Philip J. Moore

Socioeconomic Status and Health: The Role of Sleep

Objective Examine the role of sleep in the relationship between socioeconomic status (SES) and health. Method Self-reported measures of income and education, sleep quantity and quality, and mental and physical health were obtained in a community sample of 1139 adults. Results More education was associated with higher income (p < .001), and higher income was associated with better physical health (p < .001) and psychological outcomes (p < .001). The effects of income on both mental and physical health were mediated by sleep quality (p values < .01), and sleep quantity was related to both measures of health (p values < .01) but to neither index of SES. Conclusion Sleep quality may play a mediating role in translating SES into mental and physical well-being, and income seems to mediate the effect of education on sleep and, in turn, health.

Inhaled Nitric Oxide and Hemodynamic Evaluation of Patients With Pulmonary Hypertension Before Transplantation

OBJECTIVES We investigated the effect of inhaled nitric oxide and infused acetylcholine in patients with pulmonary hypertension undergoing cardiac catheterization before cardiopulmonary transplantation. BACKGROUND The fate of patients under consideration for transplantation of the heart or lungs, or both, is influenced by the evaluation of their pulmonary vascular reactivity. METHODS We evaluated 11 patients who were classified into two groups on the basis of mean left atrial pressure > 15 mm Hg (group I, n = 6) or < or = 15 mm Hg (group II, n = 5). All patients inhaled nitric oxide at 80 ppm. This was preceded by an infusion of 10(-6) mol/liter of acetylcholine in seven consecutive patients (n = 3 in group I, n = 4 in group II). RESULTS In group I, inhaled nitric oxide decreased pulmonary artery pressure from (mean +/- SE) 71 +/- 13 to 59 +/- 10 mm Hg (p < 0.05), pulmonary vascular resistance from 14.9 +/- 3.8 to 7.6 +/- 1.7 Um2 (p < 0.05) and intrapulmonary shunt fraction from 17.8 +/- 3.6% to 12.7 +/- 2.1% (p < 0.05). Left atrial pressure tended to increase from 27 +/- 4 to 32 +/- 5 mm Hg (p = 0.07). In group II pulmonary vascular resistance decreased in response to nitric oxide from 36.4 +/- 9.0 to 31.1 +/- 7.9 Um2 (p < 0.05). Cardiac index, systemic pressure and resistance did not change in either group. Seven patients who received acetylcholine had no significant alteration in pulmonary hemodynamic variables. CONCLUSIONS These preliminary observations suggest that nitric oxide is a potent pulmonary vasodilator with minimal systemic effects. It may be useful in discriminating patients needing combined heart and lung transplantation from those requiring exchange of the heart alone.

Social comparison and affiliation under threat: effects on recovery from major surgery.

This study extends stress and affiliation research by examining the effects of preoperative roommate assignments on the affiliation patterns, preoperative anxiety, and postoperative recovery of 84 male coronary-bypass patients. Patients were assigned preoperatively to a room alone or to a semiprivate room with a roommate who was either cardiac or noncardiac and either preoperative or postoperative. Patients assigned to a roommate who was postoperative rather than preoperative were less anxious, were more ambulatory postoperatively, and had shorter postoperative stays. Independently, patients were more ambulatory postoperatively and were discharged sooner if assigned to a roommate who was cardiac rather than noncardiac. No-roommate patients generally had the slowest recoveries. Affiliations reflecting cognitive clarity concerns, emotional comparison, and emotional support were examined. Theoretical implications for research involving social comparison and affiliation under threat are considered.

Psychosocial factors in medical and psychological treatment avoidance: the role of the doctor-patient relationship.

A community sample of 1106 adults was examined to assess the impact of the doctor–patient relationship on participants’ avoidance of treatment for a recognized medical or psychological problem. Of five aspects of participants’ previous experience with their physicians, all but waiting time predicted participants’ self-reported treatment avoidance. In two logistic regression models participants who felt their physicians listened more to their concerns were less likely to avoid treatment for both medical and psychological problems during the previous 12 months. These findings suggest that patients’ perceptions of how they are treated by physicians may help explain why many people delay or avoid healthcare treatment, even when faced with a significant health problem.

Fetoscopic and Open Transumbilical Fetal Cardiac Catheterization in Sheep Potential Approaches for Human Fetal Cardiac Intervention

BACKGROUND Shortening the prenatal disease course of severe aortic and pulmonary stenoses by balloon valvuloplasty may diminish their postnatal expression. The purpose of this study in fetal sheep was to assess the feasibility of fetoscopic and open transumbilical fetal cardiac catheterization guided by fetal transesophageal echocardiography to provide alternative approaches for human fetal cardiac intervention. METHODS AND RESULTS We studied a total of nine fetal sheep (95 to 103 days of gestation; term = 145 to 150 days) and performed transumbilical fetal cardiac catheterization by a minimally invasive fetoscopic (n = 6) or an open fetal surgical approach (n = 3). Monitored by fetal transesophageal echocardiography, with an 8F or 10F, 10-MHz intravascular ultrasound catheter we placed guidewires and interventional catheters via the umbilical arterial route into the fetal heart. In three of the fetuses, we created supravalvar pulmonary artery stenosis by open fetal cardiac surgery After fetal and maternal recovery, we exteriorized these fetuses and performed open transumbilical fetal cardiac catheterization with successful pulmonary arterial angioplasty in two. Three fetuses survived fetoscopic transumbilical catheterization for 1 or 2 days and died most likely of blood loss after sheath dislodgment (n = 1) or removal (n = 2). By securing the sheath insertion site with a suture, we prevented sheath dislodgment and minimized bleeding during sheath removal in three fetuses. These fetuses then survived fetoscopic transumbilical fetal cardiac catheterization for 1 to 2 weeks before being killed. CONCLUSIONS This study in fetal sheep demonstrates that fetoscopic and open transumbilical fetal cardiac catheterization are feasible and, guided by fetal transesophageal echocardiography, provide potential alternative approaches for human fetal cardiac intervention.

The levoatriocardinal vein: Morphology and echocardiographic identification of the pulmonary—systemic connection

OBJECTIVES This study considers the array of pulmonary-systemic connections made by the levoatriocardinal vein. The primary and associated lesions that play a role in forming this vein are examined, and echocardiography is discussed as a method for its rapid identification. BACKGROUND The levoatriocardinal vein is a pulmonary-systemic connection that provides an alternative egress for pulmonary venous blood in left-sided obstructive lesions. It is thought to result from the persistence of anastomotic channels that connect the capillary plexus of the embryonic foregut to the cardinal veins. Only 12 cases of levoatriocardinal vein have been reported since its first description in 1926. A comprehensive description of the morphology and echocardiographic identification of this lesion has been unavailable because of its rarity. METHODS A retrospective study was performed in 13 patients with a levoatriocardinal vein from the University of California, San Francisco. Echocardiographic findings were compared with those obtained by angiography or at necropsy. In addition, the details of 12 previously published case reports were reviewed. Age at presentation, primary obstruction to pulmonary venous return, integrity of the atrial septum and origin and drainage of the levoatriocardinal vein were compared. RESULTS Patient age at presentation was < 2 years, with most patients presenting before age 6 months. Variations of the hypoplastic left heart syndrome accounted for the majority of primary defects encountered, although multiple but less severe left-sided lesions were seen. The atrial septum was functionally intact in most patients. The levoatriocardinal vein, defined echocardiographically, originated predominantly from the smooth-walled left atrium and drained to the superior vena cava or innominate vein; however, variations of this pattern existed. CONCLUSIONS As a physiologic entity, the levoatriocardinal vein provides a mechanism for decompression of pulmonary venous return primarily in patients with left ventricular inflow obstruction. A levoatriocardinal vein is thought to form when the atrial septum fails to provide an alternate egress for left atrial blood. However, when a septal defect or alternative shunt occurs in conjunction with a levoatriocardinal vein, the clinical presentation may be postponed. Echocardiography provides a rapid, noninvasive modality for identifying the pulmonary-systemic connection, which may masquerade as the vertical vein in anomalous pulmonary venous connection or act as an occult source of left to right shunting in patients undergoing surgery for hypoplastic left heart syndrome.

The long-term physical health and healthcare utilization of women who were sexually abused as children

This article addresses the relationship between childhood sexual abuse and the long-term physical health and healthcare utilization of 148 female participants in an eight-year prospective study. Five factors of physical health emerged: General Health; Vegetative Health Symptoms; Colds and Flu; Gastrointestinal/Gynecological; and Healthcare Utilization. Abused females scored higher on the healthcare utilization and gastrointestinal/gynecological factors than comparison females. Abused females experiencing multiple perpetrators, violence, longer duration and older age at onset endorsed significantly more gastrointestinal/gynecological problems than did the other abused females and the comparison group. Findings suggest that: (1) sexual abuse affects long-term health outcomes and healthcare utilization; and (2) physical health sequelae of abuse may differentially affect females, depending upon the pattern of abuse characteristics.

Phase contrast MR imaging to measure changes in collateral blood flow after stenting of recurrent aortic coarctation: Initial experience

To assess the feasibility of using phase contrast magnetic resonance (PC‐MR) imaging to measure the change in collateral blood flow early after stenting of aortic coarctation.

The Differential Effects of Sleep Quality and Quantity on the Relationship between SES and Health

Although socioeconomic status (SES) has long been recognized as a principal determinant of health, one factor yet to be considered in the context of SES and health is the role of sleep. Individuals of lower socioeconomic status have been found more likely to experience sleep disorders, 1 and sleep disturbances have been associated with poorer health. 2 The amount of sleep people get has been found to mediate the relationship between stress-related intrusive thoughts and natural killer cell levels. 3 However, sleep has yet to be examined as a potential mediator of the impact of socioeconomic status on physical or mental health. This study tested the following three hypotheses. First, participants of higher socioeconomic status will report better psychological health. Second, participants of higher socioeconomic status will report better physical health. Third, the relationship between participants’ socioeconomic status and their health will be mediated by either their quantity or quality of sleep.

Information integration and emotion : How do anxiety sensitivity and expectancy combine to determine social anxiety?

Relatively little is known about the integration of peoples fear-related dispositions and their expectations about stressful events. This research used information integration theory to examine how participants’ anxiety sensitivity and event expectancy are integrated to determine their social anxiety. Three studies were conducted—two with university students and one with anxiety clinic patients—in which participants were presented with multiple scenarios of a socially embarrassing event, each representing a different degree of event probability, from which subjective expectancies were derived. Independent variables included anxiety sensitivity (low, moderate, high) and event expectancy (low, medium, high, no probability information). Participants were asked to indicate their anxiety (dependent measure) in each expectancy condition in this 3 × 4 mixed, quasi-experimental design. The results of all three studies strongly suggest that anxiety sensitivity and event expectancy are integrated additively to produce social anxiety. Additional results and their implications for the treatment of anxiety-related disorders are also discussed.