Search

Objective The aim of this study was to examine the concurrent effects of vital exhaustion and depression on the development of cardiovascular disease (CVD) morbidity. Method The sample of this representative, 4-year longitudinal study comprised 2,725 participants (43.56% male, Mage = 58.39 years, SDage = 14.39 years). Individuals being treated for hypertension (n = 277) and cardio- and/or cerebrovascular incidents (n = 131) for the first time during the follow-up period were compared with participants never treated for CVD (n = 2,317). Joint principal component analysis was conducted on the items of the vital exhaustion (shortened Maastricht Questionnaire) and depression (shortened Beck Depression Inventory) measures simultaneously resulting in 3 components representing depression, vital exhaustion, and sleep difficulties. The role of these 3 components in predicting the incidence of CVD morbidity was examined using logistic regression-controlling for traditional risk factors such as sex, age, education, body mass index, smoking, alcohol use, and physical inactivity. Results In the multivariate analyses, vital exhaustion (OR = 1.20, CI = 1.03-1.39, p = .021) and sleep-related problem (OR = 1.16, CI = 1.00-1.33, p = .044) scores proved to be independent predictors of treatment initiation for hypertension, while sleep-related difficulties predicted CVD event incidence (OR = 1.27, CI = 1.06-1.52, p = .009). However, depressive symptomatology factor scores were not associated with either cardiovascular outcome in the regression analyses. Conclusions Vital exhaustion and depressive symptomatology showed a different pattern in their relationship with CVD incidence, with vital exhaustion being the more robust predictor. These results suggest that the 2 constructs are not identical and that vital exhaustion deserves consideration when planning and implementing interventions to reduce CVD risk. (PsycINFO Database Record

Follow-up after curative treatment for breast cancer consists of frequent outpatient clinic visits, scheduled at regular intervals. Its aim is primarily to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support. The cost-effectiveness of these frequent visits is being questioned however, leading to a search for less intensive follow-up strategies, such as follow-up by the general practitioner, patient-initiated or nurse-led follow-up or contact by telephone. These strategies are generally considered to be safe, but they are not yet widely accepted in clinical practice. Since brief interventions based on self-education and information have been shown to be able to improve quality of life, we hypothesise that these interventions may lead to a better acceptance of reduced follow-up by both patients and professionals.

Objective The effects of a short intervention on behavioral risk factor modification in patients with coronary artery disease (CAD) on Type A behavior, vital exhaustion, and depression were studied in a randomized controlled trial. Methods Acute myocardial infarction patients or patients who underwent coronary artery bypass grafting (CABG) were randomly assigned to an 8-week multiple risk modification group program ( n =94) or to a control group ( n =90) that received usual care with standard physical exercise training. Patients were assessed before intervention, directly after intervention, and at 9-month follow-up. Results The intervention was effective in reducing hostility and total Type A behavior at postintervention ( P =.01) and at 9-month follow-up ( P =.03). The intervention had no overall impact on vital exhaustion and depression, measured by the Beck Depression Inventory (BDI), whereas we unexpectedly found that the percentage of patients with major depression was reduced in the control group but not in the intervention group. Conclusion The results indicate that a short behavioral intervention for coronary patients can result in relatively large and persistent reductions in cognitive aspects of Type A behavior and hostility, in particular. In view of the unwanted findings on the diagnosis of depression, however, we do not unequivocally advise the intervention to the general population of AMI and CABG patients.

Background Recently, a considerable amount of evidence suggested that anxiety, depression and other psychosocial variables might influence the outcomes of cardiac surgery. This study investigated the relationship between length of stay at the intensive care unit (ICU) and hospital after surgery and different psychosocial variables (e.g. depression, anxiety, self rated health, happiness, satisfaction). Methods We enrolled prospective patients who were waiting for elective cardiac surgery (N = 267) and consented to take part in the study. We collected data of sociodemographic, medical and perioperative factors as well as psychosocial questionnaires completed 1.56 days (standard deviation [SD] = 0.7) before surgery. The primary clinical endpoint was an ICU stay of at least 3 days and the secondary was hospital stay of at least 10 days. Results Two hundred sixty-seven patients participated in this study. Four patients (1.5%) died in the hospital and 38 patients (14.5%) spent more than 3 days in the ICU and 62 patients (23.2%) spent more than 10 days in the hospital. After controlling for medical and sociodemographic factors, lower self rated health (Adjusted Odds Ratio [AOR]: 0.51, 95% confidence interval [CI]: 0.28-0.95; p = 0.03), lower rate of happiness (AOR: 0.76, 95% CI: 0.59-0.97, p = 0.03), postoperative cardiac failure (AOR: 7.09, 95% CI:1.21-41.54; p = 0.03) and postoperative complications (AOR: 9.52, 95% CI: 3.76-24.11; p

Coronary heart disease (CHD) is still the main cause of death in developed countries. Because of improved treatment, many patients survive the acute phase of a myocardial infarction, which makes secondary prevention of CHD of major importance. Most risk factors responsible for the development and progression of CHD are associated with behavior. Therefore, interventions aimed at behavior change may contribute to risk factor modification and secondary prevention of CHD. The effects of separate risk factor modification efforts by means of randomized, controlled clinical trials of nonpharmacological interventions in patients suffering from CHD are reviewed. Interventions aimed at healthy lifestyles may stimulate smoking cessation rates, reduce elevated serum total and low-density lipoprotein (LDL)-cholesterol concentrations, and favorably modify type A behavior in CHD patients. Moreover, reduction of coronary atherosclerosis has been reported after intensive lifestyle and exercise interventions, whereas exercise and type A interventions may also lead to reduced CHD morbidity and mortality. As for hypertension and obesity, studies aimed at secondary prevention are lacking.

This study concerns the prevalence of current and lifetime Posttraumatic Stress Disorder (PTSD) in various groups of officially recognized Veterans of the Dutch civilian Resistance against the Nazi occupation during World War II. In total, 1046 Resistance veterans living in The Netherlands and 52 who emmigrated to the United States after the war were examined. Between four and five decades after the end of WW 11, between 25 and 50% were suffering from current PTSD. The life-time prevalence is estimated to be substantially higher. The course of PTSD proved highly variable. There had often been a delay of several decades between the end of the war and reoccurrence or first onset of posttraumatic symptoms. The prevalence of PTSD in Resistance veterans who emigrated to the United States was hardly different from that of the veterans still living in The Netherlands.

The extraordinary trauma experienced by Resistance veterans from World War II (WW II) and other veterans may be associated with an increased incidence of posttraumatic stress disorder (PTSD) and somatic morbidity, including cardiovascular disease (CVD). This study explored some relationships between current PTSD and CVD risk factors in 147 male Dutch WW II Resistance veterans. They were compared to 65 same-aged male patients with a recent myocardial infarction and 79 surgical patients. Of these subjects, WW II Resistance veterans scored highest on CVD risk factors (i.e., angina pectoris, type A behavior, life stressors, and vital exhaustion), except smoking. Fifty-six percent of these veterans were currently suffering from PTSD. They reported CVD risk factors, in particular type A behavior and vital exhaustion, more often than veterans without PTSD; they also reported more premorbid adverse living conditions. These data suggest that early sensitization to environmental stressors may be associated with a high prevalence of current PTSD and excess CVD risk factors in subjects exposed to extraordinary war-time trauma and that this may lead to vital exhaustion.

Background After curative treatment for breast cancer women frequently attend scheduled follow-up examinations. Usually the follow-up is most frequent in the first 2–3 years (2–4 times a year); thereafter the frequency is reduced to once a year in most countries. Its main aim is to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support. However, the cost-effectiveness of these frequent visits is under much debate, leading to a search for less intensive and more cost-effective follow-up strategies. In this paper the design of the MaCare trial is described. This trial compares the cost-effectiveness of four follow-up strategies for curatively treated breast cancer patients. We investigate the costs and effects of nurse-led telephone follow-up and a short educational group programme. Methods/design The MaCare trial is a multi centre randomised clinical trial in which 320 breast cancer patients are randomised into four follow-up strategies, focussed on the first 18 months after treatment: 1) standard follow-up; 2) nurse-led telephone follow-up; 3) arm 1 with the educational group programme; 4) arm 2 with the educational group programme. Data is collected at baseline and 3, 6, 12 and 18 months after treatment. The primary endpoint of the trial is cancer-specific quality of life as measured by the global health/QoL scale of the EORTC QLQ-C30. Secondary outcomes are perceived feelings of control, anxiety, patients' satisfaction with follow-up and costs. A cost-effectiveness analysis will be performed from a societal perspective. Discussion Reduced follow-up strategies for breast cancer have not yet been widely applied in clinical practice. Improvement of psychosocial support and information to patients could lead to a better acceptance of reduced follow-up. The MaCare trial combines a reduced follow-up strategy with additional psychosocial support. Less frequent follow-up can reduce the burden on medical specialists and costs. The educational group programme can improve QoL of patients, but also less frequent follow-up can improve QoL by reducing the anxiety experienced for each follow-up visit. Results of the trial will provide knowledge on both costs and psychosocial aspects regarding follow-up and are expected in 2009.

Serum cholesterol changes after an 8-week behavior modification program for patients with coronary artery disease (CAD) were studied in a randomized controlled clinical trial. Acute myocardial infarction (AMI) or coronary artery bypass grafting (CABG) patients were randomly assigned to the intervention (N = 94) or to usual care (N = 90). After 9 months’ follow-up the intervention was effective in reducing total cholesterol and LDL cholesterol levels, particularly in patients with high baseline lipid levels. After correcting for changes in dose of statins during follow-up, effects were weakened, but for patients with high baseline cholesterol levels favorable effects remained. In these patients, the intervention group showed a decline of total cholesterol and LDL cholesterol levels of 20% and 29%, respectively, compared to a 12% and 19% reduction in the control group (p < .01). These effects could not be explained by changes in dietary fat consumption. An unexpected finding was a lower increase in HDL cholesterol in the intervention group than in the control group.

Male Dutch Resistance veterans from World War II who reported on chronic diseases were compared with subjects from a population survey. Resistance veterans in general reported significantly more disease. Veterans with symptoms of posttraumatic stress disorder reported more disease than those who had none. Furthermore, 13 specific disease categories were more prevalent in the Resistance veterans than in the general population. In the Resistance veterans total number of reported diseases was significantly correlated with anxiety, depression, and posttraumatic stress disorder. In Resistance veterans weekly tobacco use was comparable to that of the control subjects, but alcohol consumption was significantly less.

To test the hypothesis that 'vital exhaustion' (VE), a state characterized by unusual fatigue, increased irritability, and feelings of demoralization, precedes the onset of myocardial infarction (MI) in females, 79 females hospitalized with a first MI (mean age: 59.3; SD = 9.3) and 90 females hospitalized in the departments of general and orthopaedic surgery (mean age: 57.4; SD = 9.1), were compared on the retrospective form of the Maastricht Questionnaire (MQ). Defining 'exhaustion' as a score above the median of the MQ, 63% of the cases and 39% of the controls were exhausted before hospitalization (chi 2 = 10.02; p0.00). The relative risk associated with exhaustion, after controlling for age, smoking, coffee consumption, diabetes, hypertension, non-anginal pain, and menopausal status, was estimated as 2.75 (95% CI:I.28-5.81; p0.01), thus corroborating the hypothesis. Exploratory analyses of the origins of exhaustion in these females showed that of all biographical characteristics, holding a job and simultaneously taking care of the household was most strongly associated with elevated exhaustion scores.

In a group of elderly males who had been exposed to excessive stress during World War II, 56% of whom suffered from current post-traumatic stress disorder, a significant association was found between snoring and the occurrence of anxiety dreams, independent of the use of sedatives, antidepressants, smoking and alcohol and coffee consumption. Anxiety dream incidence was highest when snoring was accompanied by respiratory pauses. The underlying pathophysiologic mechanisms are thought to be hypercapnia and autonomic-vegetative arousal, resulting from obstructive sleep apneic episodes in heavy snoring. Polysomnographic sleep studies are needed to confirm this hypothesis.

In a case-control study in adult men from The Netherlands, the associations of work stressors with both exhaustion prior to first acute myocardial infarction (AMI) and with first AMI itself were explored. The 133 AMI-cases reported more exhaustion, work stressors, and smoking than the controls (i.e. 133 neighborhood controls and 192 hospital controls). After controlling for smoking, exhaustion constituted a firm risk indicator for first AMI; it was also positively associated with work stressors, in particular conflicts at work. Work stressors that may disrupt one's occupational career, and increased responsibility (in younger AMI-cases), were directly associated with elevated risk for first AMI. Conflicts at work were conducive to first AMI through their associations with exhaustion.

Prodromal symptoms of vital exhaustion and sleep complaints are increasingly being recognized as important risk indicators for myocardial infarction (MI). In this study, the relationships between vital exhaustion, behavioral characteristics, and MI, and between several sleep complaints and MI were investigated. The subjects were 133 male cases with first MI, 192 male hospital controls, and 133 male neighborhood controls. The instruments used were the Maastricht Questionnaire (vital exhaustion), the Life Styles Questionnaire (sleep complaints, coffee consumption, and current smoking), and the Structured Interview (Type A behavior). All sleep complaints, vital exhaustion, Type A behavior, excessive coffee consumption, and current smoking occurred significantly more often in MI-cases. After controlling for these potential confounders, and age, most sleep complaints retained significant associations with MI, in particular often taking naps during the day and waking up in the morning feeling tired and...