bluuebunny/crossref_metadata_2025 huggingface dataset:
Nocardia veterana
Isolated from Ascitic Fluid of a Patient with Human Immunodeficiency Virus Infection
Authors: Godreuil Sylvain , Didelot Marie-Noëlle , Perez Colette , Leflèche Anne , Boiron Patrick , Reynes Jacques , Laurent Frédéric , Jean-Pierre Hélène , Marchandin Hélène
Published: June 2003

Nocardia veterana
is a recently characterized species within the genus
Nocardia
, and only three human clinical isolates have been reported for this species. We describe a case of ascitic fluid infection in an immunocompromised patient due to
N. veterana
. To our knowledge, this is the first report of a
Nocardia
sp. strain from ascitic fluid and the fourth report of
N. veterana
isolated from human samples. Chemotaxonomic methods showed the strain to belong to the genus
Nocardia
, and identification to the species level was done by 16S ribosomal DNA gene sequencing. The antibiotic susceptibility profile of
N. veterana
is reported here for the second time. The strain was deposited in the Collection of the Pasteur Institute and in the Culture Collection of the University of Göteborg (CIP 107497 and CCUG 46576). The corresponding 16S ribosomal DNA gene sequence is available from the GenBank database under accession number
AY149599
. A phylogenetic analysis was conducted and showed that
N. veterana
was most closely related to the recently characterized species
Nocardia africana
rather than to
Nocardia vaccinii
, as previously reported.
Francisella tularensis
Bacteremia
Authors: Haristoy X. , Lozniewski A. , Tram C. , Simeon D. , Bevanger L. , Lion C.
Published: June 2003

Bacteremia caused by
Francisella tularensis
is rare and has been reported mainly in the United States and infrequently in Europe. We report herein the first case of bacteremic
F. tularensis
pneumonia in an immunocompetent individual in southern Europe.
Corynebacterium freneyi
Bacteremia
Authors: Auzias Amélie , Bollet Claude , Ayari Raouf , Drancourt Michel , Raoult Didier
Published: June 2003

Corynebacterium freneyi
is a recently described alpha-glucosidase-positive species of the genus
Corynebacterium
. To our knowledge, there is no description of human infection due to this species. We report on a case of bacteremia due to
C. freneyi
following vascular surgery.
Soft Tissue Infection Caused by a Novel Pigmented, Rapidly Growing
Mycobacterium
Species
Authors: Turenne Christine Y. , Suchak Amar A. , Wolfe Joyce N. , Kabani Amin , Nicolle Lindsay E.
Published: June 2003

Molecular techniques are playing an important role in the diagnosis of nontuberculous mycobacterial infections. This case report describes a chronic soft tissue infection in an immunocompetent patient caused by a previously undescribed pigmented, rapidly growing
Mycobacterium
species, emphasizing the importance of clinical suspicion and effective laboratory techniques in the diagnosis and treatment of infection.
Lactobacillus paracasei
Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis and Review of the Literature
Authors: Neef Phyllis A. , Polenakovik Hari , Clarridge Jill E. , Saklayen Mohammad , Bogard Laura , Bernstein Jack M.
Published: June 2003

We describe the first case of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis due to
Lactobacillus paracasei
. It occurred in a 65-year-old patient with recurrent episodes of peritonitis while he was receiving a prolonged course of intraperitoneal vancomycin.
L
.
paracasei
should be considered in the differential diagnosis of pathogens in CAPD-related peritonitis, especially in patients receiving prolonged vancomycin or glycopeptide treatment.
Disseminated Infection with a Mycobacterium Related to
Mycobacterium triplex
with Central Nervous System Involvement Associated with AIDS
Authors: Zeller Valérie , Nardi Anne-Lyse , Truffot-Pernot Chantal , Sougakoff Wladimir , Stankoff Bruno , Katlama Christine , Bricaire François
Published: June 2003

We report on a case of disseminated infection with central nervous system involvement due to an atypical mycobacterium related to
Mycobacterium triplex
in a severely immunodepressed human immunodeficiency virus-infected man.
Tuboovarian Abscess Caused by
Atopobium vaginae
following Transvaginal Oocyte Recovery
Authors: Geißdörfer Walter , Böhmer Christoph , Pelz Klaus , Schoerner Christoph , Frobenius Wolfgang , Bogdan Christian
Published: June 2003

A 39-year-old woman with tubarian sterility fell ill with acute pelvic inflammatory disease 2 months after transvaginal oocyte recovery. Laparotomy revealed a large tuboovarian abscess, from which
Atopobium vaginae
, an anaerobic gram-positive coccoid bacterium of hitherto unknown clinical significance, was isolated. The microbial etiology and the risk of pelvic infections following transvaginal punctures are discussed.
Limits to the measurement of habitual physical activity by questionnaires
Authors: Shephard R J
Published: June 2003

