The roles of employment status and income in the mental health of informal caregivers in Germany.

BACKGROUND: Informal caregivers often experience multiple negative consequences as a result of the informal care they provide. Among other factors, employment status, financial resources, and mental health are related to informal caregiving. This analysis examined the association between informal caregivers' employment status and their mental health, as well as the moderating effect of net household income on this relationship. METHODS: The research question was addressed with data from the German Socio-Economic Panel (SOEP) survey, comprising 3,053 informal caregivers (1,007 male; 2,046 female). Data were obtained through self-reports, and mental health was measured with the Summary Scale Mental Score. Stepwise adjusted multiple linear regression models were used to examine the association between employment status and mental health. The moderating effects were tested with interaction terms. All analyses were also stratified for gender. RESULTS: Informal caregivers with full-time jobs reported better mental health than unemployed or marginally employed caregivers (ß = 0.077, p < 0.001). The significant interaction term for full-time (ß=-0.066, p = 0.001) and part-time workers (ß=-0.066, p = 0.003) indicated a moderating effect of net household income on the association between employment status and mental health. This finding was especially evident in women. CONCLUSIONS: Employment appears to be a relevant protective factor for informal caregivers' mental health. However, if informal caregivers are not employed, a low net household income might additionally restrict their mental health. Therefore, welfare policy structures must be created to reduce the negative financial consequences for informal caregivers and enable them to achieve work-life-care balance.

Associations of individual factors and early childhood education and care (ECEC) centres characteristics with preschoolers' BMI in Germany.

BACKGROUND: The number of obese children is rising worldwide. Many studies have investigated single determinants of children's body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI. METHODS: Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children's standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status. RESULTS: Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 - 25 children; B = -.54; p = 0.022 [ref.: < 20 children]), and the ratio of overweight children (more overweight children B = -1.39; p < 0.001 [ref.: few overweight children]). For girls the number of siblings (two and more siblings; B = .67; p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: < 20 children]) were related to SDS BMI. CONCLUSIONS: The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.

[Social Inequalities in Health and Health Behaviors among University Students]. / Sozialbedingte Ungleichheiten von Gesundheit und Gesundheitsverhalten bei Studierenden.

AIM OF THE STUDY: Disease prevention and health science research have focused increasingly on students in recent years. However, students are usually perceived as a homogeneous group. The aim of this article was to examine if there exist health inequalities among students. METHODS: A nationwide student survey, the so-called NuPhA study, was used to answer this question (n=689, 69.5% female, average age: 22.69 years). RESULTS AND CONCLUSIONS: We found that socio-economic indicators were associated with health and health behavior. For instance, being a scholarship holder was associated with a better general, mental, and physical health. In particular, subjective social status was positively associated with better general, mental, and physical health as well as higher physical activity. The results indicate that while students initially appeared to form a homogenous group, health inequalities exist among them. This suggests the need for a differentiated view on the student group and the importance of examining and explaining health inequalities among students in depth and to finally reduce them.

Associations of Changes in Organizational Justice with Job Attitudes and Health-Findings from a Prospective Study Using a Matching-Based Difference-in-Difference Approach.

BACKGROUND: Ample evidence indicates that unfairness at the workplace (organizational injustice) is associated with both job attitudes and health of employees. Several factors that influence these associations have been identified: e.g., personality traits, such as the Big Five traits, justice sensitivity, type of occupation (e.g., white-collar), and unobserved time-invariant factors. Previous studies only addressed parts of these issues, and the ideal research design to mitigate biases-an experiment with random assignment to a treatment and control group-is not feasible. This study therefore mimics a randomized experiment using two statistical techniques. METHODS: First, matching was implemented to balance the treatment and control group in confounding factors (demographics and personality) in two prospective waves (2012-2014) of observational data (4522 white-collar, 2984 blue-collar) taken from the Linked Personnel Panel, which is an employee survey representative for German private sector companies with more than 50 employees. Second, a difference-in-difference approach excludes unobserved time-invariant factors by estimating associations of changes in organizational justice (distributive, procedural, interactional) with job attitudes (job satisfaction, turnover intention) and health (general and mental) in these groups, separate for white- and blue-collar employees. RESULTS: A decrease in perceived justice was associated with lower job attitudes (less job satisfaction and higher turnover intentions), while an increase was associated with higher values. This pattern was found for white- and blue-collar workers and also for health indicators, with the latter, however, being less pronounced. CONCLUSIONS: Increased fairness at the workplace is related to better job attitudes and health for white- and blue-collar employees, independent of personality traits and unobserved time-invariant factors.

