Comprehensive rehabilitation in chronic heart failure - better psycho-emotional status related to quality of life, brain natriuretic peptide concentrations, and clinical severity of disease

To evaluate the effects of a comprehensive outpatient rehabilitation program in chronic heart failure (CHF) on quality of life (QoL) in relation to emotional status and clinical severity of disease.

Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure

BACKGROUND: Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF. DESIGN: All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program. METHODS: Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1). RESULTS: Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20). CONCLUSION: Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.

Patterns of exposure to infectious diseases and social contacts in early life and risk of brain tumours in children and adolescents: an International Case-Control Study (CEFALO)

BACKGROUND Infectious diseases and social contacts in early life have been proposed to modulate brain tumour risk during late childhood and adolescence. METHODS CEFALO is an interview-based case-control study in Denmark, Norway, Sweden and Switzerland, including children and adolescents aged 7-19 years with primary intracranial brain tumours diagnosed between 2004 and 2008 and matched population controls. RESULTS The study included 352 cases (participation rate: 83%) and 646 controls (71%). There was no association with various measures of social contacts: daycare attendance, number of childhours at daycare, attending baby groups, birth order or living with other children. Cases of glioma and embryonal tumours had more frequent sick days with infections in the first 6 years of life compared with controls. In 7-19 year olds with 4+ monthly sick day, the respective odds ratios were 2.93 (95% confidence interval: 1.57-5.50) and 4.21 (95% confidence interval: 1.24-14.30). INTERPRETATION There was little support for the hypothesis that social contacts influence childhood and adolescent brain tumour risk. The association between reported sick days due to infections and risk of glioma and embryonal tumour may reflect involvement of immune functions, recall bias or inverse causality and deserve further attention.

Health Care Providers' Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene

Human trafficking is a complex and multifaceted problem that takes the form of economic, physical and sexual exploitation of people, both adults and children, who are reduced to simple products for commerce. Human trafficking in the United States also has both a domestic and an international aspect. Health care providers are in a unique position to screen for victims of trafficking and may provide important medical and psychological care for victims while in captivity and thereafter. Trafficked persons are likely to suffer a wide spectrum of health risks that reflect the unique circumstances and experiences in a trafficked victim’s life. Although trafficked victims typically have experienced inadequate medical care, once contact is made by the victim with the health care professionals, the opportunity then exists to identify, treat, and assist such victims. The range of services and supports required to appropriately respond to human trafficking victims once identified is broad and typically goes beyond just what is immediately provided by the health care professional and includes safe housing, legal advice, income support, and, for international victims, immigration status related issues. An informed and responsive community is necessary to serve both the international and domestic victims of human trafficking, and needs assessments demonstrated a number of barriers that hindered the delivery of effective services to human trafficking victims. One of the consistent needs identified to combat these barriers was enhanced training among all professionals who might come in contact with human trafficking victims. We highlight the efforts of the Houston Rescue and Restore Coalition (HRRC), a local grassroots non-profit organization whose mission focuses on raising awareness of human trafficking in the Greater Houston Metropolitan area. HRRC responded to the consistent recommendation from various community needs assessments for additional training of front line professionals who would have the opportunity to identify human trafficking victims and supported the design and pilot testing of a health professions training program around human trafficking. Dissemination of this type of training along with careful evaluation and continued refinement will be one way for health care professionals to engage in a positive manner with human trafficking victims.

Longitudinal Measurement Invariance Issues Illustrated by Examples of Marital Satisfaction in Later Life and the Structure of Psychopathology Before and After Psychotherapy

Talk at the Symposium "Opportunities and Challenges of Longitudinal Perspectives"

Adolescents’ willingness for intergenerational support: Relations to maternal expectations and mothers’ life satisfaction in 14 cultures

How is adolescents’ willingness for intergenerational support affected by parents’ expectations and parenting behavior? Does youths’ willingness for intergenerational support in turn affect parents’ well-being? The current study addresses these questions from a cross-cultural perspective, using data from connected samples of mother-adolescent dyads (N = 4162) from 14 diverse cultural contexts as part of the “Value of Children and Intergenerational Relations Study” (Trommsdorff & Nauck, 2005). The results are based on mixed model analyses (with culture as a random factor). Associations were investigated between family norms (expectations of support by adult children), parenting goals (obedience, independence) and parenting behavior (acceptance, control) reported by mothers and adolescents’ reports on willingness to support (help in household tasks, willingness to tolerate burdens in order to help their parents in case of accident, emotional support given to mothers and fathers). Across cultures, maternal expectations of adult children were positively related to adolescents’ reported household help and their current emotional support to mothers and fathers. Obedience, and control were positively related to the amount of adolescent help in the household, while independence and acceptance were related to a higher willingness to tolerate burdens as well as to higher emotional support given to the mother. Regarding associations between adolescents’ actual and intended intergenerational support with mothers’ life satisfaction, adolescents’ willingness to tolerate burdens was related to a higher maternal life satisfaction while adolescents’ reported household help was not. Adolescents’ current emotional support to fathers (but not to mothers) was also related to higher maternal life satisfaction. While most of the effects were stable across cultures (no significant random slope variance across cultural groups), some effects did significantly vary across cultures. Traditional-vs.-secular values as culture-level characteristics will be discussed as explanation for these culture-specific relations among mothers’ expectations, adolescents’ intergenerational support, and mothers’ life satisfaction.

