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No description available.

Introduction: Dyspnea on exertion (DOE) is a common symptom experienced by 40% of healthy obese women. Dyspnea has at least two dimensions: a sensory (intensity) and an affective dimension. The affective dimension was measured in this study by unpleasantness and negative emotions (i.e., depression, anxiety, frustration, anger, and fear) related to DOE, measured as rating of perceived breathlessness (RPB). Purpose: To examine whether RPB during exercise was associated with unpleasantness and negative emotions and the relative exercise intensity and to examine whether 12-week exercise training can reduce unpleasantness and negative emotions related to breathlessness in healthy obese women. Methods: A secondary analysis was conducted from data collected from an interventional study. Volunteers underwent body measurements, underwater weighing, pulmonary function testing, and a constant-load cycle test (60 watts). RPB, unpleasantness, and negative emotions related to DOE were obtained. Results: There was a positive relationship (n = 74) between RPB and unpleasantness (r = .61) and RPB and anxiety (r = .50). There was a relationship (n = 52) between unpleasantness and %VO₂max, r = .28 as well as %HRmax r = .38; anxiety and %HRmax, r = .28 (p < .05). Unpleasantness and anxiety were different between groups (n=55). Unpleasantness was higher in the +DOE group (M = 3.91, SD = 2.29) than the–DOE group (M = 1.37, SD = 2.01), t(53) = 4.27, p = < .0001; Anxiety was higher in the +DOE group (M = 2.76, SD = 2.99) than in–DOE group (M = 0.72, SD = 1.23), t(41.95) = 3.45, p = < .001. Within group analysis (n = 13) showed that participants in +DOE experienced a decrease in unpleasantness after 12-week exercise training (p = .013; paired t test). There was a main effect of exercise on unpleasantness (p = .0307) and a group x training interaction (p = .0285) indicating that persons with DOE prior to the exercise intervention experienced less unpleasantness after the intervention. Conclusion: Unpleasantness and anxiety have been identified as the most common symptoms associated with RPB. Healthy obese women who engage in physical activity may experience higher rates of unpleasantness and anxiety based on their relative intensity of exercise. In addition, women with DOE who experience unpleasantness as an associated symptom could possibly decrease the level of unpleasantness if they engage in an exercise-training program.

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Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12956号 / 論医博第2098号 / 新制||医||1011(附属図書館) / 32355 / 明治鍼灸大学大学院鍼灸学研究科鍼灸学専攻 / (主査)教授 伊達 洋至, 教授 佐藤 俊哉, 教授 森田 智視 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

This dissertation describes the background, setting, set-up and analysis of several 11-year prospective longitudinal studies with exposures of Proteinuria or Dyspnea and the primary outcome of all-cause mortality. Cause-specific mortality was also obtained for each exposed/unexposed group to determine whether exposures are at all related to mortality outcome. These studies came out of the Health Effects of Arsenic Longitudinal Study (HEALS). The objectives of this dissertation are to: 1) assess the reproducibility of dyspnea as determined by questionnaire in evaluating for the presence or absence of dyspnea; 2) examine the association between arsenic exposure and dyspnea cross-sectionally since one of the longitudinal studies proposed, evaluating the symptom of dyspnea as a predictor of mortality, is embedded in an ongoing study evaluating the effects of chronic exposure to arsenic in well water; 3) review the worlds relevant literature on the potential for dyspnea, a symptom, to be a predictor of all-cause mortality; 4) try to determine whether dyspnea, a symptom, is a predictor of all-cause and cause-specific mortality in the developing country of Bangladesh; 5) try to determine whether simple dipstick proteinuria, is a predictor of all-cause and cause-specific mortality in rural Bangladesh. A methodologic study was done on a small subgroup of subjects to determine whether dyspnea determined by simple questionnaire was reproducible. If the presence or absence of dyspnea on questionnaire occurred by chance, then using dyspnea as the exposure variable would not be valid. The results of this study revealed that: 1) dyspnea as determined by questionnaire was reproducible ie the same response occurs when the same question on dyspnea was asked at a later time and disguised by being buried in a list of questions; 2) the reproducibility of the response was greater than 90%, independent of whether dyspnea was present or absent on the initial response. A second preliminary cross-sectional evaluation was done to determine whether the exposure variables of proteinuria or dyspnea were associated with arsenic exposure at baseline since the primary overall focus of HEALS is related to arsenic exposure. No definitive association for proteinuria and arsenic was found. However, an analysis and study found a strong dose-response relationship between arsenic well water concentration (exposure) and the presence of dyspnea, independent of smoking. A weak dose-response relationship was also found between smoking and dyspnea. Clearly, both arsenic exposure and smoking are two of a number of important variables that need to be controlled for in these prospective studies. In addition, dyspnea was found in a longitudinal study to be associated with all-cause and cause-specific mortality, diseases most related to the heart and lungs. Finally, dipstick proteinuria at the 1+ level (not trace) was found to be a predictor of all-cause and cardiovascular disease mortality in rural Bangladesh. Further discussion is on the implications of the study findings including the concepts of dipstick proteinuria in screening and dyspnea in screening and directions of future research.

