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Social-evaluative threat plays a key role in research on stress, health and related psychophysiological mechanisms such as cardiovascular reactivity (CVR). Social-evaluative threats can activate two broad social motives: striving for status, achievement and influence, and/or striving for acceptance, inclusion, and connection. Prior research emphasizes threats related to status (e.g., task performance) or combined threats to status and acceptance, obscuring their independent effects. Further, because prior research has mostly utilized single stressors, it is not clear if effects of social-evaluative threats involving status and acceptance on CVR persist or adapt quickly over repeated exposures. To address these issues, 139 undergraduates (93 females) were randomly assigned to undergo two repetitions of a stressful role-played interaction with a pre-recorded antagonistic partner under one of four conditions in a factorial design: low evaluative threat, high status threat only, high acceptance threat only, or a combined threat. In a single laboratory session, systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were recorded during baseline and two stressor exposures. Task-induced CVR demonstrated significant adaptation across exposures. Both forms of social evaluative threat produced additional CVR, and these differences between high and low social-evaluative threat were generally maintained across exposures. Hence, threats to social status and acceptance have independent and sustained effects on CVR across multiple stressor exposures, even in the context of overall adaptation of cardiovascular responses.

Although dispositional optimism and pessimism have been prospectively associated with health outcomes, little is known about how these associations manifest in everyday life. This study examined how short-term optimistic and pessimistic expectations were associated with psychological and physiological stress processes.A diverse sample of adults (Moments that were more optimistic than typical for a person were followed by moments with lower likelihood of reporting a stressor, higher positive affect (PA), lower negative affect (NA), and less subjective stress (SS). Moments that were more pessimistic than typical were not associated with any affective stress outcome at the following moment. Neither optimism nor pessimism were associated with ABP, and did not moderate associations between reporting a stressor and outcomes.These findings suggest that intraindividual fluctuations in optimistic and pessimistic expectations are associated with stressor appraisals.

Nonsuicidal self-injury (NSSI) frequently functions to regulate shame-based emotions and cognitions in the context of interpersonal stress. The present study sought to examine how sleep quality (SQ) may influence this process in a laboratory setting.Participants included 72 adults (MNo significant results emerged for NSSI history and SQ as statistical predictors of shame reactivity. However, NSSI history was significantly associated with heightened shame intensity during the recovery period of the task, and this was moderated by SQ. Simple slopes analyses revealed a conditional effect whereby poorer SQ (1SD above the mean) was associated with greater intensity of shame during recovery, but only for those with a history of NSSI.Poor SQ may contribute to worrisome emotional responses to daytime stressors in those at risk for NSSI.

Negative affective symptoms (e.g., anxiety, depression, and anger) are correlated and have parallel associations with outcomes, as do related personality traits (i.e., facets of neuroticism), often prompting statistical control (i.e., partialing) to determine independent effects. However, such adjustments among predictor variables can alter their construct validity. In three studies, the interpersonal circumplex (IPC) and a related analytic approach (i.e., Structural Summary Method) were used to evaluate changes in interpersonal correlates of negative affective characteristics resulting from partialing.Samples of undergraduates (Sample 1 n = 3283; Sample 2 = 688) and married couples (n = 300 couples) completed self-report (three samples) and partner rating (sample 3) measures of anxiety, depression and anger, and IPC measures of interpersonal style.Anxiety, depression, and anger had expected interpersonal correlates across samples. Partialing depression eliminated interpersonal correlates of anxiety. When anxiety was controlled, depression measures were more strongly associated with submissiveness and less closely associated with low warmth. Adjustments involving anger magnified differences in dominance versus submissiveness associated with the negative affects.Removal of overlap among negative affective measures via partialing alters their interpersonal correlates, potentially complicating interpretation of adjusted associations.

Comparative data on the economic burden of alopecia areata relative to the general population are limited. The objective of this retrospective database analysis was to evaluate healthcare resource utilization and direct medical costs among patients with alopecia areata from the US payer perspective compared with matched controls.Validated billing codes were used to identify patients with alopecia areata from the IQVIA PharMetrics Plus (2016-2018) who had continuous pharmacy and medical enrollment for 365 days both before (baseline period) and after (evaluation period) the index date. Demographic and clinical characteristics were characterized, and baseline comorbidities were assessed with the Quan Charlson Comorbidity Index.Using the exact matching feature from Instant Health Data, 14,340 patients with alopecia areata were matched with 42,998 control patients aged ≥ 12 years. Patients with alopecia areata had higher healthcare resource utilization and adjusted total all-cause mean medical costs versus matched controls ($8557 versus $6416; p 0.0001), because of higher inpatient costs, emergency department visits, ambulatory visits, number of prescriptions and prescription costs, and other costs such as durable medical equipment and home healthcare. The number of inpatient visits did not significantly differ between the two groups. Mean ambulatory costs were $3640 for patients with alopecia areata and $2062 for controls, and mean pharmacy costs were $3287 and $1843, respectively (p 0.0001 for both). Pharmacy costs related to immunologic agents represented 50.0% of the total difference in pharmacy spending between patients with alopecia areata and controls. Surgery on the integumentary system accounted for 9.5% of the total difference in ambulatory costs.Alopecia areata is associated with significant incremental healthcare resource utilization and costs relative to matched controls due to increased spending in areas such as surgical procedures and psychological and pharmacological interventions. Costs are primarily driven by ambulatory and pharmacy spending.

