Women's subjective and objective health over time : the role of psychosocial conditions and physiological stress responses

Today, health problems are likely to have a complex and multifactorial etiology, whereby psychosocial factors interact with behaviour and bodily responses. Women generally report more health problems than men. The present thesis concerns the development of women’s health from a subjective and objective perspective, as related to psychosocial living conditions and physiological stress responses. Both cross-sectional and longitudinal studies were carried out on a representative sample of women. Data analysis was based on a holistic person-oriented approach as well as a variable approach. In Study I, the women’s self-reported symptoms and diseases as well as self-rated general health status were compared to physician-rated health problems and ratings of the general health of the women, based on medical examinations. The findings showed that physicians rated twice as many women as having poor health compared to the ratings of the women themselves. Moreover, the symptom ”a sense of powerlessness” had the highest predictive power for self-rated general health. Study II investigated individual and structural stability in symptom profiles between adolescence and middle-age as related to pubertal timing. There was individual stability in symptom reporting for nearly thirty years, although the effect of pubertal timing on symptom reporting did not extend into middle-age. Study III explored the longitudinal and current influence of socioeconomic and psychosocial factors on women’s self-reported health. Contemporary factors such as job strain, low income, financial worries, and double exposure in terms of high job strain and heavy domestic responsibilities increased the risk for poor self-reported health in middle-aged women. In Study IV, the association between self-reported symptoms and physiological stress responses was investigated. Results revealed that higher levels of medically unexplained symptoms were related to higher levels of cortisol, cholesterol, and heart rate. The empirical findings are discussed in relation to existing models of stress and health, such as the demand-control model, the allostatic load model, the biopsychosocial model, and the multiple role hypothesis. It was concluded that women’s health problems could be reduced if their overall life circumstances were improved. The practical implications of this might include a redesign of the labour market giving women more influence and control over their lives, both at and away from work.

The evolution of health status and chronic conditions in Catalonia, 1994-2006: the paradox of health revisited using the Blinder - Oaxaca decomposition

[EN] Background: The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006. Methods: Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied. Results: Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect. Conclusions: The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions.

Estimating the prevalence of comorbid conditions and their effect on health care costs in patients with diabetes mellitus in Switzerland.

BACKGROUND Estimating the prevalence of comorbidities and their associated costs in patients with diabetes is fundamental to optimizing health care management. This study assesses the prevalence and health care costs of comorbid conditions among patients with diabetes compared with patients without diabetes. Distinguishing potentially diabetes- and nondiabetes-related comorbidities in patients with diabetes, we also determined the most frequent chronic conditions and estimated their effect on costs across different health care settings in Switzerland. METHODS Using health care claims data from 2011, we calculated the prevalence and average health care costs of comorbidities among patients with and without diabetes in inpatient and outpatient settings. Patients with diabetes and comorbid conditions were identified using pharmacy-based cost groups. Generalized linear models with negative binomial distribution were used to analyze the effect of comorbidities on health care costs. RESULTS A total of 932,612 persons, including 50,751 patients with diabetes, were enrolled. The most frequent potentially diabetes- and nondiabetes-related comorbidities in patients older than 64 years were cardiovascular diseases (91%), rheumatologic conditions (55%), and hyperlipidemia (53%). The mean total health care costs for diabetes patients varied substantially by comorbidity status (US$3,203-$14,223). Patients with diabetes and more than two comorbidities incurred US$10,584 higher total costs than patients without comorbidity. Costs were significantly higher in patients with diabetes and comorbid cardiovascular disease (US$4,788), hyperlipidemia (US$2,163), hyperacidity disorders (US$8,753), and pain (US$8,324) compared with in those without the given disease. CONCLUSION Comorbidities in patients with diabetes are highly prevalent and have substantial consequences for medical expenditures. Interestingly, hyperacidity disorders and pain were the most costly conditions. Our findings highlight the importance of developing strategies that meet the needs of patients with diabetes and comorbidities. Integrated diabetes care such as used in the Chronic Care Model may represent a useful strategy.

New systems of management to improve the health and welfare of rabbits in farm conditions = Nuevos sistemas de cría y manejo para mejorar la salud y bienestar de conejos de granja

