Perceived stress, sex and occupational status interact to increase the risk of future high blood pressure: the IPC cohort study

Life Satisfaction of Nurses during the COVID-19 Pandemic in Poland

BACKGROUND

Health care practitioners are at highest risk of COVID-19 disease. They experience an enormous overload of work and time pressures. The objective of the study was to assess nurses' life satisfaction.

METHOD

The study included professionally active nurses. The research method was an author's questionnaire and a standardized questionnaire, the Satisfaction with Life Scale (SWLS).

RESULTS

The study group included 361 working nurses. The mean raw score and the sten score of the nurses' responses to the statements on the SWLS questionnaire were 21.0 (SD ± 5.6, range = 5-35) and 5.73 (SD ± 1.94, range = 1-10), respectively. It was shown that lower life satisfaction was experienced by nurses aged 51 to 60 (raw score: p = 0.003, sten score: p = 0.005), as well as nurses with secondary and undergraduate nursing education (raw score: p = 0.061, sten score: p = 0.043). Nurses who had a higher self-evaluation of the level of knowledge about SARS-CoV-2 infection experienced greater life satisfaction (raw score: p = 0.008, sten score: p = 0.022).

CONCLUSIONS

The majority of Polish nurses surveyed during the COVID-19 pandemic had a low or medium level of life satisfaction. The low response rate to the survey was most likely due to work overloads during the pandemic. Working in a public service profession, a nurse is exposed to stressful conditions related to protecting human health. Constant difficult and stressful situations and total fatigue experienced by nursing professionals can be the cause of a lack of motivation, occupational burnout, listlessness and mental and physical disease. Further research is necessary to assess the factors positively influencing the level of life satisfaction.

Sleep and Professional Burnout in Nurses, Nursing Technicians, and Nursing Assistants During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic may trigger sleep disorders and burnout in nursing professionals.

PURPOSE

This study was designed to describe the occurrence of sleep disorders and burnout in a nursing team during the COVID-19 pandemic and to identify the associated factors.

METHODS

A cross-sectional approach was used. The questionnaire was administered via the Internet. All of the participants were nursing professionals who had provided care during the COVID-19 pandemic, and data were collected between June and August 2020. Sociodemographic and work characterization instruments, the Jenkins Sleep Scale, and the Maslach Burnout Inventory were used.

RESULTS

Five hundred seventy-two nursing professionals (nurses, nursing technicians, and nursing assistants) responded. Slightly over one quarter (26.4%) presented a sleep disorder, and 17.3% presented burnout. Professional category was a factor found to be associated with having a sleep disorder. Moreover, a lower prevalence both of disorders and of starting to use sleep medication was found among nurses than nursing assistants. Moreover, an association was found between having a high level of emotional exhaustion burnout and being a nursing technician, having a higher number of patients needing care, and starting to use sleep medication. The level of burnout related to depersonalization was significantly higher for nursing assistants, those with a weekly workload of 50 hours or more, and those starting to use sleep medication. Furthermore, burnout related to personal accomplishment was significantly higher in those starting to use sleep medication. Among the participants with sleep disorders, according to Jenkins Sleep Scale results, all of the participants presented a high or moderate level of emotional exhaustion and a high level of burnout related to personal accomplishment.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings indicate that the incidence of sleep disorders and burnout were high among nursing professionals during the COVID-19 pandemic and mainly related with starting to use sleep medication. The results demonstrate the importance of detecting and assessing the frequency of sleep disorders and professional exhaustion. Interventions that aim to improve sleep quality and working conditions for these professionals should be developed.

Biological and sociocultural determinants of increased blood pressure among women with a history of gestational diabetes mellitus in rural China: a retrospective cohort study

OBJECTIVES

Gestational diabetes mellitus (GDM) increases the risk of hypertension and cardiovascular events among mothers later in life. This risk has not been well recognised by healthcare professionals in rural China. Our objectives were to (1) describe the proportion of rural women with increased blood pressure and a history of GDM; and (2) explore the biological and sociocultural factors associated with increased blood pressure.

DESIGN

A retrospective cohort study using data from a cross-sectional survey.

SETTING

Data were collected in two county-level hospitals in the central south of China between November 2017 and June 2018.

PARTICIPANTS

Postpartum women aged >18 years with a history of GDM (N=397).

METHODS

Biological and sociocultural variables were examined. We used bivariate analyses to examine the associations between time since delivery and 2-hour postload glucose, and logistic regression to determine the biological and sociocultural factors associated with increased postpartum blood pressure.

