A review of research examining the coronary-prone behavior pattern.

With the increasing incidence of coronary heart disease (CHD) and the subsequent interest in factors which contribute to its development, the idea of a coronary-prone (Type A) behavior pattern has attracted much attention in recent years. In this paper, research on the coronary-prone behavior pattern is reviewed. Type A behavior is found to be fairly accurate in predicting the likelihood and severity of CHD, at least in large groups of people. Problems in measuring and in more clearly defining the components of Type A behavior are discussed. Future investigations are urged, focusing on how the behavior pattern develops and on strategies for intervention.     

Type A in relation to job-stress, social and bioclinical variables: the Belgian Physical Fitness Study

The present study focuses on the relationship of Type A behavior, a suspected coronary-prone behavior pattern in its overall or specific aspects, to "stress" experienced at work, and to social and coronary bioclinical risk factors. In order to measure Type A behavior and Job-Stress, respectively, the Jenkins Activity Survey Questionnaire (J.A.S. for employed persons, 1969 version) and a self-constructed Job-Stress Questionnaire were administered at a base-line examination to 2,302 men aged 40-50 years. The multivariate analysis shows: A strong Type A behavior-Job-Stress relationship; An important relationship between employment grade, educational attainment and--to a lesser extent--, marital status and, overall Type A behavior, Speed and Impatience and Job-Involvement, A weak relationship between cholesterol and triglycerides (not found in univariate analysis), and, overall Type A behavior; a small weak relationship between smoking habits, and, Speed and Impatience and Hard-Driving. A direct relationship between heavy physical activity during leisure-time and Job-Involvement.     

Measurement assessment of the type A coronary prone behavior pattern and hyperactivity/problem behaviors in children: are they related? The Bogalusa Heart Study

The purpose of this study was to contribute to concept clarification regarding identification of the Type A behavior pattern in children. To accomplish this, two measurement techniques for assessing Type A behavior in children (MYTH and Hunter-Wolf) were compared to a third (a teacher-rated measure of hyperactivity: the Conners), since this latter measure, although often used to diagnose hyperactive children, seemed also to measure some Type A-like behaviors. The Hunter-Wolf also included a self-assessment of Type A behavior. The conceptual and measurement issue was: Are teachers rating Type A or hyperactive/problem behaviors in children? Fifty-five teachers participated. They rated 253 students, aged 8 to 17 years, in a biracial community. The clear overlap between teacher-assessed Type A and the Conners hyperactivity measure was demonstrated when the best predictor of teacher-assessed Type A measure was the Conners. This was especially true for black males and white females. Little relationship existed between teacher-assessed Type A and self-assessment. The conclusions suggest that implications drawn from teacher-assessed Type A behavior in children may be inadequate because of potential ethnic and gender artifactual measurement error.     

Assessment of type A behavior in preschoolers

Teachers and mothers of 219 four-year-old preschoolers assessed their children for Type A behavior pattern using the Matthews Youth Test for Health (MYTH). The sample was derived from five day care centers with Black, White, and Hispanic teachers and students from middle and lower class families. This study indicates that Type A behavior can be identified in four-year-old preschoolers on the basis of ratings by their teachers. A statistically significant difference was found between the ratings of Type A/B characteristics by teachers and those by mothers; however, these were not related to the sex or ethnicity of the children. Repeated measurements of Type A ratings in a subsample of the children at age five showed no significant change among boys or girls. However, repeated measurements at age six on a second subsample showed that boys had lower mean scores, i.e. were more Type B at age six than at age four.     

A test of the cognitive social learning model of type A behavior

Portions of the cognitive social learning model proposed by Price as an explanation for the development and maintenance of Type A behavior were examined empirically. Specifically, the hypothesis that Type A behavior is fostered by various beliefs and fears and that these same beliefs and fears arise, in part, as the result of certain parental characteristics was investigated. A questionnaire assessing Type A behavior and the beliefs, fears, and parental characteristics proposed by Price was constructed and administered to a sample of males and females. The results indicated moderate associations between the variables examined for both males and females, with no significant gender differences in the pattern of relationships. The findings are congruent with relationships proposed by Price's model. Implications of the model are discussed in terms of additional research needed.     

Different types of circulatory responses to mental tasks

The present study investigated the circulatory responses to two mental tasks. Forty males and females performed a mental subtraction task and a color-word task. During each task, the systolic and diastolic blood pressure, mean arterial pressure, heart rate, stroke volume, cardiac output, and total peripheral resistance were measured as cardiovascular indices for a 5-min baseline, a 5-min task period, and a 10-min recovery period. As for the results, three hemodynamic reactivity patterns were verified: Pattern C, characterized by increased cardiac output and decreased total peripheral resistance; Pattern M, characterized by a moderate increase in both cardiac output and total peripheral resistance; and Pattern V, characterized by increased total peripheral resistance and decreased cardiac output. Also, four response types were found among all subjects: Type 1: cardiovascular responses showed the cardiac pattern for both tasks; Type 2: cardiovascular responses changed between the cardiac pattern and the mixed pattern with a change of tasks; Type 3: cardiovascular responses showed the mixed pattern for both tasks; Type 4: cardiovascular responses changed between the mixed pattern and the vascular pattern with a change of tasks. The comparison between types showed that Type 3 and Type 4 had an elevation in their blood pressure by an increased total peripheral resistance. On the other hand, Type 1 and Type 2 tended to have an increased blood pressure by a rise in their cardiac output. And Type 3 and Type 4 showed higher blood pressure and higher scores on the Type A behavior pattern questionnaire. In conclusion, at least four types of circulation response to the mental tasks existed, with Type 3 and Type 4 having higher blood pressure responses and tending to have an elevated blood pressure by a rise in their total peripheral resistance.     

Reliability of the MYTH scale in assessing type A behavior in preschool children

The reliability of the Matthews Youth Test for Health (MYTH) scale in assessing Type A behavior patterns among four-year-old children was evaluated, as was the degree of association between the behavior pattern of teachers and their ratings of the children. The Pearson product-moment correlations for the total MYTH scores and for the competitiveness and the impatience/aggression subscale scores ranged from .68 to .73 over a test-retest interval of three months. The teachers completed the Jenkins Activity Survey. No significant correlations were found between the behavior patterns of the teachers and their ratings of the children. The high degree of reliability that was found in test-retest scores on the MYTH was similar to that found in other studies.     

Principal dimensions of the Framingham Type A scale: differential relationships to cardiovascular reactivity and anxiety

The present investigation sought to identify the principal dimensions of the Framingham Type A scale (FTAS) and then to examine their physiological and psychological correlates. A factor analysis of the FTAS items, which was cross-validated, revealed two factors. Items concerning achievement and competitive-striving loaded primarily on the first factor. Scores on a subscale composed of these items (labeled Competitive Drive) were related to systolic blood pressure reactivity during an interpersonal task but were unrelated to anxiety. FTAS items concerning impatient, time urgent, and domineering propensities loaded primarily on the second factor. Scores on a subscale composed of these items (labeled Speed and Impatience) were not related to cardiovascular reactivity during the task but were related to anxiety. Results are discussed in terms of the psychological heterogeneity of the Type A behavior pattern and possible differences between dimensions of the overall Type A pattern and their association with different manifestations of coronary heart disease.     

The inhibited power motive, type A behavior, and patterns of cardiovascular response during the structured interview and Thematic Apperception Test

The Type A behavior pattern and the inhibited power motive have been implicated in the development of coronary heart disease (CHD). Since it is widely believed that enhanced cardiovascular responsivity may be one mechanism by which individuals develop CHD, the present study examined the relationship of Type A behavior and the inhibited power motive to different patterns of cardiovascular response during two behavioral tasks. Forty-one (24 Type A's, 17 Type B's) male undergraduates underwent the Type A structured interview (SI) and the Thematic Apperception Test (TAT) while a broad range of cardiovascular functions were simultaneously recorded. Different patterns of cardiovascular response were observed during the SI and TAT, and Type A's showed a greater tendency than Type B's to exhibit increased heart rate (HR), systolic blood pressure (SBP), and forearm blood flow (FBF) during the SI and the preparatory phase (but not the story-telling phase) of the TAT. The inhibited power motive was not related to enhanced cardiovascular responsivity during the SI or TAT. The implications of these findings for the development of CHD are discussed.     

Personality and self-motivation during biochemical fatigue

The present study was conducted to determine whether females exhibiting the Type A behavior pattern would exert greater effort and work to higher levels of physiological fatigue in a self-motivated ergometer test. Twenty female subjects, half of them Type A and the other half Type B, were administered an incremental ergometer test to determine their peak oxygen consumption value. On the first experimental session no experimenter encouragement was given to the subjects. Consequently the test measured physical motivation levels. During a second laboratory session, each subject was continuously encouraged by the experimenter to maintain exercising until she was truly incapable of further work. The highest rate of oxygen extraction during this latter session was considered the subject's maximum oxygen consumption (i.e., VO2 max). Type A and B subjects were compared in the nonmotivated testing session (experimental session 1) to their "true" individual capacities (maximum oxygen consumption demonstrated in experimental session 2). ANOVAs indicated no significant differences in self-initiated competitive behavior during a physical stressor.     

