Biomedical subjects

Ilene C Siegler

Publications and source records attributed to Ilene C Siegler.

At least 19 recordsLinked to original sources

PubMed2006

Associations among perceptions of social support, negative affect, and quality of sleep in caregivers and noncaregivers.

The authors used structural equation modeling to examine associations among perceptions of negative affect, social support, and quality of sleep in a sample of caregivers (n = 175) and noncaregiver control participants (n = 169). The authors hypothesized that caregiver status would be related to sleep quality directly and also indirectly by way of negative affect and social support. This hypothesis was partially supported in that caregiving was found to be indirectly related to sleep quality. However, after accounting for the indirect effects of negative affect and social support, the direct effect of caregiving on sleep quality was no longer statistically significant. The structural model accounted for approximately 43% of the variance in sleep quality. The present findings may be useful in the development of successful sleep interventions for caregivers.

Affect↗

PubMed2006

Prospective associations between sedentary lifestyle and BMI in midlife.

OBJECTIVE: A strong positive cross-sectional relationship between BMI and a sedentary lifestyle has been consistently observed in numerous studies. However, it has been questioned whether high BMI is a determinant or a consequence of a sedentary lifestyle. RESEARCH METHODS AND PROCEDURES: Using data from four follow-ups of the University of North Carolina Alumni Heart Study, we examined the prospective associations between BMI and sedentary lifestyle in a cohort of 4595 middle-aged men and women who had responded to questionnaires at the ages of 41 (standard deviation 2.3), 44 (2.3), 46 (2.0), and 54 (2.0). RESULTS: BMI was consistently related to increased risk of becoming sedentary in both men and women. The odds ratios of becoming sedentary as predicted by BMI were 1.04 (95% confidence limits, 1.00, 1.07) per 1 kg/m(2) from ages 41 to 44, 1.10 (1.07, 1.14) from ages 44 to 46, and 1.12 (1.08, 1.17) from ages 46 to 54. Controlling for concurrent changes in BMI marginally attenuated the effects. Sedentary lifestyle did not predict changes in BMI, except when concurrent changes in physical activity were taken into account (p < 0.001). The findings were not confounded by preceding changes in BMI or physical activity, age, smoking habits, or sex. DISCUSSION: Our findings suggest that a high BMI is a determinant of a sedentary lifestyle but did not provide unambiguous evidence for an effect of sedentary lifestyle on weight gain.

Adult↗

PubMed2006

Prediction of all-cause mortality by the Minnesota Multiphasic Personality Inventory Optimism-Pessimism Scale scores: study of a college sample during a 40-year follow-up period.

OBJECTIVE: To examine a measure of explanatory style, the Optimism-Pessimism (PSM) scale derived from college-entry Minnesota Multiphasic Personality Inventory scores, as a predictor of all-cause mortality. SUBJECTS AND METHODS: A total of 7007 students entering the University of North Carolina at Chapel Hill completed the Minnesota Multiphasic Personality Inventory during the mid-1960s. Of those students, 6958 had scores on the PSM scale and data for all-cause mortality through 2006. Scores on the PSM scale were evaluated as predictors of mortality using the Cox proportional hazards regression model, adjusted for sex. During the 40-year follow-up period, 476 deaths occurred. RESULTS: Pessimistic individuals who scored in the upper tertile of the distribution had decreased rates of longevity (hazard ratio, 1.42; 95% confidence Interval, 1.13-1.77) compared with optimistic individuals who scored in the bottom tertile of the distribution. CONCLUSION: In a model that adjusted only for sex, a measure of optimistic vs pessimistic explanatory style was a significant predictor of survival during a 40-year follow-up period such that optimists had Increased longevity.

Female↗

PubMed2005

Hostility, age, and mortality in a sample of cardiac patients.

This study examined hostility as a predictor of survival in a sample of 1,328 patients who had documented coronary artery disease. After controlling for disease severity, there was a significant interaction between age and hostility. Hostility was significantly associated with poorer survival but only in younger (<61.2 years) patients.

