Workplace harassment, active coping, and alcohol-related outcomes.

PURPOSE: While sexual harassment and generalized workplace abuse (GWA) have been linked with alcohol use and abuse, active problem-focused coping has been shown to lessen vulnerability to deleterious mental health consequences of varied social stressors. At the same time, active coping is relatively more efficacious in response to stressors, which are amenable to change by personal actions. However, the moderating role that coping plays in relation to harassment and drinking is unknown. METHOD: Using data from a two-wave survey of university employees (N=2038), we addressed the extent to which (1) active coping was utilized by harassed and abused employees, (2) whether coping impacted on the continuation or cessation of harassment and abuse, and (3) the extent to which nonsuccessful coping was predictive of alcohol use and abuse. RESULTS: Active coping had no significant impact on the ability to end harassing or abusive experiences. Moreover, the use of problem-focused coping that was unsuccessful predicted some drinking outcomes for both men and women, controlling for Wave I drinking and sociodemographic characteristics. IMPLICATIONS: The data suggest that increased institutional attention to the prevention of workplace harassment and abuse might impact on decreasing alcohol use and abuse.

Training-related harassment and drinking outcomes in medical residents versus graduate students.

This study examined the prevalence of sexual harassment and generalized workplace abuse, and their differential effects on drinking behaviors in medical residents and graduate students at an urban American university. While medical residents had greater odds of experiencing harassment and abuse in their training programs, it was found that in most cases their deleterious drinking behaviors decreased, whereas graduate student drinking behaviors increased as a consequence of these experiences. The drinking outcomes of men were more affected by harassment and abuse than those of women.

Feminist perspectives on the social construction of chronic fatigue syndrome.

We contrast Western medical views of chronic fatigue syndrome (CFS) etiology, diagnosis, and treatment with views maintained by a predominantly female CFS population. We argue that the failure of Western medicine to demonstrate a viral etiology for CFS led to a paradigmatic shift in research perspectives, which then embraced psychiatric and sociocultural explanations for CFS. As a result, CFS was delegitimized as a biomedical phenomenon within medical, academic, governmental, and public arenas. We compare alternative social constructions of CFS with issues pertaining to multiple sclerosis (MS), an illness that similarly predominates among women. Patient perspectives suggest that the history of medical attitudes toward CFS may eventually parallel the transformations that occurred in relation to MS. In particular, the discovery of biological markers for CFS may lay to rest the categorization of CFS as largely within the psychiatric realm.

Sexual identity and alcohol-related outcomes: contributions of workplace harassment.

PURPOSE: While workplace sexual harassment has received a great deal of attention in both the popular media and scientific literature, less attention has been directed to the differential occurrence of sexual harassment among lesbians, gay men, and heterosexual men and women, and the relationships between these experiences and alcohol-related outcomes. Additionally, the distribution of alcohol-related outcomes of non-sexual forms of workplace harassment among these groups have not been adequately explored. METHOD: Using data from a university-based study of workplace harassment and alcohol use (N = 2492), we focus on exposure to workplace harassment and alcohol-related outcomes for lesbians, gay men, and bisexuals compared to heterosexual men and women. RESULTS: Lesbian/bisexual women did not differ significantly from heterosexual women in their experiences of workplace harassment. However, stronger linkages between harassment and increased alcohol consumption and problems were found for lesbian and bisexual women than for heterosexual women. Gay/bisexual men, on the other hand, experienced significantly more sexual harassment than heterosexual men, but did not report a corresponding increase in alcohol use and abuse. IMPLICATIONS: Implications for future research on sexual identity, alcohol use, and workplace harassment are discussed.

Chronicity of sexual harassment and generalized work-place abuse: effects on drinking outcomes.

