Alief——影响心血管康复的潜在心理状态

心血管康复是涉及医学评价、处方运动、心血管危险因素矫正、教育、咨询和行为干预等的长期综合治疗程序,以改善心血管病的生理和心理状态,减少再次心肌梗死和猝死的危险,控制心血管症状,稳定或逆转动脉硬化过程和改善患者的心理和职业状态。心血管康复干预具体包括药物治疗、行为干预和心理介入等治疗。其中涉及一系列的心理-行为现象及概念。最近,心理医学领域提出了介于信念和想象的状态——Alief,这一具象派状态可以很好地解释与心血管康复相关的一些心理-行为现象,本文就此作一论述。     

State gratitude for one’s life and health after an acute coronary syndrome: Prospective associations with physical activity,medical adherence and re-hospitalizations

Abstract

Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patients with a recent acute coronary syndrome. State gratitude for one’s health 2 weeks post-event was associated with increased physical activity (measured via accelerometer) 6 months later, controlling for relevant demographic, social, medical and psychological factors (β = 340.9; 95% confidence interval = 53.4–628.4; p = .020). Gratitude for one’s life was associated with increased self-reported medical adherence at 6 months on the maximally adjusted model (β = .60; 95% confidence interval = .16–1.04; p = .008); no gratitude items were associated with rehospitalizations. In contrast, dispositional gratitude, measured by the Gratitude Questionnaire-6, was less dynamic and responsive to change over the 6-month period and was not associated with physical activity.     

Depression and marital status determine the 10-year (2004–2014) prognosis in patients with acute coronary syndrome: The GREECS study

Background: The aim of the present work was to examine the association of depression and marital status, with the long-term prognosis of acute coronary syndrome (ACS), among a Greek sample of cardiac patients.

Methods: From October 2003 to September 2004, a sample of 2172 consecutive ACS patients from 6 hospitals was enrolled. In 2013–2014, the 10-year follow-up was performed in 1918 participants. Depressive symptoms were evaluated using the validated CES-D score (range 0–60), while marital status was classified as: single, married/cohabitants, divorced and widowed at the time of entry to the study.

Results: Patients in the upper tertile of CES-D (>20 score) had 41% (95%CI 14%, 75%) higher risk of ACS incidence as compared with those in the lowest (<7 score). In contrary, married patients had 29% lower risk (95%CI 6%, 46%) of ACS mortality compared with single, widowed or divorced. Multi-adjusted analysis revealed that among the ‘not married’ patients, 1-point increase in the CES-D score was associated with 2% (p = .02) and 4% (p = .001) higher risk of having non-fatal and fatal cardiac events, respectively.

Conclusions: The present study highlights the important role of depression in the context of marital relationships among ACS patients. Secondary public health care intervention programmes are needed to improve patient outcomes and minimise disease burden in clinical and community setting.     

Hope and cardiovascular health-promoting behaviour: Education alone is not enough

We investigated hope’s ability to predict cardiovascular disease (CVD) knowledge and health-promoting behaviours. Snyder defined hope as the combination of goal-directed planning and motivation, and theorised that high-hope people seek knowledge relevant to goal pursuits. We surveyed 391 Latino and Asian participants undergoing CVD risk screening, nearly all immigrants to the USA. This was a particularly important sample because, in general, these populations are considered underserved and under-researched. Pre-screening hope levels were measured. After screening and education, participants rated perceived importance of behaviour change. Behaviour change (salt/fat intake, exercise, CVD information-seeking and visiting a physician) and CVD knowledge were assessed one month later by telephone. Unexpectedly, hope did not predict knowledge. However, hope predicted self-reported behaviour change, though results differed by ethnicity. Among Asian individuals, hope?×?knowledge predicted reduced salt/fat, CVD information-seeking and physician visits. Among Latino individuals, hope?×?perceived importance of diet change predicted reduced salt/fat and hope?×?perceived importance of exercise change predicted increased exercise.     

Patient and spouse perceptions of the patient's heart disease and their associations with received and provided social support and undermining

Numerous empirical studies have investigated the relationships between cardiovascular diseases (CVD) and patients’ psychological well-being, with a focus almost exclusively on its dark side. Very little is known on the impact of illness severity on both negative and positive indicators of patients’ well-being, as well as on the psychosocial variables that may mediate this association. Aim of the study was to investigate the impact of illness severity on depression as well as on health satisfaction and life satisfaction of patients undergoing a cardiovascular rehabilitation. It also aimed at testing the mediation of illness perception and self-efficacy beliefs in managing cardiac risk factors. The study involved 172 patients (mean age?=?66.43?years; SD?=?9.99?years; 76.2% men). Illness severity was measured in terms of left ventricular ejection fraction at discharge from the cardiology department, whereas all psychological dimensions were assessed one week later. Results showed significant relationships among illness severity, depression and health satisfaction that were fully mediated by illness perception and self-efficacy beliefs, but not significant relation between disease severity and life satisfaction (χ ²(1)?=?2.30, p?=?n.s.). Overall, findings underline the importance of working on illness perception and self-efficacy beliefs to contrast depression and to improve health and life satisfaction in patients with CVD.     

阻塞性睡眠呼吸暂停低通气综合征对心血管系统的影响

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是常见却又不被广泛认识的疾病,可以导致多种器官和系统的损害,特别是心血管系统的损害.随着肥胖人群的增加,OSAHS的患病率有可能继续升高,这已经是一个重要的公共卫生问题,本文就OSAHS导致心血管疾病的发病机制,对常见心血管疾病的影响进行探讨.     

病证周一论

中医和西医是两大立体网络系统,虽各自有其发生发展过程,但二者在一定条件下可以同一,如同一病人中西医两种诊断,中西医病名证名,其概念的外延相交叉,相交部分呈现交融状态,即是二者同一的条件。就客观而言,两系统之交融状态是病证同一的前提,就认识而言,只有先认识病证同一,方能认识这二系统之交融同一。所谓病证同一,是运用中医理论和方法对西医疾病全过程本质认识,移植西医病名转化为中医的基本证,初步实现中医病证与西医病名在理论与临床上融汇同一,进而实现中医现代化。     

The CODE: A revised battery for coping and defense and its relations to subjective health

A condensed test battery (the CODE) based on the Utrecht Coping List (UCL) and part of the Defense Mechanisms Inventory (DMI) has been developed to assess coping and defense in large population studies. It was tested for reliability and validity in students and back pain patients. Principal components factor analysis of the subscales of the UCL and DMI in the student sample revealed two coping clusters: “Instrumental mastery-oriented coping” and “Emotion-focused coping” and two defensive clusters: “Cognitive defense” and “Defensive hostility”. “Instrumental mastery-oriented coping” was negatively related to subjective health complaints measured with Ursins Health Inventory (UHI). The back pain patients were clearly different from the students, using less coping and more defensive strategies. They had more subjective health complaints that showed negative correlations with “Instrumental mastery-oriented coping”. The CODE is a comprehensive battery that may be valid for large population studies of psychological determinants of muscle pain and other subjective health problems.     

The influence of gender, hypertension risk, and aerobic fitness on cardiovascular responses to laboratory-induced stress

The study sought to evaluate the influence of gender, hypertension risk, and aerobic fitness on cardiovascular responses to laboratory-induced stress. Sixty nonsymptomatic subjects (30 males, 30 females) participated in the experiment. Half of the subjects had at least one biological parent with hypertension, while half had no parental history of hypertension and served as comparison subjects. Subjects completed a laboratory procedure measuring cardiovascular responses (i.e., pulse rate and blood pressure) while performing stressful laboratory tasks (i.e., the Stroop Color Naming Test and a sham IQ test). Aerobic fitness (i.e., VO_2max using the Bruce protocol) was also determined using a submaximal treadmill test in the laboratory. Results suggest that males with a family history of hypertension were more stress responsive based on systolic blood pressure, while females were more stress-responsive according to pulse rate activity. Fitness levels were significantly associated with diastolic blood pressure throughout the stress and recovery periods but were unrelated to pulse rate and systolic blood pressure.