Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study. Social relationships and their biological correlates: Coronary Artery Risk Development in Young Adults (CARDIA) study Women, Loneliness, and Incident Coronary Heart Disease A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol Protocol for ADDITION-PRO: a longitudinal cohort study of the cardiovascular experience of individuals at high risk for diabetes recruited from Danish primary care Social isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study. The effect of social support and physical touch on cardiovascular reactions to mental stress. Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study. Affiliation Moderates the Effects of Social Threat on Stress-Related Cardiovascular Responses: Boundary Conditions for a Laboratory Model of Social Support Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study Effects of a psychosocial skills training workshop on psychophysiological and psychosocial risk in patients undergoing coronary artery bypass grafting. The Psychological Impact of Screening for Risk of Coronary Heart Disease in Primary Care Settings A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings Mental activation of supportive ties, hostility, and cardiovascular reactivity to laboratory stress in young men and women.
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 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 Objective : To examine associations between loneliness and risk of incident coronary heart disease ( CHD )  over a 19-year follow-up period in a community sample of men and women .  Loneliness , the perceived discrepancy between actual and desired social relationships , has been linked to several adverse health outcomes . However , no previous research has prospect ively examined the association between loneliness and incident CHD in a community sample of men and women . Methods : Hypotheses were examined using data from the First National Health and Nutrition Survey and its follow-up studies ( n = 3003 ) .  Loneliness  , assessed by one item from the Center for Epidemiologic Studies of  Depression scale , and covariates were derived from baseline interviews .  Incident CHD was derived from hospital records/death certificates over 19 years of follow-up . Hypotheses were evaluated , using Cox proportional hazards models . Results : Among women , high loneliness  was associated with increased risk of incident CHD ( high : hazard ratio = 1.76 , 95 % Confidence Interval = 1.17–2.63 ; medium : hazard ratio = 0.98 , 95 % Confidence Interval = 0.64–1.49 ; reference : low ) , controlling for age , race , education , income , marital status , hypertension , diabetes , cholesterol , physical activity , smoking , alcohol use , systolic and diastolic blood pressures , and body mass index . Findings persisted additionally controlling for depressive symptoms . No significant associations were observed among men . Conclusions : Loneliness was prospect ively associated with increased risk of incident CHD , controlling for multiple confounding factors . Loneliness among women may merit clinical attention , not only due to its impact on quality of life but also its potential implication s for cardiovascular health . CHD = coronary heart disease ; SBP = systolic blood pressure ; NHANES I = First National Health and Nutrition Examination Survey ; CESD = Center for Epidemiologic Studies of Depression ; BMI = body mass index ; ICD-9 = International Classification of Diseases , Ninth Revision Introduction Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk . In this project , we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice . Consumer Navigation of Electronic Cardiovascular Tools ( CONNECT ) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Isl and er and non-indigenous adults , recruited through primary care , at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care . Methods and analysis R and omised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk . The trial will be augmented by formal economic and process evaluations to assess acceptability , equity and cost-effectiveness of the intervention . The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management . The programme is electronically integrated with the primary care provider 's software and will include interactive smart phone and Internet platforms . The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline -recommended blood pressure ( BP ) and cholesterol targets . Secondary outcomes include change in mean BP and fasting cholesterol levels , proportion meeting BP and cholesterol targets separately , self-efficacy , health literacy , self-reported point prevalence abstinence in smoking , body mass index and waist circumference , self-reported physical activity and self-reported medication adherence . Ethics and dissemination Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences Clinical Trials registration number ACTRN12613000715774 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 AIMS Prospect i ve studies have shown that social isolation ( i.e. lack of social contacts ) predicts incident coronary heart disease ( CHD ) , but it is unclear whether it predicts incident heart failure ( HF ) and what factors might mediate this association . HF patients may be more susceptible to social isolation as they tend to be older and may have disrupted social relationships due to life course factors ( e.g. retirement or bereavement ) . We prospect ively examined whether individuals with higher vs. low social isolation  have a higher incidence of HF and determined whether this association