[Gender as a key effect modifier of the relationship between physician work stressors and the acquired cardiovascular disorders]

The relationship between occupational stress, health status, and temporary and permanent work disability among security guards in Serbia

Purpose. This study aimed to examine the influence of occupational stress on health status and work disability among security guards in Serbia. Methods. Three hundred and ninty nine male security guards (aged 25-65 years) were examined during regular medical preventive check-ups at the Institute of Occupational Health. Data on their health status and permanent and temporary work disability were obtained, and correlations with the levels of occupational stress (measured by occupational stress index [OSI] questionnaire) were analysed. Results. A high prevalence of health impairments, including diabetes (38.8%), dyslipidaemia (82.7%), hypertension (69.9%) and metabolic syndrome (77.7%), was found. Highly significant correlations were shown between reported levels of total stress at work (total OSI score) and measured values of glucose, lipids, blood pressure, heart rate, Framingham cardiovascular risk scale, occurrence of diabetes and impaired fasting glucose, dyslipidaemia, hypertension, metabolic syndrome, coronary heart disease, cerebrovascular insults, degenerative eye-fundus changes, and temporary and permanent work disability. All of these correlations remained significant even after adjustments for age, body mass index and smoking status. Regression analysis confirmed the independent effect of occupational stress on the analysed parameters. Conclusions. There is a significant independent impact of occupational stress on development of health impairments and work disability among security guards.

Which health professionals are most at risk for cardiovascular disease? Or do not be a manager

OBJECTIVES

Health care workers constitute a high-risk occupational category owing to the character of their work that includes high-risk environment, shift work and mental as well as physical stress. In occupational medicine, caring for their health condition should be a priority and include measures aimed at preventing cardiovascular diseases. The study aimed at determining the prevalence of cardiovascular disease (CVD) risk factors in employees of a large hospital and assessing their effect on the incidence of cardiovascular events.

MATERIALS AND METHODS

The group comprised 3124 employees with a mean age of 36.1 years (SD = 11.4), out of whom 562 were males (mean age of 37.1 years, range: 18-72; SD = 12.26) and 2562 were females (mean age of 35.9 years, range: 18-68; SD = 11.24). At their initial examination, the employees filled in a questionnaire on basic CVD risk factors (according to valid recommendations). This was supplemented with objective data to determine the risk of CVD using valid charts. From this group, a subset of persons at a high or intermediate risk was selected, comprising 247 individuals with a mean age of 54.1 years (SD = 5.73). After 5-9 years (mean 7.24±1.38 years), they either underwent another examination or their health status was ascertained by phone or in a computer database. The end point was the incidence of cardiovascular events (sudden death, acute myocardial infarction, unstable angina pectoris, percutaneous coronary intervention, cardiac failure, stroke or transient ischemic attack).

RESULTS

The end point was noted in a total of 15 males (6.07%) and 6 females (2.42%), being statistically significantly present in managers (males p < 0.00007, females p < 0.00001), male physicians/surgeons (p < 0.025), tertiary-educated males (p < 0.0095), female smokers (p < 0.015), male ex-smokers (p < 0.007), overweight or obese males (p < 0.02) and those with the waist-to-hip ratio above 1.0 (p < 0.005).

CONCLUSIONS

Cardiovascular events are most likely to occur in obese male physicians/surgeons holding managerial positions and in female managers.

Stigmatization of a person visiting psychiatrist depends on observer's gender

Introduction. The two types of stigmatization are social stigma, which includes discrimination, underestimation and distance in various social circumstances and personal stigma, which includes private relation i.e. a contact in person with stigmatized subject. Majority of recent publications has shown gender asymmetry in stigmatization (mostly indicating male predominance in stigmatizing processes), whereas the opposite data can be also found in some publications. The present study was aimed at exploring the relation of students' gender with their tendency to stigmatize subjects visiting a psychiatrist and at analyzing whether the gender influences the process of stigmatization. Material and methods. The survey included 523 students (227 on the second and 296 on the sixth year of School of Medicine, University of Belgrade). The instrument consisted of a vignette with questionnaire (14 items). Four versions of vignette were distributed: with/without 'label' and male/female subject in the vignette. Results. A more personal stigmatization was evident in the female students (p<0.05), while no gender-differences existed in social stigmatization (p>0.05). The stigmatization positively correlated with the intimacy of student's relation with the subject going to a psychiatrist. A higher rate of stigmatization was evident if the vignette was showing a person of the opposite gender. Discussion and conclusion. This is a unique study which analyzes separately the gender of a stigmatizing subject versus the subject being stigmatized and types of stigmatization. The data obtained should contribute to recognizing, understanding and controlling the widespread problem of stigma.

[Work stressors among physicians with and without the acquired cardiovascular disorders: assessment using the Occupational Stress Index]

The Occupational Stress Index (OSI) questionnaire for physicians was used in a case-control study, with a high participation rate (> 90%). The study was carried out among physicians employed at clinical institutions in Novi Sad, receiving their medical care at the health center situated within the Novi Sad clinical center. The cases were physicians with one or more of the acquired (potentially stress-related) cardiovascular disorders (ACVD) (myocardial infarction, angina pectoris, arterial hypertension and certain arrhythmias). The control group included physicians without manifest ACVD. Two OSI dimensions: high demands (p < 0.05) and threat avoidance (p < 0.05) were dominant in showing significantly higher exposure levels among the cases. The most consistent and significant stressors that distinguished the physicians with ACVD from the referents were long work hours, speed-up and threat of job loss. Personality patterns were not associated with case status. Physicians are a heavily burdened occupational group, and several occupational stressors are significantly associated with case status. Improvements in working conditions as well as early diagnosis are essential for preventing further increases in these disorders among physicians. The next step would be multidisciplinary intervention studies aimed at the work environment, with the goal of identifying scientifically-based strategies that are most effective in preventing ACVD among physicians.