Occupational Stress Levels among Radiologists and Radiographers in Hungary during the COVID-19 Era

The COVID-19 pandemic has heightened stress levels, potentially affecting the occupational wellbeing of radiographers and radiologists. Our study aimed to assess occupational stress levels within the radiology department and identify contributing factors. A cross-sectional survey was conducted between September and November 2022, with participants comprising radiographers and radiologists affiliated with the Hungarian Society of Radiographers and the Hungarian Society of Radiologists. The online survey collected socio-demographic and COVID-19 data, and the participants completed an effort-reward imbalance questionnaire. The analysis of 406 responses revealed significantly higher effort-reward imbalance (ERI) levels among the radiologists compared to the radiographers (p < 0.05). The healthcare professionals with over 30 years of experience exhibited significantly lower ERI levels than those with 1-9 years, 10-19 years, or 20-29 years of experience (p < 0.05). Additionally, the individuals aged 31-40 demonstrated higher ERI levels compared to their counterparts aged 19-30, 41-50, and over 51 (p < 0.05). The respondents cohabiting with a spouse/partner reported significantly higher stress levels than their single colleagues (p < 0.05), while the dog owners exhibited significantly lower ERI levels (p < 0.05). Elevated occupational stress highlights specific groups requiring targeted interventions to reduce stress and mitigate burnout among radiologists and radiographers.

Burnout and occupational stress among Hungarian radiographers working in emergency and non-emergency departments during COVID-19 pandemic

INTRODUCTION

The increased workload caused by the coronavirus pandemic may have had a significant impact on the mental health of radiographers. The aim of our study was to investigate burnout and occupational stress in radiographers working in emergency departments (ED) and non-emergency departments (NED).

METHODS

Quantitative, cross-sectional, descriptive research was carried out among radiographers working in the public health sector in Hungary. Due to the cross-sectional nature of our survey, there was no overlap between the ED and NED groups. For data collection, we used simultaneously the Maslach Burnout Inventory (MBI), the Effort-Reward Imbalance questionnaire (ERI), and our self-designed questionnaire.

RESULTS

We excluded incomplete questionnaires from our survey; finally, 439 responses were evaluated. Significantly higher scores for depersonalisation (DP; 8.43 (SD = 6.69) vs. 5.63 (SD = 4.21) and emotional exhaustion (EE; 25.07 (SD = 11.41) vs. 19.72 (SD = 11.72)) were observed in radiographers working in ED (p = 0.001; p = 0.001) when compared to NED. Male radiographers working in ED aged 20-29 and 30-39 years with experience of 1-9 years were more affected by DP (p ≤ 0.05). Worrying about one's own health had a negative effect on DP and EE (p ≤ 0.05). Having close friend with a COVID-19 infection had a negative effect on EE (p ≤ 0.05); not being infected with coronavirus, not being quarantined and relocating within the workplace had a positive effect on personal accomplishment (PA); radiographers who were 50 years or older with 20-29 years of experience were more affected by depersonalisation (DP); and those who worried about their health had significantly higher stress scores (p ≤ 0.05) in both ED and NED settings.

CONCLUSION

Male radiographers at the beginning of their careers were more affected by burnout. Employment in EDs had a negative impact on DP and EE.

IMPLICATIONS FOR PRACTICE

Our results support the implementation of interventions to counter the effects of occupational stress and burnout among radiographers working in ED.

How Is Body Composition and Nutrition Status Associated with Erythropoietin Response in Hemodialyzed Patients? A Single-Center Prospective Cohort Study

Background: Anemia is the most common finding in patients with end-stage kidney disease undergoing renal replacement therapy. A certain percentage of patients does not respond adequately to erythropoietin (EPO) treatment, not being able to reach desirable hemoglobin levels even when treated with large-dose EPO and intravenous/oral iron. In our study, we wanted to further investigate how nutritional status is associated with erythropoietin responsiveness. To quantify EPO response, we used the Erythropoietin Resistance Index (ERI), which is defined as the weekly weight-adjusted dose of EPO divided by the hemoglobin level. Patients and methods: Seventy-eight patients undergoing hemodialysis were included. All of them were measured by a SECA mBCA body composition analyzer and evaluated by Kalantar-Zadeh’s MIS score. Routine biochemical tests were also taken into account. The Shapiro-Wilk test was used to study the distributions of quantitative variables, which were significantly different from normal (p < 0.05). We used nonparametric Mann-Whitney U-test to compare groups. Correlations were studied by means of Spearman’s rank correlation coefficient. Bonferroni correction for multiple testing was performed. To find independent determinants of ERI, we additionally performed multivariate analysis using the General Linear Model (GLM). Results: In terms of body composition, factors that are associated with high ERI are low BMI, low fat mass, low visceral fat volume, high total body water percentage, low phase angle and low fat-free mass. In addition to body composition parameters, total MIS score and IL-6 serum levels correlated positively with ERI value. IL-6 was an independent determinant of ERI value, based on multivariate analysis. After correction for multiple analysis, BMI and eGFR both remained significant factors associated with EPO response. Conclusions: It seems crucial to prevent inflammatory malnutrition as a part of a holistic approach to anemia treatment in dialysis patients.

The Gutenberg health study: a five-year prospective analysis of psychosocial working conditions using COPSOQ (Copenhagen psychosocial Questoinnaire) and ERI (effort-reward imbalance)

Background

Psychosocial working conditions were previously analyzed using the first recruitment wave of the Gutenberg Health Study (GHS) cohort (n = 5000). We aimed to confirm the initial analysis using the entire GHS population at baseline (N = 15,010) and at the five-year follow-up. We also aimed to determine the effects of psychosocial working conditions at baseline on self-rated outcomes measured at follow-up.

Methods

At baseline, working GHS participants were assessed with either the Effort-Reward-Imbalance questionnaire (ERI) (n = 4358) or with the Copenhagen Psychosocial Questionnaire (COPSOQ) (n = 4322); participants still working after five years received the same questionnaire again (ERI n = 3142; COPSOQ n = 3091). We analyzed the association between working conditions and the outcomes job satisfaction, general health, burnout, and satisfaction with life at baseline, at follow-up and also prospectively from baseline to follow-up using linear regression models. We examined the outcome variance explained by the models (R²) to estimate the predictive performance of the questionnaires.

Results

The models’ R² was comparable to the original baseline analyses at both t0 and t1 (R² range: ERI 0.10–0.43; COPSOQ 0.10–0.56). However, selected scales of the regression models sometimes changed between assessment times. The prospective analysis showed weaker associations between baseline working conditions and outcomes after five years (R² range: ERI 0.07–0.19; COPSOQ 0.07–0.24). This was particularly true for job satisfaction. After adjusting for the baseline levels of the outcomes, fewer scales still explained some of the variance in the distribution of the outcome variables at follow-up. The models using only data from t₀ or t₁ confirmed the previous baseline analysis. We observed a loss of explained variance in the prospective analysis models. This loss was greatest for job satisfaction, suggesting that this outcome is most influenced by short-term working conditions.

Conclusions

Both the COPSOQ and ERI instruments show good criterion validity and adequately predict contemporaneously measured self-reported measurements of health and (occupational) well-being. However, the COPSOQ provides a more detailed picture of working conditions and might be preferable for improvment strategies in workplaces. Additional prospective research with shorter follow-up times would be beneficial for estimating dose-response relationships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12240-3.

Additive Interaction of Work-Related Stress and Sleep Duration on Arthritis Among Middle-Aged Civil Servants

Aim

Occupational strain is recognized as a risk for arthritis, yet little is known about how psychological stress affects arthritis moderated by sleep duration. The objective of this study is to assess work-related stress using the effort-reward imbalance (ERI) model and the job-demand-support (JDS) model on arthritis moderated by sleep duration.

Methods

A nationwide cross-sectional study randomly collected a total of 11,875 middle-aged, employed civil servants from 647 registered governmental institutions. Each participant anonymously and voluntarily filled out a web-based questionnaire and informed consent at the time of the study. Psychosocial work stress was assessed by ERI and JDS measured by a Chinese version of the job content questionnaire.

Results

There were significant odds ratios (ORs) of arthritis positively associated with high ERI (OR = 1.58), high overcommitment (OC) (OR = 1.57), and job demand (OR = 1.31) and negatively associated with job support (OR = 0.69) using multivariate analysis after being adjusted for covariates. For the short sleep duration group, there was an interaction effect of both high ERI and OC on arthritis, with a synergy index of 18.91 and 1.52, respectively. Similarly, there are high ORs of arthritis in both the high job demand and low job support groups.

Conclusion

Work-related stress related to arthritis moderated by sleep duration for civil servants. Civil servants with high job demand and low job support should use caution to reduce the risk of arthritis.

Measuring job stress in transportation workers: psychometric properties, convergent validity and reliability of the ERI and JCQ among professional drivers

BACKGROUND

The accumulated evidence has shown how professional drivers are, in psychosocial terms, among the most vulnerable workforces, and how their crashes (some of them preceded by stressful working conditions) constitute both an occupational and public health concern. However, there is a clear lack of validated tools for measuring stress and other key hazardous issues affecting transport workers, and most of the existing ones, frequently generic, do not fully consider the specific features that properly describe the work environment of professional driving. This study assessed the psychometric properties, convergent validity and consistency of two measures used for researching occupational stress among professional drivers: the Siegrist's ERI (Effort-Reward Imbalance Inventory) and Karasek's JCQ (Job Content Questionnaire).

METHODS

We examined the data collected from 726 Spanish professional drivers. Analyses were performed using Structural Equation Models, thus obtaining basic psychometric properties of both measures and an optimized structure for the instruments, in addition to testing their convergent validity.

RESULTS

The results suggest that the abbreviated versions of ERI (10 items) and JCQ (20 items) have clear dimensional structures, high factorial weights, internal consistency and an improved fit to the task's dynamics and hazards, commonly faced by of professional drivers; a short set of items with low psychometrical adjustment was excluded, and the root structure of the questionnaires was kept.

CONCLUSIONS

This study supports the value and reliability of ERI-10 and JCQ-20 for measuring job stress among professional drivers. Also, there is a high consistency between both measures of stress, even though they belong to different theoretical conceptions of the phenomenon. In practical settings, these instruments can be useful for occupational researchers and practitioners studying stress-related issues from the perspective of human factors.

Stress at work is associated with intima media thickness in older male employees, independent of other sources of stress perception

Chronic stress at work shows a moderate but robust longitudinal association with cardiovascular disease (CVD). Atherosclerosis is a pathophysiological process of most CVD, for which intima media thickness (IMT) of the carotid artery is used as an early marker. Its relationship with stress at work has remained largely unexplored, and the present study therefore aimed to elucidate the association between stress at work, assessed as effort-reward imbalance (ERI), and IMT. This cross-sectional study comprised of 501 male German employees aged 42 (19-64) years at enrollment into the Mannheim Industrial Cohort Study. Clinical assessments used fasting blood samples and IMT measurement. Self-report questionnaires assessed sources of perceived stress. Analyses adjusted for medical history, life style, and socio-economic status (SES) indicators as well as general perceived stress and worries to determine the specificity of ERI. Linear regression models estimated the association of ERI with IMT, stratifying for age groups and adjusting for potential confounders. ERI ratio increased until the age of 50 years and abated thereafter. In participants younger than 50 years IMT measurements were not associated with ERI ratios. However, despite lower mean ERI ratios in participants older than 50 years, this age group showed a significant relationship with IMT (standardized Beta = .36, p < .01), adjusting for multiple confounders including general perceived stress and worries. These analyses suggest that atherosclerosis in older employees is specifically related to stress at work. Longitudinal studies will help to elucidate the temporal relationship between stress exposure and downstream biological mechanisms.Lay summaryOur study explored the association of job stress and the calcification of the carotid artery in German employees. We found out that this association is stronger in employees older than 50 years. In addition, it is independent of medical risk factors and stress caused by private issues.

Mental health among university students: The associations of effort-reward imbalance and overcommitment with psychological distress

BACKGROUND

Mental health problems are highly prevalent among university students, but little is known about their underlying determinants. This study explores mental health among university students, the association between "effort-reward imbalance" (ERI), overcommitment and mental health, and to what extent ERI and overcommitment explain gender differences in mental health.

METHODS

Cross-sectional data were analyzed from 4760 Italian university students. The Kessler Psychological Distress Scale-10 was used to measure self-reported psychological distress, as an indicator of mental health, and the ERI - Student Questionnaire to measure effort, reward and overcommitment. The associations between ERI and overcommitment with psychological distress were estimated with multinomial logistic regression analyses.

RESULTS

78.5% of the respondents experienced psychological distress, with 21.3%, 21.1%, and 36.1% reporting respectively mild, moderate and severe psychological distress. Female students were more likely to report moderate and severe psychological distress. ERI and overcommitment were strongly associated with severe psychological distress with ORs respectively up to 19.9 (95% CI: 12.2-32.5) and 22.2 (95% CI: 16.1-30.7). ERI and overcommitment explained part of the higher odds of severe psychological distress among female students comparing to males, attenuating the ORs from 2.3 (95% CI: 1.9-2.7) to 1.4 (95% CI: 1.2-1.7).

LIMITATIONS

This cross-sectional study was performed on a large, but convenient sample.

DISCUSSION

More than one out of three students reported severe psychological distress. Decreasing ERI and overcommitment may be beneficial in the prevention of psychological distress among university students and may reduce gender differences in psychological distress. Longitudinal studies are needed to further investigate these associations.

Geophysical and hydrogeological investigation for the saline water invasion in the coastal aquifers of West Bengal, India: a critical insight in the coastal saline clay-sand sediment system

The Digha-Shankarpur area in West Bengal suffers from the problem of saline water intrusion in the near-surface to shallow subsurface aquifers. In the present study, geophysical surveys were conducted and integrated with measured hydrogeological parameters to delineate the possible locations of saline water-invaded zones in the shallow aquifers. One hundred eighty-eight groundwater samples were collected, and parameters like salinity, EC, total dissolved solids (TDS), pH, temperature, and water level were measured. The geophysical survey, such as resistivity profiling, self-potential, and electrical resistivity imaging techniques, was applied. High TDS, salinity, and EC were observed in various places. Resistivity profiling survey indicates a low resistivity zone (< 10 Ωm), self-potential anomaly indicates a positive anomaly and resistivity imaging survey indicated very low resistivity zones (0-3 Ωm) in near-surface to shallow subsurface locations which are concurrent with the other coastal aquifers in the eastern part of India. These low resistivity zones are interpreted as saline water intrusion zone mixed with clay/sand layers up to a depth of 15 m possibly due to the ingression of seawater and also due to anthropogenic activities. Hence, protection from seawater intrusion from the canals into the coastal aquifers (shallow and deep) and human-made activities should be restricted to minimize the effect of saline water pollution.

Delineation of contaminated aquifers using integrated geophysical methods in Northeast Punjab, Pakistan

A decline in surface water sources in Pakistan is continuously causing the over-extraction of groundwater resources which is in turn costing the saltwater intrusion in many areas of the country. The saltwater intrusion is a major problem in sustainable groundwater development. The application of electrical resistivity methods is one of the best known geophysical approaches in groundwater study. Considering the accuracy in extraction of freshwater resources, the use of resistivity methods is highly successful to delineate the fresh-saline aquifer boundary. An integrated geophysical study of VES and ERI methods was carried out through the analysis and interpretation of resistivity data using Schlumberger array. The main purpose of this investigation was to delineate the fresh/saline aquifer zones for exploitation and management of fresh water resources in the Upper Bari Doab, northeast Punjab, Pakistan. The results suggest that sudden drop in resistivity values caused by the solute salts indicates the saline aquifer, whereas high resistivity values above a specific range reveal the fresh water. However, the overlapping of fresh/saline aquifers caused by the formation resistivity was delineated through confident solutions of the D-Z parameters computed from the VES data. A four-layered unified model of the subsurface geologic formation was constrained by the calibration between formation resistivity and borehole lithologs. i.e., sand and gravel-sand containing fresh water, clay-sand with brackish water, and clay having saline water. The aquifer yield contained within the fresh/saline aquifers was measured by the hydraulic parameters. The fresh-saline interface demarcated by the resistivity methods was confirmed by the geochemical method and the local hydrogeological data. The proposed geophysical approach can delineate the fresh-saline boundary with 90% confidence in any homogeneous or heterogeneous aquifer system.

Stress among university students: factorial structure and measurement invariance of the Italian version of the Effort-Reward Imbalance student questionnaire

Background

In the last decade academic stress and its mental health implications amongst university students has become a global topic. The use of valid and theoretically-grounded measures of academic stress in university settings is crucial. The aim of this study was to examine the factorial structure, reliability and measurement invariance of the short student version of the effort-reward imbalance questionnaire (ERI-SQ).

Methods

A total of 6448 Italian university students participated in an online cross-sectional survey. The factorial structure was investigated using exploratory factor analysis and confirmatory factor analysis. Finally, the measurement invariance of the ERI-SQ was investigated.

Results

Results from explorative and confirmatory factor analyses showed acceptable fits for the Italian version of the ERI-SQ. A modified version of 12 items showed the best fit to the data confirming the 3-factor model. Moreover, multigroup analyses showed metric invariance across gender and university course (health vs other courses).

Conclusions

In sum, our results suggest that the ERI-SQ is a valid, reliable and robust instrument for the measurement of stress among Italian university students.

Enhancing CO2 Adsorption and Separation Properties of Aluminophosphate Zeolites by Isomorphous Heteroatom Substitutions

Mg, Co-substituted aluminophosphate zeolites with ERI framework topology (denoted as MgAPO-ERI and CoAPO-ERI) have been synthesized under hydrothermal conditions by using N, N, N', N'-tetramethyl-1,6-hexanediamine as organic template. Their CO₂ adsorption properties are investigated in comparison to those of the pure aluminophosphate counterpart AlPO-ERI. CoAPO-ERI shows the highest CO₂ uptake of 57.3 cm³ g^-1 (273 K and 1 bar) and the highest isosteric heat of 39.0 kJ mol^-1 among the three samples. Importantly, the incorporation of Mg²⁺ and Co²⁺ ions in the framework of AlPO-ERI can greatly improve the adsorption selectivities of CO₂ over CH₄ and N₂. Whereafter, transient breakthrough simulations were investigated and further proved the advantages of heteroatoms for separations. These results demonstrate that isomorphous heteroatom substitutions in aluminophosphate zeolites play a key role in enhancing CO₂ adsorption and separation abilities.

Positive verbal feedback about task performance is related with adaptive physiological responses: An experimental study of the effort-reward imbalance stress model

Effort-reward imbalance in the workplace has been related with poor mental and physical health and a variety of negative organisational outcomes including increased rates of absenteeism, presentism, and job turnover, but the model has rarely been assessed using experimental designs. Female participants (N = 90) were randomly assigned to positive verbal feedback and no verbal feedback conditions. Within a simulated office environment, all participants were under time-pressure to successfully complete computer-based tasks in order to gain remuneration. Positive verbal feedback about task performance was provided to improve the aspect of 'esteem reward' (while keeping effort constant) using a mixed within-between subjects design. Psychological, behavioural (task performance), and physiological (heart rate variability, salivary alpha amylase) measures assessed the impact of the positive verbal feedback. Participants receiving the esteem manipulation did not self-report increased rewards, but performed moderately better on the task, and had more adaptive physiological reactivity in the high reward versus the standard condition. Similar to recent research our findings highlight the importance of concurrent assessments of both self-reports and physiological measures of stress, and suggest that positive verbal feedback about work performance can elicit adaptive physiological responses and may also positively influence task efficacy.

The salivary alpha amylase awakening response is related to over-commitment

We assessed the relationship between physiological and psychological measures of workplace stress as measured by the effort-reward imbalance (ERI) model, with a seldom studied sample of owner-operator dairy farmers. Dairy farmers (N = 74) self-reported ERI, over-commitment (OC), dedication, and health then provided awakening saliva samples that were used to calculate the salivary alpha amylase awakening response (sAA-AR), cortisol awakening response (CAR), and salivary immunoglobulin A (sIgA) level. ERI, OC, and dedication levels were not related with sIgA or the CAR, but more over-committed farmers had a less pronounced sAA-AR. OC was more associated than ERI with the physiological indicators of stress, potentially due to the owner-operator sample used in this investigation. The suitability of sAA as a viable physiological measure of autonomic nervous system activity has been debated, but our findings promote its inclusion in future occupational stress research.

Hair cortisol and work stress: Importance of workload and stress model (JDCS or ERI)

Hair cortisol concentrations (HCCs) are a potential physiological indicator of work related stress. However, studies that tested the relationship between HCC and self-reported stress in a work setting show mixed findings. This may be because few studies used worker samples that experience prolonged stress. Therefore, we compared a high workload sample (n = 81) and a normal workload sample (n = 91) and studied whether HCC was related to: (i) high job demands, low control, and low social support (JDCS model), and (ii) high effort, low reward, and high overcommitment (ERI model). Results showed that self-reported stress related to HCC only in the high workload sample and only for the variables of the ERI model. We found that HCC was higher when effort was high, reward low, and overcommitment high. An implication of this study is that a certain stress threshold may need to be reached to detect a relationship between self-reported stress and physiological measures such as HCC.

Psychosocial work environment and oxidative stress among nurses'

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusions:

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

Chronic work stress and decreased vagal tone impairs decision making and reaction time in jockeys

The inverse relationship between acute stress and decision-making is well documented, but few studies have investigated the impact of chronic stress. Jockeys work exhaustive schedules and have extremely dangerous occupations, with safe performance requiring quick reaction time and accurate decision-making. We used the effort reward imbalance (ERI) occupational stress model to assess the relationship of work stress with indices of stress physiology and decision-making and reaction time. Jockeys (N=32) completed computerised cognitive tasks (Cogstate) on two occasions; September and November (naturally occurring lower and higher stress periods), either side of an acute stress test. Higher ERI was correlated with the cortisol awakening responses (high stress r=-0.37; low stress r=0.36), and with decrements in decision-making comparable to having a blood alcohol concentration of 0.08 in the high stress period (p<0.001) The LF/HF ratio of heart rate variability impacted the association of ERI with decision-making. Potentially, this may be attributed to a 'tipping point' whereby the higher ERI reported by jockeys in the high stress period decreases vagal tone, which may contribute to reduced decision-making abilities.

Age-related associations between work over-commitment and zest for work among Swedish employees from a cross-sectional and longitudinal perspective

BACKGROUND

In aging societies, zest for work may be pivotal when deciding to stay occupationally active longer. Psychosocial work stress is a prevalent public health problem and may have an impact on zest for work. Work over-commitment (WOC) is a personal coping strategy for work stress with excessive striving and a health risk. However, the long-term effect of WOC on zest for work is poorly understood.

OBJECTIVE

To investigate the age-related associations of work over-commitment with zest for work.

METHODS

During 1996-1998 and 2000-2003, predominantly industrial workers (n = 2940) participated in the WOLF-Norrland study and responded to a questionnaire referring to socio-demographics, WOC, zest for work, effort-reward imbalance proxies, and mental health. Age-adjusted multiple logistic regressions were performed with original and imputed datasets.

RESULTS

Cross-sectionally, work overcommitted middle-aged employees had an increased prevalence of poor zest for work compared to their contemporaries without WOC (OR: 3.74 [95%-CI 2.19; 6.40]). However, in a longitudinal analysis associations between onset of 'poor zest for work' and the WOC subscales 'need for approval' (OR: 3.29 [95%-CI 1.04; 10.37]) and 'inability to withdraw from work' (OR: 5.14 [95%-CI 1.32; 20.03]) were observed.

CONCLUSION

The longitudinal findings among older employees could be relevant regarding the expected need to remain occupationally active longer.

Magnetic Resonance Imaging in Nondependent Pacemaker Patients with Pacemakers and Defibrillators with a Nearly Depleted Battery

BACKGROUND

Magnetic resonance imaging (MRI) in patients with non-MRI-conditional cardiac implantable electronic devices (CIEDs) has been shown to be safe when performed under closely monitored protocols. However, the safety of MRI in patients with devices with a nearly depleted battery has not been reported.

METHODS

Prospective data were collected between January 2008 and May 2015 in patients with non-MRI-conditional CIEDs undergoing clinically indicated MRI under institutional protocol. Patients who were pacemaker dependent were excluded. Patients whose devices were at elective replacement indicator (ERI) at the time of MRI or close to ERI (ERI or replacement for battery depletion within 3 months of scan) were identified through database review and analyzed for clinical events.

RESULTS

MRI scans (n = 569) were performed in 442 patients. Of these, we identified 13 scans performed with a nearly depleted battery in nine patients. All scans with implantable cardioverter defibrillators (ICDs, n = 9) were uneventful. However, two scans with pacemakers close to ERI resulted in a power-on-reset (PoR) event. One scan with a pacemaker close to ERI that was programmed to DOO mode reached ERI during MRI and automatically changed to VVI mode. Additionally, one scan with a pacemaker at ERI did not allow programming. All pacemakers with events were implanted before 2005.

CONCLUSION

Patients with pacemakers and ICDs with a nearly depleted battery can safely undergo MRI when patients are not pacemaker dependent. Attention should be paid because old devices can result in PoR or ERI during MRI, which may lead to oversensing and inhibition of pacing.

An experimental examination of the effort-reward imbalance model of occupational stress: Increased financial reward is related to reduced stress physiology

Effort-reward imbalance in the workplace is linked to a variety of negative health and organisational outcomes, but it has rarely been assessed experimentally. We manipulated reward (while keeping effort constant) in a within-subjects design with female participants (N=60) who were randomly assigned to high and standard reward conditions within a simulated office environment. Self-report, behavioural (task performance), and physiological (heart rate variability, salivary alpha amylase) measures assessed the impact of increased financial reward. Participants reported increased perceptions of reward, performed moderately better on the task, and were less physiologically reactive in the high reward versus the standard condition. These findings highlight the importance of assessing both subjective self-reports of stress together with objective physiological measures of stress, and suggest that increasing monetary rewards has the potential to decrease stress physiological reactivity, and in turn, reduce the risk of ill-health in employees, and may also positively influence task efficacy.

Ferritin Elevation and Improved Responsiveness to Erythropoiesis-Stimulating Agents in Patients on Ferric Citrate Hydrate

Introduction

In hemodialysis patients on ferric citrate hydrate, the increase in ferritin level is mainly due to the administration of the compound. We investigated possible other factors associated with ferritin level and how erythropoietin resistance index and erythropoiesis in those patients were affected. We looked at ferritin-elevating factors using data from a Japanese phase III long-term clinical trial of ferric citrate hydrate.

Methods

The factors with a strong association with ferritin levels at week 28 were selected by the process of variable selection. In addition, selected factors were analyzed by Mixed Model for Repeated Measurement. Subjects were divided into 3 groups by quantiles (<Q1, Q1-Q3, Q3<) of the most strongly correlated factors. Then the least-squares means of change of ferritin at each time point for each group were calculated. Finally, the differences of the least-squares means were examined. Changes of both erythropoiesis-stimulating agent dose and erythropoietin resistance index for each group were investigated. The differences in mean erythropoietin resistance index between groups at baseline, week 28, and week 52 were analyzed using t tests.

Results

Dose of ferric citrate hydrate showed the strongest correlation with change of ferritin and the second strongest was the reduction of erythropoiesis-stimulating agents. The mean erythropoietin resistance index was lowered in group <Q1. Group <Q1 showed significantly lower levels of ferritin at baseline.

Discussion

It is suggested that not only iron load but also the erythropoiesis-stimulating agent dose reduction may be involved in ferritin elevation during ferric citrate hydrate treatment, resulting in a decrease of erythropoietin resistance index.

Criterion validity and sensitivity to change of the Early Rehabilitation Index (ERI): results from a German multi-center study

Background

Evaluation of functional status is difficult in neurological and neurosurgical early rehabilitation patients. The Early Rehabilitation Index (ERI) was introduced in Germany over 20 years ago, but since then validation studies are lacking. The ERI (range −325 to 0 points) includes highly relevant items including the necessity of intermittent mechanical ventilation or tracheostomy.

Methods

The present paper analyzed data from a German multi-center study, enrolling 754 neurological early rehabilitation patients. Together with ERI, Barthel Index (BI), Glasgow Coma Scale (GCS), Glasgow Outcome Score Extended, Coma Remission Scale (CRS), Functional Ambulation Categories and length of stay were obtained.

Results

ERI showed significant improvements from admission to discharge (p < 0.001). In addition, there were significant correlations of the ERI upon admission and at discharge with BI, CRS and GCS.

Conclusions

Evaluation of our study data suggest that the ERI may be used as a valid assessment instrument for neurological and neurosurgical early rehabilitation patients.

Dynamics of the erythropoiesis stimulating agent resistance index in incident hemodiafiltration and high-flux hemodialysis patients

Hyporesponsiveness to erythropoiesis-stimulating agent therapy in dialysis patients is poorly understood. Some studies report an improvement in the erythropoiesis-stimulating agent resistance index (ERI) with hemodiafiltration (HDF) versus high-flux hemodialysis (HD). We explored ERI dynamics in 38,340 incident HDF and HD patients treated in 22 countries over a 7-year period. Groups were matched by propensity score at baseline (6 months after dialysis initiation). The follow-up period (mean of 1.31 years) was stratified into 1 month intervals with delta analyses performed for key ERI-related parameters. Dialysis modality, time interval, and polycystic kidney disease were included in a linear mixed model with the outcome ERI. Baseline ERI was nonsignificantly higher in HDF versus HD treatment. ERI decreased significantly faster in HDF-treated patients than in HD-treated patients, was decreased in both HD and HDF when patients were treated with intravenous darbepoetin alfa, but only in HDF when treated with intravenous recombinant human erythropoietin (rHuEPO). A clear difference between HD- and HDF-treated patients could only be found for patients with high baseline ERI and assigned to intravenous rHuEPO treatment. A significant advantage in terms of lower ERI for patients treated by HDF was found. Sensitivity analysis limited this advantage for HDF to those patients treated with intravenous rHuEPO (not darbepoetin alfa or subcutaneous rHuEPO) and to patients with a high baseline ERI. Thus, our results allow more accurate planning for future clinical trials addressing anemia management in dialysis patients.

elegans Enhancer of RNAinterference, leads to enhanced growth

Organisms adopt a wide range of strategies to adapt to change. Gene silencing describes the ability of organisms to modulate the expression of susceptible genes at certain times at the transcriptional or the translational level. In all known eukaryotic organisms 21-nt long short interfering RNAs (siRNAs) are the effector molecules of post-transcriptional gene silencing (PTGS), while 24-nt long siRNAs are involved in PTGS in plants. Mutant studies in Caenorhabditis elegans lead to the identification of the enzyme ERI (Enhancer of RNAinterference) with enhanced PTGS. Although the genes involved in growth vigor and growth rate are still unknown, it becomes clearer that the population of small RNAs plays a role in the very early phase of plant development. To pinpoint the link between growth and siRNAs, the expression of Arabidopsis uni-gene Enhancer of RNAi (ERI) homolog from C. elegans was modulated. Increased degradation of small RNAs was achieved by ectopic AtERI overexpression in planta. Based on global small RNA analysis, AtERI overexpression affects mainly the population of 21 mers, excluding miRNAs. To identify target genes, AtERI gain-of-function mutants were analyzed, and differentially abundant small RNAs were identified. Plants with an elevated level of AtERI were bigger in all three light intensities analyzed, indicating an inhibitory function of particular small RNAs in plant growth, with differences in relative growth rates depending on developmental stage and light intensity. Understanding the role of these siRNAs could open new avenues for enhancing plant growth.

Validity of the effort/reward imbalance questionnaire in health professionals from six Latin-American countries

BACKGROUND

This study tests the validity and the invariance of ERI questionnaire (ERIQ) data from health professionals in six different Latin-American countries.

METHODS

One thousand two hundred ninety-two (1292) participants who worked in hospitals in Argentina, Chile, Colombia, Mexico, Peru and Venezuela completed the ERI and GHQ questionnaires. Partial correlations were carried out as well as reliability statistics and confirmatory factor analyses to examine factor structure and invariance of ERIQ in each subsample.

RESULTS

Overall confirmatory factor analyses confirmed the theoretical structure of the ERIQ. The effort and overcommitment scales were invariant (equivalent) across the six countries, but the reward scale was only partially invariant. Several associations between ERIQ and mental health remain significant after controlling for sociodemographic variables.

CONCLUSIONS

Although the validity of the ERIQ' scales were generally satisfactory in most Latin-American samples, future research should examine in depth the equivalence of reward scale across Latin-American cultures.