Employment status, mental disorders and service use in the working age population

OBJECTIVES: This study examined the association between employment status and specific DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, IVth edition) depressive, anxiety and alcohol use disorders and the association between employment status and service use for these disorders. METHODS: As part of the representative population-based "Health 2000 Study" of Finns aged 30 years or over, 3440 employed, 429 unemployed, and 820 economically inactive persons of working age (30-64 years) participated in a comprehensive health examination, including the standardized Composite International Diagnostic Interview. RESULTS: The risk of mental disorders was generally higher among the unemployed and the economically inactive than among the employed. The respective odds ratios were 1.79 [95% confidence interval (95% CI) 1.26-2.54] and 1.54 (95% CI 1.06-2.25) for depressive disorders, 2.68 (95% CI 1.85-3.89) and 2.53 (95% CI 1.76-3.65) for anxiety disorders, and 2.58 (95% CI 1.82-3.65) and 1.43 (95% CI 0.91-2.22) for alcohol use disorders. Similar results were obtained for most of the specific categories of these disorders. Among the persons with anxiety disorders, the odds for treatment contact were 2.35 (95% CI 1.06-5.23) times higher for the unemployed than for the employed after control for disorder severity. For those with an alcohol use disorder, the corresponding odds ratio was 3.51 (95% CI 1.23-9.98). CONCLUSIONS: Common mental disorders are less prevalent among the employed than among unemployed and economically inactive people. Among those with anxiety or alcohol use disorders, service use is less common among the employed than among the unemployed. This difference is not explained by the severity of the clinical state.     

Pulse pressure responses to psychological tasks improve the prediction of left ventricular mass: 10 years of follow-up

OBJECTIVES: To examine the role of casual blood pressure measurements and blood pressure responses to psychological tasks in the prediction of future left ventricular mass index (LVMI), and to determine the importance of different components of blood pressure, and the predictive value of an individual's personal characteristics and antihypertensive medication on future LVMI. METHODS: At baseline, blood pressure was recorded by casual measurements; during tests it was recorded by intra-arterial monitoring. The participants were healthy, untreated 35-45-year old men. Echocardiography data both at baseline and after 10 years of follow-up were available from 65 individuals, of whom 49 (75%) were not taking antihypertensive medication at follow-up. Those not taking antihypertensive medication were included in the prediction of LVMI (g/m2). RESULTS: Baseline LVMI correlated significantly with future LVMI only among the 49 unmedicated individuals (r = 0.52, P < 0.0001). The predictive value of baseline LVMI on future LVMI among them (adjusted coefficient of determination = 0.26) was not improved by the inclusion of casual blood pressure. In contrast, blood pressure responses to the psychological tasks improved the prediction of future LVMI by 4-13%. Pulse pressure was the blood pressure variable that entered the final prediction models; the correlations with future LVMI were best for pulse pressure response to habituation task (r = 0.43, P < 0.05) and to relaxation (r = 0.37, P < 0.05). CONCLUSIONS: To our knowledge, this is the longest prospective follow-up to show that blood pressure responses to psychological tasks improve the prediction of LVMI compared with casual blood pressure measurements. The pulse pressure, which reflects the properties of the arterial wall, is the most significant blood pressure variable in predicting future LVMI.     

3D-visualization of the temporomandibular joint with focus on the articular disc based on clinical T1-, T2-, and proton density weighted MR images

Objective An approach of 3D-visualization of the temporomandibular joint (TMJ) with special focus on the articular disc based on magnetic resonance imaging (MRI) was developed for the purpose of diagnosis support. Materials and methods Mandibular condyle and fossa were reconstructed as 3D-surfaces. Articular disc, retrocondylar tissue, and the lateral pterygoid muscle were visualized by means of direct volume rendering. By simultaneous visualization of both, the bony surfaces and the soft tissue, anterior disc displacement could be recognized in 3D-context. Additional superposition of the 3D-visualization with the original 2D-MRI slices allowed for a combination with conventional diagnostics. The method was tested for clinical T1-, T2-, and proton density weighted MRI data from four independent medical institutions. Results For all cases, the skeletal anatomy could be reproduced. Applied validation approaches showed good results. Anterior disc displacement could be clearly depicted as well as the incidence of reduction of the disc. By several experienced observers, the approach was rated as significant. Conclusion Although partially non-standard in the clinical routine the new method provided promising results for efficient diagnosis support. Its validity in the medical practice, namely, its impact for dislocation/deformity of the mandibular disc will be further analyzed. This paper has been written on behalf of a publication request following Cars 2006 conference held in June 2006 in Osaka, Japan. The title of the talk at Cars 2006 conference was “An approach for three-dimensional rendering of the mandibular disc based on high-resolution MR images” authored by Kober C, Hayakawa Y, Kinzinger G, Yamamoto M, Sano T, Sader R, see Int J Comput Assist Radiol Surg 2006 1(Suppl 1): 405–406. I apologize for the delay which was caused by very dense time schedule. In return, the article is a considerable extension of the work presented at Cars 2006.     

