Generalised anxiety disorder doubles risk of cardiovascular events in people with stable coronary heart disease

Does generalised anxiety disorder (GAD) affect cardiovascular events associated with coronary heart disease (CHD)? Population: 1015 patients with stable coronary heart. Eligible patients had at least one of the following: history of myocardial infarction (MI), 50% stenosis in one or more coronary vessels (angiographic evidence), history of coronary revascularization, diagnosis of CHD or previous evidence of exercise-induced ischaemia (treadmill or nuclear testing). Setting: Medical centres and public health clinics in San Francisco, USA; September 2000 to December 2002. Prognostic factors: GAD according to Diagnostic Interview Schedule for DSM-IV criteria. Outcomes:\ud Cardiovascular events occurring between baseline and March 2009. Events included stroke, heart failure, MI, transient ischaemic attack or death. Heart failure was defined as hospitalisation for a clinical syndrome involving at least two of the following: orthopnoea, third heart sound, pulmonary rales, paroxysmal nocturnal dyspnoea, elevated jugular venous pressure, cardiomegaly or pulmonary oedema on chest radiography. Non-fatal MI was defined based on the presence of symptoms, electrocardiographic changes and cardiac enzymes using standard criteria

Teaching critical appraisal to Sport & Exercise Sciences and Biosciences students

Seminars were implemented to develop undergraduates’ critical appraisal skills and their effectiveness was evaluated. Participants were 140 undergraduate students consisting of 103 students from Sport and Exercise Sciences and 37 from Biosciences. Four seminars were employed to develop and reinforce critical thinking and provide an opportunity for practise and group work. Source material included research proposals and published journal articles. Two linked pieces of coursework assessed critical thinking skills. Teaching method effectiveness was examined using the students’ questionnaire responses and comparison of coursework grades across the module. Students reported finding the seminars useful and helpful, and their self-ratings of critical appraisal skills improved from pre- to post-seminar. However, this was not generally reflected in assessment grades across the group. Overall, there was a significant decline in grades from the first to the second piece of coursework. However, although Sport and Exercise Sciences students’ scored significantly lower on the second coursework, Biosciences students scored higher. It is possible that this type of teaching helps to boost performance in students who originally are new to such skills. Future studies would need to examine whether different methods or longer follow-up might also yield improvements in objective measurements of students’ critical appraisal ability

Blunted cardiovascular reactivity relates to depression, obesity, and self-reported health

The reactivity hypothesis implicates exaggerated cardiovascular reactions to acute psychological stress in the development of hypertension and other cardiovascular disease outcomes. However, cardiovascular reactivity has also been suggested as a mediator between a variety of psychosocial and behavioural risk factors and cardiovascular disease. Data from various analyses of the West of Scotland Twenty-07 study are discussed together, and caution against over-stretching the original reactivity hypothesis. Blood pressure and heart rate were assessed at rest and during an acute mental arithmetic stress task. First, depression, though a putative risk factor for cardiovascular disease, does not appear to confer this risk via exaggerated reactivity, as it was negatively related to reactivity. Second, obesity, another risk factor, was also associated with blunted rather than heightened reactivity. Finally, lower reactivity was related to poorer self-reported health. Similar associations emerged from both cross-sectional and prospective analyses. These seemingly paradoxical results are discussed in terms of implications for the reactivity hypothesis

Does Work Stress Predict the Occurrence of Cold, Flu and Minor Illness Symptoms in Clinical Psychology Trainees?

Objectives: The present study examined the three/four-day lagged relationship between daily work stress and upper respiratory tract infection (URTI) and other minor illness symptoms. Methods: Twenty-four postgraduate clinical psychology trainees completed work stress, cold/flu symptoms and somatic symptoms checklists daily for four weeks. Results: Increases in work stress were observed two days prior to a cold/flu episode but not three or four days preceding a cold/flu episode. Work stress was unrelated to peaks in somatic symptom reporting. Conclusions: There was some evidence of a lagged relationship between work stress and symptoms, but not of the expected duration, suggesting that the relationship between work stress and URTI symptoms was not mediated by the immune system

Sexual behaviour of men who have sex with men (MSM) and transgenders in Southern India

