Childhood cumulative risk and later allostatic load: mediating role of substance use. Stress self-management: an intervention for women with physical disabilities. Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study. Don't hide your happiness! Positive emotion dissociation, social connectedness, and psychological functioning. Upward spirals of the heart: Autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness Does the nature of schools matter? An exploration of selected school ecology factors on adolescent perceptions of school connectedness. Are Electronic Cigarettes an Effective Aid to Smoking Cessation or Reduction Among Vulnerable Groups? A Systematic Review of Quantitative and Qualitative Evidence. Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men Social relationships and their biological correlates: Coronary Artery Risk Development in Young Adults (CARDIA) study Study protocol for BeWEL: The impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal adenomas A resilience-oriented treatment for posttraumatic stress disorder: results of a preliminary randomized clinical trial. Enhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial. Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 School Connectedness Is an Underemphasized Parameter in Adolescent Mental Health: Results of a Community Prediction Study Social relationships and health. Protocol for ADDITION-PRO: a longitudinal cohort study of the cardiovascular experience of individuals at high risk for diabetes recruited from Danish primary care The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adults Effect of social networks intervention in type 2 diabetes: a partial randomised study [Psychological mechanisms in the transition from acute to chronic pain: over- or underrated?]. Emotional Health Predicts Changes in Body Mass Index (BMI-z) Among Black and Latino Youth Traditional Indigenous Games promoting physical activity and cultural connectedness in primary schools--cluster randomised control trial. Building Capacity for System-Level Change in Schools: Lessons from the Gatehouse Project
OBJECTIVE The present study investigated the long-term impact of exposure to  poverty-related stressors during childhood on allostatic load , an index of physiological dysregulation , and the potential mediating role of substance use . METHOD Participants ( n = 162 ) were rural children from New York State , followed for 8 years ( between the ages 9 and 17 ) .  Poverty- related stress was computed using the cumulative risk approach , assessing stressors across 9 domains , including environmental , psychosocial , and demographic factors . Allostatic load captured a range of physiological responses , including cardiovascular , hypothalamic pituitary adrenal axis , sympathetic adrenal medullary system , and metabolic activity . Smoking and alcohol/drug use were tested as mediators of the hypothesized childhood risk-adolescent allostatic load relationship . RESULTS Cumulative risk exposure at age 9 predicted increases in allostatic load 8 years later . Smoking , but not alcohol and drug use , was a significant mediator of the prospect i ve , longitudinal relationship between childhood cumulative risk and adolescent allostatic load . CONCLUSIONS The present paper contributes to the underst and ing of the role of early life stress in health across the life span and of the mechanisms by which adverse childhood environments impact health as children emerge into early adulthood . This knowledge will have implication s for early intervention efforts PURPOSE We sought to develop and evaluate the efficacy of an innovative , theory-driven , group stress self-management intervention design ed to ameliorate stress and promote health among women with physical disabilities such as spinal cord injury , multiple sclerosis , and arthritis . METHODS We recruited a voluntary sample of 78 community-living women with disabilities who were r and omly assigned to either the group stress management intervention or the wait-listed control group  , and we used a within- and between-groups pretest/posttest design with a 3-month follow-up . RESULTS Group differences in changes over time on measures of perceived stress and mental health offer support for the efficacy of the intervention . At the 3-month follow-up assessment , the intervention group also showed greater improvement on measures of pain and role limitations owing to physical health when compared the wait-listed control group . Perceived stress was supported as a mediator of the effect of the intervention on mental health . We found support for social connectedness and self-efficacy as mediators of the relation between the intervention and perceived stress ; however , there was relatively weak evidence for differential change over time in those proposed mediators . CONCLUSION This study provides the first of its kind , that is , an evaluation of the efficacy of a stress self-management intervention design ed specifically for women with physical disabilities . The results are consistent with a model in which the stress management intervention enhances self-efficacy and social connectedness , which leads to reduced stress , which then contributes to improved mental health Puerto Ricans living in the United States mainl and present multiple disparities in prevalence of chronic diseases , relative to other racial and ethnic groups . Allostatic load ( AL ) , or the cumulative wear and tear of physiological responses to stressors such as major life events , social and environmental burden , has been proposed as a possible mechanism for the inequalities observed in minority groups , but has not been studied in Puerto Ricans . The aim of this study was to determine the association of AL to six chronic diseases ( abdominal obesity , hypertension , diabetes , and self-reported cardiovascular disease ( CVD ) , arthritis and cancer ) in Puerto Ricans , and to contrast AL to metabolic syndrome ( MetS ) . Participants of the Boston Puerto Rican Health Study ( n=1116 , ages 45 - 75 years ) underwent a  home-based interview  , where question naires were completed and biological sample s collected . A summary definition of AL was constructed using clinical ly-defined cutoffs and medication use for 10 physiological parameters in different body systems . Logistic regression models were run to determine associations between AL score and disease status , controlling for age , sex , smoking , alcohol use , physical activity , total fat intake and energy intake . Parallel models were also run with MetS score replacing AL . We found that increasing categories of AL score were significantly associated with abdominal obesity , hypertension , diabetes and self-reported cardiovascular disease ( CVD ) and arthritis , but not with self-reported cancer . The strength of associations of AL with all conditions , except diabetes and cancer , was similar to or larger than those of MetS score . In conclusion , Puerto Rican older adults experienced physiological dysregulation that was associated with increased odds of chronic conditions . AL was more strongly associated with most conditions , compared to MetS , suggesting that this cumulative measure may be a better predictor of disease . These results have prospect i ve research implication s for Puerto Ricans and other ethnic groups It is now clear that positive emotion leads to enhanced psychological functioning . What is less clear , however , is just why this is so . Drawing on a social-functional perspective , we argue that positive emotional behavior that accurately signals to others the individual 's internal state will enhance social connectedness . Positive emotional behavior that does not accurately signal a person 's experience -- such as a smile that is not felt -- may impede social connectedness and , in turn , psychological functioning . This perspective suggests that ( a ) the degree to which experience and behavior are dissociated during positive emotional episodes , over and above level of positive behavior , should predict worse psychological functioning and ( b ) the effect of dissociation should be mediated by social connectedness . To test these hypotheses , we conducted a short-term prospect i ve longitudinal study , with a baseline assessment of depressive symptoms and well-being at Time 1 . Six months later , at Time 2 , we used a novel within-individual laboratory paradigm to measure the degree to which positive emotional behavior was dissociated from ( vs. coherent with ) a participant 's positive emotional experience . We also assessed level of positive behavior and experience . Then , another 6 months later , we assessed social connectedness as a mediator and depressive symptoms and well-being as outcomes at Time 3 . Even when controlling for baseline functioning and for level of positive emotion behavior and experience , we found that greater positive experience-behavior dissociation at Time 2 predicted higher levels of depressive symptoms and lower levels of well-being at Time 3 . As predicted , these associations were mediated by social connectedness Vagal tone ( VT ) , an index of autonomic flexibility , is linked to social and psychological well-being . We posit that the association between VT and well-being reflects an " upward spiral " in which autonomic flexibility , represented by VT , facilitates capitalizing on social and emotional opportunities and the result ing opportunistic gains , in turn , lead to higher VT . Community-dwelling adults were asked to monitor and report their positive emotions and the degree to which they felt socially connected  each day for 9 weeks . VT was measured at the beginning and end of the 9-week period . Adults who possessed higher initial levels of VT increased in connectedness and positive emotions more rapidly than others . Furthermore , increases in connectedness and positive emotions predicted increases in VT , independent of initial VT level . This evidence is consistent with an " upward spiral " relationship of reciprocal causality , in which VT and psychosocial well-being reciprocally and prospect ively predict one another BACKGROUND Connectedness to school is a significant predictor of adolescent health and academic outcomes . While individual predictors of connectedness have been well-described , little is known about school-level factors which may influence connectedness . A school 's ecology , or its structural , functional , and built aspects , coupled with interpersonal interactions , may also help to enhance adolescent connectedness . AIM This study aims to identify school ecological characteristics which predict enhanced connectedness in secondary school . SAMPLE Data from 5,159 Grade 8 students ( 12 - 13 years ) from 39 r and omly selected schools were tracked until the end of Grade 9 ( 13 - 14 years ) . METHOD Students '  self-reported school , teacher , and family connectedness , mental health and peer relationships were measured at two time points . Accounting for school-level clustering , student- and school-level ecological characteristics were modelled on self-reported school connectedness in Grade s 8 and 9 . RESULTS Students ' higher school connectedness in Grade s 8 and 9 was influenced by greater levels of family connectedness , fewer classroom and peer problems , less difficult secondary school transition , fewer emotional problems , and greater prosocial skills . Seven school-level ecological variables were significantly associated with school connectedness after controlling for student-level predictors . At the school-level , priority for pastoral care and students ' aggregated writing skills scores significantly predicted concurrent and future enhanced connectedness . CONCLUSIONS Interventions to improve students '  school connectedness should address individual student characteristics and school functional features such as pastoral care strategies and helping students to achieve greater academic outcomes . Future studies should focus on the cumulative longitudinal influence of school ecological and student-level predictors of school connectedness INTRODUCTION Smoking prevalence remains high in some vulnerable groups , including those who misuse substances , have a mental illness , are homeless , or are involved with the criminal justice system .  