Biomedical subjects

Patrice G Saab

Publications and source records attributed to Patrice G Saab.

11 recordsLinked to original sources

PubMed2005

The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology.

Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness.

Affective Symptoms↗

PubMed2005

Behavioral indices of threat and challenge in Hispanic adolescents and hemodynamic responses to a speech stressor.

Behavioral ratings of performance and nervousness during a speech were used to divide participants (n=54) into threat and challenge groups. Comparisons on cardiac output, Heather index, heart rate, vascular resistance, and blood pressure reactivity indicated greater myocardial responses for the challenge group. This study extends the threat-challenge literature by employing behavioral definitions of constructs and examining a Hispanic adolescent sample.

Adolescent↗

PubMed2004

Technological and medical advances: implications for health psychology.

Behavioral telehealth, health informatics, organ and tissue transplantation, and genetics are among the areas that have been affected by advances in technology and medicine. These areas illustrate the opportunities and the challenges that new developments can pose to health psychologists. Each area is discussed with respect to implications for practice, research, public policy, and education and training: recommendations are provided.

Behavioral Medicine↗

PubMed2004

Ethnicity, gender, and age effects on adrenoceptors and physiological responses to emotional stress.

We examined the unique and joint effects of ethnicity, gender, and age on cardiovascular and catecholamine responses to the anger recall interview, and beta(2)-adrenergic receptor density and function on peripheral blood mononuclear cells. Participants were 179 nonsmoking, normotensive men and women aged 18-49 years. All subjects showed similar blood pressure increases during the anger recall interview. Black men, however, showed the smallest increases in heart rate in conjunction with an attenuated peripheral vasodilatation. Black women and Whites showed similar increases in heart rate and peripheral vasodilatation. Increasing age was associated with greater norepinephrine increases to anger recall in Black males. Black men also exhibited higher epinephrine levels throughout the protocol, higher dissociation constant to (125)I-pindolol, and age-dependent increases in beta(2)-receptor density. Relative to Whites and Black females, arousal of negative affect in Black males led to a pattern of sympathetic nervous system activity that may help explain the higher prevalence of hypertension in this population.

Adolescent↗

PubMed2004

Exercise, depression, and mortality after myocardial infarction in the ENRICHD trial.

PURPOSE: The large and well-characterized population of acute myocardial infarction (AMI) patients studied in the recently completed Enhancing Recovery in Coronary Heart Disease (ENRICHD) multicenter clinical trial provides a unique opportunity to examine the importance of self-reported regular physical exercise in a large cohort of patients with a recent AMI who are depressed or report low levels of social support. METHODS: We prospectively examined the association between self-reported physical exercise and all-cause mortality and cardiovascular morbidity among 2078 men (N = 1175; 56.5%) and women (N = 903; 43.5%) with an AMI participating in the ENRICHD Trial. Six months after suffering an AMI, patients were surveyed about their exercise habits and were then followed for up to 4 yr. RESULTS: During an average 2 yr of follow-up, 187 fatal events occurred. Patients reporting regular exercise had less than half the events (5.7%) of those patients reporting they did not regularly exercise (12.0%). After adjustment for medical and demographic variables, the hazard ratio for fatal events was 0.62 (95% CI = 0.44-0.86, P = 0.004). The rate of nonfatal AMI among the exercisers was 6.5% compared with 10.5% who reported no regular exercise. After adjustment for covariates, the hazard ratio for nonfatal AMI was 0.72 (95% CI = 0.52-0.99, P = 0.044). CONCLUSIONS: The present findings demonstrate the potential value of exercise in reducing mortality and nonfatal reinfarction in AMI patients at increased risk for adverse events by virtue of their either being depressed or having low social support.

Cognitive Behavioral Therapy↗

PubMed2004

John Henry Active Coping, education, and blood pressure among urban blacks.

The John Henryism hypothesis posits that individuals who actively cope with psychosocial stressors in the face of low socioeconomic resources are more likely to exhibit higher blood pressure levels than those with greater socioeconomic resources. It has been proposed that John Henryism may contribute to the disproportionately high rates of hypertension among blacks. Previous studies which support the John Henryism hypothesis have been conducted among blacks who reside in primarily southern rural settings. However, more recent studies conducted among urban blacks, have yielded contrasting results. This study examined the John Henryism hypothesis in a middle-aged urban sample of blacks in south Florida. The results of the study confirmed that there is indeed a relationship among John Henry Active Coping, years of education, and blood pressure among urban blacks in south Florida. Upon closer examination, higher John Henry Active Coping scores were associated with higher systolic and diastolic blood pressure among higher educated men, and John Henry Active Coping scores were associated with higher systolic and diastolic blood pressure among women with lower levels of education. The findings are discussed in terms of sociocultural factors that may influence the coping styles of black men and women in different communities and environments.

Adaptation, Psychological↗

PubMed2003

Assessing the reliability and validity of the John Henry Active Coping Scale in an urban sample of African Americans and white Americans.

OBJECTIVES: The primary focus of this study was to examine the psychometric properties of the John Henry Active Coping scale (JHAC12) among an urban middle-aged sample of African Americans and white Americans. DESIGN: The sample consisted of 75 African Americans and 129 white Americans from South Florida ranging in age from 25 to 54 years. Subjects completed the JHAC12, the Life Orientation Test (LOT), Coping Orientation to Problems Encountered (COPE) subscales, and the Marlowe-Crowne Social Desirability scale. RESULTS: Major findings supported the validity and reliability of the JHAC12 among both African Americans and white Americans. For both the African American and white American subsamples, the JHAC12 was correlated with the active coping and suppression of competing activities subscales of the COPE and negatively correlated with the Marlowe-Crowne Social Desirability scale. In the African American subsample the JHAC12 was positively correlated with the LOT. The JHAC12 was also negatively associated with the behavioral disengagement subscale of the COPE among white Americans. Multiple regression analyses revealed that the proportion of variance in the JHAC12 explained by the various subscales of the COPE, Marlowe-Crowne, and the LOT was 43% for African Americans and 20% for white Americans. Factor analyses suggested two similar and meaningful factors among the African American and white American subsamples. Finally, Cronbach alpha reliabilities revealed similar subsample coefficients. DISCUSSION: The implications of the findings are discussed in terms of the JHAC12's ability to assess the construct of active coping among African Americans and white Americans.

Adaptation, Psychological↗

PubMed2002

Hemodynamic response patterns: responder type differences in reactivity and recovery.

We examined whether responder type groups reflecting patterns of hemodynamic reactivity might also differ in recovery responses. Cardiac output (CO), total peripheral resistance (TPR), systolic and diastolic blood pressure, heart rate, and Heather index were assessed at rest and during speech and cold pressor tasks in young adults. Participants (n = 152) were classified as myocardial, vascular, or mixed-mild responders based on CO and TPR responses to speech presentation. Vascular responders exhibited slower CO and TPR speech recovery than the myocardial and/or mixed-mild groups. Responder type differences in reactivity showed limited task-generalizability. The sustained vascular response pattern of the vascular group is consistent with that seen in hypertension. In light of associations of heightened TPR with markers of disease risk, this suggests potentially negative health implications for vascular responders.

Adolescent↗

PubMedDate not supplied

Applying latent growth curve modeling to the investigation of individual differences in cardiovascular recovery from stress.

OBJECTIVE: This paper provides an introduction to latent growth curve (LGC) modeling, a modern method for analyzing data resulting from change processes such as cardiovascular recovery from stress. LGC models are superior to traditional approaches such as repeated measures analysis of variance and simple change scores. METHODS: The basic principles of LGC modeling are introduced and applied to data from 167 men and women whose systolic blood pressure was assessed before, during, and after the cold pressor and evaluated speech stressors and who had completed the Cook-Medley Hostility Inventory. RESULTS: The LGC models revealed that systolic blood pressure recovery follows a different nonlinear trajectory after speech relative to the cold pressor. The difference resulted not from the initial decline at the completion of the stressor, but from higher levels at the end of the stressor and slower rate of change in decline for the speech. Hostility predicted the trajectory for speech but not for cold pressor. This relationship did not differ as a function of gender, although men had larger systolic blood pressure responses than women to both stressors. CONCLUSIONS: LGC modeling yields an understanding of the processes and predictors of change that is not attainable through traditional statistical methods. Although our application concerns cardiovascular recovery from stress, LGC modeling has many other potential applications in psychosomatic research.

Adult↗

PubMedDate not supplied

Psychosocial treatment within sex by ethnicity subgroups in the Enhancing Recovery in Coronary Heart Disease clinical trial.

OBJECTIVE: Intervening in depression and/or low perceived social support within 28 days after myocardial infarction (MI) in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial did not increase event-free survival. The purpose of the present investigation was to conduct post hoc analyses on sex and ethnic minority subgroups to assess whether any treatment subgroup is at reduced or increased risk of greater morbidity/mortality. METHODS: The 2481 patients with MI (973 white men, 424 minority men, 674 white women, 410 minority women) who had major or minor depression and/or low perceived social support were randomly allocated to usual medical care or cognitive behavior therapy. Total mortality or recurrent nonfatal MI (ENRICHD primary endpoint) and cardiac mortality or recurrent nonfatal MI (secondary endpoint) were analyzed as composite endpoints by group for time to first event using Cox proportional hazards regression. RESULTS: There was a trend in the direction of treatment efficacy for white men for the primary endpoint (hazard ratio [HR], 0.80; 95% confidence interval, 0.61-1.05; p =.10) and a significant (p <.006, Bonferroni corrected) effect for the secondary endpoint (HR, 0.63; 95% CI, 0.46-0.87; p =.004). In contrast, the HRs for each of the other three subgroups were nonsignificant. The magnitude of differences in treatment effects between white men and the other subgroups remained significant for the secondary endpoint (p =.04) after adjustment for age, education, living alone, antidepressant use, comorbidity score, cardiac catheterization, ejection fraction, history of hypertension, and major depression. CONCLUSIONS: White men, but not other subgroups, may have benefited from the ENRICHD intervention, suggesting that future studies need to attend to issues of treatment design and delivery that may have prevented benefit among sex and ethnic subgroups other than white men.

Cognitive Behavioral Therapy↗

PubMedDate not supplied

Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study.

OBJECTIVE: The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which patients with depression and/or low perceived social support after an acute myocardial infarction were randomly assigned to an intervention consisting of cognitive behavior therapy and, in some cases, sertraline, or to usual care. There was no difference in survival between the groups. A possible reason why the intervention failed to affect survival is that too many patients with mild, transient depression were enrolled. Another is that some patients died too soon to complete the intervention. This analysis evaluates whether there was a difference in late (ie, > or =6 months after the myocardial infarction) mortality among initially depressed patients who had a Beck Depression Inventory score > or =10 and a past history of major depression, and who completed the 6-month post-treatment assessment. It also examines the relationship between change in depression and late mortality. METHODS: Out of the 1,165 (47%) of the Enhancing Recovery in Coronary Heart Disease study participants who met our criteria, 57 died in the first 6 months, and 858 (409 usual care, 449 intervention) completed the 6-month assessment. Cox regression was used to analyze survival. RESULTS: The intervention did not affect late mortality. However, intervention patients whose depression did not improve were at higher risk for late mortality than were patients who responded to treatment. CONCLUSIONS: Patients whose depression is refractory to cognitive behavior therapy and sertraline, two standard treatments for depression, are at high risk for late mortality after myocardial infarction.

Cognitive Behavioral Therapy↗