Threats and violence in the Swedish pre-hospital emergency care.

Although acts of threats and violence are problems that have received increased attention in recent years within Swedish pre-hospital care, only a handful of scientific studies have been carried out in this field. Threats and violence have a negative influence on the well-being of ambulance personnel. The aim in this study was both to investigate the incidents of threats and violence within the Swedish ambulance service and to describe these situations. Data was collected with questionnaires answered by 134 registered nurses and paramedics from 11 ambulance stations located in four counties. The respondents' experiences of pre-hospital care varied from 3 months to 41 years (mean=12 years, median=8 years). The results showed that 66% of the ambulance personnel experienced threats and/or violence during their work while 26% experienced threats and 16% faced physical violence during the last year. The most common kind of threat was threats of physical violence with 27% of the respondents experiencing threats involving weapons. Commonly occurring physical violence was in the form of pushes, punches, kicks and bites. In most cases, the perpetrator was the patient himself often under the influence of alcohol or drugs. The most serious situations occurred when the reason for raising the ambulance alarm was intoxication or a decreased level of consciousness.

Effects of prophylactic ankle supports on pronation during gait.

We performed a gait analysis of 12 healthy subjects in order to analyse the rear foot pronation-supination angle and the shift of centre of pressure (COP) during walking. We used a video system and a force plate and examined the effects of semi-rigid Air-Stirrup brace, lace-up cloth RocketSoc brace, ankle taping and no bracing. Both the lace-up cloth brace and taping increased the maximum pronation angle during the stance phase. The lace-up cloth brace alone was associated with a larger maximum pronation velocity. With the lace-up cloth brace and taping, the COP was more laterally placed, allowing greater leverage about the subtalar axis and thus increasing the tendency toward pronation. The two braces and the tape did not similarly affect ankle joint biomechanics during gait. The ability to reduce excessive amounts of pronation is an important design consideration for prophylactic ankle supports.

Salivary cortisol and serum prolactin in relation to stress rating scales in a group of rescue workers.

BACKGROUND: Rescue service personnel are often exposed to traumatic events as part of their occupation, and higher prevalence rates of psychiatric illness have been found among this group. METHODS: In 65 rescue workers, salivary cortisol at 8 AM and 10 PM and serum prolactin at 8 AM were related to the psychiatric self-rating scale General Health Questionnaire (GHQ-28) measuring psychiatric health, and the Impact of Events Scale (IES) and Post Traumatic Symptom Scale (PTSS) measuring posttraumatic symptoms. RESULTS: Seventeen percent of the study population scored above the GHQ-28 cut-off limit but none scored beyond the cut-off limit in the IES and PTSS questionnaires. Salivary cortisol concentration at 10 PM correlated with statistical significance to anxiety (p < .005) and depressive symptoms (p < .01) measured with GHQ-28, as well as to posttraumatic symptoms, with avoidance behavior measured with IES (p < .01) and PTSS (p < .005). Two of the rescue workers were followed over time with the same sampling procedure after a major rescue commission. CONCLUSIONS: The correlation between evening salivary cortisol and anxiety, depressiveness, and posttraumatic avoidance symptoms indicates that these parameters can be used in screening and follow-up after traumatic stress events.

Smokeless tobacco, reaction time, and strength in athletes.

PURPOSE: This study investigated the effects of smokeless tobacco on reaction time and strength in a group of Division III athletes. METHODS: Athletes were tested for simple and choice reaction time, maximum voluntary force, and maximum rate of force generation of the knee extensors on a KinCom dynamometer at 250 degrees.s-1. Smokeless tobacco-using athletes (N = 20) were tested while both using and after abstaining from smokeless tobacco. Another group of athletes (N = 20) who did not use smokeless tobacco served as a control group. RESULTS: Simple and complex reaction times were not affected by smokeless tobacco use or abstention. In the simple reaction time test, maximum voluntary knee extensor force was higher in the smokeless tobacco-using group while abstaining (P < 0.05). Maximum rate of force generation in the simple reaction time test was not statistically different between the conditions. In the choice reaction test, both strength parameters (maximum force and maximum rate of force generation) were higher in the user group while abstaining (P < 0.05) compared with the using condition. The strength parameter measurements in the control group were not statistically different from the tobacco-using group, while either using or abstaining. CONCLUSIONS: We conclude that smokeless tobacco use has no effect on reaction time but may detrimentally influence maximum voluntary force and maximum rate of force generation.

Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior.

The study comprises 149 refugees from various countries, reporting exposure to severe traumata, who were referred for psychiatric diagnosis and assessment of suicide risk. The stressors reported comprised both personal experience of and/or forced witnessing of combat atrocities (including explosions or missile impacts in urban areas), imprisonment (including isolation), torture and inflicted pain, sexual violence, witnessing others' suicide, and of summary and/or mock executions. Posttraumatic stress disorder (PTSD) was diagnosed in 79% of all cases, other psychiatric illness in 16% and no mental pathology in 5%. The prevalence of suicidal behavior was significantly greater among refugees with principal PTSD diagnoses than among the remainder. PTSD patients with depression comorbidity reported higher frequency of suicidal thoughts; PTSD nondepressive patients manifested increased frequency of suicide attempts.

Early traumatic stress reactions among Swedish survivors of the m/s Estonia disaster.

BACKGROUND: This study is a three-month follow-up study in order to assess the short-term impact of traumatic stress among 53 Swedish survivors of the Estonia disaster. METHOD: A questionnaire consisting of general questions about conditions during and after the disaster and self-assessment by Post Traumatic Symptom Scale (PTSS-10), Impact of Event Scale (IES), Sense of Coherence-short version (SoC-12), and the DSM-IV list of dissociative symptoms of Acute Stress Disorder formulated as questions regarding individual reactions was distributed. RESULTS: The response rate was 79.2% (n = 42). The participants scored an average of 3.9 on PTSS-10, 28.5 on IES ('intrusion' and 'avoidance' subscales) and 62.8 on SoC-12, which shows elevated levels of post-traumatic stress reactions but a normal level of sense of coherence. The reported occurrence of dissociative symptoms during the disaster was as follows: emotional numbing in 43% of the survivors, reduction of awareness in 55%, derealisation in 67%, depersonalisation in 33%, and dissociative amnesia in 29%. Survivors scoring low in SoC scored significantly higher in both PTSS-10 and IES than those with high scores in SoC. All dissociative symptoms were predictive of post-traumatic reactions. CONCLUSIONS: This study substantiates the importance of assessing dissociative symptoms during a life-threatening event as a possible for later post-traumatic reactions and possible PTSD. The Sense of Coherence Scale may be useful as an instrument to sort out survivors at risk.

[A study of post-traumatic stress reactions among war refugees based on medical records. A standard model may support the treatment]. / Journalstudie av krigsflyktingars posttraumatiska stressreaktioner. Standardmall kan ge stöd i behandlingen.

A special project designed to aid Bosnian refugees in Stockholm County was initiated and funded by the County Council in February 1994. The present study, a joint endeavour involving the Bosnian Project, the Centre for Trauma and Torture Diagnostics, and the Red Cross Centre for torture victims, was designed to fulfil the following aims: To characterise the patient population in terms of social situation, trauma history, symptoms and treatment; To review accumulated experience at the three centres; To outline and discuss the treatment; and To suggest new avenues for further research concerning refugees and trauma. To obtain comparable material for this retrospective review of case records at the three centres, a special case chart format was adopted, covering pre-war and pre-treatment information on general background, social situation, health status and medication, as well as trauma history, symptoms and treatment. Most patients reported good pre-war health, but at the time of the study exhibited manifest effects of trauma history; 95 per cent reported mental problems, and 39 per cent medical disease or physical disorders. These refugees were thus characterised by manifest post-traumatic stress symptoms and need of treatment. Despite their relatively short time in Sweden, almost all had permanent residence permits and fixed addresses. The absence of a comparable control group precluded comparison with other refugee or normal populations. The findings suggest the need of co-ordination and co-operation between the special facilities available to refugees, and of a standardised format for case records.

Visual guidance to force plates does not influence ground reaction force variability.

Gait analysis methods commonly require the subject to avoid visual guidance, that is, targeting, the force plate upon which a foot-strike is necessary. The putative rationale underlying the preference for not using targeting is the unsubstantiated contention that gait is altered. This study evaluated the influence of force plate targeting on the variability of ground reaction forces (GRF) in 15 normal subjects. Secondary factors of single vs multiple steps to the force plate and whether or not subjects were informed of the study's primary purpose were also examined. ANOVA main effects revealed that targeting did not significantly affect GRF variability (p > 0.05). A significant main effect of the number of steps required to reach the force plate on AP force variability was found (p = 0.002). Prior knowledge of the purpose of the study did not significantly affect GRF variability (p > 0.05). It was concluded that the variability of ground reaction forces is not significantly affected by targeting the force plate. Thus, targeting would not be expected to influence the variability of calculated kinetic variables that are subservient to GRF.