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease that negatively impacts overall health, quality of life (QoL), and work productivity. Prior studies on AD burden by severity have focused on moderate-to-severe disease. Here, we describe the clinical and humanistic burden of AD in Europe across all severity levels, including milder disease.Data were analyzed from the 2017 National Health and Wellness Survey from adult respondents with AD in the EU-5 (France, Germany, Italy, Spain, and the UK). AD disease severity was defined based on self-reported assessments as "mild," "moderate," or "severe" and by Dermatology Life Quality Index (DLQI) severity bands. Self-reported outcomes for AD respondents by severity were assessed using propensity score matching. These outcomes included a wide range of selected medical/psychological comorbidities, overall QoL and functional status (EuroQol 5-Dimensions 5-Level and Short Form-36 version 2 questionnaires), and work productivity and activity impairment (Work Productivity and Activity Impairment questionnaire).In total, 4208 respondents with AD (mild AD, 2862; moderate AD, 1177; severe AD, 169) and 4208 respondents without AD were included in this analysis. Results showed greater burden across severity levels compared with matched non-AD controls. A higher proportion of respondents with mild-to-moderate AD, defined by DLQI severity bands, reported atopic comorbidities (P 0.05) and a wide range of cardiac, vascular, and metabolic comorbidities, including hypertension, high cholesterol, angina, and peripheral vascular disease (P 0.005), compared with non-AD controls. Relative to potential impacts of various medical and psychological burdens, respondents with mild-to-moderate AD reported higher activity impairment than controls (P 0.0001).Clinical and humanistic burden was observed in European respondents with AD compared with matched non-AD controls across severity levels, with burden evident even in milder disease, highlighting the importance of improving disease management in early stages of AD.

Previous research has identified increased negative affect as a potential mechanism linking early adversities and later poor mental and physical health. Further, increased self-criticism associated with early adversities may partially explain the association between early adversities and negative affect. Early adversities are more common at lower income levels, and much of the previous research has focused on low-income samples. Hence, little is known about whether the association between early adversities and negative affect is similar across income levels. First, we examine the interactive effect of early adversities and family income on negative affect (anger, hostility, shame and guilt) in a sample of 180 young adults (52% female, 73.6% White, Mage = 21 years). Second, we examine whether self-criticism mediates the association between early adversities and negative affect using moderated mediation analyses. The interaction between early adversities and family income was significant for each outcome. Those from high-income families reported significantly more negative affect when exposed to more early adversities. Further, self-criticism mediated the relationship between early adversities and negative affect, and family income moderated this mediational path such that the mediational effect was stronger at high family income levels. Results are interpreted as consistent with the biological sensitivity to context theory, which suggests individuals from highly supportive and resource rich environments (e.g., high family income) should be more sensitive to stressors than those from moderately supportive, moderately safe environments (e.g., average family income), displaying worse outcomes when exposed to environmental stressors.

Partialing correlated predictors to test independent effects is an essential tool in couple research. In actor-partner models, partners' parallel scores are partialed in tests of unique associations with outcomes. Correlated aspects of couple functioning are also often partialed within individuals to examine separate effects. Partialed versions of measures are typically interpreted as assessing the same construct as original unadjusted variables, but in fact their meaning can change. Extending a prior report on changes in construct validity resulting from partialing partners' parallel scores, the present analyses examined effects of partialing measures of positive and negative relationship variables within individuals, specifically perceived support from the partner and relationship conflict. In 300 middle-aged and older couples, we utilized participants' interpersonal circumplex ratings of their partner's typical behavior during marital interactions to compare interpersonal correlates of unadjusted and within-person partialed forms of the Quality of Relationships Inventory Support and Conflict scales. Compared to unadjusted scores, partialed support scores (i.e., adjusted for conflict) were substantially less closely associated with ratings of partner's warmth, and were associated with a less submissive (i.e., less agreeable, cooperative) form of warmth. Compared to unadjusted scores, partialed conflict scores (i.e., adjusted for support) were substantially less closely correlated with ratings of the partner's hostility, and were associated with a more controlling (i.e., critical, coercive) form of hostility. Results were nearly identical for wives and husbands. Partialing correlated scores within individuals can alter the construct validity of relationship measures, suggesting the need for careful reporting and interpretation in couple research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Atrial fibrillation (AF) is the most common arrhythmia in the United States, affecting approximately 1 in 10 adults, and its prevalence is expected to rise as the population ages. Treatment options for AF are limited; moreover, the development of new treatments is hindered by limited (1) knowledge regarding human atrial electrophysiological endpoints (e.g., conduction velocity [CV]) and (2) accurate experimental models. Here, we measured the CV and refractory period, and subsequently calculated the conduction wavelength, in vivo (four subjects with AF and four controls), and ex vivo (atrial slices from human hearts). Then, we created an in vitro model of human atrial conduction using induced pluripotent stem (iPS) cells. This model consisted of iPS-derived human atrial cardiomyocytes plated onto a micropatterned linear 1D spiral design of Matrigel. The CV (34-41 cm/s) of the in vitro model was nearly five times faster than 2D controls (7-9 cm/s) and similar to in vivo (40-64 cm/s) and ex vivo (28-51 cm/s) measurements. Our iPS-derived in vitro model recapitulates key features of in vivo atrial conduction and may be a useful methodology to enhance our understanding of AF and model patient-specific disease.

