Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study

OBJECTIVES: This study sought to examine the association between the psychosocial work environment and subsequent rates of sickness absence. METHODS: The analyses were based on a cohort of male and female British civil servants (n=9072). Rates of short spells (7 days) of sickness absence were calculated for different aspects of the psychosocial work environment, as measured by self-reports and personnel managers' ratings (external assessments). RESULTS: Low levels of work demands, control, and support were associated with higher rates of short and long spells of absence in men and, to a lesser extent, in women. The differences were similar for the self-reports and external assessments. After adjustment for grade of employment, the differences were diminished but generally remained significant for short spells. The combination of high demands and low control was only associated with higher rates of short spells in the lower grades. CONCLUSIONS: The psychosocial work environment predicts rates of sickness absence. Increased levels of control and support at work could have beneficial effects in terms of both improving the health and well-being of employees and increasing productivity.     

Is the SF-36 a valid measure of change in population health? Results from the Whitehall II Study

OBJECTIVE: To measure within-person change in scores on the short form general health survey (SF-36) by age, sex, employment grade, and disease status. DESIGN: Longitudinal study with a mean of 36 months (range 23-59 months) follow up, with screening examination and questionnaire to detect physical and psychiatric morbidity. SETTING: 20 civil service departments originally located in London. PARTICIPANTS: 5070 male and 2197 female office based civil servants aged 39-63 years. MAIN OUTCOME MEASURES: Change in the eight scales of the SF-36 (adjusted for baseline score and length of follow up) and effect sizes (adjusted change standard deviation of differences). RESULTS: Within-person declines (worsening health) with age were greater than estimated by cross sectional data alone. General mental health showed greater declines among younger participants (P for linear trend < 0.001). Employment grade was inversely related to change; lower grades had greater deteriorations than higher grades (P < 0.001 for each scale in men; P < 0.05 for each scale in women except general health perceptions and role limitations due to physical problems). The greatest declines were seen among participants with disease at baseline, with the effects of physical and psychiatric morbidity being additive. Effect sizes ranged from 0.20 to 0.65 in participants with both physical and psychiatric morbidity. CONCLUSIONS: Health functioning, as measured by the SF-36, changed in hypothesised directions with age, employment grade, and disease status. These changes occurred within a short follow up period, in an occupational, high functioning cohort which has not been the subject of intervention, suggesting that the SF-36 is sensitive to changes in health in general populations.     

Dietary assessment in Whitehall II: the influence of reporting bias on apparent socioeconomic variation in nutrient intakes

OBJECTIVE: To assess socio-economic differences in nutrient intake, giving particular consideration to the influence of reporting bias. DESIGN: Cross-sectional study. Three methods of data analysis (inclusion of all subjects, exclusion of low energy reporters, and regression-based energy adjustment) were evaluated against biomarkers of fatty acid and antioxidant intakes. SETTING: London-based Civil Servants. SUBJECTS: Age and employment grade stratified random sub-sample of 459 men and 406 women aged 39-61 y who completed 7 d diet diaries at Phase 3 follow-up (1991-93) of the Whitehall II Study. DIETARY MEASURES: Mean daily intakes by employment grade (6 levels) of dietary energy, total fat, saturated fatty acids, polyunsaturated fatty acids (PUFA), linoleic acid, carbohydrate excluding fibre, dietary fibre, protein, alcohol, vitamin C, vitamin E, carotenes, potassium and calcium. Biomarkers: serum cholesterol ester fatty acids (CEFA), total cholesterol, plasma alpha-tocopherol and beta-carotene. RESULTS: Low energy reporting (LER), defined as a reported energy intake below 1.2 times calculated basal metabolic rate, was strongly associated with employment grade (top grade: men 17.3%, women 19.3%, bottom grade: men 45.7%, women 49.2% trend P < 0.0001 both sexes). This association is only to a small extent accounted for by the relative weight distribution across grades. The direct associations with grade--high status, high intakes--of total fat, saturated and polyunsaturated fatty acids seen in the results overall were greatly reduced or abolished when LER were excluded or when energy adjustment was used. Direct associations between grade and intakes of vitamin C and potassium in both sexes were evident regardless of data presentation method. Spearman correlations between biomarkers and reported intakes, for example CEFA and dietary linoleate (men 0.46, women 0.61), plasma beta-carotene/cholesterol ratio and dietary carotenes (men 0.16, women 0.21) together with theoretical considerations indicate that energy adjustment may be the preferred method for reducing the influence of reporting bias. CONCLUSIONS: Low energy reporting is a major source of bias in dietary surveys and its prevalence shows a marked inverse association with socio-economic status. The energy adjustment method provides an approach which reduces this bias without exclusion of low energy reporters. Intakes of micronutrients including vitamin C, rather than fatty acids, showed associations with socio-economic status consistent with a dietary explanation for social inequalities in cardiovascular disease.     

Public health implications of ageing

Household pets were examined when we carried out an investigation to study intrafamilial spread of group A streptococcal infection. Cultures were taken from 114 index cases, and 61 pets. Group A streptococci were demonstrated in eye secretions from 2 pets. Transmission of group A streptococci from humans to pets and vice versa can probably occur, but is uncommon.     

Anthropometry in health assessment: the importance of measurement error

Anthropometry is the hallmark technique of biological anthropology, and has become increasingly important in health assessments across this century. Although the need for accurate anthropometric measurement has been repeatedly stressed, the ways in which measurement error can influence the characteristics of anthropometric data is poorly appreciated. In this article, guidelines for acceptable measurement error are examined critically, and in light of repeat measurements data collected by the two authors on adults in Papua New Guinea.     

The relationship between socioeconomic status, hostility, and blood pressure reactions to mental stress in men: Data from the Whitehall II study.

This study investigated the relationship among blood pressure reactions to mental stress, cynical hostility, and socioeconomic status (SES) in 1,091 male public servants. Occupational grade served to index SES and cynical hostility was assessed using the Cook-Medley scale. (Cook & Medley, 1954). The magnitude of systolic, but not diastolic, blood pressure change scores to stress was positively associated with occupational grade: the higher the grade, the greater the reactions. Mental stress task performance also varied with occupational grade but was unrelated to reactivity. Ratings of task difficulty did not vary with occupational grade. Cynical hostility was negatively related to occupational grade, and, contrary to previous findings, negatively related to systolic blood pressure reactivity. Cynical hostility was also negatively related to mental stress task performance but unrelated to ratings of task difficulty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and depression among older adults living alone: the importance of friends within and outside of a retirement community

Using socioemotional selectivity theory as a framework, the study described in this article examined the extent to which social support from friends both within and outside of a retirement community was associated with depression. Although levels of social support from friends within the retirement community were quantitatively high, they failed to have a significant effect on depression. In contrast, social support from friends living elsewhere consistently predicted low levels of depression. Practice implications include the importance of maintaining friendship ties with people living elsewhere and of strengthening friendship ties within the retirement community.     

A review of water balance in ageing in health and disease

The elderly are at increased risk of changes in body water and sodium, often accompanying comorbid disease states, which are associated with increased mortality. The clinical assessment of the hydration status of an elderly patient is difficult and the elderly care physician relies on both the clinical picture and laboratory investigation. Although still contentious, research suggests that the elderly may appreciate thirst less readily. However, healthy elderly may be able to produce an enhanced vasopressin response to osmotic stimulation compared to their younger counterparts, possibly in response to reduced renal function. The changes in these systems, when combined with coincident disease, place elderly patients at risk of water imbalance and electrolyte disturbance.     

The impact of health on retirement behaviour: empirical evidence from West Germany

In this paper, the relative importance of an individual's health status on retirement behaviour is analysed within the framework of a structural, discrete-time hazard rate model which is estimated using a balanced panel of elderly West German men. The results obtained reveal that the presence of chronic complaints or disability have a significant positive impact on the probability of early retirement. Moreover, the relative intensity of the individual preference for leisure appears to be, ceteris paribus, below average among public sector employees. Education, too, is shown to exert considerable influence on retirement behaviour, but the relationship between an individual's educational status and the probability of early retirement appears to be rather complex. A policy-related simulation experiment based on the estimates is carried out in order to assess the effects of changes in the incentive structure of the existing pension scheme.     

The importance of public health for twenty-first-century health care: lessons from tuberculosis

Once epidemic, tuberculosis has re-emerged, often in newly drug-resistant forms. This public health threat calls for strong public action as well as improved private care. Action has been hampered by failures in public health infrastructure and legal-philosophical support for government intervention. Josephine Gittler's accompanying article usefully suggests rebuilding public-health agencies and adapting traditional authority and controls from the age of epidemics to take account of today's circumstances and sensibilities.     

Paradigms and expectations: the nature of research and diagnostics

OBJECTIVES: Our purpose was to evaluate the long-term benefit of myocardial viability assessment for stratifying risk and selecting patients with low ejection fraction for coronary artery bypass grafting and to determine the relation between the severity of anginal symptoms, the amount of ischemic myocardium, and clinical outcome. METHODS: We studied 93 consecutive patients with severe coronary artery disease and low ejection fraction (median, 25%) who underwent positron emission tomography to delineate the extent of perfusion-metabolism mismatch (reflecting hibernating myocardium) for potential myocardial revascularization. Median follow-up was 4 years (range, 0 to 6.2 years). RESULTS: Fifty patients received medical therapy, and 43 patients underwent bypass grafting. In Cox survival models, heart failure class, prior myocardial infarction, and positron emission tomographic mismatch were the best predictors of survival. Patients with positron emission tomographic mismatch receiving bypass grafting had improved 4-year survival compared with those on medical therapy (75% versus 30%; P =.007) and a significant improvement in angina and heart failure symptoms. In patients without positron emission tomographic mismatch, bypass grafting tended to improve survival and symptoms only in those patients with severe angina (100% versus 60%; P =.085), whereas no survival advantage was apparent in patients with minimal or no anginal symptoms (63% versus 52%; P =.462). CONCLUSIONS: Patients with low ejection fraction and evidence of viable myocardium by positron emission tomography have improved survival and symptoms with coronary bypass grafting compared with medical therapy. In patients without evidence of viability, survival and symptom improvement with bypass grafting are apparent only among those patients with severe angina.     

Hammerhead ribozymes: importance of stem-loop II for activity

The activity of several hammerhead ribozyme constructs with constant lengths of stems I and III of 5 nt each but with variously shortened stems II is reported. Stems with 2 bp rather than the conventional 4 bp show essentially unaltered catalytic activity, independent of the composition of the tetraloop. Further reduction in size to 1 bp or 0 bp decreases activity drastically. Inversion of the G10.1.C11.1 bp next to the invariant core leads to a loss in activity, even when the stem consists of 4 bp. Thus, the minimal structural requirement for stem-loop II is a 2-bp stem with a conserved G.C bp. The reduction in catalytic activity is predominantly a result of a decrease of catalytic constant kcat, whereas Km is only slightly affected. Thus, the structural requirement for optimal activity in these constructs where the chemical-cleavage step is rate limiting is determined by the stabilization of the transition state.     

Psychology's role in the new health care systems: The importance of psychological interventions in primary health care.

Discusses the new health policies of the World Health Organization. It is suggested that these policies are particularly concerned with prevention and health-enhancing life-styles and, therefore, with the role of psychology in primary health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing retirement satisfaction and perceptions of retirement experiences.

A 2-part investigation developed a measure of retirement as a life transition. Study 1 generated items from interviews with retirees (n?=?40) and service providers. Item analysis with recent retirees (n?=?86) produced a 51-item Retirement Satisfaction Inventory assessing 6 areas: preretirement work functioning, adjustment and change, reasons for retirement, satisfaction with life in retirement, current sources of enjoyment, and leisure and physical activities. Study 2 examined a heterogeneous sample of men (n?=?159) and women (n?=?243) retirees. Factor analyses produced internally consistent subscales. Moderate, but acceptable, test–retest reliability was demonstrated. Satisfaction scores correlated with concurrent measures and, together with pre- and postretirement experiences, discriminated 4 groups of voluntary and involuntary retirees. Few effects related to gender, SES, length of retirement, and part-time employment were found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the importance of disregulatory processes in models of health.

Outlines similarities and differences between a model of positive health proposed by J. Seeman (see record 1989-40866-001) and a systems model of wellness that D. R. Nicholas and D. C. Gobble are formulating. It is suggested that Seeman consider the importance of disregulatory processes in health and disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)