Transdiagnostic and tailored internet intervention to improve mental health among university students: Research protocol for a randomized controlled trial.

BACKGROUND: Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components. METHODS: This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned. DISCUSSION: This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.

Effects of COVID-19 contagion in cohabitants and family members on mental health and academic self-efficacy among university students in Sweden: a prospective longitudinal study.

OBJECTIVE: This study used causal inference to estimate the longitudinal effects of contagion in cohabitants and family members on university students' mental health and academic self-efficacy during the COVID-19 pandemic. DESIGN: A prospective longitudinal study including a baseline online measurement in May 2020, and online follow-ups after 5 months and 10 months. Participants were recruited through open-access online advertising. SETTING: Public universities and university colleges in Sweden. PARTICIPANTS: The analytical sample included 2796 students. OUTCOME MEASURES: Contagion in cohabitants and in family members was assessed at baseline and at the 5-month follow-up. Mental health and academic self-efficacy were assessed at the 5-month and 10-month follow-ups. RESULTS: Mild symptoms reported in cohabitants at baseline resulted in negative mental health effects at follow-up 5 months later, and mild baseline symptoms in family members resulted in negative effects on academic self-efficacy at follow-ups both 5 and 10 months later. CONCLUSIONS: Notwithstanding the lack of precision in estimated effects, the findings emphasise the importance of social relationships and the challenges of providing students with sufficient support in times of crisis.

How do Effort, Reward, and Their Combined Effects Predict Burnout, Self-rated Health, and Work-family Conflict Among Permanent and Fixed-term Faculty?

Employment conditions and psychosocial factors have been linked to various health-related outcomes in different occupational groups, but few studies focus on the conditions in academia. This study explores the effects of effort, reward, and their interaction to explain health-related outcomes, namely burnout, self-rated health, and work-family conflict among academic faculty in Sweden. We also explore these effects among those with permanent and fixed-term employment contracts. Questionnaire data, collected online in 2016, came from 2335 employees (57% women) with a doctoral degree, working at a Swedish higher education institution. Latent moderation analysis combined with multi-group analysis was conducted. Main effects of effort were found for all health-related outcomes revealing that effort was associated with higher burnout, poorer self-rated health, and greater work-family conflict. Reward was negatively associated with burnout and self-rated health revealing that reward reduced burnout and improved self-rated health. The interaction between effort and reward was significantly associated with all outcomes among permanent contract employees, but was non-significant among those with fixed-term contracts. This may suggest that fixed-term faculty are less affected by the presence or lack of reward. Overall, the findings emphasize the importance of the psychosocial work environment to understand health-related consequences for permanent and fixed-term faculty with a doctoral degree.

Experiences of physical activity and exercise among women with obstructive pulmonary disease.

BACKGROUND: With more women being diagnosed with obstructive pulmonary disease, it is important to know how women experience non-pharmacological rehabilitation including different types of physical activity and exercise. OBJECTIVE: This study aimed to explore how women with obstructive pulmonary disease experienced participating in pulmonary rehabilitation including yoga or strength- and endurance training to promote physical activity. A second aim included exploring experiences of physical activity and exercise through life. METHODS: Fifteen women with asthma or chronic obstructive pulmonary disease were interviewed about their experiences of participating in an exercise intervention and about their experiences of physical activity and exercise in their lives. The transcribed interviews were analyzed using qualitative content analysis. RESULTS: An overall theme, "Wishing to succeed in attending physical activity and exercise," emerged. Three categories were identified: 1) strategies to overcome insecurity; 2) a life situation which enables and hinders; and 3) an inner drive and focus on myself. CONCLUSIONS: The women's wishes to be physically activity and exercise involved hindering and enabling factors. Specifically, their gender roles as women were described as a hinder. This suggests a need to include a gender perspective when promoting physical activity and exercise to women with obstructive pulmonary disease.

Academic self-efficacy: Associations with self-reported COVID-19 symptoms, mental health, and trust in universities' management of the pandemic-induced university lockdown.

Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities' management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities' capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students' academic performance will be adversely affected.

Sickness absence and disability pension three years before and seven years after first childbirth: A Swedish population-based cohort study.

AIMS: There is a widely held belief, in Sweden and internationally, that women with children are more likely to be on sickness absence (SA) than their nulliparous counterparts. However, empirical findings in the field are limited and inconsistent. We aimed to explore initially nulliparous women's patterns of SA and disability pension (DP) three years before and seven years after 2009, by later parity. METHODS: We conducted a longitudinal cohort study of nulliparous women in Sweden on 31 December 2009 (N=426,918). We compared crude and standardized numbers of SA/DP net days in the three years before (Y-3 to Y-1) and the seven years (Y+1 to Y+7) after the date of the first birth in 2010 or 2 July 2010 in the following three groups: (1) women with no childbirth during the seven-year follow-up and an additional nine months (i.e. 7.8 years), (2) women with a first childbirth in 2010 and no additional childbirth during the next 7.8 years, and (3) women with their first childbirth in 2010 and minimum one more during the next 7.8 years. RESULTS: Women remaining nulliparous had consistently more standardized mean SA/DP days than women giving birth. Compared with women with one birth, women with several births had similar mean numbers of standardized SA/DP days during Y-3 and Y-2, more during Y+1 to Y+3 and fewer during Y+4 to Y+7. CONCLUSIONS: In contrast to the widely held societal belief, we found that in all years women who gave birth had fewer SA/DP days than those remaining nulliparous.

Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study.

BACKGROUND: Pregnancy and childbirth entail increased risks of sickness absence (SA). Many women work in education and care, two branches characterised by high SA levels; it is not known if the link between childbirth and SA in these branches differs between private and public sectors. We examined SA and disability pension (DP) in relation to childbirth among women working in the education and care branches, and if these patterns differed between public and private sectors. METHODS: We performed a Swedish register-based cohort study. Study participants were nulliparous women living in Sweden in December 2004 and employed in education or care (n = 120,013). We compared SA/DP in the three years before and after 2005 among women who had no childbirth during follow-up (B0), had one childbirth in 2005 and no more (B1), and had one childbirth in 2005 and at least one more during follow-up (B1+). Analyses were performed for all and by public or private sector. RESULTS: Of all studied women, 70% worked in the public sector. Women in B1 and B1+ had, except for the year before childbirth, comparable or lower mean combined SA/DP days than women in the B0 group; women in the B1+ group had, except for the year before childbirth, the lowest mean level of SA/DP. We observed no substantial differences in these patterns between public and private sectors. CONCLUSIONS: Patterns of SA/DP among nulliparous women who did or did not give birth did not differ substantially between public and private sectors among women in the educational and care branches.

Occupational exposure to particles and biomarkers of cardiovascular disease-during work and after vacation.

OBJECTIVE: Ambient particle matter is a risk factor for cardiovascular disease (CVD). However, little is known about associations between particles in occupational settings and risk of CVD. We investigated associations between occupational dust exposure and biomarkers of CVD, and potential recovery effects after vacation. METHODS: Personal dust exposure measurements (respirable silica, respirable dust < 4 µm, and particles of 0.1-10 µm (PM 0.1-10) were conducted once, and biological sampling were performed twice on non-smoking, male construction workers in Stockholm county, Sweden; during work and immediately after summer vacation. Linear regressions with adjustments for confounders and covariates were performed evaluating associations between occupational dust exposure and biomarkers. Paired t tests were performed evaluating changes before and after vacation. RESULTS: Sixty-five workers participated. Homocysteine concentrations were significantly higher with increasing concentrations (mg/m3) of respirable silica, respirable dust, and PM 0.1-10, and pulse rate with higher levels of respirable dust and dust of PM 0.1-10. Homocysteine levels were also positively correlated to number of years of dust exposure, as were low-density lipoprotein (LDL) levels. A clear recovery effect was present for LDL after vacation, but not for homocysteine. CONCLUSIONS: Occupational dust exposure was associated with some CVD risk markers, even at mean exposure concentrations below the Swedish occupational exposure limits for respirable silica and respirable dust, respectively. Vacation resulted in recovery for some risk markers. However, the change of the homocysteine and LDL levels suggest a long-term effect. Reduction of occupational exposure to dust may decrease the risk of CVD among exposed workers.

