A longitudinal examination of generic and occupational specific job demands, and work-related social support associated with burnout among nurses in Sweden.

OBJECTIVE: Burnout is a familiar problem within nursing. This longitudinal study was designed to examine the roles that generic and occupational specific job demands (i.e. "pain and death", "patient and relative needs", "threats and violence", "professional worries"), and various work-related sources of support play in association with burnout in a sample of registered nurses in Sweden. METHODS AND PARTICIPANTS: A questionnaire was completed on two different occasions, by the same group of nurses from three hospitals and two primary health care centers. Nurses with initial low and moderate scores on emotional exhaustion (n=585) and depersonalization (n=631) were included in the logistic regression analyses. Initial scores, as well as four categories examining change over time in the predictors (unchanged low, improved, impaired, unchanged high), were associated with burnout approximately one year later. RESULTS: In the multivariate analyses, quantitative job demands and professional worries were associated with emotional exhaustion. Poor co-worker support was associated with depersonalization over time. CONCLUSION: This study suggests an association between generic as well as occupational specific job demands and emotional exhaustion. Furthermore, an association between poor co-worker support and depersonalization was suggested. Implications of these findings and recommended directions for future research are discussed.

Fear of hypoglycaemia in adults with Type 1 diabetes.

AIMS: The aim of this study was to examine the fear of hypoglycaemia and its association with demographic and disease-specific variables in a large and unselective population of adult patients with Type 1 diabetes. METHODS: Questionnaires were sent by post to all patients with Type 1 diabetes who were identified in the local diabetes registries of two hospitals in Stockholm, Sweden (n=1387). Fear of hypoglycaemia was measured using the Swedish Hypoglycaemia Fear Survey, the Worry subscale and the Aloneness subscale. Demographic variables and disease-specific factors were collected from patients' self reports and medical records. Univariate analysis and multiple stepwise linear regression analysis were used in the statistical analyses of the data. RESULTS: Seven hundred and sixty-four (55%) patients participated in the study (mean age 43.3 years and mean HbA(1c) 7.0%, normal <5.0%). The Hypoglycaemia Fear Survey - Worry subscale was significantly associated with frequency of severe hypoglycaemia, number of symptoms during mild hypoglycaemia, gender, hypoglycaemic symptoms during hyperglycaemia and hypoglycaemic unawareness. The Hypoglycaemia Fear Survey - Aloneness subscale was significantly associated with frequency of severe hypoglycaemia, number of symptoms during mild hypoglycaemia, gender, frequency of mild hypoglycaemia, HbA(1c) , hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycaemia. Fear of hypoglycaemia proved to be more prevalent in females and indicated a different pattern between genders in relation to factors associated with fear of hypoglycaemia. CONCLUSIONS: This study identifies the frequency of severe hypoglycaemia as the most important factor associated with fear of hypoglycaemia. Moreover, for the first time, we document gender differences in fear of hypoglycaemia, suggesting that females are more affected by fear of hypoglycaemia than men.

Organisational factors, individual characteristics and social support: what determines the level of social support?

A large body of research has linked social support to health, but there are fewer studies that have focused on factors that influence the level of social support available and/or perceived by employees in different organisations. This cross-sectional study therefore investigated the relationship between on the one hand, organisational, individual and socio-demographic factors and on the other, the level of social support at the workplace, i.e., the degree of supervisor support and a supportive work atmosphere. Organisational variables (job demands, job control, job content), individual (self-esteem, mistrust) and socio-demographic variables (type of employer, occupational position, age, gender and educational level) were used as independent variables in the analyses. The sample consisted of 16,144 individuals at a variety of different organisations in Sweden, who had responded to a questionnaire covering different psychosocial and psychological stress factors ("the Stress Profile"). Multiple hierarchical regression analyses were performed separately for each of the two dependent variables, which yielded almost identical results, and indicated that organisational determinants, particularly perceived job control, had the largest impact on the degree of social support.

Psychosocial risk factors for coronary heart disease, their importance compared with other risk factors and gender differences in sensitivity.

BACKGROUND: Few studies have focused on risk factors in women's lives concerning psychosocial factors and coronary heart disease (CHD). The present study is one of a series in which a wide range of psychosocial factors will be analysed with a focus on women. Women and men have been compared with respect to sensitivity to psychosocial risk factors regarding CHD. The importance of psychosocial risk factors for women, compared with biomedical risk factors has also been studied. METHODS: A questionnaire (The Stress Profile) was answered by 538 rehabilitation participants (97 women, 441 men) and a reference group (5308 women, 5177 men), aged 40-65 years. Psychosocial factors were investigated using means and b-coefficients. Comparisons between psychosocial and biomedical risk factors were made, with respect to the product of the beta-coefficient and the standard deviation for each compared risk factor. RESULTS: Significant differences appeared concerning five areas: work content, workload and control, physical stress reactions, emotional stress reactions and burnout. All showed that the relative sensitivity was larger for women than for men. Predictive psychosocial risk factors for women with respect to CHD were physical stress reactions, emotional stress reactions, burnout, family relationships and daily hassles/satisfactions, and they were on approximately the same level as biomedical risk factors. CONCLUSIONS: Women appear to be more sensitive than men with respect to psychosocial risk factors for CHD, and the predictive ability of psychosocial risk factors shows great importance. Actions against unhealthy psychosocial conditions are recommended. Both presumptive CHD patients and others might benefit from preventive actions, and since women are more sensitive they will probably gain more than men.

Two-year results of a controlled study of residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty. A randomized study of a multifactorial programme.

AIMS: In a multifactorial lifestyle behaviour programme, of 2 years duration, to study the maintenance of achieved behaviour and risk factor-related changes. METHODS AND RESULTS: Out of a consecutive population of 151 patients treated with percutaneous transluminal angioplasty under 65 years of age, 87 were randomly allocated to an intervention group (n=46) or to a control group (n=41). The programme started with a 4 week residential stay, which was focused on health education and the achievement of behaviour change. During the first year of follow-up, a maintenance programme included regular contacts with a nurse, while no further rehabilitative efforts were offered during the second year. One patient died (control). During the second year the proportion of hospitalized patients was lower in the intervention group (4% vs 20%;P<0.05). Patients in the intervention group improved several lifestyle dependent behaviours: diet (index at 0, 12 and 24 months): 10.5+/-3. 4, 12.9+/-2.5 and 12.4+/-2.6 in the intervention group (I) vs 10. 1+/-3.2, 10.7+/-3.0 and 11.8+/-3.2 in the control group (C);P<0.05, exercise sessions per week: 2.5+/-2.3, 4.5+/-1.9 and 4.4+/-2.1 (I) vs 3.1+/-2.2, 3.5+/-2.3 and 3.7+/-2.7 (C);P<0.05, and smoking; 18%, 6% and 9% (I) vs 12%, 21% and 18% (C);P<0.05. This corresponded to improvement in exercise capacity (0, 12 and 24 months): 156+/-42, 174+/-49 and 165+/-47 W (I) vs 164+/-40, 163+/-49 and 156+/-48 watts (C);P<0.05. There were no significant differences between the two groups with regard to serum cholesterol levels at 0 and 24 months: 5. 4+/-0.8 and 5.2+/-0.9 mmol. l(-1)(I) vs 5.4+/-1.0 and 4.9+/-0.9 mmol. l(-1)(C); ns, low density lipoprotein cholesterol level: 3.6+/-0.8 and 3.4+/-0.8 mmol. l(-1)(I) vs 3.7+/-0.9 and 3.3+/-0.7 mmol. l(-1)(C); ns, triglyceride level: 2.2+/-1.6 and 1.8+/-1.3 mmol. l(-1)(I) vs 2.2+/-1.4 and 1.6+/-0.6 mmol. l(-1)(C); ns, body mass index (0, 12 and 24 months): 27.5+/-4.5, 27.0+/-4.3 and 27.4+/- 4.5 kg. m(-2)(I) vs 26.8+/-2.8, 26.9+/-2.7 and 26.9+/- 3.2 kg. m(-2)(C); ns, waist/hip ratio or blood pressure. The two groups did not differ in quality of life, or psychological factors. Return to work after 12 and 24 months was 74% and 78% (I) vs 68% and 61% (C); ns. CONCLUSION: This rehabilitation programme influenced important lifestyle behaviour and reduced some, but not all, important risk factors

Multifactorial evaluation of a program for lifestyle behavior change in rehabilitation and secondary prevention of coronary artery disease.

A comprehensive, multifactorial lifestyle behavior change program was developed for rehabilitation and secondary prevention of subjects with coronary artery disease. The purpose of the present report is to describe this intervention model and to analyze results achieved in a first group of consecutive participants. Main inclusion criteria for the 292 subjects were a recent history of acute myocardial infarction, coronary artery bypass surgery, or percutaneous transluminal coronary angioplasty. The program commenced with a 4-week residential stay, with the focus on health education and the achievement of behavior change in major lifestyle areas. During the year of follow-up a systematic maintenance program included regular contact with a nurse. Morbidity and mortality was low. Self-reported quality of life improved and there were significant improvements in blood lipids, exercise capacity and body mass index. There were also significant changes both in psychological variables such as Type A behavior, anger, hostility, and in major lifestyle areas such as stress reactions, diet, exercise and smoking. These changes compared favorably with data from relevant samples from the Swedish normal population. This program had a considerable effect on a number of important factors for rehabilitation and secondary prevention of coronary artery disease.

Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study.

A group of 93 coronary patients recently treated with percutaneous transluminal coronary angioplasty (PTCA) were randomly assigned to either an intervention or a control group. Subjects in the intervention group participated in a comprehensive behaviorally oriented program aimed at achieving significant long-term changes in risk factor-related lifestyle behavior. Assessments of lifestyle behaviors, psychological factors, biological risk factors, and rehabilitation as well as secondary prevention endpoints were carried out, at inclusion and after 12 months. Results showed that the intervention patients, as compared with controls, improved significantly on measures assessing smoking, exercise, and diet habits. These self-rated changes were confirmed by weight reductions and improved exercise capacity, as well as by between-group differences in subclinical chest pain during an exercise test. However, few effects were found on the different psychological variables, as well as on morbidity or return to work.

Psychological patterns in patients with coronary heart disease, chronic pain and respiratory disorder.

Patients with coronary heart disease (CHD), chronic pain and respiratory disorder were investigated for different patterns of psychological factors. Several psychological factors were measured: depression (using Beck's 'BDI'), anxiety (using Spielberger's 'STAI'), anger (Spielberger's 'AX'), and cynicism (Greenglass & Julkunen's 'CD'). The special psychological pattern in patients with CHD was characterized by an increase in suppressed anger, overall experienced anger, and cynicism. Patients with chronic pain did not show any comparable pattern of elevated psychological factors. The pattern in patients with respiratory disorder was characterized by increased cynicism and, in women, also clinical depression.

Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample.

The Hospital Anxiety and Depression Scale (HAD) was evaluated in a Swedish population sample. The purpose of the study was to compare the HAD with the Beck Depression Inventory (BDI) and Spielberger's State Trait Anxiety Inventory (STAI). A secondary aim was to examine the factor structure of the HAD. The results indicated that the factor structure was quite strong, consistently showing two factors in the whole sample as well as in different subsamples. The correlations between the total HAD scale and BDI and STAI, respectively, were stronger than those obtained using the different subscales of the HAD (the anxiety and depression subscales). As expected, there was also a stronger correlation between the HAD and the non-physical items of the BDI. It was somewhat surprising that the factor analyses were consistently extracting two factors, 'depression' and 'anxiety', while on the other hand both BDI and STAI tended to correlate more strongly with the total HAD score than with the specific depression and anxiety HAD subscales. Nevertheless, the HAD appeared to be (as was indeed originally intended) a useful clinical indicator of the possibility of depression and clinical anxiety.

BVP-biofeedback in the treatment of migraine. The effects of constriction and dilatation during different phases of the migraine attack.

Biofeedback training for self-regulation of blood-volume pulse ("BVP") amplitude of the temporal arteries has been used previously with good results in treatment of migraine headaches. In the present study, 23 subjects were randomly assigned to one of three groups and given (a) biofeedback training in temporal artery constriction and instructions to apply these skills during headaches; (b) the same training and instructions to apply the skills between headaches, during stress periods, and (c) biofeedback training to dilate the temporal arteries, and instructions to use these skills during stress periods. Clinically meaningful headache reductions were achieved and maintained at follow-up. Furthermore, results indicated that voluntary temporal artery dilatation also leads to headache reductions, and that there is a connection between levels of achieved self-regulation skill and the clinical effects.

Long-term follow-up of migraine treatment: do the effects remain up to six years?

Fifty migraine subjects (constituting 79% of the originally treated sample) participated in a follow-up study to 6 yr after the end of treatment. Subjects had been treated with different forms of biofeedback methods (skin temperature, BVP of the temporal artery) and applied relaxation training. The assessment included 4 weeks of continuous self-monitoring of headache activity and medication usage, as well as a retrospective self-rating scale. The main results indicated that, on a group basis, headache reductions achieved at the end of treatment persisted for up to 6 yr, and were indeed enhanced during the follow-up period.