Healthily Nourished but Depleted? Is It Possible to Improve the Health of Shift Workers through Lifestyle Interventions?

The relationship between diet and health is well-researched, and there is also information regarding the effects of diet on mental health. This study aimed to investigate whether motivation to optimize lifestyles without regulations or restrictions could improve the health of rotating shift workers. In this pilot study, 18 male shift workers were randomly divided into two groups. All participants completed the Short Form Health Survey-36 questionnaire (SF-36) before the start and at the end of the study. Group I (n = 9, mean age 42 ± 6.6 y) received dietary and lifestyle information every other month for one year, and the other, Group II (n = 9 mean age 36 ± 7.3 y), one year later. All participants were motivated to follow the trained dietary recommendations and to engage in physical activity. Almost all scores had improved. Surprisingly, physical performance scores worsened, which was not expected. The impairment in mental health due to the change in ownership of the company could have been better explained. Nutritional advice over a longer period and the motivation to integrate more exercise into everyday life can potentially improve the health of rotating shift workers.

Slim larks and overweight owls? A two years dietary intervention in shift workers.

Previous studies have shown that shift workers are more prone to non-communicable diseases. The aim of the present crossover study is to investigate whether it is possible to improve the health status of shift workers. Nineteen male shift workers (38.5 years ± 7.4) received every other month a dietary counseling for one year. All subjects kept a seven-day diet diary during a night shift, received bioelectrical impedance analysis, and a laboratory examination was performed at the beginning of the study, after one year and at the end of the study. The laboratory blood test included the main metabolic parameters, melatonin and serotonin. Beside subjects were also motivated to incorporate more physical training into their daily routine. After the intervention period, participants reduced energy intake, mean portion size, table salt, consumption of sugar and saturated fat. C-reactive protein (CRP), mean corpuscular volume (MCV), liver enzymes, triglycerides, and uric acid decreased, while melatonin level increased. Participants lost body weight and reduced waist circumference after the intervention. Lifestyle modification and dietary information could contribute to the health of shift workers. However, further studies are needed to investigate whether this can prevent disease and whether melatonin production can be influenced by diet.

Recovery intention: its association with fatigue in the working population.

PURPOSE: To investigate the association of the intention to recover from work with fatigue and its moderating effect on the link between occupational characteristics and fatigue. METHODS: Three hundred and eighty Austrian employees (nurses, teachers and administrative staff) participated in a survey assessing fatigue, the intention to create and engage in recovery activities and effort-reward imbalance as a measure of job characteristics. Data were analysed by regression analysis. RESULTS: Recovery intention was negatively associated with fatigue. This association was especially pronounced under conditions of high effort-reward imbalance, thus suggesting a buffering effect. Effort-reward imbalance, in return, was positively related to prolonged fatigue, indicating that fatigue was partly work related in the present sample. CONCLUSIONS: Individuals differ in their intent to engage in recovery activities. Those high in recovery intention are less exhausted, especially under conditions of more demanding and less rewarding work characteristics. Thus, a promotion of recovery intentions could contribute to the prevention of work-related fatigue.

General and Disease-Specific Health Indicator Changes Associated with Inpatient Rehabilitation.

OBJECTIVES: Rehabilitation plays a vital role in the mitigation and improvement of functional limitations associated with aging and chronic conditions. Moderating factors such as sex, age, the medical diagnosis, and rehabilitation timing for admission status, as well as the expected change related to inpatient rehabilitation, are examined to provide a valid basis for the routine assessment of the quality of medical outcomes. DESIGN: An observational study was carried out, placing a focus on general and disease-specific health measurements, to assess representative results of multidisciplinary inpatient rehabilitation. Aspects that were possibly confounding and introduced bias were controlled based on data from a quasi-experimental (waiting) control group. MEASURES: Existing data or general health indicators were extracted from medical records. The indicators included blood pressure, resting heart rate, self-assessed health, and pain, as well as more disease-specific indicators of physical function and performance (eg, activities of daily living, walking tests, blood lipids). These are used to identify moderating factors related to health outcomes. SETTING AND PARTICIPANTS: A standardized collection of routine data from 16,966 patients [61.5 ± 12.5 years; 7871 (46%) women, 9095 (54%) men] with different medical diagnoses before and after rehabilitation were summarized using a descriptive evaluation in terms of a content and factor analysis. RESULTS: Without rehabilitation, general health indicators did not improve independently and remained stable at best [odds ratio (OR) = 0.74], whereas disease-specific indicators improved noticeably after surgery (OR = 3.20). Inpatient rehabilitation was shown to reduce the risk factors associated with certain lifestyles, optimize organ function, and improve well-being in most patients (>70%; cutoff: z-difference >0.20), with a standardized mean difference (SMD) seen in overall medical quality outcome of -0.48 ± 0.37 [pre- vs post-rehabilitation: ηp2 = 0.622; dCohen = -1.22; 95% confidence interval (95% CI) -1.24 to -1.19]. The baseline medical values obtained at the beginning of rehabilitation were influenced by indication, age, and sex (all P < .001); however, these factors have less significant effects on improvements in general health indicators (ηp2 < 0.01). According to the disease-specific results, the greatest improvements were found in older patients (SMD for patients >60 vs ≤60 years: 95% CI 0.08-0.11) and during the early rehabilitation stage (ηp2 = 0.063). CONCLUSIONS AND IMPLICATIONS: Compared with those who received no inpatient rehabilitation, patients who received rehabilitation showed greater improvements in 2 independent areas, general and disease-specific health measures, regardless of their diagnosis, age, and sex. Due to the study design and the use of a nonrandomized waiting group, causal conclusions must be drawn with caution. However, the comparability and stability of the presented results strongly support the validity of the observed improvements associated with inpatient rehabilitation.

Effect of vacation on health: moderating factors of vacation outcome.

BACKGROUND: Vacation has recently become a topic of interest in health research as both beneficial and adverse health effects have been documented. The present study was aimed at identifying vacation characteristics predicting health-related vacation outcome. METHODS: One hundred ninety-one predominantly white-collar employees (109 female, 82 males; mean age 37.8 yr, range 16-62 yr) received a questionnaire in the week after vacation assessing subject characteristics, physical vacation characteristics, the individual structuring of the day, health and social behavior, and stress during vacation as well as the perceived change of recuperation and exhaustion from before to after a vacation. Regression analysis was used to identify variables predicting vacation outcome. RESULTS: Twenty-seven percent of the variance of the change of recuperation and 15% of the change of exhaustion could be explained. Recuperation was facilitated by free time for one's self, warmer (and sunnier) vacation locations, exercise during vacation, good sleep, and making new acquaintances, especially among vacationers reporting higher levels of prevacation work strain. Exhaustion was increased by vacation-related health problems and a greater time-zone difference to home, and was reduced by warmer vacation locations. CONCLUSION: Health-related vacation outcome is significantly affected by the way an individual organizes his or her vacation.

Combined inpatient rehabilitation and spa therapy for breast cancer patients: effects on quality of life and CA 15-3.

The present study investigated the changes of quality of life, mood, and the tumor marker CA 15-3 associated with a 3-week inpatient breast cancer rehabilitation program incorporating spa therapy. One hundred forty-nine women, 32 to 82 years, participated in the study 3 to 72 months after breast cancer surgery. Quality of life (QoL, EORTC QLQ-C30), anxiety, and depression (HADS) were measured 2 weeks before, at the end, and 6 months after rehabilitation; CA 15-3 at the beginning, end, and at 6 months follow-up. Patients received an individualized rehabilitation program incorporating manual lymph drainage, exercise therapy, massages, psychological counseling, relaxation training, carbon dioxide baths, and mud packs. Quality of life and mood improved significantly, the greatest short-term improvements found for mood-related aspects of quality of life, the most lasting improvements found for physical complaints (eg, fatigue). Also, the tumor marker CA 15-3 declined significantly to follow-up. Patient characteristics, as well as the time since surgery, moderated rehabilitation outcome to a limited extent. Older patients, nonobese patients, patients with a greater lymphedema, and patients with an active coping style showed slightly greater improvements. Hot mud packs inducing hyperthermia did not affect CA 15-3. In conclusion, the combination of inpatient rehabilitation with spa therapy provides a promising approach for breast cancer rehabilitation.

Quantitative analysis of peroxisome proliferator-activated receptor gamma (PPARgamma) expression in arteries and hearts of patients with ischaemic or dilated cardiomyopathy.

PPARgamma, a nuclear transcription factor, is expressed in various cells within the vasculature and in cardiomyocytes. It has been suggested that PPARgamma is involved in atherogenesis and in cardiac hypertrophy. Therefore, we sought to quantify PPARgamma mRNA in coronary arteries, the aorta and left ventricular specimens from patients with ischaemic (CHD) and dilated cardiomyopathy (CMP). Using real-time PCR, we were able to demonstrate the expression of PPARgamma in all of the human specimens. The lowest expression of PPARgamma was detected in the aorta specimens of both groups (this was set to one). In comparison, the expression in coronary arteries was 2.32-fold in CHD- and 3.78-fold in CMP specimens and in the left ventricle specimens, 2.12-fold in CHD- and 3.51-fold in CMP. Samples from CHD patients showed a higher expression of PPARgamma in all of the samples compared to those from CMP patients (aorta: 1.99-fold; coronary arteries: 1.35; left ventricles: 1.23). PPARgamma levels were not significantly correlated to CD 36 expression values in any group, suggesting that higher levels of PPARgamma are not principally due to increased PPARgamma expression in macrophages. This was confirmed by immunohistochemical analysis, which showed that PPARgamma is also located in the smooth muscle layer and in cardiomyocytes. In conclusion, our observations of increased PPAR mRNA expression in the coronary arteries and left ventricles from CHD and CMP patients suggest an important function of this nuclear receptor in the pathogenesis of heart disease.

Urinary excretion of 8-iso-PGF(2 alpha) in three patients during sepsis, recovery and state of health.

Sepsis is known to be associated with oxidative stress. Novel markers of oxidative stress are now believed to be F2-isoprostanes which are produced in situ in phospholipids and subsequently released into circulation and excreted in the urine. This study, therefore, sought to investigate whether the excretion of the isoprostane, 8-iso-PGF(2 alpha), is elevated during sepsis. The excretion of 8-iso-PGF(2 alpha), in the 24 h urine of three patients was studied in the septic stage, during mobilisation and in the state of health by a radioimmunological method. Extrapolating the urinary excretion of 8-iso-PGF(2 alpha) over time showed an insignificant variation in the excretion values during 24 h. The amount of mean 24 h urinary 8-iso-PGF(2 alpha) was about similar in the septic stage and in the state of health but increased remarkably during mobilisation in two of the patients. We suggest that mobilisation of septic patients can be associated with an increase of oxidative stress which may stem from an increase in oxygen consumption and/or from a depletion of antioxidants leading to the enhanced formation of free radicals.

Improving homocysteine levels through balneotherapy: effects of sulphur baths.

BACKGROUND: Plasma homocysteine (tHcy) is a risk factor for cardio-vascular diseases. Furthermore it has been associated with antioxidative status. Additionally balneotherapeutic sulphur baths have been shown to influence antioxidative status. METHODS: 40 patients with degenerative osteoarthrosis were randomised into two equal groups, a treatment group, receiving stationary spa therapy plus daily sulphur baths (sulphur group) and a control group receiving spa therapy alone (control group). Blood tHcy levels and urinary 8-OHdG (an indicator for oxidative stress) were measured at the beginning and the end of spa therapy. RESULTS: tHcy (micromol/l) was significantly reduced from 11.41 (+/-2.91) to 10.55 (+/-2.28) in the sulphur group (p=0.016) and rose insignificantly from 12.93 (+/-2.28) to 13.80 (+/-3.87) in the control group. 8-OHdG (ng 8-OHdG/mg creatinine) declined from 18.00 (+/-18.28) to 11.16 (+/-5.33) in the sulphur group (n.s.) and from 17.91 (+/-5.87) to 18.17 (+/-5.70) in the control group (n.s.). Differences between the two groups showed significant effects of sulphur baths for tHcy (p=0.006) but not for 8-OHdG (p=0.106). CONCLUSIONS: Sulphur baths exert beneficial effects on plasma tHcyt whereas effects on 8-OHdG seem to be unlikely.

Contribution of individual spa therapies in the treatment of chronic pain.

OBJECTIVES: The aim of the present study was to evaluate the contribution of individual spa therapies administered during a period of 3 weeks on measures of well being and pain in a sample of patients with chronic back pain. DESIGN: One hundred fifty-three patients with chronic back pain undergoing inpatient spa therapy in Bad Tatzmannsdorf, Austria, participated in the study. According to the prescription of their spa physician, patients underwent two or more of the following treatments: mud packs, carbon dioxide baths, massages, exercise therapies, spinal traction, and electrotherapy. The outcome measures were general pain, back pain, negative mood, and health satisfaction. Regression analyses were conducted to predict the 4 outcome measures at the end of spa therapy and at 6 weeks' follow-up for all therapies applied. The pretreatment outcome measure, age, and sex were controlled for by entering them into the analysis. RESULTS: Patients showed significant improvements in all 4 outcome measures. The prediction of improvement was generally small: only 1% to 11% of the change of the outcome measures could be explained by the type and number of therapies received. On a short-term basis, mud packs and exercise were found to be associated with a greater improvement in mood, whereas a greater frequency of massage therapy and carbon dioxide baths was associated with a smaller improvement in health satisfaction. On a long-term basis, exercise therapy and spinal traction were associated with a greater reduction in back pain. CONCLUSIONS: The results indicate that, in addition to the individual therapies, other factors relating to spa therapy as a whole must contribute to overall treatment outcome. In addition, the results support the efficacy of exercise therapy for chronic back pain.

Toxic and biochemical effects of zinc in Caco-2 cells.

Zinc (in relatively high concentrations) can be toxic to intestinal cells. The aim of the present study was to quanitfy cellular injury in preconfluent, colonic cancerous cells and in postconfluent, differentiating human intestinal Caco-2 cells. Cellular damage was measured by using cell proliferation, lactate dehydrogenase (LDH)-release, and apoptosis studies. Furthermore, the activities of the major antioxidative enzymes [superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase] and differentiation markers (alkaline phosphatase and aminopeptidase-N) were determined after exposure of the cells to increasing amounts of zinc sulfate. Proliferation and viability decreased in a concentration-dependent manner. A noticeable increase of LDH-release correlated to cell rounding and detachment at relatively high zinc levels (200 muM) was observed in both groups of cells. Above 100 muM of zinc, significant apoptotic activity was found in the preconfluent cells. Zinc supplementation did not alter SOD activities. However, GPx and, in part, catalase activities tended to be higher in zinc-treated cells (nevertheless the results were not significant). Differentiation markers were noticeably induced by increasing amounts of zinc, especially in the preconfluent cells. In conclusion, we suggest that the susceptibility to zinc induced damage is equal in both confluentation groups of Caco-2 cells. Risk assessment for high concentrations seems recommendable.

The peroxisome proliferator-activated receptor gamma (PPARgamma) is highly expressed in human heart ventricles.

Peroxisome proliferator-activated receptor gamma (PPARgamma) is a ligand activated transcription factor which regulates gene expression in various tissues. PPARgamma was primarily found to be associated with lipid and glucose metabolism. Recent experimental studies provided evidence that PPARgamma is also expressed in the arterial wall and in cardiomyocytes and described PPARgamma as a transducer of antihypertropic signaling in the heart. This comparative study sought to investigate whether PPARgamma is differently expressed in the aorta, coronary arteries and left ventricle specimens derived from healthy heart donors (n = 5). By using quantitative PCR, we found that PPARgamma is expressed in all of the human specimens with the by far highest expression (5.01-fold) in the left ventricles compared to aorta, whereas no significant difference was detected between coronary arteries (0.93-fold) vs. aorta. Furthermore, especially great interindividual variations were observed in PPARgamma expression in aorta, and to a lesser extent, in coronary arteries and left ventricle specimens. In conclusion, our data argue for the prominent role of PPARgamma in the human heart, particularly in the normal left ventricle.

Serum lipids responses to a respite from occupational and domestic demands in subjects with varying levels of stress.

OBJECTIVES: To investigate the effect of a temporary respite from domestic and job demands on serum lipid concentrations in subjects with high and low levels of perceived demands. METHODS: 111 females and 42 males (mean age 57.1+/-9.8) staying at a health resort for 3 weeks and receiving spa treatments participated in the study. Serum cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG) and LDL/HDL were measured at the beginning and end of the stay. In addition, levels of perceived demands were assessed. Data were analysed with MANCOVA for repeated measures with known confounding variables as covariates. RESULTS: Subjects with a higher level of perceived demands had higher levels of CHOL, LDL/HDL and TG and lower levels of HDL-c. In response to the respite, subjects experiencing more demands showed a greater decrease of LDL-c (P<.01) and LDL/HDL (P<.001). Sex moderated these stress-related respite effects for HDL-c (P<.01) and LDL/HDL (P<.005), high demand males showing a smaller decrease in HDL and a greater decrease in LDL/HDL than females in response to the respite. CONCLUSIONS: The results indicate that a respite from chronic demands may reduce LDL-c and LDL/HDL in chronically stressed individuals.

Seasonal variation in effect of spa therapy on chronic pain.

This study sought to investigate whether the effects of spa therapy are subject to seasonal variation as suggested by conventional spa therapy research. A total of 268 female (age 31-90 yr) and 119 male (age 35-85 yr) patients with noninflammatory chronic pain were studied. Patients stayed at an Austrian spa for 3 wk and received 2-4 treatments per day, including mudpacks, massages, and exercise therapy. In different groups of patients for 2 yr, pain (self-assessed by questionnaire and Likert scales) and associated variables (mood, fatigue) were measured at the beginning, end, and 6 wk after spa therapy. Data were analyzed by multivariate analysis of covariance controlling for possible group differences between seasons and cosinor analysis. The effect of spa therapy on pain was seasonally dependent; short-term decrease of pain was best between April and June and medium-term decrease of pain was best between October and November, with a second minor peak in fall and spring, respectively. The magnitude of the seasonal variation was greater for back (approximately 30%) than for joint (approximately 20%) pain. Positive mood also improved most between April and June. The observed semi-annual variations of pain do not correspond to the well-known annual change in many physiological and psychological variables. The results suggest that the effects of spa therapy and possibly other related treatments, such as physical and alternative therapies, are subject to seasonal variation.

Vacation at moderate and low altitude improves perceived health in individuals with metabolic syndrome.

BACKGROUND: Recent data suggest that vacation may improve cardiovascular health, an effect possibly moderated by altitude. The aim of the present study was to study the effect of a 3-week vacation at moderate and low altitude on perceived health in individuals with increased cardiovascular risk. METHODS: Seventy-two overweight males, both occupationally active and retired (mean age=56.6 +/- 7.2 years), with signs of metabolic syndrome were randomly assigned to identical sojourns at either moderate (1,700 m) or low (300 m) altitude and engaged in four 3- to 4-h heart-rate-controlled hiking tours per week. Perceived health was measured 2 weeks before vacation, at the beginning and end of vacation, and 7 weeks after vacation. RESULTS: Fitness, recreational ability, positive and negative mood and social activities improved during vacation, independent of altitude and occupational status, although the day-to-day improvement in quality of sleep was delayed at moderate altitude. During the follow-up examinations, improvements in all reported aspects of health except for social activities were maintained. In comparison to retired individuals, active individuals showed a greater long-term improvement in social activities. CONCLUSION: Vacation positively affects perceived health independent of altitude or occupational status in generally inactive overweight males.

Pharmacological levels of copper exert toxic effects in Caco-2 cells.

Copper might be toxic to human intestinal cells because of its ability to catalyze the formation of free radicals. The aim of the present study was to quantify toxicological effects of increasing copper concentrations in preconfluent, colonic cancerous cells as well as in postconfluent, differentiating Caco-2 cells. Our results indicate that postconfluent cells might be more sensitive to copper toxicity. A significant rise of lactate dehydrogenase (LDH) release (150 microM or above) and decrease of cell proliferation (100 microM or above) with increasing copper levels was found, as compared to the control. To the contrary, preconfluent cells were not significantly affected by copper (LDH release) or, if so, only at a concentration of 250 microM (proliferation). Loss of viability and morphological changes, including loss of adherence and cell rounding, were visible after incubation with 250 microM copper in both groups. Superoxide dismutase (SOD) activities were not affected by copper. Glutathione peroxidase (GSH-Px) and catalase activities were higher in copper-treated cells, especially in the postconfluent ones (nevertheless, the results were not significant because of high standard deviations). In conclusion, we demonstrated that copper exerts intracellular, toxicological effects on both groups of Caco-2 cells, although the effects seem to be more evident in the postconfluent (enterocytelike) group. Risk assessment, especially for high concentrations, might be of special interest.

The treatment experience questionnaire: development and validation of a questionnaire assessing the individual's emotional, perceptual, and cognitive reactions to alternative, physical, and dental treatments.

BACKGROUND: The aim of this study was to develop and validate a questionnaire designed to assess the patient's affective, cognitive, and perceptual state during treatment administration. METHODS: 362 individuals (214 females, 148 males, mean age 54.6 years) with predominantly musculoskeletal or dental problems participated in the study. Patients responded to the questionnaire immediately following a treatment. The questionnaire included items of 9 proposed scales devised to assess mood, psychological tension, sleepiness, mental absorption, treatment appraisal, perceived cooperation during treatment administration, perceived somatosensory intensity of treatment as well as negative and positive bodily sensations during treatment. Treatments were administered in 2 spa centers, a clinic for physical medicine and rehabilitation and a clinic for dentistry. Treatments investigated were among others dental treatment, massage, packs, baths, relaxation training, exercise, and acupuncture. RESULTS: The proposed scales were confirmed. Scales had adequate to good reliability and validity. All scales significantly distinguished between treatments. CONCLUSION: The devised questionnaire has adequate properties to assess patients' experiences during treatment administration.

Travel-related change of residence leads to a transitory stress reaction in humans.

OBJECTIVE: It is well known that animals show a stress response when confronted with a novel environment. The aim of the this study was to investigate whether humans show a similar response by studying the reaction to a travel-related transitory change of residence. METHOD: Forty-eight individuals (32 women, 16 men, age 40-83 years) traveling to a health resort approximately 120 km from their home town participated in the study. Individuals monitored their blood pressure (BP) twice a day 3 weeks before (baseline) and during the stay and filled out a diary stating their mood and sleep. The change of the variables relative to baseline on the day before departure, the travel day, and the day after arrival as well as 5 days after arrival were determined. RESULTS: Systolic and diastolic BPs were increased on the day before travel and diastolic BP remained increased on the travel day and the day after arrival. Sleep was poorer during the first night at the new residence. All three variables had returned to baseline level 5 days into the stay. Mood was not affected by the change of residence. CONCLUSION: The results indicate that not only the change of residence but also its anticipation affects individuals in a transient way. The findings are relevant not only for the basic understanding of the reaction to novel environments but also to travel, tourism as well as rehabilitation, and spa-research.

Association of spa therapy with improvement of psychological symptoms of occupational burnout: a pilot study.

OBJECTIVES: The aim of the present study was to investigate effects of a 3-week resort-based spa therapy (a combination of balneotherapy, massages, exercise etc., including a respite from work) on psychological symptoms associated with occupational burnout. PATIENTS AND METHODS: In a longitudinal design, a group of 65 actively working individuals (45 women, 20 men, mean age 50.4 +/- 6.7 years) of various occupations selected on the basis of their level of burnout and undergoing spa therapy primarily for musculoskeletal pain were studied in regard to the change in fatigue, distress, reduced motivation, and quality of sleep. Variables were assessed at the beginning and at the end of spa therapy as well as 4 weeks and 3 months after treatment. Two levels of burnout were distinguished: individuals with mild burnout (i.e. increased emotional exhaustion) and individuals with a full burnout syndrome (i.e. increased exhaustion plus social detachment and/or performance dissatisfaction). RESULTS: At the end of the treatment, all four symptoms of burnout showed a significant improvement in both groups compared to their pre-treatment level. This improvement was sustained up to 3 months post-treatment for both burnout groups. CONCLUSION: Spa therapy may be a helpful measure for treating the symptoms of occupational burnout.