Anxiety Disorder Journal

Sign language interpreting is one of the highest-risk professions for ergonomic injury, according to a new study conducted by Rochester Institute of Technology. The research indicates that interpreting causes more physical stress to the extremities than high-risk tasks conducted in industrial settings, including assembly line work. It also found a direct link between an increase in the mental and cognitive stress of the interpreter and an increase in the risk of musculoskeletal injuries such as carpal tunnel syndrome and tendonitis.

The research, conducted through RIT’s Department of Industrial and Systems Engineering, is one of the first to catalog the effect of signing on interpreters and show a correlation between mental and cognitive stress and increased ergonomic risk. The results of the study are available in the March 2008 edition of the peer-reviewed journal Ergonomics and were also presented at the 2007 biennial conference of the Registry of Interpreters for the Deaf.

“The impact of repetitive stress in industrial and office settings has been well documented, but there is less data on the risk of ergonomic injury to sign language interpreters,” says Matthew Marshall, associate professor of industrial and systems engineering at RIT and a leader of the research group. “Our findings indicate that interpreters may actually be at a higher risk of injury than other professions.”

Marshall notes that the impact of injury on interpreters and its effect on retention is a major issue in the deaf community because any reduction in the interpreter population would have an adverse effect on the full societal participation of deaf and hard-of-hearing individuals.

“Gaining a better understanding of the factors contributing to interpreter injury can show us ways to intervene and reduce the risks,” adds Steve Nelson, director of access services for the National Technical Institute for the Deaf. “Informed intervention can help drastically reduce injuries and keep much-needed skilled interpreters at work.”

In developing its findings, the RIT team studied a group of interpreters and measured the physical impact of signing over a fixed time period, utilizing metrics developed for industrial settings. The team found that wrist velocity and acceleration during interpreting, factors used to measure physical impact, were more acute than the high risk limits for industrial workers. In addition, an increase in mental and cognitive stress led to a 15-19 percent increase in wrist velocity and acceleration during interpreting.

Marshall will next look to enhance this data through additional studies placing interpreters in a wide variety of settings. The information will assist in furthering understanding of the impact of sign language interpreting on repetitive stress, while also assisting organizations in developing better training programs to reduce ergonomic risk.

“The ultimate goal is to enhance knowledge of the impacts of interpreting and help make the profession more conducive for workers,” notes Marshall.

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Fruit flies’ ability to discern one sex from another may depend on the number of receptors on the surface of nerve cells, and the number of receptors is controlled by levels of a ubiquitous brain chemical, University of Illinois at Chicago researchers have found.

Everything from the ability to concentrate, perceive and learn to debilitating illnesses such as amyotrophic lateral sclerosis, muscular dystrophy, post-traumatic stress syndrome and schizophrenia is influenced by the number of receptors on nerve cells. The more receptors each cell has at its communication points, or synapses, the better that messages are carried through the brain.

A UIC research team led by David Featherstone, assistant professor of biological sciences, has discovered that receptor numbers are controlled by the brain’s level of glutamate. But it is not the same glutamate that most neuroscientists think about — the neurotransmitter that moves in message packets across the synapse. Instead, it is what Featherstone calls ambient extracellular glutamate, which just floats around the nervous system and has generally been ignored because no one knew where it came from or what it was doing.

For years, scientists failed to identify glutamate as a key neurotransmitter precisely because there was so much of it.

“It made no sense,” said Featherstone. “People figured you couldn’t use glutamate to send messages because there was too much glutamate background noise in the brain. It turns out that this background noise plays an important part in regulating information transfer.”

Featherstone and his lab team found that glia cells are the source of the excess ambient glutamate. Along with neurons, these poorly understood “support” cells fill the brain.

The team discovered proteins in fruit fly glia cells that regulate the amount of ambient glutamate in the brain. Called xCT transporter proteins, they pump glutamate out of glia cells.

“When we mutate the protein, we get less ambient extracellular glutamate, more glutamate receptors, and so a stronger transfer of messages at synapses,” Featherstone said.

The gene mutation also made the flies bisexual, leading him to name the gene “genderblind.”

“The mutants are completely bisexual, but fertile. It’s the first gene that really specifically affects homosexual behavior without affecting heterosexual behavior,” he said.

“Trying to understand fly bisexuality sounds silly, but these behavioral changes are important evidence that ambient extracellular glutamate and xCT transport proteins play important, unsuspected roles in brain function,” Featherstone said. “We think we’ll be able to learn a lot about perception and development from figuring out exactly what’s happening in these flies.

“It’s amazing how many biomedical breakthroughs have come from crazy directions.”

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Children who are anxious before surgery experience a more painful, slow, and complicated postoperative recovery, according to a Yale School of Medicine study published this month in Pediatrics.

The study is important, said lead author, Zeev Kain, M.D., professor in the Departments of Anesthesiology, Pediatrics, and the Yale Child Study Center, because more than five million children in the United States undergo surgery every year and up to 45 percent experience significant stress and anxiety prior to surgery.

In his five-year study supported by the National Institutes of Health (NIH), Kain and his team recruited 241 children aged five- to 12-years-old who were scheduled to undergo elective tonsillectomy and adenoidectomy. The personality characteristics of the children and their parents were assessed before the surgery. All of the children were admitted to a research unit at Yale following the surgery and postoperative pain and analgesic consumption were recorded every hour. After 24 hours in the hospital, the children were discharged and followed up at home for the next 14 days.

The researchers found that anxious children experienced more problems emerging from anesthesia and significantly more pain both during the hospital stay and over the first three days at home. During home recovery anxious children also consumed significantly more codeine and acetaminophen and had a higher incidence of postoperative anxiety and sleep problems.

“The results of our study indicate that decreasing the anxiety of children before surgery will result in improved recovery after surgery, reduced pain, and lower hospital costs,” Kain said. “But ongoing randomized, controlled trials are needed to clearly draw this conclusion.” Kain and his colleagues currently are examining this issue in an NIH funded study.

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A new online poll conducted by WEJZ-FM radio reveals that traffic from the daily commute and roadway construction in and around Jacksonville are the leading causes of stress in the city, according to the respondents. The poll also found that Jacksonville residents are most likely to react to stress by getting less sleep. Eisai Inc. and PriCara(TM), Unit of Ortho-McNeil, Inc., sponsored the poll as part of a program about acid reflux disease that they are conducting in Jacksonville.

While stress affects people in a variety of ways, everyone experiences stress at some point in life. Stress can even lead to behaviors that may aggravate symptoms of certain conditions, such as acid reflux disease, which affects more than 7 million Americans. Conversely, engaging in healthy behaviors in response to stress may prevent symptoms of reflux from getting worse.

“Stress from things you can’t control, like traffic or roadway construction, may lead to behaviors that can have an effect on your health,” said Nancy Mramor, PhD, noted health psychologist. “My goal is to help people take steps to lessen their stress and have a healthy response to stress.”

According to Antony Maniatis, MD, of the Borland-Groover Clinic in Jacksonville, “In my practice, I see an increasing number of patients suffering from acid reflux disease. While stress does not cause acid reflux disease, it can lead to behaviors that may aggravate the condition.

“In addition to finding ways to lower their stress levels through lifestyle changes, there are treatment options for acid reflux disease available to patients, such as ACIPHEX(R), or rabeprazole sodium, a prescription medication that reduces acid production in the stomach. People should talk to their doctors to find out what they can do to control their acid reflux disease,” Dr. Maniatis said.

According to Dr. Mramor and Dr. Maniatis, the following simple lifestyle changes can help ease stress:

— Lead a healthy lifestyle. Eat sensibly, get enough rest, exercise regularly and balance work with play. Be sure to check with your doctor before starting any new exercise program. Watch your caffeine and alcohol intake – both can upset your sleep patterns as well as trigger acid reflux disease.

— Make time for yourself. Take the time to read a book, watch a movie, garden or indulge in a warm bath. You may also want to try a new hobby or join a club.

— Set realistic goals. Don’t try to take on too much at once. If you feel overwhelmed by responsibilities and events in your schedule, learn to say “no” or at least to find an acceptable compromise.

— Find someone with whom you can talk. Seek out the support and guidance of friends, colleagues and family members. You may find that you’re not the only one having a bad day.

— Don’t worry about what you can’t control. Some things are completely out of your control, like traffic and the weather. Identify what you can’t change and learn to let it go.

About ACIPHEX(R) (rabeprazole sodium) ACIPHEX(R) is a prescription medication. One ACIPHEX 20 mg tablet daily is used for the treatment of persistent, frequent (2 or more days a week) heartburn and other symptoms associated with acid reflux disease.

ACIPHEX is also used for the short-term (4 to 8 weeks) treatment in the healing and symptom relief of damaging (erosive) acid reflux disease (gastroesophageal reflux disease) and to maintain healing of damage (erosions) and relief of heartburn symptoms that happen with acid reflux disease. ACIPHEX has not been studied for treatment lasting longer than 12 months (1 year).

Important Safety Information

ACIPHEX has a well-established safety profile. The most common side effect possibly related to ACIPHEX is headache. Symptom relief does not rule out other serious stomach conditions. Patients on warfarin (such as Coumadin(R)) may need to be monitored more closely by their doctor. To learn more, talk to your doctor and see the important product information at http://www.aciphex.com.

To obtain more information about acid reflux disease, please visit http://www.aciphexoffer.com.

About Acid Reflux Disease

Acid reflux disease occurs when stomach acid regularly escapes into the esophagus. A common symptom is heartburn. Persistent, frequent (2 or more days a week) heartburn, despite use of over-the-counter (OTC) medications and diet changes, could be acid reflux disease (sometimes referred to as GERD – gastroesophageal reflux disease). It’s a condition that could get progressively worse if left untreated. Acid reflux disease can cause a number of symptoms in addition to heartburn, including regurgitation, belching, bloating, and early satiety (feeling full too soon).

Survey Methodology and Results

The survey was conducted by WEJZ-FM, Jacksonville, through an online survey of 142 listeners on behalf of Eisai/PriCara, May 28-June 13, 2007. When asked what causes them the most stress, 48.6 percent of respondents reported traffic from the daily commute; an additional 23.2 percent reported that roadway construction in and around Jacksonville caused the most stress. Additionally, 43 percent of respondents reported that they are most likely to react to stress by getting less sleep.

About Eisai Inc.

Eisai Inc. is a U.S. pharmaceutical subsidiary of Eisai Co., Ltd., a research-based human health care (hhc) company that discovers, develops and markets products throughout the world. Eisai focuses its efforts in three therapeutic areas: neurology, gastrointestinal disorders and oncology/critical care. Established in 1995 and ranked among the top-20 U.S. pharmaceutical companies (based on retail sales), Eisai Inc. began marketing its first product in the United States in 1997 and has rapidly grown to become an integrated pharmaceutical business with sales of approximately $2.6 billion in fiscal year 2006 (year ended March 31, 2007). Eisai Inc. employs approximately 1,500 people at its headquarters in Woodcliff Lake, NJ, at its state-of-the-art pharmaceutical production and formulation research and development facility in Research Triangle Park, NC, and in the field. For more information about Eisai, please visit http://www.eisai.com.

About PriCara(TM), Unit of Ortho-McNeil, Inc.

PriCara(TM), Unit of Ortho-McNeil, Inc., is a major healthcare company dedicated to the needs of primary care providers who serve a vital role on the frontline of medicine. Based in Raritan, NJ, PriCara provides high quality prescription medicines, education and resources in the areas of pain, gastrointestinal and infectious diseases. For more information about the company, please visit http://www.PriCara.com.

ACIPHEX is a registered trademark of Eisai Co., Ltd.

Coumadin is a registered trademark of Bristol-Myers Squibb Pharma Company.

Eisai Inc.; PriCara(TM)
http://www.eisai.com

Contrary to popular notions about what is normal or healthy, new research has found that it is okay not to express one’s thoughts and feelings after experiencing a collective trauma, such as a school shooting or terrorist attack.

In fact, people who choose not to express their feelings after such an event may be better off than those who do talk about their feelings, according to University at Buffalo psychologist Mark Seery, Ph.D., lead author of a study to appear in the June issue of Journal of Consulting and Clinical Psychology.

