The effect of physical, social and psychological factors on drug compliance in patients with mild hypertension

Background. In patients with hypertension noncompliance with drug treatment is between 15 to 54%, and has been recognised as a relevant contributor to the burden of cardiovascular morbidity. Up to 92% of patients experience unpleasant symptoms with their condition and, particularly in these patients, the symptoms experienced may enhance compliance. Objective. To simultaneously assess the effects of physical, social and psychological factors on noncompliance. Methods. Patients with mild hypertension despite drug treatment, from the departments of cardiology and internal medicine, were requested to answer a self-administered questionnaire addressing the presence of physical symptoms as well as psychosocial factors. The questionnaire was based on previously used test batteries and consisted of two lists of physical complaints and four lists addressing the four domains of planned behaviour regarding medical non-adherence according to Baron and Byrne. These domains mainly assess psychosocial factors. Each list consisted of three or more items and each item was scored on fiveto seven-point scales. Mean scores were used for assessment. The lists were also separately assessed for internal consistency and reliability using Cronbach’s alphas. One-way analysis of variance and multivariate analysis of variance (MANOVA) with compliance as outcome variable and the physical, social and psychological variables as indicator variables were used for data analysis. MANOVA was adjusted for multiple testing. Results. Many patients experienced physical symptoms due to hypertension, such as tiredness (31%), hot flushes (28%), headache (24%), reduced daily life energy (23%), palpitations (22%), with 95% confidence intervals between 16 to 38%. Scores for physical symptoms and social factors did not differ between self-reported adherers (n=165) and nonadherers (n=11). However, the score for psychological factors was significantly larger in the adherers than in the non-adherers, 5.05 versus 3.06, p<0.018. The MANOVA showed a significant overall difference between the adherers and non-adherers in the data at p<0.012, which was mainly due to the score for psychological factors. Conclusion. The effect of physical symptoms on non-compliance in mildly hypertensive patients is negligible. So is the effect of social factors. Psychological factors such as lacking a sense of guilt, regret and shame are major determinants of non-compliance. Physicians may play an educational role in improving their patients’ compliance by addressing these determinants. We should add that the conclusions should be made with reservations, given the small number of non-adherers in our sample. (Neth Heart J 2008;16:197-200.)     

A strategy for sequence phylogeny research.

Minimal mutation trees, and almost minimal trees, are constructed from two data sets, one of phenylalanine tRNA sequences, and the other of 5S RNA sequences, from a diverse range of organisms. The two sets of results are mutually consistent. Trees representing previous evolutionary hypotheses are compared using a total weighted mutational distance criterion. The importance of sequence data from relatively little-studed phylogenetic lines is stressed. A procedure is illustrated which circumvents the computational difficulty of evaluating the astronomically large number of possible trees, without resorting to suboptimal methods.     

A novel 'sit and wait' reproductive strategy in social wasps

I present evidence indicating that a subset of spring females in the social wasp Polistes dominulus do not initiate colonies but rather ''sit and wait'' to adopt colonies initiated and abandoned by other conspecifics. These results are, to my knowledge, the first to demonstrate conclusively this alternative reproductive strategy in social wasps. Individuals engaging in the sit-and-wait strategy behave selfishly by adopting the most mature nests available; such nests will produce workers sooner than less mature nests and, consequently, are more likely to survive. The sit-and-wait reproductive strategy may safeguard an individual from early-season, foraging-related mortality as well as reduce early-season energy expenditure.     

Simulated Trust: A cheap social learning strategy

Animals use heuristic strategies to determine from which conspecifics to learn socially. This leads to directed social learning. Directed social learning protects them from copying non-adaptive information. So far, the strategies of animals, leading to directed social learning, are assumed to rely on (possibly indirect) inferences about the demonstrator’s success. As an alternative to this assumption, we propose a strategy that only uses self-established estimates of the pay-offs of behavior. We evaluate the strategy in a number of agent-based simulations. Critically, the strategy’s success is warranted by the inclusion of an incremental learning mechanism. Our findings point out new theoretical opportunities to regulate social learning for animals. More broadly, our simulations emphasize the need to include a realistic learning mechanism in game-theoretic studies of social learning strategies, and call for re-evaluation of previous findings.     

