Regulating the effects of depletion through monitoring

A robust finding is that participants who perform a depleting initial self-regulatory task are less persistent on a contiguous second task than are those who perform a less arduous initial self-regulatory task. We explain this regulatory depletion effect in terms of a monitoring process. According to this view, depleted individuals focus on the resources they have devoted to a second task, neglect to monitor their performance against their standards for such activities, and prematurely suspend their performance. Consistent with this view, we demonstrate that the regulatory depletion effect can be eliminated when individuals are encouraged to monitor their performance against some standard (Studies 1, 2, and 4) or when they have a proclivity to engage in such monitoring (Studies 3 and 4). © 2008 by the Society for Personality and Social Psychology, Inc.postprin

Spirituality, religion and health: evidence and research directions

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146567/1/mja201040.pd

Assessment of Barriers to Improve Diabetes Management in Older Adults: A randomized controlled study

OBJECTIVE To evaluate whether assessment of barriers to self-care and strategies to cope with these barriers in older adults with diabetes is superior to usual care with attention control. The American Diabetes Association guidelines recommend the assessment of age-specific barriers. However, the effect of such strategy on outcomes is unknown. RESEARCH DESIGN AND METHODS We randomized 100 subjects aged ≥69 years with poorly controlled diabetes (A1C >8%) in two groups. A geriatric diabetes team assessed barriers and developed strategies to help patients cope with barriers for an intervention group. The control group received equal amounts of attention time. The active intervention was performed for the first 6 months, followed by a “no-contact” period. Outcome measures included A1C, Tinetti test, 6-min walk test (6MWT), self-care frequency, and diabetes-related distress. RESULTS We assessed 100 patients (age 75 ± 5 years, duration 21 ± 13 years, 68% type 2 diabetes, 89% on insulin) over 12 months. After the active period, A1C decreased by −0.45% in the intervention group vs. −0.31% in the control group. At 12 months, A1C decreased further in the intervention group by −0.21% vs. 0% in control group (linear mixed-model, P < 0.03). The intervention group showed additional benefits in scores on measures of self-care (Self-Care Inventory-R), gait and balance (Tinetti), and endurance (6MWT) compared with the control group. Diabetes-related distress improved in both groups. CONCLUSIONS Only attention between clinic visits lowers diabetes-related distress in older adults. However, communication with an educator cognizant of patients’ barriers improves glycemic control and self-care frequency, maintains functionality, and lowers distress in this population

Religious Participation and DSM IV Major Depressive Disorder Among Black Caribbeans in the United States

This study examines the relationship between religious involvement and 12-month and lifetime DSM-IV major depressive disorder (MDD) within a nationally rep- resentative sample of Black Caribbean adults. MDD was assessed using the DSM-IV World Mental Health Com- posite International Diagnostic Interview (WMH-CIDI). Religious involvement included measures of religious coping, organizational and nonorganizational involvement, and subjective religiosity. Study findings indicate that religious involvement is associated with 12-month and lifetime prevalence of MDD. Multivariate relationships between religious involvement and MDD indicate lower prevalence of 12-month and lifetime MDD among persons who use religious coping and characterize themselves as being religious (for lifetime prevalence only); persons who frequently listen to religious radio programs report higher lifetime MDD. Lower rates of 12-month and lifetime MDD are noted for persons who attend religious services at least once a week (as compared to both higher and lower levels of attendance), indicating a curvilinear relationship. The findings are discussed in relation to previous research on religion and mental health concerns, conceptual models of the role of religion in mental health (e.g., prevention, resource mobilization) that specify multiple and often divergent pathways and mechanisms of religious effects on health outcomes, and the role of religion among Caribbean Blacks.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107411/1/Religious Participation and DSM IV Major Depressive Disorder Among Black Caribbeans in the United States.pdfDescription of Religious Participation and DSM IV Major Depressive Disorder Among Black Caribbeans in the United States.pdf : Main articl

The Social Determinants of Health Disparities: The Role of Social and Temporal Contexts.

The goal of this dissertation is to examine contextual determinants of racial disparities in health across the life course. I progress from “downstream” to “upstream” processes by focusing in one chapter on the prenatal context, in another on health behaviors and family context, and in the third, on the neighborhood context. Chapter 2 examines the relationship between lifetime exposure to abuse among pregnant women in the Boston area and elevated cord blood IgE. Results demonstrate that greater exposure to violence throughout the mother’s life course is associated with increased risk of offspring elevated IgE at birth, after adjusting for maternal and family-level confounders. Abuse occurring more proximate to pregnancy is not correlated with elevated cord blood IgE, suggesting that the cumulative exposure to violence (i.e., chronic abuse) may have the most salient fetal effects. The results indicate that the detrimental effects of violence may a) accumulate over the life course and b) transmit across generations through the fetal environment. Chapter 3 explores the intergenerational transmission of disadvantage by examining the relationship between teen childbearing and offspring health among a nationally representative sample of children ages 5-19. Logistic regressions reveal no increased risk of low birthweight, chronic illness, obesity or asthma among offspring of teens versus non-teens and a slight decrease in obesity among offspring of teens, suggesting that the timing of one’s pregnancy may matter less than other contextual factors in influence offspring health. Chapter 4 uses multilevel methods to investigate the extent to which one’s residential environment is linked to currently active asthma. No association is found between neighborhood sociodemographic factors and asthma. Random-slope models demonstrate significant effects of affluence and immigrant concentration for non-blacks; however, the unexpected direction of the coefficients and the small sample size call into question the reliability and validity of these findings. Emerging from these three studies is a complex picture of how contextual factors may affect health disparities. The findings confirm the value of incorporating social contexts in studying health disparities, while underscoring the pitfalls in overlooking the diversity in age, ethnicity, life stage, and health outcomes within such research.Ph.D.Public Policy & SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/64666/1/mjste_1.pd

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.