Depression and anxiety have been linked with reduced stress‐induced cardiovascular reactivity (CVR), which could be indicative of autonomic dysregulation. Less is known about the association between ...work‐related fatigue and CVR. Truck drivers experience high levels of depression, anxiety, and fatigue, with repeated psychophysiological stressors on the road, yet little is known about the effects of these conditions on their CVR. Three hundred eighty six truck drivers completed the Hospital Anxiety and Depression Scale (HADS) and the Occupational Fatigue Exhaustion/Recovery Scale (OFER‐15). Systolic (SBP) and diastolic (DBP) blood pressure and heart rate (HR) were measured at rest and during a stressor protocol to measure CVR. Multivariate regression analyses were used to determine relationships between variables and adjusted for nine key covariates. Higher symptoms of persistent fatigue were related to a reduced SBP reactivity (β = −.236, p = .009) and reduced DBP reactivity (β = −.257, p = .005), whereas there was a positive trend between acute fatigue and DBP reactivity (β = .169, p = .052). Higher symptoms of anxiety were related to a reduced SBP reactivity (β = −.164, p = .016). This study demonstrated in a population of truck drivers that both anxiety and persistent fatigue were related to an attenuated SBP reactivity in a combined model, whereas there was a positive trend between acute fatigue solely and DBP reactivity. These novel findings may have serious implications for cardiovascular disease risk in truck drivers, and future research should attempt to establish the causal effect of these associations and the underlying physiological mechanisms.
Truck drivers experience high levels of depression, anxiety, and fatigue, as well as repeated psychophysiological stressors on the road. Our study is novel by showing that increased fatigue and symptoms of anxiety are related to attenuated cardiovascular reactivity in truck drivers. Attenuated physiological responses may have negative consequences for future health status of truck drivers.
Today the need to analyze health behaviour from a gender perspective is as imminent as ever, particularly at university, where the number of women who register is on the rise and has exceeded the ...number of male students worldwide. We carried out a prevalence study aimed at analyzing Spanish university students' lifestyles and identify differences according to gender and academic discipline. Of 3,646 eligible subjects doing university courses related to health (Group A), education (Group B) and other professions (Group C), 985 (27.0%) participated in the study. Information was elicited about their physical activity level, disturbed eating attitudes, consumption of alcohol, tobacco and illegal substances. Prevalence and Odds Ratios (OR) were calculated according to sex and kind of academic discipline. The obtained data confirmed that only 27.4% of the students were considered as sufficiently active, while 14.9% of them suffered from disturbed eating attitudes (DEA). Women were particularly less active (OR 0.46 (0.32-0.66); p < 0.0001), and more sedentary than men (OR 1.40 (1.00-1.97); p = 0.03). Binge drinking was more frequent in female than in male students (OR 1.79 (1.29-2.47); p = 0.0004). A third of the analyzed sample admitted that they had used illegal substances, while a lower consumption prevalence was found in women (OR 0.53 (0.40-0.71); p < 0.0001). The studied population was not very active (27.4%), especially women (OR = 0.45). Therefore, it seems that Spanish university students lead an unhealthy lifestyle, a situation which seems more conspicuous amongst females.
OBJECTIVE:The aim of this study was to examine the effects of implementing a lifestyle health behavior intervention on cardiovascular risk markers in a sample of lorry drivers.
METHODS:Fifty-seven ...males participated in the pre-post evaluation of a multicomponent 12-week intervention.
RESULTS:Favorable changes in several cardiovascular health indicators were observed, including fasting blood glucose (−0.6 mmol/L), LDL-Cholesterol (−0.7 mmol/L), total cholesterol (−0.7 mmol/L), waist-hip ratio (−0.10), and waist circumference (−2.5 cm) (P < 0.01). The proportion of participants with a more than 10% risk of a cardiovascular event in the next 10 years was reduced by 12% (P < 0.05). A 21%, 12%, and 7.5% reduction in drivers with pre-diabetes (P < 0.001), undiagnosed diabetes (P < 0.05), and the metabolic syndrome (P < 0.05), respectively, was observed.
CONCLUSION:This study highlights the feasibility of implementing a multicomponent health intervention within the transport setting and provides preliminary evidence of its beneficial effects on some markers of health.
This study explored the validity of ActiGraph-determined sedentary time (<50 cpm, <100 cpm, <150 cpm, <200 cpm, <250 cpm) compared with the activPAL in a free-living sample of bus drivers. ...Twenty-eight participants were recruited between November 2013 and February 2014. Participants wore an activPAL3 and ActiGraph GT3X+ concurrently for 7 days and completed a daily diary. Time spent sedentary during waking hours on workdays, non-workdays, during working-hours, and non-working hours were compared between instruments. During working hours, all ActiGraph cut-points significantly underestimated sedentary time (p < 0.05), whereas during non-working hours the <50 cpm cut-point demonstrated the closest agreement (ActiGraph sedentary time: 250 ± 75 minutes versus activPAL sedentary time: 236 ± 65 minutes). Receiver operating characteristic analyses revealed that on workdays and non-workdays the ActiGraph cut-points exhibited relatively low sensitivity (all <0.62) and specificity (all <0.49) values. The use of the ActiGraph to measure sedentary time in this understudied, highly sedentary and at risk occupational group is not recommended.
Hepatokines such as fibroblast growth factor 21 (FGF21), leukocyte cell–derived chemotaxin 2 (LECT2), fetuin-A, fetuin-B, and selenoprotein P (SeP) are liver-derived proteins that are modulated by ...chronic energy status and metabolic disease. Emerging data from rodent and cell models indicate that hepatokines may be sensitive to acute nutritional manipulation; however, data in humans are lacking.
The aim was to investigate the influence of hyperenergetic, high-fat feeding on circulating hepatokine concentrations, including the time course of responses.
In a randomized, crossover design, 12 healthy men mean ± SD: age, 24 ± 4 y; BMI (kg/m2), 24.1 ± 1.5 consumed a 7-d hyperenergetic, high-fat diet HE-HFD; +50% energy, 65% total energy as fat (32% saturated, 26% monounsaturated, 8% polyunsaturated) and control diet (36% total energy as fat), separated by 3 wk. Whole-body insulin sensitivity was assessed before and after each diet using oral-glucose-tolerance tests. Fasting plasma concentrations of FGF21 (primary outcome), LECT2, fetuin-A, fetuin-B, SeP, and related metabolites were measured after 1, 3, and 7 d of each diet. Hepatokine responses were analyzed using 2-factor repeated-measures ANOVA and subsequent pairwise comparisons.
Compared with the control, the HE-HFD increased circulating FGF21 at 1 d (105%) and 3 d (121%;P ≥ 0.040), LECT2 at 3 d (17%) and 7 d (32%;P ≥ 0.004), and fetuin-A at 7 d (7%;P = 0.028). Plasma fetuin-B and SeP did not respond to the HE-HFD. Whole-body insulin sensitivity was reduced after the HE-HFD by 31% (P = 0.021).
Acute high-fat overfeeding augments circulating concentrations of FGF21, LECT2, and fetuin-A in healthy men. Notably, the time course of response varies between proteins and is transient for FGF21. These findings provide further insight into the nutritional regulation of hepatokines in humans and their interaction with metabolic homeostasis. This study was registered at clinicaltrials.govas NCT03369145.
Abstract
Background
Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for ...workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome.
Purpose
To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave.
Methods
This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits – one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned.
Results
Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (
n
= 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (
n
= 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed.
Conclusions
Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial.
This study explored the association between inactive time and measures of adiposity, clinical parameters, obesity, type 2 diabetes and metabolic syndrome components. It further examined the impact of ...reallocating inactive time to time in bed, light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on cardio-metabolic risk factors, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults.
This is a cross-sectional analysis of baseline data from 2189 Caucasian men and women (age 55-75 years, BMI 27-40 Kg/m
) from the PREDIMED-Plus study (http://www.predimedplus.com/). All participants had ≥3 components of the metabolic syndrome. Inactive time, physical activity and time in bed were objectively determined using triaxial accelerometers GENEActiv during 7 days (ActivInsights Ltd., Kimbolton, United Kingdom). Multiple adjusted linear and logistic regression models were used. Isotemporal substitution regression modelling was performed to assess the relationship of replacing the amount of time spent in one activity for another, on each outcome, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults.
Inactive time was associated with indicators of obesity and the metabolic syndrome. Reallocating 30 min per day of inactive time to 30 min per day of time in bed was associated with lower BMI, waist circumference and glycated hemoglobin (HbA1c) (all p-values < 0.05). Reallocating 30 min per day of inactive time with 30 min per day of LPA or MVPA was associated with lower BMI, waist circumference, total fat, visceral adipose tissue, HbA1c, glucose, triglycerides, and higher body muscle mass and HDL cholesterol (all p-values < 0.05).
Inactive time was associated with a poor cardio-metabolic profile. Isotemporal substitution of inactive time with MVPA and LPA or time in bed could have beneficial impact on cardio-metabolic health.
The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered.
This paper presents the mixed methods process evaluation of the randomised controlled trial (RCT) of the Structured Health Intervention For Truckers (SHIFT), a multi-component intervention targeting ...physical activity and positive lifestyle behaviours in a cohort of 382 truck drivers in the UK. The SHIFT RCT found a significant difference in daily steps between intervention and control groups at 6-months in favour of the intervention participants. SHIFT was evaluated within a cluster-RCT and involved 25 transport sites (12 intervention and 13 control sites). Intervention components included an education session, Fitbit, text messages, and cab workout equipment. Participants completed questionnaires at baseline and 6-months follow-up. Semi-structured focus groups/interviews were conducted with drivers (n = 19) and managers (n = 18) from each site, after completion of the final follow-up health assessment (16-18 months post-randomisation). Questionnaires and interviews collected information on fidelity, dose, context, implementation, barriers, sustainability, and contamination. Questionnaire and interview data from intervention participants indicated favourable attitudes towards SHIFT, specifically towards the Fitbit with a high proportion of drivers reporting regularly using it (89.1%). 79.2% of intervention participants attended the education session, which was deemed useful for facilitating improvements in knowledge and behaviour change, dietary changes were predominantly recalled. Despite not being part of the intervention, participants reported that feedback from the health assessments motivated them to change aspects of their lifestyle (intervention = 91.1%, control = 67.5%). The cab workout equipment was used less and spoken unfavourably of in the interviews. The main barriers to a healthy lifestyle at work were reported as long hours and irregular shift patterns. The most suggested improvement for the intervention was more frequent contact with drivers. Managers were positive about the objectives of SHIFT, however almost all mentioned the challenges related to implementation, specifically in smaller sites. Overall, SHIFT was predominantly implemented as intended, with minimal discrepancies seen between the delivery and protocol. Having said this, transport sites each have distinct characteristics, which may require adaptations to individual settings to encourage participation. Managers and drivers reported enthusiasm and necessity for SHIFT to be included in future Certificate of Professional Competence training.
Long distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion ...initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent 'Structured Health Intervention For Truckers' (SHIFT), compared to usual care, at 6- and 16-18-month follow-up.
We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16-18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit® and resistance bands/balls to facilitate a 'cab workout'). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population.
Three hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m
, 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145-1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (- 24 mins/day, 95% CI: - 43 to - 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3-11). Differences were not maintained at 16-18 months. No differences were observed between groups in the other secondary outcomes at either follow-up.
The SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group.
ISRCTN10483894 (date registered: 01/03/2017).
There is increasing interest in using patient and public involvement (PPI) in research to improve the quality of healthcare. Ordinarily, traditional methods have been used such as interviews or focus ...groups. However, these methods tend to engage a similar demographic of people. Thus, creative methods are being developed to involve patients for whom traditional methods are inaccessible or non-engaging.
To determine the strengths and limitations to using creative PPI methods in health and social care research.
Electronic searches were conducted over five databases on 14th April 2023 (Web of Science, PubMed, ASSIA, CINAHL, Cochrane Library). Studies that involved traditional, non-creative PPI methods were excluded. Creative PPI methods were used to engage with people as research advisors, rather than study participants. Only primary data published in English from 2009 were accepted. Title, abstract and full text screening was undertaken by two independent reviewers before inductive thematic analysis was used to generate themes.
Twelve papers met the inclusion criteria. The creative methods used included songs, poems, drawings, photograph elicitation, drama performance, visualisations, social media, photography, prototype development, cultural animation, card sorting and persona development. Analysis identified four limitations and five strengths to the creative approaches. Limitations included the time and resource intensive nature of creative PPI, the lack of generalisation to wider populations and ethical issues. External factors, such as the lack of infrastructure to support creative PPI, also affected their implementation. Strengths included the disruption of power hierarchies and the creation of a safe space for people to express mundane or "taboo" topics. Creative methods are also engaging, inclusive of people who struggle to participate in traditional PPI and can also be cost and time efficient.
'Creative PPI' is an umbrella term encapsulating many different methods of engagement and there are strengths and limitations to each. The choice of which should be determined by the aims and requirements of the research, as well as the characteristics of the PPI group and practical limitations. Creative PPI can be advantageous over more traditional methods, however a hybrid approach could be considered to reap the benefits of both. Creative PPI methods are not widely used; however, this could change over time as PPI becomes embedded even more into research.
PDF
