The impact of annuloplasty ring or band implantation on post-repair mitral valve haemodynamic performance.

OBJECTIVES: The clinical importance of optimal post-repair mitral valve diastolic performance is increasingly being recognized. The haemodynamic effect of a partial annuloplasty band implantation, in comparison to a full ring, remains insufficiently explored. METHODS: Patients undergoing mitral valve repair for pure degenerative disease between 2011 and 2019 at 2 experienced heart valve centres were eligible for inclusion. Exclusion criteria were concomitant procedures other than tricuspid valve repair and ablation procedures for atrial fibrillation. Pre-discharge and follow-up echocardiograms (1-4 years after surgery) were analysed to assess haemodynamic mitral valve performance. RESULTS: Of 535 patients meeting the inclusion criteria, 364 (68.0%) patients underwent full annuloplasty ring and 171 (31.0%) partial band implantation. On predischarge echocardiogram, post-repair mitral valve gradient and area did not differ between groups [2.89 mmHg (IQR 2.26-3.72) vs 2.60 mmHg (IQR 1.91-3.55), P = 0.19 and 1.98 cm2 (IQR 1.66-2.46) vs 2.03 cm2 (IQR 1.55-3.06), P = 0.15]. However, multivariable linear regression analysis demonstrated band annuloplasty as a determinant of larger valve area (coefficient 0.467 cm2, standard error 0.105, P < 0.001). On multivariable analysis, no significant impact on post-repair gradient was observed (-0.370 mmHg, standard error 0.167, P = 0.36). At follow-up, the differences between groups disappeared and multivariable regression analysis failed to demonstrate a significant impact of annuloplasty device type on mitral valve gradient (coefficient -0.095 mmHg, standard error 0.171, P = 1.00) or area (coefficient -0.085 cm2, standard error 0.120, P = 1.00). These results were confirmed with a linear mixed model analysis. CONCLUSIONS: Partial band annuloplasty was related to an improved haemodynamic profile directly after valve repair for degenerative disease but the effect was short-lived. Our results suggest that the type of annuloplasty device has no durable impact on diastolic valve performance.

The Role of Time Perspective and Mindfulness on Life Satisfaction in the United States of America, Spain, Poland and Japan: A Cross-Cultural Study.

We assessed the cross-cultural role of Time Perspective (TP) tendencies [Past Positive (PP), Past Negative (PN), Present Hedonistic (PH), Present Fatalistic (PF), and Future (F)], the Deviation from a Balanced Time Perspective (DBTP) profile, the Deviation from a Negative Time Perspective (DNTP) profile, and mindfulness on life satisfaction (LS). The sample consisted of psychology undergraduate students (N= 867, MAGE= 20.19, SD= 3.417) in four countries: USA, Spain, Poland and Japan. We used a 17-item short version of the Zimbardo Time Perspective Inventory (ZTPI), the Mindful Attention Awareness Scale (MAAS), and the Satisfaction with Life Scale (SWLS) in all countries. For ensuring measurement invariance, we conducted pairwise CFAs for the ZTPI-17, MAAS and SWLS. Regression analyses showed that PN predicted decreased LS in Poland and Japan. PP predicted increased LS in Spain. F predicted increased LS in Poland. DNTP predicted decreased LS in Poland. Mindfulness predicted decreased LS in Japan and increased LS in USA, Spain and Poland. Moreover, mediation analyses revealed that the DBTP partially mediated the relationship between mindfulness and LS in Spain and USA. The DNTP partially mediated the relationship between mindfulness and LS in Spain, Poland and Japan (opposite direction). The findings suggest that the association of TP, mindfulness and LS differs across the investigated countries as a function of culture.

Repair of mitral prolapse: comparison of thoracoscopic minimally invasive and conventional approaches.

