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PubMed2000

Occupational status, cortisol secretory pattern, and visceral obesity in middle-aged men.

OBJECTIVE: Despite several studies indicating that social gradients are predictive of cardiovascular mortality, the pathogenetic mechanisms remain incompletely understood. RESEARCH METHODS AND PROCEDURES: A population sample of 51-year-old men (N = 284) was divided into a socioeconomic gradient with manual laborers, civil servants, and university graduates. Anthropometric measurements were registered. Cortisol concentrations were measured in saliva, collected repeatedly during an ordinary working day, and a low-dose dexamethasone suppression test was performed. RESULTS: Lower socioeconomic status was associated with visceral obesity and higher cortisol values in relation to perceived stress. However, total cortisol secretion over the day of study was not elevated. The regulation of cortisol secretion showed less plasticity and dexamethasone inhibition was less efficient in the men in the lower socioeconomic status group than in those with a higher socioeconomic status. These are known consequences of long term stress. Longer duration in low socioeconomic conditions seemed to worsen these phenomena. DISCUSSION: It was concluded that a low socioeconomic status is associated with perturbed cortisol secretion, which is elevated in relation to perceived stress. When the hypothalamic-pituitary-adrenal axis is subjected to prolonged increases in cortisol elicited by chronic stress, the regulation of cortisol secretion is affected, indicating neuroendocrine dysregulations. These observations may provide a means for understanding the association of socioeconomic impairments with visceral obesity and the social inequality in risk for prevalent and serious diseases.

Anthropometry↗
PubMed1999

[Occupational status of Saxony social psychiatry service clients as a result of the reunification of Germany].

PURPOSE: Evaluating the establishment of social psychiatry services (SPS) in Saxony was part of a public health research project. METHOD: One of the variables in a specifically designed assessment instrument--used in 8 SPS during the period 08/95-01/97--was the retrospective statement concerning changes in the client's vocational situation caused by the social upheavals in 1989. RESULTS: 40.6% (n = 335) answered in the affirmative. Men are significantly overrepresented in the group with vocational changes; compared to the population without vocational changes the proportion of currently unemployed persons (56%) is five times higher; only 16% are still employed. Neurotic/personality disorders as well as brief mental disturbances and dependency disorders are more frequent than in the whole SPS-clientele.--The most important constellation (19%) identified by a configuration-frequency analysis is that of patients with prolonged psychotic disorders (started < 1990, not associated with dependency disorder) who were employed at sheltered workplaces during the GDR-period despite of their mental disorder. CONCLUSION: Following the political German reunification possibilities of vocational rehabilitation have deteriorated and up to now the number of newly established alternatives in regional mental health services is insufficient.

Adult↗
PubMed1982

[Results of a clinico-epidemiologic study with special reference to the occupational status of psychiatric patients].

The contribution reports on the results of an epidemiological sociopsychiatric pilot study. Figures showing the attendance without appointment at a clinic in one district of Leipzig were used to obtain statistical data regarding morbidity (outpatient morbidity, age, sex and diagnosis distributions). Main attention was paid to the vocational situation of those with psychic disorders. The concentration of the psychically ill, especially schizophrenics, in vocations requiring low standards of qualification described in the literature from nonsocialist countries was not confirmed. The vocational mobility of the psychically ill is currently being investigated.

Adult↗
PubMed1995

[Psychological, behavioral and occupational status changes after an aortocoronary bypass intervention].

BACKGROUND. Studies on the quality of life after coronary artery by-pass grafting (CABG) have yielded discordant results. Several studies have described psychological and social improvements while others have reported a lack of change in behavioural risk factors and return to work. There have been no reports on Italian patients, and, because of the wide range of psychological measures used in previous studies, it is difficult to draw any general conclusions. The aim of this study was to assess the psychological sequelae of CABG. METHODS. A total of 164 patients (142 men and 22 women, aged 60 years) with myocardial ischemia, completed the CBA-H Questionnaire 3-5 days before elective CABG and again after 6 months. RESULTS. State anxiety scores were lower after surgery (p < .000) as were health fears (p < .000), depression (p < .009) and life stress (p < or = .000) scores. There were also improvements in well-being (p < .003), affective relationships (p < .000) and sexual relations (p < .0007). There was a decline in behavioural risk factors, namely: smoking behaviour (p < .09), alcohol consumption (p < .002), over-eating (p < .0000) and sedentary life-style (p < .02). Clinical post-operative complications did not negatively influence patients' psychological state and return to work. Preoperative health fears (p < .04) and social anxiety (p < .02) did influence patients' return to work. CONCLUSIONS. In conclusion, psychosocial function, health state and quality of the life generally improved after elective CABG. Return to work was found to be an unreliable measure of the success of surgery. Pre- and post-operative data revealed a general denial trait which identifies patients at greater risk of cardiovascular events after CABG.

Adult↗
PubMed2003

[Assessing social inequality in microcensus data and German national health examination survey].

To analyse the impact of social inequality on health and illness public health officials in Germany request for more data on socio-demographic indicators in official population statistics at Federal and State level. The aim of the study was to examine whether the national sample census Microcensus is suitable for scaling social inequality. For this purpose, coding instructions for calculating social strata index by Winkler were applied to databases of the Microcensus. The results were compared with the German Health Survey, because social data of this survey are already scaled according to the coding instruction for social strata index by Winkler. Data analyses were based on subgroups of North Rhine-Westphalia originated from national samples of Microcensus and German Health Survey. For index indicators "education" and "income" coding structure was transferred to databases of Microcensus without any problems. For index indicator "occupational status" occupational groups were less comparable. This refers to the classification of the occupational status of formerly employed people. However this limitation applies also to employees because the model for "occupational status" is assessed only on a four-year basis. From a methodical point of view it seems to be a problem that "household" has a different meaning in the index by Winkler and Microcensus and is only partly transferable to Microcensus databases. Additionally, identification of the main income earner of the household proved extremely difficult. Therefore, at the present conceptional stage of Microcensus it seems appropriate to classify occupational status as an individual criterion.

Censuses↗
PubMed1990

Psychological distress and somatic symptoms after natural disaster: differential vulnerability among older adults.

In a panel study, more than 200 older adults were interviewed before and after a severe flood in southeastern Kentucky in 1984. The issue in this study was whether older adult flood victims were differentially vulnerable to increases in psychological and physical symptoms on the basis of their age, sex, marital status, occupational status, education level, and preflood symptom levels. Flood exposure was related to increases in depressive, anxiety, and somatic symptoms at 18 months postflood. Within this older adult sample, men, those with lower occupational status, and persons aged 55-64 were at significantly greater risk for increases in psychological symptoms. Sociodemographic status did not moderate the impact of flood exposure on physical health. Implications for crisis-intervention services to older adult disaster victims are discussed.

Adaptation, Psychological↗
PubMed2001

[Social determinants of smoking behavior in Germany: results of a 1995 micro-census].

OBJECTIVES: The negative health effects of cigarette smoking are nowadays well known. An important prerequisite for the implementation of rewarding health promotion campaigns aiming at reducing the tobacco dependency in the general population is the knowledge about smoking prevalences in different social population groups, and specific information about social factors and determinants influencing smoking behaviour. METHODS: In this regard, the Microcensus is a very valuable data source for Germany. Included in the present analysis are persons aged 18 years and older, which are present in the "Microcensus Public Use File 1995" and had answered the questions about their smoking behaviour (N = 186,424). The dependent study variable is current cigarette smoking. Independent study variables are sociodemographic factors (age, sex, family status), occupational status, unemployment, socio-economic situation and regional-specific variables (size of community, East vs West Germany). RESULTS: All together, 30.5% of the males and 18.0% of the females were current smokers. Significantly higher smoking rates were observed for persons living in metropolitan areas, persons with low educational achievement and low occupational status, for people being divorced, unemployed, and living on social welfare. In a second step, we analysed the cumulative effect of these social factors for current smoking status. In summary, it was found that the cumulation of social determinants explained a great part of the variance in smoking prevalence. Current smoking was four to six times more prevalent in population groups characterised by several unfavourable social conditions compared to more privilege population groups. CONCLUSIONS: Thus, smoking related prevention activities should be evaluated, among others, regarding their potential to reduce the social polarisation of the smoking epidemic.

Adolescent↗
PubMed1988

The relationship of self-esteem, maternal employment, and work-family plans to sex role orientations of late adolescents.

Self-esteem, maternal employment, and work-family plans are examined in relation to sex role orientations of late adolescents. Data are analyzed from questionnaires administered to 387 males and females. It was found that future work-family plans were closely tied to sex role orientations of adolescents of both sexes. However, self-esteem, evaluation of the relative difficulty of male-female sex roles, and projected childlessness were salient to sex role attitudes of females but not of males. Positive evaluations of self were related to non-traditional sex role orientations among females. Maternal employment differentially affected male and female children. Sons of women in high-status occupations were reluctant to get involved in a two-career family with children. Mothers' occupational status had little influence on the plans or sex role attitudes of daughters. The results indicate that future research should investigate whether maternal employment in high-status occupations, while providing a wider range of acceptable models for girls, may serve as a negative model for boys.

Adolescent↗
PubMed1999

Access to the environment and life satisfaction after spinal cord injury.

OBJECTIVE: To determine the potential relation between satisfaction with life after spinal cord injury and access to the environment as measured by selected items from the Craig Handicap Assessment and Reporting Technique (CHART). DESIGN: Prospective, correlational/predictive study using cross-sectional and longitudinal data from 18 Model Spinal Cord Injury Systems of Care. SUBJECTS: Adult persons with traumatic-onset spinal cord injury (n = 650) evaluated at 1 or 2 years postinjury. OUTCOME MEASURE: Satisfaction With Life Scale (SWLS). PREDICTOR VARIABLES: Demographic characteristics, impairment and disability classifications. medical complications, rehabilitation insurance status, occupational status as measured by the CHART Occupation Scale, self-perceived health (from SF-36), and access to the environment as measured by items from the CHART Mobility Scale. RESULTS: Access to the environment was positively and linearly associated with satisfaction with life, demonstrated both positive and negative change over time, and was positively associated with subject's neurologic status. Access to the environment added to the explanatory model to predict life satisfaction even after all other independent measures were accounted for. CONCLUSION: Access to the environment (an "outside the person" factor) is important in predicting satisfaction with life for persons with spinal cord injury. The measure of access to the environment developed here is promising and worthy of further exploration and expansion.

Activities of Daily Living↗
PubMed2002

Inequalities in the transition of cerebrovascular disease mortality in New South Wales, Australia 1969-1996.

With reference to epidemiological transition theory, this paper examines change in cerebrovascular disease mortality in Australia's most populous state in the 28 year period, 1969-1996. The hypotheses were that in the context of overall stroke mortality decline over the period, marital status, occupational status and spatial differences decreased. However, while overall mortality declined, differentials increased. The reasons for this are considered, with particular implications for epidemiological transition theory and for the targeting of populations at risk in policy terms.

Adult↗
PubMed2004

Effect of employee worktime control on health: a prospective cohort study.

AIMS: To investigate the health effects of employee worktime control. METHODS: Prospective cohort study among 4218 permanent full time municipal employees linking questionnaire data from 1997 and 2000 with sickness absence records from 1997 and 2001. Worktime control was considered high for the highest tertile in both 1997 and 2000, low for the lowest tertile for both years, and intermediate for all other combinations. Self rated health status, psychological distress, and medically certified periods of sickness absence were used as the health outcomes. Adjustments were made for age, baseline health status, occupational status, marital status, dependent children, and behavioural health risks. RESULTS: In the follow up, women with a low level of worktime control had a 1.9 times (95% CI 1.4 to 2.5) higher odds ratio for poor self rated health, a 1.4 times (95% CI 1.1 to 1.8) higher odds ratio for psychological distress, and a 1.5 times (95% CI 1.3 to 1.7) higher risk of medically certified sickness absences than women with a high level of worktime control. The health effects of worktime control were particularly evident among women with families. Among men, worktime control was not associated with self rated health or distress, but it predicted sickness absences in two subgroups: those with dependent children and those with manual occupations. CONCLUSIONS: A low level of worktime control increases the risk of future health problems. The risk is highest among women, especially those with families, and among manual workers. The results suggest that worktime control can help workers integrate their work and private lives successfully.

Cohort Studies↗