Emotion Regulation and Perceptions of Illness Coherence and Controllability on Regimen Adherence and Negative Cardiac Health Events in African American Women With Heart Failure

Background: African American women with heart failure (HF) have stressors that negatively impact HF self-management adherence and heighten the occurrence of negative cardiac health events. Perceptions of illness coherence and controllability and emotion regulation are known to facilitate self-management in the face of stressors. Objective: The aim of this study was to determine whether difficulties with emotion regulation and negative perceptions of illness coherence and controllability are detrimental to adherence and increase negative cardiac health events in this patient population. Methods: African American women (n = 54) with HF, aged 49 to 84 years, participated in this longitudinal descriptive correlational study. Using convenience sampling, we recruited patients from hospitals and HF clinics. They completed interviews at intake and 30 days, and their medical records were reviewed at 90 days. Linear and logistic regression models were used to assess predictors of general adherence and negative cardiac health events. Results: Of 54 patients who participated in the study, 28 experienced a negative health event during 90 days, and 57% of these events were cardiac related. The only clear predictor of these events was greater New York Heart Association functional classification (β = 1.47, P = .027). No associations were found between predictors (emotion regulation, controllability, coherence, age, education) and general adherence. Conclusions: Emotion regulation showed a possible greater impact on negative cardiac health events than on general adherence. Perceived illness coherence showed less impact on negative cardiac health events than on general adherence

Emotion Regulation in Chronic Disease Populations: An Integrative Review

Background and Purpose: Emotion regulation, the experiencing, processing, and modulating of emotional response, is necessary to manage the emotional stressors common in patients with chronic illness. Overwhelming emotional demands deplete the resources needed for everyday self-care management of chronic disease, contributing to poor health outcomes. Emotion regulation is shown to impact behaviors in healthy individuals; yet, a review of literature examining evidence of associations in chronically ill populations is lacking. The purpose of this article is to examine the state of the science relative to the impact of emotion regulation on health outcomes in chronic illness populations. Methods: Articles were reviewed (N = 14) that focused on emotion regulation and outcomes of patients with chronic illness. Results: Indicate that most of the studies focused on these concepts are cross-sectional and measure emotion regulation using various surveys. Potential relationships exist with increased age, male gender, higher education, decreased stress, depressive, and anxiety symptoms being associated with more adaptive emotion regulation. Of primary importance to patients with chronic illnesses is the potential link between greater difficulties with emotion regulation and the presence of chronic disease as well as poorer physical function. Implications for Practice: Care should include attention to affective regulation as well as physiologic responses of chronic illness

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Worry and cognitive representations of illness in cancer.

The study examined the impact of worry on formation of illness representations among individuals newly diagnosed with lung cancer. Worry, a cognitive process driven by anxiety and fears, is a common phenomenon among individuals with a new cancer diagnosis. Cognitive representations are learned knowledge structures that guide adjustment to the illness. Worry may influence the formation of cognitive representations of illness by biasing perceptions and facilitating formation of threat-laden representations that lead to further anxiety and poorer adjustment. The study examined relationships between: (1) worry and formation of cognitive representations of illness over time, and (2) selected patient and disease factors on worry and the cognitive representation of illness. A theoretical framework of person-environment compatibility from a cognitive map perspective was used. Forty-two volunteers (27 males, 15 females) aged 37 to 83 years, mean age 63.7 +/- 10.8, with confirmed and suspected lung cancer were assessed in the early post-diagnostic period, and about 3 to 4 weeks following surgery. Participants were tested with measures of worry (Penn State Worry Questionnaire, Cancer-Related Worry Questionnaire) and cognitive representation of illness (Conceptual Cognitive Map, Illness Perception Questionnaire) at both assessments. In addition, measures of social support, optimism, cognitive functioning, state-trait anxiety, and the illness experience were used. Correlation and regression analyses were used to determine relationships between worry measures and the cognitive representations of illness, and to determine possible covariates. Repeated measures ANOVA were used to determine changes in worry and representation of illness measures over time. The findings showed relationship between higher worry and negative dimensions of the cognitive representation of illness. The high worriers were more likely to have higher psychological and risk attributions, higher emotional distress, lower perceived personal and treatment control, and lower perceptions of illness coherence, in comparison to the low worriers over time. State anxiety predicted cancer-related worry, and trait anxiety predicted generalized worry. State anxiety, the illness experience, optimism, and cognitive functioning were predictors of dimensions of the cognitive representation. The findings have implications for design of nursing interventions aimed towards modifying worry and negative effects on the cognitive representation of illness in lung cancer.Ph.D.Health and Environmental SciencesNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/124238/2/3137873.pd

Relationships between Death Anxiety and Quality of Life in Iranian Patients with Cancer

Objective: The purpose of the study was to examine relationships between death anxiety and quality of life (QOL) parameters of patients with cancer in the Iranian sociocultural context. Methods: A descriptive, correlational methodology was used. The sample included 330 patients. Demographics, health information, religious behaviors, death anxiety, and QOL data were collected. Results: Overall death anxiety levels were moderate with satisfactory overall QOL. Death anxiety was predictive of lowered QOL. Female patients had lower QOL and higher death anxiety compared to men Conclusions: Findings support that higher death anxiety negatively impacts QOL in an Iranian sample with cancer. Alleviation of existential concerns in vulnerable patients may palliate mental health distress associated with facing cancer and its challenging treatments