterproductive. In contrast, health promotion research suggests that the use of graphic, high impact warnings designed to highlight the health risks of smoking can effectively reduce smoking motivations, particularly through discouraging smoking uptake. What explains these differences in findings? Are they artifacts arising from the use of controlled, laboratory experiments in psychology research as opposed to the reliance by necessity on survey designs in public health research?
This symposium includes researchers representing multiple disciplines, including health and experimental psychology, public health, social epidemiology, and cancer prevention. They report recent experimental studies and longitudinal surveys which, taken together, provide compelling evidence that graphic warnings can serve as potent deterrents of smoking—more so than do messages focusing on the benefits of quitting or those emphasizing personal control over risks. The findings reveal specific mechanisms, including risk and threat cognitions and affect, through which graphic images may influence smoking motivations. The studies also provide insights into the specific types of graphic images and messages that are most likely to deter smoking and the social groups for whom they are most likely to be effective. In doing so, they identify patterns of psychosocial processes that appear to resolve the seeming research paradox by suggesting how immediate aversive reactions (as predicted by reinforcement theory) can yield to protection motivations over time.
Keywords: health communication, smoking, tobacco control, health promotion, health education, risk perception
CORRESPONDING AUTHOR: Cameron Linda, University of California, Merced, lcameron@ucmerced.edu
S584
RESPONSES OF YOUNG AMERICAN ADULTS TO GRAPHIC WARNING LABELS FOR CIGARETTE PACKAGES
Cameron L.1, Pepper K .2, Brewer T.2
1 University of California, Merced, Department of Psychology, Merced, USA
2 University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, Chapel Hill, USA
Background: The US is joining many countries around the world in adopting policies to replace text-based warning labels on tobacco products with graphic labels depicting health consequences of tobacco use. In 2010, the Food and Drug Administration (FDA) proposed a series of 36 graphic warning labels for cigarette packages. We evaluated the impact of the labels on worry about health consequences and smoking motivations of young adults.
Methods: We conducted an experimental study in 2010-2011 with 325 smokers and nonsmokers ages 18 to 30 who we recruited through local community distribution lists and a national survey company. Each participant viewed 27 labels (18 of the proposed labels with graphic images and text warnings, and 9 with text-only warnings) in a random order, evaluating each label on its understandability, impact on worry about the harms of smoking, and smoking motivations. Nonsmokers reported their susceptibility to start smoking in the next year, and we tested whether nonsusceptible and susceptible nonsmokers differed in their smoking attitudes, worry, and responses to the labels.
Results: Respondents found most of the proposed labels easy to understand. About 61% of the proposed labels induced greater worry and discouraged respondents from wanting to smoke relative to corresponding text-only labels. Labels with the greatest impact were photographs (as compared to drawings or other art graphics) or depicted diseased body parts or people who were suffering or dead. In almost every comparison, smokers reported less worry and less discouragement from smoking than nonsmokers did. Compared to nonsusceptible nonsmokers, susceptible nonsmokers reported less worry about addiction which, in turn, predicted weaker reactions to the warning labels.
Conclusions: Most of the proposed graphic warning labels enhanced worry about health consequences of smoking and reduced motivations to smoke, although some had larger effects than others. All but one of the nine warning labels recently adopted by the FDA effectively enhanced worry and reduced smoking motivations. Worry about addiction may be an important target for interventions with nonsmokers, and enhancing their addiction worry may enhance the effectiveness of graphic warning labels as smoking deterrents.
Keywords: health promotion, tobacco control, health communication, risk perception, smoking, health behaviors
CORRESPONDING AUTHOR: Cameron Linda, University of California, Merced, lcameron@ucmerced.edu
S585
REACTIONS TO HEALTH WARNINGS ON CIGARETTE PACKS AND SUBSEQUENT QUITTING
Borland R.
Cancer Council Victoria, Melbourne, Australia
Background: This paper reports on longitudinal population-based studies that provide insights into how graphic health warnings on cigarette packs work.
Methods: Data from the ITC-four country survey (USA, UK, Canada and Australia), and the ITC-SEA survey (Malaysia and Thailand). These surveys follow cohorts of smokers/recent quitters using standardised questions. Sample sizes are typically around 2000 per year and with loss to follow-up, leaving around 1400 per country for any wave to wave comparison. Smokers and recent quitter are asked about awareness of and reactions to warnings and these responses are related to quitting activity over the next year, controlling for other known determinants of quitting.
Results: Where countries change warnings, inevitably strengthening them (UK, Australia, Thailand), it results in them being noticed more and reacted to more, including being avoided more. While some of these effects dissipate over time, some persist. Salience of warnings (noticing, paying attention to) is not directly related to quitting, nor is avoidance, but both are positively related to thoughts about the harms of smoking and desirability of quitting, and forgoing cigarettes. These latter variables prospectively predict quit attempts and do so independent of what type of warning stimulated them. Further, among ex-smokers in the ITC-Four-country survey, reporting use to prevent relapse actually predicts lower rates of relapse, independent of post-quit cravings and self-efficacy, the main identified predictors of relapse.
Conclusions: The effects of pack warnings appear to be universal or nearly so. Pack warnings appear to stimulate quitting to the extent they generate relevant affectively charged cognitions. Similar findings are emerging from research on the impact of graphic anti-smoking advertisements. We conclude that while threatening health promotion messages might generate initial reactance and a tendency to avoid exposure, these effects either do not last, but translate into longer term negative attributions about smoking, which motivates subsequent attempts to quit.
Keywords: Health behaviour change, health communication, smoking
CORRESPONDING AUTHOR: Borland Ron, Cancer Council Victoria, ron.borland@cancervic.org.au
S586
TOBACCO-RELATED THREATS AND SMOKING BEHAVIORS: CONVEYING RISK AND THREAT MESSAGES THROUGH GRAPHIC PRINT ADS
Song A., Skorek M.
University of California, Merced, Health Psychology, Merced, USA
Background: A key to understanding why some health communication efforts work and how they can be made more effective lies in an important yet untested assumption: relaying risks will make people feel as though their health/lives are threatened. If individuals feel that their health is threatened, they will act to lessen the threat. Consequently, this line of thinking has led health researchers to treat risk and threats interchangeably when they may be distinct constructs that lead to different outcomes. The current study examines whether graphic print ads targeting perceptions of threat versus risk differentially influence smoking motivations.
Methods: In Study 1, 234 young adults (mean age = 20.2) viewed 7 graphic anti-tobacco print ads belonging to either a risk or threat condition. The risk condition highlighted one’s individual control and responsibility over smoking. These ads included a two-part slogan that started with the phrase “Know the risks and live responsibly”. The same 7 graphic images were used in the threat condition, but were accompanied by a two-part phrase beginning with “Don’t let them fool you”. Afterwards, participants reported their smoking intentions (7 items) and smoking attitudes (15 items). In Study 2, a national sample of respondents across all age groups participated in an online study with the same procedure as described above.
Results: In Study 1, participants in the threat condition reported lower short/mid-term intentions to smoke in the next 30-days and next 6 months (F(1,233) = 4.26 and 4.78, p < .05, respectively. Moreover, the threat condition had a marginally stronger effect on smoking intentions among smokers, compared to nonsmokers (F(1,233) = 3.13, p = .07). Results from Study 2 were similar to findings from Study 1.
Conclusions: When designing graphic anti-smoking messages, targeting threat perceptions may be more effective than targeting risk perceptions in reducing smoking behaviors. Presenting smoking and other health behaviors as a threat can be more effective, because threats are more imminent and require immediate action, whereas risks can be easily ignored. Long-term research is needed to confirm whether this communication tool elicits changes in smoking attitudes and intentions that persist over time.
Keywords: Health communication Health beliefs Health behaviors Smoking
CORRESPONDING AUTHOR: Song Anna, University of California, Merced, avsong@gmail.com
S587
AMERICAN MALE ADOLESCENTS’ REACTIONS TO CIGARETTE WARNING LABELS
Pepper J. K., Cameron L. D., Reiter P. L., McRee A. L., Brewer N. T.
University of North Carolina, Chapel Hill, Department of Health Education and Behavior, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
Background: Unlike many countries, the U.S. does not currently require cigarette package warning labels to include graphic images. In November, 2010, the U.S. Food and Drug Administration (FDA) released a set of proposed graphic warning labels which, if implemented, would represent the first change in cigarette warnings in more than 25 years. We sought to examine whether warning labels discourage smoking and alter perceived likelihood of harms among adolescent males in the U.S., and whether these label effects vary by age.
Methods: A national sample of 386 non-smoking American males ages 11-17 participated in 2010, before the FDA released the new labels for public comment. We randomly assigned participants to view warning labels in a 2x2 between-subjects online experiment. The labels described a harm of smoking (addiction or lung cancer) using text only or text plus an image used on European cigarette packs. Analyses examined whether age moderated the labels’ impact on risk perceptions and smoking motivations.
Results: The warning labels discouraged most adolescents from smoking, but lung cancer labels discouraged them more than addiction labels did (60% vs. 34% were “very discouraged”, p < .001). Including an image had no effect on discouragement from smoking. The warning labels affected several beliefs about the likelihood of harms, and age moderated some of these effects. For older adolescents, labels with images were more effective than text-only labels in conveying risks of lung cancer. Adolescents said addiction was easier to imagine and more likely to happen to them than lung cancer. They believed that their true likelihood of experiencing either harm was lower than what an expert would say.
Conclusions: Implementation of the graphic labels in the U.S. is currently blocked by an ongoing lawsuit. Our findings suggest that, should graphic warning labels be permitted in the U.S., those focusing on lung cancer, rather than addiction, are more likely to discourage smoking among adolescent males and enhance their ability to imagine the harmful consequences. Labels should include images in order to ensure that they effectively enhance risk perceptions for older male adolescents, who are at a particularly vulnerable age for smoking initiation.
Keywords: Health communication, health behaviors, smoking
CORRESPONDING AUTHOR: Pepper Jessica, University of North Carolina, lcameron@ucmerced.edu
Social Influences on Health: Psychological and Biological Mediators
S588
SOCIAL INFLUENCES ON HEALTH: PSYCHOLOGICAL AND BIOLOGICAL MEDIATORS
Ditzen B.1, Knoll N.2, Cacioppo J T.3, Holt-Lunstad J.4
1 University of Zurich, Psychology, Zurich, Switzerland
2 Free University Berlin, Psychology, Berlin, Germany
3 University of Chicago, Psychology, Chicago, USA
4 Brigham Young University, Psychology, Provo, USA
Social interactions have a substantial influence on individual health and longevity, which make the analysis of the mechanisms underlying this effect an important topic in behavioral medicine.
Consequently, the symposium will focus on cognitive, affective, and psychobiological mechanisms which might mediate the effects of social interactions. A broad range of methods were employed in the present studies: questionnaire studies using both cross-sectional and longitudinal designs in either healthy participants or patients after surgery, as well as pharmacological challenge studies, thereby investigating related biological factors.
1) In a longitudinal design, Nina Knoll and colleagues investigated N = 209 prostatectomy patients and their partners during 5 measurement points spanning 8 months pre and post surgery. The authors focused on individual goals and social support as well as the interaction of these variables in their effect on health and adjustment in both partners.
2) John Cacioppo et al. present data from an undergraduate university population and a population-based longitudinal sample of middle-aged and older adults in Chicago (the Chicago Health, Aging, and Social Relations Study, or CHASRS). They analyzed data on social isolation and will discuss these data in relation to behavioral, neural, hormonal, cellular, and genetic mechanisms of individual health.
3) Psychobiological mechanisms underlying social influences on health will also be in the focus of Beate Ditzen’s presentation. The authors investigated the effects of the neuropeptide oxytocin on autonomic nervous system reactivity and emotional activation during couple conflict in N = 94 men and women.
4) The discussion by Julianne Holt-Lunstad will integrate these findings and highlight the potential of examining an inter-individual perspective in behavioral medicine. The discussant will elaborate on the combination of psychological, psychobiological and medical data and, thereby, outline future directions in the research of social influences on health.
Keywords: social support, social stress, research methods, health
CORRESPONDING AUTHOR: Ditzen Beate, University of Zurich, Zurich, b.ditzen@psychologie.uzh.ch
S589
MEN’S UTILIZATION OF SPOUSAL SUPPORT AFTER PROSTATECTOMY: MANAGING AUTONOMY IN THE FACE OF POSTOPERATIVE MORBIDITIES
Knoll N.1, Wiedemann A. U.2, Heckhausen J.3, Burkert S.2, Felber J.4, Schader M.5
1 Free University Berlin, Division of Health Psychology, Berlin, Germany
2 Charité - University Medical Center Berlin, Institute of Medical Psychology, Berlin, Germany
3 University of California, Irvine, Department of Psychology and Social Behavior, Irvine, USA
4 University of Potsdam, Department of Psychology, Potsdam, Germany
5 Ulm University Medical Center, Department of Urology, Ulm, Germany
Following radical prostatectomy (RP), postoperative functional limitations give rise to new challenges for patients’ autonomy and well-being. To meet these challenges, the Life-Span Theory of Control suggests that individuals actively regulate their development by adjusting goals and control strategies for goal attainment. Control strategies of goal engagement can involve utilization of external help when an individual’s capacities are constrained. In this way, goal engagement and control-strategy use can be extended to incorporate dynamics of enacted social support. Aims of this study were the investigation of patients’ changes in autonomy-related goals (Lines of Defense Model) and utilization of spousal support. Also, interactions between autonomy goals and support utilization were investigated as potential protective functions for patients’ and their partners’ emotional adaptation to patients’ postoperative morbidities. 209 RP patients and their partners (ages 38-76 years) were recruited for participation in a prospective longitudinal study with 5 measurement points spanning 8 months peri-surgery. Patients’ functional limitations, autonomy-related goals as well as both partners’ spousal support and positive and negative affect were repeatedly assessed. Within the first 8 months post-surgery, patients’ functional limitations decreased significantly which was associated with increasing endorsement of goals to protect self-reliance. Spousal support to patients was at high levels throughout, but also decreased with decreases in patients’ functional limitations. For patients with strong goal commitment to protect self-reliance, receiving spousal support was not associated with decreases in negative affect, whereas the contrary was true for patients who did not endorse this goal. Partners of patients with strong goals to protect self-reliance experienced increases in negative affect after providing support to patients. Findings suggest that patients’ autonomy goals moderate the effects of spousal support on well-being not only for patients as support recipients, but also for their partners as support providers.
Keywords: Social Support, Cancer
CORRESPONDING AUTHOR: Knoll Nina, Freie Universität Berlin, Berlin, nina.knoll@fu-berlin.de
S590
SOCIAL ISOLATION, MORBIDITY, AND MORTALITY
Cacioppo J T., Hawkley L C., Norman G N.
University of Chicago, Psychology, Chicago, USA
Background: Social species, by definition, form organizations that extend beyond the individual. These structures evolved hand in hand with behavioral, neural, hormonal, cellular, and genetic mechanisms to support them because the consequent social behaviors helped these organisms survive, reproduce, and care for offspring sufficiently long that they too reproduced. Social isolation represents a lens through which to investigate these behavioral, neural, hormonal, cellular, and genetic mechanisms.
Methods: N = 143 undergraduate students from the bottom and top quintiles of loneliness and 229 (approximately half male) from the population-based longitudinal sample of middle-aged and older adults in Chicago (the Chicago Health, Aging, and Social Relations Study, CHASRS) were investigated. The undergraduates were tested during the afternoon, night, and next morning in the university hospital and during the course of their day while ambulatory physiological recordings were obtained. The CHASRS sample was tested annually (since 2001) with overnight urine, one day of laboratory testing (psychological, autonomic, neuroendocrine, genotyping, and gene expression), as well as end of day diaries and test tubes for three days of in home testing.
Results: Evidence indicates that isolation heightens sensitivity to social threats and motivates the renewal of social connections.
Conclusions: The effects of perceived isolation in humans share much in common with the effects of experimental manipulations of isolation in nonhuman social species: increased tonic sympathetic tonus and HPA activation, and decreased inflammatory control, immunity, sleep salubrity, and expression of genes regulating glucocorticoid responses. Together, these effects contribute to higher rates of morbidity and mortality in older adults.
Keywords: social stress, social support, immune function
CORRESPONDING AUTHOR: Ditzen Beate, University of Zurich, Zurich, b.ditzen@psychologie.uzh.ch
S591
EFFECTS OF INTRANASAL OXYTOCIN ON AUTONOMIC AND EMOTIONAL AROUSAL DURING COUPLE CONFLICT
Ditzen B.1, Nater UM.2, Bodenmann JG.1, Ehlert U.1, Heinrichs M.3
1 University of Zurich, Psychology, Zurich, Switzerland
2 University of Marburg, Psychology, Marburg, Germany
3 University of Freiburg, Psychology, Freiburg, Germany
Background: Unhappy couple relationships are associated with impaired individual health, an effect which is thought to be mediated through ongoing couple conflicts. Little is known, however, about the underlying mechanisms regulating psychobiological stress, and particularly autonomic nervous system (ANS) reactivity, during negative couple interaction. In this study, we tested the effects of oxytocin, a neuropeptide that plays a key role in pair-bonding in non-human mammals, on ANS reactivity during couple conflict in a standardized laboratory paradigm.
Methods: In a double-blind, placebo-controlled study design, 47 heterosexual couples (total N = 94) received oxytocin or placebo intranasally prior to a standardized instructed couple conflict discussion in the laboratory. The conflict session was videotaped and salivary alpha-amylase (sAA), a measure of ANS activity, and emotional arousal were repeatedly measured during the experiment.
Results: Oxytocin significantly reduced sAA during couple conflict in women, whereas men showed increases in sAA levels (sex * group interaction: B = -49.36, t = -2.68, p = .009). In men, these increases were related to augmented emotional arousal (r = .286, p = .028) and more positive behavior (r = .291, p = .026) during the conflict, whereas there was no such association in women.
Conclusions: Our results imply sex-specific effects of oxytocin on ANS reactivity to negative couple interaction, with the neuropeptide reducing ANS responses and emotional arousal in women while increasing them in men.
Keywords: Couple-focused, social stress, emotions
CORRESPONDING AUTHOR: Ditzen Beate, University of Zurich, Zurich, b.ditzen@psychologie.uzh.ch
Panel: Challenges to Conducting Translational Behavioral Medicine Research: Cross National Perspectives
PA592
PANEL: CHALLENGES TO CONDUCTING TRANSLATIONAL BEHAVIORAL MEDICINE RESEARCH: CROSS-NATIONAL PERSPECTIVES
Weiss S.1, Jones D.1, Oldenburg B.2, Peltzer K.3, Tobin J.4
1 University of Miami, Psychiatry and Behavioral Sciences, Miami, USA
2 Monash University, Epidemiology and Public Health, Melbourne, Australia
3 Human Sciences Research Council, HAST, Pretoria, South Africa
4 Yeshiva University, Epidemiology, New York, USA
Panel:
Stephen M. Weiss (Chair)
Brian Oldenburg (Australia)
Deborah Jones (Zambia)
Karl Peltzer (South Africa)
Jonathan N. Tobin (USA)
Abstract: Creating new knowledge is necessary but not sufficient to improve global health; this knowledge must be made accessible to the national/regional/local health care delivery systems to have the intended public health impact. This panel will address the general as well as culture-specific processes and challenges to convert what we have learned into improvements in clinical and public health practices.
For example, such challenges might include:
When can we consider a specific biobehavioral intervention “evidence-based”?
How do we deal with issues of external validity when crossing geopolitical boundaries, particularly those involving economic disparities? Do we have an “agreed upon” model to resolve the external validity question?
Which theoretical models appear to be the most effective and comprehensive (e.g., Rogers Diffusion of Innovation Theory; Glasgow’s RE-AIM model) in providing theoretical as well as empirical infrastructure guidance?
Should we adopt the gold standard in biomedical research (RCT - randomized clinical trial) as a working model?; should we convert the Phase 1 to 4 study sequence into a systematic approach to achieving the imprimatur of ‘evidence-based’ for biobehavioral research?
What organizational factors are associated with intervention sustainability, and how do political and economic changes (e.g., war, migration, elections, health care reform) affect sustainability?
Panel members will briefly (5-7 minutes) share their experiences, using data from their own “translation” efforts to provide support for their perspective, and then the Chair will open the floor for comments, questions and suggestions.
Keywords: research to practice translation; evidence-based; interventions
CORRESPONDING AUTHOR: Weiss Stephen, University of Miami, sweiss2@med.miami.edu
Physical Activity and Behavioral Medicine
O593
PHYSICAL ACTIVITY AND PERFORMANCE AT SCHOOL
Singh AS.1, Uijtdewilligen L.1, Twisk JWR.2, Van Mechelen W.1, Chin A Paw MJM.1
1 VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Amsterdam, The Netherlands
2 VU University Medical Center, Department of Clinical Epidemiology and Biostatistics, Amsterdam, The Netherlands
Background and aim of the study: Physical activity and sports are generally promoted for their positive effect on children’s physical and mental health. In addition to the positive physical and mental health impacts, there is a strong belief that regular participation in physical activity is linked to enhancement of brain function and cognition, thereby positively influencing academic performance. Given this suggested relationship and the ongoing discussions on the replacement of physical education lessons by academic subjects, we aimed to review the evidence on the longitudinal relationship between physical activity and academic performance.
Methods: Prospective studies were identified from searches in PubMed, PsycINFO, Cochrane Central, and Sportdiscus from 1990 through 2010. We screened the titles and abstracts for eligibility, rated the methodological quality of the studies, and extracted data. Studies had to report (1) at least 1 physical activity or physical fitness measurement (2) at least 1 academic performance or cognition measure during childhood or adolescence.
Results: We identified 10 observational and 4 intervention studies. The quality score of the studies ranged from 22% to 75%. Two studies were scored as high quality. Methodological quality scores were particularly low for the reliability and validity of the measurement instruments. Based on the results of the best-evidence synthesis, we found evidence of a significant longitudinal positive relationship between physical activity and academic performance.
Conclusion: Participation in physical activity is positively related to academic performance in children. Because we found only 2 high-quality studies, future high-quality studies are needed to confirm our findings. These studies should thoroughly examine the dose-response relationship between physical activity and academic performance as well as explanatory mechanisms for this relationship.
Keywords: children, adolescents, physical activity, academic performance
CORRESPONDING AUTHOR: Singh Amika, VU University medical center, a.singh@vumc.nl
O594
CHILDREN’S SITTING TIME AT SCHOOL AND HOME AND WHAT PARENTS THINK ABOUT IT
Salmon J.1, Arundell L.1, Brown H.1, Ridgers N.1, Cerin E.2, Ball K.1, Hume C.3, Chin A Paw M.4, Hesketh K.1, Crawford D.1
1 Deakin University, Centre for Physical Activity and Nutrition Research, Melbourne, Australia
2 The University of Hong Kong, Institute of Human Performance, Hong Kong, Hong Kong SAR
3 Deakin University, Centre for Physical Activity and Nutrition, Melbourne, Australia
4 VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
Introduction: The amount of time children spend sitting in class and home may be detrimental to their health. This paper will present objective data on the duration of children’s sitting at school and also parents’ perceptions of potential strategies to reduce their child’s sitting throughout the day.
Methods: A subsample of participants in the baseline Transform-Us! Intervention wore an activPAL inclinometer for 8 consecutive days (n = 140, 60% female, aged 8.2) to assess sitting and standing time. Parents (n = 455, 88% female, mean age 38) completed a baseline proxy-report survey in Feb-June 2010. On a five-point Likert scale, parents indicated their agreement with six statements about strategies to reduce sitting in class and at home.
Results: On average, children spent 404 minutes per weekday sitting of which 54% was performed during the school day (218 mins/day) and 48% during class time (191 mins/day). On average, children spent 160 minutes per day standing of which 50% was performed during the school day (81 mins/day) and 35% during class time (57 mins/day). Children performed 18.5 sitting bouts per day of which 10.3 were performed during the school day and 9.2 during class time. The school day was typically 6.5 hours long; of which 66% was spent sitting and 21% standing. Class time was typically 5 hours, of which 53% was spent sitting and 19% was spent standing. Parents believed that if their child spent more time standing during class time, they would be tired when they got home (43%); it would benefit their health (32%); they would be less productive in class (30%); they would be too tired to play outdoors after school (20.3%); it would benefit their academic performance (15%); and they would concentrate more (11%). Parents believed that if their child spent more time standing completing homework, they would be too tired to complete his/her homework (25%); s/he would be more likely to finish their task (11%); and they would be able to concentrate more (10%).
Conclusions: Findings suggests that children sit for much of the day and parents should be informed of the benefits of reducing their child’s sitting for educational related tasks; particularly if the necessary perceived support of such incentives is to be achieved.
Keywords: Physical activity; child health
CORRESPONDING AUTHOR: Salmon Jo, Deakin University, Melbourne, jo.salmon@deakin.edu.au
O595
ADOLESCENT PREDICTORS OF OBJECTIVELY MEASURED PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR AT AGE 42: THE AMSTERDAM GROWTH AND HEALTH LONGITUDINAL STUDY (AGAHLS)
Uijtdewilligen L.1, Singh AS.1, Twisk JWR.2,3, Koppes LLJ.4, Van Mechelen W.1, Chinapaw MJM.1
1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
2 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
3 Department of Health Sciences, Section Methodology and Applied Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
4 Division Work and Employment, TNO, Hoofddorp, The Netherlands
Background This study investigated the associations of physical characteristics and personality in adolescence with physical activity and sedentary behaviour in adulthood.
Findings Physical characteristics (i.e. objectively measured BMI, sum of skin folds, aerobic fitness, MOPER test battery performance), and personality (i.e. self-reported inadequacy, social inadequacy, rigidity, self-sufficiency/recalcitrance, dominance, achievement motivation, facilitating anxiety, debilitating anxiety, and social desirability) were assessed in 217 adolescent boys (Mean 13.0, SD 0.6) and girls (Mean 12.9, SD 0.6). Twenty-nine years later, at the age of 42, their physical activity and sedentary behaviour were assessed by means of accelerometry. Boys who scored lower on self-sufficiency/recalcitrance and higher on facilitating anxiety spent more time sedentary in adulthood. Girls with a superior standing high jump performance, and a lower score on social desirability spent more time sedentary in adulthood. In contrast with sedentary behaviour, physical activity at age 42 year could not be predicted by physical characteristics or personality in adolescence.
Conclusions Sedentary behaviour in adulthood was partly explained by physical characteristics and/or personality in adolescence. Thus, our results suggest that it may be possible to identify people who are at risk of becoming sedentary at a rather young age.
Keywords: physical activity, longitudinal research, accelerometry, adolescence, adulthood
CORRESPONDING AUTHOR: Uijtdewilligen Léonie, VUmc, Amsterdam, l.uijtdewilligen@vumc.nl
O596
CHANGES IN PHYSICAL ACTIVITY AND TV VIEWING TIME AFTER TRANSITION TO RETIREMENT: THE EPIC-NORFOLK PROSPECTIVE POPULATION STUDY
Barnett I., Van Sluijs E., Ogilvie D., Wareham N.
Medical Research Council Epidemiology Unit, Cambridge, Centre for Diet and Activity Research, Cambridge, United Kingdom
Background: The transition to retirement has been recognised as a turning point in physical activity (PA) and offers opportunities for interventions aiming to promote active aging. While evidence suggests an increase in recreational PA after retirement, the consequences of retirement on other domains of PA (at home, for transport), overall PA and sedentary behaviours such as time spent watching television (TV) are unclear. This study aimed to examine the association between the transition to retirement and changes in PA (overall and domain-specific) and TV watching time.
Methods: Data were derived from the population-based EPIC (European Prospective Investigation into Cancer) Norfolk cohort. 1648 men (mean age: 55.6 + 6.1years) and 1829 women (mean age: 54.1 + 6.1 years) who were working at baseline (1997-2000) and had either retired or continued to work at follow-up (2002-06) were included. PA was measured by a validated questionnaire (EPAQ2) at baseline and follow-up and MET (metabolic equivalent task) h·wk-1 for all activity domains were calculated. TV viewing time was self-reported and summed as h·wk-1. Linear regression models stratified by sex and comparing retirees with those remaining working were fitted, adjusted for baseline values for age, socioeconomic and marital status, PA or TV viewing, body mass index, chronic disease, smoking and alcohol intake.
Results: 26% of men and 27% of women retired during follow-up. Compared to those remaining in work, recreational PA and home-based PA increased in men and women who had retired (both p < 0.001). Overall PA and transport PA declined (both p < 0.001). Compared with those who did not retire, the effect on overall PA in men was significantly greater than in women (men: -39.3 MET h·wk-1; women: -24.3 MET h·wk-1; p < 0.001). Retirement was associated with a net increase in TV viewing time (men: +2.8 h·wk-1; women: +2.5 h·wk-1; p < 0.001).
Conclusions: The results suggest that the loss of occupational PA in retirement is not fully compensated by an increase in recreational and home-based PA. Retirement was also associated with an increase in TV viewing time. Interventions to promote PA and reduce sedentary behaviours such as TV viewing should be targeted at people who are about to retire or have just retired.
Keywords: physical activity, aging, health behavior change
CORRESPONDING AUTHOR: Barnett Inka Barnett, Cambridge University, Cambridge, ib304@medschl.cam.ac.uk
O597
BALANCE BETWEEN LIGHT-INTENSITY PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR ACROSS THE LIFESPAN MEASURED BY ACCELEROMETRY
Spittaels H.1, Haerens L.1, Deforche B.2, Cardon G.1, De Bourdeaudhuij I.1
1 Ghent University, Movement and Sports Sciences, Ghent, Belgium
2 VUB, Human Biometry & Biomech, Brussels, Belgium
Introduction: Recent research shows that sedentary behaviour (SB) has negative health effects independently from people meeting the current physical activity (PA) recommendations. As there is an inverse linear relationship between light intensity physical activity (LIPA) and a number of cardiometabolic biomarkers, Hamilton et al. (2008) suggest to promote a healthy balance between time spent in LIPA and SB (i.e. spending more time in LIPA than time spent in SB).
Aims: The aim of this study was to objectively investigate the time spent in SB, in LIPA and moderate-to-vigorous intensity physical activity (MVPA) in Belgian population. Further, we wanted to explore which proportion of the population had a favorable balance between LIPA and SB and combined this with recommended amount of MVPA.
Methods: Accelerometer data from 7 cross-sectional studies (N = 2083) in four Belgian age groups (preschoolers, primary schoolchildren, secondary schoolchildren and adults) were aggregated and analyzed to categorize participants into one of four groups: (1) positive LIPA-SB balance (LIPA > SB) & sufficient MVPA (2) negative LIPA-SB balance & sufficient MVPA (3) positive LIPA-SB balance & insufficient MVPA (4) negative LIPA-SB balance & insufficient MVPA.
Results: For the total sample, 55% of the waking time was spent in SB (<100cpm), 39% in LIPA (<2000cpm) and 6% in MVPA (>2000cpm). A positive LIPA-SB balance was assessed in 18% of the total sample and only 10% combined this positive balance with recommended amount of MVPA. Secondary schoolgirls were most at risk, with only 1% of the sample combining a positive LIPA-SB balance with sufficient MVPA. Remarkable was also the high proportion of adult men (43%) who combined sufficient MVPA with a negative LIPA-SB balance.
Conclusion: A high proportion of the Belgian population is at risk if taking into account both SB and PA levels. Secondary schoolgirls have the unhealthiest SB and PA profile and are therefore an important target group for interventions both increasing MVPA and decreasing SB. In men more attention should be given in promoting a positive LIPA-SB balance independently from their compliance with the MVPA guidelines.
Keywords: Physical activity; Measurement; Health behaviors; Lifespan; Sedentary Behavior
CORRESPONDING AUTHOR: Spittaels Heleen, UGent, Ghent, heleenspittaels@gmail.com
O598
USING ART TO DRAW ATTENTION TO HEALTH PROMOTION
Eves F.1, Puig-Ribera A.2
1 University of Birmingham, School of Sport and Exercise Sciences, Birmingham, United Kingdom
2 University of Vic, Department of Health Sciences, Barcelona, Spain
Background: Habits are described as behaviours triggered by contextual cues associated with successful goal pursuit. No studies have experimentally tested whether healthy ‘habits’ can be linked to contextual cues.
Objectives: To investigate whether visual contextual cues, namely art or a simple coloured background, can prompt health behaviour after pairing with health promotion messages. Here, the healthy behavior of increased stair climbing indexed disruption of the habit of escalator choice.
Methods: In quasi-experimental, interrupted time-series designs, inconspicuous observers coded pedestrian choices between stairs and escalators. Design alone phases, i.e. art or a coloured background, were compared with design plus health promotion message phases.
Results: In two studies in Barcelona and Coventry (total n = 46,044), the design alone phase had no effect whereas a subsequent design plus message phase increased stair climbing. In five further studies, a design plus message phase that increased stair climbing preceded a design alone phase. Thus, the background behind the text of the intervention was reintroduced 3-4 weeks after the intervention was removed. A simple coloured background had no effect in a Birmingham shopping mall (n = 32,583) or station (n = 22,454) but increased stair climbing in a Barcelona station (n = 31,302). In contrast, a background containing art consistently increased stair climbing in stations (Barcelona, n = 33,117; Leiden, n = 22,563; Barcelona, n = 36,470).
Conclusion: Successful health behavior of stair choice can be prompted by environmental cues after they have been paired with health promotion messages. Thus, visual contextual cues alone can disrupt habitual behavior.
Keywords: Health Promotion, Behavior change
CORRESPONDING AUTHOR: Eves Frank, Birmingham University, Birmingham, evesff@bham.ac.uk
Pain, Musculoskeletal and Neuromuscular Disorders
O599
DOES PRIOR PAIN EXPERIENCE MODULATE NEURAL CORRELATES OF EMPATHY FOR PAIN?
Preis M.1, Schmidt-Samoa C.2, Dechent P.2, Kröner-Herwig B.1
1 Göttingen University, Clinical Psychology, Göttingen, Germany
2 Göttingen University, Department of Cognitive Neurology, Göttingen, Germany
The construct of empathy refers to the ability to understand and respond to the affective experience of another person (Decety and Jackson, 2004). In accordance with the perception-action model (PAM; Preston and De Waal, 2002), which provides a theoretical framework for the explanation of the neural mechanisms underlying empathy, recent fMRI studies revealed partial shared neural substrates for both the actual experience of pain and empathy elicited by the pain of others. This overlapping network includes the bilateral anterior insular cortex (AI) and the anterior midcingulate cortex (aMCC; Lamm et al., 2011). A growing number of studies indicates that empathic neural responses can be modulated by situational characteristics (e.g. Xu et al., 2009). For instance, Preston (2006) argued that empathy increases with past similar experience.
The present functional magnetic resonance imaging (fMRI) study examined whether or not prior pain experience increased neural correlates of empathy for pain. 64 right handed participants (32 women, 32 men) aged between 19 and 37 years (M = 22.98 years, SD = 4.10) watched pictures displaying people being exposed to pressure pain (pain pictures) and neutral pictures. Prior to the experiment, half of the participants were exposed to the same pain stimulus; the others had no such experience.
The results revealed that viewing the pain pictures contrasted to neutral pictures activated regions regularly associated with empathy for pain, mainly bilateral AI and aMCC in all participants. In the region of interest analysis, women with pain experience showed decreased activity in bilateral AI and aMCC relative to women without pain experience while watching the pain pictures. No differences were found in men. Whole brain analyses revealed stronger activation in the precuneus, retrosplenial cortex (RSC) and medial prefrontal cortex (mPFC) in participants with pain experience contrasted to participants without pain experience while viewing the pain pictures. These areas are associated with episodic memory retrieval (RSC, precuneus), perspective taking (mPFC) and the evaluation of emotional stimuli (RSC).
In conclusion, pain experience did not increase activity in regions regularly associated with empathy for pain. In contrast, in women activity in these areas (aMCC, AI) was decreased. However, pain experience increased activity in regions associated with memory retrieval and perspective taking.
Keywords: Pain, Emotion
CORRESPONDING AUTHOR: Preis Mira, Georg-August, Göttingen, mira.preis@psych.uni-goettingen.de
O600
CHRONIC LOW BACK PAIN PATIENTS WITH HIGH AND LOW KINESIOPHOBIA IMAGINE PAINFUL AND NEUTRAL MOVEMENTS – FMRI STUDY OF NEURAL CORRELATES
Barke A.1, Schmidt-Samoa C.2, Dechent P.2, Kröner-Herwig B.1
1 Göttingen University, Institute for Psychology, Göttingen, Germany
2 University Medicine, Department of Cognitive Neurology, Göttingen, Germany
Introduction: The fear avoidance model postulates that in chronic low back pain (CLBP) a fear of movement is acquired in the acute phase, which leads to subsequent avoidance of physical activity and thereby drives the chronification of the pain syndrome. In a previous study we failed to find neural correlates of such fear in an fMRI paradigm in which patients passively viewed pictures of painful and neutral movements. With that paradigm we could not rule out that the patients failed to relate the movements to themselves. In the present fMRI study we therefore instructed the participants to imagine that they perform the depicted movements.
Method: 62 patients (53.2% women, age 49.9 ± 9.9 years) with CLBP and 31 participants matched for age and sex (58.1% women, age 47.5 ± 9.1 years) took part in the study. The CLBP patients were divided on the basis of the Tampa Scale of Kinesiophobia (TSK) into a high kinesiophobic group (HK; n = 31, TSK: 40.5 ± 3.2) and a low kinesiophobic group (LK; n = 31, TSK: 30.5 ± 4.3). While lying in a 3T fMRI scanner, the participants were shown photos of painful and neutral movements: They were instructed to imagine that they execute each movement. After the fMRI session, the participants rated the valence and arousal associated with the movements.
Results: The ratings indicated that in all groups the painful movements were regarded as more negative than the neutral ones and that the CLBP patients rated the negative movements as more negative and more arousing than the controls. The comparison HK vs. LK of the contrast painful > neutral movements revealed stronger activations of the hippocampus and inferior temporal gyrus for HK and stronger activations of the DLPFC and the OFC for LK. The comparison HK vs. controls showed stronger activations for the controls in the ACC, the DLPFC, the hippocampus and the parahippocampal gyrus.
Discussion: On the basis of the fear avoidance model we expected activations in fear-related areas for the patients with kinesiophobia compared with patients without kinesiophobia or controls. In line with our previous findings no activations in such areas were observed. The group differences in activations may, however, point to differences in cognitive strategies vis-à-vis potentially painful movements.
Keywords: Chronic Pain
CORRESPONDING AUTHOR: Barke Antonia, Göttingen University, Göttingen, abarke@gwdg.de
O601
ILLNESS PERCEPTIONS IN A POPULATION OF EMPLOYEES WITH LONG-TERM SICK LEAVE FOR LOW BACK PAIN
Tveito TH.1, Petrie KJ.2, Eriksen HR.1
1 Uni Research, Uni Health, Bergen, Norway
2 University of Auckland, Department of Psychological Medicine, Auckland, New Zealand
Background: Modern pain research has established that the perception of pain is influenced by cognitions and the gate control theory of pain (Melzack & Wall, 1965) suggests that also the physiologic pain processes are influenced by cognitions. Acknowledging this, it follows that the patients’ own thoughts about their illness and its consequences may have an impact on the development of the illness and disability. CBT is a treatment that has proved effective in changing behaviour by changing cognitions in treatment of a variety of conditions, among them chronic pain. The aim of this study was to assess illness perceptions in a population of employees sick-listed for LBP and investigate whether cognitive treatments are effective in changing the illness perceptions.
Methods: In a randomised controlled trial employees sick-listed for 2 – 10 months because of unspecific LBP (n = 413) received one of four different interventions. All four groups received a brief cognitive intervention (BI), the BI group got no further treatment, the cognitive behavioural therapy (CBT) group received CBT, and the last two groups received capsules with either seal oil or soy oil in a double blind trial. Mean age of the participants was 44 years and 53% were women.
Results: Illness perceptions changed from baseline to 1 year follow-up in the total population for all scales except cyclical timeline (t = -.06, p = .952). The participants had a more positive view of the consequences of their complaints (t = 6.10, p < .001), they reported more personal control (t = 4.19, p < .001), a better coherence or understanding of their complaints (t = -4.43, p < .001), and more positive emotional representations (t = 6.03, p < .001). They had a more negative view of the chronicity (t = -3.04, p = .003) and treatment control (t = 6.76, p < .001) than at baseline. Women viewed their complaints as more cyclical than men (F(1,264) = 5.99, p = .015) and they had a more positive view on the consequences of their complaints (F(1,264) = 7.05, p = .008), otherwise there were no gender differences regarding illness perceptions. At follow-up the group receiving CBT reported more treatment control (F(3,262) = 3.31, p = .02) and a more positive view of the timeline (F(3,263) = 3.24, p = .02) than the other groups.
Conclusion: Cognitive interventions were effective in creating positive changes in illness perceptions. More comprehensive cognitive treatment further improved the effect.
Keywords: CBT, Musculoskeletal disorders, Worksite health
CORRESPONDING AUTHOR: Tveito Torill Helene, Uni Health, Bergen, Norway, torill.tveito@uni.no
O602
BODY MASS INDEX AND DEPRESSION ARE INDEPENDENTLY ASSOCIATED WITH PAIN AND ACTIVITY LIMITATIONS IN KNEE OSTEOARTHRITIS: RESULTS FROM THE AMS-OA COHORT
Holla JFM.1, Van der Leeden M.1, Roorda LD.2, Van der Esch M.1, Lems WF.3, Voorneman RE.4, Dekker J.5
1 Reade, Rehabilitation Research, Amsterdam, The Netherlands
2 Reade, Rehabilitation Medicine, Amsterdam, The Netherlands
3 VU University Medical Center, Rheumatology, Amsterdam, The Netherlands
4 Reade, Rheumatology, Amsterdam, The Netherlands
5 VU University Medical Center, Rehabilitation Medicine, Amsterdam, The Netherlands
Background: Body mass index (BMI) and depression are positively associated with each other (Rosemann et al. 2008), and positively associated with pain and activity limitations in knee osteoarthritis (OA) patients (Dekker et al. 2009). There is growing evidence that metabolic factors are involved in both the development of overweight and depression (McIntyre et al. 2007). This raises the question whether BMI and depression are related to pain and activity limitations independently of each other.
Objectives: To establish if BMI and depression are independently associated with pain and activity limitations in knee OA patients.
Methods: A cross-sectional study was conducted in a sample of 304 participants with knee OA from the Amsterdam Osteoarthritis Cohort. All patients fulfilled the American College of Rheumatology (ACR) clinical criteria for knee OA. Depression was measured with the Hospital Anxiety and Depression Scale. Pain was measured with a numeric rating scale for knee pain during the last week, and activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index and the timed get up and go test. Multivariable regression analyses were performed with BMI and depression as independent variables, and pain and activity limitations as dependent variables. Regression models with only BMI or only depression as independent variable were compared with regression models with both BMI and depression as independent variables. All analyses were adjusted for age, gender, civil status, educational level and comorbidity count.
Results: BMI and depression were independently associated with knee pain. After adjustment for each other the regression coefficients (Bs) of BMI and depression changed with 20.5% and 16.4% respectively, and were still significantly associated with knee pain (p ≤ 0.01). BMI and depression were independently associated with both self-reported and performance-based activity limitations (p ≤ 0.01). After adjustment for each other the Bs of BMI and depression changed with 10.3% and 27.9% in the analyses with self-reported activity limitations as dependent variable, and with 4.7% and 40.6% in the analysis with performance-based activity limitations as dependent variable.
Conclusions: The association between overweight and pain and activity limitations is not explained by depression, and the association between depression and pain and activity limitations is not explained by overweight. In treating patients with knee OA, overweight and depression should both be targeted.
Keywords: Depression, Disability, Musculoskeletal disorders, Obesity, Pain
CORRESPONDING AUTHOR: Holla Jasmijn, Reade, Amsterdam, j.holla@reade.nl
O603
PREDICTORS OF MULTIDISCIPLINARY TREATMENT OUTCOME IN FIBROMYALGIA: A SYSTEMATIC REVIEW
De Rooij A.1, Roorda L.1, Otten R.2, Van der Leeden M.1, Dekker J. 3, Steultjens M.4
1 Reade, Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
2 VU University, Medical Library, Amsterdam, The Netherlands
3 VU University Medical Center Amsterdam, Netherlands, Rehabilitation Medicine, Amsterdam, The Netherlands
4 Glasgow Caledonian University, School of Health, Glasgow, United Kingdom
Objectives: To identify outcome predictors for multidisciplinary treatment in patients with chronic widespread pain (CWP) or fibromyalgia (FM).
Methods: A systematic literature search in PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Pedro. Selection criteria included: age over 18; diagnosis CWP or FM; multidisciplinary treatment; longitudinal study design; original research report. Outcome domains: pain, physical functioning, emotional functioning, global treatment effect and ‘others’. Methodological quality of the selected articles was assessed with adapted Hayden criteria. Qualitative data synthesis was performed to identify the level of evidence.
Results: 14 studies (all with FM patients) fulfilled the selection criteria. Six were of high quality. Poorer outcome (pain, moderate evidence; physical functioning and quality of life, weak evidence) was predicted by depression. Similarly, poorer outcome was predicted by the disturbance and pain profile of the Minnesota Multiphasic Personality Inventory (MMPI), strong beliefs in fate and high disability (weak evidence). A better outcome was predicted by a worse baseline status, the dysfunctional and the adaptive copers profile of the Multidimensional Pain Inventory (MPI), and high levels of pain (weak evidence). Some predictors were related to specific multidisciplinary treatment (weak evidence). Inconclusive evidence was found for other demographic and clinical factors, cognitive and emotional factors, symptoms and physical functioning as predictors of outcome.
Discussion: Depression is a predictor of poor outcome in FM (moderate evidence). Baseline status, specific patient profiles, belief in fate, disability, and pain are predictors of treatment outcome (weak evidence). Some factors predict the outcome of specific forms of treatment.
Keywords: Pain, Rehabilitation
CORRESPONDING AUTHOR: Dekker Joost, VU University Medical Center, j.dekker@vumc.nl
O604
MINDFULNESS-AND CBT BASED COPING STRATEGIES FOR PAIN IN HEALTHY INDIVIDUALS AND IN FIBROMYALGIA PATIENTS: A SERIES OF STUDIES
Glombiewski J. A., Kohl A. M., Rief W.
University of Marburg, Clinical Psychology, Marburg, Germany
Introduction: Pain patients might benefit from mainly Cognitive Behavioral Therapy (CBT) strategies such as cognitive restructuring as well as from mainly mindfulness-based strategies such as acceptance. Little is known about micro-processes underlying CBT and mindfulness-based approaches (e.g. Acceptance and Commitment Therapy).
Objectives: In a series of studies we examined differential effects of cognitive restructuring, distraction and acceptance on pain tolerance and pain intensity in healthy individuals and in fibromyalgia patients.
Methods: First, we performed a meta-analytic review examining results of experimental comparisons between acceptance and other emotion regulation strategies (e.g. distraction, reappraisal) for pain intensity and pain tolerance. Second, we performed an experiment using a thermode to induce pain in 109 healthy females. After assessing a baseline pain tolerance and pain intensity, we taught the participants in either acceptance or cognitive restructuring or distraction pain coping strategies. Then, heat pain was induced again. We conducted mixed-model ANCOVAs with ‘pretest vs. posttest’ as the within-group factor and ‘type of instruction’ as the between-group factor. Third, we repeated this experiment in a sample of 60 fibromyalgia patients, comparing cognitive restructuring to acceptance.
Results: The meta-analytic search identified 30 studies. For pain tolerance, a small to medium between-group ES was found favoring acceptance strategies (g = 0.43, p < 0.01, 95% CI [0.12, 0.73]). With respect to pain intensity, meta-analysis did not show any significant differences between the different emotion regulation strategies.
In the first experiment, acceptance led to a higher increase in pain tolerance than cognitive restructuring in healthy females [F(2,99) = 3.2, p < 0.05]. Distraction led to lower pain intensity compared to acceptance [F(2,103) = 3.97,p < 0.05].
In the second experiment, we replicated the superiority of the acceptance based strategies on pain tolerance in fibromyalgia patients. Cognitive restructuring showed a tendency towards being more effective then acceptance in reducing pain intensity.
Discussion: Acceptance strategies increase pain tolerance more than cognitive restructuring instructions when pain is experimentally induced. Cognitive restructuring might be more useful in reducing pain then other strategies. In sum, we recommend applying a wide range of strategies for managing chronic pain to influence diverse outcomes.
Keywords: Pain; CBT; Mindfulness
CORRESPONDING AUTHOR: Glombiewski Julia, University of Marburg, Marburg, jg@uni-marburg.de
Novel Technologies and Applications in Behavioral Medicine Research
O605
PROMOTING PHYSICAL ACTIVITY THROUGH MOTIVATIONALLY DISTINCT MOBILE PHONES APPS: THE MILES STUDY
King A.1, Hekler E. 2, Grieco L.3, Winter S.3, Buman M.2, Banerjee B.4, Cirimele J.5, Robinson T.6, Mezias B.3, Chen F.5
1 Stanford University, Medicine, Palo Alto, USA
2 Arizona State University, Applied Health Science, Phoenix, USA
3 Stanford University, Department of Medicine, Palo Alto, USA
4 Stanford University, Engineering, Palo Alto, USA
5 Stanford University, Computer Science, Palo Alto, USA
6 Stanford University, Pediatrics, Palo Alto, USA
Smartphones and other mobile devices offer a promising means of delivering personalized guidance and support for key health behaviors such as physical activity (PA). Yet, few health-oriented mobile phone applications (apps) are currently based on theoretically derived constructs and empirical evidence. A major objective of the current research is to explore the efficacy of smartphone apps reflecting different motivational domains to promote initial physical activity adoption. 30 smartphone-naïve inactive adults ages 45 years and older (mean age = 57.9 years; 64% women) were randomized to receive 1 of 4 motivationally distinct Android smartphone apps: a Cognitive app, Social app, Affective app, or Control (dietary information) app. An interdisciplinary team developed the apps using an iterative design process. All apps drew from learning theory and its derivatives, and involved informational tailoring in response to participants’ daily physical activity, assessed using the smartphone’s built-in accelerometer. The Cognitive app focused on individualized goal setting, feedback, and problem solving. The Social app focused on social norms and comparisons within the context of a virtual ‘group’. The Affective app promoted attachment to an animal avatar whose behavior was determined by the participant’s own physical activity levels. Physical activity was measured using continuous data from the smartphone’s accelerometer. Smartphone accelerometry readings were verified against Actigraph accelerometry (R-square = 0.83), and the Freedson cutpoints were used to define intensity thresholds (light activity, moderate to more vigorous activity).
94% of participants reported the apps to be generally easy to use, and 97% found them to be a fast and efficient way to gain information. ANOVA indicated significant between-group differences across the 2-month period in daily moderate to vigorous physical activity (MVPA) for the Affect app (mean daily MVPA = 11.2 minutes more than Control) and Social app (mean daily MVPA = 16.3 minutes more than Control) (Ps < 0.01). The Cognitive app mean minutes of MVPA did not differ from Control (p = 0.39). Only the Affect app showed significantly more daily light-intensity physical activity relative to Control (by a mean of 37.8 more light intensity minutes per day; P < 0.001). A second experiment with refined versions of the apps is currently underway, and potential moderators of behavioral success for each app will be discussed. These initial experimental results suggest that easy-to-use apps targeting affective and social motives may be particularly useful in promoting early physical activity adoption among adults with minimal mobile device experience.
Keywords: Physical activity, Mobile Phone, Interactive Technology
CORRESPONDING AUTHOR: Abby King, Stanford University, Stanford, king@stanford.edu
O606
EXPERIENCES WITH AN INTERNET-BASED MAINTENANCE TREATMENT OF PATIENTS WITH EATING DISORDERS
Gulec H.1, Bauer S.2, Moessner M.2, Mezei A.1, Kohls E.1, Túry F.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
Eating disorders are often characterized by multiple illness episodes and chronic courses. Treatment response is limited and the drop-out rates are high for these disorders. Even after successful treatment, patients experience a high risk of relapse that is particularly pronounced in the first months following treatment termination. Maintenance of treatment gains and promotion of continued recovery is highly relevant to improve outcome and ultimately reduce the burden of illness. Interventions based on new technologies have the potential to extend the reach of treatment providers and to provide such maintenance support at reasonable cost and effort.
An Internet-based program, which provides an information and communication platform as well as professional online counselling, has been developed for this purpose. The program addresses patients with bulimia nervosa and related eating disorders not otherwise specified following treatment termination. The key modules of the program include 1) psycho-education, 2) monitoring and supportive feedback, 3) forum and 4) chat. The modules provide support of varying intensity, which can be tailored according to the individual needs and preferences of the participants.
The efficacy of the intervention is studied in an ongoing waiting list randomized controlled trial. N = 84 participants have been included until January, 2012. To date, no data on the use of internet-based programs as a maintenance strategy in eating disorders have been published. The presentation will focus on participants’ satisfaction with the online program and their adherence to the various components at the end of 4-month participation period. Furthermore, the potential of Internet-based interventions for healthcare delivery will be discussed. This research was funded by the European Commission in the Marie Curie Research Training Network INTACT (Individually Tailored Stepped Care for Women with Eating Disorders).
Keywords: e-health, eating behaviors, internet
CORRESPONDING AUTHOR: Gulec Hayriye, Semmelweis University, Budapest, hayriye_g@yahoo.com
O607
DEMYSTIFYING EPILEPSY STIGMA: THE IMPACT OF SMS-BASED MOBILE EPILEPSY EDUCATION SYSTEM (MEES) ON AWARENESS, KNOWLEDGE AND ATTITUDES (AKA)
Lua P. L., Neni W. S.
Universiti Sultan Zainal Abidin, Centre for Clinical & Quality of Life Studies, Kuala Terengganu, Malaysia
Stigma remains an important but undesirable feature of epilepsy worldwide and is frequently associated with lack of awareness, limited knowledge and negative attitudes even among patients themselves. Consequently, educational programmes are considered extremely important in the process of demystifying stigma. This study aimed to 1) assess the level of awareness, knowledge and attitude (AKA) pre- and post-intervention and 2) compare the AKA between control and intervention group pre- and post-intervention. Epilepsy out-patients from three general hospitals in East Coast Peninsular Malaysia were randomised into two groups: intervention and control. Patients in the control group were supplied with only printed epilepsy educational module while those in the intervention group additionally received short message service (SMS) from Mobile Epilepsy Educational System (MEES). Data analysis was carried out using SPSS v16 employing descriptive and parametric statistics. A total of 101 people with epilepsy (PWE) completed the study (age = 29.6 ± 11.0; single = 59.4%; education level ≤ SPM/ Cambridge O’ level = 75.2%; unemployed = 30.7%; monthly income ≤ MYR 500/ USD 158.5 = 64.4%).Overall, AKA level has significantly improved after both interventions (5.22 ± 1.48 vs. 6.06 ± 1.42, p < 0.001). Both groups’ AKA did not vary significantly pre-intervention (p > 0.05) but expectedly, patients who received SMS reported better AKA level post-intervention compared to the control group (6.32 ± 1.33 vs. 5.80 ± 1.47, p > 0.05). Over-time, control patients’ overall AKA had been significantly increased with the exception of Awareness (p > 0.05). On the other hand, all AKA domains showed significant improvement in the intervention group after the SMS-based MEES (5.40 ± 1.51 vs. 6.32 ± 1.33, p < 0.001). This study has provided early evidence on the effectiveness of MEES in elevating PWE’s AKA and could represent a promising technology to alleviate the negative stereotypes associated with epilepsy.
Keywords: epilepsy, health education, informatics, mobile phone
CORRESPONDING AUTHOR: Lua Pei Lin, Universiti Sultan Zainal Abidin, peilinlua@unisza.edu.my
O608
U-CARE - A RESEARCH PROGRAM ON PSYCHOSOCIAL CARE VIA THE INTERNET
Olsson E.1, Alfonsson S.1, Ander M.1, Burell G.1, Grönqvist E.2, Held C.3, Johansson B.4, Lindahl Norberg A.1, Mattsson S.1, Norlund F.1, Sjöström J.5, Toft T.1, Lochan R. 5 Von Essen L.1
1 Uppsala University, Department of Public Health and Caring Sciences, Uppsala, Sweden
2 Uppsala University, The Institute for Labour Market Policy Evaluation, Uppsala, Sweden
3 Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden
4 Uppsala University, Department of Radiology, Oncology and Radiation Science, Uppsala, Sweden
5 Uppsala University, Department of Informatics and Media, Uppsala, Sweden
U-CARE is one of the Swedish government’s strategic research programs at Uppsala University. The overarching goal is to promote psychosocial health among patients suffering from somatic disease and their significant others by means of self-help programs delivered via an internet platform. Another goal is to reduce costs for individuals and the society caused by emotional distress in response to somatic disease. Professionals within clinical psychology, health economics, and information systems collaborate to reach this goal.
Approximately 20% of patients suffering from somatic disease as well as their significant others experience a clinically relevant level of emotional distress in response to disease and treatment. This is in itself alerting, but becomes even more problematic since physicians and nurses show low sensitivity and specificity in detecting patients and significant others experiencing a clinically relevant level of distress. This can result in persistent distress causing human suffering as well as costs for individuals and the society.
During 2010-2011 an internet platform: www.u-care.se to provide interactive support and cognitive behavioral therapy has been constructed within the U-CARE program. The platform supports, among other things, rule-based unfolding of self-help material for participants, interaction between participants and therapists, interaction within a participant community, and research including a detailed log of participants’ behaviors on the platform. In addition self-help programs of interactive support and cognitive behavioural therapy for adolescents with cancer: U-CARE: TeenCan, adults with cancer: U-CARE: AdultsCan, and adults having had a myocardial infarct: U-CARE: Heart to be provided via www.u-care.se have been constructed.
Through a multi-disciplinary and design-oriented approach, the U-CARE program aims at developing new evidence-based knowledge in basic and applied psychosocial health care, and actively promoting its implementation in health care practice as well as in undergraduate and advanced education.
Keywords: Internet, CBT, Cancer, Cardiovascular disease, Adolescents, Economic, Depression, Anxiety
CORRESPONDING AUTHOR: Olsson Erik, Uppsala University, Uppsala, erik.olsson@pubcare.uu.se
O609
DEVELOPMENT AND PRACTICAL APPLICATION OF PERSONAL DIGITAL ASSISTANT (PDA) WITH SELF-MONITORING SYSTEM FOR TYPE-2 DIABETES
Inada S.1, Yoshiuchi K.1, Azuma A.1, Takimoto Y.1, Iizuka Y.2, Ohashi K.3, Kikuchi H.4, Yamamoto Y.5, Kadowaki T.2, Akabayashi A.1
1 The University of Tokyo, Graduate School of Medicine, Department of Stress Science and Psychosomatic Medicine, Tokyo, Japan
2 The University of Tokyo, Graduate School of Medicine, Department of Diabetes and Metabolic Diseases, Tokyo, Japan
3 National Cancer Center Hospital, Department of Internal Medicine, Tokyo, Japan
4 National Institute of Mental Health, National Center of Neurology and Psychiatry, Department of Psychosomatic Research, Tokyo, Japan
5 The University of Tokyo, Graduate School of Education, Tokyo, Japan
It is difficult to change one’s lifestyle for diabetes treatment. Self-monitoring is one of the most useful technique for changing a lifestyle. However, self-monitoring of a dietary pattern with a paper-and-pencil (P&P) diary is hardly used in a clinical setting because of difficulty in calorie estimation or burdens of recording food. In addition, it is not possible to know by a P&P diary when patients recorded. We have developed an electronic food diary using personal digital assistance (PDA) to overcome these disadvantages of a P&P food diary (J Am Diet Assoc 109:1232-1236, 2009). Using the PDA-based food diary, we are developing self-monitoring system to visualize patients’ dietary patterns and physical conditions in a daily life as an ecological momentary assessment technique. Therefore, the aim of the present study was to introduce the development of the self-monitoring system and a clinical example in which a diabetic patient used the system for six months.
The self-monitoring system was implemented in a PDA consisting of an electronic food diary, a query program for asking mood, hunger, and whether taking a medication, and a record of body weight and blood pressure transferred automatically from a weight scale and sphygmomanometer via Bluetooth. Data input to the PDA, such as calorie intake, weight and blood pressure were shown to patients with graphs on the screen of the PDA, which could function as the feedback to patients. Feasibility and efficacy of the system are now being evaluated in a randomized clinical trial for Japanese patients suffering type-2 diabetes.
The patient was a 43-year-old man with type-2 diabetes. He was asked to use the self-monitoring system for six months and record every meal, and weight and blood pressure. He recorded 94.7% of meals. Compared before using self-monitoring system, daily calorie intake, weight and HbA1c decreased (calorie, 1970kcal to 1820kcal; weight, 68.6kg to 67.4kg; HbA1c, 7.7% to 7.5%). After the usage, he reported that he had been able to change a food intake according to the previous meal recorded in the system. He also preferred automatic recording of weight and blood pressure. In conclusion, the system might be useful for changing caloric intake in diabetic patients as the feedback in a daily life.
Keywords: Diabetes, Self Management, Eating Behavior, e-Health, Mobile Phone
CORRESPONDING AUTHOR: Shuji Inada, The University of Tokyo, Tokyo, shiinada-tky@umin.ac.jp
Conflict of Interest: This study was partly supported by SHARP Corporation, Osaka, Japan (Kazuhiro Yoshiuchi, Ken Ohashi, Yoko Iizuka, and Yoshiharu Yamamoto).
O610
SMS-DELIVERED HEALTH INFORMATION FOR HIV-INFECTED PEOPLE: ACCEPTABILITY AND OUTCOMES ON PATIENT CARE IN MALAYSIA
Lua P. L.1, Abdul Rahman A. K..2, Sulaiman . N.2, Hassan R.3, Abdul Aziz A. B.3
1 University Sultan Zainal Abidin, Centre for Clinical & Quality of Life Studies , Kuala Terengganu, Malaysia
2 Hospital Sultanah Nur Zahirah, Department of Medicine, Kuala Terengganu, Malaysia
3 Hospital Sultanah Nur Zahirah, Department of Pharmacy, Kuala Terengganu, Malaysia
The use of IT-based tools has for sometimes been recognised as one of the most crucial foundation in telemedicine. Following the current telecommunication trend, short message service (SMS) is also fast gaining popularity as a simple, cost-effective health information delivery tool. This prospective longitudinal study was embarked in a sample of HIV patients to 1) determine acceptance level and 2) compare medication adherence and satisfaction levels pre- and post-intervention with SMS-delivered HIV information. Stable HAART patients were enrolled from a public hospital in Kuala Terengganu, Malaysia. Medication adherence level was assessed both by the pharmacist (via pill count) and patients’ self-declaration [via Malay Modified Medication Adherence Scale (MMMAS)] while Patient Satisfaction With Pharmaceutical Care Questionnaire (PSPCQ) was administered to gauge satisfaction level. Descriptive and non-parametric statistics were utilised for data analysis (SPSS 16.0). Randomly-chosen eligible patients (n = 31; median age = 39 years; male = 61.3%; married = 38.7%; self-employed = 51.6%) received 8 separate informative SMSes within a period of 3 months (contents: symptoms, transmission, drug-taking, social support and clinic appointment). None of the patients thought that the SMS was not useful, with the majority considering it “useful” (67.8%). Pharmacist-assessed adherence level was significantly better post-intervention (p = 0.011), with the proportion of completely-adherent patients having improved from 67.7% to 87.1% (MMMAS-assessed). Nonetheless, patient satisfaction generally did not exhibit any significant changes in all aspects of Friendly Explanation, Managing Therapy and Overall Satisfaction (p > 0.05). SMS-delivered HIV information is encouragingly acceptable to patients, with proven benefits in medication adherence. This reflects a potentially promising technology in attempts to propel healthcare services delivery in Malaysia to greater heights.
Keywords: adherence, health communication, informatics, mobile phone
CORRESPONDING AUTHOR: Lua Pei Lin, Universiti Sultan Zainal Abidin, peilinlua@unisza.edu.my
Media Exposures and Adolescent Substance Use: Mechanisms and Modifiers
S611
MEDIA EXPOSURES AND ADOLESCENT SUBSTANCE USE: MECHANISMS AND MODIFIERS
Wills TA.1, Hanewinkel R.2
1 University of Hawaii Cancer Center, Prevention and Control Program, Honolulu, Hawaii, USA
2 University of Kiel, Institute for Therapy and Health Research, Kiel, Germany
This symposium examines current questions about the impact of media exposure to tobacco and alcohol cues on adolescents. Dr. Wills et al. present findings from a study of younger adolescents in Hawai'i showing significant impact of movie exposure on smoking and alcohol use among Asian-Americans, Caucasians, and Filipinos but not among Native Hawaiian youth; effects were mediated through expectancies about use and perception of peer users. Dr. Hanewinkel et al. present longitudinal findings from a study of younger adolescents in six European countries showing how movie exposure is related to onset of cigarette smoking and binge drinking. Dr. Hunt et al. present findings from two samples of Scottish youth (12-14 years and 15-16 years) showing how consumer orientation and peer status factors are related to viewing movies with substance use. Dr. Waylen et al. present data on how movie exposure is related to a high risk of current alcohol use among a sample of 15-year old British adolescents. All studies included possible confounding variables and findings are independent of the controls. The results show that the impact of mass media on adolescent smoking and drinking is robust across different populations and occurs through both cognitive and social mechanisms. The observed impact of media on substance use at early ages presents a public health concern and the presenters discuss implications for efforts to reduce smoking and alcohol use among youth.
1. Authors: Thomas A. Wills, Frederick X. Gibbons, James D. Sargent, Rebecca Knight, Mercedes Tappe, and Megan Forbes
Institutions: University of Hawai'i Cancer Center, Dartmouth College, Norris Cotton Cancer Center
Title: Media Exposures and Substance Use among Adolescents in Hawai'i
2. Authors: Reiner Hanewinkel & Matthis Morgenstern
Institution: Institute for Therapy and Health Research, University of Kiel
Title: Longitudinal Analyses for a Study of Movie Effects on Smoking and Alcohol Use among Adolescents in Six European Countries
3. Authors: Kate Hunt & Helen Sweeting
Institution: MRC Social and Public Health Sciences Unit, University of Glasgow.
Title: Modifying Factors for Impact of Media Exposure among Adolescents in Scotland.
4. Authors: Andrea E. Waylen, Sam D. Leary, Andrew R. Ness, and James D. Sargent
Institution: School of Oral and Dental Sciences, University of Bristol.
Title: Cross-sectional Associations between Movie Viewing, Alcohol and Cigarette Use in a Cohort of British Adolescents
Keywords: Addictive Behaviors Adolescents
CORRESPONDING AUTHOR: Wills Thomas, University of Hawaii, Honolulu, twills@cc.hawaii.edu
S612
MEDIA EXPOSURES AND SUBSTANCE USE AMONG ADOLESCENTS IN HAWAI'I
Wills TA.1, GIbbons FX.2, Sargent JD.3, Knight R.1, Tappe M.4, Forbes M.4
1 University of Hawaii Cancer Center, Prevention and Control Program, Honolulu, Hawaii, USA
2 Dartmouth College, Department of Behavioral and Brain Sciences, Hanover, NH, USA
3 Norris Cotton Cancer Center, Cancer Control Program, Lebanon, NH, USA
4 University of Hawaii, Department of Psychology, Honolulu, Hawaii, USA
Effects of movie exposure to smoking and alcohol cues on adolescent smoking and drinking behavior have been replicated several times but studies have been conducted among largely White populations and further research is needed to examine the impact and mechanisms of media exposure across a range of ethnic groups. We conducted school-based data collection with a sample of 2,000 adolescents (M age 12.9 years, 51% were female) who were in public and private schools on Oahu, Hawai'i. The sample was 38% Asian-American, 29% Caucasian, 17% Native Hawaiian, 8% Filipino, and 8% other ethnicity. In the assessment procedure the participant (P) was presented with a list of 50 movie titles randomly drawn from a population of 500 and asked (Yes, No) whether he/she had viewed the movie. Ps also completed psychosocial scales and responded to items about their use of cigarettes, alcohol, and marijuana. Each movie was independently coded and data showed that on average, Ps had viewed 17 of the movies on the lists of 50 presented; in these they had seen an average of 47 occurrences of smoking and 41 minutes of onscreen alcohol use. Correlations with adolescent substance use in the whole sample were r = .27 (p < .0001) for movie smoking exposure and r = .31 (p < .0001) for movie alcohol exposure. These effects remained significant with control for P gender and parental education, for parental support and monitoring, and for P rebelliousness and sensation seeking. Effects of movie exposure were significant among Asian-Americans, Caucasians, and Filipinos but there was no significant impact of movies for Native Hawaiian adolescents. Structural modeling analyses with movie exposure as exogenous (with covariates) showed that the effect of movie exposure on adolescent substance use was mediated through more positive expectancies about use, more positive perception of users, and greater affiliation with peers who smoked or drank; some evidence for direct effects was also found. These findings extend previous research with a multiethnic population, show that movie impact occurs for most (but not all) of the ethnic groups studied, and provide confirmation that movie effects are largely mediated through theoretically relevant variables. Implications for prevention of tobacco and alcohol use through media-based interventions are discussed.
