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Biomedical subjects

N Fiedler

Publications and source records attributed to N Fiedler.

36 records · Page 2Linked to original sources
PubMed1996

Neuropsychological approaches for the detection and evaluation of toxic symptoms.

The purpose of this paper is 3-fold: a) to review briefly the neuropsychological tests that have been used to evaluate the effects of neurotoxicants; b) to identify individual factors that may create heightened sensitivity to neurotoxicants; and c) to discuss test parameters that will increase the sensitivity of neuropsychological tests for detecting symptoms in low-level exposure situations. While the body of literature on neurobehavioral toxicology has increased dramatically during the past 10 years, it remains difficult to discern which tests are most effective in detecting behavioral effects even among workers with significant exposures. Few investigators have evaluated the interactions between individual differences, such as gender and psychiatric function, and exposure to neurotoxicants. Detection of behavioral performance decrements among uniquely susceptible populations such as those with sensitivities to low-level exposures (e.g., multiple chemical sensitivities) will require more difficult tests than are frequently used in current neuropsychological test batteries.

Cognition Disorders↗
PubMed1995

Measuring chemical sensitivity prevalence: a questionnaire for population studies.

Because no information exists on the prevalence of chemical sensitivity syndromes such as multiple chemical sensitivities, a questionnaire for use in population studies was developed and tested to assess the presence or absence of chemical sensitivity. Seven hundred five individuals attending clinics answered a questionnaire asking whether each of 122 common substances caused symptoms. Results showed that patients with multiple chemical sensitivities and asthma had average total scores that were significantly different from each other and from those of each of the other diagnostic categories. Higher total scores were also reported by female patients. The instrument described here may facilitate meaningful prevalence studies of multiple chemical sensitivities. It will also allow study of chemically induced symptoms in other conditions such as asthma.

Adolescent↗
PubMed1994

Cognitive functioning of patients with chronic fatigue syndrome.

Neuropsychological problems are a distressing and frequent component of the symptom complex associated with chronic fatigue syndrome. Objective assessment of these difficulties is essential to understanding the nature of this illness. Results of the studies discussed in this paper suggest that impaired information processing, rather than primary memory dysfunction, may be at the root of the cognitive problems that afflict so many patients with CFS.

Cognition↗
PubMed1992

Evaluation of chemically sensitive patients.

An increasing number of patients have been presenting with multiple symptoms they attribute to low-level chemical exposures, ie, multiple chemical sensitivities (MCS). Although some studies have evaluated such patients, the selection criteria has not been rigorously defined. The present study is the first to use a relatively rigorous definition of MCS to select patients for study. Comprehensive evaluation of medical, psychiatric, neuropsychological, and immunological status of a series of MCS patients is presented. In contrast to previous studies, patients in this study did not have a history of psychiatric disorder. However, some patients were currently depressed. Neuropsychological assessment did not reveal any abnormalities with the exception of one test of verbal memory for which performance was consistently poor relative to the normative sample. No significant immunological abnormalities were noted.

Adult↗
PubMed1991

Employee assistance program compliance: impact of contrasting insurance coverage.

Employee assistance programs are offered by employers to assist employees with personal problems through professional evaluation of the problem and referral to an appropriate treatment source. Although some research has been conducted to document the effect of these programs on such variables as absenteeism and disciplinary action, little information is available regarding compliance with clinical recommendations, ie, initiating and remaining in prescribed treatment. The present study evaluated the effect of two different rates of insurance coverage for outpatient mental health services offered by two comparable blue-collar organizations. Employees from the organization with a higher rate of payment were significantly more likely to initiate treatment and to remain in treatment longer. This outcome was not accounted for by demographic differences between the groups or by differences in diagnostic categories or treatment approaches. Implications of this finding are discussed as well as the utility of an employee assistance program to prepare employees for treatment.

Adult↗
PubMed1989

Evaluation of a work site relaxation training program using ambulatory blood pressure monitoring.

