Cardiac sarcoidosis resembling panic disorder: a case report.

BACKGROUND: Sarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. It has been reported that patients with sarcoidosis are more likely to develop panic disorder than members of the general population. However, there are many unknown factors concerning the causal relationship between these conditions. CASE PRESENTATION: We present the case of a 57-year-old woman who appeared to have panic disorder, as she experienced repeated panic attacks induced by transient complete atrioventricular block, associated with cardiac sarcoidosis. Psychotherapy and pharmacotherapy were not effective in the treatment of her panic attacks. However, when we implanted a permanent pacemaker and initiated steroid treatment for cardiac sarcoidosis, panic attacks were ameliorated. Based on these findings, we diagnosed the patient's symptoms as an anxiety disorder associated with cardiac sarcoidosis, rather than panic disorder. CONCLUSIONS: This report highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of panic disorder. This cardiac disease should be considered especially in patients have a history of cardiac disease (e.g., arrhythmia) and atypical presentations of panic symptoms. Panic disorder is a psychiatric condition that is typically diagnosed after other medical conditions have been excluded. Because the diagnosis of sarcoidosis is difficult in some patients, caution is required. The palpitations and symptoms of heart failure associated with cardiac sarcoidosis can be misdiagnosed as psychiatric symptoms of panic disorder. The condition described in the current case study appears to constitute a physical disease, the diagnosis of which requires significant consideration and caution.

Psychological impact of electrocardiogram screening in National Collegiate Athletic Association athletes.

PURPOSE: Determine the psychological impact of false-positive ECG screening in National Collegiate Athletic Association (NCAA) athletes. METHODS: Athletes representing seven NCAA institutions received a standardised history, physical examination and ECG interpreted using the 2013 Seattle Criteria. Assessments of health attitudes, anxiety and impact of screening on sport were conducted using validated prescreen and postscreen measurements. RESULTS: 1192 student-athletes participated (55.4% male, median age 19 years, 80.4% Caucasian). 96.8% of athletes had a normal cardiovascular screen, 2.9% had a false-positive ECG and 0.3% were diagnosed with a serious cardiac condition. Prior to screening, 4.5% worried about potentially harbouring cardiac disease and 70.1% preferred knowing about an underlying condition, rather than play sports without this knowledge. There was no difference in anxiety described by athletes with a normal versus false-positive screen (p=0.369). Reported anxiety levels during screening also did not differ when analysed by different gender, race, division of play or sport. Athletes with normal and false-positive screens had similar levels of satisfaction (p=0.714) and would recommend ECG screening to other athletes at similar rates (p=0.322). Compared with athletes with a normal screen, athletes with false-positive results also reported feeling safer during competition (p>0.01). In contrast, athletes with false-positive screens were more concerned about the possibility of sports disqualification (p<0.001) and the potential for developing a future cardiac condition (p<0.001). CONCLUSIONS: Athletes with a false-positive ECG do not experience more anxiety than athletes with a normal screen but do express increased concern regarding sports disqualification and the development of a cardiac disorder. These findings do not justify avoiding advanced cardiovascular screening protocols. Further understanding of athlete experiences could better prepare the practising physician to counsel athletes with an abnormal ECG.

Results of voluntary cardiovascular examination of elite athletes in Denmark: Proposal for Nordic collaboration.

We investigated the cardiovascular status of elite athletes in Denmark, the extent of abnormal cardiac findings--both training related and pathologic--and how participating in cardiac examination was perceived by the athletes. A standardized protocol of questionnaires, physical examination, resting electrocardiogram, and 2D echocardiography was used. In total 1347 elite athletes were invited; 516 athletes (38%) from 30 different sports participated. Results were stored in a web-based database for future research and long-term follow-up. Cardiac pathology was infrequent; eight athletes (1.6%) received a cardiac diagnosis; one athlete (0.2%) diagnosed with long QT syndrome was advised against competition level sports. In total, 60 athletes (11.6%) were referred for additional testing. The athletes presented a very low level of psychological stress before and a slight decrease immediately after the examination as measured by the REST-Q 76 Sport questionnaire. Athletes needing further examinations did not present a higher level of stress after the initial examination compared with athletes with normal test results. Overall, very few athletes were diagnosed with a cardiac condition that increased risk of sudden cardiac death. Less than half of the invited athletes volunteered, but participation was not perceived stressful by the enrolled athletes, not even when additional testing was needed.

Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes: a new model.

IMPORTANCE: Sudden cardiac death (SCD) in sports is a tragic event. Pre-participation cardiovascular screening is required before participation in high school and college athletic programs and is universally endorsed by major medical societies. The medical impact of a diagnosis may be life-saving; however, the detection of disease should not be the sole endpoint of care. Physicians have an obligation to attend to both the medical and psychological well-being of their patients. OBJECTIVE: To determine the psychological impact of being diagnosed with cardiac disease in young competitive athletes. DESIGN: Athletes diagnosed with cardiac conditions were recruited to participate in a semi-structured interview, which was analyzed by sport psychology experts using qualitative research. Individuals shared reactions and experiences regarding diagnosis, lifestyle implications, coping strategies, major concerns, and overall impact on psychosocial functioning. SETTING: Young competitive athletes from across the United States. PARTICIPANTS: 25 athletes (52% male, 80% Caucasian, median age 17.7) participated. Diagnoses included: 5 hypertrophic cardiomyopathy, 8 Wolff Parkinson White, 4 long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia, and 3 other. MAIN OUTCOME MEASURES: Interviews were analyzed using consensual qualitative research (CQR) to identify domains, categories, and core ideas. RESULTS: Athletes progressed through 4 stages of psychological impact including: 1) immediate reactions and challenge to athlete identity, 2) grief/coping, 3) adaptation, and 4) acceptance. Risk factors for increased psychological morbidity included: higher level of competition, permanent disqualification from sports, persistent reminders (e.g. daily medication, monitoring heart rate during activity), and unanticipated outcomes (e.g. failed procedures). Those undergoing simple corrective procedures came to terms with their diagnosis quickly with little impact on daily life. Few athletes described emotional support mechanisms provided by medical programs. Diagnosis often led to new goals such as mentoring or coaching. All athletes diagnosed through advanced cardiovascular screening stated they would repeat the process. CONCLUSIONS AND RELEVANCE: Athletes diagnosed with cardiac disease represent an emotionally vulnerable population and experience 4 stages of psychological adjustment not previously described. This proposed model of psychological impact should be used to develop improved support mechanisms, awareness, and education to assist athletes diagnosed with serious or potentially lethal cardiac disease.

The Psychological Impact of Cardiovascular Screening in Young Athletes: Perspectives Across Age, Race, and Gender.

OBJECTIVE: To determine the psychological impact of electrocardiogram (ECG) screening in young competitive athletes based on age, race, and gender. DESIGN: Prospective multisite cross-sectional investigation. SETTING: Young competitive athletes. PATIENTS: One thousand five hundred six high school athletes (59.3% male with a mean age of 15.5 years, 56.2% white, 24.5% African American). INDEPENDENT VARIABLES: Athletes underwent screening with a standardized American Heart Association-based history, physical examination, and ECG. MAIN OUTCOME MEASURES: Prescreen and postscreen validated assessments for health attitudes, anxiety, and impact of screening on sport. RESULTS: Of the athletes participated, 76.3% had normal screens, 22.7% false-positive (FP) results (12.9% history, 4.2% examination, 3.1% ECG), and 0.9% were diagnosed with serious cardiac disorders. There were no differences in anxiety levels among athletes screening normal versus FP (P = 0.69). There was no difference in anxiety based on the reason for a FP result (history, physical examination, or ECG) both during (P = 0.95) and after (P = 0.40) screening. Analysis by age, race, and gender demonstrated that before screening, females were more likely to prefer knowing about underlying cardiac conditions compared with males (P < 0.001), and males were less concerned about having cardiac disease (P < 0.001) compared with females. African Americans were less concerned about underlying disease (P < 0.001) and less interested (P < 0.001) in cardiac screening compared with whites. Athletes diagnosed with a cardiac disease described anxiety after screening, but still believe that all athletes should receive an ECG before competition. CONCLUSIONS: Electrocardiogram screening does not cause excessive anxiety in US high school athletes across spectrums of age, race, and gender. Recognition of age, race, and gender-specific perspectives could improve physician-patient dialogue and support mechanisms for those diagnosed with potentially lethal cardiac disorders. CLINICAL RELEVANCE: This article provides evidence that undue anxiety should not be used as an argument against the implementation of ECG screening during the preparticipation examinaton for young athletes. Although males and African Americans seem to be at highest risk for sudden cardiac death during exercise, they actually report being the least concerned and least worried about potentially harboring an underlying condition that might predispose them to such an event. Emotional support should readily be available for athletes who are diagnosed with cardiovascular conditions as these individuals report emotional distress after their diagnosis.