Keywords: Adolescents Addictive Behaviors
CORRESPONDING AUTHOR: Wills Thomas, University of Hawaii, Honolulu, twills@cc.hawaii.edu
S613
LONGITUDINAL ANALYSES OF MOVIE EFFECTS ON SMOKING AND ALCOHOL USE AMONG ADOLESCENTS IN SIX EUROPEAN COUNTRIES
Hanewinkel R., Morgenstern M.
University of Kiel, Kiel, Germany
Objective: To investigate whether the association between exposure to images of smoking and alcohol use in movies and substance use among adolescents is independent of cultural context.
Methods: A longitudinal survey in six European countries (Germany, Iceland, Italy, the Netherlands, Poland, and Scotland) was conducted. Using previously validated methods, exposure to alcohol use in movies as well as exposure to onscreen smoking were estimated from the 250 top-grossing movies of each country (years 2004-2009). Main outcome measures were lifetime binge drinking (more than 5 alcoholic drinks in one occasion) and lifetime smoking. For the longitudinal analysis we only considered students that were never smokers and never bingers at baseline.
Results A total of 16,551 pupils from 114 public schools with a mean age of 13.4 years (SD = 1.18) were studied at baseline of which 13,642 (82.4%) could be reached at follow-up one year later. Overall, 17% of the sample had initiated smoking and 22% had initiated binge drinking during the observation period. We calculated initiation frequencies dependent on movie smoking and movie drinking exposure, respectively, controlling for age, gender, family affluence, school performance, television screen time, sensation seeking, rebelliousness and substance use of friends, parents and siblings. In the group with lowest movie smoking exposure (quartile 1), the adjusted frequency of starting to smoke was 13%, compared to 20% in the group with the highest exposure (quartile 4). The numbers for binge drinking initiation were 17% in the group with the lowest movie drinking exposure and 26% in the group with highest exposure. Quartile 1 initiation rates were significantly different from Quartiles 2, 3, and 4, both for ever smoking and for ever binge drinking.
Conclusions: The link between tobacco and alcohol use in movies and adolescent substance use is robust and seems relatively unaffected by cultural contexts.
Keywords: Addictive Behaviors, Adolescence
CORRESPONDING AUTHOR: Hanewinkel Reiner, Kiel University, Kiel, hanewinkel@ift-nord.de
S614
MODIFYING FACTORS FOR IMPACT OF MEDIA EXPOSURE AMONG ADOLESCENTS IN SCOTLAND
Hunt K., Sweeting H.
Medical Research Council, Glasgow, United Kingdom
Analyses of media exposures and adolescent substance use typically adjust for a wide range of social and behavioural variables, but a number of important potential modifiers have not received attention. We report here results from two independent studies in Scotland which look at different modifying factors. The first, which included data on 1,999 15-16 year olds in 2007, showed that those who viewed films with smoking content repeatedly, or watched films mainly with friends, were more likely to smoke, whilst adolescents who reported parental rules about tv/film viewing were less likely to smoke. The second study, of 2,937 Scottish 12-14 year olds in 2010, investigated the impact of consumerism and peer status. A small number of studies suggest higher substance use and greater susceptibility to advertising and promotion among those with more consumerist values. Further, an adolescent’s social status within their peer group is associated with particular attributes and (risk) behaviours. Questionnaires included items representing four dimensions of consumer involvement (‘brand awareness’, ‘dissatisfaction’, ‘consumer orientation’ and ‘anti-consumerism’) and a list of material possessions. Pupils were also asked to rate various aspects of their own status compared to the rest of their school year group. Factor analysis distinguished three status dimensions: ‘peer’, ‘scholastic’ and ‘sports’. Smoking and drinking were more likely among those with greater consumer involvement and more material possessions, and also among those with higher ‘peer’ status, but less likely among those with higher ‘scholastic’ or ‘sports’ status. Strong associations between film exposures to smoking and drinking and adolescents’ own smoking and drinking were reduced after adjusting for these measures of consumer involvement, material possessions and peer status.
Keywords: Adolescents; Smoking; Alcohol
CORRESPONDING AUTHOR: Sweeting Helen, MRC SPHSU, Glasgow, helen@sphsu.mrc.ac.uk
S615
CROSS-SECTIONAL ASSOCIATIONS BETWEEN MOVIE VIEWING, ALCOHOL AND CIGARETTE USE IN A COHORT OF BRITISH ADOLESCENTS
Waylen A.1, Leary S.1, Ness A.1, Sargent J.2
1 University of Bristol, School of Oral and Dental Sciences, Bristol, United Kingdom
2 Dartmouth Medical School, Norris Cotton Cancer Center, Lebanon, NH, USA
Our aim was to see whether viewing movies was associated with alcohol consumption in a population cohort of British adolescents. We compared these associations with previous research showing that increased exposure to smoking depictions in movies is associated with a higher risk of tobacco use.
Data about frequency of movie viewing and alcohol consumption was collected from 5162 15-year old adolescents in the UK using a computer-assisted structured interview. Adolescents were asked which of 50 movies they had seen, randomly selected from a larger pool of popular contemporary movies. Outcome measures were initiation and current (weekly) use of alcohol. Social, family and behavioural factors were adjusted for together with peer alcohol / tobacco use.
On average, adolescents had seen 17.7 (SD 8.3) of the 50 movies listed; exposure was grouped into quartiles. In this cohort 85.7% of adolescents had tried alcohol and 21.3% of the cohort drank alcohol weekly. More frequent movie viewing was associated with a dose-response increase in alcohol use: adolescents in the highest quartile of movie viewing were 1.14 (95%CI 1.09-1.18) times more likely (adjusted risk ratio ARR) to have tried alcohol and were twice as likely to be current drinkers (ARR 2.02 (95%CI 1.66-2.46)).
More frequent movie viewing is associated with a higher risk of initiating and current alcohol use in adolescence even after adjusting for social, family and individual factors. Our results are comparable to previous findings for tobacco use although the pattern for each differs: by age 15 most adolescents have tried an alcoholic drink but the higher risk of trying alcohol associated with movie viewing is weak compared to that of smoking onset. Conversely, frequent movie viewing is associated with a high risk of current alcohol use at 15 despite adjustment for social, family and behavioural factors but adjustment for behavioural factors reduces this risk for tobacco use. These preliminary analyses suggest that there may be an association between frequent movie viewing and higher levels of alcohol use in adolescence. Further work is required according to the alcohol specific content of movies before we can confirm that the relationship is as important as it is for tobacco use.
Keywords: Adolescents, alcohol, multiple risk factors, smoking, tobacco use
CORRESPONDING AUTHOR: Waylen Andrea, University of Bristol, Bristol, andrea.waylen@bristol.ac.uk
Post Traumatic Stress & Health
O617
PSYCHIC TRAUMA AS AN INITIATION INTO NOTHINGNESS
Bánfalvi A.
University of Debrecen, Department of Behavioural Sciences, Debrecen, Hungary
Our contemporary ‘Weltanschauung’ is dominated by the feeling of homelessness, because meaning of life has been strongly undermined. The common framework which would provide a shared moral and meaningful background for the inhabitants has been lost. As a consequence, life is pervaded by deep-seated existential anxieties. In our so called trauma culture we can find a rejection of all kinds of suffering as meaningless and at the same time a wish for finding a tormenting moment in biography, which can provide a basis for creating a new possibility for reinterpreting the personal past with the hope of a new start. For the sake of a deeper understanding of the cultural role of trauma theme, a distinction must be made between being abused and being traumatised. Because being abused does not necessary mean being traumatised at the same time. Pain, shock, or even suffering is not enough for being traumatised. What is absolutely necessary for a psychic trauma is a missing meaning of the unbearable experience. This is the point which makes difference between abuse experiences in previous historical periods, in other cultures and in our own contemporary situation. As we know initiation rituals or ‘rites of passages’ were fairly general cultural series of events in the so called pre-modern societies. These rituals seem as painful, even sometimes tormenting experiences for the candidates. Nevertheless this is understandable, because ‘The central moment of every initiation is represented by the ceremony symbolizing the death of the novice and his return to the fellowship of the living. But he returns to life a new man, assuming another mode of being.’ (M. Eliade) On the surface, the psychic death is the direct outcome of the first phase of initiation and individual sexual abuse also. In both cases, the main rules, norms, values, attitudes, relationships of previous life, the so-called ontological security of a person have destroyed and lost. But after this ‘falling in the nothingness’, a new set and net of meanings, values, norms, knowledge, a new meaningful life emerges for the novices in premodern societies; a new identity has created, which is based on the well-established meaning system of that culture. However, in the case of modern trauma, after the annihilation of the previous self, there is no possibility of entering a new meaningful way of life, because this stable set of values is not provided by our culture. These processes can be understood through the perspectives of Sandor Ferenczi’s account of trauma.
Keywords: culture, sexual abuse
CORRESPONDING AUTHOR: Attila Bánfalvi, University of Debrecen, Debrecen, banfalvia@t-online.hu
O618
WHAT PREDICTS PTSD 12 MONTHS AFTER A ROAD TRAFFIC ACCIDENT?
Pires T., Maia Â.
University of Minho, School of Psychology, Braga, Portugal
Background: Discussions about Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) diagnosis criteria are an actual issue. The symptoms are similar but the period of time they evaluate is different. Our aim was to explore how the peri and posttraumatic reactions contribute to PTSD symptoms 12 months after a serious Road Traffic Accident (RTA).
Methods: 101RTA victims (76 male and 25 female) were evaluated 5 days, 4 and 12 months after RTA. Participants filled in an Acute Stress Disorder Questionnaire, a Personality Scale (NEO-FFI), the Peritraumatic Dissociation Experiences Questionnaire, the Ways of Coping Questionnaire, the Sickness Impact Profile and a Rating Scale for PTSD.
Results: 32.7% of the participants had ASD, 58.4% had PTSD 4 months after the accident and 46.5% 12 months after the RTA. The hierarchical regression analysis revealed that peritraumatic dissociation, ASD, neuroticism and PTSD symptoms evaluated 4 months after the RTA and health status and general coping evaluated 12 months after the RTA explained 46.2% of the PTSD symptoms variance 12 months after the accident. The variables that give better contributions to the final model were neuroticism (4 months) and general coping (12 months).
Discussion: Victims of serious accidents can have high prevalence of PTSD symptoms. Data showed that ASD and peritraumatic dissociation does not give an important contribution to explain PTSD 12 months after an RTA, when other variables are included in the model. Personality characteristics and coping strategies are significant predictors of PTSD among RTA victims and should be considered in prevention programs.
Keywords: Multiple risk factors, stress
CORRESPONDING AUTHOR: Pires Tânia, University of Minho, taniasfpires@hotmail.com
O619
PTSD AND PHYSICAL HEALTH COMPLAINTS IN PORTUGUESE SPECIAL OPERATIONS FORCES DEPLOYED TO AFGHANISTAN
Maia A.1, Osório C.1, Carvalho C.1, Greenberg N.2
1 University of Minho, School of Psychology, Braga, Portugal
2 Kings College London University, Institute of Psychyatry, London, UK
The recent military operations in Afghanistan have exposed military personnel to several combat and non-combat experiences. Accumulating evidences have linked these adverse experiences to increased risks in mental health problems such as PTSD and also diseases and physical health complaints. A total of 113 members from Portuguese Special Operations Forces deployed in Afghanistan completed a self-reported questionnaire for military experiences, PTSD, physical health complaints and diseases. In overall, high levels of exposure to combat and adverse physical conditions have been experienced by soldiers, but also high levels of within unit comradeship. Analyses for mental health suggested that only 2.7% reported symptoms compatible with PTSD and 8.8% with partial PTSD. As for physical health, results showed the presence of common physical health complaints such as back pain, fatigue and muscle pain. Regarding diseases, data indicated the presence of gastrointestinal, nervous and respiratory disease. Regression analysis revealed that combat experiences marginally explain PTSD, but adverse physical conditions also made a small contribution in the presence of symptoms. On the other hand, PTSD symptoms explained the variance in physical health complains after controlling for illnesses to the same variable. Despite the low rates in PTSD, special programs must be established by Portuguese military institutions with the objective of monitoring and evaluate for the occurrence of mental health problems in all military personnel returning from Afghanistan.
Keywords: PTSD war veterans
CORRESPONDING AUTHOR: Maia Ângela, University of Minho, Braga, angelam@psi.uminho.pt
O620
PERITRAUMATIC DISTRESS, WATCHING TELEVISION AND POSTTRAUMATIC STRESS SYMPTOMS AMONG RESCUE WORKERS AFTER THE GREAT EAST JAPAN EARTHQUAKE
Matsuoka Y.1, Nishi D.2, Nakaya N.3, Sone T.4, Noguchi H.5, Hamazaki K.6, Hamazaki T.7, Koido Y.8
1 National Center of Neurology and Psychiatry, Translational Medical Center, Tokyo, Japan
2 National Disaster Medical Center, Department of Psychiatry, Tokyo, Japan
3 Kamakura Women’s University, Department of Nutrition & Dietetics, Kanagawa, Japan
4 Tohoku Fukushi University, Department of Rehabilitation, Sendai, Japan
5 National Center of Neurology and Psychiatry, Department of Adult Mental Health, Tokyo, Japan
6 University of Toyama, Department of Public Health, Toyama, Japan
7 University of Toyama, Department of Clinical Science, Toyama, Japan
8 National Disaster Medical Center, Clinical Research Institute, Tokyo, Japan
Background: The Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake.
Method: In this prospective observational study, the DMAT member (physicians, nurses, and operational coordination staff) recruited for this study was assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multivariate regression analysis.
Results: Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multivariate regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms.
Discussion: The PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.
Keywords: posttraumatic stress disorder, peritraumatic distress, television, disaster mental health, rescue worker
CORRESPONDING AUTHOR:Matsuoka Yutaka, NCNP, yutaka@ncnp.go.jp
O621
CHANGES IN MOTIVES FOR FOOD SELECTION AFTER A NATURAL DISASTER
Kuijer R.
University of Canterbury, Department of Psychology, Christchurch, New Zealand
Background: The negative psychological impact of exposure to natural disasters is well documented. In contrast, little is known about how trauma exposure impacts on health behaviours such as dietary choices and food intake. There is increasing evidence from laboratory studies and surveys examining coping with daily stressors that stress affects people’s dietary choices in an undesirable way (increased fat/sugar consumption, decreased main meal and fruit/vegetable consumption). Unhealthy eating behaviours may have long-term negative health effects, as well as more immediate effects (e.g., low energy, low mood). This study examines changes in motives for food choice from pre- to post earthquake exposure and examines potential predictors of these changes (earthquake impact, posttraumatic stress (PTS) and dispositional self-control). Since September 2010, the Canterbury region in New Zealand has been hit by two major earthquakes (September 2010 and February 2011) and countless aftershocks causing significant damage and loss of life (181 deaths).
Method: As part of a longitudinal study, female participants completed a food choice questionnaire (FCQ; Steptoe et al, 1995) 20 months pre-September 2010 earthquake and again 3 months post-February 2011 earthquake (N = 101, M age = 57). The FCQ measures 8 factors that influence people’s dietary choices: health, mood, convenience, sensory appeal, price, natural content, familiarity, and weight concerns. PTS (Impact of Event Scale-R) and earthquake impact (amount of damage, financial strain etcetera) were measured post-earthquakes. Self-control was assessed pre-earthquakes.
Results and Conclusion: A multivariate significant effect for Time was found, F(8,93) = 5.53, p < .001. Univariate statistics showed that mood (p < .000) and convenience (p < .05) became more important in determining food choice from pre to post-earthquakes and health reasons (p < .05) and natural content (p < .001) became less important. Hierarchical regression analyses (controlling for T1 measure, age, income) showed that people with higher levels of PTS symptoms were more likely to choose food for mood reasons (p < .001), convenience (p < .05) and familiarity (p < .05), whereas people with higher levels of self-control were more likely to maintain choosing food for health reasons (p < .05) and natural content (p < .05). These findings are important as the short-term negative effects associated with an unhealthy diet such as low energy and low mood, may make coping in the aftermath of a natural disaster even more difficult.
Keywords: Eating behaviours; Longitudinal research; Health behaviour change
CORRESPONDING AUTHOR: Kuijer Roeline, University of Canterbury, roeline.kuijer@canterbury.ac.nz
Poster Session C
P622
ANALYSING LATENT CONSTRUCTS FOR OLDER ADULTS’ AGE REPRESENTATION: THE IMPORTANCE OF TIME PERSPECTIVE
Von Humboldt S., Leal I.
University Institute of Applied Psychology, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: To investigate latent constructs that can act as major determinants in age representation (AR) and subjective age (SA) and to explore associations between AR and SA, in an older adults’ cross-national population.
Methods: Measures were completed using a variety of culturally appropriate methods, including demographics and interviews. All variables had less than 1% missing values and complete information on 231 older adults aged between 74-102 years (M = 83.1; SD = 6.692) from four different nationalities, was available. The data was subjected to content analysis. Representation of the associations and latent constructs were analyzed by a Multiple Correspondence Analysis (MCA). Standardized instruments measured regular cognitive abilities.
Results: Findings showed a model for each pre-category. A three-dimension model formed by ‘past-oriented’, ‘present-oriented’ and ‘future-oriented’ was indicated as a best-fit solution for AR. SA was explained by a two-factor model: ‘age-cautious’ and ‘young-at-heart’. AR is shown to bear associations with individuals’ SA, in a model composed by ‘enjoyers’, ‘engaged’ and ‘conciliated’.
Conclusions: AR and SA are strongly explained by underlying constructs provided by the participants. AR is related to SA in older adults. Enhancing AR on shared perceptions of SA might be an important target to improve older adults’ interventions’ outcomes and aging well.
Keywords: Geriatrics, health beliefs, culture, aging
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon, sofia.humboldt@gmail.com
P624
INCOMPLETENESS OF DEATH REGISTRATION IN GHANA: THE ROLE OF MORTUARIES IN DEATH REGISTRATION
Gyimah C., Osei Tutu E.
Catholic University College of Ghana, Department of Public Health and Allied Sciences, Sunyani - Fiapre, Ghana
Background: Accurate worldwide information on the levels and patterns of mortality (deaths) is essential for planning and monitoring global public-health initiatives. The gold standard method for collecting such information is death registration. In high-income countries, death registration is effectively 100% complete, but the situation in many developing countries is very different. In most African countries, for example, less than one-quarter of deaths are officially recorded.
Methods: The study was done to find out how provision of mortuaries could help increase death registration coverage in Ghana from the current 25%. In a cross sectional survey of 20 districts (those with mortuaries and without), a structured questionnaire was administered to 204 relatives to seek their knowledge on deaths they registered in the year 2010; and 20 districts registrars of births and deaths to explore the problems associated with death registration.
Results: According to the relatives, 59.8% of the registered deaths expired at home compared to 33.3% deaths occurring in the hospitals and the remaining 6.9% were coroner’s cases. Again, among the relatives, 46.1% were not aware of death registration and let alone knowing why they should register a death of a relative. In all the 20 districts studied, 95% had no computer. Eighty five percent of the registrars had only secondary education. Seventy percent of the districts had just one employed staff and 15% of the districts had no employed staff. Conclusions or Significance: It was observed in the present study that, the districts with mortuaries registered more deaths as compared to the districts without mortuaries. It is therefore evident that death registration coverage will increase if mortuaries are provided in the districts. Public education should be intensified on the need to register deaths and the registry given the needed assistance to perform. A more holistic and durable programme should be put in place such as the keeping of community register for the entry of all deaths in every community (unit committee level).
Keywords: Measurement, Population health, Health disparities, Public health, Low-income,
CORRESPONDING AUTHOR: Gyimah Charles, St. Patrick's Hospital, Offinso, gyimahc@gmail.com
P625
THE RELATIONSHIPS BETWEEN THE SENSE OF COHERENCE AND SOCIAL PARTICIPATION AMONG PEOPLE WITH MENTAL DISABILITIES IN JAPAN AND CHINA
Amagai M.1, Li C.2, Kobayashi N.3, Hiroshima M.4
1 National College of Nursing, School of Nursing, Tokyo, Japan
2 Shanghai Jiao Tong University, School of Medicine, Shanghai, China
3 National College of Nursing, School of Nursing, Tokyo, Japan
4 Kyoto University, Graduate School of Medicine, Human Health Science, Kyoto, Japan
Background: Mentally disabled persons have a low tolerance for stress. Hence it is considered to be useful to increase their ability to cope with the stress of life in order to decrease the recurrence of their illness. The importance of success and self-efficacy has also been pointed out to play an important role in the recovery process. Self-efficacy for social participation is defined as “one’s self-confidence when participating in social events and activities and being a member of society.” This has been shown to also be related to the “sense of coherence,” the ability to cope and retain their health in society. However, empirical studies of these issues have not yet been performed comparing subjects in China and Japan. We therefore carried out a comparative study of subjects in Japan and China in order to clarify the relationship between self-efficacy for social participation and the sense of coherence.
Method: The first study investigated140 mentally handicapped people who lived in a Japanese community. The second investigation included 126 mentally handicapped people who lived in a Chinese community, who were evaluated from February to April in 2011. Questionnaires, including the 27-item Self-Efficacy for Social Participation(SESP), the 13-item sense of coherence (SOC) and a self-rated questionnaire regarding their living conditions were used for this study. We then used the results to assess the relationship between the SOC and SESP, and the differences between the average value of these scores.
Result: A significant correlation was thus observed between the SESP and SOC. We also found that mentally disabled persons in China had significantly higher SOC and SESP scores than did those in Japan. We also observed differences to exist in the SOC-related factors between Japanese and Chinese subjects.
Consideration: A relationship between self-efficacy and social participation with regard to the SOC was observed. Increasing the ability of the subjects to cope with stress synergistically helped foster confidence in social participation so that they could prevent a recurrence of illness. Increases in the ability to cope with stress have also been suggested to help mentally disabled subjects to regain their confidence. In addition, the method used to enhance the ability to cope with stress should be based on the actual situation of the people after taking into account the individual customs and attitudes of that country.
Keywords: Self-efficacy, Mental health, Sense of Coherence, Cross-cultural study
CORRESPONDING AUTHOR: Amagai Manami, NCN, amagaim@adm.ncn.ac.jp
P626
SUBJECTIVE HEALTH EVALUATION AND SOCIAL INTEGRATION AMONG PATIENTS AFFECTED BY HARDSHIP
Vasconcelos V., Santos D.
University Autonomous Lisbon, Department Psychology, Lisbon, Portugal
The subjective evaluation made by individuals about their own health involves an interpretation of their experience of illness as well as of their living experiences. In this field, dimensions as social integration, self-esteem and stress assume special relevance, since they are factors that may influence that evaluation and people’s adaptation to illness. The purpose of the present paper is to examine the relationship between subjective health evaluation and social integration in 201 patients, from fourteen health-care centres (Coimbra/Portugal), living under socio-economic hardship. Participants completed a questionnaire measuring, among other variables, feelings of social integration (a ten-item scale, to be answered in Likert-format, resulted from the one made by Tap, Sordes & Vasconcelos (2004) for the exploratory research concerning this project), and the evaluation of their own health (based on a scale from 1 to 20, the patient are asked to attribute a score corresponding their health state). Participants had a mean age of 44.47 (SD = 17.55). Mean scores (standard deviations) on study variables are: feelings of social integration M = 31.15 (DP = 5.89), out of a maximum score of 50 points; subjective health evaluation M = 11.37 (SD = 4.75), out of a maximum score of 20 points. Pearson correlations showed that feelings of social integration are positively correlated with subjective health evaluation (r = .332; p = 0.01). Results are discussed in terms of the specificity of feelings of social integration and subjective health evaluation. They suggest that, among individuals affected by hardship, feeling better integrated plays a role in the way they experience and cope with their own state of health.
Keywords: Health, Social Class
CORRESPONDING AUTHOR: Vasconcelos Maria de Lourdes, University Autonomous Lisbon, mlvasconcelos@netcabo.pt
P627
STUDY OF THE WOMEN’S EMPLOYMENT AND THEIR ROLE IN DEVELOPMENT OF IRAN
Jariani A., Vazirizadeh V.
Iranian Nursing Association, Nursing, Tehran, Iran
Introduction: Women are half of the population of Iran, but in developing countries they are being treated as “the hidden half” of the community and therefore they have a faded presence in the economical, political or social fields. So we decided to carry out a study to review the women’s employment and their role in development of Iran.
Method: In the year 2010, an analytic-explanatory study was performed, based on reliable books and articles. This study is based on the presented information and statistics comparing with a number of developing and developed countries about the women’s employment in different age, educational and social groups and also their presence in political and social platforms in last decades.
Results: The results show that the women in different groups, including the self-supporting women, in different cities or rural areas are in different employment situations. Generally, the number of total employees in the country was 13,000,000 people out of the whole population of 75,000,000. It means that each person has to provide life facilities for 3.5 people which in this case the women’s share is less than eight percent. The outcomes show that in 2000, the percentage of the woman-supporting families was 7.3% of the total families which this figure has increased to 8.4% in 2010.Also the number of woman-supporting families was 329,062 in 2000 which has reached to 373,021 in 2010 and the average increase in a year was 3.9 which is more than the average increase in the number of total families in a year, that is 3%, whereas in the developed countries this figure is an average of 16%. Also this study revealed that about one third of the woman-supporting families are the one-member families or in some other word, the single women. And then the most part of the group is the woman-supporting families with two or three members.
Also in 2011 about 14.5% of the urban women were seeking job while this figure was more than 14%. In addition the presence of women in making decisions for the country was less than 3% in 2011.
Conclusion: Involving women in different social, political and economical affairs and providing serious means of co-operation in different levels of the society can play an efficient role in the development of the country.
Keywords: employment, women, self supporting women, development
CORRESPONDING AUTHOR: Jariani Abolfazl, Iranian Nursing Association, dr_jariani@yahoo.com
P628
BEHAVIORS AND SOCIO-CULTURAL FACTORS ASSOCIATED WITH SANITATION (OPEN-DEFECATION) AND HAND-WASHING AMONG MOTHERS AND IMPLICATIONS FOR CHILD MORBIDITY AND MORTALITY IN INDIA
Chatterjee S.1, RamMurthy S.2, Satya Sekhar P.3
1 Johns Hopkins University Center for Communication Programs (JHUCCP), Behavior Change Communication, New Delhi, India
2 Indian Institute of Health and Family Welfare (IIHFW), Department of Health Behavior and Health Education, Hyderabad, India
3 Indian Institute of Health and Family Welfare (IIHFW), Management & Statistics, Hyderabad, India
Basic sanitation is Millennium Development Goal (MDG) Number 7 (Target 7c). With 665 million practicing open-defecation, India has the highest proportion of people without access to sanitation in Asia. Inadequate sanitation caused losses estimated at US$ 53.8 billion, nearly 6.4% of India’s GDP in 2006, through lost productivity and high child morbidity and mortality. Despite government investments, India may not reach the 2015 MDG targets for sanitation and child mortality.
In order to study perceptions and practices related to sanitation and hand-washing among rural mothers a quantitative household survey, using a structured questionnaire, was conducted in September-October 2011with 2178 mothers between 15-49 years (mean household size of 4.9 and monthly income Rs 4173) in 72 villages across 6 districts of Andhra Pradesh state. Additionally, 6 FGDs were conducted with 50 mothers to gain deeper understanding.
Although more than 80% of households owned televisions and mobile-phones, only 29% had a toilet. Toilets are considered dirty, smelly, and impure; most prefer it outside the house. Absence of toilets was main reason for open-defecation. No one carried soap to site of defecation and washed hands after returning home. None thought hand-washing and diarrhea were related or considered feces of child as a potential contaminant. Only 2/3rds of mothers washed hands after disposing child’s excreta; mere 10% always used soap; 77% believed water is safe and did not require special treatment. Prevalence of child diarrhea and respiratory infection in preceding two-weeks was 11% and 22% respectively.
Many women described open-defecation as embarrassing, stressful, and unsafe. Women with toilets in-house said they will never return to open-defecation.
Lack of knowledge among mothers about disease-transmission through oro-fecal route and benefits of hand-washing with soap has implications for child morbidity and mortality. Demand generation within households for improved sanitation requires comprehensive behavior change programs with emphasis on disease-reduction for children and safety for women. Women who currently use toilets are strong proponents and potential community role-models.
Keywords: Childhood illness, sanitation, hand-washing, socio-cultural factors, mother's behaviors, hygiene behaviors
CORRESPONDING AUTHOR: Chatterjee Nilesh, JHUCCP, nileshchatterjee@gmail.com
P629
ASSOCIATION OF SOCIOECONOMIC STATUS WITH MATERNAL HEALTH OUTCOME, MATERNAL DEPRESSION, AND PRENATAL ATTACHMENT IN JAPANESE WOMEN
Amagai S., Emori Y.
University of Tsukuba, Nursing and Midwifery, Tsukuba, Japan
Background: Socioeconomic status is a combined measure of an individual’s position in society based on income, education, occupation, and home ownership. The relationship between socioeconomic status and health disparities has been studied in terms of correlations between the working classes and mortality rates as well as correlations between low socioeconomic status and infant mortality and premature birth. However, no studies have reported the impact of socioeconomic status on maternal health outcomes, prenatal attachment and depression in Japan.
Purpose: This study aimed to investigate the relationship between the socioeconomic status of pregnant women and (1) maternal health outcomes as well as (2) maternal depression, prenatal attachment, and life satisfaction.
Methods: This descriptive cross-sectional study consisted of (1) a self-administered questionnaire survey completed during pregnancy and (2) a structured interview held after delivery, with different participation requirements. Participants in survey 1 had been receiving prenatal care at a pregnancy research facility, and those in survey 2 had started delivery and had a live birth at the research facility. Among the participants who fulfilled both requirements, only those who provided answers during each survey period were included in this study. Survey items were participants’ objective socioeconomic status (annual income, educational background, and employment status) and subjective economic indicators (comfortable lifestyle, financial difficulties, and recognition of socioeconomic status) in addition to participants’ attributes, prenatal attachment, maternal depression, life satisfaction, and maternal health outcomes.
Results: Lower recognitions of socioeconomic status was related to birth weight (Χ 2 = 4.454, p = 0.035) and fetal distress (Χ 2 = 5.550, p = 0.025). It was also educational background associated with meconium staining (Χ 2 = 9.071, p = 0.015). Furthermore maternal depression was significantly associated there SES condition, but not with prenatal attachment.
Summary: This study revealed that socioeconomic status is a factor influencing maternal health in Japan. To improve the safety of maternal care and ensure the comfort of perinatal patients, it is necessary to identify patients’ socioeconomic status and provide high quality care.
Keywords: Socio-economic health, Woman's Health
CORRESPONDING AUTHOR: Amagai Shizuka, Tsukuba University, Tsukuba, buroccoli@yahoo.co.jp
P630
STATUS OF DELIVERY IN WOMEN WITHOUT PRENATAL CARE IN JAPAN
Nasuno J., Takayama N., Emori Y.
University of Tsukuba, Nursing and Midwifery, Tsukuba, Japan
Introduction: “Un-booked delivery” by women without prenatal health checkups and their unpaid delivery expenses has been pointed out as a significant problem by hospital. It refers to a delivery by a woman who has just a few regular checkups, if not at all, during pregnancy and visits a hospital upon onset of contraction. Hospital which accept such women are required not only for high level medical management but also for care accompanied by some risks. The study is aiming at compiling documents for figuring out maternal and child health care and policies, by sorting out articles relating to “un-booked delivery” in Japan. Methods of Study: A search function of web of Japan Medical Abstracts Society was used for searching original articles and reports published in Japan from 1983 to 2011. As the result, 48 documents of articles and reports were hit. Results: Most of which were retrospective studies, consisted of four reports of wide areas in prefectures, and 40 were those conducted for individual medical institutions. As for published years of articles, 2 and 5 of them were published during 1980’s and 1990’s respectively, and 34 of them published from 2000 to 2010.Number of “un-booked delivery” was larger in primiparous women in their 10’s. And unmarried and divorced single women were observed in 12 literatures. It has been reported in 14 literatures that low-weight babies were observed. With regard to reasons why they did not receive health checkups during pregnancy, “unnoticed pregnancy” was reported in 17 cases, “unaffordable economic conditions for receiving checkups” in spite of recognition of pregnancy in 19 cases, and “tolerance for not receiving checkups”, “indifference to pregnancy” and “disregard of pregnancy” were reported in 11 cases. Discussion: Three points were figured out as the reasons for “un-booked delivery”. Firstly, they were unaffordable for medical expenses due to economic difficulties. Secondly, they were careless about health to the extent being unable to notice their own pregnancy with lack of medical knowledge. Finally, they had lower basis of value against significance of consultation behavior since their previous pregnancy was resulted in easy delivery which made them excuse that checkup was thought to be unnecessary.
Keywords: Health behaviors, Pregnancy
CORRESPONDING AUTHOR: Nasuno Junko, University of Tsukuba, Tsukuba, s1030534@u.tsukuba.ac.jp
P631
THE EFFECT OF A STRESS MANAGEMENT PROGRAM FOR INFANTS' MOTHERS
Kusakabe N.1, Sakano Y.2
1 Fukuyama University, Faculty of Psychology, Fukuyama, Japan
2 Health Sciences University of Hokkaido, Faculty of Psychology, Sapporo, Japan
Introduction: Recently, it has been reported that 10-20% of the women who delivered baby had depression, so-called postpartum depression, in Japan (Fujita, Ide, & Iwasaki, 2007). Postpartum depression sometimes continues for a long time after delivery. Almost 20% of mothers who engage in parenting under 3-years-old infants are supposed to be in depressive mood. Programs based on cognitive behavior therapy have been proved to be effective for preventing depression. In this study, the stress management program for mothers was carried out, and the effect of the program was verified. The participants were ten mothers (M = 33.6 years old), whose infants were aged 4 and below. The program consisted of four sessions, and each session was 90 minutes, and the included intervention components were as follows: “changing a view against stressors will reduce your stress”, “how to praise your infants”, “how to change your infants’ problem behaviors”, and “let’s relax.” The program also included educational session, participants’ talks, and a role play. Participants were requested to complete a set of questionnaires including SDS, Parenting Coping Behavior Scale (PCB: Kusakabe, 2009) at the beginning and the end of program.
Results and Discussion: The average of SDS score at the beginning was 42.43(SD = 6.16), and participants felt strong stress for children’s problem behavior. The SDS scores decreased significantly at the end of the program (M = 39.86, SD = 6.04, t = 3.75,p < .01). The scores of “factor2: maltreatment and withdrawing” and “factor 3: support seeking” of PCB increased significantly after the program. The multiple linear regression analysis showed that “factor2: maltreatment and withdrawal” and “factor 3: support seeking” had influenced SDS score at the end of the program. It was suggested that this stress management program reduced maltreatment to children and withdrawal coping style from stressors, and increased support seeking coping behavior that affected the reduction of mothers’ depressive state.
Keywords: Depression, Coping
CORRESPONDING AUTHOR: Kusakabe Noriko, Fukuyama University, Fukuyama, noriko@fuhc.fukuyama-u.ac.jp
P632
THE INFLUENCE OF AMBIVALENT SEXISM ON THE ASSOCIATION BETWEEN THE ANTICIPATION OF IMPROVEMENTS IN THE SOCIAL STATUS OF WOMEN AND ATTITUDES ABOUT THE INTIMATE PARTNER
Goto S.1, Sakata K.2, Otsuka Y.1
1 Hiroshima University, Graduate School of Education, Hiroshima, Japan
2 Hiroshima University, Graduate School of Integrated Arts and Sciences , Hiroshima, Japan
Purpose: Gender inequality is a complicated problem influenced by both macro-level factors, such as the anticipation of improvements in the social status of women, as well as by micro-level factors, such as attitudes about the intimate partner. The influence of ambivalent sexism on the association between the anticipation of improvements in the social status of women and attitudes about the intimate partner was investigated. We hypothesized highly sexist men that anticipate gender equality in the future would strengthen traditional gender role attitudes, because they are threatened by changes in current gender roles.
Methods: Participants were male university students (n = 71). They responded to the following questionnaires: The Japanese version of the Ambivalent Sexism Inventory, which assesses hostile and benevolent sexism (11 items for each variable); the Gender-Role Assignation with Intimate Partner Scale (4 items); the Anticipation of Improvement in Social Status of Women Scale (12 items); the Power Relation with Intimate Partner Scale (4 items).
Results: A two-way Analysis of Variance for hostile and benevolent sexism (high/ low) × the anticipation of social change (high/ low) was conducted. Results indicated that the interaction between housework assignation measured by the Gender-Role Assignation with Intimate Partner Scale was marginally significant. (F(1,69) = 3.44, p < .10). Post-hoc comparison revealed that in the group with high anticipation of social changes, men with high scores for hostile sexism wanted their partners to have more time for doing household work (p < .10).
Moreover, the interaction between the power relationship and the partner was also significant (F(1,69) = 5.71, p < .05). In the group with high anticipation of social changes, participants scoring high in benevolent sexism wanted their partners to maintain more power (p < .05). Discussion: Men with high hostile sexism that predicted a change in social status in the direction of equality for women wanted their partner to have more time for household duties. Conversely, men with high benevolent sexism that predicted a change in social status in the direction of equality with women wanted their partner to keep more power and gave them preferential treatment.
Keywords: Gender, Social class
CORRESPONDING AUTHOR: Goto Sana, Hiroshima Univercity, m110555@hiroshima-u.ac.jp
P634
ANXIETY AND DEPRESSION IN PATIENTS WITH ULCERATIVE COLITIS: THE ROLE OF GENDER AND NUMBER OF RELAPSES
Trikos L.1, Jovanovic A.2, Bojic D.3, Jojic NJ.3
1 Zvezdara University Clinical Centre, Center of Psychiatry, Belgrade, Serbia
2 Clinical Centar of Serbia, Institute for Psychiatry, Belgrade, Serbia
3 Zvezdara University Clinical Centre, Department of Gastroenterology and Hepatology, Belgrade, Serbia
Background: Ulcerative colitis (UC) is chronic relapsing disease from the group of Inflammatory Bowel Disease (IBD). Results of studies have suggested that patients with UC have higher levels of anxiety and depression than either the general population or groups of patients with other types of chronic illness. Previous research about the impact of the number of relapses and gender on anxiety and depression did not give consistent results.
AIMS: The aims of our study were to investigate the influence of gender and number of relapses on the levels of anxiety and depression in patients with UC.
Methods: The study included 46 outpatients with confirmed UC in clinical remission, aged 19-65, both genders (26 male, 20 female). Subjects were divided into five groups according to the number of relapses. The levels of anxiety and depression were obtained by the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD). To assess the impact of independent categorical variables (gender, number of relapses) on dependent variables (anxiety, depression) we used ANOVA.
Results: Average HAMD-score were 14.35 + - 4.60 (for male 13.81 + - 4.95 and for female 15.05 + - 4.12). Average HAMA-score were 12.85 + - 3.55 (for male 12.58 + - 3.64 and for female 13.20 + - 3.49). There was no significant main effect of the number of relapses on the anxiety, F(4,36) = 1.61, p = 0.19. The main effect of the number of relapses on the depression was not significant, F(4,36) = 1.47, p = 0.23. There was no significant main effect of gender on the anxiety, F(1,36) = 0.42, p = 0.52, or on the depression, F(1,36) = 0.11, p = 0.75. There was no significant interaction effect between the number of relapses and the gender of person on the anxiety, F(4,36) = 1.06, p = 0.39. The interaction effect between the number of relapses and the gender on the depression was no significant, F(4,36) = 1.13, p = 0.36.
Conclusion: This study did not confirm that number of relapses or gender have influence on the levels of anxiety and depression in patients with Ulcerative colitis in remission.
Keywords: Gender, Chronic Disease
CORRESPONDING AUTHOR: Trikos Lela, Center Zvezdara, Belgrade, lela_trikos@yahoo.com
P635
MALADAPTIVE CORTISOL STRESS RESPONSE PATTERNS IN FEMALE OLDER ADULTS
Rohleder N., Thoma M., Chen X., Gianferante D., Hanlin L., Fiksdal A., Wang D.
Brandeis University, Department of Psychology, Waltham, United States
Aging is associated with physiological alterations, and related with increased morbidity. The aging process is becoming better understood at the molecular and cellular level, but less is known about the causes of interindividual differences. Differences in how individuals respond physiologically to stressful events in their lives might explain some of the variation. Maladaptive acute stress response patterns might predispose to physiological damage and contribute to disease, but evidence on stress response patterns in older adults is still scarce.
A sample of n = 26 young (mean age 22.0 yrs.; SD = 4.5), and n = 23 older adults (57.4 yrs.; SD = 5.8) of both genders were exposed to repeated acute stress (Trier Social Stress Test). HPA axis activation and habituation was assessed by measuring cortisol in repeated saliva samples taken both days.
As expected, female participants of both age groups showed significantly lower HPA axis responses to acute stress than males (F = 3.23; p = 0.042). While the overall group showed only a trend towards lower cortisol responses to the second TSST (F = 2.26; p = 0.095), habituation was strong in the younger group (F = 3.70; p = 0.02), but absent in the older group (F = 0.99; p = 0.39). Furthermore, in the older group, a marginally significant interaction of gender with repeated stress exposure (F = 3.49; p = 0.066) was found; Older men showed habituation, while in postmenopausal women, HPA axis responses, although smaller than those of older men, showed signs of sensitization.
Although preliminary, the current data allow the cautious conclusion that older age is associated with changes in acute stress response patterns. Particularly in older, postmenopausal women, sensitization of HPA axis responses to repeated stress might be a sign of development of a maladaptive pattern. Data on peripheral inflammation will be presented at the conference and will allow conclusions about the potential health effect of the observed HPA axis response pattern.
Keywords: Psychoneuroendocrinology, Aging, Stress
CORRESPONDING AUTHOR: Rohleder Nicolas, Brandeis University, Waltham, rohleder@brandeis.edu
P636
PROTECTIVE EFFECTS OF GLOYCOSIDES OF CISTANCHE ON THED-GALACTOSE INDUCED BRAIN AGING MODEL MICE
Xinyuan W.
Xinjiang Mental Health Center, Department of Psychiatry, Urumqi, China
Objective: To observe the influence of glycosides of cistanche (GCs) on the D-galactose induced brain aging model mice and explore the mechanism of GCs.
Methods: There were two stages including 30 and 50 days. 120 NIH mice of every stage were randomly divided into six groups: normal control group (NC), model group (D-gal), VitaminE group , GCs groups which was divided into lower dose, middle dose and large dose[(mg.kg-1d –1) 31.25, 62.5, 125]. Every group had 20 mice. Except for NC group, other groups were given hypodermic injection of D-gal (50mg.kg-1.d-1). NC group was given hypodermic injection of NS. D-gal group and NC group were given oral administration of water. VitaminE group and GCs groups were given oral administration. Mice of various groups of every stage were repeatedly given hypodermic injection and oral administration one time every day, and respectively measured erroneous number in 5 minutes, latent period and SOD activities MDA content and LF content (brain) after 30 and 50 days.
Results (1) Compared with other groups, D-gal groups were obviously higher on erroneous number in 5 minutes which were [ (8.25 ± 4.03) time] of 30 days and [ (9.63 ± 6.18) time] of 50 days(p < 0.01).(2) Compared with NC groups, middle dose and large dose groups of GCs , D-gal groups were lower on latent periods which were [ (25.21 ± 13.86) s]of 30 days and [ (31.75 ± 17.77) s] of 50 days (p < 0.05 and p < 0.01).(3)Compared with other groups, D-gal groups of brain tissue were lower on SOD activities of 30 days and 50 days. (p < 0.05 and p < 0.01). (4) Compared with other groups, D-gal groups of brain were higher on MDA contents of 30 and 50 days. (p < 0.05 and p < 0.01). (5) Compared with NC groups, D-gal groups were higher on LF contents of brain tissue of 30 and 50 days. Compared with D-gal groups, lower dose group of GCs and VitaminE group of 30 days, and various groups of GCs and VitaminE group of 50 days were lower on LF contents of brain tissue (p < 0.05 and p < 0.01).(6)D-gal group was different from NC group ,large dose group of GCs and VitaminiE group on hippocampus CA1 region. of 50 days.
Conclusions: It indicated that GCs could improve the function of learning and memory, increase SOD activities and decrease MDA and LF contents of brain, the mechanism of which may relate with antioxidation.
Keywords: Glycosides of cistanche; D-galactose; Brain aging model;
CORRESPONDING AUTHOR: Xinyuan Wang, Xinjiang Mental Health Center, wxyuan01@126.com
P637
EFFECTIVENESS OF A COLLAGE THERAPY IN MILD ALZHEIMER'S TYPE DEMENTIA
Sugiura K.1, Takata Y.2, Sakata Y.2, Kitamura S.3, Ishii C.4
1 University of Tsukuba, Graduate School of Comprehensive Human Sciences, Tsukuba, Japan
2 University of Tsukuba, Faculty of Medicine, Tsukuba, Japan
3 Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
4 Nippon Medical School, Dementia consultation center, Kawasaki, Japan
Objective: To prove the effectiveness of collage therapy, we conducted a collage program with Mild Alzheimer's type dementia (AD) patients. We verified the stabilization of emotions and activation of the acknowledgment function, and proved the effectiveness of collage therapy. Then, we verified the effect immediately after collage making, and its continuing effect.
Subjects: 31 patients with AD selected by a neurologist were divided into an experimental group (A) of 19 patients, and a control group (B) of 12 patients. Their average age was 80 years; the average value of the MMSE was 19.
Experimental period: March 2010 through October 2011.
Method: The first time, group A made a collage for 30 minutes. group B spent 30 minutes freely. We repeated this at one week intervals so that it was done a total of 4 times. For both groups we did FS before and after the experiment and MMSE after. This experiment was conducted at Nippon Medical School dementia consultation center.
Analytical methods: We did statistical analysis of the psychological examination.
(FS: effect immediately after, MMSE: continuing effect)
Results: As for FS, a significant difference (t = 4.92,p < .001) between before and after the collage making was found in group A. The FS results proved that collage making improved their emotions and the effect occurred immediately after collage making. The results of the MMSE after the fourth time were more significant (t = 2.18,p = .04) than after the first time. This suggested that the continuing effect and the improvement in the acknowledgment function happened because of the collage making. In this collage program, there was the process of "see a clipping, choose, composition, paste, talk". Therefore, the process included the cognitive functions of vision, consideration, recall, reasoning, judgment, understanding, selection, avoidance, planning, problem solving and decision-making. This can be considered to be effective in the activation of cognitive function in patients with AD. This study indicates a new therapeutic approach in which the cognitive function of patients with AD can be activated and maintained by collage therapy.
Keywords: Alzheimer's disease, Collage therapy
CORRESPONDING AUTHOR: Sakata Yumiko, University of Tsukuba, Ibaraki, sakata@md.tsukuba.ac.jp
P638
AFFECT BALANCE AND PSYCHOSOCIAL CORRELATES AMONG COMMUNITY-DWELLING AND INSTITUTIONALIZED ELDERS
Godoy Izquierdo D., Lara Moreno R., López-Chicheri García I., Vázquez Pérez ML., Araque Serrano F., Godoy García JF.
University of Granada, Behavioral Medicine/Health Psychology Research Group, Granada, Spain
Objectives: To explore the affect balance of community-dwelling and institutionalized 65 years and older elders and its association with several psychosocial variables.
Methods: Participants were 55 institutionalized elders (43.6% females, age M = 81.04; SD = 7.47) recruited from local geriatric care facilities and day centers, and 99 community-dwelling elders (53.5% females, age M = 75.4; SD = 7.65) recruited from various community places. They voluntarily completed self-reports on affect balance and several psychosocial variables as well as on personal and sociodemographic data.
Results: One out of two elders reported a negative affect balance. A higher percentage of non-institutionalized elders (56.6%), compared to institutionalized ones (38.2%), demonstrated a positive affect balance. For both institutionalized and non-institutionalized participants, affect balance was significantly related to health indicators, general self-efficacy beliefs, number and monthly frequency of leisure activities and perceived social support, besides life satisfaction and current happiness. Further, among non-institutionalized elders, affect balance was also positively related to marital and family satisfaction and social self-efficacy, and inversely to perceived daily stress, whilst among institutionalized elders it was also related to number of available relatives and friends, and inversely related to number of stressful events. Different profiles of associations were found for institutionalized and non-institutionalized elders depending on gender.
Conclusions: Our findings stress that a high number of elders, particularly those in care facilities and women, demonstrate a negative affect balance which can be improved throughout an intervention aimed at enhancing psychosocial resources to feel more frequently and intensely positive emotions.
Keywords: Health promotion, Emotions, Mood, Quality of life, Mental health, Aging, Older adults, Gender
CORRESPONDING AUTHOR: Godoy Izquierdo Débora, University of Granada, Spain, deborag@ugr.es
P639
AFFECT BALANCE AMONG COMMUNITY-DWELLING AND INSTITUTIONALIZED WOMEN AND MEN: AN INTERACTION EFFECT
Godoy Izquierdo Juan Fco. Godoy García D., Vázquez Pérez ML., Lara Moreno R., Araque Serrano F., Godoy García JF.
University of Granada, Behavioral Medicine/Health Psychology Research Group, Granada, Spain
Objectives: To explore the affect balance of community-dwelling and institutionalized 65 years and older elders in relation to their gender and residing condition.
Methods: Participants were 55 institutionalized elders (43.6% females, age M = 81.04; SD = 7.47) recruited from local geriatric care facilities and day centers, and 99 community-dwelling elders (53.5% females, age M = 75.4; SD = 7.65) recruited from various community places. They voluntarily completed self-reports on affect balance and several psychosocial variables as well as on personal and sociodemographic data.
Results: Among institutionalized elders, 38.2% (of them, 38.1% women) demonstrated a positive affect balance in comparison to 56.6% (51.8% women) among non-institutionalized participants. A univariate general linear model analysis demonstrated significant simple effects for gender (p < 0.01) and residing condition (p < 0.05), as well as a significant interaction effect (p < 0.01), with both institutionalized and non-institutionalized women reporting a lower affect balance than men, and both institutionalized women and men reporting a lower affect balance compared to non-institutionalized elders. Institutionalized women demonstrated the lowest affect balance.
Conclusions: Our findings stress that a high number of elders, particularly those in care facilities and women, demonstrate a negative affect balance. Establishing modifiable psychosocial variables with an influence on affect balance among each collective of elders might improve their affect balance.
Keywords: Health promotion, Emotions, Mood, Quality of life, Mental health, Aging, Older adults, Gender
CORRESPONDING AUTHOR: Godoy Izquierdo Débora, University of Granada, Spain, deborag@ugr.es
P640
A CLUSTER-BASED DETERMINATION OF PSYCHOSOCIAL PROFILES IN ELDERS: WHO ARE THE HAPPIEST?
Godoy Izquierdo D.1, Lara Moreno R.2, Vázquez Pérez ML.1, Araque Serrano F.1, Godoy García JF.1
1 University of Granada, Behavioral Medicine/Health Psychology Research Group, Granada, Spain
2 University of Groningen, Behavioral Medicine/Health Psychology Research Group, Granada, Spain
Objectives: We sought out to identify groups of elders characterized by distinct profiles in terms of general well-being and healthy and functional aging based on their scores on several psychosocial variables, and to relate these psychosocial configurations with participants’ subjective well-being by exploring differences in current happiness, affect balance and life satisfaction.
Methods: Participants were 154 men and women aged 65 to 96 years (M = 77.44, SD = 8.03; 50% women), 35.7% of whom were recruited from geriatric and nursing homes and the remaining were community-dwelling elders recruited from various community places. Participants fulfilled voluntarily a broad psychosocial assessment protocol including health, self-efficacy, optimism, leisure, stress, social support and subjective well-being indicators.
Results: Three psychosocial profiles reflective of different levels of adaptation and healthy and active aging emerged from a k-means cluster analysis, with 97.2% of the cases correctly classified by the clustering. Due to the revealed psychosocial configurations, a first cluster (35.2% of participants) was composed of highly adapted elders, a second group (14.5%) was composed of highly impaired elders, and a third cluster (50.3%) was composed of moderately impaired elders. ANOVAs revealed differences (p < 0.01) among these profiles regarding their current happiness, affect balance, positive and negative affect and life satisfaction, with the highly adapted elders demonstrating the highest levels and the highly impaired elders demonstrating the lowest ones.
Conclusions: There are different psychosocial configurations in the elderly depending on their personal and social resources, and more adapted and healthy configurations are associated with better subjective well-being. Our findings help us in designing interventions aimed to increase psychosocial resources to be happier as we grow old.
Keywords: Health promotion, Emotions, Mood, Quality of life, Mental health, Aging, Older adults, Gender
CORRESPONDING AUTHOR: Godoy Izquierdo Débora, University of Granada, Spain, deborag@ugr.es
P641
APPROACHING OLDER ADULTS’ SENSE OF COHERENCE: THE EFFECTS OF RELIGIOUS BELIEFS
Santos S., Von Humboldt S., Carvalho C.
ISPA Universitary Institute, Research Unit in Psychology and Health, Lisbon, Portugal
Introduction: Given the major growth of the elderly population, it became relevant to develop studies, focusing on the strategies used by older adults to promote healthy aging, while facing the associated challenges.
Aims: This study aims to analyze (a) the sense of coherence among older adults with different religious beliefs, and (b) the existence of an association between participant’s sense of coherence and their religious beliefs.
Methods: One hundred and twenty three senior adults, aged above 74 years (M = 82.4, SD = 5.6) were assessed with the Sense of Coherence Scale (SOC), the Mini-Mental State Examination (MMSE). Sociodemographic data, including the type of belief system (Catholic (39%), Protestant (20.3%), Taoist (2.4%), Islamic (7.3%), Judaic (4.9%), Buddhist (3.3%) or the absence of religious beliefs (22.8%) were also assessed.
Results: The findings suggest that religious beliefs have an effect on SOC and that this effect differs according to the type of belief system. Participants with Judaic religious beliefs show the highest score of SOC (MJUD = 4.9, in a Likert scale that ranges from 1 to 7), while the Islamic participants had the lowest SOC score (MISL = 3.7).
Conclusions: This study revealed the relevance of religious beliefs on the SOC of the elderly. The association between religious beliefs and the SOC of older adults is thus relevant to a better understanding of this age group. Implications of this finding in clinical approaches are discussed.
Keywords: Behavioral approach, healthy aging, older adults, religious beliefs, sense of coherence
CORRESPONDING AUTHOR: Santos Susana, ISPA, Lisbon, susmsantos@gmail.com
P642
ASSESSING PSYCHO-EMOTIONAL CHALLENGES IN PERSON-CENTERED THERAPY WITH OLDER ADULTS
Von Humboldt S., Leal I.
University Institute of Applied Psychology, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: This research aims to evaluate psycho-emotional challenges for older adults and the relevance of person-centered therapy (‘PCT’) for older adults.
Methods: Forty senior adults, aged above 65 years (M =71.7;SD = 4.6) were assessed with the the Self-Esteem Scale (‘SES’), the Mini-Mental State Examination (MMSE). Socio-demographic data, including gender (57.5% women), marital status (37.5% married) and education (39.2% mandatory school) were also assessed. Bivariate associations were also performed
Results: Results yielded a set of five descriptive categories that captured the distinct ways older adults perceived psycho-emotional challenges and that reflected the individual's perceived importance of PCT: ’time perspective’, ‘the aging body’, ‘autonomy and control’, ‘cognitive endurance’ and ‘loss and reminiscing’. Regarding bivariate associations, results indicated that ‘autonomy and control’ was associated with the ‘aging body’ and with ‘time perspective’. This latter was also associated with ‘loss and reminiscing’.
Conclusions: This study highlights the importance of PCT for older adults facing psycho-emotional challenges in old age. Interventions with older adults may benefit from clearly understanding older adults’ specific issues as an important component for promoting successful aging and reducing health disparities.
Keywords: Geriatics, culture, health promotion, health behavior change
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon, sofia.humboldt@gmail.com
P643
ASSOCIATION OF EMOTIONAL LABOR WITH WORK ENGAGEMENT AMONG JAPANESE HOSPITAL NURSES
KAGATA S.1, KUBOTA K.2
1 Toyohashi Sozo University, Faculty of Health Sciences, Toyohashi, Japan
2 The University of Tokyo, Graduate School of Medicine, Department of Mental Health, Tokyo, Japan
Previous studies have reported mainly the association of emotional labor with negative effects (e.g., psychological distress, burnout). However, there were few studies that focus on the association between emotional labor and positive effects (e.g., work engagement). Therefore, the present study aimed to demonstrate the association of emotional labor with work engagement as positive effects among Japanese hospital nurses.
The participants were 416 Japanese registered nurses of a hospital in Kanto area, and they answered questionnaires which were to measure emotional labor, work engagement, and social support and demographic items from August 9th to September 1st in 2011. 353 respondents returned the questionnaires (response rate, 84.6%). A total of 42 respondents were excluded because of male nurses (n = 13) and missing values (n = 29), resulting in 311 respondents for analysis (all female). Multiple regression analysis was conducted to identify the association of emotional labor with work engagement, and it had five components for measurements; “Exploring and understanding”, “Suppressed expression”, “Surface adjustment”, “Expression on caring”, and “Deep adjustment”. Covariates included demographics (age, ward, and housemate status) and social support.
The results showed that “Exploring and understanding” was positively related to work engagement (β = 0.34, p < 0.05), whereas “Suppressed expression” was negatively related to work engagement (β = - 0.22, p < 0.05). However, “Surface adjustment”, “Expression on caring”, and “Deep adjustment” were not significantly related to work engagement.
In conclusion, these results suggest that “Exploring and understanding” is positively associated with work engagement, and “Suppressed expression” is negatively associated with work engagement.
Keywords: Emotions, Mental health, Worksite health
CORRESPONDING AUTHOR: Kagata Satoko, Toyohashisozo University, satoppe0821@gmail.com
P644
EFFECT OF REINFORCEMENT SENSITIVITY ON JOB SATISFACTION AND STRESS RESPONSES
Suzuki S.1, Tanoue A.1, Shimizu K.2, Ohno M.2, Ito D.3, Suyama H.4, Yokoyama S.4, Kunisato Y.1, Okayama N.4, Son S.4
1 Waseda University, Faculty of Human Sciences, Tokorozawa, Japan
2 Koishikawa Clinic, Tokyo, Japan
3 Kanazawa University, Kanazawa, Japan
4 Waseda University, Graduate School of Human Sciences, Tokorozawa, Japan
Introduction: Reinforcement sensitivity is an essential determinant of the decision-making process and emotional vulnerability. According to Gray [1987], reinforcement sensitivity composed of the Behavioral Activation System [BAS] for the sensitivity to reward acquisition and the Behavioral Inhibition System [BIS] for the sensitivity to punishment can help determine the psychological status of a subject. The influences of the BAS and BIS on job stress have not been investigated. The purpose of this study was to explore the effects of reinforcement sensitivity on job stress and satisfaction.
Method: The study subjects consisted of 1405 employees [983 male, 422 female; 45 ± 9.78years]. The measurements recorded were the responses to the NIOSH Job Stress Questionnaire, Tri-axial Coping Scale-24, Beck depression inventory-II, and Japanese version of the BIS/BAS Scale.
Results: The results of the stepwise regression analyses [step 1: demographic status, step 2: stressors, step 3: coping style and perceived social support, step 4: BIS/BAS] revealed that the sensitivity for avoiding punishment [BIS] was the strongest predictor of depression [β = .30, p < .001]. The effect of sensitivity for reward acquisition [BAS] on depression was also higher than that of coping and social support [β = -.15, p < .001]. Furthermore, the effects of the BIS and BAS on job satisfaction were relatively higher than those of other variables [BAS: β = .13, p < .001, BIS β = -.13: p < .001].
Conclusion: Reinforcement sensitivity was suggested to be a major determinant of job stress and satisfaction.
Keywords: Stress, Worksite health, Cognitive factor
CORRESPONDING AUTHOR: SUZUKI SHINICHI, Waseda University, ssuzuki@waseda.jp
P645
EFFECTS OF GRATITUDE EXERCISE ON EMOTIONS, WORK ENGAGEMENT, AND JOB STRESSORS AMONG JAPANESE EMPLOYEES
Otsuka Y.1, Kawahito J.2
1 Hiroshima University, Graduate School of Education, Hiroshima, Japan
2 Fukuyama University, Faculty of Human Cultures and Sciences, Hiroshima, Japan
The purpose of this study was to examine the effectiveness of worksite intervention consisting of a gratitude exercise on employees’ gratitude-related feelings, positive affect, work engagement, and job stressors among Japanese workers. One hundred and thirty-three Japanese daytime employees were recruited to participate in the study. Participants were randomly assigned to one of two groups: the gratitude group or intervention control group. Participants in the gratitude group were asked to write down up to five people at work to whom the participant was grateful or thankful during the past week for 4 weeks. Gratitude-related feelings, positive affect, work engagement, and job stressors were measured three times, i.e., baseline, immediately post-intervention, and one month after the intervention. Gratitude-related feelings were measured with two items: thankful and appreciative. Positive affect was assessed using the Japanese version of the Positive and Negative Affect Schedule. Work engagement consisting of three subscales (Vigor, Dedication, and Absorption) was assessed using the Japanese version of the Utrecht Work Engagement Scale. Job stressors (e.g. job demands, job control, interpersonal conflicts, etc.) were measured with the Brief Job Stress Questionnaire. Analyses of covariance controlling for age, life events, work hours, life style, and income revealed that in the gratitude group, interpersonal conflicts was significantly lower than control group at immediately post-intervention. At one month after intervention, gratitude-related feelings were significantly higher and Vigor was marginally higher in the gratitude group compared with control group. In conclusion, gratitude exercise in which participants list up to five people at work to whom the participant is grateful or thankful every week might be effective in increasing gratitude-related feelings and decreasing interpersonal conflicts. However, effects of gratitude exercise were not clear on the work engagement.
Keywords: Intervention, Mental health, Mood, Occupational health, Quality of life, Worksite health
CORRESPONDING AUTHOR: Yasumasa Otsuka, Hiroshima University, Hiroshima, yasumasa-otsuka@hiroshima-u.ac.jp
P646
PROCESS EVALUATION OF AN INTERVENTION PROGRAM, “SUCCESSFUL SELF”, DESIGNED TO PREVENT PSYCHOSOCIAL DISTRESS AMONG NEW HEALTH PROFESSIONALS.
Ando M.1, Ando S. 2
1 Okayama University, Department of Clinical Psychology in Education, Okayama, Japan
2 Okayama Citizens’ Hospital, Department of Internal Medicine, Okayama, Japan
Objectives: ‘Successful Self’ program focused on self-understanding, communicating with others and coping with difficult situations was made to prevent psychosocial distress among new health professionals. The objective of this study is to evaluate the feasibility, understandability and usefulness of the program.
Methods: This program included four weekly sessions consisted of group work activities (session 1: identifying goals, session 2: discussing their own and others feelings, session 3: problem solving, session 4: stress management). Five physicians, fifteen nurses and two pharmacists attended the program and completed surveys after each session in 2010. After the modification of the program, four physicians, fifteen nurses and two pharmacists attended the program and completed surveys after each session in 2011.
Results: The participants reported positively 69.6% after the first session, 90.0% after the second session, 85.7% after the third session, and 90.0% after the fourth session. Seventy-five percent of the participants reported the program was useful after attending the program in 2010. We increased the number of the program facilitators from one (one physician) in 2010 to two or three (one physician and one or two nurses) in 2011 program. We also changed one scenario in session 2. In 2011, the participants reported positively 85.7% after the first session, 78.9% after the second session, 80.0% after the third session, and 90.5% after the fourth session. Ninety-five percent of the participants reported the program was useful after attending the program in 2011.
Conclusion: The program was feasible and successfully modified to increase the usefulness among new health professions.
Keywords: Occupational health, Prevention, Stress
CORRESPONDING AUTHOR: Ando Shinichiro, Okayama Citizens’ Hospital, shinichiro_ando@yahoo.co.jp
P647
IS THE GOODNESS-OF-FIT HYPOTHESIS EFFECTIVE IN REDUCING STRESS RESPONSE? -SELECTING A COPING STRATEGY ON THE BASIS OF ONE’S ESTIMATION OF OTHERS’ APPROVAL OF IT –
Morimoto H.1, Shimada H.2
1 Waseda University, Advanced Research Center for Human Sciences, Tokorozawa, Japan
2 Waseda University, Faculty of Human Sciences, Tokorozawa, Japan
An employee’s stress response is affected by person-related variables, particularly the stressor evaluation and coping effort. Although Lazarus and Folkman (1984) indicated that the fit between the appraisal of a stressor’s controllability and the type of coping strategy is important in reducing stress response (the goodness-of-fit hypothesis; GOF), there is no clear picture regarding the application of the hypothesis. Many Japanese employees are concerned about their colleagues’ evaluations of them and tend to express high stress responses (Natsume et al., 2005). Morimoto (2011) indicated that when Japanese employees select coping strategies on the basis of their stressor evaluation, their selection is also affected by their estimation of how their coping is being evaluated by others. Given that the evaluation that motivates coping strategy selection buffers the influence of coping on stress response (Suzuki, 2006), we examined the effect of the estimation of others’ approval of one’s coping on the relation between coping and stress response and on GOF. Japanese employees (n = 747) each reported a stressor, their coping, their appraisal of the stressor’s controllability, their estimation of others’ approval of their coping, and their stress responses. The results of the analyses show that estimating that others approve the use of problem-focused coping relates to lower stress response in task (β = -.11, p < .01) and interpersonal stressors (β = -.29, p < .01). A significant interaction between the estimation of others’ approval of one’s coping and GOF score, which indicates the degree to which coping strategies are in line with the GOF employed, indicates that a higher GOF score relates lower stress response with regard to the estimation of others’ high approval of that type of coping with task stressors (+1 SD: β = -.27, p < .01; -1 SD: β = -.07, n.s.). A higher GOF score relates higher stress response with regard to the estimation of others’ low approval of that type of coping with interpersonal stressors (+1 SD: β = -.08, n.s.; -1 SD: β = .31, p < .01). Therefore, to reduce stress responses in Japanese employees, stressor evaluation as well as the estimation of others’ approval of one’s coping should be taken into consideration.
Keywords: Stress, Coping
CORRESPONDING AUTHOR: Morimoto Hiroshi, Waseda University, Tokorozawa, hiro.foresta@gmail.com
P648
RELATIONSHIPS BETWEEN MEANINGFUL WORK, PERSON AND WORK ENVIRONMENT FIT, AND WORK ENGAGEMENT AMONG MANUFACTURING EMPLOYEES.
Nakamura S.1, Kawahito J.2, Otsuka Y.1
1 Hiroshima University, Graduate School of Education, Hiroshima, Japan
2 Fukuyama University, Faculty of Human Cultures and Sciences, Hiroshima, Japan
Purpose: Work engagement is one of the positive aspects at workplace. Work engagement is defined as a positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption.
Maintaining high levels of work engagement are necessary not only for keeping good mental health states at work, but also for improve productivity.
According to person and work environment fit (P-E fit) model, whether personal predicable and environment fitted each other or not, provide job satisfaction and stress reaction. Furthermore, meaningful work is conceptualized as a clinical psychological state resulting from a job that is high in task significance, task identity, and skill variety.
In this study, we investigated the relationships between meaningful work, person and work environment fit, and work engagement among Japanese manufacturing employees.
Method: On November 2010, 158 manufacturing employees answered self-reporting questionnaire. The mean of the age was 38 years old (SD = 9.24), and 84.1% of the sample identified as male. 93.0% of them were full-time worker.
Meaningful work and subjective person and work environment fit were assessed using the Brief Job Stress Questionnaire, scored on a 4-point frequency rating scale ranging from 1 (no) to 4 (yes).
Work Engagement was assessed using the Japanese Versions of the Utrecht Work Engagement Scale (J-UWES). J-UWES consisted of 17 items with three subscales; Vigor (6 items: α = 0.77), Dedication (5 items: α = 0.91) and Absorption (6 items: α = 0.81). All items are scored on a 7-point frequency rating scale ranging from 0 (never) to 6 (always).
Result: Two-way ANOVA revealed that employees with high level of meaningful work scored higher vigor, dedication and absorption compared to employees with low level of meaningful work. Furthermore, when levels of meaningful work and subjective person and work environment fit were high, employees were absorbed in their job (F (1,154) = 4.68, p < .05) and dedicated in their job (F (1,154) = 5.81, p < .05).
Conclusion: For manufacturing employees, improving both meaningful work and subjective person and work environment fit may be beneficial to enhance work dedication and absorption.
Keywords: Occupational health, Worksite health
CORRESPONDING AUTHOR: NAKAMURA Shizuka, Hiroshima University, Hiroshima, shzk.nkmr@gmail.com
P649
GENDER DIFFERENCES IN ASSOCIATIONS OF WORK ADDICTIONS WITH SICKNESS PRESENTEEISM AND STRESS RESPONSES AMONG JAPANESE HIGH SCHOOL TEACHERS
Matsuoka N.1, Kawahito J.2, Otsuka Y.1
1 Hiroshima University, Graduate School of Education, Hiroshima, Japan
2 Fukuyama University, Faculty of Human Cultures and Sciences, Fukuyama, Japan
Introduction: This study aimed at finding the gender differences in associations of work addictions with sickness presenteeism and stress responses among Japanese high school teachers.
