Differences Between Blacks and Whites With Coronary Heart Disease in Initial Symptoms and in Delay in Seeking Care

BACKGROUND: Mortality rates for coronary heart disease are higher in blacks than in whites. OBJECTIVES: To examine differences between blacks and whites in the manifestation of symptoms of coronary heart disease and in delay in seeking treatment. METHODS: Patients were directly observed as they came to an emergency department with symptoms suggestive of coronary heart disease. The sample included 40 blacks and 191 whites with a final diagnosis of angina or acute myocardial infarction. RESULTS: After controlling for pertinent demographic and clinical characteristics, logistic regression analysis revealed that blacks were more likely than whites to have shortness of breath (odds ratio = 3.16; 95% CI = 1.49-6.71; P = .003) and left-sided chest pain (odds ratio = 2.55; 95% CI = 1.10-5.91; P =.03). Blacks delayed a mean of 26.8 hours (SD = 30.3; median = 11 hours), whereas whites delayed a mean of 24.4 hours (SD = 41.7; median = 5 hours) in seeking care. Mean delay time was not significantly different for blacks and whites; differences in median delay time were of borderline significance (P = .05). CONCLUSIONS: Blacks were more likely than whites to have shortness of breath and left-sided chest pain as the presenting symptoms of coronary heart disease. Differences in delay in seeking treatment were not significant, although blacks tended to delay longer than did whites. The relatively small number of blacks may account for the lack of observed racial differences in both initial symptoms and in delay in seeking treatment

Presentation and Symptom Predictors of Coronary Heart Disease in Patients With and Without Diabetes

The aims of this prospective, observational study were to compare: (1) symptom presentation of coronary heart disease (CHD) between patients with and without diabetes and (2) symptom predictors of CHD in patients with and without diabetes. We directly observed 528 patients with symptoms suggestive of CHD as they presented to the ED of a 900-bed cardiac referral center in the northeastern United States. There were no significant differences in symptom presentation of CHD between patients with and without diabetes, although patients with diabetes were slightly more likely to present with shortness of breath (P =.056). Patients with diabetes reported their symptoms to be more severe compared with those without diabetes (P =.036). Neck/throat pain and arm/shoulder pain were of borderline significance in predicting CHD in patients with diabetes (P =.059 and P =.052, respectively). Classic chest symptoms and diaphoresis were independent predictors of CHD in patients without diabetes (P =.002 and P =.049, respectively). The perceived severity of symptoms was not predictive of CHD in patients with or without diabetes. Symptoms thought to be diagnostic of CHD are not helpful in patients with diabetes. Future research should focus on identifying more useful predictors of CHD in patients with diabetes

Physical and Psychological Health Outcomes of Qigong Exercise in Older Adults: A Systematic Review and Meta-Analysis

Physical limitations, depression and anxiety are prevalent among older adults. Mild to moderate exercise can promote physical and psychological health and reduce the risk of chronic diseases. Qigong, a type of Chinese traditional medicine exercise, has demonstrated beneficial effects on physical ability and mental health in adults with chronic conditions. The purpose of this review was to systematically assess the effects of Qigong exercise on physical and psychological health outcomes in older adults. A total of 1282 older adults aged 62 to 83 years with depressive symptoms, frailty or chronic medical illnesses were included in this review. The meta-analysis showed that Qigong exercise resulted in significantly improved physical ability compared with active control or usual care (standardized mean difference [SMD] = 1.00 and 1.20, respectively). The pooled effects of studies with thrice weekly Qigong sessions had the greatest effect (SMD=1.65) on physical ability in older adults. Lower quality studies demonstrated larger effect sizes than those of higher quality. Although Qigong exercise showed favorable effects on depression, balance and functioning, the overall effects did not reach statistical significance. No significant adverse events were reported. The findings suggest that the Qigong exercise may be an option for older adults to improve physical ability, functional ability, balance and to lessen depression and anxiety. However, the number of RCTs that enroll older adults is limited. More methodologically sound RCTs are needed to confirm the efficacy of Qigong exercise on physical and psychological health in older adults with chronic illnesses

Feasibility and Acceptability of Qigong Exercise in Community-Dwelling Older Adults in the United States

