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Objective: To examine the unique role of migraine aura in predicting day‐to‐day levels of headache‐related disability. Background: Migraine symptoms and psychological variables contribute to headache‐related disability. Migraine aura may be associated with more severe symptom profiles and increased risk of psychiatric comorbidities, but the impact of aura on daily functioning is unknown. The present study sought to evaluate the role of migraine aura in predicting same‐day and subsequent‐day migraine‐related disability while accounting for demographic, headache, and psychological variables. Methods: This was an observational prospective cohort study among 554 adults with migraine. For each participant, data on migraine symptoms and psychological variables were collected daily for 90 days using the N‐1 Headache™ digital app (N = 11,156 total migraine days). Analyses assessed whether the presence of aura predicted daily ratings of migraine‐related disability independently of other headache and psychological variables. Given the number of predictors examined, statistical significance was set at p < 0.01. Results: The mean (standard deviation, range) patient‐level Migraine Disability Assessment questionnaire score across days of the migraine episode was 1.18 (1.03, 0–3). Aura was significantly associated with higher disability ratings on all days of the migraine episode (odds ratio [OR] 1.40, 99% confidence interval [CI] 1.13–1.74; p < 0.001). This relationship remained unchanged after adjusting for patient‐level variables (OR 1.40, 99% CI 1.13–1.73; p < 0.001) and day‐level psychological variables (OR 1.39, 99% CI 1.12–1.73; p < 0.001) but was fully negated after controlling for day‐level headache variables (OR 1.19, 99% CI 0.95–1.49; p = 0.039). Aura on the first day of the episode was associated with increased odds of allodynia (OR 1.87, 99% CI 1.22–2.86; p < 0.001), phonophobia (OR 1.62, 99% CI 1.17–2.25; p < 0.001), photophobia (OR 1.89, 99% CI 1.37–2.59; p < 0.001), and nausea/vomiting (OR 1.54, 99% CI 1.17–2.02; p < 0.001) on all days of the episode, but not episode duration (p = 0.171), peak severity (p = 0.098), or any examined psychological variables (sleep duration [p = 0.733], sleep quality [p = 0.186], stress [p = 0.110], anxiety [p = 0.102], or sadness [p = 0.743]). Conclusion: The presence of aura is predictive of increased headache‐related disability during migraine episodes, but this effect is attributable to associated non‐pain symptoms of migraine. Plain Language Summary: We used daily diary data from a headache app to see how aura was associated with disability from migraine. Aura was associated with worse disability, but this was attributable to other non‐pain symptoms of migraine, not aura itself. These findings add to studies suggesting aura is best viewed as one of many symptoms of migraine. [ABSTRACT FROM AUTHOR]

Suboptimal disease self-management among adults with type 2 diabetes is associated with greater risk of diabetes related health complications and mortality. Emotional distress has been linked with poor diabetes self-management; however, few studies have examined the role of emotion dysregulation in diabetes management. The purpose of this study was to examine the relations between different facets of emotion dysregulation and diabetes self-management behaviors among a sample of 373 adults with type 2 diabetes. Separate median regression and binary logistic regression models were used to examine the association of emotion dysregulation facets and each diabetes self-care behavior (i.e., medication nonadherence, diet, exercise, self-monitoring of blood glucose (SMBG), foot care, and smoking). Generally, greater difficulties in emotion regulation were associated with poorer self-management behaviors. However, several facets of emotion dysregulation were linked with better self-management behaviors. Addressing emotion dysregulation among adults with type 2 diabetes has the potential to improve diabetes related self-management. [ABSTRACT FROM AUTHOR]

Aims To evaluate the relationship between neuroticism personality traits and cardiovascular magnetic resonance (CMR) measures of cardiac morphology and function, considering potential differential associations in men and women. Methods and results The analysis includes 36 309 UK Biobank participants (average age = 63.9 ± 7.7 years; 47.8% men) with CMR available and neuroticism score assessed by the 12-item Eysenck Personality Questionnaire-Revised Short Form. CMR scans were performed on 1.5 Tesla scanners (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) according to pre-defined protocols and analysed using automated pipelines. We considered measures of left ventricular (LV) and right ventricular (RV) structure and function, and indicators of arterial compliance. Multivariable linear regression was used to estimate association of neuroticism score with individual CMR metrics, with adjustment for age, sex, obesity, deprivation, smoking, diabetes, hypertension, hypercholesterolaemia, alcohol use, exercise, and education. Higher neuroticism scores were associated with smaller LV and RV end-diastolic volumes, lower LV mass, greater concentricity (higher LV mass to volume ratio), and higher native T1. Greater neuroticism was also linked to poorer LV and RV function (lower stroke volumes) and greater arterial stiffness. In sex-stratified analyses, the relationships between neuroticism and LV stroke volume, concentricity, and arterial stiffness were attenuated in women. In men, association (with exception of native T1) remained robust. Conclusion Greater tendency towards neuroticism personality traits is linked to smaller, poorer functioning ventricles with lower LV mass, higher myocardial fibrosis, and higher arterial stiffness. These relationships are independent of traditional vascular risk factors and are more robust in men than women. [ABSTRACT FROM AUTHOR]

Objective: To examine the relative contribution of headache symptoms and psychological factors to headache‐related disability. Background: Both headache symptoms and comorbid psychological factors (psychiatric symptoms and transdiagnostic constructs) negatively impact functioning among individuals with migraine and tension‐type headache, but few studies have explored their relative contribution to headache‐related disability. We hypothesized that psychiatric symptoms and transdiagnostic variables would afford incremental contribution to disability beyond headache symptoms, and we investigated the moderating role of headache diagnosis on these relationships. Methods: This cross‐sectional study examined data from a southern U.S. university online sample of 1818 young adults (mean [SD] age 19.0 [5.1] years; 74.6% female) who met the International Classification of Headache Disorders, third edition criteria for primary headache disorders (46.6% episodic migraine, 11.6% chronic migraine, 38.3% episodic tension‐type headache, 3.5% chronic tension‐type headache) and completed measures assessing psychological factors and headache‐related disability. Headache, psychiatric symptoms, and transdiagnostic factors were examined in relation to headache‐related disability, after controlling for sex. Moderation analyses examined the conditional effect of diagnosis on disability. Results: As predicted, both psychiatric and transdiagnostic symptoms accounted for unique variance in headache‐related disability beyond headache symptoms (R2 changes of 2.7% and 2.3%, respectively). Significant three‐way interactions revealed the relationship between psychiatric symptoms and disability (b = −3.16, p = 0.002), and between transdiagnostic variables and disability (b = −2.37, p = 0.034). Tests of simple slopes showed greater psychiatric symptoms and transdiagnostic variables were associated with higher levels of disability. However, the associations of these variables with disability were strongest among individuals with chronic tension‐type headache (B = 3.93 for psychiatric symptoms and B = 4.62 for transdiagnostic symptoms, both p < 0.001). Conclusion: Psychiatric and transdiagnostic factors contribute uniquely to headache‐related functional impairment, which may be important for expanding targeted assessment and behavioral interventions. [ABSTRACT FROM AUTHOR]

Aims Left ventricular systolic dysfunction (LSVD) is a heterogeneous condition with several factors influencing prognosis. Better phenotyping of asymptomatic individuals can inform preventative strategies. This study aims to explore the clinical phenotypes of LVSD in initially asymptomatic subjects and their association with clinical outcomes and cardiovascular abnormalities through multi-dimensional data clustering. Methods and results Clustering analysis was performed on 60 clinically available variables from 1563 UK Biobank participants without pre-existing heart failure (HF) and with left ventricular ejection fraction (LVEF) < 50% on cardiovascular magnetic resonance (CMR) assessment. Risks of developing HF, other cardiovascular events, death, and a composite of major adverse cardiovascular events (MACE) associated with clusters were investigated. Cardiovascular imaging characteristics, not included in the clustering analysis, were also evaluated. Three distinct clusters were identified, differing considerably in lifestyle habits, cardiovascular risk factors, electrocardiographic parameters, and cardiometabolic profiles. A stepwise increase in risk profile was observed from Cluster 1 to Cluster 3, independent of traditional risk factors and LVEF. Compared with Cluster 1, the lowest risk subset, the risk of MACE ranged from 1.42 [95% confidence interval (CI): 1.03–1.96; P < 0.05] for Cluster 2 to 1.72 (95% CI: 1.36–2.35; P < 0.001) for Cluster 3. Cluster 3, the highest risk profile, had features of adverse cardiovascular imaging with the greatest LV re-modelling, myocardial dysfunction, and decrease in arterial compliance. Conclusions Clustering of clinical variables identified three distinct risk profiles and clinical trajectories of LVSD amongst initially asymptomatic subjects. Improved characterization may facilitate tailored interventions based on the LVSD sub-type and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Summary: Background: Youth with attention‐deficit hyperactivity disorder (ADHD) are more vulnerable to developing obesity. Stimulant medication use, an evidence‐based treatment for ADHD, is associated with lower body mass index (BMI) and higher blood pressure among non‐overweight youth. Objectives: The purpose of this study was to examine the longitudinal influence of ADHD and stimulant medication use on BMI and blood pressure among a sample of 456 youth with overweight and obesity treated in a paediatric weight management clinic. Methods: Mixed linear modelling examined the main and interactive effects of time by ADHD status and stimulant medication use on BMI and blood pressure. Results: Youth without ADHD experienced a significantly faster decrease in BMI compared to youth with ADHD (p < 0.001). Youth with ADHD who were taking stimulant medication had a significantly faster decrease in BMI compared to youth with ADHD who were not taking stimulant medication (p = 0.009). There was no significant effect of ADHD status or stimulant medication use on diastolic or systolic blood pressure trajectories over time (ps >0.05). Conclusions: Results from this study suggest that youth with ADHD who are not taking stimulant medication may not benefit from clinical weight management to the same extent as either youth without ADHD or youth with ADHD who are taking a stimulant medication. [ABSTRACT FROM AUTHOR]

Adults with diabetes frequently experience diabetes related distress, which is associated with negative health outcomes. Family members are commonly involved in patients' diabetes self-management. However, family involvement can have helpful and/or harmful effects on patients' diabetes outcomes. Use of interpersonal strategies to regulate negative emotions may play a role in patients' interactions with family members and experience of diabetes distress. This study examined the influences of interpersonal emotion regulation and family and friend involvement on diabetes distress among 373 adults with type 2 diabetes. Two separate three-step sequential linear regression models were used to test the main and interactive effects of harmful and helpful family involvement and interpersonal emotion regulation on diabetes distress. Greater use of interpersonal strategies to regulate negative emotions (p =.006) and greater harmful family involvement (p <.001) were significantly associated with greater diabetes distress. Interpersonal emotion regulation moderated the relationship of helpful (p =.007), but not harmful (p =.171) family involvement on diabetes distress. Specifically, greater helpful family involvement was associated with lower diabetes distress among adults with low (p =.017) but not high (p =.419) use of interpersonal strategies to regulate negative emotions. Helpful family involvement appears to be associated with lower diabetes distress, but only among patients with low levels of interpersonal emotion regulation. [ABSTRACT FROM AUTHOR]

Background: Long-term treatment adherence is a worldwide concern, with nonadherence resulting from a complex interplay of behaviors and health beliefs. Determining an individual's risk of nonadherence and identifying the drivers of that risk are crucial for the development of successful interventions for improving adherence. Here, we describe the development of a new tool assessing a comprehensive set of characteristics predictive of patients' treatment adherence based on the Social, Psychological, Usage and Rational (SPUR) adherence framework. Concepts from existing self-reporting tools of adherence-related behaviors were identified following a targeted MEDLINE literature review and a subset of these concepts were then selected for inclusion in the new tool. SPUR tool items, simultaneously generated in US English and in French, were tested iteratively through two rounds of cognitive interviews with US and French patients taking long-term treatments for chronic diseases. The pilot SPUR tool, resulting from the qualitative analysis of patients' responses, was then adapted to other cultural settings (China and the UK) and subjected to further rounds of cognitive testing. Results: The literature review identified 27 relevant instruments, from which 49 concepts were included in the SPUR tool (Social: 6, Psychological: 13, Usage: 11, Rational: 19). Feedback from US and French patients suffering from diabetes, multiple sclerosis, or breast cancer (n = 14 for the first round; n = 16 for the second round) indicated that the SPUR tool was well accepted and consistently understood. Minor modifications were implemented, resulting in the retention of 45 items (Social: 5, Psychological: 14, Usage: 10, Rational: 16). Results from the cognitive interviews conducted in China (15 patients per round suffering from diabetes, breast cancer or chronic obstructive pulmonary disease) and the UK (15 patients suffering from diabetes) confirmed the validity of the tool content, with no notable differences being identified across countries or chronic conditions. Conclusion: Our qualitative analyses indicated that the pilot SPUR tool is a promising model that may help clinicians and health systems to predict patient treatment behavior. Further steps using quantitative methods are needed to confirm its predictive validity and other psychometric properties. [ABSTRACT FROM AUTHOR]