Insomnia is a risk factor for suicidal thoughts and behaviors. The present study examined the role of pre-sleep arousal in this association. Seventy-eight adults (Mage = 24.28, 56% had recent history of suicidal thoughts and behaviors) attended two lab visits over four consecutive days. We tested if generally experienced self-reported pre-sleep arousal explained the association between self-report insomnia symptoms experienced over the past two weeks and past week-suicidal ideation. Results indicated full mediation for pre-sleep cognitive arousal, but not somatic arousal. Pre-sleep cognitive arousal could be a key variable linking insomnia symptoms to suicide risk.

In research on couples, statistical adjustment (i.e., partialing) for correlations between partners' parallel scores is common and useful, as in the actor-partner interdependence model. Original and partialed scores are typically interpreted as assessing the same construct, but this may not be a valid assumption. Other approaches to nonindependence-such as common fate modeling-may better represent some couple constructs. This study of 300 couples utilized participants' interpersonal circumplex ratings of partners' typical behavior during marital interactions to evaluate the interpersonal meaning of unadjusted and partialed forms of the Marital Adjustment Test (MAT), a measure of overall relationship quality, and the Quality of Relationships Inventory-Support (QRI-S) and Conflict (QRI-C) scales, which measured perceived support from and conflict with the partner. After partialing partners' scores, MAT and QRI-S scores were substantially less closely associated with ratings of partners' warmth, their primary expected interpersonal correlates. Partner-partialed QRI-C scores were substantially less closely correlated with ratings of partners' hostility and were associated with a somewhat more controlling form of hostility. In contrast, partialing partners' trait optimism scores resulted in minimal changes in interpersonal correlates of this personality characteristic. Couple-level MAT, QRI-S, and QRI-C variables representing overlapping variance across partners while partialing unshared variance in spouses' scores (i.e., common fate scores) had highly similar interpersonal correlates when compared to unadjusted versions. Potential alterations in construct validity resulting from partialing partners' scores warrant interpretive caution, and alternative analytic frameworks (e.g., the common fate model) may better maintain the construct validity of some dyadic measures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective Lesbian, gay, and bisexual (LGB) individuals who report greater minority stress (e.g., discrimination) are at an elevated risk for multiple health problems. However, few studies have examined physiological mechanisms that might link minority stress to health. This study tested how cardiovascular and cortisol responses to a laboratory-induced social stressor differed when that stressor contained an additional minority stress component. Method LGB adults (n = 141; 51% male, 49% female) participated in a social stress task in which they were interviewed by a prerecorded confederate. Participants were randomized to receive information that their interviewer held either antigay or progay social/political beliefs. Cardiovascular reactivity and salivary cortisol were assessed at baseline, during the task, and during recovery. Results All participants experienced significant task-related increases in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP). However, participants in the antigay condition had greater increases in HR and SBP during the task and smaller decreases in SBP during recovery. Salivary cortisol increased significantly only in the antigay condition. High frequency heart rate variability (hfHRV) was constant throughout the stress task for participants in the progay condition but decreased significantly during the task for participants in the antigay condition. Conclusions Minority stress has the potential to affect LGB individuals' health through cardiovascular and endocrine mechanisms. Moreover, its physiological signature may differ from other social stress in ways that have implications for health and emotion regulation more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction The burden of mild-to-moderate atopic dermatitis (AD) in the United Kingdom (UK) is not well understood. Long-lasting AD flares may lead to systemic inflammation resulting in reversible progression from mild to more severe AD. This study aimed to assess the clinical and economic burden of mild-to-moderate AD in the UK. Methods AD patients were identified in the Health Improvement Network (THIN) from 2013 to 2017 and propensity score matched to non-AD controls by demographics. Patients were identified based on continuous disease activity using validated algorithms and sufficient patient status to fully validate data integrity for the entire period. Mild-to-moderate AD patients were identified by using treatment as a surrogate. Demographics, clinical characteristics and healthcare resource use (HCRU) were obtained from THIN. Literature reviews were conducted to obtain additional outcomes. A cost-of-illness model was developed to extrapolate the burden in 2017 to the UK population and in subsequent years (2018–2022). Results In 2017, the prevalence of mild-to-moderate AD in THIN was 1.28%. These patients reported higher comorbidity rates and significantly higher (p

