Stress symptoms, burnout and suicidal thoughts of Finnish physicians.
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Adult↗
Biomedical subjects
J Juntunen
Publications and source records attributed to J Juntunen.
Exposure to organic solvents and neuropsychological dysfunction: a study on monozygotic twins.
Twenty one monozygotic twins exposed to organic solvents were compared with their non-exposed cotwins by performance in psychological tests. A further 28 monozygotic twin pairs were examined as a reference group. The study used 11 tests, 10 of which had shown an effect in previous studies on the results of exposure to solvents. Paired comparisons of the test scores showed the exposed twins to have lower performance in associative learning, digit span, and block design. These results agree with two previous studies that used a similar set of tests. Contrary to some other studies, psychomotor speed was not affected, but the results indicated a marginal effect on the control of hand movements. Further comparison of subgroups with a low and a high exposure showed the prevalence of subtle neuropsychological dysfunction to be greater among the more exposed twins.
Adult↗
[Traffic and brain].
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Accidents, Traffic↗
Viral antibodies in multiple sclerosis. A nationwide co-twin study.
Serum viral antibody titers against 21 viruses were studied in 19 of 23 same-sex twin pairs with multiple sclerosis derived from the Finnish Twin Cohort. Thorough neurologic examinations showed two monozygotic pairs to be concordant, whereas all dizygotic pairs were discordant. Special attention was given to measles, mumps, and rubella viruses, against which the antibody levels were determined with the complement fixation, hemagglutination inhibition, hemolysis-ingel, and enzyme immunoassay methods. Epstein-Barr virus antibody levels were determined by enzyme assay. In pairwise comparisons, the measles, mumps, and Epstein-Barr virus-IgG antibody levels were more often elevated in the patients with multiple sclerosis, compared with the healthy co-twins. The same antibody levels were more often above the median in the diseased twin, compared with the healthy twin, but the difference was not significant. No human T-cell lymphotropic virus type I antibodies were found in any of the individuals examined. The total IgG, IgA, and IgM levels did not differ between the diseased and healthy subjects. The HLA types, severity of the disease, and cell-mediated immunity parameters did not influence antibody levels.
Antibodies, Viral↗
Stress symptoms, burnout and suicidal thoughts in Finnish physicians.
Stress symptoms, burnout and suicidal thoughts in Finnish physicians were studied using a questionnaire. The questionnaire, containing 99 questions or groups of questions, was mailed to 3,496 physicians representative, as regards age, sex, specialization and employment, of all active physicians in Finland. Altogether, 2,671 physicians (76%) responded. Stress symptoms in male physicians were similar to those in male managers. In female physicians they were slightly less than in female white-collar workers. In male specialists highest burnout indices were found in general practice and occupational health; psychiatry and child psychiatry; internal medicine, oncology, pulmonary diseases, and dermatology and venereology. In female specialists they occurred in general practice and occupational health; radiology; internal medicine, neurology, pulmonary diseases, and dermatology and venereology. Non-specialists had higher burnout scores than specialists for both sexes. Highest burnout scores in both men and women occurred in those working in municipal health centres. Lowest scores occurred in those working in private practice, universities, research institutes, and public offices and organizations. Suicidal intent tended to be commoner in physicians than in the general population. It was also commoner in female (26%) than in male (22%) physicians. The results indicate a polarization between "higher burnout specialities", often dealing with chronically ill, incurable or dying patients (e.g. specialties such as oncology, pulmonary diseases and psychiatry), on the one hand and "lower burnout specialties", often dealing with curable diseases and favourable prognoses (e.g. specialties such as obstetrics and gynaecology, otorhinolaryngology and ophthalmology), on the other.
Adult↗
Lymphocyte activation in discordant multiple sclerosis twin pairs.
Phytohemagglutinin-induced lymphocyte activation sequence was studied in monozygotic and dizygotic discordant multiple sclerosis (MS) twin pairs in a quiescent disease phase. The study group included all available 11 pairs listed in a nation-wide twin register. Lymphocyte activation markers, DNA synthesis and gamma-interferon secretion were studied using avidin-biotin-peroxidase complex (ABC) stainings, [3H]thymidine incorporation, and a solid-phase double-antibody immunoradiometric assay (IRMA), respectively. The level and kinetics of interleukin-2 receptor expression, DNA synthesis, gamma-interferon secretion, and major histocompatibility complex (MHC) locus II antigen expression were similar (Wilcoxon's test for paired samples) in both the diseased and healthy monozygotic and dizygotic twins. Our results suggest that the cell-mediated immune system may not be primarily at fault, but rather that both MS itself and its exacerbations are caused by an unknown triggering stimulus facing a properly functioning immune system.
Antigens, CD↗
MS and SLE in twins of successive generations.
During a nationwide twin study on multiple sclerosis (MS) in Finland a dizygotic pair discordant for MS was found. The affected co-twin had dizygotic twin daughters. The affected co-twin of the second generation had systemic lupus erythematosus (SLE). Both pairs were thoroughly examined. No evidence of CNS involvement in the healthy co-twins was found. In pairwise comparisons, virus-specific IgG antibodies to measles and mumps were significantly increased in the MS patient whereas the same was true for rubella in the SLE patient. Both MS and SLE patient expressed HLA alleles most often found to be associated with these disorders. Reversed CD4/CD8 ratios were observed in both MS and SLE patient. No difference in interleukin-2 receptor expression were found but gamma-interferon secretion in the MS patient showed marked increase whereas that of the SLE patient was of the same magnitude as in the healthy members. A different triggering stimulus rather than the dissimilarity in the immunogenetic predisposition may be decisive as to whether or not they develop MS or SLE.
Adult↗
Vibration sensitivity thresholds: methodological considerations.
Vibration sensitivity thresholds were studied in 12 healthy volunteers using 25, 50, 100 and 250 s-1 stimulus frequencies from an instrument with automated and manual modes ('Vibra Mk II'). For the automated mode, a forced choice principle was adopted. All measurements were performed from both the knuckle of the IInd metacarpophalangeal joint and the medial malleolus on four successive days. In addition, a conventional tuning fork method for vibration sensitivity was applied. The results show high interindividual and intraindividual variation in all measurements. The threshold values measured by the automated system were significantly lower than those by manual system at all frequencies. The largest variation was seen at 250 s-1 and the most uniform values at 100 s-1. There was a clear difference between the values from knuckle and medial malleolus, the values in the foot being lower. There was no learning effect. Clear age-related increase in vibration thresholds was observed. Conventional tuning fork-method showed clear differences in vibration sensitivity between hand and foot, in accordance with computer assisted method. The higher sensitivity of the automated method compared to the manual makes this the method of choice, although further investigations to finish the method and to build up a broader reference material is desirable.
Adult↗
Occupational exposure to solvents and cerebellar, brainstem and vestibular functions.
Forty-eight persons (age 44, SD 9 years) exposed to paint solvents and 40 nonexposed referents (age 45, SD 9 years) were examined. The duration of exposure was 4 to 30 (mean 20) years and the life-time exposure level was estimated to have been 10 to 330 (mean 60%) of the hygienic standard. The methods used were a neurological examination, electroencephalography, brainstem auditory-evoked potentials, electronystagmography, and posturography. Life-time exposure was estimated on the basis of a detailed occupational history and environmental measurements made at the work places over several years. The average weekly alcohol consumption was established in a detailed interview. Due to the small number of subjects examined, the study was inconclusive. The findings classified as abnormal were slightly more common in the exposed than in the referents, and in the persons who used alcohol than in the non-users. The differences were not statistically significant, and no exposure-response relationships were found.
Adult↗
Serum selenium concentration, glutathione peroxidase activity and lipid peroxides in a co-twin control study on multiple sclerosis.
Serum selenium concentration, glutathione peroxidase activity and lipid peroxides were determined in patients with multiple sclerosis (MS). The series consisted of 13 same-sexed twin pairs derived from the Finnish Twin Cohort of 15,815 pairs. Fourteen subjects had a definite and 1 a probable MS, and their 11 co-twins showed no evidence of central nervous system disease. No statistical differences were observed, but the 3 patients with active progressive MS had a higher mean level of lipid peroxides than the rest of the patients. We suggest that serum lipid peroxidation may be involved in the activity of MS.
