Blood pressure reactivity to active and passive behavioral conditions in hypertensives and normotensives

Blood pressure reactivity and passive behavioral tasks was studied in patients with mild essential hypertension and normotensive controls. The passive condition included 10 presentations of a 6 sec, 78 dB, 1000 Hz tone without any response requirements. In the active condition subjects were given an additional 10 tone presentations and asked to press a push-button at tone termination. The absolute and percent increase in systolic blood pressure from rest was greater in hypertensives than normotensives in response to the active condition but similar to the passive condition. It is concluded that patients with hypertension compared to normotensive controls show exaggerated blood pressure reactivity to tasks involving active but not passive coping efforts. Since the tasks used to induce active and passive coping in the present study were identical apart from coping requirements, the notion that the activity dimension in and of itself modulates reactivity differences between patients and controls is supported.     

Poor emotional responsiveness in clinical hypertension: Reduced accuracy in the labelling and matching of emotional faces amongst individuals with hypertension and prehypertension

Psychological factors are known to play an important part in the origin of many medical conditions including hypertension. Recent studies have reported elevated blood pressure (even in the normal range of variation) to be associated with a reduced responsiveness to emotions or ‘emotional dampening’. Our aim was to assess emotional dampening in individuals with more extreme blood pressure levels including prehypertensives (N = 58) and hypertensives (N = 60) by comparing their emotion recognition ability with normotensives (N = 57). Participants completed novel facial emotion matching and facial emotion labelling tasks following blood pressure measurement and their accuracy of emotion recognition and average response times were compared. The normotensives demonstrated a significantly higher accuracy of emotion recognition than the prehypertensives and the hypertensives in labelling of facial emotions. This difference generalised to the task where two facial halves (upper & lower) had to be matched on the basis of emotions. In neither the labelling nor matching emotion conditions did the groups differ in their speed of emotion processing. Findings of the present study extend reports of ‘emotional dampening’ to hypertensives as well as to those at-risk for developing hypertension (i.e. prehypertensives) and have important implications for understanding the psychological component of such medical conditions as hypertension.     

Cardiovascular reactivity to psychological stress in aerobically trained versus untrained mild hypertensives and normotensives

Cardiovascular reactivity to video game and mental arithmetic stressors was compared among three groups of men: aerobically trained mild hypertensives, untrained mild hypertensives, and a comparison group of untrained normotensives. Relative to the untrained hypertensives, the trained hypertensives reacted to the video game with marginally smaller systolic blood pressure and diastolic blood pressure, but there were no significant differences between these groups in reactivity during the mental arithmetic task. Comparisons between each hypertensive group and the normotensive group showed that blood pressure (BP) reactivity of normotensives during the video game was generally similar to that of trained hypertensives but smaller than that of untrained hypertensives. These results indicate that aerobic training, which has been found to reduce resting BP in mild hypertensives, may also exert a favorable impact in reducing cardiovascular reactivity of hypertensives during some stressful situations.     

Neuropeptide and cardiovascular responses to intravenous catheterization in normotensive and hypertensive blacks and whites

Research suggests that heightened cardiovascular and neuroendocrine (typically catecholamine) responses to stressors may lead to the development of hypertension and that there may be race differences in patterns of reactivity that are potentially pathogenic. Certain neuropeptides exert profound effects on blood pressure (BP) and heart rate (HR), yet no published studies have examined relationships between these peptides, hypertensive status, race, and reactivity. Seventeen Black and 20 White normotensive and borderline-hypertensive male 19- to 50-year-olds underwent intravenous catheterization while cardiovascular and neuropeptide responses to the stress of being catheterized were examined. Results indicate that, in response to the stressor, Black hypertensives, showed significantly lower endorphin levels compared to Black normotensives, and White hypertensives showed significantly higher levels of beta-endorphin compared to White normotensives. Groups were not significantly different in endorphin levels at recovery. Black hypertensives also showed significantly higher stressor-induced HR and systolic and diastolic BP compared to White hypertensives and normotensives. Lower levels of beta-endorphin and lower urine sodium excretion were associated with higher BP and HR.     

