Non-specific Health Complaints Research Articles

An Exploration of the Influence of Non-Biomechanical Factors on Lifting-Related LBP.

Objective: The primary objective was to compare non-biomechanical factors between manual workers with and without a history of LBP related to lifting. A secondary objective was to investigate associations between the change in pain intensity during repeated lifting (termed pain ramp) and non-biomechanical factors tested in the LBP group. Methods: Manual workers currently in lifting occupations with and without a history of lifting-related LBP were recruited (21 LBP and 20 noLBP) and took part in a repeated (100) lift task. A series of non-biomechanical factors, including psychological, work-related, lifestyle, whole health and psychophysical factors, were collected. Psychophysical factors (pressure pain thresholds (PPTs) and fatigue) were also measured at different time points. Associations between pain ramp during lifting and non-biomechanical factors were investigated with linear regression. Results: The LBP group reported worse perceived sleep quality, more musculoskeletal pain sites other than LBP and greater symptoms related to gastrointestinal complaints and pseudo-neurology compared to the group with no history of LBP. The group with LBP were also slightly more worried about the lifting task and felt more fatigued at the end of the lifting task. The feeling of fatigue during lifting was positively associated with pain ramp in the LBP group. Anxiety and gastrointestinal complaints were weakly negatively associated with pain ramp during lifting. Conclusions: The group differences of poorer perceived sleep, greater non-specific health complaints, slightly more worry about the lifting task and more perceived fatigue in the LBP group highlight the complex and multi-factorial nature of LBP related to lifting. The feeling of fatigue was positively associated with pain ramp in the LBP group, suggesting a close relationship with pain and fatigue during lifting that requires further exploration.

Maternal depression and non-specific health complaints in the offspring: a cross-sectional study in Danish primary care.

BackgroundMaternal depression has been linked to adverse outcomes in the offspring. Existing literature is mainly based on parental reports, which can be an unreliable source when the parent has depression.AimTo explore if maternal depression was associated with daily health complaints and low self-assessed health (SAH) in the offspring.Design and settingParticipants were 45 727 children from the Danish National Birth Cohort recruited between 1996 and 2002. At 11-year follow-up, mothers and their children were invited to complete a questionnaire. Maternal depression was categorised into: no depression, first-time treatment, continued treatment, post-treatment, and relapse.MethodBinomial regression was used to estimate the adjusted prevalence proportion ratio (aPPR) of frequent health complaints and low SAH in children of mothers with depression compared to children of mothers without depression.ResultsThe prevalence of any daily health complaint was 11.4%, daily somatic complaints 4.1%, daily mental complaints 8.9%, both daily mental and somatic complaints 1.5%, and low SAH 5.3%. Children of mothers with depression (any category) were more likely to report a daily health complaint: first-time treatment aPPR 1.35 (95% confidence interval [CI] = 0.96 to 1.85), continued treatment aPPR 1.59 (95% CI = 1.37 to 1.85), post-treatment aPPR 1.30 (95% CI = 1.20 to 1.41), and relapse aPPR 1.56 (95% CI = 1.35 to 1.79). Children of mothers with depression were also more likely to report low SAH: first-time treatment aPPR 1.58 (95% CI = 0.99 to 2.54), continued treatment aPPR 1.86 (95% CI = 1.51 to 2.28), post-treatment aPPR 1.34 (95% CI = 1.19 to 1.50), and relapse aPPR 1.56 (95% CI = 1.26 to 1.93). Girls had a higher prevalence of mental and somatic health complaints and more often reported low SAH compared to boys.ConclusionTreatment of maternal depression was associated with higher prevalence of daily health complaints and low SAH in the offspring at age 11 years. The association was strongest for children of mothers with continued depression or relapse.

Non-specific Health complaints and self-rated health in pre-adolescents; impact on primary health care use

The objective of the present study was to explore past and future primary health care use in preadolescents reporting frequent non-specific health complaints or a low self-rated health compared to that of preadolescents with no frequent health complaints or with good self-rated health. The study was conducted as a cohort study based within the Danish National Birth Cohort (1996–2002). Information on non-specific health complaints and self-rated health was obtained by an 11-year follow-up questionnaire. Information about number of general practitioner (GP) contacts was obtained from the Health Insurance Service Register. A total of 44,877 pre-adolescents gave complete exposure information. Pre-adolescents who reported frequent non-specific health complaints had a higher use of GP compared to pre-adolescents without complaints across the five years following the index date (somatic complaints: IRR = (1.46 [1.38; 1.55], mental complaints: IRR = 1.16 [1.12; 1.19], both complaints: IRR = 1.58 [1.47; 1.69]). The same pattern was found for the association between low self-rated health and number of GP contacts (IRR = 1.41 (1.36; 1.46)). Non-specific health complaints and a poor self-rated health in pre-adolescents was associated with a higher past and future use of GP, indicating a need for development of early interventions with help for symptom management.

Psychosocial treatments for employees with indoor air associated persistent and non-specific health complaints – 12-month follow-up randomized controlled trial results

Psychosocial treatments for employees with indoor air associated persistent and non-specific health complaints – 12-month follow-up randomized controlled trial results

Protocol for the atWork trial: a randomised controlled trial of a workplace intervention targeting subjective health complaints.

BackgroundSubjective health complaints, such as musculoskeletal and mental health complaints, have a high prevalence in the general population, and account for a large proportion of sick leave in Norway. It may be difficult to prevent the occurrence of subjective health complaints, but it may be possible to influence employees’ perception and management of these complaints, which in turn may have impact on sick leave and return to work after sick leave. Long term sick leave has many negative health and social consequences, and it is important to gain knowledge about effective interventions to prevent and reduce long term sick leave.Methods/DesignThis study is a cluster randomised controlled trial to evaluate the effect of the modified atWork intervention, targeting non-specific musculoskeletal complaints and mental health complaints. This intervention will be compared to the original atWork intervention targeting only non-specific musculoskeletal complaints. Kindergartens in Norway are invited to participate in the study and will be randomly assigned to one of the two interventions. Estimated sample size is 100 kindergartens, with a total of approximately 1100 employees. Primary outcome is sick leave at unit level, measured using register data from the Norwegian Labour and Welfare Administration. One kindergarten equals one unit, regardless of number of employees. Secondary outcomes will be measured at the individual level and include coping, health, job satisfaction, social support, and workplace inclusion, collected through questionnaires distributed at baseline and at 12 months follow up. All employees in the included kindergartens are eligible for participating in the survey.DiscussionThe effect evaluation of the modified atWork intervention is a large and comprehensive project, providing evidence-based information on prevention of long-term sick leave, which may be of considerable benefit both from a societal, organisational, and individual perspective.Trial registrationClinicaltrials.gov: NCT02396797. Registered March 23th, 2015.

Symptom reporting after the introduction of a new high-voltage power line: A prospective field study

BackgroundThere is public concern about the potential health effects of exposure to extremely low frequency electromagnetic fields (ELF-EMF) of high-voltage power lines (HVPLs). Some residents living near HVPLs believe ELF-EMF might cause non-specific health complaints. ObjectivesThe present study is the first to prospectively investigate whether self-reported health complaints and causal beliefs increase after the construction of a new power line. MethodsWe used a quasi-experimental design with two pretests before and two posttests after a new HVPL was put into operation. Residents living near (0–300m, n=229; 300–500m, n=489) and farther away (500–2000m, n=536) participated in the study. Linear mixed models were fitted to test whether symptom reports and beliefs that power lines caused health complaints increased more in residents living close to the new line compared to residents living farther away. ResultsA significantly (p<.05) larger increase from baseline in symptom reports and causal beliefs was found in residents living within 300m from the new power line when compared to residents living farther away. While symptom reports did not differ at baseline, the belief that a power line could cause these symptoms was at baseline already stronger for residents living close compared to residents living farther away. ConclusionsWe found a negative impact of a new HVPL on health perceptions of nearby residents, even before the line was put into operation.

