Reactivity and recovery from different types of work measured by catecholamines and cortisol: a systematic literature overview

Association between ergonomic risk exposures and insomnia symptoms: a mediation analysis of the 5th Korean working conditions survey

BACKGROUND

This study investigates the relationship between ergonomic risk exposures and insomnia symptoms, using data representative of Korea's general working population.

METHODS

Data from the 5th Korean Working Conditions Survey were used for this study. The eligible population (employees) for the current study was 37,026. Insomnia symptoms were estimated using the minimal insomnia symptom scale (MISS) questionnaire. Logistic regression analysis was conducted to explore the association between ergonomic risks and insomnia symptoms.

RESULTS

All the investigated ergonomic risks increased odd ratios (ORs) for insomnia symptoms: Tiring or painful positions (OR, 1.64; 95% CI, 1.43-1.88); lifting or moving heavy loads (OR, 2.33; 95% CI, 1.99-2.71); long periods of standing (OR, 1.47; 95% CI, 1.29-1.69); and repetitive hand or arm movements (OR, 1.46; 95% CI, 1.29-1.67). The mediated proportion of musculoskeletal pain was 7.4% (95% CI, 5.81-10.13), and the mediated proportion of feeling of exhaustion was 17.5% (95% CI, 5.81-10.13).

CONCLUSIONS

This study provides evidence for the relationship between ergonomic risks and insomnia symptoms, for which musculoskeletal pains and the feeling of exhaustion may be potential mediators.

Sociotechnical Work System Approach to Occupational Fatigue

INTRODUCTION TO THE PROBLEM

Occupational fatigue is a characteristic of excessive workload and depicts the limited capacity to complete demands. The impact of occupational fatigue has been studied outside of health care in fields such as transportation and heavy industry. Research in health care professionals such as physicians, medical residents, and nurses has demonstrated the potential for occupational fatigue to affect patient, employee, and organizational outcomes. A conceptual framework of occupational fatigue that is informed by a sociotechnical systems approach is needed to (1) describe the multidimensional facets of occupational fatigue, (2) explore individual and work system factors that may affect occupational fatigue, and (3) anticipate downstream implications of occupational fatigue on employee well-being, patient safety, and organizational outcomes.

CONCEPTUAL FRAMEWORK OF OCCUPATIONAL FATIGUE

The health care professional occupational fatigue conceptual framework is outlined following the Systems Engineering Initiative for Patient Safety (SEIPS) model and adapted from the Conceptual Model of Occupational Fatigue in Nursing. Future research may apply this conceptual framework to health care professionals as a tool to describe occupational fatigue, identify the causes, and generate solutions. Interventions to mitigate and resolve occupational fatigue must address the entire sociotechnical system, not just individual or employee changes.

Effects of brief exposure to campus environment on students' physiological and psychological health

Experiences in natural environments can enhance human wellbeing and promote the recovery of physiological and psychological health. During the COVID-19 pandemic, university students' activity off-campus was limited, thus, the campus environment was particularly important for the recovery of students' physiological and psychological health. Although the benefits of sustained natural exposure are obvious for people's physiological and psychological health, the effects of brief exposure on physiological and psychological are unclear. In the present study, four types of campus environments, including square space, dense forest space, sparse forest space, and waterfront space, were selected to explore the transient recovery effects of different types of campus environments. Sixty university students were recruited, measuring their systolic blood pressure, diastolic blood pressure, and heart rate as physical parameters to assess stress recovery. Respondents also reported scores about their personal feelings in questionnaires to evaluate their psychological states. Both physiological and psychological indicators responded to the brief natural exposure (5 min), and physiological and psychological health was restored. However, only the recovery amounts of psychological indicators were significantly different in waterfront space, dense forest space, and sparse forest space. These results indicate that being compare with other spaces, the brief exposure in the waterfront space was the most beneficial to students' psychological health recovery. This recovery was attributed to the great role played by the sense of escape, but after the brief exposure, the attraction and compatibility of the environment would hinder the psychological health recovery. In conclusion, according to tests on both physiological and psychological aspects, the waterfront environment on campus is the best choice for students' transient health recovery.

The impact of the COVID-19 pandemic on stress and other psychological factors in pregnant women giving birth during the first wave of the pandemic

BACKGROUND

The onset of mental illness such as depression and anxiety disorders in pregnancy and postpartum period is common. The coronavirus induced disease 2019 (COVID-19) pandemic and the resulting public policy responses represent an exceptional situation worldwide and there are hints for adverse psychosocial impact, hence, the study of psychological effects of the pandemic in women during hospitalization for delivery and in the postpartum period is highly relevant.

METHODS

Patients who gave birth during the first wave of the COVID-19 pandemic in Germany (March to June 2020) at the Department of Obstetrics and Gynecology, University of Würzburg, Germany, were recruited at hospital admission for delivery. Biosamples were collected for analysis of SARS-CoV-2 infection and various stress hormones and interleukin-6 (IL-6). In addition to sociodemographic and medical obstetric data, survey questionnaires in relation to concerns about and fear of COVID-19, depression, stress, anxiety, loneliness, maternal self-efficacy and the mother-child bonding were administered at T1 (delivery stay) and T2 (3-6 months postpartum).

RESULTS

In total, all 94 recruited patients had a moderate concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at T1 with a significant rise at T2. This concern correlated with low to low-medium general psychosocial stress levels and stress symptoms, and the women showed a significant increase of active coping from T1 to T2. Anxiety levels were low and the Edinburgh Postnatal Depression Scale showed a medium score of 5 with a significant (T1), but only week correlation with the concerns about SARS-CoV-2. In contrast to the overall good maternal bonding without correlation to SARS-CoV-2 concern, the maternal self-efficiency correlated negatively with the obstetric impairment caused by the COVID-19 pandemic.

CONCLUSION

Obstetric patients` concerns regarding SARS-CoV-2 and the accompanying pandemic increased during the course of the pandemic correlating positively with stress and depression. Of note is the increase in active coping over time and the overall good mother-child-bonding. Maternal self-efficacy was affected in part by the restrictions of the pandemic. Clinical trial registration DRKS00022506.

"Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance

Recovery activities during short breaks taken between work tasks are solutions for preventing the impairing effects of accumulated strain. No wonder then that a growing body of scientific literature from various perspectives emerged on this topic. The present meta-analysis is aimed at estimating the efficacy of micro-breaks in enhancing well-being (vigor and fatigue) and performance, as well as in which conditions and for whom are the micro-breaks most effective. We searched the existent literature on this topic and aggregated the existing data from experimental and quasi-experimental studies. The systematic search revealed 19 records, which resulted in 22 independent study samples (N = 2335). Random-effects meta-analyses shown statistically significant but small effects of micro-breaks in boosting vigor (d = .36, p < .001; k = 9, n = 913), reducing fatigue (d = .35, p < .001; k = 9, n = 803), and a non-significant effect on increasing overall performance (d = .16, p = .116; k = 15, n = 1132). Sub-groups analyses on performance types revealed significant effects only for tasks with less cognitive demands. A meta-regression showed that the longer the break, the greater the boost was on performance. Overall, the data support the role of micro-breaks for well-being, while for performance, recovering from highly depleting tasks may need more than 10-minute breaks. Therefore, future studies should focus on this issue.

Relationship between job rotation and work-related low back pain: a cross-sectional study using data from the fifth Korean working conditions survey

Background

Job rotation was introduced in various industries as a strategic form of work for improving workers' job skills and health management. This study aims to examine the relationship between job rotation and work-related low back pain (LBP), one of the typical work-related musculoskeletal symptoms of Korean workers.

Methods

We conducted this study using the data of the 5th Korean Working Conditions Survey (KWCS). As the subject of this study, 27,163 wage workers were selected, and classified into three groups according to occupational type (white-collar, service and sales, and blue-collar). In this study, job rotation means to change the work-related activities with other colleagues periodically and work-related LBP was defined as whether there was work-related LBP in the last 12 months. Chi-square test and logistic regression were used to analyze the relationship between job rotation and work-related LBP.

Results

Out of 27,163 workers, 2,421 (8.9%) answered that they had job rotation and 2,281 (8.4%) answered that they experienced work-related LBP. According to the results from logistic regression, job rotation was significantly associated with low prevalence of work-related LBP among blue-collar workers (odds ratio [OR]: 0.71, 95% confidence interval [CI]: 0.58–0.88), whereas no significant relationship was observed among white-collar, service and sales groups. In addition, the negative association between job rotation and work-related LBP among blue-collar workers was more pronounced when exposed to ergonomic risk factors (uncomfortable posture OR: 0.79, 95% CI: 0.64–0.98; heavy work OR: 0.74, 95% CI: 0.57–0.96; repetitive work OR: 0.74, 95% CI: 0.60–0.92).

Conclusions

Job rotation was associated with low prevalence of work-related LBP among workers in the blue-collar occupational group in Korea. It is necessary to evaluate the effect of job rotation by occupational type and introduce an appropriate method of job rotation to reduce workers' work-related musculoskeletal symptoms.

Comparison of Cortisol level by Shift Cycle in Korean Firefighters

(1) Study Objectives: By investigating the change of cortisol levels during shift cycles among professional firefighters in Korea, this study aims to evaluate the difference between individuals' stress response and the recovery of their circadian rhythm after working night shifts. (2) Methods: A total of 325 shift firefighters, who were working in 3, 6, 9, or 21 day cycles, participated in the study. Their urinary and serum cortisol levels were measured during the day (09-18), during the night (18-09), and every 24 h (09-09) per shift cycle, and adjustments were made for confounding factors. (3) Results: Serum cortisol levels were significantly increased after working during the night or for 24 h compared with that of working throughout the day. However, whether working night or 24 h shifts, the serum cortisol levels were undoubtedly different based on the 3, 6, 9, or 21 day cycles. In all shift cycles, the urinary cortisol level decreased during the night or throughout the 24 h shifts compared with sleeping during this time, but this was considered to be significantly applicable only to those working in 21 day cycles. Additionally, in serial measurements, the recovery of urinary cortisol secretion after a night or 24 h shift was successful for individuals working in 9 day cycles, but the recovery was delayed for those working in 6 or 21 day cycles. (4) Conclusions: After analyzing the urine cortisol levels, the study indicates that only subjects working in 9 day cycles fully recovered their circadian rhythm while those working in 6 day or 21 day cycles did not completely recover. Therefore, it is important to recognize how stressful night shifts can be, and it is crucial to enhance firefighters' current shift cycles in order to allow sufficient recovery of their circadian rhythm as well as the prevention of disrupting their circadian rhythm after working at night. Further research is necessary to take into account the amount of work load, the challenges of being sleep deprived, and the individual's capacity to overcome sleepiness.

