Encountering the suffering other in illness narratives : between the memory of suffering and the suffering memory

Cette étude porte sur la dimension intersubjective de la souffrance qui affecte le rapport du souffrant à son corps, au temps et à l’espace vécus de même que son identité narrative et sa mémoire narrative. Mon argument principal est que la voix narrative constitue le rapport intersubjectif dans les récits de maladie que les proches écrivent sur leurs partenaires souffrant de cancer de cerveau ou de la maladie d’Alzheimer. Ma discussion est basée sur l’éthique, la phénoménologie, les théories de l’incorporation, les études des récits de vie, la sociologie et l’anthropologie médicales et la narratologie. L’objet de mon étude est l’expérience incorporée de la souffrance dans les récits de maladie et je me concentre sur la souffrance comme perte de la mémoire et du soi narratif. J’analyse le journal How Linda Died de Frank Davey et les mémoires de John Bayley, Iris: A Memoir of Iris Murdoch et Iris and Her Friends: A Memoir of Memory and Desire. J’explore comment les récits de maladie constituent le rapport éthique à l’Autre souffrant de la rupture de la mémoire. La discussion de la voix est située dans le contexte des récits de vie et se propose de dépasser les limites des approches sociologiques et anthropologiques de la voix dans les récits de maladie. Dans ce sens, dans un premier temps je porte mon attention sur des études narratologiques de la voix en indiquant leurs limites. Ma propre définition de la voix narrative est basée sur l’éthique dans la perspective d’Emmanuel Levinas et de Paul Ricœur, sur l’interprétation du temps, de la mémoire et de l’oubli chez St-Augustin et la discussion levinasienne de la constitution intersubjective du temps. J’avance l’idée que la “spontanéité bienveillante” (Ricœur, Soi-même comme un autre 222) articule la voix narrative et l’attention envers l’Autre souffrant qui ne peut plus se rappeler, ni raconter sa mémoire. En reformulant la définition augustinienne du temps qui met en corrélation les modes temporels avec la voix qui récite, j’avance l’idée que la voix est distendue entre la voix présente de la voix présente, la voix présente de la voix passée, la voix présente de la voix future. Je montre comment la voix du soignant est inscrite par et s’inscrit dans les interstices d’une voix interrompue, souffrante. Je définis les récits de vies comme des interfaces textuelles entre le soi et l’Autre, entre la voix du soi et la voix du souffrant, comme un mode de restaurer l’intégrité narrative de l’Autre.

Cow's milk allergy and the development of tolerance

Aims: To gain insight on the immunological processes behind cow’s milk allergy (CMA) and the development of oral tolerance. To furthermore investigate the associations of HLA II and filaggrin genotypes with humoral responses to early oral antigens. Methods: The study population was from a cohort of 6209 healthy, full-term infants who in a double-blind randomized trial received supplementary feeding at maternity hospitals (mean duration 4 days): cow’s milk (CM) formula, extensively hydrolyzed whey formula or donor breast milk. Infants who developed CM associated symptoms that subsided during elimination diet (n=223) underwent an open oral CM challenge (at mean age 7 months). The challenge was negative in 112, and in 111 it confirmed CMA, which was IgE-mediated in 83. Patients with CMA were followed until recovery, and 94 of them participated in a follow-up study at age 8-9 years. We investigated serum samples at diagnosis (mean age 7 months, n=111), one year later (19 months, n=101) and at follow-up (8.6 years, n=85). At follow-up, also 76 children randomly selected from the original cohort and without CM associated symptoms were included. We measured CM specific IgE levels with UniCAP (Phadia, Uppsala, Sweden), and β-lactoglobulin, α-casein and ovalbumin specific IgA, IgG1, IgG4 and IgG levels with enzyme-linked immunosorbent assay in sera. We applied a microarray based immunoassay to measure the binding of IgE, IgG4 and IgA serum antibodies to sequential epitopes derived from five major CM proteins at the three time points in 11 patients with active IgE-mediated CMA at age 8-9 years and in 12 patients who had recovered from IgE-mediated CMA by age 3 years. We used bioinformatic methods to analyze the microarray data. We studied T cell expression profile in peripheral blood mononuclear cell (PBMC) samples from 57 children aged 5-12 years (median 8.3): 16 with active CMA, 20 who had recovered from CMA by age 3 years, 21 non-atopic control subjects. Following in vitro β-lactoglobulin stimulation, we measured the mRNA expression in PBMCs of 12 T-cell markers (T-bet, GATA-3, IFN-γ, CTLA4, IL-10, IL-16, TGF-β, FOXP3, Nfat-C2, TIM3, TIM4, STIM-1) with quantitative real time polymerase chain reaction, and the protein expression of CD4, CD25, CD127, FoxP3 with flow cytometry. To optimally distinguish the three study groups, we performed artificial neural networks with exhaustive search for all marker combinations. For genetic associations with specific humoral responses, we analyzed 14 HLA class II haplotypes, the PTPN22 1858 SNP (R620W allele) and 5 known filaggrin null mutations from blood samples of 87 patients with CMA and 76 control subjects (age 8.0-9.3 years). Results: High IgG and IgG4 levels to β-lactoglobulin and α-casein were associated with the HLA (DR15)-DQB1*0602 haplotype in patients with CMA, but not in control subjects. Conversely, (DR1/10)-DQB1*0501 was associated with lower IgG and IgG4 levels to these CM antigens, and to ovalbumin, most significantly among control subjects. Infants with IgE-mediated CMA had lower β -lactoglobulin and α-casein specific IgG1, IgG4 and IgG levels (p<0.05) at diagnosis than infants with non-IgE-mediated CMA or control subjects. When CMA persisted beyond age 8 years, CM specific IgE levels were higher at all three time points investigated and IgE epitope binding pattern remained stable (p<0.001) compared with recovery from CMA by age 3 years. Patients with persisting CMA at 8-9 years had lower serum IgA levels to β-lactoglobulin at diagnosis (p=0.01), and lower IgG4 levels to β-lactoglobulin (p=0.04) and α-casein (p=0.05) at follow-up compared with patients who recovered by age 3 years. In early recovery, signal of IgG4 epitope binding increased while that of IgE decreased over time, and binding patterns of IgE and IgG4 overlapped. In T cell expression profile in response to β –lactoglobulin, the combination of markers FoxP3, Nfat-C2, IL-16, GATA-3 distinguished patients with persisting CMA most accurately from patients who had become tolerant and from non-atopic subjects. FoxP3 expression at both RNA and protein level was higher in children with CMA compared with non-atopic children. Conclusions: Genetic factors (the HLA II genotype) are associated with humoral responses to early food allergens. High CM specific IgE levels predict persistence of CMA. Development of tolerance is associated with higher specific IgA and IgG4 levels and lower specific IgE levels, with decreased CM epitope binding by IgE and concurrent increase in corresponding epitope binding by IgG4. Both Th2 and Treg pathways are activated upon CM antigen stimulation in patients with CMA. In the clinical management of CMA, HLA II or filaggrin genotyping are not applicable, whereas the measurement of CM specific antibodies may assist in estimating the prognosis.

Desire and the paths of recognation [sic] in Hegel's intersubjectivity

This thesis poses two fundamental issues regarding Hegel's philosophy of intersubjectivity. Firstly, it examines Kojeve's problematic interpretation of Hegelian intersubjectivity as being solely rooted in the dialectic of lordship and bondage. It is my contention that Kojeve conflates the concepts of recognition {Anerkennung) with that of desire (Begierde), thereby reducing Hegel's philosophy of intersubjectivity to a violent reduction of the other to the same. This is so despite the plenary of examples Hegel uses to define intersubjectivity as the mutual (reciprocal) recognition between the self and the other. Secondly, it examines Hegel's use of Sophocles' Antigone to demonstrate the notion of the individual par excellence. I contend that Hegel's use of Antigone opens a new methodological framework through which to view his philosophy of intersubjectivity. It is Antigone that demonstrates the upheaval of an economy of exchange between the self and the other, whereby the alterity of the other transcends the self Ultimately, Hegel's philosophy of intersubjectivity must be reexamined, not only to dismiss Kojeve's problematic interpretation, but also to pose the possibility that Hegel's philosophy of intersubjectivity can viably account for a philosophy of the other that has a voice in contemporary philosophical debate.

Patterns of molecular response to and relapse after combination of sorafenib, idarubicin, and cytarabine in patients with FLT3 mutant acute myeloid leukemia

BACKGROUND: FMS-like tyrosine kinase 3 (FLT3) is a class III receptor tyrosine kinase involved in hematopoietic progenitor cell development. Mutations of FLT3 have been reported in about a third of patients with acute myeloid leukemia (AML), and inhibitors of FLT3 are of clinical interest. Sorafenib is an orally active multikinase inhibitor with potent activity against FLT3 and the Raf/ERK/MEK kinase pathway. METHODS: We studied the patterns of molecular response and relapse in 18 patients with mutated FLT3 treated with the combination of sorafenib, idarubicin, and cytarabine. RESULTS: The median follow-up was 9 months. Sixteen patients achieved complete remission (CR), and the other 2 patients achieved CR but lacked platelet recovery for an overall response rate of 100%. Ten patients had their FLT3-mutated clone eradicated, with 6 patients who showed some residual FLT3-mutated cells, and 2 patients who showed persistent FLT3-mutated cells. The elimination of FLT3-mutated population at the time of morphologic CR, however, was not predictive of relapse. After a median follow-up of 9 months (range, 1-16 months), 10 (55%) patients had relapsed, with a median CR duration of 8.8 months (range, 1-9.5 months). By DNA sequencing, there was no evidence of an acquired FLT3 point mutation at the time of relapse in 7 patients tested, which suggested the presence of other mechanisms of sorafenib resistance. CONCLUSION: Sorafenib, combined with chemotherapy, is effective in attaining CR, but relapses still occur.

Assessing forest response-type diversity to natural disturbances in Peninsular Spain and the Balearic Islands = Evaluación de la diversidad de tipos de respuesta a perturbaciones naturales en la España peninsular e Islas Baleares

Disturbances shape forest ecosystems by influencing their composition, structure, and processes. In the Mediterranean Basin, changes in the disturbance regimes have been predicted to occur in the next future with a higher occurrence of extreme events of drought, wildfire, and – to a lesser extent – windstorm. Woody species are the main elements defining the structure and functioning of forest ecosystems. Recently, response-type diversity has been pointed out as an appropriate indicator of ecosystems resilience. For this, we have elaborated a complete response-trait database for the tree and shrubby species considered in the Third Spanish National Forest Inventory (3SNFI). In the database, the presence or absence of nine response traits associated to drought, fire, and wind were assigned to each species. The database reflected the lack of information about some important traits (in particular for shrubby species) and allowed to determine those traits most widely distributed. The information contained in the database was then used to assess a relative index of forest resilience to these disturbances calculated from the abundance of response traits and the species redundancy for each plot of the 3SNFI; considering both tree and shrubby species. In general, few plots showed high values of the resilience index, probably because some traits were scarcely presented in the species and also because most plots presented very few species. The cartographic representation of the index showed low values for the stands located in mountainous ranges, which are mostly composed by species typical from central Europe. In the other side, Eucalyptus plantations in Galicia appeared as one thee the most resilient ecosystems, due to its higher adaptive capacity to persist after the occurrence of drought, fire, and windstorm events. We conclude that the response traits database can constitute a useful tool for forest management and planning and for future research to enhance the forest resilience.

ApcD is necessary for efficient energy transfer from phycobilisomes to photosystem I and helps to prevent photoinhibition in the cyanobacterium Synechococcus sp PCC 7002

Phyrobilisomes (PBS) are the major light-harvesting, protein-pigment complexes in cyanobacteria and red algae. PBS absorb and transfer light energy to photosystem (PS) II as well as PS I, and the distribution of light energy from PBS to the two photosystems is regulated by light conditions through a mechanism known as state transitions. In this study the quantum efficiency of excitation energy transfer from PBS to PS I in the cyanobacterium Synechococcus sp. PCC 7002 was determined, and the results showed that energy transfer from PBS to PS I is extremely efficient. The results further demonstrated that energy transfer from PBS to PS I occurred directly and that efficient energy transfer was dependent upon the allophycocyanin-B alpha subunit, ApcD. In the absence of ApcD, cells were unable to perform state transitions and were trapped in state 1. Action spectra showed that light energy transfer from PBS to PS I was severely impaired in the absence of ApcD. An apcD mutant grew more slowly than the wild type in light preferentially absorbed by phyrobiliproteins and was more sensitive to high light intensity. On the other hand, a mutant lacking ApcF, which is required for efficient energy transfer from PBS to PS II, showed greater resistance to high light treatment. Therefore, state transitions in cyanobacteria have two roles: (1) they regulate light energy distribution between the two photosystems; and (2) they help to protect cells from the effects of light energy excess at high light intensities. (C) 2009 Elsevier B.V. All rights reserved.

The neural dynamics of stimulus and response conflict processing as a function of response complexity and task demands.

Both stimulus and response conflict can disrupt behavior by slowing response times and decreasing accuracy. Although several neural activations have been associated with conflict processing, it is unclear how specific any of these are to the type of stimulus conflict or the amount of response conflict. Here, we recorded electrical brain activity, while manipulating the type of stimulus conflict in the task (spatial [Flanker] versus semantic [Stroop]) and the amount of response conflict (two versus four response choices). Behaviorally, responses were slower to incongruent versus congruent stimuli across all task and response types, along with overall slowing for higher response-mapping complexity. The earliest incongruency-related neural effect was a short-duration frontally-distributed negativity at ~200 ms that was only present in the Flanker spatial-conflict task. At longer latencies, the classic fronto-central incongruency-related negativity 'N(inc)' was observed for all conditions, but was larger and ~100 ms longer in duration with more response options. Further, the onset of the motor-related lateralized readiness potential (LRP) was earlier for the two vs. four response sets, indicating that smaller response sets enabled faster motor-response preparation. The late positive complex (LPC) was present in all conditions except the two-response Stroop task, suggesting this late conflict-related activity is not specifically related to task type or response-mapping complexity. Importantly, across tasks and conditions, the LRP onset at or before the conflict-related N(inc), indicating that motor preparation is a rapid, automatic process that interacts with the conflict-detection processes after it has begun. Together, these data highlight how different conflict-related processes operate in parallel and depend on both the cognitive demands of the task and the number of response options.

Reaping the benefits: science and the sustainable intensification of global agriculture

Food security is one of this century’s key global challenges. By 2050 the world will require increased crop production in order to feed its predicted 9 billion people. This must be done in the face of changing consumption patterns, the impacts of climate change and the growing scarcity of water and land. Crop production methods will also have to sustain the environment, preserve natural resources and support livelihoods of farmers and rural populations around the world. There is a pressing need for the ‘sustainable intensifi cation’ of global agriculture in which yields are increased without adverse environmental impact and without the cultivation of more land. Addressing the need to secure a food supply for the whole world requires an urgent international effort with a clear sense of long-term challenges and possibilities. Biological science, especially publicly funded science, must play a vital role in the sustainable intensifi cation of food crop production. The UK has a responsibility and the capacity to take a leading role in providing a range of scientifi c solutions to mitigate potential food shortages. This will require signifi cant funding of cross-disciplinary science for food security. The constraints on food crop production are well understood, but differ widely across regions. The availability of water and good soils are major limiting factors. Signifi cant losses in crop yields occur due to pests, diseases and weed competition. The effects of climate change will further exacerbate the stresses on crop plants, potentially leading to dramatic yield reductions. Maintaining and enhancing the diversity of crop genetic resources is vital to facilitate crop breeding and thereby enhance the resilience of food crop production. Addressing these constraints requires technologies and approaches that are underpinned by good science. Some of these technologies build on existing knowledge, while others are completely radical approaches, drawing on genomics and high-throughput analysis. Novel research methods have the potential to contribute to food crop production through both genetic improvement of crops and new crop and soil management practices. Genetic improvements to crops can occur through breeding or genetic modifi cation to introduce a range of desirable traits. The application of genetic methods has the potential to refi ne existing crops and provide incremental improvements. These methods also have the potential to introduce radical and highly signifi cant improvements to crops by increasing photosynthetic effi ciency, reducing the need for nitrogen or other fertilisers and unlocking some of the unrealised potential of crop genomes. The science of crop management and agricultural practice also needs to be given particular emphasis as part of a food security grand challenge. These approaches can address key constraints in existing crop varieties and can be applied widely. Current approaches to maximising production within agricultural systems are unsustainable; new methodologies that utilise all elements of the agricultural system are needed, including better soil management and enhancement and exploitation of populations of benefi cial soil microbes. Agronomy, soil science and agroecology—the relevant sciences—have been neglected in recent years. Past debates about the use of new technologies for agriculture have tended to adopt an either/or approach, emphasising the merits of particular agricultural systems or technological approaches and the downsides of others. This has been seen most obviously with respect to genetically modifi ed (GM) crops, the use of pesticides and the arguments for and against organic modes of production. These debates have failed to acknowledge that there is no technological panacea for the global challenge of sustainable and secure global food production. There will always be trade-offs and local complexities. This report considers both new crop varieties and appropriate agroecological crop and soil management practices and adopts an inclusive approach. No techniques or technologies should be ruled out. Global agriculture demands a diversity of approaches, specific to crops, localities, cultures and other circumstances. Such diversity demands that the breadth of relevant scientific enquiry is equally diverse, and that science needs to be combined with social, economic and political perspectives. In addition to supporting high-quality science, the UK needs to maintain and build its capacity to innovate, in collaboration with international and national research centres. UK scientists and agronomists have in the past played a leading role in disciplines relevant to agriculture, but training in agricultural sciences and related topics has recently suffered from a lack of policy attention and support. Agricultural extension services, connecting farmers with new innovations, have been similarly neglected in the UK and elsewhere. There is a major need to review the support for and provision of extension services, particularly in developing countries. The governance of innovation for agriculture needs to maximise opportunities for increasing production, while at the same time protecting societies, economies and the environment from negative side effects. Regulatory systems need to improve their assessment of benefits. Horizon scanning will ensure proactive consideration of technological options by governments. Assessment of benefi ts, risks and uncertainties should be seen broadly, and should include the wider impacts of new technologies and practices on economies and societies. Public and stakeholder dialogue—with NGOs, scientists and farmers in particular—needs to be a part of all governance frameworks.

Forage mass production and grazing loss of sorghum hybrid in response to the density of the sowing and the spacing between planting lines

The objective of this experiment was to evaluate dry matter yield and loss of grazing due to animal trampling in response to sowing density and spacing between lines in the planting. Sorghum hybrid 1P400 was submitted to six treatments, composed of three sowing density combinations (12; 16 and 20 kg/ha of seeds) and two spacing between lines (0.40 and 0.80 m). Sorghum hybrid 1P400 was sowed in two seasons, at the end of spring (December 3rd, 2005) and the other at the end of summer (March 20th, 2006). Cultivation strategies influenced plant population in the two experimental seasons. Diameter of the stem in season 1 decreased with density increase, whereas in the second season, interaction between sowing density and spacing was significant. In the first season, 0.40-m spacing promoted greater losses due to grazing stepping, that is, 891 kg/ha of DM, whereas in the second season there was no statistical difference. There was no significant difference in forage dry matter yield in sowing densities among the two studied seasons. Dry mater production of sorghum hybrids 1P400 did not increase with the increase of the sowing density in the two sowing seasons, therefore it is recommended 12 kg/ha of seeds for the sowing. Sorghum IP400 cultivated in 0.80-m spacing resulted in lower forage loss caused by grazing bovine trampling. © 2011 Sociedade Brasileira de Zootecnia.

SPIRIT Women, evaluation of the safety and efficacy of the XIENCE V everolimus-eluting stent system in female patients: referral time for coronary intervention and 2-year clinical outcomes

SPIRIT Women is the first interventional trial dedicated exclusively to women, focusing on symptoms at presentation, referral time to coronary intervention and the safety and performance of the XIENCE V stent.

Table 2.- Bryozoa collected during the LAMPOS expeditions between Punta Arenas and the northernmost tip of the Antarctic Peninsula

The 78 bryozoan species collected by the German R/V "Polarstern" during the LAMPOS cruise in April 2002, encompassing the Scotia Arc archipelagos between Tierra del Fuego and the Antarctic Peninsula, were studied to discern the biogeographical patterns of the Magellan region of South America, the Scotia Arc archipelagos and the Antarctic. The resulting dendrogram shows three clusters: an isolated one with the three easternmost archipelagos and the other two linking some of the northern and southern Scotia Arc archipelagos with Tierra del Fuego. A more comprehensive analysis using all the species previously recorded from the Scotia Arc archipelagos and adjacent areas (214 spp.) produced a clearer zoogeographical pattern without isolated clusters of localities. The Antarctic Peninsula plus the Scotia Arc archipelagos form a large cluster distinct from the Magellan-Falkland Subantarctic area. A third analysis making use of 78 genera present in the study area plus Australia and New Zealand reinforces this pattern, showing two clusters: one uniting South America and the Australian-New Zealand realm and the other linking the Scotia Arc archipelagos with the Antarctic Peninsula. These results indicate that the Scotia Arc archipelagos represent merely a very narrow bridge connecting two different bryozoan faunas with only a few bryozoan species in common between the study areas.

The relationship of culturally responsive instruction and the reading comprehension and attitude of struggling urban adolescent readers

Culturally responsive instruction refers to the identification of relevant cultural aspects of students' lives and infusion of these into the curriculum. This instructional approach assumes that a culturally appropriate curriculum can potentially motivate, engage, and lead students to higher rates of achievement. This quasi-experimental study (N=44) investigated the relationship of culturally responsive instruction and the reading comprehension and attitude of struggling urban adolescent readers. The study incorporated the use of culturally responsive instruction using culturally relevant literature (CRL), the Bluford Series Novels, as authentic texts of instruction. Participants were seventh grade reading students at a Title I middle school in South Florida. After a baseline period, two different classes were taught for 8 weeks using different methods. One class formed the experimental group ( n=22) and the other class formed the comparison group (n =22). The CRI curriculum for the experimental group embraced the socio-cultural perspective through the use of small discussion groups in which students read and constructed meaning with peers through interaction with the Bluford Series Novels; gave written responses to multiple strategies according to SCRAP - Summarize, Connect, Reflect, Ask Questions, Predict; responded to literal and inferential questions, while at the same time validating their responses through evidence from the text. The Read XL (basal reader) curriculum of the comparison group utilized a traditional form of instruction which incorporated the reading of passages followed by responses to comprehension questions, and teacher-led whole group discussion. The main sources of data were collected from the Gates-MacGinitie Reading Tests, the Florida Assessments for Instruction in Reading (FAIR), and the Rhody Secondary Reading Attitude Assessment. Statistical analyses were performed using Repeated Measures ANOVAs. Findings from the study revealed that the experimental participants' reading attitudes and FAIR comprehension scores increased when compared to the comparison group. Overall, the results from the study revealed that culturally responsive instruction can potentially foster reading comprehension and a more positive attitude towards reading. However, a replication of this study in other settings with a larger, more randomized sample size and a greater ethnic variation is needed in order to make full generalizations.

The Relationship of Culturally Responsive Instruction and the Reading Comprehension and Attitude of Struggling Urban Adolescent Readers

Culturally responsive instruction refers to the identification of relevant cultural aspects of students’ lives and infusion of these into the curriculum. This instructional approach assumes that a culturally appropriate curriculum can potentially motivate, engage, and lead students to higher rates of achievement. This quasi-experimental study (N=44) investigated the relationship of culturally responsive instruction and the reading comprehension and attitude of struggling urban adolescent readers. The study incorporated the use of culturally responsive instruction using culturally relevant literature (CRL), the Bluford Series Novels, as authentic texts of instruction. Participants were seventh grade reading students at a Title I middle school in South Florida. After a baseline period, two different classes were taught for 8 weeks using different methods. One class formed the experimental group (n=22) and the other class formed the comparison group (n=22). The CRI curriculum for the experimental group embraced the socio-cultural perspective through the use of small discussion groups in which students read and constructed meaning with peers through interaction with the Bluford Series Novels; gave written responses to multiple strategies according to SCRAP – Summarize, Connect, Reflect, Ask Questions, Predict; responded to literal and inferential questions, while at the same time validating their responses through evidence from the text. The Read XL (basal reader) curriculum of the comparison group utilized a traditional form of instruction which incorporated the reading of passages followed by responses to comprehension questions, and teacher-led whole group discussion. The main sources of data were collected from the Gates-MacGinitie Reading Tests, the Florida Assessments for Instruction in Reading (FAIR), and the Rhody Secondary Reading Attitude Assessment. Statistical analyses were performed using Repeated Measures ANOVAs. Findings from the study revealed that the experimental participants’ reading attitudes and FAIR comprehension scores increased when compared to the comparison group. Overall, the results from the study revealed that culturally responsive instruction can potentially foster reading comprehension and a more positive attitude towards reading. However, a replication of this study in other settings with a larger, more randomized sample size and a greater ethnic variation is needed in order to make full generalizations.

A history of heart interventions moderates the relationship between psychological variables and the presence of chest pain in older women with self-reported coronary heart disease

Objectives: This study examines the hypothesis that a past history of heart interventions will moderate the relationship between psychosocial factors (stressful life events, social support, perceived stress, having a current partner, having a past diagnosis of depression or anxiety over the past 3 years, time pressure, education level, and the mental health index) and the presence of chest pain in a sample of older women. Design: Longitudinal survey over a 3-year period. Methods: The sample was taken from a prospective cohort study of 10,432 women initially aged between 70 and 75 years, who were surveyed in 1996 and then again in 1999. Two groups of women were identified: those reporting to have heart disease but no past history of heart interventions (i.e., coronary artery bypass graft/angioplasty) and those reporting to have heart disease with a past history of heart interventions. Results: Binary logistic regression analysis was used to show that for the women with self-reported coronary heart disease but without a past history of heart intervention, feelings of time pressure as well as the number of stressful life events experienced in the 12 months prior to 1996 were independent risk factors for the presence of chest pain, even after accounting for a range of traditional risk factors. In comparison, for the women with self-reported coronary heart disease who did report a past history of heart interventions, a diagnosis of depression in the previous 3 years was the significant independent risk factor for chest pain even after accounting for traditional risk factors. Conclusion: The results indicate that it is important to consider a history of heart interventions as a moderator of the associations between psychosocial variables and the frequency of chest pain in older women. Statement of Contribution: What is already known on this subject? Psychological factors have been shown to be independent predictors of a range of health outcomes in individuals with coronary heart disease, including the presence of chest pain. Most research has been conducted with men or with small samples of women; however, the evidence does suggest that these relationships exist in women as well as in men. What does this study add? Most studies have looked at overall relationships between psychological variables and health outcomes. The few studies that have looked at moderators have mainly examined gender as a moderator. To our knowledge, this is the first published study to examine a history of heart interventions as a moderator of the relationship between psychological variables and the presence of chest pain.