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Cognitions attributing health complaints to disaster exposure are associated with more severe health complaints and are therefore a promising target for interventions. Little is known about the best strategy to modify such cognitions following exposure to a technological disaster at the community level. In 1992, a Boeing 747 crashed in a residential area in Amsterdam, the Netherlands. Persisting rumours about the possible toxic cargo of the plane led to increasing health concerns among the residents and rescue workers involved in the disaster. The current study investigates (a) the effectiveness of providing information on the health consequences of exposure to the aviation disaster to residents and rescue workers with varying degrees of exposure to the disaster, and (b) individual characteristics which may moderate the effectiveness of the health information provided. A total of 1019 rescue workers and 453 residents involved with varying degrees in the disaster participated in an epidemiological investigation and 1736 rescue workers and 339 residents, all involved, participated in an individual medical examination. Participants were assessed at baseline and 6 weeks after communication of the results of the epidemiological study. Main outcome measures evaluated health anxiety, somatic sensitivity, reassurance by a physician, psychopathology, post-traumatic stress symptoms, fatigue and quality of life. All participants reported elevated levels of psychopathology and fatigue, increased anxiety and uncertainties about their health 6 weeks after communication of the study results irrespective of the degree of exposure to the disaster. In particular, the conviction that health complaints were caused by toxic exposure was related to more severe health complaints and worries in both rescue workers and residents. Our study shows that communication about the health consequences of exposure to an aviation disaster at the community level has no symptom reducing or reassuring effects. Tailoring of the communication to individual characteristics such as existing expectancies may enhance its impact. Keywords: Disaster; Psychopathology; Somatic complaints; Reassurance; Risk communication: The Netherlands

This study investigated the intensity of DSM-III-R and ICD-10 personality disorder features among females experiencing self-reported homesickness. Three groups were compared: (a) a group of women experiencing chronic feelings of homesickness (CHS); (b) a group of women experiencing episodic attacks of homesickness, each time they go on holidays (EHS); and (c) a group of healthy control females, recruited from the general population (HC). This study aimed to investigate whether the homesick participants showed stronger features of personality pathology than the controls and whether those who report experiencing chronic feelings of homesickness showed stronger features of personality pathology than those who at the moment of testing were not in an actual state of homesickness. Glass effect sizes revealed that the DSM-III-R avoidant and dependent and the ICD-10 anxious and dependent traits were most strongly associated with either type of homesickness. Finally, CHS was particularly associated with passive-aggressive traits and EHS with sadistic traits. Based on the stories of 21 homesick women, a link between adverse attachment experiences in childhood and certain personality features on the one hand and homesickness on the other is tentatively suggested. [ABSTRACT FROM AUTHOR]

Purpose of Review: Many noninherited or inherited variations have been described in fibrinogen and they may affect the different functions of fibrinogen., Recent Findings: A number of the acquired variations in fibrinogen affect the properties of the fibrinogen molecule, such as the conversion rate to fibrin and/or the characteristics of the fibrin clot. Also, genetic polymorphisms are known that can affect the function of the fibrinogen molecule. In addition, some other genetic variants are associated with plasma levels of fibrinogen and with the increase of fibrinogen levels during an acute-phase reaction., Summary: In this review the authors discuss the noninherited and inherited variations of fibrinogen and the clinical implications (e.g. when determining the risk of cardiovascular disease).

Background: Elevated plasminogen activator inhibitor-1 (PAI-1) concentrations are associated with cardiovascular diseases. PAI-1 antigen levels are influenced by environmental factors such as body mass index (BMI), and by genetic factors. The PAI-1 promoter of the PAI-1 gene contains two common polymorphisms (-844A/G and -675(4G/5G)) and the 4G allele of the -675(4G/5G) variation has been associated with elevated PAI-1 concentrations and on some occasions with an increased risk of cardiovascular disease., Objectives: The aim of our study was to investigate the effect of the PAI-1 promoter haplotype on PAI-1 concentrations and to determine the role of BMI., Methods: The association between the PAI-1 promoter haplotype and PAI-1 antigen levels was investigated in two independent populations, each including 600 healthy Caucasians. Furthermore, to assess the effect of the PAI-1 promoter haplotype on PAI-1 promoter activity, in vitro reporter gene assays were performed in HepG2 and BAEC cells., Results: We observed significantly higher PAI-1 concentrations in A-4G homozygotes than in G-5G carriers in lean subjects (BMI in the lowest quartile). In these lean subjects, the PAI-1 concentrations in A-4G/G-5G heterozygotes were reduced to 60-75%, and the concentrations in G-5G homozygotes to 45-55%, compared to the PAI-1 concentrations of A-4G homozygotes (p < 0.01). PAI-1 concentrations increased approximately four-fold from the lowest to the highest BMI quartile (p < 0.01). The reporter gene assays did not support a direct effect of the PAI-1 promoter haplotype on promoter activity in HepG2 or BEAC cells., Conclusions: Our study suggests that the PAI-1 promoter haplotype and BMI affect PAI-1 concentrations and that BMI is a stronger determinant than PAI-1 promoter variation.

An elevated plasma fibrinogen level is an independent risk factor for cardiovascular disease. Therefore, an understanding of the regulation of fibrinogen expression is important. Inflammation and genetic variation of the fibrinogen beta gene regulate plasma fibrinogen levels, and there are indications that inflammation and genetic variation interact. The aim of our study was to gain more understanding of the regulation of the inflammatory response of the fibrinogen beta gene and to determine the effects of genetic variation. Luciferase reporter gene assays in hepatoma cells, mutation analysis, and electrophoretic mobility shift assays were used to investigate the transcriptional regulation of the fibrinogen beta promoter. We identified a hepatocyte nuclear factor-3 (HNF-3) site located just upstream of previously identified interleukin-6 (IL6)-responsive sequences. This HNF-3 site is essential for a full response of the promoter to IL6, which is a new function for HNF-3. The activity of the CCAAT box/enhancer-binding protein site (located 18 nucleotides downstream of the HNF-3 site and important to the IL6 response) depends on the integrity of the HNF-3 site and vice versa, explaining the necessity of HNF-3 in the IL6 response of the fibrinogen beta promoter. Furthermore, small interfering RNA to HNF-3 reduces the fibrinogen beta mRNA levels. The rare T allele of the -148C/T polymorphism, which is present between the binding sites of HNF-3 and CCAAT box/enhancer-binding protein, interferes with this mechanism, and this polymorphism is in our assay system the only genetic determinant of IL6-induced promoter activity among six polymorphisms in the fibrinogen beta promoter.

The acute phase reaction is important in many disease processes. Habitual levels of the acute phase proteins fibrinogen, C-reactive protein (CRP) and interleukin-6 (IL-6) are associated with an increased risk of cardiovascular disease, but the dynamic variation of plasma levels of acute phase proteins may be of importance as well. The aim of this study was to document the variation in response by fibrinogen, CRP and IL-6 levels to a mild inflammatory stimulus (yellow fever vaccination) in 25 healthy individuals. Plasma levels of fibrinogen, CRP and IL-6 were determined at baseline and 7 days after vaccination, and genetic polymorphisms in these genes were determined. After vaccination, fibrinogen levels had changed between -13 and +44% (P = 0.003), CRP levels between -88 and +672% (not significant), and IL-6 levels between -55 and +448% (not significant). Genetic variation partly explained the interindividual variation in response, as IL-6 -174G homozygotes showed a significantly stronger increase in CRP levels than IL-6 -174C allele carriers. In conclusion, this study suggests that a large interindividual variation exists in the acute phase response to yellow fever vaccination, indicating that individuals may be classified as hyper-responders or hypo-responders, and that genetic variation may influence the responsiveness of an individual., (Copyright 2004 Lippincott Williams and Wilkins)

Background: The effectiveness of the testimony method has not been established in rural communities with survivors of prolonged civil war., Aims: To examine the effectiveness and feasibility of a testimony method to ameliorate post-traumatic stress symptoms., Method: Participants (n=206) belonged to former war zones in Mozambique. They were divided into a case (n=137) and a non-case group (n=69). The case group was randomly divided into an intervention (n=66) and a control group (n=71). Symptoms were measured during baseline assessment, post-intervention and at an 11-month follow-up., Results: Post-intervention measurements demonstrated significant symptom reduction in both the intervention and the control group. No significant differences were found between the intervention and the control group. Follow-up measurements showed sustained lower levels of symptoms in both groups, and some indications of a positive intervention effect in women., Conclusions: A remarkable drop in symptoms could not be linked directly to the intervention. Feasibility of the intervention was good, but controlling the intervention in a small rural community appeared to be a difficult task to accomplish.

Background: Anxiety sensitivity (AS), the belief that bodily sensations have harmful consequences, is a reliable predictor of panic attacks in both clinical and nonclinical populations. Recently, a new measure of AS has been proposed. The AS profile (ASP) was designed to be a more comprehensive measure of AS, and to be more suitable for the measurement of different AS dimensions. Preliminary evidence (college student sample) suggests that the ASP has 4 dimensions. In the present study, the dimensional structure of the ASP was further investigated, as well as its relationship with temperament and character traits., Methods: Exploratory and confirmatory factor analysis of ASP scores in two large samples of psychiatric outpatients and nonclinical controls (combined n = 742). Correlations and partial correlations of ASP with temperament and character., Results: Exploratory factor analysis yielded a single AS factor. However, confirmatory factor analysis showed that the 6-dimensional structure, as Taylor and Cox had originally intended it, might be a defendable solution. However, the number of items is much too high, with many subscales consisting of semantic clusters. ASP scores were found to be weakly related to the temperament dimension harm avoidance, corroborating earlier findings that were not statistically significant because of small sample sizes., Conclusions: The ASP may be shortened from 60 to 24 items without loss of reliability or content. Future studies using challenge paradigms and studies with general hospital patients may further investigate the usefulness of a shortened version of the ASP., (Copyright 2003 S. Karger AG, Basel)

Increased plasma levels of fibrinogen are associated with a higher risk of cardiovascular disease. It has been suggested that lipid levels may influence the fibrinogen levels by a mechanism other than the synthesis rate, for example a decreased clearance rate. We performed a pilot study to explore this possibility. Twelve male Wistar rats were fed for four weeks with a control low fat/low cholesterol diet, a high fat/high cholesterol diet, and a high fat/high cholesterol diet with an additional 0.5% cholic acid. Labeled 125I fibrinogen was injected, and blood was sampled repeatedly. From the plasma radioactivity of the samples, fibrinogen halflife time was calculated for each animal. Our results suggest that plasma lipids lengthen the fibrinogen halflife times, although the differences were not statistically significant in this small study. Our final conclusion from this study is that lipids may have an effect on the turnover rate of fibrinogen and possibly affect fibrinogen levels through this mechanism.

This study addresses the time ordering of both quantitative and qualitative social support variables, social support seeking and psychological distress. Number of contacts, perceived understanding, satisfaction, severity of network conflicts, social support seeking and symptomatology were assessed at two points in time: at the start of a short term behavioural therapy (T1) and six months later (T2). Severity of symptomatology at T2 was best predicted by the severity of symptomatology at referral and by the change in interpersonal problems. Social support-seeking was at both measurements unrelated to symptomatology. The number of contacts, satisfaction, understanding and social support seeking demonstrated high temporal stability, in contrast to symptomatology and interpersonal problems. A more fine-grained analysis demonstrated that of all social support variables, interpersonal conflicts were most strongly related to symptomatology, especially to interpersonal sensitivity and depression. It is concluded that interventions aimed in particular at relieving interpersonal sensitivity and interpersonal stress and at fostering interpersonal effectiveness may prove to be critical in breaking vicious circles.