Capillary Zone Electrophoresis in Humboldt Penguins (Spheniscus humboldti)

Electrophoresis is a useful diagnostic tool for detecting inflammation, including inflammation associated with infectious diseases (eg, aspergillosis in penguins). To our knowledge, reference intervals are not available for plasma proteins via electrophoresis in Humboldt penguins (Spheniscus humboldti). Therefore, preliminary reference intervals for blood plasma proteins measured by capillary zone electrophoresis were calculated for Humboldt penguins from a single zoological collection, and possible differences between the sexes and the ages of the birds were evaluated. Lithium heparinized plasma samples from 39 Humboldt penguins were analyzed. The following sex- and age-independent reference intervals were calculated: total protein 33.8-70.4 g/L, prealbumin 1.9-4.9 g/L, albumin 12.9-31.1 g/L, albumin: globulin ratio 0.7-1.7, α-globulins 4.5-11.6 g/L, β-globulins 5.6-20.6 g/L, and γ-globulins 2.6-8.4 g/L. Male penguins had a significantly (P = 0.047) higher albumin: globulin ratio and lower percentage of β-globulins (P = 0.015) in comparison with female penguins. Prealbumin (g/L) significantly (P = 0.021) decreased with increased age of the penguins. These results showed some differences between the sexes and ages of the penguins, which should be considered when interpreting the results. Further studies are needed to determine whether differences in other age groups or seasons exist, and also to evaluate which infectious diseases affect plasma proteins and how the reference values calculated here may deviate in ill penguins.

Clinical Chemistry and Haematology Values of a Captive Population of Humboldt Penguins (Spheniscus humboldti)

Reference intervals for clinical chemistry and haematology analytes are essential for the interpretation of blood results, but limited data are available for Humboldt penguins (Spheniscus humboldti) in zoological collections as well as in the wild. The aim of the present study was therefore to establish reference intervals for a series of clinical chemistry and haematology analytes in a single zoological population of Humboldt penguins. Furthermore, possible variations of the analytes influenced by the age and sex of the individuals were investigated. Lithium heparinized plasma and whole blood samples from 39 animals were analysed and statistically evaluated. The following clinical chemistry analytes were significantly higher in females: glutamate dehydrogenase (p = 0.0003), alanine transaminase (p = 0.0005), alkaline phosphatase (p = 0.0245), aspartate aminotransferase (p = 0.0043), creatine kinase (p = 0.0016), lactate dehydrogenase (p < 0.0001), inorganic phosphorus (p = 0.0223), and sodium (p = 0.0415). No significant differences between males and females were found for any haematology analyte. Cholesterol (p = 0.0233; -0.39), white blood cell count (p = 0.0208; -0.40), and absolute heterophiles (p = 0.0148; -0.42) had significant negative correlations with the age of the penguins. The results indicate that the factors of sex and age should be considered when interpreting the results of haematological and clinical biochemistry assays, and further studies are needed to determine whether there are more differences in other age groups or seasons.

Detection of nidoviruses in samples collected from captive snakes in Europe between 2016 and 2021

BACKGROUND

Nidoviruses are increasingly detected in various snake species worldwide, but much remains to be learned about their distribution and the factors influencing their epidemiology.

METHODS

This retrospective study evaluated the results of routine nidovirus testing, by PCR, of 5210 swab samples from pet snakes from various European countries that were submitted to a commercial veterinary laboratory in Germany between 2016 and 2021.

RESULTS

The overall detection rate was 19.96%. However, the detection rate varied significantly depending on the snake species (p < 0.0001), with the highest rate in Indian pythons (Python molurus) (42.24%). Rates also varied depending on the season of sample collection (p < 0.0001), with the highest rate in winter (24.46%), and the country of sample origin (p < 0.0001), with the highest rate in Austria (36.69%). The detection rate also decreased significantly (p = 0.0003) over the 6-year observation period, from 26.43% to 17.64%.

LIMITATION

No information on clinical signs was available for most of the sampled snakes.

CONCLUSION

The present study supplies new information on the distribution of python nidoviruses (subgenus Roypretovirus) in pet snakes in Europe and indicates a dynamic situation with possible changes in prevalence over time.

Comparison of Plasma Trace Elements Between 2 Captive Humboldt Penguin (Spheniscus humboldti) Populations

Environmental pollutants and their effect on wildlife health play an important role in the conservation of endangered species and can be clinically relevant in captive animals too. Data on relevant concentrations of trace elements in captive birds with no known exposures are rare. For this study, silver, arsenic, gold, barium, cadmium, cobalt, chromium, copper, iron, mercury, magnesium, manganese, molybdenum, thallium, selenium, and zinc were measured by inductively coupled plasma mass spectrometry in lithium heparinized plasma samples from 18 Humboldt penguins at 2 zoological collections in Germany. The results showed that the plasma concentrations of silver, arsenic, gold, cadmium, cobalt, chromium, mercury, and selenium differed significantly (P ≤ 0.05) between the 2 penguin collections. The results indicate that the location of the birds has a strong influence on the plasma trace element concentrations. Well water used in the enclosures was suspected to be associated with these significant differences. Trace elemental concentrations in feed (eg, marine fish) and contamination from enclosure construction materials may also play a role. This study could provide a basis for further comparative, biomonitoring, toxicity, and reference interval studies.

Antibodies against Two Testudinid Herpesviruses in Pet Tortoises in Europe

Herpesviruses are important pathogens of tortoises, and several serologically and genetically distinct virus types have been described in these animals. Virus neutralization testing is commonly used in Europe to determine previous infection with the two types most often found in pet European tortoises, testudinid herpesvirus (TeHV) 1 and 3. In this retrospective study, the results of serological testing for antibodies against each of these viruses in serum or plasma samples from 1728 tortoises were evaluated, and antibody detection rates were compared based on virus type, host species, year, season, and country of origin. Antibodies (titer 2 or higher) against at least one of the two viruses used were detected in a total of 122 (7.06%; 95% CI 5.95−8.37%) of the animals tested. The antibody detection rates differed significantly depending on the tortoise species (p < 0.0001) and the year of sampling (TeHV1 p = 0.0402; TeHV3 p = 0.0482) for both virus types. For TeHV1, antibody detection rates differed significantly (p = 0.0384) by season. The highest detection rate was in summer (5.59%; 95% CI 4.10−7.58%), and the lowest was in fall (1.25%; CI 0.53−2.87%). TeHV1 antibody detection rates did not differ significantly (p = 0.7805) by country, whereas TeHV3 antibody detection rates did (p = 0.0090). The highest detection rate, 12.94% (95% CI 7.38−21.70%), was found in samples from Italy. These results support previous hypotheses on the species’ susceptibility to TeHV1 and 3 and the use of serology as a diagnostic test for the detection of herpesvirus-infected tortoises.

Herpesviruses in Captive Chelonians in Europe Between 2016 and 2020

Herpesviruses are important pathogens in tortoises and turtles, yet little is known about the epidemiology of these viruses. We analyzed herpesviruses detected by PCR in samples from captive chelonians in Europe according to virus strain, host species, year and season in which the animal was tested, and country in which the animal was kept. A total of 4,797 samples submitted to a diagnostic laboratory in Europe between January 2016 and December 2020 were evaluated. Of these, 312 (6.50%) were positive for herpesviruses. The types most commonly found were testudinid herpesvirus (TeHV)1 (143 positive, 45.83%) and TeHV3 (153 positive, 49.04%), but also included TeHV2 (1 positive, 0.32%), TeHV4 (3 positive, 0.96%), Terrapene herpesvirus 1 (7 positive, 2.24%), Trachemys herpesvirus 1 (2 positive, 0.64%), and three previously undescribed herpesviruses (0.96%). Herpesviruses were detected in chelonians in the families Testudinidae, Emydidae, Geoemydidae, and in the suborder Pleurodira. Among the species for which 100 samples or more were available, the highest proportions of positive samples (positivity rates) were found in samples from Horsfield's tortoises (Testudo horsfieldii) (14.96%), and radiated tortoises (Astrochelys radiata) (14.05%). Among tortoises (Testudinidae), viruses were most often detected in the spring, while in emydid turtles (Emydidae) they were most often detected in the summer. A comparison of the positivity rates according to country showed significant differences, with the highest rate in samples from Italy (16.01%). This study indicated possible differences in herpesvirus positivity rates depending on host species, virus strain, year of sampling, season, and country of origin. It provides useful information in further understanding fluctuations in infection rates as well as in helping to guide decision making for herpesvirus diagnostics in chelonian patients. It also provides evidence for the international dispersal of herpesviruses with their hosts through international trade.

A testudinid herpesvirus 1 (TeHV1)-associated disease outbreak in a group of Horsfield's tortoises (Testudo horsfieldii)

In spring 2020, a severe disease outbreak with high morbidity and mortality was observed in a collection of 15 Horsfield's tortoises (Testudo horsfieldii). Affected tortoises showed upper respiratory- and gastrointestinal tract signs, including rhinitis and stomatitis. Testudinid herpesvirus 1 (TeHV1) and Mycoplasma spp. were detected by PCR in oral swabs of affected animals. Histological examination of one deceased animal showed intranuclear inclusion bodies typical for herpesvirus infections in liver, spleen and oesophagus. The virus was likely introduced into the collection 2 years earlier by a clinically healthy Horsfield's tortoise that was tested positive for TeHV1 by PCR.

Comparison of Capillary Zone Electrophoresis in Greater Flamingos (Phoenicopterus roseus) and American Flamingos (Phoenicopterus ruber)

Electrophoresis can be used to aid in the diagnosis of infectious diseases (eg, aspergillosis) in avian species. Reference intervals for blood plasma proteins of 2 different flamingo species (Phoenicopterus roseus and Phoenicopterus ruber) and their hybrids were calculated by capillary zone electrophoresis (CZE) and differences between these species, sexes, and age groups were evaluated. Lithium-heparinized plasma samples from 111 animals from a zoological collection were analyzed by CZE and statistically evaluated. Differences were only found between greater and American flamingos (P = .003) and between greater flamingos and hybrids (P = .001) in the γ-globulin fraction. Male greater flamingos showed significantly higher α-globulins (P = .022) and females higher total albumin by CZE (P = .037). In American flamingos, the percent total albumin (P = .017), total albumin (P = .025), prealbumin (P = .005), and albumin/ globulin (A/G) ratio (P = .008) were higher in females, and α- (P = .023) and β-globulins (P = .021) were higher in males of the same species. The following parameters differed significantly between the age groups: γ-globulins (P = .048) in greater and α- (P = .021) and β-globulins (P = .001) in American flamingos increased with increased age and percent total albumin (P = .002), total albumin (P = .024), and A/G ratio (P = .002) decreased with age in American flamingos. The results showed only small differences between the species, but greater differences between the sexes and ages, especially in American flamingos, which must be considered when interpreting laboratory results.

Comparing the acute effects of shiftwork on mothers and fathers

Background

Shift work may impact women more negatively than men due to the increased burden of coping with demanding work schedules while also undertaking more of the domestic chores, including childcare.

Aims

To examine whether the combination of shift working and caring for children affects the sleep, fatigue and work–family conflict experienced by women more than it affects men.

Methods

Using data from a survey of the Swedish working population, mixed linear regression models examined work schedule (daywork, shift work with nights, shift work without nights), gender and presence of children <13 years at home as predictors of sleep insufficiency, sleep disturbance, fatigue and work–family conflict, over up to three successive measurement occasions. Adjustments were made for age, education, full/part-time working and baseline year.

Results

In fully adjusted models (N = 8938), shift work was associated with insufficient sleep (P < 0.01), disturbed sleep (P < 0.01), fatigue (P < 0.05) and work–family conflict (P < 0.001). Interactions in the analyses of sleep disturbance (P < 0.001) and work–family interference (P < 0.05) indicated that among participants with no children, females reported more disturbed sleep and more work–family conflict than their male counterparts, irrespective of schedule; while among participants with children, female dayworkers reported more disturbed sleep than their male counterparts, and females working shifts without nights reported more work–family interference.

Conclusions

Having young children did not exacerbate negative effects of shift work, in either men or women. This may reflect high levels of gender equality and childcare provision in Sweden.

A comparison of thyroid hormone levels and plasma capillary zone electrophoresis in red-eared sliders (Trachemys scripta elegans) and map turtles (Graptemys spp.) depending on season and sex

BACKGROUND

Thyroid hormones and capillary zone electrophoresis are rarely studied in reptile medicine.

OBJECTIVES

The goal of this prospective study was to establish RIs for plasma proteins and thyroid hormones, total tetraiodothyronine (tT4), free T4 (fT4), total triiodothyronine (tT3), and free T3 (fT3), as well as iodine blood levels in red-eared sliders (Trachemys scripta elegans) and map turtles (Graptemys spp.).

METHODS

Variables were measured over 1 ½ years to determine variations depending on sex and season, as well as any correlations between the parameters. A total of 131 blood samples from red-eared sliders and 51 blood samples from map turtles were collected from May 2016 to November 2017. The levels of tT4, fT4, and fT3 were measured using standardized autoanalyzer test systems; tT3 was measured by ELISA and iodine inductively coupled plasma mass spectrometry. Total protein was quantitated using the biuret method, and plasma protein fractions were measured using capillary zone electrophoresis.

RESULTS

The results showed significant variations in thyroid hormone levels and plasma protein fractions depending on sex and season. Total T4 and fT4 concentrations were significantly (P < .05) correlated in both turtle species and sexes in all seasons. Thyroid hormone levels correlated with blood proteins in a few seasons, including a positive correlation between tT4 and fT4 in female red-eared sliders in fall and female map turtles in summer and fall.

CONCLUSIONS

This study demonstrates the importance of considering species, season, and sex variations when interpreting thyroid hormone and plasma protein levels. It also shows that thyroid hormone levels are not always influenced by total protein and albumin.

Prevalence of inclusion body disease and associated comorbidity in captive collections of boid and pythonid snakes in Belgium

Inclusion body disease (IBD) is caused by reptarenaviruses and constitutes one of the most notorious viral diseases in snakes. Although central nervous system disease and various other clinical signs have been attributed to IBD in boid and pythonid snakes, studies that unambiguously reveal the clinical course of natural IBD and reptarenavirus infection are scarce. In the present study, the prevalence of IBD and reptarenaviruses in captive snake collections and the correlation of IBD and reptarenavirus infection with the clinical status of the sampled snakes were investigated. In three IBD positive collections, long-term follow-up during a three- to seven-year period was performed. A total of 292 snakes (178 boas and 114 pythons) from 40 collections in Belgium were sampled. In each snake, blood and buffy coat smears were evaluated for the presence of IBD inclusion bodies (IB) and whole blood was tested for reptarenavirus RNA by RT-PCR. Of all tested snakes, 16.5% (48/292) were positive for IBD of which all were boa constrictors (34.0%; 48/141) and 17.1% (50/292) were reptarenavirus RT-PCR positive. The presence of IB could not be demonstrated in any of the tested pythons, while 5.3% (6/114) were reptarenavirus positive. In contrast to pythons, the presence of IB in peripheral blood cells in boa constrictors is strongly correlated with reptarenavirus detection by RT-PCR (P<0.0001). Although boa constrictors often show persistent subclinical infection, long-term follow-up indicated that a considerable number (22.2%; 6/27) of IBD/reptarenavirus positive boas eventually develop IBD associated comorbidities.

Blood reference intervals for rabbits (Oryctolagus cuniculus) from routine diagnostic samples

OBJECTIVE

The goal of this study was to establish reference intervals for blood parameters in rabbits based on data from routine diagnostic samples.

MATERIALS AND METHODS

Data sets from 1679-2039 values for clinical chemistry and 937-1559 values for hematological parameters were evaluated using the statistical program Reference Limit Estimator 20151017.

RESULTS

The following reference intervals were calculated for hematology: erythrocytes 4.37-7.43 × 10¹² cells/l; hematocrit 0.28-0.48 l/l; hemoglobin 89.63-153.82 g/l; leucocytes 2.71-12.23 × 10⁹ cells/l; neutrophils 0.87-7.82 × 10⁹ cells/l; lymphocytes 0.36-6.58 × 10⁹ cells/l; monocytes 0.08-1.71 × 10⁹ cells/l; eosi nophils 0.07-0.19 × 10⁹ cells/l; basophils 0.06-1.1 × 10⁹ cells/l; thrombocytes 225.45-905.3 × 10⁹ cells/l. Calculated intervals for clinical chemistries were: alkaline phosphatase 9.05-94.68 U/l; aspartataminotransferase 3.75-32.44 U/l; creatine kinase 1.63-559.53 U/l; γ-glutamyltransferase 2.5-14.46 U/l; glutamatdehydrogenase 0.68-14.78 U/l; fructosamin 248.08-501.43 µmol/l; bile acid 0.76-19.63 μmol/l; total protein 48.66-73.64 g/l; urea 2.63-10.28 mmol/l; creatinine 51.38-154.35 µmol/l; calcium 3.02-4.3 mmol/l; magnesium 0.66-1.51 mmol/l; phosphorus 0.54-2.18 mmol/l; sodium 132.61- 154.0 mmol/l and potassium 3.52-6.04 mmol/l.

CONCLUSION AND CLINICAL RELEVANCE

The calculation of intervals based on a large number of routine diagnostic samples allows the establishment of labora tory specific reference intervals without the use of experimental animals.

Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data

BACKGROUND

Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.

METHOD

We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.

RESULTS

We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32).

CONCLUSIONS

Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

Informal caregiving as a risk factor for type 2 diabetes in individuals with favourable and unfavourable psychosocial work environments: A longitudinal multi-cohort study

AIM

To examine whether informal caregiving is associated with increased risk of type 2 diabetes (T2D), and whether job strain and social support at work modify the association.

METHODS

Individual participant's data were pooled from three cohort studies-the French GAZEL study, the Swedish Longitudinal Occupational Survey of Health (SLOSH) and the British Whitehall II study-a total of 21,243 study subjects. Informal caregiving was defined as unpaid care for a closely related person. Job strain was assessed using the demand-control model, and questions on co-worker and supervisor support were combined in a measure of social support at work. Incident T2D was ascertained using registry-based, clinically assessed and self-reported data.

RESULTS

A total of 1058 participants developed T2D during the up to 10 years of follow-up. Neither informal caregiving (OR: 1.09, 95% CI: 0.92-1.30) nor high job strain (OR: 1.04, 95% CI: 0.86-1.26) were associated with T2D risk, whereas low social support at work was a risk factor for T2D (OR: 1.18, 95% CI: 1.02-1.37). Also, informal caregivers who were also exposed to low social support at work were at higher risk of T2D (OR: 1.40, 95% CI: 1.08-1.82) compared with those who were not informal caregivers and had high social support at work (multiplicative test for interaction, P=0.04; additive test for interaction, synergy index=10).

CONCLUSION

Informal caregiving was not independently associated with T2D risk. However, low social support at work was a risk factor, and informal caregivers with low social support at work had even higher risks of T2D.

Hospital organizational factors influence work-family conflict in registered nurses: Multilevel modeling of a nation-wide cross-sectional survey in Sweden

BACKGROUND

The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence.

OBJECTIVE

This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict.

DESIGN

A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments.

RESULTS

We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work-family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part.

CONCLUSION

These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling.

Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies

BACKGROUND

Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses.

OBJECTIVES

To examine the association between job strain and body mass index (BMI) in a large adult population.

METHODS

We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222).

RESULTS

A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up.

CONCLUSIONS

In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.

Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: prospective cohort study

BACKGROUND

Covert coping with unfair treatment at work--occurring when an employee does not show the "aggressor" that he/she feels unfairly treated--has been found to be associated with cardiovascular risk factors. This study examined whether covert coping also predicts incident coronary heart disease.

METHODS

A prospective cohort study (the WOLF Stockholm study) of workplaces in the Stockholm area, Sweden. The participants were 2755 men with no history of myocardial infarction at baseline screening in 1992-1995. The main outcome measure was hospitalisation due to myocardial infarction or death from ischaemic heart disease until 2003 obtained from national registers (mean follow-up 9.8 ± 0.9 years).

RESULTS

Forty-seven participants had myocardial infarction or died from ischaemic heart disease during follow-up. After adjustment for age, socioeconomic factors, risk behaviours, job strain and biological risk factors at baseline, there was a dose-response relationship between covert coping and risk of incident myocardial infarction or cardiac death (p for trend=0.10). Men who frequently used covert coping had a 2.29 (95% CI 1.00 to 5.29) times higher risk than those who did not use coping. Restricting the analysis to direct coping behaviours only strengthened this association (p for trend=0.02).

CONCLUSIONS

In this study, covert coping is strongly related to increased risk of hard-endpoint cardiovascular disease.

Psychosocial stress and atherosclerosis: family and work stress accelerate progression of coronary disease in women. The Stockholm Female Coronary Angiography Study

OBJECTIVE

To examine the impact of psychosocial stress, experienced in the family and work life, on the progression of coronary atherosclerosis in women cardiac patients.

DESIGN

Longitudinal follow-up study. The mean luminal diameter change over 3 years was averaged over 10 predefined coronary segments, representing the entire coronary tree. Stress in family life was measured by using the Stockholm Marital Stress Scale and that of work life by the demand-control questionnaire.

SUBJECTS

Amongst patients enrolled in the Stockholm Female Coronary Angiography Study, 80 women were evaluated for stress exposure and coronary atherosclerosis progression using serial quantitative coronary angiography.

RESULTS

Multi-variable-controlled mixed models anova analyses revealed that women with high stress from either family or work had significant disease progression over 3 years, whereas those with low stress had only slight progression. In women who were free of stress from either family or work life, i.e. they were satisfied with both of these life domains, the coronary artery changes had regressed. Their mean coronary luminal diameter increased by 0.22 mm (95% CI: 0.10; 0.35 mm) when compared with women who experienced stress from both sources, whose luminal diameter decreased by 0.20 mm (95% CI: -0.14; -0.25). These associations were independent of baseline luminal diameter and standard cardiovascular risk factors, including age smoking, hypertension and HDL at baseline.

CONCLUSIONS

Stress from family or work life may accelerate coronary disease processes in women, whereas relative protection may be obtained from a satisfactory job and a happy marriage.