Higher Hostility Scores Research Articles

Supersized Alcopop Consumption Associated With Homelessness and Gang Membership.

Supersized alcopops are single-serving, ready-to-drink beverages with very high alcohol content. Research suggests that consumption of these products is especially dangerous. The current study was one of the first to examine individual-level characteristics associated with recent consumption of supersized alcopops. Adults on probation (n=253; 70% male) in Baltimore City, MD, and Dallas, TX, who reported heavy drinking or any illicit drug use completed interviews. Psychosocial scales were drawn from the Criminal Justice Client Evaluation of Self and Treatment Intake. Bivariate analyses were conducted to examine characteristics associated with past 30-day consumption of supersized alcopops. Past 30-day consumption of supersized alcopops was significantly associated with higher scores for hostility and risk-taking, and lower scores on the self-esteem scale compared to nonconsumers. Recent consumption of supersized alcopops was also significantly associated with past 30-day homelessness and current gang affiliation. Among those who did not experience homelessness, 11% consumed supersized alcopops, compared to 30% of those who experienced homelessness. Further, 11% of those who were not gang-affiliated reported consuming a supersized alcopop within the past 30days, compared to 57% of those who were gang-affiliated. This study identifies disparate consumption of dangerous supersized alcopop products by vulnerable and at-risk groups. Better regulation of supersized alcopop marketing is needed to reduce alcohol consumption among high-risk groups, including people who are homeless and gang members, and display greater hostility and risk-taking traits. Previous research suggests that reducing the alcohol by volume and increasing the retail price of supersized alcopops would reduce some of the harms associated with consumption.

T148. FIRST EPISODE PSYCHOSIS, TRAUMA AND SUBSTANCE USE IN A HIGH HIV PREVALENCE SETTING IN SUB-SAHARAN AFRICA

BackgroundHIV, substance use and trauma are associated with more severe symptoms and poorer outcomes in psychosis. We aim to describe the profile of adults with first episode psychosis (FEP) and associations with substance use and trauma in a cohort of patients in a low resource, high HIV prevalence setting in South Africa.MethodsWe recruited all adult patients (18–45 years) presenting with FEP to five psychiatric units in the eThekwini Municipality, KwaZulu-Natal Province. Psychiatric diagnosis was made using the MINI. We used the PANSS for psychotic symptoms, WHO ASSIST for substance use and CTQ for early childhood trauma. HIV status was confirmed by ELISA.ResultsSixty participants were recruited, mean age 26 years (SD 8, IQR 19–33), 68% (n=41) were male. Mean age at presentation was 24 and 31 years for males and females respectively, with males being significantly younger than females (p=0.0003). Duration of untreated psychosis (DUP) was 12.5 months (IQR 1–10.3 months). Lifetime tobacco, alcohol and cannabis use was reported at 57%, 55%, and 47% respectively. Substance use was more prevalent among males compared to females, p=0.10, 0.13 and 0.0001 for tobacco, alcohol and cannabis respectively. Lifetime cannabis use was associated with higher negative PANSS scores (mean score 32, SD 10) compared to non-users (mean score 17, SD 7), p=0.05. Sixty eight percent (n=41) reported any traumatic event. Sixty-two percent (n=37) experienced trauma before 18 years and 35% (n=21) reported traumatic experiences in adulthood. Individuals who reported trauma in adulthood had higher hostility scores in the PANSS compared to those who experienced no trauma in adulthood (p=0.05).Fifteen (25%) of the cohort was HIV infected. Females were more likely to be HIV infected (58% HIV infected females compared to 9.8% HIV infection in males, p=0.0001).Eleven of the 15 HIV infected patients had been on antiretroviral treatment prior to the psychosis onset and four were newly diagnosed at the time of psychosis presentation. Of the 11 individuals on antiretroviral treatment, 6 (45%) were virologically suppressed.There was no significant difference in PANSS scores by HIV status (p=0.5) and childhood trauma (p=0.5).DiscussionThe study found participants with FEP had a high prevalence of HIV, particularly in females, and high prevalence of tobacco, alcohol and cannabis use. This suggests that these individuals are particularly vulnerable to the triple burden of psychosis, substance use and HIV. In addition, they had long DUP suggesting delay in accessing treatment, which all serve as poorer prognostic indicators in an already overwhelmed health care setting.The high rates of trauma (more than half the sample reporting childhood trauma) is another major public health concern as trauma exposure has been associated with poorer physical and mental health outcomes. In this study the lack of association between childhood trauma and psychosis severity is inconsistent with literature and needs to be further explored. The association between adult exposure to trauma and increased hostility scores suggests the need to include psychological treatment strategies to address the trauma exposure to improve outcomes.

Perceived Institutional Restraint Is Associated With Psychological Distress in Forensic Psychiatric Inpatients.

Background: Patients in forensic mental health care experience internal and external coercion; the latter comprises different levels of institutional restraint. These restrictions of individual freedom are mainly justified by the safety interests of third parties and are not necessarily in the patients’ best interests. The effects of such a setting on mentally disordered offenders’ psychological state and treatment course are not fully understood. Assessing both patients’ perception of restraint and psychopathological symptoms would allow us to better understand how restraint and psychopathology interact and how they might influence treatment. Methods: In 184 forensic psychiatric inpatients, we assessed perception of institutional restraint with an adapted version of the Measuring the Quality of Prison Life (aMQPL) questionnaire and current psychological state with the Brief Symptom Checklist (BSCL) and Beck Hopelessness Scale (BHS). Results: Perceived institutional restraint (as expressed in the aMPQL subscales Transparency of procedures and decisions, Fairness, and Respect) was associated with a higher general level of psychological symptoms. Furthermore, patients who perceived a lack of institutional transparency and respect were more likely to have higher scores for hostility, depression, and suicidal ideation. We also found age and sex differences, with higher levels of psychological symptoms in younger and female patients. The diagnosis and duration of detention did not relate to perceived restraint. Discussion: Our results indicate that certain aspects of institutional restraint in long-term forensic inpatient settings correlate with certain psychological symptoms. The observed association might be explained by different kinds of factors: institutional (custodial focus), individual (self-efficacy, diagnosis, and personality), and situational (duration of detention). Although not all of these explanatory factors were addressed by the present study design, forensic mental health professionals should be aware of the relationship between perceived institutional restriction and psychopathology because it might influence treatment course and outcome.

Cyberbullying among a clinical adolescent sample in Turkey: effects of problematic smartphone use, psychiatric symptoms, and emotion regulation difficulties

BACKGROUND: Cyberbullying, has concerned professionals due to increased use of media over time and as predicted, this type of bullying is fairly common among adolescents. We aimed to define the prevalence of cyberbullying and cyber victimization, examine relationships between problematic smartphone (SP) use (PSU), psychiatric symptoms and emotion regulation difficulties in a clinical adolescent sample. Also, we aimed to predict risk factors of being an E-Victim and E-Bully.METHODS: One hundred and fifty adolescents have recruited the study. Demographic Information Form, Problematic Mobile Phone Usage Scale, Brief Symptom Inventory, Difficulties in Emotion Regulation Scale, E-Victimization–E-Bullying Scale were filled out by adolescents.RESULTS: Our results indicated that the prevalence of cybervictimization and cyberbullying were 62.6% and 53.3%, respectively. BEVEB (Both E-Victim and E-Bully) group adolescents were older than NVB (Non-Victim/Bully) groups. Access internet via own SP, PSU, problems in strategies and impulse control and were significantly higher and “lack of awareness” scores were significantly lower in BEVEB group than others. In addition, when compared with OEV (only E-Victims) group, BEVEB group had also higher hostility scores. Logistic regression analysis revealed that high scores of “lack of awareness” and higher E-bullying scores increase the risk of being an E-Victim; and higher scores of hostility and E-victimization and lower scores of “lack of awareness” (in other words being more aware of feelings) increase the risk of being an E-bully.CONCLUSIONS: According to analyses, contrary to our expectations, PSU was important but not an independent predictor of being an E-Victim/E-Bully. Our results also demonstrated an interesting finding: lack of awareness is a risk factor for being an E-victim. We interpreted this result as could not be aware of feelings increase the victimization risk. On the other hand, E-Bullies have higher hostility and victimization while having lower “lack of awareness” scores. It could be speculated that, re-victimization and being aware of hostility feelings could increase the cyberbullying among adolescents. In addition being an E-Bully could be a consequence of being an E-victim and increasing hostility and awareness over time. These results should be re-examined in larger clinical samples.

Influence of Depression and Hostility on Exercise Tolerance and Improvement in Patients with Coronary Heart Disease.

