Risultati per: Incontinenza urinaria da stress o mista

Circulation, Volume 148, Issue Suppl_1, Page A16817-A16817, November 6, 2023. Introduction:Adenosine and regadenoson are commonly used vasodilators in myocardial perfusion imaging for assessment of suspected coronary artery disease.Hypothesis:The aim of this study is to determine the difference between the different vasodilators by quantifying stress and rest myocardial perfusion using cardiovascular magnetic resonance (CMR).Methods:Subjects with known or suspected CAD from 10 centers undergoing invasive coronary angiography or CT angiography were enrolled for rest and stress first-pass perfusion images using dual sequence. First-pass stress perfusion images were acquired on 1.5T or 3.0T GE scanner during adenosine or Regadenoson. Fully quantitative perfusion values were determined using Fermi deconvolution. Significant CAD was defined by: presence of≥50% stenosis in the left main coronary artery or ≥70% in the one major vessel. Diagnostic performance of stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) was measured using receiver operating characteristics curves.Results:A total of 89 subjects were recruited with a median age of 66 yrs, 69% men, 55% significant CAD, history of hypertension in 78%, diabetes in 48%, and hyperlipidemia in 74%. 36 subjects used adenosine, while 53 used regadenoson as the vasodilator agent. Stress MBF had a good area under the curve for adenosine vs. regadenoson [ 0.89 (0.78-1.00) vs. 0.82 (0.66-0.98), p=0.43], sensitivity (100% vs. 84%), and specificity (80% vs. 80%). MPR had a higher area under the curve for adenosine than regadenoson [0.87 (0.75-0.98) vs. 0.68 (0.52-0.84), p=0.06], sensitivity (100% vs. 61%), and specificity (68% vs. 73%). (Figure)Conclusions:Our study showed that fully quantitative perfusion using CMR, regadenoson, and adenosine have similar good diagnostic accuracy when stress MBF was used as the diagnostic parameter. However, adenosine outperformed regadenoson for the detection of significant CAD when MPR was used as the diagnostic parameter.

Circulation, Volume 148, Issue Suppl_1, Page A17343-A17343, November 6, 2023. Background:As a professional group, physicians are at increased risk of burnout and job stress, both of which are associated with an increased risk of coronary heart disease that seems more prevalent among male than female physicians.Aim:This study aimed to examine the association of burnout and job stress with coronary microvascular function, a predictor of major adverse cardiovascular events.Methods:Thirty male physicians with clinical burnout and 30 controls without burnout were included. Burnout was assessed with the Maslach Burnout Inventory and job stress with the effort-reward imbalance and overcommitment questionnaire. All participants underwent myocardial perfusion positron emission tomography to quantify endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular function. Burnout and job stress were regressed on measures of coronary microvascular function in the same model while adjusting for age and body mass index.Results:Burnout and job stress had significant and independent effects on endothelium-dependent microvascular function. Burnout was positively associated with coronary flow reserve, myocardial blood flow (MBF) response, and hyperemic MBF (r partial: 0.29 to 0.35; p-value: 0.008 to 0.027). Effort-reward ratio (r partial: -0.32 to -0.34; p-value: 0.009 to 0.017) and overcommitment (r partial: -0.29 to -0.35; p-value: 0.008 to 0.027) showed inverse associations with these measures.Conclusions:In male physicians, burnout and high job stress showed opposite effects on coronary microvascular endothelial function. Longitudinal studies are needed to show potential clinical implications. Future studies should include burnout and job stress for a more nuanced understanding of their potential impact on cardiovascular health.

Circulation, Volume 148, Issue Suppl_1, Page A16706-A16706, November 6, 2023. Introduction:Coronary vascular dysfunction (CVaD) is associated with major adverse outcomes, recurrent chest pain, and can be triggered by mental stress.Hypothesis:We hypothesized that women with CVaD have heightened emotional response and attenuated recovery compared to reference control (RC) women.Methods:Women diagnosed with CVaD (cases, n=57, age: 57±1 years) by abnormal adenosine or acetylcholine response during invasive coronary function testing were enrolled in Cardiac Autonomic Nervous System Study and compared to age-matched, asymptomatic RCs women (n=25, age: 56±3 years), free of cardiac or risk factor history. All underwent two 4-minute standardized mental stress tests – anger recall and mental arithmetic – followed by 15 minutes of recovery. Emotional arousal (tension, anxious, depressed) and chest pain were assessed via self-reported Likert scale at baseline, after stress, and after recovery. The difference between post-stress or post-recovery and baseline scores was used to evaluate stress provocation and recovery. Increased differences indicate more provocation or recovery attenuation. We utilized multivariate models adjusted for anti-anginal medications, statins, and aspirin or traditional cardiovascular risk factors and chest pain to assess associations between CVaD and chest pain or emotional arousal, respectively.Results:The two groups did not differ in hemodynamic response to mental stress (p >0.05). In multivariate models, CVaD status was associated with more stress-provoked chest pain (β 1.24 [0.1, 2.4], p=0.03) and more attenuated chest pain recovery (β 1.5 [0.6, 2.3], p=0.001) than RC. Similarly, after adjustment, cases were associated with more stress-provoked anxiety (β 1.2 [0.2, 2.2], p=0.02) and tension (β 1.2 [0.001, 2.4], p=0.05) while having more attenuated recovery of anxiety (β 1.1 [0.1, 2.0], p=0.02) and tension (β 1.1 [0.2, 2.0], p=0.02) compared to RC. There were no differences in feelings of depression between the two groups.Conclusions:Response to mental stress is heightened with attenuated recovery in women with CVaD. An improved understanding of mechanisms in stress response and CVaD is needed for potential therapeutic targets that may improve angina and quality of life.

Circulation, Volume 148, Issue Suppl_1, Page A15544-A15544, November 6, 2023. Introduction:Human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) hold great promise for myocardial infarction (MI) treatment. Although O2-releasing engineering approaches have been developed to enhance stem cell engraftment, a significant gap persists in knowledge regarding the oxidative stress controlling viability and functionality of hPSC-CMs.Hypothesis:Preconditioning hPSC-CMs with appropriate oxidative levels will enhance their adaptation and engraftment in the infarcted heart.Aims:To develop a novel system that produces a controlled release of O2to supply engineered heart tissue for regenerative therapies.Methods:An O2-releasing hydrogel system (ORHS) was engineered using peroxides (sodium percarbonate) and antioxidants (β-carotene) encapsulated in PLGA-based particles. The effect of ORHS on hPSC-CMs was evaluated through oxidative stress assays, cell viability assessments, and contractility measurements. RNA-seq profiling was performed to analyze the gene expression of hPSC-CMs in response to ORHS. After implantation of ORHS-hPSC-CMs in infarcted hearts of immunodeficient mice, heart functions were monitored with echocardiography. Implanted cell engraftment was assessed using in vivo imaging systems and immunostaining.Results:The dissolved O2levels were increased in ORHS for 7 days, while the oxidative stress was minimized by β-carotene. The optimal ORHS significantly enhanced the viability and mitigated cell death of hPSC-CMs under hypoxic stress conditions. ORHS also enhanced cell contractility and improved calcium signaling in hPSC-CMs. Genes related to maturation and functionality (such as TNNT2, TNNI3, GJA1, and RYR2) were upregulated by ORHS in hPSC-CMs. Implantation of ORHS-hPSC-CMs for 4 weeks resulted in improved ejection fraction, reduced ventricular remodeling, alleviated infarct size, and scar formation. Furthermore, the engraftment and survival of hPSC-CMs were significantly increased by ORHS compared to control hydrogels, as demonstrated by luciferase reporter assays and troponin immunostaining with TUNEL.Conclusion:The development of ORHS offers a promising approach for inducing oxidative preconditioning and achieving enhanced regenerative outcomes of hPSC-CMs.

Circulation, Volume 148, Issue Suppl_1, Page A17390-A17390, November 6, 2023. Introduction:Interventions to reduce cardiovascular disease (CVD) risk factors are key for improving the health and well-being of rural caregivers who are often referred to as invisible patients. The Rural Intervention for Caregivers’ Heart Health (RICHH), a CVD risk reduction intervention (2017-2022) included a stress management module. The COVID-19 pandemic (2020-2021) had an unknown impact on this intervention on perceived stress. The aim of this study was to determine whether the COVID-19 pandemic moderated the effects of RICHH on perceived stress for rural caregivers.Methods:This was a randomized controlled trial of a CVD risk reduction intervention that promoted self-care. Caregivers were randomized to usual care or the RICHH intervention. Data were collected at baseline, 4 and 12 months. Participants were grouped into two groups by COVID-19 timing: 1) the pre-pandemic group (n=145) completed the study before the pandemic; and 2) the pandemic group (n=114) completed the study during the pandemic. A piecewise linear mixed-effect model was used to evaluate the impact of the intervention and COVID-19 timing on perceived stress (Cohen’s Perceived Stress Scale).Results:The effect of the intervention on perceived stress in 259 participants (mean age = 55 ± 13 years, 78% female, 95% white, and 73 % married) was significant in the pandemic group (β= -.59, SE = .14, P < .001) but not in the pre-pandemic group (β = -.10, SE = .13, P = .45 [Figure1). The differences in perceived stress changes between the pre-COVID and during-COVID groups was significant, indicating a moderating effect of COVID (β = -.50, SE = .19, P = .009).Conclusion:The RICHH intervention helped to mitigate stress during the COVID-19 pandemic among those in the intervention group at the 4 months, however this effect was not sustained at 12 months. It remains unclear if the reduction in perceived stress during the pandemic was due to participation in the intervention or weekly contact with an interventionist.

Le donne di mezza età a rischio maggiore aterosclerosi carotidea

This Viewpoint discusses the value of assessing specific stressors that may vary by gender when assessing mental health to better inform our knowledge of stress effects and aid in developing better targeted, gender-informed prevention and treatment efforts in psychiatry.

Various forms of psychological intervention have proven to be powerful in the treatment of posttraumatic stress disorder (PTSD). Two of the best-studied interventions, prolonged exposure (PE) and cognitive processing therapy (CPT), have strong support for their efficacy and have been extensively disseminated by Veterans Affairs, while a third intervention, eye movement desensitization and reprocessing, also is efficacious and widely practiced. Each of these treatments requires considerable therapist training, typically involves numerous sessions over several months, and is variably tolerated by patients. These limitations of extant psychotherapies for PTSD have hastened the demand for therapies that might provide alternatives that are less burdensome for therapists and patients.

Introduction
Botulinum toxin injection is a common way to help reduce spasticity in the body caused by central neurological damage such as cerebral stroke, multiple sclerosis or traumatic brain injury. The pain felt during the injection causes most patients to experience significant stress for further injections, the level of which is variable between patients.
Immersive virtual reality is a digital technique that simulates the three-dimensional spatial and sound environment around a person said to be immersed in this virtualised world. The effectiveness of virtual reality comes from the intensity of this multisensory immersion, known as the feeling of presence (ie, subjective experience of being in one place or one environment, even when you are physically in another one).
Only one research article in paediatrics has shown that immersive reality technique has a positive impact on the level of pain and agitation suffered during botulinum toxin injections. The purpose of this study is therefore to evaluate with sufficient assurance the following research hypothesis: virtual reality can help adults cope with the stress and pain of botulinum toxin treatment injection.

Methods and analysis
The research hypothesis will be tested using a randomised stepped-wedge method versus a non-invasive technique (headset with virtual reality session) to its control (headset with no image nor audio).
The design leads to considering the injection as a statistical unit as all participants will undergo the standard condition, the control technique and virtual reality technique.

Ethics and dissemination
Patients will be fully and fairly informed in terms of their understanding of the objectives and constraints of the study and the possible risks involved. They will also be entitled to refuse the study and/or withdraw, and this refusal will have no impact on their follow-up as part of their pathology. Dissemination of the results of this study will be through peer-reviewed publications, and national and international conferences.
Ethics were approved by the Comité de Protection des Personnes Nord-Ouest in January 2022.

Trial registration number
NCT05364203.

Giorlandino, ‘obesità dopo il parto è una sfida clinica e di salute pubblica’

Objectives
The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

Design
A longitudinal study with follow-ups from 42 days to 6 months after delivery.

Settings and participants
A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

Methods
Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

Results
Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p

Higher use was not associated with improved outcomes.

Stroke, Ahead of Print. Background:Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status.Methods:Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported.Results:Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31–3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (β=0.18,P

Evitabili 8 morti su 10 per malattie cardiovascolari. Il 29 giornata mondiale

Introduction
The environment at a psychiatric inpatient ward can lead to emotional distress and behavioural deviations in vulnerable individuals potentially resulting in conflicts, increased use of need-based medication and coercive actions, along with low satisfaction with treatment. To accommodate these challenges, recreational and entertaining interventions are recommended. The tested interventions have, however, shown varying effects and demand a high degree of planning and staff involvement while being difficult to adapt to individual needs. Virtual reality (VR) may help overcome these challenges.

Methods and analysis
The study is a mixed-methods clinical trial with a target sample of 124 patients hospitalised at a closed psychiatric ward in the capital region of Denmark. Outcomes (eg, coercion, need-based medication and perceived stress) for a 12-month period where all patients are offered VR-based recreational experiences during their hospitalisation will be compared with outcomes for a 12-month period where VR is not offered. Feasibility and acceptability will be explored with qualitative interviews supplemented with non-participant observations and focus groups. The study began on 1 January 2023, and we expect to complete data collection by 31 December 2024.

Ethics and dissemination
The study is registered at Danish Data Protection Agency (j.no P-2022-466) and is approved by the Committee on Health Research Ethics of the capital region of Denmark (j.no 22013313). All patients will be required to provide informed consent. Results from this study will be disseminated via peer-reviewed journals and congress/consortium presentations.

Trial registration number
NCT05654740.