Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994

BACKGROUND AND METHODS: To clarify the determinants of contemporary trends in mortality from coronary heart disease (CHD), we conducted surveillance of hospital admissions for myocardial infarction and of in-hospital and out-of-hospital deaths due to CHD among 35-to-74-year-old residents of four communities of varying size in the United States (a total of 352,481 persons in 1994). Between 1987 and 1994, we estimate that there were 11,869 hospitalizations for myocardial infarction (on the basis of 8572 hospitalizations sampled) and 3407 fatal coronary events (3023 sampled). RESULTS: The largest average annual decrease in mortality due to CHD occurred among white men (change in mortality, -4.7 percent; 95 percent confidence interval, -2.2 to -7.1 percent), followed by white women (-4.5 percent; 95 percent confidence interval, -0.7 to -8.2 percent), black women (-4.1 percent; 95 percent confidence interval, -10.3 to +2.5 percent), and black men (-2.5 percent; 95 percent confidence interval, -6.9 to +2.2 percent). Overall, in-hospital mortality from CHD fell by 5.1 percent per year, whereas out-of-hospital mortality declined by 3.6 percent per year. There was no evidence of a decline in the incidence of hospitalization for a first myocardial infarction among either men or women; in fact, such hospital admissions increased by 7.4 percent per year (95 percent confidence interval for the change, +0.5 to +14.8 percent) among black women and 2.9 percent per year (95 percent confidence interval, -3.6 to +9.9 percent) among black men. Rates of recurrent myocardial infarction decreased, and survival after myocardial infarction improved. CONCLUSIONS: From 1987 to 1994, we observed a stable or slightly increasing incidence of hospitalization for myocardial infarction. Nevertheless, there were significant annual decreases in mortality from CHD. The decline in mortality in the four communities we studied may be due largely to improvements in the treatment and secondary prevention of myocardial infarction.     

Beer drinkers have fewer myocardial infarcts. Moderate beer drinking lowers infarct incidence and total mortality]

Hypotensive efficacy and tolerance of a new antiglaucoma drug lathanoprost, a 0.005% xalathane solution, prostaglandin F2 alpha analog, is studied. A single instillation of xalathane decreased ophthalmic tone in normal subjects and glaucoma patients with increased intraocular pressure. Combination of the drug with other hypotensive agents (pilocarpine + timolol) amplified their hypotensive effects. Long (3 months) follow-up showed that xalathane efficacy is comparable to that of pilocarpine and timolol combination but it is tolerated much better.     

"Exact" and approximate methods for analysis of total error in radiation measurements

BACKGROUND: It is documented that truncal vagotomy and Billroth II gastroenterostomy disturbs the emptying of the gallbladder. The aim of the present prospective study was to assess the emptying of the gallbladder after Roux-en-Y gastroenterostomy. STUDY DESIGN: There were 34 patients, who had undergone either truncal vagotomy with pyloroplasty (TVP, 14 instances) or Billroth II gastrectomy (20 instances), and were subsequently subjected to Roux-en-Y gastroenterostomy. The emptying of the gallbladder was assessed before and after the Roux-en-Y procedure, by milk-technetium-99m labeled hepatoiminodiacetic acid (milk-99mTc-HIDA) scintigraphy. Milk-99mTc-HIDA scintigraphy was also performed on twenty-eight healthy subjects, who served as the control group. RESULTS: After excluding the subjects having spontaneous gallbladder evacuation before milk ingestion, there remained 26 subjects in the control group, 12 patients with TVP, and 19 with Billroth II gastrectomy. Truncal vagotomy with pyloroplasty was associated with delayed onset (p < 0.001) and decreased rate (p < 0.01) of emptying of the gallbladder compared with the control group. Truncal vagotomy with pyloroplasty also changed the normal pattern of emptying in two patients (sequential emptying and refilling events). Billroth II gastrectomy was associated with decreased extent and abnormal pattern of emptying compared with subjects in the control group (p < 0.0001) and patients having TVP. Roux-en-Y gastroenterostomy, performed upon patients with TVP, significantly increased lag phase duration (p < 0.001), decreased ejection fraction (p < 0.01), and changed the pattern of emptying of the gallbladder (p < 0.01). Roux-en-Y procedure performed upon patients with Billroth II gastrectomy significantly increased lag phase duration (p < 0.0001). CONCLUSIONS: Roux-en-Y gastroenterostomy severely disturbs all parameters of the emptying of the gallbladder.     

Treatment failures in private practice: How do psychologists proceed?

