Biomedical subjects
J Siegrist
Publications and source records attributed to J Siegrist.
[What is the contribution of stress research towards explaining the social gradient of coronary heart disease?].
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[Primary prevention-psychosocial aspects].
Psychosocial risk factors like low socio-economic status, social isolation and lack of social support, chronic work or family stress, depression, and hostility contribute significantly to the development and adverse outcome of coronary heart disease (CHD). The prevention of CHD should therefore include screening for psychosocial risk factors and adequate interventions. Methods to assess psychosocial risk factors are single item questions to be included in the cardiologist clinical interview and/or standardized questionnaires. Recommended interventions include an appropriate physician-patient interaction, multimodal, behavioral interventions with face to face or group counselling, and, in case of clinically significant depression, psychotherapy and medication.
Baseline recruitment and analyses of nonresponse of the Heinz Nixdorf Recall Study: identifiability of phone numbers as the major determinant of response.
The Heinz Nixdorf Recall Study is an ongoing population-based prospective cardiovascular cohort study of the Ruhr area in Germany. This paper focuses on the recruitment strategy and its response results including a comparison of participants of the baseline examination with nonparticipants. Random samples of the general population were drawn from residents' registration offices including men and women aged 45-74 years. We used a multimode contact approach including an invitational letter, a maximum of two reminder letters and phone calls for the recruitment of study subjects. Nonparticipants were asked to fill in a short questionnaire. We calculated proportions of response, contact, cooperation and recruitment efficacy to characterize the participation. Overall, 4487 eligible subjects participated in our study. Although the elderly (65-75 years) had the highest contact proportion, the cooperation proportion was the lowest among both men and women. The recruitment efficacy proportion was highest among subjects aged 55-64 years. The identifiability of the phone number of study subjects was an important determinant of response. The recruitment efficacy proportion among subjects without an identified phone number was 11.4% as compared to 65.3% among subjects with an identified phone number. The majority of subjects agreed to participate after one invitational letter only (52.6%). A second reminding letter contributed only very few participants to the study. Nonparticipants were more often current smokers than participants and less often belonged to the highest social class. Living in a regular relationship with a partner was more often reported among participants than nonparticipants.
[The importance of the specialty "medical sociology" for teaching and research at university medical faculties in Germany].
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Do changes in effort-reward imbalance at work contribute to an explanation of the social gradient in angina?
AIMS: To determine whether an increase in effort-reward imbalance over time increases the risk of angina, and whether such increases are associated with lower occupational position. METHODS: Effort-reward imbalance (ERI) at work was measured in the Whitehall II occupational cohort of London based civil servants at baseline (1985-88) and in 1997. Coronary heart disease was measured in a self-reported health questionnaire by combining the Rose Angina Questionnaire with doctor diagnosed angina in 2001. RESULTS: Among men, increase in ERI over time was associated with an increased risk of incident angina. Moreover, as increases in ERI were more common among lower grade civil servants, change in imbalance, to some extent, contributed to explaining the social gradient in angina. Among women, increases in imbalance were not associated with risk of angina, and therefore did not contribute to the explanation of the social gradient. CONCLUSIONS: Reductions in effort-reward imbalance at work may reduce the risk of coronary heart disease among men.
Housing and health in Germany.
STUDY OBJECTIVES: To examine the association between housing tenure and self rated health, controlling for socioeconomic measures and testing the mediating effects of physical features of the home, pollution in the local environment, and relationships with neighbours. DESIGN: Cross sectional panel study with people nested within households. Analyses were performed using multilevel methods. SETTING: Population based sample in Germany. PARTICIPANTS: People aged 16 or older were interviewed in the 1999 wave of the socio-economic panel study (n = 14 055) and nested within households (n = 7381). MAIN RESULTS: 44.0% of the population lived in homes that they owned. In bivariate analyses, women, people who live in apartment buildings, reside near cities, live in crowded homes, have homes in need of renovation, report higher pollution, and have distant contact with neighbours are more likely to live in rented homes. In multilevel analyses, renting a home was found to be associated with poor self rated health (OR 1.48, 95% CI 1.31 to 1.68). This relation persisted after controlling for education and income and was partially mediated by the need for household renovation, the perception of air and noise pollution in the local area, and distant relationship with neighbours, all of which were significantly associated with self rated health. CONCLUSIONS: This study provides evidence that home ownership is significantly associated with self rated health in Germany, and this relation may be, in part, mediated by physical and social features of home and neighbourhood.
Is the effect of work stress on cardiovascular mortality confounded by socioeconomic factors in the Valmet study?
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The psychosocial work environment and alcohol dependence: a prospective study.
