Cardiotoxicity and cardiovascular disease risk assessment for patients receiving breast cancer treatment

Background: Cardiotoxicity from anticancer therapy affects heart function and structure. Cardiotoxicity can also lead to accelerated development of chronic diseases, especially in the presence of risk factors. Methods: This study aimed to develop and pilot a combined cardiovascular disease and cardiotoxicity risk assessment questionnaire to quantify the potential extent of risk factors in breast cancer patients prior to treatment. The questionnaire underwent content and face validity evaluation by an expert panel followed by pilot testing in a sample of breast cancer patients (n = 36). Questionnaires were self-administered while attending chemotherapy clinic, in the presence of a research assistant. Results: Mean age of participants was 54.8 years (range 36–72 years). Participants reported CVD risk factors including diabetes 2.8%, hypertension 19.8%, hypercholesterolaemia 11% and sleep apnoea 5%. Lifestyle risk factors, included not eating the recommended serves of vegetables (100%) or fruit (78%) per day; smoking (13%) and regularly consuming alcohol (75%). Twenty five percent reported being physically inactive, 61%, overweight or obese, 24%, little or no social support and 30% recorded high to very high psychological distress. Participants were highly (75%) reluctant to undertake lifestyle changes; i.e. changing alcohol consumption; dietary habits; good emotional/mental health strategies; improving physical activity; quitting smoking; learning about heart-health and weight loss. Conclusion: This study is an important step towards prevention and management of treatment-associated cardiotoxicity after breast cancer diagnosis. We recommend that our questionnaire is providing important data that should be included in cancer registries so that researchers can establish the relationship between CVD risk profile and cardiotoxicity outcomes and that this study revealed important teaching opportunities that could be used to examine the impact on health literacy and help patients better understand the consequences of cancer treatment

Medical psychometrics:A psychometric evaluation of Type D personality and its predictive value in medical research

Type D personality–a combination of high negative affectivity and high social inhibition–has been identified as a risk factor for adverse outcome in various patient populations. However, common methods used to establish the predictive value of Type D personality have been criticized and several recent studies were not able to replicate previous findings. To explain these inconsistencies, this interdisciplinary dissertation brings together experts from the fields of medical psychology and psychometrics. It presents a psychometric evaluation of the construct Type D personality and illustrates how it can best be modeled in medical and psychological research. Based on thousands of computer-simulated datasets, as well as empirical data from patients with various types of diseases, this dissertation shows why most published research testing a Type D personality effect should be reanalyzed using modern psychometric and statistical methods. It also presents a first attempt at this endeavor by reanalyzing various earlier published datasets, showing that coronary artery disease patients with Type D personality are at increased risk for adverse outcome

Understanding the role of Inflammation in Coronary Heart Disease Patients with and without Depression

Coronary heart disease (CHD) and depression are very common and often co-existing disorders. The prevalence of depression among patients with CHD is considerably higher as compared to the general population. Depression exacerbates adverse cardiac outcomes in CHD patients increasing the risk of cardiovascular morbidity and mortality, besides worsening the psychological and social morbidity. Inflammation has been recognised to be involved in the association between these two debilitating disorders. Therefore, the present PhD thesis aimed to evaluate inflammatory responses and to investigate the pathophysiological mechanisms underlying the inflammatory activation in CHD patients with and without depression by assessing the function of two important biological factors regulating inflammation: the hypothalamus-pituitary-adrenal (HPA) axis and the glucocorticoid receptor (GR). Serum C-reactive protein (CRP), and plasma and salivary cortisol were measured using commercially available ELISA kits. Gene expression of GR and inflammatory biomarkers were analysed by means of quantitative real time PCR. GR function was assessed in vitro in isolated peripheral blood mononuclear cells using the dexamethasone inhibition of lipopolysaccharide-stimulated IL-6 production method. Serum levels of kynurenine pathway of tryptophan metabolism metabolites were measured using high performance liquid chromatography. CHD patients with depression showed higher CRP levels and IL-6 gene expression compared with CHD non-depressed. Both plasma cortisol levels and salivary cortisol awakening response were significantly lower in patients with depression when compared with CHD alone. The CHD depressed group exhibited a reduction in GR expression and function. Tryptophan levels were significantly lower in patients with depression who also showed an increased kynurenine/tryptophan ratio, which in turn was associated with an increased in 3-hydroxykynurenine level

Evidence Synthesis for Complex Interventions Using Meta-Regression Models

This study was funded by the Canadian Institutes of Health Research (grants FDN-143269 and FRN-123345) and a research fellowship held by K.J.K. (Frederick Banting and Charles Best Canada Graduate Scholarship GSD-134936). N.M.I. holds a Canada Research Chair (Tier 2) in Implementation of Evidence Based Practice and a Clinician Scientist Award from the Department of Family and Community Medicine at the University of Toronto (Toronto, Ontario, Canada). J.M.G. held a Canada Research Chair in Health Knowledge Transfer and Uptake during the time of the study’s conduct and was supported by a Foundation Grant from the Canadian Institutes of Health Research. D.M. was supported by a University of Ottawa Research Chair during the time of study conduct.Peer reviewedPublisher PD

Crosstalk between Depression, Anxiety, and Dementia: Comorbidity in Behavioral Neurology and Neuropsychiatry