E-cigarette use is increasing and may support smoking cessation/reduction . METHODS Systematic review of quantitative and qualitative data on the effectiveness of e-cigarettes for smoking cessation/reduction among vulnerable groups . Data bases search ed were MEDLINE , EMBASE , PsychINFO , CINAHL , ASSIA , ProQuest Dissertations and Theses , and Open Grey . Narrative synthesis of quantitative data and thematic synthesis of qualitative data . RESULTS 2628 records and 46 full texts were screened ; 9 studies were identified for inclusion . Due to low quality of evidence , it is uncertain whether e-cigarettes are effective for smoking cessation in vulnerable population s. A moderate quality study suggested that e-cigarettes were as effective as nicotine replacement therapy . Four studies suggested significant smoking reduction ; however , three were uncontrolled and had sample sizes below 30 . A prospect i ve cohort study found no differences between e-cigarette users and nonusers . No significant adverse events and minimal side effects were identified . Qualitative thematic synthesis revealed barriers and facilitators associated with each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceptions of effectiveness for cessation/reduction ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . CONCLUSION Further research is needed to identify the most appropriate device types for practicality and safety , level of support required in e-cigarette interventions , and to compare e-cigarettes with current best practice smoking cessation support among vulnerable groups . IMPLICATION S Smoking prevalence among people with mental illness , substance misuse , homelessness , or criminal justice system involvement remains high . E-cigarettes could support cessation . This systematic review found limited quantitative evidence assessing effectiveness . No serious adverse events were identified . Qualitative thematic synthesis revealed barriers and facilitators mapping to each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceived effectiveness ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . Further research should consider appropriate devices for practicality and safety , concurrent support , and comparison with best practice smoking cessation support Abstract Objectives : To examine the association between self perceived psychological stress  and cardiovascular disease in a population where stress was not associated with social disadvantage . Design : Prospect i ve observational study with follow up of 21 years and repeat screening of half the cohort 5 years from baseline . Measures included perceived psychological stress , coronary risk factors , self reported angina , and ischaemia detected by electrocardiography . Setting : 27 workplaces in Scotl and . Participants : 5606 men ( mean age 48 years ) at first screening and 2623 men at second screening with complete data on all measures Main outcome measures : Prevalence of angina and ischaemia at baseline , odds ratio for incident angina and ischaemia at second screening , rate ratios for cause specific hospital admission , and hazard ratios for cause specific mortality . Results : Both prevalence and incidence of angina increased with increasing perceived stress ( fully adjusted odds ratio for incident angina , high versus low stress 2.66 , 95 % confidence interval 1.61 to 4.41 ; P for trend < 0.001 ) . Prevalence and incidence of ischaemia showed weak trends in the opposite direction . High stress was associated with a higher rate of admissions to hospital generally and for admissions related to cardiovascular disease and psychiatric disorders ( fully adjusted rate ratios for any general hospital admission 1.13 , 1.01 to 1.27 , cardiovascular disease 1.20 , 1.00 to 1.45 , and psychiatric disorders 2.34 , 1.41 to 3.91 ) . High stress was not associated with increased admission for coronary heart disease ( 1.00 , 0.76 - 1.32 ) and showed an inverse relation with all cause mortality , mortality from cardiovascular disease , and mortality from coronary heart disease , that was attenuated by adjustment for occupational class ( fully adjusted hazard ratio for all cause mortality 0.94 , 0.81 to 1.11 , cardiovascular mortality 0.91 , 0.78 to 1.06 , and mortality from coronary heart disease 0.98 , 0.75 to 1.27 ) . Conclusions : The relation between higher stress , angina , and some categories of hospital admissions probably result ed from the tendency of participants reporting higher stress to also report more symptoms . The lack of a corresponding relation with objective indices of heart disease suggests that these symptoms did not reflect physical disease . The data suggest that associations between psychosocial measures and disease outcomes reported from some other studies may be spurious . What is already known on this topic Higher psychological stress has predicted coronary heart disease in several observational studies Exposure to stress and heart disease outcomes were often based on self report so that a general tendency to negative perceptions may have generated a spurious association between higher perceived stress and heart disease symptoms What this study adds Perceived stress was strongly related to subjective symptoms of heart disease , including those