Posttraumatic stress disorder (PTSD) is associated with strain in marriage and similar intimate relationships, and such difficulties could contribute to associations of PTSD with risk of cardiovascular disease (CVD). Heightened cardiovascular reactivity (CVR) during stressful marital interactions may be an important mechanism in this regard. This study examined dysfunctional behavior during marital conflict as a mediator of the association of PTSD with heightened CVR during these interactions. In 64 couples comprising male military veterans and female partners, participants underwent a 17-min video-recorded conflict discussion, with assessment of blood pressure and cardiac sympathetic activation (i.e. preejection period). In half of the couples, veterans met interview and questionnaire criteria for PTSD. Behavior was coded for aspects of affiliation (e.g., warmth vs. hostility) and control (e.g., dominance vs. deference), as well as blends of these broader dimensions. Extending previous reports from this study, actor-partner mediational analyses indicated that PTSD contributed to larger increases in veterans' and spouses' systolic blood pressure during the interaction through effects of the individual's own expressions of low warmth. PTSD contributed to veterans' and spouses' greater cardiac sympathetic activation through effects of the individual's own expressions of hostile control (e.g., blame, criticism). Hence, expressions of low warmth and high hostile control contribute to effects of PTSD on veterans' and spouses' heightened CVR during marital conflict discussions, suggesting a mechanism linking PTSD with CVD risk and potential targets for risk-reducing behavioral interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). To provide additional clinical evidence in regulatory submissions for a modified-release (MR) once-daily (QD) tofacitinib formulation, we compared real-world adherence and effectiveness between patients initiating the MR QD formulation and patients initiating an immediate-release (IR) twice-daily (BID) formulation. Methods Two noninterventional cohort studies were conducted. First, adherence and two effectiveness proxies were compared between patients with RA who newly initiated tofacitinib MR 11 mg QD or IR 5 mg BID in the IBM® MarketScan® Commercial and Medicare Supplemental US insurance claims databases (March 2016–October 2018). Second, using data collected in the Corrona US RA Registry (February 2016–August 2019), two Clinical Disease Activity Index (CDAI)-based measures of effectiveness were compared between tofacitinib MR 11 mg QD and IR 5 mg BID, and against noninferiority criteria derived from placebo-controlled clinical trials of the tofacitinib IR formulation. Multiple sensitivity analyses of the registry data were conducted to reassure regulators of consistent results across different assumptions. Results In each study, approximately two-thirds of patients initiated the MR formulation. In the claims database study, improved adherence and at least comparable effectiveness were observed with tofacitinib MR vs IR over 12 months, particularly in patients without prior advanced therapy. In the registry study, the noninferiority of tofacitinib MR vs IR was demonstrated for both CDAI outcomes at ~6 months; this finding was robust across multiple sensitivity analyses. Conclusion These results demonstrate the value of real-world evidence from complementary data sources in understanding the impact of medication adherence with a QD formulation in clinical practice. These analyses were suitable for regulatory consideration as an important component of evidence for the comparability of tofacitinib MR 11 mg QD vs IR 5 mg BID in patients with RA. Trial Registration Claims database study: ClinicalTrials.gov identifier NCT04018001, retrospectively registered July 12, 2019. Corrona US RA Registry study: ClinicalTrials.gov identifier NCT04267380, retrospectively registered February 12, 2020. Electronic supplementary material The online version of this article (10.1007/s12325-020-01501-z) contains supplementary material, which is available to authorized users.

AIMS: Higher quality relationships have been linked to improved outcomes; however, measurement of relationship quality often ignores its complexity and the possibility of co-occurring positivity and negativity across different contexts. The goal of this paper is to test the added benefit of including multiple dimensions, contexts, and perspectives of relationship quality from both individuals in predicting marital functioning. METHODS: The Social Relationships Index assessed positive and negative dimensions of relationship quality under neutral, positive, and support seeking-contexts for 183 heterosexual married couples. RESULTS: Models showed that the inclusion of multiple dimensions of relationship quality across all three contexts improved prediction of marital functioning for both women and men. CONCLUSION: The use of multidimensional, multi-contextual relationship quality assessments is highly recommended.

Increasing evidence indicates that psychological factors important to therapy effectiveness are associated with physiological activity. Knowledge of the physiological correlates of therapy process variables has the potential to provide unique insights into how and why therapy works, but little is currently known about the physiological underpinnings of specific therapy processes that facilitate client growth and change. The goal of this article is to introduce therapy process researchers to the use of physiological methods for studying therapy process variables. We do this by (a) presenting a conceptual framework for the study of therapy process variables, (b) providing an introductory overview of physiological systems with particular promise for the study of therapy process variables, (c) introducing the primary methods and methodological decisions involved in physiological research, and (d) demonstrating these principles and methods in a case of therapeutic presence during couple therapy. We close with a discussion of the promise and challenges in the study of physiological correlates of therapy process variables and consideration of future challenges and open questions in this line of research. Online supplemental materials include additional resources for therapy process researchers interested in getting started with physiological research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Graphical abstract, Highlights • Coronary cameral fistula is a rare cardiac anomaly. • Coronary fistula can occur as complication of surgical trauma. • 3D transesophageal echocardiogram can be used in the detection of coronary fistulae.