AIMS: This study examined the impact of two forms of interpersonal conflict in the work-place, sexual harassment (SH) and generalized work-place abuse (GWA), on drinking outcomes. We hypothesized that SH and GWA would be associated more strongly with negative outcomes than task-related work stressors, especially when SH and GWA were chronic problems. DESIGN: This was a two-wave panel study. SETTING: The study was conducted at an urban university in the United States. PARTICIPANTS: Participants were 2038 university employees in four occupational groups (faculty, student, clerical and service workers) who responded to both waves of the survey. MEASUREMENTS: Data on SH, GWA, task-related stressors and drinking outcomes were gathered from self-report mail questionnaires. Data from 1880 non-abstaining respondents were included in the analyses. FINDINGS: SH and GWA experiences were widespread, typically chronic, and tended to co-occur. In regression analyses controlling for demographics, occupational group, prior drinking and task-related stress, GWA chronicity was linked to increased odds of reporting one or more indicators of problem drinking at time 2, in contrast to onset and remission. SH chronicity coupled with no GWA experiences was also significantly related to increased drinking variability. Task-related stressors generally did not explain significant variance in drinking outcomes. CONCLUSIONS: SH and GWA may be better predictors of drinking behavior compared to task-related stressors, particularly when harassment is chronic. Increased attention to conflictual relationships in the work-place, the relationship between SH and GWA and the dynamic nature of stressors in general is necessary in future research on drinking behavior.

A community-based study of chronic fatigue syndrome.

BACKGROUND: Most previous estimates of the prevalence of chronic fatigue syndrome (CFS) have derived largely from treated populations, and have been biased by differential access to health care treatment linked with sex, ethnic identification, and socioeconomic status. OBJECTIVE: To assess the point prevalence of CFS in an ethnically diverse random community sample. DESIGN AND PARTICIPANTS: A sample of 28,673 adults in Chicago, Ill, was screened by telephone, and those with CFS-like symptoms were medically evaluated. MAIN OUTCOME MEASURES AND ANALYSES: Self-report questionnaires, psychiatric evaluations, and complete medical examinations with laboratory testing were used to diagnose patients with CFS. Univariate and multivariate statistical techniques were used to delineate the overall rate of CFS in this population, and its relative prevalence was subcategorized by sex, ethnic identification, age, and socioeconomic status. RESULTS: There was a 65.1% completion rate for the telephone interviews during the first phase of the study. Findings indicated that CFS occurs in about 0.42% (95% confidence interval, 0.29%-0.56%) of this random community-based sample. The highest levels of CFS were consistently found among women, minority groups, and persons with lower levels of education and occupational status. CONCLUSIONS: Chronic fatigue syndrome is a common chronic health condition, especially for women, occurring across ethnic groups. Earlier findings suggesting that CFS is a syndrome primarily affecting white, middle-class patients were not supported by our findings.

Sexual harassment and generalized workplace abuse among university employees: prevalence and mental health correlates.

OBJECTIVES: This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use. METHODS: Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n = 2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status. RESULTS: The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and abuse were significantly linked to most mental health outcomes for men and women. CONCLUSIONS: Interpersonally abusive workplace dynamics constitute a significant public health problem that merits increased intervention and prevention strategies.

A Community-based Study of Prolonged Fatigue and Chronic Fatigue.

Previous estimates of the prevalence of fatigue and chronic fatigue have derived largely from treated populations and have been biased by differential access to health-care treatment linked with gender, racial/ethnic and social class status. This study involves a community-based prevalence study of prolonged fatigue and chronic fatigue. It addresses: (1) the rate of prolonged fatigue and chronic fatigue in a socioeconomically and ethnically diverse sample of 28,673 adults in Chicago; and (2) establishes the relative prevalence of prolonged fatigue and chronic fatigue across race/ethnicity, socio-economic status and gender. Univariate and multivariate statistical techniques were utilized to delineate the overall rate of prolonged fatigue and chronic fatigue in the Chicago population and its relative prevalence by gender, race/ethnicity, and social class. Findings indicated that fatigue is common in urban populations, but that prolonged fatigue and chronic fatigue occur in about 5.00 to 7.68 percent and 2.72 to 4.17 percent, respectively, of the sample of the population. Highest levels of fatigue were consistently found among women and those with lower levels of education and occupational status.

Intramedullary pressure and pulmonary function during total knee arthroplasty.