AIMS: To examine whether a stressful psychosocial work environment predicts alcohol dependence. METHODS: Alcohol dependence of participants in the Whitehall II occupational cohort of London based civil servants (1985-88) was measured in 1991-93 using the CAGE questionnaire. The psychosocial work environment was measured by self report questions on the job demand-support-control model and on the model of effort-reward imbalance. Potential mediators including physical illness and poor mental health (GHQ) were measured at follow up in 1989. RESULTS: Effort-reward imbalance at work was associated with alcohol dependence in men after adjustment for employment grade and other baseline factors related to alcohol dependence. Although effort-reward imbalance predicted future longstanding illness, poor mental health and negative aspects of close relationships, the association between effort-reward imbalance and alcohol dependence in men was only partially mediated through these health and social support measures. In women, low decision latitude was related to alcohol dependence to some extent, but alcohol dependence among women was more prevalent in higher occupational grades. Men with high job demands or with low work social supports had a slightly reduced risk of alcohol dependence. No association was found between objectively assessed demands, job control, and alcohol dependence in either men or women. CONCLUSION: A stressful psychosocial work environment in terms of effort-reward imbalance was found to be a risk factor for alcohol dependence in men. In view of the public health importance of alcohol dependence in working populations these findings call for more emphasis on psychosocial factors in occupational health research and prevention.
[10 years public health in science and teaching].
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[Stress at work: a new risk factor. What do we know and what can we do?].
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[Evaluation of physician-accompanied vacation trips for heart patients ("heart vacation trips"). Participants' satisfaction and long term impact on health related quality of life].
Physician-accompanied vacation trips for heart patients (so-called "heart vacations trips") have been offered since 1981 and have been regulated by guidelines by the German Society of Prevention and Rehabilitation of Cardiovascular Diseases since 1993. The goal of this evaluation is to assess the satisfaction of the participants and to analyze the long-term impact on health-related quality of life. Between October 1995 and May 1998, 22 vacation trips with 228 participants were evaluated. Satisfaction with the vacation trips was assessed by a questionnaire specifically designed for this study. Health-related quality of life was measured with 5 discrete scales from the standardized and validated instrument "Profile of Quality of Life for the Chronically Ill" ("physical capacity", "ability to enjoy and relax", "positive mood", "absence of negative mood", "sociability"). The proportion of satisfied or very satisfied participants ranged from 81 % (accommodations) to 94 % (physician care). Regarding health-related quality of life, significant or borderline significant improvements were observed on three of the five scales (ability to enjoy and relax: p = 0.02, positive mood: p = 0.001, physical capacity: p = 0.08). Stratified analyses showed improvements for younger participants (< or = 70 years) on all five quality of life scales, whereas no statistically significant improvement was found for older participants. Participants who had a cardiovascular disease other than coronary heart disease showed significant improvements on four scales, whereas participants with coronary heart disease only showed an increase on the scale "positive mood". This evaluation shows that physician-accompanied vacation trips were assessed very positively by the participants and that these trips are associated with long-term improvement in health-related quality of life for specific groups of participants.
[What does prevention and rehabilitation research contribute to health policy?].
Rational health policy calls for a close collaboration between health-related political organizations and scientific communities, in particular public health sciences and health economics. Based on selected examples, this contribution highlights the benefits of primary and secondary prevention measures with re-spect to two widely distributed chronic diseases, coronary heart disease and depressive disorders. These examples refer to (1) lifestyle changes in secondary prevention of coronary heart disease, (2) theory-based measures of worksite health promotion, and (3)early detection and optimised treatment of depressive disorders. The relevance of interdisciplinary research on prevention and rehabilitation is emphasized by increasing pressures that arise from the current health care system.
[A theory-based study on psychosocial workload as an instrument of health promotion in a hospital].
Starting with theory-based assessment of workload as experienced by employees of a hospital we aim at facilitating measures of health promotion. Using the effort-reward-imbalance model of psychosocial stress we look for differences in stress experience as related to objective work stressors and for associations of stress experience and subjective health. Two assessments (in 2000 and in 2002) showed pronounced differences in stress experience between professional groups and between points in time, which were both related to differences in objective workload. The expected associations between psychosocial stress and subjective health (assessed only in 2002) could be demonstrated consistently. As was shown by logistic regression analysis the risk for reduced subjective health was roughly 4 times higher for those in the upper tertile of the effort-reward-imbalance index as compared to all others when controlling for age, sex and professional group. Sources of psychosocial workload could be identified which are modifiable by measures of health promotion.
Socioeconomic differences in children's and adolescents' hospital admissions in Germany: a report based on health insurance data on selected diagnostic categories.
