Acoustics and psychosocial environment in intensive coronary care.

BACKGROUND: Stress, strain, and fatigue at the workplace have previously not been studied in relation to acoustic conditions. AIMS: To examine the influence of different acoustic conditions on the work environment and the staff in a coronary critical care unit (CCU). METHOD: Psychosocial work environment data from start and end of each individual shift were obtained from three shifts (morning, afternoon, and night) for a one-week baseline period and for two four-week periods during which either sound reflecting or sound absorbing tiles were installed. RESULTS: Reverberation times and speech intelligibility improved during the study period when the ceiling tiles were changed from sound reflecting tiles to sound absorbing ones of identical appearance. Improved acoustics positively affected the work environment; the afternoon shift staff experienced significantly lower work demands and reported less pressure and strain. CONCLUSIONS: Important gains in the psychosocial work environment of healthcare can be achieved by improving room acoustics. The study points to the importance of further research on possible effects of acoustics in healthcare on staff turnover, quality of patient care, and medical errors.

Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis.

OBJECTIVE: The purpose of this study was to describe the sequence of psychosocial events and infections preceding the onset of chronic fatigue syndrome (CFS). This information was related to the temporal development of crucial symptoms in relation to the onset of, namely, fatigue, sadness, irritability, pain, and feeling of fever. METHODS: A personal interview was conducted in 46 patients (mean age, 39.5 years; SD, 9 years) who fulfilled international CFS criteria. These patients were matched with regard to age and gender to 46 carefully matched control subjects. Twenty-three percent of the study subjects were men, and 77% were women. The patient at first identified the month that coincided with the onset of CFS. Similarly, each control subject was asked to identify a "very difficult period" within approximately the same period as the patient with whom the control subject was matched. A list of 14 different life events was perused. Participants were asked to identify for each month whether each of the listed events had occurred. Furthermore, they were asked to rate the importance of the events they had experienced. In addition, for each of the cardinal symptoms (fatigue, sadness, irritability, pain, and feeling of fever) and for each month, the subjects were asked to rate, on a visual analogue scale, the symptom intensity. Also, the number of infections was noted. RESULTS: A statistically significant group difference in fatigue intensity existed during the period 4 to 10 months before the onset of CFS. During the 3 months preceding the diagnosis for the CFS patients or the peak of the crisis for the control group, there was a dramatic rise in fatigue in both groups. The CFS group reached a much higher fatigue level, which leveled off somewhat during the first year of follow-up but still remained very high in comparison with the control group, which reached precrisis levels 4 months after the peak. Similar patterns were observed for fever and pain. With regard to sadness and irritability, no group difference was observed during the period preceding the crisis. In the patient group, the level stayed high throughout the whole first year of follow-up, whereas a slow return started in the control group; precrisis levels were reached after 1 year in this group. The prevalence ratio (CFS patients/control subjects) for negative events was around 1.0 for the periods 4 to 12 months preceding CFS but 1.9 during the quarter year preceding the onset. For infections, the prevalence ratio increased successively during the four quarters preceding CFS (from 1.4 to 2.3). CONCLUSIONS: According to the retrospective self-reports, there were differences between the groups in fatigue, pain, and feeling of fever during the months preceding the crisis. With regard to depressive and irritable feelings, no preillness differences were reported between the groups. There was a reported excess prevalence of both infections and negative life events during the quarter year preceding the onset of CFS or crisis. Potential sources of error are discussed. These findings must be replicated in longitudinal studies.

Coping style and social support in women suffering from cluster headache or migraine.

BACKGROUND: Many clinical neurologists have considered cluster headache patients to differ from migraine patients as to behavioral patterns. There is, however, little empirical validation of such a differentiation. METHODS: Coping profiles and social networks were studied in patients suffering from two kinds of recurrent headache. Twenty-four female patients with cluster headache, aged 23-72 years, and 24 age-matched migraine patients with and without aura participated in the study. All female cluster patients treated at the neurologic clinic of the hospital were included, and consecutive outpatients, who had been referred to the policlinics for diagnosis and treatment, whose symptoms agreed with the IHS criteria for migraine and who had ages matching the cluster headache patients, participated in the study. RESULTS: In the semiprojective coping tests the cluster headache patients were found to be statistically significant more 'positive' as to their anticipated activities in the future compared to the migraine patients (p < 0.04). No other statistical differences were found between the two groups. Compared to randomly selected and age-matched referents in the population. cluster headache patients reported significantly poorer social support (p < 0.01), while no other difference was found when the migraine patients were compared with controls. CONCLUSIONS: The findings indicate that there are differences in perception of anticipated activities and social support between patients with cluster headache and migraine.

Social support and the development of immune function in human immunodeficiency virus infection.

A psychosocial investigation offered to all human immunodeficiency virus (HIV)-infected men with moderately severe or severe hemophilia in Sweden was made in 1986. Most of these men had been infected in the years 1980 to 1984 and told about their infections in 1985. Forty-nine subjects had answered questions in regard to sources of emotional support in their life situation. Based on the responses to these questions a score of "availability of attachment" (AVAT) was calculated, and two groups of patients were identified: one with high AVAT and one with low AVAT scores. The subjects were followed with regard to the state of their immune system, as reflected by CD4 counts, until 1990. The results indicated that a low AVAT score in 1985 was associated with a significantly more rapid progressive deterioration in CD4 count during subsequent years. The mechanism behind this association is unknown. Several possible confounders were not studied. However, if the association between a poor AVAT score and rapid CD4 deterioration after HIV infection is replicated in other samples, it could be important to the future clinical care of HIV-infected subjects.

Psychosocial self-prognosis in relation to mortality and morbidity in hemophiliacs with HIV infection.

HIV-infected hemophiliacs participated in a psychosocial prognosis study. The Coping Wheel was filled out 1-2 years after the subjects had been told that they were HIV-infected and between 1 and 7 years after they had become infected. The number of significant signs of disease as well as mortality were recorded during the years following the psychosocial measurements. These measures were related to three measures of anticipated future activities derived from the Coping Wheel, namely 'number of activities for oneself', 'number of activities with others' and a combined measure 'number of activities for oneself in relation to number of activities with others'. The results indicated that the subject's own psychosocial prognosis added to the prediction of mortality. The most important psychosocial factor was the combined measure: those with few anticipated activities for oneself in relation to activities with others had a greater likelihood of dying soon during follow-up. The latter prediction was true even after adjustment for age and condition of the immune system (CD4 count) at the start of follow-up. The conclusion is that the Coping Wheel, applied as in the present examination, may be of help in prognosis and in identifying psychosocial needs in patients with HIV infection.

Coping style in relation to the consumption of factor concentrate in HIV-infected hemophiliacs during the years after their infection became known.

A psychosocial investigation offered to all HIV-infected men with moderately severe or severe hemophilia in Sweden was made in 1986. Most of these men had been infected in the years 1980-1984 and told about their own infection in 1985. A noninfected group of hemophiliacs was used as a reference group in the psychosocial investigation. A psychosocial prognosis was made on the basis of the coping style observed by means of the Coping Wheel. Among subjects who showed evidence of a passive-pessimistic copying style, there was a significant decrease in the number of factor concentrate units received in 1987 and 1988. Among subjects in the group with a more active-optimistic coping style, there was a tendency of increasing the use of factor concentrate during the years after the HIV-infection became known. This result indicates that awareness of HIV-infection may influence specific hemophilia behavior among subjects with passive-depressed copying style.