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The SUNY Open Access Repository (SOAR) is a centrally managed online digital repository that stores, indexes, and makes available scholarly and creative works of SUNY faculty, students, and staff across SUNY campuses. SOAR serves as an open access platform for those SUNY campuses that do not have their own open access repository environments.
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Association between ambulatory blood pressure and alternative formulations of job strain.Objectives: The goal of the study was to determine whether alternative formulations of Karasek & Theorell's job-strain construct are associated with ambulatory blood pressure and the risk of hypertension. Methods: Full-time male employees (N = 262) in eight worksites completed a casual blood pressure screening, medical examinations, and questionnaires and wore an ambulatory blood pressure monitor for 24 h on a workday. Cases of hypertension were ascertained from casual blood pressure readings for a case-referent analysis. A cross-sectional analysis was also conducted, ambulatory (continuous) blood pressure measurements being used as the outcome. Results: All formulations of job strain exhibited significant associations with systolic blood pressure at work and home, but not with diastolic blood pressure. Employees experiencing job strain had a systolic blood pressure that was 6.7 mm Hg (approximately 0.89 kPa) higher and a diastolic blood pressure that was 2.7 mm Hg (approximately 0.36 kPa) higher at work than other employees, and the odds of hypertension were increased [odds ratio (OR) 2.9, 95% confidence interval (95% CI) 1.3-6.6]. Using national means for decision latitude and demands to define job strain increased the systolic and diastolic blood pressure associations to 11.5 mm Hg (approximately 1.53 kPa) and 4.1 mm Hg (approximately 0.54 kPa), respectively. Adding organizational influence to the task-level decision latitude variable produced a stronger association for hypertension with job strain (OR 3.7, 95% CI 1.6-8.5). Adding social support to the job-strain model also slightly increased the hypertension risk. Conclusions: The impact of job strain, at least on systolic blood pressure, is consistent and robust across alternative formulations, more restrictive cut points tending to produce stronger effects.
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Clinical experience and results of a Sentinel Health Investigation related to indoor fungal exposure.This is a review of exposure conditions, clinical presentation, and morbidity of children and adults with indoor fungal exposure such as toxic Stachybotrys chartarum. Indoor exposure was characterized using different methods including microscopic, culture, cytotoxicity screening tests, and chemical analyses. Clinical case histories and physical and laboratory findings are presented of children (age < 18 years, n = 22; mean age 9 years; 60% females) and adults (age >18 years, n = 125; mean age 39 years, 67% females) who consulted an environmental health specialty clinic. In the pediatric patients' exposure history, widespread fungal contamination of water-damaged building materials with known toxic or allergic fungi was identified. Primarily disorders of the respiratory system, skin, mucous membranes, and central nervous system were reported. Some enumeration and functional laboratory abnormalities, mainly of the lymphatic blood cells, were observed, although no statistically significant differences were found. IgE or IgG fungi-specific antibodies, used as exposure markers, were positive in less than 25% of all tested cases. In an evaluation of a symptomatic girl 11 years of age (sentinel case investigation) living in an apartment with verified toxigenic fungi (i.e., S. chartarum), several health indicators showed improvement after exposure cessation.
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Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremityThis clinical review will describe the epidemiology, clinical presentation, and management of the following work-related musculoskeletal disorders (WMSDs) of the distal upper extremity: deQuervain's disease, extensor and flexor forearm tendinitis/tendinosis, lateral and medial epicondylitis, cubital tunnel syndrome, and hand-arm vibration syndrome (HAVS). These conditions were selected for review either because they were among the most common WMSDs among patients attending the New York State Occupational Health Clinics (NYSOHC) network, or because there is strong evidence for work-relatedness in the clinical literature. Work-related carpal tunnel syndrome is discussed in an accompanying paper. In an attempt to provide evidence-based treatment recommendations, literature searches on the treatment of each condition were conducted via Medline for the years 1985-1999. There was a dearth of studies evaluating the efficacy of specific clinical treatments and ergonomic interventions for WMSDs. Therefore, many of the treatment recommendations presented here are based on a consensus of experienced public health-oriented occupational medicine physicians from the NYSOHC network after review of the pertinent literature. A summary table of the clinical features of the disorders is presented as a reference resource.
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Lower socioeconomic status among men in relation to the association between job strain and blood pressureObjectives: This study attempted to determine whether the association between job strain (high job demands plus low job control) and blood pressure among men varies by socioeconomic status. Methods: The cross-sectional associations between job strain and ambulatory blood pressure, by level of education, occupational status, and income, and the interaction between job strain and these measures of socioeconomic status were assessed by multiple linear regression, adjusted for age, race or ethnicity, body mass index, alcohol use, smoking, standing position, and worksite for 283 men, aged 30-60 years, from eight worksites in New York City. Results: A substantial association between job strain and work ambulatory blood pressure was found among men with lower socioeconomic status, ranging from 2.7-11.8 mm Hg systolic to 1.9-6.1 mm Hg diastolic blood pressure, depending upon the measure of socioeconomic status examined. However, in the groups with high socioeconomic status, the association between job strain and ambulatory blood pressure at work was much smaller, the range in blood pressure being 0-5.3 (systolic) and 0.2-2.1 (diastolic) mm Hg. Two of the 10 tests of the interaction between job strain and socioeconomic status had a P-value of <0.05. Conclusions: These data provide evidence that the relationship between job strain and blood pressure is greater among men with lower socioeconomic status. PubMed Disclaimer
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Is job strain a major source of cardiovascular disease risk?Empirical studies on job strain and cardiovascular disease (CVD), their internal validity, and the likely direction of biases were examined. The 17 longitudinal studies had the highest validity ratings. In all but two, biases towards the null dominated. Eight, including several of the largest, showed significant positive results; three had positive, nonsignificant findings. Six of nine case-control studies had significant positive findings; recall bias leading to overestimation appears to be fairly minimal. Four of eight cross-sectional studies had significant positive results. Men showed strong, consistent evidence of an association between exposure to job strain and CVD. The data of the women were more sparse and less consistent, but, as for the men, most of the studies probably underestimated existing effects. Other elements of causal inference, particularly biological plausibility, corroborated that job strain is a major CVD risk factor. Additional intervention studies are needed to examine the impact of ameliorating job strain upon CVD-related outcomes.