742 research outputs found
Addition of 24âhour heart rate variability parameters to the Cardiovascular Health Study stroke risk score and prediction of incident stroke: The Cardiovascular Health Study
Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24âhour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHSâSCORE), previously developed at the baseline examination. Methods and Results N=884 strokeâfree CHS participants (age 75.3Âą4.6), with 24âhour Holters adequate for HRV analysis at the 1994â1995 examination, had 68 strokes over â¤8 year followâup (median 7.3 [interquartile range 7.1â7.6] years). The value of adding HRV to the CHSâSCORE was assessed with stepwise Cox regression analysis. The CHSâSCORE predicted incident stroke (HR=1.06 per unit increment, P=0.005). Two HRV parameters, decreased coefficient of variance of NN intervals (CV%, P=0.031) and decreased power law slope (SLOPE, P=0.033) also entered the model, but these did not significantly improve the câstatistic (P=0.47). In a secondary analysis, dichotomization of CV% (LOWCV% â¤12.8%) was found to maximally stratify higherârisk participants after adjustment for CHSâSCORE. Similarly, dichotomizing SLOPE (LOWSLOPE <â1.4) maximally stratified higherârisk participants. When these HRV categories were combined (eg, HIGHCV% with HIGHSLOPE), the câstatistic for the model with the CHSâSCORE and combined HRV categories was 0.68, significantly higher than 0.61 for the CHSâSCORE alone (P=0.02). Conclusions In this sample of older adults, 2 HRV parameters, CV% and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during â¤8âyear followâup. These findings will require validation in separate, larger cohorts. Keywords: autonomic nervous system, clinical stroke risk model, heart rate variability, prediction, predictors, risk prediction, risk stratification, strok
Personality factors and cognitive functioning in patients with somatic symptom and related disorders
Objective Somatic symptom and related disorders (SSRD) are often complicated by cognitive symptoms, including reduced information processing speed, memory, and planning. Depression has been related to poor cognitive functioning in SSRD, but the role of underlying personality factors is poorly understood. This study investigates the association between personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) with cognitive functioning in patients with SSRD. Methods Data from 366 patients with SSRD from a tertiary care expert center (mean age = 42.1 years (SD = 13.4), 59.6% women) were analyzed using a cross-sectional design. Neuropsychological assessments included measures of information processing speed, memory, attention, and executive function. Personality factors were assessed using the NEO-FFI and depressive symptoms using the PHQ-9. Results Regression analyses showed associations between neuroticism with poorer performance on visual memory (B = â0.09, SE = 0.04, β = â0.14, p = .019), and planning (B = â0.09. SE = 0.02, β = â0.23, p < .001). Extraversion was also inversely associated with visual memory (B = â0.13, SE = 0.05, β = â0.18, p = .011) and planning (B = â0.07, SE = 0.03, β = â0.17, p = .021) and openness was associated with better visual memory (B = 0.17, SE = 0.05, β = 0.19, p = .002). These associations were attenuated but remained significant after adjusting for depressive symptoms. Conclusion Neuroticism, extraversion, and low openness were associated with lower cognitive functioning (particularly planning and visual memory) in patients with SSRD, which remained significant after taking depressive symptoms into account
A personalized eHealth intervention for lifestyle changes in patients with cardiovascular disease::Randomized controlled trial
BACKGROUND: Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes. OBJECTIVE: This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated. METHODS: Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies. RESULTS: The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean -1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F1,149.0=0.48; P=.07). CONCLUSIONS: The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change. TRIAL REGISTRATION: ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281
Cobertura florestal secundåria em pequenas propriedades rurais na Amazônia: implicaçþes para a agricultura de corte e queima.
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Facial expressions of emotions during pharmacological and exercise stress testing:The role of myocardial ischemia and cardiac symptoms
Background Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion expression was examined. Methods Patients undergoing cardiac stress testing (CST) using bicycle exercise or adenosine with myocardial perfusion imaging were included (N = 256, mean age 66.8 +/- 8.7 year., 43% women). Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery. Nuclear images were evaluated using SPECT. Results Ischemia (N = 89; 35%) was associated with higher levels of sadness (p = .017, d = 0.34) and lower happiness (p = .015, d = 0.30). During recovery, patients with both ischemia and anginal symptoms had the highest sadness expression (F (3,254) = 3.67, p = .013, eta(2) = 0.042) and the lowest happiness expression (F (3, 254) = 4.19, p = .006, eta(2) = .048). Conclusion Sadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions
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