Dissertations / Theses on the topic 'Diseases Psychosomatic aspects'

Mitral Valve Prolapse Syndrome (MVPS) is a benign psychosomatic cardiac condition that can severely impair one's quality of life. Symptoms targeted in this study include, atypical chest pain, palpitations, anxiety, panic, and shortness of breath.This study was undertaken to examine the effects of a diaphragmatic breathing intervention on the symptoms and underlying mechanism of dysautonomia in a small group of symptomatic females with MVPS. The intervention was based on both yoga theory and cardiorespiratory empirical studies.Seven of eight participant's completed the nine week study using a single subject multiple baseline design across subjects. Participant's began a respiratory retraining intervention, in a weekly staggered pair start, after the first week of baseline measurement. Respiratory training consisted of a four week training in diaphragmatic breathing with home practice three times a day.Autonomic, behavioral, and cognitive systems were assessed. Dependent measures included State and Trait Anxiety, Anxiety Sensitivity, a Symptom Checklist, and Respiratory Sinus Arrhythmia (RSA). RSA is a current noninvasive measure of parasympathetic tone. Data on thoracic and abdominal respiratory predominance, respiration rate, diet, exercise, and adherence were also gathered.Data were analyzed via visual inspection of trends and phase average changes. Treatment effect sizes were calculated for standardized measures to indicate the meaningfulness of change.Two of the seven participants demonstrated a decrease in total symptom frequencies over the course of intervention. One participant demonstrated a weekly progression of lowered state anxiety scores from baseline through intervention. In terms of phase averages, three participants showed a lowering of state anxiety. All seven participants demonstrated lowered trait anxiety scores from pre to post intervention. Two of the seven participants demonstrated a meaningful pre to post intervention decrease in anxiety sensitivity. Respiratory training was effective in stabilizing abdominal respiration. Results regarding vagal tone could not be determined due to unreliable ECG data.In general, results were poor with several inconsistencies. Adherence rates were low and it did not appear that a therapeutic level of change in respiration rate was achieved. Controlling respiration rate may be a critical factor in the therapeutic effectiveness of respiratory retraining interventions.
Department of Counseling Psychology and Guidance Services

Given the presumed importance of cardiovascular reactivity and the role of anger in the development of hypertension and coronary heart disease, this study is the first to jointly examine three related areas (i.e. gender effects, anger direction preference, and opportunity/no opportunity to aggress following an anger Inducing situation). The present study tested the following hypotheses: a) that cardiovascular reactivity would vary as a function of subjects' gender and direction preference; b) that the rate of cardiovascular recovery would vary as a function of anger direction preference and opportunity/no opportunity to aggress; c) that the subjective feelings of anger after harassment would vary as a function of gender, anger direction preference, and opportunity/no opportunity to aggress; and d) that the evaluation of experimenter's competency and performance would vary as a function of anger preference. 56 females and 49 males executed a math task while being harassed for "poor performance". Next, they were randomly assigned to either write a negative evaluation of the frustrator or to copy a neutral paragraph and then to circle some letters in another paragraph. Heart rate and blood pressure were measured intermittently throughout. Subjects' preferred mode of anger expression (i.e. anger-in versus anger-out) had been previously assessed and cross validated by self as well as peer evaluations. Results indicated that gender was a better predictor than anger direction preference for cardiovascular reactivity to harassment. Complex patterns of recovery were detected with Intriguing sex differences. Results on male diastolic recovery were consistent with a matching hypothesis of anger direction preference but only for anger-out males. In addition, subjective anger for males was related to opportunity/no opportunity conditions, whereas females did not show such a relationship. Female anger-ln's showed quicker systolic recovery than anger-out's. Lastly, the evaluation of experimenter's competency and performance did not vary as a function of anger preference. Therapeutic implications of the findings within the context of anger control as well as trends for future research are discussed.
Arts, Faculty of
Psychology, Department of
Graduate

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A endometriose é uma doença inflamatória estrógeno-dependente que afeta de 5 a 10% das mulheres em idade reprodutiva. É caracterizada pela presença de tecido endometrial fora da cavidade uterina e está associada à dismenorreia, dor pélvica e infertilidade. Os níveis de expressão dos receptores nucleares SF1 (fator esteroidogênico 1), estrógeno e progesterona estão alterados no tecido endometriótico comparado ao endométrio normal. Estudos prévios relataram que os genes codificadores dos receptores dos hormônios esteróides ESR1 (receptor de estrógeno 1), ESR2 (receptor de estrógeno 2) e progesterona (PGR) apresentam promotores alternativos que são modulados epigeneticamente por alterações na metilação do DNA, que ocorre preferencialmente nas ilhas CpG presentes nestas regiões. Em células endometriais normais foi observada uma associação entre a presença de metilação e ausência de expressão dos genes SF1 e ESR2 (receptor de estrógeno â) enquanto a perda da metilação foi correlacionada com níveis aumentados de expressão gênica na endometriose peritoneal e ovariana. Com base nestas evidências, o presente trabalho investigou o padrão de metilação dos genes PGR (promotores A e B), ESR1 (promotores A e B) e uma região intragênica ao ESR2. O promotor B do gene PGR e a ilha CpG localizada na 5’UTR do gene ESR2 foram avaliadas em 44 amostras de endometriose profunda intestinal pela técnica de MSP (Methylation-Specific Polymerase Chain Reaction). Em sete destas, também foi possível a investigação na amostra pareada de endométrio eutópico. O padrão de metilação dos promotores A e B do gene ESR1 e o promotor A do gene PGR...
Endometriosis is an estrogen-dependent inflammatory disease which affects 5 to 10% of women of reproductive age. This disease is characterized by the presence of endometrial tissue outside the uterine cavity and is associated with dysmenorrhea, pelvic pain, and infertility. Abnormal expression levels of SF1 (steroidogenic factor 1), estrogen and progesterone nuclear receptors were detected in the endometriotic tissue compared to the normal endometrium. Previous studies have reported that genes encoding the steroid hormone receptors ESR1 (estrogen receptor 1), ESR2 (estrogen receptor 2) and progesterone (PGR) are characterized by alternative promoters epigenetically regulated by DNA methylation at CpG islands co-localized in these regions. In normal endometrial cells, it was observed an association between DNA methylation and absence of expression of the genes SF1 and ESR2 (estrogen receptor â), while loss of DNA methylation was correlated with increased expression levels of these genes in peritoneal and ovarian endometriosis. Based on these findings, this study investigated the methylation pattern of the PGR (promoters A and B), ESR1 (promoters A and B) genes and an intragenic region of the gene ESR2. The promoter B of PGR gene and the CpG island mapped at 5 'UTR of the ESR2 gene were evaluated in 44 samples of intestinal deep endometriosis by MSP (methylation-specific polymerase chain reaction). In seven cases, paired samples of eutopic endometrium from the same patients were also evaluated, the methylation patterns of the ESR1 gene (promoters A and B) and the promoter region A of the PGR gene were investigated in 37 samples of endometriosis. The MSP method is based on the DNA modification by sodium bisulfite, which converts unmethylated cytosines to uracil. Subsequently, the target region... (Complete abstract click electronic access below)

One hundred women aged 20 to 50 were asked to compare their sexual experience before diagnosis and following treatment for benign and malignant cervical disease. The subjects were divided into five groups: three groups had definite cervical intraepithelial neoplasia (CIN), (Class II or III). Two groups were treated with cryotherapy, and one with hysterectomy. One group had a provisional diagnosis of CIN I, but received no treatment. Subjects in the last group had microinvasive cervical carcinoma and were also treated with hysterectomy. All subjects had ovarian function; all were sexually active at the time of treatment. They were interviewed at least six months post-cryotherapy and 15 months post-hysterectomy. All subjects completed a variant version of the Derogatis Sexual Function Inventory (DSFI).

Orientador: Cláudia Aparecida Rainho
Banca: Roberta Guembarovisk
Banca: Celia Regina Nogueira
Resumo: A endometriose é uma doença inflamatória estrógeno-dependente que afeta de 5 a 10% das mulheres em idade reprodutiva. É caracterizada pela presença de tecido endometrial fora da cavidade uterina e está associada à dismenorreia, dor pélvica e infertilidade. Os níveis de expressão dos receptores nucleares SF1 (fator esteroidogênico 1), estrógeno e progesterona estão alterados no tecido endometriótico comparado ao endométrio normal. Estudos prévios relataram que os genes codificadores dos receptores dos hormônios esteróides ESR1 (receptor de estrógeno 1), ESR2 (receptor de estrógeno 2) e progesterona (PGR) apresentam promotores alternativos que são modulados epigeneticamente por alterações na metilação do DNA, que ocorre preferencialmente nas ilhas CpG presentes nestas regiões. Em células endometriais normais foi observada uma associação entre a presença de metilação e ausência de expressão dos genes SF1 e ESR2 (receptor de estrógeno â) enquanto a perda da metilação foi correlacionada com níveis aumentados de expressão gênica na endometriose peritoneal e ovariana. Com base nestas evidências, o presente trabalho investigou o padrão de metilação dos genes PGR (promotores A e B), ESR1 (promotores A e B) e uma região intragênica ao ESR2. O promotor B do gene PGR e a ilha CpG localizada na 5'UTR do gene ESR2 foram avaliadas em 44 amostras de endometriose profunda intestinal pela técnica de MSP (Methylation-Specific Polymerase Chain Reaction). Em sete destas, também foi possível a investigação na amostra pareada de endométrio eutópico. O padrão de metilação dos promotores A e B do gene ESR1 e o promotor A do gene PGR... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Endometriosis is an estrogen-dependent inflammatory disease which affects 5 to 10% of women of reproductive age. This disease is characterized by the presence of endometrial tissue outside the uterine cavity and is associated with dysmenorrhea, pelvic pain, and infertility. Abnormal expression levels of SF1 (steroidogenic factor 1), estrogen and progesterone nuclear receptors were detected in the endometriotic tissue compared to the normal endometrium. Previous studies have reported that genes encoding the steroid hormone receptors ESR1 (estrogen receptor 1), ESR2 (estrogen receptor 2) and progesterone (PGR) are characterized by alternative promoters epigenetically regulated by DNA methylation at CpG islands co-localized in these regions. In normal endometrial cells, it was observed an association between DNA methylation and absence of expression of the genes SF1 and ESR2 (estrogen receptor â), while loss of DNA methylation was correlated with increased expression levels of these genes in peritoneal and ovarian endometriosis. Based on these findings, this study investigated the methylation pattern of the PGR (promoters A and B), ESR1 (promoters A and B) genes and an intragenic region of the gene ESR2. The promoter B of PGR gene and the CpG island mapped at 5 'UTR of the ESR2 gene were evaluated in 44 samples of intestinal deep endometriosis by MSP (methylation-specific polymerase chain reaction). In seven cases, paired samples of eutopic endometrium from the same patients were also evaluated, the methylation patterns of the ESR1 gene (promoters A and B) and the promoter region A of the PGR gene were investigated in 37 samples of endometriosis. The MSP method is based on the DNA modification by sodium bisulfite, which converts unmethylated cytosines to uracil. Subsequently, the target region... (Complete abstract click electronic access below)
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The proposal of this thesis, based on psychosomatic theoretical literature, was to present the perception of women with vitiligo about a group psychological intervention on their coexistence with the disease. The participants were evaluated in two moments, with the use of the following instruments: semi-structured interview and group psychological intervention. The intervention was carried out in five encounters, with a sample of 12 women, of the State of Sergipe, divided into Group A (n=8) and B (n=4), aged between 20 and 72 years old, who live with the disease in the range of 5 to 58 years old. The intervention included the use of three resources: word, body, and art. The data were analyzed and grouped into five main themes: 1) perception of self; 2) perception of the disease; 3) perception of the relationship with the disease; 4) perception of friendly, lovely and family relations; 5) perception of group psychological clinical intervention. The overall results indicate, for all participants, different expressions of psychological suffering associated with the illness by vitiligo, pointing to a not recognized grieving process. Women complain that there is no social validation of clinical condition presented and, at the same time, it does not seem to allow the personal recognition of losses arising with the pathology. There was either the need for guidance to the family because one realizes that living with vitiligo has the potential to affect not only the people with the disease, but also their family members, in addition to the love and friendship relational contexts. We observed that the intervention allowed the participants to express the anguish and to recognize the limitations and defensive behaviors due to the illness, being perceived by them in a positive way, therefore, revealing itself as a useful resource in the care of patients with vitiligo, striving for the development of resiliency. Bring these issues to debate can contribute to the minimization of individual and collective effects, by the reduction of discrimination and stigmatization associated with the diagnosis, which can contribute to a more satisfying prognosis and improvements to the quality of life of the public
A proposta desta tese, sustentada no referencial teórico da psicossomática, foi apresentar a percepção de mulheres com vitiligo acerca de uma intervenção clínica psicológica grupal na sua convivência com a doença. As participantes foram avaliadas em dois momentos, com a utilização dos seguintes instrumentos: entrevista semiestruturada e intervenção clínica psicológica grupal. A intervenção foi realizada em cinco encontros, com uma amostra de 12 mulheres, do estado de Sergipe, divididas em grupo A (n=8) e B (n=4), com idades entre 20 e 72 anos, que convivem com a doença no intervalo de 5 a 58 anos. A intervenção contou com a utilização de três recursos: palavra, corpo e arte. Os dados foram analisados e agrupados em cinco eixos temáticos: 1) percepção de si; 2) percepção da doença; 3) percepção da relação com a doença; 4) percepção das relações de amizade, amorosas e familiares; 5) percepção da intervenção clínica psicológica grupal. Os resultados gerais indicam, para todas as participantes, diferentes expressões de sofrimento psicológico associadas ao adoecimento por vitiligo, que apontam para um processo de luto não reconhecido. As mulheres se queixam de que não há uma validação social da condição clínica apresentada e, ao mesmo tempo, isso parece não possibilitar o reconhecimento pessoal das perdas advindas com a patologia. Verificou-se, ainda, a necessidade de orientações à família, pois se percebe que a vivência com vitiligo tem o potencial de afetar não somente as pessoas com a doença, mas também seus familiares, além dos contextos relacionais amorosos e de amizade. Observamos, igualmente, que a intervenção permitiu às participantes a expressão de angústias e o reconhecimento de limitações e comportamentos defensivos devido à doença, sendo percebida por elas de forma positiva, revelando-se, portanto, como um útil recurso no cuidado a pacientes com vitiligo, com vistas ao desenvolvimento da resiliência. Trazer ao debate essas questões pode colaborar com a minimização de efeitos individuais e coletivos, pela redução da discriminação e estigmatização associadas ao diagnóstico, o que pode contribuir para um prognóstico mais satisfatório e melhorias para a qualidade de vida desse público

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
O exercício de uma atividade profissional proporciona ao ser humano fazer parte da vida em sociedade, como membro de uma cultura. Nessa perspectiva, o trabalho confere a possibilidade de construção de identidade profissional e pessoal. Entretanto, há algumas situações em que o trabalhador adoece. O presente estudo tem por objetivo principal compreender a relação existente entre a constituição do mundo psíquico do indivíduo, ou seja, a formação inicial da mente humana, que é subjetiva e inconsciente, e a ocorrência da doença relacionada ao trabalho; que é a doença decorrente do exercício profissional. Para a coleta de dados foram utilizadas entrevistas psicológicas semidirigidas e individuais com quatro participantes que receberam diagnóstico de doença relacionada ao trabalho. A psicanálise e a psicossomática psicanalítica constituem as principais referências teóricas desta dissertação. Como resultado deste estudo, pôde-se observar que as experiências infantis e as relações que se estabelecem no seio familiar são determinantes para a constituição do psiquismo humano e interferem na vivência profissional destes trabalhadores. Entretanto, fatores relacionados ao ambiente de trabalho também contribuem decisivamente para o adoecimento do indivíduo no trabalho. Os entrevistados apresentavam algum componente psíquico que facilitava a ocorrência da doença relacionada ao trabalho, mas todos queixavam-se da sobrecarga de trabalho, falta de humanização nos ambientes de trabalho e atribuíam o agravamento de seu quadro de saúde às más condições a à insalubridade...