Aims Data regarding the effects of regular alcohol consumption on cardiac anatomy and function are scarce. Therefore, we sought to determine the relationship between regular alcohol intake and cardiac structure and function as evaluated with cardiac magnetic resonance imaging. Methods and results Participants of the UK Biobank who underwent cardiac magnetic resonance were enrolled in our analysis. Data regarding regular alcohol consumption were obtained from questionnaires filled in by the study participants. Exclusion criteria were poor image quality, missing, or incongruent data regarding alcohol drinking habits, prior drinking, presence of heart failure or angina, and prior myocardial infarction or stroke. Overall, 4335 participants (61.5 ± 7.5 years, 47.6% male) were analysed. We used multivariate linear regression models adjusted for age, ethnicity, body mass index, smoking, hypertension, diabetes mellitus, physical activity, cholesterol level, and Townsend deprivation index to examine the relationship between regular alcohol intake and cardiac structure and function. In men, alcohol intake was independently associated with marginally increased left ventricular end-diastolic volume [ β  = 0.14; 95% confidence interval (CI) = 0.05–0.24; P  = 0.004], left ventricular stroke volume (β  = 0.08; 95% CI = 0.03–0.14; P  = 0.005), and right ventricular stroke volume (β  = 0.08; 95% CI = 0.02–0.13; P  = 0.006). In women, alcohol consumption was associated with increased left atrium volume (β  = 0.14; 95% CI = 0.04–0.23; P  = 0.006). Conclusion Alcohol consumption is independently associated with a marginal increase in left and right ventricular volumes in men, but not in women, whereas alcohol intake showed an association with increased left atrium volume in women. Our results suggest that there is only minimal relationship between regular alcohol consumption and cardiac morphology and function in an asymptomatic middle-aged population. [ABSTRACT FROM AUTHOR]

This study examined the role of autonomy support from adults' informal health supporters (family or friends) in diabetes-specific health behaviors and health outcomes. Using baseline data from 239 Veterans with type 2 diabetes at risk of complications enrolled in behavioral trial, we examined associations between autonomy support from a support person and that support person's co-residence with the participant's diabetes self-care activities, patient activation, cardiometabolic measures, and predicted risk of a cardiac event. Autonomy support from supporters was associated with significantly increased adherence to healthy lifestyle behaviors (diet, p <.001 and exercise, p =.003); higher patient activation (p <.001); greater patient efficacy in interacting with healthcare providers, and lower 5-year (p =.044) and 10-year (p =.027) predicted cardiac risk. Autonomy support was not significantly associated with diabetes-specific behaviors (checking blood glucose, foot care, or medication taking); or hemoglobin A1c, systolic blood pressure, or non-HDL cholesterol. There was a significant interaction of autonomy support and supporter residence in one model such that lack of autonomy support was associated with lower patient activation only among individuals with in-home supporters. No other interactions were significant. Findings suggest that autonomy support from family and friends may play a role in patient self-management, patient activation, and lower cardiac risk. [ABSTRACT FROM AUTHOR]

Aims  The non-invasive assessment of left ventricular (LV) diastolic function and filling pressure in hypertrophic cardiomyopathy (HCM) is still an open issue. Pulmonary blood volume index (PBVI) by cardiovascular magnetic resonance (CMR) has been proposed as a quantitative biomarker of haemodynamic congestion. We aimed to assess the diagnostic accuracy of PBVI for left atrial pressure (LAP) estimation in patients with HCM. Methods and results  We retrospectively identified 69 consecutive HCM outpatients (age 58 ± 11 years; 83% men) who underwent both transthoracic echocardiography (TTE) and CMR. Guideline-based detection of LV diastolic dysfunction was assessed by TTE, blinded to CMR results. PBVI was calculated as the product of right ventricular stroke volume index and the number of cardiac cycles for a bolus of gadolinium to pass through the pulmonary circulation as assessed by first-pass perfusion imaging. Compared to patients with normal LAP, patients with increased LAP showed significantly larger PBVI (463 ± 127 vs. 310 ± 86 mL/m2, P  < 0.001). PBVI increased progressively with worsening New York Heart Association functional class and echocardiographic stages of diastolic dysfunction (P  < 0.001 for both). At the best cut-off point of 413 mL/m2, PBVI yielded good diagnostic accuracy for the diagnosis of LV diastolic dysfunction with increased LAP [C-statistic = 0.83; 95% confidence interval (CI): 0.73–0.94]. At multivariable logistic regression analysis, PBVI was an independent predictor of increased LAP (odds ratio per 10% increase: 1.97, 95% CI: 1.06–3.68; P  = 0.03). Conclusion  PBVI is a promising CMR application for assessment of diastolic function and LAP in patients with HCM and may serve as a quantitative marker for detection, grading, and monitoring of haemodynamic congestion. [ABSTRACT FROM AUTHOR]

Objective Adults with serious mental illness are at increased risk for diabetes mellitus and diabetes-related complications. This article classifies subgroups among people with serious mental illness and comorbid diabetes with respect to functional status and examines differences among those groups. Methods This analysis used a baseline sample of 157 adults with serious mental illness and diabetes mellitus enrolled in a National Institute of Health-funded research study. Latent profile analysis was used to distinguish health status profiles and investigate how these subgroups differed across assessment domains. Results Participants with depression, schizophrenia, and bipolar disorder (n = 157) were included in the study. Mean age was 52.9 years (standard deviation = 9.8), and 62 (40%) were African American. From the latent profile analysis, a three-class model appeared to provide the best fit. Class 1 (34.9%) had a very low functional health status approximately two standard deviations below the general population mean. Class 2 (43.7%) had a low functional status approximately one standard deviation below the general mean. Class 3 (21.4%) had moderate functional status with scores near population mean. Groups differed on measures of personal characteristics, clinical status and symptom severity, self-care behaviors, and environmental characteristics. Conclusions Although individuals with schizophrenia generally have poor prognosis once they develop diabetes, latent profile analysis identified distinct health status subgroups. Although all three groups demonstrated illness burden, the pattern of differences between these groups across measures may suggest the need for different interventions for highly diverse adults who received care within safety-net primary care. [ABSTRACT FROM AUTHOR]

Aims Adenosine can induce splenic vasoconstriction (splenic switch-off, SSO). In this study, we aim to evaluate the utility of identifying a lack of SSO for detecting false-negative adenosine stress perfusion cardiac magnetic resonance (CMR) scans. Methods and results We visually analysed 492 adenosine stress perfusion CMR scans reported as negative in a cohort of patients with no previous history of coronary artery disease. A lack of SSO was identified in 11%. We quantified the phenomenon by drawing regions of interest on the spleen and comparing intensity between stress and rest scans, the spleen intensity ratio (SIR). Inter-rater agreement for qualitative determination of SSO was k = 0.81 and inter-class correlation for quantitative determination of SSO was 0.94. The optimal threshold for SIR as an indicator of SSO was 0.40 (sensitivity = 82.5%, specificity = 92.3%, AUC = 0.91). 23 065 CMR scans and 9926 invasive coronary angiogram reports were retrospectively examined to identify patients with negative CMR scans who required coronary intervention in the subsequent 12 months (false negatives). We compared these scans with true positives who had positive adenosine stress perfusion CMR scans followed by coronary intervention. The rate of lack of SSO was 20.7% in the false-negative group versus 13.1% in true positives (P = 0.37). Conclusion The lack of SSO is prevalent, easily measureable, and has potential to improve on haemodynamic criteria as a marker of adenosine understress in CMR perfusion scans. [ABSTRACT FROM AUTHOR]

