Are occupational stress levels predictive of ambulatory blood pressure in British GPs? An exploratory study.

BACKGROUND: Occupational stress has been implicated as an independent risk factor in the aetiology of coronary heart disease and increased hypertensive risk in a number of occupations. Despite the large number of studies into GP stress, none have employed an objective physiological stress correlate. OBJECTIVES: We conducted an exploratory study to investigate whether self-reported occupational stress levels as measured by the General Practitioner Stress Index (GPSI) were predictive of ambulatory blood pressure (ABP) using a Spacelabs 90207 in a sample of British GPs. METHOD: Twenty-seven GPs (17 males, 10 females) participated in the study. Each GP wore an ABP monitor on a normal workday and non-workday. All GPs completed the GPSI before returning the ABP monitors. Demographic data were also collected. RESULTS: Stress associated with 'interpersonal and organizational change' emerged from the stepwise multiple regression analysis as the only significant predictor of ABP, explaining 21% of the variance in workday systolic blood pressure, 26% during the workday evening and 19% during the non-workday. For diastolic blood pressure, the same variable explained 29% of the variability during the workday and 17% during the non-workday. No significant gender differences were found on any of the ABP measures. CONCLUSIONS: For the first time in GP stress research, our findings established that higher levels of self-reported occupational stress are predictive of greater ABP in British GPs. More detailed psychophysiological research and stress management interventions are required to isolate the effects of occupational stress in British GPs.

Comments on 'Call for a follow-up study of experiments on long-term deprivation of human infants' by Micha Razel.

Razel's examination of the early work of McGraw and the Dennises puts a heavy requirement on studies of single subjects and on some possible interpretations for which, unfortunately, documentation is insufficient. Further, the Dennises placed more emphasis on the autotelic quality of motor mastery than Razel notes. Rather than looking for these persons whose behavior was studied long ago, direct study of motor mastery by systematic provision of enrichment conditions during early development is more likely to be instructive and a better use of scientific resources.

Rate of mortality for elderly patients after fracture of the hip in the 1980's.

At an average follow-up of 2.1 years, we reviewed the records of 241 patients who had had a fracture of the hip. The average age of the patients was 75.4 years. The rate of mortality one year after the fracture was 21.6 per cent for the total group, 8.0 per cent for the low-risk group, and 49.4 per cent for the high-risk group. The standard mortality ratio was six times higher for the high-risk group than for the general population (individuals who did not have a fracture), matched for age. It was highest for patients who were less than seventy years old and lowest for those who were older than eighty. However, in the second year after the fracture, the standard mortality ratio approached unity--that is, the rate of mortality approached that of the general population. The results suggest that there is an inverse relationship between mortality and advanced age and that the impact of a fracture of the hip on mortality is seen primarily in the first year after injury.

The immotile cilia syndrome--one cause of persistent upper respiratory tract infection.

Four patients with persistent recurrent upper respiratory tract infections are presented. Electron microscopic studies of respiratory mucosal biopsies from these patients reveal ultrastructural abnormalities of cilia consisting of partial to complete loss of dynein arms, radial spoke disruption, and compound cilia. The concept of immotile cilia as an important cause of recurrent infections is receiving more attention. This study stresses the need for simple, rapid screening tests for cilial activity followed by electron microscopic evaluation in selected cases.