The GDF5 mutant BB-1 enhances the bone formation induced by an injectable,poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced,brushite-forming cement in a sheep defect model of lumbar osteopenia

Background Context

Targeted delivery of osteoinductive bone morphogenetic proteins (eg, GDF5) in bioresorbable calcium phosphate cement (CPC), potentially suitable for vertebroplasty and kyphoplasty of osteoporotic vertebral fractures, may be required to counteract augmented local bone catabolism and to support complete bone regeneration. The biologically optimized GDF5 mutant BB-1 may represent an attractive drug candidate for this purpose.

Work stress and coronary heart disease: what are the mechanisms?

AIMS: To determine the biological and behavioural factors linking work stress with coronary heart disease (CHD). METHODS AND RESULTS: A total of 10 308 London-based male and female civil servants aged 35-55 at phase 1 (1985-88) of the Whitehall II study were studied. Exposures included work stress (assessed at phases 1 and 2), and outcomes included behavioural risk factors (phase 3), the metabolic syndrome (phase 3), heart rate variability, morning rise in cortisol (phase 7), and incident CHD (phases 2-7) on the basis of CHD death, non-fatal myocardial infarction, or definite angina. Chronic work stress was associated with CHD and this association was stronger among participants aged under 50 (RR 1.68, 95% CI 1.17-2.42). There were similar associations between work stress and low physical activity, poor diet, the metabolic syndrome, its components, and lower heart rate variability. Cross-sectionally, work stress was associated with a higher morning rise in cortisol. Around 32% of the effect of work stress on CHD was attributable to its effect on health behaviours and the metabolic syndrome. CONCLUSION: Work stress may be an important determinant of CHD among working-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.     

Work-place social capital and smoking cessation: the Finnish Public Sector Study

Aims To examine whether high social capital at work is associated with an increased likelihood of smoking cessation in baseline smokers. Design Prospective cohort study. Setting Finland. Participants A total of 4853 employees who reported to be smokers in the baseline survey in 2000–2002 (response rate 68%) and responded to a follow‐up survey on smoking status in 2004–2005 (response rate 77%). Measurements Work‐place social capital was assessed using a validated and psychometrically tested eight‐item measure. Control variables included sex, age, socio‐economic position, marital status, place of work, heavy drinking, physical activity, body mass index and physician‐diagnosed depression. Findings In multi‐level logistic regression models adjusted for all the covariates, the odds for being a non‐smoker at follow‐up were 1.26 [95% confidence interval (CI) = 1.03–1.55] times higher for baseline smokers who reported high individual‐level social capital than for their counterparts with low social capital. In an analysis stratified by socio‐economic position, a significant association between individual‐level social capital and smoking cessation was observed in the high socio‐economic group [odds ratio (OR) (95% CI) = 1.63 (1.01–2.63)], but not in intermediate [(OR = 1.10 (0.83–1.47)] or low socio‐economic groups [(OR = 1.28 (0.86–1.91)]. Work unit‐level social capital was not associated with smoking cessation. Conclusions If the observed associations are causal, these findings suggest that high perceived social capital at work may facilitate smoking cessation among smokers in higher‐status jobs.     

Impact of change in the price of percutaneous coronary intervention devices on medical expenses.

Percutaneous coronary intervention (PCI) devices are much more expensive in Japan than in the United States, but their prices were reduced in April 2002. This study evaluated the impact of that change in the price of PCI devices on medical expenses. In-hospital costs of 22 consecutive patients who underwent elective single-vessel PCI without a debulking procedure before April 2002 were collected and the in-hospital cost of each patient was recalculated by applying the current prices of the PCI devices and those in the USA. For patients treated with PCI before April 2002, the in-hospital cost was 1,456,375+/-358,781 yen, but when the current price is used, the in-hospital cost is estimated to be 1,355,812 +/-313,237 yen (7% reduction). If the prices of the devices were reduced to those in USA, there would be a 53% reduction (689,417 +/-99,139 yen). Although the change in the price of PCI devices in April 2002 has reduced in-hospital costs, the devices are still much more expensive in Japan than in the USA. Further reduction of the price is required to make PCI more cost-effective.