Randal D. Beaton

Coping responses and posttraumatic stress symptomatology in urban fire service personnel

Emergency workers, including urban fire fighters and paramedics, must cope with a variety of duty-related stressors including traumatic incident exposures. Little is known about coping responses of emergency workers or whether their coping responses predict future mental health outcomes. The previously formulated Coping Responses of Rescue Workers Inventory (CRRWI) underwent a principal components analysis employing a sample (N = 220) of urban fire fighters and paramedics. Six empirically and theoretically distinct CRRWl components were identified which were relatively stable over a 6-month period. Scores on one of the CRRWI scales, but neither years of service nor their past half years traumatic incident exposures, predicted future changes in self-reports of posttraumatic stress symptomatology.

Exposure to duty-related incident stressors in urban firefighters and paramedics.

Little is known about the variables that might be associated with posttraumatic stress symptomatology in high-risk occupational groups such as professional firefighters and paramedics. A sample of 173 urban professional firefighter/EMTs and firefighter/paramedics rated and ranked the stressfulness of 33 actual and/or potential duty-related incident stressors. They also reported whether they had experienced each of these incident stressors within the past 6 months and, if they had, to recall on how many occasions within the past 6 months. A principal components analysis of their rescaled incident stressor ratings yielded five components: Catastrophic Injury to Self or Co-worker, Gruesome Victim Incidents, Render Aid to Seriously Injured, Vulnerable Victims, Minor Injury to Self and Death & Dying Exposure.

Effects of a Full-Body Massage on Pain Intensity, Anxiety, and Physiological Relaxation in Taiwanese Patients with Metastatic Bone Pain : A Pilot Study

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%-45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29)=16.5, P=0.000; t(29)=8.9, P=0.000], short-term (20-30 minutes) [t(29)=9.3, P=0.000; t(29)=10.1, P=0.000], intermediate (1-2.5 hours) [t(29)=7.9, P=0.000; t(29)=8.9, P=0.000], and long-term benefits (16-18 hours) [t(29)=4.0, P=0.000; t(29)=5.7, P=0.000] on PPI and anxiety. The most significant impact occurred 15 [F=11.5(1,29), P<0.002] or 20 [F=20.4(1,29), P<0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.

Occupational Stressors, Stress Responses, and Alcohol Consumption Among Professional Firefighters: A Prospective, Longitudinal Analysis

This dual-site longitudinal prospective study monitored and measured change in self-reported occupational stressors, emotional trauma, symptoms of stress, and alcohol consumption in urban firefighters. Study participants were 188 firefighters employed by two urban fire departments. The results showed that of 19 occupational stressors examined, only 5 (26%) changed significantly over time, and of those 5, only two—job skill concerns and concerns regarding reduction in force and benefits—decreased, reflecting less bothersome subjective ratings. Of the 12 measures of posttraumatic and other symptoms of stress, 9 (75%) increased significantly over time and none decreased significantly, whereas alcohol consumption was stable over time. Job stressors, trauma caseness, and stress response symptoms at baseline were strongly and significantly associated with the same measures at the two-year follow-up. The implications of the findings for prevention and remediation of stress disorders in fire service personnel are considered. It can be concluded that the stressful nature of urban firefighting is significantly associated with negative health outcomes, including the potential overreliance on alcohol use.

Systematic review of massage intervention for adult patients with cancer: a methodological perspective.

Findings from studies of massage, one of the most commonly used nonpharmacological nursing interventions for managing cancer pain, are inconsistent. The purpose of this article was to elucidate the methodological underpinnings of these inconsistencies with a systematic review of study design, methods, and massage efficacy in adult patients with cancer. A total of 15 studies published in English between 1986 and 2006 were identified by searching in 6 electronic databases. An author-developed tool and an adapted assessment tool were used to extract information from each study and examine the quality of reviewed studies. Methodological issues that potentially account for discrepancies across studies included less rigorous inclusion criteria, failure to consider potential confounding variables, less than rigorous research designs, inconsistent massage doses and protocols, measurement errors related to sensitivity of instruments and timing of measurements, and inadequate statistical power. Areas for future study include determination of appropriate cutoff values of selected outcome measures, delivery of equal doses along with standardized massage protocols, examination of length of massage effects over time, and use of single-blinding randomized clinical trials with large sample sizes.

Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: A randomized clinical trial

Summary Massage therapy provides benefits that are statistically superior to a social attention control on pain intensity, mood status, and muscle relaxation in hospitalized Taiwanese patients with metastatic bone pain. Abstract To date, patients with bony metastases were only a small fraction of the samples studied, or they were entirely excluded. Patients with metastatic cancers, such as bone metastases, are more likely to report pain, compared to patients without metastatic cancer (50–74% and 15%, respectively). Their cancer pain results in substantial morbidity and disrupted quality of life in 34–45% of cancer patients. Massage therapy (MT) appears to have positive effects in patients with cancer; however, the benefits of MT, specifically in patients with metastatic bone pain, remains unknown. The purpose of this randomized clinical trial was to compare the efficacy of MT to a social attention control condition on pain intensity, mood status, muscle relaxation, and sleep quality in a sample (n = 72) of Taiwanese cancer patients with bone metastases. In this investigation, MT was shown to have beneficial within‐ or between‐subjects effects on pain, mood, muscle relaxation, and sleep quality. Results from repeated‐measures analysis of covariance demonstrated that massage resulted in a linear trend of improvements in mood and relaxation over time. More importantly, the reduction in pain with massage was both statistically and clinically significant, and the massage‐related effects on relaxation were sustained for at least 16–18 hours postintervention. Furthermore, massage‐related effects on sleep were associated with within‐subjects effects. Future studies are suggested with increased sample sizes, a longer interventional period duration, and an objective and sensitive measure of sleep. Overall, results from this study support employing MT as an adjuvant to other therapies in improving bone pain management.

Sampling Bias and Other Methodological Threats to the Validity of Health Survey Research

Data from a longitudinal occupational health survey of professional fire fighters were used to explore the potential impact of two types of methodological bias: sample selection and reactivity. No significant differences on demographic variables were observed between the group who first responded after a within-study change in survey administration format (Delayed) and respondents who had completed surveys since the studys inception (Initial). However, statistically significant differences in the studys 26 outcome measures provided some evidence that between-group differences did exist and that an “administration format” type of response bias was also potentially present. The effect sizes associated with the 37 observed significant differences ranged from small to medium. These results provide a context for a reexamination of standard techniques for the identification and interpretation of survey research biases. Methods are suggested to strengthen tests for selection bias and to minimize the impact of response biases.

RESPONSE TO SYMPTOMS IN HEALTHY, LOW UTILIZERS OF THE HEALTH CARE SYSTEM

From the literature, it is clear that a small proportion of people account for an inordinately high number of health care visits. Conversely, there exists a group of individuals who rarely seek professional medical intervention and, yet, who remain healthy. This study examines a sample of adults who have not received remedial treatment for any symptom in the previous year, who consider themselves as healthy and who pass a comprehensive physical examination. A gender and age balanced group of healthy low utilizers was administered the Symptom Response Questionnaire, an instrument designed to elicit response tendencies to thirteen standardized symptoms. There were significant differences between age groups in response to symptoms with the older individuals more likely to seek professional help. There were few gender differences within the healthy sample. This sample of healthy low-utilizers was not without symptoms, reporting an average of 20 symptoms occurring in the previous week as measured by the SCL-90. A clinical headache group was also administered the SRQ to provide information about their response tendencies to symptoms. This preliminary study suggests that response to illness may be significantly influenced by age and patient status and that reported gender differences in health care utilization may need to be examined more carefully. It is proposed that behavior patterns of healthy, low utilizers may have direct implications for intervention with high utilizers of the health care system.

Response pattern complexity of auditory cells in the cortex of unanesthetized monkeys

Abstract Complex temporal response patterns of neurons in auditory cortex were studied in unanesthetized, alert monkeys under controlled behavioral conditions. Responses to various frequencies and intensities of pure tones and various intensities of white noise stimuli were studied. Approximately 48% of the cells studied exhibited multiple, temporally discrete response components. In about one-third of these cells the temporally discrete components varied independently of one another in their response to changes in stimulus parameters. These observations bear on questions of the structural and functional organization of the auditory system and neural coding.

Work and nonwork stressors, negative affective states, and pain complaints among firefighters and paramedics

Prior research has suggested that occupational stressors may contribute to the etiology, progression, and chronicity of pain problems in workers. This study used anonymous survey methods to assess the prevalence and frequency of self-reported pain symptoms and their relationships to demographic variables, sources of occupational stressors, nonwork stressors and affective distress in a large sample (N≈2000) of employed career public sector firefighters and paramedics. The findings were consistent with those of previous studies of high strain workers. More than 95% of the firefighter/paramedic sample reported at least one pain complaint (using a 1 week assessment time frame). A hierarchical multiple regression analysis entering demographic, occupational, and nonwork stressors, as well as measures of negative affective states targeting total pain scores, yielded significant relationships. Five occupational stressors were associated with respondent pain complaints. The results also suggest that negative affective states mediated the relationships between work and nonwork variables, and pain complaint outcomes. The implications of these findings for the development of preventive interventions for firefighters and paramedics as well as other emergency service workers are considered.