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Biomedical subjects

E Friedmann

Publications and source records attributed to E Friedmann.

At least 19 recordsLinked to original sources
PubMed1995

Pet ownership, social support, and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST).

Social support and pet ownership, a nonhuman form of social support, have both been associated with increased coronary artery disease survival. The independent effects of pet ownership, social support, disease severity, and other psychosocial factors on 1-year survival after acute myocardial infarction are examined prospectively. The Cardiac Arrhythmia Suppression Trial provided physiologic data on a group of post-myocardial infarction patients with asymptomatic ventricular arrhythmias. An ancillary study provided psychosocial data, including pet ownership, social support, recent life events, future life events, anxiety, depression, coronary prone behavior, and expression of anger. Subjects (n = 424) were randomly selected from patients attending participating Cardiac Arrhythmia Suppression Trial sites and completed baseline psychosocial questionnaires. One year survival data were obtained from 369 patients (87%), of whom 112 (30.4%) owned pets and 20 (5.4%) died. Logistic regression indicates that high social support (p < 0.068) and owning a pet (p = 0.085) tend to predict survival independent of physiologic severity and demographic and other psychosocial factors. Dog owners (n = 87, 1 died) are significantly less likely to die within 1 year than those who did not own dogs (n = 282, 19 died; p < 0.05); amount of social support is also an independent predictor of survival (p = 0.065). Both pet ownership and social support are significant predictors of survival, independent of the effects of the other psychosocial factors and physiologic status. These data confirm and extend previous findings relating pet ownership and social support to survival among patients with coronary artery disease.

Adult↗
PubMed1994

Older patient satisfaction with communication during an initial medical encounter.

There has been extensive research on the factors associated with patient satisfaction with communication during medical encounters, however, little attention has been paid to satisfaction among subgroups of patients, including the elderly. It is inappropriate to assume that all patients have the same physician-patient relationship needs, and thus, they will all be satisfied with the same communication approaches during medical visits. In this study, we examine the interactional correlates of older patient satisfaction with an initial visit with a general internist. A multidisciplinary team composed of social scientists and physicians used the Multi-dimensional Interaction Analysis system to code audiotapes. Patients and physicians completed post-visit satisfaction questionnaires. Older patient satisfaction was positively correlated with the following variables: physician questioning and supportiveness on patient-raised topics; patient information-giving on patient-raised topics; the length of the visit; the physician's use of questions worded in the negative; shared laughter between the physician and the patient; and physician satisfaction. These findings suggest that older patients prefer encounters in which: (1) there is physician supportiveness and shared laughter; (2) they are questioned about and given an opportunity to provide information on their own agenda items; and (3) physicians provide some structure for the first meeting through their use of questions worded in the negative. The authors caution that although this sample of older patients appears to be satisfied with a communication style usually considered characteristic of the traditional model of the physician-patient relationship (i.e. a warm interpersonal style and physician-generated structure for the visit), older patients in other settings and future cohorts of elderly patients may prefer other communication approaches. It is also suggested that aspects of communication which provide satisfaction to patients in first visits may be different than aspects of communication associated with patient satisfaction in follow-up visits.

Adult↗
PubMed1994

The cardiovascular effects of rate of verbal communication.

This study was designed to evaluate the effect of modifying rate of speech on the cardiovascular responses of type A and type B cardiac patients during verbalization. Blood pressure and heart rate were recorded in 111 cardiac patients every minute during two series: rapid and slow verbalization. Cardiovascular responses were significantly greater during rapid than during slow verbalization, independent of type A behavior pattern. This study demonstrates that reducing rate of speech can decrease cardiovascular reactivity during verbalization.

Analysis of Variance↗
PubMed1992

Cardiovascular responses of patients with cardiac disease to talking and exercise stress testing.

The blood pressure (BP), heart rate (HR), and premature ventricular contraction responses of patients with cardiac disease during talking were compared with those during exercise stress testing (EST). BPs, HR, and heart rhythm were recorded in 52 patients with cardiac disease before and during talking about an intentionally neutral topic and compared with changes during EST. The systolic and diastolic BP and HR increased significantly during talking. Diastolic BP increased significantly more during talking than during EST stages 1 and 2. The increase in diastolic BP during EST stage 3 did not differ from the increase during talking. HR and systolic BP increased more during EST than during talking. Nine patients had premature ventricular contractions during both EST and talking, two during EST only, and one while talking only. The verbalization protocol provides information about changes in diastolic BP that are not seen with EST. It also may be of value for evaluating heart rhythm, HR, and systolic BP changes for patients whose disabilities preclude EST.

Adult↗
PubMed1990

[Recurrent hypoglycemia in the insulin autoimmune syndrome].

A 72-year-old man with recurrent hypoglycaemia was suspected of having an insulinoma. But several diagnostic methods (computed tomography; mesenteric and coeliac angiography; sella imaging) did not reveal any tumour. 72-hour hunger test did not precipitate any spontaneous hypoglycaemia. A falling insulin-glucose ratio spoke against an insulin-producing tumour. Reactive symptomatic hypoglycaemia occurred 4.5 hours after an oral glucose test. Measurement of insulin concentration demonstrated a slow but pronounced increase (3500 microU) over an already raised initial value (816 microU/ml), typical of prediabetic metabolic regulation. Demonstration of insulin autoantibodies confirmed the diagnosis of an insulin autoimmune syndrome, which has a good prognosis. The patient became free of symptoms on a regimen of frequent small, carbohydrate-poor but fat and bulk-rich meals. Hypoglycaemia recurred when the diet was not observed.

Aged↗
PubMed1989

Concordance between physicians and their older and younger patients in the primary care medical encounter.

To test the hypothesis that less concordance exists between older patients and their physicians than between younger patients and their physicians, we examined agreements between physicians and patients on the major goals and topics discussed during an outpatient medical encounter. Using coded audiotapes of the medical visit, patient postvisit interviews, and physician questionnaires, concordance was found to be significantly greater for younger patients and their physicians than for older patients and their physician on the major goals and major medical topics discussed during the primary care interview. This paper explores possible explanations for these findings.

Age Factors↗
PubMed1989

Blood pressure, heart rate, and heart rhythm changes in patients with heart disease during talking.

Blood pressure and heart rate were recorded in 37 patients with cardiac disease while they were resting quietly and talking. Heart rate, systolic blood pressure, and diastolic blood pressure were all significantly greater while the patients were speaking than while they were resting silently. In addition, ventricular and atrial arrhythmias were more frequent while they were talking than while they were quiet. Higher resting systolic blood pressure levels also were associated with larger blood pressure increases while the patients were speaking. Older patients exhibited significantly greater systolic pressure increases while talking than younger patients. Therapeutic doses of antihypertensive medications, including beta-blockers, calcium channel blockers, and diuretics did not block the heart rate and blood pressure increases while the patients were talking. These findings suggest that more attention needs to be paid to the hemodynamic consequences of communication in patients with coronary heart disease. Coupled with previous research findings, these data also suggest that clinicians need to attend to verbal communications during routine diagnostic procedures for evaluating cardiovascular function.

Adult↗
PubMed1987

Parathyroid hormone stimulation of renal adenylate cyclase in various vertebrate species: evidence for an effect in the frog.

The effect of [Nle8,18,Tyr34]bPTH-(1-34)amide on renal plasma membrane adenylate cyclase, in the presence of 0.1 mM guanylylimidodiphosphate was measured in rat, chicken, frog and trout. All species showed an enrichment of at least 8-fold (relative to homogenate) in the marker enzyme Na+,K+-ATPase. A significant dose-dependent adenylate cyclase stimulation was found in frog, with affinity values similar to those of rat and chicken (ED50=8, 10 and 3 nM, respectively), but not in trout. The frog response was specific since [Nle8,18,Tyr34]bPTH-(3-34)amide strongly inhibited the agonist-stimulated enzyme. These results suggest the existence of a PTH-like substance in anurans acting via cyclic AMP formation in the kidney.