The psychological impact of cardiovascular screening: the athlete's perspective.

BACKGROUND: Published guidelines suggest that ECG screening in US athletes may cause excessive anxiety, especially in those with false-positive findings. However, this has never been formally evaluated. METHODS AND STUDY DESIGN: Prospective, non-randomised controlled trial. High school athletes received a standardised history and physical examination (control) or a history and physical examination with an ECG (experimental). Prescreen and postscreen assessments for health attitudes, anxiety and impact of screening on sport were conducted. RESULTS: 952 athletes (49.7% girls, mean age 15.5 years) participated (control=150; experimental=802). 4.4% worried about having an underlying cardiac condition, and 73% wanted to learn if they had a cardiac abnormality prior to competition. In the experimental group, 576 had normal screens, 220 had an abnormal screen (by history 15.8%, physical examination 6.2% or ECG 1.7%) but normal work up (false-positive) and 6 were identified with a serious cardiac condition (true-positive, 0.75%). Compared with the control group, those who received an ECG were more likely to: (1) be significantly more satisfied with their screening (p<0.001), (2) feel safer during competition (p<0.01), (3) support that all athletes should receive cardiac screening (p<0.001) and (4) state the ECG positively impacted their training (p<0.001). False-positive athletes did not report anxiety during or after screening. Distress levels did not differ based on reason for needing further evaluation (history, physical examination or ECG, p=0.311). Compared with control participants, individuals with false-positive results: (1) reported no difference in postscreen anxiety (p=0.775), (2) felt safer during competition (p<0.001), (3) would recommend ECG screening to others (p<0.001) and (4) expressed a positive impact on training (p<0.001). CONCLUSIONS: Excessive anxiety should not be used as a reason to forego ECG screening in athletes.

Separation anxiety disorder in children: disorder-specific responses to experimental separation from the mother.

BACKGROUND: Separation anxiety disorder (SAD) is one of the most common anxiety disorders in childhood and is predictive of adult anxiety disorders, especially panic disorder. However, the disorder has seldom been studied and the attempt to distinguish SAD from other anxiety disorders with regard to psychophysiology has not been made. We expected exaggerated anxiety as well as sympathetic and respiratory reactivity in SAD during separation from the mother. METHOD: Participants were 49 children with a principal diagnosis of SAD, 21 clinical controls (CC) with a principal diagnosis of anxiety disorder other than SAD, and 39 healthy controls (HC) not meeting criteria for any current diagnosis. Analyses of covariance controlling for age were used to assess sympathetic and parasympathetic activation (preejection period and respiratory sinus arrhythmia) as well as cardiovascular (heart rate, mean arterial pressure, total peripheral resistance), respiratory (total breath time, minute ventilation, tidal volume, end-tidal CO(2) , respiratory variability), electrodermal, and self-report (anxiety, cognitions, symptoms) variables during baseline, 4-min separation from, and reunion with the mother. RESULTS: Children with a diagnosis of SAD were characterized by elevated self-reported anxiety responses to separation and increased sympathetic reactivity compared with CC and HC groups. The SAD group also displayed greater vagal withdrawal and higher reactivity in multiple cardiovascular, respiratory, and electrodermal measures compared with the HC group, while corresponding responses were less in the CC group and not significantly different from the other groups. CONCLUSIONS: Separation from the mother elicits greater autonomic, respiratory, and experiential responses in children with SAD. Our findings based on brief experimental separation demonstrate differential subjective and physiological manifestations of specific anxiety diagnoses, thus supporting the validity of the diagnostic category of SAD.

Pharmacotherapeutic determinants for QTc interval prolongation in Japanese patients with mood disorder.

An increased incidence of sudden death has been observed among patients treated with antidepressants. A prolonged QTc interval is a known prognostic factor for fatal arrhythmia, and several studies have shown that the use of antidepressants can cause a prolonged QTc interval. However, few studies, especially in Japan, have compared the effects of multiple drugs on QTc interval or examined dose relationships in a clinical setting.We compared the effects of antidepressants on QT interval, corrected to QTc by Bazett's formula, in 729 Japanese patients who were diagnosed with mood disorder.Using stepwise multiple linear regression analysis, we found that the use of tricyclic antidepressants (P<0.01) and concomitant use of antipsychotics (P<0.05), as well as advanced age and being female (known factors for prolonged QTc interval; both P<0.01), significantly prolonged the QTc interval. Analysis of individual antidepressants also revealed that the use of clomipramine (P<0.01) and amitriptyline (P<0.05) significantly prolonged the QTc interval.Our results reveal that tricyclic antidepressants, especially clomipramine and amitriptyline, confer a risk of prolonged QTc interval in a dose-dependent manner. The selective serotonin reuptake inhibitors investigated (fluvoxamine, paroxetine, sertraline) were not indicated as risk factors for QTc prolongation.

Heart rate variability spectral analysis in patients with panic disorder compared with healthy controls.

OBJECTIVES: The aim of our study is to measure very low frequency band (VLF), low frequency band (LF) and high frequency band (HF) components of R-R interval during orthostatic test in patients with panic disorder and a comparison with healthy controls. METHODS: We measured HRV in 31 patients with panic disorder and 20 healthy controls. Diagnosis was done according to the ICD-10 research diagnostic criteria confirmed with MINI (MINI international neuropsychiatric interview). Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions. Intensity of symptoms was assessed using psychiatric scales. RESULTS: There were highly statistically significant differences between panic patients and control group in all components of power spectral analysis in 2nd and 3rd VLF components and in HF components of 2nd. We have found highly statistically significant negative correlations between level of dissociation measured by DES and some parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder and dosage of antidepressants. CONCLUSION: These findings demonstrate a lower parasympathetic activity and higher sympathetic/parasympathetic ratio in panic disorder patients measured during the changes of postural position in comparison with healthy controls. Autonomic dysregulation is associated with panic disorder and has the relation with the level of dissociation, the age of patiens and age of onset of disorder.

Electrocardiographic anxiety profiles improve speech anxiety.

The present study was to set out in efforts to determine the effect of electrocardiographic (ECG) feedback on the performance in speech anxiety. Forty-six high school students participated in a speech performance educational program. They were randomly divided into two groups, an experimental group with ECG feedback (N = 21) and a control group (N = 25). Feedback was given with video recording in the control, whereas in the experimental group, an additional ECG feedback was provided. Speech performance was evaluated by the Korean Broadcasting System (KBS) speech ability test, which determines the 10 different speaking categories. ECG was recorded during rest and speech, together with a video recording of the speech performance. Changes in R-R intervals were used to reflect anxiety profiles. Three trials were performed for 3-week program. Results showed that the subjects with ECG feedback revealed a significant improvement in speech performance and anxiety states, which compared to those in the control group. These findings suggest that visualization of the anxiety profile feedback with ECG can be a better cognitive therapeutic strategy in speech anxiety.

Maternal satisfaction and acceptability of foetal electrocardiographic (STAN®) monitoring system.

OBJECTIVE: To assess the acceptability of the foetal electrocardiographic (STAN®) monitoring system by patients at a London Hospital, before its introduction into routine clinical care. METHOD: This was a prospective questionnaire-based study of patients who were monitored in labour by foetal electrocardiographic (STAN®) monitoring system. RESULTS: Ninety-three percent (CI 85, 98) of the patients felt that the midwife(s) responsible for their intrapartum care took time to explain why their babies were being monitored continuously in the first instance. Ninety-nine percent (CI 93, 99.9) of patients felt that the obstetricians explained why they were being monitored continuously in labour. After delivering and having been monitored with STAN® 95% (CI 87, 99) of women felt that it was an acceptable way of monitoring their babies in labour. CONCLUSION: In resource-limited organisation, such as the NHS, holistic approach to intrapartum care may sometimes feel difficult to achieve. However, with emphasis on women centred care and information sharing women are able to understand and comment on intrapartum monitoring systems.

Usefulness of heart rate variability indices in assessing the risk of an unsuccessful return to work after sick leave in depressed patients.

AIM: The present study aimed to examine whether heart rate variability (HRV) indices in depressed patients measured at return to work after sick leave are related to the outcome of reinstatement. METHODS: This study included 30 workers who took a leave of absence due to major depressive disorder. HRV was measured twice, once when participants left work and another when they returned to work. One month after returning to work, 19 participants continued their original work (successful return group), while 11 failed to perform their original work (unsuccessful return group). HRV indices including high- and low-frequency components (HF and LF) were calculated in three conditions within a session lasting for about 5 minutes, initial rest (Rest), mental task (Task), and rest after task (After), and were compared between the two participant groups. Psychological states were evaluated using Self-rating Depression Scale and State-Trait Anxiety Inventory. RESULTS: No significant differences were observed in the HRV indices on leaving work between groups. On returning to work, the "unsuccessful return group" exhibited lower HF Rest score, higher HF Task/Rest ratio, and higher LF/HF Rest score than the "successful return group." Psychological scores improved in both groups. CONCLUSION: These results indicate that autonomic dysregulations revealed by HRV measurement at return to work after a leave of absence in MDD patients were related to the outcome of reinstatement and can serve as useful information for the assessment of the risk of unsuccessful return.