Cardiovascular reactivity (CVR), such as increases in blood pressure, during stressful marital interactions have been identified as a possible mechanism linking marital discord with cardiovascular disease (CVD). Both expressions of and exposure to negative behavior during marital conflict may influence CVR, but analytic approaches to date have not permitted firm conclusions as to whether CVR during conflict reflects an individual's own actions, actions of the spouse, or both. Additionally, evidence suggests health-relevant marital interaction varies along the affiliation dimension (i.e., warmth vs. hostility) and control dimension (i.e., dominance vs. submissiveness) of social behavior, but there is much less research on the latter. To address these issues, the present study used the Actor-Partner Interdependence Model (APIM) to examine associations of behavioral measures of affiliation and control with concurrent changes in blood pressure (i.e., CVR) during a marital conflict discussion in 146 middle-aged couples. Factor analyses of observer-coded behaviors during conflict discussions revealed a single factor for husbands and for wives, characterized by high hostility and dominance, and low warmth. The validity of these behavioral factors was supported by their predicted associations with spouse ratings of behavior during the conflict discussions, concurrent increases in anger, and reports of overall marital quality. Although expression of and exposure to negative conflict behaviors were correlated, only expression independently predicted increases in blood pressure. Exposure to negative partner behavior might alter other elements of physiological burden contributing to CVD risk, but the individual's own behavioral expressions are more closely associated with concurrent blood pressure reactivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective Obstructive sleep apnea (OSA), a serious respiratory disorder, confers increased risk of cardiovascular disease and mortality. Adherence to the standard and effective treatment, continuous positive airway pressure (CPAP), is often poor. Personal relationships can influence adherence, but some forms of partner involvement (e.g., support, encouragement) have positive effects on CPAP adherence, whereas others (e.g., criticism, blame) are counterproductive. In the former, constructive partner efforts may enhance a patient's sense of autonomy, an important foundation for self-care. The present study examined how patients' perceptions of autonomy support from an intimate partner predict adherence to CPAP, and whether it is an independent predictor, relative to generally positive partner behavior (i.e., partner responsiveness) and partner negativity (i.e., negative social control). Method Ninety-two married or cohabiting OSA patients (mean age 49.7 years) completed measures of perceived partner autonomy support, responsiveness, and negative social control at Days 14 and 60 of CPAP treatment. Objective daily CPAP machine adherence data were collected for 60 days. Results Perceived partner autonomy support predicted more minutes of CPAP used per night and increasing CPAP use over time. These effects were independent of the significant adverse effects of partner negative social control and the more limited beneficial effects of partner responsiveness. Conclusion The study findings establish perceived partner autonomy support as an interpersonal predictor of adherence that is independent of negative social control and perceived partner responsiveness, and may inform psychosocial interventions for CPAP adherence and more general couple approaches to chronic illness management. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

OBJECTIVES Racial-ethnic differences in physical/mental health are well documented as being associated with disparities; however, emerging conceptual models increasingly suggest that group differences in social functioning and organization contribute to these relationships. There is little work examining whether racial-ethnic groups respond similarly to classic measures of social networks and perceived support and whether there are significant between-groups differences on these measures. METHOD A multisite, cross-sectional study of 2,793 non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic participants was conducted using common measures of social networks and perceived support. A confirmatory factor analytic model was used to test for the invariance of factor covariance and mean structures in a three latent constructs model including social network, social provisions, and interpersonal support. Between-group differences in structural and functional support were assessed. RESULTS We established measurement invariance of the latent representations of these measures suggesting that racial-ethnic groups responded comparably. In direct comparisons, Hispanics and NHWs demonstrated similar levels of network structure and support. In contrast, NHWs reported support advantages on a majority of measures compared with NHBs. CONCLUSIONS Findings support the use of these measures across groups and provide initial support for potential differences in this hypothesized mediator of racial-ethnic health disparities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Although dispositional optimism and pessimism are associated with cardiovascular disease (CVD), their relative independence and unique contributions to CVD risk are unclear. This study addressed these issues by using multiple indicators of optimism and pessimism and linking them to objective risk factors for CVD. A diverse sample of adults (N = 300) completed baseline assessments (including global reports of optimism and pessimism), a 2-day/1-night EMA protocol with ambulatory blood pressure (BP) at 45-minute intervals, and had inflammatory markers and carotid intima media imaging collected. EMA reports of momentary positive and negative expectations were averaged to form intraindividual (person) means of optimism and pessimism, respectively. Optimism and pessimism were only modestly correlated between- and within-assessment methods. Higher pessimism, regardless of assessment method, predicted both lower odds of whether BP dipping occurred and a smaller degree of dipping, but was unrelated to other biomarkers. Optimism was not uniquely predictive of CVD risk factors. Pessimism thus appears to exhibit stronger relative contribution to risk indicators of CVD than optimism.

Social support has been linked to lower cardiovascular morbidity and mortality. However, most studies have examined perceived support as an intrapersonal construct. A dyadic approach to social support highlights how interdependence between individuals within relationships, including partner perceptions and interactions, can influence one’s health. This study’s overall purpose was to test actor–partner models linking perceived social support to inflammation. Ninety-four cisgender married couples completed perceived support measures and had their blood drawn for CRP and IL-6 to produce an overall inflammatory index. The primary results indicate that only a partner’s level of perceived support was related to lower inflammation in their spouse. Our sample size, although moderate for inflammatory studies, was probably not large enough to detect actor influences. These data highlight the importance of taking a dyadic perspective on modeling perceived support and its potential mechanism.

IntroductionType 2 diabetes is prevalent among US adults. Lifestyle interventions that modify health behaviours prevent or delay progression to diabetes among individuals at high risk. Despite the well-documented influence of individuals’ social context on their health, evidence-based type 2 diabetes prevention interventions do not systematically incorporate participants’ romantic partners. Involving partners of individuals at high risk for type 2 diabetes in primary prevention may improve engagement and outcomes of programmes. The randomised pilot trial protocol described in this manuscript will evaluate a couple-based lifestyle intervention to prevent type 2 diabetes. The objective of the trial is to describe the feasibility of the couple-based intervention and the study protocol to guide planning of a definitive randomised clinical trial (RCT).Methods and analysisWe used community-based participatory research principles to adapt an individual diabetes prevention curriculum for delivery to couples. This parallel two-arm pilot study will include 12 romantic couples in which at least one partner (ie, ‘target individual’) is at risk for type 2 diabetes. Couples will be randomised to either the 2021 version of the CDC’s PreventT2 curriculum designed for delivery to individuals (six couples), or PreventT2 Together, the adapted couple-based curriculum (six couples). Participants and interventionists will be unblinded, but research nurses collecting data will be blinded to treatment allocation. Feasibility of the couple-based intervention and the study protocol will be assessed using both quantitative and qualitative measures.Ethics and disseminationThis study has been approved by the University of Utah IRB (#143079). Findings will be shared with researchers through publications and presentations. We will collaborate with community partners to determine the optimal strategy for communicating findings to community members. Results will inform a subsequent definitive RCT.Trial registration numberNCT05695170

Overvaluation of shape and weight (OSW) involves defining self-worth by body shape/weight. Among persons seeking bariatric surgery, cross-sectional studies have found associations between OSW, depressive symptoms, and disordered eating.Relationships among OSW, depressive symptoms, binge eating symptoms, and BMI were analyzed both cross-sectionally and over time among 145 adults who had bariatric surgery. Participants completed the following measures pre-surgery and 1.5 to 3 years post-surgery: Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale, Patient Health Questionnaire, and body weight and height. OSW was measured by averaging two items on the EDE-Q which ask participants to rate how much their weight/shape influences how they judge themselves as a person. Analyses included Wilcoxon signed-ranks, bootstrapped Pearson correlations, and bootstrapped hierarchical linear regressions.OSW was significantly associated with depressive symptoms and binge eating symptoms both pre- and post-surgery, but was not associated with BMI at either timepoint. Improvements in OSW were associated with concurrent changes in depression and binge eating; reductions in BMI were not significantly associated with changes in any of these variables.Findings suggest that self-evaluation is more important in regard to changes in depressive and binge eating symptoms than is BMI (and vice versa), and support the importance of assessing and treating psychological considerations among persons seeking bariatric surgery.

Single-dimension measures of marital quality can obscure distinct effects of positive and negative aspects of relationships. The present study extended evidence regarding the two-dimension relationship quality model generally, and the Quality of Relationship Inventory (QRI) Support and Conflict scales in particular, by examining associations with overall marital adjustment, represented continuously and as a discrete category of significant marital discord, and depressive symptoms, using younger, middle-aged and older couples. Using multilevel modeling (MLM), QRI Support and Conflict scales were independently associated with overall marital adjustment in the continuous and categorical analyses. As expected, QRI Conflict was more consistently associated with depressive symptoms than was QRI Support. Results were consistent across age and sex. Hence, the two-dimension model is applicable for continuous and more clinically relevant categorical representations of marital quality across adulthood, and the QRI Support and Conflict scales provide additional measures of positive and negative aspects of relationship quality.