Despite extensive use over 40 years, physical activity questionnaires still show limited reliability and validity. Measurements have value in indicating conditions where an increase in physical activity would be beneficial and in monitoring changes in population activity. However, attempts at detailed interpretation in terms of exercise dosage and the extent of resulting health benefits seem premature. Such usage may become possible through the development of standardised instruments that will record the low intensity activities typical of sedentary societies, and will ascribe consistent biological meaning to terms such as light, moderate, and heavy exercise.
Acetabular labrum and its tears
Authors: Narvani A A , Tsiridis E , Tai C C , Thomas P
Published: June 2003

Groin pain is a major cause of morbidity in athletes. Only in the last decade have acetabular labrum tears been recognised as a possible diagnosis. Awareness of this condition is important for appropriate management. The basic science and pathological and clinical features of acetabular labrum tears are reviewed, and diagnostic and treatment options are presented.
Four weeks of androstenedione supplementation diminishes the treatment response in middle aged men
Authors: Beckham S G , Earnest C P
Published: June 2003

Objectives:To examine baseline hormonal concentrations and the pharmacokinetic response on day 0 and day 28 of 28 days of androstenedione supplementation.

Methods:Eight men (mean (SD) age 44.1 (3.0) years (range 40–48), weight 76.3 (9.4) kg, and percentage body fat 20.6 (6.7)) participated in a randomised, double blind, cross over, 2 × 28 day placebo controlled study. Subjects were tested on day 0 and 28 days after receiving 200 mg/day oral androstenedione and a placebo treatment with a 28 day washout period between treatments. Serum hormone concentrations were examined at baseline (time 0) and then at 30 minute intervals for 180 minutes to measure day 0 and day 28 pharmacokinetic responses. Analytes included androstenedione, total testosterone, dehydroepiandrosterone sulfate (DHEAS), oestradiol, and sex hormone binding globulin (SHBG). Lipid concentrations, weight, body composition, resting heart rate, and blood pressure were also measured.

Results:Analysis of integrated area under the curve (AUC) and time 0 hormonal concentrations by repeated measures multivariate analysis of variance (p<0.05) and Fisher’s post hoc analysis showed a significant increase in AUC for serum androstenedione at day 0 (108.3 (27.6) nmol/l) in the supplemented condition as compared with day 28 (43.4 (13.1) nmol/l) and placebo (2.1 (0.8) nmol/l) conditions. No other significant AUC changes were noted. After 28 days of supplementation, DHEAS levels were significantly elevated (p = 0.00002) at time 0 (12.9 (1.3) μmol/l) compared with placebo (7.0 (0.8) μmol/l) with a trend (p = 0.08) toward elevation of time 0 androstenedione concentrations (16.4 (7.0) nmol/l) compared with placebo (5.6 (0.4) nmol/l). No changes were found for lipids, resting heart rate, or blood pressure, weight, or percentage body fat.

Conclusion:Although supplementation with 200 mg/day androstenedione increases AUC for serum androstenedione in the day 0 condition, continued supplementation is characterised by a diminished treatment response, coupled with time 0 increases in testosterone precursors but not testosterone.
The current status of sports medicine training in United States internal medicine residency programmes
Authors: Sweeney C L , Davidson M , Melgar T , Patel D , Cucos D
Published: June 2003

Objective:To determine the general status of sports medicine training in internal medicine residency programmes in the United States.

Methods:A cross sectional survey of the programme directors and chief residents of each of the 407 accredited internal medicine programmes listed in the 1999–2000 Graduate Medical Education Directory.

Results:The questionnaire was returned by 231 of 404 (57%) programme directors and 233 of 404 (58%) chief residents. A chief and director of the same programme (paired responses) replied from 144 of 404 (36%) programmes surveyed. A formal sports medicine curriculum was reported by 22.1% of programme directors. Programmes with a formal curriculum were 2.9 times more likely to offer any of the sports medicine educational experiences (p<0.0001; Cochran-Mantel-Haenszel). Programmes with block rotations were more likely to include all of the educational experiences surveyed than those without (p<0.002 for each; χ2test). A total of 162 programmes included sports medicine as part of other rotations. Most programmes only included sports medicine as part of other rotations: 44.6% (103/231) of all programmes and 63.6% (103/162) of programmes with sports medicine as part of other rotations. Some 29.9% (69/231) of directors reported having an elective, and 3.9% (9/231) reported a required rotation. Almost a quarter (21.7%; 50/231) of directors reported that their residents received no clinical experience in sports medicine.

Conclusions:Little attention is given to the subject of sports medicine when internal medicine residency curricula are developed in the United States. Thus only a small percentage of American internal medicine residency programmes provide significant training in sports medicine.
A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics
Authors: Taunton J E , Ryan M B , Clement D B , McKenzie D C , Lloyd-Smith D R , Zumbo B D
Published: June 2003

Objectives:Seventeen running training clinics were investigated to determine the number of injuries that occur in a running programme designed to minimise the injury rate for athletes training for a 10 km race. The relative contributions of factors associated with injury were also reported.

Methods:A total of 844 primarily recreational runners were surveyed in three trials on the 4th, 8th, and 12th week of the 13 week programme of the “In Training” running clinics. Participants were classified as injured if they experienced at least a grade 1 injury—that is, pain only after running. Logistic regression modelling and odds ratio calculation were performed for each sex using the following predictor variables: age, body mass index (BMI), previous aerobic activity, running frequency, predominant running surface, arch height, running shoe age, and concurrent cross training.

Results:Age played an important part in injury in women: being over 50 years old was a risk factor for overall injury, and being less than 31 years was protective against new injury. Running only one day a week showed a non-significant trend for injury risk in men and was a significant risk factor in women and overall injury. A BMI of > 26 kg/m2was reported as protective for men. Running shoe age also significantly contributed to the injury model. Half of the participants who reported an injury had had a previous injury; 42% of these reported that they were not completely rehabilitated on starting the 13 week training programme. An injury rate of 29.5% was recorded across all training clinics surveyed. The knee was the most commonly injured site.

Conclusions:Although age, BMI, running frequency (days a week), and running shoe age were associated with injury, these results do not take into account an adequate measure of exposure time to injury, running experience, or previous injury and should thus be viewed accordingly. In addition, the reason for the discrepancy in injury rate between these 17 clinics requires further study.
Energy demands during a judo match and recovery
Authors: Degoutte F , Jouanel P , Filaire E
Published: June 2003

Objective:To assess energy demand during a judo match and the kinetics of recovery by measuring the metabolites of the oxypurine cascade, lipolytic activity, and glycolytic pathway.

Methods:Venous blood samples were taken from 16 national judoists (mean (SEM) age 18.4 (1.6) years), before (T1) and three minutes (T2), one hour (T3), and 24 hours (T4) after a match. A seven day diet record was used to evaluate nutrient intake.

Results:Nutrient analysis indicated that these athletes followed a low carbohydrate diet. Plasma lactate concentration had increased to 12.3 (1.8) mmol/l at the end of the match. An increase in the levels of extracellular markers of muscle adenine nucleotide catabolism, urea, and creatinine was observed at T2, while uric acid levels remained unchanged. High concentrations of urea persisted for 24 hours during the recovery period. Ammonia, hypoxanthine, xanthine, and creatinine returned to control levels within the 24 hour recovery period. Uric acid concentrations rose from T3and had not returned to baseline 24 hours after the match. The levels of triglycerides, glycerol, and free fatty acids had increased significantly (p<0.05) after the match (T2) but returned to baseline values within 24 hours. Concentrations of high density lipoprotein cholesterol and total cholesterol were significantly increased after the match.

Conclusions:These results show that a judo match induces both protein and lipid metabolism. Carbohydrate availability, training adaptation, and metabolic stress may explain the requirement for these types of metabolism.
Cricket injuries: a longitudinal study of the nature of injuries to South African cricketers
Authors: Stretch R A
Published: June 2003

Objective:To determine the incidence and nature of injuries sustained by elite cricketers during a three season period in order to identify possible injury patterns.

Methods:Thirty six physiotherapists and 13 doctors working with 11 provincial and the South African national teams completed a questionnaire for each cricketer who presented with an injury during each season to determine anatomical site of injury, month of injury during the season, diagnosis, mechanism of injury, whether it was a recurrence of a previous injury, whether the injury had recurred again during the season, and biographical data.

Results:A total of 436 cricketers sustained 812 injuries. Bowling (41.3%), fielding and wicketkeeping (28.6%), and batting (17.1%) accounted for most of the injuries. The lower limbs (49.8%), upper limbs (23.3%), and back and trunk (22.8%) were most commonly injured. The injuries occurred primarily during first class matches (27.0%), limited overs matches (26.9%), and practices (26.8%) during the early part of the season. Acute injuries made up 64.8% of the injuries. The younger players (up to 24 years) sustained 57% of the first time injuries, and the players over 24 years of age sustained 58.7% of the injuries that recurred from a previous season. The injuries were mainly soft tissue injuries predominantly to muscle (41.0%), joint (22.2%), tendon (13.2%), and ligament (6.2%). The primary mechanism of injury was the delivery and follow through of the fast bowler (25.6%), overuse (18.3%), and fielding (21.4%).

Conclusion:The results indicate a pattern of cause of injury, with the young fast bowler most likely to sustain an acute injury to the soft tissues of the lower limb while participating in matches and practices during the early part of the season.
Heart rate responses of women aged 23–67 years during competitive orienteering
Authors: Bird S , George M , Balmer J , Davison R C R
Published: June 2003

Objectives:To compare the heart rate responses of women orienteers of different standards and to assess any relation between heart rate responses and age.

Methods:Eighteen competitive women orienteers completed the study. They were divided into two groups: eight national standard orienteers (ages 23–67 years); 10 club standard orienteers (ages 24–67 years). Each participant had her heart rate monitored during a race recognised by the British Orienteering Federation. Peak heart rate (HRPEAK), mean heart rate (HRMEAN), standard deviation of her heart rate during each orienteering race (HRSD), and mean change in heart rate at each control point (ΔHRCONTROL) were identified. The data were analysed using analysis of covariance with age as a covariate.

