The impact of high-calorie-expenditure exercise on quality of life in older adults with coronary heart disease

The acceptability of a high-calorie-expenditure (HCE) exercise program in older coronary heart disease patients participating in a behavioral weight-control program was evaluated. Seventy-four overweight patients (median age 63 yr) were randomly assigned to a 5-mo intervention of HCE exercise (3,000-3,500 kcal/wk daily walking) or standard cardiac-rehabilitation (CR) exercise (700-800 kcal/wk). Both groups received counseling to achieve a dietary caloric deficit of 3,500 kcal/ wk. Assessments at baseline and 5 mo included self-reported measures of quality of life and psychosocial variables. The HCE group experienced significantly greater weight loss (8.2 ± 4 vs. 3.7 ± 5 kg, p < .001). Changes from baseline to 5 mo on scores of physical, emotional, and social functioning were greater for the HCE than CR group (p < .05). HCE exercise also resulted in greater positive change in exercise enjoyment (p = .05), which was mediated by weight change. Even high-risk older adults can be successful in an HCE exercise program and experience no adverse physical or emotional changes.     

Association of shorter mean telomere length with large artery stiffness in patients with coronary heart disease

Background.?Accumulating evidence implicates leukocyte telomere length (LTL) shortening as a potential risk predictor for cardiovascular disease. Arterial stiffness chronicles the cumulative burden of cardiovascular disease risk factors. Therefore, the capacity of LTL to predict arterial stiffness was examined.

Methods.?A total of 275 unrelated Chinese males: 163 patients with coronary artery disease (CAD) and 112 healthy controls, 40–73 years of age were included in this study. The relative telomere length of leukocytes was determined by a real-time fluorescence quantitative polymerase chain reaction (PCR). Large artery stiffness was measured with carotid-femoral pulse wave velocity (PWV).

Results.?The relative telomere length (T/S) ratio was significantly shorter in patients with CAD (0.79?±?0.26) than in control subjects (1.08?±?0.22) (p?<?0.001). The correlation between LTL and PWV in patients with CAD was stronger than that in the controls (r?=??0.467, r²?=?0.227, p?<?0.001 for patients with CAD versus r?=??0.223; r ²?=?0.050; p?=?0.018 for controls). The log_e-transformed T/S ratio was inversely correlated with age (r?=??0.345; p?<?0.001), PWV (r?=??0.326; p?<?0.001) and C-reactive protein ( r?=??0.133; p?=?0.027).

Conclusions.?The data show an association of leukocyte telomere length shortening with increased arterial stiffness and cardiovascular burden, suggesting that telomere length is a biomarker of large artery elasticity and CAD. Further studies are warranted to study the role of LTL dynamics in the pathogenesis of atherosclerosis.     

Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.     

Diagnosis of cardiovascular disease in women

Cardiovascular disease (CVD, comprising coronary heart disease and stroke) is the leading cause of death in both sexes in developed countries. Although women are nine times more likely to die from CVD than they are from breast cancer, there is a general public belief that the most common cause of death is cancer. The symptoms of acute myocardial infarction and acute coronary syndromes differ between the sexes. Women are less likely to experience chest pain and may have non-specific symptoms. Normal or non-obstructive coronary disease, as detected by angiography, is more common in women. Scintigraphy improves the detection of coronary disease in women. There is an urgent need to increase awareness of both coronary heart disease in women and the limitations of commonly used diagnostic tools.     

Gender differences in cardiovascular disease prevention

Risk factors are generally shared between men and women with the major differences being hormonal. Nine modifiable risk factors account for over 90% of the risk of a coronary event in men and women--smoking, hypertension, hyperlipidaemia, diabetes, abdominal obesity, lack of exercise, alcohol excess, reduced intake of fruit and vegetables, and psychosocial issues. Approximately half the decline in deaths from coronary heart disease (CHD), between 1980 and 2000, can be attributed to a reduction in the major risk factors and the other half to the use of evidence-based management. As educational efforts to increase awareness of cardiovascular disease (not cancer) to be the leading cause of death and disability in women are also associated with preventative action, it is important that health-care professionals educate themselves about CHD in women and communicate with women themselves, so that women can come forward for advice and evaluation.     

Primary prevention services for children and youth

Described and empirically supported is an interventive model for primary prevention of social and health problems among children and youth. Involving three components—information dissemination, information personalization, and skills acquisition—preventive intervention is delivered through a group training format. Data from two field applications of the model document its feasibility and effectiveness. The first application focuses on helping adolescents prevent unwanted pregnancy; the second on preventing cigarette smoking among preadolescents. In both studies self-report, behavioral, and objective data obtained at program's end and at 6-month follow-up favored trained youths when compared to those in untrained control conditions. The model's adjunctive benefits and directions for further research are discussed.     

Management of Parkinson's disease in older women

Elderly women with Parkinson's disease (PD) represent a specific patient population that may benefit from individualized treatment strategies. PD has been shown to occur approximately twice as often in men than in women, resulting in theories regarding estrogen being protective against the disease and as a potential treatment strategy. Given women's longer life expectancy, they are more likely to reach an age where antiparkinsonian medications are associated with side-effects. This paper will review medical and surgical treatments as well as the relationship of gender and age with respect to the management of PD.     

HIV prevention barriers in transgender women: a qualitative study

Abstract

Sexual contact is still one of the most important routes of HIV transmission. The aim of this study was identify the factors that underlie the higher prevalence of high-risk sexual behaviors in a sample of transgender women in Iran. The qualitative study used face-to-face, semi-structured, in-depth interviews in a sample of 15 transgender women. Our participants used sexual practices as a way to be approved/accepted as a woman. Using sex for this purpose led them to engage in high-risk sexual relationships. It is essential to consider these issues in consulting and education about high-risk behaviors.     

Utilizing findings from a gender-based analysis to address chronic disease prevention and management among African-American women in a Michigan community

This research note underscores the importance of including strategies to address gender-based disparities when planning and implementing community health improvement programs. Working in collaboration with the Inkster Partnership for a Healthier Community (IPHC), the National Kidney Foundation of Michigan conducted a gender-based analysis as part of its broader community health needs assessment efforts in Inkster, MI. The findings from these studies revealed significant challenges impacting women that were not being adequately addressed within the community. In response to these findings, the IPHC created a strategic action plan to respond to the highest priority needs by increasing community awareness of and linkages to resources that provide supportive services for low-income African-American women.     

Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms"

Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.     

Functional foods for cardiovascular disease in women

Cardiovascular disease (CVD) is the leading cause of death in women. Functional food consumption can play an important role in the prevention and treatment of CVD. The purpose of this review is to establish recommendations for the intake of functional food ingredients in a healthy diet, such as soy proteins and isoflavone, omega-3 fatty acids (FAs) from fish oils (FOs) including eicosapentaenoic acid (EPA) and docoshexaenoic acid (DHA) and plant sterols-(PS) enriched foods - for prevention and treatment of CVD in postmenopausal women. First, controversial results exist on CVD risk factors after intake of soy protein and isoflavone that indicates that further clinical studies need to be done to better understand their role in maintaining and improving cholesterol levels. However, since soy contains polyunsaturated fats, replacing some higher fat meat protein sources with soy products may contribute to cardiovascular health. Secondly, FOs, including EPA and DHA, have shown promising effects for lowering triglyceride levels. In addition, emerging research appears to show that omega-3 FAs may have additional health effects with improved arterial health and a reduction in oxidative stress in postmenopausal women. Thirdly, foods and beverages supplemented with PS may reduce cholesterol; therefore, are a worthy addition to interventions aimed at lowering heart disease risk in women. Overall, incorporating functional foods into a healthy diet may be beneficial in helping to reduce lipids levels and thus the risk of CVD.     

Sexual assault prevention with college-aged women: a bibliotherapy approach

The present research evaluated the efficacy of a skills-based bibliotherapy approach to sexual assault prevention for college-aged women. One hundred and ten participants were followed prospectively for 16 weeks. A self-help book, written by the authors, was compared to a wait-list control on several self-report measures. Results revealed significant differences between groups, with bibliotherapy participants reporting decreased participation in risky dating behaviors and improvement in sexual communication strategies across a variety of dating situations. However, results suggested that the self-help book was no more effective than the wait-list control in reducing rates of sexual victimization. Limitations of the study and directions for future sexual assault prevention research with women are discussed.     

Heart disease risk perception in college men and women

The authors sought to assess the perception of risks for coronary heart disease (CHD) in college men and women. They surveyed 470 undergraduates from 2 major 4-year institutions who completed a questionnaire that measured perceived risks for heart disease. Sixty-eight percent of the respondents rated their risks as lower or much lower than those of their peers, indicating a clear optimistic bias. The research also revealed that the students who exercised regularly rated their risk of coronary disease lower than those who did not do so. In addition, women perceived a number of risk markers to be more potent or causative factors than men did. A significant number of participants did not comprehend commonly understood causal relationships associated with heart disease risk. The findings in this preliminary investigation suggest that college men and women do not accurately perceive their risks for developing heart disease.