Depression in Working Adults: Comparing the Costs and Health Outcomes of Working When Ill

Objective

Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill (“presenteeism”) amongst employed Australians reporting lifetime major depression.

Methods

Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar).

Results

Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only.

Conclusions

Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.     

Optimal Cutoff Values of WHO-HPQ Presenteeism Scores by ROC Analysis for Preventing Mental Sickness Absence in Japanese Prospective Cohort

Objectives

Sickness absence due to mental disease in the workplace has become a global public health problem. Previous studies report that sickness presenteeism is associated with sickness absence. We aimed to determine optimal cutoff scores for presenteeism in the screening of the future absences due to mental disease.

Methods

A prospective study of 2195 Japanese employees from all areas of Japan was conducted. Presenteeism and depression were measured by the validated Japanese version of the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) and K6 scale, respectively. Absence due to mental disease across a 2-year follow-up was surveyed using medical certificates obtained for work absence. Socioeconomic status was measured via a self-administered questionnaire. Receiver operating curve (ROC) analysis was used to determine optimal cutoff scores for absolute and relative presenteeism in relation to the area under the curve (AUC), sensitivity, and specificity.

Results

The AUC values for absolute and relative presenteeism were 0.708 (95% CI, 0.618–0.797) and 0.646 (95% CI, 0.546–0.746), respectively. Optimal cutoff scores of absolute and relative presenteeism were 40 and 0.8, respectively. With multivariate adjustment, cohort participants with our proposal cutoff scores for absolute and relative presenteeism were significantly more likely to be absent due to mental disease (OR = 4.85, 95% CI: 2.20–10.73 and OR = 5.37, 95% CI: 2.42–11.93, respectively). The inclusion or exclusion of depressive symptoms (K6≥13) at baseline in the multivariate adjustment did not influence the results.

Conclusions

Our proposed optimal cutoff scores of absolute and relative presenteeism are 40 and 0.8, respectively. Participants who scored worse than the cutoff scores for presenteeism were significantly more likely to be absent in future because of mental disease. Our findings suggest that the utility of presenteeism in the screening of sickness absence due to mental disease would help prevent such an absence.     

Influence of the "Rijeka model" of bioethics education on attitudes of medical students towards death and dying--a cross sectional study

The aim of this study was to assess attitude towards euthanasia, and the influence of socio-demographic data and death education carried out through the "Rijeka model" of bioethics education for the first-year medical students of the School of Medicine, University of Rijeka, Croatia. The cross-sectional study was conducted in the academic year 20031 2004. 124 (61% female) participants were surveyed by using an anonymous questionnaire before and after training. Catholics (p = 0.003) and students from areas with populations of less than 50,000 inhabitants (p = 0.001) had significantly negative attitude towards euthanasia than others before the course, yet no differences were found following this training. Attitude towards euthanasia was significantly positive after the course (p = 0.005). All items in the questionnaire, except "Croatia should legalise euthanasia", received more positive scores after the course. Death education carried through the "Rijeka model" of bioethics education has changed attitudes of medical students towards a more positive perception of euthanasia.     

Coenzyme Q10-containing composition (Immugen) protects against occupational and environmental stress in workers of the gas and oil industry

The manual workers of the gas-and-oil extraction industry are exposed to hostile environmental and occupational conditions, resulting in elevated mortality and disability, due to chronic neurological and cardiovascular diseases. We evaluated the degree of oxidative stress, often associated with these pathological features, in the blood of manual and office employees of Russian Siberian extraction plants, and their psycho-physiological conditions. Results showed increased levels of spontaneous (p < 0.05) and PMA-activated (p < 0.01) luminol-dependent chemiluminescence (LDCL) in the white blood cells (WBC), and decreased peroxynitrite levels (p < 0.05) in the group of manual workers, and less markedly in the clerks and technicians working on spot, vs. a control group of city clerks. Superoxide release by WBC, and plasma/WBC membrane ubiquinol levels did not display major differences in the three groups. A relevant percentage of manual/office workers of extraction platforms presented impaired cardiovascular and neurological functions. The short term administration of a nutraceutical formulation based on coenzyme10, vitamin E, selenium, methionine and phospholipids led to significant improvement of cardiovascular parameters and psycho-emotional status, consistent with the normalization of LDCL and peroxynitrite production by WBC, with a good compliance to treatment confirmed by the increased blood levels of ubiquinol.     

Carbohydrate binding properties and carbohydrate induced conformational switch in sheep secretory glycoprotein (SPS-40): crystal structures of four complexes of SPS-40 with chitin-like oligosaccharides

Crystal structures of four complexes of sheep secretory glycoprotein (SPS-40) with N-acetylglucosamine oligosaccharides (GlcNAc(n), (n=3-6)) have been determined at moderate resolutions. The binding studies of SPS-40 have been carried out using fluorescence spectroscopy and Surface Plasmon Resonance (SPR). Structure determinations of four complexes have shown a novel binding pattern of GlcNAc(n) molecules to SPS-40. The results indicate that the most preferred recognition region in the carbohydrate binding groove in SPS-40 is at subsites -4 to -2 among which subsite -2 provides the maximum interactions with carbohydrate residues. These structures have also shown that the interactions of GlcNAc3 and GlcNAc4 do not perturb the protein structure and those of GlcNAc5 induce partial conformational changes while in the case of GlcNAc6 the partially closed binding groove opened up completely. As in other SPX-40 structures, SPS-40 structure contains three overlapping flexible surface segments, His188-His197, Phe202-Arg212 and Phe244-Pro260 with several charged residues protruding outwardly. It creates a cluster of positive charges with a flexible base thus indicating a good scope of promoting the intermolecular interactions. This protein is glycosylated at Asn39 and may recognize other receptors having sugar binding sites. It appears that SPS-40 may involve both carbohydrate and protein bindings. The systematic carbohydrate-binding studies and the detailed structural results of four protein-carbohydrate complexes provide an excellent insight into the mechanism of carbohydrate binding. These are the first studies of this kind on secretory glycoproteins and their interactions with carbohydrates.     

Workplace Health Promotion: Assessing the Cardiopulmonary Risks of the Construction Workforce in Hong Kong

Objective

Health needs of different employee subgroups within an industry can differ. We report the results of a workplace cardiopulmonary risk assessment targeting workers and support staff in the construction industry.

Methods

A free worksite-based cardiopulmonary risk assessment for 1,903 workers on infrastructural contracts across Hong Kong was initiated in May 2014. Cardiopulmonary risk screening was performed in 60-minute blocks for approximately 30 workers/block with individualized feedback and lifestyle counseling. Risk profiles stratified by occupational roles are differentiated using the χ²-test for categorical and Student’s t-test for continuous variables.

Results

Most construction workers and clerks/professionals were male (83.2% and 71.2%, respectively) and Chinese (78.7% and 90.9%, respectively). Construction workers were older (mean: 44.9 years, SD 11.5) and less well-educated (6.1% received tertiary education) than clerks/professionals (35.0 years, 10.7; 72.6% received tertiary education), but more likely to be hypertensive (22.6% vs. 15.4%, p<0.001), overweight/obese (71.7% vs. 56.6%, p<0.001), centrally obese (53.1% vs. 35.5%, p<0.001), and have undesirable levels of high-density lipoprotein (41.6% vs. 35.8%, p<0.05) and diabetic levels of non-fasting blood glucose (4.3% vs. 1.6%, p<0.05). Up to 12.6% of construction workers and 9.7% of office clerks/professions had three or more metabolic syndrome risk factors. While construction workers were more likely than clerks/professionals to be daily smokers, they reported better work-related physical activity and diet.

Conclusions

Simple worksite health risk screening can identify potentially high-cardiopulmonary-risk construction industry employee subgroups for onward confirmatory referral. Separate cardiopulmonary health promotion strategies that account for the varying lifestyle profiles of the two employee subgroups in the industry appear justified.     

Examining psychic consequences in firefighters exposed to stress

The total of 178 firefighters from the Littoral Mountainous County, the Republic of Croatia, have undergone psychotestings in three groups--99 professionals from city Rijeka, 44 professionals from suburb and 35 volunteers from suburb. The scores of PSS 10 Cohen Stress Perception Scale, COPE questionnaire, STAI X1 anxiety test as condition and STAI X2 anxiety test as trait personality and Beck Depression Inventory were analyzed. The results have shown that firefighters do not suffer from negative effects of stress. There is slight anxiety as condition in city firefighters and medium anxiety as trait personality in all firemen. All firefighters are often problem-oriented, need only occasionally compassion of environment and sometimes react by avoiding to face stress. They differ significantly by depression (p < 0.001), which is negligible in relation to ordinary population. "Working anxiety", i.e. medium anxiety which is a distinctive trait of their personality becomes the necessary initiator of functioning in the most difficult working conditions.     

Usual meal times in relation to age, sex, work activity and morningness-eveningness

Meal-timing is considered an important socio-environmental synchronizer of circadian rhythms and influences human metabolism; the temporal distribution of food intake has also an influence on human performance. In these last years, in industrialized countries, remarkable changes, both in quality and quantity and in timing, have been determined in eating behavior brought about by changes in social and working organization. In this study the authors have verified the usual mealtimes during working and free-days in a population of 670 city-dwellers, 404 men and 266 women, aged between 17 and 60, including students, housewives, clerks, artisans, tradesmen and industrial workers. The results can be summarized as follows: a. the times of the two main meals show a high stability, both in working and in free-days, at about 1230 for lunch and 1915 for dinner, with a higher variability for the dinner-time; b. there are no relevant differences between men and women; c. there is a progressive advance of the breakfast-time (together with sleeping and waking times) with oncoming age; d. industrial workers advance the breakfast-time, on work days, compared to housewives, clerks, artisans and tradesmen, while the latter delay dinner-time as compared to the others; e. shiftwork breaks up the usual timetables interfering with at least one of the main meals, according to the different shifts (morning, afternoon, night); f. morning types anticipate meal and sleeping times in comparison to evening types, both while working and, above all, on free-days.     

Impact of nightshift work on overweight and abdominal obesity among workers of a poultry processing plant in southern Brazil

The authors examined the associations of shiftwork with overweight and abdominal obesity through a cross-sectional study of 1206 employees 18 to 50 yrs of age who were working on a production line in a poultry processing plant. Night-shift workers (n = 800) were considered exposed, whereas day shiftworkers (n = 406) were considered nonexposed. Overweight was defined as a body mass index ≥ 25 kg/m(2) and abdominal obesity as a waist circumference ≥ 88 cm in women and ≥ 102 cm in men. The mean age of the workers was 30.5 yrs (standard deviation = 8.7 yrs), and 65.2% were women. Nightshift workers compared to dayshift workers showed higher prevalences of overweight (42.2% vs. 34.3%; p=?.020) and abdominal obesity (24.9% vs. 19.5%; p =?.037). After adjusting for sociodemographics, parental overweight status, behavioral characteristics, and sleep characteristics, including hours of sleep, the prevalence ratios for overweight and abdominal obesity were 1.27 (95% confidence interval [ CI]: 1.00-1.61) and 1.45 (95% CI: 1.10-1.92), respectively, for the nightshift workers compared to the dayshift workers. A consistent finding in our study was the independent contribution of night shiftwork to overweight and abdominal obesity among Brazilian workers. Further studies are needed to understand the biological mechanisms involved and the complex behavioral and social adaptations experienced by night-shift workers.     

Effects of shift work on attention deficit,hyperactivity, and impulsivity,and their relationship with chronotype

There is growing evidence that shift-work schedules cause severe disturbances to circadian rhythms and the sleep–wakefulness cycle, and that these changes in turn lead to cognitive and behavioral problems. The objective of this study is to explore the relationships between biological rhythm differences (chronotype) and impulsive behaviors and attention-deficit hyperactivity symptoms in shift workers. Seventy-nine nurses working in the daytime and 127 nurses working on night shifts were evaluated with the Barratt Impulsiveness Scale, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), and Morningness–Eveningness questionnaire for identifying circadian preference. It was found that shift workers had more attention deficit (p < .05) and impulsivity (p < .01) when compared with daytime workers. Morning-type workers reported lower hyperactivity and ASRS total scores than evening- and intermediate-type workers. The mean impulsivity score of evening-type workers was higher than both the other groups (p < .05). It has been shown that attention deficit, hyperactivity, and impulsivity levels that appear as a result of working shifts might change in accordance with the individual’s chronotype. It might, therefore, be desirable to evaluate an individual’s chronotype to establish suitability for working shifts.     