The relation of hypertension to cognitive function

Hypertension is an established risk factor for stroke. However, prior to such a major clinical event, hypertension exerts a more subtle impact on the brain that is revealed by diminished cognitive function. Studies comparing the performance of people with high and normal blood pressure levels have shown that high blood pressure or hypertension is related to poorer performance on tests of attention, learning and memory, executive functions, visuospatial skills, psychomotor abilities, and perceptual skills. Hypertension is also predictive of cognitive decline. Variables that may alter (i.e., moderate) the relation of hypertension to cognitive function include age, education, several biological characteristics of hypertension, and the presence of concurrent diseases. Although hypertensives are not clinically impaired, their diminished levels of cognitive performance could affect their perceived quality of life. Various brain mechanisms may explain the relation of hypertension to lower levels of cognitive function. Further understanding of the relation between hypertension and cognition is critical to the preservation of cognitive function across the life span.     

Cost–benefit estimates for early intensive behavioral intervention for young children with autism—general model and single state case

Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost–benefits of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorder—not otherwise specified (PDD—NOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD—NOS can attain intellectual, academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost–benefit model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI effects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of effectiveness and in constant dollars, this model estimates that cost savings range from $187,000 to $203,000 per child for ages 3–22 years, and from $656,000 to $1,082,000 per child for ages 3–55 years. Differences in initial costs of $33,000 and $50,000 per year for EIBI have a modest impact on cost–benefit balance, but are greatly outweighed by estimated savings. The analysis indicates that significant cost-aversion or cost-avoidance may be possible with EIBI. © 1998 John Wiley & Sons, Ltd.     

Neuropsychological correlates of hypertension: review and methodologic considerations.

Essential hypertension is a chronic disorder having many potential physical and behavioral sequelae. This article evaluates the impact of hypertension on neuropsychological test performance. First, cross-sectional and longitudinal studies that examine the neuropsychological correlates of hypertension are reviewed. In general, hypertensives are found to perform more poorly than normotensives, particularly on tests of memory, attention, and abstract reasoning, and less consistently on tests of perception, constructional ability, mental flexibility, and psychomotor speed. Next, the influence of variables that may moderate relationships between hypertension and neuropsychological performance--such as age, education, and medication usage--are examined. Finally, potential mechanisms, both physiological and psychological, underlying associations between hypertension and neuropsychological performance are discussed.     

Hypertension and cognitive function

Previous research indicates that blood pressure may impact a variety of cognitive functions, including short-term memory, abstract reasoning, visual-spatial abilities, and attention (Boller, Vrtunski, Mack, & Kim, 1977; Elias, Robbins, Schultz, & Pierce, 1990; Franceschi, Tancredi, Smirne, Mercinelli, & Canal, 1982; Mazzucchiet al., 1986). However, studies which have assessed the cognitive functioning of hypertensive adults have offered conflicting results, particularly when hypertension levels were in the mild range (e.g., Bolleret al., 1977; Eliaset al., 1990; Elias, Wolf, D'Agostino, Cobb, & White, 1993; Farmeret al., 1987, 1990; Franceschiet al., 1982; Pérez-Stable, Coates, Halliday, Gardiner, & Hauck, 1992; Schmidtet al., 1991; Waldstein, Ryan, Manuck, Parkinson, & Bromet, 1991). A number of factors may contribute to the inconsistent findings in this area. Researchers have employed a wide range of neuropsychological instruments to assess varying domains of cognitive function. Sample sizes in some studies have been too small to ensure sufficient power. Finally, studies have employed varying methodological control over potential confounding factors such as concurrent medical conditions, alcohol abuse, psychiatric disorders, or antihypertensive medication. This study compared male veterans with blood pressures in the mildly hypertensive range (n=166) to normotensive veterans (n=176) on neuropsychological measures of verbal fluency, visual-spatial ability, verbal and visual memory, dexterity, attention, and executive functions. Results revealed that, after controlling for differences in education and income, there was no relationship between mild hypertension and combined measures of cognitive performance. The present findings suggest that mild hypertension alone has little effect on cognitive function in adults.     

Negative relationships between abilities

Abilities are usually assumed to exist in a “positive manifold.” Experimental manipulations of physiological variables, however, suggest that negative relationships exist between certain of the neural processes contributing to simple perceptual-motor vs. perceptual-restructuring tasks. First-order correlative evidence of this phenomenon cannot be obtained because the between-individual differences in general ability level tend to exceed the behavioral effects of the intra-individual opposition between neural processes. Also, since statistical removal of the “g” variance induces bipolarity in the remaining variance, the second-order negative correlations are necessarily regarded as artifactual. A combined correlational-experimental approach is suggested to overcome this difficulty. This work was supported in part by the Dementia Praecox Research Project, Worcester State Hospital, and research grant HD 02557 from the National Institute of Child Health and Human Development, U. S. Public Health Service.     

Age-related effects of blood pressure on everyday cognitive function in community-dwelling women

ABSTRACT

Objectives: Blood pressure is an indicator of vascular health that has been associated with cognition and quality of life in older age. Few studies have examined blood pressure across everyday cognitive tasks, which may have superior predictive functional utility than traditional cognitive measures. We explored blood pressure as a predictor of everyday problem solving (EPS) performance in middle-aged and older women. Method: Community-dwelling women (age: 51–91) with low-normal blood pressure to mild hypertension underwent traditional and everyday cognitive testing. EPS was determined by the number of safe/effective solutions generated for real-world scenarios. Results: Analyses revealed that lower systolic blood pressure and pulse pressure were associated with worse EPS ability after controlling for age, education, and traditional cognitive abilities. Discussion: These results support that blood pressure may be an important predictor of everyday cognitive abilities in older age. Potential implications for real-world functioning are discussed.     

Benchmarking Treatment Effectiveness of Community‐Delivered Trauma‐Focused Cognitive Behavioral Therapy

It is critical for urban youth with post‐traumatic stress disorder (PTSD) living in poverty to have access to evidence‐based interventions for their traumatic stress. However, there is limited research on the effectiveness of these interventions when provided in urban, community settings. The objectives of the current study are to (a) evaluate the effectiveness of trauma‐focused cognitive behavioral therapy delivered from 2013 to 2016 in 15 behavioral health agencies on youth (N = 114) PTSD as well as  general mental health symptoms and  functioning, and (b) benchmark these clinical outcomes against other published efficacy and effectiveness trials. Effectiveness data are from the Philadelphia County Community Behavioral Health System, a system that has invested significantly in the training and ongoing support of clinicians providing high‐quality trauma services to youth since 2012. From baseline to last assessment, youth PTSD symptom severity (d = 0.34), PTSD functional impairment (d = 0.38), and overall mental health problem severity (d = 0.29) improved. The effect sizes of  improvements were smaller than effect sizes observed in efficacy and effectiveness studies. This study is the first benchmarking study of TF‐CBT and provides preliminary findings with regard to the effectiveness, and transportability, of TF‐CBT to urban community settings that serve youth in poverty.     

Does anxiety or cardiovascular reactivity have a causal role in hypertension?

Anxiety, stress, and cardiovascular reactivity (CVR) are variously believed to play a role in sustained hypertension. Although acute anxiety or stress elicits acute pressor responses, there is little support for their significant role in sustained hypertension. Anxiety correlates poorly with CVR, and blood pressure levels and anxiolytics do not sustain blood pressure lowering in subjects with hypertension-associated anxiety. Chronic anxiety disorders tend to be characterized by relatively low blood pressure and prevalence of sustained hypertension. Blood Pressure Regulation in hypertension is normal, and normo- and hypertensives have similar ambulatory blood pressure variability. Laboratory CVR fails to predict variability in natural environments, hyperreactors do not exhibit increased variability in natural environments, and the increased variability and ambulatory reactivity that is "accounted for" by laboratory responses is small. These findings do not support the belief that hypertension is related to a summation of heightened pressor responses over time. Antihypertensives normalize elevated blood pressures but do not alter CVR in the laboratory or variability in natural environments, probably because of a dual central regulation of resting and reactive blood pressures. Psychological stress responses result from selective neuronal activation rather than from generalized sympathetic neural responses or dysregulation. Differences in blood pressure responses during various emotions are only quantitative, with no specificity of sympathoadrenal or emotional responses to stressors. It may be time to regard reactive cardiovascular responses as physiological, rather than as psychological, and to require much stronger evidence to confirm causal roles of anxiety, stress, and reactivity in sustained hypertension.     

