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  • 1.
    Díaz, Miguel
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Manchester Metropolitan University, UK.
    Avila, A
    Manchester Metropolitan University, UK / KU Leuven, Belgium.
    Degens, H
    Manchester Metropolitan University, UK / Lithuanian Sports University, Lithuania.
    Coeckelberghs, E
    KU Leuven, Belgium.
    Vanhees, L
    KU Leuven, Belgium.
    Cornelissen, V
    KU Leuven, Belgium.
    Azzawi, M
    Manchester Metropolitan University, UK.
    Acute resveratrol supplementation in coronary artery disease: towards patient stratification2019In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, p. 1-20Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Resveratrol (RV) is a polyphenol with antioxidant, anti-inflammatory and cardio-protective properties. Our objective was to investigate whether acute supplementation with high doses of RV would improve flow-mediated dilation (FMD) and oxygen consumption (VO2) kinetics in older coronary artery disease (CAD) patients.

    DESIGN: We employed a placebo-controlled, single-blind, crossover design in which ten participants (aged 66.6 ± 7.8 years) received either RV or placebo (330 mg, 3x day-1) during three consecutive days plus additional 330 mg in the morning of the fourth day with a seven-day wash-out period in-between. On the fourth day, FMD of the brachial artery and VO2 on-kinetics were determined. Results; RV improved FMD in patients who had undergone coronary artery bypass grafting (CABG; -1.4 vs. 5.0%; p = 0.004), but not in those who had undergone percutaneous coronary intervention (PCI; 4.2 vs. -0.2%; NS).

    CONCLUSION: Acute high dose supplementation with RV improved FMD in patients after CABG surgery but impaired FMD in patients who underwent PCI. The revascularization method-related differential effects of RV may be due to its direct effects on endothelial-dependent dilator responses. Our findings have important implications for personalized treatment and stratification of older CAD patients.

  • 2.
    Gudmundsson, Kristjan
    et al.
    Karolinska Institutet.
    Lynga, P
    Karolinska Institutet.
    Langius-Eklof, A
    Karolinska Institutet.
    Hagglund, E
    Karolinska Institutet; Karolinska University Hospital.
    Hägg Martinell, Ann
    Karolinska Institutet.
    Persson, H
    Karolinska Institutet.
    Hagerman, I
    Karolinska Institutet; Karolinska University Hospital.
    Braunschweig, F
    Karolinska Institutet.
    Daily body weight in patients with chronic heart failure: improved diagnostic value by analysing prolonged time intervals2019Conference paper (Refereed)
  • 3.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Elfstrom, Magnus L.
    Mälardalen University, Academy of Health, Care and Social Welfare, Eskilstuna/Västerås.
    Persson, Hans
    Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured2015In: Cardiology Research, ISSN 1923-2829, E-ISSN 1923-2837, Vol. 6, no 2, p. 239-248Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

    Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

    Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

    Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

  • 4.
    Nahlen Bose, Catarina
    et al.
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet / Sophiahemmet University.
    Elfström, Magnus L.
    Academy of Health, Care and Social Welfare, Mälardalen University.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.
    Persson, Hans
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.
    Saboonchi, Fredrik
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 704-713Article in journal (Refereed)
    Abstract [en]

    Introduction: Emotional distress in patients with chronic heart failure (CHF) predicts mortality, hospital readmission and quality of life. The patient's avoidant coping style and beliefs about the disease have been linked to emotional distress in CHF. However, the pattern and transmitting effects of these variables are indefinite.

    Aim: This study aimed to examine the links between and the potential mediating role of illness perceptions and avoidant coping style on depression and anxiety in patients with CHF.

    Method: Self-assessment data from 103 patients with CHF were subjected to path analysis in two hypothesised models. The outcome measures were coping styles, illness perception, anxiety and depression.

    Results: Avoidant coping had a direct adverse effect on anxiety and depression. The perception of symptom burden and personal control, significantly mediated the effect between avoidant coping and anxiety and depression.

    Conclusions: Avoidant coping style appears to influence not only emotional distress, but also a malignant symptom perception and low sense of control over the illness.