Although hostility and depression have been linked to higher cardiac risk and poor prognosis of patients with coronary heart disease (CHD), there is a lack of research that studies how they may influence the short-term outcomes among patients participating in cardiac rehabilitation (CR). This study aimed to investigate the influence of hostility and depression on patients' exercise tolerance and improvement trajectory in a CR program over 6weeks. Participants were 142 patients with CHD, with a mean age of 62years. Latent growth curve modeling was conducted to determine whether hostility and depression predicted patients' baseline exercise tolerance and rates of improvement on treadmill, while controlling for age and severity of illness. In addition, analysis was conducted to examine whether depression mediated the influence of hostility on exercise outcomes. Patients with CHD with higher hostility scores had a lower baseline exercise tolerance and slower rates of improvement over 6weeks. Depressive symptom severity mediated the influence of hostility on exercise baseline and improvement. Patients with higher hostility were more likely to have more severe depressive symptoms, which in turn were associated with lower baseline exercise tolerance and slower improvement. While both hostility and depression predicted the exercise outcomes in CR, depression explained the influence of hostility. The findings underscore the importance of addressing psychosocial issues in treatment of CHD patients and provide support for psychosocial interventions in CR to facilitate patients' recovery.

Subclinical Posttraumatic Stress Disorder Symptoms: Relationships with Blood Pressure, Hostility, and Sleep.

The purpose of this study was to examine the relationships among subclinical PTSD symptoms, blood pressure, and several variables linked to both frank PTSD and the basic psychobiological adaptation to stress. The authors recruited a sample of 91 healthy, young men and women between 18 and 35 years. We examined links among subclinical posttraumatic stress disorder symptoms, blood pressure, sleep quality, and hostility. Posttraumatic stress disorder symptoms were associated with poorer sleep quality and higher hostility scores in both women and men. In men, PTSD symptoms were also associated with elevated resting diastolic blood pressure, and sex was an important moderator of that relationship. Moreover, sleep quality and hostility are substantive mediators of the relationship between diastolic blood pressure and PTSD. Behavioral interventions designed to increase sleep quality and restructure hostile attitudes could potentially serve as preventive interventions for PTSD and the underlying cardiovascular comorbidities in young adults.

Hostility, religious involvement, gratitude, and self-rated health in late life.

This study evaluates a latent variable model that assesses the relationships among hostility, church attendance, helping others, gratitude, and self-rated health. The participants come from the sixth wave of a nationwide survey of older adults (N = 1,011). The data suggest that older individuals who go to church less often help others less frequently, older people who help others less are less grateful, and older adults who are less grateful rate their health in a less favorable manner. In addition, the data indicate that older people with high hostility scores help others less often and are less grateful. The results reveal that the way in which older people view their health may be traced in part to the interplay between personality traits (i.e., hostility) and virtues that are part of most faith traditions (e.g., helping others).

“High on My Own Supply”: Correlates of Drug Dealing among Heterosexually Identified Methamphetamine Users

Although rates of methamphetamine use continue to increase throughout the United States, little is known about the individuals who sell methamphetamine at the street level. This exploratory study examined the prevalence and correlates of drug-dealing behavior in a sample of 404 heterosexually identified methamphetamine users who were participants in a sexual risk reduction intervention in San Diego, California. Twenty-nine percent of participants (N = 116) reported "dealing" methamphetamine in the past 2 months. In a multivariate logistic regression, methamphetamine dealing was associated with being male (OR = 1.99; 95% CI 1.16-3.39), younger age (OR = 1.87 per year; 95% CI 1.10-3.17), more frequent use of methamphetamine (OR = 2.69; 95% CI 1.59-4.57), injecting methamphetamine (OR = 3.10; 95% CI 1.79-5.37), and higher hostility scores (OR = 1.07 per unit increase; 95% CI 1.01-1.13). These characteristics, particularly intensity of drug use and hostility, may be associated with greater resistance to drug treatment and lower success in treatment programs.

Medical and Psychological Risk Factors for Incident Hypertension in Type 1 Diabetic African-Americans

Objective. To determine risk factors for the development of hypertension among African-Americans living with type 1 diabetes. Methods. African-Americans with type 1 diabetes (n = 483) participated in a 6-year followup. At both baseline and followup blood pressure was measured twice in both sitting and standing positions using a standard protocol. Patients had a structured clinical interview, ocular examination, retinal photographs, and blood and urine assays and completed the Hostility and Direction of Hostility Questionnaire (HDHQ) and the Beck Depression Inventory (BDI). Results. Of the 280 diabetic patients with no hypertension at baseline, 82 (29.3%) subsequently developed hypertension over the 6-year followup. Baseline older age, longer duration of diabetes, family history of hypertension, greater mean arterial blood pressure, overt proteinuria, increasing retinopathy severity, peripheral neuropathy, smoking, and higher hostility scores were significantly associated with the development of hypertension. Multivariate analyses showed that higher hostility scores and overt proteinuria were significantly and independently associated with the development of hypertension in this population. Conclusions. The development of hypertension in African-Americans living with type 1 diabetes appears to be multifactorial and includes both medical (overt proteinuria) as well as psychological (high hostility) risk factors.

Hostility and physiological responses to laboratory stress in acute coronary syndrome patients

ObjectiveEvidence suggests that emotional stress can trigger acute coronary syndromes in patients with advanced coronary artery disease (CAD), although the mechanisms involved remain unclear. Hostility is associated with heightened reactivity to stress in healthy individuals, and with an elevated risk of adverse cardiac events in CAD patients. This study set out to test whether hostile individuals with advanced CAD were also more stress responsive. MethodsThirty-four men (aged 55.9±9.3 years) who had recently survived an acute coronary syndrome took part in laboratory testing. Trait hostility was assessed by the Cook Medley Hostility Scale, and cardiovascular activity, salivary cortisol, and plasma concentrations of interleukin-6 were assessed at baseline, during performance of two mental tasks, and during a 2-h recovery. ResultsParticipants with higher hostility scores had heightened systolic and diastolic blood pressure (BP) reactivity to tasks (both P<.05), as well as a more sustained increase in systolic BP at 2 h post-task (P=.024), independent of age, BMI, smoking status, medication, and baseline BP. Hostility was also associated with elevated plasma interleukin-6 (IL-6) levels at 75 min (P=.023) and 2 h (P=.016) poststress and was negatively correlated with salivary cortisol at 75 min (P=.034). ConclusionHostile individuals with advanced cardiovascular disease may be particularly susceptible to stress-induced increases in sympathetic activity and inflammation. These mechanisms may contribute to an elevated risk of emotionally triggered cardiac events in such patients.

Family History of Suicide and Personality

The objective of this study was to analyze the impact of family history of suicidal behaviour on psychopathlogical features of inmates. A sample of 1,179 prisoners had a psychiatric interview including the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA). Prisoners completed the Barratt Impulsivity Scale (BIS), Buss-Durkee Hostility Inventory (BDHI), and Eysenck Personality Questionnaire (EPQ). Prisoners with a family history of suicide were compared with prisoners without a family history of suicide on clinical and personality variables. Seventy of the 1,179 prisoners (5.9%) had a family history of suicide. Significantly more FHS positive prisoners had attempted suicide compared with FHS negative prisoners (36% vs. 12%, P < 0.0001). Significantly more FHS positive prisoners had a previous history of convictions, a history of juvenile convictions, and had exhibited aggressive behavior in jail. FHS positive prisoners had significantly higher aggression scores on the BGLHA, higher hostility scores on the BDHI, higher impulsivity scores on the BIS, and higher neuroticism scores on the EPQ. A family history of suicide may be a useful clinical indicator that a prisoner is at increased risk for suicidal behaviour and may have problems with impulsive-aggression.

Hostility in coronary artery disease patients and health care workers in Slovakia

Increased levels of hostility are associated with the increased risk of coronary artery disease (CAD), and with poorer outcomes in CAD patients. The purpose of this paper is to estimate the level of hostility in CAD patients and in health care (HC) workers, as potential groups for intervention programmes. A qualitative cross-sectional study was undertaken. Hostility questionnaires were distributed in a non-randomized fashion in a group of 236 CAD patients (187 men, 49 women), aged from 33 to 69 years (average 52 years) and 181 health care workers (52 men, 129 women), aged from 19 to 65 (average 31 years). The results of the survey were discussed in a focused group. The results showed that the high level of hostility in both CAD patients and HC workers exceeded the risk value of 10 in 89 per cent of CAD patients and 95 per cent of HC workers. No difference was found in the hostility scores between CAD patients and HC workers. There was a tendency to higher scores of hostility or of its subcategories (cynicism, anger, aggression) in physicians and nurses of the invasive cardiology or the intensive care units. This paper is of value by showing how increased level of hostility was the issue in both patients and HC workers, with potential consequences of health risk for individuals, as well as deteriorated interpersonal relations and a conflict-generated corporate culture for organizations. Differently tailored programmes for hostility management for particular target groups may help to prevent negative developments.