The exercise of a professional activity provides the human beings the possibility of making part of the life in society, as members of a culture. In this perspective, the work confers the possibility of the construction of the professional and personal identity. However, there are some situations in which the worker gets sick. The present study has as principal objective to comprehend the existent relation between the individual’s psychic world constitution, that is to say the initial formation of the human mind, which is subjective and unconscious, and the occurrence of the disease related to the work; the disease derived of the professional exercise. To the data collection, semi-directed psychological and individual interviews with four participants, who received diagnosis of disease related to the work, were utilized. The psychoanalysis and the psychoanalytic psychosomatic constitute the main theoretical references of this dissertation. As results of this study, it was possible to observe that the childish experiences and the relations established in the familiar heart are determinant to the constitution of the human psychism and interfere in these workers’ professional living. However, factors related to the work environment also contribute decisively to the individual to get sick in the work. The interviewees presented some psychic component that facilitated the occurrence of the disease related to the work, but all of them complained about the work overload, lack of humanization in the work environment and they attributed the aggravation of their picture of health to the bad conditions and the insalubrity of the environment where the professional activities are developed. The interviewees presented impediments to return to exercise the work activities in the function of getting sick in the work ...

Cardiovascular disease is one of the leading causes of death in industrialized nations. Research indicates that job strain may be significantly related to cardiovascular disease in employees with little to no social support. Using the JDC-S model developed by Karasek (1979) and elaborated upon by Johnson and Hall (1988), the family-supportive supervisory behaviors (FSSB) measure created by Hammer et al., (2009), and the blood pressure wrist monitor device Omron317T, this study examined FSSB as a moderator of the relationship between job strain, job demands, job control and workers' blood pressure on work and non-work days. Sixty-nine grocery store workers from a Midwest grocery store chain participated in this study, fifty-six of which were included in the analyses. Though none of the interactions were significant at the .05 level, results indicate that FSSB is significantly related to a number of blood pressure readings at the grand centered mean of job strain, job control, and job demands.

Orientador: Francisco Hashimoto
Banca: Manoel Antonio dos Santos
Banca: Wilka Coronado Antunes Dias
Resumo: O exercício de uma atividade profissional proporciona ao ser humano fazer parte da vida em sociedade, como membro de uma cultura. Nessa perspectiva, o trabalho confere a possibilidade de construção de identidade profissional e pessoal. Entretanto, há algumas situações em que o trabalhador adoece. O presente estudo tem por objetivo principal compreender a relação existente entre a constituição do mundo psíquico do indivíduo, ou seja, a formação inicial da mente humana, que é subjetiva e inconsciente, e a ocorrência da doença relacionada ao trabalho; que é a doença decorrente do exercício profissional. Para a coleta de dados foram utilizadas entrevistas psicológicas semidirigidas e individuais com quatro participantes que receberam diagnóstico de doença relacionada ao trabalho. A psicanálise e a psicossomática psicanalítica constituem as principais referências teóricas desta dissertação. Como resultado deste estudo, pôde-se observar que as experiências infantis e as relações que se estabelecem no seio familiar são determinantes para a constituição do psiquismo humano e interferem na vivência profissional destes trabalhadores. Entretanto, fatores relacionados ao ambiente de trabalho também contribuem decisivamente para o adoecimento do indivíduo no trabalho. Os entrevistados apresentavam algum componente psíquico que facilitava a ocorrência da doença relacionada ao trabalho, mas todos queixavam-se da sobrecarga de trabalho, falta de humanização nos ambientes de trabalho e atribuíam o agravamento de seu quadro de saúde às más condições a à insalubridade ...
Abstract: The exercise of a professional activity provides the human beings the possibility of making part of the life in society, as members of a culture. In this perspective, the work confers the possibility of the construction of the professional and personal identity. However, there are some situations in which the worker gets sick. The present study has as principal objective to comprehend the existent relation between the individual's psychic world constitution, that is to say the initial formation of the human mind, which is subjective and unconscious, and the occurrence of the disease related to the work; the disease derived of the professional exercise. To the data collection, semi-directed psychological and individual interviews with four participants, who received diagnosis of disease related to the work, were utilized. The psychoanalysis and the psychoanalytic psychosomatic constitute the main theoretical references of this dissertation. As results of this study, it was possible to observe that the childish experiences and the relations established in the familiar heart are determinant to the constitution of the human psychism and interfere in these workers' professional living. However, factors related to the work environment also contribute decisively to the individual to get sick in the work. The interviewees presented some psychic component that facilitated the occurrence of the disease related to the work, but all of them complained about the work overload, lack of humanization in the work environment and they attributed the aggravation of their picture of health to the bad conditions and the insalubrity of the environment where the professional activities are developed. The interviewees presented impediments to return to exercise the work activities in the function of getting sick in the work ...
