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Cardiopulmonary exercise testing in heart failure risk assessment and prognosis 心肺运动试验在心力衰竭风险评估及预后中的应用
Q4 Psychology Pub Date : 2023-01-01 DOI: 10.4103/hm.hm_57_22
J. Laukkanen, S. Kunutsor
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引用次数: 0
Exercise and the brain in cardiovascular disease: A narrative review 心血管疾病中的运动和大脑:一个叙述性的回顾
Q4 Psychology Pub Date : 2023-01-01 DOI: 10.4103/hm.hm_50_22
Jenna L. Taylor
Patients with cardiovascular diseases (CVDs) (including heart failure) are at increased risk of cognitive impairment and dementia. Vascular risk factors contribute to cognitive decline through cerebral small vessel diseases, pathological brain changes, and hypoperfusion. Habitual exercise and increased cardiorespiratory fitness are associated with higher cognitive function, greater cerebral blood flow, and attenuation of the decline in gray matter volume and white matter integrity. Furthermore, moderate-vigorous exercise training has been shown to improve cognitive function in healthy middle-aged and older adults. Cardiac rehabilitation (CR) is a class 1A recommendation for patients with CVD, which involves exercise training and intensive risk factor modification. This article reviews the current evidence for the effect of exercise-based CR on cognitive function, cerebrovascular function, and brain structure in patients with CVDs. Overall, exercise-based CR appears to improve global cognitive function and attention-psychomotor functions but not language processes. Furthermore, the effect of exercise-based CR on executive function and memory is less clear and there is limited research into the effect of exercise-based CR on cerebrovascular function and brain structure.
心血管疾病(包括心力衰竭)患者发生认知障碍和痴呆的风险增加。血管危险因素通过脑小血管疾病、病理性脑改变和灌注不足导致认知能力下降。习惯性运动和增强的心肺健康与更高的认知功能、更大的脑血流量以及灰质体积和白质完整性下降的衰减有关。此外,中等强度的运动训练已被证明可以改善健康中老年人的认知功能。心脏康复(CR)是心血管疾病患者的1A级推荐,包括运动训练和强化危险因素改变。本文综述了目前关于基于运动的CR对心血管疾病患者认知功能、脑血管功能和脑结构影响的证据。总的来说,基于运动的CR似乎改善了整体认知功能和注意力-精神运动功能,但没有改善语言过程。此外,基于运动的CR对执行功能和记忆的影响尚不清楚,关于基于运动的CR对脑血管功能和大脑结构的影响的研究有限。
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引用次数: 3
The interaction between exercise and cardiovascular disease 运动和心血管疾病之间的相互作用
Q4 Psychology Pub Date : 2023-01-01 DOI: 10.4103/hm.hm_3_23
Steven Bailey
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引用次数: 0
Improving fitness through exercise will improve our heart and mind 通过锻炼来提高身体素质可以改善我们的身心
Q4 Psychology Pub Date : 2023-01-01 DOI: 10.4103/hm.hm_59_22
C. Lavie, Icey Zhang, Doris G. Yang, Meiyan Liu
In the interview, Prof. Carl “Chip” J. Lavie gave suggestions on daily exercise, shared impressive cases of cardiovascular disease (CVD) patients, gave professional explanations of weight management and CVD outcomes, etc. His major viewpoints are: (a) psychological stress is a major risk factor for CVDs, (b) a low-level physical activity contributes to a high prevalence of most CVD risk factors, and regular exercise training can improve cardiac function and aerobic performance, and (c) the prognosis and survival among CVD patients with low physical activity are better in the obese than the lean.
在采访中,Carl“Chip”J.Lavie教授就日常锻炼提出了建议,分享了令人印象深刻的心血管疾病(CVD)患者案例,对体重管理和CVD结果等进行了专业解释。他的主要观点是:(a)心理压力是心血管疾病的主要风险因素,(b)低体力活动导致大多数心血管疾病危险因素的高患病率,定期运动训练可以改善心脏功能和有氧运动能力,以及(c)肥胖者的预后和低体力活动的心血管疾病患者的生存率高于瘦者。
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引用次数: 1
Proposing an #EASIER cardiopulmonary rehabilitation protocol for coronavirus disease 2019 survivors 为2019年冠状病毒病幸存者提出#更容易心肺康复方案
Q4 Psychology Pub Date : 2023-01-01 DOI: 10.4103/hm.hm_28_22
Cássia da Luz Goulart, R. Silva, M. Oliveira, G. Back, Ross Arena, M. Faghy, A. Borghi-Silva
The economic and social impact that coronavirus disease 2019 (COVID-19) can bring is undeniable since high numbers of active workers in production and service provision are being contaminated. In addition, those infected may have long-term sequelae, impairing their functional capacity, and consequently, their work activities. It considers that intervention in cardiopulmonary rehabilitation is of great importance, especially in the recovery stage, and should be carried out mainly with the aim of improving dyspnea, severe muscle weakness, and fatigue, to promote functional independence, and increase quality of life. Based on the limitations demonstrated in COVID-19 survivors, we developed a protocol based on the acronym #EASIER, which is divided into six phases. Such a study will be able to early identify the impact of COVID-19 in different severities as well as provide subsidies to guide physiotherapists early, through the correct prescription of rehabilitative interventional measures.
2019冠状病毒病(新冠肺炎)可能带来的经济和社会影响是不可否认的,因为大量从事生产和服务的活跃工人正在受到污染。此外,感染者可能会有长期后遗症,损害他们的功能能力,从而损害他们的工作活动。它认为心肺康复的干预非常重要,尤其是在恢复阶段,应该主要以改善呼吸困难、严重肌无力和疲劳为目的,促进功能独立,提高生活质量。根据新冠肺炎幸存者的局限性,我们开发了一个基于首字母缩写#EASIER的协议,该协议分为六个阶段。这项研究将能够早期识别新冠肺炎在不同严重程度上的影响,并通过正确的康复干预措施处方,为理疗师提供早期指导补贴。
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引用次数: 0
The heart and brain connection: Contribution of cardiovascular disease to vascular depression – A narrative review 心脏和大脑的联系:心血管疾病对血管性抑郁的贡献——一篇叙述性综述
Q4 Psychology Pub Date : 2023-01-01 DOI: 10.4103/hm.hm-d-23-00016
Augusto Vicario, GustavoHernán Cerezo
The relationship between depression and cardiovascular disease (CVD) is bidirectional. Depression is a risk factor for developing CVD, and this, together with vascular risk factors (VascRFs), increases vulnerability to precipitate some types of geriatric depression (vascular depression). The particular semiology of depression of vascular origin (polymorphic), the symptoms of the comorbidities (vascular disease and/or risk factors), and those symptoms of old age constitute a challenge for clinical medicine. Although the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth/Fifth Edition do not differentiate between early-onset (young adult) and late-onset depression (older adult), the clinical expression of patients with depression of vascular origin presents its own characteristics as well as a poor response to treatment. Thus, cerebrovascular disease could be considered the link between VascRFs and the clinical expression of mood disorders (vascular depression), creating a challenge not only in its diagnosis but also in its treatment.
抑郁症与心血管疾病(CVD)之间的关系是双向的。抑郁症是发生心血管疾病的一个危险因素,它与血管危险因素(vascrf)一起,增加了某些类型的老年抑郁症(血管性抑郁症)的易感性。血管源性抑郁的特殊符号学(多态)、合并症的症状(血管疾病和/或危险因素)以及老年症状构成了临床医学的挑战。虽然《精神障碍诊断与统计手册》第四/第五版的诊断标准没有区分早发性(年轻人)和晚发性(老年人)抑郁症,但血管源性抑郁症患者的临床表现有其自身的特点,且对治疗反应较差。因此,脑血管疾病可以被认为是vascrf与情绪障碍(血管性抑郁症)临床表达之间的联系,这不仅对其诊断,而且对其治疗提出了挑战。
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引用次数: 0
Disparities in health-related quality of life among adults with ischemic heart disease, stroke, and both conditions: A cross-sectional study 缺血性心脏病、中风和两种情况的成年人健康相关生活质量的差异:一项横断面研究
Q4 Psychology Pub Date : 2023-01-01 DOI: 10.4103/hm.hm-d-23-00025
MollyM Jacobs, Elizabeth Evans, CharlesJr Ellis
Background: Notable disparities exist in ischemic heart disease (IHD) and stroke outcomes. Studies have identified several causal factors that contribute to these disparities, but few have assessed the disparate quality of life (QOL) among individuals living with IHD, stroke, or both. This study evaluated the impact of IHD, stroke, and both conditions on health-related QOL (HRQOL) and quantified existing disparities. Materials and Methods: Using the data from the 2021 National Health Interview Survey, we calculated the health and activities limitation index — a generic HRQOL measure comprising perceived health and activities limitations — for 29,482 adults. Adjusting for sex, age, income, education, urbanicity, marital status, household size, region of residence, and insurance status, the differences in HRQOL between racial and ethnic groups were estimated as well as racial/ethnic differences in the HRQOL of IHD, stroke, or both conditions. Results: Compared to those with neither condition, individuals with IHD (−0.214, Standard Error (SE)=0.015, stroke (−0.291, SE=0.028), and both (−0.438, SE=0.040) had 20% to 44% lower HRQOL. Blacks (−0.014, SE=0.004) and hispanics (−0.012, SE=0.003) had lower HRQOL compared to whites even after sample heterogeneity. Diagnosis with stroke (−0.182, SE=0.082), IHD (−0.137, SE=0.052), or both (−0.208, SE=0.126) lowered the HRQOL more for black individuals compared to white individuals, while other subgroups showed no statistically significant difference in HRQOL. In general, sex, age, and household composition showed little difference in adjusted HRQOL. Conclusion: While IHD and stroke are independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL, particularly among minoritized racial groups.
背景:缺血性心脏病(IHD)和脑卒中预后存在显著差异。研究已经确定了导致这些差异的几个原因,但很少有研究评估患有IHD、中风或两者兼而有之的个体的不同生活质量(QOL)。本研究评估了IHD、卒中以及这两种疾病对健康相关生活质量(HRQOL)的影响,并量化了存在的差异。材料和方法:使用2021年全国健康访谈调查的数据,我们计算了29,482名成年人的健康和活动限制指数——一种包括感知健康和活动限制的通用HRQOL指标。调整性别、年龄、收入、教育程度、城市化程度、婚姻状况、家庭规模、居住地区和保险状况等因素后,估计不同种族和民族之间的HRQOL差异,以及IHD、中风或两种情况下HRQOL的种族/民族差异。结果:与无上述两种疾病的患者相比,IHD(- 0.214,标准误差(SE)=0.015)、卒中(- 0.291,SE=0.028)和两者(- 0.438,SE=0.040)患者的HRQOL降低20% ~ 44%。即使在样本异质性后,黑人(- 0.014,SE=0.004)和西班牙裔(- 0.012,SE=0.003)的HRQOL也低于白人。与白人相比,被诊断为中风(- 0.182,SE=0.082)、IHD (- 0.137, SE=0.052)或两者(- 0.208,SE=0.126)的黑人患者的HRQOL更低,而其他亚组患者的HRQOL差异无统计学意义。总体而言,性别、年龄和家庭构成对调整后的HRQOL差异不大。结论:虽然IHD和卒中单独与较低的HRQOL相关,但它们的共存对HRQOL有显著的负面影响,特别是在少数民族人群中。
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引用次数: 0
Existential suffering, futility, and the mental stress of moral distress in health care 存在的痛苦、徒劳与医疗道德困境的心理压力
Q4 Psychology Pub Date : 2022-10-01 DOI: 10.4103/hm.hm_30_22
Philip Crowell
This article explores the relationship of existential suffering and moral distress by examining life-threatening medical situations and the distress on persons engaged in medical ethics decision-making. The aim and focus are to articulate how existential suffering experienced by the patient and family generates moral distress in the health-care team as they perceive ongoing treatments as futile. Suffering and existential suffering pose a challenge ethically and therapeutically on a number of levels, first in terms of determining what a patient wants to be addressed or what a substitute decision-maker needs to consider in fulfilling the best interests of the patient who is suffering. Second, when there are unrelenting and intolerable sufferings, a difficult medical assessment is sometimes made that any further treatments are “futile,” which leads to conflict with the family and moral distress for the medical team. Moral distress and mental stress have physiological, psychological, social/behavioral, and existential-spiritual dimensions. Existential suffering consists of a constellation of factors, not only severe pain but also the inclusion of harms from the illness, which are irreversible, irremediable, and unrelenting, adding to the total suffering. This article argues that the existential suffering of the patient and family has a special moral status that significantly and legitimately guides decisions at the end of life, and addressing the existential suffering of the patient/family can relieve levels of moral distress for the health-care team.
本文通过考察危及生命的医疗状况和参与医学伦理决策的人的痛苦,探讨了生存痛苦与道德痛苦的关系。其目的和重点是阐明患者和家人所经历的生存痛苦如何在医疗团队中产生道德痛苦,因为他们认为正在进行的治疗是徒劳的。痛苦和生存痛苦在多个层面上构成了伦理和治疗上的挑战,首先是确定患者想要解决什么问题,或者替代决策者在实现痛苦患者的最大利益时需要考虑什么。第二,当有无情和无法忍受的痛苦时,有时会做出艰难的医学评估,认为任何进一步的治疗都是“徒劳的”,这会导致与家人的冲突和医疗团队的道德痛苦。道德困境和精神压力具有生理、心理、社会/行为和存在的精神维度。存在的痛苦由一系列因素组成,不仅是剧烈的疼痛,还包括疾病带来的伤害,这些伤害是不可逆转的、无法治愈的、无情的,增加了总的痛苦。本文认为,患者和家人的生存痛苦具有特殊的道德地位,它在生命结束时对决策有着重要而合法的指导作用,解决患者/家人的生存苦难可以缓解医疗团队的道德痛苦。
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引用次数: 0
Stressors and cardiovascular disease 压力源和心血管疾病
Q4 Psychology Pub Date : 2022-10-01 DOI: 10.4103/hm.hm_56_22
I. Laher
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引用次数: 0
Medical maximizing-minimizing preferences and health beliefs associated with emergency department patients' intentions to take a cardiac stress test after receiving information about testing 医疗最大化-最小化偏好和健康信念与急诊科患者在收到测试信息后接受心脏负荷测试的意图相关
Q4 Psychology Pub Date : 2022-10-01 DOI: 10.4103/hm.hm_48_21
Andrew J. Foy, A. Bucher, L. V. Van Scoy, Laura D. Scherer
Purpose: The Medical Maximizer-Minimizer Scale (MMS) has been validated to predict preferences for health-care service use on hypothetical vignettes in nonclinical cohorts. Using mixed methods, we sought to determine whether it would predict preferences for cardiac stress testing in a cohort of emergency department (ED) patients with low-risk chest pain within the context of the Health Belief Model (HBM). Design: Patients who met the definition for low-risk chest pain and who were eligible to take a cardiac stress test before being discharged from the hospital were recruited to participate. Each participant provided demographic information and completed the MMS-10 paper-and-pencil scale. They then watched a 7-min informational video on an iPad tablet that provided information about the condition of “low-risk chest pain” and the probabilities of results and outcomes following a cardiac stress test. After the video, participants answered a one-question survey on their intention-to-take (ITT) a cardiac stress test or not and were then interviewed about factors that influenced their decision-making. Interviews were interpreted using a HBM lens. Results: Sixty participants were enrolled in the study who were between the ages of 29 and 80 years with a mean age of 53 (± 10.8); 58% were women and 90% were white. The mean MMS score was 4.6 (± 0.8) and ranged from 2.6 to 6.8. Minimizers accounted for 25% (n = 15) of the cohort while maximizers accounted for 75% (n = 45). MMS scores followed a normal distribution and were found to be mildly correlated with ITT scores (r = 0.25; P = 0.051). The mean ITT scores for individuals with MMS scores in the 1st and 4th quartiles were 3.9 ± 2.2 and 5.9 ± 1.7, respectively. After watching the informational video, individuals' perceptions related to the: (1) low threat posed by the condition, (2) low utility (low benefits + significant barriers) of taking a cardiac stress test, and (3) high benefits of taking a cardiac stress test were all strongly associated with ITT scores in a directional manner. No direct connection was found between minimizer-maximizer preferences and health beliefs after watching the informational video. This may have been due to sample size and underrepresentation of minimizers in the cohort. Conclusions: MMS and health beliefs predicted preferences for cardiac stress testing in ED patients with low-risk chest pain after viewing an informational video on the topic. However, we did not find direct evidence that the relationship between MMS and decision-making is mediated through the formation of perceptions of threat and utility consistent with the HBM. More research is needed to establish this connection and understand how framing of information in the health-care space may interact with stable personality traits to influence decision-making.
目的:医学最大化-最小化量表(MMS)已被验证用于预测非临床队列中假设小插曲对医疗服务使用的偏好。使用混合方法,我们试图确定它是否能在健康信念模型(HBM)的背景下预测急诊科(ED)低风险胸痛患者的心脏压力测试偏好。设计:招募符合低风险胸痛定义并有资格在出院前进行心脏压力测试的患者参加。每个参与者都提供了人口统计信息,并完成了MMS-10纸笔量表。然后,他们在iPad平板电脑上观看了一段7分钟的信息视频,视频提供了关于“低风险胸痛”的情况以及心脏压力测试后结果和结果的概率。视频结束后,参与者回答了一个关于他们是否打算进行心脏压力测试(ITT)的一个问题调查,然后就影响他们决策的因素进行了采访。访谈采用HBM镜头进行解读。结果:60名参与者年龄在29岁至80岁之间,平均年龄为53岁(±10.8);58%为女性,90%为白人。平均MMS评分为4.6(±0.8),范围为2.6至6.8。最小化者占队列的25%(n=15),而最大化者占75%(n=45)。MMS得分呈正态分布,与ITT得分轻度相关(r=0.25;P=0.051)。MMS得分在第一和第四分位数的个体的平均ITT得分分别为3.9±2.2和5.9±1.7。在观看了信息视频后,个体对以下方面的感知:(1)疾病造成的低威胁,(2)进行心脏压力测试的低效用(低益处+显著障碍),以及(3)进行心脏应激测试的高益处,都与ITT分数有方向性强相关。在观看信息视频后,未发现最小化者-最大化者偏好与健康信念之间存在直接联系。这可能是由于样本量和队列中最小者的代表性不足。结论:MMS和健康信念预测了低风险胸痛ED患者在观看该主题的信息视频后对心脏压力测试的偏好。然而,我们没有发现直接证据表明MMS和决策之间的关系是通过形成与HBM一致的威胁和效用感知来调节的。需要更多的研究来建立这种联系,并了解医疗保健空间中的信息框架如何与稳定的人格特征相互作用,从而影响决策。
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引用次数: 0
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Heart and Mind
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