Mittuniversitetet

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: 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. 

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:  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 major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A(1c)), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH. Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A(1c) measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs. Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, self-monitoring) were significantly associated with FOH but R (2) increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetes-related anxiety, hypoglycemia history, self-monitoring, and glycemic control. There is a strong link between FOH and non-diabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions.

Of the many of Information and Communication Technology (ICT) products, electronic games are considered as having great potential for improving health and social outcomes. This chapter considers the factors that may be involved in facilitating health and social outcomes and also those factors that might be considered risk factors by reviewing studies that have shown both positive and detrimental effects on people's physical and mental health. The authors also debate some research questions that remain unanswered and suggest guidelines for practitioners, researchers, and game designers.

Objective: The present experiment analyzed the effects of playing a violent video game on player’s sensitivity to victimized people by measuring the involuntary pupil dilation responses (PDRs) during a passive picture viewing paradigm and examining the mediating role of PDR on aggression. Method: Participants (N = 135) were randomly assigned to play a violent video game or a nonviolent video game. The participants’ PDRs were then recorded while they were exposed to pictures of alleged victims of violence displayed in negative, neutral, and positive contexts. A competitive reaction time task was also used to measure aggression. Results: Participants in the violent game condition demonstrated both a lower PDR to the victims of violence in a negative circumstances and greater aggression than participants in the nonviolent game condition. Lower PDR to victims displayed in negative context mediated the relationship between violent game play and aggression. Conclusion: The negative effects of playing violent games are a societal concern. Our results indicate that a single violent gaming session can reduce the player’s involuntary PDRs to pictures of victimized people in negative context and increase participant aggression, a new relevant finding that should encourage further research in this area.

The present study examined whether eye movements when regarding pictures of other people in fortunate (positive) and unfortunate (negative) circumstances are influenced by background music. Sixty-three participants were randomly assigned to three background music conditions (happy music, sad music, or no music) where pairs of negative-positive pictures were shown. Participants' eye movements were recorded throughout the experiment to assess distinct phases of attentional processes, i.e., initial orienting to, and subsequent engagement with, visual scenes. We found that these attentional processes were not uniformly influenced by the music. The type of background music had no effect on initial visual attention but played a relevant role in guiding subsequent gaze behaviour by maintaining attention in a mood-congruent fashion: sad music enhanced attentional bias to visual images of others in unfortunate circumstances, whereas happy music contributed to longer gazes at images of others in fortunate circumstances. These results support the notion that attention is affected by background music and reflected by gaze behaviour.

This chapter gives a comprehensive state-of-the-art review on the effects that exposure to or enactment of violence in mainstream media has on aggressive behavior, emotions, and empathy. In line with contemporary technological developments, the authors also cover the more and more widespread consumption of violent video games, which put the player in a more active role than traditional media (such as television) put their viewers. As the field is extremely controversial, the authors are careful in their analysis of the actually existing evidence as well as in their conclusions and recommendations for future research. Despite all controversy, and after reviewing existing literature, as well as a large number of own empirical work, the authors come to the conclusion that there is evidence for increased aggressive motivation and impulsivity as a result of exposure to media violence, but that it is not clear yet how much it affects people’s real-life behavior. Nevertheless, it is clear that there is no evidence for cathartic effects, a conclusion that is similar in research on the effects of filmed violence, and an idea that had been present in the controversy for decades but can now be abandoned.

The alerting effects of both caffeine and short wavelength (blue) light have been consistently reported. The ability of blue light to enhance alertness and cognitive function via non-image forming neuropathways have been suggested as a non-pharmacological countermeasure for drowsiness across a range of occupational settings. Here we compare and contrast the alerting and psychomotor effects of 240 mg of caffeine and a 1-h dose of similar to 40 lx blue light in a non-athletic population. Twenty-one healthy subjects performed a computer-based psychomotor vigilance test before and after each of four randomly assigned trial conditions performed on different days: white light/placebo; white light/240 mg caffeine; blue light/placebo; blue light/240 mg caffeine. The Karolinska Sleepiness Scale was used to assess subjective measures of alertness. Both the caffeine only and blue light only conditions enhanced accuracy in a visual reaction test requiring a decision and an additive effect was observed with respect to the fastest reaction times. However, in a test of executive function, where a distraction was included, caffeine exerted a negative effect on accuracy. Furthermore, the blue light only condition consistently outperformed caffeine when both congruent and incongruent distractions were presented. The visual reactions in the absence of a decision or distraction were also enhanced in the blue light only condition and this effect was most prominent in the blue-eyed participants. Overall, blue light and caffeine demonstrated distinct effects on aspects of psychomotor function and have the potential to positively influence a range of settings where cognitive function and alertness are important. Specifically, despite the widespread use of caffeine in competitive sporting environments, the possible impact of blue light has received no research attention.