Soins Gerontol

Improving immunisation coverage for older adults is a public health issue. Since 2008, nurses have been authorised to vaccinate this population against influenza without a medical prescription. One study examined the opinions of a sample of 78 private duty nurses in Martinique on influenza and anti-tetanus vaccination of elderly populations. The majority of nurses said they were not in favour of vaccination

Diminished autonomic nervous system responsiveness in rheumatoid arthritis of recent onset

To investigate responsiveness of the autonomic nervous system in rheumatoid arthritis (RA) of recent onset. 21 patients (17 women, mean age 55.7 years) and 20 healthy controls (16 women, mean age 52.7 years) were subjected to 4 tasks eliciting divergent autonomic reactions: film watching, mild physical exercise, cognitive discrimination, and the Stroop color-word interference test. Changes in heart rate, diastolic (DBP) and systolic (SBP) blood pressure, and skin conductance relative to pretask baseline values were computed and related to erythrocyte sedimentation rate, pain, mobility, and dexterity. Mean autonomic levels of patients were normal, as well as autonomic responses to film watching and mild physical exercise. Diminished autonomic responses were observed during cognitive discrimination and during the Stroop test. Blood pressure responses were negatively related to pain severity, but positively to impaired dexterity. Diminished autonomic nervous system response is observed in RA of recent onset, most clearly in patients with more severe pain. This suggests that it is associated with primary pathophysiological mechanism

Tachistoscopic and questionnaire methods for the measurement of psychological defences

Only few attempts have been made to compare different methods aiming at quantifying defensive strategies. In this study the tachistoscopic Defence Mechanism Test (Kragh, 1960b and 1985) is compared to paper-and-pencil tests of defence. There were virtually no correlations between the DMT and the other measures of defence. This may indicate that the concept of defence is a highly complex one. It is suggested that the Defence Mechanism Test may be measuring primary defence while defence questionnaires may be assessing more secondary forms of defence. The two questionnaires used for assessing defence correlated significantly, while a scale for social desirability showed no correlation with DMT or the two defence questionnaire

Self-rated health as a predictor of mid-term and long-term mortality in older Afro-Caribbeans hospitalised via the emergency department

International audienc

Results of aortic screening in the brothers of patients who had elective aortic aneurysm repair

BACKGROUND: Brothers of patients with an abdominal aortic aneurysm (AAA) are at high risk. In the present study brothers of patients who underwent elective AAA surgery were invited for aneurysm screening and the psychological consequences studied. METHODS: All brothers over the age of 50 years were invited for abdominal ultrasonography. They were asked to complete a standard psychological well-being questionnaire both before, and 3 months after screening. RESULTS: Some 571 brothers were identified: 251 were dead, 35 lived abroad, 16 could not be contacted for other reasons, 46 refused to participate and 13 were already known to have an AAA. Some 210 subjects (37.8 per cent) accepted the offer of screening. A new AAA was detected in 26 (12.3 per cent, 95 per cent confidence interval 8-18 per cent) of the men screened resulting in an overall prevalence of 18 per cent (95 per cent confidence interval 13-26 per cent). Eight (3.8 per cent) aneurysms were 5 cm or more in diameter and elective surgery was performed in five patients (2.4 per cent). The psychological dimensions of well-being (depression, anxiety, energy, and positive well-being) had not changed significantly 3 months after screening. CONCLUSION: The prevalence of AAA in brothers of patients with AAA is far higher than in the overall male population of the same age. Screening does not seem to have a negative influence on psychological well-being

Experimental stress and immunological reactivity: a closer look at perceived uncontrollability

Although stressor uncontrollability has been shown to suppress immune responses in animals and for human subjects, the results have been inconsistent. We reanalyzed results of our previous study regarding stress-related immune deviation in man, to establish whether perceived uncontrollability of an acute stressor acts as a co-determinant in the observed changes in immunological parameters. Three types of cognitive reactions to an acute interpersonal stressor were assessed: "motivation," "uncontrollability," and "guiltiness." Stress-induced changes in the number of several types of immune cells in peripheral blood and proliferative responses of lymphocytes to antigens and mitogens were assessed. In comparison with control subjects and with subjects perceiving high control over the experimental stress situation, the subject perceiving low control showed a stressor-induced decrease in the number of T helper cells. Reversely, subjects perceiving high control showed an increase in the number of B cells as opposed to the other two groups. The effects of perceived uncontrollability could not be accounted for by mood changes, but they were related to previously experienced life stress. Perceived uncontrollability of an acute stressor can have immuno-modulating effects over and above those of the stressor per s

Experimentally challenged reactivity of the hypothalamic pituitary adrenal axis in patients with recently diagnosed rheumatoid arthritis

There is evidence that the hypothalamic pituitary adrenal (HPA) axis is subresponsive in patients with rheumatoid arthritis (RA). We assessed HPA axis responses to experimental stressors mimicking daily life challenges in patients with RA to determine whether HPA axis activity is associated with Th1 and Th2 activity. ACTH and cortisol responses in reaction to the succession of a bicycle ergometer task, a cold pressor task, and a computerized Stroop Color-Word interference test, as well as basal Th1 and Th2 cell activity, were assessed in 29 patients (21 female, 8 male) with recently diagnosed RA (mean disease duration 29 wks, range 5-69), mean age 55.7 years, none receiving glucocorticoid treatment, and 30 (20 female, 10 male) healthy age and sex matched controls (mean age 54.1 yrs). Mean ACTH and cortisol levels did not differ between the groups (p > 0.10). Patients tended to have a less pronounced ACTH response (F2.50 = 2.7, p = 0.08) and had a significantly smaller cortisol response (P F2.50 = 6.1, p 0.19) with basal interferon-gamma and interleukin 4 as reflections of Th1 and Th2 cell activity, respectively. HPA axis activity was not linked to current disease activity. Our findings show reduced HPA axis responsiveness in RA patients with recent diagnosis receiving longterm medication that is suggested to be located both at a hypothalamic/pituitary and at an adrenal level. It appears that common HPA axis activity accomplishes low amounts of cortisol release, which makes it difficult to determine an influence of endogenous cortisol changes on the Th1/Th2 balanc

Influence of life stress on immunological reactivity to mild psychological stress

This study investigated the effects of self-reported life stress and locus of control on reactivity of several immune parameters to a mild and short-lasting interpersonal stressor. Subjects were 86 male teachers aged 24 to 55 years. Immune reactivity was defined as changes in numbers of monocytes. T-lymphocytes and subsets, HLA-DR+ cells, and NK cells as well as changes in (in vitro) proliferative responses of peripheral blood lymphocytes to the antigens PHA and PWM. Multiple regression analysis was used to study the interaction effects of life stress and locus of control by experimental condition on immune reactivity. Life stress, but not locus of control, influences reactivity of the immunological parameters to the stressor. In particular, high numbers of daily hassles were associated with stressor-induced decreases in numbers of T cells and NK cells in peripheral blood. On the other hand, numbers of HLA-DR+ cells in high life stress scorers decreased only slightly during the stressor, whereas they increased in the control condition. The findings suggest that accumulated life stress is related to reactivity of immunological parameters to subsequent experimental stress. Possible physiological explanations and implications of these effects are discusse