Age Factors↗

PubMed2005

Ratings of positive and depressive emotion as predictors of mortality in coronary patients.

BACKGROUND: An extensive body of research has demonstrated an association between negative affective states and health outcomes. Positive emotions may also influence physical health, however, their examination has received far less attention. METHODS: Positive and depressive emotion ratings were examined as independent and joint predictors of survival in a sample of 866 cardiac catheterization patients. The mean follow-up was 11.4 years, during which 415 deaths occurred. The mean age of the sample was 60.3 years and 74.3% of the sample were males. RESULTS: Both positive and depressive ratings were associated with survival (hazard ratio=0.80, 95% CI=0.66-0.97, p<0.025 and hazard ratio=1.32, 95% CI=1.13-1.54, p<0.001, respectively), adjusted for risk factors. Positive emotion ratings were no longer significantly related to mortality when the two emotion measures were simultaneously included in a survival model. CONCLUSION: The current findings are consistent with a theory that suggests that the relation between positive emotion and mortality may be partly mediated by depressive emotion.

Coronary Disease↗

PubMed2005

Initiation and discontinuation of hormone therapy for menopausal symptoms: results from a community sample.

Factors related to initiation and discontinuation of hormonal therapy (HT) for treatment of menopausal symptoms were examined in a community sample of 533 peri/postmenopausal women aged 45-54 by telephone three times. Over 40 variables including: sociodemographic characteristics, clinical reasons to start HT use, HT contraindications, HT attitudes/knowledge, and health behaviors were examined in logistic regression models comparing women who discontinued HT to women who continued using HT over 9 months (discontinuers) and women who initiated HT versus women who never used HT over 9 months (initiators). Increased understanding of HT, confidence, mental health symptoms, perception that menopause is natural, and having gynecological surgery were related to decreased likelihood of HT discontinuation. Increased understanding about risks of HT, vasomotor symptoms, mood symptoms, and having gynecological surgery were related to increased likelihood of HT Initiation. These findings highlight the importance of physicians discussing HT with their patients, particularly because of recent clinical trial developments.

Communication↗

PubMed2005

Does personality at college entry predict number of reported pain conditions at mid-life? A longitudinal study.

UNLABELLED: The purpose of this study was to evaluate whether personality traits, as assessed by the Minnesota Multiphasic Personality Inventory (MMPI), at time of college entry can predict the number of reported pain conditions at an approximate 30-year follow-up for 2332 subjects, 1834 men and 498 women, who were administered the MMPI on entry to the University of North Carolina (Chapel Hill) between 1964 and 1966. In 1997, a follow-up was conducted in which subjects were administered a self-report questionnaire regarding whether they had experienced 1 or more chronic pain conditions. Analyses of the relationship between the MMPI clinical scales at college entrance and the report of number of chronic pain conditions at follow-up were conducted. Among male participants, elevations of Scales 1 (Hypochondriasis), 3 (Hysteria), and 5 (Masculinity/Femininity) predicted increases in number of chronic pain conditions at follow-up. For female participants, elevations in Scales 1, 3, and 6 (Paranoia) predicted increases in number of chronic pain conditions at follow-up. The current study suggests that a statistically significant relationship exists between MMPI responses at college entry and reports of chronic pain conditions at mid-life. PERSPECTIVE: This study found a small, but significant relationship between elevations on MMPI scales measuring hypochondriasis and hysteria and the report of chronic pain conditions at follow-up. The study is important because it is the first to examine how personality assessed in younger adults relates to the number of chronic pain conditions reported 30 years later.

Adult↗

PubMed2005

Psychophysiological mediators of caregiver stress and differential cognitive decline.

The authors examined relationships between chronic stress and cognitive decline and whether such relationships were mediated by psychophysiological factors. Ninety-six caregivers of spouses with Alzheimer's disease (AD) were compared with 95 similar noncaregiver spouses. All were free of diabetes. Although the groups started similarly, over 2 years caregivers declined by a small but significant amount (1 raw score point and 4 percentile points, each p<.05) on Shipley Vocabulary. In contrast, noncaregivers did not change. Higher hostile attribution (beta=-.09; p<.05) and metabolic risk (beta=-.10; p<.05) in caregivers mediated the cognitive decline. This is the first study of cognitive decline and mediators in caregivers. This work has implications for caregiver and care-recipient health and for research on cognition, psychophysiology, diabetes, and AD.

Aged↗

PubMed2005

Effect of race on cultural justifications for caregiving.

OBJECTIVE: Our objective in this study was to explore the effects of caregiver characteristics on cultural reasons given for providing care to dependent elderly family members. METHODS: The sample included 48 African American and 121 White caregivers. Using multivariate analyses, we used caregiver characteristics (e.g., race, gender, education) to predict scores on the Cultural Justifications for Caregiving Scale (CJCS). RESULTS: Confirmatory factor analysis showed that the CJCS was appropriate for both African American and White caregivers. African Americans had stronger cultural reasons for providing care than Whites, education levels were inversely related to CJCS scores, and the influences of gender and age on cultural reasons were moderated by race. Compared to females, African American males had lower CJCS scores, whereas White males had higher CJCS scores. Younger as compared to older White caregivers had higher CJCS scores. DISCUSSION: This study supports the long-standing cultural tradition of African American families providing care to dependent elders. Cultural reasons for caregiving need to be interpreted within the context of race and gender socialization. Social roles, such as husband or wife, son or daughter, can also help determine how individuals within a particular cultural group experience cultural expectations and obligations. Information from this study can inform culturally appropriate caregiving interventions.

Black or African American↗

PubMed2004

Prospective study of perceived stress in cardiac patients.

BACKGROUND: Psychological stress is known to have a negative effect on the health and well-being of coronary artery disease (CAD) patients. Although the study of stress CAD samples has received considerable attention, few studies have examined the effects of gender and age, had multiple follow-ups over an extended period, and had extensive baseline assessment batteries. PURPOSE: In this study, demographic, clinical, social, and personality variables were evaluated as predictors of nine repeated assessments of stress over a 2-year period in 322 CAD patients (33.2% female). METHODS: At baseline, perceived social support, coping style, and social conflict were associated with stress ratings. Mixed models were used to evaluate predictors of reported stress during the subsequent 2 years. RESULTS: The results showed that higher stress was present in patients who were female and young. Follow-up stress was also found in patients with moderate income, congestive heart failure, high social conflict, low social support, and negative coping style. CONCLUSIONS: These findings may help clinicians identify patients who are likely to experience higher levels of stress over a prolonged period following a diagnosis of CAD and may also suggest which patients may benefit most from stress reduction interventions.

Adaptation, Psychological↗

PubMed2003

Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease.

It has been suggested that one of the mechanisms linking depression with elevated mortality risk is the association between depressive symptoms and other established coronary artery disease (CAD) risk factors, such as smoking and failure to exercise. The present study examined this hypothesis using repeated assessments of smoking and exercise from patients with CAD in whom depressive symptoms had been shown to predict decreased survival. Initially, associations between depressive symptoms and the risk factors of smoking and sedentary behavior were assessed. Next, patterns of smoking and sedentary behavior were examined as mediators and/or moderators of the association between depressive symptoms and mortality. Depressive symptoms were positively related to smoking (p <0.01) and sedentary behavior (p <0.01). Depressive symptoms, smoking, and sedentary behavior were independent predictors of mortality. Results indicated that smoking and/or sedentary behavior may partially mediate the relation between depressive symptoms and mortality. No evidence for moderation was found.

Age Distribution↗

PubMed2003

Community recruitment process by race, gender, and SES gradient: lessons learned from the Community Health and Stress Evaluation (CHASE) Study experience.

