Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization.

Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization.

Methods: Data from the Ontario Health Survey, a representative population sample (n=9,953) of respondents aged 15 years and older, were analyzed using logistic regression. Adverse childhood experiences examined were childhood physical and sexual abuse, parental marital conflict, poor parent-child relationship, low parental education and parental psychopathology.

Coronary artery bypass graft surgery: exploring a broader perspective of risks and outcomes.

Although the literature is replete with evidence related to physiological predictors and short-term outcomes of coronary artery bypass graft (CABG) surgery, there is still a paucity of data that encompass a broader perspective of risk and outcomes. The primary objective of this prospective cohort study was to explore the physiological and psychosocial dimensions of preoperative status that may be predictive of the short- and longer term outcomes of CABG surgery. Patients (N = 136) scheduled for elective/urgent CABG surgery were followed from the time of placement on the waiting list until 6 months after the surgery.

The coronary artery bypass graft surgery trajectory: Gender differences revisited.

Over the past several decades there has been substantial research interest in gender differences within the coronary artery bypass graft (CABG) surgery trajectory. However, the debate persists regarding the reasons why women may have less favorable outcomes. As part of a larger study, we explored gender differences in the physiological and psychosocial dimensions of pre-operative status, and post-operative morbidity and quality of life outcomes in CABG surgery patients.

Determinants of self-care behaviors in community-dwelling patients with heart failure.

Background And Research Objective: As the population ages, chronic conditions such as heart failure are becoming more prevalent. An important goal is to understand how patients with heart failure learn to manage the often debilitating disease symptoms. The research objective was to examine the determinants of general and therapeutic self-care behaviors among community-dwelling heart failure patients.

Health risk behaviors and mental health problems as mediators of the relationship between childhood abuse and adult health.

Objectives: We examined the relationship between childhood abuse and adult health risk behaviors, and we explored whether adult health risk behaviors or mental health problems mediated the relationship between childhood abuse and adult health problems and health care utilization.

Methods: We used logistic regression to analyze data from the Mental Health Supplement of the Ontario Health Survey, a representative population sample (N = 8116) of respondents aged 15 to 64 years.

Results: We found relationships between childhood sexual abuse and smoking (odds ratio [OR] = 1.

Childhood abuse, adult health, and health care utilization: results from a representative community sample.

The long-term consequences of childhood abuse on adult mental health have been a major focus of research. Much less attention has been directed to its effects on physical health outcomes. By use of data from the Ontario Health Survey (n = 9,953), the association between retrospective reports of childhood physical and sexual abuse and adult health and health care utilization was examined in men and women.

Nonspecific behaviors as early indications of cerebral vasospasm.

This study investigated nonspecific behaviors as early indications of vasospasm following subarachnoid hemorrhage. Although symptoms of vasospasm (e.g.

Influential factors for self-care in ambulatory care heart failure patients: a qualitative perspective.

Chronic heart failure is associated with debilitating symptoms, diminished quality of life and frequent hospitalizations. The literature suggests that effective everyday self-care decision-making can improve heart failure outcomes. This article focuses on the qualitative portion of a study of self-care decision-making in community-dwelling individuals attending a heart failure clinic.

Uncertainty, symptom distress, anxiety, and functional status in patients awaiting coronary artery bypass surgery.

Objective: The study's objective was to (1) describe uncertainty, anxiety, the symptom distress experience, and functional status of patients on a coronary artery bypass graft (CABG) waiting list and express the relationship between these concepts; (2) explore whether length of time waited has an influence on the psychosomatic condition of patients; and (3) explore the use of semistructured interviews within the context of a theoretic framework and compare open-ended responses to quantitative results.

Design: A descriptive, correlational, cross-sectional design was used with supplementary telephone interviews using semistructured questions. Quantitative data were collected with a mailed questionnaire.

Fitness centre membership is related to healthy behaviours.

Aim: Maximizing the health benefits associated with reducing inactivity levels requires an understanding of the individual and environmental determinants of physical activity. Membership in a fitness facility promotes physical activity, yet little is known of its relationship to health. The purpose of this study was to compare physical activity levels, and health status, behaviours, and beliefs, in members of a fitness centre, and non-member community residents.

Cardiovascular health promotion in aging women: validating a population health approach.

Objective: Although cardiovascular disease is the leading cause of death in North American women, most cardiovascular research has focused on men. In addition, while there has been a recent trend toward population health promotion (PHP) and a consequent focus on the broad determinants of health, there is still a dearth of research evidence related to the promotion of cardiovascular health within this context. The purpose of this study was to explore and describe the interrelationships between the determinants of health and individual cardiovascular health/risk behaviors in healthy women, within the context of a framework for PHP.

A qualitative analysis of the experience of uncertainty while awaiting coronary artery bypass surgery.

The aim of this article is to present a qualitative examination of the phenomenon of uncertainty in patients awaiting CABG surgery. Cardiac symptoms are presented as an antecedent to uncertainty and both positive and negative outcomes of uncertainty are discussed. Semi-structured interview questions, based on Mishel's Uncertainty in Illness Theory, were developed to investigate the experience of waiting for CABG surgery and identify what patients were doing: to make their cardiac symptoms more manageable, to relieve their own anxiety while waiting, and to identify why patients felt having CABG surgery would benefit them.

Analysis of nursing assessments in a cohort patients with ruptured cerebral aneurysms.

