Occupation, social support and quality of life in persons with schizophrenic or affective disorders.

BACKGROUND: Most people suffering from severe mental illness (SMI) lack paid employment. This study investigates the relationship between work status and objective as well as subjective quality of life (QoL) in people with SMI. METHODS: The sample consists of 261 subjects (102 women, 159 men) aged 35 (men) and 38 (women) years on average, of whom 158 suffer from a schizophrenic disorder (ICD-10: F2) and 103 were diagnosed as having an affective disorder (ICD-10: F3). Subjective QoL was assessed with the WHOQOL-BREF scale. RESULTS: Subjects with an occupation in general have a larger social network at their disposal and receive more social support. With regard to income, few (12%) of the subjects with a job on the open labour market live below the poverty level, but many (28-38%) of those engaged in sheltered or other work-like activities do. Occupation ameliorates satisfaction with life domains referring to social integration (social relationships, environment), whereas the individual's well-being (psychological, physical) is hardly affected. Social support is an important mediator of the relationship between occupation and subjective QoL. Income is weakly and negatively related to subjective QoL. CONCLUSIONS: Supportive relationships to colleagues at the workplace mainly explain the better subjective QoL of SMI people with an occupation. When designing specific employment possibilities for people with SMI, we should take notice of the social support dimension at the workplace. Mentally ill people have a substantial poverty risk, even when they are working. In particular, payment for sheltered work should be ameliorated.

[Social change in the physician's role and medical practice caused by managed care in Switzerland]. / Sozialer Wandel der Arztrolle und der Arzteschaft durch Managed Care in der Schweiz.

Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

[Who is rehospitalized in a psychiatric hospital? Psychiatric hospitalization rates and social indicators in the Zurich canton (Switzerland)]. / Wer wird psychiatrisch rehospitalisiert? Psychiatrische Hospitalisierungsraten und soziale Indikatoren im Kanton Zürich (Schweiz).

There are two approaches in the research on the relation between social conditions and mental disorder: The ecological approach is concerned with characteristics of the social composition of a certain geographical area and their relation to the frequency of disorders, whereas for the individualistic view variables of the psychosocial background of the individual are of interest. This study is on the risk for psychiatric admission (first and re-admission). While considering variables of the social context of the community as well as of the background of the individual, it tries to take into account both the ecological and the individualistic view of the relationship between social conditions and (treated) mental disorder. The sample of the study includes data of 4021 psychiatric inpatients treated in 1997 in one of the seven psychiatric hospitals of the Swiss canton of Zurich as well as data of social context of the 171 communities of the canton of Zurich. The psychiatric first and re-admission rates of the community can be predicted by the following variables of its social context: 1. pro portion of foreigners, 2. urban character of the living area, 3. population density. Two other variables are of relevance only for the prediction of first admissions: 4. proportion of one-person households and 5. local tax rate. However, further results of the study show that correlations between variables of the social context and psychiatric admission rate of the community cannot be interpreted as risks for the individual.

[Social support, social stress and health of slightly disabled elderly persons]. / Soziale Unterstützung, soziale Belastungen und Gesundheit bei leicht hilfebedürftigen Betagten.

The paper examines the influence of social networks on social support and social stress and analyses the impact of social support and stress on health. 171 (t1, 1992) and 135 (t2, 1993) persons aged 75 and older in need of a little help but still living on their own were personally interviewed in three districts of the city of Zurich. The results demonstrate that social networks are important for mobilizing social support and that these mobilizing processes are characterized by sex differences: The family (i.e. the partner) is much more important for men than for women who rely both on family and non-family social networks. There are only weak relationships between social networks and social stress. Social support affects health positively by indirect mechanisms. From t1 to t2 social networks, social support and health remain rather constant while social stress changes substantially.

[Spontaneous and organized support among Italian women and men in the city of Zurich]. / Spontane und organisierte Hilfe unter Italienerinnen und Italienern in der Stadt Zürich.