is mediated by vital exhaustion . METHODS AND RESULTS We estimated incident HF hospitalization or death among 14 348 participants from Visit 2 ( 1990 - 1992 ) in the Atherosclerosis Risk in Communities ( ARIC ) study using Cox proportional hazard models which were sequentially adjusted for age , race/ study community , gender , current smoking , alcohol use , and co-morbidities . We conducted mediation analyses according to the Baron and Kenny method . After a median follow-up of 16.9 person-years , 1727 ( 13.0 % ) incident HF events occurred . The adjusted hazard of incident HF was greater for those in the higher vs. low social isolation risk group ( hazard ratio 1.21 , 95 % confidence interval 1.08 - 1.35 ) . Our data suggest that vital exhaustion strongly mediates the association between higher social isolation and incident HF ( the percentage change in beta coefficient for higher vs. low social isolation groups after adjusting for vital exhaustion was 36 % ) . CONCLUSION These data suggest that greater social isolation is an independent risk factor for incident HF , and this association appears to be strongly mediated by vital exhaustion To examine the effects of social support on cardiovascular reactions to behavioral stress , the present study tested the relative contribution of three elements of social support : the presence of another person in the laboratory ; the presence of a person considered to be a friend ; and physical touch .  Sixty undergraduate females were assigned to one of the following groups : alone ( A ) ; friend present-touch ( FT ) ; friend present-no touch ( FNT ) ; stranger present-touch ( ST ) ; and stranger present-no touch ( SNT ) . Heart rate ( HR ) , systolic blood pressure ( SBP ) , and diastolic blood pressure ( DBP ) measures were obtained across baseline phases and during presentation of two behavioral challenges ( mental arithmetic , mirror-tracing ) . The findings suggest that neither the presence of a stranger nor physical touch are related to attenuated cardiovascular reactions to stress ; rather , if the extent of cardiovascular reactivity is related to social support , the presence of a friend may be the important mediating variable BACKGROUND Social inequalities in the incidence of type 2 diabetes and the relation of health behaviors and psychosocial factors to the incidence of type 2 diabetes are not well established . METHODS Prospect i ve occupational cohort study of 10 308 civil servants aged 35 to 55 years at baseline in phase 1 ( 1985 - 1988 ) . Diagnosis of diabetes was ascertained by question naire at baseline and follow-up at phases 2 ( 1989 ) , 3 ( 1992 - 1993 ) , 4 ( 1995 ) , and 5 ( 1997 - 1999 ) and glucose tolerance tests in phases 3 and 5 . RESULTS Participants working in the lower employment grade s had a higher incidence of diabetes than those in higher employment grade s ( men : odds ratio [ OR ] , 2.9 ; 95 % confidence interval [ CI ] , 1.9 - 4.4 ; women : OR , 1.7 [ 95 % CI , 0.8 - 3.7 ] ) . Body mass index and other risk factors considered traditional for type 2 diabetes were found to be so in this cohort . In men , of the psychosocial risk factors examined , only effort-reward imbalance was related to incidence of diabetes ( OR , 1.7 [ 95 % CI , 1.0 - 2.8 ] ) . The General Health Question naire depression subscale was related to incidence of diabetes and impaired glucose tolerance ( OR , 1.25 [ 95 % CI , 1.0 - 1.6 ] ) . These associations remained after adjustment for other confounding factors . In men only , social difference in incidence of diabetes was reduced but still significant after adjustment for conventional risk factors . CONCLUSIONS An inverse relationship exists between social position and incidence of diabetes that is partly explained by health behaviors and other risk factors . Effort-reward imbalance , which is reportedly associated with coronary heart disease , is also associated with type 2 diabetes The authors tested the hypothesis that the response-attenuating effects of affiliation under stress are limited to conditions that involve high social threat . Ninety-six young adult women were exposed to st and ardized psychological challenges  in one of four conditions that involved two levels of social affiliation ( alone or accompanied by a close friend ) and two levels of social threat ( variations in the social behavior and perceived status of the experimenter ) . Social affiliation was associated with attenuated blood pressure responses to the challenges but only under conditions of high social threat . Affiliation was not associated with differences in self-reported emotional response to the challenges nor with alterations in cognitive task appraisal . Exploratory analyses suggested that some of these effects were stronger in hostile or socially avoidant individuals . Implication s of these findings for interpreting the literature on social support and cardiovascular reactivity , and for underst and ing the potential role of social support in reducing stress-related disease pathogenesis , are discussed 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 Objectives Investigate the association between socioeconomic deprivation and completeness of cardiovascular disease ( CVD ) risk factor recording in primary care , uptake of screening in people with incomplete risk factor recording and with actual CVD risk within the screened subgroup . Design Cross-sectional study . Setting Nine UK general practice s. Participants 7987 people aged 50–74 years with no CVD diagnosis . Methods CVD risk was estimated using the Framingham equation from data extracted from primary care