Ambulatory blood pressure, heart rate, and neuroendocrine responses in women nurses during work and off work days

Association of work-related psychosocial factors and day-to-day home blood pressure variation: the Finn-Home study

OBJECTIVES

Stress, and particularly job strain, has been found to associate with ambulatory blood pressure (BP). Moreover, BP is known to vary between days. One potential over-looked factor underlying this day-to-day BP variation could be work-related psychosocial factors. Thus, we aimed to study the association between job strain, job demands, job control and day-to-day BP variation.

METHODS

The home BP of 754 regularly working participants (mean age 50.9 ± 4.8, women 51%) of the Finn-Home Study was measured twice in the morning and twice in the evening over seven days. Average SBP and DBP were calculated for each day. Work-related psychosocial factors were measured with survey. Multivariable-adjusted generalized linear models were used for statistical analysis.

RESULTS

We found a greater SBP/DBP decrease between weekdays and weekend among participants with high job strain (-1.8 [95% confidence interval, 95% CI, -2.7 to -0.8]/-1.7 [95% CI, -2.3 to -1.1] mmHg) compared to participants with low job strain (-0.7 [95% CI, -1.1 to -0.2]/-0.7 [95% CI, -1.0 to -0.4] mmHg). The participants with high job demands showed a higher BP decrease between weekdays and weekend (-1.4 [95% CI, -2.0 to -0.8]/-1.3 [95% CI, -1.6 to -0.9] mmHg) than the participants with low job demands (-0.5 [95% CI, -1.1 to 0.0]/-0.6 [95% CI, -1.0 to -0.3] mmHg). We did not find BP differences regarding job control.

CONCLUSION

High job strain and high job demands were associated with a greater BP reduction from weekdays to the weekend. Work-related psychosocial factors should be considered when assessing day-to-day BP variation.

Exploration of the experiences of working stressors and coping strategies associated with menstrual symptoms among nurses with shifting schedules: a Q methodology investigation

Background

The essence and workload of nursing can easily lead to burdens associated with female nurses’ menstrual symptoms, and consequently, result in decreased working performance. Without effective support this can lead to resignation due to maladaptation. This study adopted Q methodology to explore the experience of working stressors and coping strategies associated with menstrual symptoms among nurses with shifting schedules.

Methods

Data were collected in two stages. First, in-depth interviews were conducted to collect nurses’ experiences. Sentences that best fit the study’s purpose were extracted for the construction of Q statements. Second, nurses were allowed to subjectively rank these Q statements by using Q-sorts. A total of 90 participants ranked the designed Q statements. The Q factor analysis revealed a five-factor solution that accounted for 48.90% of the total variance.

Results

The five evident factors included: menstrual symptoms interfering in collaboration with colleagues, deficiency of professional function and stress due to symptoms burden, diverse experiences without a clear pattern, adapted self-management with and without medication use, and stress due to symptoms burden and using medication for self-management.

Conclusions

The identification of these five groups may facilitate the development of responsive strategies to meet nurses’ preferences. Furthermore, identifying workplace factors that are associated with the adverse effects of menstrual symptoms on nurses will be helpful for nursing supervisors and hospital managers. Additionally, strategies that can be implemented to create supportive work environments are discussed.

Relationship between work-family conflict and unhealthy eating: Does eating style matter?

There is increasing evidence to suggest that work-family conflict is implicated in poor eating patterns. Yet, the underlying mechanism remains unexplored. The objectives of the present study were to demonstrate the interplay between work-family conflict, eating style, and unhealthy eating, and to test whether body mass index (BMI) and its interactions further explicate the relationships. In this study, 586 Malaysian adults (normal weight n = 437, overweight n = 149) completed a questionnaire, which included demographic variables, work-family scales, eating style measures, namely, restrained, emotional or external eating and reported food intake. As hypothesized, results showed that family-to-work conflict (FWC), emotional eating and external eating were positively related to unhealthy food consumption. In addition, emotional eating was found to moderate the impact of FCW on eating. These findings are consistent with research that has revealed emotional eating can indeed increase the positive association between stress such as conflict and unhealthy food choices. However, we found no clear support for the interactive effects of BMI. Our research builds on the findings of existing research as it demonstrates the role of eating style in explaining the association between work-family conflict and unhealthy eating. This conclusion has potential implications for appropriate interventions and calls for the enhancement of various policies to tackle obesity and other health problems.

Job Strain and Casual Blood Pressure Distribution: Looking beyond the Adjusted Mean and Taking Gender, Age, and Use of Antihypertensives into Account. Results from ELSA-Brasil

Methodological issues are pointed to as the main sources of inconsistencies in studies about the association between job strain and blood pressure (BP)/hypertension. Our aim was to analyze the relationship between job strain and the whole BP distribution, as well as potential differences by gender, age, and use of antihypertensives. Additionally, we addressed issues relating to the operationalization of the exposure and outcome variables that influence the study of their inter-relations. We evaluated the baseline date of 12,038 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (2008–2010), a multicenter cohort study of 35–74-year-old civil servants. Job strain was assessed by the Demand-Control-Support Questionnaire. The distribution of casual BP by categories of job strain was compared by a combination of exploratory techniques. Participants were classified into three subgroups (normotensives, medicated hypertensives, and unmedicated hypertensives), and analyses were stratified by gender and age. The relationship between job strain and casual BP varied along the whole outcome distribution. Hypertensive participants had greater differences in casual BP by job strain category, especially medicated hypertensives. Differences in casual BP were also greater for systolic than for diastolic BP and for older participants. No differences were encountered by gender. The exclusion of participants susceptible to misclassification for the exposure and outcome variables increased the differences observed between the categories of low and high job strain. In conclusion, the relationship between job strain and casual BP varied along the whole outcome distribution and by use of antihypertensive drugs, age, and BP parameter evaluated. Misclassification for exposure and outcome variables should be considered in analyses of this topic.