Interpersonal interaction and cardiovascular response in type A subjects and coronary patients

The present study tested the hypothesis that Type A subjects respond with greater cardiovascular response than Type B subjects during the structured interview used to assess the Type A pattern. Coronary patients (n = 31) and patient controls (n = 33) were subjected to the interview and a history quiz while ECG and blood pressure were monitored. As predicted, Type A relative to Type B subjects evidenced significantly greater increases in both systolic and diastolic blood pressure, which were sustained over the course of the entire 12-15 minute interview. Type A subjects compared with B's also showed significantly greater blood pressure elevations during the quiz. Coronary patients displayed significantly greater Type A attributes than control subjects and tended to show greater blood pressure elevations than controls during the interview. In addition, the quiz induced significant elevations in the blood pressure of coronary patients, but not patient controls, over that displayed during the interview, despite the presence of beta-adrenergic blocking medication. Implications of the findings for coronary-prone behavior and coronary heart disease are discussed.     

Beliefs and fears underlying type A behavior: what makes Sammy run--so fast and aggressively?

Price has proposed that Type A behavior allows individuals to cope with fears and anxieties engendered by beliefs they develop about their environment through socialization. Three investigations tested her cognitive social learning model of Type A behavior by developing measures of beliefs and fears, and validating them against a standardized Type A measure, the Jenkins Activity Survey (two studies), and measures of Time Urgency, Hostility, Time for Reverie and Self-Centeredness (one study). Respondents provided data by completing questionnaires. Three beliefs and four fears were assessed. Findings indicated that the measures of beliefs and fears had desirable psychometric properties and produced modest relationships with the JAS, Time Urgency and Hostility. Future research directions and practical implications are offered.     

The role of challenging incentives in feedback-assisted heart rate reduction for coronary-prone adult males

Three experiments were performed to study the influence of challenging incentives on feedback-assisted heart rate reduction for coronary-prone (Type A) and non-coronary-prone (Type B) males. In the first experiment, when subjects were given a competitive instructional set, Type As were significantly more successful relative to Type Bs in reducing their heart rate; with a noncompetitive set, Type Bs were significantly more successful than were Type As. In the second experiment, when told that heart rate reduction was a scarce ability, Type As reduced heart rate significantly better than did Type Bs; when told that heart rate reduction was a common ability, Type Bs achieved significantly greater heart rate reduction than did Type As. In the third experiment, when heart rate reduction was described as being instrumental to time-urgency (i.e., getting more done in less time), Type As reduced heart rate significantly bettern than did Type Bs; when heart rate reduction was described as being instrumental to relaxation, Type Bs were significantly better able to reduce heart rate. In all three studies, the incentives had no effect on heart rate when feedback was not provided. The results are discussed as support for the notion that Type A behavioral pattern characteristics can be exploited to reduce Type A symptoms. Implications for how coronary-prone individuals may be challenged to modify symptoms within the clinical setting are discussed.     

Cardiovascular responses of Type A and Type B behavior patterns to visual stimulation during rest, stress and recovery

Differences in the cardiovascular responses of individuals with behavior patterns of Type A and Type B were investigated during rest, stress, and recovery by visual stimulation. Thirty healthy undergraduate and graduate students (mean age: 22.18+/-1.44 years) were categorized as Type A (N=14), or Type B (N=16) based on the Kwansei Gakuin's daily life questionnaire. The cardiovascular reactivity of all participants was repetitively monitored for 6 sessions, with each session comprising 3 conditional phases, viz., resting, stress, and post-stress recovery. A gray screen was displayed during resting, displeasure-evoking images were displayed under the stress condition, and video clips of a forest or a control image (a gray screen) were displayed during the recovery condition. When participants were subjected to different stimuli on a 42-inch plasma television screen in each session, electrocardiograms (ECG), impedance cardiograms and the blood pressure (BP) of the respective participants were continuously monitored. According to the results, Type A indicated higher sympathetic reactivity than Type B during resting and under stress. As such, Type A indicated a shorter pre-ejection period (PEP) level during resting and a greater cardiac output (CO) increase under stress than Type B. Furthermore, parasympathetic predominance and parasympathetic antagonism accompanying the enhanced sympathetic activity induced by the unpleasant stress images decreased heart rate (HR) in both Type A and Type B, although the decrease in Type A was relatively meager. Unlike previous studies, the present study demonstrated that Type A indicated more enhanced sympathetic reactivity than Type B in resting physiological arousal levels and visual stimulus-induced stress.     

Development and Validation of a Severity Scale for Leprosy Type 1 Reactions

Objectives

To develop a valid and reliable quantitative measure of leprosy Type 1 reactions.

Methods

A scale was developed from previous scales which had not been validated. The face and content validity were assessed following consultation with recognised experts in the field. The construct validity was determined by applying the scale to patients in Bangladesh and Brazil who had been diagnosed with leprosy Type 1 reaction. An expert categorized each patient''s reaction as mild or moderate or severe. Another worker applied the scale. This was done independently. In a subsequent stage of the study the agreement between two observers was assessed.

Results

The scale had good internal consistency demonstrated by a Cronbach''s alpha >0.8. Removal of three items from the original scale resulted in better discrimination between disease severity categories. Cut off points for Type 1 reaction severities were determined using Receiver Operating Characteristic curves. A mild Type 1 reaction is characterized using the final scale by a score of 4 or less. A moderate reaction is a score of between 4.5 and 8.5. A severe reaction is a score of 9 or more.

Conclusions

We have developed a valid and reliable tool for quantifying leprosy Type 1 reaction severity and believe this will be a useful tool in research of this condition, in observational and intervention studies, and in the comparison of clinical and laboratory parameters.     

The relation of stress hormone excretion to type A behavior and to health

The relation between catecholamine and cortisol excretion and Type A behavior, assessed using an 11-item self-report questionnaire based on the Jenkins Activity Survey, is examined in a Swedish sample of young adults (N = 149). Cluster analysis indicates that the items measure four aspects of Type A behavior: irritability, hurried behavior, work achievement, and competitiveness. These clusters are not correlated with measures of recent health care utilization. In both sexes, a higher total Type A behavior score is related to decreased daytime urine concentrations of norepinephrine and day and night concentrations of cortisol. In males, increased hurried behavior is related to lower night levels of norepinephrine; higher irritability and competitiveness predict lower night levels of epinephrine and cortisol and increased urine excretion rate. In females, higher irritability and lower competitiveness scores are related to increases in daytime urine excretion and slightly lower levels of cortisol. These results indicate that only certain aspects of the Type A syndrome are related to stress processes and imply that the behaviors serve to lower stress responses in early adulthood.     

Mechanisms of biphasic action of glucocorticoids on alpha-lactalbumin production by rat mammary gland explants

The highly selective Type II glucocorticoid ligand RU28362 showed a clear biphasic effect on alpha-lactalbumin (alpha-LA) production in rat mammary gland explants, with a peak at 1 nM and a return to basal levels at 30-300 nM; dexamethasone showed a similar profile. Corticosterone, which has a higher affinity for Type I than Type II receptors, produced a variable response. In six out of eleven studies this was biphasic, with a maximum at 300 nM; in five no increase above baseline was seen. Classical Type I receptor ligands--aldosterone and deoxycorticosterone--showed responses parallel to their Type II agonist activity. We interpret these data as follows occupancy of Type I receptors does not increase alpha-LA production the response to selective Type II receptor ligands is truly biphasic and one explanation of this pattern may be the existence of both "turn-on" and "turn-off" acceptor sites in the nucleus.     

Phase diagrams and lipid domains in multicomponent lipid bilayer mixtures

Understanding the phase behavior of biological membranes is helped by the study of more simple systems. Model membranes that have as few as 3 components exhibit complex phase behavior that can be well described, providing insight for biological membranes. A number of different studies are in agreement on general findings for some compositional phase diagrams, in particular, those that model the outer leaflet of animal cell plasma membranes. These model mixtures include cholesterol, together with one high-melting lipid and one low-melting lipid. An interesting finding is of two categories of such 3-component mixtures, leading to what we term Type I and Type II compositional phase diagrams. The latter have phase regions of macroscopic coexisting domains of {Lα + Lβ + Lo} and of {Lα + Lo}, with domains resolved under the light microscope. Type I mixtures have the same phase coexistence regions, but the domains seem to be nanoscopic. Type I mixtures are likely to be better models for biological membranes.     

Practical review of self-mutilation in horses

Self-mutilation in horses includes biting, stomping and kicking, rubbing, and lunging into objects. Based on the author's clinical experience, three distinct types of self-mutilation are proposed and described. Type I represents normal behavioral response to continuous or intermittent physical discomfort. Type II, seen in stallions and geldings, can be recognized as self-directed intermale aggression. The behavior includes the elements and order of the natural interactive sequence typical of encounters between two stallions, except that the stallion himself is the target of his intermale behavior. Type III involves a more quiet, often rhythmically repetitive or methodical behavioral sequence of a stereotypy, for example nipping at various areas of the body in a relatively invariant pattern, stomping, or kicking rhythmically against an object. The prevalence of the various types of self-mutilation in horses is not known. In one survey, results suggested that self-mutilation of one form or another has been observed in as many as 2% of domestic stallions. Among and between stallions, self-mutilation varies in frequency and intensity, and can reach levels that are fertility and/or life threatening. Careful evaluation of the horse's behavior is often necessary to distinguish the specific type. Type I self-mutilation, where physical discomfort is the root cause, can be eliminated by relieving the discomfort. For Types II and III, understanding of intermale interactive behavior of horses and the environmental factors that may trigger or exacerbate the self-mutilative form, can be useful in guiding humane management or behavior modification. Pharmacologic interventions may be a useful adjunct to management and nutritional changes.