RESUMEN
BACKGROUND: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are at elevated risk. OBJECTIVE: To assess the 10 year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. METHODS: Analysing data from the nationally representative US Health and Retirement Survey (HRS), Cox proportional hazards analysis was used to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. The sample included 4301 individuals who were employed at the 1992 study baseline. RESULTS: Over the 10 year study frame, 582 individuals (13.5% of the sample) experienced involuntary job loss. After controlling for established predictors of the outcomes, displaced workers had a more than twofold increase in the risk of subsequent MI (hazard ratio (HR) = 2.48; 95% confidence interval (CI) = 1.49 to 4.14) and stroke (HR = 2.43; 95% CI = 1.18 to 4.98) relative to working persons. CONCLUSION: Results suggest that the true costs of late career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and programme planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.
Asunto(s)
Infarto del Miocardio/psicología , Accidente Cerebrovascular/psicología , Desempleo/psicología , Factores de Edad , Femenino , Estudios de Seguimiento , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Modelos de Riesgos Proporcionales , Factores de Riesgo , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Accidente Cerebrovascular/epidemiología , Encuestas y CuestionariosRESUMEN
AIM: To determine the prevalence of chronic fatigue syndrome (CFS)-like caseness in the working population. METHODS: Using data from the prospective Maastricht Cohort Study on Fatigue at Work, the prevalence and incidence of CFS-like cases (employees meeting research criteria for CFS) were determined among 5499 employees who responded to the follow up assessment 3 years and 8 months after baseline. RESULTS: Of the 5499 employees, 199 (3.6%) were identified as CFS-like cases. By deleting possible CFS-like cases at baseline, the annual incidence of CFS-like caseness was estimated to be 85 per 10 000. Twenty employees (0.36%) reported having been diagnosed with CFS by a physician. CONCLUSIONS: The prevalence of CFS-like cases (3.6%) was considerably higher than the prevalence of CFS reported in previous studies (0.006-3%). These findings suggest that the CFS-like caseness may be underdetected in the working population and perhaps in other populations as well.
Asunto(s)
Síndrome de Fatiga Crónica/epidemiología , Fatiga/epidemiología , Adulto , Estudios de Cohortes , Fatiga/diagnóstico , Síndrome de Fatiga Crónica/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Prevalencia , Lugar de TrabajoRESUMEN
OBJECTIVES: To examine the associations between psychosocial work characteristics and fatigue in employees in the Maastricht Cohort Study. A second objective was to compare the relationships for fatigue versus psychological distress with these psychosocial work characteristics. METHODS: The design was cross-sectional and included 11,020 employees who responded to the self-administered baseline questionnaire of the Maastricht Cohort Study. Fatigue was measured with the Checklist Individual Strength, a 20-item self-report instrument. Psychological distress was measured with the 12-item version of the General Health Questionnaire. Psychosocial work characteristics comprised: psychological demands, decision latitude, and social support at work as measured by the Job Content Questionnaire, as well as emotional demands at work, physical demands at work, job insecurity, and conflict with supervisor/co-worker, which were assessed with items from existing Dutch questionnaires. RESULTS: Low decision latitude and low social support at work were associated with fatigue in both men and women. Associations were also found between emotional demands at work, job insecurity, physical demands and conflict with supervisor and fatigue in men; and high psychological demands and fatigue in women. As regards psychological distress, there was no association with low decision latitude, but strong associations with emotional demands and conflict with supervisor in both genders. CONCLUSIONS: The study provides strong support for associations between psychosocial work characteristics and fatigue in men and women, even after adjustment for psychological distress. Moreover, it suggests some differential effects of psychosocial work characteristics on fatigue and psychological distress.
Asunto(s)
Empleo/psicología , Fatiga/psicología , Estrés Psicológico/psicología , Adolescente , Adulto , Anciano , Estudios de Cohortes , Fatiga/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Tolerancia al Trabajo ProgramadoRESUMEN
BACKGROUND: Prolonged fatigue has recently attracted attention in occupational (mental) health research since it may lead to sickness absenteeism and work disability. To date, little is known about the role of psychosocial work characteristics in the aetiology of fatigue. In this study we examined prospectively a wide range of psychosocial work characteristics as possible risk factors for the onset of fatigue and psychological distress in the working population. METHODS: This study is based on 8833 employees, participating in the Maastricht Cohort Study of 'Fatigue at Work'. A wide range of psychosocial work characteristics, measured at baseline, was used to predict the onset of fatigue and psychological distress 1 year later. Fatigue was measured with the Checklist Individual Strength; the General Health Questionnaire was used to measure psychological distress. RESULTS: The cumulative incidence of fatigue during 1 year follow-up was 9.7% (N = 492) in men, and 13.5% (N = 241) in women. Psychological demands at work as well as physical and emotional demands increased the risk for fatigue in men, whereas decision latitude in men and co-worker social support in women were protective against fatigue. These prospective associations remained significant after adjustments for potential confounders and baseline fatigue. As regards psychological distress, no association was found with decision latitude, while conflicts at work increased the risk of psychological distress. CONCLUSIONS: Psychosocial work characteristics were significant predictors for the onset of fatigue in the working population. The prospective associations suggest some differential effects in the aetiology of fatigue and psychological distress. Good interpersonal relationships at work and high decision authority were demonstrated to be relevant aspects that should be targeted for prevention.
Asunto(s)
Fatiga/psicología , Satisfacción en el Trabajo , Enfermedades Profesionales/psicología , Estrés Psicológico/complicaciones , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Estudios Prospectivos , Factores de Riesgo , Carga de Trabajo/psicologíaRESUMEN
Differences in fatigue and psychological distress across occupations were examined among 8521 employees participating in the Maastricht Cohort Study of "Fatigue at Work." Additional information on the perceived psychosocial work environment was incorporated. A total of 131 occupations, classified according to the Netherlands Standard Classification of Occupations 1992, were studied. Results showed that occupation as a proxy index of the "objective" work environment adds little explanatory information beyond perceived measures of the work environment. Although "occupation" seems to be an easy entree for intervention, focusing on occupation exclusively to prevent, or at least reduce, fatigue and psychological distress may be inadequate. Supplementary information about the perceived work environment of the job occupant is needed to develop preventive measures on the individual level. Further research, including a longitudinal analysis, is required to elucidate the complex relation between occupation, psychosocial risk factors, and fatigue and psychological distress.
Asunto(s)
Fatiga/epidemiología , Enfermedades Profesionales/epidemiología , Estrés Psicológico/epidemiología , Adulto , Análisis de Varianza , Estudios de Cohortes , Fatiga/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Enfermedades Profesionales/etiología , Ocupaciones , Prevalencia , Factores de Riesgo , Estrés Psicológico/etiologíaRESUMEN
OBJECTIVES: Although it is frequently assumed that issues of religious faith become more salient at the end of life, there is little or no population-based empirical evidence testing this assumption. METHODS: Using data from the New Haven site of the Established Populations for Epidemiologic Studies of the Elderly (N = 2,812), the authors examined self-reports of attendance at services, self-ratings of religiousness, and strength and comfort felt from religion for respondents who did and did not die within 12 months following an interview. Religiousness was assessed at baseline (1982) and in follow-up interviews in 1985, 1988, and 1994. Cross-sectional comparisons of levels of religiousness were made among persons in their last 6 months of life, persons in their last 12 months of life, and persons who survived 12 months, and longitudinal comparisons were made with religiousness at the previous wave. RESULTS: After adjusting for age, sex, education, marital status, religious affiliation, and a set of health status measures, the authors found that although attendance at religious services declined among the near-deceased, this group showed either stability or a small increase in feelings of religiousness and strength/comfort received from religion. Overall levels of attendance and religious feelings were high for this religiously diverse sample. DISCUSSION: Community studies of respondents in their last year of life are rare. In this sample, religious involvement appears to continue throughout the last months of life.
Asunto(s)
Actitud Frente a la Muerte , Religión y Psicología , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Estudios Longitudinales , Masculino , Análisis de SupervivenciaRESUMEN
PURPOSE: Previous studies have suggested the importance of communicating with patients about prognosis at the end of life, yet the prevalence, content, and consequences of such communication have not been fully investigated. The purposes of this study were to estimate the proportion of terminally ill inpatients with documented discussions about prognosis, describe the nature and correlates of such discussions, and assess the association between documented discussions about prognosis and subsequent advance care planning. SUBJECTS AND METHODS: Inpatients (n = 232) at least 65 years old who had brain, pancreas, liver, gall bladder, or inoperable lung cancer were randomly selected from six randomly chosen community hospitals in Connecticut. The presence and content of discussions about prognosis, advanced care planning efforts, and sociodemographic and clinical factors were ascertained by comprehensive review of medical records using a standardized abstraction form. RESULTS: Discussions about prognosis were documented in the medical records of 89 (38%) patients. Physicians and patients were both present during the discussion in 46 (52%) of these cases. Time until expected death was infrequently documented. Having a documented discussion about prognosis was associated with documented discussions of life-sustaining treatments (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.8 to 12.0) and having a do-not-resuscitate order (adjusted OR = 2.2; 95% CI: 1.1 to 4.2). CONCLUSIONS: Among terminally ill patients with cancer, discussions about prognosis as documented in medical charts are infrequent and limited in scope. In some cases, such documented discussions may be important catalysts for subsequent discussions of patient and family preferences regarding treatment and future care.
Asunto(s)
Comunicación , Registros Médicos/normas , Neoplasias , Planificación de Atención al Paciente , Participación del Paciente , Pronóstico , Enfermo Terminal , Revelación de la Verdad , Directivas Anticipadas , Anciano , Anciano de 80 o más Años , Connecticut , Documentación/normas , Femenino , Hospitales Comunitarios , Humanos , Pacientes Internos , Masculino , Neoplasias/diagnóstico , Neoplasias/terapia , Órdenes de ResucitaciónRESUMEN
OBJECTIVES: We sought to examine whether depressive symptoms are associated with poorer prognosis in patients with heart failure. BACKGROUND: Depression is an established risk factor for poor outcome in patients with coronary heart disease (CHD). Little is known of its role in patients with heart failure. METHODS: We prospectively followed 391 patients > or =50 years of age who met criteria for decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living (ADL) at six months, relative to baseline. Depressive symptoms were measured at baseline by means of the Geriatric Depression Scale, Short-Form, with 6 to 7 symptoms, 8 to 10 symptoms and > or =11 symptoms indicating mild, moderate and severe levels of depressive symptoms, respectively. RESULTS: There was a strong and graded association between the severity of depressive symptoms at baseline and the rate of the combined end point of either functional decline or death at six months. After adjustment for demographic factors, medical history, baseline functional status and clinical severity, patients with > or =11 depressive symptoms, compared with those with <6 depressive symptoms, had an 82% higher risk of either functional decline or death, whereas the intermediate levels of depressive symptoms showed intermediate risk (p = 0.003 for trend). A similar graded association was found for functional decline and death separately; however, after multivariate analysis, the association with mortality was less strong and no longer statistically significant. CONCLUSIONS: An increasing number of depressive symptoms is a negative prognostic factor for patients with heart failure, just as it is for patients with CHD.
Asunto(s)
Depresión , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/psicología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
This study examines the reported use of palliative care practices by nurses caring for terminally ill patients in the acute care setting. Randomly selected nurses (n = 180) from six randomly selected hospitals in Connecticut completed a self-administered questionnaire. Factors associated with use of palliative care practices were examined by using bivariate and multivariate analyses. Most nurses surveyed (88.5%) reported using palliative care practices when caring for their terminally ill patients. Factors associated with greater use included greater knowledge about hospice, having practiced nursing for less than 10 years, and having had hospice training in the past 5 years. A substantial proportion of nurses reported that they never discuss hospice (51.7 per cent of nurses) and prognosis (26.6 per cent of nurses) with their terminally ill patients. Educational preparation (bachelor's degree versus less education) was not associated with greater use of palliative care practices. Palliative care practices are commonly used by nurses in the acute care setting. However, many report having limited training and substantial gaps in knowledge about hospice among this group of nurses, suggesting greater attention to palliative care and hospice may be warranted in nursing educational programs.
Asunto(s)
Enfermedad Aguda/enfermería , Atención de Enfermería/métodos , Personal de Enfermería en Hospital/estadística & datos numéricos , Cuidado Terminal/métodos , Actitud del Personal de Salud , Competencia Clínica/normas , Connecticut , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Cuidados Paliativos al Final de la Vida , Hospitales Comunitarios , Humanos , Masculino , Investigación en Evaluación de Enfermería , Cuidados Paliativos/psicología , Pronóstico , Encuestas y Cuestionarios , Enfermo Terminal , Revelación de la VerdadRESUMEN
OBJECTIVES: This study examined the associations of poverty income ratio (PIR), education, and occupational status with type 2 diabetes prevalence among African American and non-Hispanic White (White) women and men aged 40 to 74 years. METHODS: We analyzed cross-sectional data from the Third National Health and Nutrition Examination Survey, controlling for age and examination-related variables. RESULTS: Among African American women, there was a strong, graded association between PIR and diabetes, which remained significant after other risk factors were adjusted for. All 3 variables were significantly associated with diabetes among White women. Among White men, only PIR was significantly associated with diabetes. Controlling for risk factors substantially attenuated these associations among White women. There were no significant associations for African American men. CONCLUSIONS: Socioeconomic status is associated with type 2 diabetes prevalence among women, but not consistently among men. Diabetes prevalence is more strongly associated with PIR than with education or occupational status. These associations are largely independent of other risk factors, especially among African American women. Economic resources should be addressed in efforts to explain and reverse the increasing prevalence of diabetes in the United States.
Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Pobreza , Adulto , Anciano , Población Negra , Educación , Femenino , Humanos , Renta , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiología , Población BlancaRESUMEN
OBJECTIVE: To estimate the effect of involuntary job loss on subsequent alcohol consumption by older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, the authors estimated multivariate models to assess the impact of involuntary job loss on subsequent alcohol use. Two outcomes were investigated: reported daily alcohol consumption and onset of drinking. The analysis sample included 207 workers who experienced involuntary job loss between survey dates and a comparison group of 2,866 continuously employed workers. RESULTS: After baseline alcohol consumption and a variety of socioeconomic and illness-related covariates were controlled, involuntary job loss was not associated (p>.05) with number of daily drinks consumed at follow-up. However, among those who did not consume alcohol at baseline, individuals who suffered involuntary job loss were twice as likely as continuously employed individuals to start drinking by follow-up (OR = 2.01; CI = 1.06-3.80). The majority of those who began drinking at follow-up reported drinking less than 1 drink per day. DISCUSSION: The findings provide evidence of a significant relationship between job loss and subsequent alcohol use among baseline nondrinkers. However, the magnitude of the changes in drinking was quite modest.
Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Conductas Relacionadas con la Salud , Reducción de Personal/psicología , Jubilación/psicología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
The purpose of this study was to determine to what extent a single measure, self-rated health (SRH), independently predicts long-term hospitalizations due to all causes and to cardiovascular diseases by using both the standard Cox proportional hazards model and a more robust events model. The study cohort consisted of 2,812 elderly subjects residing in New Haven, Connecticut, who were followed from 1982 to 1996 as part of the Established Populations for Epidemiologic Study of the Elderly. After adjustment for baseline risk factors, using the Cox model, a favorable SRH was associated with a significantly lowered risk for a first hospitalization for all causes (risk ratio (RR) = 0.850, 95% confidence interval (CI): 0.774, 0.934) and congestive heart failure (RR = 0.599, 95% CI: 0.426, 0.841) but not for myocardial infarction (RR = 0.882, 95% CI: 0.565, 1.379). With the adjusted robust events model, a positive SRH was associated with a decreased risk in both a first (RR = 0.813, 95% CI: 0.744, 0.889) and a second (RR = 0.870, 95% CI: 0.782, 0.968) hospitalization for any cause. These results indicate that a single measurement of SRH predicts long-term patterns of hospitalization, especially for heart failure, among older adults.
Asunto(s)
Estado de Salud , Hospitalización/estadística & datos numéricos , Anciano , Estudios de Cohortes , Intervalos de Confianza , Connecticut/epidemiología , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Análisis Multivariante , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Autoevaluación (Psicología) , Factores SocioeconómicosRESUMEN
The purpose of this investigation was to (1) determine whether there was variability in the quality of services offered in mammography facilities across Connecticut and (2) determine whether African American women were more likely than white women to receive mammograms in facilities that offered substandard services. Since most facilities do not routinely record information on race, this investigation represents a unique opportunity to address the question of race-linked variation in the quality of screening mammography. Information on equipment, personnel, and record keeping in mammography facilities was used to construct indices that represented separate domains of quality: technical attributes, educational practices, and tracking of clients. While some variation in the quality of mammography services was found, there were no significant differences between the two race categories in the mean scores for each of three quality indices. Thus, variation in quality of screening mammographic services does not appear to be race linked.
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Negro o Afroamericano , Neoplasias de la Mama/diagnóstico , Mamografía/normas , Tamizaje Masivo/normas , Calidad de la Atención de Salud/clasificación , Población Blanca , Acreditación , Neoplasias de la Mama/prevención & control , Certificación , Connecticut , Femenino , Encuestas de Atención de la Salud , Humanos , Mamografía/métodos , Mamografía/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Prejuicio , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: This study examined the association between a diagnosis of traumatic grief and quality of life outcomes. METHOD. Sixty-seven widowed persons were interviewed at a median of 4 months after their loss. The multiple regression procedure was used to estimate the effects of a traumatic grief diagnosis on eight quality of life domains, controlling for age, sex, time from loss and diagnoses of major depressive episode and post-traumatic stress disorder. RESULTS: A positive traumatic grief diagnosis was significantly associated with lower social functioning scores, worse mental health scores, and lower energy levels than a negative traumatic grief diagnosis. In each of these domains, traumatic grief was found to be a better predictor of lower scores than either major depressive episode or post-traumatic stress disorder. CONCLUSIONS: The results suggest that a traumatic grief diagnosis is significantly associated with quality of life impairments. These findings provide evidence supporting the criterion validity of the proposed consensus criteria and the newly developed diagnostic interview for traumatic grief the Traumatic Grief Evaluation of Response to Loss (TRGR2L).
Asunto(s)
Trastorno Depresivo Mayor/psicología , Pesar , Calidad de Vida/psicología , Trastornos por Estrés Postraumático/psicología , Viudez/psicología , Adulto , Anciano , Trastorno Depresivo Mayor/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Trastornos por Estrés Postraumático/etiología , Estados UnidosRESUMEN
OBJECTIVE: To examine whether socioeconomic status (SES) explains differences in the prevalence of type 2 diabetes between African-American and non-Hispanic white women and men. DESIGN: Cross sectional study of diabetes prevalence, SES, and other risk factors ascertained by physical examination and interview. SETTING: Interviews were conducted in subjects' homes; physical examinations were conducted in mobile examination centres. PARTICIPANTS: 961 African-American women, 1641 non-Hispanic white women, 839 African-American men and 1537 non-Hispanic white men, aged 40 to 74 years, examined in the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of the non-institutionalised civilian population of the United States, 1988-1994. MAIN RESULTS: Among women, African-American race/ethnicity was associated with an age adjusted odds ratio of 1.76 (95% confidence intervals 1.21, 2.57), which was reduced to 1.42 (95% confidence intervals 0.95, 2.13) when poverty income ratio was controlled. Controlling for education or occupational status had minimal effects on this association. When other risk factors were controlled, race/ethnicity was not significantly associated with type 2 diabetes prevalence. Among men, the age adjusted odds ratio associated with African-American race/ethnicity was 1.43 (95% confidence intervals 1.03, 1.99). Controlling for SES variables only modestly affected the odds ratio for African/American race/ethnicity among men, while adjusting for other risk factors increased the racial/ethnic differences. CONCLUSIONS: Economic disadvantage may explain much of the excess prevalence of type 2 diabetes among African-American women, but not among men.
Asunto(s)
Negro o Afroamericano , Diabetes Mellitus Tipo 2/etnología , Adulto , Negro o Afroamericano/estadística & datos numéricos , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Oportunidad Relativa , Prevalencia , Distribución por Sexo , Factores Socioeconómicos , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
Several initiatives to improve care at the end of life involve educational programs to influence clinicians' attitudes about care for patients with terminal illnesses. The objective of this research was to develop and test a short and easily administered instrument for measuring physicians' and nurses' attitudes towards care at the end of life. The instrument was tested using a cross-sectional study of 50 clinicians (25 physicians and 25 nurses) from general medicine, cardiology, oncology, and geriatric medicine. Both reliability and validity were assessed, and the instrument was found to have acceptable test-retest reliability and construct validity. Such an assessment instrument may be useful in evaluating the impact of initiatives to modify attitudes towards terminal care and in improving the quality of care at the end of life.