Differences in personality between sustained hypertension,isolated clinic hypertension and normotension

The aim of this study was to determine whether there are differences in personality between hypertension and normotension. Forty‐two male patients with essential hypertension were divided into two groups after self‐assessment of blood pressure, 18 with sustained hypertension and 24 with isolated clinic (white coat) hypertension, and were compared with 25 men with normotension on Spielberger's State‐Trait Anxiety Inventory and the Jenkins Activity Survey. In line with hypotheses, the sustained hypertensive group showed higher levels of trait anxiety, Type A behaviour pattern, and hard‐driving behaviours/competitiveness than the normotensive group, whereas isolated clinic hypertensives occupied an intermediate position between those two groups. Results provide support to the hypothesised relationship between personality and hypertension and stress the need of distinguishing sustained hypertension from isolated clinic hypertension. Copyright © 2006 John Wiley & Sons, Ltd.     

Cognitive-behavior therapy for disaster-exposed youth with posttraumatic stress: results from a multiple-baseline examination

Youth traumatized by natural disasters report high levels of posttraumatic stress such as symptoms of posttraumatic stress disorder, other anxiety disorders, and depression. Research suggests that cognitive behavioral therapies are promising interventions for symptom reduction; however, few cognitive behavioral treatments have been systematically tested in youth hurricane survivors. The current study provides an examination of the efficacy of an intervention manual designed specifically for hurricane-exposed youth (i.e., the StArT manual) using a partially nonconcurrent multiple baseline design. Youth ages 8–13 (n = 6) who met diagnostic criteria for posttraumatic stress disorder were provided the individual StArT treatment in their school. Youth were assessed at pretreatment, weekly during treatment, and at posttreatment. Results provide initial evidence for the efficacy of the StArT manual and suggest the feasibility of conducting the StArT manual in a school setting. The importance of large-scale tests of effectiveness and implementation of cognitive behavioral treatments in the wake of disaster among youth are discussed.     

Computer software patents: Some perspectives and misunderstandings

The importance that in-house software plays today in many organizations is without question. Perspectives of efficiencies, effectiveness, competitive advantage, and so on are but three areas where such applications exist. Many organizations have adopted measures to protect such software as a specific type of intellectual property. In the 1990s quite often the form of protection taken is software patents. The understanding and enthusiasm about software patents that is exhibited by organizations is not often shared by information systems researchers, however. For the most part, IS researchers dismiss software patents as an appropriate protective measure. This paper presents some background on patents and their applicability to software. Some US and international perspectives are also discussed to provide the reader with a somewhat broader perspective. We then discuss several IS research endeavors that either dismiss patents, or treat them incorrectly. We conclude with a research agenda for IS researchers. the Department of Computer Information Systems & Quantitative Analysis, University of Arkansas. She has conducted extensive research in the area of the law and information technology. Her published research has appeared in MIS Quarterly, Journal of Management Information Systems, and Knowledge and Policy. His research interests include examination of the strategic aspects of information systems and the relationship between the law and information technology. His research has been published in Information Systems Research, MIS Quarterly, and the Journal of Management Information Systems. Her current research is focused on interogranizational systems and the human relationships that exist in parallel to these systems.     

Behavioral Self‐Regulation,Early Academic Achievement,and the Effectiveness of Urban Schools for Low‐Income Ethnic Minority Children

The independent and joint associations between child behavioral self‐regulation ability and school effectiveness in relation to academic achievement were examined in a sample of low‐income African American (n = 132) and Latino (n = 198) children attending kindergarten and first grade across a large metropolitan area. Child behavioral self‐regulation and school effectiveness were positively associated with both reading and mathematics performance. School effectiveness moderated the effect of behavioral self‐regulation on reading but not math achievement. Lower child behavioral self‐regulation during early elementary school was associated with lower reading achievement the following year but only among children attending less effective schools. Behavioral self‐regulation was not related to reading achievement among children attending more effective schools. Implications of these findings for policies addressing disparities in early academic achievement are discussed.     

