Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients

Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.     

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M_age = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.     

EVALUATION OF BIOFEEDBACK IN THE TREATMENT OF BORDERLINE ESSENTIAL HYPERTENSION1

Direct biofeedback of blood pressure was compared with frontal EMG biofeedback and with self-instructed relaxation for the treatment of essential hypertension in a controlled group outcome study. Patients were followed up for four months after the end of treatment. Generalization of treatment effects was assessed through pre- and posttreatment measurements of blood pressure under clinical conditions in a physician's office. There were no significant reductions in diastolic blood pressure. The systolic blood pressure (SBP) of the patients receiving blood pressure biofeedback decreased 8.1 mm mercury (p = 0.07) and the SBP of the patients in the relaxation condition decreased 9.5 mm mercury (p = 0.05). In the generalization measures, there were significant reductions in SBP for the relaxation group. The results are discussed in terms of the general lack of replicability within the area of biofeedback treatment of hypertension.     

Testing two variances for superiority/non-inferiority and equivalence: Using the exhaustion algorithm for sample size allocation with cost

The equality of two group variances is frequently tested in experiments. However, criticisms of null hypothesis statistical testing on means have recently arisen and there is interest in other types of statistical tests of hypotheses, such as superiority/non-inferiority and equivalence. Although these tests have become more common in psychology and social sciences, the corresponding sample size estimation for these tests is rarely discussed, especially when the sampling unit costs are unequal or group sizes are unequal for two groups. Thus, for finding optimal sample size, the present study derived an initial allocation by approximating the percentiles of an F distribution with the percentiles of the standard normal distribution and used the exhaustion algorithm to select the best combination of group sizes, thereby ensuring the resulting power reaches the designated level and is maximal with a minimal total cost. In this manner, optimization of sample size planning is achieved. The proposed sample size determination has a wide range of applications and is efficient in terms of Type I errors and statistical power in simulations. Finally, an illustrative example from a report by the Health Survey for England, 1995–1997, is presented using hypertension data. For ease of application, four R Shiny apps are provided and benchmarks for setting equivalence margins are suggested.     

17α-羟化酶缺陷症2例报告及文献总结

17α-羟化酶缺陷症（17α-OHD）是先天性肾上腺皮质增生症（CAH）的一种罕见类型,很容易漏诊和误诊。17α-OHD是一种常染色体隐性遗传性疾病,可导致糖皮质激素合成减少,促肾上腺皮质激素增多;性腺激素合成减少,而促性腺激素反馈性增高,同时可伴有盐皮质激素水平的升高。对该疾病的早期诊断非常重要,早期诊断并予以激素替代治疗对提高患者生活质量有很大帮助。现报道2例我科17α-OHD的诊治经过,以提高对本病的认识。     

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.     

血红素氧合酶-1与动脉粥样硬化和高血压的关系

血红素氧合酶-1（HO-1）是血红素分解的起始酶和限速酶,它分解血红素最终生成胆红素、一氧化碳和铁.这三种产物通过抗炎症损伤、抗氧化应激、抗细胞增殖、抗细胞凋亡、抑制血小板聚集、调节血管张力及细胞内信号传递等途径对心血管系统起着重要的保护作用.研究显示,HO的诱导剂及多种能降低心血管病风险的药物能诱导 HO-1表达增加,从而起到抗动脉粥样硬化的发生发展及调节血压的作用.因此开发临床可应用的HO诱导剂,甚至开发HO的基因治疗方法是目前研究的方向.     

El tiempo de tránsito del pulso: un índice de cambios en la presión arterial

Resumen

Los propósitos de este trabajo fueron: primero, evaluar el grado con el cual el tiempo de tránsito del pulso (TTP) covería con la presión sistólica; segundo, estimar la influencia del período de preeyección sobre el TTP; tercero, probar un índice de reactividad en la presión arterial, y cuarto, estudiar el decremento en la actividad cardiovascular a lo largo del tiempo.

Los resultados revelan una alta correlación entre el TTP y la presión sistólica (¯=—. 866), aunque el TTP probablemente no sólo refleje cambios de la presión arterial, sino también del período de preeyección.

La respuesta ante una tarea de aritmética mental, en contraste con una linea base de relajación, se mostró como un buen índice de la reactividad en la presión sistólica.

El cuarto propósito no pudo realizarse por no producirse el decremento esperado en la actividad cardiovascular.     

Neurodevelopmental Disorders Across the Lifespan: A Neuroconstructivist Approach.

Objectives. To investigate neuropsychological and neurobehavioral outcome in children with arterial ischemic stroke (AIS).

Background. Childhood stroke can have consequences on motor, cognitive, and behavioral development. We present a cross-sectional study of neuropsychological and neurobehavioral outcome at least one year poststroke in a uniquely homogeneous sample of children who had experienced AIS.

Method. Forty-nine children with AIS aged 6 to 18 years were recruited from a specialist clinic. Neuropsychological measures of intelligence, reading comprehension, attention, and executive function were administered. A triangulation of data collection included questionnaires completed by the children, their parents, and teachers, rating behavior, executive functions, and emotions.

Key Findings. Focal neuropsychological vulnerabilities in attention (response inhibition and dual attention) and executive function were found, beyond general intellectual functioning, irrespective of hemispheric side of stroke. Difficulties with emotional and behavioral regulation were also found. Consistent with an “early plasticity” hypothesis, earlier age of stroke was associated with better performance on measures of executive function.

Conclusions. A significant proportion of children poststroke are at long-term risk of difficulties with emotional regulation, executive function, and attention. Data also suggest that executive functions are represented in widespread networks in the developing brain and are vulnerable to unilateral injury.     

Effect of Relaxation Therapy in Reducing Blood Pressure of Essential Hypertension Patients

The study investigated the effect of relaxation therapy on arterial blood pressure of Patients with essential hypertension. Ten known essential hypertension patients (males = 3; females = 7, age range 41–70, mean age 57.2 years, SD = 9.93 years) were sampled randomly from Medical outpatient department of the State owned University teaching Hospital in Ebonyi State South East, Nigeria. These Participants were exposed to 30 minutes relaxation therapy and their blood pressures were taken before and after the treatment. Using matched t test to compare baseline and post treatment scores, result showed that relaxation therapy progressively decreased both diastolic and systolic blood pressure readings of the Participants. The study concluded that Relaxation therapy can transiently lower the systolic and diastolic blood pressure.