Illustration by
Gilbert Ford |
In the United States today, the major ailments that keep
employees on the sick list, Bernacki says, fall into five
categories: muscular skeletal disorders, arthritic
conditions, depression, migraines, and cardiovascular
disease. Decreasing the incidence and duration of these
ailments, Bernacki says, can have a far greater impact on
productivity than any motivational speech or office space
makeover. In Bernacki's eyes, any effort to increase worker
productivity should follow a three-word strategy: Keep
people well.
"That is the goal of our division," Bernacki says. "As the
workforce ages, we need to ask ourselves how we can
intervene to reduce the risk of disability from disease.
Thus, our research mission is to look at the application of
medicine to reduce disability duration and actual medical
care cost, etc., amongst working-age individuals."
To accomplish its goals, Occupational Medicine provides
consulting services and occupational health programs to
businesses. The division currently has contracts with such
major employers as Pepsi Bottling Group and Hughes
Electronics Corp., where it places Hopkins-trained nurse
practitioners and physician assistants to help manage
health care for employees. The major problem in U.S. health
care today, Bernacki says, is that care is fragmented and
people often don't have a primary physician to
"quarterback" their care.
"Employees don't see a physician right away, or they might
fail to keep a doctor's appointment and let something
progress too far, which in turn can lead a person to be out
of work for long periods," Bernacki says. "What we attempt
to do is intervene early in the disease process and help
knit together a person's care to get them back to work.
This is exactly what we do for Pepsi and employees here at
Johns Hopkins — we try to manage the individual's
case so they don't become worse. Muscles, for example, get
deconditioned very rapidly though inactivity. If you can
slow down the downward trajectory by coordinating care, he
or she can get back to work a lot earlier."
What someone might perceive as laziness, might in reality
be an undiagnosed ailment that can be controlled.
"Depression, for instance, can mask for laziness," Bernacki
says. "That individual may not be lazy, but he or she has
so many competing problems that they are unable to do their
job properly. But once an individual is on the proper
medication they are fine and able to work."
Johns Hopkins holds itself up as a role model in terms of
occupational health, Bernacki says. Twelve years ago
Hopkins had roughly 240 people out on any given day on
worker's compensation, compared to the 40 to 45 absent on
any given day now for a workforce twice as large. Hopkins
has been successful in reducing lost hours by pooling its
health-related resources, Bernacki says, whether that means
offering flu shots, initiating programs in ergonomics-based
injury prevention, or going latex-free as part of an effort
to reduce contact dermatitis. The net result: more people
able to come to work. —GR
On the Sin of Being a Layabout
Homewood House
took five years and $40,000 (four times its planned
expense) to complete. Today, It stands as one of the most
elegant and widely copied Federal-period homes in the
country. So it's hard to believe that the man who oversaw
its design and construction, Charles Carroll Jr., was a bit
of a layabout.
|
Illustration by
Gilbert Ford |
This is just one of the most recent examples of how sadness
can take its toll on your heart's health, according to Roy
C. Ziegelstein, executive vice chairman of the
Department of Medicine at
Johns
Hopkins Bayview Medical Center and director of the
Residency Program in Internal Medicine. "There are a
variety of ways that sadness and heart health are
connected," he says.
Heartfelt
Connection: "It's possible that the two
conditions, depression and heart disease, are linked in a
way that people might be more prone to develop both,"
Ziegelstein says. The link could be biochemical. "One
chemical in particular, serotonin, is implicated both in
depression and in blood clot formation," he says.
"Disturbances in the biochemistry of serotonin in the brain
and in blood platelets, the cells that contribute to blood
clot formation, have been described in people with
depression."
The connection between heart disease and depression could
also be genetic. A 1998 Johns Hopkins study led by Daniel
E. Ford, an associate professor of medicine, found that men
with clinical depression are more than twice as likely to
develop coronary artery disease as their non-depressed
counterparts. The study, published in the Archives of
Internal Medicine, used data from the Johns Hopkins
Precursors Study, a long-term investigation of 1,190 male
medical students who were enrolled at Hopkins between 1948
and 1964.
Risky
Business: People who are depressed or have
problems with low mood or sadness often exhibit behaviors
that may harm the heart, like smoking. "It's clear that
people who are depressed have more 'unhealthy' behaviors as
a rule," Ziegelstein says. "They tend to smoke more and
engage less in 'heart healthy' behaviors like a healthy
diet, regular exercise, and visiting the doctor." Such
risky behavior could not only lead to heart disease, it
could also negatively affect recovery from a heart attack
or stroke. Some depressed heart attack survivors are so
convinced they'll never be healthy again that their belief
becomes a self-fulfilling prophecy, according to a 2001
Hopkins study of 160 men and women recovering from heart
attacks. "Depressed patients think they're in poor physical
health and that changing their behavior isn't going to make
a difference," explains David E. Bush, senior author on the
study and assistant professor of medicine.
Tipping the
Balance: The way the body responds to sadness
and emotional stress may affect bodily functions in people
with heart problems and make them more likely to experience
either a major heart disease, recurrent episodes of heart
problems, or complications of heart disease.
"It turns out that stress in the body activates parts of
the brain and adrenal gland to make hormones like
adrenaline," Ziegelstein says. "These activate the
sympathetic nervous system." In all of us, the heart is
stimulated by both the sympathetic and parasympathetic
nervous systems. "It's the balance between these two lines
of communication to the heart that results in heart
health," he says. "Disease can result when the sympathetic
stimulation of the heart is in overdrive, as it appears to
be under conditions of emotional stress or during episodes
of sadness." This disturbed balance, with excessive
sympathetic stimulation, can result in either the
development of a weak heart, such as in the "broken heart"
study cited above, or in greater susceptibility to
potentially lethal heart rhythm disturbances.
—MB
Return to The Seven Deadly Sins ...
Lust |
Gluttony |
Envy |
Pride |
Sloth |
Avarice |
Anger
Return to September 2005 Table
of Contents
|