The Framingham Type A behaviour pattern and coronary heart disease in three countries: a cross-cultural comparison.

The Framingham Type A behaviour pattern (TABP), a risk factor for cardiovascular disease mortality, was examined in a cross-cultural study involving three countries known to differ in cardiovascular disease mortality, namely Germany, Lithuania and Northern Ireland. The factorial structure of the Framingham TABP scale was strikingly similar in the three countries, with three factors (work pressure, hard driving, and impatience) identified; evidence for the cross-cultural validity of the scale. Scores on all three factors showed considerable variation between the three populations for both men (multivariate P < 0.0001) and women (multivariate P < 0.0001). Of particular note, on the two factors, hard driving and impatience, thought to be core pathogenic elements in the TABP complex, Lithuanian and Northern Irish males and females scored substantially higher than their German counterparts. These cross-cultural variations in levels of risk are discussed in the context of the different ischaemic heart disease mortality rates in the three countries.     

The John Henryism and Framingham type A scales. Measurement properties in elderly blacks and whites

In 1984-1985, the authors interviewed 1,017 participants in the Charleston Heart Study in Charleston County, South Carolina to investigate the measurement properties of the Framingham Type A Scale in elderly blacks and whites and those of the John Henryism Scale for Active Coping, which was originally designed for use in black populations. They conclude that the Framingham Type A and John Henryism scales do in fact measure two quite different behavior patterns, and do have different correlates in elderly blacks and whites. The results are of particular interest since the Charleston Heart Study sample includes an oversampling of high socioeconomic status black males (n = 69). In this respect, it is unique among long-term cardiovascular studies and provides the opportunity to estimate separate race and socioeconomic status effects, as well as to examine their interaction.     

Type A behaviour in two ethnic rural communities of males in Israel with and without coronary heart disease

In an all male case-control study, 40 coronary heart disease patients were compared with 80 controls without coronary disease in terms of selected behavioural variables. The coronary patients were drawn from several rural villages receiving medical care from the Shimshon Medical Centre in Israel. The controls were selected at random from the computerized medical records of the Centre. The major behavioural assessment was the Jenkins Activity Survey (JAS) designed to measure the coronary-prone behaviour pattern (Type A). Coronary patients were found to score significantly more in the Type A direction than those men free of coronary disease. These results replicate earlier findings reported for several U.S.A. and European samples of retrospective coronary cases and controls. The Israeli sample was also compared in terms of other demographic variables and found to be similar to the prevalence samples studied in the U.S.A. This study is one of the first to provide evidence linking the Type A coronary-prone behaviour pattern, as measured by the JAS, to coronary disease in a rural population outside the United States. In addition, cases scored consistently higher than controls for both ethnic groups studied.     

The Correlation Between Postpartum Depression and Health Status

To investigate a purported correlation between postpartum depression and self-rated maternal general health status in a sample of mothers in Southern Brazil. As part of this process, the Personal Health Scale (PHS), a self-rated health status measure, was tested for the first time among postpartum women. Research volunteers completed the Structured Clinical Interview for DSM-IV Disorders (SCID), the 12-item General Health Questionnaire (GHQ), the PHS, the Postpartum Depression Screening Scale (PDSS), and the Edinburgh Postnatal Depression Scale (EPDS). Correlation coefficients were computed among the scores of the health status questionnaires and the postnatal depression scales. Bivariate linear regression analyses were conducted to evaluate the prediction of scores of postnatal depression scales having the scores of health status questionnaires as predictors. Significant correlations among both health status questionnaires and both postnatal screening tools attest to a significant interconnection between the expression of depressive symptoms and maternal health status in the postpartum period. The health status measures predicted the scores of postpartum depression scales. This study demonstrates that both general health questionnaires and postpartum depressive rating scales are useful tools for detecting depressive phenomena in postpartum women. The association between self-rated health measures and postpartum depression may be even more significant in the context of socioeconomic deprivation.     