Residential Greenspace Is Associated with Lower Levels of Depressive and Burnout Symptoms, and Higher Levels of Life Satisfaction: A Nationwide Population-Based Study in Sweden.

Population-based studies of individual-level residential greenspace and mental health outcomes are still limited. Thus, the present study investigates greenspace-mental health associations-including depressive symptoms, burnout symptoms, and life satisfaction-in a population-based sample of adults, the Swedish Longitudinal Occupational Survey of Health, in 2016 (n = 14,641). High-resolution land cover of greenspace and green-blue-space was assessed at 50, 100, 300 and 500 m buffers around residential addresses. Higher residential greenspace and green-blue-space were associated with lower levels of depressive and burnout symptoms among non-working individuals and with higher life satisfaction in the whole study population, after controlling for age, sex, individual income, and neighborhood socioeconomics. The immediate residential-surrounding environment (50 m) consistently showed the strongest associations with the outcomes. Having a partner was associated with better mental health outcomes and with having more residential greenspace, and adjusting for this rendered greenspace-health associations mostly statistically non-significant. In conclusion, higher levels of greenspace and green-blue-space in the immediate residential-surrounding environment were associated with better mental health outcomes in the present study, which contributes additional nuances to prior studies. The importance of residential greenspace for public health, urban planning, and development is discussed.

Sustainable Working Life in Intensive Care: A Qualitative Study of Older Nurses.

To counteract the shortage of nurses in the workforce, healthcare organizations must encourage experienced nurses to extend their working lives. Intensive care (IC) has higher nurse-to-patient ratios than other settings, which includes a particular susceptibility to staff shortage. This qualitative study investigated how older IC nurses experienced their working life and their reflections on the late-career and retirement. Semi-structured interviews with 12 IC nurses in Sweden (aged 55-65 years) were analyzed using an interpretative phenomenological analysis approach. The results showed that nurses planned to continue working until the age of 65 and beyond. When reflecting on their late-career decisions, nurses considered nine areas covering individual, work, and organizational factors as being central to their ability and willingness to stay. Overall, the nurses had good health and were very satisfied and committed to their job and to the organization. They mentioned having both the job and personal resources required to cope with the physical and mental job demands, which were perceived as motivational challenges, rather than hinders. They also reflected on various human resource management practices that may promote aging-in-workplace. These findings may inform organizations aiming at providing adequate conditions for enabling healthy and sustainable working lives for IC nurses.

Symptoms of COVID-19 contagion in different social contexts in association to self-reported symptoms, mental health and study capacity in Swedish university students.

OBJECTIVE: The present study investigates if symptoms of COVID-19 contagion in different social contexts (cohabitants, family, acquaintances, and others) are associated with university students' own self-reported symptoms of COVID-19 contagion, mental health, and study capacity. This was investigated by a cross-sectional survey administrated in Sweden during the first wave of the COVID-19 pandemic, at the time when universities were locked down to limit viral spread and contagion. RESULTS: Mild to moderate symptoms of COVID-19 in cohabitants and family members were associated with student's self-reported symptoms of contagion, while no associations could be seen in relation to mental health and study capacity. Symptoms of COVID-19 contagion in acquaintances and others were not associated with students' self-reported symptoms, nor with their mental health and study capacity. To conclude, during the initial lockdown of universities students' self-reported symptoms of contagion were mainly associated with cohabitants and family members, while symptoms of contagion in different social contexts were not associated with mental health and study capacity. Findings suggest that lockdown of universities may have contributed to limiting infection pathways, while still allowing students to focus on their studies despite significant contagion among others known to the student.

Approaching retirement: A qualitative study of older nursing assistants' experiences of work in residential care and late-career planning.

In many countries, eldercare workers are approaching retirement. To remain attractive to older and experienced workers, organizations need to understand how employees nearing retirement think about and experience their work situation. This qualitative study investigated how older nursing assistants within residential care for older people experienced aging at work, their psychosocial work environment, and their late-career planning. Semi-structured interviews with eight nursing assistants (aged 55-61 years) in Sweden were analyzed using an Interpretative Phenomenological Analysis approach. The results show that the psychosocial work environment was perceived as stressful and considered a long-term health risk, and that (future) health and work ability were key factors determining nursing assistants' late-career planning. Moreover, personal resources and social support from colleagues seemed protective against job demands. Aspects considered in late-career planning also included personal finances and meaningfulness of work. While these findings may be sample-specific, they still provide insights into the experiences of an important occupational group. This means that the findings can be useful for organizations aiming at promoting successful and sustainable aging-in-workplace and encouraging extended working lives.

Political skill in higher military staff: Measurement properties and latent profile analysis.

Social effectiveness, including political skill, reflects individuals' ways of handling interpersonal processes at work. Most research has used a variable-oriented approach to investigate associations between political skill and key organizational factors, including performance, in civil settings. Thus, little is known of whether political skill transfers to a military context and whether there are specific profiles of political skill. Combining variable-oriented and person-oriented approaches, this study used self-reports from two samples of military student officers to: (1) investigate measurement properties of the 18-item political skill inventory; (2) explore whether it is possible to identify different profiles of political skill; and (3) investigate whether such profiles differ in demographics, personality, and job performance. Exploratory (sample 1: n = 185) and confirmatory (sample 2: n = 183) factor analyses supported a four-dimensional representation of political skill including networking ability, apparent sincerity, social astuteness, and interpersonal influence. Latent profile analysis (samples 1 and 2: N = 368) identified four distinct combinations of these dimensions, namely: (1) weak political skill; (2) weak political skill with strong sincerity; (3) moderate political skill; and (4) strong political skill. Importantly, profiles differed consistently in networking ability. Subsequent comparisons suggested potentially important differences in demographics, personality, and job performance. Despite needing additional research of how profiles of political skill develop over time, these findings may have practical implications for recruitment and training in organizational settings where social effectiveness is important.

Occupational stress and pregnancy-related hypertension and diabetes: Results from a nationwide prospective cohort.

OBJECTIVES: Using a large, national, prospective cohort, while adjusting for other work exposures, this study aims to investigate whether exposure to occupational stress during pregnancy is associated with hypertensive disorders of pregnancy (HDP) and gestational diabetes. METHODS: Our cohort consisted of 1 102 230 singleton births between 1994-2014 in Sweden, based on high-quality register data of Swedish pregnancies. Exposure to occupational stress was obtained from a job exposure matrix (JEM) constructed from 12 questions pertaining to the psychosocial work environment from the 1997-2013 cycles of Swedish Work Environment Survey, including approximately 75 000 individuals. We utilized the decision authority, demands, and social support indices. Decision authority and demands were combined to categorize occupations into low, active, passive, and high strain work. We estimated relative risks (RR) and adjusted for relevant confounders, such as age, smoking and other work exposures. RESULTS: Occupations with lower levels of decision authority were associated with increased risks of 12-23% for HDP and preeclampsia and 36-58% for gestational diabetes compared to occupations with the highest levels of decision authority. Passive occupations had increased risks of 10% for HDP and preeclampsia and 15% for gestational diabetes when compared to low strain jobs. No significant associations were found for high strain occupations. CONCLUSIONS: As a whole, occupational stress was not consistently associated with pregnancy outcomes in our study. However, decision authority was associated with an increased risk for pregnancy-related complications. Further studies should investigate whether improvements in working conditions can help decrease these risks.

Compliance with recommendations limiting COVID-19 contagion among university students in Sweden: associations with self-reported symptoms, mental health and academic self-efficacy.

AIMS: The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibility for compliance. Universities were one of few public institutions subject to strict closure, meaning that students had to adapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance and associations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacy among university students in Sweden in May-June 2020. METHODS: This was a cross-sectional 23 question online survey in which data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesis testing. RESULTS: A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%. Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19 symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of the participants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacy were reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertainty about contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy. CONCLUSIONS: Students generally followed public health recommendations during strict closure of universities, but many reported considerable negative consequences related to mental health and academic self-efficacy. Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviate student suffering during the pandemic and future similar crises.

Associations between compliance with covid-19 public health recommendations and perceived contagion in others: a self-report study in Swedish university students.

OBJECTIVE: During the COVID pandemic, government authorities worldwide have tried to limit the spread of the virus. Sweden's distinctive feature was the use of voluntary public health recommendations. Few studies have evaluated the effectiveness of this strategy. Based on data collected in the spring of 2020, this study explored associations between compliance with recommendations and observed symptoms of contagion in others, using self-report data from university students. RESULTS: Compliance with recommendations ranged between 69.7 and 95.7 percent. Observations of moderate symptoms of contagion in "Someone else I have had contact with" and "Another person" were markedly associated with reported self-quarantine, which is the most restrictive recommendation, complied with by 81.2% of participants. Uncertainty regarding the incidence and severity of contagion in cohabitants was markedly associated with the recommendation to avoid public transportation, a recommendation being followed by 69.7%. It is concluded that students largely followed the voluntary recommendations implemented in Sweden, suggesting that coercive measures were not necessary. Compliance with recommendations were associated with the symptoms students saw in others, and with the perceived risk of contagion in the student's immediate vicinity. It is recommended that voluntary recommendations should stress personal relevance, and that close relatives are at risk.

Does the management of personal integrity information lead to differing participation rates and response patterns in mental health surveys with young adults? A three-armed methodological experiment.

OBJECTIVES: This study evaluates whether initiation rates, completion rates, response patterns and prevalence of psychiatric conditions differ by level of personal integrity information given to prospective participants in an online mental health self-report survey. METHODS: A three-arm, parallel-group, single-blind experiment was conducted among students from two Swedish universities. Consenting participants following e-mail invitation answered the World Health Organization (WHO) World Mental Health-International College Student (WMH-ICS) mental health self-report survey, screening for eight psychiatric conditions. Random allocation meant consenting to respond (1) anonymously; (2) confidentially, or (3) confidentially, where the respondent also gave consent for collection of register data. RESULTS: No evidence was found for overall between-group differences with respect to (1) pressing a hyperlink to the survey in the invitation email; and (2) abandoning the questionnaire before completion. However, participation consent and self-reported depression were in the direction of higher levels for the anonymous group compared to the two confidential groups. CONCLUSIONS: Consent to participate is marginally affected by different levels of personal integrity information. Current standard participant information procedures may not engage participants to read the information thoroughly, and online self-report mental health surveys may reduce stigma and thus be less subject to social desirability bias.

Fatigue, Stress, and Performance during Alternating Physical and Cognitive Tasks-Effects of the Temporal Pattern of Alternations.

In occupational life, performing cognitive work tasks in between fatiguing physical work tasks may allow recovery and reduce stress without losing productive working time. The temporal pattern of such alternations is likely a determinant of the recovery effect, influencing both stress and fatigue; the difficulty of the cognitive task (CT) would also be a likely determinant. The aim of this study was to determine to what extent the temporal pattern of alternations between a repetitive physical task and a CT of different difficulties influenced perceived fatigability, performance fatigability, stress-related outcomes, and performance. Fifteen women performed four work sessions comprising 110 min of repeated bouts of a repetitive physical task (pipetting), alternating with a CT (n-back). Sessions differed in bout cycle time (short: 7 + 3 min versus long: 14 + 6 min) and CT difficulty (CTdiff; easy versus difficult). Fatigue was assessed from recordings of maximal voluntary contraction force in shoulder elevations and handgrip pre- and post-work, electromyography (EMG) from the right trapezius and right forearm extensors during work, and repeated self-ratings of fatigue and pain throughout the session. Stress was assessed using electrocardiography (heart rate variability), salivary alpha-amylase, and self-reports. Perceived fatigue increased significantly over time for all protocols and more in long-cycle than short-cycle conditions. EMG activity did not increase markedly over time in any condition. Neither objective nor subjective indicators suggested that stress increased over time, regardless of the temporal pattern. Pipetting performance remained stable in all conditions. Cognitive performance, measured by the proportions of correct positive and false positive answers, differed between CTdiff levels but remained stable over time, with no significant difference between temporal patterns. In summary, temporal patterns of alternating tasks influenced fatigue to some extent but had no obvious influence on stress indicators or performance. Thus, designing job rotation with alternating physical and cognitive work should consider the temporal patterns of alternations to minimize fatigue.

How do job insecurity profiles correspond to employee experiences of work-home interference, self-rated health, and psychological well-being?

OBJECTIVES: Traditional variable-oriented research has shown that employee perceptions of job insecurity (JI) are associated with negative consequences, including more work-home interference, poorer health, and impaired well-being. Besides the negative consequences of high JI, particular combinations of JI perceptions may also be associated with different consequences. Taking a person-oriented approach, this study aimed to investigate (1) whether it is possible to distinguish different combinations of JI perceptions among working women and men and (2) whether such JI profiles involve different experiences of work-home interference, health, and well-being. METHODS: Self-reports in questionnaires of JI, including both quantitative and qualitative threats of perceived job loss, work-home interference (WHI), health, and psychological well-being came from 1169 white-collar workers (52.4% women) in Sweden. Latent profile analysis was performed to identify JI profiles. Subsequent analyses included comparing profiles with respect to WHI, health, and well-being. RESULTS: Four distinct JI profiles were identified: (1) Secure; quality-concerned, (2) Insecure: employment-concerned, (3) Insecure, and (4) Secure. Comparisons of cluster profiles showed significant differences in work-home interference (family-work conflict), self-rated health, and psychological well-being. CONCLUSIONS: Findings suggest that the Insecure profile may be most vulnerable to adverse consequences of perceived JI. Taken together, different JI profiles may be associated with differential experiences of work-home interference, health, and psychological well-being among working women and men.

Stress-Related Responses to Alternations between Repetitive Physical Work and Cognitive Tasks of Different Difficulties.

Alternating between physical and cognitive tasks has been proposed as an alternative in job rotation, allowing workers to recover from the physical work while still being productive. However, effects of such alternations on stress have not been investigated. This controlled experiment aimed at determining the extent to which stress-related responses develop during alternating physical and cognitive work, and to determine the extent to which cognitive task (CT) difficulty influences these responses. Fifteen women performed three sessions of 10 consecutive work bouts each including a seven-minute repetitive physical task (pipetting) and a three-minute CT (n-back) at one of three difficulty levels. Stress was assessed in terms of changes in heart rate variability, blood pressure, salivary alpha-amylase, salivary cortisol, perceived stress, and cognitive performance. The work session did not result in any marked stress response, and CT difficulty did not significantly influence stress, apart from alpha-amylase being higher at the easiest CT (F = 5.34, p = 0.02). Thus, according to our results, alternating between repetitive physical tasks and cognitive tasks may be a feasible alternative to classic job rotation between physical tasks only, even if the cognitive task is quite difficult. Future studies should address possible effects of the temporal pattern of alternations, and combine even other occupationally relevant tasks, preferably for extended periods of time.