Two alternative job stress models and the risk of coronary heart disease

Incorporating sex and gender considerations in research on psychosocial work exposures and cardiovascular diseases: A systematic review of 55 prospective studies

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality, with disparities observed between males and females. Psychosocial work exposures (PWE), including workload, job control, reward and long working hours, are associated with CVD development. Despite higher prevalence among females, the association with CVD is consistently observed in males, with limited explanations for these differences. This study aimed to examine the consideration of sex and gender in prospective studies within systematic reviews on PWE - specifically, the demand-control model, the effort-reward imbalance model, and long working hours - and CVD. Conducting a systematic review, we assessed sex and gender considerations using criteria from the Sex and Gender Equity in Research (SAGER) guidelines. While most studies recognized potential sex and gender differences in the associations between PWE and CVD, only about half of the 28 studies that included both sexes (15 studies) analyzed females and males separately. Moreover, few studies included criteria for sex- and gender-based analyses. Less than half of the studies (23 studies) incorporated a sex and/or gender perspective to discuss observed differences and similarities between men and women. Although there is a rising trend in integrating sex and gender considerations, significant gaps persist in methodologies and reporting, highlighting the need for comprehensive incorporation of sex and gender considerations to bolster CVD prevention strategies and policies.

Improving Cardiovascular Disease Prediction With Machine Learning Using Mental Health Data: A Prospective UK Biobank Study

Background

Robust and accurate prediction of cardiovascular disease (CVD) risk facilitates early intervention to benefit patients. The intricate relationship between mental health disorders and CVD is widely recognized. However, existing models often overlook psychological factors, relying on a limited set of clinical and lifestyle parameters, or being developed on restricted population subsets.

Objectives

This study aims to assess the impact of integrating psychological data into a novel machine learning (ML) approach on enhancing CVD prediction performance.

Methods

Using a comprehensive UK Biobank data set (n = 375,145), the correlation between CVD and traditional and psychological risk factors was examined. CVD included hypertensive disease, ischemic heart disease, heart failure, and arrhythmias. An ensemble ML model containing 5 constituent algorithms (decision tree, random forest, XGBoost, support vector machine, and deep neural network) was tested for its ability to predict CVD based on 2 training data sets: using traditional CVD risk factors alone, or using a combination of traditional and psychological risk factors.

Results

A total of 375,145 subjects with normal health status and with CVD were included. The ensemble ML model could predict CVD with 71.31% accuracy using traditional CVD risk factors alone. However, by adding psychological factors to the training data, accuracy increased to 85.13%. The accuracy and robustness of the ensemble ML model outperformed all 5 constituent learning algorithms.

Conclusions

Incorporating mental health assessment data within an ensemble ML model results in a significantly improved, highly accurate, CVD prediction model, outperforming traditional risk factor prediction alone.

Occupational stress in clinical and non-clinical staff in Child and Adolescent Mental Health Services (CAMHS): a cross-sectional study

BACKGROUND

Previous literature has highlighted high rates of burnout among doctors and nurses in healthcare settings. Non-clinical and support staff such as administrative, housekeeping and managerial staff are also exposed to the stressors of a health care setting, but fewer studies report on their experiences. Therefore, the aim of this research is to examine occupational stress in all staff working in Child and Adolescent Mental Health Services (CAMHS) in Ireland and identify risk and protective factors.

METHOD

Fifty-nine clinical and non-clinical staff (44% response rate) were surveyed. Participants completed the Copenhagen Burnout Inventory (CBI) and the Effort Reward Imbalance scale, as well as survey-specific questions.

RESULTS

Both clinical and non-clinical staff were found to experience moderate or high rates of work-related, personal and patient-related burnout (57.6%, 52.2% and 50.8%, respectively). Univariate general linear modelling showed an association between total CBI scores and effort reward index (B = 64 306, t = 3.430, p = 0.001); overcommitment (B = 1.963, t = 3.061, p = 0.003); and an unwillingness to work in CAMHS (B = 28.429, t = 3.247, p = 0.002).

CONCLUSION

Pre-pandemic levels of stress were high among clinical and non-clinical staff surveyed. Given the anticipated increased demand on CAMHS post COVID-19, urgent action is needed to protect all staff from intolerable levels of occupational stress and burnout.

[Sociological Research and Teaching in the Context of Medical Faculties - An Autobiographical Report]

With the introduction of medical psychology and medical sociology as examination subjects in the medical curriculum, as enacted by the year 1970 in Germany, medical faculties established professorships and departments for these disciplines. This raised the concern of how the two separate scientific cultures of the social and behavioural sciences and of medicine, rooted in basic sciences, could reconcile their teaching and research activities in a constructive way. It turned out that the quality and the thematic affinity of new research aligning with core medical interests were important preconditions of successful integration of the new disciplines. This paper exemplifies a respective success in case of a scientific development in medical sociology. Based on a theoretical model, a longstanding, internationally collaborating research program analysing social determinants of stress-related disorders resulted in a series of innovative insights. Furthermore, the paper illustrates close links between biographical luck and structural opportunities and constraints, and it emphasizes the important role of committed inter-disciplinary scientific collaboration.

Differences in Effort, Reward, Grit, Burnout, and Continuous Exercise Intention: Assessing the Effort-Reward Imbalance among Korean Athletes

Although studies have shown that an imbalance between effort and reward in the workplace negatively affects an individual's physiological and mental health, few have looked at how this imbalance may affect the mental state of athletes. Therefore, this study aimed to evaluate the importance of the effort-reward imbalance (ERI) in athletes by examining whether psychological variables would differ depending on the ERI. To accomplish this, 795 registered collegiate athletes were recruited. Of them, 227 and 230 responses with the ERI in the bottom and in the top 30% of the ERI scale were selected to compare groups with a high and a low ERI. Athletes completed a self-reported 64-item questionnaire (general characteristics: 5; effort: 14; rewards: 14; grit: 12; burnout: 15; and continuous exercise intention: 4 items). Data analysis included reliability and validity using the Jamovi and SPSS/AMOS software. The results showed no significant differences in effort, reward, grit, burnout, and intention to continue to exercise based on gender, weekly training frequency, and hours of training per day. There were differences in effort, reward, grit, burnout, and intention to continue exercising based on the presence of a professional league. Additionally, differences were found in effort, reward, grit, burnout, and intention to continue exercising between the low and high ERI groups. There was a clear difference between the mental state of those who were satisfied with their effort and reward, and those who were not. However, given that the two groups spent approximately the same amount of time exercising each week, the difference may have been more a function of the psychology of athletes than an actual difference in effort and reward. As our findings confirmed that the level of the ERI in athletes is related to their mental state, further research is necessary to identify and control factors that affect the ERI in athletes.

Psychosocial Stressors at Work and Coronary Heart Disease Risk in Men and Women: 18-Year Prospective Cohort Study of Combined Exposures

BACKGROUND

Psychosocial stressors at work, like job strain and effort-reward imbalance (ERI), can increase coronary heart disease (CHD) risk. ERI indicates an imbalance between the effort and received rewards. Evidence about the adverse effect of combined exposure to these work stressors on CHD risk is scarce. This study examines the separate and combined effect of job strain and ERI exposure on CHD incidence in a prospective cohort of white-collar workers in Quebec, Canada.

METHODS

Six thousand four hundred sixty-five white-collar workers without cardiovascular disease (mean age, 45.3±6.7) were followed for 18 years (from 2000 to 2018). Job strain and ERI were measured with validated questionnaires. CHD events were retrieved from medico-administrative databases using validated algorithms. Marginal Cox models were used to calculate hazard ratios (HR) stratified by sex. Multiple imputation and inverse probability weights were applied to minimize potential threats to internal validity.

RESULTS

Among 3118 men, 571 had a first CHD event. Exposure to either job strain or ERI was associated with an adjusted 49% CHD risk increase (HR, 1.49 [95% CI, 1.07-2.09]). Combined exposure to job strain and ERI was associated with an adjusted 103% CHD risk increase (HR, 2.03 [95% CI, 1.38-2.97]). Exclusion of early CHD cases and censoring at retirement did not alter these associations. Among 3347 women, 265 had a first CHD event. Findings were inconclusive (passive job HR, 1.24 [95% CI, 0.80-1.91]; active job HR, 1.16 [95% CI, 0.70-1.94]; job strain HR, 1.08 [95% CI, 0.66-1.77]; ERI HR, 1.02 [95% CI, 0.72-1.45]).

CONCLUSIONS

In this prospective cohort study, men exposed to job strain or ERI, separately and in combination, were at increased risk of CHD. Early interventions on these psychosocial stressors at work in men may be effective prevention strategies to reduce CHD burden. Among women, further investigation is required.

Ist Stress am Arbeitsplatz ein Thema für den kardiologischen Alltag? Evidenz, Erkennung und Therapie aversiver Stressbedingungen im Arbeitsumfeld

In modernen Industriegesellschaften verbringen die Menschen die aktivste Zeit ihres Lebens in beruflicher Umgebung, die damit weitgehend Alltag und Lebensqualität bestimmt. Immer mehr verschwimmen die Grenzen zwischen Privatem und Beruflichem. Neben „klassischem“ Arbeitsstress – häufig definiert als Missverhältnis von hohen Anforderungen bei gleichzeitig geringen Entscheidungsmöglichkeiten oder als Missverhältnis zwischen Arbeitseinsatz und Belohnung – gehören u. a. Überarbeitung, Mobbing und Arbeitsplatzverlust sowie negative Arbeitsplatzbedingungen zu den Belastungen, die seelische und körperliche gesundheitliche Probleme auslösen können. Evidenz aus Megastudien mit > 100000 Teilnehmern belegt die Bedeutung von Arbeitsstress als Risikofaktor (RF) für Hypertonie, Schlafstörungen und Depressionen. Unter Arbeitsstress werden häufig gesundheitsgefährdende Verhaltensweisen als Kompensationsversuche eingesetzt. Andauernder Arbeitsstress wird damit zu einem signifikanten RF für ischämische Herzerkrankungen, zerebrovaskuläre Ereignisse und Diabetes mellitus. Arbeitsstress sollte daher in der kardiologischen Praxis exploriert werden. Grundzüge einer auf Arbeitsstress fokussierten Gesprächsführung für den Alltagseinsatz werden vorgestellt.

Gender equality in the Italian academic context. Results from the IGEA project

The Innovation for Gender Equality in Academia (IGEA) project is focused on the analysis of the gender composition in academia, on the identification of the health needs of the academic population and on the assessment of their organizational wellbeing, in order to promote equal working conditions and opportunities. The study, focused on the identification of health needs, involved the construction of an ad hoc questionnaire in order to collect the socio-demographic characteristics and the perception of working environment of the participants. Differences between males and females were evaluated by the Mann-Whitney test, and Pearson Chi-Square or Fisher exact tests as appropriate, highlighting significant differences between genders regarding the occurrence of anxiety, panic, irritation and annoyance related to work activities. A multivariate logistic regression analysis was performed to identify factors associated with the perception of work-related anxiety/panic, showing a direct association with the difficulty in work performance and the work-related stress during the pandemic period, whereas, an indirect association was found with job satisfaction and the feeling of being appreciated by colleagues. Occupational stress can increase the risk of developing physical and mental conditions, also affecting work performance and absenteeism. It is therefore fundamental to plan targeted interventions, implement policies and specific actions, in order to avoid and reduce any differences related to gender.

The sex-dependent response to psychosocial stress and ischaemic heart disease

Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.

Unrewarding work and major depressive episode: Cross-sectional and prospective evidence from the U.S. MIDUS study

Depression is a serious mental health condition and is the leading cause of disability worldwide. Previous research has demonstrated that work stress may contribute to the development of depression through psychophysiological pathways. The present study assessed associations of work stress - in terms of the effort-reward imbalance (ERI) model measuring unrewarding work - with major depressive episode (MDE). Data were from the Mid-life in the United States study, a national, population-based sample of U.S. workers with 9-year follow-up prospective cohort design. The cross-sectional sample at baseline had 2204 workers, and the prospective sample had 1591 workers at follow-up (78.7% follow-up rate). Multivariable Bayesian logistic regression and Poisson regression were applied for examining cross-sectional and prospective associations, respectively. ERI was assessed by a validated 17-item scale at baseline, and MDE in the past 12 months was assessed by the Composite International Diagnostic Interview Short Form at both baseline and follow-up. It was found that ERI at baseline was associated with higher odds of prevalent MDE in the cross-sectional sample (OR = 1.47, HPD interval [1.26-1.69]), and with higher risk of MDE at follow-up in the prospective sample (RR = 1.29, HPD interval [1.01-1.60]). In both cross-sectional and prospective analyses, strongest associations were observed among workers with the highest quartile of ERI, after adjusting for demographic, socioeconomic, lifestyle, and other psychosocial factors. The stable and robust findings strengthen and extend previous findings that unrewarding work is a risk factor of mental health. If confirmed by further evidence, intervention targeting work stress reduction is warranted.

