Impact of anxiety and depression on morbidity and mortality of patients with coronary syndrome / Impacto de la ansiedad y depresión en la morbimortalidad de pacientes con síndrome coronaria / Impacto da ansiedade e depressão na morbimortalidade de pacientes com síndrome coronariana

ABSTRACT Objective: Evaluate the impact of anxiety and depression on morbidity and mortality of patients with acute coronary syndrome. Method: Retrospective cohort study, with follow-up of two years, conducted with 94 patients. The morbidity and mortality (readmission, myocardial revascularization, and death) was evaluated immediately after discharge and after one and two years. Anxiety and depression were evaluated by the State-Trait Anxiety Inventory and by Beck's Depression Inventory. The Kaplan-Meier estimator and the Logrank test were used. The significance level adopted was 0.05. Results: We observed that 76.6% of the patients did not present symptoms of depression or had mild signs, while 78.8% had low to moderate anxiety. The symptoms of depression and anxiety were not related to morbidity (need for MR p=0.098 and 0.56, respectively; readmission p=0.962 and 0.369, respectively) and mortality (p=0.434 and 0.077, respectively). Conclusion: No relationship was found between levels of anxiety and depression with the morbidity and mortality of patients.

RESUMEN Objetivo: Evaluar el impacto de la ansiedad y de la depresión en la morbimortalidad de pacientes con síndrome coronaria aguda. Método: Estudio de cohorte retrospectivo, con seguimiento de dos años, ha sido realizado con 94 pacientes. La morbimortalidad (la readmisión, la revascularización del miocardio y del óbito) ha sido evaluada inmediatamente después del alta hospitalaria y después de uno y dos años. La ansiedad y la depresión han sido evaluadas por el Inventario de Ansiedad Trazo y por el Inventario de Depresión de Beck. Se ha utilizado de los gráficos de Kaplan-Meier y de la prueba Logrank. El nivel de significancia que ha sido adoptado ha sido de 0,05. Resultados: Se ha observado que el 76,6% de los pacientes no presentaban síntomas de depresión o presentaban señales leves y el 78,8% tenían ansiedad de baja a moderada. Los síntomas de depresión y de ansiedad no se han relacionado a la morbilidad (necesidad de RM p=0,098 y 0,56, respectivamente; readmisión p=0,962 y 0,369, respectivamente) y a la mortandad (p=0,434 y 0,077, respectivamente). Conclusión: No hubo relación entre niveles de ansiedad y depresión con la morbimortalidad de los pacientes.

RESUMO Objetivo: Avaliar o impacto da ansiedade e depressão na morbimortalidade de pacientes com síndrome coronariana aguda. Método: Estudo de coorte retrospectivo, com seguimento de dois anos, realizado com 94 pacientes. A morbimortalidade (readmissão, revascularização do miocárdio e óbito) foi avaliada imediatamente após a alta hospitalar e depois de um e dois anos. A ansiedade e a depressão foram avaliadas pelo Inventário de Ansiedade Traço e pelo Inventário de Depressão de Beck. Utilizou-se dos gráficos de Kaplan-Meier e do teste Logrank. O nível de significância adotado foi de 0,05. Resultados: Observou-se que 76,6% dos pacientes não apresentavam sintomas de depressão ou apresentavam sinais leves e 78,8% tinham ansiedade baixa a moderada. Os sintomas de depressão e ansiedade não se relacionaram à morbidade (necessidade de RM p=0,098 e 0,56, respectivamente; readmissão p=0,962 e 0,369, respectivamente) e à mortalidade (p=0,434 e 0,077, respectivamente). Conclusão: Não houve relação entre níveis de ansiedade e depressão com a morbimortalidade dos pacientes.

Ansiedade e desfechos clínicos em pacientes coronariopatas submetidos ao cateterismo não programado / Ansiedad y resultados clínicos en pacientes con coronariopatías sometidos a cateterismo no programado / Anxiety and clinical outcomes in coronary patients undergoing unplanned catheterization

Resumo Objetivos Descrever o nível de ansiedade traço e estado em pacientes com síndrome coronariana aguda submetidos a cateterismo não programado; verificar a influência da ansiedade traço na ansiedade estado antes e após o cateterismo e verificar se a ansiedade (traço e estado) é preditiva da ocorrência de arritmias não fatais, da gravidade dos pacientes medida pela classificação Killip e pelo índice de comorbidade de Charlson, e do tempo de permanência hospitalar. Métodos Estudo observacional, correlacional e longitudinal, no qual foram avaliados participantes com síndrome coronariana aguda aguardando cateterismo cardíaco não programado. No encontro inicial (Ti) foram coletados dados sociodemográficos e clínicos, aplicados inventários de ansiedade traço e estado (IDATE) e de depressão de Beck. No encontro final (Tf), aplicou-se o IDATE-estado. Os participantes foram acompanhados até alta hospitalar ou óbito quanto a ocorrência de arritmias não fatais e tempo de permanência hospitalar. Resultados Foram incluídos 100 participantes (62,2±11,4 anos; 61% do sexo masculino). O escore do IDATE-traço foi 42,2±10,4 e influenciou o escore do IDATE-estado em Ti e Tf (p<0,005). O IDATE-estado diminuiu significativamente de Ti para Tf (40,2±10,4 vs 37,2±11,2, respectivamente, p=0,002). Não se observou associação do IDATE-traço ou do IDATE-estado com os índices de gravidade, tempo de permanência hospitalar ou ocorrência de arritmias. Entretanto, o escore de depressão aumentou 9,5% a chance de ocorrência de arritmias (OR=1,009; IC95%=0,913-1,115). Conclusão O nível de ansiedade reduziu de forma significativa após a realização do cateterismo, e não foi um preditor de desfechos clínicos em curto prazo.

Resumen Objetivos Describir el nivel de ansiedad rasgo y estado en pacientes con síndrome coronario agudo sometidos a cateterismo no programado, verificar la influencia de la ansiedad rasgo en la ansiedad estado antes y después del cateterismo, y verificar si la ansiedad (rasgo y estado) es predictiva de la ocurrencia de arritmias no fatales, de la gravedad de los pacientes medida por clasificación Killip e índice de comorbilidad de Charlson, y del tiempo de permanencia hospitalaria. Métodos Estudio observacional, correlacional y longitudinal. Fueron evaluados participantes con síndrome coronario agudo esperando cateterismo cardíaco no programado. En el encuentro inicial (Ti) fueron recolectados datos sociodemográficos y clínicos, aplicando inventarios de ansiedad rasgo y estado (IDATE) y de depresión de Beck. En el encuentro final (Tf), se aplicó IDATE-estado. Los participantes recibieron seguimiento hasta el alta o el deceso, respecto de la ocurrencia de arritmias no fatales y tiempo de permanencia hospitalaria. Resultados Fueron incluidos 100 participantes (62,2+11,4 años; 61% de sexo masculino). El puntaje de IDATE-rasgo fue 42,2±10,4, influyendo en el puntaje del IDATE-estado en Ti y Tf (p<0,005). El IDATE-estado disminuyó significativamente entre Ti y Tf (40,2±10,4 vs 37,2±11,02 respectivamente; p=0,002). No se observó asociación del IDATE-rasgo ni del IDATE-estado con los índices de gravedad, tiempo de permanencia hospitalaria u ocurrencia de arritmias (OR=1,099; IC%=0,913-1,115). Conclusión El nivel de ansiedad se redujo significativamente luego de realizarse el cateterismo, y no constituyó un predictor de resultados clínicos en el corto plazo.

Abstract Objectives To describe the state and trait anxiety level in patients with acute coronary syndrome undergoing unplanned catheterization; to assess the influence of trait anxiety on state anxiety before and after catheterization, and check if anxiety (state and trait) is predictive of non-fatal arrhythmias, of patients' clinical severity measured by the Killip score and the Charlson Comorbidity Index (CCI), and of length of hospital stay. Methods An observational, correlational and longitudinal study in which were evaluated participants with acute coronary syndrome waiting for unplanned cardiac catheterization. At the initial meeting (Ti), were collected sociodemographic and clinical data, and were applied the State and Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). At the final meeting (Tf), was applied the STAI-state. Participants were followed up until hospital discharge or death regarding the occurrence of non-fatal arrhythmias and length of hospital stay. Results A total of 100 participants were included (62.2±11.4 years; 61% male sex). The STAI-trait score was 42.2±10.4 and it influenced the STAI-state score at Ti and Tf (p<0.005). The STAI-state decreased significantly between Ti and Tf (40.2±10.4 vs 37.2±11.2, respectively, p=0.002). There was no association of STAI-trait or STAI-state with severity indexes, length of hospital stay or arrhythmia occurrence. However, the depression score increased the chance of occurrence of arrhythmias by 9.5% (OR=1.009, 95% CI=0.913-1.115). Conclusion The level of anxiety reduced significantly after catheterization, and was not a predictor of short-term clinical outcomes.

Análisis con perspectiva de género sobre percepción y prácticas en enfermedad coronaria en mujeres en el norte de México / A gender perspective analysis of perception and practices in coronary disease in women from northern México

Resumen: Objetivo: Analizar la percepción de riesgo coronario y prácticas de cuidados de un grupo de mujeres mexicanas, desde una perspectiva de género. Material y métodos: Estudio realizado de septiembre de 2013 a diciembre de 2014 en el estado de Sonora, México. Diseño mixto: encuesta a 140 mujeres. Análisis: contraste de proporciones; nueve entrevistas en profundidad a mujeres con enfermedad coronaria; ocho entrevistas semiestructuradas a médicos. Aplicación de técnicas de la teoría fundamentada. Resultados: Más de 50% desconoce su riesgo y cómo reducirlo. Mujeres informadas vulnerables con dolor de pecho buscan menos atención médica que las no vulnerables p=0.01 y son responsabilizadas por parte del personal médico sobre su enfermedad. Las mujeres consideran que están desinformadas sobre cómo reducir el riesgo de enfermedad coronaria; sin embargo, se culpabilizan por enfermar. Conclusiones: Las condiciones de vulnerabilidad de las mujeres modulan una baja percepción de riesgo coronario y mínimas prácticas de cuidados.

Abstract: Objective: To analyze the perception of coronary risk and health care practices in a group of Mexican women, from a gendered perspective. Materials and methods: Mixed methods: survey of 140 women; nine in-depth interviews to women with coronary disease; eight semi-structured interviews to physicians. Analysis: proportions contrast for quantitative data; and procedures of grounded theory for qualitative information. Results: More than 50% of women don't know their coronary risk and how to reduce it. Despite having information about heart disease, vulnerable women with chest pain sought medical attendance less than non-vulnerable women (p=0.0l); and are blamed by physicians. Women consider they lack sufficient information about how to reduce the risk of coronary disease, and blame themselves when ill. Conclusions: There are vulnerability conditions in women that modulate a low perception of their being at risk, and the scarcity of health care practices.

Crenças, valores e atitudes dos familiares conviventes com pacientes coronariopatas / Beliefs, values and attitudes of cohabiting relatives of coronary artery disease patients / Creencias, valores y actitudes de familiares de pacientes con coronariopatía

A alta incidência e prevalência da doença coronariana é evidente no Brasil e no mundo. A concepção de saúde e enfermidade influencia nas atitudes e condutas dos indivíduos diante do processo saúde doença e afeta o desempenho e o desenvolvimento do núcleo familiar. O objetivo foi analisar crenças, valores e atitudes dos familiares conviventes com pacientes com síndrome coronariana aguda sobre a doença coronariana. Trata-se de estudo transversal com abordagem qualitativa realizado em um Hospital Universitário. A amostra foi composta de nove familiares, mediante uma entrevista semi estruturada. Os dados foram coletados por meio de instrumentos com questões elaboradas tendo como base as premissas do referencial teórico e avaliados segundo o Modelo de Crença em Saúde. Os familiares tinham entre 26 e 66 anos. As categorias suscetibilidade, severidade, benefícios e barreiras percebidas derivadas do Modelo de Crença em Saúde, assim como a categoria conscientização e mudança, mostraram que os familiares possuem conhecimento sobre os aspectos preventivos e de controle das consequências da doença coronariana, porém as crenças e valores adquiridos ao longo de suas vidas, influenciados pelo contexto cultural, social, econômico, emocional e principalmente familiar, interferem nos comportamentos preventivos da doença e promotores de saúde. A despeito do conhecimento que os familiares conviventes possuem sobre a doença, o enfermeiro precisa adequar o processo educacional para minimizar os conflitos decorrentes de crenças, valores e contexto do ambiente familiar, facilitar e promover a incorporação de novos hábitos.

The high incidence and prevalence of coronary heart disease is evident in Brazil and worldwide. The concept that individuals have on health andillness influences their attitudes and behaviors before the health-disease process and affects the performance and development of the familynucleus. The objective was to analyze beliefs, values and attitudes of family members that live with patients with acute coronary syndrome ofcoronary heart disease. This is a cross-sectional study with qualitative approach conducted at a university hospital. The sample consisted ofnine relatives of patient. Semi-structured interviews were applied. Data were collected through instruments with questions prepared upon theassumptions of the theoretical framework. Data were evaluated according to the Health Belief Model. Family members were aged between 26 and66 years. The categories susceptibility, severity, benefits and perceived barriers derived from Health Belief Model, as well as the categories awarenessand change, showed that family members have knowledge about the prevention and control aspects of the consequences of coronary heart disease.However, the beliefs and values acquired throughout their lives, influenced by cultural, social, economic, emotional and especially family context,hinder behaviors with preventive and health promoter character. Despite the knowledge that family member of coronary patients have about thedisease, nurses need to tailor the educational process aiming to minimize conflicts arising from beliefs, values and family environment context, aswell as facilitate and promote the incorporation of new habits.

La elevada incidencia y prevalencia de la enfermedad coronaria en Brasil y en el mundo es evidente. El concepto de salud y enfermedad influye en las actitudesy comportamientos de los individuos en el proceso de salud-enfermedad y afecta el rendimiento y desarrollo del núcleo familiar. El objetivo del presenteestudio fue analizar las creencias, valores y actitudes de familiares que conviven con pacientes con síndrome coronario agudo de la enfermedad arterialcoronaria. Se trata de un estudio cualitativo transversal realizado en un hospital universitario. La muestra estaba compuesta por nueve familiares. Los datosfueron recogidos en entrevistas semiestructuradas a través de instrumentos con preguntas preparadas en base a los supuestos del marco teórico según elModelo de Creencias en Salud. Los familiares tenían entre 26 y 66 años. Las categorías “susceptibilidad”, “gravedad”, “beneficios” y “barreras” percibidasderivadas del modelo Creencias en Salud, así como la categoría “concienciación y cambio”, mostraron que los familiares tienen conocimiento sobre losaspectos de prevención y control de las consecuencias de la enfermedad cardíaca coronaria. Sin embargo, las creencias y valores adquiridos durante toda lavida, influenciados por el contexto cultural, social, económico y emocional de la familia interfieren con los comportamientos preventivos de la enfermedad ypromotores de la salud. A pesar del conocimiento que los familiares tienen sobre la enfermedad, los enfermeros precisan adecuar el proceso educativo paraminimizar los conflictos resultantes de las creencias, valores y contexto familiar para facilitar y promover la incorporación de nuevos hábitos.

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

INTRODUCTION: The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS: Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations. .

Avances en la construcción del Inventario de Factores Psicosociales asociados a Enfermedad Cardíaca (IFPEC) / Progress in the construction of the Psychosocial Factors Inventory associated with Heart Disease (IFPEC)

El estudio y evaluación de los factores psicosociales en pacientes con enfermedad cardíaca cobra cada vez mayor importancia a medida que la prevalencia de este fenómeno crece alrededor del mundo. A través de numerosas investigaciones, la depresión, la ansiedad, la ira, el estrés laboral y el apoyo social han mostrado tener efectos sobre el desarrollo, curso y rehabilitación de la enfermedad (Bennett, Owen, Koutsakis, & Bisson, 2002). Si bien existen en nuestro medio una serie de pruebas que evalúan estos factores, se presenta la necesidad de contar con un instrumento que los evalúe en su conjunto, validado en esta población particular. Asimismo, contar con herramientas específicas para evaluar a estos pacientes resulta de vital importancia para poder realizar luego las intervenciones requeridas para su recuperación. El objetivo de este artículo es presentar la versión preliminar del Inventario para evaluar Factores Psicosociales asociados a Enfermedad Cardíaca (IFPEC). Se presentan las distintas etapas en el proceso de construcción y las características del instrumento en su etapa actual.

Asociación entre evento coronario y factores de riesgo psicosociales: agotamiento vital, ansiedad e ira en una población de Argentina. Estudio de correlación entre factores de riesgo / [Association between acute coronary events and psychosocial risk factors: vital exhaustion, anxiety and anger in an Argentinian population. A correlation study between risks factors].

OBJECTIVE: To study the association between vital exhaustion, anxiety and anger with acute coronary event; second, determine whether they are associated with each other, and third, if the joint interaction of two or more factors increases the risk for coronary event. METHOD: We conducted a case-control study with 165 patients, both sexes, between 35 and 75 years, 90 patients with acute ischemic coronary event and 75 controls hospitalized with an acute event of non-ischemic cardiac causes. RESULTS: Statistically significant differences between the control group and the ischemic coronary group for vital exhaustion was found (OR = 3.0 (1.6-5.5) p < 0.001 (chi2)). Psychosocial risk factors are associated each with p < 0.001: anxiety and vital exhaustion (Spearman Rho = 0.58), anger and vital exhaustion (Spearman Rho = 0.41) and anxiety and anger (Spearman Rho = 0.38). The simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event (p < 0.01). CONCLUSIONS: In this study we found a significative association between vital exhaustion and acute ischemic coronary event, psychosocial risk factors are associated with each other and simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event.

Personality Profile and Coping Skills among Coronary Heart Disease Patients and Non-Patient Groups.

Background: Coronary heart disease is a leading cause of death and a major cause of disability worldwide. Aims: This study was conducted to see whether there are certain specific personality pattern of coronary heart disease patients and the coping strategies they use to deal with these stressful situations. Methodology: A sample of 30 male patients diagnosed as having coronary heart disease were selected from the outdoor and indoor patient cardiology departments of Ramkrishna Care Hospital and Modern Medical Hospital, Raipur, Chhattisgarh. Results and Conclusions: It was found that CHD patients have certain specific personality traits which reflect that these persons have low frustration tolerance for unsatisfactory conditions, are neurotically fatigued, easily annoyed and emotional (Factor C). They are suspicious and are often involved in their own ego and are self-opinionated and interested in internal mental life.

Alexithymia and Type “A” Behavior Pattern (TABP) in Coronary Heart Diseases: A preliminary study.

Background: The number of patients with CHD is increasing and psychosocial factors are now recognized as playing a significant and independent role in the development of CHD and its complications. Aims: The present study aimed at examining the association between alexithymia and Type A Behavior Pattern (TABP) in Coronary Heart Disease (CHD) patients. Methodology: The sample consisted of 150 participants, comprising 50 in the study group (drawn from the outpatient clinical services) and 50 in the control group (from the general population) from Kashmir. Further 50 controls from the general population of Haryana were included to study alexithymia in broader context. The tools used included Jenkins Activity Survey (JAS-C) and Toronto Alexithymia Scale (TAS-20). Statistical analysis was done using SPSS-12.0 and various descriptive and inferential statistics were applied. Results: The results revealed a high prevalence (40%) of alexithymia in our study group. However the association of alexithymia with CHD was not clearly indicated as the comparison of alexithymia between our study group and control group did not reveal any significant difference and paradoxically the prevalence in the control group was even higher. Further a comparison of the control group from Kashmir with that of Haryana revealed a highly significant difference. Thus, our study suggests that perpetual trauma and unending stress due to present prevailing condition in Kashmir together with the presence of some kind of mental disorders in a significant segment of Kashmiri population has rendered the whole population more vulnerable to developing alexithymia. Further, our findings did not reveal any association between Type A Behavior Pattern and CHD. Conclusion: This indicates a need for further clarification of the precise role of personality types in producing and preventing CHD.

Influencia de la rehabilitación cardíaca sobre la tasa de re-hospitalización en pacientes con infarto agudo de miocardio, Santander, Colombia / The influence of cardiac rehabilitation on acute myocardial infarction patients' readmission rate in Santander, Colombia

Objetivo Estimar el efecto de la rehabilitación cardiaca (RC) pos-infarto, según sus niveles de intervención, sobre las tasas de re-hospitalización. Métodos Estudio de cohorte prospectiva de pacientes con diagnóstico de IAM. Se obtuvieron datos sobre gravedad del infarto, antecedentes, historia médica, evolución intrahospitalaria, clasificación Killip, estancia y condición de egreso. A través de la historia clínica electrónica y mediante contacto telefónico se constató si el paciente recibió RC y cuáles fueron sus componentes; el seguimiento se extendió hasta por un año. Resultados Se incluyeron 96 pacientes de ambos sexos con IAM. En 72 se contó con información sobre RC; 5 de los cuales recibieron RC basada únicamente en actividad física; 49 pacientes recibieron una RC más completa que integró actividad física, educación, psicología y nutrición; 18 pacientes no recibieron RC. Durante el seguimiento, se registraron 10 nuevas hospitalizaciones y una muerte. En un modelo de Poisson, los pacientes cuya RC se basó sólo en la actividad física presentaron una tasa de re-hospitalizaciones significativamente mayor que la de los pacientes que recibieron un esquema completo de RC (Razón de tasas: 5,89; IC 95 %:1,14-30,49; ρ=0,04). Conclusiones La RC debe tener un enfoque multidisciplinario, que además del componente físico, incluya el psicológico, nutricional y educativo.

Objective Estimating the effect of post-infarction cardiac rehabilitation (CR) on readmission/re-hospitalization rates according to intervention level. Method This was a prospective cohort study of patients diagnosed as suffering acute myocardial infarction (AMI). Data concerning infarction severity, previous illness, medical history, hospital course, Killip classification, length of hospital stay and condition on discharge. Medical records and telephone contact were used to confirm whether a patient had received CR and ascertain pertinent components. Follow-up was extended to one year. Results 96 AMI patients of both genders were included; information about CR was available for 72 of them,5 of whom had received CR based only on physical activity. 49 patients received complete CR based on education, physical activity, psychological and nutritional assessment. 18 patients had not received CR. One death and 10 new admissions/hospitalizations were recorded during follow-up. A Poisson regression model showed that patients who had received CR based only on physical activity presented significantly higher re-hospitalization rates than patients who had received a complete CR scheme (rate ratio 5.89:1.14-30.4995 % CI; p=0.04). Conclusions A multidisciplinary approach must bead opted to CR involving physical activity, education and psychological and nutritional assessment.

Comparative Study of Prevalence of Psychological Distress Factors in Coronary Heart Disease Patients Living Under Disturbed Conditions and a normal place of North India.

Background: The experience of heart disease seems to contribute to risk for numerous psychiatric problems, especially depression, anxiety, and stress. Although, these psychosocial factors appear to be outside the immediate realm of medicine, they have a profound impact on morbidity and mortality in cardiac patients. Aims: Purpose of the present study was to assess psychological distress (depression, anxiety, perceived stress) in Coronary Heart Disease (CHD) patients and compare the levels of these constructs among CHD patients living in disturbed condition (Kashmir) and a normal place (Haryana). Methods: Hospital Anxiety Depression Scale (HADS) and Perceived Stress Scale (PSS-4) were administered to a total of 200 male participants, 100 (50 CHD Patients and 50 healthy controls) from Kashmir and 100 (50 CHD Patients and 50 healthy controls) from Haryana. Statistical analysis was done using SPSS- 12.0. Results: The results revealed a high prevalence of depression, anxiety and stress in our study groups from both the places. Unlike Haryana, the stress levels between the CHD patients and healthy controls in the Kashmiri population did not show any significant difference. Comparison of depression between the study groups of the two states also did not reveal any significant difference. Further comparison of anxiety and stress between the study groups of the two states revealed a highly significant difference. The levels of depression, anxiety and stress in the control groups of the 2 states also differed significantly with alarmingly higher levels of psychological distress in the Kashmiri population. Conclusions: Thus, our study suggests that increased exposure of the Kashmiri population to traumatic events and stressful conditions has increased their levels of emotional distress, adversely affecting the mental connotation of their chronic physical condition (CHD) as well as putting the whole population at a greater risk of developing psychological problems due to extremely high levels of psychological distress.

Perfil lipídico sérico de ratos tratados com surfactante / Serum lipid levels of rats treated with surfactant

A aterosclerose é uma doença multifatorial, lenta e progressiva e a hiperlipidemia um dos fatores potenciais no desenvolvimento de doenças cardíacas ateroscleróticas. As vantagens da indução das dislipidemias experimentais são a produção de lesões ateromatosas em curto espaço de tempo; adequado controle dietético e fatores ambientais; a possibilidade de estudos sobre a reversibilidade de lesões ateroscleróticas e ensaios pré-clínicos de substâncias hipolipidêmicas. Este estudo visou avaliar o perfil lipídico sérico de ratos tratados com surfactante. Foram utilizados 28 ratos Wistar, machos, albinos, adultos e hígidos. Estes foram distribuídos em quatro grupos experimentais formados por sete animais cada, a saber: Grupo I – (controle); Grupo II – tratado com tyloxapol, na dose de 500 mg/kg de peso corporal, via intraperitoneal a cada 48 horas, durante duas semanas; Grupo III – tratado com tyloxapol na dose de 500 mg/kg de peso corporal, via intraperitoneal a cada 48 horas, durante três semanas; Grupo IV – tratado com tyloxapol na dose de 500 mg/kg de peso corporal, via intraperitoneal a cada 48 horas, durante quatro semanas. Na avaliação do perfil lipídico, os valores de triacilgliceróis e HDL demonstraram que o grupo III diferiu significativamente do grupo I e os valores de colesterol total e LDL indicaram que o grupo I diferiu significativamente dos grupos II, III e IV. Conclui-se que o surfactante tyloxapol foi efetivo na indução da hiperlipidemia.

Atherosclerosis is a multifactorial, progressive and slow disease, and hyperlipidaemia is one of the potential factors in the development of atherosclerotic cardiac diseases. The experimental dyslipidaemia carrying out advantages are the production of atheromatous lesions in a short period of time, an adequate dietetic control and environmental factors, the possibility of studies concerning reversibility of atherosclerotic lesions, and pre-clinic experiments with hypolipidaemic substances. This study aims at evaluating tyloxapol analyzing serum lipid levels. Twenty-eight healthy Wistar adults’ albino male rats, weighing an average of 200 g were utilized. They were distributed into four experimental groups with seven animals each, as follows: Group I – (control); Group II – treated with tyloxapol at a dose of 500mg/kg of body weight, through intraperitoneal via each 48 hours, for two weeks; Group III - treated with tyloxapol at a dose of 500mg/ kg of body weight, through intraperitoneal via each 48 hours, for three weeks; Group IV - treated with tyloxapol at a dose of 500mg/kg of body weight, through intraperitoneal via each 48 hours, for four weeks. As lipid profile evaluation is concerned, the values of triacylglycerols and HDL have indicated that group III has significantly differed from group I and the values of total cholesterol and LDL have indicated that group I has significantly differed from group II, III and IV. It was concluded that for the studied period the surfactant tyloxapol was effective to inducing hyperlipidaemia.

Relationship between depression and apolipoproteins A and B: a case-control study

OBJECTIVE: To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease. INTRODUCTION: Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein. METHODS: This case-control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high-and low-density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t-test, χ2 test, Pearson correlation test and linear regression were applied. RESULTS: Depression was a negative predictor of apolipoprotein A (β = -0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = -0.269, p<0.05) and positively predicted by high-density lipoprotein (β = 0.401, p<0.01). Also, low-density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level. CONCLUSION: In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.

Desenvolvimento de instrumento para medida dos fatores psicossociais determinantes do comportamento de atividade física em coronariopatas / Development of an instrument to measure psychosocial determinants of physical activity behavior among coronary heart disease patients / Desarrollo de un instrumento para la medida de los factores psicosociales determinantes del comportamiento de la actividad física en individuos con coronariopatía

Este estudo teve como objetivo apresentar o desenvolvimento, a análise de conteúdo e da confiabilidade do Questionário para identificação dos fatores psicossociais determinantes do comportamento de atividade física em coronariopatas, baseado na extensão da Teoria do Comportamento Planejado. O instrumento foi submetido à validade de conteúdo, com realização de sua avaliação por três juízes e pré-teste com cinco sujeitos, até mostrar-se conceitualmente adequado e compreensível aos sujeitos entrevistados. Foi aplicado em 51 sujeitos para a avaliação preliminar da consistência interna, por meio da determinação do coeficiente alfa de Crombach. Foram observados coeficientes alfa de Crombach >0,75 para os constructos Intenção, Atitude, Norma Subjetiva, Autoeficácia e Hábito. O instrumento desenvolvido mostrou evidências de validade de conteúdo e de confiabilidade.

The aim of this study was to report the development and the analysis of content validity and reliability of the Psychosocial Determinants of Physical Activity among Coronary Heart Disease Patients Questionnaire, based on an extension of the Theory of Planned Behavior. In the content validity step, three experts evaluated the instrument which was, afterwards, pre-tested with five subjects in order to obtain a conceptually appropriate and easily understood instrument. Fifty-one patients participated in the evaluation of internal consistency of the reviewed instrument. Cronbach's alpha coefficients above 0.75 were observed for the constructs: Intention, Attitude, Subjective Norm, Self-efficacy and Habit. The new instrument demonstrated acceptable evidence of content validity and reliability.

Este estudio tuvo como objetivo presentar el desarrollo, el análisis de contenido y de confiabilidad del Cuestionario para la identificación de los factores psicosociales determinantes del comportamiento de actividad física en pacientes afectados de coronariopatías, basado en la extensión de la Teoría del Comportamiento Planificado. Se sometió la validez del contenido del instrumento a la evaluación por parte de tres jueces y pre test con cinco sujetos, hasta mostrarse conceptualmente adecuado y comprensible para los sujetos entrevistados. Fue aplicado en 51 sujetos para la evaluación preliminar de consistencia interna, a través de la determinación del coeficiente Alfa de Cronbach. Fueron observados coeficientes Alfa de Cronbach >0,75 para los constructos Intención, Actitud, Norma Subjetiva, Autoeficacia y Hábito. El instrumento desarrollado evidenció la validez de su contenido, así como su confiabilidad.

[ effectiveness of stress inoculation group training on somatization and anxiety of the coronary heart disease patients]

The purpose of this study was to determine the effectiveness of stress inoculation training on the Somatization and Anxiety of coronary heart disease patients. Subjects were consisted of 40 patients with coronary heart disease, who were randomly selected from the hospitals Golestan, Mehr, naft and Tapesh Clinic of Ahwaz, through systematic sampling method. These patients were randomly assigned to experimental [N=20] and control [N=20] groups. There was 10 females and 10 males in each group. The experimental group received 8 weekly sessions of stress inoculation training that the control group did not received it. It was hypothesized that training would increase the general health of the training group as compared with the control group. The GHQ-28 was administered to both groups before and after training. The results of analysis of covariance showed that training significantly improved the general health in the experimental group as compared with the control group. Also, compared with the control groups, the experimental group showed significantly lower scores on the somatization Anxiety disorder and insomni. The result of research showed the stress inoculation training effected on the amount of general health, somatization and Anxiety disorder and insomnia in coronary heart disease and this method can be used with usual medicine care in improvement and rehabilitation in cardiovascular diseases

Avaliação do apoio social e da auto-estima por indivíduos coronariopatas, segundo o sexo / Evaluación del apoyo social y de la autoestima entre pacientes con coronariopatías según el sexo / Gender-specific evaluation of coronary disease patients' self-esteem and social support

Este estudo descritivo teve como objetivo avaliar o apoio social e a auto-estima de pacientes coronariopatas internados para tratamento clínico dessa doença. Uma amostra de 80 pacientes, sendo 49 homens, 52 casados e com idade média de 52 anos, foram entrevistados de agosto de 2005 a junho de 2006. Os dados coletados foram analisados por estatística descritiva, e as medidas de apoio social e auto-estima foram comparadas pelo teste de Mann-Whitney, de acordo com o sexo. As consistências internas das escalas foram verificadas, obtendo-se valores que indicam boa consistência interna para ambas. Os resultados indicaram valores elevados de apoio social e auto-estima no grupo estudado. Não constatamos diferenças estatisticamente significantes entre estes valores, segundo o sexo dos pacientes. Essas variáveis têm sido apontadas como favorecedores no processo de reabilitação dos pacientes cardíacos após a alta.

The purpose of this descriptive study was to evaluate the social support and self-esteem of coronary disease patients hospitalized for the clinical treatment of this disease. The sample consisted of 80 patients, 49 men, 52 married, and with an average age of 52 years. Interviews took place from August 2005 to July 2006. The collected data were analyzed using descriptive analysis, and the measured social support and self-esteem were compared by the descriptive statistics, and the social support and self-esteem measures were compared using the Mann-Whitney test, according to patient gender. Internal consistency was verified, achieving values that indicate good internal consistency for both scales. The results showed high social support and self-esteem values in the studied group. No statistically significant differences were found between these values, according to patient gender. These variables have been pointed out as aspects that favor the rehabilitation process of heart disease patients after hospital discharge.

Este estudio descriptivo tuvo como objetivo evaluar el apoyo social y la autoestima de pacientes con coronariopatía internados para tratamiento clínico de esa enfermedad. Se utilizó una muestra de 80 pacientes, siendo 49 hombres, 52 casados y con edad promedio de 52 años; fueron entrevistados de agosto 2.005 a junio 2.006. Los datos recolectados fueron analizados con la estadística descriptiva y las medidas de apoyo social y de autoestima fueron comparadas, según el sexo, por la prueba de Mann-Whitney. Las consistencias internas de las escalas fueron verificadas, obteniéndose valores que indican una buena consistencia interna para ambas. Los resultados indicaron valores elevados de apoyo social y autoestima en el grupo estudiado. No constatamos diferencias estadísticamente significativas entre esos valores, según el sexo de los pacientes. Esas variables han sido apuntadas como favorecedores en el proceso de rehabilitación de los pacientes cardíacos después del alta.

Factors Predicting Patient Discomfort after Coronary Angiography

PURPOSE: The purpose of this study was to identify the factors that predict discomfort after coronary angiography or percutaneous coronary intervention (PCI) among hospitalized patients. METHODS: A total of 203 patients who underwent coronary angiography or PCI were recruited from C hospital located in S city, J province, from June through August 2008. The level of discomfort was measured and standardized by two instruments, discomfort questionnaire and the Visual Analogue Scale (VAS). RESULTS: Stepwise multiple regression showed that the factors predicting the level of discomfort were type of angiography, gender, previous angiography, dysuria, pre-information, and sleep satisfaction, which together explained 30.6% of the total variance of the level of discomfort. CONCLUSION: Patients who had previous experience with these procedures, received a pre-information about the upcoming procedure, had no dysuria, and had slept well after the procedure were less likely to complain discomfort. Pre-informed education should be given by nurses to patients who will have an angiography or PCI to reduce their physical and emotional discomforts.

[Study of mental health of the patients who need coronary angiography and its relationship with drug abuse]

Coronary heart disease as a reason for mortality is occurring with psychiatric disorders. This descriptive- analytic study aims at assess mental health of patients who need to perform coronary angiography and its relationship with drug abuse. Sampling was done by census and data was collected using General Health Questionnaire and clinical interview. At first, all the patients who needed coronary angiography completed questionnaire and after calculating the patients' score, psychiatrist visited the patients with score more than 28. Data showed that from 200 patients surveyed in this search, 49.5 percent had mental disorders; specially physical signs, distress and sleep disorders, but they were healthy from view point of social functioning and depression. Also, drug abuse is known as an effective factor of mental disorder and rises the chance of mental disorders, so the drug abusers are susceptible to mental disorders 7 times more than the patients with no drug abuse. This study proved that being married plays a positive role on mental health, so the risk of mental disorders in divorcees and widows are 20 times greater than in married patients. Consequently we prefer that patient with coronary heart disease who needs angiography get psychiatric cares and consultation