Objective: Although many coronary heart disease (CHD) risk factors are known, the role of an individual's changing personal health history is unclear. We implemented this study to evaluate whether accounting for previous Framingham Risk Scores (FRSs) improves the predictive ability of a current FRS for future CHD in middle-aged adults.

Methods: We analyzed data from the Atherosclerosis Risk in Communities Study (ARIC), a longitudinal cohort of people 45 to 64 years old at entry (1986 to 1989 through 2001). FRSs were calculated for participants in the ARIC cohort (3901 men, 5406 women) at baseline (visit 3) and 3 and 6 years before. Using Cox regressions we evaluated the risk of CHD development for the FRS 6 years from baseline and then evaluated whether the addition of the change in FRS assessments from 3 and 6 years before the baseline improved the predictive ability of the FRS. Areas under the receiver operating characteristic (AUROC) curves were compared.

Results: The addition of the difference between the baseline FRS (eg, in 1995) and the FRS from 6 years earlier (eg, in 1989) to predict CHD development by 2001 for the entire cohort yielded an AUROC of 0.730, which was a significant improvement over just using the baseline FRS (P < .05). The effect was located primarily among women, with the AUROC curve improving from 0.667 to 0.709 (P < .05). There was no improvement for CHD risk prediction in men when the earlier FRS assessments were taken into account. Men seem to have less change in some risk factors over time.

Conclusions: Accounting for an individual's history improves risk assessments based on current measures.

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Purpose: To assess the relationship between the presence of a mental health condition and health care utilization among family medicine patients.

Methods: We used the Patient Health Questionnaire plus a posttraumatic stress disorder screen to measure 6 common mental health conditions. In a sample of 367 patients recruited from 3 urban family medicine practices affiliated with Boston University Medical Center, we measured self-reported health care utilization of primary care provider visits, emergency department visits, nonpsychiatric hospitalizations, and outpatient mental health visits. We determined the association between screening positive for the mental health conditions and health care utilization using both multivariable logistic regression and Poisson regression methods while controlling for sex, age, race, income, insurance status, marital status, educational level, and the presence of chronic medical conditions.

Results: After controlling for potential confounders, generalized anxiety disorder, panic disorder, and posttraumatic stress disorder were statistically significantly associated with more PCP visits, ED visits, and nonpsychiatric hospitalizations. Neither major nor minor depression were associated with more PCP visits, ED visits, or nonpsychiatric hospitalizations, except that minor depression was associated with 103% increase in PCP visits (P < .001). Alcohol use disorder was associated with 16% fewer PCP visits (P = .01) but 238% more nonpsychiatric hospitalizations (P < .001).

Conclusions: After controlling for confounders we found that mental health conditions among a sample of family medicine patients were associated with increased use of ED services, nonpsychiatric hospitalizations, and, to a lesser extent, PCP visits.

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Objective: Many physicians use prednisone to treat acute sciatica with the hope of speeding recovery. There is little clinical evidence to support this practice. Our objective was to determine whether early administration of oral prednisone affects parameters related to recovery from acute sciatica.

Methods: In this double-blind, controlled clinical trial, 27 patients were sequentially assigned to receive either a 9-day tapering course of prednisone (n = 13) or placebo (n = 14) within 1 week of developing sciatic symptoms. Patients and investigators were blinded to the drug administered. Follow-up assessment was done weekly for 1 month and then monthly for 5 months.

Results: Prednisone and control groups showed no statistically significant differences in physical findings, use of nonsteroidal anti-inflammatory drugs or narcotic medications, or rates of patients returning to work at any time interval studied. Compared with controls, patients who received prednisone had more rapid rates of improvement from baseline in pain, mental well-being, and disability scores. These changes were subtle but statistically significant. Patients who received prednisone tended to receive fewer epidural injections for pain.

Conclusions: Early administration of oral steroid medication in patients with acute sciatica had no significant effect on most parameters studied. It did, however, lead to slightly more rapid rates of improvement in pain, mental well-being, and disability scores. The impact of oral steroids on other outcomes is suggested by this study, but its small sample size limited its statistical power.

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