Methods: The questionnaire was distributed to a hundred seventy-three high school teachers. Seventy-nine (62 male, 16 female, and 1 missing values) responded to the Brief Job Stress Questionnaire (BJSQ) and Japanese version of the Work and Well-being Survey (DUWAS) in May and June, 2011. Work addictions, as independent variables, measured by DUWAS consisted of working excessively (α = .80), working compulsively (α = .75), working hours, holiday work, and job spill. For dependent variables, sickness presenteeism was measured with a single item included in DUWAS, “I go to work while feeling ill”. Stress responses, vigor (α = .95), irritation (α = .89), fatigue (α = .91), anxiety (α = .77), depression (α = .90), and somatic stress responses (α = .87) were also considered as dependent variables. Multiple regression analyses by gender were performed with the SPSS version 18.
Results: In men, working excessively (β = .42) and working compulsively (β = .42) were positively associated with sickness presenteeism. Working excessively (β = .35) was positively and job spill (β = -.31) was negatively associated with irritation. Working compulsively (β = .55) was also positively associated with anxiety. In women, working excessively and working compulsively were not associated with sickness presenteeism. Working excessively (β = -.59) was negatively and holiday work (β = .60) was positively associated with vigor. No associations were found between working excessively and job spill, and irritation. Working compulsively had no associations with anxiety.
Conclusions: Gender differences were revealed in associations of work addictions with sickness presenteeism and stress responses, respectively. The differences between men and women might be generated from dissimilarities between roles expected by gender at work and home.
Keywords: Anxiety, Fatigue, Gender, Social stress, Stress, Worksite health
CORRESPONDING AUTHOR: Matsuoka Nobuko, Hiroshima University, Hiroshima, nobuko.pinetree@gmail.com
P651
"DIFFICULT ADULT PATIENT”: A PSICOLOGICAL PROFILE ACCORDING TO DENTISTS’ PERCEPTIONS
Herrera A., Bustos C., Rojas G.
Universidad de Chile, Department of Dentistry, Santiago, Chile
Purpose: The success of the dental treatment depends on the relationship between the dentist and the patient. Certain characteristics of patients are perceived by the dentist as obstacles in the relationship. The aim of this study is to describe the dentists’ perceptions of the group of patients known as difficult.
Methods: The present study is an exploratory research with qualitative methods. The information was obtained through in-depth interviews with a semi-structure list of questions to eight dentists, belonging to the Primary Attention System of Metropolitan Region. The interviews were recorded and typed to be coded and analyzed according to the principles of The Grounded Theory developed by Glaser and Strauss.
Results: In the first stage of the interviews’ analysis, certain dimensions appeared related to characteristics and behaviors of difficult patients, some possible causes of their attitudes, feelings of their dentists and strategies to achieve the success of treatment. In the second stage there were two types of difficult patients, conceptualized as “the anxious” and “the suspicious”. There was a third type of patient identified during the analysis, the “ideal patient” with its own characteristics, and strategies on how to treat them. Finally a selective coding was made that integrated these three types.
Conclusions: There were two types of patients identified, the anxious and the suspicious, both making the professional practice harder, generating distress and frustration in their dentists. Regardless of the type of patient, all of the dentists, try to handle the situation in a better way by explaining the procedures and by calming the patient, however, its effectiveness is unknown. Therefore it is important to be able to identify these patients to achieve the success of the dental treatment, and then even difficult patients can become non-difficult or even ideal.
Keywords: health communication, coping,
CORRESPONDING AUTHOR: Herrera Andrea, Universidad de Chile, Chile, andrea.herrera.ronda@gmail.com
P652
THE RISK OF SLEEP PROBLEM AMONG SHIFT WORKERS
Nozaki T.1, Tanaka N.1, Hori C.1, Masuda K.1, Mafune K.1, Inoue A.1, Kurioka S.2, HIro H.1
1 University of Occupational and Environmental Health, Mental Health, Kitakyushu, Japan
2 University of Occupational and Environmental Health, Health Policy and Management, Kitakyushu, Japan
Introduction: In this study, we investigated the risk of sleep problems among shift workers. We adjusted for confounders which were considered to be associated with sleep problems, such as demographic factors, life style factors and other work related factors.
Method: The subjects of this study were 9,884 workers of a company in Japan, who responded in full to the questionnaires described below. A self-administered questionnaire survey was conducted from April to June 2010. The questionnaire included hours of sleep, sleep complications (to have good sleep, to have difficulty falling asleep, to wake up during the night or too early in the morning, or to feel a lack of sleep), demographic factors and lifestyle factors. Additionally, in September 2010, we asked participants about their work shift (day work or shift work) and other work related factors. The demographic factors were sex, age and household state. Lifestyle factors were frequency of alcohol drinking per week and smoking habit. Other work related factors were type of job, occupational position, average amount of overtime in the past few months and job stress. The job stress was assessed by the Brief Job Stress Questionnaire (BJSQ: Kato et al., 2000). We used 4 subscales of the BJSQ: job demand, job control, supervisor support and co-worker support, corresponding to the demand-control-support model (Johnson & Hall, 1988).
We define “sleep problem” as having less than 6 hours sleep, not having good sleep and having more than one complication about sleep.
We conducted a multiple logistic regression with work shift, demographic factors, lifestyle factors and other work related factors as independent variables, and sleep problem as a dependent variable. For work shift, we defined day work as a reference.
Results: Work shift (χ2(1) = 9.0, p < .01), type of job(χ2(1) = 14.0, p < .001), household state (χ2(3) = 17.7, p < .001) and job demand (χ2(1) = 14.0, p < .001) had a significant association with sleep problem. The odds ratio of shift work was 2.35 (95% CI: 1.35-4.05).
Discussion: The present study showed that shift work had a high risk of sleep problem, even after adjustment for some kinds of confounders. Further study is needed to reveal what factors in shift work are related to sleep problem.
Keywords: Occupational health, abnormal sleep,
CORRESPONDING AUTHOR: Nozaki Takuro, UOEH, Japan, Kitakyushu, nozaki-takuroh@med.uoeh-u.ac.jp
P653
ASSOCIATION OF JOB STRESSORS WITH BODY MASS INDEX IN JAPANESE YOUNG ADULT WORKERS: A CROSS-SECTIONAL STUDY
Kawahito J.1, Nakata A.2, Ikeda T.3, Sakurai K.4, Otsuka Y.5
1 Hiroshima University, Department of Education, Hiroshima, Japan
2 Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, OH, USA
3 University of Occupational and Environmental Health, Fukuoka, Japan
4 Okinawa International University, Department of Human Welfare, Okinawa, Japan
5 Hiroshima University, Graduate School of Education, Hiroshima, Japan
Although a number of past studies have suggested that job stressors contribute to an increase or a decrease in body weight, the evidence regarding this relationship in Japanese young workers is lacking. To investigate the relationships between job stressors and BMI among Japanese young workers, a total of 12,264 workers aged 20–29 years were categorized into four groups according to the standard obesity index by the Japan Obesity Association as follows: underweight (18.5 or less: n = 1,556), normal weight (18.5 ≤ to < 25: n = 9,168), overweight (25 ≤ to < 30: n = 1,053), and obesity (30 or higher: n = 261). The data were collected by the Mental Health and Life style Inventory (MALI) between April 2008 and December 2010. The questionnaire included self-reported height and weight to define BMI (kg/m2) and eight job stressors were measured by the Brief Job Stress Questionnaire, i.e., quantitative workload, qualitative workload, physical workload, workplace environment, job control, skill underutilization, job fitness, and interpersonal conflict. Results indicated that the average score of quantitative workload was significantly higher in the normal weight, the overweight, and the obesity group compared to the underweight group. The obesity group had the highest average scores in qualitative workload, physical workload, and interpersonal conflict, whereas the group had the lowest level of job control among the whole group. Scores on other job stressors were not significantly different between the groups. Exposure to high levels of job stressors may contribute to weight gains by overeating/physical inactivity while workers with higher body mass may perceive their workload more demanding than the leaner counterparts. Health promotion targeting reduction of job stressors and control of body weight may be of a particular importance for young Japanese workers.
Keywords: job stressors, body mass index, young workers, Japanese
CORRESPONDING AUTHOR: Kawahito Junko, Hiroshima University, kawakawahito@yahoo.co.jp
P654
THE FARMING FAMILY WORK ENVIRONMENT: CONSIDERATION OF A HYPOTHESISED MODEL OF ROLE INTERFERENCE.
McShane C., Quirk F., Swinbourne A.
James Cook University, Department of Psychology, Townsville, Australia
Background: Existing models of the work-home interface and work-family conflict has traditionally considered role interference to occur from only the two domains of work and home (Carlson et al., 2000; Greenhaus & Beutell, 1985; Frone et al., 1992). However, more recent research suggests that maintaining balance between these domains requires consideration of multiple potential sources of conflict (Pocock et al., 2009). This difference in perspective is particularly relevant to family business environments which present more complex interfaces due to dual roles, blurred boundaries, and succession issues (Danes & Morgan, 2004). The aim of the current research was to explore the factors which affected role completion in the context of a farming family business. Research has suggested that the farming family work-home interface may be unique to other workplace structures and therefore likely to have a differential impact on health and well-being (McShane & Quirk, 2009).
Methods: Participants (N = 278) from farming families from across Australia and farming produce types were invited to complete a questionnaire package which explored the relationship between characteristics of the working environment and reported levels of psychological distress, work burnout, and life satisfaction.
Findings: Factors that interfered with role completion originated from multiple sources such as personal characteristics, work demands, home demands, and external demands. Findings from correlation matrices, exploratory factor analysis and path analysis (χ2 (18) = 23.98, p = .156) indicate that work stressors, role interference, and low commitment and identification with farming results in higher reported psychological distress and work burnout and lower reported life satisfaction.
Discussion: Communication, trust and commitment to farm and family appeared to be important in reducing the impact of role interference on well-being. Outcomes of the research have resulted in a hypothesised contextually specific model of role interference for farming families of Australia.
Keywords: Family; Occupational health; Stress; Mental health
CORRESPONDING AUTHOR: McShane Connar, JCU, Townsville, connar.mcshane@my.jcu.edu.au
P655 ADAPTATION OF COPENHAGEN PSYCHOSOCIAL QUESTIONNAIRE VERSION II (COPSOQ-II) IN HUNGARY
Nistor K1., Cserháti Z.1 , Szabó A.2 , Stauder A.1
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 Outcome Budapest, Hungary
Adaptation of Copenhagen Psychosocial Questionnaire version II (COPSOQ-II) in Hungary
Background: COPSOQ II is a complex and scientifically validated questionnaire for the measurement of psychosocial factors at work. COPSOQ II is used in more than 15 countries measuring 28 dimensions related to work stress. Through COPSOQ II users can get profiles of psychosocial factors at individual, group and company levels. In Hungary, there is no validated tool for assessing psychosocial risk factors.
Aim: Cultural and linguistic adaptation of COPSOQ II in Hungary. Setting up a widely-used tool for the psychosocial risk assessment process.
Methods: After the translation and linguistic validation of the COPSOQ II, the reliability of the Hungarian questionnaire was analyzed on a voluntary sample of 287 persons. The mean age of the sample was of 35.8 years, over 58% of those who completed the questionnaire had university degree and less than 15 % were unqualified workers. Inner reliability was calculated for the whole questionnaire and the different subscales. For cross-validating the tool Karasek’s Job Demand/Control/Support questionnaire (JCQ), Siegrist’s Effort/ Reward Imbalance questionnaire (ERI), Cohen’s Perceived Stress Scale (PSS10) and the WHO WB questionnaire (WHO-WB5) were used.
Results: The Cronbach alpha values for all subscales were good (above 0.7). We have found strong correlations among the corresponding subscales (r = 0.65-0.73), thus well-being had the strongest negative correlation with burnout (r > 0.63), stress (r > 0.55) and work-family conflict (r > 0.41), also we have found a strong positive correlations between well-being and workplace commitment (r > 0.5) reward(r > 0.39) and job satisfaction (r > 0.47). The results of the construct validity suggest that the five theoretically defined areas i.e. demands (3 scales), work organization and job contents (4 scales), collaboration and leadership (8 scales), work-individual interphase (2 scales), values (3 scales) and strain (outcomes-4 scales) can partly be confirmed by exploratory factor analysis.
Conclusions: The results suggest that the adapted COPSOQ II has a good conceptual structure, is culturally accepted and relevant. Regarding the division of the sample from professional point of view, the sample of unqualified workers was underrepresented, thus further research is required on a more diversified sample.
Keywords: stress, risk factors
CORRESPONDING AUTHOR: Katalin Nistor, Semmelweis University, Hungary, nistorkata@yahoo.com
P656 FEASIBILITY OF THE MENTAL-ROSAI, NEW WEB-BASED MENTAL HEALTH ASSISTANCE PROGRAM FOR WORKERS
Ito S.1, Yamamoto H.1, Kageyama T.2, Tomita E.1, Momotani H.1, Eto C.1, Tsuda A.3
1 Yokohama Rosai Hospital, Workers' Mental Health Center, Yokohama, Japan
2 Oita University of Nursing and Health Sciences, Department of Mental Health and Psychiatric Nursing, Oita, Japan
3 Kurume University, Department of Psychology, Kurume, Japan
Background and objectives: The Japanese national government recently added mental disorders to the five major diseases nationally needed to focus on. To proactively maintain and promote mental health, it is important for workers to become aware of their own mental health status, stressors, and resources, and to use a variety of coping strategies available for managing stress in everyday life. To support workers to expand their coping repertoire, we revised our original web-based mental health assistance system for workers, “Mental-Rosai”, by adding the Brief Scales for Coping Profile (BSCP) (Kageyama, et al, 2004) to improve and enhance its function for providing advice on the effective use of coping strategies. The revised system, “Mental-Rosai II (MR-II)”, provides self-administered questionnaires on strains, work and lifestyle related stressors, and coping profile, results of which are summarized in a computer-tailored personal report for feedback. Prior to the practical use of MR-II, we conducted the feasibility test and examined the MR-II users’ motivation for stress-management and usability of MR-II. Since slight gender differences in BSCP subscales are reported, it was particularly examined whether this gender difference makes any problem in MR-II.
Methods: Voluntary participants in the feasibility test for MR-II were 15 male (42.5 ± 10.6yrs) and 18 female (50.0 ± 7.8yrs) Japanese workers. They first used MR-II individually on computer and then received semi-structured interview on motivation for stress coping and usability of MR-II. Their strain, stressors, and coping profile were measured by CES-D, the Brief Job Stress Questionnaire, Lifestyle index, and BSCP. Their motivation for stress coping and usability of MR-II were checked by the survey and interview.
Results and discussion: Males were significantly younger, not married, and more depressed. They perceived lower job control and more amount of conflict at work, compared with females. As for coping profile, males less frequently used two kinds of coping strategies, “Changing mood” (t(31) = -2.111,p < .05) and “Changing point of view” (t(31) = -3.963,p < .001). However, after reading personal reports, all male and 97% of female participants showed motivation for using some coping strategies they seldom used. These results indicated that the gender difference does not seem to make any problems in MR-II’s function to help workers to expand coping repertoire. Of the participants, 88% evaluated MR-II as easily answered, 70% could operate it easily, 82% thought personal report was useful, and 88% wanted to use MR-II again. Thus MR-II is considered to be a user-friendly and useful tool to promote workers’ motivation for stress-management.
Keywords: Mental Health, Coping, Stress, Computers, Occupational health
CORRESPONDING AUTHOR: ITO Sakurako, Yokohama Rosai Hospital, tksacra@hotmail.com
P657
PREDICTORS OF PHYSICAL SYMPTOMS IN ADULT PORTUGUESE WAR VETERANS’ OFFSPRING WITH SYMPTOMS OF SECONDARY TRAUMATIC STRESS DISORDER
Pedras S., Pereira MG .
University of Minho, School of Psychology, Braga, Portugal
Introduction: Traumatic events can affect family members beside the primary victim of trauma. The basic assumption in STSD is a transmission mechanism of trauma between primary victim with a PTSD diagnosis and other elements who have meaningful relationship with the victim and develop similar responses.
Method:80 veteran’s adult offspring were assessed on: Post Traumatic Stress Evaluation Scale (PTSES; McIntyre, 1997); Brief Symptoms Inventory (BSI, Derogatis, 1993, adapted version of Canavarro, 1999); Health Symptoms Checklist (HSC, Proctor et al., 1998, Research version of Pereira & Pedras, 2008).
Results: Psychopathology and secondary traumatic stress symptoms were predictors of physical symptoms and the model explained 71% of variance. Also, veterans offspring’s with secondary traumatic stress disorder showed more psychopathology and physical symptoms than offspring’s with secondary traumatic stress symptoms only, especially in veterans offspring’s with less education.
Conclusions: These results emphasize the relationship between mental and physical health and the impact of traumatic stress on physical health. Primary care providers should therefore screen veterans offspring’s with physical health complains and assess whether they are a consequence of trauma.
Keywords: Stress, Health
CORRESPONDING AUTHOR: Pedras Susana , Minho University, susanapedras@gmail.com
P658
PEACE OPERATIONS AND POSTTRAUMATIC STRESS DISORDERS
Correia C., Vasconcelos V.
University Autonomous Lisbon, Department Psychology, Lisbon, Portugal
The Posttraumatic Stress Disorder (PTSD) was acknowledged for the first time as psychopathological nosology in the 3rd. edition of DSM-III (1980). However, there is still rolling a big controversy over its etiology and symptoms which are related to traumatic stressor exposure.
The longitudinal study (Dobbs, D., 2009) involving military personnel who served in Iraq and Afghanistan wars was expected to prove large PTSD rates, but that did not happen. Another study (Bertelsen, M., 2009) has identified a substantial percentage of PTSD with previous symptoms.
This research aimed to assess the prevalence of Posttraumatic Stress Disorder and associated pathology in a sample of 241 Portuguese militaries engaged in Peace Operations in 2011 (Kosovo and Afghanistan) and to understand the relation between psychosocial variables and PTSD. The evaluation methods used in this study were the traumatic event (PCL-M), emotional adjustment (SCL-90-R), self-esteem (SERTHUAL), coping (ETC) and social support (MDSS). This is a longitudinal and quantitative study. The results showed that 34% of the militaries were exposed to traumatic events, 5% were in the PTSD criteria and 15% revealed significant PTSD symptomatology. There are differences in the average level of PTSD, with the post-war military mission to present an average higher than pre mission. There are strong significant associations between PTSD and emotional adjustment, and moderate associations between coping, self-esteem, social support and PTSD. This study also intends to contribute to the implementation of preventive programmes and monitoring military intervention of referenced with PTSD.
Keywords: Health Behaviors, Coping
CORRESPONDING AUTHOR: Vasconcelos Maria de Lourdes, University Autonomous Lisbon, mlvasconcelos@netcabo.pt
P659
WHAT DO PEOPLE THINK ABOUT THE EFFECTIVENESS AND USEFULNESS OF COPING STRATEGIES TOWARD RECALLING TRAUMATIC MEMORIES? : THE STUDY AMONG JAPANESE UNDERGRADUATES.
Osawa K.
Konan university, Faculty of Letters, Kobe, Japan
Several studies found that college students had a high encounter rate to traumatic events (e.g., Vrana & Lauterbach, 1994), and over 50% of Japanese undergraduates experienced some sort of trauma (Nagae et al., 2004). On the other hand, some studies in non-clinical and clinical groups revealed the types of coping strategies to get traumatic stress responses worse or better after recalling traumatic memories (e.g., Osawa & Sakano, 2006; Osawa, Kamo, & Sakano, 2009).
This study was intended to investigate what college students think about the effectiveness and usefulness of coping strategies toward recalling traumatic memories. Participants of this study were seventy-four undergraduates (Male = 19, Female = 55; mean ages = 20.15, SD = 1.07). They assessed the degree of effectiveness of each item from the Japanese version of Ways of Coping Check Lists-Revised (WCCL-R; Kodama et al., 1994), as coping strategies toward recalling traumatic memories (1-5). The WCCL-R consists of 32 items and 5 subscales (“problem-focused coping”, “seeking social supports”, “distancing from thoughts and emotion”, “self-blame coping”, “positive cognitive coping”). Participants also assessed the subjective length of time until effect of the coping appears (1-5), and the degree to select the coping (0-3).
As results of one-way ANOVA, significant differences were found in the degree of effectiveness (F (3.14, 232.12) = 91.60, p < .001), the subjective length of time (F (3.51, 259.90) = 67.80, p < .001), and the degree to select the coping (F (3.17, 234.89) = 13.15, p < .001). From results of this study, the degree of effectiveness of “seeking social supports” was the highest among other strategies (p < .05). The length of time until effect of “seeking social supports” was shorter than other coping strategies without “positive cognitive coping” (p < .001). The degree to select this strategy was higher than other coping without “positive cognitive coping” (p < .01). These results suggested that undergraduates may view “seeking social supports” as the most effective and useful coping strategy toward recalling traumatic memories. However, several studies (Osawa & Sakano, 2006; Osawa, Kamo, & Sakano, 2009) indicated that frequency of adoption and use of “seeking social supports” is not related to intensity of traumatic stress responses. In addition, Osawa & Sakano (2006) suggested that individuals with low traumatic stress responses who appraise recalling traumatic memories as controllable tend to adopt positive cognitive coping, and frequent use of such strategies may decrease traumatic stress responses. However, the results of this study showed that the use of “positive cognitive coping” is less effective than that of “seeking social supports” (p < .05), and the usefulness of “positive cognitive coping” is the same as that of “seeking social supports”. It is suggested that eliminating such gaps between recognition of general undergraduates and research results may be the important role in psychoeducation of traumatic stress and preventing the onset of stress-related disease.
Keywords: Coping, Prevention
CORRESPONDING AUTHOR: Osawa Kaori, Konan University, Kobe, Japan, caosawa@center.konan-u.ac.jp
P660
A BASIC STUDY OF HABITUAL WRIST CUTTING BEHAVIORS ―FROM THE POINT OF DISSOCIATION―
Aoki S.1, Tamura H.2
1 University of Tsukuba, Faculty of Human Sciences, Tsukuba, Japan
2 Rissho University, Faculty of psychology, Tokyo, Japan
1. Purpose: The purpose of this work is to examine the feature of people who harm themselves habitually by wrist-cutting. In particular, we focused on the consciousness condition at the time of a self-injurious behavior.
2. Method: The subjects were 32 psychiatry consultation persons who are performing the wrist-cutting habitually (man = 2•Woman = 30). The average age of the 32 persons is 24.3 (SD = 7.3).
3. Results: 1) The number of those who had psychic-traumatic experiences among those with habitual wrist-cutting behavior was 26 (81%). Among them many were sexually abused (25%). Subsequently, there was much bullying, abuse, and other family problems etc. 2) Self-injurious behaviors other than wrist-cutting were observed in 69%. Most were due to drug overdose. Moreover, it was shown that the bad prognostic group was performing two or more self-injurious behaviors as compared with the control group (χ2 = 5.71, df = 1, p < .05). 3) As a result of investigating the consciousness condition at the time of self-cutting, it was shown that there were 30 (94%) in dissociation state. Among these, 16 persons did not feel pain at cutting, but had only the memory of cutting, while 14 persons had no recollection of cutting. 4) As a result, the significant difference arose in the depth of the crack between the group with recollection of wrist-cutting (16) and without recollection of wrist-cutting group (14). It was shown that the persons without recollection have deep cracks (χ2 = 6.45, df = 1, p < .05). Moreover, when comparing the way of cutting, the persons without recollections adopted the irregular way of cutting significant in many cases (χ2 = 13.27, df = 1, p < .01).
4. Discussion: In this study it was shown that most wrist-cutters had psychic-traumatic experiences, and some dissociative symptoms at the time of a self-injurious behavior. Especially as for wrist-cutters without recollection of cutting, low control was presumed. Even if they did not plan to commit suicide, their low control might have resulted in a suicide. Moreover, the result that the person using two or more self-mutilation tools had a bad prognostic outcome. A close observation of these persons is recommended.
Keywords: coping, self-management, wrist-cutting
CORRESPONDING AUTHOR: Aoki Sanae, Tsukuba University, s-aoki@human.tsukuba.ac.jp
P661
MEDICINE USE FOR HEADACHE IS ASSOCIATED WITH SMOKING, DRUNKENNESS AND CANNABIS USE AMONG ADOLESCENTS: INTERNATIONAL COMPARATIVE STUDY
Holstein BE.1, Andersen A.1, Due P.1, Holme Hansen E.2, HBSC Medicine Use Writing Group
1 University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
2 University of Copenhagen, Department of Pharmacy, Copenhagen, Denmark
Introduction: Medicine use for headache is frequent among adolescents. It is a public health issue to promote appropriate use of headache medicines because all kinds of pain killing medicine - even common over-the-counter (OTC) medicines - are toxic and may have side effects. In 2008, Andersen et al. suggested that adolescents’ medicine use is part of a cluster of risk behaviours such as tobacco and alcohol use. The objective of this study was to examine the association between medicine use for headache and three kinds of risk behaviour (smoking, drunkenness, cannabis use) among adolescents, using standardised and comparable data from 19 European countries.
Methods: We used data from the international Health Behaviour in School-aged Children (HBSC) study 2006. The study population was 11-, 13-, and 15-years old school-children from random samples of schools in 19 European countries. The response rate varied by country but was high in all countries. The study population was 77,864. The participants answered the anonymous and internationally standardised HBSC questionnaire and we used these self-reported data about medicine use for headache, smoking, drinking alcohol, and use of cannabis.
Results: The prevalence of medicine use for headache was much higher among girls (55.3%) than boys (37.6%) and there were considerable between-country-variations. Among boys, the OR (95% CI) for medicine use was 1.5 (1.4-1.7) among daily smokers compared to non-smokers. It was 1.5 (1.3-1.7) among pupils who had been drunk 4+ times vs. those who had not been drunk. It was 1.3 (1.2-1.5) among students who had tried cannabis 3+ times versus those without cannabis experience.
Among girls, the similar estimates were 2.0 (95% CI 1.8-2.3), 1.7 (95%1.5-1.8), and 1.4 (1.2-1.6). All estimates attenuated and most of them remained statistically significant when controlled for age and country. The associations were not entirely consistent across countries.
Discussion: Medicine use for headache showed a significant and graded association with three kinds of risk behaviour: drunkenness, smoking, and cannabis use.
Keywords: childhood and adolescence; health behaviour; substance use
CORRESPONDING AUTHOR: Bjorn E. Holstein, Univ. of S. Denmark, Copenhagen, bho@si-folkesundhed.dk
P662
THE INFLUENCE OF PEERS IN THE LEGAL DRUG USE IN ADOLESCENTS
Sánchez O.1, Andrade P.1, Betancourt D.2, González A.3
1 National Autonomous University of Mexico, División de Estudios de Posgrado, Mexico City, Mexico
2 Universidad Anáhuac del norte, Centro Anáhuac de Investigación en Psicología, Mexico City, Mexico
3 National Autonomous University of Mexico, Dirección General de Servicios Médicos, Mexico City, Mexico
In Mexico City alcohol consumption among adolescents has increased in recent years while tobacco consumption has declined, but it still remains high.
The aim of this study was to determine the influence of peers in alcohol and tobacco consumption. 587 adolescent students from middle and high level of public schools in Mexico City participated. Of them 48.2% were men and 51.8% women, the mean age was 14.8 years (SD = 2.7). To measure the influence of the models of friends and schoolmates, we adapted the scale of models of friends and colleagues, the Adolescent Health and Development Questionnaire (Jessor, et al., 2002), which has three dimensions: friend as protection factor (9 items, alpha = 0.75), friends as a risk factor (10 items, alpha = 0.85), and schoolmates as a risk factor (4 items, alpha = 0.85). To assess alcohol and tobacco 11 indicators were used to measure frequency and amount of consumption.
The results indicated that 66.4% of youth reported having consumed alcohol at some point in their life and the average age of first consumption was at 12.1 years (SD = 3.9); in tobacco consumption, 37.4% of adolescents reported having consumed at some point in their life, with a mean age of first consumption of 12.4 years (SD = 3.9).
A risk indicator for alcohol and tobacco consumption was created, combining the frequency and quantity indicators. To determine the effect of peers on risk of alcohol and tobacco, regression analyses were performed by sex. As for women the predictors of tobacco and alcohol consumption were: the friends and schoolmates models as risk factors, accounting for 19% of the variance in both substances. For men, three dimensions entered as predictors, in alcohol consumption 13% of the variance was explained, and 12% of tobacco consumption.
Keywords: adolescents, peers, alcohol, tobacco use
CORRESPONDING AUTHOR: Sánchez Omar, National University of Mexico, omarxicotencatl@hotmail.com
P663
THE BRAIN IN VIVO PROTON MAGNETIC RESONANCE SPECTROSCOPY CHARACTERISTICS OF INTERNET ADDICTION(IA) COLLEGE STUDENTS
Li GY.1, Liu J.2, Bai B.1, Yang ZY.1, Zhang ZJ.1, Ma HX.1
1 Institute of Behavioral Medicine, Shandong Provincial Key Laboratory of Behavioral Medicine, Jining, Shandong Province, China
2 Centra South University, Second Xiangya Hospital, Department of Radiology, Changsha, China
Objective: To study encephalic spectroscopy characteristic of Internet addiction(IA) college students by using 1H-proton magnetic resonance imaging (1H-MRS).
Methods: 2 dimensional chemical shift imaging 1H-MRS (2D CSI 1H-MRS ) in bilateral frontal lobe and brainstem were acquired from 14 healthy volunteers(control group) and 14 cases(patient group) with IA. The relative concentrations of NAA,Cr, and Cho were observed and the ratios of NAA/Cr and Cho/Cr were evaluated.
Results: IA group showed descended the peak of NAA and ascended the peak of Cho. NAA/Cr and Cho/Cr levels in bilateral frontal lobe of IA group showed markedly statistical difference(p<0.01).There were no statistical difference of NAA/Cr and Cho/Cr levels in bilateral brainstem of the two groups (p>0.05).
Table 1 The demographic data of two groups
IA group (n = 14) | Control group (n = 14) | t | p | |
Age(y) | 20 ± 1.1 | 19 ± 1.5 | 2.0115 | >0.05 |
Education(y) | 15 ± 0.6 | 14 ± 2.0 | 1.7919 | >0.05 |
Weekly Internet time(h) | 49 ± 10.8 | 10 ± 2.6 | 13.1362 | <0.001 |
Table 2 The metabolite ratios comparison in Bilateral frontal lobe between two groups
Metabolite ratios | IA group (n = 14) | Control group(n = 14) | t | p |
\( \overline x \)+sD | \( \overline x \)+sD | |||
R:NAA/Cr | 1.630 ± 0.006 | 1.841 ± 0.006 | 93.0423 | <0.01 |
L:NAA/Cr | 1.506 ± 0.026 | 1.798 ± 0.008 | 41.013 | <0.01 |
R:Cho/Cr | 1.593 ± 0.035 | 0.851 ± 0.026 | 62.018 | <0.01 |
L:Cho/Cr | 1.486 ± 0.017 | 0.849 ± 0.016 | 102.276 | <0.01 |
Table 3 The metabolite ratios comparison in Bilateral brain stem between two groups
Metabolite ratios | IA group(n = 14) | control group(n = 14) | t | p |
\( \overline x \)+sD | \( \overline x \)+sD | |||
R:NAA/Cr | 1.648 ± 0.008 | 1.653 ± 0.005 | 1.9831 | >0.05 |
L:NAA/Cr | 1.598 ± 0.053 | 1.633 ± 0.042 | 1.9366 | >0.05 |
R:Cho/Cr | 1.001 ± 0.068 | 0.968 ± 0.045 | 1.9731 | >0.05 |
L:Cho/Cr | 0.978 ± 0.017 | 0.965 ± 0.019 | 1.9079 | >0.05 |
Conclusion: IA group may be abnormal function with frontal lobe or loss of partial neurons. To a certain extent, cell membrane function of neurons may be damaged or signal transduction may be abnormal.
Keywords: Internet addiction; Magnetic Resonance Imaging(MRI); Magnetic Resonance Spectroscopy(MRS); Functional Magnetic Resonance(fMRI)
CORRESPONDING AUTHOR: Li Gongying, Jining Medical College, Jining, ligongying2005@126.com
P664
FATHERS' IQ AND SOCIAL PROBLEMS MEASURED AT AGE 18-20 ARE ASSOCIATED WITH OFFSPRING SMOKING
Sörberg A., Lundin A., Hemmingsson T.
Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
Background: Intergenerational risk factors for smoking have previously been identified. Here, we examine the association of social and psychosocial factors in fathers, measured at ages 18-20, with offspring smoking.
Methods: Data on smoking, IQ, mental health, social class, parental divorce and indication of social problems (contact with police or childcare authorities) among men born 1949-51 who conscripted for military service in 1969-70 was linked to smoking data for 716 offspring interviewed in the Swedish Level of Living Conditions 1984-2009. The association between characteristics among the men and offspring smoking was calculated using logistic regression analyses adjusting for offspring age and year of birth.
Results: Lower IQ among fathers, measured at ages 18-20, was associated with offspring smoking, independent of other characteristics of the father. Indication of social problems in adolescence among the fathers was also associated with offspring smoking while psychiatric disorders among the fathers, fathers’ smoking, or fathers’ experience of parental divorce were not.
Conclusion: Fathers’ IQ and indication of social problems in adolescence are associated with offspring smoking. The associations are independent of each other and are not explained by fathers’ social class in childhood or the higher prevalence of mental illness and smoking measured among the fathers in their late adolescence.
Keywords: Smoking, Cognitive factors, Life span
CORRESPONDING AUTHOR: Sörberg Alma, Karolinska Institutet, Stockholm, alma.sorberg@ki.se
P63
DIFFERENCES, PREDICTORS AND MODERATORS OF PARTNER’S SUPPORT IN SMOKERS, ABSTINENTS AND NON-SMOKERS
Afonso F., Pereira MG.
University of Minho, School of Psychology, Braga, Portugal
Background: Smoking has important physical and psychological consequences (Bohadana & Martinet, 2003). According to the World Health Organization, about five million people died because of tobacco and in 2030 this number will rise to ten million (WHO, 2009).
Method: 564 participants (224 smokers for at least 3 years, 169 abstinents for at least 3 months and 171 non-smokers) with an age range between 18 and 65 years old participated in the study. Instruments used were Brief-IPQ (Broadbent, Petrie, Main, & Weinman, 2006); Anxiety, Depression and Stress Scale, EADS (Lovibond & Lovibond, 1995); Revised Dyadic Adjustment Scale, R-DAS (Busby, Christensen, Crabe & Larson); Family Crisis Oriented Personal Scales, F-COPES (McCubin, Olson & Larsen, 1991); Medical Outcomes Study Short Form-36 (Ware & Sherbourne, 1992); Fagerström Dependence Nicotine Test (Heatherton, Kozlowski, Frecker & Fagerstrom, 1991). All instruments were adapted to the Portuguese population. The aim of this study was to assess differences, predictors and moderators of partner’s support in smokers, abstinents and non-smokers.
Results: Smokers showed more quality of life (physical) when compared to abstinents and non-smokers. Abstinents revealed more cognitive representations regarding tobacco when they were smokers, more anxiety, more family coping (spiritual support and mobilizing to acquire and accept help), more partner support to stop smoking and more quality of life (emotional performance). Non-smokers revealed more emotional representations regarding tobacco and more couple adjustment than smokers and abstinents. Age, better couple adjustment, less identity, more emotional response, quality of life and psychological morbidity were predictors of partner’s support (positive and negative) in smokers. In abstinents, age, nicotine dependence, couple adjustment, personal control, identity, comprehension, emotional response and familiar coping were predictors of partner’s support. The number of attempts to quit smoking worked as a moderator in the relationship between nicotine dependence and physical quality of life in smokers only.
Conclusions: Results indicate the importance of including of tobacco representations and family variables in smoking behavior programs. According to results, partners should be part of these interventions.
Keywords: Quality of life, Smoking, Social support
CORRESPONDING AUTHOR: Afonso Fernanda, University of Minho, Braga, fernandafonso@gmail.com
P665
THE PRECAUTION ADOPTION PROCESS IN SECONDARY PREVENTION OF CIGARETTE CONSUMPTION IN UNIVERSITY STUDENTS
Londoño C.
Universidad Católica de Colombia, Faculty of psychology, Bogotá, Colombia
The present study, that used a quasi-experimental pre-test post-test design for paired groups, aimed at assessing the effect of an intervention based on the so-called Precautions Adoption Process (PAP) in the reduction or cessation of smoking in university students from three Higher Education Institutions. The research took into account some key elements of PAP: motivation, vulnerability perception, susceptibility, cost and benefit, decisional balance and change, as a result of cognitive functioning and planning in the first place, and later to the passage through seven consecutive stages. Starting from these elements, an intervention program was developed and implemented in six work sessions. At the end, results from pre-test and post –test measurements of both the experimental and control groups were compared. In order to classify participants for each one of these groups several instruments were used: The Classification of Cigarette Consumers Questionnaire (C4) by Londoño, Rodríguez & Gantiva (in press), the Expectations Regarding Cigarettes Questionnaire (CEC) by Londoño & Rodríguez (2007), and the Motivation Questionnaire (Temptation). Results showed significant differences between groups in the level of consumption, expectations and motivation (Londoño & Rodríguez, 2007). These and other important findings are discussed.
Key words: Precaution Adoption Process, cigarette consumption, secondary prevention and adolescents.
Keywords: cigarette, prevention
CORRESPONDING AUTHOR: Londoño Constanza, Universidad Católica de Colombia, clondono@ucatolica.edu.co
P666
PREVALENCE OF TOBACCO USE AMONG ST ELEVATION MYOCARDIAL INFARCTION'S PATIENTS IN THE LIBYAN NATIONAL CARDIAC CENTER IN TAJURA -TRIPOLI, LIBYA
Bouni E.
University of Tripoli, School of Medicine, Tripoli, Libya
Introduction: ST elevation myocardial infarction continues to be a significant public health problem in industrialized countries and becoming an increasingly significant problem in developing countries, tobacco use is closely related to risk of CVD
The objective of this paper is to determine the prevalence of tobacco use among ST elevation myocardial infarction's patients who were admitted in cardiac care unit in the Libyan National Cardiac Center .
Method: 65 patients were included in our study . They have been selected randomly from the cardiac care unit. The necessary information concerning these patients were obtained from their official files. A questionnaire was constructed to cover variables related to most important cardio vascular risk factors.
Results: the sample consists of 53 (81.5%) males and 12 (18.5%) females. The age ranged from 17 to 95 years. Prevalence of smoking among males was 39 (72.2%) and among females was zero (0%), Prevalence of diabetes Mellitus was 55.7%, prevalence of hypertension was 43.3%, and prevalence of hyperlipidaemia was 52.5.
Conclusion: Previous data indicating that tobacco use among the study sample (72.2%) is more prevalent comparing to diabetes Mellitus, Hypertension, and hyperlipidaemia. Thus management programs designed to help patients with coronary artery disease to stop smoking is an important issue.
Keywords: smoking, cardiovascular disease, coronary artery disease, STEMI
CORRESPONDING AUTHOR: Bouni Eman, University of Tripoli, Libya, emanbuni@yahoo.com
P667
TEMPERAMENTAL AND PERSONALITY CHARACTERISTICS OF SEXUAL DYSFUNCTION PATIENTS: A HOSPITAL BASED STUDY
Chaudhry RK., Mishra BP.
Dayanand Medical College & Hospital, Department of Psychiatry, Ludhiana, India
It is reasonable to assume that personality factors will influence sexual development and establishment of sexual intimacy. Neuroticism was regarded as relevant to sexuality in earlier studies but results are not consistent (Copper, 1968; Eysenck, 1976; Slater. 1945). Costa et al (1992) found neuroticism to be correlated with lower sexual satisfaction and extroversion with sexual drive.
Aim of the study: To see the personality characteristics of the patients presenting with sexual dysfunction and how it is associated with the pathology.
Material and method: Personality evaluation of 50 (both married and unmarried) diagnosed patients of sexual dysfunction presenting to Psychiatry outpatient department was done using Cattel’s 16 PF questionnaire. Patients with hypertension, diabetes, head injury and comorbid substance abuse were excluded from the study.
Results: The 16 PF profile of these patients reflect that they are more prone to decide impulsively rather than using their intellectual ability or reasoning. They have low frustration tolerance and get easily upset and frustrated in smaller things. These types of emotional status lead to pre-mature ejaculation and erectile dysfunction since the patient gets distracted to other things. These patients have apprehensive tendencies which in turn lead to depressive cognition which is again a known factor for sexual inadequacy.
Keywords: Addictive behaviors, Sexual orientation
CORRESPONDING AUTHOR: Chaudhry Dr. Rupesh, D. M. C. & H, India, rupeshchaudhry123@yahoo.co.in
P668
EFFECT OF ALCOHOL DRINKING ON PERCEIVED JOB STRESSES
Hiro H., Nozaki T., Inoue A., Mafune K.
University of Occupational and Environmental Health, Department of Mental Health, Kitakyusyu, Japan
Background: The problem of alcohol, which includes alcohol related diseases, industrial accidents and absenteeism, is one of the most important issues in occupational health. Many cross-sectional and longitudinal studies have been conducted to assess the association of the occupational environment and stress with alcohol consumption, harmful drinking and alcohol dependence, but the findings are still conflicting and inconclusive. Job stresses probably affect alcohol consumption in some workers, but heavy drinking may change the severity of perceived job stress in other workers. The objective of the present longitudinal study is to investigate the effect of drinking on perceived job stresses.
Methods: Questionnaire surveys conducted in 2009 and 2010 contained questions about sex, age, occupational class, and alcohol consumption (g/week), and the Brief Job Stress Questionnaire (BJSQ). The BJSQ, which was developed and is used widely in Japan, includes six subscales of perceived job stresses: qualitative workload, quantitative workload, job control, physical workload, underutilization of abilities, and interpersonal conflict. The present study analyzed the data from 5,800 male Japanese workers in a large listed company who have a drinking habit. Heavy drinking was defined as weekly alcohol consumption of >210g/week, and a total of 2,164 workers (37.3%) were classified as heavy drinkers. Multi-way ANOVA was conducted with age, occupational class, and drinking pattern in 2009 and 2010 as independent variables, and perceived job stresses as the dependent variable. There were no dramatic events in the company between 2009 and 2010.
Results: After adjusting for age, occupational class, and heavy drinking/non-heavy drinking in 2009 and 2010, the scores of quantitative workload and underutilization of abilities were higher in the non-heavy drinkers than in the heavy drinkers in 2009. The score of job control was lower in the non-heavy drinkers. There was no significant difference between the drinking patterns in the scores for qualitative workload, physical workload and interpersonal conflict.
Discussion and Conclusions: The present study suggests that alcohol consumption affects some perceived job stresses, but the relationships were somewhat unexpected. Further studies are needed to examine the long-term effects of drinking on perceived job stresses.
Keywords: Alcohol, Stress, Worksite health
CORRESPONDING AUTHOR: Hiro Hisanori, UOEH, Kitakyushu, hiro@med.uoeh-u.ac.jp
P669
THE IMPACT OF STRESS MANAGEMENT BEHAVIOR CHANGE PROGRAM BASED ON TRANSTHEORETICAL MODEL IN JAPANESE UNIVERSITY STUDENTS
Tsuda A.1, Okamura H.2, Kim E.3, Togawa A.4, Matsuda T.4, Deng K.4, Yajima J.5, Tanaka Y.6, Tsuda S.7
1 Kurume University, Department of Psychology, Kurume, Japan
2 Kurume University, Cognitive and Molecular Research Institute of Brain Diseases, Kurume, Japan
3 Inha University, Psychology, Incheon, South Korea
4 Kurume University, Graduate School of Psychology, Kurume, Japan
5 Beppu University, Department of Human Relations, Beppu, Japan
6 Kyoto Tachibana University, Department of Psychology, Kyoto, Japan
7 Ibaraki Christian University, Department of Nursing, Hitachi, Japan
Background: Stress management behavioral change program based on Transtheoretical model (TTM) has been developed as a population approach tool in health psychology domain. The program was designed to facilitate practicing effective stress management behavior to reduce perceived stress. It included a self-help work book and an expert feedback system to the individual prescription for effective stress management behavior change based on the results of TTM-related assessments such as the stage of change, self-efficacy, decisional balance and process of change. However, thus far, there was no study to compare of a self-help work book and an expert system which content of stress management behavior change program based on TTM is more effective to stress management behavior change as well as stress reduction.
Purpose: This study is to evaluate the impact of stress management behavior change program based on the TTM in Japanese college students on the transition of stage for effective stress management behavior change and levels of perceived stress with focused on an expert feedback system to the individual prescription for effective stress management behavior add to a self-help workbook.
Method: Participants (n = 445) were recruited from several universities in Japan. They were randomly assigned into the Workbook (W) group which received a self-help workbook of stress management behavior change and engaged in self-help stress management without the expert feedback system, and the Workbook + Feedback (W + B) group which received the workbook and the expert feedback system generated the prescription for effective stress management behavior. The participants from both groups engaged in the self-help stress management behavior program for 6 months with and without the prescription from the expert feedback system. Finally, 248 participants completed assessment at baseline and at 12 months follow-up. Primary outcomes were the portion of participants who were practicing effective stress management and levels of perceived stress.
Results and discussion: The W + FB group showed significant improvements in progression to the stage of change and significant decreases of perceived stress, as compared with the W group. These results suggest that receiving an expert system generated messages facilitates efficacy of a TTM-based workbook for effective stress management. It appears to reveal the impact of the stress management behavioral change program based on Transtheoretical model (TTM) consisted of a self-help work book and an expert feedback system.
Keywords: Stress, Randomized controlled trial
CORRESPONDING AUTHOR: Tsuda Akira, Kurume University, Kurume, tsuda_akira@kurume-u.ac.jp
P671
LEISURE ACTIVITIES OF UNIVERSITY STUDENTS: PROS AND CONS
Meneses R.1, Miyazaki C.2, Pais-Ribeiro J.3
1 Universidade Fernando Pessoa, Faculdade de Ciências Humanas e Sociais, Porto, Portugal
2 Faculdade de Medicina de São José do Rio Preto, Laboratório de Psicologia e Saúde, São José do Rio Preto, Brazil
3 University of Porto, Faculdade de Psicologia e de Ciências da Educação, Porto, Portugal
With the Positive Psychology Movement, there has been an even greater interest in positive variables, like quality of life and leisure, and in the promotion of these variables. Research has been displaying the importance of leisure activities for the well-being and quality of life of individuals. Nevertheless, it is not frequent to explore leisure correlates, namely the relationship between leisure and quality of life in university students. In fact, quality of life is not routinely monitored in this group of individuals, limiting the possibilities of its promotion. Consequently, the aim of the present study is to explore the relationship between perception of leisure opportunities, quality of life and socio-demographic variables in university students. A total of 250 university students from both sexes, between 17 and 50 years of age (M = 22,84; SD = 5,38), answered to a socio-demographic questionnaire and to items 1 (“How would you rate your quality of life?”) and 14 (“To what extent do you have the opportunity for leisure activities?”) of the WHOQOL-Bref. A statistically significant correlation was found between the perception of leisure opportunities and: quality of life (r(247) = 0,42, p < 0,0001) and age (r(249) = -0,15, p < 0,02). No statistically significant differences were found between men (n = 61) and women (n = 186) in the perception of leisure opportunities. Individuals with health problems (n = 63) perceived less leisure opportunities than those that had no such problems (n = 187). The present results suggest that age, health status and quality of life of university students may limit (or be limited by) their perception of leisure opportunities, revealing the need of a more thorough analysis of this variable. In fact, leisure activities may be a relevant way to promote university students health and quality of life.
Keywords: Health; Quality of life
CORRESPONDING AUTHOR: Meneses Rute F., Univ. Fernando Pessoa, Porto, rmeneses@ufp.edu.pt
P672
SEX EDUCATION, SEXUAL DEBUT AND SEXUAL OUTCOMES IN ADULTHOOD IN IRELAND
Bourke A.1, Boduszek D.1, Kelleher C.1, McBride O.1, Morgan K.2, McGee H.1
1 Royal College of Surgeons in Ireland, Psychology, Dublin, Ireland
2 Perdana University-Royal College of Surgeons in Ireland, Psychology, Perdana, Malaysia
Background: Research investigating the direct relationship between the positive or protective effects of sex education on sexual health outcomes is inconclusive (Yu, 2010). However, recent evidence suggests that the association between sex education and longer-term outcomes may be moderated by age at first sex (Lindberg & Maddow-Zimet, 2012).
Methods: Respondents were adults (18-45 years) surveyed in the 2010 Irish Contraception and Crisis Pregnancy Survey (n = 3002), a national cross-sectional telephone survey designed to assess knowledge, attitudes and behaviours in relation to sex, contraception and pregnancy in Ireland. A path analysis, with receipt of sex education as a latent variable, explored the relationship between sex education and age and use of contraception at first sexual intercourse and later sexual health behaviours in adulthood.
Findings: Results indicate that sex education predicts age of first sex and contraception use at first sex. A direct positive relationship was found between sex education and STI screening. There was no direct relationship found between sex education and the experience of an unplanned (‘crisis’) pregnancy; however, an indirect relationship was found, mediated by age of first sex. The relationship between sex education and current contraception use was mediated by contraception use at first sex.
Discussion: This study suggests that sex education may only impact on some later sexual health behaviours indirectly, and these relationships may be more appropriately viewed through their interaction with the age and contraception use at first sex. Experience of first sex is a significant milestone that is influenced by sex education and one which later impacts on sexual health behaviours into adulthood.
Keywords: Health education, Sexual behavior, Health outcomes
CORRESPONDING AUTHOR: Bourke Ashling, RCSI, Dublin, ashlingbourke@rcsi.ie
P673
RELATIONSHIP BETWEEN SOCIAL SUPPORT AND SENSE OF COHERENCE OF PEOPLE WITH PSYCHIATRIC DISABILITIES
Hiroshima M.1, Amagai M.2, Kobayashi N.2, Sakuraba S.3
1 Kyoto University, Graduate School of Medicine, Human Health Science, Kyoto, Japan
2 National College of Nursing, School of Nursing, Tokyo, Japan
3 Kyoto Koka Women's University, Kyoto, Japan
Objective: Mental health problems have become a vital issue. As for mental health, prevention is as important as treatment, early detection and early intervention. Moreover, support to empower people with psychiatric disabilities involves not only physical aid and objective improvement but also their subjective emotions and tolerance. Sense of coherence indicates individual’s tolerance against stress, and very useful to prevent damaging from mental problems. Therefore, to investigate how we can enhance sense of coherence is a problem of the pressing need. The purpose of this study is to investigate the relationship between social support and sense of coherence of people with psychiatric disabilities. Also, we consider what support is good for enhancing sense of coherence.
Method: The subjects were 58 people with psychiatric disabilities living on the market who agreed to participate in the research. We had them fill out an anonymous questionnaire. The questionnaire contains Sense of Coherence 13, General Health Questionnaire 12, and Norback’s Social Support Questionnaire. We investigated the relationship between social support and sense of coherence.
Results: We found that individuals who had informant or consultant had significantly higher sense of coherence than those who did not have them. Also, we found that there were significant relationship between age, sex, general health and sense of coherence. On the other hand, we found that there were no significant relationship between the number of important person and sense of coherence.
Conclusion: These results imply quality of support is more important than quantity of support
Keywords: Social support, Mental health
CORRESPONDING AUTHOR: Hiroshima Mayo, Kyoto University, Kyoto, hiroshima-mayo@hs.med.kyoto-u.ac.jp
P674
A TELEPHONE-BASED INTERVENTION TARGETING PRESCHOOL CHILDREN CAN ALSO INCREASE THE FRUIT AND VEGETABLE CONSUMPTION OF THEIR PARENTS AFTER 12 MONTHS.
Wyse R., Wolfenden L., Campbell E.
University of Newcastle, Faculty of Health Sciences, Newcastle, Australia
Introduction: Parents exert an important influence on the dietary behaviours of their children through the environments they create and the foods that they allow into their home, provide to their children and role model. It is recommended that interventions to improve children’s dietary behaviours also focus on changing their parents’ dietary behaviours in order to increase the likelihood of success and the longevity of the intervention effect. The Healthy Habits cluster randomised control trial demonstrated that a four contact telephone-based parent intervention could increase the fruit and vegetable (F&V) consumption of 3-5 year-old children. This poster investigates whether the intervention also increased parents’ F&V consumption after 12 months.
Method: The Healthy Habits trial was conducted with 394 parents, recruited from 30 preschools within the Hunter region of Australia. The unit of randomisation was the preschool. Parents in the intervention group received four 30-minute scripted telephone calls focusing on changing the home food environment to facilitate children’s F&V consumption, specifically focusing on their own F&V consumption and role-modeling. Control parents received written resources. The number of serves of F&V that parents consumed each day was assessed at baseline and 12 months later via telephone survey using questions from the National Nutrition survey, and answers to these questions have previously been associated with objective biomarkers of F&V consumption including carotenoids and red-cell folate. Generalised estimating equations, adjusted for baseline values and clustering by preschool, were used to compare mean daily F&V serves between the intervention and group parents.
Results: At the 12 month follow-up the vegetable consumption among intervention parents was 0.5 serves (95%CI: 0.3-0.7, p < 0.001) higher than control parents, and fruit consumption was 0.2 (95%CI: 0.04-0.39, p = 0.015) serves higher than control parents (n = 329).
Conclusion: A four contact telephone-based intervention can increase parents’ F&V consumption after 12 months and demonstrates the ability of home food environment interventions to influence the consumption of family members beyond than the primary intervention target.
Keywords: Intervention, Nutrition, Randomized controlled trial, Health behavior change
CORRESPONDING AUTHOR: Wyse Rebecca, University of Newcastle, Aust, rebecca.wyse@hnehealth.nsw.gov.au
P675
VIEWS AND EXPERIENCES REGARDING WEIGHT MANAGEMENT AMONG IRISH MEN AND WOMEN AGED 50-70
Delaney M.1, McCarthy M.1, Shortt E.2
1 University College Cork, Department of Food Business & Development, Cork, Ireland
2 University College Dublin, School of Public Health, Physiotherapy and Population Science, Dublin, Ireland
Background: Increasing BMI, associated with chronic disease risk, tends to occur up to late middle age. Although there is a slight drop off in BMI from age 65, the majority of Irish adults are overweight or obese and almost half report actively trying to manage their weight. This study explores how men and women aged 50-70 consider and engage in weight management in everyday life.
Method: In-depth semi-structured interviews were conducted with a purposive sample of 50 older men and women who varied by BMI (20 healthy BMI, 17 overweight and 13 obese), diet, and health status. Interviews explored life course experiences and influences on food and eating. An inductive thematic analysis was carried out.
Findings: Personal weight was an issue raised spontaneously by 44 out of 50 participants. Five themes relating to weight management were identified. Age-related weight gain was seen as the norm and some participants whose weight had remained similar over time without effort described themselves as ‘lucky’. Over half described desiring to either lose or maintain their current weight. Weight was thought to have been affected by various life transitions relating to roles at work, in the home and in leisure pursuits resulting in an upward trend over time. The majority felt that preventing weight gain required increased effort with age due to physical factors. Women described more appearance-related weight consciousness which had emerged from their teens while men expressed more concern about physical functioning. While some participants monitored and controlled small variations in weight closely, others had made attempts to control weight after a process of cumulative influencing factors or particular trigger events. Management of chronic health problems also emerged as a strong motivation for some participants. Various strategies for keeping weight in check were described including limitation of foods, routinisation of eating, finding acceptable excuses to refuse food in social situations, and increasing physical activity levels. Men were typically uninvolved with food work and were more likely to mention compensatory physical activity, while women referred more to changing aspects of their diets. Participants aimed to maintain or achieve a personally acceptable weight level using an approach that incorporated notions of balance and moderation, which was perceived to be suited to their life stage. For some, conforming to medical BMI ideals was viewed as unachievable or undesirable.
Conclusion: Understanding older people’s lived experiences of weight change and management can help to inform socially meaningful health promotion strategies.
Keywords: Aging, Weight control, health behaviors
CORRESPONDING AUTHOR: Delaney Mary, University College Cork, Cork, mary.delaney@ucc.ie
P676
MENOPAUSAL SYMPTOMS AND HEALTH PROBLEMS OF WOMEN AGED 50-65 YEARS IN SOUTHERN JORDAN
Shakhatreh FMN.
University of Jordan, Faculty of Medicine, Amman, Jordan
Objectives: To identify menopausal symptoms and health disorders of women aged 50-65 years in under-privileged areas of southern Jordan.
Method: A multistage, random-sampling design was applied to select a sample of households from three governorates. A total of 143 women were eligible to be included in the analysis. Women were asked about a list of symptoms (somatic, psychological and genitourinary) and about a list of morbidities such as hypertension, diabetes mellitus and urinary tract infection. Ever-screening by mammogram, regular breast self-examination, ever-screening by cervical smear, general medical check-up, physical activity, smoking habit, and ever-receiving information about menopause were also investigated.
Results: The median age of onset of natural menopause was 50 years; 77% of women were illiterate, and 59% of the couples were relatives. The most frequently reported somatic symptoms were joint aches/stiffness (89%), bone pains (74%) and paresthesia in the extremities (51%). Hot flushes were experienced by 62% and urinary incontinence by 30%. Almost 62% reported irritability and mood changes, 56% had high blood pressure, and 18% and 14% suffered from urinary tract infection and reproductive tract infection, respectively. Eight percent and 11% reported ever-screening by mammogram and cervical smear, respectively, and 11% reported performing breast self-examination regularly. Regular physical exercise was reported by 8%, and 81% were overweight or obese. One-quarter received information on menopause, and 58% reported the need to know 'everything' about menopause.
Conclusion: Women in southern Jordan experienced multiple menopause-related symptoms and morbidities. The majority of them did not receive any health education about this phase of life. Preventive health practices and health-promoting behaviors are relatively.
Keywords: public health
CORRESPONDING AUTHOR: Shakhatreh Farouk, University of Jordan, farouk3000@hotmail.com
P677
EFFECTS OF HEAVINESS AND WARMTH SUGGESTIONS ON THE VIVIDNESS OF MENTAL IMAGERY
Tamura H.1, Aoki S.2
1 Rissho university, Faculty of psychology, Tokyo, Japan
2 University of Tsukuba, School of Human Sciences, Tsukuba, Japan
Purpose: Imagery is one of the most important factors in autogenic training and autogenic therapy. Many therapists have hypothesized that autogenic training improves the vividness of imagery. This study examined: (1) whether heaviness and warmth autosuggestions increases the vividness of mental imagery, and (2) the sensory modalities in which vividness of imagery is increased through autosuggestions.
Procedure: Participants were 22 university students and graduate students. Each two items for each sensory modality in the Shortened Form of the Questionnaire on Mental Imagery (QMI; Sheehan, 1967) were orally administered to participants in both waking and autosuggestive conditions. In both conditions, participants responded to each item after ten seconds of recollecting imagery. In the suggestive condition, participants responded to the QMI after they experienced the first standard exercise and the second standard exercise of autogenic training for three minutes as heaviness and warmth autosuggestions. In the waking condition, participants imaged with their eyes closed and then responded after opening their eyes. The order of the two conditions was counterbalanced across participants.
Results: T-tests indicated that scores in the visual and gustatory modalities, as well as the total scores in the autosuggestive condition were higher than those in the waking condition. The auditory, cutaneous, kinaesthetic, olfactory and organic modality scores were not significantly different between the two conditions.
Conclusions: Our results suggest that the heaviness and warmth autosuggestions increases the vividness of mental imagery. However, the effect of autosuggestion varies according to the sensory modality. The heaviness and warmth autosuggestions increases the vividness especially in visual and gustatory sensations. In this study, subjects were experienced only on one occasion. In order to understand the effect of autogenic training on mental imagery in more detail, it is necessary to examine whether the vividness of mental imagery increases by repeating and practicing the first standard exercise and the second standard exercise of autogenic training.
Keywords: relaxation, self management, mental health, stress, anxiety
CORRESPONDING AUTHOR: Tamura Hanae, Rissho University, Tokyo, h-arumat27@r5.dion.ne.jp
P678
DOES ATTENTION CONTROL FUNCTION DECREASE INFLUENCE OF PASSIVE PROCESSING ON ANXIETY AND DEPRESSION?
Miyazaki K.1, Nedate K.2
1 Waseda University, Graduate School of Human Sciences, Saitama, Japan
2 Waseda University, Faculty of Human Sciences, Saitama, Japan
Basic research on anxiety and depression has mainly focused on active processing which occurs when an individual actively pays attention to a stimulus. However, this study focused on passive processing which is important to an individual dealing with problems experienced in his/her daily life. Passive processing occurs when an individual passively notices a stimulus. Only a few studies have examined the relationship between passive processing and anxiety and depression, and it is unclear what cognitive factors are associated with passive processing. Previous studies have demonstrated that individuals with the high attention control ability are likely to engage in flexible cognitive processing and show low anxiety and depression. The purpose of this study was to investigate how passive processing influences anxiety and depression, and to reveal if attention control function decreases the influence of passive processing.
Method: A questionnaire survey was administered to 165 male and female university students. The following scales were used: 1) items to assess the difficulty of passive processing; 2) the Japanese version of the State-Trait Anxiety Inventory (STAI; Hidano et al., 2000); 3) the Japanese version of the Beck Depression Inventory Second Edition (BDI-II; Kojima & Hurukawa, 2003); and 4) the Attention Control Scale (Imai, 2009) to measure the ability of controlling attention.
Results: Multiple linear regression analysis was performed with “the perceived difficulty of passive processing (PDPP)” and the interaction between the PDPP and “the attention control (AC)” as the independent variables, and state-trait anxiety and depression as the dependent variables. Results showed that scores of anxiety (β = .536, R2 = .251) and depression (β = .304, R2 = .102) increased as those of the PDPP rose. Furthermore, the interaction between the PDPP and AC had a significant negative effect on anxiety (β = -.498) and depression (β = -.351).
Discussion: This study showed that the perceived difficulty of passive processing may predict the level of anxiety and depression. The findings suggest the necessity for an intervention which helps individuals to engage in passive processing appropriately. Results of multiple linear regression analysis showed that attention control function decreased the impact of the perceived difficulty of passive processing on depression and anxiety. Therefore, it may be effective to enhance the attention control ability to promote passive processing in a cognitive behavioral intervention.
Keywords: Anxiety, Depression, Passive processing, Attention control
CORRESPONDING AUTHOR: Miyazaki Kyuichi, Waseda University, Japan, kyuichim@toki.waseda.jp
P679
THE ISOMETRIC YOGIC BREATHING EXERCISE, A SIMPLIFIED YOGIC RESPIRATORY ROUTINE, INCREASES ANTI-OXIDANT ABILITY
Kamei TK.1, Kimura H.2, Kimura K.3, Hök J.4, Walach H.5
1 Nagasaki University, Head Office, Nagasaki, Japan
2 Toho University, Department of Anesthesiology and Intensive Therapy, Tokyo, Japan
3 Japan Yoga Niketan, None, Yonago, Japan
4 Karolinska Institutet, Department of Neurobiology, Huddinge, Sweden
5 European University Viadrina, Institute for Transcultural Health Studies, Frankfurt (Oder), Germany
Yoga is today popular worldwide in relieving stress. There are many reports of the physical benefits of yoga. There are also reports on how yogic respiratory exercise activates cellular immunity and helps in the recovery of mental and physical harmony in humans. We have developed a fairly simplified but effective yogic respiratory exercise which can be easily practiced even by beginners of yoga. We have named this simplified yogic respiratory exercise the Isometric Yogic Breathing Exercise.
Our Yogic Breathing Exercise is programmed to be performed while sitting and standing during 20-minute periods. Each program has breathing exercises synchronized with body movements and effort to increase awareness of tension and the relaxation of body muscles.
Twenty five female Chernobyl victims who were beginners of yoga were randomly gathered as our subjects, and were instructed to practice this Isometric Yogic Breathing Exercise daily for a period of six months. Seventeen (average age: 60 years old) of the subjects were able to continue the Isometric Yogic Breathing Exercise for the six-month period; we checked their anti-oxidant ability (BAP test) and oxidant stress level (d-ROM test) using FRAS4 (H&D srl, Italy) prior to starting the Isometric Yogic Breathing Exercise routine and after their completion of the practice for the six months. The results showed anti-oxidant ability increases in 15 subjects (t(16) = –5.40, P < 0.0001) and oxidant stress level decreases in 16 subjects (t(16) = –4.93, P < 0.0002) after the six-month Isometric Yogic Breathing Exercise practice.
These findings suggest that the continual practice of this simplified yogic respiratory exercise generates activation of the anti-oxidant ability of circulating blood cells, resulting in not only a stress-free mental state but also, gradually, an oxidant stress-free physical state. We anticipate that this simplified yogic respiratory exercise will be useful and applied in many clinical and health care situations in which anti-aging effects are needed, especially in the prevention of the occurrence of cancer. As conventional yogic respiratory exercise has also been shown to activate cellular immunity, we would like to propose this newly developed Isometric Yogic Breathing Exercise as an important method to re-activate a latent ability, such as anti-oxidant ability, related to the harmonization which humans naturally possess.
Keywords: yoga breathing anti-aging oxidant stress
CORRESPONDING AUTHOR: Kamei Tsutomu, Nagasaki University, Nagasaki, ttm@fork.ocn.ne.jp
P680
ADHERENCE IN PATIENTS OF A RENAL PROTECTION PROGRAM IN CALI, COLOMBIA
Velasco M.1, Gonzalez M.2, Gomez O.3, Mendez F.2, Rincon-Hoyos H. 4, Varela M.5, Diago F.2, Otero L.2, Schneiderman N.6, Ramos M.2, Hernandez C.2
1 Comfandi IPS / Universidad Libre, Subdirección de Salud, Cali, Colombia
2 Comfandi IPS (Colombia), Subdirección de Salud, Cali, Colombia
3 Fundacion FES, Area de Salud, Cali, Colombia
4 Comfandi IPS / Fundacion Valle del Lili / University of Miami, Salud Mental / Psiquiatria / Psychiatry, Cali, Colombia
5 Universidad Javeriana Cali, Facultad de Humanidades y Ciencias Sociales, Cali, Colombia
6 University of Miami, Department of Psychology, Miami, United States
Introduction: Adherence to treatment is defined as having patient’s active participation in treatment based on responsibility, awareness and diagnosis. In chronic diseases, patient’s compliance involves appropriate use of medications and services, and lifestyle changes like following a proper diet and exercise.
Methodology: We performed a cross-sectional study with 277 adult patients in a renal protection program at a private primary health care network in Cali Colombia, selected by simple random sampling from March 2010 to July 2011. Adherence was assessed with an instrument of 20 questions based on the questionnaire for adherence to treatment of hypertension developed by Universidad Javeriana Cali’s group of Psychology, Health and Quality, which was modified to include adherence to treatment of diabetes. The clinical status and diagnosis was obtained from medical records and a questionnaire was designed for socio-demographic variables. Outcomes of interest were adherence to treatment according to: medication use, attendance to appointments, completing laboratory tests, performing physical activity, consumption of more than one carbohydrate per meal (among other questions), adjusted by demographic variables, disease type and stage KDOQI (Kidney Disease Outcomes Quality Initiative).
Results: 64% of patients were female, average age was 56 years; 76% of patients gained less than 2 current legal monthly wage (718 dollars / month); 72% of patients were hypertensive; 28% had diabetes or diabetes and hypertension; 70%of patients were married or lived in company with a steady partner; 93% of patients reported taking all prescribed medicines; 92% of patients reported always attended program’s follow up appointments; 98% reported always to perform the laboratory tests requested; 77% reported doing physical activity in the last month and 73% of patients reported consumption of more than one carbohydrate per meal. Gender differences in attendance to follow-up appointments and physical activity were: 96% of men said always attended visits vs. 90% of women (p = 0.03); and 84% of men had physical activity in the last month compared to 73% of women (p = 0.03).
Conclusion: Patients with chronic disease report high adherence to traditional care (medications, follow up visits and lab tests) and greater difficulty to adhere to lifestyle changes. Women reported lower physical activity than men.
Keywords: Adherence, Renal/urologic Disorders, Chronic Illness, Health Behavior Change, Primary Care, Diet, Exercise, Treatment
CORRESPONDING AUTHOR: RINCON-HOYOS HERNAN, FUNDACION VALLE DEL LILI, hernangrincon@gmail.com
Conflict of Interest: Funded by Departamento Administrativo de Ciencia, Tecnología e Innovación Colciencias Republica de Colombia
P681
ONE SIZE FITS ALL: COMMUNICATING THE UNKNOWN IN HEALTH PROMOTION
Pedruzzi R.1, Swinbourne A.1, Quirk F.2
1 James Cook University, Psychology, Townsville, Australia
2 James Cook University, Medicine, Townsville, Australia
Recently, there has been a call for an integrated conceptual model to better understand the communication of health information to patients and consumers (Longo, 2005). Of particular interest to the current research project is the identification of factors that influence attention to health information in order to develop innovative methods for communicating such information. In practise, health promotion campaigns tend to exist under a one size fits all framework. That is, most public health campaigns highlight the negative effects of engaging in risky behaviours. An examination of this method with 303 community participants revealed attention to health risk information differed across two health threats. Participants were randomly assigned to receive information about heart health or road behaviours. Participants in the heart health condition remembered significantly more risk information than participants in the road behaviours condition (t (292) = -4.35, p = .00). In interpreting these findings it is hypothesised that there is an unknown component inherent to some health threats that impacts on attention to risk information. These unknown components are perceived to be outside of personal control hence attention to information may be redundant. For example, risk on the road is also a function of other people’s behaviour which an individual cannot control. Research is now exploring this idea by examining perceptions of controllability across a number of health threats. It appears that health promotion campaigns should not operate on a one size fits all approach if increased attention to preventative information is the desired outcome.
