Association Between Psychosocial Work Characteristics And Health Functioning In American Women
Cheng Y, Kawachi I, Coakley EH, Schwartz J, Colditz G
Objective: To examine prospectively the relation between psychosocial work characteristics and
changes in health related quality of life over four years in a cohort of working women in the United
Design: Longitudinal cohort study. Setting: United States. Participants: 21 290 female
registered nurses who completed the Karasek's job content questionnaire and a modified version
of the short form 36 questionnaire (SF-36) as used for a survey of health status by the medical
Main outcome measures: Seven dimensions of health status: physical functioning,
role limitations due to physical health problems, bodily pain, vitality, social functioning, role
limitations due to emotional problems, and mental health.
Results: Examined separately low job
control, high job demands, and low work related social support were associated with poor health
status at baseline as well as greater functional declines over the four year follow up period.
Examined in combination, women with low job control, high job demands, and low work related
social support ("iso-strain" jobs) had the greatest functional declines. These associations could not
be explained by age, body mass index, comorbid disease status, alcohol consumption, smoking
status, education level, exercise level, employment status, marital status, or presence of a
Conclusions: Adverse psychosocial work conditions are important predictors of poor
functional status and its decline over time.
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Incidence And Remission Rates Of Lower Urinary
Tract Symptoms At One Year In Women Aged
Moller LA, Lose G, Jorgensen T
Objectives: To determine the incidence and rates of remission of lower urinary tract symptoms at
one year in women aged 40-60, and to assess factors associated with remission.
longitudinal cohort study. Setting: One rural and one urban county in Denmark. Participants: 4000
women recruited on a random basis, 2860 of whom were followed up at one year.
Measurements: Incidence and rates of remission of lower urinary tract symptoms.
Results:Prevalence, incidence, and rates of remission of lower urinary tract symptoms in 2284 women
were respectively 28.5% (95% confidence interval 26.7% to 30.4%), 10.0% (8.5% to 11.4%),
and 27.8% (25.6% to 30.0%). Overall, symptoms were not significantly associated with events
performed or initiated in the study period: medical consultation (1.6, 0.8 to 2.8), pelvic floor
physiotherapy (0.9, 0.5 to 1.8), treatment with antibiotics on suspicion of a lower urinary tract
infection (1.3, 0.8 to 2.2), or other treatment (1.7, 0.7 to 4.1). Many of the individual symptoms
were, however, associated with seeking professional help.
Conclusions: Lower urinary tract
symptoms constitute dynamic conditions, with women experiencing more or fewer symptoms, and
eventually a cessation of symptoms. The distinction between permanent and fluctuating cases may
have important clinical and scientific implications.
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Endometriosis: Clinical Evidence
Definition: Endometriosis is characterised by ectopic endometrial tissue, which can cause
dysmenorrhoea, dyspareunia, non-cyclical pelvic pain, and subfertility. Diagnosis is made by
laparoscopy. Most endometrial deposits are found in the pelvis (ovaries, peritoneum, uterosacral
ligaments, pouch of Douglas, and rectovaginal septum). Extrapelvic deposits, including those in
the umbilicus and diaphragm, are rare. Endometriomas are cysts of endometriosis within the
Incidence/prevalence: In asymptomatic women, the prevalence ranges from 2% to 22%, depending on the diagnostic criteria used and the populations studied. In women with dysmenorrhoea, the incidence of endometriosis ranges from 40% to 60%, and in women with
subfertility it ranges from 20% to 30%. The severity of symptoms and the probability of diagnosis
increase with age. Incidence peaks at about age 40. Symptoms and laparoscopic appearance do
not always correlate.
Etiology: The cause is unknown. Risk factors include early menarche and
late menopause. Embryonic cells may give rise to deposits in the umbilicus, while retrograde
menstruation may deposit endometrial cells in the diaphragm. Oral contraceptives reduce the risk
of endometriosis, and this protective effect persists for up to a year after their discontinuation.
Prognosis: We found one small randomised controlled trial (RCT) in which repeat laparoscopy
was performed in the women treated with placebo. Over 12 months, endometrial deposits
resolved spontaneously in a quarter, deteriorated in nearly half, and were unchanged in the
Desired Therapeutic Benefit: To relieve pain (dysmenorrhoea, dyspareunia, and other pelvic pain) and to
improve fertility, with minimal adverse effects.
Outcomes: American Fertility Society scores for
size and number of deposits; recurrence rates; time between stopping treatment and recurrence;
rate of adverse effects of treatment. In women with pain: relief of pain, assessed by visual
analogue scale and subjective improvement. In women with subfertility: cumulative pregnancy
rate, live birth rate. In women undergoing surgery: ease of surgical intervention (rated as easy,
average, difficult, or very difficult).
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