published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Bakgrund: Hjärt- och kärlsjukdomar är ett globalt växande folkhälsoproblem som dessutom är en ekonomisk last på samhället. Forskning har uppskattat att majoriteten av dödsfall kommer att bero på hjärt- och kärlsjukdomar vid år 2030. Några riskfaktorer för att utveckla hjärt- och kärlsjukdom är ett högt BMI, rökning och låg fysisk aktivitet. Forskning har visat att primärpreventivt arbete med livsstilsförändringar är något som minskar riskfaktorerna och är kostnadseffektivt för samhället. Syftet: var att beskriva vilka primärpreventiva metoder sjuksköterskan använder för att uppmuntra till livsstilsförändringar hos patienter med risk för  hjärt- och kärlsjukdom samt att beskriva hur dessa primärpreventiva metoder påverkar riskfaktorerna. Syftet var också att beskriva urvalsgrupperna i de valda vetenskapliga artiklarna. Metod: För att besvara syftet och frågeställningarna hade denna litteraturstudie en beskrivande design där tolv vetenskapliga artiklar har analyserats. Databaserna PubMed och CINAHL användes vid sökningen för att finna de vetenskapliga artiklarna. Resultat: Sjuksköterskor använde olika metoder för att uppmuntra till livsstilsförändring hos hjärt- och kärlsjuka patienter. Dessa metoder innebar att sjuksköterskan antingen fungerar som en informationsgivare eller samarbetspartner gentemot patienten. Effekten av metoderna varierade och enligt vissa studier gav de ej gav någon effekt. Slutsats: Utifrån litteraturstudiens resultatet går det ej med säkerhet att säga vilka metoder som är mest effektiva. Sammanfattningsvis kan sjuksköterskan i sitt kliniska arbete ta hänsyn till båda förhållningssätt i mötet med patienterna och anpassa metoden utifrån ett individuellt perspektiv. / Background: Coronary heart disease is a growing health issue from a global perspective. Research has estimated that coronary heart disease will stand for the majority of deaths by the year 2030.  Risk factors include a high BMI, smoking and low level physical activity. Research has also shown that lifestyle change can decrease the risk factors and is cost-effective for the society. Aim: The aim with the litterature study was to describe which primary prevention methods nurses use to encourage lifestyle change for patients at  risk of developing coronary heart disease, and to describe how these methods affect the risk factors. The purpose was also to describe the sample groups in the chosen articles. Method: To answer the study questions, the literature study had a descriptive design where twelve scientific articles were analysed and categorized. The databases PubMed and CINAHL were used to find the scientific articles. Results: Nurses use an array of different methods to encourage life style change in patients with coronary heart disease. These methods include the nurse either acting as a information giver or a collaboration partner towards the patient. The effect of these methods varied and some of the studies didn’t show any effect whatsoever. Conclusion: On the basis of the literature study, the methods nurses use and their effectiveness are inconclusive. In conclusion, the nurse can consider all of the methods in the work place, and decide which method is adequate based on the individual variations of the patients.

Cardiovascular disease is the leading cause of death in the United States. Chronic short sleep duration is also a significant public health problem and has been linked to several markers and outcomes of cardiovascular disease. To date, inconsistency of assessments of sleep duration and insufficiency, use of covariates, and cardiovascular disease measurement across studies limits strong conclusions about the relationship between sleep duration, sleep insufficiency, and cardiovascular disease. The current study examined the association between sleep duration, sleep insufficiency, and a marker of preclinical coronary heart disease (i.e., carotid intima-media thickness) in a community sample using a cross-sectional design. Some evidence for a relationship between sleep duration and cIMT was found, with longer sleep duration predicting higher cIMT in some segments. Additionally, the interaction between sleep duration and sleep insufficiency was significant. However, neither of these effects were significant after adjusting for age and in some cases race/ethnicity, suggesting demographics may explain this association. Actigraphy and sleep diary duration assessments demonstrated significantly different correlations with cIMT in some segments, suggesting the nature of the assessment method may impact the strength or direction of the relationship between sleep duration and cIMT. Limitations and future directions are discussed.

