Occupation and 20-year hearing decline: findings from The HUNT Study.

BACKGROUND: Studies show that certain occupations are associated with an increased risk of hearing loss. However, many studies are cross-sectional, and the few longitudinal studies are mostly small or focus on only one occupation. AIMS: We aimed to quantify the long-term hearing decline among workers in different occupations and assess whether the change differs between the occupations. METHODS: The study population was 4525 adults who participated in two population-based health studies in Norway, HUNT2 1996-1998 and HUNT4 2017-2019. Linear regression models assessed the association between occupations (clerks as reference) and 20-year hearing decline (hearing thresholds at 3-6 kHz, averaged over both ears) from HUNT2 to HUNT4. Models were adjusted for age, sex, recurrent ear infections, smoking and ear pathology. RESULTS: Among the participants (40% men), the mean age at HUNT2 was 31.2 ± 5.4 years (range 20-39) and the average 20-year hearing decline was 11.3 ± 9.8 dB. Occupations that were associated with larger hearing decline included other craft and related trades workers (3.9 dB, 95% confidence interval [CI] 0.2-7.7) and building frame and related trades workers (3.4 dB, 95% CI 1.3-5.4). Among occupations with larger hearing decline, a higher proportion of the workers reported exposure to noise. CONCLUSIONS: This large longitudinal study shows a larger long-term hearing decline among building frame workers and craft and related trades workers. Differences between occupations were modest, which may indicate successful preventive measures in Norway during the last two decades.

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study.

OBJECTIVE: To study the prognosis for pelvic girdle pain, and to explore the association between presence of emotional distress during pregnancy and pelvic girdle syndrome 6 months after delivery. DESIGN: Longitudinal population study. SETTING: Norway, for the period 1999-2008. POPULATION: A follow-up of 41 421 women in the Norwegian Mother and Child Cohort who reported pelvic girdle pain at 30 weeks of gestation. METHODS: Data were obtained by self-administered questionnaires in weeks 17 and 30 of gestation, and 6 months after delivery. MAIN OUTCOME MEASURE: Pelvic girdle syndrome 6 months after delivery, defined as pain in the anterior pelvis and on both sides in the posterior pelvis. RESULTS: Six months after delivery, 78.0% of the women had recovered, 18.5% reported persistent pain in one or two pelvic locations, 3.0% reported pelvic girdle syndrome and 0.5% reported severe pelvic girdle syndrome. The recovery rates decreased with increasing levels of pain severity in pregnancy. Being emotionally distressed at two time points during pregnancy was associated with the presence of pelvic girdle syndrome (adjusted OR 1.5, 95% CI 1.2-1.9) and severe pelvic girdle syndrome (adjusted OR 1.9, 95% CI 1.1-3.1), after adjustment for pain severity in pregnancy, other medical conditions, body mass index, age at menarche, previous low back pain, and smoking during pregnancy. CONCLUSIONS: In this follow-up of women with pelvic girdle pain in pregnancy, the recovery rates after delivery were high. Our findings suggest that the presence of emotional distress during pregnancy is independently associated with the persistence of pelvic girdle pain after delivery.

Hearing status among Norwegian train drivers and train conductors.

BACKGROUND: There is a general perception that train drivers and conductors may be at increased risk of developing noise-induced hearing loss. AIMS: To study job-related hearing loss among train drivers and train conductors. METHODS: Audiograms from train drivers and train conductors were obtained from the medical records of the occupational health service of the major Norwegian railway company. The results were compared with audiograms from an internal control group of railway workers and an external reference group of people not occupationally exposed to noise. The monaural hearing threshold level at 4kHz, the mean binaural value at 3, 4 and 6kHz and the prevalence of audiometric notches (≥25 dB at 4kHz) were used for comparison. RESULTS: Audiograms were available for 1567 drivers, 1565 conductors, 4029 railway worker controls and 15 012 people not occupationally exposed to noise. No difference in hearing level or prevalence of audiometric notches was found between study groups after adjusting for age and gender. CONCLUSIONS: Norwegian train drivers and conductors have normal hearing threshold levels comparable with those in non-exposed groups.

Polysomnographic sleep is not clinically impaired in Vietnam combat veterans with chronic posttraumatic stress disorder.

BACKGROUND: Because sleep is typically disturbed in posttraumatic stress disorder (PTSD), this study was undertaken to evaluate a group of Vietnam combat veterans with the disorder using clinical polysomnographic techniques. METHODS: Eighteen Vietnam combat veterans with PTSD and 10 healthy non-combat-exposed Vietnam era veterans participated in 2 nights of polysomnographic study and a multiple sleep latency test. RESULTS: No significant differences between subjects and controls were noted except for greater sleep onset latency to stage 2 (p < .03), and lower arousals/hour from stages 3 & 4 (p < .04) on night 2, and lower subjectively estimated total sleep time on night 1 (p < .005) in the case of PTSD subjects. Otherwise, results from the second night served to replicate those from the first, and no significant differences appeared on 2 successive nights for any polysomnographic variable. No daytime hypersomnolence was detected. CONCLUSIONS: Polysomnographically recorded sleep was notably better than expected in the presence of clinically significant PTSD with typical histories of disrupted sleep. In these subjects, there is no clinically significant sleep disorder or typical pattern of sleep disturbance detectable by standard polysomnography.

Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder.

BACKGROUND: Although sleep disturbances are commonly reported by individuals with posttraumatic stress disorder (PTSD), objective findings have been inconsistent, due in part to small sample sizes, comorbid psychiatric disorders, variations in the recentness of trauma exposure, and the use of PTSD subjects involved in psychiatric treatment. METHODS: A community sample of elderly males (n = 59) exposed to war trauma 28-50 years ago and free from sleep-affecting medications and disorders other than PTSD completed 3 nights of polysomnography. Of these participants, 30 met criteria for current PTSD; three were receiving supportive outpatient psychotherapy. RESULTS: Two statistically significant differences were observed: Those with PTSD had a higher percentage of rapid eye movement (REM) sleep and fewer arousals from non-REM sleep. The perceptions of sleep quality among the participants with PTSD were lower than the perceptions of non-PTSD participants. Although participants with untreated obstructive sleep apnea and sleep movement disorders were not included in the sample, many cases were detected on initial screening. Treatment resulted in improved sleep and increased feelings of well being. CONCLUSIONS: Alterations in REM and arousals characterized PTSD in this sample. When comorbid sleep disorders were ruled out, sleep was clinically similar across the groups. Trauma-related sleep disturbances that subjects reported as arising early in the course of the disorder appear to have declined over time.

A longitudinal and retrospective study of PTSD among older prisoners of war.

OBJECTIVE: The authors examined the longitudinal changes in posttraumatic stress disorder (PTSD) symptom levels and prevalence rates over a 4-year time period among American former prisoners of war (POWs) from World War II and the Korean War. Retrospective symptom reports by World War II POWs dating back to shortly after repatriation were examined for 1) additional evidence of changing PTSD symptom levels and 2) evidence of PTSD cases with a long-delayed onset. METHOD: PTSD prevalence rates and symptom levels were measured by the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. For the longitudinal portion of the study, participants were 177 community-dwelling World War II and Korean POWs. For the retrospective portion, participants were 244 community-dwelling World War II POWs. RESULTS: PTSD prevalence rates and symptom levels increased significantly over the 4-year measurement interval. Retrospective symptom reports indicated that symptoms were highest shortly after the war, declined for several decades, and increased within the past two decades. Long-delayed onset of PTSD symptoms was rare. Demographic and psychosocial variables were used to characterize participants whose symptoms increased over 4 years and differentiate participants who reported a long-delayed symptom onset. CONCLUSIONS: Both longitudinal and retrospective data support a PTSD symptom pattern of immediate onset and gradual decline, followed by increasing PTSD symptom levels among older survivors of remote trauma.

Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war.

OBJECTIVE: The authors assessed DSM-III-R disorders among American former prisoners of war. Comorbidity, time of onset, and the relationship of trauma severity to complicated versus uncomplicated posttraumatic stress disorder (PTSD) were examined. METHOD: A community sample (N=262) of men exposed to combat and imprisonment was assessed by clinicians using the Structured Clinical Interview for DSM-III-R. RESULTS: The rates of comorbidity among the men with PTSD were lower than rates from community samples assessed by lay interviewers. Over one-third of the cases of lifetime PTSD were uncomplicated by another axis I disorder; over one-half of the cases of current PTSD were uncomplicated. PTSD almost always emerged soon after exposure to trauma. Lifetime PTSD was associated with increased risk of lifetime panic disorder, major depression, alcohol abuse/dependence, and social phobia. Current PTSD was associated with increased risk of current panic disorder, dysthymia, social phobia, major depression, and generalized anxiety disorder. Relative to PTSD, the onset of the comorbid disorders was as follows: major depression, predominantly secondary; alcohol abuse/dependence and agoraphobia, predominantly concurrent (same year); social phobia, equal proportions primary and concurrent; and panic disorder, equal proportions concurrent and secondary. Trauma exposure was comparable in the subjects with complicated and uncomplicated PTSD. CONCLUSIONS: The types of comorbid diagnoses and their patterns of onset were comparable to the diagnoses and patterns observed in other community samples. The findings support the validity of the PTSD construct; PTSD can be distinguished from comorbid disorders. Uncomplicated PTSD may be more common than previous studies suggest, particularly in clinician-assessed subjects exposed to severe trauma.

Posttraumatic stress disorder in a community group of former prisoners of war: a normative response to severe trauma.

OBJECTIVE: The goal of this study was to assess and describe the long-term impact of traumatic prisoner of war (POW) experiences within the context of posttraumatic psychopathology. Specifically, the authors attempted to investigate the relative degree of normative response represented by posttraumatic stress disorder (PTSD) in comparison to other DSM axis I disorders often found to be present, either alone or concomitant with other disorders, in survivors of trauma. METHOD: A community group of 262 U.S. World War II and Korean War former POWs was recruited. These men had been exposed to the multiple traumas of combat, capture, and imprisonment, yet few had ever sought mental health treatment. They were assessed for psychopathology with diagnostic interviews and psychodiagnostic testing. Regression analyses were used to assess the contributions of age at capture, war trauma, and postwar social support to PTSD and the other diagnosed disorders. RESULTS: More than half of the men (53%) met criteria for lifetime PTSD, and 29% met criteria for current PTSD. The most severely traumatized group (POWs held by the Japanese) had PTSD lifetime rates of 84% and current rates of 59%. Fifty-five percent of those with current PTSD were free from the other current axis I disorders (uncomplicated PTSD). In addition, 34% of those with lifetime PTSD had PTSD as their only lifetime axis I diagnosis. Regression analyses indicated that age at capture, severity of exposure to trauma, and postmilitary social support were moderately predictive of PTSD and only weakly predictive of other disorders. CONCLUSIONS: These findings indicate that PTSD is a persistent, normative, and primary consequence of exposure to severe trauma.

Colon cancer: personality factors predictive of onset and stage of presentation.

This study examined premorbid personality correlates of colon cancer and stage of presentation of colon cancer to health care providers. Sixty-one male veterans who completed the MMPI between 1947 and 1975 and were then diagnosed with colon cancer between 1977 and 1988 were matched with control patients. A 21-factor solution of the MMPI [1] was used to seek potential personality differences between colon cancer cases and their controls in terms of presence of colon cancer and stage of presentation for this disease. A stepwise conditional regression analysis found significant differences between the colon cancer and control groups on the Aggressive Hostility variable (p < 0.018). A multivariate analysis of variance conducted across the stages of colon cancer presentation found that patients who presented later on for colon cancer had higher Phobia scores (p < 0.05). Religious Fundamentalism was also related to presentation (p < 0.05), but in a nonlinear manner. Discussion is related to previous findings regarding the relationship between personality and development of cancer, as well as to implications for patient screening.

Effects of noise and exercise on distortion product otoacoustic emissions.

The effect of physical exercise on both distortion product otoacoustic emissions (DPOAE), and on the temporary effects of noise on human cochlear function was examined. Changes in DPOAEs were compared to changes in behavioural thresholds and the possible relation between contralateral suppression of DPOAEs and susceptibility to noise exposure was investigated. Békésy audiometry, tympanometry and DPOAEs were measured in 8 subjects on 3 separate occasions: before and after noise exposure; before and after exercise at 60% of maximal oxygen uptake (VO2max); and before and after a combination of noise exposure and exercise, all of 10 min duration. Noise exposure was third-octave band noise of 102 dB SPL centered at 2 kHz. The magnitude of the effect of noise exposure on DPOAE amplitude averaged in the 2-4 kHz range was comparable but weakly correlated to the magnitude of the temporary threshold shift (TTS) measured as the change in Békésy threshold at 3 kHz. There was no effect of physical exercise without noise exposure on either the Békésy threshold or the DPOAE amplitude. Physical exercise significantly increased the noise-induced TTS and the effect of noise exposure on DPOAE amplitude. A positive correlation was found between the temporary effect of noise exposure and the contralateral suppression effect on DPOAE amplitude.

