Ideal cardiovascular health and psychosocial risk factors among Finnish female municipal workers.

AIMS: Ideal cardiovascular health has been defined by the American Heart Association as the absence of disease and the presence of seven key health factors and behaviours. However, little is known about the mental aspects associated with ideal cardiovascular health metrics. The objective of this study was to assess the relationships between psychosocial risk factors and ideal cardiovascular health metrics among Finnish women at municipal work units. METHOD: A cross-sectional study was conducted in Finland among 732 female employees (mean±SD age 48±10 years) from ten work units in 2014. Ideal cardiovascular health metrics were evaluated with a physical examination, laboratory tests, medical history and self-administrated questionnaires. Psychosocial risk factors (social isolation, stress, depressive symptoms, anxiety, hostility and type D personality) were assessed with core questions as suggested by the European Society of Cardiology. RESULTS: The prevalence of having 5-7 ideal cardiovascular health metrics was 183 (25.0%), of whom 54.1% had at least one psychosocial risk factor. Anxiety (31.3%), work stress (30.7%) and type D personality (26.1%) were the most prevalent of the psychosocial risk factors. The prevalence of depressive symptoms ( p<0.001) and type D personality ( p=0.049) decreased linearly according to the sum of ideal cardiovascular health metrics after adjustment for age and years of education. CONCLUSIONS: Even women with good cardiovascular health are affected by psychosocial risk factors at municipal work units. Although the association is possibly bidirectional, screening and treating depression and dealing with type D personality might be crucial in improving cardiovascular health among women.

Headache and quality of life in Finnish female municipal employees.

OBJECTIVES: Migraine and other specific types of chronic headache impair health-related quality of life (HRQoL). However, undefined headache is common in general population and little is known about its impact on QoL. This study addresses the impact of undefined headache symptoms on quality of life in a population of working-age females. METHODS: This cross-sectional study consisted of 633 female municipal employees. Self-reported headache recurrence was defined by asking whether headache was occasional or recurrent. We assessed quality of life with two different instruments, the generic EUROHIS-QOL 8-item index (EUROHIS-8) and the preference-based instrument EuroQoL (EQ-5D) representing health-related QoL. Anxiety, depressive symptoms and work stress were measured using validated questionnaires. Adjusted hypothesis of linearity was evaluated using bootstrap type analysis of covariance with age, education and number of comorbidities as covariates. RESULTS: In the study population, 76% (n=481) had experienced headache during the past year, and of those 38% (n=184) had recurrent headache. The EQ-5D index decreased linearly with increasing headache symptoms and four out of five EQ-5D dimensions were lowest in recurrent headache group. Females with headache had lower QoL on every EUROHIS-8 item except for conditions of living place, compared to females without headache. These results remained statistically significant after adjustment with age, education and number of comorbidities. There were no differences in prevalence of musculoskeletal disorders between study groups. CONCLUSIONS: This cross-sectional, observational study showed that self-reported recurrent headache is common among Finnish women belonging to active work force. Both health-related and general QoL is best in females without headache and lowest in the recurrent headache group. We conclude that recurrent headache, even when the subjects have low anxiety and depressive symptoms scores, is associated with low HRQoL in working-age females. These results underline the importance of headache, a common and neglected symptom deteriorating female employees' wellbeing.

The Impact of Self-Reported Recurrent Headache on Absenteeism and Presenteeism at Work Among Finnish Municipal Female Employees.

PURPOSE: The aim of this cross-sectional, observational study was to determine the impact of self-reported headache on absenteeism and presenteeism in a female working-age population. SUBJECTS AND METHODS: The study population consisted of 594 Finnish female municipal employees, who answered self-administered questionnaires including sociodemographic, lifestyle, health, and work-related data. Sickness absence days were obtained from the official records of the employer. Headache recurrence was defined by asking whether headache was occasional or recurrent. Headache impact was measured by the HIT-6. RESULTS: In our study, 456 (77%) females had headache, and headache was recurrent in 178 (39%). The self-reported recurrence of headache was related to age, AUDIT-C, health-rated quality-of-life, self-rated work ability, depressive symptoms, and work stress (P for linearity <0.001). They also had more depressive symptoms and work stress (P for linearity <0.001). Mental work load was highest in those with recurrent headache (P=0.042), and work engagement was highest in those without headache (P=0.038). There was no statistically significant difference in absenteeism days between the headache groups when adjusted with confounding variables. Presenteeism was associated with the recurrence of headache (P for linearity <0.001). Presenteeism and the HIT-6 score were significantly associated in the recurrent headache group (P=0.009). CONCLUSION: Headache was not related to absenteeism, but the self-reported recurrence of headache was clearly associated with presenteeism in this female working-age population.

The role of psychosocial risk factors in the burden of headache.

Purpose: Psychosocial risk factors are common in headache patients and affect the impact of headache in multiple ways. The aim of our study was to assess how psychosocial risk factors correlate with the headache impact test-6 (HIT-6). To our knowledge this is the first study to evaluate the impact of several psychosocial factors on the HIT-6 score. Patients and methods: Our study population consisted of 469 Finnish female employees reporting headache during the past year. Psychosocial risk factors were assessed using validated, self-administered questionnaires: the generalized anxiety disorder 7-item scale (GAD-7) for anxiety, the major depression inventory (MDI) for depressive symptoms, the ENRICHD short social support instrument (ESSI) for social isolation, the cynical distrust scale for hostility and the Bergen burnout indicator (BBI-15) for work stress. Results: Exploratory factor analysis of the HIT-6 scores revealed two factors, one describing psychological and quality of life aspects affected by headache and the other describing severity of pain and functional decline. Internal consistency of the HIT-6 was 0.87 (95%CI: 0.85-0.89). Correlations between the total HIT-6 score and all measured psychosocial risk factors except for hostility were weak, but statistically significant. Conclusion: The HIT-6 questionnaire has good construct validity and it describes reliably and independently the impact of headache without interference of psychosocial factors in general working-aged female population.

Relationship of musculoskeletal pain and well-being at work - Does pain matter?

BACKGROUND AND AIMS: Musculoskeletal pain is a common symptom and many people even with chronic pain continue to work. The aim of our study is to analyze how musculoskeletal pain affects work well-being by comparing work engagement in employees with or without pain, and how pain-related risk of disability is associated with work engagement. In a separate analysis, we also studied, how psychosocial factors are related to work engagement. METHODS: This is a cross-sectional study of Finnish female employees of the city of Pori, Finland (PORi To Aid Against Threats (PORTAAT) study). Data was collected by trained study nurses and self-administrated questionnaires. Work well-being was measured by work engagement using Utrecht Work Engagement Scale (UWES-9) questionnaire and the burden of pain was measured by using the short version of Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). Study population was divided into four groups: those without pain and the groups with low (I), medium (II) or high (III) ÖMPSQ score, reflecting increasing risk of long term disability due to musculoskeletal pain. The study nurse assessed psychosocial risk factors using defined core questions. RESULTS: We evaluated 702 female employees, 601 (86%) had suffered from musculoskeletal pain over the past 12 months, whereas 101 (14%) reported no pain at all. Pain was chronic (duration at least 3 months) in 465/601 (77%) subjects. Subjects with musculoskeletal pain were older, had higher BMI and were on sick leave more often than subjects without pain. Of the psychosocial risk factors, depression, type D personality, anxiety and hostility were significantly more common among subjects with musculoskeletal pain. Hypertension and the use of non-steroidal anti-inflammatory drugs were significantly more frequent in the musculoskeletal pain group. Quality of sleep and working capability were significantly better among persons without pain. Average weekly working hours were slightly higher among those with musculoskeletal pain. In crude analysis, work engagement (UWES-9) was similar in women without pain and those with musculoskeletal pain (4.96 vs. 4.79; p=0.091). After adjustment for age, education years, BMI, working hours and financial satisfaction, the difference between the groups became statistically significant (p=0.036). Still, there was no difference between the groups of no-pain and low burden of pain (p=0.21, after adjustment). Work engagement was significantly lower in the groups of medium (p=0.024, after adjusted) and high (p<0.001, after adjustment) burden of pain. Linearity across the Linton tertiles was significant (p<0.001). In univariate and multivariate ordered logistic regression analyses relating study variables to the work engagement musculoskeletal pain per se did not enter in the model to explain work engagement. Work and family stress, type D personality and duration of sick leave due to pain reduced work engagement, whereas financial satisfaction, moderate and high leisure time physical activity and higher BMI improved it. CONCLUSIONS: Among women with musculoskeletal pain psychosocial and lifestyle factors significantly correlate with work engagement, while the pain itself does not. IMPLICATIONS: Special attention should be paid to the psychosocial aspects in female employees with musculoskeletal pain to improve work well-being and maintain work ability.

Brain metabolic alterations in patients with type 1 diabetes-hyperglycemia-induced injury.

Microangiopathic end-organ injury is common in type 1 diabetes. However, the pathophysiology of diabetic encephalopathy is poorly understood. The authors studied 10 normotensive patients with type 1 diabetes with retinopathy, autonomic neuropathy, but without nephropathy, and 10 healthy subjects. Proton magnetic resonance spectroscopy was performed at 1.5 T in the frontal cortex, thalamus, and posterior frontal white matter. There was no change in N-acetyl-containing compounds (NA), but choline-containing compounds (Cho) were increased in the white matter and in the thalamus; myo-inositol was increased in the white matter, glucose excess was found in all brain, and water intensity was increased in the cortical voxel in the patients. Calculated lifetime glycemic exposure correlated inversely with Cho and NA in white matter and with Cho in thalamus. Concentrations of soluble intercellular adhesion molecules and vascular cell adhesion molecules were increased in the patients. In conclusion, in patients with type 1 diabetes, the increase in adhesion molecules and an association between altered brain metabolites and glycemic exposure suggest the presence of a vascularly mediated, progressive metabolic disturbance in the brain.

Association of the fibrinolytic system and hemorheology with symptoms in patients with carotid occlusive disease.

BACKGROUND AND OBJECTIVES: The risk of stroke caused by a symptomatic high-grade carotid stenosis (CS) is high. Disturbed balance between the procoagulant and fibrinolytic activity in blood associated with unfavorable hemorheology could render CS symptomatic. We wanted to assess whether hemostatic and fibrinolytic plasma markers as well as basic indicators of hemorheology differentiate asymptomatic and symptomatic patients with a high-grade CS and whether they are associated with the macroscopic appearance of the plaque and the rate of microembolization. METHODS: We recruited 92 consecutive consenting patients referred to the neurological or the surgical department of our university teaching hospital for treatment of their high-grade CS. Blood samples were collected before surgery for determination of prothrombin fragments F1 and 2, thrombin-antithrombin complex, tissue-type plasminogen activator (tPA) activity and antigen, plasminogen activator inhibitor-1 (PAI-1) activity and antigen, D-dimer, homocysteine, fibrinogen, in plasma, and hematocrit in blood, and the patients underwent transcranial Doppler ultrasonology for evaluation of microembolic signals (MES). RESULTS: Patients with symptomatic plaques had higher hematocrit levels (p = 0.04), as well as trends for higher tPA antigen and MES rate (p = 0.07). Hematocrit, tPA antigen, and PAI-1 antigen and activity were positively correlated with the degree of stenosis. Ulceration was more common in symptomatic plaques but did not reflect variables of hemostasis or fibrinolysis. In multivariate analysis, tPA antigen and hematocrit were risk factors for a symptomatic high-grade stenosis. CONCLUSION: Mediators of fibrinolysis and unfavorable hemorheology may contribute to the development of a symptomatic disease in patients with a high-grade CS.