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Biomedical subjects

A Perski

Publications and source records attributed to A Perski.

At least 19 recordsLinked to original sources
PubMed1995

Psychological reactions in men screened for prostate cancer.

OBJECTIVE: To investigate the possible negative psychological impact of screening for prostate cancer with special focus on the impact of false positive and true positive test results. SUBJECTS AND METHODS: As part of an early detection study for prostate cancer psychological and psychophysiological reactions to various phases of the diagnostic procedures were examined in 2400 randomly selected men divided into various groups. Their psychophysiological reactions were assessed by measurements of serum cortisol and their psychological reactions by questionnaires directed at determining emotional states and sleep disturbance. In a stratified sample of the population (100 men) measurements were made at the time of the screening examination and again 2 weeks later. In patients undergoing biopsy (307 men) measurements were made 2 weeks after screening, but before they were informed of the biopsy results, and again 4 and 16 weeks after screening. RESULTS: Serum cortisol levels at the screening examination were higher than corresponding levels of a comparable sample of Swedish men during normal daily activity, indicating that an invitation to examination for prostate cancer per se might create emotional stress. Two weeks after the screening the elevated levels had decreased to normal. The highest cortisol levels were found in men who had undergone biopsy, immediately before they were informed of the results 2 weeks after screening. After they were informed, cortisol levels fell, regardless of the results of the biopsy. The patterns of emotional state and sleep disturbance were similar except that sleep disturbance was delayed. CONCLUSION: In screening programmes for prostate cancer it is important to define clearly the high-risk groups to minimize the risk of adverse psychological reactions in those subjects with a low risk of having the disease. The results also emphasize the need to reduce the number of false positive results by choosing diagnostic tests of high specificity. The interval between a test and informing the subject of the results should be minimized to decrease the duration of the increased emotional stress.

Aged↗
PubMed1992

Minimum heart rate and coronary atherosclerosis: independent relations to global severity and rate of progression of angiographic lesions in men with myocardial infarction at a young age.

The relations of hemodynamic factors, plasma fibrinogen concentration, serum lipoprotein levels, and clinical risk indicators to coronary atherosclerosis were studied in 56 men who had survived a first myocardial infarction before the age of 45 years and who subsequently underwent two coronary angiographies with an intervening time interval of 4 to 7 years. Presence, severity, and rate of progression of both diffuse lesions and distinct stenoses were determined by means of separate classification systems in 15 proximal coronary arterial segments. High minimum heart rate measured during a 24-hour period in connection with the reangiography was associated with progression of both diffuse lesions and distinct stenoses. High minimum heart rate also correlated positively with angiographic scores of global severity of diffuse atherosclerosis and stenoses. Progression of disease was predicted independently by minimum heart rate and low-density lipoprotein/high-density lipoprotein ratio, whereas lipoprotein A, fibrinogen levels, hypertension, smoking, and beta-adrenergic receptor blockade treatment did not discriminate between patients with and without progression.

Adult↗
PubMed1991

The effects of the strain of returning to work on the risk of cardiac death after a first myocardial infarction before the age of 45.

Seventy-nine men who had suffered a myocardial infarction before the age of 45 while they were vocationally active in the greater Stockholm area were followed for five years. Forty-nine survived without cardiac complications and 13 died due to ischaemic heart disease during the period of follow-up. These two contrasting groups were compared with regard to psychosocial risk factors at work before the first myocardial infarction (as reported by the patient when he was interviewed during the weeks after the onset of disease). It was hypothesized that returning to stressful work (high demands and limited possibilities of influencing decisions and developing skills) would be associated with an increased risk of death. All the subjects who died had returned to the work that they had performed prior to the first myocardial infarct. Work performed by these patients was described as having significantly higher psychological demands in relation to the possibility of learning new things and higher demands in relation to variety as well as almost significantly higher demands in relation to influence. Multivariate logistic regression with these factors concerning employment, together with biomedical risk factors recorded at the same time, showed that increasing age, increasing degree of coronary atherosclerosis and number of stenosed coronary arteries, as well as high demands in relation to the possibility of learning new things, were independent predictors of death due to coronary arterial disease. The remaining 17 subjects either survived a re-infarction, or had coronary arterial by-pass surgery during the period of follow-up. This heterogeneous group occupied intermediate positions with regard to psychosocial job factors.

