Non-Cardiac Chest Pain as a Persistent Physical Symptom: Psychological Distress and Workability.

Non-Cardiac Chest Pain (NCCP) is persistent chest pain in the absence of identifiable cardiac pathology. Some NCCP cases meet criteria for Persistent Physical Symptoms (PPS), where the symptoms are both persistent and distressing/disabling. This study aimed to identify patients that might need specialist treatment for PPS by examining cases of NCCP that meet PPS criteria. We analysed data from 285 chest pain patients that had received an NCCP diagnosis after attending an emergency cardiac department. We compared NCCP patients who did and did not meet the additional criteria for heart-related PPS and hypothesised that the groups would differ in terms of psychological variables and workability. We determined that NCCP patients who meet PPS criteria were more likely than other NCCP patients to be inactive or unable to work, reported more general anxiety and anxiety about their health, were more depressed, ruminated more, and, importantly, had a higher number of other PPS. A high proportion of NCCP patients meet PPS criteria, and they are similar to other PPS patients in terms of comorbidity and disability. This highlights the importance of focusing psychological interventions for this subgroup on the interplay between the range of physical and psychological symptoms present.

Different cardiorespiratory fitness expressions based on the maximal cycle ergometer test show no effect on the relation of cardiorespiratory fitness to the academic achievement of nine-year-olds.

The relationship between cardiorespiratory fitness and academic achievement has been inconclusive. The results may depend on how cardiorespiratory fitness is expressed. The aim of this study is to explore the impact of different cardiorespiratory fitness expression methods, measured by the maximal cycle ergometer test, on the relationship between cardiorespiratory fitness and academic achievement. A cross-sectional study consisting of 303 Icelandic 4th grade students (163 girls) was conducted. Cardiorespiratory fitness was assessed using a graded maximal cycle ergometer test and scores of standardized tests in Icelandic and math obtained from the Icelandic National Examination Institute. Cardiorespiratory fitness was measured as absolute power output in watts in a maximal progressive cycle ergometer test. To adjust for different body sizes, the power output was scaled to body weight, body height, body surface area, and allometrically expressed body weight. In addition, linear regression scaling was also used to adjust for different body sizes. No significant relationship was found between any of the cardiorespiratory fitness expressions and academic achievement, using both univariate and multivariate linear regression analyses. The use of different methods to express cardiorespiratory fitness does not significantly affect the association with the academic achievement of fourth grade students.

[Non-cardiac chest pain and its association with persistent chest pain and poor mental well-being].

INTRODUCTION: An estimated 50-75% of visits to cardiac emergency departments are due to chest pain which is non-cardiac in nature (non-cardiac chest pain (NCCP). This study evaluates the prevalence of NCCP in the emergency departments at Landspitali, and assesses its association with continued chest-pain post discharge, mental well--being and the information-provision provided to NCCP patients during hospitalization. MATERIAL AND METHODS: Participants were 390 patients (18-65 years) presenting with chest pain to the cardiac emergency or the general emergency department at Landspitali from October 2015-May 2016. Measurements included questionnaires assessing somatic symptoms, mental well-being and quality of life, and questions regarding continued chest-pain and information-provision during hospitalization. RESULTS: In total 72% of participants (282) were considered having NCCP while 24% (92) had cardiac disease. NCCP patients experienced a similar burden of somatic and depressive symptoms, but slightly more anxiety and mental distress than cardiac patients. Equal proportions (60%) of NCCP and cardiac patients reported having experienced chestpain post discharge. Continued chest-pain was, however, associated with greater anxiety (ß=0.18, p<0.001) and depression (ß=0.18, p<0.003) among NCCP patients. Thirty percent of NCCP patients lacked instructions of how to respond to continued chest-pain and only 40% received information regarding other possible causes of chest pain. CONCLUSION: NCCP was prevalent among patients presenting to emergency departments at Landspitali. The majority of NCCP patients experienced continued chest-pain after discharge, and such pain experience was associated with mental distress. A third of NCCP patients lacked information about possible causes for the pain and advice about coping with symptoms.

Organized leisure-time sport participation and academic achievement in preadolescents.

AIMS: The aims of this study were to study the correlation between lifestyle-related factors, such as organized leisure-time sport participation (OLSP), cardiorespiratory fitness, and adiposity, and academic achievement among preadolescents. METHODS: A cross-sectional study involving 248 nine-year-old school children was carried out. OLSP was self-reported with parental assistance, categorized as ≤ 1× a week, 2-3× a week, and ≥ 4× times a week or more. Academic achievement was estimated with results from standardized test scores in Icelandic and math. Cardiorespiratory fitness was estimated using a maximal cycle ergometer test. The sum of four skinfolds was used to estimate adiposity. RESULTS: Tests of between-subjects effect indicated that OLSP significantly correlated with achievement in math only (F(2,235) = 3.81, p = 0.024). Further analysis showed that the two less active groups had significantly lower scores in math compared to the most active group with OLSP ≥ 4× times a week or more (2-3× times a week, unstandardized coefficient (b) = -4.08, 95% confidence interval (CI) [-7.09, -1.07]; ≤ 1× a week, b = -3.84, 95% CI [-7.59, -0.08]), independent of sex, age, maturity level (age to/from peak height velocity), family structure, and parental education. Neither cardiorespiratory fitness nor adiposity significantly correlated with academic achievements. CONCLUSIONS: The study's result indicates that frequent (four times per week or more often) sport participation is not harmful but may be beneficial to learning. However, further intervention-based study of this topic is needed to determine if this relationship is causal.

Importance of physical health and health-behaviors in adolescence for risk of dropout from secondary education in young adulthood: an 8-year prospective study.

BACKGROUND: Education and health constitute two interlinked assets that are highly important to individuals. In Iceland, prevalence of dropout from secondary education poses a considerable problem. This 8-year prospective study assesses to what extent poor physical health and negative health-behaviors of Icelandic adolescents predict increased odds of dropout from secondary education. METHODS: The sample included n = 201 Icelandic children who participated at age 15 (baseline) and again at age 23 (follow-up). Data included objective measurements of physical health and questionnaires assessing health-behaviors, education status, parental education, neighborhood characteristics, self-esteem, and depression. Independent t-tests and chi-square were used to assess differences in physical health and health-behaviors at follow-up stratified by education status. Ordinal regression models were conducted to assess whether physical health and health-behaviors at age 15 predicted increased odds of dropout from secondary education at age 23, independent of gender, parental education and psychological factors. RESULTS: At age 23, 78 % of girls and 71 % of boys had completed a secondary education. Completion of a secondary education was associated with significant health benefits, especially among women. Women without a secondary education had lower fitness, more somatic complaints, higher diastolic blood pressure, less sports participation, and poorer sleep, whilst men without a secondary education watched more television. In logistic regression models somatic complaints during adolescence were associated with 1.09 (95 % CI: 1.02-1.18) higher odds of dropout from secondary education in young adulthood, independent of covariates. Health-behaviors associated with higher dropout odds included smoking (3.67, 95 % CI: 1.50-9.00), alcohol drinking (2.57, 95 % CI: 1.15-5.75), and time spent watching television (1.27, 95 % CI:1.03-1.56), which were independent of most covariates. Finally, mother's higher education was strongly associated with significantly lower dropout odds (OR 0.54, 95 % CI: 0.34-0.88) independent of father's education and psychological factors, whilst high self-esteem was independently associated with lower dropout odds (OR 0.91, 95 % CI: 0.85-0.98). CONCLUSIONS: Completion of a secondary education yields substantial physical health benefits for young women, but not for men. Importantly, somatic complaints and negative health-behaviors among adolescent boys and girls adversely impact their educational outcomes later in life, and may have widespread consequences for their future prospects.

Association of type D personality with unhealthy lifestyle, and estimated risk of coronary events in the general Icelandic population.

BACKGROUND: Type D personality is associated with an increased morbidity and mortality risk in cardiovascular disease patients, but the mechanisms explaining this risk are unclear. We examined whether Type D was associated with coronary artery disease (CAD) risk factors, estimated risk of developing CAD, and previous cardiac events. DESIGN: Cross-sectional study in the general Icelandic population. METHODS: A random sample of 4753 individuals (mean age 49.1 ± 12.0 years; 49% men) from the REFINE-Reykjavik study completed assessments for Type D personality and conventional CAD risk factors. Ten-year risk of developing CAD was estimated with the Icelandic risk calculator. RESULTS: Type D personality (22% of sample) was associated with a higher prevalence of hypertension (35 vs. 31%, p = 0.009), but less use of hypertension medication (58 vs. 65%, p = 0.013) in hypertensives, more diabetes (6 vs. 4%, p = 0.023), wider waist circumference (p = 0.007), and elevated body mass index (p = 0.025) and blood lipids (p < 0.05). Type D individuals reported less physical exercise (p = 0.000) and more current (26 vs. 21%, p = 0.003) and former smoking (48 vs. 44%, p = 0.036). Estimates of 10-year risk of CAD were higher in Type D individuals (12.4%, 95% CI 1.9 to 23.8%), and Type Ds reported more previous cardiac events than non-Type Ds (5 vs. 3%, p < 0.01; OR 1.71, 95% CI 1.21 to 2.42). CONCLUSIONS: In the general Icelandic population, Type D personality was associated with differences in lifestyle-related CAD risk factors, a higher estimated risk of developing CAD, and higher incidence of previous cardiac events. Unhealthy lifestyles may partly explain the adverse cardiovascular effect of Type D personality.

Type D personality is associated with impaired psychological status and unhealthy lifestyle in Icelandic cardiac patients: a cross-sectional study.

BACKGROUND: Type D (distressed) personality has been associated with adverse cardiac prognosis and poor emotional well-being in cardiac patients, but it is still unclear what mechanisms link Type D personality with poor clinical outcomes in cardiac patients. In the present cohort of Icelandic cardiac patients, we examined potential pathways that may explain this relationship. The objectives were to examine 1) the association between Type D personality and impaired psychological status, and to explore whether this association is independent of disease severity; and 2) the association between Type D personality and an unhealthy lifestyle. METHODS: A sample of 268 Icelandic coronary angiography patients (74% males (N = 199); mean age 62.9 years (SD 10.5), range 28-85 years) completed the Type D Scale (DS14), Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS) at hospitalization. Health-related behaviors were assessed 4 months following angiography. Clinical data were collected from medical files. RESULTS: Type D personality was associated with an increased risk of anxiety (OR 2.97, 95% CI:1.55-5.69), depression (OR 4.01, 95% CI:1.42-11.29), and stress (OR 5.99, 95% CI:3.08-11.63), independent of demographic variables and disease severity. Furthermore, fish consumption was lower among Type Ds, as 21% of Type Ds versus 5% of non-Type Ds consumed fish < 1 a week (p < 0.001). Type D patients were also more likely to smoke at follow-up (22% versus 10%, p = 0.024) and to use antidepressants (17% versus 9%, p = 0.049) and sleeping pills (49% versus 33%, p = 0.019) compared to non-Type Ds. Type D personality was not associated with other health-related behaviors, aside from trends towards less fruit and vegetable consumption, and more weight gain. CONCLUSION: Type D personality was associated with psychological distress and an unhealthy lifestyle in Icelandic cardiac patients. Future studies should further investigate the association between Type D personality and health-related behaviors.

Validity of Type D personality in Iceland: association with disease severity and risk markers in cardiac patients.

Type D personality has been associated with poor prognosis in cardiac patients. This study investigated the validity of the Type D construct in Iceland and its association with disease severity and health-related risk markers in cardiac patients. A sample of 1,452 cardiac patients completed the Type D scale (DS14), and a subgroup of 161 patients completed measurements for the five-factor model of personality, emotional control, anxiety, depression, stress and lifestyle factors. The Icelandic DS14 had good psychometric properties and its construct validity was confirmed. Prevalence of Type D was 26-29%, and assessment of Type D personality was not confounded by severity of underlying coronary artery disease. Regarding risk markers, Type D patients reported more psychopharmacological medication use and smoking, but frequency of previous mental problems was similar across groups. Type D is a valid personality construct in Iceland, and is associated with health-related risk markers, but not cardiac disease severity.