Objective Minimally invasive cardiac surgery via a right minithoracotomy (RMT) is a common approach to different valve pathologies, tumor resection, and atrial septal defect (ASD) closure. We studied intraoperative field block using liposomal bupivacaine (LB) in these operations. Methods Consecutive 171 minimally invasive RMTs (fourth intercostal space) were studied, and patients in cardiogenic or septic shock, intravenous drug abuse, and those re-explored were excluded ( n = 12). An early cohort was treated with standard postoperative analgesia while another underwent intraoperative field block with LB immediately after incision. We compared postoperative pain level, narcotic utilization (morphine milligram equivalent), and intensive care unit (ICU) and hospital length of stay. Results The procedures included 48 isolated mitral valve replacements (MVR); 2 MVR with other procedures; 93 mitral valve repairs (MVRr); 9 MVRr with other procedures; 4 isolated tricuspid valve repairs; 2 myxoma resections; 1 ASD closure. There were 13 patients in the non-LB group and 146 patients in the LB group. Use of LB decreased mean postoperative narcotic utilization by 50% ( P = 0.003). The LB group had lower pain levels on postoperative day 1 ( P = 0.039), which continued through postoperative day 5 ( P = 0.030). We found no difference in ICU or hospital length of stay between groups. There were no complications from LB field block. Conclusions LB field block decreases postoperative pain and narcotic utilization after cardiac surgery via a RMT, but it does not reduce length of stay. The technique is safe and should be considered in all patients undergoing RMT cardiac surgery.

In this real-world analysis, patients with ulcerative colitis frequently required steroids up to a year after initiating immunosuppressant or biologic therapies, with high ulcerative colitis-related costs. This suggests an ongoing challenge in managing patients with moderate to severe ulcerative colitis., Background Ulcerative colitis (UC) treatment aims to induce response and maintain steroid-free remission. For patients with moderate to severe UC and/or nonresponse to conventional treatment, advanced therapies (immunosuppressants and biologics) are available. We assessed real-world effectiveness of advanced UC therapies. Methods This retrospective analysis of claims data included adult patients with UC initiating immunosuppressant or biologic therapy, with 12 months’ continuous enrollment pre- and postinitiation. Patients had no prescription for biologic therapy (and/or immunosuppressant if initiating immunosuppressant) in the previous 12 months. Proportion of patients remaining steroid-free (excluding 14-week tapering period), hospitalizations, and costs in the 12 months postinitiation were assessed. Results In total, 3562 patients were included in the analysis. Most patients (83.0%) used steroids in the 12 months before initiating advanced therapy. Overall, 47.8% remained steroid-free after 12 months (excluding tapering). After adjusting for patient characteristics, remaining steroid-free was significantly more likely with infliximab (43.9%) than with adalimumab (39.4%; P < 0.05); golimumab (38.2%) and vedolizumab (41.4%) were not significantly different vs adalimumab. Overall, 12.2% of patients had a UC-related hospitalization within 12 months of initiation, with a mean (SD) total length of stay of 8.2 (8.9) days and no significant differences between biologic therapies. Mean, unadjusted, UC-related costs in the 12 months postinitiation were $42,579 and were similar between therapies. Conclusions Patients with UC initiating advanced therapy frequently continued using steroids for at least a year. Some patients experienced extended UC-related hospitalizations, with high UC-related costs overall. This suggests an ongoing challenge in managing patients with moderate to severe UC.

Posttraumatic Stress Disorder (PTSD) is associated with difficulties in intimate relationships, with most prior research examining associations with continuous, single-dimension, and often-unstanda...

Individuals seeking bariatric surgery evidence risk for binge and disordered eating behaviors, which can lead to poorer post-surgical weight loss outcomes. Use of avoidant coping strategies to manage stress, along with symptoms of depression, are associated with disordered eating in the general population. However, the role of coping has not been examined among candidates for bariatric surgery, and coping and depression have rarely been considered in combination. Given the emerging standard that psychologists are involved in evaluations and treatment before and after surgery, consideration of these variables is clinically relevant. Participants were 399 patients undergoing pre-surgical bariatric psychological assessment. Hierarchical linear regression analyses tested whether gender, age, and BMI; approach and avoidance coping; and depression and anxiety were associated with disordered eating (binge eating, restraint, eating concerns, shape concerns, weight concerns) in a cross-sectional study design. In initial steps of the model controlling demographic variables, approach coping predicted less and avoidance coping predicted more disordered eating across most outcomes examined. In models including depression and anxiety, avoidance (but not approach) coping remained a relevant predictor. The effects of depression were also quite robust, such that participants who were more depressed reported more disordered eating. More anxious participants reported more restrained eating. Avoidance coping and depressive symptoms emerged as key variables in understanding recent disordered eating among patients considering bariatric surgery. Pre-surgical psychological evaluations and treatment approaches could be enhanced with consideration of patient coping strategies, particularly avoidant coping responses to stress, independent of psychological distress.

Objective: Despite its simplicity, single-item measures of self-rated health have been associated with mortality independent of objective health conditions. However, little is known about the mechanisms potentially responsible for such associations. This study tested the association between self-rated heath and inflammatory markers as biological pathways, and whether sleep quality and/or depression statistically mediated such links.Method: Eighty-six heterosexual married couples completed a standard measure of self-rated health, the Center of Epidemiological Studies-Depression Scale, and the Pittsburgh Sleep Quality Index. Participants also had blood drawn for determination of plasma levels of interleukin 6 and high-sensitivity C-reactive protein. The Monte Carlo method was used to construct confidence intervals for mediation analyses.Results: Results indicated that poor self-rated health was associated with higher CRP levels (B = .31, SE = .14, p = .028). Importantly, the Monte Carlo mediational analyses showed that these results were statistically mediated by sleep quality (aXb = 0.10, 95% confidence interval = 0.003 to 0.217) but not depressive symptoms (aXb = 0.03, 95% confidence interval = −0.03 to 0.10).Conclusions: These results highlight the biological and behavioral mechanisms potentially linking self-rated health to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.

