The effect of different traumatic experiences on the development of post-traumatic stress disorder.

This investigation was conducted during the war in Croatia from 1991 to 1993. General characteristics, traumas, and frequency of post-traumatic stress disorder (PTSD) were compared in three groups of soldiers: (1) soldiers who sustained non-disabling injuries; (2) soldiers who sustained permanently disabling injuries; (3) active soldiers (controls). Significant differences were found in general characteristics and in PTSD in the groups observed. Both groups of wounded soldiers were significantly younger (mean of 8 years), fewer of them were married, and they had fewer children than active soldiers (controls). The differences in marital status and the number of children were obviously due to the age difference. Soldiers who sustained non-disabling injuries developed PTSD significantly more often than soldiers who sustained permanently disabling injuries and active soldiers (controls). Possible reasons for the differences of PTSD in compared groups of soldiers are discussed.

Epidemiological model of hepatitis B with age structure.

Multistate epidemiological model with age structure is constructed on the grounds of natural history of the hepatitis B. Essential epidemiological classes constitute the basis of the model. Epidemiological parameters and the coefficients of transfer among the classes were determined from available information. Uncertainty of infectiousness of some classes of the population was an important constraint in model formulation. Population structure, the distribution of epidemiological classes and other parametric values were rather arbitrarily set but these can be changed as more accurate information becomes available. As new information on natural history may become available this can be incorporated into the present model, with appropriate modifications of its structure. The computer program+ of the model has been written in BASIC language, and can be accommodated within microcomputers. The model is used for simulation of endemic and epidemic situations. It is applied for simulating the natural course of infection as well as the effects of various public health interventions, such as passive and active immunization and/or application of appropriate sanitary and hygienic measures. The cost-effectiveness analysis of various public health control programmes can also be carried out with the model. The model is evaluated through the simulations of actual and hypothetical situations. The model in its present form, permits simulation of the disease dynamics in various populations and epidemic situations. It seems to be a useful tool in the study of hepatitis B dynamics, its epidemic patterns and in the search for the effective and cost-effective, control strategies.

Gender, psychological well-being and somatic cardiovascular risk factors.

The purpose of this study is to determine associations between cardiovascular risk factors and subjective experience of psychological general well-being with special reference to gender related differences. One-hundred fifty white-collar workers in a car manufacturing plant in Sweden participated in a health care screening program. Subjective experience of psychological well-being was significantly correlated with cardiovascular risk factors among both men and women. There were, however, marked differences between the genders. For men, the following specific psychological variables were correlated with different cardiovascular risk factors: estimation of general health and psychological well-being, anxiety, depression, self-control and vitality. For women, more complex significant relationships between the two sets of variables were found. Moreover, the direction of the correlations differed between the genders. For example, men with cardiovascular risk factors, such as increased waist-hip-ratio, age and cholesterol, reported significantly more positive estimation of their self-control and vitality. For women the relation was the opposite with a significantly positive correlation (p=3D0.008) between experience of good health and a low risk factor profile indicating the concordance between physiological and psychological parameters. Possible reasons for these sex differences are discussed.

Construct validity of the Sivik Psychosomaticism Test and test of operational style: correlations with Karolinska Scheme of Personality.

To evaluate the construct validity (convergent and divergent) of Sivik Psycho Somaticism test (SPS) and test of Operationality (OPER), Pearson correlation coefficients between SPS scales and subscales and Karolinska Scheme of Personality (KSP) were calculated. Seventy-eight healthy individuals and 196 psychosomatic patients completed the SPS and OPER tests and KSP. The results show that the SPS and OPER subscales are significantly correlated to most KSP subscales. The correlations were higher for the psychosomatic group than for the normal population. The results confirm the validity of the SPS and OPER constructs.

Construct validity of the Sivik Psychosomaticism Test and test of operational style: correlations with four Minnesota Multiphasic Personality Inventory (MMPI) subscales.

To evaluate the construct validity (convergent and divergent) of the Sivik Psycho Somaticism test (SPS) and test of Operationality (OPER), Pearson correlation coefficients between SPS scales and subscales, OPER and Minnesota Multiphasic Personality Inventory (MMPI) subscales Hypochondria (Hs), Depression (D), Hysteria (Hy) and Alexithymia (Al) were calculated. Eighty-eight healthy individuals and 285 psychosomatic patients completed the SPS and OPER tests and MMPI; Hs, D, Hy and Al. The results show that most of the SPS subscales and OPER are significantly correlated to several MMPI subscales in both a normal and a psychosomatic population. The results are in concordance with the theoretical hypotheses and confirm the validity of the SPS and OPER constructs.

The role of blood pressure, cortisol, and prolactin among soldiers injured in the 1991-1993 war in Croatia.

Ninety soldiers with at least three months of combat exposure--60 injured soldiers (30 with permanent disabling and 30 with nondisabling injuries), 30 noninjured soldiers and 30 healthy controls--were interviewed and investigated with physiological (Prolactine, Cortisol, BP, Hb) and psychological tests (MMPI), IES-15 (Impact of Event Scale), PTSS (Post-Traumatic Symptom Scale). Their war related injuries had a different effect on the physiological stress response of the soldiers as reflected in the levels of prolactine, cortisol, hemoglobin and blood pressure. In a report of personality characteristics of the same soldiers, we demonstrated that the experience of posttraumatic stress was not dependent upon physical injury, but rather on the psychological appraisal of the situation. The results of the present article confirm earlier findings that the relationship between physiological and psychological consequences of trauma are complex, and that the perception of an event and the social context within which the traumatized soldier exists is as important as the event itself. The physiological response to the trauma varied greatly among the soldiers regarding the psychosocial impact of the consequence of the injury. So the anticipation of future possible trauma among less severely wounded soldiers (expected to go back to war) was followed by pathological stress responses. Trauma seems to operate somewhat independently from the overt conscious appraisal of the situation and relationship between psychological, psychosocial, and physiological aspects are interrelated in a multifactorial way. An integrative approach is therefore of great importance in assessment as well as in treatment of Posttraumatic Stress Disorder (PTSD).

The significance of immunocompromised condition in the prophylaxis of hepatitis B in chronic renal insufficiency.

The paper presents the immunogenicity of hepatitis vaccine (obtained by genetic engineering) in immunocompromised patients with preterminal renal insufficiency defined by depression of creatinine clearance of 10 to 25 ml/min. The study consisted of 28 randomized patients with impaired renal function. Sixteen patients received a single dose and, twelve a double dose of vaccine. Revaccination following 3 intramuscular doses of vaccine had been undertaken after 24 weeks if antibodies were not detected or their titer was 10 i. u. or less. All patients obtained a booster dose following 52 weeks. There was no statistically significant difference in titer values between immunocompromised patients regardless of whether they were vaccinated with a single or double dose. The antibody titer in patients with chronic renal insufficiency was significantly lower as compared with the results of vaccination in healthy population. It may be concluded that it is more beneficial and less expensive to use a single dose vaccine and revaccination if the titer is negative or insufficiently high.

[Detection of IgG and IgM antibodies to herpes simplex virus type 1 and type 2 in human serum using an immunoenzyme method (ELISA) and the complement fixation reaction]. / Detekcija IgG i IgM antitijela za herpes simplex virus tip 1 i tip 2 u ljudskim serumima pomocu imunoenzimne metode (ELISA) i RVK.

On the basis of borderline optical density values (OD) in an enzyme-linked immunosorbent assay (ELISA) resulting from comparative testing of this method with complement fixation reactions (CF), determination was made of a set criteria for negative, weakly positive and positive results of IgG and IgM antibody detection of Herpes simplex type 1 (HSV 1), respectively type 2 (HSV 2). Of the 192 examined specimens by ELISA, 69.2% and 49.5% IgG HSV 1 and HSV 2 antibodies were found respectively. The number of sera containing IgM HSV 1 od HSV 2 antibodies was low (5.7%), since in the majority of cases the relapsing form of infection was involved. The sensitivity of ELISA to IgG in comparison with CF was slightly higher with the HSV 1 antigen (69.2:68.2%), and apparently lower with HSV 2 (49.5:28.2%). ELISA permits partial differentiation to be made between HSV 1 and HSV 2 antibodies due to a greater degree of antigen purity compared with the unpurified antigen used in CF. In fact, CF is known not to possess the sensitivity necessary to differentiate between HSV 1 and HSV 2 antibodies. For diagnostic purposes, ELISA findings could be more appropriately expressed quantitatively, in corresponding measurement units.

[Ventricular extrasystole in comparison with manifestations of ventricular tachycardia and ventricular fibrillation in acute myocardial infarct]]. / Ventrikulska ekstrasistolija u usporedbi s pojavom ventrikulske tahikardije i fibrilacije ventrikula u akutnom infarktu miokarda.

We studied 76 patients with first recent myocardial infarction being not older than 12 hours. The patients included 58 men and 18 women. Their mean age was 62 years. We recorded continuously during the first three days following infarction the heart rate, all forms of ventricular premature beats, ventricular tachycardia, ventricular fibrillation, clinical status and activity of creatinine-phosphokinase and its isoenzyme MB. The results showed that ventricular premature beats (coupled and multiform) as well as ventricular tachycardia were more frequent in the first day of illness, while ventricular premature beats (except bigeminy, for which there is no explanation) were infrequent in the second and the third day after development of an infarct. The incidence of ventricular tachycardia during the follow-up period did not differ significantly. Ventricular fibrillation developed in 7 patients (9.2%). A comparison of the relation between ventricular premature beats and malignant ventricular tachycardia, i.e. ventricular tachycardia and ventricular fibrillation, revealed that the patients with more frequent ventricular tachycardia usually had frequent ventricular premature beats, particularly more often bigeminy, trigeminy, polymorphous ventricular premature and coupled ventricular premature beats, but not ventricular premature beats with R-on-T phenomenon. Ventricular tachycardia, however, was also found in patients with an evidence of more rare ventricular premature beats. This suggests that the occurrence of aforementioned forms of ventricular premature beats denotes only a somewhat greater probability that ventricular tachycardia will occur. The fact that there is a lack of correlation between ventricular tachycardia and R-on-T phenomenon indicates that this probability is not so significant. In conclusion, the authors believe that the patients with recent myocardial infarction and ventricular premature beats should be adequately followed up, and that prophylactic antiarrhythmic therapy is not required in most cases, as it was previously widely accepted concept. It should be administered only when ventricular tachycardia develops. Patients with ventricular fibrillation had more frequent ventricular premature beats, although ventricular premature beats in these patients were not statistically more frequent from those found in the patients in whom ventricular fibrillation was not verified. The presence or absence of ventricular tachycardia and ventricular fibrillation, respectively, had no influence on the other followed up parameters.