Workplace bullying and psychotropic drug use: the mediating role of physical and mental health status.

OBJECTIVES: The association between workplace bullying and psychotropic drug use is not well established. This study was aimed at exploring the association between workplace bullying, and its characteristics, and psychotropic drug use and studying the mediating role of physical and mental health. METHODS: The study population consisted of a random sample of 3132 men and 4562 women of the working population in the south-east of France. Workplace bullying, evaluated using the validated instrument elaborated by Leymann, and psychotropic drug use, as well as covariates, were measured using a self-administered questionnaire. Covariates included age, marital status, presence of children, education, occupation, working hours, night work, physico-chemical exposures at work, self-reported health, and depressive symptoms. Statistical analysis was performed using logistic regression analysis and was carried out separately for men and women. RESULTS: Workplace bullying was strongly associated with psychotropic drug use. Past exposure to bullying increased the risk for this use. The more frequent and the longer the exposure to bullying, the stronger the association with psychotropic drug use. Observing bullying on someone else at the workplace was associated with psychotropic drug use. Adjustment for covariates did not modify the results. Additional adjustment for self-reported health and depressive symptoms reduced the magnitude of the associations, especially for men. CONCLUSIONS: The association between bullying and psychotropic drug use was found to be significant and strong and was partially mediated by physical and mental health.

Workplace bullying and sleep disturbances: findings from a large scale cross-sectional survey in the French working population.

STUDY OBJECTIVES: The purpose of this study was to explore the associations between workplace bullying, the characteristics of workplace bullying, and sleep disturbances in a large sample of employees of the French working population. DESIGN: Workplace bullying, evaluated using the validated instrument developed by Leymann, and sleep disturbances, as well as covariates, were measured using a self-administered questionnaire. Covariates included age, marital status, presence of children, education, occupation, working hours, night work, physical and chemical exposures at work, self-reported health, and depressive symptoms. Statistical analysis was performed using logistic regression analysis and was carried out separately for men and women. SETTING: General working population. PARTICIPANTS: The study population consisted of a random sample of 3132 men and 4562 women of the working population in the southeast of France. RESULTS: Workplace bullying was strongly associated with sleep disturbances. Past exposure to bullying also increased the risk for this outcome. The more frequent the exposure to bullying, the higher the risk of experiencing sleep disturbances. Observing someone else being bullied in the workplace was also associated with the outcome. Adjustment for covariates did not modify the results. Additional adjustment for self-reported health and depressive symptoms diminished the magnitude of the associations that remained significant. CONCLUSIONS: The prevalence of workplace bullying (around 10%) was found to be high in this study as well was the impact of this major job-related stressor on sleep disturbances. Although no conclusion about causality could be drawn from this cross-sectional study, the findings suggest that the contribution of workplace bullying to the burden of sleep disturbances may be substantial.

[Type B natriuretic peptide (BNP) versus n-terminal type B natriuretic propeptide in the diagnosis of cardiac failure in the elderly over 75 population]. / Peptide natriurétique de type B (BNP) versus n-terminal propeptide natriurétique de type B (NT-proBNP) pour le diagnostic de l'insuffisance cardiaque chez le sujet agé de plus de 75 ans.

Type B natriuretic peptide (BNP) versus n-terminal type B natriuretic propeptide in the diagnosis of cardiac failure in the elderly over 75 population The value of BNP is well established in the diagnosis of cardiac failure in cases of dyspnoea in the emergency room in young and, more and more, in elderly subjects. However, there are few studies comparing the diagnostic value of BNP and of the n-terminal pro-BNP in patients over 75 years of age. The aim of this study was to compare the diagnostic value of BNP and NT-pro BNP in dyspnoea of the elderly patient. One hundred and three consecutive patients over 75 years of age admitted to the emergency unit for dyspnoea were included. A blood sample for measuring the BNP (Biosite) and the NT-proBNP (Roche Diagnostic) was taken in the admission unit in addition to the standard blood workup. The final reference diagnosis was established by two independent cardiologists. Of the 103 patients, 61 were women and the average age was 84.9 +/- 6.2 years. The final diagnosis was cardiac failure in 49 patients (48%), pulmonary embolism in 6 patients, an acute exacerbation of chronic obstructive airways disease in 36 patients and an acute bronchitis in 30 patients. In 9 cases, the dyspnoea was considered to result from mixed cardiac and pulmonary disease. Renal function was assessed by calculating the creatinine clearance by Cockcroft and Gault's formula. The average value of the creatinine clearance was 41.7 +/- 16.4 ml/min indicating that mild renal failure was relatively common. The diagnostic value, assessed by the area under the ROC curve, was similar for the BNP (0.79; CI: 0.70-0.88) and NT-proBNP (0.80; CI: 0.71-0.89). A BNP value of 300 pg/ml had the same sensitivity and specificity as an NT-proBNP of less than 1 500 pg/ml. A BNP of less than 200 pg/ml and an NT-proBNP of less than 1 000 pg/ml had excellent negative predictive values for excluding the diagnosis of cardiac failure. The authors conclude that the BNP and NT-proBNP are useful for the diagnosis of cardiac failure in acute dyspnoea of the elderly and seem to have a comparable diagnostic value.

Severe valvular heart disease in patients on chronic dialysis. A five-year multicenter French survey.

A retrospective multicenter survey of the 230 chronic dialysis centers in metropolitan France, conducted between January 1 1998 and December 31 1992, to assess the incidence, causes and features of severe valvular heart disease among chronic dialysis patients, identified 98 patients. The annual incidence was estimated to be 15 to 19 cases per 10,000 dialysed patients. The most common etiologies were calcific valvular disease (69%) and endocarditis (19%). Calcific valvular disease led mostly to aortic stenosis, whereas endocarditis primarily caused mitral insufficiency. Two valves were damaged in 32% of the endocarditis patients versus 9% of those with calcific valvular disease. Sixty-one patients underwent surgery. Median overall survival after surgery was 25 +/- 3.0 months. Patients who underwent surgery for calcific valvulopathy, aortic stenosis or only aortic valve replacement had a median survival of 36 months. Patients who underwent surgery for endocarditis or replacement of 2 valves had a median survival of < 12 months. Actuarial survival of surgical patients differed significantly between: i) the patients for whom presurgical evaluation showed a single valvular lesion and those with multiple valvular lesions (p = 0.002), ii) the patients who had surgery to replace a single heart valve and those who had another type of surgery (p = 0.001), and iii) the patients who had surgery to insert a single aortic prosthetic heart valve and those who had another type of surgery (p = 0.004). Multivariate analysis (including etiologies, number of valvular lesions and type of surgery) showed that survival was significantly dependent only on the number of severe valvular lesions (p = 0.002). Five patients with severe calcific aortic stenosis died before scheduled surgery could be performed. These data suggest that, for patients on chronic dialysis, calcific aortic stenosis is the most frequent form of severe valvular disease. Because aortic stenosis progresses rapidly in these patients and thus quickly leads to irreversible cardiac failure, the operative risk, although high in this population, seems acceptable when only one valve is affected.

Metabolic adverse reactions to diuretics. Clinical relevance to elderly patients.

There is a wide variety of diuretic-induced metabolic abnormalities of unequal severity. Renal failure can be caused by excessive sodium loss, or by certain drug combinations comprising, for instance, a nonsteroidal anti-inflammatory drug (NSAID) or an ACE inhibitor. Hyponatraemia is uncommon. It is encountered with thiazides, especially among women. A sodium level less than 120 mmol/L may result in neurological complications. Hypokalaemia is frequent and might increase the risk of cardiac arrhythmia. Hyperkalaemia induced by potassium-sparing diuretics is often combined with another contributive cause. Glucidic, lipidic and uric acid abnormalities are common, but their clinical effects are slight. They do not seem to worsen cardiovascular risks among elderly patients. Nevertheless, prescribing diuretics for elderly patients requires special precautions. Reducing the diuretic dose, as is now recommended for treating hypertension, seems to lessen adverse effects, and despite all the adverse reactions just mentioned, it has been proven that diuretics are beneficial in many diseases.

[Morbidity and severity of malaria attacks in carriers of sickle-cell trait]. / Etude de la morbidité palustre et de la gravité des accès pernicieux chez les porteurs du trait drépanocytaire.

The authors made a survey in a permanent high Plasmodium falciparum transmission area to compare frequency and severity of malaria attacks in children belonging to different haemoglobin types before 15 years; 291 young out-patients of the local infirmary and 467 outpatients of the hospital were examined. Diagnosis of malaria was inferred from clinical and parasitological criteria and subsequent evolution of the disease. Pathogenic threshold of parasitaemia was similar in all haemoglobin type groups of children and was about 3,000 parasite-infected red cells per mm3. Malaria was diagnosed more often among HbAA patients, than among other patients. Mortality rate in AA haemoglobin children was higher than 3% whereas in sickle cell trait carriers no death could be certainly attributed to malaria. The S gene rate was significantly weaker (p < 0.05) in subjects attacked by Malaria (5%) than in all other groups of children. In the endemic malaria areas the susceptibility of S gene carriers appears to be lesser than in AA haemoglobin children and could explain the paradoxically lower rate of mortality in this group.

[A study of malaria morbidity in a pediatric hospital service in Benin (West Africa) in 1988 and 1989]. / Une étude de la morbidité palustre dans un Service hospitalier de Pédiatrie au Bénin (Afrique de l'Ouest) en 1988 et 1989.

Authors report on a prospective study about malaria morbidity, carried out from April 1988 to March 1989. Malaria diagnosis was based on: 1. An unexplained fever, hours before, during or after entrance. 2. A parasitic density superior to 3,000 trophozoites per mm3 of blood. 3. Efficacy of parenteral malaria therapy. Among 480 hospitalized children, 20% suffered from a malaria attack; 44% of malaria attacks occurred within 6 and 23 months of age. Thus, malaria incidence seems considerable in this urban and lagoon environment. Malaria attacks were observed all year long but with unequal seasonal rates of incidence. As regards malaria morbidity studies, we propose that rates of incidence should be calculated according to several parasitic density thresholds so as to be able to compare various works.