Terry A. Cronan

Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression

OBJECTIVE This study is an examination of sleep, pain, depression, and physical functioning at baseline and 1-year followup among patients with fibromyalgia syndrome (FMS). Although it is clear that these symptoms are prevalent among FMS patients and that they are related, the direction of the relationship is unclear. We sought to identify and report sleep problems in this population and to examine their relationship to pain, depression, and physical functioning. METHODS Patients diagnosed with fibromyalgia were recruited from a Southern California health maintenance organization and evaluated according to American College of Rheumatology criteria in the research laboratory. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. Measures included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. RESULTS The majority of the sample (96% at baseline and 94.7% at 1 year) scored within the range of problem sleepers. Path analyses examined the impact of baseline values on 1-year values for each of the 4 variables. No variable of interest predicted sleep, sleep predicted pain (beta = 0.13), pain predicted physical functioning (beta = -0.13), and physical functioning predicted depression (beta = -0.10). CONCLUSION These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating FMS symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning.

Scores on the MacArthur Communicative Development Inventory of children from lowand middle-income families

This study compared the language skills in a group of very low-income toddlers with those of a middle-income sample matched on age and sex. The assessment instrument was the MacArthur Communicative Development Inventory (CDI) for toddlers, a parent report form. The scores for the low-income group were strikingly lower on the three key indices evaluated: size of expressive vocabulary, age of appearance of word combinations, and complexity of utterances. The entire lowincome distribution was shifted about 30% toward the lower end of the middle-income distribution for both productive vocabulary and grammatical development. The magnitude of these income/ social class effects was larger than reported in most prior reports for children in this age range. This finding underscores the cautionary note issued by the CDI developers, which states that the published CDI norms, based on a middle-class sample, may not be directly applicable to low-income samples.

Smoking, exercise, and physical fitness☆

BACKGROUND Research on smoking and physical activity provides strong evidence of smokings negative impact and physical activitys positive impact on long-term health. However, evidence regarding the association between smoking and exercise activity and the independent effects of these factors on fitness is lacking. METHODS The associations among exercise activity, smoking behavior, and physical fitness were examined in 3,045 Navy personnel. Exercise and smoking behaviors were measured using a lifestyle survey. Physical fitness was assessed using scores on the Navys Physical Readiness Test. Analyses of variance were conducted to examine the relationships among smoking status, exercise activity, and PRT performance. Multiple regression procedures were used to examine the relationship between smoking and physical fitness after statistically controlling for the effects of exercise. RESULTS Smoking was associated with lower exercise levels and lower physical endurance--both cardiorespiratory (1.5-mile run) and muscular (sit-ups). After controlling for exercise activity, smoking remained significantly associated with lower physical endurance but was not related to overall body strength (lean body mass) or percentage body fat. CONCLUSION Smoking is a detriment to physical fitness even among relatively young, fit individuals. Study findings suggest that smokers will have lower physical endurance than nonsmokers, even after differences in the average exercise levels of smokers and nonsmokers are taken into account. Cigarette smokers should be given strong encouragement to stop smoking as part of any effort to improve physical fitness.

An examination of the physical health, health care use, and psychological well-being of spouses of people with fibromyalgia syndrome.

The present study compared the physical and mental health and the health care use of spouses of patients with fibromyalgia syndrome (FS group; n = 135) with that of spouses of healthy individuals (n = 153). FS group participants reported lower health and affective states and scored higher on depression, loneliness, and subjective stress than comparison group participants (p < .017). Husbands in the FS group who reported more illness impact and whose wives reported worse sleep quality and less self-efficacy had more psychological difficulties. No differences were found in health care costs between groups. These findings suggest that chronic illness in a partner may negatively affect an individuals physical and mental health.

A cost analysis of self-management programs for people with chronic illness.