Objetivo: Traduzir e adaptar para o português falado no Brasil a escala Dyspnoea-12. Fornecer dados de validação da escala para pacientes com DPOC e hipertensão pulmonar (HP). Métodos: A versão em inglês da escala Dyspnoea-12 sofreu processo clássico de tradução, até obtenção de versão definitiva em português denominada Dispneia-12-Pt. A escala Dispneia-12-Pt foi aplicada a 51 pacientes com DPOC (33 homens; idade: 66,4±8,1 anos; VEF1: 48,7±17,2%) e 15 com HP de diferentes etiologias (12 mulheres; idade: 45,8±12,7 anos; pressão sistólica da artéria pulmonar: 88±33,2 mmHg). Os voluntários responderam a escala de dispneia do Medical Research Council(MRC), o índice de dispneia basal (IDB), a escala hospitalar de ansiedade e depressão, questionário respiratório de Saint George (QRSG), avaliação funcional respiratória e teste da caminhada dos seis minutos (TC6min). Sessenta voluntários responderam a escala uma segunda vez, duas semanas após a primeira avaliação. Resultados: No grupo DPOC a escala Dispneia-12-Pt apresentou correlações significantes com as escalas MRC (r=0,4641; p=0,0006), IDB (r=0,515; p <0,0001), QRSG (r=0,8113; p<0,0001), ansiedade (r=0,4714; p=0,0005), depressão (0,4139; p=0,0025) e distância percorrida no TC6min (r=0,3293; p=0,0255). No grupo com HP a escala mostrou correlações significantes com as escalas MRC (r=0,5774; p=0,0242), QRSG (r=0,6907; p=0,0044), distância percorrida no TC6min (r=0,7193; p=0,0025) e difusão do monóxido de carbono (r=0,564; p=0,0447). O alfa de Cronbach para os voluntários analisados em um único grupo foi 0,927 e o coeficiente de correlação intraclasse 0,8456. Conclusões: A escala Dispneia-12-Pt apresenta propriedades biométricas aceitáveis e pode ser empregada em pacientes brasileiros com dispneia de diferentes etiologias. / Objective: To translate and to adapt for the Portuguese spoken in Brazil the scale Dyspnoea-12. To obtain validation data, regarding the use of this scale in patients with COPD and pulmonary hypertension (PH). Methods: The English version of the scale Dyspnoea-12 received a formal translation process and the final version was called Dispneia-12-Pt. The latter was applied to 51 COPD patients (33 men; age: 66.4±8.1 years; FEV1: 48.7±17.2 % pred) and 15 subjects with PH from different etiologies (12 women; age: 45.8±12.7 years; systolic pulmonary arterial pressure: 88±33.2 mmHg). The volunteers also answered the Medical Research Council dyspnea scale (MRC), the basal dyspnea index (DBI), the hospital scale of anxiety and depression, the Saint George Respiratory Questionnaire (SGRQ), respiratory functional evaluation and the six minute walk test (6 MWT). Sixty volunteers also answered the Dispneia-12-Pt scale about two weeks after the first evaluation. Results: In the COPD group the Dispneia-12-Br showed significant correlations with the scales MRC (r=0.4641; p=0.0006), BDI (0.515; p<0.0001), SGRQ (r=0.8113; p<0.0001), anxiety (r=0.4714; p=0.0005), depression (0.4139; p=0.0025) and walked distance in the 6 MWT (r=0.3293; p= 0.0255). In the HP group the scale showed significant correlations with the scales MRC (r=0.5774; p=0.0005), SGRQ (r=0.6907; p=0.0044), walked distance in the 6 MWT (0.7193; p=0.0025) and carbon dioxide diffusion capacity (r=0.564; p=0.0447). Cronbach´s alpha calculated for all volunteers evaluated as a whole was 0.927 while the intraclass correlation coefficient was 0.8456. Conclusions: The Dispneia-12-Pt exhibits acceptable biometric properties and may be used as a tool in Brazilian patients with dyspnea of different etiologies.

Heart failure is a cause of significant burden to both individuals and society. Individuals live with a disease where there is a decline in physical functioning, the experience of a range of symptoms including breathlessness and pain, frequent hospitalisations and death. The frequent hospital admissions that are usually precipitated by shortness of breath places an economic burden on the current health system. This burden of heart failure is expected to increase in the coming years due to factors such as the ageing population and improved survival from acute cardiac events. This current and predicted continuing burden has been recognised by the health system and has resulted in significant improvement in the pharmacotherapy and nonpharmacotherapy treatment of heart failure. Despite this improvement and with the exception of those few who receive cardiac transplantation, there is no cure for heart failure. Whist the advances in therapy have promoted significant improvements in heart failure management, symptoms including breathlessness (dyspnoea) remain a major issue. The Management of Dyspnoea in Advanced Heart Failure project explored and assessed the current therapeutic management of dyspnoea in advanced heart failure and examined two potential therapeutic options namely nebulised frusemide and long-term oxygen therapy. Following a comprehensive review of the nebulised frusemide literature, The Haemodynamic Effects of Nebulised Frusemide in Heart Failure study showed that nebulised frusemide did have an impact on the haemodynamic parameters of participants. Whilst many consider oxygen therapy as a common sense approach for breathlessness, the lack of scientific evidence for its use in chronic breathlessness with people who have normal or mildly low oxygen levels has prevented funding to supply oxygen therapy to this group of patients. The O2 Breathe Study is a palliative care study that is testing long-term home oxygen therapy versus medical air in patients who do meet the current funding arrangements. The analysis of the screening data showed that the symptom burden as a result of dyspnoea is similar to that seen in cancer and respiratory patients, and heart failure patients had lower levels of physical functioning than the respiratory group. Whilst the design of the studies in this thesis will not allow conclusions to be made regarding their efficacy for dyspnoea management in heart failure, they have provided preliminary data and hypotheses to be tested in the future. / Doctor of Philosophy (PhD)

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / "December 2002." Typescript. Vita. Includes bibliographical references (leaves 202-211). Also available on the Internet.