Effect of Retirement on Sleep Disturbances: the GAZEL Prospective Cohort Study

Objectives:

Changes in health following retirement are poorly understood. We used serial measurements to assess the effect of retirement on sleep disturbances.

Design:

Prospective cohort study.

Setting:

The French national gas and electricity company.

Participants:

Fourteen thousand seven hundred fourteen retired employees (79% men).

Measurements and Results:

Annual survey measurements of sleep disturbances ranging from 7 years before to 7 years after retirement (a mean of 12 measurements). Before retirement 22.2% to 24.6% of participants reported having disturbed sleep. According to repeated-measures logistic-regression analysis with generalized estimating equations estimation, the odds ratio (OR) for having a sleep disturbance in the postretirement period was 0.74 (95% confidence interval 0.71-0.77), compared with having a sleep disturbance in the preretirement period. The postretirement improvement in sleep was more pronounced in men (OR 0.66 [0.63-0.69]) than in women (OR 0.89 [0.84-0.95]) and in higher-grade workers than lower-grade workers. Postretirement sleep improvement was explained by the combination of preretirement risk factors suggesting removal of work-related exposures as a mechanism. The only exception to the general improvement in sleep after retirement was related to retirement on health grounds. In this group of participants, there was an increase in sleep disturbances following retirement.

Conclusions:

Repeated measurements provide strong evidence for a substantial and sustained decrease in sleep disturbances following retirement. The possibility that the health and well-being of individuals are significantly worse when in employment than following retirement presents a great challenge to improve the quality of work life in Western societies in which the cost of the aging population can only be met through an increase in average retirement age.

Citation:

Vahtera J; Westerlund H; Hall M; Sjösten N; Kivimäki M; Salo P; Ferrie JE; Jokela M; Pentti J; Singh-Manoux A; Goldberg M; Zins M. Effect of retirement on sleep disturbances: the GAZEL prospective cohort study. SLEEP 2009;32(11):1459-1466.     

Is there need for change of health examinations for sea pilots?

Sea pilots must be capable of carrying out their work in all situations. Thus, they must not have any disease or defect, that could impair their job performance. By periodic medical examinations attempts are made to ensure their working capacity. In most countries these examinations are carried out by a general practitioner and they include only few if any objective laboratory tests. The aim of the present investigation was to study the effectiveness of the periodic medical examinations to find out in the population of pilots examined persons with health risks, especially risks for cardiovascular diseases. All the pilots examined were over 45 years old (n = 135, response rate 88%). Self-evaluation of health was carried out by a questionnaire. Blood analyses were made and chest X-ray as well as exercise-ECC were taken. The most common subjective symptoms concerned musculoskeletal and gastrointestinal systems; sleep disturbances were also quite common. The three most frequent diseases diagnosed earlier by a doctor were musculoskeletal and gastrointestinal diseases, and arterial hypertension. About 24% of pilots had a lower physical working capacity than predicted. The body mass index indicated at least 11% overweight in half of the cases. At exercise-ECG four pilots appeared to have an ischaemic heart disease and additionally eleven pilots had abnormal ECG. Over 80% of pilots had a serum cholesterol value higher than 5 mmol/l, and serum triglyceride values exceeded the normal value of 2.0 mmol/l in every fourth case. Serum glutamyl transaminase was pathological in over 20% of the cases, and serum glucose level in 8%. The findings by routine physical examinations were very few consisting of stiffness in musculoskeletal system, two cases of elevated blood pressure, two heart murmurs, varicose veins etc. In two cases an inguinal hernia was suspected. The current periodic health examinations does not seem to effectively prevent a person with possible health defect from working as a sea pilot. More objective tests must be included in these examinations and more attention should be paid to prevention of overweight, effective treatment of musculoskeletal symptoms, improving physical working capacity and helping pilots to manage their psychic stress.     

Location,morphology, and central projections of mesencephalic trigeminal neurons innervating rat masticatory muscles studied by axonal transport of choleragenoid-horseradish peroxidase

Retrograde and transganglionic transport of horseradish peroxidase conjugated to the B-fragment of cholera toxin (B-HRP) was used to study the location, morphology, and central projections of mesencephalic trigeminal (Me5) neurons innervating rat masticatory muscles. Labeled Me5 cell bodies were found throughout the Me5 nucleus from a level slightly caudal to the trigeminal motor nucleus to the level of the superior colliculus 5 mm further rostrally. Occasionally, labeled Me5 cells were observed in the anterior medullary velum, in the cerebellum, and in the brainstem contralateral to the B-HRP injection. The vast majority of the labeled Me5 cells were pseudounipolar, but multipolar cells were also found. Extensive central projections from labeled Me5 cells could be seen extending from the nucleus of Darkschewitsch rostrally to the C2 segment caudally. Small but consistent projections from Me5 neurons were observed in nuclear islands among the incoming Me5 root fibers. Trigeminal and hypoglossal motor nuclei received direct projections from Me5 cells, but not the facial motor nucleus. The most prominent Me5 projections appeared in the brainstem reticular formation, including the supratrigeminal nucleus. Smaller projections also extended into the main sensory trigeminal nucleus, trigeminal subnucleus oralis, and the nucleus of the solitary tract. © 1993 Wiley-Liss, Inc.     

Dihydrotestosterone in prostatic hypertrophy: II. The formation and content of dihydrotestosterone in the hypertrophic canine prostate and the effect of dihydrotestosterone on prostate growth in the dog

Three types of studies have been performed in immature, mature, and hypertrophic prostate glands of the dog. First, the concentrations of testosterone and dihydrotestosterone have been measured in the three types of gland. Dihydrotestosterone was the predominant hormone recovered in all prostates studied and was present in approximately five times higher concentration in the hypertrophic as compared to the other types of dog prostate. Second, pharmacological doses of dihydrotestosterone were administered to castrated dogs for 9 months and resulted in a distinct acceleration of prostatic growth as compared to testosterone treatment. Third, the rates of formation and degradation of dihydrotestosterone were measured in normal and hypertrophic tissue and were found to be essentially the same. These observations suggest that dihydrotestosterone accumulation may be causally linked to the development of canine prostatic hypertrophy. However, the mechanism by which dihydrotestosterone accumulates in the prostate remains to be determined.     

Early puerperal insertions of Copper-T-200

The Copper-T-200 (CuT-200) was inserted after delivery at term in 197 women on the day preceding discharge from the hospital. The majority of the insertions were done on day 5 or 6 after delivery. Every subject in the study was followed more than 12 months. The insertions were well tolerated; no perforations or serious side effects occurred. During the first year of use, only 9 infections were recorded. The first segment pregnancy rate (7.2) and expulsion rate (14.8) were significantly higher and the continuation rate, 69.5, lower than that obtained with the same device inserted in postmenstrum women. The expulsions were mainly partial (11.1), and were discovered during the first and second months postpartum. The postpartum insertions were found to be safe and well accepted. The high pregnancy and expulsion rates make the CuT-200 an unsuitable IUD in postpartum programs where follow-up is not adequate and early removals of partially expelled or displaced devices is not possible.     

Humoral immunity induced by a live Francisella tularensis vaccine. Complement fixing antibodies determined by an enzyme-linked immunosorbent assay (CF-ELISA)

A complement-fixing enzyme-linked immunosorbent assay (CF-ELISA) with bacterial sonicate as the antigen, human AB serum as the source of complement and alkaline-phosphatase-labelled anti-(human C3e) as the conjugate was developed for detecting antibodies to Francisella tularensis. Humoral responses after inoculation with a live attenuated tularemia vaccine were studied in 13 subjects by this method. Twelve responded with CF antibodies, which in most cases appeared 4 weeks after vaccination, the response time varying from 1 week to 2 months. The highest individual CF titres, of 140–9990, were reached 1–4 months after vaccination (average 2.4 months). The CF titres tended to decrease with time, and at 10 months two of the 12 subjects with an earlier CF positive response were negative again. CF antibodies were nevertheless still detectable in all three subjects studied 1.5 years after vaccination.     

Changes in headache after treatment of mandibular dysfunction

To analyse the effect of treatment of mandibular dysfunction on headache, 35 patients with migraine, 20 patients with combination headache and 36 patients with muscle contraction headache were studied in a clinical double-blind trial. Patients in the treatment group received occlusal adjustment and those in the placebo group mock occlusal adjustment. After eight months and four months, respectively, the neurologist evaluated the treatment outcome. The frequency of headache was reduced in 79% and the intensity in 53% of patients suffering from muscle contraction headache or combination headache in whom the adjustment of the dental occlusion had been successfully accomplished. The difference from the placebo group was statistically significant. The decrease in headache frequency as calculated from the headache diaries correlated with the decrease in the index of clinical signs of mandibular dysfunction.