The study investigated the mental and physical effects of collective traumas on people who are exposed to a tragedy but who do not experience a direct loss of a friend or family member. It focused on people’s responses to the terrorist attacks of Sept. 11, 2001, but the results may generalize to include responses to other collective traumas.

The findings have important implications for expectations of how people should respond in the face of a collective trauma affecting a whole community or even an entire nation, says Seery, an assistant professor of psychology..

Seery says the results should not be interpreted to mean that expressing one’s thoughts and feelings is harmful or that if someone wants to express their emotions they should not do so. “It’s important to remember that not everyone copes with events in the same way, and in the immediate aftermath of a collective trauma, it is perfectly healthy to not want to express one’s thoughts and feelings,” he says.

Seery points out that immediately after last year’s tragic shootings at Virginia Tech University there were many “talking head” psychiatrists in the media describing how important it is to get all the students expressing their feelings.

“This perfectly exemplifies the assumption in popular culture, and even in clinical practice, that people need to talk in order to overcome a collective trauma,” Seery says.

“Instead, we should be telling people there is likely nothing wrong if they do not want to express their thoughts and feelings after experiencing a collective trauma. In fact, they can cope quite successfully and, according to our results, are likely to be better off than someone who does want to express his or her feelings.”

Using a large national sample, Seery and co-researchers tested people’s responses to the terrorist attacks of 9/11, beginning immediately after the event and continuing for the following two years. In an online survey, respondents were given the chance to express their thoughts and feelings on the day of 9/11 and a few days afterward.

The researchers then compared people who chose to express their thoughts and feelings versus those who chose not to express.

If the assumption about the necessity of expression is correct — that failing to express one’s feelings indicates some harmful repression or other pathology — then people who chose not to express should have been more likely to experience negative mental and physical health symptoms over time, the researchers point out.

“However, we found exactly the opposite: people who chose not to express were better off than people who did choose to express,” Seery says.

Moreover, when the researchers looked only at people who chose to express their thoughts and feelings, and tested the length of their responses, they found a similar pattern. People who expressed more were worse off than people who expressed less.

“We assessed various alternative explanations in secondary analyses, but nothing else accounts for this effect,” Seery says.

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The latest in the series of Courage to Care fact sheets targeted to support our nation’s military service members and their families are now available on the web. Suicide Facts for Primary Care Providers: Helping Service Members and Families Overcome Barriers to Care”; “Suicide Facts: What Military Families Should Know to Help Loved Ones Who May Be at Risk”; and, “Health Literacy: Addressing Communication Barriers to Foster Patient Self-Care and Family Care” have been added to the collection of educational resources available from the Center for the Study of Traumatic Stress (CSTS) at http://tinyurl.com/bk58gx.

“Rates of suicide are tragically elevated amongst soldiers. It is most important to identify those at risk and help them access care,” said Robert J. Ursano, M.D., CSTS Director at the Uniformed Services University of the Health Sciences (USU). “The newest issues of Courage to Care address suicide warning signs, risk factors, and the barriers to care often felt by those in need. If we can educate the families and friends of our service members, and at the same time provide a valuable resource for the service members directly, we can help to reduce ‘job-related’ stress and at times even save lives, while also improving operational effectiveness and performance within the military.”

Courage to Care is an ongoing health communication initiative of USU and CSTS, which is part of the USU Department of Psychiatry and a partnering center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Courage to Care disseminates timely and important issues to enhance and sustain the well-being of our military community. Courage to Care fact sheets are in the public domain and are available for reposting on outside organization’s websites and for redistribution. Each installment includes a fact sheet for healthcare professionals and a fact sheet for families and patients. Courage to Care can be distributed in office waiting areas, or on an organization’s website.

Located on the grounds of Bethesda’s National Naval Medical Center and across from the National Institutes of Health, USU is the nation’s federal school of medicine and graduate school of nursing. The university educates health care professionals dedicated to career service in the Department of Defense and the U.S. Public Health Service. Students are active-duty uniformed officers in the Army, Navy, Air Force and Public Health Service, who are being educated to deal with wartime casualties, natural disasters, emerging infectious diseases, and other public health emergencies. Of the university’s more than 4,200 physician alumni, the vast majority serve on active duty and are supporting operations in Iraq, Afghanistan, and elsewhere, offering their leadership and expertise.

Uniformed Services University of the Health Sciences (USU)
4301 Jones Bridge Rd.
Bethesda
MD 20814-4799
United States
http://www.usuhs.mil

Reshaping of the DNA scaffolding that supports and controls the expression of genes in the brain may play a major role in the alcohol withdrawal symptoms, particularly anxiety, that make it so difficult for alcoholics to stop using alcohol.

The finding is reported by researchers at the University of Illinois at Chicago and the Jesse Brown VA Medical Center in the April 2 issue of the Journal of Neuroscience.

DNA can undergo changes in function without any changes in inheritance or coded sequence. These “epigenetic” changes are minor chemical modifications of chromatin — dense bundles of DNA and proteins called histones.

“This is the first time anyone has looked for epigenetic changes related to chromatin remodeling in the brain during alcohol addiction,” said Dr. Subhash C. Pandey, professor and director of neuroscience alcoholism research at the UIC College of Medicine and the Jesse Brown VA Medical Center in Chicago, the lead author of the study.

Chemical modification of histones can change the way DNA and histones are wound up together. Histone acetyltransferases (HATs) are enzymes that add acetyl groups to histones and loosen the packing, promoting gene expression. On the other hand, histone deacetylases (HDACs) remove acetyl groups from histones, causing them to wrap with DNA more tightly, decreasing gene expression.

The UIC researchers had previously shown in an animal model that levels of neuropeptide Y in the amygdala modulate anxiety and alcohol-drinking behavior. In the new study, they looked at the HDAC activity, acetylation of histones, and expression of the genes for NPY in the amygdala and the anxiety-like behaviors associated with withdrawal from chronic alcohol use.

Pandey and his colleagues found that acute exposure to alcohol decreases HDAC activity; increases the acetylation histones; increases levels of NPY — and reduced anxiety in the animals.

Conversely, anxiety-like behaviors during withdrawal in animals with chronic alcohol exposure was associated with an increase in HDAC activity and decrease in histones acetylation and NPY levels.

Importantly, blocking the observed increase in HDAC activity using an HDAC inhibitor during alcohol withdrawal brought up histone acetylation and NPY expression levels in the amygdala and prevented the development of anxiety-like behaviors.

“Our findings suggest that HDAC inhibitors may have potential as therapeutic agents in treating alcoholism,” Pandey said.

The researchers also found that levels of a protein known as CREB binding protein, which has HAT enzymatic activity, were increased by acute alcohol but were decreased during ethanol withdrawal.

They concluded that the enzymes that are involved in remodeling of chromatin play an important role in the anxiety that accompanies alcohol withdrawal as well as in the anti-anxiety effects of acute alcohol use.

“We need new strategies to treat alcoholism that are directed toward the prevention of withdrawal symptoms,” Pandey said. “Anxiety associated with withdrawal from alcohol abuse is a key factor in the maintenance of alcohol addiction.”

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Researchers at UT Southwestern Medical Center, working with mice, have shown how the body’s own natural stress hormone can help lastingly decrease the fearful response associated with reliving a traumatic memory.

Days after experiencing a traumatic event – a mild electrical shock -mice in the study still showed a fearful response when re-exposed to the place where it happened, a condition that could be a model for post-traumatic stress disorder in humans. But mice receiving the hormone corticosterone at the time they “relived” the event experienced a significant drop in that fear.

“Corticosterone appears to enhance new memories that compete with the fearful memory thereby decreasing its negative emotional significance,” said Dr. Craig Powell, senior author and assistant professor of neurology and psychiatry at UT Southwestern. “When an animal or human is exposed to or relives an aversive scenario, a process called extinction creates a competing memory.”

“We’re not erasing memories,” said Dr. Robert Greene, professor of psychiatry at UT Southwestern and another author of the study. “What the steroid does is attenuate the fear memory by helping the mice to learn that these contexts should no longer be perceived as dangerous.”

The study is being published online and in the Sept. issue of the Journal of Neuroscience.

While other researchers have tested such steroids clinically with some success for patients with disorders of emotional memories such as post-traumatic stress disorder (PTSD) and phobias, those studies did not control for a number of variables and were not designed to address the mechanism of the drug’s action, Dr. Greene said.

This study focused on a mechanism called extinction, in which a memory gradually diminishes, but can be re-established by a small reminder of the original event.

“Our studies show that glucocorticoids work specifically to enhance the extinction of fear memory, as opposed to other mechanisms affecting recall, such as eliminating the memory entirely,” said Dr. Greene. “This provides a proof of principle, and is an essential step in advancing this therapeutic approach.”

A UT Southwestern study is now under way in collaboration with the Dallas VA Medical Center with veterans suffering from PTSD to see if receiving a stress hormone while reliving their memories can reduce their disabling fear responses to their traumatic memories.

“The natural release of stress hormones during recall of a fearful memory may be a natural mechanism to decrease the negative emotional aspects of the memory,” said Dr. Jacqueline Blundell, a postdoctoral fellow in neurology at UT Southwestern and one of the paper’s co-lead authors. “Conversely, patients with post-traumatic stress disorder have blunted stress hormone responses and thus may not decrease fearful memories normally over time.”

In the published study, mice were placed in a plastic box and given an electrical shock to the feet equal to the standard protocol for this type of research. The shock, Dr. Powell said, is similar to a static electricity shock people experience when wearing socks on carpet and then touching metal. “Except that instead of a brief spark, it persists for two seconds,” he said. “It’s more than enough to scare you, makes you react briskly, and makes you hesitant to touch the door handle again.”

The mice were returned to the box two days later, and their fear, gauged by how long they “froze” in place, remained high. A few minutes later, they were injected with the stress hormone corticosterone.

The day after the injection, when they were returned to the box, the mice showed significantly less fear. The strength of this effect depended on the dosage of the hormone given.

In order for the effect to work, the corticosterone had to be given after the mice were returned to the site of the initial trauma, causing the memory to be re-activated. Giving it beforehand or giving it without placing the mice in the box had no effect when tested a day later.

However, when the injections were given over four days, the timing became less important – giving the steroid either before or after secondary exposure to the box reduced fear.

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Harvard Health Publications, the publishing division of Harvard Medical School, today announced the creation of its online Stress Resource Center at http://www.health.harvard.edu/stress. The resource center was created to help the general public understand the ways that daily stress affects their bodies and how they can reduce these damaging effects.

The Stress Resource Center was unveiled by Dr. Michael Miller, editor in chief of Harvard Health Publications’ Harvard Mental Health Letter, in his appearance today on the Martha Stewart Show, in a segment titled “Stress Less with Dr. Michael C. Miller.”

Harvard Health Publications’ Stress Resource Center offers a variety of tools, including:

- How Stress Affects Your Body: An interactive illustration showing how stress triggers physical changes in the body
- How to Measure Your Blood Pressure at Home, an instructional video showing how to monitor blood pressure at home to make sure it’s not rising too high
- Q & A — The Impact of Stress: Answers to five common questions about how stress affects your health
- The Portable Guide to Stress Relief, which includes tips on taking the sting out of 10 common stressors and instructions for doing mini-relaxations: http://www.health.harvard.edu/stress-relief.

The Stress Resource Center also provides links to stress-related articles from other Harvard Health Publications newsletters and special health reports, including the Harvard Mental Health Letter, Harvard Health Letter, Harvard Heart Letter, Harvard Men’s Health Letter, and Harvard Women’s Health Letter. Topics include:

- Resilience: Remaining mentally strong and healthy during times of stress
- Caregiver Stress: When helpers need help
- Sing Along for Health: Singing to boost mood, relieve stress, promote relaxation, and enhance the immune system
- Optimism and Your Health

As part of Dr. Miller’s appearance on the Martha Stewart Show, Harvard Health Publications distributed to the studio audience 200 free copies of its special health report Stress Management: Approaches for preventing and reducing stress. This report helps readers identify stress warning signs and provides information on how to better manage stressful situations.

http://www.health.harvard.edu features additional health resources, diagnostic tools, and customer reviews of products.

http://www.health.harvard.edu

Caring for a family member with a serious heart ailment may increase your risk of cardiac disease, according to a report presented at the American Heart Association’s 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

Researchers examined heart risk factors in family members of cardiac patients and found that those who provided all or most of a patient’s care had higher levels of risk factors for heart disease than non-caregivers and those who reported higher caregiver strain after six months were more likely to be depressed than those who provided less or no care. There is growing evidence that suggests stress and depression may play an important role in the development of cardiovascular disease.

“It appears that cardiac caregivers may be at increased risk of cardiac diseases themselves,” said Lori Mosca, M.D., Ph.D., senior author of the study and professor of medicine and director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center. “When a cardiac patient is hospitalized, there may be a unique opportunity to identify and help family members at risk of heart disease themselves.”

In a second study, Mosca and her colleagues found that educating caregivers and family members of hospitalized cardiac patients about their own heart risks and providing them information about a heart-healthy diet improved their eating habits after six weeks.

The researchers conducted both studies as part of the ongoing National Institutes of Health-sponsored Family Intervention Trial for Heart Health (F.I.T. Heart), for which Mosca is the principal investigator. She said participants in the trial will be followed for one year.

“As doctors, we need to recognize that cardiac caregivers may be at increased risk of heart problems,” Mosca said. “And there is a high prevalence of cardiac caregivers that we can identify who may potentially benefit from education and outreach programs.”

Prior to launching F.I.T. Heart, she and her team reviewed medical studies related to the health issues of people providing care to family members with chronic problems.

“Almost everything we found was on Alzheimer’s disease, cancer or disabled children,” Mosca said. “We found very few studies on the risks of cardiac caregivers.”

For F.I.T. Heart, researchers recruited 501 family members or co-habitants of patients hospitalized for such cardiac events as a heart attack or narrowed arteries that required bypass surgery or an angioplasty procedure. Six months later, researchers determined the approximate time each spent as a caregiver, and assessed their lifestyles, psychological strain and whether they were depressed.

For their analysis, the team designated 39 percent of the sample as primary caregivers (those who provided care all or most of the time), 11 percent were caregivers most of the time, 32 percent were caregivers some of the time or occasionally, and 17 percent were caregivers none of the time. Caregivers were significantly more likely than non-caregivers to be women (63 percent), married or living with someone, older than age 50, unemployed and people who did not complete high school. They were also less likely to adhere to heart risk-reduction dietary guidelines than non-caregivers, consuming significantly more saturated fat and having larger waist measurements. Mosca said the team identified several characteristics of caregivers that increase their risk for heart disease.

The average strain scores of caregivers six months after their loved ones were hospitalized were significantly higher among those with depression and low social support, even after the researchers adjusted for gender, marital status and levels of depression and social support at enrollment.

“There is an association between depression and higher caregiver strain,” Mosca said. “We don’t know if high caregiving strain leads to depression or if depression makes you more strained.”

Researchers hypothesized that family members of a hospitalized heart patient might think at the time about their own risk of cardiac disease. If so, “this is a motivational moment and a unique opportunity to educate them and help them lower their risks,” Mosca said.

In the second study, participants in F.I.T. Heart received dietary advice on how to reduce their heart risks, most of them during the time the patient was in the hospital.

Six weeks later, the family members showed a significant increase, 79 percent versus 53 percent at enrollment, in the number following the National Heart, Lung, and Blood Institute’s Therapeutic Lifestyle Change diet. The diet restricts saturated fat to 7 percent of calories consumed, total fat to less than 30 percent of calories, and cholesterol to 200 milligrams per day.

Researchers found that participants’ willingness to change their eating patterns was predicted by high blood glucose or triglycerides at enrollment, a perception of poor health and a younger age.

“It’s important that we develop more systematic approaches to identifying caregivers, educating them and providing them with the proper support systems,” Mosca said. “If a caregiver dies of a heart attack, it’s not going to help the cardiac patient.”

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