Contemporary use of devices in chronic heart failure in the Netherlands

Aims: Despite previous surveys regarding device implantation rates in heart failure (HF), insight into the real-world management with devices is scarce. Therefore, we investigated device implantation rates in HF with reduced left ventricular ejection fraction (LVEF) in 34 Dutch centres. Methods and results: A cross-sectional outpatient registry was conducted in 6666 patients with LVEF < 50% and with information about device implantation available [74 (66–81) years of age; 64% male]. Patients were classified into conventional pacemakers (PM, n = 562), implantable cardioverter defibrillato

The Effect of Exercise Training Modality on Serum Brain Derived Neurotrophic Factor Levels in Individuals with Type 2 Diabetes

Introduction: Brain derived neurotrophic factor (BDNF) has been implicated in memory, learning, and neurodegenerative disease. However, the relationship of BDNF with cardiometabolic risk factors is unclear, and the effect of exercise training on BDNF has not been previously explored in individuals with type 2 diabetes. Methods: Men and women (N=150) with type 2 diabetes were randomized to an aerobic exercise (aerobic), resistance exercise (resistance), or a combination of both (combination) for 9 months. Serum BDNF levels were evaluated at baseline and follow-up from archived blood samples. Results: Baseline serum BDNF was not associated with fitness, body composition, anthropometry, glucose control, or strength measures (all, p\u3e0.05). Similarly, no significant change in serum BDNF levels was observed following exercise training in the aerobic (-1649.4 pg/ml, CI: -4768.9 to 1470.2), resistance (-2351.2 pg/ml, CI: -5290.7 to 588.3), or combination groups (-827.4 pg/ml, CI: -3533.3 to 1878.5) compared to the control group (-2320.0 pg/ml, CI: -5750.8 to 1110.8). However, reductions in waist circumference were directly associated with changes in serum BDNF following training (r=0.25, p=0.005). Conclusions: Serum BDF was not associated with fitness, body composition, anthropometry, glucose control, or strength measures at baseline. Likewise, serum BDNF measures were not altered by 9 months of aerobic, resistance, or combination training. However, reductions in waist circumference were associated with decreased serum BDNF levels. Future studies should investigate the relevance of BDNF with measures of cognitive function specifically in individuals with type-2 diabetes

D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data

Importance: Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. Objective: To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. Data Sources: PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Study Selection: Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Data Extraction and Synthesis: Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Results: Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. Conclusions and Relevance: D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.2018-05-0

Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV?

Living with HIV involves management of multiple stressful disease-related and other life events. Distress tolerance may provide a functional, individual-based context for qualifying the established relationships between major life events and psychosocial variables important in the management of HIV. The present study provided a preliminary test of the hypothesis that distress tolerance moderates the impact of major life events on these predictors of disease progression. HIV-positive patients (n=116) completed psychosocial and medical questionnaires. Results indicated that major life events interacted with distress tolerance such that lower distress tolerance and higher life events were associated with significantly higher levels of depressive symptoms, substance use coping, alcohol and cocaine use, and medication adherence. In addition, distress tolerance was directly related to self-reported HIV-related symptoms. These results suggest that low distress tolerance, particularly in the face of major life events, may present significant challenges to adaptive management of HIV. Distress tolerance assessment may help to specify targets for cognitive-behavioral and stress management treatments for people living with HIV

The impact of prior and ongoing threat on the false alarm threshold for facial discrimination

Perceptual adaptations facilitate rapid responses to threats but can come with the cost of false alarms, or the failure to discriminate safe or novel stimuli from signals of true threat. For example, a fatigued colleague might be avoided when their tired expression is interpreted as a scowl, or a glimpse at a stranger might cause a rush of anxiety if they resemble a known adversary. We examined false alarms in the context of facial cues, which can become exaggerated signals of threat across anxiety disorders. In Experiment 1, ongoing threat lowered the false alarm threshold for discrimination based on anger intensity compared to prior and no threat. In Experiment 2, prior and ongoing threat each lowered the false alarm threshold for identity-based facial discrimination compared to no threat. These results could be relevant for anxiety disorders in which excessive false alarms may contribute to overgeneralized threat responses

Exposure Therapy Consortium

https://exposure.la.utexas.ed

The Impact of Criteria-based and Data-driven Sampling Approaches on the Heterogeneity and Interpretability of Posttraumatic Stress Symptom Networks

Background. The application of psychopathological symptom networks requires reconciliation of the observed cross-sample heterogeneity. We leveraged the largest sample to be used in a PTSD network analysis (N = 28,594) to examine the impact of criteria-based and data-driven sampling approaches on the heterogeneity and interpretability of networks. Methods. Severity and diagnostic criteria identified four overlapping subsamples and cluster analysis identified three distinct data-derived profiles. Networks estimated on each subsample were compared to a respective benchmark network at the symptom-relation level by calculating sensitivity, specificity, correlation, and density of the edges. Negative edges were assessed for Berkson’s bias, a source of error that can be induced by threshold samples on severity. Results. Criteria-based networks showed reduced sensitivity, specificity, and density but edges remained highly correlated and a meaningfully higher proportion of negative edges was not observed relative to the benchmark network of all cases. Among the data-derived profile networks, the Low Severity network had the highest proportion of negative edges not present in the benchmark network of symptomatic cases. The High Severity profile also showed a higher proportion of negative edges, whereas the Medium Severity profile did not. Conclusion. Although networks showed differences, Berkson’s bias did not appear to be a meaningful source of systematic error. These results can guide expectations about the generalizability of symptom networks across samples that vary in their ranges of severity. Future work should continue to explore whether network heterogeneity is reflective of meaningful and interpretable differences in the symptom relations from which they are composed