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Biomedical subjects

R R Wing

Publications and source records attributed to R R Wing.

At least 217 records · Page 12Linked to original sources
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Psychosocial correlates of glycemic control: the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study.

The psychosocial correlates of glycemic control were examined in an incident cohort of childhood onset insulin-dependent diabetic subjects aged 18 years or older (n = 592). Glycosylated hemoglobin was measured at subjects' clinical examination, and questionnaires on diabetes self-care activity, barriers to regimen adherence and social support were completed. Demographic information was also collected. Glycosylated hemoglobin (GHb) was correlated with age, income and educational attainment (correlations coefficients between -0.1 and -0.2; P < 0.01), suggesting that older, more educated and wealthier patients have better glycemic control. GHb was also inversely associated with the degree of self-care activity (r = -0.11; P < 0.01), in particular administering injections at the recommended times and the frequency of performing blood/urine tests. Factors related to self-care behavior were identified, and included degree of social support (r = 0.14; P < 0.001) and patients' reports of difficulties adhering to their self-care regimen (r = -0.3; P < 0.0001). Gender was also related to self-care activities, with women reporting more self-care behavior than men (mean self-care scores 17.9 +/- 3.7 vs. 16.9 +/- 4.0; P < 0.01). Thus psychosocial factors (e.g. low income and education) may have an important effect on glycemic control in adults, and also (e.g. social support and adherence difficulties) seem particularly important in influencing the performance of self-care. As good metabolic control may help avoid the progression of diabetic complications, efforts need to be directed towards patients with these characteristics who are more likely to experience difficulties with self-care.

Adolescent↗
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Coping with dietary relapse crises and their aftermath.

We examined dieters' attempts to cope with dietary relapse crises (Immediate coping) and their aftermath (Restorative coping). We analyzed posttreatment interviews with 57 obese subjects with Type-II diabetes, comparing coping in situations in which subjects lapsed with those in which they survived temptations to overeat. Performance of Immediate coping predicted survival but the particular type of coping made little difference. Eight types of Immediate cognitive coping were equally associated with survival: each was significantly more effective than no coping and equal to the aggregate of the other types. A similar pattern held for 5 types of Immediate behavioral coping, except that social support was no more effective than no coping and restraint was less effective than the other types. Restorative behavioral coping was elicited as a response to overeating, while Restorative cognitive coping seemed elicited by the negative thoughts and feelings that sometimes accompany lapses or temptations. Implications for treatment and future research on relapse crises and coping are discussed.

Adaptation, Psychological↗
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Effects of mastery criteria and contingent reinforcement for family-based child weight control.

This study tested the effects of mastery criteria and contingent reinforcement in a family-based behavioral weight control program for obese children and their parents over two years. Families with obese children were randomized to one of two groups. The experimental group was targeted and reinforced for mastery of diet, exercise, weight loss, and parenting skills. The control group was taught behavior-change strategies and provided noncontingent reinforcement at a pace yoked to the experimental group. Both groups received the same behavioral family-based educational components over 6 months of weekly meetings and six monthly follow-up meetings. Results showed significantly better relative weight change at 6 months and 1 year for children in the experimental compared to the control group, but these effects were not maintained at 2 years. These results suggest the introduction of mastery criteria and contingent reinforcement for mastery can improve outcome during treatment in behavioral treatments for childhood obesity.

Analysis of Variance↗
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Sex differences among participants in a weight-control program.

The present study examines whether sex differences in behavioral and psychological variables related to weight control are explained by sex differences in weight standards and prior history of dieting. The predictive value of these sex differences for subsequent outcome in a behavioral weight-loss program was also examined. Women (N = 88) reported (a) more dieting behavior (both past and present), (b) leaner standards of desired weight, (c) more knowledge of weight-loss methods and nutrition, and (d) more motivational barriers to weight control than men (N = 98). Men reported (a) more knowledge barriers to weight control, and (b) higher levels of physical activity. Sex differences in motivational barriers, nutrition knowledge, and some of the weight-loss behaviors were eliminated by controlling statistically for weight standards and dieting history. Weight losses at 6, 12, and 18 months were consistently related to only two of the variables discriminating between men and women. Positive eating behaviors, such as eating diet foods and limiting food quantity, were prospectively related to less weight loss. Stimulus-control eating behaviors, such as eating only in one location, were prospectively related to greater weight loss. Men and women differed little in weight loss success. Since few behavioral and psychological variables were related to weight loss, different emphases in weight-loss treatments for men and women are not clearly indicated.

Adult↗
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Food intake and physical activity: a comparison of three measures of dieting.

We examined food preferences, dietary intake, and physical activity in dieters and nondieters using three different methods of dieting classification. One hundred three women and 99 men completed the cognitive restraint subscale of Stunkard and Messick's (1985) Three Factor Eating Questionnaire (TFEQ-R) and Herman and Polivy's (1980) Restraint Scale (RS), and answered questions about their current efforts to lose or maintain weight. Women identifying themselves as currently dieting to lose weight reported expending twice as much energy in physical activity compared to those reporting that they were either currently dieting to maintain weight or not dieting. There were no significant differences in dietary intake or physical activity by current dieting status in men. Women chronic dieters identified by high TFEQ-R scores reported lower total calorie intake and less frequent sweets consumption than women with low TFEQ-R scores. In men, those with high TFEQ-R scores reported consuming a greater percent of calories from protein and carbohydrate, less beef, pork, whole milk, and sweets. In women, the RS did not distinguish dieters from nondieters on any measure. In men, the RS results were similar to those from the TFEQ-R. These results show that current measures of dieting are only weakly related to behaviors thought to be indicative of dieting. Future research must develop more precise measures of dieting in order to examine the relationship between self-reports of dieting and behaviors thought to be related to dieting.

Adult↗
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Biobehavioral aspects of menopause: lessons from the Healthy Women Study.

The Healthy Women Study is an ongoing natural history study of the menopause in a sample of relatively healthy women. We report data from this paper on the behavioral and biological changes that occur during the transition from pre- to postmenopausal status and argue for the importance of behavioral change interventions to prevent or attenuate some of the adverse changes due to the menopause.

Adult↗
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Psychologic stress and blood glucose levels in nondiabetic subjects.

This study analyzed the effect of a standardized psychologic stressor on blood glucose levels in nondiabetic subjects. Subjects participated in a stress and nonstress session, presented in counterbalanced order. At each session, subjects were fed a carbohydrate load and blood glucose responses were measured 0, 30, 60, 90, and 120 min after the load. On nonstress days, subjects relaxed after drinking the load, while on stress days subjects participated in 30 min of competitive tasks immediately after the drink. The stress impaired the subjects' ability to handle the carbohydrate load; whereas on nonstress days, blood glucose levels peaked at 30 min after the load, on stress days the peak blood glucose response was delayed until 60 min after the drink.

Adult↗
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The effect of laboratory stressors on glycemic control and gastrointestinal transit time.

This study compared effects of an active coping task (computerized stressors involving arithmetic, anagrams, and Atari games) and a passive coping task (cold pressor) on gastrointestinal transit time and glycemic response to an oral glucose load. Eleven normal weight males were studied; subjects participated in three counterbalanced sessions, each including a 45-minute baseline, 20-minute experimental period (active coping, passive coping, or nonstress control) and 2.5-hour recovery period. The stressors produced different cardiovascular and catecholamine responses; systolic and diastolic blood pressure were highest during cold pressor (p less than 0.001), heart rate was highest during computer stressor (p less than 0.001), and norepinephrine excretion was greatest during cold pressor (p less than 0.002). However, both stressors delayed gastrointestinal transit time compared with the control condition (p less than 0.009 and p less than 0.026 for cold pressor and computerized stressor, respectively) and both delayed the time of peak glucose response (p less than 0.002 and p less than 0.05, respectively). Implications of these findings for patients with diabetes and for effects of stress on eating behavior are discussed.

Adaptation, Psychological↗
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Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors.

Waist to hip ratio (WHR) was measured in 487 middle-aged women participating in the Healthy Women Study. Upper body fat distribution was found to be associated with numerous behaviors that affect cardiovascular risk, including smoking, low exercise levels, weight gain during adulthood, and higher caloric intake. Moreover, WHR was also associated with higher levels of anger, anxiety, and depression and lower levels of perceived social support. Women with upper body fat obesity had higher systolic blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, and apolipoprotein B and lower levels of high density lipoprotein (HDL) and the HDL subfractions 2 and 3. These associations remained significant after adjusting for body mass index. Among 108 women who had repeat measurements of WHR, changes in WHR over a 3-year period were significantly correlated with changes in activity and with decreases in HDL2. Thus, WHR appears to be an integral component of the cardiovascular risk profile. WHR is related to those behaviors and psychosocial attributes that influence cardiovascular risk.

Adult↗
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Insulin, body mass index, and cardiovascular risk factors in premenopausal women.

This study assessed the relationship between insulin, glucose, body mass index, and cardiovascular risk factors in a sample of 489 white premenopausal women. All women were participants in the Healthy Women Study (University of Pittsburgh) and had normal blood pressure and fasting blood glucose of less than 140 mg/dl and a 2-hour value after a 75-g glucose load of less than 200 mg/dl. Both body mass index and fasting insulin were significantly and independently associated with blood pressure, triglycerides, and high density lipoprotein (HDL) cholesterol and its subfractions. Body mass index and fasting insulin were more strongly associated with coronary heart disease (CHD) risk factors than were 2-hour insulin, or fasting or 2-hour glucose; glucose levels did not contribute independently to multivariate predictions of any of the CHD risk factors. When patients were divided into tertiles according to fasting insulin and body mass index, there were significant main effects of insulin and body mass index on blood pressure, triglycerides, and HDL cholesterol and its subfractions; the interaction of insulin times body mass index was also significant for systolic blood pressure, triglycerides, and apoprotein B. These data confirm the previous findings of a strong association between insulin and CHD risk factors and extend this to healthy premenopausal women.

Adult↗
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Type II diabetic subjects lose less weight than their overweight nondiabetic spouses.

To determine whether diabetic individuals have more difficulty losing weight than nondiabetic individuals, 12 overweight diabetic subjects (6 men, 6 women) and their overweight nondiabetic spouses were treated together in a behavioral weight-control program. Diabetic and nondiabetic subjects did not differ in age, weight, or percent overweight. Weight losses of nondiabetic spouses were significantly greater than those of diabetic patients (13.4 +/- 1.7 vs. 7.5 +/- 1.4 kg; P less than .01). Differences emerged by wk 5 and became greater over the 20-wk program. Nondiabetic subjects reduced their intake significantly more than diabetics, suggesting that differences in dietary adherence were responsible for the differences in weight loss.

Behavior Therapy↗
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Analysis of changes in eating behavior and weight loss in type II diabetic patients. Which behaviors to change.

To identify the behavior-change strategies that are most clearly related to weight loss, 106 patients with type II (non-insulin-dependent) diabetes completed the Eating Behavior Inventory (EBI) before and after participating in a behavioral weight-loss program and at 1-yr follow-up. The EBI is a standardized questionnaire that assesses behavioral strategies typically taught in a behavioral weight-loss program. Pretreatment scores on the EBI were not related to weight-loss outcome, but changes on the EBI in the direction of more frequent use of appropriate strategies were related to weight loss at both posttreatment and 1-yr follow-up. Specific strategies related to weight loss at both times were 1) eating foods that help in losing weight, 2) recording foods eaten, 3) refusing food offered by others, and 4) being able to stop eating when appropriate. However, few patients maintained frequent use of these strategies at follow-up. It is concluded that weight-loss programs should focus on the strategies most strongly related to weight loss and try to improve long-term use of these techniques.

Diabetes Mellitus, Type 2↗
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Accuracy in estimating fasting blood glucose levels by patients with diabetes.

This study was designed to assess the accuracy with which diabetic patients can estimate their fasting blood sugars (FBS) and to determine whether experience with self-monitoring of blood glucose improves this ability. Twenty patients with type II diabetes who had no experience with self-monitoring of blood glucose were compared with 17 patients who had been monitoring blood sugar regularly for the previous 8 mo. All patients were asked to estimate FBS immediately before it was measured in the laboratory. Patients were very accurate in estimating their FBS; the average error in estimation was 2 mg/dl, and 65% of patients estimated FBS within 20% of actual FBS. However, there was no evidence that experience in self-monitoring of blood glucose improved the accuracy of estimation. Additional studies are needed to determine the types of cues that patients use in estimating blood sugar.

Adult↗
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Frequency and accuracy of self-monitoring of blood glucose in children: relationship to glycemic control.

We evaluated the long-term effects of self-monitoring of blood glucose (SMBG) on glycemic control in a large unselected group of insulin-dependent diabetic (IDD) children and adolescents (N = 282) treated at a diabetes clinic. Among those who had been taught SMBG techniques (N = 229) and reported frequency of use (N = 209), only 26% reported monitoring three or more times per day. HbA1 levels of patients who monitored their blood most frequently did not differ from those who monitored blood less frequently or those who monitored only urine. Likewise, HbA1 levels of patients who monitored with machines did not differ from Chemstrip bG users. Accuracy was assessed in a subsample of 100 randomly selected Chemstrip bG users by comparing their Chemstrip reading with a laboratory value. Fifty-eight percent of the readings were within 20% of the laboratory value. Accuracy did not relate to frequency of monitoring or to HbA1 levels. These data suggest that frequency and accuracy of SMBG are independent and that neither ensures good glycemic control.

Adolescent↗
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Compliance to self-monitoring of blood glucose: a marked-item technique compared with self-report.

This study compared subjects' self-reported rates of compliance to self-monitoring of blood glucose (SMBG) with an objective measure based on a "marked-item" technique. We followed 25 obese patients with type II diabetes who were participating in a behavorial weight control program and monitoring their blood glucose with Chemstrips bG (Bio-Dynamics, Inc., Indianapolis, Indiana). Subjects' self-report significantly overestimated actual compliance as assessed by the marked-item technique. Moreover, the self-report measure failed to identify 35-45% of the noncompliant patients. Compliance decreased steadily over the course of the 37-wk program. Accuracy of SMBG was less problematic than compliance; 85% of patients were able to read Chemstrips bG within 20% of actual blood sugar, and the average blood sugar reading obtained from 2 mo of SMBG correlated highly (r = 0.78, P less than 0.01) with HbA1. Our data suggest that objective measures such as the marked-item technique described in this article should be used to assess compliance to SMBG and behavioral strategies to improve compliance should be developed.

Adult↗
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Subclinical eating disorders and glycemic control in adolescents with type I diabetes.

Several recent case reports have shown that anorexia nervosa and bulimia negatively affect glycemic control in diabetic patients. However, there have been no systematic studies to assess the prevalence of clinical or subclinical eating disorders among diabetic patients or to determine the impact of such disturbances on glycemic control. This study reports a survey of 202 adolescents, aged 12-18 yr, seen in the Diabetes Clinic, Children's Hospital of Pittsburgh, who were asked to complete the Binge Eating Scale (BES) and the EAT-26 questionnaire. Responses of diabetic patients to the EAT-26 questionnaire were compared with those of a nondiabetic control group and were related to measures of glycemic control. Diabetic subjects scored higher on the total EAT-26 than nondiabetic control subjects, ordinarily indicative of more eating pathology. However, diabetic subjects scored higher only on the dieting subscale of this questionnaire, probably reflecting adherence to the diabetes dietary regimen. Subjects with diabetes scored lower, or did not differ significantly, from nondiabetic control subjects on measures of oral control and bulimia. Among diabetic subjects, self-reported bulimic behaviors were related to poorer glycemic control. Patients with the highest scores on the BES had an average HbA1 of 13.1% compared with 11.8% for age- and sex-matched patients at the 50th percentile, and 10.8% for patients in the lowest 10th percentile. Further studies are needed to determine whether modification of these eating behaviors would improve glycemic control.

Adolescent↗
PubMedDate not supplied

Behavioral skills in self-monitoring of blood glucose: relationship to accuracy.

Sixty-two children and adolescents with IDDM were observed while performing self-monitoring of blood glucose (SMBG) to determine which of the behaviors involved in SMBG were most likely to be performed incorrectly and which errors had the greatest effect on the accuracy of SMBG readings. Behaviors related to cleanliness and timing were performed most poorly; only 60% of the subjects correctly timed the first minute, and 30-33% correctly timed the second interval. The duration of SMBG and frequency of monitoring were not related to proper performance of the behaviors involved in SMBG. Accuracy of SMBG was assessed by comparing subjects' readings to laboratory values obtained immediately afterward. The behavior that had the greatest effect on the accuracy of SMBG readings was that concerning whether the blood was adequately wiped from the Chemstrip bG. This behavior should receive more emphasis in SMBG training programs. The systematic observation procedure used in this study may help to identify errors made by patients while performing SMBG and may serve as the basis for training programs to improve SMBG accuracy.

Adolescent↗