Results:National standard orienteers displayed a lower within orienteering race standard deviation in heart rate (6 (2)v12 (2) beats/min, p<0.001) and a lower ΔHRCONTROL(5 (1)v17 (4) beats/min, p<0.001). The mean heart rate during competition was higher in the national standard group (170 (11)v158 (11) beats/min, p = 0.025). The HRMEANfor the national and club standard groups were 99 (8)% and 88 (9)% of their age predicted maximum heart rate (220−age) respectively. All orienteers aged >55 years (n = 4) recorded HRMEANgreater than their age predicted maximum.

Conclusions:The heart rate responses indicate that national and club standard women orienteers of all ages participate in the sport at a vigorous intensity. The higher ΔHRCONTROLof club standard orienteers is probably due to failing to plan ahead before arriving at the controls and this, coupled with slowing down to navigate or relocate when lost, produced a higher HRSD.
Peroneus longus stretch reflex amplitude increases after ankle brace application
Authors: Cordova M L , Ingersoll C D
Published: June 2003

Background:The use of external ankle support is widespread throughout sports medicine. However, the application of ankle bracing to a healthy ankle over a long period has been scrutinised because of possible neuromuscular adaptations resulting in diminished dynamic support offered by the peroneus longus.

Objective:To investigate the immediate and chronic effects of ankle brace application on the amplitude of peroneus longus stretch reflex.

Methods:Twenty physically active college students (mean (SD) age 23.6 (1.7) years, height 168.7 (8.4) cm, and mass 69.9 (12.0) kg) who had been free from lower extremity pathology for the 12 months preceding the study served as subjects. None had been involved in a strength training or conditioning programme in the six months preceding the study. A 3 × 3 × 2 (test condition × treatment condition × time) design with repeated measures on the first and third factor was used. The peroneus longus stretch reflex (% of maximum amplitude) during sudden foot inversion was evaluated under three ankle brace conditions (control, lace up, and semi-rigid) before and after eight weeks of ankle brace use.

Results:A 3 × 3 × 2 repeated measures analysis of variance showed that peroneus longus stretch reflex amplitude increased immediately after application of a lace up brace (67.1 (4.4)) compared with the semi-rigid (57.9 (4.3)) and control (59.0 (5.2)) conditions (p<0.05). Peroneus longus stretch reflex also increased after eight weeks of use of the semi-rigid brace compared with the lace up and control conditions (p<0.05).

Conclusions:Initial application of a lace up style ankle brace and chronic use of a semi-rigid brace facilitates the amplitude of the peroneus longus stretch reflex. It appears that initial and long term ankle brace use does not diminish the magnitude of this stretch reflex in the healthy ankle.
Relation between the occurrence of bony union and outcome for fractures of the lateral process of the talus: a case report and analysis of published reports
Authors: Parsons S J
Published: June 2003

Fractures of the lateral process of the talus are uncommon, but the incidence has probably risen because of the increased popularity of snowboarding, an increased awareness of doctors, and the ready availability of computed tomography scanning. One case report and a review of the literature are provided. Aggressive management rarely resulted in non-union (7%) and was always associated with a good outcome (100%), even if the fracture fragments were excised initially. The relations between method of treatment, bony union, and outcome were significant (Fisher’s exact test, p<0.01).
Assessment of fatigue among working people: a comparison of six questionnaires
Authors: De Vries J , Michielsen H J , Van Heck G L
Published: June 2003

Aims:To compare the psychometric qualities of six fatigue questionnaires in a sample of working persons.

Methods:Internal consistency and test-retest reliability, content validity, convergent validity, and the dimensionality of the fatigue instruments were explored.

Results:All scales had a satisfactory internal consistency. Furthermore, based on factor analyses and Mokken scale analyses, all scales were unidimensional and appeared to measure an identical construct. The Fatigue Assessment Scale (FAS) had the highest factor loading on the one factor solution obtained in a factor analysis of the total scores of all scales.

Conclusions:All the questionnaires were unidimensional and had good reliability and validity. The FAS was the most promising fatigue measure.
Quality of rehabilitation among workers with adjustment disorders according to practice guidelines; a retrospective cohort study
Authors: Nieuwenhuijsen K , Verbeek J H A M , Siemerink J C M J , Tummers-Nijsen D
Published: June 2003

Aims:To assess the quality of occupational rehabilitation for patients with adjustment disorders and to determine whether high quality of care is related to a shorter period of sickness absence.

Methods:A retrospective cohort study was conducted by means of an audit of 100 files of patients with adjustment disorders who visited their occupational physicians. Quality of rehabilitation was assessed by means of 10 performance indicators, derived from the guidelines for the treatment of employees with mental health disorders. Performance was dichotomised into optimal and deviant care according to explicit criteria. The performance rates were related to time until work resumption during a one year follow up period. Kaplan-Meier survival analyses and Cox proportional hazards analysis were used to study this relation.

Results:Four of 10 performance rates were below 50%: continuity of care (34%), interventions aimed at providers of care in the curative sector (39%), assessment of impediments in the return to work process (41%), and assessment of symptoms (45%). The highest performance rate concerned assessment of work related causes (94%). Overall optimal care was found in 10% of the cases. Median time to complete recovery was 195 days (IQR 97 to 365), and 73% of all patients recovered completely after one year. Optimal continuity of care was significantly related to a shorter time to both partial and complete work resumption (hazard ratio (HR) 0.3; CI 0.2 to 0.6) independently of other performance indicators. Performance regarding interventions aimed at the organisation was also related to a shorter time until first return to work (HR 0.5; CI 0.3 to 0.9).

Conclusions:This study shows that the rehabilitation process of employees with adjustment disorders leaves significant room for improvement, especially with regard to continuity of care. Quality of care was partly related to a better outcome. More rigorous study designs are needed to corroborate these findings.
An epidemiological approach to study fatigue in the working population: the Maastricht Cohort Study
Authors: Kant IJ , Bültmann U , Schröer K A P , Beurskens A J H M , van Amelsvoort L G P M , Swaen G M H
Published: June 2003

In 1998, a large scale prospective cohort study of prolonged fatigue in the working population was started in the Netherlands. The ultimate goal of this Maastricht Cohort Study was to identify risk factors involved in the aetiology and natural course of prolonged fatigue in the working population and to develop preventive measures and treatments that can be used in occupational health settings. In this paper, a conceptual model for epidemiological research on prolonged fatigue is presented. This model is the basis for the Maastricht Cohort Study. Alongside the model and design, the characteristics of the study population, the prevalence and one year cumulative incidence of prolonged fatigue, as well as its relation with secondary health outcomes (psychological distress, need for recovery, and burnout) are presented. Furthermore, model, design, and the presented results are discussed.
Acute and chronic job stressors among ambulance personnel: predictors of health symptoms
Authors: van der Ploeg E , Kleber R J
Published: June 2003

Objectives:To predict symptomatology (post-traumatic distress, fatigue, and burnout) due to acute and chronic work related stressors among ambulance personnel.

Methods:Data were gathered from 123 ambulance workers in The Netherlands in a longitudinal design. At two measurements they completed standardised questionnaires to assess health symptoms, such as the Impact of Event Scale, the Maslach Burnout Inventory, and the Checklist Individual Strength. Acute stressors were assessed with specific questions, and chronic work related stressors were measured with the Questionnaire on the Experience and Assessment of Work.

Results:Most of the ambulance workers had been confronted with acute stressors in their work. They also reported more chronic work related stressors than a reference group. Of the participants, more than a tenth suffered from a clinical level of post-traumatic distress, a tenth reported a fatigue level that put them at high risk for sick leave and work disability and nearly a tenth of the personnel suffered from burnout. Best predictors of symptomatology at time 2 were lack of social support at work and poor communication, such as not being informed about important decisions within the organisation.

Conclusions:Ambulance personnel are at risk to develop health symptoms due to work related stressors. Although, acute stressors are related to health symptoms, such as fatigue, burnout, and post-traumatic symptoms, it was not found to predict health symptoms in the long term. Main risk factors have to do with social aspects of the work environment, in particular lack of support from the supervisor as well as colleagues and poor communication. When implementing workplace interventions these social aspects need to be taken into account.
Work schedules and fatigue: a prospective cohort study
Authors: Jansen N W H , van Amelsvoort L G P M , Kristensen T S , van den Brandt P A , Kant IJ
Published: June 2003

Aims:(1) To describe the prevalence of fatigue among employees in different work schedules (day work, three-shift, five-shift, and irregular shift work); (2) to investigate whether different work schedules are related to increasing fatigue over time, while taking into account job title and job characteristics; and (3) to study fatigue among shift workers changing to day work.

Methods:Data from nine consecutive four-monthly self administered questionnaires from the Maastricht Cohort Study on Fatigue at work (n = 12 095) were used with 32 months of follow up. Day and shift workers were matched on job title.

Results:The prevalence of fatigue was 18.1% in day workers, 28.6% in three-shift, 23.7% in five-shift, and 19.1% in irregular shift workers. For three-shift and five-shift workers substantial higher fatigue levels were observed compared to day workers at baseline measurement. In the course of fatigue over the 32 months of follow up there were only small and insignificant differences between employees in different work schedules. However, among employees fatigued at baseline, fatigue levels decreased faster over time among five-shift workers compared to fatigued day workers. Shift workers changing to day work reported substantially higher fatigue levels prior to change, compared to those remaining in shift work.

Conclusions:Substantial differences in fatigue existed between day and shift workers. However, as no considerable differences in the course of fatigue were found, these differences have probably developed within a limited time span after starting in a shift work job. Further, evidence was found that fatigue could be an important reason for quitting shift work and moving to day work. Finally, in the relation between work schedules and fatigue, perceived job characteristics might play an important role.
Physiological differences between burnout patients and healthy controls: blood pressure, heart rate, and cortisol responses
Authors: De Vente W , Olff M , Van Amsterdam J G C , Kamphuis J H , Emmelkamp P M G
Published: June 2003

Objectives:To investigate differences between burnout patients and healthy controls regarding basal physiological values and physiological stress responses. Measures of the sympathetic-adrenergic-medullary (SAM) axis and the hypothalamic-pituitary-adrenal (HPA) axis were examined.

Methods:SAM axis and HPA axis activity was compared between 22 burnout patients and 23 healthy controls. SAM axis activity was measured by means of heart rate (HR) and blood pressure (BP). HPA axis activity was investigated by means of salivary cortisol levels. Resting levels of HR, BP, and cortisol were determined as well as reactivity and recovery of these measures during a laboratory session involving mental arithmetic and speech tasks. In addition, morning levels of cortisol were determined.

Results:Burnout patients showed higher resting HR than healthy controls. BP resting values did not differ between burnout patients and healthy controls, nor did cardiovascular reactivity and recovery measurements during the laboratory session. Basal cortisol levels and cortisol reactivity and recovery measures were similar for burnout patients and healthy controls. However, burnout patients showed elevated cortisol levels during the first hour after awakening in comparison to healthy controls.

Conclusions:The findings provided limited proof that SAM axis and HPA axis are disturbed among burnout patients. Elevated HR and elevated early morning cortisol levels may be indicative of sustained activation.
Need for recovery from work related fatigue and its role in the development and prediction of subjective health complaints
Authors: Sluiter J K , de Croon E M , Meijman T F , Frings-Dresen M H W
Published: June 2003

Aims:To present the available empirical evidence for the assumed position of the concept of work related fatigue as: (1) short term effect of the working day; and (2) an intermediate variable between work demands and the development of subjective health complaints and sickness absence.

Methods:Results from six single occupation studies, conducted between 1996 and 2002, are presented. Work demands (working hours, decision latitude, break control/autonomy, and mental, emotional, and physical demands) were assessed through validated scales. Work related fatigue was represented and assessed by means of the need for recovery after working time scale in all studies. Subjective health complaints and duration of sickness absence were quantified with the same instruments in most studies as well. Both cross sectional studies (four) as well as prospective studies (two; up to two years follow up) were performed. Cross sectional data of 3820 workers, in total, were available. Prospective data were accessible for 1200 workers in industry and health care. Models were tested with stepwise multiple regression analyses.

Results:Strong associations between work demands and need for necovery were found in different occupations. The variance explained in need for recovery by work demands, age, and (baseline) need for recovery ranged between 14% and 48% in both types of studies. The amount of explained variance by work demands, age, and (baseline) need for recovery in subjective health complaints ranged between 24% and 58% in the different occupations. The prospective data showed the prognostic value of need for recovery in relation to subjective health complaints (in terms of psychosomatic complaints, emotional exhaustion, or sleep problems) and duration of future sickness absence.

Conclusions:The hypothesised role for work related fatigue as a link in the causal string of events, that is assumed to exist between repeated adverse work demands and the development of work related stress reactions, (psychological) overload and, eventually, health problems, was confirmed.
The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems
Authors: Nieuwenhuijsen K , de Boer A G E M , Verbeek J H A M , Blonk R W B , van Dijk F J H
Published: June 2003

Aims:To (1) evaluate the psychometric properties and (2) examine the ability to detect cases with anxiety disorder and depression in a population of employees absent from work because of mental health problems.

Methods:Internal consistency, construct validity, and criterion validity of the Depression Anxiety Stress Scales (DASS) were assessed. Furthermore, the ability to identify anxiety disorders or depression was evaluated by calculating posterior probabilities of these disorders following positive and negative test results for different cut off scores of the DASS-Depression and DASS-Anxiety subscales.

Results:Internal consistency of the DASS subscales was high, with Cronbach’s alphas of 0.94, 0.88, and 0.93 for depression, anxiety, and stress respectively. Factor analysis revealed a three factor solution, which corresponded well with the three subscales of the DASS. Construct validity was further supported by moderately high correlations of the DASS with indices of convergent validity (0.65 and 0.75), and lower correlations of the DASS with indices of divergent validity (range −0.22 to 0.07). Support for criterion validity was provided by a statistically significant difference in DASS scores between two diagnostic groups. A cut off score of 5 for anxiety and 12 for depression is recommended. The DASS showed probabilities of anxiety and depression after a negative test result of 0.05 and 0.06 respectively. Probabilities of 0.29 for anxiety disorder and 0.33 for depression after a positive test result reflect relatively low specificity of the DASS.

Conclusion:The psychometric properties of the DASS are suitable for use in an occupational health care setting. The DASS can be helpful in ruling out anxiety disorder and depression in employees with mental health problems.
Need for recovery after work and the subsequent risk of cardiovascular disease in a working population
Authors: van Amelsvoort L G P M , Kant IJ , Bültmann U , Swaen G M H
Published: June 2003

Background:A high need for recovery after work can be regarded as a short term adverse effect of working day stressors and the person’s inability to cope and recover. Consequently, it might be an intermediate factor between job stressors and cardiovascular disease (CVD).

Aim:To investigate, in a longitudinal study, the relation between need for recovery and subsequent CVD.

Methods:Data from the Maastricht Cohort Study of 12 140 workers were used, with 42 incident self reported CVD cases during 32 months of follow up. Cox proportional hazards analysis was used to calculate age, gender, smoking status, and educational level adjusted relative risks.

Results:The adjusted relative CVD risk for the second compared to the first tertile of the need for recovery score was 1.22 (95% CI: 0.49 to 3.04), and for the third compared to the first tertile was 3.16 (95% CI: 1.34 to 7.48). When need for recovery was entered as continuous score, an adjusted relative risk per SD increase of 1.54 (95% CI: 1.15 to 2.03) was found. Additional adjustment for several work related factors as job demands, did not notably change the observed relation between need for recovery and CVD. Moreover, the increased risk for subjects reporting high job demands (1.38 per SD increase; 95% CI: 1.02 to 3.92) decreased substantially after adjustment for need for recovery.

Conclusion:The results show that need for recovery is a strong predictor of subsequent cardiovascular disease and might be an intermediate factor between job stressors and cardiovascular disease.
Fatigue as a risk factor for being injured in an occupational accident: results from the Maastricht Cohort Study
Authors: Swaen G M H , van Amelsvoort L G P M , Bültmann U , Kant IJ
Published: June 2003

Aims:To determine whether fatigue and need for recovery are risk factors for being injured in an occupational accident.

Methods:These associations were investigated within the Maastricht Cohort Study of “Fatigue at Work”, a prospective cohort study of employees from a wide range of companies and organisations. For 7051 employees information was available on fatigue as measured with the Checklist Individual Strength (CIS), need for recovery as measured with the VBBA, and possible confounding factors such as age, smoking, alcohol consumption, educational level, shift work, and work environment. Information on the risk factors was collected in May 1999 and January 2000, before the occurrence of the occupational accidents. The incidence of being injured in an occupational accident was inventoried over the year 2000. A total of 108 employees reported having been injured in an occupational accident in 2000.

Results:For the highest CIS fatigue score tertile a for age, gender, educational level, smoking, shift work, and work environment, adjusted relative risk for being injured in an occupational accident of 1.29 (95% CI: 1.03 to 2.78) was found compared to the lowest tertile, and for the highest tertile of need for recovery a relative risk of 2.28 (95% CI: 1.41 to 3.66) was found.

Conclusions:Fatigue and need for recovery were found to be independent risk factors for being injured in an occupational accident. This means that in the push back of occupational accidents, fatigue, and even more importantly need for recovery, need special attention.
Fatigue in employees with diabetes: its relation with work characteristics and diabetes related burden
Authors: Weijman I , Ros W J G , Rutten G E H M , Schaufeli W B , Schabracq M J , Winnubst J A M
Published: June 2003

Aims:To examine the relations between work characteristics as defined by the Job Demand-Control-Support model (JDCS) (that is, job demands, decision latitude, and social support), diabetes related burden (symptoms, seriousness of disease, self care activities, and disease duration), and fatigue in employees with diabetes mellitus.

Methods:Employees (n = 292) aged 30–60 years, with insulin treated diabetes, filled in self administered questionnaires that assess the above mentioned components of the JDCS model and diabetes related burdens.

Results:Both work and diabetes related factors are related to fatigue in employees with diabetes. Regression analyses revealed that work characteristics explain 19.1% of the variance in fatigue; lack of support, and the interaction of job demands and job control contribute significantly. Diabetes related factors explain another 29.0% of the variance, with the focus on diabetes related symptoms and the burden of adjusting insulin dosage to circumstances. Fatigue is more severe in case of lack of social support at work, high job demands in combination with a lack of decision latitude, more burden of adjusting insulin dosage to circumstances, and more diabetic symptoms. Furthermore, regression analysis revealed that diabetic symptoms and the burden of adjusting the insulin dosage to circumstances are especially relevant in combination with high job demands.

Conclusions:Both diabetes and work should be taken into consideration—by (occupational) physicians as well as supervisors—in the communication with people with diabetes.
Associations between fatigue attributions and fatigue, health, and psychosocial work characteristics: a study among employees visiting a physician with fatigue
Authors: Andrea H , Kant IJ , Beurskens A J H M , Metsemakers J F M , van Schayck C P
Published: June 2003

Aims:To study associations between characteristics of employees active at work and making a fatigue related visit to the general practitioner (GP) or occupational physician (OP) in terms of fatigue, physical health problems, mental health problems, psychosocial work characteristics, and attributions of their fatigue complaints.

Methods:Self report questionnaires from the Maastricht Cohort Study Fatigue at Work were used to measure fatigue (Checklist Individual Strength, Maslach Burnout Inventory–General Survey), physical health problems (chronic illness), mental health problems (Hospital Anxiety and Depression Scale), psychosocial work characteristics (Job Content Questionnaire), and fatigue attributions (somatic, psychological, none) in employees who made a fatigue related visit to the GP or OP over a six month period.

Results:In employees visiting only the GP, fatigue was an important reason to visit in one of seven (13.9%) employees. These fatigue related visits were in particular associated with high fatigue levels and mental health problems. A psychological fatigue attribution was reported by 41.8%, a somatic fatigue attribution by 44.0%. On a multivariate level, mental health problems showed the strongest association with psychological fatigue attributions, over and beyond fatigue itself. No associations were found between fatigue attributions and psychosocial work characteristics. Attributional patterns appeared to be different between visitors of the GP and the OP.

Conclusions:Fatigue is a common reason among employees to consult a GP. Asking employees for their own fatigue attributions in terms of somatic or psychological causes may be useful for the GP—and possibly also the OP—to gather information about underlying health problems in employees active at work and making a fatigue related visit.
Occupation and gastric cancer
Authors: Raj A , Mayberry J F , Podas T
Published: June 2003

Gastric cancer is a cause of significant morbidity and mortality. There are several risk factors, with occupation emerging as one of these. There is considerable evidence that occupations in coal and tin mining, metal processing, particularly steel and iron, and rubber manufacturing industries lead to an increased risk of gastric cancer. Other “dusty” occupations—for example, wood processing, or work in high temperature environments have also been implicated but the evidence is not strong. The mechanism of pathogenesis of gastric cancer is unclear and the identification of causative agents can be difficult. Dust is thought to be a contributor to the pathological process, but well known carcinogens such as N-nitroso compounds have been detected in some environments. Further research on responsible agents is necessary and screening for detection of precursor gastric cancer lesions at the workplace merits consideration.
Management of asthma in adults: current therapy and future directions
Authors: Green R H , Brightling C E , Pavord I D , Wardlaw A J
Published: June 2003

Asthma is increasing in prevalence worldwide and results in significant use of healthcare resources. Although most patients with asthma can be adequately treated with inhaled corticosteroids, an important number of patients require additional therapy and an increasing number of options are available. A further minority of patients develop severe persistent asthma which remains difficult to manage despite current pharmacological therapies. This review discusses the various treatment options currently available for each stage of asthma severity, highlights some of the limitations of current management, and outlines directions which may improve the management of asthma in the future.
Mechanisms and management of diuretic resistance in congestive heart failure
Authors: De Bruyne L K M
Published: June 2003

Diuretic drugs are used almost universally in patients with congestive heart failure, most frequently the potent loop diuretics. Despite their unproven effect on survival, their indisputable efficacy in relieving congestive symptoms makes them first line therapy for most patients. In the treatment of more advanced stages of heart failure diuretics may fail to control salt and water retention despite the use of appropriate doses. Diuretic resistance may be caused by decreased renal function and reduced and delayed peak concentrations of loop diuretics in the tubular fluid, but it can also be observed in the absence of these pharmacokinetic abnormalities. When the effect of a short acting diuretic has worn off, postdiuretic salt retention will occur during the rest of the day. Chronic treatment with a loop diuretic results in compensatory hypertrophy of epithelial cells downstream from the thick ascending limb and consequently its diuretic effect will be blunted. Strategies to overcome diuretic resistance include restriction of sodium intake, changes in dose, changes in timing, and combination diuretic therapy.
Paediatric tuberculosis
Authors: Hoskyns W
Published: June 2003

Children are important in the epidemiology of tuberculosis as a marker of recent disease transmission and a reservoir for the future. Once infected they have a higher risk of progressing to tuberculous disease. Chest radiography and tuberculin testing with or without tissue for culture are still the standard tools for confirming the diagnosis once this is considered. Well researched treatment protocols are available but multidrug resistant tuberculosis and coexistent HIV are a challenge. Ensuring compliance with treatment is a major concern. Controversy still surrounds the place of BCG. Advances in the molecular genetics of tuberculosis hold out the possibility of better vaccines.
Feasibility and safety of day care laparoscopic cholecystectomy in a developing country
Authors: Bal S , Reddy L G S , Parshad R , Guleria R , Kashyap L
Published: June 2003

Background

Although day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centres with adequate infrastructure for day care surgery, its feasibility and safety in developing countries has never been studied. Because of differences in the quality of health care delivery, western guidelines for day care surgery cannot be universally applied to developing countries.

Patients and methods

Patients less than 65 years who were graded I and II on the American Society of Anesthesiologists physical status score, irrespective of their educational status, living within 20 km, and willing to make their own arrangements for a return to hospital in case of problems were selected for DCLC. Follow up was done by patients calling the hospital the morning after surgery.

Results

50% of the eligibility criteria were new; 313/383 patients were suitable for DCLC. The commonest cause for rejection was that the patient lived out of the defined area (50%). Altogether 92% were discharged within eight hours of surgery. The reasons for failure to discharge were the presence of abdominal drains in four (2%), nausea and vomiting in nine (3%), and conversion to open surgery in five (2%). Ten patients (3%) were readmitted; of these only two (<1%) had complications needing re-exploration. Analysis of results showed that the inclusion and discharge criteria were valid and that the readmission and complication rates as well as the ease and accuracy of follow up were comparable to published data. DCLC reduced waiting times and increased patient turnover and may have a positive impact on resident training.

Conclusions

DCLC is safe, feasible, and has potential benefits for health care delivery in developing countries. Each surgical service needs to develop their own guidelines based on local patient demography.