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The most important risk factors for coronary heart disease (CHD) appear to be high blood pressure, elevated blood cholesterol, and smoking. However, 'type A behavior' is also thought to increase the risk of CHD. Type A behavior has been used to describe individuals who are highly competitive, oriented towards meeting deadlines, aggressive, and hostile, while type B behavior is characterized by an absence of these traits. A study was done in which 375 young adults living in rural Kentucky were assessed for risk factors for CHD. Data were collected on blood pressure, smoking habits, body weight and height, and blood cholesterol and triglycerides; subjects were also characterized as either type A or type B, based on the Jenkins Activity Survey. The participants were approximately 21 years old at the first evaluation and 29 at the second. It was found that type A subjects had significant increases in blood pressure and in cigarettes smoked during this eight-year period. Systolic blood pressure (when the heart contracts) rose an average of 2.9 mm Hg, while diastolic (when the heart relaxes) rose 3.8 mm Hg on average. Type A subjects were smoking an average of 3.3 more cigarettes per day in their late twenties than their early twenties. The type B subjects had no significant changes in blood pressure or smoking; changes in weight, blood cholesterol and blood triglycerides were similar for both groups. When analyses were performed by sex and race, differences between type A and type B subjects in blood pressure were found for women but not men, and for black subjects but not white subjects. The results indicate that type A behavior may be a significant CHD risk factor that is present in young adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

This study investigated the relationship of American Indian boarding school attendance and chronic physical health. We hypothesized boarding school attendance would be associated with an increased number of chronic physical health problems. We also examined the relationship between boarding school attendance and the 15 chronic health problems that formed the count of the chronic health conditions. American Indian attendees had a greater count of chronic physical health problems compared with nonattendees. Father's attendance was independently associated with chronic physical health problems. Attendees were more likely to have tuberculosis, arthritis, diabetes, anemia, high cholesterol, gall bladder disease, and cancer than nonattendees. [ABSTRACT FROM AUTHOR]

Objective: This study described service use among American Indian veterans, compared use patterns across biomedical care and traditional healing options, and tested whether utilization varied as a function of need or availability. Methods: A cross-sectional survey of 621 male combat veterans selected from tribal rolls was conducted between 1992 and 1995 in American Indian reservation communities in the Southwest and in the Northern Plains. Measures included assessments of demographic characteristics, physical and mental health conditions, and self-reports of any use during the past year of Veterans Administration (VA), Indian Health Service (IHS), and other biomedical services as well as participation in traditional ceremonies and use of indigenous healing options. Results: Tribal groups were similar in sociodemographic characteristics and in number of health problems and mental and substance use problems during the past year. The same types of services from IHS were available to the two groups, and the geographic distance to these services was similar. VA facilities were more readily available in the Northern Plains than in the Southwest, where they were far from reservation boundaries. Use of IHS services was similar for the two tribal groups, but use of VA services was significantly less in the Southwest. Overall, biomedical services were used more in the Northern Plains, reflecting greater use of VA facilities. However, these differences in overall health service disappeared when traditional healing options were considered. Use of traditional healing was greater in the Southwest, offsetting lower biomedical service use. Conclusions: When the full array of options is examined, service use functions according to need for health care, but the kind of services used varies according to availability. [ABSTRACT FROM AUTHOR]

Collaborative care can treat depression in HIV but existing studies have been limited by excluding patients with acute or severe depression. The purpose of this analysis is to determine if real-world implementation of collaborative care in HIV is associated with improvement in depression, and to identify correlates of depression outcomes. Collaborative care was implemented as part of a large practice transformation initiative. Change in depression, measured by PHQ-9 score, at baseline compared to 12 months post-enrollment was the outcome, which was operationalized as remission, response, and neither response nor remission. Bivariate and multivariate associations were assessed between several variables at baseline and the outcome. Out of 416, 99 (23.79%) patients remitted and 89 (21.39%) responded (without remission). In the bivariate analysis having a documented psychiatric comorbidity was associated with low remission [31 (16.58%)]; p = 0.008. Having generalized anxiety disorder was associated with low remission [18 (15.00%)] and response rates [26 (21.67%)]; p = 0.022. Having a substance use disorder (alcohol, cocaine, or amphetamine) – was associated with poor remission [29 (16.67%)] and response [33 (18.97%)]; p = 0.004. Social isolation was correlated with lower response and remission rates (p = 0.0022). In the multivariate analysis older age was associated with higher remission rates (OR: 1.10; 95% CI: 1.005–1.194) whereas being a Medicaid beneficiary (OR: 0.652; 95% CI: 1.123–2.797), having comorbid generalized anxiety disorder (OR: 0.267; 95% CI: 0.122–0.584) or a stimulant use disorder (cocaine [OR: 0.413; 95% CI: 0.222–0.926] or amphetamines [OR: 0.185; 95% CI: 0.037–0.766]), was associated with lower remission rates. We found that depression improved in our study subjects. We identified several modifiable correlates of depression outcomes. [ABSTRACT FROM AUTHOR]

Background: An explicit clinical significance (CS) criterion was added to many DSM-IV diagnoses in an attempt to more closely approximate the clinical diagnostic process and reduce the proportion of false positives in epidemiological studies. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) offered a unique opportunity to examine the success of this effort., Objective: To determine the impact of distress, impairment, and help-seeking reported in a lay structured interview on concordance with a clinical reappraisal. Further, to test the efficacy of 5 operationalizations of CS on the concordance and prevalence of DSM-IV lifetime disorders., Design: Completed between 1997 and 2000, a cross-sectional probability sample survey with clinical reappraisal of approximately 10% of participants., Setting: General community., Participants: A population-based sample of 3084 members of 2 American Indian tribal groups, who were between the ages of 15 and 54 years and resided on or near their home reservations, were randomly sampled from the tribal rolls and participated in structured psychiatric interviews. Clinical reappraisals were conducted with approximately 10% of the lay-interview participants. The response rate for the lay interview was 75%, and for the clinical reappraisal it was 72%., Main Outcomes Measures: The AI-SUPERPFP Composite International Diagnostic Interview (CIDI), a culturally adapted version of the CIDI, University of Michigan version. Adapted to assess DSM-IV diagnoses, questions assessing the CS criterion were inserted in all diagnostic modules. The Structured Clinical Interview for DSM-III-R (SCID) was used in the clinical reappraisal., Results: Most participants who qualified as having AI-SUPERPFP CIDI lifetime disorders reported at least moderate levels of distress or impairment. Evidence of increased concordance between the CIDI and the SCID was lacking when more restrictive operationalizations of CS were used; indeed, the CIDI was very likely to underdiagnose disorders compared with the SCID (false negatives). Concomitantly, the CS operationalizations affected prevalence rates dramatically., Conclusion: The CS criterion, at least as operationalized to date, demonstrates little effectiveness in increasing the validity of diagnoses using lay-administered structured interviews.