Carlos F. Mendes de Leon

Driving Cessation and Increased Depressive Symptoms: Prospective Evidence from the New Haven EPESE

OBJECTIVES: The purpose of this study was to determine the association between driving cessation and depressive symptoms among older drivers. Previous efforts in this area have focused on the factors associated with cessation, not the consequences of having stopped.

Beyond single indicators of social networks: A LISREL analysis of social ties among the elderly

While the health promoting influences of social networks have been shown in a number of studies, little attention has been paid to measurement issues within the field of epidemiology. The purpose of this paper is to propose a new set of measures of social networks for use in epidemiological research on the elderly. We use confirmatory factor analysis to test a multidimensional model of social networks using data from a large epidemiologic study of community-dwelling adults age 65 and over (U.S.A.). Confirmatory factor analysis conducted using LISREL showed that our model provides a good fit to the data after several adjustments for correlated measurement error were introduced. Based on this analysis, we developed new measures of four dimensions and a summary index of social networks. Bivariate relationships between our new measures and several sociodemographic variables of interest are also presented.

Financial Strain and Symptoms of Depression in a Community Sample of Elderly Men and Women: A Longitudinal Study

For many older Americans, managing economic resources is a considerable challenge, often resulting in chronic financial strain. This study examines the impact of financial strain on one domain of distress: symptoms of depression. Data came from a longitudinal study of a representative community sample of an ethnically and socioeconomically diverse elderly population. In multivariate analysis, financial strain was strongly associated with concurrent depression as measured by the Center for Epidemiologic Studies-Depression Scale (CES-D) among men and women. In addition, financial strain was associated with increases in CES-D scores over a 3-year period, but only among men. Again among men only, emotional support buffered the adverse effect of financial strain, whereas poor physical health aggravated its effect on depressive symptoms. These findings provide further evidence that financial strain is related to psychological distress in the elderly, particularly in men, and that in these men, this effect is modified by social support and physical health.

Anger and impatience/irritability in patients of low socioeconomic status with acute coronary heart disease

This case-control study examines the relationship between anger and impatience/irritability and acute coronary heart disease (CHD) in middle-aged men of low socioeconomic status (SES). Subjects included patients with myocardial infarction (MI) (N=31) or unstable angina (AP) (N=26), who were compared with hospital controls (N=26). In separate multi-variate analyses for each anger scale, MI was associated with Anger-Out and Impatience/Irritability, particularly in the subgroup of patients who did not have a previous MI. The same factors were associated with AP, but only when this acute ischemic event was not preceded by a ML No relationship was found between Trait-Anger and Anger-In and either acute ischemic outcome. The results indicate that particularly overt behavioral expression of anger is related to CHD in lower SES patients and that there is similarity in the behavioral factors associated with acute CHD between low- and high-SES men.

Prognostic value of noninvasive testing one year after orthotopic cardiac transplantation

OBJECTIVES We sought to evaluate the prognostic value of routine noninvasive testing--stress thallium-201 imaging, rest two-dimensional echocardiography and rest equilibrium radionuclide angiography--1 year after cardiac transplantation. BACKGROUND Coronary artery vasculopathy is the most important cause of late death after orthotopic cardiac transplantation. Several clinical variables have been identified as risk factors for development of coronary vasculopathy. Traditional noninvasive diagnostic testing has been shown to be relatively insensitive for identifying patients with angiographic vasculopathy. METHODS Results of prospectively acquired noninvasive testing in 47 consecutive transplant recipients alive 1 year after transplantation were related to subsequent survival. Other clinical variables previously shown to be associated with the development of coronary artery vasculopathy were also included in the analysis. RESULTS The 5-year survival rate after cardiac transplantation was 81%. By univariate analysis, echocardiography (chi-square 9.21) and stress thallium-201 myocardial perfusion imaging (chi-square 16.76) were predictive for survival, whereas rest equilibrium radionuclide angiography was not. Clinical contributors to survival were donor age (chi-square 4.56), number of human leukocyte antigen mismatches (chi-square 3.06) and cold ischemic time (chi-square 3.23). By multivariate analysis, stress myocardial imaging remained the only significant predictor of survival (risk ratio 0.27; 95% confidence interval 0.06 to 0.89). CONCLUSIONS Normal thallium-201 stress myocardial perfusion imaging 1 year after cardiac transplantation is an important predictor of 5-year survival.

Relation of hostility to medication adherence, symptom complaints, and blood pressure reduction in a clinical field trial of antihypertensive medication

The impact of hostility was examined in relation to the conduct and results of a clinical field trial. Data were derived from a multi-center randomized double-blind study of the comparative effects of antihypertensive therapy (captopril, methyldopa and propranolol) on the quality of life of 620 hypertensive men. Hostility levels were higher in subjects reporting skipping medication dosages compared to those reporting they always complied with the medication schedule. Reporting of symptoms often associated with antihypertensive drug regimens was positively related to hostility scores throughout the study, even during the blinded placebo period. Persons with high hostility scores showed the greatest decline in blood pressure independent of type of antihypertensive medication. However, there was some limited evidence that hostility levels were significantly reduced by one antihypertensive medication. Overall, the present findings suggest that double-blind pharmacologic clinical trials may benefit from using reliable measures of hostility as covariates in the evaluation of symptom reports and amount of blood pressure reduction.