M.A. / Chronic degenerative disease is responsible for a high percentage of deaths in industrialised westernised communities. These findings are not surprising if viewed in the light that most people consider physical activity not to be a priority in their daily activities. During the last decade, it would seem that employers have realised that the health status of an employee can have a direct influence on productivity, efficiency and absenteeism in the working environment. In an attempt to lower health-related costs, reduce absenteeism and improve productivity, some employers have started implementing a variation of total wellbeing and workers’ support programmes as part of their employee assistance programmes. A pressing question is, however, how effective these wellness programmes are. In order to evaluate the effect of such a programme, the present study used a sample of 76 employees in middle- to top management at a big corporate company. During 2002, tests were performed on twelve CAD risk factors, after which an intervention programme was introduced. Twelve months later (2003), the first intermediate test was conducted, using the same protocol. The second intermediate test followed in 2004, duplicating the procedures. The post-test and data analysing were conducted four years after the first evaluations. Subjects were monitored for changes in: total cholesterol, HDL-cholesterol, LDLcholesterol, triglycerides, TC/HDL ratio, LDL/HDL ratio, fasting blood glucose, systolic blood pressure, diastolic blood pressure, body mass index, waist-to-hipratio and waist circumference. The Repeated Measures General Linear Model Test was used to determine significance (P ≤ 0.05) from pre- to post-test. A novel CAD risk score was also iv developed from peer-reviewed literature by considering each of the 12 CAD risk factors measured. The results demonstrated that the wellness programme decreased CAD risk by 26% amongst the 76 participants in this study. The TC, LDL-C, LDL/HDL-C ratio, TC/HDL-C ratio, fasting blood glucose, resting systolic blood pressure, resting diastolic blood pressure and waist-to-hip ratio improved significantly, while triglycerides showed a non-significant improvement. The three CAD risk factors that deteriorated significantly during the study period were high-density lipoprotein cholesterol, BMI and waist circumference. The major finding of this investigation thus suggests that a corporate wellness programme has long-term beneficial effects on CAD risk and that the reduction in CAD risk is mainly attributed to the beneficial effects of regular exercise.

M.Cur. (Intensive General Nursing Science) / "Patient experiences in a critical contextual, qualitative research phenomenological method to obtain and objectives of the study are: care unit" is a study using the analyse data. The - to establish and describe how myocardial infarction patients experience the critical care unit (CeU) environment, and - to propose guidelines for optimal nursing care. The Nursing for the Whole Person Theory forms the paradigmatic framework of the study. The central proposition states that the myocardial infarction patient's experience of the CCU as his external environment, will have direct impact upon his quest for health. Five participants were interviewed. The interviews were coded by the researcher and an independent nursing specialist, using the Kerlinger method of content analysis. The findings were compared to relevant available literature. Data obtained revealed that certain aspects of the CCU environment generate anxiety and therefore impede the quest for health in myocardial infarction patients! Guidelines for optimal nursing care of myocardial infarction patients were proposed.

Coronary Artery Disease (CAD) is one of the most common cardiovascular disorder in adults. CAD often results in myocardial infarction or angina (Wilson, 2003:21). It is an accepted fact that the incidence of CAD has reached endemic proportions in South Africa (Venter, 1993:15). Coronary Artery Bypass Graft (CABG) surgery, Percutaneous Transluminal Coronary Angioplasty (PTCA) and insertion of a coronary stent are major therapeutic approaches to the treatment of CAD. However, these procedures do nothing to correct the underlying disease process (Hunt, Hendrata, Myles, 2000:389; Venter, 1993:15). Due to physiological changes patients suffering from CAD are expected to make lifestyle adaptations, in order to improve quality of life and prevent further damage to coronary arteries (Gotto, 1987:29). It is suspected that patients do not always adapt their lifestyle when they suffer from CAD, or if they do, do not maintain these adaptations. The following question emerges: • Do patients with coronary artery disease adapt their lifestyle and if they do, do they maintain these adaptations? The purpose of this study is to explore and describe the extent to which patients with CAD who underwent CABG, PTCA or insertion of a coronary stent adapt their lifestyles and to what extent they maintain these adaptations. Secondly, the purpose is to set guidelines to help with the improvement of lifestyle adaptations and contingency of adaptations. The objectives of the study is to explore and describe the extent to which patients with CAD adapt their lifestyles following CABG surgery, PTCA or insertion of a i coronary stent, the comparison of the extent of these lifestyle adaptations after two and four months and to set guidelines to improve the extent and contingency of lifestyle adaptations. An explorative and descriptive study was done in order to explore and describe the extent to which patients with CAD, who underwent CABG surgery, PTCA or insertion of coronary a stent, adapted their lifestyle, and to determine the maintenance of these lifestyle adaptations. For the purpose of this study questionnaires, based on a conceptual framework, were designed. The questionnaires enabled the researcher to explore and describe the lifestyle adaptations that patients with CAD underwent. The study was conducted in five private hospitals in Gauteng. The data obtained confirmed that patients suffering from CAD do adapt their lifestyle after having CABG surgery, PTCA or insertion of a coronary stent. Data also showed that the presence of a cardiac rehabilitation centre at the hospital where participants were treated, has a significant influence on patients’ ability to adapt their lifestyle and to maintain this new lifestyle. / Dr. W.O.J. Nel Ms. W. Jacobs

There currently exists a large body of research associating the Type A behavior pattern with an increased risk of coronary heart disease. Further, studies in the area of social support and health suggest that an absence of supportive relationships may result in a decreased resistance to disease in general, both physical and psychological. The present study sought to integrate the Type A research and social support literature through a correlational investigation of the relationship between Type A behavior and perceived quality of social support in 46 male subjects undergoing out-patient treatment for symptomatic coronary disease. It was hypothesized that the Type A pattern would show a significant inverse relationship with perceived quality of social support.

Myocardial ischemia, infarction, heart failure and arrhythmias are the manifestations of coronary artery disease. Reduction of ischemic damage is a major concern of cardiovascular biology research. As per recent studies, the mitochondrial ATP-sensitive potassium channel (mitoKATP) opening is believed to play key role in the physiology of cardioprotection, protection against ischemia-reperfusion injury or apoptosis. However, the structural information of mitoKATP is not precisely known. Elucidating the structural integrity and functioning of the mitoKATP is therefore a major goal of cardiovascular biology research. The known structure and function of the cell ATP-sensitive potassium channel (cellKATP) is functional in interpreting the structural and functional properties of mitoKATP. The primary goal of my research was to characterize the activity of mitoKATP in the isolated mitochondria from the control mouse heart. The mitoKATP activity, if preliminarily characterized in the control strains through the light scattering technique, then the structure of the channel could possibly be established and analyzed by means of the transgenic model and with the help of immunological techniques such as western blotting and immunoflorescence. With this experimental model it was possible to demonstrate that the mitoKATP activity in control mouse heart mitochondria is activated by potassium channel openers (KCOs) such as diazoxide and cromakalim and activators of mitoKATP such as PMA (phorbol12 myristate-13-acetate), and inhibited by KATP inhibitors such as glibenc1amide and 5-hydroxydecanoate (5 HD). It was evident that the KATP activity in mouse heart mitochondria was comparable to that exhibited by the rat heart mitochondria. The various selective and non-selective activators and inhibitors of the channel elicited their activity at a similar concentration used for the rat heart mitochondria. The results were reproducible in five independent experiments for each combination, further reinforcing the significance of existing channel activity in the mouse heart mitochondria.

The purpose of this study was to test the hypothesis that arbutamine, a specific B₁-adrenergic agonist, will not cause different circulatory and physiologic effects than the less specific endogenous catecholamines released in response to an exercise stress test in persons with known or suspected coronary artery disease. Nine male subjects, mean age 66 years, completed symptom-limited arbutamine (ESA) and exercise (ETT) stress tests in a randomized cross-over study. The ESA delivery device controlled infusion rate to induce a graded heart rate increase of 8 bt min⁻¹. Heart rate, systolic blood pressure, diastolic blood pressure, rate pressure product, ST segment shift, and specimens for epinephrine, norepinephrine, dopamine, cortisol, insulin, glucagon, glucose, free fatty acids, glycerol, and lactate were collected at baseline, immediate post-stress, and 10, 30, and 60 minutes post-stress. The research hypothesis was rejected. Repeated measures analysis of variance for each measure demonstrated a significant (p ≤ .05) time treatment interaction in heart rate, systolic blood pressure, rate pressure product, insulin, glucagon, glycerol, free fatty acid, and lactate responses and a significant time effect for cortisol response. Circulatory differences included higher systolic blood pressure and rate pressure product responses for ETT than ESA and a more rapid recovery of circulatory variables following ETT. Metabolic differences were due to higher free fatty acid and glycerol responses for ESA than ETT and a slower recovery of these metabolites and lactate following ESA. Hormonal differences included an earlier and greater magnitude rise in insulin response for ESA than ETT. There were no differences (p ≤ .05) by treatment, time, or time treatment interaction for diastolic blood pressure, ST segment shift, catecholamines, or glucose. In conclusion, arbutamine caused different circulatory and physiologic effects consistent with differences in adrenergic receptor activity. Arbutamine caused substantial B₁₊₂ agonist effects on hormonal and metabolic responses in cardiotonic doses employed clinically for diagnostic stress testing and may impact clinical interpretation of stress test results. / Ph. D.

[Truncated abstract] The main objective of this study was to develop and validate a demographic/epidemiologic Markov model for population modelling/forecasting of CARPs as well as CHD deaths and incidence in Western Australia using population, linked hospital morbidity and mortality data for WA over the period 1980 to 2000. A key feature of the model was the ability to count events as individuals moved from one state to another and an important aspect of model development and implementation was the method for estimation of model transition probabilities from available population data. The model was validated through comparison of model predictions with actual event numbers and through demonstration of its use in producing forecasts under standard extrapolation methods for transition probabilities as well as improving the forecasts by taking into account various possible changes to the management of CHD via surgical treatment changes. The final major objective was to demonstrate the use of model for performing sensitivity analysis of some scenarios. In particular, to explore the possible impact on future numbers of CARPs due to improvements in surgical procedures, particularly the introduction of drug eluting stents, and to explore the possible impact of change in trend of CHD incidence as might be caused by the obesity epidemic. ... When the effectiveness of PCI due to introduction of DES was increased by reducing Pr(CABG given PCI) and Pr(a repeat PCI), there was a small decline in the requirements for PCIs and the effect seemed to have a lag. Finally, in addition to these changes when other changes were incorporated which captured that a PCI was used more than a CABG due to a change in health policy after the introduction of DES, there was a small increase in the requirements for PCIs with a lag in the effect. Four incidence scenarios were developed for assessing the effect of change in secular trends of CHD incidence as might be caused by the obesity epidemic in such a way that they gradually represented an increasing effect of obesity epidemic (assuming that other risk factors changed favourably) on CHD incidence. The strategy adopted for developing the scenarios was that based on past trends the most dominant component of CHD incidence was first gradually altered and finally the remaining components were altered. iv The results showed that if the most dominant component of CHD incidence, eg, Pr(CHD - no history of CHD) levelled off and the trends in all other transition probabilities continued into future, then the projected numbers of CABGs and PCIs for 2001-2005 were insensitive to these changes. Even increasing this probability by as much as 20 percent did not alter the results much. These results implied that the short-term effect on projected numbers of CARPs caused by an increase in the most dominant component of CHD incidence, possibly due to an ?obesity epidemic, is small. In the final incidence scenario, two of the remaining CHD incidence components-Pr(CABG - no history of CHD) and Pr(CHD death - no CHD and no history of CHD) were projected to level off over 2001-2005 because these probabilities were declining over the baseline period of 1998-2000. The projected numbers of CABGs were more sensitive (compared to the previous scenarios) to these changes but PCIs were not.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008. / Title from first page of PDF file (viewed June 12, 2008). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 70-81).

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published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy