Fatigue rating scales: an empirical comparison

BACKGROUND: There has been limited research comparing the efficacy of different fatigue rating scales for use with individuals with chronic fatigue syndrome (CFS). This investigation explored relationships between two commonly-used fatigue rating scales in CFS research, the Fatigue Scale and the Fatigue Severity Scale. Theoretically, these scales have been described as measuring different aspects of the fatigue construct. The Fatigue Scale was developed as a measure of the severity of specific fatigue-related symptoms, while the Fatigue Severity Scale was designed to assess functional outcomes related to fatigue. METHODS: Associations of these scales with the eight definitional symptoms of CFS and with eight domains of functional disability were examined separately in: (1) an overall sample of individuals with a wide range of fatigue severity and symptomatology; (2) a subsample of individuals with CFS-like symptomatology, and, (3) a subsample of healthy controls. RESULTS: Findings revealed that both scales are appropriate and useful measures of fatigue-related symptomatology and disability within a general population of individuals with varying levels of fatigue. However, the Fatigue Severity Scale appears to represent a more accurate and comprehensive measure of fatigue-related severity, symptomatology, and functional disability for individuals with CFS-like symptomatology.     

Psychological distress and somatisation as prognostic factors in patients with musculoskeletal illness in general practice.

BACKGROUND: Musculoskeletal illness is a common cause of absenteeism from work, workers' compensation, and disability retirement, and accounts for 9.3% to 17% of patient contacts in general practice. To understand the increase in self-reported musculoskeletal illness and to improve treatment and prevention, it is important to know which factors to target when dealing with these patients. AIM: To investigate whether the prognosis for patients with musculoskeletal illness referred to physiotherapy from general practice can be predicted by the presence of psychological distress and somatisation identified by a general practitioner (GP) and standard questionnaires. METHOD: A multi-practice survey based on questionnaires (index and three-month follow-up). Nine hundred and five consecutive patients referred to physiotherapy from 124 different general practices in Denmark were included. Outcome measures were physical health change, sick leave, patient self-rated improvement, and change in use of medication. RESULTS: Psychological distress and somatisation rated by both GPs and standard questionnaires acted with almost no exception as significant predictors of all four outcome measures. CONCLUSION: Psychological distress and somatisation are important factors when considering preventive initiatives and treatment of patients with musculoskeletal illness in general practice.     

Psychological distress and visual functioning in relation to vision‐related disability in older individuals with cataracts

Objective. To determine whether demographic, health status and psychological functioning measures, in addition to impaired visual acuity, are related to vision‐related disability. Methods. Participants were 105 individuals (mean age = 73.7 years) with cataracts requiring surgery and corrected visual acuity in the better eye of 6/24 to 6/36 were recruited from waiting lists at three public out‐patient ophthalmology clinics. Visual disability was measured with the Visual Functioning‐14 survey. Visual acuity was assessed using better and worse eye logMAR scores and the Melbourne Edge Test (MET) for edge contrast sensitivity. Data relating to demographic information, depression, anxiety and stress, health care and medication use and numbers of co‐morbid conditions were obtained. Results. Principal component analysis revealed four meaningful factors that accounted for 75% of the variance in visual disability: recreational activities, reading and fine work, activities of daily living and driving behaviour. Multiple regression analyses determined that visual acuity variables were the only significant predictors of overall vision‐related functioning and difficulties with reading and fine work. For the remaining visual disability domains, non‐visual factors were also significant predictors. Difficulties with recreational activities were predicted by stress, as well as worse eye visual acuity, and difficulties with activities of daily living were associated with self‐reported health status, age and depression as well as MET contrast scores. Driving behaviour was associated with sex (with fewer women driving), depression, anxiety and stress scores, and MET contrast scores. Conclusion. Vision‐related disability is common in older individuals with cataracts. In addition to visual acuity, demographic, psychological and health status factors influence the severity of vision‐related disability, affecting recreational activities, activities of daily living and driving.     

Sick leave and its determinants in professional soldiers of the Slovenian Armed Forces

Aim

To assess whether demographic characteristics, self-rated health status, coping behaviors, satisfaction with important interpersonal relationships, financial situation, and current overall quality of life are determinants of sick leave duration in professional soldiers of the Slovenian Armed Forces.

Methods

In 2008, 448 military personnel on active duty in the Slovenian Armed Forces were invited to participate in the study and 390 returned the completed questionnaires (response rate 87%). The questionnaires used were the self-rated health scale, sick leave scale, life satisfaction scale, Folkman-Lazarus'' Ways of Coping Questionnaire, and a demographic data questionnaire. To partition the variance across a wide variety of indicators of participants’ experiences, ordinal modeling procedures were used.

Results

A multivariate ordinal regression model, explaining 24% of sick leave variance, showed that the following variables significantly predicted longer sick leave duration: female sex (estimate, 1.185; 95% confidence interval [CI], 0.579-1.791), poorer self-rated health (estimate, 3.243; 95% CI, 1.755-4.731), lower satisfaction with relationships with coworkers (estimate, 1.333; 95% CI, 0.399-2.267), and lower education (estimate, 1.577; 95% CI, 0.717-2.436). The impact of age and coping mechanisms was not significant.

Conclusion

Longer sick leave duration was found in women and respondents less satisfied with their relationships with coworkers, and these are the groups to which special attention should be awarded when planning supervision, work procedures, and gender equality policy of the Armed Forces. A good way of increasing the quality of interpersonal relationships at work would be to teach such skills in teaching programs for commanding officers.Self-rated health represents a person''s comprehensive and subjective assessment of his or her health, which incorporates the subjective feeling of health together with biological, psychological, and socio-economic dimensions (1,2), any present illness, symptoms, and the functional status (3). The term is frequently used in population research and social epidemiology as an indicator of a typical health behavior of the individual (4,5). Self-rated health is associated with physical fitness (3) and predicts morbidity and mortality (6-11).In middle-aged healthy individuals, self-rated health has several predictors: physical and psycho-social working conditions (12), economic situation, psychological status, and lifestyle (13). Among work-related factors the most important is stress, which has been shown to increase the likelihood of taking a sick leave (14-17). It has also been shown that the number of days of sick leave increased as self-reported health decreased (13,18). Sick leave duration has been found to have a negative correlation with self-rated health even over a period of 10 years (19).In Sweden, long-term sick leave (>90 days) was taken mostly by women in the public sector, and it was caused by depression-related illness and work-related stress (20). However, the impact of job-related stress as a reason for disability remains unexplained. It is unclear whether this impairment is a result of prolonged stress exposure or a pre-existing susceptibility factor. In a study of white-collar workers’ absenteeism, there was no association between employee’s psychological distress, type of employee, and productivity (21). However, in blue-collar workers high psychological distress resulted in an 18% increase in absenteeism rates (21). A study of 54 264 full-time employees from different levels of the corporate hierarchy showed that elevated psychological distress was associated with increasing absenteeism (22).Subjective health assessment is a valid health status indicator for middle-aged people (23) and can be used to study the relationship between stress, burnout, and organizational conditions at work. The validity of self-rated health can be confirmed by objective assessment methods, for example, by the number of visits to the physician, absenteeism from work, and mortality. In 2008, Erikksson analyzed the connection between sick leave and self-rated health in the Swedish population using the EQ-5D Questionnaire for Health Assessment (24).In Slovenia, only one epidemiological study on self-rated health was conducted, and it studied the factors leading to poor health ratings (25). Only a few studies have assessed the effects of threats, fears, or various other psychological difficulties on subjective health, and these have shown that subjective health was influenced by perceived threat and stress, a source of which can also be a chronic illness (26).In our previous study, we explored key psychological factors in the members of the Slovenian armed forces who reported poorer bio-psycho-social well-being and more burnout, and therefore had reduced working effectiveness and motivation (27). The present analysis specifically analyzed the predicting factors of absence from work due to illness in professional soldiers of the Slovenian Armed Forces.     

Association of Physical Activity and Sitting Time with Overweight/Obesity in Chinese Occupational Populations

AbstractThe aim of this study was to explore association of physical activity and sitting time with overweight/obesity in Chinese occupational populations for the development of intervention and prevention strategies for obesity.MethodsA total of 23,112 participants were selected from the 2010–2012 China National Nutrition and Health Survey (CNNHS). A logistics regression model was used to examine the associations of physical activity and sitting time with overweight/obesity by gender after adjusting for age, educational level, marital status, and family economic level.ResultsThe prevalence of overweight/obesity based on the WHO definition and the WGOC definition was 30.8% and 41.3%, respectively. Male employees with moderate and heavy occupation activity intensity had a lower risk for overweight/obesity than those with light occupation activity intensity (moderate: OR 0.90, 95% CI 0.82–0.98; heavy: OR 0.75, 95% CI 0.65–0.86), and the risk of overweight/obesity of male employees with long work-time spent sitting was higher than those with short work-time spent sitting (2–4.9 h/day: OR 1.26, 95% CI 1.14–1.40; ≥5 h/day: OR 1.29, 95% CI 1.15–1.44). The risk of overweight/obesity of male employees with active transportation mode was lower than those with inactive transportation mode (OR 0.91, 95% CI 0.84–0.99), while the risk of overweight/obesity of female employees with active transportation mode was higher (OR 1.14, 95% CI 1.04–1.25). Female employees with leisure-time physical activity (LTPA) for ≥150 min/week had lower risk of overweight/obesity than those with LTPA for <150 min/week (OR 0.69, 95% CI 0.56–0.84). There was no significant association of leisure-time sitting and housework time with overweight/obesity in Chinese occupational populations.ConclusionOccupation activity intensity, LTPA, transportation mode, and work sitting time were associated with overweight/obesity. Reducing work sitting time, moderate and heavy occupation activity intensity, and an active transportation mode could help male employees decrease the risk of overweight/obesity. Increasing leisure-time physical activity could reduce the risk of overweight/obesity in women. Our findings provided insight into the association of physical activity and sitting time with overweight/obesity. It will be necessary to carry out workplace-based interventions, have an active transportation mode, and increase leisure-time physical activity to decrease the risks of overweight/obesity.     

Impact and correlates of poor sleep quality in Japanese white-collar employees

STUDY OBJECTIVES: This study estimated the prevalence, examined associated impacts, and identified correlated factors of poor sleep quality among Japanese white-collar employees who were working in a labor market that included extensive downsizing and restructuring. DESIGN: A cross-sectional self-administered questionnaire survey was conducted as part of 2 consecutive studies on sleep. Sleep quality was measured with the Pittsburgh Sleep Quality Index. SETTING: A telecommunications company in the Tokyo metropolitan area. PARTICIPANTS: Of 5,924 workers, 5,090 responded (85.9%). Results from 4,868 daytime employees were analyzed. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The 1-month point prevalence of poor sleep quality was approximately 30% to 45% across age and gender and was significantly higher than in the general population of Japanese adults. The overall prevalence of absenteeism, poor physical and psychological health, problems in work performance and personal relationships, and accidents were 16.5%, 18.3%, 17.3%, 2.5%, 2.1%, and 1.8%, respectively. Poor sleepers were more likely to take sick leave, suffer from poor physical and psychological health, and have problems in occupational activities and personal relationships. The most strongly associated factor underlying poor sleep quality was perceived stress, followed by job dissatisfaction, being unmarried, poor bedroom environment, lower academic attainment, younger age, and hypertension. CONCLUSIONS: This study suggests that the cost related to poor sleep quality is extremely high. Comprehensive countermeasures against poor sleep quality at not only the individual, but also the organizational and societal levels, need to be considered for both employees and employers in order that health, safety, and productivity are ensured.     

Prognostic Factors and Treatment-Related Changes Associated with Return to Work in the Multimodal Treatment of Chronic Back Pain

The goals of the current study were to determine those preprogram (=prognostic) variables and treatment-related changes that predict return to work in the multimodal management of chronic back pain. The outcome measures for 143 patients at 6-month follow-up were analyzed. The program had a duration of 4 weeks, was based largely on the functional restoration approach (Mayer and Gatchel, 1998), and occurred within a workers' compensation framework. Some 87% of the patients successfully returned to work. Three sets of predictor variables were considered: demographic/socioeconomic data, physical measures, and psychological measures. Three prognostic variables proved to be significant negative predictors of return to work: time off work, previous spinal surgery, and a clinically elevated (preprogram) score on the MMPI-2 scale Lassitude-Malaise (Hy3). A repeated-measures MANOVA showed an incomplete return to work to be associated with only limited improvement in self-reported disability and pain report. However, patients who failed to return to work did not differ with regard to improvement in objective physical functioning or psychological distress. It is therefore hypothesized that a change in the perceived disability status is the key element necessary to return patients with chronic back pain to work, although ongoing reinforcement schemes operative in the home work environment may lead to a relapse in the post treatment phase.     

Psychosocial work characteristics as risk factors for the onset of fatigue and psychological distress: prospective results from the Maastricht Cohort Study

BACKGROUND: Prolonged fatigue has recently attracted attention in occupational (mental) health research since it may lead to sickness absenteeism and work disability. To date, little is known about the role of psychosocial work characteristics in the aetiology of fatigue. In this study we examined prospectively a wide range of psychosocial work characteristics as possible risk factors for the onset of fatigue and psychological distress in the working population. METHODS: This study is based on 8833 employees, participating in the Maastricht Cohort Study of 'Fatigue at Work'. A wide range of psychosocial work characteristics, measured at baseline, was used to predict the onset of fatigue and psychological distress 1 year later. Fatigue was measured with the Checklist Individual Strength; the General Health Questionnaire was used to measure psychological distress. RESULTS: The cumulative incidence of fatigue during 1 year follow-up was 9.7% (N = 492) in men, and 13.5% (N = 241) in women. Psychological demands at work as well as physical and emotional demands increased the risk for fatigue in men, whereas decision latitude in men and co-worker social support in women were protective against fatigue. These prospective associations remained significant after adjustments for potential confounders and baseline fatigue. As regards psychological distress, no association was found with decision latitude, while conflicts at work increased the risk of psychological distress. CONCLUSIONS: Psychosocial work characteristics were significant predictors for the onset of fatigue in the working population. The prospective associations suggest some differential effects in the aetiology of fatigue and psychological distress. Good interpersonal relationships at work and high decision authority were demonstrated to be relevant aspects that should be targeted for prevention.     

Sleep disturbances as a predictor of cause-specific work disability and delayed return to work

Study Objective:

To examine sleep disturbances as a predictor of cause-specific work disability and delayed return to work.

Design:

Prospective observational cohort study linking survey data on sleep disturbances with records of work disability (≥ 90 days sickness absence, disability pension, or death) obtained from national registers.

Setting:

Public sector employees in Finland.

Participants:

56,732 participants (mean age 44.4 years, 80% female), who were at work and free of work disability at the study inception.

Measurements and Results:

During a mean follow-up of 3.3 years, incident diagnosis-specific work disability was observed in 4,028 (7%) employees. Of those, 2,347 (60%) returned to work. Sleep disturbances 5-7 nights per week predicted work disability due to mental disorders (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.3-1.9) and diseases of the circulatory system (HR = 1.6, 95% CI 1.2-2.1), musculoskeletal system (HR = 1.6, 95% CI 1.4-1.8) and nervous system (HR = 1.5, 95% CI 1.0-2.2), and injuries and poisonings (HR = 1.6, 95% CI 1.2-2.1) after controlling for baseline age, sex, socioeconomic status, night/shift work, health behaviors (e.g., smoking, exercise), diagnosed somatic diseases, use of pain killers, depression, and anxiety. In addition, sleep disturbances prior to disability were associated with higher likelihood of not returning to work after work disability from musculoskeletal diseases (HR = 1.2, 95% CI 1.1-1.7) and, in men, after work disability due to mental disorders (HR = 4.4, 95% CI 1.7-11.1).

Conclusions:

Sleep disturbances are associated with increased risk for subsequent disabling mental disorders and various physical illnesses. They also predict the outcome of work disability due to musculoskeletal disorders.

Citation:

Salo P; Oksanen T; Sivertsen B; Hall M; Pentti J; Virtanen M; Vahtera J; Kivimäki M. Sleep disturbances as a predictor of cause-specific work disability and delayed return to work. SLEEP 2010;33(10):1323-1331.     

Mental disorders in medical inpatients and the association to severity of illness, self-rated physical disability, and health perception

In a study of 294 consecutive medical inpatients, the authors assessed a subsample of 157 patients for psychiatric diagnoses using an extensive semistructured interview, Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Patients rated their health and physical functioning, and medical consultants assessed them for chronic and life-threatening diseases. A life-threatening condition increased odds for having a psychiatric diagnosis by 3.1 times (95% Confidence Interval (CI): 1.03-9.1), while a chronic medical disease had no such impact (OR=1.1; 95% CI: 0.5-2.3). In women, mental disorders were strongly associated with self-rated disability (OR=6.7; 95% CI: 1.6-27.8) and self-rated health (OR=9.4; 95% CI: 2.7-32.4). This association was absent in men (OR(disability)=0.7; 95% CI: 0.2-2.7; OR(health)=1.6; 95% CI: 0.6-4.7). Analyses included adjustment for age and gender.     

Predictors of outcome in a fatigued population in primary care following a randomized controlled trial

BACKGROUND: The objective of this study was to examine factors that predicted outcome in a chronically fatigued group of patients who were randomized to cognitive behaviour therapy or counselling in primary care. METHOD: Illness perceptions, attributions, fatigue, disability and demographic variables were recorded at assessment and levels of fatigue and disability were measured at 6 months post randomization. Logistic regression was used to examine associations. RESULTS: Factors that predicted a poor outcome (four or more on the fatigue questionnaire) were: poor social adjustment at assessment; the patients self-report that they had never seen the GP for an emotional reason; a physical illness attribution; and, a long perceived future illness duration. CONCLUSIONS: Patients who are more psychologically minded are more likely to improve with psychological treatments in primary care. General practitioners need to assess this before referring to an appropriate therapist.     

The relations between psychosocial factors at work and health status among workers in home care organizations

A considerable proportion of sickness absence and disability pension is caused by subjective health complaints, especially low back pain (LBP). In recent years focus has been on psychosocial characteristics of work as potential risk factors. The aim of this study is to examine the relations between psychosocial work aspects and subjective health complaints, LBP, and need for recovery. A total of 779 employees working in home care participated in a cross-sectional study. Higher psychological demands were associated with subjective health complaints and need for recovery. However, decision authority, skill discretion, and the 2 aspects of social support did not seem to be important factors. Higher psychological demands do not seem to be associated with severity of LBP, but does show an association with sick leave. This study was performed by Hege R. Eriksen while pursuing her MSc in Epidemiology at The Netherlands Institute for Health Sciences in Rotterdam, The Netherlands. We want to thank Linda Sandal and Nina Konglevoll for technical assistance.     

Job strain, job insecurity, and health: rethinking the relationship

Job strain (high demands and low control) is a widely used measure of work stress. The authors introduce a new way of looking at work stress by combining job strain with job insecurity, a combination increasingly prevalent in contemporary economies, using data from a cross-sectional survey (N = 1,188) of mid-aged Australian managers and professionals. Those reporting both strain and insecurity showed markedly higher odds for mental and physical health problems (depression: odds ratio [OR] 13.88, 95% confidence interval [CI] 5.67-34.01; anxiety: OR 12.88, CI 5.12-32.39; physical health problems: OR 3.97, CI 1.72-9.16; and poor self-rated health: OR 7.12, CI 2.81-18.01). Job strain and insecurity showed synergistic associations with health, and employees experiencing both could be at heightened health risk.     

Work-family characteristics as determinants of sickness absence: a large-scale cohort study of three occupational grades

This study examined the previously unexplored occupational grade-specific relationships of domestic responsibilities, the age of children, and work-family spillover, with registered sickness absence (>3 days' sick leave episodes, a mean follow-up of 17 months; n = 18,366 municipal employees; 76% women). The results showed that negative spillover from work into family life predicted a heightened rate of sickness absence spells among both women and men in all occupational categories (except upper white-collar men), but especially among blue-collar and lower white-collar employees. Furthermore, among all white-collar employees (except upper white-collar men), having young children (<7 years of age) was predictive of an increased absence rate. Bearing the main responsibility for domestic work did not considerably predict sickness absenteeism in any occupational grade. The authors conclude that some specific work-family characteristics play a role in sickness absence, but their impact on sickness absence partly varies according to gender and occupational grade.     

Chronic fatigue syndrome and related disorders in UK veterans of the Gulf War 1990-1991: results from a two-phase cohort study

BACKGROUND: The aim was to determine the prevalence of chronic fatigue syndrome (CFS), chronic fatigue and fibromyalgia in UK military personnel after the Gulf War 1990-1991. METHOD: A two-phase cohort study was used. Three randomly selected subsamples identified from a population-based cross-sectional postal survey of over 10,000 current and ex-service UK military personnel (Gulf veterans were those deployed to the Gulf War 1990-1991; non-Gulf veterans were Bosnia peacekeepers 1992-1997 and those on active duty during the Gulf War 1990-1991 but not deployed) were recruited. Their disability status was assessed using the Short Form 36 physical functioning scale; Gulf veterans who reported physical disability (n=111) were compared with non-Gulf (n=133) veterans who reported similar levels of physical disability. Screening for known medical and psychiatric conditions was conducted to exclude medical explanations for disability and symptomatic distress. Standardised criteria for CFS, chronic fatigue and fibromyalgia were used. RESULTS: Disabled Gulf veterans were more likely to be overweight, have elevated gamma-glutamyl transferase levels and screen positive for hypertension. There were no other clinically significant differences in clinical markers for medically explainable conditions. Disabled Gulf veterans were more likely than similarly disabled Bosnia and Era veterans (adjusted odds ratio 7.8, 95% confidence interval 2.5-24.5) to meet the criteria for CFS. Rates for other medically unexplained conditions were not significantly increased. CONCLUSIONS: Symptoms in keeping with CFS account for a significant part of the symptomatic distress in Gulf veterans.     

Sickness absence as an interactive process: gendered experiences of young, highly educated women with mental health problems

Objective

Highly educated Dutch women experience more work related mental health disability than their male counterparts, and yet little is known regarding the process. Using the theory of symbolic interactionism, we examined how women interpret their roles at work, during sick leave, and upon their return to work.

Methods

Semi-structured interviews focusing on role perceptions and interactions with other actors were conducted with 13 women (aged 29–41 years) on sick leave or off work for periods ranging from half a year to 8 years.

Results

The women worked overtime because of workaholism, or to meet supervisors’ expectations. This led to mental health problems and social isolation. Taking sick leave aided recovery, but further isolated the women. Insufficient support from the workplace and social insurance professionals intensified negative feelings. Psychological counselling provided alternatives whereby work and private roles could become more balanced. However, their reintegration into the workplace failed because the women could not implement these strategies when the organizational culture failed to change.

Conclusions

A long lead-up time preceded sickness absence and sick leave allowed for recovery and value adjustment. However, a variety of interpretations reinforced the women's individualized focus, thereby hampering their successful reintegration.

Practice implications

Given the importance of implementing effective sick leave prevention measures in the workplace, psychological treatment should focus on women's interactions with their work environment.     

Insomnia and long sleep duration are risk factors for later work disability. The Hordaland Health Study

Both insomnia and sleep duration have previously been linked with a range of adverse outcomes, but no studies have explored their relative effect on subsequent work disability. The aim of the present study was to investigate the contribution of insomnia versus sleep duration to later long-term work disability. Using a historical cohort design with 4-year follow-up, data on insomnia, sleep duration and potential confounders were gathered from 6599 working persons (40–45 years). The outcome was award of disability pension, as registered in the National Insurance Administration. After controlling for baseline exposure to disability and sick leave, insomnia was a strong predictor of permanent work disability [odds ratio (OR) = 4.56], and this effect remained significant after controlling for sleep duration, as well as for other possible confounders (OR = 1.88). Short sleep duration was not significantly associated with subsequent work disability, while long sleep duration (>8.5 h) did predict work disability (OR = 2.96), also in the fully adjusted model (OR = 2.14).The present study demonstrates that both insomnia and long sleep duration are strong and independent risk factors for subsequent work disability.     

Sleep physiology in recovery from burnout

This study aimed to investigate the role of sleep physiology in recovery from burnout, in particular the relation between sleep and changes in fatigue and whether those changes would be related to return to work.23 white-collar workers on long-term sick leave (>3 months) due to a burnout related diagnosis and 16 healthy controls were subjected to polysomnographic recordings at baseline and after 6-12 months’ rehabilitation. Occupational status, subjective sleep quality, fatigue, anxiety and depression were assessed. Recovery from burnout was accompanied by improved sleep continuity. Significant interaction effects were seen for number of arousals, sleep fragmentation, sleep latency, sleep efficiency and time of rising. The burnout group improved significantly on all symptom variables although the post-treatment levels did not reach the levels of the controls. Recovery from fatigue was related to a reduction of the arousal from sleep and was the best predictor of return to work.     

Predictors of nonadherence to single-dose nevirapine therapy for the prevention of mother-to-child HIV transmission

BACKGROUND: Adequate adherence is required for prevention of mother-to-child transmission of HIV (pMTCT) programs to be effective. We investigated predictors and extent of nonadherence to single-dose nevirapine. METHODS: Data on nevirapine intake and possible predictors were collected among 760 HIV-positive women with liveborn babies enrolled in a study in Lusaka, Zambia. RESULTS: Most (94%) women took nevirapine before delivery, and most (91%) newborns received it soon after delivery. Maternal nonadherence was associated with home births (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.3 to 7.4), no high school education (OR: 2.4; 95% CI: 1.1 to 5.3), and low newborn birth weight (OR: 4.6; 95% CI: 1.3 to 20.1). Disclosure of HIV status and couples counseling was only associated with adherence among home births. Failure to administer nevirapine to the newborn was associated with birth at the tertiary hospital (OR: 7.2; 95% CI: 3.7 to 13.8), lower 5-minute Apgar scores (OR: 0.5; 95% CI: 0.4 to 0.7), and neonatal death (OR: 5.8; 95% CI: 2.0 to 16.3). CONCLUSIONS: Excellent adherence to single-dose nevirapine for pMTCT can be achieved. Nonadherence seems to be affected by place of birth and by poor health status of the newborn. Procedures to ensure that viable yet ill neonates receive nevirapine should be part of clinical protocols and training within pMTCT programs.     

Sleep complaints in middle‐aged women and men: the contribution of working conditions and work–family conflicts

This study aimed to examine how physical working conditions, psychosocial working conditions and work–family conflicts are associated with sleep complaints, and whether health behaviours explain these associations. We used pooled postal questionnaire surveys collected in 2001–2002 among 40–60‐year‐old employees of the City of Helsinki (n = 5819, response rate 66%). Participants were classified as having sleep complaints if they reported sleep complaints at least once a week on average (24% of women and 20% of men). Independent variables included environmental work exposures, physical workload, computer work, Karasek’s job strain and work–family conflicts. Age, marital status, occupational class, work arrangements, health behaviours and obesity were adjusted for. Most working conditions were associated strongly with sleep complaints after adjustment for age only. After adjustment for work–family conflicts, the associations somewhat attenuated. Work–family conflicts were also associated strongly with women’s [odds ratio (OR) 5.90; confidence interval (CI) 4.16–8.38] and men’s sleep (OR 2.56; CI 1.34–4.87). The associations remained robust even after controlling for unhealthy behaviours, obesity, health status, depression and medications. Physically strenuous working conditions, psychosocial job strain and work–family conflicts may increase sleep complaints. Efforts to support employees to cope with psychosocial stress and reach a better balance between paid work and family life might reduce sleep complaints. Sleep complaints need to be taken into account in worksite health promotion and occupational health care in order to reduce the burden of poor sleep.