El objetivo general de esta Tesis Doctoral fue evaluar nuevos sistemas de alojamiento y cría de conejos de granja, estudiando tanto parámetros comportamentales (experimento 1) como productivos y reproductivos (experimento 3). Además, se evaluaron diferentes técnicas de muestreo con el fin de optimizar el tiempo empleado para el estudio del comportamiento animal (experimento 2). En el experimento 1, se estudió el comportamiento de conejas alojadas en dos tipos de jaulas (TJ), convencionales vs. alternativas con una plataforma elevada, en distintos estados fisiológicos (EF), lactantes y gestantes. Se observó el comportamiento de 12 conejas reproductoras con grabaciones de una duración de 24 h continuas. Independientemente del EF y TJ, las conejas pasaron gran parte de su tiempo sobre el reposapatas (57,7 %, de media). Sin embargo, debido al uso de la plataforma (23,0% del tiempo, de media), las conejas lactantes permanecieron un 36,6 % menos de tiempo (P<0,001) sobre el reposapatas y las gestantes un 27,0% menos (P<0,001) sobre el enrejillado en jaulas alternativas que en convencionales. En las jaulas alternativas, las conejas podían adoptar la postura “levantada”, sin embargo ésta fue observada solamente en conejas gestantes una media de 4,6 veces al día. Las conejas bebieron con mas frecuencia en jaulas convencionales que en alternativas (24,6 vs 19,1 veces al día; P<0,05). Se observó una mayor duración y frecuencia del comportamiento “interactuando con compañeras” en conejas gestantes alojadas en jaulas convencionales (276 s/d y 4,6 veces/d; P<0,05). La frecuencia de “interactuando con gazapos” fue menor en jaulas alternativas que en convencionales (2,4 vs 8,6 veces al día; P<0,01). La hora del día afectó al comportamiento de las conejas, teniendo un comportamiento menos activo durante las horas centrales del día. Durante las horas de oscuridad, las conejas estuvieron más inquietas realizando comportamientos como ‘encabritarse’ o amamantar, coincidiendo éstos en el tiempo en el cual las conejas pasaron más tiempo en la plataforma. Las conejas utilizaron frecuentemente la plataforma, independientemente del estado fisiológico. En la fase de lactación, las conejas utilizaron la plataforma para huir de los intentos de mamar por parte de los gazapos cuando éstas no estaban receptivas. El uso de la plataforma puede dar lugar a problemas higiénicos debidos tanto por la acumulación de heces sobre ella como por la caída de heces y orina sobre los animales que están en la parte inferior. La ausencia de estereotipias por parte de las conejas tanto en jaulas alternativas como en convencionales no sugiere una falta de bienestar debida al sistema de alojamiento. En el experimento 2, se compararon distintos métodos de observación simplificada con respecto un método de referencia usando grabaciones continuas de 24 h para la evaluación del comportamiento de conejas en distintos estados fisiológicos (gestantes y lactantes) alojadas en dos tipos de jaulas (convencionales y alternativas). Se analizaron un total de 576 h de grabaciones continuas de 24 h en 12 conejas reproductoras al final del periodo de lactación y en las mismas conejas después del destete. Los comportamientos observados se clasificaron en tres categorías independientes (localización en la jaula, postura y comportamientos funcionales). Se utilizaron grabaciones continuas de 24 h como método de referencia para validar otros cuatro métodos de observación simplificados, utilizando grabaciones de distinta duración y frecuencia a lo largo del día. Métodos regulares: corto y largo con 2.4 y 8 h de observación respectivamente, y métodos irregulares: corto y largo con 6 y 8 h de observación, respectivamente. Como resultado, se observó que independientemente del sistema de alojamiento, el mejor método para reducir el tiempo de observación necesario para evaluar el comportamiento de conejas reproductoras depende del tipo de variable a estudiar y del estado fisiológico de las conejas. En gestantes, los métodos irregulares no fueron adecuados para estimar comportamientos de larga duración tales como tumbada, sentada, descansando y acicalándose. Sin embargo, en ambos estados fisiológicos, los métodos regulares fueron precisos para los comportamientos de los grupos localización y postura y para comportamientos funcionales de larga duración. Por otro lado, los coeficientes de variación de los comportamientos poco frecuentes realizados principalmente durante el periodo de oscuridad fueron muy altos, y el método irregular largo obtuvo los menores errores de estimación para éstos comportamientos. En el experimento 3, se estudió el efecto de un uso combinado de lactaciones largas (hasta 46 días) con jaulas alternativas sobre los parámetros productivos y reproductivos de 104 conejas y sus camadas durante cinco ciclos reproductivos. La mitad de las conejas fueron alojadas en jaulas polivalentes convencionales (39 cm x 100 cm x 30 cm) y la otra mitad en jaulas polivalentes alternativas (39 cm x 100 cm x 60 cm), con una plataforma elevada. Dentro de cada grupo de alojamiento, la mitad de las conejas se destetaron a 32 días y la otra mitad a 46 días tras el parto. Las lactaciones más largas afectaron negativamente al peso (P<0,001), contenido en grasa y energía (P<0,05) de las conejas al final del periodo de lactación, pero éste efecto disminuyó con el número de partos. La fertilidad, prolificidad y la mortalidad de las conejas no fue afectada por la duración de la lactación. El destete tardío dio lugar a un mayor tamaño y peso de la camada al final del periodo de crecimiento (8,9 y 11,3 %, respectivamente) y a un menor índice de conversión por jaula durante el todo el periodo experimental (13,5 %) con respecto al destete convencional (P<0,001). Éstos resultados fueron paralelos a la menor mortalidad global (12,6 vs 17,6 %; P<0,05) observada en gazapos con destete tardío. Las diferencias en los parámetros productivos con las distintas edades al destete sólo fueron observadas en los ciclos con peor estado sanitario (tercer y quinto ciclo), en los cuales el destete tardío redujo la mortalidad. El tipo de jaula no afectó al peso de la coneja, condición corporal, mortalidad, fertilidad ni tamaño de camada durante los cinco primeros ciclos reproductivos. Sin embargo, el peso de la camada y el índice de conversión a los 21 días de edad fueron 4,2% mayor (P<0,001) y 5,0% menor (P<0,005) en animales alojados en jaulas alternativas que en jaulas convencionales. A día 59 las jaulas alternativas dieron lugar a camadas más pesadas (P<0,01); sin embargo, éste efecto fue influenciado por la densidad alcanzada en cada ciclo, ya que cuando la densidad de los animales fue menor que 40kg/m2 (tercer y quinto ciclo), el efecto del tipo de jaula sobre el peso de la camada no fue significativo. De los resultados obtenidos se puede concluir que el uso combinado de lactaciones más largas y jaulas con mayor superficie disponible con una plataforma elevada podría ser una alternativa para mejorar el bienestar animal en determinadas situaciones productivas. ABSTRACT The general aim of this PhD Thesis was to evaluate new housing and husbandry systems of farmed rabbits, studying behavioral (experiment 1), productive and reproductive (experiment 3) parameters. Moreover, different sampling techniques were evaluated in order to optimize the assessment of rabbit behaviour (experiment 2). In experiment 1, the behaviour of rabbit does housed in two different types of cage (TC), conventional vs. alternative with an elevated platform, at different physiological stages (PS), lactation and gestation was to study. Behavioural observations were carried out on 12 commercial rabbit does using continuous 24 hour video recording. Independently of PS and TC, rabbit does spent most of their time on foot mats (57.7 %, as average). However, due to the use of platforms (23.0% of time, as average), lactating does spent 36.6% less time (P<0.001) on foot mats and gestating does spent 27.0% less (P<0.001) time on wire mesh in alternative cages than in conventional cages. Alternative cages allowed for standing posture but this behaviour was only observed in gestating does (4.6 times a day, as average). Frequency of drinking was higher in conventional than in alternative cages (24.6 vs. 19.1 times a day; P<0.05). Gestating does housed in conventional cages reached the highest duration and frequency of interacting with neighbours (276 s/d and 4.6 times/d; P<0.05). The frequency of interacting with kits was lower in alternative than in conventional cages (2.4 vs. 8.6 times a day; P<0.01). Does’ behaviour was influenced by hour of day, being less active at the midday hours. During dark hours rabbit does more frequently performed restless behaviour such as hyperactivity or nursing, matching the time at which rabbit does spent more time on the platform. The platform was frequently used by rabbit does, independent of their physiological state, and during late lactation phase, when mothers were not receptive to nursing, does housed in alternative cages used the platform as a mean to flee from kids trying to suckle. The use of the platform might lead to hygienic problems due to retained faeces on the platform and faeces and urine falling onto animals located in the lower part of the cage. Stereotypies were not observed in any housing system, therefore conventional cages do not suggest lack of animal welfare. In experiment 2, it was compared the results of different simplified sampling methods of behavioural data with respect to reference records of 24-h in order to assess rabbit does behaviours at different physiological stages (gestation and lactation) in animals housed in two types of cages (conventional and alternative). A total of 576 h of continuous video of 12 rabbit does at the end of lactation and on the same females after weaning were analysed. The behavioural observations were studied using three independent categories of classification (location in the cage, posture and functional behaviours). Continuous behavioural recordings of 24 h were considered as the reference method to validate another 4 sampling methods of data collection by aggregated video recordings of different frequency and duration (regular short and long methods with 2.4 and 8 h of observation respectively, and irregular short and long methods with 6 and 8 h of observation, respectively). The current results showed that, independently of housing system, the best method to reduce the total observation time required to assess rabbit does behaviour depends on the trait studied and physiological stage of does. In gestating does, irregular methods were not suitable to estimate behaviours of long duration such as lying, sitting, resting and grooming. However, in both physiological stages, regular methods were accurate for location behaviours, postures and functional behaviours of long duration. Instead, for the study of infrequent behaviours performed mainly during dark period, where coefficients of variation were high, the irregular long method led to the lowest mean estimation errors. In experiment 3, the effects of the combined use of long lactation periods (46 days) with alternative cages on the reproductive and growth performance of 104 rabbit does and their litters during five consecutive reproductive cycles were studied. Half of does were housed in conventional polyvalent cages (39 cm x 100 cm x 30 cm) and the other half in alternative polyvalent cages (39 cm x 100 cm x 60 cm), with a raised platform. Half of the rabbit does in each type of cages were weaned at 32 and the other half at 46 days after parturition. Longer lactations affected negatively to body weight (P<0.001), fat and energy content (P<0.05) of rabbit does at the end of the lactation period, but this effect decreased with the number of parturitions. Fertility, prolificacy and doe mortality were not affected by lactation length. Late weaning led to higher litter size (by 8.9 %) and litter weight (by 11.3 %) at the end of growing period and lower feed conversion ratio per cage during the overall experimental period (13.5 %) than standard weaning (P<0.001). These results were parallels to a lower mortality (12.6 vs 17.6 %; P<0.05) of young rabbit weaned later during the overall experimental period. Differences in performances at different weaning ages were only observed during cycles with worst health status (third and fifth cycles) in which late weaning decreased mortality. Type of cage did not affect doe body weight and body condition, mortality, fertility, prolificacy and litter size during the five firsts reproductive cycles. Nevertheless, at day 21 litter weight and feed conversion ratio were 4.2 % higher (P<0.001) and 5.0 % lower (P<0.005) in animals housed in alternative than in conventional cages. Alternative cages also led to heavier litters at 59 days (P<0.01); however, this effect was influenced by density reached in each cycle, as when the density of animals was lower than 40 kg/m2 (cycles three and five), the difference of litter weight between alternative and conventional cages was not significant. From the results obtained it can be concluded that the combined use of longer lactations and cages with higher available surface with a raised platform could be an alternative to improve animal welfare in some productive situations.

Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review

Introduction: Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010. Methods: A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes. Results: Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more exposed to noise and worked longer hours than women did. Conclusions: This systematic review has identified a set of working and employment conditions as determinants of gender inequalities in occupational health from the occupational health literature. These results may be useful to policy makers seeking to reduce gender inequalities in occupational health, and to researchers wishing to analyse these determinants in greater depth.

From the boom to the crisis: changes in employment conditions of immigrants in Spain and their effects on mental health

Background: Migrant workers have been one of the groups most affected by the economic crisis. This study evaluates the influence of changes in employment conditions on the incidence of poor mental health of immigrant workers in Spain, after a period of 3 years, in context of economic crisis. Methods: Follow-up survey was conducted at two time points, 2008 and 2011, with a reference population of 318 workers from Colombia, Ecuador, Morocco and Romania residing in Spain. Individuals from this population who reported good mental health in the 2008 survey (n = 214) were interviewed again in 2011 to evaluate their mental health status and the effects of their different employment situations since 2008 by calculating crude and adjusted odds ratios (aORs) for sociodemographic and employment characteristics. Findings: There was an increased risk of poor mental health in workers who lost their jobs (aOR = 3.62, 95%CI: 1.64–7.96), whose number of working hours increased (aOR = 2.35, 95%CI: 1.02–5.44), whose monthly income decreased (aOR = 2.75, 95%CI: 1.08–7.00) or who remained within the low-income bracket. This was also the case for people whose legal status (permission for working and residing in Spain) was temporary or permanent compared with those with Spanish nationality (aOR = 3.32, 95%CI: 1.15–9.58) or illegal (aOR = 17.34, 95%CI: 1.96–153.23). In contrast, a decreased risk was observed among those who attained their registration under Spanish Social Security system (aOR = 0.10, 95%CI: 0.02–0.48). Conclusion: There was an increase in poor mental health among immigrant workers who experienced deterioration in their employment conditions, probably influenced by the economic crisis.

Manufacture of china and earthware. Report to Her Majesty's principal Secretary of State for the Home Department on the conditions of labour in potteries, the injurious effects upon the health of the workpeople, and the proposed remedies.

Mode of access: Internet.

Hygiene or health as depending upon the conditions of the atmosphere, foods and drinks, motion and rest, sleep and wakefulness... /

Mode of access: Internet.

Human science, or, Phrenology : its principles, proofs, faculties, organs, temperaments, combinations, conditions, teachings, philosophies, etc., etc. : as applied to health, its values, laws, functions, organs, means, preservation, restoration, etc. : mental philosophy, human and self improvement, civilization, home, country, commerce, rights, duties, ethics, etc. : God, His existence, attributes, laws, worship, natural theology, etc. : immortality, its evidences, conditions, relations to time, rewards, punishments, sin, faith, prayer, etc. : intellect, memory, juvenile and self education, literature, mental discipline, the senses, sciences, arts, avocations, a perfect life, etc., etc., etc. /

Mode of access: Internet.