Sleep disturbance as a moderator of the association between physical activity and later pain onset among American adults aged 50 and over: evidence from the Health and Retirement Study

OBJECTIVE

To examine whether sleep disturbance modifies the association between physical activity and incident pain.

DESIGN

Prospective population-based study.

SETTING

Health and Retirement Study.

PARTICIPANTS

American adults aged ≥50 years who reported no troublesome pain in 2014 were re-assessed for pain in 2016. Of 9828 eligible baseline respondents, 8036 (82%) had complete follow-up data for adjusted analyses (weighted analysis population N=42 407 222).

EXPOSURES

Physical activity was assessed via interview with questions about time spent in moderate and vigorous physical activity. Sleep disturbance, assessed using a modified form of the Jenkins Sleep Scale, was examined as a potential moderator.

MAIN OUTCOME MEASURE

Troublesome pain.

RESULTS

In weighted analyses, 37.9% of the 2014 baseline pain-free sample participated in moderate or vigorous physical activity once a week or less, with an overall mean Physical Activity Index Score of 9.0 (SE=0.12). 18.6% went on to report troublesome pain in 2016. Each one-point higher on the Physical Activity Index Score was associated with a reduced odds ratio (OR) of incident pain for those who endorsed sleep disturbance never/rarely (OR=0.97, 95% CI 0.94 to 0.99), but not for those who endorsed sleep disturbance sometimes (OR=0.99, 95% CI 0.97 to 1.01) or most of the time (OR=1.01, 95% CI 0.99 to 1.03). The analysis of possible interaction demonstrated that frequency of sleep disturbance moderated the physical activity and incident pain association (Wald test: p=0.02).

CONCLUSIONS

The beneficial association of physical activity on reduced likelihood of later pain was only observed in persons who endorsed low levels of sleep disturbance.

Work design for airport security officers: Effects of rest break schedules and adaptable automation

This study investigated whether there is empirical support for the current EU regulation mandating breaks of at least 10 min after each period of 20 min continuously reviewing X-ray images in airport security screening. As a second goal, it examined whether providing more autonomy to airport security officers (in the form of spontaneous rest breaks and adaptable automation) would improve their performance and subjective state. Seventy-two student participants had to indicate the presence (or absence) of a threat item (either a gun or a knife) in a series of grey-scaled X-ray images of cabin baggage. Three work-rest schedules were examined: spontaneous breaks (i.e. participants could take breaks at any time), two 5-min breaks and two 10-min breaks during a 1-h testing session. Furthermore, half of the participants were assisted in their task by an adaptable support system offering three levels of automation: (1) no support, (2) cues indicating the presence of a potential threat item, and (3) cues indicating the exact location of a potential threat item. Results showed no performance differences between break regimes, which suggests that there may be viable alternatives to the current EU regulations. It also emerged that providing participants with adaptable automation did not lead to better detection performance but resulted in a less positive response bias than participants without automatic support. Implications for current aviation security regulations are discussed.

Relation between Psychological Restorativeness and Lifestyle, Quality of Life, Resilience, and Stress-Coping in Forest Settings

Previous research has mainly dealt with the physiological and psychological restorative effects of the forest environment. However, comparatively few studies have focused on how the traits and attributes of individuals (individual traits) affect the restorative effects of the forest environment. In this study, we examined the relationships between the psychological restorative effects offered by perceived restorativeness of outdoor settings and the individual traits. Then, we investigated the relationships between the restorative indicators that are useful in examining the restorative properties (i.e., the Perceived Restorativeness Scale (PRS); seven indicators in total), the psychological restorative effect (Profile of Mood States (POMS), Restorative Outcome Scale (ROS), positive and negative affect schedule (PANAS), and Subjective Vitality Scale (SVS); 10 indicators in total), and the individual trait indicators that could be used to investigate individual traits (Development of Health and Life Habit Inventory for lifestyle, Lazarus-type Stress Coping Inventory for stress coping, World Health Organization Quality of Life Assessment 26 for quality of life (QOL), and Sukemune-Hiew Resilience test for resilience; 28 indicators in total) in forest and urban settings. Respondents consisted of 46 male students in their twenties. A short-term experiment was conducted using the same method in both environmental settings. We then analyzed the intrinsic restorative properties and the restorative effects of the settings and referred to prior research to determine the restorative effects. Furthermore, we analyzed the relationship between the restorative indicators and the individual trait indicators by correlation analysis and multiple regression (step-wise) analysis. These new findings were obtained: (1) the forest setting was a restorative environment with a higher restorative effect than the urban setting; (2) although the forest setting had a higher restorative effect than the urban setting, and the influence of individual traits was small; (3) in the forest setting, the relationship between the restorative indicators and individual traits indicators were arranged; (4) distancing (Stress coping), psychological health (QOL), and satisfaction with living environment (QOL) were likely important indicators that are related to the restorative effects in the forest setting.

Creating a Culture of Health in Planning and Implementing Innovative Strategies Addressing Non-communicable Chronic Diseases

Ongoing demographic changes are challenging health systems worldwide especially in relation to increasing longevity and the resultant rise of non-communicable diseases (NCDs). To meet these challenges, a paradigm shift to a more proactive approach to health promotion, and maintenance is needed. This new paradigm focuses on creating and implementing an ecological model of Culture of Health. The conceptualization of the Culture of Health is defined as one where good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities where citizens have the opportunity to make choices and be co-producers of healthy lifestyles. Based on Antonovsky's Salutogenesis model which asserts that the experience of health moves along a continuum across the lifespan, we will identify the key drivers for achieving a Culture of Health. These include mindset/expectations, sense of community, and civic engagement. The present article discusses these drivers and identifies areas where policy and research actions are needed to advance positive change on population health and well-being. We highlight empirical evidence of drivers within the EU guided by the activities within the thematic Action Groups of the European Innovation Partnership on Active and Healthy Aging (EIP on AHA), focusing on Lifespan Health Promotion and Prevention of Age-Related Frailty and Disease (A3 Action Group). We will specifically focus on the effect of Culture on Health, highlighting cross-cutting drivers across domains such as innovations at the individual and community level, and in synergies with business, policy, and research entities. We will present examples of drivers for creating a Culture of Health, the barriers, the remaining gaps, and areas of future research to achieve an inclusive and sustainable asset-based community.

An active transition from offshore work to family life: Activities that may impact recovery

BACKGROUND

Night shift workers, particularly those working offshore, take a long time to recover from their shifts. The activities that shift workers, such as offshore employees, pursue during their leisure time can influence the process of recovery from work-related fatigue, but little is known about these leisure time activities.

OBJECTIVE

To explore what leisure time activities are pursued that may be relevant to recovery for offshore employees.

METHODS

Sixty-one offshore working family men-20 night shift, 16 swing shift, and 25 day shift workers-reported on six predefined activities for 14 days following their offshore tours. Generalized estimating equations analysis was used to explore trends in the data.

RESULTS

From the start of the free period, almost all participants were involved in household chores and childcare; these activities declined over the 14 days. Throughout the study period, participants actively pursued social, volunteer, and leisure time physical activities. Work-related activities were pursued by half of the participants at some time during the 14 days. Night and swing shift workers were more physically active than day workers throughout the first 14 days of the free period.

CONCLUSIONS

The transition from offshore work to family life can be characterised as active. The activities engaged in by this sample of employees are likely to promote their recovery.

A test-retest assessment of the effects of mental load on ratings of affect, arousal and perceived exertion during submaximal cycling

This study aimed to test the effects of mental (i.e. executive) load during a dual physical-mental task on ratings of perceived exertion (RPE), affective valence, and arousal. The protocol included two dual tasks with matched physical demands but different executive demands (2-back and oddball), carried out on different days. The procedure was run twice to assess the sensitivity and stability of RPE, valence and arousal across the two trials. Linear mixed-effects analyses showed less positive valence (-0.44 points on average in a 1-9 scale; R_β² = 0.074 [CI90%, 0.052-0.098]), and heightened arousal (+0.13 points on average in a 1-9 scale; R_β² = 0.006 [CI90%, 0.001-0.015]), for the high executive load condition, but showed no effect of mental load on RPE. Separated analyses for the two task trials yielded best-fitting models that were identical across trials for RPE and valence, but not for arousal. Model fitting was improved by assuming a 1-level autoregressive covariance structure for all analyses. In conclusion, executive load during a dual physical-mental task modulates the emotional response to effort, but not RPE. The autoregressive covariance suggests that people tend to anchor estimates on prior ones, which imposes certain limits on scales' usability.

Effects of Walking in Bamboo Forest and City Environments on Brainwave Activity in Young Adults

Background. In Japan, “Shinrin-yoku” or forest bathing (spending time in forests) is a major practice used for relaxation. However, its effects on promoting human mental health are still under consideration. The objective of this study was to investigate the physiological and psychological relaxation effects of forest walking on adults. Sixty participants (50% males; 50% females) were trained to walk 15-minute predetermined courses in a bamboo forest and a city area (control). The length of the courses was the same to allow comparison of the effects of both environments. Blood pressure and EEG results were measured to assess the physiological responses and the semantic differential method (SDM) and STAI were used to study the psychological responses. Blood pressure was significantly decreased and variation in brain activity was observed in both environments. The results of the two questionnaires indicated that walking in the bamboo forest improves mood and reduces anxiety. Moreover, the mean meditation and attention scores were significantly increased after walking in a bamboo forest. The results of the physiological and psychological measurements indicate the relaxing effects of walking in a bamboo forest on adults.

Development and validation of the Workplace Interruptions Measure

In 3 studies, we developed and tested the first comprehensive, self-report measure of workplace interruptions. The Workplace Interruptions Measure (WIM) is based on a typology of interruptions that included intrusions, distractions, discrepancy detections, and breaks. The four-factor structure was reduced to a 12-item measure in Study 1 (N = 317) and confirmed in a diverse sample of employees in Study 2 (N = 160). Study 3 (N = 323) further examined the psychometric properties of the WIM in a sample of university faculty and staff. Studies 2 and 3 demonstrated that both effort-enhancing interruptions (intrusions, distractions, and discrepancy detections) and recovery-enhancing interruptions (breaks) were associated with stressors and strains. Distractions, discrepancy detections, and breaks uniquely predicted strain outcomes beyond other workplace stressors (i.e., quantitative workload, interpersonal conflict, and role conflict). We discuss implications of the WIM for the theory and practice of interruptions research.

Burnout of the Mind – Burnout of the Body?

Abstract. In the present paper we investigate whether patients with a clinical diagnosis of burnout show physiological signs of burden across multiple physiological systems referred to as allostatic load (AL). Measures of the sympathetic-adrenergic-medullary (SAM) axis and the hypothalamic-pituitary-adrenal (HPA) axis were assessed. We examined patients who had been diagnosed with burnout by their physicians (n = 32) and were also identified as burnout patients based on their score in the Maslach Burnout Inventory-General Survey (MBI-GS) and compared them with a nonclinical control group (n = 19) with regard to indicators of allostatic load (i.e., ambulatory ECG, nocturnal urinary catecholamines, salivary morning cortisol secretion, blood pressure, and waist-to-hip ratio [WHR]). Contrary to expectations, a higher AL index suggesting elevated load in several of the parameters of the HPA and SAM axes was found in the control group but not in the burnout group. The control group showed higher norepinephrine values, higher blood pressure, higher WHR, higher sympathovagal balance, and lower percentage of cortisol increase within the first hour after awakening as compared to the patient group. Burnout was not associated with AL. Results seem to indicate a discrepancy between self-reported burnout symptoms and psychobiological load.

Flow method based on cloud point extraction for fluorometric determination of epinephrine in human urine

A novel stepwise injection fluorometric method for the determination of epinephrine in human urine has been developed. In the current study, the stepwise injection analysis (SWIA) was successfully combined with on-line in-syringe cloud point extraction (CPE) and fluorometric detection. The procedure was based on the epinephrine derivatization in the presence of o-phenylenediamine followed by the preconcentration stage based on the CPE with the nonionic surfactant Triton X-114. After the phase separation into a syringe of the flow system, the micellar phase containing the epinephrine derivative was transported to a fluorometric detector. The excitation and emission wavelengths were set at 447 nm and 550 nm, respectively. The conditions of epinephrine derivatization and CPE have been studied. The calibration plot constructed using the developed procedure was linear in the range of 1·10(-11)-5·10(-7) mol L(-1). The limit of detection, calculated as 3 σ of a blank test (n = 10), was found to be 3·10(-12) mol L(-1). The proposed method was successfully applied for the determination of epinephrine in human urine samples.

Self-Reported Recovery from 2-Week 12-Hour Shift Work Schedules: A 14-Day Follow-Up

Background

Recovery from fatigue is important in maintaining night workers' health. This study compared the course of self-reported recovery after 2-week 12-hour schedules consisting of either night shifts or swing shifts (i.e., 7 night shifts followed by 7 day shifts) to such schedules consisting of only day work.

Methods

Sixty-one male offshore employees—20 night workers, 16 swing shift workers, and 25 day workers—rated six questions on fatigue (sleep quality, feeling rested, physical and mental fatigue, and energy levels; scale 1–11) for 14 days after an offshore tour. After the two night-work schedules, differences on the 1^st day (main effects) and differences during the follow-up (interaction effects) were compared to day work with generalized estimating equations analysis.

Results

After adjustment for confounders, significant main effects were found for sleep quality for night workers (1.41, 95% confidence interval 1.05–1.89) and swing shift workers (1.42, 95% confidence interval 1.03–1.94) when compared to day workers; their interaction terms were not statistically significant. For the remaining fatigue outcomes, no statistically significant main or interaction effects were found.

Conclusion

After 2-week 12-hour night and swing shifts, only the course for sleep quality differed from that of day work. Sleep quality was poorer for night and swing shift workers on the 1^st day off and remained poorer for the 14-day follow-up. This showed that while working at night had no effect on feeling rested, tiredness, and energy levels, it had a relatively long-lasting effect on sleep quality.

Intercorrelation between Immunological Biomarkers and Job Stress Indicators among Female Nurses: A 9-Month Longitudinal Study

Some immunological biomarkers have been reported to be associated with job-related stress. This study was conducted to explore the intercorrelation between the psychosocial components of job stress and various immunological biomarkers among female nurses. To assess monthly and weekly job stress, 41 nurses have repeatedly completed questionnaires such as the National Institute for Occupational Safety and Health General Job Stress Questionnaire, the profile of mood states short version and the Center for Epidemiologic Studies-Depression scale. Using flow cytometry and radioimmunoassay, the number of white blood cells, lymphocytic proliferation to mitogens, and toxoid were measured. Moreover, levels of hydrocortisol, interleukin-β, interferon-γ, and tumor necrosis factor-α and salivary immunoglobulin A were evaluated by enzyme-linked immunosorbent assay. When the Pearson correlation coefficients between job stress and immunological biomarkers were estimated after adjusting for age and smoking status, “Clashes: conflict at work” was significantly related to the number of CD4 cells (r = 0.36, p-value <0.05), CD4 to CD8 ratio (0.35; <0.05), response to concanavalin A (0.42; <0.05), and phytohemagglutinin (0.35; <0.05). Additionally, the level of hydrocortisol was significantly related to seven psychosocial measures; i.e., role conflict (−0.47; <0.01), role ambiguity (−0.39; <0.05), clashes at work (−0.38; <0.05), control and influence at work (0.53; <0.01), task control (0.55; <0.001), resources at work (0.35; <0.05), and skill underutilization (0.43; <0.05). The results indicate that (1) the psychosocial job stress is associated with the levels of some immunological biomarkers in nurses; and in particular, (2) hydrocortisol shows a remarkable relationship with diverse job stress indicators.

From recovery to regulation: an attempt to reconceptualize 'recovery from work'

The concept of 'recovery' (from work) has quickly gained in importance in the occupational health literature. However, we think that the conceptualization of 'recovery' needs some more attention. Although many authors acknowledge that 'recovery' refers to a 'process', the concept is often treated as a static construct. In this paper, we argue that recovery should be conceptualized as a dynamic construct related to changes in psychophysiological state of the person. We refer to two main theories that have provided a theoretical framework for research in this area: Meijman & Mulder's Effort-Recovery (E-R) model and Hobfoll's Conservation of Resources theory. In particular, the E-R model has been seminal in this area and stresses the element of changing psychophysiological states that has been used for reconceptualising 'recovery'. Various biological rhythms influence these changing psychophysiological states, and thus the level of energy (or effort) a person can mobilize or wants to mobilize. A distinction is made between 'physical fatigue' and 'mental fatigue' and its consequences for recovery. The discrepancy between 'actual state' and 'required state' has been suggested as the basis for 'recovery'. This emphasises that recovery is a dynamic and ongoing process, which also included motivational aspects, in particular as far as mental work is concerned. The capacity to maintain self-regulation of one's psychophysiological state is important in this respect. Thus, we propose that 'recovery' is the continuous process of harmonizing the 'actual state' with the state that is 'required' at that moment.

Vacation effects on behaviour, cognition and emotions of compulsive and non-compulsive workers: do obsessive workers go 'cold turkey'?

Compulsive workers often face psychological and physical health disturbances because of working long hours and an obsessive preoccupation with work during off-job time. Prolonged respite episodes may either relief these employees from their daily stressors to recover or trigger withdrawal symptoms. Our research question was as follows: How do (1) work hours, (2) rumination and (3) affective well-being unfold for compulsive workers compared with non-compulsive workers across long vacations? In a longitudinal field study, work hours, rumination and affective well-being were assessed in 54 employees 2 weeks before, during and in the first, second and fourth week after a long summer vacation. Working compulsively was assessed 3 weeks before vacation. Work hours decreased during and increased after vacation. Levels of rumination dropped during vacation and remained below baseline until 2 weeks after vacation. Initial differences in rumination between obsessive and non-obsessive workers disappeared during and directly after vacation. Affective well-being rose during vacation and returned to baseline directly after vacation. Increases in affective well-being during vacation as well as decreases after vacation were greater in obsessive workers than in non-obsessive workers. Vacations seem to temporarily offset characteristic differences between obsessive and non-obsessive workers, decrease rumination and improve affective well-being.

Emotional, restorative and vitalizing effects of forest and urban environments at four sites in Japan

The present study investigated the well-being effects of short-term forest walking and viewing (“forest bathing”). The hypothesis in our study was that both environment (forest vs. urban) and activity (walking and viewing) would influence psychological outcomes. An additional aim was to enhance basic research using several psychological methods. We conducted the experiments using 45 respondents in four areas of Japan from August to September, 2011. The hypothesis in our study was supported, because significant interaction terms between the environment and activity were confirmed regarding the Profile of Mood States (POMS) indexes, Restorative Outcome Scale (ROS) and Subjective Vitality Scale (SVS). No statistical differences between the two experimental groups in any of the ten scales were found before the experiment. However, feelings of vigor and positive effects, as well as feelings of subjective recovery and vitality were stronger in the forest environment than in the urban environment.

Measuring short-term and long-term physiological stress effects by cortisol reactivity in saliva and hair

Purpose

The aims of this study were to investigate (1) the concurrent relationship between short-term and long-term stress reactivity measured by cortisol excretion and (2) the relationship of these physiological stress effects with self-reported stress and need for recovery after work (NFR).

Methods

Participants were production workers in the meat-processing industry. Short-term cortisol excretion was calculated by summing 18 saliva samples, sampled over a 3-day period. Samples were delivered by 37 participants. Twenty-nine of them also supplied one hair sample of at least 3 cm in length for an analysis of long-term (3 months) cortisol excretion. All of them filled in a short questionnaire on self-reported stress and NFR. Self-reported stress was assessed by a three-item stress screener; NFR was assessed by an 11-item scale.

Results

Short-term and long-term cortisol excretion are significantly, but moderately, associated (r = 0.41, P = 0.03). Short-term and long-term cortisol excretion correlated weakly to self-reported stress and NFR (correlations varied from −0.04 to 0.21).

Conclusions

Short-term and long-term physiological stress excretion levels are moderately associated. Physiological stress effects assessed from saliva and hair cannot be used interchangeably with self-reported stress because they only correlate weakly. To better predict long-term cortisol excretion in workers, the predictive value of short-term cortisol excretion must be evaluated in a prognostic longitudinal study in a working population.

Employment and work schedule are related to telomere length in women

OBJECTIVES

To examine the association of employment and work schedule with shorter DNA telomeres, a marker of cellular ageing and disease risk factor, and consider whether differences were related to health, behaviours and sociodemographic factors, or varied by stress levels or menopausal status.

METHODS

This cross-sectional analysis of 608 women aged 35-74 in the Sister Study examined determinants of relative telomere length (rTL) measured by quantitative PCR in leucocyte DNA. Age-adjusted regression models estimated base pair (bp) rTL differences for current and lifetime schedule characteristics (ie, part-time, full-time or overtime hours; multiple jobs; irregular hours; shiftwork; work at night). Covariates included race, smoking, perceived stress, sleep, physical activity, health and menopausal status, education, marital status, live births, children under 18, measured body mass index and urinary stress hormones.

RESULTS

Compared with non-employed women with moderate or substantial past work histories (n=190), those currently working full-time (n=247; median 40 h/week) had a shorter rTL, an age-adjusted difference of -329 bp (95% CI -110 to -548). Longer-duration full-time work was also associated with shorter rTL (age-adjusted difference of -472 bp, 95% CI -786 to -158 for 20+ vs 1-5 years). Findings were not explained by health and demographic covariates. However, rTL differences for working at least full-time were greater in women with higher stress and epinephrine levels.

CONCLUSIONS

Current and long-term full-time work were associated with shorter rTL, with differences of similar magnitude to smoking and history of heart disease or diabetes. Longitudinal data with specific stress measures are needed to further evaluate the impact of work schedule on rTL.

Neurohormonal and inflammatory hyper-responsiveness to acute mental stress in depression

Depression is associated with dysregulated hypothalamic-pituitary-adrenal (HPA) axis function, overactivity of the sympathoadrenal system, and increased levels of inflammation markers. It is not known whether these biological processes are disproportionately elevated in response to acute negative emotional arousal by mental stress (MS). The present study investigates responses of neurohormones and inflammatory markers to MS in 14 clinically depressed (age: 42+/-10 years; 50% female) and 14 non-depressed control (age: 39+/-6 years; 50% female) participants. Heightened acute MS reactivity was documented in depressed participants (adrenocorticotropic hormone, rho=0.001; norepinephrine, rho=0.042; epinephrine, rho=0.039), and a delayed increase in cortisol was observed (rho=0.002). Inflammation markers increased more strongly in depressed versus non-depressed participants (IL-6, rho=0.027; tumor necrosis factor-alpha, rho=0.050; and recovery C-reactive protein, rho=0.003). It is concluded that depressed individuals display hyper-reactivity of neuroimmunological markers in response to acute negative emotions. This hyper-reactivity may serve a pathologic role in the elevated morbidity and mortality risk associated with depression.

Identification and measurement of work-related psychological injury: piloting the psychological injury risk indicator among frontline police

OBJECTIVE

To develop a self-report measure of work-related psychological injury, the Psychological Injury Risk Indicator (PIRI), with a comparable level of accuracy and reliability to individual clinical assessment by a skilled clinical psychologist.

METHOD

Two pilot studies investigated the responses of a) 34 frontline police officers completing the PIRI measure who were also examined by a highly experienced clinical psychologist and b) 217 officers who completed the PIRI measure and also the General Health Questionnaire 12 measure.

RESULTS

The PIRI scale identified both the presence and the level of psychological injury in the clinical group with a remarkably high level of correspondence to concurrent clinical assessment (r = 0.80).

SIGNIFICANCE

The PIRI scale can be used both for the individual assessment of psychological injury and as a potential online screening tool. Its latter use is that it could enable the early identification of evolving psychological injury among workers, facilitating timely and career-preserving intervention.

Physical activity, job demand-control, perceived stress-energy, and salivary cortisol in white-collar workers

PURPOSE

The aim of the present study is to examine the association between physical activity and perceived job demand, job control, perceived stress and energy, and physiological arousal reflected by morning and evening concentrations of cortisol in saliva among white-collar workers.

METHODS

Physical activity during the last week was assessed during work and leisure time by a Danish version of the International Physical Activity Questionnaire and saliva samples were collected. The study group comprised 389 white-collar workers, aged 25-67 years, and of which 257 were women.

RESULTS

We found that physical activity during leisure time was associated with higher perceived energy, and for men also with lower perceived stress. Further, we found that physical activity at leisure time affected the association between salivary cortisol and perceived stress and energy so that respondents being physically active at leisure time and perceiving higher energy showed higher evening saliva cortisol.

CONCLUSION

Physically active employees perceive less stress and more energy. The association between stress-energy and salivary cortisol was affected by vigorous physical activity. No association between job control-demand and the degree of physical activity was found. Based on the present data, we recommend office workers-exposed to high job strain and inactivity at the job-to perform physical activity, preferably of high intensity, in order to reduce stress and increase energy.

Long‐term stability of salivary cortisol

The measurement of salivary cortisol provides a simple, non-invasive, and stress-free measure frequently used in studies of the hypothalamic-pituitary-adrenal axis activity. In research projects, samples are often required to be stored for longer periods of time either because of the protocol of the project or because of lack of funding for analysis. The aim of the present study was to explore the effects of long-term storage of samples on the amounts of measurable cortisol. Ten pools of saliva were collected on polyester Salivette tampons from five subjects. After centrifugation the samples were either stored in small vials or spiked to polyester Salivette tampons before analysis for cortisol using Spectria RIA kits. The effects of storage were evaluated by a linear regression model (mixed procedure) on a logarithmic scale. No effects on cortisol concentrations were found after storage of saliva at 5 degrees C for up to 3 months or at -20 degrees C and -80 degrees C for up to one year. In contrast, concentrations of cortisol were found to decrease by 9.2% (95% confidence interval (CI): 3.8%; 14.3%) per month in samples stored at room temperature. Repeated freezing and thawing of samples up to four times before analysis did not affect the measured concentrations of cortisol. The coefficient of residual variation (CVresid) for samples stored on Salivette tampons were twice the CVresid for samples stored in separate vials after centrifugation. In conclusion, centrifuged saliva samples for analysis of cortisol may be stored at 5 degrees C for up to 3 months or at -20 degrees C or -80 degrees C for at least one year. However, long-term storage at room temperature cannot be recommended. Repeated cycles of freezing and thawing did not appear to affect the concentrations of cortisol.

Assessment of salivary cortisol as stress marker in ambulance service personnel: comparison between shifts working on mobile intensive care unit and patient transport ambulance

PURPOSE

The aim of this study was to describe and compare salivary cortisol of ambulance personnel on days with different work demands as well as to correlate the individual perception of demands to the physiological outcome cortisol.

METHODS

Diurnal cortisol profiles on a day in emergency service and on a day in patient transport were monitored for 24 subjects working in an urban ambulance station. Changes of cortisol were also observed during 42 operations in emergency service and 24 operations in patient transport and were compared to the individual perception of physical and emotional demands.

RESULTS

Rise of cortisol in the morning on days in emergency service was significantly higher than in patient transport suggesting adjustment to forthcoming demanding tasks. There were only few situations with strong endocrine reaction in emergency service as well as in patient transport. The magnitude of this reaction was not related to the individual perception of demand.

CONCLUSION

Ambulance service personnel seem to be used to critical situations. There was few awareness of the "physiological" stress response indicating that stress is probably not perceived in work situations characterised by routines.

Do we recover from vacation? Meta-analysis of vacation effects on health and well-being

OBJECTIVES

The aim of this meta-analysis is to investigate to what extent vacation has positive effects on health and well-being, how long such effects endure after work resumption, and how specific vacation activities and experiences affect these relationships.

METHODS

Based on a systematic literature search (PsycInfo, Medline) and methodological exclusion criteria, in a stepwise approach, 7 studies were selected and reviewed. Effect sizes (Cohen's d) were calculated i) for every outcome variable within every study, ii) for every study by averaging the effect sizes per study, and iii) for homogeneous categories of outcome variables (exhaustion, health complaints, life satisfaction).

RESULTS

The results suggest that vacation has positive effects on health and well-being (small effect, d=+0.43), but that these effects soon fade out after work resumption (small effect, d=-0.38). Our research further demonstrated that vacation activities and experiences have hardly been studied. Therefore, their contribution to vacation effect and fade out remains unclear.

DISCUSSION

Progress in future vacation research will depend on strong research designs that incorporate repeated measurements pre-, inter- and post-vacation.

Neuroendocrine biomarkers, social relations, and the cumulative costs of stress in Taiwan

Allostatic load (AL) is thought to represent the physiological toll that builds up over the life course as a consequence of the body's response to stress. An important aim of this paper is to test this widely held-but little investigated-understanding of what AL represents. More specifically, using the Social Environment and Biomarkers of Aging Study (SEBAS), a nationally representative survey of Taiwan conducted in year 2000, this paper scrutinizes the connection between stressful life histories and neuroendocrine allostatic load (NAL). Stressful life histories are operationalized through the use of two sets of indicators: one set makes use of respondents' subjective interpretations of various life domains and the other makes use of non-subjective data about conditions that are expected to be stressful (e.g., widowhood, living alone, and low education). NAL is an index of four neuroendocrine biomarkers (cortisol, dehydroepiandrosterone sulfate (DHEAS), epinephrine, and norepinephrine) collected in blood and urine samples under resting, basal states. The major findings of this paper are twofold. First, there is little evidence to support the hypothesis that baseline levels of the neuroendocrine markers stem from stressful life histories. Second, report of current stress (among women only) is positively correlated with higher NAL levels. Taken together, these findings question whether the neuroendocrine markers of the AL construct reflect long-term processes over the life course. Indeed, evidence here suggests that the neuroendocrine markers may reflect the exact opposite-a transient state at the time of the study.

An Investigation of the Role of Non–Work-Time Behavior in Buffering the Effects of Work Strain

OBJECTIVE

In this exploratory study, we investigated the extent to which common leisure time behaviors, which generate positive feelings of fulfillment and personal reward, are significant in alleviating work-induced stress between successive work periods. We tested the hypotheses that such activities increase recovery from stress directly, and also by improving sleep quality, thereby alleviating maladaptive outcomes from work strain.

METHOD

An on-line survey study was completed by a heterogeneous sample of 314 workers in diverse occupations, in good health.

RESULTS

Non-work-time behaviors play a significant role in mediating maladaptive outcomes from work strain. Multivariate analysis of these relationships indicates both direct and indirect effects, the latter being associated with mediating sleep quality. Respondents reporting higher levels of active leisure activities, exercise, and creative (hobby) and social activity, reported significantly better sleep, recovery between work periods, and lower chronic maladaptive fatigue symptomology.

CONCLUSION

Active and fulfilling non-work-time behaviors are more significant in maximizing recovery from work strain than is commonly recognized. This effect is arguably due to the downregulation of stress-induced brain arousal, and stimulation of the pleasure-reward brain neurophysiology. Consistent recovery from work strain between work periods may represent a crucial factor in avoiding work-related "loss spirals" leading to maladaptive health outcomes, which can be particularly relevant to workers in inherently stressful occupations.