Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe / Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean / Questionário básico e critérios metodológicos para as Pesquisas sobre Condições de Trabalho, Emprego e Saúde na América Latina e Caribe

Resumen: El objetivo de este trabajo es presentar un cuestionario básico y criterios metodológicos mínimos, para ser considerados en futuras Encuestas sobre Condiciones de Trabajo, Empleo y Salud (ECTES) en América Latina y el Caribe. Para ello, se llevó a cabo un proceso de consenso, tanto virtual como presencial, con la participación de un grupo internacional de expertos que, para definir la propuesta, partieron de las encuestas disponibles en la región hasta 2013. El cuestionario final incluyó 77 preguntas agrupadas en seis dimensiones: características sociodemográficas del trabajador y la empresa; condiciones de empleo; condiciones de trabajo; estado de salud; recursos y actividades preventivas; y características familiares. Entre los criterios metodológicos mínimos destacan el domicilio de la persona entrevistada como lugar de la entrevista y los relacionados con la calidad del trabajo de campo. Estos resultados pueden ayudar a mejorar la comparabilidad de las futuras ECTES en América Latina y el Caribe, lo que contribuiría a mejorar la información en salud laboral en la región.

Abstract: This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Resumo: O objetivo deste trabalho é apresentar um questionário básico e critérios metodológicos mínimos, para serem considerados em futuras pesquisas sobre Condições de Trabalho, Emprego e Saúde (ECTES) na América Latina e Caribe. Para tal, foi realizado um processo de consenso, tanto virtual como presencial, com a participação de um grupo internacional de expertos que, para definir a proposta, partiram das pesquisas disponíveis na região até 2013. O questionário final incluiu 77 perguntas agrupadas em seis dimensões: características sociodemográficas do trabalhador e a empresa; condições de emprego; condições de trabalho; estado de saúde; recursos e atividades preventivas; assim como características familiares. Entre os critérios metodológicos mínimos destacam-se o domicílio da pessoa entrevistada como lugar da entrevista e os relacionados com a qualidade do trabalho de campo. Estes resultados podem ajudar a melhorar a comparabilidade das futuras ECTES na América Latina e Caribe, o que contribuiria para melhorar a informação sobre saúde do trabalhador na região.

Dolor musculoesquelético en trabajadores de América Central: resultados de la I encuesta Centroamericana de condiciones de trabajo y salud / Musculoskeletal pain in Central American workers: results of the first survey on working conditions and health in Central America

OBJETIVO: Examinar la prevalencia de dolor musculoesquelético (DME) en los seis países de habla hispana de América Central con un instrumento único, la I Encuesta Centroamericana de Condiciones de Trabajo y Salud, en trabajadores de todos los sectores, manuales y no manuales, y con cobertura o no de la seguridad social como un indicador de formalidad o informalidad. MÉTODOS: Trabajadores encuestados en sus domicilios (n = 12 024). Se calculó la prevalencia ajustada por edad en el último mes de DME en la espalda (alta o cervical, media o dorsal y baja o lumbar) o en las articulaciones de los miembros superiores (hombro, codo y muñeca). La prevalencia fue estimada por sexo, ocupación (manual o no), sector económico (agrícola, industrial y servicios) y cobertura de la seguridad social. Se utilizaron modelos de regresión Poisson para calcular las razones de prevalencia e intervalos de confianza de 95%, con estratificación por país y localización anatómica. RESULTADOS: Por localizaciones, la prevalencia ajustada por edad de DME cervical-dorsal es la más elevada, en especial en El Salvador (47,8%) y Nicaragua (45,9%), y la de DME lumbar la menos frecuente, sobre todo en Panamá (12,8%) y Guatemala (14,8%). Tras ajustes adicionales, la prevalencia de DME fue mayor en mujeres y los trabajadores manuales en todas las localizaciones y países. No hubo diferencias de DME respecto a la cobertura de la seguridad social y el sector de actividad económica. CONCLUSIONES: La elevada prevalencia de DME en América Central, independiente del sector de actividad y cobertura o no de la seguridad social, indica que la prevención de los DME debe constituir también una prioridad en salud laboral en países de bajos y medianos ingresos, en especial en mujeres y trabajadores manuales.

Objective: Examine the prevalence of musculoskeletal pain (MSP) in the six Spanish-speaking countries of Central America using a single standardized instrument, the First Survey on Working Conditions and Health in Central America in workers from all manual and non-manual labor sectors, using social security coverage as an indicator of formal versus informal employment. Methods: The workers (n = 12 024) were surveyed in their homes. The age-adjusted prevalence of MSP during the previous month was calculated for pain in the back (upper, or cervical; middle, or thoracic; and lower, or lumbar) and arm joints (shoulder, elbow, and wrist). Prevalence was estimated by sex, occupation (manual or non-manual), economic sector (agriculture, industry, or services), and social security coverage. Poisson regression models were used to calculate the prevalence rates and 95% confidence intervals, with stratification by country and anatomical site. Results: By sites, the age-adjusted prevalence of cervical-dorsal MSP was the highest, especially in El Salvador (47.8%) and Nicaragua (45.9%), and lumbar MSP was less prevalent, especially in Panama (12.8%) and Guatemala (14.8%). After additional adjustments, the prevalence of MSP was higher in women and manual workers for all the sites and in all the countries. There were no differences in MSP in terms of social security coverage or sector of economic activity. Conclusions: The high prevalence of MSP in Central America, regardless of sector of activity or social security coverage, indicates that the prevention of MSP should be a priority in occupational health programs in low- and middle-income countries, especially for women and manual workers.

Cross-national comparisons of sickness absence systems and statistics: towards common indicators.

We aimed to identify common elements in work sickness absence (SA) in Spain, Sweden and The Netherlands. We estimated basic statistics on benefits eligibility, SA incidence and duration and distribution by major diagnostics. The three countries offer SA benefits for at least 12 months and wage replacement, differing in who and when the payer assumes responsibility; the national health systems provide health care with participation from occupational health services. Episodes per 1000 salaried workers and episode duration varied by country; their distribution by diagnostic was similar. Basic and useful SA indicators can be constructed to facilitate cross-country comparisons.

Heterogeneity and event dependence in the analysis of sickness absence.

BACKGROUND: Sickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration. METHODS: To overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders. RESULTS: As expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM. CONCLUSIONS: The CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases.

Associations between change in sleep duration and inflammation: findings on C-reactive protein and interleukin 6 in the Whitehall II Study.

Cross-sectional evidence suggests associations between sleep duration and levels of the inflammatory markers, C-reactive protein and interleukin-6. This longitudinal study uses data from the London-based Whitehall II study to examine whether changes in sleep duration are associated with average levels of inflammation from 2 measures 5 years apart. Sleep duration (≤5, 6, 7, 8, ≥9 hours on an average week night) was assessed in 5,003 middle-aged women and men in 1991/1994 and 1997/1999. Fasting levels of C-reactive protein and interleukin-6 were measured in 1997/1999 and 2002/2004. Cross-sectional analyses indicated that shorter sleep is associated with higher levels of inflammatory markers. Longitudinal analyses showed that each hour per night decrease in sleep duration between 1991/1994 and 1997/1999 was associated with higher levels of C-reactive protein (8.1%) and interleukin-6 (4.5%) averaged across measures in 1997/1999 and 2002/2004. Adjustment for longstanding illness and major cardiometabolic risk factors indicated that disease processes may partially underlie these associations. An increase in sleep duration was not associated with average levels of inflammatory markers. These results suggest that both short sleep and reductions in sleep are associated with average levels of inflammation over a 5-year period.

[Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)]. / Distribución de la duración de la incapacidad temporal por contingencia común por diagnóstico médico (Cataluña, 2006-2008).

We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes.

Organisational justice and cognitive function in middle-aged employees: the Whitehall II study.

BACKGROUND: Little is known about the role that work-related factors play in the decline of cognitive function. This study examined the association between perceived organisational justice and cognitive function among middle-aged men and women. METHODS: Perceived organisational justice was measured at phases 1 (1985-8) and 2 (1989-90) of the Whitehall II study when the participants were 35-55 years old. Assessment of cognitive function at the screening clinic at phases 5 (1997-9) and 7 (2003-4) included the following tests in the screening clinic: memory, inductive reasoning (Alice Heim 4), vocabulary (Mill Hill), and verbal fluency (phonemic and semantic). Mean exposure to lower organisational justice at phases 1 and 2 in relation to cognitive function at phases 5 and 7 were analysed using linear regression analyses. The final sample included 4531 men and women. RESULTS: Lower mean levels of justice at phases 1 and 2 were associated with worse cognitive function in terms of memory, inductive reasoning, vocabulary and verbal fluency at both phases 5 and 7. These associations were independent of covariates, such as age, occupational grade, behavioural risks, depression, hypertension and job strain. CONCLUSIONS: This study suggests an association between perceived organisational justice and cognitive function. Further studies are needed to examine whether interventions designed to improve organisational justice would affect employees' cognition function favourably.

Mechanical systems versus smoking bans for secondhand smoke control.

INTRODUCTION: Despite international efforts to implement smoking bans, several national legislations still allow smoking and recommend mechanical systems, such as ventilation and air extraction, to eliminate secondhand smoke (SHS) health-related risks. We aimed to quantify the relative contribution of mechanical systems and smoking bans to SHS elimination. METHODS: A cross-sectional study was conducted in randomly selected establishments from 4 Mexican cities (3 with no ban). SHS exposure was assessed using nicotine passive monitors. Establishment characteristics, presence of mechanical systems, and enforcement of smoking policies were obtained through direct observation and self-report. Multilevel models were used to assess relative contributions to SHS reduction. RESULTS: Compared with Mexico City, nicotine concentrations were 3.8 times higher in Colima, 5.4 in Cuernavaca, and 6.4 in Toluca. Mechanical systems were not associated with reduced nicotine concentrations. Concentration differences between cities were largely explained by the presence of smoking bans (69.1% difference reduction) but not by mechanical systems (-5.7% difference reduction). CONCLUSIONS: Smoking bans represent the only effective approach to reduce SHS. Tobacco control regulations should stop considering mechanical systems as advisable means for SHS reduction and opt for complete smoking bans in public places.

Association of CRP and IL-6 with lung function in a middle-aged population initially free from self-reported respiratory problems: the Whitehall II study.

To assess whether two inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), and change in their concentrations over 12 years, are associated with lung function (FVC and FEV(1)) 12 years after baseline. Data are from over 1,500 participants free from self-reported respiratory problems in a large-scale prospective cohort study of white-collar male and female civil servants. CRP and IL-6 measured at baseline (1991-1993) and follow-up (2002-2004) and FVC and FEV(1), measured at follow-up. Results adjusted for sociodemographic and anthropometric characteristics, health behaviours, biological factors, chronic conditions and medications, and corrected for short-term variability in CRP and IL-6 concentrations. Higher baseline levels of CRP and IL-6 were strongly associated with lower FVC and FEV(1), independent of potential confounders. A 10% increase serum CRP from baseline to follow-up was associated with lower values of FVC and FEV(1) at follow-up, 4.7 and 3.0 ml, respectively. The corresponding values for a 10% increase in IL-6 were 12.6 ml for FVC and 7.3 ml for FEV(1). Systemic low-grade inflammation is associated with only slightly poorer pulmonary function in a population free from self-reported respiratory problems 12 years earlier. These data provide evidence linking inflammation to adverse outcomes beyond cardiovascular disease. Interventions targeting inflammation may prevent lung function impairment.

Natural course of recurrent psychological distress in adulthood.

BACKGROUND: The course of major depressive disorder is often characterized by progressing chronicity, but whether this applies to the course of self-reported psychological distress remains unclear. We examined whether the risk of self-reported psychological distress becomes progressively higher the longer the history of distress and whether prolonged history of distress modifies associations between risk markers and future distress. METHODS: Participants were British civil servants from the prospective Whitehall II cohort study (n=7934; 31.5% women, mean age 44.5 years at baseline) followed from 1985 to 2006 with repeat data collected in 7 study phases. Psychological distress was assessed with the 30-item General Health Questionnaire (GHQ). Sex, socioeconomic status, marital status, ethnicity, physical activity, alcohol consumption, smoking, and obesity were assessed as risk markers. RESULTS: Recurrent history of psychological distress was associated with a progressively increasing risk of future distress in a dose-response manner. Common risk markers, such as low socioeconomic status, non-White ethnicity, being single, and alcohol abstinence, were stronger predictors of subsequent distress in participants with a longer history of psychological distress. Sex differences in psychological distress attenuated with prolonged distress history. LIMITATIONS: The participants were already adults in the beginning of the study, so we could not assess the progressive chronicity of psychological distress from adolescence onwards. CONCLUSIONS: These data suggest that self-reported psychological distress becomes more persistent over time and that a longer prior exposure to psychological distress increases sensitivity to the stressful effects of certain risk markers.

Organisational justice and markers of inflammation: the Whitehall II study.

OBJECTIVES: Low organisational justice has been shown to be associated with increased risk of various health problems, but the underlying mechanisms remain unclear. We tested whether organisational injustice contributes to chronic inflammation in a population of middle-aged men and women. METHODS: This prospective cohort study uses data from 3205 men and 1204 women aged 35-55 years at entry into the Whitehall II study (phase 1, 1985-1988). Organisational justice perceptions were assessed at phase 1 and phase 2 (1989-1990) and circulating inflammatory markers C-reactive protein (CRP) and interleukin (IL)-6 at phase 3 (1991-1993) and phase 7 (2003-2004). RESULTS: In men, low organisational justice was associated with increased CRP levels at both follow-ups (phase 3 and 7) and increased IL-6 at the second follow-up (phase 7). The long term (phase 7) associations were largely independent of covariates, such as age, employment grade, body mass index and depressive symptoms. In women, no relationship was found between organisational justice and CRP or IL-6. CONCLUSIONS: This study suggests that organisational injustice is associated with increased long-term levels of inflammatory markers among men.

