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.     

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.     

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.     

Negative cognitive emotion regulation as a predictor of adolescent heart rate variability and entropy under social stress

ABSTRACT

Background and Objectives: Negative cognitive emotion regulation (ER) strategies are particularly important within the framework of anxiety problems amongst youths and how they cope with stressful events. The aim of this study was to examine the associations between both negative and positive ER style and cardiac regulation under stressful conditions.

Design: Eighty-nine adolescents (M?=?13.31 years, SD?=?0.68, 44.94% girls) were exposed to a socially relevant stress induction protocol.

Methods: Participants’ emotion regulation strategies were assessed and their cardiac function was recorded.

Results: A negative ER style predicted heart rate (HR) entropy at the stressful stage after controlling for anxiety scores. In addition, heart rate variability reactivity and recovery and HR entropy recovery were larger (p?<?.05) in the low negative ER style group (n?=?16) than in the high negative ER style group (n?=?23).

Conclusions: Results suggest that individuals with a highly negative ER style have diminished autonomic flexibility.     

Relationship between heart rate variability and cognitive function during threat of shock

Abstract

The aim of the present study was to investigate the relationship between resting heart rate variability (HRV) and cognitive functions during threat of shock. A Continuous Performance Task and a Working Memory Task were used to measure cognitive functions. Sixty-five male participants from the Royal Norwegian Navy participated. HRV was measured during baseline, test conditions and recovery. Participants were randomly assigned into non-threat and threat groups. Based on the median split of the high frequency (HF) spectral power, groups were divided into two additional groups. Overall, the high HRV participants showed superior performance on cognitive tasks independent of non-threat or threat conditions. During threat condition the low HRV group showed improved performance. Thus, individuals with high HRV were more stress tolerant and resilient in the face of environmental changes. The results from the study might have implications with regard to performance in operational settings, but also for other fields of psychological research such as individual differences, anxiety and coping.     

Developing physical activity interventions for youth with cystic fibrosis and congenital heart disease: Learning from their parents

Despite the benefits of physical activity for youth with cystic fibrosis (CF) and congenital heart disease (CHD), most are insufficiently active. More information is required on how to facilitate physical activity in these populations. Although there are no studies that provide information about participation in CF and CHD youth from the perspective of parents, the involvement of caregivers may be an important facilitator to physical activity in youth with chronic diseases.

Objective

This qualitative study explored how the parents of youth with CF and CHD experience physical activity, and parents commented on both their own and their child’s physical activity.

Methods

Twenty-nine parents from a CHD and CF clinic participated in a semi-structured interview, and a thematic analysis of the transcribed data was undertaken.

Results

Parents discussed the numerous benefits and barriers associated with physical activity for both child and self. Role modeling was a critical social process to overcoming barriers. Parents experiences were situated within the broader family context characterized by a prevailing sense of stress and complexity.

Conclusion

By illustrating how the parents of youth with CF and CHD understand the role of physical activity in their and their child’s life, this study provides valuable information regarding the development of interventions to increase physical activity among children with CF and CHD.     

Acute effects of alcohol on cardiovascular reactivity to stress in college-age Type A (coronary prone) individuals

Healthy college-age males and females classified as Type A or Type B were randomly assigned to an alcohol (N=24) or a no-alcohol condition (N=24). Subjects were exposed to a verbal stress quiz while blood pressure, heart rate, peripheral vascular response (PVR), and self-reported anxiety indices were monitored. Results indicated that alcohol effected a reduction in resting levels of systolic blood pressure and a tonic reduction in the peripheral vascular response. Alcohol attenuated the systolic blood pressure, heart rate, and PVR to stress and efffected a decrease in anxiety following the Stressor. When analyzed relative to the participants' drinking experience, data indicated that the strongest stress-modulating effect of alcohol was evidenced by Type A subjects who have been identified as long-term drinkers. During recovery from stress Type A subjects identified as short-term drinkers maintained high levels of PVR. Types A and B subjects who did not ingest alcohol evidenced high PVR levels during stress. The findings are discussed in terms of the protective action of moderate chronic alcohol use on cardiovascular disease risk reduction in persons evidencing the coronary-prone behavior pattern.     

Trimodal assessment in agoraphobia research: Further observations on heart rate and synchrony/ desynchrony

This paper reports new observations on heart rate and synchrony/desynchrony in the context of 22 chronic agoraphobic patients' trimodal assessment pre and post exposure treatment. The results corroborated previous reports showing weak and/or inconsistent improvement in heart rate, in contrast to significant improvement in behavioral and subjective response systems. Moreover, the results did not support recent suggestions that heartrate reactivity at pretreatment or global categories of synchrony/dysynchrony at posttreatment have important implications for treatment outcome. However, subtypes of dysynchrony based on the direction of divergence between variables had different implications for the clinical response, indicating that simply dichotomizing patients into synchronizers/desynchronizers may be misleading in addition to being uninformative.This work was supported by Grants MH34177 and MH40141 from the National Institute of Mental Health. Mary Sue Hamann, M.S., assisted in the statistical analyses.