Very little is known about how psychotherapists proceed when patients fail to progress. Psychologists in independent practice (N = 591) were surveyed regarding their approach to treatment failures in an updated partial replication of P. C. Kendall, D. Kipnis, and L. Otto-Salaj (1992). Overall, practitioners reported seeing patients a median of 12 sessions before concluding no progress was being made and relying on colleague consultation and clinical experience to formulate their next steps. Practitioners of different orientations varied on treatment duration and ensuing strategies. Specifically, psychodynamic practitioners treated patients significantly longer than cognitive-behavioral and eclectic practitioners before concluding treatment failure. Cognitive-behavioral and eclectic practitioners were more likely than psychodynamic practitioners to utilize treatment materials informed by psychotherapy outcome research and to refer patients to other clinicians. The ethical and practical implications of handling treatment failures in private practice are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlation of factor VIIa values with factor VII gene polymorphism, fasting and postprandial triglyceride levels, and subclinical carotid atherosclerosis

BACKGROUND: Factor VII plays a pivotal role in coagulation. Factor VIIc levels were reported to be a risk factor for fatal coronary heart disease (CHD). Factor VIIc and VIIag levels were noted to be positively associated with plasma triglyceride (TG) levels and influenced by a VII gene polymorphism. The purpose of this study is to determine whether these associations are related to activated factor VII (factor VIIa). METHODS AND RESULTS: Fasting and 3.5-hour postprandial samples from 216 cases with subclinical atherosclerosis and 341 matched controls selected from the ARIC cohort were assayed for levels of factors VIIa, VIIc, and VIIag and TG, and factor VII codon 353 gene polymorphism. The level of factor VIIa was higher in Arg/Arg than in Arg/Gln+Gln/Gln genotypes, and the difference was in accord with that of factors VIIag and VIIc. However, the factor VIIa difference was statistically insignificant. Factor VIIa values were not correlated with fasting or 3.5-hour postprandial TG levels, nor were they associated with subclinical atherosclerosis. CONCLUSIONS: Factor VIIa levels, like factor VIIag and VIIc levels, are influenced by factor VII gene codon 353 polymorphism. However, unlike factor VIIag or VIIc, factor VIIa is not influenced by TG levels; none of these is associated with subclinical atherosclerosis.     

The structure of expressed emotion: A three-construct representation.

Confirmatory factor analysis was used to explore a 3-factor model of expressed emotion (Criticism, Emotional Overinvolvement, and Positivity) in a sample of 104 outpatients with agoraphobia or obsessive-compulsive disorder and 104 relatives of these patients. Multiple methods of measurement included the Camberwell Family Interview, observation of verbal and nonverbal behaviors during patient–relative problem-solving interactions, and ratings of relatives' behavior made by patients and by relatives. The convergent validity of the 3 individual constructs was demonstrated through single-factor models fitted to Criticism, Positivity, and Emotional Overinvolvement measures. A 3-factor model was then estimated and determined to provide adequate fit to the data, thus demonstrating the distinctiveness of the constructs. Criticism and Positivity were strongly and negatively correlated, whereas Emotional Overinvolvement bore little relationship to the other 2 factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressed emotion and behavior therapy outcome: A prospective study with obsessive–compulsive and agoraphobic outpatients.

The relationship of expressed emotion (EE) to behavior therapy outcome for obsessive-compulsive disorder (n?=?60) and panic disorder with agoraphobia (n&=?41) was investigated. Relatives' emotional overinvolvement and hostility predicted higher rates of treatment dropout. Higher hostility, as assessed by the Camberwell Family Interview (CFI), was related to poorer outcome for target ratings and for the Social Adjustment Scale; higher perceived criticism was also predictive of worse response on target ratings. In contrast, nonhostile criticism on the CFI was associated with better outcome on the behavioral avoidance test. In general, the relationship of EE to outcome was not moderated by type of relative, diagnosis, amount of contact with the relative, or use of psychotropic medication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement of panic disorder by a modified panic diary

The psychometric characteristics of panic diary measures were investigated in a sample of 37 patients suffering from panic disorder with agoraphobia. Following recommendations made in the recent consensus development conference on the assessment of panic disorder, daily ratings included not only the occurrence of panic attacks but also fear of panic, expectancy of panic, and expected aversiveness of panic. These new measures were reliable and, on the whole, demonstrated good divergent and convergent validity. Further, adding such measures increased the incremental validity of panic disorder assessment.     

Cognitive therapy of anxiety disorders.

A review of studies of cognitive-behavioral therapy (CBT) for generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia indicates that CBT is consistently more effective than waiting-list and placebo control groups. In general, CBT has proved more beneficial than supportive therapy as well. Comparisons with active behavioral treatments provide more variable results. Converging evidence suggests that cognitive change may be a strong predictor of treatment outcome, but that such change may be produced by a number of therapeutic approaches. Pretest–posttest change with CBT is depicted in meta-analytic summary form for each disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)