Screening for sedentary behaviour in cardiac rehab.

Sedentary behaviour is on the rise, particularly among people with cardiovascular disease. Here, Michelle Rogerson and colleagues examine the risks of this behaviour, the presence and absence of guidelines, and incorporation of screening during cardiac rehabilitation

Television viewing time and 13-year mortality in adults with cardiovascular disease: data from the Australian diabetes, obesity and lifestyle study (AusDiab)

Background In the general population, excessive sedentary behaviour is associated with increased all-cause mortality. Few studies have examined this relationship in people with cardiovascular disease (CVD). Using a sample of people with CVD who were excluded from an analysis of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study, we examined the relationship between sedentary behaviour and 13-year all-cause mortality

Cardiac rehabilitation online pilot: extending reach of cardiac rehabilitation

BACKGROUND: While cardiac rehabilitation (CR) is recommended for all patients after an acute cardiac event, limitations exist in reach. OBJECTIVE: The purpose of the current study was to develop and pilot a flexible online CR program based on self-management principles "Help Yourself Online." METHODS: The program was designed as an alternative to group-based CR as well as to complement traditional CR. The program was based on existing self-management resources developed previously by the Heart Research Centre. Twenty-one patients admitted to Cabrini Health for an acute cardiac event were recruited to test the program. The program was evaluated using qualitative and quantitative methods. RESULTS: Quantitative results demonstrated that patients believed the program would assist them in their self-management. Qualitative evaluation, using focus group and interview methods with 15 patients, showed that patients perceived the online CR approach to be a useful instrument for self-management. CONCLUSIONS: Broader implications of the data include the acceptability of the intervention, timing of intervention delivery, and patients\u27 desire for additional online community support

Unraveling the Complexity of Cardiac Distress: A Study of Prevalence and Severity

INTRODUCTION: While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. METHOD: A sample of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. RESULTS: Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were “being physically restricted” (66%), “lacking energy” (60%), “being short of breath” (60%), “thinking I will never be the same again” (57%), and “not sleeping well” (51%). While less prevalent, “not having access to the health care I need,” “being concerned about my capacity for sexual activity,” and “being unsupported by family and friends” were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. CONCLUSION AND IMPLICATIONS: Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery

The cardiac distress inventory: A new measure of psychosocial distress associated with an acute cardiac event

BACKGROUND: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. METHOD: An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. RESULTS: Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. CONCLUSION: The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-022-02897-y

It Looks Good, but What is it Like to Live There? Exploring the Impact of Innovative Housing Design on Crime

This paper reports on the findings of a collaborative project (funded by the Home Office and managed by the Commission for Architecture and the Built Environment - CABE) which was conducted in late 2009 and early 2010. The project set out to strengthen and update the evidence base on the impact of design on a range of crime types – with a specific focus upon housing developments acclaimed for their innovative design and award winning architecture. This paper presents the findings of an in-depth assessment of the impact of housing design features on crime. Utilising a comprehensive data collection exercise, the specific design features of thousands of homes were collated and assessed against police recorded crime data. The design features were based upon the key elements of Crime Prevention Through Environmental Design (CPTED) including road layout, house design, surveillance, territoriality, car parking, communal space, management and maintenance and physical security. The unique and painstaking methodology not only provided an excellent dataset for analysis, but also highlighted the need both for greater conceptual clarity within CPTED and for crime-risk assessments to be based on the careful operationalisation and measurement of CPTED factors. As well as assessing the impact of specific (and combined) design features upon crime, the research also resulted in the production of a new data collection tool designed to address the weaknesses of existing checklists in assessing innovative contemporary developments, which are often unconventional in nature. The paper explores the degree of conflict and/or synergy between the traditional principles of CPTED and contemporary directions in architecture and design. Finally the paper considers the extent to which traditional CPTED principles remain relevant within contemporary residential developments and explores whether areas of revision are required

Development of a short form of the Cardiac Distress Inventory

Abstract Background Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient’s capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. Methods A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. Results The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of ≥ 18 as the reference variable, the CDI-SF had a very high Area Under the Curve (AUC) (AUC = 0.913 (95% CI: 0.88 to 0.94). A CDI-SF score of ≥ 13 was found to indicate general cardiac distress which may warrant further investigation using the original CDI. Conclusion The psychometric findings detailed here indicate that the CDI-SF provides a brief psychometrically sound screening measure indicative of general cardiac distress, that can be used in both clinical and research settings

Additional file 1 of Development of a short form of the Cardiac Distress Inventory

Additional file 1: The final CDI-SF instrumen