ABSTRACT
BACKGROUND: Nonadherence to treatment recommendations is a leading preventable cause of rehospitalization and premature mortality in chronic heart failure (HF) patients. PURPOSE: This study examined whether self-efficacy mediates the contributions of social support and depression to treatment adherence. METHODS: A sample of 252 HF outpatients with a mean age of 54 years completed self-report questionnaires assessing depression, perceived social support, self-efficacy, and treatment adherence. RESULTS: Self-efficacy mediated the associations of social support and depression with treatment adherence after adjusting for demographic (age, gender, marital status, education, and ethnicity) and medical (New York Heart Association Classification and comorbidity) covariates. CONCLUSION: Self-efficacy explains the influence of social support and depression on treatment adherence and may be a key target for interventions to improve disease management and self-care behaviors in HF patients.
Subject(s)
Depression/complications , Depressive Disorder/complications , Heart Failure/therapy , Patient Compliance/psychology , Self Efficacy , Social Support , Adaptation, Psychological , Adult , Aged , Depression/psychology , Depressive Disorder/psychology , Female , Heart Failure/complications , Heart Failure/psychology , Humans , Male , Middle Aged , Self Care , Surveys and QuestionnairesABSTRACT
The relationships among stress, obesity, and inflammation in women remain unclear. This study examined the relationships among marital stress, waist circumference, and C-reactive protein (CRP) in 201 healthy women from the Stockholm Female Coronary Risk Study. We tested whether marital stress was associated with CRP and whether this association was moderated by waist circumference. Hierarchical multiple regression revealed that after adjusting for age, occupation status, fasting glucose, apolipoprotein A1, apolipoprotein B, blood pressure, smoking, and menopausal status, marital stress was not directly associated with CRP. However, waist circumference significantly moderated the association between marital stress and CRP (p = 0.012) such that marital stress was significantly associated with higher CRP among women with larger waist circumferences but not in those with smaller waists. More obese women may be particularly vulnerable to the effects of marital stress by manifesting higher inflammation.
Subject(s)
C-Reactive Protein/metabolism , Family Conflict , Obesity/blood , Waist Circumference , Blood Pressure , Female , Humans , Inflammation/blood , Middle Aged , Regression Analysis , Risk Factors , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The objective of this study was to determine maternal hormonal and metabolic factors associated with insulin sensitivity in human pregnancy. RESEARCH DESIGN AND METHODS: This was a prospective observational cross-sectional study of 180 normal pregnant women, using samples collected at the time of a blinded oral glucose tolerance test (OGTT) between 24 and 32 weeks' gestation as an ancillary to the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. The study was conducted at two public university teaching hospitals, Cleveland, Ohio, and Brisbane, Australia. Fasting maternal serum cholesterol, triglycerides, free fatty acids, insulin, leptin, tumor necrosis factor-alpha, placental growth hormone (PGH), insulin-like growth factors (IGFs) 1 and 2, and insulin-like growth factor binding proteins (IGFBPs) 1 and 3 were assayed. Correlation and multiple regression analyses were used to determine factors associated with maternal insulin sensitivity (IS) estimated using both OGTT-derived (IS(OGTT)) and fasting (using the homeostasis model assessment [HOMA]; IS(HOMA)) insulin and glucose concentrations. RESULTS: Insulin sensitivity correlated (r = x and y for IS(OGTT) and IS(HOMA,) respectively) with fasting maternal serum leptin (-0.44 and -0.52), IGFBP1 (0.42 and 0.39), and triglycerides (-0.31 and -0.27). These factors were significantly associated with insulin sensitivity in multiple regression analyses (adjusted R(2) 0.44 for IS(OGTT) and IS(HOMA)). These variables explained more than 40% of the variance in estimates of insulin sensitivity. CONCLUSIONS: Maternal hormonal and metabolic factors related to the placenta, adipose tissue, and the growth hormone axis are associated with the variation in insulin sensitivity seen during normal human pregnancy.