electronic health records . Where there was insufficient information to calculate risk , patients were invited to attend a screening assessment . Analysis Proportion of patients for whom clinical data were sufficiently complete to enable CVD risk to be calculated ; proportion of patients invited to screening who attended ; proportion of patients who attended screening whose 10-year risk of a cardiovascular event was high ( > 20 % ) . For each outcome , a set of logistic regression models were run . Crude and adjusted ORs were estimated for person-level deprivation , age , gender and smoking status . We included practice -level deprivation as a continuous variable and practice as a r and om effect to account for clustering . Results People who had lower  Indices of Multiple Deprivation ( IMD ) scores ( less deprived ) had significantly worse routine CVD risk factor recording ( adjusted OR 0.97 ( 0.95 to 1.00 ) per IMD decile ; p=0.042 ) . Screening attendance was poorer in those with more deprivation ( adjusted OR 0.89 ( 0.86 to 0.91 ) per IMD decile ; p<0.001 ) . Among those who attended screening , the most deprived were more likely to have CVD risk > 20 % ( OR 1.09 ( 1.03 to 1.15 ) per IMD decile ; p=0.004 ) . Conclusions Our data suggest that those who had the most to gain from screening were least likely to attend , potentially exacerbating existing health inequalities . Future research should focus on tailoring the delivery of CVD screening to ensure engagement of socioeconomically deprived groups Substantial evidence links high levels of hostility , stress , depression , and social isolation with increased risk of cardiovascular disease ( CVD ) , along with poorer prognosis after myocardial infa rct ion ( MI ) . Further , these variables have been shown to cluster in particular individuals , producing even greater risk . One of the mechanisms thought to link psychosocial factors with CVD is cardiovascular reactivity ( CVR ) . Exaggerated CVR to stress has been shown to be associated with accelerated atherosclerosis , increased CVD risk , and stroke incidence . Interventions for reducing psychosocial coronary risk factors and promoting recovery from coronary heart disease ( CHD ) have included both educational programs aim ed at lifestyle and behavior change and cognitivebehavioral interventions targeted at changing specific psychosocial risk factors such as hostility . A recent meta- analysis found that stress management and educational programs for CHD patients significantly reduced blood pressure ( BP ) , cholesterol , body weight , and emotional distress and lowered the recurrence of MI and mortality by 29 % and 34 % , respectively . However , not all of the trials evaluating these interventions have been r and omized , and some have had small sample sizes . In addition , a number of these interventions have been targeted at patients identified as being at high psychosocial risk , which raises questions about the extent to which the effectiveness of such programs is limited to high-risk patients as compared with the patient Aims A prospect i ve study was conducted to identify the psychological impact of labelling middle-aged men as having above average risk for coronary heart disease . A second aim was to find out the psychological effect of participation in a subsequent clinical trial . Methods 5813 men attended nine special screening clinics in Engl and and Scotl and for baseline measurement of psychological symptoms and coronary disease risk factors . Each man was later informed of his risk status by letter as either above average risk ( high-risk ) or no special risk ( low-risk ) . In three clinics some men also received an intermediate risk ( moderate-risk ) between high-risk and low-risk . Follow-up psychological measurements were made after labelling and 3 months later . Results Men who received either the high-risk label ( n = 838 ) or the low-risk label ( n = 3114 ) showed a decrease in reported psychological symptoms after labelling . Men receiving the unexpected intermediate risk ( moderate-risk ) label , which communicated specific test abnormalities , increased their psychological symptoms to ‘ case ’ levels on the General Health Question naire ; relative risk ( compared with low-risk ) was 1.80 ( 95 % confidence interval 1.19 - 2,71 ) after adjustment for confounding factors . Compliers with a subsequent clinical trial decreased their risk of becoming cases and , if ill at trial entry , increased their case remission rate . Conclusions The ascription of an ‘ above average risk ’ label for coronary disease to middle-aged men does not adversely affect the psychological state of those who receive it if they have received preparation for risk labelling . However , communicating abnormal coronary disease test results without adequate preparation confers short-term psychological harm . Non-specific support from familiar general practice professionals received by participants in a clinical trial reduces the risk of psychological ill-health . All coronary disease screening programmes should include adequate pre-labelling preparation for all risk labels and abnormal results Loneliness is a prevalent and global problem for adult population s and has been linked to multiple chronic conditions in quantitative studies . This paper presents a systematic review of quantitative studies that examined the links between  loneliness  and common chronic conditions including : heart disease , hypertension , stroke , lung disease , and metabolic disorders . A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness population s.  Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease , hypertension , stroke , and lung disease . The relationships among loneliness , obesity , and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons . Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions . Future longitudinal r and omized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care Abstract Background Coronary heart disease ( CHD ) is the most prevalent type of cardiac disease among adults worldwide , including those in Singapore . Most of its risk factors , such as smoking , physical inactivity and high blood pressure , are preventable . mHealth has improved in the last decade , showing promising results in chronic disease prevention and health promotion worldwide . Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention ( SBCHDP ) programme in improving awareness and knowledge of CHD , perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore . Methods The smartphone app “ Care4Heart ” was developed as the main component of the programme . App content was review ed and vali date d by a panel of experts , including two cardiologists and two experienced cardiology-trained nurses . A pilot r and omised controlled trial was conducted . Eighty working people were recruited and r and omised to either the intervention group ( n = 40 ) or the control group ( n = 40 ) . The intervention group underwent a 4-week SBCHDP programme , whereas the control group were offered health promotion websites only . The participants ’ CHD knowledge , perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Question naire-2 , Perceived Stress Scale , and Behavioural Risk Factor Surveillance System . Results After the SBCHDP programme , participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore ( X2 = 6.486 , p = 0.039 ) , a better overall CHD knowledge level ( t = 3.171 , p = 0.002 ) , and better behaviour concerning blood cholesterol control ( X2 = 4.54 , p = 0.033 ) than participants in the control group . Conclusion This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population . Due to the small sample size and short follow-up period , this study was underpowered to detect significant differences between groups . A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme Background Relatively little is known about how  depression amongst people with chronic illness is identified and managed in diverse primary health care setting s. We evaluated the role of complex physical needs in influencing current practice of depression screening , documentation and antidepressant prescriptions during a 12-month period , among adults with Type 2 diabetes attending Aboriginal and Torres Strait Isl and er primary care health centres in Australia . Methods We analysed clinical audit data from 44 health centres participating in a continuous quality improvement initiative , using previously reported st and ard sampling and data extraction protocol s. Eligible patients were those with Type 2 diabetes with health centre attendance within the past 12 months . We compared current practice in depression screening , documentation and antidepressant prescription between patients with different disease severity and co-morbidity . We used r and om effects multiple logistic regression models to adjust for potential confounders and for clustering by health centre . Results Among the 1174 patients with diabetes included , median time since diagnosis was 7 years , 19 % of patients had a co-existing diagnosis of Ischaemic Heart Disease and 1/3 had renal disease . Some 70 % of patients had HbAc1>7.0 % ; 65 % had cholesterol > 4.0 mmol1 - 1 and 64 % had blood pressure>130/80 mmHg . Documentation of screening for depression and of diagnosed depression were low overall ( 5 % and 6 % respectively ) and lower for patients with renal disease ( Adjusted odds ratio [ AOR ] 0.21 ; 95 % confidence interval [ CI ] 0.14 to 0.31 and AOR 0.34 ; 95 % CI 0.15 to 0.75 ) , and for those with poorly controlled disease ( HbA1c>7.00 ( AOR 0.40 ; 95 % CI 0.23 to 0.68 and AOR 0.51 ; 95 % CI 0.30 to 84 ) ) . Screening for depression was lower for those on pharmaceutical treatment for glycaemic control compared to those not on such treatment . Antidepressant prescription was not associated with level of diabetes control or disease severity . Conclusions Background levels of depression screening and documentation were low overall and significantly lower for patients with greater disease severity . Strategies to improve depression care for vulnerable population s are urgently required . An important first step in the Australian Indigenous primary care context is to identify and address barriers to the use of current clinical guidelines for depression screening and care In addition to actual social interactions , internal representations of supportive ties could affect mechanisms linking relationships and health . Undergraduates ( 41 men , 41 women ) wrote about supportive ties or casual acquaintances . Supportive ties were rated as warmer and less controlling than acquaintances , and writing about them evoked reductions in negative affect , especially for low-hostile participants . Compared with the acquaintance condition , the supportive tie condition result ed in reduced heart rate and blood pressure response during a subsequent speech stressor . Among women , the supportive tie condition reduced blood pressure response among low- but not among high-hostile participants . Hence , mental activation of supportive ties altered effects of laboratory stress and might be relevant to the effects of social relations on health
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 .