Otoacoustic emissions and improved pass/fail separation using wavelet analysis and time windowing.

A new method is presented for the purpose of improving pass/fail separation during transient evoked otoacoustic emission (TEOAE) hearing screening. The method combines signal decomposition in scales using the discrete wavelet transform, non-linear denoising and scale-dependent time windowing. The cross-correlation coefficient between two subaveraged, processed TEOAE signals is used as a pass/fail criterion and assessed in relation to the pure-tone, mean hearing level. The performance is presented in terms of receiver operating characteristics for a database of 5,214 individuals. The results show that the specificity improves from 68% to 83% at a sensitivity of 90% when compared with the conventional wave reproducibility parameter.

Effects of supplemental feed with or without ionophores on lambs and Angora kid goats on rangeland.

Effects of supplemental feed and of ionophore concentration in supplemental feed on gastrointestinal rate parameters, forage intake and weight gain were measured in individually supplemented grazing lambs and Angora kid goats. The 12 dietary treatments included negative control (NC; grazed forage only), positive control (PC; grazing plus 13.6 g supplement DM/kg.75), and PC plus monensin or lasalocid, each at 33, 66, 99, 132 or 165 mg/kg in the supplement. Gastrointestinal fill, retention time, turnover rate and fecal output were estimated by applying a single-compartment model to the fecal excretion of a single dose of ytterbium. Forage digestibility was estimated from forage and fecal concentrations of indigestible fiber. Supplemental feed increased digestibility of forage and total intake in sheep but had no effect on forage intake. In goats, supplemental feed did not increase digestibility of forage but decreased forage intake. Supplemental feed increased weight gain in both species. Increasing the monensin concentration in supplemental feed reduced supplement intake greatly in sheep and slightly in goats. Lasalocid did not affect intake of supplement by either sheep or goats. Overall, ionophores had minimal effects on the response criteria. Because feed intake and digestibility were not affected, any increase in gain or efficiency in lambs or kid goats on rangeland from consumption of ionophores must be a result of their therapeutic value or of improved physiological efficiency.

Attachment style classification and posttraumatic stress disorder in former prisoners of war.

Adult attachment style and post-traumatic stress disorder (PTSD) symptomatology were investigated in 107 former prisoner of war veterans. Those with secure attachment styles scored significantly lower on measures of PTSD than did those with insecure styles, and attachment style was a stronger predictor of PTSD symptom intensity than was trauma severity. The suggested association between attachment style and PTSD's development and persistence are discussed in relation to research and clinical practice.

The synchronous neural interactions test as a functional neuromarker for post-traumatic stress disorder (PTSD): a robust classification method based on the bootstrap.

Traumatic experiences can produce post-traumatic stress disorder (PTSD) which is a debilitating condition and for which no biomarker currently exists (Institute of Medicine (US) 2006 Posttraumatic Stress Disorder: Diagnosis and Assessment (Washington, DC: National Academies)). Here we show that the synchronous neural interactions (SNI) test which assesses the functional interactions among neural populations derived from magnetoencephalographic (MEG) recordings (Georgopoulos A P et al 2007 J. Neural Eng. 4 349-55) can successfully differentiate PTSD patients from healthy control subjects. Externally cross-validated, bootstrap-based analyses yielded >90% overall accuracy of classification. In addition, all but one of 18 patients who were not receiving medications for their disease were correctly classified. Altogether, these findings document robust differences in brain function between the PTSD and control groups that can be used for differential diagnosis and which possess the potential for assessing and monitoring disease progression and effects of therapy.

Post-traumatic stress disorder: a right temporal lobe syndrome?