The Use and Performance of Productivity Scales to Evaluate Presenteeism in Mood Disorders

ObjectiveMood disorders are associated with a high societal cost, mainly due to presenteeism. The objective of this study was to review the use of 10 instruments that rate presenteeism in mood disorders and to provide recommendations regarding the appropriateness of instruments in different study settings.MethodsA systematic review of the literature was conducted to identify scales used to measure presenteeism, including the World Health Organization Health and Work Performance Questionnaire, the Lam Employment Absence and Productivity Scale, the Sheehan Disability Scale, the Work Limitation Questionnaire, and Work Productivity and Activity Impairment questionnaire. Study characteristics and major results (by symptom level, by treatment arm, correlation to other scales, and use of monetization) were data extracted.ResultsTwenty-nine studies were identified. The Sheehan Disability Scale, the Work Limitation Questionnaire, and Health and Work Performance Questionnaire were the most commonly used instruments. The majority (60%) of scales demonstrated higher presenteeism in individuals with mood disorders than in individuals without. The Lam Employment Absence and Productivity Scale, the Sheehan Disability Scale, and the Work Limitation Questionnaire showed that presenteeism increased with increasing severity of disease. Few studies reported results on presenteeism by treatment, with only small between-treatment differences observed. Good correlations between presenteeism instruments and clinical or quality-of-life scales were reported. Three studies converted results from presenteeism scales into monetary units.ConclusionsLimited experiential evidence exists comparing the performance of presenteeism scales in mood disorders. Therefore, recommendations for inclusion of a presenteeism tool must be driven by instrument properties (ease of administration, amenability to monetization) and the study type. Future research should focus on the responsiveness of the instrument and on how mood disorders impact self-reported assessment.     

An analysis of coronary-prone behavior patterns of anti-coronary club members

Recently, evidence has been produced that there is a type of behavior that permits prospective identification of persons prone to develop coronary heart disease (CHD). In order to categorize the behavior patterns of Anti-Coronary Club Members as Type A (coronary-prone) or Type B, the New York City Department of Health mailed the Jenkins Activity Survey (JAS) to all participants in the diet-heart study. This questionnaire was designed to measure coronary-prone characteristics automatically according to the Rosenman-Friedman criteria. Completed questionnaires (1010) were forwarded to Dr. C. David Jenkins for scoring.Differences in scores were found primarily on the basis of age. Subjects who developed new CHD cases in the 40–49 yr old group scored significantly higher JAS means than those who had no events. The mean scores of the older group (50–59 yr) with and without new events were not different.According to the Rosenman-Friedman criteria, the active experimental group was more coronary-prone than the control group. Nevertheless, this group developed substantially lower incidence rates of new CHD than the control group. This suggests that the intervention of the Prudent Diet was very effective in lowering the rates for the active experimental group.     

A chronological decrease in type A behavior patterns among Japanese male workers in 1995-1999

We examined the chronological change in Type A behavior pattern (TABP) among Japanese male workers for 5 yr. A brief questionnaire to measure TABP was administered to 21,711 male workers who underwent health check-ups at least once during the period from 1995 to 1999 and were born in 1936-1965. The mean TABP scores decreased year by year linearly. Then the repeated measurement analysis of variance was performed with the data of 5,689 subjects who completed the questionnaire successively through the study period. Both year and the age effects were highly significant (p<0.001, respectively), whereas the time trends were comparable by baseline age. In conclusion, TABP among Japanese male workers decreased in all generations during the period from 1995 to 1999.     

Personality correlates of disordered eating

As part of a larger study, 299 college students completed two self-report measures of eating behavior and four other personality scales. Scores obtained on a new Compulsiveness Inventory—particularly the Indecision subscale—were related to scores on the MacAndrew addiction scale were associated with Compulsive Eating and with Dieting; whereas among females, a measure of Type A behavior was related to each eating measure. Measures of compulsiveness and addiction accounted for 26% of variance (R = .51) obtained by males on the Dieting Scale; and males who scored above the mean on the Compulsive Eating Scale obtained a mean of the MacAndrew scale that was equivalent to the alcoholic cut-off. In toto, results suggested that, although compulsive eating among females may have represented simply a stress response, among males it may have reflected more pervasive psychological distress.     

Partner violence among homeless young adults: measurement issues and associations.

PURPOSE: The primary goal of this study was to test the reliability of the Partner Violence Interview and examine validity by measuring differential correlates of partner violence. METHODS: Sixty young adults (30 males and 30 females) housed in an urban shelter participated in this study. All participants were between the ages of 18 and 21 years and the majority were African-American. The participants were administered two measures of partner violence exposure, one measure of community violence exposure and one measure of depression. A random selection of 30 of the participants was retested after 1 month. RESULTS: As predicted, current and past partner violence was common in this sample, with over 70% endorsing a history of physical violence. The Partner Violence Interview (PVI) had adequate retest reliability (Pearson r for two PVI scales =.7 and.85) and internal consistency (KR-20 for each scale =.78 to.93). Preliminary evidence of convergent validity was suggested by the fact that the PVI lifetime partner violence scale was significantly correlated with a physical violence scale from a second measure (the Conflict Tactics Scale; r =.596, p <.001). Violence in past relationships, as opposed to current relationships, was associated with both lifetime community violence exposure and current level of depression. CONCLUSIONS: The Partner Violence Interview is a reliable, comprehensive instrument suited to high-risk populations. Homeless young adults commonly experience severe partner violence, and preventive intervention is clearly indicated for this group.     

