The Effectiveness of Case-management Rehabilitation Intervention in Facilitating Return to Work and Maintenance of Employment After Myocardial Infarction: Results of a Randomized Controlled Trial.

OBJECTIVE: To study the long-term effectiveness of case-management rehabilitation intervention on vocational reintegration of patients after myocardial infarction (MI). DESIGN: Blinded simple randomization was used to construct an intervention and control groups that were followed up for two years. SUBJECTS AND SETTING: 151 patients, aged 50.3 ± 5.9 years, who experienced uncomplicated MI and were enrolled in a cardiac rehabilitation program were recruited. INTERVENTIONS: included an early referral to an occupational physician, tailoring an occupational rehabilitation program, based on individual patient needs, coordination with relevant parties, psychosocial intervention, intensive follow-up sessions during a two-year follow-up. MAIN MEASURES: Return to work within six months of hospitalization and maintenance of employment at one and two years of follow-up. RESULTS: Return-to-work (RTW) rate in the intervention group was 89% and nearly all maintained employment at one year of follow-up (92%) and two years of follow-up (87%). Moreover, almost all of them returned to and maintained their previous jobs. The corresponding figures were: 98%, 94% and 98%, respectively. The figures for the RTW and employment maintenance for the control group were: 74%, 75%, and 72%, respectively. Only about 75%, in this group kept their previous job. The case-management intervention was associated with increased odds of maintaining employment at follow-up of one year (OR = 5.89, 95% CI 1.42-24.30) and two years (OR = 3.12, 95% CI 1.01-10.03). CONCLUSIONS: The extended case-management rehabilitation intervention had a substantial positive impact on both the RTW of MI patients and their maintenance of employment at one and two years of follow-up. TRIAL REGISTRATION: This trial is registered at US National Institutes of Health #NCT04934735.

Burnout, but not job strain, is associated with irritable bowel syndrome in working adults.

OBJECTIVE: Although stress is an important component of irritable bowel syndrome (IBS) pathophysiology, the possibility that work-related stress is implicated in the pathophysiology of IBS has not been widely studied. This study aimed to examine whether job strain (a combination of high job demands and low control at work) and/or burnout, the outcome of a gradual depletion of energetic resources resulting from chronic exposure to work-related stress, are associated with IBS. METHODS: Fifty-five patients fulfilling the Rome III criteria for IBS and 214 matched healthy controls (HC) participated in this cross-sectional study. All participants completed a job strain measure, the Shirom - Melamed Burnout Measure (SMBM), and dietary and health questionnaires. RESULTS: There was no significant difference in the prevalence of job strain between IBS patients and HC (25.5% vs. 23.0%, respectively). Job strain was not associated with increased IBS prevalence (adjusted OR = 1.99, 95% CI: 0.54-7.33). In contrast, the mean burnout score in the IBS group was significantly higher than in HC (2.9 ± 1.1 vs. 2.1 ± 0.8, p < .001). Burnout was associated with a 2.41-fold elevated prevalence of IBS (95% CI: 1.16-5.02), after adjusting for potential confounding variables including job strain. Moreover, the odds of having IBS increased in patients with a high burnout level (adjusted OR = 3.3, 95% CI:1.09-10.03). CONCLUSION: Burnout, but not job strain, is associated with the prevalence of IBS in working adults.

Perceived assistance in pursuing personal goals and personal recovery among mental health consumers across housing services.

Personal goals/plans play a central role in personal recovery and psychiatric rehabilitation of persons with mental illnesses. Yet, few studies have explored whether perceiving practitioners' assistance towards the pursuit of goals are associated with personal recovery and other favorable rehabilitation outcomes. A total of 2121 mental health consumers, of which 1222 use supported-housing services and 899 use group-home services, completed self-report questionnaires as part of a larger quality-assurance study conducted during the years 2013-2014. Eighty percent of participants living in supported-housing and 72% living in group-homes reported having personal goals/plans for the forthcoming year. Furthermore, their type of goals was different. Irrespective of the type of goal or housing service, participants who reported having goals/plans (compared with those who did not) showed higher levels of personal recovery and more favorable psychosocial outcomes. Regression analyses showed that perceiving professional staff members (but not para-professionals) as assisting in pursuing goals/plans was positively associated with personal recovery. This study empirically validates the value of having personal goals and professionals' assistance in pursuing goals/plans in regards to personal recovery. We propose that recovery-oriented services should seek to enhance goal setting and goal-pursuit, and to train practitioners in these areas.

Self-rated health is associated with elevated C-reactive protein even among apparently healthy individuals.

BACKGROUND: A single self-rated health (SRH) assessment is associated with clinical outcome and mortality, but the biological process linking SRH with immune status remains incompletely understood. OBJECTIVES: To examine the association between SRH and inflammation in apparently healthy individuals. METHODS: Our analysis included 13,773 apparently healthy individuals attending the Tel Aviv Sourasky Medical Center for periodic health examinations. Estimated marginal means of the inflammation-sensitive biomarkers [i.e., highly sensitive C-reactive protein (hs-CRP) and fibrinogen] for the different SRH groups were calculated and adjusted for multiple potential confounders including risk factors, health behavior, socioeconomic status, and coexistent depression. RESULTS: The group with the lowest SRH had a significantly higher atherothrombotic profile and significantly higher conentrations of all inflammation-sensitive biomarkers in both genders. Hs-CRP was found to differ significantly between SRH groups in both genders even after gradual adjustments for all potential confounders. Fibrinogen differs significantly according to SRH in males only, with low absolute value differences. CONCLUSIONS: A valid association exists for apparently healthy individuals of both genders between inflammation-sensitive biomarker levels and SRH categories, especially when comparing levels of hs-CRP. Our findings underscore the importance of assessing SRH and treating it like other markers of poor health.

The reciprocal relationship between vigor and insomnia: a three-wave prospective study of employed adults.

Vigor is a positive affect experienced at work. It refers to feelings of possessing physical strength, emotional energy, and cognitive liveliness. Accumulated evidence suggests that vigor has a protective effect on health, but the mechanisms of this link remain to be discovered. This study focused on sleep quality as one possible mechanism. We used a full-panel, longitudinal design to investigate the hypothesis that changes in vigor over time have inverse effects on insomnia and vice versa. The study was conducted on a multi-occupational sample of working adults (N = 1,414, 70 % men) at three time points (T1, T2, and T3), over a period of about 3 years. Vigor was assessed by the Shirom-Melamed Vigor Measure, while insomnia was assessed by the Brief Athens Insomnia Scale. Results of SEM-analyses, controlling for neuroticism, and other potential confounding variables, offered a strong support for the study hypotheses, indicating cross-lagged reciprocal inverse relationships between vigor and insomnia. The results suggest that vigor has a protective effect on sleep quality and that vigor might positively influence health through this pathway.

Joint effect of chronic medical illness and burnout on depressive symptoms among employed adults.

OBJECTIVE: Chronic medical illnesses (CMIs) are prevalent in nearly half the working population and are associated with a two-fold risk for developing depression. Burnout is a chronic affective state comprised of symptoms of emotional exhaustion, physical fatigue, and cognitive weariness. It is an outcome of depletion of energetic resources resulting from prolonged exposure to work and life stresses. Building upon the Conservation of Resources theory (Hobfoll, 1989), this prospective study was designed to test the hypothesis that CMI interacts with burnout to facilitate the development of depressive symptoms. METHOD: Participants were 4,861 employed men and women, aged 19 to 67 years, who came for routine health examinations and were followed for 18 months on average. Forty-seven percent reported having one or more diagnosed CMIs. RESULTS: Burnout was found to predict an increase in depressive symptoms in apparently healthy individuals. Furthermore, the coexistence of burnout in employees with a CMI accelerates the process of developing depressive symptoms within a relatively short period. Burnout was also found to be associated with intensification of preexisting depressive symptoms in employees suffering from different chronic medical conditions (other than cancer), independent of medical comorbidities and other potent confounding variables. CONCLUSIONS: Among employees, coexistence of burnout and at least one CMI predicts an increase in depressive symptoms with time. Health care professionals should be made aware of such at-risk employees and follow and manage them closely.

The relationship between job enrichment and abdominal obesity: a longitudinal field study of apparently healthy individuals.

Obesity has become an epidemic in modern society. However, there is a paucity of research about how job context affects obesity. To enhance our knowledge we used a large, heterogeneous sample of apparently healthy employees (n = 1,949) across two time periods with an average of close to 3.5 years between measures. We tested a hypothesized curvilinear effect of job enrichment on changes in two stress related indicators of abdominal obesity over time: waist circumference (WC) and waist-hip ratio (WHR). Job enrichment consisted of the job dimensions of variety, identity, significance, autonomy, and feedback, and in our analysis we controlled for demographics and health related behaviors, including weekly sports activity, number of cigarettes smoked per day, and weekly alcohol consumption. The results supported the hypothesized U-shaped relationship between job enrichment and changes in both indicators of abdominal obesity over time, such that the level of abdominal obesity was reduced when job enrichment was moderate and was increased when job enrichment was either high or low. As expected, no such association was observed for the general obesity measure of body mass index (BMI). We discuss the theoretical and practical implications of these results.

Burnout and vigor as predictors of the incidence of hyperlipidemia among healthy employees.

We examined the effects of burnout and vigor on the incidence of hyperlipidemia. Based on the bivariate theoretical approach to negative and positive affects and on past studies on the prediction of blood lipids by burnout and vigor, we expected increases from Time 1 (T1) to Time 2 (T2) in burnout levels to be associated with an increase in the risk for hyperlipidemia and T1-T2 increases in vigor levels to be associated with a decrease in the risk of hyperlipidemia. Our sample consisted of 3,337 healthy employees (2,214 men and 1,123 women) who were followed up for about 27 months on average. Burnout and vigor were assessed by well-validated multiple-item instruments. We used logistic regressions and controlled for variables associated with blood lipids as well as with vigor and burnout. We cross-validated all self-reported hyperlipidemia by their T2 lipids levels. As expected, we found that T1-T2 increases in vigor levels were associated with a decreased risk of hyperlipidemia. However, the T1-T2 change in burnout levels was marginally significant (p = .06) in predicting hyperlipidemia. We consider our finding that vigor and burnout are independently associated with the risk of hyperlipidemia as providing support for the bivariate approach to affective states. In addition, our major finding suggests a possible mechanism via which vigor influences physical health outcomes.

Burnout and risk of coronary heart disease: a prospective study of 8838 employees.

OBJECTIVE: Burnout is a negative affective state consisting of emotional exhaustion, physical fatigue, and cognitive weariness symptoms. This study was designed to evaluate prospectively the association between burnout and coronary heart disease (CHD) incidence and to test the possibility that this association is nonlinear. METHODS: Participants were 8838 apparently healthy employed men and women, aged 19 to 67 years, who came for routine health examinations at the Tel Aviv Sourasky Medical Center. They were followed up for 3.4 years on average. Burnout was measured by the Shirom-Melamed Burnout Measure. CHD incidence was defined as a composite of acute myocardial infarction, diagnosed ischemic heart disease, and diagnosed angina pectoris. RESULTS: During follow-up, we identified 93 new cases of CHD. Baseline levels of burnout were associated with an increased risk of CHD, after adjustment for various risk factors (hazard ratio = 1.41; 95% confidence interval = 1.08-1.85). In addition, we observed a significant threshold effect of burnout on CHD incidence. Participants who scored high on burnout (scores in the upper quintile of the Shirom-Melamed Burnout Measure scores distribution) had a higher risk (hazard ratio = 1.79; 95% confidence interval = 1.05-3.04) of developing CHD on follow-up compared with others. CONCLUSIONS: Burnout is an independent risk factor for future incidence of CHD. Individuals with high levels of burnout (upper quintile) have a significantly higher risk of developing CHD compared with those with low levels of burnout.

Work characteristics as predictors of diabetes incidence among apparently healthy employees.

The objective of this article was to investigate the associations of the Job Demand Control-Support (JDC-S) model's components, job demands, job control, and work social support, as well as their interactive terms, with the risk of Type 2 diabetes. Participants were apparently healthy 5,843 men and women who underwent routine health checks at two points of time, about 41 months apart from one another. New cases of diabetes (N = 182) during follow-up period were defined based on fasting glucose value ≥ 126 mg/dl or glycosylated hemoglobin value ≥ 6.5% or self-reported physician diagnosis of diabetes and taking medications to treat it. The measures for assessing workload (representing job demands), job control, and work social support were all based on validated scales constructed to test the JDC-S model. In testing the hypotheses, we used logistic regressions and controlled for well-established risk factors for diabetes, including sociodemographic, physiological, and behavioral risk factors. We also controlled for depressive symptoms. The hypothesis that the higher the baseline levels of work social support, the lower the risk of diabetes, was supported (Odd Ratio = .78, significant at the p < .05 level). In an exploratory analysis, workload was found to have a U-shaped relationship with diabetes risk. We did not find direct effects of job control nor of any interactive term including the JDC-S model components on diabetes risk. Work social support is a protective factor, reducing the risk of diabetes. Both underload and overload may increase the risk of diabetes.

The effects of vigour on measures of obesity across time.

OBJECTIVES: Past studies expected measures of obesity to be positively associated with positive affects. However, this hypothesis was not tested in reference to a specific positive affect. We tested the hypothesized unidirectional effects of measures of obesity on vigour, representing a positive affect, and of vigour on measures of obesity. DESIGN: We used a longitudinal design, separately for men and women. Participants were 1,876 and 931 healthy men and women, respectively, examined at Time 1 (T1) and Time 2 (T2), about 2 years apart. METHODS: Measures of obesity included body mass index, waist circumference, and waist-to-hip ratio. Vigour was assessed by the Shirom-Melamed Vigour Measure. We used structural equation modelling to test our hypotheses. RESULTS: We found that for both genders, T1 measures of obesity did not predict either T1 or T2 vigour. Among both genders, we found support for the effects of T1 vigour on T1 but not on T2 measures of obesity. CONCLUSIONS: To the extent that the 'Jolly fat hypothesis' refers to the effects of measures of obesity on positive affects, we failed to support it for vigour as a positive affect. Vigour has contemporaneous but not longitudinal effects on body weight.

The relationships between self-rated health and serum lipids across time.

BACKGROUND AND PURPOSE: We studied the hypothesized effects of changes in self-rated health (SRH) on subsequently assessed changes in the levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglycerides (TRI), separately for men and women. We also investigated the reverse causation hypothesis, expecting the initial changes in the levels of serum lipids to predict subsequently assessed changes in SRH levels. METHODS: We used a longitudinal design and controlled for possible confounders known to be precursors of both SRH and the above three serum lipids. Participants were apparently healthy men (N = 846) and women (N = 378) who underwent a routine health check at three points of time (T1, T2, and T3); T1 and T3 were on the average 40 and 44 months apart for the men and women, respectively. RESULTS AND CONCLUSIONS: For the men, relative to T1 SRH, an increase in T2 SRH was associated with an increase in the T3 HDL-C levels relative to T2 HDL-C and with a decrease in the T3 TRI levels relative to T2 TRI. For the women, initial changes in the SRH levels did not predict follow-up changes in either of the lipids. For both genders, the reverse causation hypothesis, expecting the T1-T2 change in each of the serum lipids to predict T2-T3 change in SRH, was not supported. For the men, there is support for the hypothesis that the effects of SRH on morbidity and mortality, found by past meta-analytic studies, could be mediated by serum lipids.

The big five personality factors as predictors of changes across time in burnout and its facets.

We tested the effects of Neuroticism and Conscientiousness on burnout across time, controlling for age, gender, work hours, and depressive symptoms. Our theoretical model included both global burnout and its physical, emotional, and cognitive facets, consistent with the bifactor approach to modeling second-order constructs in structural equation modeling. Data were gathered from 1,105 respondents (63% men) who completed questionnaires at Time 1 (T1) and approximately 24 months later at Time 2 (T2). Neuroticism positively predicted T1 global burnout and negatively predicted T1 and T2 emotional exhaustion. Conscientiousness negatively predicted T1 global burnout and T1 and T2 cognitive weariness, and positively predicted T1 and T2 emotional exhaustion. Our gender-specific exploratory analysis revealed that for each gender, Neuroticism and Conscientiousness predicted different facets of burnout at T1 and T2. We recommend that future research test the possibility that the associations of Neuroticism and Conscientiousness with global burnout and its facets may be gender specific.

Life and Job Satisfaction as Predictors of the Incidence of Diabetes.

We studied the hypothesised effects of baseline levels of life satisfaction and of job satisfaction on the incidence of diabetes. Participants were 2,305 apparently healthy men and women who underwent routine health checks at two points in time, about 20 months apart. New cases of diabetes (N=104) were defined based on fasting glucose value > 125, or glycosylated hemoglobin value > 6.5, or self-reported physician diagnosis of diabetes and taking medications to treat it. Life satisfaction was measured using the scale constructed by Diener et al. (1985) while job satisfaction was assessed based on the Survey of Working Conditions. In the analyses, we controlled for socio-demographic predictors, for known physiological and behavioral precursors of diabetes, and for depressive symptoms. There was support for our hypothesis that the higher the baseline levels of life satisfaction, the lower the incidence of diabetes. However, job satisfaction did not predict the incidence of diabetes. We obtained the same results when limiting the analysis to new cases of diabetes based on objective criteria only and when using as predictors both life and job satisfaction. We suggest that life satisfaction could be a protective factor reducing the risk of diabetes.

Treatment beliefs and attending follow-up visits in a lipid clinic.

OBJECTIVE: To explore the value of demographics, clinical parameters, and treatment beliefs in predicting attendance at follow-up visits in a lipid clinic. DESIGN: Prospective cohort study. METHODS: A total of 104 consecutive patients, who attended the Meir Medical Center lipid clinic for the first time, were followed for an average of 14 months. During the first visit, demographic and clinical parameters were obtained and a treatment beliefs and a self-rated health questionnaire were completed. Those who kept all scheduled follow-up visits were categorized as attendees and those who were lost to follow up as non-attendees. The two groups were compared on demographic and clinical parameters, as well as on treatment and health beliefs. RESULTS: Lipid target level achievement was higher in attendees (p < .001). However, only 49 patients (47%) attended the scheduled clinic visits. None of the demographic or clinical parameters significantly predicted attendance. Both groups scored high on perceived risk-to-health of uncontrolled lipid levels and on perceived effectiveness and benefits of treatment. Non-attendees reported significantly more perceived barriers and treatment misconceptions/disbeliefs, and lower self-rated health. CONCLUSIONS: Beliefs concerning lipid-lowering treatment should be identified so that they may be effectively addressed in order to improve patient attendance at follow-up visits to a lipid clinic.

Elevated burnout predicts the onset of musculoskeletal pain among apparently healthy employees.

Musculoskeletal (MS) pain is highly prevalent in the working population, often resulting in chronic disability. Burnout represents accumulated exposure to work-related stresses and therefore could predict the incidence of MS pain. We investigated prospectively the extent to which changes in the levels of burnout over time predict new cases of MS pain. Participants were 1,704 apparently healthy employed men and women who underwent periodic health examination at three points of time (T1, T2, and T3), over a period of about three years. We used the T1 to T2 changes in the levels of burnout, depressive symptoms, and anxiety to predict the onset of new cases of MS pain between T2 and T3, while controlling for possible confounders. Logistic regression results indicated that the T1-T2 change in burnout levels was associated with a 2.09-fold increased risk of MS pain (95% confidence interval = 1.07-4.10). No support was found for the possibility of reverse causation; that is, that MS pain predicts subsequent elevations of burnout levels. It was concluded that burnout might be a risk factor in the development of MS pain in apparently healthy individuals.

Aroused versus calm positive affects as predictors of lipids.

OBJECTIVE: The authors hypothesized that high-pleasure low-arousal (HPLA) would predict a subsequent decrease of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TRI), as well as a subsequent increase of high-density lipoprotein cholesterol (HDL-C). The authors also hypothesized that high-pleasure high-arousal (HPHA) would have the opposite effects on these blood lipids, predicting a subsequent increase of LDL-C and TRI, and a decrease of HDL-C. DESIGN: Participants were 990 male and 595 female apparently healthy employees who underwent a routine periodic health examination at two points in time, Time 1 (T1) and Time 2 (T2), about 24 months apart. Data were analyzed separately for the men and women, and the authors controlled for possible confounders shown in past research to be implicated with hyperlipidemia. MAIN OUTCOME MEASURES: HPHA and HPLA were assessed based on the Job-Related Affective Well-Being Scale, while LDL-C, TRI, and HDL-C were assessed based on fasting blood samples. RESULTS: For the men, support for our hypotheses was found relative to HDL-C and TRI. The authors did not find support for our hypotheses for thee women. CONCLUSION: Our findings suggest that for men, the two types of positive affects may have opposite physiological consequences with respect to subsequent changes in blood lipid levels.

Workload, control, and social support effects on serum lipids: a longitudinal study among apparently healthy employed adults.

The authors investigated the direct and interactive effects of the job demand- control-support (JDC-S) model's components on subsequent changes in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides (TRI) separately for male and female employees. In contrast to all 14 past studies on these relationships, the authors used a longitudinal design. Study participants (N = 1,137, 66% men) were all apparently healthy employees who underwent a routine health check at 2 points in time (Time 1 and Time 2) about 22 months apart. In these analyses, the authors controlled for the Time 1 level of each criterion and for other confounders. Most of the direct and moderating effects found did not support the predictions of the JDC-S model; this finding is in agreement with the majority of past cross-sectional studies. The authors did not find any evidence supporting the existence of a reverse causation for either of the components of the JDC-S model. The authors suggest that serum lipids may not be a physiological mechanism mediating the effects of the JDC-S model on atherosclerotic diseases.

Debilitating beliefs and emotional distress in patients given immunotherapy for insect sting allergy: a prospective study.

Patients who receive venom immunotherapy (VIT) for systemic reactions (SRs) to insect stings are advised that once they reach the maintenance dose they are almost 100% protected against future SRs. However, initial evidence indicates that some patients continue to perceive themselves as highly debilitated by the allergy and are preoccupied with the allergic event. These factors have significant impact on their emotional well-being and allergy-related quality of life (ARQOL). We aimed to explore prospectively whether patients would experience these adverse psychological outcomes after receiving VIT coupled with professional explanation and reassurance of protection. Thirty-four patients who received VIT for systemic insect allergy and were under close medical surveillance were included. Before and 1 year after initiation of treatment, patients completed a questionnaire that measured debilitating beliefs, preoccupation with the SR event, emotional distress ARQOL, and QOL in general. Physician-graded severity of the reaction was recorded as well. VIT had a beneficial effect on all allergy-related variables. Self-imposed debilitating beliefs, preoccupation with the anaphylactic event, and ARQOL significantly but modestly improved over time. No association was found between ARQOL and QOL in general. The later variable as well as emotional distress remained unchanged after the VIT. This study shows that patients with sting allergy guided by trained personnel and treated with VIT show a reduction in dysfunctional beliefs and an improvement in ARQOL. Disputing medically unfounded beliefs that persist in some patients might improve their ARQOL.

Relation of educational level to inflammation-sensitive biomarker level.

It is a well-established finding that cardiovascular morbidity varies among groups of different socioeconomic status. Inflammatory processes have been proposed as a possible mediator of this variance. Level of education is an important indicator of socioeconomic status, inversely related to levels of inflammatory biomarkers. Whether this association was significant in a subpopulation of highly educated individuals was questioned. This cross-sectional study enrolled attendees of an executive health screening program intended specifically for executive and high-wage personnel from September 2002 to November 2007. A detailed questionnaire, anthropometric measurements, and laboratory data were used to determine self-reported years of education and cardiovascular risk factors. Linear regression models included high-sensitivity C-reactive protein, fibrinogen, erythrocyte sedimentation rate, and white blood cell count as dependent variables and were adjusted for multiple potential confounders. Data for 8,998 subjects (5,757 men, 3,241 women) with a mean age of 44 years (range 18 to 84) were analyzed. More than two-thirds reported >or=14 years of schooling, and >2,900 reported >or=17 years of schooling. We found a statistically significant inverse association between number of school years and high-sensitivity C-reactive protein, fibrinogen, and erythrocyte sedimentation rate. Higher levels of education were associated with lower prevalences of diabetes and current smoking in both genders and lower prevalences of hypertension and dyslipidemia in women. In conclusion, level of education was inversely associated with inflammatory biomarkers and prevalence of cardiovascular risk factors, even within highly educated populations.