Stewart Wolf

Psychosocial Forces in Myocardial Infarction and Sudden Death

ACCEPTABLE evidence on causative factors in myocardial infarction is not available because knowledge of the mechanisms responsible for myocardial infarction is lacking. Efforts have therefore been directed toward the identification of precipitating or risk factors. Such studies, involving either anecdotal or epidemiological data, allow only inferences based on the evidence of coincidence. Other intensive studies have focused on the antecedent condition, coronary atherosclerosis, usually present with myocardial infarction, but also widely distributed among those who have never experienced myocardial infarction. Workers have also directed attention toward putative causes of myocardial infarction, such as blood coagulation and other associated dynamic processes. In each of these avenues of inquiry there have appeared indications of a role for psychosocial factors. The evidence is no more persuasive than is that for other associated phenomena, such as diet, lack of exercise, smoking and the like, and it cannot be conclusive until

The Roseto effect: a 50-year comparison of mortality rates.

OBJECTIVESnEarlier studies found striking differences in mortality from myocardial infarction between Roseto, a homogeneous Italian-American community in Pennsylvania, and other nearby towns between 1955 and 1965. These differences disappeared as Roseto became more Americanized in the 1960s. The present study extended the comparison over a longer period of time to test the hypothesis that the findings from this period were not due to random fluctuations in small communities.nnnMETHODSnWe examined death certificates for Roseto and Bangor from 1935 to 1985. Age-standardized death rates and mortality ratios were computed for each decade.nnnRESULTSnRosetans had a lower mortality rate from myocardial infarction over the course of the first 30 years, but it rose to the level of Bangors following a period of erosion of traditionally cohesive family and community relationships. This mortality-rate increase involved mainly younger Rosetan men and elderly women.nnnCONCLUSIONSnThe data confirmed the existence of consistent mortality differences between Roseto and Bangor during a time when there were many indicators of greater social solidarity and homogeneity in Roseto.

Social aspects of coronary heart disease in two adjacent, ethnically different communities.

Q BSERVATIONS regarding the incidence of coronary heart disease have been made in numerous different cultural groups throughout the world. Schwartz, et al., found myocardial infarction and ischemia rare among the South African Bantu. Cosnett2 has made similar observations among the African Zulu. Christakis, et al.,3 report a low incidence of coronary heart disease among men on the island of Crete. Toor, et al.,4 report that Near Eastern Jews who immigrated to Israel have a lower incidence of coronary heart disease than European Jews who are nonmigrants. Dreyfuss, et al.,5 found a low incidence of coronary heart disease among Jews who immigrated to Israel from the Atlas Mountain region of North Africa. Jervell, et al., found that the mortality rate from coronary heart disease in seven small rural towns in Norway was about half that in Oslo. White and Toomey7 noted a low incidence of coronary heart disease among the isolated Hunzas living in the Himalayas. Mann, et al.,8 report a low

Changes in Serum Lipids in Relation to Emotional Stress during Rigid Control of Diet and Exercise

IN AN earlier study of ambulatory human subjects, significant increases in the serum concentration of lipids and cholesterol were observed to correlate with emotionally stressful events in the life situation. Other workers have also observed such changes.? The changes seemed to occur independently of diet and exercise, but since it was not possible in ambulatory subjects to rule out such influences, the present study was undertaken while subjects were hospitalized, and with careful attention to maintaining diet and exercise constant.

The Separate Determination of Human Pepsin and Gastricsin.

Summary The synthetic substrate, N-acetyl-L-phenylalanyl-L-diiodotyrosine was found to be hydrolyzed by pepsin but not at all by gastricsin. This difference has made possible the separate determination of pepsin and gastricsin in a mixture. The proteolytic activity of the mixture against APDT yielded the amount of pepsin present. The proteolytic activity of the mixture against bovine hemoglobin yielded the total amount of pepsin and gastricsin present. The amount of gastricsin was then simply calculated from the differences in these activities. The accuracy of the method was demonstrated using a reconstituted mixture of human pepsin and gastricsin. The content of pepsin and gastricsin in the native gastric juice was measured in 9 individuals both before and after histamine stimulation. Histamine stimulated the secretion of both pepsin and gastricsin. The authors are grateful to Dr. John Mills, Mr. Gene May and Mr. Lee Poyer for helpful suggestions in preparing this manuscript.

Community social change and mortality

This paper first reviews the types of explanations that have been used in analyzing unequal distribution in coronary heart disease among different groups and changes in prevalence over time. The explanations have mostly focused on the individual: individual behaviors, personalities, stressors, or social ties. It is suggested here that a shift in focus to community-level characteristics may also aid in understanding changes in mortality. Data are presented from Roseto, PA--a town that became known in the 1960s for its strong Italian traditions and very low mortality from myocardial infarction and that subsequently experienced a sharp rise in mortality--and from the adjacent comparison town of Bangor. Data collected over several decades--in some cases as far back as 1925--on marriages, population composition, organizational memberships, voting patterns, and social class indicators suggest that important community changes that accelerated significantly in the 1960s coincided with and may help to explain Rosetos loss of protection from coronary heart disease deaths after 1965.

The fine structure of human gastric parietal cells

SummaryElectron-microscopic observations were made of human gastric parietal cells in 22 gastric mucosal biopsies. Half of the specimens were taken during the nonsecretory phase of gastric function and half during active secretion following histamine stimulation.During secretory activity, the intracellular canals within the cytoplasm of the parietal cells became more prominent and complex, apparently reflecting an increase in the surface area of the canalicular membrane. Also, with secretion, there was a decrease in the number of cytoplasmic vesicles, which became oriented about the canaliculi. In contrast, the nonsecreting parietal cell contained large numbers of cytoplasmic vesicles generally distributed, and the canalicular system was shorter and less racemose.

Arterial pressures recorded in hospital and during ordinary daily activities: contrasting data in subjects with and without ischemic heart disease.

Abstract Using a fully automatic recorder of established reliability, blood pressures were recorded every 15 min during a single day at work or at home in 21 patients with prior myocardial infarctions and 22 healthy subjects. The values obtained from the automatic recorder were contrasted with readings obtained by conventional means in the hospital out-patient department at intervals over a years time. It was learned that the average blood pressures under inactivity circumstances at work and at home for both controls and patients were higher (> 10 mm Hg , systolic and diastolic) than their mean casual values in approximately one third of all subjects and were the same (± 10 mm Hg ) in about two thirds, and lower (> 10 mm Hg ) in just 2 controls (systolic only). The patients, contrasted with the controls, showed mean group blood pressures under all environmental circumstances which were ‘set approximately 10 mm Hg higher. The variability of diastolic pressures in both controls and patients was significantly greater when inactive outside the hospital than when at rest in the physicians offices.

Part IV. Placebos: Problems and pitfalls

Recently, the head of a clinical department in a medical school was heard to observe: “We very much hope that our young men will do research. Basic research is encouraged, clinical research is tolerated, therapeutic research is frowned upon.” Perhaps this conference will explain what it is about therapeutic research that arouses such an attitude, why it has become fashionable to be snobbish about this very difficult and exacting line of study. It may be that scientists in other areas are offended by the welter of uncritical therapeutic literature and the almost countless cacophonous names, worthy of Jonathan Swift, which the pharmaceutical houses have attached to their products. Until recently, the serious investigator had only a still, small voice in this whirlwind of drug promotion.

Clinical pharmacology of anticonvulsant compounds.

This review has integrated recent anticonvulsant pharmacologic data derived from both the clinical and experimental approaches in a way meaningful to the practicing physician, clinical investigator, or neuropharmacologist. It is hoped that if these groups use the same language, the epileptic patient may profit.