Psychological Consequences of Screening for Abdominal Aortic Aneurysm and Conservative Treatment of Small Abdominal Aortic Aneurysms

AbstractObjective to describe the potential psychological consequences of screening for abdominal aortic aneurysms (AAAs). Methods the participants were prospectively and randomly sampled from a randomised screening trial for AAA and asked to complete a validated generic and global anonymous quality of life (QL) questionnaire by self-assessment (ScreenQL). Material case–control study: ScreenQL was completed once by 168 (48%) of 350 non-responders to screening, 271 (81%) of 335 attenders before screening, 286 (85%) of 335 attenders after screening, 127 (85%) of 149 with a small AAA diagnosed at screening, and 231 (66%) of 350 who were randomised not to be offered screening for AAA (controls). Prospective study (paired data): 127 men having a small AAA diagnosed. Twenty-nine (81%) of 36 men operated after initial conservative treatment. Results initially, the QL score was 5% lower among men with a small AAA compared to the controls (p<0.05), mainly because of poorer health perception. The QL score declined significantly further to 7% below control values during the period of conservative treatment. This impairment was mainly due to a 21% and 15% reduction in scores relating to health perception and psychosomatic distress, respectively. However, all scores improved to control levels in patients operated on. The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening. No differences were noticed concerning the non-attenders.Conclusion the offer of screening causes transient psychological stress in subjects found not to have AAA. However, diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases. This impairment seems reversible by operation. Nevertheless, the impairment seems considerable, and must be considered in the management of AAA and in the final evaluation of screening for AAA

The Plasma Level of Matrix Metalloproteinase 9 may Predict the Natural History of Small Abdominal Aortic Aneurysms. A Preliminary Study

AbstractObjectives: increased levels of various proteinases have been detected in abdominal aortic aneurysms (AAA) and are assumed to cause the degradation of the aortic wall. To determine whether systemic measurement of these proteinases and their inhibitors may predict the natural cause of AAA. Methods and material: serum (S) and plasma (P) samples were obtained from 121 men following the diagnosis of a small AAA (3–5 cm) at population screening. Annual control scans were performed to check for expansion. Circulating levels of elastase-alpha 1 antitrypsin-complexes, alpha 1antitrypsin, matrix metalloproteinase (MMP) 2 & 9, tissue-inhibitor-matrixproteinase 1 & 2, procollagen III-N-terminal-propeptide, and elastin-peptides were measured in a random group of 36 men. Results: alpha 1 antitrypsin was significantly and positively associated with expansion. Similarly, P-MMP9 levels were significantly associated with size and expansion. There was a difference between median serum and plasma values, probably because of secretion from platelets. Conclusion: P-MMP9 and P-alpha 1 antitrypsin may predict the natural history of AAA

Five-year Results of Elastin and Collagen Markers as Predictive Tools in the Management of Small Abdominal Aortic Aneurysms

AbstractObjective small abdominal aortic aneurysms (AAAs) do rupture and only half of AAAs above 5 cm would have ruptured unoperated. Furthermore, conservative treatment of AAAs may cause psychological side effects and impaired quality of life. To optimise the indication and time for operation for AAAs, we analysed whether serum elastin peptides (EP), procollagen-IIIN-terminal propeptide (PIIINP), and the initial AAA size could predict operation for AAAs in initially conservatively treated AAA. Material and methods in 1994, 4404 65–73 year old males were invited to hospital-based screening for AAAs by ultrasonography. Seventy-six percent attended. One hundred and forty-one (4.2%) had AAAs (def: +30 mm). Nineteen were offered operation (AAA +50 mm), and 112 were followed with annual control scans for 1–5 years (mean 2.5 years). Of these, 99 had their EP (ng/ml) and PIIINP (ng/ml) determined using ELISA and RIA techniques. Two observers and one scanner were used. Results the mean expansion rate was 2.7 mm/year. The initial AAA size (r=0.46; 0.26–0.61), EP ( r =0.31; 0.11–0.49), and NPIIIP ( r =0.24; 0.02–0.44) was independently significant associated to expansion rate in a multiple linear regression analysis including the three mentioned variables. The multivariate formula could by ROC curve analysis predict cases reaching 5 cm in diameter within 5 years with a sensitivity and specificity of 91% and 87%, respectively, increasing to 91% and 94%, respectively, by accepting a 2 mm variation in those measurements. Twenty-three were lost to follow up, 21 of these due to death or severe illness. Of these, seven would have been predicted to reach an AAA size recommendable for surgery. If all 23 were included in the analysis, the sensitivity and specificity would have been 87% and 85%, respectively. Conclusion a predictive model using EP, PIIINP, and initial AAA size seems capable of predicting nine out of 10 AAAs that will be operated on within 5 years. However, a larger sample size is needed for clinical recommendations

Life style related to blood pressure and body weight in adolescence: Cross sectional data from the Young-HUNT study, Norway

Background The associations between physical activity, unhealthy dietary habits and cigarette smoking and blood pressure, overweight and obesity are well established in adulthood. This is not the case for similar associations in adolescence. Thus, the purpose of this study is to examine how physical activity, smoking status and dietary habits were related to overweight, obesity and blood pressure in a population of Norwegian adolescents. Methods Weight, height, systolic (SBP) and diastolic blood pressure (DBP) were measured, and body mass index (BMI) was calculated among 8408 adolescents who participated in a population based study in 1995–97 in the county of Nord-Trøndelag. Internationally accepted cut-off values were used to determine if the adolescents were overweight or obese. The adolescents also completed a detailed questionnaire including dietary habits, physical activity and smoking habits. We calculated adjusted mean blood pressures and odds ratios for being overweight or obese for different exposure categories of life style variables. Results Low levels of physically activity were associated with increased odds of being overweight (odds ratio (OR), 1.4; 95% confidence interval (CI), 1.1–1.8 in girls and OR, 2.0; 95% CI, 1.6–2.5 in boys) or obese (girls: OR, 3.1; 95% CI, 1.6–6.0; boys: OR, 3.7; 95% CI, 2.1–6.4). In addition, the least physically active girls had a 1.5 mmHg higher mean DBP compared with the most active (p-trend <0.001), and among boys this difference was 1.0 mmHg (p-trend < 0.001). Smokers were more likely to be obese (OR, 1.6; 95% CI, 1.1–2.5 in girls and 1.4; 95% CI, 0.9–2.1 in boys) compared with non-smokers. Smokers also had lower mean SBP than non-smokers; however, this finding was restricted to smokers with the lowest smoking exposure. Associations between dietary habits and weight status largely disappeared after adjusting for weight losing behaviour. Conclusion In this population of adolescents low levels of physical activity were associated with higher mean DBP and higher odds of overweight or obesity. Smoking was also associated with higher odds of overweight and obesity. The paradoxical associations between healthy dietary habits and overweight and obesity are most likely an effect of reverse causality

Sexual harassment and abuse in sport: The research context

This special issue of the Journal of Sexual Aggression draws on the contributions to a Symposium on ‘Sexual Harassment in Sport – Challenges for Sport Psychology in the New Millennium’, held at the Xth Congress of the International Society for Sport Psychology, Skiathos, Greece from May 28th to June 2nd 2001. The symposium, which was organised by the authors of this editorial, was intended to move forward the international research agenda on sexual harassment and abuse in sport and to examine professional practice issues for sport psychologists. It was clear from the attendance of over 60 delegates at that symposium that international interest in this subject is growing. Further evidence of this came from the attendance of 26 members states – from Azerbaijan to Sweden - at a Council of Europe seminar on The Protection of Children, Young People and Women in Sport, held in Helsinki in September 2001

Consequences of sexual harassment in sport for female athletes

Sexual harassment research was first undertaken in the workplace and educational settings. Research on sexual harassment in sport is scarce but has grown steadily since the mid-1980s. Even so, very little is known about the causes and/or characteristics and/or consequences of sexual harassment in sport settings. This article reports on the findings from interviews with 25 elite female athletes in Norway who indicated in a prior survey (N =572) that they had experienced sexual harassment from someone in sport. The consequences of the incidents of sexual harassment that were reported were mostly negative, but some also reported that their experiences of sexual harassment had had no consequences for them. “Thinking about the incidents”, a “destroyed relationship to the coach”, and “more negative view of men in general” were the most often negative consequences mentioned. In addition, a surprising number had chosen to move to a different sport or to drop out of elite sport altogether because of the harassment

Defining appropriateness in coach-athlete sexual relationships: The voice of coaches

The sporting culture, with omnipotent coaches, fierce competition for recognition and funding, and ‘win at all cost’ ethos, creates an environment conducive to sexual exploitation of athletes. Recent increased public awareness and the development of child protection policies in sport have led to the questioning of previously accepted coach-athlete relationships. This study is an exploratory investigation into male swimming coaches’ perceptions of appropriateness of coach-athlete sexual relationships. Sexual relationships with athletes under the age of 16 were unanimously considered totally inappropriate. With regard to sexual relationships with athletes above the age of consent for heterosexual sex, opinions ranged from “totally inappropriate” to “it’s a question of civil liberties.” These results are discussed in relation to how coaches have adapted their own behaviours in the face of public scrutiny but are still reluctant to restrict the rights of their fellow coaches

Prevalence of sexual harassment among Norwegian female elite athletes in relation to sport type

Although it is often assumed that the prevalence of sexual harassment is different in different sports, this assumption has not been empirically tested. This study considers whether the experience of sexual harassment varies by sport. The female elite athletes (N = 553) in the study participated in 56 different sport disciplines. These were grouped as follows :1) team or individual sports; 2) extent to which clothing required for competition is revealing ; 3) gender structure (male-or female dominated membership statistics); and 4) gender culture (masculine, gender-neutral, or feminine). The data show that sexual harassment occurs in every sport group. Female elite athletes who participated in ‘masculine’ sports appear to experience more harassment than women in the other groups. We conclude that, when it comes to female athletes’ experiences of sexual harassment, sport type matters far less than sport participation per se

The characteristics of sexual abuse in sport: A multidimensional scaling analysis of events described in media reports

Most research on sexual abuse has been conducted within family settings (Fergusson & Mullen, 1999). In recent years, following several high profile convictions and scandals, research into sexual abuse has also encompassed institutional and community settings such as sport and the church (Gallagher, 2000; Wolfe et al., 2003). Research into sexual abuse in sport, for example, began with both prevalence studies (Kirby & Greaves, 1996; Leahy, Pretty & Tenenbaum, 2002) and qualitative analyses of the processes and experiences of athlete sexual abuse (Brackenridge, 1997; Cense & Brackenridge, 2001, Toftegaard Nielsen, 2001). From such work, descriptions of the modus operandi of abusers in sport, and the experiences and consequences for athlete victims, have been provided, informing both abuse prevention work and coach education. To date, however, no study has provided empirical support for multiple associations or identified patterns of sex offending in sport in ways that might allow comparisons with research-generated models of offending outside sport. This paper reports on an analysis of 159 cases of criminally defined sexual abuse, reported in the print media over a period of 15 years. The main aim of the study was to identify the nature of sex offending in sport focusing on the methods and locations of offences. The data were analysed using multidimensional scaling (MDS), as a data reduction method, in order to identify the underlying themes within the abuse and explore the inter-relationships of behaviour, victim and context variables. The findings indicate that there are specific themes that can be identified within the perpetrator strategies that include ‘intimate’, ‘aggressive’, and ‘’dominant’ modes of interaction. The same patterns that are described here within the specific context of sport are consistent with themes that emerge from similar behavioural analyses of rapists (Canter & Heritage, 1990; Bishopp, 2003) and child molester groups (Canter, Hughes & Kirby, 1998). These patterns show a correspondence to a broader behavioural model – the interpersonal circumplex (e.g., Leary 1957). Implications for accreditation and continuing professional education of sport psychologists are noted

Sport events and human rights: positive promotion or negative erosion?

© 2015 Taylor & Francis. In this paper, we build upon recent scholarship on sport event legacies to identify, categorise, and describe the key processes underpinning sport event interactions with human rights (HR). It develops a simple, representative model to illustrate the points where sport events bisect with HR and considers what factors can modify these impacts. The development of this model is based on a meta-review of literature and examination of case studies. It is clear from our analysis that sport events are malleable, symbolic, and political occurrences that can be positioned to provide evidence and support of benefice or harm to the cause of HR. The model also provides a nuanced approach to consider how sport event organisers may begin to think about the tactics and strategies that might be employed, and how they might leverage HR through their sport event. The model also indicates that HR, being similarly malleable political tools, are paradoxical in application in the sport event context and consequently cannot be assumed to be taken-for-granted as event outcomes or outputs