Progression of age related maculopathy in phakic versus pseudophakic eyes

Age-related maculopathy (ARM) is one of the leading causes of central visual acuity loss in older western population. Many factors are responsible for the fast development of ARM. One of this is significant increases of optical radiations through artificial lens after removal of the catarctous lens. The aim of this study was to compare progression of ARM in phakic and pseudophakic patients and to calculate the possibility ofpseudophakia as a risk factor for faster progression of ARM. Medical records of 76 patients, older than 60 years (32 male and 44 female) with early forms of ARM were randomly evaluated. They had undergone cataract removal by phacoemulsification with intraocular lens implantation from January 2002 to December 2006 at the Department of Ophthalmology, Rijeka University Hospital, Croatia. Patients were examined two weeks after the surgery and followed up for two years. The control group consisted of 48 patients (21 males and 27 females) with also early forms of ARM, older than 60 years, examined at the Policlinic Department from January 2006 to December 2006 and followed up at least for two years without any cataract surgery. Comparing progression of ARM in these two groups, a total of 19 patients (25%) in pseudophakic group showed progression to late forms of ARM, but only 6 patients (12.5 %) in the control group developed these aggressive ARM forms. More aggressive forms of ARM in pseudophakic group indicate that pseudophakia should be considered as a risk factor for development of ARM.     

The genotoxic risk of hospital, pharmacy and medical personnel occupationally exposed to cytostatic drugs--evaluation by the micronucleus assay

The aim of this study was to evaluate the genotoxicity of cytostatic drugs in hospital and pharmacy employees (n=100), occupationally exposed. The micronucleus assay was used to study lymphocytes in 247 peripheral blood samples. Samples were collected at "baseline level" without any cytostatic drugs exposure before recruiting or after at least 3 weeks without cytostatic drugs contact and at three times (cycle 1-3) post-exposure. Samples from 60 office employees served as controls. Furthermore, our results were compared to urinary analyses of cytostatic drugs (oxazaphosporines, anthracyclines, platinum) which were collected in parallel to the cytogenetic investigation. Statistical analyses were performed under consideration of age, gender and X-ray exposure. The frequency of micronuclei was significantly related to the age of the subjects (r(Spearman)=0.16; P<0.05). However, there were no significant differences in micronucleus rates between controls and exposed hospital workers. Similarly, micronucleus rates were not significantly different at the various sampling time points and there was no correlation between duration of employment and micronucleus rates. Furthermore, no correlation between current biomonitoring data of exposure (urine tests) and micronuclei frequency was found. Therefore, significantly increased genotoxic damage of the lymphocytes investigated in this study could not be demonstrated.     

Simulation of working conditions by maximum work load on firefighters

The aim of this research is to find out whether the firefighter manpower is adequate to the requirements in the field under the most severe conditions. It also attempts to test whether firefighters' working ability corresponds to their age. To that purpose 220 Croatian firefighters from the Littoral Mountainous county, 99 professional firefighters from the city of Rijeka, 45 professional firefighters from its suburbs and 76 volunteer firefighters from the suburbs were submitted to load test, fitness test--stepping on the bench for three minutes, repetitive power test--sit-ups lasting 1 minute, and a leap-explosive power test. The fitness test was repeated carrying Drd?er's respiratory apparatus PSS 100 with compressed air, so respiratory values were compared before and after the burden of the respiratory apparatus. The results have shown that professional firefighters from the city have the mean increased body mass index (BMI) 26, and professionals from the suburbs BMI 27. In spite of the increased body mass they showed good fitness, spirometric values before and after the load showed neither restrictive nor obstructive ventilation difficulties, which indicates a good condition of cardio respiratory system and also adequate protective equipment. The initial hypothesis has been confirmed: with age, equipped with personnel does not necessarily mean operative equipment, because linear regressive analyses have shown a negative correlation coefficient in relation to repetitive and explosive power. Also, on the average somewhat younger volunteer firefighters are stronger in performing the repetitive power test (p < 0.05) compared to professional firefighters. Occupational medicine should suggest administrative health measures to improve the accelerated retirement plan and shorten the shifts so that all available firefighters could instantaneously be included in the field intervention.     

Prognostic values of morphological and clinical parameters in pT2-pT3 prostate cancer in elderly people

Prostate cancer is a disease of elderly men, the incidence of which increases in an age dependent manner. This study presents the correlation of clinical and morphological parameters in locally confined (pT2) and locally advanced (pT3) prostate cancer. We analyzed a group of elderly men treated with radical prostatectomy in the period 1999-2008 in the University Hospital Rijeka. We found no statistical association between pT stage and age categories, preoperative prostate-specific antigen, digitorectal examination and biopsy Gleason score. There was a significant correlation of higher Gleason score in prostate specimens after radical prostatectomy and a higher frequency of a positive surgical margin in tumors with pT3 than in pT2 stage (p = 0.003; p = 0.011 respectively). Recurrence-free survival was shorter in patients with tumors with positive surgical margins as well as in patients with pT3 stage (p = 0.030; p = 0.001 respectively). We conclude that higher tumor grade and positive surgical margins are indicators of a worse prognosis in our patients.     

Shift work tolerance and the importance of sleep quality: a study of police officers

The aim of this study was to examine how subjective shift work tolerance was related to general health variables, with the expectation of inter-individual differences in the nature of this relation. A total of 740 employees of the Dutch Police force completed a questionnaire, covering seven health-related domains: sleep quality, sleep duration, need for recovery, fatigue, physical health, mental health, and work–life balance. Based on subjective reports of shift work tolerance, participants were classified as intolerant, medium-tolerant, or tolerant workers. Analysis involved group comparisons, regression, and cluster analysis. Eighteen percentage of the shift workers were classified as intolerant. The intolerant and medium-tolerant workers expressed more severe complaints than the tolerant workers, for all seven health-related domains. Shift work tolerance was primarily related to sleep quality and subsequently to need for recovery, fatigue, and work–life balance. No indications were found for systematic inter-individual differences in the nature of this relationship. For all participants equally, the degree of shift work tolerance was related to the severity of health-related complaints. This study highlights the central role of sleep for tolerance to shift work and underlines the need for occupational medicine to take explicit account of sleep.     

Teen at work: the burden of a double shift on daily activities

The purpose of this study was to the evaluate time spent by working and nonworking adolescents on daily activities (work, home duties, school, transportation, other activities, leisure, sleep, and naps). Twenty-seven students, 8 male workers, 8 female workers, 5 male nonworkers, and 6 female nonworkers, ages 14-18 yrs participated in the study. They attended evening classes Monday-Friday (19:00-22:30h) in a public school in the city of S?o Paulo, Brazil. The students answered a comprehensive questionnaire on the characterization of their life, work, and health conditions. Simultaneously, they wore actigraphs (Ambulatory Monitoring, Inc.) and completed a diary of their daily activities (time spent at work, on home duties, commuting, leisure, other activities) for a minimum of 10 to a maximum of 17 consecutive days. The means of the variables were tested for differences by a two-factor (work and sex) ANOVA and Student-t test applied to pair-wise samples (weekdays and weekends). The average duration during weekdays of working time was 7 h 09 min and home duties 0 h 48 min. As for commuting time, there was a work effect [F(1,23) = 4.9; p = 0.04]; mean commuting time was 2 h 22 min for workers (males and females) and 1 h 25 min for nonworkers. There was a significant difference between workers and nonworkers [F(1,23) = 4.6; p = 0.04] regarding extra-cirricular class activities; workers spent a mean of 3 min/day on them as opposed to 1 h 14 min by nonworkers. The average daily time spent on leisure activities by workers was 6h 31 min; whereas, for nonworkers it was 7h 38min. Time spent in school amounted to 2h 47min for workers in comparison to 3h 22min by nonworkers. There was a significant work effect upon sleep [F(1,23)= 10.0; p <0.01]. The work effect upon nighttime sleep duration was significant [F(1,23)= 16.7; p <0.01]. Male workers showed a mean night sleep of 6 h 57 min and female workers 07h 15min. The average nighttime sleep duration for nonworkers was 9 h 06 min. There was a significant interactive effect between work and sex [F(1,23)= 5.6; p=0.03] for naps. Female workers showed took shortest nap on average (36 min; SD = 26 min), and female nonworkers the longest naps (1 h 45min; SD= 35min). Study and employment exert significant impact on the life and activities of high school students. Work affects sleep and nap duration plus the amount of time spent in school and other extra-curricular activities.     

Postprandial metabolic profiles following meals and snacks eaten during simulated night and day shift work

Shift workers are known to have an increased risk of developing cardiovascular disease (CVD) compared with day workers. An important factor contributing to this increased risk could be the increased incidence of postprandial metabolic risk factors for CVD among shift workers, as a consequence of the maladaptation of endogenous circadian rhythms to abrupt changes in shift times. We have previously shown that both simulated and real shift workers showed relatively impaired glucose and lipid tolerance if a single test meal was consumed between 00:00-02:00 h (night shift) compared with 12:00-14:00 h (day shift). The objective of the present study was to extend these observations to compare the cumulative metabolic effect of consecutive snacks/meals, as might normally be consumed throughout a period of night or day shift work. In a randomized crossover study, eight healthy nonobese men (20-33 yrs, BMI 20-25kg/m2) consumed a combination of two meals and a snack on two occasions following a standardized prestudy meal, simulating night and day shift working (total energy 2500 kcal: 40% fat, 50% carbohydrate, 10% protein). Meals were consumed at 01:00/ 13:00 h and 07:00/19:00h, and the snack at 04:00/16:00 h. Blood was taken after an overnight fast, and for 8 h following the first meal on each occasion, for the measurement of glucose, insulin, triacylglycerol (TAG), and nonesterified fatty acids (NEFA). RM-ANOVA (factors time and shift) showed a significant effect of shift for plasma TAG, with higher levels on simulated night compared to day shift (p < 0.05). There was a trend toward an effect of shift for plasma glucose, with higher plasma glucose at night (p = 0.08), and there was a time-shift interaction for plasma insulin levels (p < 0.01). NEFA levels were unaffected by shift. Inspection of the area under the plasma response curve (AUC) following each meal and snack revealed that the differences in lipid tolerance occurred throughout the study, with greatest differences occurring following the mid-shift snack. In contrast, glucose tolerance was relatively impaired following the first night-time meal, with no differences observed following the second meal. Plasma insulin levels were significantly lower following the first meal (p < 0.05), but significantly higher following the second meal (p < 0.01) on the simulated night shift. These findings confirm our previous observations of raised postprandial TAG and glucose at night, and show that sequential meal ingestion has a more pronounced effect on subsequent lipid than carbohydrate tolerance.     

Correlation of levels of depressiveness and choice of elective subjects in medical students

The aim of this research was to establish if a correlation exists between the choice of an elective subject, namely subjects "Depression" and "Diabetes", and levels of depressiveness in medical students. Three groups of third year medical students attending School of medicine, Rijeka University, were tested for the level of depression using Beck's self-evaluation scale. The groups consisted of 30 non-randomly selected students that had enrolled elective subject "Depression" and 29 non-randomly selected students that had enrolled elective subject "Diabetes", and the third group of 30 randomly selected third year medical students that had enrolled none of the previously mentioned elective subjects. Median age of participants in this research was 25.24. The results showed no statistically significant difference in overall level of depressiveness among the groups. By testing for the difference between group pairs, there was a statistically significant difference between depressiveness in students attending "Depression" and "Diabetes", the latter being significantly more depressed (M = 8.30 in "Depression" group; M = 11.41 in "Diabetes" group; p = 0.04). In total there were 33 males and 56 females that participated in this research. Gender difference was also tested, and there was no statistically significant difference between sexes among groups. The difference was found only within the group of students attending "Depression" elective subject, where females scored significantly higher on Beck's questionnaire (z = 2.26; p = 0.03). The analysis of difference between items of the Beck's questionnaire showed statistically significant difference in the item "Feeling of rejection", where students attending elective subjects other then "Depression" scored significantly higher; differences in the items "Urge for punishment" and "Suicidal tendencies" were also found between "Diabetes" and "other elective subjects" group, in favor of "Diabetes" group; in the item "Weight loss" students attending "Diabetes" elective subject scored significantly higher then their peers in both other groups. The results indicate the possibility of a protective role of psycho-educative component provided to the students attending elective subject on depression within medical school environment, that has repeatedly been shown to be stressful and demanding and is beneficial for the onset of depressive disorders.     

The fortysomething barrier: medicine and age discrimination.

Agism in the medical profession is mainly covert but it is not uncommon. It is widely believed that people become less productive as they get older. However, research has shown that older people have less absenteeism, more job stability, and greater output than younger workers. Job losses, which until recently were unheard of in the NHS, usually affect older people first, resulting in the loss of those with the most skill and experience. With an aging population it is important that the government takes steps to discourage age discrimination in the NHS and Britain as a whole.