leading to hospital admission However , stress showed a weakly inverse relation to all objective indices of heart disease : socially advantaged men perceived themselves to be most stressed , and the “ protective ” effect of stress was probably attributable to residual confounding Suggestions that psychological stress is an important determinant of heart disease may be OBJECTIVE Analyses test the hypothesis that aspects of social relationships ( quantity of ties , social support and social strain ) are associated with differences in levels of biological risk across multiple major physiological regulatory systems and consequently overall multi-systems risk ( i.e. , allostatic load [ AL ] ) . METHODS Data are from the Coronary Artery Risk Development in Young Adults ( CARDIA ) study --a bi-ethnic , prospect i ve , multi-center epidemiological study , initiated in 1985 - 1986 to track the development of cardiovascular risk in young adulthood ( N=5115 ) . At the year 15 follow-up when participants were between 32 and 45 years of age , additional social and biological data were collected ; biological data used to assess AL were collected at the Oakl and , CA and Chicago , IL sites ( N=844 ) . RESULTS Social strains were most strongly and positively related to overall AL ( Cohen 's d=.79 for highest vs. lowest quartile ) , and to each of its component biological subsystems , independent of social ties and support as well as sociodemographics and health behaviors . Social ties and emotional support were also negatively related to AL ( Cohen 's d=.33 and d=.44 for lowest vs. highest quartiles of ties and support , respectively ) though controls for social strains reduced these associations to non- significance . Social support and social strain were more strongly related to overall AL than to any of its component subscales while social ties were less strongly related to AL and to its component subscales . There was no evidence that effects differed by sex , age or ethnicity . CONCLUSIONS Findings focus attention on the particularly strong relationship between social strains and profiles of biological risk and support the cumulative impact of social factors on biological risks , showing larger effects for cumulative AL than for any of the individual biological systems Background Colorectal cancer ( CRC ) is the third most commonly diagnosed cancer and the second highest cause of cancer death in the UK . Most cases occur in people over 50 years and CRC often co-exists with other lifestyle related disorders including obesity , type 2 diabetes mellitus ( T2DM ) and cardiovascular disease ( CVD ) . These diseases share risk factors related to the metabolic syndrome including large body size , abnormal lipids and markers of insulin resistance indicating common aetiological pathways . Methods / Design This 3 year study will be a two-arm , multicentre , r and omised controlled trial comparing the BeWEL lifestyle ( diet , physical activity and behaviour change ) programme against usual care . The pre-trial development will take 6 months and participants will be recruited over a 12 month period and undertake the intervention and follow up for 12 months ( total 24 months recruitment and intervention implementation ) with a further 6 months for data collection , analysis and interpretation . Four hundred and fifty two participants who have had a colorectal adenoma detected and removed ( through the national colorectal screening programme ) will provide 80 % power to detect a weight loss of 7 % over 12 months . Primary outcomes are changes in body weight and waist circumference . Secondary outcomes will include cardiovascular risk factors , psycho-social measures and intervention costs . Discussion The results from this study will enhance the evidence base for lifestyle change in patients at higher risk of chronic disease including obesity related cancers . International St and ard R and omised Controlled Trials No : IS RCT This preliminary r and omized trial examined the effect of a resilience-oriented intervention for  posttraumatic stress disorder ( PTSD )  versus a waitlist control on anxiety and depressive symptoms , positive emotional health , and cognitive performance in 39 veterans with a variety of traumatic exposures . From pre- to posttreatment , the intervention but not the control group showed improvements that were large in magnitude for affective symptoms and positive emotional health ( ds = 0.73 - 1.18 ) , moderate in magnitude for memory ( ds = 0.50 - 0.54 ) , and small-to-moderate in magnitude for executive function ( ds = 0.30 - 0.35 ) . Findings suggest that treatment explicitly targeting resilience re sources ( e.g. , positive emotional engagement , social connectedness ) may provide broad benefits , including alleviation of anxiety and depressive symptoms and improved positive emotional and cognitive function This paper describes a r and omized study to evaluate the effects of a comprehensive lifestyle management intervention for 279 postmenopausal women with type 2 diabetes who are at elevated risk for coronary heart disease ( CHD ) . The intervention , called the Mediterranean Lifestyle Trial , is focused on dietary factors , physical activity , social support and stress management . The Mediterranean Lifestyle Trial relies on a synthesis of Social Cognitive Theory and Social Ecologic Theory , as well as goal -systems theory , to explicitly inform the lifestyle intervention and to address maintenance . Thus , the trial should help illuminate the theoretical mechanisms responsible for lifestyle change . Primary outcome variables are dietary , stress management and physical activity behavior change , quality of life , and CHD-related biological risk factors . Hypothesized mediating variables include self-efficacy , coping , and social and environmental support . Following the initial 6-month