Ambivalence in the Early Years of Marriage: Impact on Ambulatory Blood Pressure and Relationship Processes.

BACKGROUND: Marriage is associated with lower cardiovascular morbidity and mortality, but quality matters. Marriages characterized by ambivalent behaviors (containing both highly positive and highly negative behaviors concurrently) may not confer the same cardiovascular benefits as characterized by purely positive behavior. Ambivalence is assumed to take time to develop but couples in the early years of marriage may already exhibit ambivalent behaviors and thus be at increased risk for future cardiovascular events. PURPOSE: The purpose of this study was to determine the frequency of spouse and own ambivalent behavior, the impact on interpersonal (i.e., responsiveness, disclosure, affective interactions) processes, and ambulatory blood pressure (ABP) in individuals in the early years of marriage. METHODS: In 84 young married couples, objective and subjective ambivalence, interpersonal functioning, and ABP over a 24-hr period were assessed. RESULTS: As predicted, ambivalence developed early in marriage. Regarding interpersonal processes, spousal and own objective ambivalent behavior was associated with lower spousal responsiveness (p < .01), disclosure (p < .05), and more negative (p < .03) and less positive interactions (p < .001). Physiologically, ambivalent spousal behavior was associated with higher systolic blood pressure (p = .02) and higher diastolic blood pressure (p = .04). Measures of subjective ambivalence were congruent. CONCLUSIONS: Early marriages already contain ambivalent behavior; in such cases, individuals may not receive the cardiovascular protection of a supportive marriage.

Associations of ambivalent leadership with distress and cortisol secretion.

Ambivalent social ties, i.e., whereby a relationship is evaluated simultaneously in positive and negative terms, are a potential source of distress and can perturb health-relevant biological functions. Social interactions at the workplace, in particular with supervisors, are often described in ambivalent terms, but the psychological and psychobiological impact of such interactions has received little scientific attention. The current study examined associations between ambivalent attitudes towards one's supervisor, perceived distress (general and work-related), and diurnal dynamics of the stress hormone cortisol. 613 employees evaluated their supervisor in terms of positive and negative behaviors, which was combined into an ambivalent index. Higher ambivalence was associated with higher perceived distress and work-related stress (p < .001), and with a larger cortisol awakening response and higher day-time secretion post-awakening (p < .01). The present study is the first to identify ambivalence towards supervisors as a predictor of employee distress and stress-related endocrine dysregulation. In consequence, focusing solely on positive or negative leader behavior may insufficiently capture the true complexity of workplace interactions and attempts to compensate negative behaviors with positive are unlikely to reduce distress-but quite the opposite-by increasing ambivalence.

Lack of supportive leadership behavior predicts suboptimal self-rated health independent of job strain after 10 years of follow-up: findings from the population-based MONICA/KORA study.

OBJECTIVES: Emerging cross-sectional research has identified lack of supportive leadership behavior (SLB) as a risk factor for workforce health. However, prospective evidence is hitherto lacking. SLB denotes support in difficult situations, recognition and feedback on work tasks. This study aims to determine the effect of SLB on suboptimal self-rated health (SRH) after 10 years considering potential moderators such as ages, sex, occupation and job strain. METHODS: The sample included 884 employed participants drawn from the population-based prospective MONICA/KORA Study. SLB, SRH, as well as job strain were assessed by questionnaire. Logistic regressions estimated odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the effect of SLB at baseline on suboptimal SRH at follow-up. Analyses were adjusted for age, gender, lifestyle (alcohol, smoking, physical activity), socioeconomic status as well as for SRH and job strain at baseline. RESULTS: Lack of SLB was associated with suboptimal SRH at baseline [OR 2.00, (95% CI 1.19-3.46)] and at follow-up [OR 2.33, (95% CI 1.40-3.89)]. Additional adjustment for job strain did not substantially alter this association [OR 2.06, (95% CI 1.20-3.52)]. However, interactions between SLB and job strain as well as gender became evident, indicating moderating influences on the association between SLB and SRH. CONCLUSION: Lack of supportive leadership was associated with suboptimal SRH at 10 years' follow-up in men, even if SRH at baseline and other risk factors were taken into account. This effect is likely to be moderated by job strain.

