Alexithymia, risk factor or consequence of work-related stress?

BACKGROUND: Primary alexithymia has been proposed as a trait-like risk factor for various psychiatric disorders. Alternatively, secondary alexithymia has been conceptualized as an inadequate coping reaction to a stressful situation. This study investigated the level and the type of alexithymia associated with occupational stress. METHOD: On 2 occasions, 69 patients with work-related stress and 62 healthy participants completed self-report instruments to measure alexithymia (20-item Toronto Alexithymia Scale), burnout complaints (Maslach Burnout Inventory) and general distress complaints (Depression Anxiety Stress Scales, Checklist Individual Strength). Group differences in alexithymia were analyzed using ANOVAs. The type of alexithymia was investigated by (a) determining absolute and relative stability, (b) exploring state dependence by adjusting alexithymia for burnout and distress complaints and (c) associating recovery of complaints with change in alexithymia. RESULTS: Alexithymia was significantly elevated among patients. In the patient group, absolute stability of two alexithymia dimensions (identifying feelings, describing feelings) and relative stability of one alexithymia dimension (identifying feelings) was lower than in the healthy group. Cross-sectional group differences became small and nonsignificant after adjustment for distress complaints. Among patients, change in alexithymia was moderately associated with symptom recovery. CONCLUSION: Elevated alexithymia among patients with occupational stress is highly state dependent, which indicates the presence of secondary alexithymia.

Physiological differences between burnout patients and healthy controls: blood pressure, heart rate, and cortisol responses.

OBJECTIVES: To investigate differences between burnout patients and healthy controls regarding basal physiological values and physiological stress responses. Measures of the sympathetic-adrenergic-medullary (SAM) axis and the hypothalamic-pituitary-adrenal (HPA) axis were examined. METHODS: SAM axis and HPA axis activity was compared between 22 burnout patients and 23 healthy controls. SAM axis activity was measured by means of heart rate (HR) and blood pressure (BP). HPA axis activity was investigated by means of salivary cortisol levels. Resting levels of HR, BP, and cortisol were determined as well as reactivity and recovery of these measures during a laboratory session involving mental arithmetic and speech tasks. In addition, morning levels of cortisol were determined. RESULTS: Burnout patients showed higher resting HR than healthy controls. BP resting values did not differ between burnout patients and healthy controls, nor did cardiovascular reactivity and recovery measurements during the laboratory session. Basal cortisol levels and cortisol reactivity and recovery measures were similar for burnout patients and healthy controls. However, burnout patients showed elevated cortisol levels during the first hour after awakening in comparison to healthy controls. CONCLUSIONS: The findings provided limited proof that SAM axis and HPA axis are disturbed among burnout patients. Elevated HR and elevated early morning cortisol levels may be indicative of sustained activation.

Effects of health information in youth and young adulthood on risk factors for chronic diseases--20-year study results from the Amsterdam Growth and Health Longitudinal Study.

In the Amsterdam Growth and Health Longitudinal Study (AGAHLS) biological risk factors for chronic diseases were measured on eight separate occasions over a period of 20 years in a group of apparently healthy males and females (n = 164). Data were first collected from participants at 13 years of age. At each of the eight measurements, a medical checkup was performed and participants were given information about their current health status based on their personal biological risk factor profile (cholesterol, blood pressure, body composition, and physical fitness). A comparable group (n = 113) was measured on two occasions only: at age 13 and again at age 33. It was hypothesized that the group with eight measurements would present a more favorable 20-year development of the risk factors than the group with only two measurements. In the present article the six additional measurements with personal feedback of one's health status were perceived as an "intervention," even though the AGAHLS never intended to improve the lifestyle or health of its subjects. The intervention appeared to have had a positive effect on body fat distribution and, in men, on systolic blood pressure. However, it was expected that these significant results were not true effects of the intervention, but that they were type-I errors. For the other variables, total cholesterol, high-density lipoprotein cholesterol, and the ratio between these two, for the sum of four skinfolds, diastolic blood pressure, neuromotor fitness, and for maximal oxygen uptake, the 20-year development did not differ between the two groups. Thus, the effects of a 20-year health measurement and information intervention begun in youth on biologic risk factors for chronic diseases were limited. The absence of clear significant findings may be due to the low contrast between the two groups, as only six intervention measurements were conducted over a period of 20 years. Another reason may be that the young and relatively healthy population under study here was not amenable to changing their fitness and health.

Effects of health information in youth on adult physical activity: 20-year study results from the Amsterdam growth and health longitudinal study.

In the Amsterdam Growth and Health Longitudinal Study (AGAHLS), a group of apparently healthy males and females (n = 200) were interviewed about their physical activities on eight separate occasions over a period of 20 years between 13 and 33 years of age (multi-measured group: MM). Information about their health was given based on their personally measured lifestyle (activity, diet, smoking) and biological risk characteristics for chronic diseases (medical check-ups). A comparable group of boys and girls (n = 200) was only measured on two occasions (bi-measured group: BM): at 13 and 33 years. Physical activity was estimated with a structured interview. Total physical activity and sports activity were estimated in three intensity levels (light, moderate, and heavy). It was hypothesized that the eight repeated medical check-ups with health information in the MM group would result in a healthier lifestyle with respect to the determinants and levels of habitual physical activity compared to the BM group. Contrary to the hypothesis, males and females in the BM group showed a significantly higher increase or a lower decrease in physical activities compared to the MM group. This negative effect on the physical activity pattern at 33 years in the MM group may have been caused by more underreporting of physical activities than in the BM group. In conclusion, there does not appear to be a significant effect of long-term (multi-measured) health information with medical check-ups during adolescence and young adulthood on level of physical activity in males and females at 33 years of age.

Effects of health measurements and health information in youth and young adulthood in dietary intake--20-y study results from the Amsterdam Growth and Health Longitudinal Study.

BACKGROUND: The Amsterdam Growth and Health Longitudinal Study (AGAHLS) is a 20 y observational study concerning biological, psychological and lifestyle risk factors for cardiovascular disease and osteoporosis. In the AGAHLS two cohorts can be distinguished: the so-called Multi-Measurement Group (MMG), which received eight repeated measurements, and a Bi-Measurement Group (BMG), which received two measurements, one at the beginning and one at the end of the 20 y period. OBJECTIVE: In health-related longitudinal research, the outcomes of the study may be influenced by the measurements themselves and the health information provided. It was hypothesized that the repeated measurements and the health information given to the MMG would result in a more healthy dietary intake in comparison to the BMG. DESIGN: The MMG consisted of 164 subjects and the BMG consisted of 90 subjects. At the start of the study, subjects were teenagers of 13-y-old. The hypothesis was tested with use of regression analysis, analysing group differences in mean individual change scores. RESULTS: Only the MMG showed a significantly larger decrease in the intake of mono- and disaccharides compared to the BMG. CONCLUSIONS: The effect of the repeated measurements and the health information provided on dietary intake was relatively small, since it was only one out of the 14 nutrients that differed between the MMG and the BMG.

Personality characteristics and alcohol consumption: longitudinal analyses in men and women followed from ages 13 to 32.

OBJECTIVE: The purpose of the present study was to investigate the relation between personality characteristics and alcohol consumption. Using a general population of young and generally healthy men and women, the focus was not on alcoholism but on the full scope of alcohol consumption, including abstinence and moderate levels of consumption. Modification of the relation between personality and alcohol consumption by gender, age and type of beverage was investigated. METHOD: The population consisted of 483 (259 female) subjects from the Amsterdam Growth and Health Longitudinal Study; they were aged 13 to 32 years over the 20-year course of the study, during which span measurements were taken between two and seven times. The longitudinal relation between five subscales of the Dutch Personality Inventory (DPI) and alcohol consumption were assessed with generalized estimating equations. RESULTS: Low prevalence of heavy alcohol consumption was found in this population. Abstinence from alcohol was more common among subjects who scored higher on Social Inadequacy, Rigidity and Self-sufficiency subscales. The amount of alcohol consumed was higher in drinkers who scored low on Rigidity and Social Inadequacy. Gender, age and type of alcoholic beverage modified some of the found relationships (e.g., adult women who scored high on Dominance were more likely to be the firmer wine drinkers). No significant relationships were found between alcohol consumption and the DPI Inadequacy subscale. CONCLUSIONS: Alcohol consumption was associated with lower scores on Social Inadequacy, Rigidity and Self-sufficiency.

Adolescent motor skill and performance: is physical activity in adolescence related to adult physical fitness?

In the Amsterdam Growth and Health Longitudinal Study (AGAHLS), a cohort of about 400 boys and girls (mean age 13 years) were followed over a period of 20 years. Over that period repeated measurements were done of body dimensions (height, weight, skinfolds), physical fitness (eight motor performance field tests: plate tapping, bent arm hang, 10 x 5 m sprint, arm pull, sit and reach, standing high jump, 10 leg lifts, 12-min endurance run, and one laboratory test to measure maximal aerobic power), and physical activity (by a cross-check interview). Three research questions were studied: (1) Is there a positive relationship between adolescent fitness (age 13-17 years) and adult physical activity (age 33 years)? (2) Do physical fitness and physical activity track from adolescence into adulthood? (3) What is the longitudinal relationship between physical fitness and physical activity? Multiple linear regression analysis showed that of the 9 physical fitness tests, only the 12-min endurance run and the maximal aerobic power during adolescence are significant (P < 0.05) predictors of adult physical activity. The effects are not influenced by biological age but by sex: only in females are the predictions significant (P < 0.05) Tracking over the period of 20 years estimated from stability coefficients showed values for physical fitness varying between 0.83 (plate tapping) to 0.38 (standing high jump and maximal aerobic power). Physical activity shows lower stability coefficients (0.35-0.29). A longitudinal linear regression technique was used to analyse the relationship between physical activity and physical fitness over the 20-year period; in this analysis corrections were made for both time-dependent (time, biological age, and cardiovascular factors) and time-independent variables (sex). All physical fitness tests show positive and significant (P < 0.05) standardized regression coefficients with physical activity, but the explained variance is less than 1%. Only maximal aerobic power has a higher explained variance of 1.8%. It can be concluded that: (1) Physical fitness in adolescence is only weakly related to adult physical activity; (2) between age 13 and 33 years, physical activity has low stability and physical fitness was higher stability; and (3) the longitudinal relationships between physical fitness and physical activity are only meaningful with maximal aerobic power.

Longitudinal trends in and tracking of energy and nutrient intake over 20 years in a Dutch cohort of men and women between 13 and 33 years of age: The Amsterdam growth and health longitudinal study.

The purpose of the present study was to describe the longitudinal development of nutrient intake and to determine the stability of this intake from adolescence into adulthood. Longitudinal data of the Amsterdam Growth and Health Longitudinal Study were analysed; the dietary intake of 200 subjects (males and females) was repeatedly measured (eight times) over a period of 20 years, covering the age period of 13-33 years. Dietary intake was determined with the detailed crosscheck dietary history interview. With use of multivariate ANOVA for repeated measurements, trends in macro- and micronutrients over time and differences between genders were analysed. Furthermore, stability coefficients, corrected for time-dependent (biological age) and time-independent covariates (gender) were calculated, taking into account all the measurements. The results showed significant time and gender effects for energy intake (kJ) and the following macronutrients: protein (g and % total energy supply), fat (g) and carbohydrate (g). Interaction effects between time and gender diminished when the macronutrients were calculated as a percentage of total energy intake. The micronutrients Ca, Fe and vitamins changed significantly over time and showed an interaction effect with gender, with the exception of cholesterol intake (mg/MJ), which did not show an interaction effect of time and gender. The tracking of the nutrient intake showed relatively low but significant stability coefficients for all macro- and micronutrients (0.28-0.52). In conclusion, dietary intake does change considerably over time, with the exception of polyunsaturated fat intake (% total energy supply) for both males and females and fat intake in females. Furthermore, stability coefficients for nutrients appeared to be low to moderate. Although these coefficients may be somewhat attenuated as a result of the relatively large measurement error of the dietary intake measurement, they suggest moderate stability of diet over time. These findings may imply that dietary intake is changeable and suggest that disease prevention measures can be implemented in adulthood.

The effect of preventive measures on the incidence of ankle sprains.

OBJECTIVE: To critically review the current data concerning the efficacy of preventive measures described in the literature, on the incidence of lateral ankle ligament injuries. DATA SOURCES: MEDLINE, Sportdiscus, and EMBASE were searched for papers published between 1980 and December 1998. Keywords used in the search were "prevention" in combination with "ankle," "ankle taping," "ankle bracing," "orthosis," "shoes," and "proprioception." Additional references were reviewed from the bibliographies of the retrieved articles. STUDY SELECTION: A study was included if: 1) the study contained research questions regarding the prevention of lateral ankle ligament injuries; 2) the study was a randomized controlled trial, a controlled trail, or a time intervention; 3) the results of the study contained incidence rates of lateral ankle ligament injuries as study outcome; and 4) the study met the cut-off score set for quality. DATA EXTRACTION AND SYNTHESIS: Two reviewers reviewed relevant studies for strengths and weaknesses in design and methodology, according to a standardized set of predefined criteria. Eight relevant studies met the criteria for inclusion and were analyzed. MAIN RESULTS: Overall, all studies reported a significant decrease in incidence of ankle sprains using the studied preventive measure. There was a great variety in methodology and study design between the eight analyzed studies, and every study had one or more drawbacks. Therefore, between studies only general results could be compared. CONCLUSIONS: The use of either tape or braces reduces the incidence of ankle sprains. Next to this preventive effect, the use of tape or braces results in less severe ankle sprains. However, braces seem to be more effective in preventing ankle sprains than tape. It is not clear which athletes are to benefit more from the use of preventive measures: those with or those without previous ankle sprains. The efficacy of shoes in preventing ankle sprains is unclear. It is likely the newness of the footwear plays a more important role than shoe height in preventing ankle sprains. Proprioceptive training reduces the incidence of ankle sprains in athletes with recurrent ankle sprains to the same level as subjects without any history of ankle sprains.

[Roaming through methodology. XXII. Application of techniques for longitudinal data analysis]. / Dwalingen in de methodologie. XXII. Toepassing van technieken voor longitudinale data-analyse.

Longitudinal studies are characterised by repeated measurements of the outcome variable on the same individuals. This implicates that observations are correlated and that statistical techniques, such as linear regression analysis cannot be used. Special longitudinal techniques correct for the dependency in repeated observations by analysing the development of a certain individual in time. Depending on the research question, the distribution of the outcome variable, and the number of repeated measurements, a certain technique should be chosen. Sophisticated longitudinal techniques like generalized estimating equations and random-coefficient models are most recommendable.