intervention , participants in the intervention condition are r and omized to one of two groups design ed to enhance maintenance of effects : either a peer-led support group or a personalized multilevel community re sources maintenance condition . Unlike the peer group , the personalized approach focuses on multiple levels of community re sources to promote healthful lifestyle change . Because this research focuses on issues of generalization and translation to practice , the RE- AIM evaluation framework is being used to evaluate Reach , Effectiveness , Adoption , Implementation and Maintenance . This framework will help to translate research into practice by directing research ers ' attention to important but seldom-investigated strategies for enhancing longer-term maintenance . Specifically , the study tests how long-term maintenance may be improved through the use of existing community re sources , an intervention based on multiple environmental factors and multiple lifestyle behaviors , and lay leaders versus personalized professional support The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified There is limited prospect i ve research on the relation between school connectedness ( i.e. , the extent to which students feel accepted , valued , respected , and included in the school ) and mental health symptoms in adolescents . A sample of 2,022 students ( 999 boys and 1,023 girls ) ages 12 to 14 years were measured at 2 time points ( 12 months apart ) on school connectedness and mental health symptoms ( general functioning , depression , and anxiety symptoms ) . School connectedness correlated extensively with concurrent mental health symptoms at both time points ( between 38 % and 55 % covariation with depression , 26 % to 46 % with general functioning , and 9 % and 16 % for anxiety symptoms ) . Using hierarchical linear modeling , school connectedness also predicted depressive symptoms 1 year later for both boys and girls , anxiety symptoms for girls , and general functioning for boys , even after controlling for prior symptoms . The reverse , however , was not true : Prior mental health symptoms did not predict school connectedness 1 year later when controlling for prior school connectedness . Results suggest a stronger than previously reported association with school connectedness and adolescent depressive symptoms in particular and a predictive link from school connectedness to future mental health problems Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health . Prospect i ve studies , which control for baseline health status , consistently show increased risk of death among persons with a low quantity , and sometimes low quality , of social relationships . Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes . The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored Background Screening programmes for type 2 diabetes inevitably find more individuals at high risk for diabetes than people with undiagnosed prevalent disease . While well established guidelines for the treatment of diabetes exist , less is known about treatment or prevention strategies for individuals found at high risk following screening . In order to make better use of the opportunities for primary prevention of diabetes and its complications among this high risk group , it is important to quantify diabetes progression rates and to examine the development of early markers of cardiovascular disease and microvascular diabetic complications . We also require a better underst and ing of the mechanisms that underlie and drive early changes in cardiometabolic physiology . The ADDITION-PRO study was design ed to address these issues among individuals at different levels of diabetes risk recruited from Danish primary care . Methods / Design ADDITION-PRO is a population -based , longitudinal cohort study of individuals at high risk for diabetes . 16,136 eligible individuals were identified at high risk following participation in a stepwise screening programme in Danish general practice between 2001 and 2006 . All individuals with impaired glucose regulation at screening , those who developed diabetes following screening , and a r and om sub- sample of those at lower levels of diabetes risk were invited to attend a follow-up health assessment in 2009–2011 ( n = 4,188 ) , of whom 2,082 ( 50 % ) attended . The health assessment included detailed measurement of anthropometry , body composition , biochemistry , physical activity and cardiovascular risk factors including aortic stiffness and central blood pressure . All ADDITION-PRO participants are being followed for incident cardiovascular disease and death . Discussion The ADDITION-PRO study is design ed to increase underst and ing of cardiovascular risk and its underlying mechanisms among individuals at high risk of diabetes . Key features of this study include ( i ) a carefully characterised cohort at different levels of diabetes risk ; ( ii ) detailed measurement of cardiovascular and metabolic risk factors ; ( iii ) objective measurement of physical activity behaviour ; and ( iv ) long-term follow-up of hard clinical outcomes including mortality and cardiovascular disease . Results will inform policy recommendations concerning cardiovascular risk reduction and treatment among individuals at high risk for diabetes . The detailed phenotyping of this cohort will also allow a number of research questions concerning early changes in cardiometabolic physiology to be addressed Background There is increasing pressure to address the social determinants of health ( SDoH ) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa ( SSA ) where health outcomes are generally poor . Available evaluation research on cash transfers ( CTs ) suggests that the programs may influence the wider determinants of health in SSA ; yet , there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities . To date , nearly all the review s on CTs ' impact on health have predominantly featured evidence from Latin America with limited transferability to the social , cultural , and political environments in SSA . Therefore , the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA . Methods / design A systematic review of published and unpublished literature on CTs ’ impact on health and health determinants covering the period 2000–2016 will be undertaken . Studies will be considered for inclusion if they present quantitative or qualitative data , including all relevant study design s. The SDoH conceptual framework will be used to guide the data extraction process . EPPI Review er software will be used for data management and analysis . Studies included in the review will be analyzed by narrative synthesis and /or meta- analysis as appropriate for the nature of the data retrieved . Discussion This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy , implementation , and research in SSA . The protocol follows the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) . Systematic review registration This protocol has been registered with the PROSPERO international prospect i ve register of systematic review s , reference CRD42015025015 Background Cardiovascular disease is the leading cause of death for adults in Australia . In recent years there has been a shift in health service delivery from institutional to community‐based care for chronic conditions , including cardiovascular disease . The general practice setting is seen to offer greater flexibility , higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector . It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management . To date , significant descriptive research has been conducted exploring the demographics , roles , educational needs and issues facing practice nurses . However , there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes , clinician satisfaction and cost‐effectiveness . Objectives This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults , as well as those with established cardiovascular disease or known cardiac risk factors . Search Strategy A systematic literature search was performed using Medline ( 1966 ‐ 2005 ) , CINAHL ( 1982 −2005 ) , Cochrane Controlled Trials Register ( Issue 4 , 2005 ) and the Joanna Briggs Institute Evidence Library . In addition , the reference lists of retrieved papers , conference proceedings and the Internet , were scrutinised for additional trials . Selection Criteria This review considered any English language r and omised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors . Interventions conducted by specialist cardiac nurses in general practice were excluded . Outcomes measured included blood pressure , smoking cessation , total cholesterol , exercise , body weight/body mass index and cost‐effectiveness . Results Eighteen trials , reported in 33 papers , were included in the review . Ten trials investigated multifaceted interventions , while the remaining eight trials reported targeted interventions . Of the trials that reported multifaceted interventions , three trials investigated risk reduction in those with established cardiovascular disease , four trials focused on those with known cardiovascular disease risk factors and three trials included the general community . The eight trials which examined the efficacy of targeted interventions focused upon dietary intake ( two trials ) , smoking cessation ( three trials ) , weight reduction ( one trial ) and physical activity ( two trials ) . The effect of both the multifaceted and targeted interventions on patient outcomes was variable . However , both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables . Improvements were demonstrated by most studies in blood pressure , cholesterol level , dietary intake and physical activity . The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions . Conclusions While interventions to reduce cardiovascular disease risk factors have produced variable results , they offer significant potential to assist patients in modifying their personal risk profile and should be developed . The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals . Further well‐ design ed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost‐effectiveness Background In this partially r and omised intervention study , we assessed the effect of social networks on the improvement of  type 2 diabetes management  in a largely African – American population in Baltimore . Methods Patients in the intervention group ( n=68 ) were asked to recruit peers , form small groups , and attend monthly diabetes education sessions , emphasising peer support .  Patients in the control group ( n=70 ) were recruited individually to attend st and ard diabetes education sessions . The primary outcomes were changes in haemoglobin A1C ( HbA1c ) and blood glucose . Secondary outcomes included blood pressure , weight , functional status , self-efficacy , perceived cohesion , social network connectedness and diabetes knowledge . General linear mixed models were built to assess mean absolute changes in primary and secondary outcomes at 3 and 6 months . Results At 6 months from baseline , the social network intervention group achieved a larger reduction in HbA1c of −0.32 % ( p<0.0001 ) and blood glucose of −10.6 mg/dL , ( p<0.0001 ) compared to the control group . In analyses of secondary endpoints , the intervention group had more favourable outcomes over time for weight , quality of life , self-efficacy , social network scores and diabetes knowledge , compared to the control group . While blood pressure decreased , and perceived cohesion increased in both groups over the duration of the study , the difference between groups was not statistically significant . Conclusions The social networks intervention showed