OBJECTIVES: Surgical repair remains the best treatment for severe primary mitral regurgitation (MR). Minimally invasive mitral valve surgery is being increasingly performed, but there is a lack of solid evidence comparing thoracoscopic with conventional surgery. Our objective was to compare outcomes of both approaches for repair of leaflet prolapse. METHODS: All consecutive patients undergoing surgery for severe MR due to mitral prolapse from 2012 to 2020 were evaluated according to the approach used. Freedom from mortality, reoperation and recurrent severe MR were evaluated by Kaplan-Meier method. Differences in baseline characteristics were adjusted with propensity score-matched analysis (1:1, nearest neighbour). RESULTS: Three hundred patients met inclusion criteria and were divided into thoracoscopic (N = 188) and conventional (sternotomy; N = 112) groups. Unmatched patients in the thoracoscopic group were younger and had lower body mass index, New York Heart Association class and EuroSCORE II preoperatively. After matching, thoracoscopic group presented significantly shorter mechanical ventilation (9 vs 15 h), shorter intensive care unit stay (41 vs 65 h) and higher postoperative haemoglobin levels (11 vs 10.2 mg/dl) despite longer bypass and cross-clamp times (+30 and +17 min). There were no differences in mortality or MR grade at discharge between groups nor differences in survival, repair failures and reinterventions during follow-up. CONCLUSIONS: Minimally invasive mitral repair can be performed in the majority of patients with mitral prolapse, without compromising outcomes, repair rate or durability, while providing shorter mechanical ventilation and intensive care unit stay and less blood loss.

How mindfulness, self-compassion, and experiential avoidance are related to perceived stress in a sample of university students.

University students constitute a population that is highly vulnerable to developing mental health problems, such as distress. The role of different variables associated with the development of states of stress has been studied in order to identify potential risk and protective factors. This study explored whether mindfulness, self-compassion, and experiential avoidance, while controlling for specific sociodemographic and academic variables, were potential significant protective or risk factors explaining perceived stress in a sample of 589 Spanish university students (81.2% female, age range 18-48 years). A hierarchical multiple regression analysis was performed using an exploratory cross-sectional design. Higher experiential avoidance, lower self-compassion, lower mindfulness, not perceiving family support, higher total study hours per week, having a partner (vs. being single), being female (vs. being male), and being older were significantly associated with higher levels of perceived stress. In conclusion, perceived stress in our sample was positively associated with experiential avoidance, which could be regarded as a potential psychological risk variable. In contrast, perceived stress was negatively correlated with self-compassion and mindfulness, which, in turn, could be seen as protective factors. Accordingly, it is concluded that programmes aimed at reducing stress and at improving well-being among university students should include experiential avoidance, self-compassion, and mindfulness as therapeutic targets.

Forest bathing and hiking benefits for mental health during the COVID-19 pandemic in Mediterranean regions.

Forest bathing (FB) has evidenced positive effects on individuals' mental health and well-being, but its benefits have mainly been studied in Asian biomes. The present study aimed to evaluate whether its benefits are also generalisable to other forests and biomes of the world, such as the Mediterranean. Eighty-six healthy adults of the general population were assessed before and after a FB near Barcelona (Spain) during the COVID-19 pandemic. A control-hiking group of participants was also analysed to contrast the FB effects on anxiety, affect, mood states and mindfulness. Results show that the guided practice of FB in Mediterranean-Catalan forests increases mindfulness states and positive affect and reduces anxiety and negative affect, with effect sizes being large to very large. Hiking also induced significant changes in all variables tested, but FB showed higher effect sizes. An exploratory analysis also revealed a different profile of the FB participants compared to the hiking practitioners, being highly educated women living in urban areas and with lower basal levels of psychological well-being. Accordingly, it is concluded that both Mediterranean FB and hiking (to a lesser degree) might be cost-effective strategies to promote and restore psychological well-being after the COVID-19 pandemic and to promote sustainable tourism in Mediterranean biomes of the European forested and protected areas.

The Third Half: A Pilot Study Using Evidence-Based Psychological Strategies to Promote Well-Being among Doctoral Students.

