Physical occupational exposures during working life and quality of life after labour market exit: results from the GAZEL study

Objective: To investigate variations in quality of life at older ages, we take a life course perspective to analyse long-term effects of physical working conditions upon quality of life after retirement. In doing so, we study to what extent these associations are explained by individuals’ health at older ages.

Method: We use administrative data and self-administered questionnaire responses from the French GAZEL cohort. Quality of life was assessed with CASP-19 in 2009 and related to three types of physical working conditions during previous working life: (1) ergonomic strain, (2) physical danger and (3) exposures to chemicals. Health was assessed in 2007 with the SF-36 Health Survey. Multiple regressions were calculated in retired men only, controlling for important confounders including social position.

Results: In contrast to men, few women were exposed to strenuous and dangerous working conditions in this cohort and were not included in subsequent analyses. Negative effects on retired men's quality of life were found for the physical occupational exposures of ergonomic strain and physical danger, but not for chemical exposures. Effects were attenuated after the introduction of physical and mental health to the models, indicating an indirect effect of physical working conditions upon quality of life via health.

Conclusion: Adverse physical working conditions have long-term consequences for health and quality of life at older ages. Improvements to physical working conditions may improve individuals’ quality of life over the long term.     

Taiwanese Experiences: Elders with Dementia in Two Different Adult Day Service (ADS) Environments

Background: Researchers have demonstrated that adult day services (ADS) benefit elders with dementia and their caregivers, but they have also observed infantilization that diminishes personhood. Many ADS are socially constructed as places for incompetent elders, where clients are labeled as child-like dependents. Most ADS research has been performed in Western society; little is known about ADS in Asian countries. The Taiwanese Government seeks to expand ADS availability to meet the needs of an aging population; researchers must examine their ADS environments and practices to inform program development and expansion that supports respectful elder care.

Objectives: Elders’ experiences of daily life were examined within the physical and social environments of one social and one medical model ADS in Taiwan. The ecological model and place rules informed our research framework.

Methods: Ethnographic data were analyzed for themes reflecting our framework with attention to physical and social environment and staff–client interactions.

Results: The social model center included unique environmental features, such as a temple, indicating the purpose of different areas. Staff treated clients like family, sometimes to clients’ detriment, providing limited privacy and demanding compulsory activity participation. The medical model center with nurse's station and institutional furniture reflected a hospital-like environment and fostered a patient–nurse relationship. Staff inattention actually created opportunities for autonomy among some clients.

Conclusion and discussion: Physical features and social interactions within Taiwanese ADS reflected infantilization similar to that seen in the US and uniquely embedded within a traditional cultural background. Our findings reveal a tension between physical and social care features reflecting Eastern traditions of respect for elders and western traditions of institutional care.     

Temporal variation in risk factors and prevalence rate of depression in urban population: does the urban environment play a significant role?

Urban environment has now been recognized as significant risk factor of depression; however, there remains a gap in the literature regarding specific stressors associated with urbanization. Therefore, the present study is designated to examine the strength of association between urban environment and depression in temporal manner, and to identify significant risk factors. A household survey based on a questionnaire was conducted in 2003 and 2013, covering 1326 and 1965 households, respectively, from 12 wards of Delhi, India, to procure household-level data. Prevalence of depression was measured using the Centre for Epidemiologic Studies Depression Scale. The individual response rate within participating households was 88.3% in 2003, while it was 82.7% in 2013. During the period of study, the percentage of depressed people increased from 30.9% (2003) to 33.4% (2013). At the univariate level, significant confounders that were associated with depression were being female, unmarried and underemployed. The risk of being depressed due to inaccessibility to basic facilities reduced by ? 1.5%, while fear of crime and reducing social support recorded a phenomenal increase of 31.1% and 14.4%, respectively, during the period of study. Within domain analysis, after adjusting for confounding factors, indoor noise pollution (OR 3.04, p < 0.001), overcrowding (OR 2.35, p < 0.001), increasing crime (OR 1.72, p < 0.001), less supportive neighbours (OR 1.16, p < 0.001) and lacking park/playground (OR 1.12, p < 0.001) remained significantly associated with being depressed. This study confirms an association between the urban environment and depression across a range of domains. This study highlights the need to intervene on both physical and social features of urban centres to promote mental well-being.     

How can we Improve the Physical and Social Environment of the School to Promote Student Resilience? Evidence from the Resilient Children and Communities Project in China

Debate on the relationship between mental health and environment is of long standing. Resilience, as a core aspect of mental health promotion, has been described as the interaction between risk and protective factors present in the environment (Rutter, 1987). Central to the concept is that protective factors — those factors in the individual or the environment that enhance an individual's ability to resist problems and deal with life's stresses — can be fostered and promoted. The paper specifies aspects of the school environment in a holistic, or ecological setting, drawing on a multi-strategy health promotion project in primary schools in Hefei and Nanjing in China. A prospective intervention study design was used to collect data in pre-intervention and post-intervention phases, and to analyse it to establish the effectiveness of the intervention in improving the health-promoting environment in Chinese primary schools. The results indicate a significant intervention effect on the physical and social school environment in primary schools, and these results can be used in forthcoming comprehensive work to improve school mental health and well-being.     

Interaction between the MTHFR C677T polymorphism and traumatic childhood events predicts depression

Childhood trauma is associated with the onset and recurrence of major depressive disorder (MDD). The thermolabile T variant of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism (rs1801133) is associated with a limited (oxidative) stress defense. Therefore, C677T MTHFR could be a potential predictor for depressive symptomatology and MDD recurrence in the context of traumatic stress during early life. We investigated the interaction between the C677T MTHFR variant and exposure to traumatic childhood events (TCEs) on MDD recurrence during a 5.5-year follow-up in a discovery sample of 124 patients with recurrent MDD and, in an independent replication sample, on depressive symptomatology in 665 healthy individuals from the general population. In the discovery sample, Cox regression analysis revealed a significant interaction between MTHFR genotype and TCEs on MDD recurrence (P=0.017). Over the 5.5-year follow-up period, median time to recurrence was 191 days for T-allele carrying patients who experienced TCEs (T+ and TCE+); 461 days for T− and TCE+ patients; 773 days for T+ and TCE− patients and 866 days for T− and TCE− patients. In the replication sample, a significant interaction was present between the MTHFR genotype and TCEs on depressive symptomatology (P=0.002). Our results show that the effects of TCEs on the prospectively assessed recurrence of MDD and self-reported depressive symptoms in the general population depend on the MTHFR genotype. In conclusion, T-allele carriers may be at an increased risk for depressive symptoms or MDD recurrence after exposure to childhood trauma.