No description available.

Mothers who have an infant with severe congenital heart disease (CHD) face an uncertain and emotionally challenging postpartum period as their baby is hospitalised and undergoes life-saving cardiac surgical treatment. There are many potential risk factors to mother-infant bonding, that is, the emotional tie a mother develops with her baby, in the context of infant illness. Having an infant with a diagnosis of severe CHD could be seen as a threat to the mother's experience of bonding. However, there is limited understanding about the maternal perception of bonding with an infant with severe CHD. This study aimed to explore mothers' bonding with their infant with severe CHD throughout antenatal, perinatal and postnatal periods and how they coped with any challenges to this bond. Interviews were conducted with eight mothers of infants aged between eight and fifteen months with severe CHD, who were recruited from a children's hospital and who were diagnosed either antenatally or postnatally. Interpretative Phenomenological Analysis was used to identify themes across the mothers' accounts. Four superordinant themes were identified: ‘An Emotional Start to Motherhood and the Mother-Infant Bond', ‘Losing Control in the Context of CHD', ‘Keeping Connected to the Baby' and ‘Moving on Together'. The findings identify mother-infant bonding as a process that can withstand challenges such as maternal-infant separation, potential loss of the infant and maternal feelings of disconnection from the baby. Practical strategies were used by mothers to maintain their bond with their infant following diagnosis and during hospitalisation. These included being close to their infant and taking over caregiving duties from the nurses. Mothers described strength and resilience from the experience and a process of increasingly feeling closer to their infant. Several potential research implications and clinical recommendations for healthcare professionals are suggested.

The main purpose of this study is to examine the differences of preventive management utilizations and diabetes complications in Asian Americans and Non-Hispanic whites using multiple years (2002-2013) Behavioral Risk Factor Surveillance System (BRFSS). SAS for complex survey procedures were used to perform the data analysis. Odds ratios (OR) were calculated to compare the prevalence of diabetes complications and preventive management rate in Asian with white. Compared to white, the prevalence of diabetes retinopathy in Asians were higher, while the rates of neuropathy and cardiovascular complications, pneumonia shot, personally management as well as management diabetes with doctors were lower. The prevalence of routine checkup in Asian was not significantly different from the prevalence in white. More attentions should be paid on Asians for diabetes related retinopathy.

No description available.

Congenital heart disease (CHD) includes a variety of disorders that are characterized by structural defects to the heart or the coronary blood vessels that occur in fetal development. CHD occurs in 8 of every 1,000 live births. CHD often requires surgical repair and increases caregiving burden for families. The purpose of this study was to better understand the relations between illness-related parenting stress, coping resources, and psychological functioning in primary caregivers of young children with CHD. 69 parents provided demographic information and completed measures of parenting stress, self-efficacy, mindfulness, social support, and adjustment. Results revealed that psychological functioning in this sample is comparable to other chronic illness populations. In regression analyses, illness-related parenting stress was positively related and mindfulness was negatively related to psychological distress.