Clinical predictors of suicidal acts after major depression in bipolar disorder: a prospective study

This study determined the clinical predictors of suicidal behavior during a 2-year follow-up of patients with bipolar disorder presenting with a major depressive episode (MDE). Sixty four patients with DSM-III-R bipolar disorder were assessed at presentation for treatment of an MDE. Correlates of past suicidal behavior were determined by comparing patients with and without a history of suicide attempts using a t-test, Wilcoxon test or chi-squared test of independence on individual explanatory variables. Putative predictors of attempts during the follow-up period were tested separately using Cox proportional hazards regression analysis. Twelve of 64 patients had at least one suicide attempt in the follow-up period, five of them attempted in the first 2 months and seven around or shortly after the 1-year follow-up visit. All attempters had a history of past suicide attempts. Most predictors of future suicidal behavior were correlates of past suicidal behavior. Family history of suicide acts and comorbid borderline personality disorder predicted early attempts, while younger age, high hostility scores, number of past attempts, subjective pessimism as reflected in depression and suicidal ideation, and few reported reasons for living predicted suicidal acts during the whole period. In this data set of bipolar patients we noted an intriguing picture of two clusters of suicide attempts. Hostility was the strongest risk factor. These findings may have implications in both the identification of at-risk patients and the timing of clinical interventions including aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptomatology.

Hostility and perceived social support: interactive effects on cardiovascular reactivity to laboratory stressors

Previous research has identified trait hostility and social isolation as possible psychosocial risk factors for coronary heart disease (CHD). However, few studies have examined hostility and social support simultaneously to determine their independent and possible interactive relations with CHD and disease-promoting mechanisms. Hypotheses derived from a general interpersonal model were tested in a study examining trait hostility and perceived social support as predictors of cardiovascular reactivity to laboratory stressors. Healthy college students (53 men, 55 women) performed speech and mental arithmetic tasks while blood pressure and heart rate were monitored. There was an interactive effect of hostility and perceived social support on systolic and diastolic blood pressure (SBP and DBP) reactivity. Higher hostility scores were associated with greater SBP reactivity for participants who were high in perceived social support; whereas for those with low social support scores, greater hostility was associated with somewhat less SBP reactivity. The same pattern was obtained for DBP, but only during the speech task. These findings encourage further research conceptualizing trait hostility within a general interpersonal framework that calls attention to both positive and negative person-environment transactions.

U-curved relation between total fasting serum cholesterol and hostility: A population-based study

Some researchers have found higher cholesterol levels linearly related to hostility, whereas others have found no relation. Even so, it remains unclear whether research should seek to find a linear relation between hostility and cholesterol levels. We hypothesized that a U-curved association was the proper test of the relation between hostility and cholesterol. Total fasting and low-density lipoprotein (LDL) cholesterol levels were collected from a population-based sample of 2,306 Canadians. Barefoot’s (1989) scoring of the Cook-Medley Hostility Scale was used to assess hostility levels. Both a linear and a U-curved relation among hostility scores, fasting total, and LDL cholesterol levels were significant. Participants with low and high cholesterol levels had significantly higher hostility scores than the normal cholesterol group. A U-curved relation between hostility and serum cholesterol levels may be a more appropriate function to consider given the all-cause mortality findings we seek to explain.

Heart rate variability in depressive and anxiety disorders

Loss of normal autonomic nervous system control of heart rate and rhythm is an important risk factor for adverse cardiovascular events. After myocardial infarction, reduction in beat-to-beat heart rate variability, a measure of cardiac autonomic innervation by the brain, is a strong predictor of death. With loss of vagal innervation, as is noted in patients with severe neuropathy and in heart transplant recipients, there is loss of heart rate variability. It is speculated that decreased parasympathetic innervation exposes the heart to unopposed stimulation by sympathetic nerves. Individuals with high hostility scores and patients with anxiety or depressive disorders have low heart rate variability and may be at increased risk for cardiovascular death associated with coronary heart disease and arrhythmias. After myocardial infarction, depressed patients exhibit higher mortality rates compared with nondepressed patients. Men with “phobic anxiety,” a construct that appears to overlap substantially with panic disorder, also have higher rates of sudden cardiac death and coronary artery disease than control populations. The reduction in autonomic nervous system control to the heart may be one link between psychopathology and heart disease. Although tricyclic antidepressants reduce heart rate variability, at least one study has suggested that, in patients with panic disorder, treatment with the selective serotonin reuptake inhibitor paroxetine normalizes heart rate variability. Hence there is potential for the treatment of psychiatric disorders to affect positively the development and course of cardiovascular disease. (Am Heart J 2000;140:S77-83.)

