Perseverative Cognition and Health Behaviors: A Systematic Review and Meta-Analysis

Recent developments in stress theory have emphasized the significance of perseverative cognition (worry and rumination) in furthering our understanding of stress-disease relationships. Substantial evidence has shown that perseverative cognition (PC) is associated with somatic outcomes and numerous physiological concomitants have been identified (i.e., cardiovascular, autonomic, and endocrine nervous system activity parameters). However, there has been no synthesis of the evidence regarding the association between PC and health behaviors. This is important given such behaviors may also directly and/or indirectly influence health and disease outcomes (triggered by PC). Therefore, the aim of the current review was to synthesize available studies that have explored the relationship between worry and rumination and health behaviors (health risk: behaviors which, if performed, would be detrimental to health; health promoting: behaviors which, if performed, would be beneficial for health). A systematic review and meta-analyses of the literature were conducted. Studies were included in the review if they reported the association between PC and health behavior. Studies identified in MEDLINE or PsycINFO (k = 7504) were screened, of which 19 studies met the eligibility criteria. Random-effects meta-analyses suggested increased PC was generally associated with increased health risk behaviors but not health promoting behaviors. Further analyses indicated that increases in rumination (r = 0.122), but not reflection (r = -0.080), or worry (r = 0.048) were associated with health risk behaviors. In conclusion, these results showed that increases in PC are associated with increases in health risk behaviors (substance use, alcohol consumption, unhealthy eating, and smoking) that are driven primarily through rumination. These findings provide partial support for our hypothesis that in Brosschot et al.'s (2006) original perseverative cognition hypothesis, there may be scope for additional routes to pathogenic disease via poorer health behaviors

Stress, Perseverative Cognition and Health Behaviours

Perseverative cognition (PC) is the repeated activation of stress-related cognitions (including worry and rumination). The Perseverative Cognition Hypothesis (PCH) posits that, in the same way as stress, PC damages health via its ensuing physiological activation. The central proposal of this thesis is that, like stress, PC may influence health via an indirect, behavioural pathway, termed the Extended PCH (EPCH). The principal aim was therefore to investigate the association between PC and health behaviours (HBs) and to investigate how PC interacts with stress in predicting HBs. Meta-analyses of 19 studies suggested an association between PC and increased health-risk behaviours (Chapter 2), and between PC and poorer sleep across 55 studies (Chapter 3). Associations between stress, PC and HBs were assessed via survey (Chapter 4). Associations emerged between worry and rumination (brooding and reflection) and some health-risk behaviours, cross-sectionally and prospectively. Brooding predicted more snacking at low-medium stress levels, but there was no relationship during high stress. A diary study (Chapter 5) revealed that components of PC predict both health-risk and health-promoting behaviours and interact with daily hassles to contribute to HBs, including unhealthy snacking, sleep and physical activity. Partial support was found for the EPCH. PC predicts some detrimental HBs but there were some contradictory findings and associations differed across types of PC (worry, brooding, reflection, state vs trait) and HBs and across measurement timeframes for stress and HBs. Therefore, the model may be more complex than originally conceptualised. There are remaining questions pertaining to the EPCH. Primarily, future research should (1) test causation, (2) assess bi-directional associations between PC and HBs, (3) improve measurement specificity of PC and, (4) test PC interventions on HBs. This thesis provides a testable theoretical framework in which to assess associations between stress, PC and HBs and contributes to our understanding of these associations

How effective are interventions in improving dietary behaviour in Low and Middle Income countries? A systematic review and meta-analysis.

Several interventions encouraging people to change their diet have been tested in low- and middle-income countries (LMICs) but these have not been meta-synthesised and it is not known which elements of these interventions contribute to their effectiveness. The current review addressed these issues. Randomized controlled trials of dietary interventions in LMICs were eligible and identified via 8 publication databases. Elements of both the intervention and comparison groups (e.g., behaviour change techniques (BCTs), delivery mode), participant characteristics and risk of bias were coded. Random effects meta-analysis of 76 RCTs found, on average, small- to medium-sized but highly heterogeneous improvement in dietary behaviour following intervention. Small and homogeneous improvements were found for BMI/weight, waist- and hip-circumference, with medium-sized, but heterogeneous, improvements in blood pressure and cholesterol. Although many BCTs have yet to be tested in this context, meta-regressions suggested some BCTs (action planning, self-monitoring of outcome(s) of behaviour; demonstration of behaviour) as well as individually-randomized trials, adult- or hypertensive-samples and lack of blinding were associated with larger dietary behaviour effect sizes. Interventions to encourage people from LMICs to change their diet produce, on average, small-to-medium-sized effects. These effects may possibly be increased through the inclusion of specific BCTs and other study elements

Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study

OBJECTIVE: To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG). STUDY DESIGN: We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks postmenstrual age with clinically suspected seizures and/or electrographic seizures. Subjects were assessed between January 2013 and April 2015 at seven U.S. tertiary care pediatric centers following American Clinical Neurophysiology Society (ACNS) guidelines for cEEG for at risk neonates. Seizure etiology, burden, management and outcome were determined by chart review using a case report form designed at study onset. RESULTS: The most common seizure etiologies were hypoxic-ischemic encephalopathy (38%), ischemic stroke (18%), and intracranial hemorrhage (11%). Seizure burden was high, with 59% having ≥7 electrographic seizures and 16% having status epilepticus; 52% received ≥2 anti-seizure medications. During the neonatal admission, 17% died; 49% of survivors had abnormal neurological examination at hospital discharge. In an adjusted analysis, high seizure burden was a significant risk factor for mortality, length of hospital stay, and abnormal neurological examination at discharge. CONCLUSIONS: In this large contemporary profile of consecutively enrolled newborns with seizures treated at centers using cEEG per ACNS guidelines, about half had high seizure burden, received ≥2 anti-seizure medications, and/or died or had abnormal examination at discharge. Higher seizure burden was associated with increased morbidity and mortality. These findings underscore the importance of accurate determination of neonatal seizure frequency and etiology, and a potential for improved outcome if seizure burden is reduced