Resting heart rate, physiological stress and disadvantage in Aboriginal and Torres Strait Islander Australians: analysis from a cross-sectional study

Background

Lower socioeconomic status has been linked to long-term stress, which can manifest in individuals as physiological stress. The aim was to explore the relationship between low socioeconomic status and physiological stress in Aboriginal and Torres Strait Islander Australians.

Methods

Using data from the eGFR Study (a cross-sectional study of 634 Indigenous Australians in urban and remote areas of northern and central Australia), we examined associations between resting heart rate and demographic, socioeconomic, and biomedical factors. An elevated resting heart rate has been proposed as a measure of sustained stress activation and was used as a marker of physiological stress. Relationships were assessed between heart rate and the above variables using univariate and multiple regression analyses.

Results

We reported a mean resting heart rate of 74 beats/min in the cohort (mean age 45 years). On multiple regression analysis, higher heart rate was found to be independently associated with Aboriginal ethnicity, being a current smoker, having only primary level schooling, higher HbA1c and higher diastolic blood pressure (model R² 0.25).

Conclusions

Elevated resting heart rate was associated with lower socioeconomic status and poorer health profile in Aboriginal and Torres Strait Islander Australians. Higher resting heart rate may be an indicator of stress and disadvantage in this population at high risk of chronic diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s12872-016-0211-9) contains supplementary material, which is available to authorized users.

Supervisor Support Buffers Daily Psychological and Physiological Reactivity to Work-to-Family Conflict

Using a daily diary design, the current study assessed within-person associations of work-to-family conflict with negative affect and salivary cortisol. Furthermore, we investigated whether supervisor support moderated these associations. Over eight consecutive days, 131 working parents employed by an information technology company answered telephone interviews about stressors and mood that occurred in the previous 24 hours. On Days 2-4 of the study protocol, they also provided five saliva samples throughout the day that were assayed for cortisol. Results indicated a high degree of day-to-day fluctuation in work-to-family conflict, with employed parents having greater negative affect and poorer cortisol regulation on days with higher work-to-family conflict compared to days when they experience lower work-to-family conflict. These associations were buffered, however, when individuals had supervisors who offered support. Discussion centers on the use of dynamic assessments of work-to-family conflict and employee well-being.

Impact of Menstrual Cycle on Cardiac Autonomic Function Assessed by Heart Rate Variability and Heart Rate Recovery

OBJECTIVE

The purpose of the present study was to investigate autonomic tone during the follicular and luteal phases of the menstrual cycle using heart rate variability (HRV) and heart rate recovery (HRR) in healthy women.

SUBJECTS AND METHODS

Thirty women aged 22-37 years with regular menstrual cycles were included in the study. The HRV and HRR were measured at the follicular and luteal phases. The HRV was obtained using the time domain method with 24-hour long-term recordings. For time domain analysis, the following were obtained: standard deviation of all normal sinus R-R intervals during 24 h (SDNN), mean of the standard deviation of all normal sinus R-R intervals for all 5-min segments (SDNN index), standard deviation of average normal sinus R-R intervals for all 5-min segments (SDANN), root mean square of the successive normal sinus R-R interval difference (rMSSD), and percentage of successive normal sinus R-R intervals longer than 50 ms (pNN50). The HRR was calculated at the first, second, and third minute of recovery after the cessation of peak exercise using a treadmill test. The paired sample t test was used for the comparison of both phases of the menstrual cycle.

RESULTS

The SDNN (136 ± 39 vs. 154 ± 32 ms; p = 0.015) and SDANN (122 ± 36 vs. 142 ± 36 ms; p = 0.004) were significantly lower during the luteal phase than during the follicular phase. The HRR, rMSSD, and pNN50 were not different between the 2 phases.

CONCLUSION

Parasympathetic tone markers of HRV and HRR were unaffected by the menstrual phase. Lower SDNN and SDANN during the luteal phase than during the follicular phase could have resulted from enhanced sympathetic activity during the luteal phase.

Psychosocial and organizational work factors and incidence of arterial hypertension among female healthcare workers: results of the Organisation des Soins et Santé des Soignants cohort

BACKGROUND

Many studies have supported the role of organizational work factors (OWFs) on the risk of cardiovascular diseases (CVDs) and CVD risk factors, including arterial hypertension. However, a little information is available concerning the role of collective stressors deriving from work organization on nurse's risk of hypertension. This study aimed to test the independent longitudinal relationships linking the 2-year incidence of arterial hypertension to collective stressors at the work unit level, among baseline normotensive female hospital registered nurses and nursing assistants, after adjusting for known individual predictors of CVDs and for occupational stress.

METHOD

Arterial hypertension was defined as the intake of antihypertensive drug or as blood pressure (BP) measures higher than 140  mmHg (SBP) or 90  mmHg (DBP) at both the clinical visit and 1 month later. We analyzed the effect of OWFs at the work unit level, constraints related to the physical work environment and the individual perception of the work environment in 2006 on the risk of arterial hypertension in 2008 among 1882 initially normotensive female healthcare workers followed in the French Organisation des soins et santé des soignants (ORSOSA) cohort.

RESULTS

We showed that OWFs at the work unit level may influence the 2-year risk of arterial hypertension independently of work factors at the worker level, baseline BP, age and BMI. In this study, OWFs affected 2-year risk of arterial hypertension only through direct effects.

CONCLUSION

Our results pointed out the possibility of a primary prevention of arterial hypertension through interventions based at the work unit level among healthcare workers.

The influence of domestic overload on the association between job strain and ambulatory blood pressure among female nursing workers

Evidence suggests that the workplace plays an important etiologic role in blood pressure (BP) alterations. Associations in female samples are controversial, and the domestic environment is hypothesized to be an important factor in this relationship. This study assessed the association between job strain and BP within a sample of female nursing workers, considering the potential role of domestic overload. A cross-sectional study was conducted in a group of 175 daytime workers who wore an ambulatory BP monitor for 24 h during a working day. Mean systolic and diastolic BP were calculated. Job strain was evaluated using the Demand-Control Model. Domestic overload was based on the level of responsibility in relation to four household tasks and on the number of beneficiaries. After adjustments no significant association between high job strain and BP was detected. Stratified analyses revealed that women exposed to both domestic overload and high job strain had higher systolic BP at home. These results indicate a possible interaction between domestic overload and job strain on BP levels and revealed the importance of domestic work, which is rarely considered in studies of female workers.

Job strain and ambulatory blood pressure: a meta-analysis and systematic review

We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985-2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case-control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions.

Occupational stress and hypertension

Occupational stress, or job strain, resulting from a lack of balance between job demands and job control, is considered one of the frequent factors in the etiology of hypertension in modern society. Stress, with its multifactorial causes, is complex and difficult to analyze at the physiological and psychosocial levels. The possible relation between job strain and blood pressure levels has been extensively studied, but the literature is replete with conflicting results regarding the relationship between the two. Further analysis of this relationship, including the many facets of job strain, may lead to operative proposals at the individual and public health levels designed to reduce the effects on health and well-being. In this article, we review the literature on the subject, discussing the various methodologies, confounding variables, and suggested approaches for a healthier work environment.

A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers

Chronic stress causes stress hormones to strain many biological systems in a process referred to as allostatic load (AL) that is measurable using an index of biomarkers. While the AL framework has been successfully applied in studies of workplace stress, few studies have investigated burnout, a debilitating condition sometimes characterized by blunted stress hormone levels. Using an AL index based on clinical norms, we hypothesized that higher AL indices would be associated with increased chronic stress, burnout symptoms, as well as hypoactive diurnal and reactive stress hormone levels. Fifteen neuroendocrine, immune, metabolic, and cardiovascular biomarkers were collected for 30 healthy participants from various professions and values were transformed into an AL index using clinical norms. Stress reactivity was assessed for salivary cortisol and α-amylase levels in response to the Trier Social Stress Test. Diurnal cortisol was measured at five time points (awakening, 30 min after awakening, 14:00 h, 16:00 h, and before bedtime) over two working days. We also administered questionnaires of chronic stress, burnout, and depression. Our results demonstrate that increased AL is associated with increased chronic stress, burnout symptoms, but not depressive symptoms. The High AL group demonstrated lower morning and stress reactive cortisol levels in comparison to the Low AL group, but no significant effects were detected for salivary α-amylase. These findings provide preliminary support for the utility of a new clinical AL index that is sensitive to physiological recalibrations intermittently observed in burnout research.

Physiological and behavioural response patterns at work among hospital nurses

AIM

The aim was to determine whether hospital nurses are experiencing physiological strain at work by examining their physiological and behavioural response patterns over 12-hour shifts.

BACKGROUND

Excessive workload for nurses may lead to poor quality of care and high nursing turnover rates. Energy expenditure (EE), heart rate (HR) and work pace (WP) can be used to examine the physiological impact from the workload.

METHODS

A total of 145 nurses wore monitors for one 12-hour day shift to record HR and WP, which were used to calculate EE. Individual and work-related factors were assessed through questionnaires and work logs.

RESULTS

Energy expenditure accumulated over the 12 hours reached the EE level of 8-hour shifts in which individuals work at a moderate physical intensity level. The HR data indicated a moderate cardiac stress level throughout the shifts, despite which WP decreased after 15.00 hours. Inadequate work break and sleep, family care-giving responsibility and aging may challenge work recovery.

CONCLUSIONS

Nursing workload of 12-hour shifts has a negative physiological impact on hospital nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to be aware of the physiological strain experienced by staff nurses, and focus on ensuring sufficient breaks and proper work accommodations for older nurses.

Heart rate variability and urinary catecholamines from job stress in korean male manufacturing workers according to work seniority

The aim of this study was to evaluate the relationships between job stress and indicators of autonomic nervous system activity in employees of the manufacturing industry. A total of 140 employees from a company that manufactures consumer goods (i.e., diapers and paper towels) were recruited for participation in this study. Job stress was assessed using Karasek's Job Content Questionnaire. Heart rate variability (HRV) was measured using a heart rate monitor, and urinary catecholamines were measured by an HPLC-ECD. Information on demographic characteristics, previous job history, smoking status and alcohol consumption was also collected. Job stress did not have a significant effect on HRV or catecholamines. However, low-frequency HRV was significantly higher in the high-strain group of subjects with a short duration of employment. Low- and high-frequency HRV were higher in the high-strain group than in the low-strain group, but these differences were not statistically significant. The results of the present study indicate that low-frequency HRV was significantly higher in the high-strain group of subjects with a short duration of employment. In addition, the results of this study show that HRV can be used as a potential physiologic indicator of job stress in employees with a short duration of employment.

If schools are closed, who will watch our kids? Family caregiving and other sources of role conflict among nurses during large-scale outbreaks

OBJECTIVES

The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as "first receivers" during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored.

METHODS

Five focus groups consisting of 100 nurses were conducted using a Structured Interview Matrix facilitation technique.

RESULTS

Four emergent themes included: (1) substantial personal/professional dilemmas; (2) assistance with child, elder, and/or pet care; (3) adequate resources and vaccinations to protect families; and (4) appropriate mechanisms to enable two-way communication between employees and their families under conditions of quarantine or long work hours.

CONCLUSIONS

Social and organizational supports are critical to help buffer the effects of stress for nurses and assist them in managing difficult role conflicts during infectious disease outbreaks. These supports are necessary to improve response capacity for bio-disasters.

