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Mierzyńska A, Jaworska I, Piotrowicz R, Kowalik I, Pencina M, Opolski G, Zareba W, Banach M, Orzechowski P, Główczynska R, Szalewska D, Pluta S, Kalarus Z, Irzmanski R, Piotrowicz E. The Influence of Hybrid Comprehensive Telerehabilitation on Anxiety in Heart Failure Patients: The TELEREH-HF Randomized Clinical Trial. J Clin Psychol Med Settings 2024; 31:403-416. [PMID: 38108961 DOI: 10.1007/s10880-023-09985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
Telerehabilitation for heart failure (HF) patients is beneficial for physical functioning, prognosis, and psychological status. The study aimed at evaluating the influence of hybrid comprehensive telerehabilitation (HCTR) on the level of anxiety in comparison to usual care (UC). The TELEREH-HF study was a multicenter prospective RCT in 850 clinically stable HF participants. Patients underwent clinical examinations, including the assessment of anxiety, at entry and after the 9-week training program (HCTR) or observation (UC). The State-Trait Anxiety Inventory (STAI) was used. 20.3% HCTR and 20.1% UC patients reported high level of anxiety as a state at baseline, with higher STAI results in younger participants (< 63 y.o.) (p = .048 for HCTR; p = .026 for UC). At both stages of the study, patients with lower level of physical capacity (measured by a peak VO2) had shown significantly higher level of anxiety. There were no significant changes in anxiety levels during the 9-week observation for the entire study population, although there were different patterns of change in anxiety (both trait and state) in younger and older groups,with the decrease in younger patients, and the increase-in the older group.Trial registry number NCT02523560 (Clinical Trials.gov), date of registration: August 14, 2015.
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Affiliation(s)
- Anna Mierzyńska
- National Institute of Cardiology, 04-628, Warsaw, Poland.
- Department of Cardiac Surgery, Military Institute of Medicine - National Research Institute, 04-141, Warsaw, Poland.
| | - Izabela Jaworska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland
| | - Ryszard Piotrowicz
- National Institute of Cardiology, 04-628, Warsaw, Poland
- College of Rehabilitation, 01-234, Warsaw, Poland
| | - Ilona Kowalik
- National Institute of Cardiology, 04-628, Warsaw, Poland
| | - Michael Pencina
- Duke University's School of Medicine, Durham, NC, 27710, USA
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Wojciech Zareba
- University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, 90-419, Łódź, Poland
| | - Piotr Orzechowski
- Telecardiology Center, National Institute of Cardiology, 04-628, Warsaw, Poland
| | - Renata Główczynska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Dominika Szalewska
- Department of Rehabilitation Medicine, Medical University of Gdańsk, 80-210, Gdańsk, Poland
| | - Sławomir Pluta
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland
| | - Robert Irzmanski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Łódź, 90-419, Łódź, Poland
| | - Ewa Piotrowicz
- Telecardiology Center, National Institute of Cardiology, 04-628, Warsaw, Poland
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Pedersen SS, Skov O. Two for the price of one: does treating depression in cardiac patients using internet-based cognitive behavioural therapy also reduce anxiety symptoms? Eur J Cardiovasc Nurs 2024; 23:e46-e47. [PMID: 38175653 DOI: 10.1093/eurjcn/zvad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
- Department of Cardiology, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark
| | - Ole Skov
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
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Douma ER, Kop WJ, Kupper N. Associations Between Psychological Factors and Adherence to Health Behaviors After Percutaneous Coronary Intervention: The Role of Cardiac Rehabilitation. Ann Behav Med 2024; 58:328-340. [PMID: 38431284 PMCID: PMC11008588 DOI: 10.1093/abm/kaae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) participation after percutaneous coronary intervention (PCI) for coronary heart disease lowers the disease burden and risk of recurrent cardiac events. Examining psychological factors may improve post-PCI health behavior adherence. PURPOSE To determine whether psychological factors are associated with post-PCI health behavior adherence, and the role of CR participation. METHODS Data from 1,682 patients (22.1% female, Mage = 64.0, SDage = 10.5 years) from the THORESCI cohort were included. Adjusted mixed models were used to examine associations between psychological factors and the 1-year course of health behaviors, using interactions to test for moderation by CR participation. RESULTS Psychological factors were associated with the trajectories of adherence to medical advice, exercise, and diet. The strongest association found was between optimism and the trajectory of dietary adherence (B: = -0.09, p = .026). Patients with high optimism levels had a worse trajectory of dietary adherence compared to patients with low to middle optimism levels. Participation in CR buffered the associations of high anxiety, pessimism, and low to middle resilience, but strengthened the associations of high stress in the past year with the probability of smoking. CONCLUSIONS Psychological factors are associated with post-PCI health behavior adherence, but the pattern of associations is complex. Patients with high levels of anxiety, pessimism, and low to middle resilience levels may disproportionately benefit from CR. Cardiac rehabilitation programs could consider this to improve post-PCI health behavior adherence. CLINICAL TRIALS REGISTRATION # NCT02621216.
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Affiliation(s)
- Emma R Douma
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Nina Kupper
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
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Kupper N, van den Houdt S, Kuijpers PMJC, Widdershoven J. The importance, consequences and treatment of psychosocial risk factors in heart disease: less conversation, more action! Neth Heart J 2024; 32:6-13. [PMID: 38015346 PMCID: PMC10781929 DOI: 10.1007/s12471-023-01831-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/29/2023] Open
Abstract
Psychosocial factors play a significant role in the incidence and prognosis of cardiovascular disease with a rapidly increasing body of knowledge, as acknowledged by their inclusion in the European Society of Cardiology cardiovascular prevention guideline since 2012. Nevertheless, psychosocial risk is not consistently assessed, acknowledged and treated in daily clinical practice. Therefore, adopting a multidimensional approach that encompasses biological, psychological, and social factors is crucial for understanding the dynamic nature of cardiovascular health and disease, delivering patient-centred care, and developing effective interventions to ultimately enhance health and satisfaction with contemporary medicine and care. The current review summarises the state-of-the-art evidence for screening and treating psychological risk factors in coronary heart disease, heart failure, and atrial fibrillation in the context of cardiac rehabilitation, along with accompanying recommendations. The limited adoption of routine screening, despite longstanding recommendations, highlights the importance of prioritising the implementation and expansion of routine screening in primary and secondary prevention. To advance psychosocial treatment, a standardised and personalised approach including comprehensive education, physical exercise, and psychosocial support with a focus on patient-reported outcomes is crucial. Treating heart and mind together has the potential to decrease psychosocial risk while enhancing the prognosis and quality of life, therefore delivering true patient-centred care.
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Affiliation(s)
- Nina Kupper
- Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
| | - Sophie van den Houdt
- Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - Jos Widdershoven
- Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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van den Houdt SCM, Widdershoven J, Kupper N. Patient and healthcare professionals' perceived barriers and facilitators to the implementation of psychosocial screening in cardiac practice: A Delphi study. Gen Hosp Psychiatry 2023; 85:104-113. [PMID: 37862959 DOI: 10.1016/j.genhosppsych.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Psychosocial risk factors contribute to the incidence and progression of coronary heart disease (CHD). Psychosocial screening may identify individuals who are at risk and aid them with getting appropriate care. To successfully implement psychosocial screening in the cardiology practice, the current study aims to identify key barriers and facilitators to its implementation and evaluate their perceived importance among health care professionals (HCPs) and patients. METHODS We took a modified 3-round Delphi study approach to gain insight into key determinants that could either impede or ease implementation. Round 1 gathered data from HCPs (n = 9; cardiologists, medical psychologists, cardiac nurses) and CHD patients (n = 21), which we transcribed verbatim, coded, and processed into unique determinants. In rounds 2 and 3, participants were asked to select the most relevant determinants and rank them based on importance. Subsequently, determinants were classified by implementation level. RESULTS Patients were generally more positive towards screening. HCP barriers included time-constraints, disruption of primary activities, and limited knowledge on psychosocial risk and screening, while patient barriers were commonly related to accessibility and patient characteristics (e.g., health literacy, motivation). Facilitators of both groups mainly pertained to the use of the screener and follow-up care, such as increasing the accessibility and the benefits of the screener. CONCLUSION Barriers may be targeted by enhancing the effects of the facilitators. Increasing the accessibility to the screener and interventions, improving information provision, and appointing a contact person to oversee the screening process may ease the screening and care process for both patients and HCPs.
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Affiliation(s)
- Sophie C M van den Houdt
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands
| | - Jos Widdershoven
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden hospital, the Netherlands
| | - Nina Kupper
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands.
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Cao X, Chair SY, Wong EML, Tao MY. An Educational Intervention for Coronary Heart Disease Patients With Type D Personality: A Randomized Controlled Trial. J Nurs Res 2023:00134372-990000000-00072. [PMID: 37440695 DOI: 10.1097/jnr.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Type D personality, a newly specified personality type defined as the interaction of high levels of negative affectivity and social inhibition, is associated with poor health outcomes. Few interventional studies have been performed to improve health outcomes in this subpopulation. PURPOSE This study was developed to examine the effects of an educational intervention on psychological health, health-promoting behaviors, and quality of life in coronary heart disease (CHD) patients with type D personality in China. METHODS A randomized controlled trial was adopted. One hundred twenty-eight patients with CHD and type D personality were randomly assigned. The intervention group received the 12-week educational intervention in addition to usual care, whereas the control group received usual care only. Data on anxiety and depression, health-promoting behaviors, and quality of life were collected at baseline and at 1 and 3 months after enrollment. After controlling for the covariates, the generalized estimating equation model was used to examine the intervention effects. RESULTS The mean age of the participants was 61.02 years, and more than 70% were male. Results of the generalized estimating equation analysis showed significantly greater improvements in anxiety, depression, and health-promoting behaviors in the intervention group than in the control group. In addition, quality of life, the domains of angina limitation, angina stability, and treatment satisfaction were found to have improved more significantly in the intervention group than the control group, whereas the posttest changes in angina frequency and disease perception were found to be similar in both groups. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The educational intervention was shown to be effective in improving psychological health, health-promoting behaviors, and certain domains of quality of life in patients with CHD and type D personality. Nurses should identify patients with this personality type and provide tailored care to improve their health outcomes in clinical practice.
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Affiliation(s)
| | - Sek Ying Chair
- PhD, RN, FAAN, Professor, The Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Eliza M L Wong
- PhD, RN, Associated Professor, School of Nursing, Tung Wah College, Hong Kong, People's Republic of China
| | - Mei Yi Tao
- MN, RN, Head Nurse, People's Hospital of Hunan Province, Changsha, People's Republic of China
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Epifanio MS, La Grutta S, Alfano P, Marcantonio S, Piombo MA, Ammirata M, Rebulla E, Grassi S, Leone S, Clemenza F, Girgenti R, Lo Baido R, Di Blasi M. Sexual Satisfaction and Quality of Life in Cardiovascular Patients: The Mediating Role of Anxiety. Healthcare (Basel) 2023; 11:healthcare11030290. [PMID: 36766865 PMCID: PMC9913900 DOI: 10.3390/healthcare11030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular diseases represent one of the most important problems for public health. Research indicates that elderly patients consider sexual satisfaction as a fundamental aspect of their quality of life and a better sexual function is related to higher general wellbeing. OBJECTIVE The main objective of this study was to investigate the mediating role of anxiety and depression in the relationship between quality of life and sexual satisfaction in cardiovascular (CVD) patients. METHODS The sample comprised 128 adult patients, males and females, hospitalized in a Cardiology Rehabilitation clinical center. To collect data, the following were used: a demographic information sheet, the left ventricular ejection fraction (EF) to evaluate cardiac function, cardiovascular diagnosis type, the HADS scale to evaluate anxiety and depression states, a test for sexual satisfaction evaluation (SAS) and the SF-36 survey to measure quality of life. RESULTS The results indicated that only SF-36 physical health is indirectly related to SAS through its relationship with anxiety. CONCLUSION A mediating model was proposed to explore the underlying association between sexual satisfaction and quality of life. We recommend investigating perceived general health and sexuality as clinical indicators for therapeutic decisions and risk evaluation for the management of cardiovascular diseases.
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Affiliation(s)
- Maria Stella Epifanio
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
| | - Sabina La Grutta
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
| | - Pietro Alfano
- Institute of Translational Pharmacology (IFT), National Research Council of Italy, 90146 Palermo, Italy
- Correspondence:
| | - Salvatore Marcantonio
- Quality, Planning and Strategic Support Area, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Marco Andrea Piombo
- Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum, University of Bologna, 40127 Bologna, Italy
| | - Martina Ammirata
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
| | - Eduardo Rebulla
- Division of Cardiology, Candela Clinic, 90141 Palermo, Italy
| | - Silvia Grassi
- Division of Cardiology, Candela Clinic, 90141 Palermo, Italy
| | - Simona Leone
- Division of Cardiology, Candela Clinic, 90141 Palermo, Italy
| | - Francesco Clemenza
- Cardiology Operating Unit, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy
| | - Rosario Girgenti
- Clinical Psychology Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy
| | - Rosa Lo Baido
- Section of Psychiatry, Experimental Biomedicine, Clinical Neuroscience and Advanced Diagnostic Department (BiND), Palermo University, 90127 Palermo, Italy
| | - Maria Di Blasi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
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von Känel R, Meister-Langraf RE, Barth J, Znoj H, Schmid JP, Schnyder U, Princip M. Early Trauma-Focused Counseling for the Prevention of Acute Coronary Syndrome-Induced Posttraumatic Stress: Social and Health Care Resources Matter. J Clin Med 2022; 11:jcm11071993. [PMID: 35407601 PMCID: PMC8999513 DOI: 10.3390/jcm11071993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022] Open
Abstract
Background: A one-size-fits-all approach might explain why early psychological interventions are largely ineffective in preventing the development of posttraumatic stress disorder (PTSD) symptoms triggered by acute medical events. We examined the hypothesis that social and health care resources are moderators of an intervention effect. Methods: Within 48 h of hospital admission, 129 patients (mean age 58 years, 83% men) with acute coronary syndrome (ACS) self-rated their social support and were randomized to one single session of trauma-focused counseling (TFC) or stress-focused counseling (SFC) (active control intervention). Clinician-rated PTSD symptoms, use of cardiac rehabilitation (CR) and use of psychotherapy were assessed at 3 and 12 months. Random mixed regression multivariable models were used to analyze associations with PTSD symptoms over time. Results: TFC did not prevent ACS-induced PTSD symptom onset better than SFC; yet, there were significant and independent interactions between “intervention” (TFC or SFC) and social support (p = 0.013) and between “intervention” and duration of CR in weeks (p = 0.034). Patients with greater social support or longer participation in CR had fewer PTSD symptoms in the TFC group compared with the SFC group. The number of psychotherapy sessions did not moderate the intervention effect. Conclusions: Early psychological intervention after ACS with a trauma-focused approach to prevent the development of PTSD symptoms may be beneficial for patients who perceive high social support or participate in CR for several weeks.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.E.M.-L.); (M.P.)
- Correspondence:
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.E.M.-L.); (M.P.)
- Clienia Schlössli AG, 8618 Oetwil am See, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, 3012 Bern, Switzerland;
| | - Jean-Paul Schmid
- Department of Internal Medicine and Cardiology, Clinic Gais AG, 9056 Gais, Switzerland;
| | - Ulrich Schnyder
- Medical Faculty, University of Zurich, 8006 Zurich, Switzerland;
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.E.M.-L.); (M.P.)
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Alameri F, Aldaheri N, Almesmari S, Basaloum M, Albeshr NA, Simsekler MCE, Ugwuoke NV, Dalkilinc M, Al Qubaisi M, Campos LA, Almahmeed W, Alefishat E, Al Tunaiji H, Baltatu OC. Burnout and Cardiovascular Risk in Healthcare Professionals During the COVID-19 Pandemic. Front Psychiatry 2022; 13:867233. [PMID: 35444572 PMCID: PMC9014179 DOI: 10.3389/fpsyt.2022.867233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The objective of this study was to investigate the psychosocial and cardiovascular markers in healthcare professionals during the COVID-19 pandemic. METHODS This was a STROBE compliant, blended exploratory study. Residents, staff physicians, nurses, and auxiliary healthcare professionals from both inpatient and outpatient medicine services were recruited using a planned random probability sample. The Maslach Burnout Inventory (MBI), Fuster-BEWAT score (FBS), and socio-demographic factors, as well as sleep quality, were studied. The correlations between burnout severity and cardiovascular risk were examined using multivariable linear regression models adjusted for confounding variables, such as sociodemographic and anthropometric characteristics. RESULTS The regression analysis with FBS as the outcome showed a negative association between cardiovascular health and emotional exhaustion [Coef.(95%CI): -0.029 (-0.048, -0.01), p = 0.002]. The higher the emotional exhaustion the lower the cardiovascular health. Further, the model showed a positive association between personal accomplishment and cardiovascular health [Coef.(95%CI): 0.045 (0.007, 0.082), p = 0.02]. Emotional exhaustion was significantly positive correlated with REM sleep and light average (Spearman's rank correlation: 0.37 and 0.35, respectively, with P < 0.05). CONCLUSION The data from this study show that healthcare practitioners who are with burnout and emotional exhaustion have an elevated cardiovascular risk, however, causality cannot be determined. As an adaptive response to stressful situations, REM sleep increases. The findings of this study may be relevant in creating preventive strategies for burnout and cardiovascular risk reduction or prevention. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT04422418].
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Affiliation(s)
- Fayeza Alameri
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Noura Aldaheri
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | | | - Manea Basaloum
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | | | | | - Nnamdi Valbosco Ugwuoke
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Mai Al Qubaisi
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Luciana Aparecida Campos
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University - Anima Institute, São José dos Campos, Brazil
| | - Wael Almahmeed
- Heart and Vascular Institute - Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan.,Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Hashel Al Tunaiji
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates.,Academic and Research Committee, Zayed Military University, Abu Dhabi, United Arab Emirates
| | - Ovidiu Constantin Baltatu
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University - Anima Institute, São José dos Campos, Brazil
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