Jocelyne Moisan

Reliability and validity of the French version of the 18-item Karasek job content questionnaire

Abstract Previous studies have shown that job strain, a combination of high psychological demands and low decision latitude, may be involved in the development of cardiovascular diseases and other health outcomes. In 1985, Karasek recommended a standard questionnaire to measure psychological demands (nine items) and job decision latitude (nine items). The internal consistency, factorial validity, discriminant validity, and 1-year stability of the French version of this instrument were evaluated in a population of 8263 white collar workers. Participants filled out the questionnaire during working hours in the context of a larger cardiovascular study. A subgroup of the study population completed the questionnaire again 1 year later (n = 953). Internal consistency was adequate: .74 for men and .73 for women for psychological demands and .83 for men and .81 for women for decision latitude. The results of the factor analysis were consistent with the two dimensions expected from the theory, although some items ...

Psychosocial factors at work, smoking, sedentary behavior, and body mass index: a prevalence study among 6995 white collar workers.

This cross-sectional study examined whether psychosocial factors at work were associated with smoking, sedentary behavior, and body mass index. The study population was composed of 3531 men and 3464 women employed as white collar workers in 21 organizations. Data were collected at worksites. Psychological demands and decision latitude at work were measured with the Karasek 18-item questionnaire. Smoking, sedentary behavior, and mean body mass index were compared by quartiles of decision latitude and psychological demands and by job strain categories. Prevalence of smoking, mean number of cigarettes smoked per day, prevalence of sedentary behavior, and mean body mass index were not consistently associated with decision latitude, psychological demands, or high job strain. However, prevalence of smoking was elevated in women belonging to the highest quartile of psychological demands (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0 to 1.6) and in the active job strain groups in both men (OR, 1.6; 95% CI, 1.2 to 2.1) and women (OR, 1.4; 95% CI, 1.0 to 2.0). Prevalence of sedentary behavior was elevated in men in the lowest quartile of decision latitude (OR, 1.3; 95% CI, 1.0 to 1.7), in the passive group (OR, 1.3; 95% CI, 1.0 to 1.5), and in the high strain group (OR, 1.2; 95% CI, 1.0 to 1.6). In women, this prevalence was elevated in the third quartile of psychological demand (OR, 1.3; 95% CI, 1.1 to 1.6). These results provide only partial support for an association between some psychosocial factors at work and the prevalence of smoking and sedentary behavior.

Effects of Job Strain on Blood Pressure: A Prospective Study of Male and Female White-Collar Workers

OBJECTIVES We evaluated whether cumulative exposure to job strain increases blood pressure. METHODS A prospective study of 8395 white-collar workers was initiated during 1991 to 1993. At follow-up, 7.5 years later, 84% of the participants were reassessed to estimate cumulative exposure to job strain. RESULTS Compared with men who had never been exposed, men with cumulative exposure and those who became exposed during follow-up showed significant systolic blood pressure increments of 1.8 mm Hg (95% confidence interval [CI]=0.1, 3.5) and 1.5 mm Hg (95% CI=0.2, 2.8), respectively, and relative risks of blood pressure increases in the highest quintile group of 1.33 (95% CI = 1.01, 1.76) and 1.40 (95% CI = 1.14, 1.73). Effect magnitudes were smaller among women. Effects tended to be more pronounced among men and women with low levels of social support at work. CONCLUSIONS Among these white-collar workers, exposure to cumulative job strain had a modest but significant effect on systolic blood pressure among men. The risk was of comparable magnitude to that observed for age and sedentary behavior. Men and women with low levels of social support at work appeared to be at higher risk for increases in blood pressure.

Effect of family responsibilities and job strain on ambulatory blood pressure among white-collar women.

OBJECTIVE This study was conducted to determine whether large family responsibilities and their combination with high job strain were associated with an increase in ambulatory blood pressure (BP) among white-collar women. METHODS A cross-sectional study was conducted in a stratified random sample of 199 white-collar women with or without children who were employed full time in jobs involving high or low strain. These women were selected from a population of 3183 women of all ages, employed in eight organizations in Quebec City, Canada. Subjects wore an ambulatory BP monitor for 24 hours during a working day. Mean BPs were calculated. Different measures of family responsibilities were used, based on the number of children and their ages, and domestic work. Job strain was measured using the Job Content Questionnaire recommended by Karasek. RESULTS Family responsibility measures were significantly related to diurnal BP among women holding a university degree (N=69). Indeed, women having large family responsibilities had increases in systolic and diastolic BPs of 2.7 to 5.7/1.8 to 4.0 mm Hg (p< or =.05). Among women holding a university degree, increases in diurnal systolic and diastolic BPs reached 8.1 to 10.9/5.5 to 7.1 mm Hg (p< or =.01) among women having both large family responsibilities and high job strain. These results were independent of confounders. There was no significant association among women without a university degree (N=130). CONCLUSIONS Large family responsibilities were associated with significant increases in diurnal systolic and diastolic BPs among white-collar women holding a university degree. In these women, the combined exposure of large family responsibilities and high job strain tended to have a greater effect on BP than the exposure to only one of these factors.