The thesis investigated the effect of exercise on endothelial function (measured as flow-mediated dilation (FMD)) and triacylglycerol concentrations following the ingestion of a high-fat breakfast and lunch in adolescent boys. The validity of measuring lipid and lipoprotein concentrations from a capillary blood sample, and the reproducibility of the postprandial FMD and triacylglycerol concentration responses to the high-fat meals, was established. The effects of prior continuous moderate-intensity exercise (60 min walking at 60% V̇O₂peak), repeated very short duration sprints (40 x 6 s maximal effort cycle sprints) and accumulated moderate-intensity exercise (6 x 10 min running at 70% V̇O₂peak) on endothelial function and triacylglycerol concentrations in adolescent boys were then established across three studies, each consisting of two, 2-day main trials (control and exercise). On day 1, participants were either inactive or completed the prescribed exercise. On day 2, FMD and triacylglycerol concentrations were measured prior to, and following, ingestion of a high-fat breakfast and lunch. In each control trial FMD was reduced (signifying endothelial dysfunction), compared to fasting, by 20-32% and 24-33% following the high-fat breakfast and lunch. Following continuous moderate-intensity exercise, repeated very-short duration sprints and accumulated moderate-intensity exercise these reductions were only 8% and 10% (main effect trial, P = 0.002; main effect time, P = 0.023; interaction effect trial x time, P = 0.088), 2% and 5% (main effect trial, P = 0.012; main effect time, P = 0.004; interaction effect trial x time, P = 0.003) and 1% and 3% (main effect trial, P = 0.020; main effect time, P < 0.001; interaction effect trial x time, P = 0.014) respectively. The continuous moderate-intensity exercise and repeated very short duration sprints also significantly reduced the total area under the triacylglycerol concentration versus time curve by 22% (Control vs. Exercise; 12.68 (sem 1.37) vs. 9.84 (sem 0.75) mmol L-1 6.5h, P = 0.018) and 13% (Exercise vs. Control: 8.65 (sem 0.97) vs. 9.92 (sem 1.16) mmol L-1 6.5h, P = 0.023). The accumulated moderate-intensity exercise also reduced the total area under the triacylglycerol concentration versus time curve by 11%, but this reduction was not significant (Control vs. Exercise: 10.71 (sem 0.94) vs. 9.56 (sem 0.67) mmol L-1 6.5h, respectively, P = 0.183). The experimental evidence from these studies emphasise that exercise might offer an acceptable, non-pharmacological means of influencing CHD risk when individuals are young. The results of these studies can help shape future physical activity guidelines.

Background: Studies regarding number of pregnancies and coronary heart disease have shown inconsistent results. In the present study, we assessed the association between number of pregnancies and heart attack (HA) in women.Methods: Using data from NHANES III a cross sectional data analysis of 10634 women aged 17 and above was conducted. We considered socio-demographic factors and other potential risk factors including physical activity, smoking, alcohol, diabetes, hypertension, hypercholesterolemia, BMI, age, and family history of heart attack. We conducted Bivariate analysis to determine prevalence and crude odds ratios. Multivariate logistic regression analysis was used to adjust for confounding variables using SPSS. Results: The prevalence and 95% CI of HA was 3.4% (3.0% – 3.7%). The age adjusted odds ratios for 7+ pregnancies was 2.33 95% CI [1.42-3.81], but this became insignificant when a fully adjusted model was used (odds ratio, 1.68: 95% CI, 0.89 to 3.16). For those with 4 pregnancies the risk was lowest in both age adjusted and fully adjusted models confirming the well known "J" shaped non linear relationship between number of pregnancies and heart attack. Conclusion: We found an association that was not significant between number of pregnancies and heart attack. Further studies using physician-confirmed diagnosis is needed to appropriately asses the potential relationship of gravidity and heart attack.

Although the drug-eluting stent (DES) has dramatically reduced the rate of coronary restenosis, it still occurs in up to 20% of patients with a DES. Monitoring drug delivery could be one way to decrease restenosis rates. We demonstrate real-time photoacoustic imaging and spectroscopy (PAIS) using a wavelength-tunable visible laser and clinical ultrasound scanner to track cardiac drug delivery. The photoacoustic signal was initially calibrated using porcine myocardial samples soaked with a known concentration of a drug surrogate (Dil). Next, an in situ coronary artery was perfused with DiI for 20 min and imaged to monitor dye transport in the tissue. Finally, a partially DiI-coated stent was inserted into the porcine brachiocephalic trunk for imaging. The photoacoustic signal was proportional to the DiI concentration between 2.4 and 120 mu g/ml, and the dye was detected over 1.5 mm from the targeted coronary vessel. Photoacoustic imaging was also able to differentiate the DiI-coated portion of the stent from the uncoated region. These results suggest that PAIS can track drug delivery to cardiac tissue and detect drugs loaded onto a stent with sub-mm precision. Future work using PAIS may help improve DES design and reduce the probability of restenosis. (C) 2017 Society of Photo-Optical Instrumentation Engineers (SPIE)

