Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/ urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between ru-ral and urban patients with ACS. 

Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in‑hospital mortality of patients with the acute coronarysyndrome (ACS) according to their SES.

Methods: All patients admitted to Tehran Heart Center due to 1st‑time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low‑SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high‑SES patients. Demographic, clinical, paraclinical, and in‑hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in‑hospital mortality was evaluated.

Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low‑SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in‑hospital mortality of the ACS patients in that the high‑SES patients had a lower in‑hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094–0.980; P = 0.046).

Conclusions: This study found that patients with low SES were at a higher risk of in‑hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

I vårt debattinlägg betonade vi att psykisk ohälsa är ett vida utbrett problem och att patienter inte får effektiv hjälp eftersom det finns ett omfattande underskott på psykologer inom primärvården. Vi var kritiska till Centerpartiets vårdreform som riskerar medföra att problemet förvärras eftersom det inte skulle öka antalet psykologer vilka kan genomföra de behandlingar som Socialstyrelsen rekommenderar.

Abstract

INTRODUCTION

Stress symptoms, burnout, poor mental health and long-term sick leave related to these are major problems in Sweden and elsewhere. Evidence-based prevention and treatment efforts are lacking. Research indicates that stress related health problems primarily could be conceptualized as deficiencies in recovery responses between stress periods rather than high level of stress responses per se. Therefore it is relevant to examine whether it is effective to intervene the recovery behavior – instead of the stress behavior - of people with stress symptoms.

OBJECTIVES

The primary purpose of this study was to investigate if a behavioral oriented recovery management intervention could enhance “recovery behaviors” and experiences of recovery and reduce stress related ill health.

METHODS A group based intervention program focusing exclusively on “recovery behavior” in everyday life (earlier developed and tested in two pilot studies) was evaluated in an experimental group study. The intervention consisted of seven group sessions of 2.5 hours over a period of approximately 10 weeks supplemented by an internet based treatment support system. Self- referred subjects with scores above 24.4 on the Perceived stress scale were randomized to the intervention (n=26) or a waiting-list (n=33).

RESUL T

Statistically significant and clinically relevant effects were achieved for the intervention group compare to the waiting-list group: recovery behaviors and experiences of recovery were increased, and levels of perceived stress, worry, anxiety, depression and exhaustion were decreased.

DISCUSSION These results are in line with two previous pilot studies that we have done. A behavioral and recovery oriented intervention seems to be effective to increase the recovery of the individual and decrease stress related ill health. There are reasons to continue to explore the potential of recovery-oriented interventions for example for different populations (such as people with more extensive clinical health problems) and in different contexts. 

Continuous and prolonged exposure to stressors or unsuccessfully dealing with such exposure has been suggested as precursors for burnout. Current research indicates that such stress problems could be conceptualized as deficiencies in recovery between periods of stress. The purpose of this study was to evaluate the efficacy of a behaviorally oriented stress recovery management intervention for people experiencing high levels of stress. A total of 73 individuals with experiences of stress symptoms and high levels of perceived stress (≥ 25 on the Perceived Stress Scale) were randomly allocated to either a 10-week intervention group or a waiting-list control group. Participants were assessed at preintervention, postintervention, and 3-month follow-up. The Perceived Stress Scale, questions about tension, and the Shirom–Melamed Burnout Questionnaire were used as primary outcome measures, and the Hospital Anxiety and Depression Scale was used as a secondary outcome measure. Data were analyzed following the intention-to-treat principle. The analysis demonstrated statistically significant improvements for all measures at posttreatment and at follow-up. The between-groups effect sizes were high at posttreatment and moderate–to-high at follow-up. Intervention focused on stress recovery behavior seems to be an effective way of reducing perceived stress, tension, burnout symptoms, anxiety, and depression in people with stress symptoms and high levels of perceived stress in everyday life. The tested intervention warrants further research. Other stress recovery behavior interventions need to be tested to draw conclusions on the efficacy of stress recovery behavior interventions in general regarding stress and burnout.

Recent research has indicated that recovery from work stress and effort might be crucial for health and well-being. Thus, a valid measurement of recovery becomes important. The main purpose of the present study was to empirically evaluate and seeking support for the hypothesized four-factor model of the Swedish version of Recovery Experience Questionnaire (REQ). The total sample (N = 680) was randomly split into two subsamples. The first subsample was used for finding the best-fitting model using an exploratory factor analysis and the second subsample was used to test the a priori model using confirmatory factor analysis. The results support the proposed four-factor structure of the scale for both males and females. Additionally, apart from high reliability estimates, this instrument proved to have good convergent and discriminant validity for all four factors. Implications for the use of the REQ in conjunction with recovery-focused interventions were discussed, as were limitations such as low response rate. 

Background: Continuous and prolonged exposure to stressors or unsuccessfully dealing with such exposure has been suggested as precursors for burnout. Current research indicates that such stress problems could be conceptualized as deficiencies in recovery between periods of stress. The purpose of this study was to evaluate the efficacy of a brief stress-recovery behavior intervention for people experiencing high levels of stress. Method: Seventy-three individuals with experiences of stress symptoms and high levels of perceived stress (≥ 25 on the Perceived Stress Scale) were randomly allocated to either a 12-week intervention group (INT) or a waiting list control group (WLC). Participants were assessed at pre-intervention, post-intervention and at 3-month follow-up. Data, including indices of Heart Rate Variability (HRV), Perceived stress scale (PSS), questions about tension, Shirom-Melamed Burnout Questionnaire (SMBQ), and the Hospital Anxiety and Depression Scale (HADS) as a secondary outcome measure, will be analyzed and presented following the intention-to-treat principle.

Background:  Stress problems could be conceptualized as deficiencies in recovery between periods of stress and research indicates that recovery from work stress and effort might be crucial for health and well-being. The purpose of this study was to evaluate the efficacy of a behaviorally oriented stress-recovery management intervention for people with high levels of perceived stress on different recovery experiences.

Method: 73 individuals with high levels of perceived stress (>24.4 on Perceived Stress Scale) were randomly allocated to either a 10-week intervention group or a waiting list control group. Participants were assessed at pre-intervention, immediately after the intervention, and 3-month after the end of the intervention. The outcome measures were the four dimensions of the Recovery Experiences Questionnaire (REQ): relaxation, mastery, control and psychological detachment. For analysis the intention-to-treat principle was used.

Results: Preliminary analysis indicated positive results on measurements of different recovery dimensions of this brief intervention.

The present study was conducted in order to investigate treatment effects in spider phobic individuals on EEG and eye movements. A previous study has shown larger ERP amplitudes in the late positive complex (LPC) post treatment compared to pre treatment during exposure of spider pictures (Leutgeb, Schäfer, & Schienle, 2009). The authors hypothesize that the result might mirror an increase in attention towards the stimuli and reduced attentional avoidance generating enhanced LPC amplitude as a consequence of directing attention to the spider pictures post treatment. In the present study spider fearful individuals (treatment and waitlist group) and control individuals were measured with EEG and Eye tracking during exposure to pictures of spiders, snakes and flowers pre and post treatment. Based on behavioral and self-assessed measures treatment effects were high. Contrary to Leutgeb et al. (2009), our results showed relatively smaller LPC amplitudes post treatment during presentations of spider pictures. Moreover, the eye movement data indicated no avoidance from spider pictures compared to other pictures, neither pre nor post treatment. These results indicate that when individuals attend to visual threat stimuli, LPC amplitude differences follow the pattern of emotional significance and attention allocation.

Many people experience distress from memories of adverse events, so called trauma memories. Trauma interventions are often long and expensive and not easily accessible to, for example, people with sub clinical symptoms or refugees. Based on findings in neurocognitive basic research, a brief method to remedy symptoms related to trauma memories has been developed. The method consists of a one hour psychoeducative session in which individuals learn about distressing traumatic memories and how to handle them. The method aims to teach a way to deploy brain resources during reactivation of a memory in order to reduce fear and anxiety at reconsolidation. Nineteen individuals with difficult and distressing memories participated in a pilot trial. In a one hour session, participants were tought the method and basic knowledge about underlying brain functioning. They were instructed to practice the method during the following week. Pre, post (+1 week), and follow up (+ 5 weeks) measures of symptoms of posttraumatic stress, depression, and anxiety, showed significant decrease on all three scales with a persistant decrease at follow up. In general, results indicate that brief treatment methods can help results indicate that briefer methods can help people suffering from trauma memories.

Influences of a concurrent cognitive demand on allocation of attentional resources and physiological responses to threatening stimuli was investigated. In two secondary task experiments, pictures of fear-relevant and fear-irrelevant stimuli (Experiment 1), as well as feared and non-feared stimuli (Experiment 2), were used as backgrounds in a discrimination task. The cognitive manipulation was provided by a constraint, induced with a threat of punishment motivating participants to respond quick and accurately. The control condition imposed no such constraint. Results showed a larger allocation of attentional resources for both fear-relevant and feared stimuli. More importantly, it was also shown that resources allocated to threatening stimuli could be manipulated by a concurrent cognitive demand. However, both response accuracy and physiological reactions persisted the manipulation when a feared versus a non-feared animal was shown, indicating that attentional resources can be manipulated by an internal cognitive demand even though a fear reaction occurs.

In two visual search experiments, the impact of distractor sets on fear relevant stimuli was investigated.  A search set with spiders, snakes, flowers, and mushrooms was compared to a search set with spiders, snakes, rabbits, and turtles. Speeded responses to spider and snake targets were found when flowers and mushrooms served as distractors, but no such effect occurred with rabbit and turtle distractors. In Experiment 2, spider sensitive individuals were compared to non-fearful individuals. Spider sensitive individuals responded faster to spider targets than did non-fearful individuals, but only in the set with flowers and mushrooms.  When using rabbit and turtle distractors, spider sensitive individuals did not show any speeded responses to their feared animal. These results indicate that behavioural expressions of the visual search task depends not only on the individual’s relationship to the stimuli included in a search set, but also on the context in which feared or fear relevant objects are presented.

Objectives: Due to the frequent use of coronary angiography the awareness of Takotsubo stress cardiomyopathy (TSC) has increased although the exact pathophysiology of TSC is still largely unknown. Our objective was to investigate the effects of mental stress on myocardial function, heart rate variability (HRV) and salivary cortisol (SC) in TSC patients. Design: This study is a case-control study and a sub-study of the Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study. Setting: Mental stress test was performed more than 6 months after the acute event in TSC patients and age- and sex-matched controls. Standard echocardiography and tissue Doppler imaging (TDI) - derived time-phases of cardiac cycle were recorded to calculate myocardial performance index (MPI) to assess ventricular function before and during mental stress. Holter-ECG recording was made to estimate HRV before, during and after mental stress. SC was measured at baseline, before and 20 minutes after mental stress. Subjects: Twenty-two TSC patients and 22 sex-and age- matched controls were recruited from the SMINC-study and investigated with a mental stress test. All TSC patients had a previous normal cardiovascular magnetic resonance investigation. Results: There were no significant differences at rest or during mental stress for left and right ventricular MPI or other standard diastolic variables between TSC patients and controls. HRV did not differ between TSC patients and controls. There was a trend towards less increase in SC after mental stress in TSC patients compared to controls. Conclusion: Mental stress did not induce a significant difference in myocardial function or HRV response between TSC and controls. Moreover, no significant difference could be seen in SC response at baseline, during or after mental stress. This study indicates that myocardial vulnerability to mental stress does not persist in TSC patients.

Objectives

This work explores the association between socio-economic position (SEP) and intimate partner violence (IPV) considering the perspectives of men and women as victims, perpetrators and as both (bidirectional).

Study design

Cross-sectional international multicentre study.

Methods

A sample of 3496 men and women, (aged 18–64 years), randomly selected from the general population of residents from six European cities was assessed: Athens; Budapest; London; Östersund; Porto; and Stuttgart. Their education (primary, secondary and university), occupation (upper white collar, lower white collar and blue collar) and unemployment duration (never, ≤12 months and >12 months) were considered as SEP indicators and physical IPV was measured with the Revised Conflict Tactics Scales.

Results

Past year physical IPV was declared by 17.7% of women (3.5% victims, 4.2% perpetrators and 10.0% bidirectional) and 19.8% of men (4.1% victims, 3.8% perpetrators and 11.9% bidirectional). Low educational level (primary vs university) was associated with female victimisation (adjusted odds ratio, 95% confidence interval: 3.2; 1.3–8.0) and with female bidirectional IPV (4.1, 2.4–7.1). Blue collar occupation (vs upper white) was associated with female victimisation (2.1, 1.1–4.0), female perpetration (3.0, 1.3–6.8) and female bidirectional IPV (4.0, 2.3–7.0). Unemployment duration was associated with male perpetration (>12 months of unemployment vs never unemployed: 3.8; 1.7–8.7) and with bidirectional IPV in both sex (women: 1.8, 1.2–2.7; men: 1.7, 1.0–2.8).

Conclusions

In these European centres, physical IPV was associated with a disadvantaged SEP. A consistent socio-economic gradient was observed in female bidirectional involvement, but victims or perpetrators-only presented gender specificities according to levels of education, occupation differentiation and unemployment duration potentially useful for designing interventions.

Abstract

Purpose

Little is known on the specific relation between

being a perpetrator or both a victim and perpetrator of

intimate partner violence (IPV) and health-related quality

of life (HRQoL). We assessed the association between

HRQoL and abuse, considering men and women as victims,

perpetrators or reciprocally.

Methods

Participants were adult men and women

(

n=

3,496), randomly selected from the general population

of six European cities. The Revised-Conflict-Tactics-Scales

and the Medical-Outcomes-Study 36-item Short-Form

Health Survey (SF-36) were used to measure IPV and

HRQoL. The age-, education-, and city-adjusted mean

scores[standard error] of the physical and of the mental SF-

36 component summaries were used to compare victimsonly,

perpetrators-only, and those involved in both (bidirectional

or reciprocal cases) with those not involved in pastyear

and lifetime physical assault and/or sexual coercion.

Results

The physical component summary was significantly

lower in women involved in past-year bidirectional

physical assault compared with non-abused women. The

mental component summary in women not involved in IPV

was significantly higher than in those physically abused,

regardless of type of involvement. Women victims-only of

past-year sexual coercion and victims or involved in bidirectional

concomitant physical and sexual IPV also presented

lower scores in the mental component summary than

women not involved in IPV. In men, significantly lower

scores in the mental component summary were found in the

past-year bidirectional physically assaulted group and

among those involved bidirectionally in both physical and

sexual IPV compared with men not involved in IPV.

We aimed to assess intimate partner violence (IPV) among men and women from six cities in six European countries.

Four IPV types were measured in a population-based multicentre study of adults (18-64 years; n = 3,496). Sex- and city-differences in past year prevalence were examined considering victims, perpetrators or both and considering violent acts' severity and repetition.

Male victimization of psychological aggression ranged from 48.8 % (Porto) to 71.8 % (Athens) and female victimization from 46.4 % (Budapest) to 70.5 % (Athens). Male and female victimization of sexual coercion ranged from 5.4 and 8.9 %, respectively, in Budapest to 27.1 and 25.3 % in Stuttgart. Male and female victims of physical assault ranged from 9.7 and 8.5 %, respectively, in Porto, to 31.2 and 23.1 % in Athens. Male victims of injury were 2.7 % in A-stersund and 6.3 % in London and female victims were 1.4 % in A-stersund and 8.5 % in Stuttgart. IPV differed significantly across cities (p < 0.05). Men and women predominantly experienced IPV as both victims and perpetrators with few significant sex-differences within cities.

Results support the need to consider men and women as both potential victims and perpetrators when approaching IPV.

BACKGROUND:

To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both.

METHODS:

This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18-64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare ('Have you been in need of a certain care service in the past year, but did not seek any help?'). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain.

RESULTS:

Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02-1.70).

CONCLUSION:

IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake.

Background: Victims of intimate partner violence (IPV) are known to refrain from seeking care when in need. Whether the impact on forgone care differs according to the victim-perpetrator role remains unexplored. We aimed to describe the relation between past-year IPV and forgone healthcare according to victims, perpetrators or both (bidirectional). Methods: Adult men and women (n=3496, aged 18-64), randomly sampled from the general population of Athens, Porto, London, Budapest, Östersund and Stuttgart were assessed using a common questionnaire. IPV was ascertained with the Revised-Conflict-Tactics-Scales. The association between IPV and forgone healthcare (“Have you been in need of a certain care service in the past year, but did not seek any help?”), sociodemographics (sex, age, education, city) and health factors (self-assessed health, public or private healthcare sector use), in victims, perpetrators and both was estimated using adjusted logistic regression odds ratios (AOR, 95% confidence intervals). Results: Forgone healthcare ranged from 12.6% (Budapest) to 22.4% (Stuttgart) and was associated with bidirectional involvement in IPV (AOR, 95%CI= 1.37, 1.05-1.78). A lower educational level was associated with forgone care in multivariate models fitted for victims of and for bidirectional involvement in IPV. A fair/poor self-assessed health (contrasting to a good/very good/excellent health) was significantly associated with forgone care in victims (AOR, 95%CI=2.61, 1.96-3.47), in bidirectional IPV (AOR, 95%CI=2.94, 2.27-3.82) and for perpetrators (AOR, 95%CI=2.58, 1.96-3.40). Conclusion: Beside the known barriers identified for inequalities and access to healthcare, the role of IPV in forgone healthcare should be considered.

Objective To describe the design, methods, procedures and characteristics of the population involved in a study designed to compare Intimate Partner Violence (IPV) in eight European countries.

Methods Women and men aged 18–65, living in Ghent-Belgium (n = 245), Stuttgart-Germany (n = 546), Athens-Greece (n = 548), Budapest-Hungary (n = 604), Porto-Portugal (n = 635), Granada-Spain (n = 138), Östersund-Sweden (n = 592), London-United Kingdom (n = 571), were sampled and administered a common questionnaire. Chi-square goodness of fit and five-age strata population fractions ratios for sex and education were computed to evaluate samples' representativeness.

Results Differences in the age distributions were found among women from Sweden and Portugal and among men from Belgium, Hungary, Portugal and Sweden. Over-recruitment of more educated respondents was noted in all sites.

Conclusion The use of a common research protocol with the same structured questionnaire is likely to provide accurate estimates of the general population IPV frequency, despite limitations in probabilistic sampling and restrictions in methods of administration.

Background: Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries. Methods: We included 99 patients with myocardial infarction with non-obstructive coronary arteries together with age- and sex-matched control groups who completed the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) 3 months after the acute event. Results: Using the Beck Depression Inventory, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (35%) was higher than in healthy controls (9%; P =.006) and similar to that of patients with coronary heart disease (30%; P =.954). Using the HADS anxiety subscale, we found that the prevalence of anxiety in patients with myocardial infarction with non-obstructive coronary arteries (27%) was higher than in healthy controls (9%; P =.002) and similar to that of patients with coronary heart disease (21%; P =.409). Using the HADS depression subscale, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (17%) was higher than in healthy controls (4%; P =.003) and similar to that of patients with coronary heart disease (13%; P =.466). Patients with myocardial infarction with non-obstructive coronary arteries and takotsubo syndrome scored higher on the HADS anxiety subscale than those without (P =.028). Conclusions: This is the first study on the mental health of patients with myocardial infarction with non-obstructive coronary arteries to show that prevalence rates of anxiety and depression are similar to those in patients with coronary heart disease. 

Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA), including Takotsubo syndrome (TS), are considered to have a better survival compared with those with coronary heart disease (CHD). Studies of patients with MINOCA measuring physical and mental function including matched control groups are lacking. The aim of this study was to determine the physical capacity and quality of life in patients with MINOCA. One-hundred patients with MINOCA along with TS (25%) were investigated from 2007 to 2011. A bicycle exercise stress test was performed 6 weeks after hospitalization and QoL was investigated by the Short Form Survey 36 at 3 months' follow-up. Both a healthy and a CHD group that were age and gender matched were used as controls. The MINOCA group had a lower physical capacity (139 ± 42 W) compared with the healthy control group (167 ± 53 W, p <0.001) but better than the CHD control group (124 ± 39 W, p = 0.023). Patients with MINOCA had lower physical and mental component summary scores compared with the healthy controls (p <0.001) and lower mental component summary (p = 0.012), mental health (p = 0.016), and vitality (p = 0.008) scores compared with the CHD controls. In conclusion, the findings of this first study on exercise capacity and QoL in patients with MINOCA showed both physical and mental distress from 6 weeks to 3 months after the acute event similar to CHD controls and in some perspectives even lower scores especially in the mental component of QoL.

Objectives: To assess whether city-level characteristics influence the risk of intimate partner violence (IPV) victimization across six European cities. Methods: The DOVE study included 3496 participants from Athens–Greece, Budapest–Hungary, London–UK, Östersund–Sweden, Porto–Portugal and Stuttgart–Germany. IPV victimization was assessed using the Revised Conflict Tactics Scales, and several contextual variables were included: GINI coefficient, gender equality index, an index of social support, unemployment rate and proportion of residents with tertiary education. Multilevel models were fitted to estimate the associations (odds ratio, 95% confidence intervals) between each type of victimization and contextual and individual-level variables. Results: 62.3% of the participants reported being a victim of IPV during the previous year, with large between-city differences (53.9%–72.4%). Contextual variables accounted for a substantial amount of this heterogeneity. Unemployment rates were associated with psychological (1.05, 1.01–1.08) and physical IPV (1.07, 1.01–1.13). GINI coefficient showed a positive association with any form of IPV (1.06, 1.01–1.11) and sexual coercion (1.13, 1.01–1.25). Conclusions: We found significant associations between contextual determinants and IPV, which emphasizes the importance of considering contextual socioeconomic conditions when policy measures are designed to address IPV. 

Background

Social support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV).

Objective

This study aimed at assessing the association between social support and the IPV victimization among adults from six European countries.

Methods

This is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18–64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support.

Results

Participants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P< 0.001, for women; and 67.1 ± 13.69 versus 69.5 ± 13.52, P = 0.002 for men. Similar results were found regarding sexual coercion victimization, 69.1 ± 14.03 versus 71.3 ± 12.97, P = 0.005 for women and 68.0 ± 13.29 versus 69.3 ± 13.62, P= 0.021 for men. This study revealed lower levels of social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors.

Conclusion

Results showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.

Social support may encourage victims to disclose their experiences of intimate partner violence (IPV), but also to seek the appropriate help and care in the social and health services. Using data from a multicenter European project, DOVE (Domestic Violence Against women/men in Europe-prevalence, determinants, effects, and policies/practices), the present study aimed at measuring the frequency of primary care and emergency use according to IPV types of victimization, and to investigate whether victims receiving different levels of informal social support are using health care differently. Results suggested a significant association between IPV types and use of emergency services, and no association was found regarding primary care services. Victims of physical abuse and sexual coercion went to the emergency department (ED) more frequently (more than once a year). Also, victims of physical abuse receiving low social support visited an ED more frequently than those with high social support, whereas victims of sexual coercion with high informal social support went more often to the ED compared with victims of sexual coercion with low social support, even after controlling for other covariates. These results seem to suggest that social support has a significant role in the decision to use health care among victims of IPV. 

The ability to adjust to a changing environment is an important aspect of every-day life and successful goal directed behavior requires the ability to suppress responses that are no longer appropriate. The main purpose of the present study was to examine if the relationship between inhibitory control (as indexed by stop-signal reaction time, SSRT) and behavioral precision is dependent on levels of Gray and McNaughton's Behavioral Inhibition System (BIS). Additionally, the relationship between BIS and electrodermal activity, and the Behavioral Approach System (BAS) and heart rate activity was investigated. A modified stop-signal task was used. The results showed that there was an interaction effect of BIS and SSRT on accuracy, suggesting that among individuals with higher levels of BIS, longer SSRT (i.e. poorer inhibitory ability) was associated with decreased accuracy. There were no significant correlations between trait variables and physiological variables. The results were discussed in terms of higher levels of BIS being a vulnerability factor when the individual's inhibitory ability simultaneously is poor in situations where the ability to inhibit inappropriate behavioral routines is important for task performance.

The reinforcement sensitivity theory of personality questionnaire (RST-PQ) is based on a theoretical analysis of the revised reinforcement sensitivity theory. Using a Swedish sample stratified by age and gender, the aim of this study was to test the six-factor structure of a Swedish version of the RST-PQ. Further, we examined the convergent and discriminant validity of the questionnaire. The results of the confirmatory factor analysis showed that the Swedish version did not fully provide support for the six-factor structure. An attempt to improve the model fit resulted in a significantly better model fit for a six-factor structure containing 52 items. Issues concerning the convergent validity were found, as indicated by all six factors having more than 50% of the variance due to error. The discriminant validity was satisfactory for all factors, except for goal-drive persistence and reward interest, which were highly correlated. This indicates a non-independence between these two factors in the model. Nevertheless, the RST-PQ has considerable promise and more emphasis should be put on investigating the convergent validity by using for example broader samples, stratified by country of origin, age, and gender. 

Background: The objective of this study was to revisit the question concerning whether athletes are better than non-athletes at fundamental cognitive abilities, such as inhibitory control, in addition to also focusing on motivational dispositions and possible sex differences. Adding the latter could be crucial since both inhibitory control and motivational dispositions, such as approach and avoidance, are central to goal-directed behavior. Methods: This study’s sample was composed of 93 participants (40 males): 29 biathletes; 30 alpine skiers; and 34 non-athletes. A non-sport-specific stop-signal task was used for the assessment of inhibitory control in terms of response inhibition, and the motivational dispositions were assessed with the BIS/BAS scales. Results: The results showed that there were no differences between the two different sports or non-athletes with regard to response inhibition. However, females showed significantly slower response inhibition than males (p = 0.018) and scored significantly higher on the trait variable BIS (p < 0.001). Conclusions: The results from this study suggest that it might be meaningful to explore the contribution of sex differences and motivational dispositions on response inhibition in conjunction with different types of sports. 

Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

Design Cross-sectional case-control.

Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

Design Cross-sectional case-control.

Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

DesignThe study has a cross-sectional case-control design.

SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.

Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

Background Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters.

Materials and methods The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires.

Results The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect.

Conclusion Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

Objective

Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).

Methods

In cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.

Results

In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.

Conclusions

Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.

Body dissatisfaction is an important factor in the development and maintenance ofeating disorders. The comparison with the thin ideal prevalent in different mediachannels, can be one of the factors that contribute to widespread of dissatisfaction withthe own body. Thus, even people not meeting the criteria for eating disorders, mightshow a very problematic way to cope with their body and food intake. The present studyaimed to investigate the attentional pattern evoked when young women were exposed topictures of female bodies varying in their body shape.Eighty-one women, aged 18 to 37 years, viewed a series of pictures, each onecontaining four photos of women. The photos were generated and manipulated digitallyin order to get different body shapes, ranging from a slim to a heavy body shape. Thephotos were exposed in a 2x2 array during 4 seconds. Body Shape Questionnaire wasused to divide participants into two groups; high and low body dissatisfaction. Thedirection and fixation of the gaze were recorded continuously by means of an eyetracker.In general, an attentional bias in the body dissatisfaction group was observed, i.e.,women looked longer to the slimmest picture in the array. Women in the control group(low body dissatisfaction) showed distributed attention to the four body shapes.These results suggest promising possibilities of using ocular tracking tests in the earlydetection of symptoms associated with eating disorders, and perhaps possibilities ofimproving clinical and preventive interventions.

Regeringens rehabiliteringsgaranti kan få förödande konsekvenser för tilltron till kognitiv beteendeterapi som behandlingsmetod och för den enskilda patienten som tror sig få KBT av en kompetent behandlare. Orsaken är regeringens lågt ställda krav på behandlarnas kompetens. Rehabiliteringsgarantin bör omformuleras, anser nio KBT-företrädare.

Background: To explore if health related quality of life(HRQoL) increased after traditional yoga(TY), mindfulness based cognitive therapy(MBCT), or cognitive behavioral therapy(CBT), in patients on sick leave because of burnout. Methods: Randomized controlled trial, blinded, in ninety-four primary health care patients, block randomized to TY, MBCT or CBT (active control) between September 2007 and November 2009. Patients were living in the Stockholm metropolitan area, Sweden, were aged 18-65 years and were on 50%-100% sick leave. A group treatment for 20 weeks, three hours per week, with homework four hours per week. HRQoL was measured by the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, each with a separate index, and scores from 0 (worse) to 100 (best). SWED-QUAL covers aspects of physical and emotional well-being, cognitive function, sleep, general health and social and sexual functioning. Statistics: Wilcoxon's rank sum and Wilcoxon's sign rank tests, Bonett-Price for medians and confidence intervals, and Cohen's D. Results: Twenty-six patients in the TY (21 women), and 27 patients in both the MBCT (24 women) and in the CBT (25 women), were analyzed. Ten subscales in TY and seven subscales in MBCT and CBT showed improvements, p <0.05, in several of the main domains affected in burnout, e.g. emotional well-being, physical well-being, cognitive function and sleep. The median improvement ranged from 0 to 27 points in TY, from 4 to 25 points in CBT and from 0 to 25 points in MBCT. The effect size was mainly medium or large. Comparison of treatments showed no statistical differences, but better effect (small) of both TY and MBCT compared to CBT. When comparing the effect of TY and MBCT, both showed a better effect (small) in two subscales each. Conclusions: A 20 week group treatment with TY, CBT or MBCT had equal effects on HRQoL, and particularly on main domains affected in burnout. This indicates that TY, MBCT and CBT can be used as both treatment and prevention, to improve HRQoL in patients on sick leave because of burnout, reducing the risk of future morbidity.