Patients admitted with subarachnoid hemorrhage are monitored for symptoms of vasospasm. A prospective study was designed to compare two monitoring instruments: a standard neurological tool (SNR) and the National Institutes of Health Stroke Scale (NIHSS). The two assessment tools were compared to evaluate their concordance and to identify areas where efficiency in recording assessments might be improved.

Effects of a long-term, community-based cardiac rehabilitation program on middle-aged and elderly cardiac patients.

The purpose of this retrospective study was to compare the effects of a 2-year, community-based cardiac rehabilitation exercise program on cardiovascular fitness, body fatness, and blood lipids in middle-aged (65 years, n=40) male cardiac patients. Estimated maximal metabolic equivalents increased in both groups; however, the increase was greater for middle-aged patients (p=0.003).

Symptoms and distress in patients awaiting coronary artery bypass surgery.

In this examination of symptom distress in patients awaiting coronary artery bypass graft (CABG) surgery, a convenience sample of 42 patients on a waiting list for first-time CABG-only surgery were contacted via mail as part of a larger study into the experience of waiting for CABG surgery. They were asked to respond to questions about the frequency and distress of their coronary artery disease symptoms. A modified version of the Symptom Frequency and Symptom Distress Scale (SFSDS) was used.

Comparison of a standard neurological tool with a stroke scale for detecting symptomatic cerebral vasospasm.

The purpose of this study was to critically analyze the effectiveness of two tools used by nurses to assess neurological status of individuals at risk of developing cerebral vasospasm following aneurysmal subarachnoid hemorrhage due to aneurysm rupture. Early detection of vasospasm provides an opportunity for prompt treatment so that further ischemia or infarction can be prevented. We hypothesized that the National Institutes of Health Stroke Scale would detect symptomatic vasospasm earlier than the standard neurological record currently used in the practice setting of a tertiary care teaching hospital.

Serum ferritin and heart disease: the effect of moderate exercise on stored iron levels in postmenopausal women.

Objective: To determine the effect of a moderate exercise regimen on stored iron as measured by serum ferritin in previously sedentary postmenopausal women.

Design: Randomized assignment to one of three groups: a five day/week walking group (five-day group, n = 27); a three day/week walking group (three-day group, n = 27) or a sedentary group (control group, n = 25).

Setting: Community-based intervention.

Cardiac structure and exercise blood pressure in urban and rural Canadian men of Icelandic descent.

The objective of the study was to determine the relationship between exercise systolic blood pressure (ESBP), during bicycle ergometry, and echocardiographically determined left ventricular structure in rural and urban Canadian men of Icelandic descent. The study was cross-sectional in design. The settings were urban Winnipeg and the rural Interlake District in the province of Manitoba, Canada.

Influence of walking volume on health benefits in women post-menopause.

The health benefits of physical activity are believed to be related more to exercise volume than to intensity. In this 24-wk study, we examined the effect of walking volume on aerobic fitness, serum lipids, and body composition in women post-menopause, a population at risk for coronary artery disease. Of 79 women randomly assigned to groups at the outset, 56 completed the study (mean age 61.

The relationship of serum ferritin with sex and exercise in Canadians of Icelandic descent: implications for prevention of coronary artery disease.

Objective: To investigate the relationship of serum ferritin with sex and exercise.

Design And Setting: A cross-sectional design study carried out in Winnipeg, Manitoba.

Subjects: Urban Canadians of Icelandic descent, aged 21 to 60 years, took part in this investigation.

Pathophysiology of cardiac dysfunction in congestive heart failure.

Although various factors, such as myocardial infarction, pressure overload and volume overload, result in the development of congestive heart failure (CHF), the pathogenesis of contractile dysfunction in this situation is poorly understood. Loss of cardiac muscle due to myocardial infarction appears to activate several humoral and hormonal pathways, including the renin-angiotensin and sympathetic systems which serve as adaptive mechanisms to maintain cardiovascular performance at early stages of failure. However, under chronic conditions, an altered hormonal profile produces deleterious effects and permits transition from the compensated heart to the failing heart.

Characteristics and mechanisms of tachyphylaxis of cardiac contractile response to insulin.

Although insulin is known to cause internalization of its own receptors, the physiological significance of this phenomenon is not clear. In the isolated rat heart we observed that the positive inotropic effect of 25 munits/ml insulin was completely abolished if the heart was preperfused with insulin for 10 min. This tachyphylactic response to insulin began to appear 3-4 min after starting preperfusion with insulin and was partially reversible after 30 min of washing.

Exercise blood pressure and echocardiographic abnormalities in genetically comparable populations.

Objective: To determine the relationship between the systolic blood pressure response to exercise and the echocardiographic dimensions of the left atrium and ventricle in two geographically separate, but genetically comparable, populations.

Design And Setting: The study was cross-sectional. The settings were two semirural communities, one in Iceland and one in Manitoba.

Echocardiographic indices and their relationship to the blood pressure response to ergometric exercise in apparently healthy men.

The relationship between atrial and ventricular echocardiographic abnormalities and ergometric exercise systolic blood pressure was studied in 77 apparently healthy men, of whom the majority (77%) were normotensive (resting blood pressure less than 140/90 mmHg), and the remainder (23%) borderline hypertensive (resting systolic blood pressure 140 to 159 mmHg and/or diastolic blood pressure 90 to 95 mmHg). Four categories of exercise systolic blood pressure were defined (less than 190, 190 to 199, 200 to 209 and greater than or equal to 210 mmHg). Left ventricular mass and left atrial dimension were measured by M-mode echocardiography and divided by body surface area to derive the left ventricular mass index and the left atrial dimension index.