Asunto(s)
Actitud del Personal de Salud , Psicometría/métodos , Encuestas y Cuestionarios , Cuidado Terminal , Adulto , Connecticut , Estudios Transversales , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: To estimate the health consequences of involuntary job loss among older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, multivariate regression models were estimated to assess the impact of involuntary job loss on both physical functioning and mental health. Our analysis sample included 209 workers who experienced involuntary job loss between survey dates and a comparison group of 2,907 continuously employed workers. RESULTS: The effects of late-life involuntary job loss on both follow-up physical functioning and mental health were negative and statistically significant (p < .05), even after baseline health status and sociodemographic factors were controlled for. Among displaced workers, reemployment was positively associated with both follow-up physical functioning and mental health, whereas the duration of joblessness was not significantly associated with either outcome. DISCUSSION: The findings provide evidence of a causal relationship between job loss and morbidity among older workers. This relationship is reflected in both poorer physical functioning and mental health for workers who experience involuntary job loss. In addition to the economic consequences of worker displacement, there may be important health consequences of job loss, especially among older workers.
Asunto(s)
Envejecimiento/psicología , Evaluación Geriátrica , Estado de Salud , Jubilación , Desempleo/psicología , Actividades Cotidianas/clasificación , Adaptación Psicológica , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
BACKGROUND: Despite the central role of hospice in end-of-life care, little is known about the proportion of terminally ill patients referred for hospice and the physician factors associated with hospice referral. METHODS: Cross-sectional data from a self-administered survey of 231 physicians were used to estimate the proportion of terminally ill patients who were referred for hospice and to assess the independent effects of physician factors on hospice referral. RESULTS: On average, physicians reported referring about 55% of their terminally ill patients for hospice; 26.7% of the physicians referred less than one quarter of their terminally ill patients. Physician specialty, board certification, and physicians' knowledge level about hospice were independently associated with the proportions of terminally ill patients referred for hospice. CONCLUSION: Many terminally ill patients are not referred for hospice care and physician factors influence the use of hospice significantly. The study suggests effective factors and groups to target with interventions to enhance the appropriate use of hospice.
Asunto(s)
Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Connecticut , Estudios Transversales , Humanos , Encuestas y CuestionariosRESUMEN
Relatives frequently accommodate patients' obsessive-compulsive symptoms and clinicians hypothesize that such accommodations adversely affect patient outcome. This study's purpose was to develop a valid and reliable measure, the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS), and to investigate the family accommodation construct. We administered the FAS and additional family and patient measures to 36 adult obsessive-compulsive patients and their primary caregivers. The FAS demonstrated excellent interrater reliability and good internal consistency and performed well on assessment of its convergent and discriminant validity. Family accommodation was significantly associated with patient symptom severity and functioning, and with relatives' own obsessive-compulsive symptoms. Although most relatives accommodated patient symptoms, many did not believe that such accommodations improved the patient's clinical status. The FAS will provide researchers and clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing more adaptive coping strategies.
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Relaciones Familiares , Trastorno Obsesivo Compulsivo/diagnóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Adaptación Psicológica , Adulto , Cuidadores/psicología , Salud de la Familia , Terapia Familiar , Humanos , Trastorno Obsesivo Compulsivo/psicología , Trastorno Obsesivo Compulsivo/terapia , Psicometría , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To examine the longitudinal effects of major depression and phobia on stage at diagnosis of subsequent breast cancer. METHOD: Data from the New Haven Epidemiologic Catchment Area (ECA) study were linked to the Connecticut Tumor Registry (CTR). The sample comprised of seventy-two women with a first primary breast cancer diagnosed sometime after their baseline ECA study interview. In the ECA study, lifetime psychiatric history was assessed using the Diagnostic Interview Schedule based on DSM-III criteria. Stage at diagnosis of breast cancer was taken from CTR records and dichotomized into early stage (in situ and localized tumors) versus late stage (regional and distant tumors). RESULTS: A positive history of major depression was associated with an increased likelihood of late-stage diagnosis of breast cancer (odds ratio [OR] = 9.81, p = 0.039), whereas a positive history of phobic disorders was associated with a decreased likelihood of late-stage diagnosis (OR = 0.01, p = 0.021), controlling for sociodemographic characteristics of the sample. CONCLUSIONS: These analyses revealed a longitudinal association between reported lifetime psychiatric history and stage at diagnosis of subsequent breast cancer. Phobia may motivate women to adhere to breast cancer screening recommendations and to report suspicious symptoms to a physician without delay. Major depression, on the other hand, was identified as an important predictor of late-stage diagnosis; proper recognition and management of depression in the primary care setting may have important implications for breast cancer detection and survival.