  • 5.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Persson, Hans
    Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Ljunggren, Gunnar
    Public Healthcare Services Committee Administration, Stockholm County Counsil; Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Centre.
    Elfström, Magnus L.
    Mälardalen University, Academy of Health, Care and Social Welfare.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet; Department of Clinical Neuroscience, Division of Insurance Medicine, Administration.
    Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, p. 537-548Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).AIMS:To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

    METHODS: Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

    RESULTS: No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

    CONCLUSION: CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

  • 6.
    Nahlén, Catarina
    et al.
    Department of Cardiology Danderyd Hospital AB, S-182 88 Stockholm.
    Saboonchi, Fredrik
    Sophiahemmet University College, Stockholm.
    Coping, Sense of Coherence and the Dimensions of Affect in Patients with Chronic Heart Failure2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, ISSN 1474-5151, Vol. 9, no 2, p. 118-125Article in journal (Refereed)
    Abstract [en]

    Background: Living with chronic heart failure has an impact on several important dimensions of an individual's life. A patient's use of coping strategies may influence his or her health condition and emotional well-being.

    Aim: To investigate factors that may relate to the coping strategies used by individuals with chronic heart failure and how the coping strategies are associated with positive and negative affect.

    Methods: A cross-sectional research design was used. The participants provided demographic data and filled out three questionnaires: Sense of Coherence scale, Brief COPE and Positive Affect Negative Affect Schedule.

    Results: No differences in relation to coping strategies were found with regard to New York Heart Association class. Substance use was associated with gender and age. Sense of coherence was negatively associated with denial, behavioural disengagement, venting and self-blame, and positively associated with acceptance. It was found that avoidant coping positively and sense of coherence negatively, predicted negative affect. Problem focused coping positively predicted positive affect. Socially supported coping predicted both negative and positive affect.

    Conclusion: The present study found that the employment of different coping strategies and sense of coherence had an impact on affect and therefore also the emotional well-being among patients with chronic heart failure.

  • 7.
    Nymark, Carolin
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance medicine.
    Mattiasson, A-C
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society.
    Henriksson, P
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Kiessling, A
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Development and validation of an instrument to assess patients' appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction: The PA-AMI questionnaire.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 3, p. 240-248Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions.

    AIM: The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction.

    METHODS: An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items.

    RESULTS: The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity CONCLUSIONS: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.

  • 8.
    Wahlström, Maria
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Department of Cardiology, Danderyd Hospital; Sophiahemmet University.
    Rydell-Karlsson, Monica
    Karolinska Institutet, Department of Clinical Sciences, Department of Cardiology, Danderyd Hospital; Ersta Sköndal Bräcke University College.
    Medin, Jörgen
    The Swedish Red Cross University College, Department of Health Sciences. Sophiahemmet University.
    Perceptions and experiences of MediYoga among patients with paroxysmal atrial fibrillation: An interview study2018In: Complementary Therapies in Medicine, ISSN 0965-2299, E-ISSN 1873-6963, Vol. 41, p. 29-34Article in journal (Refereed)
    Abstract [en]

    Objectives

    We investigated the perceptions and experiences of a therapeutic yoga form, MediYoga, which is evolved from Kundaliniyoga among patients with symptomatic paroxysmal atrial fibrillation (PAF).

    Design and setting

    an inductive exploratory design was chosen with individual semi-structured interviews. The study was conducted with 12 participants (7 men and 5 women, average age 63.5) at a university hospital, Sweden. Informed consent was obtained from all participants. The data were analyzed using a qualitative content analysis with an inductive method and a manifest approach.

    Results

    Three categories were found in the analysis. In the category “A time for a sense of existence and presence”, the patients described an increased thoughtfulness and experiences of gaining access to an inner self. The category “A way of gaining well-being and increased consciousness” describes patients` feelings of relaxation and feeling of comfort, with components of mental and physical well-being. Furthermore, “Access to a tool to gain willpower and relieve symptoms” describes the perceptions from patients to obtained access to a tool for handling the emotions, such as fear and anxiety, as well as symptoms that they could struggling with between, and during, their episodes of atrial fibrillation. No adverse events were reported by the yoga group, during the study.

    Conclusions

    Patients with PAF described MediYoga as an accessible tool to manage emotions and symptoms related to episodes of AF. MediYoga may also assist in enhancing body awareness, whereby physical, mental and spiritual components are integrated. MediYoga may strengthen self-management among patients with PAF.

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