ORCID Profile
0000-0001-5902-6131
Current Organisations
Australian Centre for Heart Health
,
University of Melbourne
,
University of Tasmania
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Publisher: Springer Science and Business Media LLC
Date: 24-03-2020
DOI: 10.1186/S12872-020-01430-3
Abstract: Obstructive Sleep Apnoea (OSA) has been recognised as a risk factor for cardiovascular diseases such as hypertension and cardiovascular events such as acute coronary syndrome (ACS). Since it is also known to reduce exercise tolerance, it is important to establish the prevalence of OSA in ACS patients, particularly in those who are commencing cardiac rehabilitation (CR) programs. Using PRISMA guidelines a systematic search was conducted in order to identify studies that objectively measured (using polysomnography or portable monitoring) the prevalence of OSA in ACS patients following hospital admission. A data extraction table was used to summarise study characteristics and the quality of studies were independently assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Meta-analysis of the selected studies was conducted in order to estimate OSA prevalence as a function of the two main methods of measurement, the severity of OSA, and timing of the OSA assessment following ACS hospital admission. Pooled prevalence estimates of OSA using the “gold standard” polysomnography ranged from 22% for severe OSA to 70% for mild OSA, at any time after hospital admission. Similar prevalence estimates were obtained using portable monitoring, but interpretation of these results are limited by the significant heterogeneity observed among these studies. Prevalence of OSA following ACS is high and likely to be problematic upon patient entry into CR programs. Routine screening for OSA upon program entry may be necessary to optimise effectiveness of CR for these patients.
Publisher: Springer New York
Date: 2018
DOI: 10.1007/978-1-4939-8603-3_9
Abstract: The kinetochore is a multiprotein complex that assembles on centromeric DNA and constitutes the main attachment interface between chromosomes and microtubules of the spindle apparatus. Kinetochores also provide the platform for integrating the surveillance mechanism known as the spindle assembly checkpoint (SAC) that regulates the timing of anaphase onset. Saturation of microtubule binding sites on kinetochores displaces SAC proteins leading to loss of SAC-mediated inhibition and the triggering of anaphase. Microtubule binding sites become saturated by bundles of microtubules attached in an end-on manner to kinetochores, termed kinetochore fibers or K-fibers. The appearance of K-fibers therefore signifies the completion of attachment between kinetochores and microtubules and the silencing of the SAC. Here we describe a method involving cold-fixation for immunostaining and imaging K-fibers during meiosis I in mouse oocytes.
Publisher: Informa UK Limited
Date: 04-10-2019
DOI: 10.1080/24694193.2019.1671915
Abstract: Families of children with congenital heart disease (CHD) can have difficulties coping with the stress of their child's condition and would benefit from assistance to cope better. To address the needs of these parents, the Australian Center for Heart Health/HeartKids Australia/Melbourne Graduate School of Education co-produced
Publisher: Wiley
Date: 04-07-2023
DOI: 10.1111/JAN.15765
Abstract: To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings. A qualitative descriptive study. Data were collected via semi‐structured interviews. In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized. Six themes and 20 sub‐themes were identified. Non‐validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed. Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness. The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post‐cardiac event counselling. Adherence to COREQ guidelines was maintained. No Patient or Public Contribution as this study explored health professionals' experiences only.
Publisher: JMIR Publications Inc.
Date: 28-10-2021
Abstract: fter a cardiac event, a large majority of patients with cardiac conditions do not achieve recommended behavior change targets for secondary prevention. Mental health issues can also impact the ability to engage in health behavior change. There is a need for innovative, flexible, and theory-driven eHealth programs, which include evidence-based strategies to assist patients with cardiac conditions with their recovery, especially in behavioral and emotional self-management. he aim of this study is to determine the short- and longer-term behavioral and emotional well-being outcomes of the i Back on Track /i web-based self-management program. In addition, this study will test whether there is enhanced benefit of providing one-on-one telephone support from a trained lifestyle counselor, over and above benefit obtained through completing the web-based program alone. eople who have experienced a cardiac event in the previous 12 months and have access to the internet will be eligible for this study (N=120). Participants will be randomly assigned to one of the two study conditions: either “self-directed” completion of the i Back on Track /i program (without assistance) or “supported” completion of the i Back on Track /i program (additional 2 telephone sessions with a lifestyle counselor). All participants will have access to the web-based i Back on Track /i program for 2 months. Telephone sessions with the supported arm participants will occur at approximately 2 and 6 weeks post enrollment. Measures will be assessed at baseline, and then 2 and 6 months later. Outcome measures assessed at all 3 timepoints include dietary intake, physical activity and sitting time, smoking status, anxiety and depression, stage of change, and self-efficacy in relation to behavioral and emotional self-management, quality of life, and self-rated health and well-being. A demographic questionnaire will be included at baseline only and program acceptability at 2 months only. ecruitment began in May 2020 and concluded in August 2021. Data collection for the 6-month follow-up will be completed by February 2022, and data analysis and publication of results will be completed by June 2022. A total of 122 participants were enrolled in this study. he i Back on Track /i trial will enable us to quantify the behavioral and emotional improvements obtained and maintained for patients with cardiac conditions and, in particular, to compare two modes of delivery: (1) fully self-directed delivery and (2) supported by a lifestyle counselor. We anticipate that the web-based i Back on Track /i program will assist patients in their recovery and self-management after an acute event, and represents an effective, flexible, and easily accessible adjunct to center-based rehabilitation programs. ustralian New Zealand Clinical Trials Registry ACTRN12620000102976 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378920& isReview=true ERR1-10.2196/34534
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.SOCSCIMED.2017.06.046
Abstract: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a erse range of research and clinical settings.
Publisher: Oxford University Press (OUP)
Date: 29-03-2023
Abstract: Behaviour modification and mood management are essential to recovery after a cardiac event. Recent times have seen a major shift to remote delivery of cardiac services. This study assessed behavioural and psychological outcomes of the Back on Track online self-management programme, comparing the programme undertaken alone (self-directed) vs. with telephone support (supported). Relevance for people with depression was also assessed. Participants with cardiac conditions (n = 122) were randomly assigned to self-directed or supported groups and given access to the online programme for 2 months. The programme addressed depression, anxiety, physical activity, and healthy eating. Supported group participants also received two telephone sessions facilitated by a trained counsellor to further enhance their self-management skills and engagement with the online modules. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Active Australia Survey and Diet Quality Tool were administered at baseline, 2, and 6 months. χ2 tests were used to compare self-directed and supported groups. Cochrane’s Q tests assessed changes over time in depression, anxiety, and physical activity (PA) and healthy diet guideline achievement. Participants in both groups showed reduced depression rates (self-directed, P & 0.05) and increased PA after programme completion (both groups, P & 0.05). Amongst those classified as depressed at baseline, significantly fewer were classified as depressed over time (P & 0.001) and significantly more were achieving the PA guidelines (P & 0.01) compared to those who were not depressed at baseline. The Back on Track telehealth programme was effective in assisting with behavioural and emotional recovery after a cardiac event. The programme may be particularly beneficial for those who are depressed early in their recovery period. Australian New Zealand Clinical Trials Registry: ACTRN12620000102976.