This Special Issue highlights the most recent research on depression, anxiety and dementia, with attention to comorbidity in a range of diseases. The symptoms of depression, anxiety and dementia are the most common comorbid manifestations present in patients suffering from neurodegenerative and psychiatric diseases. Together, these illnesses constitute an extremely complex and challenging research field due to their inherent multifactorial causative factors, heterogeneous pathogenesis, and mental and behavioral manifestations. This Special Issue covers laboratory, clinical and statistical studies on the crosstalk between depression, anxiety, dementia, Alzheimer’s disease, multiple sclerosis, schizophrenia, diabetes mellitus, Down’s syndrome, and/or compulsive disorders. It contains contributions from 71 authors, has been reviewed by 25 referees, and edited by three academic editors and one managing editor

Being stressed and active!? An analysis of different aspects of the relationship between physical activity, individual perceived stress, and individual health

Die sportwissenschaftliche Forschung zeigt deutlich, dass Sport und körperliche Aktivität positive Effekte für die Gesundheit haben, im Gegensatz dazu aber erlebter Stress negative Folgen hat. Es stellt sich die Frage, welche Rollen und Effekte Sport im Stress-Gesundheit Kontext spielen kann. In drei Studien wurde der Moderatoreffekt von Sport auf den Zusammenhang zwischen Stress und Beschwerden sowie der Effekt von erlebtem Stress auf die Sportaktivität selbst untersucht

Salutogenesis 2.0: An examination of healthy ageing-in-place using a qualitative application of the Sense of Coherence.

The aim of this thesis was to examine the theory of salutogenesis (Antonovsky, 1987; 1996), within the context of later life, and to consider the value of salutogenesis as an analytical perspective applicable to understanding older people’s health and wellbeing as they age-in-place. This was done by applying the theory’s analytical construct, the Sense of Coherence (SOC), qualitatively and using its three components comprehensibility, manageability and meaningfulness, to make sense of data gathered from life review interviews. These interviews were conducted with a sample of ‘healthy’ and active older people, aged 75 years and older, living independently in the East and South-East of Ireland. The results and analysis presented demonstrate the potential value of the qualitative application of the SOC, and additionally suggest that qualitative methods are underutilised in salutogenic research. Furthermore, using qualitative approaches to explore the SOC provides additional scope to incorporate context and place as central positions of analysis, thereby opening up the theory of salutogenesis more fully to health geographers. The results of this research contribute to the geographies of health and ageing literature by providing a detailed exploration of the theory of salutogenesis as a framework that can contribute to the geographer’s understanding of the health-place relationship. The thesis also contributes to the salutogenic literature by examining the SOC through the lens of relational geographies of health and ageing. What emerges is a complementary dialogue and flow of ideas between diverse perspectives on health and wellbeing in later life

Development and feasibility testing of a buddy intervention to increase postnatal physical activity

Childbirth is a life event that negatively influences mothers’ physical activity (PA) levels and is identified as a teachable moment for health behaviour change and therefore interventions to increase postnatal PA are required. This thesis broadly follows the first two steps in the Medical Research Council (MRC) intervention development guidance, combined with methods from the Behaviour Change Wheel (BCW). The first study systematically reviewed the existing literature on the effectiveness of postnatal PA interventions. Eleven studies were included in the narrative review and eight in the meta-analysis. There was a small but significant increase in PA behaviour in the intervention group compared to the control group, but heterogeneity was high. A need for interventions with larger sample sizes, longer follow-up periods and objective PA measurements was identified. Study two utilised a multi-methods design to explore the factors that influence postnatal PA according to the COM-B model of behaviour. Semi-structured interviews qualitatively explored participants’ views on what factors influenced PA, and a questionnaire determined their relative importance. Qualitative findings indicated that all COM-B components influenced behaviour, and quantitative findings indicated that the most important factors that influenced behaviour were time, feeling tired, lack of available childcare, lack of advice from a healthcare professional, lack of motivation and development of a habit. The results are presented in a behavioural analysis for postnatal PA. The next section of this thesis described the remaining steps of the BCW to identify intervention options, content and implementation options resulting in ‘Buddy Up’, an intervention that matches two new mothers as PA buddies to provide mutual support to increase PA. A buddy is an existing friend or another eligible participant. The intervention includes three PA counselling sessions based on Motivational Interviewing principles supplemented by a booklet. The final study explored the feasibility of delivering ‘Buddy Up’ utilising a single group pre-post study design. The study explored the feasibility of recruitment, data collection, intervention acceptability and preliminary efficacy data. 44 participants (existing friends (n=22); new match (n=22)) were recruited, and 21 participants 5 remained unmatched. Key recruitment challenges were engaging Children’s Centres (CCs) with recruitment and matching participants. Participants engaged in PA with their buddy on 1.06 days (SD=1.76) in the past week and provided support by sending encouraging messages (85.7%), sharing PA ideas/information (71.4%) and doing PA together (60%). Findings from the post-intervention interviews suggest good acceptability of the intervention sessions, minimal usage of the booklet and varied views on the acceptability of the buddy element among participants. Preliminary effectiveness data is promising for objective (Baseline=697.68 counts per minute (cpm); Follow-up=765.05 cpm) and self-report PA (Baseline=1533.56 MET-min/week; Follow-up=1917.50 MET-min/week) and has a significant effect on self-efficacy to overcome some barriers to PA (when feeling depressed, when there is no one to be physically active with, during bad weather and when they have no money). Collectively, this thesis describes the intervention development process and presents the first buddy intervention for postnatal physical activity. The feasibility study findings show promise that this is a fruitful research avenue, but the intervention’s operational feasibility requires further refinement prior to recommending a large-scale efficacy trial.This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care