Work stress and health in Western European and post-communist countries: an East-West comparison study

Work stress, overcommitment personality and alcohol consumption based on the Effort-Reward Imbalance model: A population-based cohort study

Work stress has been extensively supported to predict health outcomes like health behaviors. Evidence has linked work stress and personality independently to health, but the interrelationships between work stress and personality and their joint effects on health might deserve more attention in research. This study attempts to integrate recent developments in psychological research (diverse roles of personality in stress processes) into the well-established Effort-Reward Imbalance (ERI) model for work stress. Based on the ERI model, this population-based cohort study aims to investigate the relationships between work stress, personality and alcohol consumption; it particularly focuses on potential roles of overcommitment (OC) personality in ERI-drinking relations, including modifying, antecedent, mediator or direct effects. This two-wave cohort study was conducted in population samples of 3782 men and 3731 women (aged 45-69 years) from Czech Republic, Poland and Russia. Alcohol consumption was assessed by three drinking outcomes: binge drinking, heavy drinking and problem drinking. To assess modifying effect of OC in ERI-drinking relations, logistic regression was used. To assess antecedent or mediator role of OC in ERI-drinking relations, path analysis with the autoregressive and cross-lagged model was conducted. The results showed that OC had no significantly modifying effect in ERI-drinking relations. OC and ERI might have bidirectional relationships in the average follow-up period of 3.5 years; the effect of OC on ERI was remarkably stronger than the reversed causation. Antecedent role of OC in ERI-drinking relationship was significant, but mediator role of OC was not. In conclusion, our findings imply that "antecedent role" of OC in ERI-drinking relations is significant and promising as a potential target for individual intervention; future interventions are suggested to identify and target potential cognitive-behavioral mechanisms via which personality might influence work stress and subsequently health behaviors.

Moderating and Mediating Effects of Over-Commitment on the Association Between Effort–Reward Imbalance (ERI) with Upper Back and Hand/Wrist Disorders in Municipal Solid Waste Collectors

Purpose

Methods

Results

Conclusion

Future trends in social inequalities in obesity in England, Wales and Scotland

BACKGROUND

Previous studies have shown persistent or increasing socioeconomic inequalities in obesity in many European countries. The aim of this study was to project trends in social inequalities in obesity to 2035 in male and female adults (aged 16+) in the UK to ascertain if the gap is widening or narrowing.

METHODOLOGY

BMI data for the UK were extracted from the Health Survey for England (2004-14), Scottish Health Survey (2008-14) and the Welsh Health Survey (2004-14), respectively. A non-linear multivariate regression model was fitted to cross-sectional risk factor data to create longitudinal projections to 2035 stratified by sex, and occupational status or education level.

RESULTS

Individuals in routine and manual jobs are projected to have the highest prevalence of obesity by 2035 and to experience the highest increases in obesity prevalence to 2035. Social inequalities based on occupation are projected to widen (except in English females). Social inequalities based on education are projected to decrease (except in Welsh females).

DISCUSSION

A population strategy of prevention focused on the structural determinants of obesity is needed to change the trajectory of obesity prevalence trends and to tackle health inequalities.

Exploring the effort-reward structure of university work focusing on perceived overall stress, self-reported health, and musculoskeletal disorders

Background: The effort-reward imbalance (ERI) model by Siegrist encouraged numerous scientific investigations that reported particular ties between psychosocial risks and poor self-reported health (SRH), while psychosocial work-related stress has also been linked to musculoskeletal disorders (MSDs). The aim of this study was to examine the health status and the perceived levels of occupational stress of university employees and to analyse the findings according to the employees’ effort and reward structure of work, perceived overall stress, SRH and the presence of MSDs.

Design and methods: 398 employees – including healthcare professionals, academic personnel and workers with administrative or other jobs – employed at the University of Szeged, Faculty of Medicine were investigated with a self-administered questionnaire including the Effort-Reward Imbalance Questionnaire (ERIQ) and Perceived Stress Scale 4 (PSS-4).

