Transitioning from having no metabolic abnormality nor obesity to metabolic impairment in a cohort of apparently healthy adults.

INTRODUCTION: The global prevalence of metabolic syndrome and its association with increased morbidity and mortality has been rigorously studied. However, the true prevalence of "metabolic health", i.e. individuals without any metabolic abnormalities is not clear. Here, we sought to determine the prevalence of "metabolically healthy" individuals and characterize the "transition phase" from metabolic health to development of dysfunction over a follow-up period of 5 years. METHODS: We included 20,507 individuals from the Tel Aviv Sourasky Medical Center Inflammation Survey (TAMCIS) which comprises apparently healthy individuals attending their annual health survey. A second follow-up visit was documented after 4.8 (± 0.6) years. We defined a group of metabolically healthy participants without metabolic abnormalities nor obesity and compared their characteristics and change in biomarkers over time to participants who developed metabolic impairment on their follow-up visit. The intersections of all metabolic syndrome components and elevated high sensitivity C-reactive protein (hs-CRP) were also analyzed. RESULTS: A quarter of the cohort (5379 individuals, (26.2%) did not fulfill any metabolic syndrome criteria during their baseline visit. A total of 985 individuals (12.7% of returning participants) developed metabolic criteria over time with hypertension being the most prevalent component to develop among these participants. Individuals that became metabolically impaired over time demonstrated increased overlap between metabolic syndrome criteria and elevated hs-CRP levels. The group that became metabolically impaired over time also presented higher delta values of WBC, RBC, liver biomarkers, and uric acid compared with participants who were consistently metabolically impaired. LDL-C (low-density lipoprotein cholesterol) delta levels were similar. CONCLUSIONS: Roughly one-quarter of apparently healthy adults are defined as "metabolically healthy" according to current definitions. The transition from health to metabolic dysfunction is accompanied with active inflammation and several non-metabolic syndrome biomarkers. Aggressive screening for these biomarkers, blood pressure and hs-CRP might help identify apparently healthy individuals at increased risk of developing metabolic syndrome over time.

Is the PHQ-9 a unidimensional measure of depression? A 58,272-participant study.

The PHQ-9 has become a measure of reference in depression research and clinical practice. However, the issue of the PHQ-9's unidimensionality has not been fully elucidated, and the usability of the PHQ-9's total score requires clarification. In this study, we examined the dimensionality, scalability, and monotonicity properties of the PHQ-9 as well as the scale's total-score reliability. We did so based on exploratory structural equation modeling (ESEM) bifactor analysis and Mokken scale analysis (MSA). We relied on a total of 58,272 participants (63% female; Mage = 43, SDage = 13) from 29 samples involving seven different countries (e.g., Germany, the U.S.) and five different languages (e.g., German, English). We found no concerning deviations from measurement invariance for our ESEM bifactor model, neither across samples nor across sexes, age groups, and languages. The PHQ-9 met the requirements for essential unidimensionality in the pooled sample and across sex-, age-, and language-based subsamples. In each case, the general factor was strong (e.g., factor loadings ranged from 0.725 to 0.893 in the pooled sample) and Omega Hierarchical values exceeded 0.900. The correlations between the general factor and the observed total scores were large (≥ 0.952). Our MSA, including multilevel MSA, revealed that the PHQ-9's scalability is satisfactory. No monotonicity violation was detected, suggesting that the scale's total score accurately orders respondents on the latent Depression variable. Total-score reliability was good. This study provides robust evidence that the PHQ-9 can be used as a unidimensional measure of depressive symptoms by researchers and practitioners. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Weakened Cholinergic Blockade of Inflammation Associates with Diabetes-Related Depression.

Emerging evidence demonstrates association of depression with both immune malfunctioning and worsened course of diverse aging-related diseases, but there is no explanation for the pathway(s) controlling this dual association. Here, we report that in post-reproductive and evolutionarily -blind" years, depression may weaken pathogen-host defense, compatible with the antagonistic pleiotropy hypothesis. In 15,532 healthy volunteers, depression scores associated with both inflammatory parameters and with increased circulation cholinesterase activities, implicating debilitated cholinergic blockade of inflammation as an underlying mechanism; furthermore, depression, inflammation and cholinesterase activities all increased with aging. In the entire cohort, combined increases in inflammation and the diabetic biomarker hemoglobin A1c associated with elevated depression. Moreover, metabolic syndrome patients with higher risk of diabetes showed increased cholinesterase levels and pulse values, and diabetic patients presented simultaneous increases in depression, inflammation and circulation cholinesterase activities, suggesting that cholinergic impairment precedes depression. Our findings indicate that dysfunctioning cholinergic regulation weakens the otherwise protective link between depression and pathogen-host defense, with global implications for aging-related diseases.

Self-rated health is associated with elevated C-reactive protein even among apparently healthy individuals.

BACKGROUND: A single self-rated health (SRH) assessment is associated with clinical outcome and mortality, but the biological process linking SRH with immune status remains incompletely understood. OBJECTIVES: To examine the association between SRH and inflammation in apparently healthy individuals. METHODS: Our analysis included 13,773 apparently healthy individuals attending the Tel Aviv Sourasky Medical Center for periodic health examinations. Estimated marginal means of the inflammation-sensitive biomarkers [i.e., highly sensitive C-reactive protein (hs-CRP) and fibrinogen] for the different SRH groups were calculated and adjusted for multiple potential confounders including risk factors, health behavior, socioeconomic status, and coexistent depression. RESULTS: The group with the lowest SRH had a significantly higher atherothrombotic profile and significantly higher conentrations of all inflammation-sensitive biomarkers in both genders. Hs-CRP was found to differ significantly between SRH groups in both genders even after gradual adjustments for all potential confounders. Fibrinogen differs significantly according to SRH in males only, with low absolute value differences. CONCLUSIONS: A valid association exists for apparently healthy individuals of both genders between inflammation-sensitive biomarker levels and SRH categories, especially when comparing levels of hs-CRP. Our findings underscore the importance of assessing SRH and treating it like other markers of poor health.

Till stress do us part: On the interplay between perceived stress and communication network dynamics.

This study of perceived stress and communication networks fills 2 theoretical gaps in the literature: First, drawing predominantly on conservation of resource theory and faultline theory, we demonstrate the role of stress as an "engine of action" in network evolution. Second, we extend the stress literature to the interpersonal domain by arguing that others' levels of stress influence the individual's communication network, and this, in turn, changes his or her stress level. At 3 time points, we evaluated the communication ties and perceived stress in a unique field setting comprising 115 male participants (in 6 groups) performing group-based tasks. We introduce stochastic actor-based models for the coevolution of network ties and actor attributes, statistical models that enable causal inferences to be drawn regarding the interplay between dynamic networks and individual attributes. Using these models, we find that over time, individuals experiencing higher levels of perceived stress were less likely to create new communication ties and were more likely to maintain existing ties to others. Participants also tended to communicate with similarly stressed others. Such communication network dynamics further increased individuals' levels of perceived stress over time, leading to stress-related vicious cycles. We discuss organizational implications that relate to stress and network-related interventions.

Fear and C-reactive protein cosynergize annual pulse increases in healthy adults.

Recent international terror outbreaks notably involve long-term mental health risks to the exposed population, but whether physical health risks are also anticipated has remained unknown. Here, we report fear of terror-induced annual increases in resting heart rate (pulse), a notable risk factor of all-cause mortality. Partial least squares analysis based on 325 measured parameters successfully predicted annual pulse increases, inverse to the expected age-related pulse decline, in approximately 4.1% of a cohort of 17,380 apparently healthy active Israeli adults. Nonbiased hierarchical regression analysis among 27 of those parameters identified pertinent fear of terror combined with the inflammatory biomarker C-reactive protein as prominent coregulators of the observed annual pulse increases. In comparison, basal pulse primarily depended on general physiological parameters and reduced cholinergic control over anxiety and inflammation, together indicating that consistent exposure to terror threats ignites fear-induced exacerbation of preexisting neuro-immune risks of all-cause mortality.

Effect of socioeconomic status on cardio-respiratory fitness: data from a health screening program.

AIM: Lower socioeconomic status (SES) is associated with reduced cardio-respiratory fitness (CRF) and predicts adverse cardiovascular outcomes. We questioned whether this association remains significant among an apparently healthy population with a presumed higher SES. METHODS: This cross-sectional study enrolled attendees of a health screening program between September 2002 and November 2010. Linear regression models included the metabolic equivalents achieved during an exercise treadmill stress test as the dependent variable and adjusted for self-reported SES parameters (level of education, occupational status, financial strain and a combined variable), cardiovascular risk factors, as well as to multiple potential confounders. RESULTS: Data on 8471 individuals (5463 men and 3008 women) with a mean (SD) age of 44 (11) years were collected. We found a statistically significant difference in mean exercise capacity between the categories of SES, especially for the level of education and occupation, when adjusted for age, sex, cardiovascular risk factors, SES variables and multiple confounders. CONCLUSIONS: Multiple factors affect CRF in apparently healthy screened individuals. When adjusted for those factors, SES correlates with CRF even within a more specific highly educated cohort.

Joint effect of chronic medical illness and burnout on depressive symptoms among employed adults.

OBJECTIVE: Chronic medical illnesses (CMIs) are prevalent in nearly half the working population and are associated with a two-fold risk for developing depression. Burnout is a chronic affective state comprised of symptoms of emotional exhaustion, physical fatigue, and cognitive weariness. It is an outcome of depletion of energetic resources resulting from prolonged exposure to work and life stresses. Building upon the Conservation of Resources theory (Hobfoll, 1989), this prospective study was designed to test the hypothesis that CMI interacts with burnout to facilitate the development of depressive symptoms. METHOD: Participants were 4,861 employed men and women, aged 19 to 67 years, who came for routine health examinations and were followed for 18 months on average. Forty-seven percent reported having one or more diagnosed CMIs. RESULTS: Burnout was found to predict an increase in depressive symptoms in apparently healthy individuals. Furthermore, the coexistence of burnout in employees with a CMI accelerates the process of developing depressive symptoms within a relatively short period. Burnout was also found to be associated with intensification of preexisting depressive symptoms in employees suffering from different chronic medical conditions (other than cancer), independent of medical comorbidities and other potent confounding variables. CONCLUSIONS: Among employees, coexistence of burnout and at least one CMI predicts an increase in depressive symptoms with time. Health care professionals should be made aware of such at-risk employees and follow and manage them closely.

The relationship between job enrichment and abdominal obesity: a longitudinal field study of apparently healthy individuals.

Obesity has become an epidemic in modern society. However, there is a paucity of research about how job context affects obesity. To enhance our knowledge we used a large, heterogeneous sample of apparently healthy employees (n = 1,949) across two time periods with an average of close to 3.5 years between measures. We tested a hypothesized curvilinear effect of job enrichment on changes in two stress related indicators of abdominal obesity over time: waist circumference (WC) and waist-hip ratio (WHR). Job enrichment consisted of the job dimensions of variety, identity, significance, autonomy, and feedback, and in our analysis we controlled for demographics and health related behaviors, including weekly sports activity, number of cigarettes smoked per day, and weekly alcohol consumption. The results supported the hypothesized U-shaped relationship between job enrichment and changes in both indicators of abdominal obesity over time, such that the level of abdominal obesity was reduced when job enrichment was moderate and was increased when job enrichment was either high or low. As expected, no such association was observed for the general obesity measure of body mass index (BMI). We discuss the theoretical and practical implications of these results.

Burnout and vigor as predictors of the incidence of hyperlipidemia among healthy employees.

We examined the effects of burnout and vigor on the incidence of hyperlipidemia. Based on the bivariate theoretical approach to negative and positive affects and on past studies on the prediction of blood lipids by burnout and vigor, we expected increases from Time 1 (T1) to Time 2 (T2) in burnout levels to be associated with an increase in the risk for hyperlipidemia and T1-T2 increases in vigor levels to be associated with a decrease in the risk of hyperlipidemia. Our sample consisted of 3,337 healthy employees (2,214 men and 1,123 women) who were followed up for about 27 months on average. Burnout and vigor were assessed by well-validated multiple-item instruments. We used logistic regressions and controlled for variables associated with blood lipids as well as with vigor and burnout. We cross-validated all self-reported hyperlipidemia by their T2 lipids levels. As expected, we found that T1-T2 increases in vigor levels were associated with a decreased risk of hyperlipidemia. However, the T1-T2 change in burnout levels was marginally significant (p = .06) in predicting hyperlipidemia. We consider our finding that vigor and burnout are independently associated with the risk of hyperlipidemia as providing support for the bivariate approach to affective states. In addition, our major finding suggests a possible mechanism via which vigor influences physical health outcomes.

The role of personality in predicting repeat participation in periodic health screening.

OBJECTIVE: Drawing on the Five-Factor Model of personality, the aim of the present study was to find out which personality traits predict health maintenance behaviors, reflected in routine participation in health screenings, over and above objective and subjective health status. METHOD: Participants were 2,803 employed individuals (61% men), free of background diseases, who underwent a routine health examination and were subsequently notified whether they were healthy or at risk. These participants were invited to repeat the examination within the next few years, as is medically recommended. RESULTS: Logistic and negative binomial regressions were used to predict participants' odds of returning for a second examination, within the next 7 years, as well as the number of consecutive visits, while controlling for sociodemographic factors, objective and subjective health, and length of follow-up. We found that both endpoints were positively predicted by Conscientiousness and negatively predicted by Extraversion and Openness. The association between Neuroticism and these endpoints followed a bell-shaped curve (i.e., individuals high or low in Neuroticism were less likely to return). CONCLUSIONS: The present findings suggest that personality traits should be taken into consideration in the planning and implementation of health-promoting interventions.

Burnout and risk of coronary heart disease: a prospective study of 8838 employees.

OBJECTIVE: Burnout is a negative affective state consisting of emotional exhaustion, physical fatigue, and cognitive weariness symptoms. This study was designed to evaluate prospectively the association between burnout and coronary heart disease (CHD) incidence and to test the possibility that this association is nonlinear. METHODS: Participants were 8838 apparently healthy employed men and women, aged 19 to 67 years, who came for routine health examinations at the Tel Aviv Sourasky Medical Center. They were followed up for 3.4 years on average. Burnout was measured by the Shirom-Melamed Burnout Measure. CHD incidence was defined as a composite of acute myocardial infarction, diagnosed ischemic heart disease, and diagnosed angina pectoris. RESULTS: During follow-up, we identified 93 new cases of CHD. Baseline levels of burnout were associated with an increased risk of CHD, after adjustment for various risk factors (hazard ratio = 1.41; 95% confidence interval = 1.08-1.85). In addition, we observed a significant threshold effect of burnout on CHD incidence. Participants who scored high on burnout (scores in the upper quintile of the Shirom-Melamed Burnout Measure scores distribution) had a higher risk (hazard ratio = 1.79; 95% confidence interval = 1.05-3.04) of developing CHD on follow-up compared with others. CONCLUSIONS: Burnout is an independent risk factor for future incidence of CHD. Individuals with high levels of burnout (upper quintile) have a significantly higher risk of developing CHD compared with those with low levels of burnout.

Work characteristics as predictors of diabetes incidence among apparently healthy employees.

The objective of this article was to investigate the associations of the Job Demand Control-Support (JDC-S) model's components, job demands, job control, and work social support, as well as their interactive terms, with the risk of Type 2 diabetes. Participants were apparently healthy 5,843 men and women who underwent routine health checks at two points of time, about 41 months apart from one another. New cases of diabetes (N = 182) during follow-up period were defined based on fasting glucose value ≥ 126 mg/dl or glycosylated hemoglobin value ≥ 6.5% or self-reported physician diagnosis of diabetes and taking medications to treat it. The measures for assessing workload (representing job demands), job control, and work social support were all based on validated scales constructed to test the JDC-S model. In testing the hypotheses, we used logistic regressions and controlled for well-established risk factors for diabetes, including sociodemographic, physiological, and behavioral risk factors. We also controlled for depressive symptoms. The hypothesis that the higher the baseline levels of work social support, the lower the risk of diabetes, was supported (Odd Ratio = .78, significant at the p < .05 level). In an exploratory analysis, workload was found to have a U-shaped relationship with diabetes risk. We did not find direct effects of job control nor of any interactive term including the JDC-S model components on diabetes risk. Work social support is a protective factor, reducing the risk of diabetes. Both underload and overload may increase the risk of diabetes.

Job burnout and depression: unraveling their temporal relationship and considering the role of physical activity.

Job burnout and depression have been generally found to be correlated with one another. However, evidence regarding the job burnout-depression association is limited in that most studies are cross-sectional in nature. Moreover, little is known about factors that may influence the job burnout-depression association, other than individual or organizational factors (e.g., gender, supervisor support). The current study seeks to address these gaps by (a) unraveling the temporal relationship between job burnout and depression and (b) examining whether the job burnout-depression association may be contingent upon the degree to which employees engage in physical activity. On the basis of a full-panel 3-wave longitudinal design with a large sample of employees (N = 1,632), latent difference score modeling indicated that an increase in depression from Time 1 to Time 2 predicts an increase in job burnout from Time 2 to Time 3, and vice versa. In addition, physical activity attenuated these effects in a dose-response manner, so that the increase in job burnout and depression was strongest among employees who did not engage in physical activity and weakest to the point of nonsignificance among those engaging in high physical activity.

The relationships between self-rated health and serum lipids across time.

BACKGROUND AND PURPOSE: We studied the hypothesized effects of changes in self-rated health (SRH) on subsequently assessed changes in the levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglycerides (TRI), separately for men and women. We also investigated the reverse causation hypothesis, expecting the initial changes in the levels of serum lipids to predict subsequently assessed changes in SRH levels. METHODS: We used a longitudinal design and controlled for possible confounders known to be precursors of both SRH and the above three serum lipids. Participants were apparently healthy men (N = 846) and women (N = 378) who underwent a routine health check at three points of time (T1, T2, and T3); T1 and T3 were on the average 40 and 44 months apart for the men and women, respectively. RESULTS AND CONCLUSIONS: For the men, relative to T1 SRH, an increase in T2 SRH was associated with an increase in the T3 HDL-C levels relative to T2 HDL-C and with a decrease in the T3 TRI levels relative to T2 TRI. For the women, initial changes in the SRH levels did not predict follow-up changes in either of the lipids. For both genders, the reverse causation hypothesis, expecting the T1-T2 change in each of the serum lipids to predict T2-T3 change in SRH, was not supported. For the men, there is support for the hypothesis that the effects of SRH on morbidity and mortality, found by past meta-analytic studies, could be mediated by serum lipids.

Life and Job Satisfaction as Predictors of the Incidence of Diabetes.

We studied the hypothesised effects of baseline levels of life satisfaction and of job satisfaction on the incidence of diabetes. Participants were 2,305 apparently healthy men and women who underwent routine health checks at two points in time, about 20 months apart. New cases of diabetes (N=104) were defined based on fasting glucose value > 125, or glycosylated hemoglobin value > 6.5, or self-reported physician diagnosis of diabetes and taking medications to treat it. Life satisfaction was measured using the scale constructed by Diener et al. (1985) while job satisfaction was assessed based on the Survey of Working Conditions. In the analyses, we controlled for socio-demographic predictors, for known physiological and behavioral precursors of diabetes, and for depressive symptoms. There was support for our hypothesis that the higher the baseline levels of life satisfaction, the lower the incidence of diabetes. However, job satisfaction did not predict the incidence of diabetes. We obtained the same results when limiting the analysis to new cases of diabetes based on objective criteria only and when using as predictors both life and job satisfaction. We suggest that life satisfaction could be a protective factor reducing the risk of diabetes.

Work-based predictors of mortality: a 20-year follow-up of healthy employees.

OBJECTIVES: This study investigated the effects of the Job-Demand-Control-Support (JDC-S) model's components, workload, control, peer and supervisor social support, on the risk of all-cause mortality. Also examined was the expectation that the above work-based components interact in predicting all-cause mortality. The study's hypotheses were tested after controlling for physiological variables and health behaviors known to be risk factors for mortality. MAIN OUTCOME MEASURE: The design used was prospective. Baseline data were obtained from healthy employees (N = 820) who underwent periodic health examinations in 1988. Follow-up data on all-cause mortality were obtained from the participants' computerized medical file, kept by their HMO, in 2008. The baseline data covered socioeconomic, behavioral, and biological risk factors in addition to the components of the JDC-S model. During the period of follow-up, 53 deaths were recorded. Data were analyzed using Cox regressions. RESULTS: Only one main effect was found: the risk of mortality was significantly lower for those reporting high levels of peer social support. The study found two significant interactions. Higher levels of control reduced the risk of mortality for the men and increased it for the women. The main effect of peer social support on mortality risk was significantly higher for those whose baseline age ranged from 38 to 43 but not for the older than 43 or the younger than 38 participants. CONCLUSION: Peer social support is a protective factor, reducing the risk of mortality, while perceived control reduces the risk of mortality among men but increases it among women.

Feeling vigorous and the risks of all-cause mortality, ischemic heart disease, and diabetes: a 20-year follow-up of healthy employees.

OBJECTIVE: To investigate prospectively the effects of vigor at work on the end points of mortality and the prevalence of ischemic heart disease (IHD) and diabetes. METHODS: We tested the hypothesized beneficial effects of feeling vigorous at work at baseline on the risks of all-cause mortality, IHD, and diabetes during a 20-year follow-up. Participants were healthy employees (n = 968) who underwent a routine health check at baseline. We calculated the risk of all-cause mortality, IHD, and diabetes, with days as the time scale, using the Cox proportional hazard model. In our analyses, we predicted the above end points by baseline vigor, age, gender, and educational level, adjusting for the physiological risk factors of total cholesterol, glucose, and body mass index, the behavioral risk factors of smoking, alcohol intake, and physical activity, and the psychological risk factors of depressive and anxiety symptoms. RESULTS: As hypothesized, we found that, after the above adjustments, baseline vigor decreased the risk of follow-up mortality by 26% (hazard ratio, 0.74; 95% confidence interval, 0.58-0.95) and the risk of diabetes by 17% (hazard ratio, 0.83; 95% confidence interval, 0.68-0.98). However, vigor did not have a significant effect on the risk of IHD. CONCLUSIONS: Independently of physiological, behavioral, and psychological risk factors, feeling vigorous at work protected the participants from diabetes and reduced their risk of mortality.

Relation of educational level to inflammation-sensitive biomarker level.

It is a well-established finding that cardiovascular morbidity varies among groups of different socioeconomic status. Inflammatory processes have been proposed as a possible mediator of this variance. Level of education is an important indicator of socioeconomic status, inversely related to levels of inflammatory biomarkers. Whether this association was significant in a subpopulation of highly educated individuals was questioned. This cross-sectional study enrolled attendees of an executive health screening program intended specifically for executive and high-wage personnel from September 2002 to November 2007. A detailed questionnaire, anthropometric measurements, and laboratory data were used to determine self-reported years of education and cardiovascular risk factors. Linear regression models included high-sensitivity C-reactive protein, fibrinogen, erythrocyte sedimentation rate, and white blood cell count as dependent variables and were adjusted for multiple potential confounders. Data for 8,998 subjects (5,757 men, 3,241 women) with a mean age of 44 years (range 18 to 84) were analyzed. More than two-thirds reported >or=14 years of schooling, and >2,900 reported >or=17 years of schooling. We found a statistically significant inverse association between number of school years and high-sensitivity C-reactive protein, fibrinogen, and erythrocyte sedimentation rate. Higher levels of education were associated with lower prevalences of diabetes and current smoking in both genders and lower prevalences of hypertension and dyslipidemia in women. In conclusion, level of education was inversely associated with inflammatory biomarkers and prevalence of cardiovascular risk factors, even within highly educated populations.

The effects of physical fitness and feeling vigorous on self-rated health.

OBJECTIVE: We prospectively studied the hypothesized beneficial effects of feeling vigorous and of objective physical fitness (gauged based on functional capacity) on subsequently assessed self-rated health (SRH), controlling for possible confounders known to be precursors of SRH and of our predictors. We also investigated the reverse-causation hypothesis that SRH predicts subsequent vigor and functional capacity. DESIGN: Participants were apparently healthy employees (N = 779) who underwent a routine health check at two points of time, Time 1 (T1) and Time 2 (T2), about 18 months apart. We used regression analysis, predicting T2 SRH by T1 SRH, the control variables, and T1vigor and functional capacity. MAIN OUTCOME MEASURES: Vigor was assessed using the Shirom-Melamed Vigor Measure; objective physical fitness was indicated by functional capacity following a treadmill exercise, and self-rated health was measured by a single item. RESULTS: As hypothesized, we found that the change in T2 SRH was positively predicted by T1 vigor, functional capacity, and their interactive term. Testing the reverse causation paths, we found that T1 SRH did not predict subsequent functional capacity and was a relatively weak predictor of subsequent vigor. CONCLUSION: The affective state of vigor and objectively assessed functional capacity interact to predict subsequent changes in self-rated health.