The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women.

A sizable body of evidence indicates that prenatal maternal stress (PNMS) has an adverse impact on birth outcomes, including birth weight and gestational age at delivery. The authors hypothesized that effects of PNMS are attributable in part to dispositions such as pessimism that lead women to view their lives as stressful and that effects of PNMS and disposition on birth outcome are mediated by prenatal health behaviors. Using structural equations modeling procedures, the authors examined prospective impact of PNMS and dispositional optimism on birth weight and gestational age in a medically high-risk sample (N = 129), controlling for effects of risk and ethnicity. After its strong inverse association with optimism was accounted for, PNMS had no impact on birth outcomes. Women who were least optimistic delivered infants who weighed significantly less, controlling for gestational age. Optimists were more likely to exercise, and exercise was associated with lower risk of preterm delivery. Results suggest that chronic stress in pregnancy may be a reflection of underlying dispositions that contribute to adverse birth outcomes.

The troubled employee. Role of the medical department.

Occupational medical departments are frequently called upon to deal with the troubled employee. Successful rehabilitation is significantly improved by early identification before significant work-related problems exist. Self-referral or diagnosis by the medical department staff are therefore the preferred means of detection. In that the medical conditions identified tend to be chronic, on-going follow-up of the troubled employee by the medical department is often indicated. In cases in which business-related issues have been identified, the occupational physician is often in a unique position to interact with both the treating physician and management to attempt rehabilitation and, where possible, selective job placement. Ethical dilemmas in handling information can be formidable, particularly when the interests of the troubled employee, management, and fellow workers diverge.

The psychiatric patient at work.

Psychiatric consultations and job performance of 135 IBM employees were studied. Psychiatric referrals were made by management and the company medical department or were self-referred. The consulting psychiatrist conducted interviews, met with management, personnel representatives and other physicians to coordinate treatment with job requirements. Every effort was made to retain employees and improve performance. After a two-three year follow-up period, 82 employees (61.7 per cent) were with the company; ten were rated outstanding, 38 exceeded job requirements, 25 were meeting job requirements, and four were not. Performance data for five employees were not available. Forty-nine of 83 employees (59.0 per cent) rated unsatisfactory in job performance at the initial referral were performing satisfactorily at follow-up. The results support an optimistic attitude toward the working patient with psychiatric disease and highlight the value of a full-time medical department with consultation facilities leading to secondary and tertiary prevention.