Keywords: health behaviours, health communication, health promotion
CORRESPONDING AUTHOR: Pedruzzi Rebecca, James Cook University, Townsville, rebecca.pedruzzi@my.jcu.edu.au
P682
USING HASHTAGS TO SPREAD HEALTH BEHAVIOR AMONG TWITTER USERS
Pagoto S., Whited M.
University of Massachusetts Medical School, Department of Medicine, Worcester, United States
Both healthy and unhealthy habits can spread through social networks. Online social networks may have a particularly high potential to spread health behavior given that two-thirds of internet users visit them regularly. Hashtags that encourage users to engage in a health behavior are appearing on Twitter. The purpose of this study is to report the activity of 7 healthy hashtags on Twitter as well as discuss the characteristics of hashtags that seemed to have higher dissemination potential.
Two healthy hashtags were started by company users (Runner’s World and The Today Show) and 5 were started by individual users. Runner’s World (182,000 followers) hosted #RWrunstreak which was a challenge to run/walk at least 1 mile per day from Thanksgiving to New Year’s Day in 2011. The challenge attracted ~614 users in 2 months and an average of 132 (SD = 42) tweets per day. The Today Show health correspondent, Joy Bauer (14,000 followers) started the #TodayJoyChallenge on January 1, 2012 which involved reporting weight loss progress throughout January. This challenge attracted 97 users in across 28 days and an average of 6 (sd = 5) tweets per day. #PlankADay, #TwitterRoadRace, #candyfree, and #31in31 were started by individual users (400-2,000 followers). #PlankADay was started by the first author and involves completing and tweeting an abdominal exercise each day. #PlankADay attracted 3,076 users in 10 months and an average of 302 (sd = 112) tweets per day. #Twitterroadrace involved a commitment to run a 5K on January 21, 2012 and April 28, 2012. It attracted 737 users over 94 days and an average of 38 (sd = 99) tweets per day. #Candyfree involved a commitment to give up candy for a self-assigned period of time. It attracted 44 users over 53 days (6/week) and an average of 4 (sd = 3) tweets per day. #31in31 involved completing 31 workouts in the 31 days of January. It attracted 32 users over 34 days and an average of 6 (sd = 3) tweets per day.
Health hashtags appear to have the potential to spread across users when initiated by either individual or company users. Some are time-limited, some are event-specific, while others are open-ended. Hashtags that involve reporting the completion of a health behavior (e.g., a run or a plank) had the most activity. Hashtags that involve reporting the absence of a behavior (i.e., #candyfree) or do not focus on a discrete behavior (#todayjoychallenge) had the least activity. Time-limited activities did not have fewer users than open-ended ones (p = .42). Frequency of tweets predicted total users (p < .001) but number of followers of the initiator did not (p = .93). The authors will discuss features of health hashtags that may promote dissemination.
Keywords: social network analysis, technology
CORRESPONDING AUTHOR: Pagoto Sherry, UMass Medical School, sherry.pagoto@umassmed.edu
P685
A CROSS-SECTIONAL STUDY OF THE PREVALENCE OF MULTIPLE RISK FACTORS FOR CARDIOVASCULAR DISEASE (CVD) IN OVERWEIGHT OR OBESE GENERAL PRACTICE PATIENTS.
Yoong S.1, Carey M.1, Sanson-Fisher R.1, D'Este C.2, Paul C.1, Inder K.3, Russell G.4, Meadows G.5
1 University of Newcastle, Behavioural Medicine, Newcastle, Australia
2 University of Newcastle, Biostatistics, Newcastle, Australia
3 University of Newcastle, Mental Health, Newcastle, Australia
4 Monash University, General Practice, Melbourne, Australia
5 Monash University, Primary Care and Population Health, Melbourne, Australia
Background: Cardiovascular disease (CVD) is a major cause of mortality and is associated with modifiable and non-modifiable risk factors. Those with multiple risk factors are at increased risk of developing CVD. There is limited data on the prevalence of multiple risk factors in those overweight or obese, particularly in the primary care setting. Given this, it is important to quantify the prevalence of multiple risk factors in overweight and obese primary care patients and determine whether body mass index (BMI) category is independently associated with increased risk factors.
Methods: This cross-sectional study was set in a random sample of general practices in three Australian cities from July 2010 to December 2011. Patients aged 18 years or older who consented to participating in the study completed a portable, touchscreen computer questionnaire, assessing self-reported weight, height and non-modifiable risk factors (age, sex, family history of heart disease, ethnicity, personal history of heart disease and stroke). Modifiable risk factors including metabolic (high blood pressure, high cholesterol and type 2 diabetes) and lifestyle (smoking, alcohol consumption and inadequate physical activity) were also reported. The proportion and 95% confidence interval (CI) of patients in each BMI category with zero, one, two or three or more risk factors were calculated. An adjusted multivariate Poisson regression was conducted in order to determine association between BMI and increased number of risk factors.
Results: 3,341 patients (86% consent rate) from 12 general practices participated. Those who were underweight were excluded, resulting in only 3,254 participants in the final analyses.31% [95% CI 27, 35] of obese patients had three or more risk factors compared to 19% [95% CI 17, 21] of overweight and 10% [95% CI 8.4, 13] of normal weight patients. Being obese increased the risk (IRR:1.6 [95% CI 1.5, 1.7]) of having multiple risk factors more than all the non-modifiable risk factors examined.
Conclusion: Overall, a significant proportion of those who are obese have three or more risk factors. This suggests that general practice is an important setting for care and management of metabolic and lifestyle risk factors, particularly in those obese.
Keywords: Primary care, obesity, risk factors
CORRESPONDING AUTHOR: Yoong Sze Lin, University of Newcastle, sze.yoong@newcastle.edu.au
P686
EXAMINING VAGALLY MEDIATED HEART RATE VARIABILITY DURING REST AS A MARKER OF REDUCED CARDIAC REACTIVITY TO PSYCHOLOGICAL STRESS
Verkuil B., Brosschot JF.
Leiden University, Institute of Psychology, Leiden, Netherlands
Being able to flexibly respond to changes in environmental demands is a characteristic of healthy organisms. According to the neurovisceral integration model of emotions (Thayer & Lane, 2000), individual differences in vagally mediated heart rate variability (HRV) during rest serve as a risk factor for inflexible, rigid autonomic responses during stressful situations. Yet, this hypothesis has only been tested in a limited set of studies. In the present experiment we tested whether low HRV levels during rest predicted diminished cardiac responses to stress in a young and healthy sample. Fifty-seven students were randomly allocated to a stress task (speech stress task) or a control condition. Results showed that heart rate (HR) increased and HRV decreased during the stress task. Diminished HR reactivity during the stress task was predicted by high body mass index but not by HRV during rest. Yet, low HRV during rest was associated with higher overall levels of HR. In addition, HRV reactivity was significantly predicted by resting levels of HRV. Whereas HRV significantly decreased during stress in participants high in resting HRV, HRV did not change during stress in participants that were low in resting HRV. These findings suggest that at least part of the autonomic response to psychological stress is due to individual differences in vagally mediated HRV.
Keywords: cardiovascular reactivity; personality; stress
CORRESPONDING AUTHOR: Verkuil Bart, Leiden University, bverkuil@fsw.leidenuniv.nl
P688
A BEHAVIORALLY-BASED MULTIDISCIPLINARY PROGRAM FOR PATIENTS WITH DIFFERENT NEUROLOGICAL AND ORTHOPEDIC DISEASES: CHANGES IN QUALITY OF LIFE AND MOOD.
Moroni L.1, Giorgetti G.2, Pedretti RFE.3, Bertolotti G.4
1 Salvatore Maugeri Foundation IRCCS, Psychology Unit, Tradate (VA), Italy
2 Salvatore Maugeri Foundation IRCCS, Division of Neurological and Motor Diseases, Tradate (VA), Italy
3 Maugeri Foundation, Division of Neurological and Motor Diseases, Tradate (VA), Italy
4 Salvatore Maugeri Foundation IRCCS, Health Director, Tradate (VA), Italy
Introduction: multidisciplinary interventions show several results in enhancing quality of life for patients with different diseases, such as cancer (Ames & coll., 2011), multiple sclerosis (Malcomson & coll., 2007), stroke (O’Connor & coll., 2005), musculoskeletal pain (Orenius & coll., 2012) or after a motor vehicle accident (Hall & coll., 2011). The McGill Quality of Life Questionnaire (MQOL; Cohen & coll., 1995) is considered the questionnaire to measure generic quality of life with the best clinimetric quality rating (Albers & coll., 2010). At this moment there are no studies that use the MQOL in neurological diseases such as stroke, brain injury or Parkinson disease, nor it is tested with an heterogeneous sample, nor there are studies about its responsiveness.
Aim: 1) to assess the efficacy of a behaviorally-based multidisciplinary program for patients with different neurological and orthopedic diseases based on a psychological support, a muscular relaxation training and an educational intervention combined with the usual rehabilitation training; 2) to check the use of MQOL with an heterogeneous sample and as an outcome measure.
Method: we enrolled 51 patients at the beginning of a day hospital rehabilitation period for a neurological disease (stroke, brain injury, Parkinson disease, polyneuropathy) or for an orthopedic disease (hip replacement, aftermath of fractures). They received the usual rehabilitation care combined with daily group sessions of progressive muscular relaxation training (Jacobson method) and of health education with a nurse, a dietitian or a CBT psychotherapist. They also received an individual psychological support tailored to their needs. All patients filled in the MQOL to measure quality of life and AD-R schedule to measure anxiety and depression at the beginning and the end of the multidisciplinary program. The physician completed the FIM scale at the same time.
Result: we observed a significant improvement in the mood of the patients (p = 0.005). The total perceived quality of life significantly increased at the end of the rehabilitation period (p = 0.014), and a part of the change is due to the improvement of the psychological symptoms subscale (p = 0.017). All patients completed the MQOL without difficulties and they follow the same program even if there were great difference in their diseases and in the FIM score at the beginning.
Conclusion: we presented a multidisciplinary program that could suit to different types of patients and could lead an improvement in quality of life and psychological status. The questionnaires we used appear good outcome measures.
Keywords: quality of life, multidisciplinary rehabilitation, neuromuscolar disorders
CORRESPONDING AUTHOR: Moroni Loretta, Salvatore Maugeri Foundation IRCCS, Tradate, loretta.moroni@fsm.it
P109
POST-TRAUMATIC STRESS DISORDER AFTER MYOCARDIAL INFARCTION: DOES HEALTH CARE COSTS MATTER?
Lachance Fiola J.1, Dupuis G.2, D'Antono B.3, White M.4
1 University of Montreal, Department of Nursing, Montreal, Canada
2 University of Quebec in Montreal, Psychology, Montreal, Canada
3 University of Montreal, Department of Psychiatry, Montreal, Canada
4 Montreal Heart Institute, Cardiology, Montreal, Canada
Objective: To determine health care costs associated with the presence of post MI PTSD symptoms as a function of 3 types of cardiovascular complications.
Method: 360 men et114 women recruited in two hospitals in the Montreal area, evaluated 2-5 days, and 3 month post MI. Information regarding the cumulative medical costs during the first year post MI were obtained from the Régie de l'assurance maladie du Québec. Three categories of cardiovascular complications were defined based on the medical record of the Department of Health and Social Services: ischemic complications (myocardial infarction, angina, etc.), cardiovascular complications/hypertension (high blood pressure, heart failure, etc.) and arrhythmia-related complications. Three factorial ANCOVAS were performed with PTSD as first independent variable and the following types of complications as second: A) cardiovascular complications all categories combined vs. no complications, B) arrhythmic complications vs. no complication, C) arrhythmic complications vs. other complications. The presence/absence of PTSD symptoms was defined on the basis of a clinical threshold on the Modified scale for PTSD symptoms.
Results: PTSD symptomatology interacts with arrhythmic complications post MI to reduce medical costs, independently of medical and sociodemographic factors for each of the three planned ANCOVAS: ANCOVA A: F = (1, 339) 7.20, p =. 008; ANCOVA B: F = 5.60 (1, 96), p =. 020; ANCOVA C: F = (1, 285) 6.87, p =. 009.
Conclusion: The lower medical costs incur by patients with post MI PTSD symptoms and arrhythmic complications may be due in part to avoidance behaviors consecutive to PTSD.
Keywords: Anxiety; Cardiovascular disease; Mental health; Stress
CORRESPONDING AUTHOR: Lachance Fiola Jacinthe, University of Montreal, Montreal, jacinthe.lachance.fiola@umontreal.ca
P689
EFFECTIVENESS OF GUIDED IMAGERY ON PAIN, ANXIETY, COPING AND ACTIVITIES OF ADOLESCENTS POST-SPINAL FUSION: A RANDOMIZED CLINICAL TRIAL
Charette S.1, Lachance Fiola J. 2, Le May S.2, Charest M-C.3, Villeneuve E.4, Farmer L.5, Joncas J.1, Parent S.6, Labelle H.6
1 Ste. Justine Hospital, Nursing, Montreal, Canada
2 University of Montreal, Department of Nursing Sciences, Montreal, Canada
3 Ste. Justine Hospital, Pain clinic, Montreal, Canada
4 Ste. Justine Hospital, Anesthesiology Department, Montreal, Canada
5 Ste. Justine Hospital, Physiotherapy Department, Montreal, Canada
6 Ste. Justine Hospital, Orthopedic Department /Research Unit, Montreal, Canada
Background: Several studies have shown that a spinal fusion is a distressing experience for adolescents. This type of surgery involves extensive surgical lesions that result in severe post-operative pain levels which can last several days after the surgery. For the past fifteen years, research on the effectiveness of relaxation with guided imagery has evolved significantly in the management of the acute postoperative pain, mainly in adults. Research has shown that these techniques used prior to surgery helps reduce the anxiety, may shorten the duration of hospital stay and reduce significantly the procedural and post-surgical pain, therefore reducing the need for analgesics. Very few studies have verified the effectiveness of guided imagery with adolescents during rehabilitation after a surgery.
Objectives: To develop and to verify the effectiveness of a home-based guided imagery and relaxation intervention combined to an educational intervention, on adolescent’s postoperative pain, anxiety and activities.
Method: Adolescents 11 to 20 years of age were assigned randomly to receive either standard medical care or the home-based guided intervention. The primary analysis was based on 40 participants, (n = 20; n = 20), comparing the two groups before the surgery, at discharge, two weeks and one month post-discharge.
Results: Intervention was significant in the experimental group regarding general pain intensity at discharge (t = -3.11, p = 0.004), two weeks (t = -3.60, p = 0.001) and one month (t = -2.87, p = 0,007),as for resuming of normal activities after 2 weeks: school or working activities (t = -3.01, p = 0,005), vital support activities (t = -3.40, p = 0,002) and capacity to walk (t = -3.04, p = 0,004). The experimental group also presented, after 2 weeks, a lower level of the most intense pain felt in the last 24 hours (t = -2.73, p = 0.01).
Discussion: Guided imagery and relaxation intervention combined to an educational intervention were more efficacious than standard care for the control of postoperative pain at discharge, two weeks and one month after being discharged home and seemed to have a positive effect on adolescents’ resuming some of their activities at home.
Keywords: Pain; Intervention; Adolescents
CORRESPONDING AUTHOR: Lachance Fiola Jacinthe, University of Montreal, Montreal, jacinthe.lachance.fiola@umontreal.ca
P690
ILLNESS COGNITIONS, HEALTH AND QUALITY OF LIFE IN CHRONIC PAIN PATIENTS
Meneses R.1, Matos A.1, Rebelo V.2
1 Universidade Fernando Pessoa, Faculdade de Ciências Humanas e Sociais, Porto, Portugal
2 Hospital de São João, Serviço de Psiquiatria - Unidade da Dor, Porto, Portugal
To help chronic pain patients cope with their pain, it is essential to know their views about their situation. The Illness Cognition Questionnaire (ICQ; Evers et al., 2001) may help health professionals in this endeavor. In fact, the ICQ assesses three ways of cognitively evaluating the stressful and aversive character of a chronic illness: helplessness, acceptance, and perceived benefits. The aim of the present study is to present the results obtained with the Portuguese version of the ICQ in a group of chronic pain patients.
A total of 70 chronic pain patients (50 women; age: M = 50.47, SD = 13.0, 20-77 years; schooling: M = 7.84, SD = 4.76; 0-17 years) answered to a socio-demographic and clinical questionnaire and to the ICQ.
The total ICQ Cronbach´s alpha = .68; the Helplessness a = .49; the Acceptance a = .90; and the Perceived benefits a = .91.
Helplessness correlated with satisfaction with health (r(70) = -.46, p < .0001), quality of life perception (r(70) = -.44, p < .0001), minimum pain experienced during the previous week (r(70) = .25, p < .03), and mean pain (r(70) = .31, p < .01). Acceptance correlated with satisfaction with health (r(70) = .42, p < .0001), and quality of life perception (r(70) = .34, p < .004). Perceived benefits correlated with satisfaction with health (r(70) = .37, p < .002), and quality of life perception (r(70) = .42, p < .0001).
These preliminary results question the internal consistency of the helplessness scale, while supporting the internal consistency of the other 2 scales. Therefore, more studies must be done with the Portuguese version of the ICQ. Additionally, the results suggest that the way patients evaluate their situation may impact on the satisfaction their experience regarding their health and their perceived quality of life. Consequently, helping patients perceive their situation differently may have a considerable effect on their satisfaction with health and quality of life.
Keywords: Cognitive factors; Pain
CORRESPONDING AUTHOR: Meneses Rute F., Univ. Fernando Pessoa, Porto, rmeneses@ufp.edu.pt
P691
SUBGROUPS OF PATIENTS WITH FIBROMYALGIA BASED ON THE MULTIDIMENSIONAL PAIN INVENTORY: DIFFERENCES IN CATASTROPHIZING.
López-Chicheri I., Aroca T., Luque EM., Torrijos MJ., Colodro H., Godoy-Izquierdo D., Godoy J F.
University of Granada, Department of Personality, Assessment and Psychological Treatment, Granada, Spain
Introduction: Multicomponent treatments for patients with fibromyalgia have generally been effective, but only for one third of the patients. Literature supports that inconsistent results are due to ignoring patient heterogeneity. Classification of patients into homogeneous subgroups, based on the Multidimensional Pain Inventory (MPI) responses, is the most useful strategy. On the other hand, there is increasing evidence about pain catastrophizing as an important risk factor for chronic pain and, specifically, for fibromyalgia.
Objectives: To replicate the psychosocial profiles derived from the MPI in patients with fibromyalgia and to describe the characteristics of the subgroups regarding pain catastrophizing.
Methods: Participants were 45 patients with fibromyalgia (93% women, age M = 51.03 (10.9) years; pain intensity M = 6.8 (2.14)) who fulfilled the Spanish versions of the West Haven-Yale Multidimensional Pain Inventory and the Pain Catastrophizing Scale in a broader assessment procedure.
Results: The expected three subgroups, previously reported by the literature, were identified: dysfunctional patients (37.5%), interpersonally distressed (27.5%), and adaptive copers (35%).
There were significant differences among the groups in pain catastrophizing and in rumination, magnification and helplessness. In general, the adaptive coper profile showed significantly higher scores on all the catastrophizing variables (all p-values < .05).
Discussion: These results highlight that there are specific characteristics on each MPI subgroup, so therapists should take them into account when designing a treatment strategy. Pain management programs should target pain catastrophizing, especially with dysfunctional patients.
Keywords: fibromyalgia; pain catastrophizing; Multidimensional Pain Inventory
CORRESPONDING AUTHOR: López-Chicheri Isabel, University of Granada, isabel.lopezchicheri@gmail.com
P692
DOES HEALTH ANXIETY EXIST WITHOUT SOMATIC SYMPTOMS? - AN EMPIRICAL EVALUATION OF THE CLASSIFICATION PROPOSALS FOR SEVERE HEALTH ANXIETY IN DSM-5
Gropalis M., Witthöft M.
University of Mainz, Department of Clinical Psychology and Psychotherapy, Mainz, Germany
Introduction: The central feature of hypochondriasis (HYP) is the fear or conviction to suffer from a serious, undiagnosed disease. According to DSM-IV, this fear or conviction is necessarily based on the misinterpretation of somatic sensations. There is clinical evidence that this mandatory presence of physical symptoms in HYP is questionable. To take account of this shortcoming, DSM-5 proposes two diagnoses related to health anxiety: the complex somatic symptom disorder with predominant health anxiety that requires at least one distressing somatic symptom, and the illness anxiety disorder that should be diagnosed if somatic symptoms are not present or only mild in intensity. Our study aimed at empirically testing the existence of these two variants of health anxiety. Method: First, 134 patients with HYP according to DSM-IV were evaluated concerning somatoform symptoms with the SOMS-7. Based on the degree of impairment three groups were defined with low, modest, and high levels of somatoform symptoms. Second, the groups were compared concerning different aspects of health anxiety. The Multidimensional Inventory of Hypochondriacal Traits (MIHT) was used to assess cognitive, affective, perceptual, and behavioral hypochondriacal traits, and the Illness Attitude Scales (IAS) to assess health anxiety and illness behavior.
Results: 26 patients were categorized as low somatizers (SOMS severity index [SSI] M = 10.7, SD = 6.5), and could be classified as illness anxious according to DSM-5. 55 patients were categorized as modest (SSI M = 21.5, SD = 8.8), and 53 as high somatizers (SSI M = 47.9, SD = 22.0). Low somatizers revealed the lowest values on each of the MIHT, and IAS subscales and differed from the high somatizers regarding the MIHT behavioral (d = 0.85), cognitive (d = 0.97), perceptual (d = 0.88), and IAS health anxiety (d = 1.02), and illness behavior subscale (d = 1.07). There were no differences between the low and modest somatizers (d = 0.10-0.54).
Discussion: In accordance with the DSM-5 proposal, we found empirical evidence for two distinguishable groups of health anxious patients with and without physical complaints. Yet, the categorization of the Illness anxiety disorder to the somatic symptoms disorders seems unfavorable, and to be better suited to the anxiety disorders.
Keywords: health anxiety, classification
CORRESPONDING AUTHOR: Gropalis Maria, University of Mainz, Mainz, gropali@uni-mainz.de
P693
THE PREVALENCE OF SYMPTOMS OF SCOTOPIC SENSITIVITY SYNDROME/MEARES-IRLEN SYNDROME IN SUBJECTS DIAGNOSED WITH CHRONIC FATIGUE SYNDROME
Loew S., Watson K.
The University of New England, Science and Technology, Armidale, Australia
Several diagnostic symptoms of the visual-perception disorder scotopic sensitivity syndrome (SSS), also known as Meares-Irlen syndrome, are remarkably similar to the visual-symptom manifestations reported by individuals with chronic fatigue syndrome (CFS). Previous research has shown that the incidence of SSS comorbidity in subjects diagnosed with CFS is exceptionally high. We surveyed the incidences of nine widely-recognised symptoms of SSS in 20 subjects who had previously been diagnosed with CFS by a medical practitioner. The prevalence of each SSS symptom in the CFS group was compared to a group of age and sex-matched controls (n = 46), and also to a second group comprised of individuals (n = 18) diagnosed with the SSS disorder itself. The prevalence of SSS symptoms in the CFS-diagnosed group (frequency: 0.50 - 0.85; m = 0.62) was significantly higher than that of the control group (frequency: 0.02 - 0.26; m = .09). In contrast, our data revealed a remarkable lack of significant variations between the CFS-diagnosed and SSS-diagnosed groups. The degree of symptom overlap between the CFS and SSS disorders may thus be far stronger than previously reported and the preliminary evidence further suggests that individuals with SSS may be at increased risk of developing chronic fatigue syndrome.
Keywords: chronic fatigue syndrome; scotopic sensitivity syndrome; Meares-Irlen syndrome; learning disorders; misdiagnosis
CORRESPONDING AUTHOR: Watson Kenneth, Uni New England, Armidale, kwatson2@une.edu.au
P694
MODULATING THE IMPLICIT HEALTH-RELATED SELF-CONCEPT IN SOMATOFORM DISORDERS
Riebel K.1, Egloff B.2, Witthöft M.1
1 University of Mainz, Clinical Psychology and Psychotherapy, Mainz, Germany
2 University of Mainz, Personality and Psychological Assessment, Mainz, Germany
Objective: Cognitive processes play an important role in the pathogenesis of somatoform disorders (SFD). We recently demonstrated that the implicit self-concept of patients with SFD is significantly more connected to the concept “illness” than the self-concept of a healthy control group who showed self-associations closer to “physical well-being”. The present study examines whether this illness-related self-concept can be experimentally manipulated and if this has a positive influence on number and severity of bodily symptoms.
Method: To modify the illness-related implicit self-concept in patients with SFD, an evaluative conditioning task was developed. Participants were repeatedly presented with trials in which self-related pronouns were paired with health-related words, and neutral words were paired with illness-related words. Based on these stimulus contingencies we intended to foster a stronger association of the self-concept with healthiness. We compared 29 patients diagnosed with SFD (according to DSM-IV) that underwent the evaluative conditioning task, with a matched control group of 22 patients with SFD that did not receive the training. To measure possible changes in the health-related self-concept, all participants completed an implicit association test (IAT) before and after the training or the waiting period.
Results: The results showed that the implicit self-concept of the patients that received the evaluative conditioning showed a significantly stronger connection with healthiness (F(1,28) = 4.8, p = .036). Furthermore, they reported significantly less bodily symptoms after the evaluative conditioning than before (F(1,28) = 10.3, p = .003).
Discussion: The present study provides evidence for the malleability of the implicit health-related self-concept through evaluative conditioning in patients with SFD. The modification of this cognitive variable had a positive influence on the number and severity of bodily symptoms encountered. These findings could therefore stimulate new ideas for treatments of SFD, which would not restrain to the modulation of explicit self-concepts – the main domain of cognitive behavioral therapy – but could directly address implicit representations of the self, which often persist even though the explicit cognitions are already transformed.
Keywords: Somatoform disorders, implicit self-concept, modification, evaluative conditioning
CORRESPONDING AUTHOR: Riebel Kathrin, University of Mainz, Mainz, kathrin.riebel@gmail.com
P695
AUTONOMIC FUNCTION CHANGES IN ANOREXIA NERVOSA PATIENTS WITH THEIR BODY WEIGHT GAIN
Takimoto Y.1, Moriya M.1, Yoshiuchi Y.1, Hayano J.2, Akabayashi A.1
1 The University of Tokyo Graduate School of Medicine, Department of Psychosomatic Medicine, Tokyo, Japan
2 Nagoya City University Graduate School of Medical Sciences, Department of Internal Medicine and Pathophysiology, Nagoya, Japan
Background: Anorexia Nervosa (AN) is known to have autonomic dysfunction of the cardiovascular system, which is most likely associated with lethal arrhythmia causing sudden death. We previously investigated heart rate variability (HRV) –based evaluation of resting-state cardiovascular autonomic function in AN patients. As a result, sympathetic hypofunction and parasympathetic hyperactivity were noted in AN patients. In this study, we measured pulse rate variability (PRV) during sleep time, and compared the changes in indices of autonomic function between before and after the hospitalization therapy, in order to investigate the effect of malnutrition on autonomic function in AN patients.
Method: The subjects were 17 female AN inpatients at the department of psychosomatic medicine of the University of Tokyo Hospital. Pulse rate data were collected during sleep time before and after the hospitalization therapy. In the frequency analysis, the powers of low frequency (LF) and high frequency (HF) components were calculated by the complex demodulation method.
Results: Body mass index (BMI) significantly gained after hospitalization therapy (14.3 ± 2.0, 14.9 ± 1.9, p < 0.001). Pulse rate was significantly greater after the hospitalization (48.8 ± 8.4, 53.9 ± 9.9, p = 0.001). HF was significantly smaller after the hospitalization therapy (45.5 ± 16.4, 39.9 ± 14.6, p = 0.015), although there were no significant differences in LF/HF (0.66 ± 0.17, 0.69 ± 0.21, p = 0.193).
Conclusions: Parasympathetic hyperactivity in AN patients had tendency to improve with their increase in BMI.
Keywords: autonomic function, pulse rate variability, anorexia nervosa
CORRESPONDING AUTHOR: Takimoto Yoshiyuki, The University of Tokyo, Tokyo, taki-tky@umin.ac.jp
P696
ILLNESS PERCEPTIONS PREDICT INTEREST IN DRUG-FREE INSOMNIA TREATMENT
Zuo L., Owens G.
University of Auckland, Psychology, Auckland, New Zealand
Although insomnia is the most common sleep problem encountered in primary care, it is often under-recognised and under-treated. It is unclear to what extent patients may avoid seeking treatment because of concerns about the types of medications used. In an attempt to identify factors which predict and determine interest in drug-free treatments 269 primary care patients (a subset of participants involved in a larger study) who were identified as suffering from insomnia completed a number of measures relating to their insomnia, their perceptions of the insomnia (using the brief IPQ) and possible remedies. Other measures included the brief PHQ and the GAD-7.
After excluding respondents with self-reported drug and alcohol abuse, and those whose problem had a duration of less than four weeks, 234 respondents remained. Hierarchical stepwise logistical analysis of the data indicated that after controlling for sleep-related and psychological factors, interest in drug-free treatment was predicted by treatment control and internal causal attributions, as well as by depression. The findings are relevant not only in terms of helping in determining insomnia treatments but also in illustrating the way that self-regulation theory and the commonsense model may help in understanding how patients arrive at their preferences for particular approaches to treatment more generally.
Keywords: Sleep disorders, treatment
CORRESPONDING AUTHOR: Owens Richard Glynn, Auckland University, Auckland, g.owens@auckland.ac.nz
P697
UNDERSTANDING THE BEHAVIORS THAT CAN INTERFERE WITH SLEEP
Loft M.1, Cameron L.2
1 Monash University, Jeffrey Cheah School of Medicine and Health Sciences, Kuala Lumpur, Malaysia
2 University of California, Merced, School of Social Sciences, Humanities and Arts, Merced, USA
Background: Many working adults suffer from significant and persistent sleep deprivation. Sleep deprivation can increase risk for a variety of illnesses through its detrimental impact on physiological and immune function as well as diet and exercise behaviors. In this study, we explored how tendencies to choose specific evening activities may undermine sleep self-regulation processes. A new measure, the Sleep-Relevant Cognitions Test (SRCT) was utilized, which provides qualitative and quantitative data about behavioral tendencies surrounding sleep-related decisions. Respondents imagine a scenario in which they are at home in the early evening and face urgent and non-urgent work demands the following day. They then fill in half-hour slots with behaviors that they are likely to engage in under this situation. Method: Daytime employees meeting criteria for sleep deprivation, with Pittsburgh Sleep Quality Index (PSQI) scores > 5, were recruited. Their mean age was 37 years (SD 10.56, range 21 to 62); the majority were female (n = 66, 63.5%). Participants completed the SRCT and the PSQI. Data were analyzed using behaviors coded from the SRCT being entered as independent variables. Behaviors included watching television, using the computer, working on urgent (deadline orientated) work-related tasks, and non-urgent work tasks. The subscales of sleep quality, sleep duration, sleep latency, sleep efficiency, medication use, sleep disturbances and daytime dysfunction from the PSQI were also analysed as dependent variables. Results: Watching television and using the computer predicted poorer sleep patterns. Watching television predicted summary PSQI scores indicating greater sleep difficulty (F(1, 100) = 3.53, p < .01) shorter sleep duration (F(1, 100) = 2.17, p < .05). and poorer sleep quality (F(1, 100) = 2.86, p < .01). Computer use also predicted higher summary PSQI scores (F(1, 100) = 2.79, p < .05) and sleep disturbance (F(1, 100) = 2.64, p < .05). Interestingly, choosing to work on the non-urgent work tasks predicted higher summary PSQI scores (F(1, 100) = 2.21, p < .05), whereas applying oneself to the urgent work task did not predict any sleep-related variables. Conclusions: The SRCT provides insights into behavior choice tendencies that contribute to poor sleep patterns, so can guide education and self-regulation campaigns targeting sleep hygiene.
Keywords: sleep disorders, risk factors
CORRESPONDING AUTHOR: Loft Marisa, Monash University, Malaysia, marisa.loft@monash.edu
698
KNOWLEDGE OF HEALTHY SLEEP BEHAVIOURS - DOES IT HELP SLEEP?
Voinescu BI.1, Szentagotai A.2
1 Babes Bolyai, Department of Clinical Psychology and Psychotherapy, Cluj-Napoca, Romania
2 Babes Bolyai, Department of Psychology, Cluj-Napoca, Romania
Introduction: Poor sleep hygiene is a risk factor for poor sleep quality and chronic insomnia and its improvement is one of the main components in the cognitive-behavioural therapy for insomnia.
Objectives: To measure the knowledge on healthy/unhealthy sleep behaviours and the self-reported sleep quality in individuals suspected of chronic insomnia compared to those that report a healthy sleep.
Methods: Three hundred nine adults aged 18-83 (mean age 32.0, standard deviation 12.9), most of them women (N = 236, 77%), were recruited via online adverts and invited to fill in a battery of tests consisting in the Romanian translations of the Sleep Condition Indicator (SCI), Sleep Disorders Questionnaire (SDQ) and Sleep Beliefs Scale (SBS). The survey was hosted on Surveygizmo.
Results: Based on SDQ responses, we identified 124 individuals complaining of chronic insomnia symptoms. They showed better sleep knowledge as they scored significantly higher (p = 0.02) in SBS (13.3 ± 2.9) compared to those reporting sound sleep (12.4 ± 3.2). Most participants (80%), either having a sleep problem or not, failed to identify going out of bed when unable to sleep as having a positive effect on sleep and sleeping more after a night of poor sleep as having a negative effect. Compared to women, men revealed significantly poorer sleep knowledge, both in the whole sample (11.8 ± 3.5 vs. 13.0 ± 2.8, p = 0.003), "sound sleep" sample (11.4 ± 3.5 vs. 12.8 ± 3.0, p = 0.014) and insomnia one (12.4 ± 3.4 vs.13.5 ± 2.6, n.s.). They also failed to identify eating late (p = 0.001), working late (p = 0.02) and smoking before going to bed (p = 0.04) as being detractors for sleep. Quality of sleep was not associated with sleep knowledge, either in the whole sample or when divided by insomnia complaints. In men, poor sleep was linked with poor sleep knowledge (r = 0.269, p = 0.02).
Conclusions: Knowledge of healthy/unhealthy sleep behaviours was rather modest in our sample, despite higher education, and was better in those reporting chronic poor sleep, as well as in women.
Keywords: sleep disorders, web-based
CORRESPONDING AUTHOR: Voinescu Bogdan, Babes-Bolyai University, bogdan.voinescu@ubbcluj.ro
P699
RELATIONSHIP BETWEEN SLEEP PARAMETERS AND LUNAR PHASES
Turányi CS.
Semmelweis University Budapest, Institute of Behavioural Sciences, Budapest, Hungary
Objectives: There are few and contradicting results regarding the association between lunar phase and sleep, and popular belief holds that the lunar cycle affects human physiology, behavior and health. Our aim was to examine the relation between lunar phases and sleep characteristics.
Methods: Data from 478 patients were analyzed in a cross-sectional survey, all patients had a kind of sleep disorder, but we excluded patients with apnea-hypopnea index ≥ 15/h. Socio-demographic parameters were recorded. Data were analyzed using ANCOVA and K independent (Kruskal-Wallis) tests. All participants underwent one-night standard polysomnography, bedrooms had no window.
Results: 57% of patients were males, mean age for men was 45 ± 14 years and 52 ± 12 years for women. Mean sleep efficiency was 78,2%. 364 persons slept during changing moon, 57 during full moon and 57 during new moon, there were no significant differences regarding age and gender between groups. Among women full moon phase was associated with lower sleep efficiency (p = .01), shorter sleep duration (p = .01) and REM duration (p = .005) after adjustment for age. Self-reported fatigue in the morning (p = .05) and self-reported time of falling asleep was higher during full moon (p = .04). Among men the sleep duration was significantly shorter at full moon (p = .05), while other sleep variables showed no difference across moon phases.
Conclusion: Our results support the widely held belief that sleep characteristics may vary with the moon phase, especially among women.
Keywords: sleep, fatigue
CORRESPONDING AUTHOR: Turányi Csilla Zita, Semmelweis University, Budapest, csillagfenyo@gmail.com
P700
THE ASSOCIATION OF SLEEPING HOURS ON PSYCHOBIOLOGICAL STRESS RESPONSIVENESS
Okamura H.1, Tsuda A.2, Yajima J.3
1 Kurume University, Cognitive and Molecular Institute of Brain Diseases, Kurume, Japan
2 Kurume University, Departament of Psychology, Kurume, Japan
3 Beppu University, Department of Human Studies, Beppu, Japan
Background: Sleep problems are associated with the cognitive function, chronic illness and reduced mental health and premature mortality. Sleeping less or more than 6-8 hours day is associated with an increased risk of coronary heart disease, hypertension, and diabetes. However, compared to the number of epidemiological studies, few have examined relationship between self-reported sleeping time and psychobiological stress responses during mental stress testing. The aim of this study was to assess the relationship between the number of hours sleep, psychobiological stress responses [3-Methoxy-4-hydroxyphenylglycol (MHPG) and Secretory immunoglobulin A (IgA), perceived stress responses] and performance during mental stress testing.
Methods: Seventy healthy men and women were recruited, and participants were divided according to the habitual number of hours of sleep as follows: adequate sleepers (AS) (N = 30), short sleepers (SS) (N = 25) and long sleepers (LS)(15). The experimental session had three parts; a baseline period of 15 minutes, a 9 minutes task period and a post task period of 15 minutes. The participants were invited to relax during the baseline and post-task periods. Each period was followed by saliva sampling and mood assessments.
Results: An increase in free-MHPG during the task period was observed in AS although free-MHPG increased only after the task period in SS. The level of s-IgA in both groups significantly increased during the task period, and quickly returned to a basal level during the recovery period. However, free-MHPG and s-IgA in LS group did not change by mental stress testing.
Discussion: These results indicated that psychobiological responsiveness to acute stress is different by habitual sleeping time. In addition, less than 5 h and more than 8h of sleep is associated with different responsiveness to the Stroop color word conflict task compared to sufficient sleep, especially in the NA system.
Keywords: psychoneuroimmunology, psychophysiology
CORRESPONDING AUTHOR: Hisayoshi Okamura, Kurume University, Fukuoka, okamura_hisayoshi@med.kurume-u.ac.jp
P701
VULNERABILITY TO STRESS IN PATIENTS IN THE PRE-SURGERY PHASE
Cunha M., Nisa T., Dias A., Chaves C.
Instituto Politécnico de Viseu, School of Health, Viseu, Portugal
The patients’ vulnerability to stress in the pre-operative is assumed as determinants of well-being and pre-operative visit as an important protector of the nosological entity occurrence. In this context, we studied the stress vulnerability in pre-surgery patients with the aim of:
- Explain the influence of socio-demographic variables in the patient stress;
- Infer the influence of pre-operative visit in the vulnerability of patients stress;
The transversal observational study was conducted in a non-probabilistic sample of 180 pre-surgical patients (55.6% women and 44.4% men) with mean age of 57.25 years, using the Vulnerability to Stress Scale - 23 QVS
There are 55.6% patients vulnerable to stress and 44.4% not vulnerable. Vulnerability to stress is higher in men (57.5%) than women (54%), individuals living alone (H = 16,349, p =. 000) in the less instructed (H = 18,023, p =. 003 ) those living in rural areas (U = 301.0, Z = -2,336, p =. 020) and older (r =. 287, p =. 000). Age explains 8.2% of the variability in vulnerability to stress and its also independent of the pre-operative visit, (U = 3452.0, p =. 186).
It was found that age, education and cultural background, influence vulnerability to stress, being consider them when planning good practice in health care of pre-surgery patients.
Keywords: Stress patients surgery
CORRESPONDING AUTHOR: Cunha Madalena, Polytechnic Institute of Viseu, madac@iol.pt
P702
IMPACT OF BIOFEEDBACK AND PROGRESSIVE MUSCLE RELAXATION IN REDUCTION OF PHYSIOLOGICAL STRESS VARIABLES IN MORE EXPRESSED DEPRESSION GROUP OF STUDENTS
Peciuliene I., Perminas A.
Vytautas Magnus University, Department of Psychology, Kaunas, Lithuania
Stress is a general term which describes physiological state and emotional reaction in relation with physical or perceived threat to bodily homeostasis (Johnson, 1992). Stress diminishes the quality of life, increases morbidity of anxiety and depression, affects interpersonal problems and increases the use of health care services. (Catala, 2002, Moulinet, 2002). Depression could be one of psychological stress components having a big impact on life quality (Brosschot, 2006). Modern science of psychology offers a wide range of relaxation methods and techniques to reduce psychological stress. Efficiency of wide range of stress coping techniques and combinations was investigated (McCubbin, 1996, Sinha, 2007), but the majority of the authors of the studies carried out with clinical groups of individuals (Yu, 2006, Barton, 2001, Hawkins, 2003), but studies analysing healthy and young people are rare (Matsumoto, 2001). Studying of relaxation intervention or regular relaxation techniques can counteract the negative effects of stress, restoring the human body to homeostasis balance (Wimbush, 2000).
Study objective: to evaluate the progressing muscle (PMR) and biofeedback (BFR) relaxations capabilities by reducing the variables of physiological tension such as galvanic skin response, skin temperature, heart rate and respiratory rate in more expressed depressed student group.
Methods: 90 students aged 18-30 years old (71 women, 19 men) from Vytautas Magnus University where examined using biofeedback device Nexus - 10, produced by Mind Media (Netherlands). Special sensors were attached to the patients chest, hands. Depression was measured using Zung Depression Scale (SDS) (Zung, 1976). Subjects were divided into 3 groups: PMR (n = 30), the BFR (n = 29) and comparative (n = 31). Four relaxation sessions for subjects in the relaxation groups were held weekly, and comparison group participants were not conducted in relaxation. The experimental group’s participants had a total of 6 meetings, and comparison group participants - 2 meetings.
The results and conclusions. The results showed that skin temperature increased for more depressed subjects, who were applied BFR sessions. Rates of skin temperature significantly increased and rates of galvanic skin response, respiratory rates decreased for more depressed subjects, who were applied PMR sessions in comparison with the rates before relaxation training. The change in these variables shows that subjects learned to relax more and their physiological tension variables decreased within 4 weeks. PMR is more effective in reducing the psychophysiological stress variables in more depression expressed student group.
Keywords: depression, relaxation
CORRESPONDING AUTHOR: Peciuliene Ieva, V.Magnus University, Lithuania, i.peciuliene@smf.vdu.lt
P703
OBSTACLES TO MANAGING STRESS: DEVELOPMENT OF A MEASURE TO ASSESS STRESS UNDERESTIMATION BELIEF
Izawa S.1, Nakamura N.2, Yamada H.3, Yamada K.4, Haratani T.1
1 National Institute of Occupational Safety and Health, Health Administration and Psychosocial Factor Research Group, Kawasaki, Japan
2 Hyogo University of Teacher Education, Center for Research on Human Development and Clinical Psychology, Kato, Japan
3 Japan Research Promotion Society for Cardiovascular Disease, Sakakibara Heart Institute, Fuchu, Japan
4 Saga University, Faculty of Medicine, Saga, Japan
Stress estimation is expected to be involved in the production of stress management behavior, and excessive stress underestimation could hinder efforts to adequately manage stress. The aim of this study was to develop a measure to assess stress underestimation belief and to examine the validity of the measure. Questionnaire surveys were conducted twice on 2,340 adults aged from 20 to 65 years via mail. The data from the surveys were subject to factor analysis, and we had finally developed a 12-item measure to assess stress underestimation belief (SUB) that included four subscales: “Excessive self-efficacy for managing stress,” “Insensitivity to stress,” “Overgeneralization of stress,” and “Evasive attitude towards stress.” The SUB had adequate internal consistency, and multiple group confirmatory factor analysis provided support for a 4-factor structure across gender. Higher SUB scores were associated with being in the precontemplation stage of change in terms of stress management behaviors, working long overtime hours (more than 81 hours per month), and having fewer self-reported stress symptoms. The SUB is potentially useful in assessing stress underestimation in the context of stress management.
Keywords: Stress, Beliefs
CORRESPONDING AUTHOR: Izawa Shuhei, JNIOSH, Kawasaki, izawa0810@gmail.com
P704
EFFECTIVENESS OF ACCEPTANCE-COMMITMENT THERAPY ON THE REDUCTION OF ANXIETY AND DEPRESSION AND DYSFUNCTIONAL ATTITUDES IN MOTHERS OF PREMATURE INFANTS
Kooshki SH.1, Harati R.2
1 Islamic Azad University of Central Tehran Branch, Psychology, Tehran, Iran
2 Academy of Medical Sciences, Pediatrics, Tehran, Iran
The purpose of present study was to examine the effectiveness of acceptance -commitment therapy in decreasing anxiety and depression and dysfunctional attitudes. A sample of 217 mothers of premature infants as voluntary sampling completed Beck's anxiety inventory (1988) and Beck's depression inventory (1961) from two hospitals in Tehran (Nikan and Milad). Based on the highest scores and on diagnosis and statistical manual of mental disorders, 60 mothers were randomly assigned to an experimental and waiting list groups equally. The experimental group received 12 sessions (1 hour a session, twice a week). Both groups were assessed by using Beck's Anxiety Inventory (1988) and Beck's Depression Inventory (1961) and Beck and Viysman dysfunctional attitudes (1978) as pre-post and follow-up tests. The results of repeated measures analysis indicated that treatment was effective. Implications for prevention and treatment of early onset of anxiety and depression and dysfunctional attitudes were discussed. Findings suggested that ACT in hospital's patients, especially in women could result in decreasing depression, anxiety and dysfunctional attitude by providing the ability to understand self and others.
Keywords: acceptance- commitment therapy, anxiety, depression, dysfunctional attitudes, premature infants,
CORRESPONDING AUTHOR: Kooshki Shirin, Islamic Azad University Tehran, shirin_kooshki@yahoo.com
P705
THE RELATIONSHIP BETWEEN SUBJECTIVE HAPPINESS AND PSYCHOBIOLOGICAL STRESS RESPONSE ON MENTAL STRESS TESTING
Yajima J.1, Tsuda A.2, Okamura H.3, Toyama H.4, Onoda A.4
1 Beppu University, Department of Human Studies, Beppu, Japan
2 Kurume University, Department of Psychology, Kurume, Japan
3 Kurume University, Cognitive and Molecular Institute of Brain Diseases, Kurume, Japan
4 Beppu University, Graduate school of clinical psychology, Beppu, Japan
Purpose: We have clarified that the health state and the daily stress influence the psychobiological stress response. This study investigated the relationship between the psychobiological stress response induced by mental stress testing and Happiness using the experimental-field study paradigm.
Method: Participants were healthy 77 volunteers (20.1 ± 1.3 years old). Subjective happiness was evaluated by Subjective Happiness Scale (SHS) and participants were classified into high (more than 4.5) (n = 41) or low happiness groups (less than 4.5) (n = 36). Participants took 10 minutes rest in an armchair prior to the stress session, and were exposed for 10 minutes mental stress testing (speech task and arithmetic task). After the task period, participants rested quietly for the 30 minutes of the recovery period. Cardiovascular measurements (Heart rate, High Frequency (HF) and LF/HF ratio) were continuously assessed during the experiment session. Before and after the task period and after the recovery period, saliva was collected and the participants were asked to the subjective stress response (Dundee Stress State Questionnaire-3).
Results: The levels of heart rate, LH/HF ratio, salivary free-MHPG, s-IgA and cortisol in all participants were increased by mental stress testing, and quickly return to the basal levels during the recovery period. In addition, negative affect such as the energetic arousal, the task engagement, the distress, and the worry increased by mental stress testing. Heart rate in the high happiness group was lower than that in the low happiness group during the experimental session. Energetic arousal in the high happiness group was higher than in the low happiness group on the pre-stress and the recovery period. On the other hands, the distress in the high happiness group was lower than the low happiness group during the pre-stress period.
Discussion: These results indicated that subjective happiness might be buffered psychobiological stress responses under the acute stress situation, namely, the happiness person gets the feeling of a weak psychological demand, and this influences the heart rate in the daily stressful situation.
Keywords: Stress, Psychophysiology, happiness, mental stress testing, psychobiological stress response
CORRESPONDING AUTHOR: YAJIMA Jumpei, Beppu University, Beppu, yajima@mc.beppu-u.ac.jp
P706
POSITIVE AFFECT IN INTIMATE RELATIONSHIPS IS ASSOCIATED WITH ELEVATED HEART RATE VARIABILITY IN EVERYDAY LIFE
Schwerdtfeger A., Gerteis A K.
Karl-Franzens-University Graz, Department of Psychology, Graz, Austria
Objective: Social support and social interaction have been discussed to positively impact health. The same is ascribed to positive affective states. However, the interaction of both psychosocial resource variables has rarely been examined to date. The major goal of this study was to examine the combined impact of various types of social interaction and positive affect on vagally mediated heart rate variability (HRV) in everyday life using ambulatory monitoring technology.
Method: The sample consisted of 41 healthy participants (54% female, 46% male, mean age 24.7 years). Ambulatory HRV, respiration, body movements, and body position were measured continuously on 3 consecutive weekdays. Social, situational and affective characteristics were assessed using a computerized diary, which randomly requested a voluntary assessment (every 50-80 minutes each day). Various types of social interactions were monitored (being alone, with colleagues, with intimate others, with indifferent others). Multilevel regression models were analyzed, controlling for biobehavioral covariates like breathing, body position and body movement.
Results and conclusion: We found that positive affect was unrelated to HRV across the three recording days. Unlike previous evidence, social interaction was also not reliably associated with HRV (p > .10). However, there was a significant interaction of positive affect and type of social interaction (p < .001). This effect suggested that intimate relationships, which were accompanied by positive affect were associated with elevated HRV in everyday life. Conversely, when these interactions were accompanied by negative affective states (e.g., ruminative thoughts), HRV was marginally significantly attenuated (p = .06). Together these findings suggest that interactions of psychological and social variables have to be considered to evaluate beneficial or adverse effects on the cardiovascular system.
Keywords: Ambulatory monitoring, Mood, Psychophysiology, Social support
CORRESPONDING AUTHOR: Schwerdtfeger Andreas, Karl-Franzens-University Graz, andreas.schwerdtfeger@uni-graz.at
P707
EPIGENETIC ASSOCIATIONS: CELLULAR AGING ASSOCIATED WITH RELIGIOUSNESS, SPIRITUALITY AND MEANING IN LIFE
Salavecz GY.1, Kopp M.1, Balog P.1, Purebl GY.1, Túry F.1, Pállinger É.2, Falus A.2
1 Semmelweis University, Institute of Behavioral Sciences, Budapest, Hungary
2 Semmelweis University, Department of Genetics, Cell- and Immunobiology, Budapest, Hungary
Background: Telomere length and rate of telomere shortening are indicators of mitotic cell age. Telomere shortness in humans is a prognostic marker of disease risk, progression, and premature mortality.
Aim of the study: We conducted a pilot study to investigate the psychosocial determinants of celullar aging. In this study we focused on religiousness, spirituality and life meaning.
Sample:40 full time working women (n = 20) and men (n = 20) participated in our study. The age range was between 40 and 70.
Methods: Telomere length was determined in peripheral blood mononuclear cells (PBMCs). Telomere PNA Kit/FITC for Flow Cytometry was used for detection of the telomeric sequences which allows the estimation of the telomere length. Religiousness and spirituality dimensions were assessed by four items derived from the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS). We used the eight-item version of the Brief Stress and Coping Inventory’s Life Meaning Subscale (BSCI-LM) to measure person’s sense that life is meaningful. Organizational religiousness was assessed by two separate items measured by the frequency of religious service attendance and the form of religious practice. We used partial correlation analyses to determine the association of psychosocial variables and telomere length. Age and gender was used as covariates.
Results: Religiousness and spirituality assessed by BMMRS positively associated with telomere length (r = 0.34; p = 0.03). A moderate positive relationship was found between meaning in life measured by BSCI-LM and the indicator of cellular age (r = 0.42; p = 0.01). Those who attended religious services more frequently, had longer telomere (r = 0.37; p = 0.02). The form of the religious practice also significantly associated with telomere length (r = 0.41; p = 0.01).
Conclusions: This pilot study showed that there were associations between cellular age and religiousness, spirituality and meaning in life, independently from age and gender. The results suggest that these psychosocial factors have protective role to avoid early health deterioration and premature mortality. Since the sample was small, further investigations on larger representative samples are needed to confirm the findings of this study.
Keywords: Religion/Spirituality, Genetics
CORRESPONDING AUTHOR: Salavecz Gyongyver, Semmelweis University, Budapest, salavecz@gmail.com
P708
DECISION MAKING AND REACTIVE AGGRESSION IN AN ADOLESCENT CLINICAL SAMPLE
Áspán N.1, Nagy P.1, Szabados B.2, Szabó A.3, Vida P.3, Preisz L.3, Horváth L.3, Halász J.1, Gádoros J.1
1 Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Child and Adolescent Psychiatry, Budapest, Hungary
2 Semmelweis University Budapest, Faculty of General Medicine, Budapest, Hungary
3 Eötvös Loránd University Budapest, Faculty of Psychology Sciences, Budapest, Hungary
Objective: IOWA Gambling Task (IGT) is widely used to assess orbitofrontal functional changes correlated with emotional decision making. Antisocial personality is markedly associated with bad IGT outcome measures. The relationship with the type of aggressive behavior and IGT performance was not studied directly so far, albeit both reactive and proactive aggression related problems are important in understanding antisocial personality related psychopathology. To our best knowledge, adolescent data are completely lacking in this respect.
Methods: A mixed clinical population of adolescents (N = 68, mean age: 13.6 ± 0.2 years, 45/23 male/female) admitted to the Vadaskert Hospital were involved in the study. The Reactive Proactive Aggression Questionnaire was used to assess the level and the type of aggressive behavior. Decision making was assessed by the IGT, while Raven IQ measures were also performed.
Results: Irrespective form age, Raven IQ, and gender, adolescents with high reactive aggression compared to adolescents with low reactive scores showed a significant impairment (p < 0.05) in IGT outcome measures (number of beneficial strategic responses and overall money), and were unable to learn adaptive responses during task. Adolescents with high reactive aggression showed higher proactive aggressive scores, compared to adolescents with low reactive aggression, but IGT outcome measures were driven exclusively by reactive and not proactive aggressive behavior.
Conclusions: Our data indicate a direct relationship between reactive aggression and orbitofrontal functioning, at least at the level of interpretation in the IGT test, and uncover important determinants in aggression related psychopathology.
Keywords: Adolescents, Decision making
CORRESPONDING AUTHOR: Áspán Nikoletta, Vadaskert Hospital, Budapest, nikoletta.aspan@gmail.com
P709 PSYCHOSOCIAL DIFFICULTIES IN ADOLESCENTS WITH CHILDHOOD CANCER AFTER DISCHARGE FROM MEDICAL TREATMENT
Takei Y.1, Ozawa M.2, Manabe A.2, Suzuki S.3
1 Waseda University, Graduate School of Human Sciences, Tokorozawa, Japan
2 St. Luke's International Hospital, Department of Pediatric Oncology, Chuo-ku, Japan
3 Waseda University, Faculty of Human Sciences, Tokorozawa, Japan
Purpose: Adolescents with childhood cancer have to go through the normal developmental process while coping with the emotional impact of cancer diagnosis and treatment as well as with the emotional, social, and physical late effects. However, only few studies have investigated the effects of cancer on an adolescent’s life after discharge and their perception of these experiences. The purpose of this study was to investigate features about psychosocial difficulties faced by adolescents with childhood cancer in their daily lives after being discharged from a hospital.
Methods: Subjects were 32 childhood cancer patients (18 male and 14 female, mean age at survey = 17.7 ± 6.2 yrs, mean age at diagnosis = 7.6 ± 5.5 yrs). Of the 32 subjects, 20 had leukemia, 5 had brain tumor, 4 had malignant lymphoma, and 3 suffered from other tumors. They were asked to answer questions about psychosocial difficulties, the level of suffering, and the degree of satisfaction with life.
Results: Results showed that many patients had physical and behavioral difficulties and each psychosocial difficulties were related to one another. As a result of cluster analysis, there were 3 types of psychosocial difficulties as follows: the anticipatory anxiety group, less disturbed group, severely disturbed group. There were statistically difference among their groups on the level of suffering and the degree of satisfaction with life.
Conclusion: This study identified the features about psychosocial difficulties faced by childhood cancer survivors in their daily lives after being discharged from a hospital. This study showed that many adolescent patients have experienced burden of cancer in their post-discharge life. This experience can be considered the predictors of their poor psychosocial adjustment. It is important to provide early support to the patients so that their daily lives are not hindered by the treatment and its side effects and to offer long-term support.
Keywords: Cancer survivorship, Quality of life, Children, Adolescents
CORRESPONDING AUTHOR: Takei Yuko, Waseda university, yuko-t@akane.waseda.jp
P710
THE VOICES OF YOUNG PEOPLE INVOLVED IN PAEDIATRIC PALLIATIVE CARE
Gaab E.1, Owens G. 2, McLeod R.3
1 University of Auckland, Department of Psychology, Auckland, New Zealand
2 University of Auckland, Psychology, Auckland, New Zealand
3 University of Auckland, School of Population Health, Goodfellow Unit, Auckland, New Zealand
Background: Although paediatric palliative care continues to expand as a field, research into psychological aspects of the experience of dying children remains scarce. The present paper presents the results of an in-depth qualitative study of young people who were either receiving palliative care themselves or were siblings of recipients, and was conducted as part of a larger research programme designed to enable the children themselves to highlight issues which they perceived as important.
Method: In all, there was a total of 16 participants from eight families. Children’s illnesses included cancer, heart conditions and dystrophies. Participants were provided either with diaries or audio recorders according to their own preference and asked to keep a record of whatever they wished. Participants were given minimal guidance as to what should be recorded, being encouraged to decide for themselves what issues they felt were most important; it was emphasised that any material was confidential between themselves and the researchers, and that they would not be identifiable in any reporting of the study. Diaries/recordings were collected on a weekly basis.
Findings: Data were analysed using thematic analysis through the computer program NVivo. Themes identified included issues of the special treatment of patients, time with family, judgment or discrimination, being understood/understanding and mortality. Particularly notable was the enthusiasm with which participants supported the research.
Discussion: The findings, although limited by geographical and numerical factors, nevertheless support the view that children involved in paediatric palliative care have much to say that is potentially of value to professionals.
Keywords: Children's health; Chronic illness
CORRESPONDING AUTHOR: Owens Richard Glynn, Auckland University, Auckland, g.owens@auckland.ac.nz
P711
CHILDHOOD OBESITY AND EDUCATION – DO OBESE CHILDREN REACH THE SAME EDUCATIONAL LEVEL AS NON-OBESE?
Andersen I.1, Gamborg M.2, Diderichsen F.1, Sørensen TIA.2, Baker JL.2
1 University of Copenhagen, Department of Public Health, Copenhagen, Denmark
2 Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
Background: This “obesity epidemic” among children is of concern because it is suspected that excess weight or adiposity in childhood negatively affects future health in addition to its concurrent social consequences. However, whether the association between overweight in childhood and the risk of low educational levels in adulthood has changed as the obesity epidemic developed has not been addressed.
Methods: We investigated the association between childhood obesity defined as body-mass index (BMI) z-score > 2 compared to BMI z-score < 2 in childhood (13 years of age) and basic schooling being the highest educational level in adulthood (40 years of age). The subjects were a cohort of 300.000 Danish schoolchildren born between 1930 and 1983 for whom measurements of height and weight were available. Educational levels were ascertained by linkage to national registers. Logistic regression analyses were performed.
Results: The preliminary results show, that the prevalence of a BMI z-score > 2 was about 4% for both boys and girls born 1945-1965 and it increased thereafter; among those born from 1980-1984 12.7 % of girls and 13.8% of boys had BMI z-scores >2 at 13 years of age. Throughout the period, as compared to boys with a BMI z-score <2, those with a z-score > 2 had an odds ratio (OR) = 0.82 ( 95% CI: 0.77-0.87) of obtaining more than basic schooling. For girls, compared to those with a BMI z-score <2, those with a z-score >2 had an OR of 0.64 (95% CI: 0.60-0.68). The odds were consistent across time in both boys and girls.
Conclusion: Compared to non-obese children, obese children have an increased risk of obtaining a lower education independent of birth cohort. As the estimates were stable over a long period of time, and even greater numbers of children are obese today, from a public health perspective it is important to further investigate whether the lower levels of education is due to co-morbidities, types of social stigmatization during the school years or impacted by parents low social position.
Keywords: obesity, socio-economic status, childhood
CORRESPONDING AUTHOR: Andersen Ingelise, Copenhagen University, DK, inan@sund.ku.dk
P712
24-HR URINE COLLECTION AS AN OBJECTIVE MEASURE OF SALT INTAKE IN AUSTRALIAN PRIMARY SCHOOL CHILDREN
Grimes C.1, Riddell L.2, Campbell K.2, Nowson C.2
1 Deakin University, Centre for Physical Activity & Nutrition Research, Melbourne, Australia
2 Deakin University, Centre for Physical Activity and Nutrition Research, Melbourne, Australia
Data from the 2007 Australian Children’s Nutrition and Physical Activity Survey indicates dietary salt intake of Australian children exceeds recommendations. However, these data are derived from reports using dietary recall which is known to underestimate total daily salt intake. Currently no objective measure of salt intake in Australian children is available. The aim of this study was to measure total daily salt intake using 24-hr urinary sodium excretion within a sample of Victorian school children aged 5–13 years. This was a cross-sectional study completed within a convenience sample of independent Victorian primary schools (n = 9). Two hundred and sixty children completed a 24-hr urine collection over a school (34%) or weekend day (66%). Samples deemed incomplete (n = 18), an over-collection (n = 1) or that were incorrectly processed at the laboratory (n = 3) were excluded. Participants included 120 boys and 118 girls with a mean age of 9.8 ± 1.7 years. The average 24-hr urinary sodium excretion (n = 238) was 103 ± 43 mmol/24-hr (salt 6.0 ± 2.5 g/d). Daily sodium excretion did not differ by sex, boys 105 ± 46 mmol/24-hr (salt 6.1 ± 2.7 g/d) and girls 100 ± 41 mmol/24-hr (salt 6.1 ± 2.7 g/d) (P = 0.38). Sixty nine percent of children (n = 164) exceeded the recommended daily Upper Limit for sodium. In conclusion, many children exceed the dietary recommendations for salt. Given the high salt intake reported in this small sample of children, further collections in a large, socio-economically diverse sample is warranted.
Keywords: Children's health, nutrition
CORRESPONDING AUTHOR: Grimes Carley, Deakin University, carley.grimes@deakin.edu.au
P713
SCHOOL STRATIFICATION AND RISK BEHAVIOURS AMONG STUDENTS IN STOCKHOLM
Olsson G., Fritzell J.
Stockholm University, Center for Health Equity Studies, Stockholm, Sweden
Background: In Sweden school segregation has increased along both socioeconomic and ethnic dimensions during the latest decades. Segregation sorts pupils into different school contexts and shapes the environments of pupils’ everyday life. The overall purpose of this study is to examine the extent to which student alcohol use and criminal behaviour vary among schools in Stockholm and how this variation is associated with the schools socio-demographic characteristics. Our theoretical basis is the social disorganization theory (SDT).
Methods: The analysis is based on 11 000 ninth-grade students distributed over 159 schools in the Stockholm area in 2004 and 2010. The data used are derived from the Stockholm School Survey, which is a total sample on ninth-grade pupils in Stockholm city. School specific information has been retrieved from the Swedish National Agency for Education. Logistic random slope models will be used.
Results: Results indicate significant school-to-school differences in relation to both alcohol consumption (9%) and serious crimes (2%). More importantly, our results also indicate that, when controlling for students background characteristics, schools characterised by a large proportion of highly educated parents and a low proportion of students with non-native background are, compared to schools with high proportions of students with low educated parents and with non-native background, associated with a higher risk of high alcohol consumption (OR 3.15 (95% CI = 2.38-4.13)) but a lower risk of having commit serious crimes (OR 0.73 (95% CI = 0.58-0.92)) at student level.
Conclusion: Our preliminary results suggest that a significant variation exists between schools in Stockholm in relation to both alcohol consumption and criminality at student level. In contrary to what could be expected from SDT the risk for high alcohol consumption is greater in schools with characteristics that are typically associated with low risk of problem behaviours. However, the association between school characteristics and risk behaviours need to be further explored as the association seems to vary depending on the type of risk behaviour under study.
Keywords: Adolescents Health behaviors
CORRESPONDING AUTHOR: Olsson Gabriella, Center for Health Equity Studies, gabriella.olsson@chess.su.se
P715
BENEFITS, BARRIERS AND STRATEGIES FOR PHYSICAL ACTIVITY IN PATIENTS WITH SCHIZOPHRENIA
Rastad C., Martin C., Asenlof P.
Uppsala University, Department of Neuroscience, Uppsala, Sweden
Physical activity (PA) is vital to mental and physical health. Perceived incentives and barriers for PA are important when planning behavior change interventions and have been described in the general population as well as in patient groups such as patients with severe mental illness, but not specifically in patients with schizophrenia. A purposive sample of twenty patients (13 men and 7 women), between 22 and 63 years of age (the majority overweight/obese) with a diagnosis of schizophrenia for at least one year and registered at 3 outpatient clinics in Sweden were interviewed regarding affordances for physical activity in daily life. The interviews lasted between 35 and 106 min (median 49 min) and were analyzed according to qualitative content analysis. The Social Cognitive Theory, the Transtheoretical Model and the Health Belief Model were used as a comprehensive theoretical framework for the study.
The analysis resulted in three main themes; (1) barriers - factors that complicate or obstruct physical activity; (2) reward - the reason for being physically active and (3) strategies and prerequisites for action. Barriers were related to psychiatric and somatic illness and disease (for ex feeling mentally unwell, fatigue, difficulties with initiative, compulsion, paranoia, voices and overweight), to immediate negative outcomes (for ex pain), negative expectations (low faith in one´s ability, avoid failure), opinions and ideas that get in the way (“no point in light intensity activities”), difficulties in interpreting information from/about the body (not knowing if pain comes from the foot or the knee or how to buy shoes that fit) and difficulties during the winter season because of darkness, cold, snow and ice. Reward was related to immediate positive outcomes (feelings of well-being, self-esteem, freedom and independence), positive expectations (symptom reduction and avoid negative consequences of inactivity). Strategies and prerequisites for action were building motivation through perceived susceptibility, positive self-talk and making a firm decision, avoid stress, using personal support from staff/others and activity planning such as scheduled times.
The diversity of possible incentives and barriers and the specific set-up for each patient should be a focus in the clinic and in future clinical studies. Several incentives and barriers are similar to those found in other patient groups, but some are specific to patients with schizophrenia.
Keywords: Physical activity, Health beliefs, Benefits, Barriers, Qualitative method
CORRESPONDING AUTHOR: Rastad Cecilia, Uppsala University, Uppsala, cecilia.rastad@neuro.uu.se
P716
APPLICATION OF BEHAVIOURAL ECONOMICS TO UNDERSTANDING ADHERENCE: STATED PREFERENCES FOR PERSISTENCE WITH MEDICATIONS
Fargher EA.1, Morrison V. 2, Plumpton CO.1, Hughes DA.1
1 Bangor University, Centre for Health Economics & Medicines Evaluation, Bangor, United Kingdom
2 Bangor University, School of Psychology, Bangor, United Kingdom
Persistence with medications is the outcome of a decision made about whether taking the medication will increase utility. This may be explained by random utility theory and examined using stated preference techniques.
Aim: To examine patients’ stated preferences for persistence with medications. To determine the characteristics of medications patients consider important and how they are prioritised, and traded, in a hypothetical decision to persist with medications.
Method: A 4-attribute DCE (mild side-effects, potentially life-threatening side-effects, dose frequency, treatment benefits) with 3-levels identified from literature and expert opinion was developed using a fractional factorial design. Scenarios were folded into nine forced binary choices: Which medicine would you be most likely to continue taking? The survey was translated, piloted and approved for eleven European countries. Target sample was 323 patients prescribed anti-hypertensives per country, recruited by posters in community pharmacies or general practices. Results were analysed in STATA using a random effects logit model.
Results: Preliminary analysis of 969 responses from England (43.65% male, mean 59.57 years), Wales (37% male, 61.05 years), Poland (47.06% male, 54.46 years), show all attributes influenced patients’ preferences to persist (p < 0.05) in the expected direction: treatment benefit (positive), dose frequency (negative), mild side-effects (negative), potentially life-threatening side-effects (negative). Patients were willing to trade an increase in dose frequency, for an increase in treatment benefit: 6% (England), 8% (Wales), 15% (Poland); whereas to decrease the risk of potentially life-threatening side-effects from ‘uncommon’ to ‘very rare’ they were willing to accept an increase in mild side-effects: 24%(England) 24%(Wales) 4% (Poland).
Conclusion: Patients’ preferences for drug attributes influence their stated decision to continue taking a medicine and should be considered when developing new medicines, formulations or interventions.
Keywords: adherence, economics
CORRESPONDING AUTHOR: Fargher Emily, Bangor University, Bangor, e.fargher@bangor.ac.uk
P717
PRELIMINARY RESULTS FROM A PATIENT SUPPOR PROGRAMME TO IMPROVE ADHERENCE AND NON-ADHERENCE BELIEFS IN DEPRESSIVE POPULATION
Fortun M.
Atlantis Healthcare, Health Psychology, Madrid, Spain
Introduction: Non-adherence to anti-depressant medication (ADM) is a considerable problem. Discontinuation rates vary significantly between studies, with recent ranges of 29% to 80% (Aikens et al., 2005; Hunot et al, 2007). A study looking at duration and adherence of ADM in Spain between 2003 and 2007 (n = 7525) found that only 22% of patients presented good compliance (duration of >4 months, adherence >80%) (Serna et al. 2010).Interestingly, Serna et al., (2010) found that half of patients abandoned treatment between the 2ndand 4thmonth following the initial prescription and only 25% continued treatment for more than 11 months.
Drivers of non-adherence have been broadly studied. Any specific non-adherence behavior can be the result of a considered deliberate decision or happen unintentionally due to misunderstanding of instructions or forgetting (Morgan & Horne, 2005).
Deliberate non-adherence is based upon a patient’s personal beliefs about their illness and treatment (Barber et al., 2004). These beliefs form the basis of the theoretical model [Self-Regulatory Model, Leventhal, Mayer & Nerenz, (1980)] and can be summarized in the following beliefs: cause of the illness, its nature, its duration, the personal consequence, the extent to which the illness can be controlled, the perception of necessity and any concerns about treatment (Horne, 1999).
Both drivers of behaviour need to be addressed if a patient support programme is to tackle non-adherence and patient support effectively
Objective: To develop an educational patient support programme (PSP) aimed at improving the adherence to ADM in Spanish depressive population by the modification of illness and treatments beliefs.
Procedure and method: 60 patients were recruited from both primary care doctors and psychiatrists along Spain. All patients consented to participate in a PSP and were assessed on their main non adherence predictors (impact of treatment in QoL, concerns, HCP relationship, treatment control, stigma) in the baseline and two months after.
The PSP had an evidence based psychoeducational approach based on the cognitive-behavioral theory to address the main non-adherence drivers (intentional and non-intentional). The participants received personalized materials (workbooks, printed materials, texts, emails and a website) focus on changing their non-adherence beliefs.
Results: The results will show the changes in non-adherence predictors and on persistence two months after starting the PSP.
Keywords: adherence, depression, patient support programme
CORRESPONDING AUTHOR: Fotun Maria, Atlantis Healthcare, maria.fortun@atlantishealthcare.com
P718
SOCIAL SUPPORT AND TREATMENT ADHERENCE IN SIX CHRONIC DISEASES
Meneses R.1, Pais-Ribeiro J.2, Pedro L.3, Silva I.1, Cardoso H.4, Mendonça D.4, Vilhena E.4, Martins A.5, Martins-da-Silva A.4
1 Universidade Fernando Pessoa, Faculdade de Ciências Humanas e Sociais, Porto, Portugal
2 University of Porto, Faculty of Psychology and Educational Sciences, Porto, Portugal
3 Instituto Politécnico do Lisboa, Escola Superior de Tecnologia da Saúde, Lisbon, Portugal
4 University of Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
5 University of Porto, Hospital Sto. António, Porto, Portugal
A considerable amount of research in Health Psychology has shown that social support can have a very important role in patients’ behaviors. Consequently, the aim of the present study is to analyze the relationships between social support and treatment adherence in six chronic diseases.
A total of 607 chronic patients were assessed with a Socio-demographic and Clinical Questionnaire, the MOS Social Support Survey, and the Medida de Adesão aos Tratamentos (MAT): 77 with type 1 diabetes (age: M = 34.83, SD = 10.52; diagnosis (years): M = 16.47, SD = 10.26), 40 with type 2 diabetes (age: M = 52.40, SD = 10.17; diagnosis (years): M = 11.74, SD = 7.44), 100 with multiple sclerosis (age: M = 35.70, SD = 6.57; diagnosis (years): M = 8.24, SD = 5.28), 79 with epilepsy (age: M = 36.10, SD = 11.09; diagnosis (years): M = 19.72, SD = 11.50), 205 with obesity (age: M = 42.83, SD = 11.16; diagnosis (years): M = 10.96, SD = 9.39), and 106 with cancer (age: M = 48.0, SD = 9.72; diagnosis (years): M = 8.99, SD = 7.58).
There were no statistically significant linear correlations between social support and treatment adherence in epilepsy, multiple sclerosis, and cancer patients. Type 1 diabetes patients’ adherence correlated with Tangible Support (r(75) = .36, p < .002) and Emotional/Info Support (r(76) = .25, p < .03). Type 2 diabetes patients’ adherence correlated with Positive Interaction (r(39) = -.34, p < .04). Obesity patients’ adherence correlated with Positive Interaction (r(200) = .16, p < .02), Emotional/Info Support (r(200) = .16, p < .03), and Overall Support (r(200) = .16, p < .02).
These preliminary results suggest that the role of social support in treatment adherence may not be very important and may vary considerably in different chronic diseases.
Acknowledgment: FCT Grant PTDC/PSI/71635/2006
Keywords: Adherence; Chronic Disease; Social support
CORRESPONDING AUTHOR: Meneses Rute F., Univ. Fernando Pessoa, Porto, rmeneses@ufp.edu.pt
P723
PREDICTIVE BIOPSYCHOSOCIAL FACTORS FOR ADHERENCE AND QUALITY OF LIFE AMONG HIV-POSITIVE INDIVIDUALS WHO ARE SUCCESSFULLY ADHERENT
Calvetti P.1, Gauer G.2, Giovelli G.2, Moraes J.3
1Centro Universitário Unilasalle - Canoas/RS - Brasil, Pós-graduação Strictu Sensu Saúde e Desenvolvimento Humano, Porto Alegre, Brazil
2Pontifícia Universidade Católica do Rio Grande do Sul, Psychology, Porto Alegre, Brazil
3Pontifícia Universidade Católica do Rio Grande do Sul, Matemática, Porto Alegre, Brazil
This study aimed to investigate predictive biopsychosocial factors for adherence and quality of life among HIV-positive people who successfully followed treatment. For this purpose, we present a biopsychological model with empirical results. This study describes the characteristics of the sample including clinical (viral load and count of CD4+ T lymphocytes) and socio-demographical data, and evaluated the psychosocial aspects (level of anxiety, level of depression and perceived stress, social support) and quality of life of this sample of HIV-positive participants. The sample had 120 HIV-positive participants, both male and female, from 18 to 65 years old, undergoing antiretroviral treatment. The assessment instruments used were: questionnaire on clinical situation and socio-demographic data, Beck Depression Inventory, Beck Anxiety Inventory, Perceived Sstress Scale (PSS), Social Support Scale for HIV-positive invividuals, World Health Organization questionnaire on quality of life (WHOQOL-HIV) and the CEAT-HIV questionnaire on evaluating antiretroviral treatment bonding. The results indicate the following predictive aspects of bonding protection: social class, perceived HIV stage, physical and environmental domains, and quality of life. Results show the importance of social support, having access to health services, gathering information about the illness, feeling well about physical health and environment, as well as safety. Therefore, attention should be given from the perspective of the biopsychosocial model in order to enhance the quality of life and a healthy lifestyle of the HIV-positive individuals.
Keywords: Adherence; Quality of life
CORRESPONDING AUTHOR: Calvetti Prisla, Unilasalle, Porto Alegre Brasil, prisla.calvetti@gmail.com
P719
PRESENCE OF ANTICIPATORY ANXIETY IN WOMEN EXPERIENCING FIRST PREGNANCY, IN SITUATIONS OF LACK OF SUPPORT FROM THE PARTNERS: THE PREVENTION METHODOLOGY
Gaspari C.1, Cantafio LR.2, Nasello G.1
1 S.C. RecripocaMente Onlus, Health Education & Promotion, Roma, Italy
2 Accademia Medico Psicologica, Psychology, Psychoterapy and Medicine Center, Roma, Italy
Aim: Developing an intervention method to prevent uneasiness in the new mother, father and infant, in order to facilitate a possible decrease in the incidence of the post-partum syndrome. To this end, it is essential to be able to incisively intervene on the anticipatory anxiety, on the sense of inadequacy with respect to the role of mother, on the sense of personal and relational ineffectiveness, on the excessive sense of responsibility and on the sense of solitude. Particular attention must be placed also on the revaluation of the father’s role, on his contribution during the pregnancy period and on the sharing of the infant caring duties along with the safeguard of the couple relationship quality.
Materials and methods: Field observation, psychological interviews, medical reports data collection, administration of the Generalised Self-Efficacy test (Bandura – 1967) to measure the perceived self-efficacy and the Social Network Questionnaire Q.R.S. (Friedrich, Greenberg, Crnic - 1983) to detect the quality of the social network on a sample of 216 pregnant women. Analysis of scientific literature produced in the last 10 years.
Results: The first author, through clinical interviews and tests comparison, found a correlation between anticipatory anxiety and the inadequate quality of support provided by the partner and the social network (family system, territorial system); the author also noted a tendency of the mother to perceive herself as inadequate to manage the new role of mother and wife.
Conclusions: The authors have formulated a functional hypothesis to a preventive action based on the results obtained. They suggest, to those working in this area, to act directly on the couple both stimulating and improving the pregnant woman partner’s skill in terms of support and identifying her calls for help as a resource. Furthermore, also the mother-son relationship must be improved.
To achieve results, the authors consider also essential to urge the institutions to take the responsibility of an appropriate intervention.
Keywords: Anxiety, pregnancy, post-partum depression, prevention, health promotion, social resources, social network support.
CORRESPONDING AUTHOR: Gaspari Chiara, S.C.ReciprocaMente Onlus Rome, lucia.cantafio@amepsi.it
P720
FAMILY COMMUNICATION IS A MEDIATOR TO INCREASE FAMILY HARMONY, HAPPINESS AND HEALTH: FINDINGS FROM A COMMUNITY-BASED PARTICIPATORY RESEARCH (CBPR) PROJECT IN HONG KONG
Chan SSC.1, Mui M.2, Soong CSS.3, Wang X.3, Lam TH.3
1 University of Hong Kong, School of Nursing, Hong Kong, Hong Kong SAR
2 Hong Kong Council of Social Service, -, Hong Kong, Hong Kong SAR
3 University of Hong Kong, Department of Community Medicine, Hong Kong, Hong Kong SAR
Introduction: Previous studies showed communication among family members is inadequate in Hong Kong. We adopted a community-based participatory research (CBPR) approach with collaboration from the academic community and service partners. Community-based programmes were designed, planned, implemented, and evaluated using a positive psychology framework and logic model to enhance family communication and well-being through the “Happy Family Kitchen” (HFK) programme.
Objective:(1) To enhance family functioning and communication in collaboration with various community stakeholders and NGOs so as to promote family health, happiness, and harmony (3Hs); and (2) To evaluate the effectiveness of various components of the project in terms of its structure, process, and outcomes.
Methods: The HFK was a CBPR project with three phases conducted in Yuen Long district in Hong Kong. Phase 1: started with formative needs assessments, and conducted a training of trainer program to build capacity among the community partners in the positive psychology framework, and programme design. Phase 2: The trained community partners prepared proposals and conduct special-design programmes (with booster) to promote family communication and 3Hs. Phase 3: Pre-, post- 6 weeks, and 3 month follow up surveys were conducted to assess outcomes on family communication and 3H indicators.
Results: A total of 1419 individuals from 612 families participated in 23 community based programs during Nov 2010 to July 2011. The majority (74.6%) of the participants (n = 1419) were aged 6-44, 65.0% were female, 46.6% had primary education level and 48.8% were married. The mean communication time showed a significant increase from 152.1 to 161.9 minutes (p-value < 0.001) per week and an increase in the mean communication score from 67.7 to 71.4 (p-value < 0.001)was observed at 3 months after the intervention. The overall mean happiness score and the mean health score showed a significant increase from 7.8 (pre-intervention) to 8.0 (p-value < 0.001), and the overall mean harmony score was improved from 7.9 (pre-intervention) to 8.2 (p-value < 0.001) at 6 week after intervention.
Conclusion: The HFK project seemed to be effective in enhancing family communication and increasing family 3Hs. Family communication is a mediator to improve family 3Hs and eating and dinning seemed to be an appropriate platform to enhance the quality and frequency of communication among family members in Hong Kong.
Acknowledgement: The study is part of the FAMILY: A Jockey Club Initiative for a Harmonious Society, funded by The Hong Kong Jockey Club Charities Trust.
Keywords: Community intervention; Behavior change
CORRESPONDING AUTHOR: Chan Sophia Siu Chee, The University of Hong Kong, nssophia@hku.hk
P721
QUALITY OF LIFE IN PATIENTS OF A RENAL PROTECTION PROGRAM IN COLOMBIA
Velasco M.1, Gonzalez M.2, Gomez O.3, Mendez F.2, Angel A.2, Rincon-Hoyos H. 4, Varela M.5, Villa A.2, Otero L.2, Schneiderman N.6, Ramos M.2, Hernandez C.2
1 Comfandi IPS / Universidad Libre, Subdirección de Salud, Cali, Colombia
2 Comfandi IPS (Colombia), Subdirección de Salud, Cali, Colombia
3 Fundacion FES, Area de Salud, Cali, Colombia
4 Comfandi IPS / Fundacion Valle del Lili / University of Miami, Salud Mental / Psiquiatria / Psychiatry, Cali, Colombia
5 Universidad Javeriana Cali, Facultad de Humanidades y Ciencias Sociales, Cali, Colombia
6 University of Miami, Department of Psychology, Miami, United States
Introduction: Quality of life is an individual's perception of position in life based on cultural context in relation to goals, objectives, expectations and concerns. In case of chronic illness, the person experience symptoms that affect adaptation, then it is important to assess subjective well-being, ability to perform social activities and functional capacity. Methodology: We performed a cross-sectional study with 277 adult patients in a renal protection program at a private primary health care network in Cali Colombia, selected by simple random sampling from March 2010 to July 2011. Quality of Life was evaluated with SF-8™ Health Survey, which measures eight domains of health: physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. The clinical status and diagnosis was obtained from medical records and a questionnaire was designed for socio-demographic variables. Outcomes of interest were Quality of Life based on physical and mental health component, adjusted by demographic variables, disease type and stage KDOQI (Kidney Disease Outcomes Quality Initiative).
Results: 64% of patients were female, average age was 56 years, 76% of patients gained less than twice the government ruled lowest monthly wage (718 dollars / month), 72% of patients were hypertensive, 28% had diabetes or diabetes plus hypertension, 70% of patients were married or had a steady partner, mean values for physical and mental health were 49.89 (SD 9.94) and 49.44 (SD 10.13) respectively (expected average: 50.0[1]). The lowest category was general health with average of 46.83 (SD 7.23),the average values of physical health were higher in males 52.97 (SD 8.72) vs. 48.25 (SD 10.19) (p = 0.000) as well as mental health 51.81 (SD 9.23) vs. 48.19 (SD 10.34) (p = 0.0034). No differences in mean values of physical or mental health adjusted by age, diagnoses and KDOQI stages were found. CONCLUSION: The perception of quality of life in patients with chronic diseases was below the average for the general population; the perception of physical and mental health was lower in females
[1]IQOLA, MQualityMetric, medical Outcomes Trust, SF8TM Health Survey, Chapter 4. How to Score the SF-8tm Healt Survey ,page 15.
Keywords: Quality of Life, Mental Health, Chronic Disease, Diabetes, Hypertension, Renal/urologic Disorders, Public Health, Gender
CORRESPONDING AUTHOR: RINCON-HOYOS HERNAN, FUNDACION VALLE DEL LILI, hernangrincon@gmail.com
Conflict of Interest: Funded by Departamento Administrativo de Ciencia, Tecnología e Innovación Colciencias República de Colombia
P722
IMPLEMENTATION OF BRIEF INTERVENTION FOR SMOKING CESSATION: A COMPARISON OF DENTAL AND GENERAL MEDICAL PRACTICES
Meyer C.1, Haut M.2, Haug S.3, Biffar R.4, Kocher T.4, John U.1, Ulbricht S.1
1 University of Greifswald, Institute of Epidemiology and Social Medicine, Greifswald, Germany
2 Dentist in private practice, -, Duesseldorf, Germany
3 University of Zurich, Institute for addiction and health research, Zurich, Switzerland
4 University of Greifswald, Dental School, Greifswald, Germany
Background: Due to high contact rates with the general population dental (DP) and general medical practices (GP) constitute superior settings for smoking cessation interventions that aim to reach a sufficient population impact. Major evidence about brief smoking interventions is derived from the GP setting. The reachable target populations and motivational aspects during consultation might differ across setting, and generalizability of those findings to the DP setting might be limited.
Method: 10 GP and 10 DP (participation rate 87% and 77%) were randomly sampled from all practices in the northern German city of Greifswald. Consecutive patients (GP n = 2799; DP n = 1387) aged 18-70 years were screened for smoking status for 3 (GP) and 2 weeks (DP). Smoking patients were asked for participation in a study including a brief smoking intervention and to fill in a baseline- questionnaire including measures of nicotine dependence and core constructs of the Transtheoretical Model of intentional behavior change.
Results: The number of patients per week entering the GP (M = 95, SD = 17) were higher compared to the DP (M = 73, SD = 20). Controlling for age and gender higher smoking prevalence was observed in the GP compared to the DP. The rate of smoking patients accepting to be included in the smoking intervention was 78% in both settings. Participants were predominantly in the precontemplation stage of change with regard to smoking cessation (GP: 65,2% ; DP: 71,8%; p = .10). Results from multivariate logistic regression analysis revealed that younger age, lower educational level, higher degree of nicotine dependence, and lower rating of the cons of non-smoking were significantly associated with being patient from the GP compared to the DP setting.
Conclusion: Our data demonstrate that the vast majority of smoking patients including all stages of change can be reached by proactive smoking interventions in both settings with slightly higher numbers in the GP. Somewhat higher ratings in motivational variables in the GP in contrast to the DP setting might indicate a “teachable moment” associated with the GP visit. Similarities with respect to the characteristic of reachable smokers and feasibility of implementation in both settings, suggest the extension of efforts to disseminate brief smoking interventions to DP.
Keywords: dental practices, general medical practices, smoking cessation, brief interventions
CORRESPONDING AUTHOR: Meyer Christian, University of Greifswald, chmeyer@uni-greifswald.de
P724
DEVELOPMENT OF A 10-POINT HEALTHY LIVING INDEX (HELI): HONG KONG JOCKEY CLUB FAMILY PROJECT COHORT STUDY
Lam TH.1, Nan H.1, Chan B.1, Lee H.1, Kavikondala S.1, Chan S. 2
1 The University of Hong Kong, Department of Community Medicine, Hong Kong, China
2 The University of Hong Kong, School of Nursing, Hong Kong, China
Purpose: In 2011, the United Nations High-level General Assembly highlighted 4 common risk factors of tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity for 4 non-communicable diseases. We sought to develop a simple 10-point HELI which included all the 4 risk factors, plus blood pressure and body mass index, to measure healthy living and health status at both individual and family levels.
Methods: From the FAMILY Project cohort study in 2009-2011, we included 18,906 individuals from 8,481 families randomly selected from the general population in Hong Kong. We collected demographic and lifestyle variables including cigarette and alcohol consumption, number of servings of fruit and vegetable consumed per day, physical activity (International Physical Activity Questionnaire), body mass index, and blood pressure. Number of chronic diseases, physical (PCS) and mental (MCS) health-related Quality of Life(QoL, SF-12) and depressive symptoms (PHQ-9) were used as validation criteria for HELI. The scoring of the 6-item HELI was based on established criteria (Table).
RESULTS: Scores of 6 and 8 or above discriminated between moderately healthy and very healthy groups. 64% and 24% of individuals were moderately and very healthy, respectively. The corresponding figures for families (based on the average of family members) were 60% and less than 10%. The Spearman ρ correlations of HELI with PCS and number of chronic diseases were 0.17 and -0.20 for individuals, and 0.18 and -0.23 for families (all p < 0.001). HELI was weakly associated with the MCS(ρ = 0.05, p < 0.001) and PHQ-9 (ρ = 0.03, p < 0.001) at individual levels but not at family levels (both p > 0.05).
CONCLUSIONS: The 10-point HELI was more strongly associated with number of chronic diseases and physical but not with mental health-related QoL, suggesting good criterion validity. Because of its simple calculation and blood test is not needed, the HELI can be worked out by people in community for individual and family health. Our results released at a press conference in Hong Kong had wide coverage. The HELI interactive calculator is free and available on our website (http://healthyindex.family.org.hk).
Table A 10-point Healthy Living Index (HELI) scale
Keywords: Health promotion; Risk factors
CORRESPONDING AUTHOR: NAN Hairong, University of Hong Kong, HK, nan.fang08@gmail.com
P725
HEALTHY CONVERSATION SKILLS TRAINING: EVALUATING TRAINER FIDELITY USING MIXED METHODS
Tinati T.1, Lawrence W.1, Begum R.1, Black C.1, Jarman M.1, Ntani G.1, Cradock S.2, Davies J.2, Margetts B.2, Inskip H.1, Cooper C.1, Baird J.1, Barker M.1
1 MRC Lifecourse Epidemiology Unit, Medicine, Southampton, United Kingdom
2 NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, Medicine, Southampton, United Kingdom
Introduction: Public health guidance has called for improvements in communication between healthcare practitioners and clients to promote and support lifestyle changes. “Healthy Conversation Skills” training enhances the ability of healthcare practitioners to support clients in changing their behaviour through identifying barriers and coming up with solutions to their problems. Communication is enhanced through “open discovery” questions (usually starting with ‘what’ or ‘how’). Behaviour change experts deliver training over three 3hr sessions, followed some weeks later by a follow-up workshop and individual telephone interview. Trainers follow a training manual to develop the five core competencies in trainees: creating opportunities to have healthy conversations; using open discovery questions; reflecting; listening and supporting goal-setting.
Aim: To examine trainer fidelity to the training manual using a mixed methods approach.
Methods: Tools were developed to assess to what extent trainers addressed and modelled the five competencies when delivering training. First, training sessions were observed by two independent observers using an observation protocol. Second, communication type was recorded every ten seconds during the training sessions to assess who was speaking and the type of communication (open or closed). Third, telephone interview transcripts were coded to assess trainers’ ability to provide trainees with opportunities to address the five competencies.
Results: Observations of training sessions showed that trainers addressed and modelled competencies, for example, demonstrating open discovery questions, listening to trainees, encouraging and modelling reflectivity.
Tallies indicated that trainees were engaged in participant activities 83% of the time, suggesting that trainees were speaking more than trainers. The use of open discovery questions by trainers also exceeded that of closed questions (6% compared to 3% of the time).
Assessing trainers’ interview transcripts showed that they generally asked questions which provided trainees opportunities to demonstrate the five competencies.
Conclusion: Evaluating trainer fidelity provides trainers with performance feedback, and evidence to assess the ability of trainers to deliver training as prescribed by the training manual. These methods may also be useful for researchers to adopt when evaluating extent to which their trainers implement their intervention. Further, fidelity data can be used as a benchmark to assess the performance of new trainers. This is important when translating an intervention such as this from a research environment into the real world.
Keywords: Health communication, Methodology, Public health
CORRESPONDING AUTHOR: Tinati Tannaze, MRC LEU Southampton, tt@mrc.soton.ac.uk
P726
AN INTERNET-BASED MULTIMEDIA HEARING LOSS PREVENTION INTERVENTION FOR FIREFIGHTERS IN THE UNITED STATES
Hong O.1, Chin D.1, Vogel S.2, Feld J.2, Ronis D.3
1 University of California, San Francisco, School of Nursing, San Francisco, USA
2 NorthShore University HealthSystems, OMEGA (Occupational Health Clinic), Evanston, USA
3 University of Michigan, School of Nursing, Ann Arbor, USA
Purpose: Noise-induced hearing loss (NIHL) is a global public health concern. Firefighters are at risk of developing NIHL at work due to exposure to intermittent but dangerously high noise. Educating about the damaging auditory effect of noise and promoting use of hearing protection is important to prevent permanent hearing loss among firefighters. Using the multimedia computer technology, this study developed and tested a theory-based tailored hearing protection intervention for firefighters in the United States (U.S).
Methods: A randomized experimental pretest-posttest control group design was used. Participants (N = 256) were randomly assigned to the experimental (n = 134) or control (n = 122) groups for receiving tailored hearing protection or cardiovascular disease prevention programs, respectively. The internet-based program was implanted for firefighters in 35 fire departments in multiple states in the US. Intervention effect was assessed at 3month after the intervention.
Results: Firefighters significantly increased their use of hearing protection devices (HPDs) from 32.5% at the pre-intervention to 37.1% at the post-intervention (p < .004), but no significant difference was noted by the type of intervention. However, experimental intervention was significantly more effective than the control for increasing firefighters’ intention to use HPDs in future (p < .006) and self-efficacy of HPD use, and decreasing barriers to use of HPDs. Several positive feedback reported by the participants included well-organized program (96.7%), easy to use (96.7%), and interesting training program (79.3%). The majority (90.1%) had no problem using the computer and 82% liked to get the training by computer. About 95% would recommend this internet-based program.
Conclusion: Although the intervention increased firefighters’ use of HPDs, their use was far lower than required to prevent hearing loss. It is suggested to provide more comprehensive hearing loss prevention program including organizational level intervention in fire service, along with firefighters’ behavioral change for this population.
Keywords: Web-based, Intervention, Occupational health
CORRESPONDING AUTHOR: Chin Dal Lae, University of California, SF, dal.chin@ucsf.edu
P728
DIETS USING MEAL REPLACEMENTS – EFFICACY OUTSIDE THE CLINICAL TRIAL
Chirila I.1, Paulik E.2, Florescu N.3
1 Gr. T Popa University of Medicine and Pharmacy, Iasi, Romania
2 University of Szeged, Faculty of Medicine, Department of Public Health, Szeged, Hungary
3 National Institute of Public Health, Regional Center, Iasi, Romania
Use of meal replacements seems to be an effective weight-loss strategy both in the short and long term in a clinical trial setting. But, there is no information about the efficacy outside a clinical trial where meal replacement products need to be purchased, and are frequently discontinued at an early stage.
The purpose of this retro-prospective study in Iasi, Romania was to assess the effectiveness of meal replacements diets in body weight management and the impact in body composition for working age people, when participants purchased the products and follow the weight loss program outside the clinical trial.
In weight loss programs (3.98 ± 2.29 months), 79 participants (56 women, 23 men) lost an average of -10.19 ± 6.12 kg of their body weight, -11.47 ± 9.15 cm in the abdominal perimeter,
-5.29 ± 3.46 of the percentage of body fat. Replacing two meals a day was an effective way to lose weight because of its simplicity and convenience of use. The cost of the products and monotony of the diet were the main causes of abandon the diet. Subsequently, in the period of maintenance of weight gained, subjects were followed for an average of 11.28 ± 8.1 months and for the entire group of participants was reached an average weight gain of +2.86 ± 3.02 kg compared to the minimum weight (31.5% of weight lost). Long-term maintenance was better in the subjects that replaced one meal a day, but is still a challenge and required further research.
Keywords: meal replacement, hypocaloric diet, obesity, body fat, body weight management
CORRESPONDING AUTHOR: Chirila Ioan, UMF & RCNIPH, Iasi, chirilaioan@yahoo.com
P729
WEIGHT LOSS MOTIVATION SUB-GROUPS AMONG OVERWEIGHT AND OBESE U.S. WORKING ADULTS
Lemon S., Schneider K., Pbert L.
University of Massachusetts Medical School, Medicine, Worcester, USA
Weight loss treatment outcomes may be enhanced if tailored to individual motivations for wanting to lose weight. However, studies addressing patterns of reasons for wanting to lose weight and the association of individual characteristics with these patterns are lacking. The goals of this were to use latent class analysis (LCA) to identify distinct sub-groups of adults with respect to their reasons for trying to lose weight; and assess the association of socio-demographic characteristics (age, gender, education, children living in the household), body mass index (BMI), self-perceived weight status, self-rated health and physician recommendations for weight loss with sub-group membership. The cross-sectional sample included 414 overweight and obese Massachusetts public high school employees who reported currently trying to lose weight. Latent class analysis (LCA), which included 9 reasons for trying to lose weight as indicators and adjusted for socio-demographic and health status variables, was used to define distinct sub-groups (classes). Logistic regression models were then computed to determine the associations of gender, age, education, having children in the home, self-perceived weight status, self-rated health status and physician recommendation for losing weight with latent class membership. The LCA resulted in three classes of reasons for trying to lose weight: class 1) improving health status only (31.2% of the sample); class 2) improving health status and looking/feeling better (52.4%); and class 3) improving health status, looking/feeling better and improving personal/social life (16.4%). Compared to those in class 1, those in class 2 were more likely to be female (OR = 4.38; p < 0.001) and younger (OR = 0.97 per year; p = 0.04). Compared to those in class 1, those in class 3 were more likely to be female (OR = 6.39, p < 0.001), younger (OR =0.95 per year, p = 0.002), have children in the home (OR = 3.88, p = 0.001), and perceive themselves to be very overweight (OR = 7.06, p < 0.001). The results suggest distinct sub-groups of overweight and obese people with respect to motivations for weight loss, on which intervention programs could be tailored to potentially enhance the likelihood of success.
Keywords: weight loss, motivation
CORRESPONDING AUTHOR: Lemon Stephenie, UMass Medical School, stephenie.lemon@umassmed.edu
P730
SELF EFFICACY AND LOCUS OF CONTROL: PREDICTIVE VARIABLES OF WEIGHT SELF REGULATION IN OBESE PEOPLE
Lugli Z.
Universidad Simón Bolívar, Ciencia y Tecnología del Comportamiento, Caracas, Venezuela
Objective: The present investigation aimed at determining the predictive capacity of perceived self-efficacy and locus of control in weight self-regulation of 243 obese persons in medical treatment in different private health centers.
Method: A non-experimental, correlational and crsoss-sectional design was used. Weight self regulation Inventory, Perceived self-efficacy in weight regulation Inventory and Weight locus of control Inventory were individually administered, on paper and pencil format.
Results: The results obtained show that the participants of this study are characterized by moderate levels in the three evaluated aspects of personal control of behavior: Self-regulation of weight, self-perceived efficacy in weight control, and the three dimensions of locus of control: internal, gambling and other powerful. It was found that obese persons who feel capable of controlling their weight and at the same time have weak beliefs that their weight depends on their actions are the ones who report greater self-regulation of weight.
Conclusion: These results suggest issues to take into account in the cognitive-behavioral treatments geared towards obesity control, specifically training self regulation abilities and at the same time work on changes in beliefs related to weight.
Keywords: Weight control, obesity
CORRESPONDING AUTHOR: Lugli Zoraide, USB, Caracas, zlugli@usb.ve
P731
CAN A DIABETES SELF-MANAGEMENT INTERVENTION REDUCE DEPRESSIVE SYMPTOMS AMONG DISADVANTAGED INDIVIDUALS WITH UNCONTROLLED DIABETES?
Rosal M., Whited M., Reed G., Lemon S.
University of Massachusetts Medical School, Preventive and Behavioral Medicine, Worcester, USA
Diabetes and depression are often comorbid with approximately 18% of patients with diabetes in the US population reporting elevated depressive symptoms. In the U.S., socioeconomically disadvantaged minorities with diabetes have even higher depression rates (25% to 70%). Depression contributes to difficulty with diabetes management and higher risk of diabetes complications. However, the impact of diabetes self-management interventions on depressive symptoms among disadvantaged populations has not been well researched. This study assessed the impact of a culturally-tailored, literacy-sensitive diabetes self-management intervention (Latinos en Control) on depressive symptoms among low-income U.S. Latino patients with uncontrolled type 2 diabetes. The sample (n = 252) was recruited from five urban community health centers and randomized to the intervention or enhanced usual care condition. The intervention was primarily group-based, with an intensive follow-up phase (12 weekly and 8 monthly sessions, respectively). Measures were collected at baseline, and 4- and 12-month follow-up. Depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D). The sample was primarily female (77%), middle-age (61%), and poor (50% had household income less than US$10,000/year), with limited formal education (75% less than high school). Average baseline HbA1c scores were 8.9 (SD = 1.8) and 9.1 (SD = 2.0) for intervention and control groups, respectively. Average baseline CES-D score was 20.9 (SD = 12.2) and 22.3 (SD = 12.5) in the intervention and control groups, and 65% and 69%, respectively, had baseline CES-D scores in the depressive range (CES-D score > 16). A significant difference in depression scores between the intervention and control conditions was observed at 4 months (-2.63 [-5.03, -0.23], p < 0.03), although this was attenuated at 12 months (-2.03 [-4.82, 0.76], p = 0.15). At 12 months, 53% and 67% of intervention and control participants had a CES-D score in the depressive range (p = 0.04). The group-based self-management intervention helped ameliorate depressive symptoms in addition to improving diabetes control in this population. This research echoes findings in other research areas in which depressive symptoms are improved as individuals make lifestyle changes. Future research needs to address mechanisms for observed improvements in depressive symptoms.
Keywords: Depression, Diabetes, Latino, Low-income and minority groups
CORRESPONDING AUTHOR: Rosal Milagros, UMass Med School, Worcester, milagros.rosal@umassmed.edu
P732
RELATIONSHIP BETWEEN QUALITY OF LIFE AND BINGE EATING DISORDER IN OBESE ADULT PATIENTS CANDIDATES FOR BARIATRIC SURGERY
Rios M., Assadi V., Barros M., Luarte M.
Pontificia Universidad Católica de Chile, Center for Treatment of Obesity , Santiago, Chile
Objective: Identify the relationship between binge eating disorder and quality of life in obese adult patients eligible for surgery, at Obesity Treatment Center of Obesity of the Catholic University of Chile.
Methodology: Descriptive-correlational, not experimental study, criteria intentioned. Sample of 415 patients (129 men and 286 women) with an average age of 38 (sd: 11.91) and an average BMI of 38.06 (sd: 5.69). For measuring of binge eating disorder, Binge Eating Scale was used (Gormally, 1982), while for the assessment of quality of life scale was used EuroQoL (Badia, 1999). For data analysis, we used central tendency statistics, and Spearman correlation coefficients for ordinal variables and Pearson coefficient for scalar variables.
Results: We observed a significant and direct correlation (rho: 0.384; P = 0.000) between BED total score and Quality of Life total score, that is, the higher BED, poorer quality of life. When performing an analysis of the relationship between binge eating and each of the subdimensions of the quality of life, we find that all them have a direct and significant association, finding greater strength in the relationship with the subdimension depression/anxiety (rho: 0.417; P = 0.000). By gender, it shows that both have a direct and significant association, although in men this relationship is stronger. For women, the presence of binge eating disorder affects them in all dimensions of quality of life, whereas in men, the presence of binge eating disorder influences in the subdomains usual activities, pain and depression/anxiety. Finally, when looking at this relationship by type of obesity, we can see that all obesity levels (type I, II and III) have significant association between the total score of quality of life and binge eating, however, differ in the subdomains of the quality of life.
Conclusion: There is a significant and direct relationship between binge eating and quality of life in all its subdomains, regardless of gender or type of obesity of the patient.
Keywords: Obesity, Binge Eating, Quality of Life
CORRESPONDING AUTHOR: Rios Matias, University of Chile, matiasrios@gmail.com
P733
ADULT RELATIONSHIPS AND TYPE 1 DIABETES: A FOCUS GROUP STUDY
Trief P.1, Sandberg J.2, Dimmock J.1, Forken P.1, Weinstock R.3
1 SUNY Upstate Medical University, Department of Psychiatry, Syracuse, USA
2 Brigham Young University, School of Family Life, Provo, USA
3 SUNY Upstate Medical University, Department of Medicine, Syracuse, USA
Background: Studies of adult type 2 diabetes (T2DM) patients and youth with type 1 (T1DM) describe the emotional challenges they face, and that partner and family support relate to better blood glucose control, adherence to self care and quality of life. Little is known about the common psychosocial challenges of adults with T1DM or the relevance of relationship factors to their ability to cope with the disease.
Methods: We held 4 focus groups (2 with adult T1DM patients; 2 with partners) and asked two broad questions: (1) What are the emotional and interpersonal challenges you have experienced because you have (your partner has) T1DM?; (2) How does the fact that you have (your partner has) T1DM affect your relationship with your partner, positively and/or negatively? A team of researchers reviewed responses to these questions and grouped answers according to similarities and differences using a constant comparative technique. Recurring themes were identified and compared according to key phrases and concepts.
Results: T1DM patients’ data: 11 females, 5 males; mean A1c = 7.6%, mean age = 48.3(20.6) years, mean years married = 19.3(17.4), 75% using insulin pump. Partners’ data: 5 females, 9 males; mean age =45.6(13.5) years; mean years married =14.1(13.3). TIDM patients reported: hypervigilance about hypoglycemia; anxiety about future complications; improved quality of life with new technologies; varying levels of partner involvement in their care; worries about child bearing and rearing. Partners reported: significant anxiety about hypoglycemia; concerns about childcare issues; difficulty dealing with partner’s mood swings; increased closeness for some, and conflict for others; fears about future complications. Examples of typical comments will be provided. These results are from a well educated group of patients, most on insulin pumps, and may not generalize to those with less education or different treatment method. Conclusions: Adults with T1DM and their partners face unique challenges adapting to the disease that can affect their relationship. They may benefit from psychosocial interventions targeted to these issues.
Keywords: diabetes, social support, quality of life
CORRESPONDING AUTHOR: Trief Paula, Upstate Medical Univ., Syracuse, triefp@upstate.edu
P734
PSYCHOMETRIC EVALUATION OF THE ADDQOL19 AND THE IMPACTS OF DIABETES ON QUALITY OF LIFE IN FINLAND
Nuutinen H.1, Ilanne-Parikka P.1, Aalto A-M.2, Tuomisto M.3
1 Finnish Diabetes Association and DEHKO, -, Tampere, Finland
2 National Institute for Health and Welfare, Department of Social Research, Helsinki, Finland
3 University of Tampere, School of Humanities and Social Sciences, Tampere, Finland
Background: In Finland, the quality of life of people with diabetes has previously been evaluated by using generic measures. The aim of this study was to conduct the translation and linguistic validation process of the diabetes-specific ADDQoL19 (© Clare Bradley, University of London) in Finnish and to explore the impacts of diabetes type 1 (T1D) and type 2 (T2D) on quality of life in Finland. Methods: Data was collected from the medication reimbursement register of the Social Insurance Institution of Finland. The sample consisted of 284 persons with T1D and 196 persons with T2D. Findings: The ADDQoL19 showed sufficient psychometric properties to be used in Finland. Quality of life was worse among those with complications. In the ADDQoL19 the respondents are asked to estimate the impacts of diabetes on 19 specific domains, and also the importance of the asked domains. The estimated impact is weighted by the importance of the asked domain. In all sub-samples (T1D women and men, T2D women and men) closest relationship and family life were assessed to be the most important. In spite of the progress in medical diabetes care, the most negative weighted impact of diabetes was assessed to be on the domain feelings about the future (among T1D women and men and T2D women). Among men with T2D the most negative weighted impact was assessed on sex life. Sex life was estimated to be more important among men than women. Discussion: The Finnish version of the ADDQoL19 shows individual, value-dependent and culturally different impacts of diabetes on quality of life. The study shows that the impact of diabetes may vary between subgroups and according to many variables, for example, different life situations and value ratings. In many other countries the ADDQoL has shown the most negative weighted impact on the freedom to eat as you wish. Diabetes was assessed to have effects on this domain also in Finland, but it was not considered to be very important. In Finland, it has been campaigned a lot about the risks of diabetes. Together with the discussion about the risks and improving medical care, it is important also to notice the need for psychosocial support in coping with self-care and feelings including fears, worries and concerns about progressing illness.
Keywords: Diabetes, Quality of life
CORRESPONDING AUTHOR: Nuutinen Helena, Finnish Diabetes Association, helena.nuutinen@diabetes.fi
P735
THE DOSE-DEPENDENT ASSOCIATION OF SMOKING AND DEPRESSION IN A COMMUNITY BASED SAMPLE WITH TYPE-2 DIABETES
Clyde M.
McGill University, Psychiatry, Montreal, Canada
Background: Smoking and depression are both independently associated with increased risk of diabetes and diabetes-related complications. However, the association between smoking and depression for people with diabetes remains poorly characterised.
Purpose: Investigate the association between depression and smoking status within a community-based population with type-2 diabetes, while controlling for socio-demographic, diabetes related characteristics and complications, disability, other chronic illness and other health-related variables.
Method: 1868 adults with type-2 diabetes were recruited via random digit dialing for the Montreal Health and Well Being Study (DHS). Smoking was classified as never, former, light (<20 cigarettes a day) and heavy (20+ cigarettes a day). Depression was assessed using the Patient Health Questionnaire-9 and individuals were classified as no major depression vs. major depression syndrome. Logistic regression was used to test the association between major depression and smoking status, while controlling for other demographic and health related variables.
Results: Major depression was associated with an increased likelihood of being a light or heavy smoker, having 2 or more diabetes complications, moderate-severe disability, and having 2 or more other chronic illnesses. Major depression exhibited a dose-dependent association with smoking status. In the fully adjusted model, having major depression was associated with an increased likelihood of being a heavy smoker (OR = 2.23, 95% CI 1.12 – 4.44) and a significant but slightly less pronounced likelihood of being a light smoker (OR = 2.10, 95% CI 1.09 – 4.03).
Conclusions: Smoking and depression are strongly associated in patients with type-2 diabetes, and this association appears to be dose dependent. This finding has important clinical implications given that smoking cessation is an important health recommendation, and potentially means depression status may be an important consideration when targeting clients with diabetes who continue to smoke.
Keywords: Diabetes, Smoking, Tobacco use, Depression, Chronic Disease, Health Behaviors
CORRESPONDING AUTHOR: Clyde Matthew, Mcgill University, Montreal, matthew.clyde@mail.mcgill.ca
P736
PRELIMINARY STUDY OF ASSOCIATION BETWEEN BODY WEIGHT CHANGE AND LABORATORY VARIABLES FROM THE MEDICAL CHECKUP
Yamada K., Eguchi Y., Sakamoto Y., Sugioka T.
Saga University, Faculty of Medicine, Saga, Japan
Background: It is important for primary prevention to establish the methodology of presymptomatic detection. Studies to examine weight variability indicate consistent associations between weight change and negative health outcomes. Japan Public Health Center-based Prospective (JPHC) Study also demonstrated the relation between body weight change and mortality. However, such studies have showed inadequately the health impact of the term of change on the body.
Purpose: The aim of this study was to investigate the association between body weight change and laboratory variables from the medical checkup.
Method: Data from the medical checkup in Saga University Hospital were used. These data were consisted of laboratory variables from blood test (e.g., HDL, LDL, HbA1c, GOT), physical examination (e.g., height, weight, chest circumference), medical history and so forth. A total of 1,214 (426 male and 788 female) were screened, and 387 (129 male and 258 female) who have experienced body weight change during the last year were selected. Other 827 (297 male and 530 female) were without change in body weight during the last year. The term of change was consisted of six categories: (1) without change; (2) slowly change in a year; (3) change in a half year, then without change; (4) change in the last half year; (5) other; (6) with pregnancy. Above four categories except (5) and (6) were used for statistical analysis. The association between the body change and other laboratory variables was evaluated using a partial correlation analysis controlled by age for each gender.
Results: For male, body weight change was significant positive correlation with body mass index (BMI: r = .208, p < .0001), chest circumference (r = .179, p < .0001), and glutamic pyruvic transaminase (GPT: r = .154, p < .01). For female, body weight change was significant positive correlation with BMI (r = .219, p < .0001), chest circumference (r = .215, p < .0001), and triglyceride (TG: r = .128, p < .01). Any other variables were not significant correlation with body weight change for male and female. Results indicated that the shorter the time of weight change the more BMI and chest circumference in male and female, GPT in male, and TG in female.
Conclusion: Our preliminary results may help to detect the association between body weight change and other laboratory variables from the medical checkup. Further research is needed to develop the methodology to prevent a disease from occurring.
Keywords: Prevention, Risk factors, Screening
CORRESPONDING AUTHOR: Yamada Kosuke, Saga University, Saga, yamadakc@cc.saga-u.ac.jp
P737
RESPONDING TO COGNITIVE CONCERNS (RECOG): GROUP COGNITIVE REHABILITATION FOR CANCER SURVIVORS HAS THE POTENTIAL TO ENHANCE COGNITIVE FUNCTION AND QUALITY OF LIFE
Schuurs A., Green H.
Griffith University, Applied Psychology, Gold Coast, Australia
This research aimed to address the gap in evidence-based treatment available for cancer survivors who are experiencing cognitive dysfunction. The research aim was to test the feasibility of a group cognitive rehabilitation intervention designed to improve cognitive function and quality of life for people who have completed cancer treatment. Three groups of adults were recruited: an intervention group of 23 cancer survivors who completed a 4-week group cognitive rehabilitation treatment, a comparison group of 9 cancer survivors, and a matched community sample of 23 adults who had never experienced cancer. The manualised “ReCog” intervention was developed by the authors for this study and was delivered by a clinical health psychologist and a provisionally registered psychologist, in small groups of 4-8 participants. The two comparison groups completed assessments but did not receive the intervention. Measures of objective and subjective cognitive functions, quality of life, psychosocial distress, and illness perceptions were used. The results indicated that the intervention was effective in improving overall cognitive function, visuospatial/constructional performance, immediate memory, and delayed memory beyond practice effects alone. It was helpful in reducing participants’ perceptions of cognitive impairment and psychosocial distress, as well as promoting social functioning and understanding of cognition. The improvements were maintained at three months after the intervention. Participants reported a high level of satisfaction with the treatment. The results provided evidence for the feasibility of a brief group-based cognitive rehabilitation intervention to treat cognitive problems experienced by cancer survivors.
Keywords: Cancer survivorship, CBT, Cognitive factors, Rehabilitation, Treatment
CORRESPONDING AUTHOR: Green Heather, Griffith University, Gold Coast, h.green@griffith.edu.au
P738
QUALITATIVE AND QUANTITATIVE ANALYSIS OF COGNITIVE PROBLEMS IN CANCER SURVIVORS ATTENDING A GROUP COGNITIVE REHABILITATION PROGRAM
Schuurs A., Green H.
Griffith University, Applied Psychology, Gold Coast, Australia
Although cognitive problems are an increasingly recognised issue affecting some cancer survivors, mechanisms are poorly understood. The self-regulatory model of illness perceptions shows promise for understanding cognitive issues for cancer survivors but has not previously been applied in this population. This study was the first to examine illness perceptions regarding cognitive function for cancer survivors. Survivors responded to open-ended questions regarding perceived cognitive problems and their impact. In addition, associations among objective and subjective cognition, psychosocial distress, quality of life, and illness perceptions were examined. Participants were 32 survivors of adult-onset non-CNS tumours (comprising 23 participants who completed a cognitive rehabilitation intervention and 9 participants who completed assessments only) plus a matched community sample of 23 adults with no cancer history. Standardised measures assessed objective and subjective cognition, psychosocial distress, quality of life, and illness perceptions. Cancer survivors who reported poor subjective cognitive function were also significantly more likely to report psychosocial distress, low quality of life and to view their impairment as having high consequences and emotional impact, and had a stronger identification with cognitive impairment. It was noted that while there was an expected discrepancy between objective and subjective cognitive function for the intervention group, this did not hold true for either comparison group. Illness perceptions appeared to play a role in influencing the associations between objective and subjective cognitive function for cancer survivors. This finding suggests that illness perceptions may play a key mediating or moderating role between subjective and objective cognition and offers novel evidence that illness perceptions may be a key component missing from current models of cognitive dysfunction for cancer survivors. It is hoped that this study can provide a valuable stepping stone towards further research into the factors which influence subjective and objective cognition function for cancer survivors.
Keywords: Cancer survivorship, Cognitive factors, Health beliefs, Rehabilitation, Treatment
CORRESPONDING AUTHOR: Green Heather, Griffith University, Gold Coast, h.green@griffith.edu.au
P739
THE RELATIONSHIP BETWEEN RATIONALITY/ANTI-MOTIONALITY AND PSYCHOSOCIAL STRESS, RESILIENCE
Toyama H.1, Yajima J.2, Onoda A.1
1 Beppu University, Graduate School of Clinical Psychology, Beppu, Japan
2 Beppu University, Department of Human Studies, Beppu, Japan
Purpose: TypeC personality is described by harmony-seeking and rationality/anti-emotionality which can be the risk factor for cancer. On the other hand, rationality/anti-emotionality is also thought as indispensable skill to social adaptation (Aobayashi, 2011). Ishihara (2011) suggested that high anti-emotionality which can control emotions adequately may contribute to the quality of life and psychological wellbeing. However, low rationality/anti-emotionality have not been fully verified. Thus, this study investigates the relationship between rationality/anti-emotionality and stress, resilience.
Method: Participants were 79 university students (34 males, 45 females, 20.7 years old). They were asked to complete Short Interpersonal Reactions Inventory which can measure typeC trait. Then, they were classified into high or low rationality/anti-emotionality groups with that average. The measurement of psychosocial stress was used Waseda Shyness Scale, Stress Response Scale-18 and UCLA loneliness scale. The measurement of resilience was used S-H Resilience test.
Results: Low group was significantly higher at the tension, depression, anger, loneliness and lower at the autonomy/healthy, self-efficacy than high group. Furthermore, a path analysis showed two ways leading rationality/anti-emotionality. One was a direct that loneliness and autonomy/healthy was related to rationality/anti-emotionality, the other was an indirect that self-efficacy, social-support, lack of confidence, anti-sociality and depression were related to rationality/anti-emotionality (CHI-square = 17.352, GFI = 0.947, AGFI = 0.854, RMSEA = 0.066). Discussion: These results described that low group may have the characteristics of high stress response and vulnerability of resilience. Moreover, the result of path analysis indicated that loneliness and autonomy/healthy, both have different nature in terms of social adaptation, are related to rationality/anti-emotionality at the same time. This result is backed up from the previous study in part (Aobayashi, 2011). Thus, it is suggested that whether to be adaptive rationality/anti-emotionality depends on cognitive process or coping strategy.
Keywords: Cancer, Personality, Risk factors, Self-efficacy
CORRESPONDING AUTHOR: Toyama Hiroyuki, Beppu University, hiroyuki_toyama_psychology@yahoo.co.jp
P740
THE RELATIONSHIP BETWEEN TRAUMATIC STRESS, EXPERIENTIAL AVOIDANCE, AND DEPRESSION IN PARENTS OF CHILDREN RECENTLY DIAGNOSED WITH CANCER
Cernvall M.1, Skogseid E.2, Ljungman L.1, Ljungman G.3, Von Essen L.1
1 Uppsala University, Department of Public Health and Caring Sciences, Uppsala, Sweden
2 Uppsala University, Departament of Psychology, Uppsala, Sweden
3 Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Parents of children recently diagnosed with cancer can experience severe psychosocial distress. Experiential avoidance has been defined as the tendency to avoid or escape from certain private experiences (e.g., thoughts, feelings, memories) or contexts that elicit them (Hayes et al., 1996). This construct has been shown to be linked to negative outcomes in several populations and has received increased interest as a target for intervention. The purpose of this study was to investigate the relationship between traumatic stress, experiential avoidance, and depression in parents of children recently diagnosed with cancer. It was hypothesized that experiential avoidance would account for the relationship between traumatic stress and depression.
48 parents (33 mothers and 15 fathers) of children recently diagnosed with cancer and who participated in the screening/pre-assessment of a RCT of a psychosocial intervention were included in the current cross-sectional study. The mean (SD) of months since the child’s diagnosis was 3.5 (1.8). Parents provided self-report of demographic characteristics, general anxiety, traumatic stress, experiential avoidance, and depression.
Hierarchical regression was used with depression as dependent variable. In step 1 demographic variables and general anxiety was entered (∆R2 = .57, p < .001). In step 2 traumatic stress was added resulting in a significant increase in explained variance (∆R2 = .04, p < .05, β for traumatic stress = 0.39, p < .05). In step 3 experiential avoidance was added resulting in a significant increase in explained variance (∆R2 = .06, p < .05, β for experiential avoidance = 0.35, p < .05). Furthermore, traumatic stress was no longer a significant predictor of depression (β = 0.15, p = 40). Total R2 in the final model was .68. Mediation analysis (Preacher & Hayes, 2008) confirmed a significant indirect effect from traumatic stress to depression via experiential avoidance (estimate = 0.21, bootstrap 95% CI = 0.03-0.38).
The current results suggest that experiential avoidance accounts for the relationship between traumatic stress and depression in parents of children recently diagnosed with cancer. Experiential avoidance could be a potential target in psychosocial interventions for this group.
Keywords: Cancer, Family, Depression.
CORRESPONDING AUTHOR: Cernvall Martin, Uppsala University, Uppsala, martin.cernvall@pubcare.uu.se
P741
ASSESSING SENSE OF COHERENCE: THE IMPACT OF BREAST CANCER IN AN OLDER POPULATION
Carneiro F., Von Humboldt S., Carvalho C.
ISPA Universitary Institute, Research Unit in Psychology and Health, Lisbon, Portugal
Introduction: Aging encompasses several losses in biological, psychological and social dimensions. Yet, innumerous gains should be emphasized. Since breast cancer is the most frequent cancer among the feminine gender, its diagnosis and treatment can indicate a significant impact on the individual’s psychological structure and on his sense of coherence (SOC).
Aims: This research aims to: (a) analyze differences in elderly women’s SOC with breast cancer and (b) assess the existence of an association between breast cancer and older women’s SOC.
Methods: The sample consisted of one hundred and twenty four older women (mean age = 82.4; SD age = 6.2; range age 74-96), from which, 62 have breast cancer in remission. Participants were assessed with the following questionnaires: ii) the Sense of Coherence Scale, ii) the Mini-Mental Sate Examination (MMSE) and iii) demographic information (65.3% married¸68.5% pensioners).
Results: We have found a higher SOC’s score (MSOC = 4.6) for older women with breast cancer in remission, by comparison with the control group (MSOC = 4.4), in a seven-point Likert scale. All estimates were statistically significant (p < .01).
Conclusions: This study stresses the impact breast cancer on older women’s SOC, hence contributing to a behavioral approach to elderly people. Implications of this finding in clinical approaches are discussed.
Keywords: aging; behavioral approach; breast cancer; elderly; health promotion; sense of coherence
CORRESPONDING AUTHOR: Carneiro Francis, ISPA , fran_teplitzky@hotmail.com
P742
BREAST CANCER IN ELDERLY WOMEN: MEASURING THE OUTCOMES OF THE SENSE OF COHERENCE
Carneiro F., Von Humboldt S., Carvalho C.
ISPA Universitary Institute, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: Recent literature highlights gerontic boomers, in consequence of the exponential growth of the older population. As the incidence of breast cancer in elderly women has been increasing, it is of relevance to examine the impact of breast cancer on elderly women’s sense of coherence (SOC), particularly in the SOC’s dimensions, namely comprehensibility, significance and management. The aims of our study are the following: 1) to examine the degree of comprehensibility, management and significance sub-dimensions of SOC in elderly women with breast cancer in remission; and 2) to compare the scores from these three sub-dimensions between elderly women with and without breast cancer.
Methods: One hundred and twenty four elderly women with age above 74 years comprised the convenience sample of this study. Participants were divided in two groups, with and without breast cancer in remission. For the purposes of this study, the (i) Sense of Coherence Scale, (ii) the Mini-Mental Sate Examination (MMSE) and (iii) demographics were included (65.3% married; 90.3% catholics; 42.7% living in cities. All participants were cognitively capable.
Results: Results indicated that elderly women with breast cancer scored higher in the totality of the subscales: ‘Comprehensibility’ (MCOMP = 4.6), ‘Management’ (MMAN = 4.7) and ‘Significance’ (MSIG = 4.6), in comparison to the control group (MCOMP = 4.3; MMAN = 4.6; MSIG = 4.4). All estimates were statistically significant (p < .01).
Conclusions: This study illuminates the effects of breast cancer on the three SOC’ dimensions, hence the importance of the development of appropriate behavioral strategies for facing aging challenges. Recommendations for future research on older women' breast cancer and clinical practice are also discussed.
Keywords: aging; behavioral strategies; breast cancer; elderly women; health promotion; sense of coherence
CORRESPONDING AUTHOR: Carneiro Francis, ISPA, fran_teplitzky@hotmail.com
P743
POSITIVE CONSEQUENCES OF CANCER AS A PSYCHOLOGICAL TRAUMA
Tanyi ZS.1, Bugán A.1, Szluha K.2
1 University of Debrecen, Department of Behavioural Sciences, Debrecen, Hungary
2 University of Debrecen, Department of Radiotherapy, Debrecen, Hungary
Background: Posttraumatic growth (PTG) is „the experience of positive change that occurs as a result of the struggle with highly challenging life crises” (Tedeschi & Calhoun, 2004). According to the growing literature significant percentage of cancer patients experience personal growth. Previous studies have found inconsistent relationships between PTG and demographic factors, illness-related factors, quality of life and adult attachment. The aim of our research was to explore the nature of these relationships.
Methods: A cross-sectional study was carried out with a sample of 150 cancer patients (breast and prostate cancer) (age > 18), who were asked to complete the Post Traumatic Growth Inventory (Tedeschi and Calhoun, 1996), the Experiences of Close Relationship Short Version (Brennan et al., 1998), the Functional Assessment Cancer Therapy General version (Cella et al., 1993) and a questionnaire about demographic variables and characteristics of cancer.
Results: 99% of cancer patients experienced positive change at least on one field. The most reported domains of growth were greater sense of personal strength (98,6%, N = 150), increased appreciation of life (98%, N = 150) and more intimate relationships with others (98%, N = 150). Preliminary analyses (N = 48) found no relationship between adult attachment and PTG. Greater social/family well-being was accompanied by higher posttraumatic growth (p = 0,000).
Discussion: The results of our study prove the presence of positive sequels of living with a cancer diagnosis.
Keywords: posttraumatic growth, cancer, quality of life
CORRESPONDING AUTHOR: Tanyi Zsuzsanna, University of Debrecen, tanyi.zsuzsanna@gmail.com
P744
PREDICTORS OF POSTTRAUMATIC GROWTH IN SURVIVORS OF STROKE
Pereira M.G., Baganha C., Fernandes S., Machado A., Santos G., Vieira C.
University of Minho, Applied Psychology, Braga, Portugal
Introduction: In general, research shows the relevance of posttraumatic growth (PTG) in chronic disease as positive psychological or personal changes in the aftermath of the diagnosis emphasizing the relationship between PTG and psychological adaptation. Since stroke is a very stressful situation that endangers one’s life, stroke victims may also report these positive changes as a result of the even or through the efforts to cope with the event. This study focused on the predictors of posttraumatic growth in stroke patients taking in consideration ruminative thoughts regarding the stroke, traumatic symptoms and, quality of life as well as the relationship among these variables.
Method: The sample consisted of 82 AVC patients collected mainly in health care centers in the North of Portugal, 49% were men. Average age of the sample was 67. The instruments used were: Medical Outcome Study (MOS-20), Stewart, Hays & Ware (1998), Event Related Rumination Inventory (ERRI) Cann, Lawrence & Calhoun, 2010) Posttraumatic Growth Inventory (PTGI)-short form (Canna, et al., 2010).and the Impact of Events Scale (IES-R), (Weiss & Marmar, 1997).
Results: Predictors of posttraumatic growth were: number of strokes, quality of life, and ruminative thoughts. The model explained 33% of variance. Results also showed positive correlations between traumatic symptoms and posttraumatic growth as well as between posttraumatic growth and quality of life. Ruminative thoughts were also positively associated to traumatic symptoms and posttraumatic growth. Younger patients had more posttraumatic growth. No differences were found regarding gender.
Conclusion: Results revealed the importance of the relationship among traumatic symptoms, ruminative thoughts, and posttraumatic growth. According to results, it is important that interventions in patients who suffered a stroke be designed in a way that includes the posttraumatic growth experience since it is associated to a better quality of life. Future research should focus on the contribution of posttraumatic growth in coping with stroke as well as for changes in lifestyle, particularly preventive health behaviors in order to minimize the occurrence of future strokes.
Keywords: illness behaviour; beliefs; growth
CORRESPONDING AUTHOR: Pereira M. Graça, University of Minho, Braga, gracep@psi.uminho.pt
P745
PERCEPTION OF ILLNESS AND SOCIAL SUPPORT IN WOMEN WITH RHEUMATOID ARTHRITIS
Rojas G.1, Moncada L.2, Porre M.2, Sassenfeld A.2, Herrera A.1, Sabugo F.3, Wurmann P.3, Cuchacovich M.3
1 Universidad de Chile, Department of Basic and Community Sciences, Santiago, Chile
2 Universidad de Chile, Department of Psychology, Santiago, Chile
3 Universidad de Chile Clinical Hospital, Department of Medicine, Santiago, Chile
Objective: The aim of this study was to identify the perceptions about disease, social support and quality of life in adult women with Rheumatoid Arthritis (AR).
Methods: Qualitative and exploratory design using narrative analysis to identify perceptions about the disease in AR patients with confirmed diagnosis based on ACR criteria. Fourteen (14) adult women (33 to 76 years old) took part in eight sessions of group discussion which were recorded.
Results: Three fields of meanings (categories) were identified; personal and family impact, emotional reaction and social relationship. The disease is perceived as a very disabling condition that changes social role. Great difficulties in emotional expression, low knowledge of joint characteristics and rejection of physical restrictions due to impairment were the main conditions observed in the patient.
Conclusions: The appearance of the disease is perceived as a vital break in the personal life history, which leads to a social role restructuring with adaptation difficulties. A suitable communication with the physician and therapeutic group participation are seen as an important instrumental and emotional support for a new life situation adjustment.
Keywords: Social support Chronic disease Health beliefs
CORRESPONDING AUTHOR: Rojas-Alcayaga Gonzalo, University of Chile. Santiago., grojasalcayaga@yahoo.es
P746
QUESTIONNAIRE FOR SURVEY ON RELATIONSHIP BETWEEN SELF-CARE PRACTICE STATUS AND SELF-EFFICACY IN PATIENTS WITH SECONDARY LOWER-EXTREMITY LYMPHEDEMA—WITH FOCUS ON LYMPHATIC DRAINAGE
Fukuda R.1, Akazawa C.1, Arakawa C.2, Yamamoto M.3
1 Kyoto University, Graduate School of Medicine, Human Health Science, Kyoto, Japan
2 University of Shiga Prefecture, Faculty of Human Nursing Science, Hikone, Japan
3 Kansai University of Nursing and Health Sciences , Faculty of Nursing, Awaji, Japan
Background: Complex physical therapy (CPT) is recommended for preventing exacerbation of secondary lymphedema and for improving edema, however, most patients discontinue CPT.
Purpose: Our study was aimed at assessing the relationship of self-efficacy (SE) and continuation of self-care practice for lymphatic drainage (LD) by patients with secondary lower-extremity lymphedema.
Methods: We included 118 secondary lower-extremity lymphedema patients who visited the lymphedema counseling office of the A university hospital. The exclusion criteria were (1) patients whose native language was not Japanese and (2) patients with dementia. The survey was conducted by mailing unsigned, self-administered questionnaires to patients from January to February 2011. The questionnaire included questions on the subject’s background (such as age and the time of onset of lymphedema), continuation status of self-care practices for LD and compression therapy, reasons for discontinuing self-care (for subjects who had discontinued self-care), and characteristic SE scale items. The score range of the SE scale was 23–115. We used the Statistical Package for the Social Sciences (SPSS) software version 17.0 for analysis. After compiling descriptive statistical data, we grouped the patients and examined the differences in SE scale scores on the basis of LD continuation status (LD continuing and discontinued groups) and practice (complete practice and partial practice groups). The present study was conducted after obtaining the approval of the ethics committees of the respective institutions of the researchers.
Results: The survey questionnaire recovery rate was 64.4% (76 subjects). After excluding respondents with 50% or more non-response rate of questionnaire items and those who did not respond to the questionnaire items for self-care status or SE scale, we analyzed the responses of 63 subjects. The average age of the subjects was 57.9 years, average time elapsed since surgery was 8.9 years, average onset time of lymphedema was 2.7 years after surgery, and average SE scale score was 78.1.
Although 43 subjects (68.3%) continued LD, only 13 (30.2%) implemented drainage for all the required sites (complete practice group). No difference in SE scale scores was observed between the 2 LD continuation status groups (p = 0.71) or the 2 LD practice groups (p = 0.27). However, the SE scale scores of the complete practice group tended to be higher than those of the partial practice group.
Conclusion: To encourage the use of proper procedures during LD, patients with low SE scale scores should be repeatedly educated on self-care procedures, or the LD procedure of these patients should be verified.
Keywords: secondary lymphedema, self-care, self-efficacy
CORRESPONDING AUTHOR: Fukuda Risa, Kyoto University, rfukuda@hs.med.kyoto-u.ac.jp
P747
THE RELATIONSHIP BETWEEN QUALITY OF LIFE AND EFFICACY IN SELF-CARE IN PATIENTS WITH SECONDARY LYMPHEDEMA OF THE LOWER EXTREMITIES
Akazawa C.1, Arakawa C.2, Fukuda R.1, Yamamoto M.3
1 Kyoto University, Department of Nursing Sciences, Graduate School of Human Health Sciences, Kyoto, Japan
2 University of Shiga Prefecture, Department of Nursing, Hikone, Japan
3 Kansai University of Nursing and Health Sciences, Department of Nursing, Awaji, Japan
Objective: This study investigates the relationship between quality of life (QOL) and efficacy in self-care in patients with secondary lymphedema of the lower extremities.
Method: This is a cross-sectional study, including 118 patients with secondary lymphedema of the lower extremities. The exclusion criteria were as follows: (1) those patients whose mother tongue was not Japanese and (2) those with senile dementia. The contents of the survey included backgrounds of the subjects, such as age and time of lymphedema onset, and a Japanese version of the general Self-Efficacy (SE) scale. The range of scores on the SEscale was 23–115 points. The Short Form-36 Health Survey version 2 (SF-36v2) was the main outcome index. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS)version 17.0 for Microsoft Windows; after descriptive statistical analyses,the correlations between the 8 subscale scores of SE scale and SF-36 v2 were evaluated, with the summary scores representing physical and mental healths (PCS and MCS, respectively).These summary scores are overall QOL evaluations that aid in evaluating the concept of QOL from both physical and mental perspective of the patient. This study was conducted with the approval of the ethics committee of the institution to which the author is affiliated.
Results: The response rate was 64.4% (76 subjects). The analysis was conducted on 51 respondents after eliminating those who did not answer any of the questions concerning SE and QOL. The average age of the subjects was 58.3 ± 9.6 years, the average number of years after surgery was 9.1 ± 6.7 years, and the average time of onset of lymphedema was 2.8 ± 3.5 years after surgery. The average SE score was 60.6. The 8 SF-36v2 subscale scores were lower than that of the national standard in 50–70% of the subjects, and the PCS and MCS averages were 44.1 ± 13.5 and 49.9 ± 8.6, respectively. A negative correlation was observed between SE and SF-36v2 scores in terms of role functioning (P = 0.04; r = -.29).
Discussion: The results of this study showed that self-efficacy increases when QOL decreases and these results are considered to be related to the continuity of self-care. However, since this is a cross-sectional study, and because there are no clear causal relationship between the continuity of self-care and improvement in QOL, future longitudinal studies are required.
Keywords: self-efficacy, lymphedema
CORRESPONDING AUTHOR: Akazawa Chiharu, Kyoto University, chiakz@hs.med.kyoto-u.ac.jp
P748
SELF-CARE BEHAVIORS AND QUALITY OF LIFE IN LIVER TRANSPLANT RECIPIENTS
Teraguchi S.1, Akazawa C.2, Kumano K.3, Nishizono T.4
1 Tenri Health Care University, Department of Nursing Sciences, TENRI, Japan
2 Kyoto University, Department of Nursing Sciences, Graduate School of Human Health Sciences, Kyoto, Japan
3 Seirei Hamamatsu Hospital, Department of Nursing, Hamamatsu, Japan
4 Osaka Medical College, Department of Nursing Sciences, Takatsuki, Japan
Objective: We examined self-care after hospital discharge and quality of life (QOL) in adult recipients after living-donor liver transplantation.
