Depression

Colombo, Joseph; Arora, Rohit; DePace, Nicholas L.; Vinik, Aaron I.

doi:10.1007/978-3-319-07371-2_16

Cited by 2 publications

(13 citation statements)

References 23 publications

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“…Again, this is not always the case as shown in Figure 5 . In fact, many younger (12 to 30 years old), otherwise healthy patients complaining of LH present with similar results, and most of these are tilt-negative [ 8 ]. Younger (healthier), tilt-table-positive, syncope patients, often demonstrate normal, average autonomic responses (see the stand response plot in Figure 5 ); however, the instantaneous S-response to stand is comparable to (less than a 3 : 1 ratio) or greater than that to Valsalva (see the S-response curve in the Trends plot in Figure 5 ).…”

Section: Resultsmentioning

confidence: 98%

“…This patient's peak S-response (the red curve) during stand (section “F” in the trends plot) is greater than the patient's peak S-response during Valsalva (section “D” in the trends plot). This is an “instantaneous SE” and is also associated with syncope, including tilt-positive patients [ 8 ]. The normal peak S-response relationship between Valsalva and stand is greater than 3 : 1, as exemplified in Figure 3 .…”

Section: Resultsmentioning

confidence: 99%

“…Younger (healthier), tilt-table-positive, syncope patients, often demonstrate normal, average autonomic responses (see the stand response plot in Figure 5 ); however, the instantaneous S-response to stand is comparable to (less than a 3 : 1 ratio) or greater than that to Valsalva (see the S-response curve in the Trends plot in Figure 5 ). Again, physiologically, the Valsalva challenge is a much more strenuous S-challenge than stand should be, at least three times as great [ 8 ]. This is a function of the fact that the average S-response to stand is averaged over 300 seconds, whereas the average S-response to Valsalva is averaged over 90 seconds.…”

Section: Resultsmentioning

confidence: 99%

“…This enables autonomic transients and the dynamic activity of P&S interactions to be captured and analyzed. The resulting P&S terms are respiratory frequency area (RFa) and low frequency area (LFa), respectively, and sympathovagal balance (SB = LFa/RFa) is computed as a true ratio of independent parameters [ 8 ]. See the differences between LF and HF and LFa and RFa in Figure 1 [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…In general, an S-excess (SE) response to the stand challenge is associated with syncope. Abnormal sympathetic responses to stand differentiate syncope (SE) from orthostatic dysfunction (e.g., POTS; SW) [ 8 , 24 ]. The subtypes of syncope are defined by the demonstration of P-excesses (PE) somewhere during the clinical challenge [ 9 ] or an abnormal HR response to stand.…”

Section: Introductionmentioning

confidence: 99%

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Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

DePace

Bateman

Yayac

et al. 2018

Cardiology Research and Practice

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Syncope is difficult to definitively diagnose, even with tilt-table testing and beat-to-beat blood pressure measurements, the gold-standard. Both are qualitative, subjective assessments. There are subtypes of syncope associated with autonomic conditions for which tilt-table testing is not useful. Heart rate variability analyses also include too much ambiguity. Three subtypes of syncope are differentiated: vasovagal syncope (VVS) due to parasympathetic excess (VVS-PE), VVS with abnormal heart rate response (VVS-HR), and VVS without PE (VVS-PN). P&S monitoring (ANSAR, Inc., Philadelphia, PA) differentiates subtypes in 2727 cardiology patients (50.5% female; average age: 57 years; age range: 12–100 years), serially tested over four years (3.3 tests per patient, average). P&S monitoring noninvasively, independently, and simultaneously measures parasympathetic and sympathetic (P&S) activity, including the normal P-decrease followed by an S-increase with head-up postural change (standing). Syncope, as an S-excess (SE) with stand, is differentiated from orthostatic dysfunction (e.g., POTS) as S-withdrawal with stand. Upon standing, VVS-PE is further differentiated as SE with PE, VVS-HR as SE with abnormal HR, and VVS-PN as SE with normal P- and HR-responses. Improved understanding of the underlying pathophysiology by more accurate subtyping leads to more precise therapy and improved outcomes.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

DePace

Bateman

Yayac

et al. 2018

Cardiology Research and Practice

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The Role of Social Context in Physiological and Psychological Restoration in a Forest: Case Study of a Guided Forest Therapy Program in Taiwan

Chen

Chao

et al. 2021

IJERPH

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Existing studies have demonstrated the restorative benefits of being in forests. However, most studies have designed participants to engage individually in forest walking and viewing, which neglects the social aspect of conversation. Researchers suggested that social context should be studied in order to have a better understanding how forests foster human health. To this end, we examined the role of social context using three types of forest therapy programs: a guided program, a self-guided program, and a walk alone program. A between-subject, pretest–posttest field experimental design was employed to evaluate restorative effects by measuring the physiological responses and mood states incurred in different forest therapy programs. Our findings showed, that the walk alone group exhibited a significant systolic blood pressure decrease and a significant increase in sympathetic nervous activity; the self-guided group showed a significant increase in heart rate values and significant decreases in systolic blood pressure and diastolic blood pressure; and the guided group revealed a significant decrease in systolic blood pressure. Further, the three forest therapy programs had positive effects on improving mood states, except a nonsignificant vigor–activity increase in the walk alone group. The three programs did not exhibit significant differences in changes of restorative benefits in physiological and psychological measures except for a significant difference in changes in sympathetic nervous activity between the walk alone group and guided group. The results showed the restorative benefits of forest therapy are apparent regardless of the program type. The management team should continue promoting forest therapy for public health by providing different types of forest therapy programs and experiences.

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Depression

Cited by 2 publications

References 23 publications

Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

The Role of Social Context in Physiological and Psychological Restoration in a Forest: Case Study of a Guided Forest Therapy Program in Taiwan

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