Type A behaviour and prevalent heart disease in the Caerphilly study: increase in risk or symptom reporting?

Type A behaviour was assessed by modified Framingham scale in a total sample of 1956 employed men in the Caerphilly study. Prevalent heart disease was measured by cardiovascular questionnaire to obtain evidence of myocardial infarction and angina, and by electrocardiogram (ECG) for evidence of ischaemia. Type A was inversely related to age and systolic blood pressure and was positively related to social class and height. It was not related to serum cholesterol or alcohol consumption. After control for age, systolic blood pressure, height, smoking and social class, type A was found to be independent of angina but positively associated with an increased risk of possible myocardial infarction (MI). Type A was also associated with increased risk of confirmed MI. An inverse association was found between type A and asymptomatic ischaemic heart disease (IHD). The association between type A and symptomatic IHD could be due to symptom reporting.     

Reliability and validity of a health-related quality of life battery for evaluating outpatient antidepressant treatment

This study was designed to evaluate the reproducibility, validity and responsiveness of a health-related quality of life (HRQOL) battery that was assembled for the evaluation of antidepressant therapy. The Montgomery-Asberg Depression Rating Scale was used to measure severity of depression. The HRQOL battery contained measures of energy and fatigue, social behaviour, cognitive function, home and work role function, and general well-being (i.e., health perceptions, life satisfaction) selected from previously developed and validated instruments. The clinical investigators and research nurses reported on difficulty in using the HRQOL battery. Most patients were able to complete the questionnaire without problems within 10 min. Reproducibility was very good with intraclass correlation coefficients ranging from 0.74 to 0.97. The HRQOL scales showed evidence of good concurrent validity. The scales were moderately correlated with MADRS scores (r=0.30–0.62). The magnitude of these correlations indicate that HRQOL scales are related to depression measures, but they are not alternative measures of depression. Changes in MADRS scores were associated with changes in all scales, except for work behaviour, indicating that improvements in depression ratings also resulted in improvements in health status and well-being. The HRQOL scales included in this study were found to be reliable, reproducible, and valid and no appreciable burden was placed on patients or investigators participating in the study. With the exception of the Work Behaviour scale, the HRQOL scales were very responsive to changes in depression severity. This brief HRQOL instrument can provide a comprehensive assessment of the outcomes of antidepressant treatment.This research was supported by a grant from Pfizer International.     

Type A behaviour and consumption of an atherogenic diet: no association in the PRIME study

It has previously been suggested that the association between Type A behaviour and coronary heart disease (CHD) may be mediated through diet. This analysis investigates associations between Type A behaviour and diet, with particular focus on foods high in saturated fats and cholesterol (cake, cheese, eggs and fried potatoes), foods high in unsaturated fats (fish and nuts), and fruit and vegetables. The analysis was conducted on data collected from 10,602 men from Northern Ireland and France screened for inclusion in the PRIME cohort study. Type A behaviour was measured using the Framingham Type A Behaviour Patterns Questionnaire, diet was measured using a Food Frequency Questionnaire and various demographic details were also assessed. Levels of Type A behaviour and intakes of all food groups were similar to previous studies. Using regression, Type A behaviour was significantly associated with diet, and specifically with a higher consumption of cheese and vegetables in Northern Ireland, and a higher consumption of cake, fish and vegetables in France. These associations are most plausibly explained as a result of lifestyle, although the possibility of independent associations between Type A behaviour and diet remains. The work is limited by the use of questionnaires, but the findings available suggest that Type A behaviour is unlikely to be associated with the consumption of a diet that has previously been linked to CHD. These findings suggest that any association between Type A behaviour and CHD is unlikely to be mediated through diet.     