[Perception over smoke-free policies amongst bar and restaurant representatives in central Mexico]. / Percepción sobre políticas de espacios libres de humo de tabaco en bares y restaurantes del centro de México.

OBJECTIVE: To analyze the perceptions and appreciations over smoke-free environments of restaurant and bar managers from four cities in central Mexico. MATERIAL AND METHODS: Managers from 219 restaurants and bars from Mexico City, Colima, Cuernavaca and Toluca were surveyed about smoke-free environments opinions and implementation. Simultaneously, environmental nicotine was monitored. RESULTS: The majority of surveyed managers considered public places should be smoke-free, although more than half were concerned with potential economic loses. Implementation of smoke-free environments was more frequent in Mexico City (85.4%) than in the other cities (15.3% overall), with consequently lower environmental nicotine concentrations. CONCLUSION: Managers acknowledge the need to create smoke-free environments. Concerns over economic negative effects derived from the prohibition could explain, at least partially, the rejection of this sector towards the implementation of this type of policy.

[Tobacco smoke exposure in public places in Mexico City, Guadalajara and Monterrey]. / Exposición a humo de tabaco ajeno en lugares públicos de la Ciudad de México, Guadalajara y Monterrey.

OBJECTIVE: To quantify environmental tobacco smoke exposure in public places in Mexico to promote policies of 100% smoke-free environments. MATERIALS AND METHODS: In hospitals, schools and public offices of Monterrey, Guadalajara and Mexico City 20% of inner areas were monitored. Median nicotine concentrations were estimated by city, type of public space and type of inner area. RESULTS: Median concentration in areas where nicotine was detected was 0.06 µg/m³ (P25=0.03, P75=0.12 µg/m³). Higher concentrations were found in Mexico City and in public offices. Nicotine was not detected in 75% of monitored areas. CONCLUSIONS: Monitoring environmental nicotine is a useful tool to evaluate compliance of public places with the smoke-free environments legislation, and could constitute an important source of information to strengthen implementation efforts.

Percepción sobre políticas de espacios libres de humo de tabaco en bares y restaurantes del centro de México / Perception over smoke-free policies amongst bar and restaurant representatives in central Mexico

Objetivo. Analizar las percepciones y apreciaciones sobre espacios libres de humo de tabaco de los responsables de bares y restaurantes en cuatro ciudades del centro de México. Material y métodos. Se encuestó a los administradores de 219 bares y restaurantes de la Ciudad de México, Colima, Cuernavaca y Toluca, acerca de opiniones e implementación de espacios libres de humo. Simultáneamente, se monitorearon concentraciones de nicotina ambiental. Resultados. La mayoría de los encuestados consideró que los espacios públicos deben ser libres de humo, más de la mitad refirió preocupación por pérdidas económicas. La implementación de espacios libres de humo fue más frecuente en la Ciudad de México (85.4 por ciento) que en las demás ciudades (15.3 por ciento global), lo que se refleja en menores concentraciones de nicotina ambiental. Conclusión. Los administradores reconocen la necesidad de crear espacios libres de humo. La preocupación sobre posibles efectos económicos negativos de la prohibición podría explicar, al menos parcialmente, el rechazo a la implementación de este tipo de políticas.

Objective. To analyze the perceptions and appreciations over smoke-free environments of restaurant and bar managers from four cities in central Mexico. Material and Methods. Managers from 219 restaurants and bars from Mexico City, Colima, Cuernavaca and Toluca were surveyed about smoke-free environments opinions and implementation. Simultaneously, environmental nicotine was monitored. Results. The majority of surveyed managers considered public places should be smoke-free, although more than half were concerned with potential economic loses. Implementation of smoke-free environments was more frequent in Mexico City (85.4 percent) than in the other cities (15.3 percent overall), with consequently lower environmental nicotine concentrations. Conclusion. Managers acknowledge the need to create smoke-free environments. Concerns over economic negative effects derived from the prohibition could explain, at least partially, the rejection of this sector towards the implementation of this type of policy.

