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PubMedDate not supplied

Healthy Communities and civil discourse: a leadership opportunity for public health professionals.

The author argues that the Healthy Communities movement provides public health professionals with an opportunity to become not just community leaders but also agents of change in a broad political sense. Extending the work of Kohlberg and other developmental psychologists, the author describes five levels of civil discourse. Professionals who practice the inclusive, consensus-oriented level of discourse, which is consistent with the philosophy of Healthy Communities, can help reinvigorate civil society and democracy as a part of making their communities healthier.

Community Health Planning↗
PubMed2002

The investigation and identification of a civil defense canister.

A Civil Defense canister was found in a high school storage area with no radioactive labels or instructions. Initial screening with a 2" x 2" NaI detector indicated elevated count rates above background. Using field instruments with gamma peak analysis features and a laboratory counting system, the collective effort indicated that the contents included 238U and 235U. A Civil Defense Item Specification introduced later in the investigation show that the canister contained approximately 3.0 g of uranyl acetate. The specification also stated that the purpose of the canister was to determine the amount of radioactive material in water and solid, or liquid food samples.

Gamma Rays↗
PubMed1986

Studies in involuntary civil commitment and involuntary electroconvulsive therapy.

On January 2, 1979, the state of Missouri enacted new mental health laws. In this tandem study the impact of the change in law at an acute urban mental health center in St. Louis, Missouri, was examined in two specific areas: involuntary civil commitment and involuntary electroconvulsive therapy (ECT). The first part of this examination was conducted by comparing all patients (N = 86) who were referred to court to determine their need for involuntary civil commitment from July 1, 1980, to June 30, 1982, to a nonadjudicated control group (N = 87). The second part of this examination was conducted by comparing all patients (N = 19) who were referred to court to determine their need for involuntary ECT from July 1, 1979, to June 30, 1983, to a voluntary ECT recipient control group (N = 24). A large series of statistical comparisons were made. The major finding to emerge from these data was that clinicians were selectively referring to court a group of patients with histories of recurrently becoming both dangerous and noncompliant with hospitalization. In addition, it appears that voluntary ECT is used conservatively and involuntary ECT is used very conservatively.

Adult↗
PubMed1986

Violence, civil commitment, and hospitalization.

The frequency of violent behavior and civil commitment leading to hospitalization of psychiatric patients was examined comparing the years 1973 and 1983. For each year, 150 patients were randomly selected among admissions to a locked acute psychiatric unit in a university setting. Medical charts were reviewed for descriptions of violent behavior, demographic information, and legal status. While the rate of preadmission violence did not change significantly between 1973 and 1983, there was a threefold increase in the proportion of patients admitted involuntarily as a danger to others. Possible explanations of the inconsistent application of civil commitment statutes are discussed.

Adolescent↗
PubMed1992

Civil commitment and arrests. An investigation of the criminalization thesis.

This study examined one part of the criminalization thesis, which holds that the dangerousness standard of reform civil commitment law has led to the frequent arrest of mentally ill persons. It followed a large statewide sample of civil commitment candidates for 6 months through arrest records to observe their number and type of arrests. It found that: ex-candidates were seldom arrested; over half of arrests were accounted for by a few with multiple arrests; the nonviolent and those released were no more likely to be arrested than the violent and those committed; and charges were more often for the less serious offenses, but not predominantly for nuisance offenses [corrected].

Adult↗
PubMedDate not supplied

Obesity, stigma, and civilized oppression.

The study was conducted to explore what it is like for individuals and family members to live with obesity as a chronic illness. An interpretive phenomenological design was used to obtain and analyze interviews of 13 obese individuals and 5 of their family members. A convenience sample was used to recruit the subjects who participated in the audiotaped interviews. The interviews used open-ended questions. Audiotapes were transcribed and analyzed for identifying the major themes within each transcript, and patterns of meaning across narratives. The major themes and patterns were described through written essays and group discussions about the transcripts. The participants revealed frequent experiences of stigmatization and discrimination on the basis of their obesity. Those who are obese are reminded through their everyday encounters with family members, peers, healthcare providers, and strangers, that their being deviates from social norms, and that they are inferior to those who are not obese. Obese subjects experience a pattern of denigration and condemnation that is so pervasive as to constitute what Harvey has called civilized oppression. A discussion of the social construction of obesity and the elements of civilized oppression, as they are experienced by those who are obese, offers new insights into interpersonal relationships that can provide a foundation for more effective care of the obese population.

