The EURO-D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.

Objectives-The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants. Methods-In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases. Results-Low social support at work and low decision authority, high job demands and eVort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score. Conclusions-Social support and control at work protect mental health while high job demands and eVort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive eVects on mental health in working populations. (Occup Environ Med 1999;56:302-307)

Abstract-Cerebral white matter lesions are frequently observed on magnetic resonance imaging (MRI) scans in elderly people and are associated with stroke and dementia. Elevated blood pressure is presumed one of the main risk factors, although data are almost exclusively derived from cross-sectional studies. We assessed in 10 European cohorts the relation between concurrently and previously measured blood pressure levels, hypertension, its treatment, and severe cerebral white matter lesions. In total, 1805 nondemented subjects aged 65 to 75 years were sampled from ongoing community-based studies that were initiated 5 to 20 years before the MRI. White matter lesions in the periventricular and subcortical region were rated separately using semiquantitative measures. We performed logistic regression analyses adjusted for potential confounders in 1625 people with complete data. Concurrently and formerly assessed diastolic and systolic blood pressure levels were positively associated with severe white matter lesions. Both increases and decreases in diastolic blood pressure were associated with more severe periventricular white matter lesions. Increase in systolic blood pressure levels was associated with more severe periventricular and subcortical white matter lesions. People with poorly controlled hypertension had a higher risk of severe white matter lesions than those without hypertension, or those with controlled or untreated hypertension. Higher blood pressure was associated with an increased risk of severe white matter lesions. Successful treatment of hypertension may reduce this risk; however, a potential negative effect of decreasing diastolic blood pressure level on the occurrence of severe periventricular white matter lesions should be taken into account. Key Words: hypertension Ⅲ stroke Ⅲ dementia Ⅲ epidemiology Ⅲ ischemia Ⅲ aging C erebral white matter lesions are frequently observed on magnetic resonance imaging (MRI) scans in elderly people. 1-3 These lesions are associated with an increased risk of stroke, cognitive decline, and dementia. 4 -7 Although the exact pathogenesis of these lesions is not fully understood, they are considered to reflect ischemic small vessel disease. Elevated levels of blood pressure are thought to contribute to these lesions. 8 Hypertension is extremely prevalent in elderly people. 9 Crosssectional population-based MRI studies have shown a positive association between higher blood pressure and severity of white matter lesions. 3 Longitudinal data are, however, scarce. Midlife blood pressure reportedly is associated with white matter lesions in the elderly. 1,10 -12 The Rotterdam Scan Study previously found that both an increase and a decrease in blood pressure levels are related to white matter lesions. 12 People with uncontrolled hypertension seem to have a higher prevalence of severe white matter lesions than people without hypertension or with controlled hypertension. 1,11 We conducted a study in 10 European cohorts to assess the relation between concurrent and earlier as...

RésuméCet article court présente la version française de l’échelle CES-D, instrument destiné á être employé en population générale. Les 20 items de l’échelle sont souvent présents chez les déprimés et sont issus d’instruments déjà validés dans la mesure clinique des états dépressifs. L’évaluation repose sur l’état au cours de la semaine précédente et les réponses sont du type jamais, très rarement, à fréquemment, tout le temps. Les études de validation de la version française ont été réalisées chez des malades psychiatriques hospitalisés, chez des malades psychiatriques ambulatoires et en médecine générale. Les instruments auxquels le CES-D a été comparé comportaient la MADRS, les catégories DSM III des troubles affectifs et un diagnostic ouvert de dépression. La note seuil utilisée aux Etats-Unis ne paraît pas être pertinente en France. Les résultats suggèrent une note seuil optimale de 17 pour les sujets masculins, 23 pour les sujets féminins. Nous soulignons qu’à l’heure actuelle ia valeur prédictive de cet instrument pour un sujet individuel n’a pu encore être evaluée.

In this study we consider both a gender model, a model that focuses on the stress associated with social roles and conditions in the home environment, and a job model, which addresses the stressful characteristics of the work environment, to investigate patterns of women's and men's psychological morbidity