Law Enforcement Officers Have an Increased Prevalence of Subclinical Cardiovascular Disease That is Not Explained by Traditional Risk Factors.

OBJECTIVES: Determine if law enforcement officers develop subclinical atherosclerotic cardiovascular disease (ASCVD) earlier than non-officers and if so, the extent to which conventional risk factors explain this difference. METHODS: Estimated pulse wave velocity (ePWV) was the marker of subclinical ASCVD. EPWV, ASCVD risk factors, metabolic syndrome (MetS), and 10-year risk for ASCVD were compared among 408 law enforcement officers and a civilian cohort. RESULTS: EPWV, 10-year ASCVD risk, and MetS prevalence increased significantly with age. All but the officers age 55 and older had higher ePWV cohort than the civilian cohort (p < .001). Ten-year ASCVD risk explained the most variability of ePWV (R2 = .49, p < .001). CONCLUSIONS: Officers develop subclinical ASCVD earlier than non-officers. Conventional ASCVD risk factors only explain about half of this increase. Occupational factors may play a role in contributing to this increased ASCVD risk.

Testing a Resilience Training Program in Police Recruits: A Pilot Study.

BACKGROUND: Stress from multiple sources is inherent in law enforcement. However, it is possible to modify responses to stress with resilience training that includes teaching techniques to modify emotional and physical responses to stress, interface with mental health professionals, and practice sessions to improve self-regulation of responses to stress including coherence, a measure of heart rate variability. A gap exists in the research, however, regarding evaluation of the duration of effects after the initial resilience training. METHOD: Subjects included ( N = 34) recruits enrolled in summer 2015 at the Milwaukee Police Academy. An experimental design was used to compare recruits who received resilience training to recruits in the control group. RESULTS: No statistically significant differences between the groups were found for self-reported measures of stress and resilience. For the treatment group ( n = 17), change in coherence was significant ( p < .001) and improvement in the Personal Organizational Quality Assessment Emotional Buoyancy subscale correlated significantly with the number of practice sessions ( r = .63, p = .01) and marginally with change in coherence ( r = .47, p = .07). CONCLUSION: Results confirm several significant effects of resilience training with recruits.

Evaluation of Stress Experienced by Emergency Telecommunications Personnel Employed in a Large Metropolitan Police Department.

Emergency telecommunications personnel (ETCP) form the hub of police agencies and persistently deal with distressing situations on a daily basis, making them highly susceptible to psychological and physiological ailments. To date, few studies have examined the necessity or feasibility of implementing a resilience training intervention for ETCP. In this study, the authors assessed baseline psychological data from the ETCP of a large police department to determine the differences in baseline measures for ETCP and police officers. Participants included ETCP ages 29 to 64 years ( n = 19). Results showed that ETCP self-reported greater levels of psychological stress compared with police officers ( p < .05) for the majority of measures; ETCP experience excessive levels of stress and greater prevalence of chronic disease. Consideration should be given to piloting resilience interventions within this group to manage stress; improve health, performance, and decision making; and decrease the prevalence of chronic disease.

Building Resilience in an Urban Police Department.

OBJECTIVE: The aim of this study is to examine a resilience training intervention that impacts autonomic responses to stress and improves cardiovascular risk, psychological, and physiological outcomes in police. METHODS: Officers [(n = 38) 22 to 54 years] modified emotional and physical responses to stress using self-regulation. Measurements include psychological and physiological measures [eg, heart rate variability (HRV), blood pressure, C-reactive protein)] obtained at three time intervals. RESULTS: Age was significantly (P < 0.05) associated with changes on several measures of psychological stress (eg, critical incident stress, emotional vitality, and depression). Associations were found between coherence and improved HbA1c (r = -0.66, P < 0.001) and stress due to organizational pressures (r = -0.44, P = 0.03). Improvements in sympathetic and parasympathetic contributors of HRV were significant (P < 0.03). CONCLUSION: A stress-resilience intervention improves certain responses to job stress with greater benefits for younger participants.

Physical activity in police beyond self-report.

OBJECTIVE: Police officers have a higher risk for cardiovascular disease. Reductions in occupational physical activity may contribute to the risk, yet there have been few efforts to characterize the physical demands of police work beyond self-report. PURPOSE: To compare measured physical activity between work and off-duty hours and assess the effects of stress on physical activity. METHODS: Officers (n = 119) from six departments wore a pattern recognition monitor for 96 hours to measure total energy expenditure (kilocalorie per hour) (1k/cal = 4184 joules), activity intensity, and step count per hour. RESULTS: Participants were more active on their off-duty days than at work; the effects of stress on physical activity seemed moderated by sex. CONCLUSIONS: Police work is primarily a sedentary occupation, and officers tend to be more active on their off-duty days than during their work hours.

The effect of work shift and sleep duration on various aspects of police officers' health.

Police officers are prone to cardiovascular disease, overweight, and obesity. Because night-shift work affects sleep, a modifiable risk factor linked to chronic disease, the researchers explored the relationship among shift work, sleep, and wellness for police officers. Sleep, C-reactive protein (CRP) levels, stress, fatigue, and body mass index were used to compare officers who worked primarily day shifts to those who worked primarily evening or night shifts, and officers who slept less than 6 hours per day to those who slept at least 6 hours per day. A cross-sectional study of 85 male officers, 20 to 63 years old, was completed at three Midwestern police departments. The Pittsburgh Sleep Quality Index was used to assess sleep. A questionnaire was used to collect officer demographics and work hours. Other measurements included serum CRP, height, weight, perceived stress, and vital exhaustion. The relative risk of sleeping less than 6 hours per day for officers who primarily worked non-day shifts, compared to those who worked day shifts, was 14.27 (95% confidence interval [CI], 1.98-102.95, p < .001), and the relative risk of overall poor sleep quality for officers who slept less than 6 hours per day, compared to those who slept more hours, was 2.44 (95% CI, 1.15-5.20, p = .027). CRP was not associated with shift or sleep duration, even when adjusted for officers' ages.

Relationships among stress measures, risk factors, and inflammatory biomarkers in law enforcement officers.

Law enforcement officers suffer higher morbidity and mortality rates from all causes than the general population. Cardiovascular disease (CVD) accounts for a significant portion of the excess illness, with a reported prevalence as high as 1.7 times that of the general population. To determine which occupational hazards cause this increased risk and morbidity, it is imperative to study law enforcement officers before they retire. The long-range goal of our research is to reduce the incidence of CVD-related illness and death among aging law enforcement officers. The purpose of the present study was to measure pro- and anti-atherogenic inflammatory markers in blood samples from law enforcement officers (n = 71) and determine what types of occupation-related stress correlate with differences in these markers. For each outcome variable of interest, we developed separate regression models. Two groups of potential predictors were examined for inclusion in the models. Selected measures of stress were examined for inclusion in the models, in addition to general covariates, such as gender, ethnicity, years in law enforcement, and body mass index. Our results revealed statistically significant relationships between several physiologic variables and measures of stress.

Body mass index misclassification of obesity among community police officers.

Occupational health nurses are at the forefront of obesity assessment and intervention and must be aware of potential inaccuracies of obesity measurement. The purpose of this study was to identify the prevalence of obesity among a sample of 84 male police officers 22 to 63 years old and determine the accuracy of body mass index (BMI) in estimating obesity compared to body fat percent (BF %). BMI identified 39.3% of the participants as obese, compared to 70.2% by BF %. BMI misclassified normal-weight officers as obese or overweight and obese officers as normal 48.8% (n = 41) of the time. The two misclassified groups had similar average BMIs but significantly different BF %. BMI was not an accurate measure of obesity among adult males. BMI underestimated the true prevalence of obesity and could represent a missed opportunity for early intervention and disease prevention.

Relationship of cardiovascular disease to stress and vital exhaustion in an urban, midwestern police department.

This study explored risk factors for cardiovascular disease (CVD) among 336 officers of a Midwestern police force. Instruments used included the Perceived Stress Scale, the Maastricht Questionnaire (measuring vital exhaustion), and a general Health Risk Appraisal. Rates of CVD, hypertension, and hypercholesterolemia were 3%, 28%, and 43%, respectively. The relative risk of hypercholesterolemia for male officers, compared to female officers, was 1.98 (95% confidence interval [CI], 1.10 to 3.56). The officers' average body mass index was 28.6 (SD = 4.9), with 80% being overweight or obese. The average vital exhaustion score was higher for female officers than male officers (p < .05). Bivariate relationships of CVD with perceived stress, vital exhaustion, and age were statistically significant (p < .05). When controlling for age, odds ratios were 1.20 (95% CI, 1.03 to 1.39; p < .05) for perceived stress and 1.31 (95% CI, 1.12 to 1.53; p < .01) for vital exhaustion.

Preventing heat-related illness among Hispanic farmworkers.

Hispanic and Latino farmworkers are at risk for negative occupational health and safety outcomes due to issues such as their extreme work conditions, their reliance on employer beneficence, and cultural barriers. The purpose of this article is to explain the unique characteristics of heat-related illness in the Hispanic agricultural work force and to provide an overview of the problems of poor hydration and heat exposure in this population. Culturally appropriate preventive strategies are discussed because industrial-type solutions may not work in a crop production environment where language and beliefs may interfere with adaptation.

Milwaukee police department retirees: cardiovascular disease risk and morbidity among aging law enforcement officers.

This study explored the self-reported prevalence of cardiovascular disease (CVD) and accompanying risk factors among 165 male retirees 43 years and older (M = 56.2, SD = 7.1) from the Milwaukee Police Department (MPD) compared to 671 individuals of similar age and income who responded to the 2005 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS). CVD and other risk factors were more prevalent in the MPD retirees than the general population (CVD 15.2% vs. 9.5%, p = .036; hypertension 51.5% vs. 36.2%, p = .001; hypercholesterolemia 62.4% vs. 44.4%, p = .001; overweight and obesity 85.1% vs. 74.7%, p = .005). In addition, other factors associated with CVD prevalence included working in law enforcement (odds ratio = 1.70; 95% confidence interval = 1.03 to 2.79). Results suggest an association between employment in law enforcement and an increase in CVD morbidity.

Developing strategic interventions to reduce cardiovascular disease risk among law enforcement officers: the art and science of data triangulation.

The purpose of this study was to use data triangulation to inform interventions targeted at reducing morbidity from cardiovascular disease (CVD) and associated risk factors among law enforcement officers. Using the Precede-Proceed Health Promotion Planning Model, survey data (n = 672) and focus group data (n = 8 groups) from the Milwaukee Police Department were analyzed. Narrative transcripts disclosed that law enforcement officers encounter potential barriers and motivators to a healthy lifestyle. Survey results indicated rates of overweight (71.1% vs. 60.8%) and hypertension (27.4% vs. 17.6%) were significantly (p < or = .001) higher among Milwaukee Police Department law enforcement officers than the general population of Wisconsin (n = 2,855). The best predictor of CVD was diabetes (p = .030). Occupational health nurses are uniquely positioned to identify health risks, design appropriate interventions, and advocate for policy changes that improve the health of those employed in law enforcement and other high-risk professions.

Teaching the abyss: living the art-science of nursing.

This column addresses how nurse educators can provide the teaching-learning experiences for novice nurses to develop the leadership competence to effectively practice nursing in an extremely demanding healthcare environment. The authors delve into Mitchell and Bunkers' use of the metaphor of an abyss to explore the lived experience of risking being with others in extremely intense interpersonal situations. Using reflection, students' journal narratives affirm connections made among past experiences and the new knowledge gleaned from exploring and naming the phenomenon of the abyss. Several teaching-learning strategies are offered as ways for addressing the leadership issues related to dealing with intense relational experiences in nursing practice, including exploring nurse theorist Rosemarie Rizzo Parse's essentials of leadership.

Relationship among risk factors for nephrolithiasis, cardiovascular disease, and ethnicity: focus on a law enforcement cohort.

This cross-sectional study determined the prevalence of nephrolithiasis and common cardiovascular disease (CVD) risk factors in a law enforcement officer (LEO) cohort and evaluated the relationship of nephrolithiasis with several CVD risk factors, including the possible effect of ethnicity. Self reported nephrolithiasis and CVD risk factors among currently employed male LEOs from nine states (n = 2,818) were compared to other men in the same states (n = 9,650). Of the LEOs, 6.2% (n = 174) self reported at least one kidney stone (range = 1 to 12, mean 2.3 6 2.1 stones). Twenty five percent of Native American LEOs (n = 7 of 28) self reported a history of stones. In LEOs with a history of nephrolithiasis, overweight defined as body mass index . 25 kg/m2 (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.04, 3.11), hypercholesterolemia (OR = 1.53, 95% CI = 1.09, 2.15), and hypertension (OR = 1.46, 95% CI = 1.02, 2.11) were associated with the disease. These results suggest officers with common CVD risk factors are also at an increased risk for nephrolithiasis. Native American LEOs have a disproportionately higher prevalence of nephrolithiasis than do other ethnic groups.

Cardiovascular disease risk factors and the perception of general health among male law enforcement officers: encouraging behavioral change.

The relationship among cardiovascular disease (CVD) morbidity, risk factors (including stress), and the perception of health among male law enforcement officers (LEOs) compared to men in the general population were examined in this study. Self reported prevalence of CVD and CVD risk factors among currently employed male LEOs from nine states (n = 2,818) were compared to those of other men in the same states (n = 9,650 for CVD risk factors, n = 3,147 for CVD prevalence). Perceived stress in LEOs was assessed to determine if it affected the relationship between CVD prevalence and CVD risk factors. Cross tabulated simple percentages showed CVD was less prevalent in the LEO group than among the general population. The best predictor variables for CVD were perceived stress, time in the profession, and hypertension. The LEO group had greater prevalence of hypercholesterolemia, overweight, and tobacco use than the general population. However, a greater percentage of LEOs perceived their health as "good to excellent" compared to men in the general population. Using multivariate analysis of variance (MANOVA) it was determined that perceived stress was associated with CVD in the LEO group and three CVD risk factors (i.e., cholesterol, hypertension, physical activity) were significantly affected by perceived stress. Among susceptible officers, stress may contribute to CVD development as well as potentiate several CVD risk factors. However, an apparent lack of association exists between perception of general health and CVD risk in LEOs.

Using electronic portfolios to measure student achievement and assess curricular integrity.

Successful achievement of program outcomes is the primary goal of nursing education programs. Electronic portfolios are a contemporary method by which to measure student achievement, assess curricular efficacy, and evaluate program integrity in nursing education. The authors outline the sequential process of understanding, introducing, and integrating electronic portfolios into a curriculum.

Relationship between cardiovascular disease morbidity, risk factors, and stress in a law enforcement cohort.

It is unclear to what extent law enforcement officers (LEOs) experience increased prevalence of cardiovascular disease (CVD; defined as coronary heart disease, myocardial infarction, angina, or stroke) and, if so, whether perceived stress affects this relationship. First, self-reported CVD risk factors among currently employed male LEOs from 9 states (n = 2818) were compared to CVD risk factors among similarly-aged males with similar incomes in the same states (n = 8046). Second, CVD prevalence was compared among LEOs (n = 1791) and similarly-aged males with similar incomes (n = 2575) from four of these states. Finally, among the LEOs only, the possible effect of perceived stress on the relationship between CVD prevalence and CVD risk factors was assessed. LEOs reported higher prevalence of hypertension, hypercholesterolemia, tobacco use, and elevated body mass index. CVD prevalence did not differ significantly between the LEO group and the general population (2.3% +/- 15% versus 3.1% +/- 17%; P = 0.095). In the LEO-only group, the best predictors of CVD were: time in the profession (OR = 1.07; 95% CI = 1.03-1.11), perceived stress (OR = 1.05; 95% CI = 1.00-1.10), and hypertension (OR = 0.33; 95% CI = 0.18-0.62). In the LEO-only group, perceived stress was associated with CVD (P = 0.008), and three CVD risk factors were significantly affected by perceived stress: cholesterol, hypertension, and physical activity. Perceived stress was affected by duration of time in the profession (P = 0.004), independent of an age effect (P = 0.353). Among susceptible officers, perceived stress may contribute to CVD directly and through potentiating several CVD risk factors.