Influence of paid work on the perceived health state in women

BACKGROUND: Several studies show that paid work has a positive effect on women's health, although few studies have shown this relationship in Southern-European countries. The aim of this paper was to analyze the self-perceived health status of women of Barcelona, Spain according to their type of work (homemaker or worker). PATIENTS AND METHODS: Cross sectional study using the 1992 Barcelona Health Interview Survey data. Subjects: 1194 women aged 25 to 64 years old. Bivariate analysis of women's perceived health status by all other variables. A logistic regression model was performed with the dependent variable being women's self-perceived health status and the independent variables: type of work (homemaker or worker), age, number of chronic diseases, medical care visits, children under 12 years and elderly over 65 years living at home and social class based on occupation. RESULTS: 15.8% of workers and 31.4% of homemakers reported poor self-perceived health status (p < 0.05). This same distribution was maintained when adjusting for all independent variables. Social class had an important relationship with health, with women from lower social classes reporting poorer self-perceived health status than homemakers from upper social classes. CONCLUSIONS: The 1992 Barcelona Health Interview Survey analysis confirms that in Barcelona as well, paid work has a positive relationship on women's self-perceived health status.     

Physical activity and women in the United States: an overview of health benefits, prevalence, and intervention opportunities

Despite decades of physical activity research and interventions conducted on men, very little is known about the patterns of physical activity among US women. Rates from several national surveys show much lower rates of physical activity for women than for men. Among women, rates may vary by socioeconomic status. Studies relating physical activity and experience with heart disease, cancer, osteoporosis, and mental health are discussed. Interventions in the workplace and the community may increase the level of physical activity among US women. A history of not participating in exercise and lack of time for this activity appear to be important constraints for many women. The Surgeon General's Report on physical activity sanctioned future research on specific groups, such as women. Applied research coupled with community and workplace policies that support women's efforts to be more physically active may decrease the rates of some chronic diseases in this population.     

Physical activity, obesity, and the incidence of type 2 diabetes in a high-risk population

This study, examining the longitudinal relation among physical activity, body mass index, and development of type 2 diabetes in a high-risk population, is unique because diabetes was determined by oral glucose tolerance testing rather than by self-report. A physical activity questionnaire assessing past year leisure and occupational activity was administered to 1,728 nondiabetic Pima individuals aged 15-59 years as part of a series of clinic examinations in the Gila River Indian Community from 1987 to 2000. During an average follow-up period of 6 years, 346 subjects developed diabetes. Using time-dependent Cox proportional hazards modeling adjusting for age, the authors found that total activity was related to diabetes incidence in women and men (p < 0.05 in women only). After additional adjustment for body mass index, the relation between activity and diabetes incidence was weakened in both men and women. When the age-adjusted diabetes incidence rates were examined by levels of activity stratified by tertile of body mass index, the diabetes incidence rate remained lower in more active than in less active men and women from all body mass index groups, with the exception of the middle body mass index tertile in men (p < 0.05 in women only). These results suggest that the adoption and maintenance of a physically active lifestyle can play a significant role in preventing type 2 diabetes.     

Physical activity and risk of breast cancer in the Framingham Heart Study

The authors analyzed data from the Framingham Heart Study to evaluate the association between physical activity and breast cancer risk. Physical activity was ascertained by a physician-administered questionnaire from 2,321 women at the fourth biennial examination conducted in 1954-1956. Breast cancers were identified by self-report, surveillance of admissions to Framingham Union Hospital, and review of death records; all but one were histologically confirmed. During 28 years of follow-up, 117 breast cancer cases were diagnosed among the 2,307 women with data on physical activity and reproductive history (a potential confounder). Analysis was performed using Cox proportional hazards models with age as the underlying time variable. Models were adjusted for age at physical activity assessment, menopausal status, age at first pregnancy, parity, education, occupation, and alcohol ingestion. We observed a gradient of increasing risk of breast cancer with increasing physical activity (trend p = 0.06). The relative risk for women in the highest versus lowest activity quartile was 1.6 (95% confidence interval 0.9-3.0; p = 0.13). Although both moderate-to-heavy leisure and occupational activities were associated with an increased risk, the association was marginally significant only for leisure activity (p = 0.06). Our findings do not support a protective effect of physical activity during adulthood for breast cancer, but suggest an increased risk among more active women.     

Physically active commuting to work--testing its potential for exercise promotion

Physical activity has considerable health-enhancing potential. It will be realized, however, only if large number of people participate in adequate activity. This summary report describes the main results of four studies aimed to find out whether physically active commuting to work (PACW) meets the requirements of health and fitness enhancing activity. Three successive mail inquiries (N = 2014) indicated that PACW provided habitual exercise to one-third of employed urban population, and that more than one-fifth expressed willingness and being able to increase PACW. A randomized controlled trial on 68 inactive middle-aged men and women revealed that PACW (1 h daily for 10 wk) increased VO2max by 4.5% (P = 0.02), maximal treadmill time by 10.3% (P = 0.0007), and HDL cholesterol by 5% (P = 0.06). A demonstration project in a large industrial plant showed that PACW can be successfully promoted by low cost measures. In conclusion, these studies suggest that PACW may offer substantial potential as health and fitness enhancing measure provided that it can be practiced safely.     

Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women

We studied physical fitness and physical activity in relation to all-cause and cancer mortality in a cohort of 7080 women and 25,341 men examined at the Cooper Clinic in Dallas, Texas, during 1970 to 1989. Physical fitness was assessed at baseline by a maximal treadmill exercise test, while physical activity was self-reported on the attendant health habits questionnaire. Both men and women averaged about 43 years of age at baseline (range, 20 to 88 years), and they were followed for approximately 8 years on average. Through the end of 1989, the women contributed 52,982 person-years of observation and incurred 89 deaths, including 44 deaths due to cancer. The men contributed 211,996 person-years and incurred 601 deaths, with 179 due to cancer. After adjustment for baseline differences in age, examination year, cigarette habit, chronic illnesses, and electrocardiogram abnormalities, we found a strong inverse association between risk of all-cause mortality and level of physical fitness in both men and women (P for trend < 0.001). Physically active men also were at lower risk of all-cause mortality than were sedentary ones (P for trend = 0.01). Among women, however, self-reported physical activity was not significantly related to risk of death from all causes. The risk of mortality from cancer declined sharply across increasing levels of fitness among men (P for trend < 0.001), whereas among women the gradient was suggestive but not significant (P for trend = 0.07). Physically active men also were at lower risk of death from cancer than were sedentary men (P for trend = 0.002), but among women physical activity was unrelated to cancer mortality.     

The Troms? Study: physical activity and the incidence of fractures in a middle-aged population

We have studied the relation of occupational and recreational physical activity to fractures at different locations. All men born between 1925 and 1959 and all women born between 1930 and 1959 in the city of Troms? were invited to participate in surveys in 1979-1980 and 1986-1987 (The Troms? Study). Of 16,676 invited persons, 12,270 (73.6%) attended both surveys. All nonvertebral fractures (n = 1435) sustained from 1988 to 1995 were registered in the only hospital in the area. Average age in the middle of the follow-up period (December 31, 1991) was 47.3 years among men and 4501 years among women, ranging from 32 to 66 years. Fracture incidence increased with age at all locations among women, but it decreased with or was independent of age among men. Low-energetic fractures constituted 74.4% of all fractures among women and 55.2% among men. When stratifying by fracture location, the most physically active persons among those 45 years or older suffered fewer fractures in the weight-bearing skeleton (relative risk [RR] 0.6, confidence interval [CI] 0.4-0.9, age-adjusted), but not in the non-weight-bearing skeleton (RR 1.0, CI 0.7-1.2, age-adjusted) compared with sedentary persons. The relative-risk of a low-energetic fracture in the weight-bearing skeleton among the most physically active middle-aged was 0.3 (CI 0.1-0.7) among men and 0.9 (CI 0.4-1.8) among women compared with the sedentary when adjusted for age, body mass index, body height, tobacco smoking, and alcohol and milk consumption. It seems that the beneficial effect on the skeleton of weight-bearing activity is reflected also in the incidence of fractures at different sites.     

Physical fitness, physical activity, and functional limitation in adults aged 40 and older

PURPOSE: A cohort of middle-aged and older men and women were followed for an average of 5.5 yr to examine the association between physical fitness, physical activity, and the prevalence of functional limitation. METHODS: The participants received medical assessments between 1980 and 1988 and responded to a mail-back survey regarding functional status in 1990. RESULTS: Among 3495 men and 1175 women over 40 yr of age at baseline, 350 (7.5%) reported at least one functional limitation in daily or household activities at follow-up. The prevalence of functional limitation was higher among women than men. Physically fit and physically active participants reported less functional limitation than unfit or sedentary participants. After controlling for age and other risk factors, the prevalence of functional limitation was lower for both moderately fit (odds ratio = 0.4, 95% CI = 0.2-0.6) and high fit men (odds ratio = 0.3, 95% CI = 0.2-0.4), compared with low fit men. Corresponding figures for women were 0.5 (0.3-0.7) and 0.3 (0.2-0.5) for moderately fit and high fit women. The association between physical activity and functional limitation was similar to the data for physical fitness. CONCLUSIONS: These data support a protective effect of physical fitness and physical activity on functional limitation among older adults and extend this protective effect to middle-aged men and women.     

Leisure-time physical activity of first-year students in 3 health science departments

BACKGROUND: Physical inactivity is a well-known risk factor for many chronic diseases which have high prevalence in developed countries. The aims of this study are to describe leisure-time physical activity levels and to identify preferences for its practice among first grade students in three Health Sciences Faculties at the University of Barcelona. METHODS: During the year 1994-95, a total of 887 first grade students of three Faculties, Pharmacy (n = 573), Medicine (n = 222) and Dentistry (n = 92), were interviewed using a recall of their leisure time physical activity over last 8 months. Physical activity level was classified into four categories: non-active, low, medium and high, based on the number of hours per week. Statistical methods consisted in the estimation of rates, comparisons using the chi-square test, and computing the odds ratio. RESULTS: Women were 75% of students. Fifty per cent of men and 71.5% of women referred to be non-active or having low physical activity level (chi 2 = 36.8; DF = 3; p < 0.0001), being no evidence of association with current smoking or overweight (Body Mass Index > or = 25). Among the rest of students, men's most frequently reported activities were football, swimming and tennis, and those of women's were swimming, aerobic and tennis. CONCLUSIONS: Physical activity level among first grade health sciences university students is poorly exemplary. More physical activity promotion is needed, particularly to female students, as an important primary preventive measure among this group.     

Increase of non-amidated muropeptides in the cell wall of vancomycin-resistant Staphylococcus aureus (VRSA) strain Mu50

BACKGROUND: In previous survey we found large socioeconomic differences in mortality among urban Swedish men which remained unexplained after controlling for smoking and standard coronary risk factors. The present analysis was undertaken in order to investigate a broader set of possible explanatory factors in another cohort of Swedish men. STUDY POPULATION AND METHODS: Occupation was coded into five occupational classes for 717 of 776 participant men from a random population sample of 1016 men who were born in 1933. All were living in G?teborg and were 50 years old at the baseline examination. After 12 years' follow-up, 68 of the 717 men had died (9.5%). RESULTS: Low occupational class was associated with a higher prevalence of smoking at baseline, but no association was found with systolic blood pressure, body mass index, waist to hip ratio, serum triglycerides or serum cholesterol. Subjects from higher socioeconomic strata were taller, had higher maximum peak respiratory flow, lower plasma fibrinogen and lower body temperature. Low occupational class was associated with low social integration, low home activity levels, low levels of activity outside home and low social activity levels (p = 0.001 for all) and with low emotional support (p = 0.018). There were also associations between low occupational class and poor self-perceived health, as well as with several cardiovascular symptoms. During 12 years' follow-up, there was a graded and inverse relationship between occupational class and mortality from all causes. The highest mortality was found among the men who could not be classified (23 per 1,000 person years) Of the men in the lowest occupational class, 12 per 1,000 died, compared to 3 per 1,000 in the highest class (relative risk 3.7 (1.4-9.8)). After controlling for smoking, the relative risk decreased to 3.2 (1.2-8.6) and after further adjustment for emotional support, self-perceived health, activity level at home, and peak expiratory flow, the relative risk was still twofold but not significantly so (RR 2.1 (0.8-5.8)). CONCLUSION: We were able to confirm earlier results as to the wide mortality differentials in urban middle-aged men in Sweden. There were also large differences in several other factors, including constitutional factors, health variables, lifestyle and social support indices, which explained important parts of the social mortality gradient, the most prominent being smoking, respiratory function, social network factors and subjective health.     

Plasma fibrinogen levels in healthy postmenopausal women: physical activity and hormone replacement status

BACKGROUND: Fibrinogen is a major component of the coagulation system and a powerful independent risk factor for cardiovascular disease in postmenopausal women. Regular physical activity has been recommended as an effective clinical approach to lowering plasma fibrinogen levels; currently, however, there are little or no data to support a relationship between habitual exercise status and plasma fibrinogen levels in healthy postmenopausal women who either use or do not use hormone replacement therapy (HRT). METHODS: Plasma fibrinogen levels were measured in 20 physically active (56 +/- 1 yr) and 31 sedentary (58 +/- 1 yr) healthy postmenopausal women. Nine (45%) physically active and 15 (48%) sedentary women had been using HRT for > 1 year; the others were nonusers of HRT. RESULTS: Plasma fibrinogen levels were approximately 15% lower (p = .001) in the physically active women (2.48 +/- .08 g/L) than the sedentary controls (2.92 +/- .06 g/L) and approximately 7% lower (p = .04) in the users (2.65 +/- .08 g/L) versus nonusers (2.84 +/- .08 g/L) of HRT. Moreover, the lower (0.4 g/L) plasma fibrinogen levels associated with regular physical activity were evident in both the users (2.39 +/- .11 vs 2.80 +/- .08 g/L, p = .001) and nonusers (2.56 +/- .11 vs 3.03 +/- .08 g/L, p = .006) of HRT. Stepwise multiple regression analysis revealed that percent body fat was the primary determinant of plasma fibrinogen levels, accounting for 30% of the variability. CONCLUSIONS: Regular physical activity is associated with lower plasma fibrinogen levels in postmenopausal women; the lower plasma fibrinogen levels associated with regular physical activity are evident in both users and nonusers of HRT; and plasma fibrinogen levels are positively related to percent body fat in postmenopausal women differing in physical activity and HRT status. Lower plasma fibrinogen levels in physically active postmenopausal women may contribute to their lower risk of cardiovascular disease.     

Physical activity, change in blood pressure and predictors of mortality in older South Africans--a 2-year follow-up study

OBJECTIVE: A 2-year follow-up study of a cohort of 200 historically disadvantaged older South Africans was conducted to: (i) characterise current levels of habitual physical activity; (ii) relate physical activity to current risk factors for chronic disease; and (iii) identify risk factors associated with 2-year mortality. The baseline sample, drawn in 1993, was found to have a high prevalence of hypertension (71.7%). RESEARCH DESIGN: Retrospective cohort study. METHODS: A baseline sample of 200 persons aged > or = 65 years, resident in the Cape Peninsula, was randomly drawn by means of a two-stage cluster design. Baseline measurements included: anthropometry, waist/hip ratio, systolic and diastolic blood pressure, body mass index (BMI), serum albumin, serum ferritin, haemoglobin and fasting plasma glucose levels, plasma lipid profiles, oral glucose tolerance test and self-reported health status. Subjects were revisited after 2 years, at which time an adapted version of the Yale Physical Activity Survey was administered and measurements of blood pressure and anthropometry were repeated. STATISTICAL ANALYSES: Spearman's rank-order correlations were used to describe relationships between various current risk factors and physical activity. Logistic regression was used to determine predictors of 2-year mortality from baseline data. RESULTS: At follow-up, 142 of the subjects (66 men, 76 women) were traced and measurements collected. Thirty-two subjects were reported to have died by relatives living in the same household (22 men, 10 women). Levels of reported physical activity in the survivors were two-thirds lower than those reported in a sample of North Americans of similar age. There was an inverse association between age and physical activity (r = -0.31; P < 0.0005) and a positive association between BMI and physical activity (r = 0.29; P < 0.005). There was, however, no association between physical activity and systolic or diastolic blood pressure. In men, BMI in the lower tertile (P = 0.07) and serum ferritin levels were positively associated with increased mortality. Serum albumin levels were protective over the 2-year follow-up period (OR = 0.85; P < 0.05). In women, being diabetic (OR = 4.88; P = 0.06) and having a waist/hip ratio in the upper tertile (OR = 3.26; P = 0.06) were associated with mortality. CONCLUSIONS: Physical activity levels in this sample of older historically disadvantaged South Africans were habitually low. Simple anthropometric assessments incorporating weight and waist/hip ratio, together with serum albumin measurements, may be useful to screen general health risk for older adults at primary care level and provide indications for social or medical intervention. Further, strategies for earlier detection and effective management of diabetes, particularly in older women, may reduce premature mortality in this population.     

Lung cancer mortality in Casale Monferrato (Italy) and attributable risk to occupations in the asbestos-cement production

The study presents mortality rates for lung cancer in the town of Casale Monferrato, where the largest Italian asbestos cement-plant was located. Cases of lung cancer dying in 1989-94 were exhaustively searched for in the register of deaths. Each case of lung cancer has been identified as ever or never employed in the factory with a linkage to the rosters of employees in the plant. Women were also identified as ever or never married to an asbestos-cement worker. The number of person-years at risk for asbestos cement workers and their wives was measured on the basis of the most recent follow-up. Mortality rates were computed separately for those exposed (workers and wives of workers) and for those with no evidence of exposure. Mortality rates for non-exposed were similar to rates in Piedmont (the region where Casale is located). The relative risk (ever exposed vs. never exposed) was 2.8 among men and 2.1 among women. Attributable risk among the exposed was 64.5% for men and 53.1% for women while among the general population it was 18.1% for men and 13.2% for women. The study confirms the dramatic effect of occupational asbestos exposure in Casale Monferrato but does not suggest an increase in lung cancer mortality among people with no occupational activity in the asbestos-cement production.     

Carpal tunnel syndrome: what is attributable to work? The Montreal study

OBJECTIVE: To estimate the fraction of carpal tunnel syndrome (CTS) that is attributable to work in the total adult population of the island of Montreal. METHODS: The population consisted of 1.1 million people 20-64 years of age, with 73.2% of men and 60.6% of women employed. The rates of first surgery for CTS were compared between occupational groups and the total adult population with the standardised incidence ratio (SIR) method. Rates of surgery for the island of Montreal were obtained from the provincial data base of payments. The occupational history was obtained from telephone interviews of a sample of surgical cases. The attributable fractions in exposed people were calculated with odds ratios (ORs) obtained from logistic regressions with non-manual workers as the control group. RESULTS: The surgical incidence of CTS was 0.9/1000 adults. SIRs for all manual workers were 1.9 (95% confidence interval (95% CI) 1.4-2.5) in men and 1.8 (95% CI 1.4-2.2) in women, and the fractions attributable to work were 76% (95% CI 47-88) and 55% (95% CI 33-69), respectively. Seven occupational groups were identified as having excess risk of surgical CTS, with fractions attributable to occupation ranging from 75% to 99%. CONCLUSION: Among manual workers on the island of Montreal, 55% of surgical CTS in women and 76% in men was attributable to work. Increased risk of surgical CTS was found in seven occupational groups.     

Customary physical activity and survival in later life: a study in Nottingham, UK

OBJECTIVE: To assess the value of broadly based customary physical activity scores, derived from a questionnaire inventory, in predicting 10 year mortality among elderly people. DESIGN: A 10 year survival analysis of participants in the first wave of the Nottingham longitudinal study of activity and ageing who, in face to face interviews in 1985, provided detailed information on customary physical activity, health, and lifestyle. SETTING: Urban and suburban Nottingham PARTICIPANTS: A total of 1042 people aged 65 years and over randomly sampled from general practitioner records. MAIN RESULTS: On the basis of factor scores derived from the interview questionnaire, activity levels were graded as "high", "intermediate", or "low". In Cox regression models controlling for age, health status, and cigarette smoking at the time of the activity assessment, these gradings were significantly related to 10 year survival. Relative to the "high" activity groups, the risk of dying was significantly increased in both the "intermediate" (hazard ratio (HR) 1.53; 95% CI 1.12, 2.09) and "low" (HR 2.07; 95% CI 1.53, 2.79) groups for women, and in the "low" group (HR 1.59; 95% CI 1.12, 2.25) for men (p < 0.01 throughout). CONCLUSION: Since the survival model controlled for age, health status, and cigarette smoking, it is unlikely that the activity gradings used here are simple proxies for physical health. It is concluded, therefore, that within the elderly population, recall based survey assessments covering a wide range of customary or habitual physical activities, can provide indices showing both cross sectional utility and predictive validity.     

Familial aggregation of leisure-time physical activity -- a three generation study

Studies of parental influence on children's physical activity have had different results. Parental effect on physical activity during adolescence is less studied, and three generation studies have not been carried out. The purpose of our study was to examine intra- and intergenerational associations of leisure time physical activity among family members in three generations. Due to the major changes in society during this time, we also took into consideration the socioeconomic status of the adult subjects. The material consisted of 3254 twins at the age of 16, their parents and grandparents. Twins and their parents received a questionnaire in 1991-1993, which included questions about the health and lifestyle, socioeconomic status and leisure time physical activity. The parents' questionnaire also included questions about their own parents' leisure time physical activity and socioeconomic status. Based on these questions adolescents, parents and grandparents were classified into physical activity classes. The socioeconomic classification of parents and grandparents was based on their occupation. Intragenerational physical activity patterns were significantly associated with each other. Among adolescents the strongest correlation were between monozygotic boys (0.720) and monozygotic girls (0.638). Physical activity patterns were not associated between generations, but there was a significant difference between very active and inactive mothers concerning their daughters' physical activity. Farmers had the lowest proportion of very active subjects only among the parental generation. Because physical activity patterns do not appear to be transmitted from one generation to the next, it is probable that by constant training and education we can obtain the benefits of physical activity.     

Factors associated with male workers' engagement in physical activity: white collar vs. blue collar workers

The purpose of this study was to identify factors associated with male workers' participation in different kinds of physical activity, noting differences between white collar and blue collar workers. This study examined the variables, perceived health status, self efficacy, perceived barriers, age, education, income, and job category (Pender, 1987) for their association with physical activity. Self efficacy and perceived health status were the cognitive-perceptual factors that predicted physical activity. Job category (e.g., blue collar vs. white collar) was found to be a highly significant predictor of physical activity. Comparing physical job requirements with the individual worker capacity can suggest to the occupational health nurse physical fitness programs that are most appropriate for individual workers.     

Linking occupational conditions to physical health through marital, social, and intrapersonal processes

In the present longitudinal study of 330 married men and 300 married women, we use a comprehensive structural equation model to investigate how occupation is linked to physical health. Results show that occupational quality influences health-risk behavior (measured by composite indices) for both men and women through a series of mediating variables: social integration, marital integration, and psychological control. Health-risk behavior is related to adverse change in physical health status over a two-year period. Occupational quality influences social and marital integration and psychological control for both husbands and wives. Social integration and marital integration also enhance husbands' psychological control, but marital integration is the only factor contributing to wives' psychological control. In turn, psychological control is associated with health-risk behaviors for both husbands and wives. In addition, both social and marital integration directly deter husbands' health-risk behaviors, while social integration is the only variable to directly influence wives' health-risk behaviors.     

Physical activity is related to ankle/brachial index in subjects without peripheral arterial occlusive disease

The purpose of this study was to determine whether physical activity level was directly and independently related to the ankle/brachial systolic blood pressure index (ABI) in subjects without peripheral arterial occlusive disease (PAOD). A total of 353 subjects between the age of 38 and 88 years (63.7 +/- 9.1 years; mean +/- standard deviation) who had ABI values > or = 1.00 were studied. The sample consisted of 230 men and 123 women, of whom 274 were caucasian and 79 were African-American. Subjects were characterized on blood pressure, physical activity level from validated questionnaires, anthropometry, plasma lipoprotein lipids, and smoking history. The ABI (1.16 +/- 0.13) was related to physical activity obtained from the Minnesota Leisure Time Physical Activity (LTPA) questionnaire (r = 0.413, P < 0.001). Multiple regression analysis identified race, hypertension, current smoking status, and body mass index (BMI) as cardiovascular risk factors that were independently related to ABI. After controlling for these variables, the relationship between ABI and physical activity persisted (partial r = 0.329, P < 0.001). Thus, physical activity was positively related to ABI in subjects free of PAOD, and the relationship between physical activity and ABI persisted after controlling for race, hypertension, current smoking status, and BMI. It is concluded that adopting a physically active lifestyle is associated with a reduced risk of developing PAOD.