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Johnson S.,University College London | Osborn D.P.J.,University College London | Araya R.,University of Bristol | Wearn E.,University College London | And 8 more authors.
British Journal of Psychiatry | Year: 2012

Background: High-quality evidence on morale in the mental health workforce is lacking. Aims: To describe staff well-being and satisfaction in a multicentre UK National Health Service (NHS) sample and explore associated factors. Method: A questionnaire-based survey (n = 2258) was conducted in 100 wards and 36 community teams in England. Measures included a set of frequently used indicators of staff morale, and measures of perceived job characteristics based on Karasek's demand-control-support model. Results: Staff well-being and job satisfaction were fairly good on most indicators, but emotional exhaustion was high among acute general ward and community mental health team (CMHT) staff and among social workers. Most morale indicators were moderately but significantly intercorrelated. Principal components analysis yielded two components, one appearing to reflect emotional strain, the other positive engagement with work. In multilevel regression analyses factors associated with greater emotional strain included working in a CMHT or psychiatric intensive care unit (PICU), high job demands, low autonomy, limited support from managers and colleagues, age under 45 years and junior grade. Greater positive engagement was associated with high job demands, autonomy and support from managers and colleagues, Black or Asian ethnic group, being a psychiatrist or service manager and shorter length of service. Conclusions: Potential foci for interventions to increase morale include CMHTs, PICUs and general acute wards. The explanatory value of the demand-support-control model was confirmed, but job characteristics did not fully explain differences in morale indicators across service types and professions.

Richards M.,Medical Research Council Unit for Lifelong Health and Ageing
The journals of gerontology. Series B, Psychological sciences and social sciences | Year: 2011

A wide variety of factors across the life course jointly influence cognitive and emotional development. Indeed, research from a variety of disciplines strongly suggests that cognition and mental health are intertwined across the life course, by their common antecedents and underlying physiology in development and in their interplay across adult and later life. We suggest that cognitive and socioemotional function fuse to form skills for life supporting self-regulation, competence, and quality of life that persist into later life through linked reciprocal processes of genetic influence, nurturing, schooling, work, and lifestyle.

Almoosawi S.,Medical Research Council Human Nutrition Research | Prynne C.J.,Medical Research Council Human Nutrition Research | Hardy R.,Medical Research Council Unit for Lifelong Health and Ageing | Stephen A.M.,Medical Research Council Human Nutrition Research
Journal of Hypertension | Year: 2013

OBJECTIVES: The role of circadian rhythm of energy and macronutrient intake in influencing cardiometabolic risk factors is increasingly recognized. However, little is known of the association between time of energy intake and blood pressure. We examined the association between time-of-day of energy intake and subsequent hypertension and change in blood pressure. METHODS: The analysis included 517 men and 635 women from the 1946 British birth cohort. Diet was assessed using 5-day estimated diaries. Diaries were divided into seven meal slots: breakfast, mid-morning, lunch, mid-afternoon, dinner, late evening and extras. Time-of-day of energy intake at age 43 years was related to hypertension prevalence at 43 years and incidence at age 53 years and 10-year changes in SBP and DBP using logistic regression and censored regression controlling for medication use. RESULTS: Cohort members in the highest quintile of energy intake at breakfast at age 43 years had 30% lower odds of hypertension prevalence compared with those in the lowest. Cohort members in the highest quintile of energy intake at late evening had higher odds of incident hypertension at age 53 years [odds ratio = 1.55; 95% confidence interval (CI) 0.93-2.61; P for linear trend = 0.052]. Compared to the lowest quintile, the highest quintile of energy intake late in the evening was related to a greater rise in SBP (β = 5.09; 95% CI 1.25-8.93) and DBP (43-53 years) (β = 2.08; 95%CI 0.27-5.32). CONCLUSION: Higher energy intake at breakfast is associated with lower hypertension prevalence. Greater energy intake late in the evening is associated with higher hypertension prevalence, incidence and greater increases in blood pressure. © 2013 Wolters Kluwer Health | Lippincott Williams &Wilkins.

Becares L.,University of Manchester | Shaw R.,University of Southampton | Nazroo J.,University of Manchester | Stafford M.,Medical Research Council Unit for Lifelong Health and Ageing | And 5 more authors.
American Journal of Public Health | Year: 2012

It has been suggested that people in racial/ethnic minority groups are healthier when they live in areas with a higher concentration of people from their own ethnic group, a so-called ethnic density effect. Ethnic density effects are still contested, and the pathways by which ethnic density operates are poorly understood. The aim of this study was to systematically review the literature examining the ethnic density effect on physical health, mortality, and health behaviors. Most studies report a null association between ethnic density and health. Protective ethnic density effects are more commonthanadverseassociations, particularly for health behaviors and among Hispanic people. Limitations of the literature include inadequate adjustment for area deprivation and limited statistical power across ethnic density measures and study samples.

Peterzan M.A.,Imperial College London | Hardy R.,Medical Research Council Unit for Lifelong Health and Ageing | Chaturvedi N.,Imperial College London | Hughes A.D.,Imperial College London
Hypertension | Year: 2012

Thiazide and thiazide-like diuretics are widely used in the management of hypertension, but recently the equivalence of hydrochlorothiazide and chlorthalidone for blood pressure (BP) lowering and prevention of cardiovascular disease has been questioned. We performed a meta-analysis to characterize the dose-response relationships for 3 commonly prescribed thiazide diuretics, hydrochlorothiazide, chlorthalidone, and bendroflumethiazide, on BP, serum potassium, and urate. Randomized, double-blind, parallel placebo-controlled trials meeting the following criteria, ≥2 different monotherapy dose arms, follow-up duration ≥4 weeks, and baseline washout of medication ≥2 weeks, were identified using Embase (1980-2010 week 50), Medline (1950-2010 November week 3), metaRegister of Controlled Trials, and Cochrane Central. A total of 26 trials examined hydrochlorothiazide, 3 examined chlorthalidone, and 1 examined bendroflumethiazide. Studies included a total of 4683 subjects in >53 comparison arms. Meta-regression of the effect of thiazides on systolic BP showed a log-linear relationship with a potency series: bendroflumethiazide> chlorthalidone>hydrochlorothiazide. The estimated dose of each drug predicted to reduce systolic BP by 10 mm Hg was 1.4, 8.6, and 26.4 mg, respectively, and there was no evidence of a difference in maximum reduction of systolic BP by high doses of different thiazides. Potency series for diastolic BP, serum potassium, and urate were similar to those seen for systolic BP. Hydrochlorothiazide, chlorthalidone, and bendroflumethiazide have markedly different potency. This may account for differences in the antihypertensive effect between hydrochlorothiazide and chlorthalidone using standard dose ranges. © 2012 American Heart Association, Inc.

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