Background Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. Methods We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). Results More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P = 0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P = 0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.)

OBJECTIVE -There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes. The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy. Unfortunately, widespread use of such interventions is not practical. The aim of the present investigation is to determine whether a cost-effective, group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results.RESEARCH DESIGN AND METHODS -Patients with type 2 diabetes were randomized to undergo a five-session group diabetes education program with or without stress management training. Participants (n ϭ 108) were followed for 1 year, during which HbA 1c tests and questionnaires assessing perceived stress, anxiety, and psychological health were administered at regular intervals to evaluate treatment effects.RESULTS -Stress management training was associated with a small (0.5%) but significant reduction in HbA 1c . Compliance with the treatment regimen decreased over time but was similar to that seen in patients receiving stress management for other reasons in the clinic. Trait anxiety (a measure of stable individual differences in anxiety proneness) did not predict response to treatment, showing that highly anxious patients did not derive more benefit from training. CONCLUSIONS -The current results indicate that a cost-effective, group stress management program in a "real-world" setting can result in clinically significant benefits for patients with type 2 diabetes.

In this article, a biopsychosocial model of adolescent development is used as an organizing framework for a review of primary, secondary, and tertiary prevention research with adolescent populations. During adolescence many critical health behaviors emerge, affecting future disease outcomes in adulthood. In addition, most of the predominant causes of morbidity and mortality in adolescence are unique to this period of development, indicating that health-focused interventions must be tailored specifically to adolescents. Moreover, it is during adolescence that lifelong patterns of self-management of and adjustment to chronic health conditions are established. Thus, an increased focus on adolescence in health psychology research is important both to improve the health of adolescents per se and to optimize health trajectories into adulthood.Adolescence has historically been a developmental period of relative neglect with respect to research on both mental and physical health intervention and outcome. Perhaps such neglect has occurred because, from a health perspective, morbidity and mortality rates are quite low during adolescence compared with other developmental periods (Holden & Nitz, 1995). However, as we argue in this article, adolescence is a pivotal period of development with respect to health and illness. First, it is during adolescence that many positive health behaviors (e.g., diet and exercise) are consolidated and important health risk behaviors (e.g., smoking, alcohol and drug use, and unsafe sexual practices) are first evident; thus, adolescence is a logical time period for primary prevention intervention. Second, the predominant causes of morbidity and mortality in adolescence are quite different from adults, indicating that early identification and treatment of adolescent health problems must be directed toward a unique set of targets in this age group. Moreover, because of the particular developmental issues that characterize adolescence, intervention efforts designed for adults are often inappropriate or ineffective in an adolescent population. Finally, even when chronic illnesses are congenital or begin in childhood (e.g., spina bifida, Type 1 diabetes), the manner in which the transition from childhood to adolescence to young adulthood is negotiated has important implications for disease outcomes throughout the remainder of the life span.Given the unique developmental challenges of adolescence, we argue that an effective and theoretically sound approach to adolescent health psychology research and treatment must be firmly grounded in a developmental framework. We present a biopsychosocial model of adolescent development as one such framework that can inform primary, secondary, and tertiary prevention research and interventions targeting adolescents. This article is organized around the three levels of health-related prevention as they apply to adolescence. Within these levels, we include discussion of the adolescent-focused aspects of what Smith and Ruiz (1999) characterize as the predominant res...

Maintenance of relationship quality requires self-regulation of emotion and social behavior, and women often display greater effort in this regard than do men. Furthermore, such efforts can deplete the limited capacity for self-regulation. In recent models of self-regulation, resting level of respiratory sinus arrhythmia, quantified as high-frequency heart rate variability (HF-HRV), is an indicator of selfregulatory capacity, whereas transient increases in HF-HRV reflect self-regulatory effort. To test these hypotheses in marriage, 114 young couples completed measures of marital quality and a positive, neutral, or negative initial marital task, preceded and followed by resting baseline assessments of HF-HRV. Couples then discussed a current marital disagreement. Resting HF-HRV was correlated with marital quality, suggesting that capacity for self-regulation is associated with adaptive functioning in close relationships. For women but not men, the negative initial task produced a decrease in resting HF-HRV. This effect was mediated by the husbands' negative affect response to the task and their ratings of wives as controlling and directive. When the subsequent disagreement discussion followed the negative initial task, women displayed increased HF-HRV during the discussion but a decrease when it followed the neutral or positive task. The valence of the initial task had no effect on men's HF-HRV during disagreement. Negative marital interactions can reduce women's resting HF-HRV, with potentially adverse health consequences. Women's reduced health benefit from marriage might reflect the depleting effects on self-regulatory capacity of their greater efforts to manage relationship quality.

A theoretical framework that includes individual differences in EF will inform behavioral medicine research on stress risk and resilience.

Interest in the association between personality characteristics and physical health has been renewed in recent years. Theory and research in this area has also been complicated by conceptual and methodological limitations. The present article briefly reviews this literature and discusses the advantages and limitations of the five-factor model of personality as an integrating framework for studies of personality and health. The model has already been fruitfully applied in several contexts, and more possibilities exist. Although it has some potential limitations, the application of the five-factor model--as well as other aspects of current personality theory and research--is likely to facilitate progress in the study of how personality influences health.

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