Work-Related Stress and Occurrence of Cardiovascular Disease: A 13-Year Prospective Study

OBJECTIVE

The aim of the study is to investigate the influence of work-related psychological and physical stresses on risk of cardiovascular disease (CVD).

METHODS

A total of 5651 CVD-free participants older than 50 years from the Survey of Health, Ageing and Retirement in Europe were followed up for 13 years to detect incident CVD. Work-related stress was assessed using job strain and job reward questionnaire. Cox regression model was used to estimate the association.

RESULTS

High physical demands (hazard ratio [HR], 1.30) and low reward (HR, 1.19) compared with their counterparts, as well as active physical jobs (HR, 1.41) and high physical strain (HR, 1.45) in comparison with low physical strain were associated with higher risk of incident CVD after adjusting for confounders. However, combining physically stressful jobs with low reward did not further increase the CVD risk.

CONCLUSIONS

Avoiding physically stressful jobs or providing appropriate reward may reduce the occurrence of CVD.

Mental and physical training with meditation and aerobic exercise improved mental health and well-being in teachers during the COVID-19 pandemic

Teachers face significant stressors in relation to their work, placing them at increased risk for burnout and attrition. The COVID-19 pandemic has brought about additional challenges, resulting in an even greater burden. Thus, strategies for reducing stress that can be delivered virtually are likely to benefit this population. Mental and Physical (MAP) Training combines meditation with aerobic exercise and has resulted in positive mental and physical health outcomes in both clinical and subclinical populations. The aim of this pilot study was to evaluate the feasibility and potential effectiveness of virtual MAP Training on reducing stress and improving mood and well-being in teachers. Participants (n = 104) were from recruited online from kindergarten to grade twelve (K-12) schools in the Northeastern region of the United States and randomly assigned to a 6-week program of virtual MAP Training (n = 58) or no training (n = 13). Primary outcomes included pre-intervention and post-intervention ratings on self-report measures of social and emotional health. Changes in cognitive functioning and physical health were also examined in secondary analyses. By intervention end, participants in the MAP Training group reported less anxiety and work-related stress compared to those who received no training (ds = −0.75 to −0.78). Additionally, MAP Training participants reported improvements in depressive symptoms, rumination, work-related quality of life, perceived stress, and self-compassion (ds = 0.38 to −0.82), whereas no changes were observed in the no training group. Participants also reported increased subjective ratings of executive functioning, working memory, cognitive flexibility, and fewer sleep disturbances (ds = −0.41 to −0.74). Together, these results suggest that the combination of meditation and aerobic exercise is an effective virtual intervention for improving mental health and well-being among K-12 teachers and may enhance resilience to stressful life events such as occurred during the coronavirus pandemic.

Stress-induced arterial hypertension

Stress is considered as one of the factors associated with the development of many diseases, including the cardiovascular system. The history of studying stress as a risk factor for hypertension began in the first half of the 20th century and continued after the introduction of 24-hour blood pressure monitoring (ABPM) into clinical practice. Then it turned out that there is normotension, stable hypertension and latent hypertension: masked (when clinical BP is within the normal range, and arterial hypertension is recorded according to ABPM and/or self-monitoring of BP) and white coat hypertension (increased BP during a visit to the doctor when normal values of blood pressure according to ABPM or self-monitoring of BP). Currently, both variants of latent hypertension are classified as stress-induced arterial hypertension. Several models have been proposed for the study of stress, but two of them are more common in clinical studies: the Karasek model (based on an imbalance between job demands and job decision latitude) and the Siegrist model (based on an imbalance of effort and reward). There are only few studies in where attempts have been made to link the increase in BP with the parameters of stress response (for example, with hormonal levels) or genetic predisposition. The review discusses the most significant studies of stress-induced arterial hypertension published to date.

Work Exposures and Development of Cardiovascular Diseases: A Systematic Review

INTRODUCTION

Cardiovascular diseases (CVDs) are the number one cause of death, and there is evidence that work exposures could be associated with their development. This study aimed to systematically review observational studies of adults exposed to job strain, effort-reward imbalance, long working hours, job insecurity, shift work, and occupational noise, and assess the association of those work exposures with CVDs.

METHODS

The Navigation Guide framework was applied. The population were adults of working age (18-65), and cohort and case-control studies were included. The work exposures were job strain, effort-reward imbalance, long working hours, job insecurity, shift work, and occupational noise. The outcomes were cerebrovascular diseases, ischaemic heart disease, and hypertensive diseases. The selection, data extraction, risk of bias assessment, and quality assessment were carried out by two reviewers independently and disagreements were solved by a third reviewer or by consensus. The synthesis of the results was done by applying the 'vote counting based on direction' method, and the results were summarized in an effect direction plot. The strength of the evidence for every risk factor and CVD was defined by consensus.

RESULTS

A total of 17 643 papers were initially identified in the literature search, but after applying the filters by title and abstract, and full text, 86 studies were finally included. From the included studies, sufficient evidence was found of the harmfulness of job strain for cerebrovascular disease and ischemic heart disease. Furthermore, there was sufficient evidence of the harmfulness of shift work for ischemic heart disease. Evidence of no relationship was found between long working hours and shift work with ischaemic heart disease and hypertensive disease, respectively. The other associations of work exposures and CVDs had limited or inadequate evidence of harmfulness.

CONCLUSIONS

In this comprehensive review, there was sufficient evidence of a harmful relationship between job strain, shift work, and CVDs. For the other work exposures, more high-quality studies are needed. In order to improve current prevention strategies for CVDs, the findings of this review imply that job strain and shift work are work exposures that constitute additional risk factors that could be approached as targets for worksite interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020179972.

How Much Do We Care about Teacher Burnout during the Pandemic: A Bibliometric Review

In this study, a descriptive bibliometric analysis of the scientific production was performed in the Web of Science on burnout and/or stress in teachers in pandemic situations. The aim of the study was to analyse the scientific production on stress and burnout in teachers during the COVID-19 pandemic. A total of 75 documents from 33 journals with 3947 cited references were considered, with 307 researchers from 35 countries publishing at least one article. The country with the most publications was the USA, followed by China and Spain. The USA was the country with the most collaborations. A total of 184 institutions published documents, and the universities with the most records were Christopher Newport and Columbia, although the American University of Sharjah and Cape Breton University had a higher overall citation coefficient. Of the 33 journals that have published on the subject, Frontiers in Psychology and the International Journal of Environmental Research and Public Health stood out in terms of the number of articles, and they were also listed in this order with regard to their impact factor.

Psychological Stress and Heart Disease: Fact or Folklore?

