Psychological interventions for coronary heart disease

A meta-analysis was conducted on 35 trials involving 10,703 individuals who had experienced a myocardial infarction and were randomised to an intervention involving some form of psychological therapy. Ten of these studies involved individuals with confirmed psychiatric diagnoses. Moderate quality evidence found no reduction of risk for total mortality or revascularisation procedures in comparison to usual care. Low quality evidence found no risk reduction for non-fatal MI although there was a 21% reduction in cardiac mortality. There was also some evidence of benefit on measures of psychological morbidity including anxiety, depression, and stress. It is concluded that psychological interventions may reduce cardiac mortality, although stronger evidence is required before this can be definitively concluded. It is also not clear who benefits most from psychological interventions

Smoking among high school students

Introduction: There are no recent data on smoking habits of high-school students in Greece. The primary objective of the study was to determine these epidemiological factors. Methods: The smoking habits of 927 high-school students (471 boys and 456 girls), aged between 15-18 years, in four regions of a Greek area (the island of Cos), were examined. Study data were collected using a questionnaire. Results: It was found that 32.48% of boys and 27.19% of girls are smokers; 43.3% had started smoking before the age of 14. The mean age for starting smoking was 14.4 ± 1.9 years for the boys and 14.9 ± 1.6 years for the girls. As many as 22.8% of the students smoke 6 to 10 cigarettes per day and 21.5% 16 to 20 cigarettes per day; 40.2% reported that they smoke out of spite. Students reported that their parents are aware that their offspring smoke in a proportion of 36.7%. Social standards and parental example were found to be the main determinants for starting smoking. The majority of the students (95.2%) stated that they are aware of the hazards associated with smoking. Discussion: Our findings highlight the need for smoking control interventions aimed at young people. Smoking is a major, yet preventable cause of morbidity and mortality. For these reasons, we view that adolescents should be targeted with a well-planned integrated anti-smoking policy and not just an initiative for raising awareness of smoking hazards. Copyright © Informa Healthcare USA, Inc

EFFECTS OF GROUP PSYCHOSOCIAL INTERVENTION ON CORONARY RISK-FACTORS

The purpose of this study was to investigate whether a psychosocial intervention approach aimed at resolving psychological conflicts could reduce the severity of risk factors for post-acute myocardial infarction patients. Twenty-three patients with a recent myocardial infarction participated in a group psychosocial intervention program which lasted 1 year. Twenty other patients with recent myocardial infarction served as controls. Patients form both groups had regular clinical and laboratory follow-up as well as medication. Mean values for seven risk factors of coronary heart disease (smoking, S; body weight, W; serum cholesterol, C; triglycerides, T; systolic and diastolic blood pressure, SBP, DBP; serum uric acid, U) were compared between the two groups in the 1 st, 3rd, 6th and 12th months of the follow-up. The maximal mean improvements of the study versus the control group were as follows: W: -2.82 vs. -1.05 kg; C: -56.04 vs. -6.25 mg/dl; T: -20.61 vs. -2.4 mg/dl; U: -0.57 vs. -0.9 mg/dl; S at 1 year -55.5 vs. -10%. It is concluded that group psychosocial intervention with post-acute myocardial infarction patients considerably reduces some coronary-disease risk factors

Cardiac tamponade rapidly evolving toward constrictive pericarditis and shock as a first manifestation of noncardiac cancer

A 44-year-old man presented with symptoms and signs of cardiac tamponade. Cytologic examination of the pericardial fluid was negative for malignancy and no manifestations of primary tumor were detected. Two weeks after pericardiocentesis the patient developed constrictive pericarditis. An emergency exploratory thoracotomy revealed a thick, fibrotic pericardium firmly adherent to the underlying myocardium. Histologic examination of the pericardium showed the presence of an adenocarcinoma, suspected to be a metastatic dissemination from a primary pulmonary source. The lymphatic spread of the tumor to the heart may explain the early development of pericardial effusion without malignant cells and the later development of pericardial and epicardial thickening. Cardiac tamponade of unknown origin should prompt a search for metastatic carcinoma, including in presence of a negative cytology

Hyperlipidemia and presence of thyroid autoantibodies in girls with Turner's syndrome or mosaic variance

Objective: The investigation of differences in the medical status between girls with Turner's syndrome or mosaic variance and healthy girls of the same age. In addition, the existence of differences between those persons with full Turner's syndrome and those with mosaic variance were examined. The influence of the treatment was also of concern because a number of the subjects in the study group were being treated with hormones (estrogen and progestin). Investigation concerned cardiovascular abnormalities, bone age, and lipid and hormonal profiles of the participating persons. Participants: Girls came to the hospital with problems in their menstrual cycles. Genetic control (karyotyping) took place. Each patient with symptoms of Turner's syndrome or mosaic variance was included in the study group. Every third patient with no symptoms of the syndromes and near the same age were included in the control group. Methods: Stratification was made according to the body mass index of the participating persons. Nonparametric tests were used for the analysis. Results: Differences were detected in the levels of cholesterol, low-density lipoproteins (LDLs), high-density lipoproteins (HDLs), and triglycerides, and were increased in the study group. Presence of thyroid autoantibodies, antithyreo-globulin-antibodies (AASTs) and antimicrosomatic antibodies (AASMs), was observed in the study group. In addition, differences were observed in HDL levels between persons with full Turner's syndrome and those with mosaic variance. Finally, significant difference was observed in the level of triglycerides and in the presence of AASTs and AASMs in treated and untreated persons with mosaic variance. Conclusions: Metabolic, genetic, eating or autoimmune mechanisms are suspected

High dose therapy with autologous stem cell transplantation for solitary bone plasmacytoma complicated by local relapse or isolated distant recurrence

We report three patients with solitary bone plasmacytoma (SBP) who developed either local recurrence within the radiotherapy field or an isolated distal recurrence and who were treated with high dose therapy supported by autologous stem cell transplantation. All patients remain without evidence of disease for 4-10 years after the procedure. High dose therapy may be of value and require further study in patients with SBP who develop local or distant failure

Autonomic nervous system responses to personal stressful events in patients with acute myocardial infarction. Preliminary results

Background: Life events specific for each individual may influence the onset of acute myocardial infarction (AMI), and we wondered whether recall of such events elicits autonomic nervous system responses in patients. Methods: Thirty-one subjects with AMI, which occurred about 1 month previously (study group), and 22 healthy subjects were interviewed. Whenever the presence of a stressful event was found within the last 2 months before AMI onset, a key phrase of the event was isolated. Each subject was faced with 20 written key sentences (including his/her own sentence if detected) at random order, for 40 s each. At the same time the heart rate (HR) and the galvanic skin response (GSR) were continuously recorded. Pearson r correlations, χ2 and t tests were employed for comparisons between study and control group as well as within each group. Results: A recent exacerbating event was detected in 30/31 AMI patients and in 0/22 healthy subjects. For the 30 AMI patients the values of HR following the sentence of the suspected event, specific for each patient, were statistically significantly higher than the mean values of HR following the remaining 19 'neutral' statements. The same significant difference appeared with regard to GSR values. The mean values of the AMI patients for the 19 neutral statements did not differ significantly from those of the healthy subjects for the 20 neutral statements, either for HR or GSR. Conclusions: Findings suggest that recall of personal stressful events elicited autonomic nervous system responses in AMI patients and, therefore, events with personal significance are related to coronary disease onset