Dissonance et engagement : comparaison de deux voies d’intervention visant à réduire les ressources énergétiques au sein d’une collectivité territoriale

This Action Research was ordered by the Energy Department's head of a southern France local authority who wanted to reduce civil servant's overconsumption behaviors in public swimming pools. The aim was to compare two methods coming from psychosocial theories: cognitive dissonance implemented by induced hypocrisy paradigm, and commitment implemented by submission without pressure paradigm. Both methods and a “classical” condition, were assigned to three independent groups of swimming pool employees (n = 21). The processes targeted the level of behavioral intentions and the effective behavioral change, as dependant variables. These elements were measured through the type of behavioral intention, and the swimming-pools’ consumption bills. Results show that induced hypocrisy reveals a higher behavioral intention's level than a classical condition, whereas the effective behavioral change is higher in the commitment condition. Moreover, we can see a decisive role of context's organizational characteristics beyond the experimental variables induction. Theoretical and managerial consequences of the results are discussed relatively to the methodological limits enforced by the characteristics of the field.     

Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of parent and family factors is associated with youth risk for depression, ranging from parental pathology to parental cognitive style to family emotional climate. Next, treatment approaches for youth depression that have been empirically tested are described and then summarized in terms of their level of parent inclusion, including cognitive–behavioral therapy, interpersonal therapy, and family systems approaches. Families have mostly not been incorporated into clinical treatment research with depressed adolescents, with only 32% of treatments including parents in treatment in any capacity. Nonetheless, the overall effectiveness of treatments that involve children and adolescents exclusively is very similar to that of treatments that include parents as agents or facilitators of change. The article concludes with a discussion of the implications of these findings and directions for further research.     

Behavioral predictors of blood pressure variation in hypertensives and normotensives

This study examined the relative impact of five behavioral factors--activity, posture, location, social involvement, and tension--on the 24-hr blood pressure (BP) variability of 21 normotensives, 18 borderline hypertensives, and 18 sustained essential hypertensives. Multiple-regression analyses indicated that within each diagnostic group, activity accounted for more variance in BP variability than any other behavioral dimension. For each behavioral dimension examined, the magnitude of the relationship with BP was generally greater for the normotensives than for both hypertensive groups. In contrast, variation due to individuals was a better predictor of BP variability for the two hypertensive groups than for the normotensive group. Number of months hypertensive and use of antihypertensive medication were related to BP variability for the sustained hypertensive group. Findings have implications for the use of ambulatory BP monitors and interpretation of resulting data.     

A crowdsourced nickel‐and‐dime approach to analog OBM research: A behavioral economic framework for understanding workforce attrition

Incentives are a popular method to achieve desired employee performance; however, research on optimal incentive magnitude is lacking. Behavioral economic demand curves model persistence of responding in the face of increasing cost and may be suitable to examine the reinforcing value of incentives on work performance. The present use‐inspired basic study integrated an experiential human operant task within a crowdsourcing platform to evaluate the applicability of behavioral economics for quantifying changes in workforce attrition. Participants included 88 Amazon Mechanical Turk Workers who earned either a $0.05 or $0.10 incentive for completing a progressively increasing response requirement. Analyses revealed statistically significant differences in breakpoint between the two groups. Additionally, a novel translation of the Kaplan‐Meier survival‐curve analyses for use within a demand curve framework allowed for examination of elasticity of workforce attrition. Results indicate greater inelastic attrition in the $0.05 group. We discuss the benefits of a behavioral economic approach to modeling employee behavior, how the metrics obtained from the elasticity of workforce attrition analyses (e.g., P _max) may be used to set goals for employee behavior while balancing organizational costs, and how economy type may have influenced observed outcomes.