Twenty-eight patients who underwent unilateral total knee arthroplasty and 20 patients who underwent simultaneous bilateral total knee arthroplasties participated in this study and were randomized to have either a fluted or round 10-mm diameter femoral intramedullary alignment rod used during surgery. The intramedullary rods were cannulated and connected with pressure tubing to a monitor which provided measurements of pressure at the tip of each rod. Arterial blood gas measurements on room air were obtained before and on the morning after surgery. An arterial line was placed and an arterial blood gas measurement was obtained at the time of skin incision and again after tourniquet release. Pulmonary shunt was calculated from the arterial blood gas measurements. Intramedullary pressure during rod insertion was significantly higher for the groups of patients having the round compared with the fluted rod. The change in pulmonary shunt during surgery was lowest for the patients in the unilateral group having the fluted rod and highest for the patients in the bilateral group having the round rod. A fluted rather than a round intramedullary alignment rod should be used to minimize intramedullary pressure and pulmonary shunting during unilateral and bilateral total knee arthroplasties.

Politics, science, and the emergence of a new disease. The case of chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) emerged as a diagnostic category during the last decade. Initial research suggested that CFS was a relatively rare disorder with a high level of psychiatric comorbidity. Many physicians minimized the seriousness of this disorder and also interpreted the syndrome as being equivalent to a psychiatric disorder. These attitudes had negative consequences for the treatment of CFS. By the mid-1990s, findings from more representative epidemiological studies indicated considerably higher CFS prevalence rates. However, the use of the revised CFS case definition might have produced heterogeneous patient groups, possibly including some patients with pure psychiatric disorders. Social scientists have the expertise to more precisely define this syndrome and to develop appropriate and sensitive research strategies for understanding this disease.

Postpartum depressive symptomatology in new mothers and fathers: parenting, work, and support.

Control and social gratification at work and in other social roles have been shown to be predictive of depression in general adult populations, yet the potential importance of these factors in the postpartum period has not been explored. This study examines the influence of self-reported social gratification, support, and control at work and in the parenting role on depressive symptomatology for both men and women in the postpartum period. A model including perceptions of control, social gratification, and support in these two life domains is tested at 6 months postpartum in a sample of 108 first-time parents. When this model is compared to a parallel model using information obtained 6 months before the birth, strong support for the increased significance of these variables in the postpartum period is found. The need to include work and role-related variables in a comprehensive stress-diathesis model of postpartum depression for both men and women is discussed.

Effect of total hip arthroplasty on cardiovascular fitness.

Thirty patients who underwent total hip arthroplasty and 18 patients with medically treated arthritis participated in this study. Both groups of patients underwent a cardiovascular fitness exercise test on entering the study and 6 months, 1 year, and 2 years later. Fitness was assessed by patient performance on a graded maximal exercise test using a bicycle ergometer and metabolic cart. In the group of total hip arthroplasty patients, significant improvements in exercise duration (P = .011), maximum workload (P = .0013), peak oxygen consumption (P = .0036), and percentage of predicted maximum oxygen uptake achieved (P = .0002) were observed during the follow-up evaluation. In the group of control patients, decreases in exercise duration (P = .0001), maximum workload (P = .0001), and workload at anaerobic threshold (P = .0108) occurred without a significant change in the other measures of cardiovascular fitness. The results indicate that resumption of routine physical activities after total hip arthroplasty is associated with a corresponding improvement in cardiovascular fitness.

Extended tibial tubercle osteotomy in total knee arthroplasty.

Thirty tibial tubercle osteotomies were performed to obtain exposure and facilitate patellar tracking in 29 patients who underwent total knee arthroplasty. The thickness and width of the bone fragment were gradually tapered from proximal to distal. Fixation was obtained with three or four titanium screws. Average follow-up period was 18 months. Twenty-nine of the osteotomies healed primarily. In one patient, postoperative displacement of the tibial tubercle developed requiring additional screw and suture fixation. Extended tibial tubercle osteotomy is a useful technique during difficult total knee arthroplasty. Poor tibial bone stock is a relative contraindication. The authors recommend that a long tapered bone fragment that is 1.5 to 2 cm thick at the level of the tibial tubercle be elevated and fixation achieved with screws.

Improvement in cardiovascular fitness after total knee arthroplasty.

Patients who have osteoarthrosis involving weight-bearing joints typically have a gradual decline in physical activity, which is often associated with cardiovascular deconditioning. After joint replacement, many patients resume routine walking and recreational activities, which may improve aerobic capacity. The purpose of the present study was to determine the effect of total knee arthroplasty on cardiovascular fitness. Nineteen patients who had had total knee arthroplasty (the arthroplasty group) performed an exercise test for cardiovascular fitness preoperatively. Sixteen of these patients were tested again at one year postoperatively and thirteen, at two years postoperatively. Sixteen patients in whom osteoarthrosis of the knee was being treated medically (the control group) were tested at the time of enrollment in the study and one year later. Nine of these patients also were tested two years after enrollment. All of the patients completed the Arthritis Impact-Measurement Scales (AIMS) at each examination. Fitness was assessed by the performance of a progressive maximum exercise test with use of a bicycle ergometer and a metabolic cart. All patients achieved the anaerobic threshold. One year postoperatively, the patients in the arthroplasty group demonstrated an increase, which approached significance, in maximum oxygen consumption (measured in milliliters of oxygen per minute) (p = 0.07), maximum oxygen consumption corrected for body weight (p = 0.08), and percentage of predicted maximum uptake of oxygen (p = 0.06). Two years after the total knee arthroplasty, the patients had a significant improvement with regard to all three parameters (p = 0.008, 0.005, and 0.005, respectively). The patients in the control group demonstrated a significant decrease in duration of exercise and in maximum workload at one year (p = 0.003 and 0.005, respectively) and at two years (p = 0.008 for both parameters). Physical activity had increased in the arthroplasty group but not in the control group, as demonstrated by the results of the Arthritis Impact-Measurement Scales. These findings demonstrate a trend toward improvement in cardiovascular fitness one year after total knee arthroplasty and a significant improvement two years postoperatively for patients who had been able to resume routine functional activities because of the arthroplasty. These improvements compared favorably with the static pattern or the decline in the measures of fitness that were observed in the control group. Our results should be considered preliminary because of the relatively small number of patients who were studied.

Perceived workplace harassment experiences and problem drinking among physicians: broadening the stress/alienation paradigm.

Sociologists who embrace the stress or alienation paradigms generally focus on explaining problem drinking in low status occupations. By contrast, this paper argues that a broadened conceptualization of stress and alienation which incorporates abusive work relationships has utility for explaining male and female drinking outcomes in both high and low status occupations. We provide empirical data on the relationship between perceived abusive experiences and drinking outcomes in a cohort of male and female physicians in their internship year of training. The data show that perceived sexual harassment, discriminatory treatment and psychological humiliation relate to various drinking outcomes in men and women, controlling for drinking prior to the internship year. While females were more likely to report experiencing abuse, these perceived experiences had deleterious effects on drinking outcomes for both genders. Personal vulnerability (narcissism) brought into the training environment somewhat influenced the later reporting of abusive experiences by males but not by females. Regression analyses showed that, for both males and females, work-place abusive experiences in interaction with personality vulnerability best explained drinking outcomes. The implications of these results for the design of future alcohol-related work-place studies are discussed.

Gender roles and alcohol abuse across the transition to parenthood.

OBJECTIVE: The transition to parenthood has been occurring within the context of the increasing labor force participation of women and potential stress-related costs of "nontraditional" as well as "traditional" gender role choices of new parents. This study addressed the extent to which gender role-related stressors lead to increased problem drinking across the transition to parenthood. METHOD: Fifty-five married couples expecting their first child were obtained from seven Chicago area hospitals and surveyed with a mailed questionnaire at two points in time: (1) during the second trimester of pregnancy and (2) at 6 months following childbirth. The study examined both wives' and husbands' changes in problem-related drinking by comparing problem drinking during the 6 months prior to pregnancy (retrospectively assessed at Time 1) with drinking during the 6 months following childbirth using a modified form of the Michigan Alcoholism Screening Test. In addition, the study contrasted problem drinkers with nonproblem drinkers following parenthood with regard to role overload (overwhelming demands from work and family roles), role deprivation (loss of work role following parenthood) and role deterioration (decreased support from role relationships). RESULTS: The data show increased problem drinking for both mothers and fathers but fail to support either role overload or role deprivation hypotheses. However, the data are congruent with the role deterioration perspective. CONCLUSIONS: If these findings are replicated, future studies of gender roles and alcohol abuse should focus greater attention on the perceived quality of social roles beyond noting their presence or absence.