Results: More than half of the investigated subjects (54.8%) reported some forms of MSDs. Low self-reported health (P<0.001) and presence of MSDs (P=0.015) were significantly associated with the level of perceived stress and effort-reward imbalance (ERI), moreover increased level of perceived stress was independently associated with the likelihood of MSDs (AOR=1.13) and low self-reported health (AOR=1.30). ERI well predicted low self-reported health (AOR=2.05) as well. Increased level of perceived stress positively correlated with high workrelated effort (r=0.247, P<0.001) and over-commitment (r=0.387, P<0.001) while with work-related reward (r=−0.181, P=0.011) perceived stress showed a negative connection.

Conclusion: Our results suggest that addressing the burden of effort-reward imbalance and MSDs would likely lessen employees’ perceived level of overall stress and affect their self-reported overall state of health.

A need for an update of Polish birth weight reference norms

The indicators of perinatal outcome are birth weight and gestational age. The standard method of assessing the outcome is comparing the newborn’s birth weight with the reference system, presented in the form of percentile charts. Acceleration or delay in prenatal development, which are associated with environmental changes, stress the need to validate the developmental norms. The goal of this study is to evaluate the need to construct new and accurate reference standards. The study includes data of newborns from singleton pregnancies: 4919 born in 2000 and 3683 born in 2015. Study variables included gestational age, sex, and birth weight. Percentile values estimated for two groups of infants born in years separated by a 15-year period, born in 2000 and in 2015, were compared. Birth weight percentiles, from the 28th to the 42nd week of gestation, were calculated using the Lambda Mu Sigma method. Estimated values revealed the birth weight standards in different weeks of gestational age for both years: 2000 and 2015. Comparison among medians estimated for infants born in these years showed the existence of significant differences among boys in the 28th, 36th, and 39th weeks and among girls in the 34th and 41st weeks of gestational age. As the period between the two measurements involves several years, environmental changes during this time period might have significantly affected the course of pregnancy and thus the birth weight. Hence, there is a need to validate the developmental norms. The reference standards should be renewed, and must be done on a periodical basis.

Professional Driver's Job Stress and 8-year Risk of Cardiovascular Disease: The Taiwan Bus Driver Cohort Study

BACKGROUND

Two main job stress models-the Demand-Control-Support (DC) model and the Effort-Reward Imbalance (ERI) model have been used to assess the impact of psychosocial work-related factors for cardiovascular disease (CVD). Limited evidence elaborates the independent and combined effects on CVD events, especially for professional drivers. This study assesses the independent and combined effects of DC and ERI models on an 8-year risk of CVD among professional drivers.

METHODS

The Taiwan Bus Driver Cohort Study recruited 1650 professional drivers from a large bus company in 2005. The subjects were interviewed in person and completed the two job stress questionnaires. Researchers found 94 new cases of CVD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 390-459) from 2006 to 2012. A Cox proportional hazards model was performed to estimate the hazard ratio (HR) for CVD events.

RESULTS

Occupational drivers with high overcommitment scores (thresholds of 15) had an elevated risk for CVD (HR = 1.71; 95% CI = 1.04, 2.82). Regarding target disease, overcommitment had an increased risk for CVD (not including hypertensive disease) (HR = 1.27; 95% CI = 1.05, 1.54) and ischemic heart disease (HR = 1.32; 95% CI = 1.05-1.65).

CONCLUSION

Overcommitment, which is associated with job stress, appears to be associated with CVD risk in professional drivers.

Occupational Stress in Helicopter Emergency Service Pilots From 4 European Countries

OBJECTIVE

Working conditions are known to affect motivation, well-being, and ultimately work performance. Helicopter emergency medical services (HEMS) pilots' work is highly demanding and safety critical, but virtually no published data on occupational stress and strain symptoms in HEMS pilots are available. We investigated work stressors and resources and their association with work engagement, subjective well-being, and energy levels in European HEMS pilots.

METHODS

Cross-sectional questionnaire data were collected consecutively from 72 European HEMS pilots (24 Western European and 48 Eastern European, mean age = 51.9 years). We examined the stressor, resource, and strain symptom levels by age group and region of origin and the association of stressors and resources with work engagement, well-being, and energy.

RESULTS

Although the responses differed notably between the Eastern and Western European pilots, their overall profile was quite favorable. At the same time, those stressor/resource variables, which on average had the most favorable ratings, were the most strongly associated with (reduced) well-being and energy.

CONCLUSION

On the whole, the HEMS pilots' perception of their work situation appears to be positive, and they are highly engaged in their work. The pilots' strong identification with their work should be taken into account in pilot mental health support systems.

Identification of Causes of the Occupational Stress for Health Providers at Different Levels of Health Care

Objectives:

To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses.

Patients and methods:

The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace.

Results:

Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload.

Conclusion:

The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

Associations between occupational stress and demographic characteristics in petroleum workers in the Xinjiang arid desert

Owing to the transformation of the biomedical model of health, more and more professionals pay close attention to the occupational social psychological factors, such as occupational stress. Due to the socioeconomic impact of occupational stress and the petroleum workers stationed in the unique environment in Xinjiang, a cross-sectional study was carried out between May and December 2016 to investigate the relationship between occupational stress and demographic characteristics. A total of 1480 workers were selected. Occupational stress was evaluated with the Occupational Stress Inventory-Revised Edition. The findings of the present study revealed that the values of the Occupational Roles Questionnaire results (t = 9.266, P < .001) and Personal Strain Questionnaire results (t = 21.381, P < .001) were found to be higher than the national normal. Personal Resources Questionnaire values (t = -17.575, P < .001) were found to be lower than the national normal in petroleum workers stationed in the arid desert, and suggested a strong correlation between occupational stress and demographic characteristics. These data provide evidence that different demographic characteristics are associated with different occupational stress levels in petroleum workers stationed in the arid desert.

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.

The Role of Work-Related Factors in the Development of Psychological Distress and Associated Mental Disorders: Differential Views of Human Resource Managers, Occupational Physicians, Primary Care Physicians and Psychotherapists in Germany

Objectives: This study analyses the perceived relevance of stress-dimensions in work-settings from the differential views of Human Resource Managers (HRM), Occupational Physicians (OP), Primary Care Physicians (PCP) and Psychotherapists (PT) in Germany. Methods: Cross-sectional study design, using a self-report questionnaire. Descriptive measures and explorative bivariate methods were applied for group-comparisons. Results are presented as rankings of perceived importance and as polarity profiles of contrasting views. Results: N = 627 participants completed the questionnaires (HRM: n = 172; OP: n = 133; PCP: n = 136; PT: n = 186). The stress dimensions with the highest mean ratings across all four professions were: ‘social relationships in the work place’ (M = 3.55, SD = 0.62) and ‘superiors´ leadership style’ (M = 3.54, SD = 0.64). Mean ratings of perceived relevance of stress dimensions differed most between HRM and the three medical professions. Conclusions: The perceived importance of work-related stress-dimensions seems to be higher in the medical disciplines (OP, PCP, PT) than in the group from the management sector (HRM). However, no fundamental disagreement on the role of work-related stress-dimensions seems to hinder e.g., intensified efforts of cooperation across sectors in tackling the “stress-pandemic” and improving the (mental) health of employees.

Psychosocial work environment and oxidative stress among nurses'

Background:

Work stress among nurses has increased in recent years due to the demands of clinical nursing.

Objectives:

To investigate psychosocial work stress among nurses using the effort-reward imbalance (ERI) model with assessment malondialdehyde (MDA) as an oxidative stress marker and total antioxidants.

Methods:

The present study was conducted on 204 registered nurses worked at two tertiary hospitals in Menoufia governorate, Egypt through the period from the 1st of February to the end of July 2016. Two questionnaires were applied including general demographic and occupational histories as well as effort-reward questionnaire. Blood analysis was performed to assess MDA and total antioxidant levels.

Results:

ERI was prevalent among the study participants (72.5%). ERI was more prevalent among young married nurses who worked more than 10 years. Nurses that worked at ICUs complained more of ERI (43.2%) while nurses that worked at operation rooms complained more of overcommitment (62.5%). MDA levels were significantly positively correlated with E/R ratios (rho = 0.350, P ≤ 0.001).

Conclusions:

Work stress was prevalent among the studied nurses as revealed by the high ERI and MDA levels. Young married female nurses complained more of work stress. ICUs and operating rooms were the most stressful departments at the studied hospitals. Hence, implementing programs and strategies that eliminate stressful working conditions at hospitals is critical to the reduction and prevention of work stress among nurses.

Emergency department nurses' experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand

BACKGROUND

Occupational stress has been a health-related issue among nurses for many decades. Emergency department nurses are frequently confronted with occupational stress in their workplace; in particular, they encounter stressful situations and unpredictable events. These encounters could make them feel more stressed than nurses in other departments. Research considering occupational stress from the perspective of Thai emergency department nurses is limited.

OBJECTIVE

This study aimed to explore nurses' perceptions of occupational stress in an emergency department.

METHODS

A qualitative approach was used to gain an understanding of nurses' experiences and perceptions regarding stress in their workplace. Semi-structured interviews were used for data collection. Twenty-one emergency department nurses working in a public hospital in Thailand were interviewed, and the data were analyzed using content analysis.

RESULTS

The findings comprised three themes: (1) perceived stress, (2) consequences of stress, and (3) stress management.

CONCLUSIONS

The results of this study can be used by hospital management to help them adopt effective strategies, such as support programs involving co-workers/supervisors, to decrease occupational stress among emergency department nurses. Future research that explores each of the themes found in this study could offer a more comprehensive understanding of nurses' occupational stress in the emergency department.

Effort–reward imbalance at work, over-commitment personality and diet quality in Central and Eastern European populations

The aims of this study were to investigate the associations between work stress defined by the effort–reward imbalance (ERI) model and diet quality and to examine the potential role of over-commitment (OC) personality in ERI–diet relationships. A cross-sectional study was conducted in random population samples of 6340 men and 5792 women (age 45–69 years) from the Czech Republic, Russia and Poland. Dietary data were collected using FFQ. The healthy diet indicator (HDI) was constructed using eight nutrient/food intakes (HDI components) to reflect the adherence to WHO dietary guideline. The extent of imbalance between effort and reward was measured by the effort:reward (ER) ratio; the effort score was the numerator and the reward score was multiplied by a factor adjusting for unequal number of items in the denominator. Logistic regression and linear regression were used to assess the associations between exposures (ER ratio and OC) and outcomes (HDI components and HDI) after adjustment for confounders and mediators. The results showed that high ER ratio and high OC were significantly associated with unhealthy diet quality. For a 1-sd increase in the ER ratio, HDI was reduced by 0·030 and 0·033 sd in men and women, and for a 1-sd increase in OC, HDI was decreased by 0·036 and 0·032 sd in men and women, respectively. The modifying role of OC in ERI–diet relationships was non-significant. To improve diet quality at workplace, a multiple-level approach combining organisational intervention for work stress and individual intervention for vulnerable personality is recommended.

Risk and resilience: health inequalities, working conditions and sickness benefit arrangements: an analysis of the 2010 European Working Conditions survey

In this article we ask whether the level of sickness benefit provision protects the health of employees, particularly those who are most exposed to hazardous working conditions or who have a little education. The study uses the European Working Condition Survey that includes information on 20,626 individuals from 28 countries. Health was measured by self-reported mental wellbeing and self-rated general health. Country-level sickness benefit provision was constructed using spending data from Eurostat. Group-specific associations were fitted using cross-level interaction terms between sickness benefit provision and physical and psychosocial working conditions respectively, as well as those with little education. The mental wellbeing of employees exposed to psychosocial job strain and physical hazards, or who had little education, was better in countries that offer more generous sickness benefit. These results were found in both men and women and were robust to the inclusion of GDP and country fixed effects. In the analyses of self-reported general health, few group-specific associations were found. This article concludes that generous sickness benefit provision may strengthen employee's resilience against mental health risks at work and risks associated with little education. Consequently, in countries with a generous provision of sickness benefit, social inequalities in mental health are smaller.

PREVALENCE OF MULTI-FOCAL ATHEROSCLEROTIC PATHOLOGY ACROSS AGE GROUPS

Aim. To compare the prevalence of multi-focal subclinical atherosclerotic pathology and its determinants in cardiovascular surgery patients.

Material and methods. The study included 1018 patients — 825 en and 193 women (mean age 59,0±12,0 years) — who were hospitalised for a planned intervention on coronary or other arteries. Group I (n=542) was aged under 60 years, Group II (n=215) — 60–64 years, Group III (n=141) — 65–69 years, and Group IV (n=120) — 70 years or older. All participants underwent coronary angiography and Doppler ultrasound; peripheral angiography was performed, if necessary. Multi-focal atherosclerosis (MFA) criteria were the presence of stenosis (≥30%) or revascularisation in two or more vascular territories.

Results. Subclinical atherosclerotic pathology of various localisation was observed in 52,3% of the patients. Advanced age was linked to an increase in the MFA prevalence: from 45,8% in Group I to 58,6% in Group II, 58,2% in Group III, and 63,3% in Group IV (p=0,0001). In Group I, MFA was associated with the intermittent claudication syndrome (ICS), decreased body mass index (BMI), increased intima-media thickness (IMT), elevated total cholesterol (TCH). However, in Groups II–IV, the only association observed was between MFA and ICS.

Conclusion. Taking into account the subclinical (hemodynamically insignificant) arterial pathology had resulted in a high prevalence of MFA. Advanced age was associated with a higher MFA prevalence. Other factors linked to MFA were increased IMT, elevated TCH, decreased BMI, and ICS. 

Social Determinants of Stroke as Related to Stress at Work among Working Women: A Literature Review

In adult life, many of the social determinants of health are connected to working life. Yet, our knowledge of the role of work-related factors for the risk of stroke is fairly limited. In contemporary occupational health research, the Demand-Control Model (DCM) is frequently used to measure work stress. Previous literature reviews of the association of work stress and cardiovascular disease (CVD) do not include stroke as a specific outcome. Results regarding work stress and the risk of CVD are less evident in working women. With the focus on working women, the purpose of the present paper was to review the current research into the DCM in relation to stroke and to scrutinize potential gender differences. A literature search was performed and eight studies from three countries were identified. Based on the reviewed studies, there is some evidence that high psychological demands, low job control, and job strain are associated with increased stroke risk in women as well as in men. Any major reduction in deaths and disability from stroke is likely to come from decreasing social inequalities in health, and reducing work stress has a potential to contribute to a reduced risk of stroke in working populations.

Determinants of self-rated health in a representative sample of a rural population: a cross-sectional study in Greece

Self-rated health (SRH) is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity) were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%), 790 (52%) and 237 (15.6%) rated their health as "very good", "good" and "poor" respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed.

Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians

PURPOSE

This study examined job satisfaction and job stress of German compared to Norwegian physicians in private practice.

METHODS

A representative sample of physicians in private practice of Schleswig-Holstein, Germany (N = 414) and a nationwide sample of Norwegian general practitioners and private practice specialists (N = 340) were surveyed in a cross-sectional design in 2010. The questionnaire comprised the standard instruments "Job Satisfaction Scale (JSS)" and a short form of the "Effort-Reward Imbalance Questionnaire (ERI)".

RESULTS

Norwegian physicians scored significantly higher (<0.01) on all items of the job satisfaction scale compared to German physicians (M 5.57, SD 0.74 vs. M 4.78, SD 1.01). The effect size was highest for the items freedom to choose method (d = 1.012), rate of pay (d = 0.941), and overall job satisfaction (d = 0.931). While there was no significant difference in the mean of the overall effort scale between German and Norwegian physicians, Norwegian physicians scored significantly higher (p < 0.01) on the reward scale. A larger proportion of German physicians (27.6%) presented with an effort/reward ratio beyond 1.0, indicating a risky level of work-related stress, compared to only 10.3% of Norwegian physicians. Working hours, effort, reward, and country differences accounted for 37.4% of the explained variance of job satisfaction.

CONCLUSIONS

Job satisfaction and reward were significantly higher in Norwegian than in German physicians. An almost threefold higher proportion of German physicians exhibited a high level of work-related stress. Findings call for active prevention and health promotion among stressed practicing physicians, with a special focus on improved working conditions.

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.

Regulation by chronic-mild stress of glucocorticoids, monocyte chemoattractant protein-1 and adiposity in rats fed on a high-fat diet

Stress has been reported as a widespread problem and several studies have linked obesity and inflammation-related diseases. Moreover, the combination of suffering from chronic stress and high energy intake might be related to the onset of some metabolic diseases. To study the possible relationships between stress, inflammatory status and obesity, a chronic-mild stress (CMS) paradigm with a high-fat dietary intake model (Cafeteria diet) was implemented on male Wistar rats for 11 weeks. Stress and dietary intake effects on animal adiposity, serum biochemical as well as glucocorticoids and inflammation markers were all analyzed. As expected, consuming a high-fat diet increased body weight, adiposity and insulin resistance in non-stressed animals. A decrease of total white adipose tissue (WAT) and an increase of fecal glucocorticoids, as well as angiotensinogen, and monocyte chemoattractant protein-1 (MCP-1) expression level in retroperitoneal WAT were found only on control-stressed rats. Regarding the serum MCP-1, a decrease was observed on animals under CMS while being fed Cafeteria diet. Furthermore, 11β-hydroxysteroid dehydrogenase activity, a glucocorticoid and obesity biomarker in the liver, was influenced by high-fat diet intake but not by stress. Finally, statistical analysis showed a strong relation between MCP-1 expression levels in retroperitoneal WAT, fecal corticosterone and total WAT. This trial proved that CMS induced a glucocorticoid-mediated response, which was reduced by the intake of a Cafeteria diet. These findings suggest that a high-fat diet could protect against a stress condition and revealed a different behavior to a stressful environment depending on the nutritional status.

Endogenous reward mechanisms and their importance in stress reduction, exercise and the brain

Stress can facilitate disease processes and causes strain on the health care budgets. It is responsible or involved in many human ailments of our time, such as cardiovascular illnesses, particularly related to the psychosocial stressors of daily life, including work. Besides pharmacological or clinical medical treatment options, behavioral stress reduction is much-needed. These latter approaches rely on an endogenous healing potential via life-style modification. Hence, research has suggested different ways and approaches to self-treat stress or buffer against stressors and their impacts. These self-care-centred approaches are sometimes referred to as mind-body medicine or multi-factorial stress management strategies. They consist of various cognitive behavioral techniques, as well as relaxation exercises and nutritional counselling. However, a critical and consistent element of modern effective stress reduction strategies are exercise practices. With regard to underlying neurobiological mechanisms of stress relief, reward and motivation circuitries that are imbedded in the limbic regions of the brain are responsible for the autoregulatory and endogenous processing of stress. Exercise techniques clearly have an impact upon these systems. Thereby, physical activities have a potential to increase mood, i.e., decrease psychological distress by pleasure induction. For doing so, neurobiological signalling molecules such as endogenous morphine and coupled nitric oxide pathways get activated and finely tuned. Evolutionarily, the various activities and autoregulatory pathways are linked together, which can also be demonstrated by the fact that dopamine is endogenously converted into morphine which itself leads to enhanced nitric oxide release by activation of constitutive nitric oxide synthase enzymes. These molecules and mechanisms are clearly stress-reducing.

The self-reported health of legal and illegal/irregular immigrants in the Czech Republic

OBJECTIVES

To test whether immigrants with illegal/irregular status have higher odds of poor self-rated health (SRH) than immigrants with legal status, and whether different demographic, socioeconomic and psychosocial factors affect SRH among legal and illegal/irregular immigrants.

METHODS

Analysis is based on data from two questionnaire surveys of 285 Post-Soviet and Vietnamese immigrants (126 legal and 159 illegal/irregular) living and working in the Czech Republic, which were conducted between 2003 and 2006. The risk of poor SRH was estimated by ordered polytomous regression, the dependent variable was SRH, and selected demographic, socioeconomic and psychosocial characteristics entered the analysis as explanatory variables.

RESULTS

Odds of poor SRH among illegal immigrants were not statistically significantly higher than among legal migrants in fully adjusted analysis. Females and older immigrants had poorer SRH. Satisfaction with work, and, partly, with housing were found to have a significant role. Educational level and 'social communication' variables did not have an important role in predicting SRH.

CONCLUSIONS

Inequalities in SRH among legal and illegal immigrants were largely explained by socioeconomic and psychosocial factors in this study. These results should stimulate further research activities that might improve health policy and planning related to immigrants' health in this and other countries in Europe.

Work stress of primary care physicians in the US, UK and German health care systems

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions.