Heart Disease (Biographies of Disease)
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In a UK study by Surtees P et al.
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Further work supports that individuals with a greater sense of coherence present higher levels of self-esteem, optimism and control over their lives, making more likely a response to a stressor with adaptive mechanisms [ 14 ]. Therefore, we may hypothesize the existence of bio-psycho-social protective factors towards cardiovascular mortality and morbidity, among a Cretan population who is highly homogeneous in terms of ethnic and religious identity. Such factors could include, among others, religiosity and spirituality.
The concurrent examination of psycho-social determinants in conjunction with biological markers in longitudinal studies is relatively rare [ 15 ]. Individuals who feel hopeless, unable to cope with stress or are socially isolated [ 3 ] are at considerable risk of developing CVD. More specifically, social determinants may be related to family status, friendships, social and religious group membership [ 16 ]. Thus, of particular importance to our project is the observation of a positive correlation between optimism and CVD focusing on sense of control.
Given that the church is an important organization for socialization, and that religious beliefs and spirituality can have an impact on feelings of hopelessness or ability to cope with stress, leading to better outcomes [ 16 ], the above-cited elements carry great significance for the proposed study. It is also suggested that individuals with high levels of religiosity in terms of church attendance, religious activities and beliefs have better coping abilities, less depression and anxiety and decreased morbidity and mortality compared with those who are less religious [ 17 ].
Among explanatory mechanisms through which religious involvement leads to positive health outcomes seems to be the promotion of positive self perceptions and health beliefs, the regulation of individual lifestyles and health behaviours, and the provision of social ties and specific cognitive or behavioral response to stress [ 17 ]. Idler et al. With regard to the role of socio-economic status SES clinical practice guidelines of the European Society of Cardiology on cardiovascular disease prevention consider low SES as an aggravating parameter in the clinical course and prognosis of CHD [ 19 ].
Furthermore, it has been reported that other psychosocial risk factors such as depression, hostility, work and family stress tend to cluster among individuals and groups of low SES [ 19 ].
The Mind of a Disease
In alignment with this, a cross-sectional study among elderly people living on the Eastern Mediterranean islands found that subjects of higher SES were more close to the traditional Mediterranean diet as compared with those in the lowest SES [ 20 ]. Researchers suggested that factors such as educational status and income may exert a possible influence on the dietary habits of this population [ 20 ]. It is noticed that research regarding bio-psycho-social interactions and health has received limited attention in Greece.
However, questionnaires and scales relevant to self-efficacy, sense of coherence [ 21 ] and spirituality [ 22 ] have been adapted and validated in Greek and are available for the measurement of unseen determinants [ 23 , 24 ]. Drawing on the above, we propose an interdisciplinary research effort, which will investigate the interaction between specific psycho-social determinants, religion and biological processes. Additionally, where possible, ex inhabitants of Spili who have moved to a more urban and stressful environment will also be recruited, to explore whether these individuals demonstrate a CVD pattern more comparable to global patterns.
A control group with patients visiting an urban primary care centre in Crete will also be selected and will be matched with the Spili population group in terms of age and sex. Participants will undergo a blood pressure assessment, electrocardiogram and anthropometric measurements height, weight, hip and waist circumference.
Participants will be further evaluated for the presence of markers of atherosclerosis [i. Ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis will also be performed [ 26 , 29 ]. Dietary patterns MedDietScore [ 30 ], activity levels International Physical Activity Questionnaire [ 31 ], smoking, and alcohol habits will also be recorded. Specific attention will be given to the social coherence of the local community [ 32 ] and their spiritual and religious beliefs and practices.
Validated questionnaires will be used to evaluate sense of coherence 13 item Sense of Coherence Questionnaire [ 21 , 33 , 34 ] religious and spiritual beliefs and practices Royal Free Interview for Spiritual and Religious Beliefs [ 22 ] and depression levels Beck Depression Inventory-I [ 35 ]. Socioeconomic background and poverty will be estimated after classification on the basis of the mean annual family income and years of education [ 20 ].
A further dimension will be added to the study by the performance of interviews with a sample of the cohort, which could provide additional insight into the qualitative findings. This could represent an opportunity to capture informants' understandings and explanations of their personal experiences of religiosity, spirituality and social coherence accessed within the context of a group defined by geography and common culture.
Incidence rates of CHD and related risk factors will be calculated as the ratio of new cases developed during the preceding years to the number of person-years. Associations between categorical variables will be tested using the chi-squared test. Comparisons of mean values of normally distributed variables between those who developed a CVD event and the rest of the participants will be performed using Student's t-test.
For the continuous variables that were not normally distributed, the Mann-Whitney non-parametric test will be applied to evaluate the differences in the distributions of the skewed variables between those who developed a CVD event and the remaining participants. Cox PH models with first order interactions will be estimated to test the potential mediating effect of bio-social aspects on the effect of the traditional CVD risk factors on CVD incidence. Written informed consent will be obtained from all participants.
The anonymity of the patients' data will be carefully approached. The collected data will be stored at the Clinic of Social and Family Medicine, School of Medicine, University of Crete in which will be accountable from any public access. The current proposed study aims to explore the extent to which Cretan individuals with greater sense of coherence and high religiosity and spirituality levels, are less likely to be affected by chronic inflammation and atherosclerosis related burden and abnormal levels of the relative bio-markers examined.
The findings will help researchers further explore possible links between biological and psychosocial health determinants.
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The study could also provide further evidence on the association of other factors such as the Mediterranean diet, which may explain a part of the CVD variation in the population studied. To achieve this, carefully designed research efforts are required in order to explore hypothetical patho-physiological pathways direct and indirect through which dynamic psycho-social determinants exert a protective biological effect and counterbalance a negative bio-profile. Furthermore, future interventions and health promotion programmes which take into consideration not only classical cardiovascular morbidity determinants e.
The proposed study may provide an explanation of the so-called "Cretan paradox", by interpreting a range of factors, which may have contributed to the low CVD incidence on the island of Crete during the last decades [ 37 ]. A weakness of the proposed study is the inevitably small population size and time related losses with regard to follow-up, since this group has already been monitored for almost two decades. Furthermore, we cannot easily reject or adopt scenarios such as the presence of other confounding factors due to genetic patterns within the study population and the beneficial effects of Christian Orthodox fasting on serum lipids and obesity.
As Strike and Streptoe underline, it is often difficult to isolate the effects of independent psychosocial variables because they interact and tend to cluster together [ 11 ].
In this collaborative proposal, researchers intend to return to the Spili cohort and link biological, psycho-social and socio-cultural data into an overarching model that may provide a clearer understanding of how biological and psycho-social determinants of health intersect and impact on morbidity.
The Spili cohort presents a rare opportunity to build on an already solid body of research by way of asking broader questions regarding the relevance of traditional practices and cultural heritage on morbidity and mortality at the individual and community level.
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We anticipate that certain patterns will be identified which could have both immediate applicability for current clinical and public health concerns, and which may also generate a new round of research questions with regard to the significance of the community for the health and well-being of the individual. CL conceived and shaped the idea. DP provided intellectual input and information on future statistical analysis. SS corrected the manuscript and provided useful suggestions on content, together with editorial support.
EC provided scientific and technical input. All authors read and approved the final manuscript. We would like to thank Prof. Nora Ellen Groce and Prof. Lowell Levin from the University of Yale USA for their useful comments and advices that they kindly provided on the final draft of this manuscript.
National Center for Biotechnology Information , U. BMC Res Notes. Published online Oct Author information Article notes Copyright and License information Disclaimer. Pulmonary hypertension : Uncontrolled high blood pressure in the arteries of the lungs can result in irreversible lung damage.
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If you or another person experiences these symptoms, it is vital to call immediately for emergency medical help. Living with CHD can cause anxiety and depression. A doctor should be able to provide the details of local support groups. Just a few decades ago, having a CHD was fatal to most people, and there was no diagnosis. A CHD can still be life-threatening, but medical advances over the last 70 years mean that the chances of survival are far higher now than they were in the past..
Doctors now expect that around 96 percent of people who get a CHD diagnosis and receive hospital treatment will survive. Future options for treatment may include replacing prostheses with bio-engineered tissues and fixing any problems in the developing heart before a child is born. Down syndrome occurs when a baby is born with an extra chromosome This extra chromosome results in small stature and low muscle tone, among other….