Diurnal rhythm in British Antarctic personnel.

INTRODUCTION: The diurnal rhythm of saliva cortisol and its association to adaptation, performance and health were examined in personnel over-wintering at two British Antarctic stations. METHODS: In total, 55 healthy individuals (49 males, 6 females) participated in the study. Cortisol in saliva was sampled on 3 consecutive days (at awakening, 15 and 45 min after waking, at 15.00 h, and 22.00 h) immediately after arrival at the station, midwinter, and the last week before departure. Subjective health complaints were also measured at arrival, midwinter, and the last week before departure, while depression (Burnam screen for depression) and positive and negative affect (PANAS) were measured at midwinter only. At the end of the winter appointment, base commanders evaluated the performance of all personnel. RESULTS: The variations in external light (darkness during winter, midnight sun during arrival and departure) did not influence the diurnal rhythms. The normal peak level in the morning, and the normal and gradual fall towards the evening were observed at arrival, midwinter, and before departure. Immediately after arrival the cortisol values were relatively high and correlated positively with base commander's evaluation of performance. During midwinter, approximately 58% scored for depression on the Burnam scale. However, when examining these data more closely, only 4 participants (7%) reported depression, the main reason for the high score on the depression scale was related to sleep problems and tiredness. CONCLUSIONS: There was no indication that over-wintering led to any disturbance in the diurnal rhythm of cortisol in British Antarctic personnel. There were no other indications of any 'over-wintering syndrome' than reports of subjective sleep problems and tiredness.

Subjective health complaints, sensitization, and sustained cognitive activation (stress).

INTRODUCTION: This review argues that "subjective health complaints" is a better and neutral term for "unexplained medical symptoms." The most common complaints are musculoskeletal pain, gastrointestinal complaints and "pseudoneurology" (tiredness, sleep problems, fatigue, and mood changes). These complaints are common in the general population, but for some these complaints reach a level that requires care and assistance. THEORETICAL ASSUMPTIONS: We suggest that these complaints are based on sensations from what in most people are normal physiological processes. In some individuals these sensations become intolerable. In some cases it may signal somatic disease, in most cases not. Cases without somatic disease, or with minimal somatic findings, occur under diagnoses like burnout, epidemic fatigue, multiple chemical sensitivity, chronic musculoskeletal pain, chronic low back pain, chronic fatigue syndrome, and fibromyalgia. These complaints are particularly common in individuals with low coping and high levels of helplessness and hopelessness. CONCLUSION: The psychobiological mechanisms for this is suggested to be sensitization in neural loops maintained by sustained attention and arousal.

Psychobiological mechanisms of socioeconomic differences in health.

The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.

Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme.

Our objective was to evaluate the effect of 12 weeks of stress management training (SMT), physical exercise (PE) and an integrated health programme (IHP) in a worksite setting on subjective health complaints. To do this, we randomly split 860 employees into the following groups: control (n = 344), PE (n = 189), IHP (comprising physical exercise and health information) (n = 165) and SMT (n = 162). There were no significant effects on subjective health complaints, sick leave or job stress. However, strong and specific positive effects were experienced for the particular goal areas defined for each intervention. The PE group showed improved general health, physical fitness and muscle pain, while the SMT group showed improved stress management. The IHP group showed the strongest effects, affecting most goals set for treatment.

Thoroughly modern worries: the relationship of worries about modernity to reported symptoms, health and medical care utilization.

OBJECTIVE: There is now greater public concern about how features of modern life pose threats to personal health. In two studies, we investigated the relationship between individuals' worries about modernity affecting health to symptom reports, perceptions of health and health care utilization. METHODS: In the first study, 526 University students completed a questionnaire measuring modern health worries (MHW), symptom reports and health perceptions. A second study utilized an existing national survey database of 7869 New Zealanders. Part of the survey examined people's concerns of modernity affecting their health in the past 12 months, as well as the use of conventional medical and alternative health care. RESULTS: We found concerns about modernity affecting health were made up of four major components: environmental pollution, toxic interventions, tainted food and radiation. MHW were significantly associated with somatic complaints and ratings of the importance of health to the individual. We also found individuals with high levels of MHW had a higher rate of food intolerance and chronic fatigue syndrome (CFS). In the second study, we found MHW to be associated with medical care utilization, particularly of alternative health practitioners. CONCLUSIONS: The results of these studies suggest concerns about modernity do cause changes in the way individuals interpret somatic information and may play a role in undermining perceptions of health. The area of MHW is worthy of study and may hold importance for understanding aspects of functional disorders.

Sensitization, subjective health complaints, and sustained arousal.

The purpose of this presentation is to discuss the possibility that sensitization is a psychobiological mechanism underlying not only multiple chemical sensitivity (MCS), but a much more general cluster of illness, referred to as "subjective health complaints". Sustained arousal, or sustained "stress" responses, may be an important factor for the development of these conditions. Patients with subjective complaints without objective changes are sometimes referred to as having "fashionable diagnoses" or "unexplained symptoms". They may be given diagnoses like MCS, epidemic fatigue, chronic fatigue syndrome, burnout, stress, a variety of intoxications, environmental illness, radiation, multiple chemical hypersensitivity, food intolerance, functional dyspepsia, irritable bowel, myalgic encephalitis, postviral syndrome, yuppie flu, fibromyalgia, or vital exhaustion. One issue is whether this is one general condition or separate entities. Another issue is whether sensitization may be the psychobiological mechanism for most or all of these conditions. Finally, is it likely that sustained arousal may facilitate the development of sensitization in some or many neural circuits? In this review, the main emphasis will be on musculoskeletal pain. This is the most frequent and most expensive condition for sickness compensation and disability. The comorbidity of other complaints, however, will also be taken into account.

Effects of psychological defense on processing of neutral stimuli indicated by event-related potentials (ERPs).

The Defense Mechanism Test (DMT) is claimed to identify personnel with a high risk for accidents. A new explanation for why the DMT seems to predict performance when survival depends on split second decisions is proposed. Sixteen right-handed, adult male students were tested with the DMT and with an ERP paradigm (two sine wave tones, presented binaurally). Each subject was tested with a one-stimulus paradigm, and a passive and an active oddball paradigm. Under the passive oddball condition, High defensive subjects differed from Low, having significantly smaller N2 amplitudes (low immediate perception), and significantly larger P3 amplitudes (rely on later associative mechanisms). High defensive subjects seem to have less ability to perceive the environment correctly immediately. This slowness may be fatal when life depends on split second decisions. The fundamental neurophysiological difference may also be the basis for the very complex cognitive and perceptual mechanisms involved in psychological defense mechanisms.

Aircrew perceived stress: examining crew performance, crew position and captains personality.

This study was conducted at NASA Ames Research Center as a part of a larger research project assessing the impact of captain's personality on crew performance and perceived stress in 24 air transport crews (5). Three different personality types for captains were classified based on a previous cluster analysis (3). Crews were comprised of three crewmembers: captain, first officer, and second officer/flight engineer. A total of 72 pilots completed a 1.5-d full-mission simulation of airline operations including emergency situations in the Ames Manned Vehicle System Research Facility B-727 simulator. Crewmembers were tested for perceived stress on four dimensions of the NASA Task Load Index after each of five flight legs. Crews were divided into three groups based on rankings from combined error and rating scores. High performance crews (who committed the least errors in flight) reported experiencing less stress in simulated flight than either low or medium crews. When comparing crew positions for perceived stress over all the simulated flights no significant differences were found. However, the crews led by the "Right Stuff" (e.g., active, warm, confident, competitive, and preferring excellence and challenges) personality type captains typically reported less stress than crewmembers led by other personality types.

Psychosomatic medicine: state of the art.

Contemporary psychosomatic medicine must take into consideration developments in psychobiology. The difficulty in accepting dualistic concepts is a serious challenge to positions distinguishing between psychological and 'real' causes of disease. There is more emphasis on life style factors for disease and on the impact of psychosocial factors on illness rather than on disease. The neurophysiological concept of activation or arousal has been important in the development of rational pathophysiological models that describe how sustained arousal may be a pathophysiological factor. For illness, sensitization may be an acceptable psychobiological mechanism underlying very frequently occurring and expensive medical conditions that require medical and economical assistance. One possible alternative to old dynamic concepts is the development of a cognitive arousal theory of stress.

Does early intervention with a light mobilization program reduce long-term sick leave for low back pain?

STUDY DESIGN: A controlled randomized clinical trial was performed. OBJECTIVE: To investigate the effect of a light mobilization program on the duration of sick leave for patients with subacute low back pain. SUMMARY OF BACKGROUND DATA: Early intervention with information, diagnostics, and light mobilization may be a cost-effective method for returning patients quickly to normal activity. In this experiment, patients were referred to a low back pain clinic and given this simple and systematic program as an outpatient treatment. METHODS: In this study, 457 patients sick-listed 8 to 12 weeks for low back pain, as recorded by the National Insurance Offices, were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic, but was treated with conventional primary health care. RESULTS: At 12-month follow-up assessment, 68.4% in the intervention group had returned to full-duty work, as compared with 56.4% in the control group. CONCLUSIONS: Early intervention with examination, information, and recommendations to stay active showed significant effects in reducing sick leave for patients with low back pain.

Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders. A study of women with random sample population controls.

