Necessity and concerns about lipid-lowering medical treatments and risk factors for non-adherence: A cross-sectional study in Palestine.

AIMS: Strong evidence indicates that drugs reduce blood lipids and improve cardiovascular end-points, leading to their wide usage. However, the success of these drugs can be affected by poor patient's adherence to prescribed medication. This study aimed to evaluate medication adherence in patients with dyslipidaemia in association with patient beliefs about medicines. METHODS: The study was conducted from January 2019 to July 2019 at the middle governmental primary healthcare clinics in Ramallah and Bethlehem cities, and used a cross-sectional design. Adherence was determined using the 4-item Morisky medication adherence scale, while beliefs were determined using the Beliefs about Medicines Questionnaire. RESULTS: Of 220 patients, 185 agreed to participate in the study, resulting in a response rate of 84.1%. Of the participants, 106 (57.3%) were men, and almost half (88, 46.5%) were ≥56 years. Medication non-adherence was high (47.6%), but a majority (65.5%) reported believing their treatment to be necessary for their continued good health. Accordingly, the mean necessity score (17.3, SD 3.7) significantly outweighed (P < .001) the mean concerns score (14.0, SD 3.5). Multivariate regression demonstrated four variables to be significantly correlated with non-adherence: illiterate (OR = 2.52; CI: 0.9-4.3; P = .03), polypharmacy (OR = 3.18; CI: 1.9-5.7; P = .007), having comorbidity (OR = 3.10; CI: 2.2-4.6; P = .005) and having concerns about side effects (OR = 2.89; CI: 1.1-4.6, P = .04). CONCLUSION: Non-adherence among patients taking lipid-lowering agents was high despite most holding positive beliefs regarding medication necessity. This may be due to concern also being high. Physicians should identify and target high-risk patients and individualise their treatment plans in order to achieve adequate control of dyslipidaemia.

Association between polypharmacy and health-related quality of life among US adults with cardiometabolic risk factors.

PURPOSE: There are known associations between cardiometabolic risk factors and polypharmacy; however, there is no evidence about how polypharmacy among adults with cardiometabolic risk factors impacts their health-related quality of life (HRQoL). The main objective of this study was to assess the association between polypharmacy and HRQoL among adults with cardiometabolic risk factors living in the USA. METHODS: Individuals age ≥ 18 years with at least one of the three cardiometabolic risk factors (diabetes, hyperlipidemia, and hypertension) were identified from the Medical Expenditure Panel Survey 2015 data. We defined polypharmacy as use of at least five classes of prescription medications. Physical component summary (PCS) and mental component summary (MCS) were obtained from the 12-item Short-Form Health Survey version 2 to measure HRQoL. We conducted adjusted ordinary least-square regressions to determine the association between polypharmacy and HRQoL. RESULTS: We identified 7621 (weighted N = 80 million) adults with at least one cardiometabolic risk factors of whom 46.9% reported polypharmacy. Polypharmacy was noted in 29.7% of those with hypertension, whereas 82.4% of those with all the three cardiometabolic risk factors had polypharmacy. The unadjusted mean PCS and MCS scores for those with polypharmacy were lower than those without polypharmacy. In the multivariable regressions, we found that adults with polypharmacy had significantly lower PCS scores (ß = - 4.27, p < 0.0001) compared to those without polypharmacy, while the MCS scores between those with and without polypharmacy were no longer significantly different. CONCLUSION: Surveillance of use of concurrent prescription medications is warranted so as to improve physical functioning in this vulnerable group.

Knowing is not half the battle: Impacts of information from the National Health Screening Program in Korea.

Health screening provides information on disease risk and diagnosis, but whether this promotes health is unclear. We estimate the impacts of information provided by Korea's National Health Screening Program by applying a regression discontinuity design around different biomarker thresholds of diabetes, obesity, and hyperlipidemia risk using administrative data that includes medical claims, biomarkers, and behavioral surveys over four years after screening. Generally, we find limited responses to disease risk information alone. However, we find evidence for weight loss around the high risk threshold for diabetes, where information is combined with active prompting for a secondary examination for diagnosis and treatment.

Morus alba L. Diminishes visceral adiposity, insulin resistance, behavioral alterations via regulation of gene expression of leptin, resistin and adiponectin in rats fed a high-cholesterol diet.

Ethanolic extract of leaves of Morus alba L. (M. alba), known as white mulberry, was orally administered (100 mg/kg b.wt) for 8 weeks to female Wistar rats that were fed a high-cholesterol diet (HCD), to investigate the potential of M. alba leaves in attenuation of obesity, dyslipidemia, insulin resistance, and deficits in mood, cognitive as well as motor activity that are linked to the adipokines secretions of visceral adipose tissue. Results showed that M. alba diminished body weight gain, hypercholesterolemia, hypertriglyceridemia, atherogenic (AI) & coronary artery indices (CRI), and ameliorated glucose level and insulin resistance index in rats on HCD, compared with untreated HCD rats. Moreover, M. alba administration significantly decreased serum leptin and resistin contents as well as their mRNA expression in visceral adipose tissue, but significantly increased serum adiponectin level, and its mRNA expression in visceral adipose tissue in rats fed on HCD, compared to those in untreated HCD group. Regarding behavioral alterations, M. alba attenuated motor deficit, declined memory, depression and anxiety-like behavior, as well in rats on HCD, compared to that noticed in untreated HCD rats. The current data showed that serum leptin and resistin showed a positive correlation with and body weight gain, triglycerides (TG), AI as well as CRI, but showed a negative correlation with exploration, declined memory, depression- and anxiety-like behavior. Conversely, serum adiponectin showed a negative correlation with and body weight gain, TG, AI as well as CRI, but showed a positive correlation with locomotor activity, exploration, declined memory, and depression- and anxiety-like behavior. In conclusion, M. alba leaves supplementation could attenuate adiposity, insulin resistance behavioral deficits via down-regulation of regulation of gene expression of leptin, resistin, but up-regulation of adiponectin gene expression in the visceral adipose tissue of rats fed a high-cholesterol diet.

Cardiovascular risk factors and risk of incident depression throughout adulthood among men: The Johns Hopkins Precursors Study.

BACKGROUND: Modifiable cardiovascular risk factors elevate risk of subsequent depression in older adults, but the effect of their onset before or after age 65 on incident depression is unclear. METHODS: Participants were 1190 male medical students without a diagnosis of depression, who matriculated in 1948-1964 and followed through 2011. Cox proportional hazards models were used to assess associations of vascular risk-factor burden, diabetes, hypertension, hyperlipidemia, smoking status, and overweight/obese status with onset of incident depression. Adjustment covariates were race, enrollment wave, baseline age, physical activity, and heavy alcohol use. RESULTS: The analysis included 44,175 person-years of follow-up. Among participants depression-free until age 65, vascular risk-factor burden after age 65 (Hazard Ratio, [HR]: 2.13, 95% Confidence Interval, [CI]: 1.17, 3.90) was associated with incident depression risk after age 65. The magnitude of vascular risk-factor burden after age 65 on depression risk after age 65 is comparable to the effect of 8.2 additional years of age. Diabetes (HR: 2.79, 95% CI: 1.25, 6.26), hypertension (HR: 2.72, 95% CI: 1.52, 4.88), and hyperlipidemia (HR: 1.88, 95% CI: 1.05, 3.35) before age 65 were associated with incident depression risk after age 65. Men diagnosed with diabetes after age 65 had 2.87 times the risk of incident depression after age 65 (95% CI: 1.24, 6.62). LIMITATIONS: Our findings are restricted to male former medical students, which may affect study generalizability. CONCLUSIONS: Results support the vascular depression hypothesis. Depression screening in older adults with vascular risk-factor burden may provide an avenue for prevention of late-onset depression.

Normative data of the EORTC QLQ-C30 for the German population: a population-based survey.

