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Dissociated or fabricated? Psychiatric aspects of repressed memory in criminal and civil cases.

During the last decade, clinicians, courts, and researchers have been faced with exceedingly difficult questions involving the crossroads where memory, traumatic memory, dissociation, repression, childhood sexual abuse, and suggestion all meet. In one criminal case, repressed memories served as the basis for a conviction of murder. In approximately 50 civil cases, courts have ruled on the issue of whether repressed memory for childhood sexual abuse may form the basis of a suit against the alleged perpetrators. Rulings that have upheld such use underscore the importance of the reliability of memory retrieval techniques. Hypnosis and other methodologies employed in psychotherapy may be beneficial in working through memories of trauma, but they may also distort memories or alter a subject's evaluation of their veracity. Because of the reconstructive nature of memory, caution must be taken to treat each case on its own merits and avoid global statements essentially proclaiming either that repressed memory is always right or that it is always wrong.

Adolescent↗

Yellow fever: ecology, epidemiology, and role in the collapse of the Classic lowland Maya civilization.

Mystery has long surrounded the collapse of the Classic lowland Mayan civilization of the Peten region in Guatemala. Recent population reconstructions derived from archaeological evidence from the central lowlands show population declines from urban levels of between 2.5 and 3.5 million to around 536,000 in the two hundred year interval between 800 A.D. and 1000 A.D., the period known as the Classic Maya Collapse. A steady, but lesser rate of population decline continued until the time of European contact. When knowledge of the ecology and epidemiology of yellow fever and its known mosquito vectors are compared with what is known of the ecological conditions of lowland Guatemala as modified by the Classic Maya, provocative similarities are observed. When infection and mortality patterns of more recent urban yellow fever epidemics are used as models for a possible series of Classic Maya epidemics, a correlation is noted between the modeled rate of population decline for a series of epidemics, and population decline figures reconstructed from archaeological evidence.

Ecology↗

Evidence of environmental suppression of familial resemblance: height among US Civil War brothers.

This study examines, with historical data, whether within family correlations in height varied across environments and whether variability in height was greater in worse environments. To investigate these hypotheses, brothers were identified who were mustered into the Union Army of the US Civil War, using linked records from the 1850 and 1860 censuses and military and medical records. Heights were available for 3898 men aged 18 and older, of whom 595 were further identified as belonging to 288 family sets of two, three or four brothers. Generalized estimating equations were used to concurrently model the mean height, the variance and the correlation between brothers as a function of county population. Heights decreased as county population size increased (p<0.001). The correlation between brothers' heights decreased significantly (p = 0.032) with increasing county population, and the variance increased (p = 0.026). The correlation ranged approximately from 0.63 in the least populous to 0.24 in the most populous counties. The degree of familial resemblance was lower in environments where mean height was lower, and the variability in height was greater, suggesting that the environmental contribution to the variability in height is of greater relative importance in populations reared, on average, in worse environments.

Adolescent↗

Circadian rhythm of heart rate, urinary cortisol excretion, and sleep in civil air traffic controllers.

The examination of Air Traffic Controllers (ATCs) from the Warsaw Airport (Poland) included 24-hr ECG monitoring. The participants were 10 civil ATCs, 9 males and 1 woman. The study was carried out on a group of 19 ATCs during their duty periods, 14 of them working 12-hr shifts and 5 performing 24-hr duties. The participants collected urine every 4 hrs, and cortisol concentration was determined. Further, the survey included the quality and duration of sleep, and subjective fatigue in the 62 participants. In ATCs, shift work modifies natural rhythms of the circulatory system and decreases the ability for intensified mental work at night. In consequence ATCs experience frequent sleep disorders.

Adult↗

Responding to substance use problems in Nigeria: the role of civil society organizations.

This descriptive study assesses the role of nongovernmental organizations (NGOs) in drug demand reduction (DDR) in Nigeria. Sixty-two respondents, representing 45 organizations, participated in the survey in 2001. Most respondents were people with university education, and many were trained in health-related fields. A large majority (84%) were active in prevention work and 63% of them were engaged in research. Survey respondents reported that they were faced with many challenges in their work as DDR practitioners. These included poor funding or lack of it and inadequate information on drugs. Many also expressed the need for drug policy reforms in the country and an interest in further training in different areas of DDR. This article argues that a well-coordinated civil society participation is necessary in the control of drug problems in Nigeria. This goal can only be achieved in an environment where drug policy strikes a reasonable balance between supply and demand reduction efforts and, consequently, where support for DDR is seen as an integral part of drug control initiatives.

Community Networks↗

Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants.

Physical inactivity and low resting heart rate variability (HRV) are associated with increased coronary heart disease incidence. In the Whitehall II study of civil servants aged 45-68 years (London, United Kingdom, 1997-1999), the strength of the association of moderate and vigorous activity with higher HRV was examined. Five-minute recordings of heart rate and HRV measures were obtained from 3328 participants. Calculated were time domain (standard deviation of NN intervals) and high-frequency-power measures as indicators of cardiac parasympathetic activity and low-frequency power of parasympathetic-sympathetic balance. Leisure-time physical activity (metabolic equivalent-hours per week) was categorized as moderate (>or=3-<5) and vigorous (>or=5). Moderate and vigorous physical activity were associated with higher HRV and lower heart rate. For men, linear trends of higher low-frequency power with increasing quartile of vigorous activity (304.6 (low), 329.0, 342.4, 362.5 (high); p < 0.01) and lower heart rate with increasing quartile of moderate activity (69.6 (low), 69.2, 68.9, 67.8 (high); p < 0.05) were found. These associations remained significant after adjustment for smoking and high alcohol intake. For men whose body mass index was >25 kg/m(2), vigorous activity was associated with HRV levels similar to those for normal-weight men who engaged in no vigorous activity. Vigorous activity was associated with higher HRV, representing a possible mechanism by which physical activity reduces coronary heart disease risk.

Aged↗

Infectious diseases during the Civil War: the triumph of the "Third Army".

The American Civil War represents a landmark in military and medical history as the last large-scale conflict fought without knowledge of the germ theory of disease. Unsound hygiene, dietary deficiencies, and battle wounds set the stage for epidemic infection, while inadequate information about disease causation greatly hampered disease prevention, diagnosis, and treatment. Pneumonia, typhoid, diarrhea/dysentery, and malaria were the predominant illnesses. Altogether, two-thirds of the approximately 660,000 deaths of soldiers were caused by uncontrolled infectious diseases, and epidemics played a major role in halting several major campaigns. These delays, coming at a crucial point early in the war, prolonged the fighting by as much as 2 years.

Communicable Diseases↗

The collection and use of funds from civil money penalties and fines from nursing homes.

PURPOSE: This study examined federal and state civil money penalties and fines collected from nursing homes and how states used the collected funds. DESIGN AND METHODS: We used a telephone survey of state officials, Freedom of Information Act requests, state Web site searches, and stakeholder interviews to describe the funds collected, the availability and the use of funds, public information about penalties and fines, and the state allocation process and policies. RESULTS: In 2004, 43 states collected a total of $21 million from more than 3,000 federal and state penalties and fines. Forty-two states had $60.5 million in fund accounts from penalties and fines available in 2005, and 32 states spent $28 million on a wide range of projects. Fifteen states spent $17.9 million on survey and certification activities, 19 states spent $5.6 million on provider projects, 6 states spent $1.3 million on advocacy projects, and 12 states spent $2.7 million for other projects. Most states did not provide information to the public about issuing penalties and fines, have formal procedures to inform stakeholders and allocate funds, or involve stakeholder groups in the decision-making process. IMPLICATIONS: Funds from federal and state penalties and fines vary widely across states. These funds are a resource for improving the quality of nursing home care that needs more attention from policy makers and stakeholder groups.

Humans↗

Blood cadmium in London civil servants.

Blood cadmium was measured in 466 randomly selected London civil servants not exposed to heavy metals at work. Blood cadmium ranged from 3.6 to 75.6 nmol/L (0.4 to 8.5 micrograms/L) with a geometric mean of 6.4 nmol/L (0.7 micrograms/L) in nonsmokers and 13.6 nmol/L (1.5 micrograms/L) in smokers (p less than 0.001). Blood cadmium was higher in women than in men (9.5 versus 7.8 nmol/L) and was inversely correlated with employment grade (p less than 0.001). The associations with age, body weight and alcohol intake were not significant. After adjusting for gender and the number of cigarettes smoked per day, 36% of the variance of blood cadmium was explained, while the contribution of employment grade was not significant. There was an unexpected negative relationship between serum creatinine and blood cadmium in men (r = -0.16; p less than 0.01). This was not true in women (r = +0.03), but the correlation remained present in men after adjustment for age, body mass index and smoking. In contrast, in the two sexes, the correlations between blood pressure and blood cadmium were weak and not statistically significant. In conclusion, in unexposed subjects, gender and smoking are important determinants of blood cadmium. In addition, a low level of environmental exposure to cadmium is not associated with a deterioration of renal function or an increase in blood pressure.

Age Factors↗

Calcium intake and 28-year cardiovascular and coronary heart disease mortality in Dutch civil servants.

Data obtained from a general health examination in 1953-1954 of 2605 middle-aged Dutch civil servants were analysed to investigate the relation between dietary calcium and cardiovascular (CVD) and coronary heart disease (CHD) mortality. Calcium intake was assessed at baseline by a 1-week food frequency recall. Multivariate adjusted odds ratios (OR) were calculated using the highest quintile of calcium intake as the reference. No statistically significant associations were observed for low calcium intake in 15 and 28 years of follow-up in both men and women. For men, multivariate adjusted OR for the lowest quintile of calcium intake were 1.3 (95% confidence interval (CI): 0.8-1.9) and 0.9 (95% CI: 0.6-1.6) for 28-year CVD and CHD mortality, respectively. For women, corresponding OR were 1.1 (95% CI: 0.6-2.0) and 1.1 (95% CI: 0.5-2.5). Although an inverse association between calcium intake and CVD and CHD mortality, possibly mediated by blood pressure, might be hypothesized, no clear association was observed. Because dietary patterns in the 1950s were quite stable, and major calcium sources were addressed, misclassification of calcium intake may not be fully responsible for this finding.

Aged↗

Adequacy of a single visit for classification of hypertensive status in a Nigerian civil servant population.

BACKGROUND: Concern has been expressed regarding the adequacy of classifying individuals as hypertensive based upon a single blood pressure determination and/or the average of readings taken at a single visit and the appropriateness of these determinations in cross-cultural comparisons of rates of hypertension. METHODS: This analysis investigated the potential classification variability by comparing hypertensive status determined by 1) a single reading, 2) an average of the second and third determination at the first visit, and 3) an average of the second and third determinations obtained at each of three visits according to a standardized protocol. Kappa statistic, sensitivity and specificity were calculated to assess the agreement of hypertension classification for 804 subjects in the Health Survey in Nigerian Civil Servants, Benin City, 1992. Data were also compared to other published studies for variability in hypertension classification with repeated blood pressure determinations. RESULTS: Good to excellent agreement was observed for the entire population between the single blood pressure determination, the average of the first visit, and the average of three visits. Sensitivity and specificity measures were also acceptable for the entire population. Further analysis by sex and staff status (a measure of socioeconomic status) found no apparent distinctions between the groups. CONCLUSION: Contrasting the data with other published studies, conducted in both developed and developing countries, we note no greater variability in repeated blood pressure measurements, and conclude that the average of blood pressure determinations at a single visit in this working urban population is adequate for determining hypertensive status for comparisons with hypertension rates in Westernized populations.

Adult↗

Seasonal variation in cause-specific mortality: are there high-risk groups? 25-year follow-up of civil servants from the first Whitehall study.

OBJECTIVES: To determine the seasonal effect on all-cause and cause-specific mortality and to identify high-risk groups. METHODS: A 25-year follow-up of 19,019 male civil servants aged 40-69 years. RESULTS: All-cause mortality was seasonal (ratio of highest mortality rate during winter versus lowest rate during summer 1.22, 95% CI : 1.1-1.3), largely due to the seasonal nature of ischaemic heart disease. Participants at high risk based on age, employment grade, blood pressure, cholesterol, forced expiratory volume, smoking and diabetes did not have higher seasonal mortality, although participants with ischaemic heart disease at baseline did have a higher seasonality effect (1.38, 95% CI : 1.2-1.6) than those without (1.18, 95% CI : 1.1-1.3) (P = 0.03). CONCLUSIONS: Seasonal mortality differences were greater among those with prevalent ischaemic heart disease and at older ages, but were not greater in individuals of lower socioeconomic status or with a high multivariate risk score. Since seasonal differences showed no evidence of declining over time, elucidating their causes and preventive strategies remains a public health challenge.

Adult↗

Social inequalities in mortality in a retrospective cohort of civil servants in Barcelona.

BACKGROUND: The objective of this study is to describe the inequalities in mortality by occupational category and sex in a retrospective cohort of civil servants working in the city council of Barcelona (Spain). METHODS: The cohort was followed for the period 1984-1993. There were 11 647 men and 9001 women. Age-adjusted hazard ratios (HR) of death for occupational categories and manual versus non-manual groups and 95% CI were derived from Cox proportional hazards models. RESULTS: For total deaths in males, compared with high-level professionals, auxiliary workers (HR = 1.30, 95% CI: 0.96-1.77), skilled manual workers (HR = 1.29, 95% CI: 0.95-1.77), unskilled manual workers (HR = 1.46, 95% CI: 1.07-1.98) and police and fire manual workers (HR = 1.42, 95% CI: 1.08-1.87) had higher risk of death. Among women, for all causes of mortality, only police manual workers had higher mortality (HR = 5.63, 95% CI: 1.89-16.7) whereas auxiliary workers had the lowest HR (HR = 0.51, 95% CI: 0.25-1.05). The HR comparing manual and non-manual categories for all causes of death was 1.29 for males (95% CI: 1.09-1.52) and 1.07 for females (95% CI: 0.77-1.49). Among males, whereas manual workers had lower cardiovascular mortality (HR = 0.85, 95% CI: 0.63-1.15), cancer mortality was higher in the manual category. No association between manual category and mortality was found among women. CONCLUSIONS: This study provides an analysis of social inequalities in mortality in a cohort from a Southern European urban area.

Adult↗

Association of weight change with ethnicity and life course socioeconomic position among Brazilian civil servants.

BACKGROUND: Adult weight gain is generally associated with ethnicity of African descent, in addition to low socioeconomic position (SEP), but little information is available from the African diaspora in less-developed countries. We evaluated ethnic differences in adult weight change and the role of life course SEP in those differences. METHODS: We conducted a cross-sectional analysis of baseline data (1999-2001) from 2594 non-faculty civil servants working at university campuses in Rio de Janeiro (Brazil) and participating in the longitudinal Pró-Saúde Study. Weight and height were measured at study entry whereas ethnicity, markers of SEP, and weight at age 20 were assessed through self-administered questionnaire. RESULTS: Black and mulatto women gained, respectively, an excess of 1.6 kg and 1.2 kg per 10 years of adult life, compared with whites. After adjustment for markers of participants' early and later-life SEP, the estimates of excess weight gain for black and mulatto women decreased by about one-third, but a statistically significant estimate was still observed for black women. Among men, neither unadjusted nor adjusted ethnic gradients in weight gain were relevant. CONCLUSIONS: Only among women, black and mulatto ethnicity was associated with increased weight gain, which was partially explained through the association with their lower SEP.

Adult↗

Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants.

BACKGROUND: The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain. OBJECTIVES: To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40-69 years). METHODS: Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968-70 and when resurveyed in 1997-98 (median age 76 years). RESULTS: The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1-1.5) for the lightest and heaviest categories relative to the middle two. Among 'healthy' men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5-0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality. CONCLUSIONS: The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI<22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.

Aged↗

Enterprise association or civil association? The UK national health service.

This paper falls into three parts. In the first part I will briefly review the current process of reform that the United Kingdom National Health Service is undergoing. Two fundamental motivations for reform, the desire for increased efficiency and for an increased responsiveness to patients' needs and preferences will be discussed in greater detail. The second part attempts to provide a perspective on the moral debate concerning health care reform by introducing the distinction between 'civil association' and 'enterprise association' as proposed by the political philosopher Michael Oakeshott. In the final part, this distinction will be used to analyze the moral and political constitution of the National Health Service, in order to establish the relevance and scope of concerns with efficiency and patient and public accountability. A framework within which the current reforms can be assessed is thereby outlined.

Catchment Area, Health↗

Minor psychiatric morbidity, its prevalence and outcome in a cohort of civil servants--a seven-year follow-up study.

During the years 1979-1986, a cohort of direct entrant executive officers in the Civil Service were followed up to examine the prevalence and outcome of minor psychiatric morbidity in an occupational setting. All studies using epidemiological standardized research methods agree that prevalence rates are high in occupational settings. As in primary care settings, half of the illness episodes followed a chronic course, which emphasizes the need for early detection and prompt management of these conditions, and for evaluative studies of intervention strategies.

Administrative Personnel↗

A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service.

BACKGROUND: This study aimed to establish how important an occupational health unit (OHU) is to its clients, and to identify the perceived needs and priorities for such a service. METHODS: A cross-sectional postal survey of a stratified, randomly selected group of employees (n = 760) and all human resources (HR) managers (n = 34) was conducted in the Irish Civil Service. Each participant was requested to rate the overall importance of the OHU and to prioritize eight proposed functions for the unit: medical surveillance, general health education, pre-employment/promotion medical assessments, ill-health retirement assessments, return-to-work (after sick leave) assessments, occupational health education, research, and general medical screening. The results were analysed according to age group, gender, grade and occupation. RESULTS: There was a response rate of 69% from employees and 74% from personnel managers. Significantly more HR managers than employees (92 versus 81%) thought an occupational health service was either important or very important. There were also differences in prioritization of functions by employees and HR managers. HR managers prioritized those functions concerned with assessing individuals' fitness for work, notably pre-employment/promotional health assessments, whereas employees consider group-directed 'preventative' functions to be more important, i.e. general medical screening, health education and medical surveillance. Both sets of opinions are not mutually exclusive, and considerable overlap exists, notably in the areas of occupational and general health education.

Adult↗