The rising physical, emotional, and economic costs of excess stress in occupational settings have resulted in a proliferation of many work site stress management programs. These programs have attempted to effect reductions in workers' stress by applying standard psychological interventions (ie, muscle relaxation and meditation) to the general work force. The benefits of these interventions for asymptomatic employee populations remain to be established. The purpose of the present study was to evaluate the physical and psychologic effects of an occupational stress management program for asymptomatic hazardous waste workers (N = 66). Both laboratory and ambulatory blood pressure (at home and at work) were monitored, and self-reported psychologic symptoms were measured. The results indicate that the stress management techniques decreased the diastolic blood pressure variability of asymptomatic workers (P less than .001); however, unlike previous studies, no reductions in laboratory blood pressures nor in psychologic symptoms were found. The efficacy of the procedures for asymptomatic employees is questioned and suggestions are made for future research.

Adult↗
PubMed1988

Utility of occupational blood pressure screening for the detection of potential hypertension.

A potential limiting factor in the detection and control of hypertension has been the assumption that a routine periodic sphygmomanometric blood pressure recording is characteristic of usual blood pressure throughout the activities of daily living. The relationship between routine periodic clinic blood pressure and ambulatory blood pressure was investigated in employed workers. Ambulatory readings were obtained at regular intervals using an automatic self-inflating and recording sphygmomanometer at home and at work. Mean ambulatory systolic and diastolic pressures were significantly higher than clinic pressures, both at home and at work, and in every position except reclining. Eleven of the 113 employees considered normotensive from clinic screening had an average of 46% of their diastolic ambulatory readings greater than or equal to 90. These persons may be considered functionally hypertensive. The authors suggest the need to focus attention on those persons with high-normal clinic blood pressures discovered in workplace screening.

Adult↗
PubMed1983

The crisis of rape: a community response.

While rape has consistently been viewed as both a personal and familial crisis, there is little evidence that its impact on the community at large has been addressed. The authors describe a program incorporating mental health education and crisis intervention strategies developed in response to a community's reaction to several sexual assaults of children. Program design and implications for replication are also discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans.

More than 68000 of the 700000 veterans of the Gulf War have become members of the Veteran Affairs' Gulf War Registry. In 1995, we undertook a questionnaire study of the symptoms and medical histories reported by a randomly selected subsample of 1935 of these veterans to characterize their complaints. All results reported were based on questionnaire responses without face-to-face evaluation or physical examinations. Inasmuch as initial registry symptoms overlapped those of Chronic Fatigue Syndrome and Multiple Chemical Sensitivities, we also included standard questions for these syndromes in the questionnaire. A total of 1161 (60%) individuals responded, and there were no major demographic biases; therefore, 15.7% of registry veterans qualified for Chronic Fatigue Syndrome in accordance with the 1994 Centers for Disease Control definition. In addition, 13.1% qualified for multiple chemical sensitivities in accordance with a widely used definition, and 3.3% of the respondents had both conditions. There were no effects of gender, race, branch, duty status (active or reserve), or rank, although Multiple Chemical Sensitivities was somewhat more prevalent in women and African Americans. The data gleaned in this study suggested that the unexplained symptom syndromes of Chronic Fatigue and Multiple Chemical Sensitivities may characterize an appreciable portion of the complaints of those who volunteered for the Veterans Affairs' Gulf War Registry, and further investigation is warranted.

Adult↗
PubMedDate not supplied

A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome.

The present study had two objectives: 1) to determine the characteristics that differentiated subjects with multiple chemical sensitivities (MCS), chemical sensitivities (CS), and chronic fatigue syndrome (CFS); and 2) to evaluate the psychiatric and neuropsychological complaints of these groups relative to normal controls. A cross-sectional comparison was made of the following groups matched for age, sex, and education: 1) patients whose sensitivities to multiple low level chemical exposures began with a defined exposure (MCS; N = 23); 2) patients with sensitivities to multiple chemicals without a clear date of onset (CS; N = 13); 3) patients meeting CDC criteria for Chronic Fatigue Syndrome (CFS; N = 18); and 4) normal controls (N = 18). Subjects with sensitivities to chemicals (MCS and CS) reported significantly more lifestyle changes due to chemical sensitivities and significantly more chemical substances that made them ill compared with chronic fatigue and normal controls. MCS, CS, and CFS patients had significantly higher rates of current psychiatric disorders than normal controls and reported significantly more physical symptoms with no medical explanation. Seventy-four percent of MCS and 61% of CFS did not qualify for any current Axis I psychiatric diagnosis. Chemically sensitive subjects without a defined date of onset (CS) had the highest rate of Axis I psychiatric disorders (69%). On the MMPI-2, 44% of MCS, 42% of CS, 53% of CFS, and none of the controls achieved clinically significant elevations on scales associated with somatoform disorders. With the exception of one complex test of visual memory, no significant differences were noted among the groups on tests of neuropsychological function. Standardized measures of psychiatric and neuropsychological function did not differentiate subjects with sensitivities to chemicals from those with chronic fatigue. Subjects with sensitivities to chemicals and no clear date of onset had the highest rate of psychiatric morbidity. Standardized neuropsychological tests did not substantiate the cognitive impairment reported symptomatically. Cognitive deficits may become apparent under controlled exposure conditions.

Adult↗
PubMedDate not supplied

Urinary biomarkers as indicators of renal disease.

Using modern technology, minute quantities of LMWP, prostanoids, growth factors, intra-renal and extra-renal enzymes can be measured in urine. Excretory patterns that are characteristic for site and mechanism of renal injury often can be found. It is possible to recognise urinary biomarker patterns that suggest the putative environmental nephrotoxin. Our own studies performed in subjects with low level occupational and environmental exposures in New Jersey confirm the pattern specificity and threshold effects for Cr, Hg and Pb. In addition, we have been able to show that increased NAG and IAP excretion following Pb exposure correlates with current (blood Pb) but not with the cumulative Pb burden (bone Pb). The relatively specific characteristic patterns of biomarker excretion are lost as renal failure progresses. Moreover, renal injury that results in tubular proteinuria may not progress to renal failure. Nevertheless, urine biomarkers can help to establish acceptable levels and identify the need for long term surveillance to ascertain when clinical renal disease may result.

Adult↗
PubMedDate not supplied

Understanding stress in hazardous waste workers.

In summary, hazardous waste workers comprise a unique occupational group that may be at risk for stress-related illness due to the unusual demands of their work. Occupational health professionals responsible for their surveillance should include surveillance of their mental as well as physical health. When symptoms of stress are evident, both organizational and individual programs may be needed to address these symptoms. Denial of the risks involved should not be promoted, given the potential such denial may have for careless work practices.

Hazardous Waste↗
PubMedDate not supplied

Neuropsychology and psychology of MCS.

Neurological symptoms are frequently reported by patients with multiple chemical sensitivities (MCS). Methods to compare the psychiatric, personality, and neuropsychological function of patients with MCS, chronic fatigue syndrome (CFS), and normal controls are described. Increased rates of Axis I psychiatric diagnoses are observed in the literature for MCS and CFS subjects relative to controls. Findings on the MMPI-2 and the Toronto Alexithymia Scale reveal profiles consistent with the tendency to report somatic rather than emotional symptoms in response to stress. However, many of the reported somatic symptoms also coincide with those found in neurologic disorders. The overall neuropsychological profile for MCS subjects does not reflect cognitive impairment. Relative to normal controls, the only difference in neuropsychological performance observed is reduced recognition of nontarget designs on a visual memory task. More fruitful areas for future psychological research will include measurement of the interaction between behavioral response styles and attentional processes in cognition, as well as observations under controlled challenge conditions.

Central Nervous System↗