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The objective of this study was to analyze the effects of a brief Jungian psychotherapeutic intervention for a group of individuals suffering from periodontal disease. A total of 26 subjects were selected, male and female, aged between 30 and 60. The subjects were randomly divided between an experimental group (N=13) and a control group (N=13). The experimental group experienced a psychotherapeutic process, which consisted of 14 weekly sessions, of one and a half hours each. The two groups were evaluated with respect to the level of cortisol saliva, level of stress and periodontal conditions, before and after the experimental period. The results identified improvements in the experimental group, that were statistically significant, with respect to the levels of cortisol saliva (NC), the levels of stress and evidence of plaque (IP) gingivitis (IG), which measure, respectively, the accumulation of bacterium plaque and gum inflammation. The control group, which did not undergo a psychotherapeutic process, reported a statistically significant worsening in the plaque levels (IP), with no statistically significant alterations in the other indices. Descriptions and qualitative analyses were made of some thematic categories from the psychotherapeutic sessions, highlighting, amongst others, the difficulty of verbal assertive expression by the subjects. Interpretations and symbolic interpretations were made of the mouth and speech. Non verbal expressive techniques and symbolic amplification provided the transduction of the organic symptom to the abstract expression of the complex, which resulted in improvements in the periodontal disease. The results identified the need to consider the use of psychotherapy as an integral part of treating periodontal disease
O presente trabalho objetivou analisar os efeitos de uma intervenção psicoterápica breve Junguiana em um grupo de portadores de doença periodontal. Foram selecionados 26 sujeitos, de ambos os sexos, com idades entre 30 e 60 anos. Os sujeitos foram divididos aleatoriamente em grupo experimental (N=13) e controle (N=13). O grupo experimental passou pelo processo psicoterápico, que constou de 14 encontros semanais, com a duração de 1H30. Os dois grupos foram avaliados quanto à taxa de cortisol salivar, nível de estresse e condições periodontais, antes e depois do período experimental. Os resultados apontaram melhoras no grupo experimental, com significância estatística, nas taxas de cortisol salivar (NC), nos níveis de estresse e nos índices de placa (IP) e gengival (IG), que medem, respectivamente, o acúmulo da placa bacteriana e a inflamação gengival. O grupo controle, que não passou pelo processo psicoterápico, apresentou piora estatisticamente significante para o índice de placa (IP), não ocorrendo modificações com significância estatística nos demais indicadores. Foram descritas e analisadas qualitativamente algumas categorias temáticas das sessões psicoterápicas, destacando-se entre elas, a dificuldade de expressão verbal assertiva dos sujeitos. Foram feitas interpretações e amplificações simbólicas da boca e da fala. As técnicas expressivas não-verbais e o método de amplificação simbólica propiciaram a transdução do sintoma orgânico para a expressão abstrata do complexo, promovendo a melhora da doença periodontal. Os resultados apontam para a necessidade de se considerar o uso da psicoterapia como parte integrante no tratamento da doença periodontal

Xu Liying.
"April 2004."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2004.
Includes bibliographical references (p. 159-175)
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.
Abstracts in English and Chinese.

