Poisoning by organophosphate insecticides. Epidemiology and prevention

In an agrarian environment, exposure to anticholinesterasic insecticides is a potential health problem. Acute or chronic intoxication may cause serious health problems due to its frequency or its severity. Extremadura is, as are other Spanish autonomous regions, mainly a rural environment which means that this problems carries special relevance there. In this article, the authors evaluate the number of cases of intoxication, the validity of the measures taken, and they describe the pedagogical programs which exist dealing with this problem. They review the physiopathological causes of this intoxication, its symptoms and its treatment. The authors reveal the results obtained from a questionnaire given to a group of Extremaduran farmers. Furthermore, the authors provide information to health professionals responsible for the treatment and prevention of this intoxication; the authors consider health education, especially in an agrarian environment, to be one of the most important action plans in order to prevent this intoxication and to reduce its mortality and chronic manifestations due to exposure to these agents.     

Determination of Psychological Stress,Serum Immune Parameters,and Cortisol Levels in Patients With Human Papilloma Virus

PurposeBecause the results of studies investigating the relation between human papilloma virus (HPV) infection and the effects of psychological stress are inconsistent, this study was conducted to expand on previous research by analyzing patient stress levels, serum immune parameters, and cortisol levels in patients with clinical HPV manifestations. It also looked for differences in clinical manifestations of HPV depending on patient level of experienced stress.MethodsThis cross-sectional study included 213 subjects (94 women and 119 men aged ≥18 years; average age, 41 years) with clinical manifestations of HPV infection (165 subjects with extragenital manifestations and 48 with genital manifestations) who were treated at the Department of Dermatovenerology, Karlovac General Hospital, from January 1, 2012, to December 31, 2015. Psychological, neurohormonal and immune parameters (serum values of leukocytes, alpha₂-globulins, beta-globulins, albumins, and proteins), and serum cortisol levels were analyzed. Questionnaires were used to determine patients' perception of stress: the Recent Life Changes Questionnaire, the Perceived Stress Scale, and the Brief Cope Test. One group of subjects had confirmed stressful experiences, defined by the Recent Life Changes Questionnaire as a period of 1 year with at least 500 life change units; the control group included patients with no significant stressful experiences.FindingsPatients with confirmed significant stress experience had a statistically significant higher degree of perception of stress. There were no statistically significant differences in terms of the impact of stress on clinical HPV manifestations (genital and extragenital), sex, lesional duration, or recurrence. In patients with significant stress experience, significantly higher values of leukocytes (6.68 × 10⁹/L), alpha₂-globulins (6.85 g/L), and beta-globulins (7.33 g/L) were observed. Adaptive coping and a lower perception of stress significantly reduced the chances of having extragenital manifestations by 2.63 times. A higher perception of stress significantly increased the likelihood of genital manifestations.ImplicationsAlthough this study found that stress increased the values of leukocytes, alpha₂-globulins, and beta-globulins, no evidence was found that it affected clinical manifestations of HPV infection. The redundancy of the immune system could account for this finding. This study is among the first to investigate the correlation between psychological, neurohormonal, and immune indicators of stress.     

Bipolar disorder: medication adherence and life contentment

Using family stress theory, we examined the influence of family and health stress, level of coping, and internal health locus of control upon the life contentment of individuals diagnosed with bipolar disorder (BPD) who were either adherent or nonadherent to their medication regimens. A survey-interview design was used with a sample of 100 individuals diagnosed with BPD; 50 participants were adherent to their medication and 50 were considered nonadherent. The results indicated that the adherent group had fewer health problems and more resources for coping with stress, possessed a stronger belief that their own behaviors controlled their health status, and had higher life contentment compared to nonadherent participants. For the participants in this study, internal health locus of control had the greatest total effect on life contentment followed by family coping. Implications included the need to comprehensively assess each individual regarding the multiple factors in one's life that influence an effective treatment regimen.     

Modeling employee stress in psychiatric rehabilitation--effects of personal and organizational factors

Increasing stress-associated health problems in Germany often are attributed to problems on the job, in particular to rising work demands. The study includes several stress predictors from other results and from literature in one predictive model for the field of work of "psychiatric rehabilitation".A cross-sectional design was used to measure personal and organizational variables with quantitative standard questionnaires as self-ratings from n=243 pedagogically active employees from various professions. Overall stress and job stress were measured with different instruments.The sample showed above-average overall stress scores along with below-average job stress scores. The multivariate predictive model for explaining the heightened stress shows pathogenetic and salutogenetic main effects for organizational variables such as "gratification crisis" and personal variables such as "occupational self-efficacy expectations" as well as an interaction of both types of variables. There are relevant gender-specific results concerning empathy and differences between professions concerning the extent of occupational self-efficacy.The results are a matter of particular interest for the practice of workplace health promotion as well as for social work schools, the main group in our sample being social workers.     

Preventing sleep problems in infants: a randomized controlled trial

In the pre-school years sleep problems are one of the most common subjects on which parents seek advice from health professionals In the majority of cases a sleepless child causes significant stress within the family, and if parents do not obtain sufficient sleep this can have a detrimental effect on then: physical and emotional well-being In a small number of cases a child who wakes frequently and will not settle back to sleep may be at risk of physical abuse In recent years it has been suggested that it may be possible to prevent sleep problems developing by providing parents with advice in the post-natal period Parents have stated that they find this type of intervention helpful, however, there has been no attempt to establish whether a preventive approach is effective
The aim of this research was to evaluate the efficacy of health education in reducing the incidence of sleep problems Adopting an experimental approach, participants were randomly allocated to a control group or an intervention group Parental knowledge of sleep and settling behaviour was manipulated when the children in the intervention group were 3 months old The sleeping behaviour of the infants in both groups was compared 6 months later, when the children were 9 months old Data was collected from 86 families in the intervention group and 83 families in the control group A comprehensive analysis of the sleeping behaviour demonstrated that a significantly smaller percentage of babies in the intervention group had settling and night-waking difficulties than in the control group     

Ileocecal, colonic, and peritoneal tuberculosis: role of imaging in diagnosis. A case report and literature review

Tuberculosis is a widespread infectious disease that still remains a deadly global health problem and a condition that is life-threatening if misdiagnosed. Extrapulmonary manifestations are prevalent in the endemic areas but limited to the immunocompromised and immigrants in economically developed areas. False diagnostic situations rely on non-specific investigatory findings, the wide spectrum of clinical manifestations, and problems in discriminating between inflammation and neoplasms of the bowel. For an early diagnosis, a high index of suspicion and correlation of clinical and imaging aspects, as well as findings from colonoscopy, tissue biopsy, and microbiologic assessments, are necessary. We present a case of a patient with non-specific abdominal symptoms, mimicking a clinical syndrome of neoplastic impregnation, finally diagnosed as ileal tuberculosis with peritoneal involvement. We stress the importance of ultrasonography as a primary method of investigation, having an important role in raising the suspicion of an infectious bowel disease, as well as the role of contrast-enhanced ultrasound examination.     

Screening for incontinence in a secure psychiatric service for women

Incontinence is associated with mental illness and neuroleptic medications but diagnosis and treatment is often poor or non‐existent. Problems of incontinence are compounded in secure psychiatric services for women by poor health, obesity, and a sedentary lifestyle. Addressing the physical health of this group necessitates a more accurate picture of the nature, incidence, and management of incontinence. A point‐in‐time survey of 108 women who agreed to be interviewed (93%) covered presence, frequency, and nature of incontinence, and information on management case note data was used to gather demographic and previous medical history, comparisons were made between patients with and without problems of incontinence. Findings indicate a problem of incontinence in 48% of women with a dominance of problems of stress and urge enuresis. Of modifiable factors that contribute to enuresis, the current study highlighted the contribution of obesity, smoking and clozapine medication. A further finding was the preference for managing rather than treating problems of incontinence. Actions to improve the detection and treatment of this problem are described.     

Assessment of the relationship between health personnel and caregivers caring for dementia patients. Results of a pilot survey

The characteristics of 129 patients admitted to 2 Nursing Homes (with and without Alzheimer ward) and one Geriatric Rehabilitation Unit and of their caregivers were described in this pilot study. Caregivers were asked to evaluate the quality of care received by the patients. Mental status of patients was assessed with the MM-SE, Functional status with ADL and behaviours with ICS and NPI. The stress of caregivers was evaluated with the Green's Relative Stress Scale. Patients with cognitive problems were admitted because of their illness (32.4%) or because impossible to care for them at home (20%), whilst for patients without cognitive problems difficulties in treatment at home (35.3%) and problems in walking (23.5%) represented the two main categories for admission. Caregivers are mostly women (65%) and the stress level of caregiver of patients with dementia is 22.7 (range 0-60) vs 14.2 of the other group. The overall judgement on the quality of care is good with few exceptions for the relationship with doctors and health personnel, and the level of competence of the health personnel of the Nursing homes without Alzheimer ward. The study was the occasion for a reflection on caregivers' expectations and wishes and for advancing proposals for a better answer to their needs.     

Anticipatory Stress Response in PTSD: Extreme Stress in Children

TOPIC: Anticipatory stress chronically activates the stress response in children with post‐traumatic stress disorder (PTSD). Effects of the allostatic load may begin even before birth in a stressful environment. PURPOSE: The purpose of this paper is to discuss the anticipatory stress response in children with PTSD. The paper discusses the etiology, the impact of the disorder on long‐term health, cognitive and behavioral manifestations, and clinical management and treatment options. SOURCES USED: A review on current literature is presented and includes several key studies. CONCLUSIONS: Anticipatory stress in PTSD has acute and long‐term health implications for the child. The psychiatric nurse plays a key role in preventing the long‐term effects of PTSD.     

The importance of social support for rural mental health

While the mentally ill are considered to be vulnerable as a group, those who are mentally ill and reside in rural communities are at a greater disadvantage due to limited access to health care, a scarcity of resources, and traditional cultural belief systems. Social support has been found to have a direct effect on the well-being of families and individuals. Specific strategies are presented which will assist rural health nurses in providing the support systems necessary to help rural residents in managing and coping with stress and mental health problems.     

Sources of Stress for Nurse Practitioners

The purpose of this study was to identify perceived stressors and manifestations of stress in nurse practitioners practicing in Missouri and California. The greatest sources of stress reported by the entire sample (N=80) were in the categories of time demands and role restrictions. Missouri nurse practitioners found role restriction problems significantly more stressful than California nurse practitioners did. Manifestations of stress fell within the norms of non-psychiatric adults on the Symptom Check List 90-R.     

Silent victims: children exposed to family violence.

Annually an estimated 3 million or more children are exposed to acts of domestic violence between adults in their homes. These children are at risk for abuse themselves as well as other immediate and long-term problems, especially if they have been exposed to repeated episodes of domestic violence. Multiple behavioral manifestations, including anxiety, depression, and posttraumatic stress disorder, may be associated with violence exposure, and it is imperative that school nurses recognize these. All children should be screened for domestic violence exposure at regular intervals, and those who are at risk should have a more thorough health assessment. Planning for the safety of the child, nonoffending caregiver, and siblings and the school nurse involved in the situation is of utmost importance.     

THE IMPORTANCE OF SOCIAL SUPPORT FOR RURAL MENTAL HEALTH

While the mentally ill are considered to be vulnerable as a group, those who are mentally ill and reside in rural communities are at a greater disadvantage due to limited access to health care, a scarcity of resources, and traditional cultural belief systems. Social support has been found to have a direct effect on the well-being of families and individuals. Specific strategies are presented which will assist rural health nurses in providing the support systems necessary to help rural residents in managing and coping with stress and mental health problems.     

Role integration and perceived health in Asian American women caregivers

In this study, role involvement, role integration (including role stress and role satisfaction), and perceived health were examined in 50 Asian American women who were caregivers of aging parents in addition to being wives, mothers, and employees. Their mean age was 47.8 years. Twenty-nine of the participants were Chinese and 21 Filipino, with an average length of caregiving for each group of 11 years. All participants were born outside the United States. Instruments used in the study were translated and back-translated into Chinese and Tagalog and tested for validity and reliability. The association of role involvement, role integration, role stress, and role satisfaction with perceived physical and psychological health in the combined and separate groups was examined. Role involvement was not associated with health in the combined group of caregivers but was associated with overall health in the sample of Chinese women. Role integration was positively associated with all three perceived health measures in the Filipino group but not in the Chinese group. Role satisfaction was consistently high in both groups. Role satisfaction and psychological well-being were significantly correlated for the combined group and for the Filipino caregivers. Total role stress was significantly correlated with overall health and current health only in the combined group. Thus, support that helps to decrease role stress and to increase role satisfaction may be more effective than efforts to decrease the extent of role involvement.     

VDT work duration and musculoskeletal discomfort

Musculoskeletal discomfort, work position, and job stress factors were compared in government office workers grouped according to whether they used video display terminals more or less than 4 hours per day. The results of this study suggest that limits on VDT use to less than 4 hours per day do not necessarily protect against health problems. The occupational health nurse's role in preventive measures useful for alleviating the musculoskeletal health problems of office work are discussed.     

Clinical presentation and therapeutic interventions for posttraumatic stress disorder post-Katrina

It has been almost 2 years since Hurricane Katrina struck the Gulf Coast. These 2 years can be characterized by constant struggle and pain as the people try to reattain some semblance of life as they knew it before Katrina struck. Some have chosen to leave their ancestral homes, homes where they were raised and where they, in turn, raised their own families. Those who did leave are able, in some way, to reestablish some semblance of normality, but those who stayed showed manifestations of and dealt with psychological trauma. These manifestations include regression, inattentiveness, aggressiveness, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer lasting effects may include depression, anxiety, adjustment disorders, and interpersonal or academic difficulties. These postdisaster manifestations can linger or remain hidden until well after the traumatic event and could persist for years. This article presents issues about the effects of Katrina on the mental health of the people of New Orleans. It discusses the profile of posttraumatic stress disorder and presents evidence-based review of interventions the health care provider can implement to care for those who continue to suffer the effects of this horrific disaster.     

Family stress and posttraumatic stress: the impact of military operations on military health care providers

This study uses data from the 2005 Department of Defense Survey of Health-Related Behaviors Among Military Personnel to examine relationships between family stress and posttraumatic stress symptoms across 4 subgroups of Operation Iraqi Freedom-deployed (i.e., war in Iraq) or Operation Enduring Freedom-deployed (i.e., war in Afghanistan) active-duty military service members. Results suggest the following: (a) the greatest positive correlation of family stressors with posttraumatic stress symptoms was found within the military health care officer group, and (b) these military health care officers differed in family stressors mediating posttraumatic stress with divorce and financial problems accounting for significant and unique portions of the variance. Implications for care of service members and their families are discussed.     

Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women

This article describes and evaluates initial steps of a gender-sensitive, youth-friendly group intervention model designed for teenage girls and young women who experience stress-related or psychosomatic problems. Fifty-four young women (16–25 years of age) participated in a gender-sensitive physiotherapy stress management course at a youth health center. Inclusion criteria were self-defined stress-related problems and a wish to participate in the group intervention. Measurements of aspects of body perception, self-image, multiple somatic problems, and mental health symptom areas were assessed both before and after intervention with the Body Perception Questionnaire ad modum Schiöler, social analysis of social behavior, and Adult Self-Report scale. Significant positive changes were found in aspects of body perception, self-image, and mental health and somatic symptoms. The changes were most significant in lower internalization of anxiety and depression symptoms. Symptoms such as headaches and sleeping problems decreased. Participants were more satisfied with their bodies and more able to listen to body signals. Among cognitive issues, significant change occurred in thought problems, but not in attention problems. The intervention model needs further evaluation in controlled trials, but is promising and should be developed further in other physiotherapy settings and subgroups of young people.     

Afghan Health Education Project: A Community Survey

Abstract This study assessed the health concerns and needs for health education in the Afghan refugee and immigrant community of the San Francisco Bay Area. The study used a telephone survey, seven community meetings and a survey administered to 196 Afghan families through face-to-face interviews. Data were analyzed qualitatively and statistically. Health problems of most concern are mental health problems and stress related to past refugee trauma and loss, current occupational and economic problems, and culture conflict. Physical health problems include heart disease, diabetes and dental problems. Needed health education topics include dealing with stress, heart health, nutrition, raising children in the United States (particularly adolescents), aging in the United States, and diabetes. Using coalition building and involving Afghans in their community assessment, we found that the Afghan community is eager for culture- and language-appropriate health education programs through videos, television, lectures, and written materials. Brief health education talks in community meetings and a health fair revealed enthusiasm and willingness to consider health promotion and disease-prevention practices.