Arterial blood pressure targets in septic shock: is it time to move to an individualized approach?

Xu and colleagues evaluated the impact of increasing mean arterial blood pressure levels through norepinephrine administration on systemic hemodynamics, tissue perfusion, and sublingual microcirculation of septic shock patients with chronic hypertension. The authors concluded that, although increasing arterial blood pressure improved sublingual microcirculation parameters, no concomitant improvement in systemic tissue perfusion indicators was found. Here, we discuss why resuscitation targets may need to be individualized, taking into account the patient's baseline condition, and present directions for future research in this field.

Rapid divergence in physiological and life-history traits between northern and southern populations of the British introduced neo-species, Senecio squalidus

Alien plants provide a unique opportunity to study evolution in novel environments, but relatively little is known about the extent to which they become locally adapted to different environments across their new range. Here, we compare northern and southern populations of the introduced species Senecio squalidus in Britain; S. squalidus has been in southern Britain for approximately 200 years and reached Scotland only about 50 years ago. We conducted common garden experiments at sites in the north and south of the species’ range in Britain. We also conducted glasshouse and growth chamber experiments to test the hypothesis that southern genotypes flower later, are more drought-tolerant, germinate and establish better at warmer temperatures, and are less sensitive to cold stress than their more northern counterparts. Results from the common garden experiments are largely consistent with the hypothesis of rapid adaptive divergence of populations of the species within the introduced range, with genotypes typically showing a home-site advantage. Results from the glasshouse and growth chamber experiments demonstrate adaptive divergence in ability to tolerate drought stress and high temperatures, as well as in phenology. In particular, southern genotypes were more tolerant of dry conditions and high temperatures and they flowered later than northern genotypes. Our results show that rapid local adaptation can occur in alien species, and they have implications for our understanding of the ecological genetics of range expansion of introduced weeds.

The Associations Between Social, Behavioral, and Health Risk Factors on a High School Student’s Decision to Pursue Post High School Plans

Background: Due to the relationship between SES and health, pursuing post high-school plans can lead to better future health outcomes for the student. The current paper assesses how behavioral and health risk factors, and family and social support, effect a student’s decision to pursue post high school plans. Methods: Data from the Youth Behavioral Component of the 2007 Connecticut School Health Survey were analyzed. Composite measures of exposure to/participation in violent behavior, mental and physical health, family/social support and substance abuse were created. The effects of these domains on the decision to pursue post high-school plans were assessed using logistic regression. Data were stratified by socioeconomic status. Results: Low SES students were more likely than high SES students to be doubtful for post high-school plans. Cocaine abuse emerged as the risk factor that put low SES students at the highest odds of not pursuing post high-school plans, followed by involvement in violent/aggressive behavior, and receiving less family/social support than their peers. Similar findings regarding violence and family/social support were found in the high SES group. Findings regarding substance abuse in the high SES group were not statistically significant. Discussion: Prevention programs regarding violence and substance abuse may have the added benefit of increasing the likelihood that high school students will make post high school plans. Preventing cocaine use among low SES students may be of particular importance. Violence prevention measures should be tailored to the target group. Adequate family/social support emerged as an encouraging factor for post high school plans.

Factors that influence the decision to produce exportables in the Chilean agricultural sector

This study analyzes there lative importance of the factors that influence the decision to produce for foreign markets in the Chilean agricultural sector. Using data obtained from personal interviews with 368 farmers, the market/production decision was estimated using a multinomial logit model. Three market/production alternatives were analyzed: production aimed for the external market, production for the internal market but with expectations of being exported, and production targeted only for the internal market. Marginal effects, odds ratios and predicted probabilities were used to identify the relevance of each variable. The results showed that a producer that is male, with a higher educational level, that does not own the land, but rents it, whose farm has irrigation and is located in an area that has a high concentration of exporting producers, will have a high probability of producing exportables. However, the factor that has the highest impact on producing for the external market is the geographic concentration of exporting producers, that is, an export spillover effect. Indeed, when the concentration change from 0 to its maximum (0.26), the odds of producing exportables rather than producing traditional products increases by a factor of 70 (against a factor of 10 in the case of irrigation).