Indiana University-Purdue University Indianapolis (IUPUI)
Prospective epidemiologic evidence indicates that both stressful life events (SLEs) and depression are associated with an increased risk of subclinical atherosclerosis and cardiovascular disease (CVD) events. Even though stressful life events (SLEs) and depression co-occur and may act together to influence cardiovascular disease (CVD) risk, these psychosocial factors have been mainly examined in isolation. For instance, depression may moderate the relationship between SLEs and CVD outcomes. I hypothesized that depressive symptoms would potentiate the deleterious effect of SLEs on subclinical atherosclerosis. This hypothesis is plausible, given that depressed adults exhibit exaggerated and prolonged sympathetic nervous system, hypothalamic-pituitary-adrenal (HPA) axis, and inflammatory responses to stress, which in turn could promote atherosclerosis. As compared to their nondepressed counterparts, depressed individuals may also be more likely to engage in maladaptive methods to cope with SLEs (e.g., increased tobacco use, alcohol use, and consumption of low-nutrient, energy dense foods), which could also promote atherosclerosis. I examined cross-sectional data from 274 to 279 (depending on the outcome measure) older, African American adults (mean age = 66 years, 67% female) with no evidence of clinical CVD or dementia who participated in the St. Louis African American Health-Heart study (2009–2011). Number of SLEs was assessed using the Life Events Calendar, a structured interview. From this interview, a continuous SLEs variable was computed (number of adult SLEs: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11+). Severity of depression symptoms was measured using the 17-item Hamilton Rating Scale for Depression (HAM-D). Two measures of subclinical atherosclerosis were obtained: carotid intima-media thickness (CIMT; assessed by ultrasonography) and coronary artery calcification (CAC; assessed by multi-detector computerized tomography). I conducted linear (CIMT) and logistic (CAC) regression models, first adjusted for demographics (age, sex, education) and then fully-adjusted (demographics; mean arterial pressure; low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C); hemoglobin A1c; BMI; tobacco use; diabetes diagnosis; and use of antihypertensitve, lipid lowering, antidiabetic, and antidepressant medications). No main effects of SLEs or HAM-D were found for CIMT or CAC. There were also no SLEs by HAM-D interactions for CIMT or CAC. Because the current results are largely inconsistent with prior literature and there is a paucity of studies utilizing African American samples, future research is needed to examine the independent and interactive associations of SLEs and depressive symptoms with measures of subclinical atherosclerosis. If the present results are replicated, it may suggest that SLEs, depressive symptoms, and their interactive effect are not cardiotoxic among African American adults.

The World Health Organization (1969) has declared that heart disease is the largest plague that ever faced humanity. Myocardial Infarction (MD, in addition to causing more deaths than all other diseases of the heart combined, is responsible for changes, and in many cases deterioration, in the quality of life of survivors. Intervention programs tend to focus on preventing re-occurrence of MI. At the same time there is an urgent need for sophisticated rehabilitation programs that aim to improve quality of life after MI. It is speculated here that identification of the personality factors that relate to the different adjustment patterms of different subgroups of post-MI patients will assist in the design of an efficient rehabilitation program. Accordingly, the present study focuses on the inquiry of the psychological mechanisms that mediate between the Type A behavior pattern (TABP) and adjustment style. An integrated crisis and developmental theory based on psychoanalytical, attachment and social learning theories is proposed. The Thesis put forward is that TABP is not a homogeneous pattern and that interpersonal dependency is an underlying personality factor that subdivides Type A patients to subgroups with different developmental and adjustment patterns. It is claimed here that dependent Type A patients have a dependent-independent developmental psychodynamic conflict, and that for them, TABP is an adopted defense mechanism. They are expected to have more adjustment difficulties to the specific characteristics of the post-MI crisis than inde pendent Type A patients for whom TABP is a socially learned developmental process in an urban Western environment. Type B patients, who also lack the psychodynamic conflict, are expected to adjust as a group better than dependent Type A patients. Seventy-nine white urban South African males aged 30-60 years, after clinical MI, were tested. A combination of qualitative and quantitative methods of assessment was used in order to test the relationships between personality factors and adjustment, which was defined by multi-dimensional criteria (32 indices of adjustment) that related to various aspects of life in the post-MI period. The results confirmed the heterogeneity of TABP, dependent Type A patients adjusted less well than independent Type A patients to 16 out of 32 indices of adjustment. As expected for the same 16 indices, the behavior of Type B patients was better adjusted than dependent Type A patients. The outcomes of the adjustment of post-MI patients to all 32 indices is discussed. On the basis of the study's results and the crisis and developmental theory set out here, a differential rehabilitation program is proposed that relates to the different needs of the subgroups of post-MI patients.
Thesis (Ph.D.)-University of Natal, Durban, 1986.