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Biomedical subjects

T Theorell

Publications and source records attributed to T Theorell.

246 records · Page 14Linked to original sources
PubMedDate not supplied

Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm Heart Epidemiology Program (SHEEP).

OBJECTIVE: Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility. METHODS: This study was a case-crossover study within the Stockholm Heart Epidemiology Program. Exposure in the period immediately preceding MI was compared with exposure during a control period for each case. From April 1993 to December 1994, 699 patients admitted to coronary care units in Stockholm County were interviewed. RESULTS: During a period of 1 hour after an episode of anger, with an intensity of at least "very angry," the relative risk of MI was 9.0 (95% CI, 4.4-18.2). In patients with premonitory symptoms, the time of disease initiation may be misclassified. When restricting the analyses to those without such symptoms, the trigger risk was 15.7 (95% CI, 7.6-32.4). The possibility of examining effect modification was limited by a lack of statistical power (eight exposed cases). Results of the analyses suggested, however, an increased trigger effect among subjects reporting nonhostile usual behavior patterns, nonovert strategies of coping with aggressive situations (not protesting when being treated unfairly), and nonuse of beta-blockers. CONCLUSIONS: The hypothesis that anger may trigger MI is further supported, with an increased risk lasting for approximately 1 hour after an outburst of anger. It is suggested that the trigger risk may be modified by personal behavior patterns.

Adult↗
PubMedDate not supplied

Employee effects of an educational program for managers at an insurance company.

BACKGROUND: Possible health effects for employees of efforts to improve the psychosocial competence of managers have not been studied scientifically in the past. OBJECTIVE: To explore how efforts to improve management will change the work environment and health of the employees. METHODS: Managers of the experimental department in a large insurance corporation underwent 2-hour biweekly training sessions for 1 year-altogether, 60 hours. A control group of employees in other departments in the corporation not affected by the modification was followed with the same assessments. Morning blood samples for the assessment of serum cortisol were collected both at baseline and after 1 year in 155 participants in the experimental group and in 147 subjects in the control group. Liver enzymes and lipids were also assessed. In the questionnaire part of the 1-year follow-up study, there were 119 participants in the experimental group and 132 in the control group. RESULTS: When repeated-measures ANOVA was used, a significant interaction effect was found for the level of serum cortisol; serum cortisol levels were decreased in the intervention group and were unchanged in the control group (ANOVA two-way interaction, p =.02; after exclusion of the managers, p =.005). A significant interaction effect was also observed for decision authority, with increased decision authority in the intervention group and, conversely, a decreased level in the control group (p =.001; after exclusion of managers, p =.02). CONCLUSIONS: The study indicates that a moderately intensive psychosocial manager program lasting for 1 year can be beneficial for the employees with regard to both lowered serum cortisol and improved authority over decisions.

Administrative Personnel↗
PubMedDate not supplied

What prevents professional drivers from following physicians' cardiologic advice?

BACKGROUND: There is a scarcity of published studies of the effects of cardiac counselling among professional drivers (PD). Aims of the study were: (1) to examine explanatory variables for two classical 'driver' risk factors - body mass index (BMI), and smoking - and to analyse the interrelations among smoking cessation, losing weight and work-related life changes; (2) to assess the effectiveness of risk factor counselling after 6 months, and (3) to gain insight into possible discrepancies between PD perception of needed changes and compliance with the physician's advice. METHODS: There were 4 groups of male PD: 13 with ischemic heart disease, 12 hypertensives, 10 borderline hypertensives and 34 normotensives. Baseline cardiovascular risk factors as well as occupational and behavioral data were assessed via questionnaire. The counselling was aimed at smoking cessation, weight loss and promoting leisure-time physical activity. Qualitative methods were used to assess PD perceptions about the work environment and health promotion. RESULTS: Baseline smoking intensity was best predicted by the total burden of occupational stress and number of smoking years. Baseline BMI was best predicted by long work hours behind the wheel, low availability of attachment outside work and low self-reported job strain. Self-initiated smoking cessation was best predicted by few smoking years, low coffee intake and admitting fear during driving. Physical activity was significantly increased after 6 months. Losing weight was associated with: quitting or diminishing smoking and making other, work-related, life changes. None of the heavy smokers decreased their daily number of cigarettes after 6 months, although expressing the need to do so in self-generated statements. CONCLUSIONS: Exposure to occupational stressors, mainly, long work hours and the concomitant denial of job strain, in combination with low availability of social attachment outside work, could contribute to maintenance of maladaptive behavior in PD. These findings could serve as a basis for designing standardized intervention trials and suggest that modification of the work environment, with participation of the drivers, is a needed component of such trials. Particular attention should be paid to the length and scheduling of work shifts.

Adult↗
PubMedDate not supplied

Coping with unfair treatment at work--what is the relationship between coping and hypertension in middle-aged men and Women? An epidemiological study of working men and women in Stockholm (the WOLF study).

BACKGROUND: An important hypothesis in psychosomatic medicine is that exposure to psychosocial factors that arouse anger may accelerate the onset of hypertension, particularly if the subject is not allowed to show anger or to deal constructively with the factor that evoked it. For working men and women, being treated in an unfair way at work may be crucial. The present study was designed to answer the question whether the pattern of coping - primarily directed towards the aggressor (open) or directed inwards or towards others (covert) - is associated with hypertension among working men and women. STUDY GROUP: Five thousand seven hundred and twenty working men and women aged 15-64 participated in the study. The participation rate was 76%. METHODS: The coping pattern was studied by means of a Swedish version of a self-administered questionnaire that was originally introduced by Harburg et al. RESULTS: Significant results were confined to the age group 45-54. All analyses were adjusted for age and body mass index. Smoking habits and social class had no effect on the relationships. Low scores (lowest quartile) for open coping tended to be associated with an elevated prevalence ratio (PR) of hypertension both among men (PR 1.3, 95% confidence interval, CI, 0.9-1.7) and women (PR 1.4, 95% CI 1.0-2.0). High scores for covert coping (highest quartile) were associated with an elevated PR of hypertension among men (PR 1.6, 95% CI 1.2-2.2) but not in women. If the analysis was confined to cases without medication, the relationship between a high level of covert coping and high blood pressure was still significant for men. For women, however, no significant findings were made after this operation. Accordingly, the relationship between a low level of open coping and hypertension in women was confined to women with medication. Coping patterns were correlated with psychosocial work environment factors, in particular decision latitude. CONCLUSION: In men, covert coping was associated with prevalence of hypertension. In women, there tended to be a relationship between low scores for open coping and hypertension.

Adaptation, Psychological↗
PubMedDate not supplied

Stress markers in relation to job strain in human service organizations.

BACKGROUND: Workers in human service organizations are often confronted with conflicting demands in providing care or education. The aim of this cross-sectional study was to relate levels of endocrine stress markers to perceived job strain in two human service organizations. METHODS: Employees in two local units of the social insurance organization and two local units of the individual and family care sections of the social welfare in Sweden were selected and 103 employees participated (56% participation rate). The perceived job strain was assessed with a standardized questionnaire containing questions of the demand-control model. Questions specially designed to measure emotional demands were also included. The stress markers cortisol, prolactin, thyroid-stimulating hormone, testosterone and IgA and IgG were analysed in blood samples. RESULTS: The main finding was an association between high emotional strain and increased levels of prolactin. The levels of cortisol, but none of the other four stress markers, increased slightly with emotional strain. CONCLUSIONS: Emotional strain experienced in human service work may cause psychological stress. The increase in prolactin was modest but consistent with findings in other published studies on stress-related endocrine alterations.

Adult↗
PubMedDate not supplied

Disablement and quality of life after stroke.

This study concerns the quality of life of patients after stroke and how this is influenced by disablement and emotional factors. Ninety-six consecutive patients of mean age 71 years were followed for two years. At the end of that time 23% had experienced a recurrence of stroke and 27% were deceased. Of the survivors 76% were independent as regards activities of daily life (ADL) and lived in their own homes. Age as well as initial function were prognostically important factors. Patients who could participate in interviews marked on a visual analogue scale their evaluation of quality of life before and after stroke. Most of them had experienced a decrease and no improvement was observed during the two years. The deterioration was more pronounced in ADL dependent patients than among the independent. However, depression and anxiety were found to be of similar importance for quality of life as was physical disablement. These findings call for a greater emphasis on psychological support in the care of post stroke patients. The visual analogue scale can be a useful tool for detecting special needs.

Activities of Daily Living↗
PubMedDate not supplied

Psychotherapy in rheumatoid arthritis--a parallel-process study of psychic state and course of rheumatic disease.

In this study, well-known psychosomatic (psychoneuroimmunological) connections have been used for therapeutic purposes. Fifteen patients with rheumatoid arthritis (RA) were treated with analytical insight therapy for 60-90 min weekly during 10 months to 4.5 years (median 3.3 years). Six patients showed great and largely continuous improvement, both psychic and physical, throughout the period of psychotherapy and often for a long time thereafter. In another five cases, improvements in psychic state and the joint disease took place over a period of 1-2 years. Later, when the emotional channels to childhood traumata were opened, these five patients relapsed and the course of their disease became more variable. In four cases, the connections between psychic state and the course of the joint disease were more varied throughout the period of psychotherapy. In the studied group the correlation between psychic state and course of rheumatic disease was highly significant. The probability of the outcome of the study being due to chance alone is considered very small, especially taking into account the fact that RA is a chronic progressive disease.

Adaptation, Psychological↗