The effects of music intervention on anxiety and stress responses in adults with CHD undergoing cardiac catheterisation.

INTRODUCTION: This study evaluated the effect of music intervention on the anxiety and stress responses of patients who underwent an interventional cardiac catheterisation. METHODS: The study design was a pre- and post-test randomised controlled trial that included 94 patients who underwent a transcatheter atrial septal defect closure. Patients were allocated to receive either music intervention (n = 47) or usual care (n = 47) during the interventional cardiac catheterisation. Music intervention effectiveness was examined in terms of anxiety, salivary cortisol level, and heart rate variability. RESULTS: The average age of participants was 45.40 years (±16.04) in the experimental group and 47.26 years (±13.83) in the control group. Two-thirds (66.0%) of the participants in each group were women. State anxiety (F = 31.42, p < 0.001), anxiety-numerical rating scale (F = 20.08, p < 0.001), salivary cortisol levels (F = 4.98, p = 0.021), and low-frequency component/high-frequency component ratio (F = 17.31, p < 0.001) in the experimental group were significantly reduced compared with those in the control group at the end of the music intervention. CONCLUSION: This study provides practical evidence of a reduction in anxiety and stress response from music intervention preceding an interventional cardiac catheterisation, indicating that this intervention should be considered in clinical management.

Safety of the Up-titration of Nifedipine GITS and Valsartan or Low-dose Combination in Uncontrolled Hypertension: the FOCUS Study.

PURPOSE: Doubling the dose of antihypertensive drugs is necessary to manage hypertension in patients whose disease is uncontrolled. However, this strategy can result in safety issues. This study compared the safety and efficacy of up-titration of the nifedipine gastrointestinal therapeutic system (GITS) with up-titration of valsartan monotherapy; these were also compared with low-dose combinations of the two therapies. METHODS: This prospective, open-label, randomized, active-controlled, multicenter study lasted 8 weeks. If patients did not meet the target blood pressure (BP) after 4 weeks of treatment with low-dose monotherapy, they were randomized to up-titration of the nifedipine GITS dose from 30 mg (N30) to 60 mg or valsartan from 80 mg to 160 mg or they were randomized to receive a low-dose combination of N30 and valsartan 80 mg for another 4 weeks. BP variability was assessed by using the SD or the %CV of the short-term BP measured at clinic. FINDINGS: Of the 391 patients (20~70 years with stage II or higher hypertension) screened for study inclusion, 362 patients who had 3 BP measurements were enrolled. The reduction in the mean systolic/diastolic BP from baseline to week 4 was similar in both low-dose monotherapy groups with either N30 or valsartan 80 mg. BP variability (SD) was unchanged with either therapy, but the %CV was slightly increased in the N30 group. There was no significant difference in BP variability either in SD or %CV between responders and nonresponders to each monotherapy despite the significant difference in the mean BP changes. The up-titration effect of nifedipine GTS from 30 to 60 mg exhibited an additional BP reduction, but this effect was not shown in the up-titration of valsartan from 80 to 160 mg. Although the difference in BP was obvious between high-dose nifedipine GTS and valsartan, the BP variability was unchanged between the 2 drugs and was similar to the low-dose combinations. There was a low rate of adverse events in all treatment groups. In addition, escalating the dose of either nifedipine GITS or valsartan revealed a similar occurrence of adverse effects with low-dose monotherapy or the low-dose combination. IMPLICATIONS: Compared with up-titration of the angiotensin receptor blocker valsartan, up-titration of the calcium channel blocker nifedipine GITS provided no additional increased safety concerns and revealed better mean reductions in BP without affecting short-term BP variability. ClinicalTrials.gov identifier: NCT01071122.

The response of the vena cava to abdominal breathing.

BACKGROUND: Recently, abdominal-breathing or diaphragmatic-breathing methods have increased in popularity. Little is known how abdominal breathing affects the circulatory system. This study was designed to determine the impact of the respiratory pattern on central venous flow using echocardiography. METHODS: The superior vena cava (SVC) and inferior vena cava (IVC) were observed in people who had practiced abdominal breathing for at least 2 years, while they were breathing in three different techniques: slow respiration, slow respiration with inspiratory pause, or normal respiration. In addition, the observation during normal respiration was compared with that of a control group. RESULTS: The abdominal-breathing group consisted of 20 people with mean duration of training of 9.6 years. The respiratory collapsibility index of IVC during slow respiration with inspiratory pause was 62±19% compared with 48±19% during normal respiration (p=0.012) in the abdominal-breathing group. The abdominal-breathing group had a higher IVC collapsibility index compared to the control group during normal respiration (48±19% versus 26±12%, p<0.001), assuming a similar respiratory rate of about 10/min. Neither the size nor the minute flow of SVC differed among breathing patterns or between groups. CONCLUSIONS: The IVC of people who practice abdominal breathing has a greater degree of collapse than those of normal people, suggesting that abdominal-breathing exercise can positively affect venous return via IVC. For those who practice abdominal breathing, the collapsibility of the IVC is the best during slow respiration with inspiratory pause. The SVC did not seem to be affected by abdominal-breathing training.

Modeling and assessing the impact of reclaimed wastewater irrigation on the nutrient loads from an agricultural watershed containing rice paddy fields.

Two models were used in concert to predict nutrient loads in a waterbody receiving irrigation return flows from a rice paddy production system. Two irrigation scenarios were simulated, one using reclaimed wastewater as the irrigation water source, the other using water from a surface reservoir designed to supply irrigation water. Total nitrogen (TN) and total phosphorus (TP) loads in irrigation return flows from the rice paddy fields were simulated using the field-scale water quality model Chemical, Runoff and Erosion from Agricultural Management System model for rice paddy fields (CREAMS-PADDY). The output from CREAMS-PADDY was then used as input data for Hydrological Simulation Program-FORTRAN (HSPF) model. HSPF was used to evaluate TN and TP loads in the receiving waterbody at the watershed-scale. CREAMS-PADDY and HSPF were calibrated for both hydrology and water quality using observed data. Both CREAMS-PADDY and HSPF showed good agreement between the observed and simulated data during the calibration and validation periods. Simulation indicated that TN and TP loads from the study paddy fields increased by 207% and 1022% when reclaimed wastewater was used for irrigation compared to conventional irrigation. Irrigating paddy fields (18.8% of the 385 ha study watershed) with reclaimed wastewater increased the TN load at the watershed outlet by 10.3% and TP by 14.0%. The increase in nutrient loads was the result of the high nutrient concentration in the reclaimed wastewater. The procedures used in this research can be used to develop wastewater reuse strategies that minimize environmental impacts on watershed water quality.

Assessment of reclaimed wastewater irrigation impacts on water quality, soil, and rice cultivation in paddy fields.

The objective of this research was to monitor and assess the impact of reclaimed wastewater irrigation on water quality, soil, and rice cultivation by comparing the effects of various wastewater treatment levels on the growth and yield of rice. A randomized complete block design was used for the application methods of the wastewater effluents to paddy rice, with five treatments and six replications. The treatments were: control with groundwater irrigation (GW); irrigation with polluted water form a nearby stream (SW); and three treatments of reclaimed wastewater irrigation at different treatment levels. The three levels of wastewater treatments included wastewater effluents: (i) directly from the wastewater plant (WW); (ii) after passing through a sand filter (WSF); and (iii) after passing a sand filter followed by an ultraviolet treatment (WSFUV). Each plot was 4 x 4 m and was planted with rice (Oryza sativa L.) in 2002 and 2003. The results indicated that irrigation of rice with reclaimed municipal wastewater caused no adverse effects on the growth and yield of rice. The chemical compositions of the rice from all plots were within the normal ranges of brown rice quality in Korea. No adverse effects were observed on chemical concentrations including the heavy metals Cu, As, Cd, Zn, Hg, and Pb, in either the brown rice or the field. The results showed that treated municipal wastewater can be safely used as an alternative water source for the irrigation of rice, although continued monitoring will be needed to determine the long-term effects with regard to soil contamination and other potential health concerns.