Exposición a humo de tabaco ajeno en lugares públicos de la Ciudad de México, Guadalajara y Monterrey / Tobacco smoke exposure in public places in Mexico City, Guadalajara and Monterrey

Objetivo. Cuantificar la exposición al humo de tabaco ajeno (HTA) en lugares públicos de México, con el fin de impulsar políticas locales de ambientes 100 por ciento libres de humo de tabaco. Material y métodos. Se monitoreó aleatoriamente 20 por ciento de las áreas interiores de hospitales, escuelas y oficinas públicas de Monterrey, Guadalajara y la Ciudad de México. La concentración mediana de nicotina ambiental fue estimada por ciudad, tipo de espacio público y área interior. Resultados. La concentración mediana en los espacios donde se detectó nicotina fue de 0.06 µg/m3 (P25=0.03, P75=0.12 µg/m3), las mayores concentraciones se obtuvieron en la Ciudad de México y en las oficinas públicas. No se detectó nicotina en 75 por ciento de los espacios monitoreados. Conclusiones. El monitoreo ambiental de nicotina es una herramienta útil para fortalecer la implementación y evaluar el cumplimiento de la política de ambientes 100 por ciento libres de humo de tabaco.

Objective. To quantify environmental tobacco smoke exposure in public places in Mexico to promote policies of 100 percent smoke-free environments. Materials and Methods. In hospitals, schools and public offices of Monterrey, Guadalajara and Mexico City 20 percent of inner areas were monitored. Median nicotine concentrations were estimated by city, type of public space and type of inner area. Results. Median concentration in areas where nicotine was detected was 0.06 µg/m3 (P25=0.03, P75=0.12 µg/m3). Higher concentrations were found in Mexico City and in public offices. Nicotine was not detected in 75 percent of monitored areas. Conclusions. Monitoring environmental nicotine is a useful tool to evaluate compliance of public places with the smoke-free environments legislation, and could constitute an important source of information to strengthen implementation efforts.

Socioeconomic position, psychosocial work environment and cerebrovascular disease among women: the Finnish public sector study.

BACKGROUND: The excess risk of fatal and non-fatal cerebrovascular disease in people from low socioeconomic positions is only partially explained by conventional cerebrovascular risk factors. This has led to the suggestion that poor psychosocial work environments provide important additional explanatory power. However, little evidence is available for women. METHODS: We examined whether job demands or job control contributed to the socioeconomic gradient in cerebrovascular disease among 48 361 women aged 18-65 years. Job demands, job control and behavioural risk factors were self-reported in 2000-2002; socioeconomic position (as indexed by occupational class) and all of the health measures were obtained from registers. The outcome was recorded hospitalization or death from cerebrovascular disease. RESULTS: During a mean follow-up of 3.4 years, 124 women had a new cerebrovascular disease event. The risk was 2.3 (95% CI 1.3-3.9) times higher among women in low vs high socioeconomic positions. Adjustment for conventional risk factors, such as prevalent hypertension, coronary heart disease, diabetes, smoking, heavy alcohol consumption, physical inactivity and obesity, attenuated this excess risk by 23%. In contrast, adjustment for job demands and job control actually amplified the gradient by 36% suggesting a suppression effect. CONCLUSIONS: In this contemporary cohort of employed women, job demands-alone and in combination with job control-suppressed rather than explained socioeconomic differences in cerebrovascular disease.

Occupational exposures and asthma in health-care workers: comparison of self-reports with a workplace-specific job exposure matrix.

The authors compared self-reported occupational exposures with a workplace-specific job exposure matrix (JEM) in a 2004 survey of Texas health-care professionals (n = 3,650), by asthma status. Sensitivity, specificity, chance-corrected (kappa) and chance-independent (phi) agreement, and associations of self-reported exposures with asthma were compared with those for the JEM. Among asthmatics, the median sensitivity of self-reported exposures was 74% (range, 53-90); specificity was 64% (range, 27-74). For nonasthmatics, median sensitivity was 67% (range, 40-88) and specificity was 70% (range, 33-82). Sensitivity was higher among asthmatics for exposures involving perceptible odors. Specificity was higher among nonasthmatics for instrument cleaning and exposure to adhesives/solvents. Asthmatics showed better agreement with the JEM for patient-care-related cleaning (phi = 0.51 vs. 0.40); there was little difference for other exposures. In all cases, confidence intervals overlapped. Prevalence ratios were higher with self-reported exposures than with the JEM; differences were greatest for cleaning products, adhesives/solvents, and gases/vapors. However, confidence intervals overlapped with those obtained using the JEM. In asthma studies, differential reporting bias by health status should be taken into consideration. Findings favor using externally developed methods of exposure classification, although information gleaned from examining distributions of exposure self-reports, particularly among nondiseased persons, can provide useful information for improving the reliability of exposure ascertainment.