A growing body of literature indicates perception of parental approval of drinking predicts college alcohol use. This study examined perception of parental monitoring as a moderator of perceived parental approval of drinking and alcohol use (quantity, frequency) among undergraduate students (N = 632). Parental monitoring moderated the relationship between parental approval and alcohol use frequency (β = .082, p = .017); however, parental monitoring did not moderate the relationship between parental approval and weekly alcohol consumption (β = .014, p = .695). Perceived parental knowledge of drinking moderated the relationship between perceived parental approval and both alcohol use frequency and weekly alcohol consumption. Implications are discussed in the context of parental communication based interventions. [ABSTRACT FROM AUTHOR]

Purpose. Health status and social networks are associated with resilience among older adults. Each of these factors may be important to the ability of adults to remain in rural and remote communities as they age. We examined the association of health status and social networks and resilience among older adults dwelling in a rural and remote county in the Western United States. Methods. We selected a random sample of 198 registered voters aged 65 years or older from a frontier Wyoming county. Hierarchical linear regression was used to examine the association of health status as well as social networks and resilience. We also examined health status as a moderator of the relationship between social networks and resilience. Results. Family networks (p=0.024) and mental health status (p<0.001) significantly predicted resilience. Mental health status moderated the relationship of family (p=0.004) and friend (p=0.021) networks with resilience. Smaller family and friend networks were associated with greater resilience when mental health status was low, but not when it was high. Conclusion. Efforts to increase mental health status may improve resilience among older adults in rural environments, particularly for those with smaller family and friends networks. [ABSTRACT FROM AUTHOR]

College student drinking is a public health concern with potentially serious consequences. A growing body of literature indicates perceived parental approval of alcohol use is associated with drinking outcomes in college populations, and that parent-based interventions may be a viable way to reduce alcohol use on campus. However, researchers have not yet identified the mechanism responsible for this relationship. In this study, a path model was used to look at the relationship between perceived parental approval of drinking and negative consequences of alcohol use among undergraduate students (N = 632)viatwo mechanisms: perceived friends’ approval of drinking and perceived parental monitoring. The path model specified in this study indicated that perceived parental approval of drinking is associated with negative consequences of alcohol use, and that this effect is not fully attributed to perceived parental monitoring, injunctive norms of friends, gender or weekly alcohol consumption. As hypothesized, perceived friends’ approval of drinking partially mediated the relationship between perceived parental approval of drinking and negative consequences of alcohol use. Contrary to hypothesis, the path model did not provide support to the mediating role of perceived parental monitoring. [ABSTRACT FROM PUBLISHER]

The investigators used qualitative methods to examine perspectives of community mental health professionals on obesity management in adults with serious mental illness (SMI). Data from 5 focus groups were subjected to constant comparison analysis and grounded theory. Results showed that influences at individual, social, community, and societal levels impact development and maintenance of obesity. Mental health providers desired a collaborative relationship with health promotion program staff. They also believed that frequent, group-based health promotion should include participation incentives for adults with SMI and should occur over durations of at least 6-months to achieve improved health outcomes for this population. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Depression and anxiety worsen COPD and lead to greater respiratory symptom severity and health care utilization. Fear of physical sensations of anxiety (AS-P) is known to exacerbate respiratory symptoms. The current study investigated the unique contribution of AS-P in respiratory symptom exacerbations, emergency department visits, hospitalizations, and COPD-related functional health status, controlling for medical characteristics, depression, and anxiety. The sample included 535 adults with COPD (M age = 56.57; 58.1% male). Participants were recruited from a web-based panel of adults with chronic respiratory disease and completed an online battery of self-report measures. Consistent with hypotheses, AS-P significantly increased the likelihood of acute symptom exacerbations by 12% and respiratory-related emergency department visits and hospitalizations by 7% during the prior 12 month period. Additionally, AS-P demonstrated a unique, large effect (f 2 = 0.37) on COPD-related functional health status. Fear of physical sensations contributed to worse respiratory outcomes and health care utilization among adults with COPD. Screening for AS-P may effectively identify at-risk COPD patients, while reducing AS-P through targeted interventions may result in decreased symptom severity, functional limitations, and burden on the health care system. [ABSTRACT FROM AUTHOR]