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.

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.

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.

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.

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.

Time dependence of estrogen receptor expression in human hearts.

OBJECTIVES AND AIMS: Transcriptional effects of estrogens are primarily mediated by the two nuclear estrogen receptors (ER), ERalpha and ERbeta. Both receptors are present in the vasculature and in the human heart and have been shown to act antiatherogenic and to be protective against the development of cardiac hypertrophy. The aim was to quantify ER mRNA expression in left ventricular specimens from patients with coronary heart disease (CHD, n=15) and dilated cardiomyopathy (CMP, n=38) and compare their levels with those from healthy heart donors (n=9). Additionally, a possible variation of ERmRNA expression in human hearts in respect to time of day was studied. METHODS AND RESULTS: mRNA expression of both ER receptors was detected by real-time PCR in all of the human specimens. There was no difference in the relative quantity of the receptors between CHD and CMP patients. However, control specimens showed significant lower levels of either receptor in the healthy myocardium (p<.001 each). Analyzing the time dependency of receptor expression with a cosinor analysis showed a significant 8-hour period rhythm for ERbeta in CMP- but no rhythm in CHD patients. Due to the low patient number, rhythmic analysis was not possible in controls. CONCLUSIONS: The increased ERalpha and ERbeta mRNA expression in left ventricular specimens from CHD and CMP patients might reflect a compensatory mechanism to counteract the decline in ventricular function. Furthermore, we provided evidence for a time dependent variation of ERbeta receptor expression in the human heart.

[Health-related effects of natural mineral waters]. / Gesundheitliche Bedeutung natürlicher Mineralwässer.

The medical importance of mineral waters depends on the contained amount of minerals and trace elements. Calcium and magnesium in mineral waters are of greatest interest with respect to their potential relevance for the health status; iodine, fluorine and lithium are the most important trace elements. The bioavailability of minerals from mineral water is good and can be compared with the values derived from milk. A positive effect of the minerals in mineral water on health status is especially apparent in the case of insufficient intake by nutrition. The apprehension that there might be an undesired hypertensinogenic effect due to the sodium content in mineral waters is not justified. Sodium is present in mineral water in small amounts only, and mainly as sodium bicarbonate, which has no effect on blood pressure. A certain advantage of a delivery of minerals and trace elements by regular drinking of mineral waters is the simultaneous intake of water, without supply of energy. Studies giving direct evidence of the health value of a regular consumption of mineral waters are, however, up to now rather scarce.

Clock genes display rhythmic expression in human hearts.

Thus far, clock genes in the heart have been described only in rodents, and alterations of these genes have been associated with various myocardial malfunctions. In this study, we analyzed the expression of clock genes in human hearts. Left papillary muscles of 16 patients with coronary heart disease, 39 subjects with cardiomyopathy, and 9 healthy donors (52 males and 12 females, mean age 55.7+/-11.2; 16-70 yrs) were obtained during orthotopic heart transplantation. We assessed the mRNA levels of PER1, PER2, BMAL1, and CRY1 by real time PCR and analyzed their rhythmic expression by sliding means and Cosinor functions. Furthermore, we sought for differences between the three groups (by ANOVAs) for both the total 24 h period and separate time bins. All four clock genes were expressed in human hearts. The acrophases (circadian rhythm peak time) of the PER mRNAs occurred in the morning (PER1: 07:44 h [peak level 187% higher than trough, p = .008]; PER2: 09:42 h [peak 254% higher than trough, p < .0001], and BMAL1 mRNA in the evening at 21:44 h [peak 438% higher than trough; p < .0001]. No differences were found in the rhythmic patterns between the three groups. No circadian rhythm was detected in CRY1 mRNA in any group. PER1, PER2, and BMAL1 mRNAs revealed clear circadian rhythms in the human heart, with their staging being in antiphase to those in rodents. The circadian amplitudes of the mRNA clock gene levels in heart tissue are more distinct than in any other human tissue so far investigated. The acrophase of the myocardial PER mRNAs and the trough of the myocardial BMAL1 coincide to the time of day of most frequent myocardial incidents.

Personality does not predict treatment preference, treatment experience does: a study of four complementary pain treatments.

INTRODUCTION: The aim of the present study was to determine the extent to which personality and treatment experience affect patients' appraisals of 4 complementary treatments for chronic pain. PATIENTS AND METHODS: A total of 232 chronic pain patients (164 females, 68 males, average age 56.6 years) visiting a spa clinic in Austria returned a questionnaire on patient characteristics and personality (autonomy, depressiveness, assertiveness, self-control) as well as attitudes towards (i.e. appealing, effective, pleasant) and experience of the treatments. Results were analysed by use of linear regression analysis and confidence intervals. RESULTS: Although all treatments were appraised positively, the passive treatments (thermal water tub baths, classical massage) were favoured more than the active treatments (relaxation training or exercise therapy). Treatment appraisal was not predicted by any of the personality traits but to a large extent by treatment experience. Relaxing, not unpleasant treatments were the most highly esteemed treatments. How strenuous or tiring a treatment was only had a minor effect on its appraisal. CONCLUSIONS: Neither do dependent, passive patients prefer passive treatments, nor do conscientious patients prefer active treatments. Instead, the appraisal of treatments that induce specific somatosensory sensations is largely determined by treatment experiences, i.e. what the treatment feels like. Despite the popularity of CAM which encompasses many experientially intensive treatments, treatment experience has to date been a neglected topic of treatment research.

Does aerobic training enhance effects of spa therapy in back pain patients? A randomized, controlled clinical trial.

OBJECTIVES: The aim of the present study was to evaluate the effects of 3 weeks of individualized aerobic exercise training combined with conventional spa therapy on patients' assessment of chronic pain and quality of life. PATIENTS AND METHODS: 44 patients of either sex and advanced age (50-70 years) with chronic pain underwent an inpatient spa therapy in Bad Tatzmannsdorf, Austria. Participants were randomized into 2 groups, a control group receiving spa therapy alone, and a training group carrying out an additional aerobic training. Every participant performed an exhaustive bicycle exercise test at the beginning of the study. Subsequently, participants of the training group performed individualized training programs, controlled and documented by ambulatory heart rate monitors. At the beginning and the end of the study the following outcome measures were assessed by use of questionnaires: positive and negative mood, general depression, health satisfaction, general pain, exhaustion, abdominal complaints, and cardiac pain. The results of the questionnaires were analyzed by use of a MANOVA to evaluate differences between the two groups. RESULTS: We observed positive effects in all participants and on all parameters investigated after 3 weeks of spa therapy. However, no significant differences could be demonstrated between the two groups (all p > 0.05). CONCLUSION: Individualized aerobic training does not seem to enhance beneficial effects of a 3-week spa therapy on chronic pain and quality of life.

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.

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.

Determination of Iron in Caco-2 cells by ET-AAS.

An electrothermal atomic absorption spectrometric method (ET-AAS) was developed for the direct determination of iron in intestinal Caco-2 cells after studying cell viability and proliferation using 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide (MTT test). Zeeman background correction and end-capped graphite tubes with L'vov platforms were used. Samples were dissolved in dimethylsulfoxide (DMSO) and pipetted directly into the graphite tube. The preashing, pretreatment and atomization steps were optimized. The temperatures selected were 600, 1200, and 2100 degrees C, respectively. Stability measurements were performed using iron standard solutions in DMSO on the one hand and acidified cell solutions on the other. Direct measurement and standard addition were compared in order to determine possible influences of the matrix. The low detection limit of the ET-AAS method (1.3 microg/L or 3.3 microg/g) combined with the small sample quantities required are ideal for the determination of iron in cells due to the low iron content and the limited growth area of the cells. The method was developed for iron uptake studies for toxicological purposes.

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.

Toxicological effects of iron on intestinal cells.

The aim of the present study was to investigate whether iron, which is involved in the formation of free radicals in vitro, can initiate cellular injury in human intestinal cells. The effects of various concentrations of iron were studied in preconfluent, colonic-cancerogenous cells, and also in postconfluent, differentiating cells. Cellular damage was assessed using cell proliferation (serial cell counting), tetrazolium dye (MTT) uptake, lactate dehydrogenase (LDH) release and apoptosis studies based on caspase-3 activities. Also the activities of the major antioxidative enzymes, superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx) were measured after the cells had been exposed to iron. Our results indicated that preconfluent cells were more susceptible to iron toxicity, as assessed by a significant reduction in cell proliferation and MTT uptake in a concentration-dependent manner compared to the control. However, no evidence for MTT uptake was observed in postconfluent cells. Caspase-3 activity, an indicator of cell apoptosis, considerably increased in preconfluent cells at high iron levels compared to the control (p < 0.05), whereas postconfluent cells were not significantly affected. LDH release was similar for both groups and was significantly higher than the control at 900 microM iron and above. SOD activities were not affected by iron in either group, whereas GPx was considerably higher in iron-treated cells in both groups compared with the control (because of relatively high standard deviations this effect was not significant). In conclusion we suggest that iron exerts its toxic effects intracellularly especially in preconfluent Caco-2 cells, whereas only high iron doses were able to alter the viability of differentiating, enterocyte-like cells.

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.

The melatonin receptor subtype MT1 is expressed in human gallbladder epithelia.

Based on the fact that human bile and, particularly gallbladder bile, contains high physiological levels of the antioxidant melatonin, the aim of this study was to investigate whether the melatonin receptor MT1 is present in human gallbladder. Expression and localization of MT1 was assessed by RT-PCR, Western blotting and immunofluorescence analysis in gallbladder samples from patients with cholelithiasis and with advanced gallbladder carcinoma. Additionally, we monitored mRNA expression of the two key enzymes of melatonin synthesis, i.e. arylalkylamine-N-acetyltransferase (AANAT) and hydroxyindole-O-methyltransferase (HIOMT). MT1 mRNA and protein were present in all cholelithiasis (n = 10) and gallbladder carcinoma (n = 5) samples. As indicated from RT-PCR and Western blot studies, MT1 is located in gallbladder epithelia. Epithelial expression was further proven by immunofluorescence staining of MT1 in paraffin-embedded cholelithiasis and gallbladder carcinoma sections. Analysis of AANAT and HIOMT mRNA expression showed that HIOMT mRNA is present in gallbladder. Surprisingly, AANAT was not detectable under conditions where it was found in a human colon specimen. The absence of AANAT suggests that in human gallbladder, HIOMT might be involved in the formation of 5-hydroxytryptamine products other than melatonin. In summary, our results provide the first evidence for the presence of MT1 in human gallbladder epithelia. Therefore, in addition to its profound antioxidative effects in the biliary system, melatonin might also act through MT1-mediated signal transduction pathways. Thereby, it might be involved in the regulation of gallbladder function.