肠道菌群与高血压及其危险因素研究进展及问题探讨

高血压是目前最常见的心血管疾病之一,已成为全球范围内的公共卫生问题。众所周知,维持血压稳态是一个复杂的过程,高血压是一种受多种因素影响的疾病,主要受遗传和环境因素影响。核酸测序揭示肠道菌群所包含的基因是人类基因的100多倍,这些基因产生的激素、神经递质和炎症分子可以进入宿主循环而影响宿主生理变化。目前越来越多的研究表明肠道菌群及其代谢产物能影响机体的代谢、免疫和内环境稳态等,从而在高血压发病机制中起主要作用。因此,通过调节肠道菌群及其代谢产物可作为治疗高血压的新策略。

     

A social ethological perspective applied to care of and research on songbirds

The interrelationships among individuals in gregarious species can have profound effects on the animals' behavior, physiology, and even health. Captive housing should address the social needs of such species because failure to do so can result in the development and expression of abnormal behavior. But determining what social stimuli to provide for any given species poses many challenges. I review recent work on brown-headed cowbirds (Molothrus ater) that was designed to identify the social stimuli critical for effective development and breeding. The work demonstrates the importance of social experiences in organizing reproductive physiology and behavior, so much so that inattention to these experiences can lead to misinterpretation of the function and mechanisms of the birds' behavior. There are no general rules applicable to all social species, however. Determining the social conditions needed for members of any species requires an ethological approach that evaluates the sensory, cognitive, and ecological characteristics of the species and considers those characteristics in the design of captive housing and research.     

The psychological and social effects of myocardial infarction on wives.

Eighty-two wives of men suffering a first myocardial infarction were interviewed while their husbands were in hospital, and again two months and a year after they went home. The wives had substantial and persistent psychological symptoms, and the husbands'' illness had continuing effects on their work, leisure and social activities, and family life and marriage, their psychosocial disability being comparable to that of the patients. Measures of psychosocial adjustment before the illness and the quality of the marriage and of family life were good predictors of outcome for the wives. The women had a major role in the patients'' readjustment during convalescence, and their attitudes and behaviour as well as the general quality of family life were important determinants of the rate and extent of the patients'' recovery. The wives of patients with myocardial infarction should have more practical help and advice during the hospital period, and the whole family should be given advice and help throughout the convalescence.     

Tay-Sachs screening: social and psychological impact.

Participants in two Tay-Sachs screening programs were generally satisifed with the organization of the tests and the results. There was no evidence of adverse impact on reproductive plans or interpersonal relations, and the respondents professed to believe in the value of screening. While the carriers discussed their condition freely with others and were no less favorable to the idea of screening than the noncarriers, about one-half of their number expressed discomfort in being told they were heterozygotes. These feelings were allayed by counseling, but there was evidence of some residual unease. It is suggested that this anxiety would be less prominent and more easily reduced if screening were done under conditions of ordinary primary medical care rather than outside the conventional system.     

Climate, social factors and research disturbance influence population dynamics in a declining sociable weaver metapopulation

Population trends are determined by gains through reproduction and immigration, and losses through mortality and emigration. These demographic quantities and resulting population dynamics are affected by different external and internal drivers. We examined how these demographic quantities were affected by weather, research-induced disturbance, local density, colony site and year in a metapopulation of 17 sociable weaver (Philetairus socius) colonies over 17 years of study (4 years for reproduction). Most colonies declined, but at different rates. The four demographic quantities were related to different drivers. Survival strongly varied among years and colonies and was positively related to rainfall and negatively related to extreme temperature (together explaining 30 % of variation) and disturbance (measured as number of captures conducted at a colony; 7 %). There was a trend for a positive relationship between reproduction and rainfall (50 %). Movement was mainly related to local density: individuals were more likely to emigrate from small to large colonies and from colonies that were either well below or above their long-term mean. They were more likely to immigrate into colonies that were nearby, and below their mean size. We then quantified the effects of these relationships on metapopulation dynamics using a multi-site matrix projection model. Rainfall was potentially a strong driver of metapopulation dynamics. In addition, field-work disturbance might have contributed to the decline of this metapopulation but could not explain its full magnitude. Hence, through a combination of analytical methods we were able to obtain information on the main drivers affecting dynamics in a declining metapopulation.     

A new research strategy for integrating studies of paleoclimate,paleoenvironment, and paleoanthropology

Paleoanthropologists (scientists studying human origins) universally recognize the evolutionary significance of ancient climates and environments for understanding human origins. 1 - 6 Even those scientists working in recent phases of human evolution, when modern humans evolved, agree that hunter‐gatherer adaptations are tied to the way that climate and environment shape the food and technological resource base. 7 - 10 The result is a long tradition of paleoanthropologists engaging with climate and environmental scientists in an effort to understand if and how hominin bio‐behavioral evolution responded to climate and environmental change. Despite this unusual consonance, the anticipated rewards of this synergy are unrealized and, in our opinion, will not reach potential until there are some fundamental changes in the way the research model is constructed. Discovering the relation between climate and environmental change to human origins must be grounded in a theoretical framework and a causal understanding of the connection between climate, environment, resource patterning, behavior, and morphology, then move beyond the strict correlative research that continues to dominate the field.     