Adult↗
Electronystagmographic findings among 127 dizzy patients: correlation with the aetiology of dizziness.
Electronystagmography (ENG) was performed on 127 dizzy patients and the findings were compared with the diagnosis obtained with a comprehensive neurological test battery. ENG was found to be abnormal in 49 (39%) of the patients: 19 with unilateral vestibular hyporeactivity, eight with directional preponderance, 12 with spontaneous or undirectional positional nystagmus, eight with abnormal smooth pursuit, and 13 with other abnormalities. Among the patients with abnormal ENGs, established central nervous system lesions were found in 28 cases (19 of these infratentorial lesions); nine peripheral vestibular lesions and five undefined vestibular lesions were found. Patients with normal ENGs showed fewer peripheral vestibular lesions and more dizziness of psychogenic aetiology. Almost half the patients with infratentorial lesions had normal ENGs. Patients with rotatory vertigo had fewer ENG abnormalities than those with other types of dizziness. These results suggest that ENG alone is of limited value in the diagnosis of dizziness. A comprehensive test battery is needed to establish the diagnosis.
Adult↗
Posturography and the dizzy patient: a neurological study of 133 patients.
A total of 133 dizzy patients under the age of 60 years were examined using a stable balance plate (posturography, PG). All the patients were thoroughly examined neurologically before PG and classified into 7 diagnostic categories. Comparison was made between these categories and PG results. The referent group consisted of 116 healthy individuals. The patients with CNS lesions had more body sway than controls or the patients with peripheral vestibular lesions, whose sway did not significantly differ from that of the controls. The PG parameters that most clearly separated the patients from the controls were the total length of the movement of the center of gravity, and the sway in lateral and antero-posterior directions. Analysis of the frequency of the sway or calculation of the Romberg index did not reveal significant differences between the categories. Men swayed more than women. Age did not correlate with PG results. Stable posturography offers useful quantitative supplementary information as a part of the examination of a dizzy patient. Increased body sway suggests a lesion in the CNS.
Adolescent↗
Multiple sclerosis and occupational exposure to chemicals: a co-twin control study of a nationwide series of twins.
From the Finnish Twin Cohort (n = 27,100 pairs with known zygosity) all cases of diagnosed multiple sclerosis (MS) were reviewed and those with clinically verified MS were invited for further examinations at the Institute of Occupational Health, Helsinki, with their co-twins. Twenty one cases (19 pairs, of which 17 were discordant) fulfilled the strict criteria of MS. Detailed occupational history showed exposure to a mixture of solvents in six subjects, to lead in one, and to trichloroethylene in one. Of these seven, two monozygotic twins had MS whereas the other five cases were healthy co-twins. These results do not support a causal association between occupational exposure to chemicals and the aetiopathogenesis of MS.
Adult↗
Incidence of Guillain-Barré syndrome during a nationwide oral poliovirus vaccine campaign.
Concomitant with a nationwide oral poliovirus vaccine (OPV) campaign in Finland in 1985, an unexpected rise in the number of patients hospitalized with the Guillain-Barré syndrome (GBS) occurred. An analysis based on hospital records covering a population of 1.17 million and 6 years revealed a significantly increased incidence of GBS coinciding with the OPV campaign. We carefully examined 10 cases with onset of GBS within 10 weeks after immunization. Only 4 patients could recall recent symptomatic infection, and we found no specific agent in these cases. Our study suggests that live-attenuated polioviruses may, like other infectious viruses, sometimes trigger the GBS.
Adolescent↗
Doctors' drinking habits and consumption of alcohol.
Alcohol consumption and drinking habits among Finnish doctors were studied as part of a survey of stress and burnout. A questionnaire containing 99 questions or groups of questions was sent to all 3496 practising doctors aged under 66 randomly selected from the registry of the Finnish Medical Association. Altogether 2671 doctors (76%) responded; this sample was representative of the Finnish medical profession. The average weekly consumption of alcohol during the past year and various aspects of drinking behaviour were assessed, and the presence or absence of symptoms and diseases often encountered among heavy drinkers and addicts was determined. The data were analysed separately for men and women, for those aged less than or equal to 40 and greater than 40, and for the men with high and low alcohol consumption and with high and low scores on the index of drinking habits. Selected variables related to work, stress, and coping were correlated with alcohol consumption and drinking behaviour. The median consumption of alcohol among male doctors was 4876 g (6.2 litres) and among female doctors 2226 g (2.8 litres) of absolute alcohol per person per year and was higher in those aged over 40. Beer was most commonly drunk by men and wine by women. Increased alcohol consumption was associated with older age, disappointment with career, heavy smoking, use of benzodiazepines, stress and burnout symptoms, suicidal thoughts, general dissatisfaction, and diseases related to alcohol. Drinking habits were heavier among doctors working in community health centres, those taking long sick leaves, younger doctors disappointed with their careers or the atmosphere at work, and older doctors immersed in their work. Alcohol consumption among doctors seems to be higher than that of the general population in Finland, and heavy drinking seems to be associated with stress and burnout.
Adult↗
Genetic susceptibility to multiple sclerosis. A co-twin study of a nationwide series.
The problems of differentiation between environmental and genetic influences on the development of multiple sclerosis are well known. Twin studies may provide valuable information on this question. However, most published twin series are selected and no through clinical twin studies based on epidemiologic series have been carried out. In this study, all available same-sex twin pairs with clinically definite multiple sclerosis derived from the Finnish Twin Cohort of 15815 pairs were studied by clinical evaluation, magnetic resonance imaging, and visual and auditory evoked responses. The mean length of follow-up of the pairs after the onset of symptoms of multiple sclerosis was 20 years. Two of the seven monozygotic pairs were concordant; one was definitely so, and in the other, the co-twin of the index case had, in addition to clinical findings, white matter changes suggestive of multiple sclerosis in magnetic resonance imaging and abnormal visual evoked responses. All six dizygotic pairs were discordant. The frequency of the HLA antigen DR2 in probands (69%) was significantly increased, but the distribution among the healthy subjects and patients showed nonsignificant differences. The results indicate a genetic influence on the susceptibility to multiple sclerosis, although still unknown genetic determinants are possible involved.
Adult↗
Diagnostic value of electroencephalography and brainstem auditory evoked potentials in dizziness.
Electroencephalogram (EEG) and brainstem auditory evoked potentials (BAEP) were recorded from 142 dizzy patients. The results were compared with those obtained by other neurological examinations of the same patients. Thirty-three percent (N = 44) of the patients had an abnormal EEG: 21% (28) showed focal abnormality, 12% (16) irritative features, and 10% (13) generalized disturbance. There were no differences in the distribution of abnormal EEGs in different diagnostic categories of dizziness, but irritative findings were not found in the cases of peripheral vestibular or psychogenic disturbances. EEG findings in 3 patients suggested temporal epilepsy, correlating with the clinical picture. BAEPs were abnormal in 18% (N = 21) of the recordings. There were 3 cases of MS and 5 ischaemic lesions in the vertebro-basilar region. Twelve of the 13 other patients with abnormal BAEP showed evidence of CNS pathology with other methods. EEG abnormalities were mostly non-specific; however, the irritative findings suggested cerebral pathology, such as epilepsy. An abnormal BAEP offers reliable evidence for brainstem lesion and is thus a useful examination in dizziness.
Adolescent↗
Postural body sway and exposure to high-energy impulse noise.
Detailed neurological and audiological examinations and body-sway measurements with a stable platform were carried out on 60 subjects who had been exposed to high-energy intermittent noise from firearms and had various degrees of noise-induced hearing loss. The results were compared with those for 115 healthy controls. The exposed subjects showed significantly more body sway, estimated as movement of the centre of gravity in the horizontal plane, than the controls. This swaying correlated poorly with the recalled level of noise exposure, though subjects with more severe hearing loss (by audiometric deterioration of high-frequency sound, 4 kHz and 6 kHz) showed more sway than those with less severe hearing loss. Age was not significantly correlated with body sway among the controls but men seemed to sway more than women. These results suggest subclinical disturbance of the vestibular system among subjects with impulse-noise-induced hearing loss.
Adult↗