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PubMed2004

A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study.

OBJECTIVE: To describe a holistic and comprehensive approach to the assessment of sufferer's perceptions of health-related quality of life (HRQoL) in a cohort of multiple sclerosis (MS) patients. METHODS: The GEDMA (Grupo de Enfermedades Desmielinizantes de Madrid, in Spanish) study is an ongoing longitudinal survey using quantitative and qualitative methodologies. The baseline cohort consisted of a large sample of MS patients recruited from 13 hospitals in Madrid, Spain. Using a standardized protocol we collected data concerning the sociodemographic and health status characteristics of patients, as well as implementing a modified Spanish version of the Functional Assessment of Multiple Sclerosis quality of life instrument Primary caregivers were interviewed using a specific protocol combined with the Zarit Burden Interview. RESULTS: The index cohort comprised 371 MS patients (68.7% female) of mean age 38.9+/-0.9 years. Age, sex and clinical form distribution were similar to other MS population-based surveys. There were 258 (69.5%) relapsing-remitting (RR) MS patients and 113 (30.5%) progressive MS patients. More than one-third of the married patients with progressive MS and almost a quarter of the RRMS patients separated or divorced following a diagnosis of MS; 71.3% of the progressive MS patients as well as 65.8% of the RRMS patients were unemployed as a consequence of the disease. Qualitative analysis showed that friendship and family relationships and occupational status were the most significant dimensions influenced by MS. On the other hand, the speech analysis of primary caregivers showed that emotional burden was related to patients' physical disability. Furthermore, primary caregivers described the influence of MS on their own occupational status, their nonacceptance of the disease, a perception of a lack of support by other members of the family as well as a 'selfish and intransigent' attitude of the patients themselves. CONCLUSIONS: The analysis of the GEDMA cohort provides valuable information that helps clarify the impact of MS on patients' HRQoL.

Adult↗
PubMed2003

[Follow-up of a sample of children with reading-spelling disorders in adulthood].

OBJECTIVE: Only a few studies--especially in Germany--deal with the long-term outcome for dyslexic children. The aim of our study was to assess a group of former students of a boarding school for dyslexic children (Chrisophorus School Oberurff). METHODS: 29 adults with spelling disorder were examined 20 years after they had left school. Their spelling ability was measured with the Mannheimer Spelling Test (MRT), psychiatric symptoms with the Symptom Checklist by Derogatis (SCL-90), occupational status with the Wegener "Magnitude-Prestigeskala" (Magnitude of Prestige Scale), and intelligence with the Culture Fair Intelligence Test (CFT 20). A self-constructed questionnaire was used to assess subjects' self-perception of their reading and spelling abilities, the role of reading and spelling in their work, and the influence of reading and spelling on their choice of employment. RESULTS: Spelling skills at follow-up were more than 0.5 standard deviations above the spelling skills measured at school. The occupational status is rather high at 75% above average. There is no evidence of a significant load of psychiatric symptoms among the dyslexic adults. CONCLUSIONS: The general finding is a favorable development of children with spelling disorder 20 years after attendance at a special boarding school for dyslexic children. High IQ, the high socioeconomic status of the probands and their parents, and the long-lasting remedial work at school are most likely the relevant factors for this development.

Adolescent↗
PubMed1995

Trends in the use of climacteric and postclimacteric hormones in Nordic countries.

The extent of menopausal and postmenopausal hormone use in Denmark, Finland, Norway, and Sweden during 1981-1992 was studied by means of drug sales figures and associations between hormone use, education, employment and occupational status, by questionnaire surveys in each of the respective countries in the 1980s-90s. According to sales figures, hormone use has been different in each of the countries studied. In 1981 use was three times more common in Denmark than in Norway. In 1992 use had increased in all the other countries except Denmark, and was highest in Finland and Sweden. Based on 1981 data for Norway, on 1987 data for Denmark and on 1989 data for Finland, use of hormone therapy was related to education, employment or occupational status in Finland but not in Denmark or Norway. Differences in the phases of innovation diffusion between these countries may offer a partial explanation for these results.

Climacteric↗
PubMedDate not supplied

[Fate of patients after surgical treatment of premature closure of cranial sutures].

From 1954 to 1971, 69 operations in patients with crs, resulting in relieving the intracranial hypertension symptoms, were performed. The patients were aged 1-34 years. In 1989, i.e. 20-29 years after the operation (mean 22.8 years), 14 patients were submitted again for a neurological, neuropsychological, EEG and brain CT check-up. The patients were divided into 3 groups: I gr. (3 patients)--with negligible disorders of attention and memory, without neurological changes in the EEG and CT--in a good social and occupational status. II gr. (4 patients)--with slight headaches, with discrete neurological and neuropsychological symptoms, slight generalized changes with the moderate burst activity in EEG, signs of hydrocephalus in CT scan. III. gr (7 patients)--with seizures, deficit symptoms, some with symptoms of mental impairment, generalized epileptic changes in EEG, signs of cortical and subcortical atrophy in CT scan. In this group some patients did not work and had no families. We have found that the frequency of epileptic seizures in the crs patients is higher, and their social and occupational status is worse.

Adolescent↗
PubMed2005

Quality of life after successful epilepsy surgery: evaluation by occupational achievement and income acquisition.

OBJECTIVES: A comprehensive epilepsy surgery program has been developed at Chulalongkorn University Hospital, Thailand to reach an international standard level, rendering patients good surgical outcomes comparable to developed countries. After successful operation, seizure free patients have become independent, self earning or employed. However, quality of life (QOL) in terms of occupational achievement and income acquisition after epilepsy surgery has never been studied. These indicators reflect the ultimate QOL in the aspects of actual independency, intact brain functions, mental health and psycho-social interactions. The authors therefore conduct the study on improvement of QOL after successful epilepsy surgery using these parameters. MATERIAL AND METHOD: One hundred and eleven intractable epilepsy who have become seizure free to worthwhile improved (Engel class I to III) after standard presurgical evaluation and epilepsy surgery from January 2002 to December 2004 were evaluated. The patients were followed up for 3 years. The occupational status and incomes were categorized according to the ranking of the patients' functioning levels. The pre and post surgery work abilities, employment and incomes were interviewed and compared. Mc Nemar test and paired t-test were used for statistical analyses. RESULTS: The average age of the 111 adults (54 males and 57 females) was 33.7 +/- 9.2 years. Eighty two percent of the patients had temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and underwent standard anterior temporal lobectomy. The rest had tumors, cortical dysplasia or scar and received lesionectomy or cortical resection assisted by intra-operative or intra-cranial EEG. The overall seizure free rate is 83.8%. The occupational status of the subjects was shown to improve significantly after surgery from unemployed to higher categories of professional achievement (p < 0.001). The number of unemployed and no income individuals decreased from 66 to 25 cases (62.1% reduction rate) after surgery (p < 0. 001). Reciprocally, the number of persons who achieved professional jobs with regular incomes or salaries increase from 30 to 53 cases (43.4% increasing rate) (p < 0.001). The patients who have not acquired any income increment showed improvement in working ability after epilepsy surgery. The average annual incomes per capita shows the increasing rate of 45.08%, from 55,657.85 Baht (approximately U.S. dollars 1390) to 80,748.15 Baht (approximately U.S. dollars 2018), with strong statistical significance (p < 0.001). The improvement is best seen in seizure free than in non-seizure free subjects. CONCLUSION: The present study, to the authors 'knowledge, is the first to use work abilities, professional achievement and income acquisition to assess the ultimate QOL after epilepsy surgery. Most subjects have been shown to significantly improve their postoperative lives in terms of occupational accomplishment and income increment, especially in seizure free individuals. The need for expansion of epilepsy surgery is emphasized.

Achievement↗
PubMed1979

Stimulus generalization along a dimension based on a verbal concept.

The present study examined generalization along a dimension based on a verbal concept of occupational status. The status dimension was scaled by students who placed occupation names into five status categories, Category 1 representing highest status and Category 5 the lowest status. In two experiments, key presses by students were occasionally reinforced when a slide showing an occupation name from Status Category 3 was present. For half the subjects, key presses were not reinforced during a name from Category 1; for the other half, presses were not reinforced during a name from Category 5. Occupation names from all status categories were later singly presented. In this generalization test, subjects typically divided the dimension into two parts, responding alike to all names within each part. The results suggest that generalization along a dimension in humans is mediated by a subject's verbal classifications of stimuli.

Journal Article↗
PubMed2002

Midlife income, occupation, APOE status, and dementia: a population-based study.

OBJECTIVE: To examine the relationship between socioeconomic factors and APOE carrier status on the development of dementia. METHODS: Subjects were derived from random, population-based samples previously studied in surveys carried out in 1972, 1977, 1982, and 1987. After an average follow-up of 21 years, 1449 (73%) subjects aged 65 to 79 years were re-examined in 1998. The diagnosis of dementia among the nonparticipants was derived from patient records of the local hospitals and primary health care clinics. RESULTS: Low income level at old age was related to dementia, but low income level at midlife was not a risk factor for dementia. Dementia was also associated with decreasing income level, from midlife to old age 21 years later, when dementia was diagnosed. A sedentary occupation (office, service, or intellectual work) was associated with a decreased risk for dementia among participants; however, when the nonparticipants were included in the analysis, the associations were no longer significant. Low educational level and the APOE epsilon4 allele independently increased the risk for dementia. CONCLUSIONS: Reduction in income level during follow-up and low income level at old age might be the consequence of a dementing process rather than being associated with risk evolution of dementia.

Aged↗
PubMed2005

Multilingual home environment and specific language impairment: a case-control study in Chinese children.

Specific language impairment (SLI) is a common developmental disorder in young children. To investigate the association between multilingual home environment and SLI, we conducted a case-control study in Hong Kong Chinese children over a 4-year period in the Duchess of Kent Children's Hospital. Consecutive medical records of all new referrals below 5 years of age were reviewed and children diagnosed with SLI (case) were compared with those referred with other developmental and behavioural problems who had been assessed as having normal language and overall development (control) using the Griffiths Mental Developmental Scale. SLI was defined as those with a language quotient more than one standard deviation below the mean and below the general developmental quotient in children with normal general developmental quotient, but without neurological or other organic diseases. We used binary and ordinal logistic regression to assess any association between SLI and multilingual exposure at home, adjusting for age and gender of subjects, parental age, education level and occupational status, number of siblings, family history of language delay and main caregiver at home. Multivariable linear regression was used to examine the effect of covariates on the language comprehension and expression standard scores assessed by the Reynell Developmental Language Scale. A total of 326 cases and 304 controls were included. The mean ages of cases and controls were 2.56 and 2.89 years respectively. Boys predominated in both groups (cases, 75.2%; controls, 60.2%). The children were exposed to between one and four languages at home, the major ones being Cantonese Chinese followed by English. The adjusted odds ratio (OR) of SLI was 2.94; [95% confidence interval (CI) 1.82, 4.74] for multilingual compared with monolingual exposure. A significant linear dose-response relationship was found (OR of SLI = 2.58 [1.72, 3.88] for each additional language to which the child was exposed). Male gender (OR = 1.88 [1.24, 2.87]), positive family history (OR = 2.01 [1.17, 3.47]), lower education levels of parents (P = 0.028 for father, P = 0.038 for mother) and lower occupational status of father (P = 0.005) were also risk factors for SLI. Multilingual exposure also significantly reduced the language quotient (P = 0.012) and language comprehension standard score (P = 0.016) of children with SLI, but not of normal children. We concluded that multilingual home environment is associated with SLI with a dose-response relationship. Exposure to multiple languages might adversely affect subsequent language ability.

Analysis of Variance↗
PubMed1990

[A comparison of coping behavior among middle-aged males with health problems in different types of communities in Tokyo].

Coping behaviors of middle-aged men living in areas of Tokyo with differing mortality rates were analyzed to determine if regional differences exist and if so why. Coping behaviors were divided into 3 separate levels: 1) coping behavior for slight symptoms, where a small change in lifestyle would seem to be a countermeasure, 2) coping behavior for symptoms which may be signs of a serious illness, and 3) coping behaviors for illness which have been identified and diagnosed by a physician. The sample was randomly selected from men 35 to 64 years of age living in two separate communities, Koto-Ward with a high middle-aged male mortality rate and Bunkyo-Ward where it is low. The following results were obtained. 1) In both communities, the proportion of interviewees who modified their lifestyle when slight symptoms occurred was associated with educational level and occupational status. The individuals who were junior high school graduates, and blue-collar workers in small enterprises, showed a low tendency toward changing their lifestyle when confronted with slight symptoms. College graduates, and white-collar workers who were members of large or medium sized enterprises, showed a strong tendency toward changing their lifestyle when confronted with slight symptoms. 2) In both communities, there were differences in coping behaviors when confronted with potentially serious illness dependent upon self-rated health and working hours per day. Interviewees with good self-rated health status and working more than ten hours a day showed a lower tendency to see a physician. 3) Compliance with the advice of a physician was lower among those interviewees who were younger and among those who did not have a family physician. In Koto-Ward, a correlation was seen between a low rate of compliance to physician advice and the non-availability of adequate medical facilities nearby. 4) In Koto-Ward where middle-aged male mortality is high, the proportion of interviewees who changed lifestyle in response to slight symptoms was significantly lower than in Bunkyo-Ward. The proportion of those who complied with the advice of a physician was also lower. 5) Regional differences in coping behaviors associated with slight symptoms appears to be due to differences in educational level and occupational status. Differences in availability of family physicians and nearby clinics could account for regional differences in the coping behavior of individuals with diagnosed illnesses.

Adaptation, Psychological↗
PubMed1997

Beer binging and mortality: results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study.

OBJECTIVE: To examine the association between beer binging (regular sessions of heavy beer drinking) and mortality. DESIGN: Prospective population based study with the baseline assessment of level of alcohol intake (dose), by type of drink and drinking pattern, previous and existing diseases, socioeconomic background, occupational status, involvement in organisations during leisure time, physical activity in leisure time, body mass index, blood pressure, serum lipids and plasma fibrinogen concentration, during an average of 7.7 years' follow up of mortality. SETTING: Finland. SUBJECTS: A population sample of 1641 men who consumed beer who were aged 42, 48, 54, or 60 years at baseline. MAIN OUTCOME MEASURES: All cause mortality, cardiovascular mortality, death due to external causes, fatal myocardial infarctions. RESULTS: The risk of death was substantially increased in men whose usual dose of beer was 6 or more bottles per session compared with men who usually consumed less than 3 bottles, after adjustment for age and total alcohol consumption (relative risk 3.01 (95% confidence interval 1.54 to 5.90) for all deaths; 7.10 (2.01 to 25.12) for external deaths; and 6.50 (2.05 to 20.61) for fatal myocardial infarction). The association changed only slightly when smoking, occupational status, previous diseases, systolic blood pressure, low density lipoprotein and high density lipoprotein cholesterol concentration, plasma fibrinogen concentration, body mass index, marital status, leisure time physical activity, and involvement in organisations were controlled for. CONCLUSION: The pattern of beer binging is associated with increased risk of death, independently of the total average consumption of alcoholic drinks. The relation is not explained by known behavioural, psychosocial, or biological risk factors. Death due to injuries and other external causes is overrepresented among beer bingers, but a strong association with fatal myocardial infarction suggests that the pathway may also involve other acute triggers of severe health events.

Adult↗
PubMed1992

Status incongruence and serum cholesterol in an English general practice.

The relationship between status incongruence and serum cholesterol was examined in a case-control study carried out in an English general practice population. Patients (n = 54) with elevated serum cholesterols (greater than or equal to 7.0 mmol/l) were compared to age and sex matched controls (n = 54). A specific type of status incongruence--lifestyle incongruity--was measured as the degree to which style of life (material consumption and status-enhancing behaviors) exceeded occupational status. Lifestyle incongruity was associated with higher serum cholesterol and an increased odds of being a case. This association was independent of age, sex, the body mass index, family history of cardiovascular disease, alcohol use, and, for women, menopausal status. Implications of these results for research on social inequality and the risk of cardiovascular disease are discussed.

Adult↗
PubMed1993

Health practices before and after a work-site health screening. Differences among subpopulations of employees.

The workplace has evolved as a venue for health promotion programs that attempt to reduce employees' risk behaviors and encourage positive health practices. There is little information about the efficacy of such programs for selected subpopulations of employees. Questionnaires designed to measure health practices were administered before and 10 weeks after a work-site health screening. Results indicated that subpopulations had distinctly different patterns of health behaviors both before and after the health screening, and the pattern of variability was inconsistent across various health practices. In general, females and salaried employees had healthier practices than males and hourly employees, respectively. Several interesting interactions between participation status and gender and occupational status need further investigation. Understanding health behaviors of subpopulations may provide insights for implementation of work-site programs that will enhance health-promoting behaviors of all employees.

Adolescent↗
PubMed1987

[Time course and prognosis of industrial workers with major depression].

To investigate the time course and the prognosis of patients with depressive disorder in industry, 60 workers with major depression (DSM-III) selected from two companies were interviewed. Average follow-up years for subjects after returning to their job was 3.5, ranging from 1 to 8. About half of the subjects relapsed and two-thirds changed their job within 5 yr after returning to their job. One case committed suicide. Subjects tended to relapse within the first 4 yr and under the same precipitating situation as at their onset phase. Fifty percent of the subjects indicated "very good" or higher social adjustment according to Axis V (DSM-III). Enough rest days at the onset and no relapse significantly correlated with higher social adjustment in the subjects within 2 yr after the return. In the subjects followed-up for 3 yr or more, marital status, education, no higher occupational status, fewer relapses, and support for them by both industrial health services and worksite supervisors were found to be significant predictors of higher adjustment. The results suggested that, in order to prevent relapses and improve social adjustment of workers with major depression, the mental health team in industry should provide continuous and careful support for them, for at least 4 yr after returning to their job.

Adult↗
PubMed1978

Preventing unplanned pregnancies.

A two-year study was undertaken in 1975--1976 to plan, implement and evaluate innovatory family planning educational and service delivery pilot projects, among those at-risk in Sydney. The study was done in three stages, described in the three parts of this paper. Part 1 describes the process of analyzing the major factors and outcomes in unplanned pregnancy and determining some characteristics of women experiencing unplanned pregnancies, from abortion and adoption records. The characteristics analyzed are: are, marital status, occupation, socio-economic status, and ethnic group. Part II describes the process of determing acceptable communication channels and services they would use. Twenty-five women were interviewed in each of eight at-risk categories. Recommendations are made about suitable educational methods, and family planning services. Part 3 describes the implementation and evaluation of pilot projects. Four major projects are described: (i) in a two lower socio-economic housing area(s), (ii) among Greek men, (iii) among South Americans, and (iv) in two factories. Recommendations are made about future educational programmes and services.

Adolescent↗
PubMed1992

Hormone status in occupational toluene exposure.

Twenty toluene-exposed rotogravure printers, without signs of solvent-induced toxic encephalopathy, had lower median plasma levels of follicle stimulating hormone (FSH) (3.2 vs. 4.9 IU/L; p = .02) and luteinizing hormone (LH) (6.4 vs. 7.2 IU/L; p = .05) and also lower serum levels of free testosterone (7.8 vs. 86.8 pmol/L; p = .05), respectively, than 44 unexposed referents. The individual time-weighted toluene levels in air were 36 (median; range 8-111) ppm. The printers' median toluene levels in blood were 1.7 (1.0-6.6) mumol/l, and in subcutaneous adipose tissue 5.7 (2.5-21) mg/kg fat. There was a negative association between blood toluene and plasma levels of prolactin. In eight printers, the levels of FSH and LH increased during a 4 week vacation, while the levels of thyroid stimulating hormone, free triiodothyronine, and free thyroxine decreased during the same period. The results indicate a slight, reversible effect of toluene on the cortical level or on the hypothalamic-pituitary axis at exposures well below the permissible levels, possibly mediated through an effect on catecholamine neurotransmission.

Adipose Tissue↗
PubMed1990

Patterns of care for chronic patients after the Italian psychiatric reform. A longitudinal case register study.

A comprehensive and well-integrated community-based system of psychiatric services has been developed in South-Verona since the Italian psychiatric reform. Using the South-Verona Psychiatric Case Register, we identified chronic psychiatric patients in the community over a 6-year period after the reform. Six first-contact sociodemographic variables (sex, age, marital status, living situation, education, occupational status) and two clinical variables (ICD-9 diagnosis and past history of state psychiatric hospital admission) were studied for these patients. Four full cohort-years of post-reform chronic patients were followed for a 2-year period to determine their subsequent patterns of care. Logistic analysis was used to examine the interaction of cohort-year with outcome and the above sociodemographic and clinical variables studied individually and in combination. We found that 36.4% of post-reform chronic patients in the community remained in long-term contact with psychiatric services for 2 years after they were first identified. Logistic analysis revealed that none of the sociodemographic and clinical variables studied individually or in combination were predictive of the probability of remaining in long-term contact with community psychiatric services.

Aged↗
PubMed1983

Retention of driving-under-the-influence offenders in alcoholism treatment.

The race, age, education, marital status, employment status, occupational level, prior treatment status, and SCL-90-R Global Severity Index scores of 244 men admitted to a 90-day outpatient treatment program for alcoholism, following their arrests for driving under the influence (DUI) of alcohol, were analyzed to determine whether or not these psychosocial characteristics were related to completing treatment. A stepwise discriminant analysis indicated that age, the SCL-90-R Global Severity Index, and current employment differentiated between offenders who completed and did not complete treatment. Older employed men complaining of less intense symptoms were more likely to finish treatment than younger unemployed men complaining of more intense symptoms.

Adult↗
PubMed1998

Women's body figure preferences across the life span.

Body figure preferences were examined in a sample of 180 women 18 to 59 years old. Participants were presented with Fallon and Rozin's (1985) set of 9 silhouette drawings ranging from very thin to every heavy. Women of all ages rated their current figure as significantly larger than their ideal figure, indicating the presence of body dissatisfaction across the life span. The degree of body dissatisfaction did not vary with age, marital status, educational level, or occupational status. However, in contrast to the younger women's responses and to the results of previous studies, women over the age of 30 years rated their ideal figure as significantly larger than the one perceived as most attractive to men. Therefore, conclusions concerning this issue that are based on studies of college undergraduates cannot necessarily be generalized to other groups of women.

Adult↗