Background Central sleep apnea (CSA) is a breathing disorder caused by the intermittent absence of central respiratory drive. Transvenous phrenic nerve stimulation is a new therapeutic option, recently approved by the FDA , for the treatment of CSA. Objective To describe the technique used to implant the transvenous phrenic nerve stimulation system (the remedē System, Respicardia, Inc). Methods The remedē System is placed in the pectoral region, typically on the right side. A single stimulation lead is placed in either the left pericardiophrenic vein (PPV) or the right brachiocephalic vein (RBC). A sensing lead is placed into the azygous vein to detect respiration. Results In the remedē System Pivotal trial, 147 of 151 (97%) patients were successfully implanted with the system. Sixty-two percent of stimulation leads were placed in the PPV and 35% in the RBC. Mean procedure time was 2.7 ± 0.8 hours and 94% of patients were free from implant-related serious adverse events through 6 months. Conclusion In patients with CSA, transvenous phrenic nerve stimulation is an effective and safe therapy with an implant procedure similar to that of cardiac implantable electronic devices.

Psoriatic arthritis (PsA) is a chronic, inflammatory disease. The effects of PsA real-world treatment patterns on patient-reported outcomes in the US and 5 European countries (EU5; France, Germany, Italy, Spain, UK) were evaluated. Respondents from the 2016 National Health and Wellness Survey received advanced therapies (e.g., biologic disease-modifying antirheumatic drugs [DMARDs]), other therapies, (e.g., conventional synthetic DMARDs), or no treatment. Assessments included demographics, disease severity (patient-reported), comorbidities (Charlson Comorbidity Index), health status (Short Form-36 Health Survey), depression (Patient Health Questionnaire-9), work productivity (Work Productivity and Activity Index), and treatment adherence (Morisky Medication Adherence Scale-8). Overall, 1037 respondents from the US and 947 respondents from the EU5 were included. Of these, 21.7% US and 7.3% EU5 respondents received advanced therapies; 16.6% and 28.5%, other therapies; and 61.7% and 64.2%, no treatment, respectively. During treatment with advanced or other therapies, 40.8–54.7% US and 57.7–58.9% EU5 respondents self-reported moderate or severe PsA. Respondents receiving advanced therapies had the highest Charlson Comorbidity Index score (US, 1.25; EU5, 1.42); the lowest scores were with no treatment (0.52 and 0.49, respectively). Employment was lowest with other therapies (US, 47.7%; EU5, 41.1%). Overall work impairment was reported by 57.9% US and 62.6% EU5 respondents receiving advanced therapies. Medication adherence was generally low in the US and medium in the EU5 (Morisky Medication Adherence Scale-8: low, US 40.1–46.7%, EU5, 29.0–35.2%; medium, US 29.3–36.1%, EU5 37.8–49.3%; high, US 23.8–24.0%; EU5, 21.7–27.0%). Advanced and other therapies reduced PsA severity; however, > 40% of respondents reported moderate or severe PsA during treatment. Better management and adherence may reduce unmet need and disease burden. Further work is required to improve PsA diagnosis and time to treatment initiation. Electronic supplementary material The online version of this article (10.1007/s00296-018-4195-x) contains supplementary material, which is available to authorized users.

OBJECTIVE: Research in psychosomatic medicine includes a long history of studying how responses to anger-provoking situations are associated with health. In the context of a marriage, spouses may differ in their anger-coping response style. Where one person may express anger in response to unfair, aggressive interpersonal interactions, his/her partner may instead suppress anger. Discordant response styles within couples may lead to increased relational conflict, which, in turn, may undermine long-term health. The current study sought to examine the association between spouses’ anger-coping response styles and mortality status 32 years later. METHODS: The present study used data from a subsample of married couples (N = 192) drawn from the Life Change Event Study to create an actor-partner interdependence model. RESULTS: Neither husbands’ nor wives’ response styles predicted their own or their partners’ mortality. Wives’ anger-coping response style, however, significantly moderated the association of husbands’ response style on mortality risk 32 years later, β = −0.18, −0.35 to −0.01, p = .039. Similarly, husbands’ response style significantly moderated the association of wives’ response style and their later mortality, β = −0.24, −0.38 to −0.10, p < .001. These effects were such that the greater the mismatch between spouses’ anger-coping response style, the greater the risk of early death. CONCLUSIONS: For a three-decade follow-up, husbands and wives were at greater risk of early death when their anger-coping response styles differed. Degree of mismatch between spouses’ response styles may be an important long-term predictor of spouses’ early mortality risk.