Moving to serene nature may prevent poor mental health—results from a swedish longitudinal cohort study

Green spaces are recognized for improving mental health, but what particular kind of nature is required is yet not elucidated. This study explores the effect of specific types of recreational nature qualities on mental health. Longitudinal data (1999/2000 and 2005) from a public health survey was distributed to a stratified sample (n = 24,945) of a Swedish population. People from rural or suburban areas (n = 9230) who had moved between baseline and follow-up (n = 1419) were studied. Individual geographic residence codes were linked to five predefined nature qualities, classified in geographic information systems (GIS). Any change in the amount of or type of qualities within 300 m distance between baseline and follow-up was correlated to any change in mental health (as measured by the General Health Questionnaire) by logistic regression models. On average, the population had limited access to nature qualities both pre- and post-move. There was no significant correlation between change in the amount of qualities and change in mental health. However, the specific quality “serene” was a significant determinant with a significantly decreased risk for women of change to mental ill-health at follow-up. The objective definition of the potentially health-promoting quality may facilitate implication in landscape practice and healthy plannin

Time trends of chest pain symptoms and health related quality of life in coronary artery disease

BACKGROUND: There is at present a lack of knowledge of time trends in health related quality of life (HRQL) in common patients with coronary artery disease (CAD) treated in ordinary care. The objective of this study is to assess and compare time trends of health related quality of life (HRQL) and chest pain in patients with coronary artery disease. METHODS: 253 consecutive CAD patients in Stockholm County, Sweden – 197 males/56 females; 60 ± 8 years – were followed during two years. Perceived chest pain symptoms and three global assessments of HRQL were assessed at baseline, after one and after two years. EuroQol-5 dimension (EQ-5D) with a predefined focus on function and symptoms; the broader tapping global estimates of HRQL; EuroQol VAS (EQ-VAS) and Cardiac Health Profile (CHP) were used. Chest pain was ranked according to Canadian Cardiovascular Society (CCS). Change in HRQL was analysed by a repeated measurements ANOVA and chest pain symptoms were analysed by Friedman non-parametric ANOVA. RESULTS: Perceived chest pain decreased during the two years (p < 0.00022); CCS 0: 41–51%; CCS 1: 19–15%; CCS 2: 31–27%; CCS 3: 5–4% and CCS 4: 4–2%. By contrast, HRQL did not change: EQ-5D: 0.76 (CI 0.73–0.79) -0.78 (CI 0.75–0.81), EQ-VAS: 0.68 (CI 0.66–0.71)-0.68 (CI 0.65–0.71) and CHP: 0.66 (CI 0.64–0.69) -0.66 (CI 0.64–0.69). CONCLUSION: HRQL did not increase despite a reduction in the severity of chest pain during two years. This implies that the major part of HRQL in these consecutive ordinary patients with CAD is unresponsive to change in chest pain symptoms

Silent cerebral infarct after cardiac catheterization as detected by diffusion weighted Magnetic Resonance Imaging: a randomized comparison of radial and femoral arterial approaches

Background and objective: Cerebral microembolism detected by transcranial Doppler (TCD) occurs systematically during cardiac catheterization, but its clinical relevance, remains unknown. Studies suggest that asymptomatic embolic cerebral infarction detectable by diffusion-weighted (DW) MRI might exist after percutaneous cardiac interventions with a frequency as high as 15 to 22% of cases. We have set up, for the first time, a prospective multicenter trial to assess the rate of silent cerebral infarction after cardiac catheterization and to compare the impact of the arterial access site, comparing radial and femoral access, on this phenomenon. Study design: This prospective study will be performed in patients with severe aortic valve stenosis. To assess the occurrence of cerebral infarction, all patients will undergo cerebral DW-MRI and neurological assessment within 24 hours before, and 48 hours after cardiac catheterization and retrograde catheterization of the aortic valve. Randomization for the access site will be performed before coronary angiography. A subgroup will be monitored by transcranial power M-mode Doppler during cardiac catheterization to observe cerebral blood flow and track emboli. Neuropsychological tests will also be recorded in a subgroup of patients before and after the interventional procedures to assess the impact of silent brain injury on potential cognitive decline. The primary end-point of the study is a direct comparison of ischemic cerebral lesions as detected by serial cerebral DW-MRI between patients explored by radial access and patients explored by femoral access. Secondary end-points include comparison of neuropsychological test performance and number of microembolism signals observed in the two groups. Implications: Using serial DW-MRI, silent cerebral infarction rate will be defined and the potential influence of vascular access site will be evaluated. Silent cerebral infarction might be a major concern during cardiac catheterization and its potential relationship to cognitive decline needs to be assessed. Study registration: The SCIPION study is registered through National Institutes of Health-sponsored clinical trials registry and has been assigned the Identifier: NCT 00329979

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

Self-efficacy of knee function in patients with an Anterior Cruciate Ligament injury

