Faculty Bibliography

OBJECTIVES: The aim of this study was to examine the relation between hostility and incident ischemic heart disease (IHD) and to determine whether observed hostility is superior to patient-reported hostility for the prediction of IHD in a large, prospective observational study. BACKGROUND: Some studies have found that hostile patients have an increased risk of incident IHD. However, no studies have compared methods of hostility assessment or considered important psychosocial and cardiovascular risk factors as confounders. Furthermore, it is unknown whether all expressions of hostility carry equal risk or whether certain manifestations are more cardiotoxic. METHODS: We assessed the independent relationship between baseline observed hostility and 10-year incident IHD in 1,749 adults of the population-based Canadian Nova Scotia Health Survey. RESULTS: There were 149 (8.5%) incident IHD events (140 nonfatal, 9 fatal) during the 15,295 person-years of observation (9.74 events/1,000 person-years). Participants with any observed hostility had a greater risk of incident IHD than those without (p = 0.02); no such relation was found for patient-reported hostility. Those with any observed hostility had a significantly greater risk of incident IHD (hazard ratio: 2.06, 95% confidence interval: 1.04 to 4.08, p = 0.04), after adjusting for cardiovascular (age, sex, Framingham Risk Score) and psychosocial (depression, positive affect, patient-reported hostility, and anger) risk factors. CONCLUSIONS: The presence of any observed hostility at baseline was associated with a 2-fold increased risk of incident IHD over 10 years of follow-up. Compared with patient-reported measures, observed hostility is a superior predictor of IHD.

BACKGROUND: Increased delay to hospital presentation with acute coronary syndrome (ACS) is associated with poor outcomes. While demographic factors associated with this delay have been well described, scarce data are available on the role of modifiable factors, such as psychosocial disorders, on pre-hospital delay. Patients with symptoms of post-traumatic stress disorder (PTSD) often avoid stressful situations and may delay presenting for care when they experience cardiac symptoms. It is unknown, however, whether PTSD symptoms negatively impact the time to presentation during an ACS. METHODS: We assessed the relationship between PTSD symptoms and pre-hospital delay in 241 adults with an ACS in the ongoing Prescription Use, Lifestyle, Stress Evaluation (PULSE) study. RESULTS: Overall, 66% of patients were male; 40% were Hispanic or Latino. The mean age was 61.9+/-11.6 years old. PTSD symptoms were present in 17.8% of patients. Pre-hospital delay was longer for patients with PTSD symptoms compared to those without [geometric mean: 25.8 hours (95% CI 13.8-44.8) vs. 10.7 hours (95% CI 8.3-13.8)]; P = 0.005. After multivariable adjustment for age, sex, ethnicity, depression, left ventricular ejection fraction and history of myocardial infarction, the mean pre-hospital delay was 173% (95% CI: 36%-450%) longer for patients with versus without PTSD symptoms. CONCLUSION: Among patients presenting with an ACS, PTSD symptoms were independently associated with longer pre-hospital delays. Future studies of pre-hospital delay should examine the mechanisms underlying this association.

OBJECTIVE: The aims of this study were to determine the annual prevalence of intimate-partner violence (IPV) in an urban pediatric emergency department (ED) among mothers seeking care for their children, to examine the associations between IPV and family socioeconomic characteristics, triage time, and child's diagnosis, and to describe perceptions and preferences for IPV screening. METHODS: A confidential 15-item survey was completed by 451 women caretakers who were unaccompanied by a male partner in an urban pediatric ED associated with a children's hospital. Women were enrolled during 4-hour time blocks selected to represent ED use patterns during June and July 2002. Survey questions addressed experiences of IPV (physical or sexual violence and perception of safety) in the preceding year and preferences for IPV screening. We also collected information about the women's socioeconomic characteristics and the child's triage time and diagnosis. RESULTS: Fifty women reported IPV, an annual prevalence of 11%. Compared with white women, the relative risk of IPV among black women was 1.1 (95% confidence interval [CI], 1.0-1.2) and among Hispanic women was 1.1 (95% CI, 1.0-1.2). Compared with women who completed college, the relative risk of women who had not completed high school was 5.8 (95% CI, 2.0-26.4). We observed no association with poverty. Women who reported IPV more often sought care for their child in the evening (4-12 pm, chi2, P < 0.01); there was no association with the child's diagnosis. Most (75%) stated that IPV screening in the pediatric ED was appropriate. CONCLUSIONS: The annual prevalence of IPV in a pediatric ED is 11%. As socioeconomic and visit characteristics are imprecise in identifying women at risk, screening should include all women. Screening for IPV in the pediatric ED is acceptable to women.

OBJECTIVE: The longitudinal association between blood pressure (BP) reactivity to a video game and resting BP 3 to 4 years later was investigated in 83 Samoan adolescents from American and (Western) Samoa as part of a multidisciplinary study of cardiovascular disease (CVD) risk in modern Samoans. METHODS: Participants ranged in age from 11 to 14 years at baseline, in 1992 to 1993, and 14 to 18 years at follow-up in 1996. Video game BP reactivity was defined as the residual score of the regression of the maximum BP during the video game on the minimum resting BP before the video game. The predictive effect of baseline video game BP reactivity on follow-up resting BP was tested using regression models with baseline resting BP, baseline body mass index (BMI), and age as covariates. RESULTS: Systolic BP reactivity to the video game at baseline was significantly, p=.04, and independently associated with resting systolic BP 3 to 4 years later. Samoan adolescents who had higher systolic BP reactivity scores at baseline had significantly higher resting systolic BP at follow-up after adjustment for the significant effects of baseline resting systolic BP, age, and BMI. There were no interactions between sex and reactivity or between residence, American Samoa or (Western) Samoa, and reactivity in the models, indicating that the effects of systolic BP reactivity in early adolescence on later adolescent resting systolic BP were similar in the entire study sample. CONCLUSIONS: Video game cardiovascular reactivity seems to assess aspects of psychophysiological arousal and prospective CVD risk in Samoan adolescents of both sexes residing in both Samoas, and may be useful for understanding the role of psychosocial stress and health in modernizing societies.