Recruitment of community participants for clinical research studies is a challenging task. When possible, community-based recruitment efforts should involve members of the targeted community in the planning, community preparation, and actual recruitment process. It becomes even more difficult to recruit study participants from the community when the research involves an invasive procedure, or when diverse target groups require that a variety of recruitment methods be used. The Community Health and Stress Evaluation (CHASE) Study was designed to determine the role of psychosocial and biobehavioral factors in the etiology of coronary heart disease. It involved both an invasive medical procedure (a spinal tap) and the collection of survey and medical information from Black and White persons in different socioeconomic status (SES) groups. Interestingly, we experienced the greatest difficulty in recruiting lower SES white persons, while groups that typically are "difficult to find" (such as Blacks) were actually easiest to recruit for the study. This paper describes the background of the CHASE study, the community recruitment methods used, and the results of the recruitment efforts by race, gender and SES gradient. We present an evaluation of the community recruitment component, why we think differences occurred, and the lessons learned from the experiences that may be applied to similar studies.

Clinical Trials as Topic↗

PubMed2003

Another round in the mammography controversy.

PURPOSE: The October 2001 publication of a meta-analysis questioning the scientific basis for recommending screening mammography sparked yet a new flame of controversy about this issue. We conducted a national survey in March 2002 to provide information about women's perspectives on the issues, including the evidence regarding the efficacy of mammography and, ultimately, their intentions to continue screening. METHODS: We added 12 questions to a national telephone omnibus survey in March 2002 to assess women's reactions to the ongoing debate. Responses were collected over three waves of the twice-weekly survey to obtain data from 733 women between the ages of 40 and 69. The sample was weighted to the U.S. population for census region, age, race, ethnicity, and educational attainment. RESULTS: Consistent with prior studies, most women were getting regular mammograms (78%) (95% confidence interval [CI] 75%-81%), >90% believed that mammography is effective in detecting breast cancer (95%) (95% CI 93%-97%) and in reducing breast cancer mortality (93%) (95% CI 91%-96%), and only about 22% (95% CI 19%-25%) said they were confused. Logistic regression analyses revealed sociodemographic differences among women who had heard about the controversy and who reported some confusion about mammograms. Women with lower levels of education, younger women, and those residing in nonmetropolitan areas were significantly less likely to be aware of the controversy. Although a majority of women said they were not confused about mammography, minority women and women with lower education levels were more likely to report being confused. There were no significant demographic differences in intentions to get future mammograms. Women who were concerned about getting breast cancer were much more likely to be planning to have future mammograms than women who were not at all concerned (odds ratio [OR] 3.63; 95% CI 2.37, 5.56). Likewise, respondents who said that they had enough information to make decisions whether to get future mammograms were much more likely to plan on getting screened than women who said they did not have enough information (OR 2.47; 95% CI 1.14, 5.40). CONCLUSIONS: These results do not suggest that controversy leads to lower rates of adherence. They do indicate that some women lack the information needed to make informed decisions about mammography.

Adult↗

PubMed2003

Associations among the NEO Personality Inventory, Revised and the serotonin transporter gene-linked polymorphic region in elders: effects of depression and gender.

OBJECTIVE: The short variant of the serotonin transporter gene-linked functional polymorphic region (5-HTTLPR) has been associated with personality traits related to anxiety, hostility, and depression. We attempted to replicate findings suggesting a positive relation between the short allele variant of 5-HTTLPR and Neuroticism, and a negative association between the short allele variant and Agreeableness. METHODS: Participants in the present study were 103 geriatric depressed patients and 99 non-depressed age matched controls. Depression status and gender were examined as potential modifiers of the association between 5-HTTLPR and personality. RESULTS: Neuroticism was associated with allele frequency such that individuals with the short variant of the allele (ss or sl, group S) were significantly lower on Neuroticism ( P<0.04) compared with individuals with the long allele variant (group L), a pattern opposite to that of previous reports. The association did not vary by clinical group (depressed or controls) but was conditional on gender ( P<0.01): the mean Neuroticism for males in group S was 48.2, whereas the mean Neuroticism for males in group L was 55.9; and the mean Neuroticism for females did not differ by allele group. In the total sample, Agreeableness was not associated with allele frequency; however, there was a significant allele groupxclinical groupxgender interaction ( P<0.01). CONCLUSIONS: The present findings failed to replicate prior work suggesting that the short variant of the 5-HTTLPR allele is associated with higher Neuroticism and lower Agreeableness.

Aged↗

PubMed2003

Associations among social support, income, and symptoms of depression in an educated sample: the UNC Alumni Heart Study.

It has been suggested that the inverse association between social support and depression may be stronger in persons with lower income. This study tested the support x income hypothesis in a sample of 2,472 individuals enrolled in the UNC Alumni Heart Study. The income was examined as a moderator of the relation between support and self-reported ratings of symptoms of depression. The appraisal subscale of the Interpersonal Support Evaluation Scale, household income level, and their interaction were modeled as predictors of depression ratings. The support x income interaction term was significantly associated with symptoms of depression, F (2, 2471)=4.71, p=.007. Social support was more strongly associated inversely with depression ratings in persons with lower income as compared to those with higher income. The present results extend previous work regarding the moderating effect of income to a sample of relatively high education and income level.

Adult↗

PubMed2002

Serotonin-related gene polymorphisms and central nervous system serotonin function.

Central nervous system (CNS) serotonergic function affects a wide range of biological and behavioral functions affecting health and disease. Our objective in this study was to determine whether functional polymorphisms of the genes that encode for the serotonin transporter promoter (5HTTLPR) and monoamine oxidase A (MAOA-uVNTR) are associated with CNS serotonin turnover-indexed by cerebrospinal fluid levels of 5-hydroxyindoleacetic acid (5-HIAA)-in a community sample of healthy adults. Subjects were 165 community volunteers without current medical or psychiatric illness, stratified with respect to ethnicity, gender, and socioeconomic status who underwent inpatient evaluation in the General Clinical Research Center of a university medical center. A significant ethnicity x genotype interaction (P=0.008) indicated that, compared to the long/long and long/short genotypes, the 5HTTLPR short/short genotype was associated with higher CSF 5-HIAA levels in African Americans, but with lower levels in Caucasians. A gender x genotype interaction (P=0.04) indicated that 5HTTLPR short/short genotype was associated with higher 5-HIAA levels in women but with lower levels in men. MAOA-uVNTR 3.5 and 4 repeat alleles were associated with higher 5-HIAA (P=0.03) levels in men, but were unrelated to 5-HIAA levels in women. These findings suggest that effects of serotonin-related gene polymorphisms on CNS serotonergic function vary as a function of both ethnicity and gender. Further research will be required to determine the mechanism(s) underlying these differential effects. In the meanwhile, both ethnicity and gender should be taken into account in research evaluating effects of these and related polymorphisms on CNS serotonergic function, as well as the broad range of biological and behavioral functions that are regulated by CNS serotonergic function.

Adult↗

PubMed2002

Evaluating participants' use of a hormone replacement therapy decision-making intervention.

BACKGROUND: Associations between optimal use of a tailored decision-aid and levels of accuracy of perceived breast cancer risk, confidence in decision-making, and satisfaction with decisions about HRT were evaluated in a randomized intervention trial with a community sample of women aged 45-54. METHODS: Data are from 289 women randomized to receive a computer-tailored three-step decision-aid. RESULTS: Forty-seven percent of participants reported optimal use of the intervention materials. African American women and those with low confidence in decision-making were less likely to use the intervention optimally than white women and those with higher confidence (P<0.05). Optimal use of the decision-aid was associated with increased accuracy of perceived risk and confidence to make a decision. DISCUSSION: When used optimally, self-directed decision-aids can improve women's ability to make decisions about HRT. Additional refinement of these aids is needed. For some subgroups of women, adjuncts such as telephone counseling also might be considered.

Black or African American↗

PubMed2002

Behavioral medicine and aging.

A brief history of behavioral medicine and aging is followed by a series of perspectives that help to understand how age is used as a variable in this research, the relative importance of age to declines in cognitive functioning, and the impact of behavioral risk indicators on healthy survival. The authors discuss Alzheimer's disease and the role of age in clinical practice. Also discussed are potential problems in age-related research, ways to improve the knowledge base in behavioral medicine and aging, and thoughts about future challenges to enhance work in behavioral medicine and aging.

Age Factors↗