Subject: The eligibility criteria for liver transplant recipients in this study were age of 20 years or older at the time of transplant, receive transplantation at the hospital in affiliation with A University School of Medicine, we considered 233 eligible recipients.
Method: Between October 7, 2011 and October 24, 2011, the unsigned self-report questionnaire survey was sent to the subjects by mail. We surveyed the attributes of the subjects, factors that might influence subject’s self-care behaviors, and post transplantation course. The self-care behaviors were defined according to the ‘Guidebook for liver transplantation’ issued by the A University School of Medicine. The Medical Outcomes Study Short-Form Survey version 2 (SF-36v2) was used as the QOL measure. The data were analysed using Statistical Package for the Social Sciences (SPSS). Further, we performed simple tabulation, chi-square test, and Fisher exact test.
Results: We obtained 72.7% responses. The mean age of the respondents was 50.6 ± 14.5 years (men, 125; women, 108). Significant subscale differences observed for the parameters are listed as follows: (1) ‘The presence of taking medicine’, subscales physical function (PF)(p = 0.32), and role-emotional (RE)(p = 0.01); (2) ‘Hand washing’, vitality (VT)(p = 0.03), mental health (MH)(p = 0.03), and mental component summary(MCS)(p = 0.21); (3) ‘Gargle’, body pain (BP)(p = 0.03),and MCS(p = 0.001); (4) ‘Mask’, BP(p = 0.14),and MCS(p = 0.46); (5) ‘Consultation to family physician,’ SF(p = 0.009), and MH(p = 0.034). (6) ‘drinking’, BP(p = 0.007); (7) ‘smoking’, Role physical high score (p = 0.41).
Conclusion: Those who engage in health-promoting self-care behaviors, such as medication compliance, infection prevention and frequent health-care-seeking, tend to have higher QOL scores. Among the infection preventing self-care behaviors, handwashing and gargling are significantly correlated with many QOL variables, however, mask-use is correlated with few QOL variables. We observed two behaviors contrary to health promotion practices: alcohol drinking and smoking. Among the smokers those who have high scores of Role-Physical tend to have high QOL scores but overall the smokers tend to have low QOL scores. The alcohol drinkers tend to show high QOL scores. It indicates the possibility that those who improve their physical condition after surgery tend to return to their undesired behavior of alcohol drinking.
Keywords: liver transplant, quality of life, SF-36, self-care behaviors
CORRESPONDING AUTHOR: TERAGUCHI Sayoko, Tenri University, Tenri, teraguchi@tenriyorozu-u.ac.jp
P749
“YOU NEED A HEART TO UNDERSTAND A PATIENT WITH KIDNEY DISEASE:” HOW PATIENTS WITH CHRONIC KIDNEY DISEASE IN INDIA VIEW THEIR ILLNESS AND WHAT DO THEY EXPECT FROM PROVIDERS?
Chatterjee N.1, Shete M.2
1 Johns Hopkins University Center for Communication Programs (JHUCCP), Behavior Change Communication, New Delhi, India
2 Apex Kidney Care, Nephrology, Mumbai, India
Understanding patient perspectives helps in planning and improving quality of health care; especially in chronic kidney disease (CKD) where patients spend significant resources on care and are dependent on providers and family. This exploratory, qualitative study contributes to scant data in this area. In-depth interviews were conducted with 18 patients (11 males, 7 females) on dialysis in Mumbai. Six themes, classified as 6 F’s, emerged from the analysis: 1) Lack of FAITH in providers; 2) FINANCIAL Burden; 3) FEELINGS of Helplessness; 4) Desertion by FRIENDS and FAMILY; 5) FATE; and 6) FIGHT.
Patients blamed misdiagnoses or mistreatment of a past condition on the current kidney malfunction. They felt the healthcare system was uninterested in patient wellbeing; CKD care focused on dialysis and not their lives. Many talked about trying alternative therapies. Diagnosis of CKD and subsequent dialysis dramatically altered patients’ lives; which became severely restricted, as did their physical functioning, lifestyle, diet. This made them call their lives “partial” or “deficient.” Along with health, their social mobility spiraled downward due to financial setbacks; many had to sell homes to pay for treatment. Friends and family members avoided patients because of fear that they may seek monetary help. However, one family member stood by them - a spouse, sibling, uncle, parent, or friend. Patients considered themselves a curse upon their families; this led to some patients contemplating suicide; however, they also attributed CKD to destiny or fate - a common reaction to adverse events in the Indian cultural context. Patients found this reaction useful in coping with distress. Finally, patients felt one had to find the will to fight back. The motivation to fight came from three sources: seeing another patient; setting goals for the future; and a supportive family.
Patients expected better provider communication with patient and family, a move from organ-centered to relationship-centered care, psychosocial support, setting of life goals, and improvement of quality of life. This requires the integration of behavioral medicine principles with the CKD care they receive.
Keywords: Chronic Kidney Disease (CKD), Adjustment, Illness perceptions, Qualitative research
CORRESPONDING AUTHOR: Chatterjee Nilesh, JHUCCP, nileshchatterjee@gmail.com
P750
ASSOCIATIONS BETWEEN ILLNESS REPRESENTATIONS AND HEALTH-RELATED QUALITY OF LIFE IN INJURED ADULTS: A BRIEF COGNITIVE-BEHAVIOURAL THERAPY EARLY INTERVENTION
Barnier J.1, Green H. 1, Chaboyer W.2
1 Griffith University, Applied Psychology, Gold Coast, Australia
2 Griffith University, Nursing and Midwifery, Gold Coast, Australia
Recovery and health-related quality of life (HRQoL) following injury can be predicted by illness perceptions regarding injury. Psychological interventions targeting illness perceptions have facilitated HRQoL in other medical conditions but no published research has evaluated such interventions regarding mild to moderate injury. In the present study, a brief cognitive behavioural therapy (CBT) early intervention targeting illness perceptions was developed and was predicted to improve HRQoL. Participants were 28 adults injured within the past 6 months who had consequently experienced limitation from participating in physical activities such as running, strenuous sports, or lifting heavy objects. They completed measures of quality of life (SF-12), illness representations (Illness Perceptions Questionnaire Revised, IPQR) and mental health symptoms (Depression, Anxiety and Stress Scale). Participants were allocated to either a control or treatment group. Treatment involved two sessions of CBT intended to facilitate helpful illness representations. Control participants received standard medical care. It was found that the Identity perceptions predicted physical health, and that Consequences and Emotional Representations predicted mental health. Treatment participants reported a trend to greater improvement in personal control over their injury than the control group at post-treatment. Moreover, following intervention, treatment participants’ depression and stress scores had improved from mildly elevated to within normal limits. Finally, the treatment group reported improved physical health following the intervention, to a significantly greater extent than control group improvements. These findings suggest that a brief manualized CBT intervention can assist individuals who have sustained a mild to moderate injury to improve recovery from injury and HRQoL.
Keywords: Injury, Pain, CBT, Prevention, Rehabilitation
CORRESPONDING AUTHOR: Green Heather, Griffith University, Gold Coast, h.green@griffith.edu.au
P751
COMPLIANCE IN DYSTONIA
Leplow B., Schönfeld R.
Martin-Luther-University, Halle, Department of Psychology, Halle(Saale), Germany
Dystonia is a disorder of the Basal Ganglia with numerous psychophysiological characteristics. Symptoms are influenced by a large variety of behavioural, emotional and cognitive factors. Despite the fact that dystonia can by treated by Botulinum Toxin (BTx) and Deep Brain Stimulation it cannot be cured. The course of dystonic disorders still remain unclear and many patients do not comply to medical treatment. Thus we investigated health behaviour and compliance in 247 patients with spasmodic torticollis of the idiopathic type. Patients were evaluated with respect to their counts of medical, psychological and paramedical treatments. Furthermore, compliance to BTx treatment protocols were assessed. Results show that patients underwent a mean of 14 different treatments including numerous paramedical and religious methods. Though BTx treatment was rated "quite" effective by most of the patients most of them still complained about their disabling condition. A substantial proportion of about 31% of the patients did not comply to BTx treatment protocol, thus undergoing BTx treatment less than once a year. Dysfunctional health behaviour (i.e., numerous paramedical treatments) and non-compliance (i.e. BTx less than once a year) was not related to anxiety or depression, severity of the disease, or duration of the condition. Instead, mental disorders prior to the onset of dystonia were associated with non-compliance and an elevated number of additional non-medical and paramedical treatment approaches. Thus, medical treatment of spasmodic torticollis patients has to be accompanied by thorough psychological assessment including the premorbid health status, patient education programmes, and other approaches from Behavioral Medicine (i.e., symptomatic control by behavioral strategies, enhancement of stress competence etc.).
Keywords: Spasmodic Torticollis, Dystonia, Botulinum Toxin, Compliance, Psychology
CORRESPONDING AUTHOR: Leplow Bernd, Martin-Luther-University, Halle, bernd.leplow@psych.uni-halle.de
Conflict of Interest: The study was sponsered by PharmAllergan. The Ethic committee of the German Society of Psychology (DGPs) has approved the study.
P752
TYPE D, SELF-PERCEIVED HEALTH AND INFECTIONS
Izdebski P.1, Ossowski R.1, Buczkowski K.2
1 Kazimierz Wielki University, Institute of Psychology, Bydgoszcz, Poland
2 Nicholaus Copernicus University, Collegium Medicum in Bydgoszcz, Torun, Poland
We have performed a study that wanted to find some relations among Type D, self-perceived health and infections. There are some suggestions that Type D (created by Johan Denollet) may have influence on health and in this way also infections.
Methods: Type D was measured with DS-14 (Polish version) – it measures Negative Affectivity and Social Inhibition, self-perceived health with self a Likert scale of self-evaluation (from very bad to very good), the number of infections during one year was assessed on the basis of patients statement and checked in by a GP in medical data. 61 patients were assessed (women: N = 34; men: N = 27), age: M = 47.85 (SD = 9.66). The sample was representative for Polish patients living in a city.
Results: We have not supported the idea of a relation between Type D with number of infections. We supported the idea that self-perceived health is associated with Type D. The correlation between Type D and self-perceived health was r = .45 (p < .001); for social inhibition and self perceived health r = .35 (p < .07); for negative affectivity and self-perceived health r = .47 (p < .001).
Conlusions: Type D is not associated with number of infections. Type D is associated with self-perceived health. The higher the levels of Type D, the lower the self-perceived health. Negative Affectivity is a more important factor. The question is open whether lower self-perceived health is caused by Type D and Negative Affectivity or whether worse perception of one’s health is a symptom of Type D.
Keywords: Type D, self-perceived health, infections
CORRESPONDING AUTHOR: Izdebski Pawel, K. Wielki Univ., Bydgoszcz, pawel@ukw.edu.pl
P753
MODERN HEALTH WORRIES IN ADOLESCENTS
Freyler A.
Eotvos University, Faculty of Education and Psychology, Psychology PhD Health- and Personality Program, Budapest, Hungary
Introduction: Modern Health worries (MHW) are concerns about the perceived harmful effects of modern life. They not only occur among adults but also among children. The new generation today is growing up in a world using modern technologies; which obviously involves some risks and perceived threats. If the child is exposed to the modern environmental concerns from different sources (e.g. parent’s modelling effect), this increases the chance to develop modern health worries in his/her life.
Studies, so far, have only examine adult age groups, thus we aimed to study a younger age group: adolescents.
Materials & Methods: We conducted a cross-sectional questionnaire study. Our sample involved 480 Hungarian pupils of secondary schools (age: 14-19 yrs). They completed a set of questionnaires consisting of 7 scales: the Modern Health Worries Scale, the Somatosensory Amplification Scale, the Patient Health Questionnaire-15; the Spielberger Trait Anxiety Scale, and the Short Health Anxiety Inventory. In addition, we analysed the psychometric properties of the factor-structure of the Modern Health Worries Scale on this sample.
Results: Modern health worries were associated with somatosensory amplification, health anxiety and physical symptoms in adolescents. Furthermore, somatosensory amplification and health anxiety are mediators between somatic symptoms and MHW.
Discussion: The results are similar to the studies based on adult samples. The confirmatory factor analysis confirmed the four-factor model, and the fit of the model was close to the values of well-fitting models.
Keywords: health, modern health worries, adolescents, somatosensory amplification, anxiety, body symptoms
CORRESPONDING AUTHOR: Freyler Anett, ELTE PPK PDI, Budapest, freyler_anett@yahoo.de
P754
HOW MANY TYPES OF MEDICALLY UNEXPLAINED SYMPTOMS: ONE OR MANY, OR BOTH AT THE SAME TIME? A BIFACTOR APPROACH TO THE LATENT STRUCTURE OF SOMATIC SYMPTOMS
Witthöft M., Hiller W., Loch N., Jasper F.
University of Mainz, Department of Clinical Psychology and Psychotherapy, Mainz, Germany
Medically unexplained symptoms are the hallmark of somatoform disorders and functional somatic syndromes. Although the latent structure of somatic symptoms remains unclear it is common to calculate sum scores of somatic symptom scales as dimensional measures of somatic symptom distress. We examined the latent structure of somatoform symptoms by means of the PHQ-15 questionnaire (i.e., a popular symptom checklist) and provide support for the construct validity of our model. The data was analyzed using nonparametric confirmatory factor analysis in a general population sample (Study 1; N = 414) and in a sample of primary care patients (Study 2; N = 308). Four different latent structure models of somatoform symptoms were compared: A general factor model, a correlated first-order factor model, a higher-order factor model and a bifactor model. In Study 1, a bifactor model with one general factor and four orthogonal symptom type factors (i.e., gastrointestinal, pain, fatigue, and cardio-pulmonary symptoms) showed the best model fit (CFI = .98; RMSEA = .04). The superior model fit of the bifactor model could also be confirmed in the primary care sample (Study 2; CFI = .97; RMSEA = .05). Additionally, the model explained 59% of the variance of the Irritable Bowel Syndrome (IBS). In this structural equation model, both the general factor (14%) as well as the gastrointestinal symptom factor (42%) significantly predicted the IBS. The findings of both studies help to clarify the latent structure of medically unexplained symptoms. The bifactor model outperformed alternative models, demonstrated external validity, and might guide further research on the causes, consequences, and correlates of medically unexplained symptoms and related clinical conditions, i.e., somatoform disorders and functional somatic syndromes.
Keywords: Assessment; Research methods; Irritable bowel syndrome
CORRESPONDING AUTHOR: Witthöft Michael, University of Mainz, Mainz, witthoef@uni-mainz.de
P755
ANALYZING OLDER ADULTS’ QUALITY OF LIFE: RESULTS FROM SF-6D
Von Humboldt S., Leal I.
University Institute of Applied Psychology, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: This quantitative research aims at examining the relationships between older adults’ quality of life (QoL) and adjustment to aging (AtA).
Methods: For the purposes of this study, the Health Survey Questionnaire (SF-6D), one measure of cognitive functioning - the Mini-Mental State Examination (MMSE) and demographics, were included. Measures were completed using a variety of culturally appropriate methods, including self-administration and interviews. All variables had fewer than 1% missing values and there complete data were available for 709 older adults (M = 84.9; SD = 6.65;range 74-102) from four different nationalities. Exploratory factor analyses were run for data reduction and for exploring theoretical structure. Controlling for age, gender and country of origin, we assessed the level of QoL of elderly people, and its effect on aging.
Results: SF-6D score was positively associated with Adjustment to Aging score (r = .295, p < .001). QoL had a moderate effect on adjustment to aging and its impact was also mediated through attitudes towards personal accomplishment and health status.
Conclusions: This cross-national study enlightens links among QoL, and aging in older age. Using developmental frameworks in future research could help us better understand how older adults adapt to aging transitions and add quality to their remaining life years.
Keywords: Geriatics, culture, health promotion, quality of life, health
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon, sofia.humboldt@gmail.com
P756
SUBJECTIVE WELL-BEING’ PREDICTORS IN A CROSS-CULTURAL OLDER POPULATION
Von Humboldt S., Leal I.
University Institute of Applied Psychology, Research Unit in Psychology and Health, Lisbon, Portugal
Aims: This research aims to explore a causal model of subjective well-being predictors in a cross-cultural older population.
Methods: Measures were completed using a variety of culturally appropriate methods, including mail-outs, self-administration and interviews. For the purposes of this study, the Positive and Negative Affect Schedule (PANAS), the Satisfaction with Life Scale (SWLS), one measure of cognitive functioning - the Mini-Mental State Examination (MMSE) and demographics, were included. All variables had fewer than 1% missing values and complete data were available for 709 older adults (M = 84.9; SD = 6.65;range 74-102) from four different nationalities. Structural equation modeling was used. Controlling for age, gender and country of origin, we assessed the level of subjective well-being of elderly people, and its predictors.
Results: Subjective well-being is predicted, not only by age progression, but also by adjustment to aging, among other variables. Subjective well-being was significantly associated with perception of health (β = - .272, p = .004). All estimates were statistically significant (p < .01).
Conclusions: Subjective well-being appears to be a catalyst to attitudinal markers of maturity and internal development, across cultures. This study highlights the predictors of subjective well-being in older age, warranting further study across cultures among frail populations over time. Recommendations for future research on older adults' well-being measures and clinical practice are also presented.
Keywords: Geriatrics, quality of life, culture, health promotion
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon, sofia.humboldt@gmail.com
P757
A MULTIPLE CORRESPONDENCE ANALYSIS ON ADJUSTMENT TO AGING, AGE REPRESENTATION AND SUBJECTIVE AGE OF OLDER COMMUNITY-DWELLING ADULTS: A CROSS-NATIONAL STUDY
Von Humboldt S.1, Leal I.2
1 University Institute of Applied Psychology, Research Unit in Psychology and Health, Lisbon, Portugal
2 University Institute of Applied Psychology, Research Unit in Psychology and Health, Lisbon, Tajikistan
Aims: To investigate latent constructs that can act as major determinants in the adjustment to aging (AtA), age representation (AR) and subjective age (SA), and to explore relations between these constructs in an older adults cross-cultural population.
Methods: Measures were completed using a variety of culturally appropriate methods, including demographics and interviews. Complete information on 231 older adults aged between 74-102 years (M = 83.1; SD = 6.692) from four different nationalities, was available. The data was subjected to content analysis. Representation of the associations and latent constructs were analyzed by a Multiple Correspondence Analysis (MCA). Standardized instruments measured regular cognitive abilities.
Results: Findings showed a model for each pre-category. SA was explained by a two-factor model: ‘age-cautious’ and ‘young-at-heart’. A three-dimension model formed by ‘maximizers’, ‘optimizers’ and ‘essentialists’ was indicated as a best-fit solution for AtA, and AR was best explained in a three-dimension model by ‘past-oriented’, ‘present-oriented’ and ‘future-oriented’. AtA is shown to bear associations with individuals’ SA and AR in a model composed by ‘enjoyers’, ‘engaged’, ‘regardful’ and ‘conciliated’.
Conclusions: AtA is related to SA and AR in older adults. Enhancing AtA on shared perceptions of SA and AR might be an important target to improve older adults’ interventions’ outcomes in aging well.
Keywords: Geriatrics, aging, health promotion, culture
CORRESPONDING AUTHOR: von Humboldt Sofia, ISPA, Lisbon, sofia.humboldt@gmail.com
P758
PHYSICAL SYMPTOMS, PSYCHOLOGICAL WELLBEING AND FORGIVENESS IN DATING COUPLES
Pereira M.G., Delgado A., Pereira D., Valente J., Lemos M..
University of Minho, Applied Psychology, Braga, Portugal
Introduction: Dating couples involved in a romantic relationship have sometimes to deal with relationship transgressions. When that occurs, in order for the relationship to carry on, some degree of forgiveness needs to be present. In fact, forgiveness is as an adaptive coping strategy positively related with psychological wellbeing and physical health. This study focused on the relationships among psychological wellbeing, physical symptoms, dating transgressions and forgiveness.
Method: 204 university dating students participated in the study. Sample was collected in several universities of the north of Portugal. 32% were men. Age average of the sample was 21. The instruments used were: Dating Infidelity (Drigotas, Safrson & Gentilla 1999), Heartland Forgiveness Scale (Thompson et al., 2005), Heath Symptoms Checklist (Proctor et al., 1998) and Psychological Well-Being Scale (Novo, Neto, Marcelino & Santo, 1997). All instruments were adapted to the Portuguese population.
Results: A positive relationship between forgiveness and psychological well-being was found as well as a negative one between forgiveness and physical symptoms. No relationship between dating transgressions and psychological wellbeing or physical symptoms was found. Differences on physical symptoms and psychological wellbeing were found in terms of degree of capacity to forgive. No differences on forgiveness were found in terms of gender.
Conclusions: The results found show the importance of forgiveness in mental and physical health in romantic relationships. Future research should focus on the possible mediator role of forgiveness in the relationship between psychological wellbeing and physical symptoms in dating and married couples. Interventions in the context of romantic relationships should incorporate coping strategies as forgiveness in order to increase mental and physical wellbeing.
Keywords: emotions; couple-focused
CORRESPONDING AUTHOR: Pereira M. Graça, University of Minho, Braga, gracep@psi.uminho.pt
P759
ESTIMATE OF THE SOCIAL COST OF MENTAL DISORDERS IN JAPAN
Yokoyama K.1, Fukuda T.2, Iijima S.3, Ito H.4, Okumura Y.4, Kurosawa M.1
1 Juntendo University Faculty of Medicine, Department of Epidemiology and Environmental Health, Tokyo, Japan
2 The University of Tokyo Graduate School of Medicine, School of Public Health, Tokyo, Japan
3 Jutendo University, Faculty of Health Care and Nursing, Urayasu, Chiba, Japan
4 National Institute of Mental Health, National Center of Neurology and Psychiatry , Department of Social Psychiatry, Tokyo, Japan
This project was conducted to calculate the social cost of mental disorders in Japan and quantitatively show the social burden. The disorders included vascular dementia and unspecified dementia, mental and behavioural disorders due to psychoactive substance use, schizophrenia, schizotypal and delusional disorders, mood [affective] disorders, neurotic, stress-related and somatoform disorders, mental retardation, and other psychosis and disorders of action (ICD-10). Specifically, the following costs of mental disorders to Japan were estimated according to the way of the Paying the Price (King's Fund, 2008). An exploratory committee and project team staffs repeated discussion to establish a valid model for the estimate. The estimate mainly used various statistical data in 2008 and a caregiver survey using questionnaire in 2010. The estimated approximate cost (Japanese Yen) was 2 trillion for medical care, 2.3 trillion for social services, 0.3 trillion for informal care (family, volunteer, etc.), and 6.6-6.9 trillion for productivity costs (affliction- and death-related), respectively. Thus, the estimated annual social cost for mental disorders exceeds 11 trillion Yen in recent Japan, which is more than 10% of the national budget.
Keywords: economics, health policy
CORRESPONDING AUTHOR: Yokoyama Kazuhito, Juntendo University, Tokyo, kyokoya@juntendo.ac.jp
P760
IMPROVING HEATSTROKE AWARENESS: OCCUPATIONAL HEALTH SUPPORT AT FUKUSHIMA 1 NUCLEAR POWER PLANT
Tateishi S.1, Hitaoka K.2, Fukai K.1, Futatsuya R.1, Okahara S.3, Kubo T.4, Mori K.5
1 University of Occupational and Environmental Health, Occupational Health Training Center, Kitakyushu, Japan
2 Nishinihon OH Service Center, Kitakyushu, Japan
3 University of Occupational and Environmental Health, Occupational Health Training Center, Kitakyshu, Japan
4 University of Occupational and Environmental Health, Department of Public Health, Kitakyshu, Japan
5 University of Occupational and Environmental Health, Department of Occupational Health Practice and Management, Kitakyushu, Japan
On March 11, 2011, the Tohoku earthquake and tsunami caused a major accident at the Fukushima 1 Nuclear Power Plant complex (1F). The University of Occupational and Environmental Health, Japan has supported occupational health and medical services at 1F since 28 April 2011.
All workers at 1F—not only employees of the Tokyo Electric Power Company (TEPCO) but also those of primary contractors and subcontractors—needed support for occupational health problems. Every day, 3000–5000 workers from more than 500 companies entered 1F for the recovery operation. The primary health risk during the summer was heatstroke, which was neglected by most of the workers, who were concentrating instead on the recovery effort. In this study, we assessed the workers’ attitude to heatstroke and its prevention.
Initially, we collected information during medical check-ups of TEPCO employees. This survey highlighted a lack of knowledge of and attention to the symptoms of heatstroke, water and salt intake recommendations, use of personal protective equipment (e.g. cool vests), emergency evacuation routes and the organizational daily health check.
We made eight suggestions to improve the situation for TEPCO employees and contractors: reduced working time, pre-placement education, posters placed along the flow line, use of cool vests, regulations for oral rehydration solution intake, easy to access rest areas, health checks at daily assembly and information sharing meetings, and clarification of the contact system to be used in emergencies.
Almost all of these suggestions were instituted. Fewer than 50 cases of heatstroke occurred, with no severe cases or deaths. A sampling survey during medical check-ups showed improvement of awareness of heatstroke.
As is the nature of a disaster setting, there was no reference group and thus we cannot determine the effectiveness of our intervention. However, we regard the intervention to have been successful, considering the severe working environment at that time.
Keywords: Fukushima heatstroke
CORRESPONDING AUTHOR: Tateishi Seiichiro, UOEH, Japan, tateishi@med.uoeh-u.ac.jp
P848
PSYCHONEPHROLOGY: THE PSYCHOSOCIAL IMPACT OF CHRONIC KIDNEY DISEASE
Novák M.1,2,
1 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
2 University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
Psychonephrology is an interdisciplinary field dealing with psychosocial factors in patients with various stages of chronic kidney disease (CKD) (e.g. non-dialysis, dialysis, and kidney transplant patients), as well as in families, caregivers and staff. CKD is a progressive condition with shortened survival and severely impaired quality of life of patients. Both dialysis and kidney transplantation are psychologically and psychosocially demanding treatments. Home dialysis modalities pose particular new challenges for patients and their families, as a unique model of self-care. Most commonly, patients (and often caregivers and family members) experience symptoms of depression, anxiety, body image disturbances, sleep disorders, difficulties coping and adhering to treatment, fear of death and dying.
This talk will review mental health issues common in this patient group, focusing on clinical significance, assessment and treatment of mood disorders and emotional reactions to chronic kidney disease. It will also cover the various psychosocial factors and aspects of quality of life of patients with chronic renal disease while being on various renal replacement modalities, as well as potential psychosocial and psychotherapeutic interventions, including group therapy. The talk will also demonstrate how interprofessional mental health education and weekly Balint group meetings for dialysis nurses can contribute to patient care and may prevent staff burnout. Balint groups have been used to help nurses understand and cope with the myriad of issues aroused by the close and intense relationships that comprise the care of patients coping with end stage renal disease. We will discuss the most important, key elements of psychonephrology services.
Keywords: psychonephrology, chronic kidney disease
CORRESPONDING AUTHOR: Novák Márta, Semmelweis University, Budapest, marta@nefros.net
Beyond Efficacy: Key Issues and Future Directions in Peer Support Interventions
S761
BEYOND EFFICACY: KEY ISSUES AND FUTURE DIRECTIONS IN PEER SUPPORT INTERVENTIONS
Fisher E.1,2, Boothroyd R.2, Baumann L.3, Heisler M.4, Mbanya JC.5, Safford M.6
1 American Academy of Family Physicians Foundation, Peers for Progress, Chapel Hill, USA
2 University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, Chapel Hill, USA
3 University of Wisconsin-Madison, School of Nursing, Madison, USA
4 University of Michigan, Internal Medicine, Ann Arbor, USA
5 University of Yaounde I, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon
6 University of Alabama at Birmingham, Preventive Medicine, Birmingham, USA
Peer support – assistance and encouragement by nonprofessionals in health behavior change, prevention, and disease management -- has gained considerable evidence for its efficacy in a variety of areas. For example, a systematic review to be briefly summarized in the Chair's introduction identified over 80% of papers reporting successes of peer support in diabetes, asthma, promotion of physical activity, obesity, and similar areas. The next generation of research will extend beyond simple demonstrations of efficacy and address issues regarding critical features and dimensions for extending peer support to the millions of people around the world who may benefit from it. This symposium will discuss key issues and future directions in peer support interventions as framed by projects of Peers for Progress, a global program of the American Academy of Family Physicians Foundation that has funded projects in 9 countries on 6 continents and engaged over 50 peer support programs worldwide. One important issue in both the success and, in some cases, failure of peer support programs is the intensity or "dose" of intervention. Drawing from a program in Uganda and other Peers for Project sites, Drs. Linda Baumann and Renée Boothroyd will address contextual issues that influence the adequate dose of peer training, peer support, and intervention methods to achieve them. Although sometimes considered in opposition to the direct interpersonal contact of peer support, interactive technologies can facilitate face-to-face contacts, can extend the reach and effectiveness of peer support to additional audiences, and can achieve economies of scale. Dr. Michele Heisler will address these issues based on projects in community settings and through the US Veterans Administration. Cultural factors pose challenges for the extension of peer support to many audiences. Dr. Jean Claude Mbanya will describe the tailoring of diabetes peer support to socio-cultural groups in Cameroon and Dr. Monika Safford will address cultural factors as they guided a peer support approach to diabetes self management among low-income African Americans in rural settings in the US. Discussion will consider key issues for extending peer support across varied contexts as good health care for all people around the world.
Keywords: Social Support, Diabetes, Chronic Disease, Health Behavior Change, Culture, Technology
CORRESPONDING AUTHOR: Fisher Edwin, UNC, Chapel Hill, edfisher@unc.edu
Conflict of Interest: Peers for Progress is a program of the American Academy of Family Physicians Foundation and receives support from the Eli Lilly and Company Foundation, the Bristol-Myers Squibb Foundation, and the Sanofi US.
S762
CONTEXTUAL ISSUES IN DETERMINING THE DOSE OF PEER TRAINING AND PEER SUPPORT
Baumann L.1, Boothroyd R.2
1 University of Wisconsin-Madison, School of Nursing, Madison, USA
2 University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, Chapel Hill, USA
While success in behavior change programs largely depends on duration of contact, peer support emphasizes the quality, not just number, of relationships and connections. The variety of contact matters (e.g., monthly meetings, in-between contacts; family meetings in the hospital following diagnosis; shopping and cooking among peer support group members), as do multiple layers and modes of delivery (e.g., resource books, phone contact, face-to-face time, social networking) to occasion, reinforce, and sustain practical, supportive, and ongoing connections. Such varied and blended approaches to peer support are also influenced by geographic, socioeconomic, cultural, and other setting features of populations and places. This presentation will review key intervention design issues of peer support for diabetes self-management conducted as part of Peers for Progress, a global program of the American Academy of Family Physicians Foundation conducted in Uganda and other settings. While often based on core themes, authors will describe the varied approaches to select, train, and maintain peers for diabetes self-management, with particular emphasis on variation in their length, assessment of acquired competencies, and incorporation of observation, feedback, and ongoing training to shape and reinforce effective and ongoing peer support. In looking across peer support projects, authors will also explore how training needs to be informed by both foundational knowledge and local realities of context. For example, insulin/other medications and glucose monitoring are important aspects of diabetes self-management; yet supplies for such activities are sometimes scarce or non-existent. Training for ongoing support that seeks to assist people with practical, emotional, and clinical and social resources needs to incorporate knowledge of the field and the practical knowledge of peers' familiarity with the living circumstances of the people they are trying to help. Discussion will focus on the contextual factors that impact the design of peer support interventions, including geographic features (urban/rural), socioeconomic conditions, and features of the health care system, especially those that facilitate or inhibit ongoing support for optimal chronic disease management.
Keywords: Research to Practice Translation, Self Management, Social Support, Culture
CORRESPONDING AUTHOR: Baumann Linda, University of Wisconsin-Madison, ljbauman@wisc.edu
S763
EXTENDING THE REACH AND EFFECTIVENESS OF PEER SUPPORT THROUGH TECHNOLOGY
Heisler M.
University of Michigan, Department of Internal Medicine, Ann Arbor, USA
Peer support models can be effective complements to formal health care as peer supporters often provide an increased intensity and different types of support and assistance to people with chronic illnesses. Two deficiencies can limit both the reach and effectiveness of peer support models: 1) Barriers to frequent face-to-face encounters; and 2) the lack of resources to facilitate face-to-face and other types of discussions between peer supporters and patients with chronic illnesses.
This presentation will provide an overview of evidence on peer support models using a range of technologies to facilitate and improve communication between peer supporters and their peers. Examples of the use of web-based platforms, cell phones, telemedicine, and email will be discussed, with a focus on lessons learned on ways to develop effective interventions using these technologies to increase reach. The second use of technology that will be discussed is the development of tailored, web-based tools to facilitate the discussions between peer supporters and their peers. Our research team has developed and is currently testing several web-based decision aid tools around diabetes and CVD treatment that community health workers are using on ipads in face-to-face sessions with diabetes patients with poor risk factor control. Key elements of these tools will be demonstrated with recommendations to guide others in developing and testing such resources.
Keywords: diabetes; technology; chronic illness
CORRESPONDING AUTHOR: Heisler Michele, University of Michigan , mheisler@umich.edu
S764
TAILORING DIABETES PEER SUPPORT TO SPECIFIC CULTURAL SETTINGS: USING COMMUNITY-BASED SOCIO-CULTURAL GROUPS IN CAMEROON
Mbanya JC., Assah F., Emmanuella A.
University of Yaounde I, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon
Health of Populations in Transition Research Group in Yaounde, Cameroon
Peer interactions embedded within the community is widely used in health promotion to improve healthcare delivery. Establishing groups wherein these interactions occur so as to maximize sharing of information, resources and support depends on intra-group cohesion and affinities. The socio-cultural context within which individuals interact in their daily lives plays a vital role in group cohesion. The organization and relative importance of these environments differ from one society to the other. In Cameroon, a country with more than 200 ethnic groups, diverse cultural and religious backgrounds, the importance of socio-cultural groups cannot be over-emphasized. This is particularly true as most Cameroonians maintain strong social ties to the ancestral ethnic/tribal origins.
This study sought to demonstrate concept and feasibility of the effectiveness of implementing a community-based multilevel peer support intervention to improve diabetes care and management. Patients were poorly-controlled diabetes patients recruited from the National Obesity Centre in Yaoundé, and grouped by similar social, professional or cultural affinity - tribe/clan, profession, religion/church, residential quarter and similar sport group. Ten groups of 10 diabetes patients were formed grouped by similar social, professional or cultural affinity - tribe/clan, profession, religion/church, residential quarter and similar sport group so as to facilitate social cohesion. Each group was led by a trained peer supporter who was bona fide member of the group. The intervention lasted 6 months, comprising once monthly group meetings to discuss a major self-care activity and individual encounters (face-to-face or telephone) between peer supporter and group members as required for specific personal diabetes related problems. All patients maintained their usual clinical care.
At the end of the study, all groups had held all 6 group meetings lasting 60 – 90 minutes on each of a series of key topics in diabetes management.
From this intervention, we observed significant improvement in diabetes self-management behaviours, blood lipids, glycaemic and blood pressure control. Diabetes peer support organized within socio-cultural community groups could serve as a useful adjunct to clinical care.
Keywords: Diabetes, Social Support, Culture
CORRESPONDING AUTHOR: Jean Claude Mbanya, University of Yaounde, jcmbanya@hopitcam.net.
S765
CULTURALLY ADAPTING A PEER SUPPORT TRIAL TO MAXIMIZE ACCEPTABILITY
Safford M.
University of Alabama at Birmingham, Medicine, Birmingham, USA
Peer support models are increasingly common in culturally diverse communities, since peer supporters who live in the same communities as the targeted individuals understand the context of their lives better than many health professionals can. However, this also means that peer support programs must be prepared to adapt materials and approaches to different cultural settings. Further, rigorous tests of such program often require randomization, and this can be challenging to implement in any community settings, especially communities that are ethnically or culturally distinct, and in which education levels are often limited.
This presentation will provide an overview of evidence on peer support models intended to enhance diabetes self-care implemented in a variety of cultural settings. We will draw on our own cluster randomized trial of a peer support program in the Alabama Black Belt, a rural, largely agricultural geographic region that stretches from Texas to Maryland and that was historically known for its rich black soil. This area is today better known for its steep poverty (>30% live below the US federal poverty line) and high proportion of African American residents (>75%), and is one of the few rural areas in the US where African Americans reside in large numbers. Although education quality is suboptimal in this region of Alabama, knowledge about the infamous Tuskegee syphilis experiment is widespread. Tuskegee, Alabama is located in the heart of the Alabama Black Belt and the syphilis experiment was conducted into the latter half of the 20th century on African American migrant workers without their consent. The Tuskegee legacy has led to a deep-seated mistrust of the healthcare system in general and medical research specifically. Adaptations in the community engagement approach, recruitment, data collection, training of peer supporters, randomization and implementation of the intervention will be provided, with recommendations to guide others in developing and testing such programs. By using these approaches, we successfully recruited more than our targeted number of individuals with diabetes into the trial (424, target 400).
Keywords: diabetes, culture
CORRESPONDING AUTHOR: Safford Monika, University Alabama at Birmingham, msafford@uab.edu
Computer Tailored Technology & Innovations
S766
COMPUTER TAILORED TECHNOLOGY & INNOVATIONS
De Vries H.
Maastricht University, Department of Health Promotion, Maastricht, The Netherlands
Computer-tailored technology (CTT) aims to provide highly individualized feedback for health behavior change. CTT uses elements of face-to-face counseling, can reach large segments of the population, and can be delivered at relatively low cost. Computer-tailored messages are better read, elaborated upon and evaluated than comparable non-tailored generic messages. The Internet created opportunities to deliver these materials at lower costs. New options, including mobile strategies, offer more refined programming and connections with other health informatics networks (e.g., Electronic Medical Records) but also pose challenges (e.g., privacy concerns). CCT research has also engendered studies exploring fundamental factors related to motivation and behavior change. This session is conducted by some of the founders of tailored health communication and aims to provide grounding from past and current research and practice combined with a vision of future directions in this rapidly growing field.
Dr. Hein de Vries will present results of RCTs testing computer tailored interventions in which sequential and simultaneous risk factor tailoring were compared for smoking, alcohol, nutrition and physical activity. Results of studies comparing video and text based computer tailored messages will also be presented.
Dr. Wayne Velicer will present data from project BEST that aims to maintain healthy behaviors in diet and physical activity and to prevent tobacco and alcohol use in early adolescence using innovative computer-based interventions. The interventions are fully multimedia with print, sound, pictures, figures, and brief movies and uses relational agents.
Dr. Oenema will present the feasibility and effects of incorporating environmental feedback in computer-tailored nutrition and physical activity promotion interventions. Targeting environmental determinants may potentially improve the efficacy of computer-tailored interventions.
Dr. Vic Strecher will present data about fundamental neurological mechanisms of tailoring effects. Results show that certain regions of the brain become activated from highly-tailored messages and that this activation results in subsequent health behavior change. Implications for future tailoring innovations will be discussed.
Keywords: e-Health; computer tailoring
CORRESPONDING AUTHOR: de Vries Hein, Maastricht University, hein.devries@maastrichtuniversity.nl
S767
ATTRACTING PEOPLE TO COMPUTER TAILORED EHEALTH PROGRAMS: RESULTS FROM SEVERAL RCTS
De Vries H.1, Schulz D.2, Schneider F.3, Elfeddali I.3, Smit E.3, Stanczyk N.3
1 Maastricht University, Health Behavior and Health Education, Maastricht, The Netherlands
2 CAPHRI School for Public Health and Primary Care, Maastricht University, Health Behavior and Health Education, Maastricht, The Netherlands
3 CAPHRI School for Public Health and Primary Care, Maastricht University, Health Education & Promotion, Maastricht, The Netherlands
Background: Computer tailoring (CT) methods have been shown to be successful. Internet provides a gateway to reach many people. Yet, research analyzing factors that determine attention and processing eHealth information is still in its infancy.
Methods: We will present the data of several RCT’s (N = 10,000) that used eHealth CT methods, to analyze patterns of visits and revisits and factors determining these patterns.
Results: Study 1 assesses the effects of simultaneous and multiple behavior change strategies for smoking, alcohol, physical activity and nutrition via computer tailoring. The results show high dropout rates in the multiple behavior condition. Furthermore, the results reveal that the more unhealthy behaviors people have, the less likely they are to continue with eHealth CT programs. Discontinuation was also predicted by a lower age. Study 2 indicates that a condition that provides prompts significantly increased the amount of visits to a multiple lifestyle computer tailoring program. Study 3 targeted the prevention of smoking cessation relapse. The results demonstrates that elaborate CT programs with several sessions including action planning outperform other conditions, provided that people keep participating in these sessions. Yet, a condition also including an even more detailed monitoring of problems did not result in better effects. Study 4 also addressed smoking cessation and compared text and video generated messages. The results do not suggest many differences in processing between video and text messages but do reveal more processing of messages by LSES than HSES smokers. Yet another study did find better evaluation and processing in the video condition concerning physical activity. Study 5 found that eHealth CT programs may reach different segments of populations when recruitment is done via GP’s or via the mass media, and that thus different channels may be used to attract different segments of the population.
Discussion: Addressing several behaviors in one eHealth program may lead to ego depletion, a finding that is supported by our results from Study 1. Since prompts increase the number of visits, its utilization is recommended although more research is needed to understand which type of prompts will be most beneficial. Study 3 shows that the more is not always better. Further research aimed at understanding how to best design eHealth CT interventions that will attract sufficient attention and keep respondents motivated to participate is needed, also to be able to develop a better theoretical understanding of attention to and processing of CT information.
Keywords: eHealth; health behavior change; health communication
CORRESPONDING AUTHOR: de Vries Hein, Maastricht University, hein.devries@maastrichtuniversity.nl
Conflict of Interest: Hein de Vries is also scientific director of Vision2Health, a company aimed at implementing evidence based eHealth programs
S768
PROJECT BEST: TAILORED INTERVENTIONS FOR MULTIPLE RISK FACTOR PREVENTION FOR ADOLESCENTS
Velicer W.1, Redding C.1, Paiva A.1, Meier K.1, Oatley K .1, Babbin S.1, McGee H.1, Mauriello L.2, Prochaska J.1
1 University of Rhode Island, Cancer Prevention Research Center, Kingston, USA
2 ProChange Behavior Systems, Vice President, Product Development, Kingston, USA
Substance abuse prevention programs have reported limited evidence of efficacy. Potential problems include the wrong delivery system and a lack of intervention fidelity. This paper will describe the development of two new computer-based interventions for tobacco and alcohol prevention. The Transtheoretical Model provided the structure and pilot data provided the empirical basis for the decision rules. Most students were classified in the Acquisition Precontemplation stage of change (aPC; not currently using the substance, not planning to start in the next six months). Within the aPC group, four subgroups have been identified: (1) Most Protected from substance use; (2) High Risk for substance use; (3) Ambivalent about staying substance free; and (4) Risk Denial about substance use. The profiles served as the basis for two multimedia computer-based interventions. A sample of 6thgraders from 20 schools (N = 4158) were randomly assigned to treatment or comparison. 96% were classified as aPC for alcohol use and 97% for smoking. The comparison group was given similar existing interventions for energy balance behaviors (diet and exercise). Each intervention involved five in-class contacts over a three year period with assessments at 12, 24, and 36 months. This paper reports complete case outcome data at 36 months. There were significant differences in the substance abuse treatment group in the degree to which members of the Most Protected group remained in that group compared to the comparison group for both smoking (75.4% vs. 67.2%) and alcohol (64.9% vs. 57.7%). In the comparison condition, strong effects were found for both diet (24.6% at criteria vs. 16.9%) and exercise (49.4% vs. 37.1%). The two substance abuse interventions did not demonstrate strong effects. The two energy balance interventions demonstrated strong effects for initiating and maintaining energy balance behavior changes within a cost-effective, science-based, and disseminable platform.
Keywords: Substance Abuse
CORRESPONDING AUTHOR: Velicer Wayne, University of Rhode Island, velicer@uri.edu
Conflict of Interest: Infomatics
S769
TARGETING ENVIRONMENTAL LEVEL DETERMINANTS IN COMPUTER-TAILORED DIETARY AND PHYSICAL ACTIVITY PROMOTION INTERVENTIONS
Oenema A.1, Lechner L.2, Prins RG.3, Springvloet L.1, De Vries H.1
1 Maastricht University, CAPHRI, Department of Health Promotion, Maastricht, The Netherlands
2 Open University of the Netherlands, Faculty of Psychology, Heerlen, The Netherlands
3 Erasmus MC, University Medical Center, Department of Public Health, Rotterdam, The Netherlands
Targeting ‘new’ determinants could be one way to improve the efficacy of computer-tailored interventions. Most computer-tailored dietary and physical activity promotion programs have primarily addressed individual level determinants. However, environmental level factors, such as availability and accessibility of physical activity facilities and healthy food options, are increasingly being recognized as important determinants of dietary and physical activity (PA) behaviors. This indicates that such determinants should also be addressed in computer-tailored interventions. One way to do so is to make people aware of the PA facilities and healthy food options that are available in their neighborhood.
We developed two interventions (one to promote physical activity among adolescents and one to promote healthy diets among adults) in which tailored environmental feedback was used as a strategy to improve awareness of PA facilities in the residential neighborhood and availability of healthy food options in local shops and supermarkets. Google Maps was used to provide information about the PA facilities in the residential neighborhood. In this presentation the rationale and possibilities for providing tailored environmental feedback will be presented, as well as the results of the c-RCT in which the physical activity promotion intervention was evaluated for effects. In this c-RCT we could not demonstrate an effect of the intervention that incorporated the environmental feedback.
The presentation will end with a reflection and discussion of the feasibility and effects of providing environmental feedback in dietary and PA promotion interventions and in which direction to go with this line of research.
Keywords: computer tailoring, diet, physical activity, environment
CORRESPONDING AUTHOR: Oenema Anke, Maastricht University, a.oenema@maastrichtuniversity.nl
S770
Pedometer-based physical activity advice through the internet: Pilot study of a computer-tailored intervention for adults
Spittaels H. 1, De Cocker K.1,2, Cardon G.1, De Bourdeaudhuij I.1, Vandelanotte C.3
1 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
2 Research Foundation Flanders, Brussels, Belgium
3 Centre for Physical Activity Studies, Institute for Health and Social Science Research, Central Queensland University, Australia.
Introduction: Computer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use.
Aims: To report dissemination of a newly developed online pedometer-based, computer-tailored step advice intervention through general practice, and to evaluate the preliminary effectiveness of this tool on total step counts in adults in comparison with a standard intervention.
Methods: We recruited 92 participants through general practitioners and randomly assigned them to a tailored condition (receiving a pedometer plus computer-tailored step advice intervention, n = 45) and a standard condition (receiving a pedometer-only intervention, n = 47). Step counts were assessed at baseline and post intervention by means of a Yamax Digiwalker SW-200. Demographics (baseline) and perceived acceptability of the interventions (post) were assessed by telephone interviews.
Results: Recruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients to find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to post intervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105–5172; F = 5.0, P = .04). No interaction or other time effects were found.
Conclusion: The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition.
Keywords: computer-tailoring, step advice, physical activity promotion, pedometer intervention, effectiveness
CORRESPONDING AUTHOR: Heleen Spittaels, University of Ghent, Heleen.Spittaels@ugent.be
Psychosocial and Behavioral Aspects of Aging
O771 FOLLOW-UP CHANGES IN THE ASSOCIATION BETWEEN COGNITIVE FUNCTION AND DEPRESSION IN ELDERLY PERSONS
Despot Lucanin J., Lucanin D.
University of Applied Health Studies, Department of Health Psychology, Zagreb, Croatia
Recent studies confirmed the association between depression and cognitive decline in old age, but the nature of this association is still not very clear (Andel, Hughes, & Crowe, 2005; Blazer, 2003; Van Horen et. al., 2005). Our previous research confirmed that depression and cognitive function in old age are associated, but this association changes in the presence of different moderating variables, which can simultaneously affect both cognitive function and depression, but to a different degree and direction (Despot Lucanin, Lucanin, & Havelka, 2011). The aims of this study were to investigate the possible longitudinal association between depression and cognitive function of elderly institutionalized people and to determine moderating psychosocial factors in this association.
Participants were 411 residents of 11 retirement homes in Zagreb, Croatia, 104 men, 307 women, aged 56-96 years (average 79) at baseline, ambulatory and not diagnosed with dementia. Variables were measured, at baseline and at 2-years follow-up: sociodemographic, cognitive function, depression, self-perceived health, social participation, and functional ability, individually, in the institution, by trained interviewers.
Regression analyses showed that baseline depression and cognitive function scores were significant predictors of 2-year follow-up depression (R = .66; R2 = .43; p < .001). Strength of predictions suggests that higher depression and lower cognitive function at earlier old age increase depression two years later. Moderating role of other observed psychosocial factors in this association was different in different test models.
These findings are interesting in terms of better identification of groups of older persons particularly susceptible to cognitive decline or clinical depression in terms of intervention in the form of specific and widely applicable strategies to maintain their psychological functioning in the ageing process.
Keywords: Aging, Depression, Cognitive factors,
CORRESPONDING AUTHOR: Lucanin Damir, UAHS, Zagreb, damirl@zvu.hr
O772
POSITIVE MAINTENANCE EFFECTS AND KEY FEATURES OF PHYSICAL ACTIVITY INTERVENTIONS IN THE ‘PERI-RETIREMENT WINDOW’: A SYSTEMATIC REVIEW
Hobbs N.1, Godfrey A.2, Mathers J.2, Rochester L.2, White M.1, Sniehotta F.1
1 Newcastle University, Institute of Health & Society, Newcastle, United Kingdom
2 Newcastle University, Faculty of Medicine, Newcastle, United Kingdom
The period before and after the main income provider in a household retires from employment (peri-retirement window) is a major transitional life stage when people make substantial lifestyle changes. Therefore, the peri-retirement window provides a good opportunity to intervene to promote healthier behaviours which are expected to enhance healthy ageing. Although there is compelling evidence that physical activity improves many aspects of the ageing phenotype, the nature of physical activity interventions which promote sustained behaviour change for those in the peri-retirement window is poorly understood. This systematic review aimed to synthesise evidence for the effectiveness of interventions to maintain physical activity behaviour change at 12 months for those in the peri-retirement window and to identify intervention features associated with effectiveness. A search of 9 databases (January 2000 - December 2010) identified 17,859 papers. Papers were screened for eligibility by two reviewers independently. Included studies were randomised controlled trials of healthy or ‘at risk’ adults (mean or median age 55-70 years) with physical activity behaviour assessed >12 months after randomisation. Forty-five papers reporting on 23 studies were included. Despite significant heterogeneity in the physical activity behaviour outcome measures used in individual studies, over 75% of studies reported greater physical activity levels at 12 months in the intervention group compared to the control. Authors of 8 studies provided additional intervention materials. Most interventions were delivered by a health professional, on a face-to-face individual basis and in a healthcare setting. Mean study duration was 17 months with, on average, 41 intervention contacts. The most intensive intervention arm of each study used between 0 and 29 behaviour change techniques (mean of 8 per study); the most frequent techniques were goal-setting and providing feedback on performance of behaviour. Intervention features which predicted intervention effectiveness are being explored and will contribute to the LiveWell Programme by informing the design and development of interventions to promote health and wellbeing of people in the peri-retirement window.
Keywords: Aging; Behavior Change; Physical Activity; Randomized Controlled Trial; Intervention
CORRESPONDING AUTHOR: Nicki Hobbs, Newcastle University, Newcastle, nicki.hobbs@ncl.ac.uk
O773
FEAR OF FALLING AND CHANGED FUNCTIONAL ABILITY FOLLOWING HIP FRACTURE AMONG COMMUNITY-DWELLING ELDERLY PEOPLE.
Jellesmark A.1, Herling S.2, Egerod I.3, Beyer N. 4
1 Roskilde Hospital, Region Sjaelland, Roskilde, Denmark
2 Herlev University Hospital, Orthopedic Department /Research Unit, Copenhagen, Denmark
3 University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
4 Bispebjerg University Hospital, Musculoskeletal Rehabilitation Research Unit, Copenhagen, Denmark
Background: Fear of falling (FOF) is a potentially limiting factor in regaining functional ability after a hip fracture, and it may have a negative impact on physical, psychological and social functioning.
Objectives: The purpose of this mixed methods study was 1) to assess self-reported FOF (Falls Efficacy Scale-International, FES-I), avoidance of activities due to FOF (The modified Survey of Activities and Fear of Falling in the Elderly, mSAFFE) and functional ability (The Functional Recovery Score, FRS), 2) to investigate whether an association between FOF, avoidance of activities and functional ability exist, and 3) to explore the experience of FOF 3-6 months post hospital discharge.
Method: Eligible participants were selected from hospital records. Inclusion criteria: Community-dwelling 65+ years, able to walk independently at discharge, and MMSE score >24.
Questionnaires were completed through face-to-face interviews with 33 patients 3 months post discharge. In-depth semi-structured interviews were carried out in 4 participants who had a high level of FOF and different levels of functional ability.
Results: Results are presented as median(range). The patients were 81(65-92) years old; MMSE score was 28(24-30). 23 of the participants reported walking and balance problems, 19 participants had a high degree of FOF and 19 went outdoors less often than before the fracture. Of the latter 16 had a high degree of FOF. Participants with a high degree of FOF avoided more activities, needed more assistance in ADL and were less mobile compared to participants with a low degree of FOF (p < 0.0001). This was supported by the strong relationship between FES-I and mSAFFE (rs = 0.83, p < 0.01) and FRS (rs = -0.78, p < 0.01), respectively.
The informants were reluctant to go on social visits because many activities could precipitate FOF. Lack of social contact increased loneliness, boredom and frustration. The interviews suggested that avoidance of activities led to a reduced quality of life, but also protected the informants from taking risks.
Conclusion: The study suggests that FOF has significant meaning for community-dwelling elderly after a hip fracture and that FOF is common in this population. Further, strong relationships may exist between FOF, avoidance of activities and disability.
Keywords: Hip fracture, Disability, Anxiety
CORRESPONDING AUTHOR: Beyer Nina, Bispebjerg Hospital, Copenhagen, ninabeyer@oncable.dk
O774
THE CHANGING INFLUENCE OF SOCIAL NETWORK MEMBERS ON INDIVIDUAL CHRONIC DISEASE MANAGEMENT: A LONGITUDINAL QUALITATIVE STUDY
Morris R., Sanders C., Kennedy A., Rogers A.
University of Manchester, School of Health Sciences, Manchester, United Kingdom
Background: The management of chronic illness is complex involving the interplay of personal and contextual factors and comprised of a number of daily activities which influence how individuals engage with self-management behaviours. Little is known about how peoples’ support needs for chronic illness management change or modify management over time.
Methods: This qualitative study was embedded within a larger randomised control trial. It used a longitudinal qualitative design with initial face to face in-depth interviews, telephone follow-ups over a year and final face-to-face interviews using an innovative social network method. All participants had at least one chronic condition of either diabetes (n = 15), chronic obstructive pulmonary disease (n = 7) or irritable bowel syndrome (n = 8).
Results: Analysis demonstrates that who is in the social network, and the types of relationships which are present, influence how chronic illness management behaviours are framed and the extent to which they are engaged with. Changes in close relationships (for example bereavement or reconnecting with distant family members) influenced the availability of resources which supported, or undermined, engagement with management and was an ongoing process changing over time. Networks included family, friends, GP, nurses and companion animals. In the absence of ‘typical’ sources of support, accounts highlighted the substitutability of network members which was often sought from a narrow field of key individuals. Support exists on a continuum between positive and negative and had reciprocal influences with health management.
Conclusions: The findings challenge the notion that size of support networks decrease with age. Rather this work highlights that change in social networks occurs over time and is an ongoing process of breaking and reconnecting the relationships which influence chronic illness management and how individual’s engage with management behaviours. Changes in health may challenge assumptions about the nature of relationships and expectations of resource and support provision. This holds particular implications for interventions aimed at supporting older adults to self-care as they tend to be based on implicit assumptions of lay support systems.
Keywords: Primary care; self-management; longitudinal research; chronic illness; social networks
CORRESPONDING AUTHOR: Morris Rebecca, University of Manchester, rebecca.morris@manchester.ac.uk
O775
INVOLUNTARY LABOUR MARKET EXIT AND RISK OF POOR HEALTH AND SLEEP PROBLEMS AMONGST SWEDISH WORKERS AGED 50 YEARS AND OVER.
Hyde M., Westerlund H.
Stockholm University, Stress Research Institute, Stockholm, Sweden
Background: A number of studies from the US have shown that involuntary labour market exit (ILME) in later life can have a detrimental effect on health and/or lead to an increase in poor health behaviours. The aim of this presentation is to examine whether ILME in later life leads to an increased risk of reporting poor health and/or sleep problems amongst older people living in Sweden.
Methods: The data are drawn from the first 3 waves of the Swedish Longitudinal Occupational Study of Health (SLOSH). This is a biennial postal survey based on the entire Swedish workforce in 2003/5. These analyses were restricted to respondents who had left work between any of the waves and who were aged 50 years and over when they left (N = 868). Respondents were asked whether they had chosen to leave work or whether they had been forced to leave. In addition they were asked to rate their general health and the quality of their sleep (using items from the Karolinska Sleep Questionnaire). Logistic regression analyses were used to examine the likelihood of reporting poor health and/or sleep problems for those who left work involuntarily compared to those who left voluntarily. All analyses were controlled for age at labour market exit, sex, marital status, income and baseline measures of health and/or quality of sleep.
Results: The results indicate that older workers who experienced ILME were at a higher risk of developing poor general health (OR, 2.01, CI 1.32-3.31) than those who left work of their own volition. However there was no statistically significant effect of ILME on the likelihood of reporting disturbed sleep (OR, 1.41, CI 0.84-2.37) or inadequate sleep (OR, 1.58, CI 0.93-2.69).
Conclusion: The analyses show that ILME in later life carries a risk of poor health in Sweden. These results are in line with earlier studies in the USA. The lack of an effect on sleep could reflect a decrease in daily stress amongst those who have left the labour market.
Keywords: Aging, Health
CORRESPONDING AUTHOR: Hyde Martin, Stress Research Institute, martin.hyde@stressforskning.su.se
O776
THE DEVELOPMENT AND EVALUATION OF A LIFESTYLE-BASED PREVENTION PROGRAM FOR DEMENTIA
Walach H., Loef M.
European University Viadrina, Institute for Transcultural Health Sciences, Frankfurt (Oder), Germany
Dementia and its most common cause, Alzheimer’s disease, are going to become major public health issues. Despite intensive research in this area the molecular etiology is not fully understood and effective treatments are not at the horizon. The primary prevention of dementia may therefore represent the most promising approach to lower the disease’s future burden.
The development and evaluation of a prevention program necessitate a multi-step and trans-disciplinary approach. In the first step, we have investigated the association between dementia and lifestyle by systematic reviews of the literature and meta-analysis. We have identified four lifestyle areas that are particularly important for the prevention of dementia: the avoidance of toxins (e.g. mercury, smoking), a healthy diet (e.g. consumption of fish, vegetables, avoidance of obesity, moderate consumption of meat), a culture of consciousness (e.g. meditation) and physical exercise.
Based on our findings we can also argue that dementia shares many risk factors with other chronic diseases such as diabetes or cardiovascular diseases and that the risk of dementia is reduced in proportion to the number of health behaviors a person adheres to (e.g. non-smoking, physical activity).
The patterns of health-related behavior of individuals are, however, embedded into social and cultural contexts and may not adequately be addressed by today’s common public health measures.
In a 2nd step it is therefore necessary to explore the motivations and the obstacles to multiple health behavior change in the field of dementia. The findings could result in an individual health coaching to find the best possible fit between requirements and personal choices and preferences of individuals.
Thirdly, this research may lead to interventional studies which apply the most recent evidence and seek to overcome the low adherence of most lifestyle based interventions by including the results of the 2nd step.
In summary, our approach indicates that an integrative healthy lifestyle is the best way to reduce the future burden of dementia and it seeks methods to implement this knowledge into public health measures. We are going to present the findings of our systematic reviews and outline the lifestyle-program.
Keywords: Alzheimer's disease, behaviour change, risk factors, prevention
CORRESPONDING AUTHOR: Harald Walach, European University Viadrina, walach@europa-uni.de
Work Environment and Health
O777
ORGANIZATIONAL JUSTICE AND PSYCHOLOGICAL DISTRESS AMONG JAPANESE WORKERS WITH HIGH OR LOW JOB INSECURITY: FINDINGS FROM THE JAPANESE STUDY OF HEALTH, OCCUPATION, AND PSYCHOSOCIAL FACTORS RELATED EQUITY (J-HOPE)
Inoue A.1, Kawakami N.2, Tsutsumi A.3, Shimazu A.2, Miyaki K.4, Takahashi M.5, Kurioka S.6, Eguchi H.7, Enta K.8, Kosugi Y.9, Sakata T.10
1 University of Occupational and Environmental Health, Department of Mental Health, Kitakyushu, Japan
2 The University of Tokyo Graduate School of Medicine, Department of Mental Health, Tokyo, Japan
3 Kitasato University School of Medicine, Department of Public Health, Sagamihara, Japan
4 National Center for Global Health and Medicine, Department of Clinical Research and Informatics, Tokyo, Japan
5 National Institute of Occupational Safety and Health, Health Administration and Psychosocial Factor Research Group, Kawasaki, Japan
6 University of Occupational and Environmental Health, Department of Health Policy and Management, Kitakyushu, Japan
7 Shinshu University School of Medicine, Department of Preventive Medicine and Public Health, Matsumoto, Japan
8 Health Care Center, Central Japan Railway Company, Nagoya, Japan
9 Kosugi Health Management Office, Toyama, Japan
10 Fukuoka Tokushukai Medical Center, Department of Laboratory Medicine, Fukuoka, Japan
Background: A number of empirical studies have reported that lack of organizational justice (procedural justice and interactional justice) is associated with adverse mental health outcomes among employees. However, study on the association of organizational justice with mental health while taking into account job insecurity is still limited. The purpose of the present study was to investigate the moderating role (or vulnerability factor) of subjective job insecurity on the association of organizational justice with psychological distress among Japanese employees.
Methods: A cross-sectional study, based on a baseline survey (from October 2010 until August 2011) of the occupational cohort study on social class and health: Japanese study of Health, Occupation, and Psychosocial factors related Equity (J-HOPE), was conducted with a total of 6,468 males and 1,848 females employed in 11 companies/organizations in Japan. These participants were surveyed using a self-administered questionnaire, including the Organizational Justice Questionnaire (OJQ), job insecurity subscale of the Job Content Questionnaire (JCQ), the K6 scale (psychological distress case was defined as having a score of five or more on the K6 scale), and other covariates. Multiple logistic regression analyses, including interaction term of procedural justice or interactional justice with job insecurity, were conducted by gender. We reduced the level of significance (< 0.20) to increase power for tests of interaction, as recommended by Selvin (2004).
Results: After adjusting for covariates, the association of low interactional justice with psychological distress was significantly greater among those with high job insecurity than those with low job insecurity for males (p for interaction = 0.195). On the other hand, for females, the association of low procedural justice with psychological distress was significantly greater among those with low job insecurity than those with high job insecurity (p for interaction = 0.138).
Conclusions: Males with higher job insecurity may be more vulnerable to lack of interactional justice in terms of psychological distress while females with lower job insecurity may be more vulnerable to lack of procedural justice rather than those with higher job insecurity.
Keywords: Mental health, Worksite health
CORRESPONDING AUTHOR: Inoue Akiomi, UOEH, Kitakyushu, akiomi-tky@umin.ac.jp
O778
WORKPLACE JUSTICE, WORK-RELATED BURNOUT AND SELF-RATED HEALTH: MODIFYING EFFECTS OF TYPE OF EMPLOYMENT SECTOR, ENTERPRISE SIZE AND GENDER
Cheng Y.1, Chen C-J.2
1 National Taiwan University, Institute of Health Policy and Management, Taipei, Taiwan
2 Council of Labor Affairs Taiwan, Institute of Occupational Safety and Health, Taipei, Taiwan
Background and objective: Workplace justice, that reflects employees’ experience of fairness within the organization, has been found to influence health of employees. However, whether the associations are different between public and private sectors and by different enterprise size and gender have not been well investigated.
Methods: Study subjects were 9636 male and 7406 female employees from a national survey conducted in 2007 in Taiwan. A self-administered questionnaire was used to assess workplace justice, work characteristics, work-related burnout and self-rated health.
Results: Employees in public sector were found to have slightly higher workplace justice than those employed in private sector. In private sector, female employees of larger enterprises (with number of employees of 200 or more) were found to have lower workplace justice than those in smaller enterprises. No significant difference by enterprise size was found in male employees. Results of multivariate regression analyses revealed that in both men and women, employees with workplace justice in the lowest tertile had increased scores in work-related burnout (11.0 and 12.8 points) and increased risks for poor self-rated health (OR = 2.5, 2.6) than those with workplace justice in the highest tertile. It was also found that the associations between workplace justice and health were stronger in employees of larger enterprises than those in smaller enterprises, and the modifying effects of enterprise size were more apparent in women than in men.
Conclusion: Low in workplace justice appeared to outweigh traditional job stressors such as heavy workloads, low in job control and employment insecurity in predicting poor health. This study further suggests that women of larger private enterprises are more susceptible to its effects.
Keywords: workplace justice, burnout, gender
CORRESPONDING AUTHOR: Cheng Yawen, National Taiwan Univ., Taipei, ycheng@ntu.edu.tw
O779
VALIDATION OF A GERMAN ORGANIZATIONAL JUSTICE QUESTIONNAIRE AND ITS ASSOCIATIONS WITH SELF-REPORTED HEALTH, DEPRESSION AND ANXIETY: FINDINGS FROM THE MIPH INDUSTRIAL COHORT STUDIES (MICS)
Herr RM.1, Li J.1, Bosch JA.2, DeJoy DM.3, Fischer JE.1, Loerbroks A.1
1 University of Heidelberg, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
2 University of Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands
3 Unversity of Georgia, Workplace Health Group, School of Public Health, Athens, USA
Objectives: The objective of our study was to validate an 11-item Organizational Justice (OJ) questionnaire, which comprised of two subscales, out of three, adapted from Moorman’s OJ questionnaire (viz., procedural justice, seven items; interactional justice, four items). Further, we aimed to determine associations of this OJ scale with self-rated health, depression and anxiety.
Methods: We used cross-sectional data from an occupational study involving 1,518 factory workers from Germany (88% male; mean age = 39 with SD = 12). Self-rated health was assessed by the question: “How would you generally describe your current health?” The response options “excellent”, “very good”, or “good” were defined as “good health” and the response options “not so good” or “bad” were classified as “poor health”. Depression and anxiety were assessed by the Hospital Anxiety and Depression Scale, whereby clinical levels of depression or anxiety were determined as a score of ≥8 on either subscale. Associations with poor self-rated health, depression and anxiety were explored by logistic regression.
Results: Factor analyses confirmed the expected 2-factor structure, denoted as “interactional justice” and “procedural justice”. The full scale and its subscales yielded Cronbach’s alpha’s ≥0.9 and item-test correlations ≥0.5. Scoring in the lowest quartile (as compared to the highest quartile) on the full OJ questionnaire as well as its subscales was associated with an ≥2.5 odds for reporting poor health, and also higher odds for being depressed (OR ≥ 2.3) or anxious (OR ≥ 2.8).
Conclusion: This shortened German version of the OJ scale had a robust internal consistency and yielded the expected factor structure. Further, OJ appeared a strong determinant of poor physical and mental health. In summary, this OJ scale seems a useful tool for observational and intervention studies in occupational behavioral medicine. Future studies may additionally explore longitudinal associations and test the generalizability of the present findings in other populations.
Keywords: Organizational Justice, Questionnaire Validation, Anxiety, Depression, Germany, Self-rated Health
CORRESPONDING AUTHOR: Herr Raphael, Heidelberg University, raphael.herr@medma.uni-heidelberg.de
O780
LEADERSHIP AND ITS EFFECT ON MENTAL HEALTH – WHICH ROLE DO PSYCHOSOCIAL RESOURCES PLAY?
Schmidt B., Kastner M., Fischer JE.
University of Heidelberg, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
Leadership has often been considered as a major determinant of mental health in the working population. The most predominant leadership style in management literature in the past years is the “full range of leadership”. Yet evidence on the influence of this leadership style on mental health is still scarce. Transformational leaders align the interests of the company with its members by intrinsically motivating and individually caring for their subordinates and fostering high performance teams. It is often assumed that this translates directly to better mental health, yet evidence so far is inconsistent.
We aim to explore if and how transformational leadership affects mental health, taking into consideration known influences of existing personal and organizational resources. The survey was conducted in a service company in Germany (mostly white collar, n = 320, 42,6 % male). The data were collected using validated scales including the transformational leadership inventory, various scales for psychosocial resources (e.g. social support, culture etc.) and a screening tool for self-reported psychological strain. We used structural equation modeling to test the effects of leadership style directly on mental health, as well as the indirect effect via protective psychological resources.
We found that full range of leadership did not show a direct effect on mental health (ß = .05; p = .40) but is fully mediated by protective resources, showing a strong indirect effect. The leadership style affects the resources positively (ß = .48; p < 0,01) while absence of resources leads to more psychological strain (ß = -.57, p < 0,01). The model fit was acceptable (CFI = .93; RMSEA = .069). These findings show that leadership has a strong influence on protective resources but not a direct effect on mental health. With respect to mental health and reducing strain at the workplace, the results encourage leaders to focus on building and securing psychosocial resources at the workplace. These perceived protective resources will in turn support the mental health of their subordinates.
Keywords: Mental health, Worksite health, Transformational Leadership, resources
CORRESPONDING AUTHOR: Schmidt Burkhard, Heidelberg University, burkhard.schmidt@medma.uni-heidelberg.de
O781
ORGANIZATIONAL INJUSTICE AND EFFORT-REWARD IMBALANCE ARE ASSOCIATED WITH JOB BURNOUT IN CHINESE SCHOOL TEACHERS
Li J.1, Meng H.2, Siegrist J.3
1 Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
2 Huazhong University of Science and Technology, School of Public Health, Wuhan, China
3 University of Duesseldorf, Department of Medical Sociology, Duesseldorf, Germany
Objectives: Teachers are under pressure at work. So far, little evidence is available from China. The aim of the study was to examine the association between work stress measured by organizational injustice and effort-reward imbalance, and job burnout in a sample of Chinese elementary school teachers.
Methods: A questionnaire survey was conducted in China during July-September 2010. The survey instruments included the Organizational Injustice Questionnaire (measuring procedural injustice and interactional injustice), the short Effort-Reward Imbalance Questionnaire, and the Maslach Burnout Inventory. The logistic regression was applied to test the associations.
Results: 425 teachers (84 men and 341 women with age of 20-55 years) participated in the study. After adjustment for age, gender, marital status, education, professional rank, smoking, alcohol drinking, and physical exercise, it was found that both organizational injustice and effort-reward imbalance were independently associated with job burnout (ORs (95% CIs) were 1.38 (1.08, 1.78) and 2.31 (1.73, 3.09), respectively). The further analysis on the two components of organizational injustice indicated that only interactional injustice contributed the significant association with job burnout (OR (95% CI) = 1.58 (1.08, 2.33)).
Conclusions: Both organizational injustice (particularly interactional injustice) and effort-reward imbalance at work are associated with job burnout. Our findings have implications that to improve these aspects of working conditions have the potential for job burnout reduction in Chinese school teachers.
Keywords: Worksite health; Stress
CORRESPONDING AUTHOR: Li Jian, Heidelberg University, Germany, lijian1974@hotmail.com
O782
A LONGITUDINAL STUDY OF OFFICE DESIGN’S INFLUENCE ON SICK LEAVES AMONG OFFICE EMPLOYEES
Bodin Danielson C., Wulf C., Westerlund H.
Stockholm University, Stress Research Institute, Stockholm, Sweden
The long-term effect of office category on sick-leaves among male and female office employees was studied. The sample consisted of 978 office employees from the Swedish Longitudinal Occupational Study of Health (SLOSH) working in three different office categories: a) Sick leaves, 1-7 days/year, b) Absence from work < 7days/year (incl. home with sick child), c) Never had long-term sick leaves, > 7days in row/year (medically certified sick leaves). ANCOVA but also multivariate regression models were used in the analysis, with adjustment for age, job rank and sector of business.
Initial studies on office type´s impact on employee general health found a significantly higher odd for sick leaves 0-7 days/year among women in Medium-sized open plan offices. This led to an in-depth study of absenteeism in relation to office environment in which office types with similar characteristics were merged into three larger office categories for statistical reasons. The three office categories, defined by ability for personal control and amount of people sharing work space, were: (1) Enabling personal control (incl. Cell-office; Flex-office), (2) Smaller shared workspace (incl. Shared-room office, 2-3 pers./room), and (3) Traditional open plan offices (incl. Small open plan office; Medium-sized open plan office; Large open plan office).
In the in-depth study were significant differences between the office categories found with regard sick absenteeism found. For the total sample and women separately showed the logistic analysis that both employees in Small shared workspace and employees in the office category that enabling personal control had significantly better odds for less number of long sick leaves, with best odds for the former. For men it was different; neither was there a significant effect of the office category on the prevalence found, nor was the same internal order between office categories with regard to prevalence for long-term sick leaves was applied. Overall the traditional open plan office stood out negatively–both in the initial study among women and in the in-depth study. For men this category appears however to be somewhat better. These results indicate that the office category possibly has an effect on some dimensions of absenteeism among employees.
Keywords: longitudinal research, office category, sick-leaves, SLOSH
CORRESPONDING AUTHOR: Bodin Danielsson Christina, Stress Research Inst., Stockholm, christina.bodin.danielsson@bredband.net
Psychosocial Stress, PNE Mechanisms, Heartrate Variability and Health Outcomes
O783
DIURNAL CORTISOL RHYTHM: ASSOCIATED WITH ANXIETY AND DEPRESSION, OR JUST AN INDICATION OF LACK OF ENERGY?
Harris A.1, Endresen Reme S.1, Tangen T.2, Hansen ÅM.3, Eriksen HR.1
1 Uni Research, Uni Health, Bergen, Norway
2 University of Bergen, Department of Medicine, Bergen, Norway
3 National Research Centre of the Working Environment, Copenhagen, Denmark
Background: Dysregulation of hypothalamus pituitary adrenal (HPA) activity has been associated with chronic low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the association between psychiatric symptoms measured with three different instruments, and the diurnal rhythm of cortisol. The study is part of the Cognitive Interventions and Nutritional Supplements (CINS) trial.
Methods: 305 patients, sick-listed 2 to 10 months due to non-specific LBP participated in the study. Psychiatric disorders were assessed by MINI. The Hospital Anxiety and depression Scale (HADS), and The Hopkins Symptom Checklist -25 (HSCL-25) were used to screen for psychological symptoms. Saliva cortisol samples were measured at awakening, 30 minutes later, at 3pm and 10pm for two consecutive days.
Results: There were no associations between any of the main diagnostic categories from the MINI interview, or levels of anxiety and/or depression measured with HADS and HSCL-25, and the cortisol awakening response (CAR), cortisol decrease during the day or cortisol levels in the evening. However, significant associations were found between low CAR and low cortisol decrease during the day and the somatization scale from HSCL-25 (dizziness or lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall a sleep, and headache).
Conclusion: The results indicate that diurnal cortisol rhythm, particularly the awakening response, are not directly associated with psychopathology, such as symptoms of anxiety and depression, but are associated with one dimension of the psychopathology; namely the lack of energy. This should be explored further to assess whether cortisol is just a measure of awakening or if it is associated to other symptoms of fatigue. Fatigue is prominent in somatic disorders, somatoform disorders and psychiatric disorders.
Keywords: Cortisol, anxiety, depression, fatique, somatisation, somatic disorders
CORRESPONDING AUTHOR: Harris Anette, Uni Health, anette.harris@uni.no
O784
SOCIAL ISOLATION AND DIURNAL CORTISOL SECRETION IN AN OLDER POPULATION: FINDINGS FROM THE BRITISH 1946 BIRTH COHORT
Stafford M.1, Kumari M.2, Gardner M.3, Kuh D.4, Ben-Shlomo Y.5
1 Medical Research Council, London, United Kingdom
2 University College London, Epidemiology and Public Health, London, United Kingdom
3 University of Bristol, Department of Social Medicine, Bristol, United Kingdom
4 Medical Research Council, London, UK
5 University of Bristol, Department of Social Medicine, Bristol, UK
Background: Social isolation is associated with increased risk of disease and death and may operate through Hypothalamic-Pituitary-Adrenal dysregulation, among other pathways. Although perceived isolation may be more strongly related to deleterious outcomes, evidence indicates that objective social isolation is associated with dysregulated cortisol response independently of loneliness. The effect of the timing of the experience of isolation has so far received little attention.
Methods: Using data from the British 1946 birth cohort (also known as the National Survey of Health and Development), we examined associations between diurnal cortisol patterns at age 60-64 and concurrent and cumulative living alone, not being married and social support. Cortisol was measured from saliva samples obtained at waking, 0.5 hours post waking, 11:00 and 21:00 hours.
Results: Night time cortisol was higher amongst study members who were never married or widowed compared to those currently married. Widowed study members also had a flatter diurnal decline throughout the day. Widowhood was most clearly associated with night time cortisol and diurnal decline amongst those who had been more recently widowed. Diurnal decline was -2.08 (95% CI -2.61 to -1.55) nmol/l/houramongst those currently married, -1.99 (95% CI -2.58 to -1.40) nmol/l/hour amongst those widowed six or more years previously and -1.83 (95% CI -2.40 to -1.26) nmol/l/hour amongst those widowed in the last five years. Study members who currently lived alone had higher night time cortisol than those who lived with others, but cortisol patterns did not differ by number of occasions living alone. Smoking, obesity and psychological symptoms assessed by the 28-item GHQ did not explain the above associations.
There was no evidence of an association between confiding, emotional or negative social support and cortisol patterns.
Conclusion: The study suggests that recent widowhood and living alone may result in dysregulated cortisol patterns. Behavioural and psychological pathways did not fully explain these links, possibly indicating a direct effect of social isolation on cortisol patterning. Findings should be replicated in (older) cohorts with larger numbers of widows and people living alone.
Keywords: Older people; Social support; Psychoneuroendocrinology
CORRESPONDING AUTHOR: Stafford Mai, MRC LHA, London, m.stafford@nshd.mrc.ac.uk
O785
EDUCATIONAL LEVEL, SALIVARY CORTISOL, AND ALL CAUSE MORTALITY IN AN OLDER POPULATION. RESULTS FROM THE AGES-REYKJAVIK STUDY
Groffen DAI.1, Bosma H.1, Koster A.1, Von Bonsdorff MB.2, Eiriksdottir G.3, Aspelund T.3, Penninx BW.4, Kempen GI.5, Kirschbaum C.6, Harris TB.7, Gudnason V.3
1 CAPHRI School for Public Health and Primary Care, Maastricht University, Department of Social Medicine, Maastricht, The Netherlands
2 The Gerontology Research Centre, Department of Health Sciences, Jyvaskyla, Finland
3 Icelandic Heart Association, -, Reykjavik, Iceland
4 EMGO Institute for Health and Care Research, VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
5 CAPHRI School for Public Health and Primary Care, Maastricht University, Department of Health Services Research, Maastricht, The Netherlands
6 Technical University of Dresden, Biological Psychology, Dresden, Germany
7 National Institute on Aging/National Institutes of Health, Laboratory of Epidemiology, Demography, and Biometry, Bethesda, MD, USA
Background: Socioeconomic status (SES) generally is a strong predictor of all-cause mortality. The underlying mechanisms of this effect are, however, less clear. One of the hypotheses is that psychosocial stress and its biological consequences mediate the relationship between low SES and mortality.
Methods: This study examined the associations between education, salivary cortisol, and all cause mortality in an older population. Data came from 3,808 participants from The Age, Gene/Environment Susceptibility (AGES) – Reykjavik Study. Data were collected using questionnaires, morning and evening saliva samples, and (cause of) death registries over an average period of 5 years time. Analyses were adjusted for age, sex (model 1), season and day of sampling, blood pressure, diabetes, depressive symptoms, cognitive status, working status, heart disease (model 2), physical activity, BMI, smoking status, and alcohol consumption (model 3).
Results: Lower educated groups had lower levels of cortisol 45 minutes after waking up (fully adjusted P = 0.02) as compared to higher educated groups. Moreover, lower education was associated with a less steep decline of cortisol during the day (i.e. lower diurnal variation). This effect was, however, explained by lifestyle factors. Educational differences in mortality in this population were weak to non-existent. Higher evening cortisol levels and lower diurnal variation of cortisol were, however, strong and independent predictors of all cause mortality, even after adjustment for all relevant covariates (HR: 1.31; 95% CI: 1.18-1.46 and HR 0.86; 95% CI: 0.79-0.94, respectively).
Discussion and conclusion: This study found evidence of socioeconomic differences in cortisol secretion in an older Icelandic population. These findings are consistent with the hypothesis that the stress response gets blunted after a whole life of living in adverse socioeconomic circumstances. Educational differences in all cause mortality were less visible, possibly due to the healthy survivor effect. Cortisol levels, however, turned out to be strong and independent predictors of all-cause mortality. Future research on the exact mechanisms underlying socioeconomic differences in cortisol secretion and mortality is recommended.
Keywords: Cortisol, Socio-economic status, social stress, older adults
CORRESPONDING AUTHOR: Groffen Danielle, CAPHRI UM Maastricht, d.groffen@maastrichtuniversity.nl
O786
SUBSTANCE P (SP) LEVELS ARE REDUCED AFTER STRESS MANAGEMENT WITH COGNITIVE BEHAVIOURAL THERAPY (CBT) IN WOMEN WITH THE FIBROMYALGIA SYNDROME (FMS). A RANDOMISED CONTROLLED CLINICAL TRIAL.
Karlsson B.1, Anderberg UM.2, Burell G.1, Nyberg F.2, Svärdsudd K.1
1 Uppsala University, Public Health and Clinical Medicine, Uppsala, Sweden
2 Uppsala University, Department of Biosciences and Nutrition, Uppsala, Sweden
Aim: To evaluate the effect of CBT based stress management on FMS patients on plasma levels of SP (p-SP).
Background: FMS has been increasingly attributed to stress (Anderberg 1999; Van Houdenhove et al 2004). SP, a neuropeptide postulated to be involved in the chronic stress response (Lyon et al 2011), is elevated in cerebrospinal fluid in patients with FMS as compared to normal controls (Russell et al 1994).
Study population and method:48 women, 27-62 years of age were randomly allocated to two groups, an early treatment group and a waiting list group. A modified protocol for CBT originally designed for treating women after myocardial infarction was used with the key components education, self-monitoring, skills training, cognitive reconstructing and spiritual development. Brief relaxation was trained. The patients were treated in groups of 5-7 during three hours once a week during six months. Two experienced clinical psychologists with competence in CBT were responsible for the therapy. Evaluation with psychometric instruments showed that stress management increased life control and decreased stress and vital exhaustion. However the experience of pain was not significantly reduced. (Karlsson, Anderberg, Burell, Svärdsudd ISBM 2010). Outcome evaluation was also made by measuring p-SP.
Results: P-SP was reduced from 8.79 fmol/ml to 5.24 fmol/ml in the treatment group as compared to 8.79 fmol/ml to 8.39 fmol/ml in the wait-list group (p = 0.02). Measurements were adjusted for baseline values.
Conclusions: CBT has the potential to improve well-being among pain patients. Reduced levels of substance P might be a marker of the biological effect of CBT for female patients with FMS.
Keywords: pain, stress
CORRESPONDING AUTHOR: Burell Gunilla, Uppsala University, Uppsala, gunilla.burell@pubcare.uu.se
O787
RACE AND GENOTYPE MODERATE THE RELATIONSHIP BETWEEN EMOTION AND AMBULATORY BLOOD PRESSURE
Bishop GD.1, Zhang X.2, Ngau F.1, Tai ES.1, Lee J.3
1 National University of Singapore, Department of Psychology, Singapore
2 National University of Singapore, Duke-NUS Graduate Medical School, Singapore
3 National University of Singapore, Department of Medicine, Singapore
Objective: This study examined the relationship of momentary emotion and other psychological states to cardiovascular responses using ambulatory monitoring.
Method: 325 Singaporeans (147 Chinese, 88 Indian, 90 Malay; 177 females, mean age 48.2 yrs) underwent 24 hour ambulatory monitoring with blood pressure and heart rate measured every 30 min during waking hours. At each measurement participants were to complete a questionnaire mounted on a palm-top computer. Participants were also genotyped for the tri-allelic 5HTTLPR. Due to relative rarity individuals with two copies of the high active allele (HH) were not included in analyses. Data were analyzed using hierarchical linear modeling.
Results: After controlling for known situational influences on ambulatory BP, genotype interacted with reported happiness (p < .03) such that individuals with two copies of the low acting allele (LL) for 5HTTLPR showed a positive relationship between the experience of happiness and SBP whereas those with one copy of the high acting allele (LH) showed the opposite trend. A significant Race by Genotype by Anger interaction (p < .005) showed that Malays with the LL allele showed a negative relationship between reported anger and SBP whereas those with the LH allele showed a positive relationship. This interaction was not found for Chinese or Indians. A significant Race by Genotype by Tired interaction (p < .02) was obtained for SBP whereby for Malays only individuals with the LH allele showed a stronger negative relationship between feelings of tiredness and SBP than was the case for those with the LL allele. This interaction was not obtained for Chinese or Indians. A similar three way interaction for alert (p < .02) showed that for Malays only individuals with the LL allele showed a positive relationship between feelings of being alert and SBP but those with the LH allele showed a negative relationship, an interaction not found for Chinese or Indians.
Conclusion: These data indicate that everyday blood pressure responses to momentary psychological states are a function of both Race and Genotype with 5HTTLPR genotype having a greater influence among Malays than among Chinese or Indians.
Keywords: blood pressure, ethnic differences, genetics
CORRESPONDING AUTHOR: Bishop George, Nat. Univ of Singapore, psygb@nus.edu.sg
O788
THE EFFECTS OF OVERCOMMITTMENT AND ACUTE STRESS ON HEART RATE IN NURSES IN A TELEPHONE HEALTH SERVICE
Johnston D.1, Allan J.1, Choudhary CJ.2, Farquharson B.3, Jones M.4, Johnston M.1
1 University of Aberdeen, College of Life Sciences and Medicine, Aberdeen, UK
2 Queen Margaret University, Psychology, Edinburgh, UK
3 University of Stirling, NMAHP Research Unit, Stirling, UK
4 University of Dundee, Nursing and Midwifery, Dundee, UK
Background: Stress in nurses is associated with burnout, ill health, clinical errors and leaving the profession.
Objectives: To investigate acute stress and overcommitment (an aspect of the chronic response to work stress) in nurses working for the telephone advice service NHS24, the gateway to out-of-hours healthcare in Scotland. This setting provided a unique opportunity to relate a continuous physiological measure of stress to nurses’ real time experience of stress and their chronic response to work stress.
Method: Nurses (n = 150) were studied over 2 shifts averaging 7.5 hours during which they dealt with an average of 19 calls per shift. Measures included self ratings of the acute stressfulness of each call (1-5 scale) obtained immediately after each call, continuous measures of heart rate (HR) and activity (Actiheart) and the overcommitment score from the Effort Reward Imbalance scale. The data were analysed using multilevel modelling (MLwiN 2.24 and Stata V12.) HR was adjusted for activity and for residual first order autoregressive effects.
Results: Nurses reported experiencing stress during 34% of calls. HR was slightly, but reliably, higher during stressful calls. Overcommitment was positively related to HR which was considerably higher in the overcommitted whether dealing with a call or not. The effect of overcommitment on HR was greatest at the start of the shift but was present throughout the working day. Overcommitment also related positively to the reported stressfulness of calls; the overcommitted rated calls as more stressful on average. Overcommitment and acute stress related independently to HR, i.e., the overcommitted did not appear to have higher HR because they found the calls more stressful.
Conclusions: Both acute stress and overcommitment (reflecting the chronic response to work stress) is associated with higher HR in nurses in a medical helpline service. The effects of chronic stress were more marked. These stress related increases in HR may, over time, pose a risk to the nurses’ health and the service they delivered.
Keywords: stress occupational health
CORRESPONDING AUTHOR: Johnston Derek, Aberdeen University, Aberdeen, d.johnston@abdn.ac.uk
Determinants of Adherence in Chronic Disease Management
O789
THE NECESSITY-CONCERNS FRAMEWORK PREDICTS MEDICATION ADHERENCE IN LONG-TERM CONDITIONS: A META-ANALYTIC REVIEW
Horne R.1, Chapman S. 1, Parham R.1, Freemantle N.2, Vanessa V.1
1 UCL School of Pharmacy, Department of Practice and Policy Primary Care and Population Health, London, United Kingdom
2 University College London, Primary Care and Population Health, London, United Kingdom
Background: Nonadherence to medication in long-term conditions reduces the efficacy of available treatments, leading to avoidable disease and healthcare costs. Perceptual factors such as beliefs may be modifiable determinants of nonadherence, and therefore a target for interventions to increase adherence. The Necessity-Concerns Framework conceptualizes the association between beliefs and nonadherence.
Purpose: To determine the utility of the Necessity-Concerns Framework for explaining adherence to medication prescribed for long-term conditions, using data from studies published over ten years.
Methods: Asystematic review and meta-analysis was conducted. Included studies used the Beliefs about Medicines Questionnaire (BMQ) to measure perceptions of personal Necessity for medication and Concerns about adverse effects in relation to adherence to medication for the treatment of long-term conditions. Relevant citations published between January 1999 and January 2010 were identified through a search of EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL databases, followed by a hand search of reference sections from relevant articles. Data on BMQ necessity and concern beliefs and adherence were extracted. Methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models.
Results: The search strategy identified 1393 studies, of which 44 (N = 11,440) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.918, 95% CI [1.663, 2.212], p < .0001, and fewer concerns about treatment, OR = 0.476, 95% CI [0.418, 0.543], p < .0001. The relationship between beliefs and adherence remained significant when data were stratified by study size and methodology, the country in which the research was conducted and the type of adherence measure used.
Conclusions: The Necessity-Concerns Framework is a useful model for explaining adherence to medication. These findings suggest that adherence may be increased by eliciting and addressing patients’ doubts about the necessity of their prescribed medication and concerns about adverse effects.
Keywords: Adherence; Chronic illness; Beliefs;
CORRESPONDING AUTHOR: Chapman Sarah, UCL School of Pharmacy, London, sarah.chapman@pharmacy.ac.uk
O790
A MULTI-NATIONAL SURVEY OF NON-ADHERENCE BY PATIENTS PRESCRIBED MEDICATION FOR HYPERTENSION
Morrison V.1, Parveen S.1, Fargher E.2, Plumpton C.2, Hughes D.2
1 Bangor University, School of Psychology, Bangor, United Kingdom
2 Bangor University, Centre for Health Economics & Medicines Evaluation, Bangor, United Kingdom
According to previous findings, prescribed medications are often taken irregularly or not at all, resulting in the patient not experiencing the full benefits of their treatment. Furthermore this incurs a substantial cost to health care systems due to the need for additional diagnostic tests, treatments and hospitalisation. The principal aim of this study was to identify the determinants of patient non-adherence to medication drawing from psychosocial theories including Fishbein’s Integrated Model of Behaviour Prediction, Leventhal’s Self Regulatory Model, McLeroy’s Ecological Model and economic models of behaviour.
323 patients currently prescribed antihypertensive medication in four countries (England, Wales, Poland, Hungary) completed a web based questionnaire. The questionnaire was designed to test the effect of behavioural factors (self efficacy and intention), environmental constraints and facilitators, socio-cognitive factors (illness beliefs, normative beliefs, behavioural beliefs and outcome expectancies), ecological factors (at the patient, the family and health care provider levels) and economic factors (income and affordability) on non-adherence. The outcome variable of adherence to medications was assessed with the Morisky scale and the Medication Adherence Report Scale (MARS).
The percentage of patients classed as non-adherent based on self-report ranged from 38% in Wales to 70% in Hungary. Economic factors such as affordability were more commonly related to non-adherence in Hungary and Poland. A larger number of factors (particularly socio-cognitive factors) emerged as significant determinants of non-adherence when using the MARS assessment of adherence as opposed to the Morisky. Low self efficacy and a high number of perceived barriers (practical difficulties with taking medication, forgetfulness and feeling overwhelmed) to taking medication were significant determinants of non-adherence across countries and when either assessment of adherence was used.
Our findings suggest that patient self efficacy and perceived barriers should be key targets in the development of interventions aimed at reducing non adherence. In addition interventions should be assessment specific and sensitive to culture.
Keywords: Adherence, Chronic illness, health beliefs, self-efficacy, economics
CORRESPONDING AUTHOR: Morrison Val, Bangor University, Bangor, v.morrison@bangor.ac.uk
O791
EFFECT OF RETIREMENT ON ADHERENCE TO ANTIHYPERTENSIVE DRUGS: A POPULATION-BASED COHORT STUDY FROM FINLAND
Herttua J. K.1, Martikainen P.2, Kivimäki M.1, Vahtera J.1
1 Finnish Institute of Occupational Health, Work and Organizations, Helsinki, Finland
2 University of Helsinki, Sociology, Helsinki, Finland
Objective: Previous research based on self-report data suggests that health becomes better after retirement. We examined whether retirement affects antihypertensive medication adherence assessed by pharmacy refill records.
Methods: This was a longitudinal population-based study utilising national registers in 1995-2009.
A total of approximately 18 000 hypertensive participants who retired during this study period were extracted from a14% sample of the Finnish population aged 40 years and over with an addition of persons living in the same households (n = 841 947). In this study population, we analysed the use of antihypertensive drugs 4 years before and 4 years after retirement due to age and due to disability.
Results: Adherence to antihypertensive drugs was generally fairly strong (rate >0.80) before retirement. However, adherence increased slightly only among women after retirement due to age. Prevalence ratio for adherence 2 years after versus 1 year before retirement due to age was 1.38 (95% CI 1.07 to 1.77). However, this stronger adherence was not maintained throughout the 4 years after retirement. The effect of retirement was marginal among men in retirement due to age and among men and women in retirement due to disability.
Conclusions: The results of this large-scale population-based follow-up study suggest that effects of retirement on adherence to antihypertensive drugs are marginal regardless of the type of retirement both among men and women. This does not confirm earlier findings that retirement is beneficial for health.
Keywords: adherence, hypertension
CORRESPONDING AUTHOR: Kimmo Herttua, Finnish Inst. of Occup. Health, kimmo.herttua@gmail.com
O792
FURTHER EVIDENCE THAT COGNITIVE IMPAIRMENT AND MEDICATION BELIEFS PREDICT POOR MEDICATION ADHERENCE IN STROKE PATIENTS
O'Carroll R.1, Chambers J.1, Dennis M.2, Johnston M.3, Sudlow C.2
1 University of Stirling, Psychology, Stirling, UK
2 University of Edinburgh, Neurology, Edinburgh, UK
3 University of Aberdeen, Health Psychology, Aberdeen, UK
We have previously shown that cognitive impairment and medication beliefs together predict poor preventative medication adherence in stroke patients. Specifically, we found that younger age, high medication concerns, low MMSE score, and low perceived benefit of medication accounted for 34% of the variance in self reported medication adherence (O'Carroll et al. (2011), Annals of Behavioral Medicine, 41(3):383-90). Based on these findings, we developed a pilot intervention study where 60 patients were randomly allocated to two arms, treatment and control. The treatment group receive 2 brief sessions. The first targets unintentional poor adherence associated with cognitive impairment by helping participants draw up specific implementation intention plans, specifying where, when and how they will take their medication, in an attempt to make medication taking a ritualised habit. The second session aims to elicit and correct any dysfunctional illness or medication beliefs. Outcome is measured via MEMS pill bottle openings, pill count and self reported adherence 3 months later (O'Carroll et al. (2011), BMC Neurology 10:15doi:10.1186/1471-2377-10-15). In this paper we report the baseline predictors of MARS self reported adherence in our treatment study participants. We again conducted a multiple regression analysis including demographic factors, stroke severity, MMSE score, illness and medication beliefs as predictor variables. The final model accounted for 36% (23% adjusted) of the variance in MARS self-reported adherence. The significant variables in the final model were low MMSE score (p = 0.024), high medication concerns (p = 0.033) and low perceived benefit of medication (p = 0.058). Age did not emerge as a significant predictor. We have thus replicated our finding, in a new sample of stroke patients, that acquired cognitive impairment and medication beliefs are significant predictors of poor medication adherence. We propose that these are key candidate substrates for non-intentional and intentional poor adherence respectively. We are currently testing whether adherence can be improved by intervening to target these variables.
Keywords: adherence, beliefs
CORRESPONDING AUTHOR: O'Carroll Ronan, Stirling University, Stirling, reo1@stir.ac.uk
O793
SELF-CARE ADHERENCE AND FAMILY VARIABLES: A LONGITUDINAL STUDY WITH DIABETES TYPE 2 PATIENTS AND THEIR PARTNERS
Pereira MG., Pedras S., Machado J.
University of Minho, Applied Psychology, Braga, Portugal
Introduction: Type 2 diabetes is one of the fastest growing public health. In Portugal 11,7% of the population have diabetes and from those, about 90% suffer from type 2 diabetes. The goal of the present study is to assess: (1) the best predictors of self care behaviors and medication adherence in diabetic patients in the 2 moment of assessment (2) to find differences in psychological variables in diabetic patients between the 1 and 2 moment of assessments; (3) to find differences in adherence in diabetic patients according to gender and illness duration.
Methods: 261diabetics, diagnosed in the last year, and their partners were assessed in two moments (first year of diagnosis and four month after); Instruments used were: Revised Summary of Diabetes Self-Care Activities (Toobert, Hampson, & Glasgow, 2000); Medication Adherence Report Scale (Horne, 2001);Multidimensional Diabetes Questionnaire (Talbot, Nouwen, Gingras, Gosselin, & Audet, 1997); Revised Dyadic Adjustment (Busby, Christensen, Crabe & Larson, 1995); Family Coping (McCubbin, Olson, & Larsen, 1991); Family Stress (McCubbin, Patterson, & Wilson, 1981).
Results: In patients, family stress decreased and marital adjustment increased form moment 1 to moment 2. In partners, no significant changes were found. In terms of differences between patients and partners results showed that only marital adjustment increased from moment 1 to moment 2 for both patients and partners. In terms of predictors of adherence to self-care behaviours, partner negative support assessed by partners is a negative predictor of exercise. Partner positive support and marital adjustment assessed by the patient are predictors of glucose monitoring. Familiar stress and marital adjustment are predictors of adherence to medication. Males showed more tobacco consumption in both moments and less physical exercise in the second moments. Patients with illness duration of less than 6 months revealed more glucose monitorization in both moments and less foot care.
Conclusion: The results emphasize the need for integrative care in diabetes. Patient’s education should take family variables in consideration and include partners in the intervention programs.
Keywords: adherence, stress, coping, marital adjustment, partner support, diabetes
CORRESPONDING AUTHOR: Pereira M. Graça, University of Minho, Braga, gracep@psi.uminho.pt
O794
THE HEMODIALYSIS SELF MANAGEMENT RANDOMISED CONTROLLED TRIAL [HED-SMART] - THE EFFECTIVENESS OF A GROUP SELF MANAGEMENT INTERVENTION TO IMPROVE TREATMENT ADHERENCE IN HEMODIALYSIS PATIENTS
GRIVA K.1, MOOPPIL N.2, Newman S.3
1 National University of Singapore, Psychology, Singapore, Singapore
2 National Kidney Foundation, Medical Directory, Singapore, Singapore
3 City University, Behavioural Medicine, London, UK
Background: Hemodialysis involves a complex regimen of treatment, medication, fluid, and diet management. Poor adherence in both medical and lifestyle aspects is common which significantly increases the risk of morbidity and mortality. This report describes a randomized controlled trial of a group-based self management intervention [HED-SMART] aimed at improving adherence in patients receiving hemodialysis
Methods: Two Hundred and thirty eight (N = 238) hemodialysis patients from National Kidney Foundation, Singapore were randomly assigned to the self-management intervention (n = 107) or standard care (n = 121). Participants were assessed at baseline and at 3 and 9 months post treatment. Using measures of adherence, beliefs, mood and quality-of-life and clinical markers of adherence. The intervention comprised 4 group sessions using educational, cognitive, and behavioral strategies to enhance effective self-management of fluid, diet and medication.
Findings: Significant group differences were found during the acute-phase analysis in fluid control (p = .001), and diet (p = .006) reflecting improved adherence over time for the intervention group. Significant changes were also evidenced in cognitions thought to be important in mediating behavioral change namely self-efficacy (p = .002), concerns medication beliefs (p = .015) and attitudes (p = .001). Observed Improvements in cognitions and adherence were maintained at 3 months post intervention.
Discussion: The current study provides evidence for the feasibility and effectiveness of a ‘light touch’ self management intervention to promote behavioral change and improve adherence to treatment
Keywords: Adherence, randomised controlled trial
CORRESPONDING AUTHOR: Griva Konstadina, National University of Singapore, psygk@nus.edu.sg
Effects of Perceived Racial Discrimination on Physical and Mental Health
S795
EFFECTS OF PERCEIVED RACIAL DISCRIMINATION ON PHYSICAL AND MENTAL HEALTH
Gibbons FX.
Dartmouth College, Hanover, USA
T. Wills, F. Gibbons, K. Kaholokula: Discrimination and Substance Use Among Adolescents in Hawai’i
J. Bastos: Which types of interpersonal discrimination are associated with common mental disorders?
J. Nazroo: Race, Racism and Health: Understanding the Impact of Perceived and Experienced Discrimination
F. Gibbons, M. Gerrard: Mediation and Moderation of the Discrimination / Health Risk Association
Disparities in health status associated with racial/ethnic group membership exist in most countries today and are particularly pronounced (and problematic) in industrialized nations. Importantly, these group effects appear to "work" independent of one another, as well as in interaction. For example, in the US, morbidity and mortality rates among Blacks exceed those of Whites, even when controlling for income, education, geographic location, and access to health care; that is especially true for Black males. Similar situations exist in other countries as well. Increasingly, medical and behavioral researchers are suggesting that a critical underlying factor in these discrepancies is perceived racial discrimination (see Thomas, Price, & Lybrand, in press; forthcoming special issue in Health Psychology). More specifically, it has been suggested that discrimination can have direct effects on health status through its impact on biological factors including cardiovascular reactivity, cortisol secretion, and allostatic load. It can also affect health status indirectly through its impact on mental health (e.g., depression) and health behavior, including substance use and nutrition. This symposium will focus on research that has examined the link between perceived racial discrimination and health status and health behavior, with a focus on factors that mediate the relation. Four researchers, from Brazil, US, and the UK, will present their work on discrimination and health. Drs. Gibbons (Chair) and Gerrard will discuss a series of survey and lab studies with African Americans examining the effects of racial discrimination on substance use and risky sexual behavior, including factors that mediate and moderate this relation. Dr. Nazroo will discuss his work looking at the effects of racial discrimination on self-reported and objectively-measured health outcomes among minorities in the UK. Dr. Wills will present his research linking racial discrimination with adolescent health-impairing behavior within a multicultural setting (Hawaii). Dr. Bastos' presentation will concern the effects of racial discrimination on mental health among Blacks in Brazil. Similarities and differences across these different countries and cultures will be discussed.
Keywords: discrimination, physical health, mental health, substance use
CORRESPONDING AUTHOR: Gibbons Rick, Dartmouth College, rick.gibbons@dartmouth.edu
S796
DISCRIMINATION AND SUBSTANCE USE AMONG ADOLESCENTS IN HAWAI'I
Wills TA.1, Gibbons FX.2, Kaholokula K.3, Knight R.1, Forbes M.4, Juan B.5
1 University of Hawaii Cancer Center, Prevention and Control Program, Honolulu, Hawaii, USA
2 Dartmouth College, Department of Behavioral and Brain Sciences, Hanover, NH, USA
3 John A. Burns School of Medicine, Department of Native Hawaiian Health, Honolulu, Hawaii, USA
4 University of Hawaii, Department of Psychology, Honolulu, Hawaii, USA
5 John A. Burns School of Medicine, Department of Public Health Sciences, Honolulu, Hawaii, USA
Racial/ethnic discrimination has been related to adverse health outcomes in several US studies, including tobacco and alcohol use among African-American adolescents (Gibbons et al., 2010). Williams (2009) noted a need for research about the mechanism of these effects in different ethnic groups. This study examined the relation between discrimination and substance use among adolescents in Hawai’i, a state where large health disparities between ethnic groups are observed (Panapasa et al., 2010). We tested for indirect pathways from discrimination to substance use through anger coping (a 5-item measure) and self-esteem (a 3-item measure). School-based data collection was done with a sample of 836 adolescents (M age 12.9 years, 51% were female). The sample was 38% Asian- American, 29% Caucasian, 17% Native Hawaiian, 8% Filipino, and 8% other ethnicity. Participants identified their primary ethnicity and responded to a 5-item measure on perceptions of unfair treatment (e.g., “You felt you were treated unfairly just because you were in the .... group”). The substance use score was based on 7-point frequency scales for tobacco, alcohol, and marijuana use. There was a significant zero-order correlation between discrimination and substance use, r = .17, p < .0001. A structural modeling analysis (including participant gender and parental education as covariates) tested for mediation of discrimination effects on substance use through two pathways. There were distal paths from discrimination to higher anger (beta = .16, p < .0001) and to lower self-esteem (beta = -.17, p <. 0001) as well as a direct effect from anger to substance use (beta = .12, p < .001). The proximal path from anger to substance use was significant (beta = .31, p < .0001) but the path from self-esteem to substance use was not (beta = -.03, ns). The overall indirect effect of discrimination on substance use was significant (CR = 3.96, p < .0001) but this was entirely through the pathway from discrimination to anger to substance use. The direct effect is also noteworthy. These findings extend the generality of discrimination effects on health-related outcomes in a Pacific Island community and show the mechanism of the relationship is partly direct and partly indirect, mediated through anger
Keywords: Adolescents Addictive Behaviors
CORRESPONDING AUTHOR: Wills Thomas, University of Hawaii, Honolulu, twills@cc.hawaii.edu
S797
WHICH TYPES OF INTERPERSONAL DISCRIMINATION ARE ASSOCIATED WITH COMMON MENTAL DISORDERS?
Bastos J.1, Barros A.2, Paradies Y.3, Faerstein E.4, Celeste R.5
1 Federal University of Santa Catarina, Public Health, Florianopolis, Brazil
2 Federal University of Pelotas, Social Medicine, Pelotas, Brazil
3 University of Melbourne, School of Population Health, Melbourne, Australia
4 State University of Rio de Janeiro, Institute of Social Medicine, Rio de Janeiro, Brazil
5 Federal University of Rio Grande do Sul, Department of Dentistry, Porto Alegre, Brazil
Background: Although research on discrimination and mental health outcomes has progressed expressively, it has been almost entirely restricted to racial discrimination and to US populations. For instance, in Brazil, there is only one published study on the mental health effects of discrimination, which was limited to a Northeastern city, and to the exclusive assessment of racial discrimination.
Objective: To assess interpersonal experiences of discrimination and their relation with common mental disorders, with a focus on the effects of different reported attributions. Methods: A cross-sectional analysis was carried out among a convenience sample of 424 undergraduate students, enrolled at a public university from Rio de Janeiro (Brazil) in 2010. Self-administered questionnaires eliciting information on experiences of discrimination, common mental disorders, and socio-demographic characteristics were completed by participants in the classrooms. The association between different types of discrimination and common mental disorders was assessed using multiple logistic regression models, with estimation of odds ratios (OR) and 95% confidence intervals (95%CI). Covariates included in these models were sex, age, socioeconomic status, race, course attended, number of semesters spent at the university, and type of admission to the university. Interactions with the different types of discrimination were examined.
Results: The most frequently reported reasons for discriminatory experiences were age, class, the way one dresses, place of residence and race, in that order. Separate multiple logistic regression models revealed that age, class, race discrimination and discrimination due to the way one dresses were statistically significantly associated with common mental disorders. The fully adjusted logistic regression model, including these types of discrimination and socio-demographic controls, showed that only class discrimination remained associated with a higher odds of common mental disorders (OR = 2.0; 95%CI = 1.2-3.5). No significant two-way interactions were found.
Conclusions: These findings underscore the need to assess different types of experiences of discrimination simultaneously, so that unique patterns of associations with health outcomes may be clarified.
Keywords: Population health; race; research methods; social class.
CORRESPONDING AUTHOR: Bastos Joao Luiz, UFSC, Florianopolis, joao.luiz.epi@gmail.com
S798
RACE, RACISM AND HEALTH: UNDERSTANDING THE IMPACT OF PERCEIVED AND EXPERIENCED DISCRIMINATION
Nazroo JY.
University of Manchester, Sociology, Manchester, United Kingdom
Racism, and consequent discrimination, may be the key to understanding racial/ethnic disparities in health. In addition to the economic inequalities that result from racism, there is an increasing body of evidence that suggests that experiences and perceptions of discrimination impact directly on the health of minority groups. However, population level surveys face serious challenges in the measurement of the main dimensions of discrimination, raising doubts about conclusions drawn. This paper will provide an overview of approaches to measuring discrimination. It will then present findings from surveys conducted in the UK by the author showing the extent of experiences of racist incidents, racial discrimination, and fear of racism for a range of ethnic minority groups. The relationship between these different types of experience of discrimination and both subjective and objective measures of health will then be explored and the mechanisms linking these relationships will be examined. Comparisons will be drawn with findings from other industrialised nations. These findings will then be used to draw conclusions around the role of racism in the generation of racial/ethnic disparities in health and implications for policy will be discussed.
Keywords: Race, Ethnicity, Racism, Discrimination, Inequalities in Health
CORRESPONDING AUTHOR: Nazroo James, University of Manchester, james.nazroo@manchester.ac.uk
S799
RACIAL DISCRIMINATION AND HEALTH BEHAVIOR: EXAMINING MEDIATION AND MODERATION OF THE PROSPECTIVE RELATION
Gibbons F.1, Gerrard M.2
1 Dartmouth College, Psychological and Brain Sciences, Hanover, NH, USA
2 Dartmouth Medical School, Cancer Control Program, Lebanon, NH, USA
Increasingly, health researchers are looking at perceived racial discrimination as a factor contributing to racial disparities in health status within many “industrialized” countries, specifically through the impact that discrimination has on health-risk behavior. In this presentation, I will discuss a series of laboratory (experimental) and survey studies we have conducted with African Americans (ages 10 to 55) that have examined factors that mediate and moderate the strong prospective relations we have found between perceived racial discrimination and both health status and health-risk behaviors, including substance use and risky sexual behavior. We have found that self-reported discrimination is associated with elevated negative affect (NA), including anxiety and depression (internalizing), and anger (externalizing); whereas in several lab studies, we have shown that manipulated discrimination has similar effects. These different types of affective responses have different health consequences, however, what we refer to as the differential mediation hypothesis: Anger is strongly linked with subsequent substance use—in adolescents and adults—whereas anxiety and depression are associated with increased willingness to engage in “risky” sex among young Black adults, and with poor health status (somatic complaints) in Blacks over the age of 45. The relations between discrimination and NA, in turn, are moderated by several modifiable factors, including racial identity (a buffer), coping style (risk factor), and genetic structure. For example, self-reported racial identity and affirmed (i.e., manipulated) racial identity are associated with reduced reports of anger after discriminatory experiences. Implications of these results for interventions aimed at reducing HIV risk behavior and substance abuse will be addressed.
Keywords: Minority health, Substance Use
CORRESPONDING AUTHOR: Gibbons Rick, Dartmouth College, rick.gibbons@dartmouth.edu
Women's Health
O800
CAUSAL SYMPTOM ATTRIBUTIONS IN PREMENSTRUAL SYNDROME
Kleinstäuber M.1, Schmelzer K.1, Herzer N.1, Andersson G.2, Hiller W.1
1 University of Mainz, Clinical Psychology, Mainz, Germany
2 Karolinska Institutet, Clinical Psychology, Stockholm, Sweden
Objective: Moderate to severe premenstrual symptoms affect up to 8% of women during their reproductive years. A bio-psychosocial approach assumes an interaction of biological, psychological, and social factors playing an important role in the development of premenstrual syndrome (PMS). This multidimensional etiological model especially focuses on how patients interpret and appraise their premenstrual symptoms. Causal symptom attributions, having an important influence on how symptoms are interpreted, were examined in a sample of women with PMS in the current study.
Methods: An online screening questionnaire, a retrospective assessment of premenstrual symptoms, a diagnostic telephone interview and a month-long prospective symptom diary were administered in order to check inclusion criteria. 91 women aged between 18 and 48 years, with at least moderate premenstrual symptoms in the retrospective and prospective assessment, and without comorbid affective, psychotic or eating disorders were included. During their luteal phase the participants completed a questionnaire of causal symptom attributions based on the Revised Illness Perception Questionnaire.
Results: Parallel analysis obtained four factors of symptoms attributions: Psychological Attributions, Somatic Attributions, Lifestyle-related Attributions, and External Attributions. Sufficient internal consistency was shown for all subscales, ranging between Cronbach’s alpha = .74 and = .89. “Hormonal imbalances or changes” were rated most frequently as a cause of premenstrual symptoms (96.7%). 90.1% of the participants agreed with more than one symptom attribution from the questionnaire. Significant correlations were found between affective, premenstrual symptoms and the number of chosen symptom attributions (r = .26, p < .05), PMS-related joint pain and somatic attributions (r = .31, p < .01), and between hormonal attributions and psychological, premenstrual symptoms (r = -.28, p < .01).
Conclusions: Results reveal that hormonal symptom attributions are dominant in women with PMS. Symptom appraisals play an important role in the etiology of PMS and can influence treatment preferences of women with PMS. Therefore PMS-related causal symptom attributions should be paid more attention in future research.
Keywords: Gender; Health beliefs; Women's health
CORRESPONDING AUTHOR: Kleinstäuber Maria, J. Gutenberg-University, Mainz, kleinsta@uni-mainz.de
O801
PSYCHOLOGICAL CORRELATES OF PERSISTENT GENITAL AROUSAL DISORDER IN A PORTUGUESE COMMUNITY SAMPLE
Carvalheira A., Leal I.
University Institute of Applied Psychology, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Introduction: Persistent genital arousal disorder (PGAD) refers to a condition of intrusive, unwanted, seemingly spontaneous genital arousal/vasocongestion that occurs in the absence of any obvious sexual trigger or explicit sexual interest/desire, and that persists for an extended period of time despite one or several orgasms (Leiblum et al., 2007). It has been provisionally identified as one kind of female sexual arousal disorder by a committee of experts in female sexuality. Causes and treatment of PGAD are still unknown.
Aim: The goal of this study was to explore the incidence of PGAD in a community sample and to make a descriptive analysis of psychological variables associated to this clinical condition.
Methods: This study is part of a large web-based survey that consisted of a self-report questionnaire about sexual functioning. Pilot testing was carried out to assess the integrity of the website and database. Participants over the age of 18 were recruited through advertisements and snowball by e-mail.
Main outcome measures: Respondents were asked about the nature, onset, and feelings concerning the symptoms. Also self-report measures of sexual arousal, orgasm, masturbation, sexual satisfaction, and other behavioural variables were used. These measures were developed for this study by the authors.
Results: Of the3687 Portuguese women who completed the survey, 94 (2.5%) met all five criteria for the condition with accompanying distress. Of the 94 women with PGAD, 25% are not committed nor have sexual partner, 8.5% are menopausal, 15% are taking an antidepressant, 24.5% were sexually abused (versus 9% of total sample), and 40% reported feeling “somewhat sexually inhibited” and 33.6% “very inhibited”. Of the 94 women with PGAD 23% reported masturbating not directly touching the genitalia (using a pillow or the shower jet), and 54.3% reported masturbation during adolescence. Some women reported involuntary genital arousal unrelated to subjective feelings of sexual desire: few times (35.6%), sometimes (26%), and many times (4.8%).
Discussion: These data shows a low incidence of PGAD: only 2.5% of women met all the criteria of PGAD and a high rate of childhood sexual abuse (25%).
Keywords: Sexual functioning; Women's Health
CORRESPONDING AUTHOR: Carvalheira Alexandra, ISPA, Lisbon, ana.carvalheira@ispa.pt
O802
MENOPAUSAL SYMPTOMS: THE PREDICTIVE INFLUENCE OF PERSONAL AND CONTEXTUAL FACTORS
Pimenta F., Leal I., Maroco J.
Instituto Superior Psicologia Aplicada, Psychology and Health Research Unit (UIPES), Lisbon, Portugal
Objective: Hormonal changes during menopausal transition are linked to physical and psychological symptoms’ emergence (Sarrel, 1999). However, it has been concluded that negative life events can also exert an influence on the manifestation of some menopausal symptoms (Binfa et al., 2004; Hardy & Kuh, 2002). Thus, this study aims at exploring how personal and contextual variables might predict menopausal symptoms’ severity in peri- and post-menopausal women.
Method: This cross-sectional research encompasses a community sample of 710 women who completed socio-demographic, health and menopause-related, and lifestyle questionnaires; the Menopause Symptoms’ Severity Inventory (MSSI-38) (Pimenta et al., 2011) and the Life Experiences Survey (Silva et al., 2003), both validated instruments, were used. Structural equation modelling was applied to build a causal model, encompassing all dependent (twelve sets of menopausal symptoms) and independent variables (eighteen variables, including socio-demographic variables, health and menopause-related factors, lifestyle characteristics, and life events).
Results: Menopausal status predicted only three symptoms: skin/facial hair changes (β = .136; p = .020), sexual symptoms (β = .157; p = .004), and, marginally, vasomotor symptoms (β = .094; p = .054). Life events predicted depressive mood (β = -.391; p = .002), anxiety (β = -.271; p = .003), cognitive impairment (β = -.295; p = .003), body shape changes (β = -.136; p = .031), aches/pain (β = -.212; p = .007), skin/facial hair changes (β = -.171; p = .021), numbness (β = -.169; p = .015), perceived loss of control (β = -.234; p = .008), mouth, nails and hair changes (β = -.290; p = .004), vasomotor (β = -.113; p = .044) and sexual symptoms (β = -.208; p = .009).
Conclusions: Only three of the menopausal symptoms assessed were predicted by the menopausal status. Since the vast majority of menopausal symptoms’ severity was significantly influenced by life events, it is possible to conclude that the symptomatology exacerbation, in peri- and post-menopausal women, might be due to life conditions and events, rather than to hormonal changes. Additionally, it is emphasized that the only symptoms that appear to be menopause-related are skin/facial changes, vasomotor and sexual symptoms. It is recommended that contextual variables are accounted for in menopause-related clinical and research settings.
Keywords: Women's Health; Aging; Menopause; Symptoms; Life Events
CORRESPONDING AUTHOR: Pimenta Filipa, ISPA - Instituto Universitário, filipa_pimenta@ispa.pt
O804
SENSE OF MASTERY AND HEALTH IN WOMEN AT MIDLIFE
Deeg DJH.1, Richards M.2, Cooper R.3, Stafford M.3, Kuh D.3
1 VU University Medical Center, EMGO Institute for Health and Care Research, Dept. of Clinical Epidemiology and Biostatistics, Amsterdam, The Netherlands
2 University College London, Unit on Lifelong Health and Ageing, London, United Kingdom
3 Medical Research Council, Unit on Lifelong Health and Ageing, London, United Kingdom
Sense of control or mastery is considered a fundamental marker of successful ageing (Rowe & Kahn 1997). There is evidence that sense of mastery delays the transition to poorer health states. Vice versa, health decline has been shown to affect the sense of mastery. This study examines the sense of mastery and its 6-year antecedents in women experiencing the midlife transition.
In the context of the National Study on Health and Development, women at ages 47-52 were sent annual questionnaires on health, well-being, and social conditions. At age 52, the Psychological Well-being subscale Environmental Mastery (Ryff 1989) was included. From women scoring in the highest and lowest 5% of scores, 10% of women were selected (n = 23). Following the life history approach (Singer et al 1998), based on all available questionnaire data, life histories for ages 47-52 were written, aided by the comments many participants wrote to the annual questionnaires.
Results: show that in many women’s lives, changes are taking place. These include getting a new job, difficulties with teenage children, children leaving the home, a loss of a relationship or a new relationship, contracting a progressive disease, husband losing his job or retiring, frail parents moving in, and moving to a new house. The level of mastery as observed at age 52 seemed at variance with these changes, in that a high sense of mastery was often found in women with health problems, and a low sense of mastery in women who felt positively about her lives.
It is concluded that the sense of mastery of women in midlife is largely independent of their current circumstances. Possibly, these findings reflect that women who are challenged by hardships but cope see themselves as having high mastery? Vice versa, British women in this particular post-war cohort may view their lives in a positive light even if they do not experience a high sense of mastery. Further research should examine to what extent earlier life circumstances may have determined their sense of mastery.
References:
Rowe JW, Kahn RL. Successful aging. Gerontologist 1997; 37(4): 433-440.
Ryff C. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology 1989, 57: 1069-1081.
Singer B, Ryff CD, Carr D, Magee WJ. Linking life histories and mental health: a person-centered strategy. In Raftery A, Sociological Methodology. Washington, DC: American Sociological Association, 1998: 1-51.
Keywords: Women's health, Mental health, Resilience
CORRESPONDING AUTHOR: Deeg Dorly J.H., VU University Medical Centre, djh.deeg@vumc.nl
O805
LIGHT DRINKING IN PREGNANCY APPEARS NOT TO BE ASSOCIATED WITH DEVELOPMENTAL DIFFICULTIES AT AGE 7: A POPULATION BASED STUDY
Kelly Y., Sacker A., Iacovou M., Kelly J.
University of Essex, Institute for Social & Economic Research, Colchester, UK
The link between heavy drinking in pregnancy and subsequent developmental problems is well established. However, the picture for light drinking (up to a maximum of 1 or 2 units of alcohol per week) in pregnancy is less clear, partly because light drinkers are more likely to be socially advantaged compared with non-drinkers. These confounding effects are difficult to account for using traditional epidemiological techniques. In this paper we apply propensity score matching to match children born to light drinkers and non-drinkers on a large range of characteristics to more effectively estimate the effect of light drinking in pregnancy on markers of child development. We test the hypothesis that children born to light drinking mothers are not at risk of cognitive deficits compared with children born to mothers who did not drink alcohol during pregnancy.
Data were from the UK Millennium Cohort Study on 9050 7 year old children. Markers of development were scores on standard cognitive ability tests for word reading, maths and spatial abilities.
In crude analysis children born to light drinkers had higher scores for word reading (16.6, SE 2.3), maths (15.8, SE 2.2) and spatial abilities (17.1, SE 2.2). After matching, effects were attenuated but remained statistically significant for word reading (8.3, SE 3.1) and spatial abilities (9.2 SE 3.1), but not for maths scores (4.4, SE 3.1). The analysis will be extended to consider markers of socioemotional wellbeing, and gender differences in observed associations will be examined.
Our findings suggest that children born to light drinking mothers are not at increased risk of cognitive deficits at 7 years of age.
Keywords: Alcohol, Pregnancy, Children
CORRESPONDING AUTHOR: Yvonne Kelly, University of Essex, Colchester, ykelly@essex.ac.uk
Emotional and Self-reported Issues in Relation to Cardiovascular Regulation
S806
EMOTIONAL AND SELF-REPORTED ISSUES IN RELATION TO CARDIOVASCULAR REGULATION
Tuomisto MT.1, Brown J.2, Gellman M.3, Steptoe A.2
1 University of Tampere, School of Social Sciences and Humanities, Tampere, Finland
2 University College London, Department of Epidemiology and Public Health, London, United Kingdom
3 University of Miami, Behavioral Medicine Research Center, Miami, USA
Self-reported experiences are important aspects of many studies in behavioral medicine. The authors of this symposium will consider the significance of different emotions and other self-reported measures in relation to cardiovascular reactivity and recovery in four presentations. In general, both positive and negative affect and their relative importance have been studied in addition to the magnitude of their effects on cardiovascular and related functions. Other self-reported variables may also be important to the interpretation of the results in behavioral medicine.
Andrew Steptoe will present a series of studies investigating the role of positive affect and other protective psychological characteristics in promoting more rapid recovery of cardiovascular responses following acute stress, and in reducing neuroendocrine and inflammatory responses to stress. Dr. Steptoe will summarise the results and show many general effects of emotions on cardiovascular health.
Jennie Brown will extend the theme of protective psychological resources in presenting a study relating resilience with heart rate variability in everyday life. Dr. Brown will also reflect on self-reported measures of regular activity.
Following the theme of the symposium Marc Gellman will present findings on depression in individuals that are at high risk for developing cardiovascular disease. These include individuals who have CVD risk factors of Type 2 diabetes and Metabolic Syndrome. Dr. Gellman will examine the relationships inflammatory biomarkers, with depression, and physical activity in these populations.
Martti T. Tuomisto will show results from the Tampere Ambulatory Hypertension Study earlier intra-arterial blood pressure data base regarding the significance of assessments of emotional and other self-reported variables in the study of blood pressure reactivity and recovery. Dr. Tuomisto asks: Do self-reported assessments of the stress tasks in the laboratory add to the prediction of cardiovascular reactivity and recovery and if so, which variables are the most important?
Keywords: Emotions, cardiovascular reactivity, physical activity, positive affect, negative affect, stress, testing, self-report
CORRESPONDING AUTHOR: Tuomisto Martti T, University of Tampere, Tampere, martti.tuomisto@uta.fi
S807
POSITIVE AFFECT AND CARDIOVASCULAR REACTIVITY AND RECOVERY
Steptoe A.
University College London, Department of Epidemiology and Public Health, London, United Kingdom
Accumulating evidence for a beneficial effect of positive wellbeing on health has driven the search for potential biological and behavioral mediators. We have carried out a series of studies evaluating the impact of positive affective states and traits on cardiovascular, neuroendocrine and inflammatory responsivity to acute mental stress. These have involved monitoring physiological function before, during and after the administration of standardized behavioral challenges in the laboratory from samples of young and middle aged men and women, and relating reactivity and recovery with individual differences in positive psychological factors. The following observations emerge from these studies: 1) positive affect and optimism are associated with more rapid recovery of diastolic blood pressure following acute stress, although reactivity is not affected; 2) positive affect also predicts attenuated cortisol responses, while optimism is correlated with lower interleukin 6 following acute stress; 3) the effects of positive affect are more consistent when assessed with measures of experienced affect (ecological momentary assessment, daily ratings) than retrospective questionnaires; 4) Associations are independent of measures of negative affective states such as distress and depression. These results suggest that independently of negative emotional influences on cardiovascular function, positive affective states are associated with favorable patterns of cardiovascular, endocrine and inflammatory response to acute mental stress.
Keywords: Cardiovascular reactivity; Mood
CORRESPONDING AUTHOR: Steptoe Andrew, UCL, London, a.steptoe@ucl.ac.uk
S808
THE ASSOCIATION BETWEEN RESILIENCE, PHYSICAL ACTIVITY AND HEART RATE VARIABILITY IN EVERYDAY LIFE
Brown J.1, Dockray S.2, Salavecz G.3, Steptoe A.1
1 University College London, Department of Epidemiology and Public Health, London, United Kingdom
2 University College Cork, Applied Psychology, Cork, Ireland
3 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
Resilience (the capacity to adapt successfully to acute or chronic adversity), is a protective psychological process thought to be associated with physical health, but the mechanisms are uncertain. We tested whether greater resilience is associated with higher heart rate variability (HRV) in everyday life. Since higher resilience may also be correlated with physical activity, and regular physical activity may increase HRV, this could be a pathway linking resilience with HRV. Ambulatory devices were used to measure objective physical activity, heart rate and HRV (indexed by high frequency (HF), low frequency (LF) and HF/LF ratio), across two 24 hour periods during a work and leisure day and evening from 202 healthy working women in Budapest. Measures of self-reported physical activity and resilience, using the Resilience Scale, were collected by questionnaire. Regression analyses showed that resilience was associated with HF, LF and HF/LF ratio measures during the working evening, and HF and HF/LF ratio during the working day. Higher resilience was associated with greater HRV, and relationships were independent of concurrent objective physical activity. Self-reported physical activity was also related to resilience but did not predict HRV. These results suggest that resilience might promote more effective adaptation to everyday stress. Greater resilience may also be related to favorable health behaviors such as regular physical activity, but self-reported activity was not associated with heart rate or HRV in this study. This may reflect limitations in the self-report measures of regular activity.
Keywords: Resilience, psychophysiology, physical activity, ambulatory monitoring
CORRESPONDING AUTHOR: Brown Jennie, University College London, jennie.brown.09@ucl.ac.uk
S809
CARDIOVASCULAR DISEASE RISK: PUTATIVE RELATIONS AMONG TYPE 2 DIABETES, METABOLIC SYNDROME, DEPRESSIVE SYMPTOMS AND INFLAMMATORY BIOMARKERS
Gellman M., Chirinos D., Gutt M., Goldberg R., Schneiderman N.
University of Miami, Behavioral Medicine Research Center, Miami, USA
Type 2 Diabetes (T2D), metabolic syndrome (MSY), depression and inflammatory biomarkers are all associated with increased cardiovascular disease (CVD) risk, but their relationships with one another are not well understood. This study examined 162 T2D and 137 MSY (without T2D) men and women patients seen in two low-income community clinics in terms of Beck Depression Inventory (BDI) score and two biomarkers of inflammation, C-reactive protein (CRP) and leptin. For the T2D patients mean BDI score was 17.5, mean CRP was 5.09 and leptin was 41.42. For the MSY patients mean BDI score was 10.16, mean CRP was 5.15 and leptin was 41.77. Thus the T2D patients were more depressed (p < .001) than the MSY patients while their levels of inflammatory biomarkers were quite similar.
We examined severity of depression and its association with inflammation, by comparing minimally depressed with more depressed BDI (10 and above) scores; and comparing mildly depressed with more depressed BDI (18 and above) scores. We found that in the MSY group patients severity of depressed affect showed significant differences for both CRP (p < .002) and leptin (p < .03 ), whereas in the T2D group patients severity of depressed affect was associated circulating leptin (p < .01) but not CRP. Multiple regression analyses indicated that the relation between depressed affect and CRP was not moderated by gender, age or HbA1c in either the MYS or T2D groups. Furthermore, the relationship between depressed affect and both CRP and leptin in the MYS group remained at least as strong after controlling for age, gender and A1c.
We conclude from this study that there are strong relationships between depressed affect and leptin in both MSY (without T2D) and T2D patients, but the association between depressed affect and CRP holds for MSY, but not for T2D patients. The lack of association between depressed affect and CRP in T2D remains to be explained.
Keywords: Diabetes, Depression, Biobehavioral mechanisms, Cardiovascular disease
CORRESPONDING AUTHOR: Gellman Marc, University of Miami, Miami, mgellman@miami.edu
S810
THE EFFECT OF EMOTIONAL AND SELF-REPORTED ASSESSMENTS ON CARDIOVASCULAR REACTIVITY AND RECOVERY IN THE LABORATORY
Tuomisto M.1, Ollikainen J.2, Parkkinen L.1
1 University of Tampere, School of Social Sciences and Humanities, Tampere, Finland
2 University of Tampere, School of Information Sciences, Tampere, Finland
Emotional and self-reported responses in the laboratory and to the laboratory tasks have sometimes been studied in addition to performance measures in stress testing. The significance of these responses is not well-known, because they have seldom been studied in the context of continuous cardiovascular responses. Here we analyzed the self-assessed variables from the Tampere Ambulatory Hypertension Study earlier intra-arterial blood pressure data base (n = 120) regarding their significance for cardiovascular reactivity and recovery. Using hierarchical regression analysis we hypothesized that self-assessed responses would add to the prediction of reactivity and recovery in the laboratory. In the models, we used those self-assessed variables that correlated at least with some of the dependent variables in active, social and passive stress tasks. The improvement in R2 varied between 0.3% and 2.9% in reactivity compared to relaxation baseline and between 0.2% and 2.5% compared to recovery baseline. Thus, the effects were not large. The variables that correlated with dependent variables in some contexts were the following: physical effort, sadness, tiredness, time pressure, and control of the situation. It appears that the common factor for these is the level of motor activity and therefore it is possible that the effect of these variables on cardiovascular reactivity and recovery could be explained using measurement of motor activity in studies of cardiovascular activity.
Keywords: Emotional responses, Self-report, Assessment, Cardiovascular reactivity, Recovery, Prediction
CORRESPONDING AUTHOR: Tuomisto Martti T, University of Tampere, Tampere, martti.tuomisto@uta.fi
Current Approaches to the Assessment and Management of Stress at Workplace
S811
CURRENT APPROACHES TO THE ASSESSMENT AND MANAGEMENT OF STRESS AT WORKPLACE
Sibilia L.1, Kawakami N.2
1 Sapienza University of Roma, Department of Internal Medicine, Roma, Italy
2 University of Tokyo, Department of Mental Health, Tokyo, Japan
Reducing work-related psychosocial stress has become an important component of programs for improving health of employees in organisations and preventing stress-related problems. However, intervention programs targeted to stress reduction should be assessment-guided, given the wide variety of professional types and jobs, and the context-dependent nature of work stressors. Moreover, assessment itself should be focused on variables which are open to modification, given that the ultimate goal of such programs is to produce a change in stress factors and climate in the working environment. In this Symposium, examples of recent research studies are presented, which illustrate how an intervention program on School teachers can rely on the assessment (Borgo & Sibilia), what changes can be expected in job satisfaction, turnover intention, work engagement, psychosomatic distress, and emotional exhaustion of emergency nurses (Adriaenssens, De Gucht & Maes), and how new information technologies (IT) can be implemented in order to perform proper and reliable online assessments of worksite stress and of the quality of working life, through the ACTIVE system (Shimazu & Kawakami) and the CACTUS System (Sibilia & Borgo). Thus, the Symposium will also provide the opportunity to compare traditional and computer-based assessment, as well as two different IT programs independently developed to that purpose.
Presentations and participants:
-
1.
A Stress management program in the school: assessment and intervention. (Stefania Borgo, Center for Research in Psychotherapy, Roma; Lucio Sibilia, Department of Internal Medicine, Sapienza University of Roma, Italy)
-
2.
Predictors of job satisfaction, turnover intention, work engagement, psychosomatic distress, and emotional exhaustion in emergency nurses: results of longitudinal analysis. (Jef Adriaenssens, Véronique De Gucht, Stan Maes, Leiden University, Department of Psychology, Leiden, The Netherlands)
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3.
Towards healthy employees in a healthy organization: A web-based questionnaire for workplace assessment (ACTIVE). (Akihito Shimazu, Norito Kawakami, Department of Mental Health, The University of Tokyo, Japan)
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4.
Cactus, a web-based system for assessing and reducing worksite stress in organisations: an initial test. (Lucio Sibilia, Department of Internal Medicine, Sapienza University of Roma, Stefania Borgo, Center for Research in Psychotherapy, Roma, Italy)
Keywords: Assessment, Intervention, Stress, Research to practice translation, Web-based, Worksite health
CORRESPONDING AUTHOR: Sibilia Lucio, Sapienza University of Rome, lucio.sibilia@uniroma1.it
S812
A STRESS MANAGEMENT PROGRAM IN THE SCHOOL: ASSESSMENT AND INTERVENTION.
Borgo S.1, Sibilia L.2
1 Center for Research in Psychotherapy, Roma, Italy
2 Sapienza University of Roma, Department of Internal Medicine, Roma, Italy
Problem: This study assessed the feasibility and effectiveness of a cognitive-behavioural intervention program aimed at reducing psychosocial stress and preventing burn-out in school teachers, both by teaching and fostering individual self-management skills and targeting context-dependent stress factors in a cooperative climate.
Procedure: 50 school teachers were selected by several Schools of the County of Rome to participate to the Program, among those who had the responsibility of health education. The assessment battery comprised an ad hoc questionnaire for "Stress Symptoms" (SS), modified from the Stress Audit (L.H. Miller & A.D. Smith, 1993), by L. Sibilia and S. Borgo, and the Automatic Thought Questionnaire (ATQ) by S. Hollon & P. Kendall (1985), for anxious and depressive thinking.
Method: The program was implemented in six 5-hour workshops in one of the Schools. The group was divided into 2 parallel sub-groups to allow for individual participation. Basic notions about psychosocial stress were taught; techniques used were emotional and cognitive self-monitoring, muscular relaxation, and basic information about dysfunctional beliefs and imagery. Moreover, a group work was carried on for rising awareness on work-site stress factors, and for constructing in a co-operative climate an assessment instrument.
Results: Compared to baseline, final measures showed a significant reduction in ATQ scores (from 45.8 to 41.2, p < .007),a more pronounced reduction in SS (from 24.45 to 15.15, p < .05). Albeit the seasonal differences between baseline and final assessment could only exert a contrasting influence, the program was felt as useful for managing stress at personal level, albeit its introductory nature, and provided evidence of reduction of stress scores up to 38% and improvement of well-being in participants.
Keywords: Assessment, Intervention, Stress, Stress management, Research to practice translation, Web-based, Worksite health
CORRESPONDING AUTHOR: Sibilia Lucio, Sapienza University of Rome, lucio.sibilia@uniroma1.it
S813
CAUSES AND CONSEQUENCES OF OCCUPATIONAL STRESS IN EMERGENCY NURSES IN SECONDARY HOSPITALS IN FLANDERS, A LONGITUDINAL STUDY
Adriaenssens J., De Gucht V., Maes S.
Leiden University, Department of Psychology, Leiden, The Netherlands
Background: The study, carried out in emergency departments (ED) in secondary hospitals in Flanders, investigated to what extent changes over time in job characteristics and organizational factors predict distress outcomes at T2 in ED-nurses: i.e. job satisfaction (JS), turnover intention (TOI), work engagement (WE), psychosomatic distress (PSD) and emotional exhaustion (EE).
Methods: This longitudinal study inquired 170 emergency nurses, who kept working on the same emergency department at T1 (2008) and T2 (2009) (response rate 70%). Self-report questionnaires were used, including the Leiden Quality of Work Questionnaire for Nurses (LQWQ-N), Utrecht Work Engagement Scale (UWES), Brief System Inventory (BSI) and Maslach Burnout Inventory (MBI). Hierarchical multiple regression analyses were conducted.
Findings: The regression model, controlling for the respective outcome at T1, and consisting of job characteristics (Job Demands, Job Control and Social Support) and several organizational variables, explained 50%, 37%, 56%, 50% and 49% of the variance in JS, TOI, WE, PSD and EE respectively. Job demands predicted JS and EE, job control predicted JS and WE, Social Support predicted JS and EE, Social harassment predicted PSD and EE, Home/Work relationships predicted PSD, work agreements predicted TOI, material resources predicted PSD and rewards predicted WE.
Discussion: Emergency nurses are prone to occupational stress. Several predictors can have long lasting effects on the ED-nurse. Awareness of this issue and investment in a healthy professional work environment is an important point of concern for hospital management.
Keywords: emergency nurse, job satisfaction, occupational stress, psychosomatic distress, social support
CORRESPONDING AUTHOR: Adriaenssens Jef, Occup. Health Psychology, j.adriaenssens@umail.leidenuniv.nl
S814
TOWARDS HEALTHY EMPLOYEES IN A HEALTHY ORGANIZATION: A WEB-BASED QUESTIONNAIRE FOR WORKPLACE ASSESSMENT (ACTIVE)
Shimazu A., Kawakami N.
The University of Tokyo Graduate School of Medicine, Department of Mental Health, Tokyo, Japan
Background: Nowadays, many companies are facing large operational challenges, and they require their employees to be more motivated, proactive, and responsible. However, traditional occupational mental health focuses on health impairment rather than health improvement. In order to improve the quality of working life, we need to focus both aspects of well-being.
Outline of the ACTIVE: The ACTIVE, products of joint projects by The University of Tokyo and Fujitsu Software Technologies, is a online questionnaire. It assesses (1) job demands and stress responses (i.e., health impairment process) and (2) job resources and job satisfaction and performance (i.e., motivational process) as hypothesized in the Job Demands-Resources model (JD-R model). Filling it in takes approximately 20 minutes.
Company report: The ACTIVE produces company report which is base on aggregated data. Average scores of the entire group of employees are calculated. By using scores on stress responses (SR) and job satisfaction and performance (JS-P), each workplace can be classified into the following four categories: (1) engaged (healthy) group (i.e., low SR and high JS-P), (2) potential burn-out group (i.e., high SR and high JS-P), (3) low motivational group (i.e., low SR and low JS-P), and (4) non-engaged (unhealthy) group (i.e., high SR and low JS-P). In addition, an overview of the scores for each element of the ACTIVE is presented separately. These average group data are compared to a reference group that acts as a benchmark. This can be the average score of Japanese employee or the average score of the employees of the same organization. Suggestions for decreasing job demands and increasing job resources are also provided.
Discussion: The results obtained by the ACTIVE constitutes a starting point for appropriate interventions. Since the ACTIVE assesses both health impairment process and motivational process, it has the potential for the collaboration of occupational mental health which aims at promoting employee health and human resource management which aims at promoting organizational performance. These collaboration can be the best strategy for reaching the common objective- healthy employees in a healthy organization.
Keywords: Mental health, Technology, Worksite health
CORRESPONDING AUTHOR: Shimazu Akihito, The University of Tokyo, ashimazu@m.u-tokyo.ac.jp
S815
CACTUS, A WEB-BASED SYSTEM FOR ASSESSING AND REDUCING WORKSITE STRESS IN ORGANISATIONS: INITIAL TEST.
Sibilia L.1, Borgo S.2
1 Sapienza University of Roma, Department of Internal Medicine, Roma, Italy
2 Center for Research in Psychotherapy, Roma, Italy
A project is described, which aimed at setting up a web-based system able to allow staff of working organisations to self-assess personal and context-related stress conditions at work; the system was also developed in order to provide a professional counselling to workers on psychosocial stress, based on gathered data, and to allow managers as well to track factors and conditions in their organisations. The system, named Cactus (Computer Aided Counselling and Tracking Utility for Stress at work), uses an assessment battery of questionnaires on worksite stress, such as the Leiden Quality of Working Life Questionnaire (LQWL) by S. Maes and M. van der Doef (1999), with 14 subscales, the Stress Symptoms Scale, modified from the Stress Audit (L.H. Miller & A.D. Smith, 1993) by L. Sibilia and S. Borgo, and the Automatic Thoughts Questionnaire (ATQ) by S. Hollon and P. Kendall (1980). As a validity control of the LQWL Questionnaire and to complete the range of dimensions tapped by the LQWL, a new scale was built and added to the battery, called VISPA (“Valutazione ed Intervento sullo Stress Personale e Aziendale”). The system has been implemented and tested on a small sample, both for usability, user satisfaction, and reliability of measures gathered. The tests performed comprised a descriptive analysis, and intercorrelations both among the subscales of LQWL, and the total scores of the other questionnaires. The results have shown that the scores of the questionnaires administered online did not differ significantly from those of the reference samples, using the usual paper-pencil administration. Given the encouraging results of this preliminary test, it is concluded that the Cactus system can be implemented on larger organisations.
Keywords: Assessment, Cactus, Counselling, Stress, Research to practice translation, Web-based, Worksite health
CORRESPONDING AUTHOR: Sibilia Lucio, Sapienza University of Rome, lucio.sibilia@uniroma1.it
Social and Behavioral Aspects of Child and Adolescent Health
O817
PARENTAL COGNITIVE DETERMINANTS OF PRESCHOOL CHILDREN’S EATING HABITS: AN INTERVENTION STUDY
Barros L., Andrade G., Gomes AI.
University of Lisbon, Department of Psychology, Lisbon, Portugal
The rising epidemics of excessive weight and obesity from early ages and the fact that eating patterns and food preferences are acquired during childhood make it essential to organize early intervention programs to promote healthy eating behaviors. Some parental cognitive dimensions associated with children’s weight have been identified, but the processes of interaction between these are still poorly understood. This study aims to contribute to the understanding of cognitive determinants of children’s eating patterns and comprises two sequential studies:
1) Study of parental determinants of preschool children eating habits. The sample consists of 232children (5-6 years old) and their parents. We assessed children’s food preferences with a forced choice task and BMI, and children’s eating habits, parental perception of child’s weight and perception of control over their children’s eating behavior with parental questionnaires. Results show that most parents of overweight and obese children underestimated their child's weight, which only occurred with few parents of normal weight children. Children’s eating habits were associated with parents’ nutritional knowledge and with parents perception of control over their child’s eating behaviors.
2) Study of the effectiveness of an intervention to promote healthy eating habits, directed to parents of preschool children and applied in schools. We structured a 4-session psycho-educational intervention with parents with the aim of changing parental perception of their child’s weight and of control over their eating behaviors. To evaluate the effect of this intervention in the modification of the eating habits and food preferences of children, we conducted a quasi–experimental study comparing threes groups (n = 3x15): psycho-education intervention, minimal contact (one informative session) and no intervention. At the end of the intervention, parents in the psycho-educational group showed more positive changes in the previously identified cognitive dimensions and their children’s eating habits showed moderate improvement. Follow-up studies are being conducted.
Taken together, these studies contributed to reinforce the important of these parental dimensions associated with children’s eating patterns.
Keywords: Children, Eating Behaviors, Parent-child transaction
CORRESPONDING AUTHOR: Barros Luísa Barros, Univeridade de Lisboa, Lisboa, lbarros@fp.ul.pt
O818
ETHNIC DIFFERENCES IN CHILDHOOD OBESITY: THE INFLUENCE OF SOCIOECONOMIC, CULTURAL AND BEHAVIOURAL FACTORS
Kelly Y.1, Skew A.2, Sacker A.2, Nazroo J.3
1 University of Essex, Institute for Social & Economic Research, Colchester, United Kingdom
2 University of Essex, Institute for Social & Economic Research, Colchester, UK
3 University of Manchester, Cathie Marsh Centre for Census and Survey Research, Manchester, UK
Childhood obesity is a major public health concern. There are socioeconomic and ethnic variations in rates of childhood obesity, but the reasons for observed ethnic inequalities in emergent chronic disease risk are not well understood. The objectives of this paper are to 1. Describe the ethnic patterning of childhood obesity 2. Examine the influence of socioeconomic (income, education, lone parenthood), cultural (migrant generation, languages spoken in the home) and behavioural (family routines, dietary patterns and maternal BMI) factors on the risk of childhood obesity across ethnic groups.
Data used were from the UK Millennium Cohort Study on 9041 7 year old children. Ethnic groups were: white; Indian; Pakistani; Bangladeshi; black Caribbean; black African.
Children from Bangladeshi (13.4%), black Caribbean (12.1%) and African (14.4%) groups were more likely to be obese compared with white (5.1%) children. There was no increased risk of obesity among Indian (5.6%) and Pakistani (6.9%) children compared with whites.
Statistical adjustment for socioeconomic disadvantage explained some of the excess risk of obesity across ethnic minority groups, but differences remained statistically significant compared with white children: Bangladeshi, OR = 3.0, p < 0.001; Caribbean 2.9, p < 0.001; African 2.3, p < 0.01. Adjustment for cultural markers reduced the odds of obesity for Bangladeshi (2.3, p < 0.05) and African (1.9, p < 0.10), but not for Caribbean children.
Additional adjustment for behavioural factors and mother’s BMI further attenuated the association for African (1.5, p > 0.1) and Caribbean (2.14, p < 0.05) but did little to explain the risk of obesity for Bangladeshi children (2.99, p < 0.001).
We show that by age 7 there are substantial ethnic inequalities in the risk of obesity among children from certain minority groups. Observed inequalities are in part explained by a combination of socioeconomic disadvantage, cultural and behavioural factors, but substantial excess risks remain unexplained for some ethnic groups. Interventions aimed at reducing rates of childhood obesity need to take account of the non-uniform distribution of relevant risk factors across ethnic minority groups.
Keywords: Ethnic differences, Obesity, Children's health, Disparities
CORRESPONDING AUTHOR: Yvonne Kelly, University of Essex, Colchester, ykelly@essex.ac.uk
O819
AFTER MALTREATMENT: COMPARISON BETWEEN HOME AND INSTITUTIONAL INTERVENTIONS.
Maia A., Pinto R.
University of Minho, Institute of Psychology, Braga, Portugal
Background: The main objective of Child Protective Services (CPS) is to identify the maltreatment, applying some kind of intervention, individual and familiar, regarding the best interests of the child. However, it remains unclear the later functioning of these children. In this study we assessed physical complaints and health risk behaviors in youths with childhood documented adversity, considering two different protective measures by CPS (family interventions vs. institutionalization). We also assessed youths that were not identified as maltreated in childhood.
Method: Participants were 216 youths, between 14 and 23 years of age (87 males, 91 females, M = 17.05, SD = 1.8);136 youths were identified by Child Protective Services (CPS) prior to the age of 12, who lived with their family for at least five years before being identified.
Results: The participants were not different in terms of global index of risk behaviors and physical complaints. After controlling for confounding variables and childhood adversity, the contribution of intervention was statistically significant, adding 3.8% of variance to predict global index of health risk behaviors, associated to group living in home (F (2, 117) = 11.95, p < .001 , 95% CI [-.707, -.115]. For physical complaints the intervention did not add any variance to the models.
Conclusions: Our results suggest that the intervention after maltreatment has effectiveness, but the evidences showed that different risk behaviors are associated with distinct protective measures. Our findings may assist the professionals from CPS to have a proper intervention, in view of the two protective measures usually applied.
Keywords: childhood adversity, home, institutions, psychopathology, physical complaints, risk behaviors.
CORRESPONDING AUTHOR: Maia Ângela, University of Minho, Braga, angelam@psi.uminho.pt
O821
QUALITY OF LIFE FOR PARENTS/CARERS OF CHILDREN WITH IMPRISONED PARENTS
Berman AH.1, Gallagher B.2, Sharratt K.2, Leach C.3, Lucock M.3, Schuster M.4, Schuetzwohl M.4
1 Karolinska Institutet, Clinical Neuroscience, Stockholm, Sweden
2 University of Huddersfield, Human and Health Sciences, Huddersfield, United Kingdom
3 University of Huddersfield, Centre for Health and Social Care Research, Huddersfield, United Kingdom
4 Dresden University of Technology, Department of Psychiatry and Psychotherapy, Dresden, Germany
Aim: Children with imprisoned parents are conjectured to have special needs due to the sometimes triple burden of stigma from parental imprisonment, economic restraint and separation from a loved parent. The FP7 EU project COPING (Children of Prisoners – Strengths and Mitigations) is exploring strength and resilience among children of prisoners as well as their families in the UK, Germany, Romania and Sweden. This presentation will focus on quality of life for the parents/carers of these children in the four countries.
Method: Families with imprisoned parents were recruited to the study mainly via non-governmental organizations offering support to families in this situation, in collaboration with a university partner in each country as well as the respective national prison systems. In each country, children and their parental carers participated in an initial quantitative survey, followed by in-depth semi-structured interviews with up to 40 families. Standard measures for the children included KIDSCREEN, the Strengths and Difficulties Questionnaire (SDQ), Rosenberg’s Self-Esteem Scale and for the parental carers, the WHOQOL-27. Data have been analyzed both quantitatively and qualitatively using SPSS and the N-VIVO program.
Results: Analyses are ongoing at this writing. At the congress, WHOQOL results will be presented for 194 parental carers in the UK, 138 in Germany, 160 in Romania and 45 in Sweden. Comparisons will be made with previously reported norm data for each country. Overall perception of quality of life, quality of health, as well as physical health, psychological well-being, social relationships and environment will be compared. The data will be supplemented with qualitative results from the in-depth interviews.
Conclusion: Our hypothesis is that the quality of life for parental carers of children with imprisoned parents is lower than for the normal population. However, sufficient everyday support may outweigh increased vulnerability among the carers. Findings may differ between countries, possibly in relation to the support available as well as socioeconomic conditions. Implications for the well-being and resilience of children of prisoners will be discussed.
Keywords: Family, Quality of Life, Children, Prison, Health Disparities
CORRESPONDING AUTHOR: Berman Anne H, Karolinska Institutet, Stockholm, anne.h.berman@ki.se
Health Behavior Interventions
O822
TIME PERSPECTIVE AS A PREDICTOR OF HEALTHY BEHAVIORAL PRACTICES AND BODY COMPOSITION.
Hall P.1, Fong G.2
1 University of Waterloo, School of Public Health, Waterloo, Canada
2 University of Waterloo, Psychology, Waterloo, Canada
This investigation examined the association between individual differences in time perspective and two health-related variables of interest: health behavior and body composition. It was anticipated that a more future-oriented time perspective would be associated with healthier practices and better body composition, and that the former would mediate the relationship between time perspective and the latter. In Study 1, it was found that more future-oriented individuals were more likely to engage in healthy behavior practices than their present-oriented counterparts in an undergraduate sample of healthy men and women (N = 357; M age = 19). Importantly, this association between time perspective and health behavior remained significant even after controlling for individual differences in impulsivity (β = .166, p < .001), supporting the contention that time perspective is a conceptually distinct construct. In Study 2, the association between time perspective and health behavior was examined in a separate sample of healthy adults drawn from the community (N = 135; M age = 55), and the focus was extended to include body composition (assessed as body mass index; BMI), as an assumed downstream outcome of health behavior practices over the lifespan. Again, those middle-aged and older adults who were more future-oriented were more likely to engage in healthy behavior patterns (β = .236, p = .009); in addition, more future-oriented individuals had lower BMI, as hypothesized (β = -.176, p = .046). A mediational analysis revealed that the association between time perspective and BMI was partially mediated by health behavior; specifically, the time perspective-BMI association was attenuated by 34% when taking into account health behavior patterns, and dropped to non-significance (β = -.110, p = .227). Taken together Studies 1 and 2 indicated that a more future-oriented time perspective was associated with healthier behavioral patterns and lower BMI; moreover, those who were more future-oriented had lower BMI, in part, because they engaged in more healthy behavioral practices.
Keywords: health behaviors, weight control
CORRESPONDING AUTHOR: Hall Peter, University of Waterloo, Waterloo, pahall@uwaterloo.ca
O824
RANDOMISED CONTROLLED TRIAL OF A THEORY-BASED INTERVENTION PROMOTING FRUIT AND VEGETABLE CONSUMPTION
Kothe E., Mullan B.
University of Sydney, Psychology, Sydney, Australia
The present study sought to test the efficacy of a theory-based intervention to promote fruit and vegetable consumption of Australian young adults. The theory-based intervention was evaluated using a randomised controlled trial design. Participants were students from an Australian university aged 18-25 years. Participants (n = 180) were allocated to one of two groups: (1) control or (2) the FreshFacts 2011 intervention. The FreshFacts 2011 intervention employed automated emails designed to increase attitude, subjective norm, and perceived behavioural control. Intervention materials were designed on the basis of the Taxonomy of Behaviour Change Techniques and focus groups conducted with the target population. Intervention participants received 10 intervention messages over the study period. Attitude, subjective norm, perceived behaviour control and fruit and vegetable intake were measured at baseline and 30 day follow-up. The intervention resulted in significant increases in attitude [F(1,130) = 6.137 p = .015] and subjective norm [F(1,130) = 4.919 p = .028] relative to control. However intention, perceived behavioural control and fruit and vegetable consumption did not change as a result of the FreshFacts 2011 intervention (ps > .05). The results show that while the intervention lead to changes in two of the three intervention targets, those changes was not translated into increased consumption of fruit and vegetables. This pattern of results has important implications for the use of theory based interventions to increase fruit and vegetable consumption. Researchers should think carefully about the selection of intervention targets and theoretical frameworks when designing similar interventions in the future.
Keywords: Nutrition, Theory, Intervention
CORRESPONDING AUTHOR: Kothe Emily, University of Sydney, Sydney, emily.kothe@sydney.edu.au
O825
A TELEPHONE-BASED PARENT INTERVENTION TO INCREASE FRUIT AND VEGETABLE CONSUMPTION IN 3-5 YEAR-OLD CHILDREN: 12-MONTH OUTCOMES FROM THE HEALTHY HABITS CLUSTER RANDOMIZED TRIAL.
Wolfenden L.1, Campbell E.1, Campbell K.2, Wiggers J.1, Brennan L.3, Fletcher A.1, Bowman J.4, Heard T.1, Wyse RJ.1
1 University of Newcastle, School of Medicine and Public Health, Newcastle, Australia
2 Deakin University, Centre for Physical Activity & Nutrition Research, Melbourne, Australia
3 Monash University, Centre for Obesity Research and Education, Melbourne, Australia
4 University of Newcastle, School of Psychology, Newcastle, Australia
Background: Inadequate fruit and vegetable consumption is associated with increased chronic disease risk and represents a considerable global health burden. Interventions delivered via telephone have successfully increased adult fruit and vegetable (F&V) consumption, but their efficacy among young children is untested beyond the short term. This paper describes the 12-month results of a cluster randomized trial of a telephone-based parent intervention to increase preschoolers’ F&V consumption.
Method: 394 parents of 3-5 year-olds were recruited from 30 Australian preschools. Parents were allocated to an intervention (telephone) or control condition (written information) by block randomization based on the preschool of recruitment. Intervention parents received 4 weekly phone calls from a trained interviewer using computer assisted telephone interviewing. The calls focused on improving characteristics of the home food environment; F&V availability and accessibility, parental role-modeling and supportive home food routines. Children’s F&V consumption was assessed at baseline and 12 months using the Children’s Dietary Questionnaire, a valid and reliable scale. Mean F&V scores were compared between the groups at 12 months using general estimating equations, adjusted for baseline consumption and clustering. Three sets of analyses were undertaken; using all the available data, using a conservative imputation approach (baseline observation carried forward), and a per protocol analysis excluding parents who did not complete all four telephone calls.
Results: Each method of analyses indicated that children’s F&V consumption was significantly higher in the intervention group compared to the control group (p
Conclusion: A brief telephone intervention can increase preschoolers’ F&V consumption at 12 months and warrants further follow up and investigation of how this intervention could translate into a public health initiative.
Keywords: Population Health; Nutrition
CORRESPONDING AUTHOR: Wyse Rebecca, University of Newcastle, Aust, rebecca.wyse@hnehealth.nsw.gov.au
O827
AN INTERNET-BASED UNGUIDED SELF-HELP TRAINING FOR ACUTE TINNITUS: ACCEPTANCE AND ADHERENCE
Nyenhuis N.1, Zastrutzki S.2, Weise C.3, Jäger B.2, Kröner-Herwig B.1
1 University of Göttingen, Department of Clinical Psychology and Psychotherapy, Göttingen, Germany
2 Hannover Medical School, Psychosomatic Hospital, Hanover, Germany
3 University of Marburg, Clinical Psychology, Marburg, Germany
Tinnitus can lead to a substantial decline in psychological well-being as early as in the in the acute phase. The authors have shown in a recent study that an unguided self-help training based on CBT-principles reduces the distress in acute tinnitus. Besides efficacy, acceptance is another core principle when evaluating the worth of an intervention. The aim of the present study is to investigate the acceptance of an Internet-based self-help training for acute tinnitus compared to bibliotherapy and group sessions. In addition, there is a great variation in participants’ use of internet-based interventions. The present study aims to investigate the use of an internet-based training for acute tinnitus.
Participants were 18 to 75 years old, suffered from subjective tinnitus for up to six months, and received no other tinnitus-related psychological treatment. A total of 304 participants were randomly assigned to a CBT-based intervention (delivered as Internet self-management, bibliotherapy or group training) or an information-only control group. Acceptance was assessed after the training. Adherence to the training was assessed by log files.
A one-way ANOVA showed that acceptance differed between groups (F(3,212) = 39.82, p < .001). Employing the Bonferroni post-hoc test, significant differences were found between all three active training conditions and the information control (p < .001), between the group training and the bibliotherapy (p < .001), and between the Internet training and the bibliotherapy (p < .05). 34 % dropped out between pre- and post-assessment. Half of the participants finished all nine chapters of the training. Those, who did not complete the whole training, most likely dropped out between the first and second half of the training.
The results indicate that participants accept an Internet-based self-help training as much as an ambulant group training. Still, one third of the participants drop out from the training. Participants drop out most likely before the beginning of the more active parts of the training.
Keywords: e-Health, Internet
CORRESPONDING AUTHOR: Nyenhuis Nele, University of Göttingen, Germany, nnyenhu@gwdg.de
Trends, Interactions and Therapies in Substance Use
O828
GROWTH IN CIGARETTE SMOKING AND ALCOHOL USE THROUGH ADOLESCENCE AND LATER ABUSE OF ILLICIT AND PRESCRIPTION DRUGS AMONG URBAN PREDOMINANTLY MINORITY YOUNG ADULTS IN NEW YORK CITY
Griffin K.1, Lowe S.2, Acevedo B.1, Botvin G.1
1 Weill Medical College of Cornell University, Department of Public Health, New York, USA
2 Weill Medical College of Cornell University, Department of Psychiatry, New York, USA
Research and theory suggest that early onset of substance use during adolescence leads to greater involvement in substance abuse later in adolescence and young adulthood. The gateway theory proposes that marijuana use is a key transitional illicit drug, typically initiated following experimentation or regular use of alcohol and/or tobacco, that increases the risk for subsequent abuse of more serious illicit drugs. However, most of the longitudinal research on substance use during adolescence and the transition to young adulthood has focused on predominantly white, suburban, middle class participants. In the present study we examined how growth in alcohol, tobacco, and marijuana use during adolescence each predicted involvement in illicit drug abuse during young adulthood in a sample of urban, predominantly minority young adults in New York City. The sample included 984 young adults, 57% female, 60% Black, and 30% Latino/Hispanic. Participants completed six annual surveys in secondary school (grades 7 through 12) and a follow-up telephone interview as young adults (mean age = 22.8, range = 21 to 26). In a series of latent growth models controlling for gender, academic performance, and eligibility for free school lunch, we found that growth in cigarette use from age 12 through young adulthood predicted levels of any illicit drug use at the last assessment, βSlope = .320, p < .001, CFI = .911, RMSEA = .079, as well as levels of cocaine, methamphetamine, narcotics, and injection drug use (IDU), βSlope = .102, p < .01, CFI = .901, RMSEA = .05. Growth in alcohol use from age 12 through young adulthood predicted levels of cocaine, methamphetamine, narcotics, and injection drug use (IDU) at the last assessment, βSlope = .122, p < .005, CFI = .903, RMSEA = .053, as well as levels of prescription drug abuse, βSlope = .097, p < .017, CFI = .901, RMSEA = .052. However, contrary to the gateway theory, growth in marijuana use was not associated with greater illicit drug use or prescription drug abuse involvement during young adulthood in the sample. In summary, our findings indicate that growth in alcohol and cigarette use in a sample of urban, predominantly minority youth contributed to later illicit and prescription drug abuse. These findings highlight the importance of implementing universal preventive interventions during early adolescence to prevent or delay the onset of alcohol and cigarette use. The present findings suggest that universal efforts for preventing youth alcohol and tobacco use may play a role in reducing illicit and prescription drug abuse during young adulthood.
Keywords: substance use, alcohol, smoking, adolescence
CORRESPONDING AUTHOR: Griffin Kenneth, Cornell University, New York, kgriffin@med.cornell.edu
O829
STRESS AND SUBSTANCE USE AMONG ADOLESCENTS: INDICATIONS FOR HYPOAROUSAL
Huizink AC.1, Prince van Leeuwen A.2, Verhulst FC.2
1 VU University, Department of Psychology, Amsterdam, The Netherlands
2 Erasmus MC, University Medical Center, Child and Adolescent Psychiatry, Rotterdam, The Netherlands
Background: In adults, numerous studies have shown that Hypothalamic-Pituitary-Adrenal (HPA) axis functioning is dysregulated in substance dependent individuals. Only few studies have focused on the role that stress may have in tendencies to engage in risky substance use among youth. We investigated the relationship of life-time and repeated cannabis use with hypothalamic-pituitary-adrenal (HPA) axis reactivity to social stress in a general population sample of adolescents.
Methods: Participants were part of a large prospective population study of Dutch adolescents, the TRacking Adolescents' Individual Lives Survey (TRAILS) study (www.trails.nl). Adolescents who reported life-time or repeated cannabis use, life-time or repeated tobacco use and never use of either cannabis or tobacco were compared with respect to their HPA axis reactivity during the Groningen Social Stress Task (GSST), based on the Trier Social Stress Task. The GSST was conducted during the third data-wave of TRAILS at age 14-17 years. Data were available of N = 591 adolescents (51% male), for whom HPA axis reactivity was indexed by four cortisol samples collected before, during and after the GSST. Additionally, all adolescents in our study completed self-reported questionnaires on cannabis and tobacco use. Models were adjusted for sex, recent alcohol use, socio-economic status, mood and time of the experimental session.
Results: Life-time cannabis users had significantly lower stress-reactivity levels when compared to abstainers (odds ratio (OR) = 0.68, confidence interval (CI) = 0.55-0.85, P < 0.01) and life-time tobacco users (OR = 0.79, CI = 0.64-0.98, P < 0.05). Repeated cannabis users also exhibited lower stress-reactivity levels when compared to life-time ever users of either tobacco or cannabis (OR = 0.74, CI = 0.53-0.98, P < 0.05). These findings are in line with our previous findings, showing that early onset cannabis use, assessed at the first data-wave assessment of TRAILS, was related to lower HPA activity at baseline.
Conclusion: Lower hypothalamic-pituitary-adrenal-axis stress-reactivity in adolescents is related specifically to life-time and repeated cannabis use. Hypoarousal of the HPA axis may be a biomarker of risk for substance use disorders in youth.
Keywords: Adolescence, Cortisol, Substance abuse, stress
CORRESPONDING AUTHOR: Huizink Anja, VU University Amsterdam, a.c.huizink@vu.nl
O831
EXAMINING THE SOCIAL NORMS APPROACH FOR THE PREVENTION AND REDUCTION OF DRUG USE IN EUROPEAN UNIVERSITY AND COLLEGE STUDENTS
Pischke C.1, Zeeb H.1, Van Hal G.2, McAlaney J.3, Bewick B.4, Akvardar Y.5, Guillén F.6, Orosova O.7, Stock C.8, Mikolajczyk R.9
1 Bremen Institute for Prevention Research and Social Medicine, Prevention and Evaluation, Bremen, Germany
2 University of Antwerp, Department of Epidemiology and Social Medicine, Antwerp, Belgium
3 University of Bradford, Department of Social Sciences and Humanities, Bradford, United Kingdom
4 University of Leeds, Institute of Health Sciences, Leeds, United Kingdom
5 Marmara University, Department of Psychiatry, Istanbul, Turkey
6 University of Navarra, Department of Health Sciences, Navarra, Spain
7 University in Kosice, Department of Educational Psychology and Health Psychology, Kosice, Slovakia
8 University of Southern Denmark, Department of Health Promotion Research, Esbjerg, Denmark
9 Bremen Institute for Prevention Research and Social Medicine, Clinical Epidemiology, Bremen, Germany
Background: Previous research investigating the role of social norms regarding alcohol and tobacco use found that incorrect perceptions about high rates of peer drug use are predictive of increased personal drug use in student populations. Correcting these misperceptions by providing feedback has been shown to be an effective intervention for reducing licit drug use in American students. However, it is unknown whether social norms play a role regarding illicit and poly-drug use and whether social norms interventions are effective in preventing and reducing drug use in European students.
Aim: To describe the design of a web-based social norms intervention aimed at reducing licit and preventing illicit drug use in European students.
Methods: An online questionnaire based on existing American social norms surveys will be adapted for the assessment of illicit and poly-drug use. Subsequently, each of the seven participating European countries will recruit 1000 students per intervention and delayed intervention control groups. All participants will complete the online questionnaire at baseline and 5 months. The baseline data will inform the development of social norms messages which will be employed in a web-based intervention. For the following 5 months, intervention group participants will receive individualized social norms feedback based on the expected discrepancy between perceptions of personal and peer drug use.
Conclusion: This project is the first cross-national European collaboration to assess licit and illicit drug use among European students and to investigate the efficacy of a social norms intervention to prevent illicit use.
Keywords: Behavior change, addictive behavior, beliefs
CORRESPONDING AUTHOR: Dr. Pischke Claudia, BIPS, Bremen, pischke@bips.uni-bremen.de
O832
ALCOHOL (MIS)USE AMONG HUNGARIAN HIGH SCHOOL STUDENTS: ARE SPIRITUALITY AND RELIGIOSITY PROTECTIVE FACTORS?
Piko B.1, Kovacs E.2, Kriston P.1
1 University of Szeged, Department of Behavioural Sciences, Szeged, Hungary
2 Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
The Eastern European countries, particularly Hungary, have the highest level of drinking among their adult populations. Alcohol use is even more common among youth living in Eastern Europe compared to other regions of Europe. Studies report a considerable decrease in non-drinking and an increase in heavy episodic drinking among Hungarian adolescents during recent years due to a greater social acceptance of alcohol and the lack of strict alcohol control and disciplinary policies. Clearly, there is a need for detecting possible risk and protective factors for prevention and health promotion strategies, particularly those providing protection against adolescent alcohol misuse. According to a systematic review of the literature, religious involvement generally acts as a resiliency factor against teenage alcohol use. The primary goal of the present study was to examine the relationship between a set of religious variables (religious denomination, church membership, religious attendance, praying, religiosity, spiritual beliefs and well-being) and drinking patterns (current alcohol use, lifetime prevalence of drinking and heavy episodic drinking) among a sample of Hungarian youth. Data were collected using high school students (N = 592; ages between 14 and 17 years; 48.1 percent males) from a randomly selected set of schools in Szeged, Hungary. Using a self-administered questionnaire and standardized procedures student participation was voluntary and confidential. Despite a high level of alcohol use and a relatively low level of religiosity in the sample, we detected a relationship between the importance of religiousness/religious well-being and alcohol use, although religious denomination and affiliation were not significant correlates. Whereas religious attendance and private praying were associated with a lower odds of alcohol use among girls, boys who reported a belief in traditional religion were less likely to engage in alcohol use. New Age belief was associated with higher odds of drinking. These results provide further details to a growing body of research showing that despite adolescents’ low religious involvement, religiosity can play an important role in some youth’s lives and may actually serve as a protection against alcohol (mis)use.
Keywords: Alcohol; Religion/Spirituality; Adolescence
CORRESPONDING AUTHOR: Piko Bettina, University of Szeged, Szeged, fuzne.piko.bettina@med.u-szeged.hu
O833
METACOGNITIVE THERAPY FOR ALCOHOL ABUSE AND DEPENDENCE
Strodl E.1, Proctor D.2, Kavanagh D.2
1 Queensland University of Technology, School of Psychology, Brisbane, Australia
2 Queensland University of Technology, Institute for Health and Biomedical Innovation, Brisbane, Australia
Alcohol is the 2nd highest contributor to substance-related deaths in Western countries such as Australia, and after cigarette smoking, is the greatest single preventable behavioural risk for physical illness and early death. Motivational Interviewing (MI), and Cognitive-Behavioural Therapies (CBTs) are the most well established and evaluated treatments for alcohol use disorders. While CBT and MI are seen as current best practice psychological interventions for alcohol misuse, there remains a need to continue to improve the effectiveness of psychological interventions. When trying to control alcohol use, desire or craving for alcohol is typically experienced. Not only is craving distressing and distracting: it also contributes to relapse, with lapses often preceded by increased craving. Existing CBTs usually offer little help with craving, providing brief education about its nature or giving advice to delay consumption. One promising innovative therapy that may offer stand-alone treatment for alcohol craving is Metacognitive Therapy (MCT). This form of therapy identifies and challenges superordinate cognitions (thoughts about thoughts—e.g. I have to act on my thoughts). This presentation will describe a randomised control trial that compared standard MI alone (n = 23) with a combination of MI plus MCT (n = 24). At post-therapy, the MI plus MCT (effect size = 1.32) was superior in reducing the consumption of alcohol compared with MI alone (effect size = 0.72). The results of this study provide promising evidence that targeting metacogntions (or thoughts about internal events such as thoughts, images, emotions and cravings) can be important in helping to reduce the consumption of alcohol in individuals with problematic drinking behaviours. As such a combination of MI plus MCT may be a useful method of conducting psychotherapy with adults who have alcohol abuse or dependence.
Keywords: Alcohol; Therapy
CORRESPONDING AUTHOR: Strodl Esben, QUT, e.strodl@qut.edu.au
Fear of Recurrence and Quality of Life in Cancer Survivors
O834
COMORBIDITY OF FEAR OF DISEASE PROGRESSION AND ANXIETY DISORDERS
Dinkel A.
Klinikum rechts der Isar TU Munich, Department of Psychosomatic Medicine, Munich, Germany
Background: Fear of disease progression (FoP), i.e. the fear that the illness will progress with all its biopsychosocial consequences or that it will recur, is a common psychological reaction to the threat of chronic disease. High levels of FoP affect psychological functioning and quality of life. As distinct from psychiatric anxiety disorders, FoP is a realistic fear. Therefore, it has been argued that FoP cannot be equalled with common anxiety disorders. However, the relationship between FoP and anxiety disorders has not been investigated, to date. Thus, this study aimed at determining comorbidity patterns between FoP and anxiety disorders.
Methods: In this cross-sectional study, N = 343 in-patients (age M = 58.4, SD = 12.8; 65 % men) with gastrointestinal cancers or hematologic malignancies underwent a structured psychiatric interview (SCID-I) in order to assess DSM-IV anxiety disorders (including hypochondriasis as extreme form of health anxiety). Furthermore, patients answered the Fear or Progression Questionnaire (FoP-Q). This reliable and valid self-report measure comprises 34 items pertaining to different aspects of FoP. We did not include the items of the coping subscale as these items are not used for computing the FoP-Q summary score. As the FoP-Q does not provide validated cut off scores for identifying dysfunctional, clinically relevant levels of FoP, we used the 80th and 90th percentile as provisional cut off points. We computed descriptive statistics and used t-test and Chi-square test for analysis.
Results: The prevalence of anxiety disorders was 18% (any anxiety disorder). The most prevalent single anxiety disorders were specific phobia (5 %) and posttraumatic stress disorder (4%); agoraphobia without history of panic disorder was least prevalent (1%). No patient was diagnosed with hypochondriasis (0%). The mean score of the FoP-Q was M = 7.1 (SD = 2.6). Patients diagnosed with any anxiety disorder showed higher levels of FoP than patients without any anxiety disorder (M = 8.7, SD = 3.0 vs. M = 6.8, SD = 2.3; p < .001). Applying 80th percentile as cut off, results showed that 34% of the patients indicating dysfunctional FoP also suffered from at least one anxiety disorder, while in the group of patients with normal levels of FoP 15% were diagnosed with any anxiety disorder (p < .001). 16% of the patients who did not evidence any anxiety disorder reported dysfunctional FoP. A comparable results pattern emerged when using 90th percentile as cut point.
Discussion: This study with cancer patients showed that the realistic fear of disease progression is associated with psychiatric anxiety disorders. The rate of patients suffering from anxiety disorder is higher in patient who also evidence dysfunctional fear of progression. However, the results also suggest that dysfunctional FoP should not be conceputalized as a common psychiatric disorder as a significant part of patients suffered from FoP without comorbid anxiety disorder, and vice versa.
Keywords: Cancer, mental health
CORRESPONDING AUTHOR: Dinkel Andreas, TU München, Munich, a.dinkel@tum.de
O835
CANCER WORRY SCALE: A SCREENING INSTRUMENT FOR FEAR OF CANCER RECURRENCE
Custers JAE.1, Van de Berg SW.1, Van Laarhoven HWM.2, Bleiker EMA.3, Gielissen MFM.1, Prins JB.1
1 Raboud University Nijmegen Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
2 Academic Medical Center, Department of Medical Oncology, Amsterdam, The Netherlands
3 The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands
Background: Fear of cancer recurrence (FCR) is a normal and common concern for cancer survivors who have completed treatment and are in remission. Even though FCR appears to be universal, some survivors report fear that is continually and excessively elevated and becomes so overwhelming that they have difficulties in performing daily activities. Adequate care should be given to these patients. However, to identify survivors with a dysfunctional level of FCR, a valid screening instrument is needed. This study investigated if the Cancer Worry Scale (CWS) could serve as an instrument to detect high levels of fear of recurrence in female breast cancer survivors.
Methods: The CWS is an 8-item instrument (score 8-32) used to measure worry about the risk of developing cancer among individuals at risk for hereditary cancer. In this study the CWS will be investigated in breast cancer survivors without hereditary risk. Women filled out the CWS, two questions of the Cancer Acceptance Scale (CAS), questionnaires on empowerment and fatigue. ROC-analysis determined the optimal cut-off point for the CWS as a screening and diagnostic instrument. Sensitivity, specificity, positive predictive value(PPV) and negative predictive value (NPV) were calculated. Internal consistency, convergent and divergent validity were measured.
Results: 197 breast cancer survivors returned the questionnaires (63% response). Women were 57.4 (sd 10.2) years old and mean time since surgery was 4.78 (sd 2.5) years. Based on the ROC curve, a cut-off score of 13 vs 14 (low: ≤ 13, high: ≥ 14) on the CWS was optimal for detecting severe levels of fear of recurrence, with a sensitivity of 77%, a specificity of 81%, a positive predictive value (PPV) of 73% and a negative predictive value (NPV) of 84%. A cut-off score of 11 vs 12 was optimal for screening, with a sensitivity of 96%, a specificity of 56%, a PPV of 60% and a NPV of 96%. Internal consistency was .88. Convergent validity: strong association with the CAS (r = 0.75, p < .001) and moderate association with fatigue (r = .034,p < .001). Divergent validity: weak negative association with empowerment (r = -.019,p < .001).
Conclusion: Overall, this study supports the reliability and validity of the CWS used in breast cancer survivors.
Keywords: cancer, cancer survivorship, anxiety
CORRESPONDING AUTHOR: Gielissen Marieke, UMC St Radboud, m.gielissen@mps.umcn.nl
O836
BELIEFS ABOUT MEDICINE & ILLNESS ARE ASSOCIATED WITH FEAR OF CANCER RECURRENCE IN WOMEN TAKING ADJUVANT ENDOCRINE THERAPY FOR BREAST CANCER
Corter A.1, Findlay M.2, Broom R.3, Porter D.3, Petrie K.4
1 University of Auckland, Psychological Medicine, Auckland, New Zealand
2 University of Auckland, Department of Oncology, Auckland, New Zealand
3 Auckland City Hospital, Department of Medical Oncology, Auckland, New Zealand
4 University of Auckland, Department of Psychosomatic Medicine, Auckland, New Zealand
Background: Research shows that fear of cancer recurrence (FoR) is a significant concern for women who have been treated for breast cancer. Clinical prognosis has little to do with recurrence fears and the self regulatory model of illness may explain individual differences in FoR. However, it is not clear from the current literature how illness and medication beliefs and treatment side effects relate to FoR among women who are taking aromatase inhibitors with the aim of preventing breast cancer recurrence.
Methods: A total of 153 post-menopausal women with early stage breast cancer completed a postal survey. Analyses were conducted to examine the relation between FoR and illness and medication beliefs, treatment side effects, demographic factors and anxiety and depression and to identify which of these factors would be most strongly associated with FoR in a regression model.
Results: The overall model accounted for 61% of the variance in FoR scores (p < .001). Although unemployment status and mood were significantly correlated with FoR, only illness and medication beliefs were significant predictors of FoR in the regression model. Based on findings, it appears that women with higher FoR may be balancing a tension between beliefs about the necessity of taking aromatase inhibitors against the belief that this treatment may not prevent recurrence. Findings indicate that women with higher FoR are also more likely to report symptoms from breast cancer.
Conclusions: Results suggest that in addition to targeting the actual FoR that women experience, it may be worthwhile to address the illness and medication beliefs behind it. Additionally, helping women to differentiate everyday symptoms from those indicative of breast cancer may help to reduce FoR.
Keywords: Cancer, Treatment, Beliefs, Anxiety
CORRESPONDING AUTHOR: Corter Arden, University of Auckland, a.corter@auckland.ac.nz
O837
PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH AUTOLOGOUS AND ALLOGENEIC STEM CELL TRANSPLANTATION IN HEMATOLOGICAL MALIGNANCIES
Braamse A.1, Gerrits M.1, Van Meijel B.2, Visser O.3, Van Oppen P.1, Boenink A.1, Cuijpers P.4, Huijgens P.3, Beekman A.1, Dekker J.5
1 VU University Medical Center Amsterdam, Psychiatry, Amsterdam, The Netherlands
2 INHolland University of Applied Sciences, Research Group Mental Health Nursing, Amsterdam, The Netherlands
3 VU University Medical Center Amsterdam, Hematology, Amsterdam, The Netherlands
4 VU University, Clinical Psychology, Amsterdam, The Netherlands
5 VU University Medical Center Amsterdam, Rehabilitation Medicine, Amsterdam, The Netherlands
Background: Identifying factors that predict health-related quality of life following hematopoietic stem cell transplantation is important in estimating patients’ ability to adjust to the consequences of their disease and treatment. As the studies that have been published on this subject are scattered, the present study aimed to systematically review prognostic factors for health-related quality of life after autologous and allogeneic stem cell transplantation in hematological malignancies.
Methods: A systematic, computerized search in Medline, EMBASE, PsycINFO, and the Cochrane Library was conducted from 2002 to June 2010. The methodological quality of the studies was assessed using an adaptation of Hayden’s criteria list. Qualitative data synthesis was performed to determine the strength of the scientific evidence.
Results: Thirty-five studies fulfilled the selection criteria. Strong to moderate evidence was found for graft-versus-host disease, conditioning regimen, being female, younger age, receiving less social support and pre-transplant psychological distress as predictors of various aspects of health-related quality of life following hematopoietic stem cell transplantation.
Conclusion: The results of this review may help transplant teams in selecting patients at risk for experiencing a diminished health-related quality of life following hematopoietic stem cell transplantation. Follow-up treatment can be provided in order to promote quality of life.
Keywords: Cancer, Quality of Life
CORRESPONDING AUTHOR: Dekker Joost, VU University Medical Center, j.dekker@vumc.nl
O838
QUALITY OF LIFE OF PATIENTS UNDERGOING SURGICAL TREATMENT FOR NEWLY-DIAGNOSED, CLINICALLY LOCALIZED RENAL CELL CARCINOMA
Ames S.1, Parker A.2, Crook J.3, Diehl N.3, Tan W.1, Williams C.4, Ames G.5
1 Mayo Clinic, Hematology and Oncology, Jacksonville, USA
2 Mayo Clinic, Urology, Jacksonville, USA
3 Mayo Clinic, Biostatistics, Jacksonville, USA
4 University of Florida, Urology, Jacksonville, USA
5 Mayo Clinic, Surgery, Jacksonville, USA
Although research conducted in other cancer populations suggests that cancer and its treatment can deleteriously affect quality of life (QOL), the impact of renal cell carcinoma (RCC) on QOL has been understudied. The primary aim of this investigation is to explore the psychological needs of individuals undergoing surgical treatment for newly diagnosed, localized RCC using a mixed qualitative-quantitative approach. The research question was: What is life like for individuals who have been newly diagnosed with localized RCC and how does it change following surgical treatment? Specific sub-objectives were to describe, from the patients perspective (1) how they define their QOL; (2) the physical effects of RCC they experience; (3) the psychological effects of living with RCC; and (4) strategies they use to cope with RCC. This qualitative component consisted of individual semi-structured interviews >4 weeks post-nephrectomy. In addition, quantitative self-report questionnaires were used to assess anxiety, depressive symptoms and both general and health related QOL prior to nephrectomy and at 4, 12, and 24 weeks post-nephrectomy. A final objective of our investigation was to develop a RCC specific subscale for a commonly used measure of disease specific quality of life, the Functional Assessment of Cancer Therapy (FACT) and gather information about participants experiences with these RCC-related symptoms.
Participants included adults undergoing nephrectomy for newly-diagnosed stage 1 or 2 localized RCC or fully resectable stage 3 RCC without clinical or x-ray manifestation of metastasis. Interviews revealed participants (N = 28) experience anxiety, fatigue, and restricted ability to engage in physical activity in the short-term following nephrectomy. Responses on the quantitative instruments at baseline indicated that individuals experience significantly greater adverse mood (p <0.001) and a trend toward experiencing a greater level of depressive symptoms (p = 0.08) versus normative data to which they were compared. However, participants reported similar, or in some cases even significantly better functioning, than the normative samples to which they were compared on measures of health-related QOL, general QOL, and state anxiety. Normative data for cancer patients do not exist for the measures of mood, depressive symptoms, general QOL, and anxiety. Thus, normative data for large samples of general medical patients were used. The analysis did not reveal any significant pattern of changes over time for any of the measures, indicating that functioning was stable from pre- to post-treatment. Development of the RCC specific QOL subscale is described.
Keywords: Cancer, Quality of Life
CORRESPONDING AUTHOR: Ames Steven, Mayo Clinic, Jacksonville, ames.steven@mayo.edu
O839
MEANING AS A PREDICTOR OF QUALITY OF LIFE IN BREAST CANCER SURVIVORS
Levine E.1, Yoo G.2, Law H.3, Aviv C.4
1 San Francisco State University, Cesar Chavez Institute, San Francisco, USA
2 San Francisco State University, Asian American Studies, San Francisco, USA
3 Association of Asian Pacific Community Health Organizations, -, San Francisco, USA
4 University of Colorado-Boulder, Program in Jewish Studies, Boulder, USA
A cancer diagnosis can prompt a search for meaning in life and of the illness. Several studies have found that meaning is a significant predictor of psychological distress in cancer patients. However, few studies have examined meaning as a predictor of overall quality of life. A sample of 176 breast cancer survivors were surveyed about their levels of meaning, psychological distress, social support, and quality of life. Quality of life was significantly correlated with being older, greater meaning, higher self-ratings of health, less anxiety, depression, fatigue, and confusion, higher vigor, and having seen a mental health counselor. Meaning was significantly correlated with having children, less anxiety, depression, fatigue, confusion, more vigor, physical, social, emotional, and functional well-being, breast cancer-related concerns, appraisal, belonging, tangible, and emotional support, and having seen a mental health counselor. After self-rating of health, anxiety, and tangible support were included in the model, meaning was found to be a significant predictor of quality of life above and beyond the other variables (adjusted R2 = .53, p = .000). Interestingly, race/ethnicity was not a significant predictor of quality of life in this model. These results suggest that meaning is an independent predictor of quality of life in cancer patients. They also suggest that seeing a mental health counselor and having support from others can increase meaning and quality of life. Although quality of life was associated with being older, women of all ages may benefit from mental health counseling as a way to increase meaning and quality of life.
Keywords: Cancer, religion/spirituality, quality of life
CORRESPONDING AUTHOR: Levine Ellen, San Francisco State University, medicalpsychology@pacbell.net
Psychobiological aspects of women's health
S840
PSYCHOBIOLOGICAL ASPECTS OF WOMEN'S HEALTH
Ehlert U.
University of Zurich, Clinical Psychology, Zurich, Switzerland
This symposium refers to psychobiological factors influencing women’s health and disease. The contributions focus on animal and human studies referring to the impact of stress on specific phases of the entire reproductive life of females.
The first presentation of the symposium will refer to rodent studies on stress in pregnancy and its effects on the maternal brain, mainly on maternal hormone secretion but also on maternal anxiety. The second contribution refers to maternal stress provocation during human pregnancy and its modulation through social support. Data will be reported on a number of endocrine parameters assessed prior, during, and following stress provocation. The third presentation of the symposium addresses to the question whether chronic stress is linked to menstrual cycle irregularity in healthy premenopausal women and which psychological resources might have a modulating effect on such an association. The final presentation refers to endocrine dysregulations in female patients suffering from psychosis with special emphasis on sex differences in comparison to male psychotic patients.
The overall interest of the symposium refers to psychobiolocial mechanisms underlying specific female life phases and will be discussed with particular attention on the interrelation of different hormonal systems like the hyphothalamus-pituitary-gonadal axis and the hyphothalamus-pituitary-adrenal axis.
Presenters of the symposium:
Allison Douglas, University of Edinburgh, UK
Maybe baby: differential effects of stress on maternal neuroendocrine and anxiety responses in early and late pregnancy
Pearl Ghaemmaghamiet al., University of Zurich, Switzerland
Protective effects of social support on the reactivity of the salivary cortisol/cortisone ratio in second trimester pregnant women
Simona Fischbacher et al., University of Zurich, Switzerland
Psychological resilience as a correlate of self-reported menstrual cycle irregularity in healthy premenopausal women
Tamagni, C. et al., Psychiatric University Clinics Basel, Switzerland
Stress indicators in emerging psychoses: gender differences
Keywords: Psychoendocrinology, biobehavioral mechanisms, gender
CORRESPONDING AUTHOR: Ehlert Ulrike, University of Zurich, u.ehlert@psychologie.uzh.ch
S841
MAYBE BABY: DIFFERENTIAL EFFECTS OF STRESS ON MATERNAL NEUROENDOCRINE AND ANXIETY RESPONSES IN EARLY AND LATE PREGNANCY
Douglas A. J.
University of Edinburgh, Centre for Integrative Physiology, Edinburgh, United Kingdom
Stress has a profound negative impact on reproduction. Pregnancy is a particularly vulnerable time and the effects of stress during pregnancy have differing outcome depending upon the stage of gestation. In early pregnancy prolonged stress may result in pregnancy failure. Later stress rarely terminates pregnancy, but still has side effects for mother and baby such as maternal mental health problems and neonatal susceptibility to disease. The mode of maternal brain responses to the stress underlies these stage-sensitive consequences. We have investigated maternal neuroendocrine and anxiety responses to stress in early and late pregnancy using rodent models. In early pregnancy stress profoundly inhibits the key pregnancy hormones progesterone and prolactin so that important signals for pregnancy maintenance are lost. Stress also robustly increases glucocorticoid and noradrenaline secretion which is further detrimental to the developing feto-maternal interface. Corresponding studies in women indicate broadly similar hormonal responses to rodents. It seems that the hormonal responses to these stressors are not necessarily driven by their hypothalamic neuroendocrine regulators, but that the pituitary could drive the response. In parallel, in early pregnancy maternal anxiety is enhanced but does not change with stress. In contrast, in late pregnancy the maternal brain does not regulate progesterone secretion. Furthermore, stress does not substantially increase glucocorticoids in rodents or women, due to strong attenuation of hypothalamic mechanisms, and so limits fetal exposure to their detrimental effects. However, circulating noradrenaline responses and activation of sympathetic neurones remain robust which compromises optimal fetal development and long term health. So the sympathetic and hypothalamic responses to stress are dissociated and the maternal brain differentially controls the consequent hormonal mode. Maternal anxiety is less than in early pregnancy but stress increases it suggesting enhanced susceptibility to mood problems. Therefore, adaptations of the maternal brain through early to late pregnancy lead to different hormone and anxiety responses to stress and contribute differentially to pregnancy success and offspring development.
Keywords: pregnancy, psychoneuroendocrinology, stress
CORRESPONDING AUTHOR: Douglas Alison, University of Edinburgh, alison.j.douglas@ed.ac.uk
S842
PROTECTIVE EFFECTS OF SOCIAL SUPPORT ON THE REACTIVITY OF THE SALIVARY CORTISOL/CORTISONE RATIO IN SECOND TRIMESTER PREGNANT WOMEN
Ghaemmaghami P.1, Dainese S .1, La Marca R.1, Zimmermann R .2, Ehlert U.1
1 University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
2 University Hospital Zurich, Division of Obstetrics, Zurich, Switzerland
A growing body of research has found stress during pregnancy to be associated with an increased risk of gestational complications, low birth weight, and adverse postpartum well-being of mother and child. Yet, little attention has been paid to the protective effects of psychosocial resources. This may be important because not all pregnant women who experience high levels of stress develop complications in the course of pregnancy. Understanding the basic mechanisms of the stress response and identifying stress-protective physiological and psychological mechanisms during pregnancy should therefore be an important focus of research.
The aim of the current study was to examine the psychobiological response of pregnant women confronted with the real-life stress situation of an amniocentesis and to investigate the effect of social support on the salivary cortisol (SalF) response. Moreover, since the enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) in the salivary glands converts SalF into inert cortisone (SalE), SalE may reflect the activity of free F in the blood more accurately than SalF. Therefore, SalE was examined as well and the following ratio between SalF and SalE was determined in order to monitor the activity of 11β-HSD2 in response to stress: SalE/(SalE + SalF).
Repeated saliva samples and measures of psychological state were obtained from 34 healthy pregnant women undergoing amniocentesis. The pregnant women also responded to the Berliner Social Support Scales (Schulz & Schwarzer, 2003).
The amniocentesis induced a significant increase in perceived stress, as well as a significant increase in SalF, SalE and a decrease in SalE/(SalE + SalF). Pregnant women with higher emotional support exhibited higher SalE/(SalE + SalF) (r = .41, p = .03). No effect of social support on SalF and SalE levels was found.
These results reveal higher 11β-HSD2 activity in subjects with higher social support and point to the importance of taking 11β-HSD2 into account when investigating the stress response of the HPA axis. Moreover, the activity of 11β-HSD2 may constitute a physiological resource of the body to counteract the adverse effects of stress. These results can provide valuable information for the development of effective stress-management programs during pregnancy.
Keywords: Pregnancy, Social support, Stress, Cortisol
CORRESPONDING AUTHOR: Ghaemmaghami Pearl, University of Zurich, Zurich, p.ghaemmaghami@psychologie.uzh.ch
S843
PSYCHOLOGICAL RESILIENCE AS A CORRELATE OF SELF-REPORTED MENSTRUAL CYCLE IRREGULARITY IN HEALTHY PREMENOPAUSAL WOMEN
Fischbacher S., Kobelt S., Ehlert U.
University of Zurich, Clinical Psychology and Psychotherapy, Zurich, Switzerland
Introduction: Variations in menstrual functioning, particularly those related to the regularity of the menstrual cycle, are emerging as important correlates of women’s health. Menstrual dysregulations seem to increase the risk for cardiac disease and type 2 diabetes. Menstrual cycle characteristics are likely to be influenced by a variety of endogenous and exogenous factors affecting the hypothalamus-pituitary-ovarian-axis, one of them being chronic stress. In this study we set out to examine (a) whether chronic stress is linked to menstrual cycle irregularity in healthy premenopausal women and (b) which psychological resources might have a modulating effect on such an association.
Method: A total of 412 healthy premenopausal women who reported no current use of hormonal contraception, no physical or mental disorder and no eating disorders completed an online survey, consisting of standardized questionnaires assessing subjective stress levels and psychological resilience, which refers to an individual’s capacity withstand stressors. Also women reported whether the onset of their menstrual cycles was generally predictable within 4 days over the course of the past year.
Results: Menstrual cycle irregularity was significantly associated with chronic stress (beta = .15, p = .01). Additionally, menstrual cycle irregularity was significantly negative associated with psychological resilience (beta = -.25, p = .000). These associations remained significant after adjusting for age, age at menarche, physical activity and body mass index. The Sobel test was significant (p = .000), showing that psychological resilience mediates the relation between chronic stress and menstrual cycle irregularity.
Discussion: Our results show that chrornic stress is associated with menstrual cycle irregularity in healthy premenopausal women and that this relation was mediated by psychological resilience. Therefore, psychological resilience might be considered as a protective factor concerning the development of menstrual irregularity.
Keywords: Women's health Resilience
CORRESPONDING AUTHOR: Fischbacher Simona, University of Zurich, s.fischbacher@psychologie.uzh.ch
S844
STRESS INDICATORS IN EMERGING PSYCHOSIS: GENDER DIFFERENCES
Tamagni C., Alter AL., Aston J., Studerus E., Riecher-Rössler A.
University of Basel Psychiatric Clinics, Psychiatric Outpatient Department, Basel, Switzerland
Several studies have shown that psychotic disorders present differently in women and men: sex influences the age of onset, frequency of symptoms, neuroanatomical abnormalities, neuropsychological deficits and hormonal dysfunction (for review see Riecher-Rössler, et al., 2010).
Previous work suggests that first episode psychosis (FE) is characterised by an enlarged pituitary gland volume (PV) and hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis (Pariante, 2008), independent of antipsychotic treatment. Furthermore, it is well known that stress can activate prolactin secretion, which might also result in an increased pituitary volume (Low, 2008; MacMaster et al., 2007; Pariante, 2008). Higher pituitary volume at the same time seems to be associated with increased emotional stress reactivity (Habets et al., 2011). Recent studies show that both pituitary gland volume and prolactin secretion may be already increased in the prodromal phase and are predictors of future transition (Garner et al., 2005; Pariante, 2008). Interestingly, we found a significant gender effect specifically in the ARMS group, with elevated prolactin values and significantly larger PV only in women (Aston et al., 2010; Büschlen et al., 2011). These sex by-group interactions might indicate that hormonal dysbalance and pituitary dysfunction play a special role in women with beginning psychosis. Possibly women suffer from higher stress reactivity.
To better understand the role of stress, hyperprolactinaemia and brain volume alterations of the pituitary gland in men and women in the process of beginning psychosis, we plan to study their association with psychopathological symptoms across different stages of emerging psychosis specifically looking at possible sex-group interactions. The present investigation might shed further light on sex differences in stress reactivity.
References
Aston J et al. Prog Neuropsychopharmacol Biol Psychiatry 2010;34:1342-1344
Büschlen J. et al. Schizophr Res 2011;125:41-48
Garner B. et al. Biol Psychiatry 2005;58:417-423
Habets P. et al. Psychol Med 2011;FirstView:1-11
Low W. (2008). Neuroendocrinology. In H. Kronenberg S et al. (Eds.), Williams Textbook of Endocrinology, 9th Ed,Philadelphia: W.B. Saunders Co., pp. 85-295
MacMaster FP et al. Schizophr Res 2007;92:207-210
Pariante C M. J Psychopharmacol 2008;22:76-81
Riecher-Rössler A et al. Schizophrenia in women. In D. Kohen (Ed.), Oxford Textbook of Women and Mental Health, Oxford: Oxford University Press, pp. 102-114
Keywords: Mental health, Psychoneuroendocrinology, Prolactin, Pituitary gland, First episode psychosis, Gender differences
CORRESPONDING AUTHOR: Riecher-Rössler Anita, Univ. of Basel Psych. Clinics, anita.riecher@upkbs.ch
Cost and Effectiveness of Health Care Services
O845
A COST-EFFECTIVENESS ANALYSIS OF THE TRIPLE P PROGRAM IN UPPSALA MUNICIPALITY, SWEDEN
Feldman I., Jeppsson K., Zarabi N.
Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Objectives: Cost-effectiveness analyses of interventions promoting children’s mental health are very limited. A question of particular interest is whether universal parenting programs, e.g. Triple P are cost-effective. This study aims to test whether health economic calculations can be applied when evaluating universal Triple P in a Swedish municipality.
Methods: The Triple P project was implemented in Uppsala municipality during the period 2009-2010. A total of 758 parents were randomly assigned to either the intervention (N = 487) or control (N = 271) group. The parents responded to a questionnaire, which included measurement of depression, anxiety and stress of parents (DASS21/QALY), strengths and difficulties (SDQ) and externalizing behavior (ECBI22) of children. In addition, they were asked to report service use, such as family contacts with professionals due to emotional/behavioural problems. Measurements were conducted at project start (baseline) and after 12 months (follow up). The health effects were defined as a) short-term in terms of improved health-related quality of life (parents) and decreased number of contacts with professionals and b) long-term in the form of fewer externalizing behavior problems in children. The program costs seek to include all societal costs expressed in Swedish kronor (SEK) year 2010 (EUR 1 = SEK 9.13). Costs were calculated in two ways in which one covered all costs including investments that the project entailed, while the second one only included operating costs.
Results: The societal costs of delivering the Triple P program in Uppsala municipality totalled 2 MSEK. Operational costs totalled 1 MSEK. Short-term cost savings (270 000 SEK) stemmed from decreased service use of intervention parents as well as improvements in quality of life (3.5 QALYs) due to decreased depression rates in the intervention group. The short-term cost-effectiveness was calculated to 600 000 SEK/QALY or 230 000 SEK/QALY (operating cost). The long-term effect was observed as a decrease in externalizing behavior problems among children, which eventually can lead to economic gains.
Conclusion: This study shows that health economic calculations of universal Triple P are feasible. It also demonstrates that the Triple P programme results in positive health effects on children and parents at a reasonable price. Thus it could be considered a sound investment for the municipality. A simulation model is necessary to make even more long term prognostic calculations of potential health effects and cost-savings due to reduction of child mental health problems.
Keywords: Children's health, Health Economics
CORRESPONDING AUTHOR: Jeppsson Karoline, Uppsala Universitet, Uppsala, karoline.jeppsson@kbh.uu.se
O847
BORROWING MONEY AND SELLING ASSETS TO PAY FOR HEALTHCARE BEFORE AND AFTER HIV TREATMENT INITIATION IN RURAL SOUTH AFRICA
Chimbindi N., Bärnighausen T., Newell ML.
Africa Centre for Health and Population studies, Research, Mtubatuba, South Africa
Background: Although HIV treatment and care is provided free of charge in the public sector in South Africa, HIV-infected patients may incur substantial expenditures due to healthcare utilization, including for transport and food. We measure the magnitude of the expenditures that HIV-infected patients incur, and investigate whether they lead to financial distress.
Methods: We collected data on self-reported healthcare expenditures and financial distress due to healthcare expenditures (borrowing money and selling assets) in patient exit interviews in 300 patients receiving antiretroviral treatment (ART) and in 200 patients enrolled in a pre-ART programme in a poor, rural area of northern KwaZulu-Natal, South Africa. About one in four adults are HIV-infected in this area. We randomly selected patients in a two-stage sampling scheme, with primary sampling units (primary healthcare clinics) selected with probability proportional to size.
Results: ART patients reported paying on average >25 South African Rand (ZAR) during the last clinic visit, and pre-ART reported paying >15 ZAR. 39% of ART and 31% of pre-ART patients reported financial distress (either borrowing money or selling household assets) due to healthcare expenditures over the past four weeks. The largest proportion of these out-of-pocket expenditures was spent on transport to clinics. Controlling for sex, age, and employment, for every 10 ZAR increase in total patient expenditures for HIV treatment and care the odds of financial distress increased by 22% in pre-ART patients and 10% in ART patients (both p < 0.01); and for every 10 ZAR increase in total patient expenditures for other healthcare it increased by 3% in both pre-ART and ART patients (both p < 0.01).
Conclusions: A considerable proportion of HIV infected adults either borrowed or sold assets to pay for healthcare in a poor, rural community in South Africa. Such financial burdens are likely to reduce ART uptake and retention. Health policy makers should consider providing free transport to clinics providing ART, in order to lessen the financial burden of HIV treatment and care that patients and households currently face.
Keywords: AIDS, HIV, Treatment, Health policy
CORRESPONDING AUTHOR: Chimbindi Natsayi, Africa Centre, Mtubatuba, nchimbindi@africacentre.ac.za
O849
HEALTH SECTOR INTERVENTION IN GENDER-BASED VIOLENCE (GBV): HOSPITAL-BASED ONE STOP CRISIS CENTRES (OSCC) IN MALAYSIA
Wong Y. L.
Julius Centre, SPM, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
GBV is now recognized as a serious public health issue. World Health Assembly called for the health sector to be the focal point of violence prevention. With a 39% GBV prevalence, the OSCC is a landmark intervention for GBV survivors in Malaysia. The OSCC policy of integrated services has been institutionalized in public hospitals since 1996. This paper presents findings of an evaluation of its effectiveness in empowerment of GBV survivors to manage violence and its impact. Mixed methods were used. In-depth interviews were conducted with 10 key stakeholders and 4 focus group discussions (FGD) were held with 21 OSCC healthcare providers to obtain their assessment of OSCC services. A GBV Knowledge, Attitudes and Practice survey was conducted with 334 OSCC healthcare providers in 10 urban and rural hospitals. The OSCCs reviewed proclaimed to ensure all services needed by GBV survivors are provided based on a patient-focus principle and inter-agency management model: identification and diagnosis; therapeutic and medical care; counselling and emotional support; multilevel crisis intervention; legal/court services; provision of temporary shelter; and medical reporting. Fundamental policy and management integration challenges were revealed. At the health systems level, lack of standard GBV policy and treatment guidelines impacted the standards of care for GBV survivors (treatment, care, forensic examination and documentation). Poor inter-agency management coordination within health systems and between latter and non-health agencies hindered full achievement of professed OSCC aims, especially services like shelters, legal aid and welfare. While “blame-the-victim” attitudes, lack of holistic GBV knowledge, and gender insensitivity affected healthcare providers’ professional competence and practice. Thus, stronger health systems integration and capacity building are needed to sustain a unified continuum of care, from emergency care, crisis intervention, forensic examination, reproductive health, and long-term health effects, toward a livelihood free from violence for GBV survivors.
Keywords: Health policy, intervention, gender-based violence, Malaysia
CORRESPONDING AUTHOR: Wong Yut Lin, Universiti Malaya, Kuala Lumpur, wongyl@ummc.edu.my
O850
ESTIMATE OF THE COST OF A COMPREHENSIVE EARLY INTERVENTION FOR PATIENTS WITH FIRST-EPISODE PSYCHOSIS IN JAPAN
Iijima S.1, Koike S.2, Kasai K.2, Yokoyama K.3
1 Juntendo University, Faculty of Health Care and Nursing, Urayasu, Chiba, Japan
2 The University of Tokyo Graduate School of Medicine, -, Tokyo, Japan
3 Juntendo University, Faculty of Medicine, Department of Epidemiology and Environmental Medicine, Tokyo, Japan
In Japan, a shortage of mental health services, particularly for outpatients and community-based supports, has been a major problem. We conducted a parallel and single-blinded interventional study to calculate the cost of a comprehensive early intervention for patients with first-episode psychosis in Japan. The study subjects comprised patients with a diagnosis of F2 and F3 (International Classification of Disease, 10th revision), with psychotic symptoms. They were patients at a national hospital with 1,150 beds where the hospital staff included psychiatrists, case managers, and accounting personnel. The inclusion criteria were ages of 15–35 years, onset of psychotic symptoms within five years, and first-episode psychosis. Allocation was conducted equally between case management and standard care groups. The subjects After enrollment, standard care was provided for both groups. In addition, community-based care was provided for the comprehensive care group for 18 months to promote recovery. A cost analysis was performed from the perspective of the health service provider; it included direct medical costs and costs of community-based care not indirect cost. The cost of the medical treatment was calculated on the basis of the medical charge in 2011 multiplied by the cost-charge ratio per service unit of the hospital. The medical cost was 1,787,610 JPY for the case-management group and 2,384,190 JPY for the standard-care group. The cost per patient was 5,969,033 JPY for those in the case-management group and 9,203,168 JPY for those in the standard-care group. Thus, case management was less costly than standard care in Japan.
Keywords: economics, health policy
CORRESPONDING AUTHOR: Iijima Sachiko, Juntendo University, siijima@juntendo.ac.jp
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Abstracts from the ICBM 2012 Meeting. Int.J. Behav. Med. 19 (Suppl 1), 1–341 (2012). https://doi.org/10.1007/s12529-012-9247-0
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DOI: https://doi.org/10.1007/s12529-012-9247-0