Perceived stress correlates with disturbed sleep: a link connecting stress and cardiovascular disease

The association between stress and cardiovascular disease (CVD) risk is becoming established. A mechanistic link clarifying the intermediate steps between the experience of stress and the development of CVD would support this association. We sought to examine the role of perceived stress as a factor associated with disturbed sleep with the goal of providing an explanation for the stress-CVD connection. We performed a cross-sectional analysis of data recorded by subjects at entry to our CVD prevention program. Data collection included questionnaire surveys, anthropometrics, and a CVD-relevant laboratory panel. Of 350 consecutively enrolled subjects (mean age 54.4 ± 12.4 [SD] years, 138 men, 39%), 165 (47%) scored above the mean for stress measures. These high-stress subjects displayed an increased cardiovascular risk profile including elevated body mass index (mean ± SD 31.1 ± 5.9 vs. 29.0 ± 5.9, r(s) = 0.175), increased waist circumference (102 ± 17 cm vs. 98 ± 14, r(s) = 0.135), and elevated high-sensitivity serum C-reactive protein (0.384 mg/dl vs. 0.356, r(s) = 0.109). High-stress subjects also demonstrated greater daytime sleepiness (Epworth Sleepiness Scale: 10.4 ± 5.0 vs. 7.8 ± 4.8, r(s) < 0.316), greater fatigue (fatigue scale: 5.4 ± 2.2 vs. 3.4 ± 2.4, r(s) = 0.484), poorer sleep quality (Pittsburgh Sleep Quality Index: 8.5 ± 4.4 vs. 5.9 ± 4.0, r(s) = 0.416), and shorter sleep duration (20 min less/24 h, r(s) = negative 0.177) with a higher risk for sleep apnea (60% at high risk vs. 40%, p = 0.003) than low-stress subjects. High stress was associated with significant disturbances in sleep duration and sleep quality. Stress levels also correlated with daytime consequences of disturbed sleep. The stress-sleep connection may be an important mechanistic mediator of the association between stress and CVD.     

Use of semantic context by patients with Alzheimer's disease

In this study we used semantic-priming procedures to examine limitations in the use of semantic context by patients with Alzheimer's disease. We also tried to determine whether any such contextual effects were mediated solely through automatic processes or whether attentional processes were also involved. Three tasks were applied to examine the effect of semantic context on the performance of 18 normal elderly and 18 normal young subjects, and on 18 patients with Alzheimer's disease. When normal and demented subjects were asked to decide whether a given item was a member of a certain category, results showed that their response times were equally affected by the item's dominance in the category. The time that demented patients took to recognize a word was actually affected more by the semantic context provided by a priming sentence than was that of normal subjects. When asked to generate the final word of an incomplete sentence, demented subjects performed very poorly unless potential responses were highly constrained by sentence context.     

The effects of duration,area, and background intensity on the visual intensity difference threshold given by the forced-choice procedure: Derivations from a statistical decision model for sensory discrimination

A model for visual discrimination is outlined. This assumes that detection is based on separating signaland noise by means of a statistical decision procedure, and that the noise arises from physical and biological sources. When the model is applied to such traditional detection procedures as the method of constant stimuli, it successfully predicts the laws of spatial and temporal summation and the form of the Weber function. The model is extended to the forced-choice procedures. It is found that it predicts departures from the classical laws for spatial and temporal summation and an increase in the slope of the Weber function when the pulsed forced-choice procedure is used, and data are presented that agree with the predictions. It is shown that data obtained with forced choice against a continuous background are consistent with the assumption that the Seither covertly detects or fails to detect an increment at each ofthe two alternative locations and this determines his final overt response, rather than that he directly compares the inputs at the two locations. A comparison between results obtained with the forced-choice procedure with a pedestal, or with the continuous forced-choice procedure, provides further evidence that Ss employ a double detection strategy in the latter case.     

