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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There are many issues in firefighting that involve human factors and cardiopulmonary conditioning. Population-based mortality and disability surveillance studies suggest a relatively small but significant excess of disability but not mortality from nonmalignant cardiovascular disease for firefighters. More targeted cohort and case-control studies do not support such an excess and instead suggest a strong healthy worker effect. Pulmonary function among firefighters has been extensively studied, with contradictory findings. Extreme exposures and long-term exposure in combination with cigarette smoking may be risk factors for respiratory disorders and accelerated decline in airflow. It appears likely that individual firefighters who show early signs of illness are often selectively transferred out of active firefighting positions. Despite exposure to substances such as carbon monoxide that may predispose to cardiovascular mortality and morbidity, excesses are not consistently shown in mortality studies. Clinical studies of individual firefighters do suggest an elevated risk for myocardial ischemia. The ergonomic demands of firefighting are extreme at peak activity because of high energy costs for activities such as climbing aerial ladders, the positive heat balance from endogenous and absorbed environmental heat, and encumbrance by bulky but necessary protective equipment. The psychological stresses of firefighting include long periods of relative inactivity punctuated by highly stressful alarms and extremely stressful situations such as rescues, as reflected in physiological and biochemical indicators. Firefighters are at risk for depression and post-traumatic stress disorder, although morale overall is generally much higher than in comparable occupations. Women firefighter candidates as a group perform less well on selection test simulating the demands of active firefighting, but some individual women perform very well.
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PMID:Human factors in firefighting: ergonomic-, cardiopulmonary-, and psychogenic stress-related issues. 139 9

Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.
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PMID:Cognitive processing therapy for sexual assault victims. 140 90

A group of 24 Dutch World War II Resistance veterans with a documented traumatic war history and a (partially) positive diagnosis of current posttraumatic stress disorder (PTSD) was studied. This special group of war victims is characterised by chronicity, suffering from intractable posttraumatic complaints for decades. They were treated with fluvoxamine (Fevarin), a selective serotonin reuptake inhibitor with antidepressive and anxiolytic properties. The study was designed as an open-ended, outpatient pilot study, with a treatment period of 12 weeks. Results of clinical examination, and questionnaires investigating PTSD, depression, sleeping problems, anxiety, and vital exhaustion indicate that a significant number of the subjects improved with respect to their PTSD symptomatology, and their symptoms of anxiety and vital exhaustion. However, at the end of the study, quantitative improvement was modest. The results indicate that treatment with fluvoxamine may offer alleviation of chronic PTSD symptoms, in particular insomnia, nightmares, anxiety, intrusive recollections, guilt feelings and tiredness.
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PMID:Fluvoxamine treatment for chronic PTSD: a pilot study. 141 Jan 91

In this study, 147 Dutch Resistance veterans from WW II are evaluated on psychometric instruments for anxiety, depression and anger. Resistance veterans appeared to be more anxious, depressive and angry on these instruments compared to controls from the validation studies of the respective instruments. Veterans currently suffering from PTSD (56%) were significantly more anxious, depressed, and angry than veterans without PTSD. With respect to staying in Nazi concentration camps, which is an extremely severe stressor, and in which half of the veterans were imprisoned, no difference on the three instruments was found. Anxiety, depression and anger were observed to be highly interrelated in PTSD. The close interrelationship between anxiety and depression, anxiety and danger, and depression and anger mediated by way of anxiety is, however, not unique for traumatized subjects. It is argued that for Resistance veterans only the intrusive reminiscences of the stressful events discriminate this constellation of symptoms from subjects with an anxious-depressive symptomatology.
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PMID:Anxiety, depression and anger in Dutch Resistance veterans from World War II. 141 Jan 93

334 of over 400 children who survived the sinking of the cruise ship, Jupiter, in Athens harbour in October 1988 completed a battery of questionnaires 5-9 months later. Compared with age- and sex-matched controls, they show significantly higher scores on depression and anxiety. They also report more fears, particularly of stimuli related to the trauma. Overall, their scores on the Impact of Events Scale are as high as those reported by adults in other disasters. Follow-up studies a year after the accident reveal that nearly half the children meet the DSM-III-R criteria for PTSD. The usefulness of this screening battery is discussed. Some evidence for the effects of early intervention in schools is presented.
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PMID:Post-traumatic stress disorder in child survivors of shipping disasters: the sinking of the 'Jupiter'. 141 Jan 97

Since the 1979 Soviet invasion of Afghanistan, more than 6 million Afghan refugees have become the world's largest refugee population. Although refugees in Pakistan and Iran are now beginning to repatriate, continuing political turmoil in Afghanistan and children's acculturation and educational opportunities will keep many Afghans in the United States permanently. Although there are no accurate statistics, local resettlement agencies and Afghan community leaders estimate that there are 10,000 to 35,000 Afghans in northern California. They suffer from a variety of problems common to refugees: language, economic and occupational problems, and substantial challenges in psychological, family, social, and cultural adjustment to the United States. Although many Afghans are doing well, many others have depression, psychosomatic symptoms, and posttraumatic stress disorder.
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PMID:Health issues of Afghan refugees in California. 141 68

Jurors on criminal trials carry a considerable burden of responsibility. They determine the defendant's fate. Additionally, during trials they can be exposed to stressful, frightening, and sordid aspects of life. The stressfulness varies depending upon the nature of the trial, its length, the nature of the testimony and evidence, the jurors' interpersonal relationships, the difficulty establishing guilt or innocence, the public's attitude, etc. These experiences can create psychological and/or physical discomfort that can be transient and mildly or moderately intense, or more serious and constitute illness. The authors have studied juries of four criminal trials--two murder cases, one child abuse case, and one obscenity case. Forty jurors were interviewed. Twenty-seven had one or more discomforting physical and/or physiological symptoms. These involved gastrointestinal distress (10 jurors); generalized nervousness (4 jurors); heart palpitation (6 jurors); headaches (4 jurors); sexual inhibitions (4 jurors); depression (4 jurors); anorexia (4 jurors); faintness (2 jurors); and numbness, lump in throat, chest pain, hives, and flu (1 juror each). Seven of the jurors became clearly ill. Illnesses included: peptic ulcer reactivation and hives, phobic reaction, anxiety state and increased alcohol use, hypertensive episode and visual scotomata, sexual inhibition, chills, fever, and depression, and post-traumatic stress disorder.
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PMID:The occupational hazards of jury duty. 142 62

This report chronicles the verbally mediated traumatisation and subsequent PTSD in an 11-year-old girl. Information obtained from parental interviews, academic transcripts, anecdotal teacher comments, structured and unstructured interviews, and standardised anxiety, depression, and misconduct scales was used to highlight the unique distress of the patient.
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PMID:Verbally mediated childhood post-traumatic stress disorder. 142 25

Clinicians have increasingly recognized posttraumatic stress disorder (PTSD) among Vietnam veterans, but the disorder may be easily overlooked among World War II combat veterans. The authors review recent studies of PTSD in older veterans and describe five cases that illustrate the diverse clinical presentations of PTSD in this population. Symptoms included anxiety, cognitive and somatic complaints, depression, alcohol dependence, and amnestic periods. Despite the varied presentations, a fairly consistent patient profile emerged. Patients avoided reminders of war, showed an exaggerated startle response, and experienced restless sleep and chronic anxiety. Factors associated with exacerbations of symptoms were retirement and reminders of war experiences. Although past studies have emphasized resuppression of the trauma, the authors encourage a flexible approach to treatment, including exploratory techniques.
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PMID:Clinical presentation of PTSD in World War II combat veterans. 142 83

This article describes psychometric assessment instruments that are available for the screening of psychosocial problems that can interfere with patient rehabilitation. Structured assessment of patient depression, anxiety, substance abuse, social support, and willingness to take control and responsibility for health care is important throughout all stages of the patient's treatment. There are psychometrically sound, relatively brief, and nonintrusive measures with which to assess these variables. The hope is that the early and accurate identification of those patients who are in need of psychosocial services can lead to the implementation of services that will ameliorate psychosocial problems and facilitate total patient rehabilitation. Although many excellent measures exist, the most important assessment tool for the screening of psychosocial problems in patients with burns, which has emerged from this review, is the Psychological Adjustment to Illness Scale (PAIS). The PAIS integrates many of the relevant characteristics of psychologic screening and provides normative values that are specific to patients with burns. Ideally, this scale should be supplemented by an assessment of post-traumatic stress disorder, substance abuse, and personality and coping styles, because these critical factors are not adequately covered by the PAIS. Finally, the Burn Specific Health Scale shows promise for the assessment of health status and quality of life in patients with burns. Future clinical research will hopefully compare and contrast the efficacy and relevance of these measures. Furthermore, future clinical evaluation and research will need to relate the influence of psychosocial factors on the patient's total health functioning. Structured psychometric evaluation of the psychosocial and health characteristics will ensure that patients who have been burned will attain the most fulfilling quality of life that is available to them.
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PMID:Psychometric assessment of psychologic factors influencing adult burn rehabilitation. 157 63


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