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Sundberg N, Millis RM. A Study of Diurnal Cortisol Adaptations in Sleep-Deprived Firefighters During a 72-Hour Work Shift: A Case Series. Cureus 2023; 15:e37504. [PMID: 37064725 PMCID: PMC10101191 DOI: 10.7759/cureus.37504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 04/18/2023] Open
Abstract
Seventy percent of US firefighters are overweight or obese. The combination of sleep deprivation and exposure to traumatic events during 72-hour work shifts, commonly employed in emergency responders, is thought to put firefighters at high risk for a variety of stress-related diseases and suicide. Previous studies suggest that the cortisol awakening response (CAR) may be increased in sleep-deprived emergency responders. This case series was designed to investigate the variations in CAR and associations with measurements of salivary cortisol and testosterone, blood glucose and triglyceride, and blood pressure during a 72-hour work shift. Measurements were made at 08:00 and 20:00 in five participants (one normal weight normotensive, three obese hypertensive, and one morbidly obese normotensive male). Data were characterized by the regression statistic R2 computed from the relationship between diurnal measurement and concentration, with significance at R2≥0.4. The predominant AM CAR adaptation response consisted of no significant 72-h change (flat response) in salivary cortisol (R2<0.4), found in three of the five participants (60%). The normal-weight participant's 72-h AM CAR adaptation was characterized as incremental (R2=0.91), and markedly different than that of the four obese firefighters who exhibited either a flat response (R2<0.4, 60%) or, in one subject, a decremental response (R2=0.40, 20%). The predominant 72-h PM cortisol adaptation was found to be decremental (R2=0.78-0.97) in three of the five participants (60%), including the normal weight subject (R2=0.78). Diurnal salivary cortisol and testosterone exhibited normal physiological circadian variations (P=0.01, AM>PM and P=0.1, AM>PM, respectively). Blood glucose and triglyceride also showed physiological circadian variations (P=0.02 AM<PM and P=0.002 AM<PM, respectively). Diurnal variation of systolic BP was found to be not significant (P=0.2). The flat AM CAR adaptation exhibited in three of four obese hypertensive firefighters may represent a blunted adaptation response, akin to the responses reported for survivors of suicide. These findings suggest that diurnal variations in salivary cortisol and testosterone, blood glucose, and triglyceride may be useful biochemical markers for identifying stress-related adaptations to 72-hour work shifts. Future studies should be designed to correlate diurnal variations in biomarkers with the risk of developing stress-related diseases and suicide in firefighters.
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Affiliation(s)
- Neil Sundberg
- Department of Pathophysiology, American University of Antigua, St. John's, ATG
| | - Richard M Millis
- Department of Pathophysiology, American University of Antigua, St. John's, ATG
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Cortisol Awakening Response and Stress in Female Nurses on Monthly Shift Rotations: A Longitudinal Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9506583. [PMID: 36158880 PMCID: PMC9499772 DOI: 10.1155/2022/9506583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 09/01/2022] [Indexed: 11/18/2022]
Abstract
The majority of shift nurses are female, there is still an expectation that they fulfil the traditional role of women in the family in Asia, often conflicting with shift work, increases stress, and affects cortisol secretion patterns. This study was to understand the changes in the cortisol awakening response (CAR) and work stress in nursing personnel working in different shifts. We recruited 41 female shift nurses. We administered the Taiwan Nurse Stress Checklist (NSC), and the nurses themselves collected saliva samples upon waking and 30 minutes after waking for three consecutive days at home. The saliva samples enabled us to analyze the increase in cortisol levels following waking (CARi) of nurses working different shifts (day, evening, and night). We then analyzed the data obtained using a hierarchical linear model (HLM). The results indicated that in terms of stress from the inability to complete personal tasks, the regression coefficients of night-shift nurses vs. day-shift nurses (B = 4.39, p < .001) and night-shift nurses vs. evening-shift nurses (B = 3.95, p < .001) were positive, which means that night-shift nurses were under significantly greater stress than day-shift and evening-shift nurses. With regard to CARi, the regression coefficients of night-shift nurses vs. day-shift nurses (B = −3.41, p < .001) and night-shift nurses vs. evening-shift nurses (B = −2.92, p < .01) were negative, which means that night-shift nurses have significantly lower CARi values than day-shift and evening-shift nurses. With regard to cortisol levels 30 minutes after waking, the regression coefficients of night-shift nurses vs. day-shift nurses (B = −3.88, p < .01) and night-shift nurses vs. evening-shift nurses (B = −3.31, p < .01) were negative, which means that night-shift nurses have significantly lower cortisol levels 30 minutes after waking than day-shift and evening-shift nurses. These results indicate that female night-shift nurses display the lowest CARi and cortisol levels 30 minutes after waking and are more negatively affected by being unable to complete personal tasks.
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Burek K, Rabstein S, Kantermann T, Vetter C, Rotter M, Wang-Sattler R, Lehnert M, Pallapies D, Jöckel KH, Brüning T, Behrens T. Night work, chronotype and cortisol at awakening in female hospital employees. Sci Rep 2022; 12:6525. [PMID: 35443768 PMCID: PMC9021274 DOI: 10.1038/s41598-022-10054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
Abstract
To examine the effect of night shift on salivary cortisol at awakening (C1), 30 min later (C2), and on the cortisol awakening response (CAR, the difference between C2 and C1). We compared shift and non-shift workers with a focus on the impact of worker chronotype. Our study included 66 shift-working females (mean age = 37.3 years, SD = 10.2) and 21 non-shift working females (mean age = 47.0 years, SD = 8.9). The shift workers collected their saliva samples at C1 and C2 on each two consecutive day shifts and night shifts. Non-shift workers collected their samples on two consecutive day shifts. We applied linear mixed-effects models (LMM) to determine the effect of night shift on CAR and log-transformed C1 and C2 levels. LMMs were stratified by chronotype group. Compared to non-shift workers, shift workers before day shifts (i.e. after night sleep) showed lower cortisol at C1 (exp [Formula: see text]=0.58, 95% CI 0.42, 0.81) but not at C2. In shift workers, the CARs after night shifts (i.e. after day sleep) were lower compared to CARs before day shifts ([Formula: see text]= - 11.07, 95% CI - 15.64, - 6.50). This effect was most pronounced in early chronotypes (early: [Formula: see text]= - 16.61, 95% CI - 27.87, - 5.35; intermediate: [Formula: see text]= - 11.82, 95% CI - 18.35, - 5.29; late: [Formula: see text]= - 6.27, 95% CI - 14.28, 1.74). Chronotype did not modify the association between night shift and CAR. In our population of shift workers, there was a mismatch between time of waking up and their natural cortisol peak at waking up (CAR) both during day and night shift duties.
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Affiliation(s)
- Katarzyna Burek
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Sylvia Rabstein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Kantermann
- Institute for Labor and Personnel (IAP), University of Applied Sciences for Economics and Management (FOM), Essen, Germany.,SynOpus, Bochum, Germany
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA.,XIMES GmbH, Vienna, Austria
| | - Markus Rotter
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Rui Wang-Sattler
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Lehnert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dirk Pallapies
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Canuto R, Garcez A, Spritzer PM, Olinto MTA. Associations of perceived stress and salivary cortisol with the snack and fast-food dietary pattern in women shift workers. Stress 2021; 24:763-771. [PMID: 33928826 DOI: 10.1080/10253890.2021.1919615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study aimed to investigate the association of perceived stress and salivary cortisol levels with the snack and fast-food dietary pattern in a sample of women shift workers. We conducted a cross-sectional study of 539 women aged 18-53 years working in the production line of a poultry processing plant. Stress was assessed with the 10-item Perceived Stress Scale (PSS-10) and by salivary cortisol levels (immediately after waking and upon returning home from work). Dietary patterns were identified by principal component analysis. We used linear and Poisson regression models to assess multivariable-adjusted associations of perceived stress and salivary cortisol levels with the snack and fast-food dietary pattern. After adjustments, women with higher PSS-10 scores had a 28% higher probability (95% confidence interval, 1.04-1.56) of consuming snacks/fast food. Mean (SD) waking cortisol levels were inversely associated with quartiles of the dietary pattern: Q1, 6.63 (0.43) nmol/L; Q2, 6.00 (0.38) nmol/L; Q3, 5.62 (0.40) nmol/L; and Q4, 5.29 (0.35) nmol/L (p = 0.019). Perceived stress was not associated with salivary cortisol levels. The work shift was not associated with perceived stress or cortisol levels. This study demonstrated an association of psychological and physiological measures of stress with a dietary pattern characterized by high intakes of hyper-palatable, energy-dense, ready-to-eat foods among women shift workers.
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Affiliation(s)
- Raquel Canuto
- Post-graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Anderson Garcez
- Post-graduate in Nutrition Sciences, Federal University of Health Science of Porto Alegre, UFCSPA, Porto Alegre, Brazil
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, UNISINOS, São Leopoldo, Brazil
| | - Poli Mara Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maria Teresa Anselmo Olinto
- Post-graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos, UNISINOS, São Leopoldo, Brazil
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5
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Cortisol and shiftwork: A scoping review. Sleep Med Rev 2021; 64:101581. [DOI: 10.1016/j.smrv.2021.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
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Nevels TL, Burch JB, Wirth MD, Ginsberg JP, McLain AC, Andrew ME, Allison P, Fekedulegn D, Violanti JM. Shift Work Adaptation Among Police Officers: The BCOPS Study. Chronobiol Int 2021; 38:907-923. [PMID: 33781135 PMCID: PMC8262273 DOI: 10.1080/07420528.2021.1895824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
Few studies have examined shiftwork adaptation among police officers or potential differences in disease biomarkers among adapted and maladapted shiftworkers. This study characterized shiftwork adaptation among 430 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Police officers working fixed night shifts with symptoms characteristic of adaptation and maladaptation were identified using latent class analysis (n = 242). Two approaches were applied, one with police-specific symptoms and another using more general symptoms as shiftwork adaptation indicators. Biomarkers of inflammation, heart rate variability, and cardiometabolic risk were then compared between shiftwork adaptation groups, and with officers working day shifts, after adjusting for confounding. When analyses included police-specific symptoms, maladapted shiftworkers (n = 73) had more self-reported stress, sleep disturbances, fatigue, and less social support than adapted shiftworkers (n = 169). Using more general symptoms, maladapted officers (n = 56) reported more stress and depression, and less social support than adapted officers (n = 186). In police-specific models, adjusted (least-squares) means (± standard error) of circulating interleukin-6 (IL-6) concentrations in maladapted officers (0.8 ± 0.1 ln[pg/ml]) were modestly elevated relative to adapted shiftworkers (0.7 ± 0.1 ln[pg/ml], p = .09) and relative to permanent day workers (0.5 ± 0.1 ln[pg/ml], p ≤ 0.01), and leptin levels in maladapted officers (9.6 ± 0.1 ln[pg/ml]) exceeded those in the adapted (9.4 ± 0.1 ln[pg/ml], p ≤ 0.01) and day shift groups (9.4 ± 0.1 ln[pg/ml], p = .03). In the general model, adjusted mean tumor necrosis factor-alpha (TNF-α) concentrations among maladapted officers (5.6 ± 0.23 pg/ml) exceeded the adapted (4.8 ± 0.2 pg/ml, p ≤ 0.01) and day workers (5.0 ± 0.2 pg/ml, p = .04), and insulin among maladapted officers was higher (2.4 ± 0.1 ln[uu/ml]) than the adapted group (1.8 ± 0.1 ln[uu/ml], p = .03). No differences were observed for the other biomarkers. The results suggest that maladaptation among police officers working fixed night shifts may lead to increases in leptin, insulin, IL-6, and TNF-α; however, the cross-sectional design and possible residual confounding preclude interpretation of cause and effect. Prospective studies are planned to further characterize the relationship between shiftwork maladaptation and biomarkers of chronic disease risk in this police officer cohort.
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Affiliation(s)
- Torrance L. Nevels
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Dorn Research Institute, WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina, USA
- Interservice-Physician Assistant Program, MEDCoE, Joint Base San Antonio-Fort Sam Houston,, Texas, USA
| | - James B. Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Dorn Research Institute, WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina, USA
| | - Michael D. Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - JP Ginsberg
- Dorn Research Institute, WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina, USA
- Department of Pharmacology, Physiology and Neuroscience, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Alexander C. McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Michael E. Andrew
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Penelope Allison
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Desta Fekedulegn
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - John M. Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, the State University of New York, Buffalo, New York, USA
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Holst MM, Wirth MD, Allison P, Burch JB, Andrew ME, Fekedulegn D, Hussey J, Charles LE, Violanti JM. An analysis of shiftwork and self-reported depressive symptoms in a police cohort from Buffalo, New York. Chronobiol Int 2021; 38:830-838. [PMID: 33706643 DOI: 10.1080/07420528.2021.1895197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Shiftwork has been associated with elevated depressive symptoms; police officers frequently work shifts and may experience depressive symptoms. This study assessed the association between depressive symptoms and shiftwork in a police cohort from Buffalo, New York, USA using a repeated cross-sectional design with data collected in 2004-2009 (n = 428) and 2010-2014 (n = 261). Electronic payroll records were used to quantitatively classify officers on the day, evening, or night shift based on the shift they spent most of their working hours. Two self-reported depressive symptomology measures were used as outcomes - the Center for Epidemiological Studies - Depression (CES-D) scale and the Beck Depression Inventory (BDI). Repeated measures linear and logistic regression analyses were used to estimate least squares means or odds, respectively, of depressive symptom questionnaire scores by shiftwork category. Those working the evening/night shift had higher odds for depressive symptoms according to the BDI (based on a cut-point score of 14) than those working the day shift (OR = 4.60, 95% CI = 1.15-18.39). Similar results were observed for the evening shift group. No differences in mean CES-D or BDI scores were observed between groups for short-term shiftwork, long-term shiftwork, or shift changes. After stratifying by stress, as measured by the Perceived Stress Scale (PSS), total Impact of Events (IES), and the Spielberger Police Stress Survey (SPSS), mean values for depressive symptoms were higher in the high-stress categories regardless of shiftwork status. Further research should include biomarkers for depression, a longitudinal study design with a larger cohort, and joint effects of shiftwork and stress on depressive symptoms.
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Affiliation(s)
- Meghan M Holst
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Penelope Allison
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Michael E Andrew
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Desta Fekedulegn
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - James Hussey
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Luenda E Charles
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - John M Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, the State University of New York, Buffalo, NY, USA
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Diurnal Cortisol Variation According to High-Risk Occupational Specialty Within Police: Comparisons Between Frontline, Tactical Officers, and the General Population. J Occup Environ Med 2020; 61:e260-e265. [PMID: 31167225 DOI: 10.1097/jom.0000000000001591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare diurnal salivary cortisol among high-risk occupational police specialties and the general population (n = 18,698). METHODS Tactical and frontline officers provided salivary cortisol samples for 2 days (four times: wake, 30 minutes, 11 hours, and 17 hours post-awakening) and were compared with a general population sample of group field studies utilizing similar methodology. Samples were analyzed for free cortisol concentrations (nmol/L) using chemiluminescence immunoassay. RESULTS Repeated-measures mixed-model analysis of variance (ANOVA) revealed significantly greater salivary diurnal cortisol among tactical than frontline officers. Furthermore, both tactical and frontline officers had higher cortisol levels on average at all time points than the general population sample. CONCLUSION Results suggest that diurnal cortisol response may be associated with level of risk exposure in hazardous occupational subspecialties within policing compared with the general population.
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Giessing L, Oudejans RRD, Hutter V, Plessner H, Strahler J, Frenkel MO. Acute and Chronic Stress in Daily Police Service: A Three-Week N-of-1 Study. Psychoneuroendocrinology 2020; 122:104865. [PMID: 32961407 DOI: 10.1016/j.psyneuen.2020.104865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 01/14/2023]
Abstract
On duty, police officers are exposed to a variety of acute, threatening stress situations and organizational demands. In line with the allostatic load model, the resulting acute and chronic stress might have tremendous consequences for police officers' work performance and psychological and physical health. To date, limited research has been conducted into the underlying biological, dynamic mechanisms of stress in police service. Therefore, this ecological momentary assessment study examined the associations of stress, mood and biological stress markers of a 28-year-old male police officer in a N-of-1 study over three weeks (90 data points). Four times a day (directly after waking up, 30 minutes later, 6 hours later, before going to bed), he answered questions about the perceived stress and mood using a smartphone application. With each data entry, he collected saliva samples for the later assessment of salivary cortisol (sCort) and alpha-amylase (sAA). In addition, data was collected after six police incidents during duty. sCort and sAA were not related to perceived stress in daily life and did not increase in police incidents. Regarding mood measures, deterioration of calmness, but not valence and energy was associated with perceived stress. The results suggest continued police service to constitute a major chronic stressor resulting in an inability to mount a proper response to further acute stress. As an indicator of allostatic load, psychological and biological hyporesponsivity in moments of stress may have negative consequences for police officers' health and behavior in critical situations that require optimal performance. Prospectively, this research design may also become relevant when evaluating the efficacy of individualized stress management interventions in police training.
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Affiliation(s)
- Laura Giessing
- Institute for Sport and Sport Sciences, Heidelberg University, Germany.
| | - Raôul R D Oudejans
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Institute for Brain and Behaviour Amsterdam, the Netherlands; Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, the Netherlands
| | - Vana Hutter
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Institute for Brain and Behaviour Amsterdam, the Netherlands
| | - Henning Plessner
- Institute for Sport and Sport Sciences, Heidelberg University, Germany
| | - Jana Strahler
- Faculty of Psychology and Sport Science, Justus-Liebig University, Gießen, Germany
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Subclinical Markers of Cardiovascular Disease Among Police Officers: A Longitudinal Assessment of the Cortisol Awakening Response and Flow Mediated Artery Dilation. J Occup Environ Med 2019; 60:853-859. [PMID: 29787400 DOI: 10.1097/jom.0000000000001358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the association of the cortisol awakening response (CAR) with change in brachial artery flow-mediated dilation (FMD%) in police officers over a 7-year period. METHODS Baseline CAR was obtained from four saliva samples taken 15 minutes apart immediately after awakening. Analysis of covariance was used to compare the change in FMD% (FMD%Follow-up-FMD%Baseline) across tertiles of area under the cortisol curve with respect to increase (AUCI). Regression analysis was use to assess trend. RESULTS Officers (n = 172; 81% men) had a mean ± SD age of 41 ± 7.6 years. Men in the lowest AUCI tertile (ie, atypical waking cortisol pattern) had a significantly larger 7-year mean decline in FMD% (mean ± SE: -2.56 ± 0.64) compared with men in the highest tertile (-0.89 ± 0.69) (P = 0.0087). CONCLUSIONS An awakening cortisol AUCI predicted worsening of FMD% approximately 7 years later among male officers.
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Holst MM, Wirth MD, Mnatsakanova A, Burch JB, Charles LE, Tinney-Zara C, Fekedulegn D, Andrew ME, Hartley TA, Violanti JM. Shiftwork and Biomarkers of Subclinical Cardiovascular Disease: The BCOPS Study. J Occup Environ Med 2019; 61:391-396. [PMID: 30649009 PMCID: PMC6610651 DOI: 10.1097/jom.0000000000001541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association of shiftwork with biomarkers of subclinical cardiovascular disease and examine the moderating role of body mass index (BMI) in a police cohort. METHODS A cross-sectional analysis was conducted among officers who were categorized as working the day, evening, or night shift. Comparisons with inflammatory biomarkers were performed among shifts using analysis of variance/covariance and further stratified by BMI to assess potential effect modification. RESULTS Associations were observed between day and night shiftworkers for leukocytes, tumor necrosis factor alpha, and homocysteine. After BMI stratification, higher c-reactive protein (CRP) levels were observed among evening shiftworkers with a BMI more than or equal to 30 kg/m versus the day shift. CONCLUSIONS Future studies examining prospective changes in these markers will allow for more comprehensive evaluation of their association with shiftwork.
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Affiliation(s)
- Meghan M. Holst
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael D. Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Anna Mnatsakanova
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - James B. Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
- WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Luenda E. Charles
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Cathy Tinney-Zara
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Desta Fekedulegn
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Michael E. Andrew
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Tara A. Hartley
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - John M. Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, The State University of New York, Buffalo, NY, USA
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Wagner Robb S, Haslam A, Wirth M, Gay J, Middleton L, Healy M, Hebert J. Relationship between Meditation and Waking Salivary Cortisol Secretion among Long-Term MBSR Instructors. Complement Med Res 2019; 26:101-109. [DOI: 10.1159/000493124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/17/2018] [Indexed: 11/19/2022]
Abstract
Background: A potential relationship between long-term meditation practice and stress reduction remains virtually unexplored. The purpose of this study was to characterize stress using salivary waking cortisol in a group of long-term meditators with training in the Mindfulness-Based Stress Reduction (MBSR) program. Materials and Methods: Four salivary cortisol samples were collected from meditators (n = 84) during the first hour of awakening. The waking cortisol rhythm was summarized using cortisol area under the curve (AUC) with respect to increased secretion above baseline (AUCI) and cortisol AUC above ground (above zero, AUCG); data on meditation duration and depth, perceived stress, and other covariates were collected via self-reported questionnaire. Results: Individuals in the highest quartile of years meditating (> 26 years) had statistically significantly elevated AUCG values (p = 0.01) as compared to individuals in the lowest quartile of years meditating (≤10 years). This relationship was more pronounced among individuals waking at or before 6: 30 a.m. Conclusions: Overall, an increasing number of years of meditation practice was related to a higher waking cortisol response. These intriguing findings warrant additional exploration, as the stress response can be complex.
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Kaplan JB, Christopher M, Bowen S. DISPOSITIONAL MINDFULNESS MODERATES THE RELATIONSHIP BETWEEN OCCUPATIONAL STRESSORS AND PERCEIVED STRESS AMONG LAW ENFORCEMENT PERSONNEL. JOURNAL OF POLICE AND CRIMINAL PSYCHOLOGY 2018; 33:227-232. [PMID: 34257476 PMCID: PMC8274578 DOI: 10.1007/s11896-017-9246-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Law enforcement personnel (LEPs) experience occupational stressors that can result in poor health outcomes and have a negative impact on the communities they serve. Dispositional mindfulness, or receptive awareness and attention to present moment experience, has been shown to negatively predict perceived stress and to moderate the relationship between stressors and negative stress-related outcomes. The current study is an investigation of the moderating role of specific facets of dispositional mindfulness (i.e., nonreactivity, nonjudging, and acting with awareness) in the relationship between occupational stressors and perceived stress in a sample of LEPs. As hypothesized, nonreactivity significantly moderated the relationship between operational stressors and perceived stress, such that LEPs low in nonreactivity exhibited a significant relationship between stressors and perceived stress, whereas those high in nonreactivity did not. Nonjudging also moderated the relationship between organizational stressors and perceived stress; however, unexpectedly, LEPs high in nonjudging evidenced a significant relationship between stressors and perceived stress, whereas those low in nonjudging did not. Potential implications of these findings for LEP stress reduction interventions are discussed.
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Chang WP. Influence of shift type on sleep quality of female nurses working monthly rotating shifts with cortisol awakening response as mediating variable. Chronobiol Int 2018; 35:1503-1512. [DOI: 10.1080/07420528.2018.1493491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Wen-Pei Chang
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Diurnal and Reactivity Measures of Cortisol in Response to Intensive Resilience and Tactical Training Among Special Forces Police. J Occup Environ Med 2018; 58:e242-8. [PMID: 27218280 DOI: 10.1097/jom.0000000000000756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Special Forces Police are called to the most dangerous situations that require skills and equipment beyond the training available to a patrol officer. We recruited a platoon of special forces (n = 18) and examined their basal and reactivity levels of cortisol in relation to occupational duties. Moreover, we measured the impact of a multiday program of intensive resilience and tactical training in improving cortisol responses to stressful situations. Participants were significantly more likely to exhibit basal cortisol levels higher than the civilian norms across all of the 5 days of intensive training. However, anticipatory cortisol, measured directly before exposure to critical incident scenarios, was significantly lower in Day 5 than in Day 1 of the training period. This study demonstrates that measuring cortisol is an objective method of examining training effects and possible long-term occupational health outcomes.
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Abstract
OBJECTIVE To investigate associations between shiftwork and diurnal salivary cortisol among 319 police officers (77.7% men). METHODS Information on shiftwork was obtained from the City of Buffalo, NY electronic payroll records. Saliva was collected using Salivettes at seven time points and analyzed for free cortisol concentrations (nmol/L) using a chemiluminescence immunoassay. Mean slopes and areas under the curve were compared across shift schedule using analysis of variance (ANOVA)/analysis of covariance (ANCOVA). RESULTS Officers working primarily on the night shift had a significantly shallower slope. Mean slope (nmol/L/minutes) of the cortisol curve varied significantly across shifts (day: -0.00332 ± 0.00017, afternoon: -0.00313 ± 0.00018, night: -0.00257 ± 0.0002); adjusted P = 0.023. CONCLUSIONS Our results suggest that night shiftwork is a workplace factor that may alter the response of the hypothalamic-pituitary-adrenal (HPA) axis to the circadian cues responsible for the pattern of the diurnal cortisol curve.
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Violanti JM, Owens SL, Fekedulegn D, Ma CC, Charles LE, Andrew ME. An Exploration of Shift Work, Fatigue, and Gender Among Police Officers: The BCOPS Study. Workplace Health Saf 2018; 66:530-537. [PMID: 29480763 DOI: 10.1177/2165079918754586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study examined the association between shift work and fatigue among male ( n = 230) and female ( n = 78) police officers. A 15-year work history database was used to define dominant shifts as day, afternoon, or night. A 10-item questionnaire created from the Standard Shiftwork Index (SSI) assessed fatigue. Gender-stratified analyses of variance and covariance and Poisson regression were used to compare means and prevalence of individual items across shifts. No significant differences in total fatigue scores were observed across shifts. However, the prevalence of the fatigue item "feelings of tiredness" was 89% higher among male officers working the afternoon shift compared with officers working the day shift (prevalence ratio [PR] = 1.89, 95% confidence interval [CI] = [1.12, 3.23], p = .020), after adjustment for covariates. Women reported a lower prevalence of tiredness than men on the afternoon shift. Organizations with afternoon shift workers should consider reducing fatigue at work through education and other methods.
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Affiliation(s)
| | | | - Desta Fekedulegn
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Claudia C Ma
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Luenda E Charles
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Michael E Andrew
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
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Simultaneous measurement of salivary cortisol and alpha-amylase: Application and recommendations. Neurosci Biobehav Rev 2017; 83:657-677. [DOI: 10.1016/j.neubiorev.2017.08.015] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/16/2017] [Accepted: 08/21/2017] [Indexed: 01/20/2023]
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Havakuk O, Zukerman N, Flint N, Sadeh B, Margolis G, Konigstein M, Keren G, Aviram G, Shmilovich H. Shift Work and the Risk of Coronary Artery Disease: A Cardiac Computed Tomography Angiography Study. Cardiology 2017; 139:11-16. [PMID: 29130963 DOI: 10.1159/000481088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022]
Abstract
AIMS Shift work disrupts the normal circadian rhythm and is associated with risk factors for coronary artery disease (CAD) and a higher incidence of CAD morbidity and mortality. Cardiac computed tomography angiography (CCTA) is a robust noninvasive modality for assessing the presence, extent, and severity of CAD. We sought to investigate whether shift workers are prone to a higher burden of CAD compared to non-shift workers. METHODS We conducted a historically prospective study in consecutive patients who underwent CCTA and answered a telephonic questionnaire. Due to significant differences in age and gender, we compared 89 well-matched pairs of shift workers and non-shift workers with the use of propensity scores. RESULTS Our cohort consisted of 349 participants, of whom 94 (26.9%) were shift workers. The mean age was 50.7 years, and 62.5% were males. After pairing, we showed that shift workers had a higher prevalence of CAD than non-shift workers (74.2 vs. 53.9%, respectively, p = 0.01), and a lower prevalence of coronary calcium scores of zero (46.8 vs. 63.4%, respectively, p = 0.034). Stenosis >50% was more prevalent in shift workers than in non-shift workers (20.2 vs. 11.2%, respectively, p = 0.006), and the extent of CAD (defined as the presence of ≥1-vessel disease) tended to be higher in shift workers than in non-shift workers (25.8 vs. 13.5%, respectively, p = 0.06). CONCLUSIONS In this CCTA study, we showed in a well-matched cohort of consecutive patients that shift workers had a higher prevalence and extent of CAD than non-shift workers.
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Affiliation(s)
- Ofer Havakuk
- Department of Cardiology, Tel Aviv Medical Center, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Boggero IA, Hostinar CE, Haak EA, Murphy MLM, Segerstrom SC. Psychosocial functioning and the cortisol awakening response: Meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies. Biol Psychol 2017; 129:207-230. [PMID: 28870447 DOI: 10.1016/j.biopsycho.2017.08.058] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/05/2017] [Accepted: 08/29/2017] [Indexed: 01/13/2023]
Abstract
Cortisol levels rise immediately after awakening and peak approximately 30-45min thereafter. Psychosocial functioning influences this cortisol awakening response (CAR), but there is considerable heterogeneity in the literature. The current study used p-curve and meta-analysis on 709 findings from 212 studies to test the evidential value and estimate effect sizes of four sets of findings: those associating worse psychosocial functioning with higher or lower cortisol increase relative to the waking period (CARi) and to the output of the waking period (AUCw). All four sets of findings demonstrated evidential value. Psychosocial predictors explained 1%-3.6% of variance in CARi and AUCw responses. Based on these effect sizes, cross-sectional studies assessing CAR would need a minimum sample size of 617-783 to detect true effects with 80% power. Depression was linked to higher AUCw and posttraumatic stress to lower AUCw, whereas inconclusive results were obtained for predictor-specific effects on CARi. Suggestions for future CAR research are discussed.
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Affiliation(s)
- Ian A Boggero
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY 40506, United States.
| | - Camelia E Hostinar
- Department of Psychology, University of California, Davis, 103 Young Hall, Davis, CA 95616, United States.
| | - Eric A Haak
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY 40506, United States.
| | - Michael L M Murphy
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, United States.
| | - Suzanne C Segerstrom
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY 40506, United States.
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Wirth MD, Andrew ME, Burchfiel CM, Burch JB, Fekedulegn D, Hartley TA, Charles LE, Violanti JM. Association of shiftwork and immune cells among police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. Chronobiol Int 2017; 34:721-731. [PMID: 28488901 DOI: 10.1080/07420528.2017.1316732] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Shift workers suffer from a constellation of symptoms associated with disruption of circadian rhythms including sleep abnormalities, and abnormal hormone secretion (e.g. melatonin, cortisol). Recent, but limited, evidence suggests that shift workers have elevated levels of circulating white blood cells (WBCs) compared to their day working counterparts. Interestingly, recent reviews highlight the strong linkage between the immune system and circadian rhythms which includes, but is not limited to, circulating cell populations and functions. The elevated levels of these WBCs may be associated with the increased chronic disease risk observed among this group. The purpose of this analysis was to examine the cross-sectional association between long- and short-term (3, 5, 7, and 14 days) shiftwork (SW) and counts of WBCs among officers in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) cohort. Data collection for this analysis took place among 464 police officers working in Buffalo, New York, USA between 2004 and 2009. Precise SW histories were obtained using electronic payroll records. Officers were assigned a shift type based on the shift (i.e. day, evening, night) that they spent a majority (i.e. ≥50%) of their time from 1994 to the data collection date for long-term SW. The same process was applied to SW over 3, 5, 7, and 14 days prior to data collection. A fasted blood sample collected in the morning of a non-work day was used for characterization of WBCs (total), neutrophils, monocytes, lymphocytes, eosinophils, and basophils. Potential confounding factors included demographic characteristics (e.g. age, sex, race), occupational characteristics (e.g. rank), health behaviors (e.g. smoking, alcohol consumption, diet), anthropometrics, and other biomarkers (e.g. lipids, hemoglobin A1C, leptin). Generalized linear models were used to estimate least square means of the immune cells according to SW categorization for long- and short-term SW histories. Compared to the day shift group, those working long-term night shifts had greater absolute numbers of total WBCs, neutrophils, lymphocytes, and monocytes (all p < 0.05). Those working mainly on the night shift over 7-days had elevated counts of WBCs, lymphocytes, and monocytes (p < 0.05) compared to those mainly working day shifts. Results based on 3-, 5-, and 14-day SW were similar to the 7-day results. This study corroborates other studies with similar findings. However, this analysis provided insights into the effect of both long- and short-term SW on the number of circulating WBCs. SW may lead to disruption of circadian-influenced components of the immune system, which in term, may result in various chronic diseases. These findings, plus previous findings, may provide evidence that SW may lead to immune system dysregulation. Future research is needed to understand whether increases in immune cells among shift workers may be associated with the increased disease risk among this group.
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Affiliation(s)
- Michael D Wirth
- a Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,b Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,c Connecting Health Innovations , Columbia , SC , USA
| | - Michael E Andrew
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - Cecil M Burchfiel
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - James B Burch
- a Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,b Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.,e WJB Dorn VA Medical Center , Columbia , SC , USA
| | - Desta Fekedulegn
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - Tara A Hartley
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - Luenda E Charles
- d Biostatistics and Epidemiology Branch, Health Effects Laboratory Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , WV , USA
| | - John M Violanti
- f Department of Epidemiology and Environmental Health, School of Public Health and Health Professions , University of Buffalo, The State University of New York , Buffalo , New York , USA
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The Impact of Shiftwork on Skeletal Muscle Health. Nutrients 2017; 9:nu9030248. [PMID: 28282858 PMCID: PMC5372911 DOI: 10.3390/nu9030248] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/26/2017] [Accepted: 03/03/2017] [Indexed: 01/11/2023] Open
Abstract
(1) Background: About one in four workers undertake shift rosters that fall outside the traditional 7 a.m.-6 p.m. scheduling. Shiftwork alters workers' exposure to natural and artificial light, sleep patterns, and feeding patterns. When compared to the rest of the working population, shiftworkers are at a greater risk of developing metabolic impairments over time. One fundamental component of metabolic health is skeletal muscle, the largest organ in the body. However, cause-and-effect relationships between shiftwork and skeletal muscle health have not been established; (2) Methods: A critical review of the literature was completed using online databases and reference lists; (3) Results: We propose a conceptual model drawing relationships between typical shiftwork consequences; altered light exposure, sleep patterns, and food and beverage consumption, and drivers of skeletal muscle health-protein intake, resistance training, and hormone release. At present, there is no study investigating the direct effect of shiftwork on skeletal muscle health. Instead, research findings showing that acute consequences of shiftwork negatively influence skeletal muscle homeostasis support the validity of our model; (4) Conclusion: Further research is required to test the potential relationships identified in our review, particularly in shiftwork populations. Part of this testing could include skeletal muscle specific interventions such as targeted protein intake and/or resistance-training.
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Association of a dietary inflammatory index with inflammatory indices and metabolic syndrome among police officers. J Occup Environ Med 2015; 56:986-9. [PMID: 25046320 DOI: 10.1097/jom.0000000000000213] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether the dietary inflammatory index (DII) is associated with inflammatory or metabolic biomarkers and metabolic syndrome (MetSyn) among police officers. METHODS Cross-sectional data from the Buffalo Cardio-Metabolic Occupational Police Stress study were derived from saliva and fasting blood samples, anthropometric measurements, long-term shiftwork histories, and demographic, stress/depression, and food frequency questionnaires (FFQs). Metabolic syndrome was defined using standard criteria. RESULTS Officers in DII quartiles 2 to 4 were more likely to exceed a threshold of 3.0 mg/L for C-reactive protein (odds ratio [OR] = 1.88; 95% confidence interval [95% CI] = 1.02 to 3.45; OR = 2.17; 95% CI = 1.19 to 3.95; OR = 1.57; 95% CI = 0.85 to 2.88, respectively) compared with quartile 1. The glucose intolerance component of MetSyn was more prevalent among officers in DII quartile 4 than among those in quartile 1 (OR = 2.03; 95% CI = 1.08 to 3.82). CONCLUSIONS A pro-inflammatory diet was associated with elevated CRP and with the glucose intolerance component of MetSyn.
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Abstract
OBJECTIVE Shift workers are affected by diet- and inflammation-related diseases, including cardiovascular disease, diabetes, and cancer. We examined a dietary inflammatory index (DII) in relation to shift work from the National Health and Nutrition Examination Survey data (2005 to 2010). METHODS The DII was calculated using data from a 24-hour dietary recall. Shift work categories included day workers, evening/night shift workers, or rotating shift workers. General linear models were fit to examine the relationship between shift work and adjusted mean DII values. RESULTS Among all shift workers and specifically rotating shift workers, higher (ie, more pro-inflammatory) mean DII scores (1.01 and 1.07 vs 0.86; both P ≤ 0.01) were observed compared with day workers. Women tended to express strong evening/night shift effects. CONCLUSIONS More proinflammatory diets observed among shift workers may partially explain increased inflammation-related chronic disease risk observed in other studies among shift workers compared with their day-working counterparts.
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Krajnak KM. Potential Contribution of Work-Related Psychosocial Stress to the Development of Cardiovascular Disease and Type II Diabetes: A Brief Review. ENVIRONMENTAL HEALTH INSIGHTS 2014; 8:41-5. [PMID: 25525370 PMCID: PMC4251185 DOI: 10.4137/ehi.s15263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 05/20/2023]
Abstract
Two of the major causes of death worldwide are cardiovascular disease and Type II diabetes. Although death due to these diseases is assessed separately, the physiological process that is attributed to the development of cardiovascular disease can be linked to the development of Type II diabetes and the impact that this disease has on the cardiovascular system. Physiological, genetic, and personal factors contribute to the development of both these disorders. It has also been hypothesized that work-related stress may contribute to the development of Type II diabetes and cardiovascular disease. This review summarizes some of the studies examining the role of work-related stress on the development of these chronic disorders. Because women may be more susceptible to the physiological effects of work-related stress, the papers cited in this review focus on studies that examined the difference in responses of men or women to work-related stress or on studies that focused on the effects of stress on women alone. Based on the papers summarized, it is concluded that (1) work-related stress may directly contribute to the development of cardiovascular disease by inducing increases in blood pressure and changes in heart rate that have negative consequences on functioning of the cardiovascular system; (2) workers reporting increased levels of stress may display an increased risk of Type II diabetes because they adopt poor health habits (ie, increased level of smoking, inactivity etc), which in turn contribute to the development of cardiovascular problems; and (3) women in high demand and low-control occupations report an increased level of stress at work, and thus may be at a greater risk of negative health consequences.
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Duan H, Yuan Y, Zhang L, Qin S, Zhang K, Buchanan TW, Wu J. Chronic stress exposure decreases the cortisol awakening response in healthy young men. Stress 2013; 16:630-7. [PMID: 23992539 DOI: 10.3109/10253890.2013.840579] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Academic examination is a major stressor for students in China. Investigation of stress-sensitive endocrine responses to major examination stress serves as a good model of naturalistic chronic psychological stress in an otherwise healthy population. The cortisol awakening response (CAR) is an endocrine marker of the hypothalamic-pituitary-adrenocortical (HPA) axis in response to stress. However, it remains unknown how chronic examination stress impacts the CAR in a young healthy population To exclude the influence of sex effects on hormone level, the CAR and psychological stress responses were assessed on two consecutive workdays in 42 male participants during their preparations for the Chinese National Postgraduate Entrance Exam (NPEE) and 21 non-exam, age-matched male comparisons. On each day, four saliva samples were collected immediately after awakening, 15 minutes, 30 minutes and 60 minutes after awakening. The waking level (S1), the increase within 30 minutes after awakening (R30), the area under the curve with respect to ground (AUCg), and the area under the curve with respect to increase (AUCi) were used to quantify the CAR. Psychological stress and anxiety were assessed by the Perceived Stress Scale and the Spielberger State-Trait Anxiety Inventory, respectively. Male participants in the exam group had greater perceived stress and anxiety scores relatibe to the non-exam group. Both R30 and AUCi in the exam group were significantly lower than the comparison group and this effect was most pronounced for participants with high levels of perceived stress in the exam group. Perceived stress and anxiety levels were negatively correlated with both R30 and AUCi. Chronic examination stress can lead to the decrease of CAR in healthy young men, possibly due to reduced HPA axis activity under long-term sustained stress.
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Affiliation(s)
- Hongxia Duan
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences , Beijing , China
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Abstract
OBJECTIVE To investigate the associations between long work hours and adiposity measures in police officers. METHODS Participants included 408 officers from the Buffalo Cardio-Metabolic Occupational Police Stress study who were examined between 2004 and 2009. Total work hours were abstracted from payroll records and questionnaires. Analysis of variance and covariance models were used. RESULTS Among male officers who worked the midnight shift, mean values of waist circumference and body mass index increased with longer work hours after adjustment for age, physical activity, energy intake, sleep duration, smoking status, police rank, activities after work (eg, child/family care, sports), and household income. Adiposity measures were not associated with work hours among women on any shift. CONCLUSION Working longer hours was significantly associated with larger waist circumferences and higher body mass index among male police officers working the midnight shift.
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Mirick DK, Bhatti P, Chen C, Nordt F, Stanczyk FZ, Davis S. Night shift work and levels of 6-sulfatoxymelatonin and cortisol in men. Cancer Epidemiol Biomarkers Prev 2013; 22:1079-87. [PMID: 23563887 DOI: 10.1158/1055-9965.epi-12-1377] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Night shift work is associated with cancer among men, but the biologic mechanism is unclear. We investigated whether male night shift workers showed changes in levels of melatonin and cortisol, potential biomarkers of cancer risk. METHODS Urine was collected from 185 night shift and 158 day shift-working male healthcare providers, aged 22 to 55 years, throughout work and sleep periods, and assayed for 6-sulfatoxymelatonin and cortisol. Morning serum was collected within 90 minutes of completing the night and assayed for cortisol. RESULTS Night shift workers had significantly lower 6-sulfatoxymelatonin levels during daytime sleep, nighttime work, and nighttime sleep on off-nights (57%, 62%, and 40% lower, respectively), relative to the day shift workers during nighttime sleep (P < 0.0001); urinary cortisol in night shift workers was 16% higher during daytime sleep and 13% lower during nighttime sleep on off-nights (P < 0.05). Morning serum cortisol post-work and post-sleep in night shift workers were 24% and 43% lower, respectively, than post-sleep levels among day shift workers (P < 0.0001). Within-subject comparisons among the night shift workers revealed significantly lower melatonin levels and significantly higher urinary cortisol levels during daytime sleep and nighttime work, relative to nighttime sleep (P < 0.01); morning serum cortisol levels post-work were lower than those post-sleep. CONCLUSIONS Night shift workers have substantially lower 6-sulfatoxymelatonin during night work and daytime sleep, and levels remain low when night shift workers sleep at night. Chronic reduction in melatonin among night shift workers may be an important carcinogenic mechanism. Cortisol secretion patterns may be impacted by night shift work, which could affect cancer risk. IMPACT Shift work could be an important risk factor for many types of cancer.
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Affiliation(s)
- Dana K Mirick
- Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4-A830, P.O. Box 19024, Seattle, WA 98109, USA.
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Wirth M, Vena JE, Smith EK, Bauer SE, Violanti J, Burch J. The epidemiology of cancer among police officers. Am J Ind Med 2013; 56:439-53. [PMID: 23255299 PMCID: PMC3655699 DOI: 10.1002/ajim.22145] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND This review summarizes peer-reviewed studies examining cancer risks among police officers. It provides an overview of existing research limitations and uncertainties and the plausible etiologic risk factors associated with cancer in this understudied occupation. METHODS Previous cancer studies among police officers were obtained via a systematic review of the MEDLINE, CABDirect, and Web of Science bibliographic databases. RESULTS Quality observational studies of cancer among police officers are sparse and subject to limitations in exposure assessment and other methods. Results from three studies suggested possible increased mortality risks for all cancers, and cancers of the colon, kidney, digestive system, esophagus, male breast, and testis, as well as Hodgkin's disease. Few incidence studies have been performed, and results have been mixed, although some associations with police work have been observed for thyroid, skin, and male breast cancer. CONCLUSIONS Police are exposed to a mix of known or suspected agents or activities that increase cancer risk. Epidemiologic evidence to date is sparse and inconsistent. There is a critical need for more research to understand the biological and social processes underlying exposures and the suggested disproportionate risks and to identify effective prevention strategies.
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Affiliation(s)
- Michael Wirth
- South Carolina Statewide Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - John E. Vena
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
- Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Emily K. Smith
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Sarah E. Bauer
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - John Violanti
- Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, New York
| | - James Burch
- South Carolina Statewide Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
- Dorn Department of Veteran’s Affairs Medical Center, Columbia, South Carolina
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Golombek DA, Casiraghi LP, Agostino PV, Paladino N, Duhart JM, Plano SA, Chiesa JJ. The times they're a-changing: effects of circadian desynchronization on physiology and disease. ACTA ACUST UNITED AC 2013; 107:310-22. [PMID: 23545147 DOI: 10.1016/j.jphysparis.2013.03.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Circadian rhythms are endogenous and need to be continuously entrained (synchronized) with the environment. Entrainment includes both coupling internal oscillators to external periodic changes as well as synchrony between the central clock and peripheral oscillators, which have been shown to exhibit different phases and resynchronization speed. Temporal desynchronization induces diverse physiological alterations that ultimately decrease quality of life and induces pathological situations. Indeed, there is a considerable amount of evidence regarding the deleterious effect of circadian dysfunction on overall health or on disease onset and progression, both in human studies and in animal models. In this review we discuss the general features of circadian entrainment and introduce diverse experimental models of desynchronization. In addition, we focus on metabolic, immune and cognitive alterations under situations of acute or chronic circadian desynchronization, as exemplified by jet-lag and shiftwork schedules. Moreover, such situations might lead to an enhanced susceptibility to diverse cancer types. Possible interventions (including light exposure, scheduled timing for meals and use of chronobiotics) are also discussed.
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Affiliation(s)
- Diego A Golombek
- Laboratory of Chronobiology, National University of Quilmes/CONICET, Buenos Aires, Argentina.
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Fu L, Kettner NM. The circadian clock in cancer development and therapy. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2013; 119:221-82. [PMID: 23899600 PMCID: PMC4103166 DOI: 10.1016/b978-0-12-396971-2.00009-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Most aspects of mammalian function display circadian rhythms driven by an endogenous clock. The circadian clock is operated by genes and comprises a central clock in the brain that responds to environmental cues and controls subordinate clocks in peripheral tissues via circadian output pathways. The central and peripheral clocks coordinately generate rhythmic gene expression in a tissue-specific manner in vivo to couple diverse physiological and behavioral processes to periodic changes in the environment. However, with the industrialization of the world, activities that disrupt endogenous homeostasis with external circadian cues have increased. This change in lifestyle has been linked to an increased risk of diseases in all aspects of human health, including cancer. Studies in humans and animal models have revealed that cancer development in vivo is closely associated with the loss of circadian homeostasis in energy balance, immune function, and aging, which are supported by cellular functions important for tumor suppression including cell proliferation, senescence, metabolism, and DNA damage response. The clock controls these cellular functions both locally in cells of peripheral tissues and at the organismal level via extracellular signaling. Thus, the hierarchical mammalian circadian clock provides a unique system to study carcinogenesis as a deregulated physiological process in vivo. The asynchrony between host and malignant tissues in cell proliferation and metabolism also provides new and exciting options for novel anticancer therapies.
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Affiliation(s)
- Loning Fu
- Department of Pediatrics/U.S. Department of Agriculture/Agricultural Research Service/Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Nicole M. Kettner
- Department of Pediatrics/U.S. Department of Agriculture/Agricultural Research Service/Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
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Wirth M, Burch J, Violanti J, Burchfiel C, Fekedulegn D, Andrew M, Zhang H, Miller DB, Youngstedt SD, Hébert JR, Vena JE. Association of the Period3 clock gene length polymorphism with salivary cortisol secretion among police officers. NEURO ENDOCRINOLOGY LETTERS 2013; 34:27-37. [PMID: 23524621 PMCID: PMC3655703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study evaluated whether measures of waking or diurnal cortisol secretion, or self-reported psychological disturbances differed among police officers with a Period3 (PER3) clock gene length polymorphism. METHODS The cortisol awakening response was characterized via the area under the salivary cortisol curve with respect to the increase (AUCI) or total waking cortisol (AUCG). Diurnal cortisol measures included the slope of diurnal cortisol and the diurnal AUCG. Psychological disturbances were characterized using the Center for Epidemiologic Studies Depression Scale, Impact of Events Scale, and Life Events Scale. RESULTS Officers with a 4/5 or 5/5 genotype had higher awakening AUCG and greater diurnal cortisol AUCG levels compared to officers with the 4/4 genotype. Among those working more afternoon or night shifts, waking AUCI and AUCG were greater among officers with a 4/5 or 5/5 genotype compared to the 4/4 referents. CONCLUSION Cortisol secretion was modified among police officers with different PER3 VNTR clock gene variants.
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Affiliation(s)
- Michael Wirth
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
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Ji BT, Gao YT, Shu XO, Yang G, Yu K, Xue SZ, Li HL, Liao LM, Blair A, Rothman N, Zheng W, Chow WH. Nightshift work job exposure matrices and urinary 6-sulfatoxymelatonin levels among healthy Chinese women. Scand J Work Environ Health 2012; 38:553-9. [PMID: 22975884 PMCID: PMC4290163 DOI: 10.5271/sjweh.3322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Six-sulfatoxymelatonin (aMT6s) is a primary urinary metabolite of melatonin. We examined the association between aMT6s levels and shift work estimated by a job exposure matrix (JEM) among healthy participants of the Shanghai Women's Health Study. METHODS Creatinine-adjusted aMT6s levels were measured in the urine samples of 300 women and related to JEM shift work categories. RESULTS Adjusted geometric means of aMT6s levels from urine samples collected before 08:00 hours were lower among persons holding nighttime shift work jobs. The adjusted aMT6s levels (ng/mg creatinine) were 8.36 [95% confidence intervals (95% CI) 4.47-15.6], 6.37 (95% CI 3.53-11.5), 6.20 (95% CI 3.33-11.5), 3.81 (95% CI 2.02-7.19), and 3.70 (95% CI 1.92-7.11) from the lowest (never held a shift work job) to the highest (current job likely involved all-night shift work) shift work JEM scores (P=0.05). CONCLUSION Our results indicate that nightshift work JEM scores were significantly and inversely associated with aMT6s levels in early morning spot urine samples collected between 07:00-08:00 hours.
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Affiliation(s)
- Bu-Tian Ji
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
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Fekedulegn D, Burchfiel CM, Violanti JM, Hartley TA, Charles LE, Andrew ME, Miller DB. Associations of long-term shift work with waking salivary cortisol concentration and patterns among police officers. INDUSTRIAL HEALTH 2012; 50:476-486. [PMID: 23047078 PMCID: PMC4685453 DOI: 10.2486/indhealth.2012-0043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this study was to evaluate whether long-term shift work is associated with both the total hormonal secretion after awakening and the pattern of the cortisol levels during the first hour following awakening, among 65 randomly selected police officers who represent a high stress occupation. Dominant shift (Day, Afternoon, or Midnight) was ascertained using daily payroll records of each participant's work activities during the 6-8 yrs prior to saliva sampling. Four salivary samples were collected at 15 min intervals upon first awakening. After accounting for potential confounders, salivary cortisol concentrations averaged across all four time points and total area under the curve differed significantly across shift with midnight shift workers showing suppressed awakening cortisol response relative to the afternoon and day shift. The percent of hours worked on midnight shift was inversely correlated with total awakening cortisol output. In contrast, the pattern of cortisol secretion during the first hour following waking appeared not to be affected as no significant interaction effect was found between time since awakening and shift work. The results show that long-term midnight shift work is associated with decreased absolute mean level and total volume of cortisol released over the waking period.
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Affiliation(s)
- Desta Fekedulegn
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA.
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Kim KS, Kim YC, Oh IJ, Kim SS, Choi JY, Ahn RS. Association of worse prognosis with an aberrant diurnal cortisol rhythm in patients with advanced lung cancer. Chronobiol Int 2012; 29:1109-20. [PMID: 22889441 DOI: 10.3109/07420528.2012.706767] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A flatter diurnal rhythm of cortisol has been reported to be associated with early mortality in patients with metastatic breast cancer. The clinical stage of disease at the time of diagnosis and the patient's performance status (PS) are known to be important prognostic factors for lung cancer (LC) survival. The authors examined the relationship between diurnal cortisol rhythms and these prognostic factors in patients with advanced LC. Cortisol concentrations were measured in saliva samples collected from 52 patients (37 males/15 females) with advanced LC and from 56 healthy subjects (32 males/24 females) to characterize the diurnal cortisol rhythm, specifically the cortisol awakening response (CAR) and diurnal cortisol decline (DCD). Variations of CAR and DCD in the patients were analyzed according to their clinical disease stage and PS score, and the differences in CAR and DCD between patients and healthy controls were compared. The patient group showed significantly reduced diurnal cortisol secretory activity and rhythmicity, compared with healthy controls. When the patients were subgrouped according to their clinical disease stage, patients with stage 4 disease showed significantly reduced CAR and flatter DCD compared with the healthy controls. However, the CAR and DCD in patients with stage 3a and 3b disease were comparable to those of healthy controls. Neither the CAR nor the DCD showed stepwise changes as the disease stage worsened. When patients were subgrouped according to their Eastern Cooperative Oncology Group (ECOG) PS score, there was stepwise reduction in the CAR and flattening of the DCD as the PS score increased. Both an abolished CAR and a flattened DCD were common in patients with ECOG PS scores of 3 and 4. These results indicate that alteration of the diurnal cortisol rhythm in patients with advanced LC is more closely associated with their PS score than with their clinical disease stage. Gradual alteration of the CAR and DCD, indicative of loss of 24-h cortisol rhythm, in concert with increase in PS score implies that endogenous circadian rhythms may also be disintegrating as the PS score worsens in these patients.
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Affiliation(s)
- Kyu S Kim
- Department of Pulmonology and Critical Care Medicine, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
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Rosenthal T, Alter A. Occupational stress and hypertension. ACTA ACUST UNITED AC 2011; 6:2-22. [PMID: 22024667 DOI: 10.1016/j.jash.2011.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/30/2011] [Accepted: 09/06/2011] [Indexed: 01/19/2023]
Abstract
Occupational stress, or job strain, resulting from a lack of balance between job demands and job control, is considered one of the frequent factors in the etiology of hypertension in modern society. Stress, with its multifactorial causes, is complex and difficult to analyze at the physiological and psychosocial levels. The possible relation between job strain and blood pressure levels has been extensively studied, but the literature is replete with conflicting results regarding the relationship between the two. Further analysis of this relationship, including the many facets of job strain, may lead to operative proposals at the individual and public health levels designed to reduce the effects on health and well-being. In this article, we review the literature on the subject, discussing the various methodologies, confounding variables, and suggested approaches for a healthier work environment.
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Affiliation(s)
- Talma Rosenthal
- Department of Physiology and Pharmacology, Hypertension Research Unit, Sackler School of Medicine, Tel Aviv University, Israel.
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