Dose-Response Relation Between Work Hours and Cardiovascular Disease Risk: Findings From the Panel Study of Income Dynamics

Social and environmental risks as contributors to the clinical course of heart failure

Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.

The Association between Occupational Categories and Incidence of Cardiovascular Events: A Cohort Study in Iranian Male Population

BACKGROUND

Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence.

OBJECTIVE

To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population.

METHODS

We followed 2134 men aged 35-65 years for 14 years during the Isfahan Cohort Study (2001-2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor.

RESULTS

The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables.

CONCLUSION

There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.

Current work hours and coronary artery calcification (CAC): The Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

Long work hours may be associated with adverse outcomes, including cardiovascular disease. We investigated cross-sectional associations of current work hours with coronary artery calcification (CAC).

METHODS

Participants (n = 3046; 54.6% men) were from the Multi-Ethnic Study of Atherosclerosis. The number of hours worked in all jobs was obtained by questionnaire and CAC from computed tomography. The probability of a positive CAC score was modeled using log-binomial regression. Positive scores were modeled using analysis of covariance and linear regression.

RESULTS

Sixteen percent of the sample worked over 50 hours per week. The overall geometric mean CAC score was 5.2 ± 10.0; 40% had positive scores. In fully-adjusted models, prevalence ratios were less than 40 hours: 1.00 (confidence interval [CI]: 0.88-1.12), 40:(ref), 41 to 49:1.13 (CI: 0.99-1.30), and ≥50:1.07 (CI: 0.94-1.23) and longer current work hours were not associated with higher mean CAC scores (<40:56.0 [CI: 47.3-66.3], 40:57.8 [CI: 45.6-73.3], 41 to 49:59.2 [CI: 45.2-77.6], ≥50:51.2 [CI: 40.5-64.8]; P = .686).

CONCLUSIONS

Current work hours were not independently associated with CAC scores.

Exploring the Association Between Health Literacy and Psychological Well-Being Among Industry Managers in Germany

OBJECTIVE

Industry managers are typically exposed to high work demands but have received limited attention by research, particularly concerning the issue of health literacy and how this relates to their psychological well-being. The aim of this study was to explore the association between health literacy and psychological well-being among managers in Germany.

METHODS

An online survey of a sample of 126 commercial industry managers was conducted. Effects of health literacy on psychological well-being (WHO-5 index) were investigated using path analysis.

RESULTS

The findings show a quarter of managers were classified as having poor well-being. Health literacy, namely the facets self-regulation (β = 0.40, P < 0.001), self-perception (β = 0.26, P < 0.001), self-control (β = 0.25, P < 0.01), and proactive approach to health (β = 0.09, P < 0.05), were positively associated with psychological well-being.

CONCLUSION

The study indicates that higher health literacy is associated with decreased risk of poor well-being.

Perception and self-management of hypertension in Chinese cardiologists (CCHS): a multicenter, large-scale cross-sectional study

OBJECTIVES

To determine the frequency of risk factors for hypertension among Chinese cardiologists using a nation-wide survey.

DESIGN

Multicenter, cross-sectional observational study.

SETTING

2441 hospitals across China were surveyed between September 2016 and August 2017.

PARTICIPANTS

All in-service cardiologists were surveyed (n=28 924).

INTERVENTIONS

WeChat-based electronic data capture system, a social application in China (Tencent, Nanshan, China), was used for data acquisition. Physician subscribed to the WeChat official account of the China Cardiologist Heart Study, and filled out an online questionnaire that included age, gender, level of in-service hospital, professional title, academic degree, area of expertise and cardiovascular risk factors. All information was required.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the presence of cardiovascular risk factors. The secondary outcome was the impact of the risk factors on the occurrence of hypertension.

RESULTS

Among 28 924 Chinese cardiologists who completed the questionnaire, 57.6% had blood pressure of 130-139/80-89 mm Hg (5.3% were taking antihypertensive drugs) and 22.0% had blood pressure >140/>90 mm Hg (36.5% were taking antihypertensive drugs). The multivariable analysis showed that age, gender, academic degree, hospital level, body mass index (BMI), smoking and comorbidities were independently associated with hypertension among cardiologists (all p<0.05). Age, female gender, BMI, smoking, family history of cardiovascular diseases (CVDs) and comorbidities were independently associated with taking antihypertensive drugs among hypertensive cardiologists (all p<0.05). Age, hospital level, professional title, BMI, family history of CVDs and comorbidities were independently associated with reaching target blood pressure among hypertensive cardiologists taking antihypertensive drugs.

CONCLUSION

Chinese cardiologists do not recognise and pay attention to their own blood pressure. Their rate of antihypertensive treatment was low. The identified risk factors could be used to identify cardiologists at higher risk for hypertension and for implementing preventive interventions.

Digital Leadership Skills and Associations with Psychological Well-Being

Due to increasing digitalisation, today's working world is changing rapidly and provides managers with new challenges. Digital leadership is an important factor in managing these challenges and has become a key concept in the discussion about what kinds of skills managers need for digital transformation. The main research question our study explored was if digital leadership is associated with psychological well-being in upper-level managers. Based on a qualitative pilot study and relevant literature, we developed a new scale for digital leadership in managers. We conducted an online survey with a sample of 368 upper-level managers from a large German ICT-company. Using a stepwise logistic regression analysis, potential effects of digital leadership on psychological well-being (WHO-5) were analysed. Logistic regression analyses showed that better skills in digital leadership were significantly associated with higher well-being. Results also showed that gender, age and managerial experience had no effect in our model. Our study provides a valuable insight into the association between digital leadership and well-being in managers. However, further research is necessary to validate the newly developed scale for digital leadership and to confirm a causal effect in the relationship between digital leadership and well-being.

Exploring nurses' work-related stress in an acute care hospital in KSA

Objectives

This study aimed to assess the perceived work-related-stress of staff nurses and determine the relationship between work-related stress and demographic profile.

Methods

This study used a descriptive cross-sectional design and was conducted in a secondary public hospital (staff nurses = 178, bed capacity = 225) in Riyadh, KSA. The hospital provides medical and surgical services that are important to achieve optimum quality patient care and services. In total, 178 staff nurses were interviewed, but 15 responses were excluded because of missing data (response rate: 92.52%).

Results

Nurses reported a moderately stressful work environment. Nationality was found to be a significant predictor of nurses' stress levels. Indian nurses had higher stress levels compared with nurses of other nationalities. Working hours per week was another significant predictor of stress.

Conclusion

This study highlighted perceived work-related stress of staff nurses and determined the relationship between work-related stress and demographic profile. Most nurses were moderately stressed. Working hours were associated directly with stress level. The study findings can serve as a guide for establishing human resources policies aiming at reducing nurses' stress and, thereby, promoting improved health care and task force work performance.

Shift work of nursing professionals and blood pressure, burnout and common mental disorders

OBJECTIVE

To analyze the influence of shift work on blood pressure, the presence of burnout and common mental disorders in nursing professionals.

METHOD

A cross-sectional study. Burnout was assessed by the Maslach Burnout Inventory, and Common Mental Disorders by the Self-Reporting Questionnaire. Casual blood pressure measurement and Ambulatory Blood Pressure Monitoring (ABPM) were performed.

RESULTS

231 professionals participated. The majority (59.7%) worked in shifts, and this condition was associated (p≤0.05) with: higher weekly workload; doing the night shift; shorter training and work time at the institution; alcoholism; leisure activity; and alteration in ambulatory blood pressure monitoring of the sleep period. The professionals with common mental disorders and who worked in shifts had lower casual diastolic pressure levels (p = 0.039) and higher hypertension prevalence (p = 0.045). The presence of emotional exhaustion was associated with normal waking blood pressure and depersonalization with altered sleep blood pressure.

CONCLUSION

Shift work was associated with a higher prevalence of work-related negative factors, inadequate habits and lifestyles, and change in sleep blood pressure.

Policy changes for preventing and recognizing overwork-related cardiovascular diseases in Taiwan: An overview

Objective

Overwork‐related cardiovascular and cerebrovascular disease (CVD) has a large impact on workers' rights and labor standards across East Asian countries. This article describes the background and impact of policies regarding overwork‐related CVD in the past decades in Taiwan.

Methods

We reviewed government policies, guidelines, literature, and news addressing the problems and impact of policy changes to prevent and recognize overwork‐related CVD since the 1990s, and collected data on overwork‐related CVD cases in Taiwan from 2006 to 2017.

Results

In 2017, overwork‐related CVD accounted for 13% of all cases of occupational diseases, but 79% of all deaths due to occupational diseases. Guidelines for recognizing overwork‐related CVD cases were established in 1991; however, under‐recognition exists in Taiwan due to poor exposure data on working hours and psychological factors and because most medical expenses are covered by the national health insurance system. Amendments on the guidelines, and stricter policies on overwork prevention were enforced following calls from labor unions, nongovernmental organizations, and legislators, but health disparities were introduced when certain industries were exempted from restrictions.

Conclusions

Long working hours and other work characteristics increase the risk of overwork‐related CVD. By reviewing the changes in policy for preventing overwork and recognizing overwork‐related disease, we identified the need for clearly defined guidance on evaluating overwork‐related CVD, with specific criteria for working hours and other risk factors regarding work characteristics. National policies that lead to better working conditions and prevent overwork‐related diseases must be developed.

Association between working hours, work engagement, and work productivity in employees: A cross-sectional study of the Japanese Study of Health, Occupation, and Psychosocial Factors Relates Equity

OBJECTIVES

The aims of the study were to investigate the association between working hours, work engagement, and work productivity, and to examine if work engagement moderates the influence of working hours on work productivity.

METHODS

We used cross-sectional data from the Japanese occupational cohort survey, which involved 2093 employees in a manufacturing industry. Working hours were self-reported by the study participants. Work productivity was assessed with absolute presenteeism based on the scale of the validated Japanese version of World Health Organization Health and Work Performance Questionnaire (WHO-HPQ). Work engagement was assessed with the Nine-item Utrecht work Engagement Scale (UWES-9). Univariate and multivariable regression analyses were conducted to examine the association of working hours and work engagement with work productivity. We also carried out stratified multivariable regression analysis separately for those with high-work engagement and those with low-work engagement.

RESULTS

Working >40 to 50 hours per week and >50 hours per week were significantly positively associated with work productivity in univariate analysis. However, the significant association no longer held after adjusting for work engagement. Work engagement was positively associated with work productivity even after controlling for potential confounders. Working hours were not significantly associated with work productivity among those with high-work engagement or among those with low-work engagement.

CONCLUSIONS

Working hours did not have any significant associations with work productivity when taking work engagement into account. Work engagement did not moderate the influence of working hours on work productivity, though it attenuated the relationship between working hours and work productivity.

Occupational Physical Activity and Cardiovascular Risk Factors Profile in the Adult Population of the Southern Cone of Latin America: Results From the CESCAS I Study

OBJECTIVE

We explore the association between occupational physical activity (OPA) and cardiovascular risk factors in four cities of the Southern Cone.

METHODS

Robust multivariable linear regression models were used to examine the associations.

RESULTS

The working population was constituted by 1868 men and 1672 women. Men performing high levels of OPA showed higher levels of high-density lipoprotein (HDL; mean adj. diff. = 2.24 mg/dL; P = 0.004), lower levels of triglycerides (-24.59 mg/dL; P = 0.006), and total cholesterol (TC)/HDL ratio values (-0.21; P = 0.015) than reference. Women in the highest category of OPA had higher levels of HDL (2.85 mg/dL; P = 0.006), lower TC/HDL (0.27; P = 0.001), and low-density lipoprotein/HDL ratios (-0.18; P = 0.003) than sedentary activities.

CONCLUSION

Individuals who performed high levels of OPA did not exhibit a worse cardiovascular risk profile and an improvement on selected biomarkers was observed when compared with those performing sedentary activities.

Use of Framingham Risk Score as a Clinical Tool for the Assessment of Fitness for Work: Results From a Cohort Study

OBJECTIVE

The aim of this study is to validate the use of the Framingham Risk Score (FRS) as clinical tool to predict the risk of diagnosis of unsuitability for work in a cohort of Italian workers.

METHODS

A cohort of workers has been observed from January 2006 to March 2014. FRS was calculated at each visit. Health surveillance diagnosis of unsuitability for work was selected as outcome.

RESULTS

Two thousand eight hundred fifty seven workers were observed, 58.9% were men, mean age was 51.6 (±6.7), the mean FRS was 15.1% (±10.7%). Increased values of FRS at baseline were associated with increased rate of diagnosis of unsuitability for work (Hazard ratio [HR], 11.2, 95%CI, 3.3 to 37.8).

CONCLUSIONS

FRS is a strong predictor of diagnosis of unsuitability for work and should be used as a clinical tool for the assessment of fitness for work in health surveillance.

Heart Disease and Occupational Risk Factors in the Canadian Population: An Exploratory Study Using the Canadian Community Health Survey

Background

The objective of this study is to find temporal trends in the associations between cardiovascular disease and occupational risk factors in the context of the Canadian population.

Methods

Population data were analyzed from the Canadian Community Health Survey (CCHS) collected between 2001 and 2014 for trends over time between heart disease and various occupational risk factors: hours worked, physical exertion at work, and occupation type (management/arts/education, business/finance, sales/services, trades/transportations, and primary industry/processing).

Results

We found no significant difference in the average number of hours worked/wk between individuals who report having heart disease in all years of data except in 2011 (F_1,96 = 7.02, p = 0.009) and 2012 (F_1,96 = 8.86, p = 0.004). We also found a significant difference in the degree of physical exertion at work in 2001 (F_1,79 = 7.45, p = 0.008). There were statistically significant results of occupation type on self-reported heart disease from 2003 to 2014.

Conclusion

Canadian data from the CCHS do not exhibit a trend toward an association between heart disease and the number of hours worked/wk. There is an association between heart disease and physical exertion at work, but the trend is inconsistent. The data indicate a trend toward an association between heart disease and occupation type, but further analysis is required to determine which occupation type may be associated with heart disease.

The Identification of a Threshold of Long Work Hours for Predicting Elevated Risks of Adverse Health Outcomes

Working long hours has been associated with adverse health outcomes. However, a definition of long work hours relative to adverse health risk has not been established. Repeated measures of work hours among approximately 2,000 participants from the Panel Study of Income Dynamics (1986-2011), conducted in the United States, were retrospectively analyzed to derive statistically optimized cutpoints of long work hours that best predicted three health outcomes. Work-hours cutpoints were assessed for model fit, calibration, and discrimination separately for the outcomes of poor self-reported general health, incident cardiovascular disease, and incident cancer. For each outcome, the work-hours threshold that best predicted increased risk was 52 hours per week or more for a minimum of 10 years. Workers exposed at this level had a higher risk of poor self-reported general health (relative risk (RR) = 1.28; 95% confidence interval (CI): 1.06, 1.53), cardiovascular disease (RR = 1.42; 95% CI: 1.24, 1.63), and cancer (RR = 1.62; 95% CI: 1.22, 2.17) compared with those working 35-51 hours per week for the same duration. This study provides the first health risk-based definition of long work hours. Further examination of the predictive power of this cutpoint on other health outcomes and in other study populations is needed.

The impact of the introduction of new recognition criteria for overwork-related cardiovascular and cerebrovascular diseases: a cross-country comparison

Cardiovascular and cerebrovascular diseases (CVDs) related to overwork are common in Asia, as is death from overwork, known as karoshi. Japan was the first country in the world to introduce criteria for recognizing overwork-related CVDs in 1961. Taiwan followed Japan in putting in place new policies and then updating these in 2010. We aimed to investigate the effect of introducing the new criteria for recognizing overwork-related CVDs in both countries. We defined the baseline period as the 5 years before launch of the new criteria, then collected data to 5 years after the new criteria. We applied a Poisson regression model to analyze the longitudinal change in rates of overwork-related CVDs before and after, adjusting for indicators of working conditions. Implementation of the new criteria was associated with a 2.58-fold increase in the rate of overwork-related CVDs (p-value < 0.05). However, the examined policy framework in Taiwan still appears to miss a substantial number of cases compared to that are captured by a similar policy framework used to capture overwork-related CVD rates in Japan by a factor of 0.42 (p-value < 0.05). Accordingly, we make a case for enhancements of Taiwan’s system for reporting and recognizing overwork-related diseases and deaths.