For at least a few centuries, if not millennia, psychological stress has been popularly believed to contribute to heart disease. Does psychological stress really contribute to heart disease? Are anecdotal, patient, and lay press reports that angina, heart attack, and even cardiac death are caused by stress based on fact, or are they just folklore? In this review, the study data supporting associations between stress and cardiovascular risk, as well as potential mechanisms by which psychological stress might contribute to heart disease and precipitate myocardial ischemia and infarction, are critically reviewed and summarized.

The Protective Role of Job Control/Autonomy on Mental Strain of Managers: A Cross-Sectional Study among Wittyfit's Users

BACKGROUND

Karasek's Job Demand-Control-Support model is the gold standard to assess the perception of work; however, this model has been poorly studied among managers. We aimed to explore the perception of work (job demand, control, and support) in managers, and to quantify their risk of job strain (high job demand and low job control) and isostrain (job strain with low job support).

METHODS

We conducted a cross-sectional study on workers from various French companies using the Wittyfit software. Job demand, control, and support were evaluated by self-reported questionnaires, as well as sociodemographic data.

RESULTS

We included 9257 workers: 8488 employees (median age of 45 years, median seniority of 10 years, 39.4% women) and 769 managers (463 were more than 45 years old, 343 with more than 10 years of service, 33.3% women). Managers had higher mean ± SD levels than employees in job control (79.2 ± 14.9 vs. 75.4 ± 16.9) and job support (25.2 ± 5.1 vs. 24.0 ± 6.1) (p < 0.001). Compared to employees, managers had a 37% decreased risk of job strain (OR = 0.63, 95% CI 0.52 to 0.77) and a 47% decreased risk of isostrain (OR = 0.53, 95% CI 0.40 to 0.69) (p < 0.001). Workers over age 45 (OR = 1.26, 95% CI 1.14 to 1.40, p < 0.001) and women (OR = 1.12, 95% CI 1.01 to 1. 25, p = 0.03) were at greater risk of job strain. Furthermore, workers over age 45 (OR = 1.51, 95% CI 1.32 to 1.73, p < 0.001), workers with over 10 years of service (OR = 1.35, 95% CI 1.16 to 1.56, p < 0.001), and women (OR = 1.15, 95% CI 1.00 to 1.31, p = 0.04) were at greater risk of isostrain.

CONCLUSIONS

Managers seem to have higher autonomy and greater social support and therefore are less at risk of job strain or isostrain than employees. Other factors such as age, seniority, and sex may influence this relationship.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT02596737.

Prospective increases in depression symptoms and markers of inflammation increase coronary heart disease risk - The Whitehall II cohort study

OBJECTIVE

Stress, inflammation, and depression are associated to coronary heart disease (CHD). However, how these constructs collectively contribute to CHD incidence is not well understood. For the first time, this study explored the concurrent relationship between workplace stress, depression symptomology and levels of low-grade inflammation with future CHD incidence.

METHODS

Data from the 5-year intervals at phase 5, 7, and 9 of the Whitehall II study (N = 8348, M_age = 56) provided measures of workplace stress, depression symptomology, inflammation (interleukin-6, C-reactive protein, fibrinogen), and CHD incidence. The proposed stress-inflammation-depression-CHD pathway was assessed with a longitudinal design incorporating a structural equation model (SEM) that measured if changes in stress, depression, and inflammation between phase 5 to phase 7 predicted first-time CHD events between phases 7 and 9.

RESULTS

The SEM empirically supported this proposed pathway and demonstrated excellent model fit, χ (72) = 3582.959, p < .001, CFI = 0.896, RMSEA = 0.076 (CI₉₀ = 0.074, 0.079), while depression symptoms mediated the association between workplace stress and CHD incidence, B = 0.003 (CI₉₀ = 0.001, 0.004). Further, survival analysis indicated that individuals with higher mean scores (across phases) of depression symptoms or fibrinogen levels were more likely to experience a first time CHD event.

CONCLUSIONS

Increases in depression symptoms and fibrinogen levels may be good indicators of future CHD morbidity among older employees. Future research is encouraged to monitor negative affective states and the potential use of biobehavioural options to reduce depression and inflammation that may mitigate CHD risk.

Understanding the health outcomes of the work pattern transformation in the age of gig economy: an investigation of the association between multiple-job holding and health status in the United States and China

OBJECTIVE

The Slash (multiple-job holders) become increasingly prevalent in the labor force under the context of fast-developing gig economy and other emerging employment forms active on platforms. However, health outcomes of multiple-job holding have not received sufficient research treatment and is far from reaching consensus. This study provides an empirical investigation on the influence of multiple-job holding on individual health.

METHOD

This study uses data from China Health and Retirement Longitudinal Study (CHARLS-2015 survey) which covers 28 provinces/municipalities in China and tracks work and health status of the population aged over 45 years using stratified random sampling (N = 12,659-16,526 for examinations of different types of health status (i.e., chronic conditions/body aches/depression, in study 1), and from the Survey of Household Economics and Decision-making (SHED-2019) which is conducted by the Federal Reserve Board of the United States and documents economic behavior and related risks of the population aged over 18 years (N = 6603 for baseline model and N = 10,718 for supplementary test, in study 2). To address the potential endogeneity of multiple-job holding, the instrumental variable (IV) regressions are conducted to ensure the validity of results. The implementation of Study 1 and 2 in different national context could help test the generalization of research results.

RESULTS

Compared with non-multiple jobs holding, multiple-job holding with only one additional job is associated with better health status (i.e., less chronic conditions and body aches, a lower level of depression shown in study 1, and better self-assessed general health shown in study 2), however, multiple-job holding with at least two additional jobs turns to be associated with worse health status (shown in both study 1 and 2). These results show that the optimal level of multiple-job holding could be featured with one additional job besides the primary job.

CONCLUSION

Multiple-job holding, with different structures, has both bright and dark side for health outcomes. To maintain an optimal level of multiple-job holding could benefit individual health.

The Role of Employees' Age for the Relation Between Job Autonomy and Sickness Absence

OBJECTIVE

We investigate whether job autonomy is associated with employees' sickness absence. In particular, we examine the role of employees' age for this relationship.

METHODS

We can make use of the representative German Study of Mental Health at Work data (n = 3099 employees) and control for relevant covariates.

RESULTS

Applying theoretical consideration such as the Job Demand Control Model, we do find evidence for an inverse relation between employees' job autonomy and days of sickness absence. This relation is only weakly mediated by job satisfaction and particularly relevant for more senior employees.

CONCLUSIONS

Theoretical implications are aimed at extending the existing theoretical models by individuals age and derive age-specific propositions. Managerial implications include recommendations which directly affect the individuals work content with regard to the use of our definition of job autonomy.

Mind-Body Connection: Cardiovascular Sequelae of Psychiatric Illness

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.

Associations of Job Strain, Stressful Life Events, and Social Strain With Coronary Heart Disease in the Women's Health Initiative Observational Study

Background

The association between psychosocial stress and coronary heart disease (CHD) may be stronger in women than men and may differ across types of stressors. In this study, we assessed associations of psychosocial stressors, including job strain, stressful life events, and social strain with the incidence of CHD in women.

Methods and Results

We used longitudinal data from 80 825 WHI‐OS (Women's Health Initiative Observational Study) participants with a mean age of 63.4 years (7.3 years) at baseline. Job strain was assessed through linkage of Standard Occupational Classification codes to the Occupational Information Network. Stressful life events and social strain were assessed via validated self‐reported questionnaires. Cox proportional hazard models were used to evaluate associations of each stressor with CHD separately and jointly. A total of 3841 (4.8%) women developed CHD during an average of 14.7 years of follow‐up. After adjustment for age, other stressors, job tenure, and socioeconomic factors, high stressful life events score was associated with a 12% increased CHD risk, and high social strain was associated with a 9% increased CHD risk. Job strain was not independently associated with CHD risk, but we observed a statistically significant interaction between job strain and social strain (P=0.04), such that among women with high social strain, passive job strain was associated with a 21% increased CHD risk.

Conclusions

High stressful life events and social strain were each associated with higher CHD risk. Job strain and social strain work synergistically to increase CHD risk.

Occupational Stress in Spanish Police Officers: Validating the Effort-Reward Imbalance Questionnaire

The Effort-Reward Imbalance Questionnaire (hereinafter, ERIQ) has been largely used worldwide to assess job stress, but it has not yet been applied in Spanish police. The objective of this study was to examine the construct validity and the internal consistency of the ERIQ in police officers. A cross-sectional study was carried out, using a nonprobability sampling (quota). A total of 217 Spanish police officers participated, 192 men (88.47%) and 25 women (11.53%). The mean age was 41 years (SD = 7.51). These police officers completed the ERIQ together with some other questionnaires (DECORE-21, MBI, GHQ and STAI) in order to provide evidence for validity based on the relationships to other constructs. A confirmatory factor analysis was performed and a matrix of correlations with the rest of constructs was created. The results showed an appropriate fit to the original model consisting of three scales. In addition, the scales of the ERIQ presented the expected relationship with the other constructs. The ERIQ is a valid instrument for assessing occupational stress in Spanish police officers and can improve the interventions in this professional group.

The impact of the great economic crisis on mental health care in Italy

The great economic crisis in 2008 has affected the welfare of the population in countries such as Italy. Although there is abundant literature on the impact of the crisis on physical health, very few studies have focused on the causal implications for mental health and health care. This paper, therefore, investigates the impact of the recent economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy and assesses whether there are heterogeneous effects across areas with distinct levels of income. We exploit 9-year (2007-2015) panel data on hospital discharges, which is merged with employment and income composition at the geographic units that share similar labour market structures. Linear and dynamic panel analysis are used to identify the causal effect of rising unemployment rate on severe mental illness admissions per 100,000 residents to account for time-invariant heterogeneity. We further create discrete income levels to identify the potential socioeconomic gradients behind this effect across areas with different economic characteristics. The results show a significant impact of higher unemployment rates on admissions for severe mental disorders after controlling for relevant economic factors, and the effects are concentrated on the most economically disadvantaged areas. The results contribute to the literature of spatio-temporal variation in the broader determinants of mental health and health care utilisation and shed light on the populations that are most susceptible to the effects of the economic crisis.

Assessing New Methods to Optimally Detect Episodes of Non-metabolic Heart Rate Variability Reduction as an Indicator of Psychological Stress in Everyday Life: A Thorough Evaluation of Six Methods

Frequent or chronic reduction in heart rate variability (HRV) is a powerful predictor of cardiovascular disease, and psychological stress has been suggested to be a co-determinant of this reduction. Recently, we evaluated various methods to measure additional HRV reduction in everyday life and to relate these reductions to psychological stress. In the current paper, we thoroughly evaluate these methods and add two new methods in both newly acquired and reanalyzed datasets. All of these methods use a subset of 24 h worth of HRV and movement data to do so: either the first 10 min of every hour, the full 24 h, a combination of 10 min from three consecutive hours, a classification of level of movement, the data from day n to detect episodes in day n + 1, or a range of activities during lab calibration. The method that used the full 24 h worth of data detected the largest percentage of episodes of reduced additional HRV that matched with self-reported stress levels, making this method the most promising, while using the first 10 min from three consecutive hours was a good runner-up.

Job strain, gender and well-being at work: a case study of public sector line managers

Purpose

The purpose of this paper is to further the understanding of public sector line managers' work-related well-being and health in relation to job strain, gender and workplace social support.

Design/methodology/approach

An online survey was sent to all senior and middle line managers (N = 357) in three administrative departments of Iceland's largest municipality. The response rate was 64.7%. Multivariate logistic regression was used to analyse the data.

Findings

A minority of respondents experience high job strain. However, for these managers, the risk of experiencing emotional exhaustion is about fivefold, compared to those not experiencing high job strain. Social support is an important buffering against job strain and enhances well-being. Female managers are more likely than their male counterparts to report myositis, back or shoulder pain and sleeping difficulty.

Practical implications

The study emphasises that workplace social support attenuates the negative impact of job strain on line managers' work-related well-being. Furthermore, it demonstrates that in a society at the forefront in gender equality, gender differences in health symptoms exist among line managers in the public sector – a finding that highlights the importance of studying all aspects of workplace well-being by gender. This calls for future research using a more comprehensive survey data and interviews to shed light on the pathways through which female line managers' health is negatively affected.

Originality/value

Knowledge relating to well-being and health of line managers in the public sector is scarce. This study contributes to filling that gap. As work-related well-being is often gender-blind, the value of the study is also the investigation of the gender patterns in the authors’ data.

Job Stress and Heart Rate Variability: Findings From the ELSA-Brasil Cohort

OBJECTIVE

Evidence suggests that exposure to psychosocial stress at work can inhibit vagal tonus, influencing the capacity to respond to environmental stimuli. We investigated whether job strain and low control and high demand at work, as separate measures, are associated with a reduction in heart rate variability (HRV).

METHODS

This is a cross-sectional study with 9658 active workers at the baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). HRV was estimated using electrocardiographic recordings for 10 minutes, at rest, examining the following indices were used: root mean square of successive difference, standard deviation of normal to normal, percentage of adjacent R-R intervals with a difference lasting more than 50 ms, low frequency (LF), and high frequency. Job strain was defined based on the demand-control model. Independent associations between job strain and HRV indices were verified using generalized linear models and the magnitude of the association was estimated by evaluating the ratios of arithmetic means.

RESULTS

Neither the unfavorable demand-control relation nor job demand dimension separately was associated with HRV. However, the increase of one unit in the control dimension was associated with an increment of 2.2% (95% confidence interval = 1.014-1.029) in the LF mean. After adjustments for sociodemographic characteristics, assessment site, health-related behaviors, and depression, this association remained statistically significant (ratio of arithmetic means = 1.008; 95% confidence interval = 1.0002-1.017).

CONCLUSIONS

Job control was associated with HRV in a large cohort of civil servants. Nevertheless, it is important to emphasize that only the LF index remained associated with low job control. Further studies are needed to develop a greater understanding of the relationship of psychosocial aspects and autonomic balance.

Instability of Personality Traits of Teachers in Risk Conditions due to Work-Related Stress

The following study aims to verify whether psychosocial risk conditions determine a variation in personality traits. The sample consisted of 301 teachers, comprising 84 men (27.1%) and 217 women (72.9%). The Big Five Questionnaire (BFQ) was used to measure personality traits, while the Organizational and Psychosocial Risk Assessment (OPRA) questionnaire was used to measure psychosocial risk. The ANOVA results notice the change of BFQ traits. These are significant (Extraversion = 0.000; Agreeableness = 0.001; Neuroticism = 0.000; Openness = 0.017), with the exception of the Conscientiousness trait (Conscientiousness = 0.213). The research supports the approach of seeing personality as the result of the interaction between the individual and the environment; this position is also recognized by work-related stress literature. Stress conditions can lead to a change in the state of health and possibly determine the onset of work-related stress diseases. In the future, it would be useful to start a series of longitudinal studies to understand in greater detail the variability of personality traits due to changes in the Risk Index.

The effects of stress on cardiovascular disease and Alzheimer's disease: Physical exercise as a counteract measure

AD is a complicated multi-systemic neurological disorder that involves different biological pathways. Several risk factors have been identified, including chronic stress. Chronic stress produces an alteration in the activity of the hypothalamic pituitary adrenal (HPA) system, and the autonomic nervous system (ANS), which over time increase the risk of AD and also the incidence of cardiovascular disease (CVD) and risk factors, such as hypertension, obesity and type 2 diabetes, associated with cognitive impairment and AD. Considering the multi-factorial etiology of AD, understanding the complex interrelationships between different risk factors is of potential interest for designing adequate strategies for preventing, delaying the onset or slowing down the progression of this devastating disease. Thus, in this review we will explore the general mechanisms and evidence linking stress, cardiovascular disease and AD, and discuss the potential benefits of physical activity for AD by counteracting the negative effects of chronic stress, CVD and risk factors.

Mental and physical health status among chronic hepatitis B patients

PURPOSE

Little is known about health-related quality of life (HRQoL) in patients with chronic hepatitis B virus (CHB) infection in the United States. Our goal is to understand factors associated with HRQoL in this population.

METHODS

We conducted a survey to assess HRQoL and behavioral risks among patients with CHB infection from four large U.S. health care systems. Primary outcomes were generated from the SF-8 scale to assess HRQoL, as measured by the mental component scores (MCS) and physical component scores (PCS). The survey also measured socio-demographic information, hepatitis-related behavioral risk factors, treatment exposure/history, stress, and social support. We supplemented survey data with electronic health records data on patient income, insurance, disease severity, and comorbidities. Multivariate analysis was used to estimate and compare adjusted least square means of MCS and PCS, and examine which risk factors were associated with lower MCS and PCS.

RESULTS

Nine hundred sixty-nine patients (44.6%) responded to the survey. Current life stressors and unemployment were associated with both lower MCS and PCS results in multivariate analyses. Lower MCS was also associated with White race and low social support, while lower PCS was also associated with Medicaid insurance.

CONCLUSIONS

Stressful life events and unemployment were related to mental and physical health status of CHB patients. Those who have social support have better mental health; White and Medicaid patients are more likely to have poorer mental and physical health, respectively. Management of CHB patients should include stress management, social support, and financial or employment assistance.

The effect of labor market shocks on health: The case of the Russian transition

During the first years of the transition to the market economy in Russia, many people experienced the whole range of stressful labor market events, including job loss, wage cuts and nonpayments; some people had to change occupations or take on additional work. These events were caused externally by the unprecedented structural shifts in the economy. This natural experiment provides an opportunity to estimate the causal effect of various labor market shocks on individual health and health-related behaviors. Propensity score matching and difference-in-difference estimates using household survey data show that labor market shocks during the early transition had long-term negative effects on individual health. I also find an increased incidence of smoking and alcohol consumption as well as a higher risk of certain types of chronic health problems for the people affected by labor market shocks.

Effort-reward imbalance at work and risk of type 2 diabetes in a national sample of 50,552 workers in Denmark: A prospective study linking survey and register data

OBJECTIVE

To examine the prospective relation between effort-reward imbalance at work and risk of type 2 diabetes.

METHODS

We included 50,552 individuals from a national survey of the working population in Denmark, aged 30-64 years and diabetes-free at baseline. Effort-reward imbalance was defined, in accordance with the literature, as a mismatch between high efforts at work (e.g. high work pace, time pressure), and low rewards received in return (e.g. low recognition, job insecurity) and assessed as a continuous and a categorical variable. Incident type 2 diabetes was identified in national health registers. Using Cox regression we calculated hazard ratios (HR) and 95% confidence intervals (95% CI) for estimating the association between effort-reward imbalance at baseline and risk of onset of type 2 diabetes during follow-up, adjusted for sex, age, socioeconomic status, cohabitation, children at home, migration background, survey year and sample method.

RESULTS

During 136,239 person-years of follow-up (mean = 2.7 years) we identified 347 type 2 diabetes cases (25.5 cases per 10,000 person-years). For each one standard deviation increase of the effort-reward imbalance score at baseline, the fully adjusted risk of type 2 diabetes during follow-up increased by 9% (HR: 1.09, 95% CI: 0.98-1.21). When we used effort-reward imbalance as a dichotomous variable, exposure to effort-reward imbalance was associated with an increased risk of type 2 diabetes with a HR of 1.27 (95% CI: 1.02-1.58).

CONCLUSION

The results of this nationwide study of the Danish workforce suggest that effort-reward imbalance at work may be a risk factor for type 2 diabetes.

Correlations of the "Work-Family Conflict" With Occupational Stress-A Cross-Sectional Study Among University Employees

Background: The working conditions at universities and hospitals are reported to be stressful. Several national and international studies have investigated occupational stress in hospitals. However, scientific studies at colleges and universities addressing psycho-social stress factors and their potential consequences are scarce. In this context, the consequences and correlations of the factor of work-family conflict, in particular, are currently uninvestigated. The aim of our study was to assess data on psychosocial stress in the context of the compatibility of work and family. Methods: Data were gathered through a cross-sectional-study, N = 844 (55% female, 41% male), on university staff (42.3% scientists, 14.3% physicians, 19.4% employees in administration, and 19.3% employees in service). Participants filled out questionnaires to provide their personal data and details of their work and private life conditions. For this purpose, we used the Work-Family and Family-Work Conflict Scales, Effort-Reward Inventory and Overcommitment Scale (ERI, OC), Patient Health Questionnaire (PHQ-4), short-form Maslach Burnout Inventory (MBI), and questions on their subjective health. Statistical analyses were performed using SPSS 22. Results: We found high levels of stress parameters in the total sample: extra work (83%), fixed-term work contracts (53%), overcommitment (OC, 26%), Effort-Reward Imbalance (18%, ERI Ratio > cut-off 0.715), work-family conflict (WFC, 35%), and family-work conflict (FWC, 39%). As hypothesized, we found significant correlations of both WFC and FWC with psychosocial work strain (ERI Ratio) as well as overcommitment (OC). Mental and somatic health parameters also had a significant positive correlation with WFC and FWC. Using a regression analysis (N = 844), we identified WFC as a predictor of burnout, while emotional exhaustion, extra work, and overcommitment could be identified as predictors of WFC and FWC. Discussion: The results of our study point toward deficits in the compatibility of work life and private life in the work fields of science, colleges, and universities. Furthermore, we found indicators that work-family conflicts (interrole conflicts) have an impact on mental and somatic health. These work-family conflicts should be targets for preventions and interventions with the aim of improving the work-life balance and mental and somatic wellbeing of employees.

A Cross-Sectional and Longitudinal Study of the Effects of a Mindfulness Meditation Mobile Application Platform on Reducing Stress and Anxiety

Introduction

The development of many lifestyle-related chronic disorders occurs as a result of stress and anxiety. In recent years, in order to overcome lifestyle-related problems, people are increasingly making use of mindfulness meditation mobile applications despite the fact that there is no substantial evidence that this practice has benefits for their health.

Aim

Testing the effectiveness of this method in reducing stress and anxiety through the development of a mindfulness meditation mobile application was the aim of this project.

Methodology

Two independent studies were conducted. For both the studies, IBM SPSS Statistics 23.0 software was used to perform the statistical analysis. The first study was conducted cross-sectionally between 111 meditators and 111 non-meditators. The use of Depression, Anxiety, Stress Scale (DASS) was employed in assessing the stress and anxiety. It was found out that stress (P < 0.000) and anxiety (P < 0.000) are significantly reduced for meditators in comparison with the non-meditators. A substantial reduction was observed using the cross-sectional study, and a longitudinal study was carried out to affirm the effectiveness of this method in reducing stress and anxiety. 67 users were shortlisted for the study and their stress and anxiety level was measured before and after practicing mindfulness meditation.

Result

The result revealed that there was a substantial reduction in stress (P = 0.01) and anxiety (P = 0.02).

Conclusion

Therefore, mindfulness meditation mobile application can serve as another medium of delivery in addressing the problems of stress and anxiety. However, future research is warranted to determine the biological effects of mindfulness meditation.

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.

Effort-reward imbalance and ambulatory blood pressure among female Las Vegas hotel room cleaners

BACKGROUND

Effort-reward imbalance (ERI) was hypothesized to be associated with ambulatory blood pressure (ABP) and pulse pressure (PP) among female hotel room cleaners.

METHODS

ERI, ABP, and PP were assessed among 419 cleaners from five hotels during 18 waking hours. Adjusted linear regression models were used to assess associations of ERI with ABP and PP during 18-hours, work hours, and after work hours.

RESULTS

There was a pattern of higher ERI being associated with higher 18-hour systolic ABP and 18-hour PP although the results were imprecise. An increase of ERI by half its range was associated with a 1.6 mmHg (95% CI, -1.6-4.7) increase in 18-hour systolic blood pressure (SBP) and a 0.7 mmHg (95% CI, -1.1-2.5) increase in 18-hour PP. An increase in rewards by half its range was associated with a 2 mmHg decrease in after-hours SBP (-2.2, 95% CI, -5.4-1.0) and after-hours PP (-1.9, 95% CI, -3.8-0.0). Among females 45 years or older, ERI was associated with 2.1 and 2.2 mmHg increase in 18-hour and work hours diastolic ABP, respectively, compared to a 0 mmHg change in 18-hour and work hours diastolic ABP in younger women. The number of dependents at home attenuated the association.

CONCLUSIONS

ERI was positively associated with ABP, particularly SBP, and the association was modified by age and the number dependents at home, although the estimates were imprecise. Workplace interventions that integrate stress management and active ABP surveillance appear warranted. However, larger studies with Latina women need to confirm our results.

An Analysis of Individual and Social Factors Affecting Occupational Accidents

BACKGROUND

Workforce health is one of the primary and most challenging issues, particularly in industrialized countries. This article aims at modeling the major factors affecting accidents in the workplace, including general health, work-family conflict, effort-reward imbalance, and internal and external locus of control.

METHODS

A cross-sectional study was conducted in Esfahan Steel Company in Iran. A total of 450 participants were divided into two groups-control and case-and the questionnaires were distributed among them. Data were collected through a 7-part questionnaire. Finally, the results were analyzed using SPSS 22.0 and Amos software.

RESULTS

All the studied variables had a significant relationship with the accident proneness. In the case group, general health with a coefficient of -0.37, work-family conflict with 0.10, effort-reward imbalance with 0.10, internal locus of control with -0.07, and external locus of control with 0.40 had a direct effect on occupational stress. Occupational stress also had a positive direct effect on accident proneness with a coefficient of 0.47. In addition, fitness indices of control group showed general health (-0.35), work-family conflict (0.36), effort-reward imbalance (0.13), internal locus of control (-0.15), and external locus of control (0.12) have a direct effect on occupational stress. Besides, occupational stress with a coefficient of 0.09 had a direct effect on accident proneness.

CONCLUSION

It can be concluded that although previous studies and the present study showed the effect of stress on accident and accident proneness, some hidden and external factors such as work-family conflict, effort-reward imbalance, and external locus of control that affect stress should also be considered. It helps industries face less occupational stress and, consequently, less occurrence rates of accidents.

Is there an association between working conditions and health? An analysis of the Sixth European Working Conditions Survey data

This paper analyses the association between working conditions and physical health using data from the Sixth European Working Conditions Survey (EWCS6) released in 2017. The econometric analysis uses two indicators to describe health status: self-assessed health (SAH), which is a subjective indicator of health; and an objective indicator of health (SICK), which is based on the occurrence of any illness or health problem that has lasted or is expected to last for more than 6 months. The theoretical hypotheses concerning the association between working conditions and SAH and the association between working conditions and SICK are tested using a standard ordered probit model and a standard probit model, respectively. The results show that encouraging working conditions, work environment, and job support are associated with both better self-assessed health and better objective health.

A lay epidemiological study on coexistent stress in hypertension: Its prevalence, risk factors, and implications in patients' lives

Introduction:

Hypertension poses a global challenge in terms of morbidity and mortality. Worldwide prevalence of hypertension is over 40%. Management of hypertension targets blood pressure control to prevent disease complications. Though stress and hypertension are closely related, stress management is often overlooked in the treatment of hypertension.

Aims:

(1) To estimate the prevalence of stress in hypertensive patients and (2) to study the associated risk factors of stress and its implications in disease management.

Materials and Methods:

It was a hospital-based, cross-sectional study done in Western India for 1 year. Data were collected from 400 hypertensive patients attending the selected health institutions using a pretested questionnaire. Chi-square tests were done using Medcalc 10.4.8.0.

Results:

The prevalence of stress in hypertensive patients was found to be 84.3%. Only 2.4% of these patients sought help from any health professional for stress. The most common stressors found in the patients were financial dependence on others, living in rented house, having a daughter of marriageable age because of associated dowry, death of a loved one, sleep-related problem, and owing a debt among others. Significant statistical association (P < 0.05) of stress was observed with the type of family and socioeconomic status. A highly significant association (P < 0.001) of stress with religion and residential area (whether urban non-slum, slum, or rural) was observed. Stress in individuals leads to poorer compliance with treatment and blood pressure control.

Conclusion:

Coexistent stress should be diagnosed and managed in patients of hypertension for proper disease management and control.

Organizational Determinants of Workplace Violence Against Hospital Workers

OBJECTIVE

To identify organizational factors contributing to workplace violence in hospitals.

METHODS

A questionnaire survey was conducted in 2013 among employees in a Midwestern hospital system (n = 446 respondents). Questions concerned employees' experiences of violence at work in the previous year and perceptions of the organizational safety climate. Logistic regressions examined staff interaction and safety climate factors associated with verbal and physical violence, respectively.

RESULTS

Interpersonal conflict was a risk factor for verbal violence (OR 1.49, 95% CI 1.04 to 2.12, P < 0.05) and low work efficiency was a risk factor for physical violence (OR .98, 0.97 to 0.99). A poor violence prevention climate was a risk factor for verbal (OR 0.48, 0.36 to 0.65, P < .001) and physical (OR 0.60, 0.45 to 0.82, P < .05) violence.

CONCLUSIONS

Interventions should aim at improving coworker relationships, work efficiency, and management promotion of the hospital violence prevention climate.

Job strain associated with increases in ambulatory blood and pulse pressure during and after work hours among female hotel room cleaners

BACKGROUND

Previously documented elevated hypertension rates among Las Vegas hotel room cleaners are hypothesized to be associated with job strain.

METHODS

Job strain was assessed by questionnaire. Ambulatory blood pressure (ABP) was recorded among 419 female cleaners from five hotels during 18 waking hours. Multiple linear regression models assessed associations of job strain with ABP and pulse pressure for 18-h, work hours, and after work hours.

RESULTS

Higher job strain was associated with increased 18-h systolic ABP, after work hours systolic ABP, and ambulatory pulse pressure. Dependents at home but not social support at work attenuated effects. Among hypertensive workers, job strain effects were partially buffered by anti-hypertensive medication.

CONCLUSIONS

High job strain is positively associated with blood pressure among female hotel workers suggesting potential for primary prevention at work. Work organizational changes, stress management, and active ABP surveillance and hypertension management should be considered for integrated intervention programs.

Occupational class and risk of renal cell cancer

OBJECTIVES

We sought to examine the association between occupational class linked to job stress and the risk of renal cell cancer. To identify potential mediators, we additionally examined whether any observed associations persisted even after controlling for the contribution of stress-related factors (eg, smoking, hypertension, and obesity).

METHODS

Using nationwide inpatient records (1984 to 2016) from the Rosai Hospital group in Japan, we identified 3316 cases of renal cell cancer (excluding upper tract urothelial cancer) and 168 418 controls. We classified patients' occupational class (blue-collar workers, service workers, professionals, and managers) and cross-classified it by industry type (blue-collar, service, and white-collar) based on a standardized national classification. Unconditional logistic regression with multiple imputation was used for the analyses.

RESULTS

A significantly elevated risk of renal cell cancer was found among men in higher occupational class (eg, professionals and managers). The elevated odds in male managers across all industries persisted even after controlling for smoking and alcohol consumption, with the association being more pronounced in blue-collar industries (OR, 1.61; 95% CI, 1.34-1.93). The association appeared to be mainly mediated by hypertension.

CONCLUSION

Occupational class is associated with the risk of renal cell cancer in men, particularly through modifiable risk factors.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Generalized Unsafety Theory of Stress: Unsafe Environments and Conditions, and the Default Stress Response

Prolonged physiological stress responses form an important risk factor for disease. According to neurobiological and evolution-theoretical insights the stress response is a default response that is always "on" but inhibited by the prefrontal cortex when safety is perceived. Based on these insights the Generalized Unsafety Theory of Stress (GUTS) states that prolonged stress responses are due to generalized and largely unconsciously perceived unsafety rather than stressors. This novel perspective necessitates a reconstruction of current stress theory, which we address in this paper. We discuss a variety of very common situations without stressors but with prolonged stress responses, that are not, or not likely to be caused by stressors, including loneliness, low social status, adult life after prenatal or early life adversity, lack of a natural environment, and less fit bodily states such as obesity or fatigue. We argue that in these situations the default stress response may be chronically disinhibited due to unconsciously perceived generalized unsafety. Also, in chronic stress situations such as work stress, the prolonged stress response may be mainly caused by perceived unsafety in stressor-free contexts. Thus, GUTS identifies and explains far more stress-related physiological activity that is responsible for disease and mortality than current stress theories.