The association of antidepressant and statin use with death and incident cardiovascular disease varies by depression severity

Depression has been reported to be associated with a greater risk of death and cardiovascular disease (CVD); however, the impact of antidepressants (ADM) on CVD risk remains controversial. Statin use is known to decrease CVD risk. Whether the use of these medications together affects CVD risk has not been studied. Patients (N = 26,828) completing the patient health questionnaire (PHQ-9), ≥40 years of age, without prior CVD, and no prior ADM use were studied. Depressive severity was categorized as none-mild (PHQ-9 score ≤14, n = 21,517) and moderate-severe (PHQ-9 score ≥15, n = 5311). Cox hazard regression was used to evaluate the association of no ADM/no statin use (n = 23,104 [86.1%]), ADM/no statin use (n = 877 [3.3%]), no ADM/statin use (n = 2627 [9.8%]), and ADM/statin use (n = 220 [.8%]) with major adverse cardiovascular events (MACE: death, CAD, stroke). Patients averaged 56 ± 12 years; 61% female. There were 1182 (4.4%) 3 year MACE events. The association of ADM and statin use with MACE varied by depressive symptom severity, with statin therapy associated with a decreased risk in the none-mild group (HR = .78, p = .007) and ADM in the moderate-high group (HR = 0.58, p = 0.02). Concomitant use of ADMs and statins did not appear to provide additive benefit.     

Supervision groups for health advisers working with patients with HIV disease

This paper describes a case supervision group with health advisors working in a clinic specializing in the treatment of patients with HIV Infection. Themes discussed in the group are presented with an evaluation of the group intervention, some consideration of group process and the health advisers views on their work. This is discussed in relation to present research into occupational stress in this field.     

Semantic sensitivity for prose in patients with probable alzheimer's disease

This study examined the sensitivity of patients with probable Alzheimer's Disease (AD) to the inherent semantic structure of prose. Patients and normal controls listened to prose passages and recalled the stories under immediate and delayed conditions. Subjects were also tested with a recognition format. Unlike controls and patients with mild AD, patients with severe AD were unable to differentiate high importance ideas from ideas of lower importance on free recall and recognition. These results suggest relative impairment of semantic processing at the encoding and consolidation process of memory in more advanced AD.     

Memory Bias for Faces that are Perceived as Hostile by Crime Victims with Acute Post-traumatic Stress Disorder

The present study tested, and found support for, the hypotheses that crime victims with acute post-traumatic stress disorder have: (i) a general memory impairment for faces; and (ii) a memory bias for faces that they perceive as hostile, even when these faces are not arranged to show any hostile face expressions. It is suggested that crime victims with acute post-traumatic stress disorder perform worse on recognition memory due to impaired concentration, and that they allocate their limited attentional resources to the detection of hostility in others in order to avoid being victimized again. This produces a memory bias for perceived hostility even in relatively innocuous everyday interactions with others, which contributes to maintaining the sense of serious current threat that characterizes post-traumatic stress disorder.     

Effects of telephone support on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease: a meta-analysis

The aim of this meta-analysis was to evaluate the effects of disease education or pulmonary rehabilitation programs assisted with telephone support on physical capacity and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. A systematic search of PubMed, Embase, Web of Science and The Cochrane Library was conducted until May 2017. Randomized controlled trials (RCTs) examining the effects of telephone-assisted intervention versus a control group on exercise tolerance and QOL in patients with COPD were included. Two independent authors assessed the methodological quality of the trials using the Cochrane risk of bias tool. A meta-analysis was conducted with the Revman5.3 to quantify the effects of telephone-assisted interventions on walking capacity and QOL. In total, 10 studies involving 1037 participants were included. Due to the effect of telephone-assisted interventions, statistically significant results were found on Saint-George’s Respiratory Questionnaire (SGRQ) symptom scores [standard mean difference (SMD) ?.18, 95% confidence interval (CI) ?.33, ?.03, p-value .02)], SGRQ impact scores [SMD ?.35, 95% CI ?.60, ?.10, p-value .006)], SGRQ activity scores [SMD ?.30, 95% CI ?.45, ?.15, p-value < .0001)], SGRQ total score [SMD ?.36, 95% CI ?.51, ?.21, p-value < .00001)]. The effects on 6-min walk test (6MWT) and all Chronic Respiratory Questionnaire (CRQ) subscales were not significant (p > .05) based on the insufficient evidence. In conclusion, the role of telephone-assisted interventions in the management of COPD remains equivocal. Some encouraging results were seen with regard to SGRQ symptom, SGRQ impact, SGRQ activity and SGRQ total score. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

