ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveBoth the startle reflex elicited by an intense acoustic or tactile stimulus and the perceived intensity of that stimulus can be diminished by a weak “prepulse” that precedes the startling stimulus. The present study examined whether prepulses can also diminish the pain produced by an intense electrical stimulus similar to that used to treat life-threatening cardiac arrhythmias in conscious patients with implantable cardioverter/defibrillators or transcutaneous pacemakers.MethodsPerceptual and pain thresholds for electrical shocks to the arm were determined in 20 adults. Participants then rated the painfulness of 25 electrical shocks that were 1.5 times the pain threshold (mean shock intensity, ≈160 V) and either presented alone or preceded (at 40–60 ms) by weak electrical prepulses equal to or 25% above the perceptual threshold.ResultsPrepulses significantly reduced the pain produced by the intense shocks. Individuals with the lowest pain thresholds experienced the greatest pain reduction with prepulses. In these more sensitive individuals, the most effective prepulses reduced perceived pain by 26% across the entire test session and by 54% in the initial block of five shocks.ConclusionsPrepulses may be useful in diminishing the pain associated with the therapeutic electrical shocks used to treat cardiac arrhythmias.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveWe investigated associations between atherosclerosis risk factors (smoking behavior, serum cholesterol, hypertension, body mass index, and functional capacity) and psychological characteristics with suspected linkages to coronary disease (depression, hostility, and anger expression) in an exclusively female cohort.MethodsSix hundred eighty-eight middle-aged women with chest pain warranting clinical investigation completed a comprehensive diagnostic protocol that included quantitative coronary angiography to assess coronary artery disease (CAD). Primary analyses controlled for menopausal status, age, and socioeconomic status variables (income and education).ResultsHigh depression scores were associated with a nearly three-fold risk of smoking (odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.4–5.7) after covariate adjustment, and women reporting higher depression symptoms were approximately four times more likely to describe themselves in the lowest category of functional capacity (OR = 3.7, 95% CI = 1.7–7.8). High anger-out scores were associated with a four-fold or greater risk of low high-density lipoprotein cholesterol concentration (<50 mg/dl; OR = 4.0, 95% CI = 1.4–11.1) and high low-density lipoprotein cholesterol concentration (>160 mg/dl; OR = 4.8, 95% CI = 1.5–15.7) and a larger body mass index (OR = 3.5, 95% CI = 1.1–10.8) after covariate adjustment.ConclusionsThese results demonstrate consistent and clinically relevant relationships between psychosocial factors and atherosclerosis risk factors among women and may aid our understanding of the increased mortality risk among women reporting high levels of psychological distress.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveBecause cardiac transplantation entails neuronal decentralization, cardiac responses to a psychological stressor in transplant patients would be expected to rely on circulating hormonal factors and therefore to be delayed and prolonged. We tested this prediction by comparing stress responses after transplantation with those in patients with coronary artery bypass grafts (to control for experience of surgery) or heart failure (to control for heart disease).MethodsFifty-six transplantation patients, 66 bypass patients, and 40 patients with heart failure underwent a 10-minute, computer-generated, Stroop color-word conflict test. Heart rate and systolic and diastolic blood pressures were recorded continuously for 1 minute before, during, and 12 minutes after the stressor. Emotional state was measured periodically by questionnaires.ResultsAll hemodynamic variables were increased by the Stroop test. There was a pattern of blunted response to the Stroop test after cardiac transplantation, particularly in comparison with bypass patients, and slower recovery in comparison with both control groups. Emotional stress responses were similar in each group.ConclusionsThis pattern cannot be attributed to the experience of major heart surgery or to cardiac disease. Nor can it be explained by differences in central processing of stress. Correspondingly the changed hemodynamic response to the Stroop test after cardiac transplantation evidently does not affect patients’ emotional responses. The hemodynamic findings are consistent with an increased reliance on hormonal rather than neuronal hemodynamic regulation after cardiac transplantation.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to evaluate the impact of indices of central nervous system (CNS) serotonin function on cardiovascular reactivity to mental stress.MethodsLumbar puncture was performed on 54 healthy volunteers to obtain cerebrospinal fluid (CSF) for determination of 5-hydroxyindoleacetic acid (5HIAA) levels. Genotypes were determined with respect to a functional polymorphism of the serotonin transporter gene promoter region (5HTTLPR). Subjects then underwent mental stress testing.ResultsPersons with one or two long (l) 5HTTLPR alleles had CSF levels of the major serotonin metabolite, 5HIAA, that were 50% higher than those of persons with thes/s5HTTLPR genotype. Persons with one or twolalleles or higher CSF 5HIAA levels also exhibited greater blood pressure and heart rate responses to a mental stress protocol.ConclusionsThese findings suggest the 5HTTLPR polymorphism affects CNS serotonin function, and they are consistent with the general hypothesis that CNS serotonin function is involved in the regulation of potentially health-damaging biobehavioral characteristics. In particular, thelallele could contribute, through its association with increased cardiovascular reactivity to stress, to increased risk of cardiovascular disease.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThis study assessed the relation of stressful life events with survival after breast cancer.MethodsThis study was based on women with histologically confirmed, newly diagnosed, localized or regional stage breast cancer first treated in 1 of 11 Quebec City (Canada) hospitals from 1982 through 1984. Among 765 eligible patients, 673 (88%) were interviewed 3 to 6 months after diagnosis about the number and perceived impact of stressful events in the 5 years before diagnosis. Three scores were calculated: number of events; number weighted by reported impact; and for almost 80% of events, number weighted by community-derived values reflecting adjustment required by the event. Scores were divided into quartiles to assess possible dose-response relationships. Survival was assessed in 1993. Hazard ratios and 95% confidence intervals (CIs) comparing all-cause and breast cancer–specific mortality were calculated with adjustment for age, presence of invaded axillary nodes, adjuvant radiotherapy, and systemic therapy (ie, chemotherapy and hormone therapy).ResultsWhen quartiles 2, 3, and 4 were compared with the appropriate lowest quartile, adjusted hazard ratios for all-cause mortality were 0.99 (CI = 0.70–1.38), 0.97 (CI = 0.73–1.31), and 1.04 (CI = 0.78–1.40) for number, number weighted by impact, and number weighted by community-derived values, respectively. Results were essentially similar for the relation between stressful life events limited to those occurring within the 12 months before diagnosis and overall mortality and between stressful life events in the 5 years before diagnosis and breast cancer–specific mortality.ConclusionsStress was conceptualized as life events presumed to be negative, undesirable, or to require adjustment by the person confronting them. We found no evidence indicating that this kind of stress during the 5 years before diagnosis negatively affected survival among women with nonmetastatic breast cancer. Evidence from this study and others on the lack of effect of this type of stress on survival may be reassuring for women living with breast cancer.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveAlthough numerous studies have independently examined ethnic differences in clinical and experimental pain, few have investigated differences in both sensitivity to controlled noxious stimuli and clinical pain reports in the same sample. The present experiment examined the effects of ethnicity (African American vs. white) on experimental pain tolerance and adjustment to chronic pain.MethodsThree hundred thirty-seven (68 African American and 269 white) patients with chronic pain referred to a multidisciplinary treatment center participated in the study. In addition to completing a number of standardized questionnaires assessing adjustment to chronic pain, participants underwent a submaximal effort tourniquet procedure. This experimental pain procedure yields a measure of tolerance for a controlled noxious stimulus (ie, arm ischemia).ResultsAfrican American subjects reported higher levels of clinical pain as well as greater pain-related disability than white participants. In addition, substantial group differences were observed for ischemic pain tolerance, with African Americans demonstrating less tolerance than whites. Correlational analyses revealed a small but significant inverse relationship between ischemic pain tolerance and the reported severity of chronic pain.ConclusionsCollectively these findings support previous research revealing ethnic differences in responses to both clinical and experimental pain. Moreover, the present results suggest that enhanced sensitivity to noxious stimuli on the part of African Americans may be associated with ethnic differences in reported clinical pain, although the magnitude of ethnic differences was much greater for ischemic pain tolerance than for clinical pain measures.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID