High-Frequency Heart Rate Variability Is Prospectively Associated With Sleep Complaints in a Healthy Working Cohort.

OBJECTIVE: Vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), has been implicated in a wide range of mental and physical health conditions, including sleep complaints. This study aimed to test associations between HF-HRV measured during sleep (sleep HF-HRV) and subjective sleep complaints 4 years later. METHODS: One hundred forty-three healthy employees (91% male; MAge = 47.8 years [time 2], SD = 8.3 years) of an industrial company in Southern Germany completed the Jenkins Sleep Problems Scale, participated in a voluntary health assessment, and were given a 24-hour ambulatory heart rate recording device in 2007. Employees returned for a health assessment and completed the Jenkins Sleep Problems Scale 4 years later. RESULTS: Hierarchical regression analyses showed that lower sleep HF-HRV measured in 2007 was associated with higher self-reported sleep complaints 4 years later after controlling for covariates (rab,c = -0.096, b = -0.108, 95% CI, -0.298 to 0.081, ΔR2 = 0.009, p = .050). CONCLUSIONS: These data are the first to show that lower sleep HF-HRV predicted worse sleep 4 years later, highlighting the importance of vagus nerve functioning in adaptability and health.

[egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants]. / egePan-VOICE-Studie zur psychosozialen Belastung durch die Covid-19-Pandemie bei medizinischtechnischen Assistent*innen.

egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants Objectives: The Covid-19 pandemic is associated with increased demands on healthcare workers. A previously neglected occupational group is medical technical assistants (MTA). The aim is therefore to identify stress factors among MTA in Germany during the pandemic. Methods: A cross-sectional online survey of medical staff was conducted in spring 2020 (N = 8088). Results: N = 1483 records of MTA were analyzed. Retrospectively, the stress increased under the pandemic, and 60.1 % of MTA suffered from work stress (ERI). Staff shortages and extra work were associated with an increase in work stress. Problems of work-life balance and contact with contaminated material/infected persons favored stressful experiences. Conclusions: Some working conditions in the pandemic pose a potential health risk to MTA. It seems necessary to create improvements in the general conditions that enable healthily and effective work.

The streamlined allostatic load index is associated with perceived stress in life - findings from the MIDUS study.

The wear and tear of the body caused by stressful events is subject of extensive research and can be measured by the allostatic load index (ALI). The aim of this cross-sectional study was to replicate an ALI-5 score in a population sample in the USA and to compare these findings with the original ALI-10 score. Data from the Midlife in the United States Study (MIDUS) assessed between 2004 and 2016 were used to calculate different ALI risk scores with 5 and 10 variables, respectively. Examinations included anthropometric data, heart rate variability (HRV), and blood and urine samples. Questionnaires assessed information on perceived stress and medical history. Logistic regression models estimated odds ratios (OR) with corresponding 95% confidence intervals (CIs) for the association between ALI indices and perceived stress, controlling for various confounders. Subgroup analysis explored the difference in gender and in three age clusters. Data of 1421 participants (43% male, 50.4 ± 9.3 years) were included in the analysis. Adjusted logistic regression models showed an odds ratio of 1.37 ± 0.19 (CI 1.05, 1.80; p=.022) for the association of ALI-5 with perceived stress. This association was stronger in females (OR = 1.62 ± 0.28, CI 1.15, 2.28; p = .006) and did not significantly differ between age clusters. Results for the original ALI-10 score did not reach significance. The streamlined ALI-5 score seems to be a reliable risk score and is strongly associated with perceived stress in life. Longitudinal studies should further elaborate this association in different samples.Lay summary: Stress from different sources can lead to serious diseases. A short composite index comprising of five medical variables is highly associated with perceived stress. This index is able to serve as an early indicator to detect people who are at risk to develop stress-related diseases.

Less immune activation following social stress in rural vs. urban participants raised with regular or no animal contact, respectively.

Urbanization is on the rise, and environments offering a narrow range of microbial exposures are linked to an increased prevalence of both physical and mental disorders. Human and animal studies suggest that an overreactive immune system not only accompanies stress-associated disorders but might even be causally involved in their pathogenesis. Here, we show in young [mean age, years (SD): rural, 25.1 (0.78); urban, 24.5 (0.88)] healthy human volunteers that urban upbringing in the absence of pets (n = 20), relative to rural upbringing in the presence of farm animals (n = 20), was associated with a more pronounced increase in the number of peripheral blood mononuclear cells (PBMCs) and plasma interleukin 6 (IL-6) concentrations following acute psychosocial stress induced by the Trier social stress test (TSST). Moreover, ex vivo-cultured PBMCs from urban participants raised in the absence of animals secreted more IL-6 in response to the T cell-specific mitogen Con A. In turn, antiinflammatory IL-10 secretion was suppressed following TSST in urban participants raised in the absence of animals, suggesting immunoregulatory deficits, relative to rural participants raised in the presence of animals. Questionnaires, plasma cortisol, and salivary α-amylase, however, indicated the experimental protocol was more stressful and anxiogenic for rural participants raised in the presence of animals. Together, our findings support the hypothesis that urban vs. rural upbringing in the absence or presence of animals, respectively, increases vulnerability to stress-associated physical and mental disorders by compromising adequate resolution of systemic immune activation following social stress and, in turn, aggravating stress-associated systemic immune activation.

[Psychological stress caused by epidemics among health care workers and implications for coping with the corona crisis: a literature review]. / Psychische Belastungen durch Epidemien bei Beschäftigten im Gesundheitswesen und Implikationen für die Bewältigung der Corona-Krise: eine Literaturübersicht.

Psychological stress caused by epidemics among health care workers and implications for coping with the corona crisis: a literature review Objectives: COVID-19 has significantly changed the working and living conditions within a short period. Despite the milder course of the disease in comparison to other countries, employees in the German health care system are particularly affected by the massive impact of the disease on their professional and private lives. From a scientific point of view, summarized empirical evidence made during other epidemics and at the beginning of the COVID-19-pandemic is largely missing. Methods: Narrative review article, literature search on PubMed database. Results: A total of 56 studies were included, 35 of them on the SARS epidemic and seven on COVID-19; included studies reported overall increased stress levels, anxiety and PTSD symptoms due to health care work during various epidemics. Direct contact with patients, quarantine experiences and perceived health risks were further stress factors in epidemics. Participation in intervention studies enabled better management of epidemic-related situations. Conclusions: Healthcare workers are exposed to high workloads because of epidemics, which can have a variety of adverse effects. Recommendations are made for dealing with periods of high exposure during the COVID-19-pandemic.

Heart rate variability and inflammation: A meta-analysis of human studies.

The inflammatory reflex is known as the body's primary defense against infection and has been implicated in a number of diseases. The magnitude of the inflammatory response is important, as an extreme or insufficient response can be differentially harmful to the individual. Converging evidence suggests that the autonomic nervous system (ANS) regulates the inflammatory reflex. Heart rate variability (HRV) can be separated into components that primarily reflect parasympathetic (PNS) or vagal activity (i.e., indices of vagally mediated HRV) and a combination of both sympathetic (SNS) and PNS influences. Given the physiological relation between the vagus and inflammatory processes, one would expect to find higher HRV, especially indices of vagally-mediated HRV, to be associated with decreased levels of inflammation via the cholinergic anti-inflammatory pathway. However, existing findings here are mixed, such that studies have also shown a positive association between indices of HRV and markers of inflammation. Therefore, the present meta-analysis aimed to synthesize existing studies, estimating the general direction and strength of the relationship between different indices of HRV and inflammatory markers. A systematic search of the literature yielded 2283 studies that were screened for inclusion eligibility (159 studies eligible for inclusion); in sum, 51 studies reported/provided adequate information for inclusion in meta-analyses. Results generally showed negative associations between indices of HRV and markers of inflammation. In this regard, the standard deviation of R-R intervals (SDNN) and power in the high frequency band of HRV (HF-HRV) showed the strongest and most robust associations with inflammatory markers compared to other time- and frequency-domain measures of HRV. Overall, we propose that indices of HRV can be used to index activity of the neurophysiological pathway responsible for adaptively regulating inflammatory processes in humans.

Cluster-randomised trial evaluating a complex intervention to improve mental health and well-being of employees working in hospital - a protocol for the SEEGEN trial.

BACKGROUND: Health care employees in Germany and worldwide are exposed to a variety of stressors. However, most of the hospitals in Germany lack a systematic workplace health management. Thus, this study aims at the evaluation of the effects of a behavioural as well as organisational (´complex´) intervention on the mental health and well-being of hospital staff. METHODS: Mental health in the hospital workplace (SEElische GEsundheit am Arbeitsplatz KrankeNhaus - SEEGEN) is an unblinded, multi-centred cluster-randomised open trial with two groups (intervention group (IG) and waitlist control group (CG)). Study participants in the intervention clusters will receive the complex intervention; study participants in the waitlist control clusters will receive the complex intervention after the last follow-up measurement. The intervention consists of five behavioural and organisational intervention modules that are specifically tailored to hospital employees at different hierarchical and functional levels. Hospital staff may select one specific module according to their position and specific needs or interests. Towards the end of the intervention roundtable discussions with representatives from all professional groups will be held to facilitate organisational change. Primary outcome is the change in emotional and cognitive strain in the working environment, from baseline (T0) to 6 month-follow up (T1), between IG and CG. In addition, employees who do not participate in the modules are included in the trial by answering shorter questionnaires (cluster participants). Furthermore, using mixed methods, a process evaluation will identify uptake of the intervention, and mediators and moderators of the effect. DISCUSSION: There seems to be growing psychological strain on people working in the health care sector worldwide. This study will examine whether investing directly in the hospital staff and their interpersonal relationship may lead to measurable benefits in subjective well-being at the workplace and improved economic performance indicators of the hospital. In case of a positive outcome, health promotion strategies looking at behavioural as well as organisational components within the hospital may gain additional importance, especially in regard of the growing financial pressure within the health sector. TRIAL REGISTRATION DRKS: The SEEGEN study is registered at the German Clinical Trial Register (DRKS) under the DRKS-ID DRKS00017249. Registered 08 October 2019, URL. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017249.

Lack of supportive leadership behavior predicts suboptimal self-rated health independent of job strain after 10 years of follow-up: findings from the population-based MONICA/KORA study.

OBJECTIVES: Emerging cross-sectional research has identified lack of supportive leadership behavior (SLB) as a risk factor for workforce health. However, prospective evidence is hitherto lacking. SLB denotes support in difficult situations, recognition and feedback on work tasks. This study aims to determine the effect of SLB on suboptimal self-rated health (SRH) after 10 years considering potential moderators such as ages, sex, occupation and job strain. METHODS: The sample included 884 employed participants drawn from the population-based prospective MONICA/KORA Study. SLB, SRH, as well as job strain were assessed by questionnaire. Logistic regressions estimated odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the effect of SLB at baseline on suboptimal SRH at follow-up. Analyses were adjusted for age, gender, lifestyle (alcohol, smoking, physical activity), socioeconomic status as well as for SRH and job strain at baseline. RESULTS: Lack of SLB was associated with suboptimal SRH at baseline [OR 2.00, (95% CI 1.19-3.46)] and at follow-up [OR 2.33, (95% CI 1.40-3.89)]. Additional adjustment for job strain did not substantially alter this association [OR 2.06, (95% CI 1.20-3.52)]. However, interactions between SLB and job strain as well as gender became evident, indicating moderating influences on the association between SLB and SRH. CONCLUSION: Lack of supportive leadership was associated with suboptimal SRH at 10 years' follow-up in men, even if SRH at baseline and other risk factors were taken into account. This effect is likely to be moderated by job strain.

Changing Me, Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy.

We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist-control, short-term couple therapy RCT study (N = 43 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ-45.2). In Study 2, N = 332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4-week follow-up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate-to-large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work-team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects.

The streamlined Allostatic Load Index: a replication of study results.

According to the World Health Organization stress in the workplace is becoming a major challenge of employers worldwide. While perceived stress levels can be assessed by questionnaires there is growing evidence that stress-related wear and tear of our body can be measured by the Allostatic Load Index (ALI). In a sample of 12,477 German industrial employees (19.6% female, 18-65 years) self-rated stress was explored by the effort-reward imbalance (ERI) questionnaire. A voluntary health check included biomarkers such as diastolic blood pressure, waist circumference, glycosylated hemoglobin, low-density lipoprotein, and heart rate variability. Based on predefined subclinical cutoff values, a 5-variable ALI was calculated. Differences in ALI according to low (ERI ≤1.0) and high (ERI >1.0) stress levels were tested. The association of ERI and ALI was explored using logistic regression analysis controlling for multiple confounders. Employees perceiving high stress levels showed significant higher ALI scores (p < .001) compared to lower stressed employees. This association was stronger in men and independent of age. ALI was associated with work stress in adjusted models (OR 1.18 ± .08 [95% CI 1.03, 1.36]; p < .05). This study replicates former results in a large sample of industrial employees indicating that work stress is associated with a short form ALI.