AIM: The aim of the present study was to generate up-to-date normative data for health-related quality of life (QoL) measured with the "European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30)" in a random sample of the population in Northern Germany. METHODS: We conducted a population-based survey of a random sample of 10,000 persons aged 16 years or older. The postal questionnaire included questions regarding lifetime prevalence of common diseases and quality of life. EORTC QLQ-C30 scales were scored according to standard procedures. The results were stratified for age and sex. RESULTS: The questionnaire was completed by 4,684 (47%) of 9,928 eligible persons. Mean age of the participants was 51.7 years (standard deviation: 18.5) and 57% were females. Missing values for the EORTC QLQ-C30 scales and items were sparse (minimum: 0.2%, maximum: 1.5%). Self-reported health related QoL varied by age and sex. Generally, men reported better functioning and fewer symptoms than women. In both sexes function declined and symptoms increased with increasing age. Symptoms most frequently reported were fatigue, pain and insomnia. Compared to the German reference data published in 2001 our participants scored more than 10 points higher on the latter three scales/items. The most frequently reported diseases were hypertension (36%), hyperlipidemia (26%) and arthritis (30%). Lifetime prevalence of depression was 16% in women and 11% in men. CONCLUSION: Our study participants are representative for the German general population with regard to age, sex and education. Of special interest is the high proportion of participants reporting depression which is also mirrored by high fatigue, pain and insomnia scores. The normative data provided should be used as comparison health-related QoL data when evaluating the QoL in German cancer patients.

Role of cardiovascular risk factors (CRF) in the patients with mild cognitive impairment (MCI).

Few therapeutic options are available nowadays to improve the prognosis of patients with Alzheimer's disease (AD). There are rather several evidences in literature that controlling vascular risk factors may be an effective intervention for modifying the course of this disease. The aim of our study was to investigate the role of CRF in 50 patients with MCI according to Petersens's criteria, and to evaluate their influence on cognitive and behavioral features of the disease and on the development of dementia. Statistical analysis of the data showed that the 60% of the patients with MCI and CRF developed dementia, while 40% maintained the same cognitive conditions at the end of the study. Only 32% of the subjects without cardiovascular comorbidities developed dementia. The results of the study suggest that CRF play a key role in cognitive decline of patients with MCI. Patients with MCI and CRF showed not only worse cognitive performances, but also behavioral disorders, depression and functional disability. Patients with CRF had higher conversion rate to AD than the other group, with a mean disease-free period 3 months shorter than the control group.

Independent and interactive effects of plant sterols and fish oil n-3 long-chain polyunsaturated fatty acids on the plasma lipid profile of mildly hyperlipidaemic Indian adults.

The present study was designed to evaluate the independent and interactive effects of a once-a-day yoghurt drink providing 2 g plant sterols/d and capsules providing 2 g fish oil n-3 long-chain (LC) PUFA/d on plasma lipids, apolipoproteins and LDL particle size. Following a 2-week run-in period, 200 mildly hypercholesterolaemic Indian adults aged 35-55 years were randomised into one of four groups of a 2 x 2 factorial, double-blind controlled trial. The 4-week treatments consisted of (1) control yoghurt drink and control capsules, (2) control yoghurt drink and fish oil capsules, (3) plant sterol-enriched yoghurt drink and control capsules, or (4) plant sterol-enriched yoghurt drink and fish oil capsules. Blood was drawn before and after the 4-week intervention. Changes in health status, lifestyle and dietary habits, and daily compliance were recorded. The main effects of plant sterols were a 4.5 % reduction in LDL-cholesterol and a 15 % reduction in TAG without a significant change in HDL-cholesterol. Overall, fish oil n-3 LC-PUFA did not significantly affect cholesterol concentrations but reduced TAG by 15 % and increased HDL-cholesterol by 5.4 %. The combination significantly lowered TAG by 15 % v. control. No significant interaction between plant sterols and n-3 LC-PUFA was observed on plasma cholesterol concentrations. In conclusion, once-a-day intake of 2 g plant sterols/d in a yoghurt drink, 2 g fish oil n-3 LC-PUFA/d in capsules, and their combination had beneficial effects on the lipid profile of mildly hypercholesterolaemic Indian adults. The potent hypotriacylglycerolaemic effect of plant sterols observed in the present study and this population warrants additional investigation.

[Incorporating a sexual questionnaire in screening examinations].