improved integration of patients within their existing networks leading to a greater reduction in HbA1c and blood glucose , as well as improved behaviour mediating outcomes INTRODUCTION During the last 20 years a great number of studies have emphasized the potential role of psychological factors as relevant predictors for the first onset of back pain as well as for the development of chronic pain . The formulation of a biopsychosocial perspective of the etiology and chronicity of back pain was a natural consequence . Actual questions concern the relative impact of psychological risk factors in the process of chronicity of back pain compared to biomedical , social and occupational factors . METHODS Whereas several review articles regarding the role of psychological risk factors are available up to now , a recently published review conducted by Steven Linton was the first systematic analysis of well controlled prospect i ve studies published since 1967 . Using a grading system similar to that recommended for guidelines the author defined a level A evidence when at least two good- quality prospect i ve studies supported the prospect i ve power of a variable . Level B evidence had support from one prospect i ve study . Level C represented inconclusive data and level D indicated that no studies met the criteria . Based on a literature search of more than 900 studies , 37 good- quality prospect i ve studies were analysed in detail . RESULTS The results indicated level A evidence for the following interrelations : ( 1 ) Psychosocial variables , especially chronic distress in daily life , depression and work dissatisfaction were clearly associated with the onset of back and neck pain ( 2 ) . Psychological variables , especially chronic stress in daily life , work dissatisfaction , depression and pain-related cognitions and coping behaviour were clearly linked to the transition from acute to chronic pain and disability ( 3 ) . Psychological variables generally had more prospect i ve power than biomedical , social or objective occupational variables . Among the pain-related cognitions , catastrophizing and fear-avoidance-beliefs yielded the most empirical support . Among coping behaviour passive coping stretegies such as avoiding behaviour was most important . At least level B evidence has been shown for the counterpart of an extreme suppressive coping behaviour . Patients who tended to suppress or ignore pain in order to finish all activities they started , who were unable to integrate phases of passive relaxation into the daily routine displayed a high risk of chronicity of pain 6 months after an acute phase of pain . One international and two German good- quality prospect i ve studies have shown the predictive power of a maladaptive suppressive behaviour pattern . Based on the avoidance-endurance-model of pain chronification , both extreme and one-sided passive pain coping as well as one-sided suppressive coping modes were conceptualized as maladaptive due to the process of chronicity . We assume that extreme passive behaviour will lead to immobility and muscular atrophy . Neurophysiological processes of sensitization will further lead to the development of chronic pain . On the other h and , extreme suppressive behaviour will lead to an overuse of muscles and joints with a repetitive combination of muscular hyperactivity and pain . These repetitive pain experiences will also elicit neurophysiological processes of sensitization . ( 4 ) Psychosocial variables displayed more predictive power than biomedical or biomechanical factors . ( 5 ) Psychosocial factors may be used as predictors of the risk for developing long-term pain and disability . Mixed empirical evidence has been shown for the role of personality factors ( level C evidence ) and no support has been found for the idea of a " pain prone " personality disorder or for the role of sexual and physical abuse . DISCUSSION 20 years of research , several qualitative review s and a recently published systematic review of 37 good- quality prospect i ve studies regarding the role of psychological , biomedical , social and objective occupational factors in the process of chronicity of back pain revealed that psychological factors are significantly related to the onset of back pain as well as to the development of chronic pain . Furthermore , the psychological factors displayed more predictive power than biomedical or biomechanical variables . As a consequence for clinical practice , these psychological risk factors have to be considered as " yellow flags " if a back pain problem wo n't respond to medical treatment for more than four weeks . As a further consequence , special risk factor - based psychosocial interventions should be offered in addition to the medical treatment to patients with high psychological risk factors for the development of chronic pain . The efficacy of such an interdisciplinary care in the very early phases of back pain in order to prevent chronicity of pain and disability has been published recently by our group Childhood obesity is a complex and multifaceted health problem linked to elevated risk for chronic diseases , such as diabetes , cancer , hypertension , and cardiovascular disease.1,2 Although research has increased dramatically in the past 2 decades , questions regarding factors driving overweight and obesity remain , particularly among youth of color who experience disproportionate rates of obesity and comorbid health conditions.3 Adolescence is a critical period in the developmental trajectory,4 in part because overweight and obese adolescents are more likely to remain overweight and /or obese in adulthood.3 Overweight and obesity have been associated with adverse symptoms and intra- and interpersonal psychological , social , and emotional issues that continue into adulthood , including depression and anxiety , social