Over the last few years, various studies have reported decreasing well-being levels among doctoral students, who show a higher risk of suffering from psychological distress than the general population. Accordingly, European policies in higher education encourage well-being promotion programs among doctoral studies to enhance young researchers' well-being. However, programs using evidence-based practices for well-being promotion are not yet generalised in public universities. The present study describes a pilot experience designed to evaluate the efficacy of a well-being program among doctoral candidates of a public European university, the Autonomous University of Barcelona. 25 doctoral students (67% women) participated in a pre-post study consisting of six sessions of 3 h each and structured by the big five criteria coming from evidence-based practices for well-being promotion: outdoor green spaces exposure, physical activity, gamification, mentoring, positive and coaching psychology techniques. Results showed how participants experienced significant increases in several indicators of emotional well-being and decreased psychological distress after the Third Half program. These positive pilot results encourage further research and future replications to assess the impact of this evidence-based psychological program among the academic community. Results also lead the way towards the creation of healthier academic workplaces by implementing cost-effective interventions that improve researchers' psychosocial support and their overall well-being.

Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention.

BACKGROUND: Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. METHODS: This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. RESULTS: The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. CONCLUSIONS: The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.

Social Inequities in the Impact of COVID-19 Lockdown Measures on the Mental Health of a Large Sample of the Colombian Population (PSY-COVID Study).

The identification of general population groups particularly vulnerable to the impact of COVID-19 lockdown measures on mental health and the development of healthcare policies are priority challenges in the current and future pandemics. This study aimed to identify the personal and social determinants of the impact of COVID-19 lockdown measures on mental health in a large sample of the Colombian population. In this cross-sectional study, an anonymous online survey was answered by 18,061 participants from the general population residing in Colombia during the first wave of the COVID-19 outbreak (from 20 May to 20 June 2020). The risk of depression, anxiety, and somatization disorders were measured using the Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and Somatic Symptom Questionnaire (SSQ-5), respectively. Overall, 35% of participants showed risk of depression, 29% of anxiety, and 31% of somatization. According to the analysis of social determinants of health, the most affected groups were people with low incomes, students, and young adults (18-29 years). Specifically, low-income young females were the most at-risk population group. These findings show how the lockdown measures affected the general population's mental health in Colombia and highlight some social risk factors in health.

Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons.

Surgical re-explorations represent 3-5% of all cardiac surgery. Concerns regarding mortality and major morbidity of re-explorations in the intensive care unit (ICU) setting exist. We sought to investigate whether they may have different outcomes compared with those performed in the operating room (OR). Single center retrospective review of patients who underwent mediastinal re-exploration in the ICU or in the OR after cardiac surgery. Mediastinal re-explorations were also classified as: "planned" and "unplanned". Primary outcome was 30-day mortality, secondary outcomes include deep sternal wound infection (DSWI), sepsis, ICU and hospital length of stay, prolonged intubation (>72 h), tracheostomy, pneumonia, acute kidney injury requiring dialysis and stroke. Between 2010 and 2019, 195 of 7263 patients (2.7%) underwent mediastinal re-exploration after cardiac surgery. More patients in the ICU group experienced two or more re-explorations (30.3% vs. 2.3%, p < 0.001), a higher incidence of postoperative pneumonia (22% vs. 7%, p = 0.004), prolonged intubation (46.8% vs. 19.8%, p < 0.001) and longer hospital stay (30.3 ± 34.2 vs. 20.8 ± 18.3 days, p = 0.014). There were no differences in mortality between ICU and OR (16.5% vs. 13.9%, p = 0.24) nor in sepsis (14.7% vs. 7%, p = 0.91) and DSWI rates (1.8% vs. 1.2%, p = 0.14). Re-explorations in the ICU were not associated with increased mortality, sepsis and mediastinitis rate.

Psychological impact of COVID-19 lockdowns among adult women: the predictive role of individual differences and lockdown duration.

COVID-19 pandemic has altered women's mental health as a consequence of the global threat and the lockdown measures adopted by public health policies. It has been suggested that women are at a higher risk for mood alterations, but most of the studies are cross-sectional or have only considered the first days of the confinement in their longitudinal designs. The present study was aimed at evaluating temporal changes in anxiety and depression in a general sample of 155 non-infected adult Spanish women after a complete quarantine. It also explored the predictive role of personality, the establishment of new routines and physical activity during lockdown in a pre-post design assessing temporal and clinical mood changes after 5 weeks of lockdown. Logistic regression analyses showed that higher neuroticism and depressive levels at baseline, lower routines engagement, and lower physical activity during lockdown predicted depression caseness, whereas anxiety caseness was best predicted by higher neuroticism, more days of lockdown and greater anxiety symptoms at baseline. It is concluded that lockdown duration, increased neuroticism and baseline levels of anxiety and depression are risk factors for women's mental health, while routines and physical activity emerge as protective factors for managing psychological wellbeing during the pandemic lockdowns.

Cannabis and Its Different Strains.

Previous studies show how time perception can be altered by cannabis consumption, but it is not clear yet whether cannabis produces temporal underproductions or overproductions after acute cannabis intoxication. The present study aimed to analyze a sample of 50 regular cannabis users controlling for cannabis strain (sativa, indica, and hybrid) and to compare their scores in a temporal production task before and after consuming cannabis with a control group of 49 nonusers. Results showed that cannabis intake leads to overproductions, suggesting that regular users' internal tempo slows down after acute intoxication. However, the analyses of main effects showed that indica users, both at baseline levels and after consuming, reported significant underproductions compared to controls, sativa, and hybrid users, and the cannabis-induced effects had a higher magnitude after smoking in the indica-strain group. Results highlight the relevance of including the type of strain consumed in cannabis studies, and they are discussed in terms of short- and long-term alterations in temporal perception under the light of the self-medication theory and the therapeutic uses of cannabis.

Dance practice and well-being correlates in young women.

Clinical research has shown the mental health benefits of dance practice. This has become a significant subject of inquiry in psychotherapeutic settings for the elderly and adolescents. However, the relationship between dance practice and correlates of psychological well-being, such as mindfulness and life satisfaction (LS)-two relevant indicators of mental health, has been explored relatively little in young women. The present study contrasted mindfulness and LS in young women (n = 81) who practiced dance regularly in three modern dance schools in the Province of Barcelona with a control group of non-practitioners (n = 120) studying at a university in Barcelona. The data were collected during the first semester of 2015, and the total sample had an average age of 20.88 ± 3.36 years. Analyses of covariance showed higher levels of both mindfulness and LS in the dance practitioners, while a multiple regression analysis showed that, after controlling for age, dance was the factor most strongly associated with LS, explaining 28% of the variance in LS. These results are discussed in terms of the embodiment theory, and conclusions suggest that dance may be an effective gender-focused practice to enhance well-being and promote mental health in young women.

Do different circadian typology measures modulate their relationship with personality? A test using the Alternative Five Factor Model.

The relationship between personality and circadian typology shows some inconsistent results and it has been hypothesized that the model used to measure personality might have a moderating effect on this relationship. However, it has never been explored if this inconsistency was dependent on the questionnaire used to measure differences in circadian rhythms as well. We explored this issue in a sample of 564 university students (32% men; 19-40 years) using the Zuckerman-Kuhlman Personality Questionnaire, which is based on an evolutionary-biological approach, in combination with the Composite Scale of Morningness (CSM) and the reduced Morningness-Eveningness Questionnaire (rMEQ). Both questionnaires detected differences between circadian typologies in Sociability (highest in evening types; ET) and Impulsive Sensation-Seeking scales (highest in ET), while the CSM also detected differences in Activity (lowest in ET) and Aggression-Hostility (highest in ET). Further, both questionnaires detected differences between circadian typologies in the subscales General Activity (morning types [MT] higher than ET), Impulsivity (ET highest) and Sensation-Seeking (highest in ET). Differences between circadian typologies/groups in the subscales Parties (highest in ET) and Isolation Intolerance (lowest in MT) were only detected by the rMEQ. The CSM clearly separated evening types from neither and morning types while the rMEQ showed that neither types are not intermediate but closer to evening types in General Activity and Isolation Intolerance, and closer to morning types in Impulsive Sensation-Seeking, Parties, Impulsivity and Sensation Seeking. The obtained results indicate that the relationship between circadian typology and personality may be dependent on the instrument used to assess circadian typology. This fact may help to explain some of the conflicting data available on the relationship between these two concepts.

Circadian typology and sensation seeking in adolescents.

The relationship of circadian typology with personality has been largely studied in adults, but there are few studies exploring such relationship in adolescents. Adolescence has been associated with a greater tendency to eveningness preference, sleeping problems, poorer academic achievement, earlier substance use, or risky behaviors, and it is suggested that this association might be mediated by personality factors. Given the relevance of identifying the behavioral outcomes of young evening types to detect and prevent health problems, the present study aimed to explore, for the first time, the relationship between sensation seeking and circadian typology in an adolescent sample of 688 students (51.45% boys) from 12 to 16 yrs old. They answered the Spanish versions of the Morningness-Eveningness Scale for Children (MESC) and the Junior Sensation Seeking Scale (J-SSS), which includes four subscales measuring Thrill and Adventure Seeking, Experience Seeking, Disinhibition, and Boredom Susceptibility. Analyses showed that boys obtained significantly higher scores than girls on J-SSS total score and all subscales except Boredom Susceptibility, whereas evening-type adolescents of both sexes scored significantly higher than neither types and than morning types on J-SSS total score. These results indicate that evening-type adolescents show a greater desire for varied, new, complex, and intense sensations, and they are ready for experiencing more risks than morning types. The implications of this study suggest the need of being aware of individual differences in the SS trait in evening-type adolescents, as well as taking into account the wide variety of behaviors associated with it, either prosocial or antisocial, to design better preventive health and academic programs.

Circadian typology, age, and the alternative five-factor personality model in an adult women sample.

Research on personality and circadian typology indicates evening-type women are more impulsive and novelty seeking, neither types are more anxious, and morning types tend to be more active, conscientious, and persistent. The purpose of this study is to examine the differences between circadian typologies in the light of the Zuckerman's Alternative Five-Factor Model (AFFM) of personality, which has a strong biological basis, in an adult sample of 412 women 18 to 55 yrs of age. The authors found morning-type women had significant higher scores than evening-type and neither-type women on Activity, and its subscales General Activity and Work Activity. In contrast, evening-type women scored significantly higher than morning-type women on Aggression-Hostility, Impulsive Sensation Seeking, and its subscale Sensation Seeking. In all groups, results were independent of age. These findings are in accordance with those previously obtained in female student samples and add new data on the AFFM. The need of using personality models that are biologically based in the study of circadian rhythms is discussed.

Morningness-eveningness, sex, and the Alternative Five Factor Model of personality.

Recent research on personality and circadian typology indicates that evening-type subjects are more extraverted, impulsive, and novelty-seeking, while morning ones tend to be more introverted, conscientious, agreeable, and emotionally stable. The purpose of this study was to examine the differences between circadian typologies on the Zuckerman's Alternative Five Factor Model of personality (AFFM), which has a strong biological basis, controlling for sex and age. A sample of 533 university students (168 men) participated in the study. Results showed that morning-type subjects had significant higher scores than evening-type and neither-type subjects in Activity, and in its subscales General Activity and Work Activity. A significant interaction between circadian typology and sex was found for Neuroticism-Anxiety: morning-type men showed higher scores than evening-type and neither-type, who had the lowest scores. Women presented the opposite pattern: neither-type obtained the highest scores, while morning-type showed the lowest. This is the first time the AFFM has been used in the context of circadian rhythms research. The results suggest that activity is the only trait related to extraversion associated with morningness, while Neuroticism-Anxiety was modulated by sex. These results might help highlight previous results on the association between morningness-eveningness and other models of personality assessment, and they offer new data that calls for further research.

Zuckerman-Kuhlman Personality Questionnaire: psychometric properties in a sample of the general population.

The Zuckerman-Kuhlman Personality Questionnaire, a tool designed to measure the alternative five-factor model of personality, was translated and adapted into the Spanish language. Some psychometric results with students have already been reported, but to date, there appears to be no published data on the psychometric properties of the questionnaire in a general population sample in any culture. The aim of the present study was to provide psychometric properties for a large Spanish community sample with a wide representation of adult age-range, a representative distribution of sexes, and a balanced distribution of education within the sample. Participants volunteered and were selected on a random basis. The questionnaire was administered to 1,000 participants of both sexes (51.4% women) with ages ranging from 18 to 88 years (M = 45.4, SD = 18.7). Analysis gave a normal distribution of all scales, good internal consistencies, and discriminant validity. Sex differences were in accord with data from tests measuring similar personality traits. Finally, the original five-component structure was also replicated.