Ambulatory blood pressure (BP) measurements of 120 female teachers of Japanese-American or Caucasian ethnicity working in public schools located in Hilo, Hawaii, were recorded. BP was measured at 15-min intervals during waking hours and 30-min intervals during sleep over a 24-hr period that included a full work day. These measurements were averaged during three daily settings: at work, at home while awake ("home"), and during sleep. ANCOVAs using ethnicity as a predictor variable of BP, with age and the body mass index (BMI) as covariates, show a significant interaction effect between age and ethnicity in some daily settings. Among Japanese-Americans partial correlations between age and systolic BP controlling for the BMI are significant in these settings, while among Caucasians none of the correlations are significant. Menopausal status is not significantly related to BP when age is controlled in analyses. There was no significant ethnic difference in number of symptoms reported, including frequency of "hot flushes/flashes," within the past two weeks. Those who reported hot flushes had significantly elevated BP in waking settings but not during sleep. The greater increase in BP with age in Japanese-Americans may be related to their elevated risk for development of hypertension. The lack of a significant relationship between menopausal status and BP may be due to the high rate of usage of hormonal replacement therapy in this sample, as well as an unusually high rate of hysterectomy.

Adult↗

PubMedDate not supplied

Epidemiology of pediatric EMS practice: a multistate analysis.

OBJECTIVE: To describe the epidemiology of pediatric emergency medical services (EMS) practice in a large patient population from several geographic areas. DESIGN: Retrospective computer analysis of EMS databases from four states using a common data set and analysis system. SETTING: Pennsylvania, Tennessee, Mississippi, and Nevada (except Clark County), 1990 through 1992. METHODS: All patient-care reports of patients 14 years old and younger were extracted from the EMS databases and analyzed for the following factors: age, gender, date, elapsed prehospital times, incident type, mechanism of injury, call disposition, illness or injuries encountered, severity of illness/injury (by abnormal vital signs), and basic life support (BLS) and advanced life support (ALS) treatment delivered. RESULTS: A total of 1,512,907 patient care reports were reviewed. Those of 61,132 children were extracted for analysis. These children comprised about 4% of prehospital responses. Male subjects predominated (56%), and children aged 7 through 14 years represented 46% of cases. Most calls occurred in the evening and daylight hours. Children were transported by ambulance in 89% of cases, and care was refused in 7.7%. Mean response time was 9 +/- 16 minutes, mean scene time 12 +/- 14 minutes, and mean transport time 14 +/- 20 minutes. Traumatic incidents predominated at 42%, with motor vehicle accidents and falls the most common mechanisms. Blunt injuries accounted for 94% of trauma, whereas respiratory problems, seizures, and poisoning/overdose were the most common medical problems. Vital signs were obtained in 56% of cases. Abnormal vital signs were noted in 21% of these, and the presumptive causes were similar in distribution to those of the general population, with the addition of cardiac arrest. The most commonly used treatments were spinal immobilization, oxygen administration, intravenous access and several ALS medications. An ALS capability was available in more than half the runs, but ALS treatment was delivered in only 14% of those cases. Outcome data were not available. CONCLUSION: This multistate analysis of pediatric EMS epidemiology confirms findings reported in smaller regional studies, with several exceptions. Excessive scene times were not noted. Few children had serious disorders as evidenced by abnormal vital signs. An ALS treatment, when available, was used infrequently. These findings have implications for EMS planners and educators.

Adolescent↗

PubMedDate not supplied

Physiological stress and culture change in a group of Filipino-Americans: a preliminary investigation.

This preliminary survey evaluates the utility of physiological measures of general stress in anthropological fieldwork. The survey was conducted in a community of Filipino-Americans whose residents share similar housing conditions and low income levels but vary in ethnicity, migration status and degree of contact with Hawaii's urban culture. General stress levels are evaluated both by a subjective stress measure--the Cornell Medical Index (CMI)--and by physiological measures--twenty-four-hour excretion rates of norepinephrine, epinephrine and VMA. In addition, sociocultural data have been collected, and a culture contact index has been constructed. Preliminary results indicate that immigrants who have either low or high levels of contact with Honolulu's urban culture have lower stress levels, as measured by catecholamine excretion, than individuals with intermediate levels of contact. These differences may be due to the presence of two strategies of urban adaptation, one emphasizing isolation from the urban culture and the other emphasizing just the reverse. Those people who do not successfully utilize one of these strategies are likely to have high stress levels. Additionally, significant ethnic differences in both CMI scores and degree of culture contact are noted, but there are no ethnic differences in catecholamine excretion. This is tentative evidence for the superiority of physiological measures over subjective reports of stress in a multiethnic setting.

Adolescent↗

PubMedDate not supplied

Acute mountain sickness and physiological stress during intermittent exposure to high altitude.

The effect of intermittent exposure to high altitude (4200 m) hypoxia on symptomatology of acute mountain sickness (AMS) was observed, and the relationship between AMS and stress hormone excretion was examined among shift workers at the United Kingdom Infrared Telescope (UKIRT) facility and a control group of sea level residents. Some of the shift workers experienced AMS during their first day at altitude, but had recovered after 5 days residence at altitude. Upon acute exposure to altitude, none of the shift workers reported severe cases of AMS after 5 days residence at sea level, but some reported severe cases after 45 residence at sea level, thus providing some evidence for a 'carry over' of acclimatization for a 5 day period. Reported symptomatology at sea level was predictive of 24 h. excretion rates of adrenaline and 17-hydroxycorticosteroids at high altitude. No good predictors of symptomatology of AMS at high altitude were found using sea level measures alone.

17-Hydroxycorticosteroids↗

PubMedDate not supplied

Physiological stress responses in Filipino-American immigrant nurses: the effects of residence time, life-style, and job strain.

OBJECTIVE: The purpose of this study was to evaluate the relationship between measures of Americanization (the adoption of American life-style and culture) and physiological measures of stress in Filipino-American immigrants. METHODS: Ambulatory blood pressure monitors and timed urine collections were used to evaluate blood pressure and urinary catecholamine excretion across the work, home, and sleep daily settings among 31 healthy, premenopausal, immigrant Filipino-American women employed as nurses or nurse's aides. Migration history and life-style were evaluated from questionnaire responses. Reported job strain, decision latitude, and psychological demand were obtained from the Job Content Questionnaire. RESULTS: Immigrants who had lived longer in the United States had elevated norepinephrine levels in the work and home settings (p < .05), higher diastolic blood pressure during sleep (p < .01), and lower dips in blood pressure during sleep (p < .05). Job strain measures were not related to blood pressure, catecholamine excretion rates, or residence time in the United States. CONCLUSIONS: The results suggest that indicators of stress increase as a function of time since immigration, although this result is not explained by self-reports of identification with Filipino or American life-style or by measures of job strain.

Adult↗