Background The HIV epidemic in India remains predominantly concentrated in groups where individuals display high risk behaviours, including men who have sex with men (MSM). Widespread behavioural changes are crucial to the control of HIV, but need to be informed by an understanding of the risk factors for infection. However, reliability and validity of self-reported behaviour are difficult to determine. This thesis aims to contribute to the literature comparing innovative data collection modes for self-reported HIV risk behaviour in developing countries. Methods The Avahan programme is a large-scale HIV-prevention project that focuses on the six states in India with the highest HIV prevalence. The programme focuses on core and bridging groups, including MSM. This thesis presents the findings of one aspect of the monitoring and evaluation: behavioural data collected using face-to-face interviews (FTFI) and informal confidential voting interviews (ICVI) among MSM sampled in public place and Hammam cruising sites in Bangalore. Results A review of empirical data collected in developing countries comparing FTFI with new interviewing tools, found private data collection methods to have mixed success in reducing underreporting of risky behaviour. A comparison of ICVI and FTFI in India found that ICVI significantly increased reporting of stigmatised behaviours, but results did not adhere consistently to expectation. A number of self-identified categories of MSM are commonly applied in the intervention context in India, each of which was generally associated with different HIV-risk behaviours. Although there was evidence of role segregation and identity-specific behaviour, the categories were found to be more fluid than has previously been documented. Bisexual behaviour was common, and condom use with female partners was low, which suggests a potential bridge of HIV transmission into the general population. Conclusions The dataset provided a solid description of HIV risk behaviours among MSM cruising in public places in Bangalore, which has immediate implications for designing appropriate targeted HIV prevention programmes that address fluidity in risk behaviour between MSM identities and reach out to behaviourally bisexual men, rather than treating MSM as a homogenous group. Both the systematic review and the comparison of ICVI and FTFI highlighted difficulties in gathering ‘truthful’ self-reported behaviour, as determining the precise reasoning where individual responses departed from the presumed norm was impossible. Qualitative research might contribute to a better understanding of the motivations behind reporting biases amongst MSM

Ageing, depression, anxiety, social support and the diurnal rhythm and awakening response of salivary cortisol

The present study compared the cortisol awakening response and diurnal rhythm in 24 young healthy students and 48 community-dwelling older adults. The associations with diurnal cortisol and depression, anxiety and social support were also examined in relation to age. Salivary cortisol was measured over the course of one day: immediately upon awakening, 30 min later, and then 3 h, 6 h, 9 h and 12 h post-awakening. Participants completed a questionnaire measuring symptoms of anxiety and depression and social support was assessed. Older adults exhibited a significantly reduced awakening response, overall cortisol levels, area under the curve (AUC) and diurnal slopes than younger adults, resulting in a flatter diurnal rhythm. Younger adults with higher depression scores had significantly higher overall cortisol and higher levels upon awakening and 30 min post-awakening. In the younger adults, anxiety and depression correlated positively with AUC and the cortisol awakening response (CAR). Older adults with lower social support had a reduced AUC where younger adults with lower social support displayed a larger AUC. These findings suggest that the diurnal rhythm and awakening response of salivary cortisol are significantly reduced in older adults and the associations between anxiety, depression and social support and diurnal cortisol vary with age.\ud \u

The very fact that Thatcher can be lauded as the woman who broke the mould is indicative of the challenges which women still face in contemporary politics

Anne Phillips reflects on the legacy which Margaret Thatcher, the UK’s first female Prime Minister, left for women. This debate has tended to be a polarised one, with sweeping claims made on the basis of what is, in essence, a single case. Furthermore such claims have tended to distract from a broader assessment of Thatcher’s social and political legacy

Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample

Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective

Blunted cardiac reactions to acute psychological stress predict symptoms of depression five years later: Evidence from a large community study

We recently reported a cross-sectional negative relationship between cardiovascular reactivity and depressive symptoms. The present analyses examined the prospective association between reactivity and symptoms of depression five years later. At the earlier time point depressive symptoms, using the Hospital Anxiety and Depression Scale (HADS), and cardiovascular reactions to a standard mental stress were measured in 1608 adults comprising three distinct age cohorts: 24-, 44-, and 63-year olds. Depression was re-assessed using the HADS five years later. Heart rate reactions to acute psychological stress were negatively associated with subsequent depressive symptoms; the lower the reactivity the higher the depression scores. This association withstood adjustment for symptom scores at the earlier time point, and for socio-demographic factors and medication status. The mechanisms underlying this prospective relationship remain to be determined