Trata-se de um estudo de revisão integrativa da literatura nacional e internacional, no período de 2000 a 2005, que teve como objetivo evidenciar a contribuição da atividade física na prevenção primária da doença arterial coronariana (DAC). Os artigos foram capturados nas bases de dados PubMed (incluindo MEDLINE) e LILACS, utilizando-se descritores relacionados à intervenção, ao enfoque, à morbidade e aos fatores de risco. Vinte e dois artigos atenderam aos critérios de inclusão deste trabalho e constituíram a amostra. Para a organização dos dados, foi utilizado um instrumento que registrou as informações essenciais dos artigos: título; fonte (dados da revista); número da busca e do resumo; autor(es); país; ano; local do estudo; objetivos; sujeitos e período da pesquisa; método e o que foi analisado; tipo de intervenção e responsável pela mesma; resultados efetivos; conclusões do autor; limitações citadas pelo autor e comentários sobre o estudo. Os resultados foram apresentados em categorias de acordo com o desenho metodológico do artigo, com os objetivos, com a forma de descrição e mensuração da atividade física e com o conteúdo das publicações. Foram notadas semelhanças nestes aspectos entre os artigos de mesmo desenho metodológico. Doze artigos foram categorizados como estudos prospectivos, sete como de corte transversal e três foram os estudos retrospectivos. A maioria dos estudos utilizou questionários do tipo recordatório para avaliar o nível de atividade física realizada no trabalho e no lazer, fazendo correlação entre o nível e o tipo de atividade. Os benefícios das atividades aeróbicas foram os mais descritos, ainda que o exercício resistido tenha sido abordado em dois artigos. Apesar de alguns estudos terem enfocado apenas a mensuração do nível de atividade física, a maioria dos artigos apresentou correlação entre a prática de atividade física e a redução do risco coronariano, contribuindo para prevenir a DAC. Não houve consenso, ainda que a maioria dos estudos tenha abordado o assunto, quanto ao nível e ao tipo de atividade física que promove o melhor efeito preventivo. Consideramos que poderia ter sido utilizado um descritor mais específico do que “atividade física" para buscar os artigos, visando-se a atingir os objetivos propostos. Este estudo evidencia a contribuição benéfica da atividade física na prevenção primária da DAC, atuando nos seus fatores de risco. Além disso, há necessidade de considerar a atividade física como uma prática corporal orientada pelas necessidades individuais e implementada de acordo com as realidades locais, podendo ser uma ferramenta-chave ao lidar com o indivíduo portador de DAC. / This study consists of an integrative review of the national and international literature made between 2000 and 2005 which main purpose is to testify the physical activities’ contributions for the primary prevention of coronary heart disease (CHD) and their risk factors. The articles are based on the PubMed data (including MEDLINE) and LILACS and they make use of descriptors related to the intervention, focus, morbidity and other factors of risk. Twenty two articles attended to the criteria adopted in this research constituting the specific sample presented. To the data organisation it was used an instrument which registered the articles’ essential information such as title, source (the magazine’s data), number of searches and summary, author(s), country, year, study place, goals, subjects and research period, method and what has been analysed, sort of intervention and its responsible, effective results, author’s conclusion, limitations quoted by the author as well as comments about the study. The results have been compiled into categories according to the methodological drawing of the article, its purposes, descriptive manners, the physical activities’ measurement and the publications’ content. It has also been noticed some similarities towards these aspects and methodological drawings of other articles. Twelve articles has been categorised as prospective studies, seven as transversal cut and three as retrospective studies. In great part of them some questionnaires of the recording type have been used in order to evaluate the physical activities’ level involved at work and leisure time establishing, this way, a correlation between the level and the sort of exercise done. It is important to say that the benefits of aerobic activities were the most described, even though resisted exercises were also mentioned in two of the articles. Despite the fact that some studies have focused only on the measurement of the physical activity, the majority of them has established a correlation between the practice of such activities and the decrease of coronary risks, therefore contributing considerably for the CHD prevention. There has not been a consensus, though almost all studies mentioned this matter, about the level and sort of physical exercises that promote the best preventive effects. Moreover, we have taken into account the fact that a more specific descriptor could have been used instead of only “physical activity" with the intention of achieving the proposed objectives. Above all, this research shows the beneficial contributions of physical activities in the primary prevention of CHD as well as its possible risks. Not only that, but there is a necessity of considering physical activity as a corporal practice based on the individual demands and directed to a specific reality, aiming to be a useful way of dealing with an individual with CHD.

