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Biomedical subjects

J Siegrist

Publications and source records attributed to J Siegrist.

At least 55 records · Page 3Linked to original sources
PubMed1998

Impact of school and vocational education on smoking behaviour: results from a large-scale study on adolescents and young adults in Germany.

While level of school education has been related to prevalence of cigarette smoking in a number of studies, less information is available on the role of vocational education and related occupational contexts. This study analyses the relative contribution of different types of educational experience to explaining prevalence and intensity of cigarette smoking in a large sample of female and male vocational trainees in Germany. A standardized questionnaire on smoking behaviour and educational performance was applied in 27 educational centers across the country, covering a total of 20,527 respondents (77.3% of the original sample; women: 59.5%, men: 40.5%). Bivariate analysis revealed a high prevalence of current smokers among vocational trainees, both men (51.2%) and women (49.4%). Men were more likely to be heavy smokers, especially with increasing age. In both sexes, prevalence of smoking was particularly high in the following occupational groups: hairdressers, butchers, painters, service personnel (hotels, restaurants), shop assistants/sellers and cooks. Multivariate analysis taking educational level, type of vocational training (occupation), age, sex and urban-rural background into account revealed the highest prevalence odds ratios (POR) of smoking in subjects with the lowest educational level (POR = 5.19 for men and 4.56 for women). Even stronger effects were observed with smoking intensity (> or = 20 cigarettes/day): in men with the lowest educational level the risk of being a heavy smoker was 8.92, and in women 13.54 compared to subjects with a high-school leaving qualification. Poor school education must be considered the relatively strongest predictor of prevalence and intensity of cigarette smoking in a large sample of female and male vocational trainees. Preventive efforts should be directed at specific target groups such as those identified by this study.

Adolescent↗
PubMed1998

Social status and the quality of care for adult people with type I (insulin-dependent) diabetes mellitus--a population-based study.

UNLABELLED: The objective of this study was to assess the degree of diabetes care and education achieved for Type I (insulin-dependent) diabetes mellitus at the community level in relation to social status and to elucidate potential pathways that mediate any social class gradient. A population-based sample of 684 adults with Type I diabetes (41% women, mean +/- SD age 36 +/- 11, diabetes duration 18 +/- 11 years) in the district of North-Rhine (9.5 million inhabitants), Germany, were examined in their homes using a mobile ambulance. RESULTS: HbA1c (normal 4.3-6.1%) 8.0 +/- 1.5%, incidence of severe hypoglycaemia (injection of glucose or glucagon) 0.21 cases per patient-year; 62% of patients had participated in a structured group treatment and teaching programme for intensification of insulin therapy; 70% used 3 or more insulin injections per day, 9% were on continuous subcutaneous insulin infusion; 91% reported to have had measurements of HbA1c during the preceding year, and 80% to have had an examination of the retina by an ophthalmologist. Care was insufficient with respect to the quality of blood pressure control (70% of patients on antihypertensive drugs had blood pressure values > or = 160/95 mmHg), patient awareness of proteinuria/albuminuria (27% of patients had not heard about it) and prevention of foot complications (only 42% with a diabetes duration over 10 years had remembered to have a foot examination during the preceding 12 months). There was a pronounced social gradient with respect to micro- and macrovascular complications (prevalence of overt nephropathy 7 vs 20% for highest vs lowest quintiles of social class [OR 3.5, 95% CI 1.6-7.5, p = 0.002]) and diabetes-specific quality of life. HbA1c, blood pressure and smoking accounted for part of the association between social class and microvascular complications. The social class gradient was not due to inequality to access to health services, but to lower acceptance among low social class patients of preventive and health maintaining behaviour. In conclusion, achieved standards of care are high with respect to the implementation of intensified treatment regimens, the level of patient education achieved, treatment control and eye care, whereas areas for improvement are blood pressure control and preventive measures for foot care. A substantial social gradient in diabetes care persists despite equal access of patients to health services.

Adolescent↗
PubMed1998

High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study.

STUDY OBJECTIVE: To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors. DESIGN: Cross sectional first screening of a prospective cohort study. SETTING AND PARTICIPANTS: The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427). MAIN RESULTS: Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/high density lipoprotein(HDL)-cholesterol ratio (upper tertile 4.61)(POR 1.26-1.30) were found among men. Among women a measure of high intrinsic effort (immersion) was related to increased low density lipoprotein (LDL)-cholesterol (upper tertile 130 mg/dl)(POR 1.37-1.39). Analyses of variance showed increasing mean values of LDL cholesterol with an increasing degree of the effort-reward ratio among men and increased LDL-cholesterol among women with high levels of intrinsic effort (upper tertile of immersion). CONCLUSIONS: Findings lend support to the hypothesis that effort-reward imbalance represents a specific constellation of stressful experience at work related to cardiovascular risk. The relation was not explained by relevant confounders (for example, lack of physical exercise, body weight, cigarette smoking).

Adult↗
PubMed1998

Modifiable stroke risk factors in volunteers willing to participate in a prevention program.

The current trends in stroke incidence require continued efforts to improve primary prevention. Compared to large-scale public health approaches, more limited programs targeting volunteers may offer some advantages. We invited all 12,824 members of a health insurance company program who lived within 50 km form one of two study sites to participate in a vascular screening program and aimed at reducing modifiable risk factors. 1,837 persons registered and participated (14.3%, mean age 53 +/- 12 years, 50% men). Using the Framingham stroke risk profile for persons aged 55 years or above (n = 961, 52.3%), 97 stroke events can be predicted for this age group within 10 years. The majority of these 97 events will occur in those with men resting blood pressure values +/- 140mm Hg (systolic) or +/- 90 mm Hg (diastolic; 420 persons, mean age 64 +/- 7 years, 60 expected events), or with a particularly high age- and sex-adjusted risk (288 persons, mean age 68 +/- 7 years, 60 expected events). Our pilot study provides an estimate of the prevalence of modifiable vascular risk factor among volunteer participants of a prevention program. Possible benefits of this approach will be investigated in a second step using a randomized intervention.

Aged↗
PubMed1998

Two alternative job stress models and the risk of coronary heart disease.

OBJECTIVES: This study examined the association between two alternative job stress models-the effort-reward imbalance model and the job strain model-and the risk of coronary heart disease among male and female British civil servants. METHODS: The logistic regression analyses were based on a prospective cohort study (Whitehall II study) comprising 6895 men and 3413 women aged 35 to 55 years. Baseline measures of both job stress models were related to new reports of coronary heart disease over a mean 5.3 years of follow-up. RESULTS: The imbalance between personal efforts (competitiveness, work-related overcommitment, and hostility) and rewards (poor promotion prospects and a blocked career') was associated with a 2.15-fold higher risk of new coronary heart disease. Job strain and high job demands were not related to coronary heart disease; however, low job control was strongly associated with new disease. The odds ratios for low job control were 2.38 and 1.56 for self-reported and externally assessed job control, respectively. Work characteristics were simultaneously adjusted and controlled for employment grade level, negative affectivity, and coronary risk factors. CONCLUSIONS: This is apparently the first report showing independent effects of components of two alternative job stress models-the effort-reward imbalance model and the job strain model (job control only)-on coronary heart disease.

Adult↗
PubMed1998

[Psychosocial factors at work and cardiovascular diseases: contribution of the Effort-Reward Imbalance model].

The effect of psychosocial factors at work on health, especially cardiovascular health, has given rise to growing concern in occupational epidemiology over the last few years. Two theoretical models, Karasek's model and the Effort-Reward Imbalance model, have been developed to evaluate psychosocial factors at work within specific conceptual frameworks in an attempt to take into account the serious methodological difficulties inherent in the evaluation of such factors. Karasek's model, the most widely used model, measures three factors: psychological demands, decision latitude and social support at work. Many studies have shown the predictive effects of these factors on cardiovascular diseases independently of well-known cardiovascular risk factors. More recently, the Effort-Reward Imbalance model takes into account the role of individual coping characteristics which was neglected in the Karasek model. The effort-reward imbalance model focuses on the reciprocity of exchange in occupational life where high-cost/low-gain conditions are considered particularly stressful. Three dimensions of rewards are distinguished: money, esteem and gratifications in terms of promotion prospects and job security. Some studies already support that high-effort/low reward-conditions are predictive of cardiovascular diseases.

Adaptation, Psychological↗
PubMed1998

[Social inequality of health changes: implications for social health research and practice].

In recent European Public Health research an increasing gap in life expectancy between higher an lower socio-economic status groups in populations was documented, in particular from Scandinavian countries and United Kingdom. To a lesser or greater extent, this social gradient affects all socioeconomic groups below the top, not simply those at the bottom. The contribution of factors related to health care systems in explaining this gradient is of limited importance. Health-related lifestyle factors and stressful conditions resulting from relative social deprivation both within and outside working life were shown to be relevant determinants. The paper presents selected examples of respective socio-epidemiological research and discusses their implications for public health services.

Delivery of Health Care↗
PubMed1997

[Assessment of the transcultural equivalence of the Spanish version of the profile of quality of life for chronic patients (PECVEC)].

BACKGROUND: In this work the transcultural adaptation and validation of a quality of life questionnaire has been approached, taking into account its increasing interest and its practice considerations. The Profil der Lebensqualität Chronischkranker (PLC) is a German instrument and titled in Spanish. Perfil de Calidad de Vida para Enfermos Crónicos (PECVEC). The main goal of the present study is the assessment of the transcultural equivalence between the Spanish version and the original questionnaire version. SUBJECTS AND METHODS: Translations and back-translations from the original instrument, using bilingual personnel, were made. The most important goal of the study was to achieve the more accurate equivalence between the original version and the Spanish version of the questionnaire. The translations were discussed between the groups of investigators in Germany and Spain and finally adapted a pretest that showed good statistical results. The instrument was applied in two groups of subjects paired by sex and age and its validation was made. RESULTS: The results of two studies (one German and other Spanish) are compared. In the Spanish study the Cronbach's Alpha coefficient (range: 0.39-0.97) and the factorial analysis of the items showed good internal consistency. Cronbach's Alpha was higher than 0.6 for all dimensions except for the scale of Social Well-Being (0.39) with an average value 0.72. The comparison between two factorial structures showed that both are similar statistically. The adapted version showed discriminant capacity between groups ("known group validity") and the final scores of quality of life were similar to the original version. CONCLUSIONS: The adaptation process from the original version to the Spanish version has finished with a transcultural equivalence between both. This preliminary validation can be seen as an important starting point to increase, in this field, the number of instruments of assessment health-related quality of life in chronic patients in Spanish language.

Chronic Disease↗
PubMed1997

Chronic work stress, sickness absence, and hypertension in middle managers: general or specific sociological explanations?

The issue of differential prediction of health outcomes by sociological models of work stress has received little attention so far. This paper argues, both on theoretical and empirical grounds, that active coping with the experience of chronic work stress is more likely to be associated with physical health consequences of sustained autonomic arousal such as hypertension, whereas passive coping may predispose individuals to withdrawal behavior such as sickness absence from work. Based on data from a cross-sectional study on 189 male middle-aged (40-55, 48.3 +/- 4.6 years) middle managers in a car-producing company in Germany, this hypothesis is tested in the framework of the theoretical model of effort-reward imbalance at work. More specifically, the simultaneous manifestation of high effort and low reward at work, indicative of active coping, is expected to statistically predict the risk of being hypertensive. Conversely, suffering from low occupational rewards in the absence of signs of sustained effort, indicative of passive coping, is expected to predict sickness absence (SA) behavior. Multivariate odds ratios (OR) derived from logistic regression analysis and adjusted for important confounders indicate that three measures of low reward are associated with short-term SA (OR ranging from 3.30 to 9.15), that one measure of low reward is associated with long-term SA (OR: 2.67) and that two measures of low reward are associated with number of SA episodes (OR 4.05 and 6.33), whereas no indicator of high effort at work is significantly associated with SA. On the other hand, the OR of being hypertensive is 5.77 in middle managers who suffer from high effort and low reward simultaneously. In conclusion, a sociological model of work stress which allows for differential prediction of health outcomes according to the important notions of active versus passive coping with work demands finds preliminary empirical support.

Absenteeism↗
PubMed1997

Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle-aged men.

OBJECTIVES: To examine the association between a model of chronic work stress (high efforts in combination with low rewards) and two risk factors of coronary heart disease, low-density-lipoprotein (LDL)-cholesterol and fibrinogen. DESIGN: A cross-sectional study in a group of 179 healthy middle-aged (48.5 +/- 4.5) male middle managers. SETTING: A large car-producing enterprise in Germany. RESULTS: After adjustment for relevant covariates, logistic regression analysis showed independent effects of a composite measure of high effort and low reward at work on the prevalence of elevated (upper tertile, i.e. > or = 160 mg dL-1) LDL-cholesterol (prevalence odds ratio (POR) = 3.57; 95% confidence intervals (CI): 1.24-10.20) and on elevated (upper quintile, i.e. > or = 420 mg dL-1) plasma fibrinogen (POR = 6.71 (CI: 1.57-28.76). Apart from this core measure, cigarette smoking, overweight and alcohol consumption were the covariates with the relatively strongest contributions to the multivariate model. CONCLUSIONS: Results give preliminary evidence on an independent association of chronic work stress with atherogenic lipids and with elevated fibrinogen in an occupationally homogeneous group of healthy middle-aged men.

Adult↗
PubMed1997

[Quality of life in advanced coronary heart disease].

The integration of aspects of health-related quality of life (QL) into diagnosis, therapy and rehabilitation of patients with advanced coronary artery disease (CAD), especially with therapy-resistant angina pectoris, is important for at least two reasons. First, restrictions in patients QL often confronts the treating cardiologist with problems which could be overcome by a more comprehensive, psychosocially oriented intervention approach. Secondly, reduced QL was shown to have a negative impact on the course of CAD and on survival. Both aspects are discussed with reference to current scientific evidence, including our own study on effects of a comprehensive lifestyle change on QL in CAD patients.

Adaptation, Psychological↗
PubMed1997

Linking sociological with physiological data: the model of effort-reward imbalance at work.

While socio-epidemiologic studies documented impressive associations of indicators of chronic psychosocial stress with cardiovascular (c.v.) disease evidence on patho-physiologic processes is still limited. In this regard, the concept of heightened c.v. and hormonal reactivity (RE) to mental stress was proposed and explored. While this concept is a static one we suggest a more dynamic two-stage model of RE where recurrent high responsiveness (stage 1) in the long run results in attenuated, reduced maximal RE due to functional adaptation (stage 2). We present results of an indirect test of this hypothesis in a group of 68 healthy middle-aged men undergoing a modified Stroop Test: in men suffering from high chronic work stress in terms of effort-reward imbalance significantly reduced RE in heart rate, adrenaline and cortisol was found after adjusting for relevant confounders. In conclusion, results underscore the potential of linking sociological with physiological data in stress research.

Humans↗
PubMed1996

[Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure (NYHA II)].

METHOD: In a multicenter, placebo-controlled double-blind study, the efficacy of the Crataegus-Specialextrakt WS 1442 in patients with NYHA stage II cardiac insufficiency was investigated. A total of 136 patients with this diagnosis were admitted to the study and, following a 2-week run-in phase, treated with Crataegus-Specialextract or placebo over a period of 8 weeks. The primary target parameter was the change in the difference of the pressure, heart rate product (systolic blood pressure x heart rate/100) (PHRP 50 W load vs. rest) measured at the beginning and end of treatment. RESULTS: On the basis of this variable, a clear improvement in the performance of the heart was shown in the group receiving the test substance, while the condition of the placebo group progressively worsened. The therapeutic difference between the groups was statistically significant. The positive result for the objective efficacy parameter was confirmed by a statistically obvious superiority of Crataegus in the patient's own assessment of improvement in the main symptoms (reduced performance, shortness of breath, ankle edema etc.). In addition, active treatment led, in comparison with placebo, to a considerably better quality of life for the patient, in particular with respect to mental well-being. The tolerability of the active substance proved to be very good-as shown by comprehensive laboratory investigations and the recording of undesirable events. CONCLUSION: All in all, the results of the present clinical investigation confirm those of previous studies showing that Crataegus-Specialextrakt WS 1442 is an effective and low-risk phytotherapeutic form of treatment in patients with NYHA II cardiac insufficiency.

Adult↗
PubMed1996

Adverse health effects of high-effort/low-reward conditions.

In addition to the person-environment fit model (J. R. French, R. D. Caplan, & R. V. Harrison, 1982) and the demand-control model (R. A. Karasek & T. Theorell, 1990), a third theoretical concept is proposed to assess adverse health effects of stressful experience at work: the effort-reward imbalance model. The focus of this model is on reciprocity of exchange in occupational life where high-cost/low-gain conditions are considered particularly stressful. Variables measuring low reward in terms of low status control (e.g., lack of promotion prospects, job insecurity) in association with high extrinsic (e.g., work pressure) or intrinsic (personal coping pattern, e.g., high need for control) effort independently predict new cardiovascular events in a prospective study on blue-collar men. Furthermore, these variables partly explain prevalence of cardiovascular risk factors (hypertension, atherogenic lipids) in 2 independent studies. Studying adverse health effects of high-effort/low-reward conditions seems well justified, especially in view of recent developments of the labor market.

Cardiovascular Diseases↗
PubMed1996

The challenges of future behavioral medicine.

To a large extent, behavioral medicine originates from the United States, and more specifically from the scientific traditions of pragmatism and behaviorism. The core notion of individual learning, mastery, and development embedded in these traditions has lent support to an almost exclusive concern with individual behavioral modification. However, individual mastery and welfare are increasingly threatened by powerful adverse socioeconomic and sociocultural developments, especially by growing social inequalities in health and by expanding social disintegration. Social differentials in morbidity and mortality are documented even in the most economically advanced countries where health-damaging lifestyles (e.g., cigarette smoking, diet) and stressful conditions of relative deprivation in occupational life and elsewhere contribute to the observed pattern. In addition, detrimental effects on health produced by social disintegration are manifest, most notably in societies that undergo rapid socioeconomic change. Implications of these developments for future behavioral medicine are discussed at the level of scientific analysis and of preventive and therapeutic intervention.

Journal Article↗