Reliability and validity of the Stanford Presenteeism Scale

OBJECTIVE: This study reports the reliability and validity of the 13-item Stanford Presenteeism Scale (SPS). The SPS differs from similar scales by focusing on knowledge-based and production-based workers. METHODS: Data were obtained from administrative and medical claims databases and from a survey that incorporated the SPS, SF-36, and the Work Limitations Questionnaire. RESULTS: Sixty-three percent (7797) of employees responded. Cronbach's alpha (0.83) indicates adequate reliability. Factor analysis identified two underlying factors, "completing work" and "avoiding distraction." Knowledge-based workers load on "completing work" (alpha = 0.97), whereas production-based workers load on "avoiding distraction" (alpha = 0.98). There were significant and positive relationships between the SPS, SF-36, and Work Limitations Questionnaire. CONCLUSIONS: The SPS demonstrates a high degree of reliability and validity and may be ideal for employers who seek a single scale to measure health-related productivity in a diverse employee population.     

Associations of Type A Behavior in Children With Risk Factors for Coronary Artery Disease

To determine the association of Type A behavior and coronary heart disease risk factors in children with a familial predisposition for premature atherosclerosis, subjects 6 to 16 years of age were evaluated on psychological and coronary risk measures. Subjects were classified as being Type A or Type B using the Student Structured Interview. Type A subjects had lower total serum and LDL cholesterol levels and lower systolic and diastolic blood pressure than Type B subjects. In addition, Type A subjects had more social competence skills and less behavioral disturbance relative to Type B subjects. Type A subjects tended to have better endurance on treadmill stress testing. These results suggest that in children with increased risk for coronary artery disease, the Type A behavior pattern may be associated with better fitness, better psychological health, and lower serum cholesterol levels. We hypothesized that the psychological and physiological characteristics of children with Type A behavior may enable them to adopt hygienic lifestyles more readily than children with Type B behavior.     

Modification of the Stockholm Vascular Scale

BACKGROUND: Staging hand-arm vibration syndrome (HAVS) depends upon accurate reporting of the extent and frequency of blanching attacks. Reporting may not be repeatable and not all individuals classifiable using the Stockholm Workshop Scale (SWS). For Department of Trade and Industry (Dti) coal miners' assessments, the SWS was modified to include a blanching score. Further modifications, which involve splitting Stage 2V into 'early' and 'late' have been proposed but the impact of this on classification has not been investigated. AIM: To investigate the impact of modifications in the SWS on HAVS classification. METHODS: Staging of individuals with HAVS according to the SWS using two modified scales. Two different cut-offs for defining 'frequent' blanching attacks (>or=3 or >or=7 attacks/week, respectively) were used. RESULTS: One hundred and sixty-five individuals were staged. Using the SWS, 58 and 31% of the population were unclassifiable using the two cut-offs, respectively. The modification splitting Stage 2V reduced the proportions that were unclassifiable to 2 and 9%, respectively, and increased those classified as Stage 2V. The cut-off for frequent attacks used (3 or 7) affected the proportion of individuals falling into the subdivisions of Stage 2 with 17 and 42% being classified as 2Vearly and 45 and 20% as 2Vlate, respectively. CONCLUSIONS: Subdividing Stage 2V enables more individuals to be classified, but the proportion falling into each category is susceptible to the cut-off used for defining frequent attacks. Caution may need to be applied if this categorization is used to make decisions regarding fitness to work.     

Associations of Type A Behavior in Children With Risk Factors for Coronary Artery Disease

To determine the association of Type A behavior and coronary heart disease risk factors in children with a familial predisposition for premature atherosclerosis, subjects 6 to 16 years of age were evaluated on psychological and coronary risk measures. Subjects were classified as being Type A or Type B using the Student Structured Interview. Type A subjects had lower total serum and LDL cholesterol levels and lower systolic and diastolic blood pressure than Type B subjects. In addition, Type A subjects had more social competence skills and less behavioral disturbance relative to Type B subjects. Type A subjects tended to have better endurance on treadmill stress testing. These results suggest that in children with increased risk for coronary artery disease, the Type A behavior pattern may be associated with better fitness, better psychological health, and lower serum cholesterol levels. We hypothesized that the psychological and physiological characteristics of children with Type A behavior may enable them to adopt hygienic lifestyles more readily than children with Type B behavior.     

Professional and executive women: Health and lifestyle characteristics

Selected health characteristics of professional and executive women, and relationships among physical fitness, physical activity, and health characteristics in this group were examined. The health characteristics examined included stress, Type A patterns of behavior, substance use (alcohol, tranquilizers, and smoking), nutrition, health practices, safety, and relaxation. A convenience sample of 104 executive/professional women between the ages of 30 and 59 years, who were working full time, were administered the Canadian Standardized Test of Fitness (Step‐Test) to measure cardiovascular fitness, the Framingham Type A Questionnaire, the Personal Lifestyle Questionnaire, the Physical Activity Questionnaire, and a visual analog scale to measure stress. The results suggest that executive women are significantly more fit than Canadian norms and that they tend to consume more alcohol and to smoke less. Demographi‐cally, they are more likely to be unmarried, childless, and have higher incomes than other Canadian women. Fitness levels are only associated (inversely) with smoking habits. Of interest are the high Type A scores, which are almost twice that of the Framingham norms. The possible consequences and implications of these findings are discussed.     