Whole-body vibration-related health disorders in occupational medicine – an international comparison

Workers with whole-body vibration (WBV) exposure are likely to report non-specific health complaints. Health and safety providers may not recognise such occupational injuries and may be unfamiliar with appropriate exposure assessment and prevention. This is a review of clinical studies, medical evidence, differential diagnostic evaluation protocols, surveillance programmes, national and international standards, and interventions recommendations utilising PubMed and other online resources. In summary, several studies show a clear trend: with increasing duration and intensity of occupational WBV exposure, primarily musculoskeletal or neurological disorders of the spine occur. Other organ damage has also been reported. In some European Union countries, spinal injury caused by WBV is recognised as an occupational disease and may be compensable. The WBV-related injury diagnosis includes a review of the work history, exposure assessment and differential diagnostic evaluation. WBV health surveillance should assess health status of WBV-exposed workers and address preventive measures.

Health responses to a new high-voltage power line route: design of a quasi-experimental prospective field study in the Netherlands

BackgroundNew high-voltage power transmission lines will be introduced due to increasing demand for reliable and renewable energy supplies. Some residents associate non-specific health complaints with exposure to electromagnetic fields from nearby power lines. This study protocol describes the design and rationale of a prospective study investigating whether the introduction of a new power line triggers health responses in residents living nearby.Methods/DesignThe study is designed as a quasi-experimental field study with two pretests during the construction of a new power line route, and two posttests after it has been put into operation. Key outcomes are self-reported non-specific somatic and cognitive health complaints, and attribution of these health complaints to a power line. The main determinant is proximity to the new power line route. One member of every household (n = 2379) residing in close proximity (0-500 meters) to the overhead parts of a new power line route in the Netherlands is invited to participate, as well as a sample of household members (n = 2382) residing farther away (500-2000 meters). Multilevel analysis will be employed to test whether an increase in key outcome measures is related to proximity to the line. Longitudinal structural equation models will be applied to test to what extent health responses are mediated by psychosocial health mechanisms and moderated by negative oriented personality traits.DiscussionThis is the first study to investigate health responses to a new power line route in a prospective manner. The results will provide theoretical insight into psychosocial mechanisms operating during the introduction of an environmental health risk, and may offer suggestions to policymakers and other stakeholders for minimizing adverse health responses when introducing new high-voltage power lines.

Reduced muscle strength, exercise intolerance and disabling symptoms in sarcoidosis

This review focuses on innovations in the field of assessment and treatment of muscle weakness and exercise intolerance in sarcoidosis and the association between these and fatigue, dyspnea and quality of life (QoL). Muscle strength and exercise intolerance are prevalent in patients with sarcoidosis. Exercise testing can be used to identify the presence of strength deficits and exercise intolerance. Routinely performed clinical tests, including lung function tests and imaging methods, are only weakly related to these nonspecific health complaints. Assessment of exercise capacity might also be useful for the early detection of parenchymal involvement and diagnosis of sarcoidosis-associated pulmonary hypertension. Both muscle weakness and exercise intolerance have been suggested as underlying causes of fatigue and dyspnea complaints, resulting in reduced QoL. Research is required to find out whether a multidisciplinary rehabilitation program is of clinical benefit in the management of sarcoidosis patients. This review underlines the added value of physical testing in the management of sarcoidosis patients, especially in those with unexplained physical complaints.

Mortality rate and causes of death in women with self-reported musculoskeletal pain: Results from a 17-year follow-up study

IntroductionChronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain is reported to be 35–53% in cross sectional studies of both genders. For many years, it has been a common opinion among medical doctors that chronic pain may indeed reduce a person's quality of life, but not affect life expectancy. However, over the previous two decades, reports about mortality and cause of death in individuals with chronic pain have been published. So far, several studies conclude that there is an increased mortality in patients with chronic pain, but it is not clear what causes this. Increased occurrences of cardio-vascular death or cancer death have been reported in some studies, but not verified in other studies. Aims of the studyThe aims of this study were to estimate the mortality rate in females with different extent of pain, to identify potential risk factors for death and to investigate if the causes of death differ according to prior reported pain. MethodsThis is a prospective population-based study of all women between 20 and 50 years registered in Arendal, Norway, in 1989 (N=2498 individuals). At follow-up in 2007, 2261 living females were retraced, 89 had died.All subjects received a questionnaire containing questions about chronic pain (pain≥3 months duration in muscles, joints, back or the whole body) as well as 13 sub-questions about pain-modulating factors, non-specific health complaints and sleep problems, by mail in 1990, 1995 and 2007. Only subjects who answered the questionnaire in 1990 were included in the analyses. Of the deceased, 71 had answered the questionnaire in 1990.A multivariate model for cox regression analysis was used in order to clarify if chronic pain, sleep problems, feeling anxious, frightened or nervous and number of unspecific health were risk factors for death.The causes of death of 87 of the deceased individuals were obtained by linking the ID-number with the Norwegian Cause of Death Registry. ResultsThe ratio of deceased responders was 2% (14/870) among those with no pain versus 5% (57/1168) among those with chronic pain at baseline. When separating into chronic regional pain and chronic widespread pain, the mortality rate was respectively 4% and 8% in the different groups. Age adjusted hazard ratio for mortality rate in individuals with initially chronic pain was [HR 2.5 (CI 1.4–4.5)] compared to pain free individuals. In the multivariate analysis, having chronic pain [HR 2.1 (1.1–4.2)] and feeling anxious, frightened or nervous [HR 3.2 (1.8–5.6)] were associated with increased risk of death. There was no difference in death from cardiovascular disease or malignancies between the groups of pain free individuals vs. the group of individuals with chronic pain. ConclusionThe mortality rate was significantly higher for individuals with chronic pain compared to pain free individuals, adjusted for age. In addition, feeling anxious, frightened or nervous were risk factors for death. There was an increase in all-cause mortality.

Are sleep problems and non-specific health complaints risk factors for chronic pain? A prospective population-based study with 17 year follow-up

IntroductionChronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain can be up to 50% in both genders. However, the prevalence of chronic widespread pain is significantly higher in females than in males. Chronic widespread pain is seen as the end of a continuum of pain. There is rather sparse knowledge about the incidence of pain in initially pain free individuals and the course of self-reported pain over time. Moreover, little is known about risk factors for incidence of chronic pain or prognostic factors for the course of self-reported pain. We believe that such knowledge may contribute to develop strategies for treatment at an early stadium of the pain condition and thereby reduce the prevalence of chronic pain included chronic widespread pain. Aims of the studyThe aims of this study were threefold: (1) to calculate the incidence of self-reported musculoskeletal pain in a female cohort, (2) to describe the course of pain and (3) to investigate whether or not health complaints and sleep problems are predictive factors for onset of pain or prognostic factors for the course of pain. MethodsThis is a prospective population-based study of all women between 20 and 50 years who were registered in Arendal, Norway, in 1989 (N=2498 individuals). A questionnaire about chronic pain (pain ≥3 months duration in muscles, joints, back or the whole body), modulating factors for pain, sleep problems and seven non-specific health complaints was mailed to all traceable women, in 1990 (N=2498), 1995 (n=2435) and 2007 (n=2261). Of these, 1338 responded on all three occasions. Outcome measures were presence and extent of chronic pain. ResultsThe prevalence of chronic pain was 57% in 1990 and 61% in 2007. From 1990 to 2007, 53% of the subjects changed pain category. The incidence of chronic pain in initially pain free individuals during follow-up was 44%, whereas the recovery rate was 25%. Impaired sleep quality predicted onset of chronic pain. There was a linear association between the number of health complaints and the incidence of chronic pain in initially pain free individuals. Equivalent results were found for persistence of pain and worsening of pain. ConclusionThe prevalence of chronic pain was rather stable throughout the follow-up period, but the prevalence of chronic widespread pain increased. Individual changes in pain extent occurred frequently. The presence of sleep disturbances and number of health complaints predicted onset, persistence and worsening of pain. ImplicationsSleep problems must be thoroughly addressed as a possible risk factor for onset or worsening of pain. Elimination of sleep problems in an early phase is an interesting approach in treating chronic pain. More research is needed to illuminate the possible pathogenetic relations between pain, non-specific health complaints, sleep problems and also depression.

Diagnosis of Whole-Body Vibration Related Health Problems in Occupational Medicine

Occupational whole-body vibration (WBV) exposed workers may report nonspecific health complaints or debilitating physical disorders. Health care providers and safety professionals may not recognize such occupational injuries and be unfamiliar with appropriate exposure assessment. Method: Review of peer-reviewed clinical studies and publications, medical evidence, differential diagnostic evaluation protocols, surveillance programs, national and international standards, and intervention recommendations regarding WBV. Results: There are well-designed epidemiological studies showing that prolonged and increasing exposures to WBV can primarily result in musculoskeletal or neurological disorders of the spine. Less frequent and weaker evidence exist for organ damage that include intestinal organs, vascular system and other body parts. In some countries spinal injury caused by long-term occupational WBV exposure is compensable. Many physicians and occupational safety experts seem to be unfamiliar with the wide spectrum of health complaints and the proper evaluation of WBV-exposed patients following expert reviews and international guidelines/standards. Detailed protective regulations and provisions exist primarily in highly industrialized countries with good occupational health systems. The causal diagnosis should be based on medical findings, a differential diagnostic methodology and adequate work exposure assessment and documentation of WBV. Conclusion: A proper WBV-related injury diagnosis includes a critical review of the work history, exposure data assessment and the clinical differential diagnostic evaluation. Many health care providers receive little or no training in the recognition of WBV-related injuries and case management. WBV health surveillance should assess the health status of WBV-exposed workers and address preventive measures for employers and employees.

Group integrative reminiscence therapy on self‐esteem, life satisfaction and depressive symptoms in institutionalised older veterans

The purpose of this study was to use group integrative reminiscence as a nursing intervention to evaluate the immediate effects on self-esteem, life satisfaction and depressive symptoms for a special group named 'institutionalised older veterans' after a 12-week intervention. The study group comprised institutionalised older veterans with combat experience, including being wounded in war and who were twice forced to relocate. The group participants had lower life satisfaction, and greater use for mental health services and greater non-specific health complaints were reported from this group. Reminiscence therapy has been considered an effective nursing intervention, but the effects on institutionalised older veterans have not been studied. A quasi-experimental design and purposive sampling were conducted. A total of 74 participants were studied with pre- and post-tests to measure the effect of group integrative reminiscence therapy. The activity was held once weekly for 12 weeks. The Life Satisfaction Index A, self-esteem scale and Geriatric Depression Scale Short Form were used as research tools, and the t-test, Fisher's exact test and generalised estimating equation were used for data analysis. All participants were male, with an average age of 81·34 years old, 91·9% unmarried and were in bad health. After 12 weeks of intervention, the reminiscence groups significantly improved their self-esteem and life satisfaction and decreased depressive symptoms compared with control groups. Group integrative reminiscence revealed immediate effects on improving the self-esteem and life satisfaction of institutionalised older veterans, and depressive symptoms were also decreased. Moreover, a sense of positive self-value and belonging to the institution was produced. Group integrative reminiscence is an applicable nursing intervention for vulnerable persons such as institutionalised older veterans. A structured protocol based on the characteristics of the residents and the aim of the intervention can lead nurses to provide appropriate reminiscent activities.

Health and Wellbeing in Relation to the Quality of Ventilation Systems in Newly Built Dwellings in the Netherlands

O-29A6-1 Background/Aims: The Netherlands is situated in a moderate maritime climate in Western Europe, where most houses today are built with thermal insulation and mechanical ventilation. Mechanical ventilation can be subdivided in systems which combine natural supply and mechanical exhaust and systems with mechanical supply and exhaust with heat recovery. In 2007, a Municipal Health Service reported health complaints of residents in dwellings with the latter type of mechanical ventilation system. Residents reported nonspecific health complaints such as respiratory, nose, and eye complaints; fatigue; and sleep problems attributed to the ventilation system. As stricter requirements for energy performance are expected in the future, mechanical ventilation with heat recovery will become more common. Therefore, understanding the relationship of mechanical ventilation and health complaints is needed. This study aimed to investigate the relationship between the quality of mechanical ventilation systems and health complaints and wellbeing in private homes. Methods: One hundred fifty newly built houses with natural supply and mechanical exhaust ventilation and 150 newly built houses with mechanical supply and exhaust with heat recovery throughout the Netherlands were selected from an existing database. A structured home inspection by trained surveyors aimed at the ventilation system was combined with a questionnaire survey among the 300 residents. The ventilation system was checked for ventilation capacity, noise levels, construction flaws, internal cleanliness, and maintenance state, etc. The questionnaire contained questions about nonspecific health complaints, sleep quality, noise annoyance, thermal comfort, environmental sensitivity, and coping strategies. Results: This paper will present results about the association of different mechanical ventilation systems with health complains and well-being. The role of perceptions and environmental sensitivity will be discussed. Conclusion: Home inspection reveals that a priori 20% of both types of ventilation systems have insufficient ventilation capacity. In working conditions, an additional 60% does not have a sufficient ventilation capacity and might result in adverse health effects.

Sense and sensibility in the context of radiofrequency electromagnetic field exposure

Abstract The association between radiofrequency exposure (RF-EMF) and non-specific health complaints in electromagnetic hypersensitive (EHS) individuals was investigated in a prospective cohort study conducted between 2008 and 2009 in Switzerland. Exposure to environmental far-field RF-EMF sources was modelled and cordless and mobile phone use was also considered in the analyses. About 8% ( n = 130 ) of the study population declared to be EHS. Health disturbances were considerably more prevalent in the EHS group compared to the rest of the study population. However, we did not find evidence that health disturbances of EHS individuals were associated with RF-EMF exposure.

Epidemiology, toxicokinetics, and health effects of methyltert-butyl ether (MTBE)

This paper reviews the published information assessing the kinetics and potential for adverse health effects related to exposure to the fuel oxygenate, methyl tert-butyl ether (MTBE). Data were obtained from previously published reports, using human data where possible. If human data were not available, animal studies were cited. The kinetic profile of MTBE in humans is similar for ingestion and inhalation. The concentrations of MTBE to which the general public is expected to be exposed are orders of magnitude below concentrations that have caused adverse health effects in animals. Controlled human studies have not replicated early epidemiology studies that suggested, but did not confirm, a possible association between MTBE exposure and nonspecific health complaints.

Persisting posttraumatic stress disorder symptoms and their relationship to functioning in Vietnam veterans: A 14‐year follow‐up

The authors examined the longitudinal association between persisting posttraumatic stress disorder (PTSD) symptoms and multiple domains of life functioning in a community sample of 1,377 American Legionnaire Vietnam veterans first assessed in 1984 and followed-up 14 years later. Almost 30 years after their return from Vietnam, 10% of veterans continued to experience severe PTSD symptoms. At all levels of combat exposure, persisting severe PTSD symptoms were associated with worse family relationships, more smoking, less life satisfaction and happiness, more mental health service use, and more nonspecific health complaints at the 14-year follow-up. Further investigation is needed to determine whether the PTSD-functioning relationship is causal and if successful treatment of PTSD is associated with improvement in functioning.

Psychological factors associated with self-reported sensitivity to mobile phones

Do persons with electrosensitivity differ from individuals reporting symptoms from exposure to mobile phones only? This is the main question addressed in the paper by Rubin et al. [1] in this issue. Previous provocation studies for electromagnetic sensitivity have found no differences in the severity of symptoms elicited by active or sham exposure to electromagnetic fields [2]. Still, a strong perceived association between electromagnetic radiation and a range of nonspecific health complaints exists in the general public. The topic is highly relevant on both an individual and a societal level. Electrosensitivity, alongside with other quite similar functional disorders with nonspecific complaints, accounts for significant public burden, including increased work absenteeism and increased health utilization [3], in addition to the individual consequences from such disorders. Thus, identifying subgroups with a high risk of these adverse consequences is of importance. The study by Rubin et al. is rather small scale, comprising 19 self-labeled electrosensitive individuals compared with 52 persons reporting sensitivity to only mobile phones, as well as 60 healthy controls. Nevertheless, the authors found significant group differences on quite a few outcome measures. A few methodological issues warrant further discussion. As noted by the authors, the most important limitation of the study is its cross-sectional design, which obviously makes it difficult to infer a direction of causality. For example, do negative affect and personal concerns regarding cell phone radiation cause electrosensitivity or

Perception of risk and subjective health among victims of the Chernobyl disaster

Several studies have demonstrated that the nuclear power plant accident at Chernobyl in 1986 had a strong impact on the subjective health of the inhabitants in the surrounding regions and that the majority of these health complaints appear to be stress-related. An epidemiological survey among the adult population of the Gomel region in Belarus near Chernobyl showed higher rates of self-reported health problems, psychological distress and medical service use in this region than in a comparable unexposed region. This paper presents an analysis of data on cognitive factors that were collected in this study. The findings support the hypothesis that cognitive variables such as risk perception and sense of control play an important role as mediating factors in the explanation of the observed health differences between the exposed and non-exposed regions. A tentative model is presented to further clarify the role of risk perception in the occurrence of non-specific health complaints after such ecological disasters.

Psychosocial factors predict medical outcome following a first myocardial infarction. Working Group on Cardiac Rehabilitation of the Swiss Society of Cardiology.

The aim of this study was to identify psychosocial variables that, in addition to known medical factors, predict the long-term outcome after a first myocardial infarction. The study population consisted of 222 men aged 30-60 years who entered an inpatient rehabilitation program a mean of 7 weeks after a first myocardial infarction. Medical data and completed questionnaires for psychosocial variables were obtained from the patients and their family physicians at entry to the rehabilitation center and 1 year later. Further data, including answers to a detailed questionnaire, were collected at the beginning of rehabilitation and after one year; this follow-up was 99% complete. The 1-year mortality was 2.2%, the reinfarction rate 1.8%, hospital readmissions for cardiac reasons occurred in 25%, and 13% of the patients underwent a subsequent revascularization procedure. At baseline and after 1 year, respectively, 84 and 83% of the patients were asymptomatic. A poor medical outcome, defined as death, reinfarction, severe symptoms or poor exercise capacity, was seen in 9% of the patients. The most important physiological predictors for an unfavourable medical outcome, found in bivariate and multivariate analyses, were age, severity of infarction, and major coronary risk factors. In addition, some of the psychosocial variables were significantly related to a poor medical outcome: lack of a stable partnership, high work load, poor general well-being with multiple chronic non-specific health complaints, and a low external locus of control (failure to identify disease-promoting factors within own surroundings or lifestyle). The medical course of coronary artery disease was predicted not only by medical variables but also by psychological and social variables. As well as being addressed directly, these factors may help to identify patients who need to be followed more closely, so that medical complications can be reduced by treating early signs of disease progression more aggressively.