Erectile dysfunction (ED) is the inability to attain and/ or maintain an erection sufficient for satisfactory sexual performance. The prevalence of ED among elderly men is 52%, and it is associated with preventable and treatable cardiovascular conditions, such as diabetes mellitus, hyperlipidemia, hypertension and smoking. Treating these conditions may prevent cardiovascular diseases and ED. Nevertheless, large-scale studies regarding the prevalence of ED among young men has never been conducted, although prevention should be performed in younger ages. A unique screening examination, including a sexual questionnaire has been conducted in Israel since 2001. Men who are suspected of ED, according to this questionnaire, are referred to a sexual clinic for consultation and treatment. In this review, we present several studies based on this database. Our main findings: ED is prevalent in young men and is associated with diabetes mellitus, hypertriglyceridemia, sleeping disorders and periodontal diseases. These findings stress the importance of incorporating a sexual questionnaire in screening examinations.

The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States.

OBJECTIVE: The prevalence of obesity and associated cardiometabolic risk factors such as diabetes, hyperlipidemia and hypertension is increasing significantly for all demographic groups. RESEARCH DESIGN AND METHODS: The 2000 and 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the U.S. population, was used to estimate the marginal impact of obesity on health function, perception, and preferences for individuals with diabetes, hyperlipidemia, and hypertension using multivariate regression methods controlling for age, sex, race, ethnicity, education, income, insurance, smoking status, comorbidity, and proxy response. Three different instruments were used: SF-12 physical component scale (PCS-12) and mental component scale (MCS-12); EQ-5D index and visual analogue scale (VAS). Censored least absolute deviation was used for the EQ-5D and VAS (due to censoring) and ordinary least squares (OLS) was used for the PCS-12 and MCS-12. RESULTS: After controlling for sociodemographic characteristics, diabetes, hyperlipidemia, and hypertension were associated with significantly lower scores compared to normal weight individuals without the condition for all four instruments. Obesity significantly exacerbated this association. Controlling for comorbidity attenuated the negative association of obesity and cardiometabolic risk factors on instrument scores. In addition, scores decreased for increasing weight and number of risk factors. CONCLUSIONS: Obesity significantly exacerbates the deleterious association between diabetes, hyperlipidemia, and hypertension, and health function, health perception, and preference-based scores in the United States.

Infliximab improves health-related quality of life in the presence of comorbidities among patients with moderate-to-severe psoriasis.

BACKGROUND: Psoriasis affects patients both physically and psychologically. OBJECTIVES: To investigate the effect of comorbidities on health-related quality of life (HRQoL) and to determine whether infliximab improved HRQoL in the presence of these conditions. METHODS: In this multicentre, double-blind study, 835 patients with moderate-to-severe plaque psoriasis were randomized to receive infliximab 3 or 5 mg kg(-1) or placebo at weeks 0, 2 and 6. Infliximab-treated patients were re-randomized at week 14 to receive the same treatment every 8 weeks or as needed through week 46; placebo patients crossed over to infliximab 5 mg kg(-1) at week 16. Disease severity (Psoriasis Area and Severity Index, PASI) and HRQoL (Dermatology Life Quality Index, DLQI; 36-item Short-Form Health Survey, SF-36) were measured at various time points. The effect of patient comorbidities on baseline HRQoL was assessed using multiple regression models. The impact of key comorbidities on infliximab treatment effect was also assessed. RESULTS: Disease severity (PASI), depression and psoriatic arthritis (PsA) were predictors of poor baseline HRQoL. At week 10, infliximab 3 and 5 mg kg(-1) significantly improved physical and mental health dimensions of the SF-36 and the DLQI (all P < 0.001). Consistent improvement in HRQoL with infliximab treatment was observed regardless of baseline patient characteristics or comorbidities. Through week 50, HRQoL and PASI scores were most improved with infliximab 5 mg kg(-1) administered every 8 weeks. CONCLUSIONS: Disease severity, depression and PsA were significant predictors of poor HRQoL. Infliximab significantly improved HRQoL, regardless of these characteristics.

Expectation to improve cardiovascular risk factors control in participants to a health promotion program.

BACKGROUND: We assessed expectations to improve cardiovascular disease risk factors (CVD-RF) in participants to a health promotion program. PARTICIPANTS AND METHODS: Blood pressure (BP), blood glucose (BG), blood total cholesterol (TC), body mass index (BMI), and self-reported smoking were assessed in 1,598 volunteers from the general public (men: 40%; mean age: 56.7 +/- 12.7 years) participating in a mobile health promotion program in the Vaud canton, Switzerland. Participants were asked about their expectation to have their CVD-RF improved at a next visit scheduled 2-3 years later. RESULTS: Expectation for improved control was found in 90% of participants with elevated BP, 91% with elevated BG, 45% with elevated TC, 44% who were overweight, and 35% who were smoking. Expectation for TC improvement was reported more often by men, persons with high level of TC, and persons who had consulted a doctor in the past 12 months. Expectations to lose weight and to quit smoking were found more often in younger persons than the older ones. CONCLUSION: Volunteers from the general population participating in a health promotion program expected improved control more often for hypertension and dysglycemia than for dyslipidemia, overweight and smoking.

Vascular risk factors and intensity of cognitive dysfunction in MCI.

Patients with Mild Cognitive Impairment (MCI) have a greater risk of developing dementia than general population. Lots of evidence suggests that cardiovascular risk factors appear more often in the MCI than in general population The aim of this study was to evaluate association between cardiovascular risk factors and intensity of cognitive impairment in MCI patients. We evaluated 24 MCI patients (9 women and 15 men) fulfilling Mayo Clinic Group Criteria. Taking under consideration presence of cardiovascular diseases patients were divided into two groups: first group (n=16) MCI with cardiovascular diseases and second group (n=8) MCI without cardiovascular disorders. Cognitive functions were assessed by neuropsychological tests battery including MMSE, Clock Drawing Test, Trail Making Test (TMT), Verbal Fluency Test with letters FAS, Auditory Verbal Learning Test (AVLT). In the MCI group with vascular risk factors we have found more distinct dysfunction of learning new information, recall and short-term memory than in MCI patients without vascular pathology. In conclusion we may suggest that more distinct cognitive deficit may indicate higher risk of developing dementia, that is why patients with MCI should be under special supervision, with at least annual neuropsychological evaluation.

[Development of E-Mail education for hyperlipidemia health check-up and application effects].

PURPOSE: This study was to monitor the effects of forming desirable eating and exercise habits and change the blood lipid levels by developing and applying E-Mail educational programs for a hyperlipidemia health check-up. METHOD: The research design used a nonequivalent control group pre-post test. Ninety-nine subjects (Exp.=50, Cont.=49) were selected randomly and the male subjects agreed to a hyperlipidemia health check-up at a comprehensive medical screening center. This study verified validity and reliability through factor analysis on a life habit measurement tool. The data was analyzed with SPSS win 12.0 using an chi- square-test,t-test, ANOVA and ANCOVA. RESULT: Eatingand exercise habit scores of the experimental group which were educated through E-Mails changed considerably more than that of the control group which was not educated. Total-cholesterol and LDL-cholesterol in the experimental group was considerably lower than that in the control group, but HDL-cholesterol increased considerably. Triglycerides, however, didn't show change. CONCLUSION: An E-Mail educational program may be applied as a hyperlipidemia health check-up nursing intervention strategy.

[Hyperlipidemia with disseminated eruptive xanthomas and hyperglycemia caused by mental stress--a case report]. / Hiperlipidemija s diseminiranim eruptivnim ksantomima i hiperglikemija izazvani psihickim stresom--prikaz bolesnika.

This article presents the case of a 36-year-old man who developed disseminated eruptive xanthomas, hyperlipidemia and hyperglycemia. The patient was exposed to strong mental stress. He was previously healthy and close family members did not show metabolic and cardiovascular diseases. After a short period of time, when the intensity of stress weakened, generalised eruptive xanthomas and metabolic disturbances completely resolved. Numerous studies have shown that psychosocial stresses lead to the disturbance of the metabolism of lipids, insulin resistance and eventually to cardiovascular diseases. The clinical signs of hyperlipidemia and especially eruptive xanthomas are rare but characteristic features of primary hyperlipidemias. Among secondary causes of hyperlipidemia, eruptive xanthomas are most often described in diabetics, usually localised on extensor surfaces, but generalised eruptive xanthomatosis is rarely the presenting feature of diabetes. The presenting case is most probably a very rare phenomenon of disseminated eruptive xanthomas and serious metabolic disturbances provoked by mental stress.

Outcome of gastric bypass patients.

BACKGROUND: The authors analyzed previously studied outcomes of Roux-en-Y gastric bypass (RYGBP), examined pre-surgical factors of post-surgical outcomes, and examined some of the psychosocial benefits. METHODS: A retrospective chart review was conducted of 138 patients who underwent RYGBP between 1997 and 2000. Pre-surgical BMI, cholesterol, blood pressure, creatinine, number of antidepressant/glycemic drugs, and hemoglobin were recorded. Post-surgical follow-up was reviewed to examine changes. RESULTS: Statistically significant changes were found in BMI, hypertension, cholesterol and glycemic control. Surgery was found to reduce creatinine from a pre-surgery average of 1.14 to 1.01 (n = 11, p = .0015)). Patients with early post-operative complications (defined as length of stay > 6 days or re-hospitalization within 1 month following surgery) had an average BMI of 57.58 (n = 23) vs a BMI of 49.9 (n = 103) in those who did not experience any complications (p = 0.0004). There was a statistically significant decrease in the rate of anti-depressant use following surgery. 49 patients were on antidepressants before surgery vs 38 following surgery (p = .0016). CONCLUSION: RYGBP significantly improves hypertension, hyperlipidemia and type II diabetes, and may also improve kidney function. Patients with higher pre-surgical BMIs are at greater risk for post-surgical complications. Postoperative antidepressant use appears to decrease.

[Perception of medical advice: in all cases and to all patients equally?]. / Percepción del consejo médico: inverted question marken todos los casos y a todos los pacientes por igual?

OBJECTIVES: To evaluate the perception of counseling in population depending of a Primary Care Centre with pathologies susceptible of receiving it. To identify variable associated to absence of medical advice. METHODS: A cross-sectional, descriptive study, accomplished in a urban Primary Care Centre is performed. 320 subjects between 15-75 years-old were randomly selected among all patients visited in our centre during the last two years. Clinical chart were reviewed and age, sex, physician, studies, profession, frequency of the visits, previous pathologies and toxic habits susceptible of medical advice (obesity/overweight, diabetes mellitus, hypertension, dyslipidemia, smoking , excessive alcohol consumption) were recorded. Afterwards, a standardized telephone questionnaire was accomplished, valuing the perception of counseling. Variable associated to absence of medical advice were studied by means of logistic regression. RESULTS: Mean age of the patients was 43.2 years-old (SD 17.4), and 53.1% were women. The survey was completed in 85% of the cases. 64.1% of the cases presented with pathologies susceptible of counseling. When it was indicated patients reminded to had received medical advice about physical exercise in 66.2% of the cases, about smoking in 50.9%, about fiber consumption in 44.3% and about alcohol abuse in 27.8%. A frequency of the visits inferior to 3 call/year was associated to lack of advice about physical exercise (OR = 3.5; IC 95%: 2.0-6.0), fiber consume (OR = 2.4; IC 95%: 1.3-4.5) and smoking (OR = 3.3; CI 95%: 1.4-8.0) Age under 26 years-old was associated to lack of counseling about physical exercise (OR = 3.5; IC 95%: 1.6-7.7) and fiber consume (OR = 3.6; CI 95%: 1.3-9.2). CONCLUSIONS: Perception of medical advice in our area is low and therefore susceptible to be improved, specially with respect to alcohol abuse. Low frequenters (with respect to physical exercise, fiber consume and tobacco) and young patients (with respect to physical exercise and fiber consume) are the least advised by their physician.

Cholesterol screening of children at high risk: behavioural and psychological effects.

OBJECTIVE: To assess the behavioural and psychosocial effects of screening asymptomatic children at high risk for hyperlipidemia. DESIGN: Observational study involving prospective longitudinal and cross-sectional portions. SETTING: Two tertiary care pediatric lipid clinics in Montreal. SUBJECTS: Longitudinal portion: all children aged 4 to 17 years who presented for screening at the lipid clinics between April 1990 and June 1991. Of the 56 eligible children 52 (93%) (and their mothers) agreed to participate, 34 with hyperlipidemia (case subjects) and 18 without hyperlipidemia (control subjects). Thirty-five children (67%) completed 3 assessments over 12 months. Cross-sectional portion: all children aged 4 to 17 years in whom hyperlipidemia had been diagnosed 2 to 5 years earlier at one of the lipid clinics. Of the 58 eligible children 48 (83%) (and their mothers) participated. OUTCOME MEASURES: For children, mean scores on the Child Behavior Checklist (Behavior Problems subscale) (CBCL), the Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAIC); for mothers, mean scores on the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). RESULTS: In the longitudinal portion of the study, there was no significant difference between the case and control subjects in the mean CDI or STAIC scores at 1 or 12 months. At 1 month after diagnosis the case subjects in the longitudinal portion had a significantly higher mean CBCL score than the children in the cross-sectional component (p = 0.01). With the control group as the reference group, the adjusted odds ratios for a high CBCL score (greater than 62) for the case subjects were 15.5 (95% confidence interval [CI] 2.4 to 99.8) at 1 month and 15.8 (95% CI 1.1 to 223.4) at 12 months. The corresponding values for the children in the cross-sectional component were 1.3 (95% CI 0.3 to 6.2) and 5.0 (95% CI 0.5 to 50.9). CONCLUSIONS: The observed behavioural problems in children with a recent diagnosis of hyperlipidemia were independent of other risk factors, such as age and sex of child and mother's age and BDI score. Our results suggest that identification of hyperlipidemia in children may have harmful psychological effects in the families involved. This evidence strengthens arguments for the exclusion of cholesterol measurement from the periodic health examination of children at moderately high risk.

Perception of quality of life before and after disclosure of trial results: a report from the Program on the Surgical Control of the Hyperlipidemias (POSCH).

The Program on the Surgical Control of the Hyperlipidemias (POSCH) was a randomized controlled clinical trial designed to ascertain whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality and the mortality and morbidity due to coronary heart disease. The trial results provided strong clinical and coronary arteriographic support for the beneficial effects of lipid modification for the reduction of atherosclerosis progression. At the same time, the surgery-assigned group experienced diarrhea and an increased incidence of kidney stones and gallstones compared to the control-assigned group. Identical quality of life determinations were performed in the POSCH study population shortly before disclosure of the trial results to the patients and shortly thereafter. The purpose of this dual assessment was to evaluate the effect of knowledge of outcomes on the patients' subjective evaluation of quality of life. The primary instrument utilized for analysis of the perception of quality of life in POSCH was the McMasters Health Index Questionnaire (MHIQ). In addition, four study-specific questions were asked of the trial patients. The results for the MHIQ before disclosure of trial results showed a difference (p = 0.07) favoring the control-assigned group (diet-treated), for the social function index of the MHIQ. After disclosure of the trial results, the difference was larger (p < 0.05). For the four study-specific questions, all differences favored the control-assigned group (p < 0.01) before and after disclosure of the trial results, with the exception of satisfaction with randomization allocation in the surgery-assigned group (p = 0.08). The intragroup MHIQ indices before and after disclosure of the trial results showed no suggestive significant differences, except in the surgery-assigned group, in which there was an improvement in the emotional function index after disclosure of the trial results (p = 0.03). The intragroup responses to the study-specific questions before and after disclosure of the trial results again showed no significant differences, except in the surgery-assigned group, in which there was an improvement in patient satisfaction with randomization allocation after disclosure of the trial results (p = 0.04).(ABSTRACT TRUNCATED AT 400 WORDS)

Hostility during late adolescence predicts coronary risk factors at mid-life.

Hostility, as measured by the Cook-Medley Hostility Scale of the Minnesota Multiphasic Personality Inventory, has been found to predict higher rates of both coronary heart disease and all-cause mortality. To evaluate one mechanism whereby hostility might contribute to health problems, the authors used regression models to determine whether hostility measured in college (1964-1966) predicted coronary risk factors assessed 21-23 years later (1987-1990) in 4,710 men and women. Of this group, 828 had lipids measured (1988-1991). Persons with higher hostility scores in college were significantly more likely at follow-up to consume more caffeine (r = 0.043), to have a larger body mass index (r = 0.055), to have higher lipid ratios (r = 0.092), and to be current smokers (r = 0.069) than those with lower hostility scores during college. Cross-sectional analyses found significant associations of contemporaneous hostility scores with the same four risk factors, as well as with alcohol consumption and hypertension (rs ranging from 0.043 to 0.117). These associations are large enough to have possible public health significance. We conclude that hostility may contribute to health problems through its influences on several coronary risk factors across the adult life span.