Stress Management Training (SMT) Improves Coping of Tremor-Boosting Psychosocial Stressors and Depression in Patients with Parkinson's Disease: A Controlled Prospective Study.

BACKGROUND: Stress reduction and relaxation exercises are therapeutically suggested to patients with Parkinson's disease (PD) and tremor, but data regarding efficacy or preferential methods are missing. OBJECTIVE: To investigate the effect of a standardized stress management training (SMT) according to Kaluza on coping with tremor-boosting psychosocial stress factors. METHODS: 8-week SMT was applied to 82 PD patients with tremor and 30 controls. Changes in stress-associated factors were measured applying four scales: Kaluza's "warning signs for stress" and "stress-amplifying thoughts" and Beck Depression Inventory (BDI) and quality of life (PDQ-8). Short-term outcome (8 weeks) was evaluated in both groups, and long-term outcome (3-6 months) was evaluated only in PD patients. RESULTS: At baseline, PDQ-8 was worse in PD patients compared to controls. PD patients improved significantly regarding short- and long-term outcome scores of "warning signs for stress," "stress-amplifying thoughts," and BDI scores, independently of disease severity or duration. Younger and male PD patients showed the best benefit. Controls improved comparably to PD patients but significantly only with respect to "stress-amplifying thoughts." Retrospectively, 88% (29/33) of PD patients were rated SMT as helpful 12-18 months later. Self-practicing SMT exercises correlated significantly with subjectively better coping with tremor-related daily impairment and subjective short-term and long-term tremor reduction. CONCLUSION: SMT should be a part of therapy of PD patients with tremor.

Deaths due to disease of seafarers on board Singapore ships.

Based on records kept in the Singapore Mercantile Marine Office, the paper presents the results of a study on deaths due to disease of seafarers on board Singapore ships. Out of a total of 373 deaths, altogether 69 fatalities were attributed to diseases. More than 65% (n=45) of theses deaths were due to circulatory diseases commonly associated with life-style factors, but only 24 cases had a specific and 9 cases had an unspecific diagnosis confirmed by a medical, practitioner. A total of 32 seafarers (46.4%) died of a sudden death and were found dead by their shipmates whereas 17 seafarers (24.6%) died on board after a short illness. In only two cases was it reported that Radio Medical advice had been sought indicating either a lack of interest of the ship's management or a lack of knowledge or information on the availability of such services. Eight of the fatalities who died on board had seen a doctor and been declared fit to stay on board, pointing to deficiencies in the port medical services or pressures on port doctors to avoid a costly repatriation. The mean annual mortality rate for deaths due to all causes was 26.5 per 10,000 seafarers and due to disease was 4.9 per 10,000 seafarers.