Purpose: To test whether combined information on job strain (JS) and on effort–reward imbalance (... more Purpose: To test whether combined information on job strain (JS) and on effort–reward imbalance (ERI) helps to improve the prediction of coronary risk. Methods: 2099 male participants in the baseline screening of the prospective Swedish Work Organization, Lipids, and Fibrinogen (WOLF) study underwent a clinical screening assessing bodyweight, blood lipids, and blood pressure and answered a standardized questionnaire measuring the psychosocial work environment, socio-demographic variables, and behavioral factors (i.e. smoking, physical activity). Associations between job strain, effort–reward imbalance and coronary risk factors (i.e. hypertension, elevated blood lipids) were tested. Results: Findings from multivariate logistic regression analysis showed the highest odd-ratios (OR) for men simultaneously exposed to the extrinsic component of effort–reward imbalance and to job strain. OR were 2.03 (95% confidence interval (CI) 1.18–3.49) for hypertension and 1.53 for low-density-lipopr...
Scandinavian Journal of Work, Environment & Health
Associations between shift work, chronic psychosocial work stress, and 2 important cardiovascular... more Associations between shift work, chronic psychosocial work stress, and 2 important cardiovascular risk factors, hypertension and atherogenic lipids were studied. The hypothesis was tested that psychosocial work stress, as defined by the model of effort-reward imbalance, mediates the effects of shift work on cardiovascular risk. Altogether 2288 male participants aged 30-55 years in the baseline screening of the Swedish WOLF (work organization, lipids, and fibrinogen) study underwent a clinical examination and answered a standardized questionnaire measuring shiftwork schedules, effort-reward imbalance at work, and health-adverse behavior. In addition to the direct effects of shift work on cardiovascular risk, mediating effects of effort-reward imbalance at work were found. The respective odds ratios (OR) ranged from 2.18 to 2.27 for hypertension and from 1.34 to 1.45 for atherogenic lipids. While the effects remained significant after extensive confounder control concerning hypertensi...
To examine associations between measures of work stress (that is, the combination of high effort ... more To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors. Cross sectional first screening of a prospective cohort study. The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427). Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/...
International Archives of Occupational and Environmental Health
The objective of this study was to investigate the validity of the effort-reward imbalance (ERI) ... more The objective of this study was to investigate the validity of the effort-reward imbalance (ERI) model in relation to disturbed sleep and fatigue. The study population derived from a subset of the WOLF (WOrk, Lipids, Fibrinogen) cohort study of cardiovascular risk in a working population who replied to the ERI-questionnaire comprising 789 men and 214 women. Cox regression analysis was used to calculate the prevalence ratio (PR) for sleep disorders and fatigue in relation to the components of ERI. As sleep disturbances and fatigue, based on literature, were defined to be represented by the uppermost quintile, 14% of the men and 23% of the women were affected by sleep disturbances while 14 and 26%, respectively, were affected by fatigue. Higher levels of exposure for the ERI components were associated with increased prevalence of sleep disturbances and fatigue. For men, the strongest association was seen between high overcommitment and fatigue (PR 5.77, 95% confidence interval 2.89-11...
Journal of Epidemiology and Community Health, 2000
STUDY OBJECTIVEThe debate on health inequalities has shifted from the consequences of occupationa... more STUDY OBJECTIVEThe debate on health inequalities has shifted from the consequences of occupational position, as expressed in the Registrar General's classification, to consequences of material living conditions. This change in interest occurred without comparative analyses of different sources of health inequalities. Thus this study investigated the relative contribution of “material resources” (income), “qualification” and “occupational position” for explaining social differentials
To investigate the relationship between physical activity and two measures of fall incidence in a... more To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches. Prospective cohort study with one-year follow-up of falls using fall calendars. Physical activity was defined as walking duration and recorded at baseline over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Average daily physical activity was extracted from these data and categorized in low (0-59 min), medium (60-119 min) and high (120 min and more) activity. The ActiFE Ulm study located in Ulm and adjacent regions in Southern Germany. 1,214 community-dwelling older people (≥65 years, 56.4% men). Negative-binomial regression models were used to calculate fall rates and incidence rate ratios for each activity category each with using (1) person-years and (2) hours walked as denominators stratified by gender, age group, f...