Bakgrund: Egenvård innebar att vidta åtgärder så sjukdomen inte förvärrades eller för att tidigt upptäcka försämring. Hjärtsjukdom innebar förändringar i hjärtat eller dess blodkärl, som kunde vara till exempel sjukdomar som hjärtsvikt och kranskärlsjukdom. I Sverige minskade insjuknandet i hjärtsjukdom men inte dödligheten vilket gjorde patienter med hjärtsjukdom till en patientgrupp som ökade. Livskvalitet sågs som ett subjektivt begrepp som förändrades över tid trots att det fanns många vedertagna instrument för att mäta livskvalité. Syfte: Syftet med denna litteraturstudie var att beskriva hur egenvårdsåtgärder påverkar livskvaliteten hos personer med hjärtsjukdom, samt beskriva vilken urvalsmetod de valda artiklarna använt sig av. Metod: I databaserna Cinahl och MEDLINE via Pubmed hittades 13 kvantitativa studier som utgjorde resultatet för denna beskrivande litteraturstudie. Huvudresultat: Resultatet visade att vid interventioner av teknologi sågs signifikant förbättring av den skattade livskvaliteten i en av tre studier. Vid interventioner i form av utbildningsprogram skattades tre av fem studier livskvaliteten signifikant förbättrad. Vid fysisk aktivitet som intervention sågs signifikant förbättring av den skattade livskvaliteten i en av två studier. Vid psykologiska interventioner skattades livskvaliteten signifikant förbättrad i två av två studier. I en jämförande studie skattade de deltagare som använde sig av egenvård sin livskvalité bättre än deltagarna som inte använde sig av egenvård. Slutsats: Resultatet visade ingen konsensus gällande hur egenvårdsåtgärder påverkade livskvaliteten hos personer med hjärtsjukdom, vissa faktorer som relationen och tid kunde vara av betydelse. Mer forskning inom detta område krävs. / Background: Self-care means taking actions so the disease does not get worse or to enable early detection of deterioration. Heart disease involves changes in the heart or its blood vessels, for exampel diseases as heart failure and/or coronary artery disease. In Sweden the onset in heart diseases decreases but not the mortality, making patients with heart diseases increasing. Quality of life is seen as a subjective concept that changes over time, even though there are many accepted instruments to measure quality of life. Aim: The aim of this study was to describe how self-care affects quality of life in people with heart disease, and also to describe the sampling-methods used in the different studies. Method: In the databases CINAHL and MEDLINE by PubMed 13 quantitative studies was found which represented the result of this descriptive literature study. Main Results: The results showed that one of three studies in intervention of technology showed a significant improvement in the estimated quality of life. Studies including interventions of education programs three out of five studies estimated significant improvement of quality of life. Interventions with physical activity showed that one out of two studies reported significant improvement in self-reported quality of life. In psychological interventions, quality of life significantly improved in two of two studies. In a comparative study the participants who used the self-care estimated their quality of life to be better than participants who did not use the self-care. Conclusion: The results showed no consensus regarding how self-care measures affects quality of life in persons with heart disease, certain factors such as relationship and the time passed can be of importance. More research in this area is required.

Objective: Theoretical and empirical evidence suggests a relationship between Repetitive Thought (RT, e.g. rumination), and depression in patients with Coronary Heart Disease (CHD). To date, cross-sectional studies indicate that rumination is associated with depression in CHD, but additional prospective longitudinal research is required to determine if rumination predicts subsequent depression. This research therefore aimed to test the hypothesis that RT, specifically rumination, is a vulnerability factor for depression over time in a CHD population. It was predicted that RT at baseline would predict depression rates at three month follow-up after controlling for baseline depression and potential confounding factors. Methods: Inpatients and outpatients with a diagnosis of CHD completed self-report questionnaires at baseline (N = 101) and at three month follow-up (N = 85). The data was analysed using a hierarchical multiple regression. Results: Baseline rumination significantly predicted depression at the three month follow-up after controlling for baseline depression and potential confounding factors. Rumination accounted for 8.3% of the variance (p< .001). Subscales of brooding and reflection were also found to be individually predictive of follow-up depression explaining 4% of the variance (p< .005) and 7% of the variance (p< .001) respectively. Conclusion: Findings are consistent with previous prospective and cross-sectional research that indicates that rumination plays a unique role in the maintenance of depression in CHD patients and is an identifiable vulnerability factor.