Subject of this article is the empirical base, the goal, origin and founding of the "Agenzia isa (informazioni, scambi e aiuto nel vicinato)". The "Agenzia isa" is a small agency promoting and mediating mutual voluntary neighbourhood help among Italian immigrants in the city of Zürich, Switzerland. The agency started its services in June 1993. Improving social support among the Italian immigrants is considered to be preventive health care to promote health (especially in the realm of stress-provoked illness). The founding and development of the agency are followed up documented and evaluated. The problem of segregation was an important theoretical starting point for the project. A third way between the classical concepts (assimilation/integration and remigration) was conceptualised for the Italian immigrants. This third way aims at establishing a link between the agency and the Swiss medical and social care system. An important idea for this innovative project was that people living in the context of emigration possible need new types of structures for help. This idea is based on the experience that often traditional structures from the home context of the immigrants are longer sufficient and Swiss structures are not utilised possible because they are considered too foreign. The situation of social support and help needed by Italian immigrants is discussed on the basis of empirical results of a survey in one district of the city of Zürich. The realisation of the "Agenzia isa" is then described.

[Economic status of the elderly and claims for financial support]. / Wirtschaftliche Lage Betagter und Inanspruchnahme finanzieller Unterstützung.

The health-related and social needs of aged people and their fulfillment are studied. Only a very weak relation is found between the financial situation and the claims for possible financial resources. On the other side education is found to have a key position for the drawing of supplementing pensions. The problems resulting for the assignment of financial support to aged people are discussed.

[Causal attributions and coping with illness by breast cancer patients: results of a longitudinal study]. / Kausalattribution und Krankheitsverarbeitung bei Brustkrebspatientinnen: Ergebnisse einer Längsschnittuntersuchung.

The present 3-year longitudinal study investigated the relationship between causal attribution and coping mechanism. Data were collected in a group of 66 breast cancer patients by self-report questionnaires. Three issues were addressed: 1. How do the patients explain the cause of their illness? 2. Do the subjective causes change over the course of three years? 3. What kind of relationship can be found between the causal attributions and the coping mechanism of the patients? Results showed a predominance of psychological attribution. Only little statistical prove could be found for changes between the four ratings. Analysing the individual data of the patients however revealed changing perceptions for about half the patients. A relationship between psychological attribution and depressive coping and problem solving as well were found.

Purification and biochemical characterization of the hydantoin hydrolyzing enzyme from Agrobacterium species. A hydantoinase with no 5,6-dihydropyrimidine amidohydrolase activity.

A soluble hydantoinase (5,6-dihydropyrimidine amidohydrolase) was purified to homogeneity from a newly isolated Agrobacterium species. This hydrolase consists of about 578 aminoacyl residues and is a slightly acidic protein with an isoelectric point of 6.5. The first 22 N-terminal amino acid residues were determined by Edman degradation. Determination of the relative molecular mass of the protein by gel-filtration chromatography gave an apparent value of 250,000. The subunit M(r) was 62,000, as estimated by analytical SDS/PAGE and 66,500, as estimated by denaturing gel-filtration chromatography. The pure hydantoinase exhibits the following hydrodynamic properties: a sedimentation coefficient of 8.8 S as determined by sedimentation velocity experiments; a Stokes radius of 6.8 nm; a diffusion coefficient of 31.5 microns2.s-1 as determined by analytical gel-filtration chromatography. From these experimental data, the following physical constants could be calculated: a theoretical M(r) of 265,000, a frictional ratio, f/fo, of 1.59, a maximal axial ratio, a/b, of 3.1; a Perrin shape factor, F, of 1.37. As shown by different Km values, the preferred substrates of this hydrolase were 5-monosubstituted hydantoins bearing aromatic substituents. 5,5-Dimethylhydantoin and different thio analogs of the 5-p-hydroxyphenylhydantoin molecule are competitive inhibitors of this hydrolase. The classification of this microbial hydantoinase, which exhibits no hydrolytic activity with all the dihydropyrimidines tested, under the systematic name of 5,6-dihydropyrimidine amidohydrolase, and its putative metabolic role are further discussed.

A novel method for the preparation of substrate-free cytochrome P-450(11) beta.

A new method for the removal of the stabilizing substrate, deoxycorticosterone, from adrenal cytochrome P-450(11) beta, has been developed. Dextran coated charcoal is used for the adsorption of the steroid and the adsorbed steroid is separated from the cytochrome P-450-preparation by low speed centrifugation. The substrate-free enzyme, obtained in this manner, has all the characteristic spectral properties of low-spin cytochrome P-450(11) beta and may be converted to the high-spin form by the addition of deoxycorticosterone. The dextran coated charcoal method has the following advantages over the previously used method of substrate removal. It does not require the addition of the cofactors for cytochrome P-450-dependant hydroxylation of deoxycorticosterone, small amounts of enzyme may be prepared in a short time and the enzyme preparation is not diluted to any great extent during the process.