Publisher: American Medical Association (AMA)
Date: 02-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
Publisher: Springer Science and Business Media LLC
Date: 13-08-2006
Abstract: Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified ( improvers and non-improvers ). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non - improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class for the MCS the most significant predictors of non - improver membership were higher scores on POMS depression-dejection and manual occupation. It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and those post-operative symptoms that could be possible targets for intervention to improve HRQoL outcomes.
Publisher: Wiley
Date: 23-03-2021
DOI: 10.1111/ADD.15454
Abstract: Past research has found that young smokers are more likely to make quit attempts however, there are conflicting findings regarding age and quit success. This study examined the degree to which smoker age is related to making quit attempts and quit success. Ten waves of the International Tobacco Control Policy Cohort survey (ITC‐4C) collected between 2002 and 2014, with nine wave‐to‐wave transitions with predictors at the first wave predicting quit attempts and success by the next wave. Canada, the United States, the United Kingdom and Australia. Data from 15 874 smokers categorized into four age groups at baseline (18–24, 25–39, 40–54 and 55+ years). Age, quit attempts and success (defined as ≥ 30 days abstinence confirmed, if possible, on a third wave for recent attempts). Older smokers were more likely to smoke daily (χ 2 = 1557.86, r = 0.136, P 0.001) than younger smokers. Daily smokers were less likely to report quit attempts (38.1 versus 58.2%) and to achieve 30 days of abstinence (22.9 versus 34.3%) than non‐daily smokers. Older daily smokers were less likely to make quit attempts [0.61, confidence interval (CI) = 0.54–0.70, P 0.001], even after controlling for indicators of nicotine dependence, country, sex, education, income, relationship status and household composition, than younger smokers. Younger smokers ( 25) were more likely to succeed for at least 30 days of abstinence, but only when compared with those aged 40–54 (OR = 0.83, 95% CI = 0.68–0.99). However, when controlling for heaviness of smoking the age effect disappeared. Significant interactions with age were found between age and intention when predicting quit attempts, and age and heaviness of smoking when predicting quit success. An international cohort study indicates that young smokers are more likely to attempt to quit and appear to have similar levels of success in abstaining from smoking compared with older smokers when controlling for dependence. Quit success in all ages is most predicted by lower levels of nicotine dependence.
Publisher: Informa UK Limited
Date: 12-2012
DOI: 10.1080/13548506.2012.661865
Abstract: The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n = 55, 29% (2) Low illness perceptions and low emotional impact, n = 45, 24% (3) Control focused and mild emotional impact, n = 10, 5% (4) Consequence focused and high emotional impact, n = 60, 32% and (5) Consequence focused and severe emotional impact, n = 20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.
Publisher: Cambridge University Press (CUP)
Date: 02-02-2007
Publisher: Oxford University Press (OUP)
Date: 08-03-2021
DOI: 10.1093/NTR/NTAB040
Abstract: This study explores patterns of use of non-cigarette tobacco and nicotine products among adult cigarette smokers and recent ex-smokers. Along with cigarette smoking status we explore differences as a function of countries with different product regulations, gender, and age. Data came from the ITC Four Country Smoking and Vaping Wave 3 Survey conducted between February–June 2020. The analytic s le consisted of 9112 current cigarette smokers (at least monthly) and 1184 recent ex-smokers (quit cigarettes ≤ 2 years) from Australia, Canada, England, and the United States. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe) noncombustible tobacco (smokeless tobacco, and heated tobacco products [HTPs]) and non-tobacco nicotine products (nicotine vaping products [NVPs], nicotine replacement therapy [NRT], and nicotine pouches). Overall, NVPs (13.7%) and NRT (10.9%) were the most reported nicotine products used, followed by cigars (5.3%), cigarillos (4.2%), and HTPs (3.5%). More than 21% current and recent ex-smokers of cigarettes reported using a non-tobacco nicotine product and noncombustible product, with respondents in England reporting the highest levels of use (& %). Males, younger respondents, and current non-daily cigarette smokers were more likely to use non-cigarette nicotine products. Notably, 11.6% of ex-cigarette smokers were using other combustible tobacco. Considerable percentages of current cigarette smokers and ex-smokers use non-cigarette nicotine products, and there are unexpectedly high levels of use of other combustible products by those recent ex-smokers of cigarettes which is concerning and has important implications for definitions of smoking cessation. The tobacco product market has evolved to include new products which add to existing non-cigarette tobacco products creating a much more erse nicotine market. This brief report provides a snapshot of use of various combustible and noncombustible nicotine-containing products among current cigarette smokers and recent ex-smokers in four western countries. Our results indicate that use of non-cigarette tobacco and nicotine products among these cigarette smokers and recent ex-smokers is not low, particularly among males, younger and non-daily cigarette smokers. Use of other combustible tobacco among respondents that recently quit cigarette smoking is concerning and has important implications for definitions of smoking cessation. Increased emphasis on researching non-cigarette nicotine product use is warranted in tobacco control generally and smoking cessation in particular.
Publisher: Oxford University Press (OUP)
Date: 11-2023
DOI: 10.1093/NTR/NTAC252
Abstract: Little is known about the continued use of nicotine following smoking cessation on perceived well-being in comparison to complete cessation of nicotine use. To explore aspects of perceived well-being and coping among recent ex-smokers as a function of vaping status. Ever-daily smokers in the International Tobacco Control 4 country smoking and vaping surveys in 2016 (w1 N = 883) and 2018 (w2 N = 1088). Cross-sectional associations and longitudinal s les for those who quit between waves and those who quit at w1 and maintained abstinence to w2. Main outcome measures were: Past 30 days of depression symptoms, perceived stress, stress management since quitting, and change in perceived day-to-day health. In the cross-sectional analyses vapers were more likely to report both improved stress management (aOR = 1.71, 95% CI 1.23–2.36) and perceived day-to-day health (aOR = 1.65, 95% CI 1.26–2.16) than nicotine abstainers. In the longitudinal analyses, smokers who switched to vaping between waves (n = 372) were more likely to report depression symptoms at w2 (aOR = 2.00, 95% CI 1.09–3.65) but reported improved perceived health (aOR = 1.92, 95% CI 1.16–3.20). For the past daily smokers who remained quit between waves (n = 382), vapers were more likely to report improved stress management relative to abstainers (RRR = 5.05. 95% CI 1.19–21.40). There were no other significant differences between vapers and nicotine abstainers. There is little evidence to support the view that perceptions of well-being deteriorate in vapers compared to complete nicotine abstainers in the immediate years after smoking cessation. This study could find no conclusive evidence that the continued use of nicotine via e-cigarettes was detrimental to health compared to completely stopping nicotine intake altogether. Our results would suggest that continuing to use nicotine may even result in some benefits in the short term such as improved stress management, however further longitudinal studies are required to examine if these effects are restricted to the early post-quitting phase and whether other positive or negative effects on psychosocial health emerge in the future.
Publisher: Mark Allen Group
Date: 02-04-2016
DOI: 10.12968/BJCA.2016.11.4.198
Abstract: Sedentary behaviour is on the rise, particularly among people with cardiovascular disease. Here, Michelle Rogerson and colleagues examine the risks of this behaviour, the presence and absence of guidelines, and incorporation of screening during cardiac rehabiliation
Publisher: Mark Allen Group
Date: 02-07-2018
DOI: 10.12968/BJCA.2018.13.7.330
Abstract: Despite the 60-year history of attempting to understand the relationship between personality and cardiovascular disease (CVD), in idual dispositions that affect the manner in which people think, feel and act are not typically considered in cardiac clinical settings. To identify how persistent negative emotional states and behavioural traits impacted cardiovascular health, early studies focused on the Type A personality (competitive, aggressive) and, later on, the Type D personality (‘distressed’). Recent evidence on other personality types or behaviours, such as borderline personality disorder, alexithymia and neuroticism, suggest that it may be the core elements of these, alongside hostility and proneness to anger, that lead to atherosclerosis, endothelial dysfunction, coronary artery calcification, and inflammation. The current paper, and part 2 of the Psychology in Cardiology series, explores the evidence supporting different interventions for people with health-compromising personality factors, to assist in planning lifestyle modification.
Publisher: Wiley
Date: 16-08-2022
DOI: 10.1111/ADD.16023
Abstract: To examine whether polyuse of cigarettes and other smoked products (polysmoking) is predictive of quit attempts and quit success. A prospective multi‐country cohort design. Australia, Canada, England and the United States. A total of 3983 adult daily cigarette smokers were surveyed in 2016 (wave 1 of data collection) and were re‐contacted in 2018 (wave 2) (i.e. waves 1–2 cohort) in the International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys and 3736 smokers were surveyed in 2018 and re‐contacted in 2020 (wave 3) (i.e. waves 2–3 cohort). Participants were asked about their cigarette smoking and use of cigars, cigarillos, pipes and waterpipes. Outcomes were quit attempts between two survey waves and success, defined as having quit smoking all the combustible tobacco at the subsequent survey for 1 month or more. Levels of polysmoking were 12.7% in the waves 1–2 cohort and 10.5% for the waves 2–3 cohort. Compared with cigarette‐only smokers, polysmokers were more likely to attempt to quit between waves 1 and 2 [54.9 versus 42.7%, adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 1.08–1.74, P 0.01], but not between waves 2 and 3 (43.8 versus 40.1%, aOR = 0.94, 95% CI = 0.72–1.22). Polysmoking predicted reduced likelihood of success in both cohorts among attempters and the overall s les. Between waves 2 and 3 there were significantly more transitions to non‐daily smoking among the polysmokers (12.4 versus 5.3%, χ 2 = 40.4, P 0.001). There is a consistent association between polysmoking (use of cigarettes together with other smoked products) and reduced quit success for combustible tobacco, but it is probably due to increased likelihood of transitioning to non‐daily use rather than complete cessation.
Publisher: Wiley
Date: 19-06-2008
DOI: 10.1002/SMI.1202
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.HLC.2011.02.004
Abstract: People who have had a cardiac event are at increased risk of a subsequent event and death and are, therefore, the priority for preventive cardiology in Australia and elsewhere. Guidelines for physiological and lifestyle risk factors have been developed to encourage risk reduction as a means of secondary prevention. The aim of the present study was to investigate achievement of recommended risk factor targets in a s le of Australian cardiac patients. A consecutive s le of 275 patients admitted to one of two Melbourne hospitals after acute myocardial infarction (AMI 32%) or for coronary artery bypass graft surgery (CABGS 40%) or percutaneous coronary intervention (PCI 28%) participated in risk factor screening approximately five weeks after hospital discharge. The 2007 National Heart Foundation (NHF) of Australia 'Guidelines for Reducing Risk in Heart Disease' (1) and the 2001 NHF and Cardiac Society of Australia and New Zealand lipid management guidelines (2) were used to define risk factor targets. Target achievement was compared for AMI, CABGS and PCI patients. Patients ranged in age from 32 to 75 years (mean=59.0 SD=9.1). Most (86%) were male. Almost three quarters of the patients were above recommended targets for waist girth (70%) and almost half were above targets for blood pressure (48%) and below target for high density lipoprotein cholesterol (47%). Around a quarter were over target for total cholesterol (27%) and under target for physical activity (27%). Most patients met the NHF guidelines of non-smoking (95%) and restricted alcohol consumption (88%). For several risk factors, PCI patients were at greater risk of not achieving recommended targets than either CABGS or AMI patients. Six weeks after an acute cardiac event, substantial proportions of Australian patients do not achieve recommended targets for waist girth, blood pressure, total cholesterol, physical activity, and HDL cholesterol. PCI patients are particularly at risk. Considerable potential remains for improving risk factor management in CHD patients, highlighting the important role of general practitioners, outpatient cardiac rehabilitation and other secondary prevention strategies.
Publisher: Frontiers Media SA
Date: 29-01-2020
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.HLC.2016.04.018
Abstract: Many cardiac rehabilitation (CR) guidelines and position statements recommend screening for psychosocial risk factors, although there is wide variation in the recommended factors and recommended screening tools. Little is known about screening in CR in Australia. Cardiac rehabilitation coordinators at the 314 CR programs operating across Australia, drawn from the 2014 Australian Directory of Cardiac Rehabilitation Services were invited to participate in an online survey. Of 165 complete responses, 157 (95%) CR coordinators indicated that they screened at entry with 132 (80%) screening on exit. At CR entry, programs screened for - depression (83%), anxiety (75%), stress (75%), and sleep disturbance (57%). The use of standardised instruments by those screening at entry varied from 89% for depression to only 9% for sleep disturbance. Organisational, resource and personal barriers inhibited the routine screening for many psychosocial factors. Surveys such as this are useful for monitoring the rate of adoption of guideline recommendations and identifying barriers to implementation. Findings can also inform discussions about what should be included in minimum data sets for CR programs, and the identification of brief screening tools that have been validated not just in the general population but in cardiac patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Oxford University Press (OUP)
Date: 09-2006
DOI: 10.1016/J.EJCNURSE.2006.01.002
Abstract: Cardiac patients are encouraged to reduce their dietary fat intake, yet few studies have assessed fat intake in female cardiac patients. We assessed changes in fat intake for female cardiac patients at four occasions during the first year following their event, and compared it with fat intake for a non-cardiac s le. The Short Fat Questionnaire (SFQ) was administered to 239 women aged 36 to 84 years consecutively admitted to four hospitals at the time of an acute event. Mplus was used to analyse change over time in SFQ scores and to identify predictors of change. Mean SFQ scores were compared with those for a s le of randomly selected Australian women and older adults. Mean SFQ scores decreased substantially during the first two months (t(139) = 8.374, p < 0.001), then increased over the subsequent 10 months (t(146) = 4.656, p < 0.001). By 12 months, SFQ scores remained significantly lower than at baseline. Older women and those with hypertension showed less reduction in fat intake. At all four time-points, mean SFQ scores were significantly lower than those reported for other Australian women and older adults. Even prior to their event, female cardiac patients reported lower fat intake than other Australian women and older adults, but showed partial deterioration in adherence following convalescence. Future studies could investigate options for assisting patients to sustain dietary changes, with attention to older patients and those with hypertension.
Publisher: Wiley
Date: 22-07-2008
DOI: 10.1002/SMI.1206
Publisher: Frontiers Media SA
Date: 31-03-2022
DOI: 10.3389/FPSYT.2022.808904
Abstract: While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. A s le of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were “being physically restricted” (66%), “lacking energy” (60%), “being short of breath” (60%), “thinking I will never be the same again” (57%), and “not sleeping well” (51%). While less prevalent, “not having access to the health care I need,” “being concerned about my capacity for sexual activity,” and “being unsupported by family and friends” were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery.
Publisher: BMJ
Date: 23-11-2012
Publisher: Research Square Platform LLC
Date: 07-07-2023
DOI: 10.21203/RS.3.RS-3143853/V1
Abstract: Background Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient’s capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. Methods A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. Results The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of ≥18 as the reference variable, the CDI-SF had a very high Area Under the Curve (AUC) (AUC = 0.913 (95% CI: 0.88 to 0.94). A CDI-SF score of ≥ 13 was found to indicate general cardiac distress which may warrant further investigation using the original CDI. Conclusion The psychometric findings detailed here indicate that CDI-SF provides a brief psychometrically sound screening measure indicative of general cardiac distress, that can be used in both clinical and research settings.
Publisher: Oxford University Press (OUP)
Date: 18-06-2021
DOI: 10.1093/NTR/NTAA108
Abstract: To test whether urges to smoke and perceived addiction to smoking have independent predictive value for quit attempts and short-term quit success over and above the Heaviness of Smoking Index (HSI). Data were from the International Tobacco Control Four Country Smoking and Vaping Wave 1 (2016) and Wave 2 (2018) surveys. About 3661 daily smokers (daily vapers excluded) provided data in both waves. A series of multivariable logistic regression models assessed the association of each dependence measure on odds of making a quit attempt and at least 1-month smoking abstinence. Of the 3661 participants, 1594 (43.5%) reported a quit attempt. Of those who reported a quit attempt, 546 (34.9%) reported short-term quit success. Fully adjusted models showed that making quit attempts was associated with lower HSI (adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI] = 0.73 to 0.90, p & .001), stronger urges to smoke (aOR = 1.08, 95% CI = 1.04 to 1.20, p = .002), and higher perceived addiction to smoking (aOR = 0.52, 95% CI = 0.32 to 0.84, p = .008). Lower HSI (aOR = 0.57, 95% CI = 0.40 to 0.87, p & .001), weaker urges to smoke (aOR = 0.85, 95% CI = 0.76 to 0.95, p = .006), and lower perceived addiction to smoking (aOR = 0.55, 95% CI = 0.32 to 0.91, p = .021) were associated with greater odds of short-term quit success. In both cases, overall R2 was around 0.5. The two additional dependence measures were complementary to HSI adding explanatory power to smoking cessation models, but variance explained remains small. Strength of urges to smoke and perceived addiction to smoking may significantly improve prediction of cessation attempts and short-term quit success over and above routinely assessed demographic variables and the HSI. Stratification of analyses by age group is recommended because the relationship between dependence measures and outcomes differs significantly for younger (aged 18–39) compared to older (aged older than 40) participants. Even with the addition of these extra measures of dependence, the overall variance explained in predicting smoking cessation outcomes remains very low. These measures can only be thought of as assessing some aspects of dependence. Current understanding of the factors that ultimately determine quit success remains limited.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Oxford University Press (OUP)
Date: 12-11-2014
Abstract: Depression is common following an acute cardiac event and can occur at a time when behaviour change is strongly recommended to reduce the risk of further cardiovascular events. The 'Beating Heart Problems' programme was designed to support cardiac patients in behaviour change and mood management. The programme was based on cognitive behaviour therapy and motivational interviewing. A randomized controlled trial (RCT) comparing the 8-week group programme with usual care was undertaken between 2007 and 2010. All patients attended a hospital-based clinic for assessment of physiological risk factors at baseline (6 weeks after their acute event), and at 4- and 12-month follow up. Psychological and behavioural indicators were assessed by self-report questionnaires. Of the 275 patients enrolled into the RCT, 42 (15%) had Beck Depression Inventory-II scores >13 at baseline. Treatment and control group comparisons were undertaken for this subgroup, using growth curve modelling and testing for group differences over time in psychological, physiological, health behaviour, and self-efficacy measures. Significantly greater improvements (p < 0.01) in depression symptoms and self-rated health were reported for the intervention group, as well as significantly larger gains in confidence in managing depression (p < 0.05) and anger (p < 0.01). Trends (0.05 < p < 0.10) for larger treatment group improvements were also seen for anxiety symptoms and confidence in managing anxiety. A group secondary-prevention programme that integrates behavioural and mood management strategies leads to decreased depression, increased confidence, and improved health perceptions in depressed cardiac patients.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.HLC.2017.08.024
Abstract: Defining cardiac rehabilitation (CR) program characteristics on a national level is crucial for decision-making on resource allocation and evaluation of service quality. Comprehensive surveys of CR programs have been conducted overseas, but, to date, no such profile had been conducted in Australia. A representative s le of 165 CR programs across Australia were asked to provide details on a range of program characteristics such as program location and size, program elements, and staffing profile. Australian CR programs differ from their overseas counterparts in characteristics such as program length, number of sessions, number of specialities represented and extent of outreach. The study findings point to a need for a routine comprehensive survey of CR programs throughout Australia.
Publisher: MDPI AG
Date: 06-01-2022
Abstract: Background: Delay discounting (DD) and time perspective (TP) are conceptually related constructs that are theorized as important determinants of the pursuit of future outcomes over present inclinations. This study explores their predictive relationships for smoking cessation. Methods: 5006 daily smokers at a baseline wave provided 6710 paired observations of quitting activity between two waves. Data are from the International Tobacco Control (ITC) smoking and vaping surveys with s les from the USA, Canada, England, and Australia, across three waves conducted in 2016, 2018 and 2020. Smokers were assessed for TP and DD, plus smoking-specific predictors at one wave of cessation outcomes defined as either making a quit attempt and/or success among those who tried to quit which was ascertained at the subsequent survey wave. Results: TP and DD were essentially uncorrelated. TP predicted making quit attempts, both on its own and controlling for other potential predictors but was negatively associated with quit success. By contrast, DD was not related to making quit attempts, but high DD predicted relapse. The presence of financial stress at baseline resulted in some moderation of effects. Conclusions: Understanding the mechanisms of action of TP and DD can advance our understanding of, and ability to enhance, goal-directed behavioural change. TP appears to contribute to future intention formation, but not necessarily practical thought of how to achieve goals. DD is more likely an index of capacity to effectively generate competing future possibilities in response to immediate gratification.
Publisher: Springer International Publishing
Date: 2019
Publisher: Oxford University Press (OUP)
Date: 10-11-2021
DOI: 10.1093/NTR/NTAB230
Abstract: This paper explores whether plans to quit, wanting to quit, and quit efficacy add predictive value over measures of habit strength and dependence in making quit attempts and/or attaining smoking abstinence. We used three waves of the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey conducted in 2016, 2018, and 2020. Baseline daily smokers (N = 6710) who provided data for at least one wave-to-wave transition (W1 to W2, N = 3511 or W2 to W3, N = 3199) and provided outcome data at the next wave (follow-up) formed the analytic s le. Generalized estimating equations (GEE) logistic regression analyses examined predictors of quit attempts and abstinence at follow-up (1- and 6-month sustained abstinence). Wanting and planning to quit were significantly positively associated with making quit attempts, but negatively associated with smoking abstinence. A significant interaction between the Heaviness of Smoking Index and age warranted an age-stratified analysis for both abstinence outcomes. Lower HSI predicted abstinence in only the younger smokers Motivation and plans to quit were positively associated with abstinence in younger smokers, but surprisingly were negatively associated with abstinence in older smokers. Quit efficacy was associated with abstinence in the older, but not the younger smokers. Models of smoking abstinence are significantly improved by including motivational predictors of smoking. Age was an important moderator of the association between abstinence for both dependence and motivational variables. The findings from this large cohort study indicate there are age-related differences in predictors of smoking abstinence but not quit attempts. These associations may reflect differential experiences of older and younger cohorts of smokers, which may have implications for interventions to motivate and assist smokers in quitting.
Publisher: Informa UK Limited
Date: 11-05-2015
DOI: 10.1080/13548506.2015.1040032
Abstract: We aimed to assess the prevalence of sleep disturbance in a cardiac patient population over a 12-month period and assess its relationship with treatment adherence, self-efficacy, anxiety and depression. A total of 134 patients consecutively admitted to two Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%) were interviewed at six weeks and four and 12 months. Sleep disturbance was measured using a recode of the Beck Depression Inventory (v.2) item 16. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Sleep disturbance was highly prevalent (69%) at 6 weeks but was not associated with 12-month psychological outcomes. Path analysis revealed that sleep disturbance at 4 months was, however, associated with reduced treatment adherence and self-efficacy, and higher anxiety and depression scores at 12 months. The high prevalence of sleep disturbance in this study and its association with psychological outcomes may have adverse prognostic implications and possibly impede cardiac rehabilitation efforts.
Publisher: Elsevier BV
Date: 12-1990
DOI: 10.1016/0301-0511(90)90035-U
Abstract: Two studies were conducted in order to assess EEG and behavioural responsiveness to auditory stimuli as a function of sleep state in infants. The subjects in the first experiment were 11 infants aged 3 months, and in the second study the responsiveness of 8 infants aged 3 months was compared with that of 8 newborn infants. The stimuli ranged in intensity from 36 to 90 dB and were presented using a modification of the method of constant stimuli. The occurrence and intensity of behavioural responses were recorded by a trained observer. Electroencephalogram (EEG) responses were defined as EEG desynchronization and were identified by a Fast Fourier Transform algorithm. The results of the two studies showed that infants were more responsive during active sleep (AS) than during quiet sleep (QS) and gave behavioural responses at lower stimulus intensities than EEG responses. Behavioural responsiveness and EEG responsiveness during AS increased as a function of age, while EEG responsiveness during QS decreased. The marked suppression of EEG responsiveness during QS at 3 months of age is thought to be a consequence of developmental changes in sleep mechanisms--an effect which may have clinical implications.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/PY18069
Abstract: Despite the large number of Australians with private health insurance (PHI), normative quality-of-life data are not available for this population. The Short Form (SF)-12 has been used to characterise the health-related quality of life of Australians in the general population, but there is debate concerning the appropriate algorithm that should be used to calculate its physical and mental component summary scores. The standard (orthogonal method) approach assumes that the mental and physical components are unrelated, whereas an alternate approach (the correlated method) assumes that the two components are related. A consecutive s le of 24957 PHI members with four major initial disease conditions were administered the SF-12 via phone and 4330 participants were followed up at a mean of 16 months after the first survey. The SF-12 was scored using both the orthogonal and correlated methods, and both scoring models were assessed for model fit and ability to discriminate between the four major disease conditions. Confirmatory factor analysis demonstrated superior model fit and improved discriminative validity when the SF-12 was scored using the correlated method instead of the default orthogonal method. Further, the correlated method demonstrated utility by producing scores that were responsive to change over time.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.HLC.2013.10.093
Abstract: Return to work is an important indicator of recovery after acute cardiac events. This study aimed to determine rates of work resumption and identify predictors of non-return to work and delayed resumption of work. 401 currently employed patients consecutively admitted after acute coronary syndrome or to undergo coronary artery bypass graft surgery were recruited. Patient characteristics, perceptions and occupational outcomes were investigated via interviews and self-report questionnaires. Twenty-three patients were lost to follow-up. Of the 378 completers, 343 (90.7%) patients resumed work, while 35 (9.3%) did not. By four months, 309 (91.1%) patients had returned to work. At 12 months, 302 (79.9%) of the 378 patients were employed, 32 (8.5%) unemployed and 20 (5.3%) retired. The employment status of 24 (6.3%) patients was unknown. Non-return to work was significantly more likely if patients were not intending to return to work or were uncertain, had a negative perception of health, had a comorbidity other than diabetes and reported financial stress. Significant predictors of delayed return to work were cardiac rehabilitation attendance, longer hospital stay, past angina, having a manual job, physically active work, job dissatisfaction, no confidante and depression. Patients at risk of poor occupational outcomes can be identified early. Strategies to improve vocational rehabilitation require further investigation.
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2018-025525
Abstract: To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke. A secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. Seventeen hospitals located across the Netherlands. Depressive symptoms (Centre for Epidemiological Studies Depression Scale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years. Compared with those without stroke, patients with HF with a stroke (10.3% n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011 OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p .001 OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034 OR 2.87, 95% CI 1.61 to 5.11, p .0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012 OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years. Patients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.
Publisher: Oxford University Press (OUP)
Date: 07-07-2016
Abstract: Many patients experience the 'cardiac blues' at the time of an acute cardiac event, and one in five go on to develop severe depression. These emotional responses often go undetected and unacknowledged. We initiated the 'Cardiac Blues Project' in order to help support patients' emotional recovery. As part of the project, we developed online training in order to support health professionals in the identification and management of the cardiac blues and depression. The aim of this study was to assess the acceptability of the training and its impacts on health professionals' self-efficacy. In July 2014, a 'cardiac blues' pack of patient resources, including access to health professional online training, was mailed to 606 centres across Australia. In the first 3 months after distribution, 140 health professionals registered to undertake the online training and participated in the present study. Participants provided information via a six-item pre- and post-training self-efficacy scale and on 10 post-training acceptability items. Health professionals' self-efficacy improved significantly after undertaking the online training across the six domains assessed and for the total score. Acceptability of the training was high across all 10 items assessed. Ratings of usefulness of the training in clinical practice were particularly favourable amongst those who worked directly with cardiac patients. The health professional training significantly improves health professionals' confidence in identifying and managing the 'cardiac blues' and depression. Monitoring of uptake is ongoing and future studies will investigate patient outcomes.
Publisher: Oxford University Press (OUP)
Date: 12-2005
Publisher: Wiley
Date: 02-2007
Publisher: BMJ
Date: 15-06-2021
DOI: 10.1136/TOBACCOCONTROL-2020-056134
Abstract: Filter ventilation creates sensations of ‘lightness’ or ‘smoothness’ and is also highly effective for controlling machine-tested yields of tar, nicotine and carbon monoxide. Nearly all factory-made cigarettes (FMC) now have filter ventilation in countries such as Australia, Canada, the UK and the USA. Research conducted before ‘light’ and ‘mild’ labelling was banned found low smoker awareness of filter ventilation and its effects. This study explores current levels of awareness of filter ventilation and current understanding of its effects in these four countries. We used data from the 2018 wave of the ITC Four Country Smoking and Vaping Survey with s les from USA, England, Canada and Australia. Analyses were conducted initially on a weighted s le of 11 844, and subsequently on 7541 daily FMC smokers. Only 40.3% of all respondents reported being aware of filter ventilation. Among daily FMC smokers, only 9.4% believed their cigarettes had filter ventilation. Believing that their usual cigarettes are smoother was positively associated with believing they are also less harmful. Both these beliefs independently predict believing their cigarettes are ventilated (smoother OR=1.97 (95% CI 1.50 to 2.59) and less harmful OR=2.41 (95% CI 1.66 to 3.49) in relation to those believing each characteristic is average. Awareness of filter ventilation is currently low, despite decades of public ‘education efforts around the misleading nature of ‘light’ and ‘mild” descriptors. Few smokers realise that their cigarettes almost certainly are vented. Smokers who believed their cigarettes have filter ventilation were more likely to believe they were both smoother and less harmful. Awareness of the technology appears to be insufficient to prevent smokers being deceived by it. Filter ventilation is inherently misleading to smokers and it is time to ban it.
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/TOBACCOCONTROL-2021-056579
Abstract: Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities. Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched. Two reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Eight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26) product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1) moving consumers to reduced risk products (n=8) tobacco-free generation (n=4) ending sales (n=2) sinking lid (n=2) tax increases (n=7) and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised. VLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.
Publisher: Oxford University Press (OUP)
Date: 04-2006
Publisher: Springer Science and Business Media LLC
Date: 03-11-2022
DOI: 10.1186/S12872-022-02897-Y
Abstract: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and in idual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. In idual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.ATHORACSUR.2006.04.005
Abstract: While many studies have investigated cognitive impairments in patients after coronary artery bypass graft surgery, very few have closely evaluated presurgical cognitive functioning of bypass candidates. A battery of neuropsychologic tests was administered to a consecutive series of patients listed for bypass surgery (n = 109). Cognitive function of bypass candidates was compared with that of a healthy control group (n = 25) and published test norms. Cognitive test scores in candidates for bypass were significantly lower than those of the control group on tests of attention, information processing speed, and verbal memory. Additionally, bypass candidates' cognitive test scores were significantly reduced compared with expected values derived from validated test norms, on all but one cognitive test. Cognitive performances of candidates for bypass were significantly lower than those of a healthy control group and published cognitive test norms.
Publisher: Mark Allen Group
Date: 02-06-2018
DOI: 10.12968/BJCA.2018.13.6.286
Abstract: After cardiac events, rates of depression and anxiety of 20–30% have been reported, along with elevated rates of post-traumatic stress disorder and higher rates of suicide. As unresolved negative affect is associated with greater morbidity and mortality, attempts have been made to understand the complexity of emotional and psychological responses to cardiac events. Although many studies purport to measure ‘cardiac distress’, they are often limited by adopting a definition of distress as depression plus anxiety. Following the lead of the oncology and diabetes fields in the development of condition-specific distress measures, this article argues for a multidimensional approach to cardiac distress and its measurement it builds on the concept of the ‘cardiac blues’, to show the importance of understanding and measuring how this transient phenomenon of adjustment can become a persistent negative state which challenges the ability to cope with living after a cardiac event.
Publisher: Oxford University Press (OUP)
Date: 09-2010
DOI: 10.1016/J.EJCNURSE.2009.11.010
Abstract: Few studies have investigated the change in mood states, such as anger, fatigue and confusion, after coronary artery bypass graft surgery (CABGS). The aim of this study was to describe the progression of these mood states over time and to determine the factors associated with these trajectories. The Profile of Mood States (POMS) was administered to 182 CABGS patients prior to surgery and at two and six months post-operatively. Socio-demographic and medical data were collected before surgery. Growth curve modelling was used to describe the POMS subscale trajectories. Four POMS subscales (tension-anxiety, fatigue-inertia, confusion-bewilderment, and vigour-activity) showed rapid improvement over the first two months after CABGS followed by a lesser improvement. There was no significant change over time for the depression-dejection and anger-hostility subscales. Being younger, male, having a manual occupation, and smoking were factors associated with poorer pre-operative mood states. Those at risk of persistent mood disturbance after CABGS were younger, unpartnered, female and those with diabetes. These patients can be identified prior to hospital admission.
Publisher: Elsevier BV
Date: 10-2021
Publisher: MDPI AG
Date: 15-08-2022
Abstract: Background and Aims: There has been limited research addressing changes in subjective well-being as a result of quitting smoking. This paper examines recent ex-smokers’ well-being related experiences overall and as a function of (1) duration of cessation and (2) continued nicotine use from vaping. Methods: A s le of 1379 ever-daily smoking ex-smokers (quit for up to 5 years) from the 2020 ITC Four Country Smoking and Vaping Survey (Australia, Canada, the UK, and the US), of which 27.1% currently vaped daily. Well-being measures were perceived changes post-quitting in emotion coping (stress and negative emotions), enjoyment of life, and day-to-day functioning. We also assessed the level of persisting worry about past smoking leading to future health problems. Results: Overall, among those answering all four well-being measures, 51.8% of the ex-smokers reported positive effects and no negatives, but 27.3% reported at least one negative effect, with the remainder reporting no change in any measure. Positive effects were greater among those who had quit more than 1 year prior. The largest improvement (56.3%) was for daily functioning, which showed improvement over time since having quit. Current daily vapers reported similar well-being as those not vaping however, fewer daily vapers reported worsening ability to cope with stress (10.2% vs. 20.7%). Overall, 84% reported being worried about future negative health effects of smoking, with no clear differences by quitting duration or vaping status. Conclusions: Most ex-smokers reported changes in their well-being since quitting, with more reporting improvements than declines. Well-being improved with duration of time since quitting, but did not appear to be influenced by daily vaping use, but stress coping may be better among vapers. Persisting worries about possible future health effects from smoking may be reducing the experienced benefits of quitting smoking for some.
Publisher: Oxford University Press (OUP)
Date: 08-2008
Publisher: AMPCo
Date: 06-2008
DOI: 10.5694/J.1326-5377.2008.TB01852.X
Abstract: To investigate rates and predictors of cardiac rehabilitation (CR) attendance after coronary artery bypass graft surgery (CABGS) at Royal Melbourne Hospital (RMH), Victoria, where current best practice referral and recruitment strategies have been adopted. Prospective cohort study of 184 patients who underwent CABGS at RMH between July 2001 and April 2004. Patients completed questionnaires pre-operatively, and 170 patients (92%) had their CR attendance tracked after referral to CR either at RMH or elsewhere. Rates of CR attendance among RMH patients referred to CR either at RMH or elsewhere sociodemographic, medical, cognitive, psychosocial and geographical predictors of CR non-attendance. The CR attendance rate was 72%. Patients referred to CR at RMH were more than four times more likely to attend than patients referred elsewhere (odds ratio [OR], 4.36 P=0.024). Travel time significantly predicted CR attendance (OR, 0.86 P=0.039). CR attendance rates were found to be higher than previously reported for CABGS patients, suggesting that best practice referral and recruitment procedures minimise common barriers to CR attendance.
Publisher: Elsevier BV
Date: 11-2017
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-034946
Abstract: Distress is experienced by the majority of cardiac patients, yet no cardiac-specific measure of distress exists. The aim of this project is to develop and validate the Cardiac Distress Inventory (CDI). Using the CDI, health professionals will be able to identify key clusters of psychological, emotional and social concern to address with patients, postcardiac event. An item pool will be generated through: identification of items by a multidisciplinary group of clinician researchers review of generic and condition-specific distress measures focus group testing with cardiac rehabilitation professionals feedback from patients. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria will be used to inform the development of the methodology for determining the CDI’s psychometric properties. The item pool will be tested with 400 cardiac patients and responses subjected to exploratory factor analysis, Rasch analysis, construct validity testing and latent class analysis. Receiver operating characteristic analysis will be used to identify the optimal CDI cut-off score for distinguishing whether a person experiences clinically significant distress. Approved by the Monash Health Human Research Ethics Committee (approval number—RES-19-0000631L-559790). The CDI will be made available to clinicians and researchers without charge. The CDI will be translated for use internationally. Study findings will be shared with cardiac patient support groups academic and medical communities via publications and presentations in the training of cardiac secondary prevention professionals and in reports to funders. Authorship for publications will follow the uniform requirements for manuscripts submitted to biomedical journals.
Publisher: JMIR Publications Inc.
Date: 23-12-2021
DOI: 10.2196/34534
Abstract: After a cardiac event, a large majority of patients with cardiac conditions do not achieve recommended behavior change targets for secondary prevention. Mental health issues can also impact the ability to engage in health behavior change. There is a need for innovative, flexible, and theory-driven eHealth programs, which include evidence-based strategies to assist patients with cardiac conditions with their recovery, especially in behavioral and emotional self-management. The aim of this study is to determine the short- and longer-term behavioral and emotional well-being outcomes of the Back on Track web-based self-management program. In addition, this study will test whether there is enhanced benefit of providing one-on-one telephone support from a trained lifestyle counselor, over and above benefit obtained through completing the web-based program alone. People who have experienced a cardiac event in the previous 12 months and have access to the internet will be eligible for this study (N=120). Participants will be randomly assigned to one of the two study conditions: either “self-directed” completion of the Back on Track program (without assistance) or “supported” completion of the Back on Track program (additional 2 telephone sessions with a lifestyle counselor). All participants will have access to the web-based Back on Track program for 2 months. Telephone sessions with the supported arm participants will occur at approximately 2 and 6 weeks post enrollment. Measures will be assessed at baseline, and then 2 and 6 months later. Outcome measures assessed at all 3 timepoints include dietary intake, physical activity and sitting time, smoking status, anxiety and depression, stage of change, and self-efficacy in relation to behavioral and emotional self-management, quality of life, and self-rated health and well-being. A demographic questionnaire will be included at baseline only and program acceptability at 2 months only. Recruitment began in May 2020 and concluded in August 2021. Data collection for the 6-month follow-up will be completed by February 2022, and data analysis and publication of results will be completed by June 2022. A total of 122 participants were enrolled in this study. The Back on Track trial will enable us to quantify the behavioral and emotional improvements obtained and maintained for patients with cardiac conditions and, in particular, to compare two modes of delivery: (1) fully self-directed delivery and (2) supported by a lifestyle counselor. We anticipate that the web-based Back on Track program will assist patients in their recovery and self-management after an acute event, and represents an effective, flexible, and easily accessible adjunct to center-based rehabilitation programs. Australian New Zealand Clinical Trials Registry ACTRN12620000102976 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378920& isReview=true DERR1-10.2196/34534
Publisher: Oxford University Press (OUP)
Date: 06-2007
Publisher: Oxford University Press (OUP)
Date: 04-2008
Publisher: Mark Allen Group
Date: 02-08-2016
DOI: 10.12968/BJCA.2016.11.8.397
Abstract: While much research has focused on supporting patients' psychological recovery after an acute cardiac event, relatively little attention has been given to the psychological wellbeing of partners of patients. There are some indications that partners experience higher levels of anxiety and depression than cardiac patients. Previous studies have identified sociodemographic and behavioural predictors of distress in partners. The aim of this study was to investigate whether the quality of the marital relationship and the social support network impact on partner distress in the aftermath of a patient's cardiac event. A mixed-method approach, including questionnaires and semistructured interviews, was used, with partners interviewed at the time of the event. Partner distress was measured at 12 months post event. Chi-square and t-tests were used to identify factors associated with partner distress, and logistic regression was used to identify unique predictors of partner distress. One-hundred partners of cardiac patients consecutively admitted to the Royal Melbourne Hospital and the Melbourne Private Hospital over a 12-month period were recruited, with 73 participants retained at 12 months. Poor marital quality at the time of the cardiac event was the only unique predictor of partner distress. Thematic analysis of the qualitative data highlighted the ways marital quality impacts partners. Quantitative and qualitative findings illustrate the multi-dimensional impact of marital dysfunction on psychological distress in partners. Psycho-education and support for partners of cardiac patients appears warranted.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.HLC.2016.03.006
Abstract: In the general population, excessive sedentary behaviour is associated with increased all-cause mortality. Few studies have examined this relationship in people with cardiovascular disease (CVD). Using a s le of people with CVD who were excluded from an analysis of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study, we examined the relationship between sedentary behaviour and 13-year all-cause mortality. In the original AusDiab study, television viewing time was used as a marker of sedentary behaviour in 609 adults (≥45 years of age) with CVD. During 6,291 person-years of follow-up (median follow-up 13 years), there were 294 deaths (48% of s le). Using the time scale of attained age, the Cox proportional hazards model predicting all-cause mortality adjusted for sex, self-rated general health, leisure-time physical activity, smoking status, education, household income, body mass index, lipid levels, blood pressure, and diabetes mellitus was used. Compared with a TV viewing time of <2hours per day, the fully adjusted hazard ratios for all-cause mortality were 1.18 (95% CI, 0.88 to 1.57) for ≥2 to 4hours per day. Sedentary behaviour was associated with increased risk of all-cause mortality in people with CVD, independent of physical activity and other confounders. In addition to the promotion of regular physical activity, cardiac rehabilitation efforts which also focus on reducing sedentary behaviour may be beneficial.
Publisher: Wiley
Date: 02-2008
Publisher: Oxford University Press (OUP)
Date: 10-07-2016
Abstract: Obstructive sleep apnoea is highly prevalent in acute coronary syndrome patients eligible for enrolment in cardiac rehabilitation programmes. This condition is an independent predictor of increased morbidity and comorbid conditions in the general population and can lead to an increase in major adverse cardiac events such as revascularization, heart failure and hospital readmission in cardiac patients. There is convincing evidence that treatments such as continuous positive airway pressure or mandibular advancement devices can successfully treat obstructive sleep apnoea and these conditions can be improved or negated resulting in improved cardiac rehabilitation outcomes and improved health related quality of life. Given the potential benefits of obstructive sleep apnoea treatment it would make sense to screen for this condition upon entry to out-patient cardiac rehabilitation programmes. A two-stage approach to screening is recommended, where patients are initially evaluated for the probability of having obstructive sleep apnoea using a brief questionnaire (The STOP-Bang) and then followed up with objective evaluation (portable home monitor or polysomnography) where necessary. Potential barriers to further referral and treatment could be partly mitigated by the training of cardiac rehabilitation staff in sleep disorders and screening.
Publisher: Informa UK Limited
Date: 30-12-2010
DOI: 10.1080/13825580903009089
Abstract: Candidates for cardiac bypass surgery often experience cognitive decline. Such decline is likely to affect their everyday cognitive functioning. The aim of the present study was to compare cardiac patients' ratings of their everyday cognitive functioning against significant others' ratings and selected neuropsychological tests. Sixty-nine patients completed a battery of standardised cognitive tests. Patients and significant others also completed the Everyday Function Questionnaire independently of each other. Patient and significant other ratings of patients' everyday cognitive difficulties were found to be similar. Despite the similarities in ratings of difficulties, some everyday cognitive tasks were attributed to different processes. Patients' and significant others' ratings were most closely associated with the neuropsychological test of visual memory. Tests of the patients' verbal memory and fluency were only related to significant others' ratings. Test scores of attention and planning were largely unrelated to ratings by either patients or their significant others.
Publisher: Oxford University Press (OUP)
Date: 24-05-2013
Abstract: While there is evidence of poor health behaviours in anxious and depressed cardiac patients, it is possible that sociodemographic factors explain these associations. Few previous studies have adequately controlled for confounders. The present study investigated health behaviours in anxious and depressed cardiac patients, while accounting for sociodemographic confounders. A consecutive s le of 275 patients admitted to hospital after acute myocardial infarction (32%) or for coronary bypass surgery (40%) or percutaneous coronary intervention (28%) was interviewed six weeks after hospital discharge. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Smoking, physical activity, alcohol intake and dietary fat intake were assessed by self-report. Backward stepwise logistic regression was used to identify the factors independently associated with anxiety and depression. In total, 41 patients (15.2%) were 'depressed' (HADS-D ≥8) while 68 (25.2%) were 'anxious' (HADS-A ≥8). Depressed patients reported higher rates of smoking (χ2)= 4.47, p = 0.034), lower physical activity (F = 8.63, p < 0.004) and higher dietary fat intake (F = 7.22, p = 0.008) than non-depressed patients. Anxious patients reported higher smoking rates (χ2)= 5.70, p = 0.024) and dietary fat intake (F = 7.71, p = 0.006) than non-anxious patients. In multivariate analyses, an association with depression was retained for both diet and physical activity, and an association with anxiety was retained for diet. Low social support and younger age were significant confounders with depression and anxiety respectively. While the high smoking rates evidenced in anxious and depressed patients were explained by sociodemographic factors, their poor diet and low physical activity (depressed patients only) were independent of these factors. Given the impact of lifestyle modification on survival after a cardiac event, anxious and depressed patients should be a priority for cardiac rehabilitation and other secondary prevention programmes.
Publisher: Public Library of Science (PLoS)
Date: 24-10-2023
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.ATHORACSUR.2006.01.008
Abstract: Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass. However, the cognitive benefit of off-pump surgery remains unclear. Consecutively listed candidates for elective bypass were randomly assigned to either off-pump or on-pump techniques (n = 107). A battery of 11 standardized neuropsychological tests was administered before surgery, and again at 2 and 6 months after surgery. The two groups were compared using a range of statistical procedures, including growth modeling. There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points. There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months, with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months. When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques, the two groups were again comparable, except for results on the test of verbal fluency, in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group. The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
No related grants have been discovered for Michael Le Grande.