Dan Hasson

Stress and prevalence of hearing problems in the Swedish working population

BackgroundCurrent human and experimental studies are indicating an association between stress and hearing problems; however potential risk factors have not been established. Hearing problems are projected to become among the top ten disabilities according to the WHO in the near future. Therefore a better understanding of the relationships between stress and hearing is warranted. Here we describe the prevalence of two common hearing problems, i.e. hearing complaints and tinnitus, in relation to different work-and health-related stressors.MethodsA total of 18,734 individuals were invited to participate in the study, out of which 9,756 (52%) enrolled.ResultsThe results demonstrate a clear and mostly linear relationship between higher prevalence of hearing problems (tinnitus or hearing loss or both) and different stressors, e.g. occupational, poorer self-rated health, long-term illness, poorer sleep quality, and higher burnout scores.ConclusionsThe present study unambiguously demonstrates associations between hearing problems and various stressors that have not been previously described for the auditory system. These findings will open new avenues for future investigations.

Prevalence and characteristics of hearing problems in a working and non-working Swedish population

Background Hearing problems are among the top 10 most common burdens of disease and are projected to be become even more common by the year 2030. The aim of the present study was to give a current assessment of the prevalence of communication difficulties because of hearing loss and tinnitus, in the general Swedish working and non-working populations in relation to sex, age, socioeconomic status (SES) and noise exposure. How prevalence is affected by SES has not been previously established. Methods A total of 18 734 individuals were invited to participate in the study, of which 11 441 (61%) enrolled. Of the participants, 9756 answered the questionnaire for those who work and 1685 answered the version for non-workers. Findings The most important findings are that 31% in the working population and 36% in the non-working population report either hearing loss or tinnitus or both. The prevalence of hearing problems increases with age, is higher among men and persons with low self-rated SES, and covaries with exposure to noise at work. Severe hearing problems are already present in men and women under 40 years of age who are exposed to work-related noise. Interpretation Prevalence of hearing problems is far more common than previously estimated and is associated with SES and noise exposure history. Hearing problems have a gradual onset that can take years to become recognised. In order to proactively intervene and prevent this deleterious, yet avoidable handicap, statistics need to be regularly updated.

Emotional Exhaustion as a Predictor of Tinnitus

Binaural hearing was tested using a tonal audiogram (500– 8,000 Hz) and speech-in-noise test using circumaural headphones (TDH39). ULL was measured in decibels hearing level at the frequencies 0.5, 1, 2 and 4 kHz in both left and right ears separately beginning at 70 dB and increasing the intensity in 5-dB steps until the study participant indicated uncomfortable loudness. Hearing status was defined as no hearing loss in tonal audiometry and speech-in-noise test (0). A hearing loss was 6 20 dB HL at any frequency in the tonal audiometry or 6 6 dB HL in the speech-in-noise test (1), threshold elevation of 6 20 dB HL at any frequency in the tonal audiometry and of 6 6 dB HL in the speechin-noise test (2). Exposure to noise at work was measured on a ratio scale by asking participants what proportion of time they were exposed to weary noise (from 0 = never to 6 = all or almost all the time). The outcomes were ‘any tinnitus’ and ‘severity of tinnitus’. Any tinnitus was defined as a ‘yes’ response (sometimes, often or always) to the question ‘Have you recently experienced a sound in one or both ears that was not from an external source (called tinnitus) which lasted for more than five minutes?’ Severity of tinnitus was the mean total score on the Tinnitus Handicap Questionnaire (THQ) comprising 26 questions [5] . It was slightly modified structurally as verbal rating scales were used instead of Likert scales. EE was assessed with the exhaustion subscale of the Oldenburg Burnout Inventory [6] . Coping was assessed using a modified version of Carver’s [7] brief COPE inventory. The overall prevalence of any tinnitus was 31% in our 348 participants, of whom 11% reported severe tinnitus. Gender-stratified analyses were conducted (n = 282, 66 missing values from any one of the variables). A logistic regression analysis was run with the dependent variable ‘tinnitus prevalence’ (yes/no) and ‘age’ (in years), ‘education’ (1–4), ‘sex’ (men/women), ‘hearing status’ in the left and right ears respectively (0–2), exposure to work-related noise (0–6), ULL (in dB), EE and coping as independent variables. All variables were included in one single step ( table 1 ). The analyses of men demonstrated that hearing loss, ULL, coping and EE were all significant predictors of tinnitus prevalence. The other variables were not significantly associated with tinnitus. The women exhibited a somewhat different pattern and significant predictors were hearing loss, noise at work, ULL and EE. In contrast to the men, coping was not a significant predictor of tinnitus prevalence. A linear regression was performed with THQ mean score as the dependent variable and age and education as covariates in a first step (enter). Hearing loss, ULL, work-related noise exposure and exhaustion were included as predictors in a second step (enter). The ANOVA was statistically significant (left ear: F = 3.67 df = 7 , p ! 0.01; right ear: F = 3.07 df = 7 , p ! 0.01) and the whole model explained 16% of the variance for the left ear and 13% for the right ear. The only significant predictors of the mean THQ score for the left ear were ULL (standardized = –0.20, p = 0.04) and exhausRecently, Hasson et al. [1] found strong and almost linear associations between self-reported hearing difficulties (no hearing problems, either tinnitus or hearing loss, or both) and stress factors. However, there is a need to have a better understanding of possible contributions of hearing, health and physical factors such as noise exposure to both the presence and severity of tinnitus. The aim of the present study was to assess possible associations between hearing status (hearing loss and noise exposure) and health (sleep quality, life satisfaction, depression and coping) in relation to tinnitus. We used uncomfortable loudness levels (ULL) as an objective measure of hyperacusis, which is a reduced sound tolerance and found in about 80% of individuals with tinnitus [2] . Emotional exhaustion (EE), the experience of feeling drained of energy due to prolonged stress, was included, for the first time, as a predictor for tinnitus. The present study is cross-sectional and includes subjective and objective measures of hearing, as well as subjective ratings of EE. A more complete description of the sample can be found in Benka Wallén et al. [3] . Briefly, the sample was drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) [4] . The sample of the present study was based on two types of inclusion criteria: (1) degree of EE and (2) living in the greater Stockholm area. The selection of participants was based on scorings on the exhaustion dimension on the Maslach Burnout Inventory – General Survey. The strategy chosen was to select contrasting groups with the highest exhaustion scores, medium EE and those with the lowest EE scores. The final cohort size was thus 671. After two reminders, 348 (52%) individuals enrolled in the study. All gave their written consent to participate and the study was approved by the local ethics committee in Stockholm (protocol No. 2009/493-31/3). Questionnaires were used to assess the participants’ general demographics, mental health (e.g., depressive symptoms, EE), hearing status (e.g., tinnitus, hearing loss), life satisfaction, sleep quality and coping. Received: June 15, 2011 Accepted after revision: November 13, 2011 Published online: August 1, 2012