Adenylyl Cyclases↗
PubMed1986

The effect of touch on nutritional intake of chronic organic brain syndrome patients.

Inadequate nutrition, a major cause of illness and complications among elderly adults, is of particular import for those who cannot provide for themselves. We evaluated the effect of gentle touch during eating on nutritional intake (NI) of 42 institutionalized chronic organic brain syndrome (COBS) patients. Patients were randomly assigned to experimental or control groups. NI was evaluated for 3 consecutive weeks. During Weeks 1 and 3 all patients were encouraged verbally to eat. In the treatment week experimental group members were touched gently during this verbal encouragement. Repeated measures analyses of variance were used to evaluate the effect of touch on NI. In the first week NI for the groups did not differ. NI was significantly greater in the experimental than in the control group (p less than .01) during the other 2 weeks. Tactile stimulation, a simple intervention, may be an important adjunct to verbal encouragement to improve NI in COBS patients.

Aged↗
PubMed1984

Changes in nurses' blood pressure and heart rate while communicating.

Cardiovascular responses of nurses were measured during two communication tasks. In the first experiment 40 nurses' blood pressures and heart rates were taken pre, during, and post change-of-shift report. In the second experiment, 30 nurses spoke to an individual nurse and to a group of nurses. Blood pressures and heart rates were recorded pre, during, and post speech in both conditions. Analyses of variances showed that speaking levels of all cardiovascular parameters were higher (p less than .001) than resting levels in both experiments. Blood pressures and heart rates were higher (p less than .0001) in front of a group than in front of an individual. These findings extend previous work that has shown communication alters blood pressure.

Adult↗
PubMed1983

Social interaction and blood pressure. Influence of animal companions.

The effect of the presence of a friendly animal on children's blood pressures and heart rates while resting and their cardiovascular responses to verbalization were examined. The presence of the dog resulted in lower blood pressures both while the children (N = 38) were resting and while they were reading. The effect of the presence of the dog was greater when the dog was present initially than when it was introduced in the second half of the experiment. We speculate that the animal causes the children to modify their perceptions of the experimental situation and the experimenter by making both less threatening and more friendly. This study provides insight into the use of pets as adjuncts in psychotherapy.

Adolescent↗
PubMed1982

The effects of normal and rapid speech on blood pressure.

The effects of two rates of speech on blood pressure and heart rate were measured in 30 normotensive individuals. Verbalization was linked to rapid and significant rises in blood pressure. Faster rates of speaking were associated with greater increases in blood pressure. These findings are discussed in light of earlier research on the blood pressure communication response and are evaluated in the context of the speech pattern characteristics of the Type A (coronary-prone) individual. Clinical applications of this research for hypertensive and Type A individuals are discussed.

Adult↗
PubMed1982

Automated blood pressure recording: the phenomenon of blood pressure elevations during speech.

The recent development of automatic non-invasive blood pressure devices has allowed the rapid and repeated assessment of both the blood pressure and pulse rate in the clinical setting. The development of this technology has allowed us to observe a striking relationship between human communication and blood pressure. Talking produces rapid increases in their systolic, diastolic and mean arterial pressures as well as pulse rate in both normotensive and hypertensive subjects. This phenomenon has been obscured by the conventional assessment techniques of blood pressure measurement. Ignoring the pattern of verbal communication during the assessment of blood pressure can result in marked differences in recorded blood pressure and its interpretation.

Adult↗
PubMed1982

Blood pressure changes while talking.

Using a noninvasive automatic device to rapidly and repeatedly measure blood pressure, a striking relationship was found between talking and an increase in blood pressure and heart rate. This finding was demonstrated in a variety of experimental settings (the laboratory, medical clinic, classroom and home) in both children and adults and in both normotensive and hypertensive individuals. A significant positive correlation was also observed between the level of resting pressure and the magnitude of increase in pressure while talking. These findings point toward an important link between human communication and blood pressure control that has previously been overlooked. They also suggest a new conceptual approach to the understanding and treatment of hypertension.

Adolescent↗