In a recent paper (Georgopoulos et al 2010 J. Neural Eng. 7 016011) we reported on the power of the magnetoencephalography (MEG)-based synchronous neural interactions (SNI) test to differentiate post-traumatic stress disorder (PTSD) subjects from healthy control subjects and to classify them with a high degree of accuracy. Here we show that the main differences in cortical communication circuitry between these two groups lie in the miscommunication of temporal and parietal and/or parieto-occipital right hemispheric areas with other brain areas. This lateralized temporal-posterior pattern of miscommunication was very similar but was attenuated in patients with PTSD in remission. These findings are consistent with observations (Penfield 1958 Proc. Natl Acad. Sci. USA 44 51-66, Penfield and Perot 1963 Brain 86 595-696, Gloor 1990 Brain 113 1673-94, Banceaud et al 1994 Brain 117 71-90, Fried 1997 J. Neuropsychiatry Clin. Neurosci. 9 420-8) that electrical stimulation of the temporal cortex in awake human subjects, mostly in the right hemisphere, can elicit the re-enactment and re-living of past experiences. Based on these facts, we attribute our findings to the re-experiencing component of PTSD and hypothesize that it reflects an involuntarily persistent activation of interacting neural networks involved in experiential consolidation.

Prevalence of somatic and psychiatric disorders among former prisoners of war.

American former prisoners of war (POWs) are an aging group who seek health care with increasing frequency. To examine the prevalence of long-term physical and emotional consequences of captivity in this population, the authors analyzed medical and psychiatric examination data for 426 former POWs. Detailed psychiatric diagnostic criteria were used to assess the POWs' mental health. Compared with general population groups, POWs had moderately elevated lifetime prevalence rates of depressive disorders and greatly elevated rates of posttraumatic stress disorder (PTSD), although their rates of hypertension, diabetes, myocardial infarction, bipolar disorder, schizophrenia, and alcoholism were not elevated. POWs who lost more than 35 percent of their body weight during captivity had higher rates of anxiety disorder, depressive disorders, PTSD, and schizophrenia, compared with other POWs.

The effect of noise exposure on the details of distortion product otoacoustic emissions in humans.

The effect of noise exposure on amplitude and phase of distortion product otoacoustic emissions (DPOAEs) was examined by five different paradigms: across a wideband of frequency, microstructure, input/output function, primary frequency ratio tuning curve, and group delay. The aim was to investigate the vulnerability of these different features to moderate levels of noise exposure. Nine subjects were exposed to third-octave-band noise. The DPOAE amplitude was reduced frequency specifically with the greatest reduction approximately half an octave above the frequency of the noise. The degree of amplitude reduction was greatest at low stimulus levels. There were no observed effects on the shape of the primary ratio tuning curve. A weak tendency to a decrease was seen in group delays. Distinct microstructure was seen in the amplitude against frequency of five out of seven subjects. The maximum to minimum ratio of the microstructure decreased, and the whole pattern shifted toward lower frequencies after noise exposure. Evidence of multiple internal reflection or interference was seen in the periodicity of the microstructure. Using a simple model of the microstructure based on multiple reflections, the noise-induced changes were reevaluated. A reduction in maximum to minimum microstructure ratio could be interpreted as a decrease in the internal reflection coefficient. The implications of these observations for the interpretation of the DPOAE measurements are considered.

[Tinnitus--etiology, diagnosis and treatment]. / Tinnitus--etiologi, diagnose og behandling.

Tinnitus is the sensation of sound, a sensation generated by the auditory system because of a pathology, without any external acoustic or electrical stimulation. 15% of the adult population have experienced shorter or longer periods of tinnitus. Three percent of these, in total about 7,000-10,000 persons in Norway, suffer from continuous tinnitus followed by symptoms that demonstrate handicap or occupational disability. The authors discuss the cause of tinnitus and its relation to different kinds of hearing loss. Treatment is dependent on a specific diagnosis. There is no universal medical or surgical treatment. Today, cognitive therapy is emphasised, to the tinnitus patients to understand what causes the tinnitus, to accept the condition and to inform them about relaxation techniques. Physical therapy and training are also emphasised. Active treatment with regular counselling can reduce the occupational and social disabilities.

Age, education, maltreatment, and social support as predictors of chronic depression in former prisoners of war.

This study examined the relationships of prisoner of war captivity trauma variables and individual protective variables to current depressive symptoms as indexed by the CES-D and its components. The sample consisted of 989 U.S. former POWs of World War II and the Korean War, who have been followed since the mid 1950s. Depressive symptoms persisted over 40 years later. Age, education, medical symptoms during captivity, and level of social support were related to later levels of adjustment. Theoretical and methodological implications of the findings were discussed.