Effects of social support on medical students' performances.

BACKGROUND: Stress among medical students has been linked to poor academic performance, while supportive social relationships have been associated with the alleviation of psychological stress. This study examines social support as a potential buffer against stress and hence as a potential strengthener of students' academic performances. METHOD: A cohort of 153 third-year students at the University of Illinois College of Medicine at Chicago was asked in the fall of 1990 to complete a questionnaire assessing role stress (stress involving competing demands between school and social and/or family life), social support, and sources of support (outside or inside medical school). Grades for the five major clerkships through which all the students rotated during their third year were collected from student transcripts. Statistical analyses of the relationships among academic performance, stress, and social support included factor analysis, hierarchical multiple-regression analysis, and Pearson correlational analysis. RESULTS: Data from 120 students (78% of the cohort) were used for correlational analysis. Of these students, 79 (66%) were men and 41 (34%) were women. Because eight of the questionnaires contained incomplete data, 112 questionnaires (73%) were used for multiple-regression analysis. No buffering effect was found for social support. Rather, social support from outside the medical school explained significant variance in academic performances and in role stress. Higher levels of outside support were associated with poorer clerkship grades for women, but with lower levels of stress for men. Also, total support (outside and inside combined) was negatively related to clerkship grades for the entire sample. CONCLUSION: The results suggest that contrary to the study's hypotheses, social support in general is related to lower levels of academic performance for both men and women, and that the negative effects of support from outside the medical school context may be particularly salient for women. These results are understandable given the nature of medical training, which places great demands on students' time. Therefore, it may be more appropriate for medical schools to promote time-management strategies than support-building interventions, especially for women.

Chronic fatigue syndrome: have flawed assumptions been derived from treatment-based studies?

Chronic fatigue syndrome is a disabling disorder that has been studied primarily in clinical settings. In the absence of an adequate epidemiological database, cultural stereotypes have influenced the characterization of chronic fatigue syndrome as "the yuppie flu," similar to the 19th century characterization of neurasthenia as a disease of the affluent. The limited epidemiological data available and the overall medical-sociological literature call this assumption into question. Only a community "true" prevalence study that is unbiased by help seeking and access to health care can provide an accurate assessment of the risk factors for and the public health ramifications of this disease.

Substance use and addiction among medical students, residents, and physicians.

When turning to our original questions, we offer the following tentative conclusions: 1. Although medical students as a group have a slightly higher percentage of use of alcohol, the pattern and prevalence of alcohol dependence is very consistent with their age mates in the general population. 2. There appears to be a pattern of increased alcohol problems with age among physicians and attorneys, as opposed to the general US population, which shows a diminution of alcohol-related problems over time. 3. There is no evidence for a marked increase in drug addiction and use of other prescription drugs among physicians. In fact, with the exception of tranquilizers and alcohol and psychedelics, which were used equally by physicians, medical students, residents, and their age mates, most other drug usage was slightly more prevalent in the general population than among students and residents. 4. Of particular concern is the finding of a lack of gender differences in problematic drinking with the pattern of female drinking rates for women approximating that of men by the end of medical school. 5. The most consistent predictive factor in alcoholism among physicians is the same as that in the general population: a family history of alcoholism. 6. Additional predictive factors of physician alcohol-related problems include a narcissistic type personality style that endorses the exploitation of others, a perception of low parental warmth in childhood, and particular stressors in the working or student environment such as being abused by others. Further predictive factors related to occupational stress await the results of ongoing perspective studies. 7. Physicians as a group probably respond more favorably to alcohol and drug addiction programs than do members of the general population. To a great extent, this is directly or indirectly due to the dire consequences of continued use, which include loss of hospital privileges and state licensure. It also would appear that required treatment and monitoring for alcohol and substance abuse has a positive effect on abstinence rates.