Expression patterns of 17ß-hydroxysteroid dehydrogenase 14 in human tissues.

17ßHSD enzymes catalyze the stereospecific oxidation/reduction at carbon 17ß of androgens and estrogens, and are important players in intracrine sex hormone synthesis. The biological relevance of 17ßHSD14, first named retSDR3, is largely unknown. We generated and validated an antibody targeting the 17ßHSD14 antigen and used this for immunohistochemical evaluation of expression patterns in 33 healthy human tissues. Furthermore, sex steroid conversional activity in HSD17B14 overexpressing HEK293 and MCF10A cells was investigated by assessing interconversion products of estrone, estradiol, androstenedione, testosterone, and dehydroepiandrosterone. Immunohistochemical staining patterns of 17ßHSD14 with the enzyme being primarily expressed in glandular epithelial tissue reveal an enzyme with possible implications in the secretion or conversion of externally derived compounds. A role for 17ßHSD14 in sex steroid metabolism is supported by the finding that 17HSD14 oxidizes both estradiol and testosterone into less bioactive steroid metabolites estrone and androstenedione, respectively.

Construct validity of the Sivik Psychosomaticism Test and test of operational style: correlations with Karolinska Scheme of Personality.

To evaluate the construct validity (convergent and divergent) of Sivik Psycho Somaticism test (SPS) and test of Operationality (OPER), Pearson correlation coefficients between SPS scales and subscales and Karolinska Scheme of Personality (KSP) were calculated. Seventy-eight healthy individuals and 196 psychosomatic patients completed the SPS and OPER tests and KSP. The results show that the SPS and OPER subscales are significantly correlated to most KSP subscales. The correlations were higher for the psychosomatic group than for the normal population. The results confirm the validity of the SPS and OPER constructs.

Construct validity of the Sivik Psychosomaticism Test and test of operational style: correlations with four Minnesota Multiphasic Personality Inventory (MMPI) subscales.

To evaluate the construct validity (convergent and divergent) of the Sivik Psycho Somaticism test (SPS) and test of Operationality (OPER), Pearson correlation coefficients between SPS scales and subscales, OPER and Minnesota Multiphasic Personality Inventory (MMPI) subscales Hypochondria (Hs), Depression (D), Hysteria (Hy) and Alexithymia (Al) were calculated. Eighty-eight healthy individuals and 285 psychosomatic patients completed the SPS and OPER tests and MMPI; Hs, D, Hy and Al. The results show that most of the SPS subscales and OPER are significantly correlated to several MMPI subscales in both a normal and a psychosomatic population. The results are in concordance with the theoretical hypotheses and confirm the validity of the SPS and OPER constructs.

Psychosomatic research and the theory of science.

In terms of current scientific paradigms, absolute knowledge in the understanding of science is beyond the capacity of the human mind. Today, linear and dualistic science are struggling against emerging new paradigms such as psychosomatic medicine, which threaten the established medical truths of contemporary society.

Physical capacity and dyspnea in patients with asthma-like symptoms but negative asthma tests.

Ten female patients with asthma-like symptoms but negative asthma tests (study group) were compared with 10 female asthmatics in an exercise test with and without pretreatment with beta 2-stimulants. The aim was to determine whether the asthma-like symptoms in the patients of the study group could be explained by bronchoconstriction, circulatory abnormalities, or physical unfitness when provoked physically, and whether the exercise test could be used to distinguish these patients from asthmatics. Without pretreatment, the asthma group reacted with bronchoconstriction, as indicated by postexercise systematic changes in PEFR, FEV1, FVC, and SaO2, which were not seen in the study group. The groups differed in the ratings of "difficulty in getting air", as only the asthma group had significantly lower ratings when pretreated. The study group's mean test performance was 94 W; the asthma group's was 106 W. The low performance was not explained by disturbances in heart rate, electrocardiogram, or blood pressure or physical unfitness. The exercise test was found to distinguish between the groups, especially for bronchoconstriction, oxygen saturation, and ratings of dyspnea. It could be used complementary to lung function tests to eliminate bronchoconstriction, circulatory abnormalities, and physical unfitness as a cause of the asthma-like symptoms.

The role of blood pressure, cortisol, and prolactin among soldiers injured in the 1991-1993 war in Croatia.

Ninety soldiers with at least three months of combat exposure--60 injured soldiers (30 with permanent disabling and 30 with nondisabling injuries), 30 noninjured soldiers and 30 healthy controls--were interviewed and investigated with physiological (Prolactine, Cortisol, BP, Hb) and psychological tests (MMPI), IES-15 (Impact of Event Scale), PTSS (Post-Traumatic Symptom Scale). Their war related injuries had a different effect on the physiological stress response of the soldiers as reflected in the levels of prolactine, cortisol, hemoglobin and blood pressure. In a report of personality characteristics of the same soldiers, we demonstrated that the experience of posttraumatic stress was not dependent upon physical injury, but rather on the psychological appraisal of the situation. The results of the present article confirm earlier findings that the relationship between physiological and psychological consequences of trauma are complex, and that the perception of an event and the social context within which the traumatized soldier exists is as important as the event itself. The physiological response to the trauma varied greatly among the soldiers regarding the psychosocial impact of the consequence of the injury. So the anticipation of future possible trauma among less severely wounded soldiers (expected to go back to war) was followed by pathological stress responses. Trauma seems to operate somewhat independently from the overt conscious appraisal of the situation and relationship between psychological, psychosocial, and physiological aspects are interrelated in a multifactorial way. An integrative approach is therefore of great importance in assessment as well as in treatment of Posttraumatic Stress Disorder (PTSD).

Risk of long-term disability among patients with back pain.

The aim of this study was to find predictors of length of time on sick-leave and the change in sick-leave as a result of intervention. Many studies of back pain show that medical and psychosocial factors covary with length of sick-leave. The results are based on the questionnaire responses of 240 patients. A stepwise multiple regression showed that the significant predictors of number of sick-days the year after intervention were the number of sick-days before the intervention and also hypochondria. Significant predictors of sick-leave change were sleep disturbance and number of sick-days before intervention. A discriminant function analysis comparing a group that had decreased its sick-leave with one that had increased its sick-leave showed 7 predictors of increased sick-leave: high risk of somatisation; many children and family members living at home; a change in tasks at work owing to pain; brothers and sisters with longstanding pain problems; frequent pain, and sleep disturbance. It is important for physiotherapists to enquire about patients' earlier sick-leave patterns in order to identify risk factors for long-term disability among patients with back pain. Some of these factors have been identified in this study.

The effect of different traumatic experiences on the development of post-traumatic stress disorder.

This investigation was conducted during the war in Croatia from 1991 to 1993. General characteristics, traumas, and frequency of post-traumatic stress disorder (PTSD) were compared in three groups of soldiers: (1) soldiers who sustained non-disabling injuries; (2) soldiers who sustained permanently disabling injuries; (3) active soldiers (controls). Significant differences were found in general characteristics and in PTSD in the groups observed. Both groups of wounded soldiers were significantly younger (mean of 8 years), fewer of them were married, and they had fewer children than active soldiers (controls). The differences in marital status and the number of children were obviously due to the age difference. Soldiers who sustained non-disabling injuries developed PTSD significantly more often than soldiers who sustained permanently disabling injuries and active soldiers (controls). Possible reasons for the differences of PTSD in compared groups of soldiers are discussed.

Gender, psychological well-being and somatic cardiovascular risk factors.

The purpose of this study is to determine associations between cardiovascular risk factors and subjective experience of psychological general well-being with special reference to gender related differences. One-hundred fifty white-collar workers in a car manufacturing plant in Sweden participated in a health care screening program. Subjective experience of psychological well-being was significantly correlated with cardiovascular risk factors among both men and women. There were, however, marked differences between the genders. For men, the following specific psychological variables were correlated with different cardiovascular risk factors: estimation of general health and psychological well-being, anxiety, depression, self-control and vitality. For women, more complex significant relationships between the two sets of variables were found. Moreover, the direction of the correlations differed between the genders. For example, men with cardiovascular risk factors, such as increased waist-hip-ratio, age and cholesterol, reported significantly more positive estimation of their self-control and vitality. For women the relation was the opposite with a significantly positive correlation (p=3D0.008) between experience of good health and a low risk factor profile indicating the concordance between physiological and psychological parameters. Possible reasons for these sex differences are discussed.

Characteristics of patients who attribute chronic pain to minor injury.

Eighty-four chronic low back pain (CLBP) patients were studied in order to determine whether personality differences existed between patients reporting a minor injury at work as the cause of their disability and ensuing insurance claims, and patients who did not. Twenty-three of the CLBP patients studied reported that their pain resulted from a accident at work. All the subjects underwent a variety of psychological and somatic tests. The results indicate that the "accident" patient group is characterized by specific psycho-dynamic personality patterns significantly different from the characteristics of the "non-accident" group. The characteristics of the patients in the "accident" group suggest that these patients tend to hold on to minor injuries, and that one possible reason for this might partly be related to the liberal insurance policies in Sweden.

Characteristics of low back pain patients who do not complete physiotherapeutic treatment.

Patients' problems in following recommendations of health professionals is an issue of great concern. The purpose of the present study was to investigate whether patients with low back pain (n = 46) who dropped out of a treatment programme differed in characteristics measured prior to treatment from a matched comparison group (n = 46) who completed the programme. Data collected on work disability and sick leave, frequency, duration and intensity of pain, physical function, and personality characteristics were compared. The results indicated that the groups differed significantly on 3 of 16 variables. The non-completers had been on sick leave for a longer time period prior to treatment, experienced more intense pain and performed at a lower level on the test of physical function than those who completed the treatment programme.

Psychological differences between asthmatics and patients suffering from an asthma-like condition, functional breathing disorder: a comparison between the two groups concerning personality, psychosocial and somatic parameters.

Fifteen patients with asthma were compared with thirteen patients with asthma-like symptoms but without physiological signs of asthma. This condition is termed Functional Breathing Disorder, FBD. All patients were examined with regard to relevant physiological variables, and to specific personality traits and psychosocial status by means of psychological tests and questionnaires. The results indicated that the patients suffering from FBD were more psychologically distressed and had lower quality of life than the asthma patients. Further, they suffered from a significantly greater variety of symptoms and more intense symptoms than the asthmatics. Such symptoms included sleeping disturbances and somatic symptoms such as chest pain, cold hands or feet, blurred vision. The FBD patients had significantly more problems in their social and family lives, at work and in their leisure time than the asthmatics. They were significantly more depressed, less hedonic and more hypochondriac than the asthmatics. Moreover, they trusted other people to a significantly lesser degree. The patients with FBD had been hospitalized less often than the asthmatics, but they had sought medical care more often. The present study indicates that it is important to identify patients suffering from FBD at as early a stage as possible in order to offer them proper treatment.

Alexithymia and hypersensitivity to touch and palpation.

Alexithymia appears to be directly related to the process of somatization of psychological distress that has not found verbal expression. The lack of a meaningful dialogue between mother and child in early infancy may predispose the development of an alexithymic strategy in expressing psychic and psychosocial stress. This can occur in the form of unpleasant bodily sensations or pain. The human skin is, in addition to the oral and gastrointestinal organs, the earliest contact sphere between the young infant and the environment. In a group of 312 randomly chosen patients at an outpatient primary health care clinic a significant relationship was found between palpational hypersensitivity to touch on the one hand and somatization proneness and the degree of alexithymia on the other hand.

Education of general practitioners in psychosomatic medicine. Effects of a training program on the daily work at Swedish primary health care centers.

Two interrelated studies are reported. One reports the results of a questionnaire interview with a reference group of 51 general practitioners. The respondents express a considerable dissatisfaction with their previous medical training as it concerns their knowledge of the psychosomatic medical paradigm. The other study evaluates the effects of a 5-year education program concerning psychodynamic theories and an integrative psychosomatic approach to treatment. Six general practitioners participated in this educational program, which included both theoretical seminars and practical training in psychotherapy (under supervision) with patients suffering from chronic idiopathic pain syndrome. All the participants reported developing substantial skill in treating such patients and in handling other kinds of patients with multifactorial etiology of symptoms. The participants of the training program did not initially differ from the larger reference group as to the previous knowledge and practice in integrative psychosomatic medicine, and it may be concluded that many physicians would profit from such post-graduate training. The self-reports of all these experienced physicians also indicate that there is too little theory and practice of the psychesoma interaction in the basic medical education.

The Thematic Apperception Test as an aid in understanding the psychodynamics of development of chronic idiopathic pain syndrome.

41 chronically ill low-back pain patients (27 women, 14 men) with a long history of work disablement (median = 2 years and 8 months) were submitted to thematic apperception testing (TAT). The tape-recorded protocols were evaluated by 2 independent, experienced clinicians well acquainted with the TAT, as well as with psychoanalytic theory and technique. The 2 evaluators judged almost all the patients as depressive, alexithymic, passive and antiaggressive with clear tendencies to reaction formation towards underlying aggressivity. Many patients were further judged as guilt-ridden with an unresolved oedipal conflict, while others had a deep oral problem with suicidal tendencies. Two of the patients were judged by both evaluators as having psychotic or prepsychotic traits. Overall interrater reliability was very high, with a correlation for the different categories between 0.50 and 0.76 (median 0.72 and p value never below 0.005). Our results indicate that one of the main characteristics of low-back pain patients is the denial of aggression. Other main features of our patients were depressivity, passivity and oral or oedipal conflicts, alexithymia and lack of internal locus of control. Also we find the TAT as a very suitable test for achieving the understanding of the complexity of the problem of pain.

Personality traits in patients with acute low-back pain. A comparison with chronic low-back pain patients.

This study investigates the possibilities to identify, within a group of acute low-back pain patients, individuals with psychogenic etiology to pain. 26 acute back pain patients and 25 healthy control subjects were tested with the Minnesota Multiphasic Personality Inventory Hysteria: (Hs), Hypochondria (Hy), Depression (D); Cesarek-Marke Personality Scale: Aggression (Agg), Defence of status (Dst), Guilt (Gui); Mood Adjective Check List: (Hedonism, Activity, Calmness = Hed, Act, Clm) and a 'pain questionnaire' including 'pain drawing'. Differences between groups and correlation patterns between test variables indicate that a combination of Hs, Hy, D, Dst, Gui, Hed, Act, Clm as well as predisposition to somatization, Som (a quantification of pain drawing) provides a useful predictive screening instrument.