STUDY OBJECTIVE: The extent of social inequalities in children's hospitalisation risks was examined in terms of socioeconomic status and parents' nationality. This was considered in terms of inpatient treatment attributable to a number of diagnoses (ICD-9), especially infectious diseases and psychiatric disorders. DESIGN AND SETTING: Analyses were performed with records of a German statutory health insurance comprising 48 412 (52.8% male and 47.2% female) children and adolescents of 15 years of age or younger who were co-insured between 1987 and 1996. Classification of socioeconomic position was based on parental occupational position. RESULTS: Social inequalities in terms of hospital admissions attributable to acute diseases were rather small. The only exception were infections of the respiratory organs: in the highest status positions as compared with the lowest one the relative risk for being admitted was RR=0.22 (95% CI 0.06 to 0.89). However, length of stay in hospital was significantly related to socioeconomic position for infections of the upper respiratory tract and infections of the respiratory organs, with children and adolescents with the lowest socioeconomic background having spent the longest periods in hospital. With regard to nationality, pneumonia/flu was the only diagnostic category where relative risks for being admitted were higher in non-German children and adolescents (RR=1.5; 95% CI 1.2 to 1.8). Conversely, hospital admissions attributable to psychiatric diagnoses were significantly lower among non-German patients (RR=0.43; 95% CI 0.30 to 0.61), thus suggesting differential utilisation patterns according to nationality. CONCLUSIONS: Health inequalities in children's and adolescents' hospital admissions in Germany are small and inconsistent if parents' socioeconomic status and nationality are taken as criterion. Yet, children of lower status background stay longer in hospital if suffering from highly prevalent infectious diseases. This last observation may be attributable to more severe disease conditions.
Psychosocial work environment and myocardial infarction: improving risk estimation by combining two complementary job stress models in the SHEEP Study.
OBJECTIVES: Associations between two alternative formulations of job stress derived from the effort-reward imbalance and the job strain model and first non-fatal acute myocardial infarction were studied. Whereas the job strain model concentrates on situational (extrinsic) characteristics the effort-reward imbalance model analyses distinct person (intrinsic) characteristics in addition to situational ones. In view of these conceptual differences the hypothesis was tested that combining information from the two models improves the risk estimation of acute myocardial infarction. METHODS: 951 male and female myocardial infarction cases and 1147 referents aged 45-64 years of The Stockholm Heart Epidemiology (SHEEP) case-control study underwent a clinical examination. Information on job stress and health adverse behaviours was derived from standardised questionnaires. RESULTS: Multivariate analysis showed moderately increased odds ratios for either model. Yet, with respect to the effort-reward imbalance model gender specific effects were found: in men the extrinsic component contributed to risk estimation, whereas this was the case with the intrinsic component in women. Controlling each job stress model for the other in order to test the independent effect of either approach did not show systematically increased odds ratios. An improved estimation of acute myocardial infarction risk resulted from combining information from the two models by defining groups characterised by simultaneous exposure to effort-reward imbalance and job strain (men: odds ratio 2.02 (95% confidence intervals (CI) 1.34 to 3.07); women odds ratio 2.19 (95% CI 1.11 to 4.28)). CONCLUSIONS: Findings show an improved risk estimation of acute myocardial infarction by combining information from the two job stress models under study. Moreover, gender specific effects of the two components of the effort-reward imbalance model were observed.
When reciprocity fails: effort-reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II study.
BACKGROUND: A deleterious psychosocial work environment, as defined by high efforts expended in relation to few rewards reaped, is hypothesised to increase the risk of future poor health outcomes. AIMS: To test this hypothesis within a cohort of London based civil servants. METHODS: Effort-reward imbalance (ERI) was measured among 6895 male and 3413 female civil servants aged 35-55 during the first phase of the Whitehall II study (1985-88). Participants were followed until the end of phase 5 (1997-2000), with a mean length of follow up of 11 years. Baseline ERI was used to predict incident validated coronary heart disease (CHD) events during follow up and poor mental and physical functioning at phase 5. RESULTS: A high ratio of efforts in relation to rewards was related to an increased incidence of all CHD (hazard ratio (HR) = 1.36, 95% CI 1.12 to 1.65) and fatal CHD/non-fatal myocardial infarction (HR = 1.28, 95% CI 0.89 to 1.84) during follow up, as well as poor physical (odds ratio (OR) = 1.47, 95% CI 1.24 to 1.74) and mental (OR = 2.24, 95% CI 1.89 to 2.65) functioning at phase 5, net of employment grade. A one item measure of high intrinsic effort also significantly increased the risk of these health outcomes, net of grade. ERI may be particularly deleterious with respect to CHD risk among those with low social support at work or in the lowest employment grades. DISCUSSION: Within the Whitehall II study, a ratio of high efforts to rewards predicted higher risk of CHD and poor physical and mental health functioning during follow up. Although the increased risk associated with ERI was relatively small, as ERI is common it could be of considerable public health importance.