摘要:

ObjectiveThis study examined the associations of social support from coworkers and supervisors to workday ambulatory blood pressure and heart rate. Specifically, analyses examined the association of work-related social support to the following measures: 1) baseline blood pressure and heart rate at the start of the workday, 2) blood pressure and heart rate during high stress periods, 3) blood pressure and heart rate levels throughout the workday.MethodsParticipants included male (N= 36) and female (N= 34) New York City Traffic Enforcement Agents. Mixed-model regression analyses were used to assess the effects of self-reported measures of workplace social support on workday ambulatory blood pressure.ResultsWorkplace support was associated with workday ambulatory blood pressure levels, with the effects depending on the source of support and the gender of the participant. For women, immediate supervisor support was negatively associated with workday systolic blood pressure level, and a similar negative trend was found for workday diastolic blood pressure level. For men, coworker support was negatively associated with workday systolic blood pressure level. We found an interaction of social support with stress level (ie, baseline vs. high stress) such that immediate supervisor support was negatively associated with systolic blood pressure during high-stress conditions, but no effects were found under resting conditions.ConclusionsThese findings suggest that workplace social support is associated with workday ambulatory blood pressure, especially during stressful work periods.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesClinical depression is a risk factor for cardiac mortality in patients with coronary heart disease. High QT interval variability is a risk factor for arrhythmic events, including sudden cardiac death. The purpose of this study was to determine whether depression is associated with increased QT variability in patients recovering from myocardial infarction.MethodsTwenty patients with major depression recovering from a recent myocardial infarction were matched with 20 nondepressed post–myocardial infarction patients on age and sex, and all underwent 24-hour Holter monitoring.ResultsThere were no differences between groups on average heart rate, heart rate variability, or other electrocardiographic measures. However, the QT interval showed significantly greater variability in the depressed than in the nondepressed group, especially at midnight and at 6:00 AM.ConclusionsDepressed post–myocardial infarction patients may be at greater risk for sudden cardiac death as a result of abnormalities in ventricular repolarization. More work is needed to determine the clinical and prognostic significance of QT variability in these patients.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThere is a convincing body of evidence linking depression, cardiovascular disease, and mortality. There is also growing evidence that depression is a risk factor for congestive heart failure (CHF) and that CHF patients with major depression have higher rates of mortality and repeat hospitalizations. Currently there are no proposed neurobiological or neuroimmune mechanisms for the comorbidity of heart failure and depression.MethodsThis review focuses on the recent literature about the role of cytokines in CHF and depression as separate conditions. This review also attempts to identify the overlapping immunological mechanisms that have a potential for future research in the pathophysiology of comorbid depression and CHF.ResultsResults of current studies suggest that cytokines exert deleterious effects on the heart and that soluble tumor necrosis factor (TNF) receptor 2 leads to reversal of the cardiotoxic effects of TNF, although the clinical significance of this is unclear. Major depression has been associated with alteration of various aspects of the innate immune system, including cellular components (such as microphages, neutrophils, and natural killer cells) and soluble mediators (such as acute-phase reaction proteins and cytokines). It is inconclusive whether antidepressants have immunoregulatory effects.ConclusionsThe literature has not yet addressed the role of cytokines in comorbid depression and CHF. But cytokines may provide a new avenue in understanding brain-body interaction in depression and heart failure.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveInfections with herpes viruses have been implicated in the pathogenesis of atherosclerosis. We tested the hypothesis that vital exhaustion (VE) is associated with multiple herpesvirus infections, such as herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus, and with an increase in pathogen burden (ie, the aggregated seropositivity to immunoglobulin G antibodies for herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus). In addition, we examined the association of VE and pathogen burden with measures of hemostasis and inflammation.MethodsBlood samples were drawn from 29 men with VE and 30 male control subjects, all healthy and nonsmokers, to assess serological evidence of infection and measures of hemostasis and inflammation.ResultsVE is associated with a relatively high pathogen burden, altered hemostasis, and higher levels of cytokines, such as interleukin-6. Across all subjects, a relatively high pathogen burden was also associated with altered hemostasis but not with increased cytokine levels. The interaction of VE with pathogen burden revealed significant linear increases in measures of hemostasis and inflammation. Finally, immunoglobulin G antibody titer levels of individual herpesvirus infections were not associated with hemostatic measures or with cytokines.ConclusionsWe conclude that stress-related alterations in hemostasis and inflammation are not necessarily linked to one particular herpesvirus infection but rather to an increase in aggregated seropositivity to herpesvirus infections.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThe objectives of this study were to systematically review the recent studies of the contribution of depression to the onset of coronary disease and to estimate the magnitude of the risk posed by depression for onset of coronary disease.MethodWe searched MEDLINE (1966–2000), PsychInfo (1967–2000), and cross references and conducted informal searches for all community studies of depression symptoms in samples with no clinically apparent heart disease at baseline. From these studies we selected all published cohort studies of 4 years or more follow-up that controlled for other major coronary disease risk factors and reported relative risks (or a comparable measure) of baseline depression for the onset of coronary disease. Following methods for the meta-analysis of epidemiologic studies, we used a random-effects model to estimate the combined overall relative risk.ResultsTen studies met our inclusion criteria. Relative risks ranged from 0.98 to 3.5. Nine studies reported significantly increased risk, including two with mixed results; one study reported no increased risk. The combined overall relative risk of depression for the onset of coronary disease was 1.64 (95% CI = 1.41–1.90).ConclusionsThis quantitative review suggests that depressive symptoms contribute a significant independent risk for the onset of coronary disease, a risk (1.64) that is greater than the risk conferred by passive smoking (1.25) but less than the risk conferred by active smoking (2.5). Future prospective community studies should examine the effect of severity and duration of depressive symptoms and disorders on the risk for the onset of coronary disease.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThe goal of this study was to investigate whether clinical insomnia is associated with immune alterations by comparing immune functioning between patients with chronic insomnia and good sleepers.MethodsThe good sleepers group was composed of 19 adults with a regular sleep schedule and no complaint of sleep disturbances. The insomnia group was composed of 17 adults meeting criteria for a chronic primary insomnia disorder. Peripheral blood samples were taken at the interview (time 1) and before the second night of polysomnographic assessment (time 2) for immune measures, including enumeration of blood cell counts (ie, white blood cells, monocytes, lymphocytes, and CD3+, CD4+, CD8+, and CD16+/CD56+ cells), natural killer cell activity, and cytokine production (ie, interleukin-1&bgr;, interleukin-2, and interferon gamma).ResultsSignificant between-group differences were observed for CD3+, CD4+, and CD8+ cells, with higher levels found in good sleepers. In addition, a significant group-by-time interaction was found on monocyte counts. Although this was the only significant interaction effect observed, between-group differences were greater at time 2.ConclusionsThis study suggests that chronic insomnia is associated with some immune alterations. More research is needed to determine the clinical significance of these findings.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveWe studied whether repetitive intracardiac shock discharges of implantable cardioverter defibrillators (ICDs) provoke an enduring enhancement of startle responses.MethodsThe study population comprised 134 patients with an ICD. Among those, 67 patients had experienced shock delivery. Thirty-five patients had received five or more shocks. We used the startle reflex paradigm, which consisted of 15 acoustic stimuli (95 dB, 1000 Hz, 500 ms duration). Skin conductance response was measured using a constant 0.5 V through 8-mm electrodes placed on each subject’s nondominant palm. Response magnitude was calculated by subtracting the baseline response level of the 2 seconds immediately preceding tone onset from the maximum response level within 1 to 4 seconds after tone onset. The left orbicularis oculi electromyogram (EMG) response was calculated by subtracting the mean EMG level during the 2 seconds immediately preceding tone onset from the highest EMG level measured within 40 to 200 ms after tone onset. Habituation was defined by the response slope of the regression equation and by the number of trials required to reach the nonresponse criterion.ResultsAlthough EMG response measures of magnitude and habituation failed to yield differences between study groups, patients who had experienced five or more ICD shocks exhibited a significantly larger skin conductance response magnitude in comparison to the patients who had experienced fewer than five shocks (median, interquartile range: 0.364, 0.209–0.618 vs. 0.512, 0.375–0.791; Mann-WhitneyUtest,p= .007). Poorer habituation in the group with five or more shocks in comparison with the low shock group was confirmed both by the number of trials needed to reach the nonresponse criterion (median, interquartile range: 10, 5–14 vs. 5, 2–13;p= .003) and by the response slope (median, interquartile range: 0.209, 0.116–0.274 vs. 0.262, 0.181–0.332;p= .008). After controlling for potential confounding factors (age, anxiety, aversiveness of stimuli, time since last shock experience, and use of &bgr;-adrenoceptor antagonists), intracardiac shock discharges had the strongest impact on augmented skin conductance response magnitude (adjusted odds ratio = 3.0, 95% confidence interval = 1.3–7.2,p= .01) and impaired habituation (adjusted odds ratio = 2.8, 95% confidence interval = 1.2–6.3;p= .015).ConclusionsIntracardiac shock discharges are associated with augmented skin conductance responses and slower habituation, indicating sustained sympathetic arousability, which is presumably centrally mediated.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveDepression has been reported to increase cardiac event rates and functional impairment in patients with coronary disease. This article describes the impact of depression on subsequent healthcare utilization for such patients.MethodsOne hundred ninety-eight health maintenance organization patients with stable coronary disease were interviewed after elective angiography using a structured psychiatric diagnostic scale. Cardiac events, hospitalizations, procedures, and costs were monitored for the next 5 years through automated data. Subjects were classified at the time of angiography by modified DSM-IV criteria into those with major, minor, and no depression.ResultsIn univariate analyses, the no depression group (N= 136) was most likely to receive coronary artery bypass grafting (CABG) (61% vs. 36% in the major depression group vs. 27% in the minor depression group,p= .001), and the major depression group (N= 25) was most likely to receive percutaneous transluminal coronary angioplasty (PTCA) (44% vs. 14% in the minor depression group vs. 24% in the no depression group). The minor depression group (N= 37) was least likely to be hospitalized for cardiac reasons during follow-up (54% vs. 80% in the major depression group vs. 80% in the no depression group,p= .005). Five-year rates of myocardial infarction and death did not differ significantly between groups. Proportional hazard models showed that those in the depression groups differed in time from catheterization to CABG (&khgr;2(2) = 11.9,p= .003) and time to PCTA (&khgr;2(2) = 7.74,p= .02) after controlling for relevant covariates. Median regression showed that patients with no depression had higher costs during the first year but tended to have lower costs in years 2 through 5 than patients with minor or major depression.ConclusionsDepression status at angiography is associated with the need for revascularization and total healthcare costs for the following year.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveIn our prior (first) study, suicide attempts were associated with the menses. The main hypothesis of this replication (second) study is that the proportion of suicide attempters during the menses is significantly higher than the expected probability in the general population.MethodsUsing the same methodology and setting, this replication naturalistic study included 120 fertile female suicide attempters with regular menstrual cycles during a 1-year period in the emergency room of a general hospital in Madrid, Spain, serving a catchment area of 500,000 people.ResultsThe significant increase in probability of attempting suicide during the menses for the first study was 1.61; for the second study, 1.72; and for both studies combined, 1.68 (95% confidence interval, 1.27–2.09). Thus, using the combined results, the probability of attempting suicide during the menses was 1.68 times higher than the overall probability of attempting suicide for any fertile women. In the catchment area, the population rate of fertile women arriving at the hospital after a suicide attempt was 166 per 100,000. The probability for women during the menses arriving at the hospital after a suicide attempt was significantly higher, 279 per 100,000 (1.68 × 166 per 100,000). The 95% confidence interval was 211 to 347 per 100,000.ConclusionsDespite inherent limitations, this naturalistic study replicates a small but significant increase of suicide attempts during the menses.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID