Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event

Background: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality. Lifestyle and health behavior changes play an important role in the primary and secondary prevention of ACS recurrence. Changes in unhealthy lifestyles after an acute coronary event have been analyzed by considering separate behaviors individually, even though research on the healthy population has demonstrated that unhealthy behaviors tend to co-occur. Purpose: The aim of this study was to identify lifestyle profiles of ACS patients and to explore their pathways of change for one year after their first coronary event by adopting a typological approach. Methods: Two hundred and twenty-three patients (84% male; mean age = 57.14) completed self-report measures of health-related behaviors at the beginning of cardiac rehabilitation, and six months and twelve months after. At each wave depression, anxiety and heart rate were also evaluated. Cluster analysis was performed to identify lifestyle profiles and to analyze their change over time. Differences in psychological factors and heart rate among clusters were assessed. Results: Patients’ diet, physical activity, and smoking behavior greatly improved six months after their first coronary event. No further improvements were detected after one year. At each wave specific lifestyle profiles were identified, ranging from more maladaptive to healthier clusters. Patients with multiple unhealthy behaviors experience greater difficulties in maintaining a healthier lifestyle over time. Moreover, the results demonstrated the association between lifestyle profiles at twelve months after the acute coronary event and depression measured six months earlier. Finally, the most maladaptive lifestyle profile had many members with elevated heart rate at twelve months after the cardiac rehabilitation. Conclusions: Current findings may have a strong practical impact in the development and implementation of personalized secondary prevention programs targeting lifestyles of ACS patients

A longitudinal study on the information needs and preferences of patients after an acute coronary syndrome

Background: Research has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome. Methods: Two hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35-75; SD = 7.98). Patients' needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran's Q Test were performed to test differences in variables of interest over time. Results: Results showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time. Conclusion: The present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients' information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care

A type A and type D combined personality typology in essential hypertension and acute coronary syndrome patients: Associations with demographic, psychological, clinical, and lifestyle indicators

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed

第964回千葉医学会例会・第31回麻酔科例会

Background: Research has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome. Methods: Two hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35-75; SD = 7.98). Patients' needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran's Q Test were performed to test differences in variables of interest over time. Results: Results showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time. Conclusion: The present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients' information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care

Correlates of identity configurations: Three studies with adolescent and emerging adult cohorts.

none4noAdolescence and emerging adulthood are two core developmental periods in which individuals can develop a meaningful identity across domains. However, there is a lack of studies exploring correlates of different identity configurations. The purpose of this article was to fill this gap in examining correlates of configurations characterized by identity stability or instability in both ideological and relational domains or identity stability in one domain and instability in the other domain. Three studies were presented. In the first study, we investigated links between identity configurations and internalizing problem behaviors in early and middle adolescents (N = 1,891; M age = 14; 55% female); in the second study, we focused on associations between identity configurations and identity functions in late adolescents and early emerging adults (N = 1,085; M age = 19; 63% female); in the third study, we investigated relationships between identity configurations, sense of coherence, and basic psychological need satisfaction in emerging adults (N = 489; M age = 21; 71% female). Overall, findings highlighted that participants experiencing a condition of identity stability in both domains reported a better profile than their peers displaying a condition of instability in both realms. Further, individuals with identity stability only in one domain reported intermediate scores and the effect provided by each domain varied according to the correlate examined and the age group taken into account. Implications of these findings are discussed.mixedCrocetti, Elisabetta; Scrignaro, Marta; Sica, Luigia Simona; Magrin, Maria ElenaCrocetti, Elisabetta; Scrignaro, Marta; Sica, Luigia Simona; Magrin, Maria Elen

Identity formation in Italian emerging adults: A cluster-analytic approach and associations with psychosocial functioning

The present study examined identity formation in Italian emerging adults using an integrative identity model including commitment making, identification with commitment, exploration in depth, exploration in breadth, and ruminative exploration. Participants were 1,130 university students, aged 18-30 years. In line with previous research, results indicated that, by means of cluster analysis, six identity statuses could be derived: achievement, foreclosure, moratorium, diffused diffusion, carefree diffusion, and undifferentiated. Each of these identity statuses exhibited a distinct profile in terms of self-esteem, anxiety, depression, and need satisfaction. Suggestions for future research and limitations are discussed

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

Objectives: Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs). Design: Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs. Main outcome measures: Intensity and frequency of PA. Results: A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs)

Information needs and psychological factors among patients with coronaropathy.

Background: Studies on chronic diseases have underlined the need for personalized healthcare, taking into account patients’ characteristics and needs to support proactive health management. Our study aimed to explore the priorities and the correlates of information needs among patients with coronaropathy. Method: 357patients with acute myocardial infarction or acute coronary syndrome completed an assessment questionnaire. Descriptive analyses were conducted to identify information needs; path analysis were conducted to explore the relationship between needs and psychological factors. Findings: The key information need was for a full understanding of the disease. Positive coping strategies were positively associated with need for information on pharmacological treatment and pathology while negative association were found with information on distress management; non adaptive coping strategies were positively related to distress management information. Anxiety was positively associated with information on distress management and risks and complications. Discussion: The comprehension of patients’ information needs and correlates could strongly improve the quality of disease management

Changes in physical activity among coronary and hypertensive patients: a longitudinal investigation using the HAPA

Background: Physical activity (PA) plays an important role in primary, secondary, and tertiary prevention of cardiovascular diseases (CVDs). This study aimed to use the Health Action Process Approach (HAPA) to investigate changes in PA in patients affected either by acute coronary syndrome (CPs) or essential arterial hypertension (HPs). Methods: CPs (N=188) and HPs (N=169) completed a questionnaire at baseline, 6 months (T1) and 12 months (T2) after baseline. Repeated measures ANOVA and multisample path analysis were performed. Results: Both the populations improved their PA, but CPs showed greater changes than HPs, strongly improving their PA at T1 and then maintaining it at T2. Moreover, results indicated equivalence of the HAPA model for both patient populations. Conclusions: Findings provide further evidence for the generalizability of the HAPA, which has never been employed to investigate PA on patients affected by hypertension. Moreover, the equivalence of the model for both the populations suggests that the process of change is almost identical for individuals who are at high risk for coronary event (HPs) and individuals who have already had the event (CPs)