Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress.
BACKGROUND: Most US troops returned home from the Persian Gulf War (PGW) by Spring 1991 and many began reporting increased health symptoms and medical problems soon after. This investigation examines the relationships between several Gulf-service environmental exposures and health symptom reporting, and the role of traumatic psychological stress on the exposure-health symptom relationships. METHODS: Stratified, random samples of two cohorts of PGW veterans, from the New England area (n = 220) and from the New Orleans area (n = 71), were selected from larger cohorts being followed longitudinally since arrival home from the Gulf. A group of PGW-era veterans deployed to Germany (n = 50) served as a comparison group. The study protocol included questionnaires, a neuropsychological test battery, an environmental interview, and psychological diagnostic interviews. This report focuses on self-reported health symptoms and exposures of participants who completed a 52-item health symptom checklist and a checklist of environmental exposures. RESULTS: The prevalence of reported symptoms was greater in both Persian Gulf-deployed cohorts compared to the Germany cohort. Analyses of the body-system symptom scores (BSS), weighted to account for sampling design, and adjusted by age, sex, and education, indicated that Persian Gulf-deployed veterans were more likely to report neurological, pulmonary, gastrointestinal, cardiac, dermatological, musculoskeletal, psychological and neuropsychological system symptoms than Germany veterans. Using a priori hypotheses about the toxicant effects of exposure to specific toxicants, the relationships between self-reported exposures and body-system symptom groupings were examined through multiple regression analyses, controlling for war-zone exposure and post-traumatic stress disorder (PTSD). Self-reported exposures to pesticides, debris from Scuds, chemical and biological warfare (CBW) agents, and smoke from tent heaters each were significantly related to increased reporting of specific predicted BSS groupings. CONCLUSIONS: Veterans deployed to the Persian Gulf have higher self-reported prevalence of health symptoms compared to PGW veterans who were deployed only as far as Germany. Several Gulf-service environmental exposures are associated with increased health symptom reporting involving predicted body-systems, after adjusting for war-zone stressor exposures and PTSD. (+info)
'Home hypertension': exploring the inverse white coat response.
BACKGROUND: The classical 'white coat response' to blood pressure measurement has been studied thoroughly. However, little is known about patients showing a reverse pattern, i.e. who have lower blood pressure readings at the clinic than outside healthcare facilities. AIM: To estimate the proportion of patients whose blood pressure levels as determined by self-measurements at home are higher than those taken at the clinic and to explore possible associations with demographic, clinical, and psychological variables. METHOD: Patients consecutively attending (n = 214) an academic family medicine department in Toronto, Canada, were eligible. Subjects aged below 16 years and those on psychotropic or blood pressure-lowering agents were excluded. The clinic-home blood pressure difference (CHBPD) was calculated for each participating subject by subtracting home blood pressure from clinic blood pressure. Those who had negative values were compared with the rest of the sample. RESULTS: A considerable proportion of patients had lower blood pressure at the clinic than at home (systolic, 34.6%; diastolic, 23.8%). These subjects did not differ from the rest of the sample with regard to age, sex, levels of education attained, immigration status, body mass index, experience of current symptoms, blood pressure levels, or psychological distress. However, in patients with a 'negative CHBPD', i.e. lower blood pressure at the clinic than at home, readings taken by an automatic, self-inflating device when still at the clinic were higher than in the rest of the sample. CONCLUSION: The results point to measurement bias being at least partly responsible for higher blood pressure readings outside the clinic. Automatic measurement devices used for self/home blood pressure measurement seem to cause an alerting reaction analogous to the well-described 'white coat response'. (+info)
The self-reported well-being of employees facing organizational change: effects of an intervention.
The objective of this study was to investigate the self-reported well-being of employees facing organizational change, and the effect of an intervention. It was a controlled intervention study. Subjects were allocated to study and control groups, and brief individual counselling was offered to the subjects in the study groups. Questionnaire measures were administered before and after counselling (a 3-month interval), and non-counselled subjects also completed questionnaires at the same times. The setting was 15 estate offices in an urban local authority Housing Department. Subjects comprised the total workforce of the Housing Management division: 193 employees, male and female, aged 22-62 years, facing compulsory competitive tendering between 1994-97. Main outcome measures were baseline and comparative measures of psychological morbidity, including the General Health Questionnaire (GHQ) and the Occupational Stress Indicator (OSI). Questionnaire response rates were 72% and 47% on first and second occasions respectively. The uptake of counselling was 37%. In comparison with (1) the UK norms for the OSI and (2) the norms for a similar occupational group, this group of workers were under more work-related pressure and their self-reported health was markedly poorer. They were not however at a disadvantage in terms of coping strategies. Those accepting the offer of counselling were subject to greater levels of work stress, had poorer self-reported health and markedly lower levels of job satisfaction than those who did not. Questionnaire scores were not significantly different before and after counselling, giving no evidence of treatment effects on symptomatology. However, almost all subjects rated counselling as having been extremely helpful. This study suggests that adverse effects on staff facing organizational change may be ameliorated by improved management practice. (+info)
The agenda of the organization. 2: Interventions.
Many contemporary organizations, though doing well in productivity, are in chaos. Stress amongst managers and employees is still rampant and the assertion that 'people are our best assets' is confirmed more in words than in actions. What interventions are needed to best add value to the agenda of the organization and influence employee performance for the better? A philosophy of employee care includes looking at how managers take responsibility for performance management, deal with their own and others' stress and how the dynamics within organizations can be understood and harnessed for the welfare of the company. It also includes reviewing, articulating and implementing policies and systems that affect individuals in the organization and the organization as a whole. (+info)
The managed care revolution: how medical technologists have tolerated the change.
A repeated cross-sectional study on the psychological profiles and interpersonal styles of highly stressed medical technologists (perfusionists) has found remarkable consistency in internal psychological profiles and differences in interpersonal dynamics over a 6-year period. Six years ago a longitudinal study was begun to track the psychological profiles of perfusionists. Surgeons can repair cardiac defects only after a beating heart has been stopped. In order for the brain and other organs to survive cardiac surgery, they must be perfused with well-oxygenated blood. As a result, the life of every cardiac surgery patient literally sits in the hands of the cardiac perfusionist. The stress of placing patients on and off the 'pump' is one that is experienced by cardiovascular perfusionists on a daily basis. This stress has been likened to that of air traffic controllers who continually prepare planes for take off and/or landing. In the 6 years between studies, medical technologists have changed very little psychologically. They remain very well balanced. However, there have been significant changes in their interpersonal behaviours. Instead of the 'well-balanced' interpersonal profiles of 6 years ago, there is a higher degree of assertiveness/aggressiveness being reported. Managed Care has begun to impact interpersonal behaviours but has not yet altered the more resilient platform of internal psychological balance. (+info)
The impact of genetic counselling about breast cancer risk on women's risk perceptions and levels of distress.
Women referred to a familial breast cancer clinic completed questionnaires before and after counselling and at annual follow-up to assess their risk estimate and psychological characteristics. The aims were to determine whether those who attended the clinic overestimated their risk or were highly anxious and whether counselling influenced risk estimates and levels of distress. Women (n = 450) at this clinic were more likely to underestimate (39%) than overestimate (14%) their risk. Mean trait anxiety scores were higher than general population data (t = 4.9, n = 1059, P<0.001) but not significantly different from published data from other screening samples. Overestimators (z = 5.69, P<0.0001) and underestimators (z = -8.01, P<0.0001) reported significantly different risk estimates (i.e. increased accuracy) after counselling, but significant inaccuracies persisted. Over- (n = 12) and underestimators (n = 60) were still inaccurate in their risk estimates by a factor of 2 after counselling. Thirty per cent of the sample scored above the cut-off (5/6) for case identification on a screening measure for psychological distress, the General Health Questionnaire (GHQ). GHQ scores were significantly lower after counselling (t = 3.6, d.f. = 384, P = 0.0004) with no evidence of increasing risk estimate causing increased distress. The risk of distress after counselling was greater for younger women and those who were more distressed at first presentation. The counselling offered was effective in increasing the accuracy of risk perceptions without causing distress to those who initially underestimated their risk. It is worrying that inaccuracies persisted, particularly as the demand for service has since reduced the consultation time offered in this clinic. Further work is needed to evaluate alternative models of service delivery using more sophisticated methods of assessing understanding of risk. (+info)
Food insecurity: consequences for the household and broader social implications.
A conceptual framework showing the household and social implications of food insecurity was elicited from a qualitative and quantitative study of 98 households from a heterogeneous low income population of Quebec city and rural surroundings; the study was designed to increase understanding of the experience of food insecurity in order to contribute to its prevention. According to the respondents' description, the experience of food insecurity is characterized by two categories of manifestations, i.e., the core characteristics of the phenomenon and a related set of actions and reactions by the household. This second category of manifestations is considered here as a first level of consequences of food insecurity. These consequences at the household level often interact with the larger environment to which the household belongs. On a chronic basis, the resulting interactions have certain implications that are tentatively labeled "social implications" in this paper. Their examination suggests that important aspects of human development depend on food security. It also raises questions concerning the nature of socially acceptable practices of food acquisition and food management, and how such acceptability can be assessed. Guidelines to that effect are proposed. Findings underline the relevance and urgency of working toward the realization of the right to food. (+info)
Effects of targeted disruption of the mouse angiotensin II type 2 receptor gene on stress-induced hyperthermia.
1. We have previously reported that brain angiotensin II type 2 receptors (AT2) contribute to immunological stress-induced hyperthermia (fever) in rats. Now, in mice, we report the effect of AT2 gene disruption on the hyperthermia induced by immunological (interleukin-1 (IL-1) injection) and non-immunological (saline injection or cage switch) stress. 2. AT2-deficient and control mice both showed typical circadian rhythmicity in body temperature and physical activity. During the latter half of the dark period, AT2-deficient mice exhibited a lower body temperature than the controls. 3. By comparison with the controls, AT2-deficient mice exhibited: (i) a significantly smaller hyperthermia after intraperitoneal (i.p.) injection of IL-1beta; (ii) significantly greater increases in body temperature and physical activity after i. p. saline; and (iii) a significantly greater hyperthermia (but a similar increase in activity) during cage-switch stress. 4. These results suggest that AT2, presumably in the brain, plays important roles in stress-induced hyperthermia in mice. (+info)