A mixed strategy model for the emergence and intensification of social learning in a periodically changing natural environment

Based on a population genetic model of mixed strategies determined by alleles of small effect, we derive conditions for the evolution of social learning in an infinite-state environment that changes periodically over time. Each mixed strategy is defined by the probabilities that an organism will commit itself to individual learning, social learning, or innate behavior. We identify the convergent stable strategies (CSS) by a numerical adaptive dynamics method and then check the evolutionary stability (ESS) of these strategies. A strategy that is simultaneously a CSS and an ESS is called an attractive ESS (AESS). For certain parameter sets, a bifurcation diagram shows that the pure individual learning strategy is the unique AESS for short periods of environmental change, a mixed learning strategy is the unique AESS for intermediate periods, and a mixed learning strategy (with a relatively large social learning component) and the pure innate strategy are both AESS's for long periods. This result entails that, once social learning emerges during a transient era of intermediate environmental periodicity, a subsequent elongation of the period may result in the intensification of social learning, rather than a return to innate behavior.     

A mixed strategy model for the emergence and intensification of social learning in a periodically changing natural environment

Based on a population genetic model of mixed strategies determined by alleles of small effect, we derive conditions for the evolution of social learning in an infinite-state environment that changes periodically over time. Each mixed strategy is defined by the probabilities that an organism will commit itself to individual learning, social learning, or innate behavior. We identify the convergent stable strategies (CSS) by a numerical adaptive dynamics method and then check the evolutionary stability (ESS) of these strategies. A strategy that is simultaneously a CSS and an ESS is called an attractive ESS (AESS). For certain parameter sets, a bifurcation diagram shows that the pure individual learning strategy is the unique AESS for short periods of environmental change, a mixed learning strategy is the unique AESS for intermediate periods, and a mixed learning strategy (with a relatively large social learning component) and the pure innate strategy are both AESS's for long periods. This result entails that, once social learning emerges during a transient era of intermediate environmental periodicity, a subsequent elongation of the period may result in the intensification of social learning, rather than a return to innate behavior.     

The impact of psychological distress on the control of hypertension

Previous research has yielded inconsistent results in the control of essential hypertension. One explanation for response to drug or behavioral therapy may be the patient's psychological status upon entering treatment. Thirty-five borderline hypertensive males entered into a self-management program with biofeedback and cognitive restructuring components. The SCL-90 (Symptom Checklist-90) and the Holmes' Schedule of Recent Events were used to determine if responders and nonresponders could be distinguished prior to treatment on the basis of psychological status. Patients whose hypertension was resistant to treatment (diastolic greater than or equal to 90 mm Hg) reported significantly greater levels of psychological distress and greater life changes than did controlled patients. Pretreatment differences could not be explained by compliance or expectation of success. This study suggests that a relationship exists between psychological distress, life changes and the subsequent control of hypertension; this has implications for treatment selection and design for psychologically distressed individuals.     

Domestic pigs alter their social strategy in response to social group size

In a series of studies, we investigated the concept that domesticated pigs may adopt cost efficient social strategies, in which individuals become less aggressive due to a higher number of potential competitors, in large social groups. Six blocks, each comprising four pens of 18 pigs (small group, SG) and two pens of 108 pigs (large group, LG) were used. Pigs were 11 weeks old at the initial group formation. Weeks 1, 6 and 12 following SG and LG formation, two randomly selected pigs with SG or LG social experience were incorporated into another SG or LG for a period of 2 h and the aggressive behaviour of pigs was observed. Four test combinations were used (SG to SG (SS), SG to LG (SL), LG to SG (LS) and LG to LG (LL)). There was less aggression in the LL compared to SS, SL and LS combinations (1.6% versus 2.5, 2.3, and 2.5% of time, respectively, P = 0.009). Furthermore, 8 weeks following SG and LG formation, a total of 200 pigs were regrouped for 2 h in groups of four in a neutral test arena to assess the effect of prior social experience (SG vs. LG) on aggressive behaviour. Pigs were regrouped with their own group members (familiar), or with unfamiliar non-group members either from SG or LG. Five test combinations were used (four pigs from the same SG (S), four pigs from the same LG (L), two pigs from a SG and two pigs from a LG (SL), two pigs each from two different LG (LL) and two pigs each from two different SG (SS)). Pigs derived from SG fought aggressively (duration, s) with unfamiliar pigs, compared to those derived from LG (4.9, 6.7, 16.1, 12.1 and 9.5 s for S, L, SS, SL and LL test combinations respectively, P < 0.001). In addition, the latency to initiate first aggressive interaction was shorter (duration, s) in SS than LL treatment combination (23.3, 22.5, 10.8, 11.8 and 19.2 s for S, L, SS, SL and LL test combinations respectively, P = 0.008). Taken together, our results suggest that pigs become less aggressive and may shift to a low-aggressive social strategy in large social groups. This may provide potential benefits for welfare of pigs under commercial production situations.