A qualitative study of a sample of women participating in an Australian randomised controlled trial of intrapartum fetal surveillance.

BACKGROUND: The STan Australian Randomised controlled Trial (START), the first of its kind in Australia, compares two techniques of intrapartum fetal surveillance (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram (STan+CTG) with CTG alone) with the aim of reducing unnecessary obstetric intervention. It is also the first comprehensive intrapartum fetal surveillance (IFS) trial worldwide, including qualitative examination of psychosocial outcomes and cost-effectiveness. In evaluating and implementing healthcare interventions, the perspectives and experiences of individuals directly receiving them is an integral part of a comprehensive assessment. Furthermore, the added value of using qualitative research alongside randomised controlled trials (RCTs) is becoming widely acknowledged. OBJECTIVE: This study aimed to examine women's experiences with the type of IFS they received in the START trial. METHODS: Using a qualitative research design, a sample of thirty-two women were interviewed about their experiences with the fetal monitoring they received. Data were analysed using thematic analysis. FINDINGS: Six themes emerged from analysis: reassurance, mobility, discomfort, perception of the fetal Scalp Electrode (FSE), and overall positive experience. CONCLUSION: Interestingly, it was found that women who had an FSE in the CTG alone arm of the trial reported very similar experiences to women in the STan+CTG arm of the trial. Despite STan and CTG differing clinically, from women's perspectives, the primary difference between the two techniques was the utilisation (or not) of the FSE. Women were very accepting of STan+CTG as it was perceived and experienced as a more accurate form of monitoring than CTG alone. Findings from this study have significant implications for health professionals including midwives and obstetricians and implications for standard practice and care. The study has demonstrated the importance and significance of incorporating qualitative enquiry within RCTs.

Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms.

Slow deep breathing (SDB) is commonly employed in the management of pain, but the underlying mechanisms remain equivocal. This study sought to investigate effects of instructed breathing patterns on experimental heat pain and to explore possible mechanisms of action. In a within-subject experimental design, healthy volunteers (n = 48) performed 4 breathing patterns: 1) unpaced breathing, 2) paced breathing (PB) at the participant's spontaneous breathing frequency, 3) SDB at 6 breaths per minute with a high inspiration/expiration ratio (SDB-H), and 4) SDB at 6 breaths per minute with a low inspiration/expiration ratio (SDB-L). During presentation of each breathing pattern, participants received painful heat stimuli of 3 different temperatures and rated each stimulus on pain intensity. Respiration, heart rate, and blood pressure were recorded. Compared to unpaced breathing, participants reported less intense pain during each of the 3 instructed breathing patterns. Among the instructed breathing patterns, pain did not differ between PB and SDB-H, and SDB-L attenuated pain more than the PB and SDB-H patterns. The latter effect was paralleled by greater blood pressure variability and baroreflex effectiveness index during SDB-L. Cardiovascular changes did not mediate the observed effects of breathing patterns on pain. PERSPECTIVES: SDB is more efficacious to attenuate pain when breathing is paced at a slow rhythm with an expiration that is long relative to inspiration, but the underlying mechanisms remain to be elucidated.

An Easy and Reliable Way to Prevent Electrocardiographic Deteriorations of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: Preoperative Anxiolytic Treatment.

OBJECTIVE: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. METHODS: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. RESULTS: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). CONCLUSION: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.

Power, distress, and compassion: turning a blind eye to the suffering of others.

Responses to individuals who suffer are a foundation of cooperative communities. On the basis of the approach/inhibition theory of power (Keltner, Gruenfeld, & Anderson, 2003), we hypothesized that elevated social power is associated with diminished reciprocal emotional responses to another person's suffering (feeling distress at another person's distress) and with diminished complementary emotion (e.g., compassion). In face-to-face conversations, participants disclosed experiences that had caused them suffering. As predicted, participants with a higher sense of power experienced less distress and less compassion and exhibited greater autonomic emotion regulation when confronted with another participant's suffering. Additional analyses revealed that these findings could not be attributed to power-related differences in baseline emotion or decoding accuracy, but were likely shaped by power-related differences in the motivation to affiliate. Implications for theorizing about power and the social functions of emotions are discussed.

Culture and the socialization of child cardiovascular regulation at school entry in the US.

The measurement of cardiovascular functioning targets an important bridge between social conditions and differential well-being. Nevertheless, the biocultural, psychosocial processes that link human ecology to cardiovascular function in children remain inadequately characterized. Childrearing practices shaped by parents' cultural beliefs should moderate children's affective responses to daily experience, and hence their psychophysiology. The present study concerns interactions among family ecology, the normative social challenge of entry into kindergarten, and parasympathetic (vagal) cardiac regulation in US middle-class children (N = 30). Although parents believed children must be protected from overscheduling to reduce stress and improve socio-emotional adaptation, maternal rather than child schedules predicted parasympathetic regulation during a nonthreatening social engagement task following school entry. Children of busier married mothers, but less busy single mothers, showed the context-appropriate pattern of parasympathetic regulation, low respiratory sinus arrhythmia (RSA). These findings are expected if: maternal and family functioning, rather than the scheduling of the child's daily life, principally drive young children's cardiovascular responsiveness to a normative challenge; and busy schedules represent high family functioning with married mothers, but not under single-parent conditions wherein adult staffing is uniquely constrained. Family ecology is shaped by culture, and in turn shapes the development of children's cardiovascular responses. Appropriately fine-grained analysis of daily experience can illustrate how culturally driven parenting practices may have unintended consequences for child biological outcomes that vary by family structure.

Prevalence of late potentials on signal-averaged ECG in patients with psychiatric disorders.

BACKGROUND: Sudden cardiac death (SCD) occurs three times more often in psychiatric patients than in the general population. QRS fragmentation (QRSfr) and signal-averaged electrocardiography (SAECG) are simple, inexpensive, readily available tools for detecting the presence of abnormal depolarization and late potentials (LPs) in these patients, a result of either the underlying disease or treatment. METHODS: Frequency of LP detection by SAECG and QRSfr was studied in 52 psychiatric patients and compared with 30 healthy (without known structural heart disease or occurrence of ventricular arrhythmia) controls. Patients were then prospectively followed up and incidence of SCD was recorded. RESULTS: LP prevalence was significantly higher in patients than in controls (16/52-31% vs 2/30-7%, p=0.012), while QRSfr was similar between these two groups (p=0.09). Of the LP presence criteria, the root mean square value at terminal 40msec of the QRS (RMS40) was significantly lower in patients (32µV, SD=19µV, vs 46µV, SD=32µV, p=0.015). Among patients, no differences were noted between the LP positive and negative groups regarding age, sex, number of medications, class of antipsychotics and defined daily doses. Mean follow-up was 46months (SD=11) and during it 3 patients suffered SCD. Although 2 SCD victims had both LPs and QRSfr concurrently present, neither of them, nor their simultaneous presence could definitely account for the events. CONCLUSIONS: LP prevalence in psychiatric patients was significantly higher than in controls. SAECG performance was feasible in all cases and constitutes a readily available tool for assessing myocardial electrophysiological alterations in this patient group.

Effects of mental workload on physiological and subjective responses during traffic density monitoring: A field study.

This study evaluated operators' mental workload while monitoring traffic density in a city traffic control center. To determine the mental workload, physiological signals (ECG, EMG) were recorded and the NASA-Task Load Index (TLX) was administered for 16 operators. The results showed that the operators experienced a larger mental workload during high traffic density than during low traffic density. The traffic control center stressors caused changes in heart rate variability features and EMG amplitude, although the average workload score was significantly higher in HTD conditions than in LTD conditions. The findings indicated that increasing traffic congestion had a significant effect on HR, RMSSD, SDNN, LF/HF ratio, and EMG amplitude. The results suggested that when operators' workload increases, their mental fatigue and stress level increase and their mental health deteriorate. Therefore, it maybe necessary to implement an ergonomic program to manage mental health. Furthermore, by evaluating mental workload, the traffic control center director can organize the center's traffic congestion operators to sustain the appropriate mental workload and improve traffic control management.

[The role of timing factors for the effect of caffeine on heart rhythm variability in healthy humans].

Caffeine upon single administration optimizes the indices of heart rhythm variability in young humans and enhances parasympathotonia. The expression of this reaction depends on the daytime (being more pronounced in the morning than in the evening) and on the chronotype (morningness) of volunteers.