Differential Responses of Urinary Epinephrine and Norepinephrine to 24-h Shift-Work Stressor in Physicians.

Multiple stressors, including 24-h-shifts characterise the working environment of physicians, influencing well-being, health and performance. We aimed to evaluate the effect of the stressor 24-h-shift on the adrenal medullary and sympathoneural system in physicians with the hypothesis that shift work might have different impacts on both systems. Twenty-two physicians collected two 12-h-urine samples ("daytime" and "nighttime") during a 24-h shift ("on-duty") and on a free weekend ("off-duty"), respectively. Urinary excretion rates per m2 body surface area were assessed for the catecholamines epinephrine, norepinephrine and their respective free O-methylated metabolites metanephrine and normetanephrine by LC-MS/MS-analysis. The stressor provoked differential responses of epinephrine and norepinephrine. Epinephrine excretion rates showed significant increases from off to on duty. The largest proportional change (off-duty to on-duty) for epinephrine was observed for nighttime (205%), the increase for daytime was 84%. An increase in norepinephrine from off to on duty was only visible for nighttime collections. For the catecholamine metabolites, normetanephrine paralleled norepinephrine and exhibited an increase in excretion from off to on duty during nighttime collections of 53% whereas there was no change during daytime collections (3%). In conclusion: Whilst the 24-h-shift-work stressor in physicians activates the sympatho-adrenomedullary system, represented by epinephrine, the sympathoneural response through norepinephrine reflects mainly an ambulatory position during working hours.

A Cross Sectional Study Evaluating Psychosocial Job Stress and Health Risk in Emergency Department Nurses.

Nurses experience psychosocial work stress that may negatively affect physical and mental health over time. In this cross-sectional study we investigated prevalence of job stress and oxidative stress in nurses, and determined if significant relationships exist between higher job stress scores and demographic factors and working conditions. Emergency department nurses (n = 42) were recruited from a University Hospital following Institutional Review Board approval. Job stress indicators, effort-reward ratio and overcommitment were evaluated from survey questionnaires using the effort-reward imbalance model, and associations with age, sex, body mass index, and working conditions were measured by logistic regression analysis. Oxidative stress biomarkers, 8-isoprostane, malondialdehyde, and antioxidant levels were measured from urine specimens. Job stress was prevalent with effort-reward ratio > 1 in 93% and overcommitment > 50 in 83% of the study participants. Age, body mass index, years of experience, weekend work, work hours per week, and shift work showed strong associations with effort-reward ratio and overcommitment scores. Malondialdehyde was higher in participants with high overcommitment. We report that psychosocial job stress is prevalent among nurses, as revealed by the high effort-reward and overcommitment scores. Job stress may be reduced through implementation of appropriate stress reduction interventions.

Work-related stress and cortisol levels: is there an association? Results of an observational study.

OBJECTIVE: Chronic exposure to work-related stress (WRS) stimulates the hypothalamic-pituitary-adrenal (HPA) axis to increase glucocorticoid secretion, including cortisol, and these hormones can be measured both in serum and urine. The Health Safety Executive Toolkit (HSE) questionnaire is used to assess WRS risk objectively. The scope of our study is to investigate whether serum or urinary cortisol levels could be used as alternative objective indicators of WRS, specifically in those subjects who are chronically exposed to it. PATIENTS AND METHODS: 130 patients (75 males and 55 females, mean age 47.7 ± 11.3 years) were evaluated at a specialized Centre for Secondary Hypertension, where both their serum (8 AM) and 24-hours urinary cortisol were measured and they were asked to complete two questionnaires: one questionnaire to collect data about their socio-demographic and job characteristics, and the HSE questionnaire to evaluate WRS. RESULTS: Multiple linear regression analysis showed an association of urinary cortisol with several variables: tobacco smoke (ß = 69.6; p = 0.003); female gender (ß = -37.3; p = 0.041); exposure to physical risks (ß = 51.8; p = 0.032); control score (ß = -22.7; p = 0.039); role score (ß= 39.3; p = 0.020). Age was the only variable associated with serum cortisol levels (ß = -3.6; p = 0.042). CONCLUSIONS: Urinary cortisol levels, but not serum levels, are associated with variables linked to WRS (score control and role) and to socio-demographic variables, namely gender and tobacco smoke. Thus, urinary cortisol can be considered a useful and non-invasive biological indicator to quantify WRS.