Cognitive behavioural therapy to treat stress and insomnia: A randomized wait list-controlled trial of two online courses.

This randomized, wait list-controlled trial aimed to evaluate the efficacy of the cognitive behavioural therapy-based online e-learning course stressfit for better stress management and the cognitive behavioural therapy for insomnia-based online course SweetDreams for coping with insomniac problems. The course modules offer state of the art psychoeducation and cognitive behavioural strategies concerning different aspects of stress, sleep and insomnia. They provide practice-oriented exercises for self-reflection, as well as a variety of evidence-based methods and measures to increase self-efficacy when dealing with stress or insomnia. Study participants were randomly assigned to the three test conditions stressfit, SweetDreams or a wait list. Participants filled in questionnaires on a wide range of scales relevant to stress and insomnia at three points in time (before, 4 weeks after, and 3 months after the treatment). Of the 588 participants in total, data from 347 participants (59%) were finally included in the data analyses. Data analyses showed that both courses yielded significant positive effects compared with the wait list condition 4 weeks and to some degree 3 months after completion in relation to insomnia symptoms, physical and psychological wellbeing, life satisfaction and general health (General Health Questionnaire), as well as on satisfaction with and effectiveness of coping with stress and sleep disorders. In conclusion, SweetDreams and stressfit proved to be feasible and effective online cognitive behavioural therapy (for insomnia) tools to reduce insomnia and stress symptoms on a broad variety of scales at the 4-weeks measurement point as well as at the 3-months follow-up.

Facilitating stress prevention in micro and small-sized enterprises: protocol for a mixed method study to evaluate the effectiveness and implementation process of targeted web-based interventions.

BACKGROUND: Workplace-related stress is a major risk factor for mental and physical health problems and related sickness absence and productivity loss. Despite evidence regarding the effectiveness of different workplace-based interventions, the implementation of stress prevention interventions is rare, especially in micro and small-sized enterprises (MSE) with fewer than 50 employees. The joint research project "PragmatiKK"+ aims to identify and address the specific barriers to the implementation of stress prevention interventions in MSE. This study protocol describes a mixed method study design to evaluate the effectiveness of adapted stress prevention interventions and the implementation process via an integrated web-based platform ("System P") specifically targeted at MSE. METHODS: First, we develop a web-based intervention, which accounts for the specific working conditions in MSE and addresses stress prevention at a structural and behavioral level. Second, we use common methods of implementation research to perform an effect and process evaluation. We analyze the effectiveness of the web-based stress prevention interventions by comparing depressive symptoms at baseline and follow-up (after 6 months and 12 months). Indicators for a successful implementation process include acceptability, adoption, feasibility, reach, dose, and fidelity, which we will measure with quantitative web-based questionnaires and qualitative interviews. We will also analyze the accumulated usage data from the web-based platform. DISCUSSION: Collecting data on the implementation process and the effectiveness of a web-based intervention will help to identify and overcome common barriers to stress prevention in MSE. This can improve the mental health of employees in MSE, which constitute more than 90% of all enterprises in Germany. + Full Project Name: "PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben "(= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises). TRIAL REGISTRATION: German Register of Clinical Studies (DRKS): DRKS00026154 , date of registration: 2021-09-16.

The prevention of musculoskeletal complaints: long-term effect of a work-related psychosocial coaching intervention compared to physiotherapy alone-a randomized controlled trial.

PURPOSE: Research shows that psychosocial factors play a significant role in the emergence of musculoskeletal complaints (MSC). The aim of this study was to determine the long-term effects on unspecific MSC by a combined physiotherapy and coaching intervention compared to physiotherapy alone. The coaching intervention focussed on enabling better strategies for coping with work stressors. METHODS: The participants of a previous randomized controlled intervention were invited to participate again in a third follow-up survey 22 months after the end of the intervention. In 2014, 65 nurses completed a 10-week personalised physiotherapy. Additionally, the intervention group (n = 33) passed five individual coaching sessions, plus an opening and closing session. 44 nurses (IG: n = 24; CG: n = 20) passed again a physical examination as well as another questionnaire assessment in 2016. The primary outcome was MSC, secondary outcomes were work ability and work-related well-being. Due to missing data, multiple imputations were conducted using the mice package in R. Data were analysed by ANOVA with two-way repeated measures, t tests for independent samples and Chi-squared tests. RESULTS: In respect of MSC, stronger improvement of movement in the vertebral column was observed in the IG compared to the CG. No differences between the IG and CG regarding other long-term effects were observed. CONCLUSIONS: The results suggest that the combined intervention of work-related coaching and physiotherapy had only a marginally stronger long-term effect with respect to MSC than physiotherapy alone.

[Promoting Self-Regulation of Adolescents in School Through Mindfulness]. / Achtsamkeit zur Förderung der Selbstregulation bei Jugendlichen in der Schule.

Promoting Self-Regulation of Adolescents in School Through Mindfulness. Evaluation of the Mindfulness Training "8-sam" Mindfulness describes the psychological process of purposely bringing one's attention to the present experiences with an accepting, non-judgmental attitude. As such, it has attracted increasing interest in educational institutions. The present study aims to evaluate a mindfulness training for adolescents in a German high school. For this purpose, the program "8-sam" has been developed. Feasibility, acceptance and efficacy of this four-week training were examined in a sample of 48 ninth-grade students. Self-ratings of mindfulness, chronic stress, emotion regulation and health, as well as behavioral measures of attention and mind-wandering of the intervention group (n = 22) were compared to the wait control group (n = 24) before, immediately and 6 weeks after the training. As indicated by self-designed evaluation questionnaires, the training proved to be well accepted and implementable at school. The intervention group showed less mind-wandering after the training than the control group. The findings offer implications for future research and the application of mindfulness trainings in schools. Implementing mindfulness in the daily school routine promises to support self-regulatory processes and thus, strengthen the resilience of children and adolescents.

[Self-evaulation of personal physical health, accidents while performing duty and preventive treatment of stress in Prison Service]. / Samoocena stanu zdrowia, wypadki w trakcie sluzby i profilaktyka stresu zawodowego w Sluzbie Wieziennej.

BACKGROUND: The purpose of the work was to assess the level of health, estimate the number of accidents during service and to identify the use and perceived effectiveness of the prevention of occupational stress in Prison Service (PS). MATERIAL AND METHODS: The questionnaire survey was carried out in 2015 at the Central Prison Service Training Center in Kalisz and in selected prisons and detention centers for the group of 250 officers. The questionnaire, which had been constructed for the purpose of the cooperation with the Occupational Safety Body of the Central Board of the Prison Service, was used. There were questions about the frequency of headaches, hypertension, sleep disorders, taking painkillers, accidents during service and prevention of occupational stress. RESULTS: For frequent headaches, sleep disorders and hypertension complain 9-14% of officers. Every 8th officer in the period of 5 years preceding the survey had an accident during his service. Participation rate in the stress prevention and interpersonal training workshops accounted for 70%, and most officers consider them to be effective. The lack of the possibility to make holidays in accordance with the schedule represents the percentage share of 10% of the sample tested, and every 20th of the PS must stop it due to the situation in the service. It was revealed that preferences in the area of applied coping strategies turned out to be slightly differentiating between officers undertaking and not undertaking activity in the field of occupational stress prevention. CONCLUSIONS: Officers serving in the multi-shift system and with a longer service period should be covered by greater prevention from the PS work medicine. Conducting training in the prevention of occupational stress should take place at the beginning of the service. Med Pr 2018;69(4):425-438.

'Health, Environment and Training': Guidance on conduct of physical exertion in hot and humid climates.

BACKGROUND: Military operations and training in hot environments present a special set of challenges to medical personnel who must support them. METHODS: Various meteorological parameters such as relative humidity (RH), ambient air temperature (Ta) and radiant temperature (Tg), were evaluated at training sites in a desert region. Development of a colour coded Heat Stress Prevention Decision Aid Tool was done using an existing guideline chart. RESULTS: Temperatures were being recorded routinely by ordinary meteorological instruments mounted within a Stevenson Screen. Onsite measurements with a USB datalogger was found to be relevant in making a decision on suitability of weather for conduct of training. Heat casualties occur when the stresses imposed by some combination of environment, work, and clothing combine to exceed individual tolerance limits. Personnel may encounter high environmental heat loads while working outdoors; during road marches; and while carrying loads or undertaking mechanical maintenance activities. Preventive strategies cannot be expected to eliminate heat stress but should minimize its impact on training while preserving the health of personnel to the extent possible. CONCLUSION: It is recommended that onsite measurement of meteorological parameters should be done, and a decision tool should be utilized for arriving at a spot decision by junior leaders.

The prevention of musculoskeletal complaints: a randomized controlled trial on additional effects of a work-related psychosocial coaching intervention compared to physiotherapy alone.

PURPOSE: Research shows that psychosocial factors play a significant role on the emergence of musculoskeletal complaints (MSC). The aim of this study was to determine whether a coaching intervention which was focussed on enabling better strategies for coping with work stressors is superior to physiotherapy alone in the reduction of MSC. METHODS: 68 nurses were randomized to an intervention group (IG, n = 34) or a control group (CG, n = 34). The IG and CG completed a weekly individual physiotherapy unit (10 weeks). Additionally, the IG passed five coaching sessions (fortnightly), plus one opening and one closing session. The primary outcome was MSC, secondary outcomes were work ability and work-related wellbeing. Outcomes were obtained by physical examinations and questionnaires. Data were analyzed by t-test, Chi-Square test, ANOVA with repeated measurements, and multilevel analyzes. RESULTS: In respect of MSC, the IG compared to the CG showed a significant improvement in the pain severity of everyday movements, and trends towards an improvement of movement in the vertebral column as well as a reduction of the pain severity due to maximum degree movements. No effects were observed in respect to muscle strengths, and restrictions of everyday activities. The IG exhibited a significant improvement of work ability in reference to the physical working demands, and work-related wellbeing. Analysis indicates that improvements in the IG increased further in the 12 weeks after the intervention. CONCLUSIONS: The results suggest that the coaching, beyond physiotherapy, can support the reduction of MSC, the improvement of work ability and work-related wellbeing.

Coping with stress in medical students: results of a randomized controlled trial using a mindfulness-based stress prevention training (MediMind) in Germany.

BACKGROUND: High prevalence rates of psychological distress in medical training and later professional life indicate a need for prevention. Different types of intervention were shown to have good effects, but little is known about the relative efficacy of different types of stress management interventions, and methodological limitations have been reported. In order to overcome some of these limitations, the present study aimed at evaluating the effect of a specifically developed mindfulness-based stress prevention training for medical students (MediMind) on measures of distress, coping and psychological morbidity. METHODS: We report on a prospective randomized controlled trial with three study conditions: experimental treatment (MediMind), standard treatment (Autogenic Training) and a control group without treatment. The sample consisted of medical or dental students in the second or eighth semester. They completed self-report questionnaires at baseline, after the training and at one year follow-up. Distress (Trier Inventory for the Assessment of Chronic Stress, TICS) was assessed as the primary outcome and coping (Brief COPE) as a co-primary outcome. Effects on the psychological morbidity (Brief Symptom Inventory, BSI) as a secondary outcome were expected one year after the trainings. RESULTS: Initially, N = 183 students were randomly allocated to the study groups. At one year follow-up N = 80 could be included into the per-protocol analysis: MediMind (n =31), Autogenic Training (n = 32) and control group (n = 17). A selective drop-out for students who suffered more often from psychological symptoms was detected (p = .020). MANCOVA's on TICS and Brief COPE revealed no significant interaction effects. On the BSI, a significant overall interaction effect became apparent (p = .002, η2partial = .382), but post hoc analyses were not significant. Means of the Global Severity Index (BSI) indicated that MediMind may contribute to a decrease in psychological morbidity. CONCLUSION: Due to the high and selective dropout rates, the results cannot be generalized and further research is necessary. Since the participation rate of the trainings was high, a need for further prevention programs is indicated. The study gives important suggestions on further implementation and evaluation of stress prevention in medical schools. TRIAL REGISTRATION: This trial is recorded at German Clinical Trials Register under the number DRKS00005354 (08.11.2013).

The consequences of nursing stress and need for integrated solutions.

PURPOSE: In a 2011 survey sponsored by the American Nurses Association (ANA), nurses identified the acute and chronic effects of stress and overwork as one of their two top safety and health concerns. DESIGN/METHODS: A review of the literature was conducted to investigate the impact that job stress has on the health and safety of nursing professionals and the role that working conditions and job characteristics play in fostering job stress. FINDINGS: Strong evidence supporting links between job stress, safety and health in general and within different types of nursing populations exists. Working conditions also contribute to the development of job stress. CONCLUSION: Combining and integrating "person-focused" strategies designed to build nurses' ability to manage stress at the individual level with "organization-focused" strategies that eliminate stressful working conditions is critical to the reduction and prevention of job stress among nursing professionals.

Effectiveness of an online text-based stress management program for employees who work in micro- and small-sized enterprises: A randomized controlled trial.

Background: Internet psychoeducational interventions improve employees' mental health. However, implementing them for employees in micro- and small-sized enterprises (MSEs) is challenging. Objectives: This randomized controlled trial examined the effectiveness of a fully automated text-based stress management program, "WellBe-LINE," in improving mental health and job-related outcomes for employees in workplaces with fewer than 50 employees. Methods: The program was developed based on stakeholder interviews and surveys of 1000 employees at MSEs. Adult full-time employees at an enterprise with fewer than 50 employees were recruited from registered members of a web survey company in Japan. Participants were randomly allocated to the intervention or control group (1:1). Participants in the intervention group were invited to register for the program using the LINE app. Psychological distress measured by Kessler 6 (K6) was a primary outcome, with self-administrated questionnaires at baseline, 2-month (post), and 6-month follow-ups. A mixed model for repeated measures conditional growth model analysis was conducted using a group ∗ time interaction as an intervention effect. Implementation outcomes were measured through implementation outcome scales for digital mental health (iOSDMH). Results: 1021 employees were included in this study. No significant effects were shown in any outcome. The reported implementation outcomes were positively evaluated, with 80 % acceptability, 86 % appropriateness, and feasibility (ease of understanding the contents [88 %], frequency [86 %], and length of content [86 %]). Conclusions: A simple text-message program for employees at MESs was acceptable, appropriate, and feasible; however, it did not result in improved mental health or job-related outcomes. Trial registration: UMIN clinical trial registration: UMIN000050624 (registration date: March 18, 2023).

Human centered design of AI-powered Digital Therapeutics for stress prevention: Perspectives from multi-stakeholders' workshops about the SHIVA solution.

Background: AI-powered Digital Therapeutics (DTx) hold potential for enhancing stress prevention by promoting the scalability of P5 Medicine, which may offer users coping skills and improved self-management of mental wellbeing. However, adoption rates remain low, often due to insufficient user and stakeholder involvement during the design phases. Objective: This study explores the human-centered design potentials of SHIVA, a DTx integrating virtual reality and AI with the SelfHelp+ intervention, aiming to understand stakeholder views and expectations that could influence its adoption. Methods: Using the SHIVA example, we detail design opportunities involving AI techniques for stress prevention across modeling, personalization, monitoring, and simulation dimensions. Workshops with 12 stakeholders-including target users, digital health designers, and mental health experts-addressed four key adoption aspects through peer interviews: AI data processing, wearable device roles, deployment scenarios, and the model's transparency, explainability, and accuracy. Results: Stakeholders perceived AI-based data processing as beneficial for personalized treatment in a secure, privacy-preserving environment. While wearables were deemed essential, concerns about compulsory use and VR headset costs were noted. Initial human facilitation was favored to enhance engagement and prevent dropouts. Transparency, explainability, and accuracy were highlighted as crucial for the stress detection model. Conclusion: Stakeholders recognized AI-driven opportunities as crucial for SHIVA's adoption, facilitating personalized solutions tailored to user needs. Nonetheless, challenges persist in developing a transparent, explainable, and accurate stress detection model to ensure user engagement, adherence, and trust.

Implementation of an internet-based stress management program in micro- and small-sized enterprises: a study protocol for a pre-post feasibility study of the effectiveness-implementation hybrid type 2 trial.

BACKGROUND: Although internet-based stress management programs are proven effective in improving mental health among workers, micro- and small-sized enterprises (MSEs), lacking in occupational healthcare services, face challenges implementing them. To address this gap, this study will develop the program with stakeholders at MSEs to aim for real-world implementation. OBJECTIVES: This paper describes a study protocol for a pre-post feasibility study of an effectiveness-implementation hybrid type 2 trial of text-based internet-based programs ("WellBe-LINE") in MSEs with less than 50 employees. This feasibility study primarily aims to evaluate trial methods for future effectiveness-implementation hybrid type 2 trials. METHODS: For this study protocol, an internet- and text-based self-care intervention program using the LINE app (a popular message tool in Japan) will be prepared according to evidence-based psychoeducational topics. Based on our online survey findings, personalized algorithms will be implemented according to employees' gender, age, and psychological distress levels. A personalized program using a popular pre-existing text app is expected to reduce employees' burdens and be attractive to them, resulting in successful implementation outcomes and mental health benefits. A pre-post design feasibility study will be conducted on ten companies to evaluate trial methods (e.g., recruitment and procedures). The primary outcome will involve individual-level penetration, defined as the proportion of the number of employees who register for the program divided by the total number of invited employees at the company. The progression criterion to go next trial specifies that more than 50% of the recruited companies obtain 60% individual penetration, which is set based on the findings of the prior survey of employees at MSEs and of interviews of stakeholders involved in this study, and will be measured by LINE system. Finally, acceptability, appropriateness, and feasibility will be measured using internet-based questionnaires and interviews. DISCUSSION: This pre-post feasibility study for future effectiveness-implementation hybrid type 2 trials will provide in-depth knowledge about the successful implementation of text-based, semi-personalized, self-care mental health interventions in real-world settings using both quantitative and qualitative data. CONCLUSIONS: This feasibility study will help validate the effectiveness of text-based interventions using a widely used social networking service (SNS) tool for employees in MSEs. TRIAL REGISTRATION: UMIN clinical trial registration, UMIN000046960. Registered on February 21, 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053570.

Microenvironment-Responsive Metal-Phenolic Nanozyme Release Platform with Antibacterial, ROS Scavenging, and Osteogenesis for Periodontitis.

Periodontitis is a chronic inflammatory disease deriving from dental plaque, characterized by the excessive accumulation of reactive oxygen species (ROS), matrix metalloproteinase (MMP) and other substances, resulting in the destruction of periodontal tissues. At present, the main therapeutic modalities, such as local mechanical debridement and antibiotic delivery, are not only difficult to solve the intractable bacterial biofilm effectively but also tricky to ameliorate the excessive inflammatory response as well as regenerate the impaired periodontal tissues. Herein, we have proposed the TM/BHT/CuTA hydrogel system formed by the self-assembly of the copper-based nanozyme (copper tannic acid coordination nanosheets, CuTA NSs) and the triglycerol monostearate/2,6-di-tert-butyl-4-methylphenol (TM/BHT) hydrogel. The negatively charged TM/BHT/CuTA can retain at the inflammation sites with a positive charge through electrostatic adsorption and hydrolyze in response to the increasing MMP of periodontitis, realizing the on-demand release of the CuTA nanozyme. The released CuTA nanozyme has antibacterial and antiplaque properties. Meanwhile, as a metal-phenolic nanozyme, it can scavenge multiple ROS by simulating the cascade process of superoxide dismutase (SOD) and catalase (CAT). Further, the CuTA nanozyme can modulate the macrophage polarization from M1 phenotype to M2 phenotype through the Nrf2/NF-κB pathway, which reduces the pro-inflammatory cytokines, increases the anti-inflammatory cytokines, and promotes the expression of osteogenetic genes successively, thus relieving the inflammation and accelerating the tissue regeneration of periodontitis. Altogether, this multifunctional nanozyme on-demand release platform (TM/BHT/CuTA) provides a desirable strategy for the treatment of periodontitis.

Working environment of health care professionals - focus on occupational stress.

INTRODUCTION AND OBJECTIVE: Healthcare professionals most often encounter occupational stress. The aim of the study was to investigate the working environment of health care professionals with the focus on expression of occupational stress, and oversee the possibilities of stress management and prevention. MATERIAL AND METHODS: 326 representatives from five different healthcare institutions were surveyed in Siauliai city, Lithuania. The validated questionnaires HSE Management Standards Indicator Tool and the SF-36 questionnaire were used. RESULTS: The study revealed that the most important organizational factors were lack of communication, inappropriate relations with authorities and colleagues, big workload and long working hours, quick decision-making, and manifestations of mobbing. Financial support was reported as one of the main motivators in stress management. The most frequent individual factors were emotional relations with patients and their relatives. The healthcare professionals who experienced stress at work more often felt aches that disturbed their work routine, and their health interfered more their ordinary social activities. The main stress prevention measures are involvement of employees in decision-making, annual interviews with authorities, education, assurance of a safe work environment, and elimination of manifestations of mobbing. CONCLUSIONS: More attention must be paid to occupational stress management. It appeared that there is a lack of knowledge by institutions about the models of occupational stress management and internal stress management policy of organization. Therefore, this stimulates the search for measures that could help to change the situation.

To be or not to be stressed: Designing autonomy to reduce stress at work.

BACKGROUND: Many organizations are undertaking efforts to reduce the stress of (oftentimes overworked) employees. Information Technology (IT) (e.g., smartphones) has the potential to be a key instrument for reducing stress. One design-relevant factor considered to reduce stress is the concept of autonomy. Unfortunately, little research exists using autonomy as a characteristic of technology design. OBJECTIVE: Against this background, this study aimed to investigate specific autonomy-related design options with the potential to prevent stress. METHODS: In a factorial survey, this experimental study tested three design options in an overwork scenario: 1) autonomy (no intervention by design), 2) nudge ("nudging" by design), and 3) enforcement (hard stop by design). 51 participants (mean age 38 years, 50% women, mean work experience 18 years) from the Netherlands, United Kingdom, United States of America, and Germany participated in the experiment for 330 seconds on average. To test our hypothesis, we used a two-step approach. First, a multiple linear regression was applied. Second, we carried out a one-way ANCOVA comparing the effects of our design options. RESULTS: Our results indicate that autonomy can be manipulated through technology design and is negatively correlated with stress. Additionally, the design options autonomy and nudge were associated with lower levels of perceived stress than was enforcement. CONCLUSION: The study proposes a careful use of IT and policies that limit the perceived autonomy of employees. Overall, this study offers a set of design recommendations arguing that organizations should implement technology that helps employees prevent overwork and maintain their autonomy.

Planning and Setting Up of a Communication Program for Hospitalized COVID-19 Patients: Challenges and Potential Solutions in Resource Constrained Setting.

Background The recent onset of COVID-19 pandemic has necessitated many patients to be hospitalized in the COVID-19 treating centers. Owing to the need for isolation of these patients and minimizing the risk of transmission to healthy people, COVID-19-positive patients are completely restricted from meeting their friends and families. This gives rise to anxiety amongst the patients' relatives as they are not able to monitor the progress of the patients and have to depend entirely on the healthcare staff for any updates regarding the patient. In contrast, the treating doctors are undergoing severe stress due to the unknown nature of the virus and the risks involved in treating patients. They are thoroughly exhausted after the long hours donning the personal protection equipment (PPE). Objective To structure and form an interface for communication between the treating physician and the families, as a "communication team," to decrease the workload on the treating physicians and minimize their contact time in a COVID-19 setting. Results The addition of a communication team improved the physicians' efficiency of patient management and family satisfaction. Several challenges were faced during the setting up of this interface effectively. However, most of these were dealt with along the way. The communication team was instrumental in allaying the anxiety of the family with respect to their patients' clinical condition. This also ensured engagement of doctors from non-clinical and laboratory-based departments in the COVID-19 treatment process. Conclusion Adding up a communication team for communicating clinical updates to the family in a resource-limited scenario greatly improved communication and thus family satisfaction of the COVID-19-positive patients.

Workers' Perception Heat Stress: Results from a Pilot Study Conducted in Italy during the COVID-19 Pandemic in 2020.

Many workers are exposed to the effects of heat and often to extreme temperatures. Heat stress has been further aggravated during the COVID-19 pandemic by the use of personal protective equipment to prevent SARS-CoV-2 infection. However, workers' risk perception of heat stress is often low, with negative effects on their health and productivity. The study aims to identify workers' needs and gaps in knowledge, suggesting the adaptation of measures that best comply with the needs of both workers and employers. A cross-sectional online questionnaire survey was conducted in Italy in the hottest months of 2020 (June-October) through different multimedia channels. The data collected were analyzed using descriptive statistics; analytical tests and analysis of variance were used to evaluate differences between groups of workers. In total, 345 questionnaires were collected and analyzed. The whole sample of respondents declared that heat is an important contributor to productivity loss and 83% of workers did not receive heat warnings from their employer. In this context, the internet is considered as the main source of information about heat-related illness in the workplace. Results highlight the need to increase workers' perception of heat stress in the workplace to safeguard their health and productivity. About two-thirds of the sample stated that working in the sun without access to shaded areas, working indoors without adequate ventilation, and nearby fire, steam, and hot surfaces, represent the main injuries' risk factors.

Design of a Participatory Organizational-Level Work Stress Prevention Approach in Primary Education.

Background: Work stress is a serious problem in primary education. Decades of research underline the importance of participatory, organizational-level work stress prevention approaches. In this approach, measures are planned to tackle causes of work stress in a participatory manner and implemented by a working group consisting of members of the organization. This approach can only be effective if the measures contain effective ingredients to decrease work stress risks and are successfully implemented. The aim of this paper is to present an outline of a work stress prevention approach that is evaluated in primary education. To ensure the appropriateness of measures, a logic model of change is built as part of the risk assessment to facilitate the selection of appropriate measures. Progression on target behaviors as well as implementation factors are real-time monitored during implementation and fed back to the working groups, to provide the opportunity to adjust action plans when needed to optimize implementation. Methods: The approach consists of five steps: (1) preparation: installing an advisory board and working groups, (2) risk assessment: inventory of work stress risks (questionnaires and focus groups). In addition, a behavioral analysis is performed to build a logic model of change to facilitate selection of measures, (3) action planning: conducting an action plan with appropriate measures (focus groups), (4) implementation: implementing the action plan. During implementation progression on target behaviors and implementation factors are monthly monitored and fed back to the working groups, and (5) evaluation: effects of the approach are studied in a controlled trial with measurements at baseline (T0), 1 year (T1), and 2 years (T2) follow-up. A process evaluation is carried out using quantitative (questionnaires and real-time monitoring data) and qualitative (interviews and data logs) data to study the implementation process of all steps of the work stress approach. Discussion: We believe that building a logic model of change and real-time monitoring of implementation could be of added value to improve the success of the work stress prevention approach. With this study, we aim to provide more insights into work stress intervention research, especially in primary education. Clinical Trial Registration: The study is registered in Netherlands Trial Register (ClinicalTrials.gov #NL9797, October 18, 2021).

Engineering Antioxidative Cascade Metal-Phenolic Nanozymes for Alleviating Oxidative Stress during Extracorporeal Blood Purification.

Oxidative stress is a compelling risk factor in chronic kidney diseases and is further aggravated for individuals during extracorporeal blood purification, ultimately leading to multiple complications. Herein, antioxidative cascade metal-phenolic nanozymes (metal-tannic acid nanozymes, M-TA NMs) are synthesized via metal ions-mediated oxidative coupling of polyphenols; then M-TA NMs engineered hemoperfusion microspheres (Cu-TAn@PMS) are constructed for alleviating oxidative stress. M-TA NMs show adjustable broad-spectrum antioxidative activities toward multiple reactive nitrogen and oxygen species (RNOS) due to the adjustable catalytic active centers. Importantly, M-TA NMs could mimic the cascade processes of superoxide dismutase and catalase to maintain intracellular redox balance. Detailed structural and spectral analyses reveal that the existence of a transition metal could decrease the electronic energy band gaps of M-TA NMs to offer better electron transfers for RNOS scavenging. Notably, dynamic blood experiments demonstrate that Cu-TAn@PMS could serve as an antioxidant defense system for blood in hemoperfusion to scavenge intracellular reactive oxygen species (ROS) effectively even in the complex blood environment and further protect endogenous antioxidative enzymes and molecules. In general, this work developed antioxidative cascade nanozymes engineered microspheres with excellent therapeutic efficacy for the treatment of oxidative stress-related diseases, which exhibited potential for clinical blood purification and extended the biomedical applications of nanozymes.

Evaluation of a Web-Based Stress Management Program for Persons Experiencing Work-Related Stress in Sweden (My Stress Control): Randomized Controlled Trial.

BACKGROUND: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user's specific needs for stress management and behavior change. OBJECTIVE: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress. METHODS: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes. RESULTS: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25). CONCLUSIONS: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made. TRIAL REGISTRATION: ClinicalTrials.gov NCT03077568; https://clinicaltrials.gov/ct2/show/NCT03077568.