The soaring cost of health care is a national problem that needs response at multiple levels, including that of the community. Reducing or limiting health care costs through interventions that emphasize the self-management of health may promote broader health care coverage, better quality of health care, and a sense of control over ones health. Therefore, it behooves community psychologists to perform cost analyses when testing interventions for people in a community. The present study investigated the effects of social support and education interventions on psychosocial variables, health status, and health care costs in older people with osteoarthritis. Participants were 363 members of a health maintenance organization (HMO), 60 years of age and older, with osteoarthritis. Participants were randomly assigned to one of three intervention groups (social support, education, or a combination of both) or to a control group. The results indicated that feelings of helplessness decreased in the intervention groups but not in the control group. All groups showed increases in self-efficacy and overall health status. In addition, health care costs increased less in the intervention groups than in the control group. Cost analysis was used to demonstrate that the monetary savings of the intervention greatly outweighed the cost of conducting the intervention. It appears that interventions can limit health care costs while improving health and increasing feelings of control for older people with osteoarthritis. Further, this paper demonstrates how a cost-benefit focus can benefit community studies.

The effects of a community-based literacy program on young children's language and conceptual development

Effects of a community-based literacy program on 1−, 2−, and 3-year-old childrens language and conceptual development were assessed. University students were trained to teach Head Start parents effective methods for reading to their children. Families were randomly assigned to receive 18, 3, or 0 instructional visits. Results indicated that parents in the 18-instructional-visit program increased their participation in appropriate literacy behaviors such as reading to their children, teaching concepts to their children, and using the library, more than parents in the 0-instructional-visit groups. Children in the 18-instructional-visit program showed greater gains in language and conceptual development than children in the 0-instructional-visit group. Few differences were found between children in the 3-visti and 0-instructional-visit groups. Thus, only a high-intensity community-based intervention designed to train parents was effective in increasing emergent literacy in low-income ethnic children.

Predictors of Mammography Screening Among Ethnically Diverse Low-Income Women

BACKGROUND AND PURPOSE Breast cancer is the second leading cause of cancer deaths among women in the United States. Minority women are less likely to be screened and more likely to die from breast cancer than are Caucasian women. Although some studies have examined ethnic disparities in mammography screening, no study has examined whether there are ethnic disparities among low-income, ethnically diverse women. The present study was designed to determine whether there are ethnic disparities in mammography screening and predictors of screening among low-income African American, Mexican American, and Caucasian women, and to determine whether the disparities and predictors vary across ethnic groups. METHODS The participants were 146 low-income women who were Mexican American (32%), African American (31%), or Caucasian (37%). Statistical analyses were performed to assess the relationships between mammography screening during the past 2 years and potential predictors of screening, both within ethnic groups and for the combined sample. RESULTS The results varied depending on whether analyses combined ethnic groups or were performed within each of the three ethnic groups. CONCLUSIONS It is, therefore, important to examine within-group differences when examining ethnic disparities in predictors of mammography.

Predictors of attrition in health intervention research among older subjects with osteoarthritis.

Attrition in an experimental osteoarthritis intervention was studied among 364 (130 male) volunteers (ages 60-87). Subjects were randomly assigned to control, social support, education, or combined treatment groups. A series of discriminant function analyses showed that the final intervention groups were more homogeneous than the original samples. The most robust predictor of attrition was having either high or very low depression scores. Social support variables were predictors of poor attendance in the social support group, indicating possible attrition bias in evaluating this treatment. The results indicate that psychosocial variables may be the best predictors of attrition in health intervention research among older subjects, and that variables related to attrition can be related to the content of the intervention.

The Effects of Maternal Depression on the Efficacy of a Literacy Intervention Program

The purpose of the present study was: (1) to determine whether depression was related to mother-child interactions in a group of low-income mothers participating in a literacy intervention; (2) to examine whether depression was related to retention; (3) to determine whether there were differential changes in depressed and non-depressed mothers in the intervention group. Participants included 488 ethnically diverse families. Depressed mothers engaged in fewer literacy enhancing behaviors with their children than non-depressed mothers and were more likely to drop out of the study. Depressed mothers were as likely to participate actively in the intervention, and benefited as much from the intervention as non-depressed mothers.

Effects of chronically administered nicotine and saline on motor activity in rats

This study investigated the differential effects of chronically administered nicotine and saline on motor activity in the rat. Nicotine was administered via a subcutaneously implanted osmotic minipump to effect an 8 hour off, 16 hour on, flow. Subjects were 48 male and 48 female albino rats, each about 165 days old. Activity was monitored every hour for 192 consecutive hours. Results indicated that the female animals were more active than the males, and that animals receiving nicotine were significantly more active on the first two days of drug administration than control animals; however, by the fourth day there were no significant differences between the activity levels of animals that received nicotine and those of control animals.