Thesis (M.S.)--University of Wisconsin. School of Nursing, 1976. / eContent provider-neutral record in process. Description based on print version record.

Thesis (D.N. Sc.)--Catholic University of America, 1974. / Includes bibliographical references (leaves [181]-217).

Thesis (Ph. D.)--University of Rhode Island, 2006. / Includes bibliographical references (leaves 181-201).

Made available in DSpace on 2014-06-11T19:32:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-20Bitstream added on 2014-06-13T19:02:37Z : No. of bitstreams: 1 farah_e_dr_botfm.pdf: 474289 bytes, checksum: e469a5b37f90ddb14b6d4798544086d8 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O infarto agudo do miocardio (IAM)é responsável por grande número de óbitos e hospitalizações em todo o mundo. O prognóstico pós-infarto está associdado a diversos fatorews como idades, sexo, tamanho do infarto, presença de comorbidades. Vem ganhando destaque na literatura, como fator de má evolução pós-IAM, a remodelação ventricular que, clinicamente, caracteriza-se por aumento da cavidade ventricular. O objetivo princiap foi avaliar a relação entre o padrão do supradesnivelamento do segmento ST e a remodelação ventricular após infarto agudo do miocárdio de parede anterior do ventrículo esquerdo (VE). Adicionalmente, avaliar a prevalência, as características clínicas e identificar novas variáveis preditoras de remodelação ventricular em tempos de terapia médica agressiva após o infarto. Estudo prospectivo, longitudinal, observacional, realizado na Unidade Coronária do Hospital das Clínicas da Faculdade de Medicina de Botucatu no período de novambro de 2007 a maio de 2010. Foram avaliados 76 pacientes com IAM de parede anterior do VE. Destes 3 foram excluídos por apresentarem fibrilação... / The acute myocardial infarction (AMI) is responsible for a great number of deaths and hospitalizations aroud the world. The prognostic after acute myocardial infarction is associated to many factors such as age, sex, size of myocardial infarciton, presence of other diseases. In the last years, another variable studied as a predictor of porr outcime after MI is ventricular remodeling, characterized by increased ventricular cavity. To evaluate the relationship between ST segment elevation pattern and ventricular remodeling after anterior wall AMI of left ventricular was the main goal of this work. In addition, we analyzed the prevalence, clinical characteristics, and predictors of left ventricular remodeling in the era of modern medical therapy. Seventy sic patients with anterior wall AMI were evaluated from november 2007 to may 2010. There patients with atrial fiblilation and one with severe valvar diseases were excluded. During the follow-up period, six patients died. Thus, the clinical characteristics, patterns... (Complete abstract click electronic access below)

Abstract The prevalence of coronary heart disease (CHD) and associated manifestations with ischaemic resting electrocardiogram (ECG) changes, clinical findings and sociodemographic factors were studied in 1990–1991 among an elderly population in southwestern Finland. One of the specific aims was to describe the health-related quality of life of elderly coronary heart disease patients, i.e. the associations between CHD and physical, psychological, cognitive and social functioning. 488 men and 708 women aged 64 years and over (93% of those eligible) participated in this cross-sectional epidemiological survey in the rural district of Lieto. The participants were examined and interviewed during two visits to the local health centre. An ECG and a chest x-ray were taken and a clinical examination was made by a doctor. The Rose questionnaire was used to determine the prevalence of angina pectoris (AP). The Minnesota codes were used in the analyses of ECG findings. The medical records were reviewed. The prevalence of AP was 9.1% (95% Confidence Interval 6.7–12.0) among men and 4.9% (3.5–6.8) among women. The respective figures for past myocardial infarction (MI) (based on the medical records or a major or moderate Q/QS item on ECG, codes 1.1–1.2) were 13.9% (10.9–17.0) and 6.5% (4.8–8.6). Ischaemic ECG findings (codes 1.1–1.3, 4.1–4.4, 5.1–5.3, 7.1) were common: 32.9% (28.7–37.1) of men and 39.3% (35.7–43.0) of women had such changes. The total prevalence of CHD, including AP, MI, past coronary bypass surgery or angioplasty or ischaemic ECG findings, was 37.7% (33.4–42.0) in men and 42.0% (38.3–45.6) in women. The patients and controls were mainly aged, non-institutionalized, community-living persons. The patients with CHD (AP and/or a past MI) had more difficulties in physical functioning than their age- and sex-matched controls. According to logistic regression analyses, CHD was not independently associated with difficulties in physical functioning. However, physical disability was associated with the use of cardiovascular drugs and also with old age, the use of psychotropic drugs, depression and cancer. More male patients than controls had depression measured on the Zung Self-Rating Depression Scale. The depression had often gone undiagnosed, especially among men. Among men, the most important factors associated with depression were difficulties in physical functioning and widowhood or divorce, while among women, previous depression and the use of ACE inhibitors emerged as significant. There were no differences between the patients and controls in cognitive functioning. The male patients had a higher frequency in visiting activity than the controls. Old age, difficulties in physical functioning, CHD and chronic obstructive pulmonary disease were associated with impaired social functioning. In conclusion, CHD is common in the Finnish elderly. The clinical picture of CHD in elderly people is varying. It seems that CHD has no independent impact on functional disability in the elderly. Old age, sociodemographic factors, medication and other chronic diseases are also contributors.

Despite advances in treatment, heart failure remains one of the top killers in Canada. This recognition motivates a new research focus to harness the fundamental repair properties of the human heart, with human cardiac stem cells (CSCs) emerging as a promising cell candidate to regenerate damaged myocardium. The rationale of this approach is simple with ex vivo amplification of CSCs from clinical grade biopsies, followed by delivery to areas of injury, where they engraft and regenerate the heart. Currently, outcomes are limited by modest engraftment and poor long-term survival of the injected CSCs due to on-going cell loss during transplantation. As such, we explored the effect of cell encapsulation to increase CSC engraftment and survival after myocardial injection. Transcript and protein profiling of human atrial appendage sourced CSCs revealed strong expression the pro-survival integrin dimers αVβ3 and α5β1- thus rationalizing the integration of fibronectin and fibrinogen into a supportive intra-capsular matrix. Encapsulation maintained CSC viability and expression of pro-survival transcripts when compared to standard suspended CSCs. Media conditioned by encapsulated CSCs demonstrated superior production of pro-angiogenic/ cardioprotective cytokines, angiogenesis and recruitment of circulating angiogenic cells. Intra-myocardial injection of encapsulated CSCs after experimental myocardial infarction favorably affected long-term retention of CSCs, reduced scar burden and improved overall cardiac function. Taken together, cell encapsulation of CSCs prevents detachment induced cell death while boosting the mechanical retention of CSCs to enhance repair of damaged myocardium.

MicroRNAs are emerging as key players in the regulation of the post-myocardial infarction (MI) environment. We previously identified that matrix-treated hearts had down-regulated expression of miR-92a, a miRNA with inflammatory and migratory effects that is normally up-regulated after MI. We have shown that type I collagen matrix treatment at 3h post-MI leads to less inflammation and improved cardiac function, but the underlying mechanisms remain to be better characterized. The goal of this study was to elucidate a possible role of miR-92a in the anti-inflammatory/pro-wound healing effect of matrix treatment post-MI. C57BL/6J mice underwent LAD ligation to induce MI. Hearts were removed at 4h, 1d, 3d, and 7d post-MI and RNA was extracted from infarct and peri-infarct tissue. PCR analysis revealed that hearts injected with matrix at 3h post-MI resulted in significantly decreased miR-92a at 4h, 1d, and 3d compared to non-injected animals at each time point (p<0.0001) and PBS injected animals at 4h and 7d (p<0.004). Several targets of miR-92a and regulators of macrophage polarization were found to be up-regulated (p<0.05) early in MI indicating early amelioration of inflammatory processes. In vitro, macrophages cultured on matrix also had decreased expression of miR-92a compared to cultures on tissue culture poly styrene (TCPS) (p<0.001). Integrins α5 (ITGAα5) and αV (ITGAαV), involved in cell-matrix interactions, as well as inflammatory regulators S1PR1 and SIRT1 were identified as putative miR-92a targets. When miR-92a is over-expressed in macrophages, ITGα5 (p=0.0002), ITGαV (p=0.02), and S1Pr1 (p<0.0001), and SIRT1 (p=0.03) all had decreased expression. STAT3 and IL-10 were found to be moderately down-regulated. In evaluating macrophage phenotypes, M2 macrophages had reduced miR-92a expression on matrix compared to M1 macrophages. The migration of M2 macrophages into the matrix is increased compared to M1 macrophages. We report that the beneficial effects of matrix treatment post-MI may be mediated, at least in part, through its ability to regulate miR-92a and pro-wound healing mechanisms in macrophages. These results present the matrix as a novel non-pharmacological approach to locally regulate miRNAs in vivo for reducing inflammation and protecting the myocardium post-MI.

Methylglyoxal (MG) is a reactive dicarbonyl derived as a by-product of glycolysis. If MG is not metabolized by glyoxalase-1 (Glo1), it glycates macromolecules producing advanced glycation end products (AGEs); these have been linked to larger infarct sizes and poorer cardiac function after myocardial infarction (MI). Proteins of the extracellular matrix (ECM) are prime targets for glycation by MG, but it is unknown if MG modification of the ECM may be a mechanism that contributes to the poor repair and function of the post-MI heart. This study sought to examine if MG-induced modifications of ECM proteins negatively affect fibroblast and endothelial cell function. Analysis with an MG-derived hydroimidazolone 1 (MG-H1) antibody confirmed MG modification of laminin and collagen type (Col) 1, 3, and 4. MG modifications decreased endothelial cell (EC) adhesion on Col3, Col4, and laminin and angiogenesis on ECMatrix. Furthermore, alpha smooth muscle actin staining indicated increased myofibroblast differentiation of fibroblasts on MG-modified proteins. Following induction of MI, extracted mouse hearts were decellularized and compared to healthy controls. Perhaps a result of technical challenges, both western blot and immunohistochemistry contrasted previous data by displaying a marked decrease in MG-H1 modifications post-MI. Overall, these results indicate that MG modifications of the ECM negatively influence EC and fibroblast function, requiring more research on their impact in cardiovascular disease progression.

This study was designed to elicit women's perceptions of their illness experience with myocardial infarction for the purpose of exploring and describing the nature and meaning of this illness experience and its impact on everyday life. The phenomenological method, a type of qualitative research, was used to direct the study. The data were compiled through a series of semi-structured intensive interviews with eight women. The women were 36 to 71 years of age. Six of the women were married and living with their husbands. The women had been at home following discharge from hospital for 2 to 14 weeks. Data collection and data analysis proceeded simultaneously and data collection ceased once consistent themes were identified and validated and the data collected were sufficiently rich and in-depth. Women explain their illness experience with myocardial infarction as a loss phenomenon and the central and dominant loss within the heart attack experience for women is loss of predictability. Women's need for information following myocardial infarction is not met and lack of energy is a prominent feature in everyday life after a heart attack. Traditional sex role socialization sets the stage for potential problems in women's cardiac rehabilitation, especially in relation to support and role enactment. Physical rehabilitation is not a selected strategy to gain control over their loss experience for women with myocardial infarction. The findings and conclusions of this study suggest a number of implications for nursing practice. There is clear direction for family-centered nursing care in the rehabilitation of women with myocardial infarction to address potential problems in relation to support and role enactment. This study reinforces the value of using the concepts of loss and grief to care for patients with myocardial infarction. Also, this study indicates that, in planning nursing care for women with myocardial infarction, nurses should focus on Interventions to increase support, to meet patient and family educational needs, and to help women to anticipate normal physical and psychological responses to myocardial infarction. This study also has specific implications for the development of structured cardiac rehabilitation programmes addressing the special needs of women. In relation to nursing education, nurses must be prepared to assess, teach, and counsel patients with myocardial infarction and their families. Most importantly, this study directs nursing educators to provide course work in women's health issues to sensitize nurses to this field of study and to equip nurses with the understanding necessary to facilitate changes in women's health care. Implications for future research include further exploration of information needs, support, and strategies for control in relation to women with myocardial infarction. / Applied Science, Faculty of / Nursing, School of / Graduate

This qualitative study was designed to explore the experience of risk factor modification from the perspective of patients who had sustained an acute myocardial infarction. Research has shown that modification of coronary risk factors including stopping smoking, reducing hypercholesterolemia and obesity, reducing hypertension, developing a habit of regular exercise, and developing methods to modify the coronary-prone behavior pattern reduces morbidity and mortality due to coronary heart disease. The literature reviewed indicated that cardiac rehabilitation programs are generally structured to provide the patient with information on coronary artery disease. However, it has been shown that information alone may not be enough to ensure that changes in behavior occur. Since there was a scarcity of information on measures to assist patients to modify their coronary risk factors, and as the literature indicated that the experience of risk factor modification had not been explored from patients' perspectives, a phenomenological design was therefore selected as the methodology for this study. Data were collected through twelve in-depth interviews with six participants. A guide of semi-structured questions was used for the initial interview and additional questions were generated from the data themselves. The constant comparative method of data analysis enabled the researcher to construct an analytic framework which represented patients' perceptions of their experiences in risk factor modification. In this framework, the central theme of patients' experiences was gaining mastery over their risk behavior(s). Gaining mastery occurred in three phases: searching for attribution, acknowledging risk, and attaining control. In attaining control, various cognitive and behavioral strategies were identified which led to a delineation of measures that could be provided to assist other patients in modifying their coronary risk factors. The findings demonstrated that a unique perspective of risk factor modification has been provided by patients based on their own experiences. It was also shown that intervention, consisting of teaching, counseling, and support, is essential to each phase of this process. The implications of this study focus on the importance of intervention in both in-hospital and out-patient cardiac rehabilitation programs. Intervention to assist patients to develop and use those skills that will enable them to gain a sense of mastery over their risk behaviors is essential if an initial or recurrent myocardial infarction is to be prevented. Implications for nursing practice, education, and research are outlined in light of the research findings. / Applied Science, Faculty of / Nursing, School of / Graduate