Adaptation, Psychological↗
PubMed2004

From disaster to sustainable civil society: the Kobe experience.

Nine years after the Kobe earthquake in Japan, social issues are still prominent, and the rehabilitation process is still ongoing. The earthquake caused two major changes in Japanese society: an increase in voluntary and non-government activities, and the enhancement of cooperation between local government and the residents' association. People's participation in the decision-making process was a significant achievement. To sustain the efforts generated after the earthquake, the Kobe Action Plan was formulated and tested in different disaster scenarios. The current study suggests that civil societies in urban areas are sustainable if, first, the activities related to daily services are provided by the resident's associations; and second, these are linked to economic incentives. Leadership plays a crucial role in collective decision-making. Creation of the support system is essential for long-term sustainability of civil-society activities. These observations are exemplified in the case study in Nishi Suma, one of the worst-affected areas in the Kobe city.

Community Health Planning↗
PubMed2001

The contributions of business and civil society sectors to rural capacity to solve local health issues.

The new health movement, which has emerged over the last decade, focuses decision making for program designs, interventions and health policies at the local level. This movement assumes that rural communities have the capacity to deal with local health issues. Local problem-solving capacity is based in local leadership patterns, relationships among different community sectors and the ability to select critical but feasible goals. In this research, 159 community leaders in 16 rural counties were interviewed regarding local health priorities, organizational interactions, and leadership roles in county health issues. Analysis of variance was used to identify differences among community sectors. The business and industry sector was found to interact with other organizations around health issues significantly less than all other sectors. Further, 69 percent of the business and industry sector compared with 32 percent of all other sectors thought that the business sector was a source of local leadership. The civil society sector, when compared with all other sectors, was significantly more likely to give priority to health services such as primary, specialty and auxiliary care goals. These findings suggest that rural communities need to find ways to more actively involve the business and industry sector in local health problem solving. In addition, the civil society sector brings to community problem solving a set of priorities that are often different from other sectors of the community.

Community Health Planning↗
PubMed1996

Health sector response to security threats during the civil war in E1 Salvador.

During the recent civil war in E1 Salvador, as in other modern wars, human rights abuses adversely affected health workers, patients, and medical facilities. The abuses themselves have been described in reports of human rights advocacy organisations but health sector adaptations to a hostile wartime environment have not. Agencies engaged in health work during the civil war adapted parties such as training of community based lay health workers, use of simple technology, concealment of patients and medical supplies, denunciation of human rights abuses, and multilevel negotiations in order to continue providing services. The Salvadorean experience may serve as a helpful case study for medical personnel working in wars elsewhere.

El Salvador↗
PubMed1995

Work characteristics and psychiatric disorder in civil servants in London.

STUDY OBJECTIVE: To describe the association between self reported and externally assessed work characteristics and psychiatric disorder. DESIGN: Analysis of questionnaire data collected from the first phase of the Whitehall II study, a cohort study of an employed population. SETTING: Twenty civil service departments in London. PARTICIPANTS: Altogether 6900 male and 3414 female civil servants aged 35-55 years. MAIN RESULTS: High levels of subjective social support at work, control at work, job variety, and skill use were associated with greater satisfaction and wellbeing and less psychiatric disorder measured by the 30 item general health questionnaire (GHQ). High levels of subjective work pace and conflicting demands were associated with less satisfaction and wellbeing and greater psychiatric disorder. The combined effects of work characteristics were similar to the effects of the work characteristics considered separately, except that for men there was a small interaction between psychological demands and control on the GHQ. There was little overall support for the two factor job strain model. In contrast, objective indices of work were generally not associated with the psychological indices. Findings in men and women were generally comparable and were not significantly influenced by employment grade. CONCLUSIONS: Negative affectivity and a tendency to report negatively about both work and the psychological indices may partly explain the difference in the findings between subjective and objective work characteristics. However, subjective work characteristics were still associated with psychiatric disorder after adjusting for negative affectivity. The potential confounding effects of employment grade did not explain the association between either subjective or objective work characteristics and the psychological indices. While modifications to the work environment may directly reduce certain adverse physical health effects, the influence of work place design and management on psychological wellbeing, satisfaction, and psychiatric disorder may be mediated through subjective perceptions of the work environment.

Adult↗
PubMed2000

Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study.

STUDY OBJECTIVE: To test the hypothesis that the association between socioeconomic status and mortality rates cuts across the major causes of death for middle aged and elderly men. DESIGN: 25 year follow up of mortality in relation to employment grade. SETTING: The first Whitehall study. PARTICIPANTS: 18,001 male civil servants aged 40-69 years who attended the initial screening between 1967 and 1970 and were followed up for at least 25 years. MAIN OUTCOME MEASURE: Specific causes of death. RESULTS: After more than 25 years of follow up of civil servants, aged 40-69 years at entry to the study, employment grade differences still exist in total mortality and for nearly all specific causes of death. Main risk factors (cholesterol, smoking, systolic blood pressure, glucose intolerance and diabetes) could only explain one third of this gradient. Comparing the older retired group with the younger pre-retirement group, the differentials in mortality remained but were less pronounced. The largest decline was seen for chronic bronchitis, gastrointestinal diseases and genitourinary diseases. CONCLUSIONS: Differentials in mortality persist at older ages for almost all causes of death.

Administrative Personnel↗
PubMed2002

Change in health inequalities among British civil servants: the Whitehall II study.

STUDY OBJECTIVE: Despite an overall decline in mortality rates, the social gradient in mortality has increased over the past two decades. However, evidence on trends in morbidity and cardiovascular risk factors indicates that socioeconomic differences are static or narrowing. The objective of this study was to investigate morbidity and cardiovascular risk factor trends in white collar British civil servants. DESIGN: Self rated health, longstanding illness, minor psychiatric morbidity (General Health Questionnaire (GHQ) 30 score, GHQ caseness and GHQ depression subscale), cholesterol, diastolic and systolic blood pressure, body mass index, alcohol over the recommended limits, and smoking were collected at baseline screening (1985-88) and twice during follow up (mean length of follow up 5.3 and 11.1 years). Employment grade gradients in these measures at each phase were compared. SETTING: Whitehall II, prospective cohort study. PARTICIPANTS: White collar women and men aged 35-55, employed in 20 departments at baseline screening. Analyses included 6770 participants who responded to all three phases. RESULTS: Steep employment grade gradients were observed for most measures at second follow up. In general, there was little evidence that employment grade gradients have increased over the 11.1 years of follow up, but marked increases in the gradient were observed for GHQ score (p<0.001) and depression (p=0.05) in both sexes and for cholesterol in men (p=0.01). CONCLUSIONS: There is little evidence of an increase in inequality for most measures of morbidity and cardiovascular risk factors in white collar civil servants over the 11.1 years to 1998. Inequalities have increased significantly for minor psychiatric morbidity in both sexes and for cholesterol in men.

Adult↗
PubMed2003

Is retirement good or bad for mental and physical health functioning? Whitehall II longitudinal study of civil servants.

BACKGROUND: To determine whether retirement at age 60 is associated with improvement or deterioration in mental and physical health, when analysed by occupational grade and gender. METHODS: Longitudinal study of civil servants aged 54 to 59 years at baseline, comparing changes in SF-36 health functioning in retired (n=392) and working (n=618) participants at follow up. Data were collected from self completed questionnaires. RESULTS: Mental health functioning deteriorated among those who continued to work, but improved among the retired. However, improvements in mental health were restricted to those in higher employment grades. Physical functioning declined in both working and retired civil servants. CONCLUSION: The study found that retirement at age 60 had no effects on physical health functioning and, if anything, was associated with an improvement in mental health, particularly among high socioeconomic status groups.

Female↗
PubMed1988

Headaches in civil servants: effect on work and leisure.

Headaches in a group of civil servants and their effects on work and leisure activities, the medication taken, and numbers consulting their general practitioners during a year were assessed by a self administered questionnaire sent to 1000 civil servants in sections of a government department in London. The response rate was 74.7%. Altogether 77% of the respondents reported having had headaches in the previous 12 months. There was a higher prevalence in women (88%) than men (70%) and a significant decrease with increasing age. Women also had more frequent and severe headaches than men: 34% reported that headaches had interfered with work, either by impaired performance, making them leave work early, or by stopping them coming into work. About half of those who reported having severe headaches denied that they had affected their work, indicating difficulty in interpreting the term "severe." Nevertheless, 22% said that headaches interfered with their leisure activities as well as work which may be regarded as further evidence that the condition was truly disabling. Eighty per cent of those with headaches took medication, but within the past year only 11% had consulted their general practitioner and only 2.2% had been referred for further specialist opinion. Of the 22% who had not had a headache during the previous 12 months, 5.6% had never had a headache. In this group there was a larger proportion of men, a higher proportion with increasing age, and a higher proportion in non-desk working grades. Differentiation of the causes of headaches was not attempted in this survey but it is concluded that the extent to which they interfere with work and leisure is an important guide to their severity. It is suggested that the occupational health services may have an important role in assessing the causes of headaches and instituting preventive measures that benefit both the worker and industry.

Adolescent↗
PubMed1991

Occupational aspects of epilepsy in the civil service.

Eighty five civil servants with epilepsy who were referred to the Civil Service Occupational Health Service over an 18 month period formed the study population. The reasons for these referrals and their outcomes have been analysed. The main reasons for referral were prolonged or frequent sickness absence, unsatisfactory work performance, epilepsy starting during employment, the discovery of undisclosed epilepsy, and for advice on working conditions. In 30 the outcome was medical retirement, although in only 15 was this due to epilepsy alone. Of the other 15, medical retirement was necessary in four because of the combination of epilepsy with another medical disorder, and in 11 because of a coincidental condition unrelated to their epilepsy. Only six out of 15 referred on account of epilepsy related sickness absence, and none of the 14 referrals due to epilepsy related unsatisfactory work performance resulted in early retirement. This reflected the invaluable role that the occupational physicians had in recognising where problems were due to poor control of the epilepsy or to the side effects of the antiepileptic medication and in arranging through general practitioners or hospital doctors for appropriate adjustment of the drug regimen. Nine of the 22 subjects who developed epilepsy during employment, however, were retired on medical grounds.

Absenteeism↗
PubMedDate not supplied

[Famine in the Spanish civil war and mortality from coronary heart disease: a perspective from Barker's hypothesis].

OBJECTIVE: To determine whether the famine experienced during the Spanish civil war and immediate postwar period influenced mortality from coronary heart disease (CHD) in persons born in this period, following the lines of Barker's hypothesis on fetal programming of chronic diseases in adult life. METHODS: Using CHD mortality data by age and sex for 1990-2002, annual and age-adjusted rates were calculated by the direct method. Poisson regressions were used to estimate period, age and cohort effects by year of birth (1918-1957). RESULTS: During the study period, CHD mortality fell by a yearly average of -2.3% in both sexes and in all ages yearly. This trend was influenced by both cohort and period effects (p<0.001); an increased risk was observed for both sexes and in all ages in the deaths corresponding to persons born during the war and postwar years when the famine was most intense (1937, 1940, 1943 and 1945). CONCLUSIONS: The results obtained by studying yearly CHD mortality are compatible with those expected by Barker's hypothesis of the effect of nutritional stress during pregnancy. In addition to its human, economic and political costs, the Spanish civil war could also have had negative consequences for the health of persons born in this period.

Aged↗
PubMed2002

Circulating human heat shock protein 60 in the plasma of British civil servants: relationship to physiological and psychosocial stress.

BACKGROUND: The Whitehall cohort studies (I and II) of British civil servants have identified sociodemographic, psychosocial, and biological risk factors for coronary heart disease (CHD). To identify mechanisms responsible for susceptibility to CHD, specific biological markers of stress are increasingly being measured. One marker linked to susceptibility to CHD is heat shock protein (Hsp) 60. METHODS AND RESULTS: Blood was taken from 229 civil servants (126 men and 103 women) in the Whitehall II cohort drawn equally from the range of employment grades. Plasma was assayed for levels of Hsp60, tumor necrosis factor alpha (TNFalpha), C-reactive protein, von Willebrand factor, high density lipoprotein (HDL), total cholesterol, and total/HDL ratio. Psychosocial measures included socioeconomic status, psychological distress, and social isolation. The majority of the participants had Hsp60 in their plasma, and approximately 20% had >1000 ng/mL of this protein (a concentration likely to induce biological effects). A positive association between plasma Hsp60 and TNFalpha and a negative association with von Willebrand factor was found. There was also a significant association between elevated Hsp60 levels, low socioeconomic status, and social isolation, together with an association with psychological distress in women. CONCLUSIONS: The majority of participants exhibited Hsp60 in their plasma, and there was evidence of an association between levels of this stress protein and the proinflammatory cytokine, TNFalpha, and with various psychosocial measures.

Biomarkers↗