The impact of work on the night blood pressure dipping profile

OBJECTIVE

The purpose of this study was to elucidate whether ambulatory blood pressure (ABPM) performed during a work day and a non-work day had any impact on the night dipping profile.

STUDY DESIGN

A crossover randomized ABPM study in primary healthcare was retrospectively analysed for the occurrence of non-dipping (ND), dipping (D) or extreme (XD) nightly dipping. Non-dippers were defined as subjects with less than 10% and extreme dippers as subjects with more than 20% nightly blood pressure fall measured as mean arterial pressure (MAP).

SUBJECTS

Forty treated hypertensives and 40 normotensives (20 men and 20 women in each group), who had performed ABPM twice in a fortnight. They had been randomly allocated to perform a work day or a non-work day as the first period.

RESULT

Only one of the 16 subjects who at any time was a non-dipper remained so during both monitoring periods. Extreme dipping was more often reproduced in nine persons out of 29. Of all 80 subjects, 43.8% (35 persons) remained dippers during both periods. No one changed from a non-dipper to an extreme dipper or the reverse. The odds of being an ND were 3.8 times more common on a non-work day, p = 0.010. XDs were slightly more common (1.7 times) on a work day than on a non-work day, p = 0.040. There was no correlation as to the degree of MAP and the dipping profile, p = 0.629.

CONCLUSIONS

More subjects were non-dippers at the end than at the beginning of the work week. It is essential to consider this when attempting to identify a non-dipper by ABPM.

The impact of menstrual cycle phase on cardiac autonomic regulation

This study investigated menstrual cycle phase differences in heart rate (HR) and RR interval variability (RRV) in 49 healthy, premenopausal, eumenorrheic women (age 30.2+/-6.2 years). HR and RRV were computed from ambulatory 24-h electrocardiogram, collected for up to 6 days, with at least 1 day each during early to midfollicular and midluteal menstrual phases. Phase effects on HR and RRV were assessed using linear mixed effects models with a random intercept to account for the correlation of observations within each subject as well as intrasubject variation. During follicular phase monitoring, women had significantly lower average HR (-2.33 bpm), and higher standard deviation, the root mean squared successive difference, and high frequency (0.04-0.15 Hz) and low frequency (0.15-0.40 Hz) RRV than during the luteal phase. These results provide strong support for the influence of menstrual phase on cardiac autonomic regulation in premenopausal women.

Hypothalamic-pituitary-adrenal axis function: relative contributions of perceived stress and obesity in women

OBJECTIVE

A range of behavioral and psychosocial factors may contribute to a chronically stimulated hypothalamic-pituitary-adrenal (HPA) axis and subsequently altered diurnal patterns. The goal of this cross-sectional study was to examine associations among diurnal cortisol levels, perceived stress, and obesity patterns.

METHODS

Seventy-eight women (aged 24-72 years) employed in a rural public school system completed the perceived stress scale, collected diurnal saliva samples, and underwent anthropometric assessments. Reduced peak-to-nadir cortisol values across the day were considered a sign of impairment in HPA function. A series of linear regression models determined the best predictors of diurnal cortisol variation.

RESULTS

There was a marginal linear trend in stress levels across body mass index (BMI) categories, with obese women reporting the highest levels of stress (p = 0.07). Perceived stress was the only significant predictor of the degree of flattening of the diurnal cortisol curve in the sample as a whole (beta = -0.042, R(2) = 0.11, F = 8.6, p = 0.005), indicating reduction in the normal diurnal pattern. Among overweight women (BMI = 25-29.9 kg/m(2)), stress and waist circumference combined predicted 35% of the variability in diurnal cortisol. In contrast, among obese women (BMI > or = 30 kg/m(2)), BMI predicted 31% of the variability in diurnal cortisol (F = 13.8, p = 0.001), but stress was no longer significantly related to diurnal cortisol.

CONCLUSIONS

Psychological stress predicts a significant portion of HPA axis functioning. In overweight women, perceived stress and waist circumference were of approximately equal importance in predicting adrenal cortisol secretion. However, among obese women, a major portion of the diurnal cortisol variation was predicted by BMI alone, not stress or waist circumference. This may help elucidate the mechanisms linking obesity to increased risk of cardiovascular disease (CVD).

Interpretations of ambiguous social situations and cardiovascular responses in adolescents

BACKGROUND

Previous research has documented effects of ambiguous outcome social situations on individual differences in cardiovascular reactivity in laboratory contexts.

PURPOSE

This study tested whether interpretations of ambiguous social situations are associated with daily life cardiovascular responses using ambulatory approaches.

METHODS

There were 206 high school adolescents assessed on interpretations of ambiguous social situations in the laboratory who then completed ambulatory monitoring of blood pressure (BP) and heart rate (HR) for 2 days.

RESULTS

Adolescents who perceived threat during ambiguous situations exhibited higher systolic BP when talking to others compared to occasions of not talking with anyone, whereas the opposite was true for those with low threat perception. For high-threat adolescents, higher systolic BP was found when interacting with friends, whereas for low threat adolescents, lower systolic BP was found when interacting with parents. Greater threat interpretations were also associated with elevated HR at night.

CONCLUSIONS

Understanding how adolescents perceive social interactions may help in gauging their daily cardiovascular responses.

Cardiac effects of momentary assessed worry episodes and stressful events

OBJECTIVE

To hypothesize that increased heart rate (HR) and decreased heart rate variability (HRV) occurs not only during stressful events but also during episodes in which stress is cognitively represented, but not necessarily present, i.e., during worry.

METHODS

Ambulatory HR and HRV of 73 female and male teachers were recorded for 4 days, during which they reported, on an hourly basis using computerized diaries, the number and characteristics of worry episodes and stressful events. Multilevel regression models were used, controlling for biobehavioral variables.

RESULTS

Compared with neutral periods, worry episodes and stressful events had independent effects on HR (2.00 beats/min and 2.75 beats/min, respectively) and HRV (-1.07 ms and -1.05, respectively). Neither psychological traits nor biobehavioral variables influenced these results. Effects were most pronounced for work-related worry on HR (9.16 beats/min) and HRV (-1.19 ms), and for worry about anticipated future stress on HR (4.79 beats/min).

CONCLUSIONS

Worry in daily life might have substantial cardiac effects in addition to the effects of stressful events, especially in the form of work-related and anticipatory stress, the latter being a type of stress that has been largely neglected in stress research.

Cortisol and testosterone levels on a weekend and a work day in three mountain villages in the Selska Valley of northwest Slovenia

BACKGROUND

In contemporary western populations, a week commonly involves 5 days of paid work (work days) and two non-working days (weekend). Work days are usually perceived as being more stressful than non-work days and this hypothesis has been tested in several studies, most of which selected subjects with jobs that are perceived to have high stress.

AIM

The study measured salivary cortisol and testosterone on a work day and a weekend in a community-based sample of people going about their everyday lives and tested the hypothesis that hormone levels will be higher on a work day.

SUBJECTS AND METHODS

Slovenian alpine villagers (30 females and 25 males) were sampled without reference to their occupation. Each individual was measured on two occasions, a day on a weekend and a work day as they went about their usual activities in the afternoon.

RESULTS

Cortisol (mean = 3.32 ng ml(-1), range 0.4-27.9) and testosterone (mean = 121 pg ml(-1), range 17-424) values were similar to other populations. Neither the age of subjects nor the time in the afternoon of sample collection were associated with hormone concentrations. On each day of collection, cortisol and testosterone values were correlated for each sex, with the estimate of the correlation coefficient ranging from 0.57 to 0.88. For females, testosterone values were higher on the weekend than the work day (102 pg ml(-1) and 60 pg ml(-1), respectively) but not for males (mean across both days 134 pg ml(-1)). Independent of this effect, the presence of a spouse or other adult in the house was significantly associated with lower testosterone levels in both sexes. Husband and wife testosterone values are correlated on the weekend (r = 0.67, p = 0.02) but not on the work day. Mean cortisol values for the weekend and work day were not different and there was no correlation between levels on these two days.

CONCLUSIONS

These results, although based upon a small sample size, reveal potential relationships between testosterone, work-rest activities, and the presence-absence of a social partner that warrant further investigation.

Moods in everyday situations: effects of combinations of different arousal-related factors

OBJECTIVE

This study examined women's mood responsiveness associated with patterns of stress hormone levels in everyday situations.

METHODS

Self-reports of negative, positive, and energy dimensions of mood were obtained from 203 nurses throughout the day on a workday and on an off-work day during the luteal and follicular phases of the menstrual cycle. Individual differences in daytime norepinephrine and cortisol were assessed.

RESULTS

Patterns of norepinephrine and cortisol levels were associated with ratings of the following moods: tired, sad, and happy. Phase of the menstrual cycle and the day factor (workday, off-work day) modified the association of mood ratings and stress hormone patterns.

CONCLUSION

The experience of negative mood is associated with both hypoarousal and hyperarousal conditions. A homeostatic arousal-related concept of mood regulation is discussed.

Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period

Stress and anxiety are risk factors for cardiovascular (CV) disease. Worry might be a mediator of their risks by prolonging their cognitive representation and concomitant CV activity. We hypothesized that daily stressors and worry, and trait anxiety and trait worry would be associated with high heart rate (HR) and low heart rate variability (HRV) during waking and the subsequent nocturnal sleep period, and that worry would mediate the effects of daily stressors. Low HRV and high HR are physiological risk factors for CV disease. Using an hourly diary, stressors, worry frequency and duration, and biobehavioral variables were measured during one day in 52 healthy subjects. During this time and the subsequent nocturnal sleep period, ambulatory ECG was measured. Stressors, worry and traits were related to higher HR and lower HRV during waking, and the effects of stressors and worry were extended into the sleeping period. Worry duration mediated the effects of stressors. The results were largely independent of biobehavioral variables including sleep quality. The results support the notion that worry, by prolonging CV activity, is a mediator of the CV risks of stress. They also imply a role for unconscious cognitive representation of stress.

Assessing mid-trimester salivary cortisol levels across three consecutive days in pregnant women using an at-home collection protocol

The Pregnancy Outcomes and Community Health (POUCH) Study enrolled women in their 15th to 27th week of pregnancy from 52 prenatal clinics located in five communities. After the study began, an at-home protocol to measure maternal stress was added, which included collection of urine and saliva twice a day (waking = AM, bedtime = PM) for three consecutive days, and completion of a daily diary. The at-home protocol was in place for 2852 POUCH participants at enrollment, and 81.3% (n = 2318) consented and returned samples and diary. For these analyses, salivary cortisol was analysed in a subset of 846 women who delivered at term. Day-to-day correlation coefficients for AM cortisol (0.45-0.55) exceeded those for PM cortisol (0.31-0.43). Study diaries indicated that there was variation in the time interval between waking and sample collection. Analyses of discrete intervals showed the same awakening response pattern in cortisol levels that has been reported in studies with serial AM sampling. The adjusted mean AM cortisol (microg/dL) was 0.506 at 0-15 min post-waking, 0.544 at 16-30 min (P < 0.05), 0.582 at 31-60 min (P < 0.01), and 0.515 at >60 min post-waking. In addition, adjusted mean AM cortisol in samples collected at or before 9 a.m. was higher than that in samples collected after 9 a.m. (0.564 vs. 0.510 microg/dL, P < 0.01). Among working women, adjusted mean AM cortisol was higher on work days than non-work days (0.564 vs. 0.489 microg/dL, P < 0.01), and in multiparae compared with primiparae (0.551 vs. 0.502 microg/dL, P = 0.07). The parity effect was not evident in non-working women. The adjusted mean PM cortisol significantly increased as week of pregnancy at sampling increased, but was not significantly related to time of collection, work day and parity. Factors influencing AM and PM cortisol levels in pregnancy appear to differ. In studies of AM cortisol levels, it is important to gather data on time of sample collection, interval from waking to sample collection, parity and work.

Responses of the autonomic nervous system during periods of perceived high and low work stress in younger and older female teachers

The aim of this study was to examine the response of the autonomic nervous system in younger (mean age 31 yrs, n=14) and older (mean age 54 yrs, n=14) healthy female teachers during work periods of perceived high and low stress. In the younger participants, heart rate, cortisol excretion rate and psychosomatic symptoms were significantly higher during the high work stress period. The older participants experienced no decrease in their heart rate and cortisol excretion during the low stress period and they exhibited no significant decrease in blood pressure after the work in the evening during both periods. It may be concluded that the recovery from the stress in the older teachers was insufficient particularly in view of their elevated diastolic blood pressure during the low work stress period. Ergonomic and individually tailored measures in terms of work time control, specific relaxation techniques, and a part-time retirement may improve the stress management of older teachers.

Prolonged stress-related cardiovascular activation: Is there any?

BACKGROUND

Prolonged physiological activation before or after stressors has gained recognition as a decisive element in theories that explain the link between stress and disease, specifically cardiovascular (CV) disease. This view is opposed to the conventional reactivity hypothesis that emphasizes responses during stressors.

PURPOSE

Prolonged activity has not often been an explicit research goal of real-life stress studies. Nevertheless, a growing number of these studies have provided evidence for prolonged activity, often as a secondary research goal.

METHODS

An overview of this evidence is lacking and is provided in this article.

RESULTS

The combined data from the reviewed studies suggest that discrete and chronic stress sources, as well as negative emotional episodes and dispositions, are related to prolonged CV activity of various durations, including sleep periods. On the other hand, evidence supporting the assumption that prolonged stress-related activation predicts disease is still very modest.

CONCLUSIONS

In this article we suggest that future research of prolonged activation should give priority to (a) the establishment of clear beginnings and endings of stressful events, (b) the prediction of disease by prolonged activation, and (c) potential psychological mediators of stress-related prolonged activation. These mediators may include, for example, worry and rumination, or other processes characterized by perseverative cognition, including unconscious processes.

Chronic stress influences ambulatory blood pressure in adolescents

BACKGROUND

High ambulatory blood pressure (ABP) predicts cardiovascular events, even after controlling for clinic BP and other established risk factors.

PURPOSE

This study examined whether chronic or discrete stress in the past year was associated with greater ABP in adolescents.

METHOD

Participants were 217 male and female Black and White adolescents who wore ABP monitors on 2 consecutive school days and completed a survey of life events.

RESULTS

Report of discrete, negative events was not associated with ABP. Adolescents experiencing greater numbers of chronic, negative life events exhibited greater systolic blood pressure (SBP), independent of ethnicity; sex; body mass index; and location, position, physical activity, and consumption of food/caffeine/nicotine at time of measurement. Greater numbers of chronic, negative events were associated with greater diastolic blood pressure (DBP) among boys. When resting clinic BP was introduced into the model, the main effect of chronic, negative life events on ambulatory SBP became nonsignificant, whereas the effect of chronic, negative life events on male adolescents' DBP persisted.

CONCLUSIONS

Chronic stress is associated with greater ambulatory SBP among male and female adolescents and with greater ambulatory DBP among male adolescents. The latter association persisted after controlling for clinic BP, suggesting that males may be more vulnerable to chronic stress as a determinant of BP regulation than females early in life.

Moods in everyday situations: effects of menstrual cycle, work, and stress hormones

OBJECTIVE

This study examined women's mood responsiveness on work and off days during different phases of the menstrual cycle.

METHODS

Self-reports of negative, positive, and energy dimensions of mood were obtained throughout the day on two work and two off days during the luteal and follicular phases of the menstrual cycle in 203 women nurses. Individual differences in daytime and nighttime epinephrine, norepinephrine, and cortisol were assessed.

RESULTS

High daytime norepinephrine, epinephrine, and cortisol levels were associated with higher ratings of stress and tired, and with lower ratings of happy. The phase of the menstrual cycle and the day factor (workday, off day) were also associated with mood differences, and the direction of the effects depended on hormone levels and hormone sampling period.

CONCLUSION

The experience of moods is affected by the arousal-related interaction of hormone levels with the phase of the menstrual cycle and occupational stress.

Changes in financial strain over three years, ambulatory blood pressure, and cortisol responses to awakening

OBJECTIVE

Chronic psychosocial stress has been associated cross-sectionally with ambulatory blood pressure and with salivary cortisol, but there have been few longitudinal studies of the effects of changes in chronic stress. We assessed the influence of changes in financial strain on ambulatory blood pressure and salivary cortisol.

METHODS

Data were analyzed from 160 men and women age 47 to 59 years at the first assessment (T1) who repeated ambulatory monitoring 3 years later (T2). We analyzed change in financial strain as a continuous variable, and specifically compared people who did and did not report an improvement in financial strain.

RESULTS

Change in financial strain was associated with change in ambulatory systolic pressure after controlling for T1 ambulatory systolic pressure, gender, socioeconomic position, age, smoking, body mass index, and T1 financial strain (p = .041). Systolic pressure at T2 was lower in the improved financial strain (121.7 +/- 11.2 mm Hg) than in the worse/no change group (125.5 +/- 11.5 mm Hg; p = .029). The corresponding diastolic pressures averaged 78.5 +/- 7.1 mm Hg and 80.7 +/- 7.9 mm Hg, respectively (p = .061). The cortisol awakening response (difference between waking and 30 minutes later) was lower (p = .048) in men who reported improved financial strain, controlling for T1 cortisol response, socioeconomic position, age, smoking, time of waking, and T1 financial strain. There were no differences in the slope of cortisol decline over the day or in evening values.

CONCLUSION

These longitudinal data extend cross-sectional findings in showing associations between favorable changes in chronic stress and reduced cardiovascular and neuroendocrine activation in everyday life.

Overcommitment to work is associated with changes in cardiac sympathetic regulation

OBJECTIVE

Work stress is associated with an increased risk for cardiovascular disease (CVD). Exaggerated cardiovascular reactivity to work-related stressors or incomplete recovery after work is a proposed mechanism underlying this increase in risk. This study examined the effects of work stress on 24-hour profiles of the pre-ejection period (PEP), a measure of cardiac sympathetic activity, obtained from ambulatory measurement of the impedance cardiogram.

METHODS

A total of 67 male white-collar workers (age 47.1 +/- 5.2) underwent ambulatory monitoring on 2 workdays and 1 non-workday. Work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (high imbalance) or 2) an exhaustive work-related coping style (high overcommitment).

RESULTS

High overcommitment was associated with shorter absolute PEP levels during all periods on all 3 measurement days, reduced wake-to-sleep PEP differences and reduced PEP variability, as indexed by the SD.

CONCLUSIONS

Overcommitment to work was associated with an increase in basal sympathetic drive and a reduction in the dynamic range of cardiac sympathetic regulation. Both findings are compatible with the hypothesis that overcommitment induces beta-receptor down-regulation.

Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort

It is thought that the salivary cortisol awakening response can serve as a reliable marker of hypothalamic-pituitary-adrenocortical activity. Response magnitude might be influenced by stress, but results of studies on work-related stress have been inconclusive. Non-compliance with the sampling schedule is a potential confounding factor that has rarely been controlled. The objective of the study was to determine whether the cortisol awakening response is greater on a work day than on a weekend day, and whether responses vary with gender and socioeconomic position. Compliance was controlled by excluding participants who reported a delay of more than 10 min between waking up and taking the first saliva sample. Data were collected from 196 men and women aged 47 to 59 years drawn from the Whitehall II cohort of British civil servants, with free salivary cortisol sampled immediately after waking up and 30 min later on 2 days. Data on stress, perceived control and happiness over the remainder of the day, and on sleep quality, time of waking, and health behaviour were also obtained. The awakening response was lower in non-compliant participants than in compliant ones, so non-compliant participants were excluded from further analyses. Salivary cortisol levels on waking did not differ by gender or socioeconomic position, or between work and weekend days. However, the cortisol awakening response (defined as the difference between waking and 30 min later) was greater on work than weekend days (mean increases 10.5 and 3.7 nmol/l, P < 0.001). On the work day, women showed larger increases than men (P = 0.011), but there were no gender differences on the weekend day. Across both days, lower socioeconomic position was associated with a larger cortisol awakening response (P = 0.014). Time of waking up was not related to the cortisol awakening response on either day. Participants rated themselves as more stressed, less in control, and less happy over the remainder of the work than weekend day. These results indicate that the cortisol awakening response occurs on both work and non-work days, but that anticipation of the working day is associated with an enhanced response. Cortisol output over the early part of the day may be particularly sensitive to the influence of chronic stress and its anticipation, especially in women.

Women, work, and well-being 1950–2000:

In this research synthesis, we summarize 161 measures of the effects of women's employment on well being reported between 1950 and 2000. Variations in the conceptualization and measurement of employment and health outcomes and the difficulty in distinguishing social selection from social causation limit the inferences that can be drawn from the evidence. Therefore, we distinguish two types of studies. Longitudinal studies measuring relevant covariates at the first measurement occasion and statistically controlling them in multivariate analyses providing effect-size information are classified as Type II studies. The remaining studies are classified as Type I studies. The main findings were that (1) results from methodologically sound Type II studies confirm the cross-sectional finding that paid employment has no adverse effects on women; (2) the outcome groups psychological distress, subjective health, cardiovascular risks and disease, and mortality do not converge completely.

Perceived work overload and chronic worrying predict weekend-weekday differences in the cortisol awakening response

OBJECTIVE

The cortisol increase after awakening has been shown to be associated with work-related stress. Several studies demonstrated a moderate stability of cortisol awakening responses on subsequent days, suggesting situation-dependent variance. This study tests whether cortisol awakening responses are different on weekdays compared with weekend days and whether such differences may be explained by chronic work overload and worrying.

METHODS

Two hundred nineteen participants took saliva samples immediately after awakening and 30, 45, and 60 minutes later on 6 consecutive days starting on Saturday. Perceived chronic work overload and worrying were assessed by a standardized questionnaire.

RESULTS

There is a clear weekend-weekday difference in the cortisol response to awakening. This difference is associated with chronic work overload and worry. Independent of sex and weekend-weekday differences in time of awakening and sleep duration, participants who report higher levels of chronic work overload and worrying show a stronger increase and higher mean levels of cortisol after awakening on weekdays, but not on weekend days.

CONCLUSIONS

The weekend-weekday differences in the cortisol awakening response and their association with chronic stress clearly demonstrate that the day of cortisol assessment is crucial in psychoendocrinological stress studies.

Nurses' health: work and family influences

Nurses represent the largest group of professional caregivers. Most are also informal caregivers for family members, including children, parents, spouses, and other relatives. The impact of these caregiving roles, individually and in combination, has important implications for the health of nurses. This article focuses on nurses' health, emphasizing research on the influence of the work and family stress on physical and psychosocial dimensions of health. Health and safety concerns of nurses are discussed and findings from longitudinal studies of nurses' health are presented. Challenges for maintaining a healthy nursing workforce for the future are discussed.

Moods in everyday situations: effects of menstrual cycle, work, and personality

OBJECTIVE

This study examined women's moods on work and off days during different phases of the menstrual cycle.

METHOD

Self-reports of the moods angry, happy, sad, stressed, tired, and anxious were obtained on two work and two off days during the luteal and follicular phases of the menstrual cycle in 203 nurses. Individual differences in anger expression, anxiety, and hostility were assessed.

RESULTS

Ratings of anxious, stressed, and tired were higher and happy and sad were lower on the workday than the off day. Menstrual cycle phase was associated with mood differences depending on the day (work, off work) and individual differences in personality traits.

CONCLUSIONS

The experience of moods in everyday life is affected by overall levels of stress and phase of the menstrual cycle. The findings suggest the need to refine sociopsychobiological and clinical models of mood regulation and of risk for disease.

Reducing the physical work load and strain of personal helpers through clothing redesign

This study assessed the effects of redesigning clients' clothing on the physical work load and strain of personal helpers. Five women, aged 18-54 years, who helped persons with physical disabilities were measured at their worksites before and after development of the clothes worn by clients. The physical work load and strain of the helpers' dressing/undressing of clients were determined from their hand and back movements, work time, muscular activity, heart rate (HR), percentage of heart rate range (%HRR), and rating of perceived exertion (RPE). The muscular activity of the right (p=0.05) and left (p=0.02) trapezius muscles, HR (p=0.03), and %HRR (p=0.03) of the helpers were lower when the new outerwear was used in place of traditional outerwear. Four helpers reported lower perceived exertion, and three had shorter work time with the new outerwear. This study showed that redesigning clients' clothing can help reduce the physical work load and strain of personal helpers.

Physiological differences between burnout patients and healthy controls: blood pressure, heart rate, and cortisol responses

OBJECTIVES

To investigate differences between burnout patients and healthy controls regarding basal physiological values and physiological stress responses. Measures of the sympathetic-adrenergic-medullary (SAM) axis and the hypothalamic-pituitary-adrenal (HPA) axis were examined.

METHODS

SAM axis and HPA axis activity was compared between 22 burnout patients and 23 healthy controls. SAM axis activity was measured by means of heart rate (HR) and blood pressure (BP). HPA axis activity was investigated by means of salivary cortisol levels. Resting levels of HR, BP, and cortisol were determined as well as reactivity and recovery of these measures during a laboratory session involving mental arithmetic and speech tasks. In addition, morning levels of cortisol were determined.

RESULTS

Burnout patients showed higher resting HR than healthy controls. BP resting values did not differ between burnout patients and healthy controls, nor did cardiovascular reactivity and recovery measurements during the laboratory session. Basal cortisol levels and cortisol reactivity and recovery measures were similar for burnout patients and healthy controls. However, burnout patients showed elevated cortisol levels during the first hour after awakening in comparison to healthy controls.

CONCLUSIONS

The findings provided limited proof that SAM axis and HPA axis are disturbed among burnout patients. Elevated HR and elevated early morning cortisol levels may be indicative of sustained activation.

[Cortisol in night-urine: Introduction of a research method in psychoneuroendocrinology]

Cortisol is one of the major parameters investigated in psychoneuroendocrinological research, but the methods employed for sample collecting are often unsatisfactory. A suitable method of sample collection should allow for the integrative assessment of long-term changes of the HPA-system, should be non-invasive, and should not exceed the subject's compliance. The assessment of cortisol in night-urine fulfils these demands; although this method has been occasionally employed, it has not yet been described systematically. For the first time a detailed description is given here that allows for a standardized replication. In ten previous studies and three investigations of our own this method has been successfully applied to detect changes in the cortisol excretion of patients with endocrinological and psychiatric disorders as well as in subjects under conditions of psychosocial stress. The determination of cortisol in night-urine represents an ideal method for the assessment of changes in the basal HPA-activity in numerous areas of psychoneuroendocrinological research, e.g. field and screening studies in natural environment, clinical studies in psychiatry and especially follow-up studies in psychotherapy research.

Literature review of role stress/strain on nurses: an international perspective

The presence of role stress/strain among nurses has been of concern throughout the world. However, to date, no one has conducted, from an international perspective, a literature review of research on the topic. This article assesses research from 17 countries, identifies the major areas of focus in the studies, compares and contrasts the findings, summarizes the state of the science on role stress/strain on nurses and makes recommendations for future research.

Marriage and health: his and hers

This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.

Job control, perceptions of control, and cardiovascular activity: an analysis of ambulatory measures collected over the working day

OBJECTIVE

To assess the influence of job control as a personal characteristic, and momentary perceptions of lack of control, on blood pressure and heart rate monitored over the working day.

METHODS

The study was carried out with a sample of 122 school teachers (45 men, 77 women), divided into high and low job control groups on a standard questionnaire. Blood pressure and heart rate were measured every 20 min using ambulatory techniques, and ratings of concurrent perceived control were also obtained. Energy expenditure was assessed using accelerometers. Cardiovascular measures associated with low perceived control were averaged for each individual, as were readings associated with high perceived control.

RESULTS

Low perceived control ratings were infrequent overall. However, in the participants who reported episodes of both high and low perceived control, systolic and diastolic blood pressure and heart rate were significantly greater during episodes of low control. These effects were independent of concurrent energy expenditure, gender, and time of day. High and low job control groups did not differ in cardiovascular responses to episodes of low perceived control. But low job control was associated with more frequent episodes of low perceived control and fewer periods of high perceived control.

CONCLUSION

The results suggest that laboratory observations concerning the impact of lack of control on cardiovascular activity are corroborated by naturalistic measures in everyday life. Differences in exposure to periods of low perceived control rather than differences in reactivity to uncontrollable situations may contribute to the elevation in cardiovascular risk associated with low job control.