Introduction There is a pressing clinical need to treat patients with acute coronary syndrome (ACS) timely and efficiently in order to improve their prognosis. Standard tools available in ED, while useful, do not comprehensively characterize ACS for either diagnosis or risk stratification. The role of CMR in ACS is emerging because it allows assessment of both myocardial composition and function. Newer CMR techniques such as: a) T2 W imaging for assessing myocardial oedema and area at risk B) pre contrast T1 mapping techniques for quantitative characterization of the tissue composition, are adding further utility for CMR in ACS. At present the clinical use of these techniques is still limited and further investigations are needed to assess their clinical applicability in ACS patients. Aims The aims of this thesis were several. Firstly we sought to establish a CMR protocol for imaging ACS patients on a 3T CMR scanner. In order to do so, we validated a novel T2 W technique for oedema imaging (T2 prep SSFP) at 3T. Second, we aimed to perform a detailed study of the time course of oedema in ACS patients in order to establish the appropriate imaging time for the assessment of area at risk. Third, by applying T2W acute oedema imaging, we sought to investigate the functional and pathological meaning of complicated remote plaques in patients with multivessel disease. Finally, we aimed to establish whether, in comparison to standard CMR techniques, novel precontrast Tl mapping allows better characterisation of the acutely injured myocardium and whether it can predict long-term functional recovery. Methods The research studies were all performed on a 3T Trio Siemens scanner. In the initial stage of the research, we validated the T2 W technique performing phantom work and scanning both volunteers and patients to assess the uniformity of signal intensity in the myocardium and to establish a threshold based method to post process the images. We then established a CMR protocol for ACS including oedema imaging, T1 mapping imaging, perfusion, functional and late gadolinium enhancement imaging. Patients with acute myocardial infarction (both ST elevation myocardial infarction (STEMI) and non STEMI) were scanned at 4 different time points after the acute event (3 scans within 2 weeks and one at 6 months). All STEMI patients underwent primary percutaneous coronary intervention (PCI) while the non-STEMI patients underwent coronary angiography and for PCI. Results We validated the T2prep SSFP technique at 3T, highlighting its limitations and establishing a threshold of mean ± 2SD to assess myocardial oedema. We found that the optimal imaging window to assess the maximal expression of myocardial oedema was within 1 week from the acute event in patients with ST elevation MI. Also, our results showed a reduction of LGE over time (from acute to chronic) in segments which also showed improvement in contractile function indicating that even segments with transmural LGE assessed in the early hours post event could be viable. By applying these techniques in acute patients with bystander disease undergoing percutaneous coronary intervention, we found that: l) T2W imaging can detect myocardial injury downstream from a vessel identified as "non culprit" 2) in 20% of NSTEMI patients, the angiographic assessment alone failed to identify the culprit vessel. Finally, we found that the diagnostic performance of acute pre-contrast Tl-mapping was at least as good as that ofT2W CMR for detecting myocardial injury. There was a significant relationship between the segmental damaged fraction assessed by either by LGE or T2W, and mean segmental Tl values and the likelihood of improvement of segmental function at 6 months decreased progressively as acute Tl values increased. Conclusions In summary, we defined a stable imaging window for the retrospective evaluation of area at risk and we also indicated that acutely detected LGE does not necessarily equate with irreversible injury and may severely underestimate salvaged myocardium. Furthermore, in NSTEMI patients with multivessel disease, by revealing acute myocardial damage in territories pertaining to vessels not treated acutely, we raised the issue of the need for better tools for the correct identification of the culprit vessel and to stratify patients rather than by angiographic assessment alone. Finally, we demonstrated how pre-contrast Tl mapping allows for assessment of the extent of myocardial damage and how Tl mapping might become an important complementary technique to LGE and T2W for the identification of reversible myocardial injury and the prediction of functional recovery in acute MI.