RESULTS

Approximately 20% (n=78) of women had increased blood pressure, defined as a systolic blood pressure ≥130 mm Hg and/or a diastolic blood pressure ≥85 mm Hg. The biological factors of advanced age, family history of hypertension and abnormal 2-hour postload plasma glucose levels were positively associated with increased blood pressure (p<0.05). General self-efficacy was the only sociocultural factor negatively associated with increased blood pressure (p<0.05).

CONCLUSIONS

One in five rural Chinese postpartum women with a history of GDM were found to have increased blood pressure. Biological and sociocultural factors were associated with increased postpartum blood pressure; women with lower general self-efficacy were more likely to have increased blood pressure. Disseminating knowledge about the high risk of developing increased blood pressure among women with prior GDM in rural China is indicated. Diabetes prevention programmes could consider adding general self-efficacy promotion strategies in this population.

Association between perceived life stress and subjective well-being among Chinese perimenopausal women: a moderated mediation analysis

BACKGROUND

The impact of perceived life stress on subjective well-being has been well-established; while few studies have explored the mediating and moderating mechanisms of the association between perceived life stress and subjective well-being among perimenopausal women. This study is aimed at exploring the mediating effect of depressive symptoms and the role of interests/hobbies as a moderator in the association between perceived life stress and subjective well-being among perimenopausal women.

METHODS

The participants were 1,104 perimenopausal women at the age of 40 to 60, who were asked to complete a paper-based questionnaire. A single item was used to measure self-perceived life stress and interests/hobbies. The Zung Self-rating Depression Scale (SDS) and Subjective Well-being Scale for Chinese Citizens (SWBS-CC) were applied to assess both depressive symptoms and subjective well-being. Multiple linear regression analysis and the PROCESS macro were adopted to analyse not only the mediating effect of depressive symptoms but also the moderating role of interests/hobbies.

RESULTS

Perceived life stress was negatively associated with subjective well-being (B =  - 1.424, β =  - 0.101, P < 0.001). The impact of perceived life stress on subjective well-being was partially mediated by depressive symptoms (mediation effect = -0.760, 95% confidence intervals (CI) [-1.129, -0.415]). In addition, the interaction term between depressive symptoms and interests/hobbies was significantly related to subjective well-being (β =  - 0.060, P < 0.05), indicating moderating effect. Moderated mediation had a significant index (Index = -0.220, SE = 0.099, 95% CI [-0.460, -0.060]).

CONCLUSIONS

Perceived life stress was negatively related to subjective well-being. The impact of perceived life stress on subjective well-being was mediated by depressive symptoms. Besides, interests/hobbies moderated the indirect effect of depressive symptoms on the relationship between perceived life stress and subjective well-being.

Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson Heart Study

Background

Chronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community‐based cohort of blacks.

Methods and Results

Analyses included 1829 participants without hypertension at baseline (Exam 1, 2000–2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005–2008) or Exam 3 (2009–2012). Each follow‐up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported “a lot” or “extreme” stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow‐up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age‐, sex‐, and time‐adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04–1.37) and 1.37 (1.20–1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001).

Conclusions

In a community‐based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk.

Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women's Health Study

Background

The few studies of the relationship between religion and/or spirituality (R/S) and hypertension are conflicting. We hypothesized that R/S may reduce the risk of hypertension by buffering adverse physiological effects of stress.

Methods

We prospectively assessed the association of R/S with hypertension within the Black Women's Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. The 2005 questionnaire included four R/S questions: (i) extent to which one's R/S is involved in coping with stressful situations, (ii) self-identification as a religious/spiritual person, (iii) frequency of attending religious services, and (iv) frequency of prayer. Incidence rate ratios (IRRs) and 95% confidence intervals were calculated for each R/S variable in relation to incident hypertension using Cox proportional hazards regression models, controlling for demographics, known hypertension risk factors, psychosocial factors, and other R/S variables.

Results

During 2005-2013, 5,194 incident cases of hypertension were identified. High involvement of R/S in coping with stressful events compared with no involvement was associated with reduced risk of hypertension (IRR: 0.87; 95% CI: 0.75, 1.00). The association was strongest among women reporting greater levels of perceived stress (IRR: 0.77; 95% CI: 0.61, 0.98; p interaction = .01). More frequent prayer was associated with increased risk of hypertension (IRR: 1.12; 95% CI: 0.99, 1.27). No association was observed for the other R/S measures.

Conclusion

R/S coping was associated with decreased risk of hypertension in African American women, especially among those reporting higher levels of stress. Further research is needed to understand the mechanistic pathways through which R/S coping may affect health.

[Psychosomatic research in 2018: Lost illusions, renewed hopes]

A critical analysis of the basic hypotheses of psychosomatic research and the sometimes hasty assertions drawn from the previous works makes it possible to better discern the data confirmed by the most recent works or the most rigorous meta-analyses and to highlight the emerging tracks. If the hypothesis of behavioral patterns specifically related to the risk of certain pathologies seems abandoned, the predictive value of depression in the cardiovascular field, more than in that of oncology, becomes clearer. Negative affect and impaired emotional awareness emerge as two complementary factors of somatic vulnerability. Several vulnerability factors seem all the more effective as they affect individuals of lower socio-economic status. Social exclusion feeling and its links with the inflammatory response appear to be a possible common denominator, both for depression and for many somatic conditions. A series of studies on the cerebral regulation of emotions and stress, as well as on bidirectional brain-bowel relations and on the mediating role of the gut microbiota, complements the available epidemiological data. The same is true for certain advances in behavioral neuro-economics, which inform the decision-making processes of patients facing preventive health choices. Lastly, it appears that a significant part of the excess mortality associated with the existence of severe mental disorders is not due to factors inherent to the patients themselves, but to disparities in the quality of the care provided to them.

Cross-sectional study of cognitive stress appraisal and related factors among workers in metropolitan areas of Japan

OBJECTIVE

Stress has major socioeconomic implications for all spheres of employment. It is a trigger for depression, and affects absenteeism, turnover, productivity, morale and suicide. Positive or negative cognitive stress appraisal can be a self-care strategy that affects workers' ability to cope with stress. This study examined cognitive stress appraisal among workers and identified related individual and environmental factors.

DESIGN

Cross-sectional study using self-administered postal questionnaires.

SETTING

Companies located in two metropolitan areas of Japan (Tokyo and Kanagawa prefectures).

PARTICIPANTS

2311 employees of 48 companies in metropolitan areas in Japan. In total, 341 questionnaires were returned (response rate: 14.8%), 337 of which were suitable for analysis (effective response rate: 98.8%).

PRIMARY MEASURES

Cognitive stress appraisal was assessed using the Japanese version of the Perceived Stress Scale (PSS). Potential variables related to stress appraisal included demographic, individual and environmental factors. Multiple regression analysis was used to identify factors related to cognitive stress appraisal.

RESULTS

Participants' mean±SD age was 42.8±11.7 years, and two-thirds were male. The mean±SD PSS score was 25.8±6.2. The multiple regression analysis controlled for age, sex and depression showed that those with poorer economic status (β=0.171, p<0.001), lower electronic health (eHealth) literacy (β=-0.113, p=0.012), higher traditional organisational climate (β=0.131, p=0.004) and lower perceived social support (β=-0.205, p<0.001) experienced significantly higher levels of negatively perceived stress.

CONCLUSIONS

The results show individual and environmental factors related to cognitive stress appraisal among workers. An effective strategy to improve mental health among workers may involve an interprofessional approach by public health nurses and health practitioners that includes enhanced self-coping skills using individual workers' eHealth literacy, improvement of organisational climates in workplaces and community-based social support.

Association Between Alexithymia and Risk of Incident Cardiovascular Diseases in the SUpplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) Cohort

OBJECTIVE

Although it has been suggested that alexythymia is associated with cardiovascular diseases, studies are scarce and a causal relationship is questionable. This study explored the prospective association between alexithymia and cardiovascular events in middle-aged participants without cardiovascular history at baseline.

METHODS

The 26-item Toronto Alexithymia Scale (TAS-26) was completed by 5586 participants of the French SUpplémentation en VItamines et Minéraux AntioXydants cohort (41.4% of men, M [SD] age = 52.2 [6.3] years) in 1996-1997. Covariates measured at baseline included age, occupational status, depressive symptoms, smoking status, body mass index, hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia. The follow-up ran from January 1, 1998, to the date of the first cardiovascular event, the date of death or September 1, 2007, whichever occurred first. Cardiovascular events were validated by an independent expert committee. Hazard ratios and 95% confidence intervals were computed with Cox regressions.

RESULTS

During an average of 8.9 years of follow-up, 171 first cardiovascular events were validated. After adjustment for age, sex, and occupational status, there was no association between baseline alexithymia and cardiovascular events at follow-up (hazard ratio [95% confidence interval] for 15 points of TAS-26 = 1.00 [0.81-1.23], p > .99). Adjusting for all covariates, using binary TAS-26 cut-offs or TAS-26 subscores yielded similar nonsignificant results.

CONCLUSIONS

In this large prospective study, alexithymia and cardiovascular events were not associated among a nonclinical population. This casts some doubt on whether alexithymia could be a meaningful target in the prevention of cardiovascular diseases.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov (NCT00272428).

Racial disparities in the prevalence and control of hypertension among a cohort of HIV-infected patients in the southeastern United States

BACKGROUND

African Americans are disproportionately affected by both HIV and hypertension. Failure to modify risk factors for cardiovascular disease and chronic kidney disease such as hypertension among HIV-infected patients may attenuate the benefits conferred by combination antiretroviral therapy. In the general population, African Americans with hypertension are less likely to have controlled blood pressure than whites. However, racial differences in blood pressure control among HIV-infected patients are not well studied.

METHODS

We conducted a cross-sectional study evaluating racial differences in hypertension prevalence, treatment, and control among 1,664 patients attending the University of Alabama at Birmingham HIV Clinic in 2013. Multivariable analyses were performed to calculate prevalence ratios (PR) with 95% confidence intervals (CI) as the measure of association between race and hypertension prevalence and control while adjusting for other covariates.

RESULTS

The mean age of patients was 47 years, 77% were male and 54% African-American. The prevalence of hypertension was higher among African Americans compared with whites (49% vs. 43%; p = 0.02). Among those with hypertension, 91% of African Americans and 93% of whites were treated (p = 0.43). Among those treated, 50% of African Americans versus 60% of whites had controlled blood pressure (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) (p = 0.007). After multivariable adjustment for potential confounders, prevalence of hypertension was higher among African Americans compared to whites (PR 1.25; 95% CI 1.12-1.39) and prevalence of BP control was lower (PR 0.80; 95% CI 0.69-0.93).

CONCLUSIONS

Despite comparable levels of hypertension treatment, African Americans in our HIV cohort were less likely to achieve blood pressure control. This may place them at increased risk for adverse outcomes that disproportionately impact HIV-infected patients, such as cardiovascular disease and chronic kidney disease, and thus attenuate the benefits conferred by combination antiretroviral therapy.

Neighborhood walk score and selected Cardiometabolic factors in the French RECORD cohort study

Background

Walkable neighborhoods are purported to impact a range of cardiometabolic outcomes through increased walking, but there is limited research that examines multiple cardiometabolic outcomes. Additionally, few Walk Score (a novel measure of neighborhood walkability) studies have been conducted in a European context. We evaluated associations between neighborhood Walk Score and selected cardiometabolic outcomes, including obesity, hypertension and heart rate, among adults in the Paris metropolitan area.

Methods and results

We used data from the second wave of the RECORD Study on 5993 participants recruited in 2011–2014, aged 34–84 years, and residing in Paris (France). To this existing dataset, we added Walk Score values for participants’ residential address. We used multilevel linear models for the continuous outcomes and modified Poisson models were used for our categorical outcomes to estimate associations between the neighborhood Walk Score (both as a continuous and categorical variable) (0–100 score) and body mass index (BMI) (weight/height² in kg/m²), obesity (kg/m²), waist circumference (cm), systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), hypertension (mmHg), resting heart rate (RHR) (beats per minute), and neighborhood recreational walking (minutes per week). Most participants lived in Walker’s Paradise (48.3%). In multivariate models (adjusted for individual variables, neighborhood variables, and risk factors for cardiometabolic outcomes), we found that neighborhood Walk Score was associated with decreased BMI (β: -0.010, 95% CI: -0.019 to −0.002 per unit increase), decreased waist circumference (β: -0.031, 95% CI: -0.054 to −0.008), increased neighborhood recreational walking (β: +0.73, 95% CI: +0.37 to +1.10), decreased SBP (β: -0.030, 95% CI: -0.063 to −0.0004), decreased DBP (β: -0.028, 95% CI: -0.047 to −0.008), and decreased resting heart rate (β: -0.026 95% CI: -0.046 to −0.005).

Conclusions

In this large population-based study, we found that, even in a European context, living in a highly walkable neighborhood was associated with improved cardiometabolic health. Designing walkable neighborhoods may be a viable strategy in reducing cardiovascular disease prevalence at the population level.

When Blue-Collars Feel Blue

Background—

The association of psychological variables with cardiovascular health might depend on socioeconomic status. We examined the moderating effect of occupational grade on the association between depression and incident cardiac events among middle-aged workers from the GAZEL cohort.

Methods and Results—

A total of 10 541 participants (7855 men, mean age: 47.8±3.5 years) free of cardiovascular diseases completed the Center of Epidemiologic Studies Depression scale in 1993. Age, sex, and occupational grade (low, medium, and high) were obtained from company records. Classical cardiovascular risk factors were self-reported. All participants were followed-up for medically certified cardiac events from January 1994 to December 2014. Associations between baseline variables and incident cardiac events were estimated with hazard ratios and 95% confidence intervals computed in Cox regressions. After a median follow-up of 21 years, 592 (5.6%) participants had a cardiac event. There was a significant interaction between depression and occupational grade in both age- and sex-adjusted ( P =0.008) and multiadjusted ( P =0.009) models. This interaction was mainly explained by an association between depression and incident cardiac events that prevailed among participants of low occupational grade (3.71 versus 1.96 events per 1000 person-years among those depressed versus nondepressed, multiadjusted hazard ratios [95% confidence intervals], 1.99 [1.12–3.48]).

Conclusions—

From a research perspective, these results may account for previous conflicting results and constitute an impetus for reanalyzing previous data sets, taking into account the moderating role of socioeconomic status. From a clinical perspective, they urge clinicians and policy makers to consider depressive symptoms and low socioeconomic status as synergistic cardiovascular risk factors.

Prospective Cohort Study to Elucidate the Correlation between Occupational Stress and Hypertension Risk in Oil Workers from Kelamayi City in the Xinjiang Uygur Autonomous Region of China

The purpose of this study was to assess the major risk factors for hypertension in oil workers, and investigate the effect of occupational stress on the incidence of hypertension after controlling for other risk factors. A prospective cohort approach was used following enrollment of 1354 oil workers. The occupational stress experienced by oil workers was higher than for the general population in China. By the end of the cohort study, 231 new cases of hypertension among the oil workers had been diagnosed. The cumulative incidence of hypertension was 17.06%. There were 44, 112, and 75 workers who developed hypertension in the low, intermediate, and high occupational stress groups, which represented a 12.0%, 15.6%, and 20.3% cumulative incidence, respectively (chi-square value = 9.812, p < 0.01). Multivariate Cox proportional hazard model analysis showed that type of work, cigarette smoking, excess body weight, and obesity were risk factors for hypertension (p < 0.05). After risk factors such as type of work, cigarette smoking, alcohol consumption, and body mass index (BMI) were controlled, the hypertension risk (hazard ratio, HR) in the high occupational stress group was 1.549 (1.072-2.236) compared to the low exposure group, and 2.337 (1.191-4.585) in female subjects. Our study indicated that an increase in occupational stress was associated with an increased risk of hypertension after other factors were adjusted.

Perceived Stress and Atrial Fibrillation: The REasons for Geographic and Racial Differences in Stroke Study

BACKGROUND

The association between perceived stress and atrial fibrillation (AF) remains unclear.

PURPOSE

The aim of this study was to examine the association between perceived stress and AF.

METHODS

A total of 25,530 participants (mean age 65 ± 9.4 years; 54 % women; 41 % blacks) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in this analysis. Logistic regression was used to compute odds ratios (OR) and 95 % confidence intervals (CI) for the association between the short version of the Cohen Perceived Stress Scale and AF.

RESULTS

In a multivariable analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, the prevalence of AF was found to increase with higher levels of stress (none: OR = 1.0, referent; low stress: OR = 1.12, 95 % CI = 0.98, 1.27; moderate stress OR = 1.27, 95 % CI = 1.11, 1.47; high stress: OR = 1.60, 95 % CI = 1.39, 1.84).

CONCLUSION

Increasing levels of perceived stress are associated with prevalent AF in REGARDS.

Association between current perceived stress and incident diabetes is dependent on occupational status: Evidence from the IPC cohort study

AIM

The role of stress in the onset of type 2 diabetes is a widespread lay belief, yet observational studies have produced inconsistent results. This study aimed to test the hypothesis that the association between perceived stress and incident diabetes might depend on occupational status (OS).

METHODS

The four-item Perceived Stress Scale (PSS-4) was completed at baseline by 22,567 participants in the labour force (16,193 men, 6374 women; mean age: 44.5±9.8 years) who had undergone two health checkups subsidized by the French national healthcare system. All subjects were free from diabetes at baseline, defined as a fasting blood glycaemia≥7mmol/L or the use of antidiabetic drugs.

RESULTS

After a mean follow-up of 5.3±2.1 years, 527 participants (2.3%) had incident diabetes. After adjusting for sociodemographic, behavioural and biomedical risk factors as well as self-rated health, the association between baseline perceived stress and diabetes at follow-up was non-significant for the total study population. However, perceived stress was significantly associated with incident diabetes in participants of low OS [odds ratio (OR) for a five-point increment: 1.39; 95% confidence interval (CI): 1.02-1.90]. In contrast, there was a negative association between perceived stress and diabetes among those of high OS (OR: 0.60; 95% CI: 0.41-0.88) and no association within other occupational categories. The interaction between perceived stress and OS was significant (P<0.01).

CONCLUSION

This study suggests that the association between perceived stress and diabetes onset is dependent on OS. Furthermore, this association does not appear to be explained by the classical risk factors for diabetes.

Occupational Disparities in the Association between Self-Reported Salt-Eating Habit and Hypertension in Older Adults in Xiamen, China

Blood pressure responses to sodium intake are heterogeneous among populations. Few studies have assessed occupational disparities in the association between sodium intake and hypertension in older people. We used cross-sectional data from 14,292 participants aged 60 years or older in Xiamen, China, in 2013. Self-reported salt-eating habit was examined with three levels: low, medium, and high. The main lifetime occupation was classified into indoor laborer and outdoor laborer. Multivariable logistic regression was used to examine associations of hypertension with self-reported salt-eating habit, main lifetime occupation, and their interactions by adjusting for some covariates, with further stratification by sex. Overall, 13,738 participants had complete data, of whom 30.22% had hypertension. The prevalence of hypertension was 31.57%, 28.63%, and 31.97% in participants who reported to have low, medium, and high salt-eating habit, respectively. Outdoor laborers presented significantly lower prevalence of hypertension than indoor laborers (26.04% vs. 34.26%, p < 0.001). Indoor laborers with high salt-eating habit had the greatest odds of hypertension (OR = 1.32, 95% CI [1.09–1.59]). An increased trend of odds in eating habit as salt-heavier was presented in indoor laborers (p-trend = 0.048), especially for women (p-trend = 0.001). No clear trend presented in men. Conclusively, sex-specific occupational disparities exist in the association between self-reported salt-eating habit and hypertension in older individuals. Overlooking the potential moderating role of sex and occupation might affect the relationship between sodium intake and hypertension.

Relationship between insomnia symptoms, perceived stress and coping strategies in subjects with arterial hypertension: psychological factors may play a modulating role

OBJECTIVE

The aim of the study was to evaluate perceived stress and coping strategies in people with hypertension, according to the presence of insomnia symptoms and by using a set of variables that included anxiety and depressive symptoms evaluation.

METHODS

A total of 371 hypertensive patients were enrolled during their first visit to the Hypertension Outpatient Unit. The Perceived Stress Scale (PSS), Brief-COPE, Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Self-rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI) were administered. Patients with other sleep disorders or with incomplete data (n = 41) were excluded.

RESULTS

Data from 330 hypertensive patients were analyzed (males 51%, mean age 57 ± 13 years). Those with insomnia symptoms (n = 70, 21%) were older (p = 0.02), more frequently females (p = 0.01), and presented with higher PSS (p < 0.001), BDI (p < 0.0001), SAS (p = 0.0003), and STAI (p < 0.0001) scores than those without insomnia symptoms. In a linear regression trait, anxiety (p < 0.0001) and depressive symptoms (p < 0.05) were independent predictors of high PSS. Patients with insomnia symptoms showed lower scores in coping strategies, such as positive reframing (p = 0.03) and emotional support (p = 0.04), and an increased score in behavioral disengagement (p = 0.03). Trait anxiety and insomnia severity were independent predictors of less effective coping strategies.

CONCLUSIONS

People with hypertension and insomnia symptoms showed higher perceived stress and less effective coping strategies than non-insomniacs; psychological factors such as trait anxiety and depressive symptoms may play a modulating role in these relationships. Prevention and treatment of insomnia symptoms and psychological factors should receive high attention for people with hypertension.