The objective of this study was to investigate whether occupational gender segregation moderates ... more The objective of this study was to investigate whether occupational gender segregation moderates the association between job stress in terms of effort-reward imbalance and the risk of myocardial infarction. This analysis was conducted in 1,381 cases and 1,697 referents of the Swedish SHEEP case control study aged 45-70 years. Information on myocardial infarction and biological coronary risk factors (e.g. hypertension, blood lipids) was achieved from clinical screenings. Information on sociodemographic variables, effort-reward imbalance, behavioral coronary risk factors (e.g., smoking), and additional coronary risk factors (e.g., diabetes, family history of coronary heart disease) was derived from well-tested standardized questionnaires. After adjustment for confounders the strongest association between overcommitment (the intrinsic component of effort-reward imbalance) and risk of belonging to the myocardial infarction group was found among women in male-dominated jobs (odds ratio [OR] = 2.71, 95% CI = 1.13-6.52) as compared to the remaining group (OR = 1.52, 95% CI = 1.01-2.31). Moreover, a significant interaction between pronounced overcommitment and male domination in relation to myocardial infarction was observed among women (OR = 2.44, 95% CI = 1. 05-5.67). In men, an association between the ratio of effort and reward (the extrinsic component of the model) and risk of myocardial infarction was found for the majority, that is the group not working in women-dominated jobs (OR = 1.39, 95% CI = 1.04-1.86). Despite methodological limitations, this study gives preliminary evidence of a moderating effect of occupational gender segregation on the association of effort-reward imbalance (i.e., the intrinsic model component overcommitment) with acute myocardial infarction risk among women, but not among men.
INTRODUCTION: In globally orientated working world stress is of rising importance as a health ris... more INTRODUCTION: In globally orientated working world stress is of rising importance as a health risk. ERI (effort-reward-imbalance) is a well-tested work-related stress model with three components: While an imbalance between its extrinsic components 'efforts' and 'rewards' leads to strain reactions 'work-related overcommitment' (WOC) has been described as a certain personal characteristic with a set of attitudes, behaviors and emotions reflecting excessive striving combined with a strong desire for approval. However, one question concerning WOC has not been well addressed in the literature: Is WOC a trait alone or prone to a changing working environment? METHODS: In this exploratory longitudinal data analysis of the prospective WOLF (WOrk, Lipids, Fibrinogen) cohort study 2940 employees were analyzed with multiple linear regression analysis. A change of WOC index or his subscales was regressed against a change of occupational decision latitude, extra work or wo...
International journal of occupational and environmental health
The effort-reward imbalance (ERI) model was used to analyze burnout and intention to leave the nu... more The effort-reward imbalance (ERI) model was used to analyze burnout and intention to leave the nursing profession (ITL) in nurses (n = 21,229) in seven European countries, as part of the NEXT-Study. Data were gathered using the short form of the ERI questionnaire. Burnout was assessed using the Copenhagen Burnout Inventory. Multivariate logistic regression analysis controlled for age and gender. ERI was very high in Poland, Germany, Italy, and Slovakia. High ERI was associated with burnout. Odds ratios (ORs) ranged from 2.6 to 13.2 for ERI and from 3.0 to 5.5 for overcommitment (OC). Nurses with high ERI also had high ORs for ITL (2.6-5.7). The association of OC and ITL was weaker (1.1-1.7). The strong and consistent associations of ERI model results with psychological health and with ITL support the relevance of the model for examining different outcome levels. Nurses in transitional countries, as expected, experienced high ERI. High ERI in stable countries suggests that their econ...
Several tests of physical performance like gait speed or standing balance are part of the geriatr... more Several tests of physical performance like gait speed or standing balance are part of the geriatric assessment. Measures of physical activity like daily walking duration are more difficult to assess but may be of higher relevance for daily requirements. It is therefore of interest to what extent physical performance measures are associated with physical activity. In a cohort study, baseline screening was performed in 1271 community-living people aged 65-90 years from Ulm, Germany. Average daily walking duration was assessed in all participants by accelerometers over a one-week period. Habitual gait speed, 5-Chair-Rise test, standing balance and handgrip strength served as measures of physical performance. The association between measures of physical performance and physical activity was calculated by linear regression analysis. The mean daily walking duration was 104.8 minutes in men and 103.0 minutes in women. A positive relationship between gait speed and walking duration was obse...
N-terminal pro B-type natriuretic peptide (NT-proBNP) has strong prognostic value for all-cause m... more N-terminal pro B-type natriuretic peptide (NT-proBNP) has strong prognostic value for all-cause mortality in the general population. High-sensitivity assays now allow detection of cardiac troponins even in asymptomatic populations. We examined the association between NT-proBNP, high-sensitivity cardiac troponin T (hs-cTnT), and hs-cTnI and all-cause mortality in older adults. We conducted a longitudinal cohort study [Activity and Function in the Elderly in Ulm (ActiFE Ulm)] including 1506 community-dwelling adults ≥65 years old with NT-proBNP, hs-cTnT, and hs-cTnI measured at baseline. We evaluated the associations between log-transformed biomarker concentrations and 4-year total mortality, accounting for possible confounders, with Cox proportional hazards models. We observed 125 deaths among 1422 participants (median follow-up 4 years). We detected effect modification by sex for all biomarkers (all P values <0.05) expressed as hazard ratio (HR) for death per 1-unit increment of ...
Journal of epidemiology and community health, Jan 6, 2015
To analyse the seasonal relationship of objectively measured physical activity with vitamin D sta... more To analyse the seasonal relationship of objectively measured physical activity with vitamin D status in older persons from Southern Germany (latitude: 48.4°N). Physical activity was assessed in 1193 community-dwelling individuals aged ≥65 years (58% men) over 1 week using a thigh-worn accelerometer. Furthermore, the 25-hydroxyvitamin D (25(OH)D) level was measured. Least-square means of 25(OH)D serum levels were calculated for quartiles of average daily walking duration stratified by season and adjusted for gender, age and body mass index. Participants with prescribed vitamin D supplements were excluded. Statistically significant linear associations between quartiles of walking duration with 25(OH)D serum levels were observed in all seasons but not in summer. Differences in 25(OH)D serum levels between the first and the last quartile were 3.42 ng/mL (p=0.002) in winter, 2.80 ng/mL (p=0.009) in spring, and 3.60 ng/mL (p<0.001) in the fall. The proportion of vitamin D insufficiency...
Our objective was to investigate the associations of vitamin D serum levels with dementia and cog... more Our objective was to investigate the associations of vitamin D serum levels with dementia and cognitive function in specific domains in community dwelling older adults. Between 2009 and 2010, we conducted a cross-sectional study in 1,373 individuals (56% men) aged 65+ years in the "Activity and Function in the Elderly in Ulm" (ActiFE) study. Dementia was defined as a Mini-Mental State Examination (MMSE) score ≤ 24. The 25-OHD serum level [ng/mL] was measured by an electrochemilumineszenz immunoassay (ECLIA). Logistic regression models were used to calculate odds ratios (OR)s for cognitive domains (cut-point: 10th percentile) by serum 25-OHD concentrations (both continuously and by cut-point of 20 ng/ml for vitamin D deficiency). Mean age of the study population was 75.6 (SD 6.6) years. We identified 75 participants (43% women) with dementia. 25-OHD concentrations were significantly lower in the participants with dementia compared to persons with a MMSE score >24. We als...
Research into the associations between work, age, and health and the impact of these associations... more Research into the associations between work, age, and health and the impact of these associations on employment status has focused on health as a crucial determinant of staying on the job. In our paper, we ask whether concentrating on health is still feasible, particularly when considering the change in demographics and the increasing proportion of older people in the workplace. We introduce a theoretical model describing health as a variable that indirectly influences leaving employment. According to our model, the immediate decision to leave employment is due to work motivation and work ability. These two factors may require intervention activities different from those needed to improve health. Our model explains employment participation as a result of complex associations between work, socioeconomic status, lifestyle, and health especially with work ability and work motivation. The complexity of these processes should be considered in studies by conducting longitudinal investigations like the German lidA study (http://www.lida-studie.de). If the model is verified in scientific studies like lidA, it can be used as a basis for preventive and intervening activities in practice, i.e., in politics, enterprises, and science.
It is not unusual for old data to be used in epidemiological studies. Recently developed instrume... more It is not unusual for old data to be used in epidemiological studies. Recently developed instruments for measuring work-related stress did not exist when the data collection was carried out. Therefore, approximate questions are sometimes used. An apparent problem is the lack of validation of proxy questions. The aim of this study was to compare the original questions for measuring
This study tests associations between stressful working conditions in terms of eort-reward imbala... more This study tests associations between stressful working conditions in terms of eort-reward imbalance and reported physical symptoms in public transport workers. We hypothesize that bus-and subway drivers suer from relatively highest level of ill health as compared to repair service workers and administrative personnel, and that a substantial part of this association is due to the imbalance experienced between high eort and low reward. 1337 employees participated in the present study. Measures of eort-reward imbalance were constructed from a large battery of standardized Likert-scaled items, and factor-based symptom scales were computed.
This study investigated the eects of the Job Demand-Control (JD-C) Model and the Eort-Reward Imba... more This study investigated the eects of the Job Demand-Control (JD-C) Model and the Eort-Reward Imbalance (ERI) Model on employee well-being. A cross-sectional survey was conducted comprising a large representative sample of 11,636 employed Dutch men and women. Logistic regression analyses were used.
Using comparative data from five countries, this study investigates the psychometric properties o... more Using comparative data from five countries, this study investigates the psychometric properties of the effort-reward imbalance (ERI) at work model. In this model, chronic work-related stress is identified as non-reciprocity or imbalance between high efforts spent and low rewards received. Health-adverse effects of this imbalance were documented in several prospective and cross-sectional investigations. The internal consistency, discriminant validity and factorial structure of 'effort', 'reward', and 'overcommitment' scales are evaluated, using confirmatory factor analysis. Moreover, content (or external) validity is explored with respect to a measure of self-reported health.
Purpose: To test whether combined information on job strain (JS) and on effort–reward imbalance (... more Purpose: To test whether combined information on job strain (JS) and on effort–reward imbalance (ERI) helps to improve the prediction of coronary risk. Methods: 2099 male participants in the baseline screening of the prospective Swedish Work Organization, Lipids, and Fibrinogen (WOLF) study underwent a clinical screening assessing bodyweight, blood lipids, and blood pressure and answered a standardized questionnaire measuring the psychosocial work environment, socio-demographic variables, and behavioral factors (i.e. smoking, physical activity). Associations between job strain, effort–reward imbalance and coronary risk factors (i.e. hypertension, elevated blood lipids) were tested. Results: Findings from multivariate logistic regression analysis showed the highest odd-ratios (OR) for men simultaneously exposed to the extrinsic component of effort–reward imbalance and to job strain. OR were 2.03 (95% confidence interval (CI) 1.18–3.49) for hypertension and 1.53 for low-density-lipopr...
Scandinavian Journal of Work, Environment & Health
Associations between shift work, chronic psychosocial work stress, and 2 important cardiovascular... more Associations between shift work, chronic psychosocial work stress, and 2 important cardiovascular risk factors, hypertension and atherogenic lipids were studied. The hypothesis was tested that psychosocial work stress, as defined by the model of effort-reward imbalance, mediates the effects of shift work on cardiovascular risk. Altogether 2288 male participants aged 30-55 years in the baseline screening of the Swedish WOLF (work organization, lipids, and fibrinogen) study underwent a clinical examination and answered a standardized questionnaire measuring shiftwork schedules, effort-reward imbalance at work, and health-adverse behavior. In addition to the direct effects of shift work on cardiovascular risk, mediating effects of effort-reward imbalance at work were found. The respective odds ratios (OR) ranged from 2.18 to 2.27 for hypertension and from 1.34 to 1.45 for atherogenic lipids. While the effects remained significant after extensive confounder control concerning hypertensi...
To examine associations between measures of work stress (that is, the combination of high effort ... more To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors. Cross sectional first screening of a prospective cohort study. The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427). Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/...
International Archives of Occupational and Environmental Health
The objective of this study was to investigate the validity of the effort-reward imbalance (ERI) ... more The objective of this study was to investigate the validity of the effort-reward imbalance (ERI) model in relation to disturbed sleep and fatigue. The study population derived from a subset of the WOLF (WOrk, Lipids, Fibrinogen) cohort study of cardiovascular risk in a working population who replied to the ERI-questionnaire comprising 789 men and 214 women. Cox regression analysis was used to calculate the prevalence ratio (PR) for sleep disorders and fatigue in relation to the components of ERI. As sleep disturbances and fatigue, based on literature, were defined to be represented by the uppermost quintile, 14% of the men and 23% of the women were affected by sleep disturbances while 14 and 26%, respectively, were affected by fatigue. Higher levels of exposure for the ERI components were associated with increased prevalence of sleep disturbances and fatigue. For men, the strongest association was seen between high overcommitment and fatigue (PR 5.77, 95% confidence interval 2.89-11...
Journal of Epidemiology and Community Health, 2000
STUDY OBJECTIVEThe debate on health inequalities has shifted from the consequences of occupationa... more STUDY OBJECTIVEThe debate on health inequalities has shifted from the consequences of occupational position, as expressed in the Registrar General's classification, to consequences of material living conditions. This change in interest occurred without comparative analyses of different sources of health inequalities. Thus this study investigated the relative contribution of “material resources” (income), “qualification” and “occupational position” for explaining social differentials
To investigate the relationship between physical activity and two measures of fall incidence in a... more To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches. Prospective cohort study with one-year follow-up of falls using fall calendars. Physical activity was defined as walking duration and recorded at baseline over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Average daily physical activity was extracted from these data and categorized in low (0-59 min), medium (60-119 min) and high (120 min and more) activity. The ActiFE Ulm study located in Ulm and adjacent regions in Southern Germany. 1,214 community-dwelling older people (≥65 years, 56.4% men). Negative-binomial regression models were used to calculate fall rates and incidence rate ratios for each activity category each with using (1) person-years and (2) hours walked as denominators stratified by gender, age group, f...
The objective of this study was to investigate whether occupational gender segregation moderates ... more The objective of this study was to investigate whether occupational gender segregation moderates the association between job stress in terms of effort-reward imbalance and the risk of myocardial infarction. This analysis was conducted in 1,381 cases and 1,697 referents of the Swedish SHEEP case control study aged 45-70 years. Information on myocardial infarction and biological coronary risk factors (e.g. hypertension, blood lipids) was achieved from clinical screenings. Information on sociodemographic variables, effort-reward imbalance, behavioral coronary risk factors (e.g., smoking), and additional coronary risk factors (e.g., diabetes, family history of coronary heart disease) was derived from well-tested standardized questionnaires. After adjustment for confounders the strongest association between overcommitment (the intrinsic component of effort-reward imbalance) and risk of belonging to the myocardial infarction group was found among women in male-dominated jobs (odds ratio [OR] = 2.71, 95% CI = 1.13-6.52) as compared to the remaining group (OR = 1.52, 95% CI = 1.01-2.31). Moreover, a significant interaction between pronounced overcommitment and male domination in relation to myocardial infarction was observed among women (OR = 2.44, 95% CI = 1. 05-5.67). In men, an association between the ratio of effort and reward (the extrinsic component of the model) and risk of myocardial infarction was found for the majority, that is the group not working in women-dominated jobs (OR = 1.39, 95% CI = 1.04-1.86). Despite methodological limitations, this study gives preliminary evidence of a moderating effect of occupational gender segregation on the association of effort-reward imbalance (i.e., the intrinsic model component overcommitment) with acute myocardial infarction risk among women, but not among men.
INTRODUCTION: In globally orientated working world stress is of rising importance as a health ris... more INTRODUCTION: In globally orientated working world stress is of rising importance as a health risk. ERI (effort-reward-imbalance) is a well-tested work-related stress model with three components: While an imbalance between its extrinsic components 'efforts' and 'rewards' leads to strain reactions 'work-related overcommitment' (WOC) has been described as a certain personal characteristic with a set of attitudes, behaviors and emotions reflecting excessive striving combined with a strong desire for approval. However, one question concerning WOC has not been well addressed in the literature: Is WOC a trait alone or prone to a changing working environment? METHODS: In this exploratory longitudinal data analysis of the prospective WOLF (WOrk, Lipids, Fibrinogen) cohort study 2940 employees were analyzed with multiple linear regression analysis. A change of WOC index or his subscales was regressed against a change of occupational decision latitude, extra work or wo...
International journal of occupational and environmental health
The effort-reward imbalance (ERI) model was used to analyze burnout and intention to leave the nu... more The effort-reward imbalance (ERI) model was used to analyze burnout and intention to leave the nursing profession (ITL) in nurses (n = 21,229) in seven European countries, as part of the NEXT-Study. Data were gathered using the short form of the ERI questionnaire. Burnout was assessed using the Copenhagen Burnout Inventory. Multivariate logistic regression analysis controlled for age and gender. ERI was very high in Poland, Germany, Italy, and Slovakia. High ERI was associated with burnout. Odds ratios (ORs) ranged from 2.6 to 13.2 for ERI and from 3.0 to 5.5 for overcommitment (OC). Nurses with high ERI also had high ORs for ITL (2.6-5.7). The association of OC and ITL was weaker (1.1-1.7). The strong and consistent associations of ERI model results with psychological health and with ITL support the relevance of the model for examining different outcome levels. Nurses in transitional countries, as expected, experienced high ERI. High ERI in stable countries suggests that their econ...
Several tests of physical performance like gait speed or standing balance are part of the geriatr... more Several tests of physical performance like gait speed or standing balance are part of the geriatric assessment. Measures of physical activity like daily walking duration are more difficult to assess but may be of higher relevance for daily requirements. It is therefore of interest to what extent physical performance measures are associated with physical activity. In a cohort study, baseline screening was performed in 1271 community-living people aged 65-90 years from Ulm, Germany. Average daily walking duration was assessed in all participants by accelerometers over a one-week period. Habitual gait speed, 5-Chair-Rise test, standing balance and handgrip strength served as measures of physical performance. The association between measures of physical performance and physical activity was calculated by linear regression analysis. The mean daily walking duration was 104.8 minutes in men and 103.0 minutes in women. A positive relationship between gait speed and walking duration was obse...
N-terminal pro B-type natriuretic peptide (NT-proBNP) has strong prognostic value for all-cause m... more N-terminal pro B-type natriuretic peptide (NT-proBNP) has strong prognostic value for all-cause mortality in the general population. High-sensitivity assays now allow detection of cardiac troponins even in asymptomatic populations. We examined the association between NT-proBNP, high-sensitivity cardiac troponin T (hs-cTnT), and hs-cTnI and all-cause mortality in older adults. We conducted a longitudinal cohort study [Activity and Function in the Elderly in Ulm (ActiFE Ulm)] including 1506 community-dwelling adults ≥65 years old with NT-proBNP, hs-cTnT, and hs-cTnI measured at baseline. We evaluated the associations between log-transformed biomarker concentrations and 4-year total mortality, accounting for possible confounders, with Cox proportional hazards models. We observed 125 deaths among 1422 participants (median follow-up 4 years). We detected effect modification by sex for all biomarkers (all P values <0.05) expressed as hazard ratio (HR) for death per 1-unit increment of ...
Journal of epidemiology and community health, Jan 6, 2015
To analyse the seasonal relationship of objectively measured physical activity with vitamin D sta... more To analyse the seasonal relationship of objectively measured physical activity with vitamin D status in older persons from Southern Germany (latitude: 48.4°N). Physical activity was assessed in 1193 community-dwelling individuals aged ≥65 years (58% men) over 1 week using a thigh-worn accelerometer. Furthermore, the 25-hydroxyvitamin D (25(OH)D) level was measured. Least-square means of 25(OH)D serum levels were calculated for quartiles of average daily walking duration stratified by season and adjusted for gender, age and body mass index. Participants with prescribed vitamin D supplements were excluded. Statistically significant linear associations between quartiles of walking duration with 25(OH)D serum levels were observed in all seasons but not in summer. Differences in 25(OH)D serum levels between the first and the last quartile were 3.42 ng/mL (p=0.002) in winter, 2.80 ng/mL (p=0.009) in spring, and 3.60 ng/mL (p<0.001) in the fall. The proportion of vitamin D insufficiency...
Our objective was to investigate the associations of vitamin D serum levels with dementia and cog... more Our objective was to investigate the associations of vitamin D serum levels with dementia and cognitive function in specific domains in community dwelling older adults. Between 2009 and 2010, we conducted a cross-sectional study in 1,373 individuals (56% men) aged 65+ years in the "Activity and Function in the Elderly in Ulm" (ActiFE) study. Dementia was defined as a Mini-Mental State Examination (MMSE) score ≤ 24. The 25-OHD serum level [ng/mL] was measured by an electrochemilumineszenz immunoassay (ECLIA). Logistic regression models were used to calculate odds ratios (OR)s for cognitive domains (cut-point: 10th percentile) by serum 25-OHD concentrations (both continuously and by cut-point of 20 ng/ml for vitamin D deficiency). Mean age of the study population was 75.6 (SD 6.6) years. We identified 75 participants (43% women) with dementia. 25-OHD concentrations were significantly lower in the participants with dementia compared to persons with a MMSE score >24. We als...
Research into the associations between work, age, and health and the impact of these associations... more Research into the associations between work, age, and health and the impact of these associations on employment status has focused on health as a crucial determinant of staying on the job. In our paper, we ask whether concentrating on health is still feasible, particularly when considering the change in demographics and the increasing proportion of older people in the workplace. We introduce a theoretical model describing health as a variable that indirectly influences leaving employment. According to our model, the immediate decision to leave employment is due to work motivation and work ability. These two factors may require intervention activities different from those needed to improve health. Our model explains employment participation as a result of complex associations between work, socioeconomic status, lifestyle, and health especially with work ability and work motivation. The complexity of these processes should be considered in studies by conducting longitudinal investigations like the German lidA study (http://www.lida-studie.de). If the model is verified in scientific studies like lidA, it can be used as a basis for preventive and intervening activities in practice, i.e., in politics, enterprises, and science.
It is not unusual for old data to be used in epidemiological studies. Recently developed instrume... more It is not unusual for old data to be used in epidemiological studies. Recently developed instruments for measuring work-related stress did not exist when the data collection was carried out. Therefore, approximate questions are sometimes used. An apparent problem is the lack of validation of proxy questions. The aim of this study was to compare the original questions for measuring
This study tests associations between stressful working conditions in terms of eort-reward imbala... more This study tests associations between stressful working conditions in terms of eort-reward imbalance and reported physical symptoms in public transport workers. We hypothesize that bus-and subway drivers suer from relatively highest level of ill health as compared to repair service workers and administrative personnel, and that a substantial part of this association is due to the imbalance experienced between high eort and low reward. 1337 employees participated in the present study. Measures of eort-reward imbalance were constructed from a large battery of standardized Likert-scaled items, and factor-based symptom scales were computed.
This study investigated the eects of the Job Demand-Control (JD-C) Model and the Eort-Reward Imba... more This study investigated the eects of the Job Demand-Control (JD-C) Model and the Eort-Reward Imbalance (ERI) Model on employee well-being. A cross-sectional survey was conducted comprising a large representative sample of 11,636 employed Dutch men and women. Logistic regression analyses were used.
Using comparative data from five countries, this study investigates the psychometric properties o... more Using comparative data from five countries, this study investigates the psychometric properties of the effort-reward imbalance (ERI) at work model. In this model, chronic work-related stress is identified as non-reciprocity or imbalance between high efforts spent and low rewards received. Health-adverse effects of this imbalance were documented in several prospective and cross-sectional investigations. The internal consistency, discriminant validity and factorial structure of 'effort', 'reward', and 'overcommitment' scales are evaluated, using confirmatory factor analysis. Moreover, content (or external) validity is explored with respect to a measure of self-reported health.
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Papers by Richard Peter