Dimensions of anger-hostility and cardiovascular reactivity in provoked and angered men

This study investigated the relationship between two dimensions of anger-hostility-the expression of anger-hostility and the experience of anger-hostility-and cardiovascular reactivity in provoked and angered men. A serial subtraction task was administered to 41 male undergraduates who were provoked and angered. A measure of the expression of anger-hostility correlated positively and significantly with systolic and diastolic blood pressure (BP) reactivity. There were no significant correlations between a measure of the experience of anger-hostility and cardiovascular reactivity. The two types of anger-hostility were also found to relate differentially to life-style variables that have been identified as risk factors for coronary heart disease (CHD), with only the expression of anger-hostility showing positive relationships with these life-style CHD risk factors. These findings are discussed within the context of a similar differential relationship between the two dimensions of anger-hostility and CAD and CHD. Finally, significant negative relationships were obtained between the experience of anger-hostility and resting BP and heart rate levels. These findings are discussed within the context of other data suggesting that trait anxiety-neuroticism may have protective properties.The research reported in this paper was supported in part by Research Grant HL-36027 from the National Heart, Lung, and Blood Institute.     

Computer assessment of life-style in a gastroenterology clinic

To examine the potential benefit of a computer-assisted interview about life-style in gastroenterology practice, 34 consecutive patients attending a gastroenterology clinic were questioned by a computer using software designed to obtain a comprehensive history of alcohol, caffeine, cigarette, and illicit drug use, together with an assessment of exercise, sexual activity, and nutrition. Comparisons of the information obtained by the computer with clinical records revealed that physicians documented only 3% of the patients as problem drinkers, 3% as caffeine abusers, and 17% as smokers, whereas the computer identified 10% of the patients as problem drinkers, 27% as caffeine abusers, and 43% as smokers. These findings imply that patients may be more apt to tell more about adverse life-style to the computer than to a physician during clinical interview. In a sample patient population from a gastroenterology clinic, a microcomputer provides an acceptable, efficient, and potentially cost-effective way to assess life-style.     

Headache in Sweden: The Importance of Working Conditions

Headache is a common health problem that causes individual suffering as well as public expense. Because epidemiological studies have shown that headache is most prevalent among persons younger than 55 years, the influence of working conditions is of interest. In this study, we examined the importance of working conditions as a risk factor for frequent headache among the general Swedish population.
Data from the Swedish Survey of Living Conditions for the 2-year period, 1988 and 1989, were used. In this survey, a probability sample of the Swedish population aged 16 years and older was interviewed. Frequent headache was defined as a positive answer to the question, "Have you (during the just 2 weeks) had recurrent headache or migraine?" Work stress was studied for two indices: physical work stress and mental work stress. The physical work stress index contained measurements of seven working conditions, and the mental work stress index contained measurements of three working conditions.
The proportion of persons who reported frequent headache was greater among women than men, and frequent headache was most common in the age group 25 to 44 years. The logistic regression analyses showed that both physical and mental work stress were strongly associated with frequent headache among both men and women even after controlling for potential confounders. The associations between work stress and frequent headache may be dose-dependent. Heavy menial work stress was most strongly associated with frequent headache among men (odds ratio 3.03 [1,92 to 4.78]) while heavy physical work stress was most strongly associated with frequent headache among women (odds ratio 3.48 [1.13 to 10.65]).
Improved working conditions could be one way of preventing headache, thereby decreasing individual suffering a and employer as well as public expense.     

A phenomenological hermeneutic access to research of the old age area. Experience with application of the qualitative research interview.

The purpose of this article is to describe the phenomenological, hermeneutic research as a scientific research method. We shall introduce the scientifically theoretical placing of the qualitative research interview and the implementation of the interview, through presentation of twelve aspects which have functioned as a scientific-theoretical/methodical guide for the whole process of interviewing. Finally, we shall briefly discuss problems connected with using the qualitative research interview as the primary method of the research process. The experience concerning the use of the qualitative research interview was gained through a study on life-style specific ways of coping with a temporary period of illness and rehabilitation of the old. A final presentation of the results of the whole study and a discussion of these are being finalized for publication.     

Interrelation between potential risk factors for cardiovascular disease in men aged 33-42 years with special reference to life-style factors: A study from Habo in the County of Skaraborg, Sweden

A population study was carried out in the community of Haboin southwestern Sweden, to which all men living in the communityaged 33–42 years were invited. Altogether 652 participated,the participation rate being 86.1%. Special reference was givento potential risk factors for coronary heart disease. Therewere significant correlations between the life-style factors(physical inactivity, smoking, alcohol intake, self-experiencedmental stress) and probable biological markers of life-stylefactors such as anthropometric data, blood pressure and serumlipids. Physical inactivity was the life-style factor whichwas most strongly associated with anthropometric measurementsand to a lower degree with serum lipid concentrations and arterialblood pressure. Of the biological markers studied, the waistto hip circumference ratio was most strongly associated withlife-style factors. The observations further emphasize the needfor a murtifactorial view on risk factors.     

The Revised Asthma Problem Behavior Checklist: Adaptation for Use in Spanish Asthmatic Patients

Behavioral problems associated with asthma management were examined in a group of 100 adult Spanish outpatients with asthma (57 women, 43 men; 17-69 years of age). All of them completed a Spanish version of the Revised Asthma Problem Behavior Checklist (RAPBC). Data about duration, severity, and self-management of asthma (self-efficacy expectancies and health care utilization), as well as dyspnea and FEVi, were also recorded. The highest-reliability Cronbach a indices were for the criteria related to emotions and behaviors that could precipitate asthma attacks. Concurrent criterion validity was examined first by Pearson correlations between the RAPBC scores and clinical data about asthma (duration, FEVi, and dyspnea), and second, by examining the differences in RAPBC scores (ANOVAs) among three severity groups of patients. Severe patients reported more behavioral problems associated with poor life-styles and self-management of their asthma and showed more psychological and physical negative consequences related to asthma. In conclusion, while the RAPBC could be considered a valid instrument to assess the behavioral problems associated with asthma in Spanish patients, and shows a good concurrent criterion validity, its reliability (internal consistency) with respect to life-style and self-management behaviors related to asthma should be improved, to ensure its utility as a screening instrument for behavior-related problems in asthmatic Spanish patients.     

强化调脂对动脉粥样硬化斑块的影响

目的:探讨强化调脂对动脉粥样硬化斑块的影响。方法:对96例经颈部血管彩色超声多普勒检查确诊为颈动脉粥样硬化斑块形成的患者为研究对象。随机分为强化调脂组和调脂组。调脂组患者进行为期8周的治疗性生活方式改变(TLC)及辛伐他汀口服;强化调脂组患者进行为期8周改进的治疗性生活方式改变(改进TLC)及辛伐他汀、维生素C口服。治疗前后采用高分辨率彩色超声多普勒观察患者颈动脉结构及血流情况,并测定颈动脉内膜-中层厚度(IMT)及血流频谱、血脂等项目,与治疗前作对照分析。结果:两组病例经治疗8周后,调脂组患者颈动脉彩超结果(颈动脉IMT、颈动脉血流的Vmax、RI、PI)与治疗前比较,差异无显著性(P>0.05),血脂检测结果 TC、TG、LDL-C均有下降(t=2.21、2.56、3.34,P<0.01),HDL-C无显著性差异(t=1.42,P>0.05)。强化调脂组患者颈动脉彩超结果(颈动脉IMT)变薄,有显著性差异(t=3.30,P<0.05),而该组颈动脉血流的Vmax、RI、PI与治疗前比较,差异无显著性(P>0.05);另外,强化调脂组患者的TC、TG、LDL-C有显著性下降(t=4.38、3.51、5.23,P<0.01),HDL-C无显著性差异(t=1.19,P>0.05)。结论:强化调脂是治疗动脉粥样硬化安全可靠的一种方案。     

Early Detection and Basic Management of Alcohol and Drug Problems

Abstract: Traditional approaches to the treatment of alcoholism have focused on the chronic alcoholic where limited impact has been achieved in terms of improvement in health or reduction in social costs. If individuals could be identified shortly after their drinking problem develops, then successful treatment by brief intervention is more likely. Although the prevalence of alcoholism in North America is around 5 to 7% of the adult population, a much larger group (20–30%) of individuals have drinking problems without major symptoms of alcohol dependence. These problem drinkers are the target audience for early identification and brief intervention. A major thrust of my research has been the development of practical assessment tools for use by health and social service professionals. One line of research has evaluated the diagnostic value of laboratory tests and medical history data. A brief, 5-item history of traumatic injuries (Trauma Scale) correctly identified 7 out of 10 problem drinkers, and diagnostic accuracy was further improved by combining the Trauma Scale and 3 laboratory tests in a composite index. This index could be used in medical settings as an “indirect” method of detecting excessive drinking. Another research line has produced questionnaires that directly inquire about alcohol/drug problems. These instruments can be used as case finding tools to signal the presence of an alcohol or drug problem (e.g., Drug Abuse Screening Test), or, at a subsequent stage of assessment, to provide more detailed information on the severity of the problem and treatment priorities. I have concentrated on evaluating a computerised lifestyle assessment of patients visiting their family doctor. The availability of low cost microcomputers offers considerable potential for assisting the busy clinician. A recent study found that the computerised lifestyle assessment was well accepted by patients. Moreover, the lifestyle assessment had a “priming effect” which resulted in a two- or three-fold increase in patients' intentions of discussing a substance use problem with their physician. Presently, the computerised lifestyle assessment is being linked with an evaluation of three brief interventions. This project will establish cost-effective strategies that can be readily incorporated in hospitals and family practices for dealing with the early stage problem drinker.     

Case-control study of prostate cancer and socioeconomic factors

A total of 1,162 prostate cancer cases and 3,124 age-matched hospital controls from several U.S. hospitals were studied to identify associations between prostate cancer and life-style variables. Among white males, college education, professional occupation, and non-Jewish ethnicity were weakly associated with the risk of prostate cancer (ORs = 1.5, 1.8, and 1.3, respectively, P less than 0.01). These relationships retained statistical significance after adjustment for age, marital status, body mass, cigarette smoking, alcohol consumption, and physical activity in multiple logistic regression models. Among black males, similar, though nonsignificant, risk elevations were observed for education and occupation. Weak positive effects of borderline statistical significance were observed for high body mass, low physical exercise, and high serum cholesterol (in elderly males only), and a significant reduction in risk was noted for never married black males. Cigarette smoking and alcohol consumption were not related to the risk of prostate cancer.     

Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system

Objective: This paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system.

Design: A qualitative, explorative study design was used, examining 20 audio- (n?=?10) and video-recorded (n?=?10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301.

Setting: Four primary health care centers in Sweden.

Subjects: Patients with hypertension (n?=?20) and their health care professional (n?=?7).

Results: The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities.

Conclusion: Patients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management

• Key points

• The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style.

  • This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations.

  • Self-reporting combined with increased patient–health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life.

  • These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.