Tinnitus Severity Is Reduced with Reduction of Depressive Mood - a Prospective Population Study in Sweden

Tinnitus, the perception of sound without external source, is a highly prevalent public health problem with about 8% of the population having frequently occurring tinnitus, and about 1–2% experiencing significant distress from it. Population studies, as well as studies on self-selected samples, have reported poor psychological well-being in individuals with tinnitus. However, no study has examined the long-term co-variation between mood and tinnitus prevalence or tinnitus severity. In this study, the relationship between depression and tinnitus prevalence and severity over a 2-year period was examined in a representative sample of the general Swedish working population. Results show that a decrease in depression is associated with a decrease in tinnitus prevalence, and even more markedly with tinnitus severity. Hearing loss was a more potent predictor than depression for tinnitus prevalence, but was a weaker predictor than depression for tinnitus severity. In addition, there were sex differences for tinnitus prevalence, but not for tinnitus severity. This study shows a direct and long-term association between tinnitus severity and depression.

Self-rated Health and Allostatic Load in Women Working in Two Occupational Sectors

This study set out to investigate how biological dysregulation, in terms of allostatic load (AL), relates to self-rated health (SRH) in women. Data on SRH and 12 biomarkers used to assess AL were available for 241 employees from the health care sector and 98 employees from the IT/media sector. In line with the hypothesis, results showed that a poor SRH, along with occupational sector, age and education, were significantly associated with a high AL, particularly for those working within the health care sector. This association between a poor SRH and AL, suggests a link between SRH and biological dysregulation.

Internet-based assessment and self-monitoring of problematic alcohol and drug use

A Swedish web-based service (www.escreen.se) offers self-assessment and self-monitoring of alcohol and drug use via on-line screening with the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) as well as in-depth risk assessment using extended versions of both tests (Alcohol-E and DUDIT-E). Users receive individualized feedback concerning their alcohol and drug consumption and can follow their alcohol and drug use over time in personal diagrams and by writing in an electronic diary. This study describes user characteristics, service utilization patterns, and psychometric test properties for 2361 individuals who created a valid account over 20 months starting in February 2007. Problematic alcohol use according to AUDIT criteria was indicated for 67.4%, while 46.0% met DUDIT criteria for problematic drug use. Men and women accessed the service equally, with a mean age of 23 years. Internal consistency reliability figures were 0.90 for 1846 first-time AUDIT users and 0.97 for 1211 first-time DUDIT users; among 213 second-time AUDIT users reliability was 0.93, and 0.96 for 97 second-time DUDIT users. Internet-based alcohol and drug monitoring could function as a self-help tool or as a complement to substance abuse treatment.

Associations between stress and hearing problems in humans

Hearing problems are a public health issue with prevalence figures far more common than previously estimated. There are well-established risk factors of hearing problems such as age, sex and noise exposure history. Here, we demonstrate additional risk factors, i.e. socioeconomic status and long-term stress exposure that are found to increase the risk of hearing problems. In order to proactively intervene and prevent hearing problems, these newly recognized risk factors need to be taken into consideration. When taking these new risk factors into account, sex differences become even more apparent than previously found. The aim of this review is to summarize our recent findings about the associations between stress and hearing problems.

Role stress among first‐line nurse managers and registered nurses – a comparative study

BACKGROUND Studies show that first-line nurse managers (F-LNMs) experience high psychological job demands and inadequate managerial guidance. The purpose of this study was to investigate whether F-LNMs have higher stress levels and show more signs of stress-related ill health than registered nurses (RNs). AIM The aim of this study was to examine possible differences in self-rated health between F-LNMs and RNs on various psychosocial factors (e.g. job demand, job control and managerial support). METHODS Data were collected at a university hospital in Sweden. Sixty-four F-LNMs and 908 RNs filled in a web-based questionnaire. RESULTS Both F-LNMs and RNs reported having good health. Approximately 10-15% of the F-LNMs and RNs showed signs of being at risk for stress-related ill health. Statistically significant differences (Mann-Whitney U-test) were found in the distribution between the F-LNMs and the RNs on three indices of job control, job demand and managerial support. CONCLUSION Our findings suggest that F-LNMs were able to cope with high-demand job situations because of relatively high control over work. IMPLICATION FOR NURSING MANAGEMENT The implication for nursing management shows the needs for a work environment for both F-LNMs and RNs that includes high job control and good managerial support.

Acute Stress Induces Hyperacusis in Women with High Levels of Emotional Exhaustion

Background Hearing problems is one of the top ten public health disorders in the general population and there is a well-established relationship between stress and hearing problems. The aim of the present study was to explore if an acute stress will increase auditory sensitivity (hyperacusis) in individuals with high levels of emotional exhaustion (EE). Methods Hyperacusis was assessed using uncomfortable loudness levels (ULL) in 348 individuals (140 men; 208 women; age 23–71 years). Multivariate analyses (ordered logistic regression), were used to calculate odds ratios, including interacting or confounding effects of age, gender, ear wax and hearing loss (PTA). Two-way ANCOVAs were used to assess possible differences in mean ULLs between EE groups pre- and post-acute stress task (a combination of cold pressor, emotional Stroop and Social stress/video recording). Results There were no baseline differences in mean ULLs between the three EE groups (one-way ANOVA). However, after the acute stress exposure there were significant differences in ULL means between the EE-groups in women. Post-hoc analyses showed that the differences in mean ULLs were between those with high vs. low EE (range 5.5–6.5 dB). Similar results were found for frequencies 0.5 and 1 kHz. The results demonstrate that women with high EE-levels display hyperacusis after an acute stress task. The odds of having hyperacusis were 2.5 (2 kHz, right ear; left ns) and 2.2 (4 kHz, right ear; left ns) times higher among those with high EE compared to those with low levels. All these results are adjusted for age, hearing loss and ear wax. Conclusion Women with high levels of emotional exhaustion become more sensitive to sound after an acute stress task. This novel finding highlights the importance of including emotional exhaustion in the diagnosis and treatment of hearing problems.

Declining Sleep Quality among Nurses : A Population-Based Four-Year Longitudinal Study on the Transition from Nursing Education to Working Life.

Background Several studies have established impaired sleep is a common problem among nurses. Overworked, fatigued and stressed nurses are at a higher risk of making mistakes that threaten patient safety as well as their own health. The aim of the present study was to longitudinally monitor the development of sleep quality in nurses, starting from the last semester at the university, with three subsequent annual follow-ups once the nurses had entered working life. Methodology/Principal Findings Nationwide, longitudinal questionnaire study of nursing students and newly qualified nurses in Sweden. The results imply a continuous decline in sleep quality among nurses during the three years of follow-up, starting from their last semester of nursing education and continuing for three years into their working life. The most pronounced short-term decline in sleep quality seems to occur in the transition between student life and working life. Conclusion/Significance This finding is important since it may affect the quality of care and the health of nurses negatively.