Colon cancer information as a source of exercise motivation for relatives of patients with colon cancer

Using a Protection Motivation Theory (PMT) framework, this study examined whether factual colon cancer information is a meaningful source of exercise motivation for relatives of patients with colon cancer. One hundred sixty-six inactive relatives were randomly assigned to one of two treatment conditions: PMT group (intervention); and non-PMT group (attention control). At baseline (T1) participants completed demographic information, a questionnaire designed to assess their beliefs toward exercise and colon cancer as well as their exercise intentions. At T2 (one week following T1) participants watched one of two DVD videos that were created for the study. The intervention DVD contained exercise and colon cancer information that was yoked within the four major components of PMT: perceived vulnerability (PV); perceived severity (PS); response efficacy (RE); and self-efficacy (SE), while the attention control DVD contained general diet and cancer information. Immediately following watching the DVD, participants completed the same measures as in T1. Participants assigned to the PMT intervention group showed significant improvement in PV, RE, SE and exercise intentions, whereas participants assigned to the attention control group showed significant improvement only in RE. RE, SE, and PS made significant and unique contributions to prediction of exercise intention. Overall, the results of the present study demonstrate that a single exposure media intervention grounded in a PMT framework can change individuals' exercise and colon cancer beliefs, as well as change their exercise intentions. Implications of these findings and direction for future research are discussed.     

The influence of a long term exercise program on lower limb movement variability and walking performance in patients with peripheral arterial disease

The purpose of this study was to examine the effects of a 12 month exercise program on lower limb movement variability in patients with peripheral arterial disease (PAD). Participants (n = 21) with an appropriate history of PAD and intermittent claudication (IC) volunteered for this study and were randomly allocated to either a control group (CPAD–IC) (n = 11), which received normal medical therapy and a treatment group (TPAD–IC) (n = 10), which received normal medical therapy treatment and a 12 month supervised exercise program. All participants underwent 2D joint angular kinematic analysis during normal walking to assess lower limb movement variability and walking speed. Between-group differences were analyzed via mixed measures ANOVA. The 12 month supervised exercise program made no significant impact on the lower limb movement variability or walking speed of the TPAD–IC group as determined by either intralimb joint coordination or single joint analysis techniques. Long term supervised exercise programs do not appear to influence the lower limb movement variability of PAD–IC patients.     

Negative beliefs about breathlessness increases panic for patients with chronic respiratory disease

Breathlessness is a multidimensional symptom of respiratory disease and is associated with the experience of panic. Patients with panic disorder have increased mortality, morbidity and healthcare utilisation that is unrelated to their disease severity. Our qualitative study aimed to appraise respiratory patients' experiences of breathlessness and whether their cognitions were associated with panic aetiology. The self-regulatory theory was utilised to develop the framework for the semi-structured interview schedule. Twelve individuals with respiratory disease at a U.K. cardiothoracic centre participated and their data were analysed using interpretative phenomenological analysis. Perceived control over the disease, symptoms and panic emerged as the core theme with three related belief systems; (1) Perceived consequences of panic and disease; (2) Illness and symptom coherence; and (3) Emotional adaptation. Panic symptoms were most prevalent in participants with low perceived control over symptoms and the disease, negative beliefs about the life-limiting consequences of unpredictable breathless attacks and by those using emotional coping strategies such as denial and avoidance. The experience of panic for respiratory patients can be explained through the cognitive-behavioural model of anxiety, which highlights the contributory role of catastrophic beliefs about the control and consequences of symptoms and disease as a significant contributory factor for the prevalence and maintenance of panic. The mortality and morbidity of respiratory patients is significantly affected by a co-morbid diagnosis of panic disorder and so it is critical to patients' long-term healthcare that their psychological experiences are assessed. Healthcare services must enhance patients' understanding about their disease to improve their confidence to control symptoms. Recent evidence suggests that cognitive-behavioural interventions that increase problem-solving coping will reduce catastrophic misinterpretations about the perceived consequences of breathlessness and improve emotional adaption to respiratory disease.     

