The impact of anticipation of job loss on psychological distress and worksite blood pressure.

The impact of occupational stressful life events on psychological distress and blood pressure was examined among employees of a major New York City brokerage firm undergoing massive layoffs. One hundred thirty-nine employees of the firm, who had participated in a blood pressure screening in 1986, were rescreened during the period of layoffs within their company in 1989. About two-thirds of the 139 employees reported being "somewhat" or "very" anxious or upset in 1989 during the period of layoffs, and psychological distress was significantly elevated among those employees reporting possible or definite layoff or job change and/or difficulty in obtaining a comparable job. However, we found no increase in overall blood pressure level, and no effect of anticipation of job loss on 1989 blood pressure when controlling for 1986 blood pressure level, age, body mass index, work hours, and other demographic variables. On the other hand, employment in a department sold to another employer on the day of screening, as well as employment in a clerical job title, were both associated with significant increases in diastolic blood pressure of about 5 mm Hg.     

Selling mental health services to businesses: concepts and strategies.

In order to interest businesses in buying mental health services for their employees, professionals must be able to speak the businessman's language and market their product--mental health services. They must emphasize the cost-effectiveness of mental health care and explain how the business can benefit from including such services in the company's benefits package. The authors describe some concepts and strategies they found helpful when they ventured into the business community to "sell" the services of their community mental health center. They discuss such factors as the need to present a polished, professional image and to gear services to the needs of the particular employer and his employees.     

Ursachen und Folgen der Nachkriegszunahme der Typhus abdominalis- und Paratyphus-B-Erkrankungen in Ostholstein

Zusammenfassung Es wurde gezeigt, daß in Ostholstein nach dem Kriege ein steiler Anstieg der Typhus abdominalis- und Paratyphus-B-Erkrankungen erfolgt ist. Er ist durch die aus den ostdeutschen Gebieten eingewanderte Bevölkerung und durch bisher unbekannte Bacillenträger hervorgerufen. Dagegen haben das nach dem Kriege eingerichtete Kriegsgefangenenlager sowie die Auslanderlager keine Bedeutung für die Ausbreitung gehabt. Die Erkrankungen haben sich vor allem auf die früher von Typhus und Paratyphus B nicht betroffene und daher nicht immunisierte einheimische Bevölkerung, dabei besonders auf die Frauen ausgewirkt, während die Männer infolge der Immunisierung durch Schutzimpfungen während des Wehrdienstes seltener erkrankt sind. Diese Voraussetzungen können aber durch spezielle Bedingungen bei der Verbreitung der Krankheitshäufungen überdeckt werden. Bei den Typhus-erkrankungen handelt es sich ätiologisch einheitlich um Xylose-positive Stämme, also nicht um die anscheinend im Osten sehr selten vorkommenden Stämme mit verzögerter Xylosevergärung. Für den Nachweis der Dauerausscheider gibt die Vi-Agglutination des Serums einen Hinweis. Es wäre daher zweckmäßig, bei der Kontrolle von Küchenpersonal auf Bacillenträger (Runderlaß v. 10. 12. 1936 RMBl. IV 1542) die Untersuchungen in dieser Richtung zu ergänzen. Ein Einfluß der Ernährung auf die Titerhöhe ließ sich nicht beweisen. Dagegen hat die Ernährung durch ihren Einfluß auf den Kreislauf eine Bedeutung für den Krankheitsverlauf und somit auf die Todesursache.     

Factors influencing the acceleration of human factor XIa inactivation by antithrombin III

Controversy exists in the literature concerning the potentiating effect of heparin on the inactivation rate of factor XIa by antithrombin III (AT III) in both purified systems and in plasma. We have analyzed the factors that could influence this reaction and found that ionic strength of the medium, as well as the type and concentration of the heparin preparations accounted for the major discrepancies in the literature. At I = 0.43 N, a preparation of bovine lung heparin at 1 U/mL did not augment the inactivation rate of factor XIa by inhibitors in plasma or by purified AT III. However, when ionic strength was decreased, a progressive increase in the potentiating effect was observed, reaching 6.5-fold at I = 0.15 N. At saturating concentrations of heparin, which results in the formation of 100% AT III-heparin complex, (greater than ten-fold molar excess over AT III) in purified systems, all heparin preparations (porcine, bovine, low molecular weight [LMW], and high affinity) yielded an approximately 30-fold augmentation of the factor XIa inactivation rate. However, when heparin was less than saturating, we observed that various heparin preparations affected the AT III-induced inactivation of factor XIa to different degrees even though they exhibited the same inhibitory activity (1 U/mL) against thrombin. This variation resulted from differences in the number of AT III binding sites in each heparin preparation, despite a similar Kd for each. Addition of high molecular weight kininogen (HK) to AT III-heparin complexes did not enhance their ability to inhibit factor XIa, and high concentrations of HK decreased the inactivation rate. A high therapeutic dose of heparin only permits the formation of 2.5% to 16.5% of the AT III-heparin complexes that can be achieved at saturation. We observed that 1 U/mL heparin (bovine lung heparin) (high therapeutic concentration) in virtually undiluted plasma only accelerated the inactivation rate of factor XIa (in the absence of other active enzymes) less than two-fold. These new observations further support our previous conclusion that therapeutic levels of heparin have little to no influence on the inactivation rate of factor XIa in plasma.     

Systemic, left ventricular and coronary hemodynamic effects of intravenous diltiazem in coronary artery disease

Systemic and coronary hemodynamic effects of intravenous diltiazem, administered as a bolus of 250 micrograms/kg followed by an infusion of 1.4 micrograms/kg/min, were examined in 14 patients with effort angina. There was no change in heart rate despite significant decreases in systolic, diastolic and mean systemic pressures (13%, 10% and 11%, respectively, all p less than 0.01). The blood pressure decrease was closely correlated with the initial blood pressure (r = 0.81, p less than 0.05). Neither left ventricular end-diastolic pressure nor peak dP/dt changed significantly, but peripheral vascular resistance decreased 16% (p less than 0.001) and stroke volume index increased 10% (p less than 0.05). The pressure-rate product decreased 15% (p less than 0.005), but coronary blood flow was maintained as coronary resistance decreased 14% (p less than 0.025). Diltiazem increased regional coronary flow in some patients. Thus, intravenous diltiazem dilates coronary and systemic resistance vessels, without an increase in heart rate, favorably altering indexes of myocardial oxygen supply and demand.     

Medizinische Beurteilungskriterien zu bandscheibenbedingten Berufskrankheiten der Lendenwirbelsäule (I)

Occupational diseases Nos. 2108 and 2110 correspond to intervertebral disc-related diseases of the lumbar spine from many years of carrying or lifting heavy loads, occupations in extreme postures of full flexion or oscillation of the whole body when seated, and which compel the cessation of all activities which are or could be the cause for the origin, exacerbation or recurrence of the disease. These occupational diseases came into force at the start of 1993, but there have been considerable problems in their implementation. The present Part I of the contribution is the result of the work of an interdisciplinary study group and contains medical criteria for the assessment of possibly strain-related clinical characteristics and the evaluation of other possible causes. Part II is to be published in Volume 4/2005 and will deal with questions related to forced cessation and to the assessment of the loss of earning ability. Agreement was reached in many areas related to the assessment of occupational claims. This should allow for evidence-based decision making in the future for the occupational diseases Nos. 2108 and 2110.