Objectives:Qigong exercise has been shown to improve physical and psychological well-being in adults with chronic conditions, but little is known about the feasibility and acceptability of engaging in a qigong exercise program in community-dwelling older adults in the United States. The purpose of this study was to explore the feasibility, acceptance, and adherence to an 8-week qigong exercise intervention in community-dwelling American older adults. Design: An exploratory study design. Setting: Two senior centers in southern Connecticut. Subjects: Forty-five community-dwelling older adults aged 65 to 85 years enrolled. Intervention: A supervised 1-h health qigong exercise session twice weekly for 8 weeks. Outcome measures: An investigator-designed questionnaire with seven items that were rated on a 1 to 6 scale, with higher scores indicating better results, and nine open-ended questions were used to obtain data on feasibility and acceptability. Adherence was calculated as the proportion of the 16 planned sessions attended. Results: Of the 45 older adults enrolled, 6 never started and 6 withdrew, with 33 evaluable at the end of the intervention. The mean age of the sample was 74.8 years; the majority were female (84.4%) and white (91.1%). Mean scores on aspects of difficulty, acceptability, suitability, or effectiveness of qigong exercise were all ≥5. Participants identified benefits of qigong exercise, such as calming and relaxing feelings, inner peace, better balance, and flexibility. Attendance rate was 78.8%, with 94% performing qigong exercise at least once weekly outside the class. All participants indicated that they would recommend qigong exercise to others. No adverse events occurred. Conclusion: An 8-week qigong exercise program was feasible, acceptable, and safe for American older adults. Future robust randomized controlled trials are needed to confirm these findings

Physical and Psychological Effects of Qigong Exercise in Community-Dwelling Older Adults: An Exploratory Study

Older adults need exercise programs that correspond to age-related changes. The purpose of this study was to explore preliminary effects of an 8-week Qigong exercise intervention on the physical ability, functional and psychological health, and spiritual well-being of community-dwelling older adults. Forty-five community-dwelling adults with the mean age of 74.8 years participated a 1-h Health Qigong exercise session twice weekly for 8 weeks. The majority were female (84%) and white (91%), and lived with their spouse (49%). Physical ability (p < 0.001), functional health (p = 0.001), balance (p < 0.001), functional reach (p < 0.001), depression (p = 0.005), and spiritual well-being (p = 0.004) improved significantly after the 8-week intervention. Most participants perceived physical ability, mental health, and spiritual well-being benefits. No adverse events were reported. A twice weekly Qigong exercise program over 8 weeks is feasible and has potential to improve physical ability, functional health, balance, psychological health, and spiritual well-being in older adults

Living the Resurrection and Loving Our Neighbors

Funk-Pihl, Marjorie. 2020. “Living the Resurrection and Loving Our Neighbors.” Fuller Theological Seminary, School of Intercultural Studies. Doctor of Intercultural Studies Degree. 220 pp. To love God with all your heart, soul and mind is the same as to love your neighbor as yourself. This is the wisdom Jesus offered in Mark 12:30-31 and Luke 10:27. This is the Lutheran Biblical missiology at the foundation of the congregational vitality process called Living the Resurrection (LtR) that I developed, implemented and evaluated for this research process. Increased mobility has increased immigration and migration throughout the USA and provided the opportunity for Christians to express love for a great diversity of neighbors. However, Chapter 2 shows that our human needs for safety and belonging have pulled us into homogeneous communities that isolated us from those who are not like us. Racism and other “isms” that separate neighbor from neighbor show that we have been unsuccessful in living into God’s commands. For this project I worked with small ELCA congregations in Southern California who had an average worship attendance of under sixty and limited staff. More importantly, they had minimal to non-existent relationships with their physical neighbors. The changes involved in expanding their love for one another to include love for their neighbors had the potential to trigger their defense mechanisms and cause them to resist the process. Chapter 3 demonstrates that Appreciative Inquiry’s ability to motivate change and minimize anxiety makes it the optimal change strategy for LtR. In Part 2 I explain the research process of this dissertation and how it overlaps with the LtR vitality process. Insider Action Research in the Appreciative Inquiry mode provided the methodology for this project and allowed me to develop, implement and evaluate the LtR process with two consecutive groups of congregations. The adjustments I make between the first and second cycles are explained in Chapter 6. Part 3 celebrates that eight of the twelve congregations who completed the LtR process significantly strengthened their relationships with their neighbors. The findings of the second cycle also suggested improvements for the third cycle which may lead to even better results. God’s love can motivate us to love our neighbors. Mentor’s Name: Dr. Steven Sage Word Count: 33

Practice standards for ECG monitoring in hospital settings: executive summary and guide for implementation.

Current goals of hospital ECG monitoring are to diagnose cardiac arrhythmias, acute myocardial ischemia, and drug-induced prolonged QT interval. Recently, experts in the field of electrocardiology and cardiac monitoring convened to develop a practice standard for hospital ECG monitoring. This executive summary reviews key elements of the practice standard and answers questions that often arise when clinicians try to implement them