[Show abstract][Hide abstract]ABSTRACT: Subjective health complaints (SHC), including nonspecific low back pain (LBP) as the most common single complaint, are the main reasons for long-term sick leave in many western countries. These complaints are often attributed to "stress". Cortisol has frequently been considered a biomarker reflecting sustained physiological HPA-axis activity, and is characterized by a high cortisol awakening response (CAR) and low evening values. The aim of the study was to investigate whether LBP patients had a normal characteristic cortisol profile, and whether possible deviations were related to coping and health. 305 patients on long-term sick leave for LBP participated in the study, and saliva cortisol profiles were compared to a reference population consisting of Danish workers. Cortisol was measured upon awakening, after 30 min, and in the evening. Additionally, patients answered questionnaires about SHC, fatigue, pain, coping, and social support. The patients showed a seemingly normal cortisol profile. However, CAR was larger among patients compared to the reference population. Patients with low cortisol reactivity had more SHC, pain, and fatigue, and those with higher evening cortisol reported higher scores on coping. The results are discussed in terms of theory, practical considerations, and possible mechanisms for the association between cortisol, health, and coping.
Full-text · Article · Aug 2015 · Applied Psychophysiology and Biofeedback
[Show abstract][Hide abstract]ABSTRACT: Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive.
The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain.
Two hundred eighty-four adults aged 18-60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months.
Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p < 0.05), depression (p < 0.01), somatization (p < 0.01)) and functioning ability (p < 0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p < 0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p < 0.001) and they took better care of their own health (p < 0.001), compared to the BI group.
The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.
Full-text · Article · Apr 2015 · International Journal of Behavioral Medicine
[Show abstract][Hide abstract]ABSTRACT: Sensitization is defined as a non-associative learning process occurring when repeated administrations of a stimulus result in a progressive amplification of a response (Shettleworth, 2010). The purpose of this review paper is to discuss whether brain sensitization is helpful in common health problems in man. The paper reviews data on brain sensitization covering increased behavioral, physiological, cognitive, and emotional responses in man and animals. The paper concludes that brain sensitization may be a helpful concept to understand subjective and “unexplained” health complaints (nonspecific muscle pain, mood changes, fatigue, and gastrointestinal complaints), and, therefore, relevant for evidence based treatment and prevention of these common health problems.
No preview · Article · Apr 2014 · Psychoneuroendocrinology
[Show abstract][Hide abstract]ABSTRACT: The severity of restraint-induced gastric ulcerations in rats may be influenced by proactive effects of earlier shock experience. Earlier experience with escapable shock offers some protection against the ulcerogenic effects of restraint stress. In this experiment, we tested the hypothesis that providing animals with safety signals during a Pavlovian conditioning session would also provide a proactive protection against restraint ulceration similar to that provided by escape responses. Animals were subjected to five daily sessions of 20 shocks before they were subjected to a single 23-h restraint stress procedure. The animals given safety signals during the conditioning sessions developed less ulceration than those subjected to random tone-shock pairings and those that were not shocked. This complements other reports of the similar properties shared by escape conditioning and safety-signal (backward) conditioning. In contrast, postrestraint corticosterone levels were higher in animals provided earlier with safety signals than they were in other groups.
No preview · Article · Dec 2013 · Physiological Psychology
[Show abstract][Hide abstract]ABSTRACT: Objectives. The primary objective of this study was to explore whether general practitioners (GPs) in Norway, Sweden, and Denmark make similar or different decisions regarding sick leave for patients with severe subjective health complaints (SHC). The secondary objective was to investigate if patient diagnoses, the reasons attributed for patient complaints, and GP demographics could explain variations in sick leave decisions. Design. A cross-sectional study. Method. Video vignettes of GP consultations with nine different patients. Subjects. 126 GPs in Norway, Sweden, and Denmark. Setting. Primary care in Norway, Sweden, and Denmark. Main outcome measure. Sick leave decisions made by GPs. Results. "Psychological" diagnoses in Sweden were related to lower odds ratio (OR) of granting sick leave than in Norway (OR = 0.07; 95% CI = 0.01-0.83) Assessments of patient health, the risk of deterioration, and their ability to work predicted sick leave decisions. Specialists in general medicine grant significantly fewer sick leaves than non-specialists. Conclusion. Sick-leave decisions made by GPs in the three countries were relatively similar. However, Swedish GPs were more reluctant to grant sick leave for patients with "psychological" diagnoses. Assessments regarding health-related factors were more important than diagnoses in sick-leave decisions. Specialist training may be of importance for sick-leave decisions.
Full-text · Article · Oct 2013 · Scandinavian journal of primary health care
[Show abstract][Hide abstract]ABSTRACT: Background. A diagnosis is the basis of medical action, the key to various social privileges and national sick leave statistics. The objectives of this study were to investigate which diagnoses general practitioners in Scandinavia give patients with severe subjective health complaints, and what kind of treatments they suggested. Methods. One hundred and twenty-six self-selected general practitioners in Scandinavia diagnosed nine patients, presented as video vignettes, in a cross-sectional study. The main outcome measures were primary, secondary, and tertiary diagnoses. Results. The nine patients got between 13 and 31 different primary diagnoses and a large variety of secondary and tertiary diagnoses. Fifty-eight percent of the general practitioners chose different primary and secondary diagnoses, indicating that they judged the patients to have multimorbid complaints. The most commonly recommended treatment was referral to a psychologist, a mix of psychological and physical treatments, or treatment by the general practitioner. Conclusion. Scandinavian general practitioners give a large variety of symptom diagnoses, mainly psychological and general and unspecified, to patients with severe subjective health complaints. Referral to a psychologist or a mix of psychological or physical treatments was most commonly suggested to treat the patients.
[Show abstract][Hide abstract]ABSTRACT: We examined scores on the Narcissistic Personality Inventory (NPI; Raskin & Terry, 1988) in relation to drive to work, enjoyment of and engagement in work, and professional position. A sample of 235 Norwegian bank employees completed a cross-sectional survey. We found that managers scored higher than subordinates on all measures. NPI scores correlated significantly and positively with drive, enjoyment of and engagement in work. Multiple regression analyses controlling for demographic and work variables showed that narcissism was significantly related to enjoyment of work and work engagement but unrelated to drive. Although the associations were rather weak, our findings support previous clinical observations of narcissistic traits in workaholics as well as findings in empirical research on narcissistic traits in managers.
Full-text · Article · Jul 2012 · Social Behavior and Personality An International Journal
[Show abstract][Hide abstract]ABSTRACT: BACKGROUND: Coping has traditionally been measured with inventories containing many items meant to identify specific coping strategies. An alternative is to develop a shorter inventory that focusses on coping expectancies which may determine the extent to which an individual attempts to cope actively. PURPOSE: This paper explores the usefulness and validity of a simplified seven-item questionnaire (Theoretically Originated Measure of the Cognitive Activation Theory of Stress, TOMCATS) for response outcome expectancies defined either as positive ("coping"), negative ("hopelessness"), or none ("helplessness"). The definitions are based on the Cognitive Activation Theory of Stress (CATS; Ursin and Eriksen, Psychoneuroendocrinology, 29(5):567-92, 2004). The questionnaire was tested in two different samples. First, the questionnaire was compared with a traditional test of coping and then tested for validity in relation to socioeconomic differences in self-reported health. METHODS: The first study was a comparison of the brief TOMCATS with a short version of the Utrecht Coping List (UCL; Eriksen et al., Scand J Psychol, 38(3):175-82, 1997). Both questionnaires were tested in a population of 1,704 Norwegian municipality workers. The second study was a cross-sectional analysis of TOMCATS, subjective and objective socioeconomic status, and health in a representative sample of the Swedish working population in 2003-2005 (N = 11,441). RESULTS: In the first study, the coping item in the TOMCATS questionnaire showed an expected significant positive correlation with the UCL factors of instrumental mastery-oriented coping and negative correlations with passive and depressive scores. There were also the expected correlations for the helplessness and hopelessness scores, but there was no clear distinction between helplessness and hopelessness in the way they correlated with the UCL. In the second study, the coping item in TOMCATS and the three-item helplessness scores showed clear and monotonous gradients over a subjective socioeconomic status (SES) ladder. Positive response outcome expectancy ("coping") was related to high subjective SES and no expectancy ("helplessness") to low subjective SES. In a model including age and sex, TOMCATS scores explained more variance (r (2) = 0.16) in self-reported health than both subjective (r (2) = 0.08) and objective SES (r (2) = 0.02). CONCLUSION: The brief TOMCATS questionnaire showed acceptable and significant correlations with a traditional coping questionnaire and is sensitive enough to register systematic differences in response outcome expectancies across the socioeconomic ladder. The results furthermore confirm that psychological and learning factors contribute to the socioeconomic gradient in health.