Multivariate evaluation of health attitudes and behaviors: development and validation of a method for health promotion research

Many self-reported measures of health status, attitudes, and knowledge used by clinicians and researchers suffer from a variety of shortcomings, including limited empirical justification, excessive complexity, assessments of nonmodifiable historic or hereditary factors, and limited utility for public health program planning. The Health Attitudes and Behavior Scale is an instrument designed to overcome many of these shortcomings and direct public health professionals toward more efficacious interventions. One hundred sixty-four subjects responded to true-false and Likert scale items related to health beliefs, attitudes, and behavioral practices. A principal component analysis of the Likert items yielded six components, tentatively labeled (a) Lack of Social Support, (b) Hurdles to Health, (c) Health Attitudes/Weight Concerns, (d) Positive Environment, (e) Disease Concerns, and (f) Time and Work Pressure. Analyses of these scales using coefficient alpha indicated adequate internal consistency for each of them. These scales were then related to demographic variables of age, educational level, sex, and marital status. Next, these scales were correlated with individual true-false items reflecting self-reported behavioral practices or health histories. A component analysis of the true-false items yielded four principal components labeled (a) Organizational Health Concerns, (b) Smoking and Exercise Concerns, (c) Coronary and Weight Concerns, and (d) Blood Pressure and Risk Factor Programs. Finally, a cluster analysis yielded six typical profiles reflecting different levels of the original six components. Of interest is the fact that the Lack of Social Support and Time and Work Pressure scales had a very limited integration into the overall patterns. The assumption that organizational and environmental factors can have an important impact on health was supported. The need for further research in this area is also discussed.     

Genetic heritability and shared environmental influences of type A measures in the NHLBI Twin Study

Data from the NHLBI Twin Study were used to investigate the genetic component in a number of Type A measures given to these twins during a second cardiovascular examination. Specifically, the objective of the current study was to determine the extent to which various Type A measures are influenced by genetic effects and by measurable environmental and cultural factors. Analyses of these data for twins yielded a number of results. First, the Type A behavior pattern as assessed by the structured interview was only weakly associated with self-report inventories developed as alternatives to the structured interview. Second, among the self-report measures of Type A, only the Thurstone Temperament Schedule Active scale showed a clear significant genetic component. Most important, a number of demographic and social characteristics known to be associated with the various Type A scales had a differential effect on twin similarities. Specifically, for the job involvement subscale of the Jenkins Activity Survey, twins of both zygosities became equally similar after adjustments for covariates, while no effect on twin similarity was noted for the Thurstone Temperament Schedule Active scale. It is concluded that a complex constellation of genetic predispositions and acquired behaviors underlies the Type A behavior construct.     

Occupational position and type a behavior: Results from the first Monica survey, Augsburg, F.R.G.

The relationships between employment status and Type A behavior pattern have been investigated with data from the first MONICA Survey Augsburg, F.R.G., 1984/85 (MONICA = Monitoring of trends and determinants of cardiovascular disease). Study population was a two-stage cluster sample of 5312 men and women, aged 25-64 (response 79.4%). Measurement instruments were interviews and a self-administered questionnaire. Type A was measured by the Framingham Type A behavior scale. In multiple logistic regression analyses. Type A behavior among men was studied as a function of various occupational positions [blue-collar, white-collar, civil (public) servants, self-employed], controlling for age, educational level, marital status, and interaction effects. In those analyses it was found that the occupational position 'self-employed' was the best predictor of Type A behavior (odds ratio 3.0 compared to blue-collar employees). Since most of the employed women were white-collar employees (a very homogeneous group) Type A behavior among women was studied as a function of full-time and part-time employment, with the same control variables as were included in the analyses for men. Taking into account the statistical significant interaction effect age by employment, it could be shown that the odds of being Type A for a 50 yr old woman was 3.5 compared to a housewife at the same age. In summary the findings show strong relationships between work situation and Type A behavior for both men and women. Especially the self-employed men have more Type A behavior patterns, so may have higher CHD risk.