withdrawal , feeling worthless , lower self-esteem , and behavioral problems.5–7 Poor mental health may lead to increases in weight due to fluctuations in appetite , obesogenic behaviors ( eg , overeating ) to cope with negative mood , sedentary behavior , and increased isolation.8 Chronic stress or experiences of discrimination may also influence physiology and behaviors that affect weight gain.9 On the other h and , increased body mass index ( BMI ) could result in adverse emotional outcomes over time due to weight-based stigma , bullying , or poor self-esteem.5,6 The few longitudinal studies that have examined the association between emotional health and physical health outcomes have primarily taken a narrow focus of mental health symptoms ( e.g. , only examining depression)10 or behavioral concerns ( e.g. , conduct).11 Physical outcomes , including BMI , were often collected by self-report12 and /or retrospectively.13 Furthermore , they have been limited to predominantly White sample s of older adolescents or adults.12,13 Persistent racial and ethnic disparities in overweight and obesity further complicate research as well as clinical prevention and intervention efforts . Black and Latino youth experience disproportionate levels of overweight and obesity beginning as early as preschool and are more likely to remain obese as adults compared with Whites.14 Blacks and Latinos also are at disproportionate risk for multiple negative health conditions associated with overweight and obesity , such as diabetes.14,15 Reasons for such disparities remain poorly understood and understudied . Although emotional health has been associated with weight in both adults and youth,16 prior research has been limited to cross-sectional studies .17 Longitudinal , prospect i ve design s are critical to explicate the association between emotional health and BMI among Black and Latino youth . The primary objective of this study is to examine whether negative emotional symptoms prospect ively predict increases in BMI z-scores ( BMI -z ) across 2 years among a sample of predominantly Black and Latino , urban youth . We hypothesize that more negative emotional symptoms measured at baseline ( grade s 5 and 6 ) would predict increases in BMI -z scores 2 years later . Results can inform programs and interventions aim ed at reducing obesity in youth of color ISSUE ADDRESSED This study investigated the effectiveness of Traditional Indigenous Games ( TIG ) to improve physical activity and cultural connectedness among primary school students in the community renewal areas of Townsville in North Queensl and . METHODS A cluster r and omised control trial was conducted in four primary schools in 2007 . Baseline and post implementation surveys were conducted in two intervention and two control schools and the results were compared . RESULTS TIG delivered in primary schools every week over period of three months did not contribute to any statistically significant improvement in intervention and control groups in physical activity levels or cultural connectedness . CONCLUSIONS Further research specifically in terms of intensity and duration of TIG may inform whether physical activity may be improved . Enhancing the Indigenous cultural features of the existing TIG kit might positively influence Indigenous cultural connectedness The Gatehouse Project is an innovative , comprehensive approach to mental health promotion in secondary schools . It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes . The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team ; the identification of risk and protective factors in each school ’s social and leaning environment from student surveys ; and , through the use of these data , the identification and implementation of effective strategies to address these issues . The project evaluation used a cluster-r and omized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children . This article describes and accounts for how system-level changes have been made in schools through a process of capacity building . This encourages teachers , parents , and students to view the core business of education differently
These studies overwhelmingly support the notion that social connectedness correlates negatively with allostatic load .
Several moderators of this relationship were also identified , including gender , social status , and quality of social ties .
The current evidence strongly indicates that the more socially connected individuals are , the less likely they are to experience chronic stress and associated allostatic load .
The negative association between social connectedness and various chronic diseases can thus , at least partially , be explained by the buffering qualities of social connectedness against allostatic load .
We argue that assessing social connectedness in clinical and epidemiological setting s may therefore represent a considerable asset in terms of prevention and intervention
In the present review , we argue that social disconnectedness could and should be included in primary -care screening protocol s for the detection of cardiometabolic disease .
Empirical evidence indicates that weak social connectedness represents a serious risk factor for chronic diseases , including cardiovascular disease , diabetes , and various cancers .
Weak social connectedness , however , is largely regarded as a second-tier health-risk factor in clinical and research setting s. This may be because the mechanisms by which this factor impacts on physical health are poorly understood .
Budding research , however , advances the idea that social connectedness buffers against stress-related allostatic load-a known precursor for cardiovascular disease and cancer .
The present paper review s the empirical knowledge on the relationship between everyday stress , social connectedness , and allostatic load .