Heart rate variability in hypothyroid patients:a systematic review and meta-analysis

INTRODUCTION: Hypothyroidism may be associated with changes in the autonomic regulation of the cardiovascular system, which may have clinical implications. OBJECTIVE: To conduct a systematic review and meta-analysis on the impact of hypothyroidism on HRV. MATERIALS AND METHODS: PubMed, Cochrane, Embase and Google Scholar were searched until 20 August 2021 for articles reporting HRV parameters in untreated hypothyroidism and healthy controls. Random-effects meta-analysis were stratified by degree of hypothyroidism for each HRV parameters: RR intervals (or normal to normal-NN intervals), SDNN (standard deviation of RR intervals), RMSSD (square root of the mean difference of successive RR intervals), pNN50 (percentage of RR intervals with >50ms variation), total power (TP), LFnu (low-frequency normalized unit), HFnu (high-frequency), VLF (very low frequency), and LF/HF ratio. RESULTS: We included 17 studies with 11438 patients: 1163 hypothyroid patients and 10275 healthy controls. There was a decrease in SDNN (effect size = -1.27, 95% CI -1.72 to -0.83), RMSSD (-1.66, -2.32 to -1.00), pNN50 (-1.41, -1.98 to -0.84), TP (-1.55, -2.1 to -1.00), HFnu (-1.21, -1.78 to -0.63) with an increase in LFnu (1.14, 0.63 to 1.66) and LF/HF ratio (1.26, 0.71 to 1.81) (p <0.001). HRV alteration increased with severity of hypothyroidism. CONCLUSIONS: Hypothyroidism is associated with a decreased HRV, that may be explained by molecular mechanisms involving catecholamines and by the effect of TSH on HRV. The increased sympathetic and decreased parasympathetic activity may have clinical implications

Work-related stress of companies' directors during the first lockdown due to the COVID-19

BACKGROUND: The COVID-19 pandemic and the first lockdown were particularly stressful with a major economic impact, but the impact on stress of company directors was not known. Therefore, this study aimed to assess that impact and the characteristics of companies the most at risk. METHOD: A online questionnaire was sent to 13,114 company. It assessed stress at work, number of employees, sector of activity, business activity rate and geographical location. It studied the mean stress levels, the percentage of stress > 8/10 and carried out an analysis of the characteristics of the most at-risk companies. RESULTS: A total of 807 company directors responded. Their stress levels increased by 25.9% during lockdown and 28.7% of them had a stress > 8/10. Sectors which had the biggest increase in stress levels during lockdown were retail trade, wholesale trade, and nursing homes. Sectors the most at risk of stress >8/10 during lockdown tended to be nursing homes, pharmacies, and IT activities. Biggest companies had the highest increase in stress levels. CONCLUSION: The first lockdown of the COVID-19 pandemic had a major impact on the stress of company directors. Directors of large companies were the most exposed to stress as well as medical and IT activities

The impact of job-demand-control-support on leptin and ghrelin as biomarkers of stress in emergency healthcare workers

Despite the available literature on the consequences of night shiftwork on stress and food intake, its impact on leptin and ghrelin has never been studied. We previously demonstrated that leptin and ghrelin were biomarkers related to stress, and acute stress-induced a decrease in leptin levels and an increase in ghrelin levels. We performed a prospective observational study to assess the influence of night work, nutrition, and stress on the levels of ghrelin and leptin among emergency healthcare workers (HCWs). We took salivary samples at the beginning of a day shift and/or at the end of a night shift. We also monitored stress using the job demand-control-support model of Karasek. We recorded 24-h food intake during the day shift and the consecutive night shift and during night work and the day before. We included 161 emergency HCWs. Emergency HCWs had a tendency for decreased levels of leptin following the night shift compared to before the dayshift (p = 0.067). Furthermore, the main factors explaining the decrease in leptin levels were an increase in job-demand (coefficient −54.1, 95 CI −99.0 to −0.92) and a decrease in job control (−24.9, −49.5 to −0.29). Despite no significant changes in ghrelin levels between shifts, social support was the main factor explaining the increase in ghrelin (6.12, 0.74 to 11.5). Food intake (kcal) also had a negative impact on leptin levels, in addition to age. Ghrelin levels also decreased with body mass index, while age had the opposite effect. In conclusion, we confirmed that ghrelin and leptin as biomarkers of stress were directly linked to the job demand-control-support model of Karasek, when the main cofounders were considered

Perceived discrimination based on the symptoms of covid-19, mental health, and emotional responses–the international online COVISTRESS survey

Background Despite the potential detrimental consequences for individuals’ health and discrimination from covid-19 symptoms, the outcomes have received little attention. This study examines the relationships between having personally experienced discrimination based on the symptoms of covid-19 (during the first wave of the pandemic), mental health, and emotional responses (anger and sadness). It was predicted that covid-19 discrimination would be positively related to poor mental health and that this relationship would be mediated by the emotions of anger and sadness. Methods The study was conducted using an online questionnaire from January to June 2020 (the Covistress network; including 44 countries). Participants were extracted from the COVISTRESS database (Ntotal = 280) with about a half declaring having been discriminated due to covid-19 symptoms (N = 135). Discriminated participants were compared to non-discriminated participants using ANOVA. A mediation analysis was conducted to examine the indirect effect of emotional responses and the relationships between perceived discrimination and self-reported mental health. Results The results indicated that individuals who experienced discrimination based on the symptoms of covid-19 had poorer mental health and experienced more anger and sadness. The relationship between covid-19 personal discrimination and mental health disappeared when the emotions of anger and sadness were statistically controlled for. The indirect effects for both anger and sadness were statistically significant. Discussion This study suggests that the covid-19 pandemic may have generated discriminatory behaviors toward those suspected of having symptoms and that this is related to poorer mental health via anger and sadness.info:eu-repo/semantics/publishedVersio

A cross-sectional study to assess job strain of emergency healthcare workers by Karasek questionnaire: The SEEK study

BackgroundEmergency healthcare workers (eHCWs) are particularly at risk of stress, but data using the gold standard questionnaire of Karasek are scarce. We assessed the level of stress of eHCWs and aimed to compare it with the general population.MethodsThis is a cross-sectional nationwide study in French Emergency Departments (EDs), using the job-content questionnaire of Karasek, compared with the 25,000 answers in the French general population (controls from the SUMER study). The descriptions of job demand, job control, and social support were described as well as the prevalence of job strain and isostrain. Putative factors were searched using mixed-method analysis.ResultsA total of 166 eHCWs (37.9 ± 10.5 years old, 42% men) from five French EDs were included: 53 emergency physicians and 104 emergency paramedics, compared to 25,000 workers with other occupations. Job demand was highest for physicians (28.3 ± 3.3) and paramedics (25.9 ± 3.8), compared to controls (36.0 ± 7.2; p &lt; 0.001). Job control was the lowest for physicians (61.2 ± 5.8) and paramedics (59.1 ± 6.8), compared to controls (70.4 ± 11.7; p &lt; 0.001). Mean social support did not differ between groups (23.6 ± 3.4 for physicians, 22.6 ± 2.9 for paramedics, and 23.7 ± 3.6 for controls). The prevalence of job strain was massively higher for physicians (95.8%) and paramedics (84.8%), compared to controls (23.9%; p &lt; 0.001), as well as for isostrain (45.1% for physicians, 56.8% for paramedics, and 14.3% for controls, p &lt; 0.001). We did not find any significant impact of sociodemographic characteristics on job control, job demand, or social support.ConclusionEmergency healthcare workers have a dramatic rate of job strain, necessitating urgent promotion of policy to take care of them

Médecine d’urgence, nutrition et biomarqueurs du stress

Background: Emergency medicine is a stressful job, but stress assessment using the Karasek job demand-control-support model has not been done, nor the impact of work on food intake. We have demonstrated that leptin and ghrelin, hormones that regulate appetite, are also biomarkers of stress. However, no holistic study integrating all these parameters had ever been done, and even less among emergency healthcare workers. Objective: To assess the influence of night work, nutrition and stress assessed by Karasek's model on ghrelin and leptin concentrations among emergency healthcare worker. Method: Prospective observational study with saliva collections at the beginning of the day shift and/or at the end of the night shift, associated with stress assessments via Karasek's model, and collection of food intake over 24 hours during a day shift and the consecutive night, and during a night shift and the previous day. Results: 161 caregivers were included. Leptin levels were lower after night shift compared to before day shift (p=0.067). The main factors explaining the decrease in leptin levels were an increase in job demand (coefficient -54.1, 95CI -99.0 to -0.92) and a decrease in job control (-24.9, -49.5 to -0.29). Despite the lack of significant changes in ghrelin levels between night and day shifts, the main factor explaining the increase in ghrelin was social support (6.12, 0.74 to 11.5). Food intake (kcal) and age also have a negative impact on leptin levels. Ghrelin levels also decreased with body mass index while age had the opposite effect. Conclusion: We confirmed that ghrelin and leptin are biomarkers of stress directly related to Karasek's job demand-control-support model, in a study controlled for major confounders.Contexte : La médecine d’urgence est une spécialité stressante, mais l’évaluation du stress par le gold standard modèle de Karasek n’avait été faite, ni l’impact du travail sur les apports alimentaires. Nous avons démontré que la leptine et la ghréline, des hormones de régulation de l’appétit, sont également des biomarqueurs du stress. Toutefois aucune étude holistique intégrant tous ces paramètres n’avait jamais été faite, et encore moins dans le contexte de la médecine d’urgence. Objectif : Evaluer l'influence du travail de nuit, de la nutrition et du stress évalué par le modèle de Karasek sur les concentrations de ghréline et de leptine chez les soignants de l’urgence. Méthode : Etude observationnelle prospective avec recueils salivaires en début de poste de jour et/ou en fin de poste de nuit, associés à des évaluations du stress via le modèle job-demand-control-support de Karasek, et recueil des ingestas sur 24 heures pendant une garde de jour et la nuit consécutive, et pendant une garde de nuit et la journée précédente. Résultats : 161 soignants ont été inclus. Les taux de leptine étaient plus faibles après une garde de nuit par rapport à avant une garde de jour (p=0,067). Les principaux facteurs expliquant la diminution des taux de leptine étaient une augmentation de la demande psychologique (coefficient -54.1, IC95 -99.0 à -0.92) et une diminution de la latitude décisionnelle (-24.9, -49.5 à -0.29). Malgré l'absence de changements significatifs dans les niveaux de ghréline entre les gardes de nuit et de jour, le principal facteur expliquant l'augmentation de la ghréline était le soutien social (6.12, 0.74 à 11.5). L'apport alimentaire (kcal) et l’âge ont également un impact négatif sur les niveaux de leptine. Les niveaux de ghréline ont également diminué avec l'indice de masse corporelle tandis que l'âge a un effet opposé. Conclusion : Nous avons confirmé que la ghréline et la leptine sont des biomarqueurs de stress directement liés au modèle demande-contrôle-soutien au travail de Karasek, dans une étude qui a pris en compte les principaux confondants

Médecine d’urgence, nutrition et biomarqueurs du stress

Background: Emergency medicine is a stressful job, but stress assessment using the Karasek job demand-control-support model has not been done, nor the impact of work on food intake. We have demonstrated that leptin and ghrelin, hormones that regulate appetite, are also biomarkers of stress. However, no holistic study integrating all these parameters had ever been done, and even less among emergency healthcare workers. Objective: To assess the influence of night work, nutrition and stress assessed by Karasek's model on ghrelin and leptin concentrations among emergency healthcare worker. Method: Prospective observational study with saliva collections at the beginning of the day shift and/or at the end of the night shift, associated with stress assessments via Karasek's model, and collection of food intake over 24 hours during a day shift and the consecutive night, and during a night shift and the previous day. Results: 161 caregivers were included. Leptin levels were lower after night shift compared to before day shift (p=0.067). The main factors explaining the decrease in leptin levels were an increase in job demand (coefficient -54.1, 95CI -99.0 to -0.92) and a decrease in job control (-24.9, -49.5 to -0.29). Despite the lack of significant changes in ghrelin levels between night and day shifts, the main factor explaining the increase in ghrelin was social support (6.12, 0.74 to 11.5). Food intake (kcal) and age also have a negative impact on leptin levels. Ghrelin levels also decreased with body mass index while age had the opposite effect. Conclusion: We confirmed that ghrelin and leptin are biomarkers of stress directly related to Karasek's job demand-control-support model, in a study controlled for major confounders.Contexte : La médecine d’urgence est une spécialité stressante, mais l’évaluation du stress par le gold standard modèle de Karasek n’avait été faite, ni l’impact du travail sur les apports alimentaires. Nous avons démontré que la leptine et la ghréline, des hormones de régulation de l’appétit, sont également des biomarqueurs du stress. Toutefois aucune étude holistique intégrant tous ces paramètres n’avait jamais été faite, et encore moins dans le contexte de la médecine d’urgence. Objectif : Evaluer l'influence du travail de nuit, de la nutrition et du stress évalué par le modèle de Karasek sur les concentrations de ghréline et de leptine chez les soignants de l’urgence. Méthode : Etude observationnelle prospective avec recueils salivaires en début de poste de jour et/ou en fin de poste de nuit, associés à des évaluations du stress via le modèle job-demand-control-support de Karasek, et recueil des ingestas sur 24 heures pendant une garde de jour et la nuit consécutive, et pendant une garde de nuit et la journée précédente. Résultats : 161 soignants ont été inclus. Les taux de leptine étaient plus faibles après une garde de nuit par rapport à avant une garde de jour (p=0,067). Les principaux facteurs expliquant la diminution des taux de leptine étaient une augmentation de la demande psychologique (coefficient -54.1, IC95 -99.0 à -0.92) et une diminution de la latitude décisionnelle (-24.9, -49.5 à -0.29). Malgré l'absence de changements significatifs dans les niveaux de ghréline entre les gardes de nuit et de jour, le principal facteur expliquant l'augmentation de la ghréline était le soutien social (6.12, 0.74 à 11.5). L'apport alimentaire (kcal) et l’âge ont également un impact négatif sur les niveaux de leptine. Les niveaux de ghréline ont également diminué avec l'indice de masse corporelle tandis que l'âge a un effet opposé. Conclusion : Nous avons confirmé que la ghréline et la leptine sont des biomarqueurs de stress directement liés au modèle demande-contrôle-soutien au travail de Karasek, dans une étude qui a pris en compte les principaux confondants

Emergency medicine, nutrition and biomarkers of stress

Contexte : La médecine d’urgence est une spécialité stressante, mais l’évaluation du stress par le gold standard modèle de Karasek n’avait été faite, ni l’impact du travail sur les apports alimentaires. Nous avons démontré que la leptine et la ghréline, des hormones de régulation de l’appétit, sont également des biomarqueurs du stress. Toutefois aucune étude holistique intégrant tous ces paramètres n’avait jamais été faite, et encore moins dans le contexte de la médecine d’urgence. Objectif : Evaluer l'influence du travail de nuit, de la nutrition et du stress évalué par le modèle de Karasek sur les concentrations de ghréline et de leptine chez les soignants de l’urgence. Méthode : Etude observationnelle prospective avec recueils salivaires en début de poste de jour et/ou en fin de poste de nuit, associés à des évaluations du stress via le modèle job-demand-control-support de Karasek, et recueil des ingestas sur 24 heures pendant une garde de jour et la nuit consécutive, et pendant une garde de nuit et la journée précédente. Résultats : 161 soignants ont été inclus. Les taux de leptine étaient plus faibles après une garde de nuit par rapport à avant une garde de jour (p=0,067). Les principaux facteurs expliquant la diminution des taux de leptine étaient une augmentation de la demande psychologique (coefficient -54.1, IC95 -99.0 à -0.92) et une diminution de la latitude décisionnelle (-24.9, -49.5 à -0.29). Malgré l'absence de changements significatifs dans les niveaux de ghréline entre les gardes de nuit et de jour, le principal facteur expliquant l'augmentation de la ghréline était le soutien social (6.12, 0.74 à 11.5). L'apport alimentaire (kcal) et l’âge ont également un impact négatif sur les niveaux de leptine. Les niveaux de ghréline ont également diminué avec l'indice de masse corporelle tandis que l'âge a un effet opposé. Conclusion : Nous avons confirmé que la ghréline et la leptine sont des biomarqueurs de stress directement liés au modèle demande-contrôle-soutien au travail de Karasek, dans une étude qui a pris en compte les principaux confondants.Background: Emergency medicine is a stressful job, but stress assessment using the Karasek job demand-control-support model has not been done, nor the impact of work on food intake. We have demonstrated that leptin and ghrelin, hormones that regulate appetite, are also biomarkers of stress. However, no holistic study integrating all these parameters had ever been done, and even less among emergency healthcare workers. Objective: To assess the influence of night work, nutrition and stress assessed by Karasek's model on ghrelin and leptin concentrations among emergency healthcare worker. Method: Prospective observational study with saliva collections at the beginning of the day shift and/or at the end of the night shift, associated with stress assessments via Karasek's model, and collection of food intake over 24 hours during a day shift and the consecutive night, and during a night shift and the previous day. Results: 161 caregivers were included. Leptin levels were lower after night shift compared to before day shift (p=0.067). The main factors explaining the decrease in leptin levels were an increase in job demand (coefficient -54.1, 95CI -99.0 to -0.92) and a decrease in job control (-24.9, -49.5 to -0.29). Despite the lack of significant changes in ghrelin levels between night and day shifts, the main factor explaining the increase in ghrelin was social support (6.12, 0.74 to 11.5). Food intake (kcal) and age also have a negative impact on leptin levels. Ghrelin levels also decreased with body mass index while age had the opposite effect. Conclusion: We confirmed that ghrelin and leptin are biomarkers of stress directly related to Karasek's job demand-control-support model, in a study controlled for major confounders