Bidirectional associations between psychological distress and hearing problems: an 18-year longitudinal analysis of the British Household Panel Survey.

OBJECTIVE: Hearing problems are a significant public health concern. It has been suggested that psychological distress may represent both a cause and a consequence of hearing problems. Prospective data that allow testing such potential bi-directionality have thus far been lacking. The present study aimed to address this knowledge gap. Random (RE) and fixed effects (FE) panel regression models estimated the association of psychological distress (GHQ-12) and participant-reported hearing problems. Data from 18 annual waves of the British Household Panel Survey were used (n = 10,008). Psychological distress was prospectively associated with self-reported hearing problems in women (multivariable odds ratios (ORs) ≥1.44; one-year time lag ≥ 1.16) and men (ORs ≥ 1.15; time lag ≥ 1.17). Conversely, self-reported hearing problems were associated with increases in psychological distress in both sexes (OR ≥ 1.26; time lag ≥ 1.08). These associations were independent of the analytical strategy and of adjustment for sociodemographic variables, lifestyle factors, and measurement period. We present first evidence of a bidirectional association between psychological distress and self-reported hearing problems. These findings suggest that stress management interventions may contribute to the prevention of self-reported hearing problems, and, in turn, alleviating self-reported hearing problems may reduce psychological distress.

Effects of psychosocial work characteristics on hair cortisol - findings from a post-trial study.

Prolonged work stress, as indicated by the effort-reward imbalance (ERI) model, jeopardizes health. Cortisol represents a candidate mechanism connecting stress to ill health. However, previous findings appear inconclusive, and recommendations were made to assess work stress at multiple time points and also to investigate ERI (sub-)components. This study therefore examines the effects of two single time points, as well as the mean and change scores between time points of ERI and its components on hair cortisol concentration (HCC), a long-term cortisol measurement. Participants were 66 male factory workers (age: 40.68 ± 6.74 years; HCC: 9.00 ± 7.11 pg/mg), who were followed up after a stress management intervention (2006-2008). In 2008 (T1) and 2015 (T2), participants completed a 23-item ERI questionnaire, assessing effort, the three reward components (esteem, job security, job promotion) and over-commitment. In 2015, participants also provided a 3-cm hair segment close to the scalp for HCC analysis, as well as information on relevant confounders (i.e. medication intake, age, work characteristics, socioeconomic and lifestyle factors, number of stressful life events). Linear regressions revealed hardly any cross-sectional or longitudinal effect of ERI and its components on HCC. Only the change scores between T1 and T2 of job security were negatively associated with lower HCC in unadjusted (ß = -.320; p = .009) and adjusted (ß = -.288; p = .044) models. In this study, only a decrease of perceived job security over time was significantly associated with higher HCC, and other predictors were not related to this outcome. Especially after correction for multiple testing, this study revealed just a weak association of different psychosocial work measurements with HCC. Lay summary This study showed that an increase in perceived job insecurity is correlated with higher levels of the stress hormone cortisol. The higher levels of cortisol might represent a biological explanation for the negative health effects of job insecurity. The association was, however, relatively low, and more and more voices are questioning whether cortisol in hair is a reliable marker for perceived work stress.

The long-term impact of a change in Effort-Reward imbalance on mental health-results from the prospective MAN-GO study.

Background: Little is yet known on the long-term effects of stress management interventions (SMIs) in the workplace. The aim this study was to prospectively examine the effect of an improvement of psychosocial working conditions measured by the Effort-Reward (E-R) Imbalance model within 2 years following an SMI, and mental health 7 years later. Methods: The study sample consisted of 97 male industrial workers from southern Germany. Data were collected pre- and post-intervention in 2006 (T1) and 2008 (T2), respectively, as well as in 2015 (T3). Change scores were computed by subtracting T1 from T3 values. The associations between E-R ratio at T1, T2 and the change score, respectively, with depression and anxiety 7 years later were estimated by means of linear regression analysis. Analyses were adjusted for baseline levels of the exposure and outcome variables, socio-demographic-, health- and work-related covariates. Results: Within-person comparisons revealed a significant reduction (i.e. improvement) in E-R ratio post-intervention (-0.103, SD 0.24, P = 0.000). This improvement in the E-R ratio was significantly associated with lower anxiety (ß = 0.358, P = 0.001) and depression (ß = 0.246, P = 0.031) scores in the fully adjusted models. The association between change scores and mental health were slightly stronger than associations with absolute values at T1 and T2. Conclusions: An improvement in E-R ratio following an SMI, was significantly associated with lower anxiety and depression 7 years later. These results strongly support the importance of improving psychosocial working conditions in order to protect the mental health of employees in the long-run.

Associations of Organizational Justice with Tinnitus and the Mediating Role of Depressive Symptoms and Burnout-Findings from a Cross-Sectional Study.

BACKGROUND: Tinnitus refers to the perception of a sound while an external source is absent. Research has identified work-related stress and its potential mental health-related sequelaes, i.e., depression and burnout, as risk factors for tinnitus. Perceived unfairness at work (organizational injustice), which is considered a psychosocial occupational stressor, has been shown to predict depression and burnout but its potential associations with tinnitus remains unaddressed. PURPOSE: The aim was to determine the relationship of organizational injustice with tinnitus, and to examine depression and burnout as potential mediators. METHOD: Cross-sectional data from a sample of 1632 employees were used. Tinnitus was assessed by self-report (n = 207; 13.9 %). Organizational justice and its subcomponents (interactional and procedural justice), burnout, and depressive symptoms were measured by validated questionnaires. Associations were assessed by logistic regressions, and mediation was assessed by maximum likelihood logistic regression estimations. RESULTS: Overall organizational justice, interactional and procedural justice were inversely related to tinnitus (z-score for overall justice: OR = 0.754; 95 % CI = 0.649 to 0.876). These associations were independent of demographics, socioeconomic status, job characteristics (including potential noise exposure), and health behaviors. Mediation analyses suggested a potential mediation by burnout (95 % CI indirect effect -0.188 to -0.066) and depressive symptoms (95 % CI indirect effect -0.160 to -0.043). Parallel multiple mediation analysis revealed that mediation through burnout was significantly larger than through depressive symptoms. CONCLUSION: Organizational justice appeared inversely related to tinnitus and this association was explained by individual differences in burnout symptoms, suggesting mediation. Longitudinal studies may further help to strengthen the evidence base for prevention of tinnitus through promotion of organizational justice and prevention of burnout.

Elevated HbA(1c) levels and the accumulation of differentiated T cells in CMV(+) individuals.

AIMS/HYPOTHESIS: Biological ageing of the immune system, or immunosenescence, predicts poor health and increased mortality. A hallmark of immunosenescence is the accumulation of differentiated cytotoxic T cells (CD27(-)CD45RA(+/-); or dCTLs), partially driven by infection with the cytomegalovirus (CMV). Immune impairments reminiscent of immunosenescence are also observed in hyperglycaemia, and in vitro studies have illustrated mechanisms by which elevated glucose can lead to increased dCTLs. This study explored associations between glucose dysregulation and markers of immunosenescence in CMV(+) and CMV(-) individuals. METHODS: A cross-sectional sample of participants from an occupational cohort study (n = 1,103, mean age 40 years, 88% male) were assessed for HbA(1c) and fasting glucose levels, diabetes, cardiovascular risk factors (e.g. lipids), numbers of circulating effector memory (EM; CD27(-)CD45RA(-)) and CD45RA re-expressing effector memory (EMRA; CD27(-)CD45RA(+)) T cells, and CMV infection status. Self-report and physical examination assessed anthropometric, sociodemographic and lifestyle factors. RESULTS: Among CMV(+) individuals (n = 400), elevated HbA(1c) was associated with increased numbers of EM (B = 2.75, p < 0.01) and EMRA (B = 2.90, p < 0.01) T cells, which was robust to adjustment for age, sex, sociodemographic variables and lifestyle factors. Elevated EM T cells were also positively associated with total cholesterol (B = 0.04, p < 0.05) after applying similar adjustments. No associations were observed in CMV(-) individuals. CONCLUSIONS/INTERPRETATION: The present study identified consistent associations of unfavourable glucose and lipid profiles with accumulation of dCTLs in CMV(+) individuals. These results provide evidence that the impact of metabolic risk factors on immunity and health can be co-determined by infectious factors, and provide a novel pathway linking metabolic risk factors with accelerated immunosenescence.

Injustice at work and leukocyte glucocorticoid sensitivity: findings from a cross-sectional study.

OBJECTIVE: Organizational justice refers to perceived fairness at the workplace. Low organizational justice has been identified as a major source of distress and a predictor of poor health. Impaired regulation of immunological and inflammatory pathways may, in part, underlie these health effects. The present study investigated the association of organizational justice with leukocyte glucocorticoid sensitivity in vivo. METHODS: Organizational justice was assessed among 541 male factory workers (mean [standard deviation] age = 46 [9] years) by questionnaire. Cortisol release was measured at three time points before blood collection and summed as the area under the curve. Blood was used to assess leukocyte (white blood cell [WBC] count) subsets (neutrophils [%WBC], lymphocytes [%WBC], and the neutrophil/lymphocyte ratio). Glucocorticoid sensitivity was operationalized as the correlation between cortisol release and these hematologic parameters. Associations were adjusted for demographics, work characteristics, and life-style variables. RESULTS: A dose-response relationship between organizational justice and glucocorticoid sensitivity was found. Cortisol and hematologic parameters showed the expected significant association among individuals reporting high (all ß values ≥ |.26|; all p values ≤.001) or medium organizational justice (all ß values ≥ |.15|; all p values ≤.050), but not among those reporting low organizational justice (all ß values ≤ |.04|; all p values > .10). These regression slopes differed significantly between organizational justice groups (p values for interaction < .050). CONCLUSIONS: Low justice at work is associated with an impaired ability of endogenous cortisol to regulate leukocyte distribution in vivo. These findings identify a novel biological pathway by which organizational justice may affect health.

Organizational justice is related to heart rate variability in white-collar workers, but not in blue-collar workers-findings from a cross-sectional study.

BACKGROUND: Perceived injustice at work predicts coronary heart disease. Vagal dysregulation represents a potential psychobiological pathway. PURPOSE: We examined associations between organizational justice and heart rate variability (HRV) indicators. Grounded in social exchange and psychological contract theory, we tested predictions that these associations are more pronounced among white-collar than among blue-collar workers. METHODS: Cross-sectional data from 222 blue-collar and 179 white-collar men were used. Interactional and procedural justice were measured by questionnaire. Ambulatory HRV was assessed across 24 h. Standardized regression coefficients (ß) were calculated. RESULTS: Among white-collar workers, interactional justice showed positive relationships with 24-h HRV, which were strongest during sleeping time (adjusted ßs≥0.26; p values≤0.01). No associations were found for blue-collar workers. A comparable but attenuated pattern was observed for procedural justice. CONCLUSIONS: Both dimensions of organizational injustice were associated with lowered HRV among white-collar workers. The impact of justice and possibly its association with health seems to differ by occupational groups.

Trigeminal induced arousals during human sleep.

BACKGROUND: Arousals caused by external stimuli during human sleep have been studied for most of the sensorial systems. It could be shown that a pure nasal trigeminal stimulus leads to arousals during sleep. The frequency of arousals increases dependent on the stimulus concentration. The aim of the study was to evaluate the influence of different stimulus durations on arousal frequency during different sleep stages. METHODS: Ten young healthy volunteers with 20 nights of polysomnography were included in the study. Pure trigeminal stimulation with both different concentrations of CO2 (0, 10, 20, 40% v/v) and different stimulus durations (1, 3, 5, and 10 s) were applied during different sleep stages to the volunteers using an olfactometer. The application was performed during different sleep stages (light sleep, deep sleep, REM sleep). RESULTS: The number of arousals increased with rising stimulus duration and stimulus concentration during each sleep stage. CONCLUSION: Trigeminal stimuli during sleep led to arousals in dose- and time-dependent manner.

The association of effort-reward imbalance and asthma: findings from two cross-sectional studies.

PURPOSE: There is evidence to suggest that work stress is positively associated with the occurrence of asthma. A limitation is that the small number of prior studies utilized unestablished work stress measures, thus constraining interpretation and generalizability. The present study re-examined this association by assessing work stress based on the well-established effort-reward imbalance (ERI) model. METHODS: We drew on data from two cross-sectional studies. Study 1 was conducted in a large pharmaceutical company in 2013 (n = 1,464). Study 2 was based on data from the 2011 wave of the population-based German Socio-Economic Panel (n = 8,388). ERI was assessed by validated questionnaires. Asthma was determined by self-report of a physician-based diagnosis. Associations between ERI or its subcomponents "effort", "reward" and "overcommitment" (z scores or categorized) with asthma were estimated by logistic regression models and reported as adjusted odds ratios (ORs) with 95 % confidence intervals (CIs). RESULTS: A one standard deviation increase of the ERI score (reflecting higher work stress) was associated with a 22-48 % elevated odds of asthma (Study 1: OR 1.48, 95 % CI 1.13-1.95, and Study 2: OR 1.22, 95 % CI 1.10-1.36). Z score-based analyses of the separate ERI components generally suggested moderate associations of effort, reward and overcommitment with asthma in both studies (Study 1: OR effort 1.25, 95 % CI 0.95-1.64, OR reward 0.67, 95 % CI 0.51-0.87, OR overcommitment 1.32, 95 % CI 1.01-1.72; and Study 2: OR effort 1.21, 95 % CI 1.09-1.34, OR reward 0.83, 95 % CI 0.76-0.92, OR overcommitment 1.12, 95 % CI 1.01-1.25). Analyses of categorized exposures largely confirmed these observations. CONCLUSIONS: This is the first study to demonstrate a link between an established work stress measure and asthma. Longitudinal studies are needed to determine the direction of these associations.

Dietary counselling for cardiovascular disease prevention in primary care settings: results from a German physician survey.

BACKGROUND: Primary care physicians (PCPs) play an important role in the promotion of healthy dietary behaviour. However, little is known about the practice of and factors associated with the provision of dietary counselling in primary health care in Germany. OBJECTIVES: To explore the attitudes towards and factors associated with the routine provision of dietary counselling in Germany using data from the nationwide, representative sample of the Physician Survey on Cardiovascular Disease Prevention. METHODS: A total of 4074 randomly selected PCPs (response rate: 33.9%) provided data on dietary counselling for prevention of cardiovascular disease (CVD) based on the 5 A's (Assess, Advise, Agree, Assist, Arrange), attitudes towards dietary counselling and patients' and practice characteristics. RESULTS: While the majority of PCPs (86%) reported having high levels of competence in providing dietary advice, only 49% felt they had been successful in counselling their patients on nutrition. PCPs routinely asked (68%) and advised patients to change their dietary habits more frequently (77%) compared to other counselling techniques based on the 5 A's. Female physicians and those with a higher percentage of privately insured patients and patients at higher risk of CVD were more likely to use the 5 A's to routinely counsel their patients on nutrition. CONCLUSIONS: The data showed high levels of involvement by German PCPs in CVD prevention and dietary counselling. The rather low perceived success of dietary intervention and differences with respect to patients' health insurance status indicate a need to address both communication skills in medical training and appropriate reimbursement of preventive services.

Psychometric properties of a German organizational justice questionnaire (G-OJQ) and its association with self-rated health: findings from the Mannheim Industrial Cohort Studies (MICS).

PURPOSE: The objective of the present study was to validate a German 11-item organizational justice questionnaire (G-OJQ) that consists of two subscales, referred to as "procedural justice" (PJ) and "interactional justice" (IJ) adapted from Moorman's organizational justice (OJ) questionnaire. A second objective was to determine associations of the G-OJQ with self-rated health. METHODS: This study used cross-sectional data from an occupational cohort of 1518 factory workers from Germany (87.7 % male; mean age = 38.8 with SD = 11.9). After splitting the sample in two random subsamples, we assessed structural validity by exploratory factor analyses in one subsample and by confirmatory factor analysis in the other subsample. Internal validity was assessed by Cronbach's α. Associations with self-reported poor health were estimated by logistic regression. RESULTS: The full scale and its subscales yielded Cronbach's α's of ≥0.9, and item-total correlations were ≥0.5. Factor analyses confirmed the expected 2-factor structure, labeled "interactional justice" (IJ, 4 items, λ 0.43-0.94) and "procedural justice" (PJ, 7 items, λ 0.46-0.83), respectively, and showed an acceptable fit to the data (χ (2) = 61; p = .001; CFI = 0.995; RMSEA = 0.037). The OJ total score as well as subscale scores in the lowest quartile, when compared to the highest quartile, was associated with an ≥2.3 increased odds of reporting poor health. CONCLUSION: The G-OJQ seems to be a valid and useful tool for observational and intervention studies in occupational settings. Future studies may additionally explore longitudinal associations and test the generalizability of the present findings to other populations and health outcomes.

Associations between supportive leadership and employees self-rated health in an occupational sample.

BACKGROUND: Protecting the health of the work force has become an important issue in public health research. PURPOSE: This study aims to explore potential associations between supportive leadership style (SLS), an aspect of leadership behavior, and self-rated health (SRH) among employees. METHOD: We drew on cross-sectional data from a cohort of industrial workers (n = 3,331), collected in 2009. We assessed employees' ratings of supportive, employee-oriented leadership behavior at their job, their SRH, and work stress as measured by the effort-reward model and scales measuring demands, control, and social support. Logistic regression estimated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) for the association between the perception of poor SLS and poor SRH controlling for work-related stress and other confounders. Sensitivity analyses stratified models by sex, age, and managerial position to test the robustness of associations. RESULTS: Perception of poor SLS was associated with poor SRH [OR 2.39 (95 % CI 1.95-2.92)]. Although attenuated following adjustment for measures of work-related stress and other confounders [OR 1.60 (95 % CI 1.26-2.04)], the magnitude, direction, and significance of this association remained robust in stratified models in most subgroups. CONCLUSION: SLS appears to be relevant to health in the workplace. Leadership behavior may represent a promising area for future research with potential for promoting better health in a large segment of the adult population.

While You Are Sleeping: Marital Ambivalence and Blunted Nocturnal Blood Pressure.

Marital relationships offer health benefits, including a lower risk of cardiovascular disease (CVD). However, quality of the relationship matters; ambivalent behaviors may increase CVD risk by affecting blunted nocturnal blood pressure (BP) dipping. This study tracked daytime and nocturnal SBP and DBP in 180 normotensive individuals (90 couples; participant mean age 25.04; 91.58% white) over a 24 h period using ambulatory blood pressure monitors to explore the impact of martial quality. Results showed that perceptions of spousal ambivalence were associated with blunted nocturnal BP dipping. Perceptions of one's own behavior as ambivalent also showed blunted nocturnal dipping. When in an ambivalent relationship, a gender interaction was found such that women were most likely to have blunted SBP dipping, but men were more likely to have blunted nocturnal DBP dipping. Overall, this study found an association between ambivalence and BP dipping, thus uncovering one virtually unexplored pathway by which marital relationships may have adverse effects on health.