Stress has emerged as one of the most important factors to consider in psychiatric diagnoses and has become a common reason for long-term sick leave (LTSL). Roughly 50% of LTSL due to psychiatric diseases are thought to be associated with work-related stress. The demarcation towards major depression is disputed, and no international consensus exists for how to diagnose and rehabilitate these individuals. The Swedish National Board of Health has suggested the term “exhaustion syndrome” to integrate these individuals into stress-related disorders. Prominent features of this syndrome are fatigue, sleeping disorders, and cognitive dysfunction. The cognitive dysfunction may be due to an interaction between personality features, environmental factors, the biological effects of stress hormones, and dysfunction in key brain areas, notably the hippocampus and prefrontal cortex. A consistent feature of chronic stress is activation of the cortisol, or hypothalamic-pituitary-adrenal, axis, which may be linked to cognitive dysfunction. Increased glucocorticoid levels, mainly cortisol in humans, are known to impair memory performance. The aim of this thesis was to investigate whether patients with exhaustion syndrome exhibit specific alterations in an extensive set of biological, psychological and immunological variables. Patients in Study 1 had significant cognitive impairment for specific tasks assumed to tap frontal lobe functioning. In Study 2 anxiety prone, worrying, pessimistic individuals with low executive drive and a persistent personality type were more likely to develop exhaustion syndrome. Decreased reactivity was found on the pituitary level after corticotropin releasing hormone (CRH) in exhaustion syndrome patients. The cortisol/adrenocorticotropic hormone response to CRH was slightly higher in patients compared to controls, indicating increased sensitivity at the adrenal cortex level. No differences were found in hippocampal volume. In Study 3, functional imaging revealed a different pattern of brain activation in working memory tests in patients with exhaustion syndrome compared to healthy individuals and patients with depression. In summary, our data suggests an intimate link between personality and wellbeing, cognitive performance and neuroendocrine dysfunction, in exhaustion syndrome. We thus find similarities with major depression but also distinct differences between the exhaustion syndrome and major depression.

No description available.

No description available.

Abstract Somatization is a widespread phenomenon causing subjective suffering and disability. The aim of the study was to assess somatization disorder (SD) and somatization symptoms among young adult population and their associations with sociodemographic factors, alexithymia and temperament as well as psychiatric comorbidity. Various suggestions have been presented to operationalize somatization but none of them has been shown to be superior to others. In this study two definitions were used: SD by DSM-III-R classification diagnostic criteria and "somatization" meaning four or more symptoms of the 35 symptoms of DSM-III-R SD criteria. The study population was a subsample of the Northern Finland Birth Cohort 1966 (NFBC 1966), consisting of cohort members living in Oulu (N = 1,609) on January 1st 1997. The NFBC 1966 is a general population birth cohort of 12,058 live-born children covering 96.3% of all deliveries in the catchment area. The best-estimated procedure was used for assessment of psychiatric morbidity including SD and somatization. Data were collected from the Finnish Hospital Discharge Register and from all available outpatient and inpatient records. Data on education were gathered from Statistics Finland. Other sociodemographic variables, alexithymia and temperament scores were drawn from questionnaires of the field study conducted in 1997 and from earlier follow-up studies. The prevalence of SD was 1.1% (N = 18). Of the subjects 6.1% (N = 97) had somatization. The female-to-male ratio was 5:1 and 6:1, respectively. SD was not recognized by any of the treating physicians, at least not documented in case notes. The observed occurrences of SD and somatization were at a level comparable with earlier international population studies. Somatization did not associate with depression or alexithymia, and neither could a characteristic temperament profile be recognized. Somatization was associated with psychological distress. These results indicate a need for training physicians to recognize SD and somatization and its comorbidity. This will have implications both for psychiatry and other medical specialties regarding collaboration and underlines the importance of liaison-psychiatry at general hospitals. The results suggest a need for more studies about the etiology and development of SD and somatization. / Tiivistelmä Somatisaatio on yleinen ilmiö, josta aiheutuu subjektiivista kärsimystä ja toimintakyvyn laskua. Tämän tutkimuksen tarkoitus oli arvioida somatisaatiohäiriön ja somatisaatio-oireilun yleisyyttä nuorilla aikuisilla sekä näiden ilmiöiden yhteyttä sosiodemografisiin tekijöihin, aleksitymiaan, temperamenttiin ja psykiatriseen sairastavuuteen. Somatisaation käsitteellistämiseksi on esitetty useita vaihtoehtoja mutta mikään niistä ei ole osoittautunut muita paremmaksi. Tässä tutkimuksessa käytetiin kahta määritelmää: DSM-III-R -diagnoosiluokituksen mukaista somatisaatiohäiriön diagnoosia tai somatisaatio-oireilua, jossa esiintyy neljä tai useampia DSM-III-R:n 35 somatisaatiohäiriön oireesta. Tutkimusaineiston muodostivat Pohjois-Suomen vuoden 1966 syntymäkohortin ne jäsenet, jotka asuivat Oulussa 1. tammikuuta 1997 (N =  1,609). Alkuperäinen kohortti koostuu 12,058 elävänä syntyneestä tutkittavasta, mikä kattaa 96.3 % kaikista synnytyksistä Pohjois-Suomessa. Niin kutsutun best-estimated -menettelyn avulla arvioitiin tutkittavien psykiatrista sairastavuutta mukaan lukien somatisaatiohäiriö ja -oireilu. Tietoa kerättiin sairaaloiden poistoilmoitusrekisteristä. Avohoidon sairauskertomustieto koottiin kattavasti. Koulutusasteesta saatiin tieto Tilastokeskukselta. Muita sosiodemografisia tekijöitä, aleksitymiaa ja temperamenttia arvioitiin vuoden 1997 kenttätutkimuksen ja aiempien seurantatutkimusten tietojen avulla. Somatisaatiohäiriön esiintyvyys oli 1.1 % (N =  18). Somatisaatio-oireita todettiin 6.1 % (N =  97) tutkittavista. Naisten osuus oli somatisaatiohäiriössä 5:1 ja somatisaatio-oireilussa 6:1. Osoittautui, että lääkärit eivät tunnistaneet somatisaatiohäiriötä, ainakaan sitä ei oltu kirjattu sairauskertomuksiin. Havaitut somatisaatiohäiriön ja -oireilun esiintyvyydet ovat sopusoinnussa aiempien kansainvälisten tutkimusten kanssa. Somatisaatio-oireilu ei liittynyt masennukseen tai aleksitymiaan eikä somatisaatio-oireilusta kärsiville tutkittavilla todettu tyypillistä temperamenttiprofiilia. Somatisaatio liittyi psyykkiseen stressiin. Johtopäätöksenä voidaan todeta, että lääkäreille tulisi tarjota koulutusta somatisaatiohäiriön ja -oireilun tunnistamisessa. On tärkeää tunnistaa somatisaatio ja siihen liittyvä oheissairastavuus. Havainnot korostavat yleissairaaloiden yhteistyöpsykiatrian ja muiden erikoisalojen yhteistyön merkitystä somatisaatiosta kärsivien potilaiden tutkimuksessa ja hoidossa. Somatisaatiohäiriön ja -oireilun etiologian ja kehittymisen selvittämiseksi tarvitaan uusia tutkimuksia.

Rail is a very expensive component of the railway track. Therefore, research methods extending rail life have great economic importance. During the past thirty years and, particularly during the past ten years there has been an increasing awareness throughout most rail networks in the world of the need to introduce improved design criteria, better construction techniques and higher standard track generally. This implies that quality control at all levels is mandatory if these objectives are to be achieved. With the improved understanding of degradation of track, a more complete comprehension of the costs associated with different operating and infrastructure conditions should also be developed, aiding in the determination of efficient maintenance costs and their contribution to access charges. Track and structures together account for 60% of maintenance costs, with 50% of the total being track. The UIC has done a lot of work on comparative performance indicators, and these show what potential savings much be out there for the taking, just by adopting current best practice. The old wisdom is that it's not enough o do things rights; we have to make sure that we do the right things. These developments have largely resulted from the demand for higher speeds particularly in passenger services and the demand to accept heavier axle loads of freight traffic. Whilst the conventional railway track structure is not likely to change significantly over the next ten years there will be a requirement over that period for better quality track infrastructure. This means less rail surface defects, less internal defects and less wheels irregularities. The presence of rail surface defects generally increases the roughness of the track leading to a poor passenger ride and increased safety risk with freight traffic. In addition, rail surface defects will generally increase the degradation rate of other track components; however, not all defects will produce visible track deterioration. Dynamic impacts produced by the rollingstock running over rail surface defects, such as poor welds, will, over time, create continuous rail defects, loosening of fastenings, abrasion and skewing of sleepers, crushing of ballast and loss of formation geometry. It is only in the recent years that the importance of poor welds in track has been identified. Dips and peaks must be recognised as a severe track irregularity that needs to be addressed and removed. Current maintenance activities have little effect on removing misaligned welds in track and the improvement obtained after the maintenance works is generally short lived. On the other hand, straightening operations have proven to solve the problem and maintain the results following 7 months of traffic. As part of this project, a six kilometre test section was selected on the Mt Isa Line and all welds located in this region were monitored for over 9 months to increase the understanding of the effect of individual maintenance activities on the track roughness. Three 2km Divisions were established; each Division had different maintenance activities and levels of intervention completed over the duration of the project. Over 15,000 readings were recorded and analysed. The following conclusions were drawn. The effect of cycle tamping was clearly identified when comparing the means of weld located in Division 1, 2 to the mean of welds in Division 3. Cycle tamping showed to have a significant positive effect on the dipped welds geometry and an increase in severity of peaked welds prior to their correction. Straightening operations completed in Division 1 and 2 reduced the overall mean of weld misalignments. These Divisions were subjected to different levels of straightening intervention however they produced similar results. Division 1 all dips were straightened and Division 2 only dips &gt0.3mm were straightened. This means that no additional benefit, in terms of overall misalignment of welds, can be gained when straightening operations target dips with a misalignment smaller than 0.3mm. Cycle grinding proved to have little effect on the removal of both dips and peaks. In fact, due to the configuration of the grinding machine, grinding operation produced a slight worsening of the dips misalignments and only a minor improvement of peaks. Although long term monitoring of the site may show minor variations in weld geometry performance, after approximately 3.9 Mgt of traffic the mean of dipped welds in Division 1 and 2 appeared to remain unaltered, as Division 3 showed a minor worsening. Furthermore, the mean of peaked welds in Division 1 and 2 appeared to remain unaltered, as Division 3 showed a minor worsening.