Dissertations / Theses on the topic 'Coronary heart disease Complications Prevention'
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1
Bose, Jolly. "Percutaneous transluminal coronary angioplasty (PTCA) in the treatment of coronary artery disease in Hong Kong : procedural success, complications and long-term follow-up /." Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2084282X.
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Leong, Yuk-yan Pauline, and 梁玉恩. "The effectiveness of exercise-based cardiac rehabilitation program for secondary prevention of coronary heart disease : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193828.
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Objective: To examine the effect of exercise-based cardiac rehabilitation program for secondary prevention of coronary heart disease on cardiac-related mortality, recurrent cardiovascular event and quality of life.
Methods: All studies published between 1990 and 2013 in PubMed, and from 1980 to 2013 in EMBASE, which evaluated the effectiveness of exercise-based cardiac rehabilitation program for coronary heart disease. Using the specific keywords “Cardiac rehabilitation”, “Coronary heart disease” OR “Ischemic heart disease” [MeSH], “Exercise” OR “Physical activities” AND “Quality of life” OR “Mortality” AND Cardiovascular events” were searched. A total of 7randomized controlled trials out of 5,051articles from PubMed and 117 articles from EMBASE were included in this systematic review. The primary outcome measures used in the included seven studies were HRQOL, restenosis, cardiac event, cardiac related mortality. Similar demographic and clinical characteristics of the subjects between the intervention and the control groups were recorded. The studies were from five countries. The average age of the subjects in the seven studies was 61years, the average half of them have history of myocardial infarction. Though there were discrepancies among the results generated in the included studies, the potential benefits of exercise-based cardiac rehabilitation could be seen.
Results: Compared with the non-exercise-based cardiac rehabilitation, patients allocated to the exercise-based cardiac rehabilitation program had greater improvement in HRQOL and reduction of cardiac events. The result of reducing restenosis was inconsistent. The cardiac related mortality is not significant difference between exercise-based and non-exercise-based cardiac rehabilitation.published_or_final_version
Public Health
Master
Master of Public Health
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Ashton, Emma Louise, and emma ashton@deakin edu au. "Effects of dietary constituents on coronary heart disease risk factors." Deakin University. School of Biological and Chemical Sciences, 2000. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20061207.153511.
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Coronary Heart Disease (CHD) is a major cause of death in Western countries. Mediterranean and Asian populations have a lower risk of death from CHD compared to Westernised population, as do vegetarian versus omnivorous populations. Dietary constituents of traditional diets consumed by these populations are thought to influence both the classical risk factors for CHD, and the more recently identified risk factors, such as oxidative modification of low density lipoprotein (LDL), LDL particle size, arterial compliance and haemostatic factors. The aim of this thesis was to examine the effects of several food components, particularly soybean and monounsaturated fat (MUFA), on CHD risk factors through 3 carefully controlled dietary interventions, and a cross-sectional study.
A randomised crossover dietary intervention study was conducted in 42 healthy males to investigate the effect on CHD risk factors of replacing lean meat with tofu, a soybean product regularly consumed by Asian populations, while controlling all other dietary factors. The tofu diet resulted in significantly lower total cholesterol and triacylglycerol levels compared to the lean meat diet, and LDL particles that were more resistant to in vitro oxidative modification. However, insulin, fibrinogen, factor VII, and lipoprotein (a) were not significantly different on the 2 diets.
A postprandial study was subsequently conducted to investigate any acute effects of a tofu test meal on the oxidative modification of LDL in 16 male subjects. There was no significant difference between the susceptibility of LDL to oxidative modification before and after the tofu meal.
Twenty eight healthy subjects completed a separate randomised crossover dietary intervention comparing a high MUFA fat diet, using an Australian high oleic sunflower oil, with a low fat, high carbohydrate diet on CHD risk factors. The high MUFA oil diet significantly increased high density lipoprotein cholesterol compared to the low fat diet as well as producing LDL that were more resistant to oxidative modification. Neither the size of the LDL particle nor arterial compliance were significantly different on the 2 diets.
Twelve matched pairs of vegetations and omnivores were also studies to compare the habitual diet of a low and higher risk population group, to compare their risk factors and identify dietary constituents that may explain the differences. The vegetarians consumed less saturated fat (SFA) and dietary cholesterol while consuming more polyunsaturated fat, dietary fibre and vitamin E compared to omnivores. The vegetarians had lower total cholesterol, LDL cholesterol and triacylglycerol levels compared to the omnivores and had LDL particles that were more resistant to in vitro oxidation.
These findings contribute to our knowledge about the dietary constituents that can alter some CHD risk factors in healthy subjects, and which could reduce the risk of developing CHD. Investigations in high risk groups might reveal even more benefits.
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Shaw, I., BS Shaw, and GA Brown. "Influence of strength training on cardiac risk prevention in individuals without cardiovascular disease." African Journal for Physical, Health Education, Recreation and Dance, 2009. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1001650.
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Abstract
It has widely been shown that exercise, particularly aerobic exercise, has extensive cardioprotective
benefits and is an important tool in the prevention of coronary heart disease (CHD). The present
investigation aimed to determine the multivariate impact of strength training, designed to prevent the
development of CHD, on the Framingham Risk Assessment (FRA) score. Twenty-eight healthy
untrained men with low CHD risk (mean age 28 years and 7 months) participated in an eight-week (3-
d/wk) strength training programme. Self-administered smoking records, resting blood pressures, total
cholesterol (TC), high-density lipoprotein cholesterol (HDLC), FRA scores and absolute 10-year risks
for CHD were determined at the pre-test and post-test. After the eight-week period, no significant (p >
0.05) differences were found in number of cigarettes smoked daily, systolic blood pressure, TC, HDLC,
FRA scores and absolute 10-year risks for CHD in both the strength-trained (n = 13) and non-exercising
control (n = 15) groups. The data indicate that strength training did not reduce the risk of developing
CHD and absolute 10-year risk for CHD as assessed by the FRA score.
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Wrigley, Martha J. "Engaging families with a premature family history of heart disease : a primary prevention study for coronary heart disease." Thesis, University of Southampton, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485524.
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This thesis focuses upon a preventative approach for people with a familial history of premature coronary heart disease. The research study had two aims; firstIy to understand the experience of individuals when their parent or sibling had been diagnosed with heart disease; secondly to develop and evaluate a primary prevention health promotion programme for these people. The thesis provides unique insight into their personal experiences of living with tIris familial diagnosis and gives details of how this population can be identified and involved successfully in a health promotion programme. The study was conducted in a district general hospital; 28 people were recruited of whom 20 participants completed the two year study. Narrative interviews were conducted at the beginning and end of the study, providing insight into people's personal experience. Salutogenesis is the theoretical framework in which the narratives are discussed; from these health resources are identified which can enhance people's progress and maintenance for a healthy lifestyle. The health promotion programme has established, developed and evaluated a nurseled and doctor supported primary pjevention strategy. Education and support was provided in the programme for individuals and families. The participants' physical and behavioural changes were reviewed six monthly, for two years. People are aware of risk factors associated with heart disease, but still seek professional support and advice in relation to their own lifestyle and behaviour. Individual lifestyle changes were achieved by most participants, which translated into significant findings for blood pressure and alcohol consumption; positive changes were seen in physical activity, smoking, diet and psychosocial stress. There were no improvements in lipid profiles. The need for a preventatiye approach in health care, which includes primordial and primary prevention for heart disease, is discussed. The issues in this thesis are reflective upon current government focus to develop preventative health services which actively engage with people as integral to this process. The thesis discusses coronary heart disease, the roles of prevention and health promotion, and identifies health resources for people at high-risk of future cardiovascular problems.
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Veroni, Margherita. "The use of pharmacotherapies in the secondary prevention of coronary heart disease." University of Western Australia. School of Population Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0029.
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[Truncated abstract] Background: This thesis examines pharmacotherapy use in the secondary prevention of coronary heart disease. It includes antiplatelet agents, beta-blockers, statins and ACE inhibitors, all shown in landmark clinical trials and meta-analyses to reduce the risk of cardiac events in patients with known coronary disease. Underuse of effective preventive therapies represents a lost opportunity to reduce mortality and morbidity. Overseas studies have shown significant underuse of effective therapies at the time of hospital discharge following an acute event and later in ambulatory care. Australian data on prescribing practices following an acute coronary event and, ongoing use in ambulatory care are sparse. Aims: The aim of this thesis was to quantify the prescription of known effective therapies at the time of hospital discharge following an acute coronary event and ongoing use in ambulatory care. A secondary aim was to identify barriers to optimal secondary prevention thus providing an evidential basis to recommend change. Methods: This was an observational study of a cohort of post-MI patients admitted to a tertiary and affiliate hospital in Perth, Western Australia. The continuum of care from the treatment plan at discharge through to the treatment regimen and risk factor management 12 months post-MI was examined. The intermediate step, communication about the treatment plan with the patient and the primary health care provider was also examined. The study involved a review of hospital medical records and follow-up questionnaires to patients and their general practitioners at 3 and 12 months post-MI. All post-myocardial patients were included in the analysis of prescriptions at discharge. The follow-up study included patients 80 years and younger with no terminal conditions. Patient interviews at 3 months and interviews and focus groups with key hospital staff provided qualitative data to inform the quantitative data.
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Rees, Lois. "The provision of disease prevention services from community pharmacies." Thesis, University College London (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339279.
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Ревенко, Жанетта Анатоліївна, and Рохіт Тхакур. "Quality of life determination in patients with coronary heart disease in various forms of this disease complications." Thesis, «Хист», Всеукраїнський медичний журнал студентів і молодих вчених. – 2016, випуск 18. – 690 с, 2016. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/10620.
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Lalonde, Lyne. "Health-related quality of life measures in coronary heart disease prevention and treatment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/NQ44484.pdf.
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Khatib, R. "Adherence to secondary prevention medicines by coronary heart disease patients : first reported adherence." Thesis, University of Bradford, 2012. http://hdl.handle.net/10454/5484.
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Background Non-adherence to evidence based secondary prevention medicines (SPM) by coronary heart disease (CHD) patients limits their expected benefits and may result in a lack of improvement or significant deterioration in health. This study explored self-reported non-adherence to SPM, barriers to adherence, and the perception that patients in West Yorkshire have about their medicines in order to inform practice and improve adherence. Methods In this cross-sectional study a specially designed postal survey (The Heart Medicines Survey) assessed medicines-taking behaviour using the Morisky Medicines Adherence 8 items Scale (MMAS-8), a modified version of the Single Question Scale (SQ), the Adherence Estimator (AE), Beliefs about Medicines Questionnaire(BMQ) and additional questions to explore practical barriers to adherence. Patients were also asked to make any additional comments about their medicines-taking experience. A purposive sample of 696 patients with long established CHD and who were on SPM for at least 3 months was surveyed. Ethical approval was granted by the local ethics committee. Results 503 (72%) patients participated in the survey. 52%, 34% and 11% of patients were prescribed at least four, three and two SPMs respectively. The level of non-adherence to collective SPM was 44%. The AE predicted that 39% of those had an element of intentional non-adherence. The contribution of aspirin, statins, clopidogrel, beta blockers, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) to overall non-adherence as identified by the SQ scale was 62%, 67%, 7%, 30%, 22% and 5%, respectively. A logistic regression model for overall non-adherence revealed that older age and female gender were associated with less non-adherence (OR = 0.96, 95% CI: 0.94, 0.98; OR = 0.56, 95% CI: 0.34, 0.93; respectively). Specific concern about SPM, having issues with repeat prescriptions and aspirin were associated with more non-adherence (OR = 1.12, 95% CI: 1.07, 1.18; OR = 2.48, 95% CI: 1.26, 4.90, OR = 2.22, 95% CI: 1.18, 4.17). Other variables were associated with intentional and non-intentional non-adherence. 221 (44%) patients elaborated on their medicines-taking behaviour by providing additional comments about the need for patient tailored information and better structured medicines reviews. Conclusions The Medicines Heart Survey was successful in revealing the prevalence of self-reported non-adherence and barriers to adherence in our population. Healthcare professionals should examine specific modifiable barriers to adherence in their population before developing interventions to improve adherence. Conducting frequent structured medicines-reviews, which explore and address patients' concerns about their medicines and healthcare services, and enable them to make suggestions, will better inform practice and may improve adherence.
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Emberson, Jonathan Robert. "Within-person variation in coronary risk factors : implications for the aetiology and prevention of coronary heart disease." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1444402/.
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Epidemiological studies clearly demonstrate the importance of numerous risk factors for coronary heart disease (CHD), including blood lipids, blood pressure, cigarette smoking and physical inactivity. These factors are widely believed to account for only around 50% of CHD cases. However, "within-person" variation in coronary risk factors can affect the size and even direction of estimated aetiological relationships, and though these effects have been explored for the univariate relations of blood pressure and blood cholesterol, much uncertainty remains. In this thesis, data from the British Regional Heart Study, a prospective study of cardiovascular disease in middle-aged British men, is used to investigate the extent and effects of "within-person variation" in a range of coronary risk factors. The effects on estimated relations with CHD are examined and the combined importance of the major risk factors to CHD risk assessed. The potential effectiveness of different CHD prevention strategies, and the size and cause of social inequalities in CHD are also estimated. The findings reveal a high degree of within-person variation in both established and novel coronary risk factors. Taking within-person variation into account, CHD risk-relations for blood lipids, blood pressure, cigarette smoking and physical inactivity increase in magnitude though the estimated protective effect from moderate alcohol intake is reduced. After correction for within-person variation, blood cholesterol, blood pressure and cigarette smoking together account for at least 75 80% of CHD cases in British men. Moderate population-wide improvements in these risk factors could there fore greatly reduce population levels of CHD, while "high-risk" strategies, unless applied to a large proportion of the population, are likely to have only a limited effect. Narrow ing social inequalities in CHD would also have a comparatively modest effect on CHD compared with population-wide control of the key causal coronary risk factors.
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裴中 and Zhong Pei. "Neuroprotection of melatonin in ischemic stroke models." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31243526.
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Boobier, Wyndham J. "The development of a functional food to reduce selected risk factors associated with coronary heart disease." Thesis, University of South Wales, 2003. https://pure.southwales.ac.uk/en/studentthesis/the-development-of-a-functional-food-to-reduce-selected-risk-factors-associated-with-coronary-heart-disease(0c4a2022-9af5-4b7c-bc44-73f00c90d27e).html.
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Coronary heart disease (CHD) remains one of this country's leading cause of mortality. This study has concentrated on the development of a functional biscuit, which will reduce selected risk factors for heart disease, in particular elevated serum homocysteine. The developed biscuit contains vitamins Be, Bi 2, and folic acid, all of which have been shown to be important in homocysteine metabolism. There were a number of criteria that had to be met for the author to receive the full support of Burton's Foods: (1) The biscuit must remain commercially viable and be accepted by the consumer. (2) Enzymes should not be used in the preparation of the dough. (3) The jam could not be modified in any way. Without exception, these have been successfully achieved. Jammie Dodgers were selected as the control product for a number of reasons. They are one of the UK's best selling biscuits and are consumed by both children and adults. This makes the target number of consumers very large. In addition, the standard product is high in both fat and sugar, its modification into a health promoting biscuit was therefore technically challenging. The product resulting from this project is commercially viable; it is low in fat and sugar, contains the vitamins that will deliver the full RNI on consumption of just two biscuits daily, and is not significantly different to the control product. The product is also palatable. Clinical trials have demonstrated that following consumption of the product, serum homocysteine, an independent risk factor for coronary heart disease, has been significantly reduced. In addition, there appears to be a relationship with consumption of the modified biscuit and a fall in serum lipoprotein(a). It is possible to reduce selected mutable risk factors associated with heart disease, simply by the daily consumption of a product that is liked and consumed by a great number of people. As far as the author is aware, there has been no other development of this kind prior to this study, i.e. a biscuit that will reduce the risk of coronary heart disease by lowering serum homocysteine. This biscuit is therefore the first of its kind.
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Moreno, Gabriel Mario. "The Effects of Coaching Strategies for Primary Prevention of Coronary Heart Disease Involving Asymptomatic Hospital Employees." Wright State University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=wright1240238745.
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Bose, Jolly. "Percutaneous transluminal coronary angioplasty (PTCA) in the treatmentof coronary artery disease in Hong Kong: procedural success, complications and long-term follow-up." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31220307.
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Vedin, Ola. "Prevalence and Prognostic Impact of Periodontal Disease and Conventional Risk Factors in Patients with Stable Coronary Heart Disease." Doctoral thesis, Uppsala universitet, Institutionen för medicinska vetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-260564.
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The purpose of this thesis was to assess the prevalence and management of established cardiovascular (CV) risk factors and the prevalence and influence of self-reported markers (number of teeth and frequency of gum bleeding) of periodontal disease (PD), a less explored CV risk factor, in patients with stable chronic coronary heart disease (CHD). We studied patients from the global STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial (n=15,828), in which patients with stable chronic CHD were randomized to either darapladib or placebo. Our studies were performed using descriptive statistics and multivariable linear, logistic and Cox regression models. The use of secondary preventive medications was generally high across the whole study population. Despite this, CV risk factors were highly prevalent, including obesity, hypertension and hypercholesterolemia. Achievement of guideline-recommended treatment targets was lacking and little improvement was seen throughout the study duration. Approximately 40% of patients reported having <15 remaining teeth and 25% reported gum bleeding. More tooth loss was associated with a greater CV risk factor burden after adjustment, while the associations for gum bleeding were less evident. After multivariable adjustment for CV risk factors and socioeconomic status, more tooth loss was associated with an increased risk of major adverse CV events (a composite of CV death, myocardial infarction and stroke), CV mortality, all-cause mortality and fatal or non-fatal stroke. We found associations between a higher degree of tooth loss and elevated levels of several prognostic biomarkers known to reflect various pathophysiological mechanisms involved in CV morbidity and mortality. Most biomarkers had little attenuating effect on the relationship between tooth loss and outcomes in a multivariable model. In conclusion, we found an inadequate CV risk factor control despite a high use of evidence-based pharmacological therapies, likely to explain some of the excess risk in CHD patients. Further, we demonstrated a high prevalence of PD markers, tooth loss in particular, that were associated with a wide range of established CV risk factors, prognostic biomarkers and outcomes. Collectively, these findings indicate that tooth loss may be a significant risk factor among patients with stable chronic CHD.
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Stokes, Helen Clare. "A study of the evolution of cardiac rehabilitation in the United Kingdom, from the 1940s to the 1990s." Thesis, University of Hull, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327183.
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Alhamarneh, Y. N. "Coronary Heart Disease-Public Knowledge and The Pharmacist's Patient-Centred Role in Prevention and Management." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527655.
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Chinwong, Surarong. "Pharmaceutical care in coronary heart disease prevention : study to measure and influence quality of prescribing." Thesis, University of Strathclyde, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.400332.
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Aachi, Venkat Raghav. "Preliminary Characterization of Mitochondrial ATP-sensitive Potassium Channel (MitoKATP) Activity in Mouse Heart Mitochondria." PDXScholar, 2009. https://pdxscholar.library.pdx.edu/open_access_etds/1667.
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Myocardial ischemia, infarction, heart failure and arrhythmias are the manifestations of coronary artery disease. Reduction of ischemic damage is a major concern of cardiovascular biology research. As per recent studies, the mitochondrial ATP-sensitive potassium channel (mitoKATP) opening is believed to play key role in the physiology of cardioprotection, protection against ischemia-reperfusion injury or apoptosis. However, the structural information of mitoKATP is not precisely known. Elucidating the structural integrity and functioning of the mitoKATP is therefore a major goal of cardiovascular biology research. The known structure and function of the cell ATP-sensitive potassium channel (cellKATP) is functional in interpreting the structural and functional properties of mitoKATP.
The primary goal of my research was to characterize the activity of mitoKATP in the isolated mitochondria from the control mouse heart. The mitoKATP activity, if preliminarily characterized in the control strains through the light scattering technique, then the structure of the channel could possibly be established and analyzed by means of the transgenic model and with the help of immunological techniques such as western blotting and immunoflorescence.
With this experimental model it was possible to demonstrate that the mitoKATP activity in control mouse heart mitochondria is activated by potassium channel openers (KCOs) such as diazoxide and cromakalim and activators of mitoKATP such as PMA (phorbol12 myristate-13-acetate), and inhibited by KATP inhibitors such as glibenc1amide and 5-hydroxydecanoate (5 HD).
It was evident that the KATP activity in mouse heart mitochondria was comparable to that exhibited by the rat heart mitochondria. The various selective and non-selective activators and inhibitors of the channel elicited their activity at a similar concentration used for the rat heart mitochondria. The results were reproducible in five independent experiments for each combination, further reinforcing the significance of existing channel activity in the mouse heart mitochondria.
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Campbell, N. C. "Secondary prevention in coronary heart disease : a randomised trial of nurse-led clinics in primary care." Thesis, University of Cambridge, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.597263.
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Ashour, Ala Fawzi. "Exploring the provision of secondary prevention services for coronary heart disease in public hospitals in Jordan." Thesis, Ulster University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.646351.
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Purpose: Coronary heart disease (CHD) is a major health problem in Jordan and the leading cause of death. It is a progressive condition but effective secondary prevention (SP) that includes behavioural change and medication reduces risk. Little is known about the current provision of SP for patients with CHD in Jordan. This study was designed to explore the current provision of SP from perspective of professionals and to evaluate patients' risk factors, SP interventions received and associated outcomes. Method: A mixed methods, parallel, repeated measures research design was used with a purposive sample from three interventional hospitals. A questionnaire was completed by 16 key staff, 20 Jordanian health care professionals (JHCP) were interviewed and 180 patients were evaluated in hospital and after 6 months. All patients had either had an acute myocardial infarction (AMI) treated medically, a Percutaneous Coronary Intervention (PCI) or a coronary artery bypass graft (CASG). The quantitative data was collected using self-reported questionnaires and a medical record review during hospitalisation and six months later. The qualitative data was collected using semi-structured interviews with JHCP. The European guidelines on CHD prevention (2012) were used to define recommended targets. Results: Provision of SP services in Jordan was poor compared to Guideline recommendations. There was no cardiac rehabilitation, smoking cessation or SP available post-discharge. Interviews established that while health professionals expressed the importance of SP, multiple barriers existed. They were generally dissatisfied with current SP provision and wanted to improve it, but identified training and other issues that needed to be addressed in order to achieve this. The prevalence of risk factors in patients was high during hospitalisation and also at follow-up, but some small improvements at 6 months were observed. Obesity and overweight reduced from 77% to 75%, smoking reduced from 59% to 47% and physical inactivity reduced from 59% to 41%. Quality of life was low and anxiety and depression were high at both baseline and 6 months, but significant improvements over time were observed. Risk factors such as hypertension and blood sugar control deteriorated over time and patients' knowledge regarding their condition remained deficient at 6 months. Conclusion: Despite an extremely high prevalence of risk factors in this population, the provision of SP is poor and obstacles to its development are widespread. There was much greater focus on medical treatment arid medication rather than on lifestyle modifications. Secondary prevention of CHD in Jordan requires urgent improvement and the potential role of nurses in SP should be enhanced.
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Harwick, Michelle Anne. "Relationships among preventive behavioral model concepts in individuals at risk for coronary artery disease." Thesis, The University of Arizona, 1989. http://hdl.handle.net/10150/276991.
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The Purpose of this research was to describe relationships between Murdaugh and Verran's (1987) Preventive Behavior Model Concepts in military-affiliated individuals at risk for coronary artery disease. One hundred forty-three subjects were recruited by their primary care physician and were requested to voluntarily complete questionnaires measuring health beliefs, health locus of control, value orientations, and health care activities. Laboratory values and blood pressure were also evaluated. There were significant positive correlations between health beliefs, health locus of control, and value orientations. However, these PBM concepts explained only 13% of the variance in dietary habits, 9% of smoking behaviors, 16% of habitual physical activity, 4% of cholesterol levels, 2% of diastolic blood pressure, 7% of body mass index, and 21 percent of glucose levels. PBM concepts explained a relatively small amount of the variance in the dependent variables within this sample and the results were not clinically significant.
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Patch, Craig Stewart. "An analysis of the potential role of functional foods in the primary prevention of coronary heart disease." Access electronically, 2005. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20050914.155815/index.html.
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Gulliksson, Mats. "Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-107347.
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Masoud, Mohamed Abdulsalam. "Validation of a recently proposed equation for the estimation of small, dense LDL particles from routine lipid measures in a population of mixed ancestry South Africans." Thesis, Cape Peninsula University of Technology, 2016. http://hdl.handle.net/20.500.11838/2490.
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Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2016.Cardiovascular diseases (CVD) are the leading cause of global mortality, of which over 75% occurred in low- and middle-income countries such as South Africa. The lipid profile, specifically decreased levels of high density lipoprotein cholesterol (HDL-C), elevated triglyceride levels and the presence of small-dense low density lipoprotein (sdLDL) has been reported associated with CVD. An increased number of sdLDL is also common in metabolic syndrome (MetS), visceral obesity and diabetes mellitus, the last a known risk factor for CVD. The modification of low density lipoprotein (LDL) size, or number of sdLDL particles, has been reported to significantly reduce CVD risk, but not conclusively so and needs further investigation. In this regard, sdLDL particles are seldom estimated routinely for clinical use because of financial and other limitations. Currently, an alternative approach for estimating sdLDL is to use equations derived from routine lipid measures, as has been proposed by several groups. However, there is a need for extensive evaluation of this equation across different ethnic and disease groups, especially since reports showed an inadequate performance of the equation in a Korean population. The aim of this study was to assess the performance of a recently proposed equation for the estimation of sdLDL in healthy and diabetic mixed ancestry South Africans. Furthermore, we also investigated the role of sdLDL as a cardiometabolic risk factor, as measured against known risk factors such as the glycemic and lipid profiles.
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Pischke, Claudia Ruth [Verfasser]. "The role of comprehensive lifestyle changes in the prevention and treatment of coronary heart disease / Claudia Ruth Pischke." Berlin : Freie Universität Berlin, 2008. http://d-nb.info/1023233622/34.
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Hemingway, Ann. "Women on a low income, understanding inequalities and coronary heart disease prevention : a lifestyle, practice and policy analysis." Thesis, University of Southampton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430724.
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Esslinger, Krista. "Dietary outcomes of a school-based trial to reduce risk factors for coronary heart disease." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31227.
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The dietary outcomes of a school-based heart health promotion program in a low-income, multiethnic, inner-city neighbourhood of Montreal, Canada, were investigated. Eight intervention schools and sixteen control schools participated in the project from 1993 to 1997. Twenty-four hour recall data, as well as data on anthropometric and sociodemographic characteristics, were collected from a subsample of all students in grades 4--6 (aged 9--12 years) at baseline (n = 498), after two years (n = 491), and after four years (n = 347). There were no significant differ in nutrient intakes between 1995 and 1997, so these data were combined for analyses. Compared to students in control schools, students exposed to the program had a significantly increased mean intake of vitamin C per 1000 kcal (4184 kJ) (p = 0.0013). Compared to students in designated intervention schools at baseline, mean make of vitamin C per 1000 kcal was significantly increased (p = 0.002) and mean folate intake was significantly domed (p = 0.0058) in exposed to the program. When the intervention group was restricted to only those students who had received 16 hours or more of program exposure (n = 113), there were no significant differences in any nutrient intakes when compared to control students or students in intervention schools at baseline. This program was unsuccessful in changing nutrient intakes of school-aged children, contributing further evidence that conscious dietary change is difficult to achieve by means of a school-based program with a reasonable number of curriculum hours.
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Zheng, Henry Public Health & Community Medicine Faculty of Medicine UNSW. "Walking interventions to prevent coronary heart disease in Australia - quantifying effect size, dose-response and cost reductions." Awarded by:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/44750.
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Coronary heart disease (CHD) is the single largest cause of death in Australia. Lack of physical activity is a primary risk factor for CHD. The thesis aimed to quantify the efficacy of walking in reducing CHD risk. Meta-analyses were performed for the quantification with the application of random-effect meta-regression models. The thesis also aimed to quantify reductions in CHD-related direct healthcare costs, productivity loss and disease burden resulting from walking interventions in Australia, using the population attributable fraction model, the work and leisure models, and the consumer surplus model. Economic evaluations were also conducted to estimate CHD-related productivity loss using the human capital and the friction methods. The results indicated that 30 minutes of normal walking a day for 5-7 days a week compared to physical inactivity reduced CHD risk by 24%. There existed a dose-response relationship between walking and CHD risk reduction. An increment of approximately 30 minutes of normal walking a day for 5 days a week reduced CHD risk by 19%. The annual productivity loss resulting from CHD was estimated at AU$1.79 billion based on the human capital method and AU$25.05 million under the friction method. 30 minutes of normal walking a day for 5-7 days a week by the country???s ???sufficient??? walking population was shown to generate an estimated $126.73 million in net direct healthcare savings annually. The net economic savings could increase to AU$419.9 million if the whole inactive population engaged in ???sufficient??? walking. The study also found that 30 minutes of normal walking a day for 5-7 days a week reduced the burden of CHD by an estimated 25,065 DALYs and the productivity loss by AU$162.65 million annually under the leisure model. If the whole inactive population engaged in such walking, the total disease burden and productivity loss could be reduced by approximately one third. The findings present epidemiological and economic evidence in support of the national physical activity guidelines, which encourage the general public to engage in moderate physical activity including walking for a minimum of 30 minutes a day for 5-7 days a week.
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Vánky, Farkas. "Surgery for aortic stenosis : with special reference to myocardial metabolism, postoperative heart failure and long-term outcome /." Linköping : Linköpings universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7471.
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Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche, and Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-106354.
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Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany.
Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications.
Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
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Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche, and Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany." Technische Universität Dresden, 2006. https://tud.qucosa.de/id/qucosa%3A26666.
Full textAbstract:
Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany.
Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications.
Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
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Strath, Scott J. "The effect of a light-moderate versus hard exercise intensity on health and fitness benefits." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1115726.
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The purpose of this study was to determine the effect of a light-moderate versus hard exercise intensity on health and fitness benefits in a previously sedentary population. Twenty-six subjects, 17 male (mean age 45 + 3 yrs), 9 female (mean age 48 + 3 yrs) with at least one coronary artery disease risk factor volunteered to participate in this study. Subjects underwent laboratory testing comprising of, resting heart rate and blood pressure, body composition, blood lipid analysis and aerobic capacity (V02 ), prior to and 22-32 weeks after participating > 2 days per week in the Adult Physical Fitness Program (APFP) at Ball State University. After an initial exercise prescription subjects self selected an exercise intensity between 40-80% of their maximal heart rate range (MHRR) at which to train. Subjects were then grouped into those who trained at < 60% (light-moderate) and those who trained at > 60% (hard) of their MHRR.Those that self selected a hard training intensity did show a significantly greater decrease in diastolic blood pressure than the light-moderate intensity group. Subjects received a main training effect with a mean decrease in systolic blood pressure (123 ± 2.8 to 119 ± 2.4 mmHg), diastolic blood pressure (78 ± 2.2 to 75 ± 1.7 mmHg), and mean increases for HDL-cholesterol (49 ± 2.5 to 53 ± 2.8 mg/dL), absolute functional capacity (2.676 +.162 to 2.843 +.169 L/min) and relative functional capacity (30.2 ± 1.5 to 32.8 + 1.8 ml/kg/min). In conclusion this study demonstrated health and fitness benefits when training at least 2 days per week with greater effects when training at a hard versus light-moderate intensity with regards to diastolic blood pressure.School of Physical Education
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Middlemass, Jo. "Behavioural change in the primary prevention of Coronary Heart Disease (CHD) : evaluating the transtheoretical/stages of change behavioural model : a mixed methods study." Thesis, University of Nottingham, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601802.
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Introduction In primary care, clinicians are engaged in trying to help patients change their behaviour in order to prevent heart disease. The risk of heart disease is increased by lack of exercise; smoking and eating a high fat diet, all of which are modifiable lifestyle behaviours. The aim of the thesis is to explore the potential for the use of the Transtheoretical Stages of Change CTIM/SOC) model in primary care and consider how the findings can be utilised by clinicians helping patients to change unhealthy behaviour. Method There are three parts to this study; the first is a structured review which examines studies using the TIM/SOC behavioural model in primary care, both when the intervention is tailored to the stage of change and/or when it is used as an outcome/predictor measure. The second part examines the secondary data from a cardiovascular disease study ('Realising the potential of the family history in risk assessment and primary prevention of coronary heart disease in primary care' - ADDFAM) which used the TIM/SOC model, to see what change predictors could be found. The third part comprises a qualitative study using semi-structured interviews to identify the facilitators and barriers of behaviour change as experienced by individuals attempting to change their unhealthy behaviour to see if these could be explained in terms of the TIM/SOC model. Results • There appears to be validity in the basic premise of moving through the stages of change which spanned the three distinct sources of evidence. However, in the interview data, no-one spoke in terms of a timeframe except for a social occasion or in terms of life priorities, which throws some doubt on the time-scales imposed on change process in the TIM/SOC model. • There is mixed evidence for the TIM/SOC model either as an intervention, or an outcome/predictor measure, in particular, there is some doubt that movement through the stages of changes equates to actual behavioural change. • There was evidence to suggest that the TIM/SOC constructs are used in the process of change. However, there were identified differences to the processes as outlined in the model, in particular the helping relationships construct was found to be in use throughout the change process, rather than as the TIM/SOC suggests between the action and maintenance stage. Specific constructs for sustaining behavioural changes are not covered under the TIM/SOC model and their inclusion may be helpful for the maintenance stage of the behaviour change. Additional constructs that may be useful to consider in the model include denial/fatalism; psychological aspects and demographic data. XlI Conclusions By triangulating the structured review with the ADDFAM study database results and findings from the qualitative interviews, this study has highlighted both positive and negative aspects of the TIMjSOC model for use in primary care. Suggestions are made for changes to the model that could be evaluated in future research and these include: comparing the TIMjSOC model against the PAPM (a non-timeframe model); inclusions of additional constructs for denial/fatalism; demographic details and psychological factors. The helping relationships construct should be expanded for use across all stages of change and specific new constructs evaluated for sustaining the change. In addition the similarities and differences between the constructs of self-efficacy and control should be explored and evaluated. The findings identified in the thesis have highlighted some areas that clinicians can focus on in primary care to help patients to change their unhealthy behaviours. Xlll
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Yan, Fengxia. "Racial Disparities Study in Diabetes-Related Complication Using National Health Survey Data." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/math_theses/90.
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The main aim of this study is to compare the prevalence of diabetes-related complications in white to the prevalence in other racial and ethnic groups in United States using 2009 Behavioral Risk Factor Surveillance System (BRFSS). By constructing the logistic regression model, odds ratios (OR) were calculated to compare the prevalence of diabetes complications in white and other groups. Compared to white, the prevalence of hypertension and stroke in African Americans were higher, while the prevalence of heart attack and coronary heart disease were lower. The Asian Americans or Pacific Islanders, African Americans and Hispanics were more likely to develop retinopathy compared to white. The prevalence of hypertension, hypercholesterolemia, heart attack, coronary heart disease, Stroke in Native Americans and “other” group were not significantly different from the prevalence in white. Asian or Pacific Islanders were less likely to experience stroke.
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Volodkaitė, Aušra. "Koronarine širdies liga sergančių pacientų sveikatos priežiūros ir slaugos poreikiai." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2008~D_20140623_180432-43359.
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Pasaulio sveikatos organizacijos duomenimis, širdies ir kraujagyslių ligos yra dažniausia neįgalumo ir ankstyvos mirties priežastis pasaulyje. Modifikuojant rizikos faktorius galima sumažinti klinikinių atvejų bei ankstyvų mirčių skaičių. Prevenciją būtina taikyti žmonėms, kuriems jau diagnozuota koronarinė širdies liga, ir žmonėms, kuriems nustatyta širdies ir kraujagyslių ligų rizika. Darbo tikslas: Koronarine širdies liga persirgusių pacientų sveikatos priežiūros ir slaugos poreikių tyrimas. Darbo uždaviniai: Įvertinti rizikos veiksnius, veikiančius koronarine širdies liga sergančius pacientus, ir nustatyti pacientų žinias apie rizikos veiksnių modifikavimo būtinumą; Ištirti koronarine širdies liga sergančių pacientų biopsichoemocinę būklę; Išanalizuoti koronarine širdies liga sergančių pacientų fizinį aktyvumą; Ištirti pacientų gyvenimo kokybę, susijusią su sveikatos būkle; Pasiūlyti galimus slaugytojo darbo su pacientais metodus, siekiant įgyvendinti širdies ir kraujagyslių ligų susirgimų prevenciją. Medžiaga ir metodika: Tyrimo objektas – koronarine širdies liga sergančių pacientų žinios, sveikatos priežiūros ir slaugos poreikiai. Tyrimo populiacija - 100 pacientų, sergančių koronarine širdies liga. Tyrimo metodas – koronarine širdies liga sergančių pacientų apklausa (interviu) panaudojant standartizuotus klausimynus, ligos istorijų analizė, fizinių paciento duomenų matavimai. Panaudoti klausimynai: Klausimynas, parengtas Europos kardiologų draugijos, skirtas ES šalių... [toliau žr. visą tekstą]Following the information by the World Health Organization (WHO) CHD is the leading cause of disability and early death all over the world. Modification of risk factors may reduce the number of clinical records and early deaths. Prevention measures need to be taken for individuals with already diagnosed CHD as well as those with risk factors for CHD. Thesis objective: Investigation of healthcare and nursing needs of patients after CHD. Thesis tasks: Assessment of risk factors affecting patients suffering from CHD and knowledge possessed by patients suffering from CHD about the need for modification of the risk factors; Examination of biopsychoemotional condition of patients suffering from CHD; Analysis of physical activity of patients suffering from CHD; Examination of health condition–related quality of life of patients suffering from CHD; Suggesting possible methods of nursing staff working with the patients aiming at CHD prevention. Material and methodology: Investigation target: Knowledge possessed by patients suffering from CHD; healthcare and nursing needs. Investigation method: interviewed patients suffering from CHD through applying standardized questionnaires; analysis of case records, measurements of physical data of patients. Questionnaires used: Questionnaire developed by the European Society of Cardiology, aimed to assess the level of knowledge on prophylaxis of CHD EU-wide; HADS Questionnaire – Hospital Anxiety and Depression scale; EUROQOL 5D Questionnaire... [to full text]
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Van, Vuuren Derick. "Postconditioning the isolated perfused rat heart : the role of kinases and phosphatases." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/20864.
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Thesis (MScMed)--Stellenbosch University, 2008.ENGLISH ABSTRACT: It has recently been observed that the application of multiple short cycles of reperfusion and ischaemia, at the onset of reperfusion, elicits cardioprotection against injury due to prior sustained ischaemia. This phenomenon has been termed “postconditioning” (postC) and is of special interest due to its clinical applicability. Although much work has been done to delineate the mechanism of protection, there is still controversy regarding the precise algorithm of postC, the importance of the reperfusion injury salvage kinases (RISK), as well as uncertainty about the possible role of p38 MAPK and the protein phosphatases in postC cardioprotection. The aims of this study were therefore: I. To develop and characterise a cardioprotective postC protocol in the ex vivo rat heart, using both the retrogradely perfused and working heart models. II. To characterise the profiles of PKB/Akt, ERK p42/p44 and p38 MAPK associated with the postC intervention. III. To investigate the possible role of the serine/threonine protein phosphatases type 1 and type 2A (PP1 and PP2A) in the mechanism of postC. Hearts from male Wistar rats were perfused in both the retrograde Langendorff (at a perfusion pressure of 100 cmH2O and diastolic pressure set between 1 and 10 mmHg) and working heart models (preload: 15 cmH20 and afterload: 100 cmH20). Several different postC protocols were tested for their cardioprotective effect, as analysed by infarct size (IFS; determined by triphenyltetrazolium chloride (TTC) staining) and functional recovery. Experimental parameters tested were the number of cycles (3,4 or 6), the duration of the cycles (10, 15, 20 or 30 seconds), the method of application (regional or global) and temperature during the intervention (36.5 or 37 °C). Different sustained ischaemic insults were also utilised: 35 minutes regional (RI) or 20, 25, 30 and 35 minutes global ischaemia (GI). Hearts treated with a cardioprotective postC intervention or standard reperfusion after sustained ischaemia, were freeze-clamped at 10 and 30 minutes reperfusion in both perfusion models. Tissue samples were then analyzed using Western blotting, probing for total and phosphorylated PKB/Akt, ERK p42/p44 and p38 MAPK. The contribution of PKB/Akt and ERK p42/p44 activation to cardioprotection was also investigated by administration of inhibitors (A6730 and PD098059 respectively) in the final 5 minutes of ischaemia and the first 10 minutes of reperfusion, in the presence and absence of the postC intervention. The effect of these inhibitors were analyzed in terms of IFS and kinase profiles. The possible role of the phosphatases in postC was investigated by observing the effect of cantharidin (a PP1 and PP2A inhibitor) treatment directly before sustained ischaemia (PreCanth) or in reperfusion (PostCanth), in the presence and absence of postC, on IFS and kinase profiles. A postC protocol of 6x10 seconds global reperfusion / ischaemia, at 37°C, was found to give the best and most consistent reduction in infarct size in both the Langendorff (IFS in NonPostC: 47.99±3.31% vs postC: 27.81±2.49%; p<0.0001) and working heart (IFS in NonPostC: 35.81±3.67% vs postC: 17.74±2.73%, p<0.001) models. It could however only improve functional recovery in the Langendorff model (after 30 minutes GI: rate pressure product (RPP) recovery: NonPostC = 12.27±2.63% vs postC = 24.61±2.53%, p<0.05; and after 35 minutes GI: left ventricular developed pressure (LVDP) recovery: NonPostC = 28.40±7.02% vs postC = 48.49±3.14%, p<0.05). This protection was associated with increased PKB/Akt (NonPostC: 0.88±0.26 AU (arbitrary unit) vs postC: 1.65±0.06 AU; p<0.05) and ERK p42 (NonPostC: 2.03±0.2 AU vs postC: 3.13±0.19 AU; p<0.05) phosphorylation. Inhibition of PKB/Akt activation with A6730 (2.5 μM) abrogated the infarct sparing effect of postC. Administration of cantharidin, either before of after ischaemia, in the absence of postC, conferred an infarct sparing effect (IFS in PreCanth: 15.42±1.80%, PostCanth: 21.60±2.79%; p<0.05) associated with an increase in the phosphorylation of MAPK p38 (administration before ischaemia: NonCanth: 1.52±0.26 AU vs PreCanth: 2.49±0.17 AU, p<0.05; and administration after ischaemia: NonCanth: 5.64±1.17 AU vs PostCanth: 10.69±1.29 AU, p<0.05) and ERK p42 (when administered in reperfusion; NonCanth: 2.24±0.21 AU vs PostCanth: 3.34±0.37 AU; p<0.05). Cantharidin treatment combined with the postC intervention did not elicit an additive infarct sparing effect (postC: 17.74±2.72%, PreCanth-postC: 13.30±3.46% and PostCanth-postC: 15.39±2.67%). In conclusion: a postC protocol of 6x10 seconds global ischaemia / reperfusion, at 37°C, confers the best infarct sparing effect in both the Langendorff and working rat heart models. This protection is associated with ERK p42 and PKB/Akt phosphorylation, although only PKB/Akt is necessary for cardioprotection. We could not find evidence for PP1 and PP2A involvement in postC, although inhibition of these phosphatases per se does elicit an infarct sparing effect. The latter observation suggests that phosphatase activation during ischaemia / reperfusion is potentially harmful.
AFRIKAANSE OPSOMMING: Dit is onlangs waargeneem dat toediening van meervoudige siklusse herperfusie / iskemie, met die aanvang van herperfusie, die hart teen iskemie / herperfusie beskadiging beskerm. Hierdie verskynsel, bekend as postkondisionering (postC), geniet tans baie aandag vanweë die kliniese toepaslikheid van die ingreep. Ten spyte van intensiewe navorsing om die betrokke meganisme van beskerming vas te stel, is daar steeds kontroversie oor die presiese algoritme van die ingreep, asook die betrokkenheid van die sogenaamde iskemie herperfusie oorlewings kinases (RISK). Daar bestaan ook onsekerheid oor die rol van die stres-kinase, p38 MAPK, asook die proteïen fosfatases in die meganisme van beskerming teen iskemiese besering. Hierdie studie het dus drie doelstellings gehad: I. Ontwikkeling van ‘n postC protokol wat beskerming ontlok in die rothart ex vivo, deur gebruik te maak van beide die retrograad geperfuseerde ballon model, asook die werkhart model. II. Analiese van die profiele van die kinases PKB/Akt, ERK p42/p44 en p38 MAPK tydens herperfusie van postC en kontrole (NonPostC) harte. III. Ondersoek na die moontlike rol van die serien / treonien proteïen fosfatases tipe 1 en tipe 2A (PP1 en PP2A) in die meganisme van postC beskerming. Harte van manlike Wistar rotte is geperfuseer in beide die retrograad geperfuseerde ballon (d.i. die Langendorff) model (teen ‘n konstante perfusie druk van 100 cmH20 en ‘n diastoliese druk gestel tussen 1 en 10 mmHg), asook die werkhart model (teen ‘n voorbelading van 15 cmH20 en ‘n nabelading van 100 cmH20). Verskeie moontlike postC protokolle is getoets vir hul vermoë om kardiobeskerming te ontlok, in terme van funksionele herstel en infarktgrootte (IFS), soos bepaal deur trifenieltetrazolium chloried (TTC) kleuring. Die eksperimentele veranderlikes tydens die postC protokol wat ondersoek is, sluit in: die aantal siklusse (3, 4 of 6), die duur van die siklusse (10, 15, 20 of 30 sekondes), die wyse van postC toediening (streeks of globaal) en laastens die temperatuur tydens die ingreep (36.5 of 37 °C). Daar is ook gebruik gemaak van verskillende periodes iskemie: 35 minute streeks iskemie (RI), asook 20, 25, 30 en 35 minute globale iskemie (GI). Na 10 of 30 minute herperfusie is harte wat blootgestel is aan ‘n kardiobeskermende postC ingreep of gewone standaard herperfusie na iskemie, in beide perfusie modelle, gevriesklamp. Die weefsel proteïen-inhoud is verder geanaliseer deur van die Western blot tegniek gebruik te maak vir bepaling van die totale en fosforileerde vlakke van PKB/Akt, ERK p42/p44 en p38 MAPK. Die funksionele belang van PKB/Akt en ERK p42/p44 is verder ondersoek deur die effek van ‘n geskikte inhibitor (onderskeidelik A6730 en PD098059, toegedien tydens die laaste 5 minute van iskemie en die eerste 10 minute van herperfusie), in die teenwoordigheid en afwesigheid van die postC ingreep, op infarktgrootte en kinase aktiwiteit te monitor. Die moontlike rol van proteïen fosfatases in postC is ondersoek deur die effek van cantharidin (‘n PP1 en PP2A inhibitor) op infarktgrootte en kinase profiele te ondersoek. Cantharidin is óf onmiddelik voor iskemie óf tydens herperfusie toegedien, in die aan – en afwesigheid van die postC ingreep. Daar is bevind dat ‘n postC protokol van 6x10 sekondes globale iskemie / herperfusie, teen 37°C, die mees effektiewe en konstante verlaging in infarktgrootte teweeg gebring het in beide die ballon model (IFS in NonPostC: 47.99±3.31% vs postC: 27.81±2.49%; p<0.0001), asook die werkhart (IFS in NonPostC: 35.81±3.67% vs postC: 17.74±2.73%, p<0.001). Funksionele herstel kon egter slegs ontlok word in die ballon model (na 30 minute GI: tempo druk produk (RPP) herstel: NonPostC = 12.27±2.63% vs postC = 24.61±2.53%, p<0.05; en na 35 minute GI: linker ventrikulêre ontwikkelde druk (LVDP) herstel: NonPostC = 28.40±7.02% vs postC = 48.49±3.14%, p<0.05). Die infarkt-besparende effek van postC was geassosieer met ‘n toename in die fosforilasie van beide PKB/Akt (NonPostC: 0.88±0.26 AU (arbitrêre eenhede) vs postC: 1.65±0.06 AU; p<0.05) en ERK p42 (NonPostC: 2.03±0.2 AU vs postC: 3.13±0.19 AU; p<0.05). Inhibisie van PKB/Akt met A6730 (2.5 μM) het die infarkt-besparende effek van postC opgehef. Inhibisie van PP1 en PP2A opsigself, deur toediening van cantharidin óf voor óf na iskemie (in die afwesigheid van postC), het ‘n infarkt-besparende effek ontlok (IFS in PreCanth: 15.42±1.80%, PostCanth: 21.60±2.79%; p<0.05). Hierdie kardiobeskerming was geassosieer met ‘n toename in die fosforilasie van beide p38 MAPK (met toediening voor iskemie: NonCanth: 1.52±0.26 AU vs PreCanth: 2.49±0.17 AU, p<0.05; en toediening na iskemie: NonCanth: 5.64±1.17 AU vs PostCanth: 10.69±1.29 AU, p<0.05), asook ERK p42, indien cantharidin toegedien is tydens herperfusie (NonCanth: 2.24±0.21 AU vs PostCanth: 3.34±0.37 AU; p<0.05). Kombinasie van cantharidin behandeling met postC toediening kon egter nie ‘n kumulatiewe infarkt-besparende effek uitlok nie (postC: 17.74±2.72%, PreCanth-postC: 13.30±3.46% en PostCanth-postC: 15.39±2.67%). In samevatting: ‘n PostC protokol van 6x10 sekondes globale iskemie / herperfusie, teen 37°C, ontlok die mees effektiewe infarkt-besparende effek in beide die ballon, sowel as die werkhart modelle. Alhoewel hierdie beskerming geassosieer is met ‘n toename in die fosforilasie van beide PKB/Akt en ERK p42/p44 tydens herperfusie, is dit slegs PKB/Akt wat van funksionele belang is in die meganisme van kardiobeskerming. Ons kon geen bewyse vind vir die betrokkenheid van PP1 en PP2A in postC beskerming nie, alhoewel inhibisie van hierdie fosfatases opsigself infarkt-besparend is. Laasgenoemde waarneming toon dat fosfatase aktivering tydens iskemie / herperfusie skadelike gevolge mag hê.
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Zhaxiduojie. "Development, implementation and evaluation of a social media-based cardiac rehabilitation and secondary prevention programme for patients with coronary heart disease in China: a randomised controlled trial." Thesis, Curtin University, 2020. http://hdl.handle.net/20.500.11937/81225.
Full textAbstract:
Access to cardiac rehabilitation and secondary prevention to help people recover from a heart attack remains low in China. This thesis evaluated a novel cardiac rehabilitation and secondary prevention programme delivered using the popular social media platform WeChat, for patients with heart disease in Shanghai. Compared with usual care, the programme resulted in improved exercise capacity, better knowledge of heart disease, increased adherence to medication and lower blood pressure and cholesterol.
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Horner, Katrina E. "The effect of increasing physical activity on health benefits in sedentary women." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1041902.
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The purpose of this study was to evaluate whether the current CDC/ACSM physical activity recommendation, ("30 minutes or more of accumulated moderate-intensity activity, most if not all, days of the week") would improve women's health through a reduction ofcoronary heart disease (CHD) risk factors. Twenty-one sedentary females (ages 49 ± 7 yrs.) with one or more CHD risk factors underwent baseline laboratory including: resting heart rate and blood pressure, resting electrocardiogram, body mass index, bioelectrical impedance, skinfold measures, waist-to-hip, blood lipid profile, and V02max. The VO2 was determined by an exercise treadmill test using the Ball State University Ramp protocol. The subjects were instructed on the CDC/ACSM recommendation, the physical activity survey, and given examples of moderate-intensity activity. The survey data was collected bimonthly over the six month period. The subjects reported participating in >_ 30 min. of moderate-intensity activity an average of 4 f 1 days/week with an average duration of 54 ± 26 min. On the remaining days, the subjects reported doing an average of 14 ± 6 minutes per day. Also, 90% of the women reported doing the activity in continuous bouts. Following the six month study period, the women were retested in the laboratory. Sixteen subjects completed the post-testing. The results of the sixteen women showed a significant improvements in HDL-cholesterol (51 ± 15 vs.56 ± 15 mmHg; p=<.05) and TC/HDL ratio (4.5 ± 1 vs.4.25 ± 1.3; p=<.05). There were no significant changes in the other risk factor variables examined or their V02,„.. It was concluded that the majority of previously sedentary, middle aged women can not meet the CDC/ACSM recommendations for daily activity and total energy expenditure. Additionally, it appears that when given the choice, these women choose to do activity in continuous time blocks versus breaking the daily activities into shorter time periods.School of Physical Education
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Whitney, Stuart Luhn. "THE RELATIONSHIP BETWEEN SOCIAL SUPPORT AND ROLE STRAIN AND PREVENTATIVE HEALTH BEHAVIORS IN CRITICAL CARE NURSES." Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276557.
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The purpose of the research was to describe the relationships between social support and role strain and preventative health behaviors. The sample consisted of 62 critical care nurses employed in three southwest acute care facilities. Subjects completed instruments measuring social support, role strain, and four preventative health care behaviors. Pearson correlations revealed significant positive relationships between social support and personal/household roles women perform and ways women handle stress. Additional significant negative relationships existed between marital/relationship roles women perform and leisure physical activities, a subset of preventative health behaviors. The parental roles, obligations, and responsibilities women perform were also significantly related with leisure physical activities. Conclusions drawn indicate that the critical care nurses did not perceive themselves susceptible to cardiovascular disease and therefore did not participate in preventative health care activities, regardless of perceived helpful social support and an absence of role strain.
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Qarizadah, Muhammad Musa. "Impacts of Observing Live Open Heart Surgery on Young Adults' Health Behaviors." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3364.
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Having a heart healthy lifestyle at a younger age is beneficial in reducing the risk of coronary heart disease (CHD) in adulthood and various health education programs for CHD prevention exist to persuade young adults to adopt a heart healthy lifestyle. Little is known, however, about the influence of watching live open heart surgery on young adults' adoption of a heart healthy lifestyle. To address that gap in knowledge, this study was conducted at a health facility in Virginia where students came to observe live open heart surgery. The purpose of the study was to understand whether watching live open heart surgery can influence young adults' attitudes and behaviors towards adopting a heart healthy lifestyle. The theory of health belief model and the theory of reasoned action were used in guiding this research. A quantitative design involving observation and administration of surveys was used. A survey with questions about participants' lifestyle practices was administered prior to observation of open heart surgery and 3 or more months afterwards. A total number of 179 young adults at baseline were considered eligible for the study. Ages of the research participants were between 18 and 35 years old. The t test and ANOVA results showed no significant differences between baseline and follow up data with regards to changes in behaviors of young adult students towards adopting a heart healthy lifestyle. The study concluded that observing live heart surgery did not significantly change behaviors of the students in adopting a heart healthy lifestyle. In order to achieve the desired changes in attitudes and behavior of students, looking into other evidence based options and pursuing those that can influence and motivate young adult students to adopt a heart healthy lifestyle can be a positive social change.
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Nerpin, Elisabet. "Screening av förstagradsanhöriga till yngrekranskärlssjuka patienter." Thesis, Högskolan Dalarna, Medicinsk vetenskap, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:du-3123.
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Barbosa, Guilherme Rodrigues. ""Atividade física e doença arterial coronariana: revisando a literatura"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-28082006-204455/.
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Trata-se de um estudo de revisão integrativa da literatura nacional e internacional, no período de 2000 a 2005, que teve como objetivo evidenciar a contribuição da atividade física na prevenção primária da doença arterial coronariana (DAC). Os artigos foram capturados nas bases de dados PubMed (incluindo MEDLINE) e LILACS, utilizando-se descritores relacionados à intervenção, ao enfoque, à morbidade e aos fatores de risco. Vinte e dois artigos atenderam aos critérios de inclusão deste trabalho e constituíram a amostra. Para a organização dos dados, foi utilizado um instrumento que registrou as informações essenciais dos artigos: título; fonte (dados da revista); número da busca e do resumo; autor(es); país; ano; local do estudo; objetivos; sujeitos e período da pesquisa; método e o que foi analisado; tipo de intervenção e responsável pela mesma; resultados efetivos; conclusões do autor; limitações citadas pelo autor e comentários sobre o estudo. Os resultados foram apresentados em categorias de acordo com o desenho metodológico do artigo, com os objetivos, com a forma de descrição e mensuração da atividade física e com o conteúdo das publicações. Foram notadas semelhanças nestes aspectos entre os artigos de mesmo desenho metodológico. Doze artigos foram categorizados como estudos prospectivos, sete como de corte transversal e três foram os estudos retrospectivos. A maioria dos estudos utilizou questionários do tipo recordatório para avaliar o nível de atividade física realizada no trabalho e no lazer, fazendo correlação entre o nível e o tipo de atividade. Os benefícios das atividades aeróbicas foram os mais descritos, ainda que o exercício resistido tenha sido abordado em dois artigos. Apesar de alguns estudos terem enfocado apenas a mensuração do nível de atividade física, a maioria dos artigos apresentou correlação entre a prática de atividade física e a redução do risco coronariano, contribuindo para prevenir a DAC. Não houve consenso, ainda que a maioria dos estudos tenha abordado o assunto, quanto ao nível e ao tipo de atividade física que promove o melhor efeito preventivo. Consideramos que poderia ter sido utilizado um descritor mais específico do que atividade física para buscar os artigos, visando-se a atingir os objetivos propostos. Este estudo evidencia a contribuição benéfica da atividade física na prevenção primária da DAC, atuando nos seus fatores de risco. Além disso, há necessidade de considerar a atividade física como uma prática corporal orientada pelas necessidades individuais e implementada de acordo com as realidades locais, podendo ser uma ferramenta-chave ao lidar com o indivíduo portador de DAC.This study consists of an integrative review of the national and international literature made between 2000 and 2005 which main purpose is to testify the physical activities contributions for the primary prevention of coronary heart disease (CHD) and their risk factors. The articles are based on the PubMed data (including MEDLINE) and LILACS and they make use of descriptors related to the intervention, focus, morbidity and other factors of risk. Twenty two articles attended to the criteria adopted in this research constituting the specific sample presented. To the data organisation it was used an instrument which registered the articles essential information such as title, source (the magazines data), number of searches and summary, author(s), country, year, study place, goals, subjects and research period, method and what has been analysed, sort of intervention and its responsible, effective results, authors conclusion, limitations quoted by the author as well as comments about the study. The results have been compiled into categories according to the methodological drawing of the article, its purposes, descriptive manners, the physical activities measurement and the publications content. It has also been noticed some similarities towards these aspects and methodological drawings of other articles. Twelve articles has been categorised as prospective studies, seven as transversal cut and three as retrospective studies. In great part of them some questionnaires of the recording type have been used in order to evaluate the physical activities level involved at work and leisure time establishing, this way, a correlation between the level and the sort of exercise done. It is important to say that the benefits of aerobic activities were the most described, even though resisted exercises were also mentioned in two of the articles. Despite the fact that some studies have focused only on the measurement of the physical activity, the majority of them has established a correlation between the practice of such activities and the decrease of coronary risks, therefore contributing considerably for the CHD prevention. There has not been a consensus, though almost all studies mentioned this matter, about the level and sort of physical exercises that promote the best preventive effects. Moreover, we have taken into account the fact that a more specific descriptor could have been used instead of only physical activity with the intention of achieving the proposed objectives. Above all, this research shows the beneficial contributions of physical activities in the primary prevention of CHD as well as its possible risks. Not only that, but there is a necessity of considering physical activity as a corporal practice based on the individual demands and directed to a specific reality, aiming to be a useful way of dealing with an individual with CHD.
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Norlén, Markus, and Stefan Persson. "Sjuksköterskans primärpreventiva metoder för att uppmuntra till livsstilsförändringar hos patienter med risk för hjärt- och kärlsjukdom : En litteraturstudie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-19367.
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Bakgrund: Hjärt- och kärlsjukdomar är ett globalt växande folkhälsoproblem som dessutom är en ekonomisk last på samhället. Forskning har uppskattat att majoriteten av dödsfall kommer att bero på hjärt- och kärlsjukdomar vid år 2030. Några riskfaktorer för att utveckla hjärt- och kärlsjukdom är ett högt BMI, rökning och låg fysisk aktivitet. Forskning har visat att primärpreventivt arbete med livsstilsförändringar är något som minskar riskfaktorerna och är kostnadseffektivt för samhället. Syftet: var att beskriva vilka primärpreventiva metoder sjuksköterskan använder för att uppmuntra till livsstilsförändringar hos patienter med risk för hjärt- och kärlsjukdom samt att beskriva hur dessa primärpreventiva metoder påverkar riskfaktorerna. Syftet var också att beskriva urvalsgrupperna i de valda vetenskapliga artiklarna. Metod: För att besvara syftet och frågeställningarna hade denna litteraturstudie en beskrivande design där tolv vetenskapliga artiklar har analyserats. Databaserna PubMed och CINAHL användes vid sökningen för att finna de vetenskapliga artiklarna. Resultat: Sjuksköterskor använde olika metoder för att uppmuntra till livsstilsförändring hos hjärt- och kärlsjuka patienter. Dessa metoder innebar att sjuksköterskan antingen fungerar som en informationsgivare eller samarbetspartner gentemot patienten. Effekten av metoderna varierade och enligt vissa studier gav de ej gav någon effekt. Slutsats: Utifrån litteraturstudiens resultatet går det ej med säkerhet att säga vilka metoder som är mest effektiva. Sammanfattningsvis kan sjuksköterskan i sitt kliniska arbete ta hänsyn till båda förhållningssätt i mötet med patienterna och anpassa metoden utifrån ett individuellt perspektiv.Background: Coronary heart disease is a growing health issue from a global perspective. Research has estimated that coronary heart disease will stand for the majority of deaths by the year 2030. Risk factors include a high BMI, smoking and low level physical activity. Research has also shown that lifestyle change can decrease the risk factors and is cost-effective for the society. Aim: The aim with the litterature study was to describe which primary prevention methods nurses use to encourage lifestyle change for patients at risk of developing coronary heart disease, and to describe how these methods affect the risk factors. The purpose was also to describe the sample groups in the chosen articles. Method: To answer the study questions, the literature study had a descriptive design where twelve scientific articles were analysed and categorized. The databases PubMed and CINAHL were used to find the scientific articles. Results: Nurses use an array of different methods to encourage life style change in patients with coronary heart disease. These methods include the nurse either acting as a information giver or a collaboration partner towards the patient. The effect of these methods varied and some of the studies didn’t show any effect whatsoever. Conclusion: On the basis of the literature study, the methods nurses use and their effectiveness are inconclusive. In conclusion, the nurse can consider all of the methods in the work place, and decide which method is adequate based on the individual variations of the patients.
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Esterhuyse, Adriaan Johannes. "Dietary red palm oil-supplementation offers cardioprotection against Ischaemia/Reperfusion injury : possible cellular mechanisms involved." Thesis, Stellenbosch : University of Stellenbosch, 2005. http://hdl.handle.net/10019.1/16514.
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Dissertation (PhD)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: Activation of the NO-cGMP pathway is associated with myocardial protection against ischaemia/reperfusion injury. However, high-cholesterol diets alter function of this pathway and these alterations have been implicated in both ischaemic/reperfusion injury and the development of ischaemic heart disease. Little is known about the effects of supplements such as Red Palm Oil (RPO) on the myocardial NO-cGMP-signalling pathway. RPO consists of saturated, mono-unsaturated and poly-unsaturated fatty acids and is rich in antioxidants such as β-carotene and Vitamin E (tocopherols and tocotrienols). The aims of this study were: 1) to determine whether dietary RPO-supplemention protects against ischaemia/reperfusion injury in rats fed a standard rat chow (control) and cholesterol-enriched diets and 2) if so, to investigate possible mechanisms for this protection. Male Long-Evans rats were fed a standard rat chow or a standard rat chow plus cholesterol and/or RPO-supplementation for 6 weeks. Myocardial functional recovery was measured and hearts were freeze-clamped for determination of myocardial phospholipid, cAMP/cGMP concentrations, total myocardial nitric oxide concentrations, lipid hydroperoxide production and superoxide dismutase- and nitric oxide synthase activity in isolated rat hearts subjected to 25 minutes of normothermic total global ischaemia. In addition, the degree of phosphorylation of extracellular signal-regulated kinase (ERK), p38, c-Jun N-terminal protein kinase (JNK) and protein kinase B (PKB/Akt) was investigated. Furthermore, the effect of RPO-supplementation on caspase-3 activation and poly (ADP-ribose) polymerase (PARP)-cleavage in hearts subjected to ischaemia and reperfusion was also investigated. Our data show that dietary RPO-supplementation protects the hearts of rats on a standard rat chow (control) and hypercholesterolaemic diet against ischaemia/reperfusion injury as reflected by improved aortic output recovery. Increased intracellular cardiomyocyte NO concentrations as observed in control hearts supplemented with RPO after 120 minutes hypoxia may contribute to the elevated cGMP concentration and may confer some of the cardioprotection to the ischaemic/reperfused heart. Although improved functional recovery with RPO-supplementation of a high-cholesterol diet was also associated with an increase in intracellular cardiomyocyte NO production after hypoxia compared to the non-hypoxic conditions, it could not be linked to increased NO-cGMP signalling. These data are in agreement with other studies, which showed that high-cholesterol diet impairs NO-cGMP signalling and confirms our hypothesis that elevated cGMP concentrations may not be the only mechanism of protection. We have also shown that RPOsupplementation caused increased phosphorylation of p38 and PKB, reduced phosphorylation of JNK and attenuation of PARP cleavage, which may contribute to the protection of the cell against apoptosis. Based on our results we propose that the myocardial protection offered by RPO-supplementation of rats on a normal and hypercholesterolaemic diet may be associated with either its antioxidant characteristics and/or changes in the fatty acid composition of the myocardium during ischaemia/reperfusion. Furthermore, we demonstrated for the first time that RPO-supplementation protects the isolated perfused working rat heart during reperfusion from ischaemia/reperfusion-induced injury through a MAPK-dependent pathway.
AFRIKAANSE OPSOMMING: Aktivering van die NO-cGMP sein transduksie pad word geassosieer met miokardiale beskerming teen isgemie/herperfusie skade. Hoë cholesterol diëte verander egter die funksie van die pad en hierdie veranderings speel ‘n rol in beide isgemie/herperfusie besering en die ontwikkeling van isgemiese hartsiekte. Daar is egter min inligting beskikbaar oor die uitwerking van aanvullings soos rooi palm olie (RPO) op die miokardiale NO-cGMP sein transduksie pad. RPO bevat versadigde, mono-onversadigde en poli-onversadigde vetsure en is ryk aan anti-oksidante nl. β-karotene en vitamien E (tokoferole en tokotriënole). Die doelwitte van hierdie studie was: 1) om vas te stel of ‘n RPO-aanvulling beskerming bied teen isgemie/herperfusie besering in rotte wat gevoed is met ‘n standaard rotmengsel (kontrole) en cholesterol-verrykte dieet en 2) indien wel, om moontlike meganismes van beskerming te ondersoek. Long-Evans manlike rotte is vir 6 weke gevoer met ‘n standaard rotmengsel of ‘n standaard rotmengsel plus cholesterol en/of RPO-aanvulling. Miokardiale funksionele herstel is gemeet en harte is gevriesklamp vir die bepaling van miokardiale fosfolipied, cAMP/cGMP, totale stikstofoksied, lipied hidroperoksied, superoksied dismutase en stikstofoksied sintase in geïsoleerde rotharte wat vir 25 minute onderwerp was aan normotermiese totale globale isgemie. Hiermee saam is die graad van fosforilering van ekstrasellulêre sein gereguleerde kinase (ERK), p38 mitogeen-geaktiveerde proteïen kinase (p38 MAPK), c-Jun-N-terminale proteïenkinase (JNK) en proteïen kinase B (PKB/Akt) ondersoek, asook kaspase-3 aktivering en poli (ADP-ribose) polimerase (PARP) kliewing in harte blootgestel aan isgemie en herperfusie. Ons resultate toon dat RPO-aanvulling van rotte op ‘n normale en hipercholesterolemiese dieet die hart beskerm soos getoon deur verbeterde herstel van aortiese uitset. Verhoogde intrasellulêre miokardiale NO vlakke in kontrole harte met ‘n RPO-aanvulling wat blootgestel was aan 120 minute hipoksie, mag bygedra het tot die verhoogde cGMP vlakke en beskerming van die hart tydens isgemie en herperfusie. Alhoewel verbeterde funksionele herstel met RPO-aanvulling van ‘n hoë cholesterol dieet ook geassosieer is met ‘n toename in intrasellulêre miokardiale NO produksie ná hipoksiese toestande, kon dit nie verbind word met verhoogde aktivering van die NOcGMP sein transduksie pad nie. Hierdie resultate stem ooreen met ander studies wat aangetoon het dat hoë-cholesterol diëte die NO-cGMP seinpad onderdruk. Hierdie bevinding bevestig ons hipotese dat verhoogde cGMP vlakke moontlik nie die enigste beskermingsmeganisme is nie. Ons resultate het ook gewys dat RPO-aanvulling fosforilering van p38 en PKB/Akt verhoog, fosforilering van JNK verminder en PARP kliewing onderdruk. Dit dui op beskerming van die sel teen apoptose. Ons resultate dui aan dat die miokardiale beskerming wat RPO-dieet aanvulling bied moontlik geassosieer kan word met sy anti-oksidant eienskap en/of veranderinge in die vetsuur samestelling van die miokardium tydens isgemie/herperfusie. Ons het ook vir die eerste keer bewys dat RPO-aanvulling die geïsoleerde geperfuseerde werkende rothart gedurende herperfusie beskerm teen isgemie/herperfusie besering deur die aktivering en/of deaktivering van die MAPK afhanklike pad.
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Van, Vuuren Derick. "The role of Protein Phosphatase 2A (PP2A) in myocardial ischaemia/reperfusion injury." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86397.
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Thesis (PhD)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Ischaemic heart disease is a major contributor to global morbidity and mortality rates. Manoeuvres such as ischaemic preconditioning confer cardioprotection against ischaemia/reperfusion (I/R) injury by activating several intracellular signalling pathways. These pathways have been defined solely in terms of the kinases involved, despite the realization in recent years that protein phosphatase activity also contributes significantly to the attributes of the propagated signal. Protein phosphatase 2A (PP2A) is a heteromultimeric enzyme involved in an array of phosphatase reactions. We hypothesized that PP2A is an important participant in the myocardial response to I/R by regulating intracellular signalling. This project aimed to (i) characterize PP2A during myocardial I/R; (ii) determine the importance of its contribution to the cellular response to I/R; and (iii) investigate its role in the signalling pathways mediated by PKB/Akt, GSK-3β, ERK p42/p44 and p38 MAPK. Two models were used to characterize PP2A during I/R: (i) H9c2 cells exposed to simulated ischaemia (SI) buffer in conjunction with hypoxia (0.5% O2) for a maximum of 2 hours, followed by reoxygenation in standard growth medium for up to 30 minutes; and (ii) isolated working rat hearts exposed to a maximum of 20 minutes global ischaemia and 10 minutes reperfusion. In both models samples were collected at several time points during I/R for Western blotting analysis. PP2A-C (the catalytic subunit) accumulated in the nucleus during early ischaemia, but later redistributed to the cytosol. At the end of ischaemia there was an elevation of PP2A-C relative to PP2A-A in the unfractionated whole cell preparation concomitant with an increase in the inhibitory phosphorylation of PP2A-C. The impact of PP2A activity was evaluated by either inhibiting PP2A using okadaic acid (OA, 10 nM) or activating it by administering FTY720 (1 μM) in an isolated working rat heart model exposed to either 35 minutes of regional ischaemia (RI) with infarct size (IFS) as primary end-point, or 20 minutes global ischaemia (GI) with functional recovery as end-point. The results showed that the pre-ischaemic administration of OA or FTY720 reduced or exacerbated IFS respectively, indicating that PP2A activation during I/R favours cell death. OA and FTY720 were also employed to assess the contribution of PP2A to intracellular signalling in an isolated working rat heart exposed to I/R. Samples were collected at several timepoints and analyzed using Western Blotting. Pre-ischaemic administration of OA enhanced the phosphorylation of PKB/Akt, ERK p42/p44 and GSK-3β at the onset of reperfusion, while FTY720 given before ischaemia reduced the phosphorylation of GSK-3β, p38 MAPK and PKB/Akt at the end of ischaemia and onset of reperfusion. In summary, PP2A is part of an early nuclear-based response to ischaemia, while long-term ischaemia induces an increase in PP2A-C. A portion of this PP2A-C is stored in an inactive form, while an active portion acts as a regulator of the pro-survival signalling components PKB/Akt, GSK- 3β and ERK p42/p44 at the end of ischaemia and the onset of reperfusion. PP2A is therefore an important component of the myocardial response to I/R by regulating pro-survival signalling.
AFRIKAANSE OPSOMMING: Iskemiese hartsiekte is een van die belangrikste komponente wat bydra tot globale morbiditeit en mortaliteit. Ingrepe soos iskemiese prekondisionering aktiveer veelvoudige intrasellulêre seintransduksiepaaie om kardiobeskerming teen iskemie/herperfusie (I/H)-besering te ontlok. Die kinases betrokke in hierdie seintransduksiepaaie is reeds deeglik nagevors, terwyl die potensiële belang van die proteïenfosfatases in seintransduksie tot onlangs misken is. Ons hipotese was dat Proteïenfosfatase 2A (PP2A), wat in ‘n wye verskeidenheid fosfatase reaksies betrokke is, ‘n belangrike rolspeler in die miokardiale reaksie op I/H-besering is, deur deelname aan die regulering van intrasellulêre seintransduksie. Hierdie projek het ten doel gehad om (i) PP2A te karakteriseer tydens miokardiale I/H; (ii) die belang van PP2A in die sellulêre reaksie op I/H-besering te bepaal; en (iii) PP2A se rol in die seintransduksiepaaie, gemedieer deur PKB/Akt, GSK-3β, ERK p42/p44 en p38 MAPK, te evalueer. Twee modelle is aangewend om PP2A tydens I/H te karakteriseer: (i) H9c2-selle blootgestel aan ‘n simuleerde iskemiebuffer tesame met hipoksie (0.5% O2) vir ‘n maksimum van 2 uur gevolg deur heroksiginasie in standaardgroeimedium vir verskillende tydsperiodes tot ‘n maksimum van 30 minute; en (ii) geïsoleerde, werkende rotharte blootgestel aan ‘n maksimum van 20 minute globale iskemie en 10 minute herperfusie. In beide modelle is monsters op verskillende tye versamel vir Western-kladanalise. Tydens vroeë iskemie het PP2A-C in die kern toegeneem, waarna dit met verloop van tyd na die sitosol herversprei het. Teen die einde van iskemie was daar ‘n toename in die vlakke van PP2A-C relatief tot PP2A-A in ongefraksioneerde weefselhomogenate, tesame met ‘n toename in die inhibitoriese fosforilering van PP2A-C. Die belang van PP2A-aktiwiteit is ondersoek deur die effek te bepaal van die inhibisie of aktivering daarvan op infarktgrootte (IFS) en funksionele herstel in ‘n geïsoleerde werkende rothartmodel, blootgestel aan onderskeidelik 35 minute streeksiskemie (RI) of 20 minute globale iskemie. Preiskemiese toediening van die PP2A-inhibitor okadaïensuur (OA, 10 nM), of aktiveerder FTY720 (1 μm) het infarktgrootte respektiewelik beperk of vergroot. PP2A-aktivering tydens I/H is dus nadelig. OA en FTY720 is ook aangewend om die bydrae van PP2A tot I/H-verwante, intrasellulêre seintransduksie in die geïsoleerde, werkende rothart te bepaal. Monsters is op verskeie tydintervalle versamel en ontleed deur gebruik te maak van die Western-kladtegniek. Preiskemiese toediening van OA het die fosforilering van PKB/Akt, ERK p42/p44 en GSK-3β by die aanvang van herperfusie bevoordeel, terwyl pre-iskemiese toediening van FTY720, die fosforilering van GSK-3β, p38 MAPK en PKB/Akt aan die einde van iskemie en die begin van herperfusie verminder het. Ter opsomming: PP2A is deel van ‘n vroeë gelokaliseerde kerngebaseerde reaksie op iskemie, terwyl langdurige iskemie ‘n toename in PP2A-C relatief tot PP2A-A induseer. ‘n Deel van hierdie PP2A-C is onaktief, terwyl die res funksioneer in die regulering van die seintransduksiekomponente PKB/Akt, GSK-3β en ERK p42/p44 wat oorlewing fasiliteer met die aanvang van herperfusie. PP2A is dus ‘n belangrike komponent in die miokardiale reaksie op I/H deurdat dit tot die beheer van seintransduksiepaaie bydra.
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De, Wet Martie. "The effect of colonic propionate and the acetate : propionate ratio on risk markers for cardiovascular disease in westernised African men." Thesis, Bloemfontein : Central University of Technology, Free State, 2009. http://hdl.handle.net/11462/30.
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McDowell, Janis Kathleen. "Recovery following an acute myocardial infarction : impact on the quality of life of patients and their partners." Thesis, Queensland University of Technology, 2002. https://eprints.qut.edu.au/15817/1/Janis_McDowell_Thesis.pdf.
Full textAbstract:
Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the industrialised world, and places a heavy burden on society in terms of personal disability and health care costs. The first signs of CHD often present acutely as a myocardial infarction (AMI), commonly known as a heart attack. Survivors of a heart attack remain vulnerable to poor health-related quality of life (HRQOL), further cardiac events, and increased morbidity due to a progression of CHD. Thus, the implementation of interventions to reduce these risks is an important public health strategy. To date, secondary prevention and rehabilitation efforts post-AMI focus primarily on the patient. However, it is argued that recovery from AMI occurs within a social context, and that risk reduction strategies are likely to be enhanced if interventions take into account the impact of the event on the quality of life of patients and their partners. Evidence from a review of couple relationship literature indicates that a significant proportion of couples experiences poor HRQOL (i.e., physical and emotional wellbeing) when coping with stressful life events, and that interactive aspects of a couple relationship (i.e., dyadic functioning and behaviour) are associated with individual well-being at such a time. Information from studies of couples dealing with recovery from heart attack is sparse, but tends to reflect the findings from the broader literature. Further research is required with post-AMI couples, though, as there are a number of shortcomings associated with the existing evidence. For instance, it is derived from studies conducted with, mostly small, samples of convenience; many different instruments are used to collect the data; and no studies specifically measure HRQOL. Analytically, most evidence is obtained with univariate and bivariate statistics, and data are analysed as groups of patients or partners, as opposed to dyads. Where multivariable analyses are undertaken a number of bivariate relationships are no longer significant after accounting for covariates such as age and gender; and few researchers investigate predictive associations between dyadic functioning/behaviour and HRQOL outcomes. Finally, there is a paucity of information from comparative analyses. Thus, it is not known whether the well-being of post-AMI couples over time is better than, similar to, or worse than, for example, that in the general population. The research program underpinning this thesis, the QUT-AMI Project, comprised two studies designed to address these methodological issues. The first was an observational, cross-sectional, pilot study conducted in 1998 with 26 post-AMI couples. The main investigation was a prospective cohort study of 93 post-AMI couples undertaken in 1999-2000. In both studies the samples comprised a consecutive series of adult males younger than 75 years who had experienced a first AMI, and their female partners. The average couple in both studies was middle-aged, had been married for many years, and both members of the dyad were working at the time of the heart attack. Prospective participants were identified in major clinical centres that admit cardiac patients, and couples were recruited to the project soon after the patient's heart attack. Clinical data were collected in hospital. Further data were collected with self-administered questionnaires during a home visit at 1 month (pilot and main study), and by mailed questionnaire or during a home visit at 6 months(main study) after the heart attack. The pilot study was undertaken to test recruitment and data collection procedures in preparation for the second (main) study, measure couples' HRQOL at 1 month after the event using the SF-36, and qualitatively investigate life issues for couples coping with recovery from AMI. In the main study couples' HRQOL outcomes were measured at 1 and 6 months post-AMI using the SF-36, and examined for changes over that time. The outcomes were also compared with those from matched population norms to estimate the impact of a heart attack on couples' HRQOL during the early and later recovery period. Additionally, the following relationships were investigated to determine the extent to which:* patients' dyadic functioning (e.g. happiness/satisfaction with relationship, measured with the Marital Adjustment Scale) and use of dyadic behaviour (e.g., hiding concerns and negative feelings from the other member of the dyad, measured with the Protective Buffering Scale) at 1 month predicted patients' emotional well-being at 6 months post-AMI;* partners' dyadic functioning and behaviour at 1 month predicted partners' emotional well-being at 6 months post-AMI;* patients' and partners' dyadic functioning at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI; and* patients' and partners' dyadic behaviour at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI. Exploratory analyses were also undertaken to determine the effect of dyadic discrepancies in functioning and behaviour, at 1 month after the heart attack, on patients' and partners' emotional well-being at 6 months after the event. Important findings were as follows:* At 1 month after an AMI the HRQOL of couples is impaired. The major impact is on physical well-being for patients, and emotional well-being for their partners.* In general, couples' HRQOL improves between 1 and 6 months after an AMI.* At 6 months after an AMI, the HRQOL of average couples is similar to that of their peers in the normal population.* There are subgroup variations in the quality of life of post-AMI couples, and these are associated with age, clinically poor physical health, and depression.* The combination of patients' and partners' use of dyadic behaviour at 1 month after an AMI explains 7% of the variation in patients' emotional well-being at 6months after the event, after adjustment for patients' concurrent physical wellbeing and prior levels of emotional well-being, as well as duration of couple relationships.* The combination of partners' perceptions of dyadic functioning and use of dyadic behaviour at 1 month after an AMI explains 5% of the variation in partners' emotional well-being at 6 months after the event, after adjustment for partners' concurrent physical well-being and prior levels of emotional well-being, as well as duration of couples' relationships.* Patients have poorer emotional well-being at 6 months after an AMI if partners use dyadic behaviour infrequently at 1 month after the event.* Partners have poorer emotional well-being at 6 months after an AMI if they are not satisfied/unhappy with the functioning of their relationships at 1 month after the event. Adjusted exploratory analyses, undertaken to determine the extent to which dyadic discrepancies in perceptions of functioning or use of protective buffering behaviour, predict emotional well-being, show that patients who are less satisfied/unhappier with functioning than their partners at 1 month after an AMI have poor emotional wellbeing at 6 months after the event; patients who use the behaviour more frequently than their partners at 1 month after an AMI have poor emotional well-being at 6months after the event; and partners who are less satisfied/unhappier with functioning than their patients at 1 month after an AMI have poor emotional well-being at 6months after the event. The evidence from the QUT-AMI Project supports the proposition that the interaction that occurs within a couple relationship, combined with individual characteristics of members of a dyad, influences the extent to which a heart attack impacts on couples' HRQOL. It is argued that it is not enough to merely focus on implementing secondary prevention strategies with post-AMI patients. Given that poor emotional well-being is known to predict adverse cardiac events, and premature mortality due to cardiac disease, it is recommended that a couple-focused intervention designed to meet specific needs should be implemented with at-risk couples as a public health strategy to improve not only the patients' quality of life but also that of his partner. Further research is recommended to determine the extent to which such an intervention improves post-AMI couples' quality of life.
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McDowell, Janis Kathleen. "Recovery following an acute myocardial infarction : impact on the quality of life of patients and their parnters." Queensland University of Technology, 2002. http://eprints.qut.edu.au/15817/.
Full textAbstract:
Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the industrialised world, and places a heavy burden on society in terms of personal disability and health care costs. The first signs of CHD often present acutely as a myocardial infarction (AMI), commonly known as a heart attack. Survivors of a heart attack remain vulnerable to poor health-related quality of life (HRQOL), further cardiac events, and increased morbidity due to a progression of CHD. Thus, the implementation of interventions to reduce these risks is an important public health strategy. To date, secondary prevention and rehabilitation efforts post-AMI focus primarily on the patient. However, it is argued that recovery from AMI occurs within a social context, and that risk reduction strategies are likely to be enhanced if interventions take into account the impact of the event on the quality of life of patients and their partners. Evidence from a review of couple relationship literature indicates that a significant proportion of couples experiences poor HRQOL (i.e., physical and emotional wellbeing) when coping with stressful life events, and that interactive aspects of a couple relationship (i.e., dyadic functioning and behaviour) are associated with individual well-being at such a time. Information from studies of couples dealing with recovery from heart attack is sparse, but tends to reflect the findings from the broader literature. Further research is required with post-AMI couples, though, as there are a number of shortcomings associated with the existing evidence. For instance, it is derived from studies conducted with, mostly small, samples of convenience; many different instruments are used to collect the data; and no studies specifically measure HRQOL. Analytically, most evidence is obtained with univariate and bivariate statistics, and data are analysed as groups of patients or partners, as opposed to dyads. Where multivariable analyses are undertaken a number of bivariate relationships are no longer significant after accounting for covariates such as age and gender; and few researchers investigate predictive associations between dyadic functioning/behaviour and HRQOL outcomes. Finally, there is a paucity of information from comparative analyses. Thus, it is not known whether the well-being of post-AMI couples over time is better than, similar to, or worse than, for example, that in the general population. The research program underpinning this thesis, the QUT-AMI Project, comprised two studies designed to address these methodological issues. The first was an observational, cross-sectional, pilot study conducted in 1998 with 26 post-AMI couples. The main investigation was a prospective cohort study of 93 post-AMI couples undertaken in 1999-2000. In both studies the samples comprised a consecutive series of adult males younger than 75 years who had experienced a first AMI, and their female partners. The average couple in both studies was middle-aged, had been married for many years, and both members of the dyad were working at the time of the heart attack. Prospective participants were identified in major clinical centres that admit cardiac patients, and couples were recruited to the project soon after the patient's heart attack. Clinical data were collected in hospital. Further data were collected with self-administered questionnaires during a home visit at 1 month (pilot and main study), and by mailed questionnaire or during a home visit at 6 months(main study) after the heart attack. The pilot study was undertaken to test recruitment and data collection procedures in preparation for the second (main) study, measure couples' HRQOL at 1 month after the event using the SF-36, and qualitatively investigate life issues for couples coping with recovery from AMI. In the main study couples' HRQOL outcomes were measured at 1 and 6 months post-AMI using the SF-36, and examined for changes over that time. The outcomes were also compared with those from matched population norms to estimate the impact of a heart attack on couples' HRQOL during the early and later recovery period. Additionally, the following relationships were investigated to determine the extent to which:* patients' dyadic functioning (e.g. happiness/satisfaction with relationship, measured with the Marital Adjustment Scale) and use of dyadic behaviour (e.g., hiding concerns and negative feelings from the other member of the dyad, measured with the Protective Buffering Scale) at 1 month predicted patients' emotional well-being at 6 months post-AMI;* partners' dyadic functioning and behaviour at 1 month predicted partners' emotional well-being at 6 months post-AMI;* patients' and partners' dyadic functioning at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI; and* patients' and partners' dyadic behaviour at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI. Exploratory analyses were also undertaken to determine the effect of dyadic discrepancies in functioning and behaviour, at 1 month after the heart attack, on patients' and partners' emotional well-being at 6 months after the event. Important findings were as follows:* At 1 month after an AMI the HRQOL of couples is impaired. The major impact is on physical well-being for patients, and emotional well-being for their partners.* In general, couples' HRQOL improves between 1 and 6 months after an AMI.* At 6 months after an AMI, the HRQOL of average couples is similar to that of their peers in the normal population.* There are subgroup variations in the quality of life of post-AMI couples, and these are associated with age, clinically poor physical health, and depression.* The combination of patients' and partners' use of dyadic behaviour at 1 month after an AMI explains 7% of the variation in patients' emotional well-being at 6months after the event, after adjustment for patients' concurrent physical wellbeing and prior levels of emotional well-being, as well as duration of couple relationships.* The combination of partners' perceptions of dyadic functioning and use of dyadic behaviour at 1 month after an AMI explains 5% of the variation in partners' emotional well-being at 6 months after the event, after adjustment for partners' concurrent physical well-being and prior levels of emotional well-being, as well as duration of couples' relationships.* Patients have poorer emotional well-being at 6 months after an AMI if partners use dyadic behaviour infrequently at 1 month after the event.* Partners have poorer emotional well-being at 6 months after an AMI if they are not satisfied/unhappy with the functioning of their relationships at 1 month after the event. Adjusted exploratory analyses, undertaken to determine the extent to which dyadic discrepancies in perceptions of functioning or use of protective buffering behaviour, predict emotional well-being, show that patients who are less satisfied/unhappier with functioning than their partners at 1 month after an AMI have poor emotional wellbeing at 6 months after the event; patients who use the behaviour more frequently than their partners at 1 month after an AMI have poor emotional well-being at 6months after the event; and partners who are less satisfied/unhappier with functioning than their patients at 1 month after an AMI have poor emotional well-being at 6months after the event. The evidence from the QUT-AMI Project supports the proposition that the interaction that occurs within a couple relationship, combined with individual characteristics of members of a dyad, influences the extent to which a heart attack impacts on couples' HRQOL. It is argued that it is not enough to merely focus on implementing secondary prevention strategies with post-AMI patients. Given that poor emotional well-being is known to predict adverse cardiac events, and premature mortality due to cardiac disease, it is recommended that a couple-focused intervention designed to meet specific needs should be implemented with at-risk couples as a public health strategy to improve not only the patients' quality of life but also that of his partner. Further research is recommended to determine the extent to which such an intervention improves post-AMI couples' quality of life.