Full-text · Article · Feb 2012 · International Journal of Behavioral Medicine
[Show abstract][Hide abstract]ABSTRACT: Introduksjon Stress er et ullent begrep som til daglig brukes om alt fra negative hendelser og situasjoner til noe man blir syk av. Men hva er egentlig stress og er det slik at stress alltid er negativt? Stress finnes hos alle mennesker, og hos alle dyrearter som vi har studert. Biologisk sett er det derfor sannsynlig at stressreaksjonene har overlevelsesverdi, vi må ha denne reaksjonen. Det er lett å forstå at disse trengs for å flykte unna farlige situasjoner, men mye tyder også på at vi trenger reaksjonene i vårt daglige liv. Tradisjonelt var sykepleien orientert mot pleie, pasientene skulle beskyttes mot belastning og «stress». Etter hvert har pleien fått et bredere perspektiv og er rettet mot en helsefremmende sykepleie. Helsefremming defineres som prosesser som «setter den enkelte så vel som fellesskapet i stand til økt kontroll over forhold som virker innpå helsen, og derigjennom bedrer sin egen helse» (2010). Dette har ført til en mer aktiv og aktiviserende sykepleie. Et av de tidligste forsøkene ble foretatt allerede på 70-tallet; beboere på et sykehjem ble enten gitt pleie som var basert på høy grad av aktiv deltagelse og medbestemmelse, eller pleie som var god og omfattende slik at pasientene slapp å gjøre noe selv. De som fikk den aktiviserende pleien rapporterte større tilfredshet, bedre helse, var mer aktivert (våken) og levde lenger (Rodin et al., 1977). Pasientens subjektive opplevelse av kontroll var den viktigste faktoren, viktigere enn den reelle kontrollen. Denne innsikten er nå en viktig del av stressteori slik den ser ut i dag (Ursin og Eriksen, 2004). Selvsagt er det fortsatt situasjoner hvor pasienten skal beskyttes mest mulig. Men det er ikke lenger slik at de skal unngå all belastning og «stress». Vi får pasientene opp av sengen så tidlig som mulig, ikke all smerte skal unngås, infarktpasienten skal trene og kvinner skal opp så snart som mulig etter fødsel. Hensikten med dette kapitelet er å gi sykepleiere økt kunnskap og forståelse om generell stressteori og mestring. Hva er en stressreaksjon, kan den vaere skadelig, eller er den en nødvendig del av livet? Videre fokuseres det på hva sykepleieren kan gjøre for at disse reaksjonene blir forstått og akseptert som en naturlig del av helsefremmende sykepleie. Kapitlet gir først en systematisk oversikt over stress teori slik den ser ut i dag. I annen del av kapitlet er det konkrete eksempler på hvordan teorien får praktiske konsekvenser i den daglige pleie.
[Show abstract][Hide abstract]ABSTRACT: The aim was to investigate how working in an extreme and isolated environment in the Arctic affected the diurnal rhythm of saliva cortisol.
Twenty-five male tunnel workers were screened during 3 different working cycles with different light conditions during a 9-month construction period; April/May (24 hours [h] light), September/October (approximately 12 h light and 12 h darkness) and November/December (24 h darkness). The work schedule was 10 h on/14 h off, 21 days at work/21 days off work. The workers alternated between the day shift in 1 work period and the night shift in the next. Four saliva samples were collected on day 14 in all 3 periods; immediately after awakening, and then 30 minutes, 6 hours and 12 hours after awakening.
Regardless of shift schedule, the workers' cortisol levels were significantly lower in the period with 24 hours of light per day compared to the period with "normal" light conditions. There were no differences in the cortisol levels of the workers on night shifts in the period with 24 hours of darkness compared to those in the period with "normal" light conditions, but the workers who were on day shifts in the period with 24 of hours darkness had a disturbed cortisol rhythm (lower peak after awakening and lack of the normal decrease during the day).
External light conditions and shift schedule were important factors in regulating the workers' cortisol rhythm. It seems to be easier to adapt to a night rhythm than an early morning rhythm in an isolated and extreme environment.
[Show abstract][Hide abstract]ABSTRACT: The aim of this study was to investigate self-reported health effects of extended work hours (10 h on/14 h off) for 21 d at work/21 d off, for 40 male tunnel workers in an Arctic area. A questionnaire obtaining information about demographics and subjective health complaints (SHC), including musculoskeletal, pseudoneurological, gastrointestinal, allergic, and flu-like complaints the last thirty days was distributed on day 14 of a work period. In addition questions on coping, psychological job demands, control, and social support were asked. The questionnaire was repeated three times during a nine months observation period. Twenty-six workers completed all three questionnaires. The prevalence of subjective health complaints did not change during the observation period. The prevalence of subjective health complaints was the same or lower than in a control group. There was a slight increase in self-reported job demands during the observation period. Coping, job control, and social support from colleagues and management were reported high and did not change. No association between this type of long work hours and changes in self-reported health was found in this study. However, this might have been a selected group of workers, and the same results may not be found in another population.
Full-text · Article · Nov 2010 · Industrial Health
[Show abstract][Hide abstract]ABSTRACT: The stress hormone cortisol shows a pronounced endogenous diurnal rhythm, which is affected by the sleep/wake cycle, meals and activity. Shift work and especially night work disrupts the sleep/wake cycle and causes a desynchronization of the natural biological rhythms. Therefore, different shift schedules may have different impact on performance at work and health.
The purpose was to study if health, reaction time, and the cortisol rhythm were negatively affected when a group of shift workers changed their work schedule from ordinary day-night shift (fixed shift) to "swing shift". METHODS AND SETTINGS: 19 healthy workers on a Norwegian oil rig participated in the study. They worked 2 weeks offshore followed by 4 weeks off work. The ordinary schedule consisted of 12-h day shift and 12-h night shift every other work period (14 days or nights=fixed shift). "Swing shift" involved 1 week of night shift, followed by 1 week of day shift during the work period. All participants worked ordinary day-night shift when baseline data were collected (questionnaires, saliva cortisol, and reaction time during work). After collection of baseline data the workers changed their work schedule to "swing shift", for every working period, and 9 months later the same data were collected.
"Swing shift" did not give any negative health effects or any negative changes in reaction time during the day they shifted from night work to day work. Personnel adapted to night shift within a week regardless of schedule, but recovery from night shift took longer time. During swing shift the cortisol rhythm went back towards a normal rhythm in the second week, but it was not returned completely to normal values when they returned home for the 4 weeks off period. However, the cortisol rhythms were readapted to normal values after 1 week at home. For personnel returning home directly from 14 consecutive night shifts, cortisol adaptation was not complete after 1 week at home.
We found no increase in health complaints from swing shift or reaction time in the shift from night to day work. Recovery from night shift takes longer time.
Full-text · Article · Oct 2010 · Psychoneuroendocrinology
[Show abstract][Hide abstract]ABSTRACT: The cognitive activation theory of stress (CATS) is based on a long series of experiments on animals and on humans, in the laboratory, and in real life situations. From the common sense coping concept formulated by Seymour Levine; coping is when my "tommy" does not hurt, we have advanced to a systematic theory for what is behind the relaxed and happy coping rat (and cat). We also cover the translational leap to humans, starting with the now classic parachutist study. The bridge is based on formal and symbolic definitions, a theoretical short cut that Levine actually never really accepted. The essential pathophysiological concept is the potential pathological effects of sustained activation, which may occur in the absence of coping (positive response outcome expectancy). We review the current status of CATS in Behavioural Medicine by discussing its potential explanatory power in epidemiology, prevention and treatment of "subjective health complaints".
[Show abstract][Hide abstract]ABSTRACT: AbstractA scoring schedule has been developed for quantification of flight and defense behavior in the captured ptarmigan (Lagopus lagopus lagopus). The reliability and validity of the method have been tested in 45 birds. This quantification makes it possible to demonstrate a reciprocal relationship between these two behavior patterns, and their differential relationships to sex, hormone-dependent physical appearance of the birds, and seasonal variations. The relative independence of the two behavior patterns supports previous neuroethological studies suggesting different anatomical substrates for the two behavior patterns.ZusammenfassungEs wurde eine Bewertungsskala zur Messung von Flucht- und Verteidi-gungsverhalten beim gefangengehaltenen Moorschneehuhn entwickelt (Lagopus lagopus lagopus). Die Zuverlässigkeit und Gültigkeit der Methode wurde an 45 Vogeln getestet. Mit Hilfe dieser Messung kann die reziproke Beziehung dieser beiden Verhaltensmuster und deren unterschiedliche Beziehung zu Geschlecht, hormonabhängigem Aussehen der Vögel und den jahreszeitlichen Veranderungen gezeigt werden. Die relative Unabhängigkeit der beiden Verhaltensmuster unterstützt frühere neuroethologische Untersuchungen, die ver-schiedene anatomische Substrate für diese beiden Verhaltensmuster annehmen.
[Show abstract][Hide abstract]ABSTRACT: The establishment of a social order in a flock of Arctic birds is important for their survival. It also has effects on the internal state of each individual bird. Submissive birds have higher levels of body temperature and of plasma corticosterone than the dominant birds following establishment of a stable hierarchy. This is explained as being due to psychological effects of success (coping) in the situation rather than indicating any primary physiological differences between dominating and submissive birds.ZusammenfassungAn 21 Moorschneehühnern, die in Gefangenschaft in zwei Gruppen gehalten waren, wurden während der Ausbildung einer Rangordnung Körper-temperatur und Corticosteron-Spiegel im Blut gemessen. Beide Maße lieferten — wie auch die Aktivität der Tiere — hohe Werte während der Ordnungs-phase und tiefere Werte, als die Rangordnung feststand. In beiden Gruppen waren die Körpertemperatur und der Corticosteron-Spiegel beim dominanten Tier geringer als bei den rangunterlegenen Tieren.
[Show abstract][Hide abstract]ABSTRACT: 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.
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.
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.
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.
Full-text · Article · Apr 2010 · Rural and remote health