Workplace health promotion and employee health in Swedish municipal social care organizations

Aim

The aim of this explorative study was to investigate the employers’ management characteristics, their provision of workplace health promotion (WHP) measures, and employee satisfaction with WHP in relation to employee health in Swedish municipal social care organizations.

Subjects and methods

A cross-sectional design was used, and questionnaires were sent to top managers (representing the employer) and employees in a nationwide random sample of 60 of the 290 municipal organizations for the social care of elderly and disabled people in Sweden. The questionnaire data from the 60 managers were linked to aggregated employee data concerning self-rated health and satisfaction with WHP from a representative sample of 8,082 employees in the same organizations. All analyses were performed at the organizational level using independent t-test, Spearman’s rank correlation and multiple linear regression analysis.

Results

In the multivariate analysis, the organizational WHP index (i.e. local WHP projects and WHP coordinators), individual WHP index (i.e. health profile assessment, fitness activities and medical check-up), and the level of employees’ satisfied with WHP were associated with employee health (F?=?9.64, p?<?0.001, adjusted R ²?=?0.48). General organizational and management characteristics were, however, not statistically related to employee health.

Conclusion

The results suggest that the provision of individual-directed and organizational-directed health-specific measures were related to employee health in Swedish municipal social care organizations and, therefore, can be part of a comprehensive approach to address WHP.     

Zielgruppenorientierung und betriebliche Gesundheitsförderung

Background

In research regarding workplace health promotion (WHP), the employees’ perspective has so far been a neglected issue. Thus, employees’ potential opposition towards WHP due to perceived program-related barriers regarding information as well as program design has also received little attention. The latter is the focus of this study.

Methods

Preliminary hypotheses regarding WHP program-related barriers as well as proposals for their reduction were created on the basis of problem-centered interviews. These interviews were conducted with 19 employees in three organizations, four persons in charge of WHP within these organizations, and nine health experts.

Results

From the employees’ perspective, individual criteria such as the perceived utility of the WHP program, social aspects such as the internal acceptance of WHP, and organizational prerequisites such as access conditions potentially create barriers to the implementation and use of WHP programs.

Conclusion

On the individual level, barriers related to program design can be reduced by, for example, stressing certain topics. On the interpersonal level, offering activities with a strong group orientation is a possibility. On the organizational level, creating attractive organizational conditions represents a favorable intervention.     

Forced mild physical training improves blood volume in the motor and hippocampal cortex of old mice

Objectives

To assess the effect of mild forced physical training on cerebral blood volume (CBV) and other brain parameters in old mice.

Setting

Treadmill in the animal house.

Participants

Thirty old (>25 mo) male mice were randomly assigned to one of three groups, exercise (E), exercise plus testosterone (T) (ET), and rest (C).

Intervention

Mild physical training on treadmill (30 min a day at belt speed = 8 m/min, five days a week) with or without one weekly injection of testosterone.

Measurements

CBV, quantitative transverse relaxation time (T2) maps, and cortical thickness were measured by magnetic resonance imaging.

Results

A significant increase of CBV was found in the motor and hippocampal cortex of E and ET mice; cortical thickness was not affected. T2 maps analysis suggested that water distribution did not change. T administration did not add to the effect of physical training.

Conclusion

This work provides first quantitative evidence that exercise initiated at old age is able to improve the hemodynamic status of the brain cortex in key regions for movement and cognition without inducing edema.     

The health promoting hospital movement in Taiwan: recent development and gaps in workplace

Objective

To examine the development in healthcare workplace health promotion (WHP) in Taiwan through the Health Promoting Hospital (HPH) initiative.

Methods

A cross-sectional survey was conducted with a self-administered questionnaire, involving all 55 hospitals committed to the HPH approach (HP hospitals) as of the end of 2009; 52 completed the questionnaire.

Results

Fifty of 52 hospitals perceived a change in organizational capacity which mainly occurred in the areas of re-aligning strategies (96 %) and more resources (71 %). Regarding re-aligning strategies, 85 % of the hospitals engaged in increased staff participation, 66 % in staff-oriented health services.

Conclusions

The HPH initiative has led to new developments in capacity building of WHP among HP hospitals in Taiwan, and this study has mapped a pattern of such developments.     

Watching sport on television, physical activity, and risk of obesity in older adults

Background

Television (TV) viewing has been associated with obesity although the effects of specific TV content on health and other behaviours remains unknown. We examined the association between watching sport on TV, physical activity levels, and risk of obesity.

Methods

We studied 6,733 (aged 64.9?±?9.2 yrs) men and women from the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Data were collected on self reported TV time and content, and physical activity. Nurses measured height and weight for the calculation of body mass index.

Results

On average, participants reported viewing TV for 5.3?±?4.1 hours per day and 30.3% of the sample watched sport on TV at least twice a week. There was no association between watching sport and physical activity levels. Participants that watched sports every day were at higher risk of obesity [odds ratio?=?1.39, 95% CI, 1.15, 1.68) after adjustment for age, sex, smoking, alcohol, physical activity, total TV time, disability, and self-rated health.

Conclusions

Watching elite athletes may have no role in the promotion of physical activity in older adults, which has implications for staging large sporting events with physical activity legacy promises.     

Factors associated with adherence to Antiretroviral Therapy (ART) among adult people living with HIV and attending their clinical care,Eastern Ethiopia

Background

To attain a successful treatment outcome, Antiretroviral Therapy (ART) treatment for people living with HIV requires more than 95 % adherence level. The adherence level varies depending on different population contexts. Thus, the objective of this study was to investigate ART adherence level among HIV positive patients attending their clinical care in public health facilities in Harar and Dire Dawa, Eastern Ethiopia.

Methods

We conducted a cross-sectional study among 626 ART attendees. Data were collected using a structured questionnaire with a face-to-face interview. ART adherence was considered when taking all antiretroviral treatment in a correctly prescribed doses at a right time (no dose missed or delayed for greater than or equal to 90 min) in the week prior to the study. Multivariable logistic analysis was applied to examine the association between the dependent and independent variables. Statistical significance was set at p-value <0.05.

Results

The level of ART adherence was 85 %. Adherence was more likely among patients of 35–44 years (AOR?=?2.39; 95 % CI?=?1.15–5.01), had monthly income of 501.00–999.00 Ethiopian Birr (ETB) (AOR?=?6.73; 95 % CI?=?2.71–16.75), no history of opportunistic infection (AOR?=?2.81; 95 % CI?=?1.47–5.36), and had good family support (AOR?=?2.61; 95 % CI?=?1.45–4.72). However, those who did not disclose their sero-status (AOR?=?0.45; 95 % CI?=?0.21–0.97) and did experience depression (AOR?=?0.36; 95 % CI?=?0.21–0.61) were less likely adherent than their counter parts.

Conclusions

The level of ART adherence was sub-optimal. Concerted and collaborative efforts through effective and efficient interventions are needed in view of the identified factors in order to improve the adherence level.

     

Health impact of sport and exercise in emerging adult men: a prospective study

Purpose

Health benefits of sport and exercise are well documented in children, adolescents and adults, but little is known about emerging adulthood—a period of life characterized by significant demographic and developmental changes. The present study aimed to assess the health impact of changes in sport and exercise levels during that specific period of life.

Methods

The analysis used baseline and 15-month follow-up data (N = 4,846) from the cohort study on substance use risk factors. Associations between baseline exercise levels or changes in exercise levels and health indicators (i.e., health-related quality of life, depression, body mass index, alcohol dependence, nicotine dependence and cannabis use disorder) were measured using chi-squared tests and ANOVA. Direction of effects was tested using cross-lagged analysis.

Results

At baseline, all health indicator scores were observed to be better for regular exercisers than for other exercise levels. At follow-up, participants who had maintained regular exercise over time had better scores than those who had remained irregular exercisers or had discontinued, but their scores for health-related quality of life and depression were close to those of participants who had adopted regular exercise after the baseline questionnaire. Cross-lagged analysis indicated that regular exercise at baseline was a significant predictor of health-related quality of life and substance use dependence at follow-up, but was itself predicted only by health-related quality of life.

Conclusions

From a health promotion perspective, this study emphasizes how important it is for emerging adult men to maintain, or adopt, regular sport and exercise.     

Children’s awareness of alcohol sponsorship of sport in Ireland: Munster Rugby and the 2008 European Rugby Cup

Objectives

Examined children’s awareness of sport sponsorship in Ireland, focussing on the 2008 European Rugby Cup win by Munster Rugby.

Methods

Following the Munster Rugby win in 2008, a cross-sectional sample of 1,175 children (7–13 years) in 11 National Schools in Ireland were asked which company sponsored “the cup that Munster won” and were then asked to name the product made by that company.

Results

Significantly higher level of awareness of the sponsor by children in Munster (69.9 %) to those outside Munster (21.5 %). No significant difference in the level of awareness of their product (alcohol) by location (inside Munster 75.9 %, outside Munster 83.6 %).

Conclusions

These findings support the view for an immediate introduction of legislation banning the sponsorship of sport.     

Betriebliche Gesundheitsförderung in mittelständischen Unternehmen

Background

Various studies have found the profitability of small and midsize enterprises (SME) to be related to their ability to innovate. Investing in human and social capital can help these companies increase their ability to innovate.

Research question

This study looked at how the level and type of workplace health promotion (WHP) programmes differ among larger, leading SME when they are actively managed by the businesses’ owners and their competitors.

Method

Structured interviews were conducted with six owner-managed enterprises, as well as with four competitors from the chemicals and metal industry.

Results

All businesses offer WHP programmes. Two of the businesses participating in the study have enrolled an employee in an in-house WHP programme. The organizations taking part in the study spend around €83 per employee per year on WHP programmes. By comparison, owner-managed enterprises clearly spend less than their competitors. One weakness stands out: “Controlling” or “active management” of the WHP programmes was found in only two of the businesses taking part in the study. The differences between the owner-controlled businesses and the management-controlled businesses are, on the whole, minor. Innovative potential by the owner-managed businesses is indicated by the fact that they focus much more strongly on the needs of their employees, as well as possess a perceptiveness and responsiveness to certain groups of employees. In conclusion, it is highly recommended that all businesses enroll more staff and more actively manage their WHP programmes.     

Betriebliche Gesundheitsf?rderung f??r Berufskraftfahrer

Background

Because driving takes place outside of company premises, access for professional drivers to workplace health promotion (WHP) is hindered. In the following cross-sectional study, we surveyed WHP experiences and needs from the viewpoint of entrepreneurs in order to gain insight into necessary preventative measures.

Material and methods

Managers of transport companies were asked for their opinion, knowledge, experiences and plans regarding WHP. Additionally, we obtained information about their willingness to participate in a pilot project. The 10% random sample was taken from the list of a statutory accident insurance association. The results were correlated with the likely predictor variables company size, engagement in long- or short-distance traffic and WHP experience.

Results

Of the responding entrepreneurs (n=598, =11% response rate), 22% had prior experience with preventative health measures for their workers; the rate depends on the company size. One third of the respondents signalled a general willingness to participate in a prevention project and detailed their preferences.

Conclusions

The current practice of WHP in transport companies is deficient. However, at least a small percentage of transport entrepreneurs are receptive to information campaigns and need-based WHP offers.     

Evaluation of an intervention using a self-regulatory counselling aid: pre- and post- intervention results of the OPTIMAHL 60plus study

Objectives

The study covers development and evaluation of an innovative counselling aid in an intervention study. The main purpose of the study was to establish whether improvements in nutrition and physical activity behaviour according to standard recommendations can be demonstrated.

Methods

OPTIMAHL 60plus is a quasi-experimental study in which participants were assigned in clusters to an intervention or control group. The study was conducted in low socio-economic-status districts in Bremen, Germany. 423 elderly participated at baseline and 369 after 3 months intervention. Face-to-face interviews (24-h recall and frequency questionnaire) were conducted at T0 and T1. χ ²-tests, sign-test and logistic regression were used for statistical analyses.

Results

No significant differences could be shown when comparing the intervention versus control group at T1. Significant changes from T0 to T1 in the intervention group were identified for daily fruit and vegetable (χ ²-test, p = 0.04), and for weekly fish consumption (χ ²-test, p = 0.04). However, similar results could also be shown for the control group.

Conclusions

A practical counselling aid for elderly was developed and evaluated. Changes in the health behaviour of elderly were identified, but effects could not be clearly traced to the intervention.     

A review of the application,feasibility, and the psychometric properties of the individualized measures in cancer

Purpose

To identify from the published literature the feasibility and the application of the individualized measures [Patient Generated Index (PGI), Schedule for the Evaluation of Individual Quality of Life (SEIQOL), and the short form of it (the direct weighting SEIQOL-DW)] in the context of cancer and to summarize the evidence on the psychometric properties of these measures.

Methods

Ovid Medline, PubMed, Embase, and CINAHL were searched up to April 2016. All studies were included if they reported information about the psychometric properties of the individualized measures and included patients diagnosed with any type of cancer at any age. Effect size (ES) was calculated to test for the responsiveness.

Results

Fifty-four full articles were reviewed. Full-text assessment of these articles resulted in 27 eligible studies that were included in our analysis. The majority of the studies (81%) reported data on the SEIQOL-DW, and only 15% on the PGI. Fourteen areas of quality-of-life (QOL) concerns were identified by patients using the PGI with the top 4 being family (90%), health (85%), finance (85%), and work (80%). At the global level, the correlation between the individualized and standard measures ranged from 0.45 to 0.49 and, at the symptom level, from 0.26 to 0.51. The ES of the individualized measures was high (ranged from 0.98 to 1.0) in the studies that expected high positive change compared to standard QOL measures (ES = 0.1).

Conclusion

Individualized measures are feasible and acceptable among people with cancer and could easily be incorporated clinically and used in a research context. Individualized measures are sensitive to change and cover a wide range of patients QOL concerns in comparison with standard measures.

     

Employee perceived barriers to participation in worksite health promotion

Aim

Many employers offer worksite health promotion (WHP), but a high percentage of the workforce does not participate. As the employees’ perspective regarding potential barriers to participation has received little attention in research so far, improvements in program design are delayed. The aims of the present paper therefore are to investigate perceived barriers to WHP participation from the employees’ point of view, and to construct a barrier typology.

Subject and methods

A quantitative questionnaire was developed on the basis of existing studies and distributed in four Austrian organisations offering comprehensive WHP programs. 237 respondents rated the appreciability of 22 potential barriers to WHP participation. Barrier categories and typologies were defined using principal component analysis (PCA), multiple correspondence analysis (MCA), and regression analysis.

Results

The PCA identified six barrier types: (1) integration into the daily routine; lack of (2) information; an (3) imbalance of benefits and costs; the requirement of too much (4) involvement; (5) interpersonal barriers; and (6) incredibility of the company’s honest commitment. According to the MCA, one group perceives barriers intensively, another hardly, and a third mainly program design related barriers. The regression analysis shows that especially being too busy at work and feeling physically not up to participating in WHP activities are major barriers.

Conclusion

The results provide a comprehensive overview and categorization of barriers to WHP participation perceived by employees in companies offering holistic programs. Moreover, they can be used as guidelines for analysing existing and/or preventing barriers of occurring when designing and implementing WHP programs.     

The effectiveness of an NaF rinse containing fTCP on eroded enamel remineralization

Objective

The authors investigated the effectiveness of a functionalized tricalcium phosphate (fTCP) combined with a low fluoride level in a mouthrinse to reharden eroded enamel lesions.

Methods

Ninety enamel slabs attached in pairs to removable appliances were randomly assigned to three treatment groups (n?=?30/group): (T1) NaF rinse (225 ppm F?+?40 ppm fTCP), (T2) NaF rinse (225 ppm F; ACT^®), and (T3) no mouthrinse (saliva). While wearing the in situ appliance for 14 days, subjects brushed their teeth with 1100 ppm F toothpaste (Crest©) for 2 min, rinsed with 15 ml of water for 10s, and then rinsed with 15 ml of their assigned treatment mouthrinse. Treatment efficacy was evaluated using surface microhardness (SMH) and transverse microradiography (TMR). Intra- and intergroup comparisons (α?=?0.05) were performed using the t-test and ANOVA followed by the Tukey test (HSD).

Results

With SMH, intragroup comparison (t-test) indicated significant rehardening of the eroded lesion with exposure to T1 (p?<?0.001) and T2 (p?<?0.01) but not with T3 However, with TMR, remineralization was only significant (p?=?0.01) with T1, but not with T2 and T3. In the intergroup comparison with percentage change in SMH, T1 was significantly different from T3 (p?<?0.01; Tukey HSD) but not from T2, and T2 was significantly different from T3. Intergroup comparison based on percentage mineral gain showed that T2 (p?=?0.02) and T3 (p?=?0.01) differed significantly from fTCP, but not between each other.

Conclusion

Addition of low level fluoride to functionalized β-tricalcium phosphate promoted rehardening of eroded enamel lesions.

     

The benefits of sleep coaching in workplace health promotion

Aim

In the present study, the benefits of a short-term sleep coaching intervention embedded in the workplace health promotion (WHP) program of the German Armed Forces was investigated.

Participants and methods

Well-being, self-care awareness, self-care behavior and irritation of participants attending the sleep coaching (n = 24) and participants attending other courses offered in the WHP program (n = 24) were assessed before and after the intervention.

Results

Participants attending the sleep coaching had a significant increase in well-being, self-care behavior and self-care awareness and a significant decrease in their irritation score after attending the sleep coaching. In the control group, no significant change in the dependent variables was observed; furthermore, participants’ evaluation of the sleep coaching was positive on both affective reactions and utility judgements.

Conclusions

Results show that the sleep coaching intervention evaluated is practically feasible and able to improve important indicators of employees’ well-being and self-care in WHP programs.

     

Gezielte individuelle Förderung von 3- bis 6-Jährigen

Background:

School entry examinations in Mecklenburg-Western Pomerania (MWP), Germany, show prevalence rates of motor, linguistic or social developmental delays in up to 17.6 % of children. These delays act unfavourably on a successful start in school (http://www.regierung-mv.de).The early detection of developmental risks in 3–6-year-olds is regulated by an amendment of the law on preschools (KiföG M-V) since 2010. As regulated in this law, preschools receive additional financial resources to implement measures of targeted individualized promotion of 3- to 6-year-old children with developmental risks.

Objectives:

In the following study the specific use and suitability of these additional financial resources was analysed.

Methods:

108 preschools received a semi-standardised questionnaire. Data collection was focused on additional measures of targeted individualized promotion and the volume and respective use of additional financial resources spent for these.

Results:

104 preschools responded to the questionnaire (response rate: 96.3 %). In 2012 these preschools received on average 36,643 € for the targeted individualized promotion. 79.8 % (n = 83) of the preschools used the money for additional personnel. Predominantly (89.2 %) state-certified educators without specific qualifications were hired. Between 12 and 15 preschools (11.5 to 14.4 %) perform structured programs for promoting motor skills, language, social skills and health, respectively.

Conclusions:

Despite additional financial resources measures of targeted individualized promotion seem to be unspecific and do not differ from already implemented activities in the preschools. Additional funds were mostly used to relieve the pedagogical staff. Educator’s access to evidence based programs seems to be limited.     

Psychometric evaluation of the hepatitis C virus patient-reported outcomes (HCV-PRO) instrument: validity,responsiveness, and identification of the minimally important difference in a phase 2 clinical trial

Purpose

To describe the psychometric properties and identify the minimally important difference (MID) of the hepatitis C virus patient-reported outcomes (HCV-PRO) instrument. Chronic HCV infection and associated treatments negatively affect PROs of function and well-being.

Methods

In a phase 2 trial, HCV-infected patients received direct-acting antivirals (DAAs) for 12 weeks with peg-interferon/ribavirin (peg-IFN/RBV) for 48 weeks, or placebo plus peg-IFN/RBV. The HCV-PRO total score, SF-36 PCS and MCS scores, EQ-5D-3L, and EQ VAS were measured at baseline, week 8, end of DAA treatment (EODT), end of peg-IFN/RBV treatment (EOT), and posttreatment week 24 (SVR₂₄). Convergent validity of the HCV-PRO was assessed by Pearson’s correlation coefficients. Discriminant validity was assessed by analyzing mean HCV-PRO total scores by EQ-5D anxiety/depression and pain/discomfort domain scores (none vs. some) and presence/absence of depression or fatigue adverse events. MID was identified through effect size (ES) and receiver-operating characteristic (ROC) curve analyses (HCV-PRO response vs. SF-36 PCS/MCS and EQ VAS MID thresholds).

Results

In 74 patients (22 % female; 81 % White; 51 % ≥50 years), correlations (0.64–0.96) between HCV-PRO total scores, SF-36 PCS/MCS scores, and EQ VAS scores at all time points supported convergent validity. HCV-PRO total scores were reduced to 10–30 points in patients impaired by depression, pain, or fatigue symptoms. Impact of peg-IFN/RBV regimen on HCV-PRO ES increased over time (EODT ?0.76; EOT ?0.93). ES and ROC curve analyses indicated an MID of ?10 points.

Conclusion

The HCV-PRO was valid and responsive in the population studied. An MID of ?10 points represented a threshold of clinical significance for the HCV-PRO.     

Positive muscle protein net balance and differential regulation of atrogene expression after resistance exercise and milk protein supplementation

Purpose

Resistance exercise and amino acid availability are positive regulators of muscle protein net balance (NB). However, anabolic responses to resistance exercise and protein supplementation deserve further elucidation. The purpose was to compare intakes of whey, caseinate (both: 0.30 g/kg lean body mass), or a non-caloric control after heavy resistance exercise on protein turnover and mRNA expressions of forkhead homeobox type O (FOXO) isoforms, muscle RING finger 1 (MuRF1), and Atrogin1 in young healthy males.

Methods

Protein turnover was determined by stable isotope-labeled leucine and femoral arteriovenous blood samples at rest and during 6-h recovery. Muscle biopsies were collected at ?60 min (rest) and at 60, 210, and 360 min in the recovery period.

Results

During recovery, leucine NB was significantly higher in the protein groups compared to control (P < 0.001). Differences in leucine NB, rate of disappearance, and oxidation were observed in the early recovery period between whey and caseinate. FOXO1A and MuRF1 were upregulated at 60 and 210 min, and, in contrast, FOXO3 and Atrogin1 were downregulated at 210 and 360 min. For leucine rate of appearance and all FOXO and atrogene mRNA expressions, no differences were observed between groups.

Conclusions

Whey and caseinate were equally superior to control in the 6-h recovery period and displayed temporal differences with whey having a fast and superior effect in the early part of the recovery period. Effects on mRNA expressions indicate different regulatory mechanisms on the ubiquitin ligases MuRF1 and Atrogin1 in recovery from heavy resistance exercise.     

Differing lifecourse associations with sport-, occupational- and household-based physical activity at age 49–51 years: the Newcastle Thousand Families Study

Objectives

We investigated the contributions of a range of factors from across life to variations in physical activity within the Newcastle Thousand Family’s birth cohort.

Methods

At age 49–51 years, 574 study members returned questionnaires, including details of physical activity (occupational, commuting, household and sport). Factor analysis of activity types produced two retained factor scores, ‘sport’ and ‘other physical activity’, analysed by path analysis.

Results

More advantaged current social class, higher education level and not smoking were associated with increased sport activity, but not ‘other physical activity’. Males had higher levels of occupational and lower levels of household activity than females. Smokers had increased work activity. Long-term illness was associated with lower activity across all types. Current social class and smoking showed the highest relative contribution for ‘sport’ and long-term illness for ‘other physical activity’.

Conclusion

Increasing activity in adults requires better understanding what the barriers to maintaining or taking on new levels of physical activity are, and long-term strategies and public health interventions need to be developed to engage adults in interesting, affordable and available activities.     

Work hours and cortisol variation from non-working to working days

Purpose

This study aims at modelling the relationship between the number of work hours per week and cortisol variation across 3 days by comparing non-working day to working day in a population of day-shift workers.

Methods

Questionnaire data and saliva samples for cortisol analysis were collected on 132 day-shift workers employed in 13 workplaces in Canada. Consenting workers provided 5 saliva samples a day (awaking, 30 min after awaking, 2 p.m., 4 p.m., bedtime) repeated 3 times (Saturday, Tuesday, Thursday) over a week, to provide measures at work and non-work times and settings. Multilevel regression models were estimated from cortisol measurements at each occasion within a day at level-1, days at level-2 and workers at level-3.

Results

Controlling for gender and age, results revealed significant variations in salivary cortisol concentration between sample, day and worker levels. Cortisol increases linearly from non-working day to work days and work hours per week interacted with days, revealing a positive association between the number of work hours per week and cortisol concentrations during these days. Work hours per week did not interact with awaking, 30 min after awaking, 2 p.m., 4 p.m., and bedtime cortisol concentrations. Gender and age had neither main effects nor interaction effects. No significant cortisol variations were found between workplaces.

Conclusion

These results suggest that work hours act as a stressor that is associated with significant variations in cortisol concentrations over working days. Non-working days may contribute to stress reduction in workers who experience longer work hours.