Biomedical subjects

A Appels

Publications and source records attributed to A Appels.

58 records · Page 4Linked to original sources

PubMedDate not supplied

Inflammation, depressive symptomtology, and coronary artery disease.

OBJECTIVE: Many patients feel exhausted or depressed before the onset of an acute coronary event, but little is known about the origin of these feelings. We tested the hypothesis that the depressive symptomatology is associated with a reactivation of latent viruses and inflammation of a coronary vessel. METHODS: A blood sample was drawn and a biopsy sample was obtained from the coronary lesion of 15 exhausted and 15 nonexhausted patients treated with directional coronary angioplasty because of severe angina. Blood samples were analyzed to measure antibody titers against Chlamydia pneumoniae, cytomegalovirus, and the cytokines interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha. The biopsy sample was analyzed for the presence of IL-1beta and TNF-alpha. RESULTS: Exhausted/depressed patients had higher antibody titers against cytomegalovirus, higher levels of C. pneumoniae immunoglobulin G, and higher levels of IL-1beta and TNF-alpha. No associations between the mental state of a patient and cytokine mRNA in the biopsy sample were found. CONCLUSIONS: The findings indicate that the mental state of angioplasty patients is positively associated with serological markers of inflammation. It remains to be seen whether the inflammation causes feelings of exhaustion, whether exhaustion and depression set the stage for inflammation, or whether existing feelings of exhaustion are amplified by the inflammation.

Adaptation, Physiological↗

PubMedDate not supplied

Vital exhaustion as a risk indicator for first stroke.

Fatigue is a common condition after stroke. An unresolved question is whether the fatigue is a consequence of the stroke or is one of the precursors. The authors' objective was to investigate whether vital exhaustion is a precursor of first stroke while controlling for other cardiovascular risk factors. The design was a prospective cohort study. Vital exhaustion was diagnosed with the Maastricht Interview Vital Exhaustion scale. The authors controlled for age, gender, diabetes mellitus, systolic and diastolic blood pressure, total cholesterol, body mass index, and smoking habits as possible confounders. Data were analyzed with Cox regression analysis. The subjects were adults ages 41-66 in an average Dutch village population. Outcome measures included first stroke. Vital exhaustion increased the risk of stroke by 13% per vital exhaustion point on the Maastricht Interview Vital Exhaustion scale. This value remained statistically significant after control for other risk factors. Total cholesterol, diastolic blood pressure, systolic blood pressure, diabetes mellitus, and smoking also increased the risk of stroke significantly. A state of exhaustion is one of the risk indicators for stroke. This means that the fatigue so often seen after stroke was already experienced by many patients before the occurrence of the stroke.

Adult↗

PubMedDate not supplied

Assessment of vital exhaustion and identification of subjects at increased risk of myocardial infarction in general practice.

Vital exhaustion, a state characterized by unusual fatigue, loss of energy, increased irritability, and feelings of demoralization, is one of the cardiovascular risk factors. The authors investigated whether vital exhaustion contributes to the identification of subjects at increased risk of myocardial infarction in general practice. In this prospective cohort study, vital exhaustion was assessed with the Maastricht Interview on Vital Exhaustion. Other cardiovascular risk factors established were age, gender, systolic and diastolic blood pressure, total cholesterol, body mass index, smoking habits, cardiovascular disease, and diabetes mellitus. A Cox regression analysis was used. The subjects were adults (41-66 years) in an average Dutch village population. Outcome measures were fatal and nonfatal myocardial infarction. At the univariate level, vital exhaustion doubled the risk of myocardial infarction. The effect of exhaustion was confounded by gender; women had higher exhaustion scores and a lower incidence of myocardial infarction. With control for gender, age, systolic blood pressure, total cholesterol, smoking habits, self-reported cardiovascular disease, and diabetes mellitus, vital exhaustion almost tripled the risk of myocardial infarction. Assessment of vital exhaustion contributes to the identification of subjects at increased risk of myocardial infarction in general practice.

Adult↗

PubMedDate not supplied

[Biographical analysis and myocardial infarct: a study of myocardial infarction patients and 2 reference groups].

In a retrospective case-referent study, 105 male myocardial infarction patients (age: 35-69), 105 hospital referents, and 105 neighbourhood referents, all of the same age, were interviewed with respect to exposure to some psychosocial risk indicators in their lives. These indicators include: Type A coronary-prone behavior pattern; the prevalence of stressful changes in childhood and adolescence, work and career, and family and social life; the syndrome of vital exhaustion and depression, which may precede myocardial infarction. The central question of this study is in what manner and in what connection these risk indicators may affect the lives of myocardial infarction patients. The results indicate that in general the prevalence of Type A behavior is twice as high in myocardial infarction patients as in both referent groups. On the other hand, this difference only reaches significance in younger patients (N = 30; age: 35-44). The prevalence of stressful life changes in myocardial infarction patients is characterized in particular by both the cohort-specific and the "non-normative" nature of these life changes. In young patients (N = 15; age: 35-39), all of whom but one are Type A, only some life changes associated with work and career occur significantly more often. In older patients (N = 30; age: 50-54, and 65-69) the latter problems are replaced by and intermingled with (chronic) conflicts in family and social life, that occur significantly more often. The myocardial infarction patients score significantly higher on the syndrome of vital exhaustion and depression than both referent groups. This syndrome is probably specific to myocardial infarction patients, and appears-unlike Type A behavior-not to be dependent on age. The results are discussed in terms of an "attributional" model that might explain the development of vital exhaustion and depression in the biography of myocardial infarction patients.

Adult↗