| 1. |
- Hallman, Tina, et al.
(författare)
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Perspectives on Differences in Perceived External Stress : A Study of Women and Men with Coronary Heart Disease
- 2002
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Ingår i: Stress and health. - : Wiley. - 1532-3005 .- 1532-2998. ; 18, s. 105-
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Tidskriftsartikel (refereegranskat)abstract
- Focuses on diiversities among women and men rare, and few studies have focused on gender differences in psychosocial factors and coronary heart disease. The present study is one of a series in which a wide range of psychosocial factors will be analysed with a focus on women. We compared women with men as regards the impact of educational level and occupational position on differences in perceived external stress. A questionnaire (The Stress Profile) was answered by 538 rehabilitation paricipants (97 women, 441 men), and a reference group (5308 women, 5177 men), aged 40-65 years. Generally, women reported a higher value of perceived external stress than men. Most interesting, however, are the patterns of differences that emerged when women and men were compared in different subgroups. Women with upper secondary school education and women in white-collar positions reported significantly higher levels of perceived external stress than men in the respective groups. When using common multivariate methods and adjusting for gender a great deal of information can be lost, and adjusting for gender makes it more difficult to find the true effect of exposures. It is only by regarding women and men separately that it is possible to link their very different working conditions and experience of stress to different health effects and vice versa.
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| 2. |
- Hallman, Tina, et al.
(författare)
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Stress, Burnout and Coping : Differences between Women with Coronary Heart Disease and Healthy Matched Women
- 2003
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Ingår i: Journal of Health Psychology. - : SAGE Publications. - 1359-1053 .- 1461-7277. ; 8:4, s. 433-446
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Tidskriftsartikel (refereegranskat)abstract
- Stress is becoming more significant for women, along with the increasing number of women in the workforce. The present study compared women with respect to burnout and coping abilities, and related to the impact of educational level on differences in coping strategies. Women with coronary heart disease reported a higher level of burnout and had the highest scores demonstrating lack of coping, which indicates lesser coping abilities. Differences concerning strain reduction, self-control and emotional distancing are discussed in terms of living conditions. We also discuss that in order to optimize the outcome of rehabilitation and prevention we need more research on women, of women and especially from women’s point of view.
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| 3. |
- Humphries, Sophia, et al.
(författare)
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Internet-Based Cognitive Behavioral Therapy for Patients Reporting Symptoms of Anxiety and Depression After Myocardial Infarction : U-CARE Heart Randomized Controlled Trial Twelve-Month Follow-up
- 2021
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: The U-CARE Heart trial was one of the first randomized controlled trials to evaluate the effect of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety or depression for patients with a recent myocardial infarction. While the effects of internet-based cognitive behavioral therapy on Hospital Anxiety and Depression Scale (HADS) scores at 14 weeks postbaseline were not significant, in this study, we investigated possible long-term effects of treatment.Objective: The aim of this study was to evaluate the long-term effectiveness of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety and depression in patients 12 months after a myocardial infarction and to explore subsequent occurrences of cardiovascular disease events.Methods: Shortly after acute myocardial infarction, 239 patients (33% female, mean age 59.6 years) reporting mild-to-moderate symptoms of anxiety or depression were randomized to 14 weeks of therapist-guided internet-based cognitive behavioral therapy (n=117) or treatment as usual (n=122). Data from national registries were used to explore group differences in clinical outcomes such as cardiovascular disease and cardiovascular-related mortality for a follow-up period of up to 5 years: group differences in HADS total score 1 year post-myocardial infarction, the primary outcome, was analyzed using multiple linear regression. Secondary outcomes, such as HADS anxiety and depression subscales and the Cardiac Anxiety Questionnaire total score (CAQ), which measures heart-focused anxiety, were analyzed in the same way. Multiple imputation was used to account for missing data, and a pooled treatment effect was estimated. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) for data pertaining to registry outcomes.Results: Both groups reported lower HADS total scores 1 year after myocardial infarction than those at baseline. HADS total scores were not significantly different between the treatment and control groups 1 year after myocardial infarction (beta=-1.14, 95% CI -2.73 to 0.45, P=.16). CAQ was the only measure improved significantly by internet-based cognitive behavioral therapy when compared with treatment as usual ( beta=-2.58, 95% CI -4.75 to -0.42, P=.02) before adjusting for multiple comparisons. The composite outcome of nonfatal cardiovascular events and cardiovascular-related mortality did not differ between groups but was numerically higher in the internet-based cognitive behavioral therapy group, who were at slightly greater risk (HR 1.8, 95% CI 0.96 to 3.4, P=.07). Adjusting for previous myocardial infarction and diabetes attenuated this estimate (HR 1.5, 95% CI 0.8 to 2.8, P=.25).Conclusions: Internet-based cognitive behavioral therapy was not superior in reducing self-reported symptoms of depression or anxiety compared to treatment as usual at the 1-year follow-up after myocardial infarction. A reduction in cardiac-related anxiety was observed but was not significant after adjusting for multiple comparisons. There was no difference in risk of cardiovascular events between the treatment groups. Low treatment adherence, which might have affected treatment engagement and outcomes, should be considered when interpreting these results.
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| 4. |
- Wallert, John, et al.
(författare)
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Attending Heart School and long-term outcome after myocardial infarction : A decennial SWEDEHEART registry study
- 2020
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 27:2, s. 145-154
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking.AIMS: Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction.METHODS: Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006-2015), with >99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6-10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves.RESULTS: After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio = 0.53 (0.44-0.64); five-year hazard ratio = 0.62 (0.55-0.69)) and cardiovascular (0.50 (0.38-0.65); 0.57 (0.47-0.69)) mortality. The results were robust in several sensitivity analyses.CONCLUSIONS: Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.
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