Abstract Self-efficacy of knee function in patients with an Anterior Cruciate Ligament injury The overall purpose of this thesis was to investigate the clinical relevance of perceived self-efficacy of knee function among patients with an Anterior Cruciate Ligament (ACL) injury. Study 1: The purpose was to develop an instrument for measuring perceived self-efficacy of knee function in patients with an ACL injury. A total of 210 patients with an ACL injury participated in the study. Items were generated and analysed and the final Knee Self-Efficacy Scale (K-SES) was tested for reliability and validity. A factor analysis revealed two factors that should be treated as separate sub-scales; how the patients perceived their present physical performance/function (K-SESPresent) and how the patients perceived their future physical performance/prognosis of their knee (K-SESFuture). The K-SES was found to be reliable and valid for perceived self-efficacy of knee function in patients with an ACL injury. Study 2: The purpose was to describe perceived self-efficacy of knee function prospectively up to one year after ACL injury/surgery. The purpose was also to describe the influence of symptoms, gender, age and physical activity on the patients’ perceived self-efficacy of knee function. Thirty patients with a recent ACL injury and 33 patients with an ACL reconstruction participated. The perceived self-efficacy of knee function changed significantly during the course of rehabilitation. There was also a significant increase between each test occasion up to six months for patients with an ACL injury and up to twelve months for patients who had undergone surgery. The improvement in perceived self-efficacy of knee function could, however, only be partly explained by the improvement in subjective symptoms. Furthermore, a significant difference in self-efficacy of knee function was observed early in the rehabilitation process, between men and women, both young and old, and patients with a low and high pre-injury physical activity level. Study 3: The purpose was to explore physical and psychological measures believed to determine patients’ perceived self-efficacy of knee function in the rehabilitation of patients with an ACL injury. One year after ACL injury or reconstructive surgery, 116 patients were tested for their self-efficacy of knee function and for 15 outcome measures. A stepwise linear regression analysis was conducted on the K-SES to detect the strongest model describing self-efficacy of knee function. The Lysholm score, KOOSSports/Recreation, Internal Locus of Control and Locus of Control by Chance explained 40% of the variance in the complete K-SES as well as 41% of the variance for K-SESPresent. The strongest model, explaining 38% of the variance for K-SESFuture, was the Lysholm score, KOOSSports/Recreation, TegnerPresent level, and Internal Locus of Control. Study 4: The purpose was to explore the potential of the K-SES to predict outcome one year after an ACL reconstruction. Thirty-eight patients scheduled for an ACL reconstruction were evaluated pre-operatively using the K-SES. One year after surgery, patients were evaluated using outcome measures for present physical activity, knee symptoms and knee muscle function. K-SESPresent and K-SESFuture were found to be significant predictors pre-operatively of present physical activity, knee symptoms and knee muscle function one year after ACL reconstruction, when adjusted for age, gender and pre-injury physical activity level (TegnerPre-injury). Conclusion: The K-SES was found to be a reliable, valid and responsive instrument to be used for assessing self-efficacy of knee function in patients with an ACL injury. The possible determinants of the K-SES may help both to provide a better understanding of some of the underlying factors characterising self-efficacy of knee function and to improve strategies in the rehabilitation of patients with an ACL injury. Clinicians may consider using the K-SES in order possibly to predict the outcome after ACL surgery and rehabilitation

Anger, depression and anxiety associated with endothelial function in childhood and adolescence

Objective Psychosocial adversity is a risk factor for cardiovascular disease (CVD) in adults. The authors assessed associations of reactive hyperaemia peripheral arterial tonometry (RH-PAT), a measure of endothelial function predictive of CVD, with self-assessed psychological health among school children. Methods A total of 248 healthy school children (mean (SD) age 14.0 (1.0); 136 girls and 112 boys) underwent RH-PAT testing. They completed the Beck Youth Inventories (BYI) of emotional and social impairment scales, which is used to screen for depression, anxiety, anger and disruptive behaviour. Results No sex differences were observed for the RH-PAT score. Statistically significant differences were observed for the BYI scores; girls had higher scores for depression, anger and anxiety. Among the girls, there were statistically significant associations between lower RH-PAT scores and higher scores for anger (B coefficient=-0.100, p=0.040), depression (-0.108, p=0.009) and anxiety (-0.138, p=0.039) after adjustment for age. Among the boys, disruptive behaviour was associated with higher RH-PAT scores (0.09, p=0.006). Conclusions The girls have higher levels of self-assessed anger; depression and anxiety compared with the boys, and these characteristics are associated with lower RH-PAT scores, indicating attenuated endothelial function. Among the boys, disruptive behaviour was associated with better endothelial function. Although psychological ill-health is associated with impaired endothelial function and CVD among adults, such processes may also be relevant to children. Psychosocial adversity in childhood might be a risk factor for subsequent CVD