Síndrome desequilibrio esfuerzo-recompensa y enfermedades cardiovasculares : revisión de la literatura 2006-2016

Introducción El modelo desequilibrio esfuerzo – recompensa es un importante predictor de estrés laboral y por consiguiente de alteraciones en la salud cardiovascular, por ello en los últimos 10 años se ha encontrado importante evidencia y estudios respecto al tema; las publicaciones científicas se han enfocado en establecer relación entre factores psicosociales en el trabajo y consecuencias sobre la salud dándole relevancia a los factores biológicos principalmente los cardiovasculares. Objetivo Se evaluó la evidencia entre el desequilibrio esfuerzo recompensa y las alteraciones cardiovasculares en los trabajadores. Metodología Se realizó una revisión de la literatura en principales bases de datos como son pubmed, ovid y revistas electrónicas, en idioma inglés – español durante los últimos 10 años, usando palabras de búsqueda como desequilibrio esfuerzo recompensa, alteraciones cardiovasculares, trabajadores. Resultados Se encontró fuerte evidencia entre el desequilibrio esfuerzo recompensa con enfermedades cardiovasculares en los trabajadores, principalmente con las alteraciones en la tensión arterial en los trabajadores más expuestos, al igual que una relación mayor en mujeres que hombres que aumentaba con la edad. Se evidenció que después de haber sufrido un evento coronario agudo los trabajadores que continuaban expuestos a altas cargas de tensión laboral eran más propensos a desarrollar enfermedad coronaria recurrente. El sobrecompromiso (PR 1,91, IC 95% 1,35-2,69) y el desequilibrio esfuerzo recompensa (PR 2,47, IC 95% 1,62-3,75) se asociaron con riesgo de hipertensión arterial después de ajustar las variables de confusión. Se encontró asociación entre el desequilibrio esfuerzo recompensa e hipertensión arterial (OR 1,53-3,71 IC 95%). La ERI alta y la baja recompensa se asociaron con enfermedad coronaria recurrente (RR = 1,75, intervalo de confianza del 95% [IC] = 0,99 - 3,08 y HR = 1,77, IC del 95% = 1,16 - 2,71). Hubo una interacción de género que mostró efectos más fuertes entre las mujeres (HR respectivamente ajustadas para ERI alta y baja recompensa: HR = 3,95, IC del 95% = 0,93- 16,79, y HR = 9,53, IC del 95% = 1,15- 78,68). Conclusiones Se encontró una relación entre el desequilibrio esfuerzo recompensa con enfermedades cardiovasculares, principalmente con las alteraciones en la tensión arterial y eventos coronarios

Adesão ao tratamento em pacientes com depressão major: A influência da percepção de doença, suporte social, espiritualidade e do estado emocional

Este estudo teve como finalidade investigar a relação entre alguns factores psicossociais e a adesão terapêutica, utilizando como variáveis preditoras, as representações de doença, a ansiedade e depressão as previsões de suporte social, e a espiritualidade e como variáveis de resultado, a adesão ao regime terapêutico, através da avaliação da adesão à medicação. Pretendeu-se testar quatro hipóteses: (1) Prevê-se que as representações de depressão nas suas dimensões da consequências, duração e controlo pessoal e de tratamento, identidade, preocupação, emoções e compreensão da doença sejam preditores significativos da adesão ao tratamento medicamentoso; (2) Prevê-se que os níveis de ansiedade e depressão dos doentes depressivos estarão significativa e negativamente correlacionados com os níveis de adesão ao tratamento medicamentoso; (3) Prevê-se que os níveis de suporte social percebido estarão significativa e positivamente correlacionados com os níveis de adesão ao tratamento medicamentoso e (4) Prevê-se que os níveis de espiritualidade se encontrem significativa e positivamente correlacionados com os níveis de adesão ao tratamento medicamentoso. Tratou-se de um estudo transversal, com desenho correlacionai e foi desenvolvido num Hospital da Região do Alentejo, mais especificamente, num Departamento de Psiquiatria a saúde Mental, com uma amostra não aleatória de 15 pacientes com o diagnóstico de Depressão. Os resultados confirmaram parcialmente a primeira hipótese, sendo as representações de doença, nas suas dimensões controlo pessoal, controlo do tratamento e emoções preditores significativos da adesão (mais especificamente das alterações das doses da medicação). A segunda hipótese também foi confirmada parcialmente, sendo a depressão preditora da adesão (tanto na dimensão do esquecimento, quanto na alteração das doses da medicação). A terceira hipótese foi, também, parcialmente confirmada sendo a aliança fiável preditora significativa da adesão (na dimensão do esquecimento da toma da medicação). Por último, a quarta hipótese foi igualmente confirmada parcialmente sendo a esperança/optimismo preditora significativa da adesão (tanto na dimensão do esquecimento, quanto na alteração das doses da medicação). Nas análises exploratórias verificou-se a influência da variável sócio­ demográfico “sexo” nas representações cognitivas e também na depressão. A "idade" também demonstrou algum efeito nas alterações à medicação e nas provisões sociais. O "estado civil" mostrou efeito no aconselhamento e na oportunidade de prestação de valores. As variáveis clínicas também mostraram ter influência. O "tempo de doença" mostrou efeito significativo nas representações emocionais, nas crenças, esperança/optimismo e no esquecimento da medicação. A "duração do tratamento com medicação" mostrou efeito na compreensão da doença e no esquecimento da medicação. Por fim, são apresentadas algumas implicações da depressão, bem como algumas sugestões para estudos futuros. /ABSTRACT: This study aimed to investigate the relationship between some psychosocial factors and the adherence, using as predictor variables, the representations of illness, the anxiety and depression, the social support predictions, and spirituality, and as outcome variables, adherence to treatment regimen, through the assessment of medication adherence. lt was intended to test four hypotheses: (1) lt is expected that the depression representations in its dimensions of consequences, duration and personal control and treatment, identity, concern, emotions and disease understanding are significant predictors of adherence to therapy; (2) lt is expected that anxiety and depression levels in depressed patients are significantly and negatively correlated with the levels of adherence to therapy; (3) lt is expected that the levels of perceived social support are significantly and positively correlated with the levels of adherence to drug treatment and (4) lt is expected that the levels of spirituality are significantly and positively correlated with levels of adherence to therapy. This was a cross-sectional study with correlational design and was developed in one Hospital of the Alentejo Region, more specifically, in a Department of Psychiatry and Mental Health, with a non¬random sample of 15 patients diagnosed with depression. The results partially confirmed the first hypothesis, being the representations of disease, in its dimensions of personal control, treatment control and emotions, significant predictors of adherence (more specifically, of the changes in the doses of medication). The second hypothesis was also partially confirmed, with depression being a predictor of adherence {both in the extent of oblivion and in the changes of medication doses). The third hypothesis was also partially confirmed, being the trustable alliance a quite significantly reliable predictor of adherence {in the dimension of the medication oblivion). Finally, the fourth hypothesis was equally partially confirmed, being the hope/optimism significant predictor of adherence (both in the extent of oblivion and in changing doses of medication). ln exploratory analyzes, it was verified the influence of socio-demographic variable "sex" in the cognitive representations and also in depression. The "age" also had some effect on changes to medication and social provisions. The "marital status" had effect in the counseling and in the opportunity to provide values. The clinical variables also proved to have influence. "Time sickness" had a significant effect on emotional representations, beliefs, hope/optimism and medication oblivion. The "treatment duration with medication" had effect in the disease understanding and the medication oblivion. Finally, are presented some implications of depression as well as some suggestions for future studies.

Psychological characterization of hypertensive patients: associations with adherence to pharmacological treatment and self-management

Introduction: The role of psychosocial factors in the onset and progression of essential hypertension has been object of a large body of literature, yet findings appear to be controversial. Aims: We assessed the predictive role of psychosomatic syndromes, affective symptomatology, psychological reactance, psychological distress, well-being and quality of life on adherence to antihypertensive medications, lifestyle behaviors, hypertension severity and absolute cardiovascular risk grading, as well as their temporal stability at 1-year follow-up, in a sample of hypertensive patients. In addition, we aimed to validate the Italian version of the Hong Psychological Reactance Scale (HPRS). Methods: Eighty consecutive hypertensive outpatients treated with antihypertensive medications were compared to 80 controls. Psychosocial variables were assessed using clinical interviews and self-rating questionnaires at baseline and at 1-year follow-up. Cardiac parameters were also collected. One-hundred and fifty individuals from general population provided data for the HPRS validation. Results: Hypertensive patients reported significantly higher levels of psychological distress and lower levels of psychological well-being at baseline compared to controls. Among hypertensive patients, allostatic overload (AO) was the most frequently reported psychosomatic syndrome at baseline. Patients with AO displayed significantly greater levels of psychological distress and lower levels of well-being and quality of life than those without. Further, patients with illness denial were significantly more likely to report poor adherence to pharmacological treatment and, as well as those with higher levels of affective symptomatology, were less likely to follow a balanced diet. At follow-up, patients displayed significantly higher levels of well-being and lower levels of stress, mental pain and quality of life. Conclusions: Findings suggest the clinical relevance of psychosocial factors and psychosomatic syndromes in the progression of hypertension, with important implications for its management. As to the Italian validation of the HPRS, results support previous findings, even though a confirmatory factor analysis should be carried out.

Psychosocial sequelae of the 1989 Newcastle earthquake .3. Role of vulnerability factors in postdisaster morbidity

Background. This paper examines the contributions of dispositional and non-dispositional factors to post-disaster psychological morbidity. Data reported are from the 845 participants in the longitudinal component of the Quake Impact Study. Methods. The phase 1 survey was used to construct dimensional indices of threat and disruption exposure. Subsequently, a range of dispositional characteristics were measured, including neuroticism, personal hopefulness and defence style. The main morbidity measures were the General Health Questionnaire (GHQ-12) and Impact of Event Scale (IES). Results. Dispositional characteristics were the best predictors of psychological morbidity throughout the 2 years post-disaster, contributing substantially more to the variance in morbidity (12-39%) than did initial exposure (5-12%), but the extent of their contribution was greater for general (GHQ-12) than for post-traumatic (IES) morbidity. Among the non-dispositional factors, avoidance coping contributed equally to general and post-traumatic morbidity (pr = 0.24). Life events since the earthquake (pr = 0.18), poor social relationships (pr = -0.25) and ongoing earthquake-related disruptions (pr = 0.22) also contributed to general morbidity, while only the latter contributed significantly to post-traumatic morbidity (pr = 0.15). Conclusions. Medium-term post-earthquake morbidity appears to be a function of multiple factors whose contributions vary depending on the type of morbidity experienced and include trait vulnerability, the nature and degree of initial exposure, avoidance coping and the nature and severity of subsequent events.

Reported Use of Anabolic Steroids and Ergogenic Substances in Gym/Health Club Settings: Associations with Psychosocial and Exercise Behavior Factors

The industry of ergogenic supplements is increasing rapidly (Cole et al., 2003). Supplements may constitute an important aid for some vigourous exercise routines, but they may also be used as a hypothetical mean to achieve increases in muscular mass. This supposed effect of suplements can lead to its use by individuals who have high levels of drive for muscularity, a condition that is known to be associated with muscular dismorphy (or as it has been called recently vigorexia, Pope et al., 1997). Another psychological factor which can influence supplement consumption is exercise dependence, a borderline problem, as most studies present a prevalence of less than 10% in regular exercisers (Palmeira & Matos, 2006). Symptoms like tolerance or continuity could lead to the use of ergogenic aids to maintain the exercise levels. Also of interest for the understanding of the use of suplements are exercise frequency, volume and intensity, which could explain the ratesof consumption on a more physicological level.

Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting country-specific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as work-load.

A Comparison of Psychosocial Risk Factors Between 3 Groups of Cardiovascular Disease Patients Referred for Outpatient Cardiac Rehabilitation

Few studies have examined psychosocial risk factors for cardiovascular disease (CVD) between diagnostic groups of CVD patients. We compared levels of depression, anxiety, hostility, exhaustion, positive affect, and social support, and the prevalence of type D personality between patient groups with a primary diagnosis of coronary heart disease (CHD), chronic heart failure (CHF), or peripheral arterial disease (PAD).

Bone-marrow derived progenitor cells are associated with psychosocial determinants of health after controlling for classical biological and behavioral cardiovascular risk factors

BACKGROUND: Circulating progenitor cells have been implicated with maintaining vascular integrity. Low counts are found in adults with high cardiovascular risk and are associated with impaired endothelial function. It remains unknown whether psychosocial risk factors are independently related to counts of circulating progenitor cells. METHODS: We investigated a random sample of 468 adult industrial employees (mean age 41.2 years, 89% men) of Caucasian origin. Cardiovascular risk factors (blood pressure, LDL, HDL and C-reactive protein), health behavior (smoking, alcohol and physical exercise), psychological variables (effort-reward imbalance social support, negative affectivity) and interaction terms served as predictors of circulating progenitor cells (CD34+ CD31dim) as enumerated by flow-cytometry. FINDINGS: Psychosocial variables were independently associated with progenitor cell counts. The association with risk factors increased with age (explained variance in 18-36 year olds R(2)=0.17, p=0.55; age 36.1-46 R(2)=0.32, p=0.001; age>46 R(2)=0.27, p<0.001). Data revealed a shift from a larger association between behavioral and psychosocial variables and cell counts to a stronger association between biological variables and cell counts in older individuals. A significant interaction was observed between smoking and effort-reward imbalance in middle-aged subjects, those with both risk factors present had lower cell counts. In older employees, the interaction between biological risk factors and smoking was related to lower cell counts. INTERPRETATION: In working middle-aged and older men, psychosocial risk factors were related to circulating counts of progenitor cells. Smoking interacted negatively with psychosocial risk factors (middle-aged men) or with biological risk factors (older employees).

Tobacco use and related psychosocial risk factors among youth in urban India: Assessment of Project MYTRI follow-up surveys

Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a large 2-year randomized school-based trial with a goal to reduce and prevent tobacco use among students in 6th and 8th grades in Delhi and Chennai in India (n=32 schools). Baseline analyses in 2004 showed that 6th grade students reported more tobacco use than 8 th grade students, opposite of what is typically observed in developed countries like the US. The present study aims to study differences in tobacco use and psychosocial risk factors between the 6th grade cohort and 8th grade cohort, in a compliant sub-sample of control students that were present at all 3 surveys from 2004-06. Both in 2004 and 2005, 6th grade cohort reported significantly greater prevalence of ever use of all tobacco products (cigarettes, bidis, chewing tobacco, any tobacco). These significant differences in ever use of any tobacco between cohorts were maintained by gender, city and socioeconomic status. The 6th grade cohort also reported significantly greater prevalence of current use of tobacco products (cigarettes, chewing tobacco, any tobacco) in 2004. Similar findings were observed for psychosocial risk factors for tobacco use, where the 6th grade cohort scored higher risk than 8th grade cohort on scales for intentions to smoke or chew tobacco and susceptibility to smoke or chew tobacco in 2004 and 2005, and for knowledge of health effects of tobacco in all three years.^ The evidence of early initiation of tobacco use in our 6th grade cohort in India indicates the need to target prevention programs and other tobacco control measures from a younger age in this setting. With increasing proportions of total deaths and lost DALYs in India being attributable to chronic diseases, addressing tobacco use among younger cohorts is even more critical. Increase in tobacco use among youth is a cause for concern with respect to future burden of chronic disease and tobacco-related mortality in many developing countries. Similarly, epidemiological studies that aim to predict future death and disease burden due to tobacco should address the early age at initiation and increasing prevalence rates among younger populations. ^

Psychosocial and non-psychosocial risk factors for the new diagnosis of diabetes in elderly women

Objectives: Determine psychosocial variables associated with the new diagnosis of diabetes in elderly women. Examine whether variables remained significant predictors after controlling for non-psychosocial risk factors and the frequency of doctor visits. Research design and methods: A longitudinal cohort study was conducted using data from 10 300 women who completed a survey in 1996 and 1999. The women were aged between 70 and 74 years of age in 1996. The were asked to provide self-reports on a number of psychosocial and non-psychosocial variables in 1996 and on whether they had been diagnosed for the first time with diabetes in the 3-year period. The relationships between the potential risk factors and new diagnosis of diabetes were examined using binary logistic regression analysis. Results: Univariate results showed that not having a current partner, having low social support and having a mental health index score in the clinical range were all associated with higher risks of being diagnosed with diabetes for the first time. However the multivariate results showed that only a mental health index score in the clinical range and not having a current partner provided unique prediction of being newly diagnosed with diabetes. Of the non-psychosocial variables measured, only having a high BMI and hypertension were associated with increased risks of new diagnosis, while there was also evidence of a U shaped relationship between alcohol consumption and new diagnosis. Even after adjusting for frequency of doctor visits and non-psychosocial risk factors, a mental health index in the clinical range proved to still be a significant risk factor. Conclusions: A score on the mental health index that is within the clinical range is an independent risk factor for the new diagnosis of diabetes in elderly women. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

Psychosocial risk factors for pregnancy risk-taking in young women in emerging adulthood: Evidence from the Australian Longitudinal Study on Women's Health

This study represents the first longitudinal investigation of distal psychosocial predictors of pregnancy risk-taking in young Australian women. Participants were from the Australian Longitudinal Study on Women's Health. Two mail-out surveys assessing sociodemographic, education/competence, psychosocial wellbeing, and aspiration/identity factors, were completed at ages 18 and 22 by 1647 young women in emerging adulthood, and a third survey assessing pregnancy risk-taking behaviour was completed by a subsample of 90 young women at age 24. Higher psychosocial distress at age 22 was a risk factor for pregnancy risk-taking at age 24 (beta=0.29-0.38). Post hoc analyses suggested that the strongest component of psychosocial distress when predicting pregnancy risk-taking was higher depressive symptoms (beta=0.44-0.68). Demographic, education, unemployment, and future aspirations factors at age 18 and 22 were unrelated to pregnancy risk-taking at age 24.

Interaction of psychosocial risk factors explain increased neck problems among female office workers

This study investigated the relationship between psychosocial risk factors and (1) neck symptoms and (2) neck pain and disability as measured by the neck disability index (NDI). Female office workers employed in local private and public organizations were invited to participate, with 333 completing a questionnaire. Data were collected on various risk factors including age, negative affectivity, history of previous neck trauma, physical work environment, and task demands. Sixty-one percent of the sample reported neck symptoms lasting greater than 8 days in the last 12 months. The mean NDI of the sample was 15.5 out of 100, indicating mild neck pain and disability. In a hierarchical multivariate logistic regression, low supervisor support was the only psychosocial risk factor identified with the presence of neck symptoms. Similarly, low supervisor support was the only factor associated with the score on the NDI. These associations remained after adjustment for potential confounders of age, negative affectivity, and physical risk factors. The interaction of job demands, decision authority, and supervisor support was significantly associated with the NDI in the final model and this association increased when those with previous trauma were excluded. Interestingly, and somewhat contrary to initial expectations, as job demands increased, high decision authority had an increasing effect on the NDI when supervisor support was low. Crown copyright (c) 2006 Published by Elsevier B.V. All rights reserved.