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N Krause

Publications and source records attributed to N Krause.

At least 19 recordsLinked to original sources
PubMed1997

Workplace demands, economic reward, and progression of carotid atherosclerosis.

BACKGROUND: Characteristics of the work environment have been associated with cardiovascular morbidity and mortality, but it is unclear whether these factors are associated with preclinical manifestations of disease. METHODS AND RESULTS: We investigated the association between job demands, economic reward, and the 4-year progression of carotid atherosclerosis in a population-based sample of 940 Finnish men. Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to estimate changes in plaque height, maximum and mean intima-media thicknesses across combinations of job demands, and income. Associations were examined in relation to atherosclerotic risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. Men who had jobs with high demands and low economic rewards had significantly greater 4-year progression of plaque height (0.33 mm, P = .008) and maximum intima-media thickness (0.32, P = .03) than men with low-demand, high-income jobs. The magnitude of these differences was not greatly attenuated by risk factor adjustment and did not differ when examined by the level of workplace resources, social support, or employment status. Larger differences were observed in a subsample of men who had more advanced atherosclerosis at baseline. CONCLUSIONS: These results show that men with demanding work that produces little economic reward have significantly greater progression of carotid atherosclerosis than more advantaged men. The relationship between job demands and health should be understood in a broad framework of interacting economic conditions, social circumstances, and behaviors that cascade over the life course and may ultimately contribute to socioeconomic inequalities in morbidity and mortality.

Arteriosclerosis↗
PubMed1997

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy in patients with fibroids.

OBJECTIVE: Introduction of laparoscopically assisted vaginal hysterectomy (LAVH) was evaluated for its usefulness to replace abdominal hysterectomy in fibroids. STUDY DESIGN: A total of 240 women with a mean age of 46.7 years underwent hysterectomy over a period of one year. The technique of LAVH was introduced starting in the second quarter of the study period. Clinical data of 60 patients undergoing either LAVH or abdominal hysterectomy for fibroids were compared in a cross-sectional study by chi 2- and t-test. RESULTS: A comparison between the first and the last quarter of the study period showed that the rate of abdominal hysterectomies decreased from 66% to 12%, whereas LAVH increased from 0 to 40% (p < 0.05). The rate of vaginal hysterectomies remained between 34% and 48%. Compared to abdominal hysterectomy, LAVH operating time was about 1/3 longer, hospital stay was shorter (3 days), and LAVH proved more cost-effective than abdominal hysterectomy (significance of all differences: p < 0.05). CONCLUSIONS: LAVH is a valid alternative to abdominal hysterectomy in fibroids.

Adult↗
PubMed1997

Workplace conditions, socioeconomic status, and the risk of mortality and acute myocardial infarction: the Kuopio Ischemic Heart Disease Risk Factor Study.

OBJECTIVES: This study investigated whether the association between workplace conditions and the risk of all-cause and cardiovascular mortality and acute myocardial infarction differed by socioeconomic status. METHODS: Prospective data were used to examine these associations in 2297 Finnish men, with adjustment for prevalent diseases and biological, behavioral, and psychosocial covariates, and stratified by employment status and workplace social support. RESULTS: Elevated age-adjusted relative hazards for all-cause mortality were found for men who reported high demands, low resources, and low income; high demands, high resources, and low income; and low demands, high resources, and low income. Similar patterns were found for cardiovascular mortality. In contrast, elevated age-adjusted relative hazards for acute myocardial infarction were observed only in men who reported high demands, low resources, and low income. These results did not differ by level of workplace social support or employment status. CONCLUSIONS: The negative effects of workplace conditions on mortality and of myocardial infarction risk depended on income level and were largely mediated by known risk factors.

Adult↗
PubMed1997

Psychosocial job factors associated with back and neck pain in public transit operators.

OBJECTIVES: This cross-sectional study examined associations between psychosocial job factors and the prevalence of nondisabling back and neck pain in professional drivers after physical work load was taken into account. METHODS: A total of 1449 transit vehicle operators completed a medical examination and a questionnaire yielding information on demographic and anthropometric variables, health status, and physical and psychosocial job factors. Company records were used to supplement information on employment history. Physical work load was measured in life-time years and current weekly hours of professional driving. The relation of psychosocial factors with back or neck pain was analyzed by logistic regression models adjusted for past and current physical work load, vehicle type, age, gender, body height, and weight. RESULTS: The main result of this study was that both physical work load and psychosocial factors were simultaneously and independently associated with back or neck pain. Psychosocial factors associated with back or neck pain included extended uninterrupted driving driving periods, frequency of job problems, high psychosocial demands, high job dissatisfaction, and low supervisory support. An analysis of specific job problems is provided which may be useful in setting priorities for research and intervention efforts in this high risk occupation. CONCLUSION: The results provide support for the role of psychosocial job characteristics in the etiology of back or neck pain in occupational settings.

Adult↗
PubMed1996

Laparoscopy-assisted radical vaginal hysterectomy modified according to Schauta-Stoeckel.

In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is used to develop the paravesical and pararectal spaces. The cardinal ligament is isolated and cut after bipolar coagulation to the level of the deep uterine vein. By the vaginal approach, the ureters are identified before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visible. After incision of the vesicocervical reflection, the uterine fundus is grasped and developed (Döderlein maneuver). The lower cardinal and uterosacral ligaments are exposed by pulling the cervix and fundus uteri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined laparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 women with cervical cancer. The mean operating time was 80 minutes for the vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three patients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achieved at primary surgery for all intraoperative complications. No fistula was observed. The patients had fully recuperated after a mean of 28 days. The laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy.

Adult↗
PubMed1996

Neighborhood deterioration and self-rated health in later life.

This study examined the relationship between the physical living environment and self-rated health in later life. It is hypothesized that older adults who reside in deteriorated neighborhoods will report more physical health problems than elderly people who live in better physical environments. However, it is further predicted that these effects will only emerge in the most dilapidated living conditions. Data from a nationwide survey of older adults provide support for this complex nonlinear relationship. Further analyses reveal that part of the effect can be attributed to friendship strains that arise in deteriorated neighborhood environments.

Aged↗
PubMed1996

Stress, gender, cognitive impairment, and outpatient physician use in later life.

The purpose of this study was to look at the interface between stressful life events, gender, cognitive impairment, and the use of outpatient physician services among older adults. A theoretical rationale is presented, suggesting that older men who are suffering from either mild or moderate levels of cognitive impairment are especially likely to use outpatient physician services when they are confronted by undesirable stressful events. Analyses with data provided by a nationwide sample of elderly people provide support for this complex three-way interaction.

Adaptation, Psychological↗
PubMed1996

Welfare participation and self-esteem in later life.

The purpose of this panel study is to see whether enrolling in a public assistance program is related to changes in self-esteem in later life. A theoretical framework is developed that specifies that older men will be more likely to experience a decline in self-esteem following enrollment in a welfare program. Data from a nationwide longitudinal survey reveal that while receiving welfare benefits is unrelated to self-esteem for all elders taken together, older men experience a substantial decline in their sense of self-worth. In contrast, significant effects fail to emerge among elderly women.

Aged↗
PubMed1996

[Laparoscopic para-aortic and pelvic lymph node excision--initial experiences and development of a technique].

It was the aim of this study to establish and analyze the laparoscopic technique of para-aortic and pelvic lymphadenectomy. During a one year period (from August 1994 till July 1995) 42 patients underwent pelvic and para-aortic laparoscopic lymphadenectomy. In 29 cases cervical cancer, in 11 cases endometrial cancer and in 2 cases tumors of low malignant potential of the ovary were the indication for lymphadenectomy which was combined with radical vaginal hysterectomy in 19 patients or simple vaginal hysterectomy in 13 patients. During the observation period the mean operating time for para-aortic and pelvic lymphadenectomy decreased and the efficiency of the lymphadenectomy increased significantly: the mean operating time for the first 10 para-aortic lymphadenectomies was 52 minutes and for the pelvic lymphadenectomies 141 minutes, respectively. For the last 10 procedures the para-aortic part took 35 minutes and the pelvic part 110 minutes. Whereas at the beginning of the study a mean of 25 lymph nodes were removed, a mean of 36 lymph nodes were sampled during the last 10 procedures. In 3 patients operative injuries to major vessels were encountered of which two were followed by laparotomy. In 3 other patients laparotomy due to postoperative hemorrhage was necessary. These 6 complications occurred during the first half of the study and were not encountered during the following operations by changing from monopolar to bipolar coagulation and by modifying the regimen for perioperative thrombosis prophylaxis. In the first half of the study in 9 women blood transfusions were necessary and in the second half only 4 patients had to be transfused. In the first 10 patients the mean intraoperative blood loss was 1300 cc, in the last 10 patients 300 cc. After a short learning curve laparoscopic para-aortic and pelvic lymphadenectomy is a safe and effective technique for staging cervical, endometrial, and early ovarian cancers. Though this technique is no standard procedure results of this pilot study warrant prospective studies comparing this technique with conventional procedures.

Adolescent↗
PubMed1995

Occupational and nonoccupational correlates of alcohol consumption in urban transit operators.

BACKGROUND: The influence of occupation and the worksite has emerged as an important area of study in research on alcohol consumption. Occupational and nonoccupational factors were studied in relation to alcohol consumption using data from a 1983-1985 cross-sectional study of transit operators. METHODS: A total of 1.853 operators underwent a medical examination for driver's license renewal (including information on age, ethnicity, gender, education). Of these operators, 1,448 completed a questionnaire about occupational (e.g., time of shift, job stressors) and nonoccupational (e.g., personality, life stressors) factors. From either the medical examination or the questionnaire, weekly alcohol consumption was available for 1,820 operators. Variables related to alcohol consumption in previous studies, or theoretically linked to consumption, were analyzed in relation to heavy ( > or = 15 drinks/week) and average weekly consumption. RESULTS: Heavy and average consumption were both related to several nonoccupational variables, including demographic (age, ethnicity, gender, marital status), personality (depression, anger expression), and life stress variables (i.e., life events). Heavy and average consumption were also related to several occupational variables, including job history (number of years driving, specific worksite) and job stressors. Neither measure was related to subjective job content (job demand, decision latitude). CONCLUSIONS: Variability in consumption by demographic factors among this population reflects that seen in society as a whole. However, occupational factors may influence consumption, since consumption was strongly related to (a) specific worksite and time of shift and (b) reported job stressors. Clarifying the exact influence of occupational and worksite factors on alcohol consumption will depend on the convergence of findings from different research designs (e.g., cross-sectional, longitudinal, ethnographic).

Adult↗
PubMed1995

Assessing stress-buffering effects: a cautionary note.

Research on the stress-buffering functions of social support is equivocal. The purpose of this study was to suggest that part of the reason for these contradictory findings may be due to the fact that researchers have misspecified the relationship between stress and support. Instead of always being an effective coping resource, this study tested the view that there are limits to the beneficial effects of assistance provided by others and that beyond a certain level support may actually exacerbate the noxious impact of stress. Data from a recent nationwide survey of older adults support this more complex perspective. More specifically, the data suggest that although emotional support initially reduces the effects of chronic financial strain on depressive symptoms, further increments in emotional assistance are associated with increased psychological distress.

Adaptation, Psychological↗
PubMed1995

Negative interaction and satisfaction with social support among older adults.

The purpose of this study was to test a conceptual model that contrasts two competing explanations of how feelings of satisfaction with social support emerge in later life. The first suggests that satisfaction with support is determined primarily by the amount of assistance provided by significant others, while the second view proposes that negative interaction may play a larger role in this process. Two main findings were obtained from this recent nationwide survey of older adults. First, negative interaction appears to be more strongly related to satisfaction with support than measures of support received from others. Second, statistical interaction effects were detected which suggest that the impact of negative interaction and received support depends upon the amount of assistance that the elderly study participants provide to their significant others.

Aged↗
PubMed1995

Religiosity and self-esteem among older adults.

The relationship between religiosity and self-esteem in later life was examined in this study. Previous research in this area provides conflicting findings. Some studies indicate that greater religious involvement tends to bolster feelings of self-worth, whereas others suggest that more religious involvement is associated with less positive self-evaluations. A new perspective is tested in the present study which predicts that there may be a nonlinear U-shaped relationship between these measures. More specifically, it is proposed that self-esteem is highest among elderly people with the greatest, as well as the least, amount of religious commitment and lowest among older adults with only modest levels of religiosity. The data tend to largely support this new view. However, feelings of self-worth tend to be lowest for those with very little religious commitment rather than those with moderate levels of religious involvement.

Aged↗
PubMed1995

Stress, alcohol use, and depressive symptoms in later life.

The purpose of this study is to use social identity theory in order to evaluate whether alcohol use buffers the effects of stress on depressive symptoms. Two hypotheses are developed from this perspective. The first specifies that alcohol use should reduce the negative impact of events arising in social roles that are not valued highly by study participants. The second predicts that alcoholic consumption will exacerbate the effects of stressors that emerge in roles that are highly salient. Support for these propositions was obtained with data provided by a recent nationwide survey of older adults.

Adaptation, Psychological↗
PubMed1995

Social class differences in social support among older adults.

The purpose of this study is to test for social class differences in social support among older adults. Data on a comprehensive range of social support measures provided by a nationwide sample of elderly people suggests that social class differences emerge when measures of contact with friends, support provided to others, and satisfaction with support are examined. However, significant differences fail to emerge with indicators of contact with family, support received from others, and negative interaction.

Aged↗
PubMed1995

[Laparoscopic radical hysterectomy with para-aortic and pelvic lymphadenectomy].

We report a case of laparoscopic radical hysterectomy with laparoscopic paraaortic and pelvic lymphadenectomy for treatment of cervical cancer FIGO stage IAI in a 26 year old patient with adipositas permagna (Quetelet-Index 40.6). Surgery took 5 hours and 55 minutes with an estimated blood loss of 1000 cc, 27 lymph nodes were resected and the patient was discharged on postoperative day 5 having completely recovered. Investment in further development of this technique in comparison with established methods seems justified.

Adult↗
PubMed1994

Occupational disability due to low back pain: a new interdisciplinary classification based on a phase model of disability.

STUDY DESIGN: This study critically reviewed current conceptualizations of occupational disability resulting from low back pain (LBP). It proposes a new classification system for back pain built on a phase-model of disability. OBJECTIVES: The goal was to develop a classification system that overcomes the shortcomings of existing classification schemes and is useful for interdisciplinary research, prevention, treatment, and rehabilitation. SUMMARY OF BACKGROUND DATA: Attempts to study and prevent disability resulting from LBP have been hampered by the use of inadequate classifications of LBP. METHODS: Current classifications of LBP were critically reviewed, and criteria for a useful classification system are described. The disabling process is organized in eight consecutive phases determined by the presence and duration of work disability. RESULTS: The proposed eight-phase classification is based primarily on the presence and duration of work-disability rather than on clinical categories. It takes into account the developmental and social character of disability. The simplicity, reliability, and expandability of the model allow for its interdisciplinary use in research and intervention. CONCLUSIONS: The prevention of disabling back pain requires an interdisciplinary approach. For this purpose, other than purely biomedical classifications of LBP are needed. The authors propose an eight-phase classification system primarily based on the duration of work disability and that takes into account other biomedical, developmental, and social characteristics of work-disability resulting from LBP.

Adult↗