Causal attributions for heart disease: A systematic review

Abstract

The aims of this systematic literature review are to describe the pattern of attributions made for the causes of heart disease, and to determine how this pattern varies with the method by which attributions are elicited, and the respondent group.

A search yielded 47 papers and reports, containing 54 datasets. Lifestyle factors and chronic stress were the most common causes cited across all datasets. Attributions to stressors and fate or luck were more likely to be reported in studies that used interval rating scales than in studies that used dichotomous ratings. Cardiac patients were more likely to mention stressors and fate or luck as causes of heart disease; non-patients rated being overweight and hypertensive as more important

The differences observed between the responses of patients and non-patients may be due to actor - observer differences, or to a methodological difference: patients are often asked to report their own experiences whereas non-patients are asked about the general case.     

How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach

Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services.

Methods: Three focus groups with adults with CHD (total of 14 participants aged 19–67) were conducted and thematic analysis was used to identify emerging themes.

Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges.

Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.     

End notes: two unpublished presentations by Michael Fordham

Following the publication in this journal of two of Fordham's unpublished papers selected by James Astor (2010, 55, 5), the editors have asked me to select a further two. I have chosen two clinical pieces, one clinical notes and the other notes that refine his previous thinking, which Fordham wrote at the end of his life. Both are examples of the way Fordham continued throughout his analytic work to turn to patients as his primary source of learning. Fordham presented the first piece, ‘A case study’, to Parkside Clinic in 1988. Its subject is his last child patient, a nine‐year‐old boy with behaviour problems that destroyed the analytic frame. The second is clearly for an SAP (Society of Analytical Psychology) audience and written probably around 1992–93. It is titled ‘Some comments on transference and countertransference’ and contains material from the patient who has become known through papers in this journal as ‘K’. The two pieces are presented together within a commentary rather than separately with footnotes, in order to provide some context for Fordham's thinking in his late years.     

Mindfulness and integrative self‐knowledge: Relationships with health‐related variables

This study examined how mindfulness and integrative self‐knowledge were related to health‐related issues. Men in general population (n = 103) and coronary heart disease samples (n = 101) completed the Mindful Attention Awareness Scale, the Integrative Self‐knowledge Scale, the Type 2 subscale of the Interpersonal Reactions Inventory, the Perceived Stress Scale, and the Anxiety and Depression Scales. In both samples, there was a moderate positive correlation between mindfulness and integrative self‐knowledge and they were negatively correlated with all health‐related variables. However, only integrative self‐knowledge explained independent variance in health‐related variables. Specifically, in both samples, the relationship between mindfulness and health‐related variables was mediated by integrative self‐knowledge. Mindfulness and integrative self‐knowledge are related domains of self‐awareness that are associated with a range of health‐related variables. These relationships are robust across samples drawn from general population and patients with coronary heart disease. The finding that integrative self‐knowledge explained additional variance in the health‐related variables after the contribution of mindfulness had been accounted for suggests that reflective self‐awareness in integrative self‐knowledge may make a unique contribution to the explanation of individual differences in health variables.     

Incremental variance in indecisiveness due to cognitive failure compared to fluid intelligence and personality traits

This study investigated the role of fluid intelligence, personality traits and perceived cognitive failure in relation to indecisiveness. The Advanced Progressive Matrices (APM), the Big Five Questionnaire (BFQ) and the Cognitive Failures Questionnaire (CFQ) were administered to 429 Italian high school students. The study revealed that perceived cognitive failure added a significant percentage of incremental variance in indecisiveness compared to variances due to fluid intelligence and personality traits thereby offering new research and intervention possibilities.     

Deformation and failure of a heterogeneous high explosive

The deformation and failure of the pristine PBX 9501 high explosive are studied experimentally by combining Brazilian disk compression with the digital image correlation (DIC) technique. The Brazilian disk specimen was loaded by a pair of compressive forces across the diameter. The full-field deformation on the surface of the disk, during the loading process, was obtained using DIC on a series of random speckle images acquired during the test. In this series of experiments, we focused on the effect of temperature while keeping the loading speed quasi-static. Tests were conducted under three different temperatures, ?15°C, 23°C, and 50°C. For all testing conditions, it was observed that as the applied load reaches maximum, localized deformation starts at the two regions near the loading points. The localized deformation then proceeds along an irregular path toward the center of the specimen and coalesces. Finally, deformation of the Brazilian disk subjected to cyclic compressive load at ambient temperature was also measured and studied.     

急性心肌梗死患者直接经皮冠状动脉介入治疗前后窦性心律振荡的临床观察

探讨急性心肌梗死（AMI）患者直接经皮冠状动脉介入（PCI）前后窦性心律振荡（HRT）的变化及意义.选择伴室性早搏的AMI患者（观察组）和无器质性心脏病的室性早搏患者（对照组）各42例,PCI前伴室早的观察组患者,用节律Ⅱ导联记录室早的心电图,PCI后2周时观察组及对照组均记录24h动态心电图（AECG）,计算其震荡初始（TO）和震荡斜率（TS）,并行心脏彩色多普勒超声检查,测定左室射血分数（LVEF）.结果观察组PCI后2周时和对照组LVEF分别为：（59.1＆#177;7.5）%和（61.3＆#177;8.4）%.观察组PCI前TO显著升高,TS显著降低,差异有统计学意义（P＜0.05）;观察组PCI后2周TO较前降低,TS较前升高,但和对照组相比差异仍有统计学意义（P＜0.05）;观察组PCI后2周时和对照组左室射血分数（LVEF）相比无差异.提示AMI患者HRT减弱,PCI后2周HRT改善但和观察组相比仍有统计学意义,提示AMI患者PCI后早期仍存在心脏自主神经功能下降,HRT可作为评价AMI患者预后的一个指标.     

胰岛素：是“天使”还是“魔鬼”？——胰岛素引起血管损伤的哲学思考

随着社会经济和医疗技术的发展进步,胰岛素在2型糖尿病患者的治疗地位越来越高.然而,胰岛素的使用却好比一把＂双刃剑＂,既可以扮演着控制血糖的＂天使＂角色,又有导致血管损伤的＂魔鬼＂一面.那么,如何理解胰岛素的＂天使＂或＂魔鬼＂的这两种截然不同的角色呢？在这里,我们将从哲学的角度来辩证的分析,从理性的角度来合理规范化用药,充分强调整体观念,并为日后临床工作中科学的使用胰岛素提出理性与科学的指导意见.     

慢快综合征患者植入起搏器后调整参数对预后的影响

为了观察慢快综合征患者植入起搏器后对心功能,心房高频事件的影响,将植入具有自动化功能双腔起搏器的39例患者分为2组,A组起搏心率55次/分,B组起搏心率65次/分,术后1年内程控获取心房起搏百分比(Ap)、心室起搏百分比(Vp)、高频心房事件发生率(AHRE)、左房内径(LAD)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)、血脑钠肽(BNP).结果显示,A组相比B组Ap、Vp明显降低,LVEDD、LVEF明显改善,BNP明显降低,LAD、AHRE两组无差异.故对于慢快综合征患者,适当降低起搏频率可明显改善LVEDD、LVEF,使BNP明显降低.     

Ageing and Isolation: Is the Issue Social Isolation or Is It Lack of Meaning in Lige?

SUMMARY

Social and spiritual isolation are growing issues for an ageing society that promotes the ideals of autonomy and high levels of individuation amongst its citizens. This chapter explores the issues of social and spiritual isolation for older adults and ways of addressing these issues both now and in the future. The need for intimacy with God and with others is illustrated using material from in-depth interviews with older adults who live independently and others who are residents of aged care facilities.