Potentially inappropriate prescriptions for older patients in long-term care

BackgroundInappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs) in long-term care in metropolitan Quebec.MethodsA cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs.ResultsAlmost all residents (94.0%) were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7%) of treated patients had a potentially inappropriate prescription (PIP). Most common PIPs were drug interactions (33.9% of treated patients), followed by potentially inappropriate duration (23.6%), potentially inappropriate medication (14.7%) and potentially inappropriate dosage (9.6%). PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication). The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43) and with the length of stay (OR: 1.78, CI: 1.43 – 2.20). On the other hand, the risk of receiving a PIP decreased with age.ConclusionPotentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

Dietary and Physical Determinants of Menarche

Age at menarche shows a downward secular trend and differs according to socioeconomic conditions, presumably the result of dietary variations. We report two studies conducted in Quebec City in which the relation between diet and menarche was evaluated. In 1978–1980, baseline information for these studies was obtained on girls aged 9 through 15 and included body weight, height, fatfold thickness at six sites, percent of body fat (derived from underwater weighing), and a 3-day dietary record. In a cross-sectional study of 207 girls aged 11 through 15, we compared dietary patterns between premenarcheal and menarcheal girls using logistic regression. In a 6-year follow-up study of 109 girls who had not experienced menarche at the baseline data collection, the relation between time of occurrence of menarche and dietary patterns was assessed using proportional hazards models. The results confirm the association between body weight and age at menarche. Body fat, however, was not strongly related to the onset of menstruation. In both studies, a higher dietary energy intake was associated with an earlier age at menarche. Dietary composition, and dietary fat in particular, was not related to menarche

Determinants of discontinuation of new courses of antihypertensive medications.

Discontinuation of medication use constitutes a major barrier to adequate control of high blood pressure. We examined the effect of an array of potential predisposing, enabling and reinforcing factors on the discontinuation of newly prescribed antihypertensive medications. We conducted a prospective cohort study through a network of 173 pharmacies across Canada where were identified individuals newly prescribed an antihypertensive monotherapy. We interviewed participants by telephone four times to obtain information for a minimum duration of 18 months after entry into the cohort. We analyzed data using a multivariate proportional hazard model. Of 682 eligible participants, 43.3% had discontinued their initial medication at the end of the observation period. Individuals more likely to discontinue their initial medication were those who perceived side effects from this medication [Hazard Ratio (HR) = 1.91; 95% Confidence Interval (CI) 1.47-2.47). Individuals with medication insurance coverage were less likely to discontinue (HR = 0.74; 95% CI 0.55-0.99). Persistence with newly prescribed medications could be improved by selecting antihypertensive medications containing fewer side effects and by lifting economic barriers to drug treatment.

Non-compliance with drug treatment and reading difficulties with regard to prescription labelling among seniors

Background: The link between experiencing difficulties in reading or understanding and non-compliance with drug treatment among seniors is not clearly established. Objectives: We measured the effect of both difficulties in reading, as well as difficulties in understanding prescription labelling, on non-compliance with drug treatments among seniors. Since the use of a pill organizer prepared by a pharmacist may compensate for the problems in reading, we also checked the potential modifying effect of the use of a pill organizer on these two associations. Method: Data on non-compliance with drug treatment, comprehension of prescription labelling and on the factors potentially linked to non-compliance, were collected during face-to-face interviews with 325 seniors. Results: In all, 126 respondents (38.8%) were not able to read all the prescription labels and 218 (67.1%) did not fully understand all the information. 153 respondents were non-compliant with their drug treatment. After adjusting for sex, age, living alone or not, having had help with taking the medication, use of a pill organizer, having had sufficient funds to procure his medicine during the previous month, belief in the efficacy of his medication, perception of his state of health, satisfaction with physician-given and pharmacist-given information, as well as the complexity of the treatment, the two associations remained statistically non-significant. The use of a pill organizer was not a modifying factor. Conclusion: Our results did not demonstrate the existence, among seniors, of an association between non-compliance and difficulty in reading and understanding prescription labelling.

Burden of Diabetes on the Ability to Work: A systematic review

Type 2 diabetes is an increasingly common disease (1) that places a considerable economic burden on society. An estimated 171 million people were suffering from diabetes in 2000, and this number could total 366 million by 2030 (1). Type 2 diabetes accounts for more than 90% of all diabetes cases, and it often appears in middle age (2). In 2010, the prevalence of diabetes in the U.S. was 11.3 and 26.9% among individuals aged 20 years or over and 65 years or older (2), respectively. In 2007, costs related to diabetes in the U.S. were an estimated

Leisure physical activity and age at menarche.

174 billion;