Dyspepsia in relation to Helicobacter pylori infection and psychosocial work stress in white collar employees

Relationship between job stress and functional dyspepsia in display manufacturing sector workers: a cross-sectional study

Background

Job stress has been reported as a risk factor of psychological changes, which have been shown to be related to gastrointestinal diseases and symptoms such as functional dyspepsia. However, few studies have assessed the relationship between job stress and functional dyspepsia. Therefore, we investigated the relationship between job stress and functional dyspepsia in South Korea.

Methods

This study was conducted between May 23 and July 6, 2016 and included 901 workers in the display manufacturing sector. Subjects completed self-reported questionnaires, regarding Korean Occupational Stress Scale (KOSS), functional dyspepsia, Insomnia Severity Index-K, and health-related behaviors and job characteristics. Subjects were divided into functional dyspepsia-positive and -negative groups based on the Rome III criteria. The KOSS high-risk group was defined as subjects with KOSS score above the 75 percentile of KOSS reference value. Multiple logistic regression analysis was performed to investigate the association between job stress and functional dyspepsia.

Results

In women, the risk of functional dyspepsia was significantly higher in the high-risk groups of the following KOSS subcategories in unadjusted model: job demand (OR 3.282, 95% CI 1.181–9.126), and occupational climate (OR 2.665, 95% CI 1.041–6.823). Even in adjusted model, the risk was significantly higher in the high-risk groups of the following KOSS subcategories: job demand (OR 3.123, 95% CI 1.036–9.416) and occupational climate (OR 3.304, 95% CI 1.198–9.115). In men, the risk of functional dyspepsia was not significant in all KOSS subcategories.

Conclusions

This study showed that job demand and occupational climates were associated with functional dyspepsia in female display manufacturing sector workers. Therefore, both clinical and mental health approaches should be used in the management of functional dyspepsia in women.

Time trends in dyspepsia and association with H. pylori and work-related stress-An observational study in white collar employees in 1996 and 2015

Purpose

We aimed to describe time trends in functional dyspepsia and the association of dyspepsia-related factors, Helicobacter pylori (H. pylori) and work-related stress with functional dyspepsia in white collar employees in 1996 and 2015.

Materials and methods

Repeat cross-sectional study conducted in 1996 (n = 190, response rate = 76.1) and 2015 (n = 195, response rate = 40.2) within a health insurance company in South-West Germany. Dyspeptic symptoms measured according to the Rome III criteria, effort-reward imbalance and further work- or dyspepsia-related factors were assessed by self-administered questionnaire. H. pylori infection as possible factor for dyspeptic symptoms was measured by a ¹³C-urea breath test or an antigen stool test. Kruskal-Wallis tests and multivariable logistic regression models were calculated comparing the upper tertile of dyspeptic symptom scale to the middle and lower tertile.

Results

Mean dyspepsia symptom scores and work-related stress did not differ comparing 1996 and 2015. In bivariate analyses, dyspeptic symptom scores were consistently correlated with sex, age, and using antacids. Further dyspepsia-related factors were smoking and non-leading occupational position in 1996 and non-steroidal anti-inflammatory drugs as well as high effort-reward imbalance in 2015. High intrinsic effort was positively associated with high dyspepsia symptom scores in both studies. Following multivariable adjustment, we observed a consistent association between high intrinsic effort at work and dyspeptic symptoms, although the association was only marginally statistically significant in 1996. Furthermore, a strong association of somatization, only measured in 2015, with dyspeptic symptoms was shown.

Conclusions

Dyspepsia-related factors may have changed throughout the last decades. Nevertheless, although occupational situations might differ, the intrinsic effort is still strongly associated with dyspeptic symptoms.

Associations of Extrinsic and Intrinsic Components of Work Stress with Health: A Systematic Review of Evidence on the Effort-Reward Imbalance Model

Mainstream psychological stress theory claims that it is important to include information on people’s ways of coping with work stress when assessing the impact of stressful psychosocial work environments on health. Yet, some widely used respective theoretical models focus exclusively on extrinsic factors. The model of effort-reward imbalance (ERI) differs from them as it explicitly combines information on extrinsic and intrinsic factors in studying workers’ health. As a growing number of studies used the ERI model in recent past, we conducted a systematic review of available evidence, with a special focus on the distinct contribution of its intrinsic component, the coping pattern “over-commitment”, towards explaining health. Moreover, we explore whether the interaction of intrinsic and extrinsic components exceeds the size of effects on health attributable to single components. Results based on 51 reports document an independent explanatory role of “over-commitment” in explaining workers’ health in a majority of studies. However, support in favour of the interaction hypothesis is limited and requires further exploration. In conclusion, the findings of this review support the usefulness of a work stress model that combines extrinsic and intrinsic components in terms of scientific explanation and of designing more comprehensive worksite stress prevention programs.

Psychosocial work stress is associated with poor self-rated health in Danish nurses: a test of the effort-reward imbalance model

Nursing staff are exposed to stressful work load which in turn is associated with poor physical and psychological health, sickness absence and job exit. The effort-reward imbalance (ERI) model is a validated approach to measure chronic psychosocial work stress by identifying nonreciprocity between occupational efforts spent and rewards received, and has been found to predict poor health. The aim of this cross-sectional study (n = 367 nurses and nurses aides) was first to test the psychometric properties of the Danish questionnaire measuring ERI, and secondly to analyse whether psychosocial work stress is associated with six indicators of poor self-rated health. Results derived from confirmatory factor analysis indicate satisfying psychometric properties. Elevated risks of poor self-rated health (odds ratios varying from 1.92 to 4.76) are observed in nursing staff characterized by high effort in combination with low reward. Effects are enhanced in those respondents who additionally exhibit a high level of work-related overcommitment. In conclusion, despite methodological limitations, this study contributes to the validation of the ERI questionnaire in Danish language. Furthermore, by documenting associations with poor self-rated health, it supports efforts of theory-guided prevention of work stress in health care professions.

Reviewing the effort–reward imbalance model: drawing up the balance of 45 empirical studies

The present paper provides a review of 45 studies on the Effort-Reward Imbalance (ERI) Model published from 1986 to 2003 (inclusive). In 1986, the ERI Model was introduced by Siegrist et al. (Biological and Psychological Factors in Cardiovascular Disease, Springer, Berlin, 1986, pp. 104-126; Social Science & Medicine 22 (1986) 247). The central tenet of the ERI Model is that an imbalance between (high) efforts and (low) rewards leads to (sustained) strain reactions. Besides efforts and rewards, overcommitment (i.e., a personality characteristic) is a crucial aspect of the model. Essentially, the ERI Model contains three main assumptions, which could be labeled as (1) the extrinsic ERI hypothesis: high efforts in combination with low rewards increase the risk of poor health, (2) the intrinsic overcommitment hypothesis: a high level of overcommitment may increase the risk of poor health, and (3) the interaction hypothesis: employees reporting an extrinsic ERI and a high level of overcommitment have an even higher risk of poor health. The review showed that the extrinsic ERI hypothesis has gained considerable empirical support. Results for overcommitment remain inconsistent and the moderating effect of overcommitment on the relation between ERI and employee health has been scarcely examined. Based on these review results suggestions for future research are proposed.

Burden of Helicobacter pylori and H. pylori-related diseases in developed countries: recent developments and future implications

Helicobacter pylori colonizes the gastric mucosa. H. pylori infection is the main cause of peptic ulcer and gastric malignancy. This review gives an overview on the epidemiology of H. pylori infection and H. pylori-associated diseases in the developed world, mainly Europe, and it discusses very recent developments with regard to the prevalence and its future implications for H. pylori-associated diseases.

[Measuring psychosocial stress at work in Spanish hospital's personnel. Psychometric properties of the Spanish version of Effort-Reward Imbalance model]

BACKGROUND AND OBJECTIVE

Two main models are currently used to evaluate the psychosocial factors at work: the Demand-Control (or job strain) model developed by Karasek and the Effort-Reward Imbalance model, developed by Siegrist. A Spanish version of the first model has been validated, yet so far no validated Spanish version of the second model is available. The objective of this study was to explore the psychometric properties of the Spanish version of the Effort-Reward Imbalance model in terms of internal consistency, factorial validity, and discriminate validity.

SUBJECTS AND METHODS

A cross-sectional study on a representative sample of 298 workers of the Spanish public hospital San Agustin in Asturias was performed. The Spanish version of Effort-Reward Imbalance Questionnaire (23 items) was obtained by a standard forward/backward translation procedure, and the information was gathered by a self-administered application. Exploratory factor analysis were performed to test the dimensional structure of the theoretical model. Cronbach's alpha coefficient was calculated to estimate the internal consistency reliability. Information on discriminate validity is given for sex, age and education. Differences were calculated with the t-test for two independent samples or ANOVA, respectively.

RESULTS

Internal consistency was satisfactory for the two scales (reward and intrinsic effort) and Cronbach's Alpha coefficients higher than 0.80 were observed. The internal consistency for the scale of extrinsic effort was lower (alpha = 0.63). A three-factor solution was retained for the factor analysis of reward as expected, and these dimensions were interpreted as a) esteem, b) job promotion and salary and c) job instability. A one-factor solution was retained for the factor analysis of intrinsic effort. The factor analysis of the scale of extrinsic effort did not support the expected one-dimension structure. The analysis of discriminate validity displayed significant associations between measures of Effort-Reward Imbalance and the variables of sex, age and education level.

CONCLUSIONS

This study is the first one supporting satisfactory psychometric properties of the Spanish version of the Effort-Reward Imbalance model. However, the factorial validity of the extrinsic effort could be questioned.

Are dyspeptic symptoms linked to Helicobacter pylori? A prospective cohort study among medical students

OBJECTIVE AND DESIGN

In Austria, the prevalence of Helicobacter pylori (Hp) infection in healthy people with or without symptoms of dyspepsia has not yet been assessed systematically. We conducted a prospective cohort study among medical students during their rotation in internal medicine to determine whether or not dyspeptic symptoms are linked to Hp infection. Symptoms were assessed before testing for Hp so that knowledge of Hp status could not influence symptom-reporting behavior.

METHODS

From February 2000 to February 2001 we invited 242 medical students to participate in this trial. Abdominal symptoms were assessed by a questionnaire. Dyspeptic symptoms were defined according to the Rome II criteria: heartburn was not considered a dyspeptic symptom. Severity of symptoms was assessed using the Glasgow dyspepsia severity score (GDSS). After determination of symptoms, students underwent a 13C-urea breath test for Hp.

RESULTS

Of 242 students (103 male, 139 female, mean age 26 years, range 21-39 years), 23 tested positive for Hp (10%). Of 34 participants reporting dyspeptic symptoms (14%, GDSS-range 1-11), four were Hp positive (12%). Of the 208 asymptomatic students, 19 were Hp positive (9%). Statistical analysis did not show a significant difference in the frequency of Hp infection between asymptomatic students and students reporting dyspeptic symptoms.

CONCLUSION

Hp prevalence in Austrian medical students is similar to that in other western countries. There was no significant difference in Hp prevalence between dyspeptic students and asymptomatic students.

Correlation between Helicobacter pylori infection and gastrointestinal symptoms in pregnancy

Nausea, vomiting, and other dyspeptic symptoms are common in pregnancy. This hospital-based, cross-sectional study was designed to determine the role of Helicobacter pylori infection in gastrointestinal (GI) symptoms during pregnancy. Standardized verbal scales were used to evaluate the frequency and severity of GI symptoms in 54 women whose pregnancies were in the first 16 gestational weeks. H. pylori infection was defined as a positive serum immunoglobulin G result on an immunochromatographic assay. The H. pylori seropositivity rate was higher in the pregnant women (69%) than in the general population (approximately 50%-55%), but seropositivity did not correlate with clinical symptoms. Moreover, no specific patterns of GI symptoms were uncovered in the H. pylori-infected patients. Maternal age, body weight, parity, gestational week, and educational level were not associated with H. pylori infection; neither were the prevalence and severity of GI symptoms.

Work stress and metabolic and hemostatic risk factors

OBJECTIVE

A high level of work stress has been associated with cardiovascular disease. However, the pathophysiological mechanisms underlying this association remain unclear. This study examined the effect of work stress on a cluster of metabolic and hemostatic risk factors.

METHODS

Blood was collected three times, on the first, third, and fifth day of a work week, from 124 middle-aged, white-collar workers. Metabolic measures were insulin, glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol. Hemostatic measures were fibrinogen, tissue-type plasminogen activator activity, tissue-type plasminogen activator antigen, and type 1 plasminogen activator inhibitor antigen. Chronic work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (effort-reward imbalance) or 2) high overcommitment (an exhaustive work-related coping style).

RESULTS

Overcommitment, but not imbalance or the imbalance-overcommitment interaction, was associated with an impaired fibrinolytic system, as reflected in decreased tissue-type plasminogen activator activity levels and increased type 1 plasminogen activator inhibitor antigen levels on all three measurement occasions. After controlling for body mass index, total cholesterol, triglycerides, high-density lipoprotein/low-density lipoprotein cholesterol ratio, glucose, and insulin, the relation between overcom-mitment and the fibrinolytic factors was attenuated but remained significant.

CONCLUSIONS

The results suggest that individuals with an exhaustive coping style at work have an impaired fibrinolytic capacity that is possibly due to the effects of chronic stress on insulin resistance.