Increased serum mitogenic activity for arterial smooth muscle cells associated with relaxation and low educational level in human subjects with high but not low hostility traits: Implications for atherogenesis

Proliferation of arterial smooth muscle cells (aSMC) is a key component of atherogenesis. A sample of 225 volunteers, aged 21–65 years, was exposed to “frustration,” “harassment,” or “relaxation,” after completing the 50-item Hostility subscale of the Minnesota Multiphasic Personality Inventory (MMPI). Whole blood was measured before and after exposure for platelet-derived growth factor (PDGF), and sera were evaluated for total and HDL cholesterol concentrations and PDGF-independent mitogenic activity (SMA). Blood pressure and pulse rate were also evaluated. Analyses of SMA (i.e., serum independent of PDGF) revealed an increase in mitogenic effect for cultured human aSMC when hostility was treated as a dichotomous modifier. Among high-hostility subjects, surprisingly, those in the relaxed group and those with a lower educational level were found to have a significant mitogen response; no significant effects were observed for the low-hostility groups. The data suggest that endogenous stresses may occur in high-hostility individuals when “relaxed,” to influence proliferation of arterial smooth muscle cells, as a contribution to atherogenesis. In individuals with lower educational levels and higher hostility scores, lifestyle changes may play a role.

Four-year follow-up of the influence of psychological comorbidity on medical rehospitalization.

This study tested the hypothesis that psychiatric comorbidity measured in medical and surgical general hospital inpatients predicts increased readmissions and days spent rehospitalized at the same hospital up to 4 years after discharge. A convenience sample of 273 medical/surgical inpatients aged 18 years and older were given psychological tests during their third to fifth hospital days on medical and surgical units from June 1, 1985, through June 30, 1986. The main outcome measure was the number of medical/surgical readmissions and number of days rehospitalized during a 4-year follow-up at the same institution. Compared to the rest of the study group, the cognitively impaired patients (according to the Mini-Mental State examination) averaged twice as many rehospitalizations and three times as many days rehospitalized at 6-month follow-up and twice as many days rehospitalized at 2-year follow-up. Compared to the rest of the group, the patients who were depressed or who had high interpersonal sensitivity scores at the index admission spent twice as many days rehospitalized during the 4-year follow-up, while the patients with high hostility scores had almost twice as many readmissions. These results remained statistically significant after separate partialing out of the effects of severity of functional impairment, age, cognitive impairment, and number of admissions or days spent hospitalized before the index admission. Psychiatric comorbidity, previously well documented as contributing to increased length of stay in the general hospital, is associated with increased hospital utilization for at least 4 years after discharge.

Hostility in asymptomatic men with angiogaphically confirmed coronary artery disease

The association of hostility and coronary artery disease was evaluated in a case-control study of aircrew members who had been referred for coronary angiography on the basis of noninvasive tests or risk factor status. The asymptomatic status of the sample and the structured nature of the referral process minimize the methodologic problems normally associated with studies of patients undergoing anglography. Cases (n = 24) had some angiographic evidence of coronary artery disease, whereas controls (n = 25) were found to have no evidence of occlusion. An interaction was observed between smoking history and a measurement of hostility based on observations of the respondent's behavior during a standard interview. Among nonsmokers, cases had higher hostility scores than did controls (p = 0.004). This association was not present among smokers. Self-reported hostility did not discriminate cases from controls. These findings support the notion that hostility plays a role in the pathogenesis of coronary atherosclerosis and point to the potential importance of interactions between hostility and other risk factors.

The Value of Urodynamic Studies in Infants Less than 1 Year Old with Congenital Spinal Dysraphism

The role and timing of urodynamic studies in infants with congenital spinal dysraphism are controversial. We reviewed 64 consecutive infants with a mean followup of 28 months who underwent video urodynamic study when they were less than 1 year old (50 of the 64 patients were less than 3 months old). A previously reported video urodynamic “hostility score” from 0 (best) to 10 (worst) was given to each study and compared with the outcome of the upper urinary tract and subsequent urodynamic studies. A larger fraction of these children with high hostility scores (5 or greater) had upper tract deterioration (39%) compared to those with low hostility scores (9%). Moreover, 6 of 14 patients in the low hostility group who underwent repeat video urodynamic studies after age 1 year had high hostility lower urinary tracts. We conclude that urodynamic studies during and after the first year of life are useful in the appropriate urological evaluation and management of infants with spinal dysraphism.