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Friday, February 8, 2013

Your Ability To Master The Violin May Depend On The Functionality Of Your Small Finger

Main Category: Bones / Orthopedics
Article Date: 07 Feb 2013 - 0:00 PST

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Your Ability To Master The Violin May Depend On The Functionality Of Your Small Finger

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Assessment of the presence of independent flexor digitorum superficialis function in the small fingers of professional string players: Is this an example of natural selection?

After the recorder, the violin is the instrument most commonly offered to children by state schools in the UK. The violin is a challenging instrument. Rapid, independent motion of the digital joints in the left hand is desirable. This study was conceived after an 11-year-old patient volunteered that she had given up playing the violin because of difficulty and discomfort manoeuvring the left small and ring fingers independently. On examination, she was found to have absent FDS (flexor digitorum superficialis) function in the small finger. The research investigated whether lack of independent movement of the small finger PIPJ affected the musical ability of string players. Because an anatomical variation is fixed, training and strengthening exercises will be unlikely to correct any issues of technique that arise as a result.

Professional string players were tested clinically, using standard and modified tests, for flexor digitorum superficialis function. Two additional physical tests were applied: the gap and stretch tests. The research confirms that elite violinists and viola players usually have independent FDS function. Based on the outcome of this study, a recommendation could be made for children to be examined when being offered the violin or viola as an instrument. Not everyone needs to reach a professional level. If absent FDS function is confirmed, an explanation about why certain movements are difficult to execute might be more helpful than giving the advice to practise more.

Abstract

This study estimated the prevalence of independent flexor digitorum superficialis function in the small fingers of 90 violin and viola players. The hypothesis tested was that the independent digital movements required in this population would select out those with absent flexor digitorum superficialis function. Professional string players were tested clinically, using standard and modified tests, for flexor digitorum superficialis function. Two additional physical tests were applied: the gap and stretch tests. These tests assess ring finger movement once the small finger is placed and the instrument is held in the chin-hold position. A statistically significant reduction in the prevalence of absent flexor digitorum superficialis function was confirmed in the musicians compared with a control group and published meta-analysis. This suggests that independent flexor digitorum superficialis function is important for professional musicians playing at an elite level.

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7 Feb. 2013. <http://www.medicalnewstoday.com/releases/255889.php>

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Source: http://www.medicalnewstoday.com/releases/255889.php

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Postmenopausal Women Treated With Steroid Injection For Back Pain At Significant Risk For Bone Loss

Main Category: Bones / Orthopedics
Also Included In: Menopause; Back Pain
Article Date: 04 Dec 2012 - 1:00 PST

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Postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief, according to a Henry Ford Hospital study

Bone density loss after six months was six times greater when compared to the typical bone density loss seen in a year in a postmenopausal woman who doesn't receive steroid injection, researchers say.

Shlomo Mandel, M.D., a Henry Ford orthopedic physician and the study's lead author, says physicians should exercise caution prescribing an epidural steroid for select patients, suggesting that multiple injections may compromise bone strength.

"The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility," Dr. Mandel says. "Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient's treatment plan.

The study was published in Spine.

Back pain is one of the most common medical conditions in the United States, affecting 8 out of 10 people at some point during their lives. As people age, their spine ages with them, causing degenerative changes in the spine.

Patients are typically treated with anti-inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is often prescribed to alleviate pain and improve function. However, steroid use has been linked to diminished bone quality.

In the observational study, Henry Ford sought to evaluate whether steroid injections used for treating lumbar stenosis, increased the risk of bone loss in postmenopausal women. Lumbar stenosis is an abnormal narrowing of the spine canal. Twenty-eight patients, aged 65 and older and treated between 2007-2010, were evaluated for bone loss using bone density testing and serum biochemical markers prior to receiving an injection, then at three- and six-month intervals.

The bone loss data was compared to bone loss data for postmenopausal women who hadn't been treated with an epidural injection.

"Patients receiving multiple steroid injections with a history of steroid exposure may be especially susceptible to compromised bone strength," Dr. Mandel says.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our bones / orthopedics section for the latest news on this subject.

The study was funded by Henry Ford Hospital.
Henry Ford Health System

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Migraine Victims Suffer In Silence; Only Half Seek Diagnosis, Prescription Medication

Main Category: Headache / Migraine
Article Date: 08 Feb 2013 - 2:00 PST

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Of those who suffer the debilitating side effects of migraine headaches, less than half get diagnosed. Most cope by isolating themselves, using over-the-counter medications, and suffering in silence.

But researchers at the University of Nebraska Medical Center College of Nursing Lincoln Division and Bryan Medical Center say many people could get more relief. The researchers -- Nancy Waltman, Ph.D., and Catherine Parker -- have been studying the effectiveness of an intervention to reduce the frequency, severity and disability from migraine headaches.

Results of the study were significant. At 12 months, study participants reported a decrease in frequency of migraines by 76 percent (from an average of two migraines a week to one); severity of pain decreased by 31 percent; and perception of disability from headaches decreased by 66 percent.

"We've found that a lot of women remain silent and don't get treated for their migraines," said Dr. Waltman, a professor of nursing and nurse practitioner at the UNMC College of Nursing Lincoln Division. "The best treatment is a combination of dietary changes, adjustments in sleep and exercise, avoiding triggers, and preventative medications. Generally narcotics aren't that effective and aren't appropriate for chronic headaches."

Researchers to date have recruited 80 employees and students between the ages of 25 and 67 at Bryan Medical Center in Lincoln. They chose Bryan since many employees are women between the ages of 20 and 55 - the prevalent age span for migraines.

Study participants were educated to identify and avoid migraine headache triggers, coached on dietary and lifestyle changes, and were given prescriptions for medications to prevent and treat migraines. Debilitating symptoms include head pain, nausea, light and sound sensitivity and vomiting, and these symptoms affect work and home life.

The National Institute of Neurological Disorders and Stroke estimates that 28 million Americans suffer from migraines. Migraines are three times more common in women than in men.

Parker, a nurse manager in Employee Health Services at Bryan Medical Center, said employers can help reduce sick days for those with migraines by encouraging employees to seek treatment and follow up treatment.

"Migraines are real and incapacitating," Parker said. "It's helpful if employers can recognize employees who suffer from migraines and make appropriate referrals for medical treatment. It's also important if employers can provide an outlet for exercise, stress management and massage therapy, which are all useful for migraine headache sufferers."

Preliminary data, published in Workplace Health and Safety, a publication of the American Association of Occupational Health Nurses, Inc., were analyzed from 28 study participants who kept headache diaries and who documented potential headache triggers as well as the effectiveness of treatments.

Some of the lifestyle and dietary prevention techniques include decreasing caffeine and alcohol consumption, exercising, managing stress, and having regular sleep patterns.

Dr. Waltman said results of the study also indicate that migraine management interventions should be tailored for each individual.

Although statistically significant results were reported, Dr. Waltman said limitations of the study were its small sample size of 28 workers from one occupational setting and not having a control group. "Another reason for this study was to gauge the feasibility of studying this intervention in a larger study. Our results are promising and we are recommending a future, larger study," she said.

Besides affecting quality of life for individuals and their families, migraine headaches result in missed work and decreased productivity. American employers lose more than $13 billion each year as a result of 113 million lost work days due to headache or migraine, according to the Migraine Research Foundation.

For more information on migraines, go to the National Headache Foundation website.

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Your Ability To Master The Violin May Depend On The Functionality Of Your Small Finger

Main Category: Bones / Orthopedics
Article Date: 07 Feb 2013 - 0:00 PST

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Your Ability To Master The Violin May Depend On The Functionality Of Your Small Finger

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Assessment of the presence of independent flexor digitorum superficialis function in the small fingers of professional string players: Is this an example of natural selection?

Abstract

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New Target Identified For Rheumatoid Arthritis

Main Category: Arthritis / Rheumatology
Article Date: 29 Jan 2013 - 0:00 PST

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New Target Identified For Rheumatoid Arthritis

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Researchers at Hospital for Special Surgery have identified a potential new target for drugs to treat patients with rheumatoid arthritis (RA), a protein known as IRHOM2. The finding could provide an effective and potentially less toxic alternative therapy to tumor necrosis factor-alpha blockers (TNF-blockers), the mainstay of treatment for rheumatoid arthritis, and could help patients who do not respond to this treatment. Efforts to develop drugs that hone in on this new target are underway.

"This study is an elegant example of the capacity of basic science cell biologists to work with translational rheumatologists to address a clinically relevant question at a basic level," said Jane Salmon, M.D., Collette Kean Research Chair and co-director, Mary Kirkland Center for Lupus Research at Hospital for Special Surgery (HSS) in New York City, and an author of the study. "We have identified a clinically relevant target that can be applied to patients in the near term." The study appears online, ahead of print, in the Journal of Clinical Investigation and in the February 2013 print issue.

Rheumatoid arthritis, an autoimmune disease, is triggered, in large part, by TNF-alpha, a small signaling protein usually involved in launching protective systemic inflammatory responses. With excessive TNF production, however, immune cells can become activated inappropriately and cause tissue inflammation. This produces a number of diseases, including RA. While TNF-blockers help many RA patients, these treatments are very expensive, and some patients do not respond. For this reason, researchers have been searching for alternative targets in patients with inflammatory diseases against which drugs can be directed.

"TNF can be thought of as a balloon tethered to the surface of cells. To work, it must be cut loose by signaling scissors called TACE (TNF-alpha converting enzyme)," said Carl Blobel, M.D., Ph.D., program director of the Arthritis and Tissue Degeneration Program at HSS. While blocking TACE could be another way to treat rheumatoid arthritis, researchers know this strategy would likely have side effects since patients lacking TACE are prone to skin infections and intestinal lesions.

Earlier this year, HSS investigators demonstrated that the TACE scissors are regulated by molecules called IRHOM1 and IRHOM2, which are thought to wrap around TACE and help it mature into functional scissors. They also demonstrated that mice that are genetically engineered to lack IRHOM2 lack functional TACE on the surface of their immune cells and don't release TNF. Surprisingly, these mice are healthy, and do not develop skin or intestinal defects.

In the current study, HSS researchers set out to investigate why this paradox exists. After examining tissues of IRHOM2-deficient mice, they found that IRHOM2 regulates TACE on immune cells, whereas IRHOM1 is responsible for helping TACE mature elsewhere in the body, such as in brain, heart, kidney, liver, lung and spleen cells. "IRHOM2 appears to have a more restrictive and exclusive function in immune cells," said Dr. Blobel.

The researchers then set out to determine whether blocking IRHOM2 could be a strategy to treat RA. They used a mouse model that mimics human rheumatoid arthritis in mice genetically engineered to be deficient in IRHOM2. They found that these rodents did not develop inflammatory arthritis and were otherwise healthy.

"When we tested mice that don't have IRHOM2 in a model for inflammatory arthritis, we found they were protected and they were protected as well as mice that didn't have any TNF," said Dr. Blobel. "Because TNF is the driver of rheumatoid arthritis in human disease, as evidenced by how well anti-TNF drugs work, we feel that this provides a completely new angle on blocking TNF release. It would be wonderful to be able to inactivate TACE in a tissue-specific manner and IRHOM2 provides a unique mechanism for us to do so."

Using drugs that inactivate IRHOM2 in humans, clinicians will be able to block the function of TACE only in immune cells. "We can prevent the deleterious contribution of TACE to rheumatoid arthritis patients and preserve its protective function in skin and intestines," said Dr. Blobel. "With IRHOM2, we have a unique and unprecedented opportunity to inactive TACE only in certain cell types, and not in others, and there is currently no other effective way of doing that."

The researchers say the next step is to identify antibodies or pharmacological compounds that can be used to block the function of IRHOM2 and are safe in patients. These HSS investigators are currently working to identify and test such agents. "In theory, IRHOM2-targeted drugs will have less toxicity than TNF alpha blockers," said Dr. Salmon. "They block TNF release only from specific cells, those known to contribute to joint inflammation and damage."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.

Dr. Salmon and Dr. Blobel are co-senior authors of the study. Other investigators involved in the study are from Weill Cornell Medical College, New York City; Ontario Cancer Institute, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Heinrich-Heine University, Dusseldorf, Germany; TriInstitutional Laboratory of Comparative Pathology, New York City; and Keio University, Tokyo, Japan.
Hospital for Special Surgery

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Researchers Hail Gene Breakthrough In Bid To Prevent Spinal Tumours

Main Category: Genetics
Also Included In: Bones / Orthopedics; Cancer / Oncology
Article Date: 06 Feb 2013 - 2:00 PST

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Medical researchers have discovered a gene that is responsible for causing an inherited form of tumour known as spinal meningioma.

Meningiomas are the commonest form of tumour affecting the brain and spine and are common in people who are affected by the genetic disorder Neurofibromatosis 2 (NF2).

NF2 patients are more susceptible to meningiomas because they have inherited a gene with the potential to cause normal cells to become cancerous.

Researchers from Saint Mary's Hospital in Manchester and the University of Manchester worked with families with a history of meningiomas affecting the spinal cord.

Using a powerful new DNA sequencing technique called Next Generation Sequencing, the team was able to check all the genes of three individuals with multiple spinal meningiomas. This led to the identification of changes in a gene called SMARCE1 which lead to spinal meningiomas in some families.

The findings have been published in the prestigious international journal Nature Genetics.

Professor Gareth Evans, a consultant in medical genetics at Saint Mary's Hospital, said: "This is internationally groundbreaking research in which we have identified the gene that causes an inherited version of spinal meningioma, a tumour that occurs on the lining of the brain and spinal cord and which is prevalent in NF2 patients.

"The next step is to develop a screening programme to assess the risk of developing spinal tumours for individuals in affected families and to investigate possible treatments to prevent spinal tumours from growing."

Just over two people in every 100,000 develop meningiomas in the head and spine, with twice as many women as men diagnosed with the condition. They can affect people of all ages, including children.

Neurofibromatosis, which has two main types - NF1 and NF2, affects the skin and nervous system including the brain. Soft, non-cancerous tumours develop on the skin and along the nerve tissue throughout the body. A tell-tale sign of the condition is often the presence of cafe-au-lait spots on the body.

More than 25,000 people in the UK are affected by NF and every day a baby is born with the condition. NF is more prevalent than Duchenne muscular dystrophy, cystic fibrosis and Huntington's Disease combined, but as yet there is no cure.

The Manchester team's pioneering work was funded by The Children's Tumor Foundation, a US-based charity supporting neurofibromatosis research, and the Association for International Cancer Research, a global cancer charity.

CTF works closely with the UK-based Children with Tumours charity - - which is chaired by Professor Evans. CWT raises funds to provide respite to children and their carers affected by Neurofibromatosis and contribute towards vital research.

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Thursday, February 7, 2013

Patients With High Blood Calcium Levels Benefit From Monitored Vitamin D Therapy

Main Category: Nutrition / Diet
Also Included In: Body Aches; Endocrinology
Article Date: 28 Jun 2012 - 0:00 PDT

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Patients With High Blood Calcium Levels Benefit From Monitored Vitamin D Therapy

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Patients with a gland disorder that causes excessive calcium in their blood who also have vitamin D deficiency can safely receive vitamin D treatment without it raising their calcium levels, a new study has determined. The results with one-year follow-up were presented at The Endocrine Society's 94th Annual Meeting in Houston.

Doctors often fear that raising vitamin D levels will further raise calcium blood levels in patients with primary hyperparathyroidism - in which glands in the neck produce too much of the parathyroid hormone, which controls calcium levels. Yet without enough vitamin D, people are at increased risk of osteoporosis and broken bones. Vitamin D helps the body absorb calcium and is vital for bone health.

"These patients need close monitoring every three to four months during vitamin D replacement therapy," said Dima Abdelmannan, MD, an assistant professor at Case Western Reserve University in Cleveland and an endocrinologist at Cleveland Veterans Affairs (VA) Medical Center.

Abdelmannan, who presented the research findings, said doctors should measure blood levels of calcium and parathyroid hormone along with vitamin D levels throughout treatment.

"Measuring vitamin D levels alone may not be helpful in the management of vitamin D deficiency in patients with primary hyperparathyroidism," she said. "The commercially available blood test for vitamin D level - the 25-hydroxyvitamin D - has limitations."

For this study, Abdelmannan and colleagues reviewed the medical records of 32 patients at the VA Medical Center who had both primary hyperparathyroidism and vitamin D deficiency. All 10 women and 22 men had hypercalcemia, or high calcium in the blood, defined as a level greater than 10.1 milligrams per deciliter (mg/dL). They also had vitamin D levels below the cutoff for normal of 30 nanograms per deciliter (ng/dL) on the 25-hydroxyvitamin D test for vitamin D.

Patients received either vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) at an average daily dose of 3,630 International Units, or IU. Most patients had their parathyroid hormone, calcium and vitamin D levels checked every three months for a year after vitamin D treatment.

Vitamin D levels returned to normal with treatment and remained normal at all intervals. Abdelmannan said the average calcium blood level "remained virtually unchanged" from the pretreatment level of 10.7 mg/dL. The calcium level was 10.8 mg/dL at three months after treatment, 10.6 at six months and 10.7 at 12 months, the authors reported. Despite calcium levels not rising, parathyroid hormone levels decreased, from an average of 124 picograms per deciliter (pg/dL) before treatment to 103 pg/dL one year after treatment.

Hyperparathyroidism develops in approximately 100,000 Americans every year and affects twice as many women as men, according to the National Institutes of Health. The risk increases with age. Although the disorder usually has no symptoms, if calcium levels are very high, it can cause bone aches, tiredness and kidney stones, Abdelmannan said.

The Endocrine Society, in its 2011 guideline on treating vitamin D deficiency, suggests that patients with primary hyperparathyroidism and vitamin D deficiency receive vitamin D treatment as needed and that serum (blood) calcium levels should be monitored.

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Sustained EHR Technical Assistance Is Vital To Boost Quality Of Care By Small Physician Practices In New York City

Main Category: IT / Internet / E-mail
Also Included In: Medical Practice Management; Primary Care / General Practice
Article Date: 09 Jan 2013 - 1:00 PST

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Sustained EHR Technical Assistance Is Vital To Boost Quality Of Care By Small Physician Practices In New York City

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The relationship between a physician practice's adoption of electronic health records (EHR) and quality improvements in patient care remains unclear. However, a new study published in the January issue of Health Affairs by Weill Cornell Medical College and the Primary Care Information Project (PCIP) of the New York City Health Department shows evidence that EHR implementation can improve patient care in small physician practices in New York City when combined with sustained high-intensity technical assistance.

To evaluate the effects EHRs have on patient care within small physician practices, the research team used an independent data source using multi-payer medical claims in New York state (New York Quality Alliance), linking the data to small practices enrolled in the Primary Care Information Project. This New York City Health Department initiative provided subsidized EHR software with clinical decision support and onsite technical assistance to 3,300 physicians at 600 primary care practices in underserved neighborhoods serving disadvantaged populations to improve quality of care. This is the United States' largest community-based EHR implementation program, and the PCIP continues to provide technical assistance and education to more than 7,200 providers through its regional extension center, NYC REACH.

The research study found EHR implementation alone was not enough to improve patient care overall or known "EHR sensitive" quality improvement measures, such as cancer screenings and diabetes care. In fact, the researchers reported it took physician practices a minimum of nine months of EHR exposure, combined with eight or more technical assistance visits, to demonstrate any significant statistical improvements in certain key quality measures, including breast cancer screening, retinal exam and urine testing for diabetes patients, chlamydia screening for women and colorectal cancer screening. Physician offices with minimal or no technical support did not show any significant improvements, even when these practices had been using EHRs for up to two years.

"EHRs were once thought to be a cure-all for helping improve patient care, but there are implementation issues and the technology has a steep learning curve," says lead author Dr. Andrew M. Ryan, assistant professor of public health at Weill Cornell Medical College. "Our study shows EHRs can in fact be a tool for quality improvement, but not in isolation. Technical assistance must be at the heart of the EHR implementation process. Under resourced, small physician practices, especially those taking care of underserved populations; need help to effectively use EHR technology to improve patient quality of care."

"These study findings are consistent with observations from our field staff that small physician practices serving the disadvantaged areas of New York City need considerably more technical support to use EHRs to improve quality," says Sarah Shih, executive director of Health Care Quality Information and Program Evaluation at PCIP. "High-intensity technical support has helped improve the quality of care provided by small physician practices in some key quality measures after nine months. In addition, PCIP has made major strides in using EHRs to improve population health among other key quality indicators not measured by claims data. We have also observed improved quality trends for smoking cessation counseling, blood pressure control, cholesterol screening and treatment."

Researchers say it will be important to continue to evaluate the effectiveness of various levels of technical support provided by regional extension centers in improving health outcomes.

EHRs supply physicians with clinical decision support, tools to reduce medical errors, e-prescribing, test result displays, patient health registry information, population data management and improved communication with patients and other providers. The rate of EHR adoption for outpatient care is rising. Physician use of basic EHR systems has increased from 22 percent in 2009 to 35 percent in 2011. But small practices, which constitute the majority of practices in the U.S., have the lowest rate of EHR adoption. Some evidence suggests small practices, especially those in underserved communities like New York City, are less likely to use EHRs.

"EHRs hold a lot of hope and promise and the technology is taking health care a step in the right direction. Our study supports proof of concept that EHRs can improve outcomes, but widespread implementation of the technology and strong technical assistance is needed," says Dr. Ryan. "Our hope is the extension of EHRs with proper technical support will have a direct impact on population health."

The study findings are consistent with other research showing that EHRs alone do not consistently improve quality of care. This is one of the few studies to have evaluated the effect of EHRs implementation on the quality of care in a community outpatient setting focusing on physicians in small practices who serve primarily disadvantaged patients.

"Our study results stand in contrast to widespread perceptions that EHRs automatically improve quality of care. It shows that regional extension centers like NYC REACH have an important role to play in facilitating the use of EHRs to improve the quality of care patients receive -- which is always our ultimate goal," says the study's senior author Dr. Lawrence P. Casalino, the Livingston Farrand Associate Professor of Public Health and chief of the Division of Outcomes and Effectiveness Research at Weill Cornell. In addition, Dr. Tara F. Bishop, assistant professor of public health and medicine at Weill Cornell, is a co-author of the study.

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This research was funded by the Robert Wood Johnson Foundation and performed in close collaboration with the New York City Department of Health and Mental Hygiene, who shared data from its Primary Care Information Project.Weill Cornell Medical College

Weill Cornell Medical College

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Those Who Help Others Derive Significant Health Benefits Not Available To Recipients

Main Category: Psychology / Psychiatry
Also Included In: Anxiety / Stress
Article Date: 07 Feb 2013 - 0:00 PST

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A five-year study by researchers at three universities has established that providing tangible assistance to others protects our health and lengthens our lives.

This, after more than two decades of research failed to establish that the same benefits accrue to the recipients of such help.

Principal investigator Michael J. Poulin, PhD, assistant professor of psychology at the University at Buffalo, says, "This study offers a significant contribution to the research literature on the relationship between social environment and health, and specifically to our understanding of how giving assistance to others may offer health benefits to the giver by buffering the negative effects of stress."

Poulin, along with colleagues at Stony Brook University and Grand Valley State University, produced the study, "Giving to Others and the Association Between Stress and Mortality," which was recently posted online by the American Journal of Public Health, which will publish the study in an upcoming print issue.

The authors point out that although it is established that social isolation and stress are significant predictors of mortality and morbidity, 20 years of studies and meta-analytical review have failed to establish that receiving social support from others buffers recipients against mortality after exposure to psychosocial stress.

"As the title of our study indicates," Poulin says, "we tested the hypothesis that providing help to others would predict a reduced association between stress and mortality for the helpers. Specifically, over the five years of the study, we found that when dealing with stressful situations, those who had helped others during the previous year were less likely to die than those who had not helped others," he says.

The study's 846 subjects, all from the Detroit, Mich., area, completed baseline interviews that assessed stressful events they had experienced in the previous year and whether they had provided tangible assistance to friends or family members in the past year.

Self-reported stressful experiences included such things as serious, non-life-threating illness, burglary, job loss, financial difficulties or death of a family member.

Respondents also reported the total amount of time in the past 12 months they had spent helping friends, neighbors or relatives who did not live with them by providing transportation, doing errands and shopping, performing housework, providing child care and other tasks.

"When we adjusted for age, baseline health and functioning and key psychosocial variables," Poulin says, "the Cox proportional hazard models (the most widely used method of survival analysis) for mortality revealed a significant interaction between helping behavior, stressful events, morbidity and mortality.

"Our conclusion," he says, "is that helping others reduced mortality specifically by buffering the association between stress and mortality.

"These findings go beyond past analyses to indicate that the health benefits of helping behavior derive specifically from stress-buffering processes," Poulin says, "and provide important guidance for understanding why helping behavior specifically may promote health and, potentially, for how social processes in general may influence health."

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Poulin's co-authors are Stephanie L. Brown and Dylan M. Smith, associate professors of preventive medicine, Stony Brook University, Stony Brook, N.Y., and Amanda J. Dillard, assistant professor of psychology, Grand Valley State University, Allendale, Mich.
University at Buffalo

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Measures Needed To Lessen The Adverse Mental Health Effects On Humanitarian Aid Workers In Uganda

Main Category: Anxiety / Stress
Also Included In: Aid / Disasters; Depression
Article Date: 05 Feb 2013 - 1:00 PST

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Latest research points to the high risk for mental health problems among staff working in humanitarian organizations in northern Uganda, due in large part to their work environment. A new study by researchers at Columbia's Mailman School of Public Health examined the mental health of 376 Ugandan workers at 21 humanitarian aid agencies and found that a significant number of the staff at these organizations experienced high levels of symptoms for depression (68%), anxiety disorders (53%), and posttraumatic stress disorder (PTSD) (26%), respectively.

Research up to now has focused on international or expatriate staff; the new study looks at humanitarian workers who are nationals of the country where they work. Workers in Gulu, Northern Uganda, are of particular interest because of their high exposure to chronic and traumatic stress following many years of conflict between the Lord's resistance Army (LRA) and the Government of Uganda forces.

Findings are published in the Journal of Traumatic Stress.

The study, based on self-reported symptoms, showed that female workers reported significantly more symptoms of anxiety, depression, PTSD, and emotional exhaustion than males. Between one-quarter and one-half of all respondents reported symptom levels associated with high risk for burnout. Chronic stressors such as financial hardship, uncertainty whether peace will continue, separation from close family, and unequal treatment of expatriate and national staff were among those cited for causing these adverse mental health effects.

"While women reported higher levels of distress than men on four of the outcomes, greater risk of poor mental health among women has been indicated by a number of studies in northern Uganda," says Alastair Ager, PhD, Professor of Clinical Population and Family Health and the study author. Therefore, he cautions against interpreting this trend purely in relation to the demands and exposures of humanitarian work.

Workers with the United Nations and its related agencies reported fewest overall symptoms. In comparison, those working for international NGOs reported significantly more signs of depression. Dr. Ager points to the structure of the UN and related organizations that serves as a protective function for national humanitarian workers.

"Although increased exposure to stressors is an inevitable consequence of working in humanitarian contexts, these findings clearly demonstrate that the characteristics of the organizational environment significantly influence the mental health and wellbeing of staff in such settings," noted Dr. Ager, who is also Director of the Program in Leadership in Global Health and Humanitarian Systems at the Mailman School.

The findings also show that over 50% of workers experienced five or more categories of traumatic events. Higher levels of social support, stronger team cohesion, and reduced exposure to chronic stressors were associated with improved mental health.

There are therefore a number of practical measures that the humanitarian agencies can do to help lessen the adverse mental health reported by workers and fortify social support mechanisms, according to Dr. Ager. These actions are:

enabling access to the telephone or Internet for personal communications
discouraging "presenteeism" and excessive hours spent at work
training managers to explicitly recognize good work performance, resolve conflict within teams, and show a commitment to employee welfare

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The research was facilitated through collaboration between Child Fund International, the Antares Foundation (a Dutch organization addressing stress issues in humanitarian workers), the Fuller Theological Seminary and the Centers for Disease Control.
Columbia University's Mailman School of Public Health

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