BACKGROUND: We compared ICD-10 psychiatric disorders in female patients with fibromyalgia (n=45) or functional dyspepsia (n=18) with age-matched random sample controls (n=49). METHOD: Version 2 of The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used for present state examination and lifetime diagnoses. RESULTS: Current psychiatric disorders (somatoform pain disorder and specific phobia omitted) were diagnosed in 80% of fibromyalgia patients (OR=8.3), 83% of functional dyspepsia patients (OR=10.3) and 33% controls. Among fibromyalgia patients 27% had lifetime panic disorder. Lifetime mood disorders were found in 83% of functional dyspepsia patients. First-degree relatives with psychiatric disorder were found in 16% of the fibromyalgia patients, 50% of functional dyspepsia patients and 20% of controls. CONCLUSIONS: Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders in substantial subgroups. Psychiatric symptoms and somatic complaints are closely related in these disorders.

The effect of exercise and diet on mental health and quality of life in middle-aged individuals with elevated risk factors for cardiovascular disease.

Mental health and quality of life were assessed before and after a one-year exercise and diet intervention among 219 healthy individuals, aged 41-50 years, with elevated risk factors for cardiovascular disease. The participants were randomized to four groups: diet (n = 55), diet and exercise (n = 67), exercise (n = 54) and no active intervention (n = 43). Quality of life was measured with one eight-item scale and two one-item scales. Mental health was measured by the General Health Questionnaire (30-item version). Depression, anxiety, feelings of competence and self-esteem, coping and social dysfunction were measured using subscales of the General Health Questionnaire. Somatic anxiety was measured by the anxiety subscale of the Symptom Check List-90. Exercise improved the total GHQ scores, perceived competence/self-esteem, and coping as measured by the GHQ subscales. There were no significant effects of diet or exercise on quality of life, depression or anxiety. A high rate of participation in the exercise programme (>70%) was associated with greater improvements in total GHQ scores, anxiety, perceived competence/self-esteem and coping.

[Prognosis in back pain]. / Prognose ved rygglidelser.

A series of Norwegian controlled studies of treatment for low back pain are reviewed with regard to the prognostic factors identified. The importance of controlled and randomized studies is emphasized. A satisfactory level of prediction can only be reached by combining medical, psychological, and social factors. Important prognostic factors are lateral mobility, generalized and intense pain, fear of pain, long duration of pain and sickness leaves, poor subjective evaluation of prognosis and ability to work, low trust in one's own ability to control health, low level of physical training and activity before the acute event, and high level of other subjective health complaints. These data are in good agreement with results from other countries. New data on treatment emphasize the importance of activation of the patient, reducing the fear and avoiding bedrest and inactivity.

The time dimension in stress responses: relevance for survival and health.

Within the Cognitive Activation Theory of Stress (CATS), the stress response occurs whenever there is a discrepancy between what the organism is expecting, and what really exists. It affects the biochemistry of the brain, mobilizes resources, affects performance, and endocrine, vegetative, and immune systems. Initial positive feedback and feed-forward mechanisms are gradually changed by homeostatic mechanisms. Slower reactive hormones such as cortisol seem to dampen the initial response. The time course may depend on psychological mechanisms. Subjects with efficient coping show the fast- and short-lasting catecholamine response, while subjects with high defense mechanisms (related to stimulus expectancies) may show more signs of prolonged activation. Non-coping individuals show a sustained general activation which may develop into somatic disease or illness.

Personality and coping strategies during submarine missions.

Relations between personality profiles, measured by the Personality Characteristics Inventory (PCI), and habitual coping strategies, measured by the Utrecht Coping List (UCL), were investigated in a sample of submarine personnel and office employees. The predictive validity of these instruments were examined for reported stress, health complaints, and salivary cortisone measures during 3 submarine missions. PCI and UCL were completed before the missions, and questionnaires and saliva were collected weekly. The results showed no significant relations between PCI profiles and coping strategies. Interpersonal orientation, achievement motivation, and habitual coping strategies were predictors for coping during the submarine missions. Problem-directed strategies and interpersonal sensitivity combined with strong achievement motivation were related to low indicated stress from social factors (lack of privacy, interpersonal tension, and crowding) and homesickness. The findings suggest that interpersonal characteristics need to be considered in the selection of submariners and personnel for other military settings in which units are exposed to prolonged stress and isolation.

A scoring system for subjective health complaints (SHC).

The aim of this study is to present a complete scoring system for subjective health complaints (SHC) as they are experienced by the lay population. The scoring system records the complaints, and does not map attributions or medical diagnoses. In all, 1,219 subjects (323 men, 896 women) from various occupations were tested with a scoring system, the SHC inventory, previously referred to as the Ursin Health Inventory (UHI). The SHC consists of 29 questions concerning severity and duration of subjective somatic and psychological complaints. The SHC inventory yields scores on single items and a total number of health complaints categorized into five factors: musculoskeletal pain (alpha=0.74), pseudoneurology (alpha=0.73), gastrointestinal problems (alpha=0.62), allergy (alpha=0.58) and flu (alpha=0.67). The SHC inventory is a systematic, easy, and reliable way to score subjective health complaints. The prevalence of these complaints is high, and should be considered before conclusions are reached about new diseases and new attributions of environmental hazards.