En litteraturbaserad studie har gjorts med analys av nio kvalitativa studier från 2005-2016. Idag överlever fler patienter med medfött hjärtfel tack vare tidig diagnostisering och förbättrade behandlingsmöjligheter. För unga vuxna mellan 13-39 år finns skilda meningar om hur de upplever sitt medfödda hjärtfel. Ett medfött hjärtfel uppstår redan i fosterstadiet, då hjärtat utvecklas. Ungefär en procent av världens barn föds varje dag med ett medfött hjärtfel. En tredjedel av hjärtfelen är varken i behov av operation eller behandling. Hjärtfelet kan förändras över tid vilket gör att uppföljning under livets gång är viktig. Tidigare har det inte varit möjligt för unga vuxna med medfött hjärtfel att växa upp, vilket gör att vuxensjukvården fått en ny patientgrupp. Det gör att det saknas kunskap om vad som kommer vänta de unga vuxna i framtiden. Dessutom har allmänsjuksköterskan inte en traditionell utbildning inom området, trots det kan allmänsjuksköterskan möta den här patientgruppen i sjukvårdens alla vårdformer. För att kunna bemöta unga vuxna på bästa sätt krävs en ökad kunskap om medfödda hjärtfel. Sjuksköterskan bör sätta sig in i patientens livsvärld och på så sätt göra vården personcentrerad. Antalet vuxna med medfött hjärtfel har ökat, vilket gör att fundera kring yrkesval, förmåga att bilda familj och ärftlighet av sjukdomen uppstår. Studiens resultat grundar sig på artiklar från olika delar av världen, vilket gör att upplevelserna kan skilja sig åt beroende på land och sjukvårdssystem. Studiens resultat visar att unga vuxna upplever sitt hjärtfel på olika sätt. En del känner att de har kontroll över sin sjukdom och därmed upplever de sig friska. Hjärtfelet är en del av identiteten och de känner sig inte begränsade i sin vardag, medan andra unga vuxna upplever att det är hjärtfelet som styr och kontrollerar deras liv och de ser sig som inneboende i sin sjukdom. Det kan leda till upplevelser om att vilja ge upp och det kan ha en negativ påverkan på hälsotillståndet. Unga vuxna lever med oro och osäkerhet om sin framtid eftersom den upplevs som oviss. En vanlig upplevelse unga vuxna har är att de känner sig annorlunda. Det kan bero på fysiska begränsningar och operationsärret men den största anledningen är hur de upplever sig bli bemötta från sin omgivning. Studien är tänkt för att sjuksköterskan ska få en ökad förståelse för patientens livsvärld. / Background: Every day approximately one percent of the world's children are born with a congenital heart disease. Life span has increased for patients with congenital heart disease due to early diagnosis and development in recent decades in cardiac surgery. Living with a congenital heart disease got young adults to think about the disease itself, the ability to start a family, sexual activity, pregnancy, childbirth, choice of profession, physical activity and heredity. Today there are more adults than children with a congenital heart disease and the study highlights the experiences of the disease of young adults aged 13-39 years. Aim: The aim of the study was to describe young adults' experiences of living with a congenital heart disease. Method: A literature-based study has been made of qualitative studies retrieved from databases Cinahl and PubMed. The study is based on nine articles from different countries around the world. The articles have been analyzed by content analysis for qualitative studies. Results: The study's analysis resulted in three main themes; "feel different", "to be controlled by the disease," and "to take control of the disease." Conclusion: Living with a congenital heart disease was experienced in different ways, it was splitted opinions if the young adults felt they had control over their heart disease or not. The most common experience was to feel different. The young adults felt anxiety and uncertainty for the future because it could be experienced as uncertain.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy. Johannesburg, South Africa 2017. / Almost half of all cases of heart failure have a preserved ejection fraction. However, therapy targeting the mechanisms of this disorder has not improved outcomes. Left ventricular (LV) diastolic dysfunction is a characteristic feature of heart failure with a preserved ejection fraction. A more sound understanding of the mechanisms responsible for LV diastolic dysfunction produced by risk factors may lead to better approaches to preventing this syndrome. Although obesity is thought to be a major risk factor for LV diastolic dysfunction, this does not occur in all obese individuals. In the present thesis I have demonstrated in 737 randomly recruited participants from a community sample of African ancestry, that the relationship between insulin resistance (homeostasis model) and LV diastolic function, as assessed from trans-mitral velocity (E/A) and tissue Doppler imaging of the lateral and septal walls of the LV (e’ and E/e’), is markedly altered by the presence of a more concentrically remodelled LV (as indexed by LV relative wall thickness [RWT]). Importantly, insulin resistance was only associated with LV diastolic function or dysfunction in those with an RWT above a threshold value. In contrast no interactive effects on LV diastolic function between either blood pressure or age and RWT were noted. These data therefore suggest that obesity will only translate into LV diastolic dysfunction if it is associated with insulin resistance and a concentrically remodeled LV. Although hypertension is thought to play an important role in contributing to LV diastolic dysfunction, the pulsatile hemodynamic change primarily responsible for this effect is uncertain. In 524 randomly selected individuals from a community sample I have demonstrated that independent of confounders including left ventricular mass and RWT, aortic backward wave pressure effects (as determined using wave separation analysis), antedate the impact of aortic stiffness (indexed by aortic pulse wave velocity) or the factors determined by aortic stiffness (the time of backward wave return or forward wave pressures) on LV filling pressures (E/e’). These data therefore suggest that to adequately prevent LV diastolic dysfunction, targeting aortic backward wave pressures may be required. As conventional risk factors account for only a portion of the inter-individual variations in LV diastolic function, it is thought that the genetic factors may play a iv significant role. In 694 randomly recruited participants of African ancestry belonging to nuclear families, I demonstrated that independent of conventional risk factors, heritability accounts for approximately 50% of the variation in LV RWT, an important LV structural determinant of LV diastolic function. Moreover, in 442 randomly recruited individuals of African ancestry belonging to nuclear families, I also demonstrated that heritability accounts for approximately 50% of the variation in the index of LV filling pressures, E/e’, independent of LV mass or RWT remodeling and aortic function. These data provide strong evidence that genetic factors responsible for LV diastolic dysfunction and the structural determinants thereof should be sought. In conclusion, the results provided in the present thesis have advanced our knowledge of possible pathophysiological mechanisms that play a role in the development of LV diastolic dysfunction and hence possibly heart failure with a preserved ejection fraction. / MT2017