Association between job strain and risk of incident stroke: A meta-analysis

Association of life stressors and suicidal ideation with long-term outcomes in patients with acute coronary syndrome and stroke

BACKGROUND

Life stressors are recognized as risk factors for the onset and prognosis of cardio-cerebrovascular events; however few studies have investigated the combined effect of life stressors and suicidal ideation (SI) on the long-term prognosis of patients with cardio- or cerebrovascular diseases.

METHODS

A total of 1152 acute coronary syndrome (ACS) patients and 396 stroke patients were recruited from a tertiary university hospital in Korea at two weeks post-disease onset. Life stressors were assessed using the List of Threatening Events Questionnaire, and SI was evaluated using the "suicidal thoughts" item of the Montgomery-Åsberg Depression Rating Scale. Long-term outcomes were examined, with major adverse cardiac event (MACE) assessed over 5-12 years following ACS, and cerebro-cardiovascular events (CCVEs) assessed over 8-14 years following stroke. Cox regression models, adjusted for a range of covariates affecting life stressor, SI and long-term outcomes, were employed.

RESULTS

In two independent cohorts, consistent associations were observed between life stressors and long-term outcomes. Life stressors were significantly associated with poor long-term composite outcomes, including MACE in ACS patients and CCVEs in stroke patients, particularly among those with SI at two weeks post-ACS or stroke. A significant interactive effect between life stressors and SI was observed only in ACS patients after adjustment for covariates.

CONCLUSIONS

Evaluating life stressors and SI during acute phase of cardio-cerebrovascular events can help identify high-risk patients for poor long-term cardio-cerebrovascular outcomes, enabling the implementation of intensive management strategies.

List of occupational diseases among farmers in Korea: a literature review

A comprehensive list of occupational diseases among farmers is crucial for both compensation and prevention efforts. In Korea, most farmers are self-employed, and some occupational diseases are compensated through farmer safety insurance. However, it is not harmonized with industrial accident compensation insurance and does not adequately reflect the true burden of occupational diseases among farmers. To address this gap, the authors compiled a list of occupational diseases tailored to Korean farmers by reviewing the International Labor Organization's list of occupational diseases, the Korean Industrial Accident Compensation Insurance List, the occupational disease lists of other countries, and relevant literature on farmers' work-related diseases.

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

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

COVID-19 and stroke in women: impact on clinical, psychosocial and research aspects

Despite the growing interest in gender medicine, the influence of sex and gender on human diseases, including stroke, continues to be underestimated and understudied. The COVID-19 pandemic has overall impacted not only the occurrence and management of stroke but has also exacerbated sex and gender disparities among both patients and healthcare providers. This paper aims to provide an updated overview on the influence of sex and gender in stroke pathophysiology and care during COVID-19 pandemic, through biological, clinical, psychosocial and research perspectives. Gender equity and awareness of the importance of sexual differences are sorely needed, especially in times of health crisis but have not yet been achieved to date. To this purpose, the sudden yet worldwide diffusion of COVID-19 represents a unique learning experience that highlights critical unmet needs also in gender medicine. The failures of this recent past should be kept as food for thought to inspire proper strategies reducing inequalities and to address women's health and wellbeing issues, particularly in case of future pandemics.

Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration

By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.

Impact of Poverty on Stroke Recurrence: A Population-Based Study

BACKGROUND AND OBJECTIVES

Poverty is associated with greater stroke incidence. The relationship between poverty and stroke recurrence is less clear.

METHODS

In this population-based study, incident strokes within the Greater Cincinnati/Northern Kentucky region were ascertained during the 2015 study period and followed up for recurrence until December 31, 2018. The primary exposure was neighborhood socioeconomic status (nSES), defined by the percentage of households below the federal poverty line in each census tract in 4 categories (≤5%, >5%-10%, >10%-25%, >25%). Poisson regression models provided recurrence rate estimates per 100,000 residents using population data from the 2015 5-year American Community Survey, adjusting for age, sex, and race. In a secondary analysis, Cox models allowed for the inclusion of vascular risk factors in the assessment of recurrence risk by nSES among those with incident stroke.

RESULTS

Of 2,125 patients with incident stroke, 245 had a recurrent stroke during the study period. Poorer nSES was associated with increased stroke recurrence, with rates of 12.5, 17.5, 25.4, and 29.9 per 100,000 in census tracts with ≤5%, >5%-10%, >10%-25%, and >25% below the poverty line, respectively (p < 0.01). The relative risk (95% CI) for recurrent stroke among Black vs White individuals was 2.54 (1.91-3.37) before adjusting for nSES, and 2.00 (1.47-2.74) after adjusting for nSES, a 35.1% decrease. In the secondary analysis, poorer nSES (HR 1.74, 95% CI 1.10-2.76 for lowest vs highest category) and Black race (HR 1.31, 95% CI 1.01-1.70) were both independently associated with recurrence risk, though neither retained significance after full adjustment. Age, diabetes, and left ventricular hypertrophy were associated with increased recurrence risk in fully adjusted models.

DISCUSSION

Residents of poorer neighborhoods had a dose-dependent increase in stroke recurrence risk, and neighborhood poverty accounted for approximately one-third of the excess risk among Black individuals. These results highlight the importance of poverty, race, and the intersection of the 2 as potent drivers of stroke recurrence.

An urgent call to address work-related psychosocial hazards and improve worker well-being

Work-related psychosocial hazards are on the verge of surpassing many other occupational hazards in their contribution to ill-health, injury, disability, direct and indirect costs, and impact on business and national productivity. The risks associated with exposure to psychosocial hazards at work are compounded by the increasing background prevalence of mental health disorders in the working-age population. The extensive and cumulative impacts of these exposures represent an alarming public health problem that merits immediate, increased attention. In this paper, we review the linkage between work-related psychosocial hazards and adverse effects, their economic burden, and interventions to prevent and control these hazards. We identify six crucial societal actions: (1) increase awareness of this critical issue through a comprehensive public campaign; (2) increase etiologic, intervention, and implementation research; (3) initiate or augment surveillance efforts; (4) increase translation of research findings into guidance for employers and workers; (5) increase the number and diversity of professionals skilled in preventing and addressing psychosocial hazards; and (6) develop a national regulatory or consensus standard to prevent and control work-related psychosocial hazards.

Occupational Risk Factors for Stroke: A Comprehensive Review

For primary prevention, it is important for public health and clinical medicine to identify and characterize modifiable risk factors of stroke. In existing literature, the impact of occupational variables on ischemic and hemorrhagic stroke has been extensively studied. This review summarizes the available data on the significance of occupational variables in stroke. The results of this review suggest that there is sufficient evidence for the relationship between increased risk of stroke and job stress, working in extreme temperatures, long working hours, and/or shift work. The association between long working hours and occupational exposure to noise and chemicals remains inconclusive although several studies have reported this finding. This review will act as a step toward future research and provide information that may serve as a baseline for developing targeted interventions to prevent stroke in the working population.

Social inequalities, stressful work and non-fatal cardiovascular disease: follow-up findings from the CONSTANCES Study

BACKGROUND

Studies show that a disadvantaged socioeconomic position (SEP) and psychosocial stress at work are both independently associated with an increased risk of cardiovascular disease (CVD). But it is not clear if the effect of stress at work on CVD varies by SEP.

METHODS

We used baseline and follow-up data from the French population-based cohort study CONSTANCES, including 48 383 employed women and men aged 30-70 years. Three SEP indicators (education, income, occupation), stressful psychosocial work as measured by effort-reward imbalance, pre-existing CVD and confounders were assessed at baseline, and incident non-fatal CVD events reported during annual follow-up (up to five follow-ups) were used as outcomes. The effect modification hypothesis was both investigated on an additive and multiplicative scale.

RESULTS

SEP was inversely associated with CVD risk (eg, for low vs high income, OR 1.28 (95% CI 1.12 to 1.46)), and for all three components of stressful work CVD risks were significantly increased (eg, for effort-reward ratio OR 1.26 (95% CI 1.17 to 1.36)). Employees with a disadvantaged SEP showed moderately increased effect sizes of stressful work on CVD. However, no clear evidence of an effect modification was found.

CONCLUSIONS

Disadvantaged SEP and stressful work contribute to higher CVD risk in this cohort. Despite moderately increased effect sizes for disadvantaged SEP groups, no evidence was found to support an effect modification hypothesis.

Guess What We Can Hear-Novel Voice Biomarkers for the Remote Detection of Disease

The advancement of digital biomarkers and the provision of remote health care greatly progressed during the coronavirus disease 2019 global pandemic. Combining voice/speech data with artificial intelligence and machine-based learning offers a novel solution to the growing demand for telemedicine. Voice biomarkers, obtained from the extraction of characteristic acoustic and linguistic features, are associated with a variety of diseases and even coronavirus disease 2019. In the current review, we (1) describe the basis on which digital voice biomarkers could facilitate "telemedicine," (2) discuss potential mechanisms that may explain the association between voice biomarkers and disease, (3) offer a novel classification system to conceptualize voice biomarkers depending on different methods for recording and analyzing voice/speech samples, (4) outline evidence revealing an association between voice biomarkers and a number of disease states, and (5) describe the process of developing a voice biomarker from recording, storing voice samples, and extracting acoustic and linguistic features relevant to training and testing deep and machine-based learning algorithms to detect disease. We further explore several important future considerations in this area of research, including the necessity for clinical trials and the importance of safeguarding data and individual privacy. To this end, we searched PubMed and Google Scholar to identify studies evaluating the relationship between voice/speech features and biomarkers and various diseases. Search terms included digital biomarker, telemedicine, voice features, voice biomarker, speech features, speech biomarkers, acoustics, linguistics, cardiovascular disease, neurologic disease, psychiatric disease, and infectious disease. The search was limited to studies published in English in peer-reviewed journals between 1980 and the present. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.

Work-Related Psychosocial Factors and Global Cognitive Function: Are Telomere Length and Low-Grade Inflammation Potential Mediators of This Association?

The identification of modifiable factors that could maintain cognitive function is a public health priority. It is thought that some work-related psychosocial factors help developing cognitive reserve through high intellectual complexity. However, they also have well-known adverse health effects and are considered to be chronic psychosocial stressors. Indeed, these stressors could increase low-grade inflammation and promote oxidative stress associated with accelerated telomere shortening. Both low-grade inflammation and shorter telomeres have been associated with a cognitive decline. This study aimed to evaluate the total, direct, and indirect effects of work-related psychosocial factors on global cognitive function overall and by sex, through telomere length and an inflammatory index. A random sample of 2219 participants followed over 17 years was included in this study, with blood samples and data with cognitive function drawn from a longitudinal study of 9188 white-collar workers (51% female). Work-related psychosocial factors were evaluated according to the Demand-Control-Support and the Effort-Reward Imbalance (ERI) models. Global cognitive function was evaluated with the validated Montreal Cognitive Assessment (MoCA). Telomere length and inflammatory biomarkers were measured using standardised protocols. The direct and indirect effects were estimated using a novel mediation analysis method developed for multiple correlated mediators. Associations were observed between passive work or low job control, and shorter telomeres among females, and between low social support at work, ERI or iso-strain, and a higher inflammatory index among males. An association was observed with higher cognitive performance for longer telomeres, but not for the inflammatory index. Passive work overall, and low reward were associated with lower cognitive performance in males; whereas, high psychological demand in both males and females and high job strain in females were associated with a higher cognitive performance. However, none of these associations were mediated by telomere length or the inflammatory index. This study suggests that some work-related psychosocial factors could be associated with shorter telomeres and low-grade inflammation, but these associations do not explain the relationship between work-related psychosocial factors and global cognitive function. A better understanding of the biological pathways, by which these factors affect cognitive function, could guide future preventive strategies to maintain cognitive function and promote healthy aging.

Does Weekends Effect Exist in Asia? Analysis of Endovascular Thrombectomy for Acute Ischemic Stroke in A Medical Center

BACKGROUND

Discussing the quality measurements based on interrupted time series in ischemic stroke, delays are often attributed to weekends effect. This study compared the metrics and outcomes of emergent endovascular thrombectomy (EST) during working hours versus non-working hours in the emergency department of an Asian medical center.

METHODS

A total of 297 patients who underwent EST between January 2015 and December 2018 were retrospectively included, with 52.5% of patients presenting during working hours and 47.5% presenting during nights, weekends, or holidays.

RESULTS

Patients with diabetes were more in non-working hours than in working hours (53.9% vs. 41.0%; p=0.026). It took longer during nonworking hours than working hours in door-to -image times (13 min vs. 12 min; p=0.04) and door-to-groin puncture times (median: 112 min vs. 104 min; p=0.042). Significant statistical differences were not observed between the two groups in neurological outcomes, including successful reperfusion and complications such as intracranial hemorrhage and mortality. However, the change in National Institute of Health Stroke Scale (NIHSS) scores in 24 hours was better in the working-hour group than in the nonworking-hour group (4 vs. 2; p=0.058).

CONCLUSION

This study revealed that nonworking-hour effects truly exist in patients who received EST. Although delays in door-to-groin puncture times were noticed during nonworking hours, significant differences in neurological functions and mortality were not observed between working and non-working hours. Nevertheless, methods to improve the process during non-working hours should be explored in the future.

Coping Methods and Satisfaction with Working from Home in Academic Settings during the COVID-19 Pandemic

In this paper, we examined how university staff and students coped with challenges related to working or studying from home during the COVID-19 pandemic, and the level of satisfaction with working from home. An online survey was conducted among faculty, staff, and students at universities in 24 countries (n = 674). The results show that over 80% of the respondents used multiple coping methods. Three clusters of coping methods were generated through factor analysis: (1) social and health factor, with focus on personal health and the social surrounding, (2) activity factor, i.e., being busy with work or studies, finding up-to-date information about COVID-19, while thinking about what one could do rather than what one could not do, and (3) public health factor, which meant trusting health authorities while avoiding misinformation from sources such as social media. Furthermore, 56% of the respondents were very or somewhat satisfied with working from home. Differences in the methods of coping and satisfaction with working from home highlight the need for employers to prepare for working from home beyond the COVID-19 pandemic.

An Explainable Machine Learning Pipeline for Stroke Prediction on Imbalanced Data

Stroke is an acute neurological dysfunction attributed to a focal injury of the central nervous system due to reduced blood flow to the brain. Nowadays, stroke is a global threat associated with premature death and huge economic consequences. Hence, there is an urgency to model the effect of several risk factors on stroke occurrence, and artificial intelligence (AI) seems to be the appropriate tool. In the present study, we aimed to (i) develop reliable machine learning (ML) prediction models for stroke disease; (ii) cope with a typical severe class imbalance problem, which is posed due to the stroke patients' class being significantly smaller than the healthy class; and (iii) interpret the model output for understanding the decision-making mechanism. The effectiveness of the proposed ML approach was investigated in a comparative analysis with six well-known classifiers with respect to metrics that are related to both generalization capability and prediction accuracy. The best overall false-negative rate was achieved by the Multi-Layer Perceptron (MLP) classifier (18.60%). Shapley Additive Explanations (SHAP) were employed to investigate the impact of the risk factors on the prediction output. The proposed AI method could lead to the creation of advanced and effective risk stratification strategies for each stroke patient, which would allow for timely diagnosis and the right treatments.

Mental Stress and Cardiovascular Health-Part I

Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.

Mental Stress and Its Effects on Vascular Health

Coronary artery disease continues to be a major cause of morbidity and mortality despite significant advances in risk stratification and management. This has prompted the search for alternative nonconventional risk factors that may provide novel therapeutic targets. Psychosocial stress, or mental stress, has emerged as an important risk factor implicated in a higher incidence of cardiovascular events, and although our understanding of this far ranging and interesting phenomenon has developed greatly over recent times, there is still much to be learned regarding how to measure mental stress and how it may impact physical health. With the current coronavirus disease 2019 global pandemic and its incumbent lockdowns and social distancing, understanding the potentially harmful biological effects of stress related to life-changing events and social isolation has become even more important. In the current review our multidisciplinary team discusses stress from a psychosocial perspective and aims to define psychological stress as rigorously as possible; discuss the pathophysiologic mechanisms by which stress may mediate cardiovascular disease, with a particular focus to its effects on vascular health; outline existing methods and approaches to quantify stress by means of a vascular biomarker; outline the mechanisms whereby psychosocial stressors may have their pathologic effects ultimately transduced to the vasculature through the neuroendocrine immunologic axis; highlight areas for improvement to refine existing approaches in clinical research when studying the consequences of psychological stress on cardiovascular health; and discuss evidence-based therapies directed at reducing the deleterious effects of mental stress including those that target endothelial dysfunction. To this end we searched PubMed and Google Scholar to identify studies evaluating the relationship between mental or psychosocial stress and cardiovascular disease with a particular focus on vascular health. Search terms included "myocardial ischemia," "coronary artery disease," "mental stress," "psychological stress," "mental∗ stress∗," "psychologic∗ stress∗," and "cardiovascular disease∗." The search was limited to studies published in English in peer-reviewed journals between 1990 and the present day. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.

Evidence From a Systematic Review and Meta-Analysis: Classical Impaired Glucose Tolerance Should Be Divided Into Subgroups of Isolated Impaired Glucose Tolerance and Impaired Glucose Tolerance Combined With Impaired Fasting Glucose, According to the Risk of Progression to Diabetes

BACKGROUND

The American Diabetes Association (ADA) 2003 diagnostic criteria divide impaired glucose tolerance (IGT) into isolated impaired glucose tolerance with normal fasting glucose (I-IGT, IGT+NFG) and impaired glucose tolerance combined with impaired fasting glucose (IGT+IFG), while the World Health Organization (WHO) 1999 criteria do not. The aim of this meta-analysis was to evaluate whether IGT should be divided into I-IGT (IGT+NFG) or IGT+IFG according to their risk of progression to type 2 diabetes.

METHODS

The MEDLINE and EMBASE were searched to identify prospective cohort studies published in English prior to April 18, 2020. Review Manager 5.3 was used to calculate the pooled risk ratios (RRs) and 95% confidence intervals (CIs) as summary statistics for each included study.

RESULTS

Sixteen eligible studies (n = 147,006) were included in the analysis. The subsequent incidence of type 2 diabetes was lower in the I-IGT (IGT+NFG) group than in the IGT+IFG group (0.45 [95% CI 0.37, 0.55] according to WHO 1999 criteria and 0.59 [95% CI 0.54, 0.66] according to ADA 2003 criteria). It was higher in the I-IFG, I-IGT (IGT+NFG), and IGT+IFG groups than in the normoglycemic group (95% CI of 5.53 [3.78, 8.08], 5.21 [3.70, 7.34], and 11.87 [7.33, 19.20] according to the WHO 1999 criteria and 95% CI of 2.66 [2.00, 3.54], 3.34 [2.81, 3.97], and 6.10 [4.72, 7.88] according to the ADA 2003 criteria). In general, the incidence of diabetes in the IGT+IFG group was the highest in the prediabetic population.

CONCLUSIONS

The present meta-analysis suggested that the established WHO diagnostic criteria for IGT should be revised to separately identify individuals with IGT+NFG or IGT+IFG.

The Role of Job Control and Job Demands in Becoming Physically Active during the COVID-19 Pandemic: A Three-Wave Longitudinal Study

Organizational studies suggest that certain psychosocial working conditions are liable to foster positive health outcomes, such as engaging in leisure-time physical activities. However, the psychosocial factors contributing to this improvement remain unexplored, particularly in the workplace and in the context of the decline observed in the physical activity level of the population worldwide. The objective of the study was to examine whether exposure to different combinations of psychosocial working conditions during the COVID-19 pandemic predicts the probability of becoming physically active among Quebec workers. Job demands, job control, and physical activity were assessed three times during the first year of the pandemic via an online questionnaire among physically inactive workers (n = 440). Logistic regression analyses were conducted to examine the associations between various combinations of psychosocial risks and physical activity. A total of 117 participants became physically active during the study. After controlling for covariates, active jobs increased the odds of becoming physically active, compared to high-strain jobs (OR = 2.57 (95% CI 1.13 to 5.87)). Having a highly demanding job may not negatively impact physical activity if workers have enough job control to achieve the required tasks.

Psychosocial stressors at work and inflammatory biomarkers: PROspective Quebec Study on Work and Health

BACKGROUND

Chronic low-grade inflammation has been associated with high risk of several chronic diseases such as cardiovascular diseases, diabetes, depression, and dementia. As low-grade inflammation could be present long before the apparition of the disease, identifying modifiable risk factors could allow to act upstream. Psychosocial stressors at work have been suggested as modifiable risk factors of low-grade inflammation, but few longitudinal studies have evaluated the association between these stressors and inflammatory biomarkers, such as C-reactive protein (CRP) and interleukin-6 (IL-6).

OBJECTIVE

This longitudinal study evaluate the associations between exposure to psychosocial stressors at work and CRP and IL-6, separately and combined into an inflammatory index.

METHODS

Data came from a cohort of 9188 white-collar workers recruited in 1991-1993 (T1) and followed-up after 8 (T2, 1999-2000) and 24 (T3, 2015-2018) years. Participants included in this study were randomly selected at T3 for serum biomarkers studies (n = 2557). CRP and IL-6 were measured using standardized protocols. Psychosocial stressors at work were assessed at T2 according to recognized models: Karasek's Demand-Control-Support model and Siegrist's Effort-Reward Imbalance (ERI) model, using validated questionnaires. High job strain was defined by an exposure to high psychological demand combined with low job control, and iso-strain was defined by an exposure to high job strain combined with low social support at work. ERI was defined by an imbalance between psychological demand and social, economic, and organizational reward. Several covariates were considered including sociodemographic, anthropometric, and lifestyle characteristics, and comorbidities. Prevalence ratios (PRs) and 95% confidence interval (CI) for the highest quartile of CRP, IL-6 and inflammatory index at T3 according to psychosocial stressors at work measured at T2 were calculated using generalized estimating equations. Multiple imputation and inverse probability of censoring weighting were done.

RESULTS

In men, an association was observed between exposure to iso-strain and the inflammatory index (PR of 1.42 (95% CI: 1.06;1.90)), mainly among men aged less than 65 years (PR of 2.00 (95% CI: 1.37;2.92)). In this same age group, associations with inflammatory biomarkers were also observed among men with exposure to ERI, and among women with exposure to low reward at work or moderate social support at work.

CONCLUSION

These results suggest that psychosocial stressors at work may increase low-grade inflammation. However, further studies are needed to corroborate these results and to clarify the potential differences between men and women. As these stressors are frequent and modifiable, their reduction is important for public health and could play a role in the primary prevention of chronic diseases.

Maternal exposure to psychosocial job strain during pregnancy and behavioral problems in the 11-year-old children: a Danish cohort study

Maternal psychosocial stress may impact child neurodevelopment, but little is known regarding psychosocial job strain. We hypothesized high psychosocial job strain during pregnancy was associated with behavioural problems in the 11-year-old children. Mothers in the Danish National Birth Cohort (1996-2002) were included if they worked, provided information on job strain [Karasek's model: high job strain (often job demand/seldom job control) and passive (seldom or sometimes job demands/seldom job control)] during early pregnancy. At the 11-year follow-up, children (N = 30,592), mothers (N = 30,993), and teachers (N = 12,810) responded to the Strength and Difficulties Questionnaire (SDQ), a screening tool for child behaviour. Scores for hyperactivity, conduct, emotional and peer problems were dichotomised [80% (no) vs. 20% (yes)] according to Danish norms (yes/no). Maternal job strain was not associated with behavioural problems with teachers as informants. When assessed by child or mother, high maternal job strain increased risk of child behavioural problems, but risks were more pronounced for mothers in passive jobs [maternal assessment of total difficulties/odds ratio (95% confidence interval): high strain-girls: 1.16 (0.97-1.40); boys: 1.24 (1.02-1.50). Passive girls: 1.43 (1.21-1.68); boys: 1.25 (1.05-1.49)]. This is one of the first studies on this topic. The different types of maternal job strain were partly associated with child behavioural problems at 11 years; more so if mothers worked in passive rather than the hypothesized high strain jobs. Findings showing dependency on informant could not only indicate unmeasured confounding or rater's bias, but also selection in the smaller numbers of teacher informants or different environments of interaction with the children.

Occupational class differences in outcomes after ischemic stroke: a prospective observational study

BACKGROUND

Occupational class is an integral part of socioeconomic status. The studies focused on the occupational difference in ischemic stroke outcome in a Chinese population are limited. We aimed to investigate the associations between occupational class and the prognosis of patients with ischemic stroke in China.

METHODS

We included 1484 ischemic stroke participants (mean age: 63.42 ± 11.26 years) from the prospective cohort study: Infectious Factors, Inflammatory Markers and Prognosis of Acute Ischemic Stroke (IIPAIS). Occupational class was categorized into white-collar workers, blue-collar workers and farmers in our study. Study outcomes were cardiovascular events and all-cause mortality within 12 months after ischemic stroke onset. We applied Cox proportional hazard model to evaluate the associations between the occupational class and study outcomes after ischemic stroke.

RESULTS

Within 12 months after ischemic stroke, there were 106 (7.5%) cardiovascular events and 69 (4.9%) all-cause deaths. The Kaplan-Meier plots showed that white-collar workers had highest risk of cardiovascular events after 12-month follow-up (Log-rank P = 0.02). Multivariate adjusted hazard ratio and 95% confidence intervals (CIs) of farmers versus white-collar workers was 0.43(0.20-0.91) for cardiovascular events. No significant difference showed in blue-collar workers versus white-collar workers, with fully adjusted hazard ratio 0.62(95% CIs, 0.23-1.67).

CONCLUSIONS

Compared with white-collar workers, farmers are associated with less risk of cardiovascular events at 12 months after ischemic stroke, while there are no significant differences in blue-collar workers.

Development Work in Healthcare: What Supportive and Deterrent Factors Do Employees Working in a Hospital Department Experience in an Improved Work Environment?

Work-related mental health issues, accounting for high worker absenteeism in the world's developed economies, are increasing, with the main cause being workplace conditions. The health services sector is especially experiencing great problems with this, because of challenging psychosocial working conditions. The aim of this study was to explore employees' experiences of development work with a focus on the work environment within a hospital department with an outspoken special development assignment. The special assignment was decided by the highest management at the hospital and concerned work environment, caring processes, and ways of organizing the work. Eleven employees completed two individually semi-structured interviews, approximately 7 and 13 months after the start of the special assignment at the department. Interviews were analyzed using thematic analysis. The results reveal that both internal and external aspects influence the development work and highlight the importance of viewing the local development work in relation to how the rest of the organization functions. Important factors and conditions for a supportive and change-friendly work culture are discussed, as well as the need to plan for integration and change to create conditions for successful implementation of the results from organizational development and change initiatives.

Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution

OBJECTIVE

To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention.

DEVELOPMENT

We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed.

CONCLUSIONS

Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.

Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind-Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women's brains are more sensitive to factors affecting mental health such as depression and stress than men's brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women's mental health can contribute to preventing cardiovascular disease. Mind-body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women's cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind-body intervention in modulating these factors.

Is job strain associated with a higher risk of type 2 diabetes mellitus? A systematic review and meta-analysis of prospective cohort studies

Objectives:

Epidemiological studies have explored the relationship between work-related stress and the risk of type 2 diabetes mellitus (T2DM), but it remains unclear on whether work-related stress could increase the risk of T2DM. We aimed to evaluate the association between job strain and the risk of T2DM.

Methods:

We searched PubMed and Web of Science up to April 2019. Summary risk estimates were calculated by random-effect models. And the analysis was also conducted stratifying by gender, study location, smoking, drinking, body mass index, physical activity, family history of T2DM, education and T2DM ascertainment. Studies with binary job strain and quadrants based on the job strain model were analyzed separately.

Results:

A total of nine studies with 210 939 participants free of T2DM were included in this analysis. High job strain (high job demands and low control) was associated with the overall risk of T2DM compared with no job strain (all other combinations) [relative risk (RR) 1.16, 95% confidence interval (CI) 1.03–1.31], and the association was more evident in women (RR 1.48, 95% CI 1.02–2.14). A statistically significant association was also observed when using high strain as a category (job strain quadrants) rather than binary variable (RR 1.62, 95% CI 1.04–2.55) in women but not men.

Conclusions:

Our study suggests that job strain is an important risk factor for T2DM, especially among women. Appropriate preventive interventions in populations with high job strain would contribute to a reduction in T2DM risk.

Health problems among Swedish ambulance personnel: long-term risks compared to other professions in Sweden - a longitudinal register study

Objectives. This study aimed to investigate whether Swedish ambulance personnel differ in the extent of suffering from health problems compared to other occupational groups. Methods. Two cohorts of ambulance personnel from 2001 and 2008, with 1778 and 2753 individuals, respectively, were followed regarding assignment of diagnostic coding (International Classification of Diseases codes) until 2016. These two cohorts represent all who were employed as ambulance personnel by public employers during these years. Two comparison groups were added: other healthcare workers and other professions. All data were retrieved from national registers. The χ² test was were used for statistical calculation. Results. Swedish ambulance personnel are at a significantly higher risk of being affected by 'Paroxysmal tachycardia, atrial fibrillation and flutter, other cardiac arrhythmias', by 'Other intervertebral disc disorders' and by 'Arthropathies', when compared to both comparison groups in both cohorts. Almost similar results were seen for 'Gonarthrosis' and for 'Dorsopathies'. Conclusions. Swedish ambulance personnel run the risk of being affected by certain diseases and injuries to a greater extent compared to other professions.

Effects of Life Events and Social Isolation on Stroke and Coronary Heart Disease

The current coronavirus disease 2019 (COVID-19) pandemic represents a severe, life-changing event for people across the world. Life changes may involve job loss, income reduction due to furlough, death of a beloved one, or social stress due to life habit changes. Many people suffer from social isolation due to lockdown or physical distancing, especially those living alone and without family. This article reviews the association of life events and social isolation with cardiovascular disease, assembling the current state of knowledge for stroke and coronary heart disease. Possible mechanisms underlying the links between life events, social isolation, and cardiovascular disease are outlined. Furthermore, groups with increased vulnerability for cardiovascular disease following life events and social isolation are identified, and clinical implications of results are presented.

Psychosocial Work Factors of the Job Strain Model and All-Cause Mortality: The STRESSJEM Prospective Cohort Study

OBJECTIVE

The objectives were to examine the prospective associations between psychosocial work factors of the job strain model and all-cause mortality in a national representative cohort of French employees using various measures of time-varying exposure.

METHODS

The study was based on a sample of 798,547 men and 697,785 women for which data on job history from 1976 to 2002 were linked to mortality data from the national death registry. Psychosocial work factors from the validated job strain model questionnaire were imputed using a job-exposure matrix. Three time-varying measures of exposure were explored: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were performed to study the associations between psychosocial work factors and mortality.

RESULTS

Within the 1976-2002 period, 88,521 deaths occurred among men and 28,921 among women. Low decision latitude, low social support, job strain, isostrain, high strain, and passive job were found to be risk factors for mortality. The model using current exposure was the best relative-quality model. The associations of current exposure to job strain and mortality were found to have hazard ratios of 1.30 (95% confidence interval [CI] = 1.24-1.36) among men and 1.15 (95% CI = 1.06-1.25) among women. The population fractions of mortality attributable to job strain were 5.64% (95% CI = 4.56%-6.71%) among men and 4.13% (95% CI = 1.69%-6.71%) among women.

CONCLUSIONS

This study supports the role of the psychosocial work factors of the job strain model on all-cause mortality. Preventive intervention to improve the psychosocial work environment may help to prevent mortality in working populations.

All-cause mortality and the time-varying effects of psychosocial work stressors: A retrospective cohort study using the HILDA survey

The effects of poor-quality work (high job demands, low job control, job insecurity, and effort-reward imbalance) are harmful to health but it isn't clear whether exposure to these psychosocial work stressors over time translates into increased risk of mortality.

OBJECTIVE

We investigated the effect of time-varying psychosocial work stressors on mortality using data from a longitudinal cohort of working Australians by examining association between job control, job demands, job insecurity, unfair pay overtime and all-cause mortality. We examined whether gender modified these relationships.

METHODS

Over 20,000 participants from the Household Income and Labour Dynamics in Australia survey with self-reported repeated exposure measures were followed for 15 years. Survival analysis models with baseline hazard specified by the Weibull distribution were used to examine the association between psychosocial work stressors over time and mortality.

RESULTS

Low job control (HR=1.39; 95% CI: 1.06-1.83) and job insecurity (1.36; 1.06-1.74) were associated with increased risk of mortality. High job demands (1.01; 0.75-1.34) and effort-reward unfairness (1.20; 0.90-1.59) were not associated with mortality. The effect of job insecurity was attenuated (1.20; 0.93-1.54) after controlling for sociodemographic and health risk factors. Male participants exposed to low job control and job insecurity had an 81% and 39% increase risk of mortality, respectively.

CONCLUSIONS

Long-term exposure to low job control and low job security is associated with increased risk of all-cause mortality. Effects were largely restricted to males and persisted after adjustments for sociodemographic and health characteristics. The lack of effects observed for females may have been due to the small number of deaths in females. Awareness of implications of the adverse effects of psychosocial work stressors on health and mortality in workplaces, and interventions to improve job control and job security could contribute to better health and wellbeing, reducing the effect of psychosocial work stressors on mortality.

Job strain and incident cardiovascular disease: the confounding and mediating effects of lifestyle habits. An overview of systematic reviews

This overview of systematic reviews (SR) aims to determine how the potential confounding and/or mediating effects of lifestyle habits were taken into consideration in SR examining the job strain effect on cardiovascular disease (CVD) incidence. Thirteen SR were identified. Lifestyle habits were often considered as confounders (n = 8). Authors reported that the job strain and CVD association remained after adjusting for lifestyle habits (n = 6); discussed lifestyle habits as potential mediators (n = 8) and postulated a total effect underestimation due to over-adjustment (n = 4). None investigated the magnitude of this bias.The effect of job strain on CVD is independent of lifestyle habits, supporting its causal effect on CVD. Lifestyle habits are also potential mediators. The current practice of adjusting for lifestyle habits can therefore lead to an underestimation of the total effect. Research using meditation methods is needed.

Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution

OBJECTIVE

To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention.

DEVELOPMENT

We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed.

CONCLUSIONS

Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.

Association between job strain and sick leave: a systematic review and meta-analysis of prospective cohort studies

OBJECTIVES

Sick leave imposes large costs on society, and job strain is one of the factors leading to sick leave. A systematic review and meta-analysis of longitudinal studies was conducted to address job strain and its association with sick leave.

STUDY DESIGN

This is a systematic review and meta-analysis.

METHODS

PubMed and Scopus databases were reviewed, in addition to searches in Google Scholar and ResearchGate to ensure the inclusion of any grey literature articles. After screening the studies, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles, articles with longitudinal design were found desirable for meta-analysis. The risk ratio (RR) and 95% confidence interval (CI) were calculated, and publication bias was examined.

RESULTS

Eighteen longitudinal cohort studies were selected. Job strain and sick leave were found to be associated, and the RR of this association was equal to 1.44. Risk of sick leave based on job strain in men and women was equal to 1.66 (95% CI: 1.15-2.40) and 1.16 (95% CI: 1.08-1.24), respectively. The results showed no publication bias as per Begg's test.

CONCLUSIONS

Job strain was associated with an increased risk of sick leave. Occupational conditions have significant effects on the risk of sick leave-one of which is job strain. Therefore, improving organisational conditions can have a significant impact on reducing sick leave.

Psychosocial work exposures of the job strain model and cardiovascular mortality in France: results from the STRESSJEM prospective study

Objectives:

The study aims to explore the prospective associations of the psychosocial work exposures of the job strain model with cardiovascular mortality, including mortality for ischemic heart diseases (IHD) and stroke, using various time-varying exposure measures in the French working population of employees.

Methods:

The study was based on a cohort of 798 547 men and 697 785 women for which job history data from 1976 to 2002 were linked to mortality data and causes of death from the national death registry. Psychosocial work exposures from the validated job strain model questionnaire were assessed using a job-exposure matrix (JEM). Three time-varying measures of exposure were studied: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were used to examine the associations between psychosocial work exposures and cardiovascular mortality.

Results:

Within the 1976–2002 period, there were 19 264 cardiovascular deaths among men and 6181 among women. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with cardiovascular mortality. Most of these associations were also observed for IHD and stroke mortality. The comparison between the different exposure measures suggested that current exposure may be more important than cumulative (or past) exposure. The population fractions of cardiovascular mortality attributable to job strain were 5.64% for men and 6.44% for women.

Conclusions:

Psychosocial work exposures of the job strain model may play a role in cardiovascular mortality. The estimated burden of cardiovascular mortality associated with these exposures underlines the need for preventive policies oriented toward the psychosocial work environment.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Is job strain a risk factor for musculoskeletal pain? A systematic review and meta-analysis of 21 longitudinal studies

OBJECTIVE

Given that job strain can be a risk factor for health, the researchers looked at the meta-analysis in which consequences of musculoskeletal pain in job strain is reviewed.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

After searching in databases based on keywords, studies were retrieved until January 2019. The extracted studies were combined altogether and the risk ratio was calculated. In addition, additional analysis was conducted at the end.

RESULTS

The results showed that job strain as a risk factor for musculoskeletal pain was 1.62. The risk ratio is equal to 1.38 in men and 1.28 in women. Begg (P = 0.629) and Egger (P = 0.251) tests were not significant but trim-and-fill method imputed 9 missing studies.

CONCLUSIONS

Job strain was a risk factor for physical health and increased the risk of musculoskeletal pain. Therefore, it seems psychologically healthy work environment is essential for the prevention of health problems.

Job strain and mortality ratio: a systematic review and meta-analysis of cohort studies

OBJECTIVES

Research has explored the relationship between job strain and adverse effects on physical and psychological health. Accordingly, the effects of job strain on mortality risk were pooled based on longitudinal studies.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Both researchers searched for published articles in scientific databases until May 2019. Then, the articles were screened based on the inclusion and exclusion criteria. The results were combined, and analyses of subgroups and reviewing the bias of the publication were performed as well.

RESULTS

Seventeen longitudinal studies included in the meta-analysis were from three continents: Europe, Asia, and America. The risk ratio (RR) of mortality based on job strain was equal to 1.20, with a confidence interval (CI) of 1.04-1.37 (P = 0.00.10). In men, the RR is 1.21, and the CI is 1.02-1.44 (P = 0.032), and in women, the RR is 0.97 and CI is 0.84-1.12 (P = 0.686). Evaluation of publication bias indicated nothing significant.

DISCUSSION

Based on the findings, it was found that job strain was a risk factor for mortality, and this finding was more appropriate for men. Hence, reducing job strain can be a deterrent against the dangers that threaten health.

Stroke in Women

PURPOSE OF REVIEW

This article reviews sex differences in stroke risk and presentation, with a particular emphasis on the unique risk factors women experience throughout the lifespan.

RECENT FINDINGS

Although prior studies suggested women have worse outcomes after stroke, it is now clear that age, prestroke functional status, and comorbidities explain many of the differences between men and women in stroke severity, functional outcomes, and mortality. Several meta-analyses and large cohort studies have evaluated the risk factors for women related to reproductive factors and found that fewer years between menarche and menopause, pregnancy complications (preeclampsia/eclampsia, preterm delivery, and stillbirth), oophorectomy, hormone replacement therapy use, and younger age at menopause all increase the risk of stroke. Although the nonreproductive risks of stroke overlap between men and women, those with greater impact on women include age, hypertension, atrial fibrillation, socioeconomic status, and depression.

SUMMARY

Significant sex differences are observed in risk factors of stroke and stroke outcome. Including this information in the clinical assessment of the individual patient may support development of more effective prevention plans.

Serum 25-Hydroxyvitamin D Levels and Depression in Older Adults: A Dose-Response Meta-Analysis of Prospective Cohort Studies

OBJECTIVE

The association between serum vitamin D and risk of depression in older adults is controversial. We performed a dose-response meta-analysis of prospective cohort studies to examine the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and the risk of depression in older population.

METHODS

Studies published before February 2018 in the PubMed, Cochrane Library, Web of Science, PsycINFO, and EMBASE databases were systematically searched. Prospective cohort studies that examined the association between serum 25(OH)D levels and the risk of depression in older adults were included. A random-effects model was used to calculate the pooled hazard ratio and the corresponding 95% confidence intervals. A nonlinear dose-response association was examined using restricted cubic spline functions.

RESULTS

Six prospective studies covering 16,287 older adults with 1,157 cases of depression were included and analyzed. The pooled hazard ratio of depression for per 10-ng/mL increment in serum 25(OH)D was 0.88 (95% confidence intervals: 0.78-0.99, I² = 79.0%, p <0.001 for heterogeneity). A linear dose-response association between serum 25(OH)D concentrations and incident depression was observed (p = 0.96 for nonlinearity).

CONCLUSION

Serum 25(OH)D concentration is negatively associated with the risk of depression in older adults. This meta-analysis suggests that increasing 25(OH)D levels may be a useful approach to reduce the risk of depression in older adults and highlights the need for further large-scale clinical studies.

Prospective associations of psychosocial work exposures with mortality in France: STRESSJEM study protocol

INTRODUCTION

Although evidence has been provided on the associations between psychosocial work exposures and morbidity outcomes in the literature, knowledge appears much more sparse on mortality outcomes. The objective of STRESSJEM is to explore the prospective associations between psychosocial work exposures and mortality outcomes among the national French working population. In this paper, we describe the study protocol, study population, data sources, method for exposure assessment, data analysis and future plans.

METHODS AND ANALYSIS

Data sources will include: the data from the national SUMER survey from DARES on the evaluation of psychosocial work exposures and the data from the COSMOP programme from Santé publique France linking job history (DADS data from INSEE) and mortality according to causes of death (data from the national death registry, INSERM-CépiDc). A sample of 1 511 456 individuals will form the studied prospective cohort for which data are available on both job history and mortality over the period 1976-2002. Psychosocial work exposures will be imputed via a job-exposure matrix using three job title variables that are available in both the SUMER and COSMOP data sets. Our objectives will be to study the associations between various psychosocial work exposures and mortality outcomes. Psychosocial work exposures will include the job strain model factors as well as other psychosocial work factors. Various measures of exposure over time will be used. All-cause and cause-specific mortality will be studied.

ETHICS AND DISSEMINATION

Both the SUMER survey and the COSMOP programme have been approved by French ethics committees. Dissemination of the study results will include a series of international peer-reviewed papers and at least one paper in French. The results will be presented in national and international conferences. This project will offer a unique opportunity to explore mortality outcomes in association with psychosocial work exposures in a large national representative sample of the working population.

A review of psychosocial factors and stroke: A new public health problem

The role of psychosocial factors (PSF) in increased risk of stroke is a novel public health challenge, but unclear definitions for PSF and the multiple stroke subtypes have led to inconsistent reports. A review of this issue is therefore warranted.

METHODS

Several databases were used for this narrative systematic review (Medline, Embase and Cochrane Library). Two independent reviewers evaluated articles from between 2001 and 2018 on the themes of PSF and stroke/transient ischemic attack (TIA). PSF criteria were job strain, psychological interpersonal and behavioral stress, and social deprivation. Ischemic and hemorrhagic stroke and TIA subtypes were also identified.

RESULTS

Forty-five cohorts, five case-control studies and two meta-analyses were included. Despite mixed results, PSF were associated with an increased risk of ischemic and hemorrhagic stroke in populations of all ages, and more predominantly in women.

CONCLUSION

This broad review shows that the presence of PSF is associated with an increased risk stroke and TIA. As such, PSF must figure in both public health policy and stroke prevention programs, similar to other established metabolic and environmental factors.

A Study on the Correlation between Working Pressure and Job Satisfaction from the Viewpoint of Work Exhaustion

Under the rapid industrialization, the country has become a major high-tech industry in Asia. Being an important industry in domestic strategic development, high-tech industry attracts a lot of manpower. During the depression after the financial crisis, organizations’ adoption of layoffs and unpaid leave to increase work or transfer positions induced employees’ worries. There was news about hi-tech millionaires dying young of overwork in past years. Working pressure therefore became the major problem emphasized by human resource managers. Stress management related issues have been discussed academically or practically in recent years. Aiming at high-tech employees of Hsinchu Science Park in Taiwan, 500 copies of questionnaire are distributed and 387 valid copies are retrieved, with the retrieval rate 77%. The research results reveal 1.positive relations between working pressure and work exhaustion, 2.negative relations between work exhaustion and job satisfaction, and 3.negative relations between working pressureandjob satisfaction. According to the results, suggestions are proposed, expecting to assist high-tech industry in improving employees’working pressure to largely benefit employee health and industrial yield.

[The role of stress factors and genetic predisposition in the development of stroke in patients with essential hypertension]

To study the interaction of polymorphic markers of matrix metalloproteinases (MMP) and chronic stress in the development of stroke associated with hypertension. MATERIAL AND METHODS: A total of 830 patients, including 303 patients with ischemic stroke associated with essential hypertension (EH) and 527 patients with EH without stroke, were examined. The study of metalloproteinases SNP was carried out using real-time PCR. The functional significance and influence of polymorphic loci on gene expression was studied using of HaploReg (v4.1) (http://archive.broadinstitute.org) and GTEx-portal (http://www.gtexportal.org). RESULTS AND CONCLUSION: An association of the genotype GG (rs11568818) of MMP7 with a high risk of stroke in patients exposed to regular stress (OR=1.71) was observed. It was found that allele 5A and genotype 5A/5A (rs3025058) of MMP3 had a protective effect on the development of stroke in patients without regular stress in the anamnesis (OR=0.73 and OR=0.60, respectively). Those SNPs are localized in the region of histone proteins H3K4me1 and H3K4me3, in the region of hypersensitivity to DNase-1, in the region of binding of regulatory proteins and transcription factors. The polymorphic locus rs11568818 is associated with the expression level of MMP7.

Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study

BACKGROUND

Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

METHODS

In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

RESULTS

We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19-2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9-44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18-3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74-21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06-1·41).

INTERPRETATION

In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

FUNDING

NordForsk, UK Medical Research Council, and Academy of Finland.

Occupational Physical Activity in Young Adults and Stroke: Was It Due to My Job?

The association of physical activity and stroke among working young adults and vice versa has increasingly empathized in recent years. Lack of physical activity, along with many other modifiable risk factors, such as hypertension, obesity, atherosclerosis, and diabetes, contributes through vascular dysfunction to the development of adverse cerebrovascular events in the future and has always been a topic of interest in the fields of neurology and stroke rehabilitation. We wrote this review article to elaborate on this relationship in detail. This article suggests that the physical activity role in stroke development and the rehabilitation process has a diverse role, where individuals with low physically active occupations are prone to develop a stroke more readily in comparison with other workers who have a moderate amount of physical activity in their jobs; however, less mobility appeared to be harmful too soon after stroke. In addition, we elucidate the effects of physical activity on sympathetic activity and remodeling of vascular response. Alterations in the neuroendocrine system include several factors. This includes harmful changes caused by increasing levels of epinephrine and norepinephrine. These changes are seen with stress-induced cerebrovascular injury and are often elevated in post-stroke patients. In contrast, post-stroke patients engaged in physical activity may prevent these harmful neurotrophic factors by reducing the elevated levels of epinephrine and norepinephrine. However, we need more studies in the near future to further explore this association process. Therefore, we recommend more research to explore the relationship of occupation-related factors and adverse stroke outcomes.

Occupational Stress and Hypertension among Railway Loco Pilots and Section Controllers

Introduction:

A cross-sectional study on occupational stress was conducted on loco pilots in 2008, in view of loco pilots being one of the high strain jobs in Indian Railways. Subsequently, a comparative cross-sectional study on occupational stress was conducted among section controllers in 2011, which is another high strain job of Indian Railways.

Objective:

The studies were conducted to analyze and compare occupational stress and hypertension.

Setting and Design:

A cross-sectional study on occupational stress and hypertension was conducted among 230 loco pilots in 2008, and subsequently, a comparative cross-sectional study was conducted among 82 section controllers in 2011.

Materials and Methods:

A closed end 24 item questionnaire on occupational stress was administered. Systolic blood pressure above 140 mmHg and diastolic blood pressure above 90 mmHg were considered as hypertension as per the VII Joint National Committee. Chi-square test and t-test were used for testing significance at P < 0.05.

Results:

The mean stress score was 8.56 in loco pilots and 7.32 in section controllers. The number of loco pilots with more than 12 stress factors was 49 (21.3%) and the number of section controllers with more than 12 stress factors was 7 (8.5%). The number employees with more than 12 stress factors in different categories of loco pilots were 30 (32%) in the goods category, 12 (12%) in the mail/passenger category, and 7 (19%) in the shunter category, and 3 (11%) in the supervisory category and 4 (7%) in the on-board category of section controllers. The prevalence of hypertension in loco pilots was 36.52% (84) and in the section controllers was 53.66% (44). The prevalence of hypertension in the category with more than 12 stress factors was 30.61% (15) in the loco pilots and 28.57% (2) in the section controllers. The prevalence of hypertension in the both the study groups were higher in the older age, with a family history of hypertension, and with a body mass index of more than 25 kg/m². The mean occupational stress and employees with more than 12 stress factors were higher in the loco pilots group. The goods category of loco pilots had highest stress factors. The prevalence of hypertension was high in the category with risk factors such as older age, family history of hypertension and BMI above 25 kg/m².

A Japanese Stress Check Program screening tool predicts employee long-term sickness absence: a prospective study

Objectives:

On December 1, 2015, the Japanese government launched the Stress Check Program, a new occupational health policy to screen employees for high psychosocial stress in the workplace. As only weak evidence exists for the effectiveness of the program, we sought to estimate the risk of stress-associated long-term sickness absence as defined in the program manual.

Methods:

Participants were 7356 male and 7362 female employees in a financial service company who completed the Brief Job Stress Questionnaire (BJSQ). We followed them for 1 year and used company records to identify employees with sickness absence of 1 month or longer. We defined high-risk employees using the BJSQ and criteria recommended by the program manual. We used the Cox proportional regression model to evaluate the prospective association between stress and long-term sickness absence.

Results:

During the follow-up period, we identified 34 male and 35 female employees who took long-term sickness absence. After adjustment for age, length of service, job type, position, and post-examination interview, hazard ratios (95% confidence intervals) for incident long-term sickness absence in high-stress employees were 6.59 (3.04-14.25) for men and 2.77 (1.32-5.83) for women. The corresponding population attributable risks for high stress were 23.8% (10.3-42.6) for men and 21.0% (4.6-42.1) for women.

Conclusions:

During the 1-year follow-up, employees identified as high stress (as defined by the Stress Check Program manual) had significantly elevated risks for long-term sickness absence.

Stroke in women - from evidence to inequalities

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke - including diabetes mellitus and atrial fibrillation - are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials - despite governmental actions highlighting the need to include both men and women in clinical trials - resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women.