Viktor E. Bovbjerg

Depression and Anxiety in Adults With Sickle Cell Disease: The Pisces Project

Objective: Depression and anxiety are common in sickle cell disease (SCD) but relatively little is known about their impact on SCD adults. This study measured prevalence of depression and anxiety in SCD adults, and their effects on crisis and noncrisis pain, quality-of-life, opioid usage, and healthcare utilization. Methods: The Pain in Sickle Cell Epidemiology Study is a prospective cohort study in 308 SCD adults. Baseline variables included demographics, genotype, laboratory data, health-related quality-of-life, depression, and anxiety. Subjects completed daily diaries for up to 6 months, reporting sickle cell pain intensity, distress, interference, whether they were in a sickle cell crisis, as well as health care and opioid utilization. Results: Two hundred thirty-two subjects who completed at least 1 month of diaries were studied; 27.6% were depressed and 6.5% had any anxiety disorder. Depressed subjects had pain on significantly more days than nondepressed subjects (mean pain days 71.1% versus 49.6%, p < .001). When in pain on noncrisis days, depressed subjects had higher mean pain, distress from pain, and interference from pain. Both depressed and anxious subjects had poorer functioning on all eight SF-36 subscales, even after controlling for demographics, hemoglobin type, and pain. The anxious subjects had more pain, distress from pain, and interference from pain, both on noncrisis pain days and on crisis days, and used opioids more often. Conclusions: Depression and anxiety predicted more daily pain and poorer physical and mental quality-of-life in adults with SCD, and accounted for more of the variance in all domains of quality-of-life than hemoglobin type. SCD = sickle cell disease; PiSCES = Pain in Sickle Cell Epidemiology Study; ED = emergency department; PHQ = patient health questionnaire; MOS SF-36 = Medical Outcome Study 36 item Short Form-36; MMSE = mini mental status examination.

I Could Move Mountains: Adults With or at Risk for Type 2 Diabetes Reflect on Their Experiences With Yoga Practice

Purpose The purpose of this study was to describe firsthand experiences with yoga as shared by adults with or at risk for type 2 diabetes and to examine their beliefs regarding maintenance of yoga practice over time. Methods In this qualitative study, 13 adults with or at risk for type 2 diabetes described their experiences with yoga and their beliefs regarding maintenance of yoga practice over time. Semistructured interviews occurred 16 to 20 months after completion of an 8-week yoga-based clinical trial. Results Themes of readiness for continuing yoga, environmental support for yoga, and integrating yoga emerged through data analysis. Conclusions Findings indicate that yoga is appealing to some individuals with diabetes, but maintaining yoga practice over time is a challenge. Diabetes educators may be able to support maintenance by discussing specific strategies with individuals who express interest in yoga practice.

Work-related traumatic injuries onboard freezer-trawlers and freezer-longliners operating in Alaskan waters during 2001–2012

BACKGROUND Workers onboard freezer-trawl (FT) and freezer-longline (FL) vessels in Alaska may be at high risk for fatal and non-fatal injuries. METHODS Traumatic occupational injuries onboard vessels in the FT and FL fleets were identified through two government data sources. RESULTS The annual risk of fatal injuries was 125 per 100,000 FTEs in the FT fleet, and 63 per 100,000 FTEs in the FL fleet. The annual risk of non-fatal injuries was 43 per 1,000 FTEs in the FT fleet and 35 per 1,000 FTEs in the FL fleet. The majority of injuries in the FT fleet occurred in the factories and freezer holds, whereas the most common injuries in the FL fleet occurred on deck while working the fishing gear. CONCLUSIONS The findings confirmed that workers in those fleets were at high risk for work-related injuries. Injury prevention should focus on removing hazards in the work processes injuring the most workers.

Major life events as potential triggers of sudden cardiac arrest.

Background: We investigated the risk of sudden cardiac arrest in association with the recent loss of, or separation from, a family member or friend. Methods: Our case-crossover study included 490 apparently healthy married residents of King County, Washington, who suffered sudden cardiac arrest between 1988 and 2005. We compared exposure to spouse-reported family/friend events occurring ⩽1 month before sudden cardiac arrest with events occurring in the previous 5 months. We evaluated potential effect modification by habitual vigorous physical activity. Results: Recent family/friend events were associated with a higher risk of sudden cardiac arrest (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1–2.4). ORs for cases with and without habitual vigorous physical activity were 1.1 (0.6–2.2) and 2.0 (1.2–3.1), respectively (interaction P = 0.02). Conclusions: These results suggest family/friend events may trigger sudden cardiac arrest and raise the hypothesis that habitual vigorous physical activity may lower susceptibility to these potential triggers.

Comorbidity, Pain, Utilization, and Psychosocial Outcomes in Older versus Younger Sickle Cell Adults: The PiSCES Project

Background. Patients with SCD now usually live well into adulthood. Whereas transitions into adulthood are now often studied, little is published about aging beyond the transition period. We therefore studied age-associated SCD differences in utilization, pain, and psychosocial variables. Methods. Subjects were 232 adults in the Pain in Sickle Cell Epidemiology Study (PiSCES). Data included demographics, comorbidity, and psychosocial measures. SCD-related pain and health care utilization were recorded in diaries. We compared 3 age groups: 16–25 (transition), 26–36 (younger adults), and 37–64 (older adults) years. Results. Compared to the 2 adult groups, the transition group reported fewer physical challenges via comorbidities, somatic complaints, and pain frequency, though pain intensity did not differ on crisis or noncrisis pain days. The transition group utilized opioids less often, made fewer ambulatory visits, and had better quality of life, but these differences disappeared after adjusting for pain and comorbidities. However, the transition group reported more use of behavioral coping strategies. Conclusion. We found fewer biological challenges, visits, and better quality of life, in transition-aged versus older adults with SCD, but more behavioral coping. Further study is required to determine whether age-appropriate health care, behavioral, or other interventions could improve age-specific life challenges of patients with SCD.

Mental health symptoms among student service members/veterans and civilian college students

Abstract Objective: The aim of this study was to investigate if and to what extent student service members/veterans differ from civilian college students in the prevalence of self-reported symptoms of poor mental health. Participants: The Fall 2011 implementation of the American College Health Association–National College Health Assessment included 27,774 respondents from 44 colleges and universities. Methods: Participants were matched using propensity scores, and the prevalence of symptoms was compared using logistic regression and zero-inflated negative binomial regression models. Results: The odds of feeling overwhelmed in the last 12 months were significantly lower among student service members/veterans with a history of hazardous duty (odd ratio [OR] = 0.46, adjusted p value <.05) compared with civilian students. Military service, with and without hazardous duty deployment, was not a significant predictor of the total number of symptoms of poor mental health. Conclusions: Current student service members/veterans may not be disproportionately affected by poor psychological functioning.

A Pilot Study of Qigong Practice and Upper Respiratory Illness in Elite Swimmers

Upper respiratory tract infections (URIs) are a common complaint in competitive swimmers and can adversely affect performance. No intervention has yet been shown to reduce URI incidence in intensively trained athletes. The University of Virginia varsity swim team received three weeks of training in qigong for the purpose of reducing stress and improving health. Our primary objective was to assess the relationship between qigong practice and symptoms of URI during a time when swimmers would be at high URI risk. Secondary objectives were to assess degree of compliance with a qigong practice regimen, to evaluate differences between qigong practitioners and non-practitioners, and to determine the response-rate and reliability of a newly developed internet-based, self-report survey. The design was observational, cross-sectional, and prospective. Weekly data on cold and flu symptoms, concurrent health problems and medication use, and qigong practice were gathered for seven weeks. Retrospective information on health and qigong training response was also collected. Participants were 27 of the 55 members of the University of Virginia Swim Team in the Virginia Athletic Department. Main outcomes were measures of aggregated cold/flu symptoms and Qigong practice. Survey completion was 100%, with no missing data, and reliability of the instrument was acceptable. Cold and flu symptoms showed a significant non-linear association with frequency of qigong practice (R(2) = 0.33, p < 0.01), with a strong, inverse relationship between practice frequency and symptom scores in swimmers who practised qigong at least once per week (R(2) = 0.70, p < 0.01). Qigong practitioners did not differ from non-practitioners in demographic or lifestyle characteristics, medical history, supplement or medication use, or belief in qigong. These preliminary findings suggest that qigong practice may be protective against URIs among elite swimmers who practice at least once per week.

Mother-Daughter Communication: A Protective Factor for Nonsmoking Among Rural Adolescents

&NA; Rural adolescent females are at‐risk for smoking at rates nearly equal to those of boys, and girls are at increased risk for smoking related diseases, reproductive, and pregnancy problems. The purpose of this study was to investigate protective factors related to nonsmoking in African American (AA) and Caucasian American (CA) female adolescents residing in rural tobacco‐producing counties in Virginia. This qualitative study targeted rural female adolescent nonsmokers and their parents because of the importance of promoting tobacco‐free, healthy lifestyles into adulthood. Participants were 18 adolescent female nonsmokers 16–17 years of age (6 AA and 12 CA) and 10 mothers (5 AA and 5 CA). Semi‐structured questionnaires based on a health behavior framework and communication theory guided four in‐depth group interviews of female adolescents and two group interviews of mothers. Protective factors identified by youth and parent groups were: frequent and open communication about smoking dangers and risks, mothers’ intentionality in messages about nonsmoking; repeated patterns of oversight of daughters activities and friends; mothers’ pride in their daughters; close knit family of support; and daughters explicit desire not to disappoint their parents. Directions for future research include the nature and type of female adolescents’ communication with parents and a parallel study of protective factors of tobacco‐free rural male adolescents to design parent‐child communication interventions for tobacco prevention.

Utility of a Work Process Classification System for characterizing non-fatal injuries in the Alaskan commercial fishing industry

Background The US commercial fishing industry is hazardous, as measured by mortality data. However, research on non-fatal injuries is limited. Non-fatal injuries constitute the majority of occupational injuries and can result in workers’ lowered productivity and wages, lost quality of life, and disability. In the United States, a Work Process Classification System (WPCS) has previously been applied in Alaskan freezer-trawl and freezer-longline fleets to identify causes of injuries and specific hazards, but not to other fishing fleets. Objectives This descriptive epidemiologic study aimed to explore the application and modification of the WPCS in multiple Alaskan fleets, characterize non-fatal occupational injuries in these fleets, and identify work processes that could be targeted for further investigation and future injury prevention efforts. Design Traumatic, non-fatal injuries on-board Alaskan commercial fishing vessels were identified through United States Coast Guard investigative reports. Characteristics of injuries, as well as worker characteristics, were analysed. Injuries were coded using the WPCS. Results We successfully utilized the WPCS to code non-fatal injury cases (n = 136). The most frequent main work processes associated with non-fatal injuries included: on-board trawlers, handling frozen fish and processing the catch; on-board vessels using pot/trap gear, handling the gear and shooting/setting the gear; on-board longliners, traffic on board and hauling the gear; and on-board processor vessels, processing the catch, other work with the catch, and handling frozen fish. Conclusions The study confirmed that a WPCS can be applied to multiple Alaskan fleets to identify hazardous tasks. Hazards were unique for each vessel gear type. Future injury prevention efforts should target work processes associated with the most frequent and most severe injuries. Future studies should establish time estimates for work processes in order to determine risk estimates. Efforts to improve non-fatal injury reporting, especially on smaller commercial fishing vessels, should be undertaken.Background The US commercial fishing industry is hazardous, as measured by mortality data. However, research on non-fatal injuries is limited. Non-fatal injuries constitute the majority of occupational injuries and can result in workers’ lowered productivity and wages, lost quality of life, and disability. In the United States, a Work Process Classification System (WPCS) has previously been applied in Alaskan freezer-trawl and freezer-longline fleets to identify causes of injuries and specific hazards, but not to other fishing fleets. Objectives This descriptive epidemiologic study aimed to explore the application and modification of the WPCS in multiple Alaskan fleets, characterize non-fatal occupational injuries in these fleets, and identify work processes that could be targeted for further investigation and future injury prevention efforts. Design Traumatic, non-fatal injuries on-board Alaskan commercial fishing vessels were identified through United States Coast Guard investigative reports. Characteristics of injuries, as well as worker characteristics, were analysed. Injuries were coded using the WPCS. Results We successfully utilized the WPCS to code non-fatal injury cases (n = 136). The most frequent main work processes associated with non-fatal injuries included: on-board trawlers, handling frozen fish and processing the catch; on-board vessels using pot/trap gear, handling the gear and shooting/setting the gear; on-board longliners, traffic on board and hauling the gear; and on-board processor vessels, processing the catch, other work with the catch, and handling frozen fish. Conclusions The study confirmed that a WPCS can be applied to multiple Alaskan fleets to identify hazardous tasks. Hazards were unique for each vessel gear type. Future injury prevention efforts should target work processes associated with the most frequent and most severe injuries. Future studies should establish time estimates for work processes in order to determine risk estimates. Efforts to improve non-fatal injury reporting, especially on smaller commercial fishing vessels, should be undertaken.

Reported traumatic injuries among West Coast Dungeness crab fishermen, 2002-2014.

BACKGROUND Commercial fishing is a high-risk occupation. The West Coast Dungeness crab fishery has a high fatality rate; however, nonfatal injuries have not been previously studied. The purpose of this report was to describe the characteristics of fatal and nonfatal traumatic occupational injuries and associated hazards in this fleet during 2002-2014. MATERIALS AND METHODS Data on fatal injuries were obtained from a surveillance system managed by the National Institute for Occupational Safety and Health. Data on nonfatal injuries were manually abstracted from Coast Guard investigation reports and entered into a study database. Descriptive statistics were used to characterise demographics, injury characteristics, and work processes performed. RESULTS Twenty-eight fatal and 45 nonfatal injuries were reported between 2002 and 2014 in the Dungeness crab fleet. Most fatalities were due to vessel disasters, and many nonfatal injuries occurred on-deck when fishermen were working with gear, particularly when hauling the gear (47%). The most frequently reported injuries affected the upper extremities (48%), and fractures were the most commonly reported injury type (40%). The overall fatality rate during this time period was 209 per 100,000 full-time equivalent workers and the rate of nonfatal injury was 3.4 per 1,000 full-time equivalent workers. CONCLUSIONS Dungeness crab fishermen are at relatively high risk for fatal injuries. Nonfatal injuries were limited to reported information, which hampers efforts to accurately estimate nonfatal injury risk and understand fishing hazards. Further research is needed to identify work tasks and other hazards that cause nonfatal injuries in this fleet. Engaging fishermen directly may help develop approaches for injury prevention.