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The authors hypothesized that the same biopsychosocial factors that raise the risk of illness incidence would influence the speed and completeness of relief from physical symptoms during recovery following cardiac surgery. This multicenter prospective study involved 463 patients aged 35 to 69 years who underwent coronary artery bypass graft or cardiac valve surgery. Predictor data were gathered 1 to 3 days before surgery, and outcome measures were collected 6 months postoperatively. The following predictors were associated with postoperative freedom from cardiac symptoms: fewer preoperative cardiac hospitalizations; low levels of angina, dyspnea, fatigue, and sleep problems; low levels of anxiety, depression, hostility, and life-change events; and high levels of psychosocial well-being, hopefulness, overall satisfaction, and social support. The predictors of not requiring daytime bed rest because of cardiac symptoms during the 6th postoperative month were male gender, higher education, less cardiac disability preoperatively, low levels of angina, dyspnea, sleep problems, depression and fatigue, and absence of Type A behavior and of intraoperative hypotension. By using separate multiple logistic regression equations, the authors identified the variables printed in bold face as independent significant contributors to prediction. Many of the predictors are strong enough and simple enough to be used in clinical practice. Many of them may also predict recovery after acute illnesses and injuries involving other organ systems.

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The validity of the biopsychosocial approach to the study of health and illness is reaffirmed by the prospective findings of the Recovery Study. This is a multidisciplinary examination, conducted in four teaching hospitals, of the predictors of symptoms of cardiac illness in 463 patients 6 months after coronary artery bypass or cardiac valve surgery. We found that the following preoperative measures predict freedom from cardiac symptoms 6 months after surgery: low levels of all of the following: angina pain, shortness of breath, fatigue and sleep problems, lifetime cigarette usage, and preoperative hospitalization for cardiac treatment; low levels of anxiety, depression, and hostility, and few life change events; high levels of all of the following: self-esteem, well-being, vigor; prevalence of activities and hobbies, social participation, and social support. The six variables in bold print contributed independently in a multiple regression equation that accounted for 21% of the variance of the symptoms score and was associated with an estimated 45% difference in success of recovery. The statistical strength and general nature of many of the predictors indicate that the predictors may also be important in recovery from other health crises. Psychosocial and biomedical factors correlate across time (predictively), as well as cross-sectionally, indicating that psychological, social, and biological mechanisms may be parts of a single general multifaceted process influencing recovery of health. A clinical trial could determine if psychological, social, or behavioral interventions will hasten and improve recovery from physical illness or trauma.

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BackgroundPoor performance is often suspected to be associated with EIPH in barrel racing horses; however, there are no published reports of EIPH for this discipline. The prevalence of EIPH in barrel racing horses is also unknown.ObjectivesThis study was performed to determine the prevalence of EIPH and signs of airway inflammation in barrel racing horses under normal racing conditions in Alberta.AnimalsAbout 170 barrel racing horses.MethodsObservational cross‐sectional study. Tracheobronchoscopic examinations were performed at least 30 minutes postrace. Video recordings were scored off‐site independently by two observers for EIPH and tracheal mucus accumulation (TMA). Horses with an EIPH score ≥2 were not assessed for TMA. Interobserver agreement was calculated by weighted κ statistics. Run times, environmental variables, and clinical information were also recorded for analysis.Results77/170 (45.3%) of horses examined showed evidence of EIPH (grade ≥ 1). Interobserver agreement was 0.94. 140/141 (99.3%) of horses assessed for TMA showed evidence of tracheal mucus accumulation (grade ≥ 1) with 104/141 (73.8%) having a TMA score ≥ 2. Interobserver agreement was 0.73. A weak positive association was found between EIPH scores and average run speed, the presence of cough at rest reported by the riders, increased recovery time, exercise intolerance, and outdoor pattern.Conclusions and clinical importanceThe high prevalence of EIPH observed in the sampled population indicates that barrel racing induces substantial stress on the lungs. The presence of EIPH did not impact negatively on performance. Factors such as environmental dust and frequent traveling might have contributed to the high prevalence of TMA observed.