This study utilized data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) at two different time points, seven years apart, to examine the relationship between physical illness and depressive symptoms in elderly Mexican Americans. The two physical illnesses studied are coronary artery disease and type II diabetes due to their high prevalence among Mexican Americans. The relationship between physical illness and depressive symptoms is examined longitudinally and prospectively, in both directions. In addition, the relationship between depressive symptoms and three behavioral health risk factors: alcohol use, cigarette smoking, and physical inactivity, at baseline is examined. The roles of gender, acculturation, nativity, and locus of control are examined as moderators of the key relationships studied. Additionally, self-rated health at baseline is examined as a predictor of physical illness and mortality at follow-up. / text

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Coronary artery bypass surgery (CABS) is highly stressful for couples, since comorbid anxiety and depression are most commonly reported and hence most researched pre- and postoperative emotional states. Thus, patients' psychological well-being may contribute more to the level of disability than their physical impairment. Despite this extremely stressful process, psychological preparation is ironically often neglected in CABS couples. The primary aim of the study was to examine the feasibility of hypnotherapeutic ego strengthening (HES) to enhance the ability of CABS couples' to cope with psychological distress associated with hospitalisation and surgery. Secondary aims were to determine the contribution of HES in reducing anxiety and depression, as well as enhancing and maintaining ego strength, quality of life and dispositional optimism in CABS patients and spouses. An overview of coronary heart disease (CHD), risk factors involved, psychological aspects concomitant to CABS (specifically anxiety and depression) and a conceptualisation of HES according to the relevant literature, preceded the empirical study. The experimental design consisted of a two-group, pre-post-follow-up assessment design. A sample of fifty married, male patients admitted to Unitas Hospital in Pretoria with a first, uncomplicated CABS was randomly assigned, together with their spouses, to an experimental- (n = 25) and control group (n = 25). Informed consent was obtained for all project participants. Thus, both groups consisted of twenty-five patients and spouses. To test the hypotheses, experimental patients and spouses were required to participate in the HES intervention. Respondents completed the Beck Depression Inventory (BDI-II) (Beck, Steer, & Brown, 1995). Profile of Mood States (POMS) (McNair, Lorr & Doppleman, 1992), Epstein and O'Brien Ego Strength Scale (1982), Quality of Life Inventory (QOLI) (Frisch, 1994) as well as the Life Orientation Test (LOT) (Scheier & Carver, 1985). Test administration of couples occurred preoperatively, on the day of discharge, and at six-week follow-up. Before commencing the intervention, group comparability was confirmed by means of the t-test for independent groups. At programme completion the significance of differences within and between groups was determined by means of t-tests. Statistically significant p-values were subjected to Cohen's d statistic to determine the practical significance of the findings. A confidence interval of 99% determined the values of the differences between the postoperative and follow-up findings. Results confirmed that the HES intervention significantly reduced postoperative anxiety and depression levels in experimental CABS patients and spouses, which was maintained at follow-up. No change was observed among control group patients and spouses. Moreover, the HES intervention significantly improved and maintained postoperative ego strength, quality of life and dispositional optimism in experimental CABS couples. The overall outcome of the control patients and spouses revealed a decreasing trend with regard to dispositional optimism and quality of life. Qualitative responses largely confirmed quantitative indications of reduced comorbidity and enhanced psychological well-being among experimental participants. Despite design limitations, the results confirmed that HES enhanced CABS couples' inner resources and attenuated concomitant negative mood states. Thus, it was concluded that HES played a meaningful role in the preparation and care of CABS couples by reducing comorbidity and improving their psychological well-being. Finally, recommendations for further studies were made. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2004.

Širdies ir kraujagyslių sistemos ligos sudaro didžiąją dalį tarp sergamumo, mirtingumo ir neįgalumo priežasčių. Mirtingumo rodiklių vertinimas - tradicinis pirminis išeičių matavimas, tačiau ir pacientai, ir medikai vis labiau domisi ne vien tuo, kaip sumažinti mirtingumą, bet ir kaip sumažinti simptomus, padidinti funkcines galimybes, kitaip tariant, pagerinti su sveikata susijusią gyvenimo kokybę. Darbo tikslas – išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę bei jos pokyčius ilgalaikio stebėjimo metu. Uždaviniai: 1. Išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę priklausomai nuo sociodemografinių rodiklių (amžiaus, lyties, išsilavinimo, darbinės padėties). 2. Išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę priklausomai nuo pradinės funkcinės būklės (kardiovaskulinės, psichoemocinės, miego kokybės). 3. Įvertinti kardiovaskulinės, psichoemocinės būklės bei miego kokybės įtaką sergančiųjų IŠL su sveikata susijusiai gyvenimo kokybei. 4. Įvertinti sergančiųjų IŠL (po ūminio miokardo infarkto, perkutaninės transliuminalinės vainikinių arterijų angioplastikos ir aorto-vainikinių arterijų jungčių operacijos) su sveikata susijusios gyvenimo kokybės pokyčius ilgalaikio stebėjimo metu. Tyrimo kontingentas ir metodai. Tiriamąjį kontingentą sudarė KMU Psichofiziologijos ir reabilitacijos instituto kardiovaskulinės reabilitacijos klinikos pacientai, atvykę reabilitaciniam gydymui po ūmaus miokardo infarkto, perkutaninės... [toliau žr. visą tekstą] / Cardiovascular diseases including coronary artery disease (CAD) are very prevalent in Lithuania. The primary outcome interest has traditionally been mortality, but patients and researchers are increasingly interest in identifying interventions that not only improve mortality, but also reduce symptoms, increase functional ability; in other words, improve patients health-related quality of life. Health-related quality of life represents the effect of an illness and its treatment as perceived by the patient, that it is modified by impairments, functional stress, perceptions and social opportunities, and is influenced by disease, injury, treatment or policy. The aim of the study was to analyze health-related quality of life in CAD patients and to assess its changes during long-term period. The objectives of the study: 1. To evaluate health-related quality of life in CAD patients according to sociodemographic factors (gander, age, education level and employment status). 2. To evaluate health-related quality of life in CAD patients according to functional status ���� angina pectoris, heart failure, NYHA functional class, anxiety, depression and sleep quality. 3. To assess the impact of demographic factors, cardiovascular status, psycho-emotional status and sleep quality on health-related quality of life in CAD patients. 4. To assess the health-related quality of life changes during long-term period in CAD patients (after acute myocardial infarction (MI), percutaneous transluminal... [to full text]

Advances in coronary Computed Tomography Angiography (CTA) have resulted in a boost in the use of this new technique in recent years, creating a challenge for radiologists due to the increasing number of exams and the large amount of data for each patient. The main goal of this study was to develop a computer tool to facilitate coronary CTA analysis by combining knowledge of medicine and image processing, and to evaluate the performance in clinical settings. Firstly, a competing fuzzy connectedness tree algorithm was developed to segment the coronary arteries and extract centerlines for each branch. The new algorithm, which is an extension of the “virtual contrast injection” (VC) method, preserves the low-density soft tissue around the artery, and thus reduces the possibility of introducing false positive stenoses during segmentation. Visually reasonable results were obtained in clinical cases. Secondly, this algorithm was implemented in open source software in which multiple visualization techniques were integrated into an intuitive user interface to facilitate user interaction and provide good over­views of the processing results. An automatic seeding method was introduced into the interactive segmentation workflow to eliminate the requirement of user initialization during post-processing. In 42 clinical cases, all main arteries and more than 85% of visible branches were identified, and testing the centerline extraction in a reference database gave results in good agreement with the gold standard. Thirdly, the diagnostic accuracy of coronary CTA using the segmented 3D data from the VC method was evaluated on 30 clinical coronary CTA datasets and compared with the conventional reading method and a different 3D reading method, region growing (RG), from a commercial software. As a reference method, catheter angiography was used. The percentage of evaluable arteries, accuracy and negative predictive value (NPV) for detecting stenosis were, respectively, 86%, 74% and 93% for the conventional method, 83%, 71% and 92% for VC, and 64%, 56% and 93% for RG. Accuracy was significantly lower for the RG method than for the other two methods (p<0.01), whereas there was no significant difference in accuracy between the VC method and the conventional method (p = 0.22). Furthermore, we developed a fast, level set-based algorithm for vessel segmentation, which is 10-20 times faster than the conventional methods without losing segmentation accuracy. It enables quantitative stenosis analysis at interactive speed. In conclusion, the presented software provides fast and automatic coron­ary artery segmentation and visualization. The NPV of using only segmented 3D data is as good as using conventional 2D viewing techniques, which suggests a potential of using them as an initial step, with access to 2D reviewing techniques for suspected lesions and cases with heavy calcification. Combining the 3D visualization of segmentation data with the clinical workflow could shorten reading time.

Coronary arteries stenosis causes ischemic heart disease which is the main fatality reason all over the world. For diagnosis arteries stenosis invasive and noninvasive methods are used. These methods are quite expensive and not all medical institutions can carry out such tests. Analysis of electrocardiogram could be one of the cheapest and current methods to diagnose arteries stenosis. Despite the fact, that in some cases such analysis is not very informative, medics look for the informative ECG parameters and their combinations in order to predict stenosis. The goal of this work is to create statistical methods and software for prognosis of coronary arteries stenosis using digital ECG parameters. Data was colecet and prepared for this reseach in Clinic of Cardiology of Kaunas Medical University. In this work are presented: 1.Statistical analysis models for prognosis of coronary arteries stenosis. 2.Software for uses. 3.Comparative analysis of statistical analysis models. 4.Results of real data analysis, which were obtained by using, developed statistical models and software. Obtained results will be used to improve methods of diagnosis ischemic heart disease and arteries stenosis in Clinic of Cardiology of Kaunas Medical University.

Lipoprotein(a) (Lp(a)) consists of an LDL-like particle and the specific protein apo(a), which is very similar to plasminogen. Apo(a) contains repeated kringle structures and a serine protease domain, which cannot be activated by t-PA. Lp(a) is considered to be a predictor for atherosclerotic disease. It has been found incorporated in atherosclerotic plaques and inhibits in vitro fibrinolysis. Lp(a) was determined in 1527 randomly selected individuals participating in the Northern Sweden WHO-MONICA project. A weak but significant relation between Lp(a) and increasing age was found. Menopausal status was the strongest independent predictor of Lp(a) level in women. Fibrinogen was independently related to Lp(a) in both sexes. Only a minor fraction of Lp(a) variance could be explained for in a multiple regression model, which is in agreement with the contention that Lp(a) is highly genetically determined. Lp(a) was determined in 1571 patients investigated with coronary angiography because of suspected severe coronary artery disease (CAD). Patients with proven CAD at elective angiography had significantly higher Lp(a) than patients without significant CAD or healthy controls. Lp(a) was found to be an independent discriminator of CAD in both sexes. HLA-DR genotype 13 or 17 was found more frequently in 30 male patients with angiographic CAD at young age (&lt; 50 years) than in 30 age matched controls. These genotypes were common in patients with high Lp(a) levels, which indicates that Lp(a) may be related to immunological processes. The reaction of Lp(a) was investigated in 32 patients with acute myocardial infarction (AMI). Lp(a) increased during the first week, but the response was comparatively weak. Individual Lp(a) responses were heterogeneous and no correlations to infarct size or changes in the acute phase proteins were found. In a randomized cross-over study on 36 hypercholesterolaemic patients treated with simvastatin/placebo during 12+12 weeks Lp(a) did not change significantly, but patients with high Lp(a) levels at baseline tended to develop further increased Lp(a). To conclude, Lp(a) was found to be an independent predictor of angiographic CAD in both men and women. Lp(a) levels are primarily genetically determined and only a small fraction of Lp(a) variance could be explained by other factors in this study. Lp(a) may be related to HLA DR types and immunological processes involved in atherosclerotic disease. Lp(a) increased slightly during the first week of AMI, but was not related to changes in the acute-phase proteins. The effective LDL-lowering agent simvastatin did not influence Lp(a) significantly. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 5 uppsatser.</p> / digitalisering@umu

Congenital heart disease (CHD) is the most common birth defect in infants. Identifying factors that are critical to embryonic heart development or CHDs in general could further our understanding of the disease and may lead to new strategies of its prevention and treatment. Endothelial nitric oxide synthase (NOS3/eNOS) is known for many important biological functions including vasodilation, vascular homeostasis and angiogenesis. Previous studies have shown that deficiency in NOS3 results in congenital septal defects, cardiac hypertrophy and postnatal heart failure. In addition, NOS3 is pivotal to morphogenesis of aortic valve and myocardial capillary development. The aim of my thesis was to investigate the role of NOS3 in the embryonic and adult heart. I discovered that NOS3 deficiency resulted in coronary artery hypoplasia in fetal mice and spontaneous myocardial infarction in postnatal hearts. Coronary artery diameters, vessel density and volume were significantly decreased in NOS3-/- mice at postnatal day 0. Lack of NOS3 also down-regulated the expression of Gata4, Wilms tumor-1, vascular endothelial growth factor, basic fibroblast growth factor and erythropoietin in the embryonic heart at E12.5, and inhibited migration of epicardial cells into the myocardium. In addition, my data show that the overall size and length of mitral and tricuspid valves were decreased in NOS3-/- compared with WT mice. Echocardiographic assessment showed significant regurgitation of mitral and tricuspid valves during systole in NOS3-/- mice. Immunostaining of Snail1 was performed in the embryonic heart. Snail1 positive and total mesenchymal cells in the AV cushion were decreased in NOS3-/- compared with WT mice at E10.5 and E12.5. Finally, in the adult aortic valves, NOS3 is important in inhibition of thrombosis formation. Deficiency in NOS3 leads to aortic valve thrombosis and calcification. At 12 months old, 72% (13/18) of NOS3-/- mice showed severe spontaneous aortic valve thrombosis compared with WT mice (0/12). Ex vivo culture of aortic valves showed that platelet aggregation and adhesion were significantly increased in NOS3-/- aortic valves compared with WT aortic valves. There was also a significant regurgitation of the aortic valve during systole in the NOS3-/- compared with WT mice. In addition, NOS3 deficiency resulted in significant aortic valve stenosis, calcification and fibrosis. In summary, these data suggest NOS3 plays a critical role in embryonic heart development and morphogenesis of coronary arteries and inhibits thrombosis formation in the adult aortic valves.

Coronary artery bypass surgery (CABS) is highly stressful for couples, since comorbid anxiety and depression are most commonly reported and hence most researched pre- and postoperative emotional states. Thus, patients' psychological well-being may contribute more to the level of disability than their physical impairment. Despite this extremely stressful process, psychological preparation is ironically often neglected in CABS couples. The primary aim of the study was to examine the feasibility of hypnotherapeutic ego strengthening (HES) to enhance the ability of CABS couples' to cope with psychological distress associated with hospitalisation and surgery. Secondary aims were to determine the contribution of HES in reducing anxiety and depression, as well as enhancing and maintaining ego strength, quality of life and dispositional optimism in CABS patients and spouses. An overview of coronary heart disease (CHD), risk factors involved, psychological aspects concomitant to CABS (specifically anxiety and depression) and a conceptualisation of HES according to the relevant literature, preceded the empirical study. The experimental design consisted of a two-group, pre-post-follow-up assessment design. A sample of fifty married, male patients admitted to Unitas Hospital in Pretoria with a first, uncomplicated CABS was randomly assigned, together with their spouses, to an experimental- (n = 25) and control group (n = 25). Informed consent was obtained for all project participants. Thus, both groups consisted of twenty-five patients and spouses. To test the hypotheses, experimental patients and spouses were required to participate in the HES intervention. Respondents completed the Beck Depression Inventory (BDI-II) (Beck, Steer, & Brown, 1995). Profile of Mood States (POMS) (McNair, Lorr & Doppleman, 1992), Epstein and O'Brien Ego Strength Scale (1982), Quality of Life Inventory (QOLI) (Frisch, 1994) as well as the Life Orientation Test (LOT) (Scheier & Carver, 1985). Test administration of couples occurred preoperatively, on the day of discharge, and at six-week follow-up. Before commencing the intervention, group comparability was confirmed by means of the t-test for independent groups. At programme completion the significance of differences within and between groups was determined by means of t-tests. Statistically significant p-values were subjected to Cohen's d statistic to determine the practical significance of the findings. A confidence interval of 99% determined the values of the differences between the postoperative and follow-up findings. Results confirmed that the HES intervention significantly reduced postoperative anxiety and depression levels in experimental CABS patients and spouses, which was maintained at follow-up. No change was observed among control group patients and spouses. Moreover, the HES intervention significantly improved and maintained postoperative ego strength, quality of life and dispositional optimism in experimental CABS couples. The overall outcome of the control patients and spouses revealed a decreasing trend with regard to dispositional optimism and quality of life. Qualitative responses largely confirmed quantitative indications of reduced comorbidity and enhanced psychological well-being among experimental participants. Despite design limitations, the results confirmed that HES enhanced CABS couples' inner resources and attenuated concomitant negative mood states. Thus, it was concluded that HES played a meaningful role in the preparation and care of CABS couples by reducing comorbidity and improving their psychological well-being. Finally, recommendations for further studies were made. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2004.

The potential that telemedicine interventions may have in effectively delivering remote specialized cardiovascular care to large numbers of patients with heart diseases has recently come under question. In the first phase of this thesis, a systematic review and meta-analysis was conducted to compare the impact of a basic form of telemedicine that is regular patient follow-up by telephone, with usual care for individuals with coronary artery disease following their discharge. In the second phase of this thesis, a network meta-analysis, using Bayesian methods for multiple treatment comparisons, was conducted to compare the more complex forms of telemedicine for patients with heart failure. In the third and final phase of this thesis, a randomized controlled trial was designed to compare the impact of two forms of telemedicine, identified in the earlier two phases as being the most promising, on clinical outcomes, cardiac risk factors and patient reported outcomes.