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OBJECTIVE To investigate the role of vigorous physical exertion and anger as triggers of acute coronary syndromes (ACS) and to identify the clinical and sociodemographic correlates of triggering. DESIGN Prospective observational clinical cohort study. SETTING Four coronary care units in the London area. PATIENTS 295 men and women with(More)
BACKGROUND Some cases of acute coronary syndrome (ACS) may be triggered by emotional states such as anger, but it is not known if acute depressed mood can act as a trigger. METHODS 295 men and women with a verified ACS were studied. Depressed mood in the two hours before ACS symptom onset was compared with the same period 24 hours earlier (pair-matched(More)
Experiencing an acute coronary syndrome (ACS) may provoke a range of negative emotional responses, including acute distress and fear of dying. The frequency of these emotional states has rarely been assessed. This study examined the presence and severity of the fear of dying and acute distress in 184 patients with ACS and analyzed its correlates and(More)
Activation of the innate immune system is commonly accompanied by a set of behavioural, psychological and physiological changes known as 'sickness behaviour'. In animals, infection-related sickness symptoms are significantly increased by exposure to psychosocial stress, suggesting that psychological and immune stressors may operate through similar pathways(More)
BACKGROUND Pre-hospital delays in patients experiencing acute coronary syndromes (ACS) remain unacceptably long. AIMS To examine simultaneously a wide range of clinical, sociodemographic and situational factors associated with total pre-hospital delay and its two components. METHODS Pre-hospital delay data were collected from 228 patients with ACS using(More)
AIMS Resumption of paid employment following acute coronary syndrome (ACS) is an important indicator of recovery, but has not been studied extensively in the modern era of acute patient care. METHODS AND RESULTS A total of 126 patients who had worked before hospitalization for ACS were studied with measures of previous clinical history, ACS type and(More)
The sleep-wake cycle in Parkinson's Disease (PD) is profoundly disrupted, but less is known about circadian rhythm in PD and its relationship to other important clinical features. This study compared rest-activity rhythms in healthy older adults and PD patients with and without hallucinations. Twenty-nine older adults and 50 PD patients (27 with(More)
Acute negative emotional states may act as triggers of acute coronary syndrome (ACS), but the biological mechanisms involved are not known. Heightened platelet activation and hemodynamic shear stress provoked by acute stress may contribute. Here we investigated whether patients whose ACS had been preceded by acute anger, stress, or depression would show(More)
This investigation focused on alternative methods for evaluating the impact of Chevron Corporation's Health Quest Fitness Center program on medical expenditures, comparing descriptive and multivariate research designs. Many uncontrolled studies of corporate health management programs base estimates of program effectiveness on descriptive analyses such as(More)