Valacyclovir versus acyclovir for the treatment of herpes zoster ophthalmicus in immunocompetent patients.

BACKGROUND: Herpes zoster ophthalmicus affects the eye and vision, and is caused by the reactivation of the varicella zoster virus in the distribution of the first division of the trigeminal nerve. An aggressive management of acute herpes zoster ophthalmicus with systemic antiviral medication is generally recommended as the standard first-line treatment for herpes zoster ophthalmicus infections. Both acyclovir and its prodrug valacyclovir are medications that are approved for the systemic treatment of herpes zoster. Although it is known that valacyclovir has an improved bioavailability and steadier plasma concentration, it is currently unclear as to whether this leads to better treatment results and less ocular complications. OBJECTIVES: To assess the effects of valacyclovir versus acyclovir for the systemic antiviral treatment of herpes zoster ophthalmicus in immunocompetent patients. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), Web of Science Conference Proceedings Citation Index-Science (CPCI-S; January 1990 to June 2016), BIOSIS Previews (January 1969 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2016. SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) in which systemic valacyclovir was compared to systemic acyclovir medication for treatment of herpes zoster ophthalmicus. There were no language restrictions. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, evaluated the risk of bias in included trials, and extracted and analysed data. We did not conduct a meta-analysis, as only one study was included. We assessed the certainty of the evidence for the selected outcomes using the GRADE approach. MAIN RESULTS: One study fulfilled the inclusion criteria. In this multicentre, randomised double-masked study carried out in France, 110 immunocompetent people with herpes zoster ophthalmicus, diagnosed within 72 hours of skin eruption, were treated, with 56 participants allocated to the valacyclovir group and 54 to the acyclovir group. The study was poorly reported and we judged it to be unclear risk of bias for most domains.Persistent ocular lesions after 6 months were observed in 2/56 people in the valacyclovir group compared with 1/54 people in the acyclovir group (risk ratio (RR) 1.93 (95% CI 0.18 to 20.65); very low certainty evidence. Dendritic ulcer appeared in 3/56 patients treated with valacyclovir, while 1/54 suffered in the acyclovir group (RR 2.89; 95% confidence interval (CI) 0.31 to 26.96); very low certainty evidence), uveitis in 7/56 people in the valacyclovir group compared with 9/54 in the acyclovir group (RR 0.96; 95% CI 0.36 to 2.57); very low certainty evidence). Similarly, there was uncertainty as to the comparative effects of these two treatments on post-herpetic pain, and side effects (vomiting, eyelid or facial edema, disseminated zoster). Due to concerns about imprecision (small number of events and large confidence intervals) and study limitations, the certainty of evidence using the GRADE approach was rated as low to very low for the use of valacyclovir compared to acyclovir. AUTHORS' CONCLUSIONS: This review included data from only one study, which had methodological limitations. As such, our results indicated uncertainty of the relative benefits and harms of valacyclovir over acyclovir in herpes zoster ophthalmicus, despite its widespread use for this condition. Further well-designed and adequately powered trials are needed. These trials should include outcomes important to patients, including compliance.

[Parental Social Status and other determinants of quality of life and behavioral problems: An analysis of German preterm births between 1987-2004]. / Elterlicher Sozialstatus und andere Determinanten von Lebensqualität und Verhaltensauffälligkeiten : Eine Analyse deutscher Frühgeborener der Jahrgänge 1987-2004.

BACKGROUND: Knowledge of the factors affecting the development of preterm children in Germany is limited. We analysed the prevalence of preterm birth in Germany using the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 and assessed factors associated with quality of life (QOL) and behavioural development in preterm children (< 37 weeks' gestational age). METHODS: Data were weighted and preterm prevalence was calculated by socioeconomic status (SES) and year of birth for 1,106 preterm children. Using linear regression models, the relationship between sociodemographic, pre- and perinatal, lifestyle, and contextual determinants on the one hand, and the QOL (KINDL® parent questionnaire) and behavioural problems (the total problem behaviour scale, the Strengths and Difficulties Questionnaire [SDQ]) on the other was calculated. RESULTS: Prevalence of preterm birth (mean 7.5 %) was higher in families with low compared with high SES (8.4 versus 7.0 %). In the final regression models, preterm children with high SES had higher QOL scores (+ 3.3 KINDL points, p = 0.024) compared with children with low SES, and adolescents (aged 14-17 years) had a higher QOL than children aged 7-13 years. All other variables (contextual, pre- and perinatal) were not related to QOL. In contrast, there were many determinants of behavioural development in preterms: the SDQ total score was lower in girls, children with older mothers, those from high SES and those with a high level of physical activity. However, both very low birth weight (< 1,500 g) and birth at > 34 weeks' gestation were associated with a higher SDQ total score. CONCLUSION: Given its high prevalence, preterm birth is a relevant public health issue in Germany. While SES may be the most important determinant of QOL in preterms, determinants of behavioural problems are the same as those in term children and also encompass perinatal factors.

Elevated HbA(1c) levels and the accumulation of differentiated T cells in CMV(+) individuals.

AIMS/HYPOTHESIS: Biological ageing of the immune system, or immunosenescence, predicts poor health and increased mortality. A hallmark of immunosenescence is the accumulation of differentiated cytotoxic T cells (CD27(-)CD45RA(+/-); or dCTLs), partially driven by infection with the cytomegalovirus (CMV). Immune impairments reminiscent of immunosenescence are also observed in hyperglycaemia, and in vitro studies have illustrated mechanisms by which elevated glucose can lead to increased dCTLs. This study explored associations between glucose dysregulation and markers of immunosenescence in CMV(+) and CMV(-) individuals. METHODS: A cross-sectional sample of participants from an occupational cohort study (n = 1,103, mean age 40 years, 88% male) were assessed for HbA(1c) and fasting glucose levels, diabetes, cardiovascular risk factors (e.g. lipids), numbers of circulating effector memory (EM; CD27(-)CD45RA(-)) and CD45RA re-expressing effector memory (EMRA; CD27(-)CD45RA(+)) T cells, and CMV infection status. Self-report and physical examination assessed anthropometric, sociodemographic and lifestyle factors. RESULTS: Among CMV(+) individuals (n = 400), elevated HbA(1c) was associated with increased numbers of EM (B = 2.75, p < 0.01) and EMRA (B = 2.90, p < 0.01) T cells, which was robust to adjustment for age, sex, sociodemographic variables and lifestyle factors. Elevated EM T cells were also positively associated with total cholesterol (B = 0.04, p < 0.05) after applying similar adjustments. No associations were observed in CMV(-) individuals. CONCLUSIONS/INTERPRETATION: The present study identified consistent associations of unfavourable glucose and lipid profiles with accumulation of dCTLs in CMV(+) individuals. These results provide evidence that the impact of metabolic risk factors on immunity and health can be co-determined by infectious factors, and provide a novel pathway linking metabolic risk factors with accelerated immunosenescence.

A streamlined approach for assessing the Allostatic Load Index in industrial employees.

Work stress is common and can lead to various bodily dysfunctions. The Allostatic Load Index (ALI) is a tool to measure the wear and tear of the body caused by chronic stress. This cross-sectional study aimed to explore the association of work-related stress and ALI in German industrial employees. A short form ALI should be developed for practical use of company physicians. In this exploration of an industrial cohort (n = 3797; 79.3% male), work stress was measured by the effort-reward imbalance (ERI) questionnaire in 2009-2011. ALI was calculated using 15 variables including anthropometric data, heart rate variability, as well as blood and urine samples based on predefined subclinical cut-off values. Differences in ALI related to low (≤1) and high (>1) ERI categories were tested. Logistic regression models estimated odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between ALI and work stress controlling for multiple confounders. Employees exposed to high work stress showed higher ALI scores (p < 0.001) compared to those with low stress levels. In multivariable models, ALI was associated with work stress (OR 1.19 [95% CI: 1.00, 1.42]; p < 0.05) following adjustment for a range of potential confounders. By reducing ALI parameters to five variables this association increased modestly and remained statistically significant (OR 1.27 [95% CI: 1.05, 1.54]; p < 0.05). The results indicate that work stress is associated with ALI in German industrial employees. A short form index seems to be a promising approach for occupational health practitioners. The results should be validated in further longitudinal explorations defining a standard set of variables including gender-related thresholds.

Organizational justice is related to heart rate variability in white-collar workers, but not in blue-collar workers-findings from a cross-sectional study.

BACKGROUND: Perceived injustice at work predicts coronary heart disease. Vagal dysregulation represents a potential psychobiological pathway. PURPOSE: We examined associations between organizational justice and heart rate variability (HRV) indicators. Grounded in social exchange and psychological contract theory, we tested predictions that these associations are more pronounced among white-collar than among blue-collar workers. METHODS: Cross-sectional data from 222 blue-collar and 179 white-collar men were used. Interactional and procedural justice were measured by questionnaire. Ambulatory HRV was assessed across 24 h. Standardized regression coefficients (ß) were calculated. RESULTS: Among white-collar workers, interactional justice showed positive relationships with 24-h HRV, which were strongest during sleeping time (adjusted ßs≥0.26; p values≤0.01). No associations were found for blue-collar workers. A comparable but attenuated pattern was observed for procedural justice. CONCLUSIONS: Both dimensions of organizational injustice were associated with lowered HRV among white-collar workers. The impact of justice and possibly its association with health seems to differ by occupational groups.

The Association of (Effective and Ineffective) Analgesic Intake, Pain Interference and Heart Rate Variability in a Cross-Sectional Occupational Sample.

OBJECTIVE: Persistent pain is associated with dysfunction of the autonomic nervous system, in particular a loss of vagal inhibitory control, that can be indexed by decreased vagally mediated heart rate variability (vmHRV). Effective treatment (e.g., analgesic self-medication) may lead to a restoration of vmHRV. The objective of this article was to further explore the relationship of pain and vagal control and to investigate the effect of analgesic self-medication on the association of vmHRV and pain. METHODS: We used a large cross-sectional data set on pain ratings and analgesic intake from the Mannheim Industrial Cohort Study for secondary analysis. The root mean square of successive differences, a measure of vmHRV corresponding to the parasympathetic regulation of the heart, was derived from 24-hour electrocardiogram recordings. RESULTS: The frequency of analgesic intake and interference of pain are significantly associated. Individuals that report greater pain interference with their normal work routine (including both work outside the home and housework) and frequent analgesic intake have significantly lower vmHRV. Subjects with ineffective analgesic intake (reporting great pain interference and high frequent analgesic intake) had the lowest vmHRV. Individuals effectively taking analgesics (reporting no or low pain interference and high frequent analgesic intake) showed greater vmHRV compared to those ineffectively taking. Analysis revealed significant differences and linear trends on vmHRV between all groups. CONCLUSION: In line with previous research, vmHRV is inversely associated with pain interference. Analgesic intake mediates the association of vmHRV and pain. Effective analgesic self-medication may lead to a restoration in vmHRV. These results further support the vagus nerve as an objective indication of pain severity and treatment efficacy in patients with persistent pain.

Association of vitamin D levels with type 2 diabetes in older working adults.

OBJECTIVES: Increasing evidence suggests that vitamin D plays a role in the development of chronic diseases including type 2 diabetes (DM). Aim of the study was to explore the association of vitamin D levels with prevalent DM in a sample of predominantly healthy working adults older than 45 years. METHODS: This cross-sectional study (2009-2011) involved 1821 employees of a German engineering company (83.1% male, mean age 51.9 ±5.6 years). Sociodemographics and medical history were assessed by self-report. Clinical characteristics were obtained including blood samples to determine vitamin D levels and diabetes status by fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c). Vitamin D was grouped into one of four categories (<10 ng/ml, 10-19.9 ng/ml, 20-29.9 ng/ml, ≥30 ng/ml). Bivariate associations between vitamin D categories and a composite indicator for DM (FPG ≥126 mg/dl or HbA1c ≥6.5% or self-reported diagnosis) were calculated; multivariable models tested this association further, controlling for potential confounders. RESULTS: Severe vitamin D deficiency (<10 ng/ml) was associated with increasing FPG (ß 3.13; 95% CI: 0.78, 5.47; p≤0.01) and HbA1c (ß 0.15; 95% CI: 0.08, 0.23; p≤0.001) values in adjusted linear regression models. In multivariable models, severe vitamin D deficiency was associated with DM (OR 2.55; 95%CI 1.16, 5.62; p≤0.05) after controlling for potential confounders. CONCLUSIONS: Vitamin D deficiency is associated with prevalent DM in working older adults. The findings highlight that the workplace may be a unique location for conducting large-scale health screening to identify those at risk of DM using vitamin D.

Lowered parasympathetic activity in apparently healthy subjects with self-reported symptoms of pain: preliminary results from a pilot study.

OBJECTIVES: The aim was to evaluate differences in the autonomic nervous system (ANS) activity, indexed by heart rate variability (HRV) in apparently healthy subjects with self-reported symptoms of pain (SRSP) within an exploratory analysis. METHODS: HRV data from 14 apparently healthy male individuals were analyzed to address potential differences in subjects with and without SRSP. SRSP was assessed using the four pain-related items from the symptom checklist (SCL-90R). Subjects were stratified based on the presence of SRSP. RESULTS: Parasympathetic activity, indexed by pNN50, RMSSD, and high frequency (HF) spectrum of HRV, was lower in subjects with SRSP. Low frequency (LF) HRV and the LF/HF ratio were greater in subjects with SRSP. However, analysis of variance revealed no significant differences between the groups. Pearson correlations showed a correlation of pNN50, HF, LF, and LF/HF ratio and the presence and frequency of SRSP. Measures of parasympathetic activity (pNN50 and HF) were inversely associated with more SRSP, indicating that subjects with more frequent SRSP show decreased parasympathetic activity. CONCLUSIONS: Consistent with evidence on changes in HRV in patients with clinical conditions of chronic or recurrent pain, this is the first study to show that healthy individuals who report symptoms of pain may have lower parasympathetic activity revealed by measures of HRV.

Consistent associations between measures of psychological stress and CMV antibody levels in a large occupational sample.

Cytomegalovirus (CMV) is a herpes virus that has been implicated in biological aging and impaired health. Evidence, largely accrued from small-scale studies involving select populations, suggests that stress may promote non-clinical reactivation of this virus. However, absent is evidence from larger studies, which allow better statistical adjustment for confounding and mediating factors, in more representative samples. The present study involved a large occupational cohort (N=887, mean age=44, 88% male). Questionnaires assessed psychological (i.e., depression, anxiety, vital exhaustion, SF-12 mental health), demographic, socioeconomic (SES), and lifestyle variables. Plasma samples were analyzed for both the presence and level of CMV-specific IgG antibodies (CMV-IgG), used as markers for infection status and viral reactivation, respectively. Also assessed were potential biological mediators of stress-induced reactivation, such as inflammation (C-reactive protein) and HPA function (awakening and diurnal cortisol). Predictors of CMV infection and CMV-IgG among the infected individuals were analyzed using logistic and linear regression analyses, respectively. Confirming prior reports, lower SES (education and job status) was positively associated with infection status. Among those infected (N=329), higher CMV-IgG were associated with increased anxiety (ß=.14, p<.05), depression (ß=.11, p=.06), vital exhaustion (ß=.14, p<.05), and decreased SF-12 mental health (ß=-.14, p<.05), adjusting for a range of potential confounders. Exploratory analyses showed that these associations were generally stronger in low SES individuals. We found no evidence that elevated inflammation or HPA-function mediated any of the associations. In the largest study to date, we established associations between CMV-IgG levels and multiple indicators of psychological stress. These results demonstrate the robustness of prior findings, and extend these to a general working population. We propose that stress-induced CMV replication warrants further research as a psychobiological mechanism linking stress, aging and health.

Associations between supportive leadership and employees self-rated health in an occupational sample.

BACKGROUND: Protecting the health of the work force has become an important issue in public health research. PURPOSE: This study aims to explore potential associations between supportive leadership style (SLS), an aspect of leadership behavior, and self-rated health (SRH) among employees. METHOD: We drew on cross-sectional data from a cohort of industrial workers (n = 3,331), collected in 2009. We assessed employees' ratings of supportive, employee-oriented leadership behavior at their job, their SRH, and work stress as measured by the effort-reward model and scales measuring demands, control, and social support. Logistic regression estimated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) for the association between the perception of poor SLS and poor SRH controlling for work-related stress and other confounders. Sensitivity analyses stratified models by sex, age, and managerial position to test the robustness of associations. RESULTS: Perception of poor SLS was associated with poor SRH [OR 2.39 (95 % CI 1.95-2.92)]. Although attenuated following adjustment for measures of work-related stress and other confounders [OR 1.60 (95 % CI 1.26-2.04)], the magnitude, direction, and significance of this association remained robust in stratified models in most subgroups. CONCLUSION: SLS appears to be relevant to health in the workplace. Leadership behavior may represent a promising area for future research with potential for promoting better health in a large segment of the adult population.