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Biomedical subjects

J A Blumenthal

Publications and source records attributed to J A Blumenthal.

At least 37 records · Page 2Linked to original sources
PubMed1999

Perception of cognitive function in older adults following coronary artery bypass surgery.

This study examined the effects of coronary artery bypass grafting (CABG) on objective and subjective measures of neurocognitive functioning. Participants were 170 older patients (127 men and 43 women; mean age = 61 years) undergoing CABG. Measures of neurocognitive function, depression, anxiety, and perceived cognitive abilities were administered immediately prior to and 6 weeks following surgery. Although objective measures of impaired cognitive performance following CABG were not related to perceived cognitive difficulties, the presence of anxiety and depression was related to the perception of cognitive functioning. Patients who reported high levels of anxiety and depression 6 weeks after surgery perceived themselves as having poorer cognitive function. Interventions designed to reduce emotional distress could improve patient's perceived cognitive abilities following CABG.

Aged↗
PubMed1998

Psychosocial influences on blood pressure during daily life.

Ambulatory blood pressure (ABP) monitoring allows frequent non-invasive blood pressure (BP) recordings in a variety of settings. Emerging evidence suggests that ABP is a better predictor of cardiovascular morbidity than clinic BP. Ambulatory blood pressure is influenced by a variety of physical, psychological and behavioral factors that comprise an individual's daily life. The present article reviews psychosocial research relating ABP to psychological factors (e.g. Type A behavior pattern, anger/hostility) and environmental influences (e.g. job strain). Psychological factors and environmental factors alone and in interaction with each other appear to substantially influence ABP. Interacting physical, psychosocial and behavioral factors that comprise daily life provide unique methodological challenges to ABP research. Methodological considerations (e.g. activity patterns, caffeine and alcohol consumption) for performing ABP research are discussed. Evidence outlined in this review suggests that psychosocial factors contribute to ABP level. To the extent that psychosocial factors contribute to ABP cardiac disease, it will be important to analyze their effects on underlying disease processes.

Animals↗
PubMed1998

The reasonable woman standard: a meta-analytic review of gender differences in perceptions of sexual harassment.

Courts and legislatures have begun to develop the "reasonable woman standard" (RWS) as a criterion for deciding sexual harassment trials. This standard rests on assumptions of a "wide divergence" between the perceptions of men and women when viewing social-sexual behavior that may be considered harassing. Narrative reviews of the literature on such perceptions have suggested that these assumptions are only minimally supported. To test these assumptions quantitatively, a meta-analytic review was conducted that assessed the size, stability, and moderators of gender differences in perceptions of sexual harassment. The effect of the actor's status relative to the target also was evaluated meta-analytically, as one alternative to the importance of gender effects. Results supported the claims of narrative reviews for a relatively small gender effect, and draw attention to the status effect. In discussing legal implications of the present findings, earlier claims are echoed suggesting caution in establishing the reasonable woman standard, and one alternative to the RWS, the "reasonable victim standard," is discussed.

Adult↗
PubMed1998

Interaction of hypertension and age in visual selective attention performance.

Previous research suggests that some aspects of cognitive performance decline as a joint function of age and hypertension. In this experiment, 51 unmedicated individuals with mild essential hypertension and 48 normotensive individuals, 18-78 years of age, performed a visual search task. The estimated time required to identify a display character and shift attention between display positions increased with age. This attention shift time did not differ significantly between hypertensive and normotensive participants, but regression analyses indicated some mediation of the age effect by blood pressure. For individuals less than 60 years of age, the error rate was greater for hypertensive than for normotensive participants. Although the present design could detect effects of only moderate to large size, the results suggest that effects of hypertension may be more evident in a relatively general measure of performance (mean error rate) than in the speed of shifting visual attention.

Adult↗
PubMed1998

Facial expression and the affective component of cynical hostility in male coronary heart disease patients.

This study describes the affective component of hostility as measured by the Cook-Medley Hostility Scale (Ho; W. Cook & D. Medley, 1954) by examining the relationship between facial expressions of emotion and Ho scores in 116 male coronary heart disease patients. Patients underwent the videotaped Type A Structured Interview, from which facial expressions were later coded using the Facial Action Coding System. They also completed the Cook-Medley Ho scale. Facial expression of the emotion of contempt was significantly related to Ho scores; anger expression was not. Also, there was a significant interaction between hostility and defensiveness, wherein low-defensive, highly hostile people showed substantially more contempt expression than others. The implications of these findings for the construct validity of Ho and for identifying clinically important subtypes of hostility are discussed.

Adult↗
PubMed1998

Effect of satisfaction with social support on blood pressure in normotensive and borderline hypertensive men and women.

The relation between blood pressure (BP) and two aspects of social support, perceived satisfaction and structural social support network characteristics, were examined in adults classified as having normal BP or borderline hypertension. Causal BPs were taken by a trained technician on 3 separate visits, each approximately 1 week apart. Participants were categorized as borderline hypertensive if screening systolic blood pressure (SBP) fell in the range 130-160 mmHG and/or diastolic blood pressure (DBP) fell in the range 85-100 mmHg; BPs below these ranges were considered normotensive. Participants underwent ambulatory BP monitoring. Individuals classified as normotensive reported significantly greater support satisfaction than individuals with borderline hypertension. Social network characteristics were not associated with BP. During 24 hr of ambulatory BP monitoring, high perceived support satisfaction was associated with lower SBP and DBP at work, home, and during sleep. These data suggest that perceived satisfaction with social support is associated with lower BP. The presence of social support also may reduce BP levels during daily life.

Journal Article↗
PubMed1998

Exercise training as an alternative treatment for depression among older adults.

This article reviews the current literature related to exercise treatment and depression among older adults. Results from investigational studies support the antidepressive effects of exercise programs. Aerobic exercise is more effective than placebo or no treatment controls, and appears to be as effective as more traditional treatment methods. However, a number of potential methodological problems leave the issue of exercise therapy for the treatment of depression unsettled. Some possible directions for future research are discussed, along with clinical recommendations.

Adolescent↗
PubMed1998

Muscarinic inhibition of substance P induced ion secretion in piglet jejunum.

We examined the effects of the muscarinic agonist carbachol on ion secretion induced by substance P (SP) in piglet jejunal tissues mounted in Ussing chambers. Tetrodotoxin was present in all solutions to inhibit neural activity. Carbachol added 10 min prior to 0.75 microM SP dose dependently inhibited subsequent SP responses, with 90% inhibition at 10 microM carbachol. Addition of an equipotent dose of SP (7.5 microM) had no effect on subsequent carbachol-induced secretion. Carbachol's inhibition of SP-induced secretion was evident for at least 45 min and was abolished by prior addition of the M3 receptor antagonist 4-diphenylacetoxy-N-methyl-piperidine methiodide (4-DAMP), but remained intact in the presence of the M2 antagonist gallamine or the nicotinic antagonist mecamylamine. Atropine added 10 min after carbachol restored subsequent SP responses toward control levels. Carbachol also reduced secretory responses to histamine and, to a lesser extent, prostaglandin E2 (PGE2). SP-induced secretion was not affected by prior addition of histamine and was reduced by PGE2 only at the highest PGE2 concentration. The results suggest that activation of the epithelial M3 receptor by carbachol inhibits subsequent secretory responses to the calcium-mediated agonists SP and histamine in piglet jejunum. This may reflect muscarinic activation of a negative messenger in epithelial cells that limits Cl- secretion.

Animals↗
PubMed1997

Cognitive function 5 years after randomization to coronary angioplasty or coronary artery bypass graft surgery.

BACKGROUND: Coronary bypass surgery often leads to short-term cognitive dysfunction, whereas coronary angioplasty does not. Perioperative cognitive dysfunction usually resolves, although a subgroup of surgical patients may continue to exhibit long-term cognitive dysfunction. The purpose of this study was to compare cognitive function 5 years after randomization to a strategy of either initial coronary surgery or initial angioplasty. METHODS AND RESULTS: Five centers in the Bypass Angioplasty Revascularization Investigation participated in this ancillary study. Patients with multivessel coronary disease randomized to angioplasty or surgery were eligible at the time of their 5-year clinic visit. A battery of five measures previously shown to be sensitive to perioperative changes in cognitive function was administered, including the Logical and Figural Memory Scales from the Wechsler Memory Scale, the Digit Symbol and Digit Span subtests from the Wechsler Adult Intelligence Scale, and Part B of the Reitan Trail Making Test. The 125 study patients were generally similar to the 133 patients who were eligible but did not participate, although study participants were significantly younger (P=.003). The 64 patients randomly assigned to angioplasty had baseline characteristics similar to those of 61 patients randomly assigned to surgery. Cognitive function scores were not significantly different between angioplasty or surgery patients in an intention-to-treat analysis (P=.57). There also was no difference in cognitive function scores when the data were analyzed according to whether the patient had ever undergone bypass surgery (P=.59). CONCLUSIONS: Long-term cognitive function is similar after coronary bypass surgery and coronary angioplasty in the majority of patients.

Adult↗
PubMed1997

Stress management and exercise training in cardiac patients with myocardial ischemia. Effects on prognosis and evaluation of mechanisms.

BACKGROUND: Previous studies have demonstrated that myocardial ischemia can be elicited by mental stress in the laboratory and during daily life and that ischemia induced by mental stress is associated with an increased risk for future cardiac events in patients with coronary artery disease. OBJECTIVES: To examine the extent to which ischemia induced by mental stress can be modified by exercise stress management, and to evaluate the impact of these interventions on clinical outcomes. METHODS: One hundred seven patients with coronary artery disease and ischemia documented during mental stress testing or ambulatory electrocardiographic monitoring were randomly assigned to a 4-month program of exercise or stress management training. Patients living at a distance from the facility formed a nonrandom, usual care comparison group. Myocardial ischemia was reassessed following treatment, and patients were contacted annually for as long as 5 years to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. RESULTS: Twenty-two patients (21%) experienced at least 1 cardiac event during a mean (+/- SD) follow-up period of 38 +/- 17 months. Stress management was associated with a relative risk of 0.26 compared with controls. The relative risk for the exercise group also was lower than that of controls, but the effect did not reach statistical significance. Stress management also was associated with reduced ischemia induced by mental stress and ambulatory ischemia. CONCLUSION: These data suggest that behavioral interventions offer additional benefit over and above usual medical care in cardiac patients with evidence of myocardial ischemia.

Adult↗
PubMed1997

Effects of mental stress on myocardial ischemia during daily life.

OBJECTIVE: To determine the relative risk of myocardial ischemia triggered by specific emotions during daily life. DESIGN AND SETTING: Relative risk was calculated by the recently developed case-crossover method, in which the frequency of a presumed trigger during nonischemic, or control, hours is compared with the trigger's frequency during ischemic, or case, hours. Outpatients at Duke University Medical Center, Durham, NC, underwent 48 hours of ambulatory electrocardiographic (ECG) monitoring with concurrent self-report measures of activities and emotions. Occurrences of negative emotions in the hour before the onset of myocardial ischemia were compared with their usual frequency based on all hours in which ischemia did not occur. SUBJECTS: From a sample of 132 patients with coronary artery disease and recent evidence of exercise-induced ischemia who underwent 48 hours of ambulatory ECG monitoring, 58 patients exhibited ambulatory ischemia and were included in the analysis. OUTCOME MEASURES: Myocardial ischemia during 48-hour ECG monitoring was defined as horizontal or downsloping ST-segment depression of 1 mm (0.1 mV) or more for 1 minute or longer compared with resting baseline. The ECG data were cross-tabulated with subjects' concurrent diary ratings of 3 negative emotions-tension, sadness, and frustration-and 2 positive emotions-happiness and feeling in contro-on a 5-point scale of intensity. RESULTS: The unadjusted relative risk of occurrence of myocardial ischemia in the hour following high levels of negative emotions was 3.0 (95% confidence interval [CI], 1.5-5.9; P<.01) for tension, 2.9 (95% CI, 1.0-8.0; P<.05) for sadness, and 2.6 (95% CI, 1.3-5.1; P<.01) for frustration. The corresponding risk ratios adjusted for physical activity and time of day were 2.2 (95% CI, 1.1 -4.5; P<.05) for tension, 2.2 (95% CI, 0.7-6.4; P=.16) for sadness, and 2.2 (95% CI, 1.1-4.3; P<.05) for frustration. CONCLUSIONS: Mental stress during daily life, including reported feelings of tension, frustration, and sadness, can more than double the risk of myocardial ischemia in the subsequent hour. The clinical significance of mental stress-induced ischemia during daily life needs to be further evaluated.

Activities of Daily Living↗
PubMed1997

Psychosocial correlates of job strain in a sample of working women.

BACKGROUND: This study identifies potential mediators of job strain effects on health by determining whether psychosocial factors known to predict an increased risk of cardiovascular disease and all-cause mortality are higher among women who report high levels of job strain. METHODS: Measures of job strain and other psychosocial risk factors were obtained in a sample of 152 female employees of a local corporation. Canonical correlation and analyses of covariance were used to assess relationships between job demands and decision latitude and other psychosocial risk factors. RESULTS: A significant (P = .002) solution to the canonical correlation analysis showed that high job demands and low decision latitude were correlated with a pattern of psychosocial factors consisting of (1) increased levels of negative emotions like anxiety, anger, depression, and hostility; (2) reduced levels of social support; and (3) a preponderance of negative compared with positive feelings in dealings with coworkers and supervisors. This pattern was confirmed by analyses of covariance that adjusted for demographic and specific job characteristics. CONCLUSIONS: The canonical correlation analysis results provide empirical support for the job strain construct. The most important finding is that health-damaging psychosocial factors like job strain, depression, hostility, anxiety, and social isolation tend to cluster in certain individuals.

Adult↗
PubMed1997

Stability over time of circadian rhythm of variability of heart rate in patients with stable coronary artery disease.

Reproducibility of circadian rhythm of variability in heart rate was studied in 40 patients with stable coronary artery disease who underwent 48-hour ambulatory electrocardiographic recordings at baseline (time 1) and after 4 months (time 2). The standard deviation of the R-R interval and the low-frequency (0.04 to 0.15 Hz) and high-frequency (0.15 to 0.45 Hz) components of variability in heart rate were assessed every 5 minutes. In 35 patients a significant circadian rhythm was observed at both time 1 and time 2 in the standard deviation of the R-R interval, with the acrophase occurring at around 5:00 AM, in the high-frequency amplitude with the acrophase around 3:00 AM, and in the low-frequency/high-frequency ratio with the acrophase around noon. In these patients, parameters of circadian rhythm (mesor, amplitude, and acrophase) showed good within-individual reproducibility with an intraclass correlation coefficient of 0.63 to 0.95 (p < 0.001 for all). In the patients who showed inconsistency about the significance of circadian rhythm between time 1 or time 2, the amplitude of circadian rhythm, even if significant, was found in the lowest five values in the distribution. We conclude that the circadian rhythms of cardiac autonomic activity are stable over time within individual patients with stable coronary artery disease.

Adult↗
PubMed1997

Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center.

BACKGROUND: Changes in memory and cognition frequently follow cardiac operations. We hypothesized that patients with the apolipoprotein E-epsilon 4 allele are genetically predisposed to cognitive dysfunction after cardiac operations. METHODS: The apolipoprotein E-epsilon 4 allele was evaluated as a predictor variable for postoperative cognitive dysfunction in 65 patients undergoing cardiac bypass grafting at Duke University Medical Center. The primary outcome measure was performance on a cognitive battery administered preoperatively and at 6 weeks postoperatively. RESULTS: In a multivariable logistic regression analysis including apolipoprotein E-epsilon 4, preoperative score, age, and years of education, a significant association was found between apolipoprotein E-epsilon 4 and change in cognitive test score in measures of short-term memory at 6 weeks postoperatively. Patients with lower educational levels were more likely to show a decline in cognitive function associated with the apolipoprotein E-epsilon 4 allele. CONCLUSIONS: This study suggests that apolipoprotein E genotype is related to cognitive dysfunction after cardiopulmonary bypass. Cardiac surgical patients may be susceptible to deterioration after physiologic stress as a result of impaired genetically determined neuronal mechanisms of maintenance and repair.

Age Factors↗
PubMed1997

Relation of mood ratings and neurohormonal responses during daily life in employed women.

Diurnal variations in urinary norepinephrine, epinephrine, cortisol, and self-reported mood states were examined in 101 employed women. Urine was collected on 2 consecutive workdays at 3 time periods: (1) overnight, (2) daytime, and (3) evening. Self-reports of 14 mood states were combined to correspond with the urinary collection periods. Factor analyses revealed 3 mood factors: Pressured (rushed, busy, stressed, hassled, and tense), Distressed (afraid, depressed, bored, and nervous), and Contented (satisfied, thoughtful, excited, and calm). The Distressed factor was significantly associated with norepinephrine excretion (p <.001). The Pressured factor was significantly associated with cortisol, epinephrine, and norepinephrine excretion (p <.001) independent of age, ethnicity, marital status, parental status, department within the company and activity level. Secretion of urinary hormones and the Pressured factor followed the same diurnal pattern. Specifically, as women's self-ratings of feeling pressured initially increased and then decreased over the course of the workday, urinary hormones also peaked and then dropped. Once time of day was statistically controlled, however, the mood factors were no longer significantly related to the urinary hormones.

Journal Article↗
PubMed1997

Personality factors differentially predict exercise behavior in men and women.

Personality assessed with the Minnesota Multiphasic Personality Inventory (MMPI) in college was used to predict exercise behavior measured at midlife in 3,630 men and 796 women enrolled in the University of North Carolina Alumni Heart Study. Logistic regression models were fitted for each of the MMPI clinical scales to test the predictive effect of personality, gender, and their interaction on adult exercise behavior. Lower depression, social introversion, and psychopathic deviance scores were associated with increased probability of exercising in midlife for both men and women. Furthermore, better psychological health (indexed by lower hypochondriases and psychasthenia) in college was generally predictive of increased exercise for men, whereas higher scores on these same factors predicted midlife exercise for women. There were two other patterns of gender interactions: (a) for men, lower scores on hysteria and schizophrenia scales were associated with increased probability of exercising at midlife, whereas these factors were unrelated to exercise for women and (b) for women, lower ego strength and higher college scores on paranoia and mania were associated with exercise behavior at midlife. These data suggest that early adulthood personality predictors of exercise behavior at midlife are both gender-neutral and gender-specific; that is, where no gender differences exist, healthier personality traits predict exercise at midlife, and when gender differences do occur, healthier college patterns of personality predict exercise behavior for men and sedentary behavior for women.

Adolescent↗