School of Kinesiology and Health Science
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Browsing School of Kinesiology and Health Science by Author "6715a274b92bcb961e339618aeccfc47"
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Item Open Access Cardiac rehabilitation I: review of psychosocial factors(Elsevier Science B.V., Amsterdam, 2002-05) Grace, Sherry L.; Abbey, Susan E.; Shnek, Zachary M.; Irvine, Jane; Franche, Renee-Louise; Stewart, Donna EileenCardiovascular disease (CVD) is the leading cause ofdeath and disability for women and men. There are gender differences in recovery from coronary events, which may be due physiological, sociodemographic, or psychosocial factors. Cardiac rehabilitation programs have beneficial effects on coronary recovery. The following presents a review of the literature from MedLine (1997-2001) and PsychInfo (1984-2001) on gender differences in participation in cardiac rehabilitation programs, with a focus on depression, anxiety, self-efficacy and social support. A critical analysis of gaps in the literature as well as areas for future research are presented.Item Open Access Cardiac rehabilitation II: referral and participation(Elsevier Science B.V., Amsterdam, 2002-05) Stewart, Donna Eileen; Franche, Renee-Louise; Irvine, Jane; Shnek, Zachary M.; Abbey, Susan E.; Grace, Sherry L.Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. Substantial health risks continue following ischemic coronary events (ICEs), but secondary prevention efforts, including cardiac rehabilitation (CR), have beneficial effects on both early and late mortality and morbidity. This prospective study examined the relationship among psychosocial factors and CR referral and participation patterns in 906 (586 men, 320 women) patients from the coronary intensive care unit (CICU) over the course of six months. Only 30% of participants were referred to CR programs, with significantly fewer women being referred. A logistic regression analysis was used to determine whether depression, anxiety, self-efficacy, or social support predicted CR participation six months following an ICE, while controlling for sociodemographic factors. Results show that higher family income, greater anxiety symptomatology, and higher self-efficacy were significantly predictive of CR participation at six months. Implications for women's recovery from an ICE are discussed.Item Open Access Gender Differences in Health Information Needs and Decisional Preferences in Patients Recovering From an Acute Ischemic Coronary Event(Elsevier Science B.V., Amsterdam, 2008-12) Grace, Sherry L.; Irvine, Jane; Shnek, Zachary M.; Abbey, Susan E.; Stewart, Donna EileenObjective: This study examined gender differences in health information needs and decisional preferences after an acute ischemic coronary event (ICE). Methods: Patients with ICE, recruited in 12 coronary intensive care units, completed a questionnaire on demographic, disease-related, and psychosocial topics. Six and 12 months later, they completed mailed follow-up questionnaires. Results: Nine hundred six patients completed the baseline questionnaire, 541 (69%) completed the 6-month questionnaire, and 522 (64%) completed the 12-month questionnaire after hospital discharge. Men reported significantly more information received and greater satisfaction with healthcare practitioners meeting their information needs. Women wanted more information than men concerning angina and hypertension. Men wanted more information about sexual function and reported receiving more information about the role of each doctor, test results, treatments, cardiac rehabilitation, and how their families could support their lifestyle changes. Patients who reported receiving more information reported less depressive symptomatology and greater self-efficacy, healthcare satisfaction, and preventive health behaviors. Although most patients of both sexes preferred a shared decision-making role with their physician, the majority felt their doctor had made the main decisions. Conclusions: Patients after ICE, especially women, reported receiving much less information than they wanted from all health professionals. Most patients wanted a shared or autonomous treatment decision-making role with their doctor, but only a minority experienced this. Clinicians must do better, because meeting patients' information needs and respecting their decisional preferences are shown to be associated with better self-efficacy, satisfaction, and health-promoting behavior.Item Open Access Longitudinal Course of Depressive Symptomatology After a Cardiac Event: Effects of Gender and Cardiac Rehabilitation(Lippincott, Williams & Wilkins, 2005-01) Pinto, Ruxandra; Abbey, Susan E.; Grace, Sherry L.; Irvine, Jane; Shnek, Zachary; Stewart, Donna EileenItem Open Access Physical health status assessed during hospitalization for acute coronary syndrome predicts mortality 12 months later(Elsevier, 2008-12) Stewart, Donna Eileen; Ziegelstein, R.C.; Thombs, Brett; Parakh, K.; Abbey, Susan E.; Grace, Sherry L.Objective: Self-report measures of health status predict mortality in several groups of patients with cardiovascular disease, although overlap with symptoms of depression may reduce or eliminate this relationship. The association between self-reported health status and mortality has not been examined in patients hospitalized for acute coronary syndrome (ACS). The objective was to investigate whether the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF12 predicted 12-month all-cause mortality after controlling for cardiac risk factors and symptoms of depression. Methods: The SF-12 and Beck Depression Inventory were administered 2-5 days after admission to 800 ACS patients from 12 coronary care units. Logistic regression was used to assess the relationship of the PCS and MCS with mortality 12 months later, controlling for age, sex, cardiac diagnosis (acute myocardial infarction vs. unstable angina), Killip class, history of myocardial infarction, and in-hospital depressive symptoms. Results: Lower scores on the SF-12 PCS (worse health) were associated with a significantly higher risk of mortality [odds ratio (OR)=0.94, 95% confidence interval (CI)=0.92-0.97, P<.OOI]. MCS scores failed to reach significance (OR=0.98, CI=0.95-1.00, P=.053). The PCS significantly predicted mortality even after controlling for other cardiac risk factors and depressive symptoms (OR=0.96, CI=0.93-0.99, P=.008), equivalent to a 34% increase in risk per lO-point (I SD) decrement in PCS scores. Conclusion: The brief SF-12 PCS presents an attractive option for improving risk stratification among hospitalized ACS patients.Item Open Access Probit structural equation regression model: General depressive symptoms predicted post-myocardial infarction mortality after controlling for somatic symptoms of depression(Elsevier, 2008-08) Thombs, Brett; Ziegelstein, R.C.; Parakh, K.; Stewart, Donna Eileen; Abbey, Susan E.; Grace, Sherry L.Objective: Reported links between depression and post-acute myocardial infarction (AMI) mortality may be due to confounding between somatic symptoms of depression and symptoms related to the AMI. The objective of this study was to assess the relationship between depressive symptoms and 12-month post-AMI mortality after removing potential bias from somatic symptoms of depression. Study Design and Setting: Four hundred seventy-seven hospitalized AMI patients from 12 cardiac care units. The relationship of a General Depression factor with mortality was assessed using a probit structural equation regression model, controlling for an uncorrelated somatic symptom factor, age, Killip class, previous AMI, and other potential confounders. Results: Mortality was significantly predicted by the General Depression factor (P =0.009), controlling for age (P = 0.128), Killip class (P = 0.210), history of AMI (P = 0.001), and other predictors in a structural equation model that removed variance related to somatic factors, but unrelated to the General Depression factor. Conclusion: This study demonstrated that the use of structural equation modeling presents a viable mechanism to test links between symptoms of depression and health outcomes among patients with AMI after explicitly removing variance due to somatic symptoms that is unrelated to the General Depression factor.Item Open Access Sex differences in predictors of illness intrusiveness 1 year after a cardiac event(Elsevier, 2004-01) Franche, Renee-Louise; Abbey, Susan E.; Irvine, J.; Shnek, Z.; Grace, Sherry L.; Devins, Gerald M.; Stewart, Donna EileenObjective: This prospective study examined sex differences in illness intrusiveness and in baseline predictors of illness intrusiveness in cardiac patients' I-year postcardiac event. Methods: Patients diagnosed with a myocardial infarction (MI) or unstable angina (UA) completed a baseline questionnaire during their hospitalization (139 men and 104 women). Eighty-one men and 67 women completed the follow-up questionnaire I-year postcardiac event. The questionnaire included measures of illness intrusiveness in three life domains, depressive symptomatology, social support, medical information, risk factors for heart disease, and sociodemographic information. Results: A MANCOVA with the three Illness Intrusiveness subscales as dependent variables, sex as the between-group factor, and partnership status as a covariate found a sex effect for the Intimacy subscale, but not for the Instrumental and the Relationships/Personal Development subscales. Men reported more intrusiveness in the Intimacy domain of their life as compared to women. After controlling for sociodemographic factors and risk factors for heart disease, hierarchical regressions indicated sex differences in baseline predictors of I-year follow-up illness intrusiveness in the three life domains. For men, being satisfied with support from partner at baseline was associated with less intrusiveness in the Instrumental Life domain 1 year after the cardiac event. For women, surprisingly, more satisfaction with support from their partner at baseline was associated with more intrusiveness in their intimate lives 1 year after their cardiac event. In addition, emotional symptoms of depression at baseline were predictive ofincreased illness intrusiveness in Relationship/Personal Development and Intimacy domains for men and in Instrumental and Intimacy domains for women. Conclusion: Support from partner may have a differential impact for men and women after a cardiac event. Depressive symptomatology during initial hospitalization, particularly emotional symptoms, is a prominent indicator ofillness intrusiveness for both sexes 1 year after the cardiac event.