Collision at sea between two Navy vessels.

During training at sea, two missile carrier vessels crashed at rather high speed on November 14, 1991. One of the vessels (HMS Luleå) was seriously damaged by the other (HMS Nynäshamn), and one conscripted seaman was killed. Both vessels had a complete crew of 29 each, 15 of whom were officers. Informal support and formal debriefing sessions were performed during the first 2 weeks. The crews of both vessels were followed by questionnaire concerning the psychological stress reactions after 1 month and 6 months. The post-traumatic symptom scale and the impact of event scale were used for assessing the psychological symptoms and reactions.

On the assumption of bilateral lower extremity joint moment symmetry during the sit-to-stand task.

This study examined the validity of the assumption of bilateral lower extremity joint moment symmetry during the sit-to-stand motion for a group of young (n = 7) and a group of elderly (n = 7) female subjects. Two force plates and a motion analysis system were used to determine peak joint moments at the ankles, knees, and hips following liftoff from a chair. Statistically, bilateral asymmetries in peak joint moments were found at the knee joint in the young group [a right to left difference of 0.43% BW x BH (body weight x body height)] and at the hip joint in both subject groups (differences of 0.20% BW x BH and 1.09% BW x BH for the young and elderly subjects, respectively). Subsequent data analysis, using an algorithm that assumed bilateral ground reaction force (GRF) symmetry, was performed to determine whether the bilateral differences were a result of kinematic or GRF asymmetry. It was concluded from these results that both the kinematic and GRF data account for the bilateral asymmetry. The results of the subsequent analysis also showed that the method which assumed bilateral GRF symmetry underestimated the peak joint moments at the ankles, knees, and hips, with the greatest difference between methods being 0.10% BW x BH for the ankle joint. The results of this study suggest that the assumption of bilateral symmetry of lower extremity joint moments during the sit-to-stand is not valid. However, the biomechanical significance of the errors associated with assuming symmetry must also be taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

The treatment of acute trauma. Post-traumatic stress disorder prevention.

Although it is not yet clear that striking gains can be made toward the goal of preventing the development of post-traumatic stress disorder (PTSD) through early treatment, an initial step has been made by identification of a new category of disorder in DSM-IV, the acute stress disorder. Evidence exists that, at the least, it is possible to have a significant effect on the symptomatology generated by acute stress through the use of culturally endorsed rituals, psychological methods such as support and formal crisis intervention, focused psychotherapy, and psychopharmacology. Whether success on this front will ultimately affect the incidence and development of PTSD remains to be seen.

Kinematics of recovery from a stumble.

BACKGROUND: Injuries most frequently related to accidents in elderly persons are falls during locomotion and stair ascent and descent. Although numerous risk factors have been related to falling behavior, effective strategies to predict and prevent falls have not evolved. The rationale underlying this study was that systematic experimental and analytical investigation of the effects of perturbations during locomotion and the subsequent requisites for recovery could lead to the development of clinically relevant evaluation(s) capable of identifying a predisposition to falling. The present study is the first biomechanical investigation of recovery from an anteriorly directed stumble. METHODS: Seven healthy, young males participated in this study. While the subjects walked along a walkway in the laboratory, stumbles were unexpectedly induced using a mechanical obstacle. Videotape records of these trials were analyzed and selected sagittal plane kinematics extracted. RESULTS: The perturbation caused an increase in the maximum trunk flexion angle from 4.3 degrees (control) to 18.3 degrees (p = .057), and this change was significantly associated with preperturbation walking velocity (p = .036). The maximum hip and knee flexion angles increased from 26 to 47 degrees (p = .039) and from 60 to 89 degrees (p = .009), respectively. The increases in maximum hip flexion velocity (79%) and maximum knee extension velocity (36%) were not significant. CONCLUSIONS: Identification of the principal elements of control during perturbed locomotion can contribute to understanding the relationship between specific age-related performance deficits and some types of falling behavior. The results suggest that recovery from a stumble is dependent upon lower extremity muscular power and the ability to restore control of the flexing trunk.