Lifestyle effects of group health education for patients with coronary heart disease

Abstract

In the present study, effects of a health education (INFO) and a PsychoEducational Prevention (INFO + PEP) Programme were Investigated in three hospitals. These programmes were offered to groups of coronary heart disease (CHD) patients and their partners alter discharge from hospital. The INFO was offered to 127 CHD patients in addition to FIT (i.e. standard medical care and physical training). The PEP was offered to 90 Patients in, addition to the INFO and FIT. A control group of 122 patients received only FIT. The INFO and the PEP consisted of four weekly two-hour group sessions each. In addition, the PEP was followed by seven telephone follow-up contacts.

On average, patients improved their lifestyles during the first three months. Between three and twelve months an extra improvement was found for eating habits, whereas there was a relapse for smoking and a sedentary lifestyle. In the short term, angina pectoris and a longer period of heart complaints were parallelled with a decrease in the risk of maintaining unhealthy eating habits, whereas in the long term a longer period of heart complaints a younger age and unemployment predicted a lower risk of maintaining unhealthy eating habits In the short term living with a partner and in the long term female gender were predictive of continued smoking behaviour In the short term, older age, a first CABG and a specific hospital setting decreased the risk of a continued sedentary lifestyle.

The FIT + INFO + PEP had a favourable short-term effect on eating habits. For smoking and a sedentary lifestyle, however, there were negative effects. In the short term patients in the FIT +INFO and those in the FIT +INFO+PEP had significantly more problems in quitting a sedentary lifestyle than those in the FIT intervention in the long term, patients in the FIT + INFO had significantly more problems in stopping smoking compared to these in the FIT.     

Family Stress and Adjustment as Perceived by Parents of Children with Autism or Down Syndrome: Implications for Intervention

ABSTRACT

This study examined stress and adjustment in parents of three groups of families: those with an autistic child, those with a Down syndrome child, and those with only developmentally normal children. A total of 54 families participated, with 18 representing each group. Parents of autistic children generally reported more family stress and adjustment problems than parents of children with Down Syndrome who, in turn, reported more stress and adjustment problems than parents of developmentally normal children. Although parents of disabled children reported more stress associated with caring for their child, they generally showed resilience in adjusting to the presence of a severely disabled family member. Implications for family intervention are discussed.     

Being at risk for cardiovascular disease: perceptions and preventive behavior in people with and without a known genetic predisposition

This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n?=?51) consisted of individuals recently diagnosed with familial hypercholesterolemia (FH) through DNA testing. The second sample (no genetic predisposition; n?=?49) was recruited among patients with CVD-risk profiles based on family history of CVD, cholesterol levels, and blood pressure, registered at general practices. Participants filled out a postal questionnaire asking about their perceived risk, causal attributions (i.e. genetic and lifestyle), and about perceived efficacy and adoption of preventive behavior (i.e. medication adherence and adoption of a healthy diet and being sufficiently active). Perceived comparative risk, genetic attributions of CVD, and perceived efficacy of medication were higher in the "genetic predisposition" sample than in the "no genetic predisposition" sample. The samples did not differ on lifestyle attributions, efficacy of a healthy lifestyle, or preventive behavior. Individual differences in perceived risk, genetic attributions, perceived efficacy of medication, and adoption of a healthy lifestyle were best explained by family history of CVD. Our findings suggest that in people diagnosed with a single gene disorder characterized by a family disease history such as FH, family disease history may be more important than DNA information in explaining perceptions of and responses to risk.     

Use of the gait deviation index for the evaluation of patients with Parkinson's disease

The authors aimed to determine whether the Gait Deviation Index (GDI) could be feasible to characterize gait in patients with Parkinson's disease (PD) and evaluate outcomes of levodopa treatment. Twenty-two PD participants were evaluated with clinical examination and 3-D quantitative gait analysis (GDI was calculated from gait analysis) in 2 states (OFF and ON) after taking levodopa. Twenty age-matched healthy participants (CG) were included as controls. The GDI value in the OFF state was 83.4 ± 11.5 (statistically different from CG) while clinical scales demonstrated a moderate-severe gait impairment of these patients. Significant improvements are evident from clinical scores and by GDI values in the ON state. The mean GDI for the ON state (GDI(ON): 87.9 ± 10.4) was significantly higher than in for the OFF state (GDI(OFF): 83.4 ± 11.5), indicating a global gait improvement after the treatment. The results show that GDI has lower value as an indicator of pathology in PD patients than in quantifying the effects of levodopa treatment in PD state.