Exhaustion-related changes in cardiovascular and cortisol reactivity to acute psychosocial stress.

Prior findings indicate that individuals scoring high on vital exhaustion show a dysfunctional stress response (DSR), that is, reduced cortisol reactivity and habituation to psychosocial stressors. The main aim of the present study was to examine whether a DSR may be a vulnerability factor in exhaustion disorder (ED). We examined whether a DSR is present during the early stages of ED, and still is present after recovery. Three groups were studied: 1. Former ED patients (n = 14); 2. persons who during the past 6 month had experienced stress at work and had a Shirom-Melamed Burnout Questionnaire (SMBQ) score over 3.75, considered to indicate a pre-stage of ED (n = 17); 3. persons who had not experienced stress at work during the past 6 months and had a SMBQ score below 2.75 (n = 20). The participants were exposed twice to a virtual version of the Trier Social Stress Test (V-TSST), during which salivary cortisol samples were collected. In addition, high frequency heart rate variability (HF-HRV), heart rate (HR), t-wave amplitude (TWA), and alpha-amylase were assessed to examine stress reactivity and habituation in the autonomic nervous system (ANS). The initial analyses showed dear hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) activations in both V-TSST sessions, together with habituation of cortisol and heart rate in the second session, but without any significant group differences. However, the former ED patients showed considerable variation in self-reported signs of exhaustion (SMBQ). This led us to assign former ED patients with lower ratings into the low SMBQ group (LOWS) and those with higher ratings to the high SMBQ group (HIGHS). When repeating the analyses a different picture emerged; the HIGHS showed a lower cortisol response to the V-TSST than did the LOWS. Both groups' cortisol response habituated to the second V-TSST session. The ANS responses did not differ between the two groups. Thus, persons in a pre-stage of ED and unrecovered former ED patients showed signs of DSR, in contrast to healthy controls and recovered former ED patients. The results may be interpreted as indicating that DSR in the HPA axis is present early on in the stress process, but subsides after successful recovery. (C) 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Detailed diesel exhaust characteristics including particle surface area and lung deposited dose for better understanding of health effects in human chamber exposure studies.

Several diesel exhaust (DE) characteristics, comprising both particle and gas phase, recognized as important when linking with health effects, are not reported in human chamber exposure studies. In order to understand effects of DE on humans there is a need for better characterization of DE when performing exposure studies. The aim of this study was to determine and quantify detailed DE characteristics during human chamber exposure. Additionally to compare to reported DE properties in conducted human exposures. A wide battery of particle and gas phase measurement techniques have been used to provide detailed DE characteristics including the DE particles (DEP) surface area, fraction and dose deposited in the lungs, chemical composition of both particle and gas phase such as NO, NO2, CO, CO2, volatile organic compounds (including aldehydes, benzene, toluene) and polycyclic aromatic hydrocarbons (PAHs). Eyes, nose and throat irritation effects were determined. Exposure conditions with PM1 (<1 mm) mass concentration 280 mg m3, number concentration 4 105 cm3 and elemental to total carbon fraction of 82% were generated from a diesel vehicle at idling. When estimating the lung deposited dose it was found that using the size dependent effective density (in contrast to assuming unity density) reduced the estimated respiratory dose by 132% by mass. Accounting for agglomerated structure of DEP prevented underestimation of lung deposited dose by surface area by 37% in comparison to assuming spherical particles. Comparison of DE characteristics reported in conducted chamber exposures showed that DE properties vary to a great extent under the same DEP mass concentration and engine load. This highlights the need for detailed and standardized approach for measuring and reporting of DE properties. Eyes irritation effects, most probably caused by aldehydes in the gas phase, as well as nose irritation were observed at exposure levels below current occupational exposure limit values given for exhaust fumes. Reporting detailed DE characteristics that include DEP properties (such as mass and number concentration, size resolved information, surface area, chemical composition, lung deposited dose by number, mass and surface) and detailed gas phase including components known for their carcinogenic and irritation effect (e.g. aldehydes, benzene, PAHs) can help in determination of key parameters responsible for observed health effects and comparison of chamber exposure studies

Return to work after a workplace-oriented intervention for patients on sick-leave for burnout - a prospective controlled study

<p>Abstract</p> <p>Background</p> <p>In the present study the effect of a workplace-oriented intervention for persons on long-term sick leave for clinical burnout, aimed at facilitating return to work (RTW) by job-person match through patient-supervisor communication, was evaluated. We hypothesised that the intervention group would show a more successful RTW than a control group.</p> <p>Methods</p> <p>In a prospective controlled study, subjects were identified by the regional social insurance office 2-6 months after the first day on sick leave. The intervention group (n = 74) was compared to a control group who had declined participation, being matched by length of sick leave (n = 74). The RTW was followed up, using sick-listing register data, until 1.5 years after the time of intervention.</p> <p>Results</p> <p>There was a linear increase of RTW in the intervention group during the 1.5-year follow-up period, and 89% of subjects had returned to work to some extent at the end of the follow-up period. The increase in RTW in the control group came to a halt after six months, and only 73% had returned to work to some extent at the end of the 1.5-year follow-up.</p> <p>Conclusions</p> <p>We conclude that the present study demonstrated an improvement of long-term RTW after a workplace-oriented intervention for patients on long-term sick leave due to burnout.</p> <p>Trial registration</p> <p>Current Controlled Trials NCT01039168.</p

Psychological methods for the assessment of chronic toxic encephalopathy and multiple chemical sensitivity

The dissertation deals with psychological methods aimed at improving the understanding and assessment of two disorders related to contact with chemicals: solvent-induced chronic toxic encephalopathy (TE) and multiple chemical sensitivity (MCS). The main aim of Paper I was to study whether the addition of some newer psychological tests of complex attention and executive functions to a traditional test battery would improve the detection of TE. An improved detection of TE could not be demonstrated. However, while most TE cases with previous clear deviations in neurobehavioral tests (TE 2B) showed a stable impairment at re-testing, cases without previous deviations (TE 2A) were unstable at re-testing, which suggests that repeated examinations might improve the assessment. Paper II showed that a sample of Swedish MCS cases did not have any obvious deviations in the neurobehavioral test battery. Paper III demonstrated that the Swedish MCS sample had a partially elevated mental distress profile in the Symptom Checklist 90, similar to previous reports on North American MCS cases – a profile much lower and more limited than found among Swedish TE cases. The TE group had elevations on several anxiety- and aggression-related scales of the Karolinska Scales of Personality trait inventory, while the MCS sample scored slightly higher than referents on only one single anxiety scale (psychasthenia). Neither group showed any deviation in the personality test Meta-Contrast Technique. Neither the TE nor the MCS group showed higher than normal ratings of health risks from environmental threats, thus not supporting a cognitively based generalized fear of ambient factors as a factor of importance in MCS. In Paper IV and V the smell intolerance reactions common in TE cases were explored, aiming to develop a standardized chemical challenge design for the assessment of chemical intolerance. The annoyance reactions of TE cases was successfully reproduced during controlled chemical challenge at exposure levels below known levels for acute CNS-effects and trigeminal irritation. However, a corresponding performance reduction in neurobehavioral tests was not observed. Neither annoyance level nor test performance was related to the neurotoxic properties of the solvents used during the challenges