When are the physiological reactions unhealthy? Helene Garde National Research Centre for the Working Environment

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1 When are the physiological reactions unhealthy? Helene Garde National Research Centre for the Working Environment

2 Model Exposure Effect Biological response

3 Models for health risk Cognitive activation theory Homeostatis/Allostasis Lack of restitution Shift of rhythms Stress-disequilibrium theory (Not included)

4 CATS The stress response: A general alarm in a homeostatic system, producing general and unspecific neurophysiological activation from one level of arousal to more arousal. Occurs if something is missing, if there is a threat, or if there is a discrepancy between what should be and what is. Essential and necessary physiological response, may lead to illness if sustained. Depends on acquired expectations of the outcomes of stimuli and available responses. Ursin & Eriksson, Psychoneuroendocrinology, 2004

Occurs if something is missing, if there is a threat, or if there is a discrepancy between what should be and what is.

5 CATS Load Brain Stress response(s) Stimulus expectation Consequence expectations of response Feedback

6 CATS Load Brain Stressresponse(s) Varying Constant Training Anabolic Strain Catabolic

7 Self-esteem og internal locus-ofcontrol Stressreaction (cortisol) in response to Trier Social Stress test Cortisol (mmol/l) High responders Low responders 5 0 Dag 1 Dag 2 Dag 3 Dag 4 Dag 5 = Stresspåvirkning Kirschbaum et al., Psychosom Med 1995; 57:

10 High responders Low responders 5 0 Dag 1 Dag 2 Dag 3 Dag 4 Dag 5

8 Self-esteem og internal locus-ofcontrol Stressreaction (cortisol) in response to Trier Social Stress test Cortisol (mmol/l) Dag 1 Dag 2 Dag 3 Dag 4 Dag 5 = Stresspåvirkning Kirschbaum et al., Psychosom Med 1995; 57:

Cortisol (mmol/l) 20 15 10 5 0 Dag 1 Dag 2 Dag 3 Dag 4 Dag 5

9 Self-esteem og internal locus-ofcontrol Stressreaction (cortisol) in response to Trier Social Stress test Cortisol (mmol/l) Dag 1 Dag 2 Dag 3 Dag 4 Dag 5 = Stresspåvirkning Kirschbaum et al., Psychosom Med 1995; 57:

10 Homeostatis The relative stability, despite environmental fluctuations, of those tissue parameters that are critical to cell survival, e.g. nutrient availability, oxygen avilability, temperature, ph, and ion concentrations. Cannon

11 Homeostatic processes or allostasis The ability to achieve stability through change. McEwen New England Journal of Medicine (1998)

12 Healthy response Exposure

13 Allostatic (or homeostatic) load The wear and tear that result from chronic overactivity or underactivity of allostatic systems McEwen New England Journal of Medicine (1998)

14 Size of response Exposure

15 Successful aging Systolic blood pressure (>148 mm Hg) Diastolic blood pressure (>83 mm Hg) Waist-hip ratio (>0.94) Total cholesterol-hdl ratio (>5.9) Total HbA 1c (>7.1%) Urinary cortisol (>25.7 mg/g creatinine) Urinary norepinephrine (>48 mg/g creatinine) Urinary epinephrine (>5 mg/g creatinine) HDL cholesterol (< 1.45 mmol/l) DHEA-S (<2.5 μmol/l) T.E. Seeman et al. (1997)

16 Successful aging New cardiovascular disease, % >=3 Allostatic load category T.E. Seeman et al. (1997)

17 Cortisol and memory No. of correctly recalled words Cortisol response (nmol/l) Kirschbaum et al. Life Sci. 1996

18 Cortisol and memory No. of recalled or completed words * 10 mg cortisol Placebo 0 Declarative memory Procedural memory Kirschbaum et al. Life Sci. 1996

19 Cortisol and memory 65 Immediate recall bits placebo 40 mg/d 160 mg/d Days Newcomer et al. Arch.Gen.Psychiatry 1999

20 Rate of recovery Exposure

21 Unwinding after work overload % of pre-overtime value of epinephrine Hours Weeks Extra working hours Daytime Evening Frankenhaueser and Johansson. Int.Rev.Appl.Psychol. (1986)

22 Reduced reactivity Stressor

23 Serum cortisol after stress test Serum cortisol (nmol/l) Stress test * *** *** Vilnius Linköping Base Minutes after stress test M. Kristensson et al. (1998)

24 Lack of variability High Flat Normal

25 Construction workers

26 Cortisol in saliva during a working day nmol cortisol/l saliva Reference group Construction workers - normal day Significantly higher concentration of Construction saliva workers cortisol - long day observed in construction workers compared to reference group. No difference was observed between construction workers having long and normal days :00 09:00 15:00 21:00 Time (hours) Hansen, 2006

27 Relative variability in salivary cortisol Construction workers Reference group P-value Long days Normal days CV (%) * CI (%) # [65-92] [91-108] CV (%) * CI (%) # [64-112] [57-95] [91-108] * Coefficient of variance # 95% Confidence interval Hansen, 2006

28 Restitution Catabolic metabolism Anabolic metabolism Demands Rest Demands

29 Restitution Catabolic metabolism Anabolic metabolism Demands Rest Demands

30 Outsourcing DHEA-S HbA 1c ** Cortisol * Noradrenaline Adrenaline Percent increase Netterstrøm et al. (2000)

31 Working hours and blood pressure Risc of increased blood pressure > 51 Weekly working hours Contolled for diabetes, tobacco, physical activty, SES, gender, age (n=24.205, år) Yang et al. 2006

32 Øresundsbron

33 Building the bridge between Sweden and Denmark 22 Testosterone (nmol/l) Pylon workers Controls Days Ørbæk et al. 2000

34 Øresundsbron 15 Exhaustion % of the day Dag Pylon workers Track workers Ørbæk et al. 2000

35 Total serum kolesterol A A Perceived stress Group A Friedman et al mg/100 ml plasma

36 Total serum kolesterol B A A and B B Perceived stress Group A Group B Friedman et al mg/100 ml plasma

37 Typical sleep Gerlach: Søvn, 2003

38 Hormones respond to sleep Sleep hormones: Growth hormone, prolactin and testosterone Thyroid hormone and adrenaline Cortisol during terminal sleep Hormones sleep: CRH reduces sleep quality Melatonin stimulates sleep

39 Stress and sleep Stress Need for increased effort Physiological arousal Sleep loss Increased cortisol and adrenaline Difficulties falling asleep

40 Sleep problems -> illness Increased risk of heart disease Review of 10 studies High quality studies found increased risk of coronary events after adjusting for age and other risk factors The combined risk was 1.7 (range ) Increased risk of diabetes 6599 non-diabetic men at baseline, aged 44.5 ± 4.0 years 281 (4.3%) developed diabetes during follow-up (14.8 years) Men with difficulties falling asleep or regular use of hypnotics had increased risk of 1.52 [95% CI: ] Schwarts S et al., J Psychosom Res, 1999 Nilsson PM et al., Diabetes Care, 2004

41 Sleep and heart disease A study of 71,617 American nurses followed for 10 years 2.5 RR Age-adjusted Adjusted for 14 factors Ayas et al. Arch Intern Med 2003;163: The Nurses Health Study

42 Ændring i søvn og død 4 3 Odds ratio for død 2 Stigning fra 5-6 timer Fald fra 6-8 timer Stigning fra 7-8 timer Reference (ingen ændring) 1 0 Alle typer Hjertekarsygdom Ikke-hjertekarsygdom Ferrie JE et al. Sleep (2007) 31:12:1659

43 Psychosocial work and sleep Increases sleep problems: High demands Low control Keep thinking of work Expect difficult workday Unsolved conflicts Unsolved problems Decreases sleep problems: Social support Kalimo et al., Stress Med, 2000 Åkerstedt et al., J Psychosom Res 53(1), 2002 Åkerstedt et al., J Psychosom Res 53(3), 2002 Kecklund et al., Biol Psychol, 2004

44 Shift of rhytms Fixed shift day 18 Fixed shift night 18 Extremely sleepy Sleepy Neither alert nor sleepy Alert μmol amt6/mol creatinine Very alert 06:00 12:00 18:00 24:00 Time KSS - workday KSS - day off 0 Melatonin - workday Melatonin - day off 06:00 12:00 18:00 24:00 Time Working hours 0 Hansen et al., 2006 Garde et al., unpublished data

45 Models for health risk Cognitive activation theory Allostatic load Lack of restitution Shift of rhythms Stress-disequilibrium theory (Not included)

Neuroscience Perspectives on Brain and Body Health. Importance of the Social Environment

{ Neuroscience Perspectives on Brain and Body Health Importance of the Social Environment Bruce S. McEwen, Ph.D. Alfred E. Mirsky Professor Head, Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology