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The aim of this study was to identify resilience qualities in families in the wake of heart-related trauma of one of their members. The theoretical framework of this study was the Resiliency Model of Family Stress, Adjustment and Adaptation, which represents a paradigmatic shift from a pathological to a strength-based view of a family. Self-report questionnaires and an open-ended question were used to collect data from 22 family members who experienced the heart-related trauma. The results indicate that family time and routines, parent-child togetherness, family chores and affirming communication are key qualities for mediating family adaptation, while inflammatory communication was found to be negatively associated with family adaptation. Other relevant qualities were social support, family hardiness and a coping style where problem situations are reformulated. The identification of these qualities can serve as the focus for intervention and prevention, enhancing the quality of life for families with a cardiovascular patient. Keywords Heart-related trauma. Family. Adaptation. Resilience. Relationships Curr Psychol (2009) 28:302-314 DOI 10.1007/s12144-009-9062-1 Publish online: 22 August 2009 [c] Springer Science + Business Media, LLC 2009

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1559-1816.2009.00502.x Byline: Shawn N. Fraser (2), Wendy M. Rodgers (*) Abstract: Within Berkman et al.'s (2000) framework, we examined sociodemographic correlates of social networks (SN) and social support (SS) in 155 heart patients (33 women, 122 men), who completed measures of sociodemographics, SN, and SS. Hierarchical regression analyses examined the relationship between sociodemographic factors and SN; and between sociodemographic factors, SN, and SS. Higher social status and more income were related to larger, more diverse networks and more SS. Higher social status and being married were related to more SS. Being married was related to more belonging and tangible support. Results show the complex relationship between higher level social factors and specific SS functions offering areas for future interventions to increase SS in heart patients. Author Affiliation: (*)Faculty of Physical Education and RecreationUniversity of AlbertaEdmonton, Alberta, Canada Article note: (2) Shawn N. Fraser, Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta, Canada T9S 3A3. E-mail: shawn.fraser@athabascau.ca

Recent research suggests that marital quality predicts the survival of patients with heart failure (HF), and it is hypothesized that a communal orientation to coping marked by first-person plural pronoun use (we talk) may be a factor in this. During a home interview, 57 HF patients (46 men and 16 women) and their spouses discussed how they coped with the patients' health problems. Analysis of pronoun counts from both partners revealed that we talk by the spouse, but not the patient, independently predicted positive change in the patient's HF symptoms and general health over the next 6 months and did so better than direct self-report measures of marital quality and the communal coping construct. We talk by the patient and spouse did not correlate, however, and gender had no apparent moderating effects on how pronoun use predicted health change. The results highlight the utility of automatic text analysis in couple-interaction research and provide further evidence that looking beyond the patient can improve prediction of health outcomes. Keywords: marriage, close relationships, heart disease, coping, text analysis

Traditional cardiac risk factors only partially explain the biological mechanisms by which persons of lower socioeconomic status (SES) have higher cardiovascular risk. Dietary factors, resulting in lower circulating levels of (n-3) fatty acids, may also contribute to the increased risk of cardiovascular disease (CVD) in patients with low SES. We tested whether low SES is associated with RBC levels of (n-3) fatty acids in patients with coronary heart disease. We performed a cross-sectional analysis of 987 adults with stable coronary artery disease (CAD) recruited from San Francisco area outpatient clinics. Four SES measures (household income, education, occupation, and housing status) were assessed by self-report. RBC fatty acid levels of 2 (n-3) fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were measured in venous blood samples from fasting subjects. Participants with lower household income, education, occupation, and housing status had lower RBC levels of (n-3) fatty acids (P < 0.001 for all 4 measures). In multivariable models, household income, education, and occupation remained strongly associated with DHA and EPA levels after adjustment for demographic factors, BMI, physical activity, statin use, and kidney function (P < 0.001 for all 3 measures). Housing status was not associated with DHA or EPA after multivariable adjustment. Among patients with CAD, 3 indicators of low SES, household income, education, and occupation, were strongly associated with lower RBC levels of (n-3) fatty acids. Our results raise the possibility that (n-3) fatty acids may be an important mediating factor in the association between low SES and CVD.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2007.01025.x Byline: Ann Adams (1), Christopher D. Buckingham (2), Antje Lindenmeyer (1), John B. McKinlay (3), Carol Link (3), Lisa Marceau (3), Sara Arber (4) Keywords: gender; decision-making; heart disease; diagnosis Abstract: Abstract Using novel methods, this paper explores sources of uncertainty and gender bias in primary care doctors' diagnostic decision-making about coronary heart disease (CHD). Claims about gendered consultation styles and quality of care are re-examined, along with the adequacy of CHD models for women. Randomly selected doctors in the UK and the US (n = 112, 56 per country, stratified by gender) were shown standardised videotaped vignettes of actors portraying patients with CHD. Patients' age, gender, ethnicity and social class were varied systematically. During interviews, doctors gave free-recall accounts of their decision-making, which were analysed to determine patient and doctor gender effects. We found differences in male and female doctors' responses to different types of patient information. Female doctors recall more patient cues overall, particularly about history presentation, and particularly amongst women. Male doctors appear less affected by patient gender but both male and especially female doctors take more account of male patients' age, and consider more age-related disease possibilities for men than women. Findings highlight the need for better integration of knowledge about female presentations within accepted CHD risk models, and do not support the contention that women receive better-quality care from female doctors. Author Affiliation: (1)Health Sciences Research Institute, Warwick Medical School, University of Warwick (2)Computer Science, Aston University (3)New England Research Institutes, Watertown, USA (4)Centre for Research on Ageing and Gender (CRAG), Department of Sociology, University of Surrey Article note: Address for correspondence: Ann Adams, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL., e-mail: a.e.adams@warwick.ac.uk

This study examined whether psychosocial and cultural factors were related to four dimensions of cardiac-related quality of life (global, physical, emotional, and social functioning) in 120 Hispanic coronary heart disease [...]

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of' knowledge structures' when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests. KEY WORDS--ageism, primary health care, coronary heart disease, classification, decision-making, cognitive processes, health inequalities.

Objective: To establish clusters of Health-Related Quality of Life (HRQL) in a population of patients hospitalised for suspected Coronary Heart Disease (CHD), and to examine the relationship between mental health and other sociodemographic and clinical variables associated with worse HRQL. Methods: We conducted a cross-sectional study of 185 patients admitted to the Cardiology Service. We used the General Health Questionnaire (GHQ-28) to assess the mental status, and the SF-36 to assess Health Related Quality Life (HRQL). Using the patients' scores obtained from the SF-36, we performed a cluster analysis and used a logistic model for the analysis of the variables associated with HRQL clusters. Results: We identified two HRQL clusters: good quality of life, for which the patients scored highest in all the dimensions of SF-36, and worse quality of life, for which patients had lower scores in all dimensions. The variables associated with the worse quality of life group were: female gender, previous history of Coronary Heart Disease (CHD), and poor mental health. Conclusions: Being female, having poor mental health and a previous history of CHD were identified as representing a vulnerable group with worse HRQL. doi: 10.1300/J013v43n02_03 [Article copies available for a fee from The Haworth Document Delivery, Service: 1-800-HAWORTH. E-mail address: Website: KEYWORDS. Health related quality of life, mental health, coronary heart disease, women, SF-36

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.05.028 Byline: Sara Arber (a), John McKinlay (b), Ann Adams (c), Lisa Marceau (b), Carol Link (b), Amy O'Donnell (b) Keywords: Gender; Ageism; Health inequalities; Primary care; Decision-making; UK/US; Randomised experiment Abstract: Numerous studies examine inequalities in health by gender, age, class and race, but few address the actions of primary care doctors. This factorial experiment examined how four patient characteristics impact on primary care doctors' decisions regarding coronary heart disease (CHD). Primary care doctors viewed a video-vignette of a scripted consultation where the patient presented with standardised symptoms of CHD. Videotapes were identical apart from varying patients' gender, age (55 versus 75), class and race, thereby removing any confounding factors from the social context of the consultation or other aspects of patients' symptomatology or behaviour. A probability sample of 256 primary care doctors in the UK and US viewed these video-vignettes in a randomised experimental design. Gender of patient significantly influenced doctors' diagnostic and management activities. However, there was no influence of social class or race, and no evidence of ageism in doctors' behaviour. Women were asked fewer questions, received fewer examinations and had fewer diagnostic tests ordered for CHD. 'Gendered ageism' was suggested, since midlife women were asked fewest questions and prescribed least medication appropriate for CHD. Primary care doctors' behaviour differed significantly by patients' gender, suggesting doctors' actions may contribute to gender inequalities in health. Author Affiliation: (a) Department of Sociology, Centre for Research on Ageing and Gender, University of Surrey, Guildford, Surrey GU2 7XH, UK (b) New England Research Institutes, Watertown, MA 02172, USA (c) Centre for Primary Health Care Studies, University of Warwick, Coventry CV4 7AL, UK

Race and ethnicity differences in door-to-drug and door-to-balloon times for patients receiving primary reperfusion for ST-segment elevation myocardial infarction are estimated. The results revealed that a substantial portion of the racial and ethnic disparity in time to treatment was accounted for by the specific hospital to which patients were admitted, in contrast to differential treatment by race and ethnicity inside the hospital.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0002-8703(00)90301-6 Abstract: Psychosocial factors, particularly depression and lack of social support, are important predictors of morbidity and mortality in patients with coronary heart disease. This article describes the design and methods of the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study, a multicenter, randomized clinical trial involving 3000 patients enrolled after acute myocardial infarction. ENRICHD aims to investigate the effects of a psychosocial intervention that targets depression and/or low social support on survival and reinfarction among adult men and women who are at high risk for recurrent cardiac events because of psychosocial factors (depressive or social isolation). Design features include the use of an individually tailored yet standardized intervention, rigorous clinical trial methods, and enrollment of a large number of women and minorities. (Am Heart J 2000;139:1-9.) Article History: Received 7 April 1999; Accepted 22 July 1999 Article Note: (footnote) [star] Supported by contracts NO1-HC-55140, NO1-HC-55141, NO1-HC-55142, NO1-HC-55143, NO1-HC-55144, NO1-HC-55145, NO1-HC-55146, NO1-HC-55147, NO1-HC-55148 from the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland., [star][star] *A complete list of investigators and participating institutions is listed in the Appendix. , a Reprints requests: James D. Hoskings, PhD, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Department of Biostatistics, CB#8030, Collaborative Studies Coordinating Center, 137 E Franklin St, Suite 203, Chapel Hill, NC 27514-4145., aa 0002-8703/2000/$12.00 + 0 4/1/101778

Byline: K.Ranga Rama Krishnan, Linda K. George, Carl F. Pieper, Wei Jiang, Rebekka Arias, Adair Look, Christopher O'Connor Abstract: Background Depression is common among patients with cardiac disease. A number of psychosocial factors may affect the relationship between physical health and depression. There is evidence from the psychiatric literature suggesting that negative life events and social support are important factors in the development and outcome of depression. It is unknown if these factors are important in the context of depression in medically ill patients. Thus it is important to examine the relationship among social support, negative life events, and the presence of depression in elderly patients with cardiac disease. Methods Patients with coronary artery disease were assessed with the Duke Depression Evaluation Schedule for the Elderly. This includes the mood and anxiety disorder section of the Diagnostic Interview Schedule modified for Diagnostic and Statistical Manual of Mental Disorders diagnoses, life events, and multidimensional assessment of social support. Two hypotheses were tested: (1) the number of concurrent negative life events will be higher in patients with coronary artery disease with major depression than those without depression, and (2) social support will be less in patients with major depression than in those without. Results Presence of major depression was associated with increased negative life events and lowered subjective social support after accounting for age, sex, and race. Conclusions The finding that subjective social support and negative life events are related to major depression suggests that even in the context of medical illness, social factors are still important in the development of major depression. (Am Heart J 1998;136:491-5.) Author Affiliation: Durham, N.C Article History: Received 2 September 1997; Accepted 16 March 1998 Article Note: (footnote) [star] From the aDepartments of Psychiatry and Behavioral Sciences, bSociology, and cCommunity and Family Health, and the dDivision of Cardiology, Department of Medicine, Duke University Medical Center., [star][star] Supported in part by MH51191, MH 40159, and MH 50570., a Reprint requests: K. Ranga R. Krishnan, MD, Department of Psychiatry & Behavioral Sciences, Box 3018, Duke University Medical Center, Durham, NC 27710., aa 4/1/90412

The present study was conducted to examine the effects of social support on adjustment to a first cardiac event. There were two goals: (a) to determine which function of support best facilitated adjustment and (b) to determine whether perceived or received support had a greater impact on psychological health. Sixty-four patients and their spouses were interviewed shortly before hospital discharge and 3 months following discharge. The results indicated that perceived support has a greater impact on adjustment than received support and that received support does not necessarily indicate that needs are being met. The most helpful form of support was best understood by considering the stressor phase, patient and spouse needs, and the adjustment outcome. Consistent with previous research, however, the negative aspects of social relationships were more robust predictors of well-being than the positive aspects of social relationships.

The psychological well-being of coronary heart disease patients under the Lifestyle Heart Trial, an intervention program on exercise, group support, stress management, and diet, is studied. Results show that psychological distress and hostility among participants were reduced after one year. The need to target multiple health behaviors in preventing coronary heart disease is explained.

Married partners' similarity in reported exercise behavior as a moderator of the association between social support for exercise provided and got by giving an actor-partner dyadic effects model is examined. In couples differing in their reported exercise behavior, no association is found between either partners' provision and receipt of support for exercise.

The life of cardiac cripple Reverend Martin C. C. Wang is discussed who despite all the obstacles placed in his path has led a charmed life. A magnificent party was conducted for Martin when his physical condition was deteriorating in which all the people whom he knew were invited to share their love and affection for the old Reverend and his family.