Mental stress-induced ischemia and all-cause mortality in patients with coronary artery disease

Prevalence of stress and its relevance on psychological well-being of the teaching profession: A scoping review

Background

Well-being among teachers contributes toward quality work and better student support. Teachers' well-being persists to be a concern in school settings; there is a lacuna in understanding the concept of well-being among them. This scoping review identifies the stress factors and map their association with the psychological well-being of teachers employed in schools. Additionally, to identify the methodology and the interventions used in reducing teachers' stress and their relevance on their psychological well-being.

Methods

First, Pubmed, Web of Science, and Scopus databases were searched for eligible studies with MeSH terms for stress factors, well-being, and teachers from 2010 to 2022. Identified studies were screened thoroughly and excluded or included based on prior established criteria. Data from the included studies were extracted and summarized according to the study protocol.

Results

Among the 60 studies that met our inclusion criteria, the majority were quantitative, with cross-sectional studies. Several studies focused on emotional exhaustion, depersonalization, and diminished personal accomplishment aspect among teachers. Almost half of the included studies focused on organizational and social pressures such as administration workload, classroom management issues, lack of supervisor and team support, students' behaviour, and pressure from parents. The most used interventions to overcome stress were coping strategies and mindfulness training intervention tools.

Conclusions

The findings from the current scoping review will reveal the different stressors which impact psychological well-being. Focus on the most used interventions to overcome stress among schoolteachers. This will also provide recommendations to regulators and management to identify the factors causing stress among teachers and their relevance to their psychological well-being, overcome employee turnover and absenteeism issues. Also, different alternatives available to reduce the stress may benefit the stakeholders and policymakers to confirm a suitable intervention that will benefit the teaching profession.

Effects of intra-aortic balloon pump counterpulsation on left ventricular mechanoenergetics in a porcine model of acute ischemic heart failure

We investigated the effects of intra-aortic balloon pump (IABP) counterpulsation on left ventricular (LV) contractility, relaxation, and energy consumption and probed the underlying physiologic mechanisms in 12 farm pigs, using an ischemia-reperfusion model of acute heart failure. During both ischemia and reperfusion, IABP support unloaded the LV, decreased LV energy consumption (pressure-volume area, stroke work), and concurrently improved LV mechanical performance (ejection fraction, stroke volume, cardiac output). During reperfusion exclusively, IABP also improved LV relaxation (tau) and contractility (Emax, PRSW). The beneficial effects of IABP support on LV relaxation and contractility correlated with IABP-induced augmentation of coronary blood flow. In conclusion, we find that during both ischemia and reperfusion, IABP support optimizes LV energetic performance (decreases energy consumption and concurrently improves mechanical performance) by LV unloading. During reperfusion exclusively, IABP support also improves LV contractility and active relaxation, possibly due to a synergistic effect of unloading and augmentation of coronary blood flow.

Effect of psychological stress on the L-arginine-nitric oxide pathway and semen quality

It has been reported that mental stress causes abnormality of spermiogram parameters. We investigated the effect of psychological stress on the L-arginine-nitric oxide (NO) pathway. Semen samples were collected from 29 healthy fourth semester medical students just before (stress) and 3 months after (non-stress) the final examinations. Psychological stress was measured by the State Anxiety Inventory questionnaire. After standard semen analysis, arginase activity and NO concentration were measured spectrophotometrically in the seminal plasma. Measurements were made in duplicate. During the stress period, sperm concentration (41.28 +/- 3.70 vs 77.62 +/- 7.13 x 10(6)/mL), rapid progressive motility of spermatozoa (8.79 +/- 1.66 vs 20.86 +/- 1.63%) and seminal plasma arginase activity (0.12 +/- 0.01 vs 0.22 +/- 0.01 U/mL) were significantly lower than in the non-stress situation, whereas seminal plasma NO (17.28 +/- 0.56 vs 10.02 +/- 0.49 micromol/L) was higher compared to the non-stress period (P < 0.001 for all). During stress there was a negative correlation between NO concentration and sperm concentration, the percentage of rapid progressive motility and arginase activity (r = -0.622, P < 0.01; r = -0.425, P < 0.05 and r = -0.445, P < 0.05, respectively). These results indicate that psychological stress causes an increase of NO level and a decrease of arginase activity in the L-arginine-NO pathway. Furthermore, poor sperm quality may be due to excessive production of NO under psychological stress. In the light of these results, we suggest that the arginine-NO pathway, together with arginase and NO synthase, are involved in semen quality under stress conditions.

The Quest for Permanent Ventricular Assistance: The Role of Aortic Counterpulsation

Temporary aortic counterpulsation is used routinely for the management of cardiogenic shock. By the perseverance of several investigators, permanent aortic counterpulsation is close to becoming a clinical reality. The initial clinical experience with permanent aortic counterpulsation (KCV) has demonstrated that it can be implanted with very low peri-operative morbidity and mortality. It is a novel non-obligatory device that has several advantages over other existing devices. There is no need for anti-coagulation and no valves or internal electronics that could fail and force VAD replacement. The control algorithm is simple, as the device is triggered "on-demand" by the electrical activity of the native heart. Furthermore, it is non-obligatory, so it can be turned on/off at will by the patient without increasing the risk of thromboembolic events. The disadvantages are that it provides only "partial" support. It increases cardiac output by approximately 40% depending on the afterload condition of the patient. It depends upon native heart activity to function and cannot be placed in patients with severe biventricular function, uncontrolled tachyarrhythmias, or with native valvular disease. However, the degree of support obtained seems sufficient to reverse the heart failure syndrome, improve end-organ dysfunction and remove inotrope dependency. The KCV is designed for intervention in NYHA class IV patients before there is severe biventricular failure or lack of any myocardial reserve. It would not be an acute recovery device or one in which IABP pumping does not improve hemodynamics. The KCV can be considered equivalent to a mechanical, permanent, non-energy depleting inotrope and may have a role in improving the length and quality of life in patients with end stage heart failure. By treating advanced CHF early, the KCV may reduce the number of patients progressing towards cardiac replacement therapy with transplantation or a total artificial heart.

Juxtaaortic Counterpulsation: Comparison with Intraaortic Counterpulsation in an Animal Model of Acute Heart Failure

This study was designed to compare the effects of juxtaaortic balloon counterpulsation (JABC), performed in ascending aorta and the aortic arch, with those yielded by intraaortic balloon counterpulsation (IABC) in descending aorta, in experimental animals during induced cardiac failure. JABC was achieved with a manufactured Dacron prosthesis and a balloon pump placed between the prosthesis and the wrapped aorta. JABC resulted in a significant increase of cardiac output (from 2.33+/-0.82 to 2.61+/-1.12 L/min, p < 0.05), cardiac index (from 0.071+/-0.025 to 0.080+/-0.033 L/min/kg, p < 0.05) and diastolic pressure augmentation evaluated through diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) index (from 0.94+/-0.21 to 1.10+/-0.33, p < 0.01). End diastolic aortic pressure showed a significant decrease with JABC (from 31.90+/-7.09 to 27.83+/-9.72 mm Hg, p < 0.05). A close association between percentage of DABAC/SABAC increases obtained with IABC and JABC was observed (r2 = 0.67; p < 0.001). Counterpulsation obtained by a juxtaaortic catheter placed in the arch and the ascending wrapped aorta results in an effective hemodynamic improvement comparable with that achieved by an intraaortic catheter in open chest sheep.