Adult↗
PubMed1991

The role of paid work in Swedish chronic dialysis patients--a nation-wide survey: paid work and dialysis.

The role of paid work in chronic illness has been investigated in this nation-wide study of all Swedish-speaking patients on chronic dialysis above the age of 16 years, who were not too tired or severely ill to participate and who had been treated for at least 3 months. Young age and female gender were consistently associated with increased prevalence of self-reported depression, poor psychological health, psychosomatic symptoms and sleep disturbance. In multivariate analyses paid work, strong emotional support, and care at intermediate or small units were independently associated with a good quality of life. Chronic dialysis patients who did paid work (19.6% of the patients below 65 years of age) perceived their work as more socially supportive than did men and women in the normal working population. It may be concluded that paid work is of particular importance to this patient group because it may give extra social support to patients whose social network is in general rather poor.

Adult↗
PubMed1991

Job strain and ambulatory blood pressure profiles.

Occupational characteristics were used to study the role of job stress in the pathogenesis of hypertension. Ambulatory 24-h recordings of blood pressure were made for 161 men with borderline hypertension. From the occupational classification system scores for psychological demands, control, support, physical demands, and occupational hazards were obtained. The results indicated that the ratio between psychological demands and control (strain) was significantly associated with diastolic (but not systolic) blood pressure at night and during work. The association between job strain and diastolic blood pressure at night and during work was greatly strengthened when the subjects with occupations classified as physically demanding were excluded from the analysis. The conclusion was reached that a measure of job strain derived from the occupational classification is useful in predicting variations in diastolic blood pressure levels during sleep and work for men with borderline hypertension.

Adult↗
PubMed1990

Cardiovascular and sympathoadrenal responses to mental stress: a study of sensory intake and rejection reactions.

Cardiovascular, sympathoadrenal and subjective responses to mental stress induced by two mental challenges eliciting sensory intake (word identification test = WIT) and sensory rejection (colour word conflict test = CWT) reactions were studied in 10 healthy males. Pressor responses to these stressors have been proposed to differ haemodynamically. Sympathoadrenal activity was assessed by arterial and femoral venous plasma catecholamine determinations and direct recordings of muscle sympathetic activity in the right peroneal nerve (MSA). Basal measurements differed little from those made during an active relaxation procedure, with the exception of MSA, which decreased. Both stress tasks elicited increases in heart rate, cardiac output, calf blood flow and brachial and pulmonary arterial blood pressures. WIT and CWT elicited qualitatively similar responses, but the amplitudes of the circulatory responses were lower with WIT, which also was rated as a weaker stressor. MSA increased during CWT, while marginal increases were seen during WIT. Arterial adrenaline showed a transient increase by 0.14 nmol l-1 during WIT. During CWT arterial adrenaline increased significantly by 50%. Increases in arterial adrenaline and subjective stress ratings were related to increases in cardiac output and reductions of systemic vascular resistance. Arterial and femoral venous noradrenaline increased during CWT, while changes during WIT were small. MSA and noradrenaline responses did not correlate to local vascular responses in the calf. Differences in the responses to mental challenges evoking sensory intake or rejection seem to be of a quantitative rather than a qualitative character.

Adrenal Glands↗
PubMed1989

Muscle sympathetic activity and norepinephrine release during mental challenge in humans.

Muscle sympathetic nerve activity (MSA; peroneal nerve) and arterial and femoral venous plasma norepinephrine (NE) were studied in 10 volunteers at rest, during a relaxation procedure (RELAX), and during two mental challenges, a word identification test (WIT) and a color word test (CWT). [3H]NE infusions were used to assess NE spillover to and clearance from plasma. Net NE overflow from the leg was calculated. RELAX reduced MSA and femoral venous NE concentrations. CWT increased blood pressure, cardiac output (thermodilution), and calf flow and reduced systemic vascular resistance. Responses to WIT were less marked. CWT increased MSA by 25%, femoral venous NE concentrations by 25%, and NE overflow from the leg by 26% at 3 min. Fractional epinephrine and [3H]NE extractions were flow related and decreased during CWT. The arterial contribution to femoral venous NE (about half) increased by 10% during CWT. Arterial NE levels and spillover increased, but NE clearance was unchanged. Femoral venous NE concentrations and NE spillover (not based on flow measurements) and regional NE overflow correlated with MSA. Thus NE concentrations in plasma reflect spillover rather than clearance at rest and during mental challenge. Biochemical and neurophysiological indexes of sympathetic activity correlate when assessed in the same region. Mental stress increases sympathetic activity in leg muscle.

Adrenal Glands↗
PubMed1988

Acute chest pain without obvious organic cause before the age of 40. Respiratory and circulatory response to mental stress.

Reactivity to mental stress and relaxation was studied in 63 consecutive patients below the age of 40 attending the emergency care unit because of chest pain without obvious organic cause. The results were compared with a control group (n = 32). Of the patients, 41% reported chest pain or oppression in the chest during mental stress compared to 10% of the control subjects (p less than 0.01). During relaxation the subjects in the female patient group reported significantly less ability to relax and had significantly higher respiration rate as compared to the female control group. There were no significant differences between the groups regarding heart rate, blood pressure or end-tidal PCO2 and there was no evidence of hyperventilation, neither during relaxation nor during mental stress. In combination with our earlier findings of high scores for "type A behaviour", "neuroticism", "vital exhaustion" and "stressful life events" these findings indicate that psychosomatic mechanisms may be of great importance for the development of chest pain in this group of patients.

Acute Disease↗
PubMed1988

Changes in job strain in relation to changes in physiological state. A longitudinal study.

A sample of 73 men and women aged 22-63 years and working in six different occupations (air traffic controllers, waiters, physicians, symphony orchestra musicians, baggage handlers, and airplane mechanics) participated in a longitudinal study four times during a year. The spontaneous variations in job strain (determined as the self-reported ratio between psychological demands and decision latitude) were substantial. The average difference between the occasion with the highest level of strain and the occasion with the lowest level was 25% of the total mean. Systolic blood pressure during workhours, as well as self-reported sleep disturbance, increased when demands increased in relation to decision latitude. Among men with a depressive tendency (according to a diary) morning plasma prolactin levels increased markedly with increasing job strain. Among subjects with a positive family history of hypertension the increase in systolic blood pressure at work was particularly pronounced, and among the men in this group a lower than expected level of morning cortisol was found measured during the period with the highest level of strain.

Adult↗
PubMed1987

Psychosocial work conditions before myocardial infarction in young men.

All male patients in the greater Stockholm area who had survived a myocardial infarction below the age of 45 were examined with regard to medical and psychosocial risk factors 3-6 months after the onset of the infarction. For each patient, a male control subject was randomly selected after matching with regard to age and residence area. In the patient group, coronary angiograms were performed and rated with regard to degree of coronary atherosclerosis. The psychosocial variables were not correlated with degree of coronary atherosclerosis. Excessive work demands combined with boredom at work ("variety" and "intellectual discretion") were significantly more often reported by the patients after adjustment had been made for life style factors. In the multivariate analysis a high LDL/HDL cholesterol ratio, a high cumulative tobacco consumption, high demands in relation to variety at work as well as high demands in relation to influence over work and finally a low alcohol consumption were significant independent predictors of case status. Excessive work demands in themselves did not differentiate cases from controls.

Adult↗
PubMed1986

Type A behaviour, education and psychosocial work characteristics in relation to ischemic heart disease--a case control study of young survivors of myocardial infarction.

The interaction of Type A behaviour, psychosocial work environment and education in relation to medical risk factors for IHD was analyzed in a case-control study of male and female post-MI-patients under age 45. In multivariate analysis LDL/HDL-cholesterol ratio and smoking (explaining 27 and 6% of the variance) emerged as the two most important discriminators of patients from control subjects. The third factor, variety of work tasks, explained 5% of the variance. Type A behaviour ranked as factor no. 7, explaining only 2% of the variance and educational level did not reach statistical significance as an independent explanatory factor. When the sample was divided into men and women with high and low education, most of the patient-control difference in Type A and psychosocial work characteristics was found among highly educated men on one hand and women with a low level of education on the other. Thus Type A behaviour seems to be less important and psychosocial work environment more important in adding psychosocial risk to the medically established risk of IHD.

Achievement↗