Pain and functional impairment as mediators of the link between medical symptoms and depression in type 2 diabetes.

BACKGROUND: Among people with diabetes, depression is more common and is associated with greater morbidity and mortality. A better understanding of mechanisms underlying the link between poor health and depression is needed. Pain and functional impairment may account for the effect of poor health on depression in diabetes. PURPOSE: The purpose of the study was to examine whether pain and functional impairment mediate the association between diabetes-related medical symptoms and depression in type 2 diabetes. METHOD: Adults diagnosed with type 2 diabetes (N = 77) completed the following measures: Patient Health Questionnaire (PHQ), Diabetes Symptom Checklist (DSC), and Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Body mass index (BMI) was computed using height and weight data from medical records. Mediation and linear regression analyses were conducted. RESULTS: Pain and functional impairment made significant, independent contributions to depression. Functional impairment mediated the link between diabetes-related medical symptoms and depression. Pain mediated the association between higher BMI and depression. CONCLUSION: Pain and functional impairment appear to play important, independent roles in depression in type 2 diabetes. Mediation analyses suggest the following: 1. diabetes-related medical problems increase functional impairment, which in turn leads to greater depression; and 2. the burden of carrying greater body mass (higher BMI) increases pain, which leads to increased depression.

Educational attainment moderates the effect of a brief diabetes self-care intervention.

AIMS: Those with less education are at increased risk for developing diabetes and have a poorer prognosis. Intensive diabetes self-care interventions have been more effective at improving glycemic control in those with lower educational attainment. Due to limited resources, the focus has shifted to brief, cost-effective health interventions. This study examined whether educational attainment moderates the effect of a brief, telephone delivered self-care intervention on glycemic control in people with type 2 diabetes. METHODS: Randomized clinical trial. Participants (N=62) were assigned to receive treatment as usual or treatment as usual plus a brief telephone intervention. The primary outcome measure was hemoglobin A1c. RESULTS: A significant education by intervention group interaction effect indicated that participants with higher educational attainment had greater improvement in glycemic control (A1c) than those with less educational attainment; whereas, educational attainment was unrelated to change in glycemic control (A1c) within the control group. CONCLUSIONS: People with higher educational attainment may benefit to a greater extent from brief self-care interventions for diabetes, while those with lower educational attainment may require more intensive treatment.

Excretion and perception of a characteristic odor in urine after asparagus ingestion: a psychophysical and genetic study.

The urine of people who have recently eaten asparagus has a sulfurous odor, which is distinct and similar to cooked cabbage. Using a 2-alternative forced-choice procedure, we examined individual differences in both the production of the odorants and the perception of this asparagus odor in urine. We conclude that individual differences exist in both odorant production and odor perception. The biological basis for the inability to produce the metabolite in detectable quantities is unknown, but the inability to smell the odor is associated with a single nucleotide polymorphism (rs4481887) within a 50-gene cluster of olfactory receptors.

Depression and hemoglobin A1c in type 1 and type 2 diabetes: the role of self-efficacy.

AIMS: To examine a self-efficacy explanation of the finding that depression is related to hemoglobin A1c (A1c) level in people with type 1 but not type 2 diabetes. METHODS: Cross-sectional design involving 124 participants with type 1 (n=32) and type 2 (n=92) diabetes. Participants completed measures of depression and diabetes-related self-efficacy. A1c was obtained from medical records. RESULTS: Replicating prior findings, A1c was significantly correlated with depression in type 1 participants (r=.51, p<.01), but not in type 2 participants (r=.11, ns). As hypothesized, A1c was significantly correlated with self-efficacy among type 1 participants (r=-.42, p<.05) but not among type 2 participants (r=-.01, ns). Self-efficacy also mediated the effect of A1c on depression among the type 1 participants (Z=2.21, p<.05). CONCLUSION: In people with type 1, but not type 2 diabetes, A1c levels are related to diabetes adherence mastery (self-efficacy), which mediates the link between A1c and depression. Results are discussed with regard to the proposal that perceptions of ineffective control over one's health play a role in the development of depression (a consequence model of depression in diabetes).

Salivary measures of stress and immunity in police officers engaged in simulated critical incident scenarios.

OBJECTIVE: This research investigated the effects of a critical incident lethal force scenario on a panel of salivary biomarkers, measured at baseline and then at 10 and 30 minutes postscenario, in 141 law enforcement volunteer officers. METHODS: Officers were randomly assigned to two virtual reality scenarios. One scenario was brief and involved a police officer chasing a suspect on a motorcycle, confronting the suspect who draws a gun and shoots the police officer. The other scenario involved a lengthy chase by the police officer through a workplace of an armed perpetrator ultimately engaging in gunfire with the police officer. Saliva was analyzed for cortisol, secretory immunoglobulin A (sIgA), interleukin-6, and alpha-amylase concentrations. RESULTS: The "workplace" scenario produced the largest responses in biomarkers, with significant rises in cortisol, interleukin-6, alpha-amylase, and secretory immunoglobulin A. These data suggest that virtual reality can produce stress and immune effects. CONCLUSIONS: This research suggests that virtual reality scenarios produce physiologic stress responses, mimicking occupational stress.