Not All Competitions Come to Harm! Competitive Biofeedback to Increase Respiratory Sinus Arrhythmia in Managers

Despite the positive impact on achievement, competition has been associated with elevated psychophysiological activation, potentially leading to a greater risk of cardiovascular diseases. Competitive biofeedback (BF) can be used to highlight the effects of competition on the same physiological responses that are going to be controlled through BF. However, it is still unknown whether competition could enhance the effects of respiratory sinus arrhythmia (RSA)-BF training in improving cardiac vagal control. The present study explored whether competitive RSA-BF could be more effective than non-competitive RSA-BF in increasing RSA in executive managers, who are at higher cardiovascular risk of being commonly exposed to highly competitive conditions. Thirty managers leading outstanding private or public companies were randomly assigned to either a Competition (n = 14) or a Control (n = 16) RSA-BF training lasting five weekly sessions. Managers in the Competition group underwent the RSA-BF in couples and each participant was requested to produce a better performance (i.e., higher RSA) than the paired challenger. After the training, results showed that managers in the Competition group succeeded in increasing cardiac vagal control, as supported by the specific increase in RSA (p < 0.001), the standard deviation of R-R wave intervals (SDNN; p < 0.001), and root mean square of the successive differences between adjacent heartbeats (rMSSD; p < 0.001). A significant increase in the percentage of successive normal sinus beat to beat intervals more than 50 ms (pNN50; p = 0.023; partial eta squared = 0.17), low frequency (p < 0.001; partial eta squared = 0.44), and high frequency power (p = 0.005; partial eta squared = 0.25) emerged independently from the competitive condition. Intriguingly, managers who compete showed the same reduction in resting heart rate (HR; p = 0.003, partial eta squared = 0.28), systolic blood pressure (SBP; p = 0.013, partial eta squared = 0.20), respiration rate (p < 0.001; partial eta squared = 0.46), and skin conductance level (SCL; p = 0.001, partial eta squared = 0.32) as non-competitive participants. Also, the same reduction in social anxiety (p = 0.005; partial eta squared = 0.25), state (p = 0.038, partial eta squared = 0.14) and trait anxiety (p = 0.001, partial eta squared = 0.31), and depressive symptoms (p = 0.023, partial eta squared = 0.17) emerged in the two groups. The present results showed that managers competing for increasing RSA showed a greater improvement in their parasympathetic modulation than non-competing managers. Most importantly, competition did not lead to the classic pattern of increased psychophysiological activation under competitive RSA-BF. Therefore, competition could facilitate the use of self-regulation strategies, especially in highly competitive individuals, to promote adaptive responses to psychological stress

L'ipotesi del bias attentivo nella fobia del sangue: un contributo psicofisiologico

The work presented in this thesis describes three studies which had as their aim the investigation of the presence of an attention bias in blood-injection-injury phobia through behavioural and eletrocortical measurements. Different experimental paradigms and emotional control categories were used to test the specificity of the attentional bias towards phobia-related stimuli and to identify the attentive processes involved.Il presente lavoro di tesi ha l'obieetivo di indagare la presenza di un bias arttentivo nella fobia di sangue-iniezioni-ferite attraverso misure comportamentali ed eletrocorticali. Sono stati impiegati paradigmi sperimentali e categorie emozionali di controllo differenti al fine di testare la specificità del bias attentivo e di identificare i processi attentivi coinvolti

Transcatheter Edge-to-Edge Repair in COAPT-Ineligible Patients: Incidence and Predictors of 2-Year Good Outcome

Background: COAPT-trial entry criteria are useful to identify patients with better outcomes after transcatheter edge-to-edge repair (TEER). However, up to one-half of real-world patients with secondary mitral regurgitation (SMR) undergoing TEER do not meet these highly selective criteria and no study has formally investigated them. The aim of this study was to evaluate the predictors of good outcome after TEER in COAPT-ineligible patients. Methods: All consecutive patients with SMR and heart failure (HF) treated with MitraClip at 3 European centres were retrospectively screened. The presence of at least 1 COAPT exclusion criterion was used to define a COAPT-ineligible profile, allowing the inclusion in the study population. Freedom from all-cause death or HF hospitalisation was evaluated at 2-year follow-up (primary end point). Results: A total of 305 patients (47%) had a COAPT-ineligible profile. An overall 58% rate of all-cause death or HF hospitalisation was detected at 2 years. Patients with a single COAPT exclusion criterion experienced fewer adverse events than those with multiple criteria (55% vs 69%). At multivariable Cox regression analysis, New York Heart Association functional class II, younger age (< 75 years), lower serum creatinine (< 2 mg/dL), lower left ventricular end-diastolic volume (< 240 mL), and the absence of hemodynamic instability, atrial fibrillation, and chronic obstructive pulmonary disease were independently associated with good outcome. Conclusions: In this real-world series of patients with SMR undergoing TEER, a COAPT-ineligible profile was common. The presence of only 1 COAPT exclusion criterion or the absence of hemodynamic instability were associated with the most favourable outcome

Personality and smoking:individual-participant meta-analysis of nine cohort studies

AIMS: To investigate cross-sectional and longitudinal associations between personality and smoking, and test whether sociodemographic factors modify these associations. DESIGN: Cross-sectional and longitudinal individual-participant meta-analysis. SETTING: Nine cohort studies from Australia, Germany, UK and US. PARTICIPANTS: A total of 79,757 men and women (mean age = 51 years). MEASUREMENTS: Personality traits of the Five-Factor Model (extraversion, neuroticism, agreeableness, conscientiousness and openness to experience) were used as exposures. Outcomes were current smoking status (current smoker, ex-smoker, and never smoker), smoking initiation, smoking relapse, and smoking cessation. Associations between personality and smoking were modeled using logistic and multinomial logistic regression, and study-specific findings were combined using random-effect meta-analysis. FINDINGS: Current smoking was associated with higher extraversion (odds ratio per 1 standard deviation increase in the score: 1.16; 95% confidence interval: 1.08–1.24), higher neuroticism (1.19; 1.13–1.26), and lower conscientiousness (0.88; 0.83–0.94). Among nonsmokers, smoking initiation during the follow-up period was prospectively predicted by higher extraversion (1.22; 1.04–1.43) and lower conscientiousness (0.80; 0.68–0.93), whereas higher neuroticism (1.16; 1.04–1.30) predicted smoking relapse among ex-smokers. Among smokers, smoking cessation was negatively associated with neuroticism (0.91; 0.87–0.96). Sociodemographic variables did not appear to modify the associations between personality and smoking. CONCLUSIONS: Adult smokers have higher extraversion, higher neuroticism and lower conscientiousness personality scores than non-smokers. Initiation into smoking is positively associated with higher extraversion and lower conscientiousness, while relapse to smoking among ex-smokers is association with higher neuroticism

Personality and smoking: individual‐participant meta‐analysis of nine cohort studies

Aims To investigate cross-sectional and longitudinal associations between personality and smoking, and test whether socio-demographic factors modify these associations. Design Cross-sectional and longitudinal individual-participant meta-analysis. Setting Nine cohort studies from Australia, Germany, the United Kingdom and the United States. Participants A total of 79757 men and women (mean age=50.8years). Measurements Personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness and openness to experience) were used as exposures. Outcomes were current smoking status (current smoker, ex-smoker and never smoker), smoking initiation, smoking relapse and smoking cessation. Associations between personality and smoking were modelled using logistic and multinomial logistic regression, and study-specific findings were combined using random-effect meta-analysis. Findings Current smoking was associated with higher extraversion [odds ratio per 1 standard deviation increase in the score: 1.16; 95 % confidence interval (CI) =1.08–1.24], higher neuroticism (1.19; 95 % CI=1.13–1.26) and lower conscientiousness (95 % CI=0.88; 0.83–0.94). Among non-smokers, smoking initiation during the follow-up period was predicted prospectively by higher extraversion (1.22; 95 % CI=1.04–1.43) and lower conscientiousness (0.80; 95 % CI=0.68–0.93), whereas higher neuroticism (1.16; 95 % CI=1.04–1.30) predicted smoking relapse among ex

Transcatheter Edge-to-Edge Repair in COAPT-Ineligible Patients: Incidence and Predictors of 2-Year Good Outcome

22siBackground: COAPT-trial entry criteria are useful to identify patients with better outcomes after transcatheter edge-to-edge repair (TEER). However, up to one-half of real-world patients with secondary mitral regurgitation (SMR) undergoing TEER do not meet these highly selective criteria and no study has formally investigated them. The aim of this study was to evaluate the predictors of good outcome after TEER in COAPT-ineligible patients.Methods: All consecutive patients with SMR and heart failure (HF) treated with MitraClip at 3 European centres were retrospectively screened. The presence of at least 1 COAPT exclusion criterion was used to define a COAPT-ineligible profile, allowing the inclusion in the study population. Freedom from all-cause death or HF hospitalisation was evaluated at 2-year follow-up (primary end point).Results: A total of 305 patients (47%) had a COAPT-ineligible profile. An overall 58% rate of all-cause death or HF hospitalisation was detected at 2 years. Patients with a single COAPT exclusion criterion experienced fewer adverse events than those with multiple criteria (55% vs 69%). At multivariable Cox regression analysis, New York Heart Association functional class II, younger age (&lt; 75 years), lower serum creatinine (&lt; 2 mg/dL), lower left ventricular end-diastolic volume (&lt; 240 mL), and the absence of hemodynamic instability, atrial fibrillation, and chronic obstructive pulmonary disease were independently associated with good outcome.Conclusions: In this real-world series of patients with SMR undergoing TEER, a COAPT-ineligible profile was common. The presence of only 1 COAPT exclusion criterion or the absence of hemodynamic instability were associated with the most favourable outcomes.noneScotti, Andrea; Munafò, Andrea; Adamo, Marianna; Taramasso, Maurizio; Denti, Paolo; Sisinni, Antonio; Buzzatti, Nicola; Stella, Stefano; Ancona, Francesco; Zaccone, Gregorio; Cani, Dario; Montorfano, Matteo; Castiglioni, Alessandro; de Bonis, Michele; Alfieri, Ottavio; Latib, Azeem; Colombo, Antonio; Agricola, Eustachio; Maisano, Francesco; Metra, Marco; Margonato, Alberto; Godino, CosmoScotti, Andrea; Munafò, Andrea; Adamo, Marianna; Taramasso, Maurizio; Denti, Paolo; Sisinni, Antonio; Buzzatti, Nicola; Stella, Stefano; Ancona, Francesco; Zaccone, Gregorio; Cani, Dario; Montorfano, Matteo; Castiglioni, Alessandro; de Bonis, Michele; Alfieri, Ottavio; Latib, Azeem; Colombo, Antonio; Agricola, Eustachio; Maisano, Francesco; Metra, Marco; Margonato, Alberto; Godino, Cosm