Introdução: Considerando a importância econômica estratégica do Brasil no mercado mundial de café e as evidências ainda pouco avaliadas sobre os efeitos do seu consumo sobre a saúde humana, este estudo buscou investigar a relação entre consumo de café e seus efeitos sobre a qualidade de vida de pacientes portadores de doença coronariana. Uma vez que esta doença é uma das principais causas de mortalidade no país. Além disso, a escolha desse mal específico como objeto de estudo está relacionada ao fato de existirem ainda poucos trabalhos na literatura. Deste modo, este estudo busca contribuir para o preenchimento desta lacuna, aumentando o grau de informação sobre o assunto. Objetivos: Verificar se os efeitos do consumo de café não são maléficos para a gravidade da doença coronariana e qualidade de vida do portador. Metodologia: Foi coletada uma amostra intencional de 115 pacientes com diagnóstico de Doença Arterial Coronariana (DAC) freqüentadores de duas instituições de saúde: ambulatório de Cardiologia do InCor Osasco, localizado na Policlínica Zona Norte \"Dona Leonil Crê Bortolosso\" e na Unidade Clínica de Coronariopatia Crônica do Instituto do Coração InCor - HCFMUSP. Os dados foram coletados através da aplicação de um questionário e para execução dos resultados foi utilizado o modelo estatístico probit com auxílio do software STATA 10.0. Resultados: O consumo de café demonstrou uma capacidade significativa de aumentar a probabilidade do paciente apresentar um melhor perfil clínico, ou seja, está relacionado com melhores níveis de gravidade da DAC. A única relação inversa significativa apontada foi entre o consumo de café e indicador de estabilidade de angina. Conclusão: O consumo de café não proporcionou efeitos maléficos para a qualidade de vida dos portadores de DAC e para a gravidade da DAC. / Introduction: Considering the strategic economic importance of Brazil in coffee market worldwide , and the still poorly evaluated evidence on the effects of its consumption on human health, this study aims to investigate the relation between coffee consumption and its effects on life quality of patients, bearers of coronary disease, since this disease is one of the main causes of mortality in the country. Besides, the specific choice of this condition as an object of study is related to the fact that there are still very few studies on it. Thus, this work seeks to contribute to filling this gap, increasing the level of information on the subject. Objectives: To verify whether the effects of coffee consumption are harmful to the severity of coronary heart disease and to the life quality of the bearer. Methodology: A sample from 115 patients diagnosed with coronary artery disease (CAD), who attended two health institutions, was collected: from InCor Osasco cardiology clinic, located in the Policlínica Zona Norte \"Dona Leonil Crê Bortolosso\" and from the Clinical Unit of Chronic Coronary Disease of Instituto do Coração InCor - HCFMUSP. Data was collected by means of a questionnaire, and for the analysis of results the Probit statistical model was used with the help of STATA 10.0 software. Results: Coffee consumption has shown a significant capacity to increase the probability of the patient present a better clinical profile, i.e., it is related to better levels of CAD severity. The only significant inverse relation was indicated between coffee consumption and angina stability indicator. Conclusion: Coffee consumption has not provided harmful effects to life quality of CAD bearers and to CAD severity.

Restrictive cardiomyopathy (RCM) is a cardiac muscle disorder characterized by increased ventricular stiffness and diastolic dysfunction. Patients with RCM often present severe cardiac problems which usually lead to heart failure and sudden death. No effective treatment is available for RCM which makes the finding of novel efficient therapies an urgent necessity. Great progress in molecular biology techniques and advances in transgenic animal development provide great opportunities for the study of RCM and other cardiovascular diseases encountered in clinical patients.... Our laboratory is among the first to generate transgenic mouse models of RCM based on cardiac troponin I (cTnI) missense mutations. In this study, transgenic mice that suffer from RCM have been generated to understand the factors behind the diastolic dysfunction associated with that myocardial disease.... The information obtained from this study allows a better understanding of the role of troponin in RCM and the factors behind the physiopathology of the disease. It will also offer a therapeutic strategy taking into account the physiological characteristic of RCM. / by Pierre-Ives Jean-Charles. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.

Restrictive cardiomyopathy (RCM) is represented in part by left ventricular stiffness and diastolic dysfunction. Missense mutations of the cardiac troponin I (cTnI) gene cause idiopathic RCM. These mutations are located in the C-terminus of cTnI and affect cardiac relaxation. Transgenic mouse models presenting the pathology observed in clinical patients with RCM have been generated previously and express the mutant cTnI in their hearts. RCM-linked mutations increase cardiac myofilament Ca2+ sensitivity and promote diastolic dysfunction in the heart. Previous studies using double transgenic mice (cTnI/R193H/ND) showed that ventricular relaxation is enhanced in the cTnI/R193H transgenic mice. In this study, another double transgenic mouse model, (cTnI/R193H/ND/KO), provides an avenue to investigate its rescuing effects on RCMlinked mutations in the cTnI /